1.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2101-2103.
[Experience of Treatment with Lenvatinib in Patients with Advanced HCC-A in a Single Institution].
[Article in Japanese]
Katsura Y1, Takeda Y, Ohmura Y, Sakamoto T, Kawai K, Inatome J, Murakami K, Naito A, Kagawa Y, Masuzawa T, Takeno A, Hata T, Egawa C, Murata K.
Abstract
The efficacy of lenvatinib was evaluated in 7 patients with advanced hepatocellular carcinoma(HCC), between March 2018 and February 2019. Their mean age was 74.3 years, and 6 of them were men. All patients had an Eastern Cooperative Oncology Group(ECOG)performance status(PS)of 0. The median number of treatment days was 185. The relative dose intensity was 87.5%. The major Grade was 3, and the overall toxicity events were AST elevation(14.3%)and hypertension (14.3%). The 6-month progression-free and overall survival rates were 71.4% and 100%, respectively. The overall response rate was 57.1%, and the disease control rate was 71.4%. Lenvatinib can be used as a standard treatment for patients with advanced HCC.
2.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2098-2100.
[A Case of Far-Advanced Esophageal Cancer with Multiple Metastases Showing Long-Term Survival after Chemotherapy].
[Article in Japanese]
Iwamoto R1, Kubota H, Kinoshita S, Kitagawa S, Ueno M, Mineta S, Okamoto Y, Watanabe Y, Higashida M, Okada T, Tsuruta A, Fujiwara Y, Ueno T.
Abstract
A 71-year-oldman with voice hoarseness was referredto our hospital for further examination. He was diagnosedwith unresectable Stage Ⅳb esophageal cancer, with direct invasion to the aorta andtrachea andmultiple metastases to the lymph nodes, lungs, and adrenal gland. Because his performance status(PS)was deemedto be favorable, he receivedchemotherapy with docetaxel(DOC), cisplatin, and5 -FU(DCF therapy). After 2 cycles of DCF therapy, the primary lesion was scarred. No malignant lesions were detected in the biopsy performed. No distant metastases were identified on PET-CT. As a subsequent treatment, S-1 plus DOC therapy was administered. Finally, single S-1 administration was continued. The treatment periodwas 14 months. Treatment was concludedbecause a complete response(CR)was maintained. Three years after the conclusion of treatment, CR remains maintained. The overall survival in cases of unresectable advanced esophageal cancer is saidto be 3-10 months, but there are remarkable cases such as this one. If a goodPS is maintained, treatment shouldbe actively considered because CR is possible.
3.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2096-2097.
[A Case of Pathological CR in Local Advanced Rectal Cancer Treated with Laparoscopic ISR after XELOXIRI Chemotherapy].
[Article in Japanese]
Kawai K1, Murata K, Hata T, Kagawa Y, Naito A, Sakamoto T, Murakami K, Katsura Y, Omura Y, Masuzawa T, Takeno A, Takeda Y.
Abstract
A 67-year-old man without a history of surgery presented with bloody stool and anal pain. Colonoscopy and abdominal CT revealed locally advanced rectal cancer with right lateral lymph node metastasis. We administered 6courses of neoadjuvant therapy with capecitabine, oxaliplatin, and irinotecan(XELOXIRI)to the patient. After neoadjuvant chemotherapy, remarkable tumor shrinkage was observed. The patient underwent safety intrasphincteric resection(ISR)and lateral lymph node dissection with anal preservation. The postoperative course was uneventful, and he was discharged 17 days postoperatively. Pathologically, no residual cancer cells were observed in the rectum and lymph nodes(pathological CR). This case of locally advanced rectal cancer was successfully treated with laparoscopic ISR after XELOXIRI chemotherapy, and showed pathological CR. ISR after neoadjuvant XELOXIRI chemotherapy was safely performed and might be a good option for locally advanced rectal cancer.
4.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2093-2095.
[Pathological Complete Response Following Chemotherapy for Sigmoid Colon Cancer with Para-Aortic Lymph Node Metastasis-A Case Report].
[Article in Japanese]
Takenoya T1, Osumi K, Morishige S, Tamura E, Kobayashi K, Iwama N, Oto I, Yoshikawa T, Yabe N, Murai S.
Abstract
A man in his 50s visitedour hospital with complaints of frequent urination, painful micturition, macrohematuria, and weight loss. On examination, he was diagnosed with RAS-wild-type sigmoid colon cancer invading the urinary bladder, ureter, andexternal iliac artery, with para-aortic lymph node metastasis(T4b, NX, M1a, Stage ⅣA according to the Union for International Cancer Control 8th edition guidelines)andsigmoid -vesical fistula. Thus, sigmoidcolostomy was performed. Postoperatively, S-1 plus oxaliplatin was administered. After 3 courses of chemotherapy, the primary tumor and para-aortic lymph node metastases shrunk. Moreover, after 8 courses of chemotherapy, further shrinkage of the primary tumor and paraaortic lymph node metastases was confirmed; however, tumor markers in the blood increased. Therefore, the patient received 3 additional courses of S-1 plus oxaliplatin plus cetuximab, which resultedin complete response. Sigmoidectomy, partial cystectomy, ureterectomy, resection of the external iliac artery, andreconstruction using a prosthetic vascular graft were performed. Subsequent pathological examination revealed no viable cancer cells(pathological response), achieving R0 resection. The patient has been followedup for 2.5 years after the curative resection, with no recurrence.
5.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2090-2092.
[A Case of Spontaneous Rupture of Non-Viral Hepatocellular Carcinoma with Subcapsular Hematoma].
[Article in Japanese]
Abstract
An 86-year-old man visited our hospital complaining of upper abdominal pain. Enhanced computed tomography showed a 37×23mm tumor with subcapsular hematoma in S3. Hepatitis B and C virus markers were negative, and serum tumor markers were elevated. The patient was diagnosed with ruptured non-viral hepatocellular carcinoma with subcapsular hematoma. Because his condition and vital signs remained stable after conservative management of the liver tumor and hematoma, elective hepatectomy was performed. The postoperative course was good, and he was discharged 12 days postoperatively without any complications. We experienced a relatively rare case of ruptured non-viral hepatocellular carcinoma with subcapsular hematoma. We describe this case with reference to the literature.
6.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2087-2089.
[Multidisciplinary Treatment for a Patient with Recurrent Gastric Cancer, Presenting 13 Years after the Radical Gastrectomy].
[Article in Japanese]
Namikawa T1, Ishida N, Yokota K, Iwabu J, Uemura S, Maeda H, Kitagawa H, Nagata Y, Kumon M, Kobayashi M, Hanazaki K.
Abstract
A 72-year-old woman was referred to our hospital for further examination of para-aortic lymph node swelling and elevated carbohydrate antigen 19-9 levels. Thirteen years ago, she had undergone distal gastrectomy for gastric cancer, and the final diagnosis was T4N1M0, Stage ⅢA. Abdominal contrast-enhanced computed tomography(CT)showed an enlarged para-aortic lymph node measuring 25 mm. Endoscopic ultrasound-guided fine-needle aspiration was performed, and biopsy specimens showed poorly differentiated adenocarcinoma. Under the clinical diagnosis of gastric cancer recurrence, the patient received chemotherapy with cisplatin plus S-1. After 5 cycles of systemic treatment, abdominal CT revealed a marked shrinkage of the para-aortic lymph node metastasis, with an 84% decrease. At 15 months after treatment, we switched to S-1 monotherapy because of general fatigue and the patient's preference. However, 22 months after the treatment, the patient was treated with ramucirumab due to the progression of para-aortic lymph node metastasis. After 33 months, the patient developed metastasis in the left ovary, measuring 11.0×8.5 cm. Because there was no evidence of further metastatic lesions in any other organs, she underwent left oophorectomy. After 37 months, the patient developed metastasis in the left cerebellum, measuring 3.2×2.5 cm, accompanied with headache and nausea. The patient underwent metastasectomy of the left cerebellum as palliative treatment. Simultaneous physical examination revealed a painful nodular elevated lesion in the subcutaneous tissue of the posterior neck region, measuring 18×15 cm. Pathological examination of the biopsy specimen showed infiltration of poorly differentiated adenocarcinoma cells into the subcutaneous mass. The patient received radiation therapy; however, she died due to septic shock with hydronephrosis 39 months after starting chemotherapy. Although late recurrence of gastric cancer is rare, identification of risk factors and the development of novel treatments should be achieved through further studies and accumulation of data from such cases.
7.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2084-2086.
[Surgical Resection of a Solitary Pulmonary Nodule in a Patient with Breast Cancer-A Case Report].
[Article in Japanese]
Abstract
Solitary lung tumors after radical surgery for breast cancer often present difficulty in diagnosis and treatment. This report describes the case of a patient with a previous history of radicalsurgery for breast cancer who underwent lung surgery. Solitary pulmonary nodules should be diagnosed in patients with breast cancer, because treatments and prognoses differ between metastatic and primary tumors. At the age of 43 years, this patient underwent surgicaltreatment for breast cancer. Eighteen years later, a solitary mass was observed in the middle lobe of the right lung. Right middle lobectomy was performed using video-assisted thoracic surgery. The diagnosis was primary lung carcinoma. In case of primary lung carcinoma, radical treatment is possible through surgical resection. On the contrary, breast cancer metastasis has been known to have subtypes with characteristics that may often be different from those of the originall esions; therefore, surgicalresection helps in the reevaluation of receptor expression. Thus, early pathological diagnosis using surgical resection is useful for early diagnosis and treatment.
8.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2081-2083.
[A Case of Resected Primary Hepatic Neuroendocrine Tumor].
[Article in Japanese]
Fujimoto N1, Tomimaru Y, Noguchi K, Nagase H, Hirota M, Ogino T, Oshima K, Tanida T, Noura S, Kawase T, Imamura H, Akagi K, Iwazawa T, Adachi S, Dono K.
Abstract
A 70s man presented with a solitary liver tumor measuring 4.5 cm on CT. On contrast-enhanced CT, the tumor appeared partly well-enhanced in the late phase, and the remaining part was enhanced in the early phase and washed out in the late phase. Contrast-enhanced MRIshowed fused multiple nodules, and the enhancement/washout pattern was clearer than that of the contrast-enhanced CT. The tumor showed a defective image in the hepatobiliary phase and a high signal on diffusionweighted imaging. Then, the tumor was diagnosed as hepatocellular carcinoma, and thus, left liver lobectomy was performed. On histological examination of the resected specimen, the tumor was found to be composed of uniform and small tumor cells with solid or trabecular growth fashion. On immunohistochemical staining, synaptophysin and chromogranin A positivity was noted, and the Ki-67 index was 14%. Finally, the tumor was diagnosed as a NET G2. Postoperatively, somatostatin receptor scintigraphy was performed to identify the primary site; however, no obvious primary site could not be identified, and thus a diagnosis of primary hepatic NET was made. Eighteen months postoperatively, the patient is alive without relapse. Preoperative diagnosis of primary hepatic NETs is difficult because NETs present various imaging findings and are rare. Moreover, no accurate preoperative diagnosis was reached in our case, suggesting the difficulty in the preoperative diagnosis of NETs.
9.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2078-2080.
[A Case of Rectovaginal Fistula after Rectal Cancer Surgery Cured with Estriol Vaginal Tablet and Vaginal Lavage].
[Article in Japanese]
Fujita S1, Momma T, Endo E, Kase K, Ujiie D, Hanayama H, Watanabe Y, Okayama H, Sakamoto W, Endo H, Saito M, Saze Z, Ohki S, Kono K.
Abstract
Although rectovaginal fistula is a rare complication of rectal cancer surgery, it is usually difficult to cure with conservative treatment, and patients generally need surgical intervention. A woman in her 70s underwent laparoscopic low anterior resection with right lateral lymph node dissection for rectal cancer. On postoperative day(POD)6, she had an anastomotic leakage and received conservative treatment. On POD 9, she underwent emergent laparotomy for urinary peritonitis as well as ileostomy and ureteral stenting. On POD 21, the rectovaginal fistula was confirmed with lower gastrointestinal tract fluoroscopic examination. The patient received conservative therapy for the rectovaginal fistula with estriol vaginal tablets and vaginal lavage for 2 weeks. Subsequently, the fistula was completely cured. After continuation of the estriol vaginal tablets for 4 weeks, the rectovaginal fistula has not recurred at the most recent follow-up.
10.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2075-2077.
[A Case of Advanced Gastric Cancer with Right Gastroepiploic Vein Tumor Thrombus Treated by Preoperative S-1 plus CDDP That Resulted in Pathological Complete Response].
[Article in Japanese]
Abstract
We report a case of advanced gastric cancer with right gastroepiploic vein tumor thrombus treated using preoperative S-1 plus cisplatin(CDDP)in which pathological complete response was achieved. A 78-year-old man was diagnosed with type 2 gastric cancer located at the greater curvature of the antrum, accompanied by right gastroepiploic vein tumor thrombus. Four courses of S-1 plus CDDP were administered as neoadjuvant chemotherapy. After 2 courses, computed tomography(CT) revealed the disappearance of the tumor in the right gastroepiploic vein thrombus. Distal gastrectomy with D2 lymphadenec- tomy was performed, and the diagnosis was pathological complete response(CR). Eight courses of S-1(100mg/day on days 1-28, followed by 2 weeks of rest)were administered as adjuvant chemotherapy. During the 1-year postoperative follow up, the patient showed no recurrence. An S-1 plus CDDP regimen can be a useful preoperative chemotherapy option for advanced gastric cancer with tumor vein thrombus.
11.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2072-2074.
[A Case of Long-Term Survival after Para-Aortic Lymph Node Recurrence Following the Curative Resection of Gastric Cancer Treated Using Multimodality Therapy Including Salvage Surgery].
[Article in Japanese]
Noumi T1, Ishizaki M, Tanioka H, Yoshikawa C, Kawasaki K, Mushiaki Y, Iga N, Yoshida R, Waki N, Kawai H, Uno F, Nishi H, Yamashita K, Sonobe H.
Abstract
This case was observed in a man in his 70s. Although symptomatic treatment was performed for epigastralgia, endoscopic examination revealed a type 3 tumor on the fornix of the stomach to the lesser curvature of the body just above the esophagogastric junction, and the patient was diagnosed with moderately differentiated tubular adenocarcinoma(cT4bN3aM0, cStage ⅣA). As esophageal and diaphragmatic invasion was suspected based on CT findings, S-1 plus CDDP was started as preoperative chemotherapy. Although the primary lesion and lymph node metastasis decreased in size, chemotherapy was discontinued after one course due to stenosis symptoms, and total gastrectomy and D2 dissection were performed. Postoperative adjuvant chemotherapy with S-1 was started. However, 6 months after starting the treatment, para-aortic lymph node recurrence was observed, and the treatment strategy was changed to weekly PTX. After 5 courses of weekly PTX, the lymph nodes continued to increase in size, and chemotherapy was discontinued per the patient's request. The patient was followed up with CT and PET-CT; however, no new recurrent lesions were found in other sites for approximately 1 year. Therefore, para-aortic lymph node dissection was performed as the salvage surgery. Pathological findings showed that gastric cancer metastasis was present in 1 swollen lymph node only, as confirmed by PET. At present, 6 years have passed since the first operation, and there has been no recurrence. In general, para-aortic lymph node metastasis is considered to result in poor prognosis in gastric cancer. However, in the absence of other noncurative factors, a good prognosis may be obtained with combined therapeutic modalities.
12.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2069-2071.
[A Case of Gastric Remnant Necrosis Following Laparoscopic Distal Gastrectomy for Gastric Cancer Successfully Treated Using a Conservative Approach].
[Article in Japanese]
Abstract
INTRODUCTION:
The stomach is an organ considered resistant to ischemia because of the microvascular networks in the stomach wall, and gastric remnant necrosis following gastrectomy is rare. Herein, we report a case of gastric remnant necrosis following gastrectomy successfully treated using a conservative approach.
CASE PRESENTATION:
An 83-year-old woman underwent laparoscopic distal gastrectomy, D1 plus lymphadenectomy, Billroth Ⅰreconstruction, and suture closure of the esophageal hiatus for early gastric cancer and giant esophageal hiatal hernia. The amylase level of the drainage fluid was abnormally high on postoperative day(POD)3, and contrast-enhanced CT confirmed gastric remnant necrosis. The patient was treated using a conservative approach, as her general condition was stable. Postoperative fluoroscopy on POD 21 revealed contrast media leakage from the gastric remnant; however, adequate drainage was observed. Upper gastrointestinal(GI)endoscopy on POD 23 demonstrated circumferential gastric remnant necrosis, whereas GI endoscopy on POD 52 revealed a decrease in the size of the gastric remnant, proliferation of the granulation tissue, and regeneration of mucosa in the gastric remnant.
DISCUSSION:
Gastric remnant necrosis following gastrectomy is a rare complication and is associated with poor prognosis. In most cases, total resection of the remnant stomach is warranted. However, for high surgical risk cases, conservative treatment options should be considered based on an assessment of patients' general condition.
