Feasibility study of S-1 adjuvant chemotherapy in patients with colorectal cancer.

BACKGROUND: We evaluated the safety, efficacy, and compliance of 1-year treatment with S-1 in patients with stage II/III resectable colorectal cancer. METHODS: S-1 was administered orally in two divided doses daily. The dose was assigned according to body surface area (BSA) as follows: BSA <1.25 m(2), 80 mg/day; BSA ≥1.25 to <1.5 m(2), 100 mg/day; and BSA ≥1.5 m(2), 120 mg/day. S-1 was given for 28 consecutive days, followed by a 14-day rest. The study objects were the rate of completion of treatment as planned at 1 year, the ratio of the actually administered dose to the planned dose at 1 year, and the total number of days of treatment. RESULTS: At 1 year, the rate of completion of treatment as planned was 77.7 % (42/54 patients), and the ratio of the actually administered dose to the planned dose was 82.9 %. The mean and median total numbers of days of treatment were 209 and 252, respectively. Grade 3 or higher toxicity (watery eyes) occurred in only 1 patient. CONCLUSION: S-1 adjuvant chemotherapy had acceptable compliance, safety, and efficacy in patients with colorectal cancer. S-1 adjuvant chemotherapy is considered a possible standard treatment regimen for colorectal cancer.

Carcinoembryonic antigen and carbohydrate antigen 19-9 are prognostic predictors of colorectal cancer with unresectable liver metastasis.

No evidence currently exists to demonstrate the prognostic value of serum carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA19-9) in patients with unresectable colorectal cancer liver metastases (CRLM). Therefore, we retrospectively investigated the correlation between serum CEA and CA19-9 levels and overall survival in patients with unresectable CRLM. The study involved 40 patients who were diagnosed with unresectable CRLM between March 2000 and August 2010 at Jikei University Hospital, Japan. We retrospectively investigated the correlation between patient characteristics, including serum CEA and CA19-9 levels, and overall survival using univariate and multivariate analyses. In the univariate analysis, the absence of primary tumor resection (p=0.0161), the absence of systemic chemotherapy (p=0.0119), serum CEA ≥100 ng/ml (p=0.0148) and CA19-9 ≥100 U/ml (p<0.0001) were significant predictors of poor survival. In the multivariate analysis, the absence of systemic chemotherapy (p=0.0356), serum CEA ≥100 ng/ml (p=0.0079) and CA19-9 ≥100 U/ml (p=0.0002) were independent predictors. Serum CEA and CA19-9 levels are therefore independent prognostic predictors of survival in patients with unresectable CRLM.

Increased lymphatic vessels in patients with encapsulating peritoneal sclerosis.

BACKGROUND: The angiogenic response is partly involved in the progression of encapsulating peritoneal sclerosis (EPS). However, the details of the angiogenic response, especially for lymphatic vessels in patients with EPS, remain unclear. In addition, because of technical limitations, morphology studies reported to date have examined only the parietal peritoneum. The morphologies of parietal and visceral lymphatic vessels in patients with EPS both need to be analyzed. METHODS: We examined peritoneal samples from 18 patients with EPS who underwent enterolysis of the visceral peritoneum and compared them with samples from 17 autopsy cases (controls). To examine the angiogenic response, we performed immunohistochemistry for the endothelial markers CD34 (blood vessels) and podoplanin (lymphatic vessels) and for the cell proliferation marker Ki-67. Immunogold electron microscopy analysis for podoplanin was also performed. In 7 of 18 cases, we compared differences in the angiogenic response of the parietal and visceral peritoneal membranes. RESULTS: Angiogenic responses were more frequent in the compact zone than in regenerated layers. The number of capillaries positive for anti-CD34 and anti-podoplanin monoclonal antibodies per unit area of visceral peritoneal tissue was, respectively, 41.1 ± 29.3/mm(2) in EPS patients and 2.7 ± 4.4/mm(2) in controls (p ≤ 0.01) and 48.1 ± 43.9/mm(2) in EPS patients and 4.1 ± 5.4/mm(2) in controls (p ≤ 0.01). The percentage of capillaries positive for anti-Ki-67, CD34, and podoplanin was 4.6% in EPS patients (p ≤ 0.01) and 0.8% in controls (p = 0.09). The immunogold electron microscopy analysis revealed that podoplanin was localized to endothelial cells with anchoring filaments, a specific feature of lymphatic vessels. Furthermore, compared with parietal peritoneal membrane, visceral peritoneal membrane had a more prominent podoplanin-positive capillary profile, but not a prominent CD34-positive capillary profile. In addition, fibroblast-like cells double-positive for podoplanin and smooth muscle actin were markedly increased in the degenerated layer, as previously reported. CONCLUSIONS: Our study demonstrated that lymphatic vessels are increased in the visceral peritoneum of patients with EPS.

