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BACKGROUND: Despite growing evidence of the effectiveness of minimally invasive surgery (MIS) for primary gastric cancer, MIS for remnant gastric cancer (RGC) remains controversial due to the rarity of the disease. This study aimed to evaluate the surgical and oncological outcomes of MIS for radical resection of RGC. PATIENTS AND METHODS: Patients with RGC who underwent surgery between 2005 and 2020 at 17 institutions were included, and a propensity score matching analysis was performed to compare the short- and long-term outcomes of MIS with open surgery. RESULTS: A total of 327 patients were included in this study and 186 patients were analyzed after matching. The risk ratios for overall and severe complications were 0.76 [95% confidence interval (CI): 0.45, 1.27] and 0.65 (95% CI: 0.32, 1.29), respectively. The MIS group had significantly less blood loss [mean difference (MD), -409 mL; 95% CI: -538, -281] and a shorter hospital stay (MD, -6.5 days; 95% CI: -13.1, 0.1) than the open surgery group. The median follow-up duration of this cohort was 4.6 years, and the 3-year overall survival were 77.9% and 76.2% in the MIS and open surgery groups, respectively [hazard ratio (HR), 0.78; 95% CI: 0.45, 1.36]. The 3-year relapse-free survival were 71.9% and 62.2% in the MIS and open surgery groups, respectively (HR, 0.71; 95% CI: 0.44, 1.16). CONCLUSIONS: MIS for RGC showed favorable short- and long-term outcomes compared to open surgery. MIS is a promising option for radical surgery for RGC.

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Aim Randomized controlled trials (RCT) are the gold standard in surgical research, and case‐matched studies, such as studies with propensity score matching, are expected to serve as an alternative to RCT. Both study designs have been used to investigate the potential superiority of laparoscopic surgery to open surgery for rectal cancer, but it remains unclear whether there are any differences in the findings obtained using these study designs. We aimed to examine similarities and differences between findings from different study designs regarding laparoscopic surgery for rectal cancer. Methods Systematic review and meta‐analyses. A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane. RCT, case‐matched studies, and cohort studies comparing laparoscopic low anterior resection and open low anterior resection for rectal cancer were included. In total, 8 short‐term outcomes and 3 long‐term outcomes were assessed. Meta‐analysis was conducted stratified by study design using a random‐effects model. Results Thirty‐five studies were included in this review. Findings did not differ between RCT and case‐matched studies for most outcomes. However, the estimated treatment effect was largest in cohort studies, intermediate in case‐matched studies, and smallest in RCT for overall postoperative complications and 3‐year local recurrence. Conclusion Findings from case‐matched studies were similar to those from RCT in laparoscopic low anterior resection for rectal cancer. However, findings from case‐matched studies were sometimes intermediate between those of RCT and unadjusted cohort studies, and case‐matched studies and cohort studies have a potential to overestimate the treatment effect compared with RCT., This article reports on similarities and differences in findings of randomized controlled trials (RCTs), case‐matched studies, and cohort studies, as revealed by meta‐analyses of previously published studies on laparoscopic low anterior resection (LAR) for rectal cancer. Results of case‐matched studies were often similar to those of RCTs in terms of outcomes of laparoscopic LAR for rectal cancer. However, case‐matched studies occasionally overestimate the effects of interventions compared to RCTs.

Data regarding risk factors for recurrence in stage I colorectal cancer patients are limited. The aim of this study was to clarify the existence of a high-recurrence-risk population among stage I colorectal cancer patients.This analysis included 7,539 stage I colorectal cancer patients treated between 1997 and 2012 at 24 leading hospitals in Japan. Risk factors for time to recurrence were evaluated using a Cox proportional hazards model, and a high-risk group for recurrence was identified. Prognostic outcomes of high-risk stage I colorectal cancer patients were compared with those of low-risk stage I and stage II patients.Multivariable analyses identified left-sided location (hazard ratio [HR]: 1.65, 95% confidence interval [CI]: 1.09-2.58), T2 tumors (HR: 1.80, 95% CI: 1.21-2.66), and lymphatic invasion (HR: 1.55, 95% CI: 1.05-2.28) as risk factors for recurrence in stage I colon cancer, and patients with these three risk factors were classified as high risk. For stage I rectal cancer, patients with poor differentiation (HR: 2.86, 95% CI: 1.21-5.69), T2 tumors (HR: 1.53, 95% CI: 1.07-2.23), and venous invasion (HR: 1.51, 95% CI: 1.08-2.13) were identified as high risk. The Kaplan-Meier analysis of cumulative recurrence rate and recurrence-free survival revealed that the high-risk stage I colorectal cancer patients have poorer clinical outcomes than the low-risk patients.Although stage I colorectal cancer patients generally have a favorable prognosis after curative surgery, poorer prognosis was observed in high-risk stage I colorectal cancer patients than in low-risk patients.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To evaluate the efficacy and safety of splenectomy in people undergoing total gastrectomy for gastric cancer.

