[Show abstract][Hide abstract] ABSTRACT: We report a case of previously unreported metastasis to the spermatic cord from esophageal squamous cell carcinoma. A 63-year-old Japanese man underwent laparoscopy-assisted esophageal bypass surgery for an advanced esophageal cancer. An elastic hard tumor was found in the right lateral inguinal fossa on intraoperative laparoscopy, and laparoscopic enucleation was performed. Histological examination of the resected tumor revealed a moderately differentiated squamous cell carcinoma, compatible with metastasis from the esophageal cancer. Two months after the operation, computed tomography revealed a heterogeneously enhanced groin mass (20 mm in diameter) involving the right spermatic cord. To our knowledge, this is the first reported case of a solitary metastasis to the spermatic cord from esophageal squamous cell carcinoma.
Preview · Article · Jan 2015 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: This study investigated gastric tube cancer (GTC) to clarify the clinicopathological characteristics in different generations. We analyzed 165 cases with metachronous GTC; 9 cases from our institution and 156 from reported Japanese cases. Cases were divided into 3 groups to provide a detailed analysis of age-specific variations. GTC most commonly occurred in the lower gastric tube, and the most common histological type was tubular adenocarcinoma (70%). There were no age-related variations in the site and histological type of GTC. The incidence rate of endoscopic detection increased from 2003 to 74% in 2012, and the incidence of early GTC detection also significantly increased in this period. The rate of endoscopic treatment before 2003 was approximately 20%, and it doubled over the 10-year course of the study. The recent progress made in the diagnosis and treatment of GTC may have contributed to an improvement in its prognosis.
No preview · Article · Mar 2014 · Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology
[Show abstract][Hide abstract] ABSTRACT: The incidence of aspiration pneumonia related to gastroesophageal reflux disease in Japan is increasing as the population ages. Such pneumonia tends to recur and to be refractory to conservative treatment because gastroesophageal reflux persists. Laparoscopic surgery provides a reliable treatment for gastroesophageal reflux but is not commonly performed in Japan, especially for patients with poor performance status. We report our experience treating patients with aspiration pneumonia caused by gastroesophageal reflux. The patients had severe pneumonia that recurred after medical management and resulted in prolonged hospitalization. These patients were referred for surgical treatment and underwent laparoscopic surgery to treat the underlying gastroesophageal reflux. In patients with poor performance status, we also performed laparoscopic gastrostomy for two reasons: 1) to provide a drainage route from the stomach if antireflux effect of surgery was inadequate and 2) to provide a feeding route if performance status did not improve and oral intake was impossible. The outcomes were excellent, the patients were discharged soon after surgery, and aspiration pneumonia has not recurred to date. In conclusion, laparoscopic antireflux surgery is a useful and promising treatment for patients with recurrent aspiration pneumonia. It may shorten hospital stays and thus reduce medical costs.
No preview · Article · Jan 2014 · Nihon Ika Daigaku Igakkai Zasshi
[Show abstract][Hide abstract] ABSTRACT: Surgical treatment is more difficult for remnant gastric cancer than for primary gastric cancer because of adhesions to adjacent organs. Severe adhesions between the remnant stomach and the left lobe of the liver make difficult to remove the remnant stomach. Laparoscopic gastrectomy has gradually gained acceptance for the treatment of primary gastric cancer because of the potential benefits of being less invasive and having a shorter recovery time but has generally been considered contraindicated in patients who have undergone open upper abdominal surgery. However, few reports have described laparoscopy-assisted total gastrectomy after open or laparoscopic gastrectomy. The benefits and feasibility of laparoscopic surgery for remnant gastric cancer remain unclear. We describe in detail the procedure of laparoscopy-assisted total gastrectomy for remnant gastric cancer and evaluate its safety and feasibility.
