[Permissibility of Stoma Closure Surgery in Patients with Colorectal Cancer Who Underwent Primary Tumor Resection Including in Cancer-Bearing Conditions].

From 2006 to 2021, 27 patients who underwent stoma construction during colorectal cancer resection followed by stoma closure were grouped into 2 groups: Group A(7 patients with cancer)and Group B(20 patients without cancer). The male- to-female ratio were 6:1 for Group A and 13:7 for Group B. The average ages were 63.7 and 65.0 years, respectively. The ratios(Group A:Group B)of the causes for stoma construction were 5:13 for bowel obstruction due to colorectal cancer, 2:2 for abdominal wall invasion/dissemination and 0:5 for covering stoma. The causes of non-curative resection for Group A were peritoneal dissemination(4 patients), liver metastasis(1 patient), bladder infiltration(1 patient), and periaortic lymph node metastasis(1 patient). For Groups A and B, Hartmann surgery was performed in 4 and 10, colectomy and stoma construction in 3 and 5, and low anterior resection and covering stoma in 0 and 5 patients, respectively. The median time to stoma closure was 10 months for Group A and 6 months for Group B(p<0.05). There was no case of anastomotic leakage and 1 case of anastomotic stenosis(case not treated with anticancer drugs). No patient died of cancer within 1 year after stoma closure(median survival time after stoma closure was >26.0 months for Group A). Although stoma closure in patients with cancer was significantly delayed compared with patients without cancer, it was performed safely.

[Long-Term Survival of Patient Having Advanced Esophageal Cancer with Cirrhosis after Overcoming Anastomotic Leakage, Purulent Osteomyelitis, Cervical Lymph Node Recurrence, and Systemic Edema-A Surgical Case].

We report the surgical case of advanced esophageal cancer with cirrhosis in a patient who has been cancer-free for 6 years after overcoming anastomotic leakage, purulent osteomyelitis, cervical lymph node recurrence, and systemic edema. A 69-year-old woman visited our hospital and presented with the complaint of a food sticking sensation. Endoscopic findings showed a type 3 tumor in the middle thoracic esophagus. Esophagectomy was subsequently performed. Histopathological findings revealed poorly differentiated squamous cell carcinoma, Mt, 17×15 mm, type 3, pT3, pIM0, pPM0, pDM0, pRM0, pN2(7/18), pStage Ⅲ, and liver cirrhosis(F4, A1-2). Postoperative suture failure was observed; however, it conservatively improved in approximately 2 months. The patient had lower back pain since approximately 6 weeks after the surgery, and she was diagnosed with purulent spondylitis and was administered antibiotics. The patient was subsequently discharged 67 days after the surgery. One course of 5-FU+CDDP was administered as postoperative adjuvant chemotherapy. However, renal function deteriorated, and chemotherapy was discontinued. Four months after the surgery, cervical echography revealed recurrence in the left cervical lymph node, and docetaxel(DTX)was administered. Five DTX doses were administered, because of which the left cervical lymph nodes markedly shrunk. Moreover, the sixth dose of DTX resulted in febrile neutropenia and a large amount of abdominal pleural effusion. Consequently, the patient was hospitalized. Tolvaptan treatment was extremely effective, and the thoracic ascites disappeared. Esophageal cancer has not recurred, and the patient is being observed at an outpatient clinic 6 years after the surgery.

[A Long-Term Recurrence-Free Survivor after Resection for Hepatopulmonary Metastases found within One Year after Rectal Cancer Surgery].

We observed a case of long-term survival without recurrence following hepatectomy and lung resection in a patient with hepatopulmonary metastases, which appeared 7 months after rectal cancer surgery. We report the case of a 68-year-old man whose chief complaint was anal pain. The patient was referred to our hospital because of a suspected rectal cancer. He was diagnosed with rectal cancer without distant metastasis, and abdominoperineal excision was then performed. Histopathological findings revealed Rb, type 2, 85×60 mm, tub 2, ly1, v1, pPM0, pDM0, pRM0, pT3(A), pN0(0/27), cM0, and pStage Ⅱa. Seven months after the surgery, abdominal computed tomography(CT)revealed a 3 cm nodule in segment 7 of the liver. In addition, chest CT detected a 2 mm nodule in segment 3 of the upper lobe of the left lung. Hepatectomy was immediately performed, whereas lung nodules were to be followed up. Three months later, chest CT showed that the lung nodules had increased in size(approximately 5 mm); therefore, the patient was diagnosed with lung metastasis, and thoracoscopic partial lung resection was performed. The histopathological findings of the hepatic tumor and lung tumor were similar to those of rectal cancer. The postoperative course was good, and the patient has been alive without recurrence for 8 years since the final surgery(lung resection)without postoperative adjuvant chemotherapy.

