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[Purpose] We examined the effect on physical and mental function of elderly persons of a group rhythm exercise designed with "safety, enjoyment, and length" as the primary considerations for elderly persons certified under the less severe grades of the long-term care insurance. [Subjects] The subjects were 20 persons (average age, 79.5 ± 7.2) certified between Need Support level 2 and Need Care level 2 who were attending a day-care service facility. [Method] The subjects were randomly allocated to an intervention and a control group. The intervention group performed an individual exercise program and the group rhythm exercise; the control group performed only the individual exercise program. To assess the effect, before the intervention and at 3 and 6 months afterwards, participants received a physical examination, performed strength tests and answered a questionnaire. [Results] In both groups a significant improvement in lower limb strength was seen. Furthermore, in the intervention group, significant improvements in mental function, walking ability and balance ability were also seen. [Conclusion] The results suggest that the group exercise could possibly become a beneficial exercise therapy for improving the mental and physical functions of elderly persons. [ABSTRACT FROM AUTHOR]

The gastrointestinal stromal tumor(GIST)guidelines state that the use of neoadjuvant chemotherapy(NAC)for curable GIST is not apparent. However, NAC is performed for massive rectal GIST at our hospital to reduce surgical invasion and improve surgical results. The cases were a 39-year-old man, a 48-year-old man, and a 78-year-old man. The site was Rb in all cases, and the maximum diameters at the rectal GIST diagnosis were respectively 70 mm, 75 mm, and 60 mm, which were massive tumors. Imatinib mesylate(imatinib)was started as NAC. The duration of NAC was respectively 6, 11, and 12 months. The maximum tumor diameter on preoperative CT was smaller than before NAC, and the average reduction rate was 23%. Two cases underwent laparoscopic abdominal perineal resection, and 1 underwent laparoscopic ultra-low anterior resection and ileostomy. No perioperative complications of Clavien-Dindo classification Grade Ⅱ or higher were unsettled. All patients were in the high risk group and received imatinib as postoperative adjuvant chemotherapy. Currently, respectively 2 years and 3 months, 1 year and 2 months, and 1 year after surgery, all are alive without recurrence. NAC with imatinib has contributed to minimally invasive and radical surgery for giant rectal GIST.

A 60-year-old man underwent palliative surgery with a diagnosis of unresectable cancer, and he visited our hospital for further treatment. Since the cancer was unresectable and multiple hepatic tumors were revealed in CT images that were not metastases, we decided to perform curative surgery for the pancreatic cancer accompanied by partial liver invasion. Pancreaticoduodenectomy plus partial hepatectomy were performed, and 2 tumors were detected in the resected specimen: one in the pancreas-duodenum region and a submucosal tumor in the duodenum bulb. The large tumor that occupied the pancreasduodenum region was histologically diagnosed as an undifferentiated carcinoma, and the duodenal submucosal tumor was consistent with findings of a poorly differentiated adenocarcinoma. Two years after surgery, CT examination revealed a mass extending into the inferior vena cava(IVC)from near the right renal vein. We eventually diagnosed lymph node recurrence with tumor thrombosis inthe IVC and started chemotherapy(FOLFIRINOX). After the tumor decreased, we performed salvage surgery involving resection of the lymph node, thrombectomy, and right nephrectomy. The tumor revealed atypical cells in the region of thrombosis, and the pathological findings were not in conflict with the findings of metastases from pancreatic cancer 2 years prior. After the treatment, chemotherapy was administered and he survived without any recurrence for 15 months after surgery.

The prognosis for hepatocellular carcinoma(HCC)with right atrium tumor thrombus(RATT)is dismal and necessary to be treated on as oncologic emergency. We report a case of HCC with RATT which was treated with multidisciplinary therapy including surgery. After repeated transarterial chemoembolization(TACE)and radiofrequency ablation(RFA), a 71-year-old man consulted to our hospital with multiple HCC, lung metastasis, and RATT. Left hemihepatectomy, thrombectomy of RATT, and 3 months of hepatic arterial infusion chemotherapy(HAIC)was performed, and intrahepatic HCCs were controlled. However, during treatment of lung metastasis by sorafenib, the patient died of brain metastasis, 3 years after the first treatment. Although surgery and HAIC may give a chance of further treatment by control of intrahepatic HCCs, stronger regimen for systemic HCC would be necessary.

