Exploratory study on the impact of intraesophageal pressure on quality of life in patients following total gastrectomy: a retrospective cohort study.

BACKGROUND: The usefulness of high-resolution impedance manometry (HRIM) in patients who underwent total gastrectomy with Roux-en-Y (R-Y) anastomosis has never been well validated. This study aimed to investigate whether intraesophageal pressure affects quality of life in patients who underwent total gastrectomy with R-Y anastomosis. METHODS: The participants comprised 12 patients who underwent total gastrectomy for gastric cancer between October 2014 and July 2022 and underwent a postsurgical HRIM examination. The association between the HRIM data and Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37) questionnaires was analyzed. RESULTS: Esophageal body motility was normal in almost all patients. The anastomosis shape (circular stapler and overlap method with linear stapler) did not influence intraesophageal pressure. The integrated relaxation pressure and lower esophageal sphincter (LES) residual pressure during swallowing-induced relaxation were involved in "diarrhea subscale" scores (p = 0.0244 and p = 0.0244, respectively). The average maximum intrabolus pressure was not involved in postgastrectomy symptom. The contractile front velocity correlated with the "indigestion subscale," "diarrhea subscale," and "constipation subscale" (p = 0.0408, p = 0.0143, and p = 0.0060, respectively). The distal latency, i.e., the time from upper esophageal sphincter relaxation to contractile deceleration, was also associated with the "abdominal pain subscale" (p = 0.0399). LES pressure and esophageal body motility affected patients' quality of life after total gastrectomy. CONCLUSIONS: HRIM for the evaluation of intraesophageal pressure is useful for the functional assessment of esophagojejunostomy with the R-Y reconstruction after total gastrectomy.

[Consideration of Surgical Treatment for Ileus Symptoms Associated with Progressing Cancer in Our Hospital].

INTRODUCTION: Many cases of terminal cancer develop ileus symptoms such as vomiting and abdominal distension. The causes of ileus symptoms include peritoneal dissemination, localized recurrence, etc. The treatments include octreotide acetate, decompression measures such as ileus tube, and surgical treatment. We evaluated the results of cases that underwent surgical methods to reduce ileus symptoms. METHODS: The subjects were 31 patients comprising 38 cases with ileus symptoms between January 2013 and January 2018. The surgical procedures included bypass(17 cases), tumor extirpation(7 cases), stoma(11 cases), and other(3 cases). RESULTS: Dietary intake information was available for 27 of the 38 cases; in cases that underwent tumor excision, all meals were able to be ingested and there were many cases of long-term survival. DISCUSSION: Surgical procedures can allow patients to eat food and should be considered as dietary intake after treatment is associated with survival duration.

Laparoscopic omental filling with intraoperative endoscopy for a perforated duodenal ulcer.

As a surgical treatment for a perforated duodenal ulcer, duodenal omental filling is effective. However, filling the perforation site with a sufficient amount of omentum is difficult in some situations. We herein report that we successfully filled a perforated duodenal ulcer with a sufficient amount of omentum using intraoperative endoscopy. The operation was performed with three ports, the operation time was 110 min, and the estimated blood loss was small. The postoperative course was good. No stenosis of deformity of the duodenum was observed on follow-up endoscopy. Laparoscopic surgery has a shorter operation time, shorter postoperative hospital stay, and less postoperative pain than open surgery. The combined use of intraoperative endoscopy with laparoscopic surgery is effective for a large perforation, and it can be expected to reduce the rate of conversion to open surgery. This combined procedure is considered useful as a laparoscopic omental filling operation.

Intraoesophageal pressure in patients receiving proximal gastrectomy with hinged double flap method for gastric cancer: a retrospective cohort study.

