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Subtotal colectomy is often performed on patients with synchronous colorectal cancer. However, compared with colorectal anastomosis, ileorectal anastomosis with subtotal colectomy is more likely to result in bowel dysfunction. The Deloyers procedure is useful in preserving bowel function in a patient with synchronous colorectal cancer. An 87-year-old man presented with bloody stool. Colonoscopy showed masses in the cecum, transverse colon, rectosigmoid, and rectum above the peritoneal reflection. Computed tomography scan revealed no evidence of regional lymph node swelling and distant metastasis. Therefore, robot-assisted low anterior resection, laparoscopic extended left hemicolectomy, laparoscopic cecal resection, and diverting ileostomy were performed. The patient was discharged from the hospital without complications. There was no recurrence, and the patient did not have complaints such as urgency, fecal incontinence, and excretory dysfunction. Hence, minimally invasive coloproctectomy using the Deloyers procedure can be safe and useful in preserving postoperative bowel function in elderly patients.
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Colectomía , Humanos , Masculino , Anciano de 80 o más Años , Colectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Neoplasias Colorrectales/cirugía , Neoplasias Colorrectales/patología , Laparoscopía/métodos , Neoplasias Primarias Múltiples/cirugía , Neoplasias Primarias Múltiples/patología , Proctectomía/métodos , Adenocarcinoma/cirugía , Adenocarcinoma/patologíaRESUMEN
Undergoing another surgery after a previous abdominal procedure can sometimes result in significant abdominal adhesions. We present a case of robot-assisted low anterior resection in a patient with rectal cancer who had a urinary reservoir. A 65-year-old male patient underwent robot-assisted total bladder resection and creation of a urinary reservoir for bladder cancer in 2013. He presented with melena. Thus, the findings revealed advanced low rectal cancer. The robot-assisted low anterior resection was performed in 2022. Extensive adhesions were observed in the pelvic space. The indocyanine green function was appropriately used, and the robotic surgery was completed without injury to the urinary reservoir or major complications. The surgical time was 510 min, and the blood loss volume was 15 mL. The patient had been recurrence free for 12 months following the surgery. Robot-assisted surgery can be beneficial for patients with rectal cancer with significant pelvic adhesions.
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Laparoscopía , Proctectomía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Robótica , Masculino , Humanos , Anciano , Resultado del Tratamiento , Laparoscopía/métodos , Neoplasias del Recto/complicaciones , Neoplasias del Recto/cirugía , Proctectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodosRESUMEN
The watch and wait strategy(W&W)is optional non-operative management for lower advanced rectal cancer patients who have achieved clinical complete response(cCR)following neoadjuvant treatment. However, the clinical implication of surgical intervention for the primary lesion is not well elucidated when distant metastasis appears with complete remission of the primary lesion. We report a case of a 47-year-old-woman with lower rectal cancer presenting inguinal lymph node metastasis after total neoadjuvant therapy(TNT)and managed through W&W after achieving cCR following chemotherapy. TNT was performed as a preoperative treatment for lower advanced rectal cancer, cT3N2aM0, cStage â ¢b. Although the primary lesion and mesenteric lymph node metastasis completely disappeared, bilateral inguinal lymph node metastasis appeared immediately after TNT. The patient was treated with FOLFOX plus panitumumab for rectal cancer with RAS and BRAF wild-type. Four months after chemotherapy, the inguinal lymph node metastasis disappeared, and W&W was used for the management. She stayed alive without recurrence 1 year and 9 months after chemotherapy.
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Terapia Neoadyuvante , Neoplasias del Recto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Femenino , Humanos , Ganglios Linfáticos/patología , Metástasis Linfática , Persona de Mediana Edad , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugíaRESUMEN
BACKGROUND: Intrapelvic aberrant needles are rare in clinical practice. Long-term foreign bodies in the abdominal cavity may form granulation tissue or an abscess, and may cause organ injury. Therefore, such foreign bodies need prompt removal. CASE PRESENTATION: A 26-year-old male athlete was referred to our hospital for investigation of an aberrant acupuncture needle in the gluteus. The needle was unable to be removed during acupuncture treatment, and the end broke off and remained in the gluteus. Abdominal X-ray examination showed a thin, 40-mm-long, metallic foreign body resembling an acupuncture needle. Abdominal computed tomography showed an abnormal shadow in the gluteus. However, it was unclear whether the tip of the needle reached the pelvic cavity. Thus, it was decided to surgically extract the needle via laparoscopic surgery under X-ray guidance as a safe and minimally invasive method. Although X-ray fluoroscopy confirmed that the aberrant needle was located in the gluteus, the needle could not be felt with the forceps, as the peritoneum surrounding the needle had granulomatous changes due to inflammation. Therefore, the retroperitoneum was further dissected to search for the needle. Once the needle was identified, its flexibility enabled it to be easily removed by grasping it directly with a needle holder. The length of the aberrant needle was 40 mm. The postoperative course was uneventful, and the patient was discharged from hospital on postoperative day 2. CONCLUSIONS: When a foreign body remains in the gluteus and its tip touches intrapelvic organs, such as the rectum, it is critical to determine the best approach for its safe removal. Given the anatomical location of the foreign body and the patient background, laparoscopic removal was considered the best approach in the present case.