13.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2066-2068.
[A Case of Gastric Cancer with Ramucirumab-Related Colon Perforation after a Subtotal Colectomy].
[Article in Japanese]
Wada N1, Akamaru Y, Hokkoku D, Wada R, Ikeshima R, Munakata K, Takiuchi D, Azama T, Morimoto O, Ota H, Kitada M, Shibata K.
Abstract
A 61-year-old man with advanced gastric cancer underwent distal gastrectomy after chemotherapy. Fifteen months later, peritoneal metastasis and colon stenosis were detected. Therefore, subtotal colectomy and ileosigmoidostomy were performed. Three weeks later, paclitaxel(PTX)treatment was initiated, followed by nab-PTX with ramucirumab(Ram)treatment at 7 weeks postoperatively. The patient experienced sudden abdominal pain diagnosed as gastrointestinal perforation 13 weeks postoperatively. Operative findings showed that the anastomosis of the ileosigmoidostomy was perforated, and this was treated using sutures. Angiogenesis inhibitors should be carefully administered even 4 weeks or more after surgery.
14.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2063-2065.
[Long-Term Survival in a Case of Breast Cancer with Brain Metastases and No Other Distant Metastases Treated by Surgical Removal and Gamma Knife Radiosurgery].
[Article in Japanese]
Egawa C1, Yanai A, Yanagawa T, Takatsuka Y, Takeno A, Masuzawa T, Hata T, Kagawa Y, Ohmura Y, Katsura Y, Murakami K, Sakamoto T, Kawai K, Takeda Y, Murata K.
Abstract
A 44-year-oldwoman was diagnosedwith right breast cancer andund erwent mastectomy andaxillary lymph node dissection in February 2006. She was pathologically diagnosed with invasive ductal carcinoma without lymph node metastasis. Immunohistochemical examination showedthat the tumor was estrogen receptor positive, progesterone receptor negative, andhada HER2 status score of 0. She received 4 cycles of AC, followedby leuprorelin andtamoxifen. Several metastases were identified in the right supraclavicular lymph nodes in August 2008 during the endocrine therapy. Then, she received S-1 as the first-line chemotherapy. Although metastases showed complete response, she developed an eye disorder caused by S-1 and thus the treatment agent was changedto leuprorelin andanastrozole. She complainedof headache andright homonymous hemianopsia in November 2013. MRI showeda 42mm diameter tumor in the left occipital lobe, suspectedto be brain metastasis from breast cancer. Craniotomy was performedto remove the brain tumor, which was pathologically diagnosedas metastasis from breast cancer. In the brain tumor, the estrogen receptor status hadchangedto negative, but the HER2 status remained unchanged, showing a score of 0. Vinorelbine was administered after the brain surgery. Unfortunately, brain metastasis was foundin the dura mater near the surgical cavity, andgamma knife radiosurgery was performedin January 2014. Thereafter, brain metastases were repeatedly found, and gamma knife radiosurgery was again performed in January 2015, September 2016, and February 2017. In addition, a large tumor appearedin the left occipital lobe andwas surgically removed in June 2016. No other distant metastases were found, andvinorelbine was continueduntil February 2018. Because the patient developed dyslexia caused by gamma knife-induced radiation necrosis, bevacizumab was administered between November 2018 and April 2019. MRI showed that the edema due to radiation necrosis reduced and dyslexia symptoms improved. As of now, she has survivedfor 5 years and 6 months after the diagnosis of brain metastases.
15.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2060-2062.
[A Case of Pancreatic Mixed Acinar-Neuroendocrine Carcinoma with Main Pancreatic Duct Development].
[Article in Japanese]
Nomoto M1, Kusashio K, Yasutomi J, Matsumoto M, Suzuki T, Iida A, Fushimi K, Furukawa A, Konishi T, Imamura N, Harano R, Fujita A, Koguchi H, Udagawa I, Ozaki D.
Abstract
A 78-year-old man was referred to our hospital owing to a pancreatic tumor detected on ultrasonography. He showed weight loss, and his diabetes mellitus had worsened over 3 months. Abdominal contrast-enhanced computed tomography revealed a 3 cm diameter pancreatic head tumor with peripheral enhancement and a dilated pancreatic duct. He underwent subtotal stomach-preserving pancreaticoduodenectomy. Examination of intraoperative frozen sections did not indicate cancer involvement at the edge of the resected pancreatic duct. The tumor was histologically diagnosed as mixed acinar-neuroendocrine carcinoma(MANEC). It was mainly detected in the pancreatic head and was accompanied by intra-ductal growth in the pancreatic duct. The patient has survived for 21 months without recurrence. MANEC is a rare disease associated with intraductal growth. Intraoperative diagnosis of tumor involvement at the edge of the pancreatic duct may be useful for R0 resection in surgery for MANEC.
16.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2057-2059.
[A Case of Pathological Complete Response with Neoadjuvant Chemotherapy for Advanced Rectal Cancer].
[Article in Japanese]
Okada S1, Kameyama H, Abe K, Tanaka K, Oyanagi H, Nakano M, Ichikawa H, Hanyu T, Takizawa K, Nakano M, Nagahashi M, Shimada Y, Sakata J, Kobayashi T, Wakai T.
Abstract
A 62-year-old man was admitted with complaints of bloody stool. Colonoscopy revealed a 5 cm diameter type 2 tumor in the lower rectum close to the anal canal. Tumor biopsy indicated a well-differentiated tubular adenocarcinoma. Computed tomography revealed locally advanced rectal cancer with mesorectal lymph node metastases(cT3N1P0M0, Stage Ⅲa, JSCCR 8th). The patient was treated with neoadjuvant chemotherapy(NAC)after transverse colostomy as an anus-preserving procedure. For the NAC, 12 courses of capecitabine plus oxaliplatin(CapeOX)and bevacizumab(BV)were administered. Colonoscopy after NAC revealed that the main tumor had considerably shrunk. No malignant tissues were found on biopsy. However, rectal wall thickness remained unchanged. Therefore, response evaluation for chemotherapy indicated partial response. Intersphincteric resection(ISR)with diverting loop ileostomy was performed as an anus-preserving surgical procedure. No remnant tumor in the rectum or lymph node metastases were found upon the pathological examination of resected specimens. Ileostomy closure was performed at 6 months post-ISR. At 12 months post-ISR, the patient was well and showed no signs of recurrence. This case demonstrated that NAC with CapeOX and BV can be a promising option for treating locally advanced lower rectal cancer and preserving the anus.
17.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2054-2056.
[A Case of Laparoscopic Local Resection of the Stomach for an Inflammatory Myofibroblastic Tumor].
[Article in Japanese]
Abstract
A 52-year-old man underwent upper gastrointestinal endoscopy screening that identified a submucosal tumor in the gastric fornix, and a solid tumor with a maximum diameter of 35mm was suspected based on abdominal computed tomography. An endoscopic ultrasound-guided fine needle aspiration biopsy showed spindle-shaped cells with KIT, CD34, desmin, and S-100 all testing negative. Based on the diagnosis of a gastrointestinal stromal tumor, subtotal gastrectomy was performed laparoscopically. Postsurgical histopathological testing led to a diagnosis of a primary gastric inflammatory myofibroblastic tumor. The present case has been defined as one involving a tumor part way along the spectrum between benign and malignant, with local recurrence and distal metastasis. Reports indicate that recurrence occurs frequently in cases wherein sufficient margins are not obtained or wherein there is enucleation, and complete surgical resection is recommended. With laparoscopic surgery, because an enlarged field of view can be obtained, and depending on the lesion site, good exposure of the operative field is possible, the authors believe that this approach would be beneficial in terms of local control. Moreover, it has been reported that anaplastic lymphoma kinase(ALK), which is a tyrosine kinase receptor protein, tests positive in approximately 60% of cases. Reports have also indicated that distal metastasis occurs frequently in cases in which ALK tests negative, and watchful waiting of these cases at regular intervals should be carried out to the same extent as of cases involving malignant tumors.
18.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2051-2053.
[A Case of Giant Parathyroid Adenoma].
[Article in Japanese]
Abstract
A 79-year-old man presenting with general fatigue was admitted to our department. Preoperative laboratory examination indicated primary hyperparathyroidism as the cause of his symptoms, with elevated parathormone and serum calcium levels. Ultrasound and 99mTc-MIBI of the cervical region revealed a giant parathyroid adenoma, sized 4×2.5 cm, located in the right thyroid lobe. Despite its size, the gland was successfully removed by performing minimally invasive parathyroidectomy. His postoperative course was uneventful, and he was discharged the next day. This report describes the case of an unusually large adenoma of the parathyroid, detected based on high serum calcium levels.
19.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2048-2050.
[Study of Skip Metastasis to Lateral Lymph Nodes in Low Rectal Cancer].
[Article in Japanese]
Abstract
We reviewed the clinical records of 302 patients with low rectal carcinoma to evaluate the effectiveness of lateral lymph node(LLN)dissection in cases of skip metastases to the LLN. Patients were divided into 4 groups according to nodal status: group N(133 cases), no metastasis in both the mesorectum lymph node(MLN)and LLN; groupM(100 cases), metastasis in the MLN and no LLN metastasis; group L(15 cases), which was defined as skip metastasis, with no metastasis in the MLN and LLN metastasis; and group ML(54 cases), node metastases in both the MLN and LLN. LLN metastasis was found in 22.8% of all patients, and skip metastasis was found in 10.1%. The recurrence rate in group L(40.0%, 6 cases)was significantly lower than that in group ML(75.9%, 41 cases)and not different from that in group M(43.0%, 43 cases). The initial recurrence sites in group L were the lung(3 cases)and local recurrence(3 cases). In group L, 20.0% had hematogenous recurrence, which was lower than in group ML. There was no significant difference between group L(5-year survival rate: 57.1%)and group M(71.7%)in terms of prognosis. Multivariate analysis revealed that histology was a risk factor for LLN metastasis in lowrectal cancer without MLN metastasis. The positive predictive value of LLN metastasis based on computed tomography was 43.9%. It was believed that LLN dissection was important, especially for non-differentiated cancer, in consideration of skip metastases to the LLN.
20.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2045-2047.
[Intraoperative Assessment of Blood Flow in the Remnant Stomach Using Indocyanine Green and Regional Oxygen Saturation Monitoring at Distal Pancreatectomy Following Gastrectomy].
[Article in Japanese]
Ezaki S1, Tomimaru Y, Noguchi K, Nagase H, Ogino T, Hirota M, Oshima K, Tanida T, Noura S, Imamura H, Iwazawa T, Akagi K, Dono K.
Abstract
A92 -year-old man was diagnosed with pancreatic cancer 14 years after undergoing distal gastrectomy for gastric cancer. His remnant stomach was fed by the cardiac branch of the left inferior phrenic artery, short gastric artery, and posterior gastric artery. We planned distal pancreatectomy(DP). Intraoperative indocyanine green(ICG)fluorography showed that the remnant stomach was perfused under the clamp of the splenic artery. We also confirmed that regional oxygen saturation (rSO2)of the remnant stomach was not decreased by the clamp. Based on the findings, we judged that blood flow in the remnant stomach was preserved at the clamp. We then performed DP with preservation of the remnant stomach. Postoperative complications associated with the remnant stomach were not observed. The patient is alive without any postoperative recurrences of pancreatic cancer or trouble associated with the remnant stomach 22 months after the surgery. This case suggested that ICG fluorography and rSO2 monitoring are useful to evaluate blood flow in the remnant stomach.
21.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2042-2044.
[A Case of SIADH in an Elderly Patient with Advanced Gastric Cancer].
[Article in Japanese]
Abstract
An 82-year-old woman underwent surgery for gastric cancer at another hospital in May 2007. The pathological diagnosis was pT4a, pN2, M1, CY1, pStage Ⅳ. Although postoperative chemotherapy was administered, recurrence was observed on the abdominal wall in March 2014, and she was treated usingchemotherapy and resection. Intestinal obstruction due to peritoneal metastasis occurred in December 2017 and mid-July 2018 but symptoms improved with conservative treatment. In late August 2018, she was unable to eat and was readmitted to the hospital. Serum Na level at admission was low at 120 mEq/L, and Na correction was performed. Hyponatremia did not improve, and the serum Na level continued to decrease to 115mEq/L on the 14th day of hospitalization. Plasma osmolality was 229mOsm/kg, urine osmolality was 323mOsm/kg, and urine sodium concentration was 56mEq/L. Diagnosis of SIADH was made according to diagnosis standards. Hyponatremia improved by fluid restriction and Na correction. Subsequently, her peritoneal metastasis exacerbated, and she died in mid- October. We would like to report a case of SIADH in an elderly patient with advanced gastric cancer.
22.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2039-2041.
[Experience of Using Aflibercept Beta and FOLFIRI Chemotherapy for Metastatic Colorectal Cancer].
[Article in Japanese]
Kagawa Y1, Hata T, Naito A, Kawai K, Sakamoto T, Murakami K, Katsura Y, Omura Y, Masuzawa T, Takeno A, Takeda Y, Murata K.
Abstract
BACKGROUND:
Aflibercept beta and FOLFIRI combination therapy were approved for metastatic colorectal cancer as secondline treatment in 2017. Aflibercept beta is a recombinant fusion protein that traps vascular endothelial growth factor(VEGF)- A, VEGF-B, and placental growth factor(PlGF).
METHODS:
We retrospectively evaluated the efficacy and safety of aflibercept beta and FOLFIRI in metastatic colorectal cancer patients(pts)between June 2017 and April 2018 at our institution. Afliber- cept beta(4mg/kg)was administered with FOLFIRI every 2weeks.
RESULTS:
Twenty pts received aflibercept beta and FOLFIRI. There were 11 males and 9 females, with a median age of 69.5(53-81)years. Performance status(PS)was 0 in 12 pts and 1 in the remaining 8 pts. Aflibercept beta and FOLFIRI were prescribed as second-line treatment in 8 pts and the others in 12 pts. The median number of aflibercept beta and FOLFIRI cycles was 5(1-11)cycles. Progression -free survival and overall survival have not yet been estimated. In terms of adverse events, serious adverse events of Grade 3 or higher, including Grade 5 neutropenia, were seen among all pts.
CONCLUSIONS:
Aflibercept beta and FOLFIRI demonstrated acceptable toxicity in heavily pretreated metastatic colorectal cancer patients.
23.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2036-2038.
[Long-Term Survival with Multidisciplinary Treatment and Nutritional Therapy for Thoracic Esophageal Cancer with Multiple Liver Metastases-A Case Report].
[Article in Japanese]
Nogi Y1, Miyazaki Y, Yamazaki M, Makino T, Tanaka K, Yamashita K, Kurokawa Y, Takahashi T, Saito T, Nakajima S, Mori M, Doki Y.
Abstract
The patient was a 63-year-old man with a chief complaint. Upper endoscopic examination revealed a semicircular type 2 lesion, sized 24-28 cm, on the incisor teeth and a 3 cm sized elevated lesion directly above the EGJ. When biopsy was performed, squamous cell carcinoma(SCC)was detected. In this case, lymph node metastasis and multiple liver metastases were observed, and diagnosis at the first examination was cT3N2M1(HEP), Stage Ⅳ. After 7 months of chemotherapy, he underwent right thoracic esophageal subtotal resection, 3-field lymph node dissection, posterior mediastinal gastric tube reconstruction, and partial hepatectomy. Despite receiving postoperative chemotherapy, he showed recurrence in the liver(S8). Four additional courses of chemotherapy were administered and partial hepatectomy(S8)was performed, without the appearance of new lesions. He was considered to be cured 1 year and 6months after starting the treatment and was followed- up without chemotherapy. However, 4 months later, chemotherapy was resumed when right adrenal and abdominal wall metastases and liver recurrence(S3)were found. After that, the regimen was modified, and he continued treatment. More than 4 years have passed since the start of treatment, but the treatment has been continued without a decline in ADL.
24.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2033-2035.
[A Case of Long-Term Survival in a Patient with Advanced Rectal Cancer and Paraaortic and Lateral Lymph Node Metastases].
[Article in Japanese]
Yamashita Y1, Kameyama H, Abe K, Tanaka K, Oyanagi H, Nakano M, Ichikawa H, Hanyu T, Takizawa K, Nakano M, Nagahashi M, Shimada Y, Sakata J, Kobayashi T, Wakai T.
