Takeshi Matsutani

Endoscopic dexamethasone injection following balloon dilatation of anastomotic stricture after esophagogastrostomy

BACKGROUNDnAnastomotic stricture is common after esophagogastrostomy. Recent advances in nonsurgical treatment include the silicon bougie and balloon dilatation. However, simple dilatation alone with a silicon bougie or endoscopic balloon dilator was repeated a mean of 4.7+/-5.4 times to control anastomotic stricture because of its temporary effect.nnnMETHODSnFor 11 patients, endoscopic injection of dexamethasone (8 mg) around the anastomosis was done immediately after balloon dilatation (40 psi for 5 minutes).nnnRESULTSnThis method significantly reduced the number of the dilatations to 1.1+/-0.3 (P < 0.05). Ten of the 11 patients did not need any further treatment. There were no side effects or complications of dexamethasone injection.nnnCONCLUSIONnA combination of endoscopic balloon dilatation and dexamethasone injection provided an easy and safe method for preventing the recurrence of anastomotic stricture.

Comparison of Long-Term Outcomes of Colonic Stent as “Bridge to Surgery” and Emergency Surgery for Malignant Large-Bowel Obstruction: A Meta-Analysis

AbstractBackgroundnThe short-term safety and efficacy of insertion of a self-expandable metallic colonic stent followed by elective surgery, bridge to surgery (BTS), for malignant large-bowel obstruction (MLBO) have been well described. However, long-term oncological outcomes are still debated. Hence, this study is conducted to evaluate long-term outcomes of colonic stent insertion followed by surgery for MLBO.MethodsA comprehensive electronic literature search through May 2014 was performed to identify studies comparing long-term outcomes between BTS and emergency surgery for MLBO. The main outcome measures were overall survival (OS), disease-free survival (DFS), and recurrence. A meta-analysis was performed using random-effects models to calculate risk ratios (RRs) with 95xa0% confidence intervals (95xa0% CIs).ResultsThere were 11 studies that matched the criteria for inclusion, yielding a total of 1136 patients, of whom 432 (38.0xa0%) underwent BTS and 704 (62.0xa0%) underwent emergency surgery. In OS analyses of all patients and patients who underwent curative resection, BTS was similar to emergency surgery [(RRxa0=xa00.95; 95xa0% CI 0.75–1.21; Pxa0=xa00.66) (RRxa0=xa00.96; 95xa0% CI 0.67–1.37; Pxa0=xa00.82), respectively]. DFS (RRxa0=xa01.06; 95xa0% CI 0.91–1.24; Pxa0=xa00.43) and recurrence (RRxa0=xa01.13; 95xa0% CI 0.82–1.54; Pxa0=xa00.46) did not differ significantly between the BTS and emergency surgery groups.ConclusionsResults of this meta-analysis on long-term as well as well-described short-term outcomes suggest that BTS could be a promising alternative strategy for MLBO patients.

Does Postoperative Complication Have a Negative Impact on Long-Term Outcomes Following Hepatic Resection for Colorectal Liver Metastasis?: A Meta-Analysis

BackgroundThe negative impact of postoperative complications (POCs) on long-term outcomes is well documented for several cancer surgeries, but conclusive evidence has yet to be provided on the influence of POCs on long-term oncological outcomes after hepatic resection for colorectal liver metastasis (CRLM).MethodsStudies published through February 2012 evaluating the oncological impact of POCs after hepatectomy for CRLM were identified by an electronic literature search. Finally, 4 studies were identified and included in the meta-analysis. The main outcome measures were 5-year disease-free survival (DFS) and overall survival (OS). A meta-analysis was performed using the DerSimonian-Laird random-effects models to compute odds ratio (OR) along with 95 % confidence intervals (95xa0% CI).ResultsThe outcomes of 2,280 patients were studied. Meta-analysis of 5-year DFS data extracted from three studies demonstrated a significant reduction in 5-year DFS after POCs, with an OR of 1.98 (95xa0% CIxa0=xa01.33–2.96; Pxa0=xa0.0008). Meta-analysis of 5-year OS data extracted from four studies demonstrated a significant reduction in 5-year OS after POCs, with an OR of 1.68 (95xa0% CIxa0=xa01.25–2.27; Pxa0=xa0.0006). No differences between study heterogeneity were observed in either the DFS or the OS analyses.ConclusionsThis study provides persuasive evidence that POCs following hepatic resection for CRLM have significant adverse oncological outcomes. These findings emphasize the need for meticulous surgical technique and careful perioperative management to minimize POCs.