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To compare the efficacy and safety the anterior and posterior mediastinal reconstruction routes after esophagectomy in patients with esophageal cancer.

Background Gastric cancer is the fifth most common cancer diagnosed worldwide. Due to improved early detection rates of gastric cancer and technological advances in treatments, a significant improvement in survival rates has been achieved in people with cancer undergoing gastrectomy. Subsequently, there has been increasing emphasis on postgastrectomy syndrome (e.g. fullness, delayed emptying, and cold sweat, amongst others) and quality of life postsurgery. However, it is uncertain which types of reconstruction result in better outcomes postsurgery. Objectives To assess the evidence on health-related quality of life and safety outcomes of Roux-en-Y and Billroth-I reconstructions after distal gastrectomy for people with gastric cancer. Search methods We searched the Cochrane Library and the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase on 4 May 2021. We checked the reference lists of the included studies and contacted manufacturers and professionals in the field. There were no language restrictions. Selection criteria Randomised controlled trials (RCTs) allocating participants to Roux-en-Y reconstruction or Billroth-I reconstruction after distal gastrectomy for gastric cancer. Data collection and analysis Two review authors independently screened studies identified by the search for eligibility and extracted data. The primary outcomes were health-related quality of life after surgery and incidence of anastomotic leakage. The secondary outcomes included body weight loss, incidence of bile reflux, length of hospital stay, and overall morbidity. We used a random-effects model to conduct meta-analyses. We assessed risk of bias of the included studies in accordance with the Cochrane Handbook for Systematic Reviews of Interventions, and the certainty of the evidence using the GRADE approach. Main results We included eight RCTs (942 participants) in the review. One study included both cancer patients and benign disease patients such as stomach ulcers. Two studies compared Roux-en-Y, Billroth-I, and Billroth-II reconstructions, whilst the other studies compared Roux-en-Y and Billroth-I directly. For the primary outcomes, the evidence suggests that there may be little to no difference in health-related quality of life between Roux-en-Y and Billroth-I reconstruction (standardised mean difference 0.04, 95% confidence interval (CI) -0.11 to 0.18; I² = 0%; 6 studies; 695 participants; low-certainty evidence due to study limitations and imprecision). The evidence for the effect of Roux-en-Y versus Billroth-I reconstruction on the incidence of anastomotic leakage is very uncertain (risk ratio (RR) 0.63, 95% CI 0.16 to 2.53; I² = 0%; 5 studies; 711 participants; very low-certainty evidence). The incidence of anastomotic leakage was 0.6% and 1.4% in the Roux-en-Y and Billroth-I groups, respectively. For the secondary outcomes, the evidence suggests that Billroth-I reconstruction may result in little to no difference in loss of body weight compared to Roux-en-Y reconstruction (mean difference (MD) 0.41, 95% CI -0.77 to 1.59; I² = 0%; 4 studies; 541 participants; low-certainty evidence). Roux-en-Y reconstruction probably reduces the incidence of bile reflux compared to Billroth-I reconstruction (RR 0.40, 95% CI 0.25 to 0.63; I² = 22%; 4 studies; 399 participants; moderate-certainty evidence). Billroth-I reconstruction may shorten postoperative hospital stay, but the evidence for this outcome is very uncertain (MD 0.96, 95% CI 0.16 to 1.76; I² = 56%; 7 studies; 894 participants; very low-certainty evidence). Billroth-I reconstruction may reduce postoperative overall morbidity compared to Roux-en-Y reconstruction (RR 1.47, 95% CI 1.02 to 2.11; I² = 0%; 7 studies; 891 participants; low-certainty evidence). Authors' conclusions The evidence suggests that there is little to no difference between Roux-en-Y and Billroth-I reconstruction for the outcome health-related quality of life. The evidence for the effect of Roux-en-Y versus Billroth-I reconstruction on the incidence of anastomotic leakage is very uncertain as the incidence of this outcome was low. Although the certainty of evidence was low, we found some possibly clinically meaningful differences between Roux-en-Y and Billroth-I reconstruction for short-term outcomes. Roux-en-Y reconstruction probably reduces the incidence of bile reflux into the remnant stomach compared to Billroth-I reconstruction. Billroth-I reconstruction may shorten postoperative hospital stay compared to Roux-en-Y reconstruction, but the evidence is very uncertain. Billroth-I reconstruction may reduce postoperative overall morbidity compared to Roux-en-Y reconstruction. Future trials should include long-term follow-up of health-related quality of life and body weight loss.