Abstract
A 65-year-old woman was referred for further examination following positive results on a fecal occult blood test. Colonoscopy revealed type 0-Ⅱa cancer, with a lesion measuring 2 cm in diameter in the rectosigmoid colon, and type 5 cancer, with a lesion measuring 6 cm in diameter in the upper rectum. Computed tomography(CT)and positron emission tomography (PET)-CT revealed mesorectal lymph node metastases. Therefore, she was diagnosed with rectosigmoid colon cancer(Stage Ⅰ)and upper rectal cancer(Stage Ⅲa). However, PET-CT also revealed slight fluorodeoxyglucose uptake in the paraaortic and lateral lymph node lesions; hence, the possibility ofmetastasis could not be ruled out. Given that chemotherapy was restricted due to renal dysfunction, low anterior resection was performed as the first choice. Analysis of intraoperative frozen sections showed paraaortic and lateral lymph node metastases; thus, we performed lymph node dissection of these lesions. Pathological examination ofthe resected lymph nodes revealed that 21 of 37 lesions were cancer metastases. S-1 was administered as adjuvant chemotherapy for 5 months. Mediastinal lymph node metastases was suspected on chest CT 5 months and 3 years post-surgery; thus, panitumumab was administrated. These lymph nodes decreased in size immediately. Six years after the first surgery, the patient was well without any signs of recurrence.
25.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2030-2032.
[A Case in Which pCR Was Obtained by S-1 plus Oxaliplatin Therapy Administered as Neoadjuvant Chemotherapy for Advanced Gastric Cancer].
[Article in Japanese]
Miyamoto H1, Hirakawa T, Morimoto J, Nakazawa K, Okada T, Tsujio G, Kurihara S, Aomatsu N, Iwauchi T, Yamagata S, Uchima Y, Takeuchi K.
Abstract
A 78-year-old man presented with anemia, with a hemoglobin level of 6.7 g/dL, during follow-up for angina pectoris and paroxysmal atrial fibrillation. Upper gastrointestinal endoscopy revealed type 2 advanced gastric cancer(por), and abdominal computed tomography(CT)showed multiple lymph node metastases. He was diagnosed with advanced gastric cancer, cStage Ⅲ(cT3N1M0). He received neoadjuvant chemotherapy in 3 courses of SOX(80mg/m / 2/day of S-1 on days 1-14 and 7 days of rest, and 100mg/m2 of oxaliplatin on day 1). Grade 1 thrombocytopenia was observed, but it resolved without any other major side effects. Upper gastrointestinal endoscopy revealed a marked reduction in the primary lesion, and abdominal CT showed a significant reduction in the metastatic lymph node. We performed laparoscopic distal gastrectomy(D2+No. 14v)for advanced gastric cancer ycT1N(+)M0, ycStage ⅡA. Histological assessment revealed no evidence of residual tumor cells in the primary tumor or lymph nodes, and the histologic response was classified as Grade 3, pathological complete response(pCR). We report a case in which pCR was obtained by SOX therapy administered as neoadjuvant chemotherapy for advanced gastric cancer.
26.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2027-2029.
[A Case in Which Trastuzumab Combined Chemotherapy Was Effective for Recurrence of Post-Operative Gastric Cancer with Partial HER2 Overexpression].
[Article in Japanese]
Kimura A1, Kagiya T, Yamauchi Y, Okano K, Sawano T, Ohashi M, Kato M, Hashimoto N, Umehara Y, Nishikawa S, Murata A, Takahashi K.
Abstract
We report a case in which recurrent partial HER2-positive gastric cancer showed complete clinical response to capecitabine (Cape)/oxaliplatin(L-OHP/OX)(CapeOX)plus trastuzumab(Tmab)combined chemotherapy for 32months. A 65-yearold man underwent distal gastrectomy, D2 lymph node dissection, and Roux-en-Y reconstruction for type 2 gastric cancer of the prepyloric anterior wall in December 2014. Pathological stage was as follows: L, ant, Type 2, 32×22 mm, tub1>tub2> por1, pT2(MP), int>med, INF c>a, Ly1a, V0, pN0, cM0, cH0, cP0, pCY0, pStage I B, pPM0(60mm), pDM0(75mm), pR0. Immunostaining of the tumor indicated overexpression of the HER2 gene in more than 10% of the well differentiated tubular adenocarcinoma(tub1). Nineteen months post-surgery, pancreatic head lymph node metastasis was diagnosed, and we started CapeOX plus Tmab combined chemotherapy. After 19 courses, the metastatic lymph node reduced its size until we could not detect it on CT. We continued treatment for 45 courses(about 32 months). During the courses, there were adverse events such as peripheral neuropathy(Grade 3, CTCAE v5.0), which required interruption of L-OHP, and oral mucosal ulcer (Grade 2).
27.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2024-2026.
[A Case of Extrahepatic Bile Duct Carcinoid Tumor Involving Diagnostic Difficulties].
[Article in Japanese]
Yabe N1, Masuda M, Tamura E, Morishige S, Saito A, Harada Y, Miyabayashi M, Kobayashi K, Iwama N, Takenoya T, Oto I, Yoshikawa T, Osumi K, Murai S.
Abstract
A patient in his 60s had undergone laparoscopic anterior resection for the treatment of carcinoma of the rectum in February 2016. Histopathologic examination revealed the lesion as a pT2(MP)n(-)M0, fStage Ⅰrectal cancer. One year post-surgery, contrast-enhanced computed tomography(CT)revealed enhancement of parts of the intrapancreatic distal bile ducts. Magnetic resonance cholangiopancreatography(MRCP)showed filling defects at the same site. Magnetic resonance imaging( MRI)with an endorectal coil(ERC)was then performed to identify reproducible bile duct filling defects. Neither cytology nor biopsy yielded any findings that definitely indicated malignancy. Intraductal ultrasonography(IDUS)led to the suspicion of a nonepithelial tumor or an enlarged lymph node. Repeated biopsies via ERC were performed based on the absence of evidence of malignancy and revealed the presence of some atypical cells within the lesions. Although no definitive diagnosis could be made, the patient was scheduled for surgery in June 2017 after obtaining his consent. Upon taping of the common bile duct during surgery, a tumor was palpable on the dorsal aspect of the pancreas. The bile duct tumor was completely excised and submitted for intraoperative diagnosis; the pancreatic dorsal aspect appeared to be totally split. There was no evidence of atypia in the neoplasm, which was therefore considered to be benign; however, malignancy could not be completely ruled out because the patient had presented with elevated serum levels of carbohydrate antigen(CA)19-9 once before the operation. After intraoperative consultation with the patient's family members, who were reluctant to provide consent for pancreaticoduodenectomy, we completed the operation with resection of the bile duct tumor, followed by choledochojejunostomy. The tumor was found to be chromogranin A(+), cluster of differentiation(CD)56(+/-), CA19-9(+, solely ductal structure), carcinoembryonic antigen(CEA)(+, solely ductal structure), and intranuclear p53(-), with an MIB- 1 index of<2%. With regard to neuroendocrine markers, a region that could potentially have been a carcinoid tumor, based on the findings on hematoxylin and eosin(HE)staining, and a lumenized superficial region showed positivity in toto. Therefore, the lesion as a whole was diagnosed as a G1 carcinoid neuroendocrine tumor(NET). However, the superficial lumenized layer was positive for both CA19-9 and CEA; therefore, the tumor was thought to concurrently have epithelial characteristics. The lateral stumpwas negative, while the status of the ablated region remained unclear. After discussing the histopathologic examination results with the patient and his family members, the patient's follow-upwas decided to consist of periodic checkups without any further surgical intervention. The patient has since remained free of recurrence. Carcinoid tumor of the bile duct is extremely rare but should be considered in cases involving bile duct tumors that show enhancement on imaging prior to surgery and for which no definitive diagnosis can be established despite repeated biopsy explorations.
28.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2021-2023.
[A Case of Pancreatic Head Cancer Resected after Neoadjuvant Chemotherapy Followed by Pseudocyst].
[Article in Japanese]
Abstract
A 41-year-old man with upper abdominal and back pain was admitted to another hospital. He had a history of recurring acute pancreatitis and pseudocyst. Six months later, abdominal CT revealed a pancreatic head tumor arising from the pseudocyst, and adenocarcinoma was suspected based on endoscopic ultrasound fine needle aspiration(EUS-FNA)findings. We selected neoadjuvant chemotherapy because resection was difficult due to severe inflammation and edema around the tumor. Chemotherapy(FOLFIRINOX followed by gemcitabine plus nab-paclitaxel)was effective, and the tumor almost disappeared on CT. Subtotal stomach-preserving pancreatoduodenectomy(SSPPD)was performed 12 months after starting chemotherapy, and curative resection was successful. The final Stage was ⅡA(T3[CH1]N0M0). Histopathological examination revealed no viable tumor cells. S-1 adjuvant chemotherapy was administered for 6 months. He was still alive 22 months postoperation without any recurrence. Neoadjuvant chemotherapy is effective in cases involving pancreatic cancer with severe inflammation, because pre-operative chemotherapy can reduce tumor size and alleviate the inflammation caused by acute pancreatitis and pseudocysts.
29.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2018-2020.
[A Case of Recurrent Breast Cancer with Contralateral Axillary Node Recurrence Cured after Mastectomy for Ipsilateral Breast Tumor Recurrence].
[Article in Japanese]
Abstract
A 65-year-old woman was treated with breast-conserving therapy for dissection of the left breast and axillary lymph nodes. Histopathological diagnosis was invasive breast cancer(scirrhous), T1cN2M0, stageⅡB, ER+/PgR+/HER2-. Approximately 4 years later, a mass found in her left breast was confirmed to be ipsilateral breast tumor recurrence(IBTR). Left mastectomy was performed because no clear metastasis was found on whole-body examination. Histopathological diagnosis was invasive breast cancer(solid-tubular), ER-/PgR-/HER2-. IBTR was of a different type, compared to the primary breast cancer. In the follow-up period, multiple axillary lymph node metastases were found in the right axilla. Histopathologically, 20 lymph node metastases were found, and ER-/PgR-/HER2-breast cancer-related lymph node recurrence was diagnosed. Postoperative adjuvant chemotherapy(PTX, TS-1)was administered. In the 10 years following IBTR, there has been no recurrence, and it is thought to be completely cured. Usually, contralateral axillary lymph node recurrence is treated the same way as distant metastases because they are extra-regional lymph nodes; however, this strategy is not applicable to IBTR. When surgery is performed for IBTR, the contralateral axillary lymph node may become a new sentinel lymph node, and thus, sufficient examination and accurate risk assessment may be necessary before surgery for local control.
30.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2015-2017.
[A Case of Peritoneal Metastases after Radiofrequency Ablation for Liver Metastasis from a Pancreatic Neuroendocrine Tumor].
[Article in Japanese]
Nagaro H1, Hirose Y, Katada T, Sakata J, Kobayashi T, Takizawa K, Miura K, Toge K, Ando T, Yuza K, Ichikawa H, Nagahashi M, Shimada Y, Kameyama H, Wakai T.
Abstract
A 77-year-old woman presented with peritoneal metastases from a pancreatic neuroendocrine tumor(p-NET). At the age of 56 years, she underwent distal pancreatectomy for p-NET, which was pathologically diagnosed as G2. She underwent right hemihepatectomy for liver metastasis(S6)from the p-NET 10 years post-pancreatectomy. Eight years post-hepatectomy, radiofrequency ablation(RFA)was attempted for liver metastasis(S4)from the p-NET. However, RFA was not completed because of hematoma development along the needle tract of RFA. She underwent partial hepatectomy for this lesion 6 months post-RFA. Two years post-RFA, localized peritoneal metastases on the right diaphragm were detected. She underwent en bloc tumor resection with partial resection of the diaphragm. She remains alive and well with no evidence of disease 2 years post-resection of the peritoneal metastases from the p-NET.
31.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2012-2014.
[A Case of Esophageal Primary Malignant Melanoma That Developed During the Follow-Up of Esophageal Melanocytosis].
[Article in Japanese]
Yamai D1, Ichikawa H, Kano Y, Hanyu T, Ishikawa T, Usui K, Nemoto M, Hirose Y, Miura K, Nagahashi M, Shimada Y, Sakata J, Kobayashi T, Kameyama H, Wakai T.
Abstract
A 78-year-old woman was endoscopically followed up for benign melanocytosis in the middle thoracic esophagus that was detected 3 years prior. She presented with chest tightness, and an endoscopic examination revealed a protruding tumor at the melanotic lesion. She was histologically diagnosedwith an esophageal primary malignant melanoma. Computedtomography showedno metastatic lesions. She underwent minimally invasive esophagectomy with 2-fieldlymphad enectomy. Immunotherapy with nivolumab is ongoing for liver metastasis, which developed1 year and6 months after esophagectomy. Careful follow-up for esophageal melanocytosis is important for early diagnosis of esophageal primary malignant melanoma.
32.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2008-2011.
[A Case of Maxillary Gingival Carcinoma Possibly Caused by Chronic Inflammation Related to Oral Candidiasis].
[Article in Japanese]
Abstract
Oral candidiasis infection is generally treated with antifungal agents. However, it often requires long-term treatment, and epithelial dysplasia may persist even after the infection has been resolved depending on the case. Malignant transformation has been reported in long-term cases involving chronic inflammation, and surgical excision should be performed as the treatment of choice when the treatment period is prolonged. This report describes a case of maxillary gingival carcinoma caused by chronic inflammation related to oral candidiasis. The patient was an 85-year-old man who was admitted to our hospital with maxillary gingival pain. Cytology and biopsy revealed oral candidiasis and squamous cell carcinoma(cT1N0M0, Stage Ⅰ). He underwent partial maxillectomy. Post-operative recovery was uneventful, and there was no sign of recurrence or metastasis at the 1-year follow-up.
33.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2005-2007.
[Radical Surgery Following Chemotherapy in a Patient with Mesenteric Recurrence Associated with Hematoma upon ESD for Rectal Cancer Three Years Six months Later].
[Article in Japanese]
Yamana I1, Sakamoto Y, Ichikawa J, Koreeda N, Sannomiya H, Shin Y, Sato K, Okamoto T, Yoshida Y, Yanagisawa J, Nakashima A, Noritomi T, Hasegawa S.
Abstract
A63 -year-old man complaining of anal pain visited our hospital. Three years 6 months previously, the patient underwent endoscopic submucosal dissection(ESD)for early-stage rectal cancer. Based on the pathological findings, adenocarcinoma with invasion to the submucosal layer(2,000 mm)and lymphovascular invasion were diagnosed. Abdominal computed tomography( CT)revealed a solid tumor 50mm in diameter and hematoma measuring approximately 90mm in length adjoining the tumor in the mesorectum. We performed exploratory laparoscopy. Ahematoma was confirmed in the mesentery from the sigmoid colon and rectum. After the surgery, endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)revealed well-differentiated adenocarcinoma. We diagnosed a hematoma associated with mesenteric recurrence following ESD for rectal cancer. The patient received chemotherapy first because of the large size of the recurrent cancer. Four courses of mFOLFOX6(5-FU: bolus 400mg/m / / / 2,2,400mg/m2,oxaliplatin 85 mg/m2) and panitumumab(6 mg/kg)were administered. Based on the CT findings following chemotherapy, the hematoma had disappeared, and the size of the recurrent cancer in the mesorectum reduced to 28 mm. The patient underwent laparoscopic lower anterior resection with D3 lymph node dissection and ileostomy. The postoperative course was uneventful. Currently, the patient has no recurrence.
34.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2002-2004.
[Short-Term and Long-Term Outcomes of Colonic Stenting as a Bridge to Surgery for Obstructive Colorectal Cancer].
[Article in Japanese]
Maruo H1, Iwase Y, Sekimoto A, Shibasaki Y, Higashi Y, Shoji T, Yamazaki M, Hirayama K, Ito T, Koike K, Ikeda T, Takayanagi Y, Kubota H.
Abstract
We examined the short-term and long-term outcomes in 50 patients who underwent stenting as a bridge to surgery(BTS) for obstructive colorectal cancer. The patients comprised 30 men and 20 women, with a mean age of 74.0 years. Stenting and decompression were successful in all patients, and the mean time to oral intake after stenting was 2.4 days. No serious complications related to stenting occurred. Colonoscopy after stenting was important for the preoperative diagnosis of coexisting lesions and planning of the extent of resection. Elective and one-stage surgeries could be performed in all patients after stenting. Regarding long-term outcomes, the 5-year overall survival rate and disease-free survival rate in the BTS patients with Stage Ⅱ plus Ⅲ cancer were 73.1% and 55.7%, respectively. The results of this study suggest that BTS for obstructive colorectal cancer is an effective treatment strategy for not only short-term but also long-term outcomes.
35.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1999-2001.
[Analysis of Palliative Stents for Colonic Stenosis Due to Extracolonic Cancers].
[Article in Japanese]
Muta Y1, Hatano S, Toyomasu Y, Kumakura M, Yamamoto E, Chikatani K, Amano K, Ishiguro T, Kumagai Y, Ishibashi K, Mochiki E, Ishida H, Inokuma S.
