[Anastomotic Recurrence after Curative Resection for Transverse Colon Cancer-A Case Report].

The rate of local and anastomotic recurrence after curative resection for colon cancer is quite low, at 2.1%. We describe an anastomotic recurrence that rapidly increased after transverse colon cancer resection. An 80-year-old man underwent laparoscopic- assisted transverse colon resection with D3 lymph node dissection. The pathological diagnosis was pT4aN1bM0, pStage Ⅲb. We diagnosed the patient with anastomotic recurrence and liver metastasis 4 months after the procedure based on PET-CT findings. Partial colon resection(small intestine and stomach combined)was performed at 6 months after the procedure. The patient's quality of life(QOL)was reduced by complications after the second procedure and continuing with chemotherapy became difficult. Although the prognosis of curative resection of local and anastomotic recurrence after transverse colon cancer surgery can be good, combined resection of an adjacent organ can result in a decline in patient QOL. Surgical intervention should be minimally invasive and neo-adjuvant chemotherapy might offer 1 option.

[Local Recurrence of Rectal Cancer under Perineal Skin after Abdominoperineal Resection].

A woman in her early 50s underwent abdominoperineal resection with left lateral lymph node resection for advanced rectal cancer. The pathological diagnosis was RC, RbP, well-differentiated, type 5, 65×47mm, pT3(A), pN0(0/40), M0, pStage Ⅱ. The local recurrence discovered under the perineal skin 2 months later was treated by resecting the tumor and both inguinal lymph nodes. Adjuvant chemotherapy containing UFT plus LV was also initiated for 6 months. She remains free of recurrence 1 year after resection of the local recurrence.

[Assessment of Short-Term Outcomes of Laparoscopic-Assisted Distal Gastrectomy in Elderly Patients Using Comorbidities as Predictive Factors].

Laparoscopic-assisted distal gastrectomy(LADG)is a recently developed minimally invasive surgery for management of early gastric cancer. We describe short-term results obtained from a retrospective study of LADG, performed in elderly patients, using comorbidities as predictive factors. We studied 160 patients diagnosed with gastric cancer who underwent LADG between January 2005 and October 2016. We compared 48 patients, aged≥75 years(elder group), with 112 patients, aged <75 years(non-elder group), who underwent LADG. Preoperative physical status was assessed using the American Society of Anesthesiologists physical status(ASA-PS)score, Charlson comorbidity index(CCI), and the prognostic nutritional index (PNI). Demographics of patients, primarily, sex, tumor lesion, and histology did not significantly differ between the groups. However, the mean ASA-PS score and CCI were significantly higher, and the PNI was significantly lower in the elder group. Surgical duration, volume of blood loss, lymph node clearance, and length of postoperative hospital stay did not significantly differ between the groups. Cardiorespiratory and surgical complications developed in 2(4.2%)and 3(2.7%), and in 5(10%) and 12(11%)patients in the elder and non-elder groups, respectively. However, the rates of intra and postoperative complications were not significantly different between them. LADG can be considered a safe and effective minimally invasive surgical procedure for management of early gastric cancer in elderly patients.

[Case Report of Long-Term Survival for Stage IV Advanced Sigmoid Colon Cancer with Para-Aortic Nodes by R0 Resection and Chemotherapy].

The patient was a man in his early 30s. He underwent sigmoidectomy with D3+ #216 for advanced sigmoid colon cancer with metastatic para-aortic lymph nodes. The pathological diagnosis was colon cancer(S), type 2, moderately differentiated, pT4a(SE), pN3(19/33), pM1a(LYM), pStage IV , KRAS wild-type, EGFR(+). He received FOLFOX plus bevacizumab(Bmab) as adjuvant chemotherapy. One year postoperatively, he experienced recurrence as multiple lung metastases. FOLFIRI plus panitumumab, SOX plus Bmab, CapeOX, nivolumab and FOLFIRI plus ramucirumab were then administered. The patient has survived for 4 years and 11 months from operation.

Ten Cases of Colovesical Fistula due to Sigmoid Diverticulitis.

Colovesical fistula (CVF) resulting from colon diverticulosis is a comparatively rare disease, and neither the diagnosis nor treatment has been established. Our experience with CVF due to sigmoid diverticulitis over a 9-year period was reviewed to clarify the clinical presentation and diagnostic confirmation. Ten patients with CVF were identified in this period, and chief complaints, laboratory findings, presenting symptoms, diagnostic investigations, and subsequent treatments were reviewed. Preoperative urinalysis showing bacteriuria (100%) was the most common presentation, followed by fecaluria (40%), abdominal pain (40%), pneumaturia (30%), hematuria (30%), pain on urination (30%), pollakiuria (10%), and dysuria (10%). The abilities of various preoperative investigations to identify CVF were: computed tomography (CT), 88.9%; magnetic resonance imaging, 40%; cystoscopy, 30%, and gastrografin irrigoscopy, 22.2%. Colonoscopy (0%) was not diagnostic. Bowel resection was performed in nine of ten patients. When inflammation was intense, covering ileostomy was performed, and an omental plasty was placed between the bowel anastomosis and bladder. When CVF is suspected, we recommend CT followed by colonoscopy and cystoscopy as a first-line investigation to rule out malignancy as a cause. Other modalities should only be used if the diagnosis is in doubt or additional information is needed to plan operative management. Primary colic anastomosis appears to be safely performed by applying omental plasty and covering ileostomy.

[Radiofrequency ablation therapy combined with hepatectomy for liver metastasis of colorectal cancer].