No preview · Article · Jan 2014 · Nihon Ika Daigaku Igakkai Zasshi
[Show abstract][Hide abstract] ABSTRACT: Objective:
The aim of this study was to assess the feasibility and safety of adjuvant chemotherapy with S-1 followed by docetaxel.
Patients and method:
Twenty-eight patients with advanced gastric cancer underwent gastrectomy without preoperative chemotherapy. These patients were divided into 3 groups on the basis of cytologic results of peritoneal lavage (CY) and the presence of local peritoneal metastatic nodules (P): CY1-P0, CY0-P1, and CY1-P1. Oral S-1 (80 mg/m(2)/day) was administered for 3 consecutive weeks, followed by intravenous docetaxel (35 mg/m(2)) on days 29 and 43 (1 cycle). This cycle was repeated every 8 weeks. The primary endpoint was the ability to complete 6 cycles of S-1 followed by docetaxel. The secondary endpoints were safety, progression-free survival, mean survival time (MST), and overall survival (OS).
The subjects were 18 men and 10 women (39 to 78 years old, median age, 64 years). The extent of peritoneal metastasis was CY1-P0 in 8 patients, CY0-P1 in 14 patients, and CY1-P1 in 6 patients. Both hematologic and nonhematologic toxicities were generally mild. The completion rate of the planned 6 cycles of the protocol was 71.4% (20 of 28 patients). Median progression-free survival was 22.9 months, and the 2-year survival rate was 78.6%. The overall MST was 34.3 months, and the MST by group was 34.5 for CY1-P0, 34.3 for CY0-P1, and 19.3 months for CY1-P1. The OS in the CY1-P0 and CY0-P1 groups was significantly longer than that in the CY1-P1 group (P<0.05).
Adjuvant chemotherapy with S-1 followed by docetaxel is safe and well tolerated and has the potential to improve OS in patients with a status of CY1P0 following relatively curative resection.
No preview · Article · Nov 2013 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: We report a case of advanced stomach cancer metastatic to the spermatic cord 1 year after curative distal gastrectomy. The patient underwent distal gastrectomy with D2 lymph node dissection. There was no metastasis to the liver or peritoneum, and cytologic examination of the peritoneal lavage fluid was negative for cancer cells (CY0). Histological examination revealed a moderately differentiated tubular adenocarcinoma that had penetrated the serosa (T4a). Postoperative staging was T4aN1M0, stage IIIA, according to the Japanese gastric carcinoma classification scale. One year after the operation, the patient was readmitted with right groin pain. Percutaneous fine needle aspiration biopsy of the inguinal tumor revealed a tubular adenocarcinoma. Extirpation of the inguinal tumor with wedge resection of the right iliac-femoral vein was performed. Pathological examination revealed a moderately differentiated tubular adenocarcinoma that had diffusely infiltrated the connective tissue surrounding the spermatic cord. Immunohistochemical studies showed the tumor cells were reactive for CK7 but not for CK20. These findings were consistent with the diagnosis of a spermatic cord tumor metastatic from a known gastric primary cancer. Laparoscopic exploration showed invagination of the peritoneum with small nodules from the median umbilical fold to the lateral umbilical fold and a markedly decreased distance between the folds. Pathological examination in this area revealed a tubular structure consisting of mesothelial cells within the cancer tissue which was associated with dense fibrosis, suggesting that the invagination of the peritoneum had been caused by minimal peritoneal metastasis.
Preview · Article · Sep 2013 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: A 56-year-old man was hospitalized for treatment of severe acute abdominal pain. Chest X-ray and abdominal CT showed the presence of free air intra-abdominally. A clinical diagnosis of acute generalized peritonitis due to gastro-duodenal perforation was made and emergency surgery was performed. At the time of surgery, a 3 cm-diameter perforation was identified on the anterior wall of the duodenal bulb, and treatment effected by omental patch. On the 12th day post-operatively, endoscopy confirmed that no leakage was present at the previously-perforated site in the duodenum. On day 17, food debris appeared unexpectedly at the surgical site due to wound dehiscence. Abdominal enhanced CT showed the presence of free air from the front of the duodenal bulb extending through the intra-abdominal space to the skin wound. Whilst fasting combined with a course of antibiotics, treatment for the site of leakage was performed. Using regular clips and nylon yarns under endoscopy, the hole was reefed and leakage of contrast medium significantly abated. Subsequently inflammation reduced dramatically. The patient’s condition discernibly improved and finally resolved without the need for invasive surgery.
