Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Ulcerative colitis-associated neoplasia (UCAN) harbors unique genetic alterations and mutational tendencies. The clinical application of gene panel testing enables precision medicine by tailoring treatment to individual gene alterations. We hypothesized that gene panel testing may detect clinically important genetic alterations in UCAN, with potential usefulness for the diagnosis and treatment of UCAN. In the present study, gene panel testing was used to identify genetic alterations in UCAN, and the possibility of clinical utility of gene panel testing in UCAN was investigated. The present study included 15 patients with UCAN, and gene panel testing was performed to identify genetic alterations associated with diagnosis and treatment. Genetic alterations of UCAN were compared with those of 203 patients with sporadic colorectal cancer (CRC). APC and PTEN mutations were less frequent, while RNF43 frameshift or nonsense mutations were more frequent in UCAN compared with sporadic CRC. TP53 mutations were identified in 13/15 patients (87%) with UCAN. Notably, 4/15 patients (27%) with UCAN had no genetic alterations other than TP53 mutation, while this occurred in 1/203 patients (0.5%) with sporadic CRC (P<0.001). Microsatellite instability-high was identified in 2/15 patients (13%) with UCAN. Mutational signature 3, which is associated with homologous recombination deficiency, was detected in 14/15 patients (93%) with UCAN, and enriched in UCAN compared with sporadic CRC (P=0.030). In conclusion, gene panel testing can detect important genetic alterations that can be useful for diagnosis and treatment in UCAN, and may provide clinicians with important information for tailored treatment strategies.

DOI： 10.3892/ol.2022.13562

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Elmer Press, Inc.  

DOI： 10.14740/wjon1530

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A woman in her 60s had been aware of perianal erosions for 1 month. Skin biopsy showed Paget's cells in the stratified squamous epithelium, and immunohistochemistry showed negative staining for CK7 and positive staining for CK20. Colonoscopy revealed well-differentiated adenocarcinoma in the anal canal. Computed tomography showed neither regional lymph node metastasis nor distant metastasis. Hence, she was diagnosed with anal canal carcinoma with pagetoid spread. We determined the extent of resection of the skin lesion preoperatively by mapping biopsy, and performed laparoscopic abdominoperineal resection. The pathological findings revealed adenocarcinoma(tub1, tub2), and the skin resection margin was negative. Immunohistochemistry for Paget's cells in the stratified squamous epithelium showed negative staining for GCDFP-15 and CK7, and positive staining for CK20. Twenty-four months after surgery, we detected right inguinal lymph node metastasis and performed right inguinal lymphadenectomy. As of 4 months after the lymphadenectomy, no local recurrence or distant metastasis has been detected during follow-up examinations.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 71-year-old man with middle thoracic esophageal cancer was treated with neoadjuvant chemotherapy using docetaxel plus 5-FU plus cisplatin therapy and was also administered pegfilgrastim. Blood tests showed elevated white blood cell counts and C-reactive protein levels before the start of the third course. Contrast-enhanced computed tomography revealed wall thickening of the aortic arch. We diagnosed this as aortitis due to pegfilgrastim. Inflammation was improved with conservative treatment. We then performed video-assisted thoracoscopic esophagectomy. Drug-induced vasculitis should be included in the differential diagnosis of patients with elevated inflammation markers of unknown cause following the administration of granulocyte colony-stimulating factor preparations.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

The patient was a 71-year-old man with a diagnosis of duodenal carcinoma. Abdominal computed tomography(CT) showed no distant metastasis, and he underwent subtotal stomach-preserving pancreaticoduodenectomy. Postoperative adjuvant chemotherapy was not administered. A left supraclavicular lymph node recurrence was detected on CT 15 months after surgery. Capecitabine and oxaliplatin(CAPOX)therapy was administered and the metastatic lesion shrank. Positron emission tomography(PET)-CT showed no lesions at other sites and left cervical lymph node dissection was performed 5 months after the recurrence. Postoperative adjuvant therapy with S-1 was administered for 6 months. However, 2 years and 10 months after the first recurrence, CT showed recurrence in the left supraclavicular lymph node. CAPOX therapy was resumed, but due to an allergic reaction to oxaliplatin, the patient was treated with capecitabine alone. The recurrent lesion was gradually increased in size, and FOLFIRI therapy was introduced. One year and 5 months after secondary recurrence, PET-CT showed that the second recurrent lesion had grown but was confined to the left supraclavicular lymph node, so radiation therapy(60 Gy)to the left neck was performed. The disease was stable for about 10 months and chemotherapy could be discontinued. The lesion increased in size thereafter, and the patient died 7 years after initial surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 74-year-old man presented to our hospital with a mass in the left supraclavicular fossa. He was diagnosed with advanced gastric cancer with liver metastasis and left supraclavicular and para-aortic lymph node metastasis, cT3N2M1 (LYM, HEP), cStage Ⅳ(the Union for International Cancer Control, TNM 7th edition). He received a total of 3 courses of S- 1 plus cisplatin therapy. Since he developed adverse reactions such as anorexia, renal dysfunction, and thrombocytopenia and the tumor was HER2-positive, he received 25 courses of capecitabine, cisplatin, and trastuzumab chemotherapy. Three years and 2 months after the first chemotherapy, remarkable tumor reduction was observed. The patient then underwent radical distal gastrectomy with D2 lymphadenectomy, and R0 resection was achieved. The histopathological diagnosis was ypT1aN0M0, ypStage ⅠA. Chemotherapy with trastuzumab may improve the long-term prognosis of HER2-positive Stage Ⅳ gastric cancer if the disease is controlled and radical resection can be achieved.

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Gastric cancer is a Lynch syndrome (LS)-associated tumor, with the cumulative lifetime risk in LS patients estimated to be 5.8-13%. Hence, surveillance for gastric cancer is important for LS patients, especially in those with a family history of gastric cancer or of Asian descent. We report a very rare case of a LS patient who showed gastric metastasis from jejunal adenocarcinoma curatively resected 8 years prior. A 79-year-old female was diagnosed with a synchronous gastric submucosal tumor (SMT) and right-sided colon cancer. She was referred to our hospital as she and her family had histories of LS-associated tumors. She underwent curative intent surgery for the tumors. Postoperative histopathological examination revealed the gastric SMT was an adenocarcinoma completely covered by non-neoplastic gastric mucosa. Immunohistochemical analyses showed the gastric SMT had the same expression pattern for CDX2, cytokeratins 7 and 20 as the jejunal adenocarcinoma. Thirty-four months after surgery the patient is alive without recurrence or any other LS-associated tumors. To the best of our knowledge, this is the first report of gastric metastasis from small bowel adenocarcinoma in a LS patient. Awareness of this case may be important for gastric cancer surveillance in LS patients.

DOI： 10.1007/s12328-022-01625-5

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Language：Japanese   Publisher：(一社)日本遺伝カウンセリング学会  

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Language：Japanese   Publisher：新潟医学会  

【目的】消化器外科術後に発症した播種性血管内凝固(disseminated intravascular coagulation;以下,DICと略記)に対する遺伝子組み換えトロンボモジュリン(recombinant human soluble thrombomodulin;以下,rTMと略記)の効果を検証し,治療成績改善に向けた方策を考察する.【方法】2016年1月から2021年5月に当科で消化器外科術後DICの改善を目的にrTMが投与された48例を対象とした.対象症例におけるDICの改善効果,および在院死亡の危険因子を検証した.DICの診断には,日本救急医学会の急性期DIC診断基準を使用した.患者背景および検査項目に関する2群間のカテゴリー変数の比較にはPearsonのχ2検定,Fisherの直接法を用いた.多変量解析はstepwise法によるロジスティック回帰分析を用いて行った.生存曲線はKaplan-Meier法で算出し,log rank検定で有意差検定を行った.有意水準5%(P<0.05)をもって有意差ありと判断した.【結果】年齢の中央値は76歳(59-91),男女比は21:27であった.原疾患は下部消化管穿孔が22例(45.8%),悪性腫瘍が11例(22.9%),消化管虚血が10例(20.8%),上部消化管穿孔が5例(10.4%)であった.DICを発症した原因は,急性汎発性腹膜炎が38例(79.2%),術後感染症が5例(10.4%),術後肝不全が4例(8.3%),術後出血が1例(2.1%)であった.rTM投与開始後7日目に28例(58.3%)で血小板数増加を認め,31例(64.6%)でDICスコアの改善を認めた.投与開始後28日の生存率は72.9%で,在院死亡率は41.7%であった.在院死亡群と生存群における比較では,在院死亡群において「悪性疾患あり」(P=0.034),「DICの原因が術後肝不全」(P=0.025),rTM投与開始時の「血小板数5万/μl未満」(P=0.009),「総ビリルビン2.0mg/dl以上」(P=0.002),rTM投与開始後7日目の「血小板数増加なし」(P=0.001),「DICスコア改善なし」(P=0.003)の占める割合が高かった.多変量解析ではrTM投与開始後7日目の「血小板数増加なし」(HR 5.076:95%CI 1.145-22.222:P=0.032)が独立した在院死亡の危険因子であった.【結語】消化器外科術後に発症するDICは極めて予後不良な病態であるが,rTM投与開始後早期に血小板数の増加を認めた場合,予後の改善を期待できる可能性がある.(著者抄録)

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-022-02466-y

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Language：English   Publishing type：Research paper (scientific journal)  

Neuroendocrine neoplasms of the colon and rectum are colorectal epithelial neoplasms with neuroendocrine differentiation. A platinum regimen used for small cell lung cancer is the currently recommended chemotherapy for gastroenteropancreatic neuroendocrine carcinomas (GEP-NECs), regardless of the organ. The BRAF V600E mutation has been recently reported as a druggable driver mutation in colorectal NECs. In BRAF V600E mutant colorectal cancer, a combination of BRAF inhibitor and anti-epidermal growth factor receptor (EGFR) antibody, with or without a MEK inhibitor, is recommended. Here, we report the case of 77-year-old man who had lymph node recurrence after surgery for primary ascending colonic NEC. Two cytotoxic regimens, cisplatin plus irinotecan and modified FOLFOX6, were administered as first- and second-line chemotherapies with no remarkable response observed. At this point, genetic analysis confirmed the tumor harbored a BRAF V600E mutation. Thus, a regimen of BRAF inhibitor plus anti-EGFR antibody was administered. After commencing this regimen, carcinoembryonic antigen levels decreased within normal range, and there was dramatic shrinkage of the lymph node metastases observed by chest and abdominal computed tomography scans. To our knowledge, this is the first reported case of a colorectal NEC responding to a BRAF inhibitor and anti-EGFR antibody.