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AIM: The clinical significance of the geriatric nutritional risk index (GNRI) in locally advanced rectal cancer (LARC) patients undergoing preoperative chemoradiotherapy (CRT) followed by curative surgery has not been comprehensively evaluated. METHODS: This retrospective study enrolled 93 LARC patients diagnosed with clinical lymph node metastasis. The GNRI formula was as follows: 1.489 × albumin (g/l) + 41.7 × current weight/ideal weight. Patients were categorized as GNRI low (GNRI < 104.25) or high (GNRI > 104.25) according to the receiver operating characteristic (ROC) curve for survival analysis. The impact of GNRI status on the prognostic outcomes of curative surgery for LARC was examined. RESULTS: There were 55 (59.14%) and 38 (40.86%) patients in the GNRI high and low groups, respectively. Of the investigated demographic factors, age, pathological tumor invasion, and presence of recurrence were significantly associated with the GNRI value. In Kaplan-Meier analysis, overall survival (OS) and disease-free survival (DFS) were significantly shorter in the GNRI low group (OS: p = 0.00020, DFS: p = 0.0044, log-rank test). Multivariate analysis using a Cox proportional hazards model showed that a low GNRI was an independent risk factor for poor OS (hazard ratio (HR) = 3.22; 95% confidence interval (CI), 1.37-8.23; p = 0.0068) and DFS (HR = 2.32; 95%CI = 1.15-4.79; p = 0.018). Although use of adjuvant therapy has no impact on prognosis (OS: p = 0.26, DFS: p = 0.29), low GNRI showed shorter OS and DFS in patients with pathological lymph node metastasis [ypN(+)] (OS: p = 0.033, DFS: p = 0.032, log-rank test). CONCLUSIONS: GNRI is a useful marker for LARC patients diagnosed with clinical lymph node metastasis and treated by preoperative CRT followed by curative surgery. GNRI is a useful tool to identify high risk of recurrence for improving the survival in LARC patients.
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Recurrencia Local de Neoplasia , Neoplasias del Recto , Anciano , Quimioradioterapia , Humanos , Recurrencia Local de Neoplasia/terapia , Pronóstico , Neoplasias del Recto/tratamiento farmacológico , Estudios RetrospectivosRESUMEN
PURPOSE: The systemic inflammatory response is attracting increasing attention as a predictive biomarker for oncological outcome in patients with colorectal cancer. This study is aimed at verifying if the lymphocyte-C-reactive protein (CRP) ratio (LCR) could be used as a predictor of oncological outcome in patients with rectal cancer (RC) receiving preoperative chemoradiotherapy (CRT). METHODS: We analyzed data for 86 patients with RC who received preoperative CRT followed by total mesorectal excision at our institution. A ratio of 6000 was used as the cut-off value for LCR for further analysis. RESULTS: The post-CRT LCR was significantly lower than the pre-CRT LCR in patients with RC. Although post-CRT LCR status was not significantly correlated with overall survival (OS), low pre-CRT LCR was significantly associated with shorter recurrence-free survival (RFS: p = 0.02) and OS (p = 0.017) in this population and was an independent prognostic factor for both RFS and OS (hazard ratio (HR) 3.19, 95% confidence interval (CI) 1.33-7.66, p = 0.009; HR 2.83, 95%CI 1.14-7.01, p = 0.025, respectively). Furthermore, low pre-CRT LCR was a stronger indicator of early recurrence (p = 0.001) and poor prognosis (p = 0.025) in RC patients without pathological lymph node metastasis compared with patients with pathological lymph node metastasis, and prognostic potential of pre-CRT LCR was clearly revealed especially RC patients receiving long-course CRT. CONCLUSIONS: Assessment of pretreatment LCR status might aid decision-making regarding postoperative treatment strategies in patients with RC receiving CRT followed by potentially curative resection.