[Clinicopathological Examination of Resected Case of Primary Duodenal Cancer at Our Hospital].

Primary duodenal cancer is a rare disease. We examined 8 resected cases of duodenal cancer at our hospital from June 2003 to February 2022. Patients with resected duodenal cancer had an average age of 69.3 years(45-84 years), with a male-female ratio of 3 : 5. Of the 8 cases, 6 cases were adenocarcinomas and 2 were neuroendocrine carcinomas. Among those with adenocarcinomas, 3 cases were Stage Ⅰ, while Stage ⅡA, ⅢA, and ⅢB accounted for one case each(UICC 8th edition). Five patients underwent a pancreaticoduodenectomy(PD), while 1 underwent partial duodenal resection. Except for 1 case of Stage ⅢB(death from tumor recurrence in 1 year), tumor recurrence was not observed in the 5 remaining cases(survival period; >1 month to >97 months). The patient with a pT3pN1M0, Stage Ⅲ neuroendocrine carcinoma underwent a partial duodenal resection due to poor cardiac and renal function. Meanwhile, the patient with a pT4pN0M0, Stage Ⅲ neuroendocrine carcinoma underwent a PD. The survival time was 123 months for the former(death from other diseases, no tumor recurrence)and 7 months for the latter(death from recurrence).

[A 10-Year Survivor with Multidisciplinary Treatment for Pancreatic Carcinoma That Recurred 17 Months after Pancreatoduodenectomy].

Postoperative recurrence of invasive pancreatic ductal carcinoma(PC)has a poor prognosis. We experienced a case of PC that relapsed 17 months after pancreaticoduodenectomy(PD)and survived for more than 10 years after PD. A 51-year-old man underwent PD in December 2011(pT3pN1bM0, pStage Ⅱb). Gemcitabine(GEM)16 cycles were performed as postoperative adjuvant chemotherapy, and a 1 cm nodule was found in the liver on abdominal CT scan, and partial liver resection was performed. After that, adjuvant chemotherapy with S-1 was performed for 12 months. Abdominal CT scan revealed abdominal lymph node metastasis, and radiation therapy(39.6 Gy)was requested from another hospital. Then, the combination therapy of 5-FU/l-LV plus L-OHP(or CPT-11)was started in September 2014. To date, a total of 131 cycles of chemotherapy have been given. 10 years and 5 months after pancreaticoduodenectomy and 9 years after hepatectomy, although recurrence around the superior mesenteric artery plexus was observed, outpatient visits are continued.

Granulomatous cholangitis mimicking hilar cholangiocarcinoma: a case report.

BACKGROUND: Hilar biliary stricture caused by isolated fungal infections in immunocompetent patients are considered to be extremely rare and difficult to the diagnose from the outset. CASE PRESENTATION: We report a unique case of granulomatous cholangitis based on isolated biliary fungal infection manifesting as obstructive jaundice and mimicking hilar cholangiocarcinoma in an immunocompetent woman. A 67-year-old Japanese woman was referred to our hospital for obstructive jaundice. She had been followed up for hypochondroplasia by the referring physician. Her total bilirubin level was 5.4 mg/dL. Viral hepatitis screening was found to be negative, and serum IgG4 was within normal limits; however, her CA19-9 level was high. Abdominal computed tomography revealed dilatation of the intrahepatic bile ducts. Abdominal echogram detected a solid mass in the hilar bile duct. Her magnetic resonance cholangiopancreatography has also revealed an abrupt stenosis of the primary biliary confluence with upstream dilatation of the intrahepatic bile ducts. Endoscopic nasobiliary drainage was then performed to improve the obstructive jaundice. Although biliary cytology did not reveal malignant findings, the bile duct in the hilum showed severe stenosis, and hilar cholangiocarcinoma could not be completely excluded. The patient had a developmental disorder based on chondrodystrophy. To avoid excessive surgical stress, such as hepatic lobectomy, we performed resection of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy reconstruction. Intraoperative frozen sections of the resection margins were determined to be negative for tumor. The resected specimen showed multiple strictures inside the common bile duct, numerous calculi in the lumen, and little free space. The final pathological diagnosis was granulomatous cholangitis due to fungal infection. The patient's postoperative course was deemed uneventful. She was discharged from our hospital 23 days after surgery without antifungal treatment. CONCLUSIONS: For a unique case of granulomatous cholangitis based on isolated biliary fungal infection mimicking hilar cholangiocarcinoma, we were able to avoid excessive invasion and performed appropriate surgical management.