Background: Objective functional assessment of esophagogastric anastomosis in patients who underwent proximal gastrectomy with the hinged double flap method for gastric cancer has not been well investigated. This study aimed to perform a functional analysis of reconstruction using high-resolution impedance manometry (HRIM). Materials and methods: The authors enroled 25 patients who underwent proximal gastrectomy for gastric cancer between May 2015 and April 2020 and subsequently underwent HRIM postoperatively. Eligible questionnaires [Postgastrectomy Syndrome Assessment Scale-37 (PGSAS-37)] were retrieved from 16 patients. The association between HRIM data and PGSAS-37 was analyzed. Results: The amplitudes of distal oesophageal peristaltic waves, contractile front velocity, and distal latency assessed by HRIM were almost normal after surgery. Most patient's lower oesophageal sphincter (LES) resting pressure created by the hinged double flap was within normal limits. Conversely, LES residual pressure values during swallowing-induced relaxation were abnormally high in most patients, and the lower the values, the more severe the reflux and diarrhoea symptoms (P=0.038, P=0.041, respectively). In addition, even when the integrated relaxation pressure (IRP) was normal, lower values corresponded to more severe reflux symptoms (P=0.020). The required LES pressure may be higher after proximal gastrectomy because of the relatively higher intragastric pressure due to the reduced volume of the remnant stomach. This also suggests that swallowing-induced relaxation of the LES was considered a trigger for oesophageal reflux in post-proximal gastrectomy patients. Conclusion: LES residual pressure and IRP values in HRIM correlated with reflux symptoms in patients after proximal gastrectomy.

Endoscopic Diagnosis and Therapy for Epstein-Barr Virus-Associated Gastric Cancer.

Epstein-Barr-virus-associated gastric cancer (EBVaGC) represents almost 7% of all GC and is a distinct subtype of GC with extreme DNA hypermethylation. EBVaGC is a tumor-infiltrating lymphocyte-rich tumor with little lymph-node metastasis in its early stage and with a relatively favorable prognosis in its advanced stage. Using upper gastrointestinal endoscopy, we recognize EBVaGC as a mainly depressed type with SMT-like protrusion in the upper part of the stomach near the gastric mucosal atrophic border or remnant stomach. The EBVaGC recognition rate of 21.4% with the endoscopic motif is not high, and further progress in endoscopic diagnosis of EBVaGC is needed. As less invasive endoscopic therapy, the extension of the criteria of endoscopic submucosal dissection (ESD) for early EBVaGC with little lymph-node metastasis should be discussed. Endoscopic diagnosis of EBVaGC may be relevant for the selection of patients who could benefit from endoscopic treatment or chemotherapy.

MicroRNA-21 regulates the proliferation and invasion in esophageal squamous cell carcinoma.

PURPOSE: MicroRNAs are approximately 22 nucleotide noncoding RNA molecules that posttranscriptionally regulate gene expression. The aim of this study was (a) to determine a role of microRNA-21 in esophageal squamous cell carcinoma and (b) to elucidate the regulation of the programmed cell death 4 (PDCD4) gene by microRNA-21. EXPERIMENTAL DESIGN: MicroRNA-21 expression was investigated in 20 matched normal esophageal epitheliums and esophageal squamous cell carcinomas and seven esophageal squamous cell carcinoma cell lines (TE6, TE8, TE10, TE11, TE12, TE14, KYSE30) by TaqMan quantitative real-time PCR and in situ hybridization. To evaluate the role of microRNA-21, cell proliferation and invasion were analyzed with anti-microRNA-21-transfected cells. In addition, the regulation of PDCD4 by microRNA-21 was elucidated to identify the mechanisms of this regulation. RESULTS: Of 20 paired samples, 18 cancer tissues overexpressed microRNA-21 in comparison with matched normal epitheliums. Specifically, patients with lymph node metastasis or venous invasion showed significantly high expression of microRNA-21. In situ hybridization for microRNA-21 showed strong positive staining in paraffin-embedded esophageal squamous cell carcinoma tissues. All seven esophageal squamous cell carcinoma cell lines also overexpressed microRNA-21, and anti-microRNA-21-transfected cells showed significant reduction in cellular proliferation and invasion. The PDCD4 protein levels in esophageal squamous cell carcinoma cells have an inverse correlation with microRNA-21 expression. Anti-microRNA-21-transfected cells increased PDCD4 protein expression without changing the PDCD4 mRNA level and increased a luciferase-reporter activity containing the PDCD4-3' untranslated region construct. CONCLUSIONS: MicroRNA-21 targets PDCD4 at the posttranscriptional level and regulates cell proliferation and invasion in esophageal squamous cell carcinoma. It may serve as a novel therapeutic target in esophageal squamous cell carcinoma.

The relationship between the glucose transporter type 1 expression and F-fluorodeoxyglucose uptake in esophageal squamous cell carcinoma.