DOI： 10.1007/s12328-022-01599-4

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 72-year-old man had a chief complaint of anal pain and difficulty in defecation. He was diagnosed with adenocarcinoma by biopsy from a tumor of the anal canal. A computed tomography scan revealed neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa anal canal cancer. Preoperative capecitabine- based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. Digital rectal examination and imaging evaluation 8 weeks after preoperative CRT revealed that the tumor had shrunk. Fifteen weeks after preoperative CRT, laparoscopic abdominoperineal resection was performed. The pathological findings showed mucinous adenocarcinoma associated with anal fistula. At present, 12 months after the operation, no local recurrence and distant metastasis has been detected under follow-up evaluations.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は72歳、男性。肛門痛と排便困難を主訴に来院した。肛門管内に腫瘤を認め、生検で腺癌と診断された。胸腹骨盤部CT検査の結果、遠隔転移を認めず、肛門管癌、cT3N0M0、cStage IIaと診断された。術前化学放射線療法(chemoradiotherapy:CRT)(capecitabine併用、1.8Gy28回、50.4Gy)を施行した。術前CRT8週間後、骨盤部CT検査にて縮小率34%とPR判定であった。術前CRTから15週間後に腹腔鏡下腹会陰式直腸切断術を施行した。病理組織学的診断では、組織型はadenocarcinoma(muc、tub1)であり、肛門周囲皮膚と肛門管重層扁平上皮の境界相当部から直腸粘膜に連続する痔瘻様上皮嵌入部に癌の上皮内病変を認めた。周囲に粘液癌を主体とする浸潤癌を認め、痔瘻癌と診断された。術後12ヵ月となる現在まで無再発生存中である。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20211216370020&doc_link_id=%2Fab8gtkrc%2F2021%2F004812%2F021%2F1515b1517%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004812%2F021%2F1515b1517%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: This study aimed to evaluate how NAD(P)H: quinone oxidoreductase-1 (NQO1) affects survival after hepatectomy in patients with colorectal liver metastasis (CRLM). PATIENTS AND METHODS: A retrospective analysis was conducted of 88 consecutive patients who underwent hepatectomy for CRLM. Of the 88 patients, preoperative chemotherapy was administered to 30 patients. Immunohistochemistry of the resected specimens was conducted using monoclonal anti-NQO1 antibody. RESULTS: NQO1-positive expression in tumor cells of CRLM was associated with worse overall survival (p=0.026) and was an independent adverse prognostic factor in multivariate analysis (hazard ratio=5.296, p=0.007). Among 30 patients who received preoperative chemotherapy, patients with loss of NQO1 expression in non-neoplastic epithelial cells of the bile ducts (NQO1 polymorphism: n=19) showed significantly better response to preoperative chemotherapy for CRLM (p=0.004). CONCLUSION: NQO1-positive expression in tumor cells of CRLM may be an adverse prognostic factor after hepatectomy for CRLM.

DOI： 10.21873/anticanres.14916

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(株)へるす出版  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(株)篠原出版新社  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 72-year-old man was referred to our hospital for treatment for rectal cancer. Digital rectal examination and colonoscopy revealed a 4 cm tumor located at the anterior rectal wall 5 cm away from the anal verge, and pathological examination confirmed that the tumor was adenocarcinoma. A computed tomography scan detected neither regional lymph node metastasis nor distant metastasis. Hence, he was diagnosed with cT3N0M0, cStage Ⅱa rectal cancer. The preoperative general examination revealed bradyarrhythmia and severe emphysema, and he was considered to be high risk for general anesthesia. After placement of a pacemaker, preoperative capecitabine-based chemoradiotherapy(CRT)(50.4 Gy in 28 fractions of 1.8 Gy each)was implemented. The digital rectal examination and imaging evaluation 4 weeks after preoperative CRT revealed that the tumor disappeared, and pathological examination showed no malignant findings. Considering the risks of general anesthesia, the"watch and wait therapy"approach was adopted with sufficient informed consent. At present, 15 months after preoperative CRT, no evidence of regrowth or distant metastasis has been detected under rigorous follow- up evaluations.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は72歳、男性。下血を主訴に来院し、大腸内視鏡検査で肛門縁から5cmの直腸前壁に下縁を有する2型腫瘍を指摘された。生検で高分化管状腺癌であった。術前胸腹骨盤部CT検査の結果遠隔転移は認めず、下部直腸癌、cT3N0M0、cStage IIaと診断された。術前の全身検査で徐脈性心房細動および重症肺気腫を認め、全身麻酔のリスクが高い症例と判断された。ペースメーカー留置後、術前化学放射線療法(CRT)(capecitabine併用、1.8Gy28回、計50.4Gy)を開始した。術前CRT後4週間目の直腸診および画像評価では腫瘍は消失し、生検で悪性所見を認めなかった。十分なインフォームド・コンセントの下、全身麻酔のリスクを勘案し、"watch and wait治療"の方針とした。現在、術前CRT後15ヵ月経過し局所の再増大および遠隔転移を認めず、経過観察を行っている。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600073&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F073%2F1960b1962%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F073%2F1960b1962%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The 9th Japanese Classification of Colorectal Cancer (9th JSCCR) has two main differences from the TNM classification (8th AJCC): first, main or lateral lymph node metastasis is classified as jN3; second, tumor nodules (ND) are treated as lymph node metastasis. In this study, we verified the 9th JSCCR for rectal cancer, focusing on the differences with the 8th AJCC. METHODS: This retrospective analysis involved 212 patients with stage I-III rectal cancer. ND was evaluated using whole-mount sections. We evaluated the relapse-free survival of each staging system, and compared the prognostic significance of the different staging systems using the Akaike information criterion (AIC) and Harrell's concordance index (c-index). RESULTS: Main or lateral lymph node metastasis was detected in nine of 212 (4%) patients. ND was detected in 79 of 212 (37%) patients. The best risk stratification power was observed in the 9th JSCCR (AIC, 759; c-index, 0.708) compared with the 7th JSCCR (AIC, 771; c-index, 0.681), 8th JSCCR (AIC, 768; c-index, 0.696), and the 8th AJCC (AIC, 766; c-index, 0.691). CONCLUSIONS: The 9th JSCCR, which includes the concepts of jN3 and ND, is useful for the risk stratification of rectal cancer, and the contributes to precise decision-making for follow-up management and adjuvant therapy.

DOI： 10.1007/s00595-020-02024-4

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Language：Japanese   Publisher：日本消化器病学会-甲信越支部  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Here, we report about a woman in her 30s who had peritoneal dissemination and multiple colon cancer with high-frequency microsatellite instability(MSI-H). Her father, paternal grandfather, and maternal grandmother had a history of colorectal cancer treatment. Thus, Lynch syndrome was suspected. We performed R0 resection for peritoneal dissemination and subsequent peritoneal dissemination. A 435-gene panel testing using a next-generation sequencer identified MSH2 and other mutations in the tumor. Hence, we speculated that she could have a germline mutation of MSH2, which causes Lynch syndrome. In the future, if she wishes to receive genetic counseling and undergo germline testing for variants to confirm the diagnosis of Lynch syndrome, we will perform them after receiving informed consent.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は30歳代、女性。家族歴は父、父方祖父、母方祖母が大腸癌である。高頻度マイクロサテライト不安定性(high-frequency microsatellite instability:MSI-H)Stage II大腸癌の術後経過観察中に、腹膜播種再発および多発大腸癌を指摘された。現病歴および家族歴からリンチ症候群が疑われたため、当院を紹介された。当院では腹膜播種再発と、その後の腹膜播種再々発に対して2回のR0切除術を施行した。腹膜播種再発の癌組織を用いて、次世代シークエンサーを用いた遺伝子パネル検査を施行したところ、MSH2変異(c.A2211-2G)を認めた。本症例では、生殖細胞系列におけるMSH2変異がリンチ症候群の原因遺伝子変異となり、MSI-H大腸癌の発生に関与している可能性がある。今後は、必要に応じて遺伝カウンセリングや生殖細胞系列の遺伝子変異検査を実施する予定である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20200728400024&doc_link_id=%2Fab8gtkrc%2F2020%2F004707%2F025%2F1113-1115%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004707%2F025%2F1113-1115%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

症例は68歳,男性.慢性腎不全による高カリウム血症に対しポリスチレンスルホン酸ナトリウムを内服中に急性心不全を発症し,弁置換術,弁形成術が施行された.術後9日目に腹痛と血便が出現した.上行結腸壊死による汎発性腹膜炎と診断し,結腸右半切除と二連銃式の人工肛門造設術を行った.術後半年後の人工肛門閉鎖の際に左側結腸に狭窄を認め,残存結腸全摘,直腸S状部切除を行った.下行結腸に著明な狭窄を伴う縦走潰瘍瘢痕を,S状結腸に潰瘍形成を認めた.病理組織検査では狭窄部,潰瘍部の腸管壁内に好塩基性結晶様異物を認め,異物反応を伴っていた.ポリスチレンスルホン酸塩が腸管壁内に取り込まれると排除困難で,慢性的な異物反応や炎症により組織障害が遷延する可能性がある.慢性腎不全患者の腸管壊死,穿孔,腸炎に対し手術を行う際には,ポリスチレンスルホン酸塩製剤の内服歴を確認し,腸切除範囲の決定や吻合の可否に注意する必要がある.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

