Preexisting Interstitial Lung Disease and Lung Injury Associated with Irinotecan in Patients with Neoplasms.

BACKGROUND/AIM: The aim of this study was to reveal risk factors for lung injury following irinotecan administration for the treatment of neoplasms. PATIENTS AND METHODS: This study included 204 patients who received irinotecan from October 2005 to November 2014 and had evaluable chest CT images before initiation of irinotecan. RESULTS: Six (2.9%) patients developed lung injury and, of these, 2 had preexisting interstitial lung disease (pre-ILD). The frequency of lung injury in patients with pre-ILD was 11% (2 of 19) while that in patients without pre-ILD was 2.2%. Risk factor analysis for the lung injury showed pre-ILD was the most predictable factor [odds ratio (OR) 5.00, p=0.07]. Combination with other agents, origin of neoplasms (lung or not), initial dose or minimum interval were not observed to be related to risk. CONCLUSION: The risk of lung injury with irinotecan was high when pre-ILD was present and the risk was comparable with previously reported other agents.

Analysis of Recurrent Cases after Laparoscopic Surgery for Colorectal Cancer.

BACKGROUND/AIMS: Although previous reports have shown similar recurrence rates and patterns between laparoscopic and open surgery for colorectal cancer, precise data regarding recurrent cases are lacking. METHODOLOGY: From January 2007 to December 2011, 137 Patients with colorectal cancer underwent laparoscopic surgery at our hospital. Of the 137 patients, 7 patients with recurrence were analyzed for oncological factors. Their outcomes were compared with those of 13 patients with recurrence of 160 patients who underwent open surgery for colorectal cancer between January 2005 and December 2006. RESULTS: In the laparoscopic group, 1 of 37 patients (2.7%) with pathological Stage II (pStage) and 6 of 37 (16.2%) with pStage III experienced recurrence; in the open surgery group, 4 of 56 patients (7.1%) with pStage II and 9 of 63 patients (14.3%) with pStage III experienced recurrence. Although majority of recurrent patterns was distant metastasis, peritoneal metastasis was observed in 2 patients with pT3 tumors in the laparoscopic group. In contrast, all 3 patients with peritoneal recurrence in the open surgery group had pT4 tumors. In the laparoscopic group, 2 patients with peritoneal metastasis were pT3N1M0, and 1 of them revealed peritoneal carcinomatosis 6 months after surgery and developed chylous ascites as a postoperative complication. CONCLUSIONS: Although the recurrence rates and sites were similar between the laparoscopic and open surgery groups, peritoneal recurrence developed only in patients with pT3 tumors in the laparoscopic group. Exfoliation of tumor cells from divided lymphatic vessels might lead to development of peritoneal recurrence after laparoscopic surgery.

Chylous ascites as a complication of laparoscopic colorectal surgery.

INTRODUCTION: Until now, no data have been available on the incidence of chylous ascites after laparoscopic colorectal surgery. METHODS: From January 2007 to December 2011, 137 patients with colorectal cancer underwent laparoscopic surgery at our institution. The clinical data of the patients with postoperative chylous ascites were compared with those of the patients without chylous ascites. RESULTS: Chylous ascites developed in 9 of the 137 patients (6.5%). Blood loss, operative time, tumor location, and extent of lymph node dissection were not associated with postoperative chylous ascites. Mean postoperative hospital stay for patients with chylous ascites was significantly longer than that for patients without any complications (14 days vs 10 days; P < 0.001). Recurrence was observed in two of the nine patients with chylous ascites; it developed locally and in the liver in one patient, and peritoneal dissemination was seen in the other. The recurrence rate in the chylous ascites group (22.2%) was significantly higher than that in the non-chylous ascites group (3.9%; P = 0.016). The 3-year disease-free survival in the chylous ascites group (76.2%) was significantly lower than that in the non-chylous ascites group (93.4%; P = 0.020); however, the 3-year overall survival rates did not differ between the groups (87.5% vs 94.4%, respectively; P = 0.332). CONCLUSION: Chylous ascites are not a rare complication of laparoscopic colorectal surgery. It was managed conservatively in all cases but was associated with longer hospital stays. We recommend careful tissue dissection at a suitable plane and meticulous clipping during lymphadenectomy to prevent chyle leakage when lymphatic invasion is suspected.

[Successful ventilator weaning by trastuzumab in a HER2-positive breast cancer patient with multiple lung metastases].

