Objective: The modified Glasgow Prognostic Score (mGPS) is an inflammation-based measure of malnutrition that reflects a state of cachexia in cancer patients. We evaluated mGPS as an index to predict ...surgical site infection (SSI) incidence in patients undergoing colorectal cancer surgery. Subjects and Methods: We retrospectively analyzed 351 patients who underwent colon cancer resection. Factors correlated with the incidence of SSIs were identified by logistic analysis and stepwise selection. Results: SSIs were observed in 32 patients, with an incidence of 9.1%. Univariate logistic analysis revealed mGPS (Score 2), laparotomy, resection of other organs, colostomy, excessive blood loss (>423 mL), long duration of surgery (>279 minutes), pulmonary dysfunction, prognostic nutritional index (PNI) ≤40, neutrophil lymphocyte ratio (NLR)(>4), and controlling nutritional status (CONUT) ≥2 to be associated with an increased incidence of SSIs. Multivariate analysis with variables selected by the stepwise procedure also revealed mGPS (Score 2) (Odds ratio (OR) =3.55, 95% Confidence interval (CI) 1.30-9.56; p=0.01), colostomy (OR=6.56, 95%CI 1.60-31.38; p=0.01), excessive blood loss (OR=3.20, 95%CI 1.23-8.42; p=0.02), and NLR (>4)(OR=3.24, 95%CI 1.31-8.17; p=0.01) to be independent risk factors. Conclusion: mGPS is an independent risk factor for SSIs. Our results suggest that cachexia before surgery in patients with colorectal cancer might predict the incidence of SSIs.
Diagnosis and treatment of superficial laryngopharyngeal cancers has recently received considerable attention. Here, we present a case of superficial hypopharyngeal cancer and superficial esophageal ...cancer treated with simultaneous endoscopic laryngopharyngeal surgery (ELPS) and endoscopic submucosal dissection (ESD). The patient was a 67-year-old man. During his follow-up for distal gastrectomy-performed earlier for stomach cancer-upper gastrointestinal endoscopy revealed three primary cancers: a superficial hypopharyngeal cancer, superficial esophageal cancer, and esophagogastric junction cancer. After total resection of the remnant stomach, combined hypopharyngeal ELPS with esophageal ESD was performed. He developed aspiration pneumonia after surgery but recovered and was discharged on the 16th day. Thus, safe and effective endoscopic therapy can be performed even for double superficial cancers of the laryngopharynx and esophagus.
Objective: We evaluated the preoperative patient status including nutrition, immunity, and inflammation as a predictive factor of remote infection (RI) in colorectal cancer surgery. Subjects and ...Methods: A total of 351 patients who underwent colorectal cancer resection were retrospectively analyzed. Factors correlated with RI incidence were identified by logistic analysis and stepwise selection. Results: RI occurred in 27 patients, with an incidence of 7.7%. In univariate logistic analysis, a significantly high incidence of RI was associated with excessive blood loss (>423 mL), long duration of surgery (>279 minutes), ileus, pulmonary dysfunction, performance status (PS) ≥1, American Society of Anesthesiologists (ASA) classification>2, prognostic nutritional index (PNI) ≤40, and controlling nutritional status (CONUT) ≥2, modified Glasgow Prognostic Score (mGPS) (Score 2).In multivariate analysis, pulmonary dysfunction (odds ratio=2.83; 95% CI: 1.14-6.97; p=0.02) and PNI≤40 (odds ratio=3.87; 95% CI: 1.45-10.31; p=0.006) were independent risk factors of RI incidence. Conclusion: RI is caused by poor nutrition, immune system dysfunction and pulmonary dysfunction.
Detection of cancer cells using molecular targets is achieved by combining immunochemical reactions with gene amplification techniques.This enables the detection of cancer cells in specimens that are ...traditionally determined to be cancer-free.These improvements in detection can lead to prognoses that are different from those derived by conventional pathological staging.Survival is worse when cancer cells are detected in regional lymph nodes compared to when the nodes are cancer-free.Furthermore,the circulating tumor cell(CTC) count increases as the cancer progresses.Consequently,there is a correlation between CTC count and prognosis.However,large-scale prospective studies are required to confirm this.The development of more convenient and cost-effective analysis techniques will facilitate the practical application of these findings.
Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is ...important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed. On the 12th postoperative day, a diagnosis of chylothorax was made. Conservative treatment was initiated, but it proved to be ineffective. Therefore, ligation of the thoracic duct via a thoracotomy was performed, but this was not effective, either. Lymphangiography undertaken to identify the site of the leak in the thoracic duct enabled a diagnosis of an extremely rare double thoracic duct and identification of the site of the leak in the thoracic duct, thereby allowing curative direct ligation of the site. This case underscores the remarkable usefulness of lymphangiography in dealing with intractable postoperative chylothorax.
