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Why is endosonography insufficient for residual diagnosis after neoadjuvant therapy for esophageal cancer?Solutions using muscle layer evaluation

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World Journal of Gastrointestinal Endoscopy 2022年第5期14卷 320-334页

作者： Shohei Yonemoto Masaya Uesato Akira Nakano Kentaro Murakami Takeshi Toyozumi tetsuro maruyama Hiroshi Suito Tomohide Tamachi Manami Kato Shunsuke Kainuma Keisuke Matsusaka Hisahiro Matsubara Frontier Surgery Graduate School of MedicineChiba UniversityChiba 260-8670Japan

BACKGROUND The diagnosis of residual tumors using endoscopic ultrasound(EUS)after neoadjuvant therapy for esophageal cancer is considered ***,the reasons for this difficulty are not well *** To investigate the ultrasound imaging features of residual tumors and identify the limitations and potential of *** This exploratory prospective observational study enrolled 23 esophageal squamous cell carcinoma patients receiving esophagectomy after neoadjuvant therapy[15 patients after neoadjuvant chemotherapy(NAC)and 8 patients after chemoradiotherapy(CRT)]at the Department of Surgery,Chiba University Hospital,between May 2020 and October *** diagnosed the T stage for specimens using ultrasound just after surgery and compared ultrasound images with the cut surface of the fixed specimens of the same level of residual *** ratio of esophageal muscle layer defect measured by ultrasound was compared with clinicopathological ***,the rate of reduction for the muscle layer defect was evaluated using EUS images obtained before and after neoadjuvant *** The accuracy of T stage rate was 61%(n=14/23),which worsened after CRT(38%,n=3/8)than after NAC(73%,n=11/15)because of ***,pT0 could not be diagnosed in all *** detection rate of residual tumor for specimens using ultrasound retrospectively was 75%(n=15/20).There was no correlation between after-NAC(79%,n=11/14)and after-CRT(67%,n=4/6)detection *** detection of superficial and submucosal types was *** pathologic tumor size and pathological response were *** borders were irregular and echogenicity was mixed type after *** was a correlation between the pT stage(pT0/1 vs pT2/3)and the length of muscle layer circumference(P=0.025),the length of muscle layer defect(P<0.001),and the ratio of muscle layer defect(P<0.001).There was also a correlation between the pT stage and the rate of muscle layer defect reduction measu

关键词： Esophageal cancer Esophageal squamous cell carcinoma Neoadjuvant therapy Endoscopic ultrasound Residual tumor Endosonography

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Successful resection of metachronous para-aortic, Virchow lymph node and liver metastatic recurrence of rectal cancer

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World Journal of Gastroenterology 2015年第44期21卷 12722-12728页

作者： Nobuyoshi Takeshita Toru Fukunaga Masayuki Kimura Yuji Sugamoto Kentaro Tasaki Isamu Hoshino Takumi Ota tetsuro maruyama Tomohide Tamachi Takashi Hosokawa Yo Asai Hisahiro Matsubara Department of Surgery Numazu City Hospital Department of Frontier Surgery Chiba University Graduate School of Medicine

A 66-year-old female presented with the main complaint of defecation trouble and abdominal distention. With diagnosis of rectal cancer, c SS, c N0, c H0, c P0, c M0 c Stage Ⅱ, Hartmann's operation with D3 lymph node dissection was performed and a para-aortic lymph node and a disseminated node near the primary tumor were resected. Histological examination showed moderately differentiated adenocarcinoma, p SS, p N3, p H0, p P1, p M1(para-aortic lymph node, dissemination) f Stage Ⅳ. After the operation, the patient received chemotherapy with FOLFIRI regimen. After 12 cycles of FOLFIRI regimen, computed tomography(CT) detected an 11 mm of liver metastasis in the posteroinferior segment of right hepatic lobe. With diagnosis of liver metastatic recurrence, we performed partial hepatectomy. Histological examination revealed moderately differentiated adenocarcinoma as a metastatic rectal cancer with cut end microscopically positive. After the second operation, the patient received chemotherapy with TS1 alone for 2 years. Ten months after the break, CT detected a 20 mm of paraaortic lymph node metastasis and a 10 mm of lymph node metastasis at the hepato-duodenal ligament. With diagnosis of lymph node metastatic recurrences, we performed lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma as metastatic rectal cancer in paraaortic and hepato-duodenal ligament areas. After the third operation, we started chemotherapy with modified FOLFOX6 regimen. After 2 cycles of modified FOLFOX6 regimen, due to the onset of neutropenia and liver dysfunction, we switched to capecitabine aloneand continued it for 6 mo and then stopped. Eleven months after the break, CT detected two swelling 12 mm of lymph nodes at the left supraclavicular region. With diagnosis of Virchow lymph node metastatic recurrence, we started chemotherapy with capecitabine plus bevacizumab regimen. Due to the onset of neutropenia and hand foot syndrome(Grade 3), we managed

关键词： Rectal cancer Surgical resection Virchow lymph nod

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Esophageal intramural pseudodiverticulosis of the residual esophagus after esophagectomy for esophageal cancer

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World Journal of Gastroenterology 2015年第30期21卷 9223-9227页

作者： Nobuyoshi Takeshita Naoki Kanda Toru Fukunaga Masayuki Kimura Yuji Sugamoto Kentaro Tasaki Masaya Uesato Tetsutaro Sazuka tetsuro maruyama Naohiro Aida Tomohide Tamachi Takashi Hosokawa Yo Asai Hisahiro Matsubara Department of Surgery Numazu City Hospital Department of Frontier Surgery Chiba University Graduate School of Medicine

A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer(T3N2M0 Stage Ⅲ) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation,including redness,erosion,edema,bleeding,friability,and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine,gastrografinfilled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly,endoscopic balloon dilatation was performed and antifungal therapy was started in the hospital. Seven weeks later,endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently,the patient was discharged. At the latest follow-up,the patient was symptomfree and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.

关键词： Esophageal intramural pseudodiverticulosis Esophageal cancer Esophageal candidiasis Anastomoticstricture Esophagectomy Residual esophagus

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True left-sided gallbladder with variations of bile duct and cholecystic vein

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World Journal of Gastroenterology 2015年第21期21卷 6754-6758页

作者： Hiromichi Ishii Akinori Noguchi Mie Onishi Koji Takao Takahiro maruyama Hiroaki Taiyoh Yasunobu Araki Takeshi Shimizu Hiroyuki Izumi Naoki Tani Masahide Yamaguchi tetsuro Yamane Department of Surgery Matsushita Memorial Hospital

A left-sided gallbladder without a right-sided round ligament,which is called a true left-sided gallbladder,is extremely rare.A 71-year-old woman was referred to our hospital due to a gallbladder *** tomography(CT) revealed not only a gallbladder polyp but also the gallbladder located to the left of the round ligament connected to the left umbilical *** portography revealed that the main portal vein diverged into the right posterior portal vein and the common trunk of the left portal vein and right anterior portal *** cholangiography revealed that the infraportal bile duct of segment 2 joined the common bile *** cholecystectomy was performed for a gallbladder polyp,and the intraoperative finding showed that the cholecystic veins joined the round ligament.A true left-sided gallbladder is closely associated with several anomalies; therefore,surgeons encountering a true left-sided gallbladder should be aware of the potential for these anomalies.

关键词： True left-sided gallbladder Infraportal bileduct of segment 2 Anomaly of the cholecystic vein Anomaly of the portal vein Laparoscopic cholecystectomy

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