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Para-aortic lymph node metastasis(PALNM)is classified as distant metastasis in colorectal cancer(CRC). Although the benefit of para-aortic lymph node dissection(PALND)for the CRC patients with PALNM suspected radiologically remains controversial, some reports have shown that the survival benefit for PALND in CRC patients with PALNM. Moreover, the report evaluating the extent of PALND showed that the patients treated with radical lymphadenectomy had better prognosis compared to those treated with targeted lymphadenectomy defined as the dissection of only swollen lymph nodes. We have performed the laparoscopic PALND for selected CRC patients with PALNM. Three radical dissections using retroperitoneoscopy have been performed in 9 CRC patients who underwent PALND in the last 6 years. Now, we show one of the effective cases treated with the retroperitoneoscopic radical resection. We additionally mention the effectiveness of the retroperitoneoscopic radical resection for the patients with PALNM. The retroperitoneoscopic resection resulted in more blood loss and longer operative time than laparoscopic resection, however, more lymph nodes were resected. The retroperitoneoscopic radical resection may be the preferable procedure for the CRC patients with PALNM, especially for the patients with multiple or extensively spread PALNM.

Late recurrence of stage ⅠB gastric cancer with high microsatellite instability(MSI-high)is rare. Here, we report a case of MSI-high StageⅠB gastric cancer recurring more than 5 years after surgery. A 78-yaer-old man was admitted to our hospital for gastric cancer surgery. Laparoscopic distal gastrectomy was performed. Histologic examination revealed a T2(MP) N0M0, HER2-negative, StageⅠB gastric tubular adenocarcinoma. Postoperatively, the patient received chemotherapy with S-1 for 1 year. He developed liver and para-aortic lymph node metastases 5 years 1 month after surgery. Pathological genetic examination revealed a high microsatellite instability. He received pembrolizumab therapy for the recurrence. This case suggests that late recurrence occurs in patients with gastric cancer with high microsatellite instability.

A 60-year-old woman was undergoing chemotherapy for triple-negative breast cancer and multiple liver metastases. One year and 3 months after the start of treatment, blood tests showed worsening liver function and a decrease in the platelet count. Multiple liver metastases tend to shrink on computed tomography, but pseudocirrhosis was suspected because the right lobe of the liver had atrophied and the marginal irregularities were conspicuous. The platelet count decreased because of hypersplenism, and continuing chemotherapy was difficult. Splenic artery embolization was performed by the internal medicine department, and chemotherapy was resumed once the platelet count recovered. Imaging findings consistent with cirrhosis without the typical cirrhosis histopathology are considered as pseudocirrhosis. This phenomenon has been reported for breast cancer. During chemotherapy for liver metastases, attention should be paid to its appearance. Furthermore, liver cirrhosis should be controlled, and chemotherapy should be continued in coordination with the internal medicine department.

Were port a 51-year-old male left renal pelvic cancer patient with paclitaxel (PTX)-induced peripheral neuropathy, which was successfully treated with pregabalin. From June 2010, a gemcitabine/PTX (GP) regimen was used as third-line treatment. In order to relieve the PTX-induced peripheral neuropathy, pregabalin (75mg/day, at night) was administered from day 6 of the 16th course. Moreover, pregabalin was increased to 150mg/day from day 12 of the course. Sensory neurotoxicity after the administration of pregabalin was decreased from CTCAE (version 4. 0) grade 3 to 1 at day 19 of the course. Therefore, there is a possibility that the PTX -induced peripheral neuropathy may be improved by pregabalin administration. Further trials may be needed to confirm the value of pregabalin.

Advanced gastric cancer cases (42 cases) undergone gastrectomy were studied on the correlation between tissue uptakes and prognosis. The patients were administrated Tegafur preoperatively and tissue samples were obtained intraoperatively, 5-FU levels in tumor and lymph node were measured by GCMF. The patients, being measured 5-FU uptake by tissue and received Tegafur over 60 g as postoperative adjuvant chemotherapy, were divided into two groups; namely, one with 5-FU up take by tumor tissue and lymph node was higher than 0.05 mcg/g and the other with lower than 0.05 mcg/g. Both groups showed no significant difference in background factors. Each survival rate was calculated by Kaplan-Meier method and examined by generalized Wilcoxon method. As the result, there was no significant correlation in the 5-FU uptake by tumor and prognosis, but prolongation of survival rate in the group of 5-FU uptake by lymph node over 0.05 mcg/g was suggested.

UFT or tegafur (5, 7.5 and 15 mg/kg, respectively) were given to Donryu rats with AH-130 cancer twice a day for 3 days, and 5-FU concentrations in the blood, tumor, normal stomach and large bowel tissues were measured by chemical assay and compared. The 5-FU concentrations in the tumor were higher than those of normal tissues and still remained 12 hours after the final dosage. According to increased UFT dosage, there were significantly higher levels of 5-FU concentration in tumor tissues but blood levels of 5-FU were low. The peak of concentration occurred at one to two hours after the final dosage. However, increase in tegafur dosage volume did not correlate with 5-FU levels. Clinical cases (74 patients) of gastric and colorectal cancer were orally administered UFT or tegafur at 300 mg twice a day for 3 days preoperatively. Materials were obtained at surgery at 5.5 hours on average after the final dosage and 5-FU levels in tissues were measured by chemical assay. Concentrations of 5-FU in cancerous tissues after UFT administration were 0.177 +/- 0.131 micrograms/g in gastric cancer and 0.130 +/- 0.051 micrograms/g in colorectal cancer, while in patients to whom tegafur had been administered, the concentrations were 0.194 +/- 0.124 micrograms/g and 0.119 +/- 0.075 micrograms/g, respectively. There was no significant difference in 5-FU levels between the UFT-administered group and the tegafur group.

Forty-one patients with advanced gastric cancer underwent gastrectomy, and the correlation between tissue uptake of the adjuvant drug and the prognosis were studied. The patients were preoperatively administered Tegafur and samples of tissue were obtained intraoperatively. 5-FU levels in the tumor and lymphnodes were measured by gas chromato-mass fragmentography (GCMF). The patients measured for 5-FU tissue uptake were given more than 60 g of tegafur as postoperative adjuvant chemotherapy, and divided into two groups; one in which the 5-FU uptake by tumor tissue and lymphnode was over 0.05 microgram/g and the other lower than 0.05 microgram/g. In both groups there were no significant differences in background factors. Each survival rate was calculated by the Kaplan-Meier method, and the generalized Wilcoxon method was used for statistical analysis. There was no statistically significant correlation between 5-FU uptake by the tumor and the prognosis, but the 5-year survival rate in the group with over 0.05 microgram/g uptake by lymphnodes was statistically significant (p = 0.018).