PubMed

DOI： 10.1016/j.ijscr.2025.112022

PubMed

DOI： 10.21037/ales-25-9

DOI： 10.1111/codi.70267

PubMed

<p><b>Objectives: </b>Sarcopenia is generally defined based on the age-related muscle mass and weakness. However, it has been reported that patients with Crohn's disease, who develop severe inflammation of the gastrointestinal tract, are more likely to develop sarcopenia. We retrospectively investigated the effect of the iliopsoas muscle area, which is an indicator of sarcopenia, on postoperative complications in patients with Crohn's disease.</p><p><b>Methods: </b>We included 98 patients with Crohn's disease who underwent surgery in our department between January 2016 and December 2021, and performed retrospectively analyzed. The psoas muscle index (PMI) was calculated as the average of the left and right iliopsoas muscles (L3, cm²) / height². We divided patients into the low PMI (men <2.33 cm²/m², women <1.85 cm²/m²) and normal PMI groups and compared their preoperative and intraoperative factors and postoperative outcomes.</p><p><b>Results: </b>The median age of the 98 patients was 37.0 (17-77) years. Complications were noted in 40 patients (40.8%), including 10 (10.2%) with anastomotic leakage. There were 26 (26.5%) patients with a low PMI. The incidence of all postoperative complications, grade ≥2 complications, anastomotic leakage and surgical site infection (SSI) were significantly higher in the low-PMI group than in the normal-PMI group. According to a multivariate analysis, low PMI (p=0.04) was only independent predictor for grade 2 or above postoperative complications.</p><p><b>Conclusions: </b>A low PMI is associated with postoperative complications, especially anastomotic leakage, in patients with Crohn's disease.</p>

DOI： 10.23922/jarc.2024-104

PubMed

CiNii Research

【目的】サルコペニアは一般的に加齢に伴う筋肉量や筋力低下に基づいて定義される概念であるが,消化管に重度の炎症を呈するクローン病患者においてもサルコペニアの状態を来たしやすいことが報告されている.我々はサルコペニアの指標である腸腰筋面積がクローン病患者の術後合併症に及ぼす影響を後方視的に検討した.【方法】2016年1月から2021年12月までに当科で手術を施行したクローン病患者98例を対象とし,術前の腹部造影CTから算出した腸腰筋指数PMI(Psoas muscle index;cm2/m2)によって患者をlow PMI群(男性<2.33cm2/m2、女性<1.85cm2/m2)とnormal PMI群に分類し,術前・術中因子と術後成績を比較した.【結果】年齢中央値は37.0歳(17-77歳),合併症は40例(40.8%)に認められ,うち10例(10.2%)が縫合不全であった.全術後合併症,Gr2以上の合併症,縫合不全,手術部位感染(SSI)の発生率はlow-PMI群がnormal群より有意に高く,多変量解析ではlow PMI(p=0.04)はGr2以上の術後合併症の唯一の独立した予測因子であった.【結論】クローン病患者において術前のPMI低値は術後合併症の独立したリスク因子と考えられた.(著者抄録)

DOI： 10.21873/invivo.14039

PubMed

DOI： 10.21873/invivo.14012

PubMed

DOI： 10.21873/invivo.13956

PubMed

DOI： 10.2468/jbes.76.115

CiNii Research

症例は48歳男性で、腹部骨盤CT検査で前仙骨と後部直腸に腫瘍が検出されたため当院に紹介された。身体所見では腫瘍を触れることはできず、血液検査では血球数、凝固パラメータ、腫瘍マーカーに異常はみられず、下部消化管内視鏡検査にて上行結腸、横行結腸およびS状結腸に複数の小型ポリープを認めたが、悪性所見や管腔外直腸圧迫はみられなかった。腹部骨盤領域のMRIではT1強調像にて低信号、T2強調像にて高信号を示す32×12×20mm大の嚢胞性病変が検出されたが、確定診断には至らず、腹腔鏡・経仙骨複合アプローチにて手術を行う方針とした。臍部に12mmカメラポートを設置した後、直腸間膜を切離して後直腸腔と直腸後壁を露出し、肛門挙筋を同定できるまで外方切除を施した。しかし、腫瘍を視認することはできず、経仙骨アプローチに移行した。会陰部の頭尾方向に7cmの正中切開をおき、超音波ガイド下に腫瘍周囲を切除し、直腸に損傷を及ぼさないよう慎重に腫瘍を摘出した。術後の組織病理所見では扁平上皮を含有する嚢胞性病変であり、表皮嚢胞と診断した。術後経過は良好で7日目に退院となり、1年後も再発徴候はみられない。

DOI： 10.21873/anticanres.17549

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: In order to clarify the optimal strategy regarding conversion surgery (CS) for gastric cancer (GC) patients, we focused on clinicopathological findings, including immunological factors, related to the favorable prognosis in patients with stage IV GC who underwent CS. MATERIALS AND METHODS: A total of 25 patients with Stage IV GC who underwent induction chemotherapy (IC) and CS at our hospital between 2010 and 2021 were enrolled in this study. Biopsy specimens before IC and surgical specimens were collected. Immunohistochemical staining was performed using programmed death-ligand 1 (PD-L1) antibody, translationally controlled tumor protein (TCTP) antibody, and CD20 antibody. Prognostic factors were investigated using clinicopathological factors as well as immunological factors such as PD-L1, TCTP, and CD20 expression. RESULTS: cN0, ycStage1-2, R0-1 surgery, D2 lymph node dissection, ypN0, and ypStage1-2 were significantly associated with favorable overall survival. Among patients who underwent R0/1 surgery, only histological type was a significant prognostic factor for recurrence-free survival. Low PD-L1 expression before IC and high TCTP expression after IC were significantly associated with favorable recurrence-free survival. CONCLUSIONS: In addition to clinical factors, high TCTP expression after IC was identified as a significant favorable prognostic factor, which could help in identifying candidates for CS in the future.

