Cases Of Postoperative Recurrence Research Articles

Conversion Surgery After Chemotherapy Plus Nivolumab as the First-Line Treatment for Unresectable Advanced or Recurrent Gastric Cancer and a Biomarker Study Using the Gustave Roussy Immune Score: A Multicenter Study.

There are few reports on conversion surgery (CS) after chemotherapy plus nivolumab as a first-line treatment in patients with unresectable advanced or recurrent gastric cancer (GC). This multicenter study was conducted to analyze real-world data on CS after chemotherapy plus nivolumab as a first-line treatment and to identify predictive biomarkers. This multicenter study included 104 patients who received chemotherapy plus nivolumab as primary treatment for unresectable advanced recurrent GC from 12 institutes. We investigated and analyzed patient characteristics and blood test data in the presence or absence of CS, the relationship between the Gustave Roussy Immune Score (GRIm-s) and CS, and the characteristics of CS cases. CS was performed in 12 patients (11.5%). Eastern Cooperative Oncology Group Performance Status (ECOG-PS) was significantly better in patients who underwent CS (p<0.0001). There were no CS cases with high-risk GRIm-s (0%), however there were 22 non-CS cases (23.9%). No high-risk GRIm-s cases were converted to CS. Minimally invasive surgery was performed in 50.0% of the cases, with R0 resection in all cases and only one case of urinary retention (Grade II) as a postoperative complication, indicating a good postoperative short-term outcome. There were two cases of postoperative recurrence (16.7%), both of which were grade 1b. The short-term postoperative results of CS after chemotherapy plus nivolumab as the first-line treatment for GC were acceptable in this study. There were no high-risk GRIm-s cases among those who underwent CS, suggesting that the GRIm-s may be a predictor of CS.

372. TREATMENT USING NIVO+CHEMO OR NIVO+IPI FOR UNRESECTABLE/RECURRENT ESOPHAGEAL SQUAMOUS CANCER IN OUR INSTITUTE

Abstract Introduction Currently, regarding stage IVB esophageal cancer treatment, the esophageal cancer treatment guideline in JAPAN was revised in 2022 based on the results of two phase III trials, KN590 and CM648, and Nivolumab+Chemo and Nivolumab+Ipilimumab would be used as 1st line treatment. Subject NIVO+Chemo19NIVO+Ipilimumab (IPI)17 Before February 2024, a total of 160 cases of unresectable/recurrent esophageal squamous cell carcinoma have been treated using IO, IO+Chemo, and IO+IO at our institute. 19 cases were treated with NIVO+Chemo and 17 cases were treated with NIVO+IPI as the 1st line treatment. We examined the treatment backgrounds and outcomes of these subjects. Result Regarding patient characteristics, median age was 66/65 years in NIVO+Chemo group/NIVO+IPI group, male to female ratio was 18:1/15:2, PS0/1 was 14/5 cases in NIVO+Chemo, and 16/1 cases in NIVO+IPI. Pre-treatment status (primary unresectable/recurrent/other) were 13/5/1 in NIVO+Chemo, and 4/12/1 in NIVO+IPI. The presence/absence of post-treatment was 12/7 cases in NIVO+Chemo and 10/7 cases in NIVO+IPI. The presence/absence of irAEs was 5/14 cases in NIVO+Chemo, and 15/2 cases in NIVO+IPI. ORR was 52.6%, and median OS was 782 days, and median PFS was 190 days in NIVO+Chemo group, and 52.9%/544days/138days in NIVO+IPI group. Consideration Both the NIVO+Chemo and NIVO+IPI groups at our facility had longer OS and PFS than previously reported. In particular, the response rate of NIVO+IPI was as high as that of the NIVO+Chemo group, and this is thought to be since many cases of postoperative recurrence with small tumor volumes were enrolled in NIVO+IPI group. We believe that it is important to distinguish between IO/IO and IO/CHEMO as a treatment strategy for unresectable/recurrent esophageal squamous cell carcinoma.

