記述言語：日本語   出版者・発行元：Esophagus  

Background: Osteosarcopenia, recognized as a consequence of aging, has garnered attention as a prognostic marker in recent years; however, its clinical significance in esophageal cancer remains uncertain. This study aimed to investigate the impact of osteosarcopenia on esophageal cancer surgery outcomes. Methods: This retrospective study included patients with advanced esophageal cancer who underwent surgical resection between 2018 and 2021. Skeletal muscle index at the L3 vertebral level and bone density at the Th11 vertebral level were measured on preoperative computed tomography scans. Based on the findings, we divided patients into sarcopenia, osteopenia, and osteosarcopenia groups, and analyzed the relationship between osteosarcopenia and clinicopathological factors, including prognosis. Results: Of the 124 patients included, 59 (48%) were diagnosed with osteosarcopenia. Among all, 46 (37%) patients experienced postoperative recurrence, and a significant correlation was observed between osteosarcopenia and recurrence (p < 0.05). Overall survival and relapse-free survival were significantly shorter in the osteosarcopenia group than in the non-osteosarcopenia group (p < 0.05 for both). In a subgroup analysis, overall survival and relapse-free survival were significantly shorter in the osteosarcopenia group than in the non-osteosarcopenia group, or in the sarcopenia and osteopenia alone groups (all p < 0.05). Conclusions: The presence of preoperative osteosarcopenia was found to affect the prognosis following esophageal cancer surgery.

DOI： 10.1007/s10388-024-01101-8

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PubMed

記述言語：日本語   出版者・発行元：Annals of Surgical Oncology  

Background: Patients with esophageal squamous cell carcinoma (ESCC) with distant metastasis were treated with systemic chemotherapy. Recent advances in multimodal treatments have made conversion therapy a viable option for patients with incurable ESCC. Objective: We aimed to assess the safety and efficacy of conversion therapy for ESCC with distant metastases. Methods: Conversion therapy was defined as surgery or chemoradiotherapy (CRT) used to cure tumors that were previously considered incurable because of distant metastasis. We conducted a retrospective review of patients who underwent ESCC conversion therapy and assessed the treatment outcomes, including adverse events and survival rates. Results: A total of 147 patients from 22 institutions were included. Systemic chemotherapy was initially administered to all patients. The most common M1 factor was the para-aortic lymph node, accounting for 55% of cases. Following the initial treatment, 116 patients underwent surgery, with 31 receiving CRT as conversion therapy. Postoperative complications in surgery patients included pneumonia (16%), anastomotic leakage (7%), and recurrent laryngeal nerve palsy (6%). During CRT, 18% of patients developed grade 3 or higher non-hematological toxicities. The 5-year overall survival (OS) rate was 31.7%. Pathological responders had significantly longer OS than non-responders (hazard ratio 0.493, p = 0.012). The distribution of distant metastasis, regimen type, clinical response, and conversion therapy modality did not have a significant impact on OS. Conclusions: Conversion therapy can be safely performed for ESCC with distant metastasis and has a favorable prognosis.

DOI： 10.1245/s10434-024-16196-7

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PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

加齢によると認識されているオステオサルコペニアは、近年予後マーカーとして注目されている。しかし、食道癌におけるその臨床的意義は明確にされていない。本研究の目的は、オステオサルコペニアの食道癌手術成績に対する影響について検討することである。本後方視的研究では、2018年から2021年の間に外科的切除を施行した進行食道癌患者を検討対象とした。L3椎体レベルでの骨格筋指数とTh11椎体レベルでの骨密度を術前CTにより計測した。これらの結果を元に、患者をサルコペニア群、オステオペニア群、オステオサルコペニア群に分け、オステオサルコペニアと予後を含む臨床病理学的因子との関連を解析した。検討対象となった124例中、59例(48%)がオステオサルコペニアと診断された。全体で46例(37%)に術後再発が認められ、オステオサルコペニアと再発との間に有意な関連が認められた(P<0.05)。オステオサルコペニア群では、非オステオサルコペニア群と比較して、全生存期間および無再発生存期間が有意に短かった(共にP<0.05)。サブグループ解析では、オステオサルコペニア群は、非オステオサルコペニア群またはサルコペニア単独群およびオステオペニア単独群と比較して、全生存期間および無再発生存期間が有意に短かった(全てP<0.05)。以上より、術前オステオサルコペニアは食道癌手術後の予後に影響を及ぼすことが明らかにされた。

記述言語：日本語   出版者・発行元：Asian Journal of Endoscopic Surgery  

Introduction: Regional disparities in medical practice between urban and rural areas in Japan represent a critical issue, and extend to the field of surgical education. To address these disparities, we evaluated the effectiveness of simultaneous remote coaching across multiple facilities using a standardized laparoscopic training method. Methods: A total of 28 trainees from a university hospital and 3 rural hospitals were categorized into remote and on-site coaching groups. The training curriculum included lectures, practical training, and assessments, conducted for 1 h per week using three sessions. The primary endpoint of the study was the change in time for ligation of one suture between the on-site and remote coaching groups, expressed as the median of the reduction suture time rate (RTR). Secondary endpoints included the RTR categorized by years of graduation and the results of a questionnaire survey of participants. Results: Participants included 19 trainees in postgraduate year (PGY) 1–2 and 9 those in PGY 3–5. The median suture ligation time for the first attempt was 145 s (remote: 136 s vs. on-site: 160 s; p = 0.33) and that for the third attempt was 51 s (remote: 33 s vs. direct: 52 s; p = 0.91). The median RTR was 57%, with no significant difference observed between the remote and on-site coaching groups (43.2% vs. 71.2%, p = 0.26). The trainees' ratings for the training were generally favorable, with median ratings of 4 (range: 3–5) for the content of practical skills and 5 (4, 5) for the distance learning aspect, based on a 5-point Likert scale. Conclusion: Simultaneous remote laparoscopic training could be effective in reducing disparities in surgical education.

DOI： 10.1111/ases.70007

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PubMed

記述言語：日本語   出版者・発行元：Gastric Cancer  

Background: Gastric cancer remains a significant global challenge, with conventional surgery for early gastric cancer often leading to post-gastrectomy complications. Sentinel node navigation surgery is being developed to preserve quality of life without compromising radicality. Although osteosarcopenia is linked to gastrointestinal cancers and prognosis, its impact on bone and muscle mass after function-preserving surgery for gastric cancer remains underexplored. Methods: We analyzed the data of patients diagnosed with early gastric cancer and not eligible for endoscopic treatments, who underwent either distal gastrectomy or sentinel node navigation surgery at our hospital between 2010 and 2020. Skeletal muscle index and bone mineral density were measured preoperatively and 1, 3, and 5 years, postoperatively; rates of changes in these measures were assessed. Results: Among the 63 patients included, 42 (67%) underwent conventional surgery, and 21 (33%) underwent function-preserving gastrectomy using the sentinel node technique. No significant difference in postoperative survival rates was observed between the two groups (P = 0.97). The rate of change in the skeletal muscle index and bone mineral density decreased in both groups from 1 to 3 years postoperatively. At 5 years postoperatively, the sentinel node navigation surgery group showed an increase in skeletal muscle index and bone mineral density change rates, the difference observed between the two groups was significant (P < 0.05). Conclusion: Sentinel node navigation surgery for early gastric cancer may help prevent decreases in bone and muscle mass. This suggests that its use has a potential role in preventing osteosarcopenia.

DOI： 10.1007/s10120-025-01617-7

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PubMed

記述言語：英語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：Annals of Gastroenterological Surgery  

Aim: Adjuvant chemotherapy (AC) is the standard treatment for patients with advanced gastric cancer (GC), yet the optimal timing for its initiation remains unclear. Besides, no studies have definitively established when AC should begin in patients receiving preoperative chemotherapy (PC). This study aimed to determine the optimal timing for initiating AC in patients with GC who underwent curative gastrectomy, either with or without PC. Methods: A total of 446 patients who underwent curative gastrectomy were evaluated, including 140 who received AC: 72 without PC and 68 with PC. Patients were categorized into two groups based on when they began AC: the early initiation group (within 8 weeks post-surgery), and the late initiation group (8 weeks or later post-surgery). Results: In the non-PC cohort, the 3-year relapse-free survival (RFS) rates were 71% in the early group versus 56% in the late group (p = 0.49), while the 3-year overall survival (OS) rates were 94% versus 73% (p = 0.003). Similar trends were observed in the PC cohort; the 3-year RFS rates were 59% versus 19% (p = 0.002), and the 3-year OS rates were 69% versus 48% (p = 0.02). Multivariate analysis identified pretherapeutic distant metastasis (p < 0.001) and delayed AC initiation (≥8 weeks) (p = 0.001) as independent predictors of worse prognosis. Conclusion: Delayed initiation of AC is associated with significantly poorer postoperative survival in patients with GC, irrespective of whether PC was administered. These findings emphasize the importance of timely AC initiation to improve long-term outcomes in this patient population.