Objectives Prevention of and early treatment for noncommunicable diseases such as hypertension, hyperglycemia, and dyslipidemia are important, as these diseases are asymptomatic in early stages but can lead to critical conditions such as macro‐ and microvascular disorders later on. While screening is conducted worldwide, low rates of hospital visits after screening is a common issue. We aimed to investigate the effect of reminder letters on the consultation behavior of screened participants. Methods We used administrative claims data from a database managed by JMDC Inc for participants of health checkups in 2014, 2015, 2016, and 2017, who belonged to a health insurance society. Reminder letters were sent regularly 6 months after checkups to improve participant consultation behavior. Participants who screened positive for hypertension, hyperglycemia, and dyslipidemia, and who were not taking medication for any of these diseases at the time of health checkups, were included in the analyses. Results A total of 1739 participants in 2014, 1693 in 2015, 2002 in 2016, and 2144 in 2017 were included in the analysis for hypertension. The cumulative proportion of hospital visits gradually increased over the course of 12 months after checkups in all years. After 2015, spikes, albeit very small ones, were observed at 6 months after checkups in accordance with the timing of reminder letters. Similar trends were observed for hyperglycemia and dyslipidemia. Conclusions Sending reminder letters is a potentially effective approach to increase hospital visits, but further improvements (ie, multiple reminders) may be necessary to affect enhancements in participant consultation behavior.

Background and objectives This prospective study aimed to identify long-term changes in sexual function of men with rectal cancer from point of diagnosis to 24 months postoperatively. Methods Male patients undergoing laparoscopic rectal cancer surgery were prospectively enrolled. International Index of Erectile Function (IIEF) Questionnaire scores were collected at diagnosis; first follow-up; and 6, 12, and 24 months postoperatively. Missing values were managed via multiple imputations using the propensity score method. Paired t tests were applied to examine changes in IIEF scores over time. Results This study analyzed 115 patients. For erectile function, there were no significant changes in scores from the point of diagnosis to first treatment (9.4 vs. 9.8 as mean scores; p = .227). Scores deteriorated postoperatively and recovered until 12 months post-surgery, but did not improve significantly from 12 months to 24 months post-surgery (8.7 vs. 8.2 as mean scores; p = .440). This pattern of change was observed in all other domains: orgasmic function, sexual desire, orgasmic satisfaction, and overall satisfaction. Conclusions Sexual function was not influenced by a rectal cancer diagnosis. Sexual function deteriorated following surgery and recovered until 12 months post-surgery; however, it did not significantly improve from 12 months to 24 months postoperatively.

Laparoscopic surgery for colorectal cancer has spread globally. The usefulness of laparoscopic surgery for elderly patients was initially indicated by comparison with open surgery. However, whether the procedure is safe for elderly as well as non-elderly patients with colorectal cancer remains unclear. In this review, patients aged ≥ 75 were defined as elderly. We conducted literature searches using PubMed, Scopus, and the Cochrane Central Register of Clinical Trials. Two authors independently reviewed resultant articles to identify relevant observational studies. Data synthesis was performed with a random-effects model. Heterogeneity was investigated by using forest plots and I2 statistics. Risk of bias of included studies was assessed by the Risk of Bias Assessment Tool for Nonrandomized Studies. Publication bias was assessed by funnel plots. Twenty-two studies were included. The incidence of overall complications was slightly higher in elderly patients than in non-elderly patients, with statistical significance (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.08–1.34). There was no difference between them in the incidence of anastomotic leakage (RR 1.24, 95% CI 0.86–1.80) and mortality (risk difference 0.00, 95% CI − 0.01 to 0.01). Laparoscopic surgery for colorectal cancer is mostly safe for elderly patients as well as non-elderly patients. Preoperative comorbidities or poor physical capacity should be cared for in the elderly.

Objective Additional surgery is considered for patients at high risk for lymph node metastasis (LNM) after local resection for early rectal cancer. Several factors are considered as indications for additional surgery, although there are currently no definitive criteria. This study aimed to clarify the need for additional surgery based on the number of risk factors for LNM and to evaluate the significance of submucosal invasion on recurrence. Methods Patients with early rectal cancer harboring risk factors for LNM who underwent local resection between March 2005 and December 2016 were retrospectively analyzed. Associations among the number of risk factors, prognosis, and additional treatment after local resection were investigated. Results A total of 29 eligible patients were classified into the surgery (n = 10), chemoradiotherapy (n = 7), and no-additional-treatment (NAT, n = 12) groups. Among the 29 patients, 15 patients (52%) with only one risk factor did not relapse. The NAT group harbored fewer risk factors for LNM, and 8 of the 12 patients (67%) had only deep submucosal invasion. Local recurrence occurred in one patient in the chemoradiotherapy group. The estimated 5-year overall survival rates were 88.9%, 75.0%, and 81.5% in the surgery, chemoradiotherapy, and NAT groups, respectively. There were no disease-specific deaths in the overall cohort. Conclusions In the present study, no recurrence occurred in patients who did not receive additional surgery with deep submucosal invasion as the only risk factor. A multicenter investigation is necessary to confirm the safety of nonsurgical options.

