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Aim We previously reported in a randomized controlled trial that Billroth I and Roux‐en‐Y reconstructions were generally equivalent regarding body weight change and nutritional status 1 year after distal gastrectomy for gastric cancer. We describe the long‐term follow‐up data 5 years after distal gastrectomy. Methods We analyzed consecutive gastric cancer patients who were randomly assigned to undergo Billroth I or Roux‐en‐Y reconstruction after distal gastrectomy. We evaluated body weight change, nutritional status, late complications, quality of life (QOL) using the European Organization for Research and Treatment of Cancer Core QOL Questionnaire, and dysfunction using the Dysfunction After Upper Gastrointestinal Surgery for Cancer, 5 years after surgery. Results A total of 228 patients (Billroth I = 105; Roux‐en‐Y = 123) were eligible for efficacy analyses in this study. Body weight loss 5 years after surgery did not differ significantly between the Billroth I and Roux‐en‐Y groups (10.0% ± 7.9% and 9.6% ± 8.4%, respectively; P = .70). There were no significant differences in other aspects of nutritional status between the two groups. Reflux esophagitis occurred in 19.0% of the patients in the Billroth I group vs 4.9% in the Roux‐en‐Y group (P = .002). Regarding QOL, Billroth I was significantly inferior to Roux‐en‐Y on the diarrhea scale (Billroth I: 28.6, Roux‐en‐Y: 16.0; P = .047). Regarding dysfunction, no score differed significantly between the two groups. Conclusions Billroth I and Roux‐en‐Y reconstructions were generally equivalent regarding body weight change, nutritional status, and QOL 5 years after distal gastrectomy, although Roux‐en‐Y more effectively prevented reflux esophagitis and diarrhea., Billroth I and Roux‐en‐Y reconstructions were generally equivalent regarding body weight change, nutritional status, and quality of life 5 years after distal gastrectomy, excluding reflux esophagitis and diarrhea.

The appropriate surgical procedure for patients with upper third early gastric cancer is controversial. We compared total gastrectomy (TG) with proximal gastrectomy (PG) in this patient population. A multicenter, non-randomized trial was conducted, with patients treated with PG or TG. We compared short- and long-term outcomes between these procedures. Between 2009 and 2014, we enrolled 254 patients from 22 institutions; data from 252 were included in the analysis. These 252 patients were assigned to either the PG (n = 159) or TG (n = 93) group. Percentage of body weight loss (%BWL) at 1 year after surgery, i.e., the primary endpoint, in the PG group was significantly less than that of the TG group (− 12.8% versus − 16.9%; p = 0.0001). For short-term outcomes, operation time was significantly shorter for PG than TG (252 min versus 303 min; p

Background Clostridioides (Clostridium) difficile infection (CDI) has become an increasingly significant disease not only as healthcare-associated infection, but also as community-acquired (CA) infection worldwide. CDI caused by the NAP1/BI/027 strain is reported to be more severe, difficult to cure, and frequently associated with recurrences in North America and Europe. Case presentation A 68-year-old woman was referred to our hospital for continuous lower abdominal pain 4 weeks after eradication therapy against Helicobacter pylori. While she was treated with fasting on the suspicion of ischemic colitis, she experienced septic shock. Emergent subtotal proctocolectomy revealed fulminant pseudomembranous C. difficile colitis. The C. difficile isolate recovered from the patient was identified as ribotype 027, which has been reported to be uncommon in Japan. Conclusion We report a rare case of CA fulminant pseudomembranous colitis caused by ribotype 027 C. difficile after H. pylori eradication therapy.

Purpose Surgical site infection (SSI) is the most frequently occurring nosocomial infection. Remarkable surgical progress has recently been made in laparoscopic surgery. Therefore, our objective was to investigate the association between increased rates of laparoscopic colon surgery and SSI. Methods We retrospectively investigated SSI surveillance data from July 2003 to December 2015. Two university hospitals and 25 university-affiliated hospitals participated in prospective SSI surveillance. Univariate and multivariate analyses were performed to detect significant associations. Results We investigated 9655 colon surgeries. The year in which surgery was performed was significantly associated with the SSI rate (p = 0.0381). The rate of laparoscopic surgery gradually increased during the study period, and by 2012 it was routinely used for > 50% of colon surgeries. Laparoscopic surgery became a significant factor associated with reduced SSI rates compared with conventional open surgery once the performance rate of laparoscopic surgery reached > 50%. Conclusions Increasing rates of laparoscopic colon surgery tended to be associated with a reduction in the SSI risk after surgical treatment of colonic disease. The results of this study might encourage surgeons to view laparoscopic surgical techniques as an evidence-based approach for reducing the risk of SSI. Electronic supplementary material The online version of this article (10.1007/s00595-019-1760-1) contains supplementary material, which is available to authorized users.

