Prognostic Impact of the Neutrophil-to-Lymphocyte Ratio in Stage I-II Rectal Cancer Patients.

BACKGROUND: Systemic inflammation and immune response play crucial roles in tumor growth; neutrophil-to-lymphocyte ratio (NLR) is a known systemic inflammatory scoring system. Previous studies have reported that NLR is a prognostic biomarker in various human cancers. The aim of this study was to determine whether the NLR predicts tumor recurrence in patients with stage I-II rectal cancer after curative resection. METHODS: We retrospectively analyzed 130 consecutive patients with stage I-II rectal cancer who underwent curative resection between January 2006 and March 2015 at our institution without any preoperative treatment. We investigated whether clinicopathologic factors including NLR were associated with cancer recurrence after curative surgery. RESULTS: There were four cases (3.1%) of cancer-specific deaths and 16 cases (12.3%) of recurrence; the 5-year disease-free survival rate was 85.6%. NLR, pathologic T-category, and lymphatic invasion were significantly associated with disease-free survival. Multivariate analysis further showed that these three factors were independently associated with disease-free survival. CONCLUSIONS: Preoperative NLR could predict tumor relapse in stage I-II rectal cancer and might be a useful biomarker for predicting recurrence in patients undergoing curative resection.

Surgical experience of using the endoscope manipulator robot EMARO in totally extraperitoneal inguinal hernia repair: A case report.

Robot-assisted surgery has advanced rapidly since the 1980s. However, new equipment is still needed to overcome problems in conventional endoscopic surgery, including unique risks, such as camera shake and communication difficulties between the operator and the scopist. EMARO, an endoscope manipulator robot, is the world's first pneumatically driven endoscope-holder robot that can operate flexibly and smoothly with the use of air pressure. We herein report the surgical experience of using EMARO in totally extraperitoneal inguinal hernia repair. A 77-year-old Japanese man presented with bulging in the right groin area. After we diagnosed a right inguinal hernia, endoscopic inguinal hernia repair was performed. We selected the totally extraperitoneal approach with EMARO. The endoscopic procedure time was 100 minutes, and no intraoperative complications occurred. EMARO brings together features of smooth motion and good manipulation performance. This operation was performed safely and was comparable to a conventional operation completed with human assistants. Solo surgery with EMARO was beneficial in this inguinal hernia patient.

Laparoscopic intraperitoneal mesh repair of Spigelian hernia: A case report.

Spigelian hernia is a rare congenital defect of the anterior abdominal wall located along the semilunar line through the aponeurosis fascia of the transversus abdominis muscle. It represents 1%-2% of all abdominal wall hernias. Few cases of laparoscopic treatment for Spigelian hernia have been reported, especially in Japan. However, several reports of laparoscopic surgery to repair Spigelian hernias have been published, and some have shown that the laparoscopic approach repair is feasible because it is associated with less morbidity and a shorter hospital stay than open surgery. We herein describe a 63-year-old Japanese woman who presented with painful bulging in the right lower abdominal quadrant. A preoperative diagnosis of Spigelian hernia was made, and we performed laparoscopic intraperitoneal repair. The patient was discharged 6 days after laparoscopic surgery with no perioperative complications. This report describes the first successful laparoscopic intraperitoneal mesh repair of Spigelian hernia in Japan.

Pedunculated hamartomatous polyp of the appendix: report of a case.

We experienced a rare case of a pedunculated polyp of the appendix, which had been incidentally found by preventive appendectomy performed when providing surgical treatment for rectal carcinoma. A pathological investigation of this polypoid lesion demonstrated branches of fibro-muscular stalks connecting with the lamina muscularis covered by a hyperplastic mucosa, which proved to be consistent with the features of hamartoma. The patient had no external characteristics of Peutz-Jeghers syndrome, including mucocutaneous pigmentation and gastrointestinal polyposis, observed by endoscopy. This case is considered to be a Peutz-Jeghers type polyp of the appendix with a pedunculated form, which is very rare.

Analysis of the impact of the body mass index in patients with gastric carcinoma.

BACKGROUND: Body mass index (BMI) has been suggested to provide clinicopathological information in tumor development and progression in patients with gastric carcinoma. METHODS: The correlation of BMI with clinicopathological features and operation-related factors was analyzed in 308 patients with gastric carcinoma who had undergone distal or total gastrectomy. RESULTS: There was no significant correlation of obesity, indicated by a high value of BMI, with tumor-related factors including survival, or with operation-related factors. On the other hand, more advanced tumors and worse preoperative nutritional and immunological conditions were found in patients with a lower value of BMI. CONCLUSIONS: BMI might be a representation of the physical condition brought about by the extent of tumor progression rather than a factor influencing the factors related to gastric carcinoma.

Squamous cell carcinoma of the breast.

Squamous cell carcinoma (SCC) of the breast is comparatively rare. Because of the small number of investigations based on sufficient population size, its clinicopathological features have not been fully elucidated. We report herein a patient with SCC of the breast who underwent surgical resection and whose therapeutic options are now considered.

Serum appearance of anti-p53 antibody in triple negative breast cancer.