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A 65-year-old woman was referred for further examination following positive results on a fecal occult blood test. Colonoscopy revealed type 0-Ⅱa cancer, with a lesion measuring 2 cm in diameter in the rectosigmoid colon, and type 5 cancer, with a lesion measuring 6 cm in diameter in the upper rectum. Computed tomography(CT)and positron emission tomography (PET)-CT revealed mesorectal lymph node metastases. Therefore, she was diagnosed with rectosigmoid colon cancer(Stage Ⅰ)and upper rectal cancer(Stage Ⅲa). However, PET-CT also revealed slight fluorodeoxyglucose uptake in the paraaortic and lateral lymph node lesions; hence, the possibility ofmetastasis could not be ruled out. Given that chemotherapy was restricted due to renal dysfunction, low anterior resection was performed as the first choice. Analysis of intraoperative frozen sections showed paraaortic and lateral lymph node metastases; thus, we performed lymph node dissection of these lesions. Pathological examination ofthe resected lymph nodes revealed that 21 of 37 lesions were cancer metastases. S-1 was administered as adjuvant chemotherapy for 5 months. Mediastinal lymph node metastases was suspected on chest CT 5 months and 3 years post-surgery; thus, panitumumab was administrated. These lymph nodes decreased in size immediately. Six years after the first surgery, the patient was well without any signs of recurrence.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 62-year-old man was admitted with complaints of bloody stool. Colonoscopy revealed a 5 cm diameter type 2 tumor in the lower rectum close to the anal canal. Tumor biopsy indicated a well-differentiated tubular adenocarcinoma. Computed tomography revealed locally advanced rectal cancer with mesorectal lymph node metastases(cT3N1P0M0, Stage Ⅲa, JSCCR 8th). The patient was treated with neoadjuvant chemotherapy(NAC)after transverse colostomy as an anus-preserving procedure. For the NAC, 12 courses of capecitabine plus oxaliplatin(CapeOX)and bevacizumab(BV)were administered. Colonoscopy after NAC revealed that the main tumor had considerably shrunk. No malignant tissues were found on biopsy. However, rectal wall thickness remained unchanged. Therefore, response evaluation for chemotherapy indicated partial response. Intersphincteric resection(ISR)with diverting loop ileostomy was performed as an anus-preserving surgical procedure. No remnant tumor in the rectum or lymph node metastases were found upon the pathological examination of resected specimens. Ileostomy closure was performed at 6 months post-ISR. At 12 months post-ISR, the patient was well and showed no signs of recurrence. This case demonstrated that NAC with CapeOX and BV can be a promising option for treating locally advanced lower rectal cancer and preserving the anus.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 37-year-old man was admitted to our hospital for the treatment of familial adenomatous polyposis and rectal carcinoma. He underwent total colectomy with ileoanal anastomosis(pT3N1M0, pStage Ⅲa)followed by adjuvant therapy with S-1. Three months after primary surgery, CT and MRIrevealed liver metastases(S5, S6). Laparoscopic partial hepatectomy was performed. Two years after primary surgery, new liver metastases(S2, S8)were found and we performed open partial hepatectomy and administered mFOLFOX6. Three years and 5 months after primary surgery, right lung metastases(S6, S9) were detected and the patient underwent a thoracoscopic-assisted right lung wedge resection. Repeated resection of metastases might have contributed to the long-survival in our case.

PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)  

AIM: This study aimed to determine surgical outcomes in patients with gynecological cancers for whom surgery was performed by gynecologists and digestive surgeons. METHODS: Seventy-three patients who underwent surgery for a gynecological malignant tumor from January 2010 to December 2014 were included in this retrospective study. Data on the definitive diagnosis, operative procedures, postoperative complications, stoma settings, length of hospital stay, and prognosis was collected for each patient. RESULTS: The median age of this female-only cohort was 60 years. Emergency surgery was performed in 8(11.0%)patients. Ovarian cancer was diagnosed in 56(76.7%)patients, and among these patients, the clinical disease Stage was Ⅰ, Ⅱ, Ⅲ, and Ⅳ in 4, 4, 20, and 11 patients, respectively. Moreover, 17 patients had recurrent ovarian cancer. Intestinal resection with anastomosis was performed in 25(34.2%)patients. Stoma formation was performed in 22 (30.1%)patients, however no patient underwent stoma closure surgery in the current study. The median operative time was 252 minutes, and the median blood loss was 1,190 mL. Regarding postoperative complications, ileus, pelvic abscess, and anastomotic leakage developed in 6(8.2%), 4(5.5%), and 2(2.7%)patients, respectively. The postoperative median survival time in patients with ovarian cancer was 1,399 days. CONCLUSION: These results suggest that tumor debulking, including intestinal tract resection, may contribute to the prolonged prognosis of gynecological tumors, although stoma closure is difficult to perform.

PubMed

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

背景:婦人科悪性腫瘍に対して、婦人科医と消化器外科医による合同手術がしばしば行われているが、その術後成績については明らかでない。目的:婦人科悪性疾患手術時に消化器外科医が介入した症例について、術式、合併症、予後などの術後成績を明らかにすることを目的とした。対象と方法:2010年1月〜2014年12月までの5年間の73例を対象とした。疾患、術式、術後合併症、ストーマの有無、入院期間、予後などを検討した。結果:年齢中央値(範囲)は60(15〜78)歳、73例全例が女性であった。緊急手術が8例(11.0%)含まれていた。疾患は、卵巣癌が56例(76.7%)と最も多く、Stageの内訳はStage I/II/III/IV/再発:4/4/20/11/17例であった。25例(34.2%)で腸管切除吻合が行われていた。また、22例(30.1%)でストーマが造設されていたが、本検討ではストーマ閉鎖を行えた症例はなかった。手術時間(婦人科原発巣手術時間も含む)中央値(範囲)は252(37〜690)分であり、出血量は1,190(0〜11,210)mLであった。術後の合併症(Clavien-Dindo II以上)として、イレウス6例(8.2%)、腹骨盤内膿瘍4例(5.5%)、縫合不全2例(2.7%)などがみられた。Grade III以上の合併症としてはイレウス、縫合不全、腹水、膵液瘻がそれぞれ1例ずつ認められた。卵巣癌全症例の術後生存期間中央値は1,399日であった。結論:婦人科との合同手術のなかで、消化器外科医は進行卵巣癌の手術に携わることが多い。ストーマを造設した症例のストーマ閉鎖は困難であるが、消化管切除を含む腫瘍切除によって予後の延長に寄与することが期待される。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は37歳、男性。家族性大腸腺腫症および直腸癌、cT3N0M0、cStage IIの診断で、大腸全摘、回腸嚢肛門吻合、D3リンパ節郭清術を施行した。病理組織学的診断の結果は直腸癌、pT3N1M0、pStage IIIaであったため、術後補助化学療法としてS-1の内服を開始した。術後3ヵ月目に肝転移(S5、S6)を認め、腹腔鏡下肝部分切除術を施行した。術後24ヵ月後、肝転移再発(S2、S8)を認め、開腹肝部分切除術を施行した。術後41ヵ月後、右肺S6、S9に転移を認め、胸腔鏡補助下肺部分切除術(S6、S9)を行った。転移巣に対し外科的切除を行い、長期生存を得られている家族性大腸腺腫症に伴う直腸癌の1例を経験した。複数回の肝転移切除術、肺転移切除術の意義を示す症例として報告する。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は62歳、男性。主訴は血便。下部消化管内視鏡検査で、下部直腸に5cm大の直腸癌が指摘された。組織型は高分化管状腺癌であり、腫瘍下縁は肛門管近傍まで達していた。腹部骨盤部造影CT検査で直腸間膜リンパ節転移が指摘され、進行直腸癌(cT3N1P0M0、Stage IIIa、大腸癌取扱い規約第8版)と診断された。本人が肛門温存を希望したため、前医で術前化学療法の方針となった。化学療法としてcapecitabine、oxaliplatin(CapeOX)+bevacizumab(BV)療法が12コース施行された。化学療法後の下部消化管内視鏡検査で腫瘍は著明に縮小し、肉眼的には厚みのある瘢痕のみとなっていた。瘢痕からの生検では悪性所見を認めなかった。しかし画像検査で直腸壁の肥厚は残存していたため、化学療法の効果判定はpartial response(縮小率40%)、ycT3N0M0、ycStage IIと診断した。肛門温存手術が可能と判断して、括約筋間直腸切除術、一時的回腸人工肛門造設術を施行した。切除標本の組織診断では主病巣に悪性細胞を認めず、リンパ節転移も陰性であった。原発巣切除後6ヵ月目に小腸人工肛門閉鎖術を施行した。術後追加治療を行わずに外来で経過観察中であるが、再発の所見は認めていない。CapeOX+BV療法によって組織学的完全奏効が得られた進行下部直腸癌の1例を経験したので報告する。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、女性。便潜血陽性のため下部消化管内視鏡検査が施行され、直腸S状部に2cm大のtype 0-IIa病変(組織型はtub2、por)、上部直腸に6cm大の5型病変(組織型はmuc、sig、tub2)が指摘された。胸腹骨盤部CT検査、PET-CT検査で腸管傍リンパ節転移陽性と診断された。直腸間膜リンパ節、大動脈周囲リンパ節、側方リンパ節領域にも淡いfluorodeoxyglucose集積を認めた。転移の可能性も否定できなかったが、直腸S状部癌cT1bN0M0、Stage I、上部直腸癌cT3N1M0、Stage IIIa(大腸癌取扱い規約第8版)と診断した。腎機能障害により化学療法の選択に制限があったため手術先行の方針とし、低位前方切除術を施行した。術中、大動脈周囲リンパ節、左総腸骨動脈リンパ節を迅速診断に提出し、リンパ節転移陽性と診断された。リンパ節以外に遠隔転移を認めなかったことからR0切除が可能と判断し、転移陽性であった領域のリンパ節は可及的に切除した。切除標本の組織診断では、直腸S状部の病変は深達度T1b、上部直腸病変は深達度T3であった。切除リンパ節37個中21個で転移陽性であった。RAS遺伝子検査では野生型であった。補助化学療法としてS-1単剤療法を施行した。術後5ヵ月目と3年目に縦隔リンパ節転移が疑われたためpanitumumab単剤療法を行ったところ、リンパ節腫大は縮小した。現在、初回手術から6年が経過したが直腸癌再発は認めていない。長期生存が得られている大動脈周囲リンパ節、側方リンパ節への転移を伴った進行直腸癌の1例を経験したので報告する。(著者抄録)

