Reina Yajima

Thickness of subcutaneous fat as a strong risk factor for wound infections in elective colorectal surgery: impact of prediction using preoperative CT.

Background/Aims:In this study, we have attempted to identify and assess factors that would be most predictive of postoperative incisional surgical site infection (SSI) in colorectal surgery, including representative markers for nutrition or obesity. Methods: 152 patients who underwent elective colorectal resection were identified for inclusion in this study. The outcome of interest was incisional SSI. Variables thought to be predictive of incisional SSI, including body mass index (BMI) and the thickness of subcutaneous fat (TSF), were assessed by univariate and multivariate analysis. TSF was evaluated preoperatively using computed tomography (CT). Results: The study’s overall incidence of incisional SSI following a colorectal operation was 29 (19.1%). TSF was independently associated with incisional SSI. While BMI was significantly associated with incisional SSI on univariate analysis, this variable lost its significance on multivariate analysis that included TSF. Other nutritional markers were not significantly associated with the risk of incisional SSI. Conclusions:Our results suggest that the risk of incisional SSI increases with obesity, and that the most useful predictor of incisional SSI is TSF, as evaluated by preoperative CT. These findings indicate that CT is useful for the evaluation of TSF and the prediction of the risk of incisional SSI.

MicroRNA-7 expression in colorectal cancer is associated with poor prognosis and regulates cetuximab sensitivity via EGFR regulation

MicroRNA-7 (miR-7) has been reported to be a tumor suppressor in all malignancies including colorectal cancer (CRC). However, its significance for CRC clinical outcomes has not yet been explored. The potential for miR-7 to act as a tumor suppressor by coordinately regulating the epidermal growth factor receptor (EGFR) signaling pathway at several levels was examined. We investigated the tumor inhibitory effect of miR-7 in CRC, with particular focus on the relationship between miR-7 and the EGFR pathway. Quantitative reverse transcription-PCR was used to evaluate miR-7 expression in 105 CRC cases to determine the clinicopathologic significance of this miRNA. The regulation of EGFR by miR-7 was examined with miR-7 precursor-transfected cells. Furthermore, we investigated whether miR-7 suppresses proliferation of CRC cells in combination with cetuximab, a monoclonal antibody against EGFR. Multivariate analysis indicated that low miR-7 expression was an independent prognostic factor for poor survival (P = 0.0430). In vitro assays showed that EGFR and RAF-1 are direct targets of miR-7, which potently suppressed the proliferation of CRC cells, and, interestingly, that the growth inhibitory effect of each of these was enhanced by cetuximab. miR-7 is a meaningful prognostic marker. Furthermore, these data indicate that miR-7 precursor, alone or in combination with cetuximab, may be useful in therapy against CRC.

Serum Albumin Is Superior to Prealbumin for Predicting Short-Term Recurrence in Patients with Operable Colorectal Cancer

The relationship between preoperative prealbumin and cancer survival has not been fully elucidated. The purpose of this study was to examine the relationship between preoperative nutritional conditions, including prealbumin and albumin concentrations, and the risk of recurrence in cases with operable colorectal carcinoma. One hundred fifty-eight patients who underwent elective colorectal resection were analyzed in this study. Of the eligible cases, 56 (35.4%) had decreased serum prealbumin and 15 (9.5%) had decreased serum albumin preoperatively. Among 158 cases in this study, 18 (11.4%) had disease recurrence. In the univariate analysis, the depth of tumor invasion, lymph node metastasis, lymphovascular invasion, serum albumin, prealbumin, and carcinoembryonic antigen were the factors significantly associated with disease recurrence. Multivariate analysis demonstrated that only serum albumin was a predictor of the recurrence; however, serum prealbumin lost its significance on multivariate analysis. Time to tumor recurrence by Kaplan-Meier curves significantly differed among patients with low serum albumin and prealbumin level. Our results suggest that prealbumin and albumin may be sensitive indicators of the risk of recurrent disease; however, low serum albumin levels are more useful than prealbumin in predicting short-term disease recurrence in operable colorectal cancer.

