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Some authors have suggested that a relationship exists between gastrectomy for gastric cancer and metabolic bone disorders. However, few studies have investigated metabolic bone disorders after gastrectomy for gastric cancer in detail. Thus, we reviewed the findings of our recent prospective study and those of other reports on this subject. Osteoporosis and osteomalacia have been observed after gastrectomy and appear to be caused by reduced food intake and absorption, and steatorrhea. Moreover, the incidence of fracture is high after gastrectomy, although subtotal or total gastrectomy and reconstruction for gastric cancer have not been identified as significant risk factors for decreased bone mineral density (BMD). Recently, we reported that the BMD decreased significantly within 12 months after gastrectomy for gastric cancer in both male and female patients, but there was no significant gender-related difference in the rate of change in BMD. More than 1 year after gastrectomy, the steep decrease in the BMD stabilized and normal levels of 1,25(OH)2 vitamin D3 were maintained, despite the lack of precursor for 1,25(OH)2 vitamin D3 synthesis after gastrectomy. Alendronate therapy might be effective and prevent postgastrectomy metabolic bone disorders; however, the optimal treatment and prevention strategy for this bone disorder has not been delineated.

The benefits of laparoscopic surgery for colorectal cancer have been well established. Several randomized controlled trials have demonstrated similar oncological outcomes between laparoscopic and open surgery for colon cancer. However, whether or not laparoscopic surgery is acceptable in patients with clinical N2 colon cancer is unclear. Therefore, the present study aimed to evaluate the safety and oncological outcomes of laparoscopic surgery for clinical N2 colon cancer. This retrospective study assessed a prospective database and identified 262 consecutive patients with clinical N2 colon cancer who underwent either laparoscopic or open primary resection between 2000 and 2016. After propensity-score matching, 162 patients were analyzed. The primary outcome of interest was the 3-year recurrence-free survival rate, and the secondary outcome of interest was the postoperative complication rate. The 3-year recurrence-free survival rate did not differ markedly between the laparoscopic and open surgery groups (77.4% vs. 76.5%, p = 0.620). In addition, the incidence of postoperative complications did not differ markedly between the laparoscopic and open surgery groups (16.6% vs. 24.0%, p = 0.317). Our findings suggest that laparoscopic surgery is safe and effective for clinical N2 colon cancer. Laparoscopic resection can be considered in patients diagnosed with clinical N2 colon cancer.

Previous studies from Western countries have shown similar survival outcomes after both open and laparoscopic resections. In Japan, radical D3 dissections performed by open resection have been routinely performed for ≥T2- or ≥N1-stage cancers, and relatively favorable survival outcomes were obtained. This study compared the survival in patients with Stage I/II colon and upper rectal cancers undergoing laparoscopic and open resection. A total of 145 patients were initially enrolled. Propensity score matching was applied to assemble a study cohort. D2 lymph node dissection for T1 cancer and D3 for ≥T2- and ≥N1-stage cancers were applied. The primary outcome measure was the disease-free survival; the cancer-specific and overall survival rates were secondary outcomes. A total of 64 patients were matched for the analysis. The length of hospitalization, postoperative complication rates, number of lymph nodes removed and surgical margins were similar between the groups. The disease-free survival following laparoscopic surgery was better than that following open surgery, but the difference was not statistically significant. Neither the cancer-specific nor overall survival rates following laparoscopic surgery were inferior to those associated with open surgery. The outcomes of the laparoscopic approach were comparable to those for open surgeries accompanied by radical lymph node dissection.

Adrenocortical carcinoma (ACC) in childhood is rare: in 2002, only three new cases were reported in Japan. Although there is no established therapeutic management system, margin-free complete surgical excision of the tumor is very important to a satisfactory outcome. We report a case of ACC with bilateral pulmonary metastasis in a 10-year-old boy. Preoperative chest computed tomography (CT) showed pulmonary metastasis with near-water density. The patient was treated successfully with complete surgical resection of the primary tumor and adjuvant chemotherapy, including mitotane. After bilateral lung surgery for the metastatic lesions, the plasma dehydroepiandrosterone sulfate level became negative.

