Two Cases of Early Carcinoma of a Reconstructed Gastric Tube after Esophagectomy Treated Extendedly with Endoscopic Submucosal Dissection

We report two cases of gastric tube carcinoma (GTC) treated with endoscopic submucosal dissection (ESD) after esophagectomy. Case 1 was a 47-year-old woman who had received esophagectomy with reconstruction of the gastric tube (GT) for esophageal squamous cell carcinoma. Sixty-seven months later, endoscopy showed a carcinoma in the lower part of the GT. The removed tumor showed a 0-IIc lesion, 10 mm in diameter, diagnosed as a signet ring cell carcinoma limited to the mucosa. Case 2 was an 83-year-old woman who simultaneously underwent lower esophagectomy for basaloid-squamous cell carcinoma of the esophagus and colectomy for ascending colon carcinoma. Sixty-one months later, endoscopy showed a carcinoma in the middle part of the GT. The tumor removed by ESD showed a 0-IIa+IIc lesion, 50 mm in diameter, diagnosed as a moderately differentiated tubular adenocarcinoma limited to the mucosa. The clinicopathologic features of 48 Japanese cases, including Cases 1 and 2, with GTC were reviewed. An extended indication of endoscopic resection for gastric carcinoma was present in 12 (25%) including Cases 1 and 2. In conclusion, ESD may be safe for GTC; however, further investigations may be necessary to confirm the safety and curative potential of ESD for GTC.Article信州医学雑誌 59(2): 81-88(2011)departmental bulletin pape

Emergency Operation for Non-Hodgkin Lymphoma of the Small Intestine

We report 5 cases of non-Hodgkin lymphoma of the small intestine (S-NHL) treated with emergency operation. These cases showed three reasons for emergency operation :［1］massive hemorrhage with shock before diagnosis of S-NHL (Case 1),［2］obstruction of the small intestine before and during chemotherapeutic treatment for S-NHL (Cases 2 and 3),and［3］spontaneous perforation with peritonitis before diagnosis of SNHL or iatrogenic perforation following chemotherapy (Cases 4 and 5).For tumor discovery,double-balloon endoscopy of the small intestine was employed in 3 cases.Three tumors were histologically diagnosed before treatment,while 2 were histopathologically diagnosed using the resected specimens after emergency operation. An advanced stage of NHL was frequently observed.No surgical mortality accurred.We always consider the possibility of emergency operation before, during, and after the diagnosis and treatment of patients with SNHL. Shinshu Med J 60 : 21-25, 2012Article信州医学雑誌 60(1): 21-25(2012)departmental bulletin pape

Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer Patients with Comorbidities

Purpose. We investigated the clinicopathologic features of early gastric cancer (EGC) patients who have undergone additional gastrectomy after endoscopic submucosal dissection (ESD) because of their comorbidities. Methods. Eighteen (7.1%) of 252 GC patients were gastrectomized after prior ESD. Reasons for further surgery, preoperative and postoperative problems, and the clinical outcome were determined. Results. The 18 patients had submucosal EGC and several co-morbidities. Other primary cancers were observed in 8 (44.4%). Histories of major abdominal operations were observed in 6 (33.3%). Fourteen patients (77.8%) hoped for endoscopic treatment. Due to additional gastrectomy, residual cancer was suspected in 10, and node metastasis was suspected in 11. A cancer remnant was histologically observed in one. Node metastasis was detected in 3 (16.7%). Small EGC was newly detected in 4. Consequently, additional gastrectomy was necessary for the one third. No patient showed GC recurrence. However, 9 (50%) had new diseases, and 4 (22.2%) died of other diseases. The overall survival after surgery in these patients with additional gastrectomy was poorer than those with routine gastrectomy for submucosal EGC (P = 0.0087). Conclusions. Additional gastrectomy was safely performed in EGC patients with co-morbidities. However, some issues, including presence of node metastasis and other death after surgery, remain

Relationships of obesity and diabetes mellitus to other primary cancers in surgically treated gastric cancer patients

AbstractBackgroundOther primary cancers (OPC) have been reported in gastric cancer (GC) patients. Recent studies have shown relationships of obesity and diabetes mellitus to cancer development in several organs. The purpose of this study was to investigate the relationships of obesity and diabetes mellitus (DM) to the prevalence of OPC in GC patients.MethodsWe reviewed 435 GC patients who were treated surgically and followed their outcomes after surgery. Patients with body mass index (BMI) ≥ 25 kg/m2 were defined as obese. Fasting plasma glucose (FPG) and HbA1c levels were examined before surgery.ResultsOPC was observed in 109 GC patients (25.1%): 40 (9.2%) with synchronous OPC and 76 (18.2%) with metachronous OPC. The most common OPC was colorectal cancer (22.8%). OPC was frequently observed in patients with DM (p = 0.0022), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.215; 95% confidence interval, 1.2007–4.0850; p = 0.011). Synchronous OPC was frequently observed in patients with obesity (p = 0.025), and obesity was an independent risk factor for the occurrence of synchronous OPC (odds ratio, 2.354; 95% confidence interval, 1.1246–4.9279; p = 0.023). Metachronous OPC was frequently observed in patients with DM (p = 0.0071), and DM was an independent risk factor for the occurrence of OPC (odds ratio, 2.680; 95% confidence interval, 1.0291–6.9780; p = 0.044).ConclusionThere is a need to be aware of the possibility of OPC in GC patients with DM/obesity. They should undergo intensive screening for OPC before and after gastrectomy

Gastric Composite Tumor of Alpha Fetoprotein-Producing Carcinoma/Hepatoid Adenocarcinoma and Endocrine Carcinoma with Reference to Cellular Phenotypes

