[Four Cases of Locally Advanced Colorectal Cancer Resected after Neoadjuvant Chemotherapy with mFOLFOX6 plus Bevacizumab].

We describe 4 cases of locally advanced colorectal cancer resected successfully after neoadjuvant chemotherapy(NAC) conducted between April 2015 and August 2016. The NAC with mFOLFOX6 plus bevacizumab was performed after ileostomy for prevention of obstruction, because of tumor invasion into other organs. After chemotherapy, we could perform resection and avoid invasive surgery in either cases.

[Safety and Feasibility of Pancreatic Surgery for Pancreatic Cancer in Elderly Patients].

PURPOSE: This study aimed to evaluate the safety and feasibility of pancreatic surgery for pancreatic cancer in elderly patients. PATIENTS AND METHODS: In total, 9 patients underwent pancreatic surgery for pancreatic cancer between April 2005 and March 2014. The surgical complications were evaluated by Clavien-Dindo classification. RESULTS: The median operating time was 420(range: 354-503)min and the median blood loss was 640(range: 350-1,170)mL. Grade 2 or higher complications were observed in 3 patients. Pancreatic fistula(Grade 3b)was observed in 1 patient, delirium was observed(Grade 2)in 1 patient, and portal vein thrombosis(Grade 2)was observed in 1 patient. No surgical mortality was observed. DISCUSSION: Our results suggest that pancreatic surgery is a safe and feasible treatment for pancreatic cancer in elderly patients.

[A Case of Primary Splenic Inflammatory Myofibroblastic Tumor].

Inflammatory myofibroblastic tumor(IMT)is a rare neoplasm. IMTs are found in a number of locations throughout the body, but splenic involvement is uncommon. One case of splenic IMT is described. A 42-year-old woman presented with anterior chest pain and was found to have a splenic mass by computed tomography(CT). Fluorine-18-FDG-PET showed no FDG accumulation in the spleen. Magnetic resonance imaging(MRI)at 6 months follow-up showed an increase in the size of the tumor. We performed splenectomy for a suspected malignant tumor. The surgical specimen was a gray-white mass in the spleen. The mass was histopathologically diagnosed as primary splenic IMT because it consisted of desmin- and SMA-positive spindle-shaped cells with various inflammatory cells. In Japan, only 6 cases(including this case)of primary splenic IMT have been reported. Surgery is the only curative approach, but recurrences occur in around 5% of cases of pulmonary IMT, and around 25% of cases of extrapulmonary IMT. This patient needs to be carefully followed up.

[A Case of Primary Liposarcoma Arising from the Duodenum].

We report a case of duodenal liposarcoma. A 62-year-old man presented with an abdominal tumor. Abdominal CT scan and MRI showed a tumor in the wall of the duodenum. Pancreaticoduodenectomy was performed. The final pathological diagnosis was mixed-type liposarcoma. Twenty-one months after the 1st surgery, the patient presented with locoregional recurrence and tumor resection was performed. However, 12 months after the 2nd operation, the patient again presented with locoregional recurrence and further surgery is planned.

The short- and long-term outcomes of radical antegrade modular pancreatosplenectomy for adenocarcinoma of the body and tail of the pancreas.

BACKGROUND: Radical antegrade modular pancreatosplenectomy (RAMPS) is a relatively new modification of the standard distal pancreatosplenectomy. In this method, dissection proceeds from right-to-left to achieve negative posterior resection margins. However, short-term and long-term outcomes of RAMPS for pancreatic cancer have not yet been clarified. The aim of this study is to evaluate short-term and long-term outcomes in the patients who have undergone RAMPS. METHODS: Consecutive 49 patients were selected from the retrospective database of the Kanagawa Cancer Center from 2000 to 2014. Data from the operative notes, pathology reports, postoperative data, and outpatient data (recurrence and survival) were entered into the database. RESULTS: All patients were undergone anterior RAMPS. The median operation time was 278 min (range from 140 to 625 mins). The median blood loss in operation was 850 ml (range from 60 to 2790 ml). The overall incidence of morbidity was 51.4% and the incidence of mortality was 0%. Forty-one patients (83.7%) had negative resection margins. The mean number of lymph nodes harvested was 15 and 27 patients had lymph node metastasis. After the median follow-up period was 41.1 months, 1-year and 3-year overall survival rates were 84.1 and 38.6%, respectively. Median overall survival was 22.6 months. CONCLUSIONS: The present study results suggested that RAMPS procedure might be safe and feasible without an increase in morbidity and morbidity and have survival benefit compared with standard DP.