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Proteína C-Reactiva , Neoplasias del Recto , Quimioradioterapia , Supervivencia sin Enfermedad , Humanos , Linfocitos/patología , Terapia Neoadyuvante , Estadificación de Neoplasias , Pronóstico , Neoplasias del Recto/patología , Estudios RetrospectivosRESUMEN
BACKGROUND: The advanced lung cancer inflammation index (ALI) has recently been shown as a prognostic marker for several cancers. However, its predictive value for surgical and oncological outcomes in gastric cancer (GC) remains unclear. METHODS: We retrospectively reviewed the preoperative ALI in 620 GC patients receiving gastrectomy to elucidate the prognostic value for overall survival (OS) and disease-free survival (DFS) and to clarify its predictive value for perioperative risk of surgical site infection (SSI) in GC patients. Propensity score matching (PSM) analysis was also conducted to certify these potentials of preoperative ALI. RESULTS: Preoperative low ALI was significantly correlated with advanced tumor-node-metastasis stage classification. Patients with low ALI showed poorer OS (p < 0.0001) and DFS (p < 0.0001) compared to those with high ALI, and multivariate analysis showed that decreased ALI was an independent prognostic factor for OS [hazard ratios of 1.59; 95% confidence interval (CI) of 1.15-2.19, p = 0.006]. Meanwhile, preoperative low ALI was also an independent risk factor for overall SSI [odds ratio (OR) of 2.04, 95% CI of 1.24-3.35, p = 0.005] or organ-space SSI (OR of 2.69, 95% CI of 1.40-5.23, p = 0.003). We further conducted PSM analysis and verified all of these findings in the PSM cohort. CONCLUSION: Quantification of preoperative ALI can identify patients with high risk of adverse perioperative and oncological outcomes in GC patients.
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Gastrectomía/mortalidad , Indicadores de Salud , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/mortalidad , Medición de Riesgo/métodos , Anciano , Femenino , Humanos , Inflamación , Neoplasias Pulmonares/cirugía , Masculino , Análisis Multivariante , Estadificación de Neoplasias , Estado Nutricional , Oportunidad Relativa , Valor Predictivo de las Pruebas , Periodo Preoperatorio , Pronóstico , Puntaje de Propensión , Estudios Retrospectivos , Factores de Riesgo , Infección de la Herida Quirúrgica/etiologíaRESUMEN
BACKGROUND: The advanced lung cancer inflammation index is considered a useful prognostic biomarker of clinical outcomes in patients with malignancies. However, the prognostic value of the advanced lung cancer index in patients with colorectal cancer who underwent surgical resection remains unclear. OBJECTIVE: In this study, we evaluated the prognostic value of the advanced lung cancer index in patients with colorectal cancer. DESIGN: Prospectively obtained data of patients with colorectal cancer were retrospectively evaluated to clarify the clinical relevance of the advanced lung cancer index. SETTINGS: We conducted this study at a single expert center. PATIENTS: We enrolled 298 patients with colorectal cancer who underwent surgical resection in this retrospective study. MAIN OUTCOME MEASURES: The primary outcome was the clinical relevance of the advanced lung cancer index in patients with rectal cancer. RESULTS: Low status of advanced lung cancer index was significantly correlated with undifferentiated histology (p = 0.004), T stage progression (p < 0.001), R1/R2 resection for primary surgery (p = 0.004), and distant metastasis (p < 0.001). Multivariate analysis showed that low advanced lung cancer index status was an independent prognostic factor for both overall survival (HR = 3.21 (95% CI, 1.97-5.19); p < 0.001) and disease-free survival (HR = 2.13 (95% CI, 1.23-3.63); p = 0.008) in patients with colorectal cancer. Furthermore, the clinical burden of the advanced lung cancer index was consistent between sexes, and its prognostic value was verified in patients with clinically relevant stage III colorectal cancer. LIMITATIONS: The present study had several limitations, including retrospective observation and a small sample size of Japanese patients from a single institution. CONCLUSIONS: The advanced lung cancer index could be a useful prognostic indicator of clinical outcomes in patients who underwent surgical resection for colorectal cancer. See Video Abstract at http://links.lww.com/DCR/B267. EL ÍNDICE AVANZADO DE INFLAMACIÓN DEL CÁNCER DE PULMÓN, PREDICE LOS RESULTADOS DE LOS PACIENTES CON CÁNCER COLORRECTAL DESPUÉS DE LA RESECCIÓN QUIRÚRGICA: