BACKGROUND Bronchogenic cysts are congenital lesions requiring radical resection because of malignant potential.However,a method for the optimal resection of these cysts has not been completely elucidated.CASE SUMMARY...BACKGROUND Bronchogenic cysts are congenital lesions requiring radical resection because of malignant potential.However,a method for the optimal resection of these cysts has not been completely elucidated.CASE SUMMARY Herein,we presented three patients with bronchogenic cysts that were located adjacent to the gastric wall and resected laparoscopically.The cysts were detected incidentally with no symptoms and the preoperative diagnosis was challenging to obtain via radiological examinations.Based on laparoscopic findings,the cyst was attached firmly to the gastric wall and the boundary between the gastric and cyst walls was difficult to identify.Consequently,resection of cysts alone caused cystic wall injury in Patient 1.Meanwhile,the cyst was resected completely along with a part of the gastric wall in Patient 2.Histopathological examination revealed the final diagnosis of bronchogenic cyst and revealed that the cyst wall shared the muscular layer with the gastric wall in Patients 1 and 2.In Patient 3,the cyst was located adjacent to the gastric wall but histopathologically originated from diaphragm rather than stomach.All the patients were free from recurrence.CONCLUSION The findings of this study state that a safe and complete resection of bronchogenic cysts required the adherent gastric muscular layer or full-thickness dissection,if bronchogenic cysts are suspected via pre-and/or intraoperative findings.展开更多
BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations ...BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.展开更多
Despite recent progress in diagnostic imaging,gastric cancer(GC)is occasionally found at an advanced stage with distant metastasis.As metastatic GC is difficult to cure,the treatment strategy should be considered indi...Despite recent progress in diagnostic imaging,gastric cancer(GC)is occasionally found at an advanced stage with distant metastasis.As metastatic GC is difficult to cure,the treatment strategy should be considered individually based on the physical and socioeconomic status of patients as well as on the GC symptoms.The first choice of treatment for metastatic GC is chemotherapy,and several chemotherapeutic regimens for metastatic or recurrent GC have been developed through randomized controlled trials.Ongoing clinical trials will provide novel therapeutic options for patients with metastatic GC in the near future,while individualization of treatment based on detailed molecular information,so-called precision medicine,is eagerly anticipated.In this article,we review recent publications and guidelines focusing on recent progress in the treatment of metastatic GC in Japan.展开更多
Gastric cancer with distant metastases,such as para-aortic lymph node metastases,hepatic metastases,and peritoneal dissemination,is classified as stage IV.In this situation,cancer cells have formed micrometastases thr...Gastric cancer with distant metastases,such as para-aortic lymph node metastases,hepatic metastases,and peritoneal dissemination,is classified as stage IV.In this situation,cancer cells have formed micrometastases throughout the body;therefore,according to the algorithm of the Japanese guidelines,stage IV cancer is outside the indication for curative resection.Recent advances in some chemical agents have been remarkable,and some patients have survived for long periods even with stage IV gastric cancer.Thus,even in patients with stage IV gastric cancer,there is a possibility that gastrectomy as conversion surgery could play an important role in the treatment strategy.Gastrectomy as conversion therapy can be safely conducted without perioperative mortality and is considered a sufficiently acceptable treatment strategy.However,the significance of conversion surgery for stage IV gastric cancer remains controversial.In this review,we summarize the treatment strategies and outcomes of conversion surgery for stage IV gastric cancer.展开更多
Chronic inflammation has been identified as an important risk factor in the development of the gastrointestinal(GI)tract cancers,and the underlying molecular mechanisms have been studied extensively.Chronic infl ammat...Chronic inflammation has been identified as an important risk factor in the development of the gastrointestinal(GI)tract cancers,and the underlying molecular mechanisms have been studied extensively.Chronic infl ammation is able to trigger cellular events to promote malignant transformation of normal epithelial cells in the GI tract to cancer.Host inflammation responses in carcinogenesis are through multiple mechanisms such as reactive oxygen and nitration species from mononuclear phagocytes and leukocytes,immune response and pro-inflammatory cytokines.Nuclear factor-κB(NF-κB)has been considered as the central mediator of the immune response.Activation of NF-κB by phosphorylation leads to translocation of NF-κB protein to the nucleus,and in turn regulates the transcription of several pro-infl ammatory cytokines and chemokines.Furthermore,chronic inflammation creates an environment for genomic and epigenetic changes.In this review,we summarize the important molecular mechanisms that link chronic infl ammation and GI tract cancer,including esophageal,gastric and colonic cancers,focusing on infective and noninfective agents such as gastroesophageal reflux disease,Helicobacter pylori gastritis and infl ammatory bowel disease.展开更多
文摘BACKGROUND Bronchogenic cysts are congenital lesions requiring radical resection because of malignant potential.However,a method for the optimal resection of these cysts has not been completely elucidated.CASE SUMMARY Herein,we presented three patients with bronchogenic cysts that were located adjacent to the gastric wall and resected laparoscopically.The cysts were detected incidentally with no symptoms and the preoperative diagnosis was challenging to obtain via radiological examinations.Based on laparoscopic findings,the cyst was attached firmly to the gastric wall and the boundary between the gastric and cyst walls was difficult to identify.Consequently,resection of cysts alone caused cystic wall injury in Patient 1.Meanwhile,the cyst was resected completely along with a part of the gastric wall in Patient 2.Histopathological examination revealed the final diagnosis of bronchogenic cyst and revealed that the cyst wall shared the muscular layer with the gastric wall in Patients 1 and 2.In Patient 3,the cyst was located adjacent to the gastric wall but histopathologically originated from diaphragm rather than stomach.All the patients were free from recurrence.CONCLUSION The findings of this study state that a safe and complete resection of bronchogenic cysts required the adherent gastric muscular layer or full-thickness dissection,if bronchogenic cysts are suspected via pre-and/or intraoperative findings.
