担当区分：筆頭著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：日本外科系連合学会  

施灸は温熱により血流を良好にすることで消化器症状などを改善する東洋医学の一つである.自宅での施灸も可能であり,危険性は少ないと考えられているが,施灸により腹腔内の癒着をきたした可能性のある症例を経験したので報告する.症例は手術歴のない84歳,男性.急性胆嚢炎に対し腹腔鏡下胆嚢摘出術を施行した.臍部よりopen法でポートを挿入し気腹後にスコープを挿入すると,臍周囲に限局する小腸と大網の著明な癒着を認めた.臍周囲に限局した施灸による皮膚変化があり,また頻繁に臍周囲のみに施灸をしていたことから,施灸が癒着の原因と考えられた.施灸による腹腔内癒着は文献的に報告がなく稀であるが,近年,商品の多様化と広告展開により施灸の普及が進んできており,今後遭遇する可能性がある.(著者抄録)

DOI： 10.4030/jjcs.41.719

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

We describe a patient in whom a fish bone penetrated the duodenum and migrated into the right renal vein. The bone was successfully removed with surgery. The 75-year-old man was admitted to Nippon Medical School Tama Nagayama Hospital because of right upper abdominal pain persisting for 7 days. The patient's medical history was not relevant to the current disorder. Plain radiography showed no abnormalities. Computed tomography revealed a linear object of high intensity that had penetrated the duodenum and migrated into the right renal vein with thrombus. The object was surrounded by a low-density area, suggesting severe inflammation. The patient had eaten fish 1 day before the onset of abdominal pain. We diagnosed duodenal penetration caused by an ingested fish bone. Endoscopic examination showed erosion, but no fish bone or ulceration was detected in the duodenum. The patient was treated conservatively with fasting, peripheral parental nutrition, and intravenous antibiotics. Three days after admission, non-contrast-enhanced computed tomography showed no movement of the foreign body. The patient continued to have pain, and the decision was made to surgically explore the abdomen. Intraoperative ultrasonography showed that the foreign body had migrated completely into the right renal vein with thrombus. Severe inflammation of the right renal vein was observed. Because we could not remove the foreign body without seriously injuring the right renal vein, right nephrectomy was performed. Macroscopic examination of the surgical specimen confirmed the presence of a fish bone with thrombus in the right renal vein. The patient was discharged 9 days after operation, with no complications. (J Nippon Med Sch 2011; 78: 189-193)

DOI： 10.1272/jnms.78.189

Web of Science

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Extrahepatic portal vein obstruction (EHPVO) is a rare disease. Most EHPVO patients are usually referred to a gastroenterologist for intestinal bleeding and hypersplenic thrombocytopenia; however, hypercoagulative diseases may be occult in these patients and require anticoagulation. The purpose of this study was to elucidate the clinical characteristics of EHPVO. We conducted a retrospective analysis of the hospital database, evaluating the medical records of 15 patients (7 males, 8 females, mean age of onset 42.0 years, range 5-74 years). Thirteen of 15 EHPVO patients (86.7%) had intestinal varices. These included 10 esophageal (66.7%), 12 gastric (80.0%), and 6 ectopic varices (40.0%). Nine (60.0%) of 15 had a history of intestinal bleeding. Regarding comorbidities, 5 of 15 (33.3%) suffered from vascular diseases, including acute myocardial infarction, cerebral infarction, pulmonary embolism, Budd-Chiari syndrome, and mesenteric vein thrombosis. The former 3 vascular commodities manifested at less than 32 years of age. Four patients (26.7%) with JAK2V617F mutation were diagnosed as myeloproliferative neoplasm (MPN). 72.3% of EHPVO patients without MPN experienced thrombocytopenic state. No EHPVO patients with MPN experienced thrombo-leukocytopenia. The elevation of white blood cell and platelet counts, and decrease of protein S were seen in EHPVO with MPN, compared with EHPVO without MPN. EHPVO is frequently associated with underlying hypercoagulative factors, causing a dilemma between thrombotic complications and portal hypertensive bleeding. Most EHPVO patients experience an evident thrombocytopenic state due to severe hypersplenism; however, hypersplenic hematologic changes are eliminated in EHPVO with MPN. MPN should be suspected in EHPVO patients negative for thrombo-leukocytopenia.

DOI： 10.5582/irdr.2023.01106

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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担当区分：筆頭著者,　責任著者  

DOI： 10.3862/jcoloproctology.76.123

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: To investigate a prognostic score for stage II-III colorectal cancer (CRC) based on post-CEA and pT4 levels. METHODS: Two cohorts of stage II-III CRC patients who underwent curative surgery between 2011 and 2017 were included. The prognostic score (T-CEA score) was calculated as follows: T-CEA-0, post-CEA ≤ 5 ng/mL and pT1-3; T-CEA-1, post-CEA > 5 ng/mL or pT4; T-CEA-2, post-CEA > 5 ng/mL and pT4. RESULTS: The T-CEA scores of the 587 patients were as follows: T-CEA-0 (n = 436; 74%), T-CEA-1 (n = 129; 22%), and T-CEA-2 (n = 10; 2%). The 5-year recurrence-free survival (RFS) rates of the T-CEA-0, 1, and 2 groups were 80.3%, 54.8%, and 0%, respectively (P < 0.01), and the 5-year overall survival (OS) rates were 90.9%, 74.2%, and 0%, respectively (T-CEA-0 vs T-CEA-1: P < 0.01, T-CEA-1 vs T-CEA-2: P = 0.04). Multivariate analysis revealed that an elevated T-CEA score of 1 or 2 was a significant risk factor for poor RFS (HR: 2.89, P < 0.01) and OS (HR: 2.85, P < 0.01). CONCLUSION: The T-CEA score is a reliable and convenient prognostic score for stage II-III CRC.

DOI： 10.1007/s00595-023-02644-6

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Angiogenesis is regulated by interactions between vascular endothelial growth factors (VEGFs) and VEGF receptors. VEGF-A, VEGF-D, placental growth factor (PlGF) and plasminogen activator inhibitor-1 (PAI-1) have tumor angiogenic activity. VEGF-A and PAI-1 levels in the blood may impact the activity of bevacizumab, and VEGF-D levels may similarly diminish the efficacy of ramucirumab. However, the dynamics of these angiogenic biomarkers for anti-VEGF therapy have not been well established; therefore, they were evaluated in this retrospective study, which included two cohorts. Cohort 1 included patients who were treated with cytotoxic agents and bevacizumab as first-line chemotherapy, and Cohort 2 comprised patients who were treated with cytotoxic agents and anti-VEGF drugs (bevacizumab, ramucirumab or aflibercept) as second-line chemotherapy. VEGF-A, VEGF-D, PlGF and PAI-1 levels were measured before starting chemotherapy and were re-assessed every 1-2 months until disease progression. Bevacizumab had reduced benefit as a first-line chemotherapeutant in patients with very low or very high levels of VEGF-A. Bevacizumab increased VEGF-A and PlGF levels, but not VEGF-D or PAI-1. Anti-VEGF drugs offered the greatest benefit to patients with high PAI-1 before first- and second-line chemotherapy. PAI-1 levels were not affected by anti-VEGF drugs. Since ramucirumab increased VEGF-D, it offered less benefit to patients with high VEGF-D in second-line chemotherapy. Conversely, aflibercept offered greater benefits to patients with high VEGF-D, without increasing VEGF-D. These biomarkers may be useful for the prediction of drug efficacy and may predict resistance to anti-VEGF drugs.

DOI： 10.3892/ol.2022.13583

PubMed

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Epithelial-mesenchymal transition (EMT) plays a pivotal role in cancer progression and metastasis in many types of malignancies, including colorectal cancer. Although the importance of EMT is also considered in colorectal neuroendocrine carcinoma (NEC), its regulatory mechanisms have not been elucidated. We recently established a human colorectal NEC cell line, SS-2. In this study, we aimed to clarify whether these cells were sensitive to transforming growth factor beta 1 (TGF-β1) and whether EMT could be induced through TGF-β1/Smad signaling, with the corresponding NEC cell-specific changes in invasiveness. In SS-2 cells, activation of TGF-β1 signaling, as indicated by phosphorylation of Smad2/3, was dose-dependent, demonstrating that SS-2 cells were responsive to TGF-β1. Analysis of EMT markers showed that mRNA levels changed with TGF-β1 treatment and that E-cadherin, an EMT marker, was expressed in cell-cell junctions even after TGF-β1 treatment. Invasion assays showed that TGF-β1-treated SS-2 cells invaded more rapidly than non-treated cells, and these cells demonstrated increased metalloproteinase activity and cell adhesion. Among integrins involved in cell-to-matrix adhesion, α2-integrin was exclusively upregulated in TGF-β1-treated SS-2 cells, but not in other colon cancer cell lines, and adhesion and invasion were inhibited by an anti-α2-integrin blocking antibody. Our findings suggest that α2-integrin may represent a novel therapeutic target for the metastasis of colorectal NEC cells.