DOI： 10.1016/j.jss.2024.12.053

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: The effectiveness of a transanal drainage tube (TAT) for the prevention of anastomotic leakage after double stapling technique (DST) anastomosis in colorectal cancer has been reported. Previously, TATs had been placed and connected to drainage bags. It was considered that a higher decompression effect could be expected by inserting an open-type TAT, without connection to a drainage bag. In this study, the relation between anastomotic leakage and the application of this type of TAT in left-sided colorectal cancer surgery was investigated, using propensity score matching (PSM). MATERIALS AND METHODS: From January 2016 to July 2023, 233 consecutive patients underwent radical surgery for sigmoid colon and rectal cancers and reconstruction using DST at Osaka Metropolitan University Hospital. Patients were divided into two groups: those who had a closed TAT inserted (CLOSED group), and those who had an open TAT inserted (OPEN group). RESULTS: Overall, open TATs were inserted in 43 patients, and closed TATs were inserted in 190 patients. PSM was performed between the OPEN and CLOSED groups on the basis of the following 13 factors: age, sex, BMI, diabetes mellitus (DM), smoking history, modified Glasgow prognostic score (mGPS), ASA-PS, location of distal tumor edge, operative procedure, surgical approach, operative time, intraoperative blood loss, and pathological stage. The multivariate analysis of significant factors identified a BMI of 25 or more, a location of distal edge on middle to lower rectum, and a closed TAT, as independent risk factors for anastomotic leakage (HR: 8.72; p = 0.038, HR: 10.06; p = 0.034 and HR: 17.43; p = 0.033). CONCLUSION: An open TAT may be effective in preventing anastomotic leakage in left-sided colorectal cancer surgery.

DOI： 10.1186/s12893-025-02775-2

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Although the phase III SUNLIGHT trial has demonstrated the survival benefit of the addition of bevacizumab (Bmab) to trifluridine/thymidine phosphorylase inhibitor (FTD/TPI), neutropenia, which frequently occurs during FDT/TPI + Bmab therapy, is a concern for clinicians. As TPI is excreted by the kidneys, the risk of adverse events is likely to be high in patients with an impaired renal function. This study aimed to investigate the relationship between renal impairment and the incidence of chemotherapy-induced neutropenia during FTD/TPI + Bmab therapy using real-world data. We retrospectively reviewed the medical records of 69 patients with metastatic colorectal cancer (mCRC) who were treated with FTD/TPI + Bmab for more than 28 days. Patients with renal impairment with an eGFR of 30-44 mL/min/1.73 m2 were defined as the G3b group. Seven patients (10.1%) were classified into the G3b group. Patients in the G3b group had an approximately 24% higher incidence of grade ≥ 3 neutropenia in comparison to others (71.4% vs. 46.8%), and the incidence of grade 4 neutropenia in the G3b group was significantly higher than that in others (42.9% vs. 9.7%, p = 0.042). The G3b group frequently developed grade ≥ 3 neutropenia within 30 days of the initiation of FTD/TPI + Bmab therapy. However, the duration required for neutrophil count to recover to ≥ 1500/mm3 and the treatment effects of the G3b group were comparable to those observed in other patients. Clinicians should pay extra attention to patients with a decreased renal function who are treated with FTD/TPI + Bmab therapy, but no special measures are required for patients with an eGFR ≥ 30 mL/min/1.73 m2 as no marked differences were observed in neutrophil count recovery.

DOI： 10.1038/s41598-024-84133-5

PubMed

DOI： 10.21873/anticanres.18014

PubMed

Publishing type：Research paper (scientific journal)  

DOI： 10.1111/ases.70068

PubMed

Publishing type：Research paper (scientific journal)  

<p><b>INTRODUCTION:</b> Jejunal diverticulosis is a rare condition, often asymptomatic, but it can lead to serious complications such as diverticulitis or perforation. Management of perforated jejunal diverticula is challenging, particularly in patients with autosomal dominant polycystic kidney disease (ADPKD) who have undergone kidney transplantation and are receiving immunosuppressive therapy. Early diagnosis is often difficult due to nonspecific symptoms and the frequent presence of multiple diverticula, which increases the risk of postoperative complications.</p><p><b>CASE PRESENTATION:</b> We present the case of a 61-year-old woman with ADPKD, who developed jejunal diverticular perforation 3 years after undergoing ABO-incompatible kidney transplantation. She initially presented with mild abdominal pain and was managed conservatively, but her condition worsened 1 month later with evidence of free air on CT. Emergency surgery revealed multiple jejunal diverticula with a perforation on the mesenteric side, and a double-barrel stoma was created to avoid anastomotic leakage. Four months postoperatively, endoscopic and fluoroscopic evaluation from both the oral and stoma sides enabled accurate identification and marking of the diseased segment. A second-stage surgery was successfully performed with segmental jejunal resection and stoma closure. Histopathology confirmed multiple true diverticula, including at the perforation site. The patient recovered well and was discharged approximately 1.5 months later.</p><p><b>CONCLUSIONS:</b> This rare case of perforated multiple jejunal diverticula in a patient with ADPKD highlights the value of a two-stage surgical approach with preoperative endoscopic evaluation to enable safe and targeted resection in complex settings.</p>

DOI： 10.70352/scrj.cr.25-0308

PubMed

CiNii Research

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: The cachexia index (CXI) has been reported to be a useful indicator for predicting the prognosis of cancer patients. However, CXI calculation requires skeletal muscle index (SMI) measurements, which involves an analysis of computed tomography images using an imaging software program, which makes the calculation process highly complex and time-consuming. Recently, the modified cachexia index (mCXI), calculated using the urea-to-creatinine ratio (UCR) instead of SMI, has been reported to be a useful marker that is easier to calculate than CXI. This study aimed to evaluate the correlation between mCXI and the prognosis of patients with colorectal cancer (CRC). PATIENTS AND METHODS: A total of 291 patients who underwent curative surgery for stage I-III CRC were enrolled. mCXI was calculated as the serum albumin concentration/neutrophil-to-lymphocyte ratio (NLR)/UCR. A receiver operating characteristic (ROC) curve analysis was used to determine the optimal cutoff value of the mCXI for predicting prognosis. RESULTS: The median mCXI was 0.089 (range=0.012-0.354). The ROC curve analysis revealed that the appropriate cut-off value for mCXI was 0.113. The low mCXI group had significantly shorter relapse-free and overall survival rates than the high mCXI group (p=0.030 and p=0.014, respectively). CONCLUSION: mCXI, which does not require an image analysis, may be closely associated with prognosis in patients undergoing curative surgery for CRC.

