Prophylactic lateral pelvic lymph node dissection in stage Ⅳ low rectal cancer

AIM To assess the clinical significance of prophylactic lateral pelvic lymph node dissection (LPLND) in stage Ⅳ low rectal cancer.METHODS We selected 71 consecutive stage Ⅳ low rectal cancer patients who underwent primary tumor resection,and enrolled 50 of these 71 patients without clinical LPLN metastasis.The patients had distant metastasis such as liver,lung,peritoneum,and paraaortic LN.Clinical LPLN metastasis was defined as LN with a maximum diameter of 10 mm or more on preoperative pelvic computed tomography scan.All patients underwent primary tumor resection,27 patients underwent total mesorectal excision(TME) with LPLND(LPLND group),and 23 patients underwent only TME(TME group).Bilateral LPLND was performed simultaneously with primary tumor resection in LPLND group.R0 resection of both primary and metastatic sites was achieved in 20 of 50 patients.We evaluated possible prognostic factors for 5-year overall survival (OS),and compared 5-year cumulative local recurrence between the LPLND and TME groups.RESULTS For OS,univariate analyses revealed no significant benefit in the LPLND compared with the TME group (28.7% vs 17.0%,P = 0.523); multivariate analysis revealed that R0 resection was an independent prognostic factor.Regarding cumulative local recurrence,the LPLND group showed no significant benefit compared with TME group (21.4% vs 14.8%,P = 0.833).CONCLUSION Prophylactic LPLND shows no oncological benefits in patients with Stage Ⅳ low rectal cancer without clinical LPLN metastasis.

Endobronchial metastasis from adenocarcinoma of gastric cardia 7 years after potentially curable resection

Endobronchial metastasis(EBM) is a rare form of metas-tasis from extrapulmonary malignant tumors,although there are few reports of EBM from gastric cancer specifically.We report the case of a 51-year-old woman who had undergone gastrectomy for advanced gastric cancer seven years previously but was diagnosed with a solitary lung tumor by follow-up computed tomography.On diagnosis of primary lung cancer,she underwent pulmonary lobectomy,but immunohistochemical examination confirmed the resected tumor to be an EBM from the gastric cancer.Six months later,she was diagnosed with peritoneal metastases and underwent chemotherapy with gastric cancer regimen.She is still alive at 33 mo after the lobectomy.Generally,the prognosis for EBM is poor although multidisciplinary treatment can lead to long-term survival.Precise diagnosis on the basis of detailed pathological and immunohistochemical evaluation can contribute to deciding the most effective treatment and improving prognosis.

Multiple carcinoids in the duodenum, pancreas and stomach accompanied with type A gastritis: A case report

我们报导多重十二指肠、胰腺、胃的良性肿瘤的一个案例。A 67- 岁女人为十二指肠的良性肿瘤的治疗进入我们的医院。实验室测试表明病人与 macrocytic 和 hypergastrinemia 被联系，并且类型 A 胃炎被 gastrofiberscopy 显示出。在外科期间，另一个肿瘤顺便说一下在胰的头被发现。在十二指肠和胰的肿瘤被胰头十二指肠切除术完全切除并且 immunohistologically 作为促胃液素诊断了 -- 并且生产血清素的良性肿瘤分别地。病理学的检查表明除了非常发现的良性肿瘤，有无临床症状的良性肿瘤，其一是内分泌的房间 micronest，在胃和十二指肠定位了。在十二指肠，胰，和胃的肿瘤词法上从对方显示出不同特征并且免疫化学上。尽管没有权威的证据被获得了，某种基因异例可能涉及了这种情况，并且 hypergastrinemia 可以由于十二指肠的 gastrinoma 导致多重胃的良性肿瘤。

Pedunculated gastric tube interposition in an esophageal cancer patient with prepyloric adenocarcinoma

Gastric carcinoma is one of the malignancies that are most frequently associated with esophageal carcinoma.We describe herein our device for advanced esophageal cancer associated with early gastric cancer in the antrum.A 57-year-old man presenting with dysphagia and upper abdominal pain was admitted to our hospital.Preoperative examinations revealed locally advanced squamous cell carcinoma (SCC) of the middle thoracic esophagus (T3N0M0 Stage ⅡA) and mucosal signetring cell carcinoma of the gastric antrum (T1N0M0 Stage ⅠA).Although the gastric tumor appeared to be an intramucosal carcinoma,its margin was obscure,so endoscopic en-bloc resection was considered inadequate.We chose surgical resection of the gastric tumor as well as the esophageal SCC after neoadjuvant chemotherapy with 5-fluorouracil and cisplatin for advanced esophageal cancer.Following transthoracic esophagectomy with three-field lymph node dissection,the gastric carcinoma was removed by gastric antrectomy,which preserved the right gastroepiploic vessels,and a pedunculated short gastric tube was used as the esophageal substitute.Twenty-eight months after the surgery,the patient is well with no evidence of cancer recurrence.Because it minimizes surgical stress and organ sacrifice,gastric tube interposition is a potentially useful technique for esophageal cancer associated with localized early gastric cancer.

