記述言語：英語   掲載種別：研究論文（学術雑誌）  

A significant association exists between the gut microbiome and colorectal carcinogenesis, as well as cancer progression. It has been reported that Escherichia coli (E. coli) containing polyketide synthetase (pks) island contribute to colorectal carcinogenesis by producing colibactin, a polyketide-peptide genotoxin. However, the functions of pks+ E. coli in initiation, proliferation, and metastasis of colorectal cancer (CRC) remain unclear. We investigated the clinical significance of pks+ E. coli to clarify its functions in CRC. This study included 413 patients with CRC. Pks+ E. coli of tumor tissue and normal mucosal tissue were quantified using droplet digital PCR. Pks+ E. coli was more abundant in Stages 0-I tumor tissue than in normal mucosal tissue or in Stages II-IV tumor tissue. High abundance of pks+ E. coli in tumor tissue was significantly associated with shallower tumor depth (hazard ratio [HR] = 5.0, 95% confidence interval [CI] = 2.3-11.3, p < 0.001) and absence of lymph node metastasis (HR = 3.0, 95% CI = 1.8-5.1, p < 0.001) in multivariable logistic analyses. Pks+ E. coli-low and -negative groups were significantly associated with shorter CRC-specific survival (HR = 6.4, 95% CI = 1.7-25.6, p = 0.005) and shorter relapse-free survival (HR = 3.1, 95% CI = 1.3-7.3, p = 0.01) compared to the pks+ E. coli-high group. Pks+ E. coli was abundant in Stages 0-I CRC and associated with CRC prognosis. These results suggest that pks+ E. coli might contribute to carcinogenesis of CRC but might not be associated with tumor progression.

DOI： 10.1111/cas.16088

PubMed

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記述言語：日本語   出版者・発行元：日本手術医学会  

腹腔鏡下手術やロボット支援手術の登場など外科手術の進歩の一方で,外科医の減少,地域格差,医師の時間外労働の上限規制や持続可能な開発目標への対応などが求められ,外科医を取り巻く環境は大きく変化している。本稿ではこれらに対する当科の取り組みとして,AI技術の手術への導入と,再利用可能な医療デバイスを用いた腹腔鏡下手術に焦点を当てる。AIシステムEurekaは手術中の解剖構造をリアルタイムで強調・視覚化し,外科医の判断を支援することで術中操作の安全性を向上させ,また手術の学習効果を高めることが期待される。また,リユーザブルデバイスBiSectとBiClampを使用した腹腔鏡補助下大腸切除術は高い経済性・資源回収性を示す一方で,操作や手技に習熟を要するため,当科で行っている工夫について詳述する。これらの取り組みは,将来的に外科医の労働環境の改善,医療経済面,そして環境への配慮に貢献すると考える。(著者抄録)

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掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40792-023-01784-8

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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：日本手術医学会  

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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：日本外科系連合学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE: Extended colectomy is sometimes chosen for treatment of transverse colon cancer (TCC) because of concerns about short- and long-term outcomes. However, there is still a lack of evidence regarding the optimal surgical procedure. METHODS: We retrospectively collected and analyzed data of patients who underwent surgical treatment of pathological stage II/III TCC at four hospitals from January 2011 to June 2019. We excluded the patients with TCC located at distal transverse colon, and just evaluated and analyzed proximal and middle third TCC. Inverse probability treatment-weighted propensity score analyses was used to compare short- and long-term outcomes between patients who underwent segmental transverse colectomy (STC) and those who underwent right hemicolectomy (RHC). RESULTS: In total, 106 patients were enrolled in this study (STC group, n = 45; RHC group, n = 61). The patients' backgrounds were well balanced after matching. The incidence of major postoperative complications (Clavien-Dindo grade ≥ III) was not significantly different between the STC and RHC groups (4.5% vs. 5.6%, respectively; P = 0.53). The 3-year recurrence-free survival and overall survival rates were not significantly different between the STC and RHC groups (88.2% vs. 81.8%, P = 0.86 and 90.3% vs. 91.9%, P = 0.79, respectively). CONCLUSION: RHC has no significant benefits over STC with respect to either short- or long-term outcomes. STC with necessary lymphadenectomy could be an optimal procedure for proximal and middle TCC.

DOI： 10.1007/s00384-023-04360-6

PubMed

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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）  

PURPOSE: In this study, we aimed to investigate the oncological impact of postoperative infection in patients with malignant large bowel obstruction managed by self-expandable metallic stent placement as a bridge to surgery. METHODS: The cohort of this multicenter retrospective study comprised 129 patients with pathological stage II/III malignant large bowel obstruction who had undergone bridge to surgery. Patients were allocated to no-postoperative infection (n = 116) and postoperative infection groups (n = 13). RESULTS: The postoperative infection group had a significantly greater proportion of men, fewer harvested lymph nodes, and longer postoperative hospital stays than did the no-postoperative infection group. Self-expandable metallic stent-related variables, including clinical failure, were not associated with postoperative infection. Male sex and low body mass index were identified as risk factors for postoperative infection by multivariate logistic regression. Three-year relapse-free survival rates were 75.5% and 30.8% in the no-postoperative infection and postoperative infection groups, respectively; this difference is statistically significant. Male sex, postoperative infection, and T4 were identified as independent prognostic factors by multivariate Cox proportional hazard analysis. The postoperative infection group had a significantly higher total recurrence rate and shorter interval to recurrence than did the no-postoperative infection group. CONCLUSION: To the best of our knowledge, this is the first study to show that postoperative infection in bridge to surgery patients has a negative oncological impact. This finding indicates that further improvement in perioperative management of bridge to surgery patients is required to minimize postoperative infection and that patient-risk stratification and additional therapy would contribute to improving oncological outcomes.