DOI： 10.1016/j.bbrep.2022.101239

PubMed

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記述言語：日本語   出版者・発行元：日本外科代謝栄養学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Surgical site infections (SSIs) remain one of the most common serious surgical complications and are the second most frequent healthcare-associated infection. Patients with SSIs have a significantly increased postoperative length of hospital stay, hospital expenses, and mortality risk compared with patients without SSIs. The prevention of SSI requires the integration of a range of perioperative measures, and approximately 50% of SSIs are preventable through the implementation of evidence-based preventative strategies. Several international guidelines for SSI prevention are currently available worldwide. However, there is an urgent need for SSI prevention guidelines specific to Japan because of the differences in the healthcare systems of Japan versus western countries. In 2018, the Japan Society for Surgical Infection published SSI prevention guidelines for gastroenterological surgery. Although evidence-based SSI prevention guidelines are now available, it is important to consider the appropriateness of these guidelines depending on the actual conditions in each facility. A systemic inflammatory host response is a hallmark of bacterial infection, including SSI. Therefore, blood inflammatory markers are potentially useful in SSI diagnosis, outcome prediction, and termination of therapeutic intervention. In this review, we describe the current guideline-based perioperative management strategies for SSI prevention, focusing on gastroenterological surgery and the supplemental utility of blood inflammatory markers.

DOI： 10.1272/jnms.JNMS.2023_90-102

PubMed

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

後期高齢者は化学療法に対する忍容性が低く、標準治療を長期間行うのは困難である。早期結腸癌術後の肺転移に対し、UFT/UZEL/bevacizumab(Bev)療法が長期奏効した後期高齢者の1例を報告する。症例は82歳、男性。他院にてS状結腸癌に対し腹腔鏡補助下S状結腸切除術を施行された。pT1b、ly1、v0、N0、M0、pStage Iであったが、術後6ヵ月で右中葉に小結節を指摘され、5ヵ月後に増大傾向を認め肺転移と診断された。高齢者であるため標準的化学療法の導入は困難と考え、また腫瘍径も小さいため術後1年2ヵ月目よりUFT/UZEL/Bevを開始した。食欲不振で一段階減量を行ったがその後は大きな副作用もなく継続可能であり、2年6ヵ月時点までpartial response(PR)を維持している。UFT/UZEL/BevはFOLFOXなどの標準治療と比較するとエビデンスは十分ではないが、vulnerableな症例に対する選択肢と考えられた。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00296&link_issn=&doc_id=20220524520021&doc_link_id=%2Fab8gtkrc%2F2022%2F004905%2F022%2F0593b0596%26dl%3D3&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2022%2F004905%2F022%2F0593b0596%26dl%3D3&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_4.gif

記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

後期高齢者は化学療法に対する忍容性が低く、標準治療を長期間行うのは困難である。早期結腸癌術後の肺転移に対し、UFT/UZEL/bevacizumab(Bev)療法が長期奏効した後期高齢者の1例を報告する。症例は82歳、男性。他院にてS状結腸癌に対し腹腔鏡補助下S状結腸切除術を施行された。pT1b、ly1、v0、N0、M0、pStage Iであったが、術後6ヵ月で右中葉に小結節を指摘され、5ヵ月後に増大傾向を認め肺転移と診断された。高齢者であるため標準的化学療法の導入は困難と考え、また腫瘍径も小さいため術後1年2ヵ月目よりUFT/UZEL/Bevを開始した。食欲不振で一段階減量を行ったがその後は大きな副作用もなく継続可能であり、2年6ヵ月時点までpartial response(PR)を維持している。UFT/UZEL/BevはFOLFOXなどの標準治療と比較するとエビデンスは十分ではないが、vulnerableな症例に対する選択肢と考えられた。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Preoperative colonic stenting for malignant large bowel obstruction (MLBO), also called bridge to surgery (BTS), is considered a great substitute treatment for emergency resection (ER) in the left-sided colon. However, its efficacy in the right-sided colon remains controversial. This systematic review and meta-analysis aimed to compare the postoperative short-term outcomes between BTS and ER for right-sided MLBO. METHODS: A comprehensive electronic literature search throughout December 2020 was performed to identify studies comparing short-term outcomes between BTS and ER for right-side MLBO. The main outcome measures were postoperative complications and mortality rates. A meta-analysis was performed using a fixed-effect or a random-effect method to calculate odds ratios (ORs) with 95% confidence intervals (95% CIs). RESULTS: Seven studies were included in this meta-analysis, comprising 5136 patients, of whom 1662 (32.4%) underwent BTS and 3474 (67.6%) underwent ER. This meta-analysis demonstrated that BTS resulted in reductions in postoperative complications (OR = 0.78; 95% CI: 0.66-0.92) and mortality (OR = 0.51; 95% CI: 0.28-0.92) than ER. CONCLUSION: The results of this meta-analysis indicate that BTS for right-sided MLBO confers preferable short-term outcomes as well as for left-sided. This suggests that BTS results in a reduction of postoperative complications and mortality for right-sided MLBO than ER.

DOI： 10.1007/s00464-022-09071-7

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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担当区分：筆頭著者,　責任著者   記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：(株)癌と化学療法社  

進行胃癌に対する化学療法first-lineとして胃癌治療ガイドライン第5版にFOLFOXが追加された。同レジメンは静脈内投与で完結するため、経口摂取の安定しない進行胃癌において有用と考えられる。本稿ではFOLFOXが著効した進行胃癌症例を報告する。多発肝転移、傍大動脈リンパ節転移を伴うStage IVBの75歳、男性。S-1+CDDP導入後早期に重篤な有害事象を認めFOLFOXへ変更した。oxaliplatinによるアレルギーを来すまで継続投与しPRを維持した。経口摂取不良や内服コンプライアンス不良の進行胃癌症例において、FOLFOXは有用な選択肢である。(著者抄録)

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: The prognosis for metastatic colorectal cancer patients (mCRC) with the BRAFV600E mutation is poor. BRAFV600E mutation frequency is reportedly low among Asians; however, the frequency of the BRAFV600E mutation in right-side colon cancer may not be low, even among Asians. In addition, spatial heterogeneity of BRAFV600E mutations also exists, as for RAS mutations. In this prospective observational study, we evaluated BRAFV600E mutations in cancer tissue and plasma of Japanese right-side colon cancer patients. METHOD: 215 patients with right-side colon cancer were included. BRAFV600E mutations of cancer tissue and plasma were detected using droplet digital PCR. Blood plasma of patients with BRAFV600E mutations in cancer tissue or plasma was drawn at intervals throughout chemotherapy, and BRAFV600E mutations were evaluated. RESULTS: BRAFV600E mutations were detected in tissue samples from 35 of 215 patients (16.3%, cecum; 22.4%, ascending colon; 17.8%, and transverse colon; 9.0%). BRAFV600E mutations were detected in plasma of 10 of 215 (4.7%) patients. Eight of the ten patients had BRAFV600E mutations in their primary tumours, but two (both were Stage IV) patients did not. Sensitivity of liquid biopsy to detect BRAFV600E mutations was 10.3% (3/29) in Stage I-III patients and 83.3% (5/6) in Stage IV patients. CONCLUSION: BRAFV600E mutations are observed in right-side colon cancer at high frequency, especially in the cecum. BRAFV600E mutations can be detected in plasma and the detection rate is high in patients with advanced cancer. Spatial heterogeneity was observed using liquid biopsy.

DOI： 10.1016/j.ejso.2022.01.016

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

A peritoneal loose body (PLB) is a tissue completely separated from other intraperitoneal organs. It is rare and usually found incidentally during laparotomy, examination, or autopsy. It is usually located free in the peritoneal cavity and does not exist in the extraperitoneal space. It is generally thought to originate from the epiploic appendices released into the abdominal cavity following ischemic necrosis. We report a case of a giant PLB outside the peritoneal cavity, adjacent to the rectovesical excavation, inan asymptomatic 83-year-old man who underwent evaluation for cholecystolithiasis, preoperatively. Computed tomography revealed a mass with well-defined margins in the rectovesical excavation, consisting of a calcified core and peripheral soft tissue measuring 60 mm in diameter; it did not seem to invade adjacent organs. Although there were no symptoms or tumor growth over time, for a definitive diagnosis, we scheduled a laparoscopic extraction. On laparoscopic exploration, a white oval mass was found in the rectovesical excavation; there was no invasion of adjacent organs. We diagnosed the patient with a giant PLB.Postoperative recovery was uneventful. Most PLBs are asymptomatic and do not require surgery except when symptomatic, large in size, or suspicious for malignancy. The PLB is rarely extraperitoneal and usually freely mobile; however, in our patient, it was fixed and outside the abdominal cavity, near the rectovesical fossa. Although it could not be diagnosed preoperatively as being extra-peritoneal, it showed the typical imaging findings of PLB; thus, it was possible to remove the mass laparoscopically without bowel resection.

