Language：English   Publishing type：Research paper (scientific journal)  

Colorectal lipomas are benign tumors that are often asymptomatic and discovered incidentally. In most cases, they can be managed conservatively with observation. We report the case of a man in his 70s with a colorectal lipoma located in the cecum. An investigation into his severe anemia led to the suspicion that the cecal lipoma was the underlying cause. An ileocecal resection was performed. Erosions were observed at the center of the lipoma. Although small colorectal lipomas are generally asymptomatic and rarely cause anemia, periodic endoscopic examinations are recommended. These lesions should be considered in the differential diagnosis of lower gastrointestinal bleeding.

DOI： 10.7759/cureus.85768

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Colorectal cancer (CRC) is considered the third most common type of cancer worldwide. Tumor-associated macrophages (TAMs) have been shown to promote drug resistance. Adenosine-to-inosine RNA-editing, as regulated by adenosine deaminase acting on RNA (ADAR), is a process that induces the posttranscriptional modification of critical oncogenes. The aim of this study is to determine whether the signals from cancer cells would induce RNA-editing in macrophages. METHODS: The effects of RNA-editing on phenotypes in macrophages were analyzed using clinical samples and in vitro and in vivo models. RESULTS: The intensity of the RNA-editing enzyme ADAR1 (Adenosine deaminase acting on RNA 1) in cancer and mononuclear cells indicated a strong positive correlation between the nucleus and cytoplasm. The ADAR1-positive mononuclear cells were positive for CD68 and CD163, a marker for M2 macrophages. Cancer cells transport pro-inflammatory cytokines or ADAR1 protein directly to macrophages via the exosomes, promoting RNA-editing in AZIN1 (Antizyme Inhibitor 1) and GLI1 (Glioma-Associated Oncogene Homolog 1) and resulting in M2 macrophage polarization. GLI1 RNA-editing in the macrophages induced by cancer cells promotes the secretion of SPP1, which is supplied to the cancer cells. This activates the NFκB pathway in cancer cells, promoting oxaliplatin resistance. When the JAK inhibitors were administered, oncogenic RNA-editing in the macrophages was suppressed. This altered the macrophage polarization from M2 to M1 and decreased oxaliplatin resistance in cancer cells. CONCLUSIONS: This study revealed that ADAR1-high TAMs are crucial in regulating drug resistance in CRC and that targeting ADAR1 in TAMs could be a promising treatment approach for overcoming drug resistance in CRC.

DOI： 10.1186/s12943-025-02312-y

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Postoperative local recurrence remains an important issue in rectal cancer, and the optimal treatment strategy, surgical approach, and prognosis after treatment are yet to be addressed. PATIENTS AND METHODS: We reviewed 21 patients who underwent surgical resection at our department for postoperative pelvic local recurrence of rectal cancer between January 2013 and December 2022, and performed a retrospective analysis of outcomes in terms of preoperative treatment and surgical approach. RESULTS: Of the 21 patients, four (19%) were treated with upfront surgery (Upfront surgery group), 13 (62%) with chemotherapy (Chemotherapy group), and four (19%) with neoadjuvant chemoradiotherapy (NACRT; NACRT group). The surgical approach was open laparotomy (Open group) in 10 (47.6%) patients and minimally invasive surgery (MIS, MIS group) in 11 (52.4%). Seventeen (81.0%) had a negative resection margin (RM). Overall median postoperative survival was 71 months and median relapse-free survival was 6.2 months. The most common form of recurrence was pelvic local re-recurrence in seven patients (33.3%). By preoperative treatment type, the RM securement rate was higher in the Chemotherapy and NACRT groups than in the Upfront surgery group, and the postoperative recurrence rate was lowest in the NACRT group. By surgical approach, intraoperative blood loss and incidence of Clavien-Dindo Grade 3 or higher postoperative adverse events were both significantly lower in the MIS group than in the Open group. CONCLUSION: Surgical intervention for postoperative recurrence of rectal cancer results in good survival, but short relapse-free survival. NACRT can deter local re-recurrence after resection, and MIS may contribute to reducing complications.

DOI： 10.21873/anticanres.17513

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: The aging population challenges surgical management of rectal cancer. This study evaluated the short-term safety of robot-assisted rectal surgery (RARS) in patients aged 75 years and older, examining perioperative complications and surgical outcomes in this vulnerable population. PATIENTS AND METHODS: A single-center retrospective cohort study was conducted at Okayama University Hospital from September 2020 to December 2024, including 109 patients undergoing RARS. Patients were divided into older (≥75 years, n=19) and non-older (<75 years, n=90) groups. Surgical procedures utilized the da Vinci Xi system, with comprehensive assessment of perioperative characteristics and complications using the Clavien-Dindo classification. RESULTS: The older group demonstrated significantly higher American Society of Anesthesiologists classification (89.5% ≥2 vs. 58.9% in non-older group, p=0.036). Postoperative complications were more frequent in the older group (8 vs. 18 cases, p=0.04), though severe complications were similar to those in the non-older group. Median postoperative hospital stay was longer in the older group (12 vs. 9 days, p=0.01), but this difference disappeared when excluding stoma cases. Critically, no postoperative mortality was observed within 30 days in either group. CONCLUSION: Robot-assisted rectal surgery appears safe for patients aged 75 years and older. While the older group experienced more complications, these were predominantly manageable. The findings suggest that careful patient selection and experienced surgical teams can successfully employ robotic techniques in older patients while maintaining oncological standards.

