記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: This study aimed to elucidate the impact of anatomic location of residual disease (RD) after initial cholecystectomy on survival following re-resection of incidental gallbladder cancer (IGBC). METHODS: Patients with pT2 or pT3 gallbladder cancer (36 with IGBC and 171 with non-IGBC) who underwent resection were analyzed. Patients with IGBC were classified as follows according to the anatomic location of RD after initial cholecystectomy: no RD (group 1); RD in the gallbladder bed, stump of the cystic duct, and/or regional lymph nodes (group 2); and RD in the extrahepatic bile duct and/or distant sites (group 3). RESULTS: Timing of resection (IGBC vs. non-IGBC) did not affect survival in either multivariate or propensity score matching analysis. RD was found in 16 (44.4%) of the 36 patients with IGBC; R0 resection following re-resection was achieved in 32 patients (88.9%). Overall survival (OS) following re-resection was worse in group 3 (n = 7; 5-year OS, 14.3%) than in group 2 (n = 9; 5-year OS, 55.6%) (p = 0.035) or in group 1 (n = 20; 5-year OS, 88.7%) (p < 0.001). There was no survival difference between groups 1 and 2 (p = 0.256). Anatomic location of RD was independently associated with OS (group 2, HR 2.425, p = 0.223; group 3, HR 9.627, p = 0.024). CONCLUSION: The anatomic location of RD independently predicts survival following re-resection, which is effective for locoregional disease control in IGBC, similar to resection for non-IGBC. Not all patients with RD have poor survival following re-resection for IGBC.

DOI： 10.1007/s00423-021-02165-1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Near-infrared fluorescence cholangiography during a laparoscopic cholecystectomy has become widely accepted as a useful auxiliary tool to visualize the extrahepatic biliary structures. We investigated the feasibility and educational value of a method with longer interval between the administration of indocyanine green and the imaging of these structures. METHODS: Approximately 18 hours before their surgery, patients (n = 51) were intravenously administered 0.25 mg/kg of indocyanine green. Each laparoscopic cholecystectomy was performed under fluorescence imaging in combination with white-light imaging. Operative outcomes including visualization of the extrahepatic biliary structures and operative time were compared between the patients on whom board-certified surgeons operated (feasibility phase; n = 18) and the patients on whom a surgery resident operated (educational phase; n = 33). RESULTS: There were no adverse events related to the longer interval method. The visualization rates of extrahepatic biliary structures were comparable between the two phases. Both the mean time to divide the cystic duct and the mean time to remove the gallbladder in the educational phase were significantly longer than those in the feasibility phase (68.2 vs 24.4 minutes and 30.2 vs 15.8 minutes, P < .001 each). There was no significant difference in other operative outcomes. The operative time learning curve did not decrease with a resident's experience. CONCLUSIONS: Fluorescence cholangiography with the longer interval method was feasible and could identify the extrahepatic biliary structures irrespective of the surgeon's experience; however, it did not decrease the operative time with experience.

DOI： 10.1111/ases.12939

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1245/s10434-020-09184-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The 8th edition of the American Joint Committee on Cancer (AJCC) TNM staging system provided a specific 'ypTNM' stage grouping for patients with esophageal cancer. OBJECTIVE: This study aimed to evaluate the clinical utility of the AJCC 8th edition ypTNM stage grouping for patients with esophageal squamous cell carcinoma (ESCC). METHODS: We enrolled 152 patients with ESCC who underwent surgery after neoadjuvant cisplatin plus 5-fluorouracil (CF) therapy between June 2005 and December 2011. ypStage was evaluated according to the AJCC 7th and 8th editions. Predictive performance for disease-specific survival (DSS) and overall survival (OS) was compared between both editions. The prognostic significance of ypTNM stage grouping was evaluated using univariate and multivariate analyses. RESULTS: Revision of the AJCC 7th edition to the 8th edition was associated with a change in ypStage in 96 patients (63.2%). The AJCC 8th edition revealed a better predictive performance than the 7th edition in terms of DSS (Akaike's information criterion [AIC] 499 vs. 513; Bayesian information criterion [BIC] 505 versus 519; concordance index [C-index] 0.725 versus 0.679) and OS (AIC 662 vs. 674; BIC 669 vs. 681; C-index 0.662 vs. 0.622). On univariate and multivariate analyses, ypStage in the 8th edition was an independent prognostic factor for both DSS and OS. CONCLUSIONS: ypTNM stage grouping in the AJCC 8th edition provided a better predictive performance for DSS and OS than that in the 7th edition. ypStage in the 8th edition was the most reliable prognostic factor for ESCC patients who underwent surgery after neoadjuvant CF therapy.

DOI： 10.1245/s10434-020-09181-3

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Society of Internal Medicine  

DOI： 10.2169/internalmedicine.5911-20

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Solitary fibrous tumor (SFT), a mesenchymal fibroblastic tumor with a hypervascular nature, rarely develops in the pelvis. Resection of a giant SFT occupying the pelvic cavity poses an increased risk of developing massive hemorrhage during resection, although surgical resection is the most effective treatment method for this tumor to achieve a potential cure. SFT rarely develops with Doege-Potter syndrome, which is known as a paraneoplastic syndrome characterized by non-islet cell tumor hypoglycemia (NICTH) secondary to SFT that secretes insulin-like growth factor-II (IGF-II). We present a case of a giant pelvic SFT with Doege-Potter syndrome, which was successfully treated with transcatheter arterial embolization (TAE) followed by surgical resection. CASE PRESENTATION: A 46-year-old woman presented with a disorder of consciousness due to refractory hypoglycemia. Images of the pelvis showed a giant and heterogeneously hypervascular mass displacing and compressing the rectum. Endocrinological evaluation revealed low serum levels of insulin and C-peptide consistent with NICTH. Angiography identified both the inferior mesenteric artery and the bilateral internal iliac artery as the main feeders of the tumor. To avoid intraoperative massive bleeding, super-selective TAE was performed for the tumor 2 days prior to surgery. Hypoglycemia disappeared after TAE. The tumor was resected completely, with no massive hemorrhage during resection. Histologically, it was diagnosed as IGF-II-secreting SFT. Partial necrosis of the rectum in the specimen was observed due to TAE. The patient was followed up for 2 years and no evidence of disease has been reported. CONCLUSIONS: Preoperative angiography followed by TAE is an exceedingly helpful method to reduce intraoperative hemorrhage when planning to resect SFT occupying the pelvic cavity. Complications related to ischemia should be kept in mind after TAE, which needs to be planned within 1 or 2 days before surgery. TAE for tumors may be an option in addition to medical and surgical treatment for persistent hypoglycemia in Doege-Potter syndrome.

DOI： 10.1186/s40792-020-01076-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 70-year-old man with insulinoma-associated antigen-2 autoantibodies developed diabetes mellitus (DM) without ketoacidosis after starting nivolumab to treat advanced gastric cancer. He subsequently exhibited preserved insulin-secretion capacity for over one year. Immune checkpoint inhibitors (ICIs) infrequently cause type 1 DM associated with the rapid loss of insulin secretion and ketoacidosis as an immune-related adverse event. ICIs may also cause non-insulin-dependent DM by inducing insulin resistance if there is islet autoantibody-related latent beta-cell dysfunction. The present case highlights the importance of testing blood glucose levels regularly to diagnose DM in patients treated with ICIs, even if they do not have diabetic ketoacidosis.

DOI： 10.2169/internalmedicine.3208-19

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Esophagectomy for esophageal cancer is known to lead to deterioration in respiratory function (RF). The aim of this study was to assess long-term trends in RF after esophagectomy and the impact of different operative procedures. METHODS: A total of 52 patients with thoracic esophageal cancer who were scheduled for esophagectomy from 2003 to 2012 were enrolled. We prospectively evaluated patients for vital capacity (VC), forced expiratory volume in 1 s (FEV1.0), and 6-min walk distance (6MWD) before and after esophagectomy at 3, 6, 12, 24, and 60 mo. RESULTS: Patients had mostly recovered their VC and FEV1.0 after 12 mo. After that point, VC and FEV1.0 declined again, reaching levels lower than baseline at 60 mo, with a median change ratio of 0.85 and 0.86, respectively. Although the 6MWD after open esophagectomy declined, patients treated with transhiatal esophagectomy and minimally invasive esophagectomy maintained above baseline levels throughout the follow-up period. Furthermore, we identified transhiatal esophagectomy (odds ratio [OR] = 0.03, 95% confidence interval [CI] 0.002-0.43, P = 0.01) and minimally invasive esophagectomy (OR = 0.14, 95% CI 0.02-0.94, P = 0.04) as favorable factors and postoperative pulmonary complication (OR = 9.14, 95% CI 1.22-68.6, P = 0.03) as an unfavorable factor for RF after 12 mo. Operative procedures had no significant impact on RF after 60 mo. CONCLUSIONS: Our results support the notion that RF does not recover to the baseline level, and operative procedures have no significant impact on RF at late phase after esophagectomy.

DOI： 10.1016/j.jss.2019.07.040

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: An important parameter for survival in patients with esophageal carcinoma is lymph node status. The distribution of lymph node metastases depends on tumor characteristics such as tumor location, histology, invasion depth, and on neoadjuvant treatment. The exact distribution is unknown. Neoadjuvant treatment and surgical strategy depends on the distribution pattern of nodal metastases but consensus on the extent of lymphadenectomy has not been reached. The aim of this study is to determine the distribution of lymph node metastases in patients with resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed. This can be the foundation for a uniform worldwide staging system and establishment of the optimal surgical strategy for esophageal cancer patients. METHODS: The TIGER study is an international observational cohort study with 50 participating centers. Patients with a resectable esophageal or gastro-esophageal junction carcinoma in whom a transthoracic esophagectomy with a 2- or 3-field lymphadenectomy is performed in participating centers will be included. All lymph node stations will be excised and separately individually analyzed by pathological examination. The aim is to include 5000 patients. The primary endpoint is the distribution of lymph node metastases in esophageal and esophago-gastric junction carcinoma specimens following transthoracic esophagectomy with at least 2-field lymphadenectomy in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and (disease free) survival. DISCUSSION: The TIGER study will provide a roadmap of the location of lymph node metastases in relation to tumor histology, tumor location, invasion depth, number of lymph nodes and lymph node metastases, pre-operative diagnostics, neo-adjuvant therapy and survival. Patient-tailored treatment can be developed based on these results, such as the optimal radiation field and extent of lymphadenectomy based on the primary tumor characteristics. TRIAL REGISTRATION: NCT03222895 , date of registration: July 19th, 2017.

DOI： 10.1186/s12885-019-5761-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The aim of this study was to assess the clinical outcomes of palliative interventions for patients with incurable locally advanced or metastatic esophageal carcinoma. METHODS: A total of 131 patients with thoracic esophageal carcinoma who underwent palliative interventions were enrolled. Insertion of a self-expandable metallic stent (SEMS), tube enterostomy for enteral nutrition (EN), and palliative esophagectomy (PE) were performed in 38, 65, and 28 patients, respectively. The clinicopathological characteristics and clinical outcomes of each group were retrospectively reviewed. RESULTS: Patients in the EN group frequently received chemoradiotherapy (P < 0.01). SEMS insertion, but not PE or EN, improved the mean dysphagia score after the intervention (P < 0.01). For the SEMS, EN, and PE groups, the occurrence of intervention-related complications was 31.6, 10.8, and 96.4%, respectively, the median survival time was 88, 208, and 226 days (P < 0.01), and the mean ratio of duration of home care to survival time was 28.9, 38.5, and 39.6% (P = 0.95). CONCLUSIONS: SEMS insertion effectively relieved obstructive symptoms, but had no survival benefit. Tube enterostomy showed a low complication rate and has the potential to improve survival in combination with additional treatment, with no palliation of obstructive symptoms.

DOI： 10.1007/s10388-019-00665-0

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担当区分：責任著者   掲載種別：研究論文（学術雑誌）   出版者・発行元：International College of Surgeons  

Gastric carcinoma is one of the most common secondary malignancies in esophageal cancer patients. We herein report our surgical procedure for esophageal reconstruction in esophageal cancer patients associated with synchronous or metachronous early gastric adenocarcinoma. Gastric adenocarcinoma was removed by pyloroantrectomy with preservation of the right gastroepiploic artery and vein, and a pedunculated short gastric tube was used as an esophageal substitute in a Roux-en-Y fashion. Surgical data of 6 esophageal cancer patients who underwent this type of surgery between 1993 and 2012 were analyzed. Three patients had synchronous early gastric carcinoma and the remaining 3 patients had metachronous early gastric adenocarcinoma. The gastric tube was easily pulled up to the neck and no problems occurred during this procedure. Postoperative complications, including leakage of esophagogastrostomy, acute respiratory failure, and diffuse peritonitis, were observed in 3 patients. No patients suffered from necrosis of the gastric tube. Although 3 patients died of other diseases, gastric cancer recurrence has not been observed to date. Despite the need for precaution to ensure technical safety, pyloroantrectomy and esophageal reconstruction using a pedunculated short gastric-tube are oncologically feasible as a potential curative surgery for esophageal cancer patients with early gastric adenocarcinoma.

DOI： 10.9738/intsurg-d-16-00011.1

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Surgical stress and inflammation can cause hyperbilirubinemia, which sometimes occurs after esophagectomy for esophageal cancer (EC). The aim of this study was to elucidate the clinical significance of postoperative hyperbilirubinemia in the management of EC patients. Materials and methods: We retrospectively reviewed records of 81 EC patients who underwent esophagectomy from 2009 to 2014. We compared the clinicopathological and perioperative factors, including the presence of hyperbilirubinemia (total bilirubin ≥1.5 mg/dL), between patients with postoperative infectious complications (PIC group) and those without (Non-PIC group). Results: PIC developed in 52 patients (64.2%). There were significant differences in incidence of postoperative hyperbilirubinemia between the PIC group and the non-PIC group (34.6% vs. 3.4%, P = 0.002), as well as the approach of esophagectomy (P = 0.045), the surgical duration (469 vs. 389 min, P < 0.001), the amount of blood loss (420 vs. 300 mL, P = 0.018), the frequency of intraoperative blood transfusions (32.7% vs. 6.9%, P = 0.012) and the peak postoperative C-reactive protein level (17.3 vs. 8.6 mg/dL, P = 0.007). Multivariate analysis revealed hyperbilirubinemia was independently associated with the occurrence of PICs (odds ratio: 38.6, P = 0.010). The median time to the diagnosis of hyperbilirubinemia was significantly shorter than that of PICs (3.0 vs. 4.5 days, P = 0.025). Conclusions: Postoperative hyperbilirubinemia was associated with the occurrence of PICs and frequently occurred before any PICs become apparent. More attention should be paid to the serum bilirubin level in the management after esophagectomy for EC.

DOI： 10.1016/j.amsu.2019.02.004

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記述言語：英語  

A 76-year-old male received concurrent chemoradiotherapy, at a dose of 60 Gy with low-dose 5-fluorouracil, for cT1bN0M0 squamous cell carcinoma of the mid-thoracic esophagus. Because his primary tumor relapsed with mediastinal and right supraclavicular node metastasis 4 months after completion of chemoradiotherapy, right transthoracic esophagectomy with mediastinal and right cervical lymphadenectomy was performed. However, metastatic tumors developed deep beneath the anterior border of the trapezius muscle 2 months after esophagectomy. En bloc dissection of the adipose tissue including the tumor and the transverse cervical artery was performed, followed by adjuvant radiotherapy of 50.4 Gy to the area of dissection. The patient died of pneumonia 11 months after metastasectomy, with locally recurrent disease. We have had three cases of this unusual lymph nodes metastasis from cancer of the thoracic esophagus to date and here present the characteristic imaging findings and the possible mechanism of this unusual lymph node metastasis.

DOI： 10.1093/jscr/rjy214

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Small bowel obstruction (SBO) remains a common complication after pelvic or abdominal surgery. However, the risk factors for SBO in ulcerative colitis (UC) surgery are not well known. The aim of the present study was to clarify the risk factors associated with SBO after ileal pouch-anal anastomosis (IPAA) with a loop ileostomy for patients with UC. METHODS: The medical records of 96 patients who underwent IPAA for UC between 1999 and 2011 were reviewed. SBO was confirmed based on the presence of clinical symptoms and radiographic findings. The patients were divided into 2 groups: the SBO group and the non-SBO group. We also analyzed the relationship between SBO and computed tomography (CT) scan image parameters. RESULTS: The study included 49 male and 47 female patients. The median age was 35.5 years (range, 14-72 years). We performed a 2- or 3-stage procedure as a total proctocolectomy and IPAA for patients with UC. SBO in the pretakedown of the loop ileostomy after IPAA occurred in 22 patients (22.9%). Moreover, surgical intervention for SBO was required for 11 patients. In brief, closure of the loop ileostomy was performed earlier than expected. A multivariate logistic regression analysis revealed that the 2-stage procedure (odds ratio, 2.850; 95% confidence interval, 1.009-8.044; P = 0.048) was a significant independent risk factor associated with SBO. CT scan image parameters were not significant risk factors of SBO. CONCLUSION: The present study suggests that a 2-stage procedure is a significant risk factor associated with SBO after IPAA in patients with UC.

DOI： 10.3393/ac.2017.06.14

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

BACKGROUND: The aim of this study was to investigate the possible prognostic factors and predictive accuracy of the Glasgow Prognostic Score (GPS) for patients with unresectable locally advanced esophageal squamous cell carcinoma (LAESCC) treated with chemoradiotherapy. METHODS: One hundred forty-two patients were enrolled in JCOG0303 and assigned to the standard cisplatin and 5-fluorouracil (PF)-radiotherapy (RT) group or the low-dose PF-RT group. One hundred thirty-one patients with sufficient data were included in this analysis. A Cox regression model was used to analyze the prognostic factors of patients with unresectable LAESCC treated with PF-RT. The GPS was classified based on the baseline C-reactive protein (CRP) and serum albumin levels. Patients with CRP ≤1.0 mg/dL and albumin ≥3.5 g/dL were classified as GPS0. If only CRP was increased or only albumin was decreased, the patients were classified as GPS1, and the patients with CRP >1.0 mg/dL and albumin <3.5 g/dL were classified as GPS2. RESULTS: The patients' backgrounds were as follows: median age (range), 62 (37-75); male/female, 119/12; ECOG PS 0/1/2, 64/65/2; and clinical stage (UICC 5th) IIB/III/IVA/IVB, 3/75/22/31. Multivariable analyses indicated only esophageal stenosis as a common factor for poor prognosis. In addition, overall survival tended to decrease according to the GPS subgroups (median survival time (months): GPS0/GPS1/GPS2 16.1/14.9/8.7). CONCLUSIONS: Esophageal stenosis was identified as a candidate stratification factor for randomized trials of unresectable LAESCC patients. Furthermore, GPS represents a prognostic factor for LAESCC patients treated with chemoradiotherapy. CLINICAL TRIAL INFORMATION: UMIN000000861.

DOI： 10.1007/s10147-017-1154-6

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その他リンク： http://link.springer.com/content/pdf/10.1007/s10147-017-1154-6.pdf

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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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記述言語：英語  

A 75-year-old male received neoadjuvant chemotherapy for locally advanced squamous cell carcinoma of the mid-thoracic esophagus, followed by right transthoracic esophagectomy with extended mediastinal lymphadenectomy. Cardiac tamponade developed on postoperative Days 1 and 13, for which emergency ultrasound-guided drainage was required. Pericardial drainage fluid became chylous after administration of polymeric formula. A computed tomography scan demonstrated the presence of a retrocardiac fluid collection, encompassed by the left pulmonary vein and left atrium, descending aorta and vertebral column. Based on these findings, the diagnosis of chylopericardial tamponade communicating with a posterior mediastinal chylocele was made. The ligation of the thoracic duct was successfully performed via the left-sided thoracoscopic approach on postoperative Day 20 and the clinical course after the second operation was uneventful. The possible mechanisms of this exceptionally rare complication after esophagectomy were discussed.

DOI： 10.1093/jscr/rjx216

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A prospective randomized study was performed to investigate the validity of intravenous carnitine administration during postoperative parenteral nutrition (PN) with lipid emulsion. METHODS: Patients undergoing surgery for gastric or colorectal cancer were enrolled in the study and were randomly divided into two groups (n = 8 in each group): 1) group L, who received a peripheral PN (PPN) solution of 7.5% glucose, 30% amino acid, and 20% lipid emulsion; and 2) group LC, who received the same PPN solution, as well as carnitine intravenously. PPN was performed from postoperative day (POD) 1 to POD4. Clinical and laboratory parameters were compared between the two groups; statistical significance was set at P < 0.05. RESULTS: Serum carnitine concentrations were significantly higher in group LC on POD3 (P < 0.01) and POD7 (P = 0.01). Postoperative changes in laboratory parameters and morbidity were comparable between the two groups. However, the decrease in C-reactive protein from POD3 to POD7 was significantly greater in group LC than in group L (P = 0.011). CONCLUSION: The results show that intravenous carnitine administration in addition to PN is safe and may be beneficial for recovery from postoperative inflammatory reactions.

DOI： 10.14740/jocmr3113w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Benign esophageal tumors are uncommon, comprising approximately 2% of esophageal tumors. Esophageal schwannomas constitute an even rarer entity, with few cases reported in the literature. CASE PRESENTATION: We present a 66-year-old male who was referred for dysphagia. A computed tomography scan showed a well-demarcated, enhancing, and homogenous esophageal tumor measuring 50 mm. The tumor was hypermetabolic on positron emission tomography, and an endoscopic ultrasound-guided fine needle aspiration demonstrated the presence of benign spindle cells. We performed an uncomplicated, simple, tumor enucleation through a cervical approach. Histology revealed spindle-shaped cells in a fasciculated, disarrayed pattern. Immunohistochemistry demonstrated positive staining for S-100 protein and negative staining for KIT, CD34, desmin, and α-smooth muscle actin. These findings were consistent with a benign esophageal schwannoma. CONCLUSIONS: We report our experience with esophageal schwannoma, a rare but benign diagnosis of the esophagus.

DOI： 10.1186/s40792-017-0369-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Aim: To investigate the appropriate extent of lymphadenectomy for squamous cell carcinoma (SCC) of the esophagogastric junction (ECJ).
Methods: We retrospectively reviewed the cases of 52 patients with SCC of the ECJ who underwent extended mediastinal lymphadenectomy. We assessed potential risk factors for lymph node metastasis (LNM) in the upper/middle mediastinum by conducting univariate and multivariate analyses, and a receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive value. Survival rates were calculated using the Kaplan-Meier method, and the therapeutic value index of each nodal basin dissection was calculated by multiplying the frequency of metastasis at the basin and the 5-year overall survival rate of patients with metastasis at that basin.
Results: Twenty patients (38%) had mediastinal LNM; 13 (25%) had metastasis in the upper/middle mediastinum, and 13 (25%) had metastasis in the lower mediastinum. Tumor length (P = 0.03) and pathological nodal status (P = 0.01) were independent risk factors for upper/middle mediastinal LNM. The optimal ROC cutoff value of tumor length was 54 mm. The 5-year overall survival rate of the patients with LNM in the upper/middle mediastinum was 46%. The therapeutic value index of upper/middle mediastinal lymphadenectomy was 11.6, which was inferior to that of perigastric lymphadenectomy at 17.3, but superior to that of lower mediastinal lymphadenectomy at 5.8.
Conclusion: An upper/middle mediastinal lymphadenectomy may be required for patients with tumors that are &gt;= 54 mm long, and in those with suspected LNM. (C) 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ijsu.2017.07.041

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：OXFORD UNIV PRESS  

Objective: Although poorly differentiated cluster has been reported to be a useful grading system for predicting prognosis in colorectal cancer, its relationship to chemotherapy efficacy has not been demonstrated. We aimed to investigate the association between poorly differentiated cluster and the efficacy of 5-fluorouracil-based adjuvant chemotherapy in stage III colorectal cancer.
Methods: This retrospective study enrolled 131 patients with stage III colorectal cancer who underwent curative resection: 72 received 5-fluorouracil-based adjuvant chemotherapy (chemotherapy group) and 59 did not (surgery-alone group). Poorly differentiated cluster was defined as a cancer cluster of &gt;= 5 cancer cells without gland-like structure, and was classified into poorly differentiated cluster G1, G2 and G3 according to the number of clusters. The benefit of 5-fluorouracil-based adjuvant chemotherapy was evaluated based on poorly differentiated cluster grade.
Results: Thirty-nine, 40 and 52 patients were classified as poorly differentiated cluster G1, G2 and G3, respectively. Significant differences in the 5-year cumulative recurrence rate and relapse-free survival were observed between poorly differentiated cluster G1/G2 and G3 (26.7% vs. 47.5%, P = 0.010; 66.0% vs. 43.9%, P = 0.004). A comparison of cumulative recurrence rate and relapse-free survival between the chemotherapy and surgery-alone groups showed a significant benefit of adjuvant chemotherapy in poorly differentiated cluster G1/G2 patients (cumulative recurrence rate: 17.4% vs. 37.3%, P = 0.035; relapse-free survival: 79.5% vs. 51.9%, P = 0.002), but not in poorly differentiated cluster G3 patients (cumulative recurrence rate: 48.6% vs. 44.8%, P = 0.885; relapse-free survival: 51.4% vs. 32.7%, P = 0.068).
Conclusions: In stage III colorectal cancer, poorly differentiated cluster G1/G2 predicts a significant benefit from 5-fluorouracil-based adjuvant chemotherapy, whereas poorly differentiated cluster G3 predicts a poor response to it.

