A multi-institutional prospective observational study to compare postoperative quality of life of patients who undergo total or proximal gastrectomy for early gastric cancer (CCOG1602).

BACKGROUND: Proximal gastrectomy (PG) has become an increasingly preferred procedure for treating early cancer in the upper third of the stomach. However, advantages of PG in postoperative quality of life (QOL) over total gastrectomy (TG) has not fully proven. METHODS: We conducted a multi-institutional prospective observational study (CCOG1602) of patients who undergo TG or PG for cStage I gastric cancer. We used the PGSAS-37 and EORTC-QLQ-C30 to evaluate the changes in body weight and QOL over a 3-year postoperative period. The primary endpoint was the weight loss rate 3 years after surgery. RESULTS: We enrolled 109 patients from 18 institutions and selected 65 and 19 patients for inclusion in the TG and PG groups, respectively. Mean postoperative weight loss rates were 16.0% and 11.7% for the TG and PG groups, respectively (p = 0.056, Cohen's d 0.656) during postoperative year 1% and 15.0% and 10.8% for TG and PG (p = 0.068, Cohen's d 0.543), respectively, during postoperative year 3, indicating that the PG group achieved a better trend with a moderate effect size. According to the PGSAS-37, the PG group experienced a better trend in the indigestion subscale (p < 0.001, Cohen's d -1.085) and total symptom score (p = 0.050, Cohen's d -0.59) during postoperative year 3 compared with the TG group. In contrast, the EORTC-QLQ-C30 detected no difference between the groups at any time point during 3-year postoperative period. CONCLUSIONS: This prospective study demonstrates that PG tended to be more favorable compared with TG with respect to postoperative weight loss and QOL, particularly regarding indigestion.

[A Case of Small Cell Carcinoma of Esophagus in Which Long-Term Survival Was Achieved with Multimodal Treatment].

A 79-year-old man presented to our hospital with 1-month history of discomfort on swallowing and pain in the thoracodorsal region. Image investigation revealed a tumor lesion affecting the area from the lower esophagus to the gastric antrum, and small cell carcinoma of esophagus was diagnosed based on biopsy. He was treated with resection of the lower esophagus and the upper part of the stomach and a postoperative chemoradiotherapy. The patient follow-upwas without recurrence until a malignant lymphoma developed 4 years and 5 months after the surgery. Chemotherapy was provided for the malignant lymphoma, however, the patient died 6 years and 4 months after the surgery for small cell carcinoma of esophagus. Small cell endocrine carcinoma of the esophagus is a relatively rare disease and its prognosis is poor. In our patient, long-term survival was achieved with multimodal treatment, however malignant lymphoma developed during the follow-upp eriod. This is the second case of metachronous cancer after the treatment for small cell carcinoma of the esophagus in Japan, and it is considered to be extremely rare.

Curative surgery for gastric cancer of the elderly in a Japanese regional hospital.

BACKGROUND/AIMS: The aim of this study was to identify the factors influencing mortality, morbidity and survival for gastric cancer in patients 80 years of age and older. METHODOLOGY: This retrospective study of gastric cancer in the elderly was conducted from 2003 to 2008. We examined demographic data, treatment, causes of death and their overall survival. RESULTS: On gastric cancer in the elderly, the stage IV was significantly higher in non-surgery group (47%) than in surgery group (12%). Moreover, non-surgery group had significantly more cardiac disease (p = 0.007) and previous stroke (p = 0.035) than surgery group. Differences in overall survival were statistically significant among stage I (p = 0.025) and stage II/III (p <0.001) patients. The other, the overall survival difference was not statistically significant between surgery group and non-surgery group, in stage IV (p = 0.05). CONCLUSIONS: In the study, age is not the only contraindication to resection for gastric cancer because when elderly patients undergo curative resection, they do not have a worse prognosis than without surgery group. In the elderly, the surgical strategy must be always modulated on the basis of preoperative comorbidities, the degree of the tumor spread, and the expected equality of life offered by a surgical procedure.

Fine needle aspiration cytology of nodular fasciitis of the breast.

We report a case of nodular fasciitis (NF) of the breast, which was cytologically diagnosed as a spindle cell proliferation with undetermined malignant potential. Owing to small size of the lesion (5.9 × 3.7 × 4.1 mm), only fine needle aspiration (FNA) cytology was performed under ultrasound guidance. The FNA smears were cellular, rich in single/clustered spindle cells but mammary ductal epithelial/myoepithelial cells were absent. These cytologic findings suggested spindle cell growth of mesenchymal origin. Pattern-less arrangement of spindle cells, heterogeneous composition of the stromal matrix, lack of nuclear/cellular atypia, occasional mitosis but no aberrant mitotic figures, and lymphocyte infiltration indicated reactive rather than neoplastic nature of the lesion. Nonetheless, lumpectomy was conducted because the possibility of neoplasm was not completely ruled out. The histologic diagnosis of the resected nodule was NF. FNA specimens were reviewed thoroughly in an attempt to define the key cytomorphologic features of NF that are important for the correct diagnosis. Differential diagnoses from the lesions that show similar cytologic pictures are discussed in detail. Although NF arising from the breast is rare, cytopathologists should be aware of its clinical and cytopathologic characteristics. Knowledge of the possibility of NF in the breast and its cytologic findings may help cytopathologists to discern its reactive, not neoplastic, characteristics of the lesion. If the referring surgeon is alerted NF as a possibility along with other differential diagnoses, close observation would become a management option. In-depth discussion of cytologic features and a review of the pertinent literature are also included.

Surgical treatment for rectal cancer with abnormally expanded inferior mesenteric vein resulting from pancreatic arteriovenous malformations.

A 52-year-old Japanese man presented for evaluation and treatment of rectal cancer. Screening computed tomography revealed pancreatic arteriovenous malformations (P-AVMs) and abnormally expanded inferior mesenteric vein (IMV) that resulted from P-AVMs. One-stage surgery for rectal cancer was dangerous so we first performed distal pancreatectomy to cure P-AVM and thus normalize the abnormally expanded IMV. After the operation, the IMV was occluded by the thrombi, and then the IMV became normal. We could perform safely radical laparoscopic surgery for rectal cancer. This is the first case report of P-AVMs combined with rectal cancer.

Absence of the caveolin-1 P132L mutation in cancers of the breast and other organs.

Caveolin-1 belongs to a family of scaffolding proteins, and the P132L point mutation of this gene has been found in up to 16% of all examined breast cancers. Subsequent studies have revealed that the P132L mutation exerts a dominant negative effect through misfolding during caveolin-1 oligomerization. However, this mutation has not been validated in other series of breast cancer samples. Contradictory to the suggested tumor suppressor function, overexpression of caveolin-1 is common in various cancer types. To clarify these inconsistent results, we examined the caveolin-1 mutation in a large series of breast cancer specimens. We first used a standard direct sequencing method and found that none of the 99 breast cancers tested had this mutation. Then we developed a sensitive method for a paraffin section that could detect the mutant allele at a rate of as little as 0.1% among wild-type allele copies. Even when using this sensitive method, none of the 80 estrogen receptor-positive breast tumors had the P132L mutation. Furthermore, 270 cancers in various organs were examined, and no caveolin-1 mutations were detected. These results raise doubt about the presence of the caveolin-1 P132L mutation in breast cancer and other cancer types, and thus further studies are warranted.