DOI： 10.21873/anticanres.17516

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本胃癌学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Trifluridine/tipiracil (FTD/TPI) is one of the options for late-line treatment of colorectal cancer (CRC). However, the specific patient populations that would particularly benefit from it remain unclear. This study attempted to identify predictive markers of chemotherapy efficacy with trifluridine/tipiracil (FTD/TPI), focusing on the RNA-editing enzyme adenosine deaminase acting on RNA 1 (ADAR1) expression and neutrophil-lymphocyte ratio (NLR). METHODS: To assess the effectiveness of FTD/TPI in CRC patients, we retrospectively analyzed 72 CRC patients at Okayama University Hospital from 2014 to 2022. RESULTS: Adding bevacizumab to FTD/TPI resulted in a more prolonged progression-free survival (PFS), consistent with the SUNLIGHT study findings (p = 0.0028). Among the participants, those with a high NLR had a shorter PFS (p = 0.0395). Moreover, high ADAR1 expression was associated with longer PFS (p = 0.0151). In multivariate analysis, low ADAR1 (HR = 3.43, p = 0.01) and absence of bevacizumab (HR = 4.25, p = 0.01) were identified as factors shortening PFS. The high ADAR1 group demonstrated fewer cases of progressive disease and a higher proportion of stable disease than the low ADAR1 group (p = 0.0288). Low NLR and high ADAR1 were predictive markers of prolonged PFS in the bevacizumab-treated group (p = 0.0036). CONCLUSION: Low NLR and high ADAR1 were predictive markers for a positive response to the FTD/TPI plus bevacizumab regimen associated with prolonged PFS. The FTD/TPI plus bevacizumab regimen should be proactively implemented in the low NLR and high ADAR1 subgroups.

DOI： 10.1186/s12885-024-13370-8

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Gastric diverticulum is a rare condition, often asymptomatic and incidentally detected. Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric procedure, but a gastric diverticulum complicates surgical planning. In this case, careful preoperative assessment allowed safe execution of LSG despite the diverticulum's proximity to the esophagogastric junction. CASE PRESENTATION: A 45-year-old woman (BMI: 46.8 kg/m2) with hypertension, dyslipidemia, and glucose intolerance was referred for bariatric surgery after unsuccessful weight loss with conservative management. Preoperative endoscopy revealed an 18 × 14 mm gastric diverticulum on the posterior wall of the gastric fundus, 40 mm from the esophagogastric junction. LSG was performed using a surgical stapler, ensuring complete diverticulum resection while preserving gastric tube integrity. The surgery was uneventful, with minimal blood loss and a duration of 2 hours and 52 minutes. The patient had an uneventful postoperative course and was discharged on day 9. Her BMI decreased to 39.3 kg/m2 at the 1-year follow-up, with improved metabolic parameters. CONCLUSIONS: This case highlights the importance of thorough preoperative evaluation when performing LSG in patients with gastric diverticulum. Accurate endoscopic measurement of the diverticulum's location aids in determining the optimal resection line, ensuring surgical safety and efficacy. Surgeons should remain vigilant when encountering such anatomical variations to optimize outcomes in bariatric surgery.

DOI： 10.70352/scrj.cr.25-0141

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

To investigate the safety and efficacy of FOLFOXIRI as neoadjuvant chemotherapy (NAC) for locally advanced rectal cancer (LARC). The outcomes of preoperative and perioperative treatments, as well as long-term outcomes, were retrospectively compared between 26 patients who underwent FOLFOXIRI as NAC for LARC with cT3-4 and/or N+ at our institute between 2015 and 2022, and 31 patients with LARC who underwent neoadjuvant chemoradiotherapy (CAPOX-RT) at our institute between 2011 and 2022. Grade 3 or higher adverse events due to neoadjuvant treatment were significantly more common in the FOLFOXIRI group (11 cases, 42.3 %) than in the CAPOX-RT group (3 cases, 9.7 %), and most of these were neutropenia. Based on the postoperative pathological findings, the complete response rate was significantly lower in the FOLFOXIRI group (1 case, 3.8 %) than in the CAPOX-RT group (7 cases, 22.6 %), but there were no significant differences in the R0 resection rate, survival rate, or relapse-free survival rate. In the CAPOX-RT group, 17 patients (54.8 %) had anal preservation, and during the observation period, 4 patients required stoma construction due to loss of anal function in the late stage. In contrast, in the FOLFOXIRI group, there were no cases of loss of anal function among the 20 patients (76.9 %) who had anal preservation. FOLFOXIRI as NAC requires caution regarding hematological toxicity, but it can be an effective treatment option for patients with LARC who wish to preserve their anus.

