ABSTRACT
BACKGROUND: Liver resection offers substantial advantages over open liver resection (OLR) for patients with hepatocellular carcinoma (HCC) in terms of reduced intraoperative blood loss and morbidity. However, there is limited evidence comparing the indications and perioperative outcomes with the open versus laparoscopic approach for resection. This study aimed to compare postoperative outcomes between patients undergoing laparoscopic liver resection (LLR) and OLR for HCC with clinically significant portal hypertension (CSPH). METHODS: A total of 316 HCC patients with CSPH (the presence of gastroesophageal varices or platelet count < 100,000/ml and spleen diameter > 12 cm) undergoing minor liver resection at eight centers were included in this study. To adjust for confounding factors between the LLR and OLR groups, an inverse probability weighting method analysis was performed. RESULTS: Overall, 193 patients underwent LLR and 123 underwent OLR. After weighting, LLR was associated with a lower volume of intraoperative blood loss and the incidence of postoperative complications (including pulmonary complications, incisional surgical site infection, and paralytic ileus) compared to the OLR group. The 3-, 5-, and 7-year postoperative recurrence-free survival rates were 39%, 26%, and 22% in the LLR group and 49%, 18%, and 18% in the OLR group, respectively (p = 0.18). And, the 3-, 5-, and 7-year postoperative overall survival rates were 71%, 56%, and 44% in the LLR group and 76%, 51%, 44% in the OLR group, respectively (p = 0.87). CONCLUSIONS: LLR for HCC patients with CSPH is clinically advantageous by lowering the volume of intraoperative blood loss and incidence of postoperative complications, thereby offering feasible long-term survival.
Subject(s)
Carcinoma, Hepatocellular , Hypertension, Portal , Laparoscopy , Liver Neoplasms , Humans , Carcinoma, Hepatocellular/complications , Carcinoma, Hepatocellular/surgery , Liver Neoplasms/complications , Liver Neoplasms/surgery , Blood Loss, Surgical , Hepatectomy/methods , Laparoscopy/methods , Hypertension, Portal/complications , Hypertension, Portal/surgery , Propensity Score , Surgical Wound Infection/etiology , Retrospective Studies , Length of Stay , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/surgeryABSTRACT
A 59-year-old woman underwent simple abdominal total hysterectomy with bilateral salpingo-oophorectomy, partial omentectomy, and extirpation of intrapelvic disseminated nodules for right fallopian tube cancer with rectal metastasis and peritoneal dissemination as primary debulking surgery(PDS). The histopathological diagnosis was high grade serous carcinoma( HGSC)of the right fallopian tube. After adjuvant chemotherapy with 4 courses of paclitaxel-carboplatin(TC), low anterior resection of the rectum for rectal metastasis and pelvic and para-aortic lymph node dissection were performed as interval debulking surgery(IDS). Histopathologically, lymph node metastasis was detected only in the right obturator lymph node. After adjuvant chemotherapy with 4 courses of TC, bevacizumab maintenance monotherapy was administered. Three years after PDS, laparoscopic splenectomy for splenic metastasis and extirpation of the solitary peritoneal metastases were performed as secondary debulking surgery(SDS). After adjuvant chemotherapy with 4 courses of TC, olaparib maintenance monotherapy was administered. The patient has remained alive without recurrence for 4 years after SDS and for 7 years after PDS. No case of metachronous splenic metastasis from fallopian tube cancer with synchronous rectal metastasis has been reported; however, long-term prognosis may be expected with PDS, IDS and SDS for platinum-sensitive HGSC.
