Two-stage treatment (Mukai's method) with hybrid 2-port HALS (Mukai's operation) for complete bowel obstruction by left colon cancer or rectal cancer.

During the initial emergency operation, a temporary loop colostomy (TLC) was constructed at the oral border of the region for subsequent radical resection. Then, radical surgery was performed by hybrid 2-port HALS (Mukai's operation) using the TLC as the hand access site. Left hemicolectomy was done in three patients, sigmoidectomy in two cases, low anterior resection in one case, and Hartmann's operation in one case. Radical surgery was not done in one patient with multiple distant metastases. The mean operating time was 3 h and 7 min (ranging from 1 h and 55 min to 3 h and 47 min), the mean blood loss was 146.4 ml (7-354 ml), the mean duration from TLC to HALS was 11.3 days (8-16 days), and the mean hospital stay after HALS was 13.9 days (9-20 days). Mild wound infection occurred postoperatively in 2/7 patients and ileus occurred in one patient. However, there was no anastomotic leakage/stricture or conversion to conventional laparotomy. These results suggest that 2-stage treatment (Mukai's method with Mukai's operation) is also applicable to large obstructing left colon or rectal cancers. This method is safe, less invasive, and achieves excellent results, including a good cosmetic outcome.

Efficacy of hybrid 2-port hand-assisted laparoscopic surgery (Mukai's operation) for patients with primary colorectal cancer.

In this study, a total of 108 patients with primary colorectal cancer who underwent hybrid 2-port hand-assisted laparoscopic surgery (HALS) were classified as 58 patients with colon cancer and 50 patients with rectal cancer. The mean operating time, mean blood loss, postoperative complications, and mean postoperative hospital stay were compared between the two groups. In patients who underwent colon cancer surgery, the mean operating time was 2 h and 26 min, the mean blood loss was 166.3 ml, and the postoperative complications were wound infection in 5/58 patients (8.6%), postoperative ileus in 3 patients (5.2%), and anastomotic stricture in 1 patient (1.7%). There was no anastomotic leakage and no conversion to conventional open laparotomy. The mean postoperative hospital stay was 12.6 days. In patients who underwent rectal cancer surgery, the mean operating time was 3 h and 38 min, the mean blood loss was 238.8 ml, and the postoperative complications consisted of wound infection in 6/50 patients (12.0%), anastomotic leakage in 3/35 patients (8.6%), anastomotic stricture in 3/47 patients (6.4%), postoperative ileus in 3/50 patients (6.0%), and conversion to conventional open laparotomy in 1/50 patients (2.0%). A covering stoma was constructed during surgery in 12/47 patients (25.5%). The mean postoperative hospital stay was 19.1 days. These results suggest that hybrid 2-port HALS (Mukai's operation) could become a standard method for the treatment of colorectal cancer, and that the long-term outcome should be compared in detail with that of standard laparotomy in the future.

Efficacy of 5-FU/LV plus CPT-11 as first-line adjuvant chemotherapy for stage IIIa colorectal cancer.

The aim of this study was to retrospectively evaluate the effect of adding CPT-11 to postoperative chemotherapy for stage III colorectal cancer. The subjects were 94 patients, including 60 in stage IIIa (or=4 positive nodes), who underwent curative resection. The clinical outcome was compared between patients receiving 5-FU/LV plus CPT-11 (FLC group) and patients receiving 5-FU/LV alone (FL group). The FLC group (54 patients) had a 3-year relapse-free survival (3Y-RFS) of 68.7%, a 5Y-RFS of 68.7% and a 5Y-OS of 67.1%, while the FL group (40 patients) had a 3Y-RFS of 67.5% (n.s.), a 5Y-RFS of 64.9% (n.s.), and a 5Y-OS of 77.3% (n.s.). There were no significant differences of these parameters between the two groups. For stage IIIa patients, the corresponding survival rates were 92.4, 92.4 and 90.9% in the FLC group (29 patients) vs. 64.5% (p=0.024), 61.1% (p=0.018), and 77.1% (n.s.) in the FL group (31 patients). For stage IIIb patients, the rates were 36.6, 36.6 and 24.8% in the FLC group (25 patients) vs. 77.8% (n.s.), 77.8% (n.s.), and 77.8% (n.s.) in the FL group (9 patients). These results suggest that the 3Y-RFS and 5Y-RFS of patients with stage IIIa colorectal cancer were significantly improved by adjuvant chemotherapy with 5-FU/LV plus CPT-11.

Successful treatment of severe reflux esophagitis with erythromycin in a patient with progressive systemic sclerosis and proximal gastrectomy.

A case of severe reflux esophagitis related to progressive systemic sclerosis (PSS) and proximal gastrectomy was successfully treated with oral erythromycin (EM). A 53-year-old woman was troubled with severe heartburn related to PSS for a long period and had undergone proximal gastrectomy for a gastric cancer a few months before. She was not readily made free from heartburn by any anti-ulcer drugs and she could barely eat. Therefore she underwent continuous intravenous hyperalimentation (IVH). She was referred to our hospital for IVH. Nine months after the proximal gastrectomy, we gave oral erythromycin to her in expectation of improvement of the heartburn. Gradually she recovered from the heartburn and became able to eat small amounts. EM is an agonist of motilin which is a gastrointestinal hormone. EM acts on the stomach and intestine not through the autonomic nervous system but through the circulation system of the blood. This is the reason why EM is effective in the residual stomach and intestine. In the case of severe esophagitis which is related to PSS and/or proximal gastrectomy and which resists anti-ulcer drugs, oral EM should be considered as a second therapy.