Since acinar cell carcinoma(ACC)of pancreas is rare, we sometimes meet a case hard to make diagnosis before surgery. We here reported a case of ACC of pancreas with extensive intraductal growth to the main pancreatic duct and the branch of the pancreatic duct. A 43-year-old man visit a clinic with a concern of uncomfortable feeling on left side abdomen. CT/MRI examination showed a ischemic tumor, 38×25 mm, in the body-tail of the pancreas, and the tumor infiltrated to left renal capsule. ERCP showed the interruption and stenosis of the pancreatic duct at the point adjacent to tumor. Cytological diagnosis of the pancreatic juice was performed, but malignant cells were not detected(Class III ). The tumor abnormally accumulated FDGin PET-CT examination(SUVmax 3.3). We diagnosed the tumor PDAC with infiltrating to the left renal capsule, and the distal pancreatectomy was performed. The pathological examination of the resected specimen showed that the tumor progressed into main pancreatic duct and the branch of the pancreatic duct accompanying with fibrosis around pancreatic duct. The tumor was diagnosed ACC with immunohistochemistry; positive to ACC phenotype(a1-antitrypsin, a1-antichymotrypsin, BCL10). The patient is alive without any recurrence findings 3 years 2 months after surgery.

A 76-year-old male visited a clinic and the images incidentally revealed a tumor in the tail of pancreas. Pancreatic ductal adenocarcinoma was diagnosed by the following examination, indicating that the tumor invasion to spleen, left adrenal gland and left kidney(cT3N0M0, cStage II A), requiring heminephrectomy for radical resection. Enhanced preoperative treatments were performed while taking into account a possibility of any restrictions for the age and the standard adjuvant chemotherapies after heminephrectomy. Although the direct tumor invasion to other organs still remained, we found the significant reductions of tumor size and FDG uptake level with the decrease of serum tumor marker levels without an appearance of distant metastasis and another disease, so a radical surgery was performed. We performed distal pancreatectomy with left heminephrectomy and left adrenalectomy. The histopathological findings showed pathological stage was ypT3N1aM0, fStage II B with the direct invasion to the spleen and left adrenal gland with the effect of preoperative therapy as Grade II b in Evans classification. He has survived so far without recurrence for 11 months after surgery without operative complications.

A 70-year-old man was diagnosed with pancreatic ductal adenocarcinoma(PDAC)with peritoneal dissemination and received systemic chemotherapy of gemcitabine(GEM)plus nab-paclitaxel. Since the patient could not continue the regimen due to an adverse event of liver dysfunction, he was administered GEM alone except for the first administration. GEM monotherapy resulted in remarkable anti-tumor effects with a distinct decrease of both tumor markers and size. Peritoneal metastases were not detected in images after 12 courses of the GEM regimen, and the vanished tumor metastasis in images was maintained until 16 courses were administered. After the laparoscopic examination proved no peritoneal metastasis, we performed curative surgery. The presence of peritoneal metastasis of PDAC indicated that it was at a lethal stage; however, a few cases were reported as receiving curative surgery after chemotherapy with modest long-term survival. We herein report a rare case of curative surgery following chemotherapy with GEM alone for unresectable PDAC accompanied with peritoneal dissemination.

A 43-year old-male was admitted to the hospital for the treatment of rectal carcinoma. Preoperative abdominal computed tomography(CT)revealed a left inferior vena cava. There is no report of the patient with left inferior vena cava which focused on an anatomical feature of autonomic nerves. We report a case of rectal cancer patient with left inferior vena cava who underwent autonomic nerve-sparing laparoscopic low anterior resection, and review the relevant literature here.

A 60-year-old woman who visited a doctor during postoperative follow-up for breast cancer was found to have elevated CEA levels. Investigation with FDG-PET CT following enhanced CT suggested gallbladder cancer(GBC)accompanied with para-aortic lymph node(PAL)metastasis. Although we could not obtain any histological evidence, we recommended she be treated as a patient with advanced GBC, and she received 8 courses of chemotherapy consisting of gemcitabine, cisplatin, and TS-1, following the protocol of a clinical trial. After the chemotherapy, imaging exhibited down-staging of the GBC, indicating tumor shrinkage and disappearance of the accumulation of FDG at the tumor sites. We first performed cholecystectomy to obtain histological evidence, and subsequently performed pancreaticoduodenectomy and partial hepatectomy at the gallbladder bed. The pathological diagnosis was pT2N1M0, Stage III B, Evans Grade II b; curative grade A surgery was recommended because the PAL did not contain a tumor any more. The prognosis of advanced GBC with PAL metastasis is extremely poor, but conversion therapy with combined modality therapy including neoadjuvant chemotherapy is a useful strategy to achieve a curative resection.