We report a case of breast cancer with severe respiratory dysfunction due to multiple lung metastases, which was recovered by treatment with weekly trastuzumab administration. A 47-year-old woman with breast cancer had received a folk remedy from a general practitioner for 4 years. However, she was delivered to a hospital because of severe dyspnea, and intubation was found to be needed and performed. She was diagnosed with left breast cancer with skin and pleural wall invasion, and multiple lung metastases. Pathological examination showed invasive ductal carcinoma which was ER-postive, PgR-negative, and HER2-postive. After transfer to our hospital, treatment with trastuzumab(4mg/kg/weekly for the first course, and 2 mg/kg/weekly thereafter)was administered. Respiratory function improved gradually, and ventilator weaning was successful at 53 days after trastuzumab administration. CT examination also showed a remarkable reduction of lung and lymph node metastases and pleural effusion. She was discharged from our hospital 80 days after treatment, and her treatment with trastuzumab and capecitabine has been ongoing at an outpatient clinic.

Clinical outcomes of laparoscopic surgery for transverse and descending colon cancers in a community setting.

INTRODUCTION: The feasibility, safety and oncological outcomes of laparoscopic surgery for transverse and descending colon cancers in a community hospital setting were evaluated. METHODS: Twenty-six patients with transverse or descending colon cancers who underwent laparoscopic surgery at our hospital were included in this retrospective analysis (group A). Their outcomes were compared with those of 71 patients who underwent laparoscopic surgery for colon cancer at other tumor sites (group B). RESULTS: There were no significant differences between the two groups in terms of operative time, estimated blood loss, postoperative hospital stay and morbidity rate. Extended lymphadenectomy was performed more frequently and the number of harvested lymph nodes was significantly higher in group B than in group A. However, no recurrence developed in group A, while recurrence occurred in four patients from group B. The 3-year disease-free survival rates were 100% for group A and 93.5% for group B. The 3-year overall survival rates were 100% for group A and 91.6% for group B. CONCLUSIONS: Laparoscopic surgery for transverse and descending colon cancers can be performed safely with oncological validity in a community hospital setting, provided there is careful selection of the patients and adequate lymphadenectomy considering the clinical stage of their disease.

Impact of adjuvant radiation therapy for microscopic residual tumor after resection of extrahepatic bile duct cancer.

OBJECTIVES: The effect of adjuvant radiation therapy (RT) in extrahepatic bile duct (EHBD) cancer patients with microscopic-positive resection margins (R1 resection) is still controversial. METHODS: Between January 2000 and March 2010, 52 patients with EHBD cancer underwent surgery at our institution, of whom 36 were subjected to a retrospective analysis. Eleven patients received adjuvant RT after resection [surgery (S)+RT group], which included 9 patients with R1 resection and 2 with para-aortic lymph node metastasis. Their oncological outcomes were analyzed and compared with those of the 25 patients with R0 resection who did not receive adjuvant RT (S group). RESULTS: Patients in the S+RT group had significantly more advanced disease than those in the S group. However, there was no significant difference in disease-free survival or overall survival between the 2 groups. Median survival times for the S+RT and the S groups were 44 and 47 months, respectively, whereas the 5-year survival rates were 38.9% and 46%, respectively (P=0.707). Locoregional recurrence was less frequent in the S+RT group as compared with the S group, but the incidence of distant metastasis was unaffected by the adjuvant RT. CONCLUSIONS: Our results support the beneficial effect of adjuvant RT in EHBD cancer patients with R1 resection. This effect seems to result from an improved control of the locoregional tumor by adjuvant RT.

Longitudinal follow-up study using the distress and impact thermometer in an outpatient chemotherapy setting.

CONTEXT: Although the combined use of the Impact Thermometer (IT) with the Distress Thermometer (DT), DIT, is reported to be a validated screening tool for clinically significant psychological distress in cancer patients, its longitudinal changes in the outpatient chemotherapy setting have not been examined. OBJECTIVES: The objective was to clarify the longitudinal changes in distress evaluated by the DIT and effects of coexisting physical symptoms in an outpatient chemotherapy setting. METHODS: A total of 297 patients who underwent chemotherapy for any malignancy on an outpatient basis were included. All the participants completed a questionnaire that included the DIT and intensities of seven physical symptoms (pain, somnolence, fatigue, dyspnea, appetite loss, abdominal distention, and nausea) at the initial and follow-up visit. RESULTS: Although 109 patients had moderate or severe distress (the DT ≥4 and IT ≥3) at the initial visit, 46.8% of these patients improved their distress (DIT score below the cutoff of moderate distress) at their follow-up visit. Also, 85 patients had severe distress (DT ≥5 and IT ≥4) at the initial visit, and 43.5% of these patients improved their distress (DIT score below the cutoff of severe distress) at their follow-up visit. In a subgroup of patients who had no severe physical symptoms at the initial visit, 69.0% and 68.4% of the patients with moderate or severe distress and severe distress at the initial visit, respectively, improved their distress (DIT scores below the cutoff of moderate and severe distress) at the follow-up visit. CONCLUSION: The distress evaluated by DIT can change on sequential measurements within short time intervals. Further study is needed to determine the appropriate use of the DIT for the screening and monitoring of psychological distress in an outpatient chemotherapy setting.

