Hirokazu Suwa

Impact of splenectomy in patients with gastric adenocarcinoma of the cardia.

Previous reports have suggested that splenectomy treatment of gastric carcinoma of the cardia results in poor patient outcome, but the reason for this is unclear. This study aimed to clarify the impact of splenectomy for gastric carcinoma patients. A total of 118 patients with gastric carcinoma of the cardia were enrolled in this study. The characteristics of patients with lymph node metastasis at the splenic hilum were determined, and the effects of lymph node dissection or splenectomy on postoperative morbidity, mortality, and pattern of recurrence were evaluated. Advanced tumors were common in patients with lymph node metastasis at the splenic hilum, Siewert type III, greater curvature sites, larger and deeper tumors, multiple metastatic lymph nodes, and high incidences of para-aortic lymph node metastasis frequently observed. The effectiveness of lymph node dissection of the splenic hilum was low and equal to that of dissection of the para-aortic lymph nodes. Postoperative morbidity, as represented by pancreatic fistula, was high following splenectomy or pancreaticosplenectomy, but patient mortality did not occur. Hematogenous metastasis was common, as well as peritoneal metastasis after curative gastrectomy. Splenectomy should be limited in those patients with gastric cardia tumors invading the spleen or with metastatic bulky lymph nodes extending to the spleen.

Allergic Reactions to Oxaliplatin in a Single Institute in Japan

Allergic reactions to oxaliplatin can be severe and are an important cause of discontinuation of treatment. A retrospective review was performed for 105 patients who received FOLFOX regimens between May 2005 and June 2007. Twenty-five cases (23.8%) of allergic reactions were identified, including 9 late onset reactions (8.6%) and 16 immediate reactions (15.2%). Severe allergy (Grades 3 and 4) occurred in seven patients (6.7%). Re-introduction of FOLFOX was attempted for seven immediate onset patients with a severity grade of 1 or 2, and three of these patients (42.9%) showed relapse of allergy. In approximately 10% of the patients, FOLFOX had to be discontinued due to allergy before the disease became refractory to the regimen. Our experience indicates that allergy to oxaliplatin may be a significant concern and that methods are required for suppression of this allergy.

Randomized clinical trial of single‐incision versus multiport laparoscopic colectomy

The efficacy and safety of single‐incision laparoscopic colectomy (SILC) for colonic cancer remain unclear. The aim of this study was to determine the outcomes of SILC compared with multiport laparoscopic colectomy (MPLC) for colonic cancer.

Salvage Total Pelvic Exenteration with Bilateral V-Y Advancement Flap Reconstruction for Locally Recurrent Rectal Cancer

Total pelvic exenteration for locally recurrent rectal cancer typically requires extensive excision of the pelvic floor with perineal skin. Due to the extensiveness of the procedure and its non-curative nature, it is controversial as purely palliative therapy. A 66-year-old male patient who had undergone abdominoperineal resection at another hospital 8 years prior was admitted to our hospital. During radiation and chemotherapy for 2 years, he complained of perineal pain, discharge, cacosmia and bleeding from a recurrent tumor. The 10 × 8 cm recurrent tumor was exposed on the perineum and the patient suffered from serious discomfort in his daily life during walking or sitting. We performed total pelvic exenteration with partial sacrectomy, after which the large perineal defect was reconstructed with a bilateral V-Y gluteus maximus advancement flap in approximately 120 min. The patients postoperative course was satisfactory and his quality of life markedly improved.

A comparative study on the short-term clinical outcomes of laparoscopic versus open Hartmann's procedure for high risk patients in colorectal cancer.

BACKGROUND/AIMS Patients with severe co-morbidities and oncological conditions would not be denied a reconstruction of anastomosis and Hartmanns procedure would be undertaken. The aim of this study is to examine the feasibility and safety of laparoscopic Hartmanns procedure compared to open Hartmanns procedure for high risk patients in colorectal cancer. METHODOLOGY Nine hundred and eighty five primary colorectal cancer resections were performed from April 2007 to December 2010. Thirty six patients (3.6%) who underwent Hartmanns procedure by the same surgical team were investigated retrospectively. RESULTS Twenty six patients (72%) in the open surgery (OS) and 10 patients (28%) in the laparoscopic surgery (LS) were undertaken Hartmanns procedure. The reason of selected Hartmanns procedure was defined as high risk with severe co-morbidities (OS 8: LS 8, n=16), oncological conditions (OS 14: LS 2, n=16), urgent situations (OS 4, n=4). The mean operation time was not significantly different (p=0.504). The median blood loss count was significantly different between both groups (OS 327.5g vs. LS 16.5g; p=0.0001). The incidence of postoperative complications was similar (OS 38% vs. LS 40%; p=0.763). The median postoperative hospital stay was not significantly different (OS 10.5 vs. LS 12; p=0.216). CONCLUSIONS Laparoscopic Hartmanns procedure is feasible and safe with a low invasiveness for high risk patients with colorectal cancer.

