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Omentectomy is considered an essential part of curative gastrectomy for locally advanced gastric cancer (GC), albeit without solid evidence. We conducted a randomized phase II trial (the TOP-G trial) comparing omentectomy and omentum preservation for gastric cancer. This report describes the short-term findings regarding the trial’s secondary endpoints. The trial protocol was submitted to the University Hospital Medical Information Network Clinical Trials Registry ( http://www.umin.ac.jp/ctr/ : UMIN000005421). The key eligibility criteria were histologically confirmed cT2–4a and N0–2 gastric adenocarcinoma. Short-term surgical outcomes, including morbidity and mortality, were compared between the omentectomy group (group A, control arm) and the omentum-preserving surgery group (group B, test arm). All procedures were performed via an open approach. Based on a non-inferiority margin of 7%, statistical power of 0.7, and type I error of 0.2, the sample size was set to 250 patients. A total of 251 patients were eligible and randomized (group A: 125 patients, group B: 126 patients) between April 2011 and October 2018. After excluding patients who had peritoneal metastasis or laparotomy history, safety outcomes were analyzed for 247 patients. Group A had a significantly longer median operation time (225 min vs. 204 min, p = 0.022) and tended to have greater median blood loss (260 mL vs. 210 mL p = 0.073). The incidences of morbidity were similar and

285 Background: A complete resection of the omentum has been believed as a standard procedure for advanced gastric cancer. However, there was no evidence for survival significance of omentectomy. Therefore, we conduct the Phase II trial (TOP-G trial) comparing gastrectomy with omentectomy and omentum preserving gastrectomy. Here, we present the short-term outcomes which was a secondary endpoint of TOP-G trial. Methods: Enrollment criteria included histologically confirmed cT2-4a and N0-2 gastric adenocarcinoma. The extent of nodal dissection was performed based on the Gastric Cancer Treatment Guidelines in Japan. All procedure was performed through laparotomy. Laparoscopic approach was not accepted. Surgical outcomes morbidity, and mortality were compared between gastrectomy with omentectomy group (group A) and omentum preserving gastrectomy group (group B). Postoperative complication was evaluated with Clavien-Dindo classification. Results: A total of 251 patients were randomly assigned to group A (n = 125) or group B (n = 126) between April 2011 and October 2018. After excluding patients who received bypass or no surgery, 246 patients were analyzed as actual treatment group. There was no difference between two groups in patient characteristics and pathological findings. There was no difference in operation time (median 244 vs 204 min, p = 0.156) and in blood loss (median 260 vs. 210 ml, p = 0.371). Median number of totally retrieved lymph nodes was similar (median 36 vs. 37, p = 0.758). There was no difference in the incidence of any postoperative complication (28.9% vs. 25.8%, p = 0.584). There was no mortality in both groups. Conclusions: Omentum preserving gastrectomy for advanced gastric cancer was similar short-term outcomes with gastrectomy with omentectomy. Clinical trial information: UMIN000005421.

Fast response in magnetic recording systems is a continuous demand as the data rate is increasing more rapidly than ever before. Recently, we observed the phenomena that several of the shortest bits are missing in random data patterns from patterns recorded on the magnetic media. This phenomenon is assumed to be caused by the shortest bits not being recorded properly because the write field rise time and transition energy are insufficient. To easily observe this phenomenon in experiments on our spinstand, we developed a method that is based on a comparison of different data patterns. In this paper, we analyze the shortest bits missing by using a spinstand and discuss the mechanism of these bits and a testing algorithm in order to contribute to designing a recording system for high data rate performance.

