記述言語：英語   出版者・発行元：Anticancer Research  

Background/Aim: Recent studies suggest that PD-L1 expression in immune cells, rather than tumor cells, plays a key role in tumor immunity. Trefoil factor family 1 (TFF1) is a secreted protein expressed mainly by the gastrointestinal epithelium and is related to the development of malignant disease. This study investigated the effects of TFF1 on tumor immunity in a xenograft mouse model of colorectal cancer (CRC). Materials and Methods: MC38 cells were implanted in wild-type (WT) and TFF1KO mice, and the tumor microenvironment was investigated using immunohistochemistry. The circulating immune cells were analyzed using flow cytometry. Results: Tumor growth was suppressed in TFF1KO mice. In the tumor microenvironment, CD8- and CD4-positive T cells and CD11c-positive dendritic cells (DCs) were frequently found in TFF1KO mice. When an immune checkpoint inhibitor was administered to these mice, almost half of the tumors in TFF1KO mice showed a complete response. The number of circulating PD-L1/DCs was markedly associated with tumor volume, with TFF1 deletion accelerating this effect and its injection decreasing it. These findings indicate that loss of TFF1 activates tumor immunity via frequent T-cell priming by DCs, and eventually suppresses tumor growth in CRC. In addition, the number of circulating PD-L1/DCs was identified as a predictive marker of checkpoint-inhibiting therapy efficacy. Conclusion: Loss of TFF1 resulted in accelerated immune response to colorectal cancer. Further studies are needed to investigate the precise mechanisms of TFF1 in immunotolerance and develop a novel TFF1-inhibiting immunotherapeutic strategy for CRC.

DOI： 10.21873/anticanres.17200

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記述言語：英語   出版者・発行元：Colorectal Disease  

DOI： 10.1111/codi.17129

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記述言語：英語   出版者・発行元：Anticancer Research  

Background/Aim: A deep ultraviolet (DUV) light-emitting diode (LED) is a device that can irradiate electromagnetic waves from 250 nm to 350 nm. Tousled-like kinase 1 (TLK1) encodes a nuclear serine/threonine kinase, which is thought to influence the effects of DUV irradiation in cancer. The aim of this study was to clarify the interaction of TLK1 with DUV irradiation-induced DNA damage in cancer cells. Materials and Methods: Pancreatic cancer cell lines were treated with or without DUV. TLK1 expression and phosphorylation in the two groups were examined. Then, these cancer cell lines were treated with thioridazine (THD), DUV or both. Thereafter, cytomorphology and apoptosis were assessed. Several proteins related to DNA damage, were analyzed in cancer cells treated with DUV and THD. Tumors in a subcutaneous xenograft model were treated with THD, DUV, or both for six weeks. Results: DUV irradiation induced the phosphorylation of TLK1 in pancreatic cancer cell lines. Cytomorphology was significantly changed in pancreatic cancer cells treated with DUV and THD. TLK1 inhibition enhanced DUV irradiation-induced apoptosis in cancer cells. Interestingly, CHK1 and pCHK1 expression was suppressed after TLK1 inhibition. In addition, inhibition of MRE11 led to a decrease in the expression of CHK1 and pCHK1, accompanied by a notable increase in apoptosis. In the subcutaneous xenograft models, the tumor volume in the DUV and THD groups was lower than that in the other groups. Conclusion: TLK1 phosphorylation is an important event in DUV irradiation. DUV irradiation combined with TLK1 inhibition has therapeutic potential in pancreatic cancer cells.

DOI： 10.21873/anticanres.17095

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記述言語：英語   出版者・発行元：Cancer Medicine  

Background and Aims: Pancreatic cancer is one of the most lethal malignancies, partly due to resistance to conventional chemotherapy. The chemoresistance of malignant tumors is associated with epithelial-mesenchymal transition (EMT) and the stemness of cancer cells. The aim of this study is to investigate the availability and functional mechanisms of trefoil factor family 1 (TFF1), a tumor-suppressive protein in pancreatic carcinogenesis, to treat pancreatic cancer. Methods: To investigate the role of endogenous TFF1 in human and mice, specimens of human pancreatic cancer and genetically engineered mouse model of pancreatic cancer (KPC/TFF1KO; Pdx1-Cre/LSL-KRASG12D/LSL-p53R172H/TFF1−/−) were analyzed by immunohistochemistry (IHC). To explore the efficacy of extracellular administration of TFF1, recombinant and chemically synthesized TFF1 were administered to pancreatic cancer cell lines, a xenograft mouse model and a transgenic mouse model. Results: The deficiency of TFF1 was associated with increased EMT of cancer cells in mouse models of pancreatic cancer, KPC. The expression of TFF1 in cancer cells was associated with better survival rate of the patients who underwent chemotherapy, and loss of TFF1 deteriorated the benefit of gemcitabine in KPC mice. Extracellular administration of TFF1 inhibited gemcitabine-induced EMT, Wnt pathway activation and cancer stemness, eventually increased apoptosis of pancreatic cancer cells in vitro. In vivo, combined treatment of gemcitabine and subcutaneous administration of TFF1 arrested tumor growth in xenograft mouse model and resulted in the better survival of KPC mice by inhibiting EMT and cancer stemness. Conclusion: These results indicate that TFF1 can contribute to establishing a novel strategy to treat pancreatic cancer patients by enhancing chemosensitivity.

DOI： 10.1002/cam4.7395

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記述言語：英語   出版者・発行元：Colorectal Disease  

DOI： 10.1111/codi.16897

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記述言語：英語   出版者・発行元：Annals of Gastroenterological Surgery  

Aim: Although the oncological impact of lateral lymph node dissection on enlarged lateral lymph nodes has been gradually accepted over the last decade, that on lateral lymph nodes without swelling remains doubtful. This study aimed to develop a prediction model for the future risk of lateral local recurrence and to clarify the value of adding lateral lymph node dissection in locally advanced rectal cancer without enlarged lateral lymph nodes. Methods: This retrospective, multi-institutional study recruited 812 patients with cStage II/III low rectal cancer without enlarged lateral lymph nodes <7 mm. Total lateral local recurrence was a hypothetical value of future risk of lateral local recurrence when lateral lymph node dissection was never performed. Results: Overall, total lateral local recurrences were observed in 67 patients (8.3%). In the multivariate analyses, the strongest risk factor for total local recurrences was no preoperative chemoradiotherapy (odds ratio [OR][95%Cl]: 33.2 [4.56–241.7], P < 0.001), followed by tumor distance ≤40 mm (OR [95%Cl]: 2.71 [1.51–4.86], P < 0.001) and lateral lymph node 5–7 mm (OR[95%Cl]: 2.38 [1.26–4.48], P = 0.007). In patients with lateral lymph nodes of 5–7 mm, the total lateral recurrence rate was 4.8% after preoperative chemoradiotherapy. Lateral lymph node dissection could reduce from a total lateral local recurrence of 21.6% to an actual lateral local recurrence of 8.0% in patients without preoperative treatment. Conclusion: We introduce a novel prediction model of future risk of lateral local recurrences, which has the potential to enable us to indicate lateral lymph node dissection selectively according to the patients' risks.

DOI： 10.1002/ags3.12742

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記述言語：英語   出版者・発行元：Colorectal Disease  

DOI： 10.1111/codi.16853

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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  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407214237

CiNii Research

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

Purpose: To clarify the influence of additional internal iliac artery (IIA) resection on the loss of the gluteus muscle volume after pelvic exenteration (PE). Methods: The subjects of this retrospective analysis were 78 patients who underwent PE with or without IIA resection (n = 44 and n = 34, respectively) between 2006 and 2018. The areas of gluteal muscles (GMs) and psoas muscles (PSMs) were calculated using CT images before and 6 months after PE, and the difference was compared. Results: The volumes of the GMs and PSMs were significantly reduced after PE (P < 0.001 and P = 0.005, respectively). In the IIA resection group, the GMs were significantly reduced after surgery, but the PSMs were not. The maximum GM (Gmax) was the most atrophied among the GMs. Multivariable analysis revealed that complete IIA resection was an independent promotor of the loss of volume of the Gmax (P = 0.044). In 18 patients with unilateral IIA resection, the downsizing rate of the Gmax was significantly greater on the resected side than on the non-resected side (P = 0.008). Conclusions: The GMs and PSMs were significantly smaller after PE. Complete IIA resection reduced the Gmax area remarkably. Preservation of the superior gluteus artery is likely to help maintain Gmax size, suggesting a potential preventative measure against secondary sarcopenia.

DOI： 10.1007/s00595-022-02635-z

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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  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407214143

CiNii Research

出版者・発行元：金原出版  

DOI： 10.18888/op.0000003383

CiNii Research

記述言語：日本語   出版者・発行元：日本外科系連合学会  

出版者・発行元：南江堂  

DOI： 10.15106/j_geka85_536

CiNii Research

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

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

Background/Aim: α-Bisabolol is an essential oil component extracted from plants, such as chamomile. We have previously reported that α-bisabolol suppressed proliferation, invasion, and motility of pancreas cancer. Cyclodextrin improved the solubility of α-bisabolol, therefore it enabled to administer intravenously. The aim of this study was to clarify the effect of cyclodextrin conjugated α- bisabolol (CD-BSB) and the signals pathways associated with α-bisabolol for pancreatic cancer. Materials and Methods: Human pancreatic cancer cell lines were treated with or without CD-BSB. Cytomorphology and apoptosis were assessed in these treated groups. In addition, several phosphorylated proteins were analyzed to clarify the signal pathway concerning CD-BSB. In subcutaneous xenograft model, tumor volume and Ki-67 expression were evaluated among Control (untreated), CD-BSB, or Gemcitabine (GEM). Results: CD-BSB significantly changed cytomorphology and induced apoptosis in pancreatic cancer cells. CD-BSB suppressed phosphorylation of focal adhesion kinase (FAK). In addition, pFAK 397 was inhibited by CD-BSB in a concentration-dependent manner in cancer cells. In the subcutaneous xenograft models, the tumor volume in the CDBSB groups was lower than Control groups. Ki67-positive cells in CD-BSB treated group were lower than the GEMtreated groups. Conclusion: We clarified the efficiency of CDBSB in xenograft tumor using intravenous administration. α- Bisabolol suppresses phosphorylation of FAK 397 and impairs cytoskeletal polymerization in a pancreatic cancer cell line. Further investigations are required to reveal the precise mechanisms of the antitumor effects of solubilized α- bisabolol to facilitate its clinical application. Our data indicate that solubilized α-bisabolol has therapeutic potential and could improve the prognosis of cancer patients.