Subject(s)
Fallopian Tube Neoplasms , Laparoscopy , Rectal Neoplasms , Splenic Neoplasms , Female , Humans , Middle Aged , Fallopian Tube Neoplasms/drug therapy , Fallopian Tube Neoplasms/surgery , Fallopian Tube Neoplasms/pathology , Splenectomy , Splenic Neoplasms/drug therapy , Splenic Neoplasms/surgery , Lymph Nodes/pathology , Rectal Neoplasms/drug therapy , Rectal Neoplasms/surgery , Rectal Neoplasms/pathologyABSTRACT
A 78-year-old man without hepatitis virus B or C underwent right hemi-hepatectomy and lymph node dissection for a tumor 5 cm in diameter located in the hepatic hilum of the posterior segment of the liver with portal vein thrombi extending into the main portal trunk and a tumor 1.5 cm in diameter in the peripheral side of segment 5 of the liver. Histopathologically, the former was diagnosed as intrahepatic cholangiocarcinoma and the latter as hepatocellular carcinoma(HCC). Five months after the surgery, intrahepatic and lymph node metastases were diagnosed based on computed tomography(CT); therefore, chemotherapy with S-1 for 3 months and gemcitabine and cisplatin(GC)for 5 months was administered, after which the metastatic lesions were not detected. Nineteen months after the surgery, partial resection of segment 2 of the liver was performed for a tumor 3 cm in diameter, which was diagnosed as HCC histopathologically. Two years after the second surgery, 2 recurrent nodules in the liver in segments 3 and 4 were detected on CT. Platinum-based hepatic arterial infusion chemotherapy(HAIC)and transcatheter arterial chemoembolization(TACE)were performed, and chemotherapy with GC was then administered for 7 months. For a new tumor detected in segment 1 in the liver, TACE was performed 17 months after initial HAIC. Seventy-four months after the initial surgery, 5 new nodules less than 1 cm in diameter were detected, and chemotherapy with sorafenib was administered for 5 months, after which the patient died of coronavirus disease 2019.
Subject(s)
Bile Duct Neoplasms , COVID-19 , Carcinoma, Hepatocellular , Chemoembolization, Therapeutic , Cholangiocarcinoma , Liver Neoplasms , Aged , Bile Duct Neoplasms/drug therapy , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic/pathology , Carcinoma, Hepatocellular/pathology , Carcinoma, Hepatocellular/surgery , Cholangiocarcinoma/drug therapy , Cholangiocarcinoma/surgery , Hepatectomy , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/surgery , MaleABSTRACT
INTRODUCTION AND IMPORTANCE: Endoscopic intervention is considered first-line therapy for common bile duct (CBD) stones, in recent times. However, surgically altered anatomy and consequent inaccessibility of the duodenal papilla necessitate surgery in some patients. CASE PRESENTATION: A 61-year-old woman presented with fever and right subcostal pain. She underwent total gastrectomy and Roux-en-Y reconstruction for gastric ulcer, 4 years prior to presentation. Based on the clinical findings, she was diagnosed with acute obstructive cholangitis secondary to a CBD stone. Endoscopic retrograde biliary drainage was attempted; however, the duodenal papilla was endoscopically inaccessible owing to the previous Roux-en-Y reconstruction, and we performed percutaneous transhepatic gallbladder drainage (PTGBD). She underwent laparoscopic cholecystectomy and choledocholithotomy, 6 days after the PTGBD. Choledocholithotomy was attempted using basket forceps under choledochoscopic guidance; however, this procedure was unsuccessful, and we performed laparoscopic choledocholithotomy using a laparotomy biliary lithotomy spoon. CLINICAL DISCUSSION: Usually, laparoscopic cholecystectomy concomitant with CBD exploration is performed in patients with an endoscopically inaccessible duodenal papilla. However, an inadequately opened basket may not capture large impacted stones at the duodenal end of the CBD. Intraductal shock wave lithotripsy (electrohydraulic or laser lithotripsy) is considered in such cases; however, the specialized instruments required for this procedure are unavailable at all centers. Laparoscopic choledocholithotomy using a laparotomy biliary lithotomy spoon may be useful to overcome this surgically challenging situation. CONCLUSION: A laparotomy biliary lithotomy spoon is a simple, user-friendly, and economical device that may be useful for laparoscopic lithotripsy and lithotomy of impacted stones.
