[Nephrotoxicity of a Short Hydration Method for the Cisplatin Regimen in Patients with Gastric Cancer]

BACKGROUND

S-1 plus cisplatin(CDDP)has been a key regimen for advanced gastric cancer treatment. However, CDDP confers dose-limiting nephrotoxicity, requires a hospital stay for conventional massive hydration, and reduces patients' quality of life. We evaluated the nephrotoxicity of CDDP combination chemotherapy in an outpatient setting with short hydration for gastric cancer and investigated the feasibility of the short hydration method.

METHODS

Twenty-nine gastric cancer patients aged under 75 years with creatinine clearance rate >40mL/min and who received S-1 plus CDDP(60mg/m2)were recruited. Intravenous hydration was administered at 1,900 mL with magnesium and a diuretic. Any renal dysfunction over 5 courses of chemotherapy was analyzed.

RESULTS

The majority(24/29)of patients could receive outpatient chemotherapy. The highest serum creatinine Grade in each course was Grade 1, and none of the patients developed creatinine toxicity of Grade 2 or higher over 5 courses of chemotherapy. An elevation in eGFR grade was found in 51.7%(15/29)patients; in 13 of those patients, the escalation was of at least 1 Grade.

CONCLUSION

The short hydration method is feasible for gastric cancer patients receiving chemotherapy including CDDP in an outpatient setting.

[A Case of Resection of a Huge Intrahepatic Cholangiocarcinoma of Extrahepatic Growth Type]

A 44-year-old woman was admitted to our hospital because of an abdominal mass. Blood examination showed no elevation of hepatic enzyme levels but did show a slight increase in the levels of tumor marker CA19-9. An abdominal contrastenhanced CT scan showed a large pedunculated tumor(15 cm)growing from the S5 to the extrahepatic area, with a pattern of earlyenhancement and wash out. Fortunately, organ invasion and tumor dissemination were not observed. Upon FDG-PET examination, marked uptake of FDG was observed in the tumor. S5 hepatic subsectionectomywas performed. The final pathological finding of this tumor was moderatelydifferentiated cholangiocarcinoma. Intrahepatic cholangiocarcinoma with exophytic growth is quite rare, and is reported to have a poor prognosis. Therefore, strict follow-up, including follow-up CT and examination for tumor markers(CA19-9 and CEA), is required.

[A Case of Endometrioid Adenocarcinoma in the Sac of a Femoral Hernia]

A 74-year-old woman presented to our institution with right inguinal swelling. The swelling had appeared 1 year previously and exhibited a tendency to increase in size. Physical examination revealed a thumb tip-sized swelling in the right inguinal region. Computed tomography revealed a right femoral hernia and fluid accumulation, resulting in the diagnosis of a right femoral hernia. Using the anterior approach, we completely removed the cystic nodule and repaired the femoral hernia. The hernia sac contained elastic nodules, and pathological examination led to the diagnosis of endometrioid adenocarcinoma. Although postoperative positron emission tomography-computed tomography and magnetic resonance imaging revealed no tumor residue, systemic chemotherapy was selected after consultation with the obstetrics and gynecology department. In summary, we herein report a case of an endometrioid adenocarcinoma that occurred in the sac of a femoral hernia.

[A Case Report of Sigmoid Colon Cancer with a Synchronous Large Liver Metastasis Curatively Resected Following Multidisciplinary Therapy]

