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Superficial thoracic esophageal cancer with a solitary metastasis to a lymph node outside the usual target area of lymphadenectomy is extremely rare. We report a case of superficial esophageal cancer with a solitary, giant metastasis to the right upper deep cervical lymph node that was treated with surgery. A 57-year-old man presented to our institution with a chief complaint of a mass in the right neck. Fine needle cytology showed squamous cell carcinoma. No lesion was found in the pharyngolaryngeal area or the lungs. Upper gastrointestinal endoscopy revealed superficial squamous cell carcinoma of the thoracic esophagus. Detailed examinations showed no other lymph node enlargement or metastasis to distant organs. The patient was diagnosed with esophageal cancer with a solitary lymph node metastasis (N4; No.102upR). Subtotal esophagectomy and 3-field lymphadenectomy were performed. The patient received adjuvant chemotherapy. At 3 years postsurgery, no recurrence has been found. We think this case is extremely rare.

Postoperative chylothorax after surgery for esophageal cancer is a rare but serious complication. Treatment initially consists of conservative therapy and, if it fails to provide improvement, it is important to perform surgical treatment without delay. We report on a recent case of intractable chylothorax. This report describes a 72-year-old man with Stage III esophageal squamous cell carcinoma. Subtotal esophagectomy, through a right thoracoabdominal approach with two-field lymphadenectomy, and cervical esophagogastric anastomosis via the retrosternal route, were performed. On the 12th postoperative day, a diagnosis of chylothorax was made. Conservative treatment was initiated, but it proved to be ineffective. Therefore, ligation of the thoracic duct via a thoracotomy was performed, but this was not effective, either. Lymphangiography undertaken to identify the site of the leak in the thoracic duct enabled a diagnosis of an extremely rare double thoracic duct and identification of the site of the leak in the thoracic duct, thereby allowing curative direct ligation of the site. This case underscores the remarkable usefulness of lymphangiography in dealing with intractable postoperative chylothorax.

Case is a 66-year-old male. He was inserted covered self expandable metallic stent(SEMS)for jejunal stenosis due to gastric cancer recurrence. Migration was occurred after 4 days from stent replacement. We had removed SEMS by endoscopy, and re-inserted non-covered SEMS. Two months later, stent stenosis was occurred by tumor ingrowth. We tried to insert another stent in the stenotic stent. The patient was able to maintain oral intake without complication for 3 months. SEMS placement would improve a quality of life for selected patients with recurrent jejunal stenosis.

There are several reasons for failure in the insertion of a self-expandable metallic stent(SEMS)into a malignant colonic obstruction(MCO)including difficulty in insertion of the catheter or guidewire through the stenotic lumen into the oral side or perforation relatedto the technique. Herein, we report a case of MCO bearing another synchronous obstructive lesion in the anal side of the colon that couldhave explainedthe difficulty in the insertion of the SEMS into the stenosis locatedin the oral side, which might have indicated the need for an emergency operation for relieving the obstruction. A 76-year-oldman with epigastralgia andmelena was admittedto our hospital andhe was diagnosedwith a MCO in the ascending colon. A series of examinations performedafter admission revealedthat the patient hadanother synchronous obstructive lesion in the descending colon, which made colonoscope insertion at the oral side difficult. The next day after admission, we observed that fasting relievedthe patient from abdominal pain causedby obstruction; therefore, we performedSEMS insertion into the MCO of the descending colon followed by SEMS insertion into the ascending colon after 6 days. These serial SEMS insertions facilitated the oral administration of the diet and the patient was discharged 15 days after admission. The patient was readmittedto our hospital andhe underwent a radical operation for both lesions in June 2015.

Background Neoadjuvant chemotherapy (NAC) with docetaxel, nedaplatin and 5-fluorouracil (5-FU) in esophageal cancer may adversely affect the postoperative clinical course following esophagectomy. Patients and methods We investigated the perioperative white blood cell count (WBC), C-reactive protein (CRP), serum albumin, body temperature (BT), heart rate (HR), respiratory rate (RR), water balance, partial pressure of oxygen in arterial blood (PaO2)/fraction of inspired oxygen (FiO2) ratio, postoperative complications and systemic inflammatory response syndrome (SIRS) in patients who underwent NAC or surgery alone (SA group). Results In the NAC group, the preoperative WBC (p=0.015) and postoperative day (POD) 3 BT (p=0.049), as well as RR (p=0.037) were lower, whereas the POD 2 PaO2/FiO2 ratio was higher (p=0.047), compared to the SA group. No differences in the incidence of postoperative complications and SIRS were observed between the groups. Conclusion NAC using docetaxel, nedaplatin and 5-fluorouracil was tolerated and feasible in esophageal cancer.

Patients with Lugol-voiding lesions of the esophagus are frequently affected with multiple cancers. Basaloid carcinoma of the esophagus is a very rare disease characterized by growth in the submucosal layer that exhibits a submucosal tumor-like shape. There have been some reports that this type of carcinoma is biologically high-grade. We report a case of metachronous squamous cell carcinoma in situ and superficial basaloid carcinoma in the esophagus with Lugol-voiding lesions. A 63-year-old man underwent gastrectomy for gastric cancer at the age of 45 years. The subsequent surveillance endoscopy found a type 0-Ⅱc lesion in the esophagus in 2000. EMR was thus performed. The pathology showed squamous cell carcinoma in situ. Dysplasia was diagnosed based on the Lugol-voiding lesions, and EMR was performed twice. In 2014, a fourth EMR was performed after a high-grade intraepithelial neoplasia was diagnosed. The pathology showed squamous cell carcinoma in situ and a basaloid carcinoma in the lamina propria, T1a-LPM, ly0, v0, pHMX, pVM0. The patient has had no recurrence for approximately 1 year after the fourth EMR.

