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Recurrent colorectal cancer after endoscopic resectionwhen additional surgery was recommended

World Journal of Gastroenterology 2016年第7期22卷 2336-2341页

作者： Yukiko Takatsu Yosuke Fukunaga Shunsuke Hamasaki Atsushi Ogura Jun Nagata Toshiya Nagasaki,Takashi Akiyoshi Tsuyoshi Konishi Yoshiya Fujimoto satoshi nagayama Masashi Ueno Department of Gastroenterological Surgery Cancer Institute HospitalJapanese Foundation for Cancer ResearchTokyo 135-8550Japan

AIM: To evaluate the type of recurrence after endoscopic resection in colorectal cancer patients and whether rescue was possible by salvage operation.METHODS: Among 4972 patients who underwent surgical resection at our institution for primary or recurrent colorectal cancers from January 2005 to February 2015, we experienced eight recurrent colorectal cancers after endoscopic resection when additional surgical resection was recommended.RESULTS: The recurrence patterns were: intramural local recurrence(five cases), regional lymph node recurrence(three cases), and associated with simultaneous distant metastasis(three cases). Among five cases with lymphatic invasion observed histologically in endoscopic resected specimens, four cases recurred with lymph node metastasis or distant metastasis. All cases were treated laparoscopically and curative surgery was achieved in six cases. Among four cases located in the rectum, three cases achieved preservation of the anus. Postoperative complications occurred in two cases(enteritis).CONCLUSION: For high-risk submucosal invasive colorectal cancers after endoscopic resection, additional surgical resection with lymphadenectomy is recommended, particularly in cases with lymphovascular invasion.

关键词： Colorectal neoplasms Colorectal surgery Laparoscopy Endoscopy Recurrence

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Rational arrangement of measuring shear wave speed in the liver

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World Journal of Gastroenterology 2019年第20期25卷 2503-2513页

作者： Takeshi Yokoo Tsutomu Kanefuji Takeshi Suda Itsuo nagayama Takahiro Hoshi satoshi Abe Shinichi Morita Hiroteru Kamimura Kenya Kamimura Atsunori Tsuchiya Masaaki Takamura Kazuyoshi Yagi Shuji Terai Department of Preemptive Medicine for Digestive Diseases and Healthy Active Life Niigata University School of MedicineNiigataNiigata 951-8122Japan Division of Gastroenterology and Hepatology Niigata Tokamachi HospitalTokamachiNiigata 948-0065Japan Department of Gastroenterology and Hepatology Uonuma Institute of Community MedicineNiigata University Medical and Dental HospitalMinami UonumaNiigata 949-7302Japan Division of Gastroenterology and Hepatology Graduate School of Medical and Dental SciencesNiigata UniversityNiigata 951-8122Japan

BACKGROUND Shear wave speed has been widely applied to quantify a degree of liver fibrosis. However, there is no standardized procedure, which makes it difficult to utilize the speed universally. AIM To provide procedural standardization of shear wave speed measurement. METHODS Point shear wave elastography (pSWE) was measured in 781 patients, and twodimensional shear wave elastography (2dSWE) was measured on the same day in 18 cases. Regions-of-interest were placed at 12 sites, and the median and robust coefficient-of-variation (CVR) were calculated. A residual sum-of-square (Σdi2) was computed for bootstrap values of 1000 iterations in 18 cases with each assumption of 1 to 12 measurements. The proportion of the Σdi2 (%Σdi2) was calculated as the ratio of Σdi2 to pSWE after converting it based on the correlation between pSWE and 2dSWE. RESULTS The CVR showed a significantly broader distribution in the left lobe (P < 0.0001),and the smallest CVR in the right anterior segment that covered 95% cases was 40.4%. pSWE was significantly higher in the left lobe than in the right lobe (1.63 ± 0.78 m/s vs 1.61 ± 0.78 m/s, P = 0.0004), and the difference between the lobes became further discrete when the subjects were limited to the cases with a CVR less than 40.4% in any segment (1.76 ± 0.80 m/s vs 1.70 ± 0.82 m/s, P < 0.0001). The highest values of the CVR in every 0.1 m/s interval were plotted in convex upward along pSWE and peaked at 1.93 m/s. pSWE and 2dSWE were significantly correlated (P < 0.0001, r = 0.95). In 216000 resamples from 18 cases, the %Σdi2 of 12 sites was 8.0% and gradually increased as the acquisition sites decreased to reach a significant difference with a %Σdi2 of 7 sites (P = 0.027). CONCLUSION These data suggest that shear wave speed should be measured at 8 or more sites of spreading in both lobes.

关键词： Liver stiffness Ultrasound Shear wave elastography Acoustic radiation force impulse Heterogeneity

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