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1.  T4 stage and preoperative anemia as prognostic factors for the patients with colon cancer treated with adjuvant FOLFOX chemotherapy 
Background
FOLFOX-based adjuvant chemotherapy is a benefit for high-risk stage II and stage III colon cancer after curative resection. But, the prognostic factor or predictive marker for the efficacy of FOLFOX remains unclear. This study was aimed to identify the prognostic value and cumulative impact of adjuvant FOLFOX on the stage II and III colon cancer patients.
Methods
A total of 196 stage II and III colon cancer patients were retrospectively enrolled in prospectively collected data. They underwent curative resection followed by FOLFOX4 adjuvant chemotherapy. The oncological outcomes included the 5-year disease-free survival (DFS) rate and 5-year overall survival (OS) rate. Cox-regression analysis was performed to identify the prognostic value, and its cumulative impact was analyzed.
Results
The 5-year DFS rate of the patients was 71.94% and the 5-year OS rate was 81.5%. The prognostic values for the 5-year DFS rate and 5-year OS rate were T4 stage and preoperative anemia in a multivariate analysis. Each patient group who had no prognostic value, single, or both factors revealed 95.35%, 69.06%, and 28.57% in the 5-year DFS rate, respectively (p < 0.0001). The 5-year OS rate also showed the significant differences in each group who had no prognostic value, single, or both factors revealed 100%, 79.3%, and 45.92%, respectively (p < 0.0001).
Conclusion
Our results showed similar efficacy to MOSAIC study in stage II and stage III colon cancer patients treated with adjuvant FOLFOX chemotherapy after curative resection. Patients who had T4 stage and/or preoperative anemia showed worse prognosis than patients without any prognostic value. These findings suggest that FOLFOX could not be effective in the patients with T4 stage colon cancer accompanied by preoperative anemia.
doi:10.1186/s12957-015-0488-7
PMCID: PMC4336700
Colon cancer; FOLFOX; T4 stage; Anemia
2.  The measurement of amylase in drain fluid for the detection of pancreatic fistula after gastric cancer surgery: an interim analysis 
Background
Pancreatic fistula is still one of the most serious and potential complications after D2-D3 distal and total gastrectomy (4% to 6%). Despite their importance, pancreatic fistulas still have not been uniformly defined. Amylase concentration of the drainage fluid after surgery for gastric cancer can be considered as a predictive factor of the presence of pancreatic fistula.
Methods
From January 2009 to April 2013, 53 patients underwent surgery for gastric cancer. Amylase concentration in the drainage fluid was measured on the first postoperative day and if it was ≥1,000 UI, it was measured again on the third postoperative day. Pancreatic fistula occurred in four cases (7.5%). Pancreatic fistulas were classified using the International Study Group on Pancreatic Fistula (ISGPF) criteria into different grades of severity. Two fistulas were Grade A, one was Grade B, and one was Grade C.
Results
Management of drainage tubes is still crucial after gastrectomy, not only for the likelihood of anastomotic leaks but also the eventual diagnosis and management of pancreatic fistula. High amylase drainage content and then the presence of the pancreatic fistula may be due to several causes: the operation itself when it includes splenectomy or pancreatic tail-splenectomy, the extended lymphadenectomy but even the ‘gently and softly’ pancreatic manipulation, according literature, may be a risk factor.
Conclusions
The authors assessed amylase concentration in the drainage fluid collected from the left subphrenic cavity on POD1 and POD3 in 53 patients who had undergone curative gastrectomy for cancer and concluded that amylase drainage content >3 times the serum amylase was a useful predictive risk factor for pancreatic fistula. Our work is an interim analysis and the aim of this study is to increase the accrual of the number of patients to have a significant number. For this reason, a protocol for a multicenter trial will be designed to verify whether the systematic measurement of amylase in drain fluid is better than abdominal ultrasound for the detection of pancreatic fistula after gastric cancer surgery.
doi:10.1186/s12957-014-0428-y
PMCID: PMC4336756
Pancreatic fistula; Gastrectomy; Risk factor; Amylase drainage concentration
3.  Usefulness of immunohistochemical studies in diagnosing metachronous gallbladder and small intestinal metastases from lung cancer with gastrointestinal hemorrhage: a case report 
Isolated metachronous gastrointestinal metastases from advanced-stage lung cancer are rarely diagnosed on the basis of symptoms and resected. In this report, we present a case of resectable metachronous gallbladder and small intestinal metastases of lung cancer. An 86-year-old woman was treated for lung cancer with resection of the right inferior lobe. Five months after the surgery, she was re-admitted because of melena and anemia. Ultrasonography showed a gallbladder tumor with gastrointestinal hemorrhage, and laparoscopic-assisted cholecystectomy was subsequently performed. However, 2 months after this event, the patient presented again with melena and anemia and was diagnosed with a small intestinal tumor. Therefore, laparoscopic-assisted partial resection of the small intestine was performed. Immunohistochemical staining for thyroid transcription factor-1 and cytokeratin 7 confirmed that the two resected tumors were metachronous metastases of the primary lung cancer. The patient died of liver metastases 5 months after the last surgery. Our experience with this case suggests that surgical resection might not be curative but palliative for patients with isolated gallbladder and small intestinal metastases diagnosed on the basis of melena that is resistant to conservative treatment.