[Long-Term Survival by Multidisciplinary Treatments in a Non-Curative Resected Case of Rectal Mucinous Carcinoma Occurring 20 Years after Surgery for Rectal Carcinoma].

We reported the long-term survival ofa patient who underwent multidisciplinary treatments for non-curative resected rectal mucinous carcinoma that occurred 20 years after rectal carcinoma surgery. A 69-year-old man who had undergone a lower anterior resection for rectal cancer diagnosed approximately 20 years prior was referred to our hospital with a diagnosis ofrectal cancer. The tumor was detected near the rectal anastomosis ofthe previous surgery. Histopathologic study ofthe biopsy specimen revealed mucinous carcinoma. We performed a Miles operation in July 2010. The pathological findings were mucinous carcinoma, pT4b(small intestine), pN0, pPM1, pDM0, pRM1. Two months after surgery, chemotherapy comprising mFOLFOX6 plus Pmab was started and 12 courses oftreatment were administrated. Then, UFT was orally administrated. The pelvic tumor gradually increased to 9 cm in diameter. Radiation therapy was performed from May 2013 but was not effective. The histopathologic findings of a CT-guided biopsy revealed mucin only. We administered oral S-1, but his serum CEA level increased to 30.7 ng/mL and skin invasion of the tumor was observed; therefore, we performed tumor reduction surgery through an incision from the perineum in July 2015. After surgery, regorafenib was administered. The serum CEA value was normalized, but repeated urinary tract infection, gradually deteriorated renal function, and local cancer progression were observed. Administration of regorafenib continued in an outpatient setting for approximately 2 years and 4 months. The patient was admitted to the hospital because his general condition deteriorated in February 2018 and he died in March 2018. We experienced a case that survived for more than 5 years and 6 months after the pelvic recurrence of the rectal mucinous carcinoma.

[Two Cases of Neuroendocrine Carcinoma of the Non-Ampullary Duodenum].

Here we report 2 cases of neuroendocrine carcinoma(NEC)of the non-ampullary duodenum which is extremely rare neoplasm. Case 1: A 76-year-old man had a type 2 duodenal carcinoma with a 3 cm-sized lymph node metastasis. Duodenal resection with subpyloric lymph nodes dissection and Roux-en-Y reconstruction were performed. The histopathological diagnosis was NEC of the duodenal bulb after surgery(pT3pN1M0, stage III A, UICC 7th edition). The patient died of chronic heart failure 10 years and 3 months after the surgery. Case 2: A 45-year-old woman had a type 2 duodenal NEC of the second part of the duodenum. A subtotal stomach-preserving pancreatoduodenectomy was performed with lymph node dissection.(pT4pN0M0, stage II B, UICC 7th edition). The patient died of recurrence 7 months after the surgery.

[A Case of a Long-Term Survivor Who Underwent Surgical Intervention for Hepatocellular Carcinoma Combined with Tumor Thrombus in the Main Trunkof the Portal Vein].

We reported a patient survived more than 7years after undergoing hepatectomy accompanied by tumor thrombectomy in the main trunk of the portal vein after preoperative hepatic arterial chemotherapy for hepatocellular carcinoma combined with tumor thrombus in the main portal vein. A 58-year-old man underwent hepatic arterial infusion therapy with 5-fluorouracil( 5-FU)plus cisplatin(CDDP)for 6 weeks for a solitary 7cm nodule of hepatocellular carcinoma on the liver(S6) with tumor thrombus in the main portal vein. Although hepatic arterial infusion therapy was effective and the tumor shrank markedly, the tumor thrombus of the main portal vein still existed and the existence of portal hypertension was predicted from lower platelet values. Therefore, we performed hepatectomy accompanied by tumor thrombectomy in the main portal vein. Four months after surgery, staining of a single tumor was observed in the residual liver by contrast computed tomography (CT)and Lipiodol-TAI was performed. There was no recurrence of cancer for about 4 years, when a single recurrent lesion was found in the liver caudate lobe and a single lung metastatic lesion was also found in the left lower lobe section. We performed hepatectomy of the caudate lobe, and furthermore, we performed the left basilar segmentectomy. After these operations, the patient remained cancer free and died suddenly of another disease 7years after the first treatment for the hepatoma.