A 50's woman referred to our hospital with high serum CEA level was found to have RAS-wild sigmoid colon cancer with a 15 cm size unresectable synchronous liver metastasis(LM)in the right lobe during the endoscopic, radiological, and immunohistological examinations. CapeOX was introduced, but the LM lesion enlarged to 18 cm after 2 courses. Therefore, the regimen was switched to FOLFIRI plus panitumumab. Six courses ofchemotherapy resulted in the reduction ofthe LM lesion to 11 cm, and the Response Evaluation Criteria in Solid Tumors revealed PR with no severe adverse effects, and curative surgical resection was planned. The patient underwent laparoscopic sigmoidectomy resection, followed by percutaneous transhepatic portal embolization(PTPE)ofthe right branch ofthe portal vein to secure the volume ofthe future remnant liver. Right lobectomy and partial resection ofsegment 4 ofthe liver and cholecystectomy was then performed. Currently, 28 months postoperatively, the patient continues to do well with no signs ofrecurrence. This case demonstrates that the sequential combination ofsystemic therapy with FOLFIRI plus panitumumab and PTPE enabled the curative surgical management ofthe sigmoid colon cancer with a large synchronous LM.

Primary Intrahepatic Squamous Cell Carcinoma with Histological Collision of Adenocarcinoma and Squamous Cell Carcinoma: A Case Report

Patient: Male, 82

Final Diagnosis: Intrahepatic squamous cell carcinoma

Symptoms: None

Medication: —

Clinical Procedure: —

Specialty: Oncology

MicroRNA-137-mediated Src oncogenic signaling promotes cancer progression

The tyrosine kinase c-Src is frequently overexpressed and activated in a wide variety of human cancers. However, the molecular mechanisms responsible for the upregulation of c-Src remain elusive. To examine whether microRNA-mediated c-Src upregulation promotes cancer progression, we screened miRNAs with complementarity to the 3'-UTR of c-Src mRNA. Among these miRNAs, down-regulation of miR-137 was tightly associated with c-Src-mediated tumor progression of human colon cancer cells/tissues. Re-expression of miR-137 in human colon cancer cells suppressed tumor growth and caused the disruption of focal contacts, suppression of cell adhesion, and invasion, although restoration of c-Src in miR-137-treated cells could not fully rescue the tumor-suppressive effect of miR-137. We found that miR-137 targets AKT2 and paxillin also and miR-137-mediated regulation of c-Src /AKT2 is crucial for controlling tumor growth, whereas that of c-Src/paxillin contributes to malignancy. miR-137 suppressed Src-related oncogenic signaling and changed the expression of miRNAs that are regulated by Src activation. miR-137 controls the expression of c-Src/AKT2/paxillin and synergistically suppresses Src oncogenic signaling evoked from focal adhesions. In various human cancers that harbor c-Src upregulation, the dysfunction of this novel mechanism would serve as a critical trigger for tumor progression.

Safety and Feasibility of Single-port Surgery for Colon Cancer in Octogenarians

BACKGROUND/AIM

The use of single-port surgery (SPS) in elderly patients with colon cancer remains controversial. The aim of this study was to evaluate the clinical outcomes of elderly patients who underwent SPS.

PATIENTS AND METHODS

Consecutive patients >80 years old of age who underwent SPS (n=86) or multi-port surgery (MPS) (n=40) for colon cancer from January 2008 to December 2014 were analyzed. Short-term and long-term outcomes were compared between groups.

RESULTS

The morbidity rate in the SPS was significantly lower than that in the MPS (p=0.027). Length of hospital stay in the SPS was significantly shorter than that in the MPS (p=0.016). Similar oncological outcomes were observed in the groups. The 3-year disease-free survival rate, the 5-year overall survival rate and the 5-year cancer-specific survival rate did not differ significantly between groups.

CONCLUSION

SPS is safe and can provide clinical outcomes comparable to those of MPS in octogenarians with colon cancer.

