Search

Original Article

Original Article

Original Article

Original Article

Original Article

Original Article, Introduction: Several reports revealed that the high soluble programmed death-ligand 1(sPD-L1) level was a risk factor for poor prognosis in various tumors. To date, the clinicopathologic and prognostic impact of the sPD-L1 level in patients with hepatobiliary-pancreatic cancer have not been determined. Methods: A total of 119 patients (66 patients with hepatocellular carcinoma, 23 patients with cholangiocarcinoma, and 30 patients with pancreatic cancer) who were treated at the Toho University Omori Hospital (Tokyo, Japan) from 2008 to 2016 were retrospectively analyzed. The sPD-L1 levels were measured using an enzyme-linked immunosorbent assay for PD-L1 to evaluate the clinicopathologic and prognostic impact. Results: The sPD-L1 levels were significantly higher in the low-albumin group than in the normal-albumin group. According to the stages in hepatocellular carcinoma and cholangiocarcinoma, no significant differences were observed in the sPD-L1 levels, which gradually increased according to the stage in pancreatic cancer. Using a cut-off value of 81.6 pg/mL for the sPD-L1 level, the high sPD-L1 group showed a significantly worse prognosis compared with the low-sPD-L1 group in patients with pancreatic cancer. Multivariate analysis identified sPD-L1 level ≧ 81.6 mg/dL (p = 0.047) as an independent predictor of poor overall survival in patients with pancreatic cancer. Conclusions: Using a cut-off value of 81.6 pg/mL for the sPD-L1 level, high sPD-L1 levels were independently associated with poor prognosis in patients with pancreatic cancer. However, this association in hepatocellular carcinoma or cholangiocarcinoma was not clear.

Case Report, A 58-year-old Japanese man was diagnosed with T4b (descending aorta) N2M1, stage IVB lower thoracic Barrett's esophageal adenocarcinoma. He was initially treated with definitive chemotherapy with cisplatin and 5-fluorouracil (FP therapy). After one course of FP therapy, he developed renal dysfunction complications. Computed tomography showed no remarkable change in the main tumor and metastatic lesion. Therefore, radical esophagectomy with resection of the invaded descending aorta and removal of the solitary metastatic lesion was performed. Superior mediastinal dissection, esophageal transection, and left adrenal gland removal were performed simultaneously. The patient underwent curative resection but died of multiple hematogenous metastases 116 days postoperatively. As aortic infiltrates were infected, artificial blood vessel replacement was selected. Although he underwent radical esophagectomy, hematogenous metastases have occurred in the early postoperative period.

Original Article, Introduction: The initial high systemic inflammatory index (SII), which is calculated as platelets × (neutrophils / lymphocytes), indicates a poor prognosis in patients with various malignant tumors, but its value after treatment in esophageal cancer is not well described. Methods: The prognostic value of the perioperative SII was evaluated in 103 esophageal cancer patients treated by radical esophagectomy. Fifty-nine of the patients received neoadjuvant chemotherapy (NAC); 44 received surgery only. The prognostic value of the SII was evaluated at each stage of the treatment. The impact of clinicopathological factors on the SII and prognosis was also evaluated after stratifying patients by treatment with surgery and NAC or surgery only. Results: Pre-treatment SII was not associated with prognosis, but pre-operative SII (p = 0.11), post-operative SII (p = 0.07), and post-NAC SII (p < 0.05) were associated with prognosis. A decrease in the SII during treatment was also associated with a good prognosis. A high SII before NAC was significantly associated with a decrease of SII during treatment (p < 0.05). Conclusions: A high or non-decreased SII after treatment of esophageal cancer was a poor prognostic indicator. The prognosis of patients with high SSIs might be improved by NAC.

Original Article, Introduction: Previous studies have indicated that hyperfibrinogenemia is a predictor of poor prognosis in various tumors. However, little information is available on the prognostic impact of preoperative hyperfibrinogenemia and its changing pattern in resectable pancreatic ductal adenocarcinoma (PDAC) patients. Methods: This retrospective study examined 102 PDAC patients who underwent curative surgery at Omori Medical Center, Toho University School of Medicine (Tokyo, Japan) between 2004 and 2016. Among these, 44 (43.1%) reported preoperative hyperfibrinogenemia. Results: Preoperative hyperfibrinogenemia was associated with an independent prognostic factor for patient survival. The cumulative 5-year overall survival time rate in the normal fibrinogen and hyperfibrinogen groups was 44.8% and 31.2%, respectively, with a significant difference between the two groups (P = 0.047). The prognostic factors in PDAC patients revealed preoperative hyperfibrinogenemia of 〓400 mg/dL (P = 0.017). The cumulative 5-year overall survival rates were 57.3% and 9.1% in the normalization and non-normalization groups, respectively, with a significant difference between the two groups (P = 0.008). In multivariate analysis, the prognostic factors in patients with preoperative hyperfibrinogenemia revealed a postoperative fibrinogen level of 〓400 mg/dL (P = 0.001). Conclusions: Preoperative hyperfibrinogenemia was the risk factor for reducing overall survival in PDAC patients. Among the patients with hyperfibrinogenemia, the non-normalization group after surgery revealed to be a high-risk group for poor prognosis.

Case Report, Full-thickness rectal prolapse (FTRP) is common among elderly adults and greatly impairs quality of life. We report successful use of laparoscopic suture rectopexy to treat FTRP in 5 patients aged 90-100 years. The median age of patients was 92 years (range, 90-100 years). Three of the 5 patients had recurrent FTRP that was previously managed by a transperineal procedure. All patients had massive protrusion of the rectal wall (range 50-150 mm), and FTRP greatly adversely affected quality of life. No severe comorbidities were noted in any patient preoperatively. All patients had an American Society of Anesthesiologists physical status classification of II. Laparoscopic suture rectopexy for all patients was selected after consultation with anesthesiologists. Although there were no deaths, medical complications were observed in 3 patients: 2 developed mild heart failure (Clavien-Dindo classification, grade I) and one had AU20aspiration pneumonitis (Clavien-Dindo classification, grade III). There were no complications associated with laparoscopic suture rectopexy. All patients were able to return home after surgery. Our experience suggests that laparoscopic suture rectopexy without resection is beneficial for selected patients older than 90 years who are active and in good general health. However, when treating very elderly patients, cautious evaluation of operative risks and careful perioperative management are required in order to avoid surgical complications.