RESUMEN
A 66-year-old man with cStage III B (cT4aN2H0P0M0) advanced gastric cancer in the cardia with esophageal invasion was treated with S-1/CDDP as neoadjuvant chemotherapy. After 3 courses of chemotherapy, a significant reduction in tumor burden was observed. Total gastrectomy and splenectomy with lymph node dissection (D2) were performed. Pathological specimens showed no cancer cells in the stomach and lymph nodes, indicating a pathological complete response.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Cisplatino/administración & dosificación , Combinación de Medicamentos , Humanos , Metástasis Linfática , Masculino , Terapia Neoadyuvante , Estadificación de Neoplasias , Ácido Oxónico/administración & dosificación , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tegafur/administración & dosificaciónRESUMEN
A 68-year-old man was admitted to our hospital. He was diagnosed with advanced gastric cancer with multiple liver metastases. The primary tumor was treated with distal gastrectomy with D2 dissection and anti-cancer agents, and then he was scheduled for a 2-stage hepatic resection. After surgery, the liver metastases disappeared, and he was diagnosed with a CR. However he complained of dizziness and was diagnosed with metachronous brain matastasis. Multidisciplinary treatment including resection and radiotherapy was administerd and he survived for 5 years after diagnosis.
Asunto(s)
Neoplasias Encefálicas/terapia , Neoplasias Hepáticas/terapia , Neoplasias Gástricas/terapia , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Encefálicas/secundario , Cisplatino/administración & dosificación , Terapia Combinada , Combinación de Medicamentos , Gastrectomía , Humanos , Neoplasias Hepáticas/secundario , Metástasis Linfática , Masculino , Ácido Oxónico/administración & dosificación , Pronóstico , Radiocirugia , Neoplasias Gástricas/patología , Tegafur/administración & dosificaciónRESUMEN
We report a case of laparoscopic gastrectomy in a patient with refractory vasospastic angina. An 83-year-old man received 2 types of oral coronary vasodilators but complained of chest pain about twice a week thereafter. He was diagnosed with refractory vasospastic angina. Upper gastrointestinal endoscopy was performed for tarry stools and revealed a type 2 tumor in the anglar posterior wall. CT revealed no lymph node swelling or metastasis. Laparoscopic gastrectomy was performed, and intravenous administration of coronary vasodilators was started before the operation. During the operation, coronary spasm could be prevented while being careful not to induce circulation change, bleeding, or traction of the peritoneum. Many cases of coronary spasm-related angina in the absence of a history of angina have been reported during non-cardiac operations. In such cases, careful coronary spasm is necessary.
Asunto(s)
Adenocarcinoma/cirugía , Angina de Pecho/complicaciones , Vasoespasmo Coronario/fisiopatología , Gastrectomía/métodos , Laparoscopía/métodos , Neoplasias Gástricas/cirugía , Anciano de 80 o más Años , Angina de Pecho/fisiopatología , Humanos , Masculino , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/patologíaRESUMEN
We encountered a case of cutaneous metastases from colorectal carcinoma. A 63-year-old woman underwent laparoscopic-assisted ileocecal resection for cecal cancer. Computed tomography (CT) showed multiple liver metastases. The tumor was diagnosed as a well-differentiated adenocarcinoma and was staged as pSE, pN1, sH2, ly1, v1, CP0cM0, fStage â £. She was treated with 33 courses of the 5-fluorouracil, Leucovorin, and irinotecan (FOLFIRI) regimen and 15 courses of the 5-fluorouracil, Leucovorin, and oxaliplatin (mFOLFOX6) plus bevacizumab regimen. Thirty-four months after resection, multiple cutaneous tumors were noted, predominantly on the lower abdomen, and we resected 2 of them. Histologically, the specimens were diagnosed as well-differentiated adenocarcinoma, which was similar to that of cecal carcinoma. After 1 course of regorafenib, she died 3 years after the primary surgical resection.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Ciego/tratamiento farmacológico , Neoplasias Cutáneas/tratamiento farmacológico , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Neoplasias del Ciego/patología , Neoplasias del Ciego/cirugía , Resultado Fatal , Femenino , Humanos , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Persona de Mediana Edad , Neoplasias Cutáneas/secundarioRESUMEN
We report a patient who underwent 2-term surgery to treat focal progression of a huge liver metastasis and peritoneal dissemination from a gastric gastrointestinal stromal tumor(GIST)during imatinib mesylate treatment. A 59-year-old man underwent an emergency surgery for perforative peritonitis caused by gastric GIST in June 2006 and a partial resection of the stomach in September 2006. Four years later, abdominal computed tomography(CT)detected a huge liver tumor that occupied the entire right lobe. We initiated imatinib mesylate treatment(400mg/day), and the patient maintained stable disease for several months. However, focal progression of the huge liver tumor and a peritoneal tumor at the splenic hilum were revealed by CT; therefore, an extended right hepatic resection was performed in August 2011 and a distal pancreatectomy, splenectomy, and partial resection of the stomach were performed in February 2012. The patient died of the primary disease at 16 months after the hepatic resection for focal progression.
