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Volume 64, Issue 1
Displaying 1-9 of 9 articles from this issue
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Original Articles
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Katsuji Tokuhara, Kazuhiko Yoshioka, Shigeyoshi Iwamoto, Yasushi Nakan ...2011 Volume 64 Issue 1 Pages 1-5
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSObjective: We evaluated the superiority of laparoscopic surgery (LS) for right-side colon cancer to compare LS clinical and economic outcomes with open surgery (OS).
Patients: The subjects were 42 consecutive persons with pathological stage II and III primary right-side colon cancer treated between 2006 to 2007 involving 25 in the LS group and 17 in the OS group.
Results: Clinical outcome: In the LS group, tumor locations were 7 in the cecum (C), 17 in the ascending colon (A), and one in the right-side transverse colon (T). In the OS group, tumor locations were one in the appendix (v), 2 in C, and 14 in A. Operating time in LS was significantly longer than that in OS, although bleeding volume during surgery was significantly lower than in OS, and hospital stay was significantly shorter. Neither the postoperative food intake nor rate of complications differed significantly between the groups. Economic outcome: Both the admission cost and DPC comprehensive cost of OS were significantly higher than those of LS, whereas the daily admission cost for LS was higher than that for OS. The LS operation cost was significantly higher than that for OS, but the LS operation cost was higher than that of OS, and so the pure profit for OS operation was higher than that for LS.
Conclusion: LS helps improve the quality of life after operation, but its cost must be reduced to help ensure the financial health and survival of hospitals.
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Akira Watanabe, Shuji Saitou, Yosuke Hashimoto, Hiroyasu Kagawa, Emima ...2011 Volume 64 Issue 1 Pages 6-10
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSPurpose: This study assessed the validation of patients with Stage III colon cancer according to the TNM, 7th edition (TNM7).
Patients and Methods: Patients with Stage III colon cancer who underwent curative surgery were investigated. We compared the relapse-free survival of these patients according to TNM7, the TNM 6th edition (TNM6) and Japanese General Rules (JGR7). We verified the relapse-free survival of these patients which we divided into subgroups according to the combination of T factor and N factor on TNM7.
Results: We reviewed 217 patients. The rates of 3-year relapse-free survival (3y-RFS) of the patients on TNM7 Stage IIIA, Stage IIIB and Stage IIIC were 95%, 82% and 74%. There was a significant difference in relapse-free survival of these patients in TNM7 (p = 0.0468), but no significant differences in TNM6 or JGR7. The main reason for the clear stratification in TNM7 was the up-staging of the patients with T4bN1 tumors (3y-RFS = 50%) from stage IIIB in TNM6 or JPG7 to Stage IIIC in TNM7.
Conclusion: The prognosis of patients with Stage III colon cancer on TNM7 was stratified, and was shown to be valid.
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Clinical Study
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Hiroshi Sashiyama, Yasunobu Tsujinaka, Yukihiro Hamahata, Osamu Tsutsu ...2011 Volume 64 Issue 1 Pages 11-16
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSObjective: The aim of this study was to investigate the correlation of high-risk human papillomavirus (HPV) with anal condylomata acuminata (ACA).
Methods: The HPV group was identified by hybrid capture II (hcII) and HPV types were determined by direct sequencing of the HPV-specific PCR fragments in 33 cases of ACA.
Results: High-risk HPV type 51 was detected in only one case by the PCR method. On the other hand, ten cases were high-risk HPV positive by hcII. Discrepancies were observed between the sequences of PCR-amplified fragments and the results of hcII. Low-risk HPVs, HPV type 6 and type 42 proved to be cross-hybridized to high-risk HPV-probes. Therefore, the cut-off point of the relative luciferase unit (RLU) should be changed to avoid false positives for high-risk HPV due to cross-hybridization on hcII. Based on the RLU value, the positive rate of high-risk HPV was 6% in ACA and 70% in HIV-positive ACA cases.
Discussion: High-risk positive cases in ACA by hcII included false positive cases due to cross-hybridization with low-risk HPV. However, HIV-positive ACA cases showed a high prevalence of high-risk HPV even considering the cross-hybridization.
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Case Reports
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Kazuhide Iwakawa, Hidenori Kiyochi, Yoshinori Imai, Shinsuke Kajiwara, ...2011 Volume 64 Issue 1 Pages 17-23
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSWe report a case of severe constipation with rectal prolapse who underwent subtotal colectomy and rectopexy. A 36-year-old woman started medication and increased laxative dependency without the benefits associated with rectal prolapse on most occasions. Barium enema showed diffuse dilatation of the colon. A study of the transit time with barium demonstrated a slow transit pattern, and persistence in the rectum for five days. Anorectal manometry showed low static pressure and no rectoanal reflex. Defecography showed inadequate rectal evacuation, hence we diagnosed rectal prolapse and severe constipation associated with slow transit constipation. We performed a laparoscopy-assisted subtotal colectomy and rectopexy. Pathological examination revealed no morphologic change. Postoperative bowel frequency was one or two times per day without laxative. This method may be an option for severe constipation with rectal prolapse.
