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A 79-year-old-woman underwent distal gastrectomy for the treatment of gastric cancer 17 years previously and total gastrectomy with Roux-en-Y reconstruction for the treatment of remnant gastric cancer 14 years previously. She was followed up at our outpatient clinic periodically after the gastric surgery. She reported an abnormal feeling in her upper abdomen, and therefore, an abdomen examination was planned. Upper gastrointestinal endoscopy showed a type II tumor extending over the esophagojejunal anastomosis. Biopsy revealed malignant findings, but the histological type could not be determined. Computed tomography revealed neither lymph node nor distant organ metastasis. Because the patient was of advanced age and had chronic obstructive pulmonary disease, we considered avoiding invasive surgeries, such as subtotal esophagectomy and reconstruction using colon tissue. Instead, we performed local resection and re-reconstruction via Roux-en-Y anastomosis by reusing the Roux-en-Y limb. More than 6 years after this surgery, the patient has not developed any signs of recurrence. Our method is less invasive and more effective than the usual surgical treatments for esophageal cancer in the lower esophagus after total gastrectomy. Source


The need for cardiac surgery among patients undergoing treatment for advanced digestive cancer is limited to the following situations:(i) heart diseases that can be life threatening if left untreated and that cannot be cured by medicinal treatment alone (e.g., cardiac tumors) and (ii) heart diseases (e.g., infectious endocarditis and pulmonary thromboembolism) occurring after digestive cancer surgery that need emergency treatment and that are resistant to medicinal treatment. We encountered 2 cases that required cardiac surgery.( Case 1) A 68-year-old woman with advanced gastric carcinoma accompanied by pyloric stenosis and left atrial myxoma underwent radical surgery for gastric cancer( Stage IIIA). Subsequently, the left atrial myxoma was resected before adjuvant chemotherapy for the treatment of gastric cancer was administered. One month after the surgery, multiple liver metastases appeared. However, they disappeared after chemotherapy was completed, and the patient survived for more than 3 years with complete response. (Case 2) A 67-year-old woman who underwent a Hartmann operation for obstructive rectal cancer (Stage II) experienced infectious endocarditis after the surgery. Because the endocarditis was resistant to medicinal treatment and acute heart failure was anticipated, cardiac surgery was performed. Approximately 2 months after the surgery, the bacilli( methicillin-resistant Staphylococcus aureus [MRSA]) were not found in blood culture. However, multiple liver metastases appeared immediately after the disappearance of the bacilli, and the patient died 3 months after the surgery. In both cases, cancer recurrence occurred early after cardiac surgery. Excessive surgical stress due to cardiac surgery may have promoted cancer recurrence. A decision pertaining to the timing of cardiac surgery is difficult in cases of patients with advanced digestive cancer and co-existing heart disease, which cannot be cured by medicinal treatment. Source


Fujisaki S.,Fujisaki Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2011

We report a case of pleural extension of mucinous tumor with pseudomyxoma peritonei. A 64-year-old man was diagnosed as pseudomyxoma peritonei according to the findings of abdominal CT scan and cytologic examination of the ascitic fluid. At laparotomy in November 2007, jelly-like ascites and a child-head size mutinous tumor involving the greater omentum, transverse colon, and ascending colon were found. Mucious nodules scattered on the undersurface of the right and left hemidiaphragms. In addition, transhiatal extension of mucinous tumors was also extended through the esophageal hiatus, suggesting that thoracic extension of pseudomyxoma peritonei. To avoid an excessive surgical stress, thracotomy was not performed. Cytoreduction surgery was conducted. Postoperative course was uneventful. Although systemic chemotherapy was performed after surgery, intra-abdominal tumor enlarged gradually. Cytoreduction surgery was performed again in September 2008. Thereafter, intra-abdomial tumor enlarged gradually and his physical condition deteriorated. He died 26 months after the first surgery. Source


Fujisaki S.,Fujisaki Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2013

In the present report, we describe the case of a patient who underwent chemotherapy for single liver metastasis, which appeared after complete resection of the primary lesion and multiple liver metastases. The initial complete response was confirmed by diagnostic imaging, but the recurrent single liver metastasis subsequently appeared at the same site. A 67- year-old man underwent Hartmann's procedure after being diagnosed with obstructive rectal cancer in June 2008. The final diagnosis was advanced cancer of RS, tub 2, type 2, pSS, pN2, and cH2 (Grade C). Complete resection of the multiple liver metastases was performed by extended left lobectomy and partial resection in August 2008. Adjuvant chemotherapy with mFOLFOX6 was initiated 2 months after the hepatectomy. However, abdominal computed tomography( CT) revealed a 5-mm-sized single nodule on the liver( S7) at 3 months after surgery. The patient did not want to undergo another hepatectomy, and continued to receive chemotherapy. Abdominal CT revealed that the small nodule disappeared 7 months after surgery. Treatment was discontinued after 10 courses of mFOLFOX6. However, after 5 months, abdominal CT revealed that a single hepatic nodule( 1.5 cm) appeared at the same site. We continued chemotherapy with mFOLFOX6 or FOLFIRI accompanied with a molecular target-based drug. At present, 51 months have passed since the appearance of the recurrent hepatic metastasis, and the metastatic lesion has remained as a single lesion, and no other organ metastases have been observed. Source


Fujisaki S.,Fujisaki Hospital
Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

We studied 13 patients who underwent surgery for perforation associated with colorectal cancer in our institute. In 10 cases, the location of primary cancer was the rectum or the sigmoid colon. Five patients had perforation at the tumor itself, and 7 proximal to the obstructive tumor. The perforation proximal to the tumor was in a location that caused obstructive colitis in 4 cases, the diverticulum in 2 cases, and a location of unknown cause in 1 case. In all of the cases of perforation at the tumor there was locally advanced cancer that had invaded other organs or had peritoneal dissemination. In 1 case where perforation had caused obstructive colitis, the primary tumor was in the sigmoid colon, whilst the perforation was in the cecum. Twelve patients had resection of primary tumor and the perforated site, and one had palliative ileostomy. Five patients had stage II cancer, 3 stage IIIa, 1 stage IIIb, and 4 stage IV. Mortality at 30 days was 15.4% (n=2). Of those who survived more than 30 days, 9(81.8%) had curative resection. Of these 9 cases, 2(22.2%) died of cancer, 1 died as a result of re-perforation and 1 died from another cause. Six patients survived for more than 2 years, 3 of which had recurrence, and 2 survived without recurrence. Our surgical plan for perforated colorectal cancer is to remove the perforation site and the cancer itself. In conclusion, long-term survival required both aggressive management of the sepsis focus and definitive oncologic surgery. Source

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