Shigeo Ninomiya

Effect of Bevacizumab, a Humanized Monoclonal Antibody to Vascular Endothelial Growth Factor, on Peritoneal Metastasis of MNK-45P Human Gastric Cancer in Mice

BACKGROUND The aim of this study was to clarify the effect of bevacizumab on gastric cancer with peritoneal metastasis in nude mice. MATERIALS AND METHODS The expression of vascular endothelial growth factor mRNA (VEGF mRNA) in four gastric cancer cell lines, NCI-N87, MKN-45, MKN-45P, and Kato-III, was examined by polymerase chain reaction. We created a model of peritoneal metastasis by injecting mice with the human gastric cancer cell line MKN-45P. Mice were injected intraperitoneally with bevacizumab (0.1 mg/100 microL) on days 5-14, after inoculation (n = 10) or with phosphate-buffered saline (PBS) over the same time period (n = 10). The maximum abdominal circumference, ascites volume, and the total number and weight of peritoneal tumors were measured. To assess the effect of bevacizumab on angiogenesis, immunohistochemical analysis was performed. RESULTS VEGF mRNA was expressed at a high level in MKN-45P cells as well as MKN-45 and Kato-III. The mean maximum abdominal circumference and ascites volume in the bevacizumab group were significantly less than those in the control group (P < 0.001, respectively). The total weight of disseminated tumors in the bevacizumab group was also significantly less than that in the control group (P < 0.01). In addition, immunohistochemical analysis of CD31-stained peritoneally disseminated nodules showed that the vessel area in the bevacizumab group was significantly less than that in the control group (P < 0.001). CONCLUSIONS These results show that intraperitoneal administration of bevacizumab inhibits peritoneal metastasis and reduces malignant ascites in tumor-bearing mice.

Outcome of Segmental Gastrectomy versus Distal Gastrectomy for Early Gastric Cancer

BackgroundBecause of the frequent occurrence of postgastrectomy disturbances after distal gastrectomy (DG), segmental gastrectomy (SG) has recently been applied to early gastric cancer (EGC). Outcomes of SG and DG in patients with EGC were compared to clarify the usefulness of SG as a treatment for EGC.MethodsThis retrospective study involved 61 patients with EGC: 28 patients who underwent DG before March 1996 and 33 patients who underwent SG after April 1996 during the period April 1991 through March 2002. Patient and tumor characteristics, operative results, and postoperative outcomes were compared between the two groups.ResultsThe postoperative/preoperative body weight ratio was higher in the SG group than in the DG group. Early dumping syndrome and reflux gastritis occurred less frequently after SG than after DG. The incidence of postoperative complications was similar in the two groups. All patients remained alive without recurrence during a mean follow-up period of 54.7 months in the SG group and 99.9 months in the DG group.ConclusionsIn comparison to DG, SG is associated with improved postoperative quality of life with no decrease in operative curability of EGC. Thus, SG is a feasible treatment for EGC.

Five-year survival after surgery for invasive micropapillary carcinoma of the stomach.

Invasive micropapillary carcinoma (IMPC) of the breast, urinary bladder, ovary, and colon has been reported. However, few reports have described IMPC of the stomach. In addition, IMPC has been described as a histological indicator for lymphatic invasion and nodal metastasis, resulting in poor prognosis. We report a case of 5-year survival after surgery for IPMC of the stomach. A 69-year-old woman was admitted to our hospital with symptoms of upper abdominal pain. Upper gastrointestinal endoscopy revealed a tumor at the antrum of the stomach. Histological examination of the biopsy specimen indicated poorly differentiated adenocarcinoma. The patient underwent distal gastrectomy with lymph node dissection. Microscopic examination of the specimen revealed that the tumor consisted of an invasive micropapillary component. Carcinoma cell clusters were floating in the clear spaces. The patient recovered uneventfully and remains alive without recurrence 5 years after surgery.

Multiple Tracheal Diverticula Detected by Multidetector-row Computed Tomography.

Multiple tracheal diverticula are rare. We report a case of a 62-year-old man who had multiple tracheal diverticula that were detected using multidetector-row computed tomography. Axial computed tomography images showed multiple air collections contiguous to the trachea. The multiple air collections were visible as outpouchings of the parts of the trachea between the cartilages, being located almost symmetrically on both lateral sides of the tracheal wall as seen on coronal multiplanar reconstruction images. Virtual bronchoscopy confirmed the presence of multiple openings in the tracheal wall of the diverticular necks. The alteration of the airway was better seen using volume-rendered reconstruction. Thin-slice multidetector-row computed tomography and advanced imaging techniques may increase the frequency of identification of multiple tracheal diverticula.

