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Purpose The differences in tumor behavior between adenocarcinoma (AC) and squamous cell carcinoma (SCC) of the esophagogastric junction (EGJ) have yet to be well investigated. The purpose of this study was to gain insights that can contribute to tailored treatments and follow-up strategies by analyzing the correlation between histological subtypes and oncological outcomes. Methods A retrospective analysis was used to determine the characteristics of the histological subtypes of EGJ cancer by comparing the appearance of postoperative recurrence. A total of 102 consecutive patients with pathological stage IIA to IVA EGJ cancer, who underwent R0 surgery in our department from 2004 to 2020, were enrolled. The recurrence pattern, timing, survival, and potential prognostic factors were compared. Results After a median follow-up time of 70.1 months, the AC group demonstrated comparable lymph node failure-free survival (P = 0.291) and significantly worse non-lymphogenous recurrence-free survival (P = 0.035) than did the SCC group. A significantly longer period from surgery to recurrence was also observed in the AC group (P = 0.029). Multivariate analysis indicated that histological subtype (P = 0.015, 95% CI 1.24–7.28) was significantly correlated with the incidence of non-lymphogenous recurrence. Conclusions The pattern and timing of postoperative recurrence were significantly different between the histological subtypes of EGJ cancer. Compared with EGJ SCC, EGJ AC may have a greater tendency toward non-lymphogenous progression and a greater propensity for longer surgery-to-recurrence periods.

Serum autoantibodies have been reported to react with tumor-associated antigens in various cancers. This study evaluated the diagnostic and prognostic significance of six autoantibody panels in esophageal squamous cell carcinoma. In this study, 193 patients with esophageal squamous cell carcinoma and 78 healthy controls were enrolled. Serum antibodies were detected using originally developed enzyme-linked immunosorbent assays to detect autoantibodies against the following tumor antigens: c-myc, p62, RalA, p53, Sui1, and NY-ESO-1. The positive rates of the six-autoantibody panel were compared with those of SCC antigen (SCC-Ag). The prognostic significance of these autoantibodies was also evaluated. The overall positive rate was significantly higher in the six-autoantibody panel than in SCC-Ag (72% vs. 28%;  < 0.01). The positive rates of the six-autoantibody panel were 71% in stage 0/I, 73% in stage II, and 71% in stage III. No clinicopathological factors were associated with autoantibodies. Although the difference was not significant, the overall survival of the autoantibody-positive group was worse than that of the autoantibody-negative group (  = 0.14). The six-autoantibody panel was useful for detecting esophageal squamous cell carcinoma, particularly in stage 0/I; however, it showed limited prognostic significance.

In Japan, the standard treatment for stage II or III gastric cancer is D2 gastrectomy followed by administration of S-1 for one year. However, patients with stage III disease have unsatisfactory survival rates. The purpose of this study was to evaluate the efficacy and safety of neoadjuvant chemotherapy consisting of S-1 and oxaliplatin for advanced gastric cancer. Patients with cT4 or cN2–3 gastric cancer were scheduled to receive two courses of chemotherapy (130 mg/m2 oxaliplatin on Day 1, 80 mg/m2 S-1 per day twice daily for 14 days) followed by surgery. The primary endpoint was the R0 resection rate. The secondary endpoints were rates of completion of protocol treatment, pathological response, and adverse events; and 3-year overall survival, 5-year overall survival, and 5-year recurrence-free survival. Between May 2016 and March 2019, 30 patients were enrolled in the study, all of whom completed the protocol treatment. The R0 resection rate (primary endpoint) was 93.3% (95% confidence interval: 77.9–99.2). The pathological response rate was 63.3%. Grade 3–4 toxicities included anemia (3.3%), anorexia (6.7%), and fatigue (3.3%). Relative dose intensities were 91.2% and 94.2% for S-1 and oxaliplatin, respectively. Neoadjuvant S-1 and oxaliplatin is highly effective, achieving an acceptable R0 resection rate with relatively few severe toxicities and good compliance.Trial registration: Registry name: A prospective intervention study on the availability of preoperative SOX therapy for T4 or N2-3 gastric cancer. Trial ID: UMIN: UMIN000024656. https://upload.umin.ac.jp/cgi-open-bin/ctr/ctr_view.cgi?recptno=R00002836

