食道
食道癌亜全胃再建 -蛍光法でみる亜全胃の血流と治療成績-
- 演 者：
- 今井 健晴1，田中 善宏1, 末次 智成1, 棚橋 利行1, 松井 聡1, 今井 寿1, 松橋 延壽1,
高橋 孝夫1, 山口 和也1, 吉田 和弘1 - 所属機関：
- 1岐阜大学・腫瘍外科
[Introduction] We performed an anastomosis using "subtotal stomach" in esophageal cancer surgery with various measures. This time, we performed an intraoperative bloodstream evaluation of subtotal stomachs by using ICG-fluorescent imaging. We evaluated reconstruction with subtotal stomach in our department so far.
[Techniques] We extrude 3 branches from the afferent region of the left gastric artery. The greater omentum was treated at a position 5cm distal to the right gastroepiploic artery, and from the end points of the left and right gastroepiploic arteries, the left separates the greater omentum along the gastric wall. When opening the gastric incision, affix a staple with both hands fully extended length-wise. To make the cervical anastomosis, hand suture is used in a layer to layer pattern. After the anastomosis, pull the reconstruction stomach to the ventral side, and secure the stomach with 3 stitches in the crura of the diaphragm.
[Results] Between January 2008 and April 2018, 278 patients with esophageal cancer underwent esophagectomy in our department. Among these patients, 220 patients underwent reconstruction with subtotal stomach. The rate of anastomotic leakage was occured in 2 cases (0.72%). We evaluated postoperative QOL by using EORTC QLQ-OES18 score (postoperative 3 months →1 →2 →3 →4 →5 years; average), and the results were as follows: for dysphagia, 1.5→1.2→1.2→1.1→1.1→1.0; early feeling of abdominal fullness, 1.5→2→1.1→1.3→1.5→1.3; and feeling of reflux, 1.3→1.4→1.7→1.3→1.3→1.3. The patients' body weights were as follows: at the initial visit, 53±8.4Kg; at postoperative 1 year, 54±6.5Kg; 3 years, 56±5.5Kg; and 5 years, 54±5.2Kg. Intraoperative ICG-fluorescent imaging showed that blood flow reaches the tip of the subtotal stomach via the vascular network in the stomach wall.
[Conclusion] Reconstruction using subtotal stomach was not only safe and feasible, but also contributed to the increase in the QOL of the patients with esophageal cancer.
腸内細菌 Fusobacterium nucleatumは食道癌に対する化学療法感受性に影響を与える
- 演 者：
- 馬場 祥史1，山村 謙介1, 江藤 弘二郎1, 日吉 幸晴1, 長井 洋平1, 岩槻 政晃1, 岩上 志朗1, 宮本 裕士1, 吉田 直矢1, 馬場 秀夫1
- 所属機関：
- 1熊本大学・消化器外科
Background: Fusobacterium nucleatum (F. nucleatum), which primarily inhabits the oral cavity, causes periodontal disease. We have reported that the presence of F. nucleatum is associated with a poor prognosis in patients with esophageal cancer (Clin Cancer Res 2016). Two recent reports revealed that the F. nucleatum was associated with chemoresistance in human cancers. However, no studies to date have examined the relationship between F. nucleatum and chemotherapeutic response in esophageal cancer.
Methods: F. nucleatum was quantified by qRT-PCR in 101 surgically-resected esophageal squamous cell carcinoma (ESCC) specimens from patients who received neoadjuvant chemotherapy prior to curative resection. RECIST, primary tumor metabolic response defined by change in SUVmax and pathological tumor regression grade (TRG) were used to evaluate the response to chemotherapy. In addition, 18 pretreatment biopsy samples were utilized as a validation set.
Results: ESCC patients with lower quantity of F. nucleatum displayed superior chemotherapeutic response for all three evaluation methods: RECIST (p=0.04), metabolic response determined by SUVmax (p=0.0004) and TRG (p=0.003). In validation set with pretreatment biopsy samples, the relationships between low F. nucleatum and favorable therapeutic response (RECIST and TRG) were confirmed (p<0.05).
Conclusions: Intratumoral F. nucleatum enhances resistance to chemotherapy in ESCC patients. An antibiotic intervention which targets F. nucleatum may improve response to chemotherapy in ESCC patients.