OBJECTIVE: Glucose transporter type 1 (Glut1) has been reported to be present in several types of carcinomas. The aims of this study are to evaluate Glut1 expression in both primary tumors and metastatic lymph nodes (LNs) of esophageal squamous cell carcinoma (ESCC) and to assess the relationship between Glut1 expression and (18)F-fluorodeoxyglucose (FDG) accumulation. METHODS: We immunohistochemically examined the expression of Glut1 in 60 surgically resected primary lesions and 95 metastatic LNs of ESCC and classified them into 3 groups. The FDG accumulation was assessed with a positron emission tomography (PET). RESULTS: In the primary tumors, a high Glut1 expression was found to be significantly associated with advanced lesions: depth of tumor (p < 0.01), LN metastasis (p < 0.05) and advanced pathological stage (p < 0.01). The Glut1 expression of the metastatic LNs significantly correlated with that of each primary tumor (p < 0.001). The PET-positive lesions had a larger size and higher Glut1 expression than the PET-negative lesions in both the primary tumors and metastatic LNs. CONCLUSIONS: In both the primary tumors and metastatic LNs of ESCC, the Glut1 expression and tumor size correlated with the FDG accumulation and influence the sensitivity of the PET scan.

p12CDK2-AP1 is associated with tumor progression and a poor prognosis in esophageal squamous cell carcinoma.

p12 CDK2-associating protein 1 (p12CDK2-AP1) is a growth suppressor that negatively regulates cyclin-dependent kinase 2 (CDK2) activities. In addition, p12CDK2-AP1 has also been shown to interfere in DNA replication. A reduction of p12CDK2-AP1 expression is known to be a negative prognostic indicator in patients with oral squamous cell carcinoma. To elucidate the role of p12CDK2-AP1 expression in esophageal squamous cell carcinoma (ESCC), we immunohistochemically examined the expression of p12CDK2-AP1 protein in 120 resected ESCC specimens and determined its association with the clinicopathological characteristics and prognosis. Of the 120 ESCCs, 79 (65.8%) showed positive staining (>or=25% of cancer cells showing p12CDK2-AP1 expression), while 41 (34.2%) lacked the staining (<25% of cancer cells showing p12CDK2-AP1 expression). Negative staining for p12CDK2-AP1 was found to be significantly associated with advanced lesions [depth of tumor (P=0.001), lymph node metastasis (P<0.001), pathological stage (P<0.0001) and venous invasion (P<0.0001)], and a poor prognosis (disease-free survival and overall survival: log-rank P<0.05). The rate of lymph node metastasis in patients with p12CDK2-AP1 negative-T1 ESCC was significantly higher than that in patients with p12CDK2-AP1 positive one (P<0.05). These results suggest the down-regulation of p12CDK2-AP1 to be related to tumor aggressiveness and a poor prognosis in patients with ESCC.

[Assessment of esophageal cancer with remote metastases treated with multidisciplinary therapy].

We present three cases of patients diagnosed with esophageal cancer with distant metastases. We conducted chemotherapy, radiotherapy, RFA, and operation for main tumor and lymph node, lung, brain metastasis. They were for a long-term survival with multidisciplinary therapy. The longest survival time was about three years. We discussed our cases in light of review of the literature.

Case of cecal volvulus successfully treated with endoscopic colopexy.

We herein report a case of cecal volvulus successfully treated with endoscopic colopexy. A 73-year-old man with a high fever and abdominal fullness was diagnosed with ileus caused by cecal volvulus. CT showed a dilated cecum and small intestine without bowel strangulation as well as acute pneumonia. Because the pneumonia increased the risk associated with general anesthesia, we attempted decompression of the bowel using endoscopy to avoid surgery. On day 1, a transanal ileus tube was inserted to the terminal ileum through the dilated cecum. On day 7, the bowel torsion spontaneously released. On day 8, we performed percutaneous endoscopic colopexy to fix the cecum on the abdominal wall and prevent re-twisting. The patient was discharged on day 15 without postoperative complications. Percutaneous endoscopic colopexy for cecal volvulus may be a treatment option when the risk associated with general anesthesia or surgery is high because of a comorbidity.

[Local ablation therapy combined with liver resection for multiple hepatocellular carcinomas].