doi:10.1186/s12957-015-0435-7
PMCID: PMC4336682
Metachronous gallbladder and small intestinal metastases; Primary lung cancer; Gastrointestinal hemorrhage; Immunohistochemical staining
4.  Primary apocrine sweat gland carcinomas of the axilla: a report of two cases and a review of the literature 
Primary apocrine sweat gland carcinoma (PASGC) is an extremely rare malignancy with a relatively favorable prognosis. PASGC is often suspected to be a benign disease during an initial clinical examination, which leads to inadequate initial treatment and extensive metastasis. Owing to the limited number of reports on PASGC, its diagnostic criteria and treatment guidelines have not yet been established. The only known curative therapy for localized PASGC is wide local excision. In the present report, we describe two cases of PASGC with locally aggressive disease that arose in the axilla and review the literature about its clinicopathological features, diagnosis, and treatment. Based on the findings of the current report, we suggest that a sentinel lymph node biopsy and adjuvant anti-estrogen therapy should be included in the management of PASGC.
doi:10.1186/s12957-015-0473-1
PMCID: PMC4336764
Primary apocrine sweat gland carcinoma; Clinicopathological features; Diagnosis; Treatment guidelines
5.  Bone marrow mesenchymal stem cells promote osteosarcoma cell proliferation and invasion 
Background
Bone marrow-derived stem cells (BMSCs) are locally adjacent to the tumor tissues and may interact with tumor cells directly. The purpose of this study was to explore the effects of BMSCs on the proliferation and invasion of osteosarcoma cells in vitro and the possible mechanism involved.
Methods
BMSCs were co-cultured with osteosarcoma cells, and CCK-8 assay was used to measure cell proliferation. The ELISA method was used to determine the concentration of stromal cell-derived factor-1 (SDF-1) in the supernatants. Reverse transcription polymerase chain reaction (RT-PCR) was performed to detect the expression of CXCR4 in osteosarcoma cells and BMSCs. Matrigel invasion assay was performed to measure tumor cell invasion.
Results
SDF-1 was detected in the supernatants of BMSCs, but not in osteosarcoma cells. Higher CXCR4 mRNA levels were detected in the osteosarcoma cell lines compared to BMSCs. In addition, conditioned medium from BMSCs can promote the proliferation and invasion of osteosarcoma cells, and AMD3100, an antagonist for CXCR4, can significantly downregulate these growth-promoting effects.
Conclusions
BMSCs can promote the proliferation and invasion of osteosarcoma cells, which may involve the SDF-1/CXCR4 axis.
doi:10.1186/s12957-015-0465-1
PMCID: PMC4334855
Bone marrow mesenchymal stem cells; Osteosarcoma
6.  Cystic lymphangioma of the adrenal gland: report of a case and review of the literature 
Background
Cystic lymphangioma is a rare tumor of the lymphatic vessels that occurs more frequently in women. Location of this pathology can be diverse but most commonly occurs in the neck or axilla. Cystic lymphangioma originating from the adrenal tissue represents a very rare entity.
Case presentation
We report here the case of a 38-year-old woman who was diagnosed with a cystic retroperitoneal mass. After further investigations, the patient was suspected to have a left adrenal cystic lymphangioma. She underwent successful open left adrenalectomy as curative treatment, and the diagnosis of cystic lymphangioma of the left adrenal gland was confirmed at histology. The postoperative course was uneventful.
Conclusion
This case report and review of the literature bring new insights into the diagnostic difficulty and management of cystic lymphangioma of the adrenal gland.
doi:10.1186/s12957-015-0490-0
PMCID: PMC4335415
Cystic lymphangioma; Retroperitoneal tumor; Adrenal tumor; Cystic lesion
7.  Prognostic factors of cervical node status in head and neck squamous cell carcinoma 
Background
Cervical nodal status is one of prognostic factors in head and neck squamous cell carcinoma (HNSCC). The objective of this study was to identify prognostic factors of cervical node status including site and size of primary tumors, presence of lymphovascular invasion, and size of cervical node for appropriate further treatment in HNSCC.
Methods
A 5-year retrospective review of patients with HNSCC in Phramongkutklao Hospital from 2009 to 2013 was conducted. Histopathologic data on primary tumors and cervical nodes were reviewed. Cervical nodes were divided into five groups: 1–3, 4–6, 7–9, 10–30, and >30 mm. Numbers of positive and negative nodes were compared in different sizes and sites and the presence of extracapsular extension.