The Effect of Intraoperative Rectal Washout on Local Recurrence after Rectal Cancer Surgery: A Meta-Analysis

BackgroundImplantation of exfoliated cancer cells has been suggested as a possible mechanism of local recurrence at the site of colorectal anastomosis. Intraoperative rectal washout has been suggested to eliminate free cancer cells; however, there is no conclusive evidence of a beneficial effect of intraoperative rectal washout on local recurrence after anterior resection of rectal cancer.MethodsStudies published through February 2012 evaluating the impact of intraoperative rectal washout for local recurrence or positive cytology from donuts wash were identified by an electronic literature search. A meta-analysis was performed using the DerSimonian-Laird random-effects models to compute risk ratio (RR) along with 95xa0% confidence intervals (CI).ResultsNine studies met the inclusion criteria, yielding a total of 5,395 patients. Eight studies evaluated overall local recurrence, including anastomotic recurrence, and five of the eight studies evaluated anastomotic recurrence separately. Two studies evaluated positive cytology from donuts wash. Local recurrence rate was 5.79xa0% in the washout group and 10.05xa0% in the no washout group—a difference that was statistically significant (RRxa0=xa00.57; 95xa0% CIxa0=xa00.46-0.71; Pxa0<xa00.00001). Rectal washout significantly reduced the risk of anastomotic recurrence (RRxa0=xa00.3; 95xa0% CIxa0=xa00.12-0.71; Pxa0=xa00.007). No influence of rectal washout was observed on positive cytology from donuts wash.ConclusionsFrom the results of this meta-analysis, it may be justified to recommend intraoperative rectal washout to prevent local recurrence in rectal cancer surgery.

Circulating IGF-binding protein 7 (IGFBP7) levels are elevated in patients with endometriosis or undergoing diabetic hemodialysis.

BackgroundInsulin-like growth factor-binding protein-7 (IGFBP7) is a secretory protein with a molecular mass of approximately 30 kDa. It is abundantly expressed in the uterine endometrium during the secretory phase of the menstrual cycle. Decreased IGFBP7 expression has been observed in some cancers and leiomyomata.MethodsTo determine whether serum IGFBP7 levels reflect changes in uterine IGFBP7 expression in humans during the menstrual cycle, and to examine whether serum IGFBP7 levels are altered in patients with various disorders, we developed a novel, dual-antibody sandwich enzyme-linked immunosorbent assay (ELISA). Firstly, concentrations of IGFBP7 released into the medium were determined in cultured endometrial stromal and glandular cells. Blood samples were collected from women who had normal menstrual cycles and who had been diagnosed with endometriosis. Serum from hemodialysis patients and gastrointestinal cancers was also used to determine the IGFBP7 levels.ResultsUsing this new ELISA, we demonstrated that cultured uterine cells secrete IGFBP7 into the medium. Patients with endometriosis and those with type II diabetes mellitus undergoing hemodialysis had significantly higher serum concentrations of IGFBP7 than the relevant control subjects. There were no differences in serum IGFBP7 levels in women at different stages of the menstrual cycle. Furthermore, serum IGFBP7 levels in patients with colorectal, esophageal, or endometrial cancer were not different than normal healthy subjects.ConclusionOur observations suggest that IGFBP7 is associated with the pathophysiology of endometriosis and diabetes mellitus, and that serum IGFBP7 levels do not reflect enhanced uterine expression of IGFBP7 mRNA during the menstrual cycle.

Preoperative Plasma Adiponectin Level Is a Risk Factor for Postoperative Infection Following Colorectal Cancer Surgery

BACKGROUNDnAdiponectin is produced exclusively by adipose tissues. It is associated with visceral adiposity and various metabolic disorders, and acts as an anti-inflammatory protein that inhibits nuclear factor-kappaB activation. The purpose of this study is to clarify the association between the preoperative plasma adiponectin levels and the development of postoperative infection following colorectal cancer surgery.nnnMETHODSnPeripheral blood samples were collected from 41 colorectal cancer patients before surgery and on postoperative days (PODs) 1, 3, 5, and 7. Plasma adiponectin, leptin, and serum C-reactive protein (CRP) levels were measured and the white blood cells (WBCs) were counted. Subcutaneous and visceral fat volumes were quantified by preoperative CT scans. The patients were divided into a group with postoperative infections and an uninfected group.nnnRESULTSnIn both groups, the postoperative plasma adiponectin levels decreased transiently and then gradually recovered. However, the infected group had significantly lower adiponectin levels throughout the perioperative period than the uninfected group. Logistic regression analysis revealed that preoperative adiponectin level was an independent risk factor for postoperative infection.nnnCONCLUSIONSnPreoperative adiponectin levels may be useful for anticipating the development of postoperative infection following colorectal cancer surgery.