DOI： 10.1272/jnms.JNMS.2023_90-302

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Colorectal cancer (CRC) is the third most common cancer worldwide, and surgical treatment remains the first-line treatment to provide a cure. In addition to the aging population, obesity, low physical activity, and smoking habits increase CRC risk. Despite advances in surgical techniques, chemotherapy, and radiotherapy, colorectal cancer remains the second leading cause of cancer-related deaths worldwide. For early-stage CRC, endoscopic treatment, including endoscopic mucosal resection and endoscopic submucosal dissection, has been performed. However, lymph node dissection is an integral part of surgical treatment for advanced-stage cancer because of the high incidence of lymph node metastasis. Conventional open surgery has evolved into laparoscopic and robotic surgery. Although prospective studies have confirmed the safety and feasibility of laparoscopic surgery for CRC, relevant treatment models of transverse colon cancer and rectal cancer still need to be further explored and validated. Furthermore, multidisciplinary treatment is needed to cure CRC completely. This review aimed to provide an update on recent advances in the surgical treatment of CRC.

DOI： 10.1272/jnms.JNMS.2022_89-310

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Anorectal melanoma is a rare disease with poor prognosis and nonspecific symptoms, leading to difficulties in preoperative diagnosis. Here, we describe the establishment of MELS, a novel anorectal melanoma cell line derived from tumor resection of the rectum in a 40-year-old Japanese man. METHODS: Histological, electron microscopic, and immunohistochemical features of S-100, HMB-45, Melan-A, and NSE positivity in the patient's tumor were confirmed as typical of surgically resected anorectal melanoma. RESULTS: MELS cells are round or oval cells with sharp thorn-like protrusions on some or all of the cell membrane. They form irregular attached colonies with numerous floating cells in two-dimensional culture. Transmission electron microscopy revealed that some MELS cells possess cytoplasmic melanosomes. Immunocytochemically, MELS cells showed the same staining patterns as surgical tissues. MELS cells had lower growth rates than Caco-2 (a colon adenocarcinoma cell line) and A375 (a cutaneous melanoma cell line) cells. Oxaliplatin and irinotecan were more effective in MELS cells than in Caco-2 and A375 cells. CONCLUSIONS: Prior to our study, no reports had provided detailed clinical information on anorectal melanoma cell lines. Thus, MELS cells should improve current knowledge on the biological behaviors of anorectal melanoma, while providing a novel platform for examining the effects of anorectal therapies.

DOI： 10.1272/jnms.JNMS.2022_89-402

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：日本ストーマ・排泄リハビリテーション学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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担当区分：筆頭著者,　責任著者   掲載種別：研究論文（学術雑誌）  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Kyphosis makes abdominal surgery difficult. Here, we report a case of rectal cancer in a patient with kyphosis on whom laparoscopic surgery was adequately performed owing to preoperative simulation. An 81-year-old woman with rectal cancer was admitted to our department, and laparoscopic surgery was planned. On physical examination, the patient showed severe kyphosis. To adequately perform laparoscopic surgery, a detailed and thorough preoperative simulation was conducted. 1) Simulations of port arrangement and anatomy with 3-D CT, 2) body position simulation, 3) selection of surgical instruments, 4) preoperative discussion with the anesthesiologist were conducted. We planned to insert the first port from the umbilical region for pneumoperitoneum and the camera port from the ventral region under pneumoperitoneum. We planned to insert the ports on the right side of the patient's body from caudal regions, considering the location of the inferior mesenteric artery and the limited degrees and space due to the costal arch and the promontorium. Beach chair position was planned. We used a fan-shaped retractor and a sponge-made retractor to remove the small intestine from the surgical view. We discussed with the anesthesiologist preoperatively, and decided to keep the pneumoperitoneum pressure under 8 mmHg during the operation considering the respiratory function. Lower anterior resection with D2 lymph node dissection was performed without any intraoperative complications, and at 2 years post-surgery, the patient was healthy with no signs of recurrence. Laparoscopic surgery may be a good choice in patients with kyphosis, and we believe that preoperative simulation will result in an uneventful surgery.

DOI： 10.1272/jnms.JNMS.2022_89-608

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Small intestinal metastasis from lung cancer is a relatively rare occurrence, and often causes intestinal obstruction, gastrointestinal perforation, and/or gastrointestinal bleeding making it is an oncological emergency. Many patients have been reported to undergo emergency surgery owing to the rapid progression of the intestinal metastatic lesion; however, information regarding the changes that occur in such metastases over time remains lacking. Therefore, we analyzed 4 patients who had small intestinal metastases arising from lung cancer, who were treated during a 10-year period (January 2011 to December 2020), and whose tumor diameter changes were recorded. The average tumor volume growth rate was 1.48 (1.31-1.78) -fold, and the median observation period was 22 (4-39) days, showing a rapid increase. Histopathologically, in patients with a high degree of primary tumor atypia, rapid tumor growth caused by intratumoral hemorrhage may occur. This was considered to be one of the factors responsible for the rapid increase in tumor volume.

DOI： 10.1272/jnms.JNMS.2022_89-501

PubMed

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞閉塞性大腸癌に対する大腸ステント治療の普及に伴い,ステント留置後の腹腔鏡手術も多く行われるようになっている.しかし,開腹移行率は非閉塞性症例と比べて高く,周囲組織への癌浸潤や炎症の波及,術中操作による腸管穿孔の回避,口側腸管の評価,適切な切離ラインの決定など,配慮すべき点も多い.また,ステント留置後から手術までの待機期間などの周術期管理も,短期成績のみならず長期成績に影響する.本稿では,大腸ステント留置後の腹腔鏡手術を安全に行うために注意すべき点および当科の取り組みについて概説し,今後の展望を述べる.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00393&link_issn=&doc_id=20210824070010&doc_link_id=10.15106%2Fj_geka83_1112&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka83_1112&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞閉塞性大腸癌に対する大腸ステント治療の普及に伴い,ステント留置後の腹腔鏡手術も多く行われるようになっている.しかし,開腹移行率は非閉塞性症例と比べて高く,周囲組織への癌浸潤や炎症の波及,術中操作による腸管穿孔の回避,口側腸管の評価,適切な切離ラインの決定など,配慮すべき点も多い.また,ステント留置後から手術までの待機期間などの周術期管理も,短期成績のみならず長期成績に影響する.本稿では,大腸ステント留置後の腹腔鏡手術を安全に行うために注意すべき点および当科の取り組みについて概説し,今後の展望を述べる.

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00393&link_issn=&doc_id=20210824070010&doc_link_id=10.15106%2Fj_geka83_1112&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka83_1112&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Circulating tumour DNA (ctDNA) is very useful for purposes of cancer genetics; however, it has some limitations. Recently, ctDNA in body fluids, such as urine, sputum, and pleural effusion, has been investigated. The aim of this study was to evaluate the quantity of ctDNA derived from urine (trans-renal ctDNA) and the accuracy of KRAS mutation detection in relation to disease stage in colorectal cancer. METHODS: Urine, plasma, and tissue samples were collected from consecutively resected colorectal cancer patients. DNA was extracted from each sample and the quantity was determined. From each DNA sample, KRAS mutations were detected using droplet digital PCR. RESULTS: 200 patients participated and KRAS mutations were detected in 84 patients (42.0%) from tumour tissue. The concentration of trans-renal ctDNA (trtDNA) was significantly lower than that of plasma; however, there was no significant difference between the sensitivity using ctDNA and that using trtDNA (29.8% VS 33.3%, p = 0.62). Concordance between these two tests was only 17.5%. Combination analysis (ctDNA + trtDNA) improved the sensitivity to 53.6%, and sensitivity was significantly higher than that of corresponding single assays (p = 0.003). In early cancer stages, trtDNA had greater sensitivity for detecting KRAS mutations than ctDNA (37.7% vs. 21.3%, p = 0.047). Conversely, it was less useful for advanced cancer stages (21.7% vs. 52.2%, p = 0.07). Notably, KRAS mutations were detected using ctDNA or trtDNA in 12 of 116 (10.3%) patients who had no KRAS mutations in their tissue samples. CONCLUSIONS: trtDNA and ctDNA have equal potential and combination analysis significantly improved the sensitivity.

