A case of laparoscopic sigmoidectomy using thermography for colonic blood flow assessment.

BACKGROUND: Indocyanine green (ICG) fluorescence imaging is widely used in gastrointestinal surgery and is considered useful for reducing anastomotic leakage; however, because ICG remains in the tissue for a certain amount of time, we occasionally must re-evaluate colonic blood flow over a short time period during surgery. Herein, we verify the usefulness of thermography (TG) for evaluating colonic blood flow in a patient who underwent a laparoscopic sigmoidectomy for sigmoid colon cancer. CASE PRESENTATION: The patient is 43-year-old man who underwent laparoscopic resection of the sigmoid colon for colon cancer. After vascular treatment of the colonic mesentery, ICG/TG identified the boundary between ischemic and non-ischemic colon tissues. An additional 2 cm of colonic mesentery was resected because of the presence of a diverticulum noted at the intended site of oral anastomosis when attaching the anvil head. After additional vascular treatment of the colonic mesentery and administration of ICG, fluorescence was observed in the colon; however, TG identified the zone of the temperature transition on the surface of the colonic mesentery, even after additional colonic mesentery resection in the same region as previously observed. This zone was used as the cut-off line. There were no complications, such as anastomotic leakage, after the surgery. CONCLUSION: Although accumulation of similar cases is necessary, TG has the potential for use as an auxiliary diagnostic tool in clinical practice. TG can depict the presence or absence of blood flow based on surface temperature without the use of imaging agents, and is inexpensive and easy to perform.

Incomplete lymphatic sealing around the inferior mesenteric artery is a risk factor for chylous ascites in robotic rectal cancer surgery.

INTRODUCTION: Compared with laparoscopic surgery (LS), robotic surgery (RS) is considered to have acceptable outcomes in rectal cancer, but few reports have focused on chylous ascites in RS. The aim of this study was to investigate the incidence and etiology of chylous ascites after RS. METHODS: This retrospective study included 291 patients with rectal cancer who underwent RS (n = 165) or LS (n = 126) with high ligation of the inferior mesenteric artery (IMA). Propensity score matching (PSM) was performed to compare the two groups. RESULTS: \Dissection around the IMA was achieved using ultrasonic coagulating shears in most LS cases, and monopolar scissors in most RS cases, sometimes using bipolar vessel sealing device or bipolar forceps. The incidence of chylous ascites was 12.2% in RS and 4.1% in LS after PSM (P = .037). When limited to the RS group, multivariate analysis identified absence of lymphatic sealing at the left side of the IMA and shorter operative time as independent risk factors for chylous ascites. Except for duration of drain placement, no outcomes differed significantly with or without chylous ascites. One patient with chylous ascites developed later infection and required antibiotic treatment. CONCLUSION: The incidence of chylous ascites is significantly higher in RS than in LS, and RS with incomplete lymphatic sealing around the IMA is a risk factor for chylous ascites in rectal cancer. Although outcomes for patients with chylous ascites were acceptable, adequate lymphatic sealing during dissection around the IMA is crucial to prevent chylous ascites in RS.

Idiopathic Omental Bleeding Treated by Laparoscopic Partial Omentectomy: A Case Report and Review of the Literature.

Omental bleeding is potentially life-threatening. There are many causes of omental bleeding including trauma, neoplasia, arterial aneurysm rupture, omental torsion, vasculitis, or segmental arterial mediolysis (SAM). Without remarkable pathological features, the diagnosis of idiopathic omental bleeding is made. Omental bleeding is relatively a rare disease, and there is no established treatment strategy.  A 53-year-old woman was brought to the ED for sudden onset abdominal pain. CT revealed hematoma in the omentum and was diagnosed as idiopathic omental bleeding accordingly. The patient underwent laparoscopic partial omentectomy and was discharged nine days after surgery. The pathological findings of the resected omentum were not remarkable, and the final diagnosis was made as idiopathic omental bleeding. In some case reports of omental bleeding, interventional radiology (IVR) was chosen for hemostasis, but IVR cannot resect tissue of omentum so it is difficult to make a pathological diagnosis. The surgical approach of idiopathic omental bleeding is uncommon. However, the use of the laparoscopic approach hasn't been reported in the literature. Laparoscopic partial omentectomy can provide effective hemostasis. We report laparoscopic partial omentectomy surgical procedure and review of the literature.

[A Postoperative Case of Rectal Cancer with Anal Pain Caused by Side Effects of Oxaliplatin].