Patients with strangulating small bowel obstructions (SBOs) can rapidly deteriorate, in condition; therefore, immediate and appropriate diagnosis is required. However, some cases of SBO are difficult to diagnose using axial computed tomography (CT) images alone. The impact of 3D vessel imaging for the diagnosis, surgical indication, and timing of strangulating SBOs was investigated, prospectively. Clinical data were collected for 111 strangulating SBOs and 48 simple SBOs from patients receiving surgical interventions from January 2009 to March 2018. The accuracy of preoperative diagnoses for the type of SBO was evaluated. Among 159 patients, 27 underwent contrast-enhanced CT imaging as well as prospectively reconstructed 3D vessel imaging of the superior mesenteric artery, vein, and branches. The concordance rate of operative findings and preoperative diagnoses of the type of SBO were compared between axial CT imaging alone and combination of axial and 3D vessel imaging. Overall concordance rate of diagnosis for the type of SBO by axial imaging was 93.1% and that of strangulating and simple SBOs was 92.8% and 93.8%, respectively. Combined axial and 3D vessel imaging resulted in 100% accuracy of preoperative diagnoses for both types of SBO. In addition, abnormalities could be classified from 3D vessel images as central twists or peripheral twists, and deteriorated vascular flow could also be detected. The combination of axial imaging and 3D vessel imaging can be used to accurately diagnose SBOs, and this imaging technique may be useful for determining the surgical indication and suitable timing of strangulating SBOs.

123 Background: Gastric cancer (GC) with liver metastasis (M1: HEP) and para-aortic lymph node metastasis (M1: LYM) is categorized as stage IV. Based on the retrospective reports, surgical resection is weakly recommended for oligo-metastasis (O-Meta), if resectable, in the Japanese GC Treatment Guidelines 2018. Whereas S-1 monotherapy as adjuvant chemotherapy after surgery for stage II/III GC and S-1 plus cisplatin (SP) as palliative chemotherapy for unresectable stage IV GC are standard treatments, there is no consensus about post-operative chemotherapy (Post-Cx) after R0 resection of stage IV GC with O-Meta. Methods: The criteria for this retrospective study were: 1) no prior treatment for GC, 2) R0 resection including O-Meta (HEP or LYM) at 20 institutions in the Stomach Cancer Group of the Japan Clinical Oncology Group between 2007 and 2012, 3) histological confirmation of adenocarcinoma for primary tumor and O-Meta (M1: HEP or LYM), 4) no other distant metastasis such as peritoneal metastasis. Results: A total of 110 patients were collected. Of the 94 eligible patients, 84 patients underwent gastrectomy followed by Post-Cx with S-1 (S-1 group: n = 55), SP (SP group: n = 22) or others (Others group: n = 7), and 10 patients did not receive post-Cx (non-Cx group). Median age for the S-1, SP, Others and non-Cx groups were 66, 60, 61, and 79 years old. Sites of oligo-metastasis (HEP/LYM) was 21/34, 9/13, 2/5, and 7/3 in the S-1, SP, Others and non-Cx groups. The 3- / 5-year overall and relapse free survival (OS and PFS) rates of all the patients were 45.6/31.4% and 24.5/21.3%, respectively. Median OS was 28.5 and 36.5 months in the S-1 and SP groups (HR 0.99; 95% CI 0.54-1.82, p = 0.986). In multivariate analysis, no Post-Cx, over 70 years old were identified as the independent poor prognostic factor for OS (p < 0.05). Conclusions: R0 resection followed by Post-Cx for GC patients with O-Meta showed favorable survival, while there seems no additional benefit of cisplatin to S-1 alone.

