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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.


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.


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.


We investigated 9 patients that had undergone resection of a pulmonary nodule discovered during postoperative observation after surgery for cancer of the digestive tract, in the past 9 years. Six of the primary lesions were colorectal carcinoma, and the others were 1 case each of esophageal carcinoma, hepatocellular carcinoma, and carcinoma of the papilla of Vater. Age at the time of first lung resection was 55 to 77 years (median 63), and the male to female ratio was 6:3. In 4 patients, pulmonary nodules were found within 1 year of primary lesion resection, and in 3 of these patients pulmonary resection was performed after it was confirmed that the nodule had increased in size. In 1 of the 4, biopsy was performed immediately after identification of a pulmonary nodule. The other 5 patients in this study were diagnosed with lung metastases between 2 and 7 years after resection of the primary lesions. Amongst this group, 7 patients had 1 nodule, whilst they were single cases of 2 and 3 nodules. In a patient with esophageal carcinoma, a right re-thoracotomy was performed. In all other patients, video-assisted thoracic surgery was performed. One patient who had had re-resection of a lung metastasis was subsequently found to have further lung metastasis. Survival after resection of the primary lesion was from 30 months to > 110 months (median survival: >82 months), whilst survival after pulmonary resection was from 6 months to >80 months (median survival: 26 months), and 5 patients are still alive. Histological examination of the resected lung lesion showed metastatic lung tumor in 7 cases, and primary lung cancer in 2 cases. It is better to perform the diagnostic biopsy before pulmonary resection in order to determine the best operative procedure, although it is difficult to perform biopsy on a small lung nodule. It is particularly important that any small pulmonary lesion found in the early postoperative period should be resected after confirming that it has increased in size.


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.


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.


Sakurai K.,Nihon University | Fujisaki S.,Fujisaki Hospital | Enomoto K.,Nihon University | Amano S.,Nihon University | Sugitani M.,Nihon University
Surgery Today | Year: 2011

Purpose. Idiopathic granulomatous mastitis (IGM) is a rare inflammatory pseudotumor. No therapeutic modality has been established because of the rareness of this disease. The aim of this study was to investigate the clinical course of IGM treated with corticosteroid, and to evaluate the optimal methods of observation during corticosteroid therapy of IGM. Methods. The retrospective study included eight women who met the required histological criteria of IGM. The clinical data of the presentation, histopathology, and management were analyzed by reviewing the medical records. Results. The mean age of the patients was 44.8 years (range, 28-75 years) and all patients complained of a breast mass. Seven of them had pain. All of them underwent a core needle biopsy and were diagnosed as having IGM. Five took prednisolone orally and three received prednisolone plus antibiotics; one patient of the latter group underwent a resection due to severe pain. Seven patients healed without surgery and it took from 4 to 10 months to achieve a cure. The period until confirmation of the disappearance of a mass was the shortest by palpation, followed by contrast magnetic resonance imaging and ultrasonography in that order. Conclusion. Steroid therapy was effective for the treatment of IGM, which was cured without surgery in seven of eight cases. Ultrasonography was considered an excellent method for evaluating the treatment outcomes. © Springer 2011.


We describe herein a 39-year-old woman with tumor recurrence in the residual pancreas and metastasis to the lymph node about 5 years after an eneclation for insulinoma in the body of the pancreas. A certain day in the morning in June 2002, she was immediately admitted to our hospital due to impairment of consciousness based hypoglycemia. On diagnostic imaging including an arterial stimulation venous sampling, localization of the recurrent lesions was not identified. In October 2002, we underwent laparotomy for the purpose of localization of the recurrent lesions and treatment. During the operation, peripheral blood glucose level, portal blood glucose level and portal insulin level were measured periodically. The mobilization started from the tail of the pancreas. Blood glucose levels were gradually elevated during the mobilization. The pancreas was mobilized to the right edge of the portal vein and was resected. Histopathological diagnosis was recurrent insulinoma in a peripancreatic lymph node and intra-pancreatic subcapsular tumor embolization. Postoperative course was uneventful. More than 8 years after surgery, she is doing well without signs of recurrence.


PubMed | Fujisaki Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

We report 2 cases of pancreatic cancer discovered incidentally in the wake of acute abdomen from other causes. Case 1 is a 67-year-old man who was referred to our hospital in October 2010 for the treatment of an incarcerated right inguinal hernia. The hernia was manually reduced, and mesh plug hernioplasty was scheduled for the next day. A 2.9 cm diameter tumor was detected in the tail of the pancreas on plain CT at the first visit and confirmed on enhanced CT soon after the hernia repair. A follow-up abdominal CT scan approximately 1 month later showed modest enlargement of the tumor to 3.5 cm diameter. The patient underwent distal pancreatectomy with lymph node dissection in December 2010. The histopathological diagnosis was tubular adenocarcinoma(tub1>tub2). Comprehensive findings were pT2, pN0, cM0, fStage II . He was treated with adjuvant chemotherapy consisting of gemcitabine 1,000mg/m2 for 6 months after surgery, and at 5 years and 7 months after surgery, he was alive and recurrence-free. Case 2 is a 74-year-old man who presented to our hospital with lower abdominal pain and diarrhea in early January 2016. Colonoscopy and barium enema revealed severe stenosis of the rectum(Rs). Rectal biopsy confirmed adenocarcinoma of the rectum. In addition, an enhanced CT scan showed irregular dilatation of the pancreatic duct in the pancreatic tail. The patient underwent low anterior resection and distal pancreatectomy, which was performed following an intraoperative pancreatic ultrasound examination that supported a diagnosis of pancreatic cancer. Pathological and comprehensive findings of rectal cancer were tubular adenocarcinoma(tub2)and pT3, pN0, cM0, fStage II , and those of the pancreatic cancer were tubular adenocarcinoma(tub2)and pT1, pN0, cM0, fStage I . The patient was discharged from the hospital 46 days after surgery. However, he died 18 days later due to sudden out-of-hospital cardiopulmonary arrest.


PubMed | Fujisaki Hospital
Type: Journal Article | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2017

We report here a case of CR of all target lesions in a patient with esophageal cancer with multiple metastases treated with systemic chemotherapy after nutritionalsupport. A 75-year-old man was referred to our hospital with a diagnosis of multiple- metastatic esophagealcancer in June 2014. He showed generalized weakness with poor dietary intake, and he was initially admitted for nutritional support by parenteral nutrition. Biopsy specimens revealed mixed squamous- and adenocarcinoma: MtLtUtAeG, 13 cm, type 2, cT3, IM1-St, cN3, cM1(liver, lungs, and stomach), cStage IV b esophagealcarcinoma. We had initiated 5-FU/CDDP/docetaxel(DCF)chemotherapy in July 2014. The target lesions exhibited PR after 2 courses of chemotherapy, and the primary esophageal lesion was markedly reduced, but was still present. The patients renalfunction deteriorated after 8 courses of DCF, and the chemotherapy protocolwas changed to single-agent docetaxelonce every 3 weeks. The patient underwent 20 courses of the chemotherapy, and over a period of approximately 1 year from March 2015, CR of all target lesions was noted, with IR/SD of the primary tumor. The patient has survived and remained in good condition for 23 months following the initial diagnosis.

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