RESUMEN
In cases of pancreatic cancer with anatomical variations of the hepatic artery, it is important to evaluate the hemodynamics of each case for surgical indication. We report the case of a 68-year-old man with locally advanced pancreatic cancer and an aberrant right hepatic artery who underwent distal pancreatectomy with celiac axis resection(DP-CAR). He was admitted to our institute due to abdominal discomfort. A CT scan showed pancreatic cancer invading the common hepatic artery. He underwent chemoradiotherapy with a diagnosis of locally advanced pancreatic cancer. After the tumor downstaging, we performed DP-CAR, which included a gastroduodenal artery and a proper hepatic artery resection. Even though delayed gastric emptying was observed after the operation, he was discharged on postoperative day 36.
Asunto(s)
Arteria Hepática , Neoplasias Pancreáticas , Masculino , Humanos , Anciano , Arteria Hepática/cirugía , Arteria Hepática/patología , Pancreatectomía , Arteria Celíaca/cirugía , Neoplasias Pancreáticas/cirugía , Neoplasias Pancreáticas/patología , Neoplasias PancreáticasRESUMEN
A 74-year-old man was under follow-up after esophageal cancer surgery and CRT for hypopharyngeal cancer. Follow-up endoscopy revealed an ulcerative lesion in the lower gastric tube, and biopsy showed group 5(tub1). Endoscopic resection was difficult, and surgery was decided. Gastric tube resection and subcutaneous jejunum reconstruction were performed. Postoperatively, chylothorax was observed. Enteral nutrition was discontinued, and the patient was managed with TPN, and continuous subcutaneous octreotide and continuous intravenous etyrefrine were started. Even after conservative treatment was started, the pleural effusion of about 2,000 mL/day was observed from the right thoracic drain. On postoperative day 14, lymphangiography was performed with lipiodol from the left inguinal lymph node. The pleural fluid was temporarily decreased to less than 500 mL/day, but it began to drain again at a rate of 1,000 mL/day. On postoperative day 30, the patient developed fever and elevated inflammatory findings due to pneumonia and empyema, and drain drainage gradually decreased. The drain was removed on postoperative day 41. The patient was discharged home on postoperative day 72.
Asunto(s)
Quilotórax , Empiema , Neoplasias , Derrame Pleural , Neumonía , Masculino , Humanos , Anciano , Quilotórax/etiología , Quilotórax/cirugía , Derrame Pleural/etiología , Empiema/complicaciones , Neoplasias/complicaciones , Complicaciones Posoperatorias/etiologíaRESUMEN
A 76-year-old man came to our hospital for a close examination after an abnormal finding during a medical checkup. Upper gastrointestinal endoscopy revealed a circumferential flat lesion with irregularity in the second to third portions of the duodenum. Biopsy diagnosed papillary adenocarcinoma. Contrast-enhanced CT of the abdomen showed no evidence of lymph node enlargement and distant metastasis. Endoscopic depth of the lesion was estimated to be intramucosal carcinoma, but it was approximately 60 mm in size, circumferential, and located near the papilla Vater. Therefore, endoscopic resection was deemed difficult. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Postoperative pathological examination revealed type 0-â ¡a, tub1>pap, pTis, Ly0, V0, 80×50 mm, BD1, Ex0, Pn0, pPM0, pDM0, pN0, pStage 0. There has been no recurrence since then. Lateral spreading duodenal carcinoma is a rare disease, and endoscopic resection, local resection, and pancreaticoduodenectomy have been reported as treatment options. We report a case of resection of a large lateral spreading duodenal carcinoma with a review of the literature.
Asunto(s)
Carcinoma , Neoplasias Duodenales , Masculino , Humanos , Anciano , Pancreaticoduodenectomía , Neoplasias Duodenales/patología , Estómago/patología , Abdomen/patología , Carcinoma/cirugíaRESUMEN
PURPOSE: The aim of this study was to evaluate the clinical outcomes of single-port surgery (SPS), compared with those of multiport surgery (MPS) in patients with pathologic T4 colon cancer. MATERIALS AND METHODS: A total of 188 patients with proven pathologic T4 colon cancer who underwent laparoscopic surgery from January 2008 to December 2014 were enrolled in this study. These patients were divided into the SPS group (n=94) and the MPS group (n=94). The clinical outcomes were compared between groups. RESULTS: The median operative time was significantly shorter in the SPS group than in the MPS group (P=0.045). Postoperative complications did not differ between the groups. The length of postoperative hospital stay was significantly shorter in the SPS group than in the MPS group (P<0.001). Oncological resection rates were similar between groups. The 3-year relapse-free survival rates, the 3-year local recurrence-free survival rates, and the 5-year overall survival rates were similar between groups. CONCLUSIONS: SPS is safe and feasible in patients with pathologic T4 colon cancer.
