Search

Introduction Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention. Presentation of case A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively. Discussion Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status. Conclusion Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting., Highlights • Pneumatosis intestinalis (PI) may be associated with life-threatening emergencies. • It is difficult to completely rule out the fatal conditions associated with PI without surgery. • Very elderly patients are at high risk for a fatal outcome if surgery is delayed. • Laparoscopy may be a useful option for diagnosing PI in very elderly patients.

Background The risk factors for incisional hernia (IH) and the association between liver fibrosis and IH after hepatic resection in patients with hepatocellular carcinoma (HCC) with liver cirrhosis (LC) are still unclear. We aimed to evaluate the rate of IH and to assess the effect of perioperative factors, including serum markers for liver fibrosis, on the risk of IH. Methods A total of 192 patients with HCC with LC who received hepatectomy were retrospectively analyzed. The primary end point was the incidence rate of IH and the secondary end points were associations between IH and 22 clinical factors. Results IH was diagnosed in 60 (31.3%) patients. The estimated incidence rates were 19.8% at 12 months, 32.5% at 36 months, and 38.8% at 60 months. In multivariable analysis, the presence of postoperative intractable ascites (odds ratio 24.83, P = .0003), abdominal wall closure by a single-layer mass closure with a continuous running suture (odds ratio 4.59, P = .0143), preoperative body mass index ≥25 kg/m2 (odds ratio 3.36, P = .0025), and preoperative serum N-terminal pro-peptide of type IV collagen 7S domain (P4NP 7S) levels ≥5 ng/mL (odds ratio 3.13, P = .0234) were independent risk factors. Conclusion There are several risk factors for IH after hepatic resection in HCC patients with LC. Preoperative serum P4NP 7S levels ≥5 ng/mL are a useful predictive marker, and abdominal wall closure with a continuous running suture by a single-layer mass closure should be avoided.

The management of hepatocellular carcinoma (HCC) in patients with concomitant esophageal varices (EV) remains controversial. We assessed the surgical outcome of hepatectomy and aimed to clarify the indications and management of HCC in patients with concomitant EV. We retrospectively enrolled 502 patients with HCC (100 with and 402 without EV), who underwent curative hepatectomy. We analyzed the prognostic outcomes and risk factors for EV bleeding after hepatectomy. Overall survival (OS) was significantly lower in HCC patients with EV than in those without EV (p = 0.003), although recurrence-free survival was similar in both groups. Multivariate analysis showed that indocyanine green retention test at 15 min (ICGR15) >17 % (p = 0.007) and α-fetoprotein >12.5 ng/ml (p = 0.003) was independent predictors of poorer OS. Among patients with EV who underwent hepatectomy, multivariate analysis identified ICGR15 >17 % (p = 0.03) as the only independent predictor of poorer OS. There was no significant difference in OS between HCC patients with EV and ICGR15 ≤17.0 % and HCC patients without EV. Ten patients experienced EV bleeding after hepatectomy. Multivariate analysis showed that preoperative endoscopic findings of blue color EV (p = 0.008) and red color sign (p = 0.0005) were independent predictors of EV bleeding in patients with HCC after hepatectomy. These results suggest that HCC patients with EV and ICGR15 ≤17 % may be suitable for surgery, but patients with preoperative endoscopic blue color EV and red color sign need to be managed appropriately.

Objective: To elucidate the mechanism of radiation-induced cancers, we analyzed the expression profiles of microRNAs extracted from formalin-fixed paraffin-embedded (FFPE) gastric cancer (GC) tissue samples from atomic bomb survivors. Methods: The expression levels of miR-21, miR-24, miR-34a, miR-106a, miR-143, and miR-145 were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR). Results: The expression of microRNAs was measured by qRT-PCR in a Hiroshima University Hospital cohort comprising 32 patients in the high-dose-exposed group and 18 patients in the low-dose-exposed group who developed GC after the bombing. The GC cases showing high expression of miR-24, miR-143, and miR-145 were more frequently found in the high-dose-exposed group than in the low-dose-exposed group. We next performed qRT-PCR of miR-24, miR-143, and miR-145 in a cohort from the Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital comprising 122 patients in the high-dose-exposed group and 48 patients in the low-dose-exposed group who developed GC after the bombing. High expressions of miR-24 and miR-143 were more frequently found in the high-dose-exposed group than in the low-dose-exposed group. Multivariate analysis demonstrated that only high expression of miR-24 was an independent predictor for the exposure status. Conclusion: These results suggest that the measurement of miR-24 expression from FFPE samples is useful to identify radiation-associated GC.

Previous reports have indicated an association between blood transfusion and prognosis of hepatocellular carcinoma (HCC) after hepatectomy. However, clinicopathological biases were not adjusted in these studies. We aimed to clarify the effect of blood transfusions in patients with HCC and Child–Pugh class A after hepatectomy by using inverse probability of treatment weighting (IPTW) analysis for selection bias control. We enrolled 479 patients with primary HCC and Child–Pugh class A retrospectively (91 transfused and 388 nontransfused patients) who underwent curative hepatectomy. After adjusting for different covariate distributions for both groups by IPTW, we analyzed the prognostic outcomes. In the unweighted analyses, overall survival (OS) rate of transfused patients was significantly lower than in nontransfused patients (P

