Search

With the advancement of endoscopic resection(ER)of colorectal cancer, surgical resection after ER has been increasing. This study evaluated the effects of initial ER on short- and long-term outcomes in T1b colorectal cancer. This retrospective cohort study enrolled patients with pathological T1b colorectal cancer who underwent colorectal surgical resection between 2008 and 2018. A total of 239 eligible patients were divided into 2 groups: patients initially treated using surgical resection with lymph node dissection(LND)(surgery alone, n=142)and patients treated using initial ER and additional surgical resection with LND(surgery after ER, n=97). No significant differences were observed in short-term outcomes(ie, operative time, blood loss, or postoperative complications)or the long-term outcomes(ie, recurrence rate, overall survival rate, or recurrence free survival rate)between groups.

In cases where carcinomatous meningitis leads to hydrocephalus and increases intracranial pressure, patients present with exacerbated pain and several neurological symptoms. It is reported that multidisciplinary therapy, including radiation therapy, drug therapy, and surgery, is performed for patients with carcinomatous meningitis; however, it is rarely successful. Ventriculoperitoneal shunting(V-P shunt)is a surgical intervention that might relieve the pain temporarily and improve the quality of life. VPS should be taken into consideration in line with patients' and their families' intentions since the overall survival is fairly short.

An 83-year-old woman was given a diagnosis of gastric cancer and received distal gastrectomy 9 years ago. Three years later, CT revealed a tumor measuring 13 mm in diameter in hepatic segment 7. She was followed for 5 years, and the size of the tumor did not change. Eight years later after gastrectomy, the tumor size slightly enlarged to 17 mm, and biopsy revealed adenocarcinoma. The patient underwent liver resection of segment 7. The pathological diagnosis was well differentiated intrahepatic cholangiocarcinoma(ICC). No sign of recurrence has been found during a 1-year. This case, in which the patient was followed for 5 years before curative surgical treatment, is significant, because it demonstrates the slow-growing nature of ICC.

Robot-assisted laparoscopic surgery(RALS)for rectal cancer has been covered by National Health Insurance in Japan since April 2018. We launched RALS in our hospital in October 2019 and now report the short-term results(up to January 2020). Altogether, 15 consecutive patients(12 men, 3 women: median age 70 years)with rectal cancer underwent RALS during that period. For the first 2 cases, we performed RALS under the instruction of an experienced proctor from another institution. Among the 15 patients, 6 underwent high anterior resection and 9 low anterior resection. Median operating time was 358 min, median intraoperative blood loss was 0 mL, and there were no apparent intraoperative complications. Median postoperative length of hospital stay was 13 days, and only 1 patient developed a high-grade complication(Clavien-Dindo Grade Ⅲb)postoperatively. Hence, RALS for rectal cancer was launched successfully in our institution.

Nodular lymphocyte-predominant Hodgkin lymphoma(NLPHL)is a subtype of Hodgkin lymphoma. It is uncommon in Japan, and only a few cases of NLPHL originating from the mesentery have been reported. Most patients with NLPHL present in the early stage, but some patients have malignancy at initial presentation. We should perform staging laparotomy for the diagnosis and treatment of cases in which a lymph node biopsy is difficult.

A phase-Ⅱtrial of TAS-102 plus bevacizumab(Bev)combination therapy showed a progression-free survival(PFS)of 3.7-4.6 months. Here, we report 12 cases of unresectable advanced recurrent colorectal cancer treated with TAS-102 plus Bev therapy at our hospital between June 2017 and February 2020. The median PFS was 6 months(2-12). Adverse events greater than Grade 3 were neutropenia(33.3%), febrile neutropenia(8.3%), thrombocytopenia(8.3%), and vomiting (8.3%). The frequency of non-hematotoxicity was low. In conclusion, the TAS-102 plus Bev therapy may be a useful option for the late-line treatment of unresectable advanced recurrent colorectal cancer.