DOI： 10.1093/jjco/hyw209

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Introduction: The elucidation of the clinical impact of comorbidities is important to optimize the treatment and follow-up strategy in oesophageal cancer. We aimed to clarify the surgical and long-term outcomes following oesophagectomy in oesophageal cancer patients with comorbidity.
Methods: A total of 658 consecutive patients who underwent oesophagectomy for oesophageal cancer between 1985 and 2008 at our institution were enrolled. Based on the criteria of comorbidity as we defined it, we retrospectively reviewed and compared the surgical outcomes and survival between the comorbid (n= 251) and non-comorbid group (n=407).
Results: Postoperative morbidity and mortality were not significantly different between the two groups. The 5-year overall survival rate of the comorbid group was significantly lower (39.3% vs. 45.2%, adjusted HR = 1.31, 95% CI: 1.07-1.62) but the 5-year disease-specific survival rate was not significantly different between the comorbid and non-comorbid groups (53.9% vs. 53.1%, adjusted HR = 1.11, 95% CI: 0.86 -1.42). The 5-year incidence rate of death from other diseases in the comorbid group was significantly higher than that in the non-comorbid group (26.7% vs. 14.8%, P &lt; 0.01). The leading cause of death from other diseases was pneumonia.
Conclusions: Oesophagectomy in oesophageal cancer patients with comorbidity can be safely performed. However, the overall survival after oesophagectomy in these patients was unfavorable because of the high incidence of death from other diseases, especially pneumonia. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ijsu.2016.10.041

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND AIMS: Transthoracic esophagectomy using 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most aggressive gastrointestinal surgeries. Early enteral nutrition (EN) for TTE-3FL patients is useful and valid for early recovery; however, EN using a fat-containing formula risks inducing chyle leak. In the present study, we retrospectively examined esophageal cancer patients treated byTTE-3FL and administered postoperative EN to elucidate the validity of lowering the fat levels in elemental formulas to prevent postoperative chyle leak and improve postoperative recovery. METHODS: A total of 74 patients who received TTE-3FL for esophageal cancer were retrospectively examined. Patients were classified into two groups according to the type of postoperative EN: Group LF patients received a low-fat elemental formula, and Group F patients received a standard fat-containing polymeric formula. The following clinical factors were compared between the groups: EN start day, maximum EN calories administered, duration of respirator use, length of ICU stay, incidence of postoperative infectious complications, use of parenteral nutrition (PN), and incidence of postoperative chyle leak. RESULTS: Patients in Group LF were started on EN significantly earlier after surgery and they consumed significantly higher maximum EN calories compared to Group F patients (P < 0.01). Duration of respirator use and length of ICU stay were also significantly shorter, and TPN was used significantly less in Group LF compared to Group F (P < 0.05). Postoperative chyle leak was observed in six patients in total (8.1%); five patients in Group F and one patient in Group LF, although there was no significant difference in frequency of chyle leak per patient between Group LF and Group F. CONCLUSIONS: Early EN using low-fat elemental formula after esophagectomy with three-field lymphadenectomy was safe and valid for postoperative recovery and potentially useful in preventing chyle leak.

DOI： 10.1016/j.clnu.2016.03.018

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：ELSEVIER SCIENCE BV  

Background: Prognoses vary substantially among patients with advanced gastric cancer following curative surgery. The aim of the current study was to develop and verify the validity of a novel nomogram that predicts the probability of 5-year relapse-free survival (RFS) in patients who underwent curative resection for stage II/III gastric cancer.
Materials and methods: A nomogram to predict 5-year RFS following surgical resection of gastric cancer was constructed based on the data of patients who underwent surgery for primary gastric carcinoma at three institutions in Japan in January 2001-December 2006. Multivariate analysis using a Cox proportional hazards regression model was performed, and the nomogram's predictive accuracy (discrimination) and the agreement between observed outcomes and predictions (calibration) were evaluated by internal validation.
Results: Multivariate analyses revealed that age at operation, depth of tumor, tumor location, lymph node classification, and presence of combined resection were significant prognostic factors for RFS. In the internal validation, discrimination of the developed nomogram for 5-year RFS was superior to that of the American Joint Committee on Cancer TNM classification (concordance indices of 0.80 versus 0.67; P &lt; 0.001). Moreover, calibration appeared to be accurate. Based on these results, we have created free software to more easily predict 5-year RFS.
Conclusion: We developed and validated a nomogram to predict 5-year RFS after curative surgery for stage II/III gastric cancer. This tool will be useful for the assessing a patient's individual recurrence risk when considering additional therapy in clinical practice. (C) 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ijsu.2016.09.080

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 63-year-old man with epigastralgia was referred to our hospital and diagnosed with simultaneous multiple gastric cancers. One lesion was type 2 advanced and the other was type 0- II c early gastric cancer. CT examination revealed 4 regional lymph node metastases. Neoadjuvant chemotherapy(NAC)with docetaxel/CDDP/S-1was administered. After 2 courses of NAC, total gastrectomy with D2(-No. 10), lymphadenectomy was performed. The pathological response to NAC was judged to be Grade 3 for advanced gastric cancer and Grade 0 for early gastric cancer. The patient is alive with no evidence of disease during the 10 months after the operation.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 57-year-old man with advanced gastric cancer and multiple liver metastases was referred to our hospital. He underwent a palliative gastrectomy to treat hemorrhage, and S-1 and cisplatin therapy was administered. After 7 courses of chemotherapy, a new liver metastatic lesion and a tumor thrombus in the right portal vein appeared. Moreover, the serum level of ammonia was elevated(296 mg/dL)following a consciousness disorder. Enhanced CT revealed an inferior mesenteric vein to left renal vein shunt, which led to the diagnosis of portal systemic encephalopathy due to portosystemic shunt. Percutaneous transvenous coil embolization was performed. The serum ammonia level decreased, and the encephalopathy disappeared. As a result, he was able to continue chemotherapy.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We report a case of advanced gastric cancer(AGC)that was resected for rebleeding after palliative radiotherapy for hemostasis. A 74-year-old man with Stage IV gastric cancer received chemotherapy and achieved stable disease. After 23 months, he experienced continuous bleeding from the tumor due to regrowth. Palliative radiotherapy was conducted to control the bleeding, and the tumor successfully achieved hemostasis. However, 6 weeks later, the patient experienced rebleeding and developed hemostatic shock. We then performed a successful emergency gastrectomy. Bleeding negatively affects quality of life in patients with AGC and is potentially lethal. Although palliative radiotherapy for bleeding of gastric cancer is a safe and useful treatment within a short time frame in cases of rebleeding, emergency gastrectomy may be necessary. Therefore, when we select this treatment, the possibility of subsequent surgical treatment must be considered.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with unresectable hepatocellular carcinoma (HCC) cannot generally be cured by systemic chemotherapy or radiotherapy due to their poor response to conventional therapeutic agents. The development of novel and efficient targeted therapies to increase their treatment options depends on the elucidation of the molecular mechanisms that underlie the pathogenesis of HCC. The DNA damage response (DDR) is a network of cell-signaling events that are triggered by DNA damage. Its dysregulation is thought to be one of the key mechanisms underlying the generation of HCC. Sphingosine-1-phosphate (S1P), a lipid mediator, has emerged as an important signaling molecule that has been found to be involved in many cellular functions. In the liver, the alteration of S1P signaling potentially affects the DDR pathways. In this review, we explore the role of the DDR in hepatocarcinogenesis of various etiologies, including hepatitis B and C infection and non-alcoholic steatohepatitis. Furthermore, we discuss the metabolism and functions of S1P that may affect the hepatic DDR. The elucidation of the pathogenic role of S1P may create new avenues of research into therapeutic strategies for patients with HCC.

DOI： 10.1007/s00595-015-1270-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The presence of extramural tumor deposits without lymph node structure (EX) is an important prognostic factor for patients with colorectal cancer. However, the clinical significance of EX in the lateral pelvic lymph node area (LP-EX) remains unclear. This study aimed to determine the prognostic implications of LP-EX for patients with low rectal cancer.
This retrospective study involved 172 consecutive patients with stage 2 or 3 low rectal cancer who underwent curative surgery including lateral pelvic lymph node (LPLN) dissection. The patients were classified into the following three groups according to the metastatic status of the LPLN area: patients without metastasis (no-LP-M group), patients with lymph node metastasis (LP-LNM group), and patients with EX (LP-EX group). Potential prognostic factors of overall survival (OS) and relapse-free survival (RFS) were identified in uni- and multivariate analyses.
Classification assigned 131 patients (76 %) to the no-LP-M group, 27 patients (16 %) to the LP-LNM group, and 14 patients (8 %) to the LP-EX group. The 5-year OS rate was 80.3 % in the no-LP-M group, 61.1 % in the LP-LNM group, and 34.9 % in the LP-EX group (P &lt; 0.001). The corresponding 5-year RFS rates were 62.2, 33.8, and 14.3 %, respectively (P &lt; 0.001). A multivariate Cox proportional hazards regression analysis showed that the presence of LP-EX was an independent prognostic factor for OS (P = 0.006) and RFS (P = 0.001).
The LP-EX classification is a useful pathologic parameter that can be used to stratify patients with metastasis in the LPLN area.

DOI： 10.1245/s10434-016-5379-9

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

BACKGROUND: Tumor budding is recognized as an important risk factor for lymph node metastasis in pT1 colorectal cancer. Immunohistochemical staining for cytokeratin has the potential to improve the objective diagnosis of tumor budding over detection based on hematoxylin and eosin staining. However, it remains unclear whether tumor budding detected by immunohistochemical staining is a significant predictor of lymph node metastasis in pT1 colorectal cancer.
OBJECTIVE: The purpose of this study was to clarify the clinical significance of tumor budding detected by immunohistochemical staining in comparison with that detected by hematoxylin and eosin staining.
DESIGN: This was a retrospective study.
SETTINGS: The study was conducted at Niigata University Medical & Dental Hospital.
PATIENTS: We enrolled 265 patients with pT1 colorectal cancer who underwent surgery with lymph node dissection.
MAIN OUTCOME MEASURES: Tumor budding was evaluated by both hematoxylin and eosin and immunohistochemical staining with the use of CAM5.2 antibody. Receiver operating characteristic curve analyses were conducted to determine the optimal cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining. Univariate and multivariate analyses were performed to identify the significant factors for predicting lymph node metastasis.
RESULTS: Receiver operating characteristic curve analyses revealed that the cutoff values for tumor budding detected by hematoxylin and eosin and CAM5.2 staining for predicting lymph node metastases were 5 and 8. On multivariate analysis, histopathological differentiation (OR, 6.21; 95% CI, 1.16-33.33; p = 0.03) and tumor budding detected by hematoxylin and eosin staining (OR, 4.91; 95% CI, 1.64-14.66; p = 0.004) were significant predictors for lymph node metastasis; however, tumor budding detected by CAM5.2 staining was not a significant predictor.
LIMITATIONS: This study was limited by potential selection bias because surgically resected specimens were collected instead of endoscopically resected specimens.
CONCLUSIONS: Tumor budding detected by CAM5.2 staining was not superior to hematoxylin and eosin staining for predicting lymph node metastasis in pT1 colorectal cancer.

DOI： 10.1097/DCR.0000000000000567

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical resection should be considered for isolated locally recurrent retroperitoneal liposarcomas. We experienced a case of successful re-resection for locally recurrent retroperitoneal liposarcomas 4 years after ex vivo tumor resection and autotransplantation of the liver. A 75-year-old man was admitted to our hospital. His diagnosis was local recurrence of liposarcomas. He had previously undergone ex vivo tumor resection and autologous orthotopic liver transplantation for a retroperitoneal tumor 4 years earlier. The resected tumor size was 23.5 × 15.5 × 12.5 cm. The tumor was revealed by means of histopathologic study to be a myxoid liposarcoma. Follow-up computerized tomography showed 2 recurrent tumors in the retropancreatic and para-aortic lesions. Although adhesion was severe within the operative field, we successfully performed complete en bloc re-resection of each recurrent tumor. The operative time was 250 minutes, and blood loss was 300 mL. The resected tumor sizes were 3.9 × 3.2 × 1.5 cm and 4.5 × 3.3 × 3.0 cm. The tumors were revealed by means of histopathologic study to be dedifferentiated liposarcomas. Postoperative complications included intestinal obstruction and colocutaneous fistula formation, both of which were treated surgically. The patient was discharged in an ambulatory state at 80 days after re-resection of the recurrent tumors. At the time of writing, he was alive with no evidence of recurrence, 14 months after re-resection and 62 months after primary ex vivo tumor resection. This is the first case of successful surgical re-resection for locally recurrent liposarcoma after ex vivo tumor resection and autotransplantation of the liver.

DOI： 10.1016/j.transproceed.2016.01.026

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endoscopic management of acute necrotic pancreatitis and walled off necrosis is less invasive than surgical treatment and has become the 1st choice for treating pancreatic necrosis and abscess. We treated a case of acute necrotic pancreatitis and walled off necrosis after auxiliary partial orthotopic living-donor liver transplantation (APOLT). A 24-year-old woman was admitted to our university hospital for removal of the internal biliary stent, which had already been placed endoscopically for the treatment of biliary stricture after APOLT. She had been treated for acute liver failure by APOLT 10 years before. After we removed the internal stent with the use of an endoscopic retrograde approach, she presented with severe abdominal pain and a high fever. Her diagnosis was severe acute pancreatitis after endoscopic retrograde cholangiography (ERC). Her symptoms worsened, and she had multiple organ failure. She was transferred to the intensive care unit (ICU). Immunosuppression was discontinued because infection treatment was necessary and the native liver had already recovered sufficiently. After she had been treated for 19 days in the ICU, she recovered from her multiple organ failure. However, abdominal computerized tomography demonstrated the formation of pancreatic walled off necrosis and an abscess on the 20th day after ERC. We performed endoscopic ultrasonography-guided abscess drainage and repeated endoscopic necrosectomy. The walled off necrosis diminished gradually in size, and the symptoms disappeared. The patient was discharged on the 87th day after ERC. This is the 1st report of a case of acute necrotic pancreatitis and walled off necrosis that was successfully treated by endoscopic management after APOLT.

DOI： 10.1016/j.transproceed.2015.12.113

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Complete immune tolerance is the chief goal in organ transplantation. This study aimed to evaluate patients who successfully withdrew from immunosuppressive (IS) agents after living donor liver transplantation (LDLT). MATERIALS AND METHODS: A retrospective review of all adult LDLT from July 1999 to March 2012 was conducted. In patients who acquired immune tolerance after LDLT, their background and the course of surgical procedures were evaluated. RESULTS: Of a total of 101 adult LDLT patients, 8 patients were completely free of IS agents. Six of these patients (75%) were female, and the median age at the time of transplantation was 56 years (range, 31-66 years). The primary disease causing liver failure was type C liver cirrhosis (50%), fulminant hepatitis (25%), type B liver cirrhosis (12%), and alcoholic liver cirrhosis (12%). The median Child-Pugh score and MELD score were 13 points (range, 8-15 points) and 19 points (range, 10-18 points), respectively. The living related donor was the recipient's child (75%), sibling (12%), or parent (12%). ABO compatibility was identical in 62%, compatible in 25%, and incompatible in 12%. CONCLUSIONS: In this study, we evaluated the adult patients who successfully withdrew from IS agents after LDLT. In most cases, it took more than 5 years to reduce IS agents. Because monitoring of the serum transaminase level is not adequate to detect chronic liver fibrosis in immune tolerance cases, further study is required to find appropriate protocols for reducing IS agent use after LDLT.

DOI： 10.1016/j.transproceed.2015.12.093

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Long-term graft survival of partial pancreas auto-transplantation after total pancreatectomy has not been clarified. The clinical implications of repeat completion pancreatectomy for locally recurrent pancreatic carcinoma in the remnant pancreas after initial pancreatectomy also have not been clarified. METHODS: We have previously reported a 61-year-old woman presenting with re-sectable carcinoma of the remnant pancreas at 3 years after undergoing a pylorus-preserving pancreaticoduodenectomy for invasive ductal carcinoma of the pancreas head. We also performed distal pancreas auto-transplantation with the use of a part of the resected pancreas to preserve endocrine function. RESULTS: The patient was discharged at 20 days after surgery without any complications. She had been followed regularly in our outpatient clinic. She had been treated with S-1 as adjuvant chemotherapy; 72 months after the completion total pancreatectomy with distal partial pancreas auto-transplantation, the patient was alive without any evidence of the pancreatic carcinoma recurrence. The pancreas graft was still functioning with a blood glucose level of 112 mg/dL, HbA1C of 6.7%, and serum C-peptide of 1.2 ng/mL; and urinary C-peptide was 11.6 μg/d. CONCLUSIONS: Our patient demonstrated that repeated pancreatectomies can provide a chance for survival after a locally recurrent pancreatic carcinoma if the disease is limited to the remnant pancreas. An additional partial pancreas auto-transplantation was successfully performed to preserve endocrine function. However, the indications for pancreas auto-transplantation should be decided carefully in the context of pancreatic carcinoma recurrence.

DOI： 10.1016/j.transproceed.2016.01.030

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Patients undergoing imatinib therapy for gastrointestinal stromal tumors (GISTs) show drug resistance during treatment in the late stages. The aims of this study were to determine survival after the appearance of imatinib secondary resistance (ISR) and to identify the prognostic factors. METHODS: Eligible were patients with unresectable and metastatic GISTs who were diagnosed with ISR and/or underwent treatment for ISR in our institution between 2001 and 2012. A total of 48 patients were enrolled and overall survival was retrospectively analyzed. The Cox proportional hazards model was used to identify the independent prognostic factors. Median follow-up time was 58 months. RESULTS: As of the cutoff date, 41 of the 48 patients with ISR had died, of which 39 died of GISTs. The overall 1-, 3-, and 5-year survival rates of the 48 patients were 64.6, 32.8, and 20.4 %, respectively, and median survival time was 22 months. The favorable independent prognostic factors identified were long progression-free survival in first-line imatinib therapy (P = 0.04), small diameter of progressive disease (PD) (P = 0.02), and surgical resection of PD (P = 0.01). CONCLUSION: Surgical resection of PD in selected cases could improve prognosis in ISR patients undergoing GIST treatment.

DOI： 10.1007/s10147-015-0903-7

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掲載種別：研究論文（学術雑誌）  

A 63-year-old woman was found to have a mass in her right breast and visited our hospital to undergo a detailed examination. A histopathological examination by using ultrasound-guided core needle biopsy revealed ductal carcinoma in situ. A partial mastectomy with sentinel lymph node biopsy was performed for the cancer of the right breast. The postoperative histopathological examination indicated apocrine carcinoma with a predominantly intraductal component without lymph node metastasis. The discrimination between ductal adenoma and apocrine carcinoma sometimes becomes a problem in making decisions about treatment. We need to take care when making a diagnosis.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

This study aimed to compare the utility of the number of positive lymph nodes with the lymph node ratio (LNR) in predicting survival after resection of extrahepatic cholangiocarcinoma.
A retrospective analysis of 142 consecutive patients who underwent radical resection of extrahepatic cholangiocarcinoma was performed. A total of 3066 regional lymph nodes were resected. The median number of nodes per patient was 21. The optimal cutoff values for the number of positive nodes and the LNR were determined using the Chi square scores calculated by the Cox proportional hazards regression model.
Nodal disease was found in 59 patients (42 %). In the subsequent analysis of the impact that nodal status has on survival, 18 patients with R1/2 resection and 6 patients with paraaortic nodal disease who did not survive for more than 5 years after resection were excluded. The optimal cutoff value for the number of positive nodes was 1, and the optimal cutoff value for the LNR was 5 %. Univariate analysis identified both the number of positive nodes (0, 1, or a parts per thousand yen2; P = 0.005) and the LNR (0, 0-5, or &gt; 5 %; P = 0.007) as significant prognostic factors. Multivariate analysis identified the number of positive nodes but not the LNR as an independent prognostic factor (P = 0.012). The 5-year survival rates were 64 % for the patients with no positive nodes, 46 % for the patients with one positive node, and 28 % for the patients with two or more positive nodes.
The number of positive lymph nodes predicts survival better than the LNR after resection of extrahepatic cholangiocarcinoma, provided that nodal evaluation is sufficient.

DOI： 10.1245/s10434-015-4609-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

The objectives of this study were to assess the incidence of recurrent laryngeal nerve paralysis (RLNP) using laryngoscopy after esophagectomy for thoracic esophageal carcinoma and to clarify the risk factors influencing postoperative RLNP.
A total of 299 patients who underwent laryngoscopic examination after esophagectomy were retrospectively reviewed. Patients who were found to have postoperative RLNP were followed up every 1-3 months, with a median follow-up period of 3 months. Recovery from paralysis was also evaluated on the basis of each affected nerve. Multivariate analyses using logistic regression were used to identify independent risk factors for RLNP. Cumulative recovery rate was calculated using Kaplan-Meier method.
A total of 178 (59.5 %) patients were diagnosed with RLNP by first laryngoscopy [bilateral in 59 (33.1 %) patients, right in 15 (8.4 %), and left in 104 (58.4 %)]. In 206 patients who underwent transthoracic and thoracoscopic esophagectomy, independent risk factors for RLNP were lymph node dissection along the right RLN (odds ratio [OR] 3.01, 95 % confidence interval [CI] 1.06-8.54, P = 0.04) and cervical anastomosis (OR 5.94, 95 % CI 1.78-19.80, P &lt; 0.01). Cumulative recovery rate from RLNP was 61.7 % at 12 months after esophagectomy with 91 nerves eventually recovering from paralysis. Median recovery time was 6 months.
RLNP developed in 60 % of patients after esophagectomy and may be associated with lymphadenectomy around the right RLN and cervical esophageal mobilization. Although 62 % of affected nerves recovered within 12 months, great attention should be given when performing these procedures.