Adenosquamous carcinoma of the stomach is very rare; at present, there are only seven published reports. We report here an eighth case involving a 77-year-old Japanese man who was diagnosed with gastric cancer by upper endoscopy and computed tomography (CT). He underwent laparoscopic-assisted distal gastrectomy for early gastric cancer and the resected specimen was diagnosed as adenosquamous carcinoma limited to the submucosal layer. Only one lymph node metastasis was noted. Seven months later, liver metastasis (3 tumors, 15 mm maximum in diameter) was detected by abdominal CT. He was started on chemotherapy with S-1 and cisplatin (CDDP) and is alive 14 months after surgery. Almost all cases of adenosquamous carcinoma of the stomach are diagnosed in advanced stages and carry a very poor prognosis. Most patients with early adenosquamous carcinoma of the stomach survive for 2 or more years without recurrence, however our patient experienced recurrence 7 months after surgery. Therefore, future treatment for recurrent adenosquamous carcinoma of the stomach should be considered., 【はじめに】胃腺扁平上皮癌はまれな疾患であり, 報告は様々だがおよそ胃癌の0.5%といわれている. 早期癌に関する報告は非常に少なく, 現在7例報告されているのみである. 今回我々は本邦で8 例目となる早期胃腺扁平上皮癌を経験したので報告する. 【症例】77歳男性で上部消化管内視鏡検査で, 胃角部に0-IIa + IIc 病変を指摘され, 生検では腺癌の診断であった. 腹腔鏡補助下幽門側胃切除施行され, 病理組織診断では胃腺扁平上皮癌, T1b（SM）N1M0 StageIB と診断された. 術後6か月目のCT で肝臓に3か所の転移を指摘され, 再発に対してS-1/CDDP 療法が施行された. 現在1 年7 か月生存中である. 【考察】腺扁平上皮癌とは腺癌と扁平上皮癌が共存しており, うち扁平上皮癌が4 分の1以上存在することが必要とされている. 腺扁平上皮癌の報告は多数あるが, ほとんどの症例は肝転移や多発リンパ節転移を伴った進行した状態で発見されている. また症例が少なくまだ不明なことが多いが, 基本的には予後不良といわれている. 理由としては①多発肝転移や多発リンパ節転移を伴った進行癌で発見されている, ②早期胃腺扁平上皮癌でも早期に再発する, ということが挙げられる. しかし, これまでの7 例の早期癌症例において3例は言及されていないが, 4例は無再発であり, 4年以上生存している症例もあるため, 胃腺扁平上皮癌が生物学的な特徴を有している可能性がある. 本症例のように早期癌であってもわずか6か月で再発をきたした症例もあることから, 通常の腺癌よりは厳重な経過観察が必要であると考えられた.

The purpose of this study was to identify prognostic genes by integrated microarray analysis between comparative genomic hybridization and gene expression with laser microdissection in non-small cell lung cancer (NSCLC). Integrated microarray analysis in 11 lung adenocarcinomas was performed, and several genes were identified. Among them, neural precursor cell-expressed developmentally down-regulated 4-like (NEDD4L) was chosen for further characterization. Quantitative reverse transcriptase-polymerase chain reaction (RT-PCR) was used to explore the clinicopathological significance of NEDD4L expression in 84 NSCLC patients. 18q was more frequently lost in advanced lung cancer. Therefore, we selected the NEDD4L gene, located on chromosome18q, for which reduced expression was significantly correlated with copy number loss. NEDD4L mRNA expression in paired tumor/normal samples from 79 cases of lung cancer was evaluated using real-time PCR analysis. NEDD4L mRNA expression was significantly lower in tumor tissues than in normal lung tissues (p

Objective: The study aimed to evaluate the efficacy of surgery after preoperative chemotherapy for unresectable advanced gastric cancer. Method: Twenty patients with disappeared peritoneal dissemination or decreased lymph node metastasis by systemic chemotherapy underwent surgery (group S), while 14 with peritoneal dissemination or lymph nodes >N2 (group C) received continuous systemic chemotherapy. Among group S patients, 15 underwent a curative resection (group R0), while the other 5 did not microscopically undergo a curative resection (group R1). Results: The median survival time for all patients was 535 days. Survival time was significantly dependent on the chemotherapy response (p < 0.002). The survival period in group S was significantly longer than that in group C (median survival time 747 vs. 476 days; p < 0.02). The relapse-free survival was 299 days in group S. In particular, the survival period of patients who underwent R0 surgery by preoperative chemotherapy was significantly longer than that of group R1 patients (median survival time 794 vs. 485 days; p < 0.02). Multivariate analysis revealed that R0 surgery was a significant and independent prognostic factor. Conclusion: Surgery was effective for advanced gastric cancer patients when performed as R0 resection following the disappearance of non-curative factors by preoperative chemotherapy.

Approximately 70 years have passed since the atomic bombs were dropped on Nagasaki and Hiroshima. To elucidate potential biomarkers and possible mechanisms of radiation-induced cancer, the expression of FKTN, which encodes fukutin protein and causes Fukuyama-type congenital muscular dystrophy, was analyzed in gastric cancer (GC) tissue samples from atomic bomb survivors. Expression of cluster of differentiation (CD) 10 was also evaluated, as it has previously been observed that positive fukutin expression was frequently noted in CD10-positive GC cases. In the first cohort from Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital (Hiroshima, Japan; n=92), 102 (53%) of the GC cases were positive for fukutin. Expression of fukutin was not associated with exposure status, but was associated with CD10 expression (P=0.0001). The second cohort was from Hiroshima University Hospital (Hiroshima, Japan; n=86), and these patients were also in the Life Span Study cohort, in which atomic bomb radiation doses were precisely estimated using the DS02 system. Expression of fukutin was detected in 58 (67%) of GC cases. GC cases positive for fukutin were observed more frequently in the low dose-exposed group than in the high dose-exposed group (P=0.0001). Further studies with a larger cohort, including precise radiation dose estimation, may aid in clarifying whether fukutin could serve as a potential biomarker to define radiation-induced GC in atomic-bomb survivors.

Objective: Plasma D-dimer levels are elevated in patients with a variety of solid tumors. Recently, it has been reported that the level before curative surgery is a prognostic factor for colorectal cancer (CRC). We investigated whether the plasma D-dimer level before systemic chemotherapies is a predictor for advanced or recurrent unresectable CRC. Methods: This study included 42 patients treated with systemic chemotherapies for advanced or recurrent unresectable CRC. Variables including clinicopathological factors, plasma D-dimer levels and the modified Glasgow Prognostic Factor Score (mGPS) were evaluated. Results: The plasma D-dimer level was closely related to the mGPS. Survival was shorter for patients with plasma D-dimer levels >5 µg/ml than for those with lower levels. Compared with an mGPS of 0 or 1, an mGPS of 2 was predictive of poor prognosis (p < 0.0001). Old age, advanced stage, plasma D-dimer level and mGPS were significantly associated with mortality, but plasma D-dimer level was the only independent risk factor in multivariate analysis, and was significant related to the clinical response to chemotherapy (p < 0.05). Conclusions: Survival was significantly shorter in patients with elevated plasma D-dimer levels having advanced or recurrent CRC. The plasma D-dimer level before systemic chemotherapies was an independent mortality predictor.