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/OBJECTIVE: Restorative proctocolectomy (RP) may improve quality of life in patients with ulcerative colitis (UC)-associated lower rectal cancer to a greater extent than total proctocolectomy. However, patients with UC-associated cancer often have flat mucosal lesions that make it extremely difficult to endoscopically delineate the tumor margins. Therefore, there is a potential risk of residual tumor and local recurrence after RP in patients with UC-associated lower rectal cancer. The aim of this study was to assess the feasibility of RP in patients with UC-associated cancer of the lower rectum. METHODS: We retrospectively identified nine patients who had undergone RP for UC-associated lower rectal cancer at the Niigata University Medical and Dental Hospital between January 2000 and December 2016. The incidence of flat mucosal cancer, distal margin status, and oncologic outcomes were evaluated in the nine patients. RESULTS: Eight (89%) of the nine patients had flat mucosal cancer in the lower rectum. The median length of the distal margin was 22 mm (range 0-55 mm). No patient developed local or distant recurrence during follow-up. One patient had a positive distal margin. This patient underwent annual pouchoscopy, but had no local recurrence and died of pancreatic cancer 81 months after RP. The remaining eight patients were alive at the final observation. Five-year and 10-year overall survival rates in the nine patients were 100% and 66.7%, respectively. CONCLUSION: Patients with UC-associated lower rectal cancer often have lesions of the flat mucosal type. However, RP is feasible and not necessarily contraindicated in such patients.

DOI： 10.1016/j.asjsur.2018.01.003

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We present a case of long-term survival in a patient with advanced ascending colon cancer and multiple liver metastases after receiving multimodality therapy, which included hepatic atrial infusion(HAI)and 4 hepatectomies. At diagnosis, the 65- year-old woman underwent right hemicolectomy for advanced ascending colon cancer with multiple liver metastases (T3N1M1[H2], Stage Ⅳ). The 11 liver metastatic lesions were treated by weekly HAI of 5-fluorouracil(5-FU). The lesions reduced in size(response rate 28.9%)immediately following treatment, and no new lesions were detected, but 10 months after treatment the size of the S2 tumor had increased. Systemic chemotherapy with irinotecan and S-1 was administered. Continued development of the S2 tumor in the liver prompted a radical lateral segment hepatectomy. Four months later, a computed tomography(CT)scan revealed a S6 tumor of the liver, for which a posterior segment hepatectomy was performed. A CT scan showing a S1 tumor in the liver 9 months later resulted in chemotherapeutic treatment with CapeOX, followed by mFOLFOX6. Despite treatment, the S1 tumor developed further, prompting a S1 partial hepatectomy. A further partial S8 hepatectomy was performed 7 years after surgery for the primary lesion following a CT scan that revealed a S8 tumor in the liver. There has been no recurrence of tumors in the 5 years and 5 months since this last hepatectomy.

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A 78-year-old man was admitted with diarrhea. Colonoscopy and computed tomography(CT)revealed rectal cancer with multiple liver metastases. Low anterior resection was performed for local control. After the operation, 5 courses of mFOLFOX6 plus bevacizumab chemotherapy were administered as first-line systemic therapy, but CT showed progressive disease with liver metastases. After the first-line systemic therapy, 2 courses of FOLFIRI plus bevacizumab chemotherapy were performed as second-line systemic therapy, but CT also revealed progressive disease with liver metastases. We retrospectively performed comprehensive genomic sequencing with a 415-gene panel and found that the patient had a hypermutation subtype. Interestingly, the panel also revealed that he had mismatch-repair(MMR)deficiency with MSH2 mutation, which is reported as a possible cause of resistance to 5-fluorouracil in colorectal cancer.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、女性。同時性肝転移を伴う上行結腸癌[T3N1M1(H2)、Stage IV]と診断し、結腸右半切除術を施行した。11個の肝転移に対して、5-FU肝動注療法を施行した。縮小率28.9%と奏効していたが、10ヵ月施行時に肝S2の病変が増大した。全身化学療法としてIRIS療法を施行したが奏効せず、拡大肝外側区域切除を施行した。さらに4ヵ月後、肝S6の再発病変に対して肝後区域切除を施行した。その9ヵ月後に肝S1の肝転移巣を指摘され、CapeOX、mFOLFOX6療法を施行したが、標的病変が増大し、肝S1部分切除を施行した。さらに4ヵ月後、肝S8に再発を来し、肝S8部分切除を行った(原発巣切除術後7年)。以後5年5ヵ月、再発を認めていない。本症例は分子標的薬導入以前の症例であり、肝動注療法、全身化学療法、4回の肝切除を行うことで12年5ヵ月の長期生存を得た。大腸癌肝転移に対する肝動注療法、複数回肝切除の意義を示す症例として報告する。(著者抄録)

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症例は78歳、男性。下痢を主訴に受診し、肝転移を伴う直腸癌と診断された。術中所見で肝転移は切除不能と診断され、局所制御のため超低位前方切除術を施行した。術後にmFOLFOX6+bevacizumab療法を5コース、FOLFIRI+bevacizumab療法を2コース施行したが、どちらも奏効しなかった。後方視的に施行した次世代シークエンサーによる遺伝子変異解析パネル検査(415遺伝子)では、原発巣に高頻度の体細胞変異を有するhypermutationであったことが判明した。大腸癌におけるhypermutationの多くはミスマッチ修復遺伝子の異常を有し、5-fluorouracil系抗癌剤が無効である可能性がある。一方で、免疫チェックポイント阻害薬が有効である可能性がある。薬物療法前に遺伝子変異解析パネル検査を行うことで、個々の患者に最適な治療法を提案できる可能性が示唆された。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Academic Press Inc.  

Background: Colitis-associated cancer (CAC) is the most serious complication of inflammatory bowel disease. Sphingosine-1-phosphate (S1P) is a bioactive lipid mediator that is generated by sphingosine kinase 1 (SphK1) and is known to play an important role in inflammation and cancer progression. Moreover, SphK1 and S1P act as upstream mediators of proinflammatory cytokine interleukin 6 (IL-6) and signal transducer and activator of transcription-3 (STAT3). We hypothesized that the expression levels of phosphorylated SphK1 (pSphK1), phosphorylated STAT3 (pSTAT3), and IL-6 are universally higher in CAC patients than in sporadic colorectal cancer (CRC) patients because all of these factors are associated with inflammation. In this study, we determined the expression levels of pSphK1 in patients with sporadic CRC and CAC and clarified the importance of S1P in CAC patients. Materials and methods: We randomly selected 10 sporadic CRC patients and 10 CAC patients who underwent curative resection, and we examined their surgical specimens by immunohistochemistry. We determined the expression levels of pSphK1, pSTAT3, and IL-6 in these samples. Results: We found pSphK1 expression to be more prevalent in CAC patients (P = 0.019) and to have a higher immunohistochemistry score (P = 0.005) than in sporadic CRC patients. However, the expression of pSTAT3 and IL-6 did not differ between the patient groups. Conclusions: To our knowledge, this is the first report comparing pSphK1 expression levels in CAC with those in sporadic CRC. The high levels of pSphK1 expression in CAC suggest an important role of S1P in the disease process of CAC.

DOI： 10.1016/j.jss.2018.05.085

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＜文献概要＞ポイント ◆内科,外科が緊密な連携をとり,ステロイド・免疫調節薬・生物学的製剤などの薬剤管理を行う.◆炎症性腸疾患に特徴的な,日和見感染,血栓症などの合併症も考慮に入れた適切な周術期管理が重要である.◆分割手術,ストーマ管理,合併症について,適切な対応と十分なインフォームド・コンセントが必要である.

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Language：Japanese   Publisher：日本臨床外科学会  

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＜ポイント＞閉塞性大腸炎をきたす疾患として大腸癌が最も多いが,憩室炎,虚血性腸疾患,便秘なども原因となりうる.閉塞部から離れた口側腸管にびらん・潰瘍を認めることが多く,切除範囲の設定には注意を要する.ステント治療により,口側腸管の評価や減圧が可能となり,閉塞性大腸炎のマネジメントに変化がみられる.(著者抄録)

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Carcinoma with elevated SRC expression is associated with distant metastasis and drug resistance. We report 2 cases of SRC amplification observed after retrospective comprehensive genomic sequencing. Case 1 was a 62-year-old man who had RAS wild-type stage IV carcinoma of the sigmoid colon with multiple liver metastases in both lobes. He underwent low anterior resection and systemic chemotherapy was initiated to treat the unresectable multiple liver metastases. Case 2 was a 73-yearold man who had RAS wild-type stage IV carcinoma of the descending colon with metastasis in the lateral segment of the liver. He underwent left hemicolectomy and lateral segmentectomy. He subsequently underwent open radiofrequency ablation and systemic chemotherapy to treat a hepatic recurrence. Several previous studies have found that molecular targeted therapy with tyrosine kinase inhibitors is effective against colorectal cancer with elevated SRC expression. This suggests that the results of comprehensive genomic sequencing may support the implementation of new treatments.