Background Emergency gastrointestinal surgery, although rare, is known for its high mortality and morbidity. However, the risks of emergency surgery for gastrointestinal cancer have not been investigated in depth. This study aimed to investigate the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and to identify associated risk factors. Methods We extracted data from the National Clinical Database, a nationwide surgery registration system in Japan, for patients with gastrointestinal cancer who underwent esophageal resection, total gastrectomy, distal gastrectomy, right hemicolectomy, or low anterior resection between 2012 and 2017. The impacts of emergency surgery on 30‐day mortality and incidence of overall postoperative complications were compared with those of non‐emergency surgery. Risk factors for mortality and overall postoperative complications were then sought in patients who underwent emergency surgery. Results Thirty‐day mortality and incidence of overall postoperative complications were significantly higher in emergency surgeries for gastric, colon, and rectal cancers than in non‐emergency surgeries (odds ratios 4.86‐6.98 and 1.68‐2.18, respectively; all P, This article shows the impact of emergency surgery on mortality and morbidity in patients with gastrointestinal cancers and associated risk factors by using a nationwide registry in Japan. Our findings are expected to serve as a reference for postoperative management.

A lack of caudal-type homeobox transcription factor 2 (CDX2) protein expression has been proposed as a prognostic biomarker for colorectal cancer (CRC). However, the relationship between CDX2 levels and the survival of patients with stage II/III CRC along with the relationship between microRNAs (miRs) and CDX2 expression are unclear. Tissue samples were collected from patients with stage II/III CRC surgically treated at Kyoto University Hospital. CDX2 expression was semi-quantitatively evaluated by immunohistochemistry (IHC). The prognostic impacts of CDX2 expression on overall survival (OS) and relapse-free survival (RFS) were evaluated by multivariable statistical analysis. The expression of miRs regulating CDX2 expression and their prognostic impacts were analyzed using The Cancer Genome Atlas Program for CRC (TCGA-CRC). Eleven of 174 CRC tissues lacked CDX2 expression. The five-year OS and RFS rates of patients with CDX2-negative CRC were significantly lower than those of CDX2-positive patients. Multivariate analysis of clinicopathological features revealed that CDX2-negative status is an independent marker of poor prognosis in stage II/III CRC. miR-9-5p was shown to regulate CDX2 expression. TCGA-CRC analysis showed that high miR-9-5p expression was significantly associated with poor patient prognosis in stage II/III CRC. In conclusion, CDX2, the post-transcriptional target of microRNA-9-5p, is a useful prognostic biomarker in patients with stage II/III CRC.

Presently, there is no consensus as to what procedure of intracorporeal esophagojejunostomy (EJS) in totally laparoscopic total gastrectomy (TLTG) is best to reduce postoperative complications. The aim of this study was to demonstrate the superiority of linear stapled reconstruction in terms of anastomotic-related complications for EJS in TLTG. We collected data on 829 consecutive gastric cancer patients who underwent TLTG reconstructed by the Roux-en-Y method with radical lymphadenectomy between January 2010 and December 2016 in 13 hospitals. The patients were divided into two groups according to reconstruction method and matched by propensity score. Postoperative EJS-related complications were compared between the linear stapler (LS) and the circular stapler (CS) groups. After matching, data from 196 patients in each group were analyzed. The overall incidence of EJS-related complications was significantly lower in the LS group than in the CS group (4.1% vs. 11.7%, p = 0.008). The incidence of EJS anastomotic stenosis during the first year after surgery was significantly lower in the LS group than in the CS group (1.5% vs. 7.1%, p = 0.011). The incidence of EJS bleeding did not differ significantly between the groups, although no bleeding was observed in the LS group (0% vs. 2.0%, p = 0.123). The incidence of EJS leakage did not differ significantly between the groups (2.6% vs. 3.6%, p = 0.771). The use of linear stapled reconstruction is safer than the use of circular stapled reconstruction for intracorporeal EJS in TLTG because of its lower risks of stenosis.