We report an unusual case of early gastric cancer and T-cell-type chronic lymphocytic leukemia accompanied by severe neutropenia that was successfully treated by laparoscopic gastrectomy.A 76-year-old female was referred to our Hospital for resection of a gastric adenoma that was suspicious for malignancy. Routine preoperative laboratory studies showed severe neutropenia and increased atypical lymphocytes in the peripheral blood. Bone marrow biopsy confirmed the diagnosis of T-cell chronic lymphocytic leukemia. One day before surgery, granulocyte colony-stimulating factor was administered. Laparoscopic-assisted distal gastrectomy was performed. The patient's postoperative course was uneventful and she was discharged after 10 days. The histopathological findings revealed well-differentiated adenocarcinoma (pT1a, pN0, and stage IA).Laparoscopic gastrectomy may be considered a primary approach in patients with neutropenia because it is associated with lower risk of postoperative infection and a lower mortality rate compared to open resection.

Objective During the decade following the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. Subsequently, the incidence of other cancers gradually increased while that of leukemia decreased. We examined the long-term clinical outcome of gastric cancer and second primary cancer in atomic bomb survivors. Methods Results of surgical treatment of gastric cancer were reviewed in 231 atomic bomb survivors and 759 control patients between 1995 and 2006. Results Long-term prognosis of gastric cancer in atomic bomb survivors was significantly poorer than that in control patients (P

Nous decrivons une observation rare de leiomyosarcome developpe a partir de la veine mesenterique superieure et associe a des metastases hepatiques chez une femme de 62 ans. Elle eut une resection tumorale avec reconstruction veineuse, une hemicolectomie droite et une hepatectomie droite. Dans la mesure ou la tumeur etait faiblement positive au c-kit, elle fut traitee par mesylate d'imatinib pour des recidives de sa tumeur hepatique. Elle a survecu environ trois ans apres ces interventions chirurgicales.

Describimos un caso poco frecuente de leiomiosarcoma de la vena mesenterica superior con metastasis hepaticas concomitantes, en una mujer de 62 anos de edad. La paciente fue tratada quirurgicamente mediante reseccion tumoral y reparacion venosa, hemicolectomia derecha y lobectomia hepatica derecha. Debido a la positividad, aunque debil, del tumor para la deteccion del gen c-kit, la paciente fue tratada con mesilato de imatinib para la prevencion de las recidivas tumorales hepaticas. Despues del tratamiento quirurgico realizado, la paciente ha sobrevivido durante 3 anos.

症例は51歳，男性．高度呼吸困難（Hugh-Jones分類IV度）が生じたため近医受診．胸部レントゲン・CTにて右胸腔を全て占める巨大な腫瘍を認め，精査加療目的に当院紹介となった．CTガイド下生検にて軟骨肉腫が疑われ，手術施行となった．手術は仰臥位にて，胸骨正中切開に右前側方切開を加え，第4肋間開胸で行った．腫瘍はゼラチン状で黄色調を呈しており，胸膜肺全摘術施行した．腫瘍総重量は8kgで，病理学的検査では粘液型悪性線維性組織球腫と診断された．術後，呼吸困難は改善（Hugh-Jones分類I度）し，経過良好にて自宅退院となった．現在明らかな再発は認められていない．胸腔を全て占拠するほどの粘液型悪性線維性組織球腫は非常に稀であり，若干の文献的考察を含め報告する．

Interferon (IFN) therapy improves the prognosis of the patients with HCV-related hepatocellular carcinoma (HCC). However, the effects of IFN therapy for hepatectomy (Hx) for primary HCC have not been established. Several published reports investigating the effects of IFN therapy on survival and tumor recurrence after curative resection of HCC have been inconclusive.Subjects included 470 patients who underwent Hx for HCV related primary HCC. One hundred and fifty nine patients received IFN therapy past or postoperatively of the first Hx. Seventy-four of those patients attained a sustained viral response (SVR group). The other 396 patients, including 85 were no responders (NR) and 311 patients who had not received IFN therapy (non-IFN) were classified as the control group.Overall survival (SVR group vs. control group: 5-yr, 93.2 vs. 61.9%; p0.0001) and disease-free survival (SVR group vs. control group: 5-yr, 56.0 vs. 27.4%; p0.0001) rates were significantly different. By multivariate analysis, NR/non-IFN was the independent risk factor for overall survival (p=0.0002) and disease-free survival (p=0.0053) after Hx.SVR achieved past or postoperatively to the Hx of HCV-related HCC significantly inhibits recurrence and consequently improves patient survival after Hx for HCC.

Postoperative pancreatic fistula (POPF) remains a major complication after pancreaticoduodenectomy (PD). In this study, we examined whether our new method using surgical loupes at 5.0× magnification and the VIO soft coagulation system (SC) for duct-to-mucosa pancreaticojejunostomy (PJ) can prevent POPF.A retrospective cohort study was performed in 81 consecutive patients who underwent PD and duct-to-mucosa PJ for periampullary tumors by a single surgeon during a recent 5-year period from 2008 to 2012. These patients were divided into two groups according to the nature of the PJ; the conventional group (n=46) and the 5.0× loupes+SC group (n=35). Short-term surgical results including POPF were compared and an independent risk factor for POPF was identified using the stepwise logistic regression analysis in our series.The rate of Grade B/C POPF was significantly decreased in the 5.0× loupes+SC group (2.9%) compared to that of the conventional group (9.9%, p=0.04). The absence of 5.0× loupes+SC for PJ was identified as the independent risk factor for Grade B/C POPF (odds ratio, 5.23; p-value, 0.03).5.0× surgical loupes+SC for duct-to-mucosa PJ could be used as a novel technique for preventing POPF after PD.

