[A Case of Multiple Liver Metastases of Mixed Adenonuroendocrine Carcinoma of the Ascending Colon with Poor Prognosis].

An 84-year-old woman presented with anorexia. CT showed ascending colon and multiple liver tumors, and a colonoscopy showed severe stenosis due to a tumor in the ascending colon. We diagnosed obstructive colon cancer with multiple liver metastases. It was difficult to approach this case with a colonic stent, and we suggested a colostomy, but the patient strongly objected and requested to undergo resection; thus, a laparoscopic right hemicolectomy was performed. Intraoperatively, there was no normal liver tissue, and liver metastases were diffuse. Histopathologically, neuroendocrine carcinoma and differentiated tubular adenocarcinoma were found; MANEC was diagnosed. Oral intake was started on the third postoperative day, but liver failure progressed gradually. Despite the best supportive care and medication, the patient died of liver failure 16 days after surgery. We report our experience of a MANEC case with a poor prognosis along with a literature review.

[A Case Report of Recurrence on Umbilical Port Site and Ileum Close to Anastomotic Portion after Laparoscopic Ileocecal Resection for Cecal Cancer].

We report a case of recurrence on umbilical port site and ileum close to anastomotic portion after laparoscopic ileocecal resection for cecal cancer. A 62-year-old woman was diagnosed as cecal cancer and performed ileocecal resection with D3 lymphadenectomy. One year and half after surgery, recurrence on umbilical port site and ileum close to anastomotic portion was detected with computed tomography and positron emission tomography. Chemotherapy(CAPOX plus Bmab)was performed. As a result of partial response, we performed resection of umbilical portion and anastomotic portion. Adjuvant chemotherapy was not performed. Neither recurrence or metastasis have been detected until 10 months after surgery.

[A Case of Gastric Perforation Due to an Unresectable Advanced Gastric Cancer That Achieved pCR after Conversion Surgery following SOX plus T-mab Therapy].

This case pertains to a 72-year-old man who visited the emergency department with a complaint of upper abdominal pain. On examination, we suspected gastric perforation due to gastric cancer and decided to perform emergency surgery. We performed laparoscopic omentoplasty and collected #4d lymph nodes that were enlarged on CT. The pathological diagnosis was lymph node metastasis. Based on CT findings, we determined it was Bulky N. For initial management, we performed 3 preoperative chemotherapy(SOX therapy)courses and staging laparoscopy. On surgery, extensive disseminated nodules on the abdominal wall, stomach wall, and liver surface were found, and ascites cytology revealed positive findings. Therefore, we did not perform primary lesion resection. Although the disseminated nodule did not pathologically show tumor cells, CY1 was found, resulting to a diagnosis of unresectable gastric cancer. Since the tumor was HER2 3+, we initiated SOX/trastuzumab therapy. After 16 courses, staging laparoscopy was performed as the lymph nodes had shrunk significantly. The results showed no tumor cells in ascites and the disseminated nodules, and laparoscopic total gastrectomy was subsequently performed. Pathological findings showed no tumor cells in the primary lesion or lymph nodes; therefore, a diagnosis of pathological complete response was made. Currently, the patient is alive without recurrence for 6 months after surgery.

[A Case in Which the ICG Fluorography Was Useful for Detecting Minute Peritoneal Disseminations].

A 65-year-old man was emergently brought to our hospital because of rupture of 10 cm hepatocellular carcinoma(HCC) at left lobe in September 2019. He underwent selective transcatheter arterial embolization(TAE)for hemostasis. Enhanced computed tomography(CT)revealed one more 26 mm HCC at segment 8(S8)in addition to the ruptured HCC. Transcatheter arterial chemoembolization(TACE)was performed for both tumors. HCC at left lobe was resistant to TACE, hence we performed left hepatectomy. During the surgery we searched for peritoneal dissemination by using indocyanine green(ICG) fluorography and found 4 nodules with ICG accumulation in the omentum. All the nodules were pathologically diagnosed as peritoneal dissemination. We reported a case in which the ICG fluorography was very useful for detecting small peritoneal disseminations.