DOI： 10.1002/ags3.12911

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記述言語：英語   出版者・発行元：一般社団法人 日本外科学会  

DOI： 10.70352/scrj.cr.24-0185

PubMed

CiNii Research

記述言語：英語   出版者・発行元：John Wiley & Sons Australia, Ltd  

記述言語：英語   出版者・発行元：一般社団法人 日本外科学会  

DOI： 10.70352/scrj.cr.24-0012

PubMed

CiNii Research

記述言語：日本語   出版者・発行元：日本リンパ学会  

切除不能進行胃癌に対する化学療法後のconversion surgery(CS)におけるリンパ節郭清の意義について検討した。2002年2月～2021年3月に当院においてstage IVの切除不能進行胃癌の診断で化学療法を導入し、CSを施行した65例(男性44例、女性21例、中央値66歳)を対象とした。切除標本の病理学的評価を行い、リンパ節転移や再発の有無と臨床病理学的因子との関係を統計学的に解析した。その結果、リンパ節転移の有無は再発と密接に相関しており、再発症例の40例中27例(68%)にはリンパ節転移が認められた。さらに、リンパ節転移症例の予後は有意に不良であり、化学療法が行われたとしてもリンパ節転移の有無は重要な予後因子であることが示唆された。これらの結果から、CS症例においても手術によるリンパ節郭清を含めた集学的治療によってリンパ節転移をコントロールすることは予後向上のために重要な戦略であると考えられた。

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: The purpose of the present study was to assess the clinical impact of body weight loss (BWL) during chemotherapy in patients with initially unresectable advanced gastric cancer who underwent conversion surgery. Patients and Methods: This retrospective study included 61 patients with stage IV gastric cancer who underwent conversion surgery after chemotherapy, and body weight changes during chemotherapy were examined. Based on receiver operating characteristic (ROC) curve analysis of body weight change for disease recurrence, the cutoff value of BWL was determined. Based on the BWL cutoff value, patients were classified into two groups. Results: Body weight change ranged from 28.2% to –21.8%. The cut-off value of BWL was set at 6% based on the ROC analysis. Of the 61 patients, 45 (74%) and 16 (26%) had <6% and ≥6% BWL, respectively. Patients with ≥6% BWL had peritoneal dissemination, pathological lymph node metastasis, residual tumor status of R1-2, and disease recurrence compared with those with <6% BWL (all p<0.05). The median survival times after conversion surgery were 21 and 63 months in the ≥6% and <6% BWL groups, respectively (p<0.01). Univariate analysis identified BWL as an independent prognostic factor (p=0.01), although histological response alone was significantly associated with survival in the multivariate analysis (p=0.02). Conclusion: Patients with severe BWL during chemotherapy may be excluded from the indication of conversion surgery.

DOI： 10.21873/anticanres.17232

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PubMed

記述言語：日本語   出版者・発行元：鹿児島県臨床外科学会  

2022年7月～2022年12月までのSecond Surgeonによるロボット支援下直腸手術8例(男性7例、女性1例、年齢中央値66歳:a群)と2018年10月～2019年9月までのFirst Surgeon症例8例(男性5例、女性3例、年齢中央値67.5歳:b群)の短期成績について比較検討を行った。術式はb群は低位前方切除術(LAR)2例、肛門括約筋間切除術(ISR)5例、Hartman手術1例、a群はLAR4例、ISR4例、腹会陰式直腸切除術1例で、TaTME併用はa群7例、b群5例であった。a群はb群と比べて手術時間、出血量、術中術後合併症、術後在院日数、郭清リンパ節郭清個数やTME gradeに有意差は無かった。コンソール時間は長かったが、導入時にTip-up Fenestrated Grasperによる視野展開や持ち替え等に時間を要したことが一因と考えられた。以上より、Second Surgeonによるロボット支援下直腸手術は安全であった。

記述言語：日本語   出版者・発行元：日本リンパ学会  

2001年～2019年にSentinel node navigation surgery(SNNS)を施行した早期胃癌81例を対象に、安全性と有用性を後方視的に検討した。全例でセンチネルリンパ節(SN)を同定でき、リンパ節転移検出感度は75%、偽陰性は1.3%と良好な結果であった。cT2症例の1例のみSN偽陰性・術後リンパ節転移を認めたが、cT1症例においては術前診断で指摘しえない小リンパ節転移についてもSN-basin郭清を行うことでSNNSの根治性が担保された。内視鏡的粘膜下層剥離術後にSNNSを受けた28例と残遺癌に対するSNNSを受けた13例は、初回切除の40例比較して非特的なリンパ流の改変は認めず、術後合併症も差異は認めず、胃癌SNNSによる術後QOLの低下にきたすような結果は認めなかった。

記述言語：英語  

DOI： 10.1186/s40792-024-01852-7

PubMed

記述言語：日本語   出版者・発行元：Esophagus  

Background: Several reports have compared narrow gastric conduit (NGC) with subtotal gastric conduit (SGC) for cervical esophagogastrostomy after esophagectomy; however, whether which one is more beneficial in terms of postoperative complications remains unclear. To determine the optimal gastric conduit type, we retrospectively investigated and compared the postoperative complications between NGC and SGC used in cervical circular-tapered esophagogastrostomy after esophagectomy through a propensity score-matched analysis. Methods: Between 2008 and 2022, 577 consecutive esophageal cancer patients who underwent esophagectomy and cervical circular-stapled esophagogastrostomy were enrolled in this study. Results: Of the 577 patients, 77 were included each in the SGC and NGC groups, after propensity score matching. Clinical characteristics did not differ between the two groups. The anastomotic leakage rate was significantly lower in the SGC group than in the NGC group (5% vs. 22%, p < 0.01). The anastomotic stenosis rate was significantly higher in the SGC group (16% vs. 5%, p = 0.03). Multivariate logistic analysis showed that NGC, subcutaneous route, and age were significant independent factors associated with anastomotic leakage (odds ratios, 8.58, 6.49, and 5.21; p < 0.01, < 0.01 and 0.03, respectively) and that SGC was a significant independent factor associated with anastomotic stricture (odds ratios, 4.91; p = 0.04). Conclusions: In cervical circular-stapled esophagogastrostomy after esophagectomy, SGC was superior to NGC in terms of reducing the risk of anastomotic leakage, although the risk of anastomotic stricture needs to be resolved.

DOI： 10.1007/s10388-023-01027-7

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: The clinical significance of laparoscopic subtotal gastrectomy (LsTG) with a small remnant stomach remains unclear in patients with gastric cancer, including at an advanced stage. The present study assessed postoperative quality of life (QOL) and survival after LsTG compared with laparoscopic total gastrectomy (LTG). Patients and Methods: We retrospectively analyzed consecutive patients with gastric cancer who underwent LsTG (n=26) or LTG (n=26). Surgical outcome, postoperative nutritional status, QOL, and prognosis were compared between the LsTG and LTG groups. The Postgastrectomy Syndrome Assessment Scale was used to evaluate postoperative QOL. Results: Operating time was significantly shorter (p<0.01) and postoperative morbidity was significantly lower (p=0.04) in the LsTG than in the LTG group. The reduction in body weight after surgery was significantly greater in the LTG than in the LsTG group (p<0.01). The Postgastrectomy Syndrome Assessment Scale revealed that, compared with LTG, LsTG significantly improved postoperative QOL (p<0.05). There was no significant difference in relapse-free survival and cancer-specific survival between the two groups. Three patients in the LTG group died of pneumonia and overall survival was significantly longer in the LsTG group (p=0.01). Conclusion: This study demonstrated the efficacy of LsTG with a small remnant stomach to prevent a decline in postoperative QOL and non-cancer-related death.

DOI： 10.21873/anticanres.16823

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PubMed

記述言語：日本語   出版者・発行元：Gland Surgery  

Background: Microporous polysaccharide hemospheres (MPH) are hydrophilic particles administered to reduce the incidence of seroma after mastectomy, but their clinical effectiveness remains controversial. Because a previous randomized, controlled study in a small cohort could not demonstrate the effectiveness of MPH in breast surgery, we evaluated their effectiveness in surgery for breast cancer in a larger cohort. Methods: Medical records of 352 patients who underwent total mastectomy for breast cancer were retrospectively reviewed. Clinical data were compared between 126 patients who received MPH during surgery (MPH group) and 226 who did not (control group) according to surgical procedures. Patients were significantly older in the MPH group than in the control group because of selection bias, but other factors, such as body mass index and number of dissected lymph nodes, did not differ between groups. Results: When analyzed by use of axillary manipulation, the drain placement period and drainage volume were significantly less in the MPH group than in the control group for patients with mastectomy and sentinel lymph node biopsy. Only drainage volume was significantly less in the MPH group for patients with mastectomy and axillary lymph node dissection. The frequency of total postoperative complications, such as seroma requiring puncture, did not differ between groups. Conclusions: Use of MPH may decrease the postoperative drainage volume and drain placement period in mastectomy for patients with breast cancer.

