Usefulness of Background Coloration in Detection of Esophago-Pharyngeal Lesions Using NBI Magnification

Background and Aim. We evaluated the usefulness of background coloration (BC), a color change in the area between intrapapillary capillary loops (IPCLs) in the early esophago-pharyngeal lesions using NBI with magnificaiton. Methods. Between April 2004 and March 2010, a total of 294 esophago-pharyngeal lesions were examined using NBI with magnification, and the presence of BC and IPCL patterns were assessed. Using BC, discrimination of squamous cell carcinoma (SCC) or high-grade neoplasia (HGN) from low-grade neoplasia (LGN) or nonatypia was conducted. Results. Among 294 lesions, 209 lesions (71.1) were positive for BC, while 85 (28.9) were negative. In the BC-positive group, 187 lesions (89.5) were diagnosed as SCC/HGN. And 68 lesions (80.0) in the BC-negative group were diagnosed as LGN/nonatypia. Overall accuracy of BC to discriminate SCC/HGN from LGN/nonatypia was 87.3. The sensitivity and specificity were 91.9, 76.7. BC could discriminate SCC/HGN from LGN/nonatypia accurately (P 0.0001). Among 68 lesions classified into the IPCL type IV, the BC-positive group (n = 26) included 21 SCC/HGN lesions, while there were 36 LGN/nonatypia lesions in the 42 BC-negative lesions. Conclusions. BC is a useful finding in differentiating SCC/HGN from LGN/nonatypia lesions in the esophagus especially when it is combined with IPCL pattern classification

Two-stage hepatectomy aiming for the development of intrahepatic venous collaterals for multiple colorectal liver metastases

Abstract Background Aggressive hepatectomy with venous resection has a higher risk of postoperative liver failure (POLF) than hepatectomy without venous reconstruction; however, venous reconstruction is technically demanding. We performed a novel two-stage hepatectomy (TSH) without venous reconstruction in a patient with bilobar multiple colorectal liver metastases located near the caval confluence, waiting for the development of intrahepatic venous collaterals between procedures. Case presentation A 60-year-old man was referred to our hospital with sigmoid colon cancer accompanied by intraabdominal abscess and two synchronous liver metastases. One of the liver tumors (tumor 1) was located in segment 8 near the caval confluence and was attached to both the right hepatic vein (RHV) and middle hepatic vein (MHV). The other tumor (tumor 2) in the left lobe invaded the umbilical portion of the portal vein. Both liver metastases decreased in size after four cycles of panitumumab/5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) therapy. Radical liver resection was planned because tumor 1 had not invaded the MHV. However, three-dimensional volumetric software showed that the non-congested volume of the future liver remnant was estimated at 354 ml, which corresponded to 26.3% of the total liver volume. TSH was scheduled to avoid POLF. We first performed limited resection of segment 8 with resection of the RHV root. After the first hepatectomy, the development of intrahepatic venous collaterals between the RHV and MHV was seen on computed tomography and magnetic resonance imaging. The estimated non-congested future liver remnant was 1242 ml, 78.5% of the total liver volume. Therefore, the patient underwent left hemihepatectomy 58 days after the first hepatectomy. We saw no adhesions around the porta hepatis, and the left hepatic artery and left branch of the portal vein were safely exposed and divided. Intraoperative Doppler ultrasonography revealed intrahepatic venous collaterals arising from RHV to MHV. The patient’s postoperative course was uneventful, and he underwent eight cycles of panitumumab/FOLFOX therapy for 5 months after the second hepatectomy. Conclusions Our TSH strategy helped avoid POLF by waiting for the development of intrahepatic venous collaterals

Clinicopathological characteristics and optimal management for esophagogastric junctional cancer; a single center retrospective cohort study

Abstract Background Esophagogastric junctional (EGJ) cancer occurs in the mucosa near the esophagogastric junction, and has characteristics of both esophageal and gastric malignancies; its optimal treatment strategy is controversial. Methods We conducted a single-center retrospective cohort study of the patients who underwent curative surgery with lymphadenectomy for EGJ cancer. Tumor specimens were categorized by histology and location into four types—centered in the esophagus  Results A total of 92 EGJ cancer patients were studied. Median follow-up of surviving patients was 35.5 months. Tumors were categorized as 12 type E (SQ), 6 type E (AD), 27 type Ge and 47 type G; of these 7 (58.3%), 3 (50%), 19 (70.4%) and 14 (29.8%) and 23 patients, respectively, had lymph node metastases. No patients with type E (AD) and Ge tumors had cervical lymph node metastasis; those with type G tumors had no nodal metastasis at cervical and mediastinal lymph nodes. Multivariate analysis showed that type E (AD) tumor was an independent prognostic factor. Conclusions We should distinguish type Ge tumor from type E (AD) tumor because of the clinicopathological and prognostic differentiation. Extended gastrectomy with or without lower esophagectomy according to tumor location and lower mediastinal and abdominal lymphadenectomy are recommended for EGJ cancer. Trial registration University Hospital Medical Information Network in Japan, UMIN000008596.</p

Surgical Outcomes and Clinicopathological Characteristics of Patients Who Underwent Potentially Noncurative Endoscopic Resection for Gastric Cancer: A Report of a Single-Center Experience

Background. Standard treatment of early gastric cancer (EGC) after endoscopic resection with risk factors of nodal metastases and incomplete resection is controversial. We investigated optimal management for the patients with potentially noncurative EGC after endoscopic resection. Methods. We retrospectively examined clinicopathological data and surgical outcomes of all patients with clinically solitary gastric adenocarcinoma who underwent curative surgery after a single peroral endoscopic resection at the Digestive Disease Center of Showa University Northern Yokohama Hospital between April 2001 and December 2012. Fisher's exact test was used for univariate analysis. For multivariate analysis, stepwise multiple linear regression was used to identify independent predictors related to lymph node metastasis and remnant of primary tumor. Results. A total of 41 patients were studied. Four patients (9.8%) had lymph node metastases. Primary tumors remained in 6 patients (14.6%). Only venous invasion was statistically significant to lymph node metastasis (P=0.017). With respect to remnant of the primary tumor, pT1b2 tumor invasion (P=0.015) and horizontal margin (P=0.013) were statistically significant. Conclusions. Surgery with limited lymphadenectomy is recommended for tumors with venous invasion or pT1b2 tumor invasion, and additional endoscopic resection may be allowed for tumors with horizontal involvement