A 41-year-old woman had undergone cyst-to-duct anastomosis for a congenital biliary dilatation when she was 3-yearold. After 38 years, she presented with a high fever, and laboratory findings showed elevation of liver and biliary enzyme levels. A CT scan showed a mass lesion in a choledochal cyst, and an adenocarcinoma was found in the anastomosis of the choledochal cyst and duodenum. We diagnosed distal bile duct cancer and performed SSPPD after neoadjuvant chemotherapy( gemcitabine plus cisplatin plus S-1). The resected tumor was pathologically diagnosed as papillary-infiltrating adenocarcinoma( ypT2N1M0, ypStage II B). Currently, 9 months after the second surgery, the patient is doing well without any signs of recurrence. The current case suggested the necessity of postoperative lifetime follow-up for patients with bile duct cancer who have undergone radical cyst excision for a congenital biliary dilatation.

A 60-year-old man visited a hospital with concerns about his physical health, including weight loss, thirst, and polyuria. He was diagnosed with acute onset of diabetes, and a pancreatic head tumor was observed on imaging studies. Computed tomography(CT)indicated that the tumor infiltrated the surrounding major vessels, portal vein(PV, 360 degrees), and superior mesenteric artery(SMA, <180 degrees). Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)was performed, and he was diagnosed with a borderline resectable(BR)clinical Stage IV a pancreatic ductal adenocarcinoma (PDAC). Chemoradiation therapy(CRT, S-1 plus gemcitabine [GEM] concurrent with 50.4 Gy radiation)followed by chemotherapy( GEM)was performed until a tumor response indicating sufficient reduction of SMA infiltration was observed on imaging studies. Twelve months after initiation of treatment, a pancreaticoduodenectomy and PV resection/reconstruction were performed. The pathological stage was ypT3N0M0(ypStage III ), and SMA infiltration was not detected in the resected specimen. He was discharged after an uneventful course following surgery, and adjuvant S-1 chemotherapy was continued from post-operative day 67 for 4 months. Now at post-operative 57 month, he has survived without recurrence. There have been some reports detailing long-term survival of patients with BR tumors who underwent multidisciplinary therapy as curative resection following preoperative CRT and postoperative adjuvant chemotherapy. During preoperative treatment, it is important to monitor the effects and determine the suitable timing to perform surgery to achieve long-term survival.

A 65-year-old woman underwent sigmoidectomy for colon cancer in January 2002. She had multiple liver metastases and received systemic chemotherapy (UFT-E plus CPT-11) for 6 months. She underwent partial hepatectomy of S7 and S3 and cholecystectomy in July 2003. After 4 years without recurrence, right adrenal and para-aortic lymph nodes metastases were detected and she underwent right adrenalectomy and para-aortic lymphadenectomy in July 2007. In July 2008, local recurrence (1 cm in size) was identified in the cavity of the right adrenal gland. She received chemotherapy (mFOLFOX6 plus bevacizumab) for 5 years. In May 2013, PET-CT showed abnormal accumulation of FDG in S7 of the liver (SUVmax 6.7). The enhanced EOB-MRI showed a mass lesion in S7 (3 cm in size) and 2 nodules (1 cm in size) in S3 and S4. We scheduled for liver surgery with reconstruction of the inferior vena cava (IVC) after systemic chemotherapy (FOLFIRI plus cetuximab). The patient underwent partial hepatectomy of the tumor in S7 combined with resection of the diaphragm and IVC. Reconstruction of the IVC was performed using a ringed Gore-Tex tube graft in February 2014. The patient is still alive without recurrence 18 months after surgery.

The patient was a 65-year-old man. In July 2014, he was diagnosed with rectal cancer in a different hospital and underwent high anterior resection(type 2, T3N0M0, StageⅡ [TMN classification, 7th edition]). During the operation, a small nodule was detected in segment 4 of the liver. Contrast-enhanced abdominal CT revealed a tumor measuring 5 cm in diameter located in segment 4/8 of the liver with a tumor thrombus in the main trunk of the portal vein. In August 2014, the patient was referred to our hospital for further examination and treatment. MR imaging showed a lobulated tumor located in segment 4/8 of the liver. Gadoxeticac id-enhanced hepatobiliary phase MR imaging showed that the tumor was less enhanced than was the adjacent liver parenchyma. 18F-FDG-PET/CT demonstrated abnormal accumulation of 18F-FDG in the main tumor(SUVmax=18.3). There was no obvious abnormal accumulation in the other organs. In September 2014, he underwent extended left hepatectomy and portal vein tumor thrombectomy. The resected specimen showed a well-differentiated adenocarcinoma. Immunohistochemical staining results were CK7/CK20 (-/+) and CDX2 (+), which suggested that the tumor was derived from the gastrointestinal tract rather than the liver. The pathological diagnosis was a liver metastasis from rectal cancer. In the 6 months after the operation, intrahepatic recurrence was detected, and the patient was treated with systemicchemotherapy.