DOI： 10.21873/anticanres.16245

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

Background/Aim: Deep ultraviolet (DUV) light spans within the 250 nm to 350 nm invisible wavelength range. Although it strongly damages various cells, the efficacy of DUV irradiation on pancreatic cancer cells has never been clarified. The purpose of this study was to reveal the antitumor effects of DUV irradiation on pancreatic cancer cells. Materials and Methods: Human pancreatic cancer cell lines were eradicated with DUV or ultraviolet A (UVA) for 5 s. Several angiogenesis-related proteins were studied in cancer cells after DUV irradiation using a protein antibody array. A subcutaneous xenograft model was established by inoculation of pancreatic cancer cells into mice. Tumors in this model were irradiated with DUV or UVA once or twice for two weeks. Tumor volumes in these groups (DUV×1: one irradiation, DUV×2: two irradiations, and untreated) were analyzed one week after the second irradiation. Results: DUV irradiation significantly changed the cytomorphology of pancreatic cancer cells. In addition, DUV irradiation induced apoptosis on pancreatic cancer cells more strongly than UVA irradiation and no irradiation. Interestingly, lower expression of thrombospondin 1 (TSP1) and tissue inhibitor of metalloproteinase 1 (TIMP1) was identified after DUV treatment. The tumor volume in the DUV-treated groups (DUV×1 and DUV×2) was smaller than that in the untreated group. Conclusion: Further investigations are required to reveal the precise mechanisms of the antitumor effects of DUV irradiation and to facilitate its clinical application as a new therapy for pancreatic cancer. Overall, DUV irradiation can be potentially used as a therapeutic option of pancreatic malignancy.

DOI： 10.21873/anticanres.16198

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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  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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

Transanal total mesorectal excision (taTME) has been rapidly accepted as a promising surgical approach to the distal rectum. The benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy. Furthermore, the distal resection margins can be secured under direct vision. Additionally, a two-team approach combining taTME with a transabdominal approach could decrease the operative time and conversion rate. Although taTME was expected to become more rapidly popularized worldwide, enthusiasm for it has stalled due to unfamiliar intraoperative complications, a lack of oncologic evidence from randomized trials, and the widespread use of robotic surgery. While international registries have reported favorable short- and medium-term outcomes from taTME, a Norwegian national study reported a high local recurrence rate of 9.5%. The characteristics of the recurrences included rapid, multifocal growth in the pelvis, which was quite different from recurrences following traditional transabdominal TME; thus, the Norwegian Colorectal Cancer Group reached a consensus for a temporary moratorium on the performance of taTME. To ensure acceptable baseline quality and patient safety, taTME should be performed by well-trained colorectal surgeons. Although the appropriate indications for taTME remain controversial, the transanal approach is extremely important as a means of goal setting in difficult TME cases and as an aid to the transabdominal approach in various types of extended pelvic surgeries. The benefits in transanal lateral lymph node dissection and pelvic exenteration are presented herein.

DOI： 10.1111/den.14464

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記述言語：日本語   出版者・発行元：Japanese Journal of Gastroenterological Surgery  

Use of immune checkpoint inhibitors (ICIs) has recently been recommended for treatment of unresectable or recurrent colorectal cancer with a microsatellite instability-high (MSI-H) status. We report a case of recurrent sigmoid colon cancer that was treated with ICIs followed by radical resection. One year after primary resection, the patient was diagnosed with localized peritoneal metastasis invading the left lower abdominal wall. The tumor presented as RAS/BRAF wild-type and was treated with FOLFIRI+panitumumab as 1st line chemotherapy. After shrinkage was observed, the patient was referred to our department for possible resection. Treated with ipilimumab plus nivolumab was used for further disease control of the borderline resectable tumor. However, interim imaging showed a slight increase in tumor size, so radical surgery (abdominal wall tumor resection+lymph node dissection+fascia lata abdominal wall reconstruction) was performed after three courses of ICI treatment. The pathological results showed a complete response, and the patient is now under observation with neither adjuvant therapy nor recurrence.

DOI： 10.5833/jjgs.2022.0056

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記述言語：日本語   出版者・発行元：日本大腸肛門病学会  

<p>症例は75歳女性で，倦怠感を主訴に精査し，盲腸癌，切除不能多発肝転移，腹膜播種と診断された．コンパニオン遺伝子検査結果ではRAS変異型（KRAS G12V），BRAF V600E野生型，microsatellite stableで，FOLFOX+bevacizumab療法を導入した．がん遺伝子パネル検査を行ったところ，生殖細胞系列に<i>BRCA1</i>病的バリアントが検出され，遺伝性乳癌卵巣癌症候群と診断され，本人および家族に対して遺伝カウンセリングを行った．がん遺伝子パネル検査の普及により，期せずして生殖細胞系列に二次的所見が得られ，遺伝性疾患の診断に繋がる機会は増えると予測される．このことは説明同意文書には必ず記載があるものの，患者側のみならず医療者側も認識に乏しい場合は少なくなく，今一度，患者への十分な説明を肝に銘じ，遺伝カウンセリングの体制を整えることが極めて重要である．</p>

DOI： 10.3862/jcoloproctology.76.443

CiNii Research

記述言語：英語   出版者・発行元：一般社団法人日本大腸肛門病学会  

DOI： 10.23922/jarc.2022-059

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Surgical Oncology  

Purpose: The aim of this study was to clarify the suitable radial margin (RM) for favourable outcomes after pelvic exenteration (PE), focusing on the discrepancy between the concepts of circumferential resection margin (CRM) and traditional R status. Methods: Seventy-three patients with locally advanced (LARC, n = 24) or locally recurrent rectal cancer (LRRC, n = 49) who underwent PE between 2006 and 2018 were retrospectively analysed. Patients were histologically classified into the following 3 groups; wide RM (≥1 mm, n = 45), narrow RM (0–1 mm, n = 10), and exposed RM (n = 18). The analysis was performed not only in the entire cohort but also in each disease group separately. Results: The rates of traditional R0 (RM > 0 mm) and wide RM were 75.3% and 61.6%, respectively, resulting in the discrepancy rate of 13.7% between the two concepts. Preoperative radiotherapy was given in 12.3%. In the entire cohort, the local recurrence and overall survival (OS) rates for narrow RMs were significantly worse than those for wide RMs (p < 0.001 and p = 0.002), but were similar to those for exposed RMs. In both LARC and LRRC, RM < 1 mm resulted in significantly worse local recurrence and OS rates compared to the wide RMs. Multivariate analysis showed that RM < 1 mm was an independent risk factor for local recurrence in both LARC (HR 15.850, p = 0.015) and LRRC (HR 4.874, p = 0.005). Conclusions: Narrow and exposed RMs had an almost equal impact on local recurrence and poor OS after PE. Preoperative radiotherapy might have a key role to ensure a wide RM.

DOI： 10.1016/j.ejso.2022.06.015

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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  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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

Late-onset postoperative pneumonia (LOPP) after esophagectomy is poorly understood. This study was designed to clarify the features and risk factors for this event. Patients who underwent esophagectomy for esophageal cancer between 2006 and 2016 were included. LOPP was defined as radiologically proven pneumonia that occurred over 3 months after surgery, and clinically relevant late-onset postoperative pneumonia (CR-LOPP) was defined as LOPP that required administration of oxygen and antibiotics in the hospital and/or more intensive treatment. The total psoas muscle area (TPA) was measured using preoperative and postoperative (at 3 months after surgery) computed tomography scan images. Potential risk factors for CR-LOPP were investigated. Among 175 study patients, 46 (26.3%) had LOPP, 29 (16.6%) of whom exhibited CR-LOPP with a cumulative incidence of 15.6% at 3 years and 22.4% at 5 years. Four (13.8%) of these patients died of LOPP. Univariable analysis showed that clinical stage ≥III (P = 0.005), preoperative prognostic nutritional index (PNI) <45 (P = 0.035), arrhythmia (P = 0.014), postoperative hospital stay ≥40 days (P = 0.003), and percent decrease of TPA more than 5% (P < 0.001) were associated with CR-LOPP but not early onset postoperative pneumonia. Multivariable analysis revealed that clinical stage ≥III (hazard ratio [HR] 3.01, P = 0.004), postoperative hospital stay ≥40 days (HR 2.51, P = 0.015), and percent decrease of TPA >5% (HR 9.93, P < 0.001) were independent risk factors for CR-LOPP. CR-LOPP occurred in over 20% of patients at 5 years, and early postoperative loss of TPA was a potential trigger for this delayed complication.

DOI： 10.1093/dote/doac019

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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  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：英語   出版者・発行元：(一社)日本癌治療学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1093/jjco/hyac045

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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  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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

Purpose: Parastomal hernia (PH) develops more frequently than incisional hernia (IH) after colorectal surgery with stoma. This study evaluated our hypothesis that inward traction of the fascia when closing a midline incision widens the stoma hole and increases the incidence of PH. Methods: A total of 795 patients who underwent colorectal resection between 2006 and 2016 were retrospectively analyzed. The risk classification was constructed from IH risk factors extracted from the non-stoma group. Then, the classification was extrapolated to the stoma group for predicting midline IH and PH. Results: The incidence of IH was 5.3% in the stoma group and 12.5% in the non-stoma group (p = 0.005). PH developed in 19.6% of 97 patients with permanent stoma. The risk classification was able to predict PH without a significant difference but was well balanced in patients with permanent stoma; however, it failed to predict IH in the stoma group. Conclusion: The risk classification constructed from the non-stoma group was useful for predicting not midline IH but PH, suggesting that the stoma site was the most vulnerable for herniation. The “fighting over the fascia” theory between the midline incision and stoma hole may explain the causal relationship between the midline IH and PH.

DOI： 10.1007/s00595-021-02434-y

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出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407213704

CiNii Research

出版者・発行元：南江堂  

DOI： 10.15106/j_geka84_484

CiNii Research

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

局所再発直腸癌に対する治療戦略はその病態の不均一性から治療は個々の症例に応じて選択すべきである.そのためには,手術技術を磨くことは当然のことであるが,近年発達著しい集学的治療の知識を身に着け,経験を積むことが必要不可欠である.性質上,無作為化比較試験からの情報を得ることが難しく,多くがセンター施設での経験に基づく指針ではあるが,本稿では,本邦および海外での局所再発直腸癌治療の現状と展望を述べる.(著者抄録)

記述言語：日本語   出版者・発行元：日本外科系連合学会  

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞ポイント ◆局所再発直腸癌の治療ではR0切除がきわめて重要であり,R0達成のためには拡大切除を躊躇すべきでない.◆尿路機能温存のためには,少なくとも片側の骨盤神経を温存する.また膀胱後屈を避けるため,腸管再建や骨盤充填術の施行が望ましい.◆切除可能同時性遠隔転移を伴う症例も手術適応としている.ただし,切除の順序やタイミングは慎重に考慮すべきである.

