Surgical Treatment of Gastroesophageal Junction Cancer

Although the incidence of gastroesophageal junction (GEJ) adenocarcinoma has been increasing worldwide, no standardized surgical strategy for its treatment has been established. This study aimed to provide an update on the surgical treatment of GEJ adenocarcinoma by reviewing previous reports and propose recommended surgical approaches. The Siewert classification is widely used for determining which surgical procedure is used, because previous studies have shown that the pattern of lymph node (LN) metastasis depends on tumor location. In terms of surgical approaches for GEJ adenocarcinoma, a consensus was reached based on two randomized controlled trials. Siewert types I and III are treated as esophageal cancer and gastric cancer, respectively. Although no consensus has been reached regarding the treatment of Siewert type II, several retrospective studies suggested that the optimal treatment strategy includes paraaortic LN dissection. Against this background, a Japanese nationwide prospective trial is being conducted to determine the proportion of LN metastasis in GEJ cancers and to identify the optimal extent of LN dissection in each type.

Analysis of a newly introduced comprehensive clinical competency examination at Osaka University / 医学教育

Background: Osaka University has introduced a new oral examination that evaluates comprehensive clinical competency. The purpose of this study was to clarify the characteristics of this examination.<br>Method: We compared the scores of this examination with those of other a&szlig;e&szlig;ments: basic medicine, clinical medicine, computer&ndash;based testing （CBT）, objective structured clinical examination （OSCE）, and clinical clerkships.<br>Results: The Pearson correlation coefficient between this examination and other examinations was relatively low: basic medicine, 0.32; clinical medicine, 0.36; CBT, 0.44; OSCE, 0.39; and clinical clerkships, 0.24. Principal component analysis revealed that this examination could be grouped with OSCE and clinical clerkships, whereas basic medicine, clinical medicine and CBT could be grouped.<br>Conclusions: This new oral examination evaluates aspects of the examinees distinct from aspects evaluated by other examinations and could be an indicator of ability to solve clinical problems.

Perspective beyond Cancer Genomics: Bioenergetics of Cancer Stem Cells

Although the notion that cancer is a disease caused by genetic and epigenetic alterations is now widely accepted, perhaps more emphasis has been given to the fact that cancer is a genetic disease. It should be noted that in the post-genome sequencing project period of the 21st century, the underlined phenomenon nevertheless could not be discarded towards the complete control of cancer disaster as the whole strategy, and in depth investigation of the factors associated with tumorigenesis is required for achieving it. Otto Warburg has won a Nobel Prize in 1931 for the discovery of tumor bioenergetics, which is now commonly used as the basis of positron emission tomography (PET), a highly sensitive noninvasive technique used in cancer diagnosis. Furthermore, the importance of the cancer stem cell (CSC) hypothesis in therapy-related resistance and metastasis has been recognized during the past 2 decades. Accumulating evidence suggests that tumor bioenergetics plays a critical role in CSC regulation; this finding has opened up a new era of cancer medicine, which goes beyond cancer genomics.