Asunto(s)
Antineoplásicos/uso terapéutico , Benzamidas/uso terapéutico , Tumores del Estroma Gastrointestinal/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Peritoneales/secundario , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Neoplasias Gástricas/cirugía , Progresión de la Enfermedad , Resultado Fatal , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Tumores del Estroma Gastrointestinal/secundario , Humanos , Mesilato de Imatinib , Neoplasias Hepáticas/tratamiento farmacológico , Neoplasias Hepáticas/secundario , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/tratamiento farmacológico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patologíaRESUMEN
Laparoscopic surgery has been increasingly performed in colon cancer patients; it has also been adapted for cases of advanced colorectal cancer. While performing an operation for rectosigmoid colon cancer, preservation of the left colic artery and prompt and accurate detection of the branch of the left colic artery from the inferior mesenteric artery is important. Detecting the left colon arterial bifurcation takes time, especially because of the presence of mesenteric fat, which is observed in many cases. In addition, in cases in which preoperative enhanced computed tomography (CT) cannot be performed, the surgery is sometimes performed without knowing the traveling vessel. As palpation is impossible, it is impossible to tactile running of the arteries as laparotomy in laparoscopic surgery. With endoscopic echo or Doppler echo, real-time identification of the blood vessels during surgery is possible without being invasive. It would be in laparoscopic surgery impossible palpation, and the combined use of intraoperative echo in ensuring the safety to be useful.
Asunto(s)
Colectomía/instrumentación , Laparoscopía , Neoplasias del Colon Sigmoide/diagnóstico por imagen , Anciano , Anciano de 80 o más Años , Colectomía/métodos , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Neoplasias del Colon Sigmoide/cirugía , UltrasonografíaRESUMEN
A 72-year-old woman was admitted for investigation of lower abdominal bloating and melena. She was diagnosed with rectal cancer with ascites, multiple liver metastases, and large bilateral ovarian metastases. The patient underwent bilateral oophorectomy for the ovarian tumors and a Hartmann procedure for rectal cancer. The ovarian lesions were diagnosed as ovarian metastasis of colorectal cancer by histological analysis. Ascites and lower abdominal bloating resolved after the intervention. At 11 months after surgery, the patient is alive and well. Ovarian metastasis from colorectal cancer is relatively rare and associated with poor prognosis. Radical intervention is generally not possible in the presence of metastases, but in the present case, the ovarian tumors were large. It is often difficult to determine the optimal type of invasive surgery, although excision of the lesion may provide palliative relief. In this case, the patient's quality of life improved following palliative resection of the primary colon cancer and ovarian metastases.
Asunto(s)
Neoplasias Colorrectales/cirugía , Neoplasias Ováricas/cirugía , Cuidados Paliativos , Anciano , Neoplasias Colorrectales/patología , Femenino , Humanos , Neoplasias Hepáticas/secundario , Invasividad Neoplásica , Neoplasias Ováricas/secundario , Calidad de VidaRESUMEN
We report a patient who had a complete response by treatment with 200 mg of imatinib mesylate daily for peritoneal recurrences of gastrointestinal stromal tumor(GIST)of the stomach. On March 2007, a 68-year-old woman underwent distal gastrectomy for GIST of the stomach. On May 2007, peritoneal recurrences were recognized on CT scan, and treatment with 400 mg daily of imatinib mesylate was started. Because grade 2 systemic edema and rash developed one week later, the imatinib mesylate dose had to be reduced to 200 mg daily from July 2007. After reduction of imatinib mesylate, the adverse reactions resolved. Peritoneal dissemination disappeared on CT scan from April 2010, and complete response has been maintained for 18 months.
