Background: The present study explored whether or not the Oral Health Assessment tool (OHAT) score is a risk factor of postoperative pneumonia after esophagectomy for esophageal cancer.

Methods: This study included 47 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for postoperative pneumonia.

Results: Postoperative pneumonia was found in 18 of the 47 patients (38.3%). Among the various factors examined (age, gender, preoperative chemotherapy status, operative type, operative duration, blood loss, lymph node dissection, alcohol habit, OHAT score), the OHAT score (p = 0.006) and age (p = 0.040) were identified as significant independent risk factors for postoperative pneumonia in univariate and multivariate analyses. The incidence of postoperative pneumonia was 5% (1 of 20) in the OHAT ≤2 group and 51.9% (14 of 27) in the OHAT ≥3 group.

Conclusion: The OHAT score is a risk factor for postoperative pneumonia in patients who have undergone curative esophagectomy for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

Oropharynx cancer has a markedly high prevalence in eastern countries. This cancer leads to complexity and persistence of dysfunction in breathing, speech, swallowing and chewing, accompanied by long-lasting and often permanent disability. In order to achieve a cure and preserve the function, we have actively performed surgical reconstruction following multidisciplinary treatment for oropharynx cancer at our institution. This is a clinical case of a 53-year-old male patient identified as having stage III squamous cell carcinoma of the right lateral tongue. Given the large size of the tongue tumor, neoadjuvant chemotherapy was particularly useful prior to surgery and radiotherapy. In addition, in cases of advanced tongue tumor, primary surgery followed by adjuvant chemotherapy is recommended for a better disease control and survival. We used an infrahyoid myocutaneous island flap for reconstruction of tongue defects after cancer resection. The infrahyoid island flap, harvested from the infrahyoid muscles, is based on the superior thyroid vessels. This thin and pliable flap provided a skin island of about 7 cm from the central part of the anterior neck in our patient. This flap was reliable and achieved primary closure of the tongue defect. The donor site was closed primarily without difficulties. The present report includes a review of the etiology, diagnosis, and contemporary methods of treating oropharyngeal cancer.

Tocilizumab is an anti-interleukin-6 receptor monoclonal antibody which was recently approved for the treatment of inflammatory arthritis and Castleman disease. Because tocilizumab suppresses immunological reactions, the more frequent occurrence of infections with atypical presentations is a conceivable complication after abdominal surgery. Herein, we would like to describe a case of a prolonged abdominal abscess with subtle abdominal pain after surgery for perforated ascending colon cancer in a patient with Castleman disease treated by tocilizumab.

Gastric cancer is leading cause of death worldwide. Although several therapeutic agents have been developed and showed positive efficacy for patients with gastric cancer, drug resistance remains severe problem during treatment. AT-rich interactive domain 1A (ARID1A) and annexin A1 (ANXA1) have a pivotal role in gastric tumorigenesis and reported as useful predictive or prognostic biomarkers. Previous study revealed that loss of ARID1A confers resistance to drugs that target the HER2/PI3K/mTOR pathway in breast cancer through activation of AKT via upregulation of ANXA1. Elevated ANXA1 levels are important for trastuzumab resistance and ANXA1 expression is inversely correlated with ARID1A levels in HER2-positive breast cancer. While trastuzumab is also used in HER2-positive gastric cancer, the expression status between ARID1A and ANXA1 in gastric cancer has yet to be determined. Here, we investigated both ARID1A and ANXA1 expressions by immunohistochemical staining in the test (n = 200) and validation (n = 220) cohorts of gastric cancer. Our results revealed that the inverse correlation between ARID1A and ANXA1 was not exist in patients with gastric cancer. The mRNA microarray analysis, which identified ARID1A-regulated genes in HER2-positive gastric cancer cells, revealed that ANXA1 was not induced by ARID1A knockdown. The present study suggested that the molecular relationship between ARID1A and ANXA1 is different in gastric cancer from in the breast cancer that ANXA1 serves as a predictive biomarker for trastuzumab-based treatment. Our results prompt a further study into the investigation of functional role of ARID1A and ANXA1 in gastric cancer.