症例は40歳代の男性で，25歳頃より腸閉塞の診断で入退院を繰り返し，保存的療法で改善していた．2008年6月にS状結腸過長症と診断され，他院で腹腔鏡下S状結腸切除術を施行された．しかし同年7月に再び腸閉塞症状のため当院に入院した．入院3日目に腹膜炎症状が出現し，緊急手術を施行した．上行結腸が捻転しており同部位より口側結腸が拡張していたため，結腸右半切除術を施行した．術後も腸閉塞状態が改善せず，腹部膨満症状を改善するため，回腸人工肛門造設を施行した．その後，慢性偽性大腸閉塞症を考え，同年12月に結腸全摘術を施行した．症状の改善は認めたが，術後も腹部単純X線検査で小腸は著明に拡張した状態であったため，慢性偽性小腸閉塞症と最終診断した．術後1年経過した現在，蠕動促進薬を内服して日常生活を送っている状態である．

Massive lymph node metastasis of the para-aortic region and supraclavicular lymph nodes, Virchow's lymph node metastasis due to colon cancer, is extremely rare. We herein report a case of such systemic lymph node metastasis that was successfully treated with a combination of irinotecan (CPT-11) and UFT, a combination drug of tegafur and uracil. The patient was a 57-year-old woman who had a tumor in the ascending colon, and massively swollen para-aortic and supraclavicular lymph node metastasis. She was treated with combination chemotherapy of CPT-11 and UFT. The main tumor was detected as a decompressed scar, and the supraclavicular and para-aortic lymph nodes had completely disappeared after the second cycle of treatment. A histopathological examination and immunohistochemistry with cytokeratin showed complete remission of adenocarcinoma in the tumor and para-aortic lymph nodes. She remains alive without recurrence 52 months after chemotherapy. Combination chemotherapy of CPT-11 and UFT may be of potential value in the treatment of advanced colorectal carcinoma, and both histopathological and immunohistochemical confirmation of a complete remission may indicate prolonged disease-free survival.

We investigated the wide variability of 18F-2-fluoro-2-deoxy-D: -glucose (FDG) uptake, semiquantified as standardized uptake value (SUV), in positron emission tomography (PET) scanning, in 20 patients with colorectal cancer (CRC), including 1 with synchronous hepatic metastasis. The sensitivity of PET in CRC diagnosis was 100%, with a mean SUV of 8.0 (3.1-11.9). Tumor size and depth of invasion were associated with higher SUVs (P=.0004, .042, respectively). Strong glucose transporter-1 (GLUT-1) expression had significantly positive correlation with the SUV (r=.619, P=.003). GLUT-1 expression revealed positive staining in 17 (85%) of the 20 primary lesions. The central part of the tumor, thought to be relatively hypoxic, had stronger GLUT-1 expression and a higher SUV than the periphery, in both the primary tumor and hepatic metastatic foci. Our data suggest that the SUVs of FDG uptake in PET may be a noninvasive biomarker for advanced CRC, indicative of a large hypoxic tumor with deep invasion.

The aim of this study was to evaluate the clinical and therapeutic value of digital fusion image (FI) of positron emission tomography (PET) using (18)F-fluorodeoxy glucose and computed tomography (CT) in patients who were suspected of having a local recurrence of rectal cancer.Forty-two patients (32 men and 10 women; mean age, 61.4 years, range, 40-79 years) with a suspicion of local recurrence after curative resection of rectal cancer were prospectively recruited and underwent (18)F-fluorodeoxy glucose-PET and CT. The FI was reconstructed with a commercially available digital software program, T-B Fusion. Wilcoxon signed rank test was used to compare FI with CT alone or PET alone.FI yielded a correct diagnosis in 39 (93%) of 42 patients, whereas CT alone and PET alone did so in 33 (79%) and 37 (88%) patients, respectively. FI had better diagnostic accuracy than CT alone (P = .0138) and PET alone (P = .0156). Overall, FI altered patient management in 11 (26.2%) patients on the basis of additional information, including differentiation of the tumor from the postoperative scar in 6 patients, exact anatomical location in 3 patients, and both in 2 patients.FI has a potential clinical value in the treatment of suspected local recurrence of rectal cancer.

