Pancreatic cancer ranks 4th among men and 3rd among women in terms of cancer-related deaths according tothe Cancer Information Service of the National Cancer Center website. The morbidity and mortality are similar,the mortality rate when affected is very high, and the 5-year survival rate for all pancreatic cancer cohorts is 5% to10%, which is the poorest prognosis among several malignant diseases. However, there is much room for improving treatment outcomes.Surgical resection is the only treatment that can be expected to cure pancreatic cancer, but the recurrence rateafter curative resection is very high. It is often the case that it is already unresectable at the time of diagnosis.Regarding surgical resection, despite various surgical improvements, the 5-year survival rate of surgery alone remains at approximately 10% to 20%, and chemotherapy is used not only in unresectable cases but also in resectedcases. The importance of multidisciplinary treatment is increasing.The paper outlines the significance of surgical resection for pancreatic cancer, the evolution of chemotherapy,and future prospects.

Breast cancer is a malignant tumor that originates from breast tissue. Breast cancer is the leading cause of morbidity among women in Japan. Early breast cancer is treated with surgery, radiation therapy, hormonal therapy,and cytotoxic anticancer chemotherapy. Recently, a number of new drugs have been approved for the treatmentof metastatic and recurrent breast cancer, and treatment is becoming individualized. The 5-year survival rate forbreast cancer is 90.5%, the 10-year survival rate is 79.3%, and the number of cancer survivors is increasing. Asthe number of cancer survivors increases, care for cancer survivors is required to cover a wide range of fields.Interest in hereditary breast cancer is also increasing, and personalized treatment is expected to advance further. Inthis article, we describe the recent trends and outlines of breast cancer treatment.

Surgical treatment for lung cancer has changed in various ways. It can be said that the history of lung cancersurgery began in 1933 with the pneumonectomy by Graham. The “radical lobectomy” presented by Cahan in1960 was the basic concept of the current surgical procedure. The LCSG821 trial conducted by the Lung CancerStudy Group established lobectomy as the standard procedure for lung cancer. With the development of diagnosticimaging, it became possible to detect early lung cancer showing ground glass opacity. The Noguchi classificationplayed a major role in the detection of curable early-stage lung cancer. The JCOG0201 trial conducted in Japanestablished the definition of noninvasive imaging of cancer, which led to the JCOG0804 trial and JCOG0802 trial.This year, the results of the JCOG0802 trial were announced. The interpretation of this trial will play a very important role in establishing standard treatments in the future.

Recent advances in multidisciplinary treatment have significantly improved the prognosis of childhood cancer.In particular, advances in chemotherapy have brought about a significant change in the surgical treatment of pediatric malignant solid tumors. Until the 1980s, the mainstay of treatment for pediatric solid malignant tumors wasto initially remove the local tumor by extended surgery, followed by chemotherapy. However, complications fromextended surgery made it difficult to perform multidisciplinary treatment smoothly. Furthermore, it has becomeclear that, even if the treatment is completed 5 or 10 years after the end of the treatment, the effects of the extended surgery include deformity of the body, permanent impairment of organ function, and extremely low QOL in theaffected child.In recent years, however, as the clinical and biological characteristics of tumors have been gradually clarified,the intensity of treatment required for each tumor has become clearer. In addition, the development of effectivechemotherapeutic agents and chemotherapeutic regimens has led to a common understanding of the importance ofpreoperative tumor reduction, avoiding complications from surgery, and implementing seamless multidisciplinarytreatment for pediatric cancer.In this article, the recent treatment concepts and surgical treatments for pediatric solid malignant tumors, especially neuroblastoma and nephroblastoma, are reviewed.

The survival outcomes of gastric cancer patients with peritoneal metastases are still dismal, even with recentadvances in chemotherapy. Paclitaxel is an antineoplastic agent with high molecular weight and hydrophobic features. It has a pharmacokinetic advantage for the control of peritoneal lesions. After intraperitoneal delivery usingan implantable peritoneal access port, it slowly exits the peritoneal cavity, resulting in reduced systemic uptakeand toxicity, as well as sustained high concentrations in the peritoneal cavity. Intraperitoneal paclitaxel plus S-1and intravenous paclitaxel therapy was developed, and phase II trials were conducted to evaluate the efficacy forgastric cancer patients with peritoneal disease. Although two trials showed promising results, a subsequent phaseIII trial failed to show statistical superiority over S-1 plus cisplatin doublet systemic chemotherapy. I reviewed thehistorical background of this therapy and discussed its pros and cons.