P168 Specialized pro-resolving lipid mediator Resolvin D1 and omega 6 dihomo-γ-linolenic acid are unable to solve inflammation in the creeping fat of patients with severe postoperative recurrence in Crohn's disease

Abstract Background The ω3 derivate resolvin D1 (RvD1), and the ω6 dihomo-γ-linolenic acid (DGLA) prevent collateral damage by overcoming inflammation and enhancing microbial clearance. In Crohn's disease, the mesenteric adipose tissue becomes inflamed and hyperplasies due to transmural lesions and bacterial translocation, developing the so-called creeping fat. This tissue is unable to clear inflammation and has been linked to severer intestinal inflammation and post-operative recurrence (POR). Recently, we have described the presence of DGLA and the increase in the ω6/ω3 ratio together with pro-inflammatory mediators in the creeping fat at surgery. Our aims were study the mechanisms within the inflammatory resolution related to polyunsaturated fatty acids depending on POR severity. Methods Creeping fat samples were obtained in the intestinal resection of Crohn's disease patients and endoscopic POR was evaluated according to the Rutgeerts score: non recurrence (i0+i1; n=18), mild recurrence (i2; n=14) and severe recurrence (i3+i4; n=10). Mesenteric adipose tissue was also collected from patients with colorectal cancer (n=10) and severe obesity (n=11) as reference groups. RvD1 was evaluated by C18/ELISA, lipoprotein lipase (LPL) and hormone-sensitive lipase (HSL) activity by radioassay, and the free fatty acid receptor 1 (FFAR1) expression by qRT-PCR. Results RvD1 was increased in the creeping fat in comparison to the mesenteric adipose tissues of the reference groups (Graphical abstract A) and correlated antagonistically with pro-inflammatory mediators in non-recurrence versus severe recurrence (B). Specifically, factors such as TNF-α, CD14 or IL-18 showed significant positive correlations with RvD1 in severe recurrence while negative in non recurrence. The LPL/HSL ratio indicated greater storage of fatty acids in severe recurrence creeping fats (C), and only in these patients, DGLA negatively correlated with HSL (D) and FFAR1 (E), a receptor that was only detected in Crohn's disease (F). At the same time, this receptor antagonistically correlated with pro-inflammatory mediators such as IL-8 in the creeping fat, positively in non-recurrence and negatively in severe recurrence (G). Conclusion The RvD1 increase suggests a greater production of this factor from ω3, but that would be insufficient to resolve inflammation in severe recurrent creeping fat at surgery time. In this phenotype, HSL activity is linked to a lower presence of DGLA, the only anti-inflammatory ω6. In contrast, the presence of this ligand in severe recurrents seems to reduce the expression of the FFAR1, which acts on the neutrophil function. Thus, immune-inflammation derived from lipid metabolism is antagonistic among the most disparate cases of POR in the creeping fat at surgery.

A new method for establishing operative channels in unilateral biportal endoscopic surgery: Technical notes and preliminary results.

The unilateral biportal endoscopic (UBE) technique has been widely used in spine surgery. At present, a traditional rigid working channel is available for the UBE system. A metal semicircular canal is located in the working channel. However, due to the metal material of the working channel, arthroscopy and instruments are constrained from moving in UBE surgery. Additionally, an assistant is needed during the procedure to hold the traditional working channel. For simplicity of operation and convenient movement of the arthroscopy and instrument, we describe a new method for establishing operative channels in UBE surgery. We retrospectively reviewed 50patients who underwent unilateral biportal endoscopic discectomy (UBED) from February 2020 to August 2020 via our new method. The Oswestry Disability Index (ODI) and visual analogue scale (VAS) score were measured preoperatively and 1month, 3months, 6months and 12months postoperatively. Statistical comparisons were made using analysis of covariance and paired t tests. The VAS scores for back pain at the five time points were 5.20 ± 2.57, 1.96 ± 0.95, 1.50 ± 0.84, 1.64 ± 1.08 and 1.18 ± 0.39. The leg pain VAS scores were 7.02 ± 2.25, 2.02 ± 1.27, 1.48 ± 0.89, 1.32 ± 0.79 and 0.88 ± 0.52. The ODI values were 51.08 ± 19.97, 19.62 ± 15.51, 8.26 ± 7.40, and 7.54 ± 6.42 to 3.24 ± 1.10. The postoperative ODIs and VAS scores of low back pain and leg pain were significantly lower than those before surgery, and differences were statistically significant (all p< 0.05). The pressure of the closed outflow was significantly higher than that of the open outflow (37.35 ± 13.11mm Hg vs. 24.55 ± 12.64mm Hg p= 0.003). After we tightened the infusion strap to open the outflow, the pressure decreased significantly (26.4 ± 14.08mm Hg vs. 37.35 ± 13.11mm Hg p= 0.015). There were 2cases of complications, including 1case of postoperative recurrence and 1case of dural tears. This study demonstrates the technical feasibility, safety, and efficacy of modified channel establishment in UBE surgery.