Asunto(s)
Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía/métodos , Adulto , Anciano , Anciano de 80 o más Años , Quimioterapia Adyuvante/estadística & datos numéricos , Colectomía/instrumentación , Neoplasias del Colon/tratamiento farmacológico , Supervivencia sin Enfermedad , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/instrumentación , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
The aim of the present study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (S-MVR) for locally advanced left colon cancer. S-MVR is a challenging technique and to the best of our knowledge this is the first report of S-MVR for left colon cancer invading or adhering to neighboring organs. A retrospective review was conducted of patients who underwent laparoscopic multivisceral resection for locally advanced left colon cancer invading or adhering to neighboring organs from January 2008 to December 2014. Short-term and long-term outcomes were analyzed between groups of patients who underwent S-MVR and multi-port laparoscopic multivisceral resection (M-MVR) retrospectively. A total of 14 patients underwent S-MVR and 15 patients underwent M-MVR. There were no significant differences between groups in terms of operative factors and postoperative complications. The length of hospital stay was significantly shorter in the S-MVR group compared with the M-MVR group (P=0.048). Three-year overall survival was 61.9% in the S-MVR group (n=14). In patients with stage II (P=0.600) and III (P=0714) disease the three-year overall and disease-free survival was 81.8 and 58.3% in the S-MVR group and 80.0 and 70% in the M-MVR groups over a median follow-up of 34 months. In conclusion, S-MVR for locally advanced left colon cancer is safe and feasible in selected patients.
RESUMEN
BACKGROUND/AIM: The use of single-port surgery (SPS) in elderly patients with colon cancer remains controversial. The aim of this study was to evaluate the clinical outcomes of elderly patients who underwent SPS. PATIENTS AND METHODS: Consecutive patients >80 years old of age who underwent SPS (n=86) or multi-port surgery (MPS) (n=40) for colon cancer from January 2008 to December 2014 were analyzed. Short-term and long-term outcomes were compared between groups. RESULTS: The morbidity rate in the SPS was significantly lower than that in the MPS (p=0.027). Length of hospital stay in the SPS was significantly shorter than that in the MPS (p=0.016). Similar oncological outcomes were observed in the groups. The 3-year disease-free survival rate, the 5-year overall survival rate and the 5-year cancer-specific survival rate did not differ significantly between groups. CONCLUSION: SPS is safe and can provide clinical outcomes comparable to those of MPS in octogenarians with colon cancer.
Asunto(s)
Neoplasias del Colon/cirugía , Endoscopía Gastrointestinal/métodos , Laparoscopía/métodos , Anciano de 80 o más Años , Neoplasias del Colon/mortalidad , Supervivencia sin Enfermedad , Endoscopía Gastrointestinal/efectos adversos , Femenino , Humanos , Estimación de Kaplan-Meier , Laparoscopía/efectos adversos , Tiempo de Internación , Masculino , Tempo Operativo , Resultado del TratamientoRESUMEN
AIM: The aim of this study was to evaluate the clinical outcomes of single-port surgery for colon cancer in octogenarians. MATERIALS AND METHODS: A retrospective cohort study was performed on patients who underwent single-port surgery for colon cancer from 2010 to 2014 at a single institution. Patients were categorized into the following 3 groups according to age: ≤69 years (n=196), 70 to 79 years (n=143), and ≥80 years (n=86). Short-term and long-term outcomes were assessed among 3 groups. RESULTS: The rate of overall postoperative complications in the octogenarian group did not differ significantly, compared with the other groups (20.9% in the octogenarians group vs. 14.3% in the ≤69 y group and 15.4% in the 70 to 79 y group, P=0.363). The 3-year relapse-free survival rates were similar among groups (83.9% in the octogenarians group vs. 87.8% in the ≤69 y group and 87.5% in the 70 to 79 y group, P=0.754). The 5-year overall survival rates were 79.8% in the octogenarians group, 89.9% in the ≤69 years group, and 81.7% in the 70 to 79 years group (P=0.063). CONCLUSION: Single-port surgery is safe, feasible, and can provide satisfactory oncological outcomes in octogenarians with colon cancer.
