RESUMEN

Clostridium paraputrificum bacteremia is very rare, and its clinical importance is poorly understood. An 86-year-old man was receiving lascufloxacin therapy for acute pharyngolaryngitis before presenting to our emergency department with a recurrent fever. Two sets of blood cultures on admission revealed C. paraputrificum. A stool culture showed a reduced presence of intestinal commensal bacteria. After admission, the patient's fever resolved without antibiotics. Colonoscopy revealed a rectal tumor. Rectal tumor and microbial substitutions caused by antibiotics may have led to bacteremia. When treating C. paraputrificum bacteremia, physicians should be mindful of coexisting gastrointestinal disorders and a history of antibiotic administration.

RESUMEN

BACKGROUND: Selective diagnostic laparoscopy in gastric cancer patients at high risk of peritoneal metastasis is essential for optimal treatment planning. In this study available clinicopathologic factors predictive of peritoneal seeding in advanced gastric cancer (AGC) were identified, and this information was translated into a clinically useful tool. METHODS: Totally 2833 patients underwent surgery for AGC between 2003 and 2013. The study identified clinicopathologic factors associated with the risk of peritoneal seeding for constructing nomograms using a multivariate logistic regression model with backward elimination. A nomogram was constructed to generate a numerical value indicating risk. Accuracy was validated using bootstrapping and cross-validation. RESULTS: The proportion of seeding positive was 12.7% in females and 9.6% in males. Of 2833 patients who underwent surgery for AGC, 300 (10.6%) were intraoperatively identified with peritoneal seeding. Multivariate analysis revealed the following factors associated with peritoneal seeding: high American Society of Anesthesiologists score, fibrinogen, Borrmann type 3 or 4 tumors, the involvement of the middle, anterior, and greater curvature, cT3 or cT4cN1 or cN2 or cN3, cM1, and the presence of ascites or peritoneal thickening or plaque or a nodule on the peritoneal wall on computed tomography. The bootstrap analysis revealed a robust concordance between mean and final parameter estimates. The area under the ROC curve for the final model was 0.856 (95% CI, 0.835-0.877), which implies good performance. CONCLUSIONS: This nomogram provides effective risk estimates of peritoneal seeding from gastric cancer and can facilitate individualized decision-making regarding the selective use of diagnostic laparoscopy.

Asunto(s)

Laparoscopía , Neoplasias Gástricas , Masculino , Femenino , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/cirugía , Neoplasias Gástricas/patología , Estadificación de Neoplasias , Estudios Retrospectivos , Peritoneo/patología , Nomogramas

RESUMEN

Esophageal bypass surgery is a treatment for oral ingestion in cases of unresectable esophageal cancer with esophageal stricture. Esophageal bypass surgery may be necessary especially in cases of advanced esophageal stricture after CRT because of the high risk of bleeding and perforation due to esophageal stent placement. In recent years, as a safe technique with fewer complications, esophageal bypass surgery using a Y-shaped gastric tube has been increasingly performed. Therefore, we will introduce cases that have undergone esophageal bypass surgery after undergoing stent placement for unresectable advanced esophageal cancer stenosed after CRT.

Asunto(s)

Neoplasias Esofágicas , Estenosis Esofágica , Neoplasias Esofágicas/complicaciones , Estenosis Esofágica/etiología , Estenosis Esofágica/terapia , Humanos , Stents

RESUMEN

We report successfull aparoscopic distalgastrectomy in a patient with early gastric cancer and an Adachi type Ⅵ arterial variant. The case is a male in his 50's who was detected a type 0-Ⅱc lesion on the antrum of the stomach and diagnosed as tub2. Laparoscopic distalgastrectomy was performed, with the pathologic diagnosis of cT1bN0M0, cStage Ⅰ. MD-CT showed absence of the common hepatic artery ventralto the portalvein, consistent with an Adachi type Ⅵ arterialvariant. The interface between pancreatic and fatty tissue was separated in suprapancreatic dissection, and was extended between the hepatoduodenal ligament and splenic artery, with exposure of the surface of the portal vein. Thus, safe dissection of No. 8a area was achieved. Discussion: Adachi classified the celiac artery branches into 6 types and 28 groups. Type Ⅵ, a variant of the common hepatic artery located on the dorsalaspect of the portalvein, has a reported frequency of 2%. Because it is a variant of the hepatic artery, a landmark of suprapancreatic dissection, careful observation is required to determine the anatomy. Although tactile sensation is limited in laparoscopic surgery, arterial pulsation is clearly visible. To ensure a safe procedure, it is important to identify vesselanatomy both pre- and intraoperatively.

