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Background The prognostic nutritional index, a marker of nutritional status and systemic inflammation, is a known biomarker for various cancers. However, few studies have evaluated the predictive value of the prognostic nutritional index in patients with biliary tract cancer. Therefore, we investigated the prognostic significance of the prognostic nutritional index, and developed a risk-stratification system to identify prognostic factors in patients with biliary tract cancer. Methods Between July 2010 and March 2021, 117 patients with biliary tract cancer were recruited to this single-center, retrospective study. The relationship between clinicopathological variables, including the prognostic nutritional index, and overall survival was analyzed using univariate and multivariate analyses. A P Results The median age was 75 (range 38–92) years. Thirty patients had intrahepatic cholangiocarcinoma; 29, gallbladder carcinoma; 27, distal cholangiocarcinoma; 17, ampullary carcinoma; and 13, perihilar cholangiocarcinoma. Curative (R0) resection was achieved in 99 patients. In univariate analysis, the prognostic nutritional index ( 20 U/mL), preoperative cholangitis, tumor differentiation, operation time (≥ 360 min), and R1–2 resection were significant risk factors for overall survival. The prognostic nutritional index (P = 0.027), lymph node metastasis (P = 0.040), and tumor differentiation (P = 0.006) were independent prognostic factors in multivariate analysis. A combined score of the prognostic nutritional index and pathological findings outperformed each marker alone, in terms of discriminatory power. Conclusions The prognostic nutritional index, lymph node metastasis, and tumor differentiation were independent prognostic factors after surgical resection in patients with biliary tract cancer. A combined prediction model using the prognostic nutritional index and pathological findings accurately predicted prognosis, and can be used as a novel prognostic factor in patients with biliary tract cancer.

Objective This study aimed to investigate the clinical significance of preoperative hyperbilirubinemia in Japanese patients and to assess its clinical potential as a predictor of the severity of acute appendicitis. Methods We studied 318 patients with appendicitis who underwent appendectomy between July 2010 and June 2017. We analyzed preoperative data including age, sex, white blood cell count, C-reactive protein (CRP) level, fever, peritoneal irritation signs, and serum total bilirubin level as potential risk factors for complicated (perforated or gangrenous) appendicitis, using multivariate analysis. Results Complicated appendicitis was significantly more frequent in patients with hyperbilirubinemia (>1.1 mg/dL), high CRP level (>0.5 mg/dL), positive peritoneal irritation signs, and fever (>37.3°C). Multivariate analysis revealed older age (>64 years), hyperbilirubinemia, high CRP level, and fever (odds ratios 3.36, 1.75, 7.61, and 2.43, respectively) as risk factors for complicated appendicitis. Multivariate analysis also identified hyperbilirubinemia, high CRP level, and fever (odds ratios 1.99, 5.90, and 2.72, respectively) as risk factors for complicated appendicitis among patients aged Conclusions Hyperbilirubinemia, high CRP level, and fever may be useful predictors of the severity of acute appendicitis, with hyperbilirubinemia being especially useful among patients aged

Introduction: We evaluated the prognostic significance of the preoperative albumin-to-globulin ratio (AGR) in patients with hepatocellular carcinoma (HCC) with various liver etiologies. Methods: We retrospectively analyzed 157 patients with HCC between July 2010 and February 2021. The relationship between clinicopathological variables was investigated using univariate and multivariate analyses. Statistical significance was set at p < 0.05. Results: The mean overall survival (OS) was 24.5 months. The 1-, 3-, and 5-year OS rates were 90.4%, 81.2%, and 68.7%, respectively. Patients were classified into 2 groups: AGR n = 43) and AGR ≥1.16 (high-AGR group; n = 114). In univariate analysis, OS was significantly reduced in patients with a low AGR (AGR p = 0.030) and microvascular invasion (2.268 [1.019–5.169]; p = 0.045) were independent predictors of OS. Discussion/Conclusion: A low AGR was significantly associated with poor OS in patients with HCC, regardless of liver etiology. This may assist in treatment stratification and better management of patients with HCC.