Asunto(s)
Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopía/métodos , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Colon Sigmoide/cirugía , Diseño de Equipo , Femenino , Humanos , Laparoscopios , Laparoscopía/instrumentación , Tiempo de Internación/estadística & datos numéricos , Masculino , Tempo Operativo , Estudios Retrospectivos , Neoplasias del Colon Sigmoide/cirugía , Instrumentos Quirúrgicos , Resultado del TratamientoRESUMEN
BACKGROUND: Single-port surgery for rectal cancer is challenging and controversial. The aim of this study was to compare the short-term outcomes of single-port laparoscopic low anterior resection (S-LAR) to multi-port laparoscopic low anterior resection (M-LAR) for upper rectal cancer. METHODS: From January 2011 to December 2015, a total of 93 patients who underwent S-LAR (nâ¯=â¯44) or M-LAR (nâ¯=â¯49) without protective diverting ileostomy for upper rectal cancer were identified. Tumors were located between the inferior margin of the second sacral vertebra and the peritoneal reflection. Short-term outcomes were compared between groups. RESULTS: S-LAR was successful in 75% of cases: 25% of cases required one additional port. Operative factors, perioperative outcomes, oncological outcomes did not differ significantly between groups. In patients with stage I-III disease, the 3-year relapse-free survival rate was significantly higher in the S-LAR group than in the M-LAR group (pâ¯=â¯0.032). The 3-year overall survival rate was similar between groups. CONCLUSIONS: S-LAR is safe, feasible and can provide satisfactory oncological outcomes in selected patients with upper rectal cancer.
Asunto(s)
Adenocarcinoma/patología , Adenocarcinoma/cirugía , Laparoscopía/métodos , Neoplasias del Recto/patología , Neoplasias del Recto/cirugía , Adenocarcinoma/mortalidad , Adulto , Anciano , Estudios de Factibilidad , Femenino , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Neoplasias del Recto/mortalidad , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del TratamientoRESUMEN
AIM: The aim of this study was to evaluate the safety and feasibility of single-port laparoscopic multivisceral resection (SLMVR) for locally advanced colon cancer invading or adhering to neighboring organs. METHOD: A prospectively collected database was collated of all patients undergoing SLMVR from January 2011 to December 2014. Short-term and long-term oncologic outcomes were evaluated. RESULTS: Thirty consecutive patients who underwent SLMVR were identified and the completion rate was 90%. The R0 resection rate of the primary tumor was 100%. The postoperative complication rate was 23.3%. The 3-year relapse-free survival rates of patients with stage II (n=11) and stage III (n=12) disease were 80.8% and 54.6%, respectively. The 5-year overall survival rates of patients with stage II and stage III disease were 75.8% and 75.0% over a median follow-up of 42 months, respectively. CONCLUSIONS: SLMVR for locally advanced colon cancer is safe and feasible in selected patients.
Asunto(s)
Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Colectomía/métodos , Neoplasias del Colon/cirugía , Laparoscopios , Laparoscopía/métodos , Complicaciones Posoperatorias/epidemiología , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/diagnóstico , Colonoscopía , Diseño de Equipo , Femenino , Estudios de Seguimiento , Humanos , Incidencia , Japón/epidemiología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Estudios Retrospectivos , Tasa de Supervivencia , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
The patient was a 78-year-old woman. She was referred to our hospital and diagnosed with advanced gastric cancer with para-aortic lymph node(#16)metastasis. She received the SOX regimen(L-OHP 100mg/m2)chemotherapy and developed fatigue, anorexia, and neutropenia. After 4 courses of the SOX regimen, the #16 metastasis was reduced remarkably. A curative operation was performed and histological evaluation of the primary and lymphatic lesion after chemotherapy showed Grade 3 findings. The SOX regimen is tolerable in the outpatient clinic and is useful as part of multidisciplinary treatment for advanced gastric cancer.
Asunto(s)
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Gástricas/tratamiento farmacológico , Anciano , Combinación de Medicamentos , Femenino , Gastrectomía , Humanos , Metástasis Linfática , Terapia Neoadyuvante , Compuestos Organoplatinos/administración & dosificación , Oxaliplatino , Ácido Oxónico/administración & dosificación , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugía , Tegafur/administración & dosificación , Resultado del TratamientoRESUMEN
The patient was a 73-year-old man. Upper gastrointestinal endoscopy revealed a type 3 tumor in the antrum of the stomach. Preoperative CT imaging showed multiple liver metastases(S2, S3, S4, S6, S7). We administered 2 courses of chemotherapy( XP therapy)for the unresectable gastric cancer; the impact of the neoadjuvant therapy was PR. We performed distal gastrectomy and D2 dissection. After gastric resection, we administered an additional 3 courses of XP therapy. Unfortunately, new lesions of liver metastases were recurrent at S5 and S8. The patient was treated with 3 courses of S-1 chemotherapy. However, abdominal CT and EOB-MRI revealed significant tumor growth despite S-1 therapy. We performed S5 sub-segment resection and S8 partial resection due to the absence of new lesions. Histopathological findings revealed that the well-differentiated adenocarcinoma had metastasized to the liver, with Grade 1a tumor destruction. Two years after the initial gastrectomy, no recurrence of gastric cancer was observed.