リンパ節転移を伴った限局性腹膜悪性中皮腫で術後に腹腔内再発を来した1例を経験したので報告する．症例は63歳の女性で．職場でのアスベストの曝露歴があった．食思不振と体重減少を主訴に当院を受診した．腹部CTで胃壁と接する境界明瞭な腫瘤を認めた．胃原発のgastro intestinal stromal tumorと診断し，手術を施行した．胃壁と癒合する手拳大の弾性軟の腫瘍を認めた．胃部分切除と近傍のリンパ節摘出を行い腫瘍を摘出した．摘出標本は10 cm大で，中心部壊死を伴う充実性の腫瘍であった．病理組織学的には限局性腹膜悪性中皮腫の診断で，リンパ節転移を認めた．術後経過は良好であったが，術後6か月に腹腔内にびまん性に再発を来した．化学療法（Paclitaxel）を行ったが，術後13か月で死亡した．切除可能な限局性腹膜悪性中皮腫は予後良好と報告されているが，再発の場合には予後不良であると考えられた．

白線ヘルニアは腹壁ヘルニアの1つで, 本邦では稀な疾患である. 腎不全増悪による腹水貯留が契機と考えられた白線ヘルニアの嵌頓の1例を経験したので報告する. 症例は45歳, 女性. 体重103kg. 以前より上腹部正中に鶏卵大の腫瘤を指摘されていたが放置していた. 糖尿病性腎症による腎不全が進行したため入院. 急激に腹水貯留が増悪し, 同時に上腹部の腫瘤も増大した. その後, 嘔吐と腹痛を訴え, 上腹部の腫瘤には圧痛が出現した. 白線ヘルニア嵌頓によるイレウスと診断し, 緊急手術を施行した. 上腹部には白線の欠損部位より突出するヘルニア嚢を認めた. ヘルニア内容は小腸で, 腸管に虚血による損傷を認めたため, 腸管切除を施行した. ヘルニア門は縫合閉鎖した. 術後12カ月を過ぎた現在再発を認めていない. 本症例は, 腹水貯留による異常な腹圧が加わったために, ヘルニア嵌頓を発症したと考えられた.

粘膜下層 (以下smと略す) 浸潤距離が微小だがリンパ節転移を認めたS状結腸癌の稀な症例を経験したので報告する. 症例は77歳, 男性. 検診で便潜血陽性を指摘され, 当院を受診した. 精査したところ, 横行結腸とS状結腸に腫瘍を認めた. 生検の結果では, S状結腸癌であった. 両病変とも術前画像所見にてsm深部浸潤を疑われたため, 当科において横行結腸切除およびS状結腸切除, 2群リンパ節郭清を施行した. 病理組織学的診断では, S状結腸癌は中分化腺癌, SM (sm1), ly1, v0, N1であった. sm浸潤距離は500μmと微小であったが, 1群リンパ節に転移を認めた. 術後補助化学療法を施行し, 現在無再発生存中である. sm微小浸潤癌にもリンパ節転移を有する症例が存在するため, 癌の組織型や脈管侵襲などのリンパ節転移のリスクを検討し治療方針を決定する必要があると考えられた.

症例は79歳,女性. 2004年10月排便時下血を主訴に来院.直腸診で1～4時方向に直径約5cmの隆起性病変を触知.注腸像ではRbに陰影欠損を認め, CTでは直腸左壁に直腸壁とisodensityの腫瘤を認めた.大腸内視鏡では1/4周性の1型腫瘍を認めた.肉眼的に黒色の部分は認めず,生検では低分化腺癌であった.直腸癌の診断で2004年12月腹会陰式直腸切断術を施行した.病理組織学的所見はa1, n1(+), P0, H0, M(-) stage IIIaであった.免疫組織染色を施行したところHMB-45・S-100が陽性で,メラニン色素はわずかに陽性の肉眼的無色素性悪性黒色腫であった.直腸無色素性悪性黒色腫は予後不良の稀な疾患で,消化管間質腫瘍では鑑別診断として念頭に置く必要がある.また本症例ではc-kitが陽性であったが,このことはc-kitがGISTに特異的ではなく,悪性黒色腫や他疾患でも陽性になり得ることも念頭に置く必要があると思われた.

