We performed staging laparoscopy (SL) for advanced gastric cancer with suspicion of positive peritoneal cytology (CY) or peritoneal metastasis (P). This study was designed to show SL's utility in advanced gastric cancer.This was a retrospective study of 124 patients with primary gastric cancer who underwent SL between October 2001 and March 2009.There were no perioperative complications without a case of bleeding. The patient breakdown was P0CY0, 67; P0CY1, 19; P1CY0, 6; and P1CY1, 32. Chemotherapy was administered as the initial treatment in 33 patients and the period from SL to chemotherapy was 19.5 days. In 7 patients undergoing laparotomy as the initial treatment but later requiring exploratory laparotomy or palliative surgery followed by chemotherapy, the period from laparotomy to chemotherapy was 36.8 days. The difference was significant (p<0.0001). P1 was confirmed in 10 (14.5%) of 69 patients undergoing laparotomy as the initial treatment. CY was re-examined in 53 of these 69 patients and CY1 was confirmed in 6 (13.3%) of 45 patients who were CY0 according to SL.With SL, early initiation of chemotherapy was possible for P1 patients. Although improved accuracy is required, SL, which can be carried out safely with minimal invasiveness, was suggested to be useful.
When a relatively small anastomotic recurrence of colorectal cancer is detected in the low rectum, trans-anal resection (TAR) might be an option both for curative intent and for preservation of anal function. We report 3 such cases. Case No. 1: A 58-year-old woman presented with an anastomotic recurrence of sigmoid colon cancer. Low anterior resection(LAR)was performed. Two small recurrent nodules were detected at the suture line 1 year after LAR, which were successfully treated with TAR. The depth of the nodules indicated T2 cancer. The patient remained cancer free 5 years after TAR. Case No. 2: A 56-year-old man developed a severe anastomotic stenosis and an anastomotic recurrence 6 months after LAR for low rectal cancer. TAR was performed circumferentially to resect both the stricture and the recurrence. The depth of the nodule indicated T2 cancer. The patient was cancer free for 7 years after TAR. Case No. 3: A 54-year-old man developed 2 small recurrent nodules at the suture line after LAR for low rectal cancer. TAR was performed. The depth of the nodule indicated T1 cancer. One of the nodules was not resected, which necessitated intersphincteric resection (ISR) 10 months later. In conclusion, in cases of a relatively small recurrence of low rectal anastomosis after colorectal cancer surgery, TAR is an effective treatment option.
DKC1 (dyskerin pseudouridine synthase 1) is a causative gene for X-linked dyskeratosis congenita. Approximately 8% of patients with dyskeratosis congenita have malignancy, but information about the development of malignancy in patients with dyskeratosis congenita is limited.A young Japanese patient with bone marrow failure developed metachronous rectal adenocarcinomas at the ages of 16 and 18 years. He had no family history of cancer. Microsatellite instability testing with rectal tumor tissue demonstrated low-level microsatellite instability. To clarify whether any cancer susceptibility genes were involved in the development of rectal cancer, RNA sequencing was performed. Cancer-related genes were assessed, and a c.361A>G (p.Ser121Gly) germline variant was detected in DKC1. The same missense variant was previously reported in two patients with dyskeratosis congenita as a pathogenic variant, but those patients did not develop malignancies.Our patient developed rectal cancer at an early age of onset compared with the previously reported typical onset age of patients with dyskeratosis congenita. DKC1 might be involved in predisposition to colorectal cancer in young adulthood; therefore, appropriate surveillance may be considered.