To elucidate the mechanism of radiation-induced cancers, we analyzed the expression profiles of microRNAs extracted from formalin-fixed paraffin-embedded (FFPE) gastric cancer (GC) tissue samples from atomic bomb survivors.The expression levels of miR-21, miR-24, miR-34a, miR-106a, miR-143, and miR-145 were measured by quantitative reverse transcription polymerase chain reaction (qRT-PCR).The expression of microRNAs was measured by qRT-PCR in a Hiroshima University Hospital cohort comprising 32 patients in the high-dose-exposed group and 18 patients in the low-dose-exposed group who developed GC after the bombing. The GC cases showing high expression of miR-24, miR-143, and miR-145 were more frequently found in the high-dose-exposed group than in the low-dose-exposed group. We next performed qRT-PCR of miR-24, miR-143, and miR-145 in a cohort from the Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital comprising 122 patients in the high-dose-exposed group and 48 patients in the low-dose-exposed group who developed GC after the bombing. High expressions of miR-24 and miR-143 were more frequently found in the high-dose-exposed group than in the low-dose-exposed group. Multivariate analysis demonstrated that only high expression of miR-24 was an independent predictor for the exposure status.These results suggest that the measurement of miR-24 expression from FFPE samples is useful to identify radiation-associated GC.

Background and Objectives Little is known about the significance of thymidine phosphorylase (TP) levels in HCC. The authors investigated the TP activity of HCC and adjacent normal liver tissue in 70 HCC patients, and the prognostic significance of the TP levels. Methods We obtained fresh samples (tumors with adjacent normal tissues) from 70 patients with HCC who have undergone curative hepatic resection. The levels of TP activity in unfixed, fresh, frozen HCC tissue, together with adjacent normal liver tissue specimens, were determined by the enzyme-linked immunosorbent assay (ELISA) method. Results The mean TP activity in HCC was approximately 1.5-fold higher than that in adjacent liver tissues (P = 0.0013). Disease-free survival rates for patients with low and high TP levels in HCC were not significantly different. Although disease-free survival rates for low and high TP levels in adjacent normal liver tissue were also not significantly different, disease-free survival for patients with low and high TP levels in adjacent normal liver tissue, excluding cases of postoperative recurrence within 700 days of hepatectomy, showed a significant difference (P = 0.0494). The group with high TP activity in adjacent liver tissue showed more frequent postoperative recurrence in the long-term than that with low TP activity. Conclusions Measurement of TP activity of adjacent normal liver tissue to HCC may allow us to predict metachronous long-term postoperative recurrence. J. Surg. Oncol. 2003;83:173–179. © 2003 Wiley-Liss, Inc.

For eradicating portal venous tumor extension and intrahepatic metastasis in hepatocellular carcinoma (HCC), anatomical resection is, in theory, preferable.We carried-out a retrospective cohort study in 110 patients who underwent curative hepatic resection (anatomical resection; n=20, and limited resection; n=90) for solitary recurrent HCC from 1990-2010.No significant difference was found in short-term surgical results such as mortality, morbidity, and duration of hospital stay between the two groups. Anatomical resection did not influence overall and disease-free survival for all patients with a solitary recurrent HCC. In patients with cancer spread, such as pathological vascular invasion and intrahepatic metastasis (n=61), or with des-γ-carboxy prothrombin (DCP) ≥ 100 mAU/ml (n=73), the disease-free survival rate in the anatomical-resection group was significantly better than that in the limited-resection group (p=0.0452 and p=0.0345, respectively).Anatomical resection should be recommended only for HCC suspected of exhibiting cancer spread as reflected by DCP ≥ 100 mAU/ml in patients with solitary recurrent HCC.

The aim of this retrospective study was to determine the effect of gross classification on the outcome of hepatic resection for small solitary hepatocellular carcinoma (HCC).This study consisted of 179 consecutive primary HCC patients who were not preoperatively diagnosed with vascular invasion or intrahepatic metastasis. The clinicopathological impact of gross classification was compared. Patients were classified into four groups, vaguely nodular (VN) type, single nodular (SN) type, single nodular type with extranodular growth (SNEG), and confluent multinodular (CMN) type, according to the gross classification of resected specimens.The SNEG and CMN types showed a significantly higher rate of MVI and intrahepatic metastasis than VN and SN type. Multivariate analysis showed SNEG and CMN type is independent predictor of MVI. The survival rates and the disease free survival rates of four groups were equal after curative hepatectomy.This study demonstrated that the gross classifications were correlated significantly with the prevalence of MVI or intrahepatic metastasis, and that aggressive tumor spread in the SNEG type and in the CMN type was observed even in patients with small solitary HCC.

The expression of P-glycoprotein in 159 non-small cell lung cancers was immunohistochemically examined using a monoclonal antibody (MoAb C219). A total of 93 (60%) cancers were found to be positive for P-glycoprotein. The 5-year survival rates of patients with P-glycoprotein (P-gp+) and those without P-glycoprotein (P-gp-) were 47.6% and 73.6%, respectively (P < 0.05). According to a univariate analysis, P-gp+ was associated with a poor prognosis for males, those with stage I cancer, those who underwent complete resection, and those with adenocarcinoma or squamous cell carcinoma. A multivariate study using the Cox regression analysis indicated that the expression of P-glycoprotein is useful for predicting the prognosis. Among 24 patients who underwent complete resection and postoperative adjuvant chemotherapy, 18 were P-gp+ and the remaining 6 were P-gp-. Of the 18 with P-gp+ cancer, 11 relapsed and 9 died from tumor-related causes, while the other 7 remain free from tumor recurrence; however, all with P-gp- cancer are alive without recurrence. These observations suggest a bias toward a shorter survival for patients with P-gp+ cancer because P-glycoprotein may be associated with chemoresistance. Thus, detection of the expression of P-glycoprotein will aid in planning appropriate adjuvant chemotherapy for patients with non-small cell lung cancer.

We describe a rare case of leiomyosarcoma originating from the superior mesenteric vein with concomitant liver metastases in a 62-year-old woman. She underwent a tumor resection and venous reconstruction, right hemicolectomy, and right hepatic lobectomy. Since the tumor was weakly positive for c-kit, she was treated with imatinib mesylate for the recurrent liver tumors. She has survived for about 3 years after undergoing the surgical procedures.

