Neoadjuvant Hyperthermia and Chemoradiotherapy for Borderline Resectable Pancreatic Cancer.

Pancreatic cancer(PC)is associated with poor prognosis and low resectability rates. Currently, only 15-20% of all patients are candidates for upfront surgery at the time of diagnosis, which offers the chance of long-term survival. In recent years, patients with borderline resectable PC(BR-PC)have been treated with surgery following neoadjuvant chemoradiotherapy or intensive multi-agent chemotherapy. In PC, which is therapy resistant due to its hypoxic microenvironment, hyperthermia may enhance the effect of chemo(radio)therapy. An 84-year-old man with fatty stool was diagnosed with pancreatic head cancer according to the result of contrast computed tomography(CT), which showed a 37 mm irregular low-density area at the pancreatic head infiltrating nearly half of the superior mesenteric artery(SMA)plexus. There were no findings of lymph node metastasis or distant metastasis. The pretreatment diagnosis was BR-PC, cT3, N0, M0, cStage Ⅱ A. The patient was treated with hyperthermia plus S-1 and radiotherapy. The size of the tumor had reduced from 37 mm to 15 mm after the neoadjuvant therapy, and the infiltration into the SMA plexus had also reduced. Therefore, the patient underwent subtotal stomach-preserving pancreaticoduodenectomy(SSPPD)concomitant resection of the PV, SMV, SV confluence. The histopathological findings were invasive ductal carcinoma with R0 radical resection. There has been no recurrence 18 months after the surgery. Based on the above-mentioned findings, hyperthermia and chemoradiotherapy can be an effective option of neoadjuvant treatment for BR-PC.

[A Case of Lipoma Arising from the Mesentery Proper That Had Difficulty in Differential Diagnosis with Well-Differentiated Liposarcoma].

A 54-year-old male patient with a chief complaint of right lower abdominal pain and nausea visited the reporting hospital. Abdominal computed tomography was performed, which showed findings of a membrane-covered internally heterogeneous solid mass associated with a 11×10 cm well-circumscribed calcification, as well as ileus in the right lower abdomen. Based on the imaging findings, it was diagnosed with liposarcoma, and surgery was performed for both diagnosis and treatment. The mass was located in the mesentery of the terminal ileitis and could be removed without gross residue. Histopathological examination showed altered fat cells and fibrous partition, most of which were lipoma, but well-differentiated liposarcoma could also not be ruled out. It was diagnosed with lipoma mixed with well-differentiated liposarcoma. In particular, lipoma and liposarcoma from the mesentery proper is extremely rare. We encountered a case of lipoma arising from the mesentery proper that had difficulty in differential diagnosis with well-differentiated liposarcoma and here in report it with the addition of some literature consideration.

Simultaneous laparoscopic total extraperitoneal inguinal hernia repair and laparoscopic appendectomy for Amyand's hernia: a case report.

BACKGROUND: An Amyand's hernia is defined by the presence of a vermiform appendix within an inguinal hernia sac. Most of these cases are not diagnosed preoperatively and the surgical approach is dependent on the type present and associated intraoperative findings. We present a case of a preoperatively diagnosed Amyand's hernia in a man who underwent treatment by simultaneous laparoscopic totally extraperitoneal repair and laparoscopic appendectomy. CASE PRESENTATION: We encountered the case of a 76-year-old Japanese man with a right inguinal pain. Ultrasound and computed tomography confirmed his vermiform appendix herniated into the right inguinal canal. We managed a simultaneous laparoscopic total extraperitoneal inguinal hernia repair with mesh and laparoscopic appendectomy. He was discharged without any postoperative morbidity. CONCLUSIONS: We recommend laparoscopic appendectomy and totally extraperitoneal hernia repair with mesh after laparoscopic reduction for Amyand's hernia.

[Two Cases of Surgery Combined with Intraoperative Radiofrequency Ablation for Colorectal Cancer and Synchronous Liver Metastases].

The therapeutic management of simultaneous liver metastasis of colorectal cancer(SCRLM)remains controversial. Although hepatic metastasectomy is the first choice for resectable liver metastasis of colorectal cancer, radiofrequency ablation (RFA)is one of the least invasive application for patients who refuse more invasive treatment such as hepatectomy and longterm systemic chemotherapy or for whom such treatment is not suitable. We report 2 cases of SCRLM treated by surgery combined with intraoperative RFA and adjuvant chemotherapy, raising the possibility of local control in the liver for selected patients.

[A Case of Recurrent Gallbladder Carcinoma Treated with Resection and Hepatic Arterial Infusion].

A 69-year-old woman underwent extended cholecystectomy for gallbladder cancer[T2N0M0, fStage Ⅱ(UICC 7th edition)]. She was then administered adjuvant S-1 and was treated for drug-induced neutropenia. One year later, recurrent lesions were detected in liver S4 and S5. We treated the patient with hepatectomy and hepatic arterial infusion adjuvant chemotherapy by cisplatin, along with the systemic administration of gemcitabine for 10 months. The patient is now doing well without any sign of recurrence 29 months after the initial operation and 16 months after the secondary liver resection.

[Long-Term Disease-Free Survival after Chemoradiotherapy for Postoperative Local Recurrence of Rectal Cancer-A Case Report].

We report a case of a 63-year-old man with a perirectal abscess due to rectal cancer referred to us from another clinic. We performed 3 courses of preoperative chemotherapy using mFOLFOX6 and then performed a Miles operation plus D3 dissection followed by reconstruction of an artificial anus using the ileum. The pathological diagnosis was tub2, pAI(prostate), pN0 (0/12), ND(v+), and fStage Ⅲa. Dehiscence of the perineum wound area occurred 4 months after surgery, for which drainage was required. Local recurrence was then discovered by cytology. We administered mild 40 Gy radiation and chemotherapy using Bmab combined with mFOLFOX6. CT scans showed a significant reduction in the tumor and the tumor marker levels returned to within normal ranges. We then converted to Pmab plus FOLFIRI, which has been administered bimonthly for 3 years to date. The overall chemoradiotherapy duration has been about 5 years. Follow-up imaging findings continue to show sustained remission.