DOI： 10.21873/cdp.10416

PubMed

<p><b>INTRODUCTION:</b> Inguinal lymph node metastasis from colon cancer is extremely rare. Therapeutic strategies have not been established regarding preventive measures for hernia recurrence following mesh removal when the mesh used in inguinal hernia repair is infiltrated by a tumor. Similarly, no treatment strategies have been developed regarding the necessity of prophylactic orchiectomy when a tumor infiltrates the spermatic cord and requires resection.</p><p><b>CASE PRESENTATION:</b> We report a rare case of metachronous isolated inguinal lymph node metastasis following potentially curative surgery for transverse colon cancer. An 83-year-old male underwent laparoscopic colectomy with D3 lymphadenectomy for transverse colon cancer. At 1 year postoperatively, he presented with a painful mass in the left inguinal region. Imaging suggested transverse colon cancer recurrence in the inguinal lymph node. Diagnostic and therapeutic inguinal lymphadenectomy was performed. The tumor had infiltrated the previously placed mesh for a prior inguinal hernia repair and adhered to the spermatic cord. Therefore, en bloc resection of the mesh and spermatic cord was performed. No additional reinforcement was necessary because the structural strength of the inguinal region was preserved following mesh removal. Furthermore, orchiectomy was not performed owing to testicular atrophy due to advanced age. Histopathological examination confirmed inguinal lymph node metastasis of transverse colon cancer. At 4 months postoperatively, the patient remained free from colorectal cancer recurrence, testicular necrosis, or inguinal hernia recurrence.</p><p><b>CONCLUSIONS:</b> This case represents an extremely rare instance of metastasis occurring at the site of a prior inguinal hernia repair with mesh implantation. Considering the potential need for spermatic cord resection and mesh removal, appropriate surgical strategies for such scenarios should be included in preoperative planning.</p>

DOI： 10.70352/scrj.cr.25-0475

PubMed

CiNii Research

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: Reduction in skeletal muscle mass during chemotherapy is associated with poor outcomes. This study investigated the impact of changes in the psoas muscle index (PMI) on the prognosis of patients with unresectable colorectal liver metastases (CRLM) undergoing chemotherapy, including subgroup analyses based on the initial treatment response assessment. PATIENTS AND METHODS: We evaluated 47 patients with unresectable CRLM who underwent systematic chemotherapy and assessed changes in PMI to determine their prognosis. RESULTS: Changes in PMI were significantly associated with the presence or absence of primary tumor resection and the chemotherapeutic responses to first-line chemotherapy. The PMI reduction group was significantly associated with poor prognosis in both overall survival (OS) and progression-free survival (PFS) in patients with CRLM, and in both OS and PFS in the partial response (PR) group at the initial chemotherapy response assessment. CONCLUSION: Skeletal muscle loss at chemotherapy initiation was significantly associated with poorer survival in patients with unresectable CRLM. Maintaining muscle mass could serve as a new indicator for identifying patients with a PR at the initial chemotherapy response assessment for prognosis. Personalized interventions should be investigated to determine whether they can improve muscle mass and lead to better clinical outcomes.

DOI： 10.21873/cdp.10414

PubMed

症例は81歳,女性。約2年前にS状結腸癌の診断で,腹腔鏡下S状結腸切除術が施行された。病理組織学的検査の結果,pT1bN1bM0,pStage IIIaであった。本人の希望により術後補助化学療法はせず経過観察としたが,術後2年目に施行した胸腹部CT検査にて頸部や縦隔,上腹部大動脈周囲に多数のリンパ節腫大を認めた。腫瘍マーカーはCEAが5.1ng/mLと軽度高値を示すのみで,肝転移や肺転移,腹膜播種はみられなかった。6ヵ月前の胸腹部CT検査では明らかな再発所見はなく,急激な病勢進行であり,リンパ節腫大のみを呈したことから悪性リンパ腫や肺小細胞癌などの大腸癌の再発以外の可能性も考慮した。頸部リンパ節生検ではadenocarcinomaが検出され,免疫組織学的には大腸癌のリンパ節再発に矛盾しなかった。その後,全身化学療法を施行するも再発診断から約9ヵ月後に死亡した。今回われわれは,大腸癌の再発としては比較的まれな頸部・縦隔リンパ節転移を契機に診断されたS状結腸癌術後再発の1例を経験したので報告する。(著者抄録)

症例は70歳,女性。主訴は残便感。腹部CT検査および下部消化管内視鏡検査にて下部直腸に50mm大の粘膜下腫瘍を指摘され,生検によりgastrointestinal stromal tumor(GIST)の診断となった。腫瘍は骨盤内を占拠しており,被膜損傷で播種を来す可能性を考慮し,術前補助化学療法としてメシル酸イマチニブ(imatinib mesylate:IM)400mg/日の投与を行うこととした。IM投与28週目の画像検査で腫瘍径は40%の縮小を認め,ロボット支援下括約筋間直腸切除術および一時的回腸瘻造設術を施行した。術後経過は良好で,術後13日目に退院となった。術後IMを継続し8ヵ月経過しているが,再発や転移は認めていない。直腸巨大GISTに対し,IMによる術前化学療法を施行することで安全に根治切除を施行し得た症例を経験したので報告する。(著者抄録)

症例は76歳,女性。直腸癌に対して腹腔鏡下直腸低位前方切除術を施行し術後9日目に軽快退院した。しかし,退院後4日目より腟から便汁の漏出がみられたため来院し,注腸造影検査の結果,直腸腟瘻と診断した。下部消化管内視鏡検査を施行すると吻合部前壁に潰瘍がみられ,その中心部に20mmの瘻孔が存在した。縫合不全に伴う直腸腟瘻と診断し,回腸瘻造設術を施行した。術後,抗菌薬投与により感染は鎮静化し,約3週間で軽快退院した。人工肛門造設後2ヵ月が経過した時点で下部消化管内視鏡検査を施行したところ,瘻孔は2mmに縮小していたが腟への造影剤漏出を認め,瘻孔は開存したままであった。瘻孔閉鎖を目的にホルモン治療としてエストリオール錠内服を開始した。エストリオール錠内服開始より1ヵ月半後に下部消化管内視鏡検査を施行したところ,瘻孔の閉鎖が確認できたためホルモン治療は終了となった。初回術後約1年6ヵ月経過するも明らかな直腸癌の再発,直腸腟瘻の再燃は認めていない。直腸癌に対する低位前方切除術後の直腸腟瘻はまれな合併症であるが,難治性で長期間の治療を要する場合が多い。治療法としては吻合部切除+再吻合という選択肢もあるが,再手術ということもあり難易度は高く,肛門機能低下も危惧される。自験例では,人工肛門造設のみでは瘻孔の閉鎖には至らなかったが,エストリオール錠開始後,速やかに瘻孔閉鎖が得られたため,ホルモン治療が有効であったと考える。直腸癌術後に生じた直腸腟瘻に対するホルモン治療は,低侵襲で有効な治療法の一つになる可能性が示唆された。(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: The use of robot-assisted minimally invasive esophagectomy (RAMIE) in the prone position for esophageal cancer has been currently increasing worldwide. In future, as surgical-assisted robots become more widespread, it is estimated that only two methods of transthoracic approach will remain: RAMIE and open thoracotomy for thoracic esophageal cancer. RAMIE in the left lateral decubitus position (RAMIE-LLDP) has the same field of view as open thoracotomy, is safe in emergency situations, and provides education on open thoracotomy. METHODS: Between September 2020 and April 2024, RAMIE-LLDP was performed in 64 consecutive patients with esophageal cancer. RAMIE-LLDP was performed with the operating table rotated and tilted 45° to the ventral side under artificial pneumothorax. The hand-control setting of the surgical-assist robot system was reversed left to right when the Patient Cart was rolled from the same direction as the RAMIE in the prone position. RESULTS: The mean total surgery and console times during the thoracic procedure were 254-min overall and 225 min in the last 24 cases and 195-min overall and 178- min in the last 24 cases, respectively. The mean amount of blood loss was 203.4 g overall and 28.3 g in the last 24 cases. Postoperative recurrent laryngeal nerve palsy with Clavien-Dindo classification (CD) was ≥ 2 in six patients (9.4%). Postoperative pneumonia with CD ≥ 2 was observed in 11 patients (17.2%). Conversion to open thoracotomy was observed in three patients (4.7%). In all three patients, an immediate conversion to thoracotomy without patients' position change was actually possible and no serious complications were noted. No mortality occurred within 30 days postoperatively. CONCLUSION: RAMIE-LLDP which facilitates emergency thoracotomy has perioperative results comparable to those of conventional thoracoscopic esophagectomy and is educational for open surgery. RAMIE-LLDP is the safest and most optimal surgery for esophageal cancer.