DOI： 10.21037/gs-23-297

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PubMed

記述言語：英語  

DOI： 10.1186/s44215-023-00114-6

PubMed

出版者・発行元：金原出版  

DOI： 10.18888/op.0000003555

CiNii Research

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: Despite investigations of intraperitoneal paclitaxel as a personalized treatment for peritoneal metastasis of gastric cancer, few studies have evaluated its prognostic impact on conversion surgery for unresectable gastric cancer with peritoneal metastasis. Our study aimed to close this gap in knowledge. Methods: We retrospectively enrolled 128 patients who underwent chemotherapy for peritoneal metastasis from gastric cancer and assigned them into intraperitoneal (IP) (n = 36) and non-IP (n = 92) groups, based on the use of intraperitoneal paclitaxel plus systemic chemotherapy. Results: Disease control rates were 94% and 69% in the IP and non-IP groups, respectively, with the former having a significantly higher tumor response rate than the latter (p < 0.01). The median survival times in the IP and non-IP groups were 665 and 359 days, respectively, with the former having significantly better prognosis than the latter (p = 0.02). Fifteen (42%) and sixteen (17%) patients underwent conversion surgery after chemotherapy in the IP and non-IP groups, respectively, with the former having a significantly higher conversion surgery induction rate than the latter (p < 0.01). Although the prognosis of the conversion surgery group was significantly better than that of the non-conversion surgery group (p < 0.01), there was no significant difference in prognosis between patients in the IP and non-IP groups who underwent conversion surgery (p = 0.22). Multivariate analysis identified performance status and conversion surgery as independent prognostic factors (all p < 0.01). Conclusion: Our study demonstrated that the IP chemotherapy was one of important factors for conversion surgery induction, while it was not a risk factor for prognosis.

DOI： 10.1007/s10147-023-02384-0

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PubMed

記述言語：日本語   出版者・発行元：鹿児島県臨床外科学会  

過去4年9ヵ月間の左側大腸癌に対し腹腔鏡下手術症例126例(男性87例、女性39例、53～80歳、中央値67歳)を対象に、腹腔鏡白色光光源を用いて血管走向を同定するeLAVE法の有効性について検討を行った。対象のうち83例は術中にICG蛍光法の併用を行った。その結果、血管走向強調良好は111例(88.1%)で、ICG併用例のうち10例(12.0%)でeLAVE法の切離線との乖離があり、切離線を変更した。縫合不全は4例(3.1%)であった。BMI 23未満の54例のうち51例(94.4%)は血管走向良好であった。eLAVE法で結腸間膜血管走向を評価し得た全例がICGの切離線決定と一致しており、左側大腸癌の腹腔鏡下手術における結腸切離線決定に対するeLAVE法の有効性が示唆された。

記述言語：日本語   出版者・発行元：鹿児島県臨床外科学会  

症例は30代男性で、食道神経鞘腫摘出後の食道壁全層欠損症例に対し有茎僧帽弁被覆を行った。本症例は欠損孔が非常に大きいため縫合閉鎖と筋弁による被覆を行った。術後経過は良好で、術後32日目にリハビリ目的に転院となった。食道壁欠損に対する僧帽弁被覆は有用な選択肢の一つである。

記述言語：日本語   出版者・発行元：Surgical Endoscopy  

Background: We performed pull-through hand-sewn coloanal anastomosis immediately after sphincter-preserving ultralow anterior resection (ULAR) [pull-through ultra (PTU)] to avoid permanent stoma and reduce postoperative complications of lower rectal tumors. This study aimed to compare the clinical outcomes of PTU versus non-PTU (stapled or hand-sewn coloanal anastomosis with diverting stoma) after sphincter-preserving ULAR for lower rectal tumors. Methods: This retrospective cohort study analyzed prospectively maintained data from 100 consecutive patients who underwent PTU (n = 29) or non-PTU (n = 71) after sphincter-preserving ULAR for rectal tumors between January 2011 and March 2023. In PTU, hand-sewn coloanal anastomosis was immediately performed using 16 stitches of 4–0 monofilament suture during primary surgery. The clinical outcomes were assessed. The primary outcomes were rates of permanent stomas and overall postoperative complications. Results: The PTU group was significantly less likely to require a permanent stoma than the non-PTU group (P < 0.01). None of the patients in the PTU group required permanent stoma and the rate of overall complications was significantly lower in the PTU group (P = 0.01). The median operative time was comparable between the two groups (P = 0.33) but the median operative time during the second stage was significantly shorter in the PTU group (P < 0.01). The rates of anastomotic leakage and complications of Clavien–Dindo grade III were comparable between the two groups. Diverting ileostomy was performed in two patients with an anastomotic leak in the PTU group. The PTU group was significantly less likely to require a diverting ileostomy than those in the non-PTU group (P < 0.01). The composite length of hospital stay was significantly shorter in the PTU group (P < 0.01). Conclusions: PTU via immediate coloanal anastomosis for lower rectal tumors is a safe alternative to the current sphincter-preserving ULAR with diverting ileostomy for patients who wish to avoid a stoma.

DOI： 10.1007/s00464-023-10184-w

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: Transanal total mesorectal excision (TaTME) remains a challenging technique for rectal dissection. This study aimed to evaluate the clinical and oncological outcomes of TaTME, compared to those of the laparoscopic TME (LaTME) in rectal cancer. Patients and Methods: Using propensity score-matched analyses, we analyzed retrospective data from 134 consecutive patients with rectal cancer who underwent TaTME or LaTME from January 2011 to June 2020 in our hospital. Clinical and oncological outcomes were evaluated. The primary endpoint was the 2-year local recurrence rate. Results: Before data analysis, significant group-dependent differences were observed only in the tumor height (p<0.01). After analysis, preoperative patient demographics were similar between the TaTME and LaTME groups. The operative time was significantly shorter in the TaTME group (p=0.02), and the rates of hand-sewn anastomosis and protective loop ileostomy were significantly higher (p<0.01). The TaTME group showed a null conversion to open surgery compared to the LaTME group (5.9%). The postoperative complications, including anastomotic leak, were comparable between the two groups. However, the rate of Clavien-Dindo grade III tended to be lower in the TaTME group (p=0.07). There were no statistically significant differences in terms of pathological findings, and the 2-year local recurrence rate was similar between the two groups (both 5.9%). Conclusion: TaTME based on embryology along the fascia is feasible and seems a safe alternative to LaTME in selected patients with rectal cancer when considering the conversion rate and the operative time.

DOI： 10.21873/anticanres.16539

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PubMed

記述言語：日本語   出版者・発行元：Colorectal Disease  

Aim: Total proctocolectomy with ileal pouch−anal anastomosis (IPAA) is the standard surgical treatment modality for familial adenomatous polyposis (FAP). It is challenging to perform proctectomy and preserve anal sphincter function. In this video, precise mucosectomy of the anal canal via transanal minimally invasive surgery (MAC-TAMIS) is reported. Methods: An asymptomatic 35-year-old man was found to have a positive faecal occult blood test in routine screening examination and was diagnosed with FAP on colonoscopic examination. The patient was scheduled for total proctocolectomy with IPAA using the TAMIS approach combined with transanal total mesorectal excision. MAC-TAMIS was performed to preserve the internal anal sphincter during laparoscopy. Results: The total duration of surgery was 543 min, blood loss was minimal, and the postoperative course was uneventful. The postoperative hospital stay was 12 days. The pathological findings demonstrated no evidence of malignancy. Gastrographic imaging from the ileostomy showed sufficient size of the J pouch and good tonus of the anus at 6 months after surgery. The Wexner scores at 1, 3 and 6 months after ileostomy closure were 5, 3 and 0, respectively. Conclusion: The MAC-TAMIS technique is safe and feasible during total proctocolectomy with IPAA in patients with FAP. This technique allows us to precisely preserve the internal anal sphincter using a laparoscopic approach.

DOI： 10.1111/codi.16595

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: To develop a recurrence risk score for determining the clinical indication for adjuvant chemotherapy in patients with initially unresectable advanced gastric cancer who underwent conversion surgery after chemotherapy. Patients and Methods: A total of 65 patients with stage IV gastric cancer who underwent conversion surgery after chemotherapy were retrospectively enrolled. We established a risk score based on clinicopathological factors related to recurrence after conversion surgery. Results: Out of 65 patients, 40 (62%) had recurrence after conversion surgery. The 5-year overall survival rates in patients with and without recurrence were 14.4% and 87.1%, respectively (p<0.01). Multivariate logistic regression analysis identified the depth of tumor invasion (pT2-4) and histological tumor response (grade 0-1a) as an independent risk factor for disease recurrence (p=0.033 and p=0.048, respectively). A scoring system determined by these two factors was created; total score ranged from 0 to 2 points, and patients were categorized into three groups (scores of 0 vs. 1 vs. 2 points). This scoring system showed that 12 (18%), 15 (23%), and 38 (58%) patients had recurrence risk scores of 0, 1, and 2 points, respectively. There was a close relationship between a high score and the presence of tumor recurrence (p<0.01). Moreover, our model system had a high sensitivity for the prediction of recurrence, compared with the pathological stage. Conclusion: Recurrence risk score is a promising tool for assessing the need for adjuvant chemotherapy in patients with initially unresectable advanced gastric cancer after conversion surgery.

