Masahiro Niihara

Adult colonic intussusception caused by cecum adenoma: successful treatment by emergency laparoscopy: report of a case.

Although intestinal intussusception is relatively common in children, in adults it remains a rare clinical entity. We report an emergency laparoscopy for an adult case of colonic intussusception caused by cecum adenoma. In the present case, owing to a successful reduction via laparoscopy, the extensive intussusception could be treated with a more limited resection (wedge resection) instead of an en-bloc wide resection (right hemicolectomy). Because of the theoretical risk of perforations which could lead to the seeding of tumor cells and microorganisms into the intra-abdominal cavity, most surgeons advocate an en-bloc resection without reduction. The experience gained from the present case suggests that laparoscopy may therefore be a useful diagnostic or therapeutic tool for selected cases of adult intussusception. The choice of using either a laparoscopic approach or an open approach depends on the clinical condition of a patient, the location and extent of intussusception, the possibility of underlying disease, and the availability of surgeons with sufficient laparoscopic expertise. Additional reports may help standardize the management of this uncommon disease.

Risk factors for complications after pharyngolaryngectomy with total esophagectomy

BackgroundPharyngolaryngectomy with total esophagectomy (PLTE) is an effective surgical treatment for synchronous or metachronous hypopharyngeal or laryngeal cancer and thoracic esophageal cancer, although it is more invasive than esophagectomy and total pharyngolaryngectomy. The aim of this study was to identify risk factors for complications after PLTE.MethodsFrom November 2002 to December 2014, a total of 8 patients underwent PLTE at the Shizuoka Cancer Center Hospital, Shizuoka, Japan. We investigated the clinicopathological characteristics, surgical procedures, and postoperative complications of these patients.ResultsOf the 8 patients, 5 underwent one-stage PLTE and 3 underwent staged PLTE. There was no mortality in this study. Two cases of tracheal necrosis, two of anastomotic leakage, and one of ileus were observed as postoperative complications. Two patients who underwent one-stage PLTE with standard mediastinal lymph node dissection developed tracheal necrosis and severe anastomotic leakage.ConclusionOne-stage PLTE and standard mediastinal lymph node dissection were identified as the risk factors for severe postoperative complications. Staged PLTE or transhiatal esophagectomy should be considered when PLTE is performed and standard mediastinal lymph node dissection should be avoided when one-stage PLTE is performed with transthoracic esophagectomy.

Comparison of curative surgery and definitive chemoradiotherapy as initial treatment for patients with cervical esophageal cancer

Esophagectomy and definitive chemoradiotherapy are recognized standard initial treatment modalities for cervical esophageal cancer. The goal of this study was to compare the treatment outcomes of curative surgery with those of chemoradiotherapy in patients who had potentially resectable tumor and who were candidates for surgery. We evaluated the data from 49 consecutive patients who were diagnosed with potentially resectable cervical esophageal cancer and who were deemed candidates for surgery. Thirteen patients were included in the surgery group, and 36 patients were included in chemoradiotherapy group. Baseline characteristics were balanced between the two groups. In the chemoradiotherapy group, the complete response rate was 58.3%. There was no significant difference in 5-year overall survival when comparing the surgery group and the chemoradiotherapy group (surgery, 60.6%; chemoradiotherapy, 51.4%; P = 0.89). In the chemoradiotherapy group, of the 15 patients who failed to respond to initial treatment, 11 patients subsequently underwent salvage surgery. In conclusion, curative surgery and chemoradiotherapy as initial treatment for cervical esophageal cancer have comparable survival outcomes. Chemoradiotherapy should be selected as the initial larynx-preserving treatment for patients with cervical esophageal cancer although chemoradiotherapy non-responders require additional treatment, including salvage surgery.

