S-1 and CPT-11 Plus Ramucirumab (IRIS+Rmab) as Second-Line Chemotherapy for Patients with Oxaliplatin-Refractory Metastatic Colorectal Cancer (mCRC): A Multicenter Phase II Study in Japan (N-DOCC-F-C-1701).

This multicenter phase II N-DOCC-F-C-1701 trial is being planned in order to investigate the efficacy and safety of CPT-11+S-1 +Ramucirumab (IRIS+Rmab), which is anticipated to have a stronger anti-tumor effect than IRIS+Bmab in patients with metastatic colorectal cancer (mCRC) previously treated with oxaliplatin (L-OHP) containing regimen, in consideration of the result of RAISE, FIRIS and some phase II trials of IRIS+Bevacicizumab (Bmab). The number of patients is set at 38 for the statistical analysis, assuming an expected median PFS of 5.0 months (threshold: 3.0 months). The primary endpoint of the study is the progression free survival (PFS), and the secondary endpoints are the overall response rate (ORR), overall survival (OS), adverse events (AE), quality of life (QOL) and review of nausea and vomiting. This trial is registered in the UMIN Clinical Trials Registry as UMIN000028170. We intend to start conducting the trial in September 1, 2017. If this trial meets the endpoint, IRIS+Rmab might be supported as a new optional standard regimen for mCRC.

Main right hepatic duct entering the cystic duct: a case report.

BACKGROUND: Risk factors for bile duct injury in laparoscopic cholecystectomy include severe inflammation at Calot's triangle and aberrant bile duct variations. Knowledge of the various biliary anomalies and early identification may therefore assist in decreasing the rate of bile duct injury. CASE PRESENTATION: A 65-year-old woman was admitted with right hypochondrial pain and high fever. A diagnosis of acute calculous cholecystitis was made by radiological imaging. Magnetic resonance cholangiopancreatography revealed that the confluence of the right and left hepatic duct was unclear. Intraoperatively, the procedure was converted from a laparoscopic cholecystectomy to laparotomy because of unclear anatomy of the cystic duct with severe inflammation at Calot's triangle. Furthermore, intraoperative cholangiography from Hartmann's pouch showed the main right hepatic duct entering the cystic duct. Subtotal cholecystectomy was performed to avoid injuring the right hepatic duct. CONCLUSION: Although an aberrant hepatic duct entering the cystic duct is not uncommon, the main right hepatic duct infiltrating the cystic duct is extremely rare. Preoperative and intraoperative evaluation of the biliary duct and awareness of aberrant biliary duct variations is important in preventing bile duct injury.

[Five Cases of Ten-Year Survival after Surgical Treatment of Pancreatic Cancer in Yamaguchi Prefecture].

A questionnaire survey was conducted regarding the prognosis for pancreatic cancer at 8 major hospitals in Yamaguchi Prefecture. A total of 552 patients with pancreatic cancer who underwent radical surgery between 1997 and 2016 were identified. Five of them survived for more than 10 years. Among the 5 patients, none was treated with neoadjuvant chemotherapy: 4 underwent PD and 1 underwent DP-CAR. Two of them were treated with adjuvant chemotherapy. No complications occurred during their postoperative courses. All of them had no recurrence and survived. Here, we reported the longterm postoperative survival of patients with pancreatic cancer with literature review.

Perioperative synbiotic therapy in elderly patients undergoing gastroenterological surgery: a prospective, randomized control trial.

OBJECTIVE: Enteral administration of synbiotics has been reported to be beneficial during various types of surgery, but its clinical value in elderly surgical patients remains unclear. The aim of this study was to quantitatively evaluate the changes in gut microbiota and environment induced by perioperative synbiotic therapy, and to investigate whether it is possible to reduce infectious complications in elderly patients undergoing gastroenterological surgery. METHODS: Forty-eight patients over the age of 70 y were randomized into a group receiving 7 d of preoperative and 10 d of postoperative synbiotic therapy (S group) and a control group without synbiotic therapy (C group). A fecal sample collected before and after surgery in each group was used for a quantitative evaluation of the microbiota. RESULTS: Forty-eight patients completed the trial (25 in the S group and 23 in the C group). Synbiotic therapy significantly maintained the status of Bifidobacterium and Lactobacillus, whereas the number of Enterobacteriaceae, Staphylococcus, and Pseudomonas was significantly decreased. The total organic acid and short-chain fatty acid concentrations were increased, and the pH was markedly decreased, in the S group compared with the C group. The incidence of postoperative infectious complications was 12% in the S group and 36% in the C group, however, the difference did not reach statistical significance (P = 0.06). A multivariate analysis revealed that only the use of perioperative blood transfusion was an independent risk factor for infectious complications. CONCLUSIONS: Synbiotic therapy improved the intestinal microbial environment, and might decrease the incidence of infectious complications in elderly surgical patients.