DOI： 10.21873/anticanres.16506

Scopus

PubMed

記述言語：日本語   出版者・発行元：Gan to kagaku ryoho. Cancer &amp; chemotherapy  

The standard treatment of locally advanced rectal cancer is preoperative chemoradiotherapy(CRT)in Europe and the United States, while that is surgical excision and lateral pelvic lymph node dissection followed by adjuvant chemotherapy in Japan. Recently, total neoadjuvant therapy(TNT), which combines neoadjuvant chemotherapy and preoperative CRT, have been popular. We performed curative excision for initially locally advanced rectal cancer with liver metastasis after TNT. A 61- year-old woman was diagnosed as having rectal cancer with liver metastasis and invasion of the uterus, vagina, bladder, and left ureter. The patient underwent 8 courses of FOLFOX plus bevacizumab, followed by radiotherapy, and totally pelvic excision for the primary tumor. Because of liver metastasis progression, hepatectomy was performed after 6 courses of FOLFIRI plus panitumumab. The patient has been cancer free for 20 months to date. TNT is considered to be an effective strategy for the treatment of large locally advanced rectal cancer.

Scopus

記述言語：日本語  

PubMed

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

近年,術前化学療法と化学放射線療法(CRT)を組み合わせたtotal neoadjuvant therapy(TNT)が普及しつつある。今回われわれは,同時性肝転移を伴う局所進行直腸癌に対してTNTを行い根治切除し得た1例を経験した。症例は61歳,女性。肝転移,子宮,腟,膀胱,左尿管浸潤を伴う最大径18cmの巨大な直腸癌を認めた。FOLFOX+bevacizumab療法を計8コース施行後に,放射線療法(40Gy/20回)を行い,骨盤内臓全摘術を行った。術後に肝転移の増大を認め,FOLFIRI+panitumumab療法を計6コース施行した後に肝切除術を施行した。肝切除術後20ヵ月が経過し,無再発生存中である。(著者抄録)

記述言語：日本語   出版者・発行元：Oncology (Switzerland)  

Introduction: This study aimed to assess the clinical significance of eligibility criteria determined by phase 3 clinical trials in the clinical practice of patients with advanced gastric cancer who underwent chemotherapy. Methods: Patients with stage IV gastric cancer who received chemotherapy between February 2002 and December 2021 were retrospectively enrolled and divided into two groups (the eligible vs. ineligible group) based on eligibility criteria determined by the SPIRITS (S-1 vs. S-1 plus cisplatin) trial. Results: Among the 207 patients, 103 (49.8%) and 104 (50.2%) patients were classified into eligible and ineligible groups, respectively. Eligibility criteria were significantly correlated with age, the first-line regimen of chemotherapy, the presence or absence of conversion surgery, and tumor response to the first-line chemotherapy (all p < 0.01). The eligible group had a significantly higher induction of post-progression chemotherapy after first-and second-line chemotherapy than did the ineligible group (all p < 0.01). The ineligible group had significantly poorer prognoses than the eligible group (p < 0.0001). Multivariate analysis showed that peritoneal dissemination, tumor response, conversion surgery, and eligibility criteria were independent prognostic factors (all p < 0.05). Conclusion: Eligibility criteria determined by the SPIRITS trial may have clinical utility for predicting tumor response, the induction of conversion surgery, and prognosis in patients with advanced gastric cancer who underwent chemotherapy.

DOI： 10.1159/000527114

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PubMed

記述言語：日本語   出版者・発行元：Asian Pacific Journal of Cancer Prevention  

Background: Delays in breast cancer diagnosis can allow the disease to progress to an incurable stage. However, factors that cause patients to delay seeking treatment are unclear. In this study, we aimed to identify behavioral economic factors and personality characteristics of patients with breast cancer who had a delayed diagnosis. Methods: We analyzed questionnaires completed by 41 patients with breast cancer. A delayed diagnosis was defined if the time between the first symptom and the medical visit was more than 6 months. Results: We found 11 patients who had a delayed diagnosis. The significant characteristics associated with patients with breast cancer who had delayed diagnosis were: (i) less experience with breast cancer screening; (ii) progressive disease stage; and (iii) low time and future time preference. We found no significant behavioral economic factors other than time preference, and personality that differed between patients with breast cancer who did and did not have a delayed diagnosis. Conclusion: Low time preference rate is a characteristic of patients with breast cancer who had a delayed diagnosis.

DOI： 10.31557/APJCP.2023.24.10.3437

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PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: Minimally invasive esophagectomy (MIE) has been widely accepted as a treatment for esophageal cancer. This retrospective study compared the short-term outcomes and surgical invasiveness between thoracoscopic esophagectomy (TE) and mediastinoscopic esophagectomy with pneumomediastinum (pneumatic mediastinoscopic esophagectomy [PME]). Methods: A total of 72 patients who underwent TE or PME were included and assessed for their surgical findings, postoperative complications, and inflammatory responses on postoperative day (POD) 1, 3, 5, and 7. Results: The PME group exhibited a significantly shorter operative time and fewer lymph nodes retrieved than the TE group. Furthermore, the PME group tended to have greater incidences of recurrent laryngeal nerve palsy and lower incidences of atelectasis than the TE group. The PME group had significantly lower white blood cell counts on POD 5, serum C-reactive protein (CRP) levels on POD 3 than the TE group. Conclusion: PME seems to be less invasive than TE and can be considered the preferred option for patients with lower-stage esophageal cancer expected to have severe pleural adhesion or who cannot tolerate TE.

DOI： 10.1007/s00595-022-02509-4

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PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: To investigate the clinical indications and prognostic significance of surgical interventions after chemotherapy using trastuzumab-containing regimens for patients with human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer (AGC). Methods: A total of 146 patients with AGC who underwent chemotherapy were enrolled in this retrospective study. Tumors with an immunohistochemistry (IHC) score of 3 + or an IHC score of 2 + plus fluorescence in situ hybridization positivity were defined as HER2-positive AGC. We devised a scoring system for predicting prognosis associated with conversion surgery. Results: Thirty-three patients received trastuzumab-based chemotherapy for HER2-positive tumors. Multivariate analyses identified advanced age, peritoneal dissemination, histologically undifferentiated tumors, and tumor response of progressive disease as independent prognostic factors for a worse prognosis. Twelve patients with HER2-positive AGC underwent conversion surgery. The conversion surgery group of patients with HER2-positive AGC had a better prognosis than the chemotherapy-alone group. A prognostic scoring system based on age, peritoneal dissemination, and histological type was significantly correlated with the presence or absence of conversion surgery and the prognosis of patients with HER2-positive AGC. Conclusions: Our scoring system has the clinical potential to predict prognosis associated with conversion surgery after trastuzumab-containing chemotherapy for patients with HER2-positive AGC.

DOI： 10.1007/s00595-022-02515-6

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PubMed

記述言語：日本語   出版者・発行元：Colorectal Disease  

Aim: Totally laparoscopic colectomy with intracorporeal anastomosis (IA) is associated with less surgical trauma and wound related complications compared to laparoscopy-assisted colectomy with extracorporeal anastomosis. Delta shaped anastomosis is a widely popular IA technique. In this study, we discuss a construction technique for an overlapped delta-shaped anastomosis using a linear stapler with a reinforced bioabsorbable material. Methods: We excised the bowel at a point 10 cm from the tumour on either sides and laid them in an overlapped fashion. The entry hole was created at a point 3 cm proximal to the right stump and 7 cm distal to the left stump on the antimesenteric side. Then, a 60-mm linear stapler with reinforced bioabsorbable material was inserted inside each lumen and fired. Finally, the common entry hole was fixed with a suture in the middle, the bowel was elevated holding the bioabsorbable material, and closed using the linear stapler in a delta-shaped manner. Results: The technique was applied in five patients with tumours in the ascending, transverse, and descending colon. The median surgery time, anastomosis construction time and postoperative stay was 329 min (range 285–682 min), 19 min (range 14–29 min), and 12 days (range 9–15 days), respectively. There were no perioperative complications and only one postoperative complication. Conclusion: The overlapped delta-shaped anastomosis technique using linear staplers with reinforced bioabsorbable material appears to be both safe and feasible.

