A prospective clinical study evaluating short-term changes in body composition and quality of life after gastrectomy in elderly patients receiving postoperative exercise and nutritional therapies.

BACKGROUND: Muscle mass loss after gastrectomy is associated with a negative impact on quality of life (QOL) and long-term prognosis following gastric cancer treatment, especially in elderly patients. We conducted a prospective study to examine short-term changes in body composition and QOL after gastrectomy in elderly patients with gastric cancer who received exercise and nutritional therapies. METHODS: Patients over aged 65 years of age who underwent gastrectomies for gastric cancer were enrolled in our study. Patients received exercise and nutritional therapies with branched-chain amino acid (BCAA)-rich supplements during 1 month after surgery. Body composition was evaluated using InBody S10 before surgery, and at 1 week and 1 month postoperatively. Other variables including QOL status (EQ-5D-5 L), serum albumin level, hand grip strength, and gait speed were evaluated at the same time. RESULTS: Eighteen patients were analyzed. The mean loss of skeletal muscle mass index (SMI) was 4.6% (1 week) and 2.1% (1 month) compared to the preoperative period. QOL scores showed almost the same degree of recovery at 1 month after gastrectomy as preoperative scores. Serum albumin levels, hand grip strength, and gait speed decreased at 1 week and then increased at 1 month after surgery, similar to the changes seen in SMI. CONCLUSIONS: Multidisciplinary approaches play key role in the surgical treatment of elderly patients. Postoperative exercise and nutritional therapies with BCAA-rich supplements may benefit elderly patients after gastrectomy by reducing loss of SMI and decreases in QOL. TRIAL REGISTRATION: UMIN Clinical Trials Registry; UMIN000034374 (registration date: 10/10/2018).

[A case of primary duodenal cancer recurrence successfully treated with CapeOX therapy].

A 55-year-old man was admitted to our hospital because of nausea and vomiting. An endoscopic examination and computed tomography(CT)scan revealed a duodenal tumor. A biopsy confirmed a diagnosis of primary duodenal adenocarcinoma. A pancreaticoduodenectomy and partial resection of the ascending colon were performed. Ten months after surgery, we observed lymph node recurrence and peritoneal dissemination. We then introduced capecitabine and oxaliplatin (CapeOX)therapy for treatment of the relapsed disease. A partial response(PR)was observed after 2 courses, and was sustained for 5 months. The patient survived another 1 year and 4 months after disease recurrence. CapeOX therapy can be an effective treatment for primary duodenal cancer.

[Case report of chemotherapeutic control of a gastric cancer producing granulocyte-colony stimulating factor].

A 79-year-old man presented with a history of vomiting. Laboratory data indicated leukocytosis (26360/µl), and elevated granulocyte-colony stimulating factor (G-CSF) level (155 pg/ml). Upper gastrointestinal endoscopy revealed a type 3 gastric cancer, and subsequent G-CSF immunohistochemical staining of a biopsy specimen was positive. He was therefore diagnosed with a G-CSF-producing gastric cancer. Computed tomography revealed multiple liver metastases. Chemotherapy was initiated, resulting in a partial response for 5 months. G-CSF-producing gastric cancer is rare; thus, we take this opportunity to report our case and to summarize the G-CSF-producing gastric cancer cases reported in Japan.

Risk factors associating with delayed gastric emptying after laparoscopic distal gastrectomy.

PURPOSE: The aim of this study was to investigate the incidence of delayed gastric emptying among the patients receiving laparoscopic distal gastrectomy, and to explore their clinical features and risk factors. METHODS: Clinical data were collected for 223 patients who underwent laparoscopic distal gastrectomy for gastric cancer. We retrospectively evaluated the clinicopathological features and analyzed the incidence of delayed gastric emptying among 223 patients. Delayed gastric emptying was diagnosed by patient's symptoms and the plane radiograph with an air fluid level and dilation of the remnant stomach. RESULTS: Delayed gastric emptying was found in five (2.2%) of the 223 patients. By univariate logistic regression analysis, greater American Society of Anesthesiologists Physical Status (ASA-PS) and older age were significantly related to occurrence of delayed gastric emptying. By multivariate logistic regression analysis, older age was independently significantly related to incident delayed gastric emptying. The area under the curve (AUC) ((95% CI) of the receiver operating characteristic (ROC) was 0.842 (0.561-0.957). The best cutoff for discriminating patients with and without delayed gastric emptying was 80 years (sensitivity 80% and specificity 83%). CONCLUSION: Our study found the occurrence of delayed gastric emptying is possibly correlated with age. Therefore, careful perioperative observation in elderly patients may possibly be important for possible development of delayed gastric emptying after laparoscopic distal gastrectomy.

Repair of a perineal hernia with a bladder patch after abdominoperineal resection: A case report and literature review.

Perineal hernia is the protrusion of the intra-abdominal viscera through the pelvic floor. It rarely occurs after abdominoperineal resection but has increasingly occurred after surgical treatment for rectal cancer. A patient was diagnosed as having perineal hernia 10 days after laparoscopic abdominoperineal resection with preoperative radiotherapy and chemotherapy. He presented with epigastric discomfort and perineal wound dehiscence. Perineal hernia was confirmed by computed tomography scan and treated with a semi-emergency surgery. The surgical field was contaminated because of the perineal wound dehiscence. The levator muscle at the pelvic floor was not sufficient, so we used a bladder patch to cover the pelvic inlet. The surgery was performed without any adverse events. To our best knowledge, this is the first case report to present the usefulness of a bladder patch for the treatment of a perineal hernia using a laparoscopic transabdominal approach in emergency situations.

[Staple dysfunction due to calcification of the pulmonary parenchyma].

A 77-year-old man who had been treated right pneumothorax by chest tube drainage 2 times visited our hospital due to dyspnea. He had been treated by home oxygen therapy due to pulmonary silicosis. Chest radiography showed a relapse of right pneumothorax. Video-assisted thoracic surgery was performed and the air leakage point was identified at bullae both of the upper and lower lobe of the lung. When we performed to staple and to resect bullae of the upper lobe, staple dysfunction happened to occur. Hard nodule in the pulmonary parenchyma was noted by palpation. Since intrapulmonary calcification of the upper lobe was shown by thoracic computed tomography (CT) prior surgery, the calcified lesion thought to be a cause of the staple dysfunction.

[A case of gastric large cell neuroendocrine carcinoma (LCNEC) for whom chemotherapy of CDDP+CPT-11 proved very effective].

Large cell neuroendocrine carcinoma(LCNEC)is a relatively new category with biological behavior similar to small cell carcinoma. Thus, it is reportedly well treated by the same chemotherapy as for small cell carcinoma. We experienced a case of gastric large cell neuroendocrine carcinoma, treated very effectively by CDDP+CPT-11.60 mg/m(2) of CDDP was administered on day 1, and 60 mg/m(2) of CPT-11 on day 1, 8 and 15. An intermission after administration for 14 days made for one course. Four courses were carried out. A complete response was obtained for a primary gastric lesion and liver metastasis, and a partial response was obtained for lymph node metastases. So far it has showed no change for 6 months after chemotherapy. Both CDDP and CPT-11 are key drugs in the chemotherapy for common gastric cancer, and it is sometimes difficult to distinguish large cell neuroendocrine carcinoma from poorly-differentiated gastric cancer. We found this combination chemotherapy is a suitable regimen for the assumed existence of large cell neuroendocrine carcinoma at the gastric lesion.