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01539&link_issn=&doc_id=20220506510007&doc_link_id=10.11477%2Fmf.1407213704&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407213704&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：日本外科系連合学会  

記述言語：日本語   出版者・発行元：日本外科系連合学会  

記述言語：日本語   出版者・発行元：日本外科系連合学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Journal of Clinical Endocrinology and Metabolism  

Background: Previous studies showed that although the risk of thyroid dysfunction [thyroid immune-related adverse events (irAEs)] induced by anti-programmed cell death-1 antibodies (PD-1-Ab) was as low as 2% to 7% in patients negative for anti-thyroid antibodies (ATAs) at baseline, it was much higher (30%-50%) in patients positive for ATAs. However, whether a similar increase occurs with combination therapy using PD-1-Ab plus anti-cytotoxic T-lymphocyte antigen-4 antibody (CTLA-4-Ab) is unknown. Methods: A total of 451 patients with malignancies treated with PD-1-Ab, CTLA-4-Ab, or a combination of PD-1-Ab and CTLA-4-Ab (PD-1/CTLA-4-Abs) were evaluated for ATAs at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation and then observed until the last clinical visit. Results: Of the 451 patients, 51 developed thyroid irAEs after immunotherapy [41 of 416 (9.9%) treated with PD-1-Ab, 0 of 8 (0%) treated with CTLA-4-Ab, and 10 of 27 (37.0%) treated with PD-1/CTLA-4-Abs]. The cumulative incidence of thyroid irAEs was significantly higher in patients who were positive vs negative for ATAs at baseline after both PD-1-Ab [28/87 (32.2%) vs 13/329 (4.0%), P < 0.001] and PD-1/CTLA-4-Abs [6/10 (60.0%) vs 4/17 (23.5%), P < 0.05] treatments. The risk of thyroid irAEs induced by PD-1/CTLA-4Abs, which was significantly higher than that induced by PD-1-Ab, in patients negative for ATAs at baseline was not statistically different from that induced by PD-1-Ab in patients positive for ATAs at baseline. Conclusions: This study showed that the incidence of thyroid irAEs was high and not negligible after PD-1/CTLA-4-Abs treatment even in patients negative for ATAs at baseline.

DOI： 10.1210/clinem/dgab829

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PubMed

出版者・発行元：南江堂  

DOI： 10.15106/j_geka84_136

CiNii Research

記述言語：日本語  

DOI： 10.1245/s10434-021-10935-w

Web of Science

PubMed

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

Introduction: Pretreatment enlarged lateral lymph nodes (LLN) in patients with locally advanced low rectal cancer are predictive for local recurrences after neoadjuvant (chemo)radiotherapy (n(C)RT) followed by total mesorectal excision (TME). Not much is known of the impact on oncological outcomes when in addition malignant features are present in enlarged LLN. Patients and Methods: A multicenter retrospective cohort study was conducted at five tertiary referral centers in the Netherlands and Australia. All patients were diagnosed with locally advanced low rectal cancer with LLN on pretreatment magnetic resonance imaging (MRI) and underwent n(C)RT followed by TME. LLN were considered enlarged with a short axis of ≥ 5 mm. Malignant features were defined as nodes with internal heterogeneity and/or border irregularity. Outcomes of interest were local recurrence-free survival (LRFS), distant metastatic-free survival (DMFS), and overall survival (OS). Results: Out of 115 patients, the majority was male (75%) and the median age was 64 years (range 26–85 years). Median pretreatment LLN short axis was 7 mm (range 5–28 mm), and 60 patients (52%) had malignant features. After a median follow-up of 47 months, patients with larger LLN (7 + mm) had a worse LRFS (p = 0.01) but no difference in DMFS (p = 0.37) and OS (p = 0.54) compared with patients with smaller LLN (5–6 mm). LLN patients with malignant features had no difference in LRFS (p = 0.20) but worse DMFS (p = 0.004) and OS (p = 0.006) compared with patients without malignant features in the LLN. Cox regression analysis identified LLN short axis as an independent factor for LR. Malignant features in LLN were an independent factor for DMFS. Conclusion: The current study suggests that pretreatment enlarged LLN that also harbor malignant features are predictive of a worse DMFS. More studies will be required to further explore the role of malignant features in LLN.

DOI： 10.1245/s10434-021-10762-z

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PubMed

記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞肝外胆管癌は,非治癒因子が存在しない限り根治切除をめざす.肝外胆管癌は肝門部領域胆管癌と遠位胆管癌に分類され,それぞれ尾状葉を伴う肝葉切除・肝外胆管切除術,膵頭十二指腸切除術(pancreaticoduodenectomy:PD)が標準術式となる.肝門部領域胆管癌に対する肝切除術式を決定する際はBismuth分類が有用である.遠位胆管癌のPDの術式は,胃切除範囲や再建法にバリエーションがあり,上腸間膜動脈周囲リンパ節郭清はリンパ節の適正評価に有用である.これら肝外胆管癌の手術適応は癌遺残度の可能性,血管浸潤,リンパ節転移などの腫瘍因子を考慮したうえで決定する.

その他リンク： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00393&link_issn=&doc_id=20220128060007&doc_link_id=10.15106%2Fj_geka84_136&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka84_136&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞ポイント ◆局所進行直腸癌に対し,術前CRTへの分子標的薬併用による局所制御・生存率への上乗せ効果は証明されていない.一方,NACやinduction chemotherapyへの分子標的薬併用による局所制御への上乗せ効果の報告は散見される.◆Stage IV・再発大腸癌では,分子標的薬を併用することで奏効率・腫瘍縮小率が上昇し,原発巣・遠隔転移巣ともR0切除やconversion手術のチャンスが増加する.◆"Cure"をめざした術前治療との併用こそが,分子標的薬の真の使いどころかもしれない.

記述言語：日本語   出版者・発行元：日本大腸肛門病学会  

<p>症例は75歳，男性．1年前に前医で，痔瘻癌に対する腹会陰式直腸切断術および右腹直筋皮弁による会陰再建が施行された．病理組織診断は粘液癌，pT4N0M0で，R1切除であった．今回，術後局所再発を指摘され当科を受診した．CT検査では，前立腺の右側で腹直筋皮弁の腹側に30mm大の嚢胞性腫瘤が存在し，穿刺生検で印環細胞癌を認めた．筋皮弁の主栄養血管である右下腹壁動静脈への浸潤はないと判断し，腹直筋皮弁温存の骨盤内臓全摘術を施行し，R0切除が得られた．</p><p>会陰部へ広範に進展する直腸癌や痔瘻癌では切除後に腹直筋皮弁による会陰再建が行われることは少なくない．しかし，術後に局所再発をきたせば，再手術時に筋皮弁の取扱いに苦慮することは想像に難くない．栄養血管の温存は技術的難易度が高く，時として癌に近付き根治性を損ないかねないため，適応は慎重に考慮すべきであるが，筋皮弁切除を回避できたメリットは大きかった．</p>

DOI： 10.3862/jcoloproctology.75.15

CiNii Research

記述言語：日本語   出版者・発行元：日本大腸肛門病学会  

<p>再発大腸癌に対する完全切除は治癒や長期予後を得るために重要な治療法である．今回，解剖学的知識に疎い大腿骨頭周囲への稀な再発を，整形外科と合同で積極的に切除した経験を報告する．</p><p>症例は69歳の女性．前医で右大腿まで広範囲に膿瘍形成を伴う盲腸癌の後腹膜穿通と診断された．全身化学療法により腫瘍は著明に縮小し，2年半前に回盲部切除術，腸腰筋および右付属器合併切除が施行された．今回，大腿骨頭腹側の腫瘤を指摘され，当院での切開生検で盲腸癌再発と診断された．孤発性転移であり，整形外科と合同で関節包および大腿神経合併切除を伴う腫瘍切除を施行した．寛骨臼との剥離面に術中放射線照射を追加した．同部は病理学的検査でR1と診断された．術後難治性リンパ漏に対し，形成外科と合同で腹直筋皮弁充填術を施行した．術後1年7ヵ月の現在，脳髄膜播種再発は認めるものの局所制御は良好で，良好なQOLを保ちつつ，全身化学療法を継続中である．</p>

DOI： 10.3862/jcoloproctology.75.44

CiNii Research

記述言語：日本語   出版者・発行元：Japanese Journal of Gastroenterological Surgery  

Purpose: Patients with metastatic colorectal cancer (mCRC) with BRAF V600E mutation have a poor response to standard cytotoxic agents and extremely poor outcomes. Thus, the optimal indication for metastasectomy remains debatable, even when the metastatic region is resectable. The aims of this retrospective study were to examine the outcomes of BRAF V600E mCRC, identify risk factors for poor survival, and establish the optimal surgical indication for resection. Materials and Methods: The subjects were 14 patients with BRAF V600E mCRC who started treatment in our department between December 2016 and April 2020. No patients underwent surgery prior to introduction of systemic chemotherapy. Patients were divided into two groups based on the initial response to firstline chemotherapy: controlled disease (CD, n=8) for tumors that shrunk or stabilized from baseline, and uncontrolled disease (UD, n=6) for tumors that increased in size. Results: The median follow-up period was 39.7 months. The 2-year overall survival rate was 35.7% in all patients, and was higher in the CD group than in the UD group (50.0% vs. 16.7%, P=0.051). Six patients (42.9%) underwent curative metastasectomy, of whom 4 developed recurrence and one underwent re-resection. In the CD group, 2 of 3 patients who underwent metastasectomy were alive without cancer, while all 3 patients in the UD group developed recurrence after metastasectomy and 2 had early recurrence within 3 months. Conclusion: This study suggests that evaluation of the initial response to first-line chemotherapy may be a useful prognostic factor in BRAF V600E mCRC. Even if a tumor is resectable, the indication for metastasectomy should be carefully considered in cases with poor disease control in the initial response

DOI： 10.5833/jjgs.2021.0129

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CiNii Research

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

Background: Intraoperative indocyanine green angiography (ICG-A) is a promising tool to confirm blood supply; however, the assessment is difficult without clear demarcation. In this study, the clinical impact of the time to arterial perfusion (TAP) on anastomotic leakage (AL) was evaluated, especially in patients without ICG demarcation. Methods: The TAP was assessed using ICG-A during colorectal surgery in 110 patients. ICG demarcation required changing the transection line, and the TAP was measured at the new stump. The patients were divided into marginal flow (MF) and direct flow (DF) groups according to the arterial route. Delayed TAP was defined as the third quartile or slower TAP in each group. Results: Sixty-six patients (60%) were classified into the MF group, including 64 patients who underwent rectal or sigmoid resection with high ligation of the inferior mesenteric artery. The cut-off value of the delayed TAP in the MF group was significantly slower than that in the DF group (30 and 22 s, respectively, p < 0.001). In the entire cohort, the transection line was changed in 2 patients, resulting in no AL. Nevertheless, AL still developed in 6 patients (5.4%), 5 of whom were in the MF group, and delayed TAP was found in 5 of 6 patients. Delayed TAP was significantly associated with AL in the MF group (p = 0.046). Conclusions: In patients without ICG demarcation, delayed TAP might be helpful for predicting the high-risk patients with AL in the MF group; however, performing diverting stoma or strictly careful observation might be a realistic reaction.