Recently, endoscopic placement of self-expanding-metal stents (SEMS) has been widely performed for treatment of acute malignant colorectal obstruction. This study aimed to compare the efficacy of SEMS placement as palliative treatment with that of surgical treatment in patients presenting with acute malignant colorectal obstruction.A retrospective review was performed for 20 patients with unresectable malignant colorectal obstruction who had received insertion of SEMS (n=9) or surgical treatment (n=11) for palliation between July 2006 and M ay 2014.Patients who had received SEMS were in poorer clinical condition regarding age and performance status. Duration of treatment was significantly lesser and the postoperative date of initial oral intake after intervention was statistically earlier in the SEMS group. SEMS-related morbidity was found in only 2 cases of obstruction due to tumor ingrowth; these patients were successfully treated by reinsertion of SEMS. The prognosis of both groups showed no statistical difference.Palliative SEMS placement for unresectable colorectal malignant obstruction in patients with more severe clinical condition relieved obstruction without severe morbidity. Palliative SEMS placement could be an alternative to surgery for the treatment of acute unresectable colorectal obstruction.

The incidence of postoperative complications and mortality are usually higher in patients with preoperative malnutrition. Malnutrition often preexists, particularly in patients undergoing surgery for esophageal cancer, which is substantially invasive. It is therefore important to understand the nutritional condition of patients and actively control perioperative nutrition.Our hospital has been providing nutritional status screening for patients before resection of esophageal cancer, and we report the current status and evaluation results in this article.This screening included 158 patients requiring radical resection of esophageal cancer.Age, comorbidity with diabetes, body mass index(BMI), serum albumin(Alb), Onodera's prognostic nutritional index(PNI), and Glasgow prognostic score(GPS)were used as nutritional indicators to stratify patients for analysis.Evaluation parameters included the incidence of postoperative complications(any complication, pulmonary complications, psychiatric disorder, and anastomotic leakage)and rates of long-term postoperative hospitalization.The analysis indicated that age, BMI, serum Alb, PNI, and GPS are useful for predicting the onset of postoperative complications and prolonged postoperative hospitalization.For such patients, more active nutritional control should be provided.

Although hepatic resection is the most effective therapy for patients with liver metastasis from colorectal carcinoma, a subset of patients cannot undergo surgical treatment for several reasons, including age-related general health decline or poor conditions associated with coexisting diseases, even if the lesions are resectable. A 75-year-old man with a recurrent lesion in the liver underwent right hemicolectomy and partial hepatic resection to treat colonic cancer and a liver metastasis, followed by uracil and tegafur plus Leucovorin( UFT+LV) as adjuvant chemotherapy at 6 months after the initial surgery. Although the lesion was resectable, the patient preferred chemotherapy to surgery, and capecitabine plus oxaliplatin plus bevacizumab was administered; however, the treatment was stopped in the middle of the second course because of oxaliplatin -related toxicities. Capecitabine plus bevacizumab was introduced as the following chemotherapy regimen, and no adverse reactions were observed during this therapy. After 5 courses of administration, the lesion disappeared on CT examination, and no new lesions were found after 9 courses. Thus, the treatment response was classified as complete response (CR) and remains as such after 13 courses.

Patients often experience decreased oral intake due to primary systemic therapy (DCF [docetaxel, cisplatin, and fluorouracil ] therapy) administered during the treatment of esophageal carcinoma; measures to cope with this problem have been sought. We therefore examined the relationship between the presence or absence of decreased oral intake and blood biochemistry( serum albumin[ Alb] level, white blood cell[ WBC] count, neutrophil count, and serum sodium[ Na] level) during the 12 courses of DCF therapy administered as primary systemic therapy to 6 patients with esophageal carcinoma. Decreased oral intake occurred frequently from day 6 to day 12 after the initiation of DCF therapy. During this period, decreased serum Alb levels were observed in patients with decreased oral intake but not in patients without decreased oral intake. The incidence of decreased oral intake was 100% in patients whose serum Alb levels decreased to3.5 g/dL, but it did not exceed 33.3% in patients whose serum Alb levels were ≥3.5 g/dL. The serum Na level, WBC count, and neutrophil count were less affected than the serum Alb level, suggesting that decreased oral intake was associated with decreased serum Alb level.

This study was conducted to analyze the outcomes of endoscopic stent placement (n=9) and bypass surgery (n=9) with regard to perioperative complications and dietary intake conditions in patients with unresectable advanced gastric cancer with stenosis. Regarding perioperative complications, 1 patient in the stent group experienced a stent failure and 1 patient in the bypass group developed an adhesive ileus. Dietary intake began from the first day in the stent group and from the fourth day in the bypass group, and it was continued for 55 and 113 days, respectively. There was no difference in the introduction of chemotherapy or length of treatment between the groups, and the survival period for the patients in the stent and bypass groups was 83 and 127 days, respectively. Endoscopic stent placement for unresectable advanced gastric cancer with stenosis is a safe and effective method for improving the quality of life( QOL) of patients.