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BACKGROUND: The prognosis for patients with colorectal cancer (CRC) is determined by tumor characteristics as well as the host immune response. This study investigated the relationship between an immunosuppressive state and patient prognosis by evaluating the systemic and tumor microenvironment (TME) interleukin (IL)-6 levels. METHODS: Preoperative serum IL-6 levels were measured using an electrochemiluminescence assay. Expression of IL-6 in tumor and stromal cells was evaluated immunohistochemically in 209 patients with resected CRC. Single-cell analysis of tumor-infiltrating immune cells was performed using mass cytometry in 10 additional cases. RESULTS: Elevated serum IL-6 levels were associated with elevated stromal IL-6 levels and a poor prognosis for patients with CRC. High IL-6 expression in stromal cells was associated with low-density subsets of CD3+ and CD4+ T cells as well as FOXP3+ cells. Mass cytometry analysis showed that IL-6+ cells among tumor-infiltrating immune cells were composed primarily of myeloid cells and rarely of lymphoid cells. In the high-IL-6-expression group, the percentages of myeloid-derived suppressor cells (MDSCs) and CD4+FOXP3highCD45RA- effector regulatory T cells (eTreg) were significantly higher than in the low-IL-6-expression group. Furthermore, the proportion of IL-10+ cells in MDSCs and that of IL-10+ or CTLA-4+ cells in eTregs correlated with IL-6 levels. CONCLUSION: Elevated serum IL-6 levels were associated with stromal IL-6 levels in CRC. High IL-6 expression in tumor-infiltrating immune cells also was associated with accumulation of immunosuppressive cells in the TME.
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Neoplasias Colorrectales , Interleucina-10 , Humanos , Neoplasias Colorrectales/metabolismo , Factores de Transcripción Forkhead/metabolismo , Interleucina-10/metabolismo , Interleucina-6 , Linfocitos Infiltrantes de Tumor , Pronóstico , Microambiente TumoralRESUMEN
This study reports a case of a 61-year-old man with a chief complaint of anemia. The patient was diagnosed with esophageal cancer(Stage â ). Preoperative examination revealed alcoholic liver cirrhosis(Child-Pugh A, liver damage B). After a period of abstinence to improve liver function, minimally invasive esophagectomy, retrosternal reconstruction with a gastric tube, and two-field lymph node dissection were performed. The thoracic duct was preserved during the operation. Post- surgery, the bill pleural effusion was increased. Drainage was initiated using thoracentesis with frosemide, spironolactone, and tolvaptan. On post-operating day(POD)35, the patient was discharged; however, right pleural effusion continued to increase. Therefore, cell-free and concentrated reinfusion therapy for right pleural effusion was performed on POD 56. After the treatment, the pleural effusion was well-controlled with 20 mg of frosemide. This case suggested that cell-free and concentrated pleural effusion reinfusion therapy contributed to the management of refractory pleural effusion in patients with esophageal cancer accompanied by cirrhosis.
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Neoplasias Esofágicas , Derrame Pleural , Drenaje , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/cirugía , Esofagectomía , Humanos , Cirrosis Hepática/complicaciones , Masculino , Persona de Mediana Edad , Derrame Pleural/etiología , Derrame Pleural/cirugíaRESUMEN
A 60-year-old man underwent thoracoscopic subtotal esophagectomy and posterior mediastinal gastric tube reconstruction after neoadjuvant chemotherapy. One year and 8 months postoperatively, recurrence was observed in the abdominal lymph nodes around the celiac artery and abdominal aorta. Chemoradiotherapy was initiated, followed by chemotherapy. Two months after the completion of chemoradiotherapy, the patient developed epigastric pain and anorexia because of the necrotic lymph node penetrating the gastric tube with cavity formation. Upper gastrointestinal endoscopy revealed a 25- mm-sized ulcer with central necrotic slough on the posterior wall of the stomach. Abdominal symptoms alleviated after conservative treatment with fasting and administration of antibiotics, and the inflammatory reaction improved. Oral nutritional supplements were started on hospitalization day 7, and abdominal symptoms or inflammatory reactions did not recur after resuming diet. The patient was discharged on hospitalization day 39 when the general condition stabilized. Subsequently, chemotherapy was restarted, and no regrowth of metastatic lesions was observed on endoscopy or CT examination 4 months later. Three years and 8 months after the recurrence, the recurrent disease has been controlled.