El índice avanzado de inflamación del cáncer de pulmón, es considerado como un útil biomarcador pronóstico, en los resultados clínicos de pacientes con neoplasias malignas. Sin embargo, aún no está claro el valor pronóstico del índice avanzado de cáncer de pulmón, en pacientes con cáncer colorrectal sometidos a resección quirúrgica.Evaluar el valor pronóstico del índice avanzado del cáncer de pulmón, en pacientes con cáncer colorrectal.Los datos obtenidos prospectivamente de pacientes con cáncer colorrectal, fueron evaluados retrospectivamente, para aclarar la relevancia clínica del índice avanzado del cáncer de pulmónEstudio realizado en un solo centro experto.Estudio retrospectivo, incluyendo 298 pacientes con cáncer colorrectal, sometidos a resección quirúrgica.El resultado primario fue la relevancia clínica del índice avanzado de cáncer de pulmón, en pacientes con cáncer rectal.Un índice avanzado de cáncer de pulmón bajo, se correlacionó significativamente con la histología indiferenciada (p = 0.004), la progresión de la etapa T (p <0.001), la resección R1 / R2 para cirugía primaria (p = 0.004) y la metástasis a distancia (p <0.001). El análisis multivariante mostró que el índice avanzado de cáncer de pulmón bajo, era un factor pronóstico independiente, tanto para la supervivencia general (HR = 3.21 IC 95% 1.97-5.19 p <0.001) como para la supervivencia libre de enfermedad (HR = 2.13, IC 95% 1.23-3.63, p = 0,008), en pacientes con cáncer colorrectal. Además, la carga clínica del índice avanzado de cáncer de pulmón, fue consistente entre los sexos y su valor pronóstico se verificó clínicamente relevante, en pacientes con cáncer colorrectal en estadio III.El presente estudio tuvo varias limitaciones, incluyendo la observación retrospectiva y la pequeña muestra de pacientes japoneses, en una sola institución.El índice avanzado de cáncer de pulmón, podría ser un indicador pronóstico útil, en los resultados clínicos de pacientes sometidos a resección quirúrgica por cáncer colorrectal. Consulte Video Resumen http://links.lww.com/DCR/B267.
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Adenocarcinoma/cirugía , Neoplasias Colorrectales/cirugía , Linfocitos , Neutrófilos , Albúmina Sérica/metabolismo , Adenocarcinoma/sangre , Adenocarcinoma/patología , Adulto , Anciano , Anciano de 80 o más Años , Índice de Masa Corporal , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/patología , Supervivencia sin Enfermedad , Femenino , Humanos , Inflamación/sangre , Japón , Recuento de Leucocitos , Recuento de Linfocitos , Masculino , Márgenes de Escisión , Persona de Mediana Edad , Clasificación del Tumor , Metástasis de la Neoplasia , Estadificación de Neoplasias , Estado Nutricional , Pronóstico , Modelos de Riesgos Proporcionales , Estudios Retrospectivos , Tasa de SupervivenciaRESUMEN
BACKGROUND: Programmed cell death ligand-1 (PD-L1) and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) play a pivotal role in cancer immunotherapy. Each of these molecules has a membrane-bound receptor form (mPD-L1/mCTLA-4) and a soluble form (sPD-L1/sCTLA-4). However, these prognostic impacts in colorectal cancer (CRC) remain unclear. METHODS: We immunohistochemically scored tumoral mPD-L1/mCTLA-4 expression and quantified preoperative circulating sPD-L1/sCTLA-4 levels using matched serum specimens from 131 patients with pStage I-III CRC. We also examined the association between these statuses and tumor infiltrating lymphocytes (TILs) in these patients. RESULTS: Elevated levels of mPD-L1, mCTLA-4, sPD-L1 and sCTLA-4 were significantly correlated with poor overall survival (OS) and disease-free survival (DFS). Co-high expression of tumoral mPD-L1 and mCTLA-4 or co-elevated levels of serum sPD-L1 and sCTLA-4 were strongly correlated with poor OS and DFS. Multivariate analysis revealed that both statuses were negative independent prognostic factors for OS [hazard ratio (HR) 3.86, 95% confidence interval (95% CI) 1.71-8.51, p = 0.001; HR 5.72, 95% CI 1.87-14.54, p = 0.004, respectively] and DFS (HR 2.53, 95% CI 1.23-4.95, p = 0.01; HR 6.88, 95% CI 2.42-17.13, p = 0.0008, respectively). Although low expression of tumoral mCTLA-4 was significantly correlated with increased CD8(+) TILs, there was no correlation in any other combination. CONCLUSIONS: We verified the prognostic impacts of mPD-L1, mCTLA-4, sPD-L1 and sCTLA-4 in pStage I-III CRC patients. Dual evaluation of immune checkpoint molecules in primary tissues or preoperative serum could identify a patient population with poor prognosis in these patients.