We herein present the case of a 36-year-old woman who developed perianal metastasis of non-small cell lung cancer that was diagnosed based on the presence of symptoms mimicking a hemorrhoid. The patient initially underwent radiotherapy for a left superior sulcus tumor, then subsequently complained of a perianal mass that had prolapsed and bled. The tumor was removed via resection. Histologically, the mass was diagnosed as poorly differentiated carcinoma and considered to be a metastatic lesion arising from the primary lung cancer.

A 75-year-old woman presented to a local doctor with a lump in the right breast. On physical examination, a tumor measuring 24mm was palpable in the BD area of her right breast. Mammography showed category 5 disease, and ultrasonography revealed a tumor measuring 24×16 mm. A mammotome biopsy provided a diagnosis of invasive ductal carcinoma of the breast(ER 7/PgR 4/HER2 1+), and the tumor was classified as stage IIA(T2N0M0)according to the UICC-TNM classification. She was recommended surgery but she rejected this option and underwent hormone therapy with anastrozole (1mg/day). One year and 8months after beginning the treatment, ultrasonography showed the tumor to measure 7.0×5.7 mm, and hormone therapy resulted in a partial response(PR). The patient hoped to undergo an operation, so she was referred to our hospital, and a right partial mastectomy and sentinel node biopsy was performed. A histopathological exami- nation indicated scirrhous carcinoma, 18mm, nuclear grade 1, f, ly1, v0, n0, ER 3/PgR 3/HER2 3+. The curative effect was grade 1a. The tumor had become HER2 positive, so the patient was then administered radiotherapy and trastuzumab and anastrozole as adjuvant therapy. Herein, we report our experience with a case of breast cancer that only became HER2 positive after hormone therapy, and also provide some bibliographic comments on this occurrence.

With the cooperation of surgeons in two separate institutes, living-related donor liver transplantation was safely performed at the Kanagawa Children's Medical Center. The donor operations were carried out at Kanagawa Cancer Center by surgeons of the hepatobiliary division and the liver grafts were immediately transported to Kanagawa Children's Medical Center by ambulance, and transplanted orthotopically. Since January 1995, five children with biliary atresia have been given partial liver grafts obtained from their mothers. The liver grafts were transported within 20 min, and functioned immediately after transplantation. The development of a pediatric liver transplantation program requires a multidisciplinary approach that can be provided only in a large tertiary referral children's medical center. Preparation for the clinical program involves training of surgical and nursing team members, both in an animal laboratory and at an established liver transplantation center. Special support for the program by the institute is essential and involves medical, nursing, and administrative divisions as well as social services, operating room personnel, and intensive care unit facilities. After careful planning, and with the invaluable help of the donor operating team, the Kanagawa Liver Transplantation Program has been realized, and its first transplantations conducted safely and successfully.

A total of 32 patients, who had undergone surgical currative resection of colorectal cancer liver metastasis, were retrospectively analyzed. Recurrences were observed in 75% of the 32 patients. These recurrences were hepatic in 33.3% of patients with recurrence, intra-and extrahepatic in 37.5% and extrahepatic in 29.2%. The residual liver recurrence rate was significantly higher in H2H3 cases than in H1 cases. The five year survival rate of H1 cases was 50.0%, while none of the H2H3 patients survived more than three years. Advanced wall invasion in the primary tumor was unfavorable prognostic indicator in H1 cases, without statistical significance. The patients who underwent adjuvant intrahepatic arterial chemotherapy had a favorable residual liver recurrence rate and survival rate, but this did nor reach statistical significance. To prolong survival in patients with undetected extrahepatic residual disease at the time of hepatic resection, effective adjuvant therapy, combining hepatic arterial chemotherapy and systemic chemotherapy, is required.

We treated three postmenopausal female patients with unresectable local recurrence from breast cancer. All pathological diagnoses of the local recurrence lesions were ER-positive breast cancer. For treatment, we administered anastrozole to these three patients. One has been stable disease for 25 months after taking anastrozole. Another has also showed stable disease for 18 months, and the last patient has been a partial response. We performed a biopsy from a recurring lesion on these three patients, and made a diagnosis of ER-positive breast cancer. This strategy of unresectable local recurrence revealed that these three patients could have had a stable condition for a long duration by taking anastrozole.