文摘BACKGROUND Although dumping symptoms constitute the most common post-gastrectomy syndromes impairing patient quality of life,the causes,including blood sugar fluctuations,are difficult to elucidate due to limitations in examining dumping symptoms as they occur.AIM To investigate relationships between glucose fluctuations and the occurrence of dumping symptoms in patients undergoing gastrectomy for gastric cancer.METHODS Patients receiving distal gastrectomy with Billroth-I(DG-BI)or Roux-en-Y reconstruction(DG-RY)and total gastrectomy with RY(TG-RY)for gastric cancer(March 2018-January 2020)were prospectively enrolled.Interstitial tissue glycemic profiles were measured every 15 min,up to 14 d,by continuous glucose monitoring.Dumping episodes were recorded on 5 patient-selected days by diary.Within 3 h postprandially,dumping-associated glycemic changes were defined as a dumping profile,those without symptoms as a control profile.These profiles were compared.RESULTS Thirty patients were enrolled(10 DG-BI,10 DG-RY,10 TG-RY).The 47 early dumping profiles of DG-BI showed immediately sharp rises after a meal,which 47 control profiles did not(P<0.05).Curves of the 15 late dumping profiles of DG-BI were similar to those of early dumping profiles,with lower glycemic levels.DGRY and TG-RY late dumping profiles(7 and 13,respectively)showed rapid glycemic decreases from a high glycemic state postprandially to hypoglycemia,with a steeper drop in TG-RY than in DG-RY.CONCLUSION Postprandial glycemic changes suggest dumping symptoms after standard gastrectomy for gastric cancer.Furthermore,glycemic profiles during dumping may differ depending on reconstruction methods after gastrectomy.
文摘Despite recent progress in diagnostic imaging,gastric cancer(GC)is occasionally found at an advanced stage with distant metastasis.As metastatic GC is difficult to cure,the treatment strategy should be considered individually based on the physical and socioeconomic status of patients as well as on the GC symptoms.The first choice of treatment for metastatic GC is chemotherapy,and several chemotherapeutic regimens for metastatic or recurrent GC have been developed through randomized controlled trials.Ongoing clinical trials will provide novel therapeutic options for patients with metastatic GC in the near future,while individualization of treatment based on detailed molecular information,so-called precision medicine,is eagerly anticipated.In this article,we review recent publications and guidelines focusing on recent progress in the treatment of metastatic GC in Japan.
文摘Gastric cancer with distant metastases,such as para-aortic lymph node metastases,hepatic metastases,and peritoneal dissemination,is classified as stage IV.In this situation,cancer cells have formed micrometastases throughout the body;therefore,according to the algorithm of the Japanese guidelines,stage IV cancer is outside the indication for curative resection.Recent advances in some chemical agents have been remarkable,and some patients have survived for long periods even with stage IV gastric cancer.Thus,even in patients with stage IV gastric cancer,there is a possibility that gastrectomy as conversion surgery could play an important role in the treatment strategy.Gastrectomy as conversion therapy can be safely conducted without perioperative mortality and is considered a sufficiently acceptable treatment strategy.However,the significance of conversion surgery for stage IV gastric cancer remains controversial.In this review,we summarize the treatment strategies and outcomes of conversion surgery for stage IV gastric cancer.
基金supported by Scientific Research(C)(KAKENHI)(15K10080)from the Japanese Society for the Promotion of Science.
文摘Chronic inflammation has been identified as an important risk factor in the development of the gastrointestinal(GI)tract cancers,and the underlying molecular mechanisms have been studied extensively.Chronic infl ammation is able to trigger cellular events to promote malignant transformation of normal epithelial cells in the GI tract to cancer.Host inflammation responses in carcinogenesis are through multiple mechanisms such as reactive oxygen and nitration species from mononuclear phagocytes and leukocytes,immune response and pro-inflammatory cytokines.Nuclear factor-κB(NF-κB)has been considered as the central mediator of the immune response.Activation of NF-κB by phosphorylation leads to translocation of NF-κB protein to the nucleus,and in turn regulates the transcription of several pro-infl ammatory cytokines and chemokines.Furthermore,chronic inflammation creates an environment for genomic and epigenetic changes.In this review,we summarize the important molecular mechanisms that link chronic infl ammation and GI tract cancer,including esophageal,gastric and colonic cancers,focusing on infective and noninfective agents such as gastroesophageal reflux disease,Helicobacter pylori gastritis and infl ammatory bowel disease.