DOI： 10.1007/s00464-024-11282-z

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: A new index, inflammation-nutrition biomarker score (INS), based on host factors, including lymphocyte to C-reactive protein ratio, C-reactive protein to albumin ratio, advanced lung cancer inflammation index, and nutritional risk index, correlated with post-operative survival time independent of the tumor, node, metastasis (TNM) stage, in a cohort of patients with various types of malignancies. Therefore, this study aimed to evaluate the prognostic value of INS in patients with colorectal cancer who underwent curative resection. PATIENTS AND METHODS: We retrospectively evaluated 476 consecutive patients who underwent curative surgery for stage I-III colorectal cancer. RESULTS: Based on the INS definition, 240, 132, 57, 23, and 24 patients had a score of 0, 1, 2, 3, and 4, respectively. Patients with INS of 0 and 1 were classified into the low-INS group, and those with INS of 2, 3, and 4 were classified into the high-INS group. The relapse-free and overall survival rates were significantly worse in the high-INS group than in the low-INS group. Furthermore, multivariate analysis of the prognostic factors indicated that INS is an independent prognostic factor for poor relapse-free and overall survival. CONCLUSION: The combined evaluation of INS and TNM stages may allow for more accurate prognostication.

DOI： 10.21873/anticanres.17382

PubMed

PubMed

PubMed

PubMed

PubMed

症例は99歳,女性。便通異常,血便を認めたため前医を受診し,直腸癌と診断された。PSは1で,認知機能の低下は認めなかった。下部消化管内視鏡検査では,直腸Rbに半周性の2型腫瘍を認めた。精査の結果,直腸癌,cT2N0M0,Stage Iと診断した。心電図,心臓超音波検査,呼吸機能検査を行い,循環器内科,麻酔科と協議の上,耐術は可能と判断し,ロボット支援下直腸低位前方切除術(ハルトマン手術)を施行した。術後経過は良好であり,術後9日目に自宅退院となった。退院後1ヵ月の時点でADLの低下はなく,ストマ管理を除けば術前と同等の生活を営むことができている。高齢者は全身状態,様々な併存疾患によりハイリスクな手術となることが多いため,耐術能の評価,合併症のリスク,術後のQOL維持,根治性などを総合的に判断し,手術適応,術式を決定しなければならない。今回われわれは,超高齢の直腸癌患者に対して安全にロボット支援下手術を施行し得たため報告する。(著者抄録)

DOI： 10.18888/op.0000004161

CiNii Research

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Anastomotic-leakage incidence has been reported to be reduced on using polyglycolic acid (PGA) sheets as reinforcing materials; however, there is insufficient evidence regarding the reinforcement mechanism. Therefore, we investigated effects of PGA sheets on gastrointestinal anastomoses in rats. In the first approach, five rats underwent laparotomy; the PGA sheet was pasted onto the normal cecal wall. After five days, the cecum was removed and histologically evaluated. In the second approach, ten rats were randomly divided into two groups of five animals each. The rats underwent laparotomy; the cecal wall was sutured after a full-thickness incision. In the PGA group, a PGA sheet was used to cover the suture area. After 5 days, the cecum was removed, and the physical pressure resistance was evaluated. We confirmed the growth of a fibrous capsule measuring 855 (648-1048) µm outside the cecal serosa in the first approach. The median pressure resistance in the second approach was 57.0 (45.0-90.0) and 90.0 (82.5-94.5) mmHg in Control and PGA groups, respectively. The pressure resistance was significantly higher in the PGA group (p = 0.046). In summary, the PGA sheet may form a barrier of fibrosis on the intestinal wall and provide reinforcement to prevent anastomotic leakage.

DOI： 10.1038/s41598-024-77894-6

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

In later-line treatment of metastatic colorectal cancer (mCRC), there may be large differences in treatment efficacy depending on cancer cachexia. Recently, the cachexia index (CXI), which was calculated from the skeletal muscle mass index (SMI), serum albumin concentration, and neutrophil-to-lymphocyte ratio, was developed to evaluate cancer cachexia. We retrospectively examined the CXI of 80 patients who were treated with trifluridine/thymidine phosphorylase inhibitor (FTD/TPI) + bevacizumab (Bmab) therapy as a later-line treatment for mCRC, and assessed the impact of cancer cachexia on chemotherapeutic efficacy using CXI. Progression-free and overall survival rates were significantly worse in the low CXI group than in the high CXI group, although there were no marked differences in tumor factors, such as the number of metastatic organs or gene mutations, between the two groups. As the cross-sectional area of the iliopsoas muscle was significantly associated with that of the skeletal muscle, the accuracy of the CXI based on the psoas mass index (P-CXI), which is easier to calculate than the SMI, in predicting treatment outcomes was equivalent to that of the CXI based on the SMI (S-CXI). Cancer cachexia is an important factor related to treatment efficacy in later-line treatments, such as FTD/TPI + Bmab therapy.