Results
In all, 165 patients and 1,472 nodes were reviewed. The mean age was 52.6 years and 77.58% were male. The most frequent primary site was oral tongue (50.91%). In sum, 52.72% showed lymphovascular invasion. Thirty-five patients (81.40%) in therapeutic neck dissections and 18 patients (69.23%) in prophylactic neck dissections showed nodal metastasis. The mean size of metastatic nodes was 3.89 mm (range, 2–45 mm) and 3.53 mm (range, 2–23 mm), respectively. Significant associations were found between the size of cervical nodes and the site of primary tumor of the oral tongue, lip, base of the tongue, and floor of the mouth (p < 0.05). Metastatic lymph nodes showed extracapsular extension 69.55%. No significance was found between extracapsular extension and clinical staging, size of primary tumor, pathologic differentiation, and size of cervical nodes. Sizes of cervical lymph node of squamous cell carcinoma (SCC) of the oral tongue and lip were statistically significant with the size of tumor and tumor grading (p < 0.05).
Conclusions
A statistical significance was found between the size of cervical nodes and the site of primary tumor of the oral tongue and lip. Herein, we recommended performing neck dissection in all cases of SCC of the base of the tongue, floor of the mouth, buccal mucosa, and retromolar trigone.
doi:10.1186/s12957-015-0460-6
PMCID: PMC4336753
Head and neck squamous cell carcinoma; Cervical node metastasis; Prognostic factors
8.  Ambulatory sentinel lymph node biopsy preceding neoadjuvant therapy in patients with operable breast cancer: a preliminary study 
Background
Sentinel lymph node biopsy (SNB)-oriented stepwise treatment under local anesthesia has been performed in the outpatient-ambulatory setting in patients receiving neoadjuvant therapy (NAT). We retrospectively reviewed our preliminary experience of ambulatory SNB in breast cancer patients scheduled to undergo NAT to evaluate the usefulness and feasibility of this method as a minimally invasive, stepwise treatment protocol.
Methods
We retrospectively identified 56 patients with breast cancer without obvious nodal involvement who were scheduled to receive NAT before breast surgery. SNB was performed under local anesthesia in an ambulatory outpatient setting before the initiation of NAT.
Results
The average number of removed sentinel lymph nodes was 1.9. Identification of the sentinel node was possible in all cases, and macrometastasis was observed in six cases (10.7%). Micrometastasis was observed in five cases, while isolated tumor cells were noted in six cases. There were no delays in the initiation of NAT as a result of complications of SNB.
Conclusions
This pilot study demonstrated the safety and feasibility of ambulatory SNB prior to NAT. Further studies are warranted to assess the strict indications, patient satisfaction, and medical economics of this procedure.
doi:10.1186/s12957-015-0471-3
PMCID: PMC4336761
Breast cancer; Operation; Ambulatory surgical procedure; Sentinel lymph node biopsy; False negative
9.  Prediction of macrometastasis in axillary lymph nodes of patients with invasive breast cancer and the utility of the SUV lymph node/tumor ratio using FDG-PET/CT 
Background
Axillary lymph node dissection (ALND) is important for improving the prognosis of patients with node-positive breast cancer. However, ALND can be avoided in select micrometastatic cases, preventing complications such as lymphedema or paresthesia of the upper limb. To appropriately omit ALND from treatment, evaluation of the axillary tumor burden is critical. The present study evaluated a method for preoperative quantification of axillary lymph node metastasis using positron emission tomography/computed tomography (PET/CT).
Methods
The records of breast cancer patients who received radical surgery at the Gifu University Hospital (Gifu, Japan) between 2009 and 2014 were reviewed. The axillary lymph nodes were preoperatively evaluated by PET/CT. Lymph nodes were dissected by sentinel lymph node biopsy (SLNB) or ALND and were histologically diagnosed by experienced pathologists. The maximum standardized uptake value (SUVmax) was measured in both the axillary lymph node (SUV-LN) and primary tumor (SUV-T). The SUV-LN/T ratio (NT ratio) was calculated by dividing the SUV-LN by the SUV-T, and the efficacies of the NT ratio and SUV-LN were compared using receiver operating characteristic (ROC) curve analysis. The diagnostic performance was also compared between the techniques with the McNemar test.
Results
A total of 171 operable invasive breast cancer patients were enrolled, comprising 69 node-positive patients (macrometastasis (Mac): n = 55; micrometastasis (Mic): n = 14) and 102 node-negative patients (Neg). The NT ratio for node-positive patients was significantly higher than in node-negative patients (0.5 vs. 0.316, respectively, P = 0.041). The NT ratio for Mac patients (0.571) was significantly higher than in Mic (0.227) and Neg (0.316) patients (P <0.01 and P = 0.021, respectively). The areas under the curves (AUCs) by ROC analysis for the NT ratio and SUV-LN were 0.647 and 0.811, respectively (P <0.01). In patients with an SUV-T ≥2.5, the modified AUCs for the NT ratio and SUV-LV were 0.757 and 0.797 (not significant).
Conclusion
The NT ratio and SUV-LN are significantly higher in patients with axillary macrometastasis than in those with micrometastasis or no metastasis. The NT ratio and SUV-LN can help quantify axillary lymph node metastasis and may assist in macrometastasis identification, particularly in patients with an SUV-T ≥2.5.