Chemotherapy-induced peripheral neuropathy (CIPN) is an issue for both cancer patients and specialists, and the number of cases of CIPN is growing with the increasing number of cancer patients worldwide. CIPN is often caused by common anticancer drugs such as taxanes and platinum analogs. These are key drugs for various cancers including colorectal and gastric cancers. However, there are currently no effective drugs to prevent CIPN. Goshajinkigan, a Japanese traditional herbal medicine (Kampo), is a promising drug which is used to treat diabetic neuropathy in Japan. This systematic review will assess the efficacy and safety of Goshajinkigan for reducing CIPN in cancer patients receiving chemotherapy. We will conduct a comprehensive search of relevant randomized controlled trials in Scopus, Ovid MEDLINE, Cochrane Central Register of Controlled Trials, and ICHUSHI. Two review authors will independently assess studies for inclusion and consult a third review author if necessary. The risk of bias of the included studies will be assessed according to the Cochrane risk of bias tool. We will investigate heterogeneity using forest plots and the chi-square test. When there are enough studies and any heterogeneity, we will use a random-effects model. Otherwise, we will use a fixed-effects model. This is a protocol for systematic review and meta-analysis and does not need ethics approval. We will disseminate the findings of this review through publication in a peer-reviewed journal. PROSPERO CRD42016045224

There have been no established criteria to distinguish patients at high and low risk of recurrence in stage II colorectal cancer. Several risk factors have been identified but recurrence could not be fully predicted by each factor alone. This retrospective study sought to develop a nomogram for accurate prediction of recurrence in stage II colorectal cancer.We reviewed the data for 4167 patients with stage II colorectal cancer who underwent surgery between January 1997 and December 2006. The risk factors for recurrence were identified, and a nomogram for recurrence was created using the factors. The performance of the nomogram was assessed with a bootstrapped-concordance index and calibration plots.Sex, carcinoembryonic antigen, tumor location, tumor depth, lymphatic invasion, venous invasion and number of lymph nodes studied were significantly associated with recurrence. A nomogram for five-year freedom from recurrence was created with these factors. The bootstrapped-concordance index of the nomogram was 0.64, and it was well calibrated.Our nomogram can be a useful tool for accurate prediction of recurrence in stage II colorectal cancer.

A small number of lymph nodes retrieved (NLNR) is a known risk factor in stage II colorectal cancer. NLNR is influenced by age, but little is known about whether the impact of small NLNR on survival differs with age. This retrospective study sought to determine such impact in elderly patients with stage II colorectal cancer. We reviewed data for 2100 patients with stage II colorectal cancer who underwent surgery without adjuvant chemotherapy between January 1997 and December 2003. The optimal cutoff value of NLNR for survival was determined, and the impact of small NLNR on survival was analyzed. The association between age and NLNR was evaluated. The relation between age and risk of small NLNR with respect to survival was then assessed to determine the impact of small NLNR on elderly patients’ survival. The optimal cutoff value of NLNR was determined as 6. The small NLNR group (SNG) showed significantly worse prognosis than the large NLNR group (LNG) (p

Upper gastrointestinal symptoms are major issues in various diseases such as postgastrectomy syndrome and functional dyspepsia. These symptoms cannot be fully controlled in such conditions and result in poorer quality of life. Rikkunshito has been traditionally used in Japan to relieve these symptoms. This systematic review assessed the efficacy and safety of rikkunshito for relieving upper gastrointestinal symptoms.A systematic literature search was conducted using Ovid MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials, and ICHUSHI. Randomized controlled trials comparing rikkunshito to alternative drugs for the treatment of upper gastrointestinal symptoms were searched without language restriction. Two review authors independently assessed the literature and extracted data from identified studies. The risk of bias in each study was assessed.Twenty-four studies with a combined total of 2175 participants were included in this review. Rikkunshito did not significantly relieve upper gastrointestinal symptoms when compared with other treatments via the Gastrointestinal Symptom Rating Scale (standardized mean difference, -0.07; 95% confidence interval [CI], -0.31 to 0.17; P = 0.59), while it significantly relieved the symptoms on a 5-point scale (mean difference, -0.38; 95% CI, -0.55 to -0.21; P 0.001). No drug-related severe adverse events were reported. Most of the included studies had high or unclear overall risk of bias.It remains still unclear whether rikkunshito is effective for the relief of upper gastrointestinal symptoms. Further high-quality studies are needed.

