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Volume 68, Issue 2
Displaying 1-8 of 8 articles from this issue
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Original Articles
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Akira Watanabe, Mitsuyoshi Ota, Yusuke Suwa, Shinsuke Suzuki, Atsushi ...2015 Volume 68 Issue 2 Pages 61-67
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSTo re-evaluate colorectal neuroendocrine tumors based on the WHO 2010 classification, we retrospectively analyzed data from 3090 cases of colon tumors treated in our department between January 2000 and June 2013. A total of 102 tumors (NET G1, NET G2, NEC, MANEC = 88, 4, 6, 4) were identified, respectively. For NET G1, NET G2, NEC, and MANEC respectively, the median tumor diameter (mm) was 7, 19, 47, and 22; the lymph node metastasis rate was 11%, 75%, 83%, and 50%; the distant metastasis rate was 0%, 50%, 83%, and 0%; and the 5-year survival rate was 94.5%, 37.5%, 16.7%, and 100%. The lymph node metastasis rate of 1-6 mm NET G1 was 0%, that of 7-9 mm NET G1 was 13%, and that of over 10 mm NET G1 was 33%. The lymph node metastasis rate of positive cases of lymphatic invasion was 50%, which was higher than that of negative cases.
In conclusion, colorectal neuroendocrine tumors based on the WHO 2010 classification reflect the malignant grade, and were well stratified. Additional surgical resection in NET G1 with positive lymphatic invasion or tumor diameter of more than 10 mm should be considered.View full abstractDownload PDF (657K) -
Motoi Koyama, Takayuki Morita, Tadashi Hashizume, Takashi Itho, Akihik ...2015 Volume 68 Issue 2 Pages 68-74
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSPurpose: The aim of this study was to clarify the risk factors associated with recurrence in patients with stage III colorectal cancer.
Method: We performed a retrospective analysis of 303 patients with stage III colorectal cancer who underwent gross radical resection between 1994 and 2003.
Results: The overall recurrence rate was 34.7%. Multivariate analysis identified 4 four risk factors associated with recurrence: depth of tumor invasion (T4; OR 2.192, p=0.004), lymph node metastasis (N2-3; OR 3.547, p<0.001), perineural invasion (PN1; OR 1.725, p=0.047) and extramural tumor deposits (EX; OR 2.555, p=0.001). The 5-year relapse-free survival rate was significantly associated with depth of tumor invasion (T4: 50.5%, T3: 73.6%; p<0.001), lymph node metastases (N2-3: 45.6%, N1: 73.8%; p<0.001), perineural invasion (PN1: 54.5%, PN0: 71.2%; p=0.002), and extramural tumor deposits (EX positive: 48.5%, EX negative: 74.6%; p<0.001).
Conclusion: The results of this study suggest that active postoperative adjuvant chemotherapy should be considered for the treatment of patients with stage III colorectal cancer with T4, N2-3, PN1, and EX.View full abstractDownload PDF (700K)
Clinical Study
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Shota Takano, Yoriyuki Tsuji, Kazutaka Yamada, Hiroo Ieda, Michiya Miy ...2015 Volume 68 Issue 2 Pages 75-80
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSBackground: Sphincter-preserving fistulectomy is a basic surgical procedure for low intersphincteric fistula-in-ano. However, the failure rate is relatively high at 5-10%. Therefore, the Miyata-Ieda method (MI method), which covers the primary opening with a myomucosal advancement flap and the fistula tract is retained in the anal sphincter, is now performed. This retrospective study compares the outcomes of the conventional sphincter-preserving fistulectomy (Takano method) with the MI method.
Patients and methods: The MI method was performed on 101 patients between January 2011 and March 2013 and the Takano method was performed on 250 patients between May 2004 and December 2013 at Takano hospital and Ieda hospital. Outcome measures included recurrence, operation time and fecal incontinence.
Results: Operation times were 17 minutes (MI method) and 19 minutes (Takano method). Recurrence was significantly lower in the MI method (2.0% vs 7.6%). Patients who underwent the MI method experienced lower gas incontinence but there was no significant difference. Moreover, there was no significant difference in the pre- and post-operative mean anal pressure in the MI group.
Conclusion: The MI method is a safe and effective method for the treatment of low intersphincteric fistula with a low recurrence rate.View full abstractDownload PDF (4754K)
Case Reports
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Fumiaki Takahashi, Masakazu Nakano, Atsushi Hoshino, Takeshi Sugaya, M ...2015 Volume 68 Issue 2 Pages 81-85
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSA 40-year-old male with severe ulcerative colitis (UC), resistant to steroid therapy, obtained clinical remission by Granulocyte and Monocyte Apheresis (GMA) during the initial hospitalization. In the subsequent maintenance therapy concomitantly with immunomodulator, repeated flare-ups occurred resulting in a second hospitalization. The Clinical Activity Index (CAI) on admission was severe and colonoscopy (CS) confirmed mucosal inflammation with spontaneous bleeding and multiple ulcers. Although tacrolimus (Tac) was given, there was no improvement in symptoms even though a high trough level was maintained. Surgery was considered, but we started treatment with infliximab (IFX) after discontinuing Tac. As a result, IFX induced remission with significant improvement in symptoms. The patient continued IFX therapy after being discharged from the hospital and ‘mucosal healing’ was confirmed by CS six months after initiating IFX therapy. Remission has been maintained for the following 18 months.