Oncological outcome of laparoscopic surgery for advanced colon cancer: a community hospital's experience.

BACKGROUND/AIMS: Similar oncological outcomes of laparoscopic and open surgery for advanced colon cancer have been reported by several large-scale studies. Whether those results are applicable to community hospitals is questionable. METHODOLOGY: From January 2007 to December 2010, 95 patients with colon cancer underwent laparoscopic surgery at Seirei Mikatahara General Hospital. Of these, 40 patients with pathological stage II/III colon cancer were subjected to this retrospective analysis (laparoscopic resection (LAP) group). Their outcomes were compared with those of 58 patients with pathological stage II/III colon cancer who underwent open surgery between January 2005 and December 2006 (open resection (OP) group). RESULTS: Surgical complications were significantly less frequent in the LAP group than in the OP group. Three-year disease-free survival (DFS) and overall survival (OS) for stage II colon cancer were 88.9% and 100% in the LAP group, and 90% and 86.7% in the OP group (p=0.976 and p=0.285), respectively. Three-year DFS and OS for stage III colon cancer were 85.4% and 86.9% in the LAP group, and 75.3% and 83.8% in the OP group (p=0.613 and p=0.837), respectively. CONCLUSIONS: Laparoscopic surgery for advanced colon cancer seems feasible and the oncological outcome is adequate in a community hospital setting.

Relationship between immunohistochemical evaluation of thymidylate synthase and proliferating cell nuclear antigen labeling index in gastrointestinal carcinoma.

We undertook this study to clarify the effect of immunohistochemical expression of thymidylate synthase (TS) on proliferative activity of carcinoma lesions in patients with gastrointestinal carcinoma. TS was immunohistochemically evaluated in 53 gastric carcinoma and 51 colorectal carcinoma patients using anti-TS polyclonal antibody. Proliferative activity represented by proliferating cell nuclear antigen (PCNA) labeling index (LI) was also immunohistochemically estimated using monoclonal antibody PC10. Then, the correlation between TS expression and PCNA LI was investigated. Both in gastric and colorectal carcinoma, the PCNA LIs of the high-TS group were significantly higher than those of the low-TS group. In gastric carcinoma, the PCNA LIs of the high-TS group were higher than those of the low-TS group in differentiated adenocarcinoma, in the depth of mucosal and/or submucosal layer, in cases without lymph node metastasis, and notwithstanding lymphatic or venous invasion. In colorectal carcinoma, PCNA LIs of the high-TS group were higher than those of the low-TS group in well differentiated adenocarcinoma, in the depth of serosa, in cases with lymph node metastasis, in cases with lymphatic invasion, and notwithstanding venous invasion. Immunohistochemical expression of TS was correlated with the proliferative activity represented by PCNA LI, but was not identical with PCNA LI.

Lymphagenesis correlates with expression of vascular endothelial growth factor-C in colorectal cancer.

Lymphagenesis in gastrointestinal tumors is not well described. To clarify its presence and regulation, we assessed the microlymphatic count (MLC) in colorectal cancer patients. Lymphatic vessels were evaluated by enzyme-histochemistry for 5'-nucleotidase (5'-NA). Since vascular endothelial growth factor (VEGF)-C is reportedly associated with lymphagenesis, the expression of VEGF-C protein was immunohistochemically assessed by the catalyzed signal amplification (CSA) method. MLC of peritumoral lesions was significantly higher than that of non-cancer and intratumoral lesions (p<0.01); it increased where VEGF-C was highly expressed (p<0.01) and increased with the depth of invasion in peritumoral lesions. These results indicate significant findings at peritumoral lesion: that lymphagenesis may be elicited by tumor spread; that VEGF-C expression is associated with lymphagenesis and is a potent factor stimulating lymphagenesis.