BACKGROUND: Postoperative ileus is a major complication for persons undergoing abdominal surgery. Daikenchuto, a Japanese traditional medicine (Kampo), is a drug that may reduce postoperative ileus. OBJECTIVES: To assess the efficacy and safety of Daikenchuto for reducing prolonged postoperative ileus in persons undergoing elective abdominal surgery. SEARCH METHODS: We searched the following databases on 3 July 2017: CENTRAL, MEDLINE, Embase, ICHUSHI, WHO (World Health Organization) International Clinical Trials Registry Platform (ICTRP), EU Crinical Trials registry (EU‐CTR), UMIN Clinical Trials Registry (UMIN‐CTR), ClinicalTrials.gov, The Japan Society for Oriental Medicine (JSOM), American Society of Clinical Oncology (ASCO), Society of American Gastrointestinal and Endscopic Surgeons (SAGES). We set no limitations on language or date of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) comparing Daikenchuto with any control condition in adults, 18 years of age or older, undergoing elective abdominal surgery. DATA COLLECTION AND ANALYSIS: We applied standard methodological procedures expected by Cochrane. Two review authors independently reviewed the articles identified by literature searches, extracted data, and assessed risk of bias of the included studies using the Cochrane software Review Manager 5. MAIN RESULTS: We included seven RCTs with a total of 1202 participants. Overall, we judged the risk of bias as low in four studies and high in three studies. We are uncertain whether Daikenchuto reduced time to first flatus (mean difference (MD) ‐11.32 hours, 95% confidence interval (CI) ‐17.45 to ‐5.19; two RCTs, 83 participants; very low‐quality evidence), or time to first bowel movement (MD ‐9.44 hours, 95% CI ‐22.22 to 3.35; four RCTs, 500 participants; very low‐quality evidence) following surgery. There was little or no difference in time to resumption of regular solid food following surgery (MD 3.64 hours, 95% CI ‐24.45 to 31.74; two RCTs, 258 participants; low‐quality evidence). There were no adverse events in either arm of the five RCTs that reported on drug‐related adverse events (risk difference (RD) 0.00, 95% CI ‐0.02 to 0.02, 568 participants, low‐quality evidence). We are uncertain of the effect of Daikenchuto on patient satisfaction (MD 0.09, 95% CI ‐0.19 to 0.37; one RCT, 81 participants; very low‐quality of evidence). There was little or no difference in the incidence of any re‐interventions for postoperative ileus before leaving hospital (risk ratio (RR) 0.99, 95% CI 0.06 to 15.62; one RCT, 207 participants; moderate‐quality evidence), or length of hospital stay (MD ‐0.49 days, 95% CI ‐1.21 to 0.22; three RCTs, 292 participants; low‐quality evidence). AUTHORS' CONCLUSIONS: Evidence from current literature was unclear whether Daikenchuto reduced postoperative ileus in patients undergoing elective abdominal surgery, due to the small number of participants in the meta‐analyses. Very low‐quality evidence means we are uncertain whether Daikenchuto improved postoperative flatus or bowel movement. Further well‐designed and adequately powered studies are needed to assess the efficacy of Daikenchuto.

Highlights • The extent of colon affected by MP varied a good deal between the cases. • Computed tomography was useful to determine the extent of affected colon. • MP caused by herbal medicine was often localized in the right colon. • Limited colonic resection is usually indicated., Introduction Mesenteric phlebosclerosis is a rare ischemic disease affecting the colon. Systemic disease and herbal medicine have been pointed out as possible causes, and the disease is characterized by calcifications involved the mesocolic veins. Patients who do not respond to conservative therapy require surgical treatment. In surgical intervention, an adequate extent of colonic resection is important. Presentation of case We present a case of an 87-year-old woman with mesenteric phlebosclerosis who had consumed herbal medicine for 40 years. She suffered from ileus caused by mesenteric phlebosclerosis, and the symptoms did not improve with conservative therapy. Right hemicolectomy was performed since the disease was localized in the right colon. Long-term use of herbal medicine was considered the potential cause of mesenteric phlebosclerosis. The postoperative course was mostly uneventful. The patient stopped using herbal medicine and had no signs of recurrence 2 years after surgery. Discussion and conclusion The greatest concern in surgery for mesenteric phleboscrerosis is to detect the affected area, which should be removed. Characteristic findings in computed tomography and intraoperative findings can help to determine the optimal extent of colonic resection. Mesenteric phlebosclerosis caused by herbal medicines occurs as localized disease in the right colon compared with mesenteric phlebosclerosis caused by other pathogenesis. Limited colonic resection is usually indicated for mesenteric phlebosclerosis caused by herbal medicine.

Anastomotic leakage after low anterior resection for rectal cancer is a critical problem. Many risk factors have been suggested and surgical techniques have improved, but anastomotic leakage remains a major postoperative challenge. This study sought to create a nomogram for precise prediction of anastomotic leakage after low anterior resection for rectal cancer. We used data of 936 patients that had been prospectively collected by the Japanese Society for Colon and Rectal Cancer between June 2010 and February 2013. Risk factors for anastomotic leakage were identified by multivariate logistic regression analysis and used to create a nomogram. The performance of the nomogram was evaluated by using a bootstrapped-concordance index and calibration plots. Sex, preoperative serum albumin, tumor location and diameter, and simultaneous resection of other organs were identified as significantly associated factors that could be combined for accurate prediction of anastomotic leakage. We created a nomogram for anastomotic leakage by using these risk factors. The area under the curve was 0.72 (95% confidence interval 0.67–0.76). The nomogram had a bootstrapped-concordance index of 0.72 and was well calibrated. Our nomogram was a useful tool for precise prediction of anastomotic leakage after low anterior resection for rectal cancer.