最近では比較的まれな梅毒性大動脈瘤の1例を経験した. 症例は72歳の女性で胸部異常陰影と腹部拍動性腫瘤を主訴とし, 梅毒反応はTPHAが160倍と強陽性であった. 血管造影では胸部下行大動脈と腎動脈下の腹部大動脈の重複大動脈瘤であり, さらに左総腸骨動脈瘤も合併していた. 胸部大動脈瘤と腹部大動脈瘤にそれぞれ人工血管置換術を一期的に施行した. 瘤壁の組織学的検索では中膜と外膜に慢性大動脈炎を示唆する所見を認めた. 重複大動脈瘤は今後も増加が予想されるが, 手術時期としては, 残存瘤の破裂の懸念がない一期的手術が好ましい. その際には手術術式, 補助手段等の面からの安全性の確認とともに, 全身状態を考慮した治療方針の決定が望ましい.

A case of ruptured aneurysm of the posteroinferior pancreaticoduodenal artery 6 days after the operation for an abdominal aortic aneurysm is reported. The patient was a 65-year-old man who underwent surgery on 15th December 1993 for treatment of an abdominal aortic aneurysm with bilateral common and internal iliac arterial aneurysms. On 6th postoperative day, the patient experienced severe lumbago of sudden onset, together with abdominal and back pain with shock. Abdominal CT visualized an intraperitoneal hematoma, suggesting postoperative bleeding or splenic trauma. An emergency operation was performed to evacuate the intraperitoneal hematoma and ligate the bleeding point, which was located on the posterior side of the pancreas. The diagnosis of rupture of a posteroinferior pan-creaticoduodenal artery aneurysm was made. The postoperative course was uneventful. Postoperative abdominal angiography revealed a block between the posteroanterior pancreaticoduodenal and posteroin-ferior pancreaticoduodenal arteries. In a review of the Japanese literature, there has been no case report of rupture of a posteroinferior pancreaticoduodenal artery aneurysm associated with an abdominal aortic aneurysm.

A 55-year-old man was seen at the hospital because of nausea and vomiting, and admitted for close examination. On admission Hb was 9.2g/dl, indicating slight anemia. Upper gastrointestinal series and barium enema revealed no abnormality. Intestinal fluoroscopy visualized a whole-circumference stenosis 15cm anal side from the Treitz ligament. Superior mesenteric arteriography showed a moderate degree of hypervascularization locating at the same area as the tumor existed, as well as vascular obstruction and extension. Endoscopy of the small intestine revealed an irregular whole-circumferential elevated lesion at the same site. Biopsy indicated a growth of atypical gland, moderate degree of atypical cell. From these findings a preoperative diagnosis of malignant tumor of the small intestine was made. Partial excision of the small intestine with lymph nodes dissection was carried out. Histopathologically it was well differentiated adenocarcinoma. This paper presents a case of malignant tumor of the small intestine which was able to be diagnosed preoperatively.

A pilot phase II study was conducted to evaluate the efficacy and safety of the combined administration of irinotecan (CPT-11) plus cisplatin (CDDP) as a second-line therapy for advanced or recurrent gastric cancer. Between November, 2006 and May, 2009, 18 patients were enrolled in this study. The patients were required to have received prior chemotherapy with S-1 (n=17), an orally administered 5-fluorouracil (5-FU) prodrug, or S-1 plus CDDP (n=1). CPT-11 and CDDP were administered at a dose of 60 and 30 mg/m2, respectively, on days 1 and 15 of a 4-week treatment cycle. The regimen was repeated until the occurrence of unacceptable toxicity, disease progression, or patient refusal. The primary endpoint of this study was the response rate (RR). In the second-line setting, 2 cases of complete response (CR), 1 of partial response (PR) and 7 of stable disease (SD) were identified. The RR was 16.7% and the disease control rate (DCR) was 55.6%. The median survival time (MST) and progression-free survival (PFS) was 282 and 111 days, respectively. As regards hematological toxicity, the major adverse effect during the second-line of chemotherapy was grade 3-4 leukopenia (22.2%). In addition, with regard to non-hematological toxicities, the major adverse effect during the second-line chemotherapy was grade 3-4 loss of appetite (11.1%). There was no mortality attributable to the adverse effects of the drugs. Findings of the present study suggested that CPT-11 and CDDP combination therapy in a second-line setting is an effective regimen in the treatment of advanced gastric cancer.

