Takashi Higashiguchi

Preoperative evaluation of pelvic lateral lymph node of patients with lower rectal cancer: comparison study of MR imaging and CT in 53 patients

BackgroundPreoperative assessment of the lateral pelvic lymph nodes is important for treatment strategy to patients with lower rectal cancer.Materials and methodsFifty-three patients with primary lower rectal cancer were preoperatively assessed by spiral computed tomography (CT) and magnetic resonance imaging (MRI) at 1.5xa0T with a phased-array coil. Preoperative tumor and lymph node stages were compared with the final histological findings.ResultsThe MRI tumor stage coincided with the histological stage in 36 of 53 patients (68%). The MRI and CT lymph node stage coincided with the histological stage in 33 (62%) and 26 (49%) of 53 patients, respectively. However the accuracy of MRI in detecting the lateral pelvic lymph node involvement was 83%, compared to 77% of CT (p<0.05).ConclusionsWith the use of MRI, the lateral pelvic lymph node involvement can be predicted with high accuracy, allowing preoperative identification of patients who need radiotherapy or extensive surgery to escape recurrence.

Long-term comorbidity of diabetes mellitus is a risk factor for perineal wound complications after an abdominoperineal resection

BackgroundThis report is an attempt to clarify the effect of diabetes mellitus on perineal wound complications including infectious entities and delayed wound healing after abdominoperineal resection and also tried to show the risk factors for perineal wound complications.Material and methodsThe data of 80 patients who underwent an abdominoperineal resection were reviewed from April 1996 to March 2006.ResultsThe rate of perineal wound complications is higher in diabetics (67%) than in nondiabetics (18%, pu2009=u20090.005). In a multivariate analysis, diabetes mellitus and operation time (≥420xa0min) were the risk factors for perineal wound complications (pu2009=u20090.040, pu2009=u20090.027, respectively). Infectious perineal wound complication was associated with diabetes mellitus (pu2009<u20090.001) but not with the operation time (pu2009=u20090.097). Furthermore, a longer comorbid duration of diabetes (≥10xa0years) was a significant predictor for perineal wound complications (pu2009=u20090.008).ConclusionThis study demonstrated diabetes mellitus to be independently associated with perineal wound complications, and when the patients have diabetes mellitus, especially with a longer comorbid duration and longer operation time, the clinical path should be changed to reduce perineal wound complications.

Identification of the Molecular Mechanisms for Dedifferentiation at the Invasion Front of Colorectal Cancer by a Gene Expression Analysis

Purpose: The aim of this study is to identify gene expression signatures that accompany dedifferentiation at the cancer invasion front in colorectal cancer. Experimental Design: Two types of colorectal cancer were selected. Both types were well-differentiated adenocarcinomas at the superficial lesion. One type showed a dedifferentiated phenotype at the invasion front (type A, 13 samples); the other showed almost no dedifferentiated cancer cells at the invasion front (type B, 12 samples). Laser microdissection was combined with a cDNA microarray analysis to investigate the superficial lesions and the invasion front in colorectal cancers. Results: Eighty-three genes were differentially expressed between types A and B in the superficial lesions, and the samples of superficial lesions were divided correctly into two clusters by these genes. Interestingly, the samples of the invasion front were also divided into the two same clusters by these genes. The text mining method selected 10 genes involved in potential mechanisms causing dedifferentiation of cancer cells at the invasion front. The potential mechanisms include the networks of transforming growth factor-β, Wnt, and Hedgehog signals. The expression levels of 10 genes were calculated by quantitative reverse transcription-PCR and 8 genes were confirmed to be significantly differentially expressed between two types (P < 0.05). The gene expression profiles of 8 genes divided 12 test cases into two clusters with one misclassification. Conclusions: The molecular mechanisms constructed with 8 genes from three networks of transforming growth factor-β, Wnt, and Hedgehog signals were found to correlate with dedifferentiation at the invasion front of colorectal cancer.

