RESUMO
BACKGROUND: Although proximal gastrectomy (PG) with the double-flap technique (DFT) is a function-preserving surgery that prevents esophagogastric reflux, there is a risk of developing metachronous remnant gastric cancer (MRGC). Moreover, details of MRGC and appropriate postoperative follow-up after PG with DFT are unclear. METHODS: We reviewed the medical records of 471 patients who underwent PG with DFT for cancer in a preceding, multicenter, retrospective study (rD-FLAP Study). We investigated the incidence of MRGC, frequency of follow-up endoscopy, and eradication of Helicobacter pylori (H. pylori) infection. RESULTS: MRGC was diagnosed in 42 (8.9%) of the 471 patients, and 56 lesions of MRGC were observed. The cumulative 5- and 10-year incidence rates were 5.7 and 11.4%, respectively. There was no clinicopathological difference at the time of primary PG between patients with and without MRGC. Curative resection for MRGC was performed for 49 (88%) lesions. All patients with a 1-year, follow-up, endoscopy interval were diagnosed with early-stage MRGC, and none of them died due to MRGC. Overall and disease-specific survival rates did not significantly differ between patients with and without MRGC. The incidence rate of MRGC in the eradicated group after PG was 10.8% and that in the uneradicated group was 19.6%, which was significantly higher than that in patients without H. pylori infection at primary PG (7.6%) (p = 0.049). CONCLUSIONS: The incidence rate of MRGC after PG with DFT was 8.9%. Early detection of MRGC with annual endoscopy provides survival benefits. Eradicating H. pylori infection can reduce the incidence of MRGC.
Assuntos
Infecções por Helicobacter , Helicobacter pylori , Segunda Neoplasia Primária , Neoplasias Gástricas , Humanos , Incidência , Estudos Retrospectivos , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/cirurgia , Neoplasias Gástricas/patologia , Segunda Neoplasia Primária/epidemiologia , Segunda Neoplasia Primária/cirurgia , Segunda Neoplasia Primária/patologia , Gastrectomia/efeitos adversos , Infecções por Helicobacter/complicações , Infecções por Helicobacter/epidemiologia , Infecções por Helicobacter/diagnóstico , Estudos Multicêntricos como AssuntoRESUMO
Oral uracil and tegafur plus Leucovorin(UFT/LV)therapy is one of the standard adjuvant chemotherapies for colorectal cancer, and is widely used without any serious adverse events. Herein, we describe a case of UFT/LV-induced acute liver failure in a 75-year-old woman who underwent laparoscopic sigmoidectomy for sigmoid colon cancer. She was diagnosed with advanced colon cancer and lymph node metastasis by postoperative histopathological analysis, and adjuvant chemotherapy was initiated. After 30 days of commencing the therapy, the patient visited our hospital with complaints of severe diarrhea and difficulty in food intake. The apparent cause of these symptoms was unclear on computed tomography(CT), and mild liver damage was revealed in blood test results. The hepatic disorder gradually progressed after the hospitalization, and the condition was diagnosed as acute hepatic insufficiency. Additionally, obvious atrophy of the liver parenchyma and significant ascites were confirmed on CT. Two months later, the platelet count decreased markedly, but fortunately, no bleeding occurred. There has been no recurrence since 2 years after the surgery without any additional adjuvant therapy.
Assuntos
Falência Hepática Aguda , Neoplasias do Colo Sigmoide , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Feminino , Humanos , Leucovorina/uso terapêutico , Falência Hepática Aguda/tratamento farmacológico , Neoplasias do Colo Sigmoide/tratamento farmacológico , Neoplasias do Colo Sigmoide/patologia , Neoplasias do Colo Sigmoide/cirurgia , Tegafur/efeitos adversos , Uracila/efeitos adversosRESUMO
The patient was a 59-year-old man with type 2 advanced gastric cancer in the antrum. Abdominal computed tomography revealed the primary tumor with regional lymph node metastasis. Distal gastrectomy and D2 lymph node dissection were performed. Histopathological findings indicated gastric small cell carcinoma. Lymph node metastasis was observed microscopically in the #6 lymph nodes. Peritoneal lavage cytology was positive. The pathologic stage of the disease was pT2(MP), med, INF b, ly2, v2, pPM0, pDM0, pN2(6/33: #5, #6), M1, P0, CY1, H0, stage â £, R1(cy+). After surgery, he received chemotherapy with capecitabine plus oxaliplatin. However, after 1 course of therapy the disease had progressed, and the patient was diagnosed with peritoneal metastasis. Chemotherapy of CDDP plus CPT-11 was initiated, and after 5 courses the patient died.