[A Case of Transduodenal Ampullectomy for an Ampullary Neoplasm Coexisting with Gastric and Colon Cancer].

We present here a case of transduodenal ampullectomy for an ampullary neoplasm coexisting with gastric and colon cancer. The patient was a 72-year-old man who was referred to our hospital with a positive fecal blood test. Colonoscopy revealed advanced cancer in the descending colon. As part of the preoperative examination, for the colonic cancer, upper gastrointestinal endoscopy was performed. Endoscopy showed a 2 cm elevated lesion(0'-II a type)with subserosalinfil tration on the small curvature side of the upper part of the stomach, and a 2 cm elevated lesion on the papilla of Vater. Histopathological examination showed that the former was a well differentiated tubular adenocarcinoma and the latter was a villous tubular adenoma with severe atypia. First, laparoscopic colectomy for advanced descending colon cancer was performed. Totalgastrectomy with Roux-en-Y reconstruction, cholecystectomy, and transduodenal ampullectomy for the ampullary neoplasm 21 days after the first surgery. The patient was discharged without any complications, such as postoperative suture failure. According to pathological tissue diagnosis, the degrees of progress of the colorectal cancer and the gastric cancer were pT2(MP)and pT1b(SM2), respectively, and there was no lymph node metastasis. The duodenal papillary tumor was a tubular villous adenoma(high grade). Local excision of the papilla is minimally invasive, leaves easy-to-secure stumps, and has less risk of complications such as bleeding and pancreatitis. Taking into account the balance with coexisting gastrointestinal cancer treatment, local excision of the papilla in this case was considered to be an appropriate treatment.

Long-term survival following hepatectomy, radiation, and chemotherapy for recurrent pancreatic carcinoma: a case report.

BACKGROUND: Recurrent pancreatic carcinoma (PC) is generally well known to have a poor prognosis. Cases in which multidisciplinary treatments have been remarkably effective are rare. CASE PRESENTATION: Herein, we reported a case of long-term survival following a combination of hepatectomy for a liver metastasis and radiation and chemotherapy for abdominal lymph node metastases after a curative pancreaticoduodenectomy for PC. A 51-year-old Japanese man underwent a pancreaticoduodenectomy following a PC diagnosis in December 2011. After the surgery, the patient received 16 cycles of gemcitabine (GEM) adjuvant chemotherapy. Abdominal computed tomography (CT) after therapy with GEM (17 months after surgery) revealed a 1-cm nodule in the liver, for which the patient underwent partial hepatectomy in May 2013. Approximately 1 month after the hepatectomy, the patient underwent adjuvant chemotherapy using tegafur/gimeracil/oteracil (S-1) for 12 months. Approximately 1 year after the second surgery, an abdominal CT scan detected the abdominal lymph node metastases, for which the patient underwent radiation therapy. After the radiation therapy, combination therapy with 5-fluorouracil(5-FU)/leucovorin plus oxaliplatin or irinotecan was started in September 2014; 59 cycles of this chemotherapy have been administered up to the time of this report. At 67 months after the pancreaticoduodenectomy and 50 months after the hepatectomy, the patient has remained healthy with no relapse or recurrent lesions. CONCLUSION: We have managed a long-term survivor who underwent hepatectomy for liver metastasis and radiation therapy and chemotherapy for abdominal lymph node metastases after curative pancreaticoduodenectomy for PC.

[A Case of Metastases to the Bone, Skin, and Ovary from Gastric Cancer Occurring More Than Eight Years after Distal Gastrectomy].