This study investigated the role of [18F]fluorodeoxyglucose (FDG) dual-head gamma camera coincidence imaging (GCI) in the pretreatment evaluation of patients with oesophageal cancer. Twenty-two patients (20 men; mean age, 64 years) with untreated, biopsy proven squamous cell carcinoma of the oesophagus underwent positron emission tomography (PET) and GCI 1 and 3 h after a single injection of FDG, respectively. Computed tomography (CT) was performed within 2 weeks of the FDG imaging. The sensitivity of lesion detection was compared between GCI and PET. Regional (N) and distant (M) metastases detected by GCI were evaluated with reference to PET and CT. The staging obtained by each modality was also compared with pathological staging in nine patients who underwent surgery. FDG PET detected 22 primary tumours, 34 metastatic lymph nodes and four organ metastases. Of them, GCI detected all primary tumours, 24 (71%) metastatic lymph nodes, and none of the organ metastases. Lymph nodes missed by GCI were smaller in size and the majority of them were located in the thoracic region. GCI provided N and M staging identical to CT and PET in eight patients and improved staging over CT in four patients. On the other hand, GCI missed metastases detected by both PET and CT in five patients. The addition of GCI to CT could improve detection of patients with metastasis to 82% (18/22) compared with 64% (14/22) detected by CT alone. In patients with pathological staging (n = 9), GCI could influence management changes in two patients (22%). In conclusion, FDG GCI has a role that is complementary to CT in the initial staging of patients with oesophageal cancer, and due to the additional detection of nodal metastasis, GCI can provide staging information, which may influence changes in management.

The control of inter-lattice magnetic interactions is a crucial issue when long-range ordered magnets that are based on low-dimensional magnetic frameworks are designed. A "pillared layer framework (PLF)" model could be an efficient system for this purpose. In this report, A magnet based on a π-stacked PLF with a phase transition temperature of 82 K, which can be increased to 107 K by applying a pressure of 12.5 kbar, is rationally constructed. Two types of low-dimensional magnetic framework systems, an electron donor/acceptor magnetic layer and a charge transfer [FeCp*2](+)TCNQ(.-) columnar magnet ([FeCp*2](+) = decamethylferrocenium; TCNQ = 7,7,8,8-tetracyano-p-quinodimethane), are integrated to fabricate the magnet. This synthetic strategy employing a combination of layers and chains is widely useful not only for magnet design, but also for the creation of multifunctional materials with pores and anisotropic frameworks.

We compared standardized uptake values (SUVs) on positron emission tomography with a glucose analog, 2-[F-18] fluoro-2-deoxy-D-glucose (FDG-PET) and serum soluble interleukin-2 receptor (sIL-2R) values in patients with non-Hodgkin's lymphoma (NHL) in the pre-, mid- (after three or four cycles), and post-treatment periods of chemotherapy (pre, mid, and post, respectively), and we examined whether the SUV was a useful tumor marker for NHL.The SUVs on PET and sIL-2R values were retrospectively evaluated based on all the clinical information available in 40 patients (31 in pre, 24 in mid, and 24 in the post periods). Patients in complete remission status were classified as group A and those with active residual disease in the mid and post periods were classified as group B.In pre, the SUV and sIL-2R values exhibited sensitivity of 100% and 84%, respectively. In mid, the SUV was lower in group A than in group B, while sIL-2R was not different. The SUV yielded better specificity than sIL-2R (88% vs. 25%, respectively), though the difference was not significant. In mid, the SUV in patients later assigned to group A in post was lower than than the SUV in group B, whereas sIL-2R was not different. In post, the specificity and accuracy of SUV were better than those of sIL-2R (95 vs. 47%, and 96 vs. 58%, respectively). Both the SUV and sIL-2R were lower in group A than in group B.The SUV on PET was better than the serum sIL-2R as a marker to evaluate the disease status of NHL, and was considered to be a useful tumor marker for NHL.