DOI： 10.1007/s00384-022-04290-9

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

AIM: To investigate the impact of postoperative infection (PI), surgical site infection, and remote infection (RI), on long-term outcomes in patients with colorectal cancer (CRC). METHODS: The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 1817 curative stage I/II/III CRC patients from April 2013 to March 2015. Patients were divided into the No-PI group and the PI group. We examined the association between PI and oncological outcomes for cancer-specific survival (CSS) and overall survival (OS) using Cox proportional hazards models and propensity score matching. RESULTS: Two hundred and ninety-nine patients (16.5%) had PIs. The 5-year CSS and OS rates in the No-PI and PI groups were 92.8% and 87.6%, and 87.4% and 83.8%, respectively. Both the Cox proportional hazards models and propensity score matching demonstrated a significantly worse prognosis in the PI group than that in the No-PI group for CSS (hazard ratio: 1.60; 95% confidence interval: 1.10-2.34; P = .015 and P = .031, respectively) but not for OS. RI and the PI severity were not associated with oncological outcomes. The presence of PI abolished the survival benefit of adjuvant chemotherapy. CONCLUSIONS: These results suggest that PI after curative CRC surgery is associated with impaired oncological outcomes. This survival disadvantage of PI was primarily derived from surgical site infection, not RI, and PI induced lower efficacy of adjuvant chemotherapy. Strategies to prevent PI and implement appropriate postoperative treatment may improve the quality of care and oncological outcomes in patients undergoing curative CRC surgery.

DOI： 10.1002/ags3.12615

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：(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：英語   掲載種別：研究論文（学術雑誌）  

AIM: Adhesive small bowel obstructions (SBO) are one of the most common complications following abdominal surgery, and they decrease patient quality of life. Since 2000, laparoscopic surgery has been employed with increasing frequency, as has adhesion prevention material (APM). In this study we tried to evaluate whether laparoscopic surgery and APM reduce the incidence of SBO. METHODS: In Cohort 1, we included patients who developed SBO and received inpatient treatment between 2015 and 2018. We evaluated the elapsed time between precedent surgery and the onset of SBO, and what kind of surgery most often causes SBO. In Cohort 2, we included patients who underwent digestive surgery between 2012 and 2014 and evaluated SBO incidence within 5 y after the precedent surgery. RESULTS: In all, 2058 patients were included in Cohort 1. Of these, 164 had experienced no precedent surgery. Among patients with a history of abdominal surgery, 29.7% experienced SBO within 1 y after the precedent surgery and 48.1% within 3 y. Altogether, 18798 patients were analyzed in Cohort 2. The incidence of SBO after laparoscopic colorectal surgery was lower than that of open colorectal surgery (P < .001), and laparoscopic gastroduodenal surgery was also lower (P = .02). However, there were no differences between laparoscopic and open surgery for other types of surgery. The use of APM had no effect on SBO incidence in any type of abdominal surgery. CONCLUSIONS: Laparoscopic surgery helps to reduce SBO incidence only in colorectal surgery, and possibly in gastroduodenal surgery. APM does not reduce SBO after abdominal surgery.

DOI： 10.1002/ags3.12569

PubMed

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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: The treatment strategies for acute appendicitis, such as emergency appendectomy (EA), interval appendectomy (IA), and repeating nonoperative management (NOM), are controversial. In this study, we examined the preoperative factors that can be used to distinguish which patients should undergo IA. METHODS: We retrospectively identified 902 patients who underwent surgery for appendicitis in our hospital from January 2010 to December 2021. Of these patients, 776 were included in this study. The patients were divided into two groups: those with a periappendiceal fluid collection (PAFC) on preoperative computed tomography (PAFC-positive group, n = 170) and those without a PAFC (PAFC-negative group, n = 606). In each group, we compared patients who underwent EA and IA. RESULTS: In the PAFC-positive group, patients who underwent EA had a significantly higher postoperative complication rate than those who underwent IA (40.5% vs. 24.0%, p = 0.037). In the multivariate analysis, only the presence of PAFC was significantly associated with an increased risk of postoperative complications (odds ratio, 7.11; 95% confidence interval, 2.73-18.60; p < 0.001). The presence of PAFC alone was not significantly associated with an increased risk of IA or NOM failure (odds ratio, 1.48; 95% confidence interval, 0.19-11.7; p = 0.71). The rate of neoplasia on pathologic examination was significantly higher in the PAFC-positive than PAFC-negative group (7.6% vs. 1.5%, p < 0.001); the rate of carcinoma was also higher in the PAFC-positive group (2.4% vs. 0.17%, p = 0.02). CONCLUSIONS: The presence of PAFC on preoperative computed tomography was found to be a risk factor for postoperative complications but not IA or NOM failure. It was also correlated with neoplasia as the etiology of appendicitis. Therefore, PAFC positivity is useful as an indication for IA.

DOI： 10.1186/s13017-022-00437-9

PubMed

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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)日本産科婦人科内視鏡学会  

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記述言語：日本語   出版者・発行元：(一社)日本産科婦人科内視鏡学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: 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：金原出版(株)  

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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）  

Background: Some studies have reported that adhesion prevention barriers (APBs) reduce adhesion after abdominal surgery; however, evidence showing that APBs reduce the incidence of postoperative small bowel obstruction (SBO), one of the most serious complications after abdominal surgery, is little. One concern is that APBs are usually applied only under the midline incision, although adhesion can occur at any place in the peritoneum where an incision is made during surgery. INTERCEEDⓇ is an APB that reportedly prevents postoperative SBO after surgery. This study aims to assess the clinical utility of INTERCEEDⓇ for the prevention of SBO after laparoscopic colorectal cancer surgery and determine whether the application site of INTERCEEDⓇ affects the incidence of SBO. Methods/Design: This study is a prospective, multicenter, observational study conducted in Japan. The primary end point is the incidence of postoperative SBO 2 years after laparoscopic colorectal cancer surgery. The secondary end points include whether the site of the application of INTERCEEDⓇ affects the incidence of SBO. Each surgeon selects one of the following three procedures: 1) INTERCEEDⓇ is placed only under the midline incision; 2) INTERCEEDⓇ is placed at the site of bowel mobilization and/or lymph node dissection, but not under the midline incision; and 3) INTERCEEDⓇ is placed at both sites. Discussion: This is the first study to assess whether the placement of APBs affects the incidence of SBO. The study results may lead to a subsequent randomized study.