DOI： 10.1016/j.ejso.2021.07.017

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: High preoperative carcinoembryonic antigen (CEA) is a well-known risk factor for stage II-III colorectal cancer (CRC); however, in most cases, cancer does not recur. Conversely, postoperative CEA (post-CEA) is occasionally measured, and high post-CEA patients often develop recurrence; however, the clinical significance of post-CEA testing is unknown. The purpose of this study was to determine whether post-CEA elevation might indicate a poor prognosis for stage II-III CRC patients who underwent curative surgery. PATIENTS AND METHODS: 482 patients with pathological stage II-III CRC were included. Univariate and multivariate analyses were performed to evaluate post-CEA levels. RESULTS: Multivariate analysis showed that elevated post-CEA (hazard ratio (HR): 3.14, P < 0.001), pathological lymph node metastasis (pN+), and pathological T4 (pT4) are associated with poor recurrence-free survival (RFS), and that elevated post-CEA (HR: 3.12; P = 0.002), pN+, pT4, age >70, and smoking are independently associated with poor overall survival. Subgroup analysis among stage III patients, in combination with the risk classification of the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) study, showed that elevated post-CEA is a significant indicator of poor prognosis for RFS in both low-risk (73.8% vs. 21.2%, P < 0.001) and high-risk (49.9% vs. 25.0%, P = 0.04) groups. CONCLUSIONS: Post-surgical CEA elevation is independently associated with poor prognosis in stage II-III CRC. Adding post-CEA levels to the IDEA risk classification may provide a more reliable indicator of the need for individualized surveillance and adjuvant chemotherapeutic strategies.

DOI： 10.1016/j.ejso.2021.05.041

PubMed

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

DOI： 10.11241/jsmtmr.36.43

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

DOI： 10.11241/jsmtmr.36.36

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Approximately 10% of patients with colorectal cancer (CRC) develop malignant large bowel obstruction (MLBO) at diagnosis. Furthermore, for 35% of patients with MLBO, curative primary tumor resection is unfeasible because of locally advanced disease and comorbidities. The practice of placing a self-expandable metallic stent (SEMS) has dramatically increased as an effective palliative treatment. Recent advances in systemic chemotherapy for metastatic CRC have significantly contributed to prolonging patients' prognosis and expanding the indications. However, the safety and efficacy of systemic chemotherapy in patients with SEMS have not been established. This review outlines the current status of this relatively new therapeutic strategy and future perspectives. Some reports on this topic have demonstrated that 1) systemic chemotherapy and the addition of molecular targeted agents contribute to prolonged survival in patients with SEMS; 2) delayed SEMS-related complications are a major concern, and this requires strict patient monitoring; however, primary tumor control by chemotherapy might result in decreased complications, especially regarding re-obstruction; and 3) using bevacizumab could be a risk factor for SEMS-related perforation, which may be lethal. Although this relatively new approach for unresectable stage IV obstructive CRC requires a well-planned clinical trial, this therapy could be promising for patients who are unideal candidates for emergency surgery and require immediate systemic chemotherapy.

DOI： 10.23922/jarc.2020-061

PubMed

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A woman in her 60s underwent lower endoscopy due to a positive fecal occult blood test. A type 2 tumor was found in the cecum, and a biopsy resulted in the diagnosis of adenocarcinoma(tub2). Contrast-enhanced CT showed an enlarged paracolonic lymph node but no distant metastasis, so the patient underwent a laparoscopic-assisted ileocolic resection and D3 lymph node dissection for cecum cancer. The pathology was pT3, pN2b, pM0, pStage Ⅲc, and 12 courses of FOLFOX were administered as adjuvant chemotherapy. Twenty-four months after the completion of adjuvant chemotherapy, an elevated CEA was observed, and a PET-CT was performed, which showed multiple peritoneal disseminated nodules with FDG accumulation. Based on this finding, CAPOX/bevacizumab therapy was introduced, and on completion of 4 courses, the PET-CT showed a decrease in the size of the nodules and the disappearance of FDG accumulation. Based on this, the patient underwent resection. A peritoneal dissemination resection and bilateral ovariectomy were laparoscopically performed, and the patient is currently under observation. In patients with metastatic recurrence of peritoneal dissemination who underwent complete resection, treatment with CAPOX/bevacizumab may allow for disease control and provide a long-term prognosis.

PubMed

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掲載種別：研究論文（学術雑誌）   出版者・発行元：Wiley  

DOI： 10.1002/jso.26245

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その他リンク： https://onlinelibrary.wiley.com/doi/full-xml/10.1002/jso.26245

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

本邦で2012年に保険収載された大腸ステントは,閉塞性大腸癌治療に大きなparadigm shiftを起している.術前減圧目的の大腸ステント留置(bridge to surgery:BTS)は,良好な短期成績が報告されている一方,長期予後への懸念から,欧州消化器内視鏡学会(ESGE)のガイドラインにおいて否定的な推奨であった.しかし,近年,長期予後の安全性を示唆する報告が多数出され,2020年のupdate版では一転,推奨する形となった.今後,さらに広がることが予想されるBTS治療戦略であるが,長期予後のみならず,手術までの至適待機期間,ステントの種類,右側結腸癌での効果,経肛門的減圧管との比較など,解決すべきclinical questionは多い.本稿では,BTSのこれまでの治療成績を概説し,今後の展望も含めて述べる.(著者抄録)

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chemotherapy with oxaliplatin is known to induce sinusoidal obstruction syndrome (SOS). In a previous single-center study, we reported that oxaliplatin-induced increase in splenic volume (SV) is strongly indicative of SOS, and that this increase in SV persisted for > 1 year after completing chemotherapy. The aim of this study was to confirm the oxaliplatin-induced SV change in a multicenter study in patients with stage III colon cancer in Japan. METHODS: We enrolled 59 patients who underwent curative resection for stage III colon cancer in the FACOS study in a phase II multi-center clinical study. Participants received mFOLFOX6 or CAPOX as adjuvant chemotherapy. SV change was assessed three times by computed tomographic volumetry: before surgery, on completion of adjuvant chemotherapy, and 1 year after completing adjuvant chemotherapy. RESULTS: SV on completing and 1 year after chemotherapy was significantly higher than that before surgery (P < 0.001). Oxaliplatin-induced SOS persisted for > 1 year after the completion of adjuvant chemotherapy in half of the patients. There was no difference in 3-year disease-free survival with respect to the presence or absence of increased SV. An increase in SV was observed in 72% of patients treated with mFOLFOX6 and 94% of patients treated with CAPOX (P = 0.13). CONCLUSION: This study can be verified the findings observed in our previous single-center study, oxaliplatin-based adjuvant chemotherapy was associated with an increase in SV. Furthermore, this increase can persist for > 1 year. The continuous presence of SOS may have a negative impact on prognosis in patients that develop recurrent disease.

DOI： 10.1007/s10147-020-01763-1

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Oncogenic RAS mutations are negative biomarkers of response to epidermal growth factor receptor (EGFR) blockade. RAS mutations are usually detected in biopsies of primary colorectal tumors. However, the genomic profiles of primary tumors and metastases are not always concordant, and chemotherapeutic agents can alter the tumor molecular landscape. Cell-free DNA (cfDNA) is a novel tool to detect molecular heterogeneity. This study evaluated the clinical utility of cfDNA to predict primary or secondary resistance to EGFR blockade in patients with metastatic colorectal cancer. Thirty metastatic colorectal cancer patients without RAS and BRAF mutations were prospectively enrolled and treated with cytotoxic agents and EGFR blockade as first-line therapy. cfDNA was analyzed for the presence of RAS, BRAF, and EGFR (S492R) point mutations before initiating chemotherapy and every 2 months during chemotherapy. The analysis was performed in 223 plasma samples from all 30 patients. Of the 30 patients, five had RAS mutations in their cfDNA before starting chemotherapy and did not respond. Twenty-four of the remaining 25 patients without cfDNA RAS mutations had a response. Twenty of the 24 responders developed secondary resistance and cfDNA RAS mutations were found in 17 of the 20. cfDNA BRAF mutations were found in seven, and EGFR mutations were found in eight of the 20 patients. Emerging RAS, BRAF, and EGFR mutations occurred in patients with primary and secondary resistance to EGFR blockade. The detection of these mutations in cfDNA is a promising approach to predict treatment response and secondary resistance.

DOI： 10.1007/s10147-020-01691-0

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記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞局所進行直腸癌に対する欧米の標準治療である術前化学放射線療法は,局所制御効果を認めるものの生存率の改善には寄与せず,遠隔転移の制御が課題である.また,放射線治療による有害事象も問題となっており,近年ではその省略も試みられている.手術成績に優れた本邦においては,術前化学療法が化学放射線療法における上述のdisadvantageを克服しうる有望な治療戦略となりうる.本稿では,術前化学療法の現況と今後の展望を概説する.