DOI： 10.1007/s00464-020-08185-0

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PubMed

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本消化器病学会-東海支部  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(株)へるす出版  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407213500

CiNii Research

記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy  

Scopus

記述言語：日本語   掲載種別：研究論文（学術雑誌）  

PubMed

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(株)医学書院  

記述言語：日本語   出版者・発行元：(株)癌と化学療法社  

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20211021370007&doc_link_id=%2Fab8gtkrc%2F2021%2F004810%2F008%2F1223-1226%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004810%2F008%2F1223-1226%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Surgical Oncology  

Background: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. Methods: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (≥5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). Results: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND- (p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent significant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. Conclusion: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution.

DOI： 10.1016/j.ejso.2021.06.004

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PubMed

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Clinical Oncology  

Background: The carcinoembryonic antigen (CEA) “value” itself is often useless in patients with a normal CEA level at initial presentation and those with tumor-irrelevant elevated CEA. Although the unified marker using CEA has been desirable for recurrent tumor staging as well as for primary tumor staging, little is known concerning its relationship with the survival of patients with recurrent colorectal cancer in particular. Methods: This retrospective historical study included patients who experienced disease relapse after curative surgery for stage I–III colorectal cancer between 2006 and 2018. A total of 129 patients with recurrent disease after curative surgery for colorectal cancer were included. We focused on the CEA “ratio” (CEA-R: the ratio of the CEA level at the time of recurrence to that measured 3 months before recurrence) and aimed to evaluate the correlation between CEA-R and survival in recurrent colorectal cancer. Results: Patients with a high CEA-R (≥ 2) exhibited significantly worse 2 year survival than those with a low CEA-R (< 2) (88.1% vs. 44.9%, P < 0.001), irrespective of the CEA value before primary resection. Multivariate analyses demonstrated that the CEA-R (HR; 3.270, 95% CI 1.646–6.497, P = 0.001) was a significant prognostic factor. Conclusion: The CEA-R is a potential marker stratifying the survival of patients with disease relapse who exhibit aggressive biology at recurrent disease foci. As a novel marker, the CEA-R would serve as a clinical guide for tailoring treatment strategies at the time of disease relapse in patients with colorectal cancer.

DOI： 10.1007/s10147-021-01919-7

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PubMed

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407213349

CiNii Research

出版者・発行元：南江堂  

DOI： 10.15106/j_geka83_506

CiNii Research

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Asian Journal of Endoscopic Surgery  

To perform complete mesocolic excision with central vessel ligation, it is important to recognize the vessel anomaly and the location of the tumor. For left-sided colon cancer, the variations in the course of the left colic artery and accessary middle colic artery must be recognized preoperatively. Here, we describe our experience with a 57-year-old man who was diagnosed with sigmoid colon cancer with complicated inter-mesenteric connections between the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA), possibly due to median arcuate ligament syndrome. We performed laparoscopic sigmoidectomy with low ligation of the IMA to preserve the extremely enlarged left colic artery. The total operative time was 155 minutes, and the estimated total blood loss was 10 mL. The patient was discharged on postoperative day 9 without any postoperative complications. For patients with vascular anomalies in the left-sided mesocolon, preoperatively ruling out SMA stenosis by using angiography and 3-D CT might be important.

DOI： 10.1111/ases.12844

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PubMed

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

今日,進行再発大腸癌治療において遺伝子検査は必要不可欠なものとなっている.中でもBRAF V600E変異症例の予後は極めて不良と報告され,その治療選択に悩むことは少なくない.今回,オキサリプラチンベースの術後補助化学療法が終了した直後の術後9ヵ月の早期に,頸部リンパ節再発を来し,BRAF V600E変異型で予後不良が予測された症例に対し,二次治療としてのFOLFIRI+aflibercept療法が著効し,切除により病理学的完全奏効を確認した1例を経験した.術後経過観察期間は9ヵ月とまだ短いが,外来で無再発,無治療で経過観察中である.予後不良とされるBRAF V600E変異型であっても野生型と同様に一定の全身コントロールが可能であれば,転移巣切除を考慮する意義はあると考えられた.(著者抄録)

その他リンク： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01117&link_issn=&doc_id=20210519510007&doc_link_id=10.5833%2Fjjgs.2020.0057&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2020.0057&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)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：英語   出版者・発行元：British Journal of Surgery  

Background: In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. Methods: Patients with low cT3-4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. Results: More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. Conclusion: Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes. Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.

DOI： 10.1093/bjs/znaa009

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記述言語：日本語  

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Clinical Oncology  

Background: The indications for neoadjuvant chemotherapy (NAC) in resectable colorectal liver metastases (CRLMs) remain unclear. Tumor burden score (TBS) is a prognostic tool based on tumor size and number of tumors. However, its utility in the NAC setting for initially resectable CRLM has never been investigated. Methods: TBS is a distance from the origin on a Cartesian plane to the coordinates (x, y) = (tumor size in centimeter, number of tumors). TBS < 3 was defined as “TBS-low”, whereas TBS ≥ 3 as “TBS-high”. Between 2008 and 2018, 102 patients who underwent hepatectomy for resectable CRLM were retrospectively analyzed using the Kaplan–Meier method and Cox proportional hazards regression models. Results: Among the TBS-low (n = 46) and TBS-high (n = 56) groups, baseline patient characteristics were mostly similar except for TBS-related parameters. NAC was more frequently administered in the TBS-high group (p = 0.038). The overall survival (OS) rates were similar between the two groups. Subgroup analysis showed that NAC was associated with non-significantly improved 5-year OS in the TBS-high group [76.1% with NAC and 54.9% without NAC (p = 0.093)]. In multivariate analysis, NAC was an independent prognostic factor for favorable OS only in the TBS-high group, while adjuvant chemotherapy (AC) was associated with improved OS only in the TBS-low group. Conclusion: In patients with resectable CRLM, the TBS-high population had a survival benefit from NAC, while the TBS-low population benefited from AC. TBS may serve as an indicator for patients who will benefit from NAC.

DOI： 10.1007/s10147-020-01793-9

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記述言語：日本語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Japanese Journal of Gastroenterological Surgery  

Patients with colorectal cancer with the BRAF V600E mutation, which rarely coexists with a RAS mutation, have an extremely poor prognosis. In contrast, the outcomes of patients with a BRAF mutation and high microsatellite instability (MSI-high) have been found to be favorable. Thus, the significance of having multiple mutations remains unclear. We experienced a rare case with cervical lymph node metastasis from right-sided transverse colon cancer with RAS mutation, BRAF mutation and MSI-high, which developed 9 months after primary resection, just after completion of oxaliplatin-based 6-month adjuvant chemotherapy. As second-line chemotherapy, the patient received FOLFIRI plus aflibercept for 12 months. The tumor shrank markedly from 37 mm to 12 mm in maximum diameter and no new lesion was found; therefore, she underwent conversion surgery. Pathological findings confirmed no residual cancer cells (pathological complete response). Although the postoperative follow-up period is still <9 months, the patient has had no additional treatment after conversion surgery and is alive without recurrence. This case suggests that even in patients with metastatic colorectal cancer with the BRAF V600E mutation, aggressive surgical treatment might be an option in a situation of well-controlled systemic disease similar to that without a BRAF mutation. Further investigation of the significance of coexisting MSI-high with a BRAF mutation is required.

DOI： 10.5833/jjgs.2020.0057

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

Purpose: This study aimed to clarify the long-term change in the renal function after pelvic exenteration (PE) and to evaluate the risk factors for any future dysfunction. Methods: This study comprised 40 patients. A greater than 25% decline in the estimated glomerular filtration rate (eGFR) at 3 years was defined as early renal function disorder (ERFD), possibly predicting future chronic kidney disease (CKD). Results: In the entire cohort, the median eGFR decreased by 23% at 3 years, and CKD developed in 50%. The patients were divided into the ERFD (n = 16) and non-ERFD (n = 24) groups. In the ERFD group, the eGFR significantly decreased by 28% during the first 1.5 years and continued to decline after that, resulting in 81.3% of patients reaching CKD, whereas it was 4% and 37.5%, respectively, in the non-ERFD group. In a growth model analysis, late urinary tract complications (UTC) and small bowel obstruction were shown to be risk factors for ERFD. Conclusion: Although PE was associated with a high incidence of future CKD, ERFD could predict it. Close observation of the eGFR decline over 1.5 years might be beneficial to identify ERFD patients. High-risk patients with late UTC and small bowel obstruction should, therefore, be observed carefully.

