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BACKGROUND: Thoracic esophageal cancer surgery using robotic approaches for the thoracic and abdominal parts has recently been reported as total robot-assisted minimally invasive esophagectomy (RAMIE). We herein present the first report of a new technique for esophageal cancer: total RAMIE with three-field lymph node dissection (3FLND) by a simultaneous two-team approach using a new docking method. METHODS: We reviewed 20 patients who underwent total RAMIE with 3FLND by a simultaneous two-team approach at the National Cancer Center East Hospital from March 2023 to September 2023. Short-term surgical outcomes and the safety and efficacy of this technique were analyzed. RESULTS: The mean operative time for abdominal surgery with this new docking technique was 135 ± 19.6 min. The total operative time was 488 ± 42.9 min, and the time from the end of abdominal manipulation to the end of surgery was 80.1 ± 15.6 min. The intraoperative blood loss was 116.7 ± 64.4 mL. The incidence of anastomotic leakage, postoperative vocal cord paralysis, and postoperative pneumonia was 10%, 5%, and 10%, respectively. The median postoperative hospital stay was 14 days (range 11-63 days). No in-hospital deaths occurred, and R0 resection was possible in all cases. The average number of lymph nodes dissected was 87.7. CONCLUSION: These results demonstrate that total RAMIE with a simultaneous two-team approach using the new docking method can be safely introduced. The simultaneous cervical and abdominal manipulation with the new docking method allowed total RAMIE without prolonging the operating time, suggesting that it may be a valuable approach for esophageal cancer surgery.
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Neoplasias Esofágicas , Esofagectomía , Escisión del Ganglio Linfático , Tempo Operativo , Procedimientos Quirúrgicos Robotizados , Humanos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/patología , Escisión del Ganglio Linfático/métodos , Esofagectomía/métodos , Masculino , Femenino , Persona de Mediana Edad , Anciano , Procedimientos Quirúrgicos Robotizados/métodos , Estudios Retrospectivos , Tiempo de Internación/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricosRESUMEN
BACKGROUND: Thoracic esophageal cancer resection through the neck approach has recently been reported as mediastinoscopic surgery. We present the first report of a new minimally invasive technique for thoracic esophageal cancer: robot-assisted transcervical esophagectomy with a bilateral cervical approach. METHODS: Ten cases of robot-assisted bilateral transcervical esophagectomy performed at the National Cancer Center Hospital East, Japan, from February 2023 to August 2023 were reviewed. The short-term surgical outcomes were presented, and the feasibility and efficacy of this procedure were discussed. RESULTS: The mean operation time for the cervical procedure was 184.2 ± 23.6 min. The total time for the whole procedure was 472.7 ± 28.4 min, and total intraoperative blood loss was 162.2 ± 40.0 ml. Among the 10 cases, one patient developed recurrent nerve paralysis, one patient developed pulmonary complications, and no patients developed postoperative pneumonia. The median postoperative hospital stay was 22 (range: 12-43) days. No patients developed severe postoperative surgical complications, which were graded as Clavien-Dindo ≥ III. The total number of surgically harvested mediastinal lymph nodes was 37.2 ± 11.2. CONCLUSIONS: Robot-assisted bilateral transcervical esophagectomy, a novel procedure for thoracic esophageal cancer, was safe and feasible. Using this procedure, the incidence of recurrent nerve palsy, which is a problem with transcervical esophagectomy and mediastinoscopic esophagectomy, is expected to decrease.