BACKGROUND: Significance of serum appearance of anti-p53 antibody in breast cancer has not been discussed fully. METHODS: The relationship between serum appearance of anti-p53 antibody and the clinicopathological features was investigated on the basis of the data of 42 women with breast cancer who had been treated with surgical resection. RESULTS: The proportion of tumors with histological grade 3 was significantly higher among tumors with serum appearance of anti-p53 antibody (P = 0.020). The proportion of triple negative tumors was also significantly higher among tumors with serum appearance of anti-p53 antibody (P = 0.003). CONCLUSIONS: Preoperative appearance of anti-p53 antibody in sera can be correlated with the incidence of triple negative breast cancer and could therefore help identify tumors with aggressive potential.

The prognostic nutritional index can be a prognostic indicator in colorectal carcinoma.

PURPOSE: Preoperative assessments regarding a patient's immunological and nutritional condition are required to predict the outcomes of patients with malignant tumors. The aim of the current study was to clarify the significance of Onodera's prognostic nutritional index (OPNI), which can simply account for the immunological and nutritional conditions, in patients with colorectal carcinoma. METHODS: The correlations of the preoperative OPNI value with clinicopathological features were examined in 219 patients with colorectal carcinoma who had been surgically treated. RESULTS: Not only the tumor stage (P = 0.028) and venous invasion (P = 0.002), but also an OPNI of less than 40 (P = 0.002) were found to be independently correlated with a worse prognosis of patients with colorectal carcinoma. CONCLUSION: The preoperative OPNI can be used as a simple prognostic indicator in colorectal carcinoma.

Assessment of predictors of mortality and severity in patients with colorectal perforation.

Colorectal perforation is a life-threatening disease with high mortality and morbidity. The correct and prompt diagnosis and accurate judgment of severity are necessary. We retrospectively investigated 30 patients with colorectal perforation to assess predictors of mortality and severity, and evaluated the usefulness of computed tomography (CT) for the initial diagnosis. The severity of peritonitis was assessed using clinical factors and Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (POSSUM) scores. Abdominal free air was detected by CT in 92% of patients with colorectal perforation, whereas only 36.6% showed evidence of abdominal free air by conventional radiography. The perforation site was correctly diagnosed in 14 of 25 cases (56%). Overall mortality was 16.7%. Survivors were younger than nonsurvivors, and POSSUM physiological and mortality scores were significantly lower for survivors compared with nonsurvivors. The amount of intraperitoneal soiling by large bowel content determined disease severity in terms of the need for postoperative respiratory management. In conclusion, CT is necessary for precise diagnosis, and the POSSUM score is helpful for the evaluation of disease mortality and severity.

Primary neuroendocrine carcinoma of the breast: report of a case.

Primary neuroendocrine carcinoma (NEC) of the breast appears to be a rare neoplasm. Due to the limited number of the cases, a definitive therapeutic option for the disease has not yet been established. We herein report the case of a 57-year-old female patient with primary NEC of the breast who underwent a surgical resection and for whom the suitable adjuvant therapy is now being considered.

Gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis.

Surgical palliation of malignant obstructive pancreatitis poses a considerable burden to patients, especially those with extensive disease. We herein present a novel technique for performing gastro-pancreaticostomy using a tube stent as a less invasive palliative treatment for malignant obstructive pancreatitis. The main pancreatic duct was punctured via the wall of the pyloric antrum. After the insertion of a guidewire, a double pigtail-type tube stent with side holes was inserted into the main pancreatic duct through the wall of the pyloric antrum. This technique was useful as a means of accomplishing less invasive palliative treatment, and has the potential to improve the quality of life for patients with malignant obstructive pancreatitis.

[Prominent efficacy from capecitabine mono-therapy for a case with lymphangiosis carcinomatosa derived from recurrent breast cancer].

We met a 61-year-old woman who had been suffering from dyspnea due to pleuritis carcinomatosa derived from recurrent breast cancer for which no former chemotherapy had been effective. Capecitabine mono-therapy could exert a drastic anticancer effect for lymphangiosis carcinomatosa causing more severe symptoms of dyspnea. This therapeutic option could be selected for patients with recurrent breast cancer for which the first- or second-line chemotherapy could not provide a sufficient anti-cancer efficacy and possibly serve to sustain the life quality of the patients.

Preoperative elevation of serum C-reactive protein as an independent prognostic indicator for gastric cancer.

PURPOSE: Preoperative elevation of serum C-reactive protein (CRP) is a prognostic indicator for some malignant tumors. We investigated the clinicopathologic importance of an elevated preoperative serum CRP value in gastric carcinoma patients. METHODS: We studied the relationship between the preoperative serum CRP value and clinicopathologic characteristics in 204 patients who underwent curative resection of gastric carcinoma. RESULTS: The patients with preoperative CRP elevation had significantly poorer survival than those without CRP elevation (P < 0.0001). According to multivariate analysis, the factors independently associated with an unfavorable prognosis were a high preoperative CRP value (P = 0.024), lymphatic invasion (P = 0.017) and advanced tumor stage (P = 0.016). CONCLUSION: Preoperative serum CRP elevation can be an independent prognostic indicator in patients with gastric carcinoma.