Alpha-fetoprotein-producing carcinoma (AFPC)/hepatoid adenocarcinoma (HAC) and neuroendocrine carcinoma (NEC) are uncommon in the stomach. Composite tumors consisting of these carcinomas and their histologic phenotypes are not well known. Between 2002 and 2007, to estimate the prevalence of composite tumors consisting of tubular adenocarcinoma, AFPC/HAC and NEC, we reviewed specimens obtained from 294 consecutive patients treated surgically for gastric cancer. We examined histological phenotype of tumors of AFPC or NEC containing the composite tumor by evaluating immunohistochemical expressions of MUC2, MUC5AC, MUC6, CDX2, and SOX2. Immunohistochemically, AFPC/HAC dominantly showed the intestinal or mixed phenotype, and NEC frequently showed the gastric phenotype. In the composite tumor, the tubular and hepatoid components showed the gastric phenotype, and the neuroendocrine component showed the mixed type. The unique composite tumor predominantly showed the gastric phenotype, and the hepatoid and neuroendocrine components were considered to be differentiated from the tubular component

Prevalence of synchronous colorectal neoplasms in surgically treated gastric cancer patients and significance of screening colonoscopy

Background and AimThe existence of other primary tumors during the treatment and management of gastric cancer (GC) is an important issue. The present study investigated the prevalence and management of synchronous colorectal neoplasms (CRN) in surgically treated GC patients. MethodsOf 381 surgically treated GC patients, 332 (87.1%) underwent colonoscopy to detect CRN before surgery or within a year after surgery. ResultsCRN were synchronously observed in 140 patients (42.2%). Adenoma was observed in 131 patients (39.4%). Endoscopic resection was done in 18 patients with adenoma. Colorectal cancer (CRC) was observed in 16 patients (4.8%), superficial CRC in 13 and advanced CRC in three patients. Endoscopicresection of superficial CRC was carried out in seven patients, whereas simultaneous surgical resection of CRC was done in nine patients. CRN were more frequently observed in men. CRC was more frequently observed in GC patients with distant metastasis, albeit without significance. The overall survival of GC patients with CRN or CRC was poorer than that of patients without CRN or CRC. ConclusionSynchronous CRN were commonly associated with GC and screening colonoscopy should be offered to patients with GC.ArticleDIGESTIVE ENDOSCOPY. 26(3):396-402 (2014)journal articl

A Case of Pill-Induced Esophagitis With Mucosal Dissection

With the advance of gastrointestinal endoscopy, pill-induced esophagitis has been detected more frequently, but the association of mucosal dissection is rare. We reported a case of pill-induced esophagitis associated with mucosal dissection

Clinical Study Additional Gastrectomy after Endoscopic Submucosal Dissection for Early Gastric Cancer Patients with Comorbidities

. Purpose. We investigated the clinicopathologic features of early gastric cancer (EGC) patients who have undergone additional gastrectomy after endoscopic submucosal dissection (ESD) because of their comorbidities. Methods. Eighteen (7.1%) of 252 GC patients were gastrectomized after prior ESD. Reasons for further surgery, preoperative and postoperative problems, and the clinical outcome were determined. Results. The 18 patients had submucosal EGC and several co-morbidities. Other primary cancers were observed in 8 (44.4%). Histories of major abdominal operations were observed in 6 (33.3%). Fourteen patients (77.8%) hoped for endoscopic treatment. Due to additional gastrectomy, residual cancer was suspected in 10, and node metastasis was suspected in 11. A cancer remnant was histologically observed in one. Node metastasis was detected in 3 (16.7%). Small EGC was newly detected in 4. Consequently, additional gastrectomy was necessary for the one third. No patient showed GC recurrence. However, 9 (50%) had new diseases, and 4 (22.2%) died of other diseases. The overall survival after surgery in these patients with additional gastrectomy was poorer than those with routine gastrectomy for submucosal EGC (P = 0.0087). Conclusions. Additional gastrectomy was safely performed in EGC patients with co-morbidities. However, some issues, including presence of node metastasis and other death after surgery, remain

Effect of Application of Subcutaneous Suction Drainage with Subcuticular Sutures for Wound Closure on the Incidence of Incisional Surgical Site Infection following Elective General Abdominal Surgery : A Randomized Controlled Trial

Article信州医学雑誌 63(2):91-101 (2015)journal articl

Prevalence of synchronous colorectal neoplasms in surgically treated gastric cancer patients and significance of screening colonoscopy

Background and AimThe existence of other primary tumors during the treatment and management of gastric cancer (GC) is an important issue. The present study investigated the prevalence and management of synchronous colorectal neoplasms (CRN) in surgically treated GC patients. MethodsOf 381 surgically treated GC patients, 332 (87.1%) underwent colonoscopy to detect CRN before surgery or within a year after surgery. ResultsCRN were synchronously observed in 140 patients (42.2%). Adenoma was observed in 131 patients (39.4%). Endoscopic resection was done in 18 patients with adenoma. Colorectal cancer (CRC) was observed in 16 patients (4.8%), superficial CRC in 13 and advanced CRC in three patients. Endoscopicresection of superficial CRC was carried out in seven patients, whereas simultaneous surgical resection of CRC was done in nine patients. CRN were more frequently observed in men. CRC was more frequently observed in GC patients with distant metastasis, albeit without significance. The overall survival of GC patients with CRN or CRC was poorer than that of patients without CRN or CRC. ConclusionSynchronous CRN were commonly associated with GC and screening colonoscopy should be offered to patients with GC.ArticleDIGESTIVE ENDOSCOPY. 26(3):396-402 (2014)journal articl