Abstract
We retrospectively reviewed 13 patients in whom endoscopic stenting for colonic stenosis due to extracolonic cancers(non- CRC group)was attempted between July 2012 and January 2018. There were 5 men and 8 women, with a median age of 69 years. Primary malignancies causing colonic stenosis were gastric cancer(n=4), cholangiocarcinoma(n=2), pancreatic cancer(n=2), lung cancer(n=2), uterine cancer(n=2), and ovarian cancer(n=1). The non-CRC group patients demonstrated a significantly lower technical success rate than those who received palliative stents for colonic stenosis for primary colorectal cancer(n=51)(69% vs 98%, p<0.01). In addition, the non-CRC group patients(n=13)also demonstrated a significantly lower technical success rate(69% vs 99%, pp<0.01)than those who received stents aiming to subsequently undergo a bridge to surgery. Nonetheless, colorectal stenting for extracolonic malignancies appears to be a minimally invasive treatment and could offer patients rapid relief. Thus, it could be an effective alternative to some palliative therapies.
36.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1996-1998.
[Assessment of Prognosis after Surgical Treatment for Colorectal Liver Metastasis Using a Nomogram].
[Article in Japanese]
Yoshimura T1, Koshiishi H, Goto H, Ohshima N, Watanabe Y, Tomii C, Sasaki M, Adachi M, Ishibashi N, Wada Y.
Abstract
A nomogram is a statistical tool that can provide the specific outcomes of individual patients. In this study, we used a nomogram developed by Beppu et al to evaluate the prognoses of 38 patients who underwent hepaticresec tion at our hospital. This nomogram predicts disease-free survival(DFS)after hepatic resection for colorectal liver metastasis based on 6 clinical and oncological factors. Using this nomogram, we divided the 38 patients into 3 groups: Group N, actual DFS was almost similar to the estimated median DFS(EMDFS)provided by the nomogram; Group A, DFS was longer than EMDFS; and Group B, DFS was shorter than EMDFS. Then, we compared and analyzed clinical and oncological factors between Groups A and B. Group B patients tended to have single metastasis and non-normal levels of CA19-9. Besides, Group B patients had DFS shorter than approximately 2 years. These results suggest that if CA19-9 levels are not normalized after hepaticresec tion for single metastasis, we should consider careful observation and adjuvant chemotherapy for potential micrometastasis.
37.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1993-1995.
[Relapse-Free Survival of over 54 Months after ESD Resection in an Elderly Patient Considered to Have Non-Curative Early Gastric Cancer].
[Article in Japanese]
Murayama M1, Murakami S, Nakashima O, Yamazaki K, Koizumi K, Miyazawa M, Asaka S, Yokomizo H, Shiozawa S, Yoshimatsu K, Shimakawa T, Katsube T, Naritaka Y.
Abstract
According to the Japanese Gastric Cancer Treatment Guideline(GL), radical surgery is recommended as an additional treatment for early gastric cancer(EGC)patients with endoscopic submucosal dissection(ESD)evaluated as non-curative for fear of lymph node metastasis(LNM). However, the reported probability of LNM was approximately 10%. Therefore, the recommendation might be aggressive for elderly patients or those in poor physical conditions. Under this context, surveillance post non-curative ESD has emerged as an acceptable option. We reported a case of an elderly patient who survived EGC for over 54 months as relapse-free with ESD resection evaluated as non-curative. An 84-year-old woman underwent ESD in July 2014 for EGC, which was deemed as non-curative with negative surgical margins. The patient had pre-existing severe bronchial asthma. Given the age and the comorbidities, the patient preferred close surveillance to radical surgery. After 54 months of surveillance, no recurrence of the initial EGC was found. However, during the annual check-ups, 2 metachronous cancers were found in July 2016 and June 2018 respectively. Both metachronous cancers were curatively resected with ESD.
38.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1990-1992.
[A Case of Gastric Large-Cell Neuroendocrine Carcinoma Combined with Adenocarcinoma in the Cecum].
[Article in Japanese]
Abstract
A 74-year-old man with anemia visited our department. Esophagogastroduodenoscopy showed a type 2 lesion from the angulus to the antrum. Histopathological findings indicated gastric neuroendocrine carcinoma. Colonoscopy showed a type 1 lesion at the cecum. Distal gastrectomy was performed with D1+lymph node dissection, Roux-en-Y reconstruction, and ileocecal resection with D3 lymph node dissection. The patient was pathologically diagnosed with large-cell neuroendocrine carcinoma in the stomach, pT4a(SE), med, INF a>>b-c, ly1-2, v1(SM, EVG), pN0, pM0, pStageⅡB, and adenocarcinoma (tub1>tub2)of the cecum, pT2(MP), ly1(HE), v1(EVG, SM), pN0, pM0, pStageⅠ. Postoperatively, he received oral S-1 as an adjuvant chemotherapy. His postoperative course was uneventful without any recurrence over 18 months.
39.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1987-1989.
[A Case of Long-Term Survival of Liver Metastasis from Biliary Carcinoma after Pancreaticoduodenectomy Treated by Multimodal Therapy].
[Article in Japanese]
Hashimoto Y1, Kishimoto T, Murotani M, Imamura H, Shigetsu K, Yoneda N, Akari T, Kidogami S, Mokutani Y, Hirose H, Yoshioka S, Endo S, Takeda M, Tamura S, Sasaki Y.
Abstract
A 73-year-old man underwent a subtotal stomach preserving pancreaticoduodenectomy(SSPPD)for biliary carcinoma without regional lymph node metastasis. Although S-1 was administrated as adjuvant chemotherapy after the operation, the serum CA19-9 level was gradually elevated, and a liver metastasis of 27mm in diameter was detected in Couinaud's segment 8 during chemotherapy. We administrated gemcitabine(GEM)and cisplatin(CDDP)combination therapy(GC therapy). The liver tumor was immediately shrunk to 6mm and kept up the PR state after 15 courses of GC therapy. A stereotactic body radiation therapy(SBRT)was performed 1 year 8 months after the operation. The patient has been alive without recurrence for 4 years since the SBRT. Although systemic chemotherapy is the standard treatment for the recurrence of biliary carcinoma, a loco-regional therapy such as SBRT may be an effective alternative when a patient has a solitary metastasis to the liver with no other evidence of recurrence.
40.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1984-1986.
[A Case of Recurrent Breast Cancer Treated with Local Irradiation Using Leadless Pacemaker Implantation].
[Article in Japanese]
Ishihara S1, Kashiwagi S, Asano Y, Tauchi Y, Morisaki T, Noda S, Takashima T, Onoda N, Hirakawa K, Ohira M.
Abstract
A 68-year-old woman noticed a tumor in her left breast and visited our hospital. She was diagnosed with left breast cancer cT2N2M0, stage ⅢA, and surgery was performed after the neoadjuvant chemotherapy. Although this case was indicated for radiation therapy(PMRT)after total mastectomy, postoperative radiation was not performed due to an implantable pacemaker placed in the left anterior chest. Therefore, postoperative adjuvant therapy with endocrine therapy was started. After 3 years of treatment, her left axillary lymph node was enlarged, and needle biopsy confirmed metastasis and recurrence. When local excision was performed, postoperative irradiation was deemed necessary because residual microlesions were suspected. Irradiation planning did not deny the possibility that the pacemaker in the anterior chest indwelling could become the irradia- tion range. Therefore, a leadless pacemaker was inserted, and local irradiation(50 Gy/20 Fr)was performed without complications. The next treatment is fulvestrant, and no recurrence has been observed 6months postoperatively.
41.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1981-1983.
[Five-Year Local Control by Stereotactic Body Radiation Therapy(SBRT)for Liver Metastasis from Colorectal Cancer-A Case Report].
[Article in Japanese]
Abstract
An 84-year-old woman presented with a 9mm sized solitary liver metastasis in liver S8 18 months after the surgery for sigmoid colon cancer. The patient was treated with stereotactic body radiation therapy(SBRT)for local control, because the patient chose not to undergo surgery or chemotherapeutic treatment for metastatic liver cancer. SBRT is a minimally invasive treatment with a very short treatment period. Therefore, it may be considered as an alternative treatment for patients who are not suitable for surgery.
42.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1978-1980.
[A Case of Multimodality Treatment Including Carbon Ion Radiotherapy to Multiple Distant Lymph Node Metastasis after a Surgery for Sigmoid Cancer].
[Article in Japanese]
Miyake M1, Uemura M, Kato T, Hamakawa T, Maeda S, Hama N, Nishikawa K, Miyamoto A, Miyazaki M, Hirao M, Ishikawa T, Yamada S, Sekimoto M.
Abstract
We reported a case of a 30s woman who underwent Hartmann's surgery for sigmoid cancer. Her pathological stage was Stage Ⅳ(pT4b, N1b, M1b[liver and lung]). Postoperatively, 10 courses of systemic chemotherapy with FOLFOX plus cetuximab( Cmab)or bevacizumab(Bmab)were administered. After the chemotherapy, partial liver dissection and radiofrequency ablation(RFA)for multiple liver metastasis were performed. After 2 years of systemic chemotherapy with FOLFIRI plus ramucirumab(RAM), no liver or lung metastasis was observed; however, left supraclavicular lymph node and para-aortic lymph node metastases existed and gradually increased. For the purpose of local control, the para-aortic lymph node metastasis was treated with cervical dissection and carbon ion radiotherapy. Therefore, carbon ion radiotherapy was a useful treatment for local control.
43.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1975-1977.
[Neoadjuvant Proton Beam Chemoradiotherapy for Locally Advanced Gall Bladder Cancer-A Case Report].
[Article in Japanese]
Abstract
A 67-year-old man visited our hospital due to progressing appetite loss and fever. He presented with a fist-sized palpable mass in his right hypochondrium. Abdominal CT showed a 10 cm diameter tumor that originated from the gall bladder infiltrating the abdominal wall, liver, duodenum, and colon. Blood tests revealed leukocytosis, elevated C-reactive protein level, and severe malnutrition. FDG-PET showed markedly high uptake in the tumor and diffuse uptake in the spine. Owing to the inability of oral intake, he underwent laparoscopic gastrojejunostomy and intraoperative tumor biopsy, which demonstrated pathologically G-CSF-producing carcinoma in the gall bladder. For the rapidly progressive tumor, he underwent proton beam chemoradiotherapy as preoperative treatment. The tumor markedly shrunk with dramatic improvement of his inflammatory and nutritional status. Consequently, R0 resection could be performed by combination surgeries of right hemi-colectomy, pancreatoduodenectomy, and partial liver resection. He received adjuvant chemotherapy and was alive without recurrence 12 months after tumor resection. To our knowledge, this is the first report of the use of neoadjuvant proton beam chemoradiotherapy in biliary cancer.
44.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1972-1974.
[A Case of Perforated Intestinal Malignant Lymphoma Induced to Remission by Multidisciplinary Therapy].
[Article in Japanese]
Hara K1, Aoyama T, Nukada S, Koumori K, Tanaka A, Amano S, Katayama Y, Numata M, Tamagawa H, Sato T, Oshima T, Jin Y, Yukawa N, Rino Y, Masuda M.
Abstract
A 61-year-old man had a sudden severe abdominal pain and visited our hospital. He was diagnosed with intestinal perforation, given the peritoneal irritation symptoms, the thickening of the intestinal wall and free air as shown on enhanced abdominal computed tomography. He then underwent emergent surgery. A tumor with small perforation was found on the intestine about 15 cm distant from the terminal ileum. Partial resection of the ileum was performed. Microscopically, a type 2 tumor of 70×50mm in diameter, was observed in the resected intestine. The tumor was diagnosed as diffuse large B-cell lymphoma via immunochemical staining. He received 6courses of R-CHOP therapy after surgery without recurrence. A primary intestinal malignant lymphoma is easily perforated, which lead to poor prognosis of the patient. We report a case of perforated intestinal malignant lymphoma, which was induced to remission by multidisciplinary therapy.
45.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1969-1971.
[A Case of Low-Grade Appendiceal Mucinous Neoplasm Complicated by Pseudomyxoma Peritoneri Successfully Treated with Cytoreductive Surgery and Intraperitoneal Chemotherapy].
[Article in Japanese]
Sakamoto S1, Ishiguro T, Kumakura M, Ishikawa H, Yamamoto E, Muta Y, Itou T, Muramatsu S, Toyomasu Y, Suzuki O, Kumagai Y, Ishibashi K, Mochiki E, Ishida H.
Abstract
We experienced a case of low-grade appendiceal mucinous neoplasm complicated by pseudomyxoma peritonei that was successfully treated with cytoreductive surgery and early postoperative intraperitoneal chemotherapy. The patient was a 26- year-old man with massive ascites and a swollen appendix on the computed tomography(CT). The appendix was a cystic mass of 5 cm in size. The entire parietal peritoneum, omentum, stomach, spleen, gall bladder, and entire colon were covered with numerous mucous nodules. Total colectomy, total gastrectomy, splenectomy, cholecystectomy, total omentectomy, parietal peritonectomy, ileostomy, and intraperitoneal irrigation were performed. The pathological diagnosis was low-grade appendiceal mucinous neoplasm. Postoperative intraperitoneal chemotherapy with cisplatin and mitomycin C was performed. A residual tumor was found on the dorsal side of the hepatoduodenal ligament 3 months postoperation on the CT. The residual tumor was successfully excised via a concomitant resection of the hepatic caudate lobe. Postoperative intraperitoneal chemotherapy was then performed. No recurrence was found at 8 months postoperation. The addition of early postoperative intraperitoneal chemotherapy improved the patient's quality of life in a short period. This could be one of the treatment options.
46.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1966-1968.
[A Case Report of Bypass Surgery for a Perforated and Unresectable Gastric Cancer].
[Article in Japanese]
Yamada M1, Yoshida T, Hijikawa T, Fumioka A, Kitano S, Uchiyama Y, Yoshimura M, Masuzawa M, Inoue K, Yoshioka K, Sekimoto M.
Abstract
A 74-year-old man was admitted to a clinic because of epigastralgia in June 2018. He was referred to our hospital for further examination of right hydronephrosis. He was diagnosed as having type 2 gastric cancer in the middle gastric body and lesser curvature, with an upper gastric fiber, swollen para-aortic lymph node, and right hydronephrosis by using abdominal computed tomography. PET-CT revealed no hot spot in the para-aortic lymph node but revealed a hot spot in the lower small bowel. He was admitted to our hospital because of severe abdominal pain and appetite loss and underwent a reduction and palliative surgery for the unresectable gastric cancer. The omental cavity was perforated and penetrated into the retroperitoneum. He underwent esophageal jejunal bypass and intestinal fistula tube insertion in the stomach. He had a central vein port and was discharged from our hospital. He was able to eat during his short overnight stay at our hospital after the operation but died on postoperative day 30.
47.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1963-1965.
[A Case of Hepatocellular Carcinoma Treated with Transdiaphragmatic Radiofrequency Ablation under Thoracotomy].
[Article in Japanese]
Hara K1, Aoyama T, Morita J, Kawabe T, Numata M, Tamagawa H, Sato T, Yamanaka K, Hatori S, Oshima T, Yukawa N, Rino Y, Masuda M, Tani K, Shiraishi R.
Abstract
The patient was a 73-year-old man. A liver tumor was found in the posterior segment(S6)during the follow-up period post the interferon treatment for hepatitis C in September 1999. An S6 sub-segmentectomy was performed. The tumor was diagnosed as a moderately differentiated carcinoma, hepatocellular carcinoma(HCC)with pT2N0M0, pStage Ⅱ(UICC TNM 7th edition). The tumor recurred twice post-surgery. The recurrent tumors were treated with local therapies such as transcatheter arterial chemoembolization(TACE), percutaneous ethanol injection(PEI)and radiofrequency ablation(RFA). The third recurrence was found in the posterior segment(S7)in April 2009. RFA was unsuccessful because an appropriate puncture route could not be found. Then, a transdiaphragmatic RFA under thoracotomy was performed as an alternative treatment, which led to an optimal outcome. We report a case of HCC that could not be treated with percutaneous RFA but with a transdiaphragmatic RFA under thoracotomy.
48.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1960-1962.
[A Case of Colitic Cancer with Ulcerative Colitis Emphasizing the Importance of Surveillance].
[Article in Japanese]
Yoshida K1, Funahashi K, Miura Y, Kouda T, Kagami S, Kaneko T, Kurihara A, Ushigome M, Mikami T, Shibuya K.
Abstract
The patient was a 77-year-old woman who visited our hospital with a chief complaint of blood in the stool. The patient had a colonoscopy 2 years earlier, which led to suspicions of total colitis-type ulcerative colitis(UC). However, the histological findings did not lead to a definitive diagnosis. Upon the withdrawal of urine in an outpatient visit, fecaluria was noted. Based on various examinations, we diagnosed this patient with Rs, cT4b(bladder), cN0, cM0 adenocarcinoma. We then performed Hartmann operation with partial cystectomy. The pathological findings indicated colorectal cancer with ulcerative colitis (CAC)(low grade and high grade dysplasia and carcinoma). Postoperative examinations of the oral side of the colon revealed a flat squamous elevated lesion in the ascending colon, which was diagnosed as adenocarcinoma. Therefore, we waited for the improvement of performance status and performed additional total colectomy with resection of the anus and ileostomy. We experienced a case of progressive CAC due to the difficulty of histological diagnosis via biopsy and a lack of appropriate surveillance post clinical suspicions. In cases of colitis-type UC, appropriate surveillance by endoscopists and pathologists is important.
