Well-differentiated Endocrine Cell Carcinoma of Ileum Treated by Laparoscopy-assisted Surgery : A Case Report

A 72-year-old woman presented at our hospital with a 1-year history of intermittent right lower abdominal pain. Colonoscopic examination revealed a submucosal tumor with a pitted surface in the terminal ileum. Histopathological diagnosis of the carcinoid tumor was made following biopsy. Blood serotonin and urine 5-hydroxy-indoleacetic acid levels were normal, and carcinoid syndrome was not detected. Enhanced abdominal computed tomography scan and 18F-fluorodeoxyglucose positron emission tomography failed to detect multiple lesions, lymph node swelling or distant metastasis. Laparoscopy-assisted ileocecal resection with lymph node dissection was performed. The resected specimen showed a submucosal tumor with a pitted surface 11 x 11 mm in size, located at the terminal ileum. Histopathological examination revealed a well-differentiated endocrine cell carcinoma with an invasion depth to the muscularis propria. Immunohistochemical analysis showed the tumor cells to be chromogranin A and CD56-positive. The patient had no sign of recurrence for 16 months

Efficacy and safety of cabazitaxel therapy in elderly (≥75 years) patients with castration-resistant prostate cancer: A multiinstitutional study

Background: There is little data on the outcome of cabazitaxel (CBZ) treatment of elderly patients with castration-resistant prostate cancer (CRPC). This study assessed the efficacy and safety of CBZ chemotherapy in patients with CRPC aged 75 years or older in a multiinstitutional study. Methods: We retrospectively reviewed the 74 patients with CRPC treated with CBZ enrolled in 10 institutions. Clinicopathological backgrounds, prognosis including prostate-specific antigen decline, time to treatment failure, progression-free survival, overall survival, and safety profiles were compared between younger (<75 years) and elder (≥75 years) patients. Results: In total, 74 patients were enrolled; 50 patients were younger than 75 years and 24 were ≥75 years. Clinicopathological characteristics were comparable between younger and elder patients, with the exception of serum albumin values at the time of CBZ treatment. The median prostate-specific antigen decline in younger and elder men was −8.8% and −32.3% from baseline, respectively. The median time to treatment failure, progression-free survival, and overall survival for younger and elder men were 0.24 and 0.33 years, 0.23 and 0.43 years, and 0.69 and 1.17 years, respectively. In addition, safety profiles were comparable between younger and elder patients. Conclusions: This multiinstitutional study suggests that patients with CRPC aged 75 years or older eligible for CBZ treatment can be treated safely and with noninferior efficacy compared with those younger than 75 years

腎癌に対する鏡視下根治的腎摘除術 : standard法とhand-assist法の比較

A laparoscopic radical nephrectomy(LRN)for renal cancer can be performed using two methods,hand-assisted laparoscopic surgery(HALS)and standard laparoscopic surgery(SLS). This institute initially used HALS to perform all radical nephrectomy,but gradually shifted to SLS. This study compared the two methods of radical nephrectomy: HALS vs. SLS, which were performed at a single institute. From March 1999 to November 2006, a total 129 patients with pathologically confirmed renal cell carcinoma underwent LRN, including 73 patients with the HALS and 56 patients with SLS. The median operative time was 264 minutes,and median estimated blood loss was 200ml in the HALS group,respectively. The median operative time and median estimated blood loss in the SLS were 215 minutes and 100 ml,respectively. There was no significant difference in either the operative time or estimated blood loss between HALS and SLS. The median time to both postoperative oral intake and ambulation in the SLS were 1 day. Neither of these events after SLS was significantly shorter than that after HALS. The 4-year disease-free and overall survival rates in the HALS patients were 97.5% and 98.2%, respectively. Both the 4-year disease-free and overall survival rates in the SLS patients were 100%. Since no significant differences were observed between the two operative methods (SLS and HALS) regarding the operative data, postoperative course and oncological outcome,the surgical method for LRN can be selected according to characteristics of each surgical method【目的】腎癌に対する鏡視下根治的腎摘除術には，ハンドアシスト（hand-assisted laparoscopic surgery：HALS）法とスタンダード（standard laparoscopic surgery：SLS）法がある．鏡視下 根治的腎摘除術におけるHALS 法とSLS 法について比較した．【方法】99 年３月から06年11月 までに計129 例（HALS：73例，SLS：53例）の鏡視下根治的腎摘除術を行った．手術成績・術後 経過・合併症・非再発率・生存率について比較検討した．【結果】HALS とSLS の手術時間/出血量 は，それぞれ264・215分，および200・100mlであった．経口摂取・歩行開始までの期間および術 後入院期間について差はなかった．HALS における４年非再発率は97.5％，４年生存率は98.2％で あり，SLS の４年非再発率・生存率はともに100％であった．【結語】手術時間・出血量・術後経過 について，HALS とSLS で有意差はなく，それぞれの手術の特徴を考慮し術式を選択すべきと思わ れた

Tc-MAG3を用いた腎摘除術前後における健側腎機能の推移

Objective : We examined the change in the renal function in the normal side kidney before and after a nephrectomy, by means of a newly developed diuretic renography technique utilizing Tc 99m-mercaptoacetyltriglycine (MAG3). Materials and methods : Forty patients who underwent a nephrectomy were evaluated using MAG3 diuretic renography. We measured the effective renal plasma flow (ERPF) and Tmax time before and after a nephrectomy. The effects of the patient age and the preoperative ERPF of ill side kidney on the post operative ERPF were then assessed statistically. Results : The ERPF increased by an average of 44.8 ml/min at 2 weeks after a nephrectomy, but it decreased by an average of 24.3 ml/min at 3 months after a nephrectomy. The Tmax time decreased by an average of 0.58 min at 2 weeks, but thereafter increased by an average of 0.58 min at 3 months after a nephrectomy. The correlation coefficient between the rate of increase in the ERPF and the patient age was 0.197. Conclusions : The rise of renal function in terms of ERPF and the Tmax time was observed at 2 weeks post-nephrectomy. However, this effect disappeared at 3 months post-nephrectomy. These data demonstrated that the rise in the renal function of the normal-side kidney in such patients was only temporary.Tc-MAG3を用いて,腎摘除術前後における健側腎機能の推移を検討した.【対象と方法】対象は当科にて腎摘除を行い,手術前後にTc-MAG3を用いたrenographyを行った40名.renographyでは,effectiverenalplasmaflow(ERPF)とTmaxtimeを評価項目とした.また,健側腎ERPFの増加率については,健側腎機能に影響を与えると考えられる患者年齢・患側腎のERPFと相関がないか検討した.【結果】健側腎のERPFは,手術後2週目には44.8ml/min有意に増加し,Tmaxtimeも0.58分有意に短縮した.しかし,術後3ヶ月目には,術後2週目と比較しERPFは24.3ml/min有意に減少し,Tmaxtimeも有意ではないが0.58分延長した.また,健側腎における術後2週目のERPF増加率と対象の患者年齢・患側腎の機能と相関がないか検討したが,相関はなかった.【結論】腎摘除術前後における健側腎機能の機能亢進は一過性であった.また,患者年齢や患側腎のERPFは,健側腎の機能亢進を起こす患者側の因子ではなかった