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Neoplasias Esofágicas , Robótica , Humanos , Escisión del Ganglio Linfático/métodos , Esofagectomía/métodos , Mediastinoscopía/efectos adversos , Mediastinoscopía/métodos , Neoplasias Esofágicas/cirugía , Neoplasias Esofágicas/complicaciones , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Posterior thoracic para-aortic lymph node (TPAN) metastasis is a distant metastasis of esophageal cancer. Several case reports have shown that radical esophagectomy and lymphadenectomy for posterior TPAN improve the prognosis of patients with cStage IVB esophageal cancer and solitary posterior TPAN metastasis; however, the true value of this procedure is unclear. The primary objective of this study was to evaluate the short- and long-term outcomes of lymphadenectomy for posterior TPAN after induction chemotherapy in esophageal cancer. This study enrolled 15 patients who underwent radical esophagectomy for cStage IVB esophageal cancer with solitary posterior TPAN metastasis after induction chemotherapy between January 2013 and October 2022 at our hospital. The short- and long-term of radical esophagectomy and lymphadenectomy for posterior TPAN were retrospectively evaluated. All patients who underwent radical esophagectomy and lymphadenectomy for posterior TPAN achieved a pR0 in this study. The median operative time and intraoperative blood loss were 385 minutes and 164 ml, respectively. Four patients (26.7%) had postoperative complications of Clavien-Dindo grade II or more. The median postoperative hospital stay was 15 days. The 5-year overall survival and recurrence-free survival rates were 55.6% (95% confidence interval: 23.1-79.0) and 55.0% (95% confidence interval: 25.3-77.2), respectively. We showed that lymphadenectomy for posterior TPAN metastasis was associated with an improved prognosis of some patients with advanced esophageal cancer. This technique may serve as a viable treatment option for patients who respond well to induction chemotherapy.
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PURPOSE: Abdominal para-aortic lymph nodes (PANs) are sites of distant metastasis in esophageal squamous cell cancer (ESCC). The prognosis of patients with Stage IVB ESCC and abdominal PAN metastasis is extremely poor. However, chemotherapy for ESCC has recently been developed, and the effectiveness of combined induction therapy and conversion surgery remains unclear. The primary objective of this study was to evaluate the short- and long-term outcomes of conversion surgery for ESCC and solitary abdominal PAN metastases after induction therapy. METHODS: Thirteen patients who underwent conversion esophagectomy for cStage IVB ESCC with solitary abdominal PAN metastasis after induction therapy between January 2017 and October 2022 at our institution were enrolled. The short- and long-term outcomes of conversion surgery were retrospectively evaluated. RESULTS: Three patients (23.1%) had pathological abdominal PAN metastasis, and six patients (46.2%) without pathological abdominal PAN metastasis showed that chemotherapy eliminated the tumors in the abdominal PAN. Three patients (23.1%) had postoperative complications of Clavien-Dindo grade II or higher. The 3-year overall and recurrence-free survival rates were 83.1% and 51.3%, respectively. CONCLUSIONS: Our findings showed that conversion surgery for ESCC and solitary abdominal PAN metastasis led to a good prognosis when induction therapy was successful.
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BACKGROUND: In thoracic esophagectomy, anastomotic leakage is one of the most important surgical complications. Indocyanine green (ICG) is the most widely used method to assess tissue blood flow; however, this technique has been pointed out to have disadvantages such as difficulty in evaluating the degree of congestion, lack of objectivity in evaluating the degree of staining, and bias easily caused by ICG injection, camera distance, and other factors. Evaluating tissue oxygen saturation (StO2) overcomes these disadvantages and can be performed easily and repeatedly. It is also possible to measure objective values including the degree of congestion. We evaluate novel imaging technology to assess tissue oxygen saturation (StO2) in the gastric conduit during thoracic esophagectomy. METHODS: Fifty patients were enrolled, with seven excluded due to intraoperative findings, leaving 43 for analysis. These patients underwent thoracic esophagectomy for esophageal cancer. The device was used intraoperatively to evaluate tissue oxygen saturation (StO2) and total hemoglobin index (T-HbI), which guided the optimal site for gastric tube anastomosis. The efficacies of StO2 and T-HbI in relation to short-term outcomes were analyzed. RESULTS: StO2, indicating blood supply to the gastric tube, remained stable beyond the right gastroepiploic artery (RGEA) end but significantly decreased distally to the demarcation line (p < 0.05). T-HbI, indicative of congestion, significantly decreased past the RGEA (p < 0.05). Three patients experienced anastomotic leakage. These patients exhibited significantly lower StO2 (p < 0.01) and higher T-HbI (p < 0.01) at both the RGEA end and the demarcation line. Furthermore, the anastomotic site, usually within 3 cm of the RGEA's anorectal side, also showed significantly lower StO2 (p < 0.01) and higher T-HbI (p < 0.01) in patients with anastomotic leakage. CONCLUSIONS: The novel device provides real-time, objective evaluations of blood flow and congestion in the gastric tube. It proves useful for safer reconstruction during thoracic esophagectomy, particularly by identifying optimal anastomosis sites and predicting potential anastomotic leakage.