Immunohistochemical expression of epidermal growth factor receptor in breast cancer.

BACKGROUND: Molecular-targeting drugs able to treat breast cancer expressing epidermal growth factor receptor (EGFR) would be clinically valuable. The aim of the current study was to determine the further significance of immunohistochemical expression of EGFR in breast cancer. METHODS: The immunohistochemical expression of EGFR was examined in 37 women with breast cancer who had been treated with surgical resection. Relationship of EGFR expression and clinicopathological characteristics was investigated. RESULTS: EGFR expression proved to be comparatively more frequent among triple-negative (estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 negative) breast cancers (P = 0.067). CONCLUSIONS: Knowledge of a patient's immunohistochemical EGFR expression, which could be one of the key molecular findings related to molecular-targeting therapy, might be useful information to treat triple-negative breast cancer.

Significance of modified Glasgow prognostic score as a useful indicator for prognosis of patients with gastric carcinoma.

BACKGROUND: The significance of the Glasgow prognostic score (GPS), an inflammation-based prognostic score, as an indicator of aggressiveness in gastric carcinoma has not been investigated fully. METHODS: Two hundred thirty-two patients with gastric carcinoma were enrolled. Patients who had both an elevated C-reactive protein (>1.0 mg/dL) and hypoalbuminemia (<3.5 g/dL) were allocated a traditional GPS (TGPS) of 2. Patients who had one of these abnormal values were allocated a TGPS of 1, and patients who had neither were allocated a TGPS of 0. RESULTS: There existed a significant difference between the survival of adjacent groups of patients when examined using the TGPS (P = .05 for TGPS 0 vs 1 and P = .006 for TGPS 1 vs 2). Multivariate analysis based on TGPS demonstrated that TGPS (P = .020) and tumor stage (P = .0007) proved to be independent prognostic indicators for worse prognosis. CONCLUSIONS: The preoperative measurement of an inflammation-based prognostic score can demonstrate a strict stratification for the prognosis of patients with gastric carcinoma.

Pathological prognostic score as a simple criterion to predict outcome in gastric carcinoma.

PURPOSE: The aim of this study was to establish a simple criterion to predict prognosis of patients with gastric carcinoma. METHODS: Two hundred four patients with gastric carcinoma, who had been treated with curative resection, were enrolled. One point was added for each category among four pathological factors of depth of tumor, lymph node metastasis, venous invasion, and lymphatic invasion. Pathological Prognostic Score (PPS) was determined by an aggregate of these points for each category. RESULTS: There existed a significant difference between survivals of patients with PPS 0 or 1 and 2 or 3 (P = 0.0002). Similarly, there also existed a significant difference between survivals of patients with PPS 2 or 3 and 4 (P = 0.010). CONCLUSIONS: PPS can be quite simple criteria to predict prognosis of gastric carcinoma with a strict stratification.

Prognostic nutritional index: a tool to predict the biological aggressiveness of gastric carcinoma.

PURPOSE: The prognostic nutritional index (PNI), which is calculated based on the serum albumin concentration and the peripheral blood lymphocyte count, has been used to assess the immunological and nutritional condition of patients with digestive diseases. However, its value as an indicator of aggressiveness in gastric carcinoma has not been fully investigated. METHODS: Two hundred and forty-eight cases of gastric carcinoma were studied with regard to the relationship between the preoperative PNI value and the clinicopathological characteristics of the patients. RESULTS: A lower preoperative PNI value significantly correlated with greater tumor depth, lymph node metastasis, lymphatic permeation, and venous invasion. Moreover, the PNI value proved to be an independent prognostic indicator in gastric carcinoma. CONCLUSION: The PNI value can be a useful tool to predict the prognosis of patients with gastric carcinoma.

[A case of recurrent gallbladder cancer responding to low-dose 5-FU and CDDP therapy].

We treated a patient with a postoperative local recurrence of gallbladder cancer who showed a long-term response to low-dose 5-fluorouracil (5-FU) and cisplatin (CDDP) therapy. A 60-year-old woman was diagnosed with advanced gallbladder cancer, for which she underwent an extended cholecystectomy, bile duct resection and a partial resection of the duodenum in March 2000. The pathological diagnosis was well differentiated tubular adenocarcinoma of si, ly1, v1, hinf2, binf2, n0. Eight months later, she presented with cholangitis and obstructive jaundice due to a local recurrence of the gallbladder cancer and her serum CA19-9 level had increased to 1,991.6 U/ml. The biliary obstruction was treated by PTCD and a subsequent self-expanding metallic stent. In addition, she was also placed on combined chemotherapy with low-dose 5-FU and CDDP. Her serum CA19-9 level thereafter gradually decreased, so that after eight months it was within the normal range, and the recurrent tumor at the hepatic hilus was also observed to have decreased in size on the CT scan. As of this writing she has undergone eight courses of low-dose 5-FU and CDDP therapy over about a year and has been able to maintain a good quality of life without any severe adverse effects.