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00393&link_issn=&doc_id=20200605170006&doc_link_id=issn%3D0016-593X%26volume%3D82%26issue%3D7%26spage%3D730&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D82%26issue%3D7%26spage%3D730&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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担当区分：筆頭著者,　責任著者   記述言語：英語  

Herein we report a case of laparoscopic cholecystectomy in a 26-year-old pregnant woman with no remarkable medical history. Laparoscopic cholecystectomy was performed at 21 weeks of gestation. To prevent uterus injury, the first trocar was inserted into the right hypochondrium using the open method after marking the site of the uterus via ultrasonography. After confirming the site of the uterus, the second trocar with a balloon was inserted 3 finger widths above the umbilicus. Additional 5-mm trocars were inserted into the epigastric and hypochondrial regions. A good surgical view was obtained with a pneumoperitoneal pressure of 8 mmHg. Laparoscopic cholecystectomy was successfully performed without any complications during or after the operation. She had a normal delivery at 39 weeks of gestation. Laparoscopic cholecystectomy is a viable treatment option during pregnancy, provided there is close consultation and cooperation between obstetricians and anesthesiologists.

DOI： 10.7759/cureus.7656

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記述言語：日本語   出版者・発行元：(株)へるす出版  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: A transomental hernia is defined as bowel invagination into an abnormal hiatus of the omentum. It is a rare type of internal hernia that is sometimes lethal. We herein report a case of a transomental hernia developing shortly after laparoscopic sigmoidectomy. CASE PRESENTATION: A 71-year-old man underwent laparoscopic sigmoidectomy. He was admitted to our hospital because of abdominal pain and nausea on postoperative day 12. Laboratory investigation showed increased levels of inflammatory markers. Abdominal computed tomography showed a closed loop and mesenteric edema of the small intestine with ascites. We performed an emergency operation under the diagnosis of strangulated bowel obstruction. Operative findings showed internal herniation of strangulated ileal loops through a defect of the omentum with hemorrhagic ascites. The incarcerated small bowel was resected and reconstructed because the ischemic change was irreversible after the reduction. We partially resected the omentum that had formed the defect. The patient's postoperative progress was good, and he was discharged on postoperative day 8. CONCLUSIONS: Almost all internal hernias after intestinal surgery are mesenteric hernias; however, we should bear in mind that the more lethal transomental hernia is also possible. Therefore, immediate surgical exploration should be performed in a timely manner for internal hernias, especially for patients with early-onset symptoms after laparoscopic intestinal surgery.

DOI： 10.1186/s40792-020-0783-6

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

We recruited 56 colorectal cancer patients and compared the mutational spectrum of tumor tissue DNA, circulating cell-free DNA (ccfDNA) and circulating tumor cell (CTC) DNA (ctcDNA) to evaluate the potential of liquid biopsy to detect heterogeneity of cancer. Tumor tissue DNA, ccfDNA, and ctcDNA were extracted from each patient and analyzed using next-generation sequencing (NGS) and digital PCR. To maximize yields of CTC, three antibodies were used in the capture process. From 34 untreated patients, 53 mutations were detected in tumor tissue DNA using NGS. Forty-seven mutations were detected in ccfDNA, including 20 not detected in tissues. Sixteen mutations were detected in ctcDNA, including five not detected in tissues. In 12 patients (35.3%), mutations not found in tumor tissues were detected by liquid biopsy: nine (26.5%) in ccfDNA only and three (8.8%) in ctcDNA only. Combination analysis of the two liquid biopsy samples increased the sensitivity to detect heterogeneity. From 22 stage IV patients with RAS mutations in their primary tumors, RAS mutations were detected in 14 (63.6%) ccfDNA and in eight (36.4%) ctcDNA using digital PCR. Mutations not detected in primary tumors can be identified in ccfDNA and in ctcDNA, indicating the potential of liquid biopsy in complementing gene analysis. Combination analysis improves sensitivity. Sensitivity to detect cancer-specific mutations is higher in ccfDNA compared with ctcDNA.

DOI： 10.1111/cas.14186

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Liquid biopsy is a collective term that refers to the analysis of tumor-derived biomarkers isolated from biological fluids of cancer patients. Recently, many authors reported the usefulness of liquid biopsy for the management of malignancy. Summary and Key Messages: The peripheral blood of cancer patients is a pool of cells and/or cell products derived from the primary or metastatic tumor, including circulating tumor cells (CTCs), circulating free (cf) DNA or RNA, and exosomes containing proteins, nucleic acids, and lipids. CTCs are tumor cells that can be isolated from peripheral blood. Free circulating DNA with a tumor-specific mutation is called circulating tumor DNA (ctDNA). Some patients who undergo curative surgery experience recurrent disease, which can be due to the presence of minimal residual disease (MRD). Thus, MRD indicates a high risk of relapse. Detection of ctDNA or CTC after surgery is a direct proof of MRD. Molecular volume (e.g., the number of CTCs and level of ctDNA) might reflect tumor burden, thus high molecular volume may indicate poor prognosis. The most notable application of liquid biopsy in cancer is to understand spatial and temporal heterogeneities. Heterogeneity is one of the causes of refractoriness and hampers prediction of chemotherapeutic effect. Emerging mutations that are not present in primary tumors but are found in their metastases can be detected in ctDNA. Some colorectal cancer patients with wild-type RAS do not respond to epidermal growth factor receptor blockade. In a subset of these patients, RAS mutation is detected in ctDNA, indicating heterogeneity.

DOI： 10.1159/000494411

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記述言語：英語  

Primary small intestinal volvulus is defined as torsion in the absence of congenital malrotation, band, or postoperative adhesions. Its occurrence as an early postoperative complication is rare. A 40-year-old woman presented with rectal prolapse, and laparoscopic rectopexy was uneventfully performed. She could not have food on the day after surgery. She started oral intake on postoperative day 3 but developed abdominal pain after the meal. Contrast-enhanced CT revealed torsion of the small intestinal mesentery. An emergent laparotomy showed small intestinal volvulus, without congenital malformation or intestinal adhesions. We diagnosed it as primary small intestinal volvulus. The strangulated intestine was resected, and reconstruction was performed. The patient recovered uneventfully after the second surgery. To the best of our knowledge, this is the first report of primary small intestinal volvulus occurring after rectopexy for rectal prolapse. Primary small intestinal volvulus could be a postoperative complication after laparoscopy.

DOI： 10.1111/ases.12462

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

【背景】絞扼性腸閉塞の本態は消化管血流異常であり、非壊死性絞扼性腸閉塞は阻血が完成していない状態である。診断には造影CTが重要であるが、非壊死性絞扼性腸閉塞の診断にどのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された壊死性絞扼性腸閉塞29例と非壊死性絞扼性腸閉塞48例を対象に造影CT所見を検討した。【結果】70%以上の頻度で認められたものは腸管壁の肥厚、腸間膜浮腫であった。非壊死性で高頻度に認められたのは、腸管壁の肥厚と腸間膜浮腫であり、Kerckring襞の消失、造影低下、血性腹水は壊死性で有意に多い所見であった。造影低下は壊死性では55%に同定されたが、非壊死性では4%と発現頻度が低かった。【考察】非壊死性絞扼性腸閉塞を造影CTで診断するために有用な所見は腸管壁の肥厚と腸間膜浮腫であり、造影低下の発現頻度は低いことに注意が必要である。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J02824&link_issn=&doc_id=20181115390003&doc_link_id=10.11231%2Fjaem.38.959&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.38.959&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Anastomotic leakage (AL) is the most serious and common complication of surgery for rectal cancer, and associated risk factors remain unknown despite developments in laparoscopic surgery. The present study aimed to determine risk factors for AL after laparoscopic anterior resection (AR) of rectal cancer. METHODS: This retrospective cohort study extracted information from a prospective database of all consecutive colorectal resections that proceeded at Nippon Medical School Hospital between January 2011 and December 2015 (n = 865). We identified 154 patients with rectal cancer treated by elective laparoscopic AR with anastomosis using primary double-stapling. Clinical variables and comorbidity, habits, and surgery-related variables were assessed by univariate and multivariate analyses to determine preoperative risk factors for clinical AL. RESULTS: The overall rate of clinical AL was 11.7% (18 of 154 patients), and 5 (27.8%) of 18 patients required revised laparotomy. Data from males were analyzed because AL occurred only in males. Univariate analysis of male patients (n = 100) significantly associated preoperative creatinine values (p = 0.03) and a history of ischemic heart disease (IHD) (p = 0.012) with AL. The frequency of AL tended to increase (p = 0.06) when patients had low AR (p = 0.06) and transanal drainage. Having AL significantly prolonged hospital stays compared with patients without leakage (36.2 vs. 11.1 days; p <  0.01). Multivariate analysis identified a history of IHD (odds ratio [OR], 4.73; 95% confidence interval [CI], 1.27-17.5; p = 0.025] as an independent risk factor for AL. CONCLUSIONS: Male sex and a history of IHD are possible risk factors for AL after elective laparoscopic rectal cancer surgery.