49.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1957-1959.
[The Outcome of Preoperative Chemoradiotherapy for Advanced Lower Rectal Cancer-The Possibility of an Omission of the Lateral Dissection].
[Article in Japanese]
Hatano S1, Kumakura M, Muta Y, Ito T, Chikatani K, Suzuki O, Toyomasu Y, Muramatsu S, Amano K, Ishiguro T, Kumagai Y, Ishibashi K, Inokuma S, Mochiki E, Ishida H.
Abstract
The objective of this study was to evaluate the outcomes of selective LPLN dissection(LPLD)based on pretreatment imaging in patients with advanced low rectal cancer treated with pre-operative CRT. We reviewed 32 patients without suspected LPLN metastasis based on the MDCT or MRI results before CRT. These patients underwent total mesorectal excision (TME)without LPLD. The clinical characteristics and oncological outcomes were examined. In all cases, the per-protocol treatments were completed. Tumor recurrence occurred in 14 patients at the liver(3 cases), the lung(7 cases)and the local sites(4 cases). Of the 4 cases with pelvic recurrence, no recurrence was found in the lateral lymph node area. Under the condition that pre-operative chemoradiotherapy is to be performed for advanced lower rectal cancer with negative lateral lymph node metastasis, a lateral dissection could be omitted.
50.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1954-1956.
[A Case of Inverted LECS for GIST in the Remnant Stomach after Distal Gastrectomy].
[Article in Japanese]
Watanabe M1, Nishizaki M, Takenaka R, Takei K, Mikane Y, Shoji R, Okada T, Aoyama K, Nogami T, Nishikawa H, Shinoura S, Shigemitsu K, Nonaka Y, Hayashi D.
Abstract
Laparoscopy and endoscopy cooperative surgery(LECS)is the surgical procedure used to avoid excessive resection of the gastrointestinal wall and preserve its function. We report the case of a patient who was successfully treated with inverted LECS for gastrointestinal stromal tumor(GIST)in the remnant stomach and underwent distal gastrectomy. The patient was a 75- year-old man who received distal gastrectomy for gastric ulcer 28 years before. Three years before he was diagnosed as having gastric submucosal tumor(SMT)as a gastrointestinal tumor(GIST)by using EUS. As the tumor increased, he was admitted to our hospital. Upper gastrointestinal endoscopy revealed a 30mm SMT just below the cardiac part of the remnant stomach. Biopsy by EUS-FNA revealed CD34(-), c-kit(+), S-100(-), and a-SMA(-), which indicated gastric GIST. Inverted LECS was performed. His postoperative course was good, and he was discharged from the hospital 9 days after the surgery.
51.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1951-1953.
[Negative Pressure Wound Therapy for Advanced Recurrent Rectal Cancer].
[Article in Japanese]
Nagae A1, Uemura M, Miyake M, Kato T, Hamakawa T, Hama N, Nishikawa K, Miyamoto A, Hirao M, Sekimoto M.
Abstract
The incidence of perineal wound complications after extended pelvic surgeries for locally advanced or locally recurrent cancer is high. The management of these refractory complications is usually difficult. Extended pelvic surgeries are commonly associated with severe infectious complications owing to pre-operative chemoradiation therapy, the tissue damage during surgery, and the dead space after radical resections. Negative pressure wound therapy(NPWT)is widely used for the management ofseveral wounds. Recently, the utility ofNPWT has been reported on the management ofinf ectious wound complications post-surgery. Some authors reported the drainage effect of NPWT on pelvic abscess after surgery. However, so far, only a few reports have been published on the usefulness of NPWT in the management of perineal wound disruption or pelvic abscess. We performed NPWT on patients with perineal wound disruption or intractable lymphorrhoea. In these cases, NPWP was effective in early successful treatment. In summary, NPWT is an effective treatment option for perineal disruption and pelvic abscess after surgery for locally advanced or locally recurrent cancers.
52.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1948-1950.
[A Case of Retroperitoneal Dedifferentiation Type Liposarcoma in Which Total Pancreatectomy and Radiation Therapy Was Performed at the Remnant Pancreas after Pancreaticoduodenectomy].
[Article in Japanese]
Abstract
A 75-year-old man presented with a fever. Computed tomography revealed a 10 cm solid tumor under the duodenum. A pre-operative diagnosis of liposarcoma was established using biopsy. Pancreaticoduodenectomy was performed, and the pathological examination led to the diagnosis of dedifferentiation type liposarcoma. Two years later, the liposarcoma recurred at the remnant pancreas. A total remnant pancreatectomy was performed. The pathological examination revealed dedifferentiated type liposarcoma and positive surgical margins. Therefore, radiotherapy of 59.4 Gy in 33 fractions was performed at the recurrence area. The patient has been recurrence-free from 1 year 6 months since the second operation.
53.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1945-1947.
[A Case of Extraosteosarcoma in the Omentum].
[Article in Japanese]
Abstract
A 51-year-old female presented to our hospital with a chief complaint of abdominal pain. A blood test showed high ALP value(7,001 IU/L), and the abdominal CT showed a mass lesion of 20 cm in diameter with calcification and infiltrated surroundings. From these findings, we diagnosed the patient with peritonealcancer pre-operatively. The intraoperative findings showed an advanced tumor infiltrated into the sigmoid, transverse colon, small intestine and uterus. There were multiple suspected metastasis tumors in the peritonealcavity. Therefore, we resected the tumor as much as possible without curative surgery. Pathologically, the spindle cells were growing with bone formation. Immunostaining showed negative epithelial markers. The tumor protruded out of the intestinal wall, and the patient was diagnosed with extraskeletal osteosarcoma in the omentum. Chemotherapy with doxorubicin and cisplatin was initiated. Because of the disease progression and the presence of side effects, the patient discontinued chemotherapy and died 4 months after the operation. Extraskeletal osteosarcoma is a very rare tumor with poor prognosis. We reported a case of extraskeletal osteosarcoma in the omentum and review the literature.
54.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1943-1944.
[A Case of Gastrointestinal Stromal Tumor Re-Resected Ten Years after the Resection of Its Recurrence].
[Article in Japanese]
Aida T1, Shiobara M, Wakatsuki K, Ogasawara T, Suda K, Miyazawa K, Miyoshi T, Sato S, Yoshioka S, Yamazaki K.
Abstract
The patient was a 75-year-old man who was diagnosed as having jejunal gastrointestinal stromal tumor(GIST)and underwent partial resection of the small intestine including the tumor 12 years ago. Two years after the first resection, recurrence was detected, and a second resection was performed. Ten years after the second resection following recurrence, he took imatinib, and computed tomography(CT)revealed abdominal and liver tumors. We was diagnosed as having GIST recurrence, and a third resection, which included an abdominal tumor resection and partial hepatectomy, was performed. The pathological findings were metastatic abdominal GIST and angiomyolipoma of the liver. The Japanese Clinical Practice Guidelines for GIST suggest a surgical indication only for local recurrence of GIST and resectable liver metastases. Recurrent GIST cannot be completely cured with antineoplastic drugs alone. Multidisciplinary treatment is necessary for long-term survival of patients with recurrent GIST.
55.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1940-1942.
[A Case of Gastric Endocrine Carcinoma with a Huge Liver Metastasis].
[Article in Japanese]
Tamesa T1, Saeki S, Nishida Y, Nabeya M, Tokunou K, Kawaoka T, Miyahara M, Sasaki S, Yamashita Y, Kubo H, Yamamoto S.
Abstract
A-67-year old man was diagnosed with gastric cancer and a liver tumor. Extended left hemihepatectomy combined with caudate lobectomy and distal gastrectomy with lymph node dissection were performed. Histological examination revealed synaptophysin and CD56positive tumor cells with a solid and rosette structure, which was diagnosed as endocrine carcinoma (EC). Additionally, a tubular adenocarcinoma was present in the stomach. The liver tumor presented as EC with tumor thrombus in the left portal vein. Finally, the patient was diagnosed with gastric EC(pT3[SS], pN0, P0, CY0, M1[HEP], Stage Ⅳ, R0). He received 6courses of the adjuvant chemotherapy with cisplatin(CDDP)plus irinotecan(CPT-11), and has been alive without recurrence for 21 months post-operation. Gastric EC is a rare subtype of gastric cancer. The resection of liver metastasis of gastric EC may improve patients' prognosis and QOL. CDDP-based chemotherapy is recommended, due to the regimen for small cell lung cancer.
56.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1937-1939.
[A Case of Laparoscopic Gastrojejunostomy for Duodenal Obstruction Caused by Unresectable Locally Advanced Pancreatic Cancer].
[Article in Japanese]
Hyakutake Y1, Kawamoto J, Uchi R, Yamada H, Matsuyama N, Shu T, Fujii K, Funatsu Y, Yamamoto Y, Otsuka M.
Abstract
The patient was an 85-year-old man who received chemotherapy with gemcitabine for 2 years 9 months under the diagnosis of unresectable locally advanced pancreatic body and tail cancer. He visited our hospital because of anorexia, upper abdominal fullness, and vomiting. A CT scan showed severe stenosis in the third portion of the duodenum, which was associated with the direct invasion of the advanced pancreatic cancer. Upper gastrointestinal fiberscopy revealed a severe duodenal obstruction; however, pancreatic cancer exposure within the duodenal mucosa was not observed. As the stenosis of the duodenum was relatively smooth because of the cancer invasion into only the submucosa, deviation of the metallic stent was possible, so we performed laparoscopic gastrojejunostomy. We started the surgery with 5-port settings. A slit was made in the gastric body by using ENDO-GIA®, and bypass surgery with a Roux-en-Y anastomosis was performed. The postoperative course was good, and oral intake resumed on the third postoperative day. Thereafter, he could leave the hospital with good progress and received systemic chemotherapy using gemcitabine. In the present case, an extramural gastrointestinal stenosis without cancer that was not exposed in the gastrointestinal mucosa was poorly fixed with gastrointestinal metallic stents and use of a deviating metallic stent was reported, so we chose laparoscopic gastrojejunostomy. In addition, after undergoing laparoscopic surgery, which is a minimally invasive treatment, he recovered quickly and shifted early to systemic chemotherapy. Herein, the usefulness of laparoscopic gastrojejunostomy for extramural stenosis is reported with a review of related literature.
57.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1934-1936.
[A Case Report of Lung Resection for Lung Metastasis from Pancreatic Cancer].
[Article in Japanese]
Abstract
A 66-year-old man had an elevated CEA level. Further examinations showed a pancreatic head tumor. A pancreaticoduodenectomy was then performed. The histopathological examination showed a mixed tumor of papillary adenocarcinoma and neuroendocrine cancer. In addition, a tumor in the upper lobe of the right lung was found 18 months after the initial pancreatic resection, and the bronchoscope indicated lung metastasis. The patient underwent partial pneumonectomy. After the pneumonectomy, he received S-1 chemotherapy. Thirty -nine months after the pneumonectomy, CEA was slightly elevated. We changed the chemotherapy to gemcitabine and nab-paclitaxel without further examinations to confirm the recurrence. The patient discontinued chemotherapy after CEA fell within the normal range. He has been alive without tumor relapse for 64 months since the second operation for the lung metastasis. We report a successful case of lung resection for lung metasta- sis from pancreatic cancer.
58.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1931-1933.
[A Case of Recurrent Gastric Cancer with Clinical Complete Response after Ramucirumab plus Paclitaxel Therapy].
[Article in Japanese]
Chuman M1, Takahashi Y, Tokito T, Chino S, Ema A, Ushiku H, Nakamura K, Kubo H, Naito M, Kondo Y, Nishi Y, Hiki N.
Abstract
We report a case of a 61-year-old man who underwent open total gastrectomy and D2 lymph node dissection for gastric cancer. The pathological findings were suggestive of pT2N3M0, fStage ⅢA. S -1 was administered for 1 year post-surgery. One year and 9 months after the operation, an epigastralgia was found, and the PET-CT showed an increase of SUVmax 3.80 around the celiac artery. S -1 plus CDDP therapy was initiated. However, due to the occurrence of neutropenia, the therapy was changed to ramucirumab plus paclitaxel. After 20 courses of the same regimen, no PET-CT uptake was observed. We thus considered it cCR and discontinued further chemotherapy. The patient has been alive for 15 months without recurrence. By performing effective chemotherapy at an early stage, cCR could be observed after a secondary treatment. Therefore, longterm survival could be expected for post-operative recurrence of gastric cancer.
59.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1928-1930.
[Conversion Surgery for Locally Advanced Unresectable Pancreatic Cancer Treated with FOLFIRINOX Therapy and Proton Beam Therapy Combined with S-1 Chemotherapy-A Case Report].
[Article in Japanese]
Umino Y1, Mizuma M, Iseki M, Hata T, Takadate T, Kawaguchi K, Aoki T, Motoi F, Naito T, Kamei T, Masamune A, Ishioka C, Ono T, Murakami M, Unno M.
Abstract
We report a case of locally advanced unresectable(UR-LA)pancreatic cancer in a patient who underwent conversion surgery after FOLFIRINOX and proton beam therapy(PBT)combined with S-1. A 68-year-old woman was referred to our hospital for a pancreatic tumor. The abdominal CT scan revealed a 40mm pancreatic body tumor with an abutment(>180°) of the celiac artery and the superior mesenteric artery. Moreover, the tumor was classified as UR-LA with a contact to the abdominal aorta. The tumor was histologically diagnosed as adenocarcinoma via an endoscopic ultrasound-guided fine-nee- dle aspiration. After 2 courses of FOLFIRINOX, PBT(50 GyE/25 Fr)combined with S-1 were administered. The tumor shrunk to 30mm at the CT scan. After 5 courses of FOLFIRINOX, the tumor reduced to 20 mm. No distant metastasis or malignant cells in abdominal washing cytology was detected using staging laparoscopy. Then, distal pancreatectomy with celiac axis resection(DP-CAR)was performed. According to the General Rules for the Study of Pancreatic Cancer(7th edition)from Japan Pancreas Society, the histological findings were suggestive of ypT3, ypN0, R0, and Grade 3 histological effect. The patient had a Grade A delayed gastric emptying post-operation. He was discharged 35 days after the surgery and has been alive without recurrence on imaging for 11 months post-operation.
60.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1925-1927.
[A Case of Advanced Gastric Cancer with Liver Metastases Treated with Curative Conversion Therapy after S-1 plus Oxaliplatin].
[Article in Japanese]
Kataoka N1, Hiramatsu S, Yasuda K, Kashu N, Yoshitake H, Takami T, Yamaguchi T, Tomita M, Shono Y, Makimoto S.
Abstract
An 81-year-old man was referred to our hospital. Upper gastrointestinal endoscopy revealed a type 2 tumor in the antrum of the stomach. The histopathological findings showed a moderately differentiated HER2-negative adenocarcinoma. Two low-density areas of 17mm and 26mm in diameter were observed in the liver S6 and S8respectively at the CT scan. Nine courses of S-1 plus oxaliplatin(SOX)therapy were administered to this patient with gastric cancer and liver metastases. Since both the primary tumor and the liver metastases were significantly reduced by the chemotherapy, distal gastrectomy(D2 dissection)and partial liver resection(liver S6, S8)were performed. The histopathological findings revealed no tumor cells in the primary tumor, lymph nodes, and liver metastases, with a histologic effect of Grade 3. The patient underwent adjuvant therapy with S-1. He has been alive without recurrence for 11 months post-surgery.
61.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1922-1924.
[A New Projection-Marking Technique for Breast-Conserving Surgery Using a Radiation Treatment Planning System and Multi-Leaf Collimator in Patients with Breast Cancer-A Pilot Study].
[Article in Japanese]
Miyoshi T1, Yamaguchi S, Shiobara M, Wakatsuki K, Suda K, Miyazawa K, Aida T, Watanabe Y, Yoneura N, Yoshioka S.
Abstract
In this study, a breast-conserving surgery(BCS)was performed involving the new image projection technique, using a radiation treatment planning system(RTPS)and a multi-leaf collimator(MLC), for patients with ductal carcinoma in situ (DCIS)and invasive ductal carcinoma(IDC)with ductal components. This study aimed to evaluate the feasibility of this procedure as a pilot study. From June 2014 to May 2017, 27 patients diagnosed with DCIS and IDC with ductal components underwent BCS. In the RTPS, the design of tumor resection was simulated, and the extent of resection was projected to the breast surface using the MLC. BCS was performed using this skin marking. Among 27 patients, 4(14.8%)had carcinoma in the surgical margins. As a pilot study, the simplicity and usefulness of this procedure was confirmed in BCS for patients with DCIS and IDC with ductal components. Further evaluation of its safety and efficacy will be conducted in more patients.
