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Although survival in cases with early recurrence after curative resection of colorectal cancer has been persistently poor, the risk factors for early recurrence remain unknown.A total of 1,043 patients with stage I-III colorectal cancer underwent curative resection at Kobe University Hospital between April 2007 and September 2020. Of these, 122 patients developed recurrence: 57 had early recurrence (1 year after surgery) and 65 patients had late recurrence (≥1 year after surgery). The clinicopathological features were compared between the groups and the risk factors for early recurrence were analyzed.Overall survival both from the date of recurrence and from the date of surgery were significantly worse in the early recurrence group. The proportion of the patients with ≥100 g of intraoperative blood loss, blood transfusion, and postoperative complications were significantly higher in the early recurrence group. R0 resection was achieved more frequently in the late recurrence group. Multivariate analysis revealed that no adjuvant chemotherapy, elevated preoperative CA19-9, blood transfusion, and the occurrence of the postoperative complication were independent risk factors for early recurrence.Early recurrence after curative resection of colorectal cancer was associated with worse overall survival. Adjuvant chemotherapy might be beneficial for patients with risk factors of early recurrence to improve prognosis.

Background/aim Cancer stem cells (CSCs) contribute to resistance against neoadjuvant chemotherapy (NAC) in esophageal squamous cell carcinoma (ESCC). We conducted a retrospective observational study for the relationship between the expression levels of CSC markers in biopsy specimens prior to 5-fluorouracil plus cisplatin (FP)-NAC and the pathological responses. Patients and methods We included 171 patients with ESCC who underwent the FP-NAC followed by radical resection. Biopsy specimens prior to the FP-NAC were obtained and immunochemically stained for CD44, CD133, and CD24. Results The biopsy specimens of the non-responders had the CD44high/CD24low expression at high levels, which was found as an independent predictor of not only FP-NAC resistance but also poor overall survival by multivariate analyses. Conclusion CD44high/CD24low expression in the biopsy specimens prior to FP-NAC may be a predictor of FP-NAC resistance and poor prognosis of ESCC patients.

BACKGROUND/AIM The safety of neoadjuvant chemoradiotherapy (NACRT) combined with total mesorectal excision (TME) and selective lateral pelvic lymph node dissection (LLND) is unclear in elderly patients with locally advanced rectal cancer (LARC). PATIENTS AND METHODS Forty-two patients with LARC underwent TME and selective LLND following NACRT at Kobe University Hospital. The clinical outcomes were retrospectively compared between the elderly (aged ≥70 years, n=13) and non-elderly patients (aged

Background/aim To investigate the outcomes of laparoscopic surgery in colorectal cancer patients with dialysis. Patients and methods Fourteen dialysis (dialysis group) and 567 non-dialysis (non-dialysis group) patients who underwent laparoscopic and open surgery for colorectal cancer between April 2008 and December 2015 were included. Short-term and long-term outcomes were compared between the groups. A 1:2 propensity score matching was performed to compare long-term outcomes. Results All the dialysis patients underwent laparoscopic surgery. There were no significant differences in operative outcomes and postoperative short-term outcomes between the two groups. In the whole cohort, overall survival of dialysis patients was shorter than that in the non-dialysis ones (p=0.020), while disease-free survival did not differ between the two groups. After matching, there was no significant difference between the groups in overall or disease-free survival. Conclusion Laparoscopic colorectal cancer surgery for dialysis patients seems safe and feasible and associates with comparable short-term outcome and recurrence rate to non-dialysis patients.

Esophageal squamous cell carcinoma (ESCC) is a deadly malignant disease. This study examined whether the platelet-to-lymphocyte ratio (PLR) can be used as a biomarker to evaluate prognosis in patients with advanced ESCC following neoadjuvant chemotherapy (NAC) and undergoing minimally invasive esophagectomy (MIE).We examined 174 patients between January 2010 and December 2015 at the Kobe University. Of these, 121 were treated with NAC. The PLR cutoff was determined through receiver-operating characteristic curve analysis. Univariate and multivariate analyses were conducted to identify prognostic factors for overall survival (OS).The PLR cutoff for OS in 121 patients was 169.6. Patients with PLR ≥169.6 had worse 5-year OS rates (31.1%) than those with a PLR169.6 (61.1%, p=0.001). Multivariate analysis revealed that a PLR of ≥169.6 was an independent factor for poor prognosis.PLR is an independent prognostic factor for patients with ESCC after NAC and MIE.