This case involved a 28-year-old female with rectal cancer in the inner pelvis. Two courses of SOX plus Cmab therapy, and 4 courses of FOLFOX-Cmab therapy were administered as preoperative chemotherapies, which resulted in a reduction in the major lesion. Subsequently, laparoscopic low anterior resection and dissection of the bilateral lymph nodes were performed. After the surgery, adjuvant chemotherapy with FOLFOX was administered. Afterwards, the patient developed severe anal pain and visited us for treatment. The severe anal pain continued even after FOLFOX treatment and increased with defecation. A side effect of oxaliplatin was suspected, and sLV5FU chemotherapy was administered. As a result, the anal pain disappeared. Thus, the pain was considered to be induced by oxaliplatin. While peripheral neuropathy is a widely known side effect of oxaliplatin, this case was considered to be unique because anal pain occurs very rarely with oxaliplatin treatment.

MicroRNA-34b has an oncogenic role in esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is a common malignancy and one of the more difficult diseases to diagnose in Japan due to its poor prognosis. MicroRNAs are small non-coding RNAs of 21-23 nucleotides that regulate gene expression. MicroRNA-34b (miR-34b) has been reported to be overexpressed in various types of cancer. However, its role in ESCC has yet to be extensively studied. The present study investigated the expression of miR-34b in 88 ESCC patients. The miR-34b expression in ESCC was significantly higher than that in the corresponding normal esophageal mucosa. It was more highly expressed in tumors with more advanced stages. However, its expression did not correlate with the p53 status. Transfection of anti-miR-34b to the ESCC cells suppressed cell growth in vitro. These results suggest an oncogenic role of miR in ESCC.

Adenocarcinoma arising in a colonic interposition following a total gastrectomy: report of a case.

A segment of the transverse colon can be used for gastric reconstruction after a total gastrectomy. This report presents the case of a 68-year-old woman with primary adenocarcinoma of the colon in a segment used for reconstruction after a total gastrectomy. The interposed colon developed colon carcinoma 9 years after the gastric reconstruction. The possibility of a primary carcinoma arising in a gastric colon interposition must be considered when employing the transverse colon as a gastric substitute.

Expression profiling of micro-RNAs in human esophageal squamous cell carcinoma using RT-PCR.

To develop novel therapeutic and diagnostic methods for esophageal cancer, it is important to understand the precise biological mechanism. Micro-RNAs (miRNAs) seem to be crucial factors in diverse regulation pathways. In this study, we analyzed the expression of mature miRNAs in esophageal squamous cell carcinoma (ESCC). The expression of 73 miRNAs was quantified by qRT-PCR in 30 primary ESCC specimens. We examined the correlation between miRNA expressions and the clinicopathological factors and prognosis of ESCC. The Kaplan-Meier survival curves showed that the high expression levels of 6 of the 72 miRNAs correlated with significantly lower patient survival rates. The overexpression of miR-129 was identified as a significant and independent prognostic factor (P = 0.031) in surgically treated ESCC patients. The hazard ratio for the prediction of early death was 18.11 for high versus low expression levels of miR-129. Similar results were obtained from an analysis performed on an additional 19 patients (test cohort) (P = 0.0057, for training cohort; P = 0.011, for test cohort; log-rank test). This experiment supports the notion that the high miR-129 expression levels, as observed in this study, might play a important role in the development of esophageal cancer.

microRNA expression profile in undifferentiated gastric cancer.

Prognosis of patients with undifferentiated gastric cancer is generally poor. The expression of various microRNAs (miRNAs) has not been comprehensively investigated in undifferentiated gastric cancer. Total RNA was extracted from the specimens of 42 undifferentiated gastric cancer tissues and paired normal gastric tissue. Quantitative reverse transcriptase-polymerase chain reaction (qRT-PCR) was performed for a set of 72 miRNAs. The expression of each miRNA relative to the internal control RNA was determined using the 2-DeltaCt method. The expression levels of 3 miRNAs (mir-34b, mir-34c and mir-128a) were significantly upregulated and those of 3 miRNAs (mir-128b, mir-129 and mir-148) were downregulated in undifferentiated gastric cancer tissue when compared with those of the paired normal tissues. The probability of survival was significantly lower in patients with high expression levels of mir-20b or 150. There was a correlation between mir-27a and lymph node metastasis. Our investigation provides a list of candidate miRNAs that may be associated with the prognosis in undifferentiated gastric cancer patients. Further study is warranted to identify the target genes of these miRNAs and their function.