DOI： 10.1038/s41598-024-77766-z

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

DOI： 10.1007/s10151-024-03014-1

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Rectal gastrointestinal stromal tumors (GISTs) complicate surgical approaches because of their anatomical position. We herein report a patient with rectal GIST on the anterior wall of the lower rectum, hat was successfully resected using a transperineal approach. CASE PRESENTATION: This report describes a unique case of a 73-year-old man who was diagnosed with rectal GIST on the anterior wall of the lower rectum. The tumor was located within 3 cm of the anal verge, a location that would require highly invasive surgery. A transperineal approach was planned to preserve the anal function. Under general anesthesia, the patient was placed in a lithotomy position and a Mercedes-Benz incision was made in the perineum. Excision of the tumor was performed. The post-operative course was uneventful, and the patient remained free from recurrence. CONCLUSION: This case highlights the importance of performing minimally invasive and safe surgery. With some surgical refinements, a transperineal approach may be an option for surgical procedures in patients with rectal GIST on the anterior wall of the lower rectum.

DOI： 10.1186/s40792-024-02007-4

PubMed

症例は73歳男性で、MRIで直腸腫瘤が偶然見つかり、精査加療目的で当院紹介となった。指診により、肛門縁から3cmの直腸前壁に小さい腫瘤が認められた。大腸内視鏡検査および経直腸的超音波検査では、直腸前壁に正常な粘膜隆起が認められた。腫瘤は直径28mmで、境界明瞭であった。腹部造影CTでは、直腸前壁に内部石灰化や出血成分を伴わない均一な造影効果を示す腫瘤が認められた。腫瘍は比較的小さく、周囲組織への浸潤がみられないため、経会陰アプローチによる腫瘍切除を行なった。全身麻酔下で患者を左側臥位とし、会陰部にメルセデス・ベンツ切開を加えて、腫瘍を切除した。手術時間は158分で、切除腫瘍は弾性硬の34×29×24mmの充実性腫瘤であった。病理組織学的検査により消化管間質性腫瘍と診断した。術後経過は良好で、術後6日目に食事を再開し、術後16日目に退院した。2年間の経過観察中、局所再発や遠隔転移は認められなかった。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Nivolumab plus ipilimumab combination therapy has been administered as a first-line treatment in Japan since 2022 for patients with unresectable progressive or recurrent esophageal cancer. The efficacy and safety of this immune checkpoint inhibitor (ICI) doublet therapy are now being evaluated, and it is necessary to identify populations that benefit from this treatment at an early phase after initiation. For patients not showing early benefit, changing as soon as possible to other therapeutic strategies could improve their survival outcomes. Therefore, we attempted to identify decision-making factors such as early tumor shrinkage (ETS) based on treatment experience with ICI doublet therapy. METHODS: The study included 19 patients who received nivolumab plus ipilimumab for non-surgically indicated or recurrent esophageal cancer between July 2022 and November 2023. Tumors were assessed approximately every 2 months after treatment initiation. The effects of ETS, depth of response (DpR), and clinicopathologic features, including immune-related adverse events (irAEs), on progression-free and overall survival were evaluated using Kaplan-Meier plots and Cox proportional hazard models. RESULTS: The mean duration of ICI doublet administration was 5.89 months (range, 1-16 months). At first evaluation, patients who exhibited no tumor progression &gt;20% indicated possible response to ICI doublet therapy, and patients whose tumors shrank even minimally exhibited favorable progression-free survival. Higher DpR at any cut-off line exhibited better progression-free survival than those with lower DpR. Fifteen patients experienced irAEs, with 13 of these patients experiencing irAEs within 3 months of treatment initiation. irAEs were associated with the efficacy of ICI doublet therapy, but efficacy could not be predicted based on early irAE experience. CONCLUSION: ETS-high, DpR-high, and irAEs might be associated with favorable responses to nivolumab plus ipilimumab. As a predictor of efficacy at an early phase, ETS &gt;0% could be a deciding factor for continuing ICI doublet therapy.

DOI： 10.1159/000540851

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

The early mechanisms of spontaneous tumor initiation that precede malignancy are largely unknown. We show that reduced aPKC levels correlate with stem cell loss and the induction of revival and metaplastic programs in serrated- and conventional-initiated premalignant lesions, which is perpetuated in colorectal cancers (CRCs). Acute inactivation of PKCλ/ι in vivo and in mouse organoids is sufficient to stimulate JNK in non-transformed intestinal epithelial cells (IECs), which promotes cell death and the rapid loss of the intestinal stem cells (ISCs), including those that are LGR5+. This is followed by the accumulation of revival stem cells (RSCs) at the bottom of the crypt and fetal-metaplastic cells (FMCs) at the top, creating two spatiotemporally distinct cell populations that depend on JNK-induced AP-1 and YAP. These cell lineage changes are maintained during cancer initiation and progression and determine the aggressive phenotype of human CRC, irrespective of their serrated or conventional origin.

DOI： 10.1016/j.devcel.2024.05.001

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: In colorectal cancer surgery, the risk of surgical site infection (SSI) is relatively high. The development of SSI is related to longer and costlier hospitalization and reduced quality of life; therefore, perioperative prevention of SSI is important. Chemical bowel preparation (CBP) combined with mechanical bowel preparation (MBP) may be more effective in preventing surgical site infection (SSI) compared to MBP alone. Since May 2021, we have been administering oral kanamycin and metronidazole as CBP, in addition to MBP, as a preoperative treatment for colorectal cancer surgery on the day before surgery. In this study, we investigated the clinical value of CBP in addition to MBP in colorectal cancer surgery using propensity score matching (PSM). PATIENTS AND METHODS: From January 2017 to December 2021, 136 consecutive patients underwent radical surgery for sigmoid colon and rectal cancer at the Osaka Metropolitan University Hospital. Patients were divided into two groups: CBP and N-CBP. In the N-CBP group, we performed only preoperative MBP, whereas in the CBP group, we performed preoperative CBP in addition to MBP. We retrospectively analyzed this relationship with PSM. RESULTS: Overall, 46 patients underwent preoperative CBP and MBP, 90 patients underwent preoperative MBP only. PSM was performed between the CBP and N-CBP groups based on the following ten factors: age, sex, diabetes mellitus, preoperative therapy, Glasgow Prognostic Score (GPS), operative time, blood loss, stoma, and pathological stage. After PSM, univariate and multivariate analyses of the relationship between SSI and clinicopathological factors were performed. Univariate analysis showed that age and CBP were correlated with the rate of SSI (p=0.039 and p=0.017, respectively), whereas sex was relatively correlated with the rate of SSI (p=0.066). The multivariate analysis of significant factors identified age of 75 or more and non-CBP as an independent risk factor for incisional SSI (HR=9.5; p=0.049 and HR=5.4×e-8; p=0.020). CONCLUSION: Preoperative CBP in addition to MBP was effective in preventing incisional SSI during colorectal cancer surgery.