ABSTRACT
CASE: A 76-year-old man was referred to our hospital for advanced hepatocellular carcinoma(HCC)with chronic hepatitis type B. Although he underwent right anterior sectionectomy and S3 segmentectomy, multiple recurrences were found in the hepatic remnant after 2 months. Transcatheter arterial chemoembolization(TACE)and transcatheter arterial infusion (TAI)were performed separately. One and a half month after the last TAI, AFP and PIVKA-â ¡ levels markedly elevated, and multiple early enhancing nodules with portal vein tumor thrombosis were detected on CT. A half dose of sorafenib(400mg/ day)was administered to the patient who was refractory to TACE. Sorafenib was discontinued after 4 weeks because the patient developed general fatigue and anorexia(Grade 3). Furthermore, these adverse events became worse, and ascites appeared. He was hospitalized in the palliative care unit for best supportive care for 3 weeks and also received outpatient treatment for more than 14 months. Fifteen months after discontinuing sorafenib administration, his condition improved dramatically, and CT revealed that the multiple HCC had reduced in size. Moreover, the portal vein tumor thrombosis disappeared. As his performance status and liver function were well preserved, he underwent partial hepatectomy for residual HCC. The patient remains alive without recurrence at 18 months, despite no administration of sorafenib. CONCLUSION: This case demonstrates that sorafenib administration combined with surgical treatment could possibly cure advanced HCC refractory to TACE.
Subject(s)
Antineoplastic Agents/therapeutic use , Carcinoma, Hepatocellular , Liver Neoplasms , Sorafenib/therapeutic use , Aged , Carcinoma, Hepatocellular/drug therapy , Carcinoma, Hepatocellular/surgery , Chemoembolization, Therapeutic , Combined Modality Therapy , Hepatectomy , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/surgery , Male , Neoplasm Recurrence, LocalABSTRACT
INTRODUCTION: Potential curative therapy for perihilar cholangiocarcinoma requires extensive surgical treatment, which can still be associated with significant morbidity and mortality. Postoperative hemorrhage from the portal vein is a rare but life-threatening complication. We herein report postoperative hemorrhage from an extrahepatic portal vein pseudoaneurysm successfully treated by stent graft placement late after surgical treatment for perihilar cholangiocarcinoma. PRESENTATION OF CASE: An 83-year-old man was referred to our hospital with a chief complaint of jaundice. Based on radiological findings, we diagnosed the patient with hilar cholangiocarcinoma. After endoscopic retrograde biliary drainage, resection of the extrahepatic bile duct combined with extended left hemi-hepatectomy, including the caudate lobe, lymphadenectomy of the hepatoduodenal ligament, partial resection and reconstruction of the portal vein, and right hepaticojejunostomy was performed. Fourteen days postoperatively, bleeding through the abdominal drain around the portal vein was observed. Twenty days postoperatively, abdominal computed tomography revealed a portal vein pseudoaneurysm that had formed at the portion of reconstruction. Therefore, 24 days postoperatively, a stent graft placement of the pseudoaneurysm through the ileocolic vein was performed. Subsequently, the portal vein hemorrhage ceased. DISCUSSION: Our present postoperative extrahepatic portal vein hemorrhage case was caused by an extrahepatic portal vein pseudoaneurysm that had formed at the reconstructed portion by erosion due to the chemical effect of the leaking bile and mechanical irritation of the surgical drain adjacent to the portal vein. CONCLUSION: Stent-graft placement is a minimally-invasive, safe, and effective treatment option for hemorrhage from postoperative portal vein pseudoaneurysm.
ABSTRACT
A 76-year-old woman had underwent 5-fluorouracil(5-FU), oxaliplatin(L-OHP)combination therapy(mFOLFOX6)as first-line chemotherapy for peritoneal recurrence after resection of sigmoid colon cancer. She showed severe general fatigue and disturbance of consciousness on the second day of the 12th course of chemotherapy. Computed tomography of the head detected no abnormal findings in the central nervous system. The laboratory results revealed a marked hyperammonemia. She was diagnosed as a disturbance of consciousness due to hyperammonemia and treated her with branched- chain amino acid solution. Then the disturbance of consciousness resolved on the following day. After changing the regimen of chemotherapy, the disturbance of consciousness was not found. Recently, it has been reported that high-dose 5-FU regimen such as mFOLFOX6 causes hyperammonemia as a rare adverse event. We should take hyperammonemia into account when disturbance of consciousness occurs during high-dose 5-FU chemotherapy.