We report a case of locally advanced huge hepatocellular carcinoma (HCC) invading the diaphragm and the right lung, which was controlled by sorafenib, thereby allowing curative resection. A 72-year-old man was diagnosed with advanced HCC invading the diaphragm and the right lung. At the time of diagnosis, his tumor was considered unresectable and he underwent transarterial embolization (TAE)/transcatheter arterial chemoembolization (TACE) 3 times. Assessment with enhanced CT after TAE/TACE showed that a viable lesion remained. Subsequently, he was treated with sorafenib for 15 months. Reassessment showed that the main tumor remained stable in size, and he was admitted to our hospital for surgery. Preoperative evaluation by enhanced CT and MRI detected an intrahepatic metastasis in segment 4 of the liver. After TACE was performed for this nodule, extended right hemihepatectomy with right diaphragmatic and right lung partial resection was performed. He had no postoperative complications and was discharged 27 days after surgery. He remains alive without recurrence 10 months after surgery.

Repeated pancreatectomy for metachronous pancreatic cancer has rarely been reported. We report 3 cases with metachronous pancreatic ductal carcinoma that developed after pancreatectomy for the first pancreatic cancer. They were successfully resected by removal of the remnant pancreas. In all 3 cases, the cancers in the remnant pancreas were treated with repeated pancreatectomy. The histological margin of the first pancreatic resection was cancer-free in all the cases. Furthermore, the second cancer tissue contained carcinoma lesions in situ adjacent to invasive ductal carcinoma. Based on these findings, the 3 patients were diagnosed with metachronous pancreatic cancers.

We report a case of curatively resected intrahepatic cholangiocarcinoma (ICC) with hepatic artery (HA) and portal vein (PV) reconstruction. A 25-year-old man was diagnosed with ICC. Computed tomography (CT) showed that the tumor had invaded the left and common hepatic duct, the right and left HA, and the main branch of the PV. Because the posterior HA was tumor free, we performed a left trisegmentectomy, PV and HA resection and reconstruction, and a hepatocholangiojejunostomy. Pathological examination revealed a tumor classification of T3, N1, M0, Stage IVB. The patient was discharged on postoperative day 59 and gemcitabine (1,000 mg/m²) was administered as adjuvant chemotherapy. However, abdominal CT revealed peritoneal metastasis 8 months after the surgery. A gemcitabine, cisplatin, and TS-1 (GCS) regimen was selected as treatment, and the patient is alive 13 months after surgery.

A 63-year-old man was diagnosed with pancreatic head cancer, and an operation was planned at his previous hospital. However, resection was not possible because of invasion of the superior mesenteric artery, and gemcitabine-based chemotherapy was administered for the tumor for 2 years. Imaging examinations after chemotherapy were unable to detect the tumor at the pancreatic head or the arterial invasion. The patient was subsequently referred to our hospital for surgery. Upon laparotomy, the tumor was judged to be resectable, and a pancreaticoduodenectomy was performed. Pathological examination indicated the presence of cancer cells in the resected specimens. The patient underwent adjuvant chemotherapy and is currently alive without recurrence. This case highlights the importance of ongoing follow-up in patients with locally advanced pancreatic cancer so that tumor resectability can be evaluated during chemotherapy.

A 61-year-old man presented with lower abdominal pain. Further examination revealed descending colon cancer and multiple liver metastases (S1, S2, and S5). The largest metastatic lesion in S1 showed massive invasion to the inferior vena cava (IVC) and was considered unresectable. Resection of the primary colon cancer was performed in January 2011, followed by several types of systemic chemotherapy(12 courses of capecitabine plus oxaliplatin [XELOX] + bevacizumab[Response Evaluation Criteria In Solid Tumors{RECIST}: PD], 5 courses of folinic acid, fluorouracil, and irinotecan [FOLFIRI] + bevacizumab[RECIST: SD], and 13 courses of FOLFIRI+ panitumumab). After these regimens, the lesions in S1 and S2 substantially decreased in size (RECIST: PR), and the lesion in S5 was no longer visible. The extent of invasion to the IVC significantly reduced, and liver resection(extended left lobectomy)and partial IVC resection were performed in November 2013 without reconstruction of the IVC by using a vascular prosthesis. The patient was discharged uneventfully on postoperative day 16, and administration of tegafur-uracil-Leucovorin (UFT/UZEL) was initiated. After 4 months, a recurrent lesion was found in S5, and partial liver resection was performed. In addition, FOLFIRI+panitumumab was reinitiated for the multiple lung metastases. The patient is alive without progression of disease 3 years and 4 months after colectomy.