Gastric cancer with Virchow's lymph node metastasis (LNM) is not indicated for initial curative surgery. Although there have been some case reports of curative resections after pre-operative treatment, including immune checkpoint inhibitors (ICIs), there is no consensus regarding the optimal timing of surgery. We describe a rare case of initially unresectable gastric cancer treated preoperatively with nivolumab combined chemotherapy, which achieved a pathologically complete response. An 82-year-old man was referred for gastric cancer treatment. Contrast-enhanced computed tomography revealed stomach wall thickening and swollen left supraclavicular LN. This gastric cancer was assessed as unresectable due to the presence of Virchow's LNM; therefore, chemotherapy and ICI using S-1 plus oxaliplatin plus nivolumab were administered. After three courses of treatment, the primary tumor and Virchow's LN showed a marked reduction in size. The patient underwent Virchow's LNM resection as a preliminary step to determine indications for curative surgery. A pathological examination revealed no viable cancer cells were found inside the resected LN. The patient underwent distal gastrectomy. Pathological examination revealed complete degeneration of the primary tumor and regional LN without residual carcinoma. The patient did not receive adjuvant chemotherapy and survived with no evidence of recurrence for one year after the initial treatment.

Background Chemotherapy with or without surgery is the first-line treatment for stage III/IV gastric cancer, while surgery is the first-line treatment for stage I/II gastric cancer. Accordingly, it is important to distinguish between stage III/IV and stage I/II gastric cancer, but clinical staging is less accurate than pathological staging. This study was performed to develop a clinical score that could distinguish stage III/IV gastric cancer from stage I/II gastric cancer. Methods We reviewed 2722 patients who underwent gastrectomy at our hospital from January 1996 to December 2015. As pretreatment factors potentially related to tumor stage, we assessed age, sex, tumor markers, tumor diameter, tumor location, tumor histology, and macroscopic type. Factors showing significance on multivariate analysis were used to develop the Clinical Stage Prediction score (CSP score), and a cutoff value for the score was determined by receiver operating characteristics analysis. Results According to multivariate analysis, clinical factors associated with stage III/IV disease were elevation of the carcinoembryonic antigen level, tumor diameter ≥ 60 mm, circumferential gastric involvement, esophageal infiltration, mucinous adenocarcinoma, and macroscopic types 2–4. The CSP score was obtained by weighting these factors according to the non-standardized β-coefficient. Receiver operating characteristics analysis indicated that the optimum cutoff value of the CSP score was 17 points. Among 1042 patients with a CSP score ≥ 17 points, 820 patients (78.7%) had stage III/IV gastric cancer. Conversely, among 1680 patients with a CSP score < 17 points, 1547 patients (92.1%) had stage I/II gastric cancer. When discrimination of stage III/IV gastric cancer from stage I/II gastric cancer by the CSP score was assessed, the sensitivity was 78.7%, specificity was 92.1%, positive predictive value was 86.0%, and negative predictive value was 87.5%. Conclusions The CSP score can be helpful for differentiating stage III/IV gastric cancer from stage I/II gastric cancer based on pretreatment clinical factors.

Abstract Leiomyosarcomas (LMS) of the ovarian vein are extremely rare and have a poor prognosis. Only 10 cases have been reported since 1977. The patient is a 69-year-old woman presented with right abdominal pain. Computed tomography showed a regularly shaped tumor, 80 mm in diameter in the retroperitoneum, adjacent to the descending part of the duodenum. Intraoperatively, the right ovarian vein was found to run through the tumor and was, therefore, resected together with the tumor. Pathological examination revealed a LMS of the right ovarian vein. Nine months postoperatively, multiple lung metastases were detected and chemotherapy was initiated. Delayed diagnosis is associated with high mortality. It is important that the diagnosis of LMS should be made preoperatively when you have already diagnosed a tumor to better direct the surgical approach. Multimodal therapy may improve prognosis.

Esophageal neuroendocrine carcinoma (NEC) is known for its aggressive behavior and poor prognosis. However, the characteristics of this disease remain unclear owing to its rarity. A 59-year-old male with an esophageal submucosal tumor-like lesion was referred to our department. Esophagogastroduodenoscopy revealed a protruding lesion in the lower esophagus and a wide range of patchy staining in the middle to lower esophagus after iodine spraying. Biopsies yielded a diagnosis of neuroendocrine carcinoma with suspicion of peripheral extension. Robot-assisted subtotal esophagectomy was performed, and histopathological examination confirmed a diagnosis of large-cell neuroendocrine carcinoma (LCNEC) accompanied by pagetoid spread of 13 cm in length. No recurrence has been observed during 24 months of follow-up. To the best of our knowledge, this is the first report of esophageal NEC with pagetoid spread. We conducted a literature review of NEC with pagetoid spread in various organs and analyzed 16 cases, including the present case. Pagetoid spread is a distinctive characteristic of NECs, especially LCNEC, arising in various organs, including the esophagus. Attention to this characteristic is warranted because it results in undetected cancer spread, which may lead to complications of incomplete therapies or tumor relapses.