DOI： 10.1007/s00595-020-02036-0

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

Background: The role of surgery for locally recurrent rectal cancer (LRRC) with resectable distant metastases or second LRRC remains unclear. This study aimed to clarify the influence of synchronous distant metastases (SDMs), a history of distant metastasis resection (HDMR), and a second LRRC on the outcome. Methods: The long-term outcomes of 70 surgically treated patients with LRRC between 2006 and 2018 were compared by SDM (n = 10), HDMR (n = 17), and second LRRC (n = 7). Results: Among the 10 patients with SDM, 4 patients underwent simultaneous resection, whereas the other 6 underwent staged resection with distant first approach. Recurrence developed in 9 patients, of which 2 patients with liver re-resection achieved long-term survival without cancer. The patients with and without SDM had equivalent 5-year overall survival rate (40.5% vs. 53.3%, p = 0.519); however, patients with SDM had a worse 3-year recurrence-free survival rate than those without SDM (10.0% vs. 37.5%, p = 0.031). Multivariate analysis showed that primary non-sphincter-preserving surgery, second LRRC, and R1 resection were independent risk factors for overall survival. Similarly, primary non-sphincter-preserving surgery, second LRRC, SDM, and R1 resection were risk factors for recurrence-free survival. Conclusions: Patients with SDM might still be suitable to undergo salvage surgery and achieve favourable overall survival. Distant metastasectomy should be performed first, followed by a sufficient interval to avoid unnecessary LRRC resection in uncurable patients. An HDMR should not be taken into consideration when making surgical plans. Surgical indication of second LRRC should be strict, especially in referred patients.

DOI： 10.1016/j.suronc.2020.09.001

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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  

記述言語：日本語   出版者・発行元：日本外科系連合学会  

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

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：Clinics in Colon and Rectal Surgery  

The importance of total mesorectal excision (TME) has been the global standard of care in patients with rectal cancer. However, there is no universal strategy for lateral lymph nodes (LLN). The treatment of the lateral compartment remains controversial and has gone to the opposite directions between Eastern and Western countries in the past decades. In the East, mainly Japan, surgeons consider LLN metastases as regional disease and have performed TME with lateral lymph node dissection (LLND) without neoadjuvant (chemo)radiotherapy ([C]RT) in patients with clinical Stage II/III rectal cancer below the peritoneal reflection. In the West, neoadjuvant radiotherapy or has been the standard, and surgeons do not perform LLND assuming the (C)RT can sterilize most lateral lymph node metastasis (LLNM). Recent evidences show that lateral nodes are the major cause of local recurrence after (C)RT plus TME, and LLND reduces local recurrence particularly from the lateral compartment. Probably a combination of the two strategies, that is, neoadjuvant (C)RT plus LLND, would be needed to improve outcomes in patients with lateral nodal disease.

DOI： 10.1055/s-0040-1714239

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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  

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

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

Purpose: The neoadjuvant rectal (NAR) score is a promising indicator of survival after preoperative chemoradiotherapy for rectal cancer. However, its effectiveness after neoadjuvant chemotherapy (NAC) alone has not been fully investigated. Methods: We analyzed data retrospectively on 61 patients with rectal cancer, who received NAC followed by surgical resection between 2010 and 2015, and evaluated the impact of the NAR score on survival. Results: The median NAR score was 14.9. Of the 61 patients, 13, 35, and 13 were classified as having NAR-low (< 8), NAR-intermediate (8–16), and NAR-high (> 16) scores, respectively. The median observation period was 49.0 months. According to the NAR score, the 3-year DFS in the NAR-low group was 100%, which was significantly better than that in the NAR-intermediate (64.8%, p = 0.041), and NAR-high (61.5%, p = 0.018) groups. When the NAR-intermediate and NAR-high groups were investigated as a single high-risk group, the 3-year DFS of the patients who received adjuvant chemotherapy was 88.7%, which was significantly better than that of the patients who did not receive adjuvant chemotherapy (53.3%, p = 0.042). Conclusions: The NAR score may predict the DFS and could serve as a favorable indicator of adjuvant chemotherapy after NAC alone.

DOI： 10.1007/s00595-020-01964-1

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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  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：英語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

出版者・発行元：金原出版  

DOI： 10.18888/op.0000001778

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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  

出版者・発行元：南江堂  

DOI： 10.15106/j_geka82_742

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担当区分：筆頭著者  

出版者・発行元：株式会社医学書院  

DOI： 10.11477/mf.1407212935

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

DOI： 10.1007/s10151-020-02158-0

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出版者・発行元：金原出版  

DOI： 10.18888/op.0000001579

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担当区分：筆頭著者  

記述言語：日本語   出版者・発行元：日本大腸肛門病学会  

<p>本邦での遠隔転移を伴わない局所進行大腸癌の標準治療は手術+術後補助化学療法であるものの，その治療成績が満足できるものとはいい難い．一方，近年の著しい薬物療法の進歩を背景に，術前化学療法（NAC）は日常臨床の中で徐々に普及しているが，その長期成績は明らかでない．</p><p>直腸癌に対する術前化学療法（NAC）は欧米では放射線化学療法（CRT）を省略することになり，高リスク症例では受け入れられ難い．しかし，術前治療を一般的に行って来なかった本邦では，NACは単に術後補助化学療法の前倒しであり，可能な施設に限りがあるCRTと比較して，多くの施設で受け入れられやすい．</p><p>NACはCRTと比較して局所効果はやや劣るものの，生存率は遜色ない．今後は，リスク分類により個別化治療を提供していく必要がある．</p>

DOI： 10.3862/jcoloproctology.73.417

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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-東海支部  

記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1186/s40792-019-0720-8

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担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

記述言語：英語   出版者・発行元：Techniques in Coloproctology  

DOI： 10.1007/s10151-019-02010-0

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記述言語：英語   掲載種別：研究論文（学術雑誌）  

DOI： 10.1155/2019/9598183

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担当区分：筆頭著者  

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

Background: Lateral nodal disease in rectal cancer remains a subject of debate and is treated differently in the East and the West. The predictive value of lateral lymph node and MRI-detected extramural vascular invasion (mrEMVI) features on oncological outcomes was assessed in this study. Methods: In this retrospective cohort study, data on patients with cT3–4 rectal cancer within 8 cm from the anal verge were considered over a 5-year period (2009–2013). Lateral lymph node size, malignant features and mrEMVI features were evaluated and related to oncological outcomes. Results: In total, 192 patients were studied, of whom 30 (15·6 per cent) underwent short-course radiotherapy and 145 (75·5 per cent) received chemoradiotherapy. A lateral lymph node short-axis size of 10 mm or more was associated with a significantly higher 5-year lateral/presacral local recurrence rate of 37 per cent, compared with 7·7 per cent in nodes smaller than 10 mm (P = 0·041). Enlarged nodes did not result in a higher 5-year rate of distant metastasis (23 per cent versus 27·7 per cent in nodes smaller than 10 mm; P = 0·563). However, mrEMVI positivity was related to more metastatic disease (5-year rate 43 versus 26·3 per cent in the mrEMVI-negative group; P = 0·014), but not with increased lateral/presacral recurrence. mrEMVI occurred in 46·6 per cent of patients with nodes smaller than 10 mm, compared with 29 per cent in patients with nodes of 10 mm or larger (P = 0·267). Conclusion: Although lateral nodal disease is more a local problem, mrEMVI mainly predicts distant recurrence. The results of this study showed an unacceptably high local recurrence rate in patients with a short axis of 10 mm or more, despite neoadjuvant (chemo)radiotherapy.

DOI： 10.1002/bjs.10949

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：European Journal of Surgical Oncology  

Background and aims: Precise endoscopic assessment of complete response to neoadjuvant chemoradiotherapy before surgery is important for optimizing surgical and non-surgical treatment. We prospectively evaluated the accuracy of the newly proposed endoscopic criteria to identify complete response, using magnifying chromoendoscopy. Methods: New endoscopic criteria were created to define endoscopic complete response, near complete response and incomplete response, using magnifying chromoendoscopy. The criteria contained notable endoscopic findings, including shape of the scar, state of the ulcer, finding of white moss, presence of residual protruded nodules, regenerated pits of the scar, presence of neoplastic pit patterns, and extension of rectal wall. Seventy-nine patients with rectal cancer who received neoadjuvant chemoradiotherapy were prospectively evaluated 1–3 days before resection. Diagnostic accuracy to identify pathological complete response and interobserver agreement among a supervising colonoscopist and two trainees were investigated. Results: Pathological complete response was obtained in 17 patients (21.5%). The diagnostic accuracy of endoscopic complete response was 85%, with a sensitivity of 47%, specificity of 97%, positive predictive value of 80% and negative predictive value of 77%. The kappa-value for interobserver agreement across 3 doctors was 0.57 (standard error, 0.74; 95% confidence interval, 0.39–0.76). Conclusion: The newly proposed endoscopic criteria using magnifying chromoendoscopy achieved excellent diagnostic accuracy to determine good responders to neoadjuvant chemoradiotherapy in rectal cancer, with fair interobserver agreement. The criteria could be clinically useful to select patients for non-surgical management.

DOI： 10.1016/j.ejso.2018.04.013

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

Background: To evaluate whether pretreatment carcinoembryonic antigen and carbohydrate antigen (CA)19-9 are useful predictors of survival in patients with stage IV rectal cancer who have undergone curative resection. Methods: In this retrospective study, data on 73 patients who had undergone curative resection of stage IV rectal cancer were reviewed. Associations between various clinicopathological factors and survival outcomes were analyzed. Results: According to univariate analysis, elevated pretreatment CA19-9 (p = 0.0028), R1 resection (p = 0.0318), and mucinous or poorly differentiated adenocarcinoma (p = 0.0228) were significantly associated with poor overall survival (OS), and lymph node metastasis (p = 0.0211) was significantly associated with poor disease-free survival (DFS). Multivariate analyses showed that elevated pretreatment serum CA19-9 concentration (hazard ratios [HR] 3.33; 95% CI 1.24-9.42; p = 0.0174) was an independent predictor for OS and lymph node metastasis (HR 2.26; 95% CI 1.15-4.82; p = 0.0164) was an independent predictor for DFS. Among 55 patients with recurrences after curative resection, the rate of complete resection of recurrences was significantly higher in patients with normal pretreatment CA19-9 than in those with elevated CA19-9 (p = 0.049). Post-recurrence survival was significantly worse in patients with elevated pretreatment CA19-9 than in those with normal CA19-9 (p = 0.0196). Conclusions: Pretreatment CA19-9 is good predictor of survival after curative resection of stage IV rectal cancer.