Clinical Characteristics of Rectal Cancer Involving the Anal Canal

BackgroundThis study evaluates the clinical characteristics of rectal cancer involving the anal canal.MethodsA total of 346 consecutive patients with primary low rectal cancer located below the peritoneal reflection were reviewed in this study. Patients were divided into two groups according to whether the lower edge of the tumor came in contact with the anal canal (P group, n = 78) or not (Rb group, n = 268). Clinical and pathological parameters, recurrence rates, and survival rates were compared between the two groups.ResultsThe occurrence of uncommon histological types of tumor was significantly higher in the P group than in the Rb group. P group patients also had a significantly higher lateral pelvic node metastasis rate (p < 0.001), lower 5-year overall survival rate (p = 0.0491), and higher 5-year local recurrence rate (p = 0.0171) than Rb group patients. Multivariate analysis revealed that tumor location was a significant risk factor for local recurrence. In the P group, multivariate analysis showed that uncommon histological tumor types were a significant prognostic factor.ConclusionRectal cancer involving the anal canal should be treated with special care, considering the particularly high lateral pelvic lymph node metastasis rate and high local recurrence rate.

Detection of gas components as a novel diagnostic method for colorectal cancer

The fecal occult blood test (FOBT) is widely accepted as the most economic and non‐invasive screening method for colorectal cancer (CRC). However, the FOBT is inconvenient because it requires a fecal sample and shows limited accuracy. Alternatively, we hypothesized that fecal gas compounds from bowel movements may be a non‐invasive biomarker for CRC.

Midterm follow-up of a randomized trial of open surgery versus laparoscopic surgery in elderly patients with colorectal cancer

BackgroundLaparoscopic surgery has been widely accepted for the treatment of colorectal cancer; however, long-term outcomes in elderly patients remain controversial. The midterm results of a randomized trial comparing open surgery with laparoscopic surgery in elderly patients with colorectal cancer are presented.MethodsThis was a randomized trial comparing open surgery with laparoscopic surgery in elderly patients with colorectal cancer. The primary outcome was complication rate, and secondary outcomes included 3-year recurrence-free survival and overall survival. A total of 200 patients were randomly assigned to open surgery or laparoscopic surgery between 2008 and 2012. The main study objective was to compare the midterm outcomes of open surgery with those of laparoscopic surgery in elderly patients with colorectal cancer. This trial is registered with Clinical Trials.gov (NCT01862562).ResultsThere were no differences between the laparoscopic surgery group and open surgery group in the 3-year overall survival rate (91.5% for laparoscopic surgery vs. 90.6% for open surgery, p = 0.638) or the 3-year recurrence-free survival rate (84.8% for laparoscopic surgery vs. 88.2% for open surgery, p = 0.324). The local recurrence rate was significantly higher in the laparoscopic surgery group than in the open surgery group in rectal cancer (13.8% for laparoscopic surgery vs. 0% for open surgery, p = 0.038). In subgroup analysis according to tumor location, there were no significant differences in the 3-year overall survival rate or 3-year recurrence-free survival rate between the two treatment groups.ConclusionThe midterm outcomes of laparoscopic surgery are similar to those of open surgery in elderly patients with colorectal cancer.

The safety of preoperative amino acid (Elental®) loading in colon cancer surgery: prospective cohort study.

Abstract Objective: The aim of this prospective study was to evaluate the safety of preoperative amino acid plus CHO drink (Elental®) loading in colon cancer surgery. Summary of Background Data: Prolonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate drinks 2 hours before surgery. Methods: We prospectively enrolled consecutive patients with a preoperative diagnosis of colon cancer who underwent surgery. The patients received 600 ml of Elental® the night before surgery and 300 ml of Elental® 3 h prior to induction of anaesthesia. Primary endpoint was the safety of preoperative amino acid (Elental®) loading in colon cancer surgery. Safety measurement was anastomotic leakage and aspiration pneumonia. Secondary endpoints were incidence rate of incisional surgical site infection, recovery of bowel movement, length of hospital stay, postoperative nutritional status and insulin resistance. Results: A total of 80 consecutive patients were enrolled in this study fro...

The novel diagnostic method for colorectal cancer: Detection of methyl mercaptan from flatus.

529 Background: Fecal occult blood test screening for colorectal cancer (CRC) reduces cancer specific mortality through the detection of early stage disease. However, medical examination rate is very low in Japan because of the inconvenience of sampling of stool. On the other hand, it is reported that dogs can be trained to distinguish breath samples of patients with lung and breast cancer from those of control. It is unclear that odour materials become effective tools in CRC screening. The aims of this study were to evaluate the gas components in the flatus of CRC patients and to compare with healthy controls. Methods: Thirty-two patient before elective colorectal surgery in Yokohama City University and 13 healthy controls were enrolled in this study.The apparatus for gas sampling was placed in the toilet. Defecation gas from a patient in a toilet stool was collected in a 25L sampling bag. A fan (50 L / min ) was arranged to aspirate air in the toilet stool. Defecation gas components were collected as fo...