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This study aimed to evaluate the health-related quality of life(QOL)using EQ-5D-5L scores for patients who underwent surgery for colorectal cancer. A total of 30 consecutive patients(14 men and 16 women; median age: 67.5 years)from the outpatient clinic of our institute in January 2017 were eligible for this study. The primary tumor was located in the colon(n= 18)or rectum/anu(s n=12). Twelve patient(s 40.0%)had cancer recurrence, and 3 patient(s 10.0%)had a stoma. In addition, 11 patients(36.7%)underwent chemotherapy. The median EQ-5D-5L score for all the patients was 0.867(range, 0.324- 1.000). The EQ-5D-5L score of patients with recurrence was significantly lower(0.820)than that of patients without recurrence( 0.948)(p=0.002). Furthermore, the EQ-5D-5L score of women(0.834)was significantly lower than that of men (0.942)(p=0.015). No significant difference was noted between the EQ-5D-5L score and other factors, such as age, cancer stage, location of primary tumor, absence/presence of chemotherapy, and absence/presence of stoma. In conclusion, using EQ-5D-5L scores, female gender and cancer recurrence were found to be associated with low QOL of patients after surgery for colorectal cancer.

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Language：Japanese   Publisher：(株)癌と化学療法社  

SRC発現の亢進した癌は遠隔転移や薬剤耐性と関連があり、治療抵抗性とされている。今回、次世代シークエンサーによる415の癌関連遺伝子パネルを使用した後方視的な解析により、SRC増幅を認めた2例を報告する。症例1は62歳、男性。両葉多発肝転移を伴うRAS野生型cStage IVのS状結腸癌に対して、S状結腸切除を施行した。切除不能多発肝転移に対して、化学療法を行った。症例2は73歳、男性。肝外側区域に転移を伴うRAS野生型cStage IVの下行結腸癌に対して、左半結腸切除および外側区域切除を施行した。その後、肝再発に対して開腹ラジオ波焼灼術および化学療法を行った。SRC発現の亢進した大腸癌に対して、チロシンキナーゼ阻害薬による分子標的治療が有効であるという報告がある。包括的癌ゲノム検査により、新たな治療提案ができる可能性が示唆された。(著者抄録)

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The patient was a 73-year-old man with ascending colon cancer and synchronous liver metastases. A right hemicolectomy with a lymph node dissection was performed for the primary lesion. The resected specimen revealed a KRAS codon 12 mutation. After 6 courses of chemotherapy with capecitabine, oxaliplatin, and bevacizumab(Bv), we performed a partial hepatectomy and resection of the peritoneal dissemination. A computed tomography(CT)scan 5 months later revealed the recurrence of the liver metastases. After 8 courses of chemotherapy with 5-fluorouracil, Leucovorin, irinotecan, and Bv, we performed a partial hepatectomy. CT scan after 13 months revealed a recurrence in the peritoneal dissemination in the Douglas pouch and the right subphrenic space; therefore, we performed a low anterior resection and resection of the peritoneal dissemination with curative intent. CT scan after 19 months revealed a recurrence in the right subphrenic dissemination, a lung metastasis, and pleural dissemination. Chemotherapy with 5-fluorouracil, Leucovorin, and Bv was administered for 2 years and 5 months. After 5 years and 9 months of the primary operation, the patient is alive. Recently, we have focused on the mechanism of multidrug resistance through NAD(P)H: quinone oxidoreductase-1(NQO1)overexpression, which can be used to determine the role of an enzyme in sensitivity to toxicity and carcinogenesis. In this case, the pathological examination of the resected specimen revealed NQO1 negative expression. In conclusion, NQO1 may play a significant role in chemotherapy resistance in colorectal cancer patients.

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症例は73歳、男性。下腹部痛を主訴に受診し、精査で上行結腸癌、多発肝転移と診断され、結腸右半切除を施行した。術後のKRAS遺伝子検査ではcodon 12の変異を認めた。CapeOX+bevacizumab(Bv)療法後に肝部分切除を施行したが、5ヵ月後に新規肝転移病変を認めた。FOLFIRI+Bv療法後に再度肝部分切除を施行し、8ヵ月後にダグラス窩と右横隔膜下の腹膜播種を認めたため、同病変に対して低位前方切除、腹膜播種切除を施行した。6ヵ月後に右横隔膜下の腹膜播種、肺転移、胸膜播種を認め、sLV5FU2(+Bv)療法を継続している。初回手術から5年9ヵ月、全身状態良好で通院中である。近年、抗酸化ストレス蛋白の一つであるNAD(P)H:quinone oxidoreductase-1(NQO1)の抗癌剤耐性に関する報告が散見される。本症例の原発巣切除標本の免疫組織化学染色ではNQO1発現が陰性であり、病勢制御や長期生存に関与している可能性が考えられる。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Baishideng Publishing Group Co., Limited  

AIM: To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage IV low rectal cancer. METHODS: We selected 71 consecutive stage IV low rectal cancer patients who underwent primary tumor resection, and enrolled 50 of these 71 patients without clinical LPLN metastasis. The patients had distant metastasis such as liver, lung, peritoneum, and paraaortic LN. Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan. All patients underwent primary tumor resection, 27 patients underwent total mesorectal excision (TME) with LPLND (LPLND group), and 23 patients underwent only TME (TME group). Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group. R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients. We evaluated possible prognostic factors for 5-year overall survival (OS), and compared 5-year cumulative local recurrence between the LPLND and TME groups. RESULTS: For OS, univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%, P = 0.523)
multivariate analysis revealed that R0 resection was an independent prognostic factor. Regarding cumulative local recurrence, the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%, P = 0.833). CONCLUSION: Prophylactic LPLND shows no oncological benefits in patients with Stage IV low rectal cancer without clinical LPLN metastasis.

DOI： 10.5306/wjco.v8.i5.412

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：W B SAUNDERS CO-ELSEVIER INC  

HER2-targeted therapy is considered effective for KRAS codon 12/13 wild-type, HER2-positive metastatic colorectal cancer (CRC). In general, HER2 status is determined by the use of immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH). Comprehensive genomic sequencing (CGS) enables the detection of gene mutations and copy number alterations including KRAS mutation and HER2 amplification; however, little is known about the utility of CGS for detecting HER2-positive CRC. To assess its utility, we retrospectively investigated 201 patients with stage I-IV CRC. The HER2 status of the primary site was assessed using IHC and FISH, and HER2 amplification of the primary site was also assessed using CGS, and the findings of these approaches were compared in each patient. CGS successfully detected alterations in 415 genes including KRAS codon 12/13 mutation and HER2 amplification. Fifty-nine (29%) patients had a KRAS codon 12/13 mutation. Ten (5%) patients were diagnosed as HER2 positive because of HER2 MC 3+, and the same 10 (5%) patients had HER2 amplification evaluated using CGS. The results of HER2 status and HER2 amplification were completely identical in all 201 patients (P &lt; .001). Nine of the 10 HER2-positive patients were KRAS 12/13 wild-type and were considered possible candidates for HER2-targeted therapy. CGS has the same utility as IHC and FISH for detecting HER2-positive patients who are candidates for HER2-targeted therapy, and facilitates precision medicine and tailor-made treatment. (C) 2017 The Authors. Published by Elsevier Inc.

DOI： 10.1016/j.humpath.2017.02.004

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症例は45歳の男性で,24歳時,家族性大腸腺腫症(familial adenomatous polyposis;以下,FAPと略記)に対して大腸全摘,W型回腸嚢肛門吻合術(ileal pouch anal anastomosis;以下,IPAAと略記)が施行された.術後,38歳時に施行した経肛門的内視鏡検査で回腸嚢内に約30個のポリープを認め,生検の結果,管状腺腫であった.44歳時に施行された経肛門的内視鏡検査で回腸嚢肛門吻合部の約1cm口側に8mm大の0-Is病変を認め,内視鏡的粘膜切除術を行った.病理組織診断の結果,腺腫内癌,高分化管状腺癌であった.現在も経肛門的内視鏡検査で経過観察中であるが,癌の再発や異所性癌の発生は認めていない.FAPに対する大腸全摘,IPAAの術後,回腸嚢内腺癌を認めた症例を経験した.早期発見・治療のためには,回腸嚢の定期的なサーベイランスが重要である.(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：E-CENTURY PUBLISHING CORP  

NAD(P)H: quinone oxidoreductase-1 (NQO1) protects cells against redox cycling and oxidative stress; however, in cancer cells, NQO1 confers resistance against anticancer agents. The aim of this study was to evaluate the association between NQO1 expression and prognosis in patients with advanced (locally advanced or metastatic/recurrent) colorectal cancer (CRC). A retrospective analysis of 47 patients [28 male and 19 female; median age: 62 years (range, 17-78)] with advanced CRC was conducted. Immunohistochemical examination of tumor tissue specimens was performed using monoclonal anti-NQO1 antibody. The association of NQO1 expression with patient characteristics, chemotherapeutic response, and clinical prognosis was assessed. Therapeutic efficacy (complete response, partial response, stable disease, and progressive disease) was evaluated using Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1. We compared the therapeutic efficacy in KRAS wild and mutant CRC because epidermal growth factor receptor (EGFR)-signaling pathway plays a pivotal role in CRC. Of the 47 patients, 31 (66.0%) had KRAS wild CRC and 16 (34.0%) had KRAS mutant CRC. Moreover, 37 (78.7%) had NQO1-positive tumors and 10 (21.3%) had NQO1-negative tumors. Among the patients with KRAS wild CRC, NQO1-negative patients showed significantly better disease control rate (complete response + partial response + stable disease) than NQO1-positive patients (P = 0.028). Moreover, NQO1-negative patients had longer progression-free survival and overall survival than NQO1-positive patients (P = 0.041 and P = 0.043, respectively). NQO1 expression in the tumor may be a predictor of therapeutic efficacy and prognosis in patients with KRAS wild advanced CRC.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Gastroenterological Surgery  

We report the case of a 45-year-old man, who at the age of 24 had total proctocolectomy with ileal W-pouch anal anastomosis for familial adenomatous polyposis. A follow-up transanal endoscopy performed at the age of 38 revealed approximately 30 polyps in the ileal pouch, which were then confirmed by biopsy to be tubular adenomas. A transanal endoscopy performed at the age of 44 revealed an 8 mm 0-Is lesion located approximately 1 cm proximal to the ileal pouch-anal anastomosis, which was then removed by EMR. Histopathological analysis showed the presence of well-differentiated tubular adenocarcinoma in adenoma. To date, no recurrence of adenocarcinoma has been confirmed in follow-up transanal endoscopies. We have experienced treating a case of adenocarcinoma arising in the ileal pouch through the adenoma-carcinoma sequence after total proctocolectomy with ileal pouch-anal anastomosis for familial adenomatous polyposis. For early diagnosis and prompt treatment, it is important to perform periodic surveillance of the ileal pouch and conduct aggressive endoscopic resection when a large adenoma exceeding 10 mm is found.