Objective: This retrospective study was designed to detect occult micrometastases in the lymph nodes with the use of monoclonal anti-cytokeratin reagent, which is specific for epithelial cells but not for lymphocytes or plasmacytes, as well as to assess the relationship between the presence of occult micrometastases in the lymph nodes and an early relapse in patients with stage I non-small-cell lung cancer. Methods: The paraffin-embedded sections of 973 regional lymph nodes from 44 patients with stage I non-small-cell lung cancer were studied. We used CAM-5.2 as the primary monoclonal anti-cytokeratin reagent and an indirect staining technique with the streptavidin-biotin-peroxidase complex method. Results: We identified cytokeratin-positive cells in 31 (70.5%) of 44 patients and in 91 (9.4%) of the 973 lymph nodes. Of these 31 patients with cytokeratin-positive cells, 19 and 12 were restaged as having N1 and N2 disease, respectively. Thirteen patients had recurrent disease at 17 sites during the follow-up. Two of these recurrences were in the mediastinal nodes and the other 15 occurred at distant organs. Twelve of the 13 patients had micrometastatic disease in the regional lymph nodes. Disease-free survival duration was significantly shorter in the patients with micrometastases in the mediastinal lymph nodes than in patients with node-negative disease ( p = 0.004). The independence of this prognostic significance was demonstrated by a multivariate analysis. Conclusion: These findings indicate that the detection of occult micrometastases in the mediastinal lymph nodes with monoclonal antibodies to cytokeratin can thus be used to predict an early relapse in patients with stage I non-small-cell lung cancer. (J Thorac Cardiovasc Surg 1997;114:535-43)

Increased levels of tumor marker in intra-operative peritoneal lavage are associated with an earlier detection of recurrent peritoneal dissemination.Intra-operative peritoneal lavage samples from 193 patients with gastric cancer were obtained to determine the levels of the tumor markers, carcinoembryonic antigen (CEA) and cancer-related antigen 72-4 (CA72-4) using a chemiluminescent enzyme immunoassay.The peritoneal lavage CEA (CY-CEA), CA72-4 (CY-CA72-4) and serosal invasion were independent factors predicting the peritoneal dissemination including CY(+). The patients were divided into four groups on the basis of peritoneal lavage tumor marker status; group A: CY-CEA (-), CY-CA72-4 (-) group (CEA0.5 ng/ml, CA72-41.3 U/ml); group B: CY-CEA (-), CY-CA72-4 (+) group (CEA0.5 ng/ml, CA72-4 ≥ 1.3 U/ml); group C: CY-CEA (+), CY-CA72-4 (-) group (CEA ≥ 0.5 ng/ml, CA72-41.3 U/ml); and group D: CY-CEA (+), CY-CA72-4 (+) group (CEA ≥ 0.5 ng/ml, CA72-4 ≥ 1.3 U/ml). The 5-year survival among the patients in groups A, B, C and D was 87, 68, 38 and 20 %, respectively (p0.0001).Combined analysis of these markers is therefore considered to be helpful for accurately determining sites of recurrence and the prognosis in advanced gastric cancer patients.

Interferon (IFN) improves the prognosis of HCV-related hepatocellular carcinoma (HCC) in patients. However, the effects of IFN therapy for second hepatectomy (Hx) for recurrent HCC have not been established.Subjects included 96 patients who underwent a second Hx for recurrence of HCV-related HCC. Forty-four patients received IFN therapy past or postoperatively of the first Hx. Twenty of those patients attained a sustained viral response (SVR). The other 24 were non-responders (NR) and 52 patients who had not received IFN therapy (non-IFN) were classified as the NR/non-IFN group.Overall survival (SVR group vs. NR/non-IFN group: 5-yr, 91.7 vs. 51.0%; p = 0.012) and disease-free survival (SVR group vs. NR/non-IFN group: 3-yr, 64.7 vs. 25.9%; p = 0.006) rates were significantly different in both groups. By multivariate analysis, NR/non-IFN therapy, was the independent risk factor for overall survival (p = 0.025) and disease-free survival (p = 0.006) after second Hx.SVR achieved past or postoperatively of the first Hx of HCV-related HCC significantly inhibits recurrence and consequently improves patient survival after second Hx for recurrent HCC. Patients with SVR to IFN therapy would be good candidates for second Hx for recurrent HCC.

Using two- and three-color flow cytometry, we investigated the surface makers of regional lymph node lymphocytes (RLNL) in 54 patients with primary lung cancer in order to determine whether or not RLNL are in an activation state when compared with the corresponding peripheral blood lymphocytes (PBL) for the purpose of clarifying the characteristics of RLNL. RLNL showed a cell composition that was different from the corresponding PBL with a high proportion of CD3 + cells, CD4 + cells and CD20 + (B) cells as well as a low proportion of CD8 + cells and CD16 + (NK) cells. RLNL also contained a significantly higher proportion of CD45RO + T cells and a lower proportion of CD45RA + T cells in comparison to the corresponding PBL. Furthermore, we explored the activation-related molecules such as the interleukin-2 receptor (IL-2R) α chain, the IL-2R β chain, HLA-DR and leukocyte function-associated antigen 1 (LFA-1) on CD4 + and CD8 + cells. The data showed that the expression of CD45RO, the IL-2R α chain, HLA-DR on CD4 + cells, and those of CD45RO and HLA-DR on CD8 + cells were significantly higher in RLNL than in PBL. On the other hand, PBL showed a higher expression of the IL-2R β chain and LFA-1 only on CD8 + cells, which are thought to include CD8 + NK cells. When these activation-related molecules were analyzed on CD45RO + T cells, which are thought to be memory T cells, then the expression of the IL-2R α chain, HLA-DR on CD4 + CD45RO + cells and HLA-DR on CD8 + CD45RO + cells were significantly higher in RLNL than in PBL. Lastly, we analyzed the surface molecules according to such clinical factors as metastasis to the lymph nodes and the stage of lung cancer. Interestingly, RLNL with lymph node metastasis showed an increase in the percentage of CD20 + cells and a decrease in the percentage of CD4 + cells in comparison to those with benign lung disease, while these differences were not observed in PBL. The expression of CD45RO and LFA-1 on CD4+ and LFA-1 on CD8 + cells on RLNL in stage I + II is significantly higher in comparison with benign lung disease. Furthermore, RLNL in stage III + IV revealed the reduced expression of CD45RO, HLA-DR and LFA-1 on both CD4 + and CD8 + cells compared with those in stage I+II. These results thus demonstrated that RLNL were in a more activated state, particularly in stages I + II, than PBL. Whether these activation states in RLNL are directed against autologous tumor cells or not can hopefully be elucidated after the completion of further ongoing studies.