DOI： 10.1007/s00268-015-3261-8

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：E-CENTURY PUBLISHING CORP  

NAD(P) H:quinone oxidoreductase-1 (NQO1) confers resistance to anticancer agents, particularly to oxidative stress inducers such as cisplatin or 5-fluorouracil in malignant tumors. Here we evaluated the association between NQO1 expression in esophageal squamous cell carcinoma (ESCC) cells and the patients' responses to preoperative chemotherapy with cisplatin and 5-fluorouracil (CF), and we elucidated the prognostic significance of NQO1 expression in ESCC patients. We retrospectively analyzed the cases of 40 patients who underwent preoperative CF therapy followed by curative esophagectomy with lymphadenectomy. Immunohistochemistry of the surgically resected specimens was conducted using the primary monoclonal antibody against NQO1. Eighteen of the 40 patients (45%) had tumors that showed high NQO1 expression (NQO1-high group). The poorer histological response to preoperative CF therapy was dominant in the NQO1-high group compared to the NQO1-low group (72% and 45%, respectively) but the difference was not significant (P=0.09). The 3-year recurrence-free survival rate after esophagectomy in the NQO1-high group was significantly lower compared to the NQO1-low group (39% vs. 76%; P&lt;0.01). A Cox proportional hazards model revealed that high NQO1 expression was an independent unfavorable prognostic factor (HR=3.53; P=0.02) as was pN3 (HR=14.7; P&lt;0.01). The immunohistochemical evaluation of NQO1 expression has potential to predict the treatment response and prognosis in patients who undergo preoperative CF therapy followed by esophagectomy for ESCC.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：E-CENTURY PUBLISHING CORP  

MED12 is a transcriptional mediator complex subunit, which negatively regulates the transforming growth factor beta (TGF-beta) pathway. The TGF-beta pathway plays a major role in the induction of epithelial-mesenchymal transition 9EMT). MED12 loss induces activation of the TGF-beta pathway, resulting in EMT and drug resistance to epidermal growth factor receptor (EGFR)-targeted therapy. We aimed to investigate the clinical significance of MED12 loss detected by immunohistochemistry in patients with colorectal cancer (CRC). A total of 100 patients diagnosed with stage I-IV CRC were enrolled in this retrospective study. MED12 expression was evaluated immunohistochemically, and classified as either positive (>= 20%) or negative (<20%) with regard to the percentage of immunoreactive cells. The relationships between MED12 loss and clinicopathological characteristics and RAS mutation status were analyzed. Overall, 79 and 21 patients were classified as MED12 positive and MED12 negative, respectively. MED12 negativity was significantly associated with tumor budding (P = 0.034), N category (P = 0.010), and M category (P = 0.031). Among stage IV CRC patients, 18 of 31 patients had the RAS wild-type gene; 6 of these patients were MED12 negative, and were considered to have the potential for resistance to EGFR-targeted therapy despite the presence of the wild-type gene. In conclusion, MED12 loss is associated with tumor budding, nodal metastasis, and distant metastasis in patients with CRC, suggesting that MED12 loss induces activation of the TGF-beta pathway resulting in EMT. Future treatment strategies focusing on patients MED12 loss may improve the prognosis of patients with CRC.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：E-CENTURY PUBLISHING CORP  

This study aimed to histologically characterize microscopic tumor invasion of the vasculo-biliary sheaths in perihilar cholangiocarcinoma so as to determine the primary tumor site and to clarify clinicopathologic differences according to the primary site. A retrospective analysis was conducted of 52 patients who underwent resection for perihilar cholangiocarcinoma involving both the hepatic hilus and the liver, verified histologically. Histologic features of the vasculo-biliary sheath invasion were evaluated by double staining with hematoxylin-eosin to assess general morphology and Victoria Blue to detect the elastic fibers of the vasculo-biliary sheaths. The perihilar cholangiocarcinomas were classified into extrahepatic-type (34 patients), featuring an extrahepatic component involving the liver, and intrahepatic-type (18 patients), featuring an intrahepatic component involving the hepatic hilus. Hemihepatectomy with extrahepatic bile duct resection was the most common surgical procedure. Tumor size (p = 0.002), pN classification (p = 0.005), and pM classification (p = 0.023) were significant independent prognostic factors. The primary site was not significantly associated with survival after resection (p = 0.214), as patients with extrahepatictype tumors had a cumulative 5-year survival rate of 32%, compared with 28% for patients with intrahepatic-type tumors. Double staining with hematoxylin-eosin and Victoria Blue permits histologic discrimination between tumors of extrahepatic and intrahepatic origin, and thereby determination of the primary tumor site in clinical cases of perihilar cholangiocarcinoma. Combining extrahepatic-type and intrahepatic-type tumors under the term perihilar cholangiocarcinoma is valid clinically, as these tumors show comparable surgical outcomes with similar clinical management.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

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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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Internal hernia after gastrectomy is a rare complication. It can progress rapidly to vascular disturbance, necrosis, and perforation, therefore early diagnosis and surgical treatment is essential. We present a case of internal hernia following laparoscopic-assisted proximal gastrectomy with jejunal interposition reconstruction in a 68-year-old man, who presented with acute abdominal pain and vomiting. Computed tomography showed a whirl sign, ascites, and a closed-loop formation of the small intestine. We diagnosed an internal hernia and performed emergency surgery. Laparotomy revealed chyle-like ascites and extensive small intestine with poor color. We recognized that about 20 cm of jejunum from the ligament of Treitz was strangulated behind the pedicle of the jejunum lifted during laparoscopic-assisted proximal gastrectomy. We relieved the strangulation, whereupon the color of the strangulated intestine was restored. Therefore, we did not perform intestinal resection and reconstruction. Finally, we fixed the jejunal pedicle and mesentery of the transverse colon. We report this case as there are few reported cases of internal hernia after laparoscopic-assisted proximal gastrectomy.

DOI： 10.1186/s40792-015-0051-3

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その他リンク： http://link.springer.com/article/10.1186/s40792-015-0051-3/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: We sought to determine the prognostic significance of intraoperative peritoneal lavage cytology (CY) at 3 different abdominal cavities and establish the optimal treatment for gastric cancer patients with positive peritoneal cytology (CY1). METHODS: A total of 1,039 patients with primary gastric adenocarcinoma who underwent CY at 3 cavities (Douglas' pouch, left subphrenic cavity, and right subhepatic cavity) were enrolled; 116 (11%) patients had at least one positive cavity. We retrospectively analyzed the clinicopathologic characteristics and survival of these 116 patients with CY1. RESULTS: Seventeen (15%) of the patients had negative cytology at Douglas' pouch but positive cytology at one or both of the other cavities. The 116 patients' overall 2-year survival rate was 22.9%, with the median survival time of 11 months. The overall 2-year survival rates for the patients with positive cytology at 1, 2, and 3 cavities were 41.9%, 35.8%, and 15%, with median survival times of 17, 18, and 9 months, respectively (P < .01). A multivariate analysis revealed that macroscopic type 4 tumor, R2 resection, lymph node metastasis, and postoperative chemotherapy were independent prognostic factors. Among the CY1 patients with type 4 tumors, there was no substantial difference in survival between the patients who underwent R1 or R2 resection, although the statistical power of this subgroup analysis was low. CONCLUSION: CY at 3 cavities might be a useful method to decrease the false-negative rate. Palliative gastrectomy for CY1 patients with type 4 tumors is still controversial.

DOI： 10.1016/j.surg.2015.04.004

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

Idiopathic spontaneous pneumoperitoneum is a rare condition that is characterized by intraperitoneal gas for which no clear etiology has been identified. We report here a case of idiopathic spontaneous pneumoperitoneum, which was successfully managed by conservative treatment. A 77-year-old woman who was bedridden with speech disability as a sequela of brain hemorrhage presented at our hospital with a 1-day history of abdominal distention. On physical examination, she had stable vital signs and slight epigastric tenderness on deep palpation without any other signs of peritonitis. A chest radiograph and computed tomography showed that a large amount of free gas extended into the upper abdominal cavity. Esophagogastroduodenoscopy revealed no perforation of the upper gastrointestinal tract. The patient was diagnosed with idiopathic spontaneous pneumoperitoneum, and conservative treatment was selected. The abdominal distension rapidly disappeared, and the patient resumed oral intake on the 5th hospital day without deterioration of symptoms. Knowledge of this rare disease and accurate diagnosis with findings of clinical imaging might contribute towards refraining from unnecessary laparotomy.

DOI： 10.1186/s40792-015-0073-x

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その他リンク： http://link.springer.com/article/10.1186/s40792-015-0073-x/fulltext.html

掲載種別：研究論文（学術雑誌）  

A 64-year-old woman discovered a mass in her left breast and visited our hospital. A thorough examination resulted in a diagnosis of left, locally advanced breast cancer (cT4bN3, M0, cStage Ⅲc) with muscle invasion and Level Ⅲ lymph node metastases. Because of drug-induced lung disease following 4 courses of adriamycin and cyclophosphamide, the chemotherapy had to be stopped. Halsted's operation and postoperative radiotherapy (50 Gy) were performed. The patient was alive with no evidence of recurrence 9 months after surgery. Although multidisciplinary therapy is recommended in locally advanced breast cancer, chemotherapy sometimes cannot be performed due to factors such as age and physical status. Halsted's operation could be considered as a treatment of choice in patients with locally advanced breast cancer. It is important to choose the treatment strategy based on the condition of the patient.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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' 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'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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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 51-year-old man underwent right nephrectomy for renal cell carcinoma. Six months later, a solitary metastatic tumor was detected in the pancreatic tail and he underwent distal pancreatectomy and splenectomy. One year and 6 months after the initial resection, a solitary metastatic tumor was detected in the pancreas head, and he underwent partial pancreatectomy. A solitary metastatic tumor was detected again in the remnant pancreatic body 3 years and 10 months after the initial resection. Partial resection of the distal part of the remnant pancreas was performed. The patient remains alive and well with no evidence of remnant disease 4 years after the initial resection.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 46-year-old woman underwent right hemihepatectomy, cholecystectomy, and sampling of the hilar lymph nodes for combined hepatocellular and cholangiocarcinoma. She received oral S-1 after hepatectomy. However, her serum level of carcinoembryonic antigen gradually increased, and solitary paraaortic lymph node recurrence was detected on positron emission tomography-computed tomography 12 months after hepatectomy. The patient underwent paraaortic lymph node dissection. Histologic examination revealed solitary paraaortic lymph node metastasis composed of hepatocellular carcinoma. After paraaortic lymph node dissection, she was administered sorafenib, and she remains alive and healthy with no evidence of disease 17 months after the initial resection.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 62-year-old man presented with pruritus caused by obstructive jaundice. He was diagnosed with carcinoma of the ampulla of Vater and underwent pylorus-preserving pancreaticoduodenectomy. Histologic examination revealed signet-ring cell carcinoma without nodal metastasis. The patient underwent a partial resection of the small bowel for small bowel obstruction 38 months after the initial resection. Histologic examination disclosed signet-ring cell carcinoma at the surface of the resected small bowel, and the diagnosis of peritoneal recurrence was confirmed. He received oral S-1(100 mg/day) every other day for 14 months until bowel obstruction caused by peritoneal carcinomatosis became apparent. The patient died of the disease 58 months after the initial resection.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 54-year-old female patient was admitted with obstructive jaundice. The patient was diagnosed with locally advanced unresectable pancreatic cancer of the head with invasion to the super mesenteric artery and the third portion of the duodenum. A biliary- and gastric-enteric bypass surgery was performed, and peritoneal lavage cytology was positive during surgery. After 6 courses of gemcitabine and S-1 combination chemotherapy, the CA19-9 level was normalized and the primary tumor shrank to 79% of its original size. Diagnostic laparoscopy revealed that distant metastasis was not detected and the peritoneal lavage cytology was negative. After additional chemoradiation therapy, a pancreaticoduodenectomy was perfomed. Microscopic investigation revealed that about 60% of the cancer tissue had been replaced by fibrosis and no cancer cells were found at the surgical margin. The patient was alive with no evidence of recurrence 17 months after radical surgery.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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掲載種別：研究論文（学術雑誌）  

Pneumatosis cystoides intestinalis (PCI) is a relatively rare condition, characterized by subserosal or submucosal air within the bowel wall. Herein, we report a rare case of PCI secondary to treatment with an epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI). A 71-year-old man, who had received gefitinib therapy for 2 years and 5 months for lung adenocarcinoma with metastases to the bones and brain, presented with abdominal pain, diarrhea, and vomiting. Computed tomography of the abdomen revealed intramural air in the small bowel, free air in the abdomen, and moderate ascites. A diagnosis of PCI was made, and the patient was managed conservatively by discontinuing gefitinib treatment, because his vital signs were stable and there was no sign of peritonitis. The patient&#039;s symptoms gradually improved, and follow-up CT after 1 week revealed that the initial findings had almost completely resolved. Clinicians should note that treatment with gefitinib might cause PCI.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND/AIMS: The aim of this study was to investigate the incidence and risk factors for anastomotic stricture after esophagectomy with gastric tube reconstruction. METHODOLOGY: A total of 150 consecutive patients with esophageal cancer who underwent esophagectomy with gastric tube reconstruction were analyzed in this study. Anastomotic stricture was de fined as disturbance of the passage of a standard endo scope, with no evidence of locoregional cancer recurrence. Cumulative incidence was calculated using the Kaplan-Meier method. A total of 38 clinicopathological variables were assessed to elucidate the risk factors by univariate and multivariate analyses. RESULTS: Anastomotic stricture developed in 61 of 150 patients 41%). The cumulative incidences were 34.2% at 6 months, and 37.9% at 12 months. Fifty-seven patients (93%) developed anastomotic stricture within 12 months after esophagectomy. A low preoperative partial pressure of arterial oxygen (odds ratio, 2.23; 95% confidence interval, 1.10-4.55; p = 0.027) and the presence of postoperative complications of Grade 3 or higher (3.05; 1.04-9.00; p = 0.043) were identified as the independent risk factors. CONCLUSIONS: The incidence of anastomotic stricture after esophagectomy was high. A modification of anastomotic procedure may be necessary for patients with a low preoperative partial pressure of arterial oxygen to prevent the development of stricture.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Abdominal wall emphysema is a common complication of laparoscopic surgery. This condition is usually harmless; however, if an infection occurs, it can develop into a serious condition such as necrotizing fasciitis. We report a case of a 51-year-old woman suffering from severe cellulitis that spread from an area of abdominal wall emphysema after laparoscopic surgery for sigmoid colon cancer. Recognizing this complication, early diagnosis, and prompt treatment are cornerstones for successful management of this potentially fatal disease.

DOI： 10.1111/ases.12159

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MOSBY-ELSEVIER  

Background. The aims of this study were to identify prognostic factors of patients with submucosa-invasive (T1b) gastric cancer and to verify the validity of adjuvant chemotherapy for this disease.
Methods. We retrospectively examined the cases of 1,236 consecutive patients in our prospectively maintained database with T1b gastric cancer who underwent gastrectomy in 1995-2012. We used 11 clinicopathologic characteristics to identify prognostic factors by univariate and multivariate analyses. We compared the survival of the 160 node-positive T1b gastric cancer patients with that of 133 patients in the same database who had node-positive muscularis propria-invasive (T2) gastric cancer and had undergone gastrectomy without adjuvant chemotherapy during the same period, as a reference cohort.
Results. The 5-year overall survival rate was 91.4% for all 1,236 patients. Advanced age (hazard ratio [HR] 4.51; 95% confidence interval [CI] 3.26-6.24; P &lt; .01), male sex (HR 2.26; 95% CI 1.5- 3.26; P &lt; .01), and the presence of lymph node metastasis (HR 1.89; 95% CI 1.33-2.70; P &lt; .01) were independent prognostic factors. The 5-year overall survival rates were 92.5 % in node-negative patients, 84.5% in patients with 1 or 2 metastatic nodes, and 80.1% in patients with 3 or more metastatic nodes (P &lt;.01). The 5-year overall survival rates of the node-positive T1b and T2 gastric cancer patients were 83.6% and 81.2%, respectively (P = .73).
Conclusion. The prognosis of node-positive T1b gastric cancer patients after curative gastrectomy was unsatisfactory. Adjuvant chemotherapy should be considered for these patients, especially those with 3 or more metastatic nodes.

DOI： 10.1016/j.surg.2014.10.009

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

Low-dose cisplatin and 5-fluorouracil (LDPF) chemotherapy with daily radiotherapy (RT) is used as an alternative chemoradiotherapy regimen for locally advanced esophageal carcinoma. We evaluated whether RT plus LDPF chemotherapy had an advantage in terms of survival and/or toxicity over RT plus standard-dose cisplatin and 5-fluorouracil (SDPF) chemotherapy in this study. This multicenter trial included esophageal cancer patients with clinical T4 disease and/or unresectable regional lymph node metastasis. Patients were randomly assigned to receive RT (2 Gy/fraction, total dose of 60 Gy) with SDPF (arm A) or LDPF (arm B) chemotherapy. The primary endpoint was overall survival (OS). A total of 142 patients (arm A/B, 71/71) from 41 institutions were enrolled between April 2004 and September 2009. The OS hazard ratio in arm B versus arm A was 1.05 (80% confidence interval, 0.78-1.41). There were no differences in toxicities in either arm. Arm B was judged as not promising for further evaluation in the phase III setting. Thus, the Data and Safety Monitoring Committee recommended that the study be terminated. In the updated analyses, median OS and 3-year OS were 13.1 months and 25.9%, respectively, for arm A and 14.4 months and 25.7%, respectively, for arm B. Daily RT plus LDPF chemotherapy did not qualify for further evaluation as a new treatment option for patients with locally advanced unresectable esophageal cancer. This study was registered at the UMIN Clinical Trials Registry as UMIN000000861.

DOI： 10.1111/cas.12622

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/cas.12622

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Patients with advanced stage of squamous cell carcinoma of esophagus have a poor prognosis with a lethal outcome. In order to explore the feasibility and effectiveness of dendritic cell (DC)-based immunotherapy for squamous cell carcinoma of esophagus, we performed a phase I/II clinical trial of monocyte-derived dendritic cells (moDCs) pulsed with SART1 peptide in seven patients with advanced stage of this disease. Although the feasibility of this therapy was definite, the effectiveness was not clearly confirmed in advanced stage of squamous cell carcinoma of esophagus. However, in vitro study revealed that moDCs generated for this therapy possessed a potent ability of inducing SART1 peptide-specific cytotoxic T lymphocytes (CTLs). In addition, these moDCs were demonstrated to be able to produce exosomes with an antigen presenting ability for inducing SART1 peptide-specific CTLs. ELISPOT assay using cryopreserved patient's lymphocytes demonstrated that IFN-γ ELISPOTs were increased after four times of SART1 peptide-pulsed moDC vaccinations compared with before the vaccination in a patient. The present study demonstrated that moDCs prepared from advanced stage of squamous cell carcinoma of esophagus possess a good immune function and in vivo immune responses (detected by ELISPOT assay) were evoked by the infusion of these moDCs. These findings suggest that DC-based immunotherapy could be one of the modalities applicable for squamous cell carcinoma of esophagus.

DOI： 10.3892/ijo.2015.2846

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掲載種別：研究論文（学術雑誌）  

We report three cases of esophageal carcinoma all of which achieved a pathological complete response after neoadjuvant chemotherapy (NAC) with cisplatin and 5-fluorouracil (CF). All three patients were men with clinical stage II squamous cell carcinoma of the middle thoracic esophagus. We administered 2 courses of CF treatment as NAC and then performed radical esophagectomy. Pathologic examination revealed no viable tumor cells in the resected esophagus. The patients are currently alive with no evidence of disease.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Prognostic markers are urgently needed to optimize the postoperative treatment strategies for gastrointestinal stromal tumors (GIST). GIST of the small intestine (I-GIST) show more aggressive behavior than those of the stomach (S-GIST), and the molecular background of the malignancy in I-GIST may include potential prognostic biomarkers. We conducted integrated proteomic and transcriptomic analysis to identify genes showing differential expressions according to the tumor site. We generated protein expression profiles for four cases each of surgically resected I-GIST and S-GIST using label-free proteomic analysis. For proteins showing differential expressions, global mRNA expression was compared between 9 I-GIST and 23 S-GIST. Among the 2555 genes analyzed, we found that promyelocytic leukemia (PML), a tumor suppressor gene, was significantly downregulated in I-GIST at both the protein and mRNA levels (P&lt;0.01; fold difference 2.0). Immunohistochemistry of 254 additional cases from multiple clinical facilities showed that PML-negative cases were significantly frequent in the I-GIST group (P&lt;0.001). The 5-year recurrence-free survival rate was significantly lower in the PML-negative than in the PML-positive cases (60.1% vs 91.7%; P&lt;0.001). Multivariate analysis revealed that downregulation of PML was an independent unfavorable prognostic factor (hazard ratio=2.739; P=0.001). Our study indicated that prognostication based on PML expression may have potential for optimizing the treatment strategy for GIST patients. Further validation studies of PML for clinical application, and investigation for the mechanistic significance of PML to clarify the molecular backgrounds of malignancy in GIST are warranted.

DOI： 10.1111/cas.12565

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記述言語：英語   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/jco.2015.33.3_suppl.155

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掲載種別：研究論文（学術雑誌）   出版者・発行元：OMICS Publishing Group  

DOI： 10.4172/2165-7920.1000635

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Elmer Press, Inc.  

BACKGROUND: In breast cancer, recent clinical trials have shown that sentinel lymph node biopsy (SLNB) alone without axillary lymph node dissection results in excellent prognosis if there is sentinel lymph node (SLN) metastasis in two or fewer nodes. The aim of the present study was to investigate the association between non-SLN metastasis and clinicopathological factors in case of SLN metastasis in two or fewer nodes in breast cancer. METHODS: Patients who underwent SLNB for invasive breast cancer and were found to have positive SLN in two or fewer nodes were evaluated. The associations between non-SLN metastasis and clinicopahological factors were examined. Statistical analyses were performed using the Mann-Whitney and Chi-square tests, with statistical significance set at P < 0.05. RESULTS: A total of 358 patients were enrolled during the study period and all of these patients were female and 54 patients had SLN metastasis (15%). Positive SLN in two or fewer nodes was identified in 44 patients (81.5%). Among these patients, 17 (38.6%) were found to have non-SLN metastasis. Non-SLN metastasis was associated with invasive tumor size (P = 0.015) and lymphatic involvement (P = 0.035). Multivariate analysis showed that tumor size (P = 0.011) and lymphatic involvement (P = 0.019) remained significant independent predictors of non-SLN metastasis, and that an invasive tumor size cut-off point of 28 mm was useful for dividing patients with positive SLN in two or fewer nodes into non-SLN-positive and non-SLN-negative groups. CONCLUSIONS: Non-SLN metastasis was found in more than 30% of patients with SLN metastasis present in two or fewer nodes. Large tumor size and the presence of lymphatic involvement were significantly associated with non-SLN metastasis.

DOI： 10.14740/jocmr2195w

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Hematogenous recurrences of esophageal squamous cell carcinoma (ESCC) have dismal prognoses, but prognostic heterogeneity exists in this disease. The objectives of this study were to clarify the prognosis in this disease with regard to the initial recurrence site and to define the prognostic factors. Methodology: We retrospectively reviewed the cases of 67 consecutive patients with hematogenous recurrence in major organs after esophagectomy for ESCC of the thoracic esophagus and the esophagogastric junction. We analyzed clinicopathological characteristics, survival probability and potential prognostic factors. Results: Lung, liver, bone, and multiple-organ metastases occurred in 24, 19, 14, and 10 patients, respectively. Twenty-seven patients simultaneously had locoregional recurrence (combined recurrence). Among all 67 patients, the median disease-free interval (DFI) was 9.7 months, and the median survival time after the initial recurrence was 4.9 months. The patients with initial lung metastasis had most favorable prognosis with the median survival time of 9.8 months. A multivariate analysis identified that initial recurrence site, DFI, combined recurrence, and anticancer therapy were independent prognostic factors. Conclusions: The initial recurrence site contributes to the prognostic heterogeneity of patients with hematogenous recurrence of ESCC. The prognostic factors identified in this study are useful to optimize the management of these patients.

DOI： 10.5754/hge13171

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掲載種別：研究論文（学術雑誌）  

Herein, we present a case of advanced rectal cancer surgically resected after chemotherapy. A 65-year-old woman presented with anal pain, and rectal cancer extending beyond the anus was diagnosed. The primary tumor was a well-differentiated adenocarcinoma with a KRAS mutation. Computed tomography revealed cancer invasion into the vagina and sacral and coccygeal bones, and cancer metastases to the bilateral inguinal lymph nodes and the left lung. Sigmoid colostomy and subcutaneous venous port insertion were performed. The patient was treated with modified oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX6) plus bevacizumab. She showed a partial response according to the Response Evaluation Criteria in Solid Tumors after 13 courses of chemotherapy. The primary tumor was then resected via posterior pelvic exenteration, bilateral inguinal lymphadenectomy, and sacral/coccygeal resection. Histological examination of the resected specimens revealed moderately differentiated adenocarcinoma with vaginal invasion. Metastasis to a right inguinal lymph node was observed. The pathological stage was ypT4bN0M1b, ypStage IV according to the tumor-node-metastasis system of the eighth edition of the Japanese Classification of Colorectal Carcinoma. The pathological response grade of the tumor after chemotherapy was determined to be Grade 1b.

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掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）  

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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掲載種別：研究論文（学術雑誌）  

Herein, we present a case of long-term survival after lateral pelvic lymph node dissection for recurrence in the form of skip metastasis of rectal cancer. A 63-year-old man underwent abdominoperineal resection without lateral pelvic lymph node dissection for advanced lower rectal cancer. The histological diagnosis was type 2, 85×50 mm, tub1, pT4a, ly0, v1, pPM0, pDM0 and pN0, pStage II (Japanese Classification of Colorectal Carcinoma, 8th edition). Six months after surgery, enhanced computed tomography showed right obturator lymph node metastasis. We performed lateral pelvic lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma in the right obturator lymph node. The lymph node metastasis was diagnosed as a skip metastasis of the rectal cancer. The patient has had no recurrence for 9 years after resection of the lateral pelvic lymph node.