Subject(s)
Hyperammonemia , Sigmoid Neoplasms , Aged , Antineoplastic Combined Chemotherapy Protocols/adverse effects , Consciousness , Female , Fluorouracil/adverse effects , Humans , Hyperammonemia/chemically induced , Hyperammonemia/drug therapy , Leucovorin/adverse effects , Neoplasm Recurrence, Local , Sigmoid Neoplasms/drug therapy , Sigmoid Neoplasms/surgeryABSTRACT
A 45-year-old man with unresectable locally advanced pancreas head cancer with multiple synchronous liver metastases was treated with gemcitabine plus nab-paclitaxel therapy as a first-line chemotherapy. During 24 months of 30 courses of this therapy, the primary lesion remained stable and liver metastases were completely disappeared on CT. Three months later, however, solitary relapse of liver metastasis occurred in segment 2. Therefore, we changed the chemotherapy regimen to the second-line treatment, FOLFIRINOX. After 3 courses of FOLFIRINOX, the primary lesion was kept well-controlled, but the solitary metastatic liver lesion was enlarged. An interdisciplinary team suggested surgical resection of the liver metastasis to control disease progress. We performed laparoscopic lateral segmentectomy of the liver. The postoperative course was uneventful, and the patient was discharged on postoperative day 8. The patient underwent another round of gemcitabine therapy owing to the good response of the primary pancreatic lesion to this drug. Three years after starting the first-line chemotherapy, the patient is still alive with well-controlled PDAC without distant metastasis. Surgical intervention for liver metastases may be a promising treatment option when unresectable primary PDAC is well controlled by chemotherapy.
Subject(s)
Adenocarcinoma , Laparoscopy , Liver Neoplasms , Pancreatic Neoplasms , Adenocarcinoma/surgery , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/surgery , Male , Middle Aged , Neoplasm Recurrence, Local , Pancreatic Neoplasms/drug therapy , Pancreatic Neoplasms/surgeryABSTRACT
A 75-year-old woman underwent transcatheter chemoembolization(TACE)for 2 small hepatocellular carcinoma(HCC) lesions associated with severe alcoholic liver cirrhosis that necessitated management for ascites. Over 5 years after the initial TACE, she received multidisciplinary therapies with TACE, transcatheter arterial infusion of anticancer agents, percutaneous ethanol injections, or percutaneous radiofrequency ablation performed on 5 occasions for small recurrent HCC lesions. Computed tomography performed after the last therapy for HCC revealed a solitary lymph node swelling(39 mm in diameter) around the common hepatic artery. Magnetic resonance imaging performed 3 months later revealed that the lymph node had enlarged to 45 mm, without recurrence of the primary HCC, and after 4 months, to 60 mm; she then underwent laparoscopic lymph node resection. Histopathological examination of the resected specimen showed HCC metastasis. A recurrent metastatic lymph node(30 mm in diameter)was detected around the common hepatic artery and was resected laparoscopically 17 months postoperatively. Pancreatic head cancer was diagnosed 22 months after the second surgery; however, the patient refused cancer therapy and died 16 months after this diagnosis. No recurrence of the primary HCC or lymph node metastasis was observed over the 38 months after the second surgery.
Subject(s)
Carcinoma, Hepatocellular , Chemoembolization, Therapeutic , Laparoscopy , Liver Neoplasms , Aged , Carcinoma, Hepatocellular/surgery , Female , Humans , Liver Neoplasms/surgery , Lymphatic Metastasis , Neoplasm Recurrence, LocalABSTRACT
A67 -year-old man was diagnosed with ascending colon cancer and multiple liver metastases and underwent laparoscopic right hemicolectomy(D3 lymphadenectomy). Pathological examination indicated tubular adenocarcinoma(tub1, pT4apN2H2M1[HEP], pStage â £). After chemotherapy, he underwent hepatectomy. One year and 9 months after the first operation, obstructive jaundice appeared. Abdominal computed tomography revealed a tumor 2 cm in size in the head of the pancreas. After several detailed examinations, he was diagnosed with pancreatic metastasis of ascending colon cancer. After partial resection of the left lung metastasis, pancreaticoduodenectomy(SSPPD-â ¡ A-1, D1 lymphadenectomy)and low anterior resection(LAR)for early rectal cancer were performed. The tumor was positive for CDX2(+), resulting in a diagnosis of pancreatic metastasis. There has been no indication of recurrence 8 months after the pancreatic surgery. Resectable pancreatic metastasis from colon cancer is rare, and there are no clear indications for resection. Some cases of long-term survival have been reported; however, further studies are needed in order to establish a consensus.
