Objective: Osteopontin (OPN) is a secreted integrin-binding glycophosphoprotein that may have a role in head and neck squamous cell carcinoma (SCC). To evaluate the clinical significance of OPN in esophageal squamous cell carcinoma (ESCC), we compared plasma OPN levels with those of common tumor markers. Methods: Preoperative plasma OPN levels were measured by enzyme immunoassay in 103 ESCC patients. Serum SCC antigen, Cyfra 21-1, and carcinoembryonic antigen (CEA) levels were also measured routinely at admission by radioimmunoassay. Results: Plasma OPN levels ranged from 82.8 to 1,980 ng/ml. High OPN level was associated with lymph node metastasis (p = 0.05), but not with tumor histology or depth of invasion. The overall survival of the patients with high OPN levels was worse than that of those with low OPN levels (p = 0.02). SCC antigen and Cyfra 21-1 levels were associated with the depth of tumor invasion, the tumor diameter, lymph node metastasis, and the overall survival, but CEA was not associated with these clinicopathological factors. Combined evaluation of OPN plus Cyfra 21-1 or OPN plus SCC antigen was useful as an independent prognostic indicator. Conclusion: Measurement of the plasma OPN level, as well as serum SCC antigen and Cyfra 21-1, may help to predict the progression of ESCC.

has not become as popular as LDG. The more diffi cult surgical technique of reconstruction after LTG compared with LDG, especially for esophagojejunostomy, appears to prevent the widespread acceptance of LTG. This article describes our procedure of extracorporeal Roux-en-Y reconstruction after LTG, which can be completed securely through a 5-cm minilaparotomy. In this procedure, by modifying a functional end-to-end anastomosis technique, esophagojejunal anastomosis is successfully created without hand sewing. Patients and methods PatientsBetween November 2005 and August 2006, seven patients (two male and fi ve female) with gastric cancer underwent LTG at our institution. These patients had a median age of 62 years (range, 32 to 82 years) and a body mass index of 20.3 (range, 17.0 to 24.0). All patients were diagnosed with gastric cancer, which was located in the upper third of the stomach and the depth of tumor invasion was limited to the proper muscular layer without lymph node involvement or invasion to the esophagus. These diagnoses were based on preoperative examinations, including gastrointestinal endoscopy, upper gastrointestinal series, and abdominal computed tomography (CT) scan. Surgical techniqueThe patient was placed in a modifi ed lithotomy position. The surgeon stood on the right side of the patient, with the fi rst assistant on the left, and the endoscopist standing between the patient's legs. After pneumoperitoneum was established using the open technique through the umbilicus, four operating ports (Fig. 1B, C, D, and E) were placed in the upper abdomen. The left lobe of Abstract Although laparoscopic distal gastrectomy (LDG) has been accepted as a surgical option for the treatment of early gastric cancer, laparoscopic total gastrectomy (LTG) has been adopted less often, because a more diffi cult surgical technique is required for reconstruction. To reduce the technical diffi culties, we made some modifi cations to the functional end-to-end anastomosis technique and performed esophagojejunal anastomosis through a minilaparotomy. First, for easier handling of the esophagus, the fi rst application of the linear stapler to create the esophagojejunal anastomosis was performed before transection of the esophagus. Second, the jejunal limb was anastomosed to the left side of the esophagus, which, compared with the right side, made available more free space, suffi cient to operate the stapling device. Third, to close the entry hole and complete the gastrectomy concurrently, a linear stapler was applied through the left lower trocar. With this technique, the closure of the access opening was performed easily and was monitored directly through the minilaparotomy. We successfully performed LTG with Roux-en-Y reconstruction using our modifi ed procedure in seven patients without any anastomotic complications. We believe our procedure is a secure and reliable method for reconstruction after LTG and will facilitate adoption of LTG as a surgical option for patients with early upper gastric cancers.

The combination of IONM and the concept of the mesoesophagus have substantial advantages in allowing accurate and safe mediastinal lymphadenectomy during prone esophagectomy.

BackgroundIncisional surgical site infection (SSI) is one of the most frequent complications that occur after colorectal surgery. Surgery for colorectal perforation carries an especially high risk of incisional SSI because fecal ascites contaminates the incision intraoperatively, and in patients who underwent stoma creation, the incision is located near the infective origin and is subject to infection postoperatively. Although effectiveness of the preventive SSI bundle of elective colorectal surgery has been reported, no study has focused exclusively on emergency surgery for colorectal perforation.MethodsPatients with colorectal perforation who underwent emergency surgery and stoma creation from 2010 to 2015 at our center were consecutively enrolled in the study. In March 2013, we developed the preventive incisional SSI bundle for patients with colorectal perforation undergoing stoma creation. The effectiveness of the bundle in these patients was determined and the rates of incisional SSI between before and after March 2013 were compared.ResultsWe enrolled 108 patients with colorectal perforation who underwent emergency operation during the study period. Thirteen patients were excluded because they died within 30 days after surgery, and 23 patients without stoma were excluded; thus, 72 patients were analyzed. There were 47 patients in the pre-implementation group and 25 patients in the post-implementation group. The rate of incisional SSI was significantly lower after implementation of preventive incisional SSI bundle (43 % vs. 20 %, p = 0.049). Postoperative hospital stay was significantly shorter after implementation of the bundle (27 vs. 18 days respectively; p = 0.008).ConclusionsThe preventive incisional SSI bundle was effective in preventing incisional SSI in patients with colorectal perforation undergoing emergency surgery with stoma creation.

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