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Fuga Anastomótica , Esofagectomía , Humanos , Fuga Anastomótica/diagnóstico , Fuga Anastomótica/etiología , Saturación de Oxígeno , Prótesis e Implantes , Estómago/cirugía , Verde de IndocianinaRESUMEN
Although minimally invasive procedures such as thoracoscopic surgery and robot-assisted surgery have become increasingly popular in esophageal cancer in recent years, perioperative management remains a very important topic. However, perioperative management is still an extremely important issue, as esophagectomy is still a highly invasive procedure. Especially in recent years, as the patient population ages, it is expected that we will have more and more opportunities to deal with patients with various pre-existing medical conditions in addition to the original decline in physical function. In this article, we discuss the management of infectious complications in the perioperative management of esophageal surgery, with a particular focus on esophagectomy and reconstruction.
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Neoplasias Esofágicas , Procedimientos Quirúrgicos Robotizados , Humanos , Esofagectomía/efectos adversos , Esofagectomía/métodos , Resultado del Tratamiento , Complicaciones Posoperatorias/etiología , Procedimientos Quirúrgicos Robotizados/efectos adversos , Neoplasias Esofágicas/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Estudios RetrospectivosRESUMEN
BACKGROUND: Photodynamic therapy (PDT) is a minimally invasive salvage treatment for local residual or recurrent lesions that persist after the definitive chemoradiotherapy (dCRT) of esophageal cancer. However, esophageal cancer persistence after PDT is associated with a poor prognosis. Although esophagectomy is a curative treatment option, few studies have evaluated its efficacy. Thus, this study aimed to evaluate the outcomes of salvage esophagectomy after PDT. METHODS: 14 patients who underwent salvage esophagectomy for residual or recurrent esophageal cancer after PDT between April 2006 and November 2022 at our institution, were enrolled. The short-term (e.g., blood loss, operative time, R0 rate, postoperative complications, and postoperative hospital stay) and long-term (e.g., overall survival [OS] and recurrence-free survival [RFS]) of salvage esophagectomy after PDT were evaluated retrospectively. RESULTS: The median operative time and intraoperative blood loss were 355 min and 350 ml, respectively. Eight patients (57.1%) had postoperative complications of Clavien-Dindo grade II or more. The median postoperative hospital stay was 20.5 days. The 3-year OS and RFS rates were 23.5% (95% confidence interval [CI] 5.7-48.0) and 16.3% (95% CI 2.7-40.3), respectively. Seven patients with an R0 had significantly longer OS than the seven patients with R1 and 2 (p = 0.045). The 3-year OS rate for patients with R0 was 52.6%. CONCLUSIONS: Although salvage esophagectomy after PDT carries certain risks, patients who achieved an R0 had a promising long-term prognosis. The location and size of the lesion may be critical factors in determining whether R0 can be achieved with salvage esophagectomy after PDT.