DOI： 10.23922/jarc.2021-030

PubMed

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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：(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：(株)癌と化学療法社  

症例は60歳代、女性。盲腸癌に対して腹腔鏡補助下回盲部切除術を施行した(pT3、pN2b、pM0、pStage IIIc)。術後補助化学療法としてFOLFOXを12コース施行したが、終了24ヵ月後にCEAの上昇を認め、PET-CTにてFDG集積を伴う腹膜播種結節を多数認めた。CAPOX/bevacizumab療法を4コース施行し、PET-CTで結節の縮小を認めたため腹膜播種切除術、両側卵巣切除術によりR0切除が行えた。腹膜播種再発症例ではCAPOX/bevacizumab投与により病勢コントロールが可能となり、R0切除が得られる可能性がある。(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=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600089&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F089%2F2006b2008%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F089%2F2006b2008%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：(株)癌と化学療法社  

症例は60歳代、女性。盲腸癌に対して腹腔鏡補助下回盲部切除術を施行した(pT3、pN2b、pM0、pStage IIIc)。術後補助化学療法としてFOLFOXを12コース施行したが、終了24ヵ月後にCEAの上昇を認め、PET-CTにてFDG集積を伴う腹膜播種結節を多数認めた。CAPOX/bevacizumab療法を4コース施行し、PET-CTで結節の縮小を認めたため腹膜播種切除術、両側卵巣切除術によりR0切除が行えた。腹膜播種再発症例ではCAPOX/bevacizumab投与により病勢コントロールが可能となり、R0切除が得られる可能性がある。(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=2020&ichushi_jid=J00296&link_issn=&doc_id=20210118600089&doc_link_id=%2Fab8gtkrc%2F2020%2F004713%2F089%2F2006b2008%26dl%3D3&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004713%2F089%2F2006b2008%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：(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：研究論文（学術雑誌）  

PURPOSE: This study investigated the short- and long-term outcomes of 18- and 22-mm-diameter self-expandable metallic stent (SEMS) as a bridge to surgery (BTS) in patients with malignant large bowel obstruction (MLBO). METHODS: Sixty-nine pathological stage II and III colorectal cancer patients who underwent BTS were included in this multi-institutional retrospective study. Patients were divided into two groups regarding the diameter of SEMS: an 18-mm group (n = 30) and a 22-mm group (n = 39). RESULTS: There was no significant difference in the clinical success rate, but both of the two re-obstructions observed occurred in the 18-mm group. The 18-mm group showed a trend toward a higher incidence of overall postoperative complications (Clavien-Dindo grading ≥ II) than the 22-mm group (33.3% vs. 10.3%, P = 0.061). The 3-year disease-free and overall survival showed no significant differences between the 18- and 22-mm groups (78.2% vs. 68.8%, P = 0.753 and 92.8% vs. 82.1%, P = 0.471, respectively). CONCLUSION: SEMS of 18 and 22 mm diameter confer statistically equivalent short- and long-term outcomes as a BTS.

DOI： 10.1007/s00595-020-02185-2

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Neoadjuvant chemotherapy to treat locally advanced rectal cancer is an effective therapeutic strategy for the prevention of local recurrence and distant organ metastasis after surgery. OBJECTIVES: To assess the prognostic significance of histopathological tumor response in rectal cancer patients undergoing neoadjuvant chemotherapy. METHODS: This study included patients with operable rectal cancer who received neoadjuvant chemotherapy using the FOLFOX regimen (5-fluorouracil, l-leucovorin, and oxaliplatin) in a hospital between February 2012 and November 2017. The main outcome measure was disease-free survival with respect to histopathological response to neoadjuvant chemotherapy in resected specimens. RESULTS: The median follow-up was 32 months. Of 48 patients treated with neoadjuvant FOLFOX, 24 (50%) were classified as responders, which included two patients with pathological complete response and 22 patients with partial response. The remaining 24 patients (50%) were classified as nonresponders. Responders had a significantly better 3-year disease-free survival than nonresponders (86% vs. 62%, p = .02). CONCLUSIONS: Patients whose surgical specimens show a pathological complete response or partial response have good oncologic outcomes.

DOI： 10.1002/jso.26245

PubMed

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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：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：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：(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：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：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：日本分子腫瘍マーカー研究会  

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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

PubMed

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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：日本外科代謝栄養学会  

5-Fluorouracil(5-FU)の代謝には骨格筋量と概日リズムが関与していると報告されている。そのため、化学療法施行中の運動量や睡眠時間の低下が有害事象の発生に影響を与える可能性があると考えられるが、両者の関係性は明らかではない。本研究では5-FUを含む大腸癌化学療法施行患者の好中球減少発生に運動量と睡眠量が与える影響を検証した。患者に活動量計を装着させ、化学療法施行中の歩行数、睡眠時間を計測し、好中球減少発生頻度を比較した。対象症例数は59例、正常群は45例、減少群は14例であった。好中球減少群の浅睡眠時間は有意に長かったが、総睡眠時間、総歩行数に差はなかった。機械学習では重要度の上位すべてを睡眠時間に関連する項目が占めていたが、歩行数に関連した項目の重要度は低かった。睡眠時間とその質が5-FUの代謝と好中凝減少に影響を与える可能性が示唆された。(著者抄録)

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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  

5-Fluorouracil(5-FU)の代謝には骨格筋量と概日リズムが関与していると報告されている。そのため、化学療法施行中の運動量や睡眠時間の低下が有害事象の発生に影響を与える可能性があると考えられるが、両者の関係性は明らかではない。本研究では5-FUを含む大腸癌化学療法施行患者の好中球減少発生に運動量と睡眠量が与える影響を検証した。患者に活動量計を装着させ、化学療法施行中の歩行数、睡眠時間を計測し、好中球減少発生頻度を比較した。対象症例数は59例、正常群は45例、減少群は14例であった。好中球減少群の浅睡眠時間は有意に長かったが、総睡眠時間、総歩行数に差はなかった。機械学習では重要度の上位すべてを睡眠時間に関連する項目が占めていたが、歩行数に関連した項目の重要度は低かった。睡眠時間とその質が5-FUの代謝と好中凝減少に影響を与える可能性が示唆された。(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=2020&ichushi_jid=J00397&link_issn=&doc_id=20200219430006&doc_link_id=%2Fdj5surgi%2F2020%2F005401%2F006%2F0036-0041%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdj5surgi%2F2020%2F005401%2F006%2F0036-0041%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：(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）  