Subject(s)
Colonic Neoplasms , Pancreatic Neoplasms , Pancreaticoduodenectomy , Aged , Colon, Ascending , Colonic Neoplasms/pathology , Humans , Male , Neoplasm Recurrence, Local , Pancreatic Neoplasms/secondary , Pancreatic Neoplasms/surgery , StomachABSTRACT
In June 2018, a 75-year-old woman was admitted for right upper quadrant pain. She had a history of radical mastectomy for left breast cancer in April 2009. The axillary lymph node, bone, gastric, and pleural metastases had been treated with hormonal therapy for 2 years from April 2016. Based on the examination findings, we diagnosed her with acute calculous cholecystitis and performed emergency percutaneous transhepatic gallbladder drainage(PTGBD). Eleven days after PTGBD, we performed laparoscopic cholecystectomy. Pathological examination revealed a metastatic tumor from breast cancer in her gallbladder. Although her postoperative course was uneventful, the patient died of progression of the other organ metastasis 7 months after cholecystectomy. Gallbladder metastasis should be considered in patients with advanced breast cancer who present symptoms of cholecystitis.
Subject(s)
Breast Neoplasms , Cholecystitis, Acute , Gallbladder Neoplasms/secondary , Aged , Cholecystitis, Acute/etiology , Cholecystitis, Acute/therapy , Drainage , Female , Gallbladder , Humans , MastectomyABSTRACT
A 47-year-old woman presented with a hard umbilical nodule that appeared red and was painful. A biopsy of the umbilical nodule revealed adenocarcinoma. As a result of general examinations, the patient was diagnosed with umbilical, hepatic, and ovarian metastases from transverse colon cancer. She was treated with S-1 and oxaliplatin(SOX)plus bevacizumab chemotherapy. After 4 courses of chemotherapy, CT revealed that the primary lesion and umbilical and hepatic metastases had reduced in size. We considered this to be a partial response and thus administered 4 additional courses of SOX plus bevacizumab chemotherapy. Finally, she remained well for 22 months and achieved relatively good prognosis. An umbilical metastasis from an internal malignancy is known as a Sister Mary Joseph's nodule, and it has very poor prognosis. Most studies show that the survival period from the time of diagnosis is within 1 year. However, our case suggests that novel anti-cancer drugs or molecular-targeted agents may improve survival.
Subject(s)
Adenocarcinoma/drug therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Colon, Transverse/pathology , Colonic Neoplasms/drug therapy , Sister Mary Joseph's Nodule/drug therapy , Adenocarcinoma/secondary , Bevacizumab/administration & dosage , Colonic Neoplasms/pathology , Drug Combinations , Female , Humans , Middle Aged , Oxaliplatin/administration & dosage , Oxonic Acid/administration & dosage , Sister Mary Joseph's Nodule/secondary , Tegafur/administration & dosageABSTRACT
PURPOSE: To analyze chemoradiotherapy results for locally advanced rectal cancers at a single institution. METHODS: The study cohort comprised 12 patients with clinically diagnosed T3/4, NX, M0 adenocarcinomas of the rectum who received preoperative chemoradiotherapy. RESULT: Pathological complete response(pCR)were observed in 2/12(16.7%)patients and pathological downstaging in 5/12(41.7%)patients, with generally mild adverse events. CONCLUSION: Preoperative che- moradiotherapy for clinical T3/4, NX rectal cancers significantly reduces local recurrences and improves prognoses.