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Carcinoma de Células Escamosas , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Fotoquimioterapia , Humanos , Carcinoma de Células Escamosas de Esófago/cirugía , Neoplasias Esofágicas/tratamiento farmacológico , Neoplasias Esofágicas/cirugía , Carcinoma de Células Escamosas/patología , Esofagectomía/efectos adversos , Estudios Retrospectivos , Estudios de Factibilidad , Recurrencia Local de Neoplasia/cirugía , Quimioradioterapia , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugíaRESUMEN
BACKGROUND: Treatment for regional lymph node recurrence after initial treatment for esophageal squamous cell carcinoma (ESCC) differs among institutions. Though some retrospective cohort studies have shown that lymphadenectomy for cervical lymph node recurrence is safe and leads to long-term survival, the efficacy remains unclear. In this study, we investigated the long-term outcomes of patients who underwent lymphadenectomy for regional recurrence after treatment for ESCC. PATIENTS AND METHODS: We retrieved 20 cases in which lymphadenectomy was performed for lymph node recurrence after initial treatment for ESCC in our hospital from January 2003 to December 2016. Initial treatments included esophagectomy, endoscopic resection (ER) and chemoradiotherapy/chemotherapy (CRT/CT). Overall survival (OS) and recurrence-free survival (RFS) after lymphadenectomy were calculated by the Kaplan-Meier method. We also used a univariate analysis with a Cox proportional hazards model to determine factors influencing the long-term outcomes. RESULTS: The five-year OS and RFS of patients who underwent secondary lymphadenectomy for recurrence after initial treatment were 50.0% and 26.7%, respectively. The five-year overall survival rates of patients who received esophagectomy, ER and CRT/CT as initial treatments, were 40.0%, 75.0% and 50.0%, respectively. The five-year OS rates of patients with Stage I and Stage II-IVB at initial treatments were 83.3% and 33.3%, respectively. CONCLUSIONS: Lymphadenectomy for regional recurrence after initial treatment for ESCC is effective to some degree. Patients with regional recurrence after initial treatment for Stage I ESCC have a good prognosis; thus, lymphadenectomy should be considered for these cases.
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Carcinoma de Células Escamosas , Neoplasias Esofágicas , Carcinoma de Células Escamosas de Esófago , Carcinoma de Células Escamosas/cirugía , Neoplasias Esofágicas/cirugía , Carcinoma de Células Escamosas de Esófago/cirugía , Esofagectomía/efectos adversos , Humanos , Escisión del Ganglio Linfático/métodos , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Recurrencia Local de Neoplasia/epidemiología , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
An 81-year-old woman lost consciousness and was taken to our hospital 3 days after colonoscopy was performed as a follow-up of endoscopic mucosal resection done 1 year ago for early sigmoid colon cancer detection. She had left hypochondrial pain. Based on abdominal contrast-enhanced computed tomography (CT) findings, she was diagnosed with abdominal bleeding due to injury to the lower splenic pole, and an urgent splenectomy was performed. In this case, there was no abdominal trauma to cause splenic injury. Injury to the lower splenic pole during colonoscopy was considered due to the adhesion found in the abdominal cavity. It is possible that the hemorrhage did not stop because she was taking antiplatelet drugs.
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Rotura del Bazo , Dolor Abdominal/etiología , Anciano de 80 o más Años , Colonoscopía/efectos adversos , Colonoscopía/métodos , Femenino , Hemorragia/etiología , Humanos , Esplenectomía/efectos adversos , Rotura del Bazo/diagnóstico , Rotura del Bazo/etiología , Rotura del Bazo/cirugíaRESUMEN
BACKGROUND AND STUDY AIMS: Although colonic diverticular hemorrhage is a common cause of lower gastrointestinal bleeding, the low rate of detection of the diverticula responsible for bleeding, together with inadequate evaluation of endoscopic hemostasis, remain unsatisfactory. PATIENTS AND METHODS: Over 3 years, we employed the hood method to diagnose diverticular hemorrhage in 53 patients and applied endoscopic band ligation (EBL) for hemostasis in 27 patients with responsible diverticula. RESULTS: The hood method revealed active bleeding in 13 patients (24.5%), nonbleeding visible vessels in 14 patients (26.4%), and presumptive diverticular hemorrhage in 26 patients (49.1%). The nonbleeding visible vessels were located in the diverticular dome in 13 patients and at the diverticular orifice in one patient. EBL was performed in 27 patients, and a hemostasis rate of 96.3% was achieved. In 9 of 12 patients treated with EBL, follow-up colonoscopy revealed resolution of the responsible diverticula. CONCLUSIONS: The hood method improves the detection rate of diverticula responsible for bleeding by revealing potential nonbleeding visible vessels in the diverticular dome. EBL may become an effective procedure for hemostasis of colonic diverticular hemorrhage.