Radiofrequency ablation (RFA) therapy combined with hepatectomy was performed in 5 patients with synchronous liver metastases of colorectal cancer. RFA of liver metastases was performed using a Cool-tip electrode (Radionics; Burlington, MA, USA). The ablation time used in each session varied according to the tumor size and intraoperative impedance. In 2 patients, hepatectomy and resection of the colorectal primary lesion were performed synchronously. In patients with multiple liver metastases, relative curative resection was performed using the complementary RFA. In the other 3 patients, synchronous hepatectomy was considered difficult and systematic chemotherapy was performed after resection of the colorectal primary lesion. After systematic chemotherapy, the range of hepatectomy was restricted for liver injury, but relative curative resection was performed using RFA therapy. Computed tomography performed after hepatectomy showed that the region that underwent RFA appeared necrotic with a safety margin. The average observation period was 25 months (maximal survival period, 50 months) and 3 of the patients are alive.

Analysis of surgical outcomes of diverticular disease of the colon.

We analyzed retrospectively the surgical outcomes of diverticular diseases of the colon at the surgical division of Fukuyama Medical Center. Data were collected from 39 patients who underwent surgery for diverticular disease at Fukuyama Medical Center. Thirty-nine patients were admitted between 2005 and 2010. The mean age of the 39 patients was 63.6 years. The collected data included patient demographics, patient history, type of surgery and complications. Patients were divided into 2 groups, Elective vs. Emergent group, right vs. left colon group and laparotomy vs. laparoscopic approach. Multivariate analysis of the logistic model of morbidity revealed a significantly higher rate in the left colon and the Cox proportional hazards model clearly showed fewer postoperative hospital days with the laparoscopic approach. Surgical procedures should be decided in reference to the particular clinical and pathological features of diverticular disease to gain an acceptable morbidity and mortality rates.

[A case of primary adenocarcinoma of small intestine responding to XELOX chemotherapy and leading to a partial metabolic response].

We report a case of adenocarcinoma of the small intestine responding to XELOX chemotherapy, leading to a partial metabolic response(PMR). The patient was a 58-year-old male with multiple peritoneal dissemination of adenocarcinoma of the small intestine. Chemotherapy with XELOX(L-OHP 130 mg/m² on day 1 , and capecitabine 1,000 mg/m2 on days 1-14)was performed. After 4 courses, a significant tumor reduction was obtained. This case suggests that chemotherapy with XELOX is a potential regimen for small intestinal adenocarcinoma.

[A case of pathological complete response of metachronous multiple liver metastases from colorectal cancer after mFOLFOX+bevacizumab chemotherapy].

A 25-year-old man with RS rectal cancer received a radical resection of the original tumor and lymph node dissection. Oral tegafur/uracil (UFT)/Leucovorin (LV) therapy has been used for adjuvant chemotherapy, as the pathological Stage was T3N1M0, Stage IIIa. After 10 months from operation, multiple liver metastases were recognized and not resectable. So a systemic chemotherapy by mFOLFOX6+bevacizumab was begun via CV port. After 5 courses of mFOLFOX6+bevacizumab, abdominal CT revealed liver metastases showed remarkable reduction in size. Hepatic resection of S6 segment was enforced, and the patient uneventfully discharged. Pathological findings of S6 segment revealed no residual cancer cells, indicating the histological effect of mFOLFOX6+bevacizumab was Grade 3. And no liver damage was recognized.

[A case of advanced hepatocarcinoma responding to combination therapy of S-1 and PEG-IFN].

A57 -year-old man. Though chronic hepatitis C was pointed out before, it had been left untreated for about 5 years. He was hospitalized because many venereal diseases had been pointed out in the liver by abdomen ultrasonography. Results of close examination revealed stage IV B with bone metastases, and pulmonary metastases was diagnosed. After consultation, whole-body chemotherapy combining S-1 and PEG-IFN was attempted as of June 26, 2007. S-1 (80 mg/day) was then administered every day for two weeks with drug withdrawal for one week. PEG-IFNalpha-2a (180 microg)was administered once a week. We set three weeks as one course. The liver tumor was markedly reduced, and the pulmonary metastases were also reduced at the completion of 5 courses. The therapeutic effectiveness of this chemotherapy was confirmed by imaging test. The course was favorable, and whole-body chemotherapy was discontinued on January 29, 2008. At this writing in October of 2008, the course has been uneventful. This treatment method is a promising choice for whole-body chemotherapy for advanced hepatocarcinoma in the future. We have added some review of the literature, and the S-1+PEG-IFN combination chemotherapy is reported.

Ciliated hepatic foregut cyst with obstructive jaundice.

Ciliated hepatic foregut cysts (CHFCs) are rare congenital cystic lesion that are most often solitary, unilocular, and located in the subcapsular region of the medial segment of the left hepatic lobe. The mucoid fluid contents affect imaging studies and often make definitive diagnosis difficult. CHFCs are usually asymptomatic and found incidentally. We report a 69-year-old female patient with a CHFC causing obstructive jaundice, which was difficult to differentiate from a biliary cystic neoplasm. A well-defined cystic lesion measuring 25 mm in diameter was located in the porta hepatis region. The lesion was densely adherent to the left and right hepatic ducts, riding on the bifurcation, and the common hepatic duct was extrinsically compressed. An extended left hepatectomy was performed. A diagnosis of CHFC was made on the basis of typical histological findings. CHFC should be included in the differential diagnosis for cystic lesions of the liver.