Nutritional Status Indicators Affecting the Tolerability of Postoperative Chemotherapy After Total Gastrectomy in Patients With Gastric Cancer.

Purpose: Nutritional problems after gastrectomy affect continuation of postoperative chemotherapy. There have been no studies limited to total gastrectomy, which is particularly prone to nutritional problems. In this study, we aimed to investigate the factors that predict the continuation of postoperative chemotherapy. Materials and Methods: We included 101 patients who underwent curative total gastrectomy and postoperative chemotherapy at Hiroshima Memorial Hospital. The effects of 37 factors, including perioperative inflammatory, nutritional, and tumor status, on the persistence of postoperative chemotherapy were analyzed. Results: In univariate analysis of preoperative factors, age, carbohydrate antigen 19-9, platelet-to-neutrophil ratio, Onodera's prognostic nutritional index (PNI), controlling nutritional status score, and nutritional risk screening (NRS-2002) score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of preoperative factors, age (≥74 years) was an independent factor for a shorter duration of postoperative chemotherapy (hazard ratio [HR], 5.24; 95% confidence interval [CI], 2.19-12.96; P<0.01). In univariate analysis of factors before postoperative chemotherapy, intraoperative blood loss, perioperative weight loss rate, postoperative performance status, PNI, albumin-to-bilirubin index, and NRS-2002 score were significantly associated with the duration of postoperative chemotherapy. In multivariate analysis of factors before postoperative therapy, age (≥74 years) (HR, 5.75; 95% CI, 1.90-19.49; P<0.01) and PNI (<39) (HR, 3.29; 95% CI, 1.26-8.56; P=0.02) were independent factors for a shorter duration of postoperative chemotherapy. Conclusions: Age and PNI are useful predictors of postoperative chemotherapy intolerance after total gastrectomy and may determine the treatment strategy and timing of chemotherapy initiation.

[A Case of Sclerosing Angiomatoid Nodular Transformation Resected for Suspected Relapse of Diffuse Large B-cell Lymphoma].

We report a case of sclerosing angiomatoid nodular transformation(SANT)5 years after remission of diffuse large B-cell lymphoma(DLBCL). A 64-year-old woman was diagnosed a nodular mass at the spleen by a contrast-enhanced CT scan 5 years after the relief for DLBCL. The mass showed accumulation of FDG. Because the possibility of the recurrence of malignant lymphoma could not be ruled out, laparoscopic splenectomy was performed for diagnosis and treatment. Immunohistologically, the resected mass revealed 3 different vascular components pattern(CD31, CD34 and CD8), so we diagnosed SANT. It is difficult to distinguish from malignant lymphoma or cancer even with various examination, so laparoscopic splenectomy is useful for diagnosis and treatment.

[A Case of Pancreatoduodenectomy for Multiple Nonfunctioning Neuroendocrine Tumors of the Duodenum].

A 42-year-old woman was referred to our hospital because of incidentally discovered multiple neoplastic lesions of the duodenum. Upper gastrointestinal endoscopy showed there were more than 10 submucosal tumors and less than 10 mm in diameter. Histological examination of the biopsy specimen revealed nonfunctioning neuroendocrine tumor(NET). Enhanced computed tomography(CT)showed neither regional lymph node nor distant metastasis, so we performed pancreatoduodenectomy with regional lymph node dissection. Pathological examination showed multiple NET G2 less than 5 mm in size with invasion to muscularis propria and 3 lymph node metastases, so diagnosed as pT2(m)N1M0, Stage Ⅲ. She is alive without tumor recurrence for 14 months after surgery. In general, sporadic nonfunctioning NET of the duodenum less than 10 mm in diameter has low possibility of lymph node metastasis. However, our case suggested the possibility of lymph node metastasis in patients with multiple NETs of the duodenum, in spite of small size. Therefore, pancreatoduodenectomy with regional lymph node dissection should be considered for multiple nonfunctioning NETs of the duodenum.

Laparoscopic resection for a large gastrointestinal stromal tumor (GIST) with diaphragm invasion following preoperative imatinib treatment: A case report.

INTRODUCTION: Neoadjuvant imatinib for large GISTs may prevent tumor rupture and the need for extended surgery by reducing tumor size. In this study, we present a case of large gastric GIST with diaphragm invasion, due to the patient receiving laparoscopic resection following preoperative imatinib treatment. PRESENTATION OF CASE: A 72-year-old woman was hospitalized with left hypochondriac pain for a month. Examinations revealed a large heterogeneous gastric mass measuring 80 mm in size, arising from the greater curvature of the corpus. The mass invaded the left thoracic diaphragm. Treatment with imatinib at an initial dosage of 400 mg/day was initiated. After a further two months of follow-up, the lesion had sustained reduction to 50 mm in size, however, the invasion to the diaphragm remained. The patient eventually underwent laparoscopic partial gastrectomy and partial resection of the diaphragm with curative intent. Adjuvant chemotherapy was initiated at one month after the surgery, however, was discontinued due to nausea. After one-year follow-up, no recurrence was noted. DISCUSSION: Neoadjuvant imatinib may shrink tumor size remarkably and prevent tumor rupture during surgery, and thus lead to increased rates of complete resection. To date, several publications have directly compared the oncologic results between laparoscopic and open resection for GISTs. In the present case, the tumor was movable, and moderately fixed on diaphragm. It was favorable condition for laparoscopic surgery. CONCLUSIONS: This is the first report of a large gastric GIST invading the diaphragm that was successfully treated by laparoscopic resection after tumor reduction by neoadjuvant imatinib.

[Efficacy and Safety of Neoadjuvant Chemotherapy Containing Nanoparticle Albumin-Bound Paclitaxel (NabPTX) in Operable Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer].

The efficacy and safety of nanoparticle albumin-bound paclitaxel (nabPTX)-containing neoadjuvant chemotherapy (NAC) were investigated in patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancers. Thirteen HER2-positive patients received NAC containing nabPTX or paclitaxel between June 2008 and December 2014. Of 13 HER2-positive patients, those who received nabPTX-containing NAC showed an 85.7% (6/7) pathological complete response (pCR) rate, whereas those who received paclitaxel-containing NAC showed a pCR rate of 50.0% (3/6). While 5 of 7 patients who received nabPTX-containing NAC developed Grade 3/4 neutropenia, none of them developed febrile neutropenia. Grade 1/2 peripheral neuropathy developed in all 7 patients who received nabPTX-containing NAC. This therapy may be a safe and effective treatment for HER2-positive breast cancer patients.