DOI： 10.1016/j.ctarc.2025.101049

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Crohn's disease (CD) often leads to complex anorectal complications, posing significant challenges in surgical management. Transperineal abdominoperineal resection (TpAPR) has emerged as a minimally invasive alternative to APR. This study aims to evaluate the safety and efficacy of TpAPR compared to APR in patients with CD. METHODS: A retrospective analysis was conducted on 19 CD patients who underwent either minimally invasive TpAPR (n = 11) or APR (n = 8) between 2008 and 2023 from a single institution. The primary outcomes were assessed: intraoperative blood loss, operative time, and surgical site infection (SSI) rates. RESULTS: The minimally invasive TpAPR group exhibited significantly reduced intraoperative blood loss (223 mL vs. 533 mL, p = 0.04) and a lower incidence of SSI rates (36.4% vs. 75%, p = 0.07). Operative time and hospital stay were comparable between groups. CONCLUSION: Minimally invasive TpAPR demonstrates potential benefits over APR in reducing blood loss and SSI rates in CD patients. Further large-scale studies are warranted to confirm these findings.

DOI： 10.1111/ases.70149

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Colorectal cancer (CRC) presents a significant challenge in oldest-old patients (≥85 years), where surgical intervention carries substantial perioperative risks. Nutritional status is a crucial determinant of outcomes, and the Geriatric Nutritional Risk Index (GNRI) has shown promise. This prospective study aimed to validate the GNRI as a key indicator of perioperative outcomes in oldest-old patients undergoing CRC surgery, and to establish its utility in preoperative risk stratification. PATIENTS AND METHODS: This prospective study enrolled patients aged ≥85 years undergoing elective surgery for CRC. Preoperative GNRI was calculated using the formula: GNRI=14.89×serum albumin (g/dl)+41.7×[actual body weight/ideal body weight (corresponding to body mass index 22)]. Patients were stratified into two groups: GNRI >98 and GNRI ≤98. Baseline demographics, clinical characteristics, geriatric assessments (including Geriatric-8 and EuroQol 5 dimension), and postoperative complication rates were analyzed. RESULTS: Twenty-four patients (median age 88 years, interquartile range=86-91) were included: 11 in the GNRI >98 group and 13 in the GNRI ≤98 group. The patients with GNRI >98 demonstrated significantly better G8 scores (median 12 vs. 11, p<0.01) and EQ-5D index values (median 88 vs. 75.0, p<0.01). The postoperative complication rate was significantly higher in the GNRI ≤98 group (p=0.02). CONCLUSION: Preoperative GNRI effectively identifies oldest-old patients with CRC at increased risk for postoperative complications. A GNRI ≤98 correlates with poorer nutritional status and impaired geriatric functional parameters. These findings highlight GNRI's utility as a simple, valuable tool for preoperative risk stratification, potentially guiding interventions to optimize outcomes in this vulnerable population.

DOI： 10.21873/invivo.14080

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Rectal gastrointestinal stromal tumors (GISTs) are often asymptomatic and may be detected as giant tumors. This may require highly invasive surgery for radical resection. Here, we describe a 74-year-old man with a locally advanced non-metastatic GIST in the right anterolateral wall of the lower rectum. The tumor was giant (128 × 93 mm), and invasion into adjacent organs (right seminal vesicle and prostate gland) was suspected. Although neoadjuvant chemotherapy (NAC) with imatinib reduced the tumor size, it was still giant, 80 mm in diameter. Therefore, we performed super-low anterior resection using a robot-assisted laparoscopic approach with the transanal approach. The bi-directional approach enabled safe and precise surgery, is expected to increase the rate of anorectal preservation as well as R0 resection, and may prevent a decline in quality of life.

DOI： 10.7759/cureus.76352

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Our perioperative management center provides preoperative intervention and functional and nutritional assessments for colorectal cancer patients aged over 75 years. This study evaluated the associations of preoperative nutritional status with postoperative outcomes and prognosis in colorectal cancer patients aged 75 years or older. METHODS: This was a prospective, observational study of 71 colorectal cancer patients aged 75 years or older who underwent surgery between July 2020 and September 2022. The Subjective Global Assessment (SGA) was evaluated as a nutritional index. The patients were classified into three groups: SGA-A (well nourished), B (moderately malnourished), and C (severely malnourished), and the correlations with postoperative outcomes and prognosis were examined. RESULTS: The median age of the 71 patients (34 males, 37 females) was 78 (75-92) years, and their median body mass index (BMI) was 22.3 (13.4-31.9) kg/m2. Forty-eight patients had colon cancer, and 23 had rectal cancer. On the SGA, 28 patients were SGA-A, 25 SGA-B, and 18 SGA-C. The SGA-B/C group had significantly higher BMI (p < 0.01) and more ICU admissions (p = 0.02). The G8 score was significantly lower (p = 0.03) in the SGA-B/C group, suggesting coexisting functional decline. In terms of postoperative outcomes, the SGA-B/C group had a significantly longer postoperative hospital stay (p = 0.04). The 3-year OS rates for all stages were 100% in the SGA-A group and 49.7% in the SGA-B/C group (p = 0.03), while the 3-year OS rates for patients excluding Stage IV were 100% in the SGA-A group and 68.5% in the SGA-B/C group, not significantly different (p = 0.14). The 3-year RFS rate was 95.5% in the SGA-A group and 65.3% in the SGA-B/C group (p = 0.15). CONCLUSION: The SGA is a promising nutritional index associated with short-term outcomes in older patients undergoing colorectal cancer surgery. The SGA can be assessed in a few minutes during an outpatient visit, making it useful for routine clinical use.