62.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1917-1921.
Effects of Cytoreductive Surgery Combined with Perioperative Chemotherapy on Long-Term Survivals of Colorectal Cancer Patients with Peritoneal Metastasis, with Special Reference to the Involved Peritoneal Sectors and Organs.
Yonemura Y1, Prabhu A, Sako S, Ishibashi H, Hirano M, Mizumoto A, Takao N, Ichinose M, Motoi S, Liu Y, Nishihara K, Fushida S.
Abstract
Peritoneal Surface Oncology Group International(PSOGI)proposed a novel treatment, named comprehensive treatment for peritoneal metastasis(PM)from colorectal cancer(CRC). The present study demonstrated the efficacies of the treatment regarding the peritoneal sectors and organs involved with PM from CRC.
MATERIALS AND METHODS:
Among 365 patients received laparotomy, 278 CRC patients with PM underwent complete cytoreductive surgery(CC-0).
RESULTS:
After CC-0 resection Grade 3, Grade 4, and Grade 5 postoperative complication were found in 20(7.2%), 26(9.3%), and 6(2.2%). Five- and 10-year survival rate(YSR)of CC-0 resection were 24.5%, and 11.6% with median survival time(MST)of 42.0 months. Regarding the peritoneal cancer index(PCI)of small bowel(SB-PCI), all patients of PCI B3 died of the disease. In contrast, 10-YSR of patients with SB-PCI of 0, 1, and 2 were 26.1%, 19.5%, and 6.2%, respectively. Ten-YSR of patients with the number of involved peritoneal sectors C9 ranged from 6.9% to 29.8%. MST of patients with PM in each peritoneal sector(sector 0 to sector 8)ranged from 26.4 months to 49.2 months, and 10-YSR ranged from 4.2%to 17.2%. Ten-YSR of patients with involvement of rectum, stomach, liver capsule, seminal vesicle, ureter, uterus, or ovary ranged from 0% to 16.9%.
CONCLUSIONS:
From the present data, PM should be removed aggressively to achieve complete cytoreduction, when the patients with PCIC26, involved peritoneal sectorsC9 and SB-PCIC2 are supposed to receive complete cytoreduction of PM.
63.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1914-1916.
[Microsatellite Instability in Gastric Cancer].
[Article in Japanese]
Choda Y1, Kubota T, Ishida M, Sato D, Yoshimitsu M, Nakano K, Harano M, Matsukawa H, Idani H, Shiozaki S, Okajima M.
Abstract
INTRODUCTION:
Pembrolizumab and nivolumab are anti-programmed death receptor-1(PD-1)antibodies. The use of pembrolizumab for unresectable or metastatic cancer with microsatellite instability-high(MSI-High)has been recently approved. However, there were few clinical reports on MSI in gastric cancer.
MATERIALS AND METHODS:
We examined the clinicopathological features and MSI for 37 patients who underwent chemotherapy for unresectable gastric cancer in January 2019.
RESULTS:
MSI-High was observed in 3 patients(8.1%). Among the MSI-High patients, there was a tendency towards older age, female sex, undifferentiated type, distal-located lesions and lymphatic vessel invasions, but the differences were not significant. Eleven patients underwent chemotherapy with nivolumab, 4 of them had partial response(PR). Three out of the 4 patients (75%)were MSI-High.
CONCLUSIONS:
These results suggested that anti-PD-1 antibody could be effective as a secondary treatment for unresectable or metastatic gastric cancer among MSI-High patients.
64.
Gan To Kagaku Ryoho. 2019 Dec;46(13):1911-1913.
[Short-Term Comparison between Trans-Anal Ileus Tube and Self-Expandable Metallic Stent for Obstructive Colorectal Cancer].
[Article in Japanese]
Numata K1, Yasukawa M, Toda S, Kamioka Y, Suematsu H, Tsuchida K, Higuchi A, Saeki H, Rino Y, Masuda M, Matsukawa H.
Abstract
The aim of this study was to compare the outcome of using trans-anal ileus tube and self-expandable metallic stent(SEMS) for obstructive colorectal cancer.
METHODS:
Between 2014 and 2018, 14 patients received trans-anal ileus tube placement (group I)and 34 received SEMS insertion as bridge to surgery(BTS)and underwent primary resection.
RESULTS:
The technical success rate was 100%in both groups, and the clinical success rate was 85.7%(12/14 cases)in group I and 91.2%(31/34 cases)in group S. In group S, the CROSS score significantly improved, the rates of stoma construction and postoperative complications were significantly lower, and the period until oral intake and hospital discharge was significantly short.
CONCLUSION:
SEMS insertion is more effective than trans-anal ileus tube placement in terms of short-term outcome.
65.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2592-2594.
[A Case of CR Achieved by Chemotherapy for Distant Metastatic Lymph Nodes after Surgery for HER2 Positive Early Gastric Cancer].
[Article in Japanese]
Koganezawa I1, Katayanagi S, Nakagawa M, Yokozuka K, Hikita K, Kobayashi T, Kuwabara H, Shigoka M, Tabuchi S, Hisada M, Kawachi S.
Abstract
The patient was a 72-year-old man who exhibited an abnormal shadow in the stomach in a series of medical check-ups of the upper gastrointestinal in August 20XX. It was diagnosed as gastric cancer(type 1)of the greater curvature of the MU region. Total gastrectomy, D2-11p dissection, and Roux-en-Y reconstruction were performed in October 20XX. The tumor was p-T1bN3aM0, Stage ⅡB, Pap, Ly1c, V1a, 90×70mm, HER2 score 3. Six courses of S-1/CDDP were administered as adjuvant chemotherapy after consultation. Two years and 8 months after the surgery, PET-CT scan showed distant lymph node metastasis(left axilla, para-aortic)and left lung metastasis. Three courses of XP-Her after 2 years and 11 months, 19 courses of X-Her after 3 years and 2 months, and 7 courses of trastuzumab alone after 4 years and 4 months to 4 years and 9 months were canceled. Three years and 4 months after the surgery, the tumor showed PR, and it showed CR, 3 years and 8 months after the surgery. Eight years and 3 months after the surgery, the tumor continued to show CR. The adverse events were blood toxicity, WBC reduction Grade 1, neutropenia Grade 3, and anemia Grade 2. There have only been a few reports on CR after chemotherapy with XP-Her for lung metastasis of gastric cancer, with a review of the literature.
66.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2589-2591.
[Stage Ⅳ Breast Cancer with Difficulty in Initiating Chemotherapy-A Case Report].
[Article in Japanese]
Abstract
We report a case of breast cancer(T4b[skin], N1, M1[lung], ER-, PR-, HER2 3+)in a 63-year-old woman with liver dysfunction of unknown cause(T-Bil 3.6mg/dL, ALP 3,483 U/L, AST 214 U/L, ALT 320 U/L, g / -GTP 1,943 U/L). Further- more, serum CA19-9(4,670 U/mL)and HbA1c(8.8%)levels were both elevated. First, she underwent chemotherapy with trastuzumab and capecitabine. Subsequently, liver dysfunction relieved gradually. CA19-9 and HbA1c levels were also decreased, but the tumor size was NC. Subsequently, trastuzumab, pertuzumab, and docetaxel were administered, as liver function became normal. The tumor shrank significantly after this treatment. Finally, she underwent mastectomy. Five years after the first visit, she has continued chemotherapy, with lung metastases almost scarred(CR).
67.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2586-2588.
[Long-Term Survival after Surgical Treatment of Neuroendocrine Carcinoma of the Ampulla of Vater-A Case Report].
[Article in Japanese]
Yoshioka R1, Tomimaru Y, Noguchi K, Nagase H, Ogino T, Hirota M, Oshima K, Tanida T, Noura S, Imamura H, Iwazawa T, Akagi K, Tamura H, Adachi S, Dono K.
Abstract
A 60s man underwent upper gastrointestinal endoscopy at a regular medical check-up without symptoms, which showed an ulcerative region in the duodenal ampulla, measuring 3 cm in diameter. He was diagnosed with poorly differentiated adenocarcinoma on biopsy and referred to our hospital. Abdominal contrast-enhanced CT scan revealed an enhanced-ulcerative tumor, measuring 3 cm, at the duodenal ampulla. After the preoperative diagnosis of adenocarcinoma of the duodenal ampulla, subtotal stomach-preserving pancreatoduodenectomy with regional lymph node dissection was performed. The final diagnosis was neuroendocrine carcinoma(NEC)of the duodenal ampulla. He has been alive for 9 years with no recurrences. NEC of the duodenal ampulla is rare, and its prognosis is poor. We report a case of long-term survival after resection of NEC of the duodenal ampulla.
68.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2583-2585.
[Bone Marrow Metastases of Breast Cancer Treated with Endocrine Therapy-A Case Report].
[Article in Japanese]
Abstract
We report a case of bone marrowmetastases of breast cancer treated with endocrine therapy. A 54-year-old woman underwent right partial mastectomy and sentinel lymph node biopsy, followed by adjuvant chemotherapy and radiotherapy. She declined the endocrine therapy and was lost to follow-up after 3 postoperative years. After 9 postoperative years, she visited our hospital because of backache and an axillary lump. FDG-PET scan, incisional biopsy of the axillary lump, and bone marrowbiopsy revealed multiple bone and bone marrowmetastases of the breast cancer. She was treated with endocrine therapy(fulvestrant: FUL), which effectively decreased the FDG uptake in the metastatic lesions after 6 months. However, tumor markers elevated after 1 year and 6 months, and she is currently under combination therapy with aromatase inhibitors and CDK4/6 inhibitors.
69.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2580-2582.
[Rectal Gastrointestinal Stromal Tumor(GIST)Excised by Two Teams Following Neoadjuvant Chemotherapy-A Case Report].
[Article in Japanese]
Abstract
A 67-year-old man presented with bloody stools. Colonoscopy showed a small submucosal tumor in the lower rectum. As the tumor was small, follow-up was chosen. Although he was instructed to undergo reexamination 1 year later, he did not comply. Four years later, he was reexamined by the previous doctor for disorders of defecation. He was admitted to our hospital for examination and treatment, as the tumor was growing. The mass measured 87×69 mm. The tumor was found on the dorsal side of the rectum with well-circumscribed, smooth margins. Trans-anal biopsy showed rectal GIST. The tumor seemed difficult to resect, and hence, imatinib mesylate(400mg/day)was administered as neoadjuvant chemotherapy for tumor reduction. After 4 months, the maximum tumor diameter was reduced by 60%, and arthroscopic surgery was performed by 2 teams. In the trans-anal arthroscopic operation, partial resection of the levator ani muscle was performed, and complete excision was achieved by securing the excision margin. The operation time was 341 min, and the hemorrhage volume was 422 mL. Postoperatively, a Grade 2 suture failure occurred at the anastomotic site, but no further complications were observed.
70.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2577-2579.
[LECS-Assisted Open Partial Gastrectomy for an Ulcerative GIST in an Elderly Patient].
[Article in Japanese]
Okano K1, Komatsu S, Tsuji R, Tomatsuri N, Asaeda K, Shiraga A, Ohta A, Tanaka S, Kumano T, Imura K, Shimomura K, Ikeda J, Taniguchi F, Shioaki Y.
Abstract
Laparoscopy and endoscopy cooperative surgery(LECS)is an excellent surgical procedure that prevents excessive resection of the gastrointestinal wall and maintains gastrointestinal functions. However, LECS is not recommended for large gastrointestinal stromal tumor(GIST)sized more than 5 cm and/or ulcerative GIST because of the oncological risk of peritoneal dissemination. Here, we report the case of an elderly patient who was successfully treated with LECS-assisted open partial gastrectomy for an ulcerative GIST near the esophagogastric junction.
71.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2574-2576.
[Successful Treatment of Necrotizing Fasciitis Due to Ascending Colon Cancer-A Case Report].
[Article in Japanese]
Ichisawa A1, Jin H, Hagiwara Y, Hara Y, Kimura T, Yonaiyama S, Yoshikawa T, Nakai M, Tokura T, Aoki K, Kawashima H, Toyoki Y, Endoh M.
Abstract
A 70-year-old woman was brought to our hospital by ambulance because of severe groin pain on the right side. Computed tomography scan revealed a tumor in the ascending colon, intraperitoneal abscess spread to the subcutaneous tissues, and a large amount of pneumoderma. She was diagnosed with necrotizing fasciitis caused by penetration of ascending colon cancer and underwent lavage and drainage, right hemicolectomy, end ileostomy, and debridement of necrotic tissues on emergency. Postoperatively, she underwent debridement and irrigation at the bedside every day, but the necrotizing tissues spread. Debridement under general anesthesia was repeated on postoperative day 8. On postoperative day 20, negative pressure wound therapy(NPWT)was initiated to manage the exudates and wound condition, and healthy granulation tissues formed gradually. After 4 weeks, she underwent split-thickness skin graft implantation. The postoperative course was uneventful, and she was discharged from the hospital. She is currently on chemotherapy and has been alive for 1 year and 3 months after the first operation.
72.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2571-2573.
[Laparoscopic Surgery for a Case of Double Digestive Cancers with X-Linked Agammaglobulinemia].
[Article in Japanese]
Abstract
A 65-year-old man was diagnosed with agammaglobulinemia at the age of 53 years. To investigate the cause of the increased CRP value, CT was performed and revealed thickening of the walls of the ascending colon and rectum. Colonoscopy revealed tumors and stenoses in the ascending colon and rectum. Both tumors were found to be adenocarcinomas in histological examinations. The preoperative diagnosis of the ascending colon and rectal cancers was cT4aN0M0, cStageⅡb. Preoperatively, we administered 10.0 g of immunoglobulin intravenously. We performed laparoscopic right hemicolectomy and high anterior resection with D3 dissection of the lymph node. On postoperative day 1, we again administered 10.0 g of immunoglobulin intravenously. The patient recovered uneventfully and was discharged on postoperative day 13. Laparoscopic colectomy for patients with agammaglobulinemia can be performed safely by administering immunoglobulin during the perioperative period.
73.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2568-2570.
[Spontaneous Disappearance of Undifferentiated Pleomorphic Primary Mesenteric Sarcoma-A Case Report].
[Article in Japanese]
Abstract
The patient was a 49-year-old man with persistent fever since the introduction of hemodialysis(HD). Vomiting and abdominal swelling appeared 4 months after initiating hemodialysis. Computed tomography(CT)scan revealed a tumor measuring 9 cm, and disorders of passage from the jejunum. Surgery was performed, and resection was impossible because of peritoneal dissemination. Histopathological examination of the disseminated nodes suggested an undifferentiated pleomorphic sarcoma. Postoperatively, drainage from the gastric fistula was approximately 2,000mL/day. Chemotherapy was considered impossible because of HD, and palliative therapy was selected. However, the volume of drainage from the gastric fistula gradually decreased, and the disorders of passage reduced. CT scan confirmed marked reduction in the size of the intraperitoneal tumor and its subsequent disappearance. At the 2-year-and-5-month postoperative follow-up, no relapses were observed, and the course had been uneventful. Undifferentiated pleomorphic sarcomas develop in the soft tissue of adults and have a poor prognosis. However, mesenteric development is rare. Total tumorectomy is the first choice of treatment. A consensus on the usefulness of chemotherapy or radiotherapy has not been reached. Furthermore, no studies have reported spontaneous tumor disappearance in the absence of treatment. Here, we report a case of minor undifferentiated primary mesenteric sarcoma and its spontaneous disappearance and review the literature.
74.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2565-2567.
[Pregnancy-Associated Stage Ⅳ Gastric Cancer with No Recurrence for a Long Time-A Case Report].
[Article in Japanese]
Ebisui C1, Yamamura N, Minoji T, Takabatake H, Tamai K, Kitahara T, Watanabe N, Okamura S, Fukuchi N, Yokouchi H, Kinuta M, Ohishi K.
Abstract
A 28-year-oldwoman visiteda clinic with a complaint of epigastralgia 3 months after delivery. She was diagnosedwith gastritis andtreatedwith medication. Two months later, in January 2006, she was admittedto our hospital with a complaint of dysphagia. Upper gastrointestinal endoscopy revealed type 3 gastric cancer in the lesser curvature of the cardia, and abdominal CT scan showed wall thickening of the upper gastric body. No apparent distant metastases were found. The patient underwent total gastrectomy with D2 lymph node dissection in February 2006. Although there was no peritoneal dissemination, the patient testedpositive in peritoneal lavage cytology. The postoperative pathological diagnosis was gastric cancer pT4aN2M1(P0CY1H0), Stage Ⅳ. She was discharged on postoperative day 22. S-1 monotherapy(100mg/day, day 1- 28q6wks)was performedfor 1 year on an outpatient basis. For 13 years and1 0 months after the surgery, no apparent recurrences of gastric cancer have been observed. In gastric cancers associated with pregnancy, it is difficult to distinguish between perinatal symptoms andsymptoms of gastric disease. Therefore, endoscopic examination shouldbe performedfor perinatal patients presenting with persistent gastrointestinal symptoms.