A 66-year-old woman admitted for nausea was found to have a type 2 tumor with stenosis at the fourth portion of the duodenum by upper gastrointestinal series and endoscopy, which was diagnosed as an adenocarcinoma by endoscopic biopsy. Abdominal computed tomography(CT)showed an irregular thick wall at the fourth portion of the duodenum but without metastasis or invasion to the adjacent vessels. We examined the lymph nodes around the pancreatic head intraoperatively and partially resected the duodenum and jejunum based on the diagnosis of negative swollen nodes. The definitive diagnosis was primary tubular adenocarcinoma of the fourth portion of the duodenum, T3, N0, M0, Stage ⅡA. Reports of primary cancer of the fourth portion of the duodenum are very rare, and we include a discussion of the current literature.

A 71-year-old woman with advanced ascending colon cancer was admitted to our hospital. Abdominal computed tomography( CT)revealed locally advanced sigmoid colon cancer with suspected invasion of the liver and duodenum. The clinical stage of the disease was cT4bN3M1a, cStage Ⅳa, with wild-type RAS and UGT1A1 expression. An ileostomy was performed because of bowel obstruction. The patient received 6 courses of FOLFOXIRI plus bevacizumab(Bev). The only adverse event was Grade 3 neutropenia. Laparoscopic right hemicolectomy with lymph node dissection was performed. The pathological diagnosis was the absence of viable, Grade 3 carcinoma cells. This result suggested that preoperative FOLFOXIRI plus Bev chemotherapy is useful for the treatment of locally advanced colon cancer.

The standard treatment for unresectable or recurrent gastrointestinal stromal tumor(GIST)is tyrosine kinase inhibitor(TKI). It is reported that resection of metastatic lesions after TKI administration prolongs progression free survival, but its influence on overall survival is not clarified. We experienced a case of GIST with peritoneal dissemination for which TKI administration and 2 local resections were effective. The patient was a man in his 70's. We started chemotherapy with imatinib for GIST with peritoneal dissemination. However, it was discontinued due to the occurrence of interstitial pneumonia. Dissemination was evaluated as radically resectable on the images. After the interstitial pneumonia was alleviated, surgery was performed. Although sunitinib was introduced at 2 months postoperatively, recurrent peritoneal dissemination was detected at 32 months postoperatively, and treatment was then changed to regorafenib. Regorafenib treatment reduced the tumor size; however, Grade 3 albuminuria was detected 16 months after treatment initiation and, thus, this treatment was discontinued. Subsequently, the tumor enlarged again. Because there was only 1 recurrent lesion, we performed radical resection. Postoperatively, a reduced dose of regorafenib was re-administered. At present, 9 months after the re-surgery, the patient is alive without recurrence.

A 67-year-old woman presented with bloody stools to a local physician. Lower gastrointestinal endoscopy revealed a type 3 all-circumferential tumor at descending colon. She was diagnosed with descending colon cancer and referred to our hospital for surgery. Preoperative computed tomography(CT)revealed a horseshoe kidney. We performed single-incision laparoscopic colectomy for descending colon cancer(cT3cN0cM0, cStageⅡa)complicated by a horseshoe kidney. The surgery was performed safely without any additional injuries. In patients with horseshoe kidneys, abnormalities have been reported in the running of the blood vascular system and the renal pelvis and ureter systems. Thus, sufficient understanding of the anatomic abnormality by preoperative examinations, such as 3D-CT, is essential for performing surgery safely.

A 75-year-old man presented with a fever. Computed tomography revealed a 10 cm solid tumor under the duodenum. A pre-operative diagnosis of liposarcoma was established using biopsy. Pancreaticoduodenectomy was performed, and the pathological examination led to the diagnosis of dedifferentiation type liposarcoma. Two years later, the liposarcoma recurred at the remnant pancreas. A total remnant pancreatectomy was performed. The pathological examination revealed dedifferentiated type liposarcoma and positive surgical margins. Therefore, radiotherapy of 59.4 Gy in 33 fractions was performed at the recurrence area. The patient has been recurrence-free from 1 year 6 months since the second operation.

