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Aim: The purpose of this study was to elucidate the differences in clinical pathology and prognosis between signet ring cell carcinoma component and adenocarcinoma in colorectal cancer. Materials and methods: From April 2007 to December 2016, a total of 4348 patients with colorectal cancer underwent surgery, of which 3283 were included in the study. One patient was diagnosed with signet ring cell carcinoma (SRCC); 16 were diagnosed with signet ring cell carcinoma component (SRCCc); and 3266 patients were diagnosed with adenocarcinoma (ADC). We matched SRCCc and ADC with a propensity score of 1:3 and analyzed overall survival rates (OS) and cancer-specific survival rate (CSS) between the 2 groups before and after matching. Results: Before matching, patients in the SRCCc group had more advanced cancer (stage III-IV: 87.5% vs 45.6%; P

Background The evolution of remote systems and artificial intelligence technology has led to increase in robotic surgeries. One system used in this case report is the Senhance robotic system. The most important premise for using robotic surgery in cancer therapeutics is to ensure oncological safety. Similar to conventional laparoscopic surgery, robotic surgery needs to be a reliable and secure surgical procedure, such as complete mesocolic excisions with central vascular ligations in Western countries or D3 lymph node dissections (dissection of the lymph nodes that locates from the origin to the terminal branch of the main feeding artery of cancer) in Japan. Case presentation A 76-year-old man underwent clinical examination for severe anemia. He was diagnosed with transverse colon cancer of tumor (T)3, node (N)1a, metastasis (M)0 cancer stage IIIA. A right hemicolectomy with D3 lymph node dissection using the Senhance surgical system was performed. The operative time was 313 min and the estimated blood loss was 5 ml. He was discharged from our hospital 12 days after the surgery without any complications. What is the remarkable of this report, not only mobilization of right colon but also D3 lymph node dissection and vascular ligation were performed intraperitoneally by using Senhance robotic system as conventional laparoscopic surgery. We tried using fourth robotic arm to accomplish lymphadenectomies and middle colic artery dissection. A right hemicolectomy with D3 dissection using the Da Vinci surgical system was reported. Another report of a right hemicolectomy performed with the Senhance robotic system was identified; however, in that study, lymph node dissections were not performed intraperitoneally. Conclusions Therefore, to our knowledge, this is the first report using the Senhance robotic system for right hemicolectomy with D3 dissection. We hope that our case report will assist in the establishment of this robotic procedure in surgical practice.

Background The 2019 revised World Health Organization (WHO) classification of tumors of endocrine organs classifies grade 3 gastroenteropancreatic neuroendocrine neoplasms (GEP-NEN G3) into well-differentiated tumors (NET G3) and poorly differentiated carcinomas (NEC G3). There are few reported cases of NET G3 occurring in the rectum. Case presentation A 71-year-old man complained of bright red blood in his stool. Total colonoscopy revealed a mass in the lower rectum. Pathologic examination yielded a diagnosis of group 1. Computed tomography revealed swollen paraintestinal lymph nodes and multiple liver metastases. We performed laparoscopic abdominoperineal resection not only to avoid the unbearable symptoms caused by tumor growth but to make a pathological diagnosis. The tumor measured 3.5 × 2.8 cm, and the pathological diagnosis was stage IV neuroendocrine carcinoma. He underwent chemotherapy with irinotecan plus cisplatin, followed by carboplatin plus etopside, but his disease did not respond to either regimen. Twenty-seven months after surgery, he died of his disease. Upon re-examination of the surgical specimen, the tumor was consistent with the 2019 WHO classification of NET G3.6 Conclusion A definite diagnosis of NET G3 or NEC G3 must be made to determine the appropriate treatment strategy for patients with GEP-NEN G3. Further case reports and case series are needed to establish the optimal therapy.

Background Several manufacturers are in the process of developing various innovative systems and expect more options in the robot market. One of the latest systems, the Senhance® platform (TransEnterix Surgical Inc, Morrisville, NC, USA), has already been introduced in Europe and has also been approved for clinical use in Japan. We report the first case of colorectal resection using Senhance in Japan. Case presentation The patient was a 79-year-old Japanese man who visited a previous physician for positive fecal occult blood. Upon close inspection, the preoperative diagnosis was cT2N0M0 stage I. We performed surgery using Senhance. The operation time was 198 min, and the estimated amount of bleeding was 10 g. He was discharged after surgery without any major complications. However, it is also true that the operability of the conventional port arrangement was poor during the surgical operation. Conclusion We report the first Senhance-assisted ileocecal resection for colorectal cancer in Japan. In the future, we would like to find more ways to use it by accumulating more cases.