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Colonoscopía/métodos , Divertículo del Colon/diagnóstico , Hemorragia Gastrointestinal/terapia , Hemostasis Endoscópica , Divertículo del Colon/complicaciones , Hemorragia Gastrointestinal/etiología , Humanos , LigaduraRESUMEN
Problem drinking affects not only the health of a population but also the productivity of a nation, especially if it is rampant among the working population. This study examines the association between problem drinking and work characteristics, work-family status, and social situations among the Japanese working population. Multivariable logistic regression analysis was performed on the basis of gender on 3136 participants (men: 65.1%, women: 34.9%) adopted from the Japanese Civil Servants Study in 2014 (response rate: 87.8%), to examine the factors related to problem drinking, after adjusting for frequency and quantity of drinking. Problem drinking was assessed using the Cutdown, Annoyed, Guilty, and Eye-opener (CAGE) questionnaire. The presence of problem drinking was found in 24.3% of men and 10.3% of women. The analysis showed that in men, poor work performance (OR: 1.34, 95% CI: 1.00-1.79), high family-to-work conflict (OR: 1.54, 95% CI: 1.14-2.09), and high work-to-family conflict (OR: 1.63, 95% CI: 1.14-2.34) were significantly associated with problem drinking, whereas in women, high work-to-family conflict (OR: 2.45, 95% CI: 1.21-4.95) was significantly associated with problem drinking. Although the number of close friends is negatively associated with problem drinking in women, the significance disappeared in the fully adjusted model. It can be concluded that it is important for both men and women to strike a balance between work and family life. Moreover, owing to gender differences, work performance may be important for men, and the presence of close friends may be important for women, in reducing the risk of problem drinking.
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Problem drinking causes a decline in labor productivity among working population. This study examined whether work characteristics, work-family status, and social activities are associated with future problem drinking behavior among Japanese civil servants. A total of 1,535 participants (men: 63.1%, women: 36.9%) with no problem drinking behavior were followed up from 2014 to 2019. A multivariable logistic regression analysis was performed to examine the factors associated with future problem drinking behavior. During the five-year follow-up period, the cumulative incidence of problem drinking was 9.6% and 5.8% in men and women, respectively. In both men and women, frequent drinking around three times a week or more and alcohol consumption of two units or more at baseline were associated with future problem drinking. In men, compared with low-grade employees, high-grade employees were less likely to become problem drinkers (OR: 0.56, 95% CI: 0.33-0.95). Shift workers were significantly associated with the incidence of problem drinking (OR: 2.96, 95% CI: 1.46-6.00). In women, poor own work performance was significantly associated with problem drinking (OR: 5.30, 95% CI: 1.57-17.86). In conclusion, disadvantaged work characteristics are associated with the development of problem drinking. To prevent problem drinking, attention should be paid to poor work characteristics.