自然気胸の治療として胸腔鏡下手術を受けた患者と開胸手術を受けた患者の術後経過をアンケートにて比較検討した.回答があった症例のうち, 片側のみの手術を受けた患者に限定すると, 開胸手術を受けた患者19人中術直後から術後1日目までに, 強い疼痛を訴えた者は6人 (31.6%) であるのに対し, 胸腔鏡手術の場合25人中2人 (8.0%) と少なく, 後直後から術後早期にかけての疼痛軽減という観点から, 胸腔鏡下手術の有用性をあらためて確認した.術創に関しても、予想より小さいと回答した患者が, 開胸手術の場合19人中5人 (26.3%) に対し, 胸腔鏡手術の場合25人中13人 (52.0%) で, 胸腔鏡手術を受けた患者の術創に対する満足度が高いことが示唆された.

Retractile mesenteritis is a rare idiopathic inflammatory process of the mesenteric adipose tissue. A 58-year-old woman who presented with acute abdominal pain and vomiting underwent laparotomy for a small bowel obstruction of unknown etiology. The laparotomy showed dilated small bowel loops and multiple tumor-like fibrous plaques in the mesentery. Histological examination revealed nonspecific chronic inflammatory processes of the mesentery. The computed tomography finding of increased density of the mesenteric fat, known as the "fat-ring sign," in a patient with small bowel obstruction and no surgical history would suggest this rare diagnosis.

腋窩松葉杖による慢性的圧迫が上腕動脈の損傷・閉塞の原因となることがある.症例は63歳,男性で,乳児期のポリオ後遺症により両下肢の麻痺・脱力を伴い,生来腋窩松葉杖を使用.右上肢の脱力・冷感・しびれをきたし来院.松葉杖による圧迫のため腋窩動脈の慢性閉塞をきたし,末梢側に二次血栓を伴ったものと診断された.松葉杖による圧迫を避けるため非解剖学的経路による鎖骨下動脈-上腕動脈バイパス術を施行した.

We retrospectively investigated 308 cases of non-small cell lung cancer of < or = 3 cm diameter. There were 204 adenocarcinomas, 78 squamous cell carcinomas, 15 large cell carcinomas, and 11 other carcinomas. According to TNM staging, there were one case stage 0, 208 stage I, 22 stage II, 49 stage IIIA, 15 stage IIIB, and 13 cases stage IV. T1 disease was seen in 262 cases, T2 in 19, T3 in 10, T4 in 16, and Tis in 1. N0 disease was seen in 217 cases, N1 in 30, N2 in 60, and N3 in 1. The 5-year survival rate of all cases was 63%. There were statistically significant differences among T status (T1 vs. T3, T4), N status (N0 vs. N1, N2), and M status (M0 vs. M1) (P < 0.01). The 5-year survival rates of cases with adenocarcinoma and squamous cell carcinoma were 60% and 64%, respectively. In 204 cases of adenocarcinoma, T3 disease was found in one case, T4 disease in 15 (7%), and nodal involvement (N1 + N2) was present in 69 (34%). In 78 cases of squamous cell carcinoma T3 was seen in 6 (8%), T4 in 1, and nodal involvement in 14 (18%). The incidence of T3 disease, T4, and N(+) varied significantly according to histology (P < 0.05). Our investigation suggested that cases of small-sized lung cancer were often at an advanced stage at detection, and that the spread of disease differed according to histology. The patient with small-sized lung cancer should be offered a standard operation regardless of histology.

We examined immunohistochemically 111 cases of primary adenocarcinoma of the lung, for transforming growth factor alpha (TGF alpha) or epidermal growth factor (EGF), and argyrophilic nucleolar organizer regions (AgNORs). The presence of more than 75% positive cells for both growth factors was designated as a high-GF, while all others were considered to be a low-GF. If AgNORs counts were more than 5.00, it was considered to be a high-AgNORs group, while less than 5.00 was designated as a low-AgNORs group. In our 111 examined specimens, there were 51 (46%) cases of high-GF, and 64 (58%) with high AgNORs. The 5-year survival rates of the patients with a high-GF and low-GF were 34% and 57% (P0.05) respectively, while those with high-AgNORs and low-AgNORs were 21% and 81% (P0.001), respectively. In the cases of high-AgNORs, the 5-year survival rates of the patients with high-GF and low-GF were 0% and 36% (P0.05), respectively. However, in the cases of low-AgNORs, the 5-year survival rates of the patients with high-GF and low-GF were 83% and 79%, respectively. These data suggest that growth factors might be related to the biological malignancy of tumours with a high cell proliferation.

Background Surgical results have been reported to be improved in hepatic resections for hepatocellular carcinoma (HCC) in recent years, but the detailed trends in surgical results for HCC in a single high-volume center are still not clear. Methods Surgical results in 1,000 hepatic resections for HCC performed at a single medical center from 1989 to 2011 were analyzed. Patients were divided into 3 groups: those performed in the early period (1989 to 1995, n = 181), the middle period (1996 to 2004, n = 391), and the late period (2005 to 2011, n = 428). Results Hospital mortality (3.9%, 1.0%, and .5%; P = .0027) and morbidity (45%, 24%, and 15%; P < .0001) rates were significantly decreased. The overall survival rates were significantly improved (50%, 72%, and 78% at 5 years; P = .0021), but there was no significant difference in the disease-free survival (29%, 34%, and 31% at 5 years; P = .7823). Conclusions Surgical results of hepatic resections for HCC were significantly improved, with the mortality rate nearly reaching 0%. The 5-year survival rate after hepatic resections for HCC was also improved to 78%, but the consistently high rate of HCC recurrence after hepatic remains a problem.