Asunto(s)
Antineoplásicos/uso terapéutico , Tumores del Estroma Gastrointestinal/tratamiento farmacológico , Piperazinas/uso terapéutico , Pirimidinas/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Antineoplásicos/administración & dosificación , Benzamidas , Terapia Combinada , Femenino , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Mesilato de Imatinib , Piperazinas/administración & dosificación , Pirimidinas/administración & dosificación , Recurrencia , Inducción de Remisión , Neoplasias Gástricas/cirugía , Tomografía Computarizada por Rayos XRESUMEN
We report two resected cases of extragastric gastric cancer growth with gastrocolic fistula whose prognoses were fairly good with surgery and chemotherapy. CASE 1: A 45-year-old man was admitted to a nearby clinic complaining of fever and abdominal pain. Endoscopy revealed gastric mucosa-associated white moss under tumor-like lesions to the mucous cancer biopsy results. The patient underwent surgery; the transverse colon had adhered to the posterior wall of the stomach, so a distal gastrectomy and a partial resection of the transverse colon were performed. He enjoyed a good QOL for 56 months after the surgery. CASE 2: A 69-year-old man. An upper GI examination revealed a protrusion at the posterior wall of the stomach, and the barium leaked from the lesion to the colon. Diagnosis of stomach cancer surgery took place. He died 20 months after the surgery.
Asunto(s)
Fístula Gástrica/cirugía , Fístula Intestinal/cirugía , Neoplasias Gástricas/cirugía , Anciano , Biopsia , Resultado Fatal , Fístula Gástrica/etiología , Fístula Gástrica/patología , Humanos , Fístula Intestinal/etiología , Fístula Intestinal/patología , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Neoplasias Gástricas/complicaciones , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patologíaRESUMEN
Intussusception is rare in adults and it is difficult to diagnose on admission. We present the case of a 43-year-old woman with the chief complaint of nausea and upper abdominal pain. Abdominal multidetector-row computed tomography showed ileo-ileal small bowel intussusception with an intraluminal soft tissue mass with attenuation numbers suggestive of a lipoma. The patient was treated with a laparoscopic-assisted extracorporeal partial resection of the small bowel including ileal lipoma, followed by a functional end-to-end anastomosis. Histologic diagnosis of the resected tumor, 2.4×2.0×2.0 cm, was an intestinal lipoma. This case serves as the basis of a review of small bowel intussusception in adults secondary to lipomas. It focuses on the utility of multidetector-row computed tomography and the cosmetic, physical, and economic benefits of laparoscopic surgery as well as the rarity of the disease.
Asunto(s)
Neoplasias del Íleon/cirugía , Lipoma/cirugía , Tomografía Computarizada por Rayos X/métodos , Adulto , Femenino , Humanos , Enfermedades del Íleon/etiología , Neoplasias del Íleon/complicaciones , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/patología , Intususcepción/etiología , Laparoscopía , Lipoma/complicaciones , Lipoma/diagnóstico por imagen , Lipoma/patologíaRESUMEN
We experienced a case with multiple liver metastases of gastric cancer that disappeared by S-1 alone. The patient has survived without recurrence after the disappearance of liver metastases.
Asunto(s)
Antimetabolitos Antineoplásicos/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Ácido Oxónico/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Tegafur/uso terapéutico , Anciano , Combinación de Medicamentos , Humanos , Neoplasias Hepáticas/diagnóstico por imagen , Neoplasias Hepáticas/secundario , Masculino , Inducción de Remisión , Neoplasias Gástricas/diagnóstico por imagen , Neoplasias Gástricas/patología , Tomografía Computarizada por Rayos XRESUMEN
The main apoptotic signal stimulated by tumor necrosis factor-related apoptosis-inducing ligand (TRAIL) streams through caspase-8 activation and evokes caspase-3, a central apoptosis activator. In this study, the status of caspase-8 and -3 in gastric cancer cells related to the anticancer effects of TRAIL was investigated. In the caspase-8 gene promoter, 9 of 10 gastric cancer cell lines harbor no hypermethylation. The pretreatment amounts of caspase-8 and -3 in these cells were not predictors for the anticancer effect of TRAIL. Caspase-8 activity 24 h after treatment with TRAIL was well correlated with the anticancer effect of TRAIL (r=0.777, p=0.0060). Caspase-3 activity 24 h after treatment with TRAIL showed a trend towards an association with the anticancer effect of TRAIL (r=0.544, p=0.1067). These results suggested that gastric cancer might be a good target of TRAIL therapy because the majority of tumor cells have intact caspase-8 expression. The anticancer efficacy may be predicted by the degree of caspase-8 activation after TRAIL treatment.