Regional education on endoscopic surgery using a teleconference system with high-quality video via the internet: Saga surgical videoconferences.

BACKGROUND: Effective education about endoscopic surgery (ES) is greatly needed for unskilled surgeons, especially at low-volume institutions, to maintain the safety of patients. We have tried to establish the remote educational system using videoconference system through the internet for education about ES to surgeons belonging to affiliate institutions. The aim of this manuscript was to report the potential to establish a comfortable remote educational system and to debate its advantages. METHODS: We established a local remote educational conference system by combining the use of a general web conferencing system and a synchronized remote video playback system with annotation function through a high-speed internet. RESULTS: During 2014-2019, we conducted 14 videoconferences to review and improve surgeons' skills in performing ES at affiliated institutions. At these conferences, while an uncut video of ES that had been performed at one of the affiliated institutions was shown, the surgical procedure was discussed frankly, and expert surgeons advised improvements. The annotation system is useful for easy, prompt recognition among the audience regarding anatomical structures and procedures that are difficult to explain verbally. CONCLUSIONS: This system is of low initial cost and offers easy participation and high-quality videos. It would therefore be a useful tool for regional ES education.

[A Case of Recurrent Breast Cancer with Drug-Induced Interstitial Pneumonia Triggered by the Switch from an Original to a Generic Aromatase Inhibitor].

We report the case of a 72-year-old woman who had undergone mastectomy for left breast cancer 9 years ago and had received anastrozole for 6 years after the operation. A year ago, she experienced a breast cancer recurrence in the thoracic wall and lymph nodes and was re-administered anastrozole, leading to a shrinking of the recurrent tumor. After the change from anastrozole to a generic product 2 months ago, she experienced respiratory distress. A CT scan showed bilateral reticular and ground-glass shadows in the lung fields, leading to the diagnosis of interstitial pneumonia, which was treated with steroids. When the generic product was restarted after the symptom had resolved, a recurrence of the lung lesions was observed. Therefore, VATS was performed and a histopathological diagnosis of interstitial pneumonia was posed. We then switched to letrozole, but because of the reappearance of the same lung lesions, the drug was discontinued, and the course was observed. Six months after, the re-expansion of breast cancer metastases was observed. When exemestane was initiated, the lung lesions recurred. The patient's condition improved on a steroid pulse and artificial respiration; however, she died of aspiration pneumonia. We report a case of recurrent breast cancer with drug-induced interstitial pneumonia triggered by the switch from an original to a generic aromatase inhibitor.

[Two cases of gastric cancer with multiple liver metastases responding to TS-1 with hepatic arterial infusion of CDDP following low-dose 5-FU and CDDP chemotherapy].

Case 1: A 77-year-old man was revealed to have type 3 gastric cancer with synchronous liver metastases. He underwent total gastrectomy with lymphatic dissection of D1+a and tubing of the hepatic artery. After surgery, two courses of hepatic arterial infusion of low-dose 5-FU plus CDDP were performed. The patient was discharged, and TS-1 (60 mg/day) was administered from day 1 to 14 followed by 7 days rest as one course. CDDP (10 mg/ body) was infused in the hepatic artery bolus on day 8 and 15 as outpatient treatment. After 8 months, the CEA was decreased from 3,098 ng/dl to 5.4 ng/dl, hepatic metastases were decreased by 85% assessed as a partial response. Case 2: A 71-year-old man was diagnosed with multiple liver metastases 10 months after distal gastrectomy for early gastric cancer. After tubing of the hepatic artery, three courses of hepatic arterial infusion of low-dose 5-FU plus CDDP were performed. TS-1 with hepatic arterial infusion of CDDP was administered using the same regimen as an outpatient. After 4 months, hepatic metastases decreased by 73%. These cases suggest that TS-1 with hepatic arterial infusion of CDDP in an outpatient may be an effective treatment with low toxicities and no damage to QOL in gastric cancer patients with multiple liver metastases.

Modification of lymph node dissection for colon cancer by clinical diagnosis.

BACKGROUND/AIMS: Less invasive procedures for colon cancer that are available now increase the needs of modified lymph node dissection. The aim of the present study is to establish oncologically safe criteria for modifying lymph node dissection for colon cancer by clinical diagnosis. METHODOLOGY: We evaluated the central extent of lymph node metastasis in 276 patients who underwent curative surgery for colon cancer according to clinicopathologic factors and analyzed the accuracy of clinical assessment of the factors. RESULTS: Only the degree in depth of invasion determined the maximum extent of lymph node metastasis. None of pTis-pT2 tumors showed metastasis to nodes along the main vessels including apical nodes, demonstrating that patients with pTis-pT2, but not pT3-pT4, tumors could be candidates for modified lymph node dissection. While the accuracy in clinical assessment of depth for pTis, pT1, and pT2 tumors was only 59.1%, 73.7%, and 53.6%, respectively, none of the clinically assessed as Tis or T1 tumors was finally diagnosed as a pT3-pT4 tumor. On the other hand, 30.8% of T2 tumors were revealed to be pT3 tumors. CONCLUSIONS: Modification of lymph node dissection by clinical diagnosis should be performed for Tis-T1 but not for T2-T4 tumors when bowel resection is performed.