The prognosis for hepatocellular carcinoma (HCC) with severe vascular invasion is dismal. Surgery alone is not enough to control recurrence. Here, we report long-term survival in a case of HCC with tumor thrombus in the portal vein and right atrium, which was successfully treated through multidisciplinary therapies including surgery. The patient, a 74-year-old man, had undergone several rounds of local ablation and transarterial chemoembolization for HCC recurrence, in another hospital. He was referred to us for recurrent HCC with vascular invasion in July 2011. An abdominal computed tomography (CT) revealed a mass lesion(4 cm in diameter)in the left hepatic lobe. It also detected a tumor thrombus in the main trunk of the portal vein (Vp4), and in the right atrium (Vv3). Consequently, the patient underwent an extended left lobectomy and removal of the tumor thrombus in the portal vein and right atrium. Subsequently, fluorouracil (FU) arterial infusion and interferon therapy (FAIT) was initiated, and followed with sorafenib administration. However, multiple recurrent lesions were found in the liver, lungs, and lymph nodes. The dose of sorafenib was increased and maintained for 10 months. So far, the patient has been alive for 35 months after the operation.

A 65-year-old woman presented to our department with a liver tumor. She had undergone subtotal colectomy and total hysterectomy for hereditary nonpolyposis colorectal cancer and uterine cancer 14 years prior to diagnosis. An abdominal CT scan revealed a ring-enhancing tumor with portal vein tumor thrombus on the left lobe. With a preoperative diagnosis of intrahepatic cholangiocarcinoma, combined hepatocellular and cholangiocarcinoma, or metastatic liver cancer; we performed an extended left hepatic lobectomy. The histopathological examination showed adenocarcinoma of the liver. The histopathological findings of the liver tumor resembled that of the previous uterine cancer. Immunohistochemical testing was positive for CK7 and negative for CK20, CDX2, PgR, vimentin, and CA125. However, PgR, vimentin, and CA125 were positively stained in the uterine cancer. Based on these findings, the final diagnosis of the liver tumor was primary intrahepatic cholangiocarcinoma.

A 51-year-old female patient was admitted to our hospital with a diagnosis of sigmoid colon cancer, and a sigmoidectomy and D3 lymphadenectomy was performed. The tumor was a moderately differentiated tubular adenocarcinoma (pT3N0M0, pStage II). No adjuvant therapy was administered. An abdominal computed tomography (CT) performed 11 months after the sigmoidectomy revealed a hepatic metastasis. The patient chose to undergo carbon ion radiotherapy (53.0 GyE/1 Fr). However, a second CT performed 10 months later indicated regrowth of the hepatic metastasis. A partial liver resection was performed, and severe deformity was observed in the irradiated region of the liver. The borderline between the tumor and surrounding tissue was not clearly discriminated. Histopathological examinations indicated increased numbers of fibrous cells in the irradiated region. To perform hepatic resection safely for liver metastasis of colorectal cancer following heavy particle radiotherapy, it is necessary to accurately determine the resection line before and during surgery. When feasible, resection of the whole irradiated area should be considered.

The patient was a 66-year-old woman who had undergone low anterior resection for rectal cancer. Although she received adjuvant chemotherapy after the surgery, a 1.5 cm hepatic metastasis was observed in segments 4/8. Radiofrequency ablation ( RFA) was performed for the metastatic tumor. Approximately 1 month after RFA, a local recurrence was identified together with intrahepatic bile duct dilation in the right lobe of the liver. Extended right hepatic lobectomy and left intrahepatic cholangiojejunostomy were performed to remove the tumor. Histopathological examination of the resected specimen showed a liver metastasis from the rectal cancer with stricture of the bile duct although the bile duct was not involved in the tumor. This suggested that the bile duct stricture was caused by RFA and not by the recurrent tumor. Currently, the patient is alive with no recurrence 14 months after the surgery. This case suggests the importance of salvage surgery for recurrent tumors after RFA therapy, especially in the case of RFA-related complications in conjunction with the tumor.