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and, therefore, an intrathoracic origin is considered to be rare. This report presents a case of giant thymoma arising in the thoracic cavity. A 61-year-old male presented with a chronic cough and breathlessness. Chest CT revealed a well enhanced giant mass approximately 18 cm in diameter in the right thoracic cavity. FDG-PET showed that the SUVmax of the tumor was 5.0 in the center and almost 2.5 in the surrounding area. A trans- bronchial needle biopsy was performed to find atypical cells. Surgery was scheduled based on the radiological and histological findings. A well-defined giant mass in the thoracic cavity, measuring 18 × 14.5 × 11 cm had undergone expansive growth without apparent invasion. The tumor was completely resected without combined resection of the other organs. The weight of the tumor was 1350 g. The tumor was histologically diagnosed to be type AB thymoma according to the World Health Organization classification and Masaoka stage IIB.

The aim of this retrospective study was to determine the effect of age on the outcome of hepatic resection in octogenarian patients with hepatocellular carcinoma (HCC).Data of 408 consecutive primary HCC patients who underwent curative hepatectomy were studied. The surgical results of the younger group (80 years of age) and the elderly group (≥80 years of age) were compared.Preoperative parameters, such as comorbid conditions and liver function tests, of the younger group (n=385) were comparable with those of the elderly group (n=23). Surgical data and the prevalence of postoperative complications did not differ significantly between the two groups. The long-term prognosis of the elderly group patients was almost identical to that of the younger group patients. Overall 3-year survival rates for the elderly group and the younger group were 95.7% vs. 84.8%, respectively (p=0.56). Disease-free three-year survival rates for the elderly group and the younger group were 47.2% vs. 47.7%, respectively (p=0.65).Hepatectomy is a viable treatment alternative with satisfactory surgical outcome for HCC even in patients aged 80 years or older.

The purpose of this study was to determine the poor prognostic factors after repeat hepatectomy (Hx) in patients with recurrent hepatocellular carcinoma (HCC). Overall survival rates and clinicopathological variables in 112 patients with repeat Hx from 1992 to 2010 were compared with those in 531 patients who underwent a primary Hx. To clarify the poor prognosis factors after repeat Hx, survival data among 112 patients were univariately and multivariately analyzed. Overall survival after repeat Hx was similar for that of the patients who underwent a primary Hx. The mean age of repeat Hx group was significantly higher, and a well-preserved liver function was recognized than the primary Hx group. Multivariate analysis revealed that: 1) indocyanine green retention rate at 15 minutes; 2) disease-free interval; 3) tumor size; 4) portal vein invasion at primary Hx; 5) gender; and 6) estimated blood loss to be an independent and significant poor prognostic factors. The overall 3-year postrecurrence overall survival rates were 100, 91.3, 59.6, and 0 per cent at risk number (R) R0, R1/2, R3, R4, respectively ( P < 0.05). Repeat Hx provided a good compatible prognosis with primary Hx. In our findings, five risk factors to predict poor outcomes after repeat Hx were useful. Patients with recurrent HCC do not have universally poor outcomes, and our simple scoring system using five poor prognostic factors could serve to advise the prognosis and the potential benefit for patient selection about repeat Hx.

The effectiveness of subcuticular absorbable suture with subcutaneous drainage to decrease the risk of postoperative incisional surgical site infection (SSI) in hepatocellular carcinoma (HCC) patients was evaluated. A total of 149 patients with HCC who underwent hepatectomy (Hx) were retrospectively investigated. Patients were divided into two groups: the patients with subcuticular suture combined with subcutaneous drainage (the drainage group; 61 patients) and the patients with nylon suture without subcutaneous drainage (the nylon group; 88 patients). After the operations, the complication rate of postoperative incisional SSI was analyzed and compared between the two groups. In the drainage group the rate of incisional SSI was significantly lower compared to the nylon group: 14–3 % (p = 0.033), respectively. Patients with incisional SSI needed significantly longer postoperative hospital care than the patients without incisional SSI: 28 versus 15 days (p

In the decade after the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. However, the incidence of other cancers gradually increased, while that of leukemia decreased after this period. We evaluated the clinical outcome of early gastric cancer and microsatellite stability over a long-term period in atomic bomb survivors.The results of surgical treatment for early gastric cancer were reviewed for 117 atomic bomb survivors and 394 control patients between 1995 and 2006. In addition, immunohistochemical staining for hMSH2 and hMLH1 expression was performed to evaluate the status of microsatellite stability in 57 atomic bomb survivors and 82 control patients.The long-term survival rate for early gastric cancer in atomic bomb survivors was significantly lower than that in control patients (p 0.01). Multivariable analysis revealed that age and sex were significant and independent prognostic factors for early gastric cancer. Defective hMSH2 and/or hMLH1 expression was also significantly higher in survivors than in control patients (p 0.001). Logistic regression analysis revealed that atomic bomb survivorship was related to defective hMSH2 and/or hMLH1 expression.The prognosis of early gastric cancer in atomic bomb survivors was poor and was related to age and sex, rather than to being an atomic bomb survivor. Furthermore, a higher rate of defective hMSH2 and/or hMLH1 expression was observed in the survivors.