In patients with multiple hepatocellular carcinomas (HCCs), a liver resection for the main tumor may be performed in combination with local ablation therapy for satellite lesions. Of 63 multiple HCC patients without radiological vascular invasions, 27 were treated with liver resection alone and the other 36 treated with the combination of liver resection and local ablation therapy. No significant differences were found in both groups with regard to age, gender, BMI, etiology of hepatitis, liver damage grade, tumor number, size of the main tumor and size of satellite lesion. In the liver resection group, 11 hemihepatectomies, 12 sectionectomies and 4 partial hepatectomies were performed. In the combination therapy group, 8 hemihepatecomies, 17 sectionectomies and 11 partial hepatectomies were performed. No significant differences were found in both groups with respect to bleeding, transfusion, disease-free survival rate, and survival rate. In the combination therapy group, a resected liver volume was significantly lower (p = 0.003) and an operation time was shorter (p = 0.009). It appears to indicate that the combination of liver resection and local ablation therapy can be useful for multiple HCCs.

[A clinical study of hepatic arterial infusion chemotherapy with low-dose CDDP and 5-FU for liver metastases].

We followed patients who underwent hepatic arterial infusion chemotherapy with low-dose CDDP+5-FU for liver metastases from colorectal cancer in the outpatient setting. A catheter was inserted from the femoral artery into the proper hepatic artery using the interventional technique. Two complete response (CR) and seven partial response (PR) were achieved, but later 2 of these patients had lung metastases. We conclude that this therapy may be effective, but control of extrahepatic lesions is necessary for life prolongation.

[Effective TS-1+paclitaxel administration for gastric cancer with malignant ascites--a case report].

We report a case in which TS-1 + paclitaxel (PTX) administration was effective for gastric cancer with malignant ascites. The patient was a 66-year-old male who received total gastrectomy, distal pancreatectomy and splenectomy. He complained of abdominal fullness and ascites 18 months later. The administered regimen of chemotherapy was TS-1 100 mg/day for two weeks, and PTX 120 mg/day on day 1 and 8 of TS-1 intake, followed by 1-week rest. Computed tomography (CT) showed complete loss of malignant ascites. The toxic events were grade 2 leukopenia and grade 2 alopecia.

Laparoscopic excision of an adult retroperitoneal cystic lymphangioma coexisting with an esophageal hiatus hernia.

Lymphangiomas are rare cystic tumors that may be present in the retroperitoneum. Retroperitoneal lymphangiomas account for approximately 1% of all lymphangiomas. We experienced an adult patient with a retroperitoneal cystic lymphangioma coexisting with an esophageal hiatus hernia. Abdominal ultrasonography showed a cyst in the abdomen of a 76-year-old woman. She was admitted to our clinic because of an enlargement of the cyst and epigastric pain after meals. She had a long history of heartburn after meals and had not undergone any treatment. She had no record of previous illnesses. Computed tomography revealed a single bunch cystic tumor with septations, located from the mediastinum to the retroperitoneal space. The tumor was not enhanced, and there was no solid part. She was diagnosed with a retroperitoneal cyst. Laparoscopic total excision was performed because the cyst was increasing in size and the patient had symptoms. The cyst was successfully removed. Although laparoscopic excision of retroperitoneal cystic lymphangiomas is the treatment of choice, surgical methods should be carefully chosen in selected patients.

Neuroendocrine tumor of the rectum.

The authors report a case of a neuroendocrine tumor of the rectum. A 57-year-old man was revealed to have a large tumor of the rectum with invasion to the urinary bladder and seminal capsule. After resection, the tumor was revealed to be composed of neuroendocrine cells. Adjuvant chemotherapy using cisplatin and camptothecin-11 was completed, and the patient was without recurrence 6 months after surgery.

"Tornado Roux-en-Y" anastomosis in laparoscopy-assisted distal gastrectomy.

The use of laparoscopy-assisted distal gastrectomy has been gradually spreading and it has become one of the standard treatment options for early gastric cancer in Japan. But anastomotic problems are still frequent with this procedure, because of its technical difficulty. We have developed a simple, safe, and speedy Roux-en-Y anastomosis for use in laparoscopy-assisted distal gastrectomy. Here, we describe our technique and the short-term results.