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Antígeno B7-H1/metabolismo , Biomarcadores de Tumor/metabolismo , Antígeno CTLA-4/metabolismo , Neoplasias Colorrectales/mortalidad , Adulto , Anciano , Anciano de 80 o más Años , Antígeno B7-H1/sangre , Antígeno B7-H1/inmunología , Biomarcadores de Tumor/sangre , Biomarcadores de Tumor/inmunología , Antígeno CTLA-4/sangre , Antígeno CTLA-4/inmunología , Colon/inmunología , Colon/patología , Colon/cirugía , Neoplasias Colorrectales/sangre , Neoplasias Colorrectales/inmunología , Neoplasias Colorrectales/cirugía , Supervivencia sin Enfermedad , Femenino , Humanos , Estimación de Kaplan-Meier , Linfocitos Infiltrantes de Tumor/inmunología , Linfocitos Infiltrantes de Tumor/metabolismo , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Pronóstico , Recto/inmunología , Recto/patología , Recto/cirugía , Estudios RetrospectivosRESUMEN
BACKGROUND: Peritumoral lymphoid aggregates, termed Crohn's-like lymphoid reaction (CLR), are markers of an antitumor immune response, which is an important predictor of patient outcome. In this study, we investigated the prognostic utility of CLR and its relationship with nutritional status in patients with gastric cancer (GC). METHODS: The study included 170 patients who underwent curative surgery for pathological stage (pStage) II/III GC. The maximum diameters of peritumoral and normal mucosal CLR aggregates were measured, and the median peritumoral diameter (0.57 mm) was used to stratify patients into two groups (large-CLR and small-CLR). The relationships between CLR size and preoperative nutritional status (body mass index, body composition status, Onodera's prognostic nutritional index), tumor-infiltrating CD8+ T-lymphocyte count, and survival were evaluated. RESULTS: Peritumoral CLR aggregates were significantly larger than aggregates in the normal mucosa. Clinicopathological variables were not significantly different between the two patient groups; however, the large-CLR group had better cancer-specific survival (p = 0.018) and recurrence-free survival (p = 0.03) than the small-CLR group. Multivariate analysis revealed that CLR size was an independent prognostic factor for cancer-specific survival [hazard ratio (HR) 2.13, 95% confidence interval (CI) 1.3-3.56, p = 0.002] and recurrence-free survival (HR 1.96, 95% CI 1.22-3.19, p = 0.005). Nutritional status markers were significantly poorer for the small-CLR group than the large-CLR group. CD8+ T-cell tumor infiltration was positively correlated with CLR size but not with patient survival. CONCLUSIONS: CLR size correlated with patient nutritional status and prognosis and may be helpful in identifying high-risk populations of pStage II/III GC patients.
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Enfermedad de Crohn/patología , Linfocitos/patología , Estado Nutricional , Neoplasias Gástricas/inmunología , Neoplasias Gástricas/patología , Adulto , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/inmunología , Linfocitos T CD8-positivos , Enfermedad de Crohn/inmunología , Femenino , Humanos , Recuento de Linfocitos , Linfocitos Infiltrantes de Tumor/inmunología , Masculino , Persona de Mediana Edad , Análisis Multivariante , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Evaluación Nutricional , Pronóstico , Neoplasias Gástricas/mortalidad , Tasa de SupervivenciaRESUMEN
PURPOSE: The clinical significance of the red blood cell distribution width (RDW) in patients with rectal cancer undergoing preoperative chemoradiotherapy (CRT) followed by surgery has not been fully evaluated. METHODS: In this retrospective study, we investigated the association between the RDW and the prognosis in 120 patients with locally advanced rectal cancer (LARC). We also performed a subgroup analysis limited to patients with pathological TNM stage I-II (ypN[-]) LARC. RESULTS: The RDW standard deviation was used to evaluate the RDW. We set 47.1% as the cut-off value of the RDW for the assessment of the prognosis. The RDW exhibited a significant negative relationship with the serum hemoglobin and albumin levels. An elevated RDW was an independent prognostic factor for the overall survival (OS) and disease-free survival (DFS) in patients with LARC. In addition, an elevated RDW predicted a poor OS and DFS in patients with pathological TNM stage I-II (ypN[-]) LARC. CONCLUSIONS: The RDW is a promising predictor of a poor survival and recurrence in patients with LARC treated by CRT.