DOI： 10.5833/jjgs.2016.0055

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Perineural invasion (PN) diagnosed by hematoxylin-eosin (HE) staining is an important prognostic factor after curative-intent surgery in patients with colorectal cancer. However, the clinical significance of PN diagnosed by immunohistochemistry (IHC) has not been investigated. The present study assessed the clinical significance of PN diagnosed by IHC with an anti-S100 antibody in patients with colorectal cancer.
We retrospectively enrolled 184 consecutive patients with stage I-III colorectal cancer who had undergone curative-intent surgery. We analyzed the absence/presence of PN diagnosed by HE staining (HE-PN) compared to that diagnosed by IHC with the anti-S100 antibody (S100-PN). Potential prognostic factors were identified by univariate and multivariate analyses of the overall and relapse-free survival. The statistics were used to assess the inter-observer reproducibility.
The incidence of HE-PN and S100-PN among the 184 patients was 60 patients (32.6 %) and 113 patients (61.4 %), respectively (P &lt; 0.001). A multivariate Cox proportional hazards regression model analysis indicated that S100-PN was an independent prognostic factor for both the overall and relapse-free survival. The value was 0.77 for S100-PN and 0.47 for HE-PN.
PN diagnosed by IHC is an important prognostic factor in patients with colorectal cancer. An inter-observer assessment showed superior judgment reproducibility for S100-PN compared with HE-PN.

DOI： 10.1007/s00595-014-1096-9

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A 58-year-old woman presenting with abdominal distension was diagnosed with a tumor in the right ovary. A chest-abdominal-pelvic computed tomography scan revealed multiple lung metastases, multiple liver metastases, and peritoneal dissemination. Invasion of the rectum by peritoneal dissemination of the Douglas&#039; pouch was suspected. She was diagnosed with Stage Ⅳ right ovarian cancer and was treated with preoperative chemotherapy. After chemotherapy, debulking surgery of the abdominal cavity (total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy, and Hartmann&#039;s procedure) was performed. Because there was swelling observed in multiple mesorectal lymph nodes, lymph node dissection was performed based on methods used for rectal cancer surgery. Postoperative histopathological examination revealed multiple mesorectal lymph node metastases arising from ovarian cancer. We suggest that mesorectal lymph node dissection be considered a part of debulking surgery for ovarian cancers that have invaded the rectum.

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The patient was a 73-year-old woman. She underwent right hemicolectomy and D3 lymph node dissection for cecal cancer in June 2003. Although a peritoneal dissemination was intraoperatively noted around the primary tumor lesion, it was resected concurrently and thus R0 surgery was accomplished. Postoperative adjuvant chemotherapy was not performed. During the follow-up on an outpatient basis, a solitary left lung metastasis was found and partial left upper lobectomy of the lung was performed in December 2004. A solitary liver metastasis was identified in the liver (S3), and lateral segmentectomy of the liver was performed in June 2007. The patient was alive with no evidence of recurrence 11 years and 9 months after resection of the primary lesion and 7 years and 9 months after the hepatectomy. Long-term survival can be achieved by performing resection without residual cancer even in some cases with metachronous metastatic recurrences in multiple organs. Metastasectomy should be considered proactively when the patient is in a good general condition and R0 resection is possible.

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Case 1: A 61-year-old man who had a diagnosis of low rectal cancer with lateral pelvic lymph node (LPLN) metastasis and multiple liver metastases underwent low anterior resection with LPLN dissection. The initial surgery was followed by chemotherapy, and then an extended right hepatectomy with partial resection of the liver was performed. Subsequently, a lung metastasis was detected, and the lung was partially resected. The patient was alive 9 years and 6 months after the initial operation. Case 2: A 53-year-old man had a diagnosis of low rectal cancer. After 5 courses of mFOLFOX6 plus bevacizumab, he underwent low anterior resection with LPLN dissection and resection of the peritoneal metastasis. The patient was alive 6 years and 3 months after the surgery without any signs of recurrence. Case 3: A 48-year-old man had a diagnosis of low rectal cancer and multiple liver metastases. He underwent low anterior resection with LPLN dissection and right hepatic lobectomy. He subsequently showed liver and lung metastases. The patient received systemic chemotherapy, and is alive with recurrent disease. We report 3 cases of Stage Ⅳ low rectal cancer with LPLN metastasis, and propose that LPLN dissection is important as a part of R0 resection for Stage Ⅳ low rectal cancer.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は58歳、女性。腹部膨満を主訴に近医を受診し、その後当院産婦人科へ紹介された。胸腹骨盤部CT検査では、右卵巣腫大、多発肺転移、多発肝転移、腹膜播種を指摘され、さらにダグラス窩の腹膜播種は直腸への浸潤が疑われた。卵巣癌Stage IVに対して術前化学療法(paclitaxel+carboplatin療法)を3コース行った。その後、腹腔内の腫瘍減量手術(子宮・両側付属器摘出、大網部分切除、腹膜播種切除、Hartmann手術)を施行した。直腸間膜内に多発するリンパ節腫大を認めたため、下腸間膜動脈根部までのリンパ節郭清を行った。術後の病理組織学的診断では、右卵巣漿液性腺癌の診断となった。また、傍直腸リンパ節にも卵巣癌の転移が認められた。術後は化学療法を再開し、現在加療中である。卵巣癌の直腸浸潤では、直腸切除と直腸所属リンパ節郭清を行うことで卵巣癌の腫瘍減量手術に寄与する可能性が示唆された。(著者抄録)

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症例は71歳、女性。肛門会陰部の硬結と疼痛を主訴に受診した。直腸癌穿通によるフルニエ壊疽と診断し、切開ドレナージおよびS状結腸人工肛門造設術を施行した。術中の生検で中分化管状腺癌と診断された。術後経過は良好で、S-1+oxaliplatin(SOX)療法を4コース施行後、両側付属器と子宮腟合併切除を伴う腹会陰式直腸切除術を施行した。最終診断はpT4b(腟)N0M0、Stage IIであり、術後補助化学療法としてUFT/Leucovorin療法を行った。根治術後7ヵ月目に右肺に再発を認め、右肺部分切除術を施行した。その8ヵ月後、右肺と右臀部皮下組織内に再発を認めた。臀部再発は切除可能と判断し、大臀筋の一部を含めた右臀部腫瘍摘出術を行った。腫瘍は切開排膿時のドレナージ創沿いの深部組織に局在していた。後日、右肺部分切除術を施行し、その後再発なく、初回の切開排膿時のドレナージ手術から3年6ヵ月生存中である。フルニエ壊疽合併直腸癌のドレナージ術後には、ドレナージ経路に再発を来す可能性を考慮する必要がある。(著者抄録)

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症例は73歳、女性。2003年6月に盲腸癌に対して結腸右半切除、D3リンパ節郭清を施行した。術中所見で原発巣近傍に腹膜播種を認めたが、同部の合併切除を行うことでR0切除となった。術後補助化学療法は行わなかった。外来で経過観察していたが、2004年12月、左肺上葉単発の肺転移に対し左肺上葉部分切除を施行した。2007年6月、肝S3単発の肝転移に対し肝外側区域切除を施行した。原発巣切除後11年9ヵ月、肝外側区域切除後7年9ヵ月が経過し、現在無再発生存中である。複数臓器へ異時性に転移再発を来した場合でも、癌の遺残なく切除を行うことで長期生存が得られる場合がある。全身状態が良好でR0切除が可能であれば、積極的に転移巣切除を考慮すべきである。(著者抄録)

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A 71-year-old woman diagnosed with Fournier's gangrene caused by penetration of a rectal carcinoma was referred to our hospital. Emergency drainage and sigmoid colostomy were performed. Pathological examination of a biopsy sample showed moderately differentiated tubular adenocarcinoma. Abdominoperineal resection with bilateral salpingo-oophorectomy and hysterectomy was performed with curative intent after 4 courses of chemotherapy with S-1 and oxaliplatin. The postoperative pathological diagnosis was StageⅡ (pT4bN0M0). The patient received tegafur/uracil and Leucovorin as adjuvant chemotherapy. Seven months after the curative operation, partial pneumonectomy was performed for the recurrence of the rectal carcinoma in the right lung. Eight months after pneumonectomy, recurrent tumors were observed in the right lung and subcutaneous fat layer of the right buttock along the drainage site. The tumor in the right buttock was excised along with part of the gluteus maximus, and partial pneumonectomy was then performed. Three years and 6 months after the emergency drainage, the patient is alive with no evidence of recurrence. After drainage for rectal carcinoma complicated by Fournier's gangrene, the possibility of recurrence around the drainage site should be considered.