This report describes a patient who underwent resection for an intracystic papillary neoplasm (ICPN) classified by the World Health Organization in 2010 as a pre-cancerous or early cancerous tumor of ...the gallbladder. The patient was a 70-year-old Japanese woman who was hospitalized for hepatic dysfunction and jaundice. Various imaging tests revealed multiple papillary tumors, present mainly in the gallbladder lumen as well as infiltrating the intra- and extra-hepatic bile ducts and the liver. Advanced gallbladder cancer was suspected. The patient underwent extended right hepatectomy and resection of the extrahepatic bile duct and regional lymph nodes along with hepatico-jejunostomy. However, the gallbladder tumor was diagnosed immuno-histopathologically as intestinal-type ICPN with high-grade dysplasia. ICPN has been described as a gallbladder papilloma (papillomatosis), comparable to benign gallbladder lesions. To date, however, there have been no reports of patients with multiple tumors in the gallbladder lumen resulting in an ICPN of large diameter. As ICPN is regarded as a pre-cancerous or early cancerous tumor of the gallbladder, the method of diagnosis and histopathological classification require standardization.
Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of incisional SSI and other wound ...complications when wound closure was achieved by subcuticular suturing and closed suction drainage following stoma reversal. We analyzed data from a total of 49 patients, all of whom had undergone insertion of a 10 Fr closed suction drainage tube in the fascia, following irrigation with approximately 300 mL of physiological saline. We then performed subcuticular suturing with 4-0 monofilament absorbable sutures. The median age of our patient population (34 men and 15 women) was 68 (range, 35-84) years. Six patients had an end stoma and 43 had a loop stoma. The wound category was 'contaminated' in 18 patients, while an incisional SSI was observed in one patient (2.0%). No wound disruptions, seromas, or drain infections were evident. Our data are reliable, but our study is limited in terms of general applicability; however, the low SSI rate indicates that the procedure is acceptable. Further research into this procedure will require a randomized trial design.
Background: In decompensated liver cirrhosis, hypoalbuminemia still persists even after they have been treated with branched-chain amino acid (BCAA) granules. We prospectively evaluated whether BCAA ...enriched nutrient switched from BCAA granules would increase the serum albumin level, and consequently extend the survival time after hepatocellular carcinoma (HCC) treatment. Methods: This study included 77 patients treated for liver cirrhosis with HCC. After the nutritional assessment, all patients initially received BCAA granules. In patients with unchanged or decreased serum albumin levels, BCAA granules were discontinued and BCAA enriched nutrient was started. Transcatheter arterial chemembolization (TACE) for HCC were performed in those with an improved Child-Pugh score. Results: TACE were performed following the aggressive intervention with BCAA nutritional education in 54 of 77 (70.1%) patients. Finally, survival time was significantly extended in the TACE group (P<0.0001). Conclusion: Timely aggressive nutritional intervention in Barcelona Clinic Liver Cancer stage B HCC, namely, early partial replacement with BCAA enriched nutrient may consequently improve the treatment outcome of HCC.
Objective: Regorafenib (BAY 73-4506) is an oral multikinase inhibitor that has been shown to inhibit various oncogenic stromal receptor tyrosine kinases and intracellular signaling kinase. The aim of ...the study is to confirm the safety and effectiveness of dose escalation therapy of regorafenib for the third- or fourth- treatments of patients with unresectable and recurrent colorectal cancer.Design: This study is designed as a single-arm, prospective, non-randomized, multi-centered open label phase II trial in Japan. The study regimen consists of 28-day cycles with escalated doses of regorafenib (80-160 mg/body on days 1 to 21). This study is a dose-escalation study using a starting dose of 80 mg/day during the first seven days. In case of no adverse events related to the administration after the first seven days of the starting dose, the administration dose will be increased to 120 mg/day on days 8 to 14. The administration dose will then be increased to 160 mg/day on days 15 to 21. Primary end point is progression free survival (PFS); secondary end points include time to treatment failure, response rate, overall survival, the interval between the initial of drug administration and performance status 2, the transition rate to the following line of treatment, the cumulative dose and the incidence of adverse events of grade 3 or higher, and genetic alterations (KRAS mutation/BRAF mutation) in circulating cell-free DNA.Conclusions: This study may contribute to determining the efficacy of the escalation of the administration dose in patients with metastatic colorectal cancer.
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