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Biomarcadores de Tumor/sangre , Quimioradioterapia Adyuvante , Procedimientos Quirúrgicos del Sistema Digestivo , Recuento de Eritrocitos , Neoplasias del Recto/diagnóstico , Neoplasias del Recto/terapia , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Periodo Preoperatorio , Pronóstico , Neoplasias del Recto/sangre , Estudios RetrospectivosRESUMEN
PURPOSE: Gastric cancer (GC) is a common malignancy, especially in East Asian countries. There is emerging evidence that circulating neutrophil and platelet levels correlate with cancer progression. We evaluated the short- and long-term outcomes of GC patients systemically, to compare the original neutrophil-platelet score (NPS) and our modified NPS (mNPS). METHODS: We analyzed the original pre-operative NPS and the mNPS of 621 GC patients. RESULTS: Racial differences between the United Kingdom and East Asian countries accounted for compelling deviation in classification using the original NPS, which could not reliably stratify the prognoses of Japanese GC patients. We developed the mNPS using appropriate cutoff levels for pre-operative neutrophils and platelets, and demonstrated that the pre-operative mNPS was significantly correlated with all of the well-established clinicopathological factors for disease development, including advanced T stage, venous and lymphatic vessel invasion, lymph node/peritoneal /distant metastasis, and tumor-node-metastasis stage. The pre-operative mNPS could stratify prognostication for both overall survival (OS) and disease-free survival (DFS): a high pre-operative mNPS was an independent prognostic factor for the OS and DFS of GC patients and also an independent predictor of post-operative surgical site infection after gastrectomy. CONCLUSION: Calculating the mNPS could help clinicians to stratify the surgical and oncological risks of patients with GC.
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Biomarcadores de Tumor/sangre , Recuento de Leucocitos , Neutrófilos , Recuento de Plaquetas , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Humanos , Pronóstico , Resultado del TratamientoRESUMEN
The present study designed a novel preoperative chemoradiotherapy (CRT) with sequential oxaliplatin and irinotecan with S-1 for locally advanced rectal cancer (LARC). This phase I study evaluated the maximum tolerated dose and recommended dose (RD) of oxaliplatin following irinotecan with S-1. Patients with clinical stage T3 or 4 or involvement of the regional nodes and no evidence of distant metastases were treated with fixed doses of S-1 (80 mg/m2/day) on days 1-5, 8-12, 15-19, 22-27 and 29-33, and irinotecan (40 mg/m2/day) on days 1 and 8, followed by oxaliplatin on days 22 and 29. The dose of oxaliplatin was initially 40 mg/m2 (level 1) with a predefined dose escalation schedule. The radiation dose was 1.8 Gy/fraction to a total dose of 45 Gy. A total of 9 patients were enrolled in the present study and 7 patients completely received CRT with this study protocol. The maximum tolerated dose for oxaliplatin was 50 mg/m2 (level 2). Three of four patients experienced dose-limiting toxicity (grade 3 diarrhea) in oxaliplatin phase of level 2 dose. The RD of oxaliplatin was 40 mg/m2 (level 1 dose). In addition, 2 patients had pathological CR (28.5%). Novel preoperative CRT with sequential oxaliplatin and irinotecan with S-1 for LARC resulted in acceptable toxicity and promising efficacy. However, the RD of oxaliplatin was lower than in previous CRT studies that combined oxaliplatin with S-1. To administer higher oxaliplatin, we have planned a phase I trial of preoperative CRT with sequential oxaliplatin followed by irinotecan with S-1 for LARC.