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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

INTRODUCTION: Most patients with colorectal liver metastases, who undergo hepatectomy, experience recurrence. Although the prognosis is poorer for patients with early recurrence (within 6 months after hepatectomy) compared with later recurrence, no biomarker has been identified to predict early recurrence. Minimal residual disease (MRD) in patients who undergo curative surgery is the main cause of recurrence. In cancer patients, long fragment cell-free DNA is detected, and the presence of long fragments of cell-free DNA after surgery can indicate MRD. In this study, we developed a novel biomarker to predict early recurrence of colorectal liver metastases using cell-free DNA. MATERIALS AND METHODS: Forty-one patients with colorectal liver metastases were enrolled. Peripheral blood samples were collected before and at 1 month after hepatectomy. Cell-free DNA was extracted from 1 ml plasma, and the long fragment/β-globin ratio, which can indicate MRD, was measured by real-time polymerase chain reaction. RESULTS: Three of 21 patients (14.3%) with decreases in the long cell-free DNA fragment/β-globin ratio after hepatectomy developed early recurrence compared with twelve of 20 patients (60.0%) with an increased ratio (P = 0.002). Patients with a decreased long fragment/β-globin ratio after hepatectomy had significantly longer recurrence-free survival compared with patients with an increased ratio (366 vs 102 days, P < 0.001). CONCLUSION: The cell-free DNA long fragment/β-globin ratio may serve as an effective biomarker of early recurrence in patients with colorectal liver metastases, who undergo hepatectomy.

DOI： 10.1016/j.ejso.2019.08.010

PubMed

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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  

大腸癌の卵巣転移は予後不良とされているが、近年の化学療法の進歩とともに長期予後を得られる症例もある。本研究では当院で2000年4月〜2017年12月に大腸癌卵巣転移として診断・加療された症例を対象として、全生存期間(overall survival:OS)に影響を与えた因子を検討した。対象は20例で、生存期間中央値18.5ヵ月、5年生存例は認めなかった。20例中18例で卵巣切除が施行され、13例(72%)で卵巣転移切除後に化学療法が施行され、そのうちの5例では分子標的薬が併用された。卵巣転移診断後OSへの影響を検討したところ、卵巣以外の他臓器転移、閉経前、原発腫瘍の組織型が未分化癌、卵巣転移巣が非切除が予後不良因子であった。大腸癌卵巣転移に対し卵巣切除は予後を改善する可能性があるが、分子標的薬の予後改善効果は認められなかった。(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=J00296&link_issn=&doc_id=20200117590159&doc_link_id=%2Fab8gtkrc%2F2019%2F004613%2F159%2F2386-2388%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2019%2F004613%2F159%2F2386-2388%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：(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：英語   掲載種別：研究論文（学術雑誌）  

There is no predictive biomarker for response to 5‑fluorouracil (5FU)‑based neoadjuvant chemotherapy (NAC) in rectal cancer. In the present study, we examined potential long non‑coding RNAs (lncRNAs) linked to the susceptibility to 5FU in cultured colorectal cancer cells, and in biopsy and resected tissues of 31 human rectal cancer cases treated with NAC. Candidate lncRNAs for the prediction of susceptibility to 5FU were investigated by comprehensive analysis of expression profiles of 84 lncRNAs in cultured cells using PCR array. Bioinformatic analysis identified H19 and urothelial cancer associated 1 (UCA1) as candidate biomarkers for 5FU susceptibility. Quantitative PCR of H19 and UCA1 in cultures of colorectal cancer cells demonstrated the notable variation in expression. The ratios of changes of H19 and UCA1 expression in response to 5FU were low in cells resistant to 5FU, whereas ratios were high in cells susceptible to 5FU. In 5FU‑susceptible cells, cell proliferation was inhibited by 5FU. Upregulation of H19 and UCA1 were associated with the reduction in target molecule expression, including retinoblastoma and p27kip1. In 31 cases of rectal cancer, H19 and UCA1 expression levels in biopsy and resected tissue were comparable. The ratios of H19 and UCA1 expression in resected tissue compared with biopsy samples were low in 17 cases, whereas the ratios were high in 14 cases; 11 of the 17 cases (65%) with low ratios exhibited poor response to NAC, whereas 4 of the 14 cases (29%) with high ratios showed poor response (P=0.045). The increase in H19 and UCA1 expression may represent the response to impaired cell cycle in cells susceptible to 5FU. Our results indicate that changes in H19 and UCA1 expression may be considered for predicting the susceptibility to 5FU‑based NAC in rectal cancer.

DOI： 10.3892/ijo.2019.4895

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

The incidence of rare neuroendocrine tumors (NET) is rapidly increasing. Neuroendocrine carcinoma (NEC) is a NET with poorly differentiated histological features, high proliferative properties and associated poor prognoses. As these carcinomas are so rare and, thus, affect only a small number of patients allowing for few cell lines to be derived from patient biopsies, the histological, immunohistochemical, and clinical characteristics associated with colorectal NEC and NEC in other organs have yet to be clearly defined. Herein, we describe the establishment of a novel NEC cell line (SS-2) derived from a tumor resection of the ascending colon from a 59-year-old Japanese woman. The histological, electron microscopic and immunohistochemical features of chromogranin A (CgA) as well as confirmation of synaptophysin positivity in this tumor were typical of those commonly observed in surgically resected colorectal NEC. Further, the Ki-67 labeling index of the resected tumor was >20% and, thus, the tumor was diagnosed as an NEC of the ascending colon. The SS-2 cell line maintained characteristic features to those of the resected tumor, which were further retained following implantation into subcutaneous tissues of nude mice. Additionally, when SS-2 cells were seeded into ultra-low attachment plates, they formed spheres that expressed higher levels of the cancer stem cell (CSC) marker CD133 compared to SS-2 cells cultured under adherent conditions. SS-2 cells may, therefore, contribute to the current knowledge on midgut NEC biological function while providing a novel platform for examining the effects of colorectal NEC drugs, including CSC.