Clinicopathological significance of decreased galectin-3 expression and the long-term prognosis in patients with breast cancer

PurposeGalectin-3 expression is modulated in cancer cells, and that finding has led to the recognition of galectin-3 as a diagnostic or prognostic marker for various cancers, including breast cancer. This study investigated the correlation between galectin-3 expression and the clinicopathological features in patients with breast cancer, in order to determine the relevance and role of galectin-3 in breast cancer progression.MethodsGalectin-3 expression was investigated immunohistochemically in 116 patients with breast cancer, and a statistical analysis was performed.ResultsGalectin-3 expression in breast cancer was significantly associated with tumor vascular invasion. However, galectin-3 expression was not associated with Ki-67 expression, which reflects tumor proliferation. Disease-free survival and long-term overall survival were significantly shorter for patients with reduced galectin-3 expression.ConclusionsThis study demonstrated that the galectin-3 expression was associated with tumor vascular invasion and metastasis, suggesting that galectin-3 plays a critical role in tumor progression via an invasive mechanism but not via proliferation in breast cancer. Furthermore, reduced expression of galectin-3 is useful for predicting a long-term poor prognosis in patients with breast cancer.

The association of VEGF-C expression with tumor lymphatic vessel density and lymph node metastasis in patients with gastric cancer and gastrointestinal stromal tumor.

BACKGROUND/AIMS Although tumors metastasize to lymph nodes via the lymphatics, the importance of vascular endothelial growth factor-C (VEGF-C) expression in mediating the process has not been well elucidated. We investigated the correlation between VEGF-C expression and lymphatic vessel density (LVD) and node metastasis in cases with gastric cancer and gastrointestinal stromal tumor (GIST). METHODOLOGY Immunohistochemistry, VEGF-C expression and LVD were performed in 41 patients with gastric cancer invading the muscularis propria and 19 patients with GIST. The clinicopathological features of these cases were compared. RESULTS In gastric cancer, VEGF-C expression was significantly associated with tumor LVD and lymph node metastasis. In GIST, none of these patients had lymph node metastasis and VEGF-C expression was not detected. The LVD was significantly higher in the cases with gastric cancer than in those with GIST. In gastric cancer, LVD was increased more in patients with positive lymph nodes than in those with negative lymph nodes. CONCLUSIONS These results indicate that the expression of VEGF-C is associated with tumor LVD and lymph node metastasis, suggesting that VEGF-C plays a critical role in node metastasis via lymphangiogenesis. The clinical observation that GIST rarely metastasizes to the lymph nodes may depend on the lack of VEGF-C expression.

Process of distant lymph node metastasis in colorectal carcinoma: Implication of extracapsular invasion of lymph node metastasis

BackgroundWe previously demonstrated that extracapsular invasion (ECI) at a metastatic sentinel node was significantly associated with the presence of positive non-sentinel nodes in patients with breast cancer. However, the mechanism of metastatic spreading of tumor cells to distant lymph nodes in patients with colorectal carcinoma is not fully understood. In this study, we investigated the factors that may determine the likelihood of additional regional lymph node metastasis when metastasis is found in nodes at the N1 site in colorectal cancer, especially focusing on the presence of ECI.MethodsTwo hundred and twenty-eight consecutive patients who underwent colorectal resection were identified for inclusion in this study, of which 37 (16.2%) had positive lymph nodes at the N1 site. Six of these 37 cases had additional metastasis in N2 site lymph nodes. We reviewed the clinicopathological features of these cases and performed statistical analysis of the data.ResultsIn the univariate analysis ECI at the N1 site was the only factor significantly associated with the presence of cancer cells in the N2 site. Other factors, including number of positive lymph nodes, lymphovascular invasion of the primary tumor, tumor size and tumor depth of invasion, were not associated with metastatic involvement at the N2 site.ConclusionsOur results suggest that the presence of ECI at metastatic lymph nodes at the N1 site is correlated with further metastasis at the N2 site. These findings imply the possibility that ECI might indicate the ability of colorectal tumor cells to disseminate to distant lymph nodes.