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PURPOSE: Several recent studies have evaluated the feasibility of the sentinel node (SN) concept for gastric cancer. The aim of our study was to investigate limited gastrectomy with SN basin dissection in SN navigation surgery (SNNS) for patients with early-gastric cancer located in the upper-third of the stomach. METHODS: 147 patients received SNNS for early-gastric cancer at our institution. Of these, 26 patients diagnosed with early-gastric cancer < 4 cm in size and located in the upper-third of the stomach were retrospectively analyzed for the distribution of SN and SN basins. RESULTS: In three of the 26 patients, lymph node metastasis was limited to the left gastric artery (LGA) basin. The breakdown of the basins were as follows: A single LGA basin, 19 cases; a non-single LGA basin, seven cases. A non-single LGA basin was significantly associated with the clinicopathological factors, such as tumor spread to the middle-third of the stomach, tumor location at the center of the greater curvature, and undifferentiated adenocarcinoma, compared to the single LGA basin group. CONCLUSIONS: Our data revealed that the distribution of the SN basins in early-gastric cancer measuring less than 4 cm in size and located in the upper-third of the stomach was significantly correlated with tumor spread, tumor location, and the pathological findings.
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Gastrectomía/métodos , Márgenes de Escisión , Ganglio Linfático Centinela/patología , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Estómago/patología , Anciano , Estudios de Factibilidad , Femenino , Artería Gástrica/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Estudios RetrospectivosRESUMEN
PURPOSE: Postoperative pulmonary complications (PCs) after thoracoscopic esophagectomy for esophageal cancer (EC) still occur too frequently. We conducted this study to identify the risk factors for PCs developing in EC patients who undergo thoracoscopic esophagectomy. METHODS: The subjects of this retrospective study were 89 patients with EC who underwent thoracoscopic esophagectomy in our department between January 2010 and December 2015. Univariate and multivariate logistic regression analyses were used to evaluate the association between the incidence of PC and clinical factors. In January 2016, we introduced a new prophylactic intervention for reducing the incidence of delirium and assessed its significance for PCs. RESULTS: PCs developed in 19 patients (21.3%). Univariate analysis revealed the following risk factors: age (> 69 years), ratio of the forced expiratory volume in 1 s to forced vital capacity (< 70%), chronic obstructive pulmonary disease (COPD), and postoperative delirium. Multivariate analysis found that COPD and postoperative delirium were independent risk factors for PCs. Our new intervention for delirium significantly reduced its occurrence (p = 0.00004) and also the frequency of PCs (p = 0.04148). CONCLUSIONS: Postoperative delirium and COPD were risk factors for PCs in patients who underwent thoracoscopic esophagectomy. Our intervention study showed clearly that reducing the occurrence of postoperative delirium could decrease the incidence of PCs.
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Delirio del Despertar , Neoplasias Esofágicas/cirugía , Esofagectomía/efectos adversos , Enfermedades Pulmonares/etiología , Complicaciones Posoperatorias/etiología , Enfermedad Pulmonar Obstructiva Crónica , Cirugía Torácica Asistida por Video/efectos adversos , Anciano , Delirio del Despertar/prevención & control , Femenino , Humanos , Incidencia , Modelos Logísticos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Atención Perioperativa , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
BACKGROUND: Sarcopenia is defined as the loss of skeletal muscle mass, accompanied by decreased muscle strength, and consists of myopenia and myosteatosis. Recent evidence has suggested the predictive value of sarcopenia for the risk of perioperative and oncological outcomes in various malignancies. The aim of this study was to clarify the clinical impact of myopenia and myosteatosis in colorectal cancer (CRC) patients. METHODS: We analyzed the preoperative psoas muscle mass index and intramuscular adipose tissue content using preoperative computed tomography images from 308 CRC patients using statistical methods. RESULTS: Despite no significant correlation between myosteatosis and prognosis, preoperative myopenia significantly correlated with clinicopathological factors for disease development, including advanced tumor depth (P = 0.009), presence of lymphatic vessel invasion (P = 0.006), distant metastasis (P = 0.0007), and advanced stage classification (P = 0.013). Presence of preoperative myopenia was an independent prognostic factor for both cancer-specific survival (hazard ratio [HR]: 2.75, 95% confidence interval [CI]: 1.5-5.05, P = 0.001) and disease-free survival (HR: 3.15, 95% CI: 1.8-5.51, P = 0.0001), and was an independent risk factor for postoperative infectious complications in CRC patients (odds ratio: 2.03, 95% CI:1.17-3.55, P = 0.013). Furthermore, these findings were successfully validated using propensity score matching analysis. CONCLUSIONS: Preoperative myopenia could be useful for perioperative management, and quantification of preoperative skeletal muscle mass could identify patients as a high risk for perioperative and oncological outcomes in CRC patients.