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掲載種別：研究論文（学術雑誌）  

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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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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掲載種別：研究論文（学術雑誌）  

A 49-year-old woman with a growing tumor of the left anterior chest wall was admitted to our hospital. This patient was diagnosed with a malignant well-differentiated tumor by needle biopsy and underwent surgery involving wide resection of the tumor, associated excision of the major pectoralis muscle, and part of the mammary tissue and skin. The tumor measured 14.2X 17.8 cm and weighed 1,220 g. Histopathologically, the tumor was confirmed to be a dedifferentiated liposarcoma, and local recurrence and metastasis often occurs in spite of complete surgical resection. However, no local recurrence or metastasis has been detected 2 months post-surgery. The main anatomic sites of liposarcomas are the retroperitoneum and lower extremities; only 19 liposarcoma cases of the anterior chest wall have been reported in Japan.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

We report a case of esophageal perforation (Boerhaave syndrome) caused by vomiting related to a duodenal ulcer with pyloric stenosis. A 45-year-old male presented with left chest pain and dyspnea after forceful vomiting. Chest radiography and computed tomography (CT) revealed a massive left pleural effusion and left tension pneumothorax. Abdominal CT revealed pyloric stenosis with a remarkably dilated stomach. Tube thoracostomy and nasogastric suction were immediately performed and we selected conservative treatment based on the following factors-a stable general condition without sepsis, early diagnosis, and good drainage. Esophagogastroduodenoscopy on hospital day 9 demonstrated a healing ulcer in the lower esophagus and pyloric stenosis. We performed distal gastrectomy as elective surgery for pyloric stenosis due to a duodenal ulcer on hospital day 30. In summary, an esophageal perforation with contamination spreading to the thoracic cavity was successfully treated with conservative treatment.

DOI： 10.1007/s12328-014-0493-3

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その他リンク： http://link.springer.com/article/10.1007/s12328-014-0493-3/fulltext.html

掲載種別：研究論文（学術雑誌）   出版者・発行元：Elsevier BV  

DOI： 10.1016/j.euprot.2014.03.001

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Few nomograms can predict overall survival (OS) after curative resection of advanced gastric cancer (AGC), and these nomograms were developed using data from only a few large centers over a long time period. The aim of this study was to develop and externally validate an elaborative nomogram that predicts 5-year OS after curative resection for serosa-negative, locally AGC using a large amount of data from multiple centers in Japan over a short time period (2001-2003). PATIENTS AND METHODS: Of 39 859 patients who underwent surgery for gastric cancer between 2001 and 2003 at multiple centers in Japan, we retrospectively analyzed 5196 patients with serosa-negative AGC who underwent Resection A according to the 13th Japanese Classification of Gastric Carcinoma. The data of 3085 patients who underwent surgery from 2001 to 2002 were used as a training set for the construction of a nomogram and Web software. The data of 2111 patients who underwent surgery in 2003 were used as an external validation set. RESULTS: Age at operation, gender, tumor size and location, macroscopic type, histological type, depth of invasion, number of positive and examined lymph nodes, and lymphovascular invasion, but not the extent of lymphadenectomy, were associated with OS. Discrimination of the developed nomogram was superior to that of the TNM classification (concordance indices of 0.68 versus 0.61; P < 0.001). Moreover, calibration was accurate. CONCLUSIONS: We have developed and externally validated an elaborative nomogram that predicts the 5-year OS of postoperative serosa-negative AGC. This nomogram would be helpful in the assessment of individual risks and in the consideration of additional therapy in clinical practice, and we have created freely available Web software to more easily and quickly predict OS and to draw a survival curve for these purposes.

DOI： 10.1093/annonc/mdu125

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The number of patients cured of esophageal cancer after esophagectomy is gradually increasing owing to advances in surgical techniques, perioperative management, and adjuvant therapies. This study assessed the clinical course and sought to identify the prognostic factors of these patients. METHODS: A series of 220 consecutive patients who underwent esophagectomy and survived for more than 5 years with no relapse were enrolled. Survival analysis was performed using 25 variables including patient characteristics and operative and perioperative factors. Potential prognostic factors were identified by univariate and multivariate analyses, and the development of other primary cancers and the causes of death were retrospectively reviewed. RESULTS: The overall 10-, 15-, and 20-year survival rates were 71.6, 50.1, and 32.2 %, respectively, with a median survival time of 180 months (range, 61-315 months). The negative independent prognostic factors identified were age at surgery [hazard ratio (HR), 1.05; P < .01], being male (HR, 2.62; P = .02), pulmonary comorbidities (HR, 2.03; P = .02), synchronous presence of other cancers (HR, 2.35; P < .01), colonic/jejunal interposition (HR, 1.76; P = .03), perioperative blood transfusion (HR, 1.92; P = .02), development of pulmonary complications (HR, 1.71; P = .02), and adjuvant radiotherapy (HR, 2.13; P = .01). Pulmonary diseases and other primary cancers were found to be the most common causes of death. CONCLUSIONS: Careful follow-up including the surveillance of other primary cancers is required for long-term survivors of esophageal cancer after esophagectomy.

DOI： 10.1245/s10434-014-3499-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

This is the first successful report of a laparoscope-assisted Hassab's operation for esophagogastric varices after living donor liver transplantation (LDLT). A 35-year-old man underwent LDLT using a right lobe graft as an aid for primary sclerosing cholangitis (PSC) in 2005. Follow-up endoscopic and computed tomography (CT) examinations showed esophagogastric varices with splenomegaly in 2009 that increased (esophageal varices [EV]: locus superior [Ls], moderator enlarged, beady varices [F2], medium in number and intermediate between localized and circumferential red color signs [RC2]; gastric varices [GV]: extension from the cardiac orifice to the fornix [Lg-cf], moderator enlarged, beady varices [F2], absent red color signs [RC0]). A portal venous flow to the esophagogastric varices through a large left gastric vein was also confirmed. Preoperative Child-Pugh was grade B and score was 9. Because these esophagogastric varices had a high risk of variceal bleeding, we proceeded with a laparoscope-assisted Hassab's operation. Operative time was 464 minutes. Blood loss was 1660 mL. A graft liver biopsy was also performed and recurrence of PSC was confirmed histologically. It was suggested that portal hypertension and esophagogastric varices were caused by recurrence of PSC. Postoperative complications were massive ascites and enteritis. Both of them were treated successfully. This patient was discharged on postoperative day 43. Follow-up endoscopic study showed improvement in the esophagogastric varices (esophageal varices [EV]: locus superior [Ls], no varicose appearance [F0], absent red color signs [RC0], gastric varices [GV]: adjacent to the cardiac orifice [Lg-c], no varicose appearance [F0], absent red color signs [RC0]) at 6 months after the operation. We also confirmed the improvement of esophagogastric varices by serial examinations of CT.

DOI： 10.1016/j.transproceed.2013.10.047

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Background: Decoy receptor 3 (DcR3), a member of the tumor necrosis factor receptor (TNFR) superfamily, shows inhibitory effects on Fas-mediated apoptosis. Currently, data are lacking on the correlation between DcR3 and the recurrence of breast cancer. The authors examined DcR3 mRNA expression and genomic amplification in breast cancer, and investigated the effect of DcR3 gene amplification on prognosis of patients. Methods: A total of 95 patients formed the basis of the current retrospective study. DcR3 mRNA expression in breast cancer tissues was examined by RNase protection assay and in situ hybridization. DcR3 gene amplification was examined by quantitative polymerase chain reaction. The correlation between DcR3 gene amplification status and clinicopathological factors was examined and also the relationship between DcR3-Amp and relapse and survival. Results: The relative copy numbers of DcR3 genomic DNA correlated significantly with the levels of DcR3 mRNA expression (ρ = 0.755, P = 0.0067). In addition, lymphatic invasion correlated significantly with DcR3 gene amplification (P = 0.012). However, there was no correlation between the remaining clinicopathological factors and DcR3 gene amplification. In the univariate analysis, the recurrence-free survival (RFS) rate of patients who were positive for DcR3 gene amplification was significantly lower than that of patients who were negative for DcR3 gene amplification (P = 0.0271). Multivariate analysis showed that DcR3 gene amplification (P = 0.028) and disease stage (P < 0.001) remained significant independent predictors of RFS. Conclusions: DcR3 gene amplification was significantly correlated with lymphatic invasion, and also DcR3 gene amplification predicts recurrence after resection, which may be an important prognostic factor in breast cancer patients.

DOI： 10.14740/wjon764w

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Early enteral nutrition within 24 h after surgery has become a recommended procedure. In the present study, we retrospectively examined whether initiating EN within 24 h after esophagectomy improves the postoperative course. METHODS: Among 103 patients who underwent thoracic esophagectomy for esophageal cancer, we enrolled the cases in which EN was initiated within 72 h after surgery. The patients were divided into two groups: EN started within 24 h (Group D1) and EN started at 24 - 72 h (Group D2-3). Clinical factors including days for first fecal passage, dose of postoperative albumin infusion, difference in serum albumin between pre- and postoperation, incidence of postoperative infection, and use of total parenteral nutrition were compared. Statistical analyses were performed by the Mann-Whitney U test and Chi square test, with significance defined as P < 0.05. RESULTS: There was no significant difference between the groups in clinical factors. While pneumonia was significantly more frequent in Group D1 than in Group D2-3 (P = 0.0308), the frequency of infectious complications was comparable between the groups. CONCLUSION: Initiating EN within 24 h showed no advantage for the postoperative course in esophageal cancer, and thus EN should be scheduled within 24 - 72 h, based on the patient condition.

DOI： 10.4021/jocmr1665w

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 66 -year-old man presenting with a chief complaint of upper abdominal pain was diagnosed as having an advanced adenocarcinoma, type 2, of the lower third of the stomach after endoscopy was performed. An abdominal computed tomography( CT)scan revealed 4 lymph node metastases at the infrapyloric nodes(station No. 6)and the nodes around the proximal splenic artery(station No. 11p)and the abdominal aorta(station No. 16a2). The clinical stage was determined to be T3(SS)N2M1(LYM), Stage IV. Gastrectomy with D2 plus para-aortic node dissection was scheduled after 2 courses of S-1 plus cisplatin(CDDP)with curative intent. On day 14 after starting S-1 therapy, the patient complained of severe abdominal pain and peritoneal irritation of acute onset. Because the abdominal CT scan showed a large amount of intra-abdominal free air, we performed an urgent laparotomy with a tentative diagnosis of perforation of the gastric cancer. On laparotomy, we found a perforated malignant ulcer, 5 cm in maximum diameter, in the lesser curvature of the stomach; therefore, distal gastrectomy with D1 plus lymphadenectomy and reconstruction using the Roux-en-Y method were performed. At the end of the surgery, a macroscopic residual tumor remained in the para-aortic lymph node. The postoperative course was uneventful, and the patient was discharged on day 23 after surgery. In the present case, despite the performance of urgent gastrectomy while the patient was receiving strong chemotherapy, perioperative management was successful, with no serious postoperative complication or adverse events as a result of the chemotherapy.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Baishideng Publishing Group Inc.  

AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrVil™. METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrVil™was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009, we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus. RESULTS: The median operation time was 314 min (range; 210-367 min), and median blood loss was 210 mL (range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3 (range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. The median hospital stay was 16 d (range: 15-20 d). The median length of esophageal involvement was 14 mm (range: 6-48 mm) and that of the resected esophagus was 40 mm (range: 35-55 mm); all resected specimens had tumor-free margins. CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.

DOI： 10.4240/wjgs.v6.i12.235

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Research Publishing, Inc.  

DOI： 10.4236/ojgas.2014.42011

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その他リンク： http://www.scirp.org/journal/doi.aspx?DOI=10.4236/ojgas.2014.42011

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The optimal treatment for patients with perforated gastric ulcer (PGU) remains controversial. This study therefore investigated the treatment status for this disease in clinical practice. METHODS: We retrospectively reviewed 183 patients with PGU from 1998 to 2007 across 15 institutions, and analyzed patient characteristics and short- and long-term outcomes according to treatments received. RESULTS: Of the 183 patients, 57 who were treated conservatively had less abdominal tenderness, lower levels of serum C-reactive protein, and shorter time to presentation than the 126 patients who underwent emergency surgery. There was no significant difference in baseline characteristics between the 41 successful patients and 16 failed patients in the conservative treatment group; however, the latter had a longer average hospital stay. Eighty-three of the emergency surgery patients who underwent gastrectomy had longer surgical times, greater blood loss, and shorter time to resumption of diet than the 57 patients undergoing stomach-preserving surgery; however, there was no significant difference in postoperative complications and hospital stay between these groups. Of 91 patients who received stomach-preserving treatment, only three had treatment failure in the long-term follow-up period. CONCLUSION: Strictly selected patients should be initially considered for conservative treatment. The short-term outcomes of stomach-preserving surgery are comparable to gastrectomy; however, further evaluation of the long-term outcomes of stomach-preserving treatment is required.

DOI： 10.1007/s11605-013-2362-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The purposes of this study were to clarify the risk factors for supraclavicular lymph node (SCLN) metastasis and the survival benefit from cervical lymph node (LN) dissections in patients with clinically submucosal (cT1b) carcinoma of the thoracic esophagus. METHODS: A total of 86 patients with this disease who underwent esophagectomy with 3-field lymph node dissection were retrospectively reviewed. Multivariate logistic regression and Cox proportional hazard model were used to identify the independent risk factors for SCLN metastasis and prognostic factors, respectively. An index calculated by multiplying the frequency of metastasis at nodal basin and the 5-year overall survival rate of patients with metastasis at that basin were used to assess the therapeutic outcomes. RESULTS: A total of 40 patients (47%) were found to have pathological LN metastasis. Also, 13 patients (15%) had cervical LN metastasis: 6 and 7 with carcinoma of the upper and mid-thoracic esophagus, respectively. SCLN metastasis was found in 6 patients (7%); however, there was no independent risk factor for SCLN metastasis. The 5-year overall survival rate was 72.5%. Cervical LN metastasis was an independent prognostic factor (p = .04; odds ratio 2.55; 95% confidence interval 1.03-6.31); however, there was no significant difference in survival between patients with SCLN metastasis and those without (p = .06). The calculated index of estimated benefit from cervical LN dissections was 6.9, following upper mediastinal LN of 15.6 and perigastric LN of 8.3. CONCLUSIONS: We could not identify risk factors to predict SCLN metastasis. Cervical LN dissection should not be omitted in patients with cT1b carcinoma, especially of the upper and mid-thoracic esophagus.

DOI： 10.1245/s10434-013-3141-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MDPI AG  

We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p &lt; 0.05. Group E showed fewer days for the first fecal passage (p &lt; 0.01), lesser dose of postoperative albumin infusion (p &lt; 0.01), less use of TPN (p &lt; 0.01), and shorter duration of SIRS (p &lt; 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.

DOI： 10.3390/nu5093461

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

To reveal the proteomic background of lymph node metastasis (LNM) in gastric cancer, we performed a proteomic study of tumor and matched nontumor tissues obtained from surgically resected specimens of 22 patients with or without LNM. Using laser microdissection, we recovered specific populations of tumor and nontumor cells. We used two-dimensional difference gel electrophoresis with a large format electrophoresis apparatus to obtain protein expression profiles consisting of 3228 protein spots, and we classified them according to their expression pattern. We found that macrophage-capping protein (CapG) was up-regulated in the tumor tissues of patients with LNM, whereas it showed an equivalent expression level between nontumor and tumor tissues of patients without LNM. It was reported that CapG associated with invasion and metastasis in various malignancies. However, CapG was not investigated in gastric cancer until our study. Western blotting of the laser microdissected tissue samples confirmed up-regulation of CapG in the tumor tissues of patients with LNM. Functional assays demonstrated that CapG promoted tumor cell invasion, but not cell proliferation. The association between CapG expression and LNM is a novel finding in gastric cancer. Further investigation for a prognostic utility of CapG may lead to a risk stratification therapy for gastric cancer.

DOI： 10.1021/pr400439m

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVES: The objective of this study was to clarify the factors influencing pleural drainage volume after transthoracic oesophagectomy and to determine criteria for the selection of patients who would benefit from the early removal of chest drains. METHODS: Clinicopathological characteristics of 155 patients who underwent transthoracic oesophagectomy were prospectively collected, and the daily drainage volume of each patient was retrospectively reviewed. Potential risk factors were compared between the high-output group (n = 39) and low-output group (n = 116), which were dichotomized using the 75th percentile of total pleural drainage volume of the total study population. Multivariate logistic regression analyses were used to identify independent risk factors. RESULTS: The median duration of drainage was 10 days, with a median total drainage volume of 2258 ml. Of 27 potential risk factors influencing the drainage volume, creatinine clearance (P = 0.04), operative approach (P = 0.03) and thoracic duct removal (P = 0.01) were significantly associated with the total pleural drainage volume. The removal of the thoracic duct (P = 0.02; odds ratio, 4.02; 95% confidence interval 1.20-13.41) and lower creatinine clearance (P = 0.04; odds ratio, 1.02; 95% confidence interval 1.00-1.04) was independent risk factors for increased pleural drainage volume after transthoracic oesophagectomy. CONCLUSIONS: The early removal of chest drains may be possible in patients without these risk factors.

DOI： 10.1093/ejcts/ezs556

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Laparoscopic treatment strategies for synchronous intra-abdominal malignancies have not yet been standardized. We report a successful case of two-step laparoscopic surgery for synchronous double cancer of the colon and stomach accompanied by severe chronic obstructive pulmonary disease (COPD). A 66-year-old man with COPD was diagnosed as having advanced colon cancer and early gastric cancer. On admission, he could not go upstairs (Grade III according to the Hugh-Jones classification) and his forced expiratory volume in 1 second was 600 mL (35.9%). The patient initially underwent laparoscopy-assisted sigmoidectomy with D3 lymphadenectomy, followed by laparoscopy-assisted distal gastrectomy with D1 lymphadenectomy 68 days later. The patient's each postoperative course was uneventful with no pulmonary complications, and the patient was discharged 9 and 11 days after the first and second operations, respectively. The present case demonstrates that two-step laparoscopic surgery may be a safe and feasible surgical procedure for high-risk patients with synchronous intra-abdominal malignancies.

DOI： 10.1155/2013/246515

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Scientific Research Publishing, Inc.  

DOI： 10.4236/ss.2013.46059

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その他リンク： http://www.scirp.org/journal/doi.aspx?DOI=10.4236/ss.2013.46059

記述言語：英語  

A 69-year-old Japanese woman with a history of distal gastrectomy with a Roux-en-Y reconstruction for advanced gastric cancer was admitted to our hospital complaining of severe dysphagia. On admission, the patient was only able to take liquids, and a firm, fist-sized tumor was palpable in her left upper abdomen. An endoscopic examination disclosed stenosis of the jejunal limb of the gastrojejunostomy. Abdominal computed tomography revealed that a recurrent tumor, 5.0 cm in diameter, was compressing the jejunal limb of the gastrojejunostomy. A knitted nitinol self-expandable metallic stent (WallFlex™ duodenal stent) was placed endoscopically at the stenotic jejunum from the gastrojejunostomy. The time required for stenting and total endoscopic manipulation was 12 and 35 minutes, respectively. No stent-related complications were observed. The patient could resume oral ingestion 1 day after endoscopic stenting and was discharged on the fifth day after treatment. She survived for 201 days after stenting. She continued oral ingestion for 194 days and stayed at home for 165 days. The WallFlex duodenal stent allows safe endoscopic stenting, even in cases of malignant stenosis of a gastrojejunostomy following distal gastrectomy. This stenting device will extend the indications for endoscopic palliation of gastric cancer patients with gastric outlet stenosis.

DOI： 10.1159/000341851

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Current advances in chemotherapy provide opportunities for stage IV gastric cancer patients with distant metastasis to undergo potentially curable resection. There are, however, few data on gastrectomy as a secondary surgery aimed at rendering such patients cancer-free. METHODS: We investigated stage IV gastric cancer patients who underwent surgery with curative intent after S-1-based chemotherapy between 2000 and 2008. Twenty-eight patients from 12 hospitals were enrolled in this study. Factors indicating that the tumors were incurable included clinical stage T4 in 9 patients, para-aortic node metastasis in 15, peritoneal metastasis in 7, and liver metastasis in 4. RESULTS: Of the 28 laparotomy patients, 26 underwent complete resection with no residual tumor, obtaining a complete resection rate of 92.9%. There were no in-hospital deaths or reoperations. In four patients, the primary tumor showed pathological complete response. The 1-, 3-, and 5-year overall survival rates after secondary gastrectomy were 82.1, 45.9, and 34.4%, respectively, with a median survival time of 29 months. Univariate analysis revealed histological tumor length, clinical depth of tumor invasion, number of metastatic nodes, pathological depth of tumor invasion, and pathological response to be the factors influencing patient survival after secondary surgery. On multivariate analysis, histological tumor length (5.0 cm or larger) was the only significant prognostic factor (relative risk 3.23, P = 0.028). CONCLUSIONS: Secondary gastrectomy following S-1-based chemotherapy was a safe and effective treatment for stage IV gastric cancer. Primary tumor size is an indicator for the appropriate selection of patients for this treatment.

DOI： 10.1007/s10120-011-0100-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Limited data are available concerning long-term results of imatinib therapy in patients with advanced gastrointestinal stromal tumors. We aimed to clarify the long-term outcomes of imatinib therapy in Japanese patients with advanced gastrointestinal stromal tumors. METHODS: A prospective, observational study of imatinib therapy for unresectable and metastatic gastrointestinal stromal tumors was conducted in our institution. Imatinib was initiated at a dose of 400 mg daily and continued until disease progression. Safety, efficacy and long-term tolerability and survival were evaluated in an intent-to-treat population. The median follow-up period in this study was 68 months. RESULTS: Seventy patients were enrolled between December 2001 and December 2009. Treatment-related Grade 3/4 adverse events occurred in 49 patients (70.0%). Although 14 patients required adverse effect management with hospitalization, only 5 patients (7.1%) withdrew from the treatment owing to imatinib intolerance. The tumor response and clinical benefit rates were 61.4 and 85.7%, respectively. Thirty-seven patients (52.9%) maintained the treatment at 400 mg daily imatinib, whereas 33 patients (47.1%) had their dose reduced to 300 mg daily or less. The overall survival rate at 5 years was 60.9% and the median survival time was 70 months. The median progression-free survival time of all the 70 enrolled patients was 30 months. Seven patients (10.0%) suffered from second malignancies, including three patients with genitourinary carcinomas. CONCLUSIONS: Despite the need for dose reduction, the long-term results of imatinib therapy for advanced gastrointestinal stromal tumors were good in Japanese patients. Physicians should pay attention to the occurrence of second malignancies during imatinib therapy for gastrointestinal stromal tumor patients.

DOI： 10.1093/jjco/hys056

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

Objectives: A treatment strategy for patients with esophageal carcinoma invading adjacent structures found during esophagectomy (surgical T4; sT4) has not been established and the role of esophagectomy remains controversial. The aims of this study were to assess the clinicopathological characteristics and to clarify the prognostic factors of patients who underwent esophagectomy for sT4 tumors.
Methods: A consecutive series of 76 patients who were found to have sT4 tumors was reviewed retrospectively. T4 tumors were divided into two groups according to the invaded structures. Cox's multivariate proportional hazard model was used to identify prognostic factors.
Results: Complete tumor clearance with combined resection was performed in 12 patients (16%). Overall 1-, 3-, and 5-year survival rates were 40.8%, 9.2%, and 7.9%, respectively. There was no significant relationship between survival and invaded structure type or residual tumor status. Postoperative therapy was selected as an independent prognostic factor.
Conclusions: The complete resection rate was low and the prognosis of patients with sT4 tumors was poor. Subclassification according to the invaded structures was not a prognostic factor in this study. Postoperative therapy may improve survival in sT4 patients and should be considered irrespective of residual tumor status after esophagectomy. J. Surg. Oncol. 2012;105:767-772. (C) 2012 Wiley Periodicals, Inc.

DOI： 10.1002/jso.22092

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report here a case of reexpansion pulmonary edema following laparoscopy-assisted distal gastrectomy (LADG) for early gastric cancer. A 57-year-old Japanese woman with no preoperative comorbidity was diagnosed with early gastric cancer. The patient underwent LADG using the pneumoperitoneum method. During surgery, the patient was unintentionally subjected to single-lung ventilation for approximately 247 minutes due to intratracheal tube dislocation. One hour after surgery, she developed severe dyspnea and produced a large amount of pink frothy sputum. Chest radiography results showed diffuse ground-glass attenuation and alveolar consolidation in both lungs without cardiomegaly. A diagnosis of pulmonary edema was made, and the patient was immediately intubated and received ventilatory support with high positive end-expiratory pressure. The patient gradually recovered and was weaned from the ventilatory support on the third postoperative day. This case shows that single-lung ventilation may be a risk factor for reexpansion pulmonary edema during laparoscopic surgery with pneumoperitoneum.

