[Effectiveness of Chemoradiotherapy for the Treatment of Local Recurrence in Rectal Cancer-A Case Report].

Chemoradiotherapy(CRT)for locally recurrent rectal cancer can shrink the tumor and permit R0 resection; however, its effectiveness and safety have not been established. Herein, we report a case of a 60s man with locally recurrent rectal cancer invading the surrounding organs who was administered CRT followed by R0 laparoscopic-assisted abdominoperineal resection( APR). Local recurrence was detected 11 months after laparoscopic-assisted low anterior resection(pT3N0M0, pStage Ⅱ). After tumor shrinkage by CRT(capecitabine 3,000mg/day plus 45 Gy/25 Fr), laparoscopic-assisted APR was performed. The pathological findings showed a pathological complete response(pCR). The patient had not experienced recurrent disease at 6 months after the second surgery. CRT may improve the prognosis of patients with locally recurrent rectal cancer, especially those with possibly unresectable tumors.

Endoscopic Detorsion for Early Postoperative Roux Limb Torsion after Laparoscopic Gastrectomy: A Case Report and Literature Review.

Various types of obstruction can occur after a gastrectomy for gastric cancer. If proper treatment is not performed, such obstructions can lead to serious conditions. Early postoperative Roux limb torsion is a rare complication, and few reports of endoscopic treatment for this complication have been made. In the present report, we describe the endoscopic detorsion of Roux limb torsion in two patients. The first case was a 77-year-old woman who underwent a laparoscopic distal gastrectomy with Roux-en-Y (R-Y) reconstruction for early gastric cancer and a laparoscopic ileocecal resection (ICR) for early colorectal cancer. On the 12th day after the gastrectomy, a Roux limb torsion was observed. Endoscopic detorsion was performed, and the patient recovered. She was discharged on postoperative day 40. The second case was a 73-year-old man who underwent a laparoscopic-assisted total gastrectomy with a R-Y reconstruction for early gastric cancer. On the 8th day after the gastrectomy, a Roux limb torsion occurred at the Y-shaped anastomosis (Y-anastomosis). Endoscopic detorsion was performed, and the patient recovered. He was discharged on postoperative day 17. In summary, we experienced two cases in which an endoscopic reduction of a Roux limb torsion was performed at the Y-anastomosis after gastrectomy with R-Y reconstruction. This study presents a further review of these cases and a summary of the existing literature.

Successful Treatment of Necrotizing Fasciitis after Rectal Surgery with the Application of a Negative-pressure Wound Therapy: A Case Study.

INTRODUCTION: Necrotizing fasciitis (NF) is an aggressive soft tissue infection that involves the deep fascia and is characterized by the extensive deterioration of the surrounding tissue. Immediate recognition and aggressive treatment, including debridement and systemic antibiotics, are mandatory for the successful management of NF. Following radical debridement, closure of the remaining wound can pose significant reconstructive challenges. Accumulating evidence indicates that application of negative-pressure wound therapy (NPWT) is useful in the treatment of patients with severe acute complex wounds, including NF. CASE PRESENTATION: A 58-year-old man who had undergone surgical resection for rectal carcinoma followed by chemo-radiation therapy developed NF of the pelvis and thigh three years after the surgical procedure. Following extensive debridement, a VAC system was applied to the large open wound and successfully contributed to wound bed cleansing, which was followed by surgery for skin grafting. CONCLUSION: This case demonstrates the successful management of a complex and potentially lethal wound of the perineum to lower leg with debridement and skin grafting as well as with the application of the VAC system.