DOI： 10.1007/s00423-024-03548-w

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Myeloid sarcoma (MS) is an extramedullary tumor constituted by myeloid blasts or immature myeloid cells. It frequently occurs in conjunction with acute myeloid leukemia (AML); however, it can exceptionally manifest in patients without leukemia. Here, we present a rare case of primary MS originating in the small bowel without evidence of bone marrow involvement. CASE REPRESENTATION: A 33 year-old female with no relevant medical history was admitted to our hospital with recurrent abdominal pain. Computed tomography (CT) revealed bowel obstruction due to thickening of the ileum wall, which was suspected to be an ileal tumor. Initially, ectopic endometriosis was suspected because of abdominal pain associated with the menstrual cycle and changes observed on a follow-up CT scan. The lesion could not be detected by double-balloon endoscopy. Despite conservative treatment, the obstruction persisted, and laparoscopic partial ileal resection was performed, which revealed extensive involvement of the ileum and mesentery. Additionally, the mesentery of the resected ileum was extremely thickened. Histopathological and immunohistochemical examinations of the surgical specimen indicated ileal MS. Bone marrow aspiration after discharge was negative for cytological findings of leukemia, leading to a final diagnosis of primary ileal MS. Her postoperative course was uneventful, and she is currently undergoing systemic chemotherapy tailored to AML at another hospital. CONCLUSIONS: Even though MS of the small bowel is rare and may not be considered preoperatively, similar surgical treatment to that of other small bowel malignancies can ensure proper postoperative diagnosis and appropriate chemotherapy. Given the potential need for chemotherapy, ensuring surgical safety that allows for its rapid initiation is critical.

DOI： 10.1186/s40792-024-02030-5

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

A minimally invasive approach using laparoscopy or robotics has become the standard procedure in surgery for colorectal cancer. However, obesity is considered to be associated with a poor prognosis in laparoscopic colorectal surgery. Perioperative management, as well as the surgical procedure, is particularly important in severely obese patients. A case of colon cancer with severe obesity that underwent laparoscopic colectomy and was managed safely by multidisciplinary perioperative management in collaboration with a bariatric and metabolic surgery (BMS) team is presented. The patient was severely obese, with a body mass index (BMI) of 50.4 kg/m2. After one month of preoperative weight loss intervention by the BMS team, the patient's weight was successfully decreased by approximately 15 kg (BMI: 46 kg/m2), and the patient underwent laparoscopic colectomy for transverse colon cancer in collaboration with the BMS team. In the laparoscopic surgery, a small incision for specimen removal was made above the umbilicus to insert the first trocar safely, and five additional trocars, whose placement was determined based on the target vessels of the dissected lymph nodes in reference to preoperative computed tomography (CT), were also inserted above the umbilicus. Gastrointestinal reconstruction was performed intracorporeally by an overlap technique using an endoscopic linear stapler to perform the procedure safely with minimal invasiveness. The patient was discharged on postoperative day eight without any postoperative complications, following early postoperative rehabilitation with intervention by the BMS team. The proportion of colorectal cancer patients with obesity is expected to increase in the future, and the establishment of multidisciplinary perioperative management and surgical techniques will be useful to improve the surgical outcomes and prognosis of colorectal cancer patients with severe obesity.

DOI： 10.7759/cureus.71401

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

BRAF-mutant microsatellite-stable colorectal cancer (CRC), metastasized to distant sites, is associated with a poor prognosis. However, the BEACON CRC regimen, comprising a BRAF inhibitor, MEK inhibitor, and anti-EGFR antibody, offered a prolonged prognosis. Nonetheless, resistance to this regimen may occur, as observed in our reported case of CRC, where a KRAS mutation was identified in addition to the BRAF V600E mutation. Here, we present a case of 74-year-old woman with rectal cancer (pT4bN1bM0 Stage IIIc) harboring the BRAF V600E mutation. After resection of the primary tumor and during adjuvant chemotherapy using CAPOX (capecitabine and oxaliplatin), liver and lung metastases became apparent, and a companion diagnosis test revealed the presence of a BRAF V600E mutation. The new lesions were deemed resistant to the CAPOX regimen, and we decided to introduce encorafenib and cetuximab. After resection of liver metastases, encorafenib and cetuximab were reintroduced, but a new lesion appeared in hepatic S7, indicating resistance to the encorafenib and cetuximab regimen. The resistant liver metastasis was subsequently resected. To elucidate the resistance mechanism, we conducted a comprehensive analysis using the FoundationOne CDx cancer gene panel test, revealing the presence of a KRAS Q61H mutation alongside the BRAF V600E mutation. Subsequent liquid biopsy after liver recurrence confirmed the persistence of the KRAS Q61H mutation. Our results highlight the significance of cancer genome profiling tests (CGP tests) and liquid biopsies in guiding treatment strategies for BRAF-mutant colorectal cancer. Therefore, CGP testing offers valuable information for treatment, even if it does not lead to new drug administrations.