[Show abstract][Hide abstract] ABSTRACT: The indications for endoscopic treatment have expanded in recent years, and relatively intestinal-type mucosal stomach carcinomas with a low potential for metastasis are now often resected en bloc by endoscopic submucosal dissection (ESD), even if they measure over 20 mm in size. However, ESD requires complex maneuvers, which entails a long operation time, and is often accompanied by complications such as bleeding and perforation. Many technical developments have been implemented to overcome these complications. The scope, cutting device, hemostasis device, and other supportive devices have been improved. However, even with these innovations, ESD remains a potentially complex procedure. One of the major difficulties is poor visualization of the submucosal layer resulting from the poor countertraction afforded during submucosal dissection. Recently, countertraction devices have been developed. In this paper, we introduce countertraction techniques and devices mainly for gastric cancer.
[Show abstract][Hide abstract] ABSTRACT: To evaluate the efficacy of S-1 for Stage IV gastric cancer, we retrospectively examined 124 patients with Stage IV gastric cancer. We classified patients into two groups based on the presence or absence of S-1 administration: the S-1 therapy group (n= 56) and the non-S-1 therapy group (n=68). Basically, patients received S-1 orally at 40 mg per square meter of body surface area twice daily for 4 weeks, followed by 2 weeks without chemotherapy. When side effects appeared, we tried dose reduction or cut short the administering period according to the dose modification criteria. Major patient characteristics were as follows: gender (male/female: 76/48), and age (median[range]: 63[24-83]). The median S-1 dosage was about 5 courses, and the median of the S-1 total dosage was 10. 08 g, based on the amount of tegafur. The relative dose intensity (RDI) was well maintained (average: 74. 9%). The survival rate in the S-1 therapy group was significantly higher than in the non-S-1 therapy group. The median survival time (MST) was 308 days in the S-1 group and 157 days in the non-S-1 group. In the S-1 therapy group, the MST was 629 days for those receiving 10 g or more, while that of those receiving less than 10 g was 209 days. The MST of patients administered 10 g or more was significantly longer than that of those receiving less than 10 g (p<0. 0001). Therefore, we consider that S-1 therapy improves survival in patients with Stage IV gastric cancer.
No preview · Article · Oct 2011 · Gan to kagaku ryoho. Cancer & chemotherapy
[Show abstract][Hide abstract] ABSTRACT: Background: Exposure to nitroso compounds and the activity of cytochrome P450 2E1 (CYP2E1), an activation enzyme for these carcinogens, are important factors in gastric carcinogenesis. Here, we investigated the potential correlation between genetic variation in CYP2E1 and its enzyme expression as detected with immunohistochemical (IHC) staining and cancer susceptibility in unoperated and remnant stomach. Methods: Expression of CYP2E1 in the stomach (n=117) was detected with IHC staining using a polyclonal anti-CYP2E1 antibody. Interindividual variation in CYP2E1 enzyme activity was then compared with genetic polymorphisms in the transcriptional flanking region of the CYP2E1 gene by restriction fragment length polymorphism (RFLP) detection using the Rsa I restriction enzyme. Genetic polymorphisms of Rsa I RFLP in CYP2E1 were investigated in 499 patients with gastric cancer (466 unoperated stomachs and 33 remnant stomachs) and 553 control patients with benign gastroduodenal diseases. Results: Mucosal IHC staining for CYP2E1 was stronger in areas of intestinal metaplasia, particularly in endocrine cells, which stained consistently and strongly. Expression of CYP2E1 enzyme in areas of IHC staining were confirmed with Western blot analysis and showed a significant association between the degree of staining and the CYP2E1 genotype (p<0.01) in cancer tissues and in the foveolar epithelium of normal gastric mucosa. No association between specific CYP2E1 genotype and gastric cancer risk in the unoperated stomach was found ineither the large study or the age- and gender-matched case-control study. However, the frequency of rare alleles (C1/C2 or C2/C2) was significantly higher in patients with cancer in the remnant stomach following gastrectomy than in controls subjects without cancer (odds ratio=2.8, 95% confidence interval=1.3-5.8) or those with primary gastric cancer (odds ratio=2.6, 95% confidence interval=1.3-5.5).