DOI： 10.1111/cas.14221

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Ovarian metastasis of colorectal cancer is associated with poor prognosis. Recent advances in chemotherapy may improve this prognosis. In this retrospective study, we evaluated indicators of poor prognosis for ovarian metastasis of colorectal cancer. Twenty patients, who were diagnosed with ovarian metastasis of colorectal cancer from April 2000 to December 2017, were enrolled. Oophorectomy was performed in 18 of the 20 patients. Postoperative chemotherapy was provided to 13 patients, and molecular targeting agents were administered in 5 patients. Metastases to other organs besides the ovaries, premenopausal condition, undifferentiated histologic type of the primary tumor, and no resection of ovarian metastases were identified as indicators of poor prognosis. The 3-year survival rate was 15%, and the 5-year survival rate was 0%. In conclusion, oophorectomy can improve the prognosis of patients with ovarian metastasis of colorectal cancer. However, prognostic improvement due to molecular target agents was not shown.

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：英語   掲載種別：研究論文（学術雑誌）  

Farnesoid X receptor (FXR) exhibits critical anti-cancer functions in several types of cancer, including colorectal cancer, in vitro and in vivo. However, the underlying mechanism remains unclear. We evaluated pharmacological activation of FXR with the synthetic agonist GW4064 using comprehensive proteomic analysis in colorectal cancer cell lines (HCT116, SW480, and DLD1). Among the commonly detected proteins in all three cell lines, death receptor 5 (DR5) was the most up-regulated protein, and key autophagy-related proteins, such as microtubule-associated protein 1 light chain 3 alpha/beta (MLP3A/3B) and p62 sequestosome-1 (SQSTM), were also differentially expressed. Western blot analysis showed that GW4064 stimulation induced activation of the extrinsic death signaling pathway in all cell lines and induced activation of the intrinsic death signaling pathway in DLD1 cells. Western blotting showed that DR5 up-regulation was associated with inhibition of autophagic activity. These results suggest that FXR activation induced DR5 up-regulation through inhibition of autophagic activity and the DR5-related death signaling pathway. In addition, DR5 selective ligand, also known as TRAIL, has been widely used for anti-cancer treatment in several clinical trials. Co-treatment of TRAIL with GW4064 synergistically inhibited colorectal cancer cell proliferation as compared with single treatments. To the best of our knowledge, our results provide novel insights into FXR function in cancer cell lines. These findings may contribute to a new therapeutic strategy for colorectal cancer.

DOI： 10.1016/j.bbrc.2019.09.033

PubMed

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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

PubMed

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記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

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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：日本臨床外科学会  

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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：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：日本臨床外科学会  

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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：(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)日本腹部救急医学会  

複雑性虫垂炎(以下,CA)に対する待機的虫垂切除術(以下,IA)は緊急虫垂切除術(以下,EA)より手術成績が良好だが,その中には逸脱症例が存在する。逸脱症例の治療成績からCAに対するIAの妥当性を検討した。2011年1月から2017年8月にCAと診断した165例を対象とし,EA,IA成功群(以下,IA-S),IA逸脱群(以下,IA-F)に分類し手術成績と入院日数を比較した。EA:95例,IA-S:53例,IA-F:17例だった。術後合併症率はEA:37.9%,IA-S:7.5%,IA-F:11.7%で,IA-SとIA-FはEAよりも低かった。出血量,手術時間ともにIA-SはEAより良好で,IA-FとEAは同等であった。総入院日数はEA:10日,IA-S:13日,IA-F:10日で,EAとIA-Fの入院日数は同等であった。IAは合併症率が低く,逸脱してもEAに劣らない。IAはCA治療の第1選択として妥当である。(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=2019&ichushi_jid=J02824&link_issn=&doc_id=20190724350004&doc_link_id=10.11231%2Fjaem.39.649&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.39.649&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：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)日本腹部救急医学会  

複雑性虫垂炎(以下,CA)に対する待機的虫垂切除術(以下,IA)は緊急虫垂切除術(以下,EA)より手術成績が良好だが,その中には逸脱症例が存在する。逸脱症例の治療成績からCAに対するIAの妥当性を検討した。2011年1月から2017年8月にCAと診断した165例を対象とし,EA,IA成功群(以下,IA-S),IA逸脱群(以下,IA-F)に分類し手術成績と入院日数を比較した。EA:95例,IA-S:53例,IA-F:17例だった。術後合併症率はEA:37.9%,IA-S:7.5%,IA-F:11.7%で,IA-SとIA-FはEAよりも低かった。出血量,手術時間ともにIA-SはEAより良好で,IA-FとEAは同等であった。総入院日数はEA:10日,IA-S:13日,IA-F:10日で,EAとIA-Fの入院日数は同等であった。IAは合併症率が低く,逸脱してもEAに劣らない。IAはCA治療の第1選択として妥当である。(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）  

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

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：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

PubMed

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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：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  

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：(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

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: 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

PubMed

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掲載種別：研究論文（学術雑誌）  

© 2018 Universidade Federal Rural do Semi-Arido. All Rights Reserved. Background/Aim: The combination of oxaliplatin, leucovorin and fluorouracil (FOLFOX) has been established as postoperative adjuvant chemotherapy for stage III colon cancer. However, the safety and efficacy of neoadjuvant FOLFOX in patients with rectal cancer are still controversial. This prospective pilot study aimed to evaluate the feasibility of neoadjuvant FOLFOX therapy without radiation for baseline resectable rectal cancer (RC). Patients and Methods: The study included 30 patients with clinical stage II/III RC between February 2012 and December 2015. The patients were treated with six cycles of FOLFOX followed by elective surgery. The primary endpoint was the R0 resection rate. The secondary endpoints were the scheduled treatment completion rate, adverse events, pathological response and the disease-free survival (DFS) rate. Results: All the patients underwent elective R0 resection after neoadjuvant FOLFOX therapy. The completion rate of the 6-cycle regimen was 93.3% (28/30 patients). Grade 3-4 adverse events occurred in seven patients (23.3%). Pathological complete response was noted in two patients (6.7%). The 3-year DFS rate was 77.5% (95% confidence interval, 61.4%-93.7%). Conclusion: Neoadjuvant FOLFOX therapy without radiation is a feasible therapeutic strategy for baseline resectable RC.