Background: The paraaortic lymph-node (PALN) is a relatively uncommon metastasis as a first site of recurrence following colorectal cancer (CRC) surgery. Localized and resectable PALN recurrence has the potential of long-term survival by curative resection. We evaluated the risk factors for the recurrence of PALN following curative surgery in patients with CRC in a pooled analysis of two large randomised control studies.

Patients and Methods: Individual patient data from the Japanese Foundation for Multidisciplinary Treatment of Cancer clinical Trials 7 and 15 were pooled for this analysis. We included total 4459 patients who had stage I-III colorectal cancer and underwent curative resection with over D2 lymph node dissection.

Results: Recurrent PALN occurred in 0.7% of all patients (30/4459). Of the 30 patients with recurrent PALN, 19 had PALN alone, whereas 11 had a recurrence in at least one other organ in addition to PALN. PALN recurrence occurred after the 3-year postoperative period in 10 patients (33%). In multivariate analysis, lymph node involvement was the only independent predictor of recurrent PALN (hazard ratio, 2.670; p = 0.0106).

Conclusions: Our findings clarify the risk factors for PALN recurrence in stage I–III CRC who undergo curative resection. These results will be useful to identify optimal subgroups for high risk of PLAN recurrence.

Purpose: Previously, we demonstrated the efficacy of rehabilitation programs after maxillofacial surgery. In the present study, we extracted and summarized recommendations for the successful and comprehensive treatment of malignant tumors in the maxillofacial area.

Material and methods: We analyzed the medical histories and ambulatory cards of 107 oncological patients with postoperative maxillofacial defects who underwent various prosthetic procedures.

Results: Using polyurethane plastics to produce a protective plate on the day of surgery is necessary to improve the short-term results of orthopedic treatment. The classification of the defect, selection of prosthesis according to the classification, applying the prosthesis without delay, and functional restoration by articulation gymnastics and mechanotherapy compose of the comprehensive approach for the defect at maxillofacial area after surgery.

Conclusions: We propose that integrating the benefits from each treatment method and rehabilitation process would further improve quality of life after resection of maxillofacial tumors.

IL(interleukin)-17A is the most widely studied member of the IL-17 family, and has been demonstrated to play a critical role in host defense against various microbial pathogens and tissue inflammation. IL-17A-producing cells including Th17 cells are involved in human psoriasis, rheumatoid arthritis, multiple sclerosis, inflammatory bowel disease, and asthma, and IL-17A-targeted therapy has been proven to be effective in the treatment of some autoimmune diseases. The pathogenic features of Th17 and IL-17A cells in cancer remain controversial, and Th17 cells appear to promote disease progression, as well as be present in the vicinity of many types of malignant diseases. Strong correlations of immunosuppression, inflammation and malnutrition appearing in advanced patients with cancer seems to involve MDSC, IL-17A, and VEGF. This review will overview the basic features of IL-17A and Th17, and their relationships with human disorders such as cancer and the therapeutic strategies in oncology were discussed.

The combination regimen of cisplatin (CDDP) and fluorouracil (5-FU) (FP) is a standard regimen for definitive chemoradiotherapy, neoadjuvant chemotherapy, and for treatment of unresectable or recurrent esophageal squamous cell carcinoma (ESCC). Here, we report a patient with FP-induced renal salt-wasting syndrome (RSWS) who presented with severe hyponatremia with disturbance of consciousness and was admitted to the intensive care unit (ICU). A 66-year-old man with recurrent ESCC was admitted and started on chemotherapy with FP. From day 3 of the first course of FP, he presented with anorexia and vomiting (grade 3). At day 6, he experienced disturbance of consciousness and blood test showed severe hyponatremia (sodium (Na): 119 mmol/L) accompanied with excessive urinary excretion of Na (181 mmol/L). He was diagnosed with RSWS because of CDDP and was transferred to the ICU. Through intensive monitoring and 3% NaCl infusion, serum Na level and symptoms recovered with no sequelae and he was discharged from the ICU after a 4-day stay.

RSWS is sometimes difficult to diagnose because of its low recognition and is misdiagnosed as the syndrome of inappropriate secretion of antidiuretic hormone. During chemotherapy with platinum-based agents, RSWS should be kept in mind as a disorder that causes hyponatremia.