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Neoplasias Esofágicas , Recurrencia Local de Neoplasia , Quimioradioterapia , Neoplasias Esofágicas/cirugía , Esofagectomía , Humanos , Ganglios Linfáticos , Masculino , Persona de Mediana EdadRESUMEN
BACKGROUND: Laparoscopic abdominal surgery is considered superior to open surgery. However, efficacy and safety outcomes of laparoscopic surgery in colorectal cancer (CRC) are unclear, particularly in patients undergoing antiplatelet therapy (APT). The aim of this study was to evaluate safety of antiplatelet agents, especially aspirin, in peri-operative management of patients undergoing laparoscopic colorectal resection for CRC. METHODS: A total of 578 radical laparoscopic colorectal surgeries in CRC patients performed between January 2005 and December 2015 at the Kokura Memorial Hospital were retrospectively reviewed. Patients were divided into three groups based on the risk for thromboembolism: a high-risk group receiving APT (APT-HR), a low-risk group receiving APT (APT-LR), and a low-risk group not receiving APT (non-APT). Bleeding complications (BC) and thromboembolic complications (TC) were assessed. Perioperative and outcome variables in groups receiving APT were compared with those in the non-APT group. RESULTS: APT-HR, APT-LR, and non-APT groups included 54 (9.3%), 114 (19.7%), and 410 (70.9%) patients, respectively. Blood loss during operation (p = 0.304), operative time (p = 0.956), hospitalisation after surgery (p = 0.307), and Clavien-Dindo classification of surgery-related complications (p = 0.467) were not significantly different in the three groups. Occurrence of intra-operative BC (blood loss ≥ 200 ml) (p = 0.864), post-operative BC (p = 0.630), and TC (p = 0.287) were also not significantly different in the three groups. Results of our analysis indicated that APT and non-interrupted APT were not associated with BC or TC. CONCLUSIONS: Analysis of laparoscopic colorectal resection in CRC showed that APT was not a major factor for fatal BC or TC. In patients with high thromboembolic risk, continuing aspirin may inhibit the increase in TC without increasing BC in the peri-operative period.
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Aspirina/uso terapéutico , Pérdida de Sangre Quirúrgica/prevención & control , Neoplasias Colorrectales/cirugía , Laparoscopía/métodos , Atención Perioperativa , Complicaciones Posoperatorias/prevención & control , Hemorragia Posoperatoria/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/patología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Inhibidores de Agregación Plaquetaria/uso terapéutico , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia , Adulto JovenRESUMEN
A 65-year-old woman with cecum cancer underwent laparoscopic right colectomy.After 3 years, she was diagnosed with a local recurrence with small bowel invasion and underwent tumor resection.One year later, she had a re-recurrent lesion involving her right iliac bone.After one year of chemotherapy, a PET-CT showed no other abdominal lesions suggestive of malignancy.She underwent resection of the re-recurrent tumor involving the right iliac bone and R0 resection was achieved. She was able to ambulate postoperatively and returned home.In selected cases, extended surgery including bone resection can be an option for the local recurrence of advanced colon cancer.
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Neoplasias del Colon , Ilion , Tomografía Computarizada por Tomografía de Emisión de Positrones , Anciano , Colectomía , Neoplasias del Colon/diagnóstico por imagen , Neoplasias del Colon/patología , Neoplasias del Colon/cirugía , Femenino , Humanos , Ilion/patología , Recurrencia Local de NeoplasiaRESUMEN
When no other non-curative treatment options are available, R0 resection can be achieved with paraaortic lymphadenectomy for patients with advanced gastric cancer with No.16 lymph node metastases. Herein, we report of a patient who underwent R0 resection for gastric cancer with No.16 lymph node metastases and who achieved long-term survival.