Electronic supplementary material
The online version of this article (doi:10.1186/s12957-014-0424-2) contains supplementary material, which is available to authorized users.
doi:10.1186/s12957-014-0424-2
PMCID: PMC4336728
Axillary lymph node; Macrometastasis; Breast cancer; PET/CT; NT ratio
10.  mRNA expression of somatostatin receptor subtypes SSTR-2, SSTR-3, and SSTR-5 and its significance in pancreatic cancer 
Background
The aim of this study is to investigate the expressions of somatostatin receptor (SSTR), SSTR-2, SSTR-3, and SSTR-5, in pancreatic tissue and non-cancerous tissue and elucidate their clinical significance.
Methods
The expression of somatostatin receptor subtypes SSTR-2, SSTR-3, and SSTR-5 messenger RNA (mRNA) in 108 cases of cancer tissue and adjacent tissue in patients with pancreatic cancer was detected by reverse transcriptase polymerase chain reaction (RT-PCR). Expression of SSTR-2, SSTR-3, and SSTR-5 mRNA was evaluated after specimens were taken from selected patients who underwent surgical resection by Whipple’s operation. We speculated the clinical significance of the expression of somatostatin receptor (SSTR) subtype genes SSTR-2, SSTR-3, and SSTR-5 in pancreatic tissue and non-cancerous tissue and further elucidated their clinical significance.
Results
The expression rates of SSTR-2 mRNA in cancer and adjacent tissue of 108 patients with pancreatic cancer were 81.5% (88/108) and 97.2% (105/108), respectively; SSTR-3 mRNA expression rates were 69.4% (75/108) and 55.6% (60/108). SSTR-5 mRNA expression rates were 13.0% (14/108) and 18.5% (20/108).
Conclusion
We propose that SSTR-2 plays an important role in clinical implications for patients with pancreatic cancer undergoing somatostatin or its analog therapy.
Electronic supplementary material
The online version of this article (doi:10.1186/s12957-015-0467-z) contains supplementary material, which is available to authorized users.
doi:10.1186/s12957-015-0467-z
PMCID: PMC4328977
Pancreatic cancer; Somatostatin receptor; mRNA
11.  A systematic review and meta-analysis of the diagnostic accuracy of pyruvate kinase M2 isoenzymatic assay in diagnosing colorectal cancer 
Background
Screening programmes exist in many countries for colorectal cancer. In recent years, there has been a drive for a non-invasive screening marker of higher sensitivity and specificity. Stool-based pyruvate kinase isoenzyme M2 (M2-PK) is one such biomarker under investigation. The aim of this systematic review and meta-analysis is to determine the diagnostic accuracy, sensitivity and specificity of M2-PK as a screening tool in colorectal cancer.
Methods
A literature search of Ovid Medline, EMBASE and Google Scholar was carried out. The search strategy was restricted to human subjects and studies published in English. Data on sensitivity and specificity were extracted and pooled. Statistical analysis was conducted using summary receiver operating characteristic (SROC) curve methodology.
Results
A total of eight studies were suitable for data synthesis and analysis. Our analysis showed a pooled sensitivity and specificity for M2-PK to be 79% (CI 73%–83%) and 80% (CI 73%–86%), respectively. The accuracy of M2-PK was 0.85(0.82–0.88).
Conclusion
Faecal M2-PK assay has a relatively good sensitivity and specificity and high accuracy for screening colorectal cancer.
doi:10.1186/s12957-015-0446-4
PMCID: PMC4333243
Colorectal cancer; Faecal test; Pyruvate kinase isoenzymatic assay
12.  Correlation between mutational status and survival and second cancer risk assessment in patients with gastrointestinal stromal tumors: a population-based study 
Background
Gastrointestinal stromal tumors are sarcomas of the digestive tract characterized by mutations mainly located in the c-KIT or in the platelet-derived growth factor receptor (PDGFR)-alpha genes. Mutations in the BRAF gene have also been described. Our purpose is to define the distribution of c-KIT, PDGFR and BRAF mutations in a population-based cohort of gastrointestinal stromal tumors (GIST) patients and correlate them with anatomical site, risk classification and survival. In addition, as most of the GIST patients have a long survival, second cancers are frequently diagnosed in them. We performed a second primary cancer risk assessment.
Methods
Our analysis was based on data from Tarragona and Girona Cancer Registries. We identified all GIST diagnosed from 1996 to 2006 and performed a mutational analysis of those in which paraffin-embedded tissue was obtained. Observed (OS) and relative survival (RS) were calculated according to risk classifications and mutational status. Multivariate analysis of variables for observed survival and was also done.
Results
A total of 132 GIST cases were found and we analyzed mutations in 108 cases. We obtained 53.7% of mutations in exon 11 and 7.4% in exon 9 of c-KIT gene; 12% in exon 18 and 1.9% in exon 12 of PDGFR gene and 25% of cases were wild type GIST. Patients with mutations in exon 11 of the c-KIT gene had a 5-year OS and RS of 59.6% and 66.3%, respectively. Patients with mutations in exon 18 of the PDGFR gene had a 5-year OS and RS of 84.6% and 89.7%. In multivariate analysis, only age and risk group achieved statistical significance for observed survival. GIST patients had an increased risk of second cancer with a hazard ratio of 2.47.