Chemoradiation was performed at Osaka Police Hospital's department of respiratory medicine on a 70-year-old male with small cell lung carcinoma(cT4N3M0, cStage ⅢC). Subsequent to secondary chemotherapy for multiple bone metastases that had been observed, he received care to control the disease. He arrived at the hospital complaining of epigastric pain. He got CT-scan and was referred to our department because of a suspected hematoma around the right gastroepiploic artery. He was treated conservatively because circulatory dynamics were steady and there was no indication that anemia had progressed. However, when a test laparotomy was performed the day after the start of treatment because he presented with decreased blood pressure and progressive anemia, a massive hematoma was found around the right gastroepiploic artery. The hematoma was removed, and hemostasis was performed. Based on the pathological findings of the excised specimen, he was diagnosed with abdominal metastasis of small cell lung carcinoma. This is a report on our experience and a literature review on a case of mesenteric hematoma caused by abdominal metastasis of small cell lung carcinoma.

We report a case of myeloid sarcoma(MS)that primarily developed in the spleen. The patient was a 60s man with a chief complainant of low-grade fever following a dental implant. Although he underwent intensive antibiotic treatment, including levofloxacin, meropenem, and vancomycin, no significant decline in fever was observed. Abdominal contrast-enhanced CT revealed an LDA occupying the majority of his spleen, which was diagnosed as a splenic abscess. Although a CT-guided biopsy and drainage for the spleen were considered, a puncture of the spleen was not performed due to the substantial concern of bleeding. Subsequently, a splenectomy was performed and HE staining revealed mitosis of tumor cells and massive necrosis. Immunohistochemical analysis revealed that the tumor cells were positive for myeloperoxidase, CD43, CD45, and CD68. Finally, the splenic LDA was diagnosed as MS instead of a splenic abscess. He was treated with systemic chemotherapy. MS primarily develops in the spleen is quite rare: we found only 2 case reports of this disease. The prognosis of MS is poor due to the complications of AML. Accordingly, MS should be considered as a differential diagnosis for accurate diagnosis and treatment of splenic LDA.

A 67-year-old woman who had been treated for cardiac sarcoidosis was diagnosed with cecal cancer by detailed examination. Although an anatomical abnormality was present, we determined that a curative operation with single-port laparoscopic surgery(SILS)was feasible. We safely performed ileocecal resection with D3 lymph node dissection(operative time of 91 min with almost no intraoperative blood loss), and the patient developed no operation-related complications during the postoperative course. Although cecal cancer with situs inversus is very rare, SILS is thought to be safe and feasible when performed by surgeons, who are familiar with the SILS technique and the spatial-cognitive features of situs inversus.

We conducted a retrospective comparative study on feasibility of S-1/oxaliplatin(SOX)therapy and S-1/cisplatin therapy with short hydration(SP-SH)for gastric cancer in the outpatient setting. The subjects were patients with gastric cancer aged younger than 75 years who underwent SOX or SP-SH therapy at our hospital. There were 22 patients in the SOX group and 30 patients in the SP-SH group. Both the groups received the first course during hospitalization and then received the subsequent courses in the outpatient section. Evaluation items for each therapy included the treatment rate in the outpatient setting, number of re-hospitalization cases, relative dose intensity(RDI), and adverse events. The treatment rate in the outpatient setting was 100%(22/22)in the SOX group and 96%in the SP-SH group(26/27). Re-hospitalization cases included 1 case of loss of appetite in the SOX group and 1 cases of loss of appetite and 2 cases of febrile neutropenia(FN)in the SP-SH group. The median values of the RDI were 86% with S-1 and 85% with oxaliplatin in the SOX group and 92% with S-1 and 80% with cisplatin in the SP-SH group. The SP-SH group had a higher proportion of neutropenia cases of Grade 3 or higher(SP-SH 33% v. s SOX 5%, p=0.012). The SOX group showed a higher proportion of loss of appetite cases for all the Grades(SOX 86% v. s SP-SH 50%, p=0.007)and peripheral neuropathy cases(SOX 64% v. s SP-SH 23%, p=0.003). It was considered that SOX and SP-SH therapies can be treated in the outpatient section, although the occurrence of loss of appetite and FN must be considered.