This study aimed to identify prognostic factors for adenocarcinoma of the esophagogastric junction (AEG) in Siewert type II and characterize the population whose prognosis is expected to improve.We retrospectively reviewed a database of 68 AEG type II patients who had undergone surgical curative resection without preoperative treatment.Although patients with pathological N0 (pN0) showed favorable 3-year disease-free survival (91%), patients with pN1-3 had poor outcomes (42%, 23%, and 10%). Multivariate analyses showed that the only independent prognostic factor was lymph node metastasis, and that tumor depth (cT3-4) and tumor size (≥4 cm) were correlated closely with lymph node metastasis.Surgical curative resection without preoperative treatment is insufficient to treat AEG type II with lymph node metastasis. Among AEG patients, those with the high-risk factors of preoperative tumor depth (T3-4) or/and size (≥4 cm) might need intensive multimodal treatment, including perioperative adjuvant chemotherapy.

Background Lateral pelvic lymph node metastasis impairs the oncological outcomes of patients with rectal cancer. Although lateral pelvic lymph node dissection (LLND) might be an effective procedure for such patients, the associated risk factors for postoperative complications are unknown. Patients and methods The operative outcomes of 21 patients undergoing unilateral LLND and 26 patients undergoing bilateral LLND for rectal cancer were compared. The risk factors for complications were evaluated using a logistic regression model. Results Univariate and multivariate analyses revealed that a longer operative time (≥480 min) was the most important risk factor for grade II or more postoperative complications according to the Clavien-Dindo classification (odds ratio=6.58; 95% confidence interval=1.35-32.1; p=0.020). A bilateral procedure was not a significant risk factor for postoperative complications. Conclusion Surgeons should make efforts to shorten the operative time to reduce the risk of postoperative complications.

Background/aim The aim of this study was to investigate PD-L1 expression and its association with prognosis in esophageal squamous cell carcinoma (ESCC) before and after neoadjuvant chemotherapy (5-fluorouracil and cisplatin, NAC-FP). Patients and methods Using a database of 69 ESCC patients, we analyzed PD-L1 expression on tumor cells (TCs) and immune cells (ICs), as well as the density of CD8+ tumor-infiltrating lymphocytes (TILs) in pretreatment biopsy specimens-versus-surgical specimens after resection. We determined the prognostic significance of these factors. Results The fraction of ESCC containing ICs expressing PD-L1 and having a high CD8+ TIL density was significantly increased after neoadjuvant treatment. However, PD-L1 expression on TCs or ICs, and CD8+ TIL density, was not significantly associated with patient survival in ESCC patients. Conclusion NAC-FP induced PD-L1 expression on ICs and CD8+ TILs in ESCC patients. This finding suggests that PD-1/PD-L1 blockade could be combined with NAC-FP to treat ESCC patients.

BACKGROUND Omentoplasty is sometimes used to prevent perineal wound complications after abdominoperineal resection (APR) following neoadjuvant chemoradiotherapy (NACRT). However, recent studies have raised some controversy about its clinical benefit. PATIENTS AND METHODS Outcomes for rectal cancer patients who received APR after NACRT were retrospectively compared between the groups with omentoplasty (n=28) and without omentoplasty (n=14). RESULTS The operative time was significantly longer in the omentoplasty group (575 vs. 404 min, p

Background/aim The aim of the study was to evaluate the necessity of gastrectomy including endoscopic submucosal dissection (ESD) scar with margin-negative early gastric cancer (EGC). Patients and methods We analyzed 83 patients with EGC who received additional gastrectomy after non-curative ESD and evaluated the risk factors for residual cancer (RC) and lymph node (LN) metastasis. Results In addition to positive ESD margin, ulceration was a risk factor for RC. Among cases with deep submucosal invasion (sm), 3 were diagnosed as having negative margins in ESD specimens, but the surgical specimens were positive for cancer. The rate of LN metastasis was 12.0%. There was no significant difference in LN metastasis between tumor characteristics. Conclusion LN dissection is recommended after non-curative ESD. Gastrectomy including the ESD scar should be performed not only for cases with positive margin in ESD, but also for cases with invasion deeper than sm2, even though the margin is negative.