DOI： 10.1186/s12876-018-0846-3

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掲載種別：研究論文（学術雑誌）  

DOI： 10.21873/invivo.11332

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Detection of gene mutations is important for planning molecular targeted therapy. Although most gene mutations are concordant between primary colon cancers and their liver metastases, new mutations can emerge in metastases. The liquid biopsy is a newly developed, gene analytic method to detect mutations in metastatic tumors. In this prospective study, we evaluated the applicability of liquid biopsies in the detection of mutations in primary and metastatic tumors. METHODS: We included 22 patients with liver metastases from colorectal cancer and extracted DNA from primary colorectal tumors, metastatic liver tumors, and peripheral blood (liquid biopsy). Next-generation sequencing (NGS) and digital PCR were performed to detect mutations in these three sample types. RESULTS: We found a total of 36 different mutations in samples from primary tumors, liver metastases, and liquid biopsies using NGS. Twenty-eight of these mutations were found in all three types of samples, whereas liquid biopsy did not identify four mutations that had been found in both primary tumors and liver metastases, but did identify four mutations that were found in liver tumors but not in primary tumors. The sensitivity of liquid biopsies for detecting mutations in liver metastases was 64% (23/36) using NGS and 89% (32/36, P = 0.02) using dPCR. The specificities of NGS and dPCR were 100% (23/23) and 100% (32/32), respectively. CONCLUSIONS: Emerging mutations, which are not found in primary tumors, can be detected in their metastases and liquid biopsies.

DOI： 10.1016/j.ejso.2018.01.224

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記述言語：日本語   出版者・発行元：(株)ヴァンメディカル  

2015年に発刊された急性腹症診療ガイドラインにて『従来の機能性イレウス(腸管麻痺)のみをイレウスとし、従来の機械的イレウスはイレウスとは呼ばず、腸閉塞と定義する』と明文化された。したがって絞扼性イレウスではなく絞扼性腸閉塞である。本疾患の本態は腸間膜および腸管のうっ血と虚血であるため、診断には造影CTが重要である。絞扼早期にはうっ血による画像所見が主として認められ、虚血による所見はないことが多い。したがって絞扼性腸閉塞を早期に診断するためには腸間膜および腸管のうっ血を見逃さないことが重要である。(著者抄録)

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: The self-expanding metallic stent (SEMS) provides effective decompression for patients with malignant large bowel obstruction (MLBO); however, mechanical damage to malignant cells from insertion may negatively affect prognosis, similar to surgical manipulation, and its oncological safety is unclear. We examined mechanical damage from SEMS placement using circulating cell-free DNA (cfDNA) and circulating tumor DNA (ctDNA). METHODS: Between 1 November 2014 and 30 June 2017, 35 MLBO patients were analyzed, comprising 25 SEMS patients and 10 transanal decompression tube (TDT) patients (control). Blood samples were collected before and after decompression on days 0, 1, 3, and 7. cfDNA, ctDNA, white blood cells, C-reactive protein, and lactate dehydrogenase were analyzed. RESULTS: The clinical success rates of SEMS and TDT were 88 and 90%, respectively (p = 1.0). The cfDNA concentration on day 7 was significantly higher in the SEMS group than in the TDT group (992 vs. 308 ng/mL; p = 0.005). A significant increase in ctDNA was observed in the SEMS group compared with the TDT group (83% vs. 22%; p = 0.002). The cfDNA concentration showed strong positive correlations with ctDNA and lactate dehydrogenase (R 2 = 0.838 and 0.593, respectively), and a weak positive correlation with C-reactive protein (R 2 = 0.263). CONCLUSIONS: Despite equivalent clinical success rates, SEMS placement increased plasma levels of cfDNA and ctDNA by tumor manipulation, but TDT did not. Colonic stenting showed oncological risk in terms of molecular analysis.

DOI： 10.1245/s10434-017-6300-x

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Purpose: Diagnostic markers for recurrence of colorectal cancer have not been established. The aim of the present study was to identify new diagnostic markers for recurrence after curative surgery of stage II colon cancer. Materials and Methods: In this study, the prognostic values of the preoperative lymphocyte count and the post/preoperative lymphocyte count ratio (PPLR) were evaluated in 142 patients with localized colon cancer treated with surgery at a single medical center. The associations of patient demographics, blood chemistry, and serum biochemical indices with recurrence-free survival (RFS) and cancer-specific survival (CSS) were examined by univariate and multivariate analyses. Results: Receiver operating characteristic (ROC) curve analysis showed that the optimal cut-off values of the lymphocyte count and PPLR were, respectively, 1555.2/μl and 1.151 for RFS. On univariate analysis, tumor depth of invasion, carbohydrate antigen 19-9 (CA19-9), and preoperative low lymphocyte count (≤1555.2/μl) were all correlated with poorer RFS (p < 0.05). On multivariate analysis, T4, low lymphocyte count, and low PPLR were independent predictors of poor RFS. Furthermore, the patients were categorized into four categories based on preoperative lymphocyte count high/low and PPLR high/low. Patients with a low preoperative lymphocyte count and low PPLR had the poorest RFS and CSS compared to the other patients. Conclusion: The combination of the preoperative lymphocyte count and the PPLR appears to be a potential marker for predicting recurrence of stage II colon cancer.

DOI： 10.18632/oncotarget.23510

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

The patient was a 70-year-old woman who was diagnosed with obstructive transverse colon cancer suspected of invading the abdominal wall by abdominal CT imaging. Since the preoperative electrocardiogram showed an ischemic change, echocardiography and coronary angiography were performed. We diagnosed chronic heart failure and angina pectoris because echocardiography showed low cardiac function(left ventricular ejection fraction; LVEF 37%)and coronary angiography indicated triple-vessel disease. We firstly performed coronary artery bypass graft surgery following self-expanding metallic stent placement as a bridge to surgery(BTS), because we judged this patient as a perioperative high-risk case. After improvement of cardiac function(LVEF 49%), expanded right hemicolectomy with partial resection of abdominal wall could be performed without perioperative complications. Colonic stenting as a BTS allowed us to treat comorbidities properly, and perform a radical surgery safely for such a high-risk patient.

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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DOI： 10.1158/1538-7445.AM2017-5682

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：SPRINGER  

Purpose Daikenchuto (DKT) has a stimulant effect on intestinal motility and reportedly has a positive effect on postoperative intestinal motility in patients with sigmoid colon cancer. In this study, we investigated the effects of DKT in patients with right-side colon cancer.
Methods This retrospective study included 88 patients with right-side colon cancer. We orally administered 7.5 g of DKT in the DKT group and did not administer any DKT to patients in the no-DKT group. All patients ingested radiopaque markers 2 h before surgery, which were used to assess intestinal motility. The postoperative intestinal motility was radiologically assessed by counting the numbers of residual markers in the large and small intestines.
Results The DKT and no-DKT groups showed no marked differences in the total number of residual markers or number of residual markers in the small intestine. However, in the elderly subgroup, the total number of residual markers in the DKT group was significantly less than in the no-DKT group.
Conclusion Although DKT had some small effect on the postoperative intestinal motility for most patients, it may have positive effects in elderly patients.

DOI： 10.1007/s00595-016-1449-7

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Association of Computer Science and Information Technology  

Small bowel obstruction is a common acute abdomen condition which can play a role in death. Small bowel strangulation (SBS) refers to a small bowel obstruction associated with bowel ischemia. Patients with SBS need emergency surgery because the ischemic small bowel can become necrotic in a short time, causing sepsis and death. Nowadays the "gold standard" for diagnosing SBS is via computed tomography (CT) scanned images. However, an easier way to detect SBS is desired among emergency medicine physicians. Thus, we tried to develop a rapid test using circulating cell-free DNA (ccfDNA). ccfDNA is part of the DNA from a cell that died because of apoptosis or necrosis. The size of ccfDNA varies depending on the origination of cell death. If a patient has SBS, long-size ccfDNA would appear in the peripheral blood. We used data including the concentration of ccfDNA in the blood of certain patients as training data to make a support vector machine, a decision tree, and a learned random forest. We evaluated these classifiers using leave-one-out cross-validation. These machine-learning methods performed well. In addition, the decision tree and random forest results indicate that long-size ccfDNA is important for classifying SBS. In this paper, we demonstrate that machine learning can be an alternative method for detecting SBS and that the concentration of ccfDNA, especially long ccfDNA, contributes to detecting SBS.