Asunto(s)

Laparoscopía , Neoplasias Gástricas , Gastrectomía , Humanos , Masculino , Persona de Mediana Edad , Arteria Esplénica , Neoplasias Gástricas/cirugía

RESUMEN

BACKGROUND: Greater lymph node retrieval in gastric cancer improves staging accuracy and may improve survival from increased clearance of nodal micrometastasis. This retrospective cohort study investigated if more lymph nodes removed in gastric cancer increases survival and if such effect is stage-specific due to differential risks of nodal micrometastasis and systemic disease. METHODS: The prospectively collected database of curatively resected gastric cancer patients in National Cancer Center, South Korea between 2000 and 2009 was reviewed. Disease-free survival (DFS) and overall survival (OS) for all patients and for each stage according to number of lymph nodes examined (1-30, 31-45, > 45) were analyzed. RESULTS: Of 4049 patients, 96.6% and 98.4% underwent D2 (perigastric and extragastric) lymphadenectomy and had ≥ 15 lymph nodes examined. Mean number of nodes examined was 43. Five-year OS & DFS rates were 83.3% and 80.7%. Patients with > 45 nodes examined had significantly lower DFS (p = 0.002) and OS (p = 0.007) compared to those with 1-30 and 31-45 nodes. However, proportion of patients with > 45 nodes examined increased with stage (p = 0.0005). Per stage, there was no significant difference in DFS and OS according to number of nodes examined except for stage IIIA favoring more nodes (p = 0.018 and p = 0.044, respectively). Similar trend was seen in stage IIB. Number of examined nodes positively correlated with number of pathologic nodes for all patients (r = 0.144, p < .001) but not for stage IIB and IIIA. Number of nodes examined was a significant survival predictor in stage IIIA. CONCLUSION: Greater lymph node harvest showed improved survival in intermediate-stage gastric cancer.

Asunto(s)

Adenocarcinoma/epidemiología , Adenocarcinoma/cirugía , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/cirugía , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/patología , Adulto , Anciano , Supervivencia sin Enfermedad , Femenino , Gastrectomía , Humanos , Estimación de Kaplan-Meier , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , Metástasis Linfática , Masculino , Persona de Mediana Edad , Micrometástasis de Neoplasia , Pronóstico , República de Corea/epidemiología , Estudios Retrospectivos , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/patología

RESUMEN

The REGARD and RAINBOW trials revealed the effectiveness of ramucirumab(RAM)for advanced gastric cancer patients who had been previously treated with chemotherapy. In the latest Japanese gastric cancer treatment guidelines, PAM plus paclitaxel(PTX)was positioned as a second-line chemotherapy for advanced gastric cancer. We report a case of advanced gastric cancer with peritoneal dissemination after gastrectomy effectively treated with RAM plus PTX. A 66-year-old woman underwent total gastrectomy with D2 lymph node dissection, splenectomy, and distal pancreatectomy. The pathological diagnosis was poorly differentiated adenocarcinoma, pT4b(pancreas), N3b, P1, CY1, Stage Ⅳ. She was treated with postoperative chemotherapy of S-1 plus cisplatin. However, 5 months after surgery, computed tomography(CT)showed ascites and recurrence of peritoneal dissemination. Cytological examination showed adenocarcinoma cells in the ascites. She was treated with combination chemotherapy of RAM and PTX as second line chemotherapy. After 1 course of this therapy, CT revealed complete disappearance of ascites and significant reduction in the size of the peritoneal dissemination. The patient survived without progression for 8 months after the recurrence was detected.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica , Neoplasias Peritoneales , Neoplasias Gástricas , Anciano , Anticuerpos Monoclonales/administración & dosificación , Anticuerpos Monoclonales Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Combinación de Medicamentos , Femenino , Gastrectomía , Humanos , Recurrencia Local de Neoplasia , Ácido Oxónico/administración & dosificación , Paclitaxel/administración & dosificación , Neoplasias Peritoneales/secundario , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Tegafur/administración & dosificación , Ramucirumab