Background/aim Inflammation-based prognostic scores are proven prognostic biomarkers in various cancers. This study aimed to identify a useful prognostic score for patients with biliary tract cancer (BTC) after surgical resection. Patients and methods This retrospective study recruited 115 patients with BTC during 2010-2020. The relationship between clinicopathological variables, including various prognostic scores and overall survival (OS), was investigated using univariate and multivariate analyses. Results BTC included 58 cholangiocarcinoma, 29 gallbladder carcinoma, 16 ampullary carcinoma, and 12 perihilar cholangiocarcinoma cases. A significant difference was detected in OS of patients with a Japanese modified Glasgow prognostic score (JmGPS) 0 (n=62) and JmGPS 1 or 2 (high JmGPS) (n=53). In the multivariate analysis, tumour differentiation (p=0.014) and a high JmGPS (p=0.047) were independent prognostic factors. Conclusion The high JmGPS was an independent prognostic predictor after surgical resection and was superior to other prognostic scores.

We experienced 63 patients with non‑inflammatory disease who underwent single‑incision laparoscopic cholecystectomy (TANKO‑LC. Herein we report the procedure of operation and the short‑term results. We compared 63 cases of TANKO‑LC with 109 cases of non‑inflammatory conventional laparoscopic cholecystectomy (S‑LC within the same period. At first our standard procedure was to insert multiple trocars in the abdominal cavity through a single wound；now we insert only a single trocar all cases. In the 63 cases investigation 3 cases required trocar addition and one case converted to open surgery. Intra and postoperative complications were recognized in 2 cases (port‑site infection. No significant complications were recognized. In comparing the TANKO‑LC group and the S‑LC group the operation time was intentionally longer in the TANKO‑LC group (TANKO‑LC group：118 min S‑LC group：90 min but there were no differences in the blood loss the rates of intra and postoperative complications and the conversion rate. Laparoscopic cholecystectomy is a standard operation for gallbladder removal but single‑incision laparoscopic cholecystectomy is considered a useful operation with the same low operative complication rate yet more satisfactory cosmetic results.

症例1:35歳,男性. 主訴:特になし. 現病歴:平成16年1月,人間ドックの腹部エコー検査にて 膵頭部に嚢胞性病変を指摘された.3月精査目的で当科紹 介となった. 既往歴:7歳 脾門リンパ節炎,14歳 十二指腸潰瘍,24歳 気管支喘息. 現症:腹部は平坦,軟. 入院時検査所見:血液,生化学検査では異常を認めなかっ た.腫瘍マーカーにおいては,CEA 1.1ヘ/ml DUPAN-2 25未満U/mlで正常であったが,Span-1が58U/ml,CA19-9 が139.2U/mlと上昇を認めた. 腹部US所見:膵頭部~体部に直径47.6mm大の多房性の嚢 胞性腫瘍を認め,一部は壁在結節様であった. EUS 所見:膵頭部の腫瘍は44×49mm大で隔壁を持つ嚢胞 性病変として描出された.内部は不均一であった. 腹部CT所見:膵体部頭側に突出して5×5cm大の多房性 嚢胞性病変を認めた.比較的厚い被膜,隔壁を有している が,内部に明らかな充実部分は認めなかった.Dynamic study にて隔壁に早期濃染を認めた(図1a). MRI(MRCP)所見:膵体部の頭側に径46mm大の分葉状の 腫瘤性病変を認めた.T1強調像にてやや高信号,T2強 調像にてやや低信号を呈していた.信号強度から嚢胞内の 性状は比較的粘稠度が高いと考えられた.主膵管との連続 性は指摘できず,主膵管の拡張も見られなかった. 血管造影:腫瘍濃染などの異常は認めなかった. 膵リンパ上皮嚢胞の2例 濱 野 亮 輔*,稲 垣 優,木 村 裕 司,磯 田 健 太, 北 田 浩 二 ,西 江 学,野 村 長 久,徳 永 尚 之, 高 橋 健 司 ,宮 宗 秀 明,常 光 洋 輔,大 塚 眞 哉, 三 好 和 也 ,岩 川 和 秀,高 橋 正 彦,岩 垣 博 巳