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Aorta/patología , Neoplasias Gástricas/patología , Adulto , Aorta/cirugía , Resultado Fatal , Gastrectomía , Humanos , Escisión del Ganglio Linfático , Metástasis Linfática , Masculino , Recurrencia , Neoplasias Gástricas/cirugía , Factores de TiempoRESUMEN
The present study aimed to identify preoperative and perioperative risk factors for postoperative infectious complications in older patients with gastric cancer. The present retrospective study included 504 patients with gastric cancer aged >65 years who underwent radical gastrectomy. After determining the cutoff values for various perioperative factors in the receiver operating characteristic curve analysis, preoperative and perioperative risk factors for the development of infectious complications after gastrectomy were examined using logistic regression analysis. Of the 504 patients who underwent gastrectomy, 95 (18.8%) developed infectious complications of grade II-V based on the Clavien-Dindo classification. In an analysis restricted to preoperative factors, male sex, low prognostic nutritional index, high visceral fat area and total gastrectomy were independent risk factors for infectious complications after gastrectomy. Among all perioperative factors, a low prognostic nutritional index and long operative duration were identified as independent risk factors for infectious complications after gastrectomy. The patients were divided into five groups according to the number of positive preoperative risk factors for infectious complications, and the incidence of infectious complications differed among the five groups (0 factors, 6.7%; 1 factor, 10.4%; 2 factors, 18.9%; 3 factors, 27.8%; and 4 factors, 47.6%; P<0.001). Older patients with gastric cancer who have a number of preoperative risk factors require careful consideration of the indication for gastrectomy and a shorter operative time to reduce infectious complications.
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BACKGROUND/AIM: We evaluated the usefulness of prophylactic mini-tracheostomy (PMT) and perioperative administration of tazobactam/piperacillin (TAZ/PIPC) in high-risk patients after esophagectomy. PATIENTS AND METHODS: We retrospectively studied 89 consecutive high-risk patients who underwent esophagectomy for esophageal cancer between January 2013 and December 2021. We defined patients with two or more of the following factors as high risk: age ≥70 years, performance status ≥1, respiratory dysfunction, liver dysfunction, cardiac dysfunction, renal dysfunction, diabetes mellitus, albumin <3.5 g/dl, and Brinkman index >600. Standard management was administered to the first 50 patients (standard group). PMT and TAZ/PIPC were administered to the next 39 patients (combination group). Patient characteristics and short-term outcomes were compared before and after propensity-score matching. RESULTS: Before propensity-score matching, 24-hour urine creatinine clearance, retrosternal route, 3-field lymph node dissection, and open abdominal approach were more common, postoperative pneumonia (13% vs. 36%, p=0.045) and complications of grade ≥3b (2.6% vs. 22%, p=0.01) were less frequent, and the postoperative hospital stay was shorter (median: 23 vs. 28 days, p=0.022) in the combination group than in the standard group. In propensity-score matching, patient characteristics, except for 24-h creatinine clearance and reconstructive route, were matched for 23 paired patients. Postoperative pneumonia (8.7% vs. 39%, p=0.035) and complications of grade ≥3b (0% vs. 26%, p=0.022) were less frequent and postoperative hospital stay was shorter (median: 22 vs. 25 days, p=0.021) in the combination group than in the standard group. CONCLUSION: PMT with TAZ/PIPC can potentially prevent postoperative pneumonia in high-risk patients after esophagectomy.
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Neoplasias Esofágicas , Esofagectomía , Combinación Piperacilina y Tazobactam , Neumonía , Complicaciones Posoperatorias , Humanos , Masculino , Femenino , Anciano , Esofagectomía/efectos adversos , Esofagectomía/métodos , Neoplasias Esofágicas/cirugía , Neumonía/prevención & control , Neumonía/etiología , Neumonía/epidemiología , Combinación Piperacilina y Tazobactam/uso terapéutico , Combinación Piperacilina y Tazobactam/administración & dosificación , Persona de Mediana Edad , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/etiología , Antibacterianos/uso terapéutico , Antibacterianos/administración & dosificación , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Curative resection can be achieved in some cases of multiple liver metastases that are initially unresectable by multistage hepatectomy. We report the case of a patient who underwent 2 hepatectomy procedures for liver metastases of advanced colon cancer after conversion chemotherapy and 2-stage hepatectomy; this treatment resulted in long-term survival.