RESUMEN

Perforated gastric cancer typically requires life-saving emergency surgery. However, preoperative diagnosis is difficult, the rate of radical resection is low, and the prognosis remains poor. Perforated gastric cancer is generally treated with 1- or 2- stage gastrectomy, but radical resection is rarely performed after a conservative medical management and chemotherapy for perforated gastric cancer. A 65-year-old man visited another hospital with left upper abdominal pain. He was diagnosed with upper GI perforation, and conservative medical management was selected because peritonitis was limited. After close examination, a Type 3 tumor was found in the cardiac region of the stomach. As the advanced gastric cancer was unresectable, chemotherapy, comprising4 courses of SP plus T-mab, was subsequently administered. As the therapeutic effect was PR, we performed total gastrectomy. The pathological findings were tub2>tub1>por2: pT2N1CY0H0P0M0, pStageⅡ, and we achieved curative resection. Postoperatively, S-1 treatment was performed as an adjuvant chemotherapy. The patient remains alive, without recurrence, for 3 years and 6 months postoperatively.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica , Gastrectomía , Recurrencia Local de Neoplasia , Neoplasias Gástricas , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Humanos , Masculino , Pronóstico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía

RESUMEN

We treateda 70-year-oldfemale patient with locally advancedrectal cancer accompaniedby metastases to other organs. Three courses of S-1 plus oxaliplatin(SOX)therapy were administered as neoadjuvant chemotherapy(NAC), andthe cancer was subsequently treatedwith laparoscopic rectal resection. She hadvisiteda physician with a chief complaint of melena. A type 2 tumor located in the rectum Rb was found during the lower gastrointestinal endoscopy, which was diagnosed as an adenocarcinoma by biopsy. Vaginal invasion andlymph node metastasis were observedon CT andMRI. After 3 courses of SOX therapy(NAC), her condition was categorized as SD. Laparoscopic rectal amputation(D3)combinedwith resection of the ovary, uterus, and vagina was performed. On histopathological examination, the tumor was an adenocarcinoma, muc> tub2, ypT4b(AI, vaginal wall), int, INF b, ly1, v2, EX(-), PN1a, grade 1, pPM0, pDM0, pRM0 and pStage Ⅲa. The histological analysis demonstrated that the therapeutic effect of chemotherapy was grade 1a. Laparoscopic surgery, which is a relatively safe procedure, may be useful after NAC for an R0 resection.

Asunto(s)

Adenocarcinoma , Laparoscopía , Neoplasias del Recto , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/cirugía , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica , Femenino , Humanos , Terapia Neoadyuvante , Invasividad Neoplásica , Neoplasias del Recto/tratamiento farmacológico , Neoplasias del Recto/cirugía , Vagina/patología

RESUMEN

The patient was a 57-year-old woman. In October 2011, she underwent distal gastrectomy, D2 lymphadenectomy, and Roux-en-Y reconstruction for gastric cancer (pT4a, pN3b, Stage ⅢC [JCGC 14th Edition]). She then received S-1 plus CDDP combination therapy and S-1 monotherapy as postoperative adjuvant chemotherapies for 1 year, and was followed up as an outpatient. In April 2013, a significant increase in the CA19-9 level was noted, and CT indicated a right ovarian tumor. Ovarian metastasis from the gastric cancer was diagnosed, and the response to 3 courses of weekly PTX was stable disease. No findings indicated metastasis to other organs. In July 2013, a salpingo-oophorectomy was performed, after which her CA19-9 level returned to the normal range. Follow-up was adopted as the postoperative strategy in part due to the desires of the patient. Presently, 3 years and 6 months after the initial surgery and 1 year and 9 months after the last surgery, no recurrence has been detected. Generally, ovarian metastasis from gastric cancer is considered to be associated with a poor prognosis. However, our patient showed long-term survival after surgeries for gastric cancer and asynchronous ovarian metastasis. Here, we report the details of our case and review the relevant literature.