2005年1月から2009年12月までの5年間に当院外科で経 験した大腸癌同時性肝転移54例を対象とし,1壁深達度, 2リンパ節転移,3腹膜播種,4遠隔転移,5肝転移分類, 6Grade 分類,7治療法別分類(肝切除群:肝切除+化学 療法,化学療法群:化学療法単独,無治療群)についてそ れぞれ臨床病理学的に検討した.なお,患者背景について は表1に示した.肝切除群症例(肝切除+術前・術後化学 療法)の術式等については表2に示したが,肝転移巣同時 切除(simultaneous resection:1期手術)が6例,大腸切 除後肝転移巣切除(staged resection:2期手術)が5例で あった.また,肝切除群においては,術後または術前後に 化学療法が施行されていた.化学療法の内容は様々で一定 の傾向はなく,肝動注,経口,全身化学療法が重複して施 行されていた(表3).当院では,可能であれば手術を第一 選択としており,大腸癌治療ガイドラインと同様,耐術可 能で,十分な残肝機能があり,肝転移巣が遺残なく切除可 能(RFAも含む)で原発巣が制御されている場合に行って いる.肝門部リンパ節転移陽性を含む遠隔転移症例は肝切 除の適応から除外している.また,肝切除群11例中3例に ラジオ波焼灼術(RFA)を併用した(表2).RFAは切除 しきれない腫瘍に対して術中に併用した.手術適応外の症 例において,可能であれば基本的には化学療法を施行して 当院における大腸癌同時性肝転移症例の臨床病理学的検討 宮 宗 秀 明*,岩 川 和 秀,稲 垣 優,木 村 祐 司, 西 江 学 ,濱 野 亮 輔,徳 永 尚 之,常 光 洋 輔, 大 塚 眞 哉 ,岩 垣 博 巳

Phlegmonous gastritis is a rare inflammatory lesion in which bacterial infection occurs in the gastric wall. A 92-year-old man was admitted to the medical ward due to early gastric cancer. The patient received endoscopic submucosal dissection (ESD), and he complained of sudden-onset upper abdominal pain the day after ESD. On physical examination he showed rebound tenderness in the upper abdomen. The white blood cell count was 16,100/μl, and an abdominal CT-SCAN showed diffuse and irregular thickening of the gastric wall. At emergency operation, a subtotal gastrectomy was performed, and the patient had an uneventful recovery.

A 77-year-old woman was admitted to our hospital due to abdominal pain and body weight loss. A palpable mass the size of an infant's head was tender on palpation and identified as an epigastric lesion. Colonoscopic examination revealed stenosis of the transverse colon, although no intraluminal growth of the tumor was found. The histologic findings of the biopsy material were poorly differentiated and/or undifferentiated cells. Abdominal CT scan showed an irregular-shaped tumor with a diameter of 10cm invading the stomach and jejunum. We performed an operation under a diagnosis of extramurally growing cancer or malignant lymphoma of the colon. Partial resection of the transverse colon was done by distal gastrectomy and partial resection of the jejunum. Histologic examination of the operative specimens revealed moderately differentiated adenocarcinoma of the transverse colon, prominently proliferating into the surrounding tissues. The finding of a long stenotic lesion and extramural compression by colonography are characteristic of this tumor, based on a review of 43 literature reports in Japan.

We experienced 20 patients with distal bile duct carcinoma from May, 1997 to December, 2007. The male/female ratio was 11/9 and the average age was 69.6 years. The operative procedures were as follows : pancreaticoduodenectomy (PD), 9 ; pyrolus preserving pancreaticoduodenectomy (PPPD), 8 ; subtotal stomach preserving pancreaticoduodenectomy (SSPPD), 2 and hepatico-jejunostomy without resection, 1. We performed a clinicopathological study on 16 patients with distal bile duct carcinoma, excluding 3 operation-related deaths and 1 unresectable case. The cumulative survival rate was 70% at 3 years and 11% at 5 years. The 3-year survival rates at fStageII, fStageIVa and fStageIVb were 100%, 80% and 0%, respectively. Log-rank analysis revealed that pathological pancreatic and duodenal invasion and curative resectability may be prognostic factors, while lymph node metastasis and perineural and stump invasion did not affect prognosis. Six recurrences in the 11 curative resection cases (54.5%) were observed ; therefore, postoperative systemic chemotherapy is warranted to curtail recurrence in advanced distal bile duct carcinoma.

A 58-year-old man was diagnosed as having descending colon cancer and underwent a left colectomy with D3 node dissection and end-to-end anastomosis reconstruction. The accessory middle colic artery was secured as a feeding artery, and the middle colic artery was preserved. Diet was started on postoperative day 5 (POD5), and nausea and vomiting appeared on POD10. An upper gastrointestinal series revealed to-and-fro peristalsis in the third portion of the duodenum and dilatation of the proximal duodenum. Abdominal CT showed that the second portion of the duodenum was markedly dilated and the third portion was compressed by the superior mesenteric artery (SMA). As a result, he was diagnosed with post-operative superior mesenteric artery syndrome (SMAS) and treated with conservative therapy. The symptoms improved with a nasogastric tube, and he started to eat after POD26, followed by a successful outcome.