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Hepatectomía , Neoplasias Hepáticas/cirugía , Neoplasias del Colon Sigmoide/patología , Adulto , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Terapia Combinada , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Masculino , Estadificación de Neoplasias , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Neoplasias del Colon Sigmoide/cirugía , Resultado del TratamientoRESUMEN
We report a case of a patient who developed cytomegalovirus colitis during chemotherapy for esophageal cancer. A 62- year-old man was admitted to our hospital complaining of epigastralgia and dysphagia. He was diagnosed as having esophageal cancer( Mt, type 3, cT3, cN2, cM0, cStage III). Neoadjuvant chemotherapy with 5-fluorouracil( 5-FU) and cisplatin (CDDP) was initiated. However, after 1 course of chemotherapy, the patient experienced a stroke. Subsequently, he was treated with radical chemoradiotherapy. Chemoradiotherapy with low-dose docetaxel was administered. However, he developed interstitial pneumonia, and thus received pulse corticosteroid therapy with methylprednisolone. On the 26th day after steroid therapy, he developed melena. Colonoscopy revealed multiple punched-out ulcers in the transverse colon, and the patient was diagnosed as having cytomegalovirus colitis on the basis of positive cytomegalovirus antigenemia. Intravenous ganciclovir therapy was initiated. On the 13th day after ganciclovir therapy, the patient required an emergency surgery because of perforation-related peritonitis. We identified a perforation in the ascending colon and performed ileocecal resection. Although he was treated with paclitaxel, he died of esophagotracheal fistula and aspiration pneumonitis. We should be aware of cytomegalovirus colitis during chemotherapy and corticosteroid therapy.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Colitis/virología , Infecciones por Citomegalovirus/complicaciones , Neoplasias Esofágicas/tratamiento farmacológico , Antivirales/uso terapéutico , Cisplatino/administración & dosificación , Colitis/tratamiento farmacológico , Infecciones por Citomegalovirus/tratamiento farmacológico , Neoplasias Esofágicas/complicaciones , Neoplasias Esofágicas/cirugía , Resultado Fatal , Fluorouracilo/administración & dosificación , Ganciclovir/uso terapéutico , Humanos , Masculino , Persona de Mediana EdadRESUMEN
INTRODUCTION: Asymptomatic lipoma only requires observation, whereas symptomatic lipoma requires treatment such as endoscopic or surgical resection. However, in case of multiple lipomas, with evident diffusion and malignancy, resection procedure and range cannot be determined. We experienced GI lipomatosis (multiple lipomas) diffusely existing from the duodenum to the small intestine and involved recurrent intussusception. PRESENTATION OF CASE: 47 year-old female was a history of open bowel resection for intestinal obstruction caused by intussusceptions of multiple small intestinal lipoma 11 years ago. EGD showed duodenal lipoma, and CT showed diffuse multiple lipomas from the proximal jejunum to the distal ileum. Another CT also showed intussusception of small intestine, but no signs of intestinal obstruction. Surgical procedures performed included diagnostic laparoscopy. All intestinal lipomas were resected with local excision, and duodenal lipoma was resected with ESD without any bowel resection. DISCUSSION: Multiple local excision ESD for multiple GI lipomatosis have not been reported. The most problematic thing is that if extensive resection is performed to cut off all multiple lipoma, short bowel syndrome may occur. Determining the range to be cut remains unclear. CONCLUSIONS: Multiple local excision ± ESD seemed to be one of the methods in resecting multiple GI lipomatosis. In the future, cases and indications of surgery and resection method for GI lipoma should be accumulated and considered, respectively.