DOI： 10.1007/s13691-024-00678-2

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English  

A 52-year-old, Japanese man presented to the hospital with a complaint of anal bleeding, and detailed examination resulted in a diagnosis of locally advanced rectal cancer. The patient underwent total neoadjuvant therapy followed by short-course radiation therapy and consolidation chemotherapy, which provided a partial response. After preoperative contrast-enhanced computed tomography showed a horseshoe kidney, robot-assisted, precise, laparoscopic, low anterior resection with D3 dissection and ileostomy construction was performed. The horseshoe renal isthmus was elevated surrounding the inferior mesenteric artery, and the left ureter and seminal vessels ran in front of the kidney. The hypogastric nerve traveled ventral to the horseshoe kidney. With robotic surgery, it was possible to perform more precise surgery while recognizing vascular and nerve anatomy in a rectal cancer patient with a horseshoe kidney due to good three-dimensional visibility and articulated forceps manipulation.

DOI： 10.1111/ases.13296

PubMed

researchmap

Language：English  

A 90-year-old Japanese woman who had been aware of a subcutaneous mass on the right perineal region for 5 years was referred to our hospital for further examination and treatment because of the rapid growth of the mass and bleeding that began 3 months earlier. A biopsy of the mass revealed a diagnosis of well-differentiated squamous cell carcinoma. On preoperative examination, the tumor was 90×40 mm in size and was suspected to have partially invaded the levator ani muscle and external sphincter. Since a preoperative cardiac evaluation indicated severe aortic stenosis, we performed transcatheter aortic valve implantation. A radical resection was then performed with general anesthesia. The skin and subcutaneous tissue defects were reconstructed with a posterior gluteal-thigh propeller flap, and a sigmoid colostomy was created. The patient had a good postoperative course and was transferred to a rehabilitation facility 28 days after the surgery. Epidermal cysts are a common benign tumor, and clinicians should keep in mind that these cysts can become malignant.

DOI： 10.18926/AMO/66930

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Tailgut cyst is a rare cystic disease of the anterior sacral surface and the remains of an embryonic tail gut. Tailgut cysts have a potential for malignancy, and complete resection with an adequate surgical margin is necessary. Even if incomplete resection does not result in recurrence of malignant disease, there is a risk of local infection leading to refractory fistulas. The optimal treatment for such refractory recurrent lesions has not been reported. We describe a case in which the combination of laparoscopic and transsacral approaches was effective for resecting a recurrent refractory fistula after incomplete resection of a tail gut cyst.

DOI： 10.18926/AMO/66928

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Post-gastrectomy syndrome (PGS) and body weight loss (BWL) decrease quality of life (QOL) and survival of the patient undergoing gastrectomy. We have introduced perioperative and post-discharge continuous nutritional counseling (CNC) to prevent BWL and improve QOL after gastrectomy. In the present study, we evaluated the effect of CNC on QOL using the Post-gastrectomy Syndrome Assessment Scale-45 (PGSAS-45). Eighty-three patients with gastric cancer (GC) who underwent curative gastrectomy between March 2018 and July 2019 were retrospectively analyzed. Patients received either pre-discharge nutritional counseling alone (control group, n = 45) or CNC (CNC group, n = 38) after gastrectomy. QOL at 12 months after gastrectomy was compared between the two groups. In QOL assessment, change in body weight (-7.98% vs. -12.77%, p = 0.0057), ingested amount of food per meal (7.00 vs. 6.07, p = 0.042) and ability for working (1.89 vs. 2.36, p = 0.049) were significantly better in CNC group than control group. Multiple regression analysis showed that CNC was a significantly beneficial factor for abdominal pain subscale (p = 0.028), diarrhea subscale (p = 0.047), ingested amount of food per meal (p = 0.012), Ability for working (p = 0.031) and dissatisfaction at the meal (p = 0.047). Perioperative and postoperative CNC could improve QOL in the patient undergoing gastrectomy in addition to preventing postoperative BWL.

DOI： 10.1080/01635581.2024.2340782

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

researchmap

Language：English  

Navigation surgery using indocyanine green (ICG) fluorescence imaging has been used in thoracoabdominal surgery, and its usefulness has been reported in many cases. In this study, laparoscopic lateral lymph node dissection was performed using ICG fluorescence imaging in a patient with left femoral spinous cell carcinoma with inguinal and external iliac lymph node metastases. Spinous cell carcinoma is classified as a rare cancer in Japan, and there is a scarcity of evidence for pelvic lymph node dissection, as well as a lack of studies that mention the dissection area. We hypothesized that visualization of lymph nodes and lymph flow using intraoperative ICG fluorescence imaging would indicate the area of dissection and lead to more efficient dissection. In conclusion, intraoperative ICG fluorescence imaging may be useful in this area where there is limited evidence, although there are some limitations.