Safety and feasibility of single-port laparoscopic multivisceral resection for locally advanced left colon cancer

The aim of the present study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (S-MVR) for locally advanced left colon cancer. S-MVR is a challenging technique and to the best of our knowledge this is the first report of S-MVR for left colon cancer invading or adhering to neighboring organs. A retrospective review was conducted of patients who underwent laparoscopic multivisceral resection for locally advanced left colon cancer invading or adhering to neighboring organs from January 2008 to December 2014. Short-term and long-term outcomes were analyzed between groups of patients who underwent S-MVR and multi-port laparoscopic multivisceral resection (M-MVR) retrospectively. A total of 14 patients underwent S-MVR and 15 patients underwent M-MVR. There were no significant differences between groups in terms of operative factors and postoperative complications. The length of hospital stay was significantly shorter in the S-MVR group compared with the M-MVR group (P=0.048). Three-year overall survival was 61.9% in the S-MVR group (n=14). In patients with stage II (P=0.600) and III (P=0714) disease the three-year overall and disease-free survival was 81.8 and 58.3% in the S-MVR group and 80.0 and 70% in the M-MVR groups over a median follow-up of 34 months. In conclusion, S-MVR for locally advanced left colon cancer is safe and feasible in selected patients.

Hitomi X-ray studies of Giant Radio Pulses from the Crab pulsar

To search for giant X-ray pulses correlated with the giant radio pulses (GRPs) from the Crab pulsar, we performed a simultaneous observation of the Crab pulsar with the X-ray satellite Hitomi in the 2 - 300 keV band and the Kashima NICT radio observatory in the 1.4 - 1.7 GHz band with a net exposure of about 2 ks on 25 March 2016, just before the loss of the Hitomi mission. The timing performance of the Hitomi instruments was confirmed to meet the timing requirement and about 1,000 and 100 GRPs were simultaneously observed at the main and inter-pulse phases, respectively, and we found no apparent correlation between the giant radio pulses and the X-ray emission in either the main or inter-pulse phases. All variations are within the 2 sigma fluctuations of the X-ray fluxes at the pulse peaks, and the 3 sigma upper limits of variations of main- or inter-pulse GRPs are 22% or 80% of the peak flux in a 0.20 phase width, respectively, in the 2 - 300 keV band. The values become 25% or 110% for main or inter-pulse GRPs, respectively, when the phase width is restricted into the 0.03 phase. Among the upper limits from the Hitomi satellite, those in the 4.5-10 keV and the 70-300 keV are obtained for the first time, and those in other bands are consistent with previous reports. Numerically, the upper limits of main- and inter-pulse GRPs in the 0.20 phase width are about (2.4 and 9.3) ×10^-11 erg cm^-2, respectively. No significant variability in pulse profiles implies that the GRPs originated from a local place within the magnetosphere and the number of photon-emitting particles temporally increases. However, the results do not statistically rule out variations correlated with the GRPs, because the possible X-ray enhancement may appear due to a > 0.02% brightening of the pulse-peak flux under such conditions.

Safety and feasibility of single-port laparoscopic low anterior resection for upper rectal cancer

BACKGROUND

Single-port surgery for rectal cancer is challenging and controversial. The aim of this study was to compare the short-term outcomes of single-port laparoscopic low anterior resection (S-LAR) to multi-port laparoscopic low anterior resection (M-LAR) for upper rectal cancer.

METHODS

From January 2011 to December 2015, a total of 93 patients who underwent S-LAR (n = 44) or M-LAR (n = 49) without protective diverting ileostomy for upper rectal cancer were identified. Tumors were located between the inferior margin of the second sacral vertebra and the peritoneal reflection. Short-term outcomes were compared between groups.

RESULTS

S-LAR was successful in 75% of cases: 25% of cases required one additional port. Operative factors, perioperative outcomes, oncological outcomes did not differ significantly between groups. In patients with stage I-III disease, the 3-year relapse-free survival rate was significantly higher in the S-LAR group than in the M-LAR group (p = 0.032). The 3-year overall survival rate was similar between groups.

CONCLUSIONS

S-LAR is safe, feasible and can provide satisfactory oncological outcomes in selected patients with upper rectal cancer.

Randomized phase III trial comparing surgery alone to UFT + PSK for stage II rectal cancer (JFMC38 trial)

Background

We conducted a randomized phase III trial comparing tegafur/uracil (UFT) and Polysaccharide-K (PSK) to surgery alone in curatively resected stage II rectal cancer patients.

