Successful open radical gastrectomy for locally advanced or metastatic gastric cancer patients who suffered from coronavirus disease 2019 during preoperative chemotherapy: a report of three cases.

BACKGROUND: According to previous reports, in patients with preoperative coronavirus disease 2019 (COVID-19) infection, mortality is increased if they undergo surgery within 6 weeks of diagnosis. However, the optimal timing and preoperative examination for gastrectomy with a previous COVID-19 infection are still controversial. We experienced three cases in which patients successfully underwent open radical gastrectomy following preoperative chemotherapy even though they developed COVID-19 infection during the chemotherapy. CASE PRESENTATION: Case 1: A 58-year-old man with locally advanced gastric cancer caught COVID-19 during preoperative chemotherapy comprising 5-fluorouracil, calcium folate, oxaliplatin, and docetaxel. Although the patient had specific lung shadows indicating COVID-19 infection and deep venous thrombosis in the lower extremities, he underwent distal gastrectomy 10 weeks after the COVID-19 diagnosis. He had a good postoperative course. Case 2: A 56-year-old man with gastric cancer and lymph node and peritoneal metastasis caught COVID-19 during palliative chemotherapy comprising S-1, oxaliplatin, and trastuzumab. He underwent total gastrectomy as conversion surgery 8 weeks after COVID-19 infection. His postoperative course was uneventful. Case 3: A 55-year-old man with gastric cancer and paraaortic lymph node and liver metastases caught COVID-19 during S-1 and oxaliplatin treatment as neoadjuvant chemotherapy. He underwent distal gastrectomy, paraaortic lymph node sampling, and partial hepatectomy 8 weeks after COVID-19 infection although he had residual lung shadows and deep venous thrombosis in the lower extremities. He had an uneventful postoperative course. CONCLUSIONS: Computed tomography for preoperative evaluation was performed for all three patients and revealed that lung shadows remained post-COVID-19 infection. Despite this finding, the patients had good operative courses and were discharged as planned. Surgery after 7 weeks from the diagnosis of COVID-19 infection can be performed safely even when patients are post-chemotherapy and have residual lung findings and deep venous thrombosis. This report may contribute to the development of a consensus on performing safe gastrectomy for advanced gastric cancer in patients previously infected with COVID-19.

Impact of preoperative endoscopy for predicting treatment response and prognosis in patients with gastric cancer after neoadjuvant chemotherapy.

Background and study aims Response evaluation criteria in solid tumors (RECIST) have been the gold standard to preoperatively predict treatment response and prognosis in patients with gastric cancer (GC) after neoadjuvant chemotherapy (NAC); however, methods for patients without evaluable lesions by RECIST are not yet confirmed. The aim of this study was to assess the utility of preoperative endoscopy for predicting treatment response and prognosis in patients with GC after NAC. Patients and methods This retrospective study included 105 patients with initially resectable GC who underwent NAC followed by surgical treatment. Preoperative factors for predicting treatment response and survival outcomes were analyzed. Results The number of patients classified as responders using preoperative endoscopic assessment, RECIST, and postoperative pathological evaluation were 25 (23.8 %), 28 (26.7 %), and 18 (17.1 %), respectively. Forty-three patients (41 %) were classified as non-targeted disease only, and their treatment responses were not evaluable by RECIST. Multivariate analysis identified endoscopic response as an independent preoperative factor to predict postoperative histological treatment response (odds ratio = 4.556, 95 % CI = 1.169-17.746, P  = 0.029). Endoscopic treatment response was the only independent preoperative predictive factor for overall survival (OS) (hazard ratio = 0.419, 95 % confidence interval (CI) = 0.206-0.849, P  = 0.016). Further, endoscopic treatment response was available for 33 patients (76.7 %) with non-targeted disease only, which showed significantly different OS between endoscopic responders (80.0 %) and non-responders (43.5 %) ( P  = 0.025). Conclusions Endoscopic evaluation was an independent preoperative factor to predict treatment response and prognosis in patients with GC after NAC. Endoscopic assessment may be especially valuable for patients who could not be assessed by RECIST.

[A case of local recurrence of rectal carcinoma 10 years after initial surgery].

Here, we report an extremely rare case of local recurrence of rectal cancer 10 years after initial tumor resection. A 53-year-old man underwent abdominoperineal resection for advanced rectal cancer at a local hospital. The tumor was graded as pStage II (pA, pN0, pH0, pP0, pM0, curA)as per the Japanese Classification of Colorectal Carcinoma, seventh edition, and diagnosed as a moderately differentiated adenocarcinoma on histopathological examination. Subsequently, the patient received adjuvant chemotherapy for 5 years. Although the patient lived without any recurrences after adjuvant chemotherapy, unfortunately, blood examination showed a high carcinoembryonic antigen(CEA)level 10 years after the initial surgical treatment. Computed tomography(CT)and positron emission tomography(PET)/CT revealed a perineal tumor, 40mm in size, without other distant metastases. On diagnosis of local recurrence of rectal cancer, the patient underwent surgical tumor resection at Okayama University Hospital. The tumor was determined to be a well- to moderately differentiated adenocarcinoma by histopathological examination, suggesting local recurrence of the primary rectal adenocarcinoma. Moreover, the radial margin was free of cancer. The patient is now doing well without any re-recurrence 30 months after the second surgical treatment, without any adjuvant chemotherapy.

[A case of advanced sigmoid colon cancer successfully treated with multimodality therapy].

A 61-year-old man underwent sigmoidectomy with partial cystectomy for advanced sigmoid colon cancer with unresectable multiple liver metastases at the Okayama University Hospital in June 2006. Pathological examination revealed moderately differentiated adenocarcinoma, pStage IV( pSI[ bladder], pN0, pH2, pP0, pM0), as per the Japanese Classification of Colorectal Carcinoma, seventh edition. The patient underwent systematic chemotherapy with irinotecan, 5-fluorouraci( l 5-FU), and folinic acid( FOLFIRI) and oxaliplatin, Leucovorin, and 5-FU( mFOLFOX6) for 13 months. In July 2007, hepatectomy was performed as the liver metastatic lesions had shrunk to a resectable size. Follow-up computed tomography (CT) in November 2009 revealed recurrence in the liver and lung. Subsequently, lateral segmentectomy was performed for the recurrent liver lesions, and radiofrequency ablation( RFA) was performed for the lung lesions. After having undergone RFA, the patient is doing well without any re-recurrence. We encountered a patient with advanced sigmoid colon cancer who was successfully treated with multimodality therapy. For patients with advanced or recurrent colorectal cancers, curative resection can lead to a good prognosis; however, in most patients, it is difficult to achieve curative resection by upfront surgery. Multimodality therapy could facilitate curative resection, thereby resulting in a good prognosis.