Asunto(s)

Neoplasias Ováricas/secundario , Neoplasias Gástricas/patología , Antineoplásicos Fitogénicos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Combinación de Medicamentos , Femenino , Gastrectomía , Humanos , Persona de Mediana Edad , Neoplasias Ováricas/tratamiento farmacológico , Neoplasias Ováricas/cirugía , Ovariectomía , Ácido Oxónico/administración & dosificación , Paclitaxel/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Neoplasias Gástricas/cirugía , Tegafur/administración & dosificación , Factores de Tiempo

RESUMEN

A man in his 60s was diagnosed with esophageal cancer (T3, N0, StageII) and treated with 5-fluorouracil and cisplatin as neoadjuvant chemotherapy (NAC). On day 18 of the second NAC course, the patient developed febrile neutropenia, and a computed tomography (CT) scan showed pneumatosis cystoides intestinalis (PCI) of the ascending and transverse colon, free air around the ascending colon, thickening of the gallbladder wall, pleural effusion, and ascites. Because there were no signs of peritoneal irritation and intestinal perforation was ruled out, conservative treatment was selected. Seven days after PCI was diagnosed, CT showed improvement in PCI and the free air had disappeared, and 26 days after the diagnosis, a subtotal esophagectomy was performed. Observation of the abdomen did not show a thickened wall or stenosis of the ascending or transverse colon. PCI could be treated conservatively, even with free air in the abdominal cavity, by comprehensively assessing not only the imaging but also the physical findings. We were able to perform radical resection of the esophageal cancer without excessive treatment for PCI.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Neoplasias Esofágicas/tratamiento farmacológico , Terapia Neoadyuvante/efectos adversos , Neumatosis Cistoide Intestinal/inducido químicamente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/efectos adversos , Fluorouracilo/administración & dosificación , Fluorouracilo/efectos adversos , Humanos , Masculino

RESUMEN

The patient was a man in his 60s with a history of 2 operations for the treatment of malignant neurogenic tumors. Partial resection of the stomach and liver was performed in December 2006, followed by chemotherapy with adriamycin and interferon; resection of a recurrent tumor in the left subphrenic space was performed in December 2007. In June 2011, recurrent tumors were detected in the lesser curvature of the stomach body and left inferior quadrant of the abdomen (12 mm [SUVmax 7.9] and 23 mm [SUVmax 10.5], respectively)by using 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET). The tumors resected in August 2011 were diagnosed as malignant peritoneal mesothelioma on immunohistochemical analysis. In February 2013, FDG-PETrevealed a 20-mm tumor of in the mesentery with a SUVmax of 7.6, and the tumor was resected. This secondary tumor had the same features of the previously resected malignant mesothelioma. Fluorescence in situ hybridization revealed no deletion of the p16 gene, and the patient had had no other recurrence during follow-up. Malignant peritoneal mesothelioma is a rare disease, accounting for 10% of all malignant mesothelioma cases, with low rates of p16 gene deletion compared with malignant pleural mesothelioma. Previous studies have reported that the lack of p16 deletion is associated with better prognosis in malignant pleural mesothelioma. Herein, we report of a patient diagnosed with malignant peritoneal mesothelioma, without deletion of the p16 gene, who survived for over 2 years and 10 months after initial diagnosis of malignant mesothelioma.

Asunto(s)

Neoplasias Pulmonares/diagnóstico , Mesotelioma/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Peritoneales/diagnóstico , Inhibidor p16 de la Quinasa Dependiente de Ciclina , Humanos , Hibridación Fluorescente in Situ , Neoplasias Pulmonares/genética , Masculino , Mesotelioma/genética , Mesotelioma Maligno , Proteínas de Neoplasias/genética , Neoplasias Primarias Múltiples/genética , Neoplasias Peritoneales/genética

RESUMEN

An approximately 50-year-old man with rectal cancer(RbP)[ cT3(cA), cN3, cM0, and cStage IIIb] who desired anus preservation was administered mFOLFOX6 therapy. This treatment decreased the size of both the tumor and the lymph node, and intersphincteric resection (ISR) was performed. Histopathology demonstrated tumor invasion beyond the muscularis propria, and the histological effectiveness was Grade 2. Because computed tomography showed an abscess in the dissection area, we performed postoperative drainage and the patient recovered. Therapy with mFOLFOX6 was repeated after the patient was discharged from hospital. Increased adoption of anus-preserving surgery is expected via successful control of local recurrence and distant metastasis by neoadjuvant chemotherapy.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias del Recto/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/administración & dosificación , Terapia Combinada , Fluorouracilo/administración & dosificación , Humanos , Leucovorina/administración & dosificación , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía

RESUMEN

BACKGROUND AND AIM: Fulminant hepatitis is mainly caused by excessive immune response-mediated liver injury and its definitive therapy is liver transplantation. Mesenchymal stem cells, one of the adult stem cells, have an immunomodulatory effect on immune cells and reside in various tissues. The aim of this study was to investigate a therapeutic effect of adipose tissue-derived mesenchymal stem cells (ASCs) on fulminant hepatitis induced by concanavalin A (ConA). METHODS: The ASCs were isolated from adipose tissues of BALB/c mice and confirmed by detection of cell surface markers and induction of multi-lineage differentiation. BALB/c mice were injected with ConA and treated with ASCs, phosphate buffered saline (PBS) or splenocytes (SPLCs). Survival rates, levels of serum liver enzymes, titers of serum cytokines, histopathology and localization of ASCs were investigated. RESULT: The survival rate of ASC-injected mice significantly increased compared to PBS or SPLC-injected mice. This effect was dependent on doses and timing of ASCs injected. Improvement of liver enzyme levels, histopathological changes and suppression of inflammatory cytokine production were observed in ASC-injected mice. Fluorescent stained ASCs were detected in inflammatory liver, but not in normal liver. CONCLUSION: These results suggest that ASC treatment has a high potential to be an innovative therapy for fulminant hepatitis.

Asunto(s)

Tejido Adiposo/citología , Enfermedad Hepática Inducida por Sustancias y Drogas/cirugía , Concanavalina A , Hígado/patología , Trasplante de Células Madre Mesenquimatosas , Células Madre Mesenquimatosas , Alanina Transaminasa/sangre , Animales , Aspartato Aminotransferasas/sangre , Biomarcadores/metabolismo , Diferenciación Celular , Células Cultivadas , Enfermedad Hepática Inducida por Sustancias y Drogas/etiología , Enfermedad Hepática Inducida por Sustancias y Drogas/inmunología , Enfermedad Hepática Inducida por Sustancias y Drogas/metabolismo , Enfermedad Hepática Inducida por Sustancias y Drogas/patología , Modelos Animales de Enfermedad , Femenino , Interferón gamma/sangre , Hígado/inmunología , Hígado/metabolismo , Células Madre Mesenquimatosas/inmunología , Células Madre Mesenquimatosas/metabolismo , Ratones , Ratones Endogámicos BALB C , Bazo/citología , Factores de Tiempo , Factor de Necrosis Tumoral alfa/sangre

RESUMEN

We examined factors contributing to an onset of postoperative pulmonary complications following esophagectomy for esophagus cancer. One hundred thirty-two cases of the resected esophageal cancer were studied. We considered the relationship between preoperative patient factors, operative factors, clinical stage factors and postoperative pulmonary complications. Postoperative pulmonary complication was observed in 27 cases (20%). The incidence of postoperative pulmonary complications was significantly higher in patients aged 70 and above and those with a preoperative serum albumin value of less than 4 .0 g/dL. Additionally, these two factors were correlated with an onset of postoperative pulmonary complications in multivariate analyses. A decrease of preoperative serum albumin value was reflecting the chronic poor nutritional condition. Moreover, it was possible that poor nutritional condition served as a prognostic factor of postoperative complications in relation to reduction of cellular immunity. The results indicated that there was a possibility of decreasing an onset of postoperative pulmonary complications using various nutrition managements before operations.

Asunto(s)

Neoplasias Esofágicas/cirugía , Enfermedades Pulmonares/etiología , Complicaciones Posoperatorias/etiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Esofagectomía , Femenino , Humanos , Enfermedades Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología

RESUMEN

We report here a long-term survival case of advanced esophageal cancer with distant lymph node metastases, treated with definitive chemoradiotherapy (CRT). A man in his 60s with disturbance of swallowing was diagnosed as middle esophageal cancer involving multiple metastases of distant lymph nodes. CRT (combination of 5-FU and nedaplatin every four weeks for four courses with 66 Gy of radiation) was administered. After a completion of CRT, CT scan revealed shrinking metastatic lymph nodes. No tumor but a scar at the site of cancer was observed by endoscopy, and histopathology of biopsy specimen detected no tumor cells. From these results, we diagnosed the curative effect of CRT as complete response. Five years after CRT, a swelling of left inguinal lymph node with uptake of fluorine-18-fluorodeoxyglucose appeared and was extirpated, and the swelling was diagnosed histopathologically as metastasis of esophageal cancer. The patient is surviving with no recurrence for 7 years and 8 months from the first diagnosis. In cases of highly advanced esophageal cancer, a long-term follow-up should be performed.