DOI： 10.1111/ases.13159

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本肥満学会  

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: An entero-neovesical fistula (ENF) is a rare troublesome complication of an orthotopic ileal bladder substitution. We report on a novel, safe technique to close ileal neovesical fistulas without extensive adhesiolysis using an NK-stapler (ENDOPATH® ENDOCUTTER ETS; Johnson & Johnson, Cincinnati, OH, USA). PATIENTS: We treated two cases of postoperative ENF after orthotopic ileal bladder substitution for radical cystectomy. Case 1 was a 63-year-old male with occasional fecaluria, and Case 2 was a 73-year-old male who experienced continuous fecaluria.Surgical procedureAfter laparotomy, we mobilized the ascending colon to bypass the anastomosis of the primary surgery by an ileo-ileal, ileo-ascending colon anastomosis. The distance between the fistula and bypass was about 10 cm. We made tunnels in the mesentery between the bypass and fistula, without damaging blood vessels, to insert the jaw of the NK-stapler. We closed the afferent and efferent loops using NK-staplers (45 mm ×2), followed by a Lembert anastomosis covering the stapler's suture lines. RESULTS: They were discharged on the ninth and seventh postoperative days, respectively. In Case 1, we experienced recanalization of the fistula after three postoperative months and required second closure with the same procedure was needed. They have not experienced any symptoms of ENF since. CONCLUSIONS: This technique is worth considering for the surgical treatment of ENF because it does not require unnecessary dissection and can ultimately achieve fistula closure.

DOI： 10.1177/03915603221110291

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Ureteral injury during pelvic surgery is a serious complication that requires special attention. The fluorescent ureteral catheter near-infrared ray catheter sets are 6.0F catheters containing fluorescent substances along their length that can be recognized by a laparoscopic indocyanine green camera. We present our experience using a near-infrared ray catheter in 6 consecutive patients who underwent surgery for recurrent pelvic tumors. TECHNIQUE: The near-infrared ray catheters were inserted into the bilateral ureters in all patients, with the exception of patient 5 (left unilateral), by urologists using a cystoscope with the same technique as that commonly used in placing ureteral stents under general anesthesia. A laparoscopic indocyanine green camera was adapted to identify the ureters. From February 2020 to July 2020, 6 consecutive patients with recurrent pelvic tumors underwent surgery using a near-infrared ray catheter. In 3 patients, recurrent tumors were detected in the pelvic cavity after surgery for colon cancer (1 patient each of peritoneal recurrence behind the seminal vesicles, lymph node metastasis on the residual superior rectal artery, and peritoneal recurrence at the peritoneal reflection). Two patients had postoperative local recurrences of rectal cancer. The last patient had a recurrence of cervical carcinoma invading the rectum. RESULTS: All patients underwent surgery under ureteral image navigation using near-infrared ray catheter not only for ureter preservation during the operation (4 patients) but also for the combined resection of the ureter with recurrent tumors (2 patients). One patient experienced postoperative ureteral stenosis on postoperative day 21 that required a ureteral double J-stent placement in the left ureter. CONCLUSION: Near-infrared ray catheter has the potential to reduce inadvertent periureteral dissection because the ureter can be identified before approaching it.

DOI： 10.1097/DCR.0000000000002144

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

The metastasis to the ureter in colorectal cancer had been recognized at the stage of an autopsy. These days, according to the progression of diagnostic modalities, a few cases of long-time survival after curative surgery of metastatic ureteral tumor of colorectal cancer were reported. We present a case of a metastatic ureteral tumor of rectal cancer who had 32 months of recurrence-free survival after extirpation. After preoperative chemoradiotherapy, a 47-year-old man underwent laparoscopic low anterior resection and left unilateral pelvic node dissection for lower rectal cancer. He underwent several metastasectomies for recurrent tumors in the liver and lung. At the 42nd postoperative month, a contrast-enhanced CT scan showed thickening of the ureteral wall and left hydronephrosis. Transureteroscopic biopsy revealed metastatic adenocarcinoma of rectal cancer. At the 52nd postoperative month, partial ureteral resection and vesicoureteral neo-anastomosis were performed after confirming negative resection margin with rapid intraoperative pathology. He has 32 months of recurrence-free survival after metastasectomy of the left ureter. We review the literature presenting surgery of the metastatic ureteral tumor of colorectal cancer. Although it is a rare recurrence pattern, curative resection of ureteral metastasis might provide a possibility of long-time recurrence-free survival in such patients.

DOI： 10.1007/s12328-021-01568-3

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 75-year-old woman was treated with TC plus Bev for cancer of unknown primary. During treatment, she presented to the clinic with chief complaints of general malaise and anorexia. On presentation, abdominal distention and upper abdominal tenderness were noted, and sepsis was suspected. A thoracoabdominal CT scan revealed prominent intramural emphysema and mesenteric gas in the ascending colon. An emergency laparotomy was performed for suspected pneumatosis intestinalis non-obstructive intestinal ischemia. However, no intra-abdominal contamination or ischemic changes were observed intraoperatively. Histological examination revealed a small adenocarcinoma on the serous surface of the ascending colon, and immunochemical staining confirmed the diagnosis of serous adenocarcinoma as the patient's primary cancer. This report describes a case in which the patient achieved long-term survival after diagnosis. It also emphasizes the importance of identifying the subset of patients with cancer of unknown primary who have a good prognosis in order to provide appropriate treatment.