DOI： 10.1159/000480247

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

Background The impact of body composition on the short- or long-term outcomes of patients with surgically treated advanced rectal cancer after neoadjuvant chemoradiotherapy remains unclear. This study examined the correlation between low skeletal muscle mass and morbidity and survival in patients with advanced lower rectal cancer. Methods We enrolled 144 clinical stage II/III patients with advanced lower rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative resection between 2004 and 2011. The cross-sectional skeletal muscle area at the third lumbar vertebra (L3) level was evaluated by computed tomography before chemoradiotherapy, and this was normalized by the square of the height to obtain the skeletal muscle index. Low skeletal muscle mass was defined as the sex-specific lowest quartile of the L3 skeletal muscle index. The association between low skeletal muscle mass and morbidity, relapse-free survival, or overall survival was assessed. Results Low skeletal muscle mass was identified in 37 (25.7%) patients. Age and body mass index were associated with low skeletal muscle mass. By multivariate analysis, we found that low skeletal muscle mass was independently associated with poor overall survival (hazard ratio = 2.93; 95%CI: 1.11–7.71; p = 0.031) and relapse-free survival (hazard ratio = 2.15; 95%CI: 1.06–4.21; p = 0.035), but was not associated with the rate of postoperative complications. Conclusions Low skeletal muscle mass is an independent negative prognostic factor for relapse-free and overall survival in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy.

DOI： 10.1371/journal.pone.0195406

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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  

症例は64歳の女性で，心窩部痛と嘔気を主訴に受診した．右季肋部に限局する軽度圧痛があり，CTで胆嚢腫大と胆嚢壁の浮腫状肥厚を認めて，急性胆嚢炎と診断した．胆嚢頸部に腫瘤影を認め，腫瘤の頸部嵌頓が胆嚢炎の原因と考えて，まずは抗菌薬による保存的治療を開始した．しかし，入院3日目に右季肋部痛と炎症所見が増悪したため緊急開腹術を施行した．胆嚢頸部に壁外から腫瘤を触知できず，胆嚢管を総胆管合流部近傍で切離して胆嚢を摘出した．切除標本では胆嚢頸部に径3cmの軟らかい有茎性腫瘍を認めた．肉眼的には腺腫あるいは早期癌が疑われ，追加切除やリンパ節郭清は行わなかった．病理組織検査で早期胆嚢癌と診断され，胆嚢剥離面や胆嚢管断端に癌の進展を認めなかった．胆嚢癌は自覚症状に乏しく，早期癌は胆石症の手術で偶然見つかることも多い．胆嚢頸部への嵌頓により生じた胆嚢炎を契機として発見された早期胆嚢癌はまれであり，報告をする．

DOI： 10.3919/jjsa.79.2346

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

Background/Objective The significance of extended lymphadenectomy for colorectal cancer with extraregional lymph node metastasis, such as para-aortic lymph node metastasis, has not been established. The purpose of this study was to evaluate the significance of extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis. Methods Between July 2004 and December 2013, 16 patients with synchronous extraregional lymph node metastasis without other organ metastases underwent curative resection and extended lymphadenectomy (R0 group). The clinical characteristics and survival outcomes of the R0 group were compared with those of 12 patients with extraregional lymph node metastasis who underwent palliative surgery (control group). Results In the R0 group, the 5-year cancer-specific survival (CSS) rate was 70.3% and the 5-year relapse-free survival (RFS) rate was 60.5%. The 5-year CSS differed significantly between the R0 and control groups (70.3% vs. 12.5%; p = 0.0003). Univariate analyses revealed that the total numbers of metastatic lymph nodes and metastatic regional lymph nodes present were significantly associated with RFS (p = 0.019 for both). Conclusion Findings from our study suggest that extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis might be effective in carefully selected patients.

DOI： 10.1016/j.asjsur.2015.10.003

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記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Colorectal Disease  

Purpose: The prognostic significance of the depth of mesorectal invasion (DMI) in patients with ypT3 rectal cancer who undergo preoperative chemoradiotherapy (CRT) is unclear. The purpose of this study was to evaluate the prognostic significance of DMI in ypT3 rectal cancer. Methods: A total of 168 (y)pT3 patients were evaluated, of whom 93 received preoperative CRT and 75 underwent surgery alone. Patients were subdivided into two groups according to the DMI (T3ab = DMI ≤5 mm and T3cd = DMI >5 mm). Oncologic outcomes were compared between the T3ab and T3cd groups and the ypT3ab and ypT3cd groups. Results: Relapse-free survival was significantly different between the pT3ab and pT3cd groups (74.1 vs 38.5%, P = 0.0192) but not between the ypT3ab and ypT3cd groups (65.9 vs 61.5%, P = 0.513). Multivariate analysis showed that DMI was an independent predictor of recurrence in pT3 patients (hazard ratio [HR] = 2.980, 95% confidence interval [CI] 1.227–7.025; P = 0.0169) and that ypN+ was an independent predictor of recurrence in ypT3 patients (HR = 3.487, 95% CI 1.570–8.827; P = 0.0016). Conclusions: DMI was not a significant predictive factor for recurrence in patients with ypT3 rectal cancer who underwent preoperative CRT, and ypN+ was the only independent predictive factor for recurrence.

DOI： 10.1007/s00384-016-2716-1

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PubMed

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

Background: The feasibility of additional lateral pelvic lymph node dissection (LPLND) compared with total mesorectal excision (TME) alone in patients treated with preoperative chemoradiotherapy (CRT) is controversial, especially in laparoscopic surgery. This study was performed to evaluate the feasibility of adding laparoscopic LPLND to TME in patients with advanced lower rectal cancer and swollen LPLNs treated with preoperative CRT. Methods: We reviewed 327 patients with lower rectal cancer without distant metastasis who underwent preoperative CRT followed by laparoscopic TME. Laparoscopic LPLND was added in patients with swollen LPLNs before CRT. Outcomes were compared between patients with (n = 107) and without (n = 220) LPLND. Results: LPLN metastasis was found in 26 patients (24.3 %) in the LPLND group. The operation time was significantly longer, and total blood loss was significantly greater in the LPLND than TME group (461 vs. 298 min and 115 vs. 30 mL, respectively; P < 0.0001). The major complication rate was similar in the LPLND and TME groups (9.3 vs. 5.5 %, respectively; P = 0.188), and there were no conversions to open surgery. The LPLND and TME groups also showed a similar 3-year relapse-free survival rate (84.7 vs. 82.0 %, respectively; P = 0.536) and local recurrence rate (3.2 vs. 5.2 %, respectively; P = 0.569) despite significantly more patients with pathological lymph node metastasis in the LPLND than TME group (37.4 vs. 22.3 %, respectively; P < 0.0001). Conclusions: Additional laparoscopic LPLND is feasible in patients with advanced lower rectal cancer and clinically swollen LPLNs treated with preoperative CRT, with no significant increase in major complications compared with TME alone.

DOI： 10.1007/s00268-016-3762-0

Scopus

PubMed

記述言語：日本語   出版者・発行元：日本大腸肛門病学会  

患者は45歳，女性，主訴は下腹部痛と下血．下部内視鏡検査で虫垂開口部に30mm径で弾性硬な粘膜下腫瘍様隆起を指摘．腹部造影CTでも同部位に造影効果を伴う充実性腫瘤を認め，原発性虫垂癌および粘膜下腫瘍を疑い，周囲リンパ節腫大もあったため診断および治療目的に腹腔鏡下回盲部切除術を施行した．切除検体の肉眼所見では虫垂体部が盲腸内腔に向かって重積様に突出し，虫垂は著明に短縮していた．病理組織学的検査で粘膜下層から固有筋層にかけて強い線維化と子宮内膜組織を散在性に認め，虫垂子宮内膜症による完全型の虫垂重積症と診断した．虫垂子宮内膜症とそれによる虫垂重積症は非常にまれであり，腸管子宮内膜症は粘膜下腫瘍様の形態をとるため術前診断は困難とされる．今回，原発性虫垂腫瘍との鑑別に苦慮し，腹腔鏡下回盲部切除術を施行した虫垂子宮内膜症による虫垂重積の1例を経験したので文献的考察を加えて報告する．

DOI： 10.3862/jcoloproctology.70.463

CiNii Research

記述言語：日本語   出版者・発行元：日本大腸肛門病学会  

症例は50歳女性，主訴は右鼠径部腫瘤．肛門管から下部直腸にかかる隆起性病変と肛門周囲皮膚に全周性の硬結・発赤を認めた．生検で肛門管内腫瘤から高分化腺癌，肛門周囲皮膚発赤部から上皮内に浸潤する癌細胞を認めた．精査にて右側方/鼠径リンパ節転移，肛門周囲皮膚へのpagetoid spreadを伴う肛門管腺癌と診断した．術前全身化学療法と術前化学放射線療法の後，腹腔鏡下直腸切断術，右側方/鼠径リンパ節郭清，会陰創皮弁形成術を施行．術後病理所見で癌細胞は認めず，pathological complete responseだった．Pagetoid spreadを伴う肛門管腺癌はまれであり確立した治療法はなく，予後不良である．本症例は術前治療が非常に有効であり，術前病期によっては前治療を含めた集学的治療も考慮するべきである．

DOI： 10.3862/jcoloproctology.70.81

CiNii Research

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

Background: For patients with low-lying rectal cancer, the feasibility of anus-preserving surgery in combination with neoadjuvant chemoradiotherapy (NACRT) has been not well established from the perspective of patient-centered outcomes. Methods: We investigated 278 patients with low-lying rectal adenocarcinoma from 2005 to 2012. We compared their symptoms and QOL scores of patients who underwent anus-preserving surgery with (n = 88) and without (n = 143) NACRT according to the Wexner scale, EORTC QLQ C-30, CR29, and the modified fecal incontinence quality life scale (mFIQL). Furthermore, to assess the rationale for intersphincteric resection (ISR) with NACRT, we also compared QOL of patients who underwent ISR with NACRT (n = 31) and abdominoperineal resection (APR, n = 47). Results: The adjusted mean differences of the Wexner score estimates of the patients who underwent ISR and very low anterior resection (VLAR) with or without NACRT were 5.29 (P = 0.004) and 2.67 (P = 0.009), respectively. No significant difference was observed in the QOL scores of two treatment groups. Furthermore, there were no significant differences in the QOL or function scores of patients who underwent ISR with NACRT and APR. Conclusion: The incontinence was significantly worse in patients who receive NACRT. However, there were no significant differences in their QOL or function scores. J. Surg. Oncol. 2016;114:630–636. © 2016 Wiley Periodicals, Inc.