BACKGROUND/AIM The purpose of this study was to investigate the clinical, pathological, and prognostic differences between adenocarcinoma (ADC) and mucinous adenocarcinoma (MUC) in colorectal cancer (CRC). PATIENTS AND METHODS This was a retrospective study of a Japanese high-volume cancer Center over a 10-year period. From April 2007 to December 2016, a total of 3,296 patients with primary CRC were included in the study. The clinical characteristics of MUC and ADC were compared. Then, propensity score matching was performed according to a 1:2 ratio. Multivariate analysis was used for independent risk factors related to prognosis. The overall survival (OS) and disease-free survival (DFS) of 126 cases of MUC and 256 cases of ADC were studied, as well as the survival rate of each stage. RESULTS MUC accounts for 3.82% of the total CRC. Compared to ADC, MUC is more common in female patients (47.62% vs. 38.77%; p=0.045), with higher carcinoembryonic antigen levels (56.35% vs. 34.95%; p

Background Persistent descending mesocolon (PDM) is a rare colonic anatomical variant. However, PDM's impact on the technical aspects and outcomes of laparoscopic colorectal cancer resection are unclear. Patients and methods This retrospective clinical cohort study was conducted at a high-volume cancer center in Japan to evaluate intra- and postoperative outcomes of laparoscopic colorectal cancer surgery in patients with (PDM+) or without (PDM-) PDM over the past 7 years. Results Between January 2012 and September 2019, 2,775 patients underwent laparoscopic colorectal cancer resection at our center, including 60 (2.1%) cases of PDM. Preoperative detection was achieved in only 5 patients (8.3%), 39 patients were men, and 21 patients were women. The average age was 67 years. Twenty patients had a history of prior abdominal surgery (33.3%), with little or no subsequent adhesions. The average duration of sigmoidectomy in PDM+ patients (n=17; 217.7±14.2 min) was significantly longer than that in PDM- patients (n=547; 176.2±2.4 min; p=0.003), as was average blood loss (32.3±10.6 ml vs. 16.7±2.8 ml; p=0.03). Likewise, average operative time for high anterior resection in PDM+ patients (n=11; 227.1±20.2 min) was significantly longer than that in PDM- patients (n=294; 195.6±3.0 min; p=0.048). Rates of postoperative anastomotic leakage and postoperative recurrence did not differ in both groups. In PDM+ patients, retention of left colic artery had no impact on proximal specimen margins or occurrences of anastomotic leakage. Conclusion PDM prolongs operative times and increases bleeding in laparoscopic colorectal cancer surgery and should be considered a risk factor when encountered.

Background: A prognosis for stage IV colorectal cancer is generally poor. As a result, the development of an appropriate treatment strategy for each individual with this disease within a limited time frame is important. In various malignancies, preoperative high C-reactive protein (CRP) levels may be a possible poor prognostic factor. However, few studies have been made of CRP in stage IV cases of colorectal cancer so it is unclear whether CRP is a useful prognostic marker for this disease. Thus, the purpose of this study was to clarify the relationship between the preoperative CRP level and the prognosis of stage IV colorectal cancer.Patients and methods: Between April 2007 and December 2015, 384 patients with stage IV colorectal cancer who underwent primary resection were included. Patients were divided into high (HCG) and low (LCG) CRP groups based on a preoperative CRP cut-off value of ³1.0 mg/dL. Postoperative short- and long-term results were examined retrospectively.Results: Preoperative carcinoembryonic antigen (CEA) levels were higher in HCG; the number of R0 surgical resections of distant metastases was smaller. The 5-year survival rate was 24.6% for HCG and 36.7% for LCG, indicating the survival rate for HCG was lower. A multivariate analysis of factors affecting survival rates identified CRP >1.0, histopathological type, positive venous infiltration, and R0 inoperability as risk factors. The rate of R0 resection was higher in LCG. Concerning R0 resection patients, differences between HCG and LCG with regard to background factors, including preoperative CEA levels, were not found. In terms of long-term survival, a significant difference in overall survival between the two groups was not observed. The study was limited to patients who were unable to undergo R0 surgery. Preoperative CEA levels were higher in HCG while the postoperative chemotherapy induction rate was lower. HCG also showed a significantly lower survival rate than LCG. Multivariate analysis showed that CRP levels above 1.0 mg/dL, poorly differentiated histopathology, and the absence of chemotherapy were risk factors affecting overall survival.Conclusion: These results suggest that the preoperative CRP level may be a useful biomarker for the prognosis of incurable stage IV colorectal cancer.