Aims: The anterior choroidal artery (AchA) supplies the inferior part of the cerebrum, including the posterior limbof the internal capsule (PLIC) of the medial to inferior levels. The characteristic of AchA infarction was studied.In particular, we studied the correlation between the locations of the infarcts in the PLIC and the presence ofsymptoms in the corticobulbar tract.Materials and methods: We investigated the neurological and MRI findings of 7 patients with AchA infarction.Results: Hemiparesis was present in all patients. Central facial nerve palsy or dysarthria was present in 4 patients.Focal sensory disturbance was shown in 1 patient. The PLIC was involved in all patients. The infarcts spread toother regions, including the thalamus, in 2 patients. Infarcts of the PLIC were located vertically within the medialto inferior levels. In the horizontal direction, the middle portion was most frequently involved in 5 patients. Infarcts in 4 patients with central facial nerve palsy or dysarthria included the middle portion; however, these 2symptoms were absent in 2 patients whose infarcts were limited to the posterior portion.Conclusion: The corticobulbar tract passes through the middle portion of the PLIC. The corticospinal tract adheres to the corticobulbar tract posteriorly and runs to the middle to posterior portions. Our results indicated thepresence of the corticobulbar tract in the middle portion in the PLIC as previously reported and showed a goodcorrelation between symptoms of the corticobulbar tract and the extent of infarcts in the PLIC in AchA infarction.

Background: Anatomical anterior cruciate ligament (ACL) reconstruction has become more common, andnumerous studies have focused on the anatomy of the ACL. The femoral ACL footprint can be divided into midsubstance insertion (MI) and fan-like extension fibers (FE). It is commonly held that the MI plays a larger role inACL function. In our previous research, we used an elliptic formula to show that the MI resembles an ellipse. Toaccurately reproduce the morphology and function of the native ACL, we concluded that femoral bone tunnelsshould be created at the two elliptical focal points of the MI. However, in recent years, it has been reported thatFE also contribute significantly to the stability of the ACL and that reconstruction of FE is likely to result in moreaccurate anatomical reproduction.Purpose: The purpose of this study was to investigate which elements of the femoral footprint, including FE,were elliptical to reveal the most anatomically accurate location for femoral bone tunnel placement.Materials and Methods: Twenty cadaveric knees were used. We examined the footprint shapes of FE, anteromedial bundle (AM), posterolateral bundle (PL), MI of AM and PL (AMm, PLm) and FE of AM and PL (AMf, PLf).Results: AM, PL, AMm, AMf, PLm and PLf were all elliptical in shape.Conclusion: Our study suggests that, among currently accepted methods of tunnel placement, creating bone tunnels at the two elliptical focal points of the AM and PL with a quadruple bundle results in the most anatomicallyaccurate reproduction of the native ACL.

Injuriests to the brain, such as ischemia and trauma, cause activation of astrocytes immediately following theinjury. Activated astrocytes form gliosis in the chronic period. Gliosis will exacerbate pathology, prevent neuronalrecovery and will be an epileptic focus. Several mechanisms are known to increase intracellular calcium levels toactivate astrocytes. Transient receptor potential canonical 3 (TRPC3) is a calcium channel that has a major contribution to calcium levels. Pyrazole-3 (Pyr3), a TRPC3 channel blocker, is reported to prevent gliosis in a cerebralischemia rat model. Another major mechanism of calcium increase is gliotransmission affected by calcium wave.Stimulation of the P2Y1 receptor triggers calcium release from intracellular stores, and blockade of the P2Y1 receptor with MRS2179 prevents calcium elevation. In the present study, Pyr3 and MRS2179 were administered toa rat cerebral contusion injury (CCI) model to prevent injury-induced astrocyte activation. The aim of the presentstudy was to determine the effects of CCI with prevention of astrocyte activation on long-term gliosis formation.Male rats were randomized to the naïve, CCI-Control, CCI-Pyr3 and CCI-MRS2179 groups. Drugs were directlyinjected into contused tissue. Rats were sacrificed on days 3, 7 and 28 following injury. The expression of TRPC3channels and P2Y1 receptors was suppressed in the CCI-MRS2179 group. On day 3, the glial fibrillary acidicprotein (GFAP) level of the CCI-Control group was significantly higher than that of the naïve group. The GFAPlevels of the CCI-Pyr3 and CCI-MRS2179 groups were higher but not significantly different from those of thenaïve group. On day 28, the GFAP level of the CCI-Control group further increased but that of the CCI-Pyr3 andCCI-MRS2179 groups was significantly lower than that of the CCI-Control group. Holzer-stained brain volumesof both the CCI-Pyr3 and CCI-MRS2179 groups showed significantly less gliosis than those of the CCI-Controlgroup on postinjury day 28. Both TRPC3 channel and P2Y1 receptor blockade immediately following injuryreduced gliosis in the chronic phase.