Methods

Patients were randomly assigned to receive either UFT and PSK or surgery alone in a 1:1 ratio with a minimization method to balance the treatment allocation. The primary end point of this study was the disease-free survival (DFS). The secondary end point was the overall survival (OS).

Results

From October 2011 to February 2013, 111 patients were registered from 62 institutions. The study was prematurely closed due to poor accrual after reaching 20% of its goal. The patients’ characteristics were similar between the UFT and PSK group and the surgery-alone group. The DFS rate was 76.0% at 3 years and 65.1% at 5 years in the UFT and PSK arm and 84.0% at 3 years and 77.2% at 5 years in the surgery-alone arm. The DFS was slightly worse in the UFT + PSK arm than in the surgery-alone arm, but the difference did not reach statistical significance (log rank p = 0.102). The OS rate was 100% at 3 years and 97.9% at 5 years in the UFT + PSK arm, while that was 100% at 3 years and 93.4% at 5 years in the surgery-alone arm. The OS was similar in the UFT + PSK arm and surgery-alone arm (p = 0.533).

Conclusion

The present study suggests that UFT and PSK are not attractive candidates to advance to the next phase III study because the DFS was slightly worse in the UFT and PSK arm than in the surgery-alone arm.

Feasibility and safety of single-incision laparoscopic cholecystectomy in elderly patients: A single institution, retrospective case series

INTRODUCTION

To evaluate the feasibility and safety of single-incision laparoscopic cholecystectomy (SILC) for uncomplicated gallbladder in elderly patients.

MATERIALS AND METHODS

A retrospective analysis of 810 patients undergoing SILC from May 2009 to October 2016 at Osaka Police Hospital was performed, and the outcomes of the patients aged < 80 years and the patients ≥ 80 years were compared.

RESULTS

The median operative times of patients <80 years and patients ≥80 years were 100 min and 110 min, respectively (p = 0.4). The conversion rates to a different operative procedure (multi-port laparoscopic cholecystectomy or open cholecystectomy) were 3% (22/763) of patients < 80 years and 0% of patients ≥ 80 years (p = 0.6). Perioperative complications were seen in 6% (46/763) of patients < 80 years and 17% (8/47) of patients ≥ 80 years (p < 0.05). Pneumonia was seen in 0% (0/763) of patients < 80 years and 4% (3/47) of patients ≥ 80 years (p < 0.05). There was no mortality in either group. The median postoperative hospital stay was 4 days for patients <80 years and 5 days for patients ≥80 years (p < 0.05).

CONCLUSION

SILC for uncomplicated gallbladder could be performed for patients ≥ 80 years with acceptable morbidity and mortality as compared with the previous reports, though the complication rate of patients ≥ 80 years was higher than that of patients < 80 years.

Single-incision totally extraperitoneal inguinal hernia repair is feasible and safe in patients on antithrombotic therapy: A single-center experience of 92 procedures

INTRODUCTION

The aim of this study was to evaluate the feasibility and safety of SILS for totally extraperitoneal inguinal hernia repair for patients on antithrombotic therapy.

METHODS

A total of 365 patients who underwent SILS for totally extraperitoneal inguinal hernia repair between January 2011 and November 2015 were analyzed retrospectively. Antithrombotic drugs were stopped preoperatively, and bridging intravenous heparin therapy was given according to the operative risk of each patient. Data on the patients' characteristics and perioperative outcomes were collected from their medical records.

RESULTS

Ninety-two patients (25%, 92/365) were treated with antithrombotic drugs preoperatively. The mean operative times for unilateral and bilateral hernia repairs were 96 min and 94 min (P = 0.5), respectively, in the antithrombotic therapy group and 140 min and 130 min (P = 0.2), respectively, in the control group. Bleeding volume was minimal in all patients. There was no significant difference in the conversion rate. The mean postoperative hospital stay was 2.5 days in the antithrombotic therapy group and 2.1 days in the control group (P = 0.1). Postoperative complications were seen in 16% (15/92) of patients in the antithrombotic therapy group and in 11% (29/273) of patients in the control group (P = 0.2). Pulmonary embolism was seen in one patient (0.4%, 1/273) in the control group.