A 58-year-old man presented with anorexia and weight loss in April 2010. Endoscopic examination revealed a type 3 tumor extending from the gastric cardia to the antrum. Preoperative imaging showed liver metastasis (S8; 2 cm) and direct invasion of the cancer into the pancreas. We administered 4 courses of chemotherapy (DCS) for the unresectable tumor; the impact of the therapy was partial response (PR). We performed total gastrectomy, D2 dissection, splenectomy, distal pancreatectomy, and partial hepatectomy (S8) in April 2011. The patient was treated with 8 courses of adjuvant chemotherapy with S-1. In April 2012, abdominal computed tomography (CT) revealed a solitary recurrent lesion in the liver (S2). After 7 courses of chemotherapy(weekly paclitaxel), abdominal CT and magnetic resonance imaging (MRI) revealed a tumor thrombus in the portal vein extending from P2 to the umbilical portion (UP). We performed left hepatectomy and cholecystectomy due to the absence of new lesions. Histopathological findings revealed that the poorly differentiated adenocarcinoma had metastasized to the liver. Abdominal CT revealed the presence of multiple recurrent metastases in the liver, 4 months after the surgery. The patient died 27 months after the initial surgery and 7 months after the last operation.

A 59-year-old man was diagnosed as having hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT) from the left branch to the main trunk and multiple liver tumors in the right lobe. He first underwent 8 courses of fluorouracil arterial infusion and interferon therapy( FAIT).The PVTT shrunk following combination therapy; however, the liver tumors were enlarged and metastasis was noted in the right adrenal gland. Treatment with sorafenib was initiated. Ten months later, additional reduction of PVTT was noted with no changes in the multiple liver tumors. After confirmation of sufficient portal flow, we performed transcatheter arterial chemoembolization (TACE).After having undergone, in total, 4 rounds of TACE with sorafenib, the patient underwent radiofrequency ablation( RFA) for the right adrenal gland metastasis. The patient is still alive, in good health. Our findings from this case suggest that, in some patients having advanced HCC with PVTT, long- term survival can be achieved when the intrahepatic lesions are controlled by various adequate therapies.

A 62-year-old man had been previously diagnosed as having a 7-cm liver tumor in segment 4 at another hospital, but did not pursue treatment. Twenty-nine months later, he was referred to our hospital suffering from jaundice. Abdominal computed tomography( CT) revealed a 13.5-cm tumor in the liver( S4) with early staining and isodensity in the portal and equilibrium phases. Because magnetic resonance imaging (MRI) of this tumor showed central scarring in T2WI and uptake of EOB in the hepatocyte phase, focal nodular hyperplasia (FNH) was included as a differential diagnosis. Alternatively, the signal decreased out of phase, suggesting a possibility of hepatocellular carcinoma( HCC). We performed extended left lobe resection because of tumor growth and exclusion of the bile duct. Histopathological examination revealed well and moderately differentiated hepatocellular carcinoma with various types of pathological patterns, including necrosis, fat, and scarring. The patient remains well at 12 months after this surgery with no signs of recurrence.

We performed surgical resection for a case of hepatic metastasis of an adenoid cystic carcinoma of the parotid gland. A 53-year-old woman underwent parotidectomy for primary adenoid cystic carcinoma in 2004. In 2005, she underwent resection of a local recurrence. However, in 2012, 8 years after primary tumor resection, abdominal ultrasonography revealed a hepatic tumor in the lateral segment, for which we performed laparoscopic partial hepatectomy. The hepatic tumor was histologically diagnosed as a hepatic metastasis of the adenoid cystic carcinoma of the parotid gland. At 8 postoperative months, no further recurrence was observed.

We report a case of multiple intrahepatic recurrence of hepatocellular carcinoma( HCC) that was successfully treated with transcatheter arterial chemoembolization( TACE) and sorafenib therapy. A 73-year-old man was diagnosed as having multiple intrahepatic recurrence in segment 2 (S2) and segment 7 (S7) of the liver on abdominal computed tomography (CT) scans 4 years after he underwent liver resection. He was treated with 5 cycles of TACE. Two years and 6 months after the initial TACE, we found that the patient had become refractory to TACE, and therefore, we initiated sorafenib therapy. The response to treatment was stable disease (SD) for 9 months, but the patient's tumor marker levels increased and the tumor gradually increased. Therefore, he underwent additional TACE for the intrahepatic lesions. The patient is still alive with recurrences 4 years and 8 months after the initial recurrence.

The patient was a 57-year-old man who was diagnosed as having stage IVa pancreatic cancer. We selected preoperative chemoradiation therapy( gemcitabine[ GEM] plus S-1; and radiation therapy[ RT], 50.4 Gy/28 Fr). A month later, distal pancreatectomy was performed after completion of the course of chemoradiation therapy. Histopathological examination revealed no cancer cells in the pancreas or the dissected lymph nodes. The pathological effect was judged as grade IV. The patient has had no recurrence for 8 months since pancreatectomy.

