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Objective: Gallbladder cancer (GBC) typically follows an aggressive course with the standard of care for advanced disease; complete responses are rarely encountered. We report a case in which tumor disappearance on positron emission tomography computed tomography (PET-CT) was treated with S-1 as the second-line treatment for local recurrence of GBC after gemcitabine (GEM) plus cisplatin (CDDP) (GC) combination therapy. Case Presentation: A 69-year-old woman was referred to our hospital with complaints of right hypochondrial pain. Based on ultrasound, CT, and magnetic resonance imaging (MRI) findings, we diagnosed patient with suspected GBC. Results: We performed the resection of the gallbladder base, partial resection of the transverse colon, and partial resection of the stomach for GBC. At four months after the surgery, PET-CT showed local recurrence. First-line chemotherapy with GC therapy was initiated. After 9 courses, PET-CT showed increased local recurrence. We concluded that GC treatment was ineffective. Second-line chemotherapy with S-1 was initiated for two weeks, followed by a 7-day rest period. PET-CT in September 2019 showed the markedly reduction of the local recurrence, and PET-CT in October 2021 showed the complete disappearance of the local recurrence. At 20 months after the discontinuation of S-1, PET-CT showed the complete disappearance of the local recurrence. Conclusions: Chemotherapy with S-1 can be managed safely and was demonstrated to be effective in treating the local recurrence of GBC recurrence.

Objective: Small bowel adenocarcinoma (SBA) is a rare disease but its clinical features have been clearly elucidated. The present study clarified the clinicopathological characteristics, the effectiveness of the surgical procedure, neoadjuvant chemotherapy, and adjuvant chemotherapy of the patients with SBA. Patients and Methods: The clinicopathological characteristics of 9 cases of SBA resected at our hospital were reviewed between 2004 and 2017. Results: The mean age of the 9 patients (4 men, 5 women) was 69.6 (57-83) years. The sites included the duodenum (n=3), jejunum (n=3), and ileum (n=3). As neoadjuvant chemotherapy, S-1 was administered to a patient with a large duodenal adenocarcinoma invading the portal vein. The surgical procedures included partial resection of jejunum (n=3); partial resection of ileum (n=3); pylorus-preserved pancreatoduodenectomy (PD) (PPPD) with right hemicolectomy due to invasion of ascending colon (n=1); subtotal stomach-preserving PD (SSPPD) (n=1); and wedge resection of the duodenum (n=1). The stage was classified as follows: stage I (n=1), stage IIA (n=1), stage IIB (n=3), stage IIIA (n=1), stage IIIB (n=2), and unknown, (n=1). As adjuvant chemotherapy, S-1 was administered to three stage IIB patients, one IIIA patient, and one IIIB patient. Tegafur uracil (UFT) + calcium folinate (LV) was administered to one stage IIIB patient. The cumulative five-year survival rate was 77.8%. Conclusions: Aggressive esophagogastroduodenoscopy, double-balloon endoscopy, and colonoscopy for symptoms such as anemia and abdominal pain, as well as intraoperative during abdominal surgery, would improve the prognosis of SBA.

Objective: Primary appendiceal adenocarcinoma accounts for 1% of colorectal tumors and is a rare malignancy. Peritoneal dissemination commonly occurs as part of the natural course of disease, following the sequence of luminal wall invasion, obstruction, and perforation. Patients and Methods: Twenty patients with appendiceal adenocarcinoma were surgically treated in our hospital between 1990 and 2021. The clinicopathological features, preoperative diagnosis, intraoperative diagnosis, surgical techniques, postoperative adjuvant chemotherapy, chemotherapy, outcome, and prognostic factors for survival of patients with primary appendiceal adenocarcinoma were reviewed. Results: Patients (8 males, 12 females), with an age from 35 to 94 years (mean: 72.8 years), were involved in the study. Before surgery, 7 (35%) patients were diagnosed with primary appendiceal adenocarcinoma and 13 were diagnosed with other conditions. 10 patients had stage I or II disease and 10 patients had stage III or IV disease. Sixteen patients received curative resection, while 4 received non-curative resection. The cumulative five-year survival rate was 62.1%. The preoperative and intraoperative diagnoses, pathological stage, and curative resection had a significant impact on survival. Conclusions: The preoperative and intraoperative diagnoses, pathological stage, and curative resection had an important impact on survival of patients with primary appendiceal adenocarcinoma.