Background/aim Surgery on hemodialysis patients requires special attention, as the tissue of these patients is vulnerable and hemorrhagic. This study explored the feasibility of laparoscopic surgery for colorectal cancer in hemodialysis patients. Patients and methods This was a retrospective study of patients who underwent laparoscopic surgery for colorectal cancer in a single institute from April 2007 to December 2016. Results A total of 2668 patients were included: 24 (0.9%) were on hemodialysis, and 2644 (99.1%) were not. After 1:1 propensity score matching, there were no significant differences in the short-term postoperative results, the disease-free survival rate (p=0.0813) or the cancer-specific survival rate (p=0.555). However, the overall survival rate was significantly lower in hemodialysis patients than in non-hemodialysis patients (p=0.0135). Conclusion Standard laparoscopic operative procedures can be safely performed for hemodialysis patients, and there was no marked difference in the long-term oncological outcomes between the two groups.

Background/aim Whether lymphovascular invasion (LVI) is a high-degree risk factor in stage II colorectal cancer has not been fully clarified, as different results have been reported in the literature. If LVI is a risk factor, postoperative chemotherapy may be recommended. The purpose of this study was to evaluate the impact of lymphovascular invasion on disease recurrence and patient prognosis in conjunction with stage II colorectal cancer (CRC). Patients and methods A total of 636 patients with stage II CRC, each undergoing radical resection between April 2007 and December 2015, were selected for the study. Subjects with or without venous or lymphatic invasion were assigned to positive and negative groups, respectively. We then compared overall survival (OS) and disease-free survival (DFS) using propensity score matching. Results After matching (n=226, each group), OS and DFS were found to be significantly lower (OS: p=0.047; DFS: p=0.004) in patients positive (vs. negative) for venous invasion. However, the same was not true of lymphatic invasion. After matching, positive and negative groups (n=92, each) did not significantly differ in terms of OS (p=0.951) or DFS (p=0.258). Conclusion In patients with stage II CRC, venous invasion proved to be a significant high-degree risk factor that may warrant adjuvant chemotherapy.

The indications for lateral lymph node dissection (LLND) in rectal cancer have been controversial. The purpose of this study was to clarify the significance of lateral lymph node metastasis in low rectal cancer. This was a retrospective study at a high-volume cancer center in Japan. In this study, 40 patients with pathologically positive LLN (LLN+) were matched with 175 negative (LLN−) patients by propensity score matching (PSM). COX regression analysis was used to identify independent risk factors related to prognosis. The relapse-free survival rate (RFS) and overall survival rate (OS) of the 2 groups before and after matching were analyzed. Of the 64 patients undergoing LLND, 40 (62.5%) patients had LLN+ disease. The LLN+ patients showed deeper infiltration of the primary tumor than the LLN− patients (T3-T4: 87.5% vs. 72.0%; p = 0.044), a greater number of metastatic lymph nodes (N2: 75.0% vs. 35.4%; p < 0.001), and a higher rate of local recurrence (30% vs. 9.1%; p < 0.001). Adjuvant chemotherapy was more common in the 40 LLN+ patients than in the 175 LLN− patients (70.0% vs. 46.8%; p = 0.008). After relapse, the rate of first-line chemotherapy administration for LLN+ patients was higher than that for the LLN− patients (62.5% vs. 29.5%; p = 0.005). The RFS of LLN+ patients was shorter than that of the LLN− patients (p = 0.005). After PSM, although more LLN+ patients received adjuvant chemotherapy than the LLN− patients (70.0% vs. 40.0%; p = 0.007), the local recurrence rate remained higher (30% vs. 10%; p = 0.025). The differences between RFS (p = 0.655) and OS rates (p = 0.164) of the 2 patient groups were not significant. Even after LLND, patients with LLN+ low rectal cancer still showed an elevated local recurrence rate. Controlling local recurrence by adjuvant chemotherapy alone is difficult, and the additional strategic treatments are needed.