A 74-year-old woman presented to our institution with right inguinal swelling. The swelling had appeared 1 year previously and exhibited a tendency to increase in size. Physical examination revealed a thumb tip-sized swelling in the right inguinal region. Computed tomography revealed a right femoral hernia and fluid accumulation, resulting in the diagnosis of a right femoral hernia. Using the anterior approach, we completely removed the cystic nodule and repaired the femoral hernia. The hernia sac contained elastic nodules, and pathological examination led to the diagnosis of endometrioid adenocarcinoma. Although postoperative positron emission tomography-computed tomography and magnetic resonance imaging revealed no tumor residue, systemic chemotherapy was selected after consultation with the obstetrics and gynecology department. In summary, we herein report a case of an endometrioid adenocarcinoma that occurred in the sac of a femoral hernia.

A 50's woman referred to our hospital with high serum CEA level was found to have RAS-wild sigmoid colon cancer with a 15 cm size unresectable synchronous liver metastasis(LM)in the right lobe during the endoscopic, radiological, and immunohistological examinations. CapeOX was introduced, but the LM lesion enlarged to 18 cm after 2 courses. Therefore, the regimen was switched to FOLFIRI plus panitumumab. Six courses ofchemotherapy resulted in the reduction ofthe LM lesion to 11 cm, and the Response Evaluation Criteria in Solid Tumors revealed PR with no severe adverse effects, and curative surgical resection was planned. The patient underwent laparoscopic sigmoidectomy resection, followed by percutaneous transhepatic portal embolization(PTPE)ofthe right branch ofthe portal vein to secure the volume ofthe future remnant liver. Right lobectomy and partial resection ofsegment 4 ofthe liver and cholecystectomy was then performed. Currently, 28 months postoperatively, the patient continues to do well with no signs ofrecurrence. This case demonstrates that the sequential combination ofsystemic therapy with FOLFIRI plus panitumumab and PTPE enabled the curative surgical management ofthe sigmoid colon cancer with a large synchronous LM.

A 44-year-old woman was admitted to our hospital because of an abdominal mass. Blood examination showed no elevation of hepatic enzyme levels but did show a slight increase in the levels of tumor marker CA19-9. An abdominal contrastenhanced CT scan showed a large pedunculated tumor(15 cm)growing from the S5 to the extrahepatic area, with a pattern of earlyenhancement and wash out. Fortunately, organ invasion and tumor dissemination were not observed. Upon FDG-PET examination, marked uptake of FDG was observed in the tumor. S5 hepatic subsectionectomywas performed. The final pathological finding of this tumor was moderatelydifferentiated cholangiocarcinoma. Intrahepatic cholangiocarcinoma with exophytic growth is quite rare, and is reported to have a poor prognosis. Therefore, strict follow-up, including follow-up CT and examination for tumor markers(CA19-9 and CEA), is required.

Background: S-1 plus cisplatin(CDDP)has been a key regimen for advanced gastric cancer treatment. However, CDDP confers dose-limiting nephrotoxicity, requires a hospital stay for conventional massive hydration, and reduces patients' quality of life. We evaluated the nephrotoxicity of CDDP combination chemotherapy in an outpatient setting with short hydration for gastric cancer and investigated the feasibility of the short hydration method., Methods: Twenty-nine gastric cancer patients aged under 75 years with creatinine clearance rate >40mL/min and who received S-1 plus CDDP(60mg/m2)were recruited. Intravenous hydration was administered at 1,900 mL with magnesium and a diuretic. Any renal dysfunction over 5 courses of chemotherapy was analyzed., Results: The majority(24/29)of patients could receive outpatient chemotherapy. The highest serum creatinine Grade in each course was Grade 1, and none of the patients developed creatinine toxicity of Grade 2 or higher over 5 courses of chemotherapy. An elevation in eGFR grade was found in 51.7%(15/29)patients; in 13 of those patients, the escalation was of at least 1 Grade., Conclusion: The short hydration method is feasible for gastric cancer patients receiving chemotherapy including CDDP in an outpatient setting.

Instead of the combination treatment with cytotoxic chemotherapy and radiation therapy, molecular targeted drugs is testing in many clinical trials. Because unexpected adverse events were reported in the previous trials using molecular targeted drugs with radiotherapy, attention should be paid to this combination. In EGFR mutated lung cancer, gefitinib with radiotherapy is testing.