Combination of p53 codon 72 polymorphism and inactive p53 mutation predicts chemosensitivity to 5-fluorouracil in colorectal cancer

There are increasing reports showing the clinical significance of the p53 polymorphism status in terms of the response to chemotherapy. We investigated whether p53 polymorphism and mutation were associated with in vitro sensitivity to 5‐fluorouracil (5‐FU) in patients with colorectal cancer. Chemosensitivity to 5‐FU was evaluated by the collagen gel droplet embedded culture drug sensitivity test. 5‐FU sensitivity of tumor cells without inactive p53 mutation in the arginine/arginine (Arg/Arg) variant was significantly higher than that of tumor cells with or without inactive p53 mutation in other variants (p = 0.022), whereas the 5‐FU sensitivity of tumor cells with inactive p53 mutation in the Arg/Arg variant was significantly lower than that of tumor cells with or without inactive p53 mutation in other variants (p = 0.002). In the Arg/Arg variant, apoptotic cells induced by 5‐FU treatment in patients without inactive p53 mutation were more markedly increased than those in patients with inactive p53 mutation (p = 0.037). Bax and Bcl‐2 protein expressions in tumor tissue treated with 5‐FU were associated with both 5‐FU sensitivity and the apoptotic cell count. Our data show that the Arg/Arg genotype without inactive p53 mutation could be predictive of a more favorable response and the Arg/Arg genotype with inactive p53 mutation a less favorable response to chemotherapy using 5‐FU in CRC. The combination of the p53 codon 72 polymorphism and p53 mutation status is a potential predictive marker of sensitivity to 5‐FU in CRC.

Rectal cancer surgery in the elderly: analysis of consecutive 158 patients with stage III rectal cancer

BackgroundIt is difficult to establish a clear-cut indication for rectal surgery in elderly patients because of greater risk. We tried to clarify the factors associated with the short-term and long-term outcomes between elderly and younger patients.Materials and methodsWe clarified the potential predictors of the cancer-related and disease-free survivals after surgery, the factors associated with the elderly, preoperative comorbid conditions, and postoperative complications in 158 patients with stage III rectal cancer who underwent surgery, including 33 elderly patients (≥75xa0years) and 125 younger patients (<75xa0years).ResultsAn old age and macroscopic types 3 and 4 were independent poor prognostic factors of cancer-related survival, whereas the disease-free survival of the younger patients was not longer than for the elderly patients. Interestingly, the survival rate in the elderly patients with recurrence was shorter than that in the younger patients. Histopathological type except well differentiated and without chemotherapy were significant tumor characteristics associated with the elderly patients. On preoperative comorbid conditions, elderly patients have more cardiovascular diseases than younger patients, whereas there were no significant differences in the postoperative complications.ConclusionStrength of the adjuvant and intensive therapies after recurrence may contribute to gain long-term survival in the elderly rectal cancer patients.

survival in Colorectal Cancer Patients With Urinary Tract Invasion

PurposeWe compared overall survival and disease-free survival in colorectal cancer patients with and without invasion of urinary organs.MethodsWe clarified the potential predictors of the overall and disease-free survivals after surgery, the factors associated with direct tumor invasion of the urinary organs, postoperative complications, recurrence sites, and survival in patients with and without urinary organ resection in 171 patients with Stage III colorectal cancer who underwent surgery, including 23 patients with tumor invasion of the urinary organs and 148 patients without invasion.ResultsOld age (65 years or older), rectal cancer, and macroscopic Type 3 and 4 disease were found to be independent poor prognostic factors for the overall and disease-free survivals in all patients. The overall and disease-free survivals in patients with direct tumor invasion of the urinary organs were not shorter than those in patients without invasion. A large extent of tumors located in the cross-sectional circumference of the bowel (≥72 percent) and a large maximum tumor size (>50xa0mm) were significant tumor characteristics associated with positive direct tumor invasion of the urinary organs by sigmoid and rectal cancers. Although the local recurrence of patients with tumor invasion of the urinary organs occurred more frequently in patients without invasion, there were no differences in the overall and disease-free survivals between the patients without a urinary organ resection and those with a local resection of urinary bladder or ureter.ConclusionsThe survival of patients with a urinary invasion was not shorter than that of patients without urinary invasion.