DOI： 10.21873/anticanres.17167

PubMed

International / domestic magazine：International journal  

DOI： 10.1111/codi.16988

PubMed

症例は44歳,女性.5年前から左季肋部の腫瘤を自覚も放置していたが,半年前からの腫瘤の増大および左下腹部痛を自覚し,受診した.腹部造影CTにて腫瘍は腹腔内左側,膵臓の尾側,左腎の腹側に位置し膵臓は頭側に圧排されていたが,境界は明瞭であった.診断は未確定であったが,腫瘍が増大傾向で悪性腫瘍も否定できず,診断的摘出術を施行した.開腹所見では,腫瘍はTreitz靱帯から直ぐの小腸粘膜下から発生し,間膜内さらに膵下縁の後腹膜内に進展していた.他臓器を損傷することなく,腫瘍および小腸部分切除を行った.再建は空腸を横行結腸背側で挙上し,十二指腸下降脚とoverlap吻合を行った.病理組織診断で管外発育型空腸平滑筋腫と診断した.術後経過は問題なく.術後14日目に軽快退院となった.腹腔内腫瘤はその鑑別に難渋し,術前の確定診断は困難で診断的摘出術を行うことも多い.さらに,管外発育型空腸腫瘤は無症状で経過することが多いため,比較的大きな腫瘤として見つかることが多い.今回われわれは,左季肋部腫瘤を契機に発見された空腸巨大平滑筋腫を経験したので報告する.(著者抄録)

Crohn病の消化管穿孔の頻度は約1.3%～4.0%と低く,消化管穿孔を契機にCrohn病関連大腸癌と診断された症例は極めて稀である.今回われわれは,Crohn病の消化管穿通を契機に発見されたCrohn病関連大腸癌の1例を経験したため報告する.症例は38歳,男性.12歳時に小腸大腸型Crohn病と診断され,以後免疫調整薬・抗TNFα抗体製剤投与で病状は安定していた.2022年,発熱および左側腹部痛を主訴に当院救急外来を受診した.血液検査で炎症反応の上昇を認め,腹部単純CTで下行結腸背側に軟部影および脂肪織濃度の上昇を認め,Crohn病増悪に伴う下行結腸穿通および膿瘍形成と診断した.保存的治療に改善後,腹腔鏡下下行結腸切除術を施行した.病理組織検査で粘液癌(pT3,Nx,H0,P0,M0)と診断し,下行結腸穿通の原因はCrohn病関連大腸癌によるものと考えられた.術後は補助化学療法を施行後13ヵ月経過した現在,再発を認めていない.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

Connective tissue growth factor (CTGF) is a target gene of the Hippo signaling pathway. Its differential role in the histological types of gastric cancer (GC) remains unknown; therefore, the present study aimed to confirm the clinical significance of CTGF expression in cancer and stromal cells in patients with GC depending on the histological type. The present study enrolled 589 patients with GC. Immunohistochemistry was used to analyze CTGF expression in cancer and stromal cells. CTGF mRNA expression data and the corresponding clinical information of GC samples were collected from The Cancer Genome Atlas (TCGA) database. Subsequently, the associations between CTGF expression and several clinicopathological factors were investigated. In the present study, CTGF expression was mainly observed in the cytoplasm of cancer and stromal cells. CTGF expression in stromal cells was significantly associated with CTGF expression in cancer cells (P<0.001). CTGF positivity in stromal cells was also significantly associated with intestinal type, non-scirrhous type, tumor depth (T1-2), lymph node metastasis (negative), lymphatic invasion (negative) and tumor size (<5 cm). Low CTGF expression in stromal cells was independently associated with worse overall survival (OS). Furthermore, the OS of patients with low CTGF expression in stromal cells, especially in patients with diffuse-type GC, was significantly worse than patients with high CTGF expression (P=0.022). This trend was similar to that revealed by TCGA data analysis. In conclusion, low CTGF expression was associated with a significantly worse OS in patients with diffuse-type GC. These data indicated that CTGF, and its control by the Hippo pathway, may be considered potential treatment targets in diffuse-type GC.

DOI： 10.3892/ol.2024.14374

PubMed

DOI： 10.18888/op.0000003907

CiNii Research

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: For patients with gastric cancer, a well-balanced treatment that considers both oncological aspects and surgical risk is demanded. This study aimed to explore the optimal extent of lymph node dissection (LND) for patients with gastric cancer according to surgical risk, stratified by the risk calculator system produced by the Japan National Clinical Database (NCD). PATIENTS AND METHODS: We retrospectively evaluated 187 patients who underwent radical gastrectomy for gastric cancer. Using the median predicted anastomotic leak rate obtained by the NCD risk calculator as the cutoff value, we classified 97 and 90 patients as having high and low risks, respectively. RESULTS: In low-risk patients, although limited LND reduced the postoperative intraabdominal infectious complications (IAIC), multivariate analysis revealed standard LND as an independent prognostic factor that improved Relapse-free survival (RFS). In high-risk patients, the rates of postoperative IAIC and RFS were similar between standard and limited LND. Pancreatic fistula was not observed in the limited dissection group. CONCLUSION: Limited LND might be the optimal treatment strategy for patients with gastric cancer with high surgical risk.

DOI： 10.1002/wjs.12117

PubMed

64歳女性。貧血と便潜血陽性を主訴とした。下部消化管内視鏡検査、造影CT検査および生検結果より、腸回転異常症を伴う横行結腸癌と診断された。本症例は術中に腹腔内超音波検査を併用して主栄養動脈および流出静脈を同定することで、安全に腹腔鏡下横行結腸切除術を行うことができた。術後は合併症なく第9病日に自宅退院となり、術後2年経過現在、再発はみられていない。

症例は57歳,女性.血便を主訴に受診し,直腸RS-Raに半周性の1型腫瘤を認めた.生検結果から直腸低分化型腺癌と診断し,腹腔鏡下直腸低位前方切除術を施行した.切除標本では,腫瘍は粘膜側より発生し,病理組織学的に,壊死組織およびN/C比の高い多形な異型細胞を認めた.また,腫瘍はvimentin・Ki-67の免疫染色で陽性を示したが,上皮性マーカー・血球表面マーカーを含むその他の免疫染色マーカーは全て陰性であった.本腫瘍は間葉性マーカーのみ陽性で,腫瘍形態は未分化多形肉腫様であるが,軟部組織ではなく粘膜側を主座とした腫瘍と考えられた.そのため確定診断に難渋したが,最終的に粘膜上皮より発生した分類不能/未分化肉腫(未分化多形肉腫)と診断した.術後2年4ヵ月現在,再発や転移なく経過している.(著者抄録)