The patient was a 73-year-old man. Upper gastrointestinal endoscopy revealed a type 3 tumor in the antrum of the stomach. Preoperative CT imaging showed multiple liver metastases(S2, S3, S4, S6, S7). We administered 2 courses of chemotherapy( XP therapy)for the unresectable gastric cancer; the impact of the neoadjuvant therapy was PR. We performed distal gastrectomy and D2 dissection. After gastric resection, we administered an additional 3 courses of XP therapy. Unfortunately, new lesions of liver metastases were recurrent at S5 and S8. The patient was treated with 3 courses of S-1 chemotherapy. However, abdominal CT and EOB-MRI revealed significant tumor growth despite S-1 therapy. We performed S5 sub-segment resection and S8 partial resection due to the absence of new lesions. Histopathological findings revealed that the well-differentiated adenocarcinoma had metastasized to the liver, with Grade 1a tumor destruction. Two years after the initial gastrectomy, no recurrence of gastric cancer was observed.

A 37-year-old woman was diagnosed with advanced gastric cancer. Pancreatic invasion of the tumor and positive cytology from peritoneal washing was found on staging laparoscopy. The patient received chemotherapy consisting of S-1 and CDDP, but the tumor size increased after 5 courses. The patient then received 2 courses of second line chemotherapy consisting of biweekly CPT-11; however, the tumor progressed and caused stenosis of the stomach. After gastrojejunostomy for the stenosis, negative cytology of intraperitoneal lavage was found. The patient underwent pancreatoduodenectomy with right hemicolectomy and wedge resection of the portal vein as curative resection. The patient was alive without recurrence 10 months after the surgery.

The patient was a 78-year-old woman. She was referred to our hospital and diagnosed with advanced gastric cancer with para-aortic lymph node(#16)metastasis. She received the SOX regimen(L-OHP 100mg/m2)chemotherapy and developed fatigue, anorexia, and neutropenia. After 4 courses of the SOX regimen, the #16 metastasis was reduced remarkably. A curative operation was performed and histological evaluation of the primary and lymphatic lesion after chemotherapy showed Grade 3 findings. The SOX regimen is tolerable in the outpatient clinic and is useful as part of multidisciplinary treatment for advanced gastric cancer.

A59 -year-old woman was referred to our hospital for a close examination and treatment of an advanced gastric carcinoma. A physical examination and CT scan showed that the right cervical and axillar lymph nodes were swelling, and a histopathological examination of the axillar lymph node revealed metastatic growth of the gastric carcinoma (Stage IV). Then, we started S-1/CDDP combination chemotherapy. S-1 (80 mg/m2/day)was orally administered for 3 weeks followed by 2 weeks of rest, and CDDP (60 mg/m2) was administered by drip on day 8. Since the distant metastases were greatly reduced after 6 courses of combination therapy, a distal gastrectomy with lymph nodes dissection (D2) was performed. Histopathological examination of the resected tissues revealed no residual cancer cells, suggesting a pathologically complete response. The clinical course after the operation went well without any complications, and the patient is alive with no evidence of recurrence 1 year after surgery. S-1/CDDP combination chemotherapy appears to be one of the effective treatments for advanced gastric carcinoma.

We report a 60-year-old female with pulmonary metastasis from breast cancer who responded to S-1. In November 2001, she underwent surgery. In October 2005, relapse was detected. As there was no hormone sensitivity, chemotherapy was selected, and oral administration of S-1 at 120 mg/day (2 divided doses) was initiated. After the fourth course, the tumor marker level returned to the reference value. Thoracic CT at the end of the sixth course revealed the disappearance of the metastatic focus. Adverse reactions during the administration period were mild. S-1 showed potent antitumor effects and good tolerance, and it may be useful for treating metastatic/recurrent breast cancer.