Comparison of the efficacy of dienogest and GnRH-a after endometriosis surgery

ObjectiveTo compare the efficacy of dienogest and GnRH-a after endometriosis surgery.MethodsPatients with endometriosis who were admitted to our hospital from December 2020 to March 2022 were randomly collected. A total of 81 patients were collected and divided into 40 cases in the control group and 41 cases in the observation group. Among them, the control group was treated with GnRH-a drug, and the observation group was treated with dienogest (DNG).ResultsThe study found that the therapeutic effects of the two drugs were basically the same in patients with endometriosis. The VAS and Kupperman scores of the control group were 0.78 ± 0.8, 3.9 ± 1.84, P < 0.05, respectively; the VAS and Kupperman scores of the observation group were 0.73 ± 0.78, 1.55, respectively ± 1.24, P < 0.05, the difference was statistically significant.In the case of postoperative recurrence, the observation group was better than the control group, with 8 cases of recurrence in the control group and 2 cases of recurrence in the observation group, P < 0.05.ConclusionIn the comparison of postoperative efficacy of the two drugs on patients with endometriosis, dienogest is better than GnRH-a adjuvant drug in postoperative recurrence, and has a good improvement and application, which is worthy of further promotion in clinical practice.

Operative versus conservative treatment of trigger thumb in children.

Trigger thumb is an uncommon anomaly in children with controversial management ranging from simple observation to surgical release. This study aimed to determine the clinical outcomes of surgical release versus conservative treatment. Data from 407 children with 511 trigger thumbs were collected from their medical records. To compare the final outcomes of conservative and operative treatments, age at onset, sex, affected side, familial history, treatment modality, time to conversion from conservative to surgical treatment, recurrence, and complications were analyzed. Forty-one children were excluded owing to loss during follow-up; thus, 366 children were finally included. Conservative treatment was administered to 96 children, of whom 25 experienced successful result and 68 experienced treatment failure and were subsequently treated surgically. There were no cases of post-operative recurrence. After 24 months of age, operative treatment had better outcomes than conservative treatment, which showed a higher failure rate.

PROX1 Was Associated with LGR5 and Wnt Signaling and Contributed to Poor Prognosis in Gastric Cancer

Introduction: We investigated whether the expression of prospero homeobox protein-1 (PROX1) in gastric cancer (GC) could be a prognostic marker. We also focused on the relationship between PROX1 and LGR5 and Wnt/β-catenin activity in GC. Methods: A total of 196 patients who underwent potentially curative surgery were collected and reviewed retrospectively. Immunohistochemistry was conducted and evaluated the expression PROX1, LGR5, Wnt3a, and β-catenin expression. And we evaluated the relationship between PROX1 expression and clinicopathological features. Results: The PROX1 low-expression group consisted of 105 patients (53.6%) and the high-expression group consisted of 91 patients (46.4%). For LGR5 expression, 76 patients (38.8%) were classified as low-expression, and 120 patients (61.2%) were classified as high-expression. The PROX1 low-expression group was significantly younger (p = 0.0095), had more intestinal type (p = 0.014), and had smaller tumor size (p = 0.013). The PROX1 high-expression group was significantly correlated with high LGR5 expression (p < 0.0001) and high Wnt3a expression (p = 0.012). In addition, there were significantly more cases of postoperative recurrence in the PROX1 high-expression group (p = 0.013). Conclusion: Our findings demonstrate that PROX1 correlated with the cancer stemness markers LGR5 and Wnt3a signaling in GC and had a poor prognosis including postoperative recurrence.