We report a case of adenocarcinoma developing in remnant rectal mucosa below a hand-sewn ileal pouch–anal anastomosis (IPAA) after restorative proctocolectomy for ulcerative colitis (UC). To our knowledge, this is the first such case to be reported from Japan. A 60-year-old man with a 13-year history of UC underwent proctocolectomy with a hand-sewn IPAA and mucosectomy for anal stenosis and serious tenesmic symptoms. About 7 years later, a follow-up endoscopy showed a flat elevated malignant lesion, 2 cm in diameter, below the ileoanal anastomosis. He was treated by abdominoperineal resection of the pouch and anus with total mesorectal excision. Histopathological examination of the resected specimen confirmed the presence of a well-differentiated adenocarcinoma but there were no metastatic lymph nodes. He recovered uneventfully and remains well without evidence of recurrent disease 2 years and 3 months after his last operation.

This open label pilot study evaluated the safety and efficacy of the oral 5-HT3 receptor antagonist granisetron for prophylaxis of delayed chemotherapy-induced nausea and vomiting (CINV) in 30 patients with advanced or recurrent colorectal cancer. Patients were studied during two cycles of a 5-week regimen with irinotecan (CPT-11) and UFT. Patients received prophylactic anti-emetic therapy that included intravenous granisetron. If Grade 1 or higher severity gastrointestinal symptoms occurred during 6 days after CPT-11 administration in Cycle 1, then oral granisetron was administered daily for the following 5 days of CPT-11 in Cycle 2. Sixteen patients (53.3%) experienced delayed CINV in Cycle 1. The incidence of Grade 2 or higher vomiting was 32.1% and 27.7% in Cycles 1 and 2 in males (P = 0.554) respectively, and 54.6% and 32.4% in females (P = 0.001) respectively. Granisetron is effective against delayed Grade 2 or higher vomiting induced by CPT-11/UFT in female patients, although granisetron alone may not sufficiently control nausea induced by this regimen.

We previously reported in a retrospective study that CEA-based RT-PCR was useful for predicting the prognosis of patients with node-negative colorectal cancer. RT-PCR is well established for laboratory use, but many issues remain to be resolved prior to its clinical application. In addition to the false positive rate of RT-PCR, we addressed several issues, including the timing of lymph node sampling, stability of RNA after surgery, and reproducibility of results. After appropriate modification, including development of a tissue sampling kit, a multi-institutional clinical study was commenced prospectively from November 2001, and 100 patients were enrolled for examination of micrometastasis. RNA was stable in lymph nodes for up to 3 h after surgical resection. This range of sampling time was acceptable to the surgeons. RNA was well preserved in RNA later at -20 degrees C for 3 weeks. Dilutions of MKN45 and LoVo cells served as positive controls for conventional PCR since these controls were found to be highly stable and ensured reproducibility. Moreover, simultaneous use of quantitative PCR (Light Cycler) ensured double confirmation of the results. Our clinical study showed that the quality of RNA was excellent or good in most samples (98 of 100; 98%). Twenty-four of 98 (24.5%) cases were judged to be micrometastasis-positive. In conclusion, the current translational research study established a clinically feasible RT-PCR system for micrometastasis. Our system could potentially be useful as a clinical tool.

Local recurrence of rectal cancer is a critical issue. Anatomical images, such as computed tomography (CT) or magnetic resonance imaging (MRI), are sometimes insufficient for preoperative evaluation. A useful modality for diagnosis of local recurrence of rectal cancer is (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), but it does not give adequate information about anatomy. To utilize the advantages of these techniques, this study was done to validate the accuracy of using fused images and their usefulness in the decision making for surgical intervention of local recurrence of rectal cancer by directly comparing the fused images with resected specimens. PET and CT/MRI were performed for patients suspected of local recurrence of rectal cancer (n=4). PET image data were re-calculated to fit CT/MRI images and manually superimposed on the anatomical images. Fusion images were compared with resected specimens. Radical operation was carried out for three patients. Fusion images provided information on precise tumor location, and extent of tumor invasion as well as the diagnosis of tumor recurrence. All patients underwent curative operation with negative surgical margins, and the information provided by the fusion images was confirmed by comparison with resected specimens. In all cases, preoperative evaluation of tumor recurrence with fusion images provided more useful clinical information for the management of patients than the anatomical images alone. PET images, when combined with MRI or CT, may prove to be a useful adjunct in the management of patients being evaluated for resection of local recurrence of rectal cancer.

8187 Background: Though significant advances have been made in cancer treatment, CINV still remains significant patients (pts) concerns. Antiemetic guidelines based on emesis rate category have bee...