Preview · Article · Aug 2011 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to evaluate the effect of vagotomy on body weight changes after gastric banding.
Rats were divided into a sham-operated group (n = 10), a vagotomy alone group (n = 10), a gastric banding alone group (n = 10) and a gastric banding + vagotomy group (n = 10). All groups were given a liquid diet for 5 days after surgery and then given free access to chow. Their body weight was measured through postoperative day (POD) 14, and caloric intake and nitrogen balance were measured until POD 7.
The increase in body weight in the banding + vagotomy group between POD 0 and POD 14 was not significant (12.5 +/- 16.8 g; p = 0.48), and it was less than in the banding alone group (52.8 +/- 3.8 g; p = 0.031). Cumulative caloric intake from POD 5 to POD 7 was less in the banding + vagotomy group than in the banding alone group (158.6 +/- 26.3 vs. 223.9 +/- 8.3 kcal; p = 0.030). Daily nitrogen balance from POD 5 to POD 7 in the banding + vagotomy group was less than in the banding group (337 +/- 77 vs. 540 +/- 42 mg; p = 0.033).
Vagotomy suppressed body weight gain in the rat model of gastric banding.
No preview · Article · Jul 2010 · Digestive surgery
[Show abstract][Hide abstract] ABSTRACT: A 38-year-old man admitted for abdominal pain and having a history of ileus due to a jejunal internal hernia and rheumatism. He was discharged after 13 days when no findings of suspected ileus were seen and his abdominal pain subsided. Two months later, when abdominal pain reoccurred, he was diagnosed with ileus. The sigmoid colon wall was thickened and completely stenotic, necessitating surgery. Postoperatively, anastomosis sutures ruptured, necessitating single- foramen stoma construction. Histopathologically, ischemic ulceration due to vasculitis of Endoarteritis (EA) occured mainly on the subserosa at the resection specimen of a narrow segment. Vasculitis in malignant rheumatoid arthritis is thought to have caused ulceration at colon, triggering ileus.
[Show abstract][Hide abstract] ABSTRACT: A 40-year-old woman was referred to our Department of Surgery because of an abdominal wall mass. Sixteen years earlier, she had undergone surgical resection of an inguinal tumor that had been diagnosed as a hemangiosarcoma. Fourteen months after the initial resection, the tumor recurred locally, and complete resection was performed. Twenty-nine months later, computed tomography showed multiple metastatic tumors in the lung. All these tumors were resected during thoracoscopic surgery. Thirteen years after the patient's 3rd operation, a firm mass was detected in the left lower quadrant of the abdominal wall. Magnetic resonance image showed a well-defined mass with heterogeneous contrast enhancement within the rectus abdominis muscle. Positron emission tomography-computed tomography demonstrated no recurrent tumors other than this mass. Complete resection was performed. Microscopic examination showed that this tumor was composed of hypercellular spindle cells and staghorn-shaped blood vessels. The average number of mitotic figures was 28 per 10 high-power fields. Immunohistochemical examination of the tumor showed focal positivity for CD34. Therefore, the tumor was diagnosed as a metastatic hemangiopericytoma with malignant potential. Careful long-term follow-up is required because metastases can develop after an extended disease-free interval. Aggressive surgical treatment is recommended for distant metastases.