Gastric carcinosarcoma with FGFR2 amplification under long-term control with pazopanib: a case report and literature review

BackgroundGastric carcinosarcoma is most frequently diagnosed at an advanced stage when the tumor is generally large with invasion into other organs, lymph node metastasis, and distant metastasis. Standard chemotherapy has not been established, and surgery is the only curative treatment. Here, we present a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib.Case presentationA 77-year-old man was referred to our hospital because of nausea and vomiting. Computed tomography and upper gastrointestinal endoscopy revealed a type 1 tumor arising from the gastric antrum and extending into the duodenal bulb. He underwent distal gastrectomy (D2) with Roux-en-Y reconstruction. Histopathologically, the tumor had mixed adenocarcinoma and sarcoma components. According to the tumor–node–metastasis classification, the diagnosis was primary gastric carcinosarcoma pT1bN1M0 stage IB. Liver metastasis was detected 2 months after surgery; multiple lung metastases were detected 17 month after surgery. A genomic profiling test was performed using liver specimens as the patient became refractory to chemotherapy commonly used for gastric cancer, and the test revealed FGFR2 amplification along with TP53 R209*, AKT3 N127D, NOTCH1 A2036T, and POLD1 M161I. The patient was treated with pazopanib (800 mg/daily), and the tumor growth was controlled for 11 months.ConclusionsWe report a case of postoperative recurrence of gastric carcinosarcoma under long-term tumor control with pazopanib. This case suggested that pazopanib may be effective in treating gastric carcinosarcoma.

Outcomes of the anterior approach versus posterior sacrospinous ligament fixation for pelvic organ prolapse.

This study aimed to compare anterior sacrospinous ligament fixation (SSLF) with the standard posterior SSLF concerning complications and outcomes in patients with apical compartment pelvic organ prolapse (POP). This is an observational descriptive study using prospective data collected from two referral urogynecological centers. The study cohort represents all 135 women in our prospective study who underwent anterior approach bilateral anterior or unilateral posterior meshless SSLF from January 2018 to December 2020 using the PFDI-20 questionnaire and the POP quantification (POP-Q) system pre- and postoperatively. The objective success rate was assessed by the number of POP recurrence cases and total vaginal length (TVL) postoperatively. Patients were followed up for at least 6 months (range, 6 to 18 months). Data were analyzed using SPSS version 21. P < 0.05 was considered statistically significant. Sixty-seven (49.6%) patients underwent posterior SSLF, and 68 (50.4%) underwent anterior SSLF. The mean age of patients was 58.2 ± 9.7 and 64.9 ± 11.6, respectively (P < 0.001). Most patients who underwent the posterior approach had stage III apical prolapse (74.6%), while 65.5% of those who underwent anterior SSLF had stage II apical prolapse (P < 0.001). Following the treatment, no significant difference was detected between these two vaginal approaches in terms of women's satisfaction rate (P > 0.05). One case of postoperative recurrence was found in the posterior group, which ultimately led to surgical retreatment. There were no major intra- or postoperative complications in the groups. Postoperative TVL was higher in the anterior SSLF group (P < 0.001). The postoperative POPDI-6, CRADI-8, UDI-6, and PFDI-20 decreased significantly compared to preoperative status in both groups (P < 0.001). It appears that the anterior SSLF approach can be regarded as effective as the posterior approach in the management of apical POP. Therefore, the proper surgical technique can be chosen according to the surgeon's expertise and other compartment's prolapse status.

Abdominal Hernia in Equine: Animal Level Risk Factors and Repair Using Polypropylene Mesh