DOI： 10.1155/2012/863163

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: There are no data concerning the occurrence of community-acquired pneumonia (CAP) in esophageal cancer patients during long-term follow-up after radical esophagectomy. The aims of the present study were to determine the incidence of CAP in esophageal cancer patients who underwent radical esophagectomy and to identify the risk factors. METHODS: A total of 186 consecutive patients who underwent radical esophagectomy for thoracic esophageal carcinoma in our hospital between 1991 and 2000 were enrolled in this study. Data on the occurrence of CAP were retrospectively collected from medical records, follow-up files, and telephone interviews with patients. The cumulative incidence of CAP was calculated by the Kaplan-Meier method, and the risk factors for CAP were determined by univariate and multivariate analyses. The median follow-up time was 77 months (range 12-216 months). RESULTS: Sixty patients suffered from CAP during the follow-up period. The cumulative incidence was 25.8% at 5 years and 38.4% at 10 years. Multivariate analysis revealed the following as the significant risk factors for CAP: presence of lymph node metastasis (Hazard ratio [HR], 2.64; 95% confidence interval [CI], 1.55-4.50; P < 0.001), colonic interposition (HR, 2.87; 95% CI, 1.41-5.82; P = 0.004), obstructive lung disease (HR, 1.95; 95% CI, 1.11-3.42; P = 0.021), and preoperative hypoalbuminemia (HR, 2.08; 95% CI, 1.20-3.60; P = 0.009). CONCLUSIONS: There is a high incidence of CAP in esophageal cancer patients after esophagectomy. Positive nodal metastasis, colonic interposition, obstructive lung disease, and preoperative hypoalbuminemia are risk factors for this long-term postoperative morbidity.

DOI： 10.1007/s00268-011-1226-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Extended radical esophagectomy with three-field lymph node dissection (3-FLD) has offered significant survival benefit, but some patients still suffer from early recurrence and die within 1 year after surgery. The purpose of this study was to identify the risk factors that influence early death due to cancer recurrence after extended radical esophagectomy with 3-FLD. METHODS: A consecutive series of 276 patients who underwent extended radical esophagectomy with 3-FLD was retrospectively reviewed. Excluding patients who underwent incomplete resection or died of other diseases within 1 year, we compared the clinicopathological characteristics between 203 patients who survived more than 1 year (1-year survival group) and 27 who died of cancer recurrence within 1 year (early-death group) by univariate and multivariate analysis. RESULTS: Sixty-six patients (32.5%) had recurrent disease in the 1-year survival group. Hematogenous recurrences were more frequent in the early-death group than in the 1-year survival group (41% vs. 26%, respectively, p = 0.0481). There was a significant difference in nodal status, number of metastatic nodes, pathological stage, vessel invasion, and intramural metastasis, and there was borderline significance in the difference of depth of invasion and histological type between the two groups by univariate analysis. Multivariate analysis demonstrated that intramural metastasis was an independent risk factor. CONCLUSIONS: Patients with intramural metastasis have a significant risk of early death even after extended radical esophagectomy with 3-FLD; however, it remains unknown whether surgical intervention can play a significant role for these patients.

DOI： 10.1245/s10434-011-1712-5

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

It is unknown how long the risk of developing secondary resistance to imatinib persists in patients with gastrointestinal stromal tumors (GISTs). Here we report a case of a patient with a metastatic gastric GIST who developed secondary resistance to imatinib 70 months after initiation of imatinib therapy. A 62-year-old woman with a gastric GIST underwent total gastrectomy with pancreaticosplenectomy. Immunohistochemistry revealed a KIT-positive GIST. The mitotic index of the tumor was 13/50 high-power fields, indicating a high-risk malignancy. After surgery, the patient developed a solitary liver metastasis and underwent right hepatic lobectomy. Four months later, a metastatic tumor was found at the left adrenal gland, and imatinib therapy was initiated in December 2004. Imatinib therapy led to marked tumor shrinkage and complete clinical remission in the patient. However, in October 2010, computed tomography scans revealed a peritoneal metastasis in the ileocecal area. The tumor progression was clinically determined to be due to the development of secondary resistance to imatinib, and the patient's treatment was switched to sunitinib. This case illustrates secondary resistance to imatinib can develop even after a sustained and marked treatment response. Long-term therapy and close monitoring are recommended for the management of patients with metastatic GISTs.

DOI： 10.1007/s12328-011-0234-9

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Gastrointestinalstromaltumors (GIST)are occasionally found as large abdominal tumors at presentation. However, the best treatment approach for such large and marginally resectable GISTs remains unclear. The survival of patients with clinically malignant GISTs or GISTs with incomplete resection was as short as 1-2 years. Imatinib, a KIT kinase inhibitor, shows promise as a preoperative treatment for marginally resectable GIST, because it exhibits potent antitumor activity for unresectable and metastatic GISTs. Data obtained from imatinib therapy for advanced GISTs indicate that preoperative treatment with 400 mg of imatinib daily for 6-12 months is recommended, although no standard regimen has been established so far. Positron emission tomography is useful for the early assessment of the efficacy of preoperative imatinib treatment, a critical step for the management of patients with marginally resectable GIST. Two case studies have shown the safety and strong antitumor activity of preoperative imatinib treatment and concluded that treatment contributed to reducing surgical morbidity. However, a multicenter phase II trial conducted in the United States has shown that complete resection was not sufficiently achieved in patients who underwent preoperative imatinib treatment: complete resection rates were 77% for primary cases and 58% for metastatic cases, whereas the treatment was not associated with severe postoperative complications. The clinical guidelines for GIST in Japan regard preoperative imatinib treatment for marginally resectable GIST as an experimental treatment. More clinical evidence is required before making preoperative imatinib treatment the standard treatment for marginally resectable GIST.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Gastrointestinal stromal tumor(GIST)is one ofthe representative diseases for which molecularly targeted therapy is very effective. Imatinib mesylate, a tyrosine kinase inhibitor of KIT and platelet-derived growth factor receptor(PDGFR), has dramatically improved the prognosis ofpatients with advanced, recurrent, and/or metastatic GISTs. Although the rate of response to imatinib therapy is high, the emergence ofimatinib -resistant tumors and the second-line therapy following imatinib therapy have become new clinical problems. Sunitinib malate, a multi-targeted tyrosine kinase inhibitor that shows activity against KIT and other receptor tyrosine kinases, including PDGFR and vascular endothelial growth factor receptor, is the only treatment for imatinib-resistant GISTs that is covered by national health insurance in Japan as ofthis writing. Several clinical trials that evaluated sunitinib as potential second-line therapy in Western countries and Japan found a clinical benefit rate of2 4 to 39% and a median time to progression of7 months. However, it is necessary to adequately manage the adverse events of sunitinib therapy in order to receive the full benefits of the therapy, because various severe adverse events, particularly thrombocytopenia and hand-foot syndrome in Japanese GIST patients, frequently lead to poor tolerability. Further investigation is required to find an appropriate regimen for Japanese GIST patients.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma. We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum. A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital. Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage IIA) and mucosal signet-ring cell carcinoma of the gastric antrum (T1N0M0 Stage IA). Although the gastric tumor appeared to be an intramucosal carcinoma, its margin was obscure, so endoscopic en-bloc resection was considered inadequate. We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer. Following transthoracic esophagectomy with three-field lymph node dissection, the gastric carcinoma was removed by gastric antrectomy, which preserved the right gastroepiploic vessels, and a pedunculated short gastric tube was used as the esophageal substitute. Twenty-eight months after the surgery, the patient is well with no evidence of cancer recurrence. Because it minimizes surgical stress and organ sacrifice, gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.

DOI： 10.4251/wjgo.v3.i5.75

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Complete surgical resection is the treatment of choice for primary gastrointestinal stromal tumor (GIST), even with current advances in molecular targeting therapy with imatinib and sunitinib. In recent years, function-preserving and minimally invasive surgeries have also been performed as treatment strategies for submucosal tumors, including GISTs that are clinically diagnosed as low-risk. It is crucial, however, not to compromise radicality when indicating these procedures. On the other hand, a multidisciplinary treatment, including surgical resection, is necessary even for the treatment of advanced or metastatic/ recurrent GISTs in which the treatment of choice is imatinib therapy. Furthermore, surgical treatment is expected to be effective for resectable liver metastases, secondary resistance to imatinib, or residual tumors responding to imatinib. In this regard, surgical resection as a multidisciplinary treatment is considered to have gained recognition as an important option. However, sufficient evidence is lacking, and thus, the results of ongoing clinical trials are highly anticipated. For the surgical treatment of GIST, it is important to select patients carefully based on objective data to obtain maximum therapeutic effects.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: Awareness of the clinical importance of second-line chemotherapy for incurable gastric cancer has been increasing. To assess the clinical validity of the new concept that second-line chemotherapy following predetermined cycles of first-line chemotherapy would improve survival, we conducted a phase II study.Methodology: Patients with pathologically proven incurable gastric adenocarcinoma and adequate organ functions were enrolled. S-1 or S-1 plus cisplatin was administered as first-line chemotherapy. The number of cycles of S-1-based chemotherapy was determined to be three as a maximum unless there was disease progression. The treatment was followed by weekly administration of paclitaxel. The primary endpoint was overall survival and the secondary endpoints were progression-free survival and safety.Results: Thirty-seven patients were eligible for enrollment. Twenty-eight patients (76%) underwent the second-line chemotherapy with paclitaxel after completion of S-1-based chemotherapy or disease progression. Treatment-related grade 3 or 4 toxicity was noted in 14 patients during S-1-based chemotherapy, and in 6 patients during paclitaxel treatment. The median survival time was 455 days and the median progression-free survival was 229 days.Conclusions: Sequential set chemotherapy with three cycles of S-1-based chemotherapy followed by weekly paclitaxel is feasible. The survival results are equivalent to those of other current regimens using S-1.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The clinical significance of operative treatment for metachronous pulmonary metastasis from esophageal carcinoma is unclear. METHODS: We retrospectively reviewed 23 consecutive patients who underwent operative resection for metachronous pulmonary metastasis from esophageal carcinoma from 1991 to 2008. Patient baseline characteristics, survival probability, and prognostic factors were analyzed. The median follow-up period was 31 months for surviving patients. RESULTS: There were 19 men and 4 women, with a median age of 66 years at the time of pulmonary resection. The median disease-free interval was 15.5 months. Cervical or mediastinal lymph node metastases preceded pulmonary metastases in 4 patients. Seven patients (30.4%) had multiple metastases with a maximum number of 4. The median operative time and blood loss were 94.5 minutes and 18 mL, respectively. The median length of postoperative stay was 12.5 days. The predicted 1-, 3-, and 5-year survival rates using the Kaplan-Meier method were 73.9%, 43.5%, and 43.5%, respectively, with a median survival time of 28.7 months. Univariate analysis revealed that an extrapulmonary metastasis as the initial recurrence site was an unfavorable prognostic factor (P = .0411). Multivariate analyses, however, did not identify the initial recurrence site as an independent prognostic factor (P = .0542). CONCLUSION: Operative resection for metachronous pulmonary metastasis from esophageal carcinoma is an acceptable treatment. This study of a limited number of patients may have created a constitutional selection bias. An antecedent extrapulmonary metastasis was found to be an unfavorable prognostic factor.

DOI： 10.1016/j.surg.2010.07.047

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Endobronchial metastasis (EBM) is a rare form of metastasis from extrapulmonary malignant tumors, although there are few reports of EBM from gastric cancer specifically. We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography. On diagnosis of primary lung cancer, she underwent pulmonary lobectomy, but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer. Six months later, she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen. She is still alive at 33 mo after the lobectomy. Generally, the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival. Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.

DOI： 10.4240/wjgs.v2.i8.270

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A 73-year-old man underwent neoadjuvant chemotherapy followed by transhiatal esophagectomy with gastric tube reconstruction for advanced esophageal cancer with palliative intent. Cervical esophagogastrostomy with circular-stapled end-to-side anastomosis was performed; however, anastomotic fistula developed. Fever, severe pain in the nape of the neck and numbness of the left hand were noted after drainage by wide opening of cervicotomy and the administration of empiric antibiotics. Magnetic resonance imaging revealed high signal intensity between the inferior C5 vertebral body and the intervertebral disc on T2-weighted images, and some areas were contrast-enhanced, suggesting purulent spondylodiscitis. Because methicillin-resistant Staphylococcus aureus was detected by bacterial culture from the drained pus, sensitive antibiotics were given, and those symptoms improved rapidly without sequelae.

DOI： 10.1510/icvts.2010.235515

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Recent improvement in the survival of patients after esophagectomy for esophageal cancer has led to increasing occurrence of second primary cancer in the pulled-up stomach as gastric tube cancer (GTC). However, a treatment strategy for GTC including surveillance has not been established. The aims of this study are to clarify the incidence and clinicopathological characteristics of GTC and to assess the treatment results of endoscopic resection. METHODS: Twenty-five patients with 29 GTC lesions treated between 1989 and 2007 were analyzed retrospectively. RESULTS: The median interval between esophagectomy and GTC detection was 86 months, and the 10-year cumulative incidence rate of GTC was 8.6%. Of 18 asymptomatic GTCs, 17 lesions (94.4%) were detected by periodic endoscopy and 15 (88.2%) of them were treated endoscopically. Of all 29 GTCs, endoscopic submucosal dissection (ESD) was performed in 10 GTCs with a completely curative resection rate of 90%, which was significantly higher than that of 7 GTCs treated with endoscopic mucosal resection (EMR) (14.3%, P = 0.004). In these 17 GTCs, no cancer recurrence developed during a median follow-up period of 24 months, and the 3-year survival rate was 80.8%. CONCLUSIONS: For patients after esophagectomy with gastric pull-up, long-term follow-up including periodic endoscopy is necessary to detect a potentially curable GTC. ESD is a feasible and safe procedure for GTC, with oncologically favorable features.

DOI： 10.1007/s00464-009-0766-y

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The rupture or bleeding of a gastrointestinal stromal tumor (GIST) is a life-threatening adverse event that can happen during imatinib therapy, but few such cases have been reported in the medical literature. Here, we report a case of intraperitoneal bleeding from GIST during imatinib therapy. A 75-year-old man was diagnosed with a large GIST with liver metastasis and admitted to our hospital for abdominal pain on the 13th day of imatinib therapy. The pain disappeared after 7 days of hospitalization; however, the patient complained of diffuse abdominal pain 5 days after discharge. He presented with muscular guarding, and abdominal-pelvic CT demonstrated dense ascites. The tentative diagnosis was peritoneal hemorrhage from GIST, and urgent laparotomy was performed. During the laparotomy, we noted hemoperitoneum of approximately 500 ml; we resected a bulky metastatic tumor on the greater omentum and a primary tumor on the jejunum. The patient took imatinib (400 mg daily) from the ninth postoperative day and underwent monthly checkups for 9 months after the surgery. When GIST patients complain of sudden and severe abdominal pain during imatinib therapy, bleeding from GIST should be considered as a possible adverse effect of imatinib.

DOI： 10.1007/s12328-010-0143-3

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s10388-009-0217-9

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

A 58-year-old woman was admitted to our hospital with the complaint of dysphagia that had developed 37 months after initiation of treatment for breast cancer. Endoscopy revealed severe stenosis 32 cm from the incisors through which the endoscope could not pass. No mucosal irregularities were observed, and biopsies of the stenotic lesion were negative for malignancy. Computed tomography showed wall thickening of the midthoracic esophagus and left pleural effusion, which had increased metabolic activity as detected by 18F-fluorodeoxyglucose positron emission tomography. Cytological examination of the pleural effusion showed adenocarcinoma compatible with metastasis from a prior lobular carcinoma of the breast. Vinorelbine effectively relieved her symptoms, and the disease stabilized for approximately 1 year. However, she died 16 months after the diagnosis of metastatic esophageal tumor from the preceding breast cancer. © Japan Esophageal Society and Springer 2010.

DOI： 10.1007/s10388-009-0216-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The electrogastrographic indices of spectral frequency, instability factor (IF), power amplitude, and power content (%) were compared between control subjects (C), and subjects following either total gastrectomy (TG), total colectomy (TC), distal gastrectomy (DG) or colonic replacement surgery (CR). In the fasting state, both the spectral frequency and IF of the epigastric 3-cycle per minute (cpm) group of the TC subjects were significantly lower than those indices in C, TG, DG, and CR subjects. In contrast, the power amplitude and power content of the epigastric 3-cpm group of both TG and DG subjects were significantly lower than those of C and TC subjects. The original epigastric waves of TG had remarkably high amplitudes. Furthermore, the absolute power of the epigastric 3-cpm of the TC subjects was 10 times higher than that in either the C or TG subjects. These results may be partially explained by the assumption that the recorded epigastric electrogastrography (EGG) is mainly contributed to by the 3-cpm myoelectric activity of the stomach and colon, while the infraumbilical EGG is mainly contributed to by the 3-cpm myoelectric activity of the colon. Topographic EGG maps visually supported these assumptions.

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

DOI： 10.1007/s10388-009-0206-z

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To elucidate the influence of liver cirrhosis (LC) on the prognosis of patients with gastric cancer (GC). METHODS: Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007, 25 patients (21 men and 4 women with a median age of 67 years; range 54-77 years) with LC were enrolled in this study. Using the Child-Pugh classification, 15 patients were evaluated as grade A and 10 patients as grade B. No grade C patient underwent gastrectomy in this series. Clinical outcomes, including postoperative morbidity and survival, were retrospectively analyzed based on medical records and surgical files. RESULTS: There was no significant difference in operative blood loss and perioperative blood transfusion between the two groups. The most common postoperative complication was intractable ascites, which was the single postoperative morbidity noted more frequently in grade B patients (40.0%) than in grade A patients (6.7%) with statistical significance (P = 0.041). Operative mortality due to hepatic failure was seen in one grade A patient. Three patients had hepatocellular carcinoma (HCC) at presentation and two patients developed HCC after surgery. Overall 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC (P = 0.230). GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3% (P = 0.010). Four patients with early GC died of uncontrolled HCC, of which two were synchronous and two metachronous. CONCLUSION: The risk of postoperative intractable ascites is high, particularly in grade B patients. Early detection and complete control of HCC is vital to improve a patient's prognosis.

DOI： 10.4240/wjgs.v1.i1.49

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: The aim of this study was to review the treatment outcomes of surgery and definitive chemoradiotherapy (CRT) in elderly patients with squamous cell carcinoma of the thoracic esophagus. METHODS: A total of 64 patients aged 75 or older were retrospectively reviewed; 40 were treated with surgery and 24 with CRT. The CRT group included eight patients with unresectable disease and four patients medically unfit for surgery. Surgery included esophagectomy with lymphadenectomy and CRT consisted of 60-70 Gy of radiation concurrent with 5-fluorouracil alone or combined with cisplatin. Short- and long-term outcomes and survival of each modality were assessed. RESULTS: In the surgery group, 33 patients (82.5%) had co-morbid conditions. Complete resection rate was 90.0%. An overall post-operative complication rate was 65.0% and in-hospital mortality was seen in three patients (7.5%). In the CRT group, complete response rate was 41.7%. Leukopenia was most common Grade 3 hematological toxicity. Treatment-related deaths caused by acute toxicities occurred in three patients (12.5%), whereas those caused by late toxicities in four (16.7%). For cStage I disease in the surgery group, the overall 1-, 3- and 5-year survival rate were 90.9%, 63.6% and 54.5%, respectively, with a median survival time of 78.7 months. For cStages II-IV, the median survival time of the surgery and the CRT group was 18.7 and 12.8 months, respectively. CONCLUSIONS: The short- and long-term outcomes of surgery for the elderly seemed acceptable; however, definitive CRT may be a promising treatment modality. Further investigation may alter the sphere of influence in the field of esophageal cancer treatment in the elderly.

DOI： 10.1093/jjco/hyp030

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The risk factors and suitable treatment of reflux esophagitis (RE) of the cervical remnant in patients undergoing radical esophagectomy remain unclear. The aim of this study was to evaluate the risk factors in patients with RE in the cervical remnant. METHODS: We retrospectively examined 141 consecutive patients who underwent esophagectomy and reconstruction with gastric tubing. RE was diagnosed by upper gastrointestinal endoscopy and graded according to the Los Angeles Classification. Statistically, 11 potential risk factors of RE were evaluated. The postoperative follow-up time ranged from 18 to 204 months (median 60 months). RESULTS: Among a total of 141 patients, 48 (34%) had RE in the cervical remnant, with 14 (29%) cases categorized as grade B, nine (19%) as grade C, and 25 (52%) as grade D. The cumulative incidence of RE in the cervical remnant was 24% at 5 years after surgery and 60% at 10 years, respectively. Pyloroplasty and bile reflux were identified as independent risk factors of RE in the cervical remnant by univariate and multivariate analyses. CONCLUSIONS: The results of this study show a high incidence and high grade of RE in the cervical remnant after esophagectomy. Routine endoscopic examination and suitable medication is required for the control of RE in the cervical remnant together with surgical procedures to avoid bile reflux.

DOI： 10.1007/s00268-008-9856-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Esophageal schwannoma is rare and it is difficult preoperatively to confirm a definitive diagnosis, even using current imaging techniques. We present a case of a benign esophageal schwannoma that was surgically excised and confirmed by immunohistochemical staining. Conventional radiological studies, including barium meal, computed tomography and endoscopic examination had shown a solid submucosal tumor of the upper thoracic esophagus but had been unable to confirm the diagnosis. Positron emission tomography was carried out to evaluate the malignant potential and showed a high uptake of 18F-fluorodeoxyglucose (FDG) into the tumor in both the early and delayed phase, suggesting that the tumor was a potentially malignant tumor such as a gastrointestinal stromal tumor. This is the first reported case of esophageal schwannoma that indicated a high FDG uptake. Although consensus has not been reached regarding the precise mechanism of FDG accumulation in schwannomas, we discuss our clinicopathological findings and review other studies of the subject.

DOI： 10.1111/j.1442-2050.2007.00712.x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Corrosive esophagitis, caused by swallowing corrosive acid or alkali, results in cicatricial stricture of the esophagus. The stricture is often accompanied by pyloric stenosis because strong acids act synergistically with gastric juice. Resection of both the esophagus and stomach is usually necessary, and the colon or jejunum is used as an esophageal substitute. We describe how we successfully treated corrosive esophagitis associated with pyloric stenosis, by performing gastric tube interposition for the esophageal reconstruction. After resecting the injured distal part of the stomach, we pulled the pedunculated gastric tube up to the cervix after anastomosis to the jejunal limb in a Roux-en-Y fashion. This reconstruction procedure prevented excessive organ sacrifice and was minimally invasive. Thus, esophageal reconstruction by interposition using a pedunculated gastric tube can be used effectively to treat corrosive esophagitis associated with pyloric stenosis.

DOI： 10.1007/s00595-008-3834-3

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Springer Science and Business Media LLC  

A 49-year-old man was referred to our hospital for treatment of an esophagorespiratory fistula following 5-year airway stenting for stenosis of tracheal anastomosis. In consideration of the prior polysurgery and the patient's poor general status and malnutrition, we selected multistep esophageal bypass combined with feeding enterostomy for nutritional support. Respiratory symptoms and pneumonia were rapidly improved by esophageal transection and decompression via a catheter esophagostomy. Nutritional status was also improved by enteral nutrition via a catheter gastrostomy. Four months after the esophageal transection, we conducted an esophageal bypass using an ileocolonic conduit because the right gastroepiploic artery had been used for omental reinforcement of tracheal anastomosis. The patient had no postoperative complications and was discharged 53 days after the bypass surgery. Multistep esophageal bypass including feeding enterostomy for perioperative nutritional management is a safe and useful alternative to direct closure for a critically ill patient with an esophagorespiratory fistula who is at high risk for operative mortality. © 2008 Japan Esophageal Soceity and Springer.