Background: Unlike the tumor nodes metastasis (TNM) lymph node classification, based solely on counts of nodal metastases, the Japanese system of classifying colorectal carcinoma (CRC) focuses on regional lymph node spread. In this study, we explored the prognostic utility of inferior mesenteric artery (IMA) apical lymph node (APN) metastasis. Patients and Methods: This was a retrospective study of patients with stage III left-sided CRC. All enrollees were subjected to D3 resection between April 2007 and December 2016 at the International Medical Center of Saitama Medical University and then stratified by histologic presence (APN+ group) or absence (APN− group) of tumor in APNs examined postoperatively. Ultimately, propensity score matching was invoked (1:2) and COX regression analysis was conducted, determining group rates of relapse-free survival (RFS) and cancer-specific survival (CSS). Results: A total of 498 patients were studied, grouped as APN+ (19/498, 3.8%) or APN− (479/498, 96.2%). Prior to matching, the APN+ (vs. APN−) group showed significantly more lymphatic involvement (73.7% vs. 47.8%; p=0.023), deep (T3/T4) tumor infiltration (100% vs. 78.9%; p=0.024), and nodal metastasis (N2: 84.2% vs. 27.6%; p

Background/aim The purpose of this study was to explore the perioperative, short-term, and long-term prognostic differences in colorectal cancer (CRC) between young and older patients. Patients and methods A total of 3095 patients were divided into young (≤45 years; n=139) and older (>45 years; n=2956) groups. Then, propensity score matching was performed for patients in stage I to III according to a ratio of 1:1. The clinicopathological factors and prognosis of the two groups were studied. Results Young patients with CRC account for 4.49% of the total number of patients with CRC. Younger patients with CRC in stage I to III showed better cancer-specific survival (CSS). Older age was an independent risk factor for CSS prognosis. The CSS of the younger group was significantly better in stage I to III as a whole, but there was no difference in stage I and II subgroups - only in stage III. The proportion of young patients with stage III disease receiving first-line adjuvant chemotherapy was significantly higher. When young patients relapsed, they were more likely to receive second-line adjuvant chemotherapy or reoperation than older patients. Conclusion Younger patients with stage III colorectal cancer had better CSS rates.

The effectiveness of lymph node dissection tends to be reduced clinically in elderly patients with colorectal cancer because of physical limitations, such as comorbidities and organ dysfunction. We investigated the influence of the level of lymph node dissection on the prognosis of elderly patients with colorectal cancer. A total of 137 patients with pT2 or more-advanced tumors or lymph node metastasis were retrospectively studied. The 5-year overall survival(OS)andrelapse free survival(RFS) rates were 74.1% and 63.9%, respectively. Lymph node dissection was an independent prognostic factor in the examination of prognostic factors of OS. In the propensity-matchedcohort, the 5-year OS rates were 87.2% and5 8.2%(p=0.02), and the 5-year RFS rates were 77.8% and4 6.4%(p=0.03)in the D3 andred ucedgroups, respectively. The D3 group hada significantly better prognosis than the reduced group. D3 lymph node dissection might contribute to the improvement of prognosis in elderly people with colorectal cancer.

Background Intestinal endometriosis is rare and most frequently involves the rectum and sigmoid colon. Case presentation Here, we report a case series of 5 patients who underwent laparoscopic resection for intestinal endometriosis. None of the patients developed postoperative complications, and all were discharged at 5–8 days after surgery. The diagnosis of intestinal endometriosis is difficult to obtain before surgery. Only 2 of 5 patients were diagnosed preoperatively. Among 1 of the 2 patients, the symptoms at the time of menstruation were obvious. In patients with submucosal tumors, the preoperative diagnosis can be difficult. Additional imaging examinations at the time of menstruation might be useful for obtaining a diagnosis. D2 dissections were performed for 3 patients, because malignancy could not be ruled out as a preoperative diagnosis. The surgical findings of 1 patient did not appear to be endometriosis. Surgery for intestinal endometriosis usually encounters advanced pelvic adhesions and fibrosis. For patients undergoing sigmoidectomy, the mean operative time was 152 min and mean blood loss was 10 mL. For patients undergoing rectal resection, the mean operative time was 282 min and mean blood loss was 17 mL. Two cases had severe pelvic adhesions, and the residual rectum could not be straightened. Therefore, side-to-side anastomosis was performed. For intestinal endometriosis surgery, flexible planning for the anastomosis method used for residual intestine should be undertaken. Conclusion Laparoscopic surgery for intestinal endometriosis was safe but technically difficult, because of fibrosis and adhesions. An accurate diagnosis should be attempted based on the clinical symptoms, imaging findings, and intraoperative findings. The method used for anastomosis should be decided on a case-by-case basis.

