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Examination of >12 lymph nodes (LNs) is important for the diagnostic accuracy of nodal status following resection of colorectal cancer. In the present study, the efficacy of a fat dissolution technique for LN retrieval was evaluated using resected colon and rectum mesentery. First, the resected mesentery was searched for LNs by inspection and palpation immediately after surgery. Subsequently, fat dissolution liquid was applied to the remnant fat and the LN search was repeated. The primary endpoint was whether the second assessment would increase the number of evaluated LNs. Recruitment of 20 patients was planned. The study was conducted after institutional review board approval and written informed consent was obtained. Among 20 participants, 1 patient was excluded because LN dissection was not performed. The median number of LNs identified at the first and second assessments was 13 and 6, respectively, producing a significant increase in total LNs evaluated (13 vs. 20, respectively; P<0.01; paired t-test). One positive node was identified among the additionally identified LNs (0.9%, 1/107). The second assessment increased the number of LNs assessed to >12 in 4 patients, and although staging was not changed, the treatment was potentially altered in 2 stage II patients. The maximum diameter of the additionally obtained LNs was significantly smaller compared with those from the first assessment (4 vs. 7.7 mm, respectively; P<0.01; Wilcoxon signed-rank test). After the fat dissolution technique, the tumor cells were satisfactorily stained by carcinoembryonic antigen and cytokeratin-20. In conclusion, applying fat dissolution liquid to the remnant adipose tissue of the mesentery of the colon and rectum identified additional LNs. This method should be considered when insufficient LNs are identified after conventional LN retrieval. [ABSTRACT FROM AUTHOR]

Accurate diagnosis of lymph node (LN) metastasis is important to determine the staging and consequent treatment of resected colorectal cancer. Therefore, factors influencing the number of retrieved LNs were explored. This study included 400 patients that underwent surgical resection for Stage 0-III colorectal cancer from 2009 to 2014 in Kochi Medical School. In all cases, surgeons retrieved the LNs within the resected mesentery immediately after the operation without fixation. Age, gender, body mass index (BMI), American Association Anesthesiologist (ASA) scores, tumor locations, maximum tumor diameters, nodal status, and pathological tumor types were extracted as patient and tumor factors. The extent of LN dissection and surgical approaches (laparoscopic or laparotomy) were extracted as operative factors. Multivariate regression analysis was performed to identify independent predictive factors for LN number retrieved, after potential influential factors were explored by univariate analysis. As results, we found that the median number of retrieved LNs was 13, ranging from 1 to 50. Approximately 60% of the patients thus received an adequate examination (LN number of 12 or more). Multivariate analysis using the remaining factors of univariate analysis identified BMI, tumor diameter, nodal status, and extent of dissection as independent predictive factors for the number of retrieved LNs ( P < 0.05). If any or all these factors are present, a vigorous search for LNs using additional measures, such as visual enhancement and fat dissolution method, should be considered., Competing Interests: None., (IJCEP Copyright © 2018.)

A 34-year-old woman underwent total gastrectomy with D2 lymphadenectomy for gastric cancer, and the final diagnosis was T4N3M0, Stage III C, R0. Bilateral ovarian metastases were identified 51 months later, which were removed, and the patient received S-1 plus CDDP chemotherapy. Because the patient developed pubic bone metastasis 16 months after the second operation, we continued chemotherapy using paclitaxel with bisphosphonate. The patient was alive 70 months after the initial operation. The second patient was a 55-year-old woman who underwent total gastrectomy with D2 lymphadenectomy and was diagnosed with T2N2M0, Stage III A gastric cancer. Bilateral ovarian metastases were identified 72 months later, which were removed, and the patient received S-1 plus CDDP chemotherapy. The patient is alive with no signs of disease recurrence 96 months after the initial operation. For patients with ovarian metastases from gastric cancer, surgical resection in addition to chemotherapy might be an effective treatment. However, further studies and assessments of additional cases are needed to confirm the ideal treatment for this condition.

This study aimed to evaluate the efficacy of protein-bound polysaccharide K (PSK)-containing chemotherapy in patients with unresectable advanced or recurrent gastric cancer (AGC). We retrospectively analyzed 190 patients with AGC who received systemic chemotherapy including 69 patients who were treated with a PSK-containing regimen. Using propensity score matching, we obtained 62 matched patients in the S-1 and S-1 plus PSK groups for outcomes analysis. There was a tendency for overall survival to be higher in the S-1 plus PSK group than in the S-1 alone group. In particular, there was a tendency for overall survival in the S-1 plus PSK group to be higher in patients with a neutrophil/lymphocyte ratio (NLR)<2.2 than in patients with a NLR<2.2. There was a tendency for fewer changes in the NLR after the beginning of treatment in the S-1 plus PSK group than in the S-1 alone group. PSK-containing chemotherapy may contribute to improved treatment outcomes of AGC patients. In particular, it may be effective in patients with a high NLR. Further investigations, including a prospective randomized controlled trial, are expected to verify the mechanisms of interaction between cancer cells and the immunoreaction.