Predicting the recurrence/metastasis of stage I and II breast cancer without lymph node metastasis.

Prediction of the recurrence of primary breast cancer was attempted by detection of occult neoplastic cells (ONCs) in lymph nodes or by using the high-risk criteria for recurrence/metastasis of gastric and colorectal cancer. The subjects were 70 patients with stage I or II node-negative primary breast cancer. Prediction of recurrence using ONCs had a sensitivity of 60.0% (3/5) and a false-negative rate of 40.0% (2/5) in the recurrence group, while the specificity was 96.9% (63/65) and the false-positive rate was 3.1% (2/65) in the non-recurrence group. The accuracy of ONCs was 78.5%. Prediction of recurrence based on positivity for at least 2 of the high-risk criteria showed a sensitivity of 60.0% (3/5) and a false-negative rate of 40.0% (2/5) in the recurrence group, while the specificity was 95.4% (62/65) and the false-positive rate was 4.6% (3/65) in the non-recurrence group. The accuracy of the high-risk criteria was 77.7%. These results suggest that ONCs show the same accuracy as the high-risk criteria for predicting recurrence/metastasis of stage I and II node-negative breast cancer with a high specificity.

Predicting the recurrence/metastasis of stage II and III breast cancer with lymph node metastasis.

This study compared prediction of the recurrence of breast cancer by detection of occult neoplastic cells (ONCs) in lymph nodes or by using the criteria for a high risk of recurrence and metastasis of gastric/large bowel cancer. The subjects were 45 patients with stage II and III node-positive breast cancer. Prediction of recurrence by detection of ONCs showed a sensitivity of 78.6% (11/14), a false-negative rate of 21.4% (3/14), a specificity of 96.4% (30/31), a false-positive rate of 3.2% (1/31), and an accuracy of 87.7% in patients with stage II and III node-positive cancer. Prediction of recurrence based on positivity for at least 2 of the high-risk criteria showed a sensitivity of 92.9% (13/14), a false-negative rate of 7.1% (1/14), a specificity of 87.1% (27/31), a false-positive rate of 12.9% (4/31), and an accuracy of 90.0% in patients with stage II and III node-positive cancer. These results suggest that ONCs plus the high-risk criteria are useful for predicting recurrence/metastasis of stage II and III node-positive breast cancer during the early postoperative period with a high sensitivity and accuracy.

Accuracy of criteria for predicting recurrence and metastasis in stage II and III gastric cancer patients with lymph node metastasis.

This study assessed the prediction of gastric cancer recurrence based on detection of occult neoplastic cells (ONCs) in lymph nodes, and by using criteria that were developed to identify patients with a high risk of recurrence/metastasis. The subjects were 60 patients of stage II or III gastric cancer with lymph node metastasis. Prediction of recurrence based on the detection of ONCs showed a sensitivity of 33.3% (2/6), specificity of 70.0% (7/10), and accuracy of 51.7% in stage II patients, while the sensitivity was 73.5% (25/34), specificity was 100.0% (10/10), and accuracy was 86.8% in stage III patients. Prediction of recurrence based on the presence of at least 2 high-risk criteria had a sensitivity of 33.3% (2/6), specificity of 100.0% (10/10), and accuracy of 66.7% in stage II patients, while the sensitivity was 82.4% (28/34), specificity was 80.0% (8/10), and accuracy was 81.2% in stage III patients. These results suggest that prediction of recurrence/metastasis soon after surgery using ONCs plus the high-risk criteria can increase the specificity in stage II cancer, and can achieve a sensitivity of 80% or more with a high specificity and accuracy in stage III cancer.

Criteria for predicting the recurrence and metastasis of stage I and II gastric cancer without lymph node metastasis.

This study examined whether detection of occult neoplastic cells (ONCs) in lymph nodes or the high-risk criteria for recurrence/metastasis of colorectal cancer were useful for predicting the recurrence of primary gastric cancer. The subjects were 122 patients with node-negative stage I or stage II primary gastric cancer. Prediction of recurrence using ONCs showed a sensitivity of 25.0% (2/8), specificity of 97.1% (100/103), and accuracy of 61.1% in stage I patients, while the respective values were 75.0% (3/4), 100.0% (7/7), and 87.5% in stage II patients. Prediction of recurrence in patients who fulfilled 2 or more of the high-risk criteria showed a sensitivity of 37.5% (3/8), specificity of 94.2% (97/103), and accuracy of 65.9% for stage I patients, while the respective values were 100.0% (4/4), 85.7% (6/7), and 92.9% for stage II patients. These results suggest that the prediction of recurrence based on the high-risk criteria shows a high sensitivity, specificity, and accuracy in patients of stage II gastric cancer without lymph node metastasis.

[A case of advanced gastric cancer with multiple liver metastases responding to TS-1 and CDDP].

A 44-year-old male presented to our hospital with abdominal pain. The upper endoscopy revealed advanced gastric cancer. On the abdominal CT, there was evidence of multiple, massive liver metastases. After total gastrectomy, the patient was treated with daily oral administration of 120 mg TS-1 for 4 weeks followed by 2 weeks' rest and 6 weekly infusions of 10 mg CDDP in an intra-hepatic artery as 1 cycle. On the follow-up CT, the liver metastases had decreased significantly both in size and number after 2 cycles. The current case suggests that TS-1 and CDDP may have a potent therapeutic efficacy in cases of advanced gastric cancer with multiple liver metastases.