DOI： 10.21873/invivo.11332

Scopus

PubMed

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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

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：(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：日本語   出版者・発行元：(一社)日本腹部救急医学会  

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掲載種別：論文集(書籍)内論文  

© Springer Nature Singapore Pte Ltd. 2018. 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

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掲載種別：論文集(書籍)内論文  

© Springer Nature Singapore Pte Ltd. 2018. 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

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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

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND AND OBJECTIVES: Oxaliplatin can cause hepatic sinusoidal obstruction syndrome (SOS). SOS can cause chemotherapy-related adverse effects or morbidity after liver resection. Conventionally, SOS is diagnosed using liver biopsy. Recently, it was reported that increased splenic volume (SV) can be used to detect SOS. In this study, we evaluated the changes in SV during adjuvant chemotherapy. METHODS: We enrolled 103 consecutive patients with stage III and high-risk stage II colorectal cancer treated with mFOLFOX6 (n = 37) or oral fluorouracil and leucovorin (n = 66) after curative surgery. SV was measured three times; pre-operatively, after chemotherapy, and 1 year after chemotherapy. RESULTS: SV was higher after mFOLFOX6 (median 135.89 mL) than pre-operatively (105.75 mL) (P < 0.001); SV at 1-year after finishing mFOLFOX6 (114.16 mL) returned to the same level as before surgery (P = 0.0015). SV increased in 28 patients (75.7%) treated with mFOLFOX6 (95%CI, 61.8-89.5), but had not recovered in 12 of these cases (42.9%) 1 year after finishing treatment (95%CI, 17.3-47.5). In contrast, oral fluorouracil and leucovorin did not change SV. CONCLUSIONS: SV increased after adjuvant mFOLFOX6, and had not recovered in almost half of cases 1-year after finishing chemotherapy. This increase may indicate continuous SOS, which can adversely affect treatment after recurrence.

DOI： 10.1002/jso.24756

PubMed

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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.

PubMed

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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）  

Squamous cell carcinoma (SqCC) in ulcerative colitis (UC) is rare. A 38 year-old Japanese woman, who suffered from left-sided UC for 18 years, underwent total colectomy due to SqCCs in the rectum and the sigmoid colon. They were well differentiated SqCC, and metastasis was found in the paracolic lymph nodes. Multiple small foci of squamous dysplasia (SD) were noted in the rectal mucosa. Glandular dysplasia was not found. TP53 was not detected in SD. Approximately 40% of cells were immunostained with TP53 in SqCC, however no mutation was found in TP53 gene. Human papilloma virus and Epstein Barr virus were negative in SD and SqCCs. The patient is free of the disease at one and half years after surgery and chemotherapy. SD may be a precursor of SqCC. It appeared that TP53 does not play a vital role in the development of SqCCs in the current case. Careful attention should be paid to SD in UC patients. Viral infection may need to be examined. The pathogenesis of SqCC in patients of UC needs to be elucidated.

DOI： 10.1111/pin.12539

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

PubMed

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DOI： 10.1158/1538-7445.AM2017-5682

Web of Science

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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   掲載種別：研究論文（学術雑誌）  

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)™ 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

PubMed

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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  

<p>【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。</p>

DOI： 10.11231/jaem.37.581

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

BACKGROUND: Chronic pain and discomfort is a notable complication after inguinal hernia repair. This study assesses the incidence and degree of chronic pain and discomfort after primary inguinal hernia repair performed in our hospital and aims to clarify its relationship to the type of mesh placement. MATERIALS AND METHODS: A retrospective analysis was conducted of 334 patients (378 lesions) who underwent primary inguinal hernia using the Lichtenstein (onlay mesh), Ultrapro Plug (UPP; onlay plus plug mesh), modified Kugel Patch (onlay and underlay mesh), or laparoscopic transabdominal preperitoneal (TAPP; underlay mesh) procedure. Postoperative pain was assessed using a numerical rating scale at postoperative 2-3 wk, 3 mo, and 6 mo. Postoperative discomfort was assessed 6 mo afterward. RESULTS: Questionnaire responses were received for 378 lesions (100%) after 2-3 wk, 229 (60.6%) after 3 mo, and 249 (65.9%) after 6 mo. The majority of chronic pain experienced was mild, and no patient suffered from severe pain. The level of pain tended to be less for the TAPP procedure than for other methods. Discomfort at rest was significantly less for TAPP versus Ultrapro Plug (P < 0.01), and discomfort with movement was significantly less for TAPP versus modified Kugel (P < 0.05). CONCLUSIONS: Onlay mesh appears to be a risk factor in chronic pain and discomfort. The lower level of chronic pain and discomfort with underlay mesh placement is considered to result from the reduced risk of nerve damage in this procedure than in the onlay mesh placement procedure.

DOI： 10.1016/j.jss.2016.08.027

PubMed

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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.

PubMed

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

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 wild-type 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

PubMed

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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

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：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：日本臨床外科学会  

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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.

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)日本門脈圧亢進症学会  

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

Portal venous gas has traditionally been considered an indicator of a poor prognosis due to bowel necrosis. Portal venous gas has recently been detected in patients with various clinical conditions, such as Crohn's disease, chemotherapy, and blunt abdominal injury without bowel necrosis. We herein report the first case of a patient with rectal cancer in whom portal venous gas developed after low anterior resection without anastomotic leakage or bowel necrosis. A 66-year-old man who had undergone low anterior resection started having severe diarrhea the day after the operation. A fever was present for 2 days after the operation but resolved on postoperative day 3. The patient complained of abdominal pain 5 days postoperatively. Computed tomography showed portal venous gas. Emergency open laparotomy was performed, but only limited ascites fluid without leakage or bowel necrosis was found. We irrigated the abdominal cavity and performed an ileostomy with insertion of a drainage tube in the rectovesical pouch. Only serous ascites was discharged through the drainage tube. The portal venous gas disappeared 3 days after the second operation. The patient was discharged in good condition 21 days after the first operation. Portal venous gas can develop after rectal surgery without anastomotic leakage or bowel necrosis. Conservative treatment is reasonable for patients without signs of bowel necrosis or panperitonitis. However, patients with portal venous gas must be carefully observed because portal venous gas may be life threatening.

