The LNR was a risk factor for overall survival in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. It is necessary to develop strategies to effectively utilize the lymph node metastasis status.

Background/Aim: Postoperative pneumonia after esophageal cancer can lead to additional pain, prolonged hospital stay, and respiratory failure. These adverse events might lead to early recurrence and/or death. We investigated the influence of postoperative pneumonia on the esophageal cancer survival and recurrence after curative surgery. Patients and Methods: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into: i) those with postoperative pneumonia (pneumonia group) and ii) those without postoperative pneumonia (non-pneumonia group). The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. Results: Postoperative complications were found in 34 of the 122 patients (27.9%). The OS rate at 5 years following surgery was 28.2% in the pneumonia group and 55.1% in the non-pneumonia group (p=0.006). The RFS rate at 5 years after surgery was 18.9% in the pneumonia group and 49.2% in the non-pneumonia group (p=0.061). A multivariate analysis showed that postoperative pneumonia was a significant independent risk factor for OS. Conclusion: The development of postoperative pneumonia was a risk factor for a decreased overall survival in patients who underwent curative surgery for esophageal cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned in order to avoid postoperative pneumonia.

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Background Most evidence regarding lateral lymph node dissection for rectal cancer is from expert settings. This study aimed to evaluate the safety and efficacy of this procedure in a practice-based cohort. Methods A total of 383 patients who were diagnosed with stage II–III mid-to-low rectal cancer between 2010 and 2019 and underwent primary resection with curative intent at a general surgery unit were retrospectively reviewed. After propensity matching, 144 patients were divided into the following groups for short- and long-term outcome evaluation: mesorectal excision with lateral lymph node dissection (n = 72) and mesorectal excision (n = 72). Results This practice-based cohort was characterized by a high pT4 (41.6%) and R1 resection (10.4%) rate. Although the operative time was longer in the lateral dissection group (349 min vs. 237 min, p < 0.001), postoperative complications (19.4% vs. 16.7%, p = 0.829), and hospital stay (18 days vs. 22 days, p = 0.059) did not significantly differ; 5-year relapse-free survival (62.5% vs. 66.4%, p = 0.378), and cumulative local recurrence (9.7% vs. 15.3%, p = 0.451) were also in the same range in both groups. In the seven locally recurrent cases in the lateral dissection group, four had undergone R1 resection. Conclusions Lateral lymph node dissection was found to be safe in this practice-based cohort; however, the local control effect was not obvious. To maximize the potential merits of lateral lymph node dissection, strategies need to be urgently established to avoid R1 resection in clinical practice.

Gastric cancer is the fifth most common cancer in the world and the third leading cause of cancer-related death (1). The outcomes of gastric cancer have been improved by gastrectomy with D2 lymph-node dissection and advances in chemotherapy (2). The Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer (ACTS-GC) demonstrated that 1 year of adjuvant chemotherapy with S-1, an oral fluoropyrimidine, significantly improves outcomes in patients with stage II/III gastric cancer who undergo gastrectomy with D2 dissection (3). However, recurrence rates after curative resection and adjuvant chemotherapy remain high in gastric cancer. In the ACTS-GC study, the 5-year overall survival (OS) rate was 84.2% in those with stage II disease, 67.1% in those with stage IIIA disease, and 50.2% in those with stage IIIB disease, even after adjuvant chemotherapy with S-1 (4). Further improvements in outcomes are likely to require personalized therapy based on biomarker analysis.We have searched for biomarkers of gastric cancer using DNA microarray analysis in patients with stage II/III gastric cancer who underwent curative resection and received adjuvant chemotherapy with S-1. We found that expression of the human tensin 4 (TNS4) gene in gastric cancer tissue was 23.52-times higher than that in paired adjacent normal mucosa (unpublished data). We, thus, focused on the clinical significance of TNS4 gene expression in gastric cancer.TNS4 is a member of the tensin gene family (5) and is also known as COOH-terminus tensin-like molecule (CTEN) (6). This gene family comprises four members (TNS1, TNS2, TNS3, and TNS4) and their products are localized in the cytoplasmic tails of integrins at focal adhesions. Tensins play important roles in various biological processes, such as cell adhesion, migration, proliferation, differentiation, apoptosis, and invasion (6-9). TNS4 expression is up-regulated in many cancer types (10)(11)(12)(13)(14), suggesting that overexpression of TNS4 may play a critical role in tumorigenesis.In this study, we evaluated the clinical significance of the relative expression of TNS4 in patients with stage II/III gastric cancer who underwent curative resection followed by adjuvant chemotherapy with S-1.

Background/Aim: We investigated the impact of Beppu's nomogram on colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. Patients and Methods: This study included 43 patients who underwent primary hepatic resection for colorectal liver metastasis at the Kanagawa Cancer Center from June 2006 to March 2011. The patients were classified as having a Beppu's nomogram score ≤9 (low-risk group) or ≥10 (high-risk group). The risk factors for the disease-free survival (DFS) were identified. Results: The respective DFS rates at 1, 2, and 3 years after surgery were 72.0%, 43.3%, and 17.3% in the low-risk group and 27.8%, 16.7%, and 8.3% in the high-risk group, the difference being significant (p=0.009). The multivariate analysis showed that Beppu's nomogram score ≥10 was a significant independent risk factor for the DFS. Conclusion: Beppu's nomogram score was an independent prognostic factor for colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. Thus, Beppu's nomogram might be a useful tool for predicting the risk of recurrence after hepatectomy, even in the era of newly-developed chemotherapy.

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234 Background: Overexpression of microRNA-21(miR-21) in pancreatic cancer has been reported to be associated with tumor cell proliferation, invasion, and also resistance to gemcitabine (GEM) chemotherapy. The aim of this study was to evaluate whether miR-21 expression, determined by microRNA ISH, was associated with clinical outcomes of pancreatic cancer patients who underwent adjuvant gemcitabine chemotherapy after curative surgery. Methods: Expression levels of miR-21 were semi quantitatively analyzed for staining intensity and distribution of positive tumor cells, by microRNA ISH in formalin-fixed paraffin embedded tissue arrays from 41 pancreatic cancer patients who underwent adjuvant GEM chemotherapy after curative resection at Kanagawa Cancer Center. The staining intensity for the miR-21 was assigned a score from 1 to 3 based on staining with1+: weakly, 2+: moderately, and 3+: strongly positive. The percentage of positive tumor cells was scored as follows, 1+: < 50% positive cells, 2+: 50-80% positive cells, and 3+: ³a 81% positive cells. A composite score was obtained by calculating the sum of these two scores. Results: 27 patients were assigned to low miR-21 expression group (score <4) and 14 patients to high miR-21 group (score 4,5,6). High miR-21 expression group had a significantly shorter DFS (P = 0.039, by log-rank test). The median DFS was 9.8 months (95% CI, 6.9-12.6) in the low miR-21 group, and 7.9 months (95% CI, 6.1-9.8) in the high miR-21 group. The median OS was 19.6 months (95% CI, 6.3-32.8) in the low miR-21 group, and 15.1 months (95% CI, 11.7-18.5) in the high miR-21 group, but was not significant. Multivariate analysis including miR-21 expression, microscopic lymphatic invasion and microscopic perineural invasion, indicated that miR-21 expression (p = 0.024) and microscopic lymphatic invasion (p = 0.035) were the independent predictor for DFS. Conclusions: A high level of miR-21 expression in pancreatic cancer was significantly associated with shorter DFS in patients who received adjuvant GEM after curative resection. miR-21 ISH analysis may serve as a significant predictor for GEM resistance in adjuvant setting.