We report a patient with multiple hepatic metastases and ovarian metastases of transverse colon cancer treated by combination of S-1 and CPT-11. The patient was a 51-year-old woman with cancer of the transverse colon and multiple hepatic metastases. She had undergone surgery. Resection of the transverse colon and left ovary was performed because left ovarian metastases were found during the operation. After the operation, the patient was given chemotherapy with S-1 (120 mg/body on days 1-14) and CPT-11 (150 mg/body on day 1). After completion of 11 courses of chemotherapy, abdominal CT scans revealed that the LDAs of the liver had disappeared, so the patient was judged to have achieved CR. No adverse event was observed. This case suggests that the combination of S-1 and CPT-11 may be an effective regimen for advanced colon cancer with multiple hepatic metastases.

The aim of this study was to evaluate the efficacy and toxicity of 5-fluorouracil (5-FU) and l-leucovorin (l-LV) given at the same dose intensity and administered monthly (given weekly for 3 weeks followed by a week of rest; arm A) or every 2 months (given weekly for 6 weeks followed by 2 weeks rest; arm B) to patients with advanced colorectal carcinoma. The dose of 5-FU was 500 mg/body or 750 mg/body, with an average dose of 432.8 mg/m2. A total of 7 institutions participated in this multi-center study and were randomly divided into 2 groups of arms A and B. Thirty-three patients were entered into arm A and 21 into B. The overall response rate was significantly (p = 0.007) greater in arm B (23.5%) than in arm A (0%). The most frequently observed toxicity was diarrhea, which was observed in 6.5% of arm A and in 33.3% of arm B, marking a significant difference (p = 0.034). These data suggest that a monthly 5-FU/l-LV regimen might be less toxic than a 2-months regimen and less effective at the dose given as above. Further study is needed to evaluate the efficacy of a monthly regimen.

The relationship between the recurrence of hepatocellular carcinoma (HCC) and the serum alanine aminotransferase (ALT) level was studied in hepatectomized patients with hepatitis C virus (HCV)-associated cirrhosis and HCC.Twenty-six hepatectomized patients with HCV-associated cirrhosis and HCC whose resected specimens showed neither portal vein nor hepatic vein invasion by HCC histologically were divided into 2 groups: 15 patients who had no recurrence 3 years after surgery (Group A) and 11 patients whose disease recurred 1-3 years after surgery (Group B). The patients' serum ALT levels during this period were examined.In Group A, serum ALT generally showed sustained low levels80 international units (INU) in 12 patients (80%). In contrast, ALT levels in Group B showed several peaks or plateaus80 INU in all patients except 2. The recurrence rate of HCC in the hepatectomized patients with sustained low levels of ALT was 14.3% (2 of 14 patients) at 3 years, and was significantly lower (P0.01) than that in those patients whose ALT levels showed several peaks or plateaus80 INU (9 of 12 patients; 75.0%). The average level of mode of ALT in Group A (48.8 +/- 26.0 INU) was significantly smaller than that in Group B (101.1 +/- 47.3 INU) (P0.005).The importance of hepatocytic necrosis in the recurrence of HCC in hepatectomized patients with cirrhosis and HCC of HCV origin was demonstrated and the significance of subsiding hepatic necroinflammatory process in the prevention of HCC recurrence suggested.