DOI： 10.1111/codi.16247

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PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_geka84_1168

CiNii Research

記述言語：日本語   出版者・発行元：鹿児島県臨床外科学会  

当院で2018年10月から2021年3月に施行したロボット支援下直腸癌手術53例(男性36例、女性17例、平均年齢67歳)の患者背景と治療成績について検討した。その結果、cStageはIが23例、IIが6例、IIIが18例、IVが6例であった。術前化学療法は26例で行われ、術式はLARが18例、Hartmannが2例、ISRが21例、APRが12例であった。手術時間は平均433分、出血量は平均54mlで、開腹移行例は認められなかった。術後合併症はClavien-Dindo分類IIIbを3例で認められ、内訳は腸閉塞、outlet obstruction、術後リンパ瘻であった。尚、病理学的に切除断端は全例が陰性であった。

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: To further improve the prognosis of locally advanced esophageal cancer patients, investigating new perioperative treatment strategies is necessary. The current study aimed to retrospectively investigate neoadjuvant radiotherapy with cisplatin and 5-fluorouracil (CF-RT) and radiotherapy with docetaxel and CF (DCF-RT) and compare their treatment outcomes in patients with locally advanced esophageal squamous cell carcinoma (ESCC). Patients and Methods: We retrospectively reviewed 95 patients with ESCC who received CF-RT or DCF-RT followed by esophagectomy. The CF-RT group received chemotherapy consisting of two courses of CF repeated every 4 weeks. The DCF-RT group received chemotherapy consisting of two courses of DCF repeated every 2 weeks. A radiotherapy dose of 1.8-2 Gy was administered per session, up to a total of 40-41.4 Gy. Adverse events of neoadjuvant chemoradiotherapy, surgical outcomes, pathological responses, prognosis, and recurrence patterns were evaluated. Results: Both the CF-RT and DCF-RT groups had equivalent pathological complete response rates of the primary tumor at 31.6% and 38.6%, respectively. However, the DCF-RT group had significantly better 5-year disease-free survival and 5-year overall survival than (HR=0.50, 95%CI=0.26-0.97, p=0.0392) than the CF-RT group. Conclusion: DCF-RT may be a candidate neoadjuvant therapy for locally advanced ESCC.

DOI： 10.21873/anticanres.15884

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: Given the increased incidence of esophageal cancer (EC) in individuals over 80 years old, the optimum therapeutic strategy for elderly patients is needed to be established with scientific evidence. Here, we studied the short-term and long-term outcomes after treatment of patients aged 80 years old or older with EC. Patients and Methods: Eighty patients with EC aged 80 years old or older, who underwent esophagectomy (n=23), definitive chemoradiotherapy (dCRT) (n=46) or best supportive care (n=11) between January 2010 and March 2019 were included in this study, and clinical data were compared among these groups. Results: Surgery had a great benefit on the 3-year overall survival (OS) compared to dCRT (68.4% vs. 29.3%, p<0.01). The cure rates of treatment were 86.9% in surgery and 34.8% in dCRT. dCRT led to a better 3-year OS compared to BSC (29.3% vs. 0%, p<0.01); however, dCRT did not improved OS in patients with T4. Patients with T4 had high frequency of adverse events and treatment-related death in dCRT; CTCAE Grade 3-5 was observed in 100% of all T4 patients and Grade 5 in 57.1%. Multivariate analysis revealed that T4 was an independent risk factor of treatment-related death after dCRT (p<0.01). Conclusion: Surgery is the first treatment option for resectable EC even in elderly patients, and dCRT can be considered as an alternative. However, dCRT may induce severe toxicity especially in T4 EC patients.

DOI： 10.21873/anticanres.15890

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PubMed

記述言語：日本語   出版者・発行元：International Journal of Clinical Oncology  

Background: Lymphatic metastasis is a major route of metastasis in distal cholangiocarcinoma (DCC). The present study aimed to elucidate the pattern of lymph node (LN) metastasis and the effectiveness of LN dissection and postoperative adjuvant chemotherapy in patients with DCC. Methods: Patients who underwent surgical resection with curative intent for DCC were enrolled. The nomenclature of the LN stations was defined according to the Japanese Society of Hepato-Biliary-Pancreatic Surgery guidelines. Effectiveness of LN dissection of each station was calculated using frequency of LN metastasis to the station and 5-year survival rate of patients with LN metastasis to that station. Results: Of the 105 patients included in the study, 46 (43.8%) had LN metastasis, and 43 (41.0%) underwent postoperative adjuvant therapy. LN metastasis, serum carbohydrate antigen (CA) 19–9 level > 37 U/mL, and positive bile duct margin were independent risk factors for shorter overall survival (OS). The most common metastatic LN station at surgery was No. 13 (32.7%), followed by No. 12 (19.2%), No. 17 (9.6%), and No. 8 (6.6%). There was no effectiveness of LN dissection of the station No. 8, 14, and 16. Adjuvant chemotherapy was significantly associated with longer OS in patients with LN metastasis but not in those with positive ductal margins or serum CA 19–9 level > 37 U/mL. Conclusions: Postoperative adjuvant chemotherapy was associated with a better prognosis in patients with DCC and LN metastasis. However, a more effective therapeutic strategy is required to improve the prognosis of patients with other negative prognostic factors.

DOI： 10.1007/s10147-022-02175-z

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PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

遠位胆管癌(DCC)患者にみられる、リンパ節転移パターンとリンパ節切除ならびに術後アジュバント化学療法の有効性について、後向きに調査した。2000年1月～2019年12月までの期間内に、著者等の医療施設で外科的切除を受けたDCC患者111例のうち、選定基準を満たした患者105例(男性80例、女性25例)を調査した。その結果、105例中46例にリンパ節転移が認められ、43例が術後アジュバント化学療法を受けていた。また、リンパ節転移、37U/mL以上の血清中CA19-9濃度および胆管断端陽性は、生存期間(OS)短縮を示す独立したリスク因子として挙げられた。なお、手術時に転移が最も多く認められたリンパ節部位はstation No.13で、次にNo.12、17、8と続き、station No.8、14、16の切除に有効性はみられなかった。だが、アジュバント化学療法においては、リンパ節転移を伴う患者のOS延長と有意な関連性が認められ、その一方、胆管断端陽性もしくはCA19-9数値が37U/mL以上の患者においては、OSとの関連性はみられなかった。以上より、リンパ節転移を伴ったDCC患者への術後アジュバント化学療法は良好な予後と関連することが示唆されたが、他にネガティブな予後因子が有する患者の生存転帰の改善には、より有効な治療法が必要と考えられた。

記述言語：英語  

DOI： 10.1097/AS9.0000000000000165

PubMed

記述言語：日本語   出版者・発行元：日本リンパ学会  

胃癌細胞株および胃癌切除症例におけるB7-H3発現について解析を行い、B7-H3抗体による腹水中腫瘍細胞検出の有無を含めた精度の高い胃癌腹膜播種診断法の臨床応用の可能性について検討した。当院で胃癌と診断され、リンパ節郭清を伴う胃切除術を行った10例と審査腹腔鏡でP1が確認された4型の切除不能進行胃癌の1例を対象とした。B7-H3 mRNA発現はすべての胃癌細胞株に認められ、B7-H3発現は細胞膜および細胞質に認められた。臨床検体である癌性腹水を用いて磁気ビーズとB7-H3抗体を用いて腹水中からの腫瘍細胞検出を試みた。その結果、in vitro assayと同様に腫瘍細胞の表面に多数の磁気ビーズが付着しているのが確認された。新規免疫チェックポイント分子であるB7-H3を用いたcell search systemは精度の高い胃癌腹膜播種診断法となる可能性が示唆された。

記述言語：日本語   出版者・発行元：Pathology Research and Practice  

Plexiform fibromyxoma (PFM) is a rare gastrointestinal tract tumor that develops in the stomach in most cases. Here, we report an extremely rare case of esophageal PFM. A female in her mid-30 s presented with difficulty in swallowing and breathing. Endoscopic examination revealed a submucosal tumor measuring approximately 45 × 50 mm in the upper thoracic esophagus. The biopsied specimen did not show definite histological evidence of gastrointestinal stromal tumors (GISTs). Since imatinib administration based on a clinical diagnosis of GIST did not show a therapeutic effect for tumor reduction, tumor resection was performed. The resected tumor exhibited proliferation of spindle tumor cells with abundant myxoid and vascular stroma separated by a muscular layer, indicating a plexiform arrangement. Immunohistochemical analysis demonstrated that the tumor cells diffusely expressed vimentin and alpha-smooth muscle actin, but not desmin, c-kit, DOG1, and CD34. MALAT1-GLI1 fusion was detected in formalin-fixed paraffin-embedded tissue using RT-PCR and Sanger sequencing. The results suggested that a fibromyxoid tumor can develop in the esophagus, showing an identical histology and MALAT1-GLI1 fusion to gastric PFM.