Lung cancer associated with Sweet's syndrome is extremely rare. There are only seven reports of such cases. As far as could be determined from a comprehensive search, there is no reported operative case of lung cancer with this syndrome in the world literature. A 75-year-old Japanese man was diagnosed as having Sweet's syndrome. A chest computed tomography (CT) scan to screen for malignant lesions associated with this syndrome revealed an abnormal shadow in the lung. Although [(18)F]2-fluoro-2-deoxy-D: -glucose positron emission tomography showed no abnormal uptake, lung cancer was most strongly suspected by chest CT. His erythema improved rapidly with steroid therapy and he underwent a segmentectomy (S(6)) of the right lower lobe. A pathological examination revealed lung adenocarcinoma (pT1N0M0: Stage Ia). The patient was discharged from the hospital without any worsening of Sweet's syndrome. We herein report a first operative case of an early stage lung adenocarcinoma with this syndrome.

Several authors have reported the relationship between gastric cancer risk and vitamins. However, there are few reports on fat-soluble vitamins after gastrectomy for gastric cancer. Fat malabsorption and suppression of food intake after gastrectomy for gastric cancer have been previously documented. Because of fat malabsorption and suppression of food intake, a potential deficiency in fat-soluble vitamins, such as vitamins A, D, E, and K, has been readily suggested. In about 20 % of patients, the serum vitamin E levels were decreased. Indeed, vitamin E deficiency is a common complication after gastrectomy. Continuous vitamin E deficiency could develop from neurological symptoms, i.e., peripheral neuropathy, limb or truncal ataxia. The total cholesterol level is associated with the vitamin E levels. However, the serum vitamin A levels were decreased in only 1.8 % of patients. In total gastrectomy cases, the serum vitamin A level may readily decrease. In contrast, 1,25(OH)2 vitamin D deficiency, which is the most active vitamin D metabolite, is rare. Additionally, vitamin K deficiency after gastrectomy has not been reported thus far. Evidence that serum fat-soluble vitamin levels may decrease after gastrectomy for gastric cancer has not been established yet. Future research must explore fat-soluble vitamin deficiency after gastrectomy.

We evaluated the long-term outcome and symptoms after inguinal hernia repair using the Prolene Hernia System (PHS).We reviewed the medical records of all patients who underwent PHS surgery at our hospital to assess the postoperative complications and recurrence rates. Late symptoms were evaluated by a standardized interview using a questionnaire.A total of 395 hernias in 367 patients were studied. Postoperative complications developed after 20 repairs (5.1%), including a severe mesh infection in one patient. Seven (1.8%) patients suffered recurrence. Of 395 cases, 363 (91.9%) responded to the interview. After a median follow-up interval of 19.3 months (range 1.0-55.8), moderate pain and moderate discomfort were reported by only 1.9% and 0.8% of patients, respectively.Prolene Hernia System surgery is a safe and feasible procedure with low rates of complication, recurrence, and late symptoms.

We report a rare case of a solitary metachronous metastasis of renal clear cell carcinoma (RCC) presenting as a thyroid tumor 19 years after a nephrectomy. Our search of the English-language literature found only sporadic reports of late RCC metastases to the thyroid. Fine-needle aspiration biopsy of the thyroid tumor was not accompanied with thyroglobulin (Tg) staining, leading us to initially suspect a primary follicular thyroid carcinoma. The patient, a 77-year-old man, underwent a total thyroidectomy with modified neck dissection. Histological examination confirmed the tumor to be RCC metastasis, and immunohistochemical analysis revealed that both Tg and thyroid transcription factor-1 (TTF-1) were negative in the tumor cells. Thus, the possibility of late RCC metastasis to the thyroid should be considered, even in a patient with a remote history. Furthermore, TTF-1 is useful for identifying thyroid metastatic carcinomas.