Systemic chemotherapy is the key treatment for patients presenting with advanced gastric cancer with peritoneal dissemination. In certain cases, adjuvant surgery following systemic chemotherapy may result in improved long-term survival. This study aimed to evaluate the efficacy of adjuvant surgery following response to chemotherapy for advanced gastric cancer with peritoneal dissemination. The study included 13 patients with a diagnosis of advanced gastric cancer with peritoneal dissemination. Of the 13 patients, 5 patients underwent surgery after the peritoneal dissemination was eradicated following systemic chemotherapy (group S), while the remaining 8 patients continued to receive systemic chemotherapy due to persistent peritoneal dissemination (group C). All 13 patients underwent treatment between October 2008 and February 2011. The chemotherapy regimen included cis-diamminedichloride platinum plus S-1 (an oral fluoropyrimidine) or docetaxel plus S-1 for all patients. The median overall survival time of the 13 patients was 660 days. The survival time did not differ with patient response to chemotherapy. The median survival time of the patients in group S was 794 days, which was significantly higher than that of the patients in group C (505 days; p

We investigated surface markers of lymphocytes infiltrating four different histological non-small cell lung cancer tissues obtained at surgery and the corresponding peripheral blood lymphocytes (PBL) of 40 clinical cases, who had undergone no prior anti-cancer treatment, by flowcytometry. In estimation of the mean proportion of each lymphocyte subset, a paired Wilcoxon test revealed that tumor-infiltrating lymphocytes (TIL) exhibited significantly higher values of CD3+ cells (P0.05), CD8+ cells (P0.05) and CD20+ cells (P0.01), and lower value of CD16+cells (P0.05), as compared with those in PBL. The Spearman test revealed that none of the values of surface markers in TIL statistically correlated with those in the corresponding PBL (r0.6, P0.05). Although there was no significant difference between the mean CD4/CD8 ratio of total TIL and that of PBL, TIL of 12 patients with squamous cell carcinoma almost always showed lower values of CD4/CD8 ratio than those in PBL (P0.05), while the CD4/CD8 ratio was similar between TIL and PBL in adenocarcinoma. These results suggest that TIL of lung cancers represent specific immunological responses, whose characteristic depend on the histological types of lung cancers.

Monoclonal antibody KP16D3 recognizes a 60 kDa protein associated with mucin-nonproducing papillary adenocarcinoma, especially that originating from nonciliated bronchiolar epithelial cells of the lung. We immunohistochemically examined 56 primary lung adenocarcinomas using the monoclonal antibody KP16D3. Of these tumors, 31 (55%) were positive for KP16D3 immunoreactivity. The disease-free survival rates showed no statistical differences between KP16D3-positive and KP16D3-negative patients. However, in stage I and T1 disease, the disease-free survival rates of KP16D3-positive patients were statistically lower than those of KP16D3-negative patients (P < 0.05). These findings suggest that KP16D3 may be useful as a prognostic marker for patients with stage I primary lung adenocarcinoma. Conversely, use of this marker and subtyping of lung adenocarcinomas reflect the prognosis of the disease.

自然気胸症例に対し, 胸腔鏡下に内視鏡用自動縫合器であるENDOGIA 30 (United States Surgical社アメリカ) を用いたブレブ切除術を施行して良好な結果を得た.対象は17歳から44歳までの男女7例で, 術後癖痛軽微のため鎮痛剤は不要で術後1日目にドレーン抜去可能, 術後4日目に退院となった.切除したブレブは直径0.5cmから5conまでで, 癒着高度の症例もあったが, 出血量も少なく, 本法は自然気胸に対する安全で確実な術式の一つであると考えられた.

platin (60 mg/m 2 on day 1) and oral administration of S-1 (40 mg/m 2 , twice a day, between days 1 and 14) administered concurrently with 50 Gy of radiation. Radiotherapy was directed to all tumors including metastatic lesions. After chemoradiotherapy, two cycles of consolidation chemotherapy were performed with cisplatin and S-1. The mediastinal tumor showed a 52% reduction in size, and the right hilar lymph nodes and pulmonary nodule disappeared completely. In a FDG-positron emission tomographic scan, although the mediastinal tumor still showed a slight uptake of FDG, the other lesions showed none (Figure 1B). The patient underwent extended thymectomy with partial resection of the left lung. The resected tumor was solid, with no cystic lesions. Microscopically, there were scattered tumor cells among hyalinized collagenous fibers. Granulation tissue was also seen in the tumor, suggesting that chemoradiotherapy had induced tumor cell degeneration. The patient has survived without recurrence for 11 months since surgery, to date.

Akt activation has been found in various human cancers, while experimental studies have suggested that Akt plays an important role in the development of tumor angiogenesis and lymphangiogenesis. Immunohistochemical analyses for VEGF-C and Akt and the lymphatic endothelial specific marker D2-40 were performed on a series of 242 invasive ductal carcinomas of the breast, in which VEGF-A expression and microvessel density (MVD) had been determined previously. Lymphatic vessel density (LVD) was estimated in three hot spots. A significant correlation was observed between the VEGF-C expression and LVD (p=0.0026) and between LVD and the lymph node status (p

A 65-year-old female patient was diagnosed with breast cancer in 1995. An abdominal mass was detected by computed tomography and the patient was preoperatively diagnosed with a gastrointestinal stromal tumor. Laparoscopy-assisted surgical resection revealed a mesenteric Castleman’s tumor of the hyaline vascular type. Mesenteric Castleman’s disease is rare, and there have been only 42 cases reported in the English literature. We herein discuss the clinical findings of these cases.

The clinical, radiographic, and pathological features of 10 patients with sclerosing hemangioma of the lung seen between 1974 and 1990 were reviewed. The incidence of sclerosing hemangioma was 22.2% of benign tumors surgically resected during that time. There were 2 male and 8 female patients aged 15 to 77 years at operation, and 9 patients were asymptomatic. All 10 patients had a solitary tumor with a well-defined homogeneous round or oval shadow on chest roentgenograms. Chest computed tomography revealed a homogeneous soft-density mass in 4 patients and a low-density portion within the tumor because of a cystic change in 1 patient. Microscopically, 5 patients had a preponderantly solid pattern, 3 had a preponderantly papillary pattern, and 1 patient had a preponderantly sclerotic pattern. One patient had an equal mixture of solid and papiliary patterns. Nine of the 10 tumors consisted of a mixture of at least three of the four major patterns. Regarding treatment, thoracotomy is indicated for a definite diagnosis. If a benign tumor is suspected at operation, an intraoperative frozen section is recommended. Once the diagnosis has been established as sclerosing hemangioma, a limited resection is indicated.