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Hyperthermia has been used for cancer therapy for a long period of time, but has shown limited clinical efficacy. Induction-heating hyperthermia using the combination of magnetic nanoparticles (MNPs) and an alternating magnetic field (AMF), termed magnetic hyperthermia (MHT), has previously shown efficacy in an orthotopic mouse model of disseminated gastric cancer. In the present study, superparamagnetic iron oxide nanoparticles (SPIONs), a type of MNP, were conjugated with an anti-HER2 antibody, trastuzumab and termed anti-HER2-antibody-linked SPION nanoparticles (anti-HER2 SPIONs). Anti-HER2 SPIONs selectively targeted HER2-expressing cancer cells co-cultured along with normal fibroblasts and HER2-negative cancer cells and caused apoptosis only in the HER2-expressing individual cancer cells. The results of the present study show proof-of-concept of a novel hyperthermia technology, immuno-MHT for selective cancer therapy, that targets individual cancer cells.Abbreviations: AMF: alternating magnetic field; DDW: double distilled water; DMEM: Dulbecco's Modified Eagle's; Medium; f: frequency; FBS: fetal bovine serum; FITC: Fluorescein isothiocyanate; GFP: green fluorescent protein; H: amplitude; Hsp: heat shock protein; MHT: magnetic hyperthermia; MNPs: magnetic nanoparticles; PI: propidium iodide; RFP: red fluorescent protein; SPION: superparamagnetic iron oxide (Fe3O4) nanoparticle.

DOI： 10.1080/15384101.2021.1915604

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

Magnetic hyperthermia (MHT), which combines magnetic nanoparticles (MNPs) with an alternating magnetic field (AMF), holds promise as a cancer therapy. There have been many studies about hyperthermia, most of which have been performed by direct injection of MNPs into tumor tissues. However, there have been no reports of treating peritoneal disseminated disease with MHT to date. In the present study, we treated peritoneal metastasis of gastric cancer with MHT using superparamagnetic iron oxide (Fe3O4) nanoparticle (SPION) coated with carboxydextran as an MNP, in an orthotopic mouse model mimicking early peritoneal disseminated disease of gastric cancer. SPIONs of an optimal size were intraperitoneally administered, and an AMF (390 kHz, 28 kAm-1) was applied for 10 minutes, four times every three days. Three weeks after the first MHT treatment, the peritoneal metastases were significantly inhibited compared with the AMF-alone group or the untreated-control group. The results of the present study show that MHT can be applied as a new treatment option for disseminated peritoneal gastric cancer.Abbreviations: AMF: alternating magnetic field; Cy1: cytology-positive; DMEM: Dulbecco's Modified Eagle's Medium; FBS: fetal bovine serum; H&E: hematoxylin and eosin; HIPEC: hyperthermic intraperitoneal chemotherapy; MEM: Minimum Essential Medium; MHT: magnetic hyperthermia; MNPs: magnetic nanoparticles; P0: macroscopic peritoneal dissemination; RFP: red fluorescent protein; SPION: superparamagnetic iron oxide (Fe3O4) nanoparticle.

DOI： 10.1080/15384101.2021.1919441

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: We present a para-sacral approach followed by a laparoscopic low anterior resection of gastrointestinal stromal tumours located between the urethra and the low rectum. METHOD: Case 1 is a 56-year-old male patient whose tumour (37 × 28 mm) was located 3.0 cm above the anal verge between the anterior wall of the rectum and the urethra; he underwent surgery after 14 months' administration of imatinib mesylate (400 mg/day). Case 2 is a 68-year-old male patient who presented with dysuria; a tumour (89 × 84 mm) was detected between the urethra and the anterior wall of the low rectum by MRI. He underwent surgery after 5 months' administration of imatinib mesylate (400 mg/day). In order to perform sphincter-preserving surgery and avoid injury not only to the tumour capsule but also to the urethra, a para-sacral approach followed by laparoscopic low anterior resection was adopted in these patients. Restoration of bowel continuity was done by coloanal anastomosis in case 1 and the double stapling technique in case 2. The postoperative course of the patients was uneventful. In case 2, tumour dissection from the urethra caused injury to the posterior wall of the urethra, which could be repaired easily under direct vision. The urethral catheter was removed after 117 postoperative days, and the diverting stoma was closed after 143 postoperative days. CONCLUSION: The para-sacral approach followed by a laparoscopic low anterior resection of an extraluminal gastrointestinal stromal tumour located between the urethra and anterior wall of the low rectum enables R0 resection of the tumour and an appropriate reconstruction of the rectum.

DOI： 10.1111/codi.15597

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

AIM: This study aimed to evaluate the relationship between p62 expression status and tumour regression grade in advanced rectal cancer. METHODS: We enrolled 47 consecutive patients with advanced rectal cancer who underwent chemoradiation therapy (CRT) before surgery. p62 expression in the biopsy specimens was immunohistochemically evaluated, and p62 expression score (staining intensity × positive tumour cells, %) was calculated (range 0-300). The relationship between p62 expression score and CRT effect was analysed. RESULTS: The staining intensity was +2 and +3 in 29 and 18 patients, respectively. The median proportion of positive neoplastic cells was 87.8%, and that of the p62 expression score was 200. Stronger staining intensity and a higher proportion of p62-positive neoplastic cells were significantly associated with CRT non-effectiveness (P = 0.0002 and P = 0.0116, respectively), and a higher p62 expression score was significantly associated with CRT non-effectiveness (P < 0.0001). The optimal cut-off value for predicting the CRT effect was 240. CONCLUSIONS: A higher p62 expression score was significantly associated with less CRT effectiveness in patients with advanced rectal cancer. Analysis of p62 expression score using biopsy specimens is a useful and easily assessable prediction marker for CRT effect and might help select patients who can undergo a 'watch-and-wait' strategy after CRT.