[The Safety and Feasibility of Conversion Surgery for Initially Unresectable Pancreatic Cancer].

BACKGROUND: By remarkable progress of chemotherapy for pancreatic cancer, we sometimes achieve resection of initially unresectable pancreatic cancer after chemotherapy. Otherwise, the safety and feasibility of radical pancreatic resection after chemotherapy is not still clear. In this report, we evaluated the safety and feasibility of conversion surgery for initially unresectable pancreatic cancer in our center. PATIENTS AND METHODS: Between 2009 and 2014, approximately 500 patients were diagnosed with unresectable pancreatic cancer and received chemotherapy, and after chemotherapy, 10 patients were found to have resectable tumors on computed tomography. We evaluated surgical complications using the Clavien-Dindo classification. Clinicopathological data were reviewed by using UICC, seventh edition, and the chemotherapeutic effect was measured by using Evans classification. RESULTS: The mean age of patients was 68 years, with 4 men and 6 women. The preoperative chemotherapy regimens were S-1 chemotherapy in 2 patients, gemcitabine in 5 patients, and gemcitabine plus S-1 chemotherapy in 3 patients. Nine patients underwent pancreatoduodenectomy, and 1 underwent distal pancreatosplenectomy. The mean operative time was 527.5 minutes, and the mean estimated blood loss was 875 mL. Surgery-related morbidity more than Grade 2 based on Clavien-Dindo classification occurred in 6 patients. Mortality was 0%. CONCLUSION: Our study suggests that conversion surgery for initially unresectable pancreatic cancer is safe and feasible.

[A Case of Undifferentiated Carcinoma of the Gallbladder].

In this paper, we present a case of undifferentiated carcinoma of the gallbladder, which is a rare disease with poor prognosis. A 77-year-old woman presented with right hypochondralgia. An abdominal CT scan showed a tumor more than 80 mm in diameter invading the liver parenchyma and transverse colon, and showed liver and lymph node metastases. We diagnosed the patient with stage Ⅳ carcinoma of the gallbladder. We resected the gallbladder, S4a plus S5 of the liver, part of the transverse colon, the lymph nodes, the greater omentum, and the extra hepatic bile duct; biliary reconstruction was then performed. Histological examination showed that most areas consisted of undifferentiated cells. The diagnosis of undifferentiated carcinoma was made according to the WHO classification of tumors of the digestive system. No recurrence has been detected for 1 year.

[Safety and Feasibility of the Bioabsorbable Staple Line Reinforcement in Distal Pancreatic Resections].

PURPOSE: The aim of this study was to evaluate the safety and feasibility of the bioabsorbable staple line reinforcement in distal pancreatic resection. PATIENTS & METHODS: Thirteen patients underwent distal pancreatic resection using the bioabsorbable staple line reinforcement between May 2014 and December 2014. Surgical complications were evaluated by Clavien-Dindo classification. RESULT: Median age was 64 years. Median operation time was 219 minutes and median blood loss was 490 mL. Complications>Grade 2 were observed in 3 patients. Among them, pancreatic fistula (Grade 2) was found in 2 patients and ileus (Grade 2) in 1. No surgical mortality was observed. DISCUSSION: Our results may suggest that the bioabsorbable staple line reinforcement is safe and feasible in distal pancreatic resection.

Clinical implications of ribonucleotide reductase subunit M1 in patients with pancreatic cancer who undergo curative resection followed by adjuvant chemotherapy with gemcitabine.