[A Case of Ileus Due to Colon Cancer with Non-Occlusive Mesenteric Ischemia].

Abdominal computed tomography(CT)revealed ileus due to sigmoid colon cancer in a 68-year-old man with abdominal pain, and endoscopic decompression using a transanal ileus tube was attempted. The blood test on the following day showed a marked increase in CRP 46.13mg/dL. Abdominal contrast CT was performed, and mesenteric ischemia was confirmed. Emergency surgery was performed on the same day. The ileum, and ascending, transverse, and descending colon appeared mottled and necrotic and were excised. A specialized diet started on the 5th postoperative day, and parenteral nutrition was used for a long period of time, due to the possibility of short bowel syndrome. The ileostomy and colostomy was closed 57 days after the operation. The patient finished parenteral nutrition on the 88th postoperative day without obvious nutritional absorption disorder and was discharged on the 94th postoperative day as oral intake only. We reported a case of ileus due to colon cancer with non-occlusive mesenteric ischemia(NOMI).

[A Case Report of Appendiceal Cancer Complicated Appendicitis Treated with Single-Incision Laparoscopic Ileocecal Resection].

We report a case of appendicitis with an abscess that was treated with single-incision laparoscopic ileocecal resection with D2 lymphadenectomy because of intraoperative suspicion of appendiceal cancer. A 73-year-old woman was admitted to the hospital because of right lower abdominal pain. She was diagnosed with appendicitis with an abscess. Although single-incision laparoscopic appendectomy was planned, appendiceal cancer was suspected from intraoperative findings. Therefore, we performed single-incision laparoscopic ileocecal resection with D2 lymphadenectomy. The pathological result was moderately differentiated adenocarcinoma in the appendix. Because of the high risk of fStage II appendiceal cancer, adjuvant chemotherapy was administered. Neither recurrence nor metastasis have been detected 7 months after surgery.

[A Case of Gastric GIST with Pathological Complete Response Achieved by Long-Term Chemotherapy with Imatinib Mesylate].

A 78-year-old woman was diagnosed with a gastrointestinal stromal tumor(GIST)of the stomach, gradually increasing from 5 years prior. The tumor was suspected to invade the pancreatic body tail and spleen, as observed with computed tomography. Because the patient refused to undergo resection, we administered imatinib mesylate for 6 years. Since early rectal cancer was revealed, the patient was referred for resection and underwent laparoscopic low anterior resection and partial gastrectomy. Histopathologically, the tumor was replaced by tissues with myxomatous changes, and no viable tumor cells were detected. This was a rare case of GIST, resected after long-term chemotherapy by imatinib mesylate, and pathological complete response was achieved.

[A case report of a patient with overlap syndrome systemic lupus erythematosus( SLE) and polymyositis( PM)whose condition improved following treatment for coexisting descending colon cancer].

Here, we report a case of a patient with overlap syndrome (systemic lupus erythematosus[SLE]and polymyositis[PM]) whose condition improved following treatment for coexisting descending colon cancer. A 75-year-old man experienced Raynaud symptoms and arthralgia. He was diagnosed as having overlap syndrome (SLE/PM) and was treated with steroids. However, the symptoms did not improve. Descending colon cancer was diagnosed by colonoscopy. After surgery, overlap syndrome improved immediately. Overlap syndrome was considered as a paraneoplastic event caused by the coexisting descending colon cancer.

[Two cases of advanced gastric cancer with peritoneal dissemination, and Virchow's metastases successfully treated by combination therapy of S-1 and docetaxel].

