Prospective feasibility study to evaluate neoadjuvant-synchronous S-1 + RT for locally advanced rectal cancer: a multicenter phase II trial (UMIN ID: 03396).

In Western countries, the standard treatment for locally advanced rectal cancer is preoperative chemoradiotherapy followed by total mesorectal excision. However, in Japan, the treatment results without preoperative chemoradiotherapy are by no means inferior; therefore, extrapolation of the results of preoperative treatment in Western countries to Japan is controversial. We consider that survival may be improved by preoperative chemoradiotherapy with new anticancer agents as they are expected not only to decrease the local recurrence rate but also to prevent distant metastases. We are conducting a multicentre Phase II study to evaluate the safety and efficacy of neoadjuvant chemoradiotherapy using S-1 in patients with locally advanced rectal cancer. The primary endpoint is the rate of complete treatment of neoadjuvant chemoradiotherapy. Secondary endpoints are the response rate of neoadjuvant chemoradiotherapy, short-term clinical outcomes, rate of curative resection and pathological evaluation. The short-term clinical outcomes are adverse events of neoadjuvant chemoradiotherapy and surgery-related complications. Thirty-five patients are required for this study.

Impact of the VIO system in hepatic resection for patients with hepatocellular carcinoma.

PURPOSES: This study aimed to evaluate a novel surgical device combination [VIO system containing a bipolar clamp (BiClamp) and the monopolar soft-coagulation (SOFT COAG)] in hepatic resection for patients with hepatocellular carcinoma (HCC). METHODS: This study performed 124 hepatic resections for HCC and divided them into 2 groups: 60 patients (Conventional group) underwent liver parenchymal transection using Cavitron Ultrasonic Surgical Aspirator (CUSA) system and saline-coupled bipolar electrocautery for hemostasis; the BiClamp was used with the CUSA system for liver parenchymal transection and SOFT COAG was used with saline-coupled bipolar electrocautery for hemostasis in 64 patients (VIO group). RESULTS: The median blood loss in the VIO group was 345 mL, which was less than that in the Conventional group (median 548 mL, P = 0.0423). A multivariate logistic regression analysis showed that no use of the VIO system (P = 0.0172) was an independent predictor of intraoperative blood loss, respectively. In patients with liver cirrhosis, the VIO group included a significantly lower proportion of patients with liver cirrhosis that experienced more than 500 mL of intraoperative blood loss in comparison to those in the Conventional group (P = 0.0262). CONCLUSIONS: The VIO system was safe for hepatic resection and its use was associated with a significant decrease in intraoperative blood loss even in cirrhotic patients.

Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: a pilot study.

BACKGROUND: Many clinical studies have demonstrated that early postoperative enteral nutrition (EN) improved the postroperative course. Post-pancreaticoduodenectomy (PD), patients tend to suffer from postoperative nausea, abdominal distention, and diarrhoea, causing difficulty in the introduction of EN. In this pilot study, we investigated the appropriate nutritional mode post-pancreatic surgery. METHODS: Between October 2006 and March 2007 2 postoperative nutritional methods were implemented in 17 patients in a prospective single-centere study. Eight patients received only enteral nutrition (EN group) and 9 patients received enteral nutrition combined with parenteral nutrition (EN + PN group). RESULTS: There were no differences in the patient characteristics and postoperative morbidity between the 2 groups. The rate of discontinuance of enteral feeding was significantly high in the EN group, and the duration of enteral feeding was significantly longer in the EN + PN group. The central venous line was retained for a significantly longer period in the EN + PN group, but there was no difference in the frequency of catheter-related infection between the 2 groups. CONCLUSION: EN combined with PN is more adequate for patients after pancreatic surgery.

Primary breast lymphoma in the right breast during treatment for left breast cancer.

BACKGROUND: Primary breast lymphoma is a rare condition, and distinguishing it from breast cancer is important because their treatments differ radically. Moreover, a recent report showed that mastectomy offered no benefit in the treatment of primary breast lymphoma. CASE PRESENTATION: A 59-year-old woman was treated with adjuvant chemotherapy and local radiation after surgery for left breast cancer. She presented with a rapidly growing mass in the right breast at 20 months after surgery. Mammography and computed tomography revealed a massive tumour. She was diagnosed with primary breast lymphoma by aspiration cytology, and surgery was performed. Histopathological and immunohistochemical findings confirmed a diffuse large B-cell type primary breast lymphoma. CONCLUSION: In this case, the lymphoma exhibited rapid growth despite chemotherapy for a malignancy in the contralateral breast. The patient had developed bronchiolitis obliterans organizing pneumonia due to radiation. Therefore, surgical treatment of the lymphoma was selected.