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND: Robotic-assisted surgery is steadily becoming more prominent. The majority of reports regarding port site hernias (PSHs) have involved laparoscopic procedures. Currently, it is common to suture the fascia at port sites that are 10 mm or larger; however, the closure of 5-mm port sites is not considered mandatory. The da Vinci® surgical system (Intuitive Surgical Inc., Sunnyvale, CA, USA) utilizes a distinctive 8-mm port. We report a case of an early-onset PSH at an 8-mm port site after robotic-assisted ileocecal resection. CASE PRESENTATION: A 74-year-old male patient with a body mass index of 19.7 kg/m2 was diagnosed with cecal cancer and underwent robotic-assisted ileocecal resection. A 3-cm midline incision was made at the umbilicus for insufflation. Under laparoscopic visualization, three ports (12 mm, 8 mm, and 8 mm) were inserted in the lower abdomen. An 8-mm port was inserted in the left subcostal region, and a 5-mm port was inserted in the left lateral abdomen. The procedure was performed without significant intraoperative complications. The fascia was closed only at the umbilicus and 12-mm port site; the fascia at the 8-mm port sites was not closed. The patient was initially discharged without complications; however, on postoperative day 11, the patient was urgently hospitalized again because of PSH incarceration. After manual reduction, the fascia was sutured closed under local anesthesia. The hernial defect was small and barely allowed the insertion of a little finger. There was no evidence of compression or significant damage to the fascia. On postoperative day 27, the patient was discharged after experiencing good recovery. CONCLUSIONS: Robotic-assisted colectomy could contribute to the risk of PSHs because of its surgical characteristics. Although routine closure of the fascia at 8-mm port sites is not mandatory, it may be beneficial in certain cases.

DOI： 10.1186/s40792-024-01878-x

PubMed

症例は74歳男性。BMI 19.7kg/m2で2型糖尿病であった。回盲弁周囲に皮下隆起性の病変を認め、各種検査でがんが示唆された。腫瘍は回腸まで進行しており内視鏡治療は困難であったため、手術目的で当科紹介となった。盲腸癌(cT1N0M0 cStage I)との診断でロボット支援回盲部切除術を施行した。臍部に3cmの正中切開を加えた後、気腹を行い、腹腔鏡視下に3つのポート(12mm、8mm、8mm)を下腹部に挿入した。8mmのポートは左肋軟骨下部に、5mmのポートは左側腹部に挿入した。術中、重大な合併症はみられなかった。筋膜は臍部と12mmポート部位のみ閉鎖し、8mmポート部位の筋膜は閉鎖しなかった。総手術時間は127分で、出血は最小限であり、病理組織診断は管状腺癌(高分化型)であった。当初は合併症がみられず退院したが、術後11日目にポートサイトヘルニアのため緊急再入院となった。用手整復後、局所麻酔下で筋膜を縫合閉鎖した。ヘルニア欠損部は小さく、小指をようやく挿入できる程度であった。筋膜の圧迫や重大な損傷はみられず、術後27日目に退院した。

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSES: Subtotal esophagectomy for esophageal cancer (EC) is associated with high morbidity rates. Tight glycemic control using an artificial pancreas (AP) is one of the promising strategies to reduce postoperative inflammation and morbidities. However, the effects of tight glycemic control using AP in patients with EC are yet to be fully elucidated. METHOD: This study reviewed 96 patients with EC who underwent subtotal esophagectomy. The postoperative inflammation parameters and morbidity rates were compared between patients who used the AP (n = 27) or not (control group, n = 69). AP is a closed-loop system that comprises a continuous glucose monitor and an insulin pump. RESULTS: The numbers of white blood cells (WBC) and Neutrophils (Neut) were noted to be lower in the AP group than in the control group, but with no significant difference. The ratio in which the number of WBC, Neut, and CRP on each postoperative day (POD) was divided by those tested preoperatively was used to standardize the results. The ratio of WBC and Neut on 1POD was significantly lower in the AP group than in the control group. The rate of surgical site infection was lower in the AP group than in the control group. CONCLUSION: AP significantly decreased WBC and Neut on 1POD; this suggests the beneficial effects of AP in alleviating postoperative inflammation.

DOI： 10.1186/s12893-024-02365-8

PubMed

<p>A 44-year-old woman presented to our hospital with a mass in the left hypochondriac region that had been present for the past 5 years, with an increase in the mass with pain over the past 6 months. Enhanced computed tomography of the abdomen revealed a tumor located on the left side of the abdominal cavity, caudal to the pancreas and ventral to the left kidney. The pancreas was compressed to the cephalad region and the boundaries were clear. Because the tumor showed an increasing tendency and a possibility of malignancy could not be ruled out, diagnostic resection was performed. Laparotomy showed that the tumor had arisen from the small bowel wall as a submucosal tumor near the Treitz ligament and extended to the retroperitoneum at the inferior border of pancreas. Without damaging other organs, we performed tumor removal with partial resection of the small intestine. The jejunum was lifted on the dorsal aspect of the transverse colon and an overlap anastomosis with the descending part of duodenum was done. The histopathological diagnosis was leiomyoma of the extra-tubular growth type. The postoperative course was uneventful and the patient was discharged from the hospital on the 14th postoperative day. Diagnostic resection is often performed for intra-abdominal masses because a definitive diagnosis is a challenge before surgery. Most jejunal masses are clinically silent for a long time and are often detected when they grow large. We encountered a case of a giant leiomyoma with extra-tubular growth type presented with a mass in the left hypochondriac region.</p>

DOI： 10.3919/jjsa.85.915

CiNii Research

<p>A 57-year-old woman was referred to the hospital due to hematochezia. Colonoscopy showed a 50-mm tumor at the rectum above the peritoneal reflection. Computed tomography and magnetic resonance imaging also showed the tumor at the posterior wall of the rectum. It was diagnosed as a poorly differentiated adenocarcinoma, after which laparoscopic low anterior resection was performed. The tumor appeared to arise from the mucosal epithelium, and histopathological examination showed necrotic tissue and pleomorphic atypical cells. On immunostaining, only vimentin and Ki-67 were positive, but epithelial markers and surface markers of blood cells were negative. In this case, only a mesenchymal marker was positive, and the tumor cells resembled undifferentiated pleomorphic sarcoma. However, undifferentiated pleomorphic sarcoma is a soft tissue tumor, and it has never been previously reported that undifferentiated pleomorphic sarcoma of the colon or rectum arose from mucosal epithelium. Therefore, the diagnosis was undifferentiated pleomorphic sarcoma in undifferentiated/unclassified sarcoma arising from mucosal epithelium. The patient is alive 2 years and 4 months later without recurrence or metastasis.</p>