Monoclonal antibodies against epidermal growth factor receptor (EGFR) are used in the treatment of advanced colorectal cancer. However, these agents can induce severe dermatological side effects that discourage their administration in patients with chronic dermatological disease. EGFR plays a key role in normal skin development and immunological function, and is expressed in various tissues and organs, although contrarily, it is overexpressed in psoriasis-related skin lesions. Thus, discussion is ongoing regarding the putative pathological role and therapeutic potential of this protein. We herein report on a patient with advanced colon cancer and concomitant long-standing psoriasis vulgaris who received anti-EGFR antibody monotherapy as a third-line treatment for metastatic disease. One week after the initiation of treatment, the patient's skin lesions dramatically subsided and the improvement was sustained during therapy. Based on this case, we propose that anti-EGFR antibody therapy is not necessarily contraindicated in patients with psoriasis vulgaris. Moreover, the findings reaffirmed that EGFR is an important molecule in the pathology of psoriasis.

A 61 -year-old man underwent total gastrectomy with distal pancreatectomy and D2 lymphadenectomy for gastric cancer. The final diagnosis was UM, Post-Gre-Less, Type 3, 12 × 9 cm, T4b (SI), N3b (31/99), H0, P0, CY0, M0, tub2, ly3, v3, Stage IIIC, R0. Fifteen months after the operation, abdominal computed tomography showed a left adrenal tumor measuring 2.5 cm in diameter. Because it was a solitary tumor, we performed tumor resection, confirming adrenal metastasis that was negative for human epidermal growth factor receptor type 2 (HER2). Subsequently, the patient was treated with a chemotherapy regimen consisting of S-1 plus cisplatin. Because he developed left adrenal metastasis 6 months after tumor resection, we initiated chemotherapy with docetaxel plus irinotecan. Left adrenalectomy was performed owing to the tumor increasing to 3.6 cm despite chemotherapy. The patient is currently alive 50 months after the initial operation, without any signs of disease recurrence. For patients with solitary adrenal metastasis from gastric cancer, surgical resection in addition to chemotherapy might be the preferred choice of treatment.

In the present study, we aimed to evaluate the efficacy and safety of trastuzumab-containing regimens in patients with unresectable advanced or recurrent gastric cancer( AGC). We retrospectively analyzed 142 patients with AGC who received systemic chemotherapy, including 10 patients treated with trastuzumab-containing regimens. Among the 72 patients, 12 (16.7)% were human epidermal growth factor receptor 2 (HER2)-positive; the HER2-positive rate was significantly greater in patients with intestinal-type than diffuse-type histology( 29.0 vs 7.3%; p=0.014). The median overall survival of patients treated with trastuzumab was significantly longer than that of patients treated without trastuzumab( 22.9 vs 11.6 months; p =0.014). Seven patients continued receiving trastuzumab therapy after disease progression, and 6 patients were treated with trastuzumab after initial chemotherapy. The objective response rate of trastuzumab-containing regimens was 40%. The frequency of hematological and non-hematological toxicities was feasible. The administration of trastuzumab therapy after disease progression may contribute to improved treatment outcomes. However, further investigations, including prospective randomized controlled trials, are needed to verify this finding.

A 65-year-old man was referred to our Hospital for examination of gastric cancer initially diagnosed by medical check-up. Esophagogastroduodenoscopy demonstrated a superficial depressed-type gastric cancer in the antrum, and abdominal computed tomography showed no evidence of distant metastases. A tumor measuring 11 mm in diameter was removed by endoscopic submucosal dissection (ESD). Since histological examinations of ESD specimens showed a well-differentiated adenocarcinoma invading the submucosal layer with lymphatic invasion, the patient subsequently underwent laparoscopy-assisted distal gastrectomy with regional lymph node dissection, resulting in no residual carcinoma and no lymph node metastasis. The patient developed solitary liver metastasis one year later and was treated with trastuzumab plus capecitabine/cisplatin since results of the immunohistochemical analysis of the resected specimens demonstrated overexpression of the human epidermal growth factor receptor 2 (HER2). The patient was alive 12 months after surgical resection of the liver metastasis and subsequently developed bone metastasis. Controversy remains over the role of HER2 status as a prognostic factor in gastric cancer. However, it has been generally reported that HER2 overexpression correlates with aggressive biological behavior and poor prognosis. HER2 overexpression is a potentially useful predictive factor for tumor recurrence and poor prognosis even in early gastric cancer cases.