Objective: Gastrointestinal stromal tumors (GISTs) present with different clinical and immunohistochemical characteristics depending on the anatomic site. The present study clarified the clinicopathological characteristics of small bowel (SB) GISTs, which are relatively infrequent. Patients and Methods: The clinicopathological characteristics of 15 cases of small intestinal GISTs resected at our hospital were reviewed. SBGISTs were divided into duodenal (d) GISTs and jejunal/ ileal (ji) GISTs for the comparison. Results: The tumors included six cases in the duodenum, six in the jejunum, and three in ileum. All patients underwent duodenal wedge resection for dGIST and partial SB resection for jiGIST. The stage was I in seven patients, II in two patients, IIIB in five patients, and IV in one patient. The median postoperative observation period was 67 (11-175) months. Ten patients had no recurrence, two had hepatic and peritoneal recurrence, one had multiple hepatic recurrence, one had peritoneal recurrence, and one had lymph node recurrence. On comparing dGISTs and jiGISTs, recurrence was significantly more frequent in jiGISTs than in dGISTs. Conclusions: In five cases of recurrence, chemotherapy and surgery at the appropriate time seemed effective for achieving a long-term survival. Recurrence was significantly more frequent in jiGISTs than in dGISTs.

Objective: The prognosis of patients with advanced gastric cancer (GC) with multiple lymph-node metastasis is poor. The present study evaluated a neoadjuvant S-1 and oxaliplatin regimen (SOX) followed by D2 gastrectomy for advanced GC with lymph-node metastasis. Patients and Methods: Ten patients with resectable clinical advanced gastric cancer with multiple lymph-node metastasis who received preoperative SOX therapy were included in this study from 2015 to 2021. Results: A clinical evaluation by RECIST version 1.1 criteria after SOX therapy showed 8 cases of partial response (PR), 2 cases of stable disease (SD), and no progress disease (PD). The histopathological stages were IB in 3 patients, IIA in 2, IIB in 2, IIIA in 2, and IIIB in 1, and downstaging was observed in 8 of 10 patients (80%). Histopathological effects were Grade 1a in 4 patients, Grade 1b in 3 patients, Grade 2a in 2 patients, and Grade 2b in 1 patient; there were no Grade 3 patients. Adverse events of neoadjuvant chemotherapy (NAC) according to the CTCAE criteria were Grade 1 anemia, nausea, dysgeusia, and peripheral neuropathy in one patient each; Grade 2 anemia in two patients; and diarrhea in one patient. No grade ≧3 adverse events were observed. The surgical techniques were distal gastrectomy in four cases, total gastrectomy in five cases, and total gastrectomy and caudal pancreatectomy in one case; all patients underwent D2 dissection, and all received R0 surgery. One patient had local recurrence, and one patient had peritoneal recurrence and is on chemotherapy. The remaining eight patients are alive without recurrence. Conclusions: In the future, neoadjuvant chemotherapy with SOX therapy may become a treatment option for advanced resectable GC with multiple lymph-node metastasis.

Objective: Even after surgery and intensive postoperative treatment, the mortality rate of patients with perforated colorectal cancer (CRC) is high. The purpose of this retrospective study was to evaluate risk factors for postoperative recurrence and hospital mortality in patients with perforated CRC. Patients and Methods: We experienced a total of 142 patients who were diagnosed with colorectal perforation and who underwent emergency surgery from 2008 to 2021. First, we performed a clinicopathological study of patients with perforated CRC. Next, we examined the clinicopathological characteristics of the CRC and non-CRC groups. We investigated the histopathological characteristics and risk factors for postoperative recurrence and hospital mortality in 32 patients with perforated CRC. Results: The Hinchey stage of the CRC group was significantly higher than that of the non-CRC group (p=0.00619), and that in the proximal site group was significantly higher than that of the cancer site group (p=0.00489). The rate of recurrence in the proximal site perforation group was significantly higher than that in the cancer site perforation group (p=0.0135). Patients with T4 disease showed a significantly higher rate of recurrence than those with T3 disease (p=0.0443). The number of dissected lymph nodes in the recurrence-free group was significantly higher than that in the recurrence group (p=0.0377). There was a tendency for more patients in the recurrence-free group to receive postoperative adjuvant chemotherapy; however, this difference was not statistically significant. The preoperative shock rate in the hospital mortality group was significantly higher than that in the alive at discharge group (p=0.0169). Conclusions: The proximal site perforation, T4 disease, and the small number of dissected lymph nodes were the risk of the recurrence. The large number of preoperative shocks was the risk of the hospital mortality.