We report a case of long-term survival of a patient with hepatocellular carcinoma( HCC) with portal vein tumor thrombus (PVTT) treated with fluorouracil arterial infusion and interferon therapy (FAIT). A 54-year-old man with severe liver cirrhosis was diagnosed as having HCC in segment 1 and 4 of the liver, with PVTT in the left branch. After 7 courses of FAIT, the main tumor and PVTT were no longer visible on enhanced computed tomography scans. However, recurrent HCC was detected in segment 4. Subsequently, the patient was treated with transarterial chemoembolization (TACE) after confirmation of portal blood flow. At 5 years after the initial treatment, the patient is alive without further recurrence of HCC. Therefore, even if patients have HCC with PVTT in the main branch and severe liver cirrhosis, long-term survival is possible by administration of a combination of FAIT and TACE.

An 82-year-old man without any complaint was shown to have a hypoechoic lesion, 2 cm in diameter, in segment 5 of the liver by ultrasonography. After 3 months, an abdominal computed tomographic (CT) scan revealed a tumor lesion, 5.5 cm in diameter, with irregular peripheral enhancement. Positron emission tomography (PET)-CT revealed abnormal accumulation of fluorodeoxyglucose in the liver tumor, but no accumulation in other lesions. Based on the diagnosis of primary malignant liver tumor, we performed S5 subsegmentectomy of the liver. Histopathological examination showed spindle tumor cells forming hemorrhagic and focal necrosis. On immunohistochemistry, the tumor cells weakly expressed CD31. We diagnosed the tumor as hepatic angiosarcoma. The patient was discharged from the hospital 17 days after the surgery and survived without evidence of recurrence for 12 postoperative months.

Recently, the number of case reports detailing cancer recurrence in the pancreatic remnants, following surgical resection of intraductal papillary-mucinous carcinoma (IPMC) of the pancreas has increased. We report the case of a 74-year-old woman who underwent pancreatic resection twice in a 3-year period for primary IPMC and remnant pancreatic ductal carcinoma. We first performed distal pancreatectomy for branched IPMC in the pancreatic tail. Histopathological examination revealed invasive IPMC and the negative margin of the pancreatic duct. The expression of tumor markers gradually increased in the 2 years and 4 months after the initial surgery, and a tumor was detected in the remnant pancreas. We performed total remnant pancreatectomy. The recurrent tumor consisted of moderately differentiated adenocarcinoma. Currently, the patient is alive without recurrence for a year since the second resection. This experience suggests that careful surveillance is necessary for IPMC.

A 73-year-old man with advanced multiple hepatocellular carcinoma(HCC) in both lobes(S2, S3, S4, S8, and S1) was admitted to our hospital. Abdominal computed tomography revealed neither vascular invasion nor distant metastasis. Because 3 attempts of transcatheter arterial chemoembolization (TACE) resulted in successful control of the tumors in the right lobe, a left hepatic lobectomy was performed. Although postoperative recurrences were observed, they were controllable by repeated TACE, and the patient remains in a relatively good general condition 3 years and 8 months since the operation.

A 57-year-old man was admitted to our hospital for hepatocellular carcinoma (HCC). He underwent right hepatectomy with preoperative adjuvant transcatheter arterial chemoembolization. A follow-up computed tomography scan revealed a single pulmonary metastasis. After 2 courses of S-1 administration, he underwent left lower lobectomy, and a pathological specimen taken at the time was diagnosed as pulmonary metastasis of HCC. Although adjuvant chemotherapy with S-1 resulted in relapse-free survival for 2 years after pulmonary resection, he was found to have recurrence of liver cancer and underwent partial hepatectomy. This case report suggests that surgical resection and S-1 administration would be a useful treatment option for hepatocellular carcinoma with distant metastasis.

An 81-year-old woman was followed-up for HCV-associated chronic hepatitis from 1995, and in 2005, a hepatocellular carcinoma(HCC) of approximately 4-cm diameter was detected in the left lateral segment of the liver. HCC was treated by transcatheter arterial-chemoembolization (TACE). In 2007 and 2009, we performed TACE 3 times for recurrent HCCs. After the last TACE, a recurrent lesion was present close to the treated lesion, and we performed laparoscopic left lateral segmentectomy in 2010, when the patient was 85 years old. She was discharged 12 days after the operation without any morbidity, and did not experience recurrent HCC for 2 years. Laparoscopic hepatectomy for HCC is an alternative radical and potentially less invasive approach for elderly persons.