In the treatment of recurrent breast cancer in patients previously treated with anthracycline drugs, taxane drugs are generally used. This time, we retrospectively studied the safety of docetaxel/cyclophosphamide combination therapy (hereinafter referred to as TC therapy). Ten patients (mean age: 52.8 years old) were included in the study. Metastatic/recurrent sites included 3 skin, 2 each of contralateral breast, lung and bone, and 1 each of liver, carcinomatous pleurisy and supraclavicular lymph node. Seven patients had a history of anthracycline treatment. The patients received TC at doses of 60 mg/m(2) and 500 mg/m(2), respectively, every 3 weeks. With regard to adverse events, non-hematotoxic events included alopecia in all the patients, generalized malaise in 5, and abnormal nail in 1. Hematotoxic events were grades 2 and 3 decreased neutrophil count in 5 patients. One patient had grade 4 pyrexia associated with oral candida. The patient was admitted and treated with fluid replacement and granulocyte colony-stimulating factor (G-CSF). There were no other patients in whom the treatment was prolonged or dosage was reduced due to adverse reactions. TC therapy is considered to be a beneficial treatment method in terms of safety since it can be instituted on an outpatient basis.

A 55-year-old woman underwent a partial breast resection in our hospital for breast cancer in May 2002. For adjuvant therapy, she received cyclophosphamide, pirarubicin and 5-FU infusion a total of 6 times, and anastrozole. Then, in May of 2004, an abnormal shadow was detected on her of chest X-ray. After CT scan we diagnosed multiple pulmonary metastasis of breast cancer. We used combination therapy of docetaxel 60 mg/m(2) and cyclophosphamide 500 mg/m(2). After 9 months, pulmonary metastasis disappeared on her CT scan. During chemotherapy, she showed no major side effect.

To assess the significance of neoadjuvant chemotherapy for large bowel cancer, we investigated an effect of tegafur on cancer cell kinetics by DNA content flow cytometric analysis. The pathologic specimens analyzed in this study were obtained from 28 patients with rectal cancer who had received tegafur suppositories prior to surgery. Mean cumulative doses administered were 13.4 g, and mean duration was 12.7 days. In 24 of the 28 specimens, the DNA ploidy and DNA index of the cancer cells were essentially unchanged after the chemotherapy, and DNA aneuploidy was present in 67%. The proportion of cells in S-phase in DNA aneuploid tumors was significantly higher than in DNA diploid tumors. The proportion of cells in G0G1-phase was inversely correlated to that in S-phase. After the chemotherapy, the proportions of cells in S-phase increased both in DNA diploid and aneuploid tumors, although a significantly higher mean value was found only for the latter (p < 0.05). In the DNA aneuploid tumors, there was a higher frequency of responders confirmed by histological evaluation (44%) as compared to the DNA diploid tumors (25%), and a tendency for increases in S-phase fraction of the responders to be greater than in non-responders. These results suggest that DNA flow cytometry-derived parameters may conceivably be useful in predicting the antitumor effect of 5-FU and its derivatives against large bowel cancer.

Hepatic arterial infusion chemotherapy using totally implantable reservoir was performed for the treatment of liver metastases of colo-rectal cancers, and the therapeutic effects, side effects and complications were evaluated. Reservoir catheters were implanted into hepatic artery via gastroduodenal artery during operation. Mitomycin C (MMC), adriamycin (ADM), and 5-fluorouracil (5-FU) were used as chemotherapeutic agents. Eleven cases of H1 (metastases in one lobe only), 7 cases of H2 (a few scattered metastases in both lobes) and 12 cases of H3 (multiple metastases in both lobes) were treated intermittently with one-shot administration of MMC or ADM (A-group). Ten cases (H1: 1, H2: 2, H3: 7) were treated with intermittent one-shot administration of MMC or ADM following two-week continuous infusion of 5-FU through infusion pump after operation (B-group). In 5 of 10 cases of B-group, serum CEA level fell below the preoperative level, and the tumor size regressed in 3 of those 5 cases which were evaluated on the basis of CT scan. But no remarkable change in CEA level or tumor size on CT scan was seen in A-group. No particular side effect such as leucopenia, liver dysfunction or gastroduodenal symptom was noted except one case developing multiple gastric ulcers and pancreatitis in B-group. Five cases (25%) showed obstruction of catheter and 3 cases (14%) evidence leakage of chemotherapeutic agents in A-group. Three cases (30%) in agents in A-group. Three cases (30%) in B-group displayed obstruction of gastroduodenal artery beyond the tip of catheter. Median survival time of both groups (A, B) was 6 months and 12 months, respectively. The treatment seemed effective for the improvement of serum CEA level and tumor size, and there was a tendency toward prolongation of survival time in B-group.