今回われわれは稀な骨盤腔後腹膜に発生した巨大な悪性末梢神経鞘腫瘍（MPNST）の1例を経験したので報告する．症例は74歳，男性．右下腹部腫瘤を主訴に2006年3月来院．CT検査，MRI検査にて骨盤腔内後腹膜に境界明瞭な約15cm大の腫瘍を認め，2006年5月手術施行した．腫瘍は巨大で骨盤腔右側を占めていたが，周辺臓器への浸潤は認めず，経腹的に腫瘍を完全摘出した．摘出腫瘍は大きさ15.0×10.0×8.5cmで重量640gであった．病理組織学診断で長紡錘状腫瘍細胞の粗な増殖がみられ，核異型，分裂像を認めた．免疫染色でS-100は陰性であったが，NSE，vimentin，MIB-1が陽性を示していたことからMPNSTと診断された．術後経過は良好で術後17日目に退院となった．術後2年経過した現在再発は認めていない．

We report a rare case of a very large nonfunctioning endocrine tumor of the pancreas without malignant histological features. A 63-year-old woman referred for appetite loss and general fatigue was found to have a tumor in the pancreas head. Computed tomography demonstrated a well-defined pancreatic tumor 45mm in diameter with hypervascular staining in the pancreas head. Angiography showed a hypervascular tumor of the pancreas head and a dilatation of the anterior superior and posterior superior pancreaticoduodenal arteries. The preoperative diagnosis was an endocrine tumor of the pancreas, with undeniable malignancy. Pylorus-preserving pancreaticoduodenectomy was performed. The histopathological diagnosis was a benign nonfunctioning endocrine tumor of the pancreas based on immunohistochemical staining for Chromogranin A, Synaptophysin, and NSE, but not for hormones. The tumor revealed a low labeling index (

The aim of the present study was to investigate the safety and immunological responses of personalized peptide vaccination in combination with oral administration of a 5-fluorouracil derivative (TS-1) in advanced gastric or colorectal carcinoma patients. Eleven patients (four with gastric cancer and seven with colorectal cancer) who failed to improve by prior TS-1-based chemotherapies were enrolled in this study. Peptides to be administered to patients were determined based on the presence of peptide-specific cytotoxic T lymphocyte (CTL) precursors in peripheral blood mononuclear cells and peptide-specific IgG in the plasma of cancer patients. Patients were vaccinated with peptides (a maximum of four) biweekly in combination with or without three different doses of TS-1 (20, 40 and 80 mg/m(2)/day). Although grade 3 toxicity, including anemia (one patient) and neutropenia (one patient) were observed, the combination therapy was generally well tolerated. An increase in peptide-specific IgG after the sixth vaccination was observed in the vast majority of patients irrespective of the dose of TS-1 used. In contrast, an increase in peptide-specific interferon-gamma production by CTL was most evident in patients who were administered the highest dose of TS-1. Furthermore, in the patients who received 80 mg/m(2)/day TS-1, CTL-mediated cytotoxicity against cancer cells was maintained at the prevaccination level. These results indicate that administration of the standard dose (80 mg/m(2)/day) of TS-1 in combination with a personalized peptide vaccination does not necessarily impede immunological responses in cancer patients, and could actually maintain or augment them.

A Case of Resected Cholangiolocellular Carcinoma during Treatment for Lung Cancer Cholangiolocellular carcinoma is an extremely rare malignant primary liver tumor, accounting for less than 1% of primary liver tumors. We herein report a case of cholangiolocellular carcinoma during treatment for lung cancer. A woman following up after operation for lung cancer was found to have a solitary hepatic tumor in the left lobe of the liver at an abdominal computed tomography checkup. It showed early enhancement with hypovascular area of the center in the arterial phase and enhancement contrast retention in the delayed phase. The tumor was seen as a hypointense nodule in the hepatocellular phase of EOB magnetic resonance imaging. We diagnosed liver metastasis of lung cancer with differential diagnosis of cholangiocellular carcinoma. We performed extended left lobectomy of the liver. Histological and immunohistochemistry findings were compatible with cholangiolocellular carcinoma./p>