Early cystoadenocarcinoma of vermiform appendix simulating submucosal tumor of the cecum.

Colonoscopy was performed on a 54-year-old man with occult melena in our hospital. A submucosal tumor with a maximum diameter of 5cm was detected in the cecum. The tissue of the submucosal tumor was not obtained by endoscopic biopsy, and tumor diagnosis could not be confirmed by this method. A large, hypodense, cystic structure extending below the inferior wall of the cecum was revealed by computed tomography (CT). Because the tumor was too large to be a benign tumor, we were able to conclude it was malignant. After receiving informed consent from the patient, laparoscopic right colectomy was performed for both diagnosis and treatment in June 2004. As the swollen vermiform appendix pressed the cecum extraluminally, endoscopic examination indicated the possibility of submucosal tumor. Postoperative pathological diagnosis was cystoadenocarcinoma, the tumor was extended within the mucosal layer, and no lymph node metastasis was detected. Cancer cells were not present in the viscous liquid of the vermiform appendix intracavitary, either. The patient left the hospital in 10 days postoperatively. He regularly underwent examinations including CT, and no recurrence was detected for more than 24 months following the laparoscopic operation.

How can we control intraoperative bacterial contamination and surgical-site infection during an anterior resection or Hartmann's/Miles' operation?

PURPOSE: Intraoperative bacterial contamination (IBC) is a major cause of surgical-site infection (SSI). Therefore, we investigated whether the ingenuity of surgical procedures could reduce the incidence of IBC/SSI. METHODS: Sixty patients who were surgically treated for recto-sigmoid cancer were investigated. Among these patients, the colon was transected during the early perioperative period (ET) in 29 patients and during the late period (LT) in 31 patients. Three samples for IBC were obtained from the irrigation fluid before abdominal closure (LAVAGE), the remaining cut sutures after peritoneal closure (SUTURE), and a subcutaneous swab of the wound (SUBCUT). RESULTS: The overall SSI and IBC rates were 25% and 55.2%, respectively. Patients who developed SSI had an extremely high IBC rate (85%), and IBC patients also had a high SSI rate (68%). IBC was highest in the LAVAGE (26%) followed by the SUBCUT (26%), and the SUTURE (12%). The incidence of IBC in the LT was significantly lower than that in the ET (19% vs. 55%, p < 0.01), although the incidence of SSI was similar in both IBC groups. CONCLUSION: Shortening the exposure of the colonic mucosa decreased the incidence of IBC/SSI; thus, careful operations to minimize IBC are recommended.

Importance of thymidine phosphorylase, dihydropyrimidine dehydrogenase and thymidylate synthase expression at the invasive front of T3 rectal cancer as prognostic factors.

BACKGROUND/AIMS: We evaluated a relationship between postoperative recurrence and thymidine phosphorylase (TP), dihydropyrimidine dehydrogenase (DPD) and thymidylate synthase (TS) expression at the invasive front of T3 rectal cancer. METHODOLOGY: This study was conducted on 61 patients with T3 rectal cancer who underwent surgically curative resection between 1998 and 2002. Paraffin-embedded sections of these patients were immunostained for TP, DPD and TS. Relationship between expression level of the three factors and postoperative recurrence were evaluated. RESULTS: There was no relationship between expression of DPD or TS in the tumor cells and recurrences. Although no relationship was present between expression of TP in the stromal cells around the invasive front of the tumor and postoperative recurrences, there was a strong correlation between expression of TP in the invasive front of the tumor and postoperative recurrence. Moreover, by multivariate logistic regression analysis, TP expression in the tumor cells was the only independent contributory factor for postoperative recurrences (p = 0.021) with an odds ratio of 8.27. CONCLUSIONS: TP expression at the invasive front of the tumor may be an important prognostic factor for T3 rectal cancer, and patients with such a condition may benefit from intensive chemotherapy.