[A recurrent case of lipid-secreting carcinoma of the breast successfully treated with capecitabine].

We herein report a recurrent case of lipid-secreting carcinoma of the breast which was successfully treated with capecitabine. A 50-year-old female underwent a pectoralis-preserving mastectomy for left breast cancer in December 2002. The clinical staging of the disease was T2N1M0 (stage II B) and ER (-), PgR(-), HER2 (1+). Microscopic examinations revealed solid alveolar proliferation in the majority of the tumor cells, which had an abundant foamy cytoplasm. A variable amount of neutral lipid was also identified in the cytoplasm of the tumor cells by Sudan III staining. After the operation, the patient received two courses of systemic chemotherapy using docetaxel (60 mg/m(2)). In March 2004, she was diagnosed to have a recurrence in the thoracic wall. She received radiotherapy (total 50 Gy radiation), but it proved to be ineffective. In June 2004, treatment using capecitabine (2,400 mg/day) was therefore attempted. Two courses of the treatment resulted in a complete response of the tumor. The above patient has since continued to show a complete response with capecitabine for over 3.5 years.

Efficacy of the tyrosine kinase inhibitor gefitinib in a patient with metastatic small cell lung cancer.

Gefitinib (Iressa, ZD1839) is an orally active inhibitor selective for the epidermal growth factor receptor tyrosine kinase and has shown promise in the treatment of non-small cell lung cancer (NSCLC). There has been no report to date of the effect of gefitinib treatment in patients with small-cell lung cancer (SCLC). Here we report a case of metastatic SCLC that was successfully treated with gefitinib. This case is the first reported of objective clinical response after gefitinib treatment in a patient with SCLC. Our report suggests that treatment with gefitinib is a novel option for a subset of patients with SCLC.

[Two cases of non-curatively resected scirrhous gastric cancer that responded well to weekly paclitaxel therapy].

We report 2 cases in which the weekly administration of paclitaxel proved to be effective for patients with scirrhous gastric cancer who underwent a curability C operation. Weekly paclitaxel therapy was observed to effectively treat peritoneal and retroperitoneal dissemination. After this treatment the tumor markers decreased markedly. This weekly paclitaxel therapy was observed to cause no adverse effects, and thanks to the treatment the patients were able to consume normal meals. These patients could also be sufficiently treated as outpatients. Weekly paclitaxel therapy is thus considered to be effective for the treatment of advanced scirrhous gastric cancer with peritoneal and retroperitoneal dissemination.

Video-assisted neck surgery for thyroid and parathyroid diseases.

BACKGROUND: Endoscopic surgery has now become a well-established modality for the treatment of various organ diseases. In the present study, we analyzed the surgical results achieved by video-assisted neck surgery (VANS) in thyroid and parathyroid diseases. METHODS: From January 2000 to April 2002, 87 patients (eight males and 79 females) with a mean age of 49 years underwent VANS. The preoperative diagnoses of these patients included 37 benign thyroid tumors, 30 Graves' diseases, 17 parathyroid adenomas and three thyroid cancers. RESULTS: The mean operative time of VANS was 165 min for a hemithyroidectomy, 287 min for a subtotal thyroidectomy, and 157 min for a parathyroidectomy. The mean intraoperative blood loss was 60, 183 and 23 g for a hemithyroidectomy, subtotal thyroidectomy and parathyroidectomy, respectively. No conversion from VANS to conventional surgery was experienced. Three patients (3.4%) had temporary palsy of the recurrent laryngeal nerve. Otherwise, the postoperative courses were uneventful. CONCLUSIONS: VANS for thyroid and parathyroid diseases was found to be safe and effective. From a cosmetic point of view, a high degree of patient satisfaction was obtained. VANS is thus considered to be an excellent option for selected patients with thyroid and parathyroid diseases.