DOI： 10.1272/jnms.82.202

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 6 8-year-old man was admitted to our hospital with lower abdominal pain. Lower gastrointestinal endoscopy showed type 2 advanced cancer in the ascending colon. Histopathological examination after endoscopical biopsy revealed both moderately differentiated adenocarcinoma and well-differentiated squamous carcinoma. Subsequently, right hemicolectomy was performed. The tumor was 55 × 40 mm in size and was diagnosed as an adenosquamous carcinoma A, type 2, pSS, pN0, sH0, sP0, sM0, fStageII. Adenosquamous carcinoma is extremely rare, represents about 0.1% of all colorectal cancer, and usually has a poor prognosis. Thirty-one months after surgery, the patient is still in good health and displays no signs of recurrence.

PubMed

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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   掲載種別：研究論文（学術雑誌）  

An upper gastrointestina(l GI) series revealed a diverticulum in the anterior wall of the middle thoracic esophagus of a 72-year-old man. Endoscopy revealed a type 0-IIc lesion in the esophageal diverticulum. The margin of the lesion was unclear. Biopsy proved that it was squamous cell carcinoma. Endoscopic ultrasonography showed that the deepest layer of the tumor was the lamina propria mucosae (cT1a-LPM) and that the underlying muscularis propria was thinning. No distant metastasis or regional lymph node metastasis was detected. Diverticulectomy or endoscopic submucosal dissection (ESD) was out of indication due to the unclear margin and thin muscularis propria. We conducted mediastinoscopy-assisted esophagectomy. The pathological diagnosis of the resected specimen was moderately differentiated squamous cell carcinoma with invasion to the lamina propria mucosae (pT1a-LPM). Pathological examination proved the thinning of the underlying muscularis propria in the diverticulum. The patient is alive without recurrence at 6 months after surgery.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 69-year-old woman with chronic hepatitis B and esophageal varices was admitted to our hospital because of a hepatocellular carcinoma( HCC) measuring 3 cm in segment S3. Computed tomography( CT) scan revealed splenomegaly, and the platelet count was 6.0×104/μL. Partial hepatectomy and splenectomy were performed sequentially under laparoscopic guidance in a right half-lateral decubitus position, using 7 working ports. The operation time was 237 min, and the amount of bleeding was 26 mL. Her postoperative course was uneventful, and she was discharged on the 10th day after the operation.

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  

胃・直腸またはS状結腸重複癌に対する一期的完全腹腔鏡下手術の報告は少ない.また,本術式の術後短期quality of life(以下,QOL)に関して一期的開腹手術との比較は十分にされていない.症例は61歳,男性.胃・直腸重複癌に対し,一期的完全腹腔鏡下幽門側胃切除術および低位前方切除術を施行した.本術式の術後短期QOLが一期的開腹手術よりも優れているかどうかを検討するために,自験例と当科で施行された胃・直腸またはS状結腸重複癌に対する一期的開腹手術症例(14例)の手術時間,出血量,術後経過を比較した.その結果,自験例は開腹手術症例の中央値よりも出血量が少なく,排ガス確認日や経口摂取開始が早く,術後入院期間は短縮した.本術式は,時間短縮の点で改善の余地はあるが,開腹手術に比べ整容性に優れ,低侵襲であるため,術後短期QOLは大幅に改善すると考える.(著者抄録)

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記述言語：日本語   出版者・発行元：The Japan Society of Coloproctology  

症例は81歳，女性．65歳時に卵巣癌に対し単純子宮全摘，両側付属器切除，大網切除術を施行された．今回，便潜血陽性の精査で下行結腸癌と診断され当科紹介となった．生検結果は低分化型腺癌であったが，免疫染色ではCK7（+）CK20（-）ER（+）であり卵巣癌大腸転移の可能性も念頭にいれ腹腔鏡下左結腸切除D3郭清術を施行した．切除標本は長径23×25mm大の2型腫瘍で低分化な腺癌像を呈し，卵巣腫瘍類似の漿液性嚢胞腺癌様な所見であった，各種免疫組織学的にも前回手術の卵巣腫瘍と類似しており，卵巣癌大腸転移と診断した．術後は婦人科にて化学療法を施行．術後1年9ヵ月無再発生存中である．卵巣癌大腸転移は多くが播種性転移によるものであり，壁内性転移は稀である．また，壁内転移では粘膜下腫瘍様形態を呈することが多く，本症例のような2型進行癌類似の形態を呈した異時性孤立性大腸転移は非常に稀であり，文献的考察を加え報告する．

DOI： 10.3862/jcoloproctology.66.529

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その他リンク： http://search.jamas.or.jp/link/ui/2013303103

記述言語：日本語   出版者・発行元：日本臨床外科学会  

食道癌術後の胃管気管瘻は難治性であり,治療法について十分な検討がなされていない.われわれは食道癌術後の胃管気管瘻に対し遊離前腕皮弁を用いた瘻孔閉鎖術を施行し治癒した症例を経験したので報告する.症例は55歳,男性.食道癌に対し胸腔鏡補助下胸腹部食道全摘,3領域リンパ節郭清,後縦隔経路胃管再建を行った.第8病日,発熱,痰の増量,頸部皮下気腫を認め,気管支鏡検査および造影CT検査にて縫合不全による胃管気管瘻と診断した.気管切開を行い,保存的治療を継続するも瘻孔は閉鎖せず.第114病日,頸部切開アプローチにて遊離前腕皮弁を用いた瘻孔閉鎖術を施行した.第143病日,瘻孔の閉鎖を確認した.経口摂取を開始し問題なく,気管カニューレを抜去,第169病日退院した.食道癌術後,頸胸境界部に生じた胃管気管瘻に対し,頸部アプローチで,胃管と気管の間に遊離前腕皮弁を介在させる治療法は安全かつ低侵襲であり,有用であった.(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=2013&ichushi_jid=J03156&link_issn=&doc_id=20130605140023&doc_link_id=10.3919%2Fjjsa.74.1245&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.74.1245&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：Japan Surgical Association  

