Katsuji Sawai

Survivin-3B Gene Decreases the Invasion-Inhibitory Effect of Colon Cancer Cells With 5-Fluorouracil

The expression of survivin molecules has been confirmed in many types of cancer cells, including colon cancer cells, and they are considered important antiapoptotic molecules. Recent studies have revealed the existence of different splicing forms of survivin molecules; however, no studies have examined their expression in gastrointestinal cancers. In 2004, we reported the existence of the survivin-3B gene, a novel splice variant of survivin. In this study, we investigated the relationship between human colon cancer and our recently cloned survivin-3B gene with a coding region of 594 bp. In the first examination, survivin-3B expression was analyzed by RT-PCR in human colon cancer and adjacent normal mucosal tissues. The associations of its expression status with clinicopathological parameters and the prognosis were also examined. Survivin-3B mRNA expression was observed in 37 (46.3%) of 80 primary colon cancers, but not in the adjacent normal colonic mucosal tissue. The rate of survivin-3B gene expression was significantly higher in colon cancer with serosal invasion. The 5-year survival rate of patients with survivin-3B gene-positive primary colon cancer was significantly poorer, at 48.7%, than that (75.4%) of survivin-3B gene-negative patients. In the second examination, after the introduction of the survivin-3B gene into cells of the colon cancer cell line DLD-1, 5-fluorouracil-induced changes in their invasive capacity was examined. The invasion-inhibitory effect of 5-fluorouracil on survivin-3B gene-transfected DLD-1 cells was significantly lower than their empty vector gene-transfected counterparts. We speculate that survivin-3B expression in colon cancer is an important factor involved in the invasive capacity of cancer cells in the presence of anticancer drug.

Five-Year Survival of Alpha-Fetoprotein-Producing Gastric Cancer with Synchronous Liver Metastasis: A Case Report

Alpha-fetoprotein-Producing gastric cancer is associated with poor prognosis because of frequent liver and lymph node metastasis. We present a case with synchronous liver metastasis who survived for 5 years. A 69-year-old man with upper abdominal pain was referred to our hospital. Gastrointestinal endoscopy revealed a Borrmann II-like tumor in the lower part of the stomach. Computed tomography revealed a tumor in the left lobe of the liver. Serum alpha-fetoprotein levels were markedly increased. We performed distal gastrectomy after administering oral tegafur/gimeracil/oteracil potassium and administered hepatic intra-arterial cisplatin injection. Liver metastasis showed partial response on computed tomography. Despite left hepatic lobectomy, further metastases to the liver and mediastinal lymph nodes became difficult to control. After sorafenib tosylate administration, stabilization of the disease was observed for 4 months. We conclude that hepatic intra-arterial chemotherapy and oral administration of sorafenib tosylate may potentially improve the prognosis in such cases.

Partial response after transcatheter arterial infusion chemotherapy in a patient with systemic chemotherapy-resistant unresectable colon cancer and hepatic metastasis: (case report)

We report here a case of partial response to hepatic arterial infusion chemotherapy in a patient who developed serious hepatic failure due to unresectable colorectal cancer and hepatic metastasis and showed resistance to systemic chemotherapy with molecular targeted drugs, mFOLFOX6, and FOLFIRI. The patient was a 60-year-old woman who underwent sigmoidectomy for sigmoid colon cancer, lateral posterior hepatic segmentectomy for metastatic liver cancer, and postoperative radiation therapy for metastatic lung cancer. As first-line systemic chemotherapy, mFOLFOX6 (oxaliplatin, 5-fluorouracil, and leucovorin), bevacizumab + FOLFIRI (irinotecan, 5-fluorouracil, leucovorin), and anti-epidermal growth factor receptor antibody + irinotecan were administered, in that order. However, recurrent hepatic metastasis was exacerbated, which induced serious hepatic failure manifested by general malaise, jaundice, abnormal hepatic function, difficulty in walking due to bilateral lower extremity edema, and decreased appetite. The patient was admitted in a serious condition. After hospitalization, the patient received hepatic arterial infusion chemotherapy with 5-fluorouracil and l-leucovorin. After two complete courses, the symptoms improved. The patient’s performance status also improved, and she was discharged from the hospital. Four months after discharge, the patient had continued outpatient chemotherapy and maintained excellent performance status. Although HAIC is not presently considered an alternative to systemic chemotherapy, it is sometimes effective in patients who show resistance to molecular targeted drug therapy, FOLFOX, and FOLFIRI, and in whom hepatic metastasis is a key factor in determining prognosis and serious hepatic failure. Further studies should be performed in the future to verify these findings.

Measures for preventing wound infections during elective open surgery for colorectal cancer: scrubbing with gauze.

In addition to the general surgical-site infection prevention measures in colorectal cancer surgery, we performed a simple subcutaneous scrubbing procedure with gauze at the time of abdominal closure, which reduced the incidence of wound infections. There are 289 patients whose primary colon cancer lesions were removed by elective surgeries. They were divided into Group A (74 patients with no wound infection prevention measures who were treated from 2002 to 2003), Group B (76 patients with wound infection prevention measures who were treated from 2007 to 2008), and Group C (139 patients with subcutaneous scrubbing with gauze plus the measures in Group B who were treated from 2009 to 2012). The incidence in Group A was 23%, while the corresponding values in Group B and Group C were 14.5% and 2.9%, respectively. The incidence of wound infections was substantially reduced by additional subcutaneous scrubbing with a saline solution and gauze during closure of a surgical incision. This very simple procedure was considered useful for surgical site infection prevention.