Conclusions
This population-based study shows a spectrum of mutations in the c-KIT and PDGFR genes in GIST patients similar to that previously published. The OS and RS of GIST with the exon 18 PDGFR gene mutation could indicate that this subgroup of patients may be less aggressive and have a good prognosis, although less sensitive to treatment at recurrence. In our study, GIST patients have an increased risk of developing a second neoplasm.
doi:10.1186/s12957-015-0474-0
PMCID: PMC4336765
Gastrointestinal stromal tumors; Sarcoma; Survival; Epidemiology; Registries; C-KIT; BRAF; PDGFR; Second primary cancer
13.  An intraventricular meningioma and recurrent astrocytoma collision tumor: a case report and literature review 
Background
Intracranial meningioma and glioma collision tumors are relatively uncommon and are even more rarely located within the ventricles.
Case presentation
Here, we report a case of a patient with an intraventricular meningioma and astrocytoma collision tumor. A 39-year-old man previously underwent excision of an astrocytoma in the triangle area of the lateral ventricle and exhibited good post-surgery recovery. The astrocytoma recurred in situ six years after the surgery, and the case was complicated by a malignant meningioma. The patient recovered well after surgery to treat the recurrence and was administered radiotherapy after discharge. In addition to reporting on this case, we conducted a literature review of collision tumors; based on this review, we propose several hypotheses regarding the formation of collision tumors.
Conclusions
We conclude that a possible cause of the collision tumor formation between the intracranial meningioma and the astrocytoma was the recurrence of an astrocytoma-induced malignancy of the arachnoid cells in the choroid plexus.
doi:10.1186/s12957-015-0436-6
PMCID: PMC4329203
14.  Prone-position thoracoscopic resection of posterior mediastinal lymph node metastasis from rectal cancer 
Mediastinal lymph node metastasis from colorectal cancer is rare, and barely any reports have described resection of this pathology. We report herein a successful thoracoscopic resection of mediastinal lymph node metastasis in a prone position. A 65-year-old man presented with posterior mediastinal lymph node metastasis after resection of the primary rectal cancer and metachronous hepatic metastasis. Metastatic lymph nodes were resected completely using thoracoscopic surgery in the prone position, which provided advantages of minimal invasiveness, good surgical field, and reduced ergonomic burden on the surgeon. Thoracoscopic resection in the prone position was thought to have the potential to become the standard procedure of posterior mediastinal tumors.
doi:10.1186/s12957-015-0466-0
PMCID: PMC4330938
Thoracoscopic resection; Prone position; Mediastinal lymph node metastasis; Colorectal cancer
15.  Better operative outcomes achieved with the prone jackknife vs. lithotomy position during abdominoperineal resection in patients with low rectal cancer 
Background
Lithotomy (LT) and prone jackknife positions (PJ) are routinely used for abdominoperineal resection (APR). The present study compared the clinical, pathological, and oncological outcomes of PJ-APR vs. LT-APR in low rectal cancer patients in order to confirm which position will provide more benefits to patients undergoing APR.
Methods
This is a retrospective study of consecutive patients with low rectal cancer who underwent curative APR between January 2002 and December 2011. Patients were matched 1:2 (PJ-APR = 74 and LT-APR = 37 patients) based on gender and age. Perioperative data, postoperative outcomes, and survival were compared between the two approaches.
Results
Hospital stay was shorter with PJ-APR compared with LT-APR (P < 0.05). Compared with LT-APR, duration of anesthesia (234 ± 50.8 vs. 291 ± 69 min, P = 0.022) and surgery (183 ± 44.8 vs. 234 ± 60 min, P = 0.016) was shorter with PJ-APR, and estimated blood losses were smaller (549 ± 218 vs. 674 ± 350 mL, P < 0.001). Blood transfusions were required in 37.8% of LT-APR patients and in 8.1% of PJ-APR patients (P < 0.001). There was no difference in the distribution of N stages (P = 0.27). Median follow-up was 47.1 (13.6–129.7) months. Postoperative complications were reported by fewer patients after PJ-APR compared with LT-APR (14.9% vs. 32.4%, P = 0.030). There were no significant differences in overall survival, disease-free survival, local recurrence, and distant metastasis (P > 0.05).
Conclusions
The PJ position provided a better exposure for low rectal cancer and had a lower operative risk and complication rates than LT-APR. However, there was no difference in rectal cancer prognosis between the two approaches. PJ-APR might be a better choice for patients with low rectal cancer.
doi:10.1186/s12957-015-0453-5
PMCID: PMC4331390
Rectal cancer; Abdominoperineal resection; Lithotomy position; Prone jackknife position
16.  Minimally invasive hybrid surgery combined with endoscopic and thoracoscopic approaches for submucosal tumor originating from thoracic esophagus 
Background
Despite the efficacy of molecular targeted therapy, surgical resection remains the only curative primary treatment for gastrointestinal stromal tumors (GISTs). However, in cases when the tumor originates from the thoracic esophagus, conventional transthoracic approach is highly invasive.