Risk factors for lymph node metastasis in non-sentinel node basins in early gastric cancer: sentinel node concept

BackgroundSentinel node (SN) concept is being applied to early gastric cancer. However, when SNs are positive for metastasis, it is unclear how often LNs in other LN basins show metastasis. We aimed to investigate LN metastasis possibility in LN basins without SNs (non-SN basins). We determined risk factors for metastasis in non-SN basins and identified a prediction model for non-SN basin metastasis using classification and regression tree (CART) analysis.MethodsWe enrolled 550 patients who were diagnosed with cT1N0M0 or cT2N0M0 gastric cancer with a single lesion and underwent SN mapping. We adopted a dual-tracer method using a radioactive colloid and blue dye to detect SNs.ResultsOf all, 45 (8.2%) patients had SN metastasis; we divided them into two groups: LN metastasis positive and LN metastasis negative in non-SN basins. Univariate analysis showed that the groups differed significantly regarding lymphatic invasion (p = 0.007), number of identified SNs (p = 0.032), and macrometastasis in SN basins (p = 0.005). The CART decision tree for predicting LN metastasis in non-SN basins had area under the curve value of 0.86. Moreover, there were significantly differences in cancer-specific survival (CSS) between the two groups (p = 0.028).ConclusionsMacrometastasis in SN basins, lymphatic invasion, and number of identified SNs ≥ 5 are risk factors for LN metastasis in non-SN basins among gastric cancer patients. We identified a prediction model with CART analysis; patients with macrometastasis in SN basins and lymphatic invasion were considered to be at the highest risk for LN metastasis.

Salvage esophagectomy with pancreatectomy for local recurrence of thoracic esophageal cancer after definitive chemoradiotherapy: A case report

Highlights • Very little article in literature has been reported the outcome of esophageal cancer patients who underwent esophagectomy with pancreatectomy.• We describe a case of thoracic esophageal cancer in which a relapse occurred in the early postoperative phase, although R0 resection was accomplished by salvage esophagectomy with pancreatectomy.• Because the risk of postoperative complications and relapse is high in patients with advanced esophageal cancer undergoing esophagectomy with pancreatectomy, the applicability of surgery needs to be carefully considered.

Reply to: Preventive role of ramelteon and suvorexant for postoperative delirium after pharyngolaryngectomy with esophagectomy

We would like to express our appreciation to Dr. Kawada for his attention and comments. We totally agree with his comments. We also had the same concern as he expressed in his letter. However, we thought the results might interest the readers and might be of some use to those who were engaged in the management of postoperative delirium. Therefore, in spite of the incompleteness in statistical treatment, we thought it worth to report the results of this small research. We also think the results should be validated by randomized control trial procedure. We reported the results of the multivariable logistic regression analysis based on only 9 events in 65 patients, because this study was conducted as an effort of our team therapy to prevent postoperative complications of esophagectomy and the objective was to understand the preventive effect of the combination of ramelteon and suvorexant to postoperative delirium using the available data. As pointed out by the letter, there is some incompleteness in the statistical treatment. Especially, based on the one in ten rule, we should have included more than 20 events in the analysis. We think that we should have displayed some statistical information such as confidence interval, sample size, event size and so on. We also should have included some statistical limitations in the article, so that the readers could interpret the results properly without confusion. Regarding individual data, retrospective single institute researches may have some kind of biases, but all patients’ charts were systematically assessed by two psychiatrists to minimize them. Regarding the recommendation to include minor tranquilizer as one of the variables, we did it as shown in Table 2. This retrospective study led to the conclusion that ramelteon with or without suvorexant was more effective than minor tranquilizer. We hope the above could be a good explanation to the comments in Dr. Kawada’s letter. This reply refers to the article available at https ://doi.org/10.1007/ s1038 8-018-0603-2.

Postoperative hemorrhage from racemose hemangioma of the bronchial artery after esophageal cancer surgery

Abstract Introduction: Racemose hemangioma of the bronchial artery is a rare disease. The diagnosis of racemose hemangioma is difficult when affected patients are asymptomatic, and causes unexplained hemoptysis. Selective bronchial artery embolization has become the first-line treatment for this rare disease. However, feasibility and safety of bronchial artery embolization was not reported in the case with permanent tracheostomy. Case presentation: A 44-year-old woman underwent endoscopic screening during which a circular tumor was detected in the cervical esophagus, which was confirmed as squamous cell carcinoma on biopsy. She underwent cervical esophagectomy with pharyngolaryngectomy through a cervical incision. Reconstruction was performed by free jejunal transfer and permanent tracheostomy. Six weeks after surgery, hemoptysis from permanent tracheostomy was observed. Computed tomography (CT) scan revealed no bleeding around the tracheostomy, and bronchoscopy could not identify the origin of the bleedi...