[A case of advanced gastric cancer with giant lymph node metastasis responding to S-1/CDDP neoadjuvant chemotherapy].

The patient was a 66-year-old man with advanced gastric cancer and bulky lymph node metastases. Since a radical resection appeared impossible, we tried neoadjuvant chemotherapy (NAC) with S-1/CDDP, expecting down staging of the tumor. S-1 (120 mg/body) was orally administered for 21 days and CDDP (40 mg/body) was administered by intravenous drip on day 8, 15 and 22. Partial response (PR) was obtained after 2 courses, and distal gastrectomy with D2 lymph node dissection was performed. The histological diagnosis revealed complete disappearance of cancer cells in stomach and a few regional lymph node metastasis (3/30). The patient was administered S-1 for one year after operation, and he is well without recurrence at one year and four months postoperatively. We considered the S-1 and CDDP in combination useful as preoperative chemotherapy for advanced gastric cancer.

Ductal carcinoma in situ arising in a benign phyllodes tumor: report of a case.

Malignant epithelial change within a phyllodes tumor (PT) is a rare event. To our knowledge, only six cases of ductal carcinoma in situ arising in a PT have been reported in English. We report a case of PT with an intraductal carcinoma component, which grew rapidly to a huge size in 3 months. Histologically, the stromal element showed mild to moderate cellularity with few mitoses and mild nuclear atypia. The epithelial element consisted of irregularly dilated ducts with a phyllodes structure that had moderate to severe epithelial hyperplasia, and foci of cribriform ductal carcinoma in situ with comedo necrosis.

[Chemoradiotherapy of unresectable and recurrent cholangiocarcinoma].

UNLABELLED: This study is for chemoradiotherapy of unresectable and recurrent cholangiocarcinoma (CCC). SUBJECTS AND METHODS: Between April 2005 and March 2007, 5 patients were evaluated for unresectable and recurrent CCC. All patients were performed percutaneous transhepatic biliary drainage (PTBD) and treated with chemoradiotherapy. The radiation method was an external beam radiotherapy (EBRT) and remote after loading system (RALS). The chemotherapy was 5-FU and gemcitabine by intravenous injection. RESULTS: Three patients had unresectable and 2 had recurrent CCC. As for the side effects, 4 patients had a slight neutropenia and 1 had an uncontrollable gastric bleeding. No patient had cholangitis. The mean survival time for unresectable and recurrent CCC was 13.7 months and 17 months, respectively. CONCLUSIONS: Our results indicated that chemoradiotherapy had been consistent with efficacy in patients with unresectable and recurrent CCC.

Endoluminal ultraflex stent for palliative treatment of malignant rectosigmoidal obstruction.

Rectosigmoidal obstruction due to a malignant tumor usually requires emergency surgical treatment, and colostomy is usually inevitable. This report describes our experience with the use of endoluminal self-expanding metallic stents in the treatment for rectosigmoidal obstruction in patients with unresectable recurrent colorectal cancer or intra-abdominal dissemination. A total of 5 cases were included (4 male and 1 female) with a mean age of 70.8 (range, 63-80) years. A self-expanding noncovered Ultraflex, 10 cm in length and 22 mm in diameter, was emplaced at the site of the obstruction under both endoscopic and fluoroscopic guidance. Each patient had a recurrent malignancy (colorectal cancer, 3; ovarian cancer, 1; gastric cancer, 1). No subsequent surgery was planned due to ascites or extensive intra-abdominal dissemination. There was no mortality related to the procedure. Immediate decompression with symptomatic relief was achieved. One stent later became obstructed due to tumor ingrowth, and in two cases there was intermittent bleeding from the tumor and these were treated by argon plasma coagulation (APC) endoscopically. The use of self-expanding Ultraflex stent provides good palliation for unresectable advanced tumors that cause left colonic obstruction.

Transanal dilation using circular stapling for benign rectal stenosis: report of a case.

When a simple procedure such as bougie, balloon dilation and transanal incision are not effective for severe stenosis after colorectal anastomotic leakage, a surgical operation is required. We report a case of transanal dilation using circular stapling for severe stricture in the colorectal anastomosis following low anterior resection.

Laparoscopic intraperitoneal repair of postoperative ventral incisional hernia using Composix mesh.

This report describes the technique and early results obtained with a simple laparoscopic intraperitoneal onlay Composix mesh repair for postoperative ventral hernia. Composix mesh is constructed from one layer of polypropylene mesh and another layer of expanded polytetrafluoroethylene (ePTFE). From March 2000 to October 2001, we performed laparoscopic repair of postoperative ventral hernia in 9 patients. Four (44%) of these patients had a history of at least one failed hernia repair. The size of the abdominal wall defect varied from 4 x 5 cm to 10 x 12 cm (median, 8 x 9 cm). In all cases, the Composix mesh (Bard Inc. USA) was stapled to the peritoneal surface of the abdominal wall, leaving the sac in situ. No death occurred as a result of surgery. Intraoperative small bowel injury occurred in one patient (11.1%) for whom surgery was converted to laparotomy and small bowel resection. No infection was observed. The length of hospital stay varied from 5 to 10 days (median, 5.6 days). During the follow-up period of 8 to 15 months (median, 2 months), there was no recurrence of hernia. Laparoscopic Composix mesh onlay repair is a safe, easy, and effective procedure with minimal discomfort and a low early recurrence rate.