Clinical Impact of Matrix Metalloproteinase-7 mRNA Expression in the Invasive Front and Inner Surface of Tumor Tissues in Patients with Colorectal Cancer

PurposeMatrix metalloproteinase-7, reversion-inducing cysteine-rich protein with Kazal motifs, chemokine receptor 7, and vascular endothelial growth factor-C have been correlated with tumor invasion and lymph node metastasis in patients with gastrointestinal cancer. Our study of patients with colorectal cancer quantified the messenger ribonucleic acid (RNA) expressions at the deepest site of tumor invasion (the invasive front) and the tumor’s inner surface. We investigated whether messenger RNA expressions can predict lymph node metastasis in colorectal cancer tumors and then evaluated the clinical implications of these results on the endoscopic treatment of early colorectal cancer.MethodsSixty patients with colorectal cancer participated in the study. Levels of matrix metalloproteinase-7, reversion-inducing cysteine-rich protein with Kazal motifs, chemokine receptor 7, and vascular endothelial growth factor-C messenger RNA in both the invasive front and inner surface of colorectal cancer tumors were measured by using real-time quantitative reverse transcriptase-polymerase chain reaction.ResultsThe matrix metalloproteinase-7 values in the invasive front and inner surface were significantly higher in tumors with lymph node metastasis than in tumors without lymph node metastasis. The matrix metalloproteinase-7 expression levels in the invasive front correlated with inner surface expression levels. Both a univariate and multiple logistic regression analysis showed the matrix metalloproteinase-7 expression levels in both the invasive front and inner surface of tumors to be significantly associated with lymph node metastasis.ConclusionsMatrix metalloproteinase-7 messenger RNA in both the invasive front and inner surface of the tumor is a predictive factor associated with lymph node metastasis for patients with colorectal cancer. The results of this study might indicate further clinical applications of an endoscopic excision for cancer with submucosal invasion.

Radiation-Induced Rectal Cancer Originating from a Rectocutaneous Fistula: Report of a Case

This report describes a patient with radiation-induced rectal cancer with an unusual history. A 51-year-old man was admitted in 2000 because of ichorrhea of the skin on the left loin. The patient had received irradiation for a suspicious diagnosis of a malignant tumor in the pelvic cavity in 1975. A subcutaneous abscess in the right loin appeared in 1989, and rectocutaneous fistula was noted in 1992. Moreover, radiation-induced rectal cancer developed in 2000. Plain computed tomography and magnetic resonance imaging of the pelvis demonstrated a presacral mass and tumor in the rectum. Finally, we diagnosed the presacral mass to be an abscess attached to the center of the rectal cancer. The rectum was resected by Miles’ operation and a colostomy of the sigmoid colon was also performed. Many cases of radiation-induced rectal cancer have been reported. However, this is a rare case of radiation-induced rectal cancer originating from a presacral abscess and rectocutaneous fistula.

Survival of Patients with T3 Stage III Rectal Cancer Is Significantly Worse than T2 Stage III Rectal Cancer

Background: The prognosis of T1 plus T2 stage III rectal cancer patients is better than that of T3 stage III rectal cancer patients. However, it is thought that T1 rectal cancer patients have a better prognosis than T2 rectal cancer patients. Aim: This study attempted to clarify the difference of the short- and long-term outcomes in T2 and T3 stage III rectal cancer patients deleting T1 cancer. Methods: The study demonstrated the potential predictors of the survival after surgery, the factors associated with T3 and T2, and the recurrence sites in 134 patients with stage III rectal cancer who underwent surgery, including 111 patients with T3 and 23 patients with T2. Results: The disease-free survival (DFS) of the T3 stage III patients was worse than the T2 stage III patients (5-year DFS rates, 52 vs. 78%; 10-year DFS rates, 43 vs. 78%; p =0.044). The maximum tumor size and operative blood loss were significant tumor characteristics associated with the depth of invasion (p =0.007,p =0.011,respectively). There was no significant difference in the recurrence sites after surgery between the two groups. Conclusion: As a result, a more detailed subdivision for stage III rectal cancer is considered necessary.