Background/aim To investigate the impact of inguinal lymph node dissection (ILND) following neoadjuvant chemoradiotherapy (NACRT) for rectal cancer patients with ILN metastasis. Patients and methods Forty-three patients with rectal cancer underwent NACRT followed by curative surgery between January 2005 and December 2016. Seven patients underwent ILND after NACRT for clinically-positive ILN metastasis (ILND (+) group), while the remaining 36 did not receive ILND for clinically negative ILN metastasis (ILND (-) group). Their outcomes were retrospectively analyzed. Results Only one patient in the ILND (+) group had a local recurrence at six years after surgery. The 5-year recurrence-free survival was 100% and 65.4% in the ILND (+) and ILND (-) groups, respectively (p=0.09), and the 5-year overall survival was 100% and 83.2%, respectively (p=0.32). Conclusion ILND following NACRT seems effective for rectal cancer patients with ILN metastasis.

Background/aim To clarify the usefulness of intraoperative colonoscopy (CS) for preventing postoperative anastomotic leakage and bleeding in rectal cancer surgery. Patients and methods The data of rectal cancer patients who underwent circular-stapled anastomosis from January 2008 to December 2016 were compared between 162 patients who received intraoperative CS (the CS group) and 23 patients who did not receive intraoperative CS (the non-CS group). Results Anastomotic leakage rate in the CS group (8.6%) was similar to that in the non-CS group (4.3%) (p=0.70). Postoperative anastomotic bleeding rate was also similar between the CS and non-CS groups (2.4% vs. 0%, p=0.50). Although a positive air leak test was observed in two patients in the CS group, no postoperative leakage developed by adding intraoperative treatment. Conclusion Although intraoperative CS did not significantly reduce the incidence of postoperative anastomotic leakage or bleeding, it can be useful for certain cases.

The aim of this study was to investigate PD-L1 expression and its association with prognosis in esophageal squamous cell carcinoma (ESCC) before and after neoadjuvant chemotherapy (5-fluorouracil and cisplatin, NAC-FP).Using a database of 69 ESCC patients, we analyzed PD-L1 expression on tumor cells (TCs) and immune cells (ICs), as well as the density of CD8The fraction of ESCC containing ICs expressing PD-L1 and having a high CD8NAC-FP induced PD-L1 expression on ICs and CD8

AIM To evaluate the clinical significance of lateral pelvic lymph node (LLN) size in predicting pathological metastasis and prognosis in rectal cancer treated with preoperative chemoradiotherapy (CRT) followed by surgery. PATIENTS AND METHODS Fifty-two patients with rectal cancer who underwent curative surgery after preoperative CRT were included. Fifteen patients underwent total mesorectal excision (TME) alone, while 37 patients underwent TME with LLN dissection for clinical LLN metastasis. RESULTS Pathological metastasis was identified in seven (2.6%) out of 270 resected LLNs in six (16.2%) out of 37 patients. The cut-off value of the short-axis diameter was 7.0 mm before and 6.0 mm after CRT. The 5-year recurrence-free survival rate was significantly higher in patients with LLNs

BACKGROUND Malignant tumors inhibit antitumor immune responses, which are driven by T-regulatory cells or myeloid-derived suppressor cells (MDSCs). Since MDSCs are involved in invasion, migration, and metastasis of tumor cells, we hypothesized that MDSCs are also involved in tumor recurrence after surgical resection. MATERIALS AND METHODS C57BL/6 mice were subcutaneously inoculated with B16F10 melanoma cells in the right flank. In some experiments, established tumors were surgically resected. Peripheral blood was drawn over time, and immune cells and cytokines were evaluated using flow cytometry. RESULTS MDSCs and relevant pro-inflammatory cytokines increased in the peripheral blood of tumor-bearing mice. Moreover, the frequency of MDSCs rapidly increased in mice with tumor recurrence. CONCLUSION The frequency of MDSCs in the peripheral blood of tumor-bearing mice reflects the status of tumor progression as well as tumor recurrence. Continuous monitoring of MDSCs in the peripheral blood might be a useful indicator of tumor recurrence.

BACKGROUND/AIM The aim of this study was to evaluate the safety and effectiveness of laparoscopic surgery in elderly patients with colorectal cancer. PATIENTS AND METHODS In total, 223 patients aged