DOI： 10.1111/codi.15486

PubMed

researchmap

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/DCR.0000000000001851

PubMed

researchmap

Language：English  

DOI： 10.1111/codi.15478

PubMed

researchmap

Language：English  

BACKGROUND: We report two resected cases of solitary fibrous tumors (SFT) that were accidentally found in the pelvic cavity. CASE PRESENTATION: Case 1 was a 54-year-old male. A colonoscopy for the examination of intestinal polyps revealed an extramural tumor in the right anterior wall of the low rectum. A preoperative MRI showed a well-demarcated T1 low and T2 mixed intensity extramural tumor (53 × 36 mm) located right lateral to the low rectum and behind the seminal vesicle. Laparoscopic surgery was successful for tumor extirpation. Immunohistochemical examination of the specimen revealed STAT6 (+) and CD34 (+) cells, a Ki67 positivity of 7-8%, a mitotic index of 4-5/50 HPF, and a diagnosis of SFT. There was no recurrence 29 months after surgery. Using RT-PCR and sequencing, we detected the NAB2-STAT6 fusion gene but the locus of genomic inversion was not detected. Case 2 was a 43-year-old male that received conservative treatment for appendicitis. A CT scan accidentally revealed a tumor of 40 mm of length in the left obturator area. A MRI revealed a well-demarcated T1 and T2 high intensity tumor. The patient underwent surgical biopsy. Immunohistochemical examination of the biopsy revealed STAT6 (+) and CD34 (+) cells, Ki67 positive cells < 1%, and a diagnosis of SFT. We could not detect the NAB2-STAT6 fusion gene in the extirpated tumor. CONCLUSIONS: Two cases of pelvic SFT were diagnosed by immunohistochemical examination, RT-PCR and sequencing and successfully resected by laparoscopic surgery.

DOI： 10.1016/j.ijscr.2020.04.079

PubMed

researchmap

Language：English  

Web of Science

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a case of an elderly patient with advanced esophageal cancer who underwent multidisciplinary treatment. An 86-year-old male consulted our hospital with complaints of pharynx discomfort and difficulty in swallowing. He was preoperatively diagnosed with esophageal cancer, T3N2M0, Stage III . We performed 2 courses of cisplatin plus 5-FU therapy as neoadjuvant chemotherapy. The primary tumor and metastatic lymph nodes reduced in size, and thoracoscopic esophagectomy in the prone position was performed. Pathological findings were esophageal cancer, pT3-Ad, INF b, ly2, v1, IM0, pPM0, pDM0, pRM1, pN3, pStage III . As the radical margin was positive, chemoradiotherapy was performed. We continued postoperative chemotherapy for approximately 1 year, and the patient has survived without relapse for 4 years from esophagectomy. Even in patients over 80 years old, long-term prognosis can be expected by performing radical surgery and chemoradiotherapy.

PubMed

researchmap

Language：Japanese   Publishing type：Research paper (scientific journal)  

The esophagorespiratory fistula(ERF)is a fatal complication ofesophageal cancer, because ofadvanced oncological status and poor conditions due to pneumonia and/or malnutrition.We report here a case of patient who was successfully treated for esophageal cancer with ERF with multimodality therapy including three-stage operation. A 65-year-old woman ofesophageal cancer received preoperative chemotherapy, and developed EFR before operation. Prolonged conservative therapies for ERF let her general condition get worse. Therefore, the patient underwent esophagostomy and gastrostomy to recover her condition. She received chemo-radiotherapy followed by esophagectomy. And she was performed the reconstruction next month. She is still alive without recurrence at 20 months after resection. In previous reports, a total of 6 cases have been performed esophagectomy for esophageal cancer with ERF in Japan. Only one case was reported that had survived longer than 12 months. This multimodality therapy can be one ofthe best strategies for the patients ofesophageal cancer with ERF, even ifthey have poor condition.

PubMed

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本胃癌学会  

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

J-GLOBAL

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：日本臨床外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本腹部救急医学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

researchmap

Language：Japanese   Publisher：(一社)日本肥満学会  

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：English   Publisher：(一社)日本癌治療学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

researchmap

Language：Japanese   Publisher：(一社)日本ハイパーサーミア学会  

researchmap

Language：Japanese   Publisher：(一社)日本ハイパーサーミア学会  

researchmap

Language：Japanese   Publisher：(一社)日本消化器外科学会  

researchmap

Language：Japanese   Publishing type：Research paper, summary (national, other academic conference)   Publisher：(一社)日本消化器外科学会  

researchmap

Language：English   Publisher：(一社)日本癌学会  

researchmap

DOI： 10.15106/J00393.2017206050

J-GLOBAL

researchmap