[A Study of the Usefulness of Decompression in Treating Bowel Obstruction Due to Colorectal Cancer].

OBJECTIVE: To determine whether to perform decompression prior to resection in cases of bowel obstruction due to colorectal cancer. SUBJECTS: There were 83 patients who underwent resection to treat a bowel obstruction due to colorectal cancer from January 2006 to August 2016. Clinical aspects and the prognosis for colorectal cancer were examined in patients who underwent decompression prior to resection and those who did not. RESULTS: Of the 83 patients, 50 underwent decompression whereas 33 did not. Patients who did not undergo decompression most often had cancer in the right colon. Surgery took longer for patients who underwent decompression; some had extensive blood loss. Patients who underwent decompression were hospitalized for significantly longer. Patients who did not undergo decompression with an obstruction of the left colorectum due to cancer had more severe complications. DFS and OS did not differ significantly in patients with a bowel obstruction due to colorectal cancer. OS did not differ significantly for patients with an obstruction of the left colorectum due to cancer, but DFS was better for patients who underwent decompression. CONCLUSION: Patients with an obstruction of the left colorectum due to cancer should undergo decompression prior to resection.

[Complete response in a case of anastomotic recurrence of rectal cancer treated with S-1 monotherapy].

A 63-year-old woman underwent a low anterior resection for rectal cancer in 2002.A n anastomotic recurrence was diagnosed in July 2011.S he rejected the possibility of colostomy as radical surgery.Chemotherapy consisting of capecitabine+ oxaliplatin (XELOX) or folinic acid, fluorouracil, and oxaliplatin (FOLFOX6) + bevacizumab were not possible because of high costs. In view of the lower costs and the potential for ambulation, S-1 monotherapy was started. After 3 months, a reduction in the recurrent lesion was observed.After 19 months, the recurrent lesion revealed a scar, which was judged by biopsy to be Group 1.We had achieved a pathological complete response (CR).The standard treatment for recurrent colon cancer is surgical resection or multidrug chemotherapy. However, in view of a patient's quality of life (QOL), S-1 monotherapy may be considered as a potential therapy.

Acute limb ischemia by a pulmonary vein stump thrombus after left lower lobectomy: a case report.

BACKGROUND: Cases of systemic thromboembolism due to thrombus formation in the pulmonary vein stump after lobectomy have been reported recently. Cerebral infarction after left upper lobectomy is a common symptom in these cases. We encountered a rare case of acute limb ischemia caused by a thrombus formed in the left inferior pulmonary vein stump after left lower lobectomy. CASE PRESENTATION: A 62-year-old man underwent video-assisted left lower lobectomy under general anesthesia with epidural anesthesia. On postoperative day 2, he suddenly developed pain in the left calf. Contrast-enhanced computed tomography showed left popliteal artery occlusion and thrombus formation in the left inferior pulmonary vein stump. Anticoagulant therapy was started immediately, and emergent endovascular thrombectomy was performed. The patient recovered without complications. CONCLUSIONS: Left lower lobectomy can cause thrombus formation in the pulmonary vein stump, leading to systemic thromboembolism. Early detection and treatment are the keys to minimize complications.

[A case of multiple liver and celiac lymph node metastases after curative esophagectomy for esophageal cancer successfully treated with hepatic arterial infusion and radiation therapy].

A 65-year-old woman, who had been operated by subtotal esophagectomy for esophageal cancer, was diagnosed as multiple liver metastases and celiac lymph node metastases one year after operation. The response evaluation revealed progressive disease after she had been suffering from nausea and anorexia throughout 2 courses of FP therapy. She refused to continue any more systemic chemotherapy, so we proposed an alternative to her, hepatic arterial infusion chemotherapy (HAI) for multiple liver metastases and radiation therapy for celiac LN metastases. Despite the marked reduction of all target lesions and maintenance of tumor marker level below the normal limits after 50 Gy of irradiation and 5 courses of HAI, a novel solitary tumor had appeared in S3 of the liver and an abdominal pain during HAI had occurred at the end of 5th course of HAI. The angiogram revealed occlusion of hepatic artery, suggesting that the emergence of new lesion was attributed to unequal distribution of the drug. Six weeks after a cessation of HAI, a subsequent CT scan showed a rapidly enlarged new lesion in S3, so that a surgical resection for this tumor was performed. The patient is alive without recurrence more than 10 months after the diagnosis of multiple liver metastases (2 months after the last surgery).

A phase II randomized trial of adjuvant chemotherapy with S-1 versus S-1 plus cisplatin for completely resected pathological stage II/IIIA non-small cell lung cancer.

OBJECTIVES: Platinum-based combination chemotherapy is the standard postoperative adjuvant treatment for pathological stage II/III non-small cell lung cancer (NSCLC). Oral S-1 therapy has good efficacy and relatively low toxicity for the treatment of advanced NSCLC. We investigated whether long-term S-1 monotherapy is also useful as an adjuvant therapy after surgery in patients with NSCLC. PATIENTS AND METHODS: We conducted a phase II randomized open-label multi-institutional study in patients with pathological stage II/IIIA NSCLC (7th TNM classification) who underwent complete resection from 2009 to 2013. The primary endpoint, the 2-year disease-free survival (DFS) rate, was evaluated using the Bayesian method. Eligible patients were randomly assigned to two arms: oral S-1 monotherapy (S-1 arm) and S-1 plus cisplatin combination therapy followed by S-1 (S-1 plus cisplatin arm) both for a total of 1 year. RESULTS: A total of 70 and 71 patients were enrolled in S-1 arm and S-1 plus cisplatin arm, respectively. The 2-year DFS rates were 52% (95% confidence interval [CI], 0.40-0.63) and 61% (95% CI, 0.48-0.70) for S-1 arm and S-1 plus cisplatin arm, respectively. Both arms met the primary endpoint. Neither DFS nor OS was significantly different between the arms (log-rank test: P = 0.1695 and P = 0.8684, respectively). The main G3/4 adverse events were loss of appetite and anemia (S-1 vs. S-1 plus cisplatin: 4.3% vs. 11.6% and 0% vs. 5.8%, respectively). The treatment completion rate did not differ between the two arms (S-1 vs. S-1 plus cisplatin: 45.7%, 95% CI, 41.9-66.3% vs. 43.5% 95% CI, 44.0-68.4%). CONCLUSIONS: Long-term adjuvant chemotherapy with S-1 was a feasible and promising treatment for patients with completely resected NSCLC, regardless of cisplatin addition. S-1 monotherapy should be investigated further, based on its low toxicity and practical convenience.