DOI： 10.1002/jso.24376

Scopus

PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

Background: Although the feasibility of laparoscopic surgery for colorectal cancer has been demonstrated, the safety of laparoscopic pelvic exenteration (PE) with urinary diversion for colorectal malignancies remains poorly studied. The present study aimed to examine the safety and feasibility of laparoscopic PE in patients with colorectal malignancies. Methods: Thirty-one consecutive patients who underwent anterior or total PE with urinary diversion for colorectal malignancies between July 2004 and April 2015 at our institution were included in the study. Perioperative outcomes were compared between patients undergoing laparoscopic (n = 13) and open (n = 18) PE. Results: There were no conversions to open surgery. The estimated blood loss (930 vs. 3003 ml; P = 0.001) and total volume of blood transfusion (0 vs. 1990 ml; P = 0.002) were significantly lower in patients undergoing laparoscopic compared with open PE. R0 resection was performed in all patients. The operation time (laparoscopic, 829 min vs. open, 875 min; P = 0.660), complication rate (laparoscopic, 61.5 % vs. open, 83.3 %; P = 0.171), and postoperative hospital days (laparoscopic, 29 days vs. open, 33 days; P = 0.356) were similar in both groups. Three patients undergoing laparoscopic PE readmitted within 30 days due to ileus, although the rate of readmission did not differ significantly (laparoscopic, 23.1 % vs. open, 5.6 %; P = 0.284). Conclusion: Laparoscopic PE performed by experienced laparoscopic pelvic surgeons should be considered as a safe and preferred option in selected patients with colorectal malignancies, with a significant advantage in terms of reduced blood loss compared with open surgery.

DOI： 10.1007/s00268-015-3364-2

Scopus

PubMed

記述言語：英語   掲載種別：研究論文（学術雑誌）  

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

AIM: To evaluate the type of recurrence after endoscopic resection in colorectal cancer patients and whether rescue was possible by salvage operation. METHODS: Among 4972 patients who underwent surgical resection at our institution for primary or recurrent colorectal cancers from January 2005 to February 2015, we experienced eight recurrent colorectal cancers after endoscopic resection when additional surgical resection was recommended. RESULTS: The recurrence patterns were: intramural local recurrence (five cases), regional lymph node recurrence (three cases), and associated with simultaneous distant metastasis (three cases). Among five cases with lymphatic invasion observed histologically in endoscopic resected specimens, four cases recurred with lymph node metastasis or distant metastasis. All cases were treated laparoscopically and curative surgery was achieved in six cases. Among four cases located in the rectum, three cases achieved preservation of the anus. Postoperative complications occurred in two cases (enteritis). CONCLUSION: For high-risk submucosal invasive colorectal cancers after endoscopic resection, additional surgical resection with lymphadenectomy is recommended, particularly in cases with lymphoRetrospective vascular invasion.

DOI： 10.3748/wjg.v22.i7.2336

Scopus

PubMed

記述言語：英語   出版者・発行元：Colorectal Disease  

DOI： 10.1111/codi.12928

Scopus

PubMed

担当区分：筆頭著者   記述言語：英語   掲載種別：研究論文（学術雑誌）  

PURPOSE:
The management of rectal cancer is a significant oncologic challenge because rectal cancer has a poor prognosis among the various types of colorectal cancer. There have been several recent reports on a nonoperative approach for advanced lower rectal cancer, and this may be best for local disease control. However, objective evaluation of tumor response after preoperative chemoradiotherapy has not been standardized. The purpose of this study is to evaluate our method of endoscopic evaluation of complete response.

METHODS:
This is a retrospective chart review. All patients received a long course of preoperative chemoradiotherapy (5-fluorouracil-based chemotherapy and 45-50.4 Gy) followed by radical surgical resection from May 2005 to March 2012 in The Cancer Institute Hospital of Japanese Foundation for Cancer Research. One hundred fifty-seven patients were reviewed consecutively. Criteria for endoscopic complete response were defined with a focus on the degree of ulcer healing and pit pattern without magnification.

RESULTS:
Endoscopic CR (E-CR) evaluation with our definitions reflected histopathologic response evaluation with an accuracy of 91.7 %, sensitivity of 27.8 %, specificity of 100 %, positive predictive value (PPV) of 100 %, and negative predictive value (NPV) of 91.4 % (p < 0.001). Our criteria of E-CR led all cases of y-clinical CR (ycCR) to pathological CR.

CONCLUSIONS:
Endoscopic evaluation focused on the degree of ulcer healing, and pit pattern without magnification is useful for judging ycCR.

記述言語：英語   掲載種別：研究論文（学術雑誌）   出版者・発行元：International Journal of Colorectal Disease  

Methods: This is a retrospective chart review. All patients received a long course of preoperative chemoradiotherapy (5-fluorouracil-based chemotherapy and 45–50.4 Gy) followed by radical surgical resection from May 2005 to March 2012 in The Cancer Institute Hospital of Japanese Foundation for Cancer Research. One hundred fifty-seven patients were reviewed consecutively. Criteria for endoscopic complete response were defined with a focus on the degree of ulcer healing and pit pattern without magnification.

DOI： 10.1007/s00384-014-2105-6

Scopus

PubMed

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞ポイント ◆経肛門的アプローチでの側方リンパ節郭清(taLPLD)は,転移頻度の高い骨盤深部領域の郭清を目の前で,かつ解剖学的構造物に対して良好な鉗子の刺入角度で施行できる.◆しかし,本法で展開される経肛門視点の術野は独特であり,十分慣れ親しんでおく必要がある.◆また,taLPLDは,プラットフォームに対して極端に側方に位置する領域に対して単孔式腹腔鏡下手術の技術を使って行う手技であるため,技術的には決して容易ではない.

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J01539&link_issn=&doc_id=20210428590013&doc_link_id=10.11477%2Fmf.1407213349&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407213349&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(株)アークメディア  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(株)南江堂  

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2021&ichushi_jid=J00393&link_issn=&doc_id=20210618050018&doc_link_id=10.15106%2Fj_geka83_506&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka83_506&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：英語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：医学図書出版(株)  

胆道癌の切除後の生存率は不良であり、とくに進行例に対する手術単独の効果には限界がある。このため集学的治療が必要で、そのなかでも切除後の補助化学療法に関する臨床試験の結果が重要である。最近、重要な第III相試験の結果が公開された。第一は、本邦のBCAT試験である。Gemcitabineと切除単独を比較したが、その有効性は認めなかった。第二はフランスで行われたPRODIGE-12試験で、GEMOXの切除単独群に対する有効性は認めなかった。第三は、Capecitabineの有効性を検証する英国BILCAP試験である。ITT解析では有意差を認めなかったものの、per protocol解析で有意差を認めた。これらの結果から、欧米諸国ではCapecitabineが胆道癌の術後補助化学療法として推奨されるに至った。一方、本邦では胆道癌に対して保険収載されていないため、本方針を日常診療で用いることはできない。(著者抄録)

記述言語：日本語   出版者・発行元：(一社)日本消化管学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：日本外科系連合学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

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

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科感染症学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

本邦での遠隔転移を伴わない局所進行大腸癌の標準治療は手術+術後補助化学療法であるものの,その治療成績が満足できるものとはいい難い.一方,近年の著しい薬物療法の進歩を背景に,術前化学療法(NAC)は日常臨床の中で徐々に普及しているが,その長期成績は明らかでない.直腸癌に対する術前化学療法(NAC)は欧米では放射線化学療法(CRT)を省略することになり,高リスク症例では受け入れられ難い.しかし,術前治療を一般的に行って来なかった本邦では,NACは単に術後補助化学療法の前倒しであり,可能な施設に限りがあるCRTと比較して,多くの施設で受け入れられやすい.NACはCRTと比較して局所効果はやや劣るものの,生存率は遜色ない.今後は,リスク分類により個別化治療を提供していく必要がある.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J01146&link_issn=&doc_id=20201202370004&doc_link_id=10.3862%2Fjcoloproctology.73.417&url=https%3A%2F%2Fdoi.org%2F10.3862%2Fjcoloproctology.73.417&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：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(株)へるす出版  

記述言語：日本語   出版者・発行元：金原出版(株)  

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00620&link_issn=&doc_id=20200730220009&doc_link_id=10.18888%2Fop.0000001778&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000001778&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一財)日本消化器病学会  

記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞局所再発直腸癌に対する治療戦略は施設間差が大きく,外科医のdecisionが患者の人生を大きく左右する可能性がある.そのため,われわれは限られた症例の中で外科治療の限界と可能性を判断し,治療戦略を決定していく必要がある.一般的に局所再発直腸癌の長期予後は不良で,特に側方再発パターンは手術の難易度も高くかつ予後がわるい.当科のデータからも,いかにして側方再発をR0切除するかが大きな課題である.そのためには坐骨神経周りの詳細な解剖の理解とピットフォールを熟知しておくことが必須である.さらに必要に応じて術中放射線療法などの追加治療を行うことによって,さらなる治療成績の向上をめざしている.

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00393&link_issn=&doc_id=20200605170008&doc_link_id=issn%3D0016-593X%26volume%3D82%26issue%3D7%26spage%3D742&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D82%26issue%3D7%26spage%3D742&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：(株)医学書院  

＜文献概要＞ポイント ◆経肛門的側方郭清は転移頻度の高い骨盤深部領域の郭清を目の前で,かつ良好な鉗子の刺入角度で施行できる.◆症例によっては非常に有用なアプローチ法であり,選択肢の1つとして習得すべき手技であると考える.◆しかし,本法で展開される経肛門視点の術野は独特であり,十分慣れ親しんでおく必要がある.

記述言語：日本語   出版者・発行元：医学図書出版(株)  

その解剖学的特性のため、肝門部領域胆管癌は容易に肝動脈や門脈に浸潤し、非切除の要因となっていた。手術手技や周術期管理の向上に伴い、門脈切除は多くの施設で行われるようになったが、肝動脈切除については十分なエビデンスが得られていないため今でも挑戦的な手術である。当教室では、2010年に動脈・門脈同時切除を行った肝門部領域胆管癌50例の治療成績を検討した。高度な技術が必要であるが、手術関連死亡は許容範囲内で長期予後が期待できることを報告した。近年、動脈切除を伴う肝門部領域胆管癌の治療成績の報告は増加しているが、その周術期死亡率や長期予後については、いまだ良好とはいえない。教室における動脈・門脈切除を伴う肝門部領域胆管癌の手術とその選択根拠について症例を通じて解説する。(著者抄録)

記述言語：日本語   出版者・発行元：金原出版(株)  

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2020&ichushi_jid=J00620&link_issn=&doc_id=20200309060010&doc_link_id=10.18888%2Fop.0000001579&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000001579&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：日本消化器病学会-東海支部  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(株)南江堂  

＜文献概要＞腫瘍下縁が腹膜翻転部よりも肛門側に位置する下部進行直腸癌に対して,側方郭清はこれまで日本の標準術式として行われてきた.近年,術前画像診断の質の向上とリスクに応じたテーラーメード治療の時代の中で,大腸癌治療ガイドライン2019において術前画像診断に基づき側方郭清の推奨度にはじめて強弱がつけられた.また術前(化学)放射線療法を標準とする海外でも,側方郭清の意義が注目を集めている.側方郭清と(化学)放射線療法,その双方の長所・短所を十分理解し治療戦略を組み立てていくことが重要である.