Methods
All procedures were performed with patients in a prone position through a double-lumen endotracheal tube for single-lung ventilation. First, to clarify the resection layer between the tumor and mucosal layer of the esophagus, a sodium hyaluronate solution colored with indigo carmine was injected into the submucosa via the esophagoscopic approach. Second, we thoracoscopically divided the longitudinal muscle of the esophagus and enucleated the tumor through three ports by dissecting along the artificially colored submucosa, thereby minimizing accidentally opening of the esophageal mucosa. Third, we sutured the divided longitudinal muscle layer and removed the tumor from the thoracic cavity.
Results
Four tumors, including one GIST, were successfully resected via this hybrid approach. The mean surgical time was 137.7 min (range, 60–231 min), and the mean blood loss was 21.2 ml (range, 3–65 ml). No perioperative complications occurred, including with accidental opening of the esophageal mucosa.
Conclusions
Our minimally invasive hybrid surgery combined with esophagoscopic and thoracoscopic approaches demonstrated successful resection. This surgery could have advantages both for curing esophageal submucosal tumor and for minimizing surgical invasiveness.
doi:10.1186/s12957-015-0452-6
PMCID: PMC4332432
Submucosal tumor; Thoracoscopy; Gastrointestinal stromal tumor; Esophagus; Esophagoscopy
17.  The iatrogenic injury of double vena cava due to misdiagnosis during the radical nephroureterectomy and cystectomy 
Double inferior vena cava (d-IVC) is a subtype of vascular anomaly that rarely needs treatment. Here, we present a rare case of d-IVC accompanied with concurrent renal pelvis and bladder carcinoma. Due to misdiagnosis, the anomalous left inferior vena cava (IVC) entering the left renal vein was mistaken as the gonadal vein and was then severed during the radical nephroureterectomy. Fortunately, the injured left IVC was recognized correctly during the following cystectomy. The vascular reconstruction operation was performed to recanalize the left iliac veins by anastomosing the ligated vascular stump to the right IVC in an ‘end-to-side’ way. During the hospitalization, the patient was treated with ‘low molecular weight heparin’ and then warfarin to ensure an ideal international normalized ratio. He recovered well from the surgery. A meticulous and comprehensive analysis of radiographic imaging is critical to avoid misdiagnosis of d-IVC.
doi:10.1186/s12957-015-0469-x
PMCID: PMC4333245
Double inferior vena cava; Vascular reconstruction; Iatrogenic injury; Misdiagnosis; Anastomosis
18.  Cruciferous vegetable consumption and the risk of pancreatic cancer: a meta-analysis 
Background
Previous studies regarding the association between cruciferous vegetable intake and pancreatic cancer risk have reported inconsistent results. We conducted a meta-analysis to demonstrate the potential association between them.
Methods
A systematic literature search of papers was conducted in March 2014 using PubMed, EMBASE, and Web of Science, and the references of the retrieved articles were screened. The summary odds ratios (ORs) with 95% confidence interval (CI) for the highest versus the lowest intake of cruciferous vegetables were calculated.
Results
Four cohort and five case–control studies were eligible for inclusion. We found a significantly decreased risk of pancreatic cancer associated with the high intake of cruciferous vegetables (OR 0.78, 95% CI 0.64–0.91). Moderate heterogeneity was detected across studies (P = 0.065). There was no evidence of significant publication bias based on Begg’s funnel plot (P = 0.917) or Egger’s test (P = 0.669).
Conclusions
Cruciferous vegetable intake might be inversely associated with pancreatic cancer risk. Because of the limited number of studies included in this meta-analysis, further well-designed prospective studies are warranted to confirm the inverse association between cruciferous vegetable intake and risk of pancreatic cancer.
doi:10.1186/s12957-015-0454-4
PMCID: PMC4336706
Cruciferous vegetables; Diet; Epidemiology; Meta-analysis; Pancreatic cancer
19.  Prognostic value of HLA class I expression in patients with colorectal cancer 
Background
Prognostic factors are useful for determination of the therapeutic strategy and follow-up examination after curative operation in cancer treatment. The immunological state of the host can influence the prognosis for cancer patients as well as the features of the cancer. Human lymphocyte antigen (HLA) class I molecules have a central role in the anti-cancer immune system. Therefore, we focused on the HLA class I expression level in cancer cells to investigate its prognostic value in patients with colorectal cancer.
Methods
We reviewed the clinical pathology archives of 97 consecutive patients with stage II colorectal cancer who underwent curative operation at the Sapporo Medical University, Japan, from February 1994 to January 2005. Fifty-six high-risk patients had adjuvant chemotherapy. The cancer cell membrane immunoreactivity level for HLA class I expressed by EMR8-5 was classified into three categories (positive, dull, and negative). In this study, the cases were divided into two groups: “positive” and “dull/negative”. HLA class I expression level and clinicopathological parameters were evaluated with the Pearson χ2 test. Survival analysis was assessed by the Kaplan-Meier methods, and the differences between survival curves were analyzed using the log-rank test.