Background Rectal leiomyosarcoma (LMS) is an extremely rare disease. Previously, LMS was not properly distinguishable from gastrointestinal stromal tumor (GIST) until c-kit, a characteristic marker of GIST, was discovered in 1998. No standard therapeutic strategy for gastrointestinal LMS has been established except for surgical resection because of its rarity. Rectal LMS is often accompanied by symptoms, which can enable detection at a small size. However, when a large LMS is detected at the lower rectum, it is difficult to excise due to the narrow pelvic space. Case presentation We present the case of an 86-year-old man with a large LMS. The LMS was asymptomatic and incidentally found at the lower rectum when he visited another hospital for management of benign prostatic hypertrophy. An abdominoperineal resection of the rectum was performed with combined resection of both seminal vesicles and a part of the prostate because tumor invasion was suspected. We used the hybrid method of laparoscopic and transanal total mesorectal excision (TaTME) approaches to achieve negative surgical margins. Late-onset urethral injury occurred in the postoperative course, which was successfully treated with a urethral catheter. The patient was discharged and received no adjuvant therapy. Local recurrence did not occur, but multiple lung metastases were detected 4 months later and the patient died 12 months after the surgery. Conclusions This is the first report of the hybrid method of laparoscopic and TaTME approaches to remove a large LMS at the lower rectum.

Hospital factors along with various patient and surgeon factors are considered to affect the prognosis of colorectal cancer. Hospital volume is well known, but little is known regarding other hospital factors. We reviewed data on 853 patients with stage IV colorectal cancer who underwent elective palliative primary tumor resection between January 2006 and December 2007. To detect the hospital factors that could influence the prognosis of incurable colorectal cancer, the relationships between patient/hospital factors and overall survival were analyzed. Among hospital factors, hospital type (Group A: university hospital or cancer center; Group B: community hospital), hospital volume, and number of colorectal surgeons were examined. In univariate analysis, Group A hospitals showed significantly better prognosis than Group B hospitals (p = 0.034), while hospital volume and number of colorectal surgeons were not associated with overall survival. After adjustment for patient factors in multivariate analysis, hospital type was significantly associated with overall survival (hazard ratio: 1.31; 95 % confidence interval: 1.05–1.63; p = 0.016). However, there was no significant difference in short-term outcomes between hospital types. Hospital type was identified as a hospital factor that possibly affects the prognosis of stage IV colorectal cancer patients.

The present article investigates a class of random partitioning distributions of a positive integer. This class is called the limiting conditional compound poisson (LCCP) distribution and characterized by the law of small numbers. Accordingly the LCCP distribution explains the limiting behavior of counts on a sparse contingency table by the frequencies of frequencies. The LCCP distribution is constructed via some combinations of conditioning and limiting, and this view reveals that the LCCP distribution is a subclass of several known classes that depend on a Bell polynomial. It follows that the limiting behavior of a Bell polynomial provides new asymptotics for a sparse contingency table. Also the Neyman Type A distribution and the Thomas distribution are revisited as the basis of the sparsity. © 2011 The Institute of Statistical Mathematics, Tokyo.

症例は71歳，女性．2002年8月に左乳癌に対して乳房温存術+センチネルリンパ節生検を施行した（T2N0M0:stageIIA，浸潤性小葉癌，ER(+)，PgR(+)，HER2(-)）．術後補助療法として残存乳房照射とAnastrozoleを5年間内服した．無再発通院中であったが，2009年9月に腹痛を主訴に当院を受診し，CT検査でイレウスと診断され入院となった．保存的治療では軽快せず，Multidetector-row CT（MDCT）検査で小腸に器質的狭窄を認めた．原発性小腸腫瘍または乳癌小腸転移を疑い，第10病日に待期的手術を施行した．術中所見はバウヒン弁から90cmの回腸の全周性狭窄と，その他に散在する小腸間膜結節を認め，小腸部分切除術を施行した．病理組織検査で乳癌小腸転移と診断した．術後経過は良好で第22病日に軽快退院し，現在，Letrozole内服治療中である．乳癌小腸転移という稀な症例を経験したため，若干の文献的考察を加えて報告する．

In the present article we derive a new discrete multivariate distribution using a limiting argument that is essentially the same as the law of small numbers. The distribution derived belongs to an exponential family, and randomly partitions positive integers. The facts shown about the distribution are useful in many fields of application involved with count data. The derivation parallels that of the Ewens distribution from the gamma distribution, and the new distribution is produced from the inverse Gaussian distribution. The method employed is regarded as the discretization of an infinitely divisible distribution over nonnegative real numbers.

The present article shows that a limiting argument that is essentially the law of small numbers produces a proper discrete multivariate distribution from any generalized Poisson distribution. Based on this result, Engen's Extended Negative Binomial (ENB) model is derived from the Poisson-Pascal distribution, which is a generalization of the inverse Gaussian-Poisson distribution. The ENB model is also derived from Sichel's generalized inverse Gaussian-Poisson distribution. The application of the ENB model is discussed thereto.