Feasibility and functional efficacy of distal gastrectomy with jejunal interposition for gastric cancer: A case series

INTRODUCTION Distal gastrectomy with jejunal interposition (DGJI) has been used in our institution for selected patients with gastric cancer as a function-preserving gastrectomy. The aim of this retrospective study was to clarify the feasibility and functional efficacy of DGJI. METHODS A retrospective analysis was performed in 61 patients who underwent DGJI between 2002 and 2011. RESULTS Mean operation time was 393.8 min and blood loss was 463.3 ml. Postoperative early major complications developed in 2 (3.3%) patients. The most common complication was gastric stasis, occurring in 7 (11.5%) patients. All patients with complications recovered with conservative treatment, and no operative mortality occurred. Endoscopy 1 year after operation revealed reflux gastritis in 1 patient. Reflux esophagitis was not found in any patient. However, anastomotic ulcer was found in 12 (22.2%) patients over the 1-year period after operation. No patient reported symptoms of early and late dumping syndrome, and 1 (1.9%) patient self-reported diarrhea. CONCLUSIONS DGJI was a feasible and safe procedure with several advantages in terms of less incidence of reflux gastritis and esophagitis, dumping syndrome and diarrhea. However, this procedure is complicated and time-consuming, and it is necessary to be aware of the potential occurrence of an anastomotic ulcer at the site of the gastrojejunostomy after DGJI.

Surgical Outcomes of Laparoscopic Versus Open Abdominoperineal Resection for Anorectal Cancer: A Comparative Study

Introduction: There has been no large, randomized prospective trial and few retrospective studies to clarify the surgical outcomes of laparoscopic abdominoperineal resection (Lap-APR) for anorectal cancer. The aim of this study was to clarify the surgical outcomes of Lap-APR for anorectal cancer. Methods: A consecutive series of 39 patients who underwent abdominoperineal resection for anorectal cancer was studied: 24 underwent Lap-APR, and 15 open abdominoperineal resection (Open-APR). Patient characteristics, tumor characteristics and operative outcomes were compared between the groups. Results: There were no significant differences between the groups in patient and tumor characteristics.The mean number of harvested nodes in the Lap-APR group was significantly more than that in the Open-APR group (11.8 ± 8.7 vs.7.6 ± 3.6, p=0.046). Although the mean operation time was similar in the two groups (372.1 ± 79.0 vs.402.7 ± 118.4 min, N.S), the mean blood loss in the Lap-APR group was significantly less than that in the Open-APR group (244.6 ± 175.0 vs.795.3 ± 544.9 g, p=0.002). Additionally, time to start oral intake of solid foods and time to first education of stoma management were significantly less after Lap-APR than Open-APR. Conclusion: Lap-APR offered particular advantages to patients with anorectal cancer,including less blood loss, rapid oral intake of solid foods and education of stoma care.

Short- and long-term outcomes of neoadjuvant-synchronus S-1+radiotherapy for locally advanced rectal cancer: Multicenter phase II study.

720 Background: Fluorouracil-based chemoradiotherapy (CRT) is regarded as a standard perioperative treatment in locally advanced rectal cancer. We investigated the efficacy and safety of substituting fluorouracil with the oral prodrug S-1. Methods: A multi-institutional (17 specialized centers), interventional phase II trial, was conducted from April 2009 to August 2011. For inclusion, patients must fulfill the following requirements before neoadjuvant CRT: (i) histologically proven rectal carcinoma; (ii) tumor located in the rectum (upper, lower); (iii) cancer classified as T3-4, N0–3 and M0; Two cycles of neoadjuvant CRT with S-1 (100 mg/m2 on days 1-5, 8-12, 22-26, and 29-33) was administered, and irradiation (total 45Gy/25fr, 1.8Gy/day, on days 1-5, 8-12, 15-19, 22-26, and 29-33) was performed. Total mesorectal excision was performed during the 4th and 8th week after the end of the neoadjuvant CRT. The primary endpoint is rate of complete treatment of neoadjuvant CRT. Secondary endpoints are response ...

Idiopathic aneurysm of the azygos arch exhibiting fluid-fluid layering on contrast-enhanced computed tomography.

To the Editor Aneurysm of the azygos arch is a rarely described abnormality. This condition is often incidentally detected on routine chest radiographs or computed tomography (CT) obtained for another purpose. Intravenous dynamic contrast-enhanced CT (CE-CT) plays an important role in the diagnosis of this phenomenon. CT findings have already been reported in the English-language literature. We report herein the first case of an azygos arch aneurysm in which fluid–fluid layers formed by blood and injected contrast material were observed using CE-CT, together with a review of the literature.