Risk Factors for Residual Tumors in Surgery Following Neoadjuvant Chemotherapy for Thoracic Esophageal Cancer

Abstract Background: Neoadjuvant chemotherapy (NAC) followed by esophagectomy is considered the standard treatment for resectable advanced esophageal squamous cell carcinoma in Japan. The purpose of this study was to identify the risk factors for residual tumors in surgery following NAC. Patients and Method: We reviewed the medical records of patients in our institution selected by using the following criteria: (1) pathologically confirmed squamous cell carcinoma or adenosquamous carcinoma before treatment; (2) cT1-3; and (3) receipt of thoracotomy with the intention of curative resection after NAC composed of 5-fluorouracil plus cisplatin between 2007 and 2010. The patients were divided into the complete resection group (R0 group) and the macroscopic or microscopic residual tumor group (R(+) group). Results: Eighty-eight patients were eligible (R0, 70 patients; R1, 9 patients; R2, 7 patients; and not resected, 2 patients). There were more cT3 cancers and clinical node-positive diseases in the R(+) group ...

Retrocardiac lung hernia after thoracic esophagectomy: report of a rare case

A retrocardiac lung hernia is an extremely rare complication after esophagectomy. A 56-year-old man was admitted to our hospital with advanced middle thoracic esophageal cancer and a giant bulla at the apical portion of the right lung. Since it appeared that dissection of the upper mediastinum would most likely require resection of the right bulla, a two-stage operation for esophageal cancer was planned. During the first-stage operation, thoracic esophagectomy and resection of the right giant bulla were performed. Fourteen days after the first-stage operation, the patient underwent laparotomy as the second-stage operation to reconstruct a narrow gastric tube via a retrosternal route. After the second-stage operation, the inflammatory reaction was prolonged. Therefore, a thoracoabdominal computed tomography scan was performed, showing retrocardiac pulmonary atelectasis. The patient was diagnosed with a retrocardiac left lung hernia in which the left lower lobe was displaced into the right thoracic cavity. Because the inflammatory reaction was due to effects of the lung hernia, a repair operation was performed via a left seventh intercostal thoracotomy. At thoracotomy, the left basal segment of the lung was atelectatic and reddish and had herniated into the right thoracic cavity through an opening between the aorta and pericardium. The herniated lung tip adhered strongly to the subcarina, and synechiotomy was performed. We believe that simultaneous removal of the right giant bulla with esophagectomy was the important cause of this complication.

Comparison of radical surgery followed by adjuvant chemotherapy with radical surgery following neoadjuvant chemotherapy as initial treatment for patients with locally advanced thoracic esophageal squamous cell carcinoma.

187 Background: Although radical surgery with neoadjuvant chemotherapy (NAC) is a standard therapy for locally advanced thoracic esophageal squamous cell carcinoma (ESCC) in response to the result of JCOG 9907 study in Japan, there was no significant difference in survival rate at adjuvant chemotherapy and neoadjuvant chemotherapy in cStage III at subanalysis. Methods: Consecutive patients histologically diagnosed with ESCC and planned to undergo radical surgery followed by adjuvant chemotherapy (ADJ) from September 2002 to April 2007 and radical surgery following NAC from May 2007 to December 2011 as initial treatment were eligible for this retrospective study. To select patients who could tolerate transthoracic esophagectomy, respiratory function, Eastern Cooperative Oncology Group performance status, and preoperative complications were considered. As adjuvant and neoadjuvant chemotherapy, cisplatin and 5-fluorouracil were administered every 3 weeks for 2 cycles (FP). Patient characteristics, 3-year ove...