Subject(s)
Chemoradiotherapy , Rectal Neoplasms/therapy , Aged , Female , Humans , Male , Neoplasm Metastasis , Preoperative Period , Rectal Neoplasms/pathology , Recurrence , Retrospective StudiesABSTRACT
A 52-year-old woman presented with sudden left lower abdominal pain, fever, and vomiting. As the symptom got improved immediately she went home then. She consulted our hospital with chief complaint of the left lower abdominal mass. Abdominal computed tomography revealed sigmoid colon cancer with abscess. She was diagnosed with sigmoid colon cancer via colonoscopy. Sigmoidectomy including partial resection of the abdominal wall was performed(D3 lymphadenectomy). Surgical specimen showed penetration of diverticulum on mucous membrane of the lesion which had been thought of a abdominal wall permeation and a tumor of I sp type at anal side. Pathological examination showed diverticulitis with penetration and the tumor was tubular adenocarcinoma(tub1, pT1bpN0, pStage I ). We had doubted penetration of sigmoid colon cancer most, but the cause of penetration turned out to be diverticulitis. We experienced a case in which we could performed surgery of sigmoid colon cancer and penetration of diverticulum at the same time.
Subject(s)
Adenocarcinoma/surgery , Diverticulum/etiology , Intestinal Perforation/surgery , Sigmoid Neoplasms/pathology , Sigmoid Neoplasms/surgery , Adenocarcinoma/complications , Adenocarcinoma/diagnostic imaging , Colonoscopy , Diverticulum/diagnostic imaging , Diverticulum/surgery , Female , Humans , Intestinal Perforation/etiology , Middle Aged , Sigmoid Neoplasms/complications , Sigmoid Neoplasms/diagnostic imaging , Tomography, X-Ray ComputedABSTRACT
A 76-year-old postmenopausal woman presented with a bloody attachment on the left nipple. She had a 3 cm-sized tumor in her left breast. Mammography showed a spiculated irregular mass. Ultrasonography showed a 38 mm, low echoic mass with an irregular border. Core needle biopsy examination indicated apocrine carcinoma of the breast, ER(-), PgR(-), and HER2(-). An overall examination showed no distant metastasis. We diagnosed her with apocrine carcinoma of the breast(T2N0M0, cStageâ ¡A). We performed total mastectomy with sentinel lymph node biopsy. The postoperative histopathological examination revealed apocrine carcinoma without lymph node metastasis. The patient recovered uneventfully and was discharged 8 days after the surgery. She has not experienced any recurrence for 1 year and 7 months after the surgery.
Subject(s)
Breast Neoplasms , Carcinoma , Aged , Breast , Breast Neoplasms/diagnostic imaging , Breast Neoplasms/surgery , Carcinoma/diagnostic imaging , Carcinoma/surgery , Female , Humans , Mammography , Mastectomy , Neoplasm Recurrence, LocalABSTRACT
A 57-year-old woman was admitted to our hospital due to a suspected rectal tumor at previous doctor. Colonoscopy showed a submucosal tumor with 8mm yellowish protrusions and smooth surfaces in the rectum, 5 cm from the anal verge. Endoscopic ultrasonography showed the appearance of the internal portions of the tumor to be relatively uniform in low echoic imagery. The tumor was located in the second to third layer. Histopathological findings showed neuroendocrine tumor- G1. We performed transanal minimally invasive surgery with GelPOINT®Path. Under general anesthesia, complete fullthickness excision of the rectal lesion was performed. Primary closure was accomplished using a 3-0 braided absorbable suture. The operation duration was 24 min; blood loss was very little in this case. The patient recovered uneventfully and was discharged 2 days after the operation. There was no anorectal dysfunction and no local and distant recurrence during the postoperative follow-up of 1 year 3 months. Transanal minimally invasive surgery with GelPOINT®Path was an effective treatment for the safe removal of small rectal tumor indicated for local resection.
Subject(s)
Neuroendocrine Tumors , Rectal Neoplasms , Transanal Endoscopic Surgery , Anal Canal , Female , Humans , Middle Aged , Minimally Invasive Surgical Procedures , Neoplasm Recurrence, Local , Neuroendocrine Tumors/surgery , Rectal Neoplasms/surgery , RectumABSTRACT
A 79-year-old woman was admitted to the hospital because of continuous right lower abdominal pain lasting for 1 day. There was tenderness with signs of peritoneal irritation at the right lower abdomen along with a palpable mass. With the diagnosis of intussusception of the ileocecal region by CT examination, an emergency surgery was performed under general anesthesia. By laparoscopic ileocecal resection with lymph node dissection, the ileocecal region was found invaginated into the transverse colon, although this was easily reduced by Hutchinson's procedure. The histological diagnosis of the tumor was highly differentiated adenocarcinoma in Stage â ¢b. The postoperative course was uneventful and the patient remained in good health without any recurrence during a follow-up period of 12 months. When a patient has a sign of peritoneal irritation, such as in our case, and intestinal tract necrosis and perforation by intussusception cannot be excluded, it is necessary to perform an emergency surgery.