We herein report a case of metastatic colon cancer RAS wild tumor progressed during the treatment with FOLFOX + panitumumab and then recognized as BRAF mutation and MSI-H. Seventy eight years-old male patient showed anastomotic recurrence of colon cancer after curative resection of Stage II ascending colon cancer six years before the appearance of the recurrence. Six months after R0 resection, surveillance CT was performed and diagnosed as recurrent tumor invaded to duodenum. For R0 resection, mFOLFOX6 plus panitumumab therapy was initiated to expect early tumor shrinkage because of RAS wild tumor. However, tumor progressed after 4 cycles. The second-line therapy was not able to started because the disease progression was extremely rapid. He died 4 months after initiation of therapy. BRAF mutation and MSI-H were recognized from his tumor by the additional analyses.

We report two cases of pyogenic spondylodiscitis caused by bacteremia following gastric surgery. [Case 1] An 85-year-old male patient underwent total gastrectomy for gastric cancer. After the surgery, leukocytosis and elevated C reactive protein (CRP) were sustained; however, there was no surgical site infection (SSI). His lumbar pain was present; therefore, we performed magnetic resonance imaging (MRI). Thereafter, he was diagnosed with L3 spondylitis, L2/3 discitis, and bilateral iliopsoas abscess on postoperative day (POD) 33. He has been treated with daptomycin (DAP). [Case 2] A 72-year-old male patient was admitted to our department for post-distal gastrectomy reflux esophagitis. After admission, conservative therapy was continued; however, severe symptoms appeared many times. Then, surgical treatment was scheduled to reduce reflux. When his body temperature (BT) was elevated to 39.1°C before the surgery, vancomycin (VCM) was administered because of suspected catheter infection. Once his BT normalized, fundoplication was performed. On POD 19, his BT elevated again, and the central vein (CV) catheter was removed. On POD 27, he complained of back pain. He was diagnosed with pyogenic spodylodiscitis using MRI. He was treated conservatively with VCM followed by sulbactam/ampicillin (SBT/ABP) based on the result of the culture.

Physicians should be alert regarding possible occurrence of pyogenic spondylitis in patients with back pain or lumbago who have undergone gastric surgery.

Ovarian cancer often presents with carcinomatous ascites effusion. Cell-free and concentrated ascites reinfusion therapy (CART) provides a symptomatic treatment. The ascitic fluid contains a large number of lymphocytes including γδ T cells which are cytotoxic and used as effector cells in cancer immunotherapy. We collected ascites-infiltrating lymphocytes (AILs) from the ascitic fluid that was obtained for CART.

We examined four patients with ovarian cancer and two patients with primary peritoneal cancer. Five patients were at stage 3c, and one was at stage 4b. In patients with ascitic ovarian cancer, in which ascites is accumulated, we collected AIL from a filter and were able to culture γδ T cells. The number of cultured Vδ2⁺ T cells were 3.2 (range, 0.7–63) × 10⁵/L. We cultured AILs obtained from CART with pyrophosphomonoester or zoledronic acid (Zol) as an antigen, interleukin (IL2), and with or without IL18. In case of culture in pyrophosphomonoester, IL2, and IL18, the proportion of Vδ2⁺ T cells / CD3 positive cells was 71%, and the proliferation rate (cell number after culture/those pre-culture) of Vδ2⁺ T cells was 83. Cells cultured in Zol, IL2, and IL18 in AILs exhibited isopentenyl pyrophosphate (IPP)-dependent cytotoxicity, and the median level of it was 5.3%.

γδ T cells from AILs obtained from CART have a cytotoxic activity. However, the cytotoxic activity was low, which needs improvement. In future, we may use it as a source for adoptive immunotherapy, if we can improve the proliferation rate and cytotoxic activity.

Aim: To assess the efficacy of palliative surgery on malignant gastrointestinal obstruction (MGIO), we analyzed postoperative results in patients underwent palliative surgery for the purpose of symptom relief.

Patients and methods: Seventeen patients with MGIO were enrolled who underwent palliative surgery to release stenotic symptoms. Post-operative course and prognosis were retrospectively analyzed.

Results: The median time to take first diet was 4 days excluding three patients who were unable to eat. Complications more than grade II in Clavien Dindo classification were observed in 3 cases. Thirty-day postoperative mortality was 17.3%. The median survival time (MST) was 148 days. Eleven out of 17 patients could be initiated chemotherapy. Duration of possible oral diet and home stay was significantly longer in patients with chemotherapy than in those without chemotherapy (p = 0.0035, p = 0.0008 respectively). A significantly prolonged survival was also observed (p = 0.0002).