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BACKGROUND: Anastomotic leakage in esophagectomy is a serious complication, and assessing blood perfusion in the conduit can help minimize this risk. Indocyanine green is the most widely used method to assess tissue blood flow; however, this technique has disadvantages. Evaluating tissue oxygen saturation in the gastric conduit during thoracic esophagectomy compared with indocyanine green blood perfusion assessment addresses these disadvantages and can be performed easily and repeatedly. METHODS: This was a prospective study of patients with esophageal cancer who underwent thoracic esophagectomy. Intraoperative tissue oxygen saturation and indocyanine green measurements were obtained to determine the anastomotic site and to compare the correlation between the 2 methods. Tissue oxygen saturation and indocyanine green values were obtained at the tip of the gastric conduit, the demarcation line indicating visible perfusion, and the end of the right gastroepiploic artery. RESULTS: Fifty-seven patients were enrolled in this study; 3 developed anastomotic leakage, and all 3 underwent robotic thoracic surgery. The tissue oxygen saturation value decreased gradually toward the tip of the conduit, as did congestion, and was significantly decreased at the tip compared with the value at the demarcation line (P = .001). Mean tissue oxygen saturation differed significantly between the leakage and no-leakage groups at the anastomosis site (P = .04). We found a negative correlation between tissue oxygen saturation and indocyanine green values at the end of the right gastroepiploic artery (r = -0.361; P = .03). CONCLUSION: Tissue oxygen saturation imaging was useful in determining the anastomotic site and addressed the disadvantages associated with indocyanine green.
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Neoplasias Esofágicas , Verde de Indocianina , Humanos , Fuga Anastomótica/etiología , Fuga Anastomótica/prevención & control , Esofagectomía/efectos adversos , Esofagectomía/métodos , Estudios Prospectivos , Saturación de Oxígeno , Estómago/diagnóstico por imagen , Estómago/cirugía , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Tecnología , Neoplasias Esofágicas/cirugíaRESUMEN
BACKGROUND: Lymphadenectomy around the recurrent laryngeal nerve (RLN) is an essential part of curative surgery for esophageal cancer. Although several single-center studies have shown that intraoperative nerve monitoring (IONM) can avoid RLN palsy, this has not been confirmed in a large-scale multicenter study. This study was performed to evaluate whether IONM can reduce postoperative RLN palsy during minimally invasive esophagectomy (MIE) for esophageal cancer using a national database. METHODS: We retrieved data of patients with esophageal cancer who underwent three-field MIE with cervical anastomosis involving thoracoscopic or robotic esophagectomy with IONM (502 patients) and without IONM (4,353 patients) from April 2020 to March 2022 from the Diagnosis Procedure Combination database in Japan. We compared the frequency of postoperative RLN palsy and respiratory complications between the IONM(+) group and IONM(-) group using propensity score-matching analysis. RESULTS: The postoperative RLN palsy rate was significantly lower in the IONM(+) than (-) group (odds ratio, 0.24; 95% confidence interval [CI], 0.13-0.46). The respiratory complication rate was also significantly lower in the IONM(+) than (-) group (odds ratio, 0.66; 95%CI, 0.45-0.97). The anesthesia time was significantly longer in the IONM(+) group (regression coefficient, 60.1 minutes; 95%CI, 44.2-76.9). The length of postoperative hospitalization tended to be shorter in the IONM(+) than (-) group (regression coefficient, -1.39 days; 95%CI, -3.91 to 1.14). CONCLUSIONS: This national cohort study showed that IONM during three-field MIE for esophageal cancer was associated with a reduction of postoperative RLN palsy and respiratory complications.