Results of Hepatic Arterial Infusion Chemotherapy in Patients with Unresectable Liver Metastases

Background: Colorectal cancer most commonly metastasizes to the liver. However, in patients with liver metastases precluding radical resection, we still have no other choice but to depend almost completely on anticancer chemotherapy. We report the results of hepatic arterial infusion chemotherapy (HAIC) in patients with multiple unresectable metastases throughout the liver and likely to develop liver failure in the near future. Patients and Methods: A total of 284 advanced colorectal cancer patients were treated. Of these patients, 40 and 24 had synchronous and metachronous liver metastases, respectively. Of these liver metastasis patients, 27 had unresectable metastases. 14 of the patients with unresectable liver metastases (likely to develop liver failure in the near future) but without extrahepatic lesions underwent HAIC. The chemotherapy regimen consisted of 5-fluorouracil 600 mg/m2 and leucovorin 250 mg/m2. Results: HAIC resulted in a complete response, partial response, stable disease, and progressive disease in 2, 7, 3, and 2 patients, respectively. The 1- and 2-year survival rates were 79 and 50%, respectively. Conclusion: Colorectal cancer patients with unresectable liver metastases without extrahepatic lesions and likely to develop liver failure in the near future showed relatively good results with no serious side effects. We suggest that HAIC is an effective treatment in selected patients.

Acute Small Bowel Perforation Caused by Obstruction of a Novel Tag-Less Agile TM Patency Capsule

A 74-year-old man visited our hospital complaining of abdominal pain. An abdominal computed tomography scan showed multiple wall thickness of the small bowel. Capsule endoscopy was recommended for further evaluation, and patency capsule examination was performed. Eighteen hours after patency capsule ingestion, he experienced small bowel perforation with severe peritonitis caused by intestinal pressure rising because of the patency capsule trapped in his terminal ileum. An ileocolic resection was performed, including the removal of the sclerotic ileum as an emergency surgery. A pathological examination showed transmural inflammation and multiple ulcers with perforation of the small intestine, consistent with Crohn’s disease. Here, we report a rare and valuable case of novel tag-less AgileTM patency capsule (Given Imaging Ltd., Yoqneam, Israel) retention leading to small bowel perforation.

A rare congenital anomaly, bridge-like appendiceal fistula to the terminal ileum, demonstrated by MDCT

Although appendiceal anatomical anomalies are very rare, understanding of the anatomical details of these anomalies is important for surgery. In this case report, we present images from multi-detector row computed tomography (MDCT) and histological findings of a rare anatomical appendiceal anomaly originating from the cecum and opening into the terminal ileum like a bridge. These anatomical details were clearly depicted on MDCT with multi-planar reconstruction. MDCT demonstrated a communication between the appendix and terminal ileum. Histological analysis revealed that a normal mucosal layer was maintained from the appendix to the connected ileum, without any evidence of inflammatory or neoplastic changes, and only thickening of the muscular layer of the appendix was identified. Based on these histological findings, the appendix was considered to represent an anatomical anomaly rather than secondary fistula caused by inflammation or neoplasm, which has not yet been reported.

Response to Modified TEGAFIRI in a Patient with Synchronous Multiple Liver Metastases of Colon Cancer

We report the case of a patient with colon cancer accompanied by multiple unresectable liver metastases who showed complete response (CR) to modified TEGAFIRI (mTEGAFIRI) (tegafur-uracil/leucovorin+irinotecan) chemotherapy. The patient was a 58-year-old Japanese male with cancer of the descending colon accompanied by multiple unresectable liver metastases. Following resection of the sigmoid colon cancer, mTEGAFIRI chemotherapy was administered. Abdominal computed tomography performed upon completion of 12 courses of chemotherapy showed that the unresectable liver metastatic lesions had disappeared, indicating CR. The only adverse drug reactions (ADRs) experienced to date have been stomatitis (grade 1) and neutropenia (grade 1). Anticancer therapy has thus been continued, and CR has been maintained for 15 months. The present patient achieved CR in response to mTEGAFIRI chemotherapy, a regimen that has not previously been reported, while experiencing only mild ADRs and maintaining a good quality of life. mTEGAFIRI chemotherapy is convenient to administer and is thought to be a potentially useful treatment option for patients with unresectable, recurrent colon cancer.We report the case of a patient with colon cancer accompanied by multiple unresectable liver metastases who showed complete response (CR) to modified TEGAFIRI (mTEGAFIRI) (tegafur-uracil/leucovorin+irinotecan) chemotherapy. The patient was a 58-year-old Japanese male with cancer of the descending colon accompanied by multiple unresectable liver metastases. Following resection of the sigmoid colon cancer, mTEGAFIRI chemotherapy was administered. Abdominal computed tomography performed upon completion of 12 courses of chemotherapy showed that the unresectable liver metastatic lesions had disappeared, indicating CR. The only adverse drug reactions (ADRs) experienced to date have been stomatitis (grade 1) and neutropenia (grade 1). Anticancer therapy has thus been continued, and CR has been maintained for 15 months. The present patient achieved CR in response to mTEGAFIRI chemotherapy, a regimen that has not previously been reported, while experiencing only mild ADRs and maintaining a good quality of life. mTEGAFIRI chemotherapy is convenient to administer and is thought to be a potentially useful treatment option for patients with unresectable, recurrent colon cancer.