DOI： 10.1016/j.prp.2022.153878

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PubMed

記述言語：英語  

DOI： 10.1186/s40792-022-01412-x

PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_geka84_358

CiNii Research

記述言語：日本語   出版者・発行元：In Vivo  

Background/Aim: To investigate changes in post-progression chemotherapy (PPC) before and after nivolumab approval and determine their prognostic impact. Patients and Methods: A total of 146 patients with unresectable gastric cancer who had at least progressive disease after first- and/or second-line chemotherapy were retrospectively enrolled. Results: Among the 146 patients, 46 and 23 received ramucirumab and nivolumab, respectively. Moreover, 95 and 62 patients received PPC after first- and second-line chemotherapy, respectively. Group B (i.e., at least chemotherapy after nivolumab approval) had significantly higher proportions of patients receiving ramucirumab therapy, nivolumab therapy, and PPC after first- or second-line chemotherapy compared to group A (i.e., termination of chemotherapy before nivolumab approval). Group A had significantly poorer prognosis than group B. Multivariate analysis showed that age, number of distant metastatic sites, and ramucirumab therapy were independent prognostic factors. Conclusion: Changes in chemotherapeutic strategies, including PPC, might contribute to improved prognosis in patients with advanced gastric cancer.

DOI： 10.21873/INVIVO.12718

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PubMed

記述言語：日本語   出版者・発行元：General Thoracic and Cardiovascular Surgery  

Esophageal bronchogenic cysts are rare, and since a limited number of cases has been reported, the treatment plan for asymptomatic patients is difficult. A 55-year-old man without any symptoms visited our hospital for further examination of an esophageal mass detected on simple computed tomography. Upper endoscopy showed the protruding, submucosal mass covered by normal mucosa, and endoscopic sonography confirmed hypoechoic lesions originating from the muscularis propria. The patient was diagnosed as having an esophageal duplication cyst and underwent thoracoscopic resection. Pathological findings were consistent with an esophageal bronchogenic cyst. The patient was discharged without any problems on the 6th postoperative day. Upper endoscopy was performed 6 months after surgery, and no evidence of esophageal diverticula or narrowing was present. In conclusion, early thoracoscopic resection of esophageal bronchogenic cysts, before appearance of the symptom, can be a considerable treatment option because it is less invasive and may be advantageous for obtaining a definitive diagnosis in patients who are candidates for safe surgical resection.

DOI： 10.1007/s11748-021-01694-2

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PubMed

記述言語：英語   出版者・発行元：シュプリンガー・ジャパン(株)  

4型胃癌に対する化学療法後の手術の適応、予後に及ぼす影響について評価した。化学療法を施行された4型胃癌67名(男性30名、女性37名、平均年齢62.5歳)を対象に、後向き研究を実施した。対象を化学療法に対する腫瘍の反応に応じて、腫瘍増悪(PD)群16例と非PD群51例に分類した。遠隔転移は58例に生じ、予後はPD群の方が非PD群に比べ有意に不良であった。化学療法後に手術を施行した23例のうち21例がR0切除であった。多変量解析では、腫瘍反応と手術は有意な独立した予後因子であり、手術群では、リンパ節転移と遺残腫瘍が有意な独立した予後因子であった。N0-1で、化学療法後に治癒的R0切除を受けた4型胃癌患者では予後改善が得られる可能性が示唆された。

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: To assess the clinical indications for, and prognostic impact of surgery after, chemotherapy for type 4 gastric cancer. Methods: The subjects of this retrospective study were 67 patients who received chemotherapy for type 4 gastric cancer. The patients were grouped into those with progressive disease (PD group) and those without PD (non-PD group), according to the tumor response to chemotherapy. Results: Distant metastases developed in 58 patients. With regard to tumor response, there were 16 patients in the PD group and 51 patients in the non-PD group. The prognosis of the PD group patients was significantly poorer than that of the non-PD group patients (p < 0.0001). R0 resection was performed for 21 of 23 patients who underwent surgery after chemotherapy. Multivariate analysis revealed tumor response and surgery as independent prognostic factors (p = 0.0001 and p = 0.0009, respectively). Moreover, multivariate analysis of the surgery group revealed that metastatic nodal status (N0-1 vs. N2-3) and residual tumor status (R0 vs. R1-2) were significant independent prognostic factors (p = 0.0258 and p = 0.0458, respectively). Conclusion: The findings of this study suggest that surgery after chemotherapy for type 4 gastric cancer may improve the prognosis of responders with N0-1 status, who undergo curative R0 resection.

DOI： 10.1007/s00595-021-02320-7

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PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: The clinical benefit of conversion surgery (CS) after chemotherapy remains unclear for stage IV gastric cancer (GC) patients. This study aimed to investigate the prognostic factors used to determine whether CS is a promising therapeutic strategy. Patients and Methods: We retrospectively analyzed data from 156 patients diagnosed with unresectable stage IV GC who underwent chemotherapy as the initial treatment, including 40 patients who had R0 resection in CS. Results: The median survival time of the CS patients was significant longer than that of patients who underwent chemotherapy alone. A multivariate analysis identified only pN3 as an independent prognostic factor in CS patients. Among the differentiated tumor type patients, carbohydrate antigen 19-9 (CA19-9) levels were significantly higher in pN3 patients than in pN0-2 patients before chemotherapy. Among undifferentiated tumor type patients, pN3 patients had a significantly lower tumor size ratio (before chemotherapy/before surgery) than pN0-2 patients. Conclusion: Although it is clinically difficult to diagnose lymph node metastasis using preoperative examinations, CA19-9 levels and tumor size ratios may be preoperative indicators for predicting pN3, which is associated with a poor prognosis in CS.

DOI： 10.21873/anticanres.15380

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PubMed

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: To investigate the drainage patterns of the inferior mesenteric vein (IMV) and measure the distance from the root of the inferior mesenteric artery (IMA) to the IMV using preoperative three-dimensional computed tomography (3D-CT) angiography in patients undergoing surgery for left-sided colorectal cancer. Methods: In this retrospective study, we analyzed data collected prospectively on 167 consecutive patients who underwent laparoscopic left-sided colorectal cancer surgery between July, 2014 and August, 2019. The drainage pattern of the IMV and the distance from the root of the IMA to the IMV were evaluated using 3D-CT angiography. We also assessed intraoperative adverse events and postoperative outcomes. Results: The IMV drained into the superior mesenteric vein (SMV) in 44 patients, into the confluence point of the SMV and splenic vein (SV) in 38 patients, into the SV in 83 patients, and into the middle colic vein in the remaining three patients. The median length from the root of the IMA to the IMV was 22.1 mm (1.3–84.9). IMV injury occurred in only one patient during surgery, but resulted in colonic ischemia. Conclusion: 3D-CT angiography is useful for the preoperative assessment of vascular anatomical variations of the IMV and IMA for safe intraoperative navigation and prevention of complications during laparoscopy-assisted left-sided colorectal surgery.

DOI： 10.1007/s00595-021-02292-8

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PubMed

記述言語：日本語   出版者・発行元：Annals of Surgical Oncology  

Purpose: Neoadjuvant therapy (NAT) is used to treat not only advanced pancreatic cancer but also resectable lesions. The present study investigated the effectiveness of postoperative adjuvant chemotherapy for patients with pancreatic cancer who underwent surgical resection after NAT. Methods: Patients who underwent macroscopically curative resection after NAT for pancreatic cancer were enrolled. Adjuvant chemotherapy was defined as at least 1 cycle of planned chemotherapy within 3 months after the date of surgery and included S-1, gemcitabine, or both. We retrospectively examined the effect of adjuvant chemotherapy on overall survival (OS) and recurrence-free survival (RFS) as a function of patients’ clinicopathological factors. Results: Ninety-seven patients were included in the study, of which 68 (70.1%) underwent adjuvant chemotherapy. Administration of adjuvant chemotherapy was significantly associated with prolonged OS and RFS in patients whose elevated levels of carbohydrate antigen 19-9 or duke pancreatic monoclonal antigen type-2 did not normalize after NAT. In patients with pathological lymph node metastasis, the administration of adjuvant chemotherapy was significantly associated with longer OS but did not improve PFS. Conclusions: Postoperative adjuvant chemotherapy was associated with prolonged postoperative survival in patients with pancreatic cancer who did not sufficiently respond to NAT as judged by tumor marker expression.

DOI： 10.1245/s10434-021-09712-6

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PubMed

記述言語：日本語   出版者・発行元：鹿児島県臨床外科学会  

2015年8月～2020年12月に当院で胸腔鏡下食道亜全摘術と胃管再建・頸部吻合を行った25例を対象に、吻合縫合不全および狭窄の発生状況を検討した。頸部吻合法は2017年9月までの5例には端々吻合を、2017年10月以降の20例にはCollard変法が行われた。その結果、臨床病理学的因子と縫合方法との間に有意な相関は認められなかった。縫合不全の発生率は端々吻合で40%、Collard法で5%であった。一方、吻合部狭窄の発生率は端々吻合で30%、Collard法で0%と、Collard法で縫合不全・吻合部狭窄の発生率が有意に少なく、有用性が示唆された。

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: To determine the prognostic utility of trastuzumab-based chemotherapy based on human epidermal growth factor receptor 2 (HER2) expression in patients with para-aortic lymph node (PAN) metastasis from gastric cancer. Patients and Methods: A total of 41 patients with clinical PAN metastasis from gastric cancer who underwent chemotherapy were retrospectively enrolled. Results: Eighteen (43.9%) patients had HER2-positive tumors and consequently, received trastuzumab-based chemotherapy. A total of 11 patients underwent surgery. HER2 status was significantly correlated with the number of distant metastatic sites, the presence or absence of trastuzumab-based chemotherapy, and the presence or absence of gastrectomy. HER2-positive patients had significantly better prognosis than HER2-negative patients. Multivariate analysis identified age and trastuzumab-based chemotherapy based on HER2 status as an independent prognostic factor. Conclusion: Assessing HER2 expression and subsequent trastuzumab-based chemotherapy can be an effective method for determining the prognosis of patients with PAN metastasis from gastric cancer.

