Does Roux-en Y reconstruction with jejunal pouch after total gastrectomy prevent complications of postgastrectomy?

BACKGROUND/AIMS: To evaluate the efficacy of a jejunal pouch after a total gastrectomy with Roux-en Y reconstruction. METHODOLOGY: Thirty patients with gastric cancer who had a total gastrectomy as a radical operation and had no recurrence were enrolled in this study. The jejunal pouch was added to Roux-en Y reconstruction in 15 patients (J-pouch group) and was not added in the other 15 patients (Roux en-Y group). A questionnaire survey which consisted of dietary intake, postprandial abdominal complaints and body weight, blood examination (hemoglobin, total protein, albumin), were conducted. The 99mTc-DTPA with semi-liquid diet emptying test and the manometry in the jejunal pouch were evaluated in 12, 2 of the J-pouch group, respectively. RESULTS: There were no significant differences between the two groups in the questionnaire survey and blood examination. The half emptying time (T1/2) of 99mTc-DTPA was over 60 minutes in 9 of the 12 J-pouch group. The manometric study did not reveal the effective contraction of the jejunal pouch. Bypass operation was necessary due to marked delay of emptying in the jejunal pouch for one patient in the J-pouch group. CONCLUSIONS: The advantage of adding a jejunal pouch to Roux en-Y reconstruction was not proven in this study.

Pyrimidine nucleoside phosphorylase and dihydropyrimidine dihydrogenase activities as predictive factors for the efficacy of doxifluridine together with mitomycin C as adjuvant chemotherapy in primary colorectal cancer.

BACKGROUND/AIMS: Pyrimidine Nucleoside Phosphorylase (PyNPase) converts 5'-deoxy-5-fluorouridine (5'-DFUR, doxifluridine) to 5-fluorouracil (5-FU). While this reaction is taking place Dihydropyrimidine Dihydrogenase (DPD) catalyzes 5-FU to inactive molecules. Mitomycin C (MMC) elevates the PyNPase level in tumor cells. METHODOLOGY: We investigated 17 colorectal cancer patients' PyNPase and DPD activities in tumor and normal tissues using an enzyme-linked immunosorbent assay (ELISA) to assess their clinical significance as indicators for selecting colorectal cancer patients for 5'-DFUR together with MMC as adjuvant chemotherapy. RESULTS: Six of 17 patients developed experienced a recurrence. Tumor DPD activity of the 6 patients who had a recurrence were higher than those of the 11 patients with no recurrence (p = 0.047). On the other hand, there were no significant differences in both the PyNPase and the PyNPase/DPD (P/D) ratio between the group with recurrence and the group without recurrence. For survival analyses, we designed the cut-off value of tumor PyNPase, DPD and P/D ratio as their median value and classified patients into a higher group and a lower group, but there were no significant differences between the groups. CONCLUSIONS: The DPD activity in the tumor may be a useful indicator for selecting patients likely respond to 5'-DFUR together with MMC as adjuvant chemotherapy. If tumor DPD is high, we had better select a different anticancer drug.

Usefulness of local excision for early lower rectal cancer.

BACKGROUND/AIMS: The purpose of this study was to examine the long-term results of transanal excision compared with major surgery for lower rectal cancer. METHODOLOGY: This retrospective study included 14 patients with early rectal cancer within 8cm from the anal verge treated by local excision in the period from January 1991 to December 2000, and 16 patients treated by major surgery in the period from January 1996 to December 2000. We evaluated the prognosis or anorectal or urinary function of these patients. RESULTS: Six of the patients had additional treatments which included additional resection or adju vant chemotherapy. None of these patients had macroscopic tumor remnants (R2). With the exception of one patient who died of heart disease, all of the patients survived without metastasis. Anorectal and urinary function maintained a good status. CONCLUSIONS: Local excision for early rectal cancer (Tis N0 M0) brought an excellent outcome, and maintained good anorectal and urinary function. We recommend local excision for the early rectal cancer patients.

Squamous cell carcinoma of the descending colon: report of a case and literature review.

It is very rare that squamous cell carcinoma (SCC) arises from colorectal epithelium. An 89-year-old man was treated in 2001 with chief complaints of anorexia, abdominal pain, and low grade fever. The histological diagnosis as SCC was determined by biopsy during a colonoscopy. We diagnosed primary SCC of the colon because except in the colon no malignant lesions were found by systemic CT. Surgical complete resection was performed. However, he died three months after surgical resection because of hepatic metastasis and cachexia. The prognosis of this disease seems to be worse than that of adenocarcinoma.