There is a paucity of information regarding the frequency and risk factors associated with the occurrence of an abdominal hernia in different equine species especially donkeys, and mules. In addition, the effectiveness of using polypropylene mesh for the surgical management of abdominal hernia in donkeys and mules is still unknown. The purpose of the present study was to evaluate the efficacy of using polypropylene mesh for the surgical treatment of abdominal hernia in horses, donkeys, and mules and to address the occurrence and risk factors associated with an abdominal hernia in the selected animal species. Based on clinical and ultrasound proof of abdominal hernia, 48 animals were included in the current study. A questionnaire was created to imply the assumed risk factors associated with occurence and clinical findings of abdominal hernia. Hernioplasty using polypropylene mesh was used for the surgical treatment. The abdominal hernia was prevalent (P < .05) in foals followed by adult horses, donkeys, and mules (25, 15, 6, and 2), respectively. Ages from 3 to 5 years exhibited more abdominal hernias in donkeys, mules, and horses (12.5%, 4.2%, and 31.3%, P < .05), respectively. In all studied animals, females were more prevalent than males (70.8%, n = 34 vs. 29.2%, n = 14) respectively. The complication of abdominal wall hernia was positively affected by the time to repair admitted cases (P = .000). The majority of the animals (36 cases) recovered without complications, however, 10 cases had mild difficulties such as suture abscess, wound infection, serous fluid accumulation, and hematoma postsurgery. In addition, two cases of postoperative recurrence were documented. The results herein indicated that polypropylene mesh hernioplasty may be an alternative to the treatment of equine abdominal hernia. Recognizing the potential risk factors associated with an abdominal hernia in different equine species may be helpful to construct the best preventive measures.

A Case of Postoperative Recurrence of Primary Malignant Melanoma of the Esophagus in the Liver with Complete Response with Nivolumab Therapy

A Case of Postoperative Recurrence of Primary Malignant Melanoma of the Esophagus in the Liver with Complete Response with Nivolumab Therapy

P51-3 Examination of CARG toxicity scores in palbociclib therapy for elderly patients with breast cancer

Palbociclib is proven to be effective against hormone receptor-positive, metastatic and recurrent breast cancer and is being adopted as a standard treatment. In clinical practice, elderly patients with poor general condition are at risk for adverse events of palbociclib. Four hormone receptor-positive breast cancer patients, aged 70 years and above, who received palbociclib therapy, were enrolled in this study. The toxicity risk of Grade 3-5 (G3-5) predicted through the Cancer Aging Research Group (CARG) toxicity scores, a tool for predicting adverse events in cancer chemotherapy, were retrospectively compared with the actual adverse events. The median age (range) of four patients was 76.5 (70 to 83) years. The group included one case of Stage 4 cancer and three cases of postoperative recurrence. Three patients were undergoing one endocrine therapy regimen after recurrence, while the remaining one was not undergoing any endocrine therapy regimens. None of them had a history of chemotherapy. All had CARG scores of 8 (moderate risk), and their toxicity risk of G3-5 was 59%. The actual adverse events were neutropenia: G2 one case / G3 two cases / G4 one case, thrombocytopenia: G5 one case, and anemia: G4 / one case. The G3-5 incidence, as predicted by the GARG scores, was 100%, with a concordance rate of 75% with the actual adverse events. The progression-free survival of the three patients who were able to continue therapy was 218, 444, and 377 days, respectively, showing a sufficient response period. The 85-year-old patient who started with a reduced initial dose was hospitalized four weeks after administration on account of impaired consciousness with pancytopenia. The patient died of cerebral hemorrhage three days after the administration. Palbociclib therapy in elderly patients can have serious outcomes with a moderate-to-high risk of toxicity based on the CARG score. Close follow-up is thus recommended even after dose reduction.

Triple combination therapy comprising angiogenesis inhibitors, anti-PD-1 antibodies, and hepatic arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma.