We report a case of advanced hepatocellular carcinoma(HCC) with tumor thrombosis in the main trunk of the portal vein successfully treated by multidisciplinary therapies. This case is that of a 61-year-old man with loss of appetite and weight loss. The abdominal computed tomography revealed an early enhanced and late wash-out lesion in the right hepatic lobe and tumor thrombosis in the major trunk of the portal vein. We diagnosed advanced HCC related to chronic hepatitis C [T4 (Vp4) N0M0, Stage IVA] and performed extended right lobectomy and extraction of the tumor thrombosis. The patient then underwent hepatic arterial infusion of 5-fluorouracil (5-FU) combined with systemic administration of interferon (IFN)-α therapy as an adjuvant therapy. Two years have passed since these therapies were performed with no recurrence of the disease. We expected that the patient would achieve long-term survival. Therefore, we administered IFN/ribavirin (RBV) therapy for chronic hepatitis C for 48 weeks. The patient is still alive, 44 months after the initial treatment. This case suggests that some patients with advanced HCC and a tumor thrombosis can achieve long-term survival by multidisciplinary therapies, including IFN-α/5-FU combination therapy.

Treatments for hepatocellular carcinoma(HCC) including surgical resection, transcatheter arterial chemoembolization (TACE), percutaneous local therapy, and systemic chemotherapy are decided upon according to tumor progression and liver function. However, it is difficult to choose a treatment after biliary tract reconstruction. Here we report a case of successful treatment for HCC and its recurrence where there had also been subtotal stomach preserving pancreaticoduodenectomy(SSPPD) for duodenal cancer. A 65-year-old female patient who had undergone SSPPD for duodenal cancer was found to have HCC in segment 8 (S8) 12 months later. Three months after super selective TACE, S8 partial resection was performed approaching through right thoracotomy and laparotomy. 2 years after the first hepatectomy, HCC was found to have reoccurred in S7/8 and S8. Right hepatic lobectomy was then performed without blocking the hepatic hilum. Liver resection was carried out with the aim of achieving A-P point. In this case then, several radical treatments have been completed without any biliary complication.

A 76-year-old man, who had been treated with interferon-α(IFN-α) for hepatitis C, was diagnosed with multiple hepatocellular carcinomas (HCC; S7/8, S8, S5, S2) with right hepatic vein tumor thrombus (Vv2). He initially underwent transcatheter arterial chemoembolization(TACE). One month after TACE, the hepatic vein tumor thrombi extended into the inferior vena cava(Vv3). No distant metastasis was observed, and his liver function was well-preserved. Therefore, we performed a posterior segmentectomy, partial hepatectomy(S8, S5, S2), inferior vena cava tumor thrombus excision, and cholecystectomy. Four months after the operation, intrahepatic recurrences were detected, and these lesions were controlled via TACE. Four years and 2 months after the initial treatment, the patient survived and presently, is in a good condition. This case suggested that long-term survival is possible by surgery and repeated TACE in case of good liver function by a sustained virologic response (SVR) via treatment with IFN-α for hepatitis C virus.

A 64-year-old woman was admitted for epigastralgia. Abdominal computed tomography demonstrated a large tumor in the right lobe of the liver to adrenal grand. An aspiration tumor biopsy was performed because of difficulty in diagnosing the tumor, and the pathological findings suggested intrahepatic cholangiocarcinoma. At surgery right hepatic lobectomy with caudate lobe combined with right adrenal glandectomy and diaphragmectomy was performed. Pathological findings showed moderately differentiated tubular adenocarcinoma with invasion to right adrenal gland, but no lymph node metastasis was involved nor invasion of lymph vessel and vein. The postoperative course was uneventful and the woman remains recurrence-free for 12 months after the surgery.

Treatments for hepatocellular carcinoma (HCC) include surgical resection, transcatheter arteral chemoembolization (TACE), percutaneous local therapy and systemic chemotherapy. However, it is difficult to perform a curative treatment for patients with far advanced multiple hepatocellular carcinomas. Here we report a case of successful surgical resection after repeated TACE for far advanced multiple hepatocellular carcinomas in both lobes associated with Vp₂ portal vein tumor thrombus. A 54-year-old male who had multiple HCC lesions in lateral, median and right lobes with portal vein tumor thrombus was admitted to our hospital. Three attempts of TACE resulted in a successful control of the tumors in the right lobe. Left hepatic lobectomy was therefore performed, and a relapse-free survival was obtained for over 5 years after surgery.