A 32-year-old woman with a history of undergoing upper gastrointestinal surgery was administered prednisolone for abortive Behçet's disease since 2015. In March 2017, upper gastrointestinal endoscopy revealed a 0-IIc type early stage gastric carcinoma at the posterior wall of the gastric antrum. The pathological diagnosis was signet-ring cell carcinoma. This gastric carcinoma was classified as cT1aN0M0; therefore, endoscopic submucosal dissection(ESD)was performed for the expanded indication lesion in April 2017. The pathological diagnosis after ESD indicated the need for non-curative resection; thus, laparoscopy-assisted distal gastrectomy and Billroth I anastomosis were performed in July 2017. A transient anastomotic structure was admitted after this surgery, but she was discharged from the hospital lighthearted. A preoperative important aspect was the careful examination of all intestinal tracts for ulcer lesions, and an intraoperative important aspect was hand-sewn anastomosis because using a metallic stapler conferred a high risk of ulcer lesions and suture failure. We encountered a case wherein laparoscopy-assisted distal gastrectomy was performed in a patient with abortive Behçet's disease, early stage gastric carcinoma, and a history of undergoing upper gastrointestinal surgery.

The factors which affect the 6-month continuation of adjuvant chemotherapy with S-1 have not been fully evaluated in pancreatic cancer. The objective of this retrospective study was to clarify the risk factors for the discontinuation of S-1 adjuvant chemotherapy after 6 months of treatment. The study included patients who underwent curative surgery for pancreatic cancer, were diagnosed with stage II or III disease, had a serum creatinine level ≤1.2 mg/dl and received adjuvant S-1 between June 2007 and March 2014. Forty patients were eligible for the present study. A comparison of the 6-month continuation stratified by each clinical factor using the log-rank test revealed a significant difference in the creatinine clearance (CCr) between the patients who continued and discontinued the treatment. A CCr of 60 ml/min was regarded as a critical point. The uni- and multivariate Cox’s proportional hazard analyses demonstrated that the CCr was the only significant independent predictive factor. The 6-month continuation rate was 70.8 % in the patients with a CCr ≥60 ml/min and was 25.0 % in patients with a CCr

This paper address the issues of surplus power that would happen when the sum of the generated power of Photovoltaic(PV) Generation Systems and minimal output of utility power plant exceeds total electricity demand that would affect the stable operation of power system. The cooperative control of customer's appliances such as Heat Pump Water Heater(HPWH) and battery is applied for utilizing surplus power effectively, that enables effective utilization of surplus power without affecting customer's appliances such as shortage of hot water supply and minimizes the electricity bill of a customer. The proposed method can consider the uncertainty of forecasting error of PV output, electricity demand, and hot water demand. The effectiveness of proposed method is validated by simulation analysis and experimental results.

Along with widespread distributed generators that use natural energy, power flow control of the distribution systems has become complicated. In particular, when a system failure occurs, distributed generators are disconnected and power flow changes rapidly. This causes concerns about supply voltage deviation from its regulated value, distribution line overload, etc. To meet this, it is required to have an operational control technology that allows rapidly taking measures for the power flow change in the event of a system failure while successively catching up with the generated output of distributed generators.The authors indicate a future concept that allows for distribution system operational management considering distributed generators, and propose, as a technology to achieve this concept, a method to estimate the operating status (whether in operation or shutdown) of co-generating systems. With this method, the operating status of a co-generating system installed by a consumer is estimated based on the power flow value measured at the consumer's inlet. The proposed method has two estimation methods, i.e. one is a “power factor method” for consumers without power factor correction capacitors and the other is a “power factor/total power method” for consumers with power factor correction capacitors. This has led to estimating the operating status of a co-generating system, which was impossible thus far, with a percentage of correct estimations of almost 90%.