DOI： 10.21873/anticanres.15094

Scopus

PubMed

記述言語：日本語   出版者・発行元：Oncology (Switzerland)  

Background: The Japanese Gastric Cancer Treatment Guidelines recommend S-1 and S-1 plus docetaxel as postoperative chemotherapy for pathological stage II and III gastric cancer (GC). There is currently no strategy for using chemotherapy to treat high-risk recurrent pathological stage II/III. Previous studies reported that the several nutritional, immunological, and inflammatory markers examined the association with clinical outcomes after surgery for GC. Methods: Ninety patients with GC (stage II, n = 48; stage III, n = 42) for whom gastrectomy was performed at our institution between November 2009 and September 2018 were examined. Nutritional, immunological, and inflammatory markers were calculated from blood samples within 1 week before surgery. Results: The prognostic nutritional index (PNI) status correlated with the pathological stage and disease recurrence after surgery (p = 0.015 and p < 0.0001, respectively). Thirty-three patients had disease recurrence after gastrectomy (stage II, n = 11; stage III, n = 22). The PNI was significantly lower in the recurrent group than in the non-recurrent group (p = 0.0003). The PNI correlated with overall survival and recurrence-free survival after gastrectomy (p = 0.0021 and p = 0.0001, respectively). A multivariate analysis identified the PNI as an independent prognostic factor (p = 0.006). Conclusion: The PNI may be useful for predicting the outcomes of patients with pathological stage II/III GC and may contribute to the selection of an appropriate adjuvant chemotherapy regimen.

DOI： 10.1159/000514572

Scopus

PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_geka83_519

CiNii Research

記述言語：日本語   出版者・発行元：Surgery Today  

Purpose: Using a circular stapler to create an anastomosis for esophagogastrostomy after esophagectomy is well accepted; however, it remains uncertain if the greater curvature (GC) or lesser curvature (LC) of the gastric conduit is better for the anastomosis. We conducted this prospective study to compare the integrity of esophagogastrostomy between the esophagus and the GC or LC side of the gastric conduit. Methods: The subjects of this study were 70 patients who underwent esophagectomy and were randomized to a “GC” group and an “LC” group (n = 35 each). The primary and secondary end points were anastomotic leakage (AL) and anastomotic stricture (AS), respectively. Results: The overall AL rate was 22.1%, without a significant difference between the groups. Stump leakage developed in eight of nine patients in the GC group, whereas leakage developed at the esophagogastric anastomosis in five of six patients in the LC group. The rate of stump leakage was significantly higher than that of esophagogastric AL in the GC group. The overall AS rate was 4.4%, with a significant difference between the groups (0% in the GC group vs. 9.1% in the LC group). Conclusions: AL rates were comparable in the two groups, but the sites of leakage were significantly different.

DOI： 10.1007/s00595-020-02147-8

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PubMed

記述言語：日本語   出版者・発行元：日本リンパ学会  

記述言語：英語  

DOI： 10.1186/s40792-021-01108-8

PubMed

記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy  

Although the effectiveness of trifluridine/tipiracil (TFTD) with bevacizumab for unresectable colorectal cancer that was refractory to previous standard chemotherapy was reported, its effectiveness as a first-line treatment, especially for elderly frail patients, is unclear. An 85-year-old woman complaining of anorexia was diagnosed with unresectable sigmoid colon cancer with multiple metastases. Her general status was very poor, and her performance status (PS) was 4. We first performed laparoscopic transverse colostomy. As her general status gradually improved, we administered TFTD with bevacizumab as a first-line treatment based on the patient's strong request for chemotherapy The patient underwent this regimen in the outpatient clinic for 9 months (9 courses). Although the size of the liver metastases increased, lung metastases and abdominal disseminations were under control and her PS became 0. She has been taking mFOLFOX6 with bevacizumab (80%) as a second-line treatment. TFTD with bevacizumab treatment was safe and efficacious as a first-line treatment for a frail elderly patient with unresectable colorectal cancer.

Scopus

記述言語：日本語  

PubMed

記述言語：英語   出版者・発行元：(一社)日本外科学会  

症例は11歳男児で、腹痛と咳嗽を主訴とした。造影CTで両側胸水と縦隔、心窩部、腸間膜、頸部および腋窩リンパ節症を認め、進行性悪性リンパ腫疑いにて紹介された。骨髄検査、フローサイトメトリー所見などからステージIV ALK陽性未分化大細胞リンパ腫(ALCL)と診断し、ALCL 99レジメンによる化学療法を開始したところ一時的な寛解が得られたが、中枢神経系浸潤がみられたためブレンツキシマブ ベドチン(BV)と大量メトトレキサート(HD-MTX)を投与した。診断5ヵ月後に寛解を得たが嚥下障害と嘔吐を発症し、食道鏡検査で中部胸部食道に重度狭窄が認められた。食道粘膜生検では悪性所見はみられず、3週後の再検では狭窄の進行が生じていた。HD-MTX 5コースとBV 8コース終了後、同種骨髄移植を施行し、完全寛解は維持されていたものの、嚥下障害と唾液貯留に改善はみられず、食道鏡検査にて先天性食道閉鎖症に類似する盲端を口部から26cmの箇所に認めた。診断から2年8ヵ月後、食道再建目的で入院となり、胸腔鏡下と腹腔鏡下に最小侵襲食道亜全摘術を施行した。切除標本の病理診断では食道上皮は観察されずヒアリン化組織と線維化組織に置き換わっており、生存細胞はみられなかった。術後合併症はみられず、68日後に転院となり、その後嚥下障害の消失が得られた。

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

既存の標準治療に抵抗性となった切除不能進行大腸癌に対するベバシズマブ併用トリフルリジン・チピラシル塩酸塩(TFTD)療法の安全性と有用性が報告されているが、一次治療で高齢フレイル患者に使用した報告はない。症例は85歳、女性。X年1月中旬より食欲不振が出現し、多発遠隔転移と腹水を伴うS状結腸癌と診断された。全身状態の低下を認め、ECOG performance status(PS)4であった。人工肛門造設術後にTFTDを開始し、2コース目以降はベバシズマブ療法を併用し、外来で化学療法を継続した。9コース投与後に肝転移の増悪を認めたが、9ヵ月間にわたって病勢コントロールが可能であった。現在はPS0まで改善し、ベバシズマブ併用mFOLFOX6療法(80%dose)を投与中である。本治療法は高齢フレイル患者の切除不能進行大腸癌に対する一次治療として有用と思われた。(著者抄録)

記述言語：英語   出版者・発行元：一般社団法人日本大腸肛門病学会  

Here, we describe the modified delta-shaped anastomosis (DSA) via the overlap method and how it was a beneficial intracorporeal anastomotic technique for four patients who underwent laparoscopic colectomy. After resecting the colon on both sides of the lesion, proximal and distal colon were laid in an overlap fashion and fixed using sutures. The entry hole was created using an ultrasound scalpel at a point 3 cm proximal to right colic stump and 7 cm distal to left colic stump on the anti-mesenteric side. Then, two arms of the linear stapler were inserted inside each lumen and fired. Finally, using the linear stapler, the common entry hole was closed in a delta-shaped manner. The mean duration of surgery was determined to be 218.4 (196-369) minutes, and amount of blood loss was measured to be 11 (5-25) mL. No intraoperative and postoperative complications were observed. Median postoperative hospital stay was 12 days. Thus, modified DSA via overlap method can be considered as a safe and simple IA technique.

DOI： 10.23922/jarc.2020-013

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PubMed

CiNii Research

記述言語：日本語   出版者・発行元：British Journal of Cancer  

Background: Previously, we identified ITIH5 as a suppressor of pancreatic ductal adenocarcinoma (PDAC) metastasis in experimental models. Expression of ITIH5 correlated with decreased cell motility, invasion and metastasis without significant inhibition of primary tumour growth. Here, we tested whether secretion of ITIH5 is required to suppress liver metastasis and sought to understand the role of ITIH5 in human PDAC. Methods: We expressed mutant ITIH5 with deletion of the N-terminal secretion sequence (ITIH5Δs) in highly metastatic human PDAC cell lines. We used a human tissue microarray (TMA) to compare ITIH5 levels in uninvolved pancreas, primary and metastatic PDAC. Results: Secretion-deficient ITIH5Δs was sufficient to suppress liver metastasis. Similar to secreted ITIH5, expression of ITIH5Δs was associated with rounded cell morphology, reduced cell motility and reduction of liver metastasis. Expression of ITIH5 is low in both human primary PDAC and matched metastases. Conclusions: Metastasis suppression by ITIH5 may be mediated by an intracellular mechanism. In human PDAC, loss of ITIH5 may be an early event and ITIH5-low PDAC cells in primary tumours may be selected for liver metastasis. Further defining the ITIH5-mediated pathway in PDAC could establish future therapeutic exploitation of this biology and reduce morbidity and mortality associated with PDAC metastasis.