Intrathoracic esophagojejunostomy using OrVil^(TM) for gastric adenocarcinoma involving the esophagus

AIM: To demonstrate a new surgical technique of lower mediastinal lymphadenectomy and intrathoracic anastomosis of esophagojejunostomy using OrV il^(TM). METHODS: After a total median phrenotomy, the supradiaphragmatic and lower thoracic paraesophageal lymph nodes were transhiatally dissected. The esophagus was cut off using a liner stapler and OrV il^(TM)was inserted. Finally, end-to-side esophagojejunostomy was created by using a circular stapler. From July 2009,we adopted this surgical technique for five patients with gastric cancer involving the lower esophagus. RESULTS: The median operation time was 314 min(range; 210-367 min), and median blood loss was 210 mL(range; 100-838 mL). The median numbers of dissected lower mediastinal nodes were 3(range; 1-10). None of the patients had postoperative complications including anastomotic leakage and stenosis. Themedian hospital stay was 16 d(range: 15-20 d). The median length of esophageal involvement was 14 mm(range: 6-48 mm) and that of the resected esophagus was 40 mm(range: 35-55 mm); all resected specimens had tumor-free margins.CONCLUSION: This surgical technique is easy and safe intrathoracic anastomosis for the patients with gastric adenocarcinoma involving the lower esophagus.

Gastric cancer surgery for patients with liver cirrhosis

AIM:To elucidate the influence of liver cirrhosis(LC) on the prognosis of patients with gastric cancer(GC).METHODS:Of the 1347 GC patients who underwent curative gastrectomy for GC between January 1984 and June 2007,25 patients(21 men and 4 women with a median age of 67 years;range 54-77 years) with LC were enrolled in this study.Using the Child-Pugh classification,15 patients were evaluated as grade A and 10 patients as grade B.No grade C patient underwent gastrectomy in this series.Clinical outcomes,including postoperative morbidity and survival,were retrospectively analyzed based on medical records and surgical f iles.RESULTS:There was no significant difference in operative blood loss and perioperative blood transfusion between the two groups.The most common postoperative complication was intractable ascites,which was the single postoperative morbidity noted more frequently in grade B patients(40.0%) than in grade A patients(6.7%) with statistical signif icance(P = 0.041).Operative mortality due to hepatic failure was seen in one grade A patient.Three patients had hepatocellular carcinoma(HCC) at presentation and two patients developed HCC after surgery.Overall 5-year survival rate was 58.9% in patients with early GC and 33.3% in patients with advanced GC(P = 0.230).GC-specific 5-year survival rate of early GC patients was 90.0% while that of advanced GC patients was 58.3%(P = 0.010).Four patients with early GC died of uncontrolled HCC,of which two were synchronous and two metachronous.CONCLUSION:The risk of postoperative intractable ascites is high,particularly in grade B patients.Early detection and complete control of HCC is vital to improve a patient's prognosis.

Serum Intestinal Fatty Acid Binding Protein in Patients with Small Bowel Obstruction

Purpose: The aims of this pilot study were to reveal the biological characteristics of serum I-FABP and explore its clinical utility as a biomarker in patients with small bowel obstruction (SBO). Methods: Serum I-FABP levels were measured in 37 consecutive patients with SBO between 2007 and 2008. Serum I-FABP levels were compared between ischemia (n = 10) and non-ischemia (n = 27) groups. Serum I-FABP levels were longitudinally analyzed in 21 patients who showed high (>2.0 ng/ml) serum I-FABP levels. The relationship between serum I-FABP level and length of damaged bowel was also analyzed. Results: Median serum I-FABP levels were 9.2 ng/ml in the ischemia group and 1.9 ng/ml in the non-ischemia group (p < 0.0001). The elevated I-FABP levels rapidly decreased after therapeutic intervention and normalized on the third day in all patients. Linear regression analysis revealed a positive correlation between I-FABP levels and lengths of surgically excised bowels (y = 2.527x - 7.660, r = 0.604, p = 0.0018). By setting the cutoff level at 7.2 ng/ml, the diagnostic ability of serum I-FABP was 70.0% in terms of sensitivity, 92.6% in terms of specificity, and 86.5% in terms of accuracy. Conclusion: Serum I-FABP sensitively reflects bowel damage in SBO patients and seems to be a potential biomarker for detecting small-bowel ischemia.

Aquaporin 8 mRNA expression after intestinal resection in rat

Backgrounds: Aquaporins (AQPs), the mammalian water channels, have been localized in various organs, including the gastrointestinal (GI) tract. We examined AQPs expression in rat models of massive intestineal resection to determine the functions of AQPs in the GI tract. Methods: Female Sprague-Dawley rats (n = 15) underwent 90% resection of the small intestine, and Female Wistar-Kyoto rats (n = 10), received subtotal colectomy, and were sacrificed following the operations. RNase protection assay and quantitative reverse transcription-polymerase chain reaction (RT-PCR) were performed to measure the AQPs mRNA expression in the GI tract. Immunohistochemistry was performed to confirm AQP8 protein expression. Results: AQP8 mRNA expression (mean ± standard error), was enhanced in the jejunum of the short bowel rats at days 7 and 14 (37.6% ± 1.4% and 18.5% ± 2.4%, respectively, p < 0.01). Enhancement of AQP8 mRNA was also observed in the remnant rectum of the subtotal colectomized rats at both days 21 and 42 (116.1% ± 4.5% and 143.3% ± 7.4%, respectively, p < 0.01). Immunohistochemistry demonstrated enhanced AQP8 expression in the remnant rectum of the subtotal colectomized rats. No intensive change was observed with other AQPs in both models. Conclusions: Our results suggest a compensatory role of AQP8 in the maintenance of intestinal fluid balance.