Assuntos
Carcinoma de Células Pequenas , Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma de Células Pequenas/tratamento farmacológico , Carcinoma de Células Pequenas/patologia , Carcinoma de Células Pequenas/cirurgia , Cisplatino , Combinação de Medicamentos , Gastrectomia , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Ácido Oxônico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgia , TegafurRESUMO
Laparoscopy and endoscopy cooperative surgery(LECS)is the surgical procedure used to avoid excessive resection of the gastrointestinal wall and preserve its function. We report the case of a patient who was successfully treated with inverted LECS for gastrointestinal stromal tumor(GIST)in the remnant stomach and underwent distal gastrectomy. The patient was a 75- year-old man who received distal gastrectomy for gastric ulcer 28 years before. Three years before he was diagnosed as having gastric submucosal tumor(SMT)as a gastrointestinal tumor(GIST)by using EUS. As the tumor increased, he was admitted to our hospital. Upper gastrointestinal endoscopy revealed a 30mm SMT just below the cardiac part of the remnant stomach. Biopsy by EUS-FNA revealed CD34(-), c-kit(+), S-100(-), and a-SMA(-), which indicated gastric GIST. Inverted LECS was performed. His postoperative course was good, and he was discharged from the hospital 9 days after the surgery.
Assuntos
Coto Gástrico , Tumores do Estroma Gastrointestinal , Laparoscopia , Neoplasias Gástricas , Idoso , Gastrectomia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Masculino , Neoplasias Gástricas/cirurgiaRESUMO
We compared the utility of self-expandable metallic stents (SEMS) to that of colostomy in palliative care patients with malignant colorectal obstruction. The SEMS-related morbidity and mortality rates were 15.4% and 7.7% in 13 patients, respectively. The median time to first diet was significantly shorter after SEMS insertion than that after colostomy, (2 vs 6 days, respectively, p=0.0102). The postprocedure median length of hospital stay of the palliative care patients without followed chemotherapy was shorter after SEMS insertion than after colostomy (10 vs 23 days, respectively). The median time to chemotherapy administration was shorter after SEMS insertion than after colostomy (13 vs 29 days, respectively); however, this difference was not statistically significant. Insertion of SEMS should be considered as the first-line treatment for palliative care patients with malignant colorectal obstruction.
Assuntos
Neoplasias Colorretais/complicações , Obstrução Intestinal/terapia , Cuidados Paliativos , Stents , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Obstrução Intestinal/etiologia , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
A 71-year-old man visited our hospital because ofepigastralgia and anorexia. Upper gastrointestinal endoscopy revealed type 1 gastric cancer. Contrast-enhanced abdominal CT revealed gastric wall thickening in the midgastric region and direct invasion ofthe transverse colon. CT findings also revealed a suspicion ofdissemination on the omentum and para-aortic lymph node swelling. We diagnosed gastric cancer with transverse colon invasion. Therefore, we performed distal gastrectomy with transverse colectomy and D2+No.16b1 lymph node dissection after obtaining patient consent. We observed direct tumor invasion into the transverse colon and seeding nodules on the omentum. Liver metastasis was not seen, and ascitic cytology was negative. He was discharged 16 days postoperatively, without any complications. Histopathological analysis revealed poorly differentiated adenocarcinoma and gastrocolic fistula. Postoperatively, S-1 was administered for 4 years as adjuvant chemotherapy. There has been no recurrence for 9 years after surgery.
Assuntos
Colo Transverso , Neoplasias Gástricas , Idoso , Colo Transverso/diagnóstico por imagem , Colo Transverso/patologia , Colo Transverso/cirurgia , Intervalo Livre de Doença , Gastrectomia , Humanos , Excisão de Linfonodo , Metástase Linfática , Masculino , Invasividade Neoplásica/diagnóstico por imagem , Neoplasias Gástricas/patologia , Neoplasias Gástricas/cirurgiaRESUMO
A79 -year-old woman underwent colonoscopic examination for positive occult blood. Aneoplastic lesion was seen in the orifice of the vermiform appendix. She was referred to our hospital and underwent colonoscopic examination again. The biopsy revealed poorly differentiated adenocarcinoma or mixed adenoneuroendocrine carcinoma(MANEC), and she was diagnosed with carcinoma of the appendix. She was treated by laparoscopic ileocecal resection with lymph node dissection (D3). Histopathological examination revealed goblet cell carcinoid(GCC)of the appendix with serosal invasion. No metastasis was detected in the dissected lymph nodes. This patient has been followed-up for 6 months after surgery and no recurrences have been detected.