Benefit of oral feeding as early as one day after elective surgery for colorectal cancer: oral feeding on first versus second postoperative day.

The optimal timing of early oral intake after surgery has not been fully established. The objective of this study was to compare early oral intake at postoperative day 1 after resection of colorectal cancer with that of day 2 to identify the optimal timing for resumption of oral intake in such patients. Consecutive patients with colorectal cancer who underwent elective colorectal resection were separated into two groups. Sixty-two patients began a liquid diet on the first postoperative day (POD1 group) and 58 patients began on POD2 (POD2 group) and advanced to a regular diet within the next 24 hours as tolerated. As for gastrointestinal recovery, the first passage of flatus was experienced, on average, on postoperative day 3.1 ± 1.0 in the POD2 group and on day 2.3 ± 0.7 in the POD1 group. The first defecation was also significantly earlier in patients in the POD1 group than those in the POD2 group (POD 3.2 ± 1.2 versus 4.2 ± 1.4, respectively). No statistical difference was found between the two groups in terms of postoperative complications. Our results suggest that very early feeding on POD1 after colorectal resection is safe and feasible and that induced a quicker recovery of postoperative gastrointestinal movement in patients.

Extracapsular invasion as a risk factor for disease recurrence in colorectal cancer.

AIM To evaluate the presence of extracapsular invasion (ECI) in positive nodes as a predictor of disease recurrence disease in colorectal cancer. METHODS Two hundred and twenty-eight consecutive patients who underwent colorectal resection were identified for inclusion in this study, of which 46 had positive lymph nodes. Among 46 cases with stage IIIcolorectal cancer, 16 had ECI at positive nodes and 8 had disease recurrence. The clinical and pathological features of these cases were reviewed. RESULTS In the univariate analysis, the number of positive lymph nodes and depth of tumor invasion were significantly associated with the presence of ECI at positive nodes. Multivariate analysis demonstrated that only ECI was a predictor of recurrence. The recurrence-free interval differed significantly among patients with ECI at positive nodes. CONCLUSION Our results suggest that ECI at metastatic nodes can identify which cases are at high risk of short-term disease recurrence in colorectal cancer.

Adenoma of the nipple projecting out of the nipple: curative resection without excision of the nipple

BackgroundAdenoma of the nipple is a rare breast tumor that is often mistaken clinically for Paget’s disease and misinterpreted pathologically as invasive ductal carcinoma.Case reportWe report herein a distinctive case of adenoma of the nipple projecting out of the nipple. In the current case, we were able to perform curative resection through a periareolar incision similar to a microdochectomy without excision of the nipple. The diagnosis of adenoma of the nipple was confirmed histopathologically.ConclusionAlthough the tumor was found on top of the nipple, curative tumor resection without excision of the nipple was possible and the nipple was completely preserved. Adenoma of the nipple is a benign tumor, and thus the diagnosis of adenoma of the nipple must be confirmed so that unnecessary surgery can be avoided.

Adenocarcinoma of Ascending Colon Associated with Sarcoid Reaction in Regional Lymph Nodes.

Lymph node swelling in the setting of malignancy generally suggests metastasis of the primary tumor. A granulomatous reaction, i.e. sarcoid reaction, occurring within the lymph nodes draining carcinomas is a well-known but uncommon occurrence. The phenomenon is especially rarely seen in colon carcinoma. We herein report a rare case of a 56-year-old Japanese male with adenocarcinoma of the ascending colon associated with sarcoid reaction in the regional lymph nodes. A typical ileocecal resection and lymph node dissection were performed. Histopathological examination revealed moderately differentiated adenocarcinoma of the ascending colon, and the dissected lymph nodes included epithelioid granulomas with multinucleated giant cells. These findings suggest the existence of a sarcoid reaction associated with colon carcinoma; there was no metastasis in the dissected lymph nodes. The significance of this rare condition is discussed.