CONCLUSIONS

SILS for totally extraperitoneal inguinal hernia repair with bridging heparin therapy can be performed safely for patients on antithrombotic therapy.

Abstract 724: Clinical impact of modified telomerase-specific adenovirus-based identification of viable-peritoneal tumor cells in peritoneal lavage fluid in patients with potentially resectable pancreatic cancer

Pancreatic cancer (PC) is a highly aggressive disease with dismal prognosis. Although only a surgical resection can offer the chance of a cure, the 5-year survival rate after a potentially curative resection have been reported to be a low as 10-30 %. In PC, the presence of peritoneal carcinomatosis preclude the possibility of surgical cure, irrespective of the resectability of the primary tumor. Peritoneal lavage cytology (CY) is used widely in the diagnosis and staging of gastric and pancreatic cancer. Positive CY findings (CY+) in PC is defined as stage IV disease, however, the true value of CY+ for the patient’s prognosis remains controversial. We rise the question of whether CY+ status has predictive value for survival and early intraperitoneal recurrence. The aim of this study was to evaluate use of a new genetically modified telomerase-specific replication-selective adenovirus, expressing GFP (TelomeScan F35) in rapid detection of viable peritoneal tumor cell (v-PTC) dissemination of PC. This human clinical trial sought to determine if the presence of virally-detected, rare v-PTC predict peritoneal recurrence and patient outcome. This study was approved by the Osaka Police Hospital IRB. Patients with resectable cytologically or histologically proven ductal adenocarcinoma of the pancreas were enrolled. Peritoneal lavage fluid was harvested just after a laparotomy in 27 patients with PC. Half of the fluid was examined by cytology with papanicolau staining and MOC-31 immunostaining and the remaining half was used to detect v-PTC with TelomeScan F35. To distinguish between leucocyte and cells with epithelial origin, cells were stained with anti-CD45 Ab. To further distinguish cells with primary tumor origin, cells were labeled with anti-CEA and anti-CA19-9 Abs. GFP-positive and CD45-negative, and either CEA- or CA19-9-positive cells were counted as v-PTC. Patients were followed after surgery to evaluate its clinical significance. Among 27 patients aged 57-91 years (16 males and 11 females), 3 were cytologically positive (CY+), other 3 were virally positive by TelomeScan F35 (v-PTC+). All 27 patients underwent a surgical resection (PD/DP/TP/H-PD=13/7/6/1). One patient was double positive (CY+/v-PTC+), and postoperative peritoneal recurrence early occurred at 5 month after resection despite adjvant chemotherapy. 2 were CY+, but v-PTC-, and no recurrence in the abdominal cavity were observed (0%). On the other hand, other 2 were CY-, but v-PTC+, and one of these 2 patients occurred local recurrence in the abdominal cavity (50%). Remaining 22 patients (CY-/v-PTC-) were observed with neither local recurrence nor distant metastasis. In conclusion, the TelomeScan F35-based v-PTC detection may be an independent prognostic factor in patients with resectable PC and had close association with local or peritoneal recurrence.

Citation Format: Masahiro Tanemura, Kenta Furukawa, Soichiro Mori, Masahisa Otsuka, Youzo Suzuki, Mitsuyoshi Tei, Toru Masuzawa, Kentaro Kishi, Yasuo Urata, Hiroki Akamatsu. Clinical impact of modified telomerase-specific adenovirus-based identification of viable-peritoneal tumor cells in peritoneal lavage fluid in patients with potentially resectable pancreatic cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 724. doi:10.1158/1538-7445.AM2017-724