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Masakatsu Numata, Syouichi Fujii, Tenni Godai, Shigeru Yamagishi, Tsut ...2011 Volume 64 Issue 1 Pages 24-28
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSThe subject was a 56-year-old female. Ulcerative colitis was found when she was 33 years old. In September 2005, abdominoperineal resection with ileostomy was performed for rectal cancer. The pathological examination showed pAI (vagina), pN2, ly2, v3 and pM1 (bilateral inguinal nodes) stage IV. FOLFIRI therapy was performed for bilateral inguinal node metastases. Within four months, the subject showed complete remission and serum CEA level was normalized. Chemotherapy was continued thereafter, but tumor markers were elevated. Therefore, PET was performed in August 2007. The results showed a high-accumulation area in the adductor of the left thigh. Adenocarcinoma was diagnosed by aspiration biopsy cytology, and rectal cancer metastasis to the left thigh was diagnosed. Excision of the tumor together with the adductor of the left thigh was performed. Pathologically, it was low differentiated adenocarcinoma and was diagnosed as metastasis from rectal cancer. After surgery, the CEA was normalized and the subject has survived without relapse (27 months after excision of metastasis to the left thigh). We report this rare case of metastasis of colon cancer to skeletal muscle.
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Masayuki Nogi, Ei Miyasaka, Toshio Sekioka, Toshiki Tanaka, Shin'ichi ...2011 Volume 64 Issue 1 Pages 29-34
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSCase1 was a 72-year-old woman with bloody stool. On gastroendoscopy, multiple map-like gastric ulcers were found. On colonoscopy, a giant circular ulcer covering almost the whole circuit of the lower rectum near the dentate line was found. This lesion seemed to be an acute hemorrhagic rectal ulcer (AHRU). However, because of the existence of multiple gastric ulcers, biopsy was performed from the rectal ulcer bottom, which showed CMV infection on immunostaining associated with plasma CMV antigenemia assay positive. Ganciclovir was administered, resulting in healing without delay.
Case 2 was a 68-year-old man with tarry stool. As with case 1, both gastric ulcer and rectal ulcer resembling AHRU were seen. Biopsy from the rectal ulcer bottom showed CMV infection on immunostaining. This case was not treated with ganciclovir.
In conclusion, we experienced two very rare cases of AHRU associated with CMV in immunocompetent patients. Both cases were associated with multiple gastric ulcers, but CMV was not confirmed from the gastric ulcers. AHRU is often seen in long-term bed-ridden elderly patients. The etiology is thought to be related to hemodynamics, not infection. The present cases suggest that even in immunocompetent patients, CMV infection could cause the same pathology like AHRU, or both non-infectious cases and infectious cases may be the same disease.
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Tomomi Yakabe, Kenji Sumi, Yuji Nakafusa, Hirokazu Noshiro, Kohji Miya ...2011 Volume 64 Issue 1 Pages 35-40
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSA man in his fifties with ileus caused by rectal cancer underwent transverse colostomy and insertion of CV catheter. On the 7th postoperative day, systemic chemotherapy by mFOLFOX6 (bolus and infusion fluorouracil and leucovorin with oxaliplatine) was started via the CV port. From the second course, bevacizumab was combined with mFOLFOX6. After 5 courses with mFOLFOX6 and Bevacizumab, the rectal cancer was remarkably reduced in size and the serum levels of CEA and CA19-9 decreased to their normal levels. Laparoscopic intersphincteric resection for rectal cancer was performed safely. The histological effect of the chemotherapy was Grade 2. The surgical margin was free from cancer cells and lymph node metastasis was not present. The patient was treated with adjuvant chemotherapy without any recurrence for 9 months. This case suggests that neoadjuvant chemotherapy with mFOLFOX6/Bevacizumab is a useful regimen for locally advanced rectal cancer.
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Naohito Beppu, Hidenori Yoshie, Tsukasa Aihara, Hidenori Yanagi2011 Volume 64 Issue 1 Pages 41-46
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSA 73-year-old male patient visited our hospital with the chief complaint of melena. Colonoscopy revealed type-2 advanced cancer of the transverse colon and lower rectum. Both biopsied specimens revealed moderately differentiated tubular adenocarcinoma. Metastasis of other organs was not found. In the first operation involving left hemicolectomy and transverse colon stoma (Hartmann operation), radical surgery for the transverse colon cancer and fecal diversion stoma for the lower rectal cancer were performed. Chemoradiotherapy was continuously performed for the lower rectal cancer. In the second operation, subtotal colon resection, super low anterior resection, intrasphincteric resection, cecoanal anastomosis, and ileostomy were performed. In recent years, anal preservation operations are performed, but this is the first report in which cecoanal anastomosis was performed. This operation seems to be useful for the treatment of lower rectal cancer.
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How I do it
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Hiroyuki Fukuda, Takaaki Kaneko, Kotaro Yoshimura2011 Volume 64 Issue 1 Pages 47-48
Published: 2011
Released on J-STAGE: December 27, 2010
JOURNAL FREE ACCESSDownload PDF (247K)
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