DOI： 10.1007/s10388-008-0148-x

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その他リンク： http://link.springer.com/article/10.1007/s10388-008-0148-x/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

We recorded and analyzed electrogastrograms (EGGs) from 12 patients following distal gastrectomy. The EGGs were recorded from between 3 and 262 months post-operatively. Gastric electrical activity, which showed a distinct repeating pattern with a frequency of 3 cycles per minute (cpm), was easily recognizable in subjects who were recorded 16-20 years postoperatively, but was not clearly evident in EGG running spectra of subjects with a shorter postoperative period. Although the postprandial instability factor of the 3-cpm components (standard deviation of mean spectral frequency of peak 3-cpm group/mean of the 3-cpm spectral frequency) of the epigastric and supraumbilical EGGs showed a significant negative linear correlation with postoperative months, no such correlation was seen in the postprandial to fasting power ratio (postprandial power / fasting power) of the 3-cpm activity component. Therefore, we hypothesized that the disorganized pacemaker activity of the remnant stomach following distal gastrectomy can be reorganized to work as a synchronized unit over a long postoperative recovery period of from 15 to 20 years. A greater degree of epigastric and supraumbilical fasting 6-cpm power seemed to result in a worse quality of life (QOL). Similarly, a larger ratio of the supraumbilical postprandial to fasting power ratio of the 6-cpm activity seemed to result in a worse QOL. In contrast a larger ratio of the infaraumbilical postprandial to fasting power content of the 6-cpm activity seemed to result in a better QOL.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: The development of new generation anticancer agents, including the oral drug, S-1, may alter the clinical importance of gastrojejunostomy in the treatment of incurable gastric cancer. We reviewed a series of patients who underwent gastrojejunostomy for this reason between 2002 and 2005. METHODS: Fourteen patients underwent gastrojejunostomy followed by S-1-based chemotherapy for incurable gastric cancer with obstruction or stenosis of the gastric outlet at Niigata University Medical and Dental Hospital and two affiliated hospitals. The safety of gastrojejunostomy, outcome of palliation, and survival time were analyzed retrospectively. We compared the survival times with those of patients who underwent palliative gastrectomy or exploratory laparotomy between 1987 and 2001. RESULTS: The median operative time and blood loss were 153 min and 66 ml, respectively. There were no major complications. The median starting time for chemotherapy after gastrojejunostomy was 15.5 days. All patients were discharged after gastrojejunostomy, and the median postoperative home stay ratio was 68%. The median survival time after gastrojejunostomy was 354 days, which was significantly longer than that of patients who underwent palliative gastrectomy or exploratory laparotomy. CONCLUSION: Gastrojejunostomy for incurable gastric cancer contributes not only to improving quality of life (QOL), but to prolonging survival through the induction and maintenance of S-1-based chemotherapy.

DOI： 10.1007/s00595-007-3749-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Microscopic cancer spreading to extranodal connective tissues (extranodal spreading: ENS) is occasionally found in resected specimens from patients with esophageal squamous cell carcinoma (SCC), but the prognostic impact of ENS remains unclear. The aims of this study were to elucidate the prognostic impact of ENS to help determine the most suitable management for the patients with ENS. METHODS: We histologically re-evaluated 7,349 lymph nodes obtained from 171 patients with SCC of the thoracic esophagus who underwent potentially curable resection between 1992 and 2003. We defined ENS as microscopic penetration of tumor cells from metastatic lymph nodes or tumor cell dissemination into extranodal connective tissues. RESULTS: Extranodal spreading was found in 37 (21.6%) patients, and it had a significant relationship with diameter and depth of the tumor, lymphatic and venous invasion, intramural metastasis, and number of metastatic nodes. Patients who were ENS positive were at higher risk of recurrence, and their overall survival rate was lower than that for ENS-negative patients. Furthermore, recurrent risk was higher and overall survival rate was lower in ENS-positive patients than in ENS-negative patients when they had 1-3 metastatic nodes, but recurrent risk and overall survival rate of the patients with 4 or more metastatic nodes were very similar in ENS-positive and ENS-negative patients. CONCLUSIONS: The present findings suggest that in SCC of the thoracic esophagus, the presence of ENS increases recurrent risk and reduces the overall survival of the patients with 1-3 metastatic nodes. Patients showing ENS should be managed in the same way as patients with 4 or more metastatic nodes.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We report a case of multiple duodenal, pancreatic, and gastric carcinoids. A 67-year old woman was admitted to our hospital for treatment of a duodenal carcinoid. Laboratory tests revealed that the patient was associated with macrocytic anemia and hypergastrinemia, and type A gastritis was shown by gastrofiberscopy. During surgery, another tumor was incidentally found in the head of the pancreas. The tumors in the duodenum and pancreas were completely excised by pancreatoduodenectomy and immunohistologically diagnosed as gastrin-and serotonin-producing carcinoids, respectively. Pathological examination revealed that in addition to the grossly found carcinoids, there were subclinical carcinoids, one of which was an endocrine cell micronest, located in the stomach and duodenum. The tumors in the duodenum, pancreas, and stomach showed different characteristics from one another morphologically and immunochemically. Although no definitive evidence has been obtained, some sort of genetic anomaly may have been involved in this case, and hypergastrinemia due to duodenal gastrinoma may induce multiple gastric carcinoids.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Gastric carcinosarcoma often presents with an elevated lesion or increased thickness of the stomach wall. Histological diagnosis is achieved using conventional hematoxylin and eosin staining to confirm the coexistence of both epithelial and mesenchymal elements. We report a case of gastric carcinosarcoma presenting as a large mass in the epigastric region. Specimens obtained by endoscopic biopsy and surgical excision showed diffuse proliferation of atypical cells in sheet formation. No mucus production or glandular structures were apparent, but immunoreactivity for both epithelial and mesenchymal markers was noted. These findings led to a definitive diagnosis of gastric carcinosarcoma. Immunohistochemical analysis is useful for the early diagnosis and treatment of gastric carcinosarcoma.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The aim of this study was to assess whether the sentinel node concept could be applicable to clinically early carcinoma of the esophagus. We studied ten consecutive cT1N0 patients who underwent radical esophagectomy with regional lymph node dissection. On the day before surgery, 99m-Tc tin colloid was injected endoscopically around the primary tumor. Lymphoscintigraphy was also performed about three hours after injection. Immediately after surgery, the radioactivity of all dissected lymph nodes was measured with a hand-held gamma probe. The radioactivity and the metastatic status assessed by routine histopathologic examination were compared. A total of six patients had hot spots detected by lymphoscintigraphy, of which the detection rate was 60% (6 of 10). The ex vivo hot node detection rate was 90% (9 of 10). Three patients were found to have metastatic nodes. In one patient, sentinel node mapping failed to identify any hot spot or hot node. In the other two patients, the metastatic nodes did not correspond to hot nodes. The accuracy of hot node status was 77.8% (7 of 9), and the false-negative rate was 100% (2 of 2). The present study showed that radio-guided sentinel node detection is insufficiently reliable at present due to the high false-negative rate and low accuracy.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We here report a case of a 51-year-old man with lung metastasis from esophageal carcinoma that was initially treated by combination chemotherapy consisting of fluorouracil and nedaplatin. Because metastatic disease disappeared, salvage esophagectomy was performed. Although chest wall recurrence developed at the thoracotomy wound, prolonged survival of 48 mo was achieved by local tumor resection and additional chemotherapy. This combination chemotherapy is regarded as a promising and considerable treatment for metastatic esophageal carcinoma.

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記述言語：英語  

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記述言語：英語  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

We examined safety and efficacy of hypotonic CDDP intraperitoneal administration followed by systemic chemotherapy using MTX/5-FU and UFT. Between 1998 and 2004, seven patients who had histologically proven gastric adenocarcinoma with peritoneal metastases underwent palliative gastrectomy at Niigata University Medical Hospital. For residual peritoneal tumors, 100 mg/body of CDDP diluted with distilled water was intraperitoneally administered to the patients before closure of abdominal wall and was drained 30 to 60 minutes after administration. During the postoperative period, a patient suffered from intraperitoneal abscess and another patient had a renal dysfunction with an increasing level of serum Cr (2.1 mg/dl). As adverse effects of the following systemic chemotherapy, three patients had grade 3 anemia and one had grade 3 leukopenia. The median time to progression was 109 days and the median survival time was 248 days. Although intraperitoneal CDDP administration is safe to be carried out intraoperatively, the effect on survival is not better than new anticancer drugs, such as TS-1 and paclitaxel.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

OBJECTIVE: Patients with advanced esophageal carcinoma including clinical T4 tumor, extensive lymph node metastasis, or intramural metastasis have a dismal prognosis, despite recent multimodality treatments. The aim of this study was to evaluate the efficacy and toxicity of neoadjuvant chemotherapy using fluorouracil, doxorubicin, and cisplatin or nedaplatin (FAP/N) in these patients. MATERIAL AND METHODS: Twenty-six patients were enrolled in this study. The first 9 patients received 600 mg/m2 fluorouracil on days 1-7 and days 29-35, and 30 mg/m2 doxorubicin and 60 mg/m2 cisplatin on days 1 and 29 (FAP). The next 17 patients received modified FAP, in which 50 mg/m2 nedaplatin was given instead of cisplatin (FAN). RESULTS: Grade 3 or 4 toxicities developed in 6 patients (23.1%) during chemotherapy, but there was no discontinuation of treatment. The clinical response rate was 46.2%. Twenty-one patients (80.8%) underwent esophagectomy, and R0 resection was achieved in 16 patients (61.5%). The 1-year survival rates of 26 patients, 21 patients with resectable tumor, 16 with R0 resection, and 12 clinical responders, were 31.3%, 32.1%, 33.3%, and 45.5%, respectively, each with a median survival time of 9 months. The median progression-free survival time of 26 patients was 6 months; in 16 patients with R0 resection progression-free survival was 6.5 months. There was no correlation between the recurrence pattern and tumor spread before treatment. CONCLUSIONS: FAP/N was found to have acceptable toxicities and the ability to control locoregional tumors, but made little contribution to patient survival. The efficacy of this treatment for patients with advanced esophageal carcinoma, however, may not yet be apparent.

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掲載種別：研究論文（学術雑誌）  

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1007/s10388-004-0020-6

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その他リンク： http://link.springer.com/article/10.1007/s10388-004-0020-6/fulltext.html

記述言語：英語   掲載種別：研究論文（学術雑誌）  

Serum carcinoembryonic antigen (CEA), carbohydrate antigen (CA) 19-9, and squamous cell carcinoma (SCC) antigen levels were assessed to determine if their levels are useful for staging esophageal cancer preoperatively and for predicting patient survival after esophagectomy. Hence their seropositivity was investigated for a correlation with resectability, clinicopathologic parameters of tumor progression, and treatment outcomes in patients with unresectable esophageal cancer ( n = 63) and those undergoing esophagectomy for resectable disease ( n = 267). Abnormal elevation of serum SCC antigen levels showed a significant correlation with resectability ( p< 0.0001), depth of tumor invasion ( p < 0.0001), lymph node status ( p = 0.0015), TNM stage ( p < 0.0001), lymphatic invasion ( p = 0.0019), blood vessel invasion ( p = 0.0079), and poor survival after esophagectomy ( p = 0.0061). A significant relation ( p = 0.0145) was found between elevated serum CEA levels and distant metastasis, whereas the seropositivity of CA 19-9 showed no association with resectability, tumor progression, or patient survival. These results indicate that abnormal elevation of serum SCC antigen is a useful predictor of advanced esophageal cancer associated with poor survival after esophagectomy.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Extended radical esophagectomy with three-field lymphadenectomy for patients with thoracic esophageal cancer has been shown to be effective. But even if this operation is performed, some patients still experience relapse of the disease. The purpose of this study was to clarify the pattern and timing of recurrence after extended radical esophagectomy. STUDY DESIGN: Recurrence of esophageal squamous cell carcinoma was examined in 171 of 174 patients who underwent extended radical esophagectomy with three-field lymphadenectomy. Recurrence patterns were classified as locoregional (at the site of the primary tumor, the anastomotic site, or the lymph nodes), hematogenous, and other (pleura or site of gastrostomy). Factors associated with recurrence were identified using univariate and multivariate statistical methods for survival analysis. RESULTS: The overall 5-year survival rate was 55.6%. Recurrence was recognized in 74 patients (43.3%). The median disease-free interval until recurrence was 11 months. Thirty patients (17.5%) developed a locoregional recurrence, and 24 (14.0%) developed a hematogenous recurrence. Five patients (2.9%) developed both recurrences simultaneously and were classified as hematogenous recurrences. Of 30 patients with cervical lymph node metastasis, recurrent disease was recognized in 19 patients (63.3%). In multivariate analysis of 160 patients, the depth of invasion and pM-lym (cervical or celiac lymph node metastasis) were significant factors for locoregional recurrence; the depth of invasion and number of lymph node metastases at operation were significant factors for hematogenous recurrence. Survival time for patients with hematogenous recurrence (median 16 months) was significantly shorter than that of patients with locoregional recurrence (median 25.5 months). CONCLUSIONS: Locoregional recurrence is associated mainly with the extent of the local tumor and lymph node metastasis; hematogenous recurrence is not only associated with tumor stage but also with the tumor's oncologic behavior.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

SUMMARY. Self-expandable metallic stents (EMS) provide a common option for malignant esophageal stenosis because of the low complication rate and high dysphagia improvement rate. However, there are few studies on the functional duration of EMS and the extent of improvement of the quality of life. We retrospectively analyzed 18 patients who received EMSs in our division from 1996 to 2002. The median duration of possible food intake and the median survival period were 94.5 and 108 days. The median duration of domiciliary treatment was 56 days. Six of the 18 patients were not discharged from hospital after EMS insertion. The Karnofsky index was found to be a significant determinant of the feasibility of domiciliary treatment. One-third of the patients are incapable of obtaining the benefits of the palliative therapy. EMS deployment should be prudently selected for patients exhibiting low performance status.

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掲載種別：研究論文（学術雑誌）  

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掲載種別：研究論文（学術雑誌）  

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記述言語：英語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The role of cervical lymphadenectomy for thoracic esophageal cancer is controversial. This study evaluated the impact of cervical lymphadenectomy on the cervical lymph node metastasis (LNM) and survival rates of patients with esophageal cancer. We analyzed 199 patients who received radical esophagectomy with three-field lymphadenectomy. The overall 5-year survival rate was 49.4%. Cervical LNM was found in 36 (18.1%) out of the 199 patients. The 5-year survival rates of the patients with cervical LNM from upper and mid-esophageal cancers were 71.4% and 35.9%, respectively. However, none of the patients with cervical LNM from lower esophageal cancer survived more than 4 years after esophagectomy. The overall survival of patients with five or more metastatic nodes (5.9%) was significantly worse than that of patients with less than five positive nodes (45.5%). Cervical lymphadenectomy is beneficial for patients with carcinoma of the upper and mid-thoracic esophagus, and with less than five positive nodes.

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：INT COLLEGE OF SURGEONS  

Carcinomas of the hypopharynx and the cervical esophagus carry poor prognosis regardless of any treatment modality. To improve long-term survival, prognostic factors for overall survival after surgical resection of these tumors were investigated. Clinical and pathological data from 52 patients undergoing surgical resection for hypopharyngeal (n = 20) and cervical esophageal (n = 32) cancers were reviewed to assess treatment outcomes and prognostic factors. The in-hospital mortality and morbidity rates were 13.5% and 50%, respectively. The 5-year survival rate of the 52 patients was 31.2%. The depth of tumor invasion, quality of tumor clearance, gender of the patients, postoperative complications, and intramural metastasis were revealed by the univariate analysis to be significant prognostic factors. The first four of these factors were specified by the multivariate analysis as independent prognostic factors for overall survival. Complete clearance of loco-regional disease and prevention of postoperative complications are of particular importance for the improvement of long-term survival in patients with these cancers.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Our previous mapping of allelic loss in gamma-ray induced thymic lymphomas in F(1) hybrid and backcross mice between BALB/c and MSM strains identified three regions with high frequencies of allelic loss which probably harbor a tumor suppressor gene. One region, Tlsr7, exists near the D16 Mit122 locus on chromosome 16. This study has further localized Tlsr7 by constructing a physical map and scanning a total of 587 thymic lymphomas. The map consists of 13 overlapping BAC clones and isolation of BAC-derived polymorphic probes leads to fine mapping of allelic losses. Eleven lymphomas show informative breakpoints of allelic loss regions relative to the flanking markers on the map. Pulsed-field gel electrophoresis of NotI digests of the clones shows that the commonly lost region is localized within an approximately 300 kb interval near D16Mit192. This map is invaluable to facilitate the identification of genes in the Tlsr7 region.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Our previous genome-wide analysis of allelic loss for thymic lymphomas that were induced by gamma-irradiation in F1 hybrid mice between BALB/c and MSM strains suggested the centromeric region on chromosome 11 as a site harboring a tumor suppressor gene. Interestingly, to this region the mouse Ikaros gene was mapped which was postulated to participate in oncogenic process from the study of Ikaros knockout mice. Here we show fine allelic loss mapping in the vicinity of Ikaros in 191 lymphomas, indicating that the critical region of allelic loss was centered at the Ikaros locus. PCR analysis revealed that nine lymphomas failed to give PCR-amplification for either of two exon primer pairs, indicative of homozygous deletion. Six and five mutations were detected in the N-terminal zinc finger domain and the activation domain of Ikaros, respectively, and six of the eleven were frameshift or nonsense mutations that resulted in truncation of Ikaros protein. The results strongly suggest a direct role for Ikaros in development of mouse thymic lymphomas. This provides the experimental basis for further analysis of Ikaros mutations in human cancer.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Male F(1) hybrids between MSM mice carrying a deficient p53 allele and BALB/c mice were irradiated with gamma-rays, and 80 thymic lymphomas were obtained, 46 of which developed in mice carrying the deficient p53 allele. Because the Y chromosome contributes little to cellular function, the stability of the Y chromosome in the tumors was assessed by polymerase chain reaction by examining three genes: Smcy and Sry on the short arm and Sts in the pseudoautosomal region of the long arm of the Y chromosome. Twenty-one lymphomas had lost one or two genes, probably as a result of mitotic recombination or interstitial deletion, whereas no lymphomas had lost all three genes. The p53 status of the lymphomas was determined by genotyping and allelic loss analysis; 34 had retained two wild-type p53 alleles, suggesting normal function; 34 had lost both alleles, indicating loss of function; and the other 12 had at least one wild-type p53 allele, so their p53 status was unclear. Compilation of these data revealed that changes in the Y chromosome were detected in only two of the 34 lymphomas retaining functional p53 but in 18 of the 34 lymphomas lacking p53 function, suggesting that p53 deficiency leads to an increase in the accumulation of radiation-induced aberrant chromosomes. This is consistent with our previous result from analysis of the inactive X chromosome. In contrast, a decrease in the fidelity of mitotic transmission in p53-deficient lymphomas was not noted for the Y chromosome.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Our previous allelic loss analysis of gamma-ray induced thymic lymphomas in F1 hybrid and backcross mice between BALB/c and MSM strains mapped the Tlsr4 region exhibiting a high frequency of allelic loss (62%) to a 2.9 cM interval between the markers D12Mit53 and D12Mit279 on mouse chromosome 12. To narrow further the interval harboring a putative tumor suppressor gene, a high-density scan has been carried out for informative 361 thymic lymphomas. Construction of a physical map of Tlsr4 with 3 YAC and 15 BAC clones and isolation of YAC- and BAC-derived polymorphic probes lead to fine allelic loss mapping. Three successive polymorphic sites within one BAC exhibit the retention of both alleles in seven, one and four lymphomas, suggesting that a common region of allelic loss for Tlsr4 exists within the BAC region. Pulsed-field gel electrophoresis of NotI digests of this and other clones determines that the commonly lost region is a 35 kb interval with a NotI site. NotI sites are frequently associated with coding regions, and our preliminary sequencing has identified ESTs in the region. Thus, the present study facilitates the identification of genes in the Tlsr4 region that would lead to isolation of a novel tumor suppressor gene.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Analysis of double mutant mice of the p53 and scid genes, which have a combination of cell cycle checkpoint/apoptosis and DNA repair defects, shows that the latter defect synergistically enhances lymphoma development with loss of the former function. These mice lack the ability to eliminate lymphocytes predisposed to neoplastic transformation resulting from faulty antigen receptor gene rearrangement. Here we examine the cooperativity in double heterozygotes of p53 and scid in which normal development of lymphocytes is not impaired. MSM mice carrying a p53-knockout allele were crossed with BALB/c mice heterozygous for the scid locus and 129 offspring were obtained. They were subjected to gamma-ray irradiation, 84 thymic lymphomas being generated. The tumors and host mice were genotyped of p53 and scid. Among 42 mice developing p53-deficient lymphomas, scid/+ and +/+ genotypes did not provide difference in onset and latency. Besides, allelic loss of the Scid gene occurred at a high frequency in those lymphomas but the loss exhibited no allelic bias. The results suggest that the scid/+ genotype is not a modifier of loss of p53 function in the double heterozygotes.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

F1 offspring of male MSM male mice with a p53-deficient (knockout) allele and normal female BALB/c mice were backcrossed with MSM mice to produce N2 mice. Female F1 and N2 mice were irradiated with gamma-radiation, and thymic lymphomas were obtained from 69 F1 and 82 N2 mice heterozygous for X chromosome markers. Of these 151 mice, 91 carried a p53-deficient allele. These lymphomas were analyzed for allelic loss by using four marker loci distributed on X chromosome to assess the stability of the inactive X chromosome, which contributes little to cellular functions. Twenty lymphomas showed allelic loss of all four loci, suggesting loss of a whole inactive X chromosome due to mitotic nondisjunction, whereas 24 lost only a part of an X chromosome, as a result of somatic recombination. The p53 status of the lymphomas was determined by genotyping and allelic loss analysis: 53 had retained two wild-type p53 alleles, suggesting normal function; 69 had lost both alleles, indicating loss of function; and the remaining 29 had at least one wild-type p53 allele, so their p53 status was unclear. Compilation of these two data revealed one nondisjunction-type change and five recombination-type mutations on X chromosome in 53 lymphomas retaining functional p53. In contrast, 14 and 16 of these alterations, respectively, were observed in 69 lymphomas lacking p53 function. These results suggest that p53 loss significantly increases the accumulation of recombinant chromosomes and decreases the fidelity of mitotic chromosome transmission of the X chromosome in gamma-ray-induced lymphomas.

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掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We conducted a retrospective study on 711 patients with early gastric cancer. Twenty-two patients (4.0%) developed recurrent disease and 21 died of recurrence during this study. One hundred and sixty-three patients died of unrelated or unknown causes. The recurrence patterns of 22 patients were as follows: hematogeneous metastasis to the liver in 11 patients, peritoneal dissemination in 3, recurrence in the remnant stomach in 3, and in the distant lymphonodes in 1. The mean survival period of patients with recurrent disease was 50.4 months, and 7 of these patients (31.8%) died more than 5 years after surgery. A retrospective clinicopathologic evaluation of the 22 patients and 526 patients without recurrence revealed significant differences between the two groups with respect to mean age at the time of surgery (62.5 years in the recurrent group vs 57.3 years in the nonrecurrent group), tumor size (41.2 vs 30.6 mm), depth of invasion (submucosal cancer: 19 vs 256), lymphnode metastasis (11 vs 48), lymphatic (11 vs 89) and venous (7 vs 18) invasion, and operative curability (curability B: 8 vs 48). Three patients with intramucosal cancer who died of hematogenous and/or peritoneal recurrence within 7 years after surgery had neither lymphnode metastasis nor lymphatic or venous invasion, suggesting that new techniques are needed for prediction of recurrent disease in patient with early gastric cancer.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A total of 429 gamma-ray-induced thymic lymphomas were obtained from F1 and backcross mice between BALB/c and MSM strains, about a half of which carried a p53-deficient allele. A genome-wide allelic loss analysis has revealed two loci exhibiting frequent allelic losses but no allelic preference, one is localized within a 2.9 cM region between D12Mit53 and D12Mit279 loci on chromosome 12, and the other is near the D16Mit122/D16Mit162 loci on chromosome 16. The frequency of allelic loss in the D12Mit279 region is 62% and does not differ in tumors between the presence and absence of the p53-deficient allele. In contrast, the loss frequency of D16Mit122 is raised by the existence of p53-deficient allele: 62% for p63(-/+) and 13% for p53(+/+), suggesting co-operative function of the two losses. The D12Mit279 and D16Mit122 regions probably harbor different types of tumor suppressor gene that play key roles in lymphoma development.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Tumor cells with metastatic potential may have a high telomerase activity that augments telomeric DNA repeats, allowing the cells to escape from the inhibition of cell proliferation due to shortened telomeres. We examined the expression level of telomerase activity using the telomeric repeat amplification protocol among a series of cell lines obtained by repeated transplantation of a mouse fibrosarcoma. The lines could be grouped into three; one has no metastatic potential, and the other two show metastatic abilities after intravenous or subcutaneous injection. Comparison of their telomerase activity indicated that more malignant lines had higher activity. A similar relation was seen in metastatic nodules formed through clonal expansion from the heterogeneous population of inoculated cells; clonality was monitored in terms of variable patterns of subtelomeric repeats. The results suggest that a high level of telomerase activity may not be requisite for metastasis, but may confer a propensity to dominate in a tumor tissue.