To the best of our knowledge, the clinical implications of using ribonucleoside reductase subunit M1 (RRM1) in patients who undergo curative resection and adjuvant chemotherapy have not been established. In the present study, the clinical data from 101 consecutive patients who underwent macroscopically curative resection, and who received adjuvant gemcitabine chemotherapy for pancreatic cancer at the Kanagawa Cancer Centre (Yokohama, Kanagawa, Japan) between April 2005 and December 2014 were retrospectively analyzed. The association between the RRM1 status and survival and clinicopathological features were assessed. Of the 101 patients, 41 patients expressed high levels of RRM1 expression (40.6%). Although a significant difference was observed in lymphatic invasion, there was no difference between the two groups with regard to any other clinicopathological parameters. The median follow-up period was 67.3 months. There was a significant difference between the recurrence-free survival (RFS) rates at 5 years after surgery, which were 12.9 and 0% in the high RRM1 and low RRM1 groups, respectively (P=0.042). Furthermore, there was a significant difference in the 5-year overall survival (OS) rates following surgery, which were 5.1 and 21.5% in the high RRM1 and low RRM1 groups, respectively (P=0.015). The results of the present study indicated that out of the factors assessed, RRM1 was the most important prognostic factor for OS and RFS in patients with pancreatic cancer who underwent curative resection followed by adjuvant chemotherapy with gemcitabine. Adjuvant chemotherapy with gemcitabine alone may be insufficient for the treatment of pancreatic cancer, particularly in patients with relevant risk factors.

Clinical implications of dihydropyrimidine dehydrogenase expression in patients with pancreatic cancer who undergo curative resection with S-1 adjuvant chemotherapy.

The predictive roles of dihydropyrimidine dehydrogenase (DPD) in patients who undergo curative resection and adjuvant chemotherapy with S-1, which is the oral 5-fluorouracil prodrug tegafur combined with oteracil and gimeracil, remain unclear. In the present study, the clinical data from 66 consecutive patients who underwent curative resection and received adjuvant chemotherapy with S-1 for the treatment of pancreatic cancer at Kanagawa Cancer Center (Yokohama City, Japan) from April 2005 to March 2014 were retrospectively analyzed. The association between the DPD status and the survival and clinicopathological features were investigated. Of the 66 patients, 34 patients exhibited positive DPD expression (51.5%). Although a significant increase in DPD expression in male patients was observed, no significant differences were identified for other clinicopathological parameters, including tumor factor or node factor, between the DPD-positive expression group and the DPD-negative expression group. The median follow-up period of the present study was 29.2 months. There was no significant difference in the 3-year overall survival (OS) rates following surgery, which were 12.6 and 14.5% in the DPD-positive and DPD-negative expression groups, respectively (P=0.352). However, in a subgroup analysis, a significant difference in the 3-year OS rates following surgery was noted, which were 58.9 and 14.5% in the DPD-high and DPD-low expression groups, respectively (P=0.019). The intratumoral DPD expression in curatively resected pancreatic cancer patients treated with S-1 adjuvant chemotherapy was identified to not be useful as a predictive marker, whereas the level of DPD expression is a potential predictive marker. The results of the present study require confirmation in another cohort or in a prospective multicenter study.

Predictive role of human equilibrative nucleoside transporter 1 in patients with pancreatic cancer treated by curative resection and gemcitabine-only adjuvant chemotherapy.

The predictive roles of human equilibrative nucleoside transporter 1 (hENT-1) in patients who undergo curative resection and adjuvant chemotherapy with gemcitabine alone have not been established. The present study retrospectively analyzed the clinical data from 101 consecutive patients who underwent curative resection and who received gemcitabine adjuvant chemotherapy for the treatment of pancreatic cancer at Kanagawa Cancer Center (Yokohama, Japan) between 2005 and 2014. The associations between the hENT-1 status and the survival and clinicopathological features of the patients were investigated. Of the 101 patients, 60 patients (59.4%) had high levels of hENT-1 expression. A significant association was observed between hENT-1 status and sex; however, for all the other clinicopathological parameters, including tumor and node stages, no differences were observed between the high and low hENT-1 expression groups. The median follow-up period of the present study was 67.3 months. Between the high and low hENT-1 expression groups, there was a statistically significant difference in the 5-year overall survival (OS) rates following surgery (20.6 and 8.9%, respectively; P=0.019). In addition, a significant difference was observed in the recurrence-free survival (RFS) rates at 5 years following surgery (P=0.049). hENT-1 status was one of the important predictive factors for OS and RFS in patients with pancreatic cancer who underwent curative resection followed by adjuvant chemotherapy with gemcitabine. Adjuvant chemotherapy with gemcitabine alone may be insufficient, particularly in patients with certain relevant risk factors.

Locked Nucleic Acid In Situ Hybridization Analysis of MicroRNA-21 Predicts Clinical Outcome in Patients After Resection for Pancreatic Cancer Treated with Adjuvant Gemcitabine Monotherapy.