Recently there has been a marked increase in wind power generation. From a power system point of view, because a wind turbine is an intermittent generator with large output fluctuation, any increase in the number of wind turbines gives rise to concerns about the adverse effects of wind turbines on power quality. The smoothing effects of wind turbine output fluctuation are of great importance in assessing the impacts of a large number of wind turbines. With regard to impacts on power system frequency (generation‐demand balance), smoothing effects on a power system-wide scale need to be examined in greater detail, because impacts of wind turbines on power system frequency are dominated by the total power output of wind turbines interconnected to the system. This article examines smoothing effects of wind power output on a power system-wide scale. First a summary of wind measurements, in which observations were made at 16 sites, is presented. Next, correlation coefficients of wind power output of distant wind turbines are analysed; considerable differences are observed in the correlation coefficients from day to day. Then a new indicator for assessing the smoothing effects—average coherence—is introduced to resolve difficulties of conventional indicators such as coherence. Average coherence is evaluated for the measured data; the results show that smoothing effects among wind farms distributed over some hundreds of kilometres may not be so significant for periods of more than about 100 min. Copyright © 2004 John Wiley & Sons, Ltd.

Recently there has been a marked increase in wind power generation. From a power system point of view, because a wind turbine is an intermittent generator with large output fluctuation, any increase in the number of wind turbines gives rise to concerns about the adverse effects of wind turbines on power quality. The smoothing effects of wind turbine output fluctuation are of great importance in assessing the impacts of a large number of wind turbines. This article examines smoothing effects at a wind farm. First it presents a summary of wind measurements taken at two locations with six masts over a period of 1 year on both flat and complex terrain. Then the spatial coherence of wind speed is analysed, paying special attention to its dependence on the distance between observation points, wind direction, wind velocity and fluctuation frequency. Approximation equations for coherence of frequency and distance are obtained by applying Davenport's expression to the observed data. Second, coherence between turbine output at a wind farm is investigated; the results indicate that coherence for wind speed and turbine output shows a considerable resemblance. The article also examines smoothing effects at a wind farm using power spectral density through a theoretical approach. The study proves that smoothing effects can be approximated with a lowpass filter and that the effects at a wind farm should not be taken into account for periods of more than 10 min in case of assessing them on the safe side. Copyright © 2004 John Wiley & Sons, Ltd.

The feasibility of treatment containing bevacizumab (BV) for elderly patients is not well established. We investigated the safety of treatment containing BV for advanced or metastatic colorectal cancer in elderly patients. From June 2008 to December 2010, 22 patients were treated with BV in our hospital. We classified them into three groups: less than 65 years (group A: 8 patients), 66-75 years (group B: 9 patients), and more than 76 years (group C: 5 patients). Then, we compared the adverse events involving BV. The patient median age was 71. 5 (range 45-84)years old; 10 patients were treated in first-line therapy and 12 patients in second-line therapy or beyond. The number of patients with hypertension was one (12. 5%) in group A, 3 (33. 3%)in group B, and 3 (60%) in group C. Treatment was continued in 4 patients, and discontinued in 18. The reasons for discontinuing BV treatment were tumor progression in 14 patients, toxicities in 3 patients, and degradation of performance state in one patient. BV-associated adverse events had a tendency to become severe with aging, and patients for whom BV treatment was discontinued because of toxicities were all in group C. Severe adverse events of rectal bleeding, cerebral hemorrhage and cerebral infarction were observed in three patients. These patients had risk factors for BV-associated adverse events such as hypertension or a history of radiation therapy, besides the risk factor of age. It is suggested that BV-associated adverse events are highly frequent and severe in elderly patients. Especially in patients over 76 years old, risk factors such as hypertension and severe adverse events were observed. The administration of BV for elderly patients should be considered very carefully.

According to Japanese governmental target, more than 50 GW will be penetrated on the whole utility system until 2030. Such large penetration of PV system may cause deterioration of power quality and stability of the whole utility grid. CRIEPI is promoting a study of future Japanese style smart grid called “Triple I (Intelligent, Interactive, Integrated) Power System (TIPS)” to keep stable and to promote effective energy use under the large penetration of unstable renewable power sources. In the study, new integrated control technique of supply and demand for utilizing surplus power due to PV systems that may cause instability of the grid is being investigated. Concept of surplus power control method in whole utility system including demand control is revealed. A new operation planning method of load in each customer having PV system taking account of satisfying both utility requirement and customer convenience is designed and verified by simulation.