75.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2562-2564.
[Long-Term Survival in a Patient with Abdominal Wall Metastasis of Early Gastric Cancer-A Case Report].
[Article in Japanese]
Abstract
A 76-year-old man was diagnosed with type 1 early gastric cancer. Attempted ESD on the lesion resulted in perforation, and distal gastrectomy with D1+dissection was performed. After 1 year and 6 months, a mass measuring 2.4 cm appeared in the abdominal wall. Cytological examination revealed adenocarcinoma, and the patient was diagnosed with abdominal wall metastasis of gastric cancer. There were no evidences of recurrence in the other organs, and extraction was performed. After 6 months, 1 year, and 2 years, the same metastases were found in the abdominal wall, and repeated extractions were performed. All 4 masses had resulted from the metastasis of gastric cancer, but the patient has been alive without recurrence for 1 year and 6 months after the surgery.
76.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2560-2561.
[Appendix Cancer with Long-Term Survival after Multimodality Therapy-A Case Report].
[Article in Japanese]
Abstract
We report a case of long-term survival in a 65-year-old woman with recurrent appendix cancer. In March 2002, she was diagnosed with appendix cancer and underwent ileocecal resection. The pathological diagnosis was mucinous cystadenocarcinoma, pT2N0M0, Stage Ⅰ. In April 2006, ovariohysterectomy was performed for right ovarian metastases. In February 2011, tumor resection was performed for disseminated recurrence after 4 courses of systemic chemotherapy(bevacizumab plus mFOLFOX6). Although no recurrent lesions had been detected on imaging, stepwise elevation of serum CEA level was observed from June 2016. In November 2017, computed tomography scan revealed a slow-growing tumor on the liver. We performed partial resection of the right hemidiaphragm for the disseminated tumor, and the pathological diagnosis was mucinous adenocarcinoma. The patient has been on continuous postoperative follow-up without recurrence until June 2019. Appendix cancer is relatively rare and has a worse prognosis compared to colorectal cancer because of higher frequency of disseminated metastases. With the multimodality therapy, our patient showed long-term survival over 17 years despite a disseminated recurrence. In cases of mucinous cystadenocarcinoma of the appendix, persistent follow-up and aggressive treatment are recommended.
77.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2557-2559.
[Palliative Radiotherapy and Sequential Nivolumab Administration for Recurrent Gastric Cancer-A Case Report].
[Article in Japanese]
Hamakawa T1, Nishikawa K, Tanaka E, Nagae A, Toshiyama R, Miyo M, Fujiwara A, Miyake M, Hama N, Miyamoto A, Kato T, Takami K, Hirao M.
Abstract
A 52-year-old man underwent total gastrectomy for advanced gastric cancer. The postoperative diagnosis was por1>muc >por2>tub2, pT4a(SE)N3bM0H0P0CY0, pStage ⅢC. He underwent 6 courses of adjuvant chemotherapy with capecitabine plus oxaliplatin. Six months after the surgery, CT showed 2 recurrent lesions: a tumor behind the esophago-jejunal anastomosis and another in the mesentery around the jejuno-jejunal anastomosis. Endoscopy showed intrajejunal invasion. Second-line therapy with paclitaxel and ramucirumab were administered for 3 courses, resulting in rapid progression of the disease. Palliative radiotherapy(39.6 Gy/22 Fr)for both lesions was performed for local control. Sequential administration of nivolumab was started 9 days after terminating radiotherapy. After 6 courses, both tumors markedly reduced PR, and the oral intake of food improved. After 10 courses, there was hyper-progression of the tumor behind the esophago-jejunal anastomosis and shrinkage of the other tumor. Surgery (left upper abdominal exenteration and enucleation of the tumor in the mesentery)was performed to release the jejunal limb obstruction. The tumor behind the esophago-jejunal anastomosis was a poorly differentiated adenocarcinoma, and no viable cancer cells were seen in the tumor in the mesentery. Radiotherapy and immune checkpoint inhibitors may be effective for gastric cancers, although the mechanism of action should be elucidated.
78.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2554-2556.
[A Case of Conversion Surgery for an Initially Locally Advanced Unresectable Pancreatic Cancer after S-1 Chemotherapy].
[Article in Japanese]
Hayashi Y1, Matsuo Y, Hamano S, Oba A, Ueda G, Omi K, Imafuji H, Saito K, Tsuboi K, Morimoto M, Ogawa R, Takahashi H, Takiguchi S.
Abstract
We report a case of conversion surgery for a locally advanced unresectable(UR-LA)pancreatic cancer that was radically resected after S-1 therapy. A 65-year-old man visited a referral physician because of fatigue and liver dysfunction. A CT scan revealed a mass in the pancreatic uncinate process that was suspected to be superior mesenteric artery(SMA)infiltration and was diagnosed as UR-LA pancreatic cancer. GEM nab-PTX therapy was initiated but was discontinued after 2 courses because of adverse events. The treatment was switched to S-1 monochemotherapy. After that, the tumor did not progress for around 1.5 years, and the patient was referred to our hospital for surgical treatment. As the contact between the tumor and the SMA was considered to be less than half-round, we made a diagnosis of borderline resectable(BR-A)pancreatic cancer. Subsequently, we performed a pancreaticoduodenectomy with partial resection of the portal vein and achieved R0 resection. The patient received adjuvant chemotherapy with S-1 and showed no signs of recurrence for 10 months after surgery.
79.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2551-2553.
[A Case of Non-Resectable Pancreatic Cancer with Multiple Hepatic Metastases Treated with FOLFIRINOX Therapy and Conversion Surgery].
[Article in Japanese]
Akaishi T1, Ishido K, Kimura N, Nagase H, Odagiri T, Fujita H, Chen Y, Saito K, Takahata T, Sato A, Hakamada K.
Abstract
A 50-year-old woman was diagnosed as having pancreatic head cancer with multiple hepatic metastases. FOLFIRINOX therapy was initiated. After completing 18 courses of therapy, partial remission(PR)was achieved based on images, and surgery was then planed. The subtotal stomach-preserving pancreaticoduodenectomy and hepatic S7 partial resection were performed. Macroscopically, complete resection was achieved. Regarding pathological findings of the primary lesion and hepatic metastatic lesions, fibrous formation and hyalinizing condition induced by chemotherapy were noted; moreover, complete disappearance of cancer cells was detected. However, metastasis of poorly differentiated adenocarcinoma was detected in 12b lymph node tissue. One month after the surgery, postoperative adjunctive chemotherapy with S-1 was initiated. However, new hepatic metastasis was detected 3 months after the surgery. Although recurrence treatment was initiated, the disease progressed, and the patient died 11 months after the surgery.
80.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2548-2550.
[Anaplastic Carcinoma of the Pancreas of the Spindle Cell Type with Rapid Growth and Liver Metastases after Resection-A Case Report].
[Article in Japanese]
Sato Y1, Kagawa S, Yoshitomi H, Furukawa K, Takayashiki T, Kuboki S, Takano S, Suzuki D, Sakai N, Nojima H, Mishima T, Nakadai E, Ohtsuka M.
Abstract
An 81-year-old man was referred to our department because of rapid progression of a cystic lesion in the pancreatic tail. Abdominal CT revealed a heterogeneously enhancing tumor, measuring 70mm in diameter, in the pancreatic tail, encompassing a low-density area with calcification and directly invading the spleen. We diagnosed the patient with malignant transformation of solid-pseudopapillary neoplasm and performed distal pancreatectomy with splenectomy, partial transverse colectomy, and partial resection of the diaphragm. Histopathological examination revealed anaplastic carcinoma of the pancreas of the spindle cell type, and R0 resection was achieved. Anastomotic leakage of the transverse colon occurred on postoperative day 4, and ileostomy was performed. Multiple liver metastases were observed on postoperative day 27, and the patient was orally administered with S-1. Although he was discharged on postoperative day 50, he died of cancer on postoperative day 61. Anaplastic carcinoma of the pancreas has a poor prognosis, and an early multidisciplinary treatment should be performed.
81.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2545-2547.
[Intraductal Papillary Mucinous Carcinoma with Penetration in the Colon and Retrograde Infection-A Case Report].
[Article in Japanese]
Abstract
We report a case of intraductal papillary mucinous carcinoma(IPMC)penetrating the colon in an 82-year-old man. He visited our hospital with left upper abdominal pain. Abdominal CT showed IPMC of the pancreatic tail, measuring 7 cm, with tumor penetration to the colon and retrograde infection. After the antibacterial treatment, we performed distal pancreatectomy with colectomy. Pathological examination showed proliferation of adenocarcinoma of the gastrointestinal tract with penetration to the colon. Severe fibrosis and calcification surrounding the invasive cancer cells suggested a long disease duration. Despite adjuvant chemotherapy, he developed recurrence of peritoneal dissemination after 9 postoperative months, and subsequently, systemic chemotherapy was started. As intraductal papillary mucinous neoplasm(IPMN)might penetrate the adjacent organs, leading to a poor prognosis, even over a prolonged time period, IPMN should be followed-up appropriately and resected soon after the suspicion of malignant transformation.
82.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2542-2544.
[Long-Term Survival after Palliative Surgery for Advanced Gastric Cancer with Bone Marrow Metastasis-A Case Report].
[Article in Japanese]
Ueda H1, Okada K, Ito K, Miyazaki H, Takiguchi N, Nakai S, Takeoka T, Matsuno H, Konishi K, Ota H, Yokoyama S, Fukunaga M.
Abstract
A 57-year-old woman was diagnosed with advanced gastric cancer with bone marrow metastasis(cT4aN1pM1[MAR], pStage Ⅳ). After 18 courses of S-1 and cisplatin and 18 courses of ramucirumab and paclitaxel, the chemotherapy was stopped because of stenosis. We performed endoscopic metallic stent placement, but stenosis reappeared after a month. Subsequently, distal gastrectomy was performed as a palliative surgery. She had no complications and improved appetite, therefore, she resumed chemotherapy after 3 postoperative months and continued for 4 years and 9 months from the first visit. In general, gastric cancer with bone marrow metastasis has a poor prognosis, however, in this case, long-term survival was achieved with palliative surgery.
83.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2539-2541.
[Successful Conversion Therapy for Gastric Cancer with Paraaortic Lymph Node Metastasis after SP Therapy-A Case Report].
[Article in Japanese]
Nakano Y1, Goto A, Kikuchi K, Suzuki K, Matsuo K, Tsuru Y, Nakamura K, Shibasaki S, Suda K, Inaba K, Hanai T, Kato Y, Sugioka A, Uyama I.
Abstract
A 69-year-old woman, who complained of loss of appetite, was admitted to our hospital and diagnosed with clinical Stage Ⅳgastric cancer and paraaortic lymph node metastases(cT4aN3M1[#16b1LYM], cStage Ⅳ). She underwent 2 cycles of SP therapy(combination of S-1 and CDDP). A partial response of the primary tumor was noted, with no distant metastases, except for the paraaortic lymph nodes. She underwent robotic total gastrectomy with D2 plus paraaortic lymph node dissection. Histopathology showed no residual tumor cells in the stomach or lymph nodes. Postoperatively, the patient underwent 3 cycles of SOX therapy(combination of S-1 and oxaliplatin)and survived for over 6 postoperative months, with no recurrences. For advanced gastric cancers with paraaortic lymph node dissection with no evidences of other distant metastases, gastrectomy with paraaortic lymph node dissection combined with chemotherapy could be a therapeutic option to achieve R0 resection.
84.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2536-2538.
[Pathologic Complete Response of Advanced Gastric Cancer after Chemotherapy with S-1 and Oxaliplatin and Conversion Surgery-A Case Report].
[Article in Japanese]
Yamamoto A1, Akaike H, Kawaguchi Y, Takahashi K, Maruyama S, Nakata Y, Shimizu H, Furuya S, Hosomura N, Amemiya H, Kawaida H, Sudo M, Kono H, Inoue S, Ichikawa D.
Abstract
A man in his 70s was admitted to our hospital for the treatment of gastric cancer type 3 located in the antrum of the stomach. Computed tomography revealed tumor invasion of the liver and metastatic lymph node invasion of the pancreatic head and splenic artery. The patient was diagnosed with unresectable T4bN3M0, Stage ⅢC advanced gastric cancer. As radical excision was impossible, the patient underwent chemotherapy with S-1 and oxaliplatin(SOX). After 13 courses of SOX, imaging showed reduction in the size of the primary tumor and disappearance or marked reduction in the size of the metastatic lymph nodes. Therefore, conversion surgery was attempted after 14 courses of SOX. Distal gastrectomy with D2 lymphadenectomy including station 14v was performed. Pathological examination demonstrated no viable tumor cells in the resected stomach specimen or dissected lymph nodes, confirming that a pathologic complete response(pCR)had been achieved.
85.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2533-2535.
[HER2-Positive Advanced Gastric Cancer with Para-Aortic Lymph Node Metastases Treated with Conversion Surgery after Chemotherapy-A Case Report].
[Article in Japanese]
Furusawa K1, Higashida M, Kubota H, Iwamoto R, Kitagawa S, Kinoshita S, Ueno M, Mineta S, Okamoto Y, Watanabe Y, Okada T, Tsuruta A, Fujiwara Y, Ueno T.
Abstract
A 56-year-old woman diagnosed with type 2 gastric cancer and multiple lymph node metastases(T3N3M1[lym], cStage Ⅳ)was treated with chemotherapy using trastuzumab with S-1 plus cisplatin for 6 cycles. The primary lesion showed PR, and lymph node metastases disappeared after the chemotherapy. Because of adverse events, she was administered with 2 additional cycles of trastuzumab with S-1 plus cisplatin and 6 cycles of trastuzumab with capecitabine plus oxaliplatin. However, the primary lesion increased in size. Therefore, she underwent distal gastrectomy and D1+ lymphadenectomy with para-aortic lymph node sampling as a conversion surgery. The pathological diagnosis was T2N0M0, pStage ⅠB, and the primary cancer was Grade 1a owing to the chemotherapeutic effect. She survives without recurrence or postoperative adjuvant therapies 3 years after the surgery.
86.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2530-2532.
[A Case Report on Larynx-Preserving Surgery with Tracheal Resection of an Advanced Esophageal Cancer with Tracheal Invasion].
[Article in Japanese]
Kobayashi N1, Tanaka K, Yamasaki M, Makino T, Miyazaki Y, Takahashi T, Kurokawa Y, Nakajima K, Mori M, Doki Y.
Abstract
We present the case of a 69-year-old man who was diagnosed with ascending colon cancer. Preoperative CT revealed 2 advanced esophageal cancers, both at T4; thus, a diagnosis of esophageal cancer(Ut-Ce, cT4b[Tr]N2M0, Stage ⅣA/Mt, cT4b[Lt-Br]N2M0, Stage ⅣA)was made. The patient received chemotherapy(DTX/CDDP/5-FU), and as the second-line treatment, he received chemoradiotherapy(40 Gy with DTX/CDDP/5-FU). We performed transthoracoabdominal esophagectomy, laryngeal preservation with tracheal resection, 3-field lymph node dissection, posterior mediastinal gastric tube reconstruction, mediastinal tracheostomy, and pectoralis major myocutaneous flap filling. He had an anterior chest wall subcutaneous abscess without respiratory complications. Pathological examination indicated a complete response. Two months after the surgery for esophageal cancer, radical surgery was performed for the colon cancer. Fifty-five months after esophagus cancer surgery, no recurrence was observed.
87.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2527-2529.
[Pulmonary Metastases of Hepatocellular Carcinoma Treated with Repeated Pulmonary Resection-A Case Report].
[Article in Japanese]
Kondo H1, Tomimaru Y, Iwazawa T, Fujimoto N, Noguchi K, Nagase H, Ogino T, Hirota M, Oshima K, Tanida T, Noura S, Imamura H, Akagi K, Adachi S, Dono K.
Abstract
A 65-year-old man visited our hospital for hepatocellular carcinoma(HCC)and underwent extended posterior sectionectomy. Eight months after the hepatic resection, follow-up computed tomography(CT)revealed a solitary, recurrent tumor in S4 of the liver, and transcatheter arterial chemoembolization and radiofrequency ablation were performed for the intrahepatic recurrence. After 12 postoperative months, follow-up CT demonstrated pulmonary metastases in S5 of the right lung and S10 of the left lung. Since there were no other metastases, the 2 metastatic lesions were resected using video-assisted thoracoscopic surgery(VATS). The resected tumors were histologically diagnosed as pulmonary metastases of HCC. Three years after the pulmonary resection, 3 additional pulmonary metastases were detected on CT in S3 and S10 of the right lung and S4 of the left lung. No other metastases were found. Bilateral VATSmetastasectomy was performed for the metastases. The tumors were diagnosed as pulmonary metastases of HCC on histological examination. One year and 8 months after the surgery, he was alive in a good condition, with no recurrences. The present case suggested that some patients with pulmonary metastasis of HCC can have long-term survival with surgical resection of the metastasis. Therefore, while systemic chemotherapy is generally considered the standard treatment for extrahepatic metastasis of HCC, surgical resection might be an option.