A treatment strategy for severe UC needs to be established, but there is still no clear consensus on the selection of Tac or IFX. We report on the selection criteria for either drug for severe cases, and review the literature.View full abstractDownload PDF (10990K) -
Noriyuki Isohata, Daiki Nemoto, Shungo Endo, Kenichi Utano, Taisuke Ot ...2015 Volume 68 Issue 2 Pages 86-91
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSA 76-year-old man was admitted to our hospital because of left lower abdominal pain. He was treated conservatively and discharged on the 9th day. However, he was admitted again on the 18th day due to the symptom of stenosis after bowel preparation for colonoscopy. Colonoscopy revealed circumferential stenosis of the descending colon and the colonoscope could not pass through the stenosis. The mucosal surface was not irregular and biopsy specimens did not show malignancy in histology. We diagnosed benign inflammatory stenosis due to stricture type ischemic colitis, and performed endoscopic balloon dilation. The initial two attempts resulted in re-stenosis, so we added submucosal steroid injection after endoscopic balloon dilation. Re-stenosis has not occurred to date and complete healing was achieved after 6 months.View full abstractDownload PDF (2515K) -
Megumi Yamaguchi, Daisuke Sumitani, Masahiro Nakahara2015 Volume 68 Issue 2 Pages 92-96
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSAn 88-year-old male was hospitalized due to abdominal pain. Computed tomography showed thickness of the ileal wall and total colonoscopy revealed an elevated lesion in the ileocecum. Signet ring cell carcinoma was diagnosed by biopsy.
Right hemicolectomy was performed and the pathological diagnosis was as follows: signet cell carcinoma, SI (parietal peritoneum), ly3, v0, N2 (9/10), H0, P1, Stage IV. Signet ring cell adenocarcinoma of the colon is very rare, with high malignancy potential such as frequent lymphatic invasion and frequent peritoneal dissemination. It is usually detected at an advanced stage of the tumor. Therefore, early diagnosis and multimodal therapy, including chemotherapy, conventional cytotoxic agents and radiotherapy are important to improve the prognosis for signet ring cell carcinoma.View full abstractDownload PDF (5669K) -
Takeshi Ueda, Shinji Nakamura, Fumikazu Koyama, Tadashi Nakagawa, Naot ...2015 Volume 68 Issue 2 Pages 97-102
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSA 76-year-old female underwent abdominoperineal resection for rectal cancer followed by sigmoid end colostomy. After the operation, the sigmoid colostomy constructed by the extraperitoneal method showed ischemic changes and peristomal inflammation. The colostomy exhibited peristomal granuloma. As it was difficult to attach the colostomy pouch because of the granuloma, we performed a resection of the peristomal granuloma and used a local skin flap to repair the colostomal defect about one year after the initial operation. After this procedure, it was easy to attach the colostomy pouch. When constructing a stoma, it is necessary to consider the optimal route for obese patients. Although it was initially difficult to attach the colostomy pouch in the present case due to peristomal granulation, this plastic surgery technique using a local skin flap was easy and noninvasive, and made it easy to attach the pouch after the procedure. The use of plastic surgeries such as local skin flaps can be useful for cases with a deformed stoma.View full abstractDownload PDF (1987K) -
Momoko Kogo, Shintaro Nakajima, Yoshiko Uno, Mitsumasa Takeda, Kenta T ...2015 Volume 68 Issue 2 Pages 103-108
Published: 2015
Released on J-STAGE: January 30, 2015
JOURNAL FREE ACCESSThe patient, a 74-year-old man who had ascending colon cancer with multiple liver metastases and right adrenal metastases, underwent mFOLFOX6 chemotherapy starting in November 2012. The patient complained of dyspnea and dizziness three days after starting the chemotherapy, and ECG showed negative T wave in II, III, aVF and V2-V6. Coronary angiography CT demonstrated no significant stenosis, though UCG showed hypokinesis in the apex. Therefore, the patient was diagnosed as having developed Takotsubo cardiomyopathy. The symptoms recovered promptly following heparin and oxygen administration, and the patient was discharged 9 days after the onset of symptoms. Takotsubo cardiomyopathy during chemotherapy is rare, and only 18 cases have been reported in the Japanese literature. Although 5-FU has been reported to be associated with spasm of the coronary arteries, the causative relationship of the drug with Takotsubo cardiomyopathy is not clear. The physical and mental stress of chemotherapy might have contributed to the development of Takotsubo cardiomyopathy. We herein report a case of colorectal cancer complicated by Takotsubo cardiomyopathy during mFOLFOX6 therapy and review the literature.View full abstractDownload PDF (2119K)
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