e16124 Background: The effects of single-drug therapy for the systemic treatment of advanced unresectable hepatocellular carcinoma (HCC) remain unsatisfactory, promoting the emergence of multi-drug and combination therapies. Here we assess the safety and efficacy of a triple combination therapy for treating advanced HCC. Methods: This single-center retrospective study included patients with unresectable HCC treated with triple combination therapy comprising angiogenesis inhibitors (oral apatinib 250 mg/day, lenvatinib 8 mg/day, or sorafenib 400 mg BID), anti-programmed cell death 1 antibodies (iv camrelizumab or sintilimab, 200 mg every 3 weeks), and hepatic arterial infusion chemotherapy (FOLFOX every 4–8 weeks). Eligible patients had completed at least one cycle of therapy and had an imaging assessment. Treatment-related adverse events (TRAEs) were assessed according to the Common Terminology Criteria for Adverse Events. Efficacy data were summarized according to modified RECIST (mRECIST) and RECIST v1.1. Results: Of 34 patients who received triple combination therapy, 25 (19 men and 6 women; median age: 59 years [range: 49–78]) had an imaging assessment. TRAEs were manageable; 28.0% of patients experienced grade 3–4 TRAEs. Efficacy outcomes are summarized in the Table. The objective response rate was 96.0% (mRECIST), the median time to response was 50.5 days (95% CI: 31.02–64.00) and the surgical conversion rate was 56%, indicating a robust therapeutic effect. Overall, 12 patients (48.0%) achieved a complete response (CR), 12 (48.0%) achieved a partial response, and one (4.0%) had stable disease (mRECIST). Fourteen patients (56.0%) underwent surgical resection, after which seven (28.0%) achieved a pathologic CR. After a median follow-up of 9.67 months, no cases of post-operative recurrence or metastasis emerged. Conclusions: Triple combination therapy had a robust therapeutic effect with a high surgical conversion rate in patients with advanced HCC. TRAEs were acceptable, and long-term efficacy is reasonably expected. Summary of efficacy outcomes (n = 25).[Table: see text]

Comparison of conventional fenestration discectomy with Transforaminal endoscopic lumbar discectomy for treating lumbar disc herniation:minimum 2-year long-term follow-up in 1100 patients

PurposeTo compare the efficacy of conventional interlaminar fenestration discectomy (IFD) with transforaminal endoscopic lumbar discectomy (TELD) for treating lumbar disc herniation (LDH).MethodsThe clinical data of 1100 patients who had been diagnosed with LDH between January 2012 and December 2017 were retrospectively analysed. IFD was performed on 605 patients in Group A, whereas TELD was performed on 505 patients in Group B. The Oswestry Disability Index, Visual Analogue Scale for pain and modified MacNab criteria were used to evaluate the outcomes. The surgery duration, intraoperative blood loss, postoperative off-bed activity and postoperative length of hospital stay were recorded.ResultsThe follow-up period ranged from 24 to 60 months, with an average of 43 months. The excellent and good outcome rates were 93.5% in Group A and 92.6% in Group B. There was no significant difference in efficacy between the groups (P > 0.05). However, Group B had significantly less intraoperative blood loss and shorter bed rest duration and postoperative length of hospital stay than Group A (P < 0.05). There were two cases of postoperative recurrence in Group A and three in Group B.ConclusionsAlthough conventional IFD and TELD had similar levels of efficacy in treating LDH, TELD had several advantages. There was less intraoperative bleeding, shorter length of hospital stay and shorter bed rest duration. It can be considered a safe and effective surgical option for treating LDH.

The impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma

Objective: To explore the impact of surgical treatment on the life quality of patients with locally advanced hypopharyngeal carcinoma. Methods: A retrospective analysis of the clinical data of 21 patients with advanced hypopharyngeal carcinoma who underwent surgery at the Shenzhen Hospital of Chinese Academy of Medical Sciences Cancer Hospital from January 1, 2017 to December 31, 2019 was conducted. There were 3 patients with recurrence after radiotherapy and chemotherapy, 4 cases of postoperative recurrence, 3 cases of postoperative recurrence after radiotherapy and chemotherapy. Three cases were hypopharyngeal carcinoma with esophageal carcinoma and 8 cases were stage Ⅳ hypopharyngeal carcinoma. Among them, 3 cases were repaired by stomach, 4 cases by free jejunum, 2 case by great saphenous vein for internal carotid artery, 1 case by artificial blood vessel for internal carotid artery, 5 cases by transfer of pectoralis major musculocutaneous flap and 2 cases by transfer of submental island flap. The 21 patients were scored using the European Cancer Research and Treatment Organization's Quality of Life Head and Neck Tumor Special Scale (EORTC QLQ-H&N35) on the 3 months before and after surgery, and the changes in postoperative life quality were compared. Results: The preoperative life quality score of 21 patients was (56.86±7.95) points and life quality score of 3 months after operation was (50.93±7.91) points. The postoperative life quality was significantly improved (P<0.05). The improvement of the postoperative life quality of the patients mainly included the improvements of the head and neck pain, swallowing function, diet, taking analgesics and indwelling nasal feeding tubes. The preoperative scores were (7.58±1.56) points, (8.46±1.63) points, (7.94±0.43) points, (1.76±0.12) points and (1.86±0.28) points, respectively, while the scores of 3 months after operation were (5.02±1.23) points, (6.28±1.58) points, (6.34±0.36) points , (1.12±0.08) points and (1.24±0.18) points, the differences were statistically significant (all P<0.05). Conclusion: The flexible selection of flap repair for locally advanced hypopharyngeal carcinoma is still feasible, and surgery can improve the life quality of patients.

