We report a patient who developed severe biliary stenosis after undergoing cholecystectomy and hepatoduodenal ligament lymph node dissection for early gallbladder cancer. A 43-year-old man underwent cholecystectomy for gallbladder cancer, developed postoperative biliary stenosis, and again underwent surgery involving bile duct resection. The pathological diagnosis for the bile duct wall was a fibrous scar with no evidence of malignancy; therefore, the biliary stenosis was presumably secondary to disruption of the bile duct blood supply caused by lymph node dissection.
Background: Our clinical data accumulated during 30 years of clinical practice at the Department of Gastroenterological Surgery, Tokai University, indicated the effectiveness of the Billroth 1 procedure that preserve duodenal food passage, as well as its suppressive effect on hepatic metastasis. Here, the effectiveness of food passage through the duodenum is examined via experiments using BALB/c mice. Methods: In the first phase, gastrojejunostomy was performed using BALB/c mice. In the second phase, by duodenum ligation or not, the non-duodenal passage and duodenal passage models, respectively, were created. Transplantable colon26 was transplanted into the spleen, and the number of hepatic metastases was examined. At the same time, Kupffer cells, NK cells, Th1 cytokines, and Th2 cytokines such as IL-12, INFγ, and IL-4 were measured in the sham operation mice. Results: (1) Hepatic metastasis was observed in 9 of 25 mice (36.0%) and 18 of 26 mice (69.2%) in the duodenum passage model and non-duodenum passage model, respectively (p = 0.017, RR = 4.000, 95%CI, 1.246-12.842), and the average numbers of metastasis were 0.76 and 3.12, respectively (p = 0.077). (2) No significant differences were observed in the number of Kupffer cells and NK activity, and the production of Th1 cytokines and Th2 cytokines between the two groups. Conclusion: It was considered that in non-duodenum passage reconstructive surgery that produced bacterial translocation due to the existence of a blind loop may have induced cytokine production, causing the activation of NK cells and leading eventually to hepatic metastasis.
Background: This article is a summary of clinical research results from a study beginning approximately 30 years ago. We have focused on human leukocyte antigens (HLA) as one of several important genetic factors for the formulation of effective personalized therapy for cancer patients that can be applied in clinical settings. HLA were also studied on the basis of the original study hypothesis that pathological states and pharmacokinetics are similar among patients with similar genetic information. Methods: HLA antigens were serologically tested using the National Institutes of Health standard microlymphocytotoxicity method for HLA-A, -B, -C, -DR and -DQ from Aug. 1977 to Aug. 2005 (n=1753) and also tested for the reproducibility and validation over the period from Sept. 2005 to Feb. 2010 (n=209). In this study, it was shown that individuals could be identified and grouped according to pair-matched parameters generated from serum HLA profiles at the protein level to represent the genetic information. Results: In patients with similar HLA profiles, the effective and ineffective personalized therapies were also similar, leading to a good ability for successful prognosis. With existing cancer therapies, 60.9% of patients experienced a positive outcome. However, 10.2% of patients received ineffective personalized therapy. If effective personalized therapy is not given, oral administration of Polysaccharide Kureha and/or fluoropyrimidines regimen will be needed for at least 2 years. Conclusion: Our hypothesis that effective and ineffective personalized therapies are similar in patients with similar genetic information, resulting in accurate therapeutic prognosis, has been established.
Background: The previous study of ours showed the prognostic impact of preoperative neutrophil to lymphocyte ratio (NLR) in resected non-small cell lung cancer (NSCLC) patients. Methods: In the present study, the relationship between postoperative NLR and patients' prognosis was examined in NSCLC patients with preoperative high NLR. Consecutive 85 resected NSCLC patients with preoperative high NLR (≥2.5) were reviewed retrospectively. In this study, patients with a follow-up period less than 5 years were omitted. Results: Among these 85 patients, the postoperative NLR in 46 patients were persistently higher than 2.5. The 5-year survival of the patients with postoperative NLR≥2.5 was significantly worse than that of the patients with postoperative NLR<2.5 (34.78% vs. 61.54%, p=0.0067). Univariate and multivariate analyses of the clinicopathological factors affecting survival revealed that postoperative high NLR was an independent prognostic determinant. Conclusion: NSCLC patients with preoperative high NLR, patients with a persistently high NLR after surgery had poor prognosis.
Generally, clinical outcome of gastric small cell carcinoma is extremely poor. In this paper, we report a case of a patient with gastric small cell carcinoma who completely responded to chemotherapy and showed a long survival without recurrence. A 56-year-old man was admitted to our hospital with symptoms of weight loss and a large mass in the upper abdomen. Esophagogastroduodenoscopy revealed a large tumor located in the posterior wall of the antrum of the stomach. Computed tomography revealed a large mass involving the stomach with regional lymph node metastasis and direct pancreatic invasion. Pathological and immunohistochemical analyses indicated a diagnosis of primary gastric small cell carcinoma. Curative resection was not considered likely, and hence, a combination chemotherapy consisting of irinotecan and cisplatin was administered. Following 4 cycles of chemotherapy, complete remission was confirmed. The treatment was stopped after 9 cycles as per the patient's request. The patient survived for more than 8 year without recurrence since the first diagnosis of cancer. This case suggests that combination chemotherapy with irinotecan and cisplatin, which is recognized as one of the standard regimens for small cell carcinoma of the lung, can provide clinical benefits for patients with gastric small cell carcinoma.
A 62-year-old female with a productive sputum was pointed out of a mass of 2.5 cm in diameter in left S4 with lymphadenopathy of station 10, 4, and 3 on computed tomographic scan, which were heterogeneously enhanced by radiocontrast agent. She was diagnosed with pulmonary adenocarcinoma and clinical stage IIIA (T1N2M0, N2-multistation). First-line induction therapy of cisplatin plus paclitaxel had been performed but failed to respond to the chemotherapy. Second-line induction therapy of gefitinib for 6 months had showed the shrinkage of the tumor and resulted in a down-stage (T1N0M0, IA). Positron emission topography revealed no abnormal accumulations of the primary tumor and the mediastinal lymph nodes. As salvage surgery, left upper lobectomy was performed and the pathology revealed negative findings of metastasis in lymph nodal station 4, 5, 6, 7, and 11 but in a positive in station 10. The viable cells in the tumor had been residual (Ef.2) and diagnosed with stage IIA (pT1N1M0). Detection test of epidermal growth factor receptor gene mutation showed a negative result. The patient obtained 5-year's long-term survival without metastasis and recurrence. The combination therapy of gefitinib-induction therapy followed by surgery for advanced lung cancer with N2-multistation would have an advantage of good outcome for such patient in the limited gefitinib-responded population as tailor-made therapies.