Results
Immunohistochemical study of HLA class I revealed the following. There were 51 cases that were positive, 40 were dull, and six negative. The HLA class I expression level had no significant correlation with other clinicopathological parameters, except for gender. Univariate and multivariate analyses related to disease-free survival (DFS) revealed that tumor location, HLA expression level, and venous invasion were significant independent prognostic factors (P < 0.05). The 5-year DFS rates in HLA class I positive group and in the dull/negative group were 89% and 70%, respectively. For high-risk patients with adjuvant chemotherapy, the 5-year DFS rates in the HLA class I positive group and in the dull/negative group were 84% and 68%, respectively. For low-risk patients without the chemotherapy, the 5-year DFS rates in the HLA class I positive group and in the dull/negative group were 100% and 71%, respectively.
Conclusions
Our study concluded that the HLA class I expression level might be a very sensitive prognostic factor in colorectal cancer patients with stage II disease.
doi:10.1186/s12957-015-0456-2
PMCID: PMC4336735
HLA class I; Colorectal cancer; Prognostic factor; Relapse; Disease-free survival
20.  Spontaneous perforation of primary gastric malignant lymphoma: a case report and review of the literature 
Background and aims
Spontaneous gastric perforation in the absence of chemotherapy is extremely rare. The authors encountered a case of spontaneous perforation of primary gastric lymphoma.
Case presentation
A 58-year-old man visited the authors’ hospital with acute severe epigastralgia. A large amount of free gas and a fluid collection around the stomach were noted on an abdominal computed tomography scan. The results of imaging studies indicated a perforated gastric ulcer, and a distal gastrectomy was performed. There was a large perforation about 50 mm in diameter in the anterior wall of the middle part of the stomach body. Microscopically, the full thickness of the gastric wall was diffusely infiltrated by a population of large atypical lymphoid cells. The lymphoid nature of these cells was indicated by the strongly positive immunohistochemical staining for CD20 and CD10. This confirmed the diagnosis of a germinal center B-cell-like type of diffuse large B cell lymphoma. Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone were administered after the operation.
Results and conclusion
Gastrectomy should be considered if a giant ulcer with necrotic matter on the ulcer floor is seen on upper gastrointestinal endoscopy because of the possibility of gastric perforation. If upper gastrointestinal endoscopy shows a finding similar to the abovementioned one during chemotherapy, dose reduction of chemotherapy or gastrectomy should be considered.
doi:10.1186/s12957-015-0458-0
PMCID: PMC4324849
Spontaneous perforation; Gastric malignant lymphoma; Distal gastrectomy; Diffuse large B cell lymphoma; Emergency; Necrotic matter
21.  Advances in surgical treatment of chronic pancreatitis 
The incidence of chronic pancreatitis (CP) is between 2 and 200 per 100,000 persons and shows an increasing trend year by year. India has the highest incidence of CP in the world at approximately 114 to 200 per 100,000 persons. The incidence of CP in China is approximately 13 per 100,000 persons. The aim of this review is to assist surgeons in managing patients with CP in surgical treatment. We conducted a PubMed search for “chronic pancreatitis” and “surgical treatment” and reviewed relevant articles. On the basis of our review of the literature, we found that CP cannot be completely cured. The purpose of surgical therapy for CP is to relieve symptoms, especially pain; to improve the patient’s quality of life; and to treat complications. Decompression (drainage), resection, neuroablation and decompression combined with resection are commonly used methods for the surgical treatment of CP. Before developing a surgical regimen, surgeons should comprehensively evaluate the patient’s clinical manifestations, auxiliary examination results and medical history to develop an individualized surgical treatment regimen.
Electronic supplementary material
The online version of this article (doi:10.1186/s12957-014-0430-4) contains supplementary material, which is available to authorized users.
doi:10.1186/s12957-014-0430-4
PMCID: PMC4326204
Chronic pancreatitis; Surgery; Treatment
22.  Rapidly developed squamous cell carcinoma after laser therapy used to treat chemical burn wound: a case report 
Background
In chronic wounds, especially burn scars, malignant tumors can arise. However, it is rare for a subacute burn injury to change to a malignant lesion within one month. Moreover, a case of squamous cell carcinoma arising from HeNe laser therapy after a chemical burn has never been reported.
Case report
In this report, we examine a rare case of squamous cell carcinoma arising from HeNe laser therapy after a chemical burn. Because pathologic investigations were made from the first operation, both early detection of the squamous cell carcinoma and consideration of the HeNe laser therapy as a risk factor for the skin cancer were possible. The cancer was completely removed and reconstruction of the defect was successfully achieved in a timely manner.