We report two cases of advanced gastric cancer successfully treated with combination S-1 and docetaxel (DOC) therapy. Case 1: A 43-year-old woman underwent radical total gastrectomy for advanced type 4 gastric cancer one and a half years ago. She was diagnosed as peritonitis carcinomatosa with much ascites, so the following combination chemotherapy was started. Case 2: A 53-year-old man underwent palliative gastrectomy for advanced type 3 gastric cancer with multiple lymph node metastases involving Virchow's metastases. After surgery, he received the following combination chemotherapy: DOC at the starting dose of 40 mg/m2 by iv infusion over 1 hour on day 1 and S-1 at the full dose of 80 mg/m2 daily for two weeks every three weeks. After administration of this combination therapy, the Case 1 gastric cancer with much ascites and the Case 2 gastric cancer with multiple lymph nodes metastases had entirely disappeared. Thereafter the 2 cases received therapy with S-1 alone. No recurrence in Case 1 has been seen with S-1 chemotherapy. Case 2 revealed a few lymph node swellings in the abdominal cavity, so he is undergoing combination therapy of DOC and S-1. The combination DOC and S-1 show a high degree of safety and can be a new tool for the management of advanced gastric cancer with peritoneal dissemination and Virchow's metastases.

Initial Report: A Novel Intraoperative Navigation System for Laparoscopic Liver Resection Using Real-Time Virtual Sonography.

Recent progress in navigation has revealed problems involving non-rigid registration for hepatic surgery. With the increasing popularity of laparoscopic liver surgery, a new laparoscopic navigation system is necessary. This study involved an in-vitro demonstration of a 3-dimensional printer model and in vivo demonstration in four patients. For the in vitro examination, a position detecting unit attached at 33 cm and 13 cm distance conditions from the tip of the electrocautery was examined eight times at the marked points on the liver surface eight times respectively. The differences between the simulation and the authentic dissecting plane were conventionally investigated in vivo. In vitro, the errors of the 33 cm and 13 cm distance model were7.8 ± 3.5 mm (mean ± SD), and 3.3 ± 1.0 mm, respectively. The mean differences of the dissection plane were within 10 mm. The potentiality and safety of the novel navigation system was confirmed, although further investigation is recommended.

MicroRNA-6826 and -6875 in plasma are valuable non­invasive biomarkers that predict the efficacy of vaccine treatment against metastatic colorectal cancer.

Various vaccine treatments against metastatic colorectal cancer have been developed and applied. However, to improve the efficacy of immunotherapy, biomarkers that can predict the effects are needed. It has been reported that various microRNAs (miRNAs) in peripheral blood may be useful as non-invasive biomarkers. In this study, miRNAs influencing the efficacy of vaccine treatment were screened for in a microarray analysis of 13 plasma samples that were obtained from patients prior to vaccine treatment. To validate the screening results, real-time RT-PCR was performed using 93 plasma samples obtained from patients prior to vaccine treatment. Four candidate miRNAs were selected according to the results of the comprehensive analysis of miRNA expression, which were ranked using the Fisher criterion and the absolute value of the log2 ratio in the screening analysis. The validation analysis showed that in the HLA-A*2402­matched patient group (vaccine-treated group), patients with a high expression of plasma miR-6826 had a poorer prognosis than those with a low expression (P=0.048). In contrast, in the HLA-A*2402-unmatched patient group (control group), there was no difference between the patients with high or low plasma miR-6826 expression (P=0.168). Similar results were obtained in the analysis of miR-6875 (P=0.029 and P=0.754, respectively). Moreover, multivariate analysis of the Cox regression model indicated that the expression of miR-6826 was the most significant predictor for overall survival (P=0.003, hazard ratio, 3.670). In conclusion, plasma miR-6826 and miR-6875 may be predictive biomarkers for a poor response to vaccine treatment. Although further clarification is needed regarding the functions of miR-6826 and miR-6875 and their relationship to immune­related molecules, plasma miR-6826 and miR-6875 may be useful negative biomarkers for predicting the efficacy of vaccine treatment.