[Effectiveness of Nivolumab in a Case of Inoperable Advanced Gastric Cancer with Lung Metastasis].

A 66-year-old man was diagnosed with inoperable advanced gastric cancer with liver and peritoneal metastases. The patient underwent SOX therapy as primary chemotherapy; subsequently, liver and peritoneal metastases disappeared. However, lung metastasis was detected later, and weekly paclitaxel(PTX)combined with ramucirumab(RAM)chemotherapy was initiated; subsequently, lung metastasis and advanced gastric cancer disappeared. During remission, lung metastasis was detected again. Although weekly PTX combined with RAM chemotherapy was reinitiated, a progressive disease status was achieved. As tertiary chemotherapy, nivolumab therapy(240 mg/body, every 2 weeks)was initiated for 20 courses over 11 months. This therapy was significantly effective, which aid the patient to achieve a complete response. The patient survived and is healthy for 5 years due to chemotherapy administration alone.

Diagnosing gangrenous cholecystitis on computed tomography using deep learning: A preliminary study.

Aim: To compare deep learning and experienced physicians in diagnosing gangrenous cholecystitis using computed tomography images and explore the feasibility of diagnostic assistance for acute cholecystitis requiring emergency surgery. Methods: This retrospective study included 25 patients with pathologically confirmed gangrenous cholecystitis and 129 patients with noncomplicated acute cholecystitis who underwent computed tomography between 2016 and 2021 at two institutions. All available computed tomography images at the time of the initial diagnosis were used for the analysis. A deep learning model based on a convolutional neural network was trained using 1,517 images of 112 patients (18 patients with gangrenous cholecystitis and 94 patients with acute cholecystitis) and tested with 68 images of 42 patients (seven patients with gangrenous cholecystitis and 35 patients with acute cholecystitis). Three blinded, experienced physicians independently interpreted the test images. The sensitivity, specificity, accuracy, and area under the receiver operating characteristic curve were compared between the convolutional neural network and the reviewers. Results: The convolutional neural network (sensitivity, 0.70; 95% confidence interval [CI], 0.44-0.87, specificity, 0.93; 95% CI, 0.88-0.96, accuracy, 0.89; 95% CI, 0.81-0.95, area under the receiver operating characteristic curve, 0.84; 95% CI, 0.68-1.00) had achieved a better diagnostic performance than the reviewers (ex. sensitivity, 0.55; 95% CI, 0.30-0.77, specificity, 0.67; 95% CI, 0.62-0.71, accuracy, 0.65; 95% CI, 0.57-0.72, area under the receiver operating characteristic curve, 0.63; 95% CI, 0.44-0.82; P = 0.048 for area under the receiver operating characteristic curve versus convolutional neural network). Conclusions: Deep learning had a better diagnostic performance than experienced reviewers in diagnosing gangrenous cholecystitis and has potential applicability for assisting in identifying indications for emergency surgery in the future.

New device with force sensors for laparoscopic liver resection - investigation of grip force and histological damage.

INTRODUCTION: As the benefits of minimally invasive surgery are recognized, the rate of laparoscopic liver resection (LLR) is rapidly increasing. Liver tissue is fragile compared to tissue of the stomach and colon. In endoscopic and robotic surgery, sufficient tactile sensation is yet to be obtained. Therefore, it is necessary to measure and indicate the grip force of forceps during surgery. We developed a new device consisting of force sensors and investigated its grip force and the resulting histological damage to liver tissue. MATERIAL AND METHODS: We measured the grip force generated during laparoscopic surgery in pigs using the forceps with pressure sensors developed by us. Throughout the hepatectomy, we measured the grip force generated by the forceps in real time. We investigated the histological damage to the liver caused by using the forceps with different grip forces. RESULTS: The subject produced a mean grip force of 1.75 N during the procedures. The maximum grip force was 3.38 N. By grasping the tissues of the liver with forceps, bleeding and destruction of the hepatic lobules were observed in a manner dependent on increasing grip force. CONCLUSION: The new device is necessary for preventing liver damage in laparoscopic hepatic resection.

[A Case of Non-Resectable Advanced Gastric Cancer for Which Nivolumab Was Markedly Effective].

A 74-year-old man presented to our hospital because of anorexia. Upper gastrointestinal endoscopy revealed type 3 gastric cancer. Further examination disclosed metastasis to the perigastric lymph nodes and to the liver, and a diagnosis of non- resectable advanced gastric cancer(cT4N2H1P0M0)in cStage Ⅳ was made. A total of 4 courses of S-1 plus oxaliplatin therapy(80 mg/body/day and 100 mg/m2/cycle, respectively, for 2 weeks followed by a 1-week rest)were administered as the primary chemotherapy. Then, another metastasis to the abdominal lymph nodes and increased liver metastasis were found; thus, the patient's condition was rated as progressive disease(PD). Secondary chemotherapy comprising 10 courses of weekly nab-paclitaxel(nab-PTX)plus ramucirumab(RAM)therapy(100 mg/m2 on days 1, 8, and 15 and 8 mg/kg on days 1 and 15, respectively, every 4 weeks)were administered. Although temporary reductions in the perigastric lymph node metastasis and liver metastasis as compared with the baseline were observed, another metastasis to the abdominal lymph nodes occurred subsequently, resulting in PD. As tertiary chemotherapy, nivolumab therapy(240 mg/body, every 3 weeks) was repeated up to a total of 30 courses over 13 months. This therapy was markedly effective, achieving a near complete response. The patient is currently being followed up as an outpatient.

[Suspected dihydropyrimidine dehydrogenase deficiency in a patient receiving capecitabine as adjuvant chemotherapy after colon resection].

We report here the case of a 75-year-old male patient who developed severe side effects after treatment with capecitabine (Xeloda®) that he received as adjuvant chemotherapy. He was suspected to have partial dihydropyrimidine dehydrogenase (DPD) deficiency. The patient underwent sigmoidectomy for sigmoid cancer and was treated with capecitabine as adjuvant chemotherapy. He was admitted to our hospital 14 days after the start of treatment with appetite loss, diarrhea, and a high body temperature. After admission, he developed severe neurotoxicity (Grade 4). We measured the DPD activity in peripheral mononuclear cells, which indicated partial DPD deficiency.