Patients with SRC histology do not have a worse prognosis than patients with other types of gastric carcinoma.

The aim of the present study was to evaluate the expression of standard CD44 (CD44s) in colorectal cancer (CRC), its relationship with clinicopathological characteristics, and its potential prognostic significance. CD44s levels were measured on immunohistochemistry in tumors and surrounding normal mucosa from 74 patients with primary colorectal carcinomas. The patients were followed for a median period of 37 months. Expression of CD44s in primary tumor and surrounding normal mucosa tissues was demonstrated in 100% (74/74) and 37.9% (28/74), respectively. The expression of CD44s in tumors was significantly associated with the depth of invasion (P = 0.034) and lymph node involvement (P = 0.031). A significant difference was observed between the overall survival and level of tumor CD44s expression, especially for stage IV carcinoma (P = 0.038). Multivariate analysis indicated that TNM stage (P = 0.020) and tumor CD44s expression (P = 0.008) were independent predictors of overall survival in adenocarcinomas. CD44s overexpression may be an independent unfavorable prognostic factor for overall survival in advanced CRC, especially stage IV disease. Further investigation, however, is necessary to assess the biological roles of CD44 in CRC, and validate their possible value as novel therapeutic targets.

Situs inversus totalis is a rare anomaly in which the abdominal and thoracic cavity structures are opposite their usual positions. A 41-yr-old woman, who had an ulcerating cancer on the rectum, was found as a case of situs inversus totalis. We present an overview of the operative technique for the first documented laparoscopic total mesorectal excision of a rectal cancer in the patient with situs inversus totalis. Careful consideration of the mirror-image anatomy permitted a safe operation using techniques not otherwise different from those used for the general population. Therefore, curative laparoscopic surgery for rectal cancer in this patient is feasible and safe.

In patients with EGC, the survival rate of patients with positive lymph nodes is significantly worse than that of patients with no lymph node metastasis. Therefore, a standard D2 lymphadenectomy should be performed in patients at high risk of lymph node metastasis: large tumor size, undifferentiated histologic type and submucosal invasion.

Patients with T4 gastric carcinoma might be benefited from curative resection. The results also emphasize the improved survivorship of T4 gastric carcinoma patients with resection compared with those who did not undergo resection. Although curative resection cannot be undertaken in patients with T4 gastric carcinoma, we recommend performing resection in patients with locally advanced gastric carcinoma, regardless of curability.

The results highlight the improved survivorship of gastric carcinoma patients with palliative resection compared to those who did not undergo the procedure. Although curative resection is not possible in this group of patients, we recommend performing resection aimed at palliation.

The poor prognosis of PGC is mainly due to its more advanced stage at diagnosis compared with that of more distally located gastric carcinoma. Early detection is important for improving the prognosis of patients with proximal third gastric carcinoma.

PurposeDownstaging after chemoradiotherapy (CRT) for rectal cancer usually occurs. The present study aimed to evaluate pathologic y-stage (yp-stage) and its influence on local recurrence and systemic recurrence in rectal cancer patients treated with CRT followed by surgical resection.MethodsWe retrospectively analyzed 261 patients underwent preoperative CRT and radical resection for rectal cancer between August 2004 and December 2010. Patients received preoperative CRT consisting of 5-fluorouracil and leucovorin delivered with concurrent pelvic radiation of 45.0-50.4 Gy, followed by radical surgery at 6-8 weeks after CRT.ResultsOf the 261 patients, 24 (9.2%) had yp-stage 0, 83 (31.8%) had yp-stage I, 86 (32.9%) had yp-stage II, and 68 (26.1%) had yp-stage III. Patients with yp-stage III had a greater prevalence of preoperative CEA, poorly differentiated tumor, lymphovascular invasion (LVI) and perineural invasion (PNI) than patients with lower yp-stages. We found that yp-stage, preoperative CEA, LVI, PNI and tumor regression grade were significant prognostic factors for both local and systemic recurrence. In multivariate analysis, yp-stage, LVI and PNI were significant factors for local and systemic recurrence. During the median follow-up of 37.5 months, the five-year local recurrence-free survival rate was 100.0%, 95.0%, 89.3%, and 80.6% of yp-stage 0-III, respectively. The five-year systemic recurrence-free survival was 95.8%, 75.3%, 71.4%, and 48.8% of yp-stages 0-III, respectively.ConclusionThe yp-stage after preoperative CRT for rectal cancer is closely correlated with local and systemic recurrence-free survival. Therefore, yp-stage should be considered as a prognostic factor for rectal cancer patients having a course of preoperative CRT.