The recent increase in the demand for power in urban areas has caused changes in the way power is supplied. Underground distribution systems have been introduced for convenience in urban areas and to prevent injuries in case of a crisis. As a result, many new types of power cables are being used. One type, XPLE cables (also called CV cables) have been rapidly taking the place of conventional cables such as OF or SL cables since the 1960s because of their relatively easy installation and maintainability. However, distribution cables used under severe environmental conditions deteriorate rapidly (due mainly to water treeing), and some cables experience insulation breakdown. Therefore, many diagnostic methods have been developed, though they have not been very effective. By combining methods, a high reliability can be achieved in comparison to the use of a single method. However, processing the data is difficult for on-site personnel, so many experts are required. But there is a lack of qualified experts, hence we have turned to the development of expert systems.

When the volume of distributed generation (DG), including photovoltaic (PV) power systems, is increased, reverse power flow from DG may cause problems. To reduce the reverse power flow from PV power systems, energy management by use of storage batteries is expected to be a solution. In addition, the combination with load control is expected to reduce the storage capacity. In this study, energy management methods by use of the Supply and Demand Interface (SDI), which is a device to control DG, batteries and loads, are proposed and the effectiveness of the methods are evaluated by simulation analyses. The simulation results show that the amount of reverse power flow from PV power systems is reduced by the proposed energy management methods, and the load control is effective in reducing the reverse power flow. The required storage capacity to prevent the reverse power flow from the distribution line to the transmission line is also shown.

553 Background: Targeted therapies of monoclonal antibodies have changed the treatment of metastatic colorectal cancer (mCRC). A target therapy with chemotherapy regimen for mCRC was decided by KRAS mutation status (KRAS exon2 [codon12, codon13]). Currently, there are many reports suggesting that in addition to analysis of KRAS mutation status, the evaluation of EGFR gene copy number, levels of EGFR ligands, BRAF, NRAS, PIK3CA mutations could be helpful to have a more accurate selection of patients who may have a benefit from anti-EGFR targeted drugs. Methods: Mutation status of 50 oncogenes were analysed in 35 mCRC patients with all RAS wild type, using next-generation sequencing technology. The response for chemotherapy was classified response group (R group) and non-response group (N group) by RECIST. The relation between mutation status of 50 oncogenes and the response for chemotherapy was assessed. Results: There were 25 oncogene mutations in the 50 genes. Driver mutation associated with oncogenic mutation deeply were 5 oncogenes, which were PIK3CA, AKT1, BRAF, PDGFRA and TP53. Only BRAF mutation was significantly associated with poor chemo response in the 5 oncogenes. A case which had two driver mutations was only in the N group. One of the two driver mutations was tumor suppressor gene, TP53. Conclusions: BRAF mutation and the number of driver mutations are key predictors of chemosensitivity in the mCRC cases with all RAS wild type.

252 Background: The clinical implications of peritoneal lavage cytology (CY) status in the patients who received curative resection and adjuvant chemotherapy have not been established. The clinical implications of peritoneal lavage cytology (CY) status in the patients who received curative resection and adjuvant chemotherapy have not been established. Methods: We retrospectively analyzed clinical data from 143 consecutive patients who underwent macroscopically curative resection and received adjuvant gemcitabine or S-1 chemotherapy for pancreatic cancer from 2005 to 2014 in our institution. Correlations between CY status and survival and clinicopathological features were investigated. Results: Of the 143 patients, 21 patients were peritoneal washing cytology positive (CY+) (14.7%). Although significant difference was observed in the tumor size, no other correlation between cytology status and clinicopathological parameter existed (age, gender, histology, UICC T status, LN metastasis, lymphovascular invasion). The recurrence free survival (RFS) rates at 3 and 5 years after surgery were 5.1% and 0% in CY+ patients, respectively, and were 21.5% and 16.1% in peritoneal washing cytology negative (CY-) patients, respectively, which were significantly different (p

446 Background: We investigated the impact of postoperative complications on pancreatic cancer survival and recurrence after curative surgery. Methods: This study included 164 patients who underwent curative surgery for pancreatic cancer between 2005 and 2014. The patients were classified into those with postoperative complications (C group) and those without postoperative complications (NC group). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. Results: Postoperative complications were found in 61 of the 164 patients (37.2%). The RFS rate at five years after surgery was 10.6% in the C group patients and was 21.0% in the NC group patients. The RFS tended to be worse in the C group than in the NC group (p=0.1756). The OS rate at five years after surgery was 7.4% in the C group and 22.8% in the NC group, which was significantly different (p=0.0189). The multivariate analysis demonstrated that postoperative complications and lymphatic invasion were significant independent risk factors for the RFS and OS. Conclusions: The development of postoperative complications was a risk factor for a decreased overall survival and for disease recurrence in patients who underwent curative surgery for pancreatic cancer. The surgical procedure, perioperative care and the surgical strategy should be carefully planned to avoid complications.