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

It has been suggested that microRNA-21 (miR-21) functions as an oncogene, as it is overexpressed in many types of tumors compared to adjacent normal tissues. However, the role of miR-21 has yet to be studied in esophageal squamous cell carcinoma (ESCC). miR-21 expression was quantified by real-time reverse transcription polymerase chain reaction in 38 ESCC specimens and their paired non-cancerous mucosa, and in 15 esophageal cancer cell lines (TE1-15). miR-21 expression levels in ESCC tissue were significantly higher than in the corresponding non-cancerous mucosa (6.873±12.664 vs. 1.000, p<0.0001). In patients with more advanced (T3 or T4) tumors, miR-21 expression levels were significantly higher than in those with less advanced (T1 or T2) tumors (P=0.0333). miR-21 expression levels in patients with more invasive infiltrative growth pattern (inf) ß tumors were significantly higher than in patients with less invasive infα tumors (P=0.0166). Among the cell lines studied, TE9 had the lowest and TE1 the highest expression of miR-21. Using the miRNA precursor or antisense miRNA inhibitor, we studied how the level of miR-21 influences the proliferation of ESCC cells. Cell proliferation of the anti-miR-21-transfected cell line was significantly lower, while that of the pre-miR-21-transfected cell line was significantly higher than in the control. In ESCC, miR-21 expression may be involved in tumor growth and invasion.

Targeting beta1 integrin restores sensitivity to docetaxel of esophageal squamous cell carcinoma.

Esophageal squamous cell carcinoma (ESCC) is a common and highly fatal cancer in Japan. Systemic chemotherapy is used, but some tumors show resistance to it. The mechanisms of tumor resistance to chemotherapy remain largely unknown. We determined the chemosensitivity of 15 ESCC cell lines (TE-1-5, TE-8-15, KYSE140 and KYSE150) to docetaxel by clonogenic and MTT assays. We used cDNA microarray analysis and quantitative RT-PCR to determine which genes might determine resistance to docetaxel. Small interfering RNA (siRNA) was used to suppress gene expression and its effect on the chemosensitivity of the cell was determined. The cell line with the most resistance to docetaxel was TE-2. Using microarray analysis, we identified beta1 integrin (ITGB1) to be overexpressed in this cell line. Higher expression of ITGB1 mRNA was significantly associated with docetaxel resistance (n=15, r2=0.66, P=0.0110). Suppression of ITGB1 expression using siRNA sensitized the TE-2 cells to docetaxel. These data suggest that overexpression of ITGB1 may be related to resistance to chemotherapy and that targeting ITGB1, particularly in patients on docetaxel therapy, may enhance the effect of chemotherapy in patients with ESCC.

Decreased expression of RUNX3 is correlated with tumor progression and poor prognosis in patients with esophageal squamous cell carcinoma.

Runt-related transcription factor 3 (RUNX3) has been reported to be a candidate tumor suppressor gene in gastric cancer. However, in esophageal cancer, the role of RUNX3 has not been studied. The expression of RUNX3 mRNA was quantified by real-time reverse transcription polymerase chain reaction using Taq Man PCR in 15 esophageal cancer cell lines (TE1-15) and 70 esophageal squamous cell carcinoma (ESCC) specimens and their paired normal esophageal mucosa. The data were analyzed with reference to clinicopathological factors. Using specific primers, methylation of the promoter region of RUNX3 was examined. RUNX3 mRNA expression in ESCC tissue was significantly lower than that in the corresponding normal esophageal mucosa (3.913+/-4.617 vs. 7.795+/-15.361, P=0.0345). RUNX3 mRNA expression levels in locally invasive T4 tumors were significantly lower than those in less invasive T1-3 tumors (P=0.0454). Patients who had low RUNX3 mRNA expression levels had a significantly shorter survival after surgery compared with patients who had high RUNX3 mRNA expression (P=0.0299). Among the 15 esophageal cancer cell lines studied, one had methylation of the promoter region of RUNX3. Only 4 in 70 ESCC tumors had methylation in this region. In conclusion, RUNX3 expression may be involved in the tumor invasion and poor prognosis of patients with ESCC. The methylation of the RUNX3 promoter region in esophageal cancer is rare. A study on the mechanisms that underlie the reduced expression of RUNX3 in ESCC is warranted.

Expression of ECRG4 is an independent prognostic factor for poor survival in patients with esophageal squamous cell carcinoma.

In this study, we examined the expression of esophageal cancer-related gene 4 (ECRG4) mRNA and evaluated its clinical significance in esophageal squamous cell carcinoma (ESCC). ECRG4 mRNA expression was quantified by real-time RT-PCR in 63 ESCC and corresponding normal esophageal mucosal samples. ECRG4 mRNA expression levels were significantly lower in ESCC tissues compared with corresponding normal esophageal mucosa (P<0.0001), in patients with locally invasive T2-4 tumors compared with less invasive T1 tumors (P=0.0229) and in stage 4 tumors compared with stage 0-3 tumors (P=0.0120). Furthermore, low ECRG4 mRNA expression levels were associated with significantly shorter survival after surgery compared with high ECRG4 mRNA expression levels (P=0.0150) in ESCC patients. On the basis of multivariate analysis, we conclude that ECRG4 mRNA expression level could be a candidate for an independent prognostic factor for ESCC patients.