Full-text · Article · Aug 2009 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: Prevention of blood glucose elevation and insulin resistance could be more pronounced in patients undergoing laparoscopic rather than open gastrectomy.
Fifty-seven patients underwent distal gastrectomy by either laparoscopy (n = 36) or an open approach (n = 21). Blood glucose, serum insulin, and the daily insulin secretion rate (urinary C-peptide) were measured. Insulin resistance was evaluated using an adapted homeostasis model assessment of insulin resistance (HOMA-R).
Blood glucose levels were lower in the laparoscopy group than in the open group on the operative day and on postoperative days (POD) 1 and 3 (P < .001, P = .001, and P = .024, respectively). Serum insulin levels were lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .045 and P = .027, respectively). HOMA-R was lower in the laparoscopy group than in the open group on POD 1 and 3 (P = .024 and P = .009, respectively). Daily insulin secretion rates were lower in the laparoscopy group than in the open group on POD 1 (P = .023).
Laparoscopic surgery prevents blood glucose elevation and improves insulin resistance compared with open surgery.
No preview · Article · Aug 2009 · Journal of Parenteral and Enteral Nutrition
[Show abstract][Hide abstract] ABSTRACT: A 67-year-old woman was admitted to our hospital for surgical management of cancer of the ascending colon. On admission, she had cholangitis due to choledocholithiasis. Abdominal computed tomography, ultrasonography, and magnetic resonance showed cholelithiasis, choledocholithiasis, and multiple liver tumors. Colonoscope showed advanced cancer of the ascending colon. Because of acute obstructive suppurative cholangitis, endoscopic sphincterotomy was performed. During the procedure, periampullary retroperitoneal perforation was identified on radiologic examination. Because computed tomography had shown extravasation of contrast medium and widespread pneumoretroperitoneum, an emergency operation was performed 2 hours after perforation. After cholecystectomy and choledocholithotomy had been performed and all bile duct stones had been removed, periampullary perforation was readily identified close to the duodenal diverticula and easily repaired. The postoperative course was uneventful. This patient could resume oral feeding soon after the operation, and colonic surgery could be performed immediately thereafter. Therefore, early surgical management is a possible first choice of treatment in patients with remaining biliary disease after periampullary perforation.
Full-text · Article · Nov 2008 · Journal of Nippon Medical School
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to evaluate the safety and value of laparoscopy-assisted distal gastrectomy (LADG) for early stage gastric cancer (stages IA, IB, and II).
We retrospectively assessed 101 cases treated by LADG and compared to 49 contemporaneous cases treated by open distal gastrectomy (DG) between 2001 and 2006. Clinical variables, such as tumor diameter, operation time, blood loss, number of lymph nodes dissected, and length of stay were investigated.
Tumor size (mm) was significantly smaller in the LADG group (p < 0.0001). Although operation time (min) in the two groups was similar (278 +/- 57 vs. 268 +/- 55), mean blood loss was significantly higher in the DG group (139 +/- 181 vs. 460 +/- 301, p < 0.0001). Fewer lymph nodes were harvested in the LADG group (27 +/- 14 vs. 34 +/- 19, p = 0.012). Hospital stay was longer in the DG group (13.3 +/- 8.5 vs. 16.7 +/- 10.5, p = 0.034). There was no mortality in either group. Postoperative surgical complications occurred in six (6%) of the LADG and four (8%) of the DG.
The authors conclude that laparoscopy-assisted distal gastrectomy is a safe and useful operation for early-stage gastric cancers. If patients are selected properly, laparoscopy-assisted distal gastrectomy can be a curative and minimally invasive treatment for gastric cancer.
No preview · Article · Aug 2008 · Journal of Gastrointestinal Surgery