419 Background: Postoperative morbidity is high after pancreatic surgery. Numerous studies have evaluated factors to predict the patients at risk. Recently, a simple and easy-to-use surgical complication prediction system, the surgical Apgar score (SAS) calculated using three intraoperative parameters (estimated blood loss, lowest mean arterial pressure and lowest heart rate) has been proposed for general surgery. In this study, we evaluated the predictability of the SAS for severe complications after pancreatic surgery for pancreatic cancer. Methods: We investigated 189 patients who underwent pancreatic surgery at Kanagawa Cancer Center between 2005 and 2014. Clinicopathological data, including the intraoperative parameters, were collected retrospectively. In this study, the patients with postoperative morbidities classified as Clavien-Dindo grade II or more were classified as having severe complications. Uni- and multivariate logistic regression analyses were performed to identify the risk factors for morbidity. Results: Postoperative complications were identified in 73 patients, and the overall morbidity rate was 38.6%. The results of both univariate and multivariate analyses of various factors for overall operative morbidity showed that a SAS of 0-4 points and a body mass index > 25 kg/m2 were significant independent risk factors for overall morbidity (P=0.024 and P=0.014, respectively). The rate of abdominal abscess formation was significantly higher in the patients with a SAS of 0-4 points, while the occurrence of a pancreatic fistula was significantly higher in the patients with a body mass index > 25 kg/m2. Conclusions: The SAS was a significant risk factor for surgical complications after pancreatic surgery for pancreatic cancer. Careful attention is required for these patients in order to help prevent complications and treat them as soon as they develop.

486 Background: The safety and feasibility of starting S-1 adjuvant chemotherapy for pancreatic cancer has not been evaluated in elderly patients. Methods: The patients who underwent curative D2 surgery for pancreatic cancer were selected to this retrospective study. The patients were diagnosed within stage I to III disease, and received adjuvant S-1 at our hospital. Patients were categorized into two groups; non-elderly patients (age

198 Background: Despite proven benefit of adjuvant chemotherapy in pancreatic cancer patients, earlyrecurrenceoccursinaconsiderablerate. Therefore, outcomeprediction in these patients remains a challenge. The aim of this study was to determine whether Glasgow Prognostic Score (GPS) and CA19-9 could predict early recurrence in patients undergoing adjuvant chemotherapy after surgery. Methods: 67 pancreatic ductal adenocarcinoma (PDAC) patients underwent curative resection and received adjuvant chemotherapy with gemcitabine after surgery at Kanagawa Cancer Center between 2007 and 2012.The GPS, CA19-9(measured prior to adjuvant therapy) and other clinicopathological factors were retrospectively reviewed. The GPS was calculated from CRP and albumin as follows: patients with both an elevated CRP level (>0.5mg/dl) and hypoalbuminemia (

Background Radical antegrade modular pancreatosplenectomy (RAMPS) is a relatively new modification of the standard distal pancreatosplenectomy. In this method, dissection proceeds from right-to-left to achieve negative posterior resection margins. However, short-term and long-term outcomes of RAMPS for pancreatic cancer have not yet been clarified. The aim of this study is to evaluate short-term and long-term outcomes in the patients who have undergone RAMPS. Methods Consecutive 49 patients were selected from the retrospective database of the Kanagawa Cancer Center from 2000 to 2014. Data from the operative notes, pathology reports, postoperative data, and outpatient data (recurrence and survival) were entered into the database. Results All patients were undergone anterior RAMPS. The median operation time was 278 min (range from 140 to 625 mins). The median blood loss in operation was 850 ml (range from 60 to 2790 ml). The overall incidence of morbidity was 51.4 % and the incidence of mortality was 0 %. Forty-one patients (83.7 %) had negative resection margins. The mean number of lymph nodes harvested was 15 and 27 patients had lymph node metastasis. After the median follow-up period was 41.1 months, 1-year and 3-year overall survival rates were 84.1 and 38.6 %, respectively. Median overall survival was 22.6 months. Conclusions The present study results suggested that RAMPS procedure might be safe and feasible without an increase in morbidity and morbidity and have survival benefit compared with standard DP.