Tetsuhisa Yamamoto

Assessment of clinicopathologic features of colorectal mucinous adenocarcinoma

The purpose of this report is to analyze the clinicopathologic features of colorectal mucinous adenocarcinoma (MC), which is generally believed to have a poor prognosis, in an attempt to assess ways in which the surgical outcome can be improved. Clinicopathologic features of 44 patients with MC (6.6%), from among 662 patients with primary colorectal cancers, were compared with those of 545 patients with nonmucinous (non-MC) adenocarcinoma. MC is more likely to invade the adjacent viscera (29% versus 10%, p < 0.005) and show more extensive lymph node involvement beyond the pericolonic region (50% versus 26%, p < 0.005) than non-MC. Based on these findings, a more aggressive attitude toward surgical intervention is recommended, including extensive lymph node dissection and the resection of adjacent organs that seems to be affected macroscopically, to improve the surgical outcome of this clinical entity.

A clinical study of the effectiveness of oral glutamine supplementation during total parenteral nutrition : Influence on mesenteric mononuclear cells

Bacterial translocation (BT) is a well-known insult during total parenteral nutrition (TPN) and a high incidence of morbidity has been reported in septic patients receiving TPN. Inflammatory cytokines were shown to play an important role in the pathogenesis of critical complications following sepsis. Previous studies have indicated that supplementation of TPN with glutamine is effective in preventing BT in animals, but its effectiveness in humans is unclear. The aim of this study was to determine the effectiveness of oral glutamine supplementation to patients receiving TPN in suppressing cytokine production of mesenteric blood mononuclear cells (M-MNC). Fifteen colorectal cancer patients were divided into 3 groups according to preoperative nutrition management. (1) TPN group: TPN with conventional glutamine-free amino acid solution. (2) Gln group: TPN with oral glutamine supplementation of 30 g/d. (3) CONTROL GROUP: oral intake of normal food. M-MNC were obtained immediately after laparotomy and tumor necrosis factor-alpha (TNF-alpha) and interleukin-10 (IL-10) production of M-MNC was evaluated with or without lipopolysaccharide (LPS) stimulation. TNF-alpha and IL-10 production by LPS-stimulated M-MNC was increased in the TPN group and suppressed in the Gln group. In conclusion, oral glutamine supplementation to patients with TPN was shown to be effective for the prevention of M-MNC activation to avoid excessive production of cytokines.

New predictor for the defecatory function after sphincter-preserving operation: lumen score.

Few studies on sphincter-preserving surgery have analyzed the colon used for the anastomotic segment. We evaluated the usefulness of measuring the square of the diameter of the sigmoid colon (cm2) (lumen score, LS) as a predictor of defecatory function after very low anterior resection (VLAR) for rectal cancer. Measurements were done by radiography with semiliquid barium, and the LS was calculated. A total of 24 patients [straight coloanal reconstruction (VLAR-S), n = 17; colonic J pouch reconstruction (LVAR-J), n = 7] were studied more than 6 months after the operation. VLAR-S was divided by the LS results: the high-LS group had an LS of 12 or more (n = 5), and the low-LS group had an LS of less than 12 (n = 12). The neorectal capacity, anal manometry, and defecatory function were studied. In the VLAR-S group, LS had a significant positive correlation with neorectal capacity (? = 0.81, p <0.01) and a negative correlation with bowel frequency (? = ?0.67, p <0.05). Regarding neorectal capacity, the high-LS group had a significantly larger capacity than the low-LS group (118.0 vs. 88.3 ml; p <0.05). The low-LS group had unfavorable defecatory function compared with that of the high-LS group, which was equal to that of the VLAR-J group. We concluded that the LS is a useful predictor of successful colonic J pouch reconstruction.

Metabolic Response to Glucose Overload in Surgical Stress : Energy Disposal in Brown Adipose Tissue

The metabolic response to total parenteral nutrition (TPN) overload was investigated in clinical studies of surgically stressed humans and in experimental studies of surgically stressed animals. In both studies, all non-protein calories were administered as glucose, and subjects were divided into two groups, classified according to the amount of caloric supplementation after surgical stress, i.e., either overfed or appropriate (groups C1 and C2, respectively, in the clinical study, and groups E1 and E2, respectively, in the experimental study). In the clinical study, the postoperative energy expenditure in group C1 increased from the preoperative value, becoming significantly more elevated than that in group C2. The respiratory quotient (RQ) in group C1 exceeded 1.0, representing lipogenesis from carbohydrate, and the plasma norepinephrine concentration was also higher in group C1, indicating that lipolysis was likely to have been enhanced in this milieu. These findings imply that lipogenesis and lipolysis can occur simultaneously, constituting a futile cycle, and that this activated cycle could be a reason for the increased energy expenditure associated with overfeeding after surgical stress. To gather further evidence, we evaluated the rate of lipogenesis and lipolytic activity in white and brown adipose tissue (WAT; BAT) in an experimental study of surgically stressed rats. In BAT, both lipogenesis and lipolysis were activated in group E1. The results of both studies suggest that glucose overload in surgically stressed individuals increases energy expenditure by activating a futile cycle and that BAT is more involved in this cycle than WAT.

Regular Finger Dilation for Preventing Anastomotic Stenosis After Low Anterior Resection

AbstractPurpose. This study evaluated the usefulness of performing regular finger dilation (RFD) of the anastomosis to prevent stenosis after low anterior resection (LAR). Methods. Defecatory function was assessed in 22 patients who had undergone LAR more than 6 months earlier. The patients were divided into an RFD group, comprising 15 patients who had undergone regular RFD, and a non-RFD group, comprising 7 patients who had dropped out of our follow-up with RFD. The physiological and clinical findings in relation to defecatory function were compared. Results. The type and size of the stapler and anal manometric parameters were similar. The RFD group had significantly better defecatory function in terms of bowel movement and sensation of incomplete evacuation (P < 0.01, respectively) with a significantly wider anastomotic diameter and higher evacuation rate (P < 0.01, respectively). Conclusion. These findings demonstrate that RFD is useful for preventing anastomotic stenosis and achieving favorable defecatory function after LAR. Therefore, a prospective randomized study should be scheduled.

Diagnostic value of measuring liver volume for detecting occult hepatic metastases from colorectal or gastric cancer.

Some studies have shown reduced portal blood flow in patients with occult hepatic metastases, which may lead to decreased liver volume. A retrospective study was conducted in patients undergoing curative resection for colorectal (n = 63) or gastric (n = 52) cancer. The ratio of the preoperative computed tomography (CT)-estimated liver volume to the standard liver volume (CV/SV ratio) was calculated. The mean ± SD CT-estimated liver volume was 858 ±109 in 14 patients who subsequently developed hepatic metastases and 1173 ± 230 ml in 101 patients without metastases (p < 0.0001). The CV/SV ratio was smaller in patients with metachronous hepatic metastases than in those without (0.78 ± 0.08 vs. 1.02 + 0.13; p < 0.0001). The results suggest that the liver with occult metastases decreases in size before metastases develop that are detectable using conventional imaging techniques. The CV/SV ratio may be of value in detecting occult hepatic metastases from colorectal and gastric cancer.