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A total of 951 backcross progeny have been obtained from a backcross segregating for the mouse deafness mutation, shaker-2(sh-2). Linkage analysis provides a detailed genetic map in the vicinity of sh-2 which comprises 40 backcross mice identified as recombinant within a 4 cM region. This allows construction of a contig consisting of 21 BAC clones across an approximately 700-kb region of sh-2. This covers the entire nonrecombinant region of sh-2 and is therefore useful to facilitate the identification of genes in the sh-2 region.

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：日本胆道学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本創傷治癒学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

胃癌肝転移による門脈腫瘍栓により、門脈体循環シャント(portosystemic shunt:PSS)・門脈体循環性脳症(Portal systemic encephalopathy:PSE)を来したまれな1例を経験した。症例は57歳、男性。多発肝転移を伴うStage IV胃癌に対し、出血制御目的に幽門側胃切除術を行った。術後S-1+cisplatin療法を導入したが、7コース施行後に肝S7の新規病変と門脈腫瘍栓が出現した。weekly paclitaxel療法に変更して化学療法を継続した。術後1年1ヵ月ごろより意識障害が出現し、術後1年3ヵ月には血中アンモニア濃度296μg/dLと高アンモニア血症を呈した。腹部CT検査で下腸間膜静脈-左腎静脈シャントを認め、PSSによるPSEの診断に至った。経皮的コイル塞栓術で短絡路の遮断を行い、脳症・高アンモニア血症は改善し、化学療法の継続が可能になった。その後、吻合部局所再発に対して残胃全摘術を施行し、以降も化学療法を継続したが、初回手術後3年5ヵ月に死亡した。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は63歳、男性。上腹部痛を主訴に近医を受診した。精査にて、胃体上部小彎に2型腫瘍(低分化型腺癌充実型)、胃体下部前壁に0-IIc型腫瘍(高分化型管状腺癌)を認め、胃小彎側と大彎側に合計4個のリンパ節腫大を認めた。同時性多発胃癌、MU、cT4aN2M0、cStage IIIBおよびL、Ant、cT1aの診断で、術前分割docetaxel/CDDP/S-1療法を2コース施行後、胃全摘術、D2(-No.10)リンパ節郭清を施行した。進行胃癌の病変および転移の痕跡のあるNo.4dリンパ節に腫瘍の遺残は認められず、組織学的治療効果はGrade 3と判定された。一方、早期胃癌の病変に治療効果は認められず、Grade 0と判定された。術後10ヵ月現在、無再発生存中である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

近年、胃癌の腫瘍出血に対する緩和的放射線治療の報告が散見される。今回われわれは、胃癌出血に対する緩和的放射線治療後に再出血を来し、胃切除術を要した症例を経験した。症例は74歳、男性。Stage IV胃癌に対し化学療法を施行し、stable diseaseを維持していた。しかし、化学療法開始から23ヵ月後に腫瘍の再増大と出血を認め、止血目的の緩和的放射線治療を施行した。いったん止血が得られたが、1ヵ月半後に再出血を来した。入院後に出血性ショックを来し、緊急で姑息的胃切除術を施行した。腫瘍出血に対する緩和的放射線治療は安全かつ有効な治療として選択されることが多い。しかし、再出血を来した際には緊急での胃切除術が避けられないことがある。本症例では迅速な手術治療により救命が得られた。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は63歳、女性。検診で右乳房腫瘤を指摘され、当科を受診した。精査で非浸潤性乳管癌と診断され、右乳房部分切除術、センチネルリンパ節生検を施行した。術後病理組織学的検査では診断に苦慮したが、最終的に乳管腺腫を背景に発生した微小浸潤アポクリン癌と診断した。乳管腺腫とアポクリン癌の鑑別は難しく病理診断上しばしば問題となる。本症例のように乳管腺腫を背景としてアポクリン癌を合併することもあり、良悪性の判別には注意を要する。乳管腺腫とアポクリン癌の鑑別が困難な場合は診断を兼ねた完全切除が望ましいと考えられる。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は62歳、男性。閉塞性黄疸に伴う全身そう痒感を主訴に当院を受診した。精査の結果、十二指腸乳頭部癌の診断となり、幽門輪温存膵頭十二指腸切除術を施行された。病理組織学的検査で印環細胞癌と診断された。リンパ節転移は認められなかった。術後補助化学療法を施行せず経過観察されていたが、術後38ヵ月目にイレウスを発症し、癒着剥離術、回腸部分切除術を施行された。病理組織学的検査では切除回腸の狭窄部に印環細胞癌を認め、腹膜播種再発と診断された。化学療法としてS-1隔日投与を開始し、14ヵ月間、腹膜播種増悪によるイレウスを発症するまで継続した。術後58ヵ月で原病死となった。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は46歳、女性。混合型肝癌に対し肝右葉切除術、胆嚢摘出術、肝門部リンパ節のサンプリングを施行した。術後にS-1内服を開始したが、血清CEA値は経時的に漸増した。術後12ヵ月目のPET-CT検査で孤立性の大動脈周囲リンパ節再発と診断され、大動脈周囲リンパ節郭清を施行した。組織学的にリンパ節再発巣は肝細胞癌成分で構成されていた。術後にソラフェニブ内服を開始した。肝切除後17ヵ月が経過し、生存中である。混合型肝癌の孤立性大動脈周囲リンパ節転移再発に対しては、特にリンパ節転移個数が少数であれば外科切除を含む集学的治療により予後改善が期待される。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は64歳、女性。左乳房腫瘤を自覚し当科を受診した。精査の結果、左乳癌cT4bN3(左腋窩、胸筋間、左鎖骨上リンパ節転移陽性)、M0、cStage IIIcと診断され、針生検診断は浸潤性乳管癌、サブタイプはトリプルネガティブであった。術前化学療法としてadriamycin+cyclophosphamide(AC)療法4コースを施行したが、grade 2の薬剤性肺障害が出現したため継続を断念した。遠隔転移を認めなかったことから、局所制御に重点を置いた治療方針の下、ハルステッド手術、術後放射線療法を施行した。9ヵ月経過した現在も再発を認めていない。化学療法有害事象発生例においては、患者の状態に合わせ施行可能な治療法を選択することが重要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は54歳、女性。閉塞性黄疸で発症し、上腸間膜動脈(SMA)浸潤および十二指腸狭窄を伴う局所進行切除不能膵頭部癌と診断された。胆道および消化管バイパス術を施行したが、開腹所見では腹膜播種は認めないものの、腹腔内洗浄細胞診(CY)は陽性であった。術後にgemcitabineおよびS-1による化学療法を6コース施行した。SMA周囲の軟部影は若干縮小したが残存し、CTでのRECISTによる効果判定はSDであった。adjuvant surgeryの適応を判断するため、審査腹腔鏡を施行した。遠隔転移は認めず、CYは陰性であった。化学放射線療法を追加した後に膵頭十二指腸切除術を行った。病理所見では腫瘍部の約60%は線維化組織に置き換わり、SMA周囲神経叢浸潤は認めなかった。根治術後17ヵ月経過し、無再発生存中である。切除不能膵癌であっても、化学療法が奏効した場合は切除へのconversionが可能となることがある。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

側方リンパ節転移陽性のStage IV下部直腸癌に対して側方リンパ節郭清を含む外科治療を行い、長期生存が得られている3例を報告する。症例1:61歳、男性。低位前方切除術、D3を施行した。5-FU肝動注療法・全身化学療法を行い、その後、肝転移に対して拡大肝右葉切除術・肝部分切除術を施行した。さらに肺転移再発に対して部分切除を行い、初回手術後9年6ヵ月経過し、無再発生存中である。症例2:53歳、男性。術前化学療法後に低位前方切除術、D3、腹膜播種切除を施行した。手術後6年3ヵ月経過し、無再発生存中である。症例3:48歳、男性。低位前方切除術、D3、肝右葉切除術、肝部分切除術を施行した。その後、肝転移・肺転移再発を来した。手術後4年経過し、現在、全身化学療法を継続中である。側方リンパ節転移陽性のStage IV下部直腸癌においても、R0切除の一環として側方リンパ節郭清は意義がある可能性が示唆された。(著者抄録)

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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は51歳、男性。右腎淡明細胞癌に対して右腎摘出術を施行した。術後6ヵ月目に膵尾部に単発の転移巣を認め、尾側膵切除術、脾摘出術を施行した。初回手術から1年6ヵ月目に膵頭部に単発の転移巣を認め、腫瘍の核出術を施行した。さらに、初回手術から3年10ヵ月目の今回、残膵体部に転移巣を認め、膵頭部を温存して残膵の尾側膵切除術を施行した。初回手術から4年が経過し、癌遺残なく生存中である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は58歳、女性。体重減少と右胸痛を主訴に前医を受診し、肝腫瘍の診断で当科を紹介された。精査の結果、進行S状結腸癌および門脈・肝静脈・下大静脈浸潤を疑う15cm大の肝転移と診断した。消化管通過障害を認めたため、S状結腸癌に対してS状結腸切除術を施行した。肝転移巣は切除困難と診断し、初回手術より13病日目からmFOLFOX6を4コース施行した。その後のCT検査では、肝転移巣は50%の著明な縮小を認め、下大静脈や肝静脈への圧排も改善しており、効果判定はpartial response(PR)であった。mFOLFOX6をさらに2コース施行後、根治切除可能と判断し、肝転移巣に対し肝右3区域切除、下大静脈・横隔膜合併切除を行った。病理診断では切離断端陰性であり、下大静脈周囲への浸潤は認めなかった。化学療法後の組織学的効果判定はGrade 2であった。術後肝内血流のうっ滞に伴う門脈血栓を生じたため、血栓溶解療法および開腹下血栓除去術を行った。術後performance statusが低下したため、本人と相談の上、術後の化学療法は施行しないこととした。肝転移巣切除より8年経過し、無再発長期生存中である。下大静脈浸潤が疑われたS状結腸癌肝転移に対し、mFOLFOX6が奏効したことで根治切除が可能となった長期生存例を経験したので報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

目的:切除不能進行癌に伴う上部消化管の通過障害に対する胃空腸バイパス手術の有用性を明らかにする。方法:2010〜2014年までの5年間に切除不能進行癌に伴う上部消化管の通過障害に対して当科で緩和治療目的の胃空腸バイパス手術を施行した21例を対象とした。手術成績、化学療法の有無、経口摂取可能期間、生存期間などを後方視的に検討した。結果:胃空腸バイパス手術後の経口摂取再開時期は中央値6(範囲2〜42)日、再度経口摂取不能になり死亡するまでの期間は中央値4(範囲0〜26)日であった。12例(57%)が自宅へ退院となった。術後化学療法を希望した9例全例に化学療法が施行できた。経口摂取可能期間中央値61日、全生存期間中央値は92日であった。結語:胃空腸バイパス手術により、自宅退院や化学療法などの治療選択肢が広がり、生活の質の向上に貢献できる可能性がある。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟医学会  

症例は64歳女性。子宮頸癌IIB期の診断で、術前化学療法後に広汎子宮全摘術を施行された。術後の化学放射線療法を施行中に腹痛が出現し、腹部造影CTで絞扼性イレウスと診断し、緊急手術を施行した。開腹所見では前回手術の際に露出・遊離させていた左外腸骨動脈によって小腸が絞扼され壊死に陥っていた。小腸部分切除術を施行し、後腹膜で外腸骨動脈を被覆した。開腹術後の露出した血管を原因としたイレウスの報告は稀であり、若干の文献的考察を加えて報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：新潟医学会  

症例は60歳、女性。人間ドックを契機に胃穹窿部大彎に7cm大の0-IIa+IIb型病変を指摘され、当院消化器内科にてESDが施行された。病理組織学的検討で、腫瘍は一部に低分化成分を伴った高分化型管状腺癌であり、免疫染色で胃型の粘液形質を有する腫瘍であった。粘膜下層浸潤があり、垂直断端陽性であったことから外科的追加切除の適応と判断され当科を受診した。高度なリンパ管侵襲を認めたこと、胃型の腫瘍であったことから、腹部CT所見では明らかなリンパ節の腫大を認めなかったものの、リンパ節転移の可能性は低くないと考えた。また、病変部位は胃上部の大彎側病変であり、脾門リンパ節郭清も省略できないと判断した。手術はESD2ヵ月後に胃全摘術、脾合併切除術、D2リンパ節郭清、Roux-en Y再建を施行した。病理組織学的検討では、ESD瘢痕部に癌の遺残を認めたが深達度は粘膜下層までであった。脾門リンパ節に4個、大彎左群リンパ節に1個、計5個のリンパ節転移を認め、いずれも原発巣と同様の胃型形質を示す腫瘍であった。胃型形質を示す高分化型腺癌は、比較的リンパ節転移をきたしやすいことが報告されている。早期胃癌で脾摘を伴うD2郭清が検討されることは稀であるが、本症例のように局在、組織型、リンパ管侵襲の程度によっては、脾門リンパ節郭清を考慮してもよいと思われた。消化器内科医、病理医と緊密な連携を図り、過不足のない術式を検討しなければならない。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟医学会  

症例は72歳、男性。貧血の精査目的に上部消化管内視鏡を施行し、胃体上部から前庭部に2型の進行癌を指摘された。腹部骨盤部造影CT検査で胃周囲リンパ節の腫大を認めcT4aN1M0、cStage IIIAと診断された。術前補助化学療法としてS-1+CDDP療法を2コース施行したところ、腫瘍の縮小効果が認められ、胃全摘術、脾合併切除、D2リンパ節郭清、Roux-en Y法再建を施行した。病理組織学的所見では、原発巣は腺癌成分とクロモグラニンA陽性の内分泌細胞癌成分とが混在する腫瘍であった。幽門下リンパ節をはじめ5個のリンパ節転移を認めたが、いずれも転移巣は腺癌成分であり内分泌細胞癌成分は認めなかった。術後補助療法としてS-1内服を開始し、術後7ヵ月現在、無再発生存中である。胃原発内分泌細胞癌は稀な組織型であり、腺癌成分との混在型が多いとされる。悪性度の高い内分泌細胞癌成分がリンパ節転移をきたすことが多いとされるが、本症例では内分泌細胞癌成分の転移はみられず、リンパ節転移の機序、補助化学療法を考察する上で示唆に富む症例と考える。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は71歳、男性。骨転移、脳転移を伴う肺腺癌に対して、2年5ヵ月前よりgefitinib(250mg/日)を連日投与され、安定(stable disease:SD)を維持中に腹痛、下痢、嘔吐を発症した。腹部骨盤造影CT検査を施行すると小腸壁内ガス像、腹腔内遊離ガス像、中等量の腹水を認め、腸管嚢腫様気腫症(pneumatosis cystoides intestinalis:PCI)の診断となった。バイタルサインが安定し、腹部理学所見で腹膜炎を疑う所見がみられなかったため、gefitinibを休薬して保存的に治療を開始した。自覚症状は徐々に改善し、治療開始7日後の腹部骨盤造影CT検査では画像所見も著明に改善した。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜ポイント＞生存延長を目的としたネオアジュバント治療のエビデンスは乏しく,完全切除が容易なGISTは術前イマチニブ治療の適応とならない.イマチニブが無効なGISTも少なからずあり,ネオアジュバント治療患者ではイマチニブの効果を可及的早期に確認する.高リスクGISTでは,ネオアジュバント治療だけでは再発抑制効果は十分ではなく,術後のイマチニブ治療の追加が推奨される.(著者抄録)

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記述言語：日本語   出版者・発行元：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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記述言語：日本語   出版者・発行元：新潟医学会  

症例は35歳男性。検診腹部エコーで脾門部に2cm大の腫瘤を指摘された。2年後検診で腫瘤の増大傾向を認め、腹部造影CT検査で膵尾部に44mm大の多房性分葉状腫瘤を認めた。血算・生化学・凝固系、腫瘍マーカー、各種ホルモン値は正常範囲内であった。SPIO造影MRIを施行したが、腫瘍より尾側におけるT2強調画像信号低下を確認したのみで、確定診断を下すことができなかった。腹腔鏡下膵尾部切除を施行し、術後病理診断で膵内副脾に生じた類上皮嚢胞と診断された。診断に苦渋した1例を報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

近年、マンモグラフィー検診の普及に伴い、非触知乳癌の発見率が上昇してきている。非触知乳癌の中には、石灰化病変のみで発見される非浸潤性乳管癌(Ductal carcinoma in situ:DCIS)も多く含まれるが、石灰化病変を超音波検査で描出することは困難なことがあり、手術に際し切除範囲の設定には苦慮することも多い。臨床上、実際に十分切除できているのか否かを術中に判断することは、その後の局所再発を防ぐ上で極めて重要である。今回、石灰化病変のみで発見された乳癌症例に対し、術中に切除標本のマンモグラフィーを撮影し、石灰化病変が切除できていることを確認できた症例を経験した。症例は51歳、女性。検診マンモグラフィーで右乳房の石灰化を指摘され、ステレオガイド下マンモトーム生検を施行し乳癌と診断された。超音波検査では石灰化病変の描出は困難であったが、マンモトーム生検時に留置したクリップ部位をマーキングし、乳房温存手術を施行した。術中に切除標本マンモグラフィーを施行し、ターゲットとした石灰化病変が切除できていることを確認して手術を終了した。術後病理診断でも術前に予測した石灰化病変が完全に切除できていることを確認できた。切除標本マンモグラフィーは、簡便に石灰化病変の切除範囲の確認が可能な方法として有用であり、文献的考察を加えて報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：新潟医学会  

今回、術前に敗血症を呈した亜急性型劇症肝炎に対し脳死肝移植を施行し救命し得た症例を経験したので文献的考察を加えて報告する。症例は62歳、男性。薬剤性亜急性型劇症肝炎として近医にて加療されるも改善なく、肝移植目的に当院に転院した。転院4日目に脳症の増悪を認め緊急生体肝移植の方針となったが、カテーテル感染による敗血症性ショック、重度の呼吸不全、腎不全のため手術を延期し、保存的に加療を継続した。その後ショックから離脱し、血液培養の陰性化を確認した。転院10日目に脳死ドナーが発生したため脳死全肝移植を施行した。手術直前に採取した血液培養検査が陽性であったため結果的には菌血症状態での肝移植となった。術後早期より持続的血液濾過透析、エンドトキシン吸着療法を開始し、タクロリムス血中濃度を低値に抑えることで全身状態は比較的速やかに改善した。その後重篤な合併症なく第10病日にICU退室した。術前に敗血症を呈した症例に対する肝移植の成績は極めて不良であるが、術後の集中管理により救命し得たので報告する。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

術前CDDP/5-FU(CF)療法にて組織学的完全奏効(pathological complete response:pCR)が得られた食道癌の3例を経験した。全例男性、胸部中部食道、臨床病期IIの扁平上皮癌であった。3例とも標準的CF療法を2コース施行後、根治的食道切除、3領域リンパ節郭清を施行した。切除標本に癌細胞の遺残は認められず、pCRと判定された。現在3例ともに無再発生存中である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜ポイント＞胆嚢癌に対する至適リンパ節郭清範囲は,胆道癌取扱い規約第6版の定める領域リンパ節である.この領域リンパ節をen blocに郭清することが進行胆嚢癌の手術成績向上の鍵である.膵頭十二指腸切除は,膵頭周囲リンパ節転移陽性胆嚢癌の予後を改善する可能性がある.(著者抄録)

DOI： 10.11477/mf.1407210613

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記述言語：日本語   出版者・発行元：医学図書出版(株)  

当科における局所進展度pT2以上の胆嚢癌145例のリンパ節転移からみた手術成績を呈示し、胆嚢癌の至適リンパ節郭清範囲について概説した。145例のリンパ節郭清範囲は、領域リンパ節が116例、領域リンパ節+膵頭周囲リンパ節(膵頭十二指腸切除併施)が29例であった。癌遺残の無いR0手術が実施された123例で解析すると、リンパ節転移陰性57例、リンパ節転移陽性66例の5年生存率は、おのおの75%、43%であった(P<0.001)。リンパ節転移陽性で5年生存したのは24例で、そのうちリンパ節転移個数が4個以上であった4例中3例で膵頭周囲リンパ節転移に対して膵頭十二指腸切除が併施されていた。胆嚢癌の至適リンパ節郭清範囲は領域リンパ節であり、領域リンパ節郭清によりリンパ節転移陽性の長期生存例を得ることができ、胆嚢癌の手術成績は向上する。膵頭十二指腸切除は膵頭周囲リンパ節転移陽性例の予後を改善する可能性がある。(著者抄録)

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

Web of Science

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

跳躍転移による側方リンパ節再発に対する摘出術により、長期生存を得た直腸癌の1例を経験したので報告する。症例は63歳、男性。進行下部直腸癌と診断され、前医で直腸切除術が施行された。側方リンパ節郭清は行われなかった。病理組織診断はtype 2、85×50mm、tub1、pT4a、ly0、v1、pPM0、pDM0、pN0、pStage II(大腸癌取扱い規約第8版)であった。術後6ヵ月目の造影CT検査で右閉鎖リンパ節転移が指摘され、当院で側方リンパ節郭清術を施行した。病理組織診断では、右閉鎖リンパ節に1個、中分化腺癌の転移を認めた。直腸癌の跳躍転移と診断した。側方リンパ節転移摘出術から9年経過し、無再発生存中である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

術前化学療法としてのmFOLFOX6+bevacizumab(BV)が奏効し、局所治癒切除が可能となった1例を経験したので報告する。症例は65歳、女性。主訴は肛門痛。肛門外まで進展する直腸癌(高分化管状腺癌)と診断された。KRAS遺伝子は変異型であった。CT検査で腟浸潤、仙骨尾骨浸潤、両側鼠径リンパ節転移陽性、左肺転移陽性であった。治癒切除困難と判断してS状結腸人工肛門造設、埋め込み式カテーテル挿入を行い、mFOLFOX6+BVを開始した。13コース施行後のResponse Evaluation Criteria in Solid Tumors判定はpartial responseであった。局所治癒切除が可能と判断し、仙骨尾骨合併切除を伴う後方骨盤内臓器全摘術、両側鼠径リンパ節郭清を施行し、局所治癒切除となった。進行度はypT4b(腟)N0M1b(LYM、PUL1)、ypStage IV(大腸癌取扱い規約第8版)、薬物治療の組織学的効果判定はGrade 1bであった。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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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記述言語：日本語   出版者・発行元：(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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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

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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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：ELSEVIER SCIENCE INC  

Web of Science

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

ACTS-GCの結果から、p-Stage II、III胃癌に対してはS-1による術後補助化学療法が標準治療となった。2007年1月〜2012年6月までにおけるp-Stage II、III胃癌47例の術後補助化学療法の現状を後方視的に検討した。高次救急機能を有する地方大学病院が当院の特徴である。術後S-1による術後補助化学療法を施行されたのは32例(投与群、68.1%)であった。そのうち1年間のS-1内服を完遂できたのは22例(68.8%)で、Grade 3の有害事象を8例(25.0%)に認めた。S-1の休薬、減量、投与スケジュールの変更を行った症例は9例(28.1%)であった。S-1を投与されなかったのは15例(非投与群、31.9%)で、その理由としては併存症、年齢によるものが12例(80.0%)と最も多かった。S-1投与群とS-1非投与群での3年生存率はそれぞれ89.3%、77.1%であった。S-1投与群はACTS-GCの結果同様、完遂率、遠隔成績ともに良好であった。しかしながら、併存症や高齢を理由にS-1治療が行われなかった症例、術後S-1を導入したものの治療完遂できなかった症例を合わせると25例(53.2%)で十分な術後補助化学療法が行われたとはいえず、今後はこれらの症例に対する補助化学療法の確立が急務である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

患者は49歳、女性。2013年初頭より左乳房腫大を自覚し、検診マンモグラフィで左乳房に異常を指摘され、精査し術前診断で分化型・粘液型脂肪肉腫とされた。手術は周囲健常組織(大胸筋の一部、乳腺の一部)を含めた広範囲切除を行った。腫瘍径14.2×17.8cm、重量1,220gであり、病理所見で脱分化型脂肪肉腫の診断であった。脱分化型では局所再発および血行転移が多いとされている。自験例は完全切除後2ヵ月間の再発徴候なく経過し、今後も慎重な経過観察を要する。脂肪肉腫の大部分は後腹膜、四肢に発生し、前胸壁に発生したものは本邦で19例のみである。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