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2019&ichushi_jid=J00393&link_issn=&doc_id=20190902150007&doc_link_id=10.15106%2Fj_geka81_1042&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka81_1042&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は64歳の女性で,心窩部痛と嘔気を主訴に受診した.右季肋部に限局する軽度圧痛があり,CTで胆嚢腫大と胆嚢壁の浮腫状肥厚を認めて,急性胆嚢炎と診断した.胆嚢頸部に腫瘤影を認め,腫瘤の頸部嵌頓が胆嚢炎の原因と考えて,まずは抗菌薬による保存的治療を開始した.しかし,入院3日目に右季肋部痛と炎症所見が増悪したため緊急開腹術を施行した.胆嚢頸部に壁外から腫瘤を触知できず,胆嚢管を総胆管合流部近傍で切離して胆嚢を摘出した.切除標本では胆嚢頸部に径3cmの軟らかい有茎性腫瘍を認めた.肉眼的には腺腫あるいは早期癌が疑われ,追加切除やリンパ節郭清は行わなかった.病理組織検査で早期胆嚢癌と診断され,胆嚢剥離面や胆嚢管断端に癌の進展を認めなかった.胆嚢癌は自覚症状に乏しく,早期癌は胆石症の手術で偶然見つかることも多い.胆嚢頸部への嵌頓により生じた胆嚢炎を契機として発見された早期胆嚢癌はまれであり,報告をする.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J03156&link_issn=&doc_id=20181205100026&doc_link_id=10.3919%2Fjjsa.79.2346&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.79.2346&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  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

患者は45歳,女性,主訴は下腹部痛と下血.下部内視鏡検査で虫垂開口部に30mm径で弾性硬な粘膜下腫瘍様隆起を指摘.腹部造影CTでも同部位に造影効果を伴う充実性腫瘤を認め,原発性虫垂癌および粘膜下腫瘍を疑い,周囲リンパ節腫大もあったため診断および治療目的に腹腔鏡下回盲部切除術を施行した.切除検体の肉眼所見では虫垂体部が盲腸内腔に向かって重積様に突出し,虫垂は著明に短縮していた.病理組織学的検査で粘膜下層から固有筋層にかけて強い線維化と子宮内膜組織を散在性に認め,虫垂子宮内膜症による完全型の虫垂重積症と診断した.虫垂子宮内膜症とそれによる虫垂重積症は非常にまれであり,腸管子宮内膜症は粘膜下腫瘍様の形態をとるため術前診断は困難とされる.今回,原発性虫垂腫瘍との鑑別に苦慮し,腹腔鏡下回盲部切除術を施行した虫垂子宮内膜症による虫垂重積の1例を経験したので文献的考察を加えて報告する.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01146&link_issn=&doc_id=20170829220004&doc_link_id=10.3862%2Fjcoloproctology.70.463&url=https%3A%2F%2Fdoi.org%2F10.3862%2Fjcoloproctology.70.463&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

記述言語：英語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

症例は50歳女性,主訴は右鼠径部腫瘤.肛門管から下部直腸にかかる隆起性病変と肛門周囲皮膚に全周性の硬結・発赤を認めた.生検で肛門管内腫瘤から高分化腺癌,肛門周囲皮膚発赤部から上皮内に浸潤する癌細胞を認めた.精査にて右側方/鼠径リンパ節転移,肛門周囲皮膚へのpagetoid spreadを伴う肛門管腺癌と診断した.術前全身化学療法と術前化学放射線療法の後,腹腔鏡下直腸切断術,右側方/鼠径リンパ節郭清,会陰創皮弁形成術を施行.術後病理所見で癌細胞は認めず,pathological complete responseだった.Pagetoid spreadを伴う肛門管腺癌はまれであり確立した治療法はなく,予後不良である.本症例は術前治療が非常に有効であり,術前病期によっては前治療を含めた集学的治療も考慮するべきである.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01146&link_issn=&doc_id=20170502290007&doc_link_id=10.3862%2Fjcoloproctology.70.81&url=https%3A%2F%2Fdoi.org%2F10.3862%2Fjcoloproctology.70.81&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)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(株)へるす出版  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：(一社)日本大腸肛門病学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

患者は42歳女性で,発熱・前胸部痛・左肩痛を主訴に受診した.精査の結果,左膿胸の診断で入院した.第7病日摂食後に胸腔ドレーンより残渣物が排出されたため外科紹介となった.胸腹部CTで左膿胸を認め,上部消化管内視鏡検査で胃穹窿部に潰瘍性病変を認めた.造影すると膿瘍腔が造影された.以上より,胃穿孔による左膿胸と診断した.感染コントロールが良好であり,癌が否定しきれなかったためPPI・抗生剤での保存治療を先行した.病理組織学検査所見では悪性所見は認めなかった.上部消化管内視鏡検査を再検すると,潰瘍底が穿通し瘻孔が太く造影されたため,第57病日に横隔膜合併胃部分切除術を施行した.術後経過は良好で術後28日目に退院した.術後の病理組織学検査所見でも悪性所見は認めなかった.今回われわれはBochdalek孔ヘルニアに嵌頓した胃の穿孔によると思われた膿胸の1例を経験したので文献的考察を含め報告する.(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J03156&link_issn=&doc_id=20140714130013&doc_link_id=10.3919%2Fjjsa.75.1532&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.75.1532&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：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は32歳,女性。左下腹部痛に軽度圧痛と嘔吐を主訴として救急外来を受診した。小児期に完全内臓逆位の指摘を受けていた。血液検査で白血球・CRP値の上昇を認め,腹部CTで左下腹部に虫垂と思われる構造物の腫脹が認められた。完全内臓逆位症に合併した急性虫垂炎と診断し,保存加療目的に入院となった。腹部症状の改善を認めたが,本人の希望もあり,第4病日単孔式腹腔鏡下虫垂切除術を施行した。術後経過は良好で術後第3病日に退院した。腹腔鏡下虫垂切除術は臓器の位置関係を容易に把握でき,さらに単孔式とすることで整容性に優れ,安全な術式になりうると考えられた。(著者抄録)

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

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

症例は89歳,女性。以前より巨大胆石を指摘されていたが高齢であるため経過観察されていた。突然の嘔吐を主訴に救急外来受診。腹部CTで40mm大の結石が十二指腸球部に嵌頓しイレウスとなっていた。上部消化管内視鏡検査では十二指腸球部に嵌頓した巨大胆石を認め,内視鏡的截石術は困難であった。上部消化管造影では,胆嚢十二指腸瘻を認めた。胆嚢十二指腸瘻を通過した胆石が十二指腸球部に嵌頓したBouveret症候群と診断した。第8病日,開腹的に経胃的截石術を施行し,胃体中部で大彎側より割を入れてBillrothII法式に空置的胃空腸吻合術を行った。瘻孔閉鎖や胆嚢摘出は施行しなかった。Bouveret症候群は非常にまれな疾患で高齢者に発症することが多く,治療法の選択に悩まされる。本症例は低侵襲を優先した空置的胃空腸吻合術のみに留めた。現在術後合併症を認めていない。若干の文献的考察を加え報告する。(著者抄録)

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J02824&link_issn=&doc_id=20140203470015&doc_link_id=10.11231%2Fjaem.33.1315&url=https%3A%2F%2Fdoi.org%2F10.11231%2Fjaem.33.1315&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  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

記述言語：日本語   出版者・発行元：(株)南江堂  

当院では急性虫垂炎に対して2000年から腹腔鏡下虫垂切除術(LA)を導入し、2008年からはLAを第一選択の術式としている。また、2010年3月から、穿孔と膿瘍形成のない虫垂炎に対して単孔式腹腔鏡下虫垂切除術(SILS-A)を導入した。今回、穿孔・膿瘍形成のない急性虫垂炎に対して2008年6月〜2011年5月に腹腔鏡下手術を行った138例を術式別にLA施行群(124例)とSILS-A施行群(14例)に分けて手術成績を比較検討した。比較項目は「手術時間」「出血量」「開腹移行率」「術後在院日数」「術後合併症」などとした。検討の結果、いずれの項目にも有意な群間差は認められなかった。患者背景を群間比較すると、SILS-A施行群は年齢が低く、炎症の程度が軽いという特徴が認められた。

その他リンク： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2013&ichushi_jid=J00393&link_issn=&doc_id=20130425120012&doc_link_id=issn%3D0016-593X%26volume%3D75%26issue%3D5%26spage%3D524&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D0016-593X%26volume%3D75%26issue%3D5%26spage%3D524&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

記述言語：日本語   出版者・発行元：日本臨床外科学会  

症例は47歳,男性.基礎疾患として高血圧,糖尿病,洞性頻脈を指摘されていた.当院泌尿器科で尿路結石の精査目的に腹部造影CT施行したところ,膵頭部前面に造影される6.0×5.5cmの腫瘤を指摘された.悪性リンパ腫を疑い,当科にて腫瘍摘出術を施行した.切除標本の病理組織学的検索および免疫染色の結果では,NSE+,chromogranin A+であり,Extraadrenal intraabdominal paragangliomaと診断した.術後経過は良好で,術後約10ヵ月の現在,再発は認めていない.膵頭部前面に発生したparagangliomaは稀であり,文献的考察を加えて報告する.(著者抄録)

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=20130605140045&doc_link_id=10.3919%2Fjjsa.74.1361&url=https%3A%2F%2Fdoi.org%2F10.3919%2Fjjsa.74.1361&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：(NPO)日本血管外科学会  

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

記述言語：日本語   出版者・発行元：金原出版(株)  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本癌治療学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

記述言語：日本語   出版者・発行元：(一社)日本腹部救急医学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本乳癌学会  

記述言語：日本語   出版者・発行元：(一社)日本消化器外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(NPO)日本血管外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

記述言語：日本語   出版者・発行元：(一社)日本内視鏡外科学会  

記述言語：日本語   出版者・発行元：日本臨床外科学会  

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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