Niigata Cancer Center Hospital

Megaprosthetic reconstruction has become the standard method for resecting bone and soft tissue tumors. However, the long-term functional outcomes and complications have not yet been sufficiently investigated. This study aimed to address a gap in the literature by analyzing patients who underwent tumor prosthesis of the hip or knee and were followed up for over 30years. We retrospectively analyzed 10 patients who underwent megaprosthetic reconstruction of the hip or knee between 1986 and 1995 at two institutions in Japan, with a minimum follow-up of 30years. Patient characteristics, complications, reoperation, and Musculoskeletal Tumor Society (MSTS) scores were reviewed. The long-term risks of reoperation, major revision, and deep infection were assessed. This study included seven distal femoral, two proximal femoral, and one proximal tibial reconstructions (median age at surgery, 22years). Histologically, the tumors were predominantly osteosarcomas (n=7). Eight of the 10 patients (80%) developed complications, with a median of 1.5 reoperations (range, 1-5). Major revisions occurred in five patients, including four with stem fractures and two with deep infections. The median overall reoperation-free survival was 16.2years (95% confidence interval, 2.4-24.2). At the final follow-up, all patients remained ambulatory, and the median MSTS score was 75.0% (range, 53.3-96.7). Despite the occurrence of frequent late complications, considerably long-term survivors following tumor endoprosthetic reconstruction in this small cohort were able to preserve ambulatory function for more than three decades, suggesting the effectiveness of this method while underscoring its lifelong risks and the necessity of long-term follow-up.

Total gastrectomy (TG) is commonly performed as the standard treatment for upper third advanced gastric cancer (AGC). Proximal gastrectomy (PG) may be a potential alternative procedure for upper-third AGC. However, its oncologic safety remains uncertain. This study aimed to compare the long-term outcomes of PG and TG for upper-third AGC and to evaluate the oncological safety of PG. We retrospectively analyzed the data of patients who underwent PG or TG for clinical T2-T4aNanyM0 upper-third gastric cancer at six institutions between 2018 and 2022. To minimize selection bias, propensity score matching (PSM) was performed at a 1:1 ratio. The primary endpoint was overall survival (OS). A total of 208 patients with upper-third AGC were included. After PSM, 104 patients were selected for analysis, with 52 patients in each group. The 3-year OS rates were 81.8% in the PG group and 70.8% in the TG group, with no statistically significant difference between the two groups (P =.167), with a hazard ratio for PG of 0.58 (95% confidence interval, 0.27-1.27; P =.173). Subgroup analysis revealed that the hazard ratio for OS was significantly lower in the PG group than in the TG group among patients with tumor diameters <50mm. The long-term survival outcomes of PG and TG for upper-third AGC patients are comparable, suggesting that PG may be an oncologically acceptable option in carefully selected patients.

Abstract We analyzed the differences in bacterial composition between 475 Japanese patients with advanced gastric cancer (median age 70 years, median BMI 20.0) and 106 healthy individuals using a comprehensive metagenome shotgun analysis. Among the patients with advanced gastric cancer, 71% were male, 37.% patients had relapsed, and 55.5% previously underwent gastrectomy. Bifidobacterium , Anaerostipes , and Parabacteroides were predominant in healthy individuals, whereas Streptococcus , Lactobacillus , and Odoribacter were predominant in patients with advanced gastric cancer. Additionally, Kyoto Encyclopedia of Genes and Genomes pathway analysis showed that butanoate and pyruvate metabolism was enriched in healthy individuals, whereas factors such as ABC transporters and ribosomes were enriched in patients with advanced gastric cancer. Clustering analysis broadly classified patients with advanced gastric cancer and healthy individuals into two clusters; however, clustering using pathway data enabled a clearer classification of patients with advanced gastric cancer and healthy individuals than clustering using flora analysis. Moreover, healthy individuals showed higher bacterial flora diversity than patients with advanced gastric cancer. Thus, we successfully identified the molecular characteristics of microbial genera and functional pathways in the gut of patients with advanced gastric cancer. Our results suggest that fecal metagenomic shotgun sequencing analysis can be used to detect gastric cancer.

This study aimed to determine the natural course of moderate adolescent idiopathic scoliosis (AIS) in terms of curve progression and health-related quality of life (HRQOL). The inclusion criteria were nonoperatively treated patients with AIS who had a major curve between 30° and 40° at skeletal maturity (Risser ≥ 4) and age ≥ 30 years at the survey. Fifty-eight patients (55 women) were included (follow-up rate, 37.4%). The mean age was 14.2 years at skeletal maturity and 39.9 years at the survey, with a mean 25.7-year follow-up. The HRQOL scores were compared with age- and sex-matched healthy volunteers (n = 112). The median magnitude of the major curve was 36.5° at skeletal maturity (n = 58), 40° at the age of 18 years (n = 30), and 45.5° at the survey (n = 47) with a progression rate of 0.5°/year. The major curve at the survey was over 50° in 46.7% of patients, 82.4% of whom had already had major curves ≥ 40° at the age of 18 years. Despite their curve progression, patients demonstrated comparable HRQOL scores with control participants, except for the SRS-22 self-image score (AIS 2.8 vs. Control 3.4, p < 0.001). Moderate AIS progressed slowly but significantly throughout adulthood. Over 40% of the curves were > 50° during the mean 25-year follow-up period. Although the HRQOL scores of adult patients with moderate AIS at skeletal maturity were comparable with those of the controls, their cosmetic concerns could not be disregarded. Therefore, moderate curves, especially those ≥ 40° at the age approximately 18 years, warrant long-term follow-up.

Abdominoperineal resection with permanent colostomy has historically been performed for very low rectal cancer located near the anal canal. Anus-preserving surgeries, such as intersphincteric resection (ISR) and low anterior resection (LAR), have recently become more common. However, postoperative anal function is a concern in these surgeries when the anastomosis is very low. The aim of this study was to examine changes in anal function and factors that worsen anal function after surgery for rectal cancer. A multicentre (47 facilities), non-randomized, single-arm phase II trial was conducted prospectively using the Wexner score questionnaire between 2014 and 2017. A total of 278 patients who underwent laparoscopic surgery for clinical Stage I very low rectal cancer were analysed using a mixed-effects model. Anal function temporarily worsened 3 months after surgery, but gradually recovered and spontaneously returned to an acceptable level in 3 years. In a comparison of surgical procedures, anal function was significantly better after LAR than after any type of ISR. There was little difference in anal function after total ISR, subtotal ISR and partial ISR. In the mixed-effects model analysis, ISR and older age (≥75 years) were identified as independent factors that worsened postoperative anal function. The results showed early deterioration of anal function followed by gradual improvement to an acceptable level after surgery. There is a higher risk of poor postoperative anal function after ISR and in older patients, and these risk factors should be communicated to patients when obtaining consent for the surgery.