食道扁平上皮癌におけるAnion exchanger 2 の細胞遊走能制御機構の解明
- 演 者：
- 塩崎 敦1，樋上 翔一朗1, 小菅 敏幸1, 工藤 道弘1, 有田 智洋1, 小西 博貴1, 森村 玲1, 村山 康利1, 栗生 宜明1, 生駒 久視1, 窪田 健1, 中西 正芳1, 藤原 斉1, 岡本 和真1, 大辻 英吾1
- 所属機関：
- 1京都府立医科大学・消化器外科
Background: Recent studies have reported essential roles for various intracellular pH regulators in epithelial carcinogenesis and tumor progression. The aims of the present study were to investigate the role of anion exchanger 2 (AE2) in the regulation of tumor progression-related genes and the prognostic value of its expression in esophageal squamous cell carcinoma (ESCC).
Methods: In human ESCC cell lines, knockdown or overexpression experiments were conducted using AE2 siRNA or overexpression plasmid, and the effects on cellular movement, proliferation and survival were analyzed. The gene expression profiles of cells were examined using a microarray analysis. An immunohistochemical analysis was performed on 61 primary tumor samples obtained from ESCC patients who underwent esophagectomy.
Results: AE2 was strongly expressed in KYSE170 and TE13 cells. The depletion of AE2 in these cells increased cell migration and inhibited the induction of apoptosis. AE2 overexpression in KYSE170 cells decreased cell migration. Further, injection of AE2 plasmid transfected KYSE170 cells subcutaneously into nude mice resulted in significantly smaller tumor volumes than those of the control plasmid transfected cells. The results of the microarray analysis revealed that various matrix metalloproteinase (MMP) signaling pathway-related genes, such as MMP1, MMP12, and TIMP4, were up- or down-regulated in AE2-depleted KYSE170 cells. Immunohistochemical staining showed that AE2 was primarily located in the cell membranes or cytoplasm of carcinoma cells, and its expression pattern at the invasive front (IF) of the tumor was related to the pT category. Prognostic analyses revealed that the low-grade expression of AE2 at the IF was associated with shorter postoperative survival.
Conclusions: The results of the present study suggest that reductions in AE2 in ESCC enhance cellular movement by affecting MMP signaling pathways and are related to a poor prognosis in patients with ESCC.
食道切除術における術後体重変化についての検討
- 演 者：
- 曽根田 亘1，新原 正大1, 赤井 俊也1, 中村 健一1, 石井 賢二郎1, 坪佐 恭弘1
- 所属機関：
- 1静岡県立静岡がんセンター・食道外科
Background : Postoperative bowel dysfunction and dysphagia following esophagectomy for esophageal cancer prevent enough oral nutrition and cause body weight loss. Long-term nutritional management for the patients underwent esophagectomy is important to improve their QOL.
Objectives : The aim of this study was to clarify the influence of VATS (video-assisted thoracoscopic esophagectomy) for the postoperative body weight loss and the nutritional status.
Patients and Methods : 67 patients without recurrence for one year, who underwent esophagectomy for esophagieal cancer between January 2014 to December 2016 at Shizuoka Cancer Center Hospital, were reviewed. All patients were performed feeding tube jejunostomy, and tube was removed in outpatient. They were divided into two groups according to the procedure : VATS group (n=40), open esophagectomy group (OE ; n=27) to compare the transition of postoperative body weight in 3, 6, 12months.
Results : The patients' average ages were 65.1 years (VATS) and 66.4 years (OE), and the male-to-female ratio was 29 : 11 (VATS) and 23 : 4 (OE). Preoperative BW and BMI was 57.9±12.0kg, 21.7±3.3 (VATS) and 58.8±9.8kg, 21.5±2.9 (OE). These differences were not statistically significant. Rate of BW loss was 10.1±6.9% (VATS) vs. 8.8±6.4% (OE) in 3POM (P=0.218), 11.0±8.6% vs. 8.5±8.0% in 6POM (P=0.117) and 10.7±9.1% vs. 8.9±7.8% in 12POM (P=0.194) .
Conclusion : This study shows that VATS may cause equal BW loss after esophagectomy comparing with OE. Regardless of the procedure, BW loss after surgery showed a flat peak at 6 months and then flat. It is necessary to continue long-term nutrition after surgery, and instruct home nutrition feeding. With the changes of serological nutritional indicators, we report it along with some literature considerations.