DOI： 10.1038/s41416-020-01093-z

Scopus

PubMed

記述言語：日本語   出版者・発行元：Anticancer Research  

Background/Aim: A combination therapy of esophageal stent and chemoradiotherapy (CRT) is currently considered risky for severe complications. The aim of this study was to assess the safety and efficacy of a fully covered self-expandable metallic stent (FCSEMS) placement in palliating incurable esophageal cancer before and/or after CRT. Patients and Methods: We retrospectively reviewed clinical outcomes of 64 incurable advanced esophageal cancer patients with FCSEMS placement. Forty-two of 64 patients had FCSEMS placement with RT. Results: The rate of all of stent-related complications tended to be higher in patients who had RT, although no significant difference was observed. The stent-related deaths occurred in one patient due to hemorrhage after FCSEMS placement in the RTnegative group. Conclusion: Palliation of dysphagia or fistulas with FCSEMS in patients with incurable esophageal cancer before and/or after RT is not associated with an increased risk of life-threatening complications.

DOI： 10.21873/anticanres.14787

Scopus

PubMed

記述言語：英語   出版者・発行元：(一社)日本大腸肛門病学会  

結腸癌に対する腹腔鏡下結腸切除術時に、リニアステープラを用いたオーバーラップ法による修正デルタ吻合術(DSA)の有用性について検討した。結腸癌患者4例(男性2例、女性2例、年齢53～73歳)を対象とした。結腸癌病変の両側結腸を切除後、近位結腸と遠位結腸を重ね、縫合糸を用いて固定した。その後、腸間膜付着対側の右結腸断端から3cm近位および左結腸断端から7cm遠位の点に超音波メスを使用して入口穴を作成し、リニアステープラの2本のアームを腔内に挿入して作動させた。最後に、リニアステープラを使用して入口穴をデルタ型に閉鎖した。患者内訳は上行結腸癌1例、横行結腸癌1例、盲腸癌2例で、手術時間は196分～369分、出血量は4～25ml、吻合時間は22～53分、入院期間は11日～13日であった。術中および術後合併症は見られなかった。本吻合法は、安全かつ簡便な体内吻合と考えられた。

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器外科学会  

<p>食道癌術後の縫合不全は，ときに難治性の消化管皮膚瘻を形成する．今回，食道癌術後の食道胃管吻合部縫合不全が原因の難治性消化管皮膚瘻に対し陰圧閉鎖療法が有用であった2例を経験したので報告する．症例1は68歳の男性で，術前化学療法後の食道切除胸骨後経路胃管再建術後に，症例2は69歳の男性で，術前化学放射線療法後の食道切除胸壁前経路胃管再建術後に，それぞれ縫合不全に伴う消化管皮膚瘻を形成した．創部の掻爬，縫合不全部の再縫合，吸収性組織補強材充填などの治療を試みたが縫合不全は治癒しなかったため陰圧閉鎖療法（negative pressure wound therapy；以下，NPWTと略記）を行ったところいずれの症例も創傷治癒が得られた．NPWTは創部の閉鎖陰圧より創面を密着させ，唾液などの消化液の漏出を遮断することで肉芽形成を促進させ創傷治癒の促進に有効と考えられた．</p>

DOI： 10.5833/jjgs.2019.0054

CiNii Research

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1403201891

CiNii Research

担当区分：筆頭著者   記述言語：日本語  

出版者・発行元：金原出版  

DOI： 10.18888/op.0000001011

CiNii Research

担当区分：筆頭著者   記述言語：日本語  

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：日本語  

出版者・発行元：金原出版  

DOI： 10.18888/op.0000000624

CiNii Research

担当区分：筆頭著者   記述言語：日本語  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

CiNii Research

出版者・発行元：金原出版  

DOI： 10.18888/j00620.2017220936

CiNii Research

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

出版者・発行元：南江堂  

DOI： 10.15106/j00393.2013323730

CiNii Research

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器外科学会  

症例は51歳の女性で，上腹部違和感を主訴に近医受診された．内視鏡検査で，胸部食道に長径12 cmの不染帯を指摘され，生検で扁平上皮癌と診断後当院へ紹介となった．精査の結果，胃壁浸潤を伴う右噴門リンパ節（No. 1）転移および総肝動脈幹前上部リンパ節（No. 8a）転移を有する表層拡大型食道癌と診断され，3領域郭清を伴う右開胸開腹食道亜全摘術を施行した．術前に右噴門リンパ節への転移と診断した病変は長径53 mmの巨大胃壁内転移であった．最終病理組織学的検査所見は深達度T1a-MMの低分化型扁平上皮癌で，遠隔リンパ節転移を伴う計10個のリンパ節転移を認めた．また，原発巣にリンパ管新生因子VEGF-Cの高発現が確認され，本症例の高いリンパ行性転移能を裏づける結果であった．術後補助化学療法施行したが，術後9か月目に腹部リンパ節再発を認め，術後29か月で死亡された．食道粘膜癌からの胃壁内転移は本邦報告4例目であった．

DOI： 10.5833/jjgs.45.1005

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：英語   掲載種別：学位論文（博士）  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

機関リポジトリURL

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器外科学会  

症例は46歳の男性で，胸部食道癌の診断で精査入院中，突然の右側胸部から季肋部に至る激痛と発熱が出現した．胸部CTで縦隔気腫および右側胸水を認め，食道癌穿孔と診断された．当科に紹介入院後，緊急手術が施行された．右胸腔内に黄白色胸水の貯留があり，食道癌の穿孔の所見を認めた．手術は右開胸開腹による食道亜全摘，胸壁前経路胃管再建および右胸腔内の洗浄ドレナージを行った．摘出標本では胸部中下部食道に7.5×4.0 cmの2型食道癌を認め，潰瘍底に穿孔部が確認された．病理組織学的には中分化型扁平上皮癌，pT3，infβ，ly3，v2と診断され，胃周囲リンパ節に計12個の転移を認めた．術後経過は良好で，追加治療として化学放射線療法を行い，さらに再発病変に対して化学療法を行い，22か月間生存された．今回，1期的切除再建により救命し，その後集学的に治療ができた食道癌穿孔症例について文献的考察を含め報告する．

DOI： 10.5833/jjgs.42.1371

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本外科学会  

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：特定非営利活動法人 日本気管食道科学会  

DOI： 10.2468/jbes.59.178

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人 日本消化器外科学会  

同時性多発肝・骨転移を認めた直腸腺扁平上皮癌を経験したので報告する. 症例は73歳の女性で, 便柱狭小化と腰痛を主訴に来院した. 直腸Rs領域に半周性の3型病変を認め, 生検で低分化腺癌と診断された. 同時に遠隔リンパ節転移, 肝両葉にわたる多発肝転移, 第1仙椎への転移も認められた. 局所に関しては出血, 狭窄症状のコントロール目的でHartmann手術を施行した. 病理組織学的検査で, 直腸腺扁平上皮癌, Rs, Type3, ss, ly3, v3, n2, H3, P0, M1でStage IVと診断された. 術後化学療法は大腸癌に準じて5-FUによる肝動注, CPT-11とl-LVによる全身化学療法および骨転移に放射線治療を行った. 本疾患はまれで, いまだ確立された治療法はないが, 多発転移を伴う直腸腺扁平上皮癌に対して今後, 薬剤感受性試験や分子生物・遺伝子学的方法による補助療法の工夫が必要と考えられた.

DOI： 10.5833/jjgs.39.1638

CiNii Research

記述言語：日本語   出版者・発行元：一般社団法人日本消化器外科学会  

CiNii Research

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）  

記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞StageIV胃癌に対する化学放射線療法(CRT)は,胃癌治療ガイドラインにおいても治療選択肢としての明確な位置づけは示されていない.一方,本邦も含めてこれまでCRTに関する臨床試験が行われ,高い組織学的奏効率や予後改善効果を認めたとする報告もあるが,薬物療法の著しい進歩もあり,現在ではCRTの臨床的意義は不明である.しかし,最終的なconversion surgeryを見据えてCRTの高い局所制御効果を利用した治療戦略は今後検討すべき課題と思われる.

担当区分：筆頭著者   記述言語：日本語  

記述言語：日本語   出版者・発行元：(株)南江堂  

記述言語：日本語   出版者・発行元：(株)へるす出版  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）  

記述言語：日本語   掲載種別：記事・総説・解説・論説等（商業誌、新聞、ウェブメディア）  

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