Asunto(s)

Quimioradioterapia , Neoplasias Esofágicas/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Esofágicas/patología , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Masculino , Estadificación de Neoplasias , Compuestos Organoplatinos/administración & dosificación , Compuestos Organoplatinos/uso terapéutico , Factores de Tiempo

RESUMEN

A male in his 40s was diagnosed with type-3 advanced esophageal cancer in the upper thoracic and cervical esophagus, which invaded to the trachea. We administered a low-dose FP combination therapy (5-FU and CDDP) along with 40 Gy radiotherapy. This chemoradiotherapy reduced the esophageal tumor significantly, and then we performed subtotal esophagectomy. Histological examination of the resected specimens revealed no residual cancer cells in the primary lesion or regional lymph nodes. No recurrence had occurred for about three years and seven months after the operation. However, CT revealed that the patient had the signs of recurrence (bone and lung), and finally he died four years and eight months after the operation. Preoperative chemoradiotherapy is potentially effective for advanced esophageal cancer invaded to adjacent organs. Although chemoradiotherapy yielded a complete response in our case( an advanced esophageal cancer patient), a patient follow-up is necessary because a recurrence may occur along the way.

Asunto(s)

Quimioradioterapia , Neoplasias Esofágicas/terapia , Tráquea/patología , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/administración & dosificación , Cisplatino/uso terapéutico , Neoplasias Esofágicas/patología , Resultado Fatal , Fluorouracilo/administración & dosificación , Fluorouracilo/uso terapéutico , Humanos , Masculino , Invasividad Neoplásica , Estadificación de Neoplasias , Recurrencia , Factores de Tiempo

RESUMEN

CASE 1: A 67-year-old man with lower thoracic esophageal carcinoma, T2N0M0, cStage II, underwent neoadjuvant chemotherapy (NAC) with 5-FU/CDDP. After 2 courses of NAC, radical resection of the esophageal carcinoma was performed. Primary tumor was not palpable, and lymph node swelling was not found in the resected specimens. Pathologic examination of the resected specimens revealed no malignant cells in the esophagus. Histologic effect of the NAC was grade 3. We obtained down-staging of carcinoma in T0N0M0, fStage 0. CASE 2: A 58-year-old man with thoracic esophageal cancer, T3N2M0, cStage III, underwent NAC with 5-FU/CDDP. After 2 courses of NAC, radical resection of the esophageal carcinoma was performed. Primary tumor was not found in the resected specimens. Pathologic examination of the resected specimens revealed only an irregular fibrosis of esophageal wall, and no malignant cells in the esophagus. Two lymph node metastasis and surrounding fibrosis was found. We obtained down-staging of carcinoma in T0N2M0, fStage II. We report two cases of complete response of primary esophageal carcinoma treated with 5-FU/CDDP as neoadjuvant chemotherapy.

Asunto(s)

Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Cisplatino/uso terapéutico , Neoplasias Esofágicas/tratamiento farmacológico , Fluorouracilo/uso terapéutico , Terapia Neoadyuvante , Anciano , Cisplatino/administración & dosificación , Neoplasias Esofágicas/patología , Neoplasias Esofágicas/cirugía , Fluorouracilo/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Clasificación del Tumor , Estadificación de Neoplasias

RESUMEN

We herein report a case of a hilar tumor with extensive invasion to the proper hepatic artery, which was successfully treated with a radical resection in a 57-year-old female patient after a stepwise hepatic arterial embolization. She underwent right colectomy and partial hepatectomy for advanced colon cancer two years ago and radiofrequency ablation therapy for a liver metastasis one year ago, respectively. A recurrent tumor was noted around the proper hepatic artery with invasion to the left hepatic duct and right hepatic artery 7 mo previously. We planned a radical resection for the patient 5 mo after the absence of tumor progression was confirmed while he was undergoing chemotherapy. To avoid surgery-related liver failure, we tried to promote the formation of collateral hepatic arteries after stepwise arterial embolization of the posterior and anterior hepatic arteries two weeks apart. Finally, the proper hepatic artery was occluded after formation of collateral flow from the inferior phrenic and superior mesenteric arteries was confirmed. One month later, a left hepatectomy with hepatic arterial resection was successfully performed without any major complications.

