[A Case of QOL Improvement after Intestinal Stenosis Due to Peritoneal Dissemination of Gastric Cancer in Elderly Patients].

Nearly 70% of gastric cancer recurrences occur as peritoneal dissemination. Most of the treatment for recurrence of gastric cancer dissemination is chemotherapy; depending on the symptoms and the site of recurrence, palliative bypass surgery may be performed. Intensive treatment is often difficult for elderly patients over 85-years-old. This case was a 91-year-old female who underwent total gastrectomy for gastric cancer(signet-ring cell carcinoma)7years prior. Two years ago, a stenosis due to recurrence was revealed in the small intestine and bypass surgery was performed. At that time, she was 89-years-old, and chemotherapy was continued for 1 year. Six months ago, recurrence was revealed in the esophago-jejuno anastomosis. Since the stenosis was severe, it was possible to resume oral reconstitution by inserting a metallic stent. Chemotherapy(S-1)is currently ongoing. There are few reports of long-term treatment for recurrence of gastric cancer peritoneal dissemination in elderly people over 80 years of age. This report is a case of long-term survival involving multidisciplinary treatments, which improved the quality of life(QOL)over the age of 90 years.

Usefulness of Reduced Port Surgery for Left Colon Cancer.

AIM: Although laparoscopic surgery has made minimally invasive treatment available for colon cancer, various innovations aimed at developing even more minimally invasive treatment modalities have been reported in recent years. Needlescopic surgery, in which forceps with a small-diameter shaft are used to safely reduce invasiveness without increasing surgeons' stress, has been reported. We introduced the reduced-port surgery (RPS) technique by using needle forceps for the treatment of sigmoidal colon cancer and cancer of the rectosigmoidal region, with the aim of safely reducing invasiveness while maintaining curability. PATIENTS AND METHODS: The subjects of this study were patients with sigmoidal colon and rectosigmoidal cancer who underwent laparoscopic resection between January 2012 and December 2014. The patients were divided into a conventional multiport surgery (MPS) group and an RPS group for comparison and analysis. RESULTS: No significant difference was observed in the operative time, volume of blood loss, incidence of postoperative complications, especially anastomotic leak, intestinal obstruction, and surgical site infection. The length of postoperative hospital stay was significantly shorter in the RPS group. CONCLUSION: Without compromising safety and curability, RPS can reduce not only the number, but also the size of incisions, and make even more minimally invasive surgery feasible. Because this procedure is relatively easy to introduce to young surgeons, we consider it to be useful.

A Study on the Tolerability of Capecitabine plus Oxaliplatin as Adjuvant Chemotherapy.

AIM: Tolerability, adverse events, and long-term outcomes were compared and analyzed between patients receiving oral anticancer agent-based adjuvant chemotherapy regimen (PO group) and those receiving combination adjuvant chemotherapy with oxaliplatin (OX group), after curative resection of colorectal cancer at our Department. PATIENTS AND METHODS: The subjects included in the study were 169 patients with stage III colorectal cancer who underwent curative resection and received postoperative adjuvant chemotherapy between June 2007 and October 2014. Fifty-three patients were included in the OX group, while 116 patients were included in PO group. RESULTS: No significant difference was observed in treatment completion rates. No significant difference in either the overall or relapse-free survival rates was observed between the two groups. CONCLUSION: Oxaliplatin has been shown to improve therapeutic outcomes after curative resection of colorectal cancer. Even compared to oral anticancer agents, oxaliplatin appears to be equal in tolerability and treatment completion rate.

Adipose-derived stem cells enhance tissue regeneration of gastrotomy closure.

BACKGROUND: The aim of this study was to examine whether transplantation of adipose-derived stem cells (ADSCs) improves healing of a gastrotomy closure in rats. In digestive surgery, anastomotic leakage is a serious postoperative complication and anastomotic stenosis may reduce quality of life. Recent studies have suggested that ADSCs play material roles in intestinal healing, acceleration of angiogenesis, and reduction of fibrosis, and treatment with ADSCs may improve healing. MATERIALS AND METHODS: ADSCs were isolated from intra-abdominal white adipose tissue of 40 male Wistar rats (weight 300 g) in four groups (n = 10 each). Gastrotomy closures were prepared surgically in all rats. Controls were treated with phosphate-buffered saline injection and sacrificed 7 d (group 1) or 28 d (group 3) after the surgery. Other animals were treated with locally autotransplanted ADSCs (labeled by CM-DiI) and sacrificed 7 d (group 2) or 28 d (group 4) after the surgery. Histopathologic features were evaluated in the four groups. RESULTS: Injection of ADSCs significantly enhanced angiogenesis and collagen deposition after 7 d, indicating improved healing of the gastrotomy closure. In contrast, ADSC transplantation significantly reduced collagen deposition after 28 d. The bursting pressure was higher in the transplant groups after 7 d. CONCLUSIONS: ADSCs enhance tissue regeneration in gastrotomy closures by accelerating angiogenesis and fibrosis in the early healing period. In the late period, ADSCs prevent excessive fibrosis and assist in regeneration of tissues that closely resemble the native structure. These results suggest that therapy with transplanted ADSCs might improve postoperative complications in digestive surgery.