【緒言】消化器外科領域では、術前・術後の栄養管理に加え、昨今では化学療法の重要性が急速に増してきており、CVカテーテルの必要性が増大している。体表解剖に基づいたランドマーク法による鎖骨下静脈(以下SCV)穿刺は、ブラインド穿刺のため、時に気胸・動脈穿刺など、種々の合併症を引き起こすことがある。リアルタイムエコーガイド下のSCV(USgSCV)穿刺で、これらの合併症が激減することが報告されているが、主に放射線科で実施されており、広く普及するには至っていない。そこで、我々は一般外科診療において、市中病院で容易に入手可能な材料を用いて、安全にSCVの穿刺を行える手技の工夫および検証を行ったため、報告する。【方法・結果】Sakamotoらの穿刺法に筆者の工夫を加え、7.5MHzの体表プローベを用いてSCVを長軸に描出し、エコー観察下にフリーハンドでSCV穿刺を行う手技を施行した。USgSCV穿刺施行例のうちCVポート増設を行ったものは3施設18例で、合併症の発生はみられなかった。平均手術時間は30分であり、経験症例数やBMIによって手術時間は影響を受けなかった。【結語】USgSCV穿刺法は、動脈・静脈の走行を直接確認しながら、合併症フリーでのSCV穿刺が可能であった。手術室のみならず、病棟での処置にも十分応用可能であり、エクストラコストを最小限に留めながら安全性のメリットを享受できうる方法であった。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本肝胆膵外科学会  

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記述言語：日本語   出版者・発行元：新潟医学会  

肝細胞癌の主たる再発形式は肝内再発であるが、リンパ節再発は比較的稀である。今回、肝細胞癌に対して肝切除後に異時性リンパ節転移再発を認めた症例を経験したので、文献的考察を加えて報告する。症例は66歳、男性。C型肝硬変の経過観察中に肝S6、S8-4の多発肝細胞癌を指摘され、各々肝部分切除術が施行された。病理組織診断は、肝S6病変が中分化型、肝S8-4病変が低分化型肝細胞癌であったが、肝S8-4の病変はサイトケラチン7、19陽性の肝細胞癌であった。術後1年4ヵ月後のCT検査で膵頭部背側のリンパ節の腫大を認めたため、肝細胞癌の孤立性リンパ節転移再発と診断し、リンパ節摘出術を施行した。病理組織診断は、サイトケラチン7、19陽性の肝細胞癌のリンパ節転移であった。本症例は、肝細胞癌2病変のうち、胆管上皮マーカーであるサイトケラチン7、19陽性であった肝S8-4病変からリンパ節転移再発をきたしたと考えられた。サイトケラチン7、19陽性の肝細胞癌は、肝内胆管癌と類似した生物学的悪性度を有しリンパ節転移をきたす可能性があるため、肝硬変に伴うリンパ節腫大との鑑別および術後の経過観察の際には肝外病変に対しても注意が必要である。(著者抄録)

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記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は66歳、男性。上腹部痛を主訴に受診し、内視鏡検査で幽門前庭部の2型進行胃癌の診断となった。腹部CT検査では幽門下(No.6)、脾動脈近位(No.11p)、腹部大動脈周囲(No.16a2)リンパ節に計4個の転移を認め、臨床病期はT3(SS)N2M1(LYM)、Stage IVと診断した。治療方針はS-1+CDDP療法を2コース投与後に、胃切除術、D2+大動脈周囲リンパ節郭清を予定した。化学療法開始から14日目に突然の上腹部痛と腹膜刺激症状が出現した。腹部CT検査で腹腔内遊離ガスを認め、胃癌穿孔の診断で緊急手術を行った。開腹所見では約5cmにわたり胃癌の穿孔を認め、手術は幽門側胃切除術、Roux-en-Y再建、D1+リンパ節郭清を行った。大動脈周囲リンパ節が遺残したが、術後経過は順調で第23病日に退院した。本症例は強力な化学療法中の緊急胃切除術であったが、術後合併症や化学療法の有害事象を生じず安全に周術期管理が可能であった。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)日本医療企画  

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記述言語：日本語   出版者・発行元：新潟医学会  

74歳男。心房細動に対しワルファリンを内服していた。今回、検診で胃体部後壁の早期癌胃癌を指摘後、著者らの施設を受診後、精査より内視鏡的切除は適応外で手術方針となった。所見では上部消化管内視鏡で胃体下部後壁に長径30mmの発赤調の陥凹性病変を確認された。また、生検ではGroup 5(低分化腺癌)で、リンパ節転移や遠隔転移は認められなかった。以上より、本症例は胃体部の早期胃癌と診断され、腹腔鏡補助下幽門側胃切除術(LADG)が行われた。その結果、術後は経過に著変なく2病日目よりワルファリンを再開したが、ベッド上で座位にてテレビをみていてところ突然意識消失の状態となった。頭部CTおよびMRIを行なったところ、左中大脳動脈の閉塞が認められ、脳梗塞と診断、高次救急病院へ搬送となった。意識状態はJCS-200で、痛み刺激に反応せず右共同偏視、失語ならびに右上下肢麻痺が認められた。一方、頭部MRIでは左中大脳動脈領域および後大脳動脈領域に広範な梗塞がみられたほか、頭部MRAでは左中大脳動脈に閉塞も認められた。以後、治療が行われることとなったが、術後急性期のため組織プラスミノーゲンアクチベータ(t-PA)の投与は禁忌で、ヘパリンの全身投与も施行せず、濃グリセリンをはじめ果糖注射液、ステロイド、エダラボンの投与にとどめた。その結果、術後3病日目の頭部CTでは対側の右側に広範な梗塞が認められるも積極的な治療を断念され、患者は術後7病日目に死亡となった。

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記述言語：日本語   出版者・発行元：(株)篠原出版新社  

機能欠損が大きい手術を要する初発転移性消化管間質腫瘍(GIST)患者13例(男5例、女8例、中央値65歳)に対し、術前にイマチニブ400mg/日を連日投与して最良効果を得た時点で手術を計画した。投与期間は中央値169日で、9例は4ヵ月以上の治療を完遂し、4例は有害事象のため途中で終了した。RECIST評価での抗腫瘍効果は、partial responseが6例、stable deseaseが5例、評価不能2例で、縮小率20%であった。全例で肉眼的・組織学的完全切除が行われ、術中出血量510ml、術後在院期間24日で、6例に術後合併症が認められたが保存的に治癒した。臓器・機能温存手術は直腸GISTの7例中6例、胃GISTの3例中2例で実施でき、食道GISTの1例、十二指腸GISTの2例は行えなかった。観察期間11〜130ヵ月で、13例中12例が無再発生存中であり、術前治療が腫瘍出血のため2日で中止となった十二指腸GIST例が再発し術後2年5ヵ月で原病死した。

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記述言語：日本語   出版者・発行元：新潟医学会  

【目的】本研究の目的は、局所進展が高度な肝内胆管癌に対する術前化学療法の効果と周術期に及ぼす影響を明らかにすることにある。【方法】当科で2009年1月から2012年8月までに術前の画像診断で根治切除が困難・不能と判断された症例に対して術前化学療法を行った5例を対象とした。根治切除が困難・不能と判断した因子は、高度局所進展(腹壁・胃への浸潤、腹膜播種)が4例、高度局所進展+大動脈周囲リンパ節転移が1例であった。術前化学療法としては、gemcitabine(GEM)が2例、テガフール・ギメラシル・オテラシルカリウム配合剤(S-1)が1例、GEM+S-1が1例、GEM+S-1からGEM+cisplatinに変更が1例であった。抗癌剤効果判定基準(RECISTガイドライン)に準じて術前化学療法の効果を判定した。【成績】標的病変の抗癌剤効果判定は、部分奏功(PR)が1例(GEM+S-1を施行し腫瘍縮小率68%)、安定(SD)が3例、進行(PD)が1例であり、奏功率は20%であった。Grade 3の有害事象を1例に認めたが、全例で術前化学療法前に立案していた術式の遂行が可能であった。全例にR0切除が行われ、pStage Iが1例、pStage IVAが3例、pStage IVBが1例であった。術後合併症を3例に認めた。その内訳は、腹腔内膿瘍2例、仮性動脈瘤破裂1例、腸炎1例、リンパ漏1例(重複あり)であった。術後在院死亡は認めなかった。術前化学療法の効果判定がPRとSDであった2例が、各々術後9ヵ月、14ヵ月に原病死したが、残り3例は生存中であった。全症例の累積1年生存率は75%、累積2年生存率は50%、生存期間中央値は14ヵ月であった。【結論】局所進展が高度な肝内胆管癌に対する術前化学療法は安全に施行でき、化学療法前に立案していた術式を遂行可能である。ただし、術前化学療法の奏功率が低いこと、奏功しないPD症例が存在することが臨床上の問題点として挙げられる。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

消化管間質腫瘍(GIST)で使用できる抗腫瘍薬はイマチニブとスニチニブの2剤だけである。そのためGISTの薬物治療では、薬剤選択が限られている分、その効果を十分に引き出すことが求められる。GISTに対する薬物治療について、臨床エビデンスの観点から解説した。「切除不能・転移性GISTの治療(ガイドライン、イマチニブ治療)」「イマチニブ増悪後の治療(二次耐性、ガイドライン、スニチニブ治療、新規分子標的薬)」について述べた。

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記述言語：日本語   出版者・発行元：(株)医学書院  

患者は88歳,男性.消化管穿孔による汎発性腹膜炎の診断で緊急手術を施行した.術中所見で胃中部の漿膜側に露出する腫瘤を認めたが穿孔はなく,小腸に5ヶ所の腫瘍性病変を認め,うち2ヶ所の小腸腫瘍が穿孔していた.また,小腸間膜にリンパ節の腫大を多数認め,胃癌の腸間膜リンパ節転移および小腸浸潤を伴う腹膜播種と考えた.穿孔部を含む小腸部分切除吻合およびドレナージ術のみ行った.切除標本では2ヶ所とも限局潰瘍型腫瘍の潰瘍底で穿孔し,病理組織学的には粘膜下層まで進展する低分化型腺癌で,粘膜筋板近傍に多数のリンパ管侵襲が認められた.癌の局在は粘膜下層主体で播種性ではなく,リンパ行性の小腸転移が強く疑われた.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

＜ポイント＞◆二次耐性腫瘍切除に比べてイマチニブ奏効残存腫瘍切除は完全切除率が高く,術後の無増悪期間も長い.◆手術で完全切除が達成されても術後のイマチニブ治療は継続する.治療の中止は術後早期の再発を生じる.◆完全切除が得られても長期の無再発患者は少ない.臨床的有用性を明確にするエビデンス作りが望まれる.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

消化管間質腫瘍(GIST)は巨大な腫瘍で見つかることがあり、切除の可否に悩むことも多い。不完全切除となったGIST患者や他臓器浸潤や播種、腫瘍破裂などを伴う臨床的悪性GIST患者の予後は極めて不良である。KITキナーゼ阻害薬イマチニブはGISTに高い抗腫瘍効果を発揮することから、marginally resectable GISTの術前治療に期待がもたれている。術前イマチニブ治療の用量や投与期間については確定してはいないものの、切除不能・転移性、GISTの治療データからは、400mg/日で6〜12ヵ月が妥当ではないかと思われる。marginally resectable症例の術前治療では効果の早期診断が必須となり、ポジトロン断層撮影が有用な診断ツールとなる。術前治療に関する二つの症例研究はいずれも、術前のイマチニブ治療は良好な安全性と抗腫瘍効果を示し、手術の縮小化に寄与したと報告している。一方、米国における多施設第II相臨床試験では、イマチニブによる術前治療は安全性に大きな問題を認めなかったものの、完全切除率が初発例で77%、転移・再発GIST患者で58%と満足し得るものではなかった。本邦におけるGIST診療ガイドラインでは、marginally resectable GISTに対するイマチニブによる術前治療を研究的治療に位置付けている。marginally resectable GISTに対する術前治療の一般化には、さらなる臨床エビデンスが必要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

消化管間質腫瘍(gastrointestinal stromal tumor:GIST)は分子標的治療が最も効果的な腫瘍の一つである。分子標的薬イマチニブはそれまで有効な治療手段のなかった進行および再発性GISTの予後を大きく改善させたが、一方でイマチニブ耐性腫瘍の治療が問題となった。スニチニブリンゴ酸塩(スニチニブ)は複数の分子を標的とする受容体型チロシンキナーゼ阻害薬であり、イマチニブ耐性GISTに対して唯一、保険診療上、使用が認められた分子標的治療薬である。国内外の臨床試験から、イマチニブ耐性腫瘍に対して24〜39%の臨床的有効率が認められており、7ヵ月の無増悪期間が得られることが示されている。しかし日本人では血小板減少を主体とした骨髄抑制が強く、有害事象のマネージメントに苦慮することが多いこともわかってきた。臨床効果を維持しつつ有害事象を最小限に止めるため、日本人に合った投与方法の検討を進めなければならない。(著者抄録)

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記述言語：日本語   出版者・発行元：金原出版(株)  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

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記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

分子標的治療の研究が進む現在においても、初発GISTに対する治療の第一選択は外科的完全切除である。近年では低リスクGISTに対する機能温存手術、低侵襲手術の検討も進んでいるが、根治性を損なわないような適用が肝要である。一方、イマチニブ治療が第一選択となる切除不能あるいは転移・再発GISTにおいても、切除可能肝転移、二次耐性腫瘍、イマチニブ奏効残存腫瘍の外科的治療は一定の効果が期待されている。集学的治療としての外科的切除はむしろ重要性を増していくものと思われるが、現状ではエビデンスに乏しく、進行中の臨床試験の結果が待たれる。GISTの外科治療においては、最大限の治療効果を得るために客観的なデータに基づく慎重な患者選択を行うことが重要である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(株)医学書院  

Gastrointestinal stromal tumor(GIST)は消化管原発の間葉系腫瘍であり,比較的稀な疾患である.メシル酸イマチニブによる分子標的治療の導入によってGIST患者の予後は大きく改善したものの,転移・再発をきたして治癒できないことも少なくない.転移・再発GIST患者の大部分は肝転移か腹膜転移によって死亡する.終末期に呈する症状や必要となる治療は基本的にはほかの消化器癌と同様であるが,再発腫瘍が大きくなっても腸閉塞症状をきたしにくいことや,耐性腫瘍を生じてもイマチニブの継続投与が望ましいことなど,細かな点では特有の性質がある.またGISTの終末期は他癌より長くなりやすいため,治療とケアの両面からquality of life(QOL)を維持する努力が重要である.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

食道表在癌に対する内視鏡治療は,内視鏡的粘膜下層剥離術(ESD)の登場によって応用範囲が飛躍的に拡大した.また,化学放射線療法の進歩と相まって,食道表在癌に対する治療の考え方が変わりつつある.本稿では,われわれの施設での食道表在癌に対するESDの現状を報告するとともに,相対的・研究的適応病変,ESD後再発病変,そしてESD後合併症に対する外科の対応について,自験例を呈示しながら概説した.ESDの普及によって食道癌に対する外科治療が多様化・複雑化している現在,食道外科医は食道癌患者が最小限の侵襲で最大限の恩恵を受けられるよう,最新の動向に精通している必要がある.(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)日本メディカルセンター  

再発GIST(gastrointestinal stromal tumor)に対するイマチニブ治療をより効率的にするため,外科治療を加えた集学的治療の重要性が認識されつつある.再発GISTの外科的切除は,イマチニブ治療のさまざまな局面で行われる.無病期間の長いGIST患者での肝転移切除の予後は良好であり,治療の一選択肢になりうる.イマチニブの二次耐性では,外科切除は限局性増悪に対して行われ,患者生存に寄与する可能性がある.また,イマチニブ奏効残存腫瘍切除の成績は良好であり,根治性を高める治療として期待されている.しかし,これら再発GISTに対する外科的切除のエビデンス・レベルはいずれも低い.その臨床的意義を明確にするための質の高いデータ作りが望まれる.(著者抄録)

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記述言語：日本語   出版者・発行元：新潟医学会  

The aim of young doctor exchange program was to exchange Japanese and Russian young doctors who have just graduated and to share experiences and knowledge in both clinical and basic fields. Oxana Podkaura (from Vladivostok), Valeria Gavrikova (from Krasnoyarsk) and Stanislav Korneev (from Khabarovsk) took part in this program held in Niigata from September 4 to 18, and studied children's leukemia and its treatment, Parkinson's disease and its treatment, and surgical treatment of liver, gastric and intestine cancer, respectively. They also attended two international symposia, CHRO2009 in Niigata and 2009 Tripartite symposium (Russia-United States-Japan Symposium on Cardiovascular Disease and Cancer) in Osaka.

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

GISTは消化管原発の間葉系腫瘍として最も多い疾患であり,近年の病態解明に伴い,その診断,治療が飛躍的に発展した.特にメシル酸イマチニブによる分子標的治療の導入により,転移・再発GISTの予後は大きく改善した.FDG-PET検査は,悪性腫瘍の抗癌剤治療効果判定で有用性が期待されているが,GISTの分子標的治療においても早期効果判定が可能であることが多数報告されている.CTなどと比べて空間分解能が劣ることなどの問題はあるが,消化管粘膜下腫瘍の質的診断,GISTの悪性度評価,イマチニブ二次耐性腫瘍の診断などにおいて有用性の高い検査と考える.GISTについてはまだ医療保険が適用されておらず,早期の適用拡大が望まれる.(著者抄録)

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(株)医学書院  

GISTのイマチニブ治療では,一部の奏効病変だけが増悪するものも多く,これは本治療の特徴ともいえる.このような限局性の増悪には,外科切除をはじめとする局所療法が有効な場合がある.エビデンス・レベルは低いものの,国内外の診療ガイドラインにもイマチニブ耐性の治療選択肢の1つとして示されている.耐性腫瘍の完全切除を行うことができれば,8ヵ月程度の術後無増悪期間が期待できる.広範性の増悪は無増悪期間がきわめて短く,手術適応にならない.二次耐性腫瘍切除では長期無増悪が少ないことから,患者QOLを損ねる手術は推奨できない.耐性腫瘍切除後もイマチニブ投与が必要であり,術後合併症を作らないことが特に重要となる.(著者抄録)

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

近年、糖尿病罹患率は増加してきており、糖尿病合併の消化器外科手術患者に関わる機会も増加してきている。糖尿病患者では創傷治癒遅延や感染症リスクが増加し、また全身性合併症も伴いうるので、問診や臨床検査により患者の全身状態、糖尿病の重症度、合併症などを十分に把握したうえで、血糖をきちんとコントロールしながら周術期栄養管理を行うことが肝要である。(著者抄録)

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(株)メディカルレビュー社  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：日本語   出版者・発行元：(株)医学書院  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

胃癌腹膜播種に対する低浸透圧CDDP腹腔内投与と,それに続くMTX/5-FUおよびUFTを用いた全身化学療法の安全性と効果について検討した.1998年4月から2004年3月までに胃癌に対し胃切除術が施行され,肉眼的腹膜播種陽性あるいは腹腔内洗浄細胞診陽性と診断された7症例(男性3例,女性4例,平均年齢59.4歳)を対象とした.腹腔内投与はCDDP100mg/bodyを蒸留水と混和し,閉腹前に腹腔内に投与し30から60分後に排出した.術後合併症として腹腔内膿瘍,腎機能低下をそれぞれ1例に認め,その後の全身化学療法に伴う有害事象としてgrade3の貧血と白血球減少をそれぞれ3例と1例に認めた.手術からの無増悪期間の中央値は109日,全生存期間の中央値は248日であった.胃癌腹膜播種に対する低浸透圧CDDP腹腔内投与は比較的安全に施行可能であるが,治療効果は新規抗癌剤による化学療法を上回るものではない(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

進行・再発胃癌患者には腹膜播種を伴うことが多いが,いまだ有効な治療法は確立されていない.教室では2002年1月から腹膜播種を伴う進行・再発胃癌患者に対してTS-1後にpaclitaxel(PTX)を用いた治療を行っており,その安全性と有効性について検討した.対象患者は腹膜播種を伴う進行・再発胃癌患者23例で,TS-1後にPTX療法を行った.TS-1による治療からPTX療法へ移行できた患者は19例(83%)であった.有害事象は,TS-1後のPTX療法においても重篤なものは少なく安全に施行可能であった.また,全治療期間の80%に外来治療が可能でありquality of lifeの維持に貢献できた.治療成績としては,無増悪期間中央値199日,生存期間中央値は全例で363日,完遂例で436日とほぼ満足いくものであった.腹膜播種を伴う胃癌患者に対するTS-1後PTX療法は安全でかつ有効な治療法と考えられる(著者抄録)

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記述言語：日本語   出版者・発行元：(株)南江堂  

消化管間質腫瘍(GIST)の遠隔転移は肝と腹膜に多く,腹腔外臓器に生じる頻度は低い.転移性GIST治療の現在の第一選択はimatinib mesylateによる分子標的治療である.KIT陰性GISTやKIT遺伝子変異をもたないGISTではimatinib mesylateが奏効する可能性は低く,切除可能な腫瘍においては外科治療が優先される.Imatinib mesylate奏効例への外科的介入が患者予後を改善するかどうかは現時点では明らかでなく,データの蓄積が待たれる(著者抄録)

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記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(有)科学評論社  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

Budd-Chiari症候群に肝細胞癌と脾動脈瘤を合併した1例を経験した.Budd-Chiari症候群が両者の発生や増悪に関与することを示唆する興味深い症例と考えられた.症例は69歳の女性で,1985年に下大静脈隔膜切開術を施行し,以後経過観察されていた.この治療から16年後の2001年7月肝S8-7,S5にそれぞれ2cm大の肝細胞癌が出現し経肝動脈塞栓術が施行された.また1989年径2.3cmで指摘されていた脾動脈瘤が3.3cmと漸次増大傾向が認められ,2002年7月瘤を含めた脾臓摘出術が施行された.門脈圧は脾摘前21cmH2Oであった.術後脾静脈から門脈にかけて血栓形成がみられたが,保存的に軽快した.同時に施行した肝生検の病理所見は門脈性,うっ血性肝硬変の混合型を呈していた.本症例における肝細胞癌,脾動脈瘤の成因について,文献的考察を加え報告する(著者抄録)

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

胃癌肝転移に対する肝切除術の有効性と適応とを明らかにする目的で,教室における肝転移治療例の実態を検討した.1982年1月から2004年4月までの間で,教室および関連施設で治療を受けた胃癌肝転移症例79例(同時性39例,異時性40例)を対象にした.同時性例ではH3が40%で,他の因子においても進行例が多かったが,異時性例ではH1,H2の症例が70%を占め,他の転移を伴う例は20%であった.生存期間を比較すると,同時性例,異時性例とも肝切除群が他の治療群に比して有意に良好であった.また,同時性例において姑息的胃切除に意義は見いだせなかった.以上より,胃癌肝転移における肝切除は同時性例では対象となる症例が限られるものの,主病巣や他の転移を含めた切除として意義があり,異時性例においてはH2までは適応があると考えられる(著者抄録)

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記述言語：日本語   出版者・発行元：(株)医学書院  

HBVキャリアーの50歳男.2000年の検診時に腹部エコーで指摘された肝S5の1cmの腫瘍性病変が,2001年の検診で6cm大に増大していたため精査加療目的で入院となった.腫瘍は,エコーで辺縁がlow,内部が比較的high echoicに描出され,ダイナミックCTでは早期相で辺縁が濃染,後期相にかけて中心へ向かい濃染されていく所見を呈した.肝外悪性病変は認められず,画像所見から胆管細胞癌を疑い肝右葉切除を施行した.病理組織学的所見より硬化型肝細胞癌と診断された.術後約半年経過現在,腫瘍マーカーの上昇や腫瘍の再発所見を認めていない

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記述言語：日本語   出版者・発行元：新潟医学会  

切除を行った食道粘膜下層浸潤癌(食道Sm癌)107例を,術後1年以内に死亡した群と術後1年以上生存した群に分け,両群の臨床病理学的諸因子をretrospectiveに比較検討した.術後1年以内の死亡は17例(16%)であった.原病死は7例で,未分化癌と血行性転移が主たる死因であった.これらの症例には手術以外に放射線・化学療法の併用が重要と考えられた.他病死は10例で,術後合併症,特に呼吸器合併症が多く,肺炎による死亡が多かった.これらに対しては愛護的な手術操作による反回神経麻痺の予防,周術期の呼吸器合併症の回避が肝要と思われた

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