This study aimed to evaluate the long-term survival outcomes from our previous study: a phase II study of neoadjuvant chemotherapy with S-1 plus oxaliplatin for cT4 or N2-3 advanced gastric cancer. The patients with clinical T4 and/or N2 or more lymph nodes received two cycles (3 weeks per cycle) of neoadjuvant chemotherapy with S-1 plus oxaliplatin (oxaliplatin at 130 mg/m2 on day 1 and S-1 at 80-120 mg/day on days 1 to 14), followed by gastrectomy with D2 lymphadenectomy. The final preplanned analysis of long-term outcomes, including overall and relapse-free survival, was performed. This trial has been completed and registered with the University Hospital Medical Information Network Clinical Trials Registry under number UMIN 000024656. Between May 2016 and March 2019, 30 patients were enrolled. All patients completed the protocol. After a median follow-up of 50 months for surviving patients, the 3-year overall and recurrence-free survival rates were 80.0% and 76.7%, respectively, at the last follow-up in March 2023, whereas the 5-year overall and recurrence-free survival rates were 72.7% and 73.0%, respectively. The administration of two cycles of neoadjuvant chemotherapy with S-1 plus oxaliplatin, followed by D2 gastrectomy, was associated with relatively good long-term oncologic outcomes for patients with high-risk gastric cancer.

A few studies have reported the relation between the atlantoaxial (C1/2) angle and cervical alignment (C2–C7) angle after a Magerl and Brooks (M&B) surgical procedure to treat atlantoaxial subluxation (AAS) in patients with rheumatoid arthritis (RA). However, no study has examined an optimum preoperative C1/2 angle reduction. We aimed to assess the relation between the C1/2 angle reduction and the C2–C7 angle change in patients with progressive RA who underwent the M&B procedure. We retrospectively analyzed the relation between the preoperative C1/2 angle and C2–C7 angle in 28 consecutive RA patients using their clinical and radiological data. Differences in the preoperative and postoperative C1/2 and C2–C7 angles were detected. Correlations of these angles and the reduced degree of angles were examined. The Ranawat grading scale and Japanese Orthopaedic Association (JOA) scores were used to determine myelopathy. Pain was categorized into five categories according to severity. Clinical and Xray evaluations were collected before surgery, at 3 and/or 6months after surgery, and at final follow-up. Clinical symptoms, Ranawat grade, and JOA scores improved postoperatively, and patients achieved bony union within 3months. We observed a strong and significant correlation between the reduced C1/2 angle and the change in the C2–C7 angle. Patients with a preoperative C1/2 angle of <20° had markedly reduced cervical lordotic angle but this condition was not seen in patients with a preoperative C1/2 angle of ≥20°. The optimum C1/2 angle was estimated as [20°−(preoperative C1/2 angle)] in patients with a C1/2 angle <20° or as an in situ angle in patients with a C1/2 angle of ≥20°. Surgeons performing the M&B procedure need to select patients carefully and avoid complete or overreduction of the C1/2 angle to prevent serious postoperative SAS and myelopathy.

Superficial duodenal epithelial tumors were previously considered rare. Laparoscopic and endoscopic cooperative surgery for duodenal tumors (D-LECS) has been developed to achieve successful endoscopic treatment. Patients who have undergone living-donor liver transplantation (LDLT) may have severe abdominal adhesions, and immunosuppressive agents (IAs) may affect the degree of postoperative abdominal adhesions and wound healing, but their effects remain unclear. Herein, we present the first case of D-LECS for duodenal adenoma after LDLT. A 66-year-old man underwent D-LECS for a non-ampullary duodenal high-grade adenoma after LDLT with an IA. The patient’s condition was uneventful 36 months after the surgery. In gastrointestinal surgery, IAs may affect the resected duodenal repair process. For duodenal neoplasms in high-risk patients, D-LECS may be better than endoscopic submucosal dissection alone. D-LECS after LDLT is a feasible and less invasive procedure.