Ectopic thymoma arising from organs other than the thymus, such as the neck, trachea, thyroid, lung and pericardium, is rare. To date, there have been only seven other cases of pericardial thymoma reported in the English literature. We herein report a case of pericardial ectopic thymoma that presented with cardiac tamponade. A 72-year-old Japanese male noticed body weight gain and leg edema. Chest computed tomography (CT) revealed pericardial effusion and an irregularly shaped mass in the pericardial space compressing the right atrium. He was considered to have cardiac tamponade due to a paracardiac tumor that developed following acute cardiac failure. The intraoperative frozen diagnosis was thymoma. Pericardectomy of the thickened pericardium, tumorectomy and thymectomy via a median sternotomy were performed. The final pathological diagnosis was pericardial ectopic thymoma associated with constrictive pericarditis. The differential diagnosis and complete resection of mediastinal tumors such as this rare case of thymoma are important to obtain a better prognosis, as patients with such tumors often present in a state of shock.

We report herein an extremely rare case of intrathoracic omental herniation through the esophageal hiatus. In fact, according to our review of the literature, only eight other cases have been reported, most of which were misdiagnosed as mediastinal lipoma after being identified as an intrathoracic mass. We report herein the ninth case of intrathoracic omental herniation through the esophageal hiatus. A 54-year-old obese woman was admitted to our hospital for investigation of a chest roentgenographic abnormality. She was asymptomatic, and her physical examination and laboratory data were all within normal limits. Her chest X-ray demonstrated a large, sharply-defined mass, and a computed tomography scan of the thorax indicated a large mediastinal mass with fat density. A thoracotomy was performed under the diagnosis of a mediastinal lipoma which revealed an encapsulated fatty mass, 10x7.5x6 cm in size, that proved to be an omental herniation through the esophageal hiatus. There was no herniation of the stomach or intestines into the thorax. The esophageal hiatus was repaired after the omental mass and hernia sac had been resected. This case report serves to demonstrate that whenever a mass of fat density is recognized in the lower thorax, an omental herniation should be borne in mind as a possible differential diagnosis.

The trastuzumab for Gastric Cancer study newly defined tumors that were positive for human epidermal receptor-2 (Her-2) and created a Her-2-oriented treatment strategy that is also applicable in the adjuvant setting for stage 2/3 cancers. However, there is currently no information available on the rate of Her-2 positivity and the relapse-free survival (RFS) stratified by Her-2 status in stage 2/3 patients.The Her-2 status, defined by the current standard method, was examined in 100 gastric cancer patients who underwent curative D2 surgery, who were pathologically diagnosed with stage 2/3 cancer, and received adjuvant S-1 chemotherapy between June 2002 and December 2011.Ten of the 100 patients were Her-2 positive. Her-2-positive status was more frequently seen in tumors with a differentiated histology. The 5-year RFS rate was 56.3 % in Her-2-positive cases, and 48.8 % in Her-2 negative cases, which was not significantly different (P = 0.786).The Her-2-positive rate for stage 2/3 gastric cancer patients was low, at only 10 %. Although the RFS was not significantly different based on the Her-2 status, the low positive rate made interpretation difficult. A multi-center study with a large sample size is necessary to clarify the prognostic impact of Her-2 in stage 2/3 gastric cancer patients.

