Abstract Background The postoperative clinical superiority of the interposition of jejunum reconstruction (INT) to Roux-en-Y reconstruction (RY) after total gastrectomy has not been clarified. ...Postoperative quality of life (QOL) was evaluated between the 2 methods by a multi-institutional prospective randomized trial. Methods A total of 103 patients with gastric cancer were prospectively randomly divided into groups for RY (n = 51) or INT reconstruction (n = 52) after total gastrectomy. They were stratified by sex, age, institute, histology, and degree of lymph node dissection. Postoperatively, body mass index (BMI) and nutritional conditions were measured serially, and QOL and postoperative squalor scores were evaluated at 3, 12, and 60 months and compared between the 2 groups. Results After removing patients who did not complete the follow-up survey or censured cases, 24 patients in the RY group and 18 patients in the INT group were clinically available and their postoperative status was assessed. QOL scores were increased and complication scores were improved in the postoperative periods ( P < .01). Postoperative BMI significantly deteriorated compared with preoperative BMI in each group. The postoperative QOL and complication scores at 60 months after surgery were significantly better than those at 3 months after surgery in each group ( P < .01). However, there was no significant difference of QOL scores and postoperative complication scores between the 2 reconstruction groups. The nutritional condition in the INT group was nearly the same as that in the RY group. Conclusions Although our patient sample was small and patients who did not complete the follow-up survey were present, we could not identify any clinical difference between INT and RY after total gastrectomy 60 months after surgery. The safer and simpler RY method may be a more suitable reconstruction method than INT after total gastrectomy.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Background & Aims Esophageal squamous cell carcinoma (ESCC) is the predominant form of esophageal cancer in Japan. Smoking and drinking alcohol are environmental risk factors for ESCC, whereas single ...nucleotide polymorphisms in ADH1B and ALDH2 , which increase harmful intermediates produced by drinking alcohol, are genetic risk factors. We conducted a large-scale genomic analysis of ESCCs from patients in Japan to determine the mutational landscape of this cancer. Methods We performed whole-exome sequence analysis of tumor and nontumor esophageal tissues collected from 144 patients with ESCC who underwent surgery at 5 hospitals in Japan. We also performed single-nucleotide polymorphism array-based copy number profile and germline genotype analyses of polymorphisms in ADH1B and ALDH2 . Polymorphisms in CYP2A6, which increase harmful effects of smoking, were analyzed. Functions of TET2 mutants were evaluated in KYSE410 and HEK293FT cells. Results A high proportion of mutations in the 144 tumor samples were C to T substitution in CpG dinucleotides (called the CpG signature) and C to G/T substitutions with a flanking 5′ thymine (called the APOBEC signature). Based on mutational signatures, patients were assigned to 3 groups, which associated with environmental (drinking and smoking) and genetic (polymorphisms in ALDH2 and CYP2A6 ) factors. Many tumors contained mutations in genes that regulate the cell cycle ( TP53, CCND1, CDKN2A , FBXW7 ); epigenetic processes ( MLL2, EP300, CREBBP , TET2 ); and the NOTCH ( NOTCH1 , NOTCH3 ), WNT ( FAT1 , YAP1 , AJUBA ) and receptor-tyrosine kinase−phosphoinositide 3-kinase signaling pathways ( PIK3CA , EGFR , ERBB2 ). Mutations in EP300 and TET2 correlated with shorter survival times, and mutations in ZNF750 associated with an increased number of mutations of the APOBEC signature. Expression of mutant forms of TET2 did not increase cellular levels of 5-hydroxymethylcytosine in HEK293FT cells, whereas knockdown of TET2 increased the invasive activity of KYSE410 ESCC cells. Computational analyses associated the mutations in NFE2L2 we identified with transcriptional activation of its target genes. Conclusions We associated environmental and genetic factors with base substitution patterns of somatic mutations and provide a registry of genes and pathways that are disrupted in ESCCs. These findings might be used to design specific treatments for patients with esophageal squamous cancers.
A-60-year-old man with liver cirrhosis who had undergone four previous surgeries, namely, distal gastrectomy, operation for ileus and hepatectomy twice for hepatocellular carcinoma was admitted to ...our hospital with melena and hemorrhagic preshock. Upper gastrointestinal endoscopy failed to reveal the source of bleeding. However, contrast-enhanced abdominal CT suggested the presence of varices in the small intestine, continuous with the right inferior epigastric vein as the collateral efferent? vessel on the abdominal wall. Active bleeding from these varices was strongly suspected and an emergency laparotomy was performed. As the findings were compatible with the preoperative CT findings, the right inferior epigastric artery and vein were both ligated, and partial resection of the adherent small intestine was performed. The postoperative course was uneventful. The possibility of ruptured small intestinal varices should also be considered in patients with portal venous hypertension presenting with gastrointestinal bleeding, especially after a previous laparotomy.