2088 A Rare Case of Postoperative Recurrence of Crohn’s Disease Associated With Abdominal Actinomyces and Bacteremia

INTRODUCTION: We present a rare case of actinomyces bacteremia in a 27-year-old woman with fistulizing Crohn's ileocolitis who presented with acute abdominal pain in the setting of sepsis &amp; microperforations 6 weeks after extensive bowel surgery. CASE DESCRIPTION/METHODS: The patient's Crohn's disease was diagnosed 10 years ago, treated initially with 6-MP, azathioprine, 5-ASA &amp; later with biologics &amp; steroids all of which provided minimal relief. Prior to undergoing surgery, she had daily complaints of RLQ abdominal pain with MRI suggestive of significant ileocolitis with fistulae. She underwent successful ileocolectomy &amp; fistula stricturoplasties with remarkable improvement in symptoms in the 3 weeks post-op. However, 6 weeks post-op her condition worsened again with new onset of pain, fever, tachycardia, hypotension and imaging concerning for perforated bowel. She was thus readmitted with admission blood cultures revealing Actinomyces odontolyticus bacteremia. Abdominal CT showed possible small perivesicular fluid collection. Repeat blood cultures on antibiotics remained sterile &amp; the patient was discharged on antibiotics. Local anaerobic cultures from the neo-terminal ileum on repeat colonoscopy with biopsy 6 weeks post-op were also found to be sterile, with no evidence of actinomyces on pathology indicating possible clearance of local infection on antibiotics. DISCUSSION: We describe an unusual complication of Crohn’s disease: abdominal Actinomyces infection presenting with bacteremia. Actinomyces spp. are anaerobic gram-positive bacilli, most commonly found as part of normal flora of the oral cavity; it can also colonize the pharynx, other parts of the GI tract, GU system and the skin. It becomes virulent if introduced into deeper tissues through disruption of mucosal surfaces. Actinomyces often mimics other intra-abdominal conditions such as Crohn’s through the formation of fistulas &amp; sinus tracts. The patient’s postoperative Crohn’s recurrence at the neo-terminal ileum confirmed on imaging paired with positive blood cultures in the setting of sepsis, raises a strong suspicion of infection due to Actinomyces spp. as the cause for worsening Crohn’s disease. This case suggests that abdominal actinomyces infection can be an unusual complication of Crohn’s disease and presents a diagnostic dilemma for clinicians given overlapping clinical &amp; imaging findings. Gram stain and anaerobic culture remain the gold standard for the diagnosis of actinomyces &amp; penicillin is usually the treatment of choice.

The clinical characteristics and surgical results of smoking-related young pneumothorax.

Primary spontaneous pneumothorax is a common disease that develops in relatively young healthy patients. Although smoking is generally believed to have a negative effect on the lungs, some authors reported that smokers with primary spontaneous pneumothorax had significantly lower postoperative recurrence rates than nonsmokers. This unexpected result suggests that primary spontaneous pneumothorax is classified into two categories: smoking-related young pneumothorax and residual primary spontaneous pneumothorax. We compared these two categories to determine their characteristics and corresponding surgical results. Between January 2009 and December 2018, we enrolled 267 consecutive cases that underwent first surgery for primary spontaneous pneumothorax in our hospital. A total of 252 eligible cases (211 residual primary spontaneous pneumothorax and 41 smoking-related young pneumothorax) underwent evaluation. Smoking-related young pneumothorax cases were defined as cases with characteristic HRCT findings and smoking habit. The mean ages for the residual primary spontaneous pneumothorax and smoking-related young pneumothorax groups were 25.9 ± 13.1 and 30.5 ± 6.9years, respectively. The groups included 186 (88.2%) and 41 (100.0%) men, and the mean body mass indices were 19.1 ± 2.2 and 20.0 ± 1.9, respectively. Fifty-nine (28.0%) and 41 (100.0%) subjects were smokers, and there were 43 (20.4%) and 1 (2.4%) cases of postoperative recurrence, respectively. These results were significantly different between the two groups. Individuals with smoking-related young pneumothorax were older, predominantly men, and had higher body mass index and significantly lower postoperative recurrence rates than those with residual primary spontaneous pneumothorax.