症例は79歳，男性．進行胃癌に対し開腹胃全摘，D2郭清，胆嚢摘出，結腸後Roux-en-Y再建術を施行した．術前低栄養があり，また，重症の慢性閉塞性肺疾患を合併していたため，術後早期経腸栄養目的で手術時にTreitz靱帯より20cmの空腸に腸瘻を造設した．術後22病日に軽快退院となったが退院24日後に腹痛・嘔吐にて受診，腸閉塞の診断で再入院となった．消化管造影検査，CT検査で左側腹部に9Frの腸瘻チューブに沿って蟹爪様陰影，target signを認めた．開腹所見ではY脚より5cm末梢から長径20cmに渡る順行性の腸重積を認めた．用手整復が困難であったため小腸部分切除を施行した．細径腸瘻チューブが原因とされる腸重積の報告はほとんどなく非常にまれな症例であるため報告する．

DOI： 10.3919/jjsa.74.96

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その他リンク： http://search.jamas.or.jp/link/ui/2013152282

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   掲載種別：研究論文（学術雑誌）  

A 51-year-old male presented with lower abdominal mass and thigh and lumbar pain. CT scan showed a large retroperitoneal tumor compressing the lumbar vertebrae and IVC. Arterial infusion of mitomycin C, epirubicin and DSM was performed for unresectable tumor. The tumor was shrunken and the infusion repeated in 6 and 10 weeks later until right femoral palsy occurred. Radical resection with lumbar fascicles and psoas muscle and IORT (25 Gy) was performed. Local recurrence appeared before the sacrum in the next year. Arterial infusion and resection was done. Local recurrence invading the right common iliac artery was found five years later. The tumor and the artery were resected, followed by extra-anatomical ilio-iliac bypass. Local recurrences occurred in the 6th, 7th and 9th year. Radiation therapy was effective. But for the last recurrence, no radiation was applicable because of over dosage. As the most important thing in the treatment of MFH is to resect the tumor with curative margin at the initial operation, and the retroperitoneum and pelvic cavity are not good places to obtain good margins, multimodal treatment including irradiation should have been considered even preoperatively. Also consultation with orthopedic oncologists, radiologists, vascular surgeons and team practice are essential to get curative margins.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A case of hepatocellular carcinoma, successfully treated with multimodal loco-regional treatments, is reported. An 80-year-old male presented with multiple pulmonary and peritoneal metastases 4 months after right heimihepatectomy for ruptured HCC. Bronchial artery infusion of mitomycin C induced pulmonary tumor regression and stabilization. Peritoneal tumor was treated by arterial infusion of SMANCS, followed by percutaneous injection of absolute ethanol, which ended in surgical removal in 28-postoperative month due to abscess formation. He had been well until right adrenal and left pulmonary metastases appeared. Resection of both metastases was carried out in 39-post hepatectomy month. Recurrent left pulmonary metastasis was treated with two sessions of bronchial artery infusion with no effect this time. Video-assisted partial resection of the left lung was performed in 54 post-hepatectomy month. But his AFP level kept rising. Eventually pulmonary metastasis recurred and tumor thrombus reached the left atrium 58 months after hepatectomy. He wanted no more treatment. He died of cerebral infarction caused by tumor thrombus. He enjoyed a good QOL for five years through multimodal loco-regional treatments.

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

Stage 0 colorectal cancer was found only in the innermost lining of the colon and rectum. Treatments for an early stage colorectal cancer were available including endoscopic polypectomy, endoscopic mucosal resection (EMR) and trans-anal or -sacral local excision, laparoscopy-assisted colectomy and open colectomy. Our study indicated that endoscopic therapy for the early stage colorectal cancer was more advantageous than the conventional operative treatment. Although EMR should be applied for intramucosal carcinomas, 11 intramucosal carcinomas were treated by a surgical resection due to several limitations at our institution.

PubMed

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記述言語：日本語   掲載種別：研究論文（学術雑誌）  

A 72-year-old man underwent sigmoidectomy for sigmoid colon cancer in January 1999. Histopathological examination revealed a moderately differentiated adenocarcinoma, tub 2, SS, ly2, v2, N1, H0, P0, M0, Stage IIIa, cur A. In March 2001, he complained of an anal bleeding and underwent colonoscopy. It showed a submucosal tumor 15 mm in diameter at the anal canal and the biopsy indicated a moderately differentiated adenocarcinoma. This tumor was suspected of metastasis from sigmoid colon cancer and transanal resection was performed in May 2001. Histopathological examination revealed a moderately differentiated adenocarcinoma, which was the same histological type as primary sigmoid colon cancer, tub 2, A, ly2, v2, RM0. The diagnosis of anal metastasis was made on the basis of three points. First, tumor was covered with anal epithelium. Secondly, there were severe lymphatic and venous involvements. Thirdly, there were no findings of other primary anal cancer. By removing anal canal metastases twice, inguinal lymph node metastases three times and lung metastases in each time, he survived for 11 years after a primary surgery. We reported here because it was a very interesting and rare case that the patient was cancer-free after surgeries as many as seven times.

PubMed

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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)日本消化管学会  

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J-GLOBAL

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記述言語：日本語   出版者・発行元：(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：(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：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：日本医科大学医学会  

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：(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：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：(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  

CiNii Books

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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：日本クリニカルパス学会  

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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  

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：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：(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  

CiNii Books

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その他リンク： http://search.jamas.or.jp/link/ui/2017338214

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：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：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：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：日本クリニカルパス学会  

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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：(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)日本消化器外科学会  

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