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According to the REGARD and RAINBOW trials, ramucirumab(RAM)was introduced as second-line therapy for advanced or metastatic gastric cancer. RAM may impair wound healing due to the inhibition of angiogenesis; details on the postoperative course of patients who underwent surgery during RAM treatment remain unclear. Between 2011 and 2016, 93 patients with incurable gastric cancer were treated with RAM in our institute. Among them, 3 patients underwent surgery after RAM treatment. Case 1: A 74-year-old man with liver metastasis from gastric cancer was treated with a paclitaxel(PTX)plus RAM regimen. Perforation of the stomach was observed 3 days after final RAM administration. He was successfully treated with omental repair and discharged 19 days after surgery. Case 2: A 31-year-old woman with peritoneal recurrence after total gastrectomy received the PTX plus RAM regimen as second-line treatment. Stenting was performed for rectal stenosis. Perforation of the rectum just proximal of the stent was observed 5 days after final RAM administration. Ileostomy was performed. Closure of the perforation was not obtained until the patient died 210 days after surgery. Case 3: A 60-year-old man with remnant gastric cancer received the PTX plus RAM regimen. Accidentally, the enteral feeding tube was removed. Six weeks after the cessation of RAM administration, the enteral feeding tube was inserted under general anesthesia. He was discharged 4 days after surgery. If surgery is required in patients receiving RAM treatment, sufficient drug withdrawal is desirable. If emergency surgery is needed, less invasive procedures should be selected to the maximum extent possible.

Posterior reversible encephalopathy syndrome(PRES)is a subacute neurological syndrome typically manifesting with headache, cortical blindness, and seizures. This syndrome is associated with risk factors such as malignant hypertension, eclampsia, and renal failure. Numerous case reports depict its occurrence in cancer patients. The direct causal mechanisms of PRES in cancer patients have not yet been identified. Cytotoxic chemotherapy may cause direct endothelial damage, which would impact the blood brain barrier. Angiogenesis inhibitors also cause elevation in blood pressure;this is significant, because PRES onset may be solely related to hypertension. An increased number of case reports involving new molecular targeted agent suggests that incidence of PRES as an oncological emergency may increase in the future.

Metastatic brain tumors have become a critical issue in clinical management for patients with cancer. We retrospectively analysed features of 105 patients with metastatic brain tumors from gastrointestinal cancer, who underwent treatment in our institute between September, 2002 and December, 2010. Treatment strategy was individualized according to the patient's systemic and neurologic conditions, size and location of the brain metastases, and expectant systemic treatment through our cancer board. Treatment outcome was significantly better in patients with RTOG RPA class 2 than in those with class 3(8.6 months vs 3.5 months: p<0.05). Metastatic brain tumors were diagnosed at 6.3/13.1/15.7 months after diagnosis of metastatic lung tumors from esophagus/stomach/colon cancers respectively. A third of the patients with metastatic brain tumor from rectal cancer presented without evident lung metastasis. In conclusion, patients with brain metastasis from gastrointestinal cancers can achieve improvement in survival with early diagnosis and multidisciplinary individualized treatments.

Aim: Patients with Stage IV gastric cancer are currently not considered operative candidates and are most often offered systemic chemotherapy. Recently, several novel regimens of combined chemotherapy have occasionally converted an initially unresectable gastric cancer to a resectable status. We evaluated the efficacy of surgical resection following the response to the primary chemotherapy for Stage IV gastric cancer., Subjects and Methods: The subjects were 30 advanced gastric cancer patients who were clinically diagnosed as resectable following their response to primary chemotherapy between 2002 and 2011., Results: Twenty patients underwent R0 resection. Two patients had a R1/2 resection, and 8 patients did not undergo surgical resection because of the presence of noncurable factors. The postoperative complication rate was high(41%), with a mortality rate of 0%. The median survival time(MST)of the patients who underwent R0 resection was 1, 409 days, and the MST of the patients who could not undergo R0 resction was 783 days(p=0. 0017)., Conclusion: Surgical resection following the response to primary chemotherapy might be effective for patients who underwent R0 resection, although it had a high postoperative complication rate. Staging laparoscopy may be useful for the evaluation of resectability after chemotherapy.