A 70-year-old man was admitted to our hospital due to severe anemia. Upper gastrointestinal endoscopy showed a type 2 tumor at the distal part of the duodenum. Computed tomography demonstrated an ...enhanced mass at the fourth portion of the duodenum, with enlarged adjacent lymph nodes and multiple small nodules in bilateral lung fields. He developed hypovolemic shock because of tumor bleeding, and emergent surgery was performed. The duodenum was segmentally resected with the periduodenal lymph nodes. Histological findings showed well to moderately differentiated adenocarcinoma invading into the sub-serosa and positive lymph nodes. He recovered successfully, and chemotherapy with S-1/oxaliplatin + bevacizumab was continued sequentially. The number and size of multiple lung and lymph node metastases were almost stable, and he survived more than one year after surgery.
A case of hyperammonemia induced by chemotherapy, including high-dose fluorouracil(5-FU), for advanced unresectable large intestinal cancer has been reported. This case involved an 81-year-old female ...who was diagnosed with pT4bcN2M1 (multiple hepatic metastases; stage Ⅳ; KRAS: mutant)after emergency surgery for sigmoid colon cancer and diffuse peritonitis. Post-operation, the 4 courses of mFOLFOX6 plus Bmab therapy was started for advanced unresectable recurrent large intestinal cancer; 48 hours later, she developed consciousness disorder(JCS Ⅲ-300). The disorder promptly disappeared after discontinuation of high-dose 5-FU. Because high-dose 5-FU was inferred to be the main cause of hyperammonemia, XELOX plus Bmab therapy was started as a post-treatment. She did not develop hyperammonemia; therefore, 8 courses were administered. The patient is being followed-up now.
Primary small bowel cancer has a low incidence and is difficult to diagnose ; patients usually present at an advanced stage at the time of diagnosis. Between 1989 and 2008, 8 patients with primary ...small bowel cancer were treated at our hospital. Seven patients exhibited some symptoms. Tumors developed in the jejunum in 6 patients and in the ileum in 2 patients. Five patients were diagnosed with small bowel tumor preoperatively, while 3 patients were diagnosed on the basis of pathology results. All the patients had advanced cancer ; 6 patients underwent curative resection. Histologically, 3 tumors had invaded the subserosa, 3 tumors had invaded the serosa, and 2 tumors had invaded other organs. Lymph node metastases were detected in 5 patients. The patients with lymph node metastases and those that did not undergo curative resection had poor prognosis ; we have not encountered any effective chemotherapeutic regiments for such cases.
(Case 1) A 43-year-old woman who had been diagnosed with ascending mesenteric cyst of the ascending colon 1 year ago visited our hospital for sudden pain in the right lower quadrant of the abdomen ...and high fever. Computed tomography (CT) showed a mesenteric cyst measuring 12×9 cm ; therefore, infection was suspected. After percutaneous drainage and antibiotic therapy, ileocecal resection was performed. Histopathologic test revealed mesenteric cystic lymphangioma with inflammation. (Case 2) A 30-year-old man visited our hospital for sudden abdominal pain and high fever. CT showed a multiple cystic tumor measuring 13×11 cm in the mesentery of the jejunum. After antibiotic therapy, the tumor was excised with about 50 cm of the jejunum. Histologic test revealed cavernous lymphangioma with hemoid necrosis. (Conclusion) Adult mesentric lymphangioma is relatively rare and usually remains occult. However, sometimes it manifests as acute abdominal pain caused by infection of lesions. Herein, we review 2 cases of lymphangioma in which resection was performed under the suspicion of infection in the context of the Japanese literature.
L‐myc polymorphism is a representative genetic trait related to an individual's susceptibility to several cancers. However, there have been no reports concerning the association between esophageal ...cancer and L‐myc polymorphism. To analyze the distribution of polymorphism in Japanese patients with esophageal cancer, a molecular genotyping method using a polymerase chain reaction‐based restriction fragment length polymorphism (PCR‐RFLP) was used. Based on an analysis of 65 Japanese patients with esophageal cancer and 107 healthy control subjects, a significant difference was observed in either the distribution of genotypes (P=0.012) or of allele frequencies between the two groups (P 0.004). The relative risk of esophageal cancer for genotypes including the shorter allele was 2.9 compared to the longer allele homozygote. Furthermore, the patients with S‐allele had a tendency for poor prognosis among those with three genotypes. A significant difference between the distribution of genotypes and the incidence of lymph node metastasis was found based on the clinicopathological features of the cancers. These results suggest that L‐myc polymorphism may be implicated as a genetic trait affecting an individual's susceptibility to esophageal cancer, at least among Japanese patients.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SBCE, SBMB, UL, UM, UPUK
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