Assuntos
Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Tumor Carcinoide/cirurgia , Ceco/cirurgia , Íleo/cirurgia , Idoso , Colectomia , Colonoscopia , Feminino , Humanos , Laparoscopia , Sangue Oculto , Resultado do TratamentoRESUMO
A 25-year-old woman presented to our hospital with left flank pain and diarrhea. Contrast-enhanced abdominal computed tomography(CT)showed a target sign in the descending colon. She was diagnosed with intussusception of the colon. Colonoscopy revealed a tumor at the splenic flexure. We performed surgery and found an invaginated transverse colon at the splenic flexure. Reduction was unsuccessful with Hutchinson's maneuver, and we performed partial resection of the invaginated colon. Histopathological diagnosis was adenocarcinoma, tub1, SM2. Adult intussusception is uncommon, especially in young adults. It is usually caused by a polyp or tumor. We report a case of intussusception caused by colon cancer in a young female patient, and review the literature.
Assuntos
Adenocarcinoma , Colo Transverso/patologia , Neoplasias do Colo/patologia , Intussuscepção/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/cirurgia , Adulto , Colo Transverso/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Colonoscopia , Feminino , Humanos , Resultado do TratamentoRESUMO
Combined modality therapy is sufficient to treat advanced rectal cancer with multiple metastases. Her, we report a case of long-term survival in a patient with multiple metastases from rectal cancer. A5 8-year-old man had previously undergone low anterior resection for advanced rectal cancer. Multiple liver and lung metastases were identified prior to operation; therefore, we initiated chemotherapy(FOLFOX). Partial resection of metastatic lesions and radiofrequency ablation(RFA)were also administered, but newly developed liver, lung, and adrenal gland metastases were identified. We changed the chemotherapy regimen and administered topical therapies(partial resection, RFA, hepatic arterial infusion chemotherapy, radiotherapy)for each chemotherapy-refractory metastatic lesion. Although the patient is in a tumor-bearing state, he is still alive 10 years after his first operation. This combined modality therapy is an option for patients with chemotherapy-refractory metastases from rectal cancer.
Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Hepáticas/terapia , Neoplasias Pulmonares/terapia , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Adenocarcinoma/secundário , Terapia Combinada , Hepatectomia , Humanos , Neoplasias Hepáticas/secundário , Neoplasias Pulmonares/secundário , Masculino , Pessoa de Meia-Idade , Pneumonectomia , Fatores de TempoRESUMO
We report a rare case of metastatic colon cancer that occurred after gastric cancer surgery. The patient was a 63-year- old man who had received distal gastrectomy for type 2 advanced gastric cancer, which was a moderately differentiated adenocarcinoma, pT4a (SE),pN0, P0, CY0, M0, and Stage IIB. He was treated with S-1 for 1 year after the operation. However, levels of CA19-9 gradually increased postoperatively. Subsequently, 2 years and 10 months after the operation, computed tomography indicated a mass in the transverse colon. Colonoscopy showed half-circumferential stenosis in the transverse colon. The histopathological diagnosis was metastasis of gastric cancer. We performed right-hemicolectomy. Histopathology showed a moderately or poorly differentiated adenocarcinoma, which was colonic metastasis of the gastric cancer. After the operation, he was treated with paclitaxel weekly. Our findings suggest that after surgery for gastric cancer, it is worthwhile to monitor for metastatic colorectal cancer.
Assuntos
Adenocarcinoma/cirurgia , Neoplasias do Colo/cirurgia , Neoplasias Gástricas/patologia , Adenocarcinoma/secundário , Neoplasias do Colo/secundário , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Recidiva , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia , Resultado do TratamentoRESUMO
PURPOSE: Peritoneal dissemination is the most frequent and life-threatening mode of metastasis and recurrence in patients with gastric cancer. A multicenter phase II study was designed to evaluate the efficacy and tolerability of S-1 and docetaxel combination chemotherapy regimen for the treatment of advanced or recurrent gastric cancer patients with peritoneal dissemination. METHODS: Nineteen patients with histologically confirmed unresectable or recurrent gastric cancer with peritoneal dissemination were enrolled. Oral S-1 at 80 mg/m(2)/day was administered twice daily for 2 weeks, followed by 1 drug-free week. Docetaxel infusion at 40 mg/m(2) was performed on day 1, simultaneous with S-1 administration. The primary endpoints were overall survival (OS) and time to progression (TTP). The secondary endpoints were the response rates and safety status. RESULTS: Patients received a median of 4 cycles of the S-1 and docetaxel regimen (range 1-43). The disease control rate was 73.7 % (14/19). Median overall survival was 459 days (15.3 months), while median time to progression was 212 days (7.1 months). Neutropenia was the most common type of toxicity (n = 7, 36.8 %). CONCLUSIONS: Combination chemotherapy with S-1 and docetaxel is a tolerable and effective treatment for advanced or recurrent gastric cancer patients with peritoneal dissemination.