人工内耳装用児のきこえの自己評価について事例をもとに検討した. 7歳0ヵ月で人工内耳埋込み術を行うことになった聴覚障害児1名を対象に, 人工内耳装用前後の日常生活場面におけるきこえの自己評価を面接法によって求めた。自己評価は, 手術前2ヵ月から手術後18ヵ月までの期間に5回実施し, 質問項目は音のきこえに関するもの22項目と母音の弁別や会話の理解に関するもの6項目であった。手術前後の自己評価の結果は, 音のきこえについては手術後6ヵ月時点で概ねきこえると評価したが, 会話の理解については18ヵ月時点でも十分ではない項目があった。評価の経時変化を検討した結果, 人工内耳による補聴閾値の改善と装用期間の増加に伴った評価の向上が認められた。対象児は自身のきこえの状態の変化を自覚しており, 7歳前後の学齢期の人工内耳装用児による日常生活におけるきこえの状態を自己評価できる可能性が示唆された。

The Human Genome Project has revealed that there about 32,000 protein-encoding genes, which are distributed throughout the genome. It is unclear, however, whether genes are distributed on the chromosomes according to patterns linked to organ specificity. To explore the relationship between genes actively transcribed in normal tissues and their chromosomal locations, we analyzed serial analysis of gene expression libraries of normal human liver, brain, breast, and colon tissues. Transcriptome mapping analysis revealed that transcriptional activity in each tissue varied according to the chromosomal domains, and a weak positive correlation was observed between transcription density and gene density. We identified six liver-related and five colon-related chromosomal domains highly transcribed in each tissue, whereas no brain-related or breast-related chromosomal domains were identified. Representative genes located on these chromosomal domains were associated with the function of each organ and were highly conserved in both mouse and rat genomes. These data revealed that the transcriptional activities of normal human tissues are well orchestrated at chromosomal levels, suggesting that highly expressed genes may share physical proximity.

金沢大学人間社会研究域経済学経営学系, The present article describes a Conditional Inverse Gaussian-Poisson (CIGP) distribution, obtained by conditioning an inverse Gaussian-Poisson population model on its total frequency. This CIGP distribution is equivalent to random partitioning of positive integers, with the possibility for a number of applications in statistical ecology, linguistics and statistical disclosure control to name a few. After showing the marginal moments of the distribution, parameter estimation is discussed. Fitting the CIGP distribution to some typical data sets demonstrates its applicability.

A random clustering distribution is useful for modeling count data. The present article derives a new distribution of this type from the Lagrangian Poisson distribution, based on the result that any infinitely divisible distribution over nonnegative integers produces a random clustering distribution through conditioning and a limiting argument that is equivalent to the law of small numbers. The resulting distribution is shown to be tractable. Its application is also presented.

McKay, Conover and Beckman introduced Latin hypercube sampling (LHS) for reducing the variance of Monte Carlo simulations. LHS is a method for stratifying a univariate margin. We consider an extension of LHS to stratify an m-variate margin with orthogonal arrays, after Owen and Tang. We define extended Latin hypercube sampling of strength m (henceforth denoted by ELHS(m)), such that ELHS(1) reduces to LHS. Using the results obtained by Owen, we first derive an explicit formula for the finite-sample variance of ELHS(m). Based on this formula, we give a sufficient condition for variance reduction by ELHS(m), generalizing similar results from McKay et al. for m = 1. Actually, our sufficient condition for m = 1 contains the sufficient condition of McKay et al. and thus strengthens their result.

金沢大学人間社会研究域経済学経営学系, Fisher's logarithmic series model (Fisher et al. (1943)) is a classical model in statistical ecology. In this paper we show that this model is a key model linking three models discussed in Takemura (1997), i.e., Poisson-gamma model (Bethlehem et al. (1990)), Dirichlet-multinomial model (Takemura (1997)), and Ewens model (Ewens (1990), Sibuya (1993)). This connection opens up the possibility of applying existing techniques of statistical ecology to the problem of microdata disclosure risk assessment.

13 hearing impaired children in special class for hard of hearing were tested audiometory during a year. We found the following results by analysing of speech audiomentory data and hearing aid training.1) Their audiogram nearly were not change, but speech receptive threshold (S. R. T.) and maximum articulation score (MAS) pointed out a little improvement.2) The improvement of speech hearing were not influenced by type of hearing loss.3) Even the ear which had limited dynamic range improved the S. R. T. and M. A. S. by auditory training.4) The confusion of speech words decreased by auditory training. It seemed important of the detail observation of confusion for training.5) The progress of adaptation of hearing aid were improved the speech hearing. There-fore the evaluation of the adaptation of hearing aid is done by the improvement of speech hearing.