DOI： 10.18178/ijmlc.2017.7.3.616

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：MEDICAL ASSOC NIPPON MEDICAL SCH  

Introduction: Single-port laparoscopic surgery has some technical limitations with respect to control of the forceps inserted through the single-access site, which results in increased internal collisions due to coaxial alignment of the instruments, as well as and decreased range of motion and visualization. To overcome these limitations, we employ a "modified marionette technique" as a way to carry out laparoscopic colorectal surgery.
Materials and Surgical Technique: The procedures for the modified marionette technique are performed as follows: An Internal Organ Retractor (IOR)TM and an atraumatic clip designed to firmly grasp tissue, with 1-0 nylon thread, are inserted through a 12-mm trocar and secured in place where adequate visualization and traction for cutting with a radio knife is required. A looped 1-0 nylon thread put through an 18-gauge injection needle is pierced through the abdominal wall, the looped nylon extruded, and the nylon attached to the IOR is pulled out by threading the looped nylon thread. This allows for adequate traction from outside the body through the abdominal wall and appropriate placing adjustments.
Conclusion: The "modified marionette technique" using IOR introduced here is an easy, economical, effective and safe traction technique for colorectal surgeries. This technique will be a useful tool for performing both reduced port and multiport laparoscopic colorectal surgeries.

DOI： 10.1272/jnms.84.49

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Meckel's diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel's diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.8 g/dl. The bleeding site was detected by neither upper gastrointestinal endoscopy nor colonoscopy. Transanal double-balloon enteroscopy showed a diverticulum with an ulceration at a site approximately 50 cm from the ileocecal valve and a polypoid lesion inside of the diverticulum. Histopathological examination of a polypoid lesion revealed an ectopic gastric mucosa of the fundic type. Furthermore, technetium-99m pertechnetate scintigraphy showed a hot spot in her lower right abdomen. On the basis of these findings, she was diagnosed as having hemorrhagic Meckel's diverticulum. Single-incision laparoscopy-assisted segmental bowel resection of the ileum was performed. The patient recovered well, and she was discharged from the hospital on postoperative day 7. She was doing well 6 months later without evidence of reoccurrence. In this report, we describe a case of Meckel's diverticulum with a polypoid lesion; hemorrhage may have occurred owing to the ulceration of the ileal mucosa with which the polypoid lesion directly came in contact. We consider this case to be of interest to gain insight into the site and mechanism of ulceration associated with Meckel's diverticulum.

DOI： 10.1186/s40792-016-0252-4

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：WILEY-BLACKWELL  

In this study, we evaluated the clinical utility of detecting KRAS mutations in circulating cell-free (ccf) DNA of metastatic colorectal cancer patients. We prospectively recruited 94 metastatic colorectal cancer patients. Circulating cell-free DNA was extracted from plasma samples and analyzed for the presence of seven KRAS point mutations. Using the Invader Plus assay with peptide nucleic acid clamping method and digital PCR, KRAS mutations were detected in the ccfDNA in 35 of 39 patients previously determined to have primary tumors containing KRAS mutations using the Luminex method, and in 5 of 55 patients with tumors containing wild-type KRAS. Curative resection was undertaken in 7 of 34 patients with primary and ccfDNA KRAS mutations, resulting in the disappearance of the mutation from the cell-free DNA in five of seven patients. Three of these patients had tumor recurrence and KRAS mutations in their ccfDNA reappeared. Epidermal growth factor receptor blockade was administered to 24 of the KRAS tumor wildtype patients. Of the 24 patients with wild-type KRAS in their primary tumors, three patients had KRAS mutations in their ccfDNA and did not respond to treatment with epidermal growth factor receptor (EGFR) blockade. We also detected a new KRAS mutation in five patients during chemotherapy with EGFR blockade, before disease progression was detectable with imaging. The detection of KRAS mutations in ccfDNA is an attractive approach for predicting both treatment response and acquired resistance to EGFR blockade, and for detecting disease recurrence.

DOI： 10.1111/cas.12959

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記述言語：英語  

We report a case involving a patient with colon cancer who underwent 5-fluorouracil (5-FU) rechallenge and maintained an oncological effect for a long period after encephalopathy caused by 5-FU. Our patient was a 61-year-old man who was diagnosed with adenocarcinoma of the ascending colon with direct liver invasion. He underwent right hemicolectomy with partial liver resection followed by adjuvant chemotherapy with modified FOLFOX6 (mFOLFOX6). Ten months after completion of mFOLFOX6, his carcinoembryonic antigen concentration increased, and ascites was revealed by computed tomography 2 months later. We started FOLFIRI, and he was taken to our hospital by ambulance because of loss of consciousness 10 days after the start of the third cycle of FOLFIRI. Laboratory investigations showed hyperammonemia and elevations of his serum creatinine and blood urea nitrogen concentrations. Brain computed tomography demonstrated no abnormalities. Transfusion of 1500 ml of crystalloid fluid resulted in gradual recovery over the next 12 h. His ammonia concentration decreased to a normal level. Twelve days after onset of the encephalopathy, we restarted FOLFIRI, but the dose of continuous 5-FU was decreased by 20 %. The patient's carcinoembryonic antigen concentration considerably decreased from 376.5 to 19.9 ng/ml, and his ascites disappeared. Nineteen months after the resumption of FOLFIRI, he underwent 34 courses of FOLFIRI and maintained stable disease. The encephalopathy did not recur.

DOI： 10.1007/s13691-016-0243-0

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Skeletal mass depletion has been reported to be a prognostic factor for cancer patients. However, special and expensive devices are required to measure skeletal mass, and this is a major reason why skeletal mass is not used extensively for prognostic marker in clinical settings. We developed a new method to measure skeletal mass for use as a prognostic marker using CT images without special and expensive devices. In this study, we evaluated the usefulness of skeletal mass as measured by this new method as a prognostic marker for gastrointestinal cancer patients. METHOD: Patients who died from gastrointestinal cancer between March 2010 and October 2013 were included. We measured the right-sided maximum psoas muscle cross sectional area (MPCA) by using CT images before surgery and after the patients developed a terminal condition. The maximum psoas muscle cross sectional area ratio (MPCA-R) was defined as follows: MPCA-R=MPCA before surgery/MPCA after developing a terminal condition. We evaluated the correlation between MPCA-R and survival. RESULT: Fifty-nine patients were included. The median survival was 44 days, and MPCA-R was significantly correlated with survival (p=0.001). On receiver operating characteristic (ROC) analysis, the area under the curve (AUC) to predict 30-day and 90-day survival was 0.710 and 0.748, respectively. CONCLUSION: MPCA-R is a new and novel prognostic marker for gastrointestinal cancer patients in terminal condition.

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：日本外科代謝栄養学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本分子腫瘍マーカー研究会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：日本消化器病学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(NPO)日本食道学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本創傷治癒学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

本邦で2012年に保険収載された大腸ステントは,閉塞性大腸癌治療に大きなparadigm shiftを起している.術前減圧目的の大腸ステント留置(bridge to surgery:BTS)は,良好な短期成績が報告されている一方,長期予後への懸念から,欧州消化器内視鏡学会(ESGE)のガイドラインにおいて否定的な推奨であった.しかし,近年,長期予後の安全性を示唆する報告が多数出され,2020年のupdate版では一転,推奨する形となった.今後,さらに広がることが予想されるBTS治療戦略であるが,長期予後のみならず,手術までの至適待機期間,ステントの種類,右側結腸癌での効果,経肛門的減圧管との比較など,解決すべきclinical questionは多い.本稿では,BTSのこれまでの治療成績を概説し,今後の展望も含めて述べる.(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01146&link_issn=&doc_id=20201202370003&doc_link_id=10.3862%2Fjcoloproctology.73.410&url=https%3A%2F%2Fdoi.org%2F10.3862%2Fjcoloproctology.73.410&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：英語   出版者・発行元：(一社)日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：日本外科代謝栄養学会  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

経鼻減圧管(long tube:以下,LT)挿入中に2度の順行性腸重積を発症した症例を経験したので報告する。症例は20代男性。潰瘍性大腸炎の治療中に膿瘍形成性虫垂炎を原因とする癒着性腸閉塞を発症した。LTを挿入し症状が改善したため一度抜去したが,再び腸閉塞となった。保存的加療目的にLTを再挿入したが症状が改善せず手術を施行した。空腸に3ヶ所順行性腸重積を認めたため,Hutchinson手技によりこれを解除した。術後イレウス予防目的で継続してLTを留置していたが,再び腸閉塞症状をきたし,画像所見で腸重積と診断した。再開腹を行い,順行性腸重積を起こしていたためこれを解除し術中にLTを抜去した。その後腸重積の再発は起こしていない。LT抜去時の操作や陰圧吸引などで逆行性腸重積が医原性に惹起されることが数多く報告される。自験例は順行性腸重積でまれな病態であるが,LTの合併症として念頭に置かなければならない病態と考えられた。(著者抄録)