Subject(s)
Cecal Neoplasms , Intussusception , Aged , Cecal Neoplasms/complications , Cecal Neoplasms/surgery , Colon, Transverse/pathology , Colon, Transverse/surgery , Female , Humans , Intussusception/etiology , Neoplasm Recurrence, LocalABSTRACT
A 47-year-old man underwent hematopoietic stem cell transplantation for malignant lymphoma. He developed acute skin graft versus host disease(GVHD)and pneumomycosis which were treated with steroids. One hundred and fifteen days later, the patient had a diagnosis of free gas images in the abdominal cavity and streakly air collections in the bowel wall from the ascending colon to the sigmoid colon in the CT scan. He was asymptomatic and his physical examination was unrevealing. We diagnosed his condition as pneumatosis cystoides intestinalis(PCI). He was managed conservatively with the high concentration oxygen administration. The CT scan performed 3 days later revealed the marked improvement of intramural gas and disappearance of free gas. We considered image in the abdominal cavity that the occurrence of PCI was related to the damage of the bowel mucosa due to long term corticosteroid administration. In patients demonstrating PCI with free air in the abdominal cavity, it is important to evaluate not only the diagnostic date based on the physical, laboratory, and imaging findings, but also their medical history. Furthermore, it is important to make a correct diagnosis to avoid unnecessary surgery.
Subject(s)
Hematopoietic Stem Cell Transplantation/adverse effects , Lymphoma/therapy , Pneumatosis Cystoides Intestinalis/therapy , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Fatal Outcome , Humans , Male , Middle AgedABSTRACT
The patient, 49-year-old woman, who was referred to our hospital in August 2016 because of left abdominal pain. The abdominal CT scan showed a large tumor, over 10 cm dimeter at splenic flexure of the transverse colon, and colonoscopy detected transvers colon cancer(por, cT4b, cN1, M0, cStage III A). There was no distant metastasis, although invasion to the retroperitoneum and the abdominal wall. Left hemicolectomy was successfully performed with D3 lymph node dissection. Pathological diagnosis was endocrine cell carcinoma, pT4a(SE), pN0, M0, pStage II . The Surgical margin was completely free of carcinoma(R0). The postoperative course was uneventful, and she has been in good health with no recurrence for 8 months after surgery. Neuroendocrine cell carcinoma is recommended for adjuvant treatment based on small cell lung cancer, but there are not effective clinical trials nor established treatment methods because it is rare disease.
Subject(s)
Carcinoma, Neuroendocrine/surgery , Colectomy , Colon, Transverse/surgery , Colonic Neoplasms/surgery , Colon, Transverse/pathology , Colonic Neoplasms/pathology , Female , Humans , Middle AgedABSTRACT
A 46-year old man presented with lower right quadrant abdominal pain caused by abdominal trauma. Abscess drainage was performed after the diagnosis of retroperitoneal abscess in the ileocecal portion of the colon. Type 2 advanced cancer was found in the cecum and ascending colon. Surgery was performed after improvement of inflammation. Considering the difficulty of curative resection for retroperitoneal invasion, we first performed ileo-transverse colon anastomosis. After surgery, the patient received FOLFOX with panitumumab(Pmab)as neoadjuvant chemotherapy. After 6 courses of this regimen, contrast enhanced computed tomography revealed shrinkage of the tumor. We performed a second surgery but the tumor was unresectable because of retroperitoneal invasion. After 47 courses of chemotherapy(5-FU plus LV with Pmab), the tumor was stable and we observed no distant metastasis. A third surgery was performed, and we were able to perform ileocecal resection including the retroperitoneum. The pathological diagnosis was pT4b(SI), pN1, ly2, V2, pPM0, pDM0, R0, pStage III a. On histological examination, the efficacy of chemotherapy was evaluated as Grade 1a. The patient received adjuvant chemotherapy with capecitabine and remains healthy without any evidence of recurrence more than 10 months after surgery.