Asunto(s)

Embolización Terapéutica/métodos , Arteria Hepática/cirugía , Neoplasias Hepáticas/cirugía , Neoplasias Hepáticas/terapia , Femenino , Hepatectomía , Humanos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/cirugía , Recurrencia Local de Neoplasia/terapia

RESUMEN

AIM: To clarify the usefulness of a new method for performing a pancreaticojejunostomy by using a fast-absorbable suture material irradiated polyglactin 910, and a temporary stent tube for a narrow pancreatic duct with a soft pancreatic texture. METHODS: Among 63 consecutive patients with soft pancreas undergoing a pancreaticoduodenectomy from 2003 to 2006, 35 patients were treated with a new reconstructive method. Briefly, after the pancreatic transaction, a stent tube was inserted into the lumen of the pancreatic duct and ligated with it by a fast-absorbable suture. Another tip of the stent tube was introduced into the intestinal lumen at the jejunal limb, where a purse-string suture was made by another fast-absorbable suture to roughly fix the tube. The pancreaticojejunostomy was completed by ligating two fast-absorbable sutures to approximate the ductal end and the jejunal mucosa, and by adding a rough anastomosis between the pancreatic parenchyma and the seromuscular layer of the jejunum. The initial surgical results with this method were retrospectively compared with those of the 28 patients treated with conventional duct-to-mucosa anastomosis. RESULTS: The incidences of postoperative morbidity including pancreatic fistula were comparable between the two groups (new; 3%-17% vs conventional; 7%-14% according to the definitions). There was no mortality and re-admission. Late complications were also rarely seen. CONCLUSION: A pancreaticojejunostomy using an irradiated polyglactin 910 suture material and a temporary stent is easy to perform and is feasible even in cases with a narrow pancreatic duct and a normal soft pancreas.

Asunto(s)

Páncreas/cirugía , Pancreatoyeyunostomía/métodos , Suturas , Anciano , Anastomosis Quirúrgica/métodos , Femenino , Humanos , Mucosa Intestinal/cirugía , Yeyuno/cirugía , Masculino , Persona de Mediana Edad , Conductos Pancreáticos/cirugía , Fístula Pancreática/etiología , Fístula Pancreática/prevención & control , Pancreatoyeyunostomía/efectos adversos , Poliglactina 910 , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Estudios Prospectivos

RESUMEN

We reported a case of metastatic tumor to the diaphragm discovered by rising CEA after operation of ascending colon cancer. A 72-year-old female underwent right hemicolectomy on January 2005. After discharge, she received adjuvant chemotherapy by S-1, but a rise of CEA was shown. Based on exploratory findings, laparotomy was done with the diagnosis of metastasis to the liver(S7). A tumor was present in the right diaphragm, and contacted the liver(S7). Partial resection of the right diaphragm was performed. The removed specimen revealed the same histological findings of the last operated ascending colon. Metastasis to the diaphragm is very rare, especially a solitary one as in this case. Etiologically speaking, the tumor cells might be absorbed or have strayed into peritoneal stomata of the diaphragm.

Asunto(s)

Colon Ascendente/patología , Neoplasias del Colon/patología , Diafragma/patología , Neoplasias de los Músculos/secundario , Anciano , Antígeno Carcinoembrionario/sangre , Colon Ascendente/cirugía , Neoplasias del Colon/sangre , Neoplasias del Colon/cirugía , Diafragma/irrigación sanguínea , Diafragma/metabolismo , Femenino , Humanos , Imagen por Resonancia Magnética , Neoplasias de los Músculos/sangre , Neoplasias de los Músculos/irrigación sanguínea , Neoplasias de los Músculos/patología , Tomografía Computarizada por Rayos X