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BACKGROUND: Although the safety of robotic distal gastrectomy has been studied in several single-center trials, the nationwide outcomes of robotic distal gastrectomy that meet the requirements of Japanese national health insurance, such as facility case volume and skill level of the surgeon, are still not clear. The objective of this study was to evaluate the short-term outcomes of robotic distal gastrectomy, which was covered by national health insurance, compared to laparoscopic distal gastrectomy. METHODS: We retrieved gastric cancer cases with cStage I to III who underwent laparoscopic distal gastrectomy (15,539 patients) and robotic distal gastrectomy (1,312 patients) between April 2018 and March 2020 from the Diagnosis Procedure Combination database. We compared the frequency of postoperative complications, anesthesia time, and postoperative hospitalization days between laparoscopic distal gastrectomy and robotic distal gastrectomy using propensity score matching analysis. RESULTS: The postoperative complication rate were not different between laparoscopic distal gastrectomy and robotic distal gastrectomy (odds ratio = 0.90, 95% confidence interval: 0.66 to 1.23, P = .52). The anesthesia time (minutes) was significantly longer (coefficient = 70.2, 95% confidence interval: 63.8 to 76.7, P < .001) and postoperative hospitalization (days) was significantly shorter (coefficient = -0.89, 95% confidence interval: -1.48 to -0.31, P = .003) in robotic distal gastrectomy than laparoscopic distal gastrectomy. CONCLUSIONS: Robotic distal gastrectomy that met strict national health insurance coverage requirements in Japan was performed as safely as laparoscopic distal gastrectomy with reduced hospitalization days.
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Laparoscopía , Procedimientos Quirúrgicos Robotizados , Neoplasias Gástricas , Humanos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Estudios Retrospectivos , Gastrectomía/efectos adversos , Gastrectomía/métodos , Pacientes Internos , Resultado del Tratamiento , Neoplasias Gástricas/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Laparoscopía/efectos adversos , Laparoscopía/métodosRESUMEN
BACKGROUND: Ischemic colitis (IC) typically develops in the elderly, where hypertension, cerebrocardiovascular disease, and past history of abdominal surgery are regarded as risk factors. Although there have been reports of younger patients with IC, its clinical features remain unclear. AIM: The aim of this study was to clarify the clinical characteristics of IC in young adults. METHODS: Three hundred fifty-nine patients were diagnosed as having IC at five hospitals across Nagano prefecture, Japan. Clinical data were compared between the young patient group [20-45 years, n = 53 (15%)] and the elderly patient group [>45 years, n = 306 (85%)], as well as with age- and gender-matched healthy individuals (n = 156). RESULTS: The presence of a smoking habit and hyperuricemia were significantly higher in the young patient group compared with the elderly patient group (42 vs. 19%, P = 0.001 and 8 vs. 1%, P = 0.019, respectively), which was confirmed by multiple logistic regression analysis (P = 0.001, odds ratio 3.239 and P = 0.028, odds ratio 16.907, respectively). Additionally, multiple logistic regression analysis of the young IC patient group and age- and gender-matched healthy individuals demonstrated that these two factors were strongly associated with IC development (P = 0.008, odds ratio 2.49 for smoking habit and P = 0.039, odds ratio 6.37 for hyperuricemia). CONCLUSIONS: High prevalences of a smoking habit and hyperuricemia are characteristic features of IC in the young adult population.
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Colitis Isquémica/diagnóstico , Colitis Isquémica/epidemiología , Estilo de Vida , Adulto , Factores de Edad , Edad de Inicio , Anciano , Anciano de 80 o más Años , Estudios de Casos y Controles , Colitis Isquémica/terapia , Colonoscopía/métodos , Terapia Combinada , Comorbilidad , Intervalos de Confianza , Estreñimiento/epidemiología , Progresión de la Enfermedad , Femenino , Estudios de Seguimiento , Humanos , Hiperuricemia/epidemiología , Japón/epidemiología , Modelos Logísticos , Masculino , Persona de Mediana Edad , Análisis Multivariante , Oportunidad Relativa , Recurrencia , Valores de Referencia , Estudios Retrospectivos , Factores de Riesgo , Índice de Severidad de la Enfermedad , Fumar/epidemiología , Estadísticas no Paramétricas , Tasa de Supervivencia , Adulto JovenRESUMEN
Recently, treatment by taxane regimen for advanced gastric cancer as second-line chemotherapy has been increasingly reported. A 58-year-old man underwent distal gastrectomy for advanced gastric cancer on November 25, 2002. There was permeation through the duodenum side, and a Billroth II operation was done for repair. Although a relapse was not clear from the picture image, due to the tumor marker increase since July 2004, chemotherapy using TS-1 100 mg/day was given. On February 2005, liver dysfunction and obstructive jaundice appeared, and the patient was diagnosed with a recurrence in the hilar lymph node of the liver through PET and CT. Because of the Billroth II operation for repair, ERBD was impossible, and we performed PTCD to decrease jaundice. Treatment by docetaxel 60 mg/m(2) every three weeks was given since March 15. After two courses of chemotherapy with docetaxel, the insertion of the guide wire was possible from the part of PTCD. Implantation of the stent became possible after four courses. PTCD could be removed, and the patient QOL has effectively improved. Outpatient treatment became possible for him in January 2006.
