No abstract

A 72-year-old woman visited our hospital for a routine health examination and underwent abdominal ultrasonography, which revealed an intra-abdominal tumor. Abdominal computed tomography and magnetic resonance imaging showed a well-defined solid mass of ~3 cm in diameter lying adjacent to the stomach. The mass was preoperatively diagnosed as gastrointestinal stromal tumor of the stomach. At laparotomy, a well-encapsulated tumor was found in the lesser omentum. It was slightly adherent to the stomach wall but was removed without difficulty. Therefore, only enucleation of the tumor was performed. The excised tumor, which was 35 × 30 × 25 mm3 in size, had a white cut surface without necrosis or hemorrhage. According to the pathological findings, the tumor was classified as a very low-risk gastrointestinal stromal tumor originating in the lesser omentum. Gastrointestinal stromal tumor of the lesser omentum is very rare, and surgical resection is the only effective treatment modality.

The submucosal tunnel technique appears to be useful and safe for transrectal peritoneal access because healing at the seromuscular incision site proceeded rapidly.

Abstract. pre-operative chemoradiotherapy (crt) is an important neoadjuvant therapy for locally advanced rectal cancer. in the present study, we investigated the factors that influence the efficacy of pre-operative CRT in locally advanced rectal cancer. We divided 50 patients with locally advanced rectal carcinoma treated with pre-operative crt into two groups according to the grade of tumor response to pre-operative crt: low-sensitivity group and high-sensitivity group. as candidates for the prediction of sensitivity to preoperative crt, clinicopathological factors and 12 biomarkers, including factors related to tumor growth, cell cycle, apoptosis, tumor stroma and cancer stem cells, were examined immunohistochemically in 48 resected specimens. thirty-one tumors showed high sensitivity and 19 showed low sensitivity to pre-operative crt. the status of stem cell-related factors, CD133 and CD24, was significantly associated respectively with sensitivity to pre-operative crt (p=0.003, p=0.029). in 10 tumors positive for both cd133 and cd24, low sensitivity to crt was found in 9 (90%), whereas in 16 tumors negative for both cd133 and cd24, low sensitivity was found in 3 (19%). Other pathological parameters were not associated with tumor response to pre-operative crt. in conclusion, overexpression of cancer stem cell-related factors, cd133 and cd24, is associated with the sensitivity of locally advanced rectal cancer to pre-operative crt.Introduction colorectal cancer is a leading cause of morbidity and mortality in developed countries (1). in Japan, an increasingly Westernized diet has led to a high incidence of colorectal cancer. patients with rectal cancers are known to have an increased rate of local recurrence and decreased survival time compared to patients with tumors of the colon, a result due primarily to the surgical constraints imposed by the location of the rectum within the pelvis (2).pre-operative chemoradiotherapy (crt) is a neoadjuvant therapy for locally advanced rectal cancer that reduces the incidence of local recurrence and improves survival (3). therefore, crt is widely used in many countries of the world. however, several tumors show a marked response to crt, whereas others do not. Furthermore, several adverse events related to crt, such as enteritis, anorexia, cardiac/ thromboembolic events, radiation dermatitis and hematologic toxicity, were reported to occur at frequencies of 6-43% (4). thus, pre-operative indicators of chemoradiosensitivity are required to avoid unnecessary application of pre-operative crt, yet little is known about potential biological markers that may be associated with response to pre-operative crt.recently, the discovery of rare subpopulations of cancer stem cells has created a new focus in cancer research. the heterogeneity of tumors can be explained by the concept of cancer stem cells supported by anti-apoptotic signaling. there are a few reports on cancer stem cells related to chemoradiation resistance (5,6). therefore, in this study we investigated the factors, inclu...

720 Background: Fluorouracil-based chemoradiotherapy (CRT) is regarded as a standard perioperative treatment in locally advanced rectal cancer. We investigated the efficacy and safety of substituting fluorouracil with the oral prodrug S-1. Methods: A multi-institutional (17 specialized centers), interventional phase II trial, was conducted from April 2009 to August 2011. For inclusion, patients must fulfill the following requirements before neoadjuvant CRT: (i) histologically proven rectal carcinoma; (ii) tumor located in the rectum (upper, lower); (iii) cancer classified as T3-4, N0–3 and M0; Two cycles of neoadjuvant CRT with S-1 (100 mg/m2 on days 1-5, 8-12, 22-26, and 29-33) was administered, and irradiation (total 45Gy/25fr, 1.8Gy/day, on days 1-5, 8-12, 15-19, 22-26, and 29-33) was performed. Total mesorectal excision was performed during the 4th and 8th week after the end of the neoadjuvant CRT. The primary endpoint is rate of complete treatment of neoadjuvant CRT. Secondary endpoints are response rate of neoadjuvant CRT, short-term clinical outcomes, rate of curative resection, and pathological response (grade2/3). Results: This trial included 37 patients (clinical StageIIA: 8, IIIB: 19, IIIC: 10; tumor located in the upper rectum; 4, the lower rectum; 33). A complete treatment of neoadjuvant CRT was found in 86.5% of patients (95%CI;75.5-97.5%), and an adverse event (grade 3/4) occurred in 4 patients(11.1%). Response rate (PR/CR;RECIST 1.0) was 56.8% (95%CI; 40.8-72.7%), and pathologic response rate (grade2/3) was 48.6% (95%CI; 32.5-64.8%). The median operating time was 448.5 min (IQR 340.5-505.5), and median blood loss was 422.5 mL (IQR 182.5-1125). Grade 3-4 postoperative complications occurred in 6 (16.7%) patients. The most common grade 3 or 4 postoperative complication was anastomotic leakage (2 [5.6%]). The 3-year overall survival rate was 88.5%. The 3-year disease free survival rate was 70.9%. Median length of follow-up was 42 months. Conclusions: A neoadjuvant-synchronus S-1+Radiotherapy for locally advanced rectal cancer is feasible in terms of pathological response, adverse events, accompany with favorable long-term outcome. Clinical trial information: 03396.