Junpei Sasaki

Gene profiling and bioinformatics analyses reveal time course differential gene expression in surgically resected colorectal tissues

It has previously been reported that gene profiles in surgically-resected colorectal cancer tissues are altered over time possibly due to the different tissue-acquisition methods and sample extraction timing that were used. However, the changes that occur are still not clearly understood. In the present study, time-dependent changes in gene expression profiling in colorectal surgical specimens were analyzed. Normal and tumor tissues at several time-points (0, 30, 60 and 120 min) were extracted, and RNA quality, microarray experiments, quantitative PCR and bioinformatics clustering were performed. Although RNA integrity was preserved 2 h after resection, inherent increased/decreased gene expression was observed from 30–120 min in approximately 10% of genes. Bioinformatics clustering could not distinguish case-by-case, probably due to gene profiling changes. Irregular changes in gene expression after surgical resection were found, which could be a crucial confounding factor for quantitative analyses.

Multiple early gastric cancer with duodenal invasion

BackgroundEarly gastric cancers with duodenal invasion are rare, and no previous case of multiple early gastric cancer, one invading the duodenal bulb, has been reported.Case presentationA 79-year-old woman was investigated for upper abdominal discomfort. Endoscopic examination revealed an irregular nodulated lesion in the antrum area, and a reddish aggregated-type semi-circumferential nodulated lesion extending from the prepyloric area to the duodenal bulb through the normal mucosa with the antrum lesion. Biopsy revealed a tubular adenoma for the antrum lesion and a well-differentiated tubular adenocarcinoma for the prepyloric lesion. Distal gastrectomy with sufficient duodenal resection was performed. Microscopically, the antrum lesion appeared as a papillary adenocarcinoma, and the prepyloric lesion as a mainly papillary adenocarcinoma which partially invaded the submucosa without any sequential elongation for endoscopic findings. The lesion extended into the duodenal bulb, and was 12 mm in length from the oral end of Brunners glands area and limited within the duodenal mucosa.ConclusionHere, we present an unusual case of multiple early gastric cancer, one of which invaded the duodenum with relative wide mucosal spreading. This case illustrates that even early stage cancers located in the gastric antrum, particularly in the prepyloric area can invade the duodenum directly.

8. Single Incision Laparoscopic Surgery for the Digestive Disease Appendix (VI)

近年外科手術において,機能を温存し低侵襲性を求める流れから腹腔鏡手術が発展し,さらに整容性の追求から 細径鉗子の利用やポート数を減らした鏡視下手術が導入されてきた.臍から approach する単孔式内視鏡手術はそ の最たる進化型であり,NOTES(Natural Orifice Translumenal Endoscopic Surgery:口,肛門,腟などの人体 に備わった自然孔から内視鏡を挿入し,管腔壁に小切開を加えて体腔内に到達して手術を行う究極の Scar less 手 術)につながる新技術として急速な普及が見られている.日本では,2010 年 2 月 20 日に第 1回単孔式内視鏡手術 研究会が催され,半年ごとの開催で活発な論議がなされており,当外科においても当初から本術式に積極的に取り 組んできている.今回,消化器疾患に対する単孔式手術の一環として,本稿では虫垂切除術について述べたい. ご存知のように急性虫垂炎は最も高頻度な外科的消化器疾患の 1つであり,虫垂切除術は外科手技の基本を学ぶ 開腹手術の導入として確立された歴史をもつ.しかし,小開腹創から行う高度炎症時の虫垂切除術は難易度が高く, 基本手技の域を逸脱する例も少なくない.一方,腹腔鏡下虫垂切除術は高度炎症時においても,良好な視野のもと に術操作が可能で,開腹手術に比べ診断的,手技的に優位とする報告も多い.急性虫垂炎は若年発症が多いことか らも,整容面での advantage が大きい単孔式腹腔鏡下手術(図 1)はよい適応になると思われる. 単孔式手術では通常 3本の trocar(腹腔鏡用および鉗子用×2)を用いるが,皮下を広範に剝離して trocar を直 挿しするmulti-trocar 法と,複数の trocar を装着できる platformを用いたmulti-channel 法とがある.当科では, 腹壁への低侵襲性と経済性を考慮し,ALEXIS wound retractor(Applied Medical)を利用した handmade の platformを用いている(図 2,3). 以下,実際にわれわれが行っている鏡視下操作を写真で供覧する(図 4~9).虫垂切除術では,虫垂間膜(虫垂 動脈が走る)を切離し,虫垂根部を処理するが,繰り返して使用できる専用の超音波凝固切開装置(SonoSurg X, Olympus)を用い,またEndo GIAなどの自動縫合器を使用せずに結紮による根部処理をするなど経済面に配慮 した工夫をしている.