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：新潟医学会  

症例は76歳の女性。主訴は右鼠径部腫瘤。肛門指診で、肛門縁から2.5cmに下縁を有する2cm大の隆起性病変、および主病巣より肛門側に0.5cm大の粘膜下腫瘤を触知した。大腸内視鏡検査で、下部直腸に主座を有し一部肛門管に進展する2cmの2型腫瘍を認め、生検で中分化型腺癌と診断された。胸腹骨盤部CT検査では、右閉鎖、右総腸骨、右鼠径リンパ節の腫大を認めた。下部直腸癌cStage IIIbの術前診断にて、腹会陰式直腸切断術D3郭清、右鼠径リンパ節郭清を施行した。術後の病理組織学的検査では、組織型は中分化〜低分化充実型腺癌、主病巣の深達度はMPで、ly2、v1と脈管侵襲を認めた。また、右閉鎖リンパ節に2個、右総腸骨リンパ節に1個、そして右鼠径リンパ節に3個それぞれ転移を認め、下部直腸癌pStage IIIbの診断となった。主病巣の肛門側に、主病巣と非連続性で低分化充実型腺癌の粘膜下腫瘍を認め、そのさらに肛門側にリンパ管侵襲を認めた。同粘膜下腫瘍は、主病巣と非連続性であること、および主病巣と類似した組織型であることから直腸癌の壁内転移と診断された。また、同粘膜下腫瘍は、周囲にリンパ管侵襲を認め、さらに鼠径リンパ節転移を認めたことから、直腸における下方向リンパ流を介した壁内転移と推定された。(著者抄録)

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)日本臨床社  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

同一病巣内に神経内分泌腫瘍(neuroendocrine tumor;NET)と腺癌の成分を認める直腸腫瘍は非常に稀である.このような腫瘍の発生過程は,NETと腺癌の両者への分化傾向をもつ単一クローン由来,それぞれ別のクローンから発生した腫瘍の衝突の2つの可能性がある.症例は52歳,男性.便潜血陽性で下部消化管内視鏡検査を施行され,下部直腸に10mm大の粘膜下腫瘍様病変を指摘された.生検でNETの診断となり,同病巣に対し内視鏡的粘膜下層剥離術を施行した.病理診断では,病巣は径8mmで,病巣内にNETと腺癌の成分があり,両成分の粘膜下層までの浸潤を認めた.病巣構築より一方から他方が発生した経路を除外できること,明らかな組織移行像を認めないこと,および免疫組織化学の染色態度の相違から,NETと腺癌が別々のクローンから発生した衝突腫瘍であると診断した.追加腸切除の適応とされ,腹腔鏡補助下超低位前方切除術,D2郭清を施行し,現在まで再発を認めていない.(著者抄録)

DOI： 10.3862/jcoloproctology.68.55

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 57-year-old woman was referred to our hospital because of descending colon cancer with multiple liver metastases. Abdominal magnetic resonance imaging (MRI) revealed 13 liver metastases across the lobes. We started combination chemotherapy with capecitabine/oxaliplatin (CapeOX) and bevacizumab. After 9 courses of the treatment, the number and size of the liver metastases were remarkably reduced on MRI. Left colectomy and partial hepatectomy were performed. Histopathological examination revealed no residual cancer cells in the colon but revealed a few cancer cells in 4 of 7 resected liver specimens. At 11 postoperative months, 1 liver metastasis reappeared, for which we performed laparoscopy-assisted partial hepatectomy. At 21 months after the second operation, the patient was well without any signs of recurrence. Thus, the combination chemotherapy with CapeOX and bevacizumab allowed for the successful resection of the tumor and metastasis in our patient who initially had unresectable colon cancer and multiple liver metastases.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 69-year-old man with advanced rectal cancer and liver metastases was treated with 2 courses of chemotherapy with irinotecan and S-1 followed by low anterior resection and partial hepatectomy. Chemotherapy with S-1 was then administered for 22 months. However, lung metastases developed, for which partial pneumonectomy was performed. Seven months later, computed tomography (CT) revealed swelling of the left supraclavicular lymph node. Despite chemotherapy with 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6)
5-fluorouracil, Leucovorin and irinotecan (FOLFIRI)
and capecitabine plus bevacizumab, the lung metastases recurred and Virchow lymph node swelling was noted again. Accordingly, palliative therapy was administered. The patient died 3 years 1 month after Virchow lymph node resection. Herein, we describe a case of advanced rectal cancer, in which lung and Virchow lymph node metastases developed after liver metastasis. Surgical excision of the metastases resulted in long-term survival of 6 years following the first operation.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 34-year-old woman presenting with bloody stools was diagnosed with a rectal tumor. Computed tomography (CT) revealed multiple liver masses in Couinaud segments IV, V, and VU. The lesions were diagnosed as multiple liver metastases from rectal cancer. Right trisegmentectomy of the liver was considered the optimal treatment option for curative resection
however, liver volumetric examination using CT estimated that the remnant liver volume after right trisegmentectomy would be only 24.6 % of the total liver volume. Therefore, she underwent resection of the primary lesion followed by systemic chemotherapy for multiple liver metastases. She showed a partial response, according to the Response Evaluation Criteria in Solid Tumors, after 5 courses of capecitabine/oxaliplatin plus bevacizumab. Embolization of the right branch of the portal vein was performed to increase liver volume. A subsequent liver volumetric examination with CT estimated that the remnant liver volume after right trisegmentectomy would be 38.4 % of the total liver volume. Therefore, she underwent right trisegmentectomy of the liver for curative resection of the liver metastases. She had had no signs of recurrence at 3 years and 6 months after initial surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 71-year-old man was referred to our hospital because of repeated bowel obstruction. He had previously undergone cystectomy with ileal conduit urinary diversion for the treatment of bladder cancer at the age of 28 years. Computed tomography revealed a mass in the ascending colon. Ileostomy was initially performed because of poor general condition that improved with postoperative nutrition management. Enema findings revealed ascending colon cancer and we therefore decided to perform curative surgery. Intraoperative findings revealed that the ascending colon cancer had invaded the ileal conduit. However, it was confirmed that the ureter-ileal conduit anastomosis and the mesentery of the ileal conduit could be preserved. We performed right colectomy and partial resection of the ileal conduit with curative intent. The pathological stage was pT4bpN0cM0, pStage II. There were no signs of recurrence 15 months after curative surgery.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Purpose: In the present study, we aimed to describe the surgical results of single-port laparoscopic stoma creation in our institution. Methods: We examined the safety of the surgical procedure and short-term results in 10 consecutive patients who underwent single-port laparoscopic stoma creation at our hospital between April 2011 and July 2013. Results: The median age of the patients was 60.5 (range, 31-75) years. Five patients were men, and 5 were women. There were 5 cases of colorectal cancer, 2 each of extramammary Paget's disease and uterine cancer, and one of perineal neurofibroma. Eight surgeries were performed for bowel obstruction or stenosis, and two surgeries were performed for other reasons. The median operative time was 59.5 (range, 40-91) min, blood loss volume was 0 (range, 0-10) mL, postoperative duration before commencement of oral intake was 2.5 (range, 1-4) days, and duration of postoperative hospital stay was 11 (range, 5-19) days. No short-term complications were noted after the surgery. Conclusion: Single-port laparoscopic stoma creation appears to be feasible in terms of safety and short-term surgical results, and may improve the quality of life of patients requiring fecal diversion.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 70-year-old man was referred to our hospital with ascending colon cancer (cT3N1M0, Stage IIIa), which was found during examinations following a positive fecal occult blood test. The patient was also diagnosed with early gastric cancer (cT1a, NO, MO, Stage IA) during a preoperative gastroscopy examination. A laparoscopically assisted right colectomy and D3 lymphadenectomy was performed for the ascending colon cancer. The postoperative pathological diagnosis was Stage IIIb (pT3N2), he was administered in combination with capecitabine plus oxaliplatin (CapeOX) as adjuvant chemotherapy before the treatment for the colon cancer. After 6 months of adjuvant chemotherapy, we were unable to detect any gastric lesions at the same location using gastroscopy, and so diagnosed a clinical complete response. A follow-up gastroscopy 6 months later showed the same findings. The patient has had no recurrence of gastric cancer for 18 months after the initial operation. He will continue to be followed up closely using gastroscopy. In this case, CapeOX as adjuvant chemotherapy for advanced colon cancer was also effective for early gastric cancer.

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

An 81-year-old man presented with chief complaints of abdominal pain and vomiting. Intestinal obstruction was found at the time of admission to a local hospital in October 2011. Conservative treatment provided symptomatic relief
however, he was readmitted with similar symptoms in December 2011. Small-intestinal wall thickening was detected by abdominal and pelvic computed tomography, and he was referred to our hospital. Small-bowel endoscopy revealed an elevated subcircumferential tumor in the jejunum. Biopsy revealed well to moderately differentiated adenocarcinoma diagnosed as jejunal cancer, which caused narrowing of the jejunum. Single-incision laparoscopy-assisted small-bowel resection was performed. The intraoperative findings were a tumor with inflammatory changes in the jejunum and enlarged surrounding lymph nodes. We performed regional lymph node dissection. Histopathological analysis showed moderately differentiated small-intestinal tubular adenocarcinoma and 2 of 5 lymph nodes positive for metastatic cancer cells. After an uneventful postoperative course, he was discharged on day 7. He preferred not to undergo postoperative adjuvant chemotherapy and quickly recovered his activities of daily living postoperatively. He stayed home until he developed abdominal distention resulting from peritoneal recurrence 1 year and 6 months postoperatively and died 1 month later.