BACKGROUND: The overexpression of microRNA-21 (miR-21) in pancreatic cancer has been implicated in drug resistance to gemcitabine. Thus far, miR-21 has gained wide attention as a potential biomarker to predict the clinical response in patients with pancreatic cancer receiving gemcitabine. The aim of this study was to evaluate the predictive value of miR-21 expression, determined by locked nucleic acid in situ hybridization (LNA-ISH), in patients with pancreatic cancer who underwent adjuvant gemcitabine after curative surgery. MATERIALS AND METHODS: Tumor miR-21 expression was analyzed via LNA-ISH and correlated with the clinical outcomes of the patients treated with adjuvant gemcitabine. RESULTS: The overexpression of miR-21 in pancreatic cancer, determined by LNA-ISH, was significantly and independently associated with a shorter disease-free survival in patients who received adjuvant gemcitabine after curative resection. CONCLUSION: The LNA-ISH analysis of miR-21 may serve as a significant predictor for gemcitabine resistance in patients with pancreatic cancer undergoing adjuvant gemcitabine after curative resection.

Glasgow Prognostic Score Predicts Clinical Outcomes in Patients with Pancreatic Cancer Undergoing Adjuvant Gemcitabine Monotherapy After Curative Surgery.

BACKGROUND/AIM: The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score, has been shown to predict the clinical outcomes of a variety of cancer types. The aim of this study was to determine whether the GPS predicts clinical outcomes of patients with pancreatic cancer treated with adjuvant chemotherapy after surgery. PATIENTS AND METHODS: Forty patients resected for pancreatic cancer who underwent adjuvant gemcitabine monotherapy after curative surgery were included. The GPS was measured prior to adjuvant therapy and correlated with clinical outcomes. RESULTS: The disease-free survival (DFS) and overall survival (OS) in patients with an elevated GPS (GPS1 or GPS2) were significantly poorer (p=0.001 and p=0.035, respectively, by log-rank test) than patients with a GPS of 0. An elevated GPS was found to be independently associated with poor DFS (p=0.002, by Cox regression model). CONCLUSION: The pre-adjuvant GPS may predict clinical outcome in patients with pancreatic cancer undergoing adjuvant chemotherapy after surgery.

Impact of postoperative complications on survival and recurrence in pancreatic cancer.

BACKGROUND: We investigated the impact of postoperative complications on survival and recurrence after curative surgery for pancreatic cancer. PATIENTS AND METHODS: This study included 164 patients who underwent curative surgery for pancreatic cancer between 2005 and 2014. The patients were classified into those with postoperative complications (C group) and those without postoperative complications (NC group). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Postoperative complications were found in 61 out of the 164 patients (37.2%). The RFS rate at five years after surgery was 10.6% in the C group and 21.0% in the NC group. The RFS tended to be worse in the C group than in the NC group (p=0.1756). The OS rate at five years after surgery was 7.4% in the C group and 22.8% in the NC group, which was significantly different (p=0.0189). The multivariate analysis demonstrated that the occurrence of postoperative complications was a significant independent risk factor for OS and a marginally significant risk factor for RFS. CONCLUSION: The development of postoperative complications was a risk factor for a decreased overall survival in the patients who underwent curative surgery for pancreatic cancer. The surgical procedure, perioperative care and the surgical strategy should be carefully planned to avoid complications.

Safety and feasibility of S-1 adjuvant chemotherapy for pancreatic cancer in elderly patients.

BACKGROUND: The safety and feasibility of administering S-1 adjuvant chemotherapy for pancreatic cancer has not yet been fully evaluated in elderly patients. METHODS: This retrospective study selected patients who underwent curative surgery for pancreatic cancer, were diagnosed with stage II disease or lower or stage III disease with combined resection of the celiac artery, and received adjuvant S-1 at our institution. The patients were categorized into two groups: non-elderly patients (<70 years of age: group A) and elderly patients (>70 years of age: group B). The toxicity and S-1 continuation rates were compared between the two groups. RESULTS: A total of 76 patients were evaluated in the present study. There were no grade 4 toxicities. The incidences of grade 3 hematological and non-hematological toxicities were <5 % in both groups, and the differences were not significantly different. The continuation rate at 6 months was 60.5 % in group A and 72.7 % in group B, which was also not significantly different. CONCLUSIONS: These results suggest that S-1 adjuvant chemotherapy for pancreatic cancer is safe and feasible, regardless of the age of the patient, especially for elderly patients who may be candidates for clinical trials.