A Rare Case of Primary Squamous Cell Carcinoma of the Stomach and a Review of the 56 Cases Reported in Japan

We report an extremely rare case of primary squamous cell carcinoma of the stomach. A 69-year-old man was admitted to our hospital with a 2-month history of dysphagia and tarry stools. Endoscopic examination revealed a cauliflower-shaped protruding mass along the lesser curvature of the gastric cardia. Biopsy of the lesion revealed squamous cell carcinoma of the stomach. Computed tomography revealed a thickened stomach wall and a mass protruding into the gastric lumen. Total gastrectomy with splenectomy, distal pancreatectomy, and Roux-en-Y reconstruction was performed, together with a lower thoracic esophagectomy via a left thoracotomy. Histopathological examination of the specimen revealed well-differentiated squamous cell carcinoma of the stomach. Postoperative follow-up was uneventful for the first 18 months. However, multiple liver metastases and para-aortic lymph node metastasis developed subsequently. Despite systemic combination chemotherapy, the patient died because of progression of the recurrent tumors. Here, we review the characteristics of 56 cases of gastric squamous cell carcinoma reported in Japan.

SnoN/SKIL modulates proliferation through control of hsa-miR-720 transcription in esophageal cancer cells.

It is now evident that changes in microRNA are involved in cancer progression, but the mechanisms of transcriptional regulation of miRNAs remain unknown. Ski-related novel gene (SnoN/SKIL), a transcription co-factor, acts as a potential key regulator within a complex network of p53 transcriptional repressors. SnoN has pro- and anti-oncogenic functions in the regulation of cell proliferation, senescence, apoptosis, and differentiation. We characterized the roles of SnoN in miRNA transcriptional regulation and its effects on cell proliferation using esophageal squamous cell carcinoma (ESCC) cells. Silencing of SnoN altered a set of miRNA expression profiles in TE-1cells, and the expression levels of miR-720, miR-1274A, and miR-1274B were modulated by SnoN. The expression of these miRNAs resulted in changes to the target protein p63 and a disintegrin and metalloproteinase domain 9 (ADAM9). Furthermore, silencing of SnoN significantly upregulated cell proliferation in TE-1 cells, indicating a potential anti-oncogenic function. These results support our observation that cancer tissues have lower expression levels of SnoN, miR-720, and miR-1274A compared to adjacent normal tissues from ESCC patients. These data demonstrate a novel mechanism of miRNA regulation, leading to changes in cell proliferation.

Effects of Pioglitazone on Survival and Omental Adipocyte Function in Mice with Sepsis Induced by Cecal Ligation and Puncture

BACKGROUNDnTo examine the effects of pioglitazone, peroxisome proliferator-activated receptor-gamma (PPAR-γ), on mortality and omental adipocyte function in mice with cecal ligation and puncture (CLP).nnnMETHODSnMale mice were assigned to receive (1) vehicle/sham-operation, (2) pioglitazone/CLP, or (3) vehicle/CLP. Pioglitazone was injected intraperitoneally for 7 d before operation. Serum and omental tissue were collected before, 24, and 48 h after CLP. Serum levels of adiponectin, cytokine, and chemokine were measured with ELISA. mRNA expressions in omental tissues were determined by RT-PCR. Survival was monitored for 7 d after CLP.nnnRESULTSnSurvival after CLP was significantly better in the pioglitazone/CLP than in the vehicle/CLP. Serum adiponectin levels before CLP were higher in the pioglitazone/CLP than in the vehicle/CLP. Treatment with pioglitazone significantly inhibited the increases in the serum interleukin-6 and monocyte chemoattractant protein-1 (MCP-1) levels after CLP and lowered the mRNA expressions of proinflammatory cytokines, interleukin-6, and MCP-1 in omental tissue after CLP.nnnCONCLUSIONnThe anti-inflammatory effects of pioglitazone on omental adipocyte function appear to be mediated in part by PPAR-γ activation, which down-regulates the production of inflammatory mediators.

Aggressive undifferentiated colon carcinoma producing granulocyte-colony stimulating factor: Report of a case

We report a rare case of granulocyte-colony stimulating factor (G-CSF)-producing undifferentiated carcinoma of the ascending colon. A 52-year-old Japanese man presented with a rapidly growing, aggressive abdominal tumor, and severe leukocytosis (63 000/mm3). The serum level of G-CSF was remarkably elevated to 640 pg/ml (normal, <18.1 pg/ml). The patient underwent palliative cytoreductive surgery for ascending colon carcinoma with lymph node and liver metastases. Histological examination revealed an undifferentiated carcinoma of the ascending colon. The tumor cells were positive for G-CSF on immunohistochemical staining. The leukocyte counts and G-CSF level decreased after surgery. Thus, we diagnosed G-CSF-producing colon carcinoma. His general condition deteriorated rapidly and he died of residual tumor growth on postoperative day 24.