Yokoyama N

Long-term outcome after laparoscopic wedge resection for early gastric cancer

BackgroundLaparoscopic wedge resection (LWR) can be applied for the management of early gastric cancer without the risk of lymph node metastasis. Although LWR for early gastric cancer is one of the minimally invasive procedures, its radicality in cancer therapy is controversial. This study aimed to evaluate the long-term outcomes after LWR.MethodsData on 43 consecutive cases of LWR performed for preoperatively diagnosed mucosal gastric cancer were analyzed retrospectively in terms of long-term outcomes.ResultsNo postoperative deaths occurred after LWR. Histologically, resected specimens showed submucosal invasion in 11 cases (26%) and positive surgical margins for cancer in 4 cases (9%). Three patients (7%) showed local recurrence near the staple line, and one patient (2%) died due to the local recurrence, but no lesional lymph node or distant recurrence occurred. The overall 5-year survival rate was 88%. The gastric remnant after LWR developed metachronous multiple gastric cancer in five cases (12%).ConclusionsThe findings show a relatively high incidence of positive surgical margin, local recurrence, and gastric remnant cancer after LWR. Although LWR can be performed for properly selected patients, periodic postoperative endoscopic examination is necessary to detect metachronous multiple gastric cancer and local recurrences.

A rare case of recurrent alpha-fetoprotein-producing gastric cancer without re-elevation of serum AFP.

We report an extremely rare case of recurrent alpha-fetoprotein (AFP)-producing gastric cancer without re-elevation of serum AFP. The patient was a 78-year-old woman with AFP-producing gastric cancer, a rare type of gastric adenocarcinoma. A Borrmann III gastric tumour was surgically resected and AFP-producing gastric cancer was diagnosed based on high levels of serum AFP (705.44 ng/ml) and immunohistochemical examination of the tumour. The serum AFP level decreased to the normal range after resection without any sign of recurrence by imaging, but the patient developed local recurrence of the cancer and died 13 months after surgery. No re-elevation of serum AFP levels was observed after recurrence. Although serum AFP levels are believed to be useful for follow-up in the post-operative period, the possibility that serum AFP levels do not always correlate with the extent of the cancer should be kept in mind.

Peduncular Liposarcoma of the Colon: a Case Report and Literature Review

Liposarcoma is one of the most common types of soft tissue tumor in adults. Most liposarcomas occur in the extremities or retroperitoneum, whereas primary liposarcoma of the alimentary tract is rare. Especially, colonic liposarcoma remains limitedly reported in eleven cases [1–11] (summarized in Table 1). Because of its low incidence rate, the pathobiological properties of primary colonic liposarcoma remain largely unknown. In this sentence, accumulation of cases is desired. Here, we describe a case of colonic liposarcoma, which exhibited a unique peduncular growth pattern in the colonic lumen. The tumor was largely composed of dedifferentiated liposarcoma cells, with an intense and diffuse cyclindependent kinase 4 (CDK4) immunoreactivity. Notably, a well-differentiated liposarcoma component was also observed in the submucosal region of the tumor. To our knowledge, this is the first case of dedifferentiated peduncular colonic liposarcoma.