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Adenocarcinoma/tratamiento farmacológico , Antineoplásicos/administración & dosificación , Ictericia Obstructiva/etiología , Neoplasias Gástricas/tratamiento farmacológico , Taxoides/administración & dosificación , Adenocarcinoma/complicaciones , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Docetaxel , Esquema de Medicación , Gastrectomía , Humanos , Ictericia Obstructiva/terapia , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática , Masculino , Persona de Mediana Edad , Calidad de Vida , Stents , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugíaRESUMEN
Although autoimmune hepatitis (AIH) is frequently complicated with chronic thyroiditis or other autoimmune disorders, reports on its association with immune thrombocytopenic purpura (ITP) are scarce. We herein describe a case of AIH associated with ITP. A 75-year-old Japanese woman was admitted to our hospital due to increased aminotransferase levels and severe thrombocytopenia. Elevated serum immunoglobulin G (IgG) was detected, and tests for platelet-associated IgG and anti-nuclear antibody were positive. Following the diagnosis of AIH-associated ITP, prednisolone treatment of 0.6 mg/kg/day resulted in a decrease in the aminotransferase levels and an increased platelet count.
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Hepatitis Autoinmune/diagnóstico , Púrpura Trombocitopénica Idiopática/diagnóstico , Anciano , Anticuerpos Antinucleares/sangre , Diagnóstico Diferencial , Femenino , Glucocorticoides/uso terapéutico , Hepatitis Autoinmune/sangre , Hepatitis Autoinmune/complicaciones , Hepatitis Autoinmune/tratamiento farmacológico , Humanos , Inmunoglobulina G/sangre , Prednisolona/uso terapéutico , Púrpura Trombocitopénica Idiopática/sangre , Púrpura Trombocitopénica Idiopática/complicaciones , Púrpura Trombocitopénica Idiopática/tratamiento farmacológicoRESUMEN
Collision tumor means that two kinds of histologically distinct tumors coexist and neighbor without histological interminglement. This report describes a rare case of an ileocecal collision tumor composed of adenocarcinoma and primary malignant lymphoma. A 76-year-old woman was referred to our institute with anemia and a right lower quadrant mass. Colonoscopy revealed type 2 advanced colon cancer in the cecum accompanied by a submucosal mound neighboring this cancer, which appeared different from the usual shape of colon cancer. A barium enema study manifested the typical apple-core sign in the cecum with a smooth semicircular line appearing in the shadow of the apple-core sign. Biopsy specimens showed adenocarcinoma, so a right hemicolectomy was performed. The gross resected specimen presented a mass measuring 64 × 58 × 28 mm at the ileocecal portion. The half of this mass on the colonic side had a crater-like appearance, whereas the remaining part of the mass on the ileal side had an aspect with a smooth surface. Microscopic examination disclosed that the mass was composed of adenocarcinoma and malignant lymphoma bordering on each other and mediated by a thin layer of connective tissue. Cases of colon tumors with an unusual epithelial and submucosal appearance may be instances of collision tumors composed of cancer and malignant lymphoma.