88.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2524-2526.
[Undifferentiated Carcinoma of the Gallbladder with Rapid Postoperative Progression-A Case Report].
[Article in Japanese]
Tashima T1, Murata A, Shimizu S, Kushiyama S, Hamano G, Kinoshita M, Nishio K, Sakurai K, Nishii T, Kodai S, Tachimori A, Tamamori Y, Kubo N, Ikeda K, Kanazawa A.
Abstract
A 74-year-old woman presented with epigastric pain. Imaging revealed a tumor measuring 80 mm, with internal necrosis, originating from the gallbladder and invading the liver. We performed extended anterior segmentectomy of the liver and lymph node resection following a preoperative diagnosis of gallbladder cancer. Histologically, the tumor was diagnosed as an undifferentiated carcinoma of the gallbladder. Although curative resection was performed, the patient developed recurrence with liver metastasis and peritoneal dissemination after 6 postoperative weeks and died after 10 postoperative weeks.
89.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2521-2523.
[Intraoperative Pancreatoscopy to Assess the Resection Margin in Intraductal Papillary Mucinous Neoplasm-A Case Report].
[Article in Japanese]
Sato S1, Miyazawa K, Shiobara M, Wakatsuki K, Ogasawara T, Suda K, Aida T, Miyoshi T, Yoshioka S, Yamazaki K.
Abstract
Intraductal papillary mucinous neoplasm(IPMN)of the pancreas often presents with multifocal lesions. Complete resection without residual skip lesions is essential for complete eradication of the disease. We experienced a case of IPMC in which intraoperative pancreatoscopy was used to determine the surgical margin. Intraoperative pancreatoscopy is a useful and easy method to evaluate the remnant duct and exclude residual tumor. A cystic lesion was incidentally detected in the pancreatic head of a 78-year-old man. Ultrasonography, abdominal computed tomography, magnetic resonance imaging, and endoscopic ultrasound revealed enhancing mural nodules in the pancreatic head and dilation of the entire main pancreatic duct. We performed pancreaticoduodenectomy for mixed IPMN. Intraoperative pancreatoscopy, which was performed to rule out skip lesions, showed no mucosal abnormalities in the remnant duct. The pathological diagnosis was non-invasive intraductal papillary-mucinous carcinoma(IPMC). No signs of recurrence were seen for 6 postoperative months.
90.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2518-2520.
[Primary Small-Cell Carcinoma of the Digestive Tract-An Analysis of Six Cases].
[Article in Japanese]
Oka Y1, Nishimura M, Yanagisawa S, Kataoka M, Kobayashi S, Okaniwa A, Watanabe Y, Senda T, Machida T, Eto R, Hyakutake Y, Kaiho T.
Abstract
INTRODUCTION:
Primary small-cell carcinomas occur commonly in the lungs but rarely in the other organs. We studied the treatment outcomes in 6 cases of primary small-cell carcinoma of the digestive tract at our hospital.
PATIENTS:
Six patients were diagnosed with small-cell carcinoma of the digestive tract histopathologically and treated at our hospital from September 2000 to December 2018.
RESULTS:
The average age of the patients was 61.5 years(range: 40-80 years). Patients were 3 men and 3 women. The occurrence sites were the esophagus, stomach, and colon in 1, 2, and 3 patients, respectively. The patient with esophageal cancer underwent chemoradiotherapy without surgery. Other patients, except for 1 patient with colon cancer, underwent adjuvant chemotherapy after the surgery. Two of the 6 patients survived for over 5 years.
DISCUSSION:
For small-cell carcinomas of the digestive tract with poor prognosis, long-term survival can be expected using multidisciplinary treatments depending on the case.
91.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2515-2517.
[Colorectal Cancer Associated with Crohn's Disease-A Case Report].
[Article in Japanese]
Abstract
We report a case of colorectal cancer associated with Crohn's disease in a 50-year-old man. He had been diagnosed with Crohn's disease 26 years before and had undergone sigmoidectomy for sigmoid colon stenosis 19 years before. Ileal resection, was performed for ileus stenosis 12 years before. Three years before, partial resection of the small intestine was performed for perforation of the small intestine. During this period, the medical treatment was continued, but the patient experienced remission and exacerbation. He complained of anal pain at a regular outpatient visit, and endoscopic examination showed an elevated lesion immediately above the dentate line. Adenocarcinoma Group 5 was detected on biopsy. The diagnosis was rectal cancer(cT2N3M0, StageⅢb). We performed an abdominoperineal resection, a D3 lymph node dissection, and colostomy. Chemotherapy with mFOLFOX6 was provided postoperatively. The patient has survived without recurrence for 1 year and 6 months after the surgery.
92.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2512-2514.
[A Case of Histological Complete Remission after Chemotherapy for Paraaortic Lymph Node Recurrence after Colon Cancer Surgery].
[Article in Japanese]
Abstract
In September 2013, a 50-year-old woman presented to our hospital with right abdominal pain as the main complaint. Careful examinations led to the diagnosis of ascending colon cancer. In October 2013, resection of the right half colon and removal of the D3 lymph nodes were performed. As postoperative adjunctive chemotherapy, 6 courses of CAPOX therapy were initiated. PET-CT conducted 17 months after the surgery revealed an enlarged right para-aoric lymph nodes and abnormal FDG accumulation. Lymph node recurrence was diagnosed. In April 2015, 10 courses of CAPOX plus BEV therapy, followed by 12courses of capecitabine single agent, were initiated. PET-CT revealed complete remission of the right para-aoric lymph nodes. However, abnormal FDG accumulation was detected in the right ovary and uterine corpus. After careful examinations in March 2017, we performed expanded total hysterectomy, bilateral resection of the appendicular organs, resection of body reticular region, and removal of the lymph nodes and those at the right side of the aorta for the ovarian and uterine cancer. Pathologically, intimal cancer in the right ovary and uterine corpus was diagnosed. Examination of the right para-aoric lymph nodes resected at the same time showed complete remission on images, although histological complete remission was found with scarring. Currently, 63 months after the initial surgery, the patient is alive without recurrence.
93.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2509-2511.
[Surgical Treatment for Extremely Elderly Patients Over 90 Years of Age with Colorectal Cancer].
[Article in Japanese]
Abstract
We report 18 cases of colorectalcancer in patients aged over 90 years who received surgicaltreatment . Except for 2 patients who had StageⅣ colorectal cancer, all patients underwent R0 colorectal resection. The mean operation time, blood loss, and length of hospitalization were 167 min, 115 mL, and 23.5 days, respectively. Postoperative complications occurred in 15 patients(83%), of which the most common was delirium. All the patients were discharged safely. We treated them successfully with a collaborative medical team that included experienced staffs for rehabilitation, oral care, skin care, and mentalcare; socialworkers; and others. Regarding the surgicaltreatment for elderly patients with colorectalcancer who are over 90 years of age, not only perioperative treatment but also post-discharge comprehensive and palliative care must be considered.
94.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2506-2508.
[Efficacy of Laparoscopic Surgery for Elderly Patients with Colorectal Cancer Over 80 Years Old].
[Article in Japanese]
Yoshimatsu K1, Ito Y, Kono T, Maeda H, Imaizumi R, Koike T, Sano M, Satake M, Yamada Y, Okayama S, Yokomizo H, Shimakawa T, Katsube T, Shiozawa S.
Abstract
The efficacy of laparoscopic surgery for elderly patients aged over 80 years who have colorectal cancer was investigated concerning complications. Sixty-five patients over 80 years old who underwent colorectal cancer resection until January 2018 were enrolled. Factors that led to complication were analyzed retrospectively. Thirty-three men and 32 women were included, with a median age of 83 years. Forty-eight cases were located at the colon; and 17, at the rectum. The median operating time was 164 minutes, including 39 cases treated with the laparoscopic approach. Postoperative complications were observed in 28 cases(43.1%), of which 15(23.1%)had a Clavien-Dindo(CD)classification of Grade BⅡ. These cases had significantly prolonged postoperative hospital stay. Complications included 10 cases of incisional surgical site infection(SSI), 9 cases of ileus, 6 cases of melena, 2 cases of urinary infection, 2 cases of urinary disorder, and 1 case of postoperative death. Open surgery was the only significant factor associated with the incidence of CD classification of BⅡ(p=0.0330). Among the complications, the incisional SSI was reduced by laparoscopic surgery(p=0.0050). The number of laparoscopic surgeries reduced the incidence of CD classification BⅡ of complications in elderly patients aged over 80 years who had with colorectal cancer resection. The use of incisional SSI also decreased with the use of laparoscopic surgery. Laparoscopic surgery for colorectal cancer in elderly patients may lead to reduced complication rates.
95.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2503-2505.
[Short-Term Outcomes of Laparoscopic-Assisted Total Gastrectomy Using the Endoscopic Purse-String Suture Instrument ENDO-PSI].
[Article in Japanese]
Tsuchida K1, Saeki H, Yasukawa M, Toda S, Kamioka Y, Suematsu H, Numata K, Higuchi A, Matsukawa H, Rino Y, Masuda M.
Abstract
Laparoscopic-assisted total gastrectomy(LATG)has several complications early during the introduction of the procedure, so a careful approach is necessary. In this study, we evaluated short-term outcomes after LATG at our hospital. From 2014 to 2017, 21 patients underwent LATG using ENDO-PSI. A 6-cm midline incision was made at the epigastrium, and the abdominal esophagus was transected using ENDO-PSI. The anvil head was fixed with extracorporeal ligation, and an end loop was added to the proximal side of the first suture. Reconstruction was performed with the Roux-en-Y method. The jejunojejunal anastomosis was performed extracorporeally, and esophagojejunostomy was performed using a circular stapler through the small incision. There were 15 men and 6 women, with a mean age of 74 years. The mean operation time was 296 min, and volume of blood loss was 75 mL. The median fasting period was 3(3-10)days, and the postoperative hospitalization period was 12(8-28)days. The postoperative complications were Grade Ⅱ in 4 patients and Grade Ⅲ in 1 patient. The complication due to esophagojejunostomy was anastomotic leakage in 1 patient, while no anastomotic stenosis was found. LATG using ENDO-PSI can be safely performed.
96.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2500-2502.
[Clinical Outcomes of Palliative Radiation Therapy for Gastric Cancer Bleeding].
[Article in Japanese]
Tsuchida K1, Saeki H, Yasukawa M, Toda S, Kamioka Y, Suematsu H, Numata K, Higuchi A, Matsukawa H, Oka H, Okazaki H, Tayama Y, Rino Y, Masuda M.
Abstract
Only a few studies have been conducted regarding the palliative radiation therapy(RT)for gastric cancer(GC)bleeding. Data of 9 patients with gastric cancer requiring blood transfusions due to gastric bleeding who were treated with RT were reviewed. All patients were men with a median age of 83(range, 70-91)years. The clinical stage was ⅡB in 2 patients, Ⅲin 1, ⅣA in 1, and ⅣB in 5. Performing gastrectomy was difficult in 4 patients with distant metastasis or tumor invasion to adjacent organ, 3 with poor performance status, and 2 with advanced age. The median hemoglobin levels before RT was 6.0 (range, 3.3-7.7)g/dL, and all patients received blood transfusions before RT. Seven patients received 30 Gy RT and 2 patients received 50 Gy. Two patients received concurrent chemotherapy. A total of 2 hematological and 4 non-hematological treatment-related adverse events occurred. All patients improved conservatively. Hemorrhage occurred in 8 patients, except for 1. Of the 8 patients who responded to RT, 1 had rebleeding on day 81. The median rebleeding-free survival time from the beginning of RT was 125(range, 21-421)days. Palliative radiation therapy was useful for bleeding control in nonresectable gastric cancer.
97.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2497-2499.
[Efficacy of Surgery and Adjuvant Chemotherapy for Distal Cholangiocarcinoma].
[Article in Japanese]
Takahashi K1, Kawaida H, Hosomura N, Amemiya H, Kono H, Nakata Y, Shimizu H, Shiraishi K, Furuya S, Akaike H, Kawaguchi Y, Sudo M, Inoue S, Ichikawa D.
Abstract
INTRODUCTION:
Surgery alone shows an insufficient result for distal cholangiocarcinoma, and postoperative adjuvant chemotherapy is commonly used. However, no definite opinion has yet been accepted.
SUBJECTS AND METHODS:
A group of 46 patients who underwent surgery for distal bile duct cancer and who received adjuvant chemotherapy including gemcitabine (GEM)(Group A)and surgery alone group(Group S)were compared for disease-free survival(DFS)and overall survival (OS).
RESULTS:
Although the median DFS was 718 days in Group A and 367 days in Group S(p=0.306)and the median OS was 1,171 days in Group A and 859 days in Group S(p=0.07), no significant difference was observed; however, the prognosis improved.
CONCLUSION:
Postoperative adjuvant chemotherapy may improve prognosis.
98.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2494-2496.
[Surgical Outcomes of Laparoscopic Repeat Hepatectomy at Our Institution].
[Article in Japanese]
Kaketaka K1, Noguchi K, Tomimaru Y, Shimizu J, Nagase H, Ogino T, Hirota M, Oshima K, Tanida T, Noura S, Kawase A, Imamura H, Akagi K, Iwazawa T, Dono K.
Abstract
Laparoscopic hepatectomy has gained popularity owing to its merits, such as low invasiveness and reduced bleeding. However, the efficacy of laparoscopic repeat hepatectomy(LRH)has not been confirmed. The aim of this study was to evaluate the feasibility and efficacy of LRH compared to that of open repeat hepatectomy(ORH). We performed 60 repeat hepatectomies from January 2011 to March 2019, of which 19 were LRH(Lap group)and 41 were ORH(Open group). This study retrospectively compared the patient characteristics and short-term outcomes of repeat hepatectomy between the Lap and Open groups. There were no significant differences in patient characteristics, except for the type of approach in the previous hepatectomy(p<0.01). The Lap group had lesser blood loss(median: 150 mL vs 355 mL, p<0.01)and shorter postoperative hospital stays(median: 8 days vs 11 days, p<0.01). There were no differences in operation time or severe postoperative complications. LRH is feasible and useful, providing good short-term outcomes.
99.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2491-2493.
[A Case of Superior Mesenteric Vein Thrombosis during Administration of Bevacizumab for Rectal Cancer].
[Article in Japanese]
Osawa H1, Ide Y, Yoshida M, Hara S, Takayama K, Yoneda K, Ohashi T, Sakai K, Noro H, Hirao T, Hatanaka N, Yamasaki Y.
Abstract
A colonoscopy to investigate fecal incontinence revealed a type 3 tumor in the rectum of a 67-year-old man. Histological findings demonstrated rectal adenocarcinoma. CT revealed multiple metastases in the liver, and the patient was diagnosed as having rectal cancer(Rb, Ant, type 3, T3, N3, M1a[H2], cStage Ⅳa). No intestinal stenosis due to the tumor was found, and chemotherapy(FOLFIRI plus bevacizumab)was initiated. After 5 courses of the chemotherapy, a thrombus was found in the superior mesenteric vein on enhanced CT. The patient had no subjective symptoms, and anticoagulation therapy was started after admission. After confirming the shrinkage of the thrombus, laparoscopic abdominoperineal resection(prxD3)was performed to remove the primary tumor. The thrombus did not grow during the perioperative time and disappeared after 6 months. For the next 2 years, no new thrombus was detected. Mesenteric vein thrombosis is a notable complication of chemotherapy with bevacizumab.
100.
Gan To Kagaku Ryoho. 2019 Dec;46(13):2488-2490.
[A Case of Omental Desmoid Tumor after a Small Bowel Resection for Gastrointestinal Stromal Tumor].
[Article in Japanese]
Abstract
An intra-abdominaldesmoid tumor, especially omentaldesmoid tumor, is rare. Here, we report a case of omentaldesmoid tumor after a smallbowelresection for gastrointestinalstromaltumor (GIST). A 73-year-old man underwent a partial resection of smallbowelfor GIST. He received adjuvant therapy with imatinib due to high risk of recurrence. After 2.5 years of treatment, a follow-up CT showed a 15mm nodule in the omentum near the splenic flexure. We considered the possibility of recurrence and imatinib failure, and laparoscopic tumor resection was performed for differential diagnosis. Immunohistochemicalstaining showed negative for c-kit, CD34, desmin, and S100. However, it was diagnosed as desmoid tumor because of positive b-catenin. Intra-abdominal desmoid tumor should be a differential diagnosis for a new single lesion in patients with GIST.
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