Conclusion
Although there has as yet been no reported case of squamous cell carcinoma induced by laser therapy, it is important for clinicians to recognize both the possibility of laser-induced cancer and the rapid change of cancer, so they can provide appropriate and timely treatment.
doi:10.1186/s12957-015-0437-5
PMCID: PMC4326292
Chemical burn; HeNe laser; Sodium hypochlorite; Squamous cell carcinoma
23.  Surgical management and outcome of rectal carcinoids in a university hospital 
Background
Rectal carcinoids are an uncommon entity comprising only 1%–2% of all rectal tumors. Rectal carcinoids are frequently diagnosed during colonoscopy, but management after polypectomy is still controversial. The aims of this study were to review the surgical procedures for rectal carcinoids and to compare the outcomes of patients after different treatment modalities in a university hospital in Hong Kong.
Methods
All rectal carcinoids diagnosed between January 2003 and September 2012 were reviewed retrospectively, including clinicopathological characteristics, their management, and surgical outcomes.
Results
There were 54 patients with a median age of 60 years, and 32 were males (59.3%). All patients underwent colonoscopy, and the most had rectal bleeding (53.7%). Two patients were diagnosed incidentally in the surgical specimens of rectal tissues. Eighteen patients were diagnosed to have rectal carcinoids after snaring polypectomy, and no further intervention was required. Twenty-five patients had local resection either by means of transanal resection or transanal endoscopic operation. Radical resection was performed in seven patients in which one had T3N1 disease and the others did not have any lymph node metastasis.
In the median follow-up of 30 months (10–108 months), there was no recurrence in the “incidental” or post-polypectomy group. However, two patients with transanal resection and two patients with radical resection developed hepatic metastases after 13–24 months post-treatment. The 5-year overall survival was 100% in patients having snaring polypectomy only, 83% for those with local resection, and 63% in patients who underwent radical surgery (p = 0.04).
Conclusions
Our data suggested that that local resection was an effective treatment for small rectal carcinoids and generally brought about good oncological and surgical outcomes. For larger tumors, radical resection seemed to provide acceptable oncological outcomes. Regular surveillance with colonoscopy and endorectal ultrasound is highly recommended for high-risk patients for long-term management. By sharing our experience, we hope to provide more evidence on the management on rectal carcinoids which, together with evidence from further studies, may guide us in the long-term management of these patients in the future.
doi:10.1186/s12957-015-0463-3
PMCID: PMC4327791
24.  Prediction of the preoperative chemoradiotherapy response for rectal cancer by peripheral blood lymphocyte subsets 
Background
Although neoadjuvant chemoradiotherapy (CRT) has become a standard procedure to downstage locally advanced rectal cancer prior to surgery, markers to predict the response to CRT have not been fully identified. The aim of this study was to identify predictive factors of response to CRT, especially focusing on peripheral blood leukocyte subsets.
Methods
A total of 45 consecutive patients diagnosed with primary rectal cancer were prospectively enrolled and received CRT followed by curative resection. The numbers of each lymphocyte subset in peripheral blood pre- and post-CRT were analyzed using flow cytometry. According to the pathological response to CRT, patients were classified into high (Hi-R) and low (Lo-R) response groups.
Results
Hi-R cases had significantly higher numbers of pre-CRT lymphocytes (p = 0.018), T lymphocytes (p = 0.009) and helper T lymphocytes (Th lymphocytes, p = 0.015) compared to the Lo-R cases. With the receiver-operating characteristic curve for numbers of pre-CRT T lymphocytes, the area under the curve (AUC) was 0.733, and the optimal cutoff value was 1196/μl, with 76.5% sensitivity, 67.8% specificity, 59.1% positive and 82.6% negative predictive values. The numbers of pre-CRT Th lymphocytes and cytotoxic lymphocytes were both independent predictors of the high CRT response in the multivariate analysis.
Conclusions
In addition to the direct cytotoxicity of CRT, recent studies have demonstrated the induction of an immunological host response, which also contributed to the tumor regression induced by CRT. Our result suggested the potential role of circulating T lymphocytes in predicting the response to CRT in colorectal cancer patients.
doi:10.1186/s12957-014-0418-0
PMCID: PMC4327968
Rectal cancer; Chemoradiotherapy; T lymphocyte; Peripheral blood
25.  Surgical resection of solid gallbladder adenocarcinoma presenting as a large mass: report of a case 
This report describes a case of a patient with a large solid gallbladder adenocarcinoma that was completely resected through aggressive surgery. The patient was a 57-year-old woman who had been diagnosed with advanced gallbladder cancer, had no indications for surgical resection and was scheduled to undergo systemic chemotherapy. She presented to our hospital for a second opinion. At the time of assessment, her tumor was large but was well-localized and had not invaded into the surrounding tissues, indicating that surgical resection was a reasonable option. Subsequently, the tumor was completely extracted via right hepatectomy with en bloc resection of the caudate lobe and extrahepatic bile duct. Histopathologically, the tumor was a solid adenocarcinoma. Although there are relatively few reports in the literature regarding solid gallbladder adenocarcinoma, well-localized growth appears to be a characteristic feature. On the basis of a tumor’s progression behavior, aggressive surgical treatment might be indicated even when the tumor has grown to a considerable size.
doi:10.1186/s12957-014-0416-2
PMCID: PMC4328207
Clinicopathological feature; Gallbladder; Solid adenocarcinoma; Surgical treatment; Tumor thrombus

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