Asunto(s)
Tejido Adiposo/metabolismo , Composición Corporal , Neoplasias Colorrectales , Procedimientos Quirúrgicos del Sistema Digestivo , Músculos Psoas/patología , Sarcopenia/complicaciones , Anciano , Anciano de 80 o más Años , Colon/patología , Colon/cirugía , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Neoplasias Colorrectales/cirugía , Procedimientos Quirúrgicos del Sistema Digestivo/efectos adversos , Supervivencia sin Enfermedad , Femenino , Humanos , Infecciones/etiología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Complicaciones Posoperatorias , Pronóstico , Puntaje de Propensión , Modelos de Riesgos Proporcionales , Músculos Psoas/metabolismo , Factores de Riesgo , Sarcopenia/patología , Análisis de Supervivencia , Tomografía Computarizada por Rayos X/métodosRESUMEN
Severe malnutrition accompanied by sarcopenia and cachexia, is strongly associated with the surgical and oncological outcomes in cancer patients. The aim of the present study was to clarify the clinical significance of sarcopenia and its correlation with sarcopenia-associated miRNA in colorectal cancer (CRC). A total of 167 CRC patients were enrolled in the present study. We evaluated psoas muscle mass index (PMI) and intramuscular adipose tissue content (IMAC). The expression of miR-21 in CRC tissues and preoperative serum was evaluated using quantitative PCR. Despite the lack of significant correlation between IMAC and disease-correlated factors, decreased PMI was significantly associated with well-established clinicopathological factors for disease progression. Decreased PMI was an independent prognostic factor for both overall survival and disease-free survival and was an independent risk factor for various types of metastasis. In contrast to the expression of tissue miR-21, the expression of serum miR-21 was significantly increased in CRC patients with low PMI. Furthermore, postoperative PMI was drastically improved compared with preoperative PMI in CRC patients with potentially curative resections. In conclusion, skeletal muscle mass may be a prognostic and predictive biomarker for distant metastasis in CRC patients and quantification of serum miR-21 expression could help clinicians make decisions regarding nutrition intervention strategies in CRC patients.
Asunto(s)
Neoplasias Colorrectales/sangre , MicroARNs/sangre , Pronóstico , Sarcopenia/sangre , Anciano , Neoplasias Colorrectales/genética , Neoplasias Colorrectales/patología , Progresión de la Enfermedad , Supervivencia sin Enfermedad , Femenino , Regulación Neoplásica de la Expresión Génica , Humanos , Masculino , MicroARNs/genética , Persona de Mediana Edad , Músculo Esquelético/metabolismo , Músculo Esquelético/patología , Sarcopenia/genética , Sarcopenia/patologíaRESUMEN
The possible role of PI3-K in the reversible temperature-dependent immobilization of fowl sperm motility was investigated by using PI3-K inhibitor (LY294002) and its inactive analogue (LY303511). The existence of the PI3-K in fowl spermatozoa was also confirmed by Western blotting analysis. Fowl sperm motility in TES/NaCl buffer remained negligible at the avian body temperature of 40 degrees C but was maintained vigorously when the temperature was decreased to 30 degrees C. At 30 degrees C, no stimulation or inhibition of motility was observed after the addition of 2 mM CaCl2 and 10 microM LY294002 or LY303511: around 70-80% of spermatozoa remained motile. In contrast, at 40 degrees C, the motility of spermatozoa was activated immediately after the addition of Ca(2+), but the subsequent addition of LY294002 inhibited the motility again. The addition of LY303511 did not appreciably affect the Ca(2+)-supplemented sperm motility, which was maintained for at least 15 min. The ATP concentrations of spermatozoa after the addition of LY294002 + Ca(2+) or LY303511 + Ca(2+) were almost the same values compared with those of Ca(2+) alone at 40 degrees C, suggesting that the addition of LY294002 was not simply affecting membrane damage or inhibiting energy production in the spermatozoa, but may be acting on some part of the motility-regulating cascade. Immunoblotting of sperm extract using an antibody to PI3-K revealed a major cross-reacting protein of 85 kDa, which corresponds to the molecular weight of the subunit of PI3-K. These results suggest that PI3-K may be positively involved in the calcium-regulated maintenance of flagellar movement of fowl spermatozoa at 40 degrees C.