DOI： 10.3919/jjsa.85.646

CiNii Research

<p>The patient, a 38-year-old man, was diagnosed with Crohn's disease at the age of 12 years. Since then, he had been treated with immunomodulators and anti-TNF-alpha antibody preparations, and his condition had been stable. He presented to the emergency department of the hospital with a chief complaint of fever and left-sided abdominal pain. When he came to our hospital, he had a fever (38.8 °C) and tenderness localized to the left side of the abdomen, but there was no evidence of peritoneal irritation. Blood hematological and biochemical tests showed an elevated inflammatory response. Simple computed tomography (CT) of the abdomen showed soft tissue shadows and increased fat stranding in the dorsal descending colon, and a diagnosis of perforation of the descending colon and abscess formation due to exacerbation of Crohn's disease was made. The patient's general condition was stable, and conservative treatment with fasting and antimicrobial agents was started. After the inflammatory response improved, a laparoscopic descending colon resection was performed. The patient had an uncomplicated postoperative course. The final histopathological result was mucinous carcinoma, pT3N0M0, pStage IIa. Two months after surgery, he underwent adjuvant chemotherapy for descending colon cancer.</p>

DOI： 10.3919/jjsa.85.940

CiNii Research

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: The adoption of intracorporeal anastomosis in minimally invasive surgery for colon cancer has gradually expanded owing to its many advantages. However, intracorporeal anastomosis has the disadvantage of a longer operative time than extracorporeal anastomosis. One reason that intracorporeal anastomosis takes longer to perform is the closure of the common enterotomy. The present study evaluated the effect of bidirectional barbed sutures on the duration of common enterotomy closure in intracorporeal anastomosis for minimally invasive colectomy. MATERIALS AND METHODS: The time required for common enterotomy closure was measured with a simulator using an intestinal model. A two-layer suture with continuous full-thickness suture followed by a continuous serosal-muscular suture was adopted. The time required to close the common enterotomy using two unidirectional barbed sutures and one bidirectional barbed suture was measured five times each. RESULTS: The duration of common enterotomy closure using bidirectional barbed suture was significantly shorter than that using two conventional barbed sutures. CONCLUSION: Bidirectional barbed sutures are useful for closing the common enterotomy in intracorporeal anastomosis for minimally invasive colectomy.

DOI： 10.21873/invivo.13418

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

PURPOSE: To examine the molecular biological differences between conjunctival mucosa-associated lymphoid tissue (MALT) lymphoma and orbital MALT lymphoma in ocular adnexa lymphoma. METHODS: Observational case series. A total of 129 consecutive, randomized cases of ocular adnexa MALT lymphoma diagnosed histopathologically between 2008 and 2020.Total RNA was extracted from formalin-fixed paraffin-embedded tissue from ocular adnexa MALT lymphoma, and RNA-sequencing was performed. Orbital MALT lymphoma gene expression was compared with that of conjunctival MALT lymphoma. Gene set (GS) analysis detecting for gene set cluster was performed in RNA-sequence. Related proteins were further examined by immunohistochemical staining. In addition, artificial segmentation image used to count stromal area in HE images. RESULTS: GS analysis showed differences in expression in 29 GS types in primary orbital MALT lymphoma (N=5,5, FDR q-value <0.25). The GS with the greatest difference in expression was the GS of epithelial-mesenchymal transition (EMT). Based on this GS change, immunohistochemical staining was added using E-cadherin as an epithelial marker and vimentin as a mesenchymal marker for EMT. There was significant staining of vimentin in orbital lymphoma (P<0.01, N=129) and of E-cadherin in conjunctival lesions (P=0.023, N=129). Vimentin staining correlated with Ann Arbor staging (1 versus >1) independent of age and sex on multivariate analysis (P=0.004). Stroma area in tumor were significant difference(P<0.01). CONCLUSION: GS changes including EMT and stromal area in tumor were used to demonstrate the molecular biological differences between conjunctival MALT lymphoma and orbital MALT lymphoma in ocular adnexa lymphomas.

DOI： 10.3389/fonc.2024.1277749

PubMed

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

BACKGROUND/AIM: The present study examined the impact of circular stapler size on anastomotic complications, including leakage and stricture in patients undergoing double-stapling technique (DST) anastomosis for left-sided colon or rectal cancer. PATIENTS AND METHODS: A total of 403 patients were enrolled in this study, with circular stapler sizes  of 25, 28, and 29 mm. RESULTS: A small circular stapler (25 mm) was used in 170 cases (42.2%), and a medium-sized circular stapler (28/29 mm) was used in 233 cases (57.8%). After propensity score matching, there was no marked difference in the incidence of anastomotic leakage/stricture between the groups (13.9% vs. 10.9%, 3.0% vs. 1.0%, respectively). CONCLUSION: The size of the circular stapler was not associated with the incidence of anastomotic leakage or stricture in this cohort.

DOI： 10.21873/cdp.10356

PubMed

DOI： 10.1200/JCO.2024.42.3_suppl.411

Publishing type：Research paper (scientific journal)   International / domestic magazine：International journal  

INTRODUCTION: Reexposure to anti-EGFR antibodies, such as a reintroduction or rechallenge with anti-EGFR antibodies, has attracted much attention in the field of metastatic colorectal cancer. A reintroduction of anti-EGFR antibodies often shows good therapeutic outcomes, as most patients eligible for such reintroduction discontinued treatment due to adverse events despite a good treatment response during front-line treatment. We herein report a case demonstrating an improvement in exertional dyspnea after the reintroduction of anti-EGFR antibody in a patient with metastatic rectal cancer who developed cancerous lymphangiopathy. CASE PRESENTATION: A 68-year-old man who had undergone curative surgery for stage IIIB rectal cancer was diagnosed with multiple lung metastases. During the late-line treatment, respiratory failure developed because of multiple lung metastases and cancerous lymphangiopathy. Two months after the initiation of irinotecan + cetuximab, which had been discontinued due to acneiform eruptions despite a good treatment response as a first-line treatment, his dyspnea and performance status dramatically improved. CONCLUSION: This case indicates that the reintroduction of anti-EGFR antibody to patients who have discontinued anti-EGFR antibody due to skin toxicity despite a good treatment response is a very useful treatment option for metastatic colorectal cancer.

DOI： 10.1159/000538235

PubMed