Excellent Long-Term Prognosis and Favorable Postoperative Nutritional Status After Laparoscopic Pylorus-Preserving Gastrectomy.

Laparoscopic pylorus-preserving gastrectomy (LPPG) has been introduced as a minimally invasive function-preserving operation for early gastric cancer (GC). This study aimed to investigate the surgical and prognostic outcomes after LPPG at the authors' institution. This study analyzed 465 patients who underwent LPPG for cT1 N0 GC located in the middle part of the stomach between 2006 and 2012. Short- and long-term surgical outcomes including 5-year survival rates, postoperative nutritional data, and body weight change were retrospectively investigated. Regarding short-term surgical results, 14 (3%) of the 465 patients had severe complications classified as Clavien-Dindo grade 3a or above, and no mortality occurred (no in-hospital deaths). The median follow-up period was 1829 days (range 226-3197 days), and the 5-year overall survival and relapse-free survival rates were respectively 98% (95% confidence interval [CI] 96.1-99.0%) and 98% (95% CI 96.1-99.0%). Only two cases of postoperative recurrence were confirmed, and their recurrence sites were not in the remnant stomach or regional lymph nodes. The postoperative nutritional status, in terms of serum total protein, albumin, and hemoglobin levels, was well maintained, and the mean relative body weight (postoperative/preoperative) was 93.24±7.29% after LPPG. For the first time, we have clarified the detailed long-term survival outcomes of LPPG for cT1 N0 GC. LPPG is an acceptable and favorable operative method for clinically diagnosed early-stage GC, in terms of long-term survival and postoperative nutrition.

Diagnosis and Management of Cervical Thymic Cysts in Children

We present the case of a 10-year-old boy with the sudden onset of a large, painless left neck mass. Findings on magnetic resonance imaging (MRI) and fine needle aspiration (FNA) biopsy suggest a cystic lesion, most likely of thymic origin. Cervical thymic cysts are a rare form of cervical mass, which are easily overlooked in the differential diagnosis of children presenting with painless neck masses. A combination of CT and MRI investigations can be helpful in differentiating thymic cysts from other congenital and neoplastic masses, but the definitive diagnosis of thymic cyst requires histopathological documentation of thymic tissue. Surgical excision is considered the management of choice for thymic cysts, and no cases of postoperative recurrence have been reported.

クリゾチニブで肝機能障害と薬疹を生じたがアレクチニブは安全に投与可能であったALK融合遺伝子転座陽性術後再発肺癌の1例

背景．クリゾチニブにより薬疹と肝障害を発症した患者への，アレクチニブの安全性は不明である．症例．65歳女性．肺腺癌（cT1aN0M0 Stage IA）の診断で，胸腔鏡下右肺上葉切除術とリンパ節郭清を施行した．pT1aN2M0 Stage IIIAのため術後補助療法を行ったところ，軽度の薬剤性肝障害を生じた．術後約3年後，縦隔リンパ節に再発を認めたため手術検体を用いてEML4-ALK遺伝子検査を行い，転座陽性であった．クリゾチニブ内服約1週間後に薬疹と肝障害を認め，減量・隔日投与を行うも改善なく中止となった．血清CEA値上昇と腫瘍増大を認めたため，放射線治療を行った後にアレクチニブを開始した．腫瘍縮小を示し，肝機能異常も生じていないため治療を継続している．結論．クリゾチニブによる薬疹や肝障害を来しても，アレクチニブは安全かつ有効に使用できた．