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J02824&link_issn=&doc_id=20190912300015&doc_link_id=10.11231%2Fjaem.39.887&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.39.887&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：英語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本胃癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J04260&link_issn=&doc_id=20181129410006&doc_link_id=130007530218&url=http%3A%2F%2Fci.nii.ac.jp%2Fnaid%2F130007530218&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_1.gif

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

本稿では、分子生物学的分類であるConsensus Molecular Subtype(CMS)、新たな分子生物学的診断法であるLiquid biopsy、そして分子生物学的検査から個別化治療を推進するSCRUM-Japanの取り組みについて概説する。Liquid biopsyにはCirculating tumor cells(CTC)やcirculating tumor DNA(ctDNA)、exosomeに含まれたmicroRNAが用いられる。CTC数やctDNA量などのMolecular volumeは腫瘍量を反映し、その増減により治療効果をモニタリングできる。術後のCTCやctDNAの存在は術後再発危険因子である。原発巣と転移巣の分子プロファイルは異なることがあるため、Liquid biopsyを用いたHeterogeneityの把握は分子標的薬の効果予測に有用である。(著者抄録)

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本医科大学医学会  

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記述言語：日本語   出版者・発行元：日本外科代謝栄養学会  

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記述言語：日本語   出版者・発行元：日本外科代謝栄養学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語   出版者・発行元：Springer Singapore  

The enhanced recovery after surgery (ERAS) protocol first established in the colorectal surgery has now been extended to application to various types of surgical procedures such as gastrectomy. Many gastric surgeons consider that it is feasible and useful to apply most of the ERAS elements to gastric surgery, but one of the greatest concerns for gastric surgeons is early postoperative feeding, especially early oral feeding. The evidence to date now shows little concern of increased morbidity by early oral feeding in gastric surgery patients. However, in contrast to colonic surgery, preoperative malnutrition is more frequent, and postoperative intake is more restricted in gastric surgery patients even though they can eat early in their postoperative course. Thus, some patients need an individualized approach because of these specific characteristics of gastric surgery that differ from those of colonic surgery. Early enteral tube feeding is a good option for those with preoperative malnutrition and those predicted to have poor oral intake after surgery. Also, patient-controlled feeding (selection of diet by patients) seems promising and should be further investigated.

DOI： 10.1007/978-981-10-6796-9_9

Scopus

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記述言語：英語   出版者・発行元：Springer Singapore  

For over a century, surgeons have used preoperative mechanical bowel preparation (MBP) to decrease fecal mass within the large bowel. However, over the past 2 decades, several randomized trials and a large meta-analysis have failed to demonstrate reduced rates of surgical site infection (SSI) after elective colorectal surgery in patients who received MBP alone. It was reported in 1971 that MBP removed gross feces but did not alter the number of microorganisms in the colonic lumen. MBP with oral antibiotics, but not alone, reduces the prevalence of SSI. MBP does not affect the prevalence of anastomotic leakage in colon surgery. However, we should not equate rectal surgery with colon surgery because the rate of anastomotic leakage is higher in the former. Also, omitting MBP may be a risk factor for anastomotic leakage in elderly patients. MBP does not reduce morbidity, including SSI, in patients undergoing digestive tract surgery (not for colorectal cancer), such as esophagocoloplasty, hepatectomy or pancreaticoduodenectomy. MBP can negatively affect intestinal motility after surgery. Of note, omission of MBP may negatively affect long-term survival
however, this hypothesis is controversial.

DOI： 10.1007/978-981-10-6796-9_3

Scopus

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：南江堂  

DOI： 10.15106/j_geka79_1371

CiNii Books

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記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

症例は70歳、女性。腹部CTにて腹壁浸潤を伴う閉塞性横行結腸癌と診断された。入院時の心電図にて広範にST低下を認めたため、冠動脈造影検査を施行した。冠動脈三枝に狭窄が指摘され狭心症と診断され、周術期合併症ハイリスク症例と判断した。治療は閉塞性大腸癌に対して大腸ステントを留置後、先に冠動脈バイパス術を施行した。心機能改善後、拡大結腸右半切除術+腹壁合併切除を施行した。術後合併症は認めず、病理所見上根治切除が可能であった。耐術能不良な閉塞性大腸癌に対し、大腸ステント留置により緊急手術を回避(bridge to surgery:BTS)することで、計画的な併存疾患の治療が可能となり、安全性かつ根治性に優れた結腸癌手術が可能であった。(著者抄録)

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その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00296&link_issn=&doc_id=20171221480273&doc_link_id=%2Fab8gtkrc%2F2017%2F004412%2F273%2F1868-1870%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2017%2F004412%2F273%2F1868-1870%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：日本外科感染症学会  

【目的】複雑性虫垂炎に対し、保存的治療が奏効せず手術に至った症例の治療成績を明らかにし、複雑性虫垂炎に対する保存的治療の安全性を検討する。【対象・方法】対象は2012年1月から2016年12月の複雑性虫垂炎症例。汎発性腹膜炎、腸閉塞、妊娠例を除いた複雑性虫垂炎症例のうち、保存的治療が奏効せず手術が施行された待機手術群と、緊急手術群の2群に関し、治療成績を後方視的に比較検討した。【結果】376例中146例(38%)が複雑性虫垂炎であり、そのうち待機手術群15例、緊急手術群85例であった。術後合併症発症率は待機手術群で有意に少なく(6.6.vs 34%、P=0.03)、術後在院日数は待機手術群で短い傾向であった(6.8±3.0日vs 8.5±5.8日:P=0.06)。【結語】保存的治療が奏効せず手術が必要となった場合でも、周術期治療成績は良好であった。複雑性虫垂炎に対するIAは安全な治療法である。(著者抄録)

CiNii Books

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER SOC CLINICAL ONCOLOGY  

DOI： 10.1200/JCO.2017.35.15_suppl.3598

Web of Science

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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記述言語：英語  

J-GLOBAL

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記述言語：日本語   出版者・発行元：日本腹部救急医学会  

&lt;p&gt;【背景】絞扼性腸閉塞の本態は消化管の虚血であるため，診断には造影CTが重要である。しかし，どのような所見が有用であるか明らかではない。【方法】術前に造影CTが施行された壊死性絞扼性腸閉塞21例と非壊死性絞扼性腸閉塞33例を対象に造影CT所見を検討した。【結果】70％以上の頻度で認められたものはbeak sign，flower bouquet sign，腸管壁の肥厚，腸間膜混濁であった。beak sign，腸管壁の肥厚，腸間膜混濁は非壊死性に限っても高い頻度で同定された。造影低下は壊死性では52％に同定されたが，非壊死性では6％と発現頻度が低かった。【考察】腸管壊死をきたす前に絞扼性腸閉塞を造影CTで診断するために有用な所見はbeak sign，腸管壁の肥厚，腸間膜混濁であり，造影低下の発現頻度は低いことに注意が必要である。&lt;/p&gt;

DOI： 10.11231/jaem.37.581

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：英語   出版者・発行元：日本癌学会  

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記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

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記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：日本語   出版者・発行元：日本臨床外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2016-3135

Web of Science

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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記述言語：英語   掲載種別：研究発表ペーパー・要旨（国際会議）   出版者・発行元：AMER ASSOC CANCER RESEARCH  

DOI： 10.1158/1538-7445.AM2016-3134

Web of Science

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記述言語：日本語   出版者・発行元：日本外科代謝栄養学会  

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記述言語：日本語   出版者・発行元：(一社)日本門脈圧亢進症学会  

大腸癌根治切除後に術後補助化学療法としてFOLFOXを施行した32例を対象に、VINCENTを用いてFOLFOX開始前、終了時、終了1年後の脾臓容積を測定した。その結果、1)治療開始前と比較し、終了時には68.7%の症例で脾臓容積が増加し、うち34.3%の症例では1年経過後も脾臓容積の増加が継続していた。2)脾臓容積増加の有無別に採血データの推移をみると、脾臓容積増加を認めた群ではASTは治療前と終了時、治療前と終了1年後で、ALTは治療前と終了時で、γGTPは治療前と終了時でそれぞれ有意な変化が認められた。一方、容積変化のない群ではAST、ALT、γGTPは治療前、終了時、1年後でいずれも有意な変化は認められなかった。

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記述言語：日本語   出版者・発行元：(一社)日本消化器内視鏡学会-関東支部  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：日本外科系連合学会  

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記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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