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は70歳、男性。検診の便潜血陽性を主訴に近医にて下部消化管内視鏡検査が行われ、2型上行結腸癌と診断された。術前の上部消化管内視鏡検査で、体中部後壁大彎に12mm大の0-IIa病変(tub1)を指摘された。上行結腸癌(cT3N1M0、Stage IIIa)、胃癌[cT1a(M)、N0、M0、Stage IA]の診断で、上行結腸癌に対して手術を先行、その後内視鏡的胃粘膜下層剥離術を行う方針とした。腹腔鏡補助下結腸右半切除、D3郭清を施行。術後経過良好で12病日に退院した。病理組織診断はtub1、pT3N2(4/15)、Stage IIIbで、35病日から術後補助化学療法としてCapeOXを6ヵ月間施行した。その後、上部消化管内視鏡検査を施行したが病変は指摘できず、6ヵ月後の再検でも同様であった。補助化学療法開始後1年6ヵ月経過したが、胃癌は臨床的に完全奏効の状態である。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

目的:当科における単孔式人工肛門造設術の手術成績を明らかにする。対象・方法:2011年4月〜2013年7月の間に当院で単孔式人工肛門造設術を施行した連続10症例において、安全性、短期的な手術成績を検討した。全例でストーマサイトを切開し、プラットフォームにEZアクセスを用いた。結果:年齢中央値(範囲)は60.5(31〜75)歳、男性5例、女性5例。原疾患は、直腸癌3例、S状結腸癌1例、子宮癌3例、乳房外パジェット病2例、会陰神経線維腫1例であった。手術時間の中央値(範囲)は59.5(40〜91)分、出血量0(0〜10)mL、術後経口摂取開始時期2.5(1〜4)病日、術後の在院日数は11(5〜19)日であった。術後短期の合併症はみられなかった。結論:単孔式人工肛門造設術は、安全性、術後の短期成績ともに良好で、QOL改善に寄与していると思われた。(著者抄録)

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症例は69歳、男性。主訴は肛門痛。肝転移、側方リンパ節転移を伴う直腸癌[Rb](cT3N3M1a)、S状結腸癌(cT1N0M0)、上行結腸癌(cTisN0M0)と診断された。全身化学療法としてirinotecan+S-1を施行後、腫瘍は著明に縮小し、低位前方切除、回盲部切除を行った。その後、肝転移巣に対し肝前区域切除、S2部分切除を行い、術後にS-1を22ヵ月服用した。さらにCT検査で右肺S2、S6に転移巣を指摘され、右肺部分切除を行った。7ヵ月後のCT検査で左鎖骨上リンパ節の腫大が指摘され、Virchowリンパ節の単独転移と判断し切除を行った。切除後3ヵ月後に肺転移が出現したため、mFOLFOX6、FOLFIRI、capecitabine+bevacizumabによる全身化学療法を施行した。その後、肺病変は増大、左鎖骨上リンパ節も再増大し、緩和治療に移行した。Virchowリンパ節切除後、3年1ヵ月で永眠された。肝転移、肺転移切除後に生じたVirchowリンパ節転移を切除し、初回手術から6年の長期生存を得た症例を経験したので報告する。(著者抄録)

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症例は71歳、男性。28歳時、膀胱癌に対して膀胱全摘術、回腸導管による尿路変向術が施行されていた。腸閉塞症状を繰り返すため当院を受診した。腹部骨盤部CT検査で、上行結腸に腫瘤性病変を認めた。腫瘤による腸閉塞と診断し緊急手術の適応と判断したが、全身状態が不良であり小腸人工肛門造設を行った。術後の栄養管理により全身状態は改善した。術中所見、術後の注腸造影検査で上行結腸癌と診断、根治手術の方針とした。術中所見では回腸導管に浸潤する上行結腸癌を認めたが、尿管回腸導管吻合部、回腸導管腸間膜の温存は可能であると判断した。回腸導管の部分切除を含めた右側結腸切除を行い、治癒切除となった。病理結果はtype2、55×44mm、tub1、med、T4b(回腸導管)N0M0、pStage IIであった。術後15ヵ月経過し再発を認めていない。局所進行上行結腸癌に対して回腸導管部分切除を行うことで、治癒切除となった1例を経験したので報告する。(著者抄録)

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症例は34歳、女性。同時性多発肝転移を伴う直腸癌の診断で当院を紹介された。CT検査で肝S4、S5、S7に腫瘤を認め、治癒切除のためには右三区域切除が必要であった。CT volumetry検査では切除後の予測残肝容積率は24.6%であり、切除不能肝転移と判断した。下血の症状があることから原発巣切除を先行した。原発巣術後に、全身化学療法としてcapecitabine/oxaliplatin+bevacizumabを5コース施行した。新規病変はみられず、Response Evaluation Criteria in Solid Tumors判定でpartial responseであった。門脈右枝塞栓術を施行し、予測残肝容積率は38.4%まで増大した。切除可能と判断して肝右三区域切除を行い治癒切除となった。肝切除から3年6ヵ月経過し再発を認めていない。(著者抄録)

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症例は81歳、男性。主訴は腹痛、嘔吐で腸閉塞を生じ、近医で入院加療が行われた。保存的治療で症状は改善したが、2ヵ月後に同じ症状で再入院となった。腹部骨盤部CT検査で小腸壁の肥厚が指摘されたため、当院紹介となった。小腸内視鏡検査で空腸に亜全周性の隆起性腫瘍を認め、生検で高分化〜中分化腺癌と診断された。狭窄所見を伴う空腸癌と診断し、単孔式腹腔鏡補助下空腸部分切除術を行った。術中所見として、空腸に炎症性変化を伴う腫瘍が確認された。リンパ節の腫大を認めたため腸管周囲リンパ節の郭清を行った。病理組織結果は小腸中分化管状腺癌、リンパ節は2/5個で転移陽性であった。術後経過は良好で、7病日に退院となった。術後補助化学療法は希望されなかった。術後すぐに日常生活動作は回復し、自宅で生活されていた。術後1年6ヵ月ごろより腹膜再発による腹部膨満を生じ、1年7ヵ月で永眠された。(著者抄録)

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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CiNii Article

CiNii Books

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Other Link： http://hdl.handle.net/10191/44313

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CiNii Article

CiNii Books

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Other Link： http://hdl.handle.net/10191/44121

Language：Japanese   Publisher：(株)癌と化学療法社  

症例は57歳、女性。検診便潜血陽性の精査で、多発肝転移を伴う下行結腸癌(1/4周、低分化腺癌)と診断された。肝転移はMRI検査で両葉に13個認め、術前化学療法の方針となった。capecitabine/oxaliplatin(CapeOX)+bevacizumab(BV)療法を9コース施行したところ、原発巣は瘢痕化、肝転移は5個と減少し、partial response(PR)と判定し、左結腸切除術、肝部分切除術を施行した。術中超音波検査では肝臓に7病変を認め、すべて部分切除が可能でR0の手術となった。病理診断では原発巣は癌細胞を認めず、肝転移は切除した7病変のうち4病変にわずかに癌細胞の残存を認めるのみであった。術後11ヵ月目に肝S5に単発の肝転移を認め、腹腔鏡補助下肝部分切除術を施行した。現在、21ヵ月無再発生存中である。CapeOX+BV療法は切除不能肝転移大腸癌に対して、根治切除を可能とする有用な治療法と考えられた。(著者抄録)

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

人工肛門閉鎖術は比較的低侵襲の手術ではあるが,術後にBacterial translocationによるものと考えられる敗血症の1例を経験したので報告する.症例は61歳,男性.3ヵ月前に直腸癌に対して超低位前方切除術,一時的回腸人工肛門造設術を施行し,今回人工肛門閉鎖を行った.第2病日に食事を開始したところ,悪寒・戦慄および発熱が出現し,第6病日に敗血症性ショックをきたした.種々の検査にて明らかな感染源は特定されなかったため,Bacterial translocationをきたし,敗血症に至ったと考えられた.人工肛門閉鎖術後は廃用性萎縮している人工肛門の肛門側腸管に食物が通過した際にBacterial translocationをきたす可能性があるため,注意が必要であると考えられた.(著者抄録)

DOI： 10.3862/jcoloproctology.67.168

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Other Link： http://search.jamas.or.jp/link/ui/2014126379

Language：Japanese   Publisher：新潟医学会  

【緒言】近年、本邦における潰瘍性大腸炎の患者数は増加傾向である。それに伴い潰瘍性大腸炎の長期経過例も増加し、潰瘍性大腸炎の慢性炎症粘膜を発生母地とする大腸癌、およびその前癌病変と考えられるdysplasiaが増加している。そのため、これらの病変を発見するためのサーベイランスプログラムを確立することが重要と考えられている。しかし、過去の研究では、潰瘍性大腸炎患者に対してサーベイランスを行うこと自体の臨床的意義については十分に検討されてこなかった。本研究の目的は、サーベイランスが潰瘍性大腸炎に合併する大腸腫瘍を早期に発見することおよび予後改善に寄与するかを明らかにすることである。【方法】1991年1月から2012年12月の間に新潟大学医歯学総合病院で手術を施行され、術後の病理診断で潰瘍性大腸炎に合併した大腸癌もしくはdysplasiaと診断された18例を対象とした。本研究では、潰瘍性大腸炎に合併する大腸腫瘍を発見するためのサーベイランスを、&quot;潰瘍性大腸炎の診断から7年以上経過した全大腸炎型もしくは左側大腸炎型症例に対して、大腸癌のスクリーニングを意図して施行した内視鏡検査&quot;と定義した。そして、サーベイランスの生検で組織学的に癌あるいはdysplasiaが証明され、手術が施行された症例をサーベイランス群とし、サーベイランス群と非サーベイランス群における臨床病理学的特徴および術後成績を統計学的に比較検討した。【結果】対象18例中、サーベイランス群は13例(72%)、非サーベイランス群は5例(28%)であった。サーベイランス群は非サーベイランス群と比較して、リンパ節転移の頻度が有意に低く(8% vs 60%;P=0.044)、Stage0、Iの頻度が有意に高かった(85% vs 20%;P=0.022)。また、サーベイランス群は13例全例が生存しているのに対し、非サーベイランス群では5例中2例が大腸癌死していた。術後の累積5年生存率は、サーベイランス群が100%、非サーベイランス群が50%であった(P=0.018)。【結論】サーベイランスを行うことにより、潰瘍性大腸炎に合併する大腸腫瘍が早期に発見され、潰瘍性大腸炎患者の予後が改善する。(著者抄録)

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