Asunto(s)
Adenocarcinoma/tratamiento farmacológico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Neoplasias Hepáticas/tratamiento farmacológico , Terapia Neoadyuvante , Neoplasias Gástricas/tratamiento farmacológico , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Anciano , Gastrectomía , Hepatectomía , Humanos , Neoplasias Hepáticas/secundario , Neoplasias Hepáticas/cirugía , Masculino , Neoplasias Gástricas/patología , Neoplasias Gástricas/cirugíaRESUMEN
Secondary solid tumors that occur after hematopoietic stem cell transplantation (HSCT) are late complications of HSCT. Previously, secondary solid tumors were considered to be recipient-derived cells because transplanted cells do not contain epithelial cells. Recently, however, not only donorderived epithelial cells but also donor-derived secondary solid tumors have also been reported in mice and humans. It means that circulating bone marrow-derived stem cells (BMDCs) including hematopoietic stem cells include the stem cells of many tissue types and the precancerous cells of many solid tumors. In most reports of donor-derived secondary solid tumors, however, tumors contained a low proportion of BMDC-derived epithelial cells in mixed solid tumor tissues. To our knowledge, there are only five known cases of completely donor-derived tumor tissues, i.e., four oral SCCs and a pharyngeal SCC. In this study, we analyzed five human clinical samples of solid tumors, i.e., two esophageal squamous cell carcinomas (SCCs), two oral SCCs and a tongue carcinoma. In the oral and tongue, completely donor-derived tissues were not observed, but in esophagus a completely donor-derived esophageal epidermis and SCC were observed for the first time. In addition, in another esophageal SCC patient, a completely donor-derived dysplasia region of esophageal epidermis was observed near recipient-derived SCC. This study suggests that BMDC-derived cells include the stem cells of esophageal epidermis and the precancerous cells of esophageal SCC and can differentiate into esophageal epithelium and esophageal SCC.
Asunto(s)
Células de la Médula Ósea/patología , Trasplante de Médula Ósea/efectos adversos , Carcinoma de Células Escamosas/patología , Linaje de la Célula , Epidermis/patología , Epitelio/patología , Neoplasias Esofágicas/patología , Neoplasias de la Boca/patología , Neoplasias de la Lengua/patología , Adulto , Anciano , Carcinoma de Células Escamosas/genética , Carcinoma de Células Escamosas/terapia , Diferenciación Celular , Aberraciones Cromosómicas , Cromosomas Humanos/genética , Neoplasias Esofágicas/genética , Neoplasias Esofágicas/terapia , Femenino , Humanos , Hibridación Fluorescente in Situ , Masculino , Persona de Mediana Edad , Neoplasias de la Boca/genética , Neoplasias de la Boca/terapia , Neoplasias de la Lengua/genética , Neoplasias de la Lengua/terapiaRESUMEN
We reported two cases of venous thrombosis occurred during systemic chemotherapy for colorectal cancer. Case 1: A 68-year-old male, who had been operated for rectal cancer received systemic chemotherapy with liver and lung metastases. Three months after the chemotherapy, the chest CT showed venous thrombosis. Case 2: A 53-year-old female, who had been operated for rectal cancer received systemic chemotherapy with lung metastases. Ten months after the chemotherapy, the contrastradiogram from catheter showed venous thrombosis. Venous thrombosis should be considered when CV ports were placed especially with systemic chemotherapy for colorectal cancer.
Asunto(s)
Neoplasias Colorrectales/tratamiento farmacológico , Infusiones Intravenosas/efectos adversos , Trombosis de la Vena/etiología , Anciano , Neoplasias Colorrectales/cirugía , Femenino , Humanos , Masculino , Persona de Mediana EdadRESUMEN
We report a 35-year-old female bearing ovarian cancer who was suffering from intestinal obstruction due to multiple recurrences. The treatment of 300 microg/day of octreotide acetate was started. The symptom of obstruction, such as vomiting and nausea, caused by intestinal obstruction was suddenly controlled and the quality of life was improved. Octreotide acetate can be applied for the management of intestinal obstruction caused by metastases at the terminal stage of cancer.