Conclusion: Early oral intake was possible by palliative surgery for MGIO. In cases with chemotherapy, it was considered possible to maintain a relatively long-term survival and QOL even in the terminal status.

Arterio-portal fistula (APF) is a rare vascular abnormality, characterized by communication between artery and portal vein. We describe a 69-year-old male patient with APF, who developed acute clinical symptoms 10 months after hepatectomy. The APF was accompanied by massive ascites and thrombosis in the superior mesenteric vein. The condition was successfully treated using anticoagulant, diuretics, and interventional coil embolization of the fistulas. This case indicates that APF is an important postoperative complication after hepatectomy, and that intrahepatic APFs could manifest acutely with ascites and superior mesenteric vein thrombosis.

We experienced a case of simultaneous operation of SILS (single-incision laparoscopic surgery) colectomy using fascia defect and the primary suture repair for incisional hernia. An 89 year old male patient was visited our hospital for the purpose of surgery for the incisional hernia. Before surgery, he was diagnosed as suspiciously cecum cancer. SILS using the fascia defect was performed for simultaneous hernia repair by the primary suture repair to avoid a mesh infection. For the repair of the hernia, the primary suture was performed using the delayed absorbable monofilament suture. Postoperative course was uneventful, then he discharged on 9th day after surgery. More than 3 years passed after surgery, no symptom of recurrence of cancer and hernia was observed by the clinical and imaging findings. It might be possible and important to obtain a satisfied treatment by selecting the most appropriate surgical procedure for each individual.

Anastomotic leakage (AL) after left-sided colorectal cancer surgery is one of the most serious complication. Once anastomotic leakage occur, we have to select the treatment, non-surgical or surgical. The aim of this study is to evaluate the outcome of the treatments for AL after left-sided colorectal surgery in our institution. Fifty-five patients who had AL after left-sided colorectal surgery were included in this study. Thirty nine were treated for non-surgical treatment (non-surgical group). In eight patients, we had to change the strategy from non-surgical to surgical during non-surgical treatment (convert group). Eight patients were treated for surgical treatment at first due to generalized peritonitis (surgical group). There were not significant differences in patient’s background and blood examination between these groups. The patients who had three symptoms (the change of drain contents, fever higher than 38℃ and abdominal pain) in convert group were significantly more frequent than those of non-surgical group (50%:7.7% P = 0.01). The rate of diverting stoma in non-surgical group were significantly more frequent than those of convert and surgical groups (25.6%:6.2% P < 0.001). In all of 55 patients, the rate of permanent stoma was 9% and mortality was 0%. In selected patients without generalized peritonitis, AL after left-sided colorectal cancer can be controlled by non-surgical treatment. Furthermore it may decrease the rate of permanent stoma. Moreover, we should select surgical treatment at first step for the patients who had three clinical symptoms even in the absence of findings of generalized peritonitis.

A 71-year-old woman with epigastric pain and fever visited our hospital. She had elevated levels of serum amylase and C-reactive protein, and computed tomography revealed a large, 20 cm diameter, pancreatic cyst. A low-density nodule was also identified in the head of the pancreas with mild dilation of the distal main pancreatic duct (MPD). The patient was diagnosed with pancreatic ductal carcinoma complicated by a pancreatic pseudocyst (PPC). After drainage of the cyst, a pancreaticoduodenectomy was safely performed. Histological examination revealed anaplastic pancreatic carcinoma (APC) composed of spindle cells and osteoclast-like giant cells. The tumor occupied the lumen of the MPD and acute and chronic obstructive pancreatitis was evident. Although her postoperative course was uneventful, the tumor recurred as multiple liver metastases three months after surgery, and she died of disease progression four months after surgery. PPCs are often caused by alcohol use, biliary tract disease, or blunt trauma. However, PPCs caused by APC is rarely seen. Although extremely rare, pancreatic cancer or APC should be considered as a cause of PPCs. A spindle cell component to the tumor seems to be associated with a dismal prognosis, while growth within the pancreatic duct is reported to carry a better prognosis.