Adjuvant chemotherapy aims to eradicate micrometastatic tumor cells before and after curative surgery. Many Phase III trials have been conducted to study the efficacy of postoperative adjuvant chemotherapy; however, most trials have failed to show any survival benefit because of their low statistical power and/or poor patient compliance. Since 2000, two pivotal Phase III trials, the ACTS-GC and the CLASSIC, have demonstrated the efficacy of postoperative adjuvant chemotherapy following D2 gastrectomy. Although treatment with S-1 for 1 year or combination therapy with capecitabine and oxaliplatin for 6 months is effective, more intensive chemotherapy is necessary to further improve the survival rates. In Europe, two Phase III trials, the MAGIC and the FNCLCC/FFCD, have produced results that strongly suggest that neoadjuvant chemotherapy is beneficial. The advantages of neoadjuvant chemotherapy include a high rate of R0 resection, tumor regression, high compliance and the avoidance of unnecessary surgery. The disadvantage of neoadjuvant chemotherapy is over-diagnosis. In Japan, the Japan Clinical Oncology Group has conducted several clinical trials using neoadjuvant chemotherapy to target extensive nodal disease and/or scirrhous carcinomas. The optimal courses and regimens of neoadjuvant chemotherapy should, therefore, be clarified in the future.

We report a case of gallbladder hernia into the lesser sac through the foramen of Winslow. The patient was a 90-year-old woman, admitted to hospital with obstructive jaundice. Computed tomography (CT) showed a left-deviated and remarkably enlarged gallbladder dragging the liver, and a dilated intrahepatic bile duct. The deviated gallbladder was thought to compress the common bile duct, causing the obstruction. Laparoscopic examination revealed gallbladder herniation into the lesser sac without a floating gallbladder; thus, we performed laparoscopic cholecystectomy. Herniation of the gallbladder is the rarest of all internal hernias and most reported cases have involved a floating gallbladder. The case we report here is therefore considered especially unusual.

We report a case of axillary lymph node metastasis (LNM) from papillary thyroid carcinoma (PTC) in a 21-year-old man. The patient presented with bilateral cervical and right axillary lymphadenopathy, and computed tomography (CT) showed a primary tumor of the thyroid and gross lymphadenopathy from the neck to the right axilla. We performed a total thyroidectomy with therapeutic nodal dissection. The resection of the primary thyroid tumor and all the node metastases was curative. Pathological examination confirmed that the resected lesions were PTC and nodal metastases from the primary tumor. Six years after the operation, cervical, upper mediastinal, and axillary lymph node recurrence developed and multiple lung metastases were found on a CT scan. He was treated with radioactive iodine therapy. Axillary LNM from PTC is unusual and seems to be associated with a poor prognosis. Thus, comprehensive treatment strategies are needed to improve the outcome of patients with PTC who present with axillary LNM.

We report the successful management of multiple small-bowel perforations caused by cytomegalovirus (CMV) infection in a 60-year-old man, 1 day after CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) therapy induction for malignant lymphoma. Emergency laparotomy was performed for perforative peritonitis, but we did not resect the lesions at this time. Instead, we exteriorized the small bowel and then irrigated the peritoneal cavity and intestinal tract. His white blood cell count was low, at 200 cells/microl, so this therapy was continued until it recovered. The intestine was highly edematous, but it improved after irrigation with peritoneal dialysis solution. In the second-stage procedure, we resected the small bowel with the perforations, and constructed a jejunostomy and colostomy, then closed the abdominal cavity. Although the patient needed central venous hyperalimentation, he had a favorable postoperative course and started treatment again for the malignant lymphoma.

It is well known that surgical intervention on the stomach will greatly alter gastric function and gastric emptying. In this study, we evaluated the difference in postoperative gastric remnant emptying following pylorus-preserving gastrectomy (PPG) and conventional subtotal gastrectomy (CDG) using sulfamethizole capsule food. The subjects comprised 18 patients who underwent PPG and 23 who underwent CDG for early gastric carcinoma. While delayed gastric emptying was observed early after PPG, 1 year after PPG it was markedly accelerated compared with that measured in the early postoperative period. However, it was slower than that in the CDG patients. On the other hand, rapid gastric emptying was observed early after CDG and did not change with time. These findings stress that although PPG results in stasis in the early postoperative period, it seems to prevent unduly rapid emptying.