We report a 72-year-old woman with rare metastases of gastric cancer to the bone, skin, and ovary occurring more than 8 years after distal gastrectomy, which were subsequently effectively controlled. Histopathological diagnosis revealed signetring cell carcinoma, and the comprehensive findings were pT4a, pN3, ly2, v0, and Stage III c. The adjuvant chemotherapy of S- 1 plus cisplatin(CDDP)was switched to S-1monotherapy for 4 years and then to tegafur/uracil(UFT)for an additional year. Eight years after the operation, I-CTP and alkaline phosphatase(ALP)levels were elevated, and bone scintigraphy revealed bone metastasis. The patient's ALP levels, which had increased to 6,617 U/L, remarkably decreased to 359 U/L 17 months after treatment with zoledronic acid. About 9 years after the operation, a 2cm subcutaneous node was seen on the patient's scalp, and a biopsy was performed. Histologically, the node was confirmed as a signet-ring cell carcinoma. S-1 therapy was initiated, and the node disappeared within 8 months. About 10 years after the gastrectomy, abdominal computed tomography( CT)scans indicated a tumor sized 11×10 cm in the pelvis, and a biopsy was performed. Histologically, the tumor was a signet-ring cell carcinoma appearing as an ovarian metastasis of gastric cancer. Ovariectomy was performed. Peritoneal dissemination was not detected. The patient was treated with S-1 plus oxaliplatin and zoledronic acid, and continues to remain in good condition 9 months after the ovariectomy.

[Two Cases Pancreatic Carcinoma Detected Incidentally during Treatment of Acute Abdomen from Other Causes].

We report 2 cases of pancreatic cancer discovered incidentally in the wake of acute abdomen from other causes. Case 1 is a 67-year-old man who was referred to our hospital in October 2010 for the treatment of an incarcerated right inguinal hernia. The hernia was manually reduced, and mesh plug hernioplasty was scheduled for the next day. A 2.9 cm diameter tumor was detected in the tail of the pancreas on plain CT at the first visit and confirmed on enhanced CT soon after the hernia repair. A follow-up abdominal CT scan approximately 1 month later showed modest enlargement of the tumor to 3.5 cm diameter. The patient underwent distal pancreatectomy with lymph node dissection in December 2010. The histopathological diagnosis was tubular adenocarcinoma(tub1>tub2). Comprehensive findings were pT2, pN0, cM0, fStage II . He was treated with adjuvant chemotherapy consisting of gemcitabine 1,000mg/m2 for 6 months after surgery, and at 5 years and 7 months after surgery, he was alive and recurrence-free. Case 2 is a 74-year-old man who presented to our hospital with lower abdominal pain and diarrhea in early January 2016. Colonoscopy and barium enema revealed severe stenosis of the rectum(Rs). Rectal biopsy confirmed adenocarcinoma of the rectum. In addition, an enhanced CT scan showed irregular dilatation of the pancreatic duct in the pancreatic tail. The patient underwent low anterior resection and distal pancreatectomy, which was performed following an intraoperative pancreatic ultrasound examination that supported a diagnosis of pancreatic cancer. Pathological and comprehensive findings of rectal cancer were tubular adenocarcinoma(tub2)and pT3, pN0, cM0, fStage II , and those of the pancreatic cancer were tubular adenocarcinoma(tub2)and pT1, pN0, cM0, fStage I . The patient was discharged from the hospital 46 days after surgery. However, he died 18 days later due to sudden out-of-hospital cardiopulmonary arrest.

[CR of All Target Lesions in a Patient with Metastatic Esophageal Cancer and Generalized Weakness Treated with Systemic Chemotherapy after Nutritional Support].

We report here a case of CR of all target lesions in a patient with esophageal cancer with multiple metastases treated with systemic chemotherapy after nutritionalsupport. A 75-year-old man was referred to our hospital with a diagnosis of multiple- metastatic esophagealcancer in June 2014. He showed generalized weakness with poor dietary intake, and he was initially admitted for nutritional support by parenteral nutrition. Biopsy specimens revealed mixed squamous- and adenocarcinoma: MtLtUtAeG, 13 cm, type 2, cT3, IM1-St, cN3, cM1(liver, lungs, and stomach), cStage IV b esophagealcarcinoma. We had initiated 5-FU/CDDP/docetaxel(DCF)chemotherapy in July 2014. The target lesions exhibited PR after 2 courses of chemotherapy, and the primary esophageal lesion was markedly reduced, but was still present. The patient's renalfunction deteriorated after 8 courses of DCF, and the chemotherapy protocolwas changed to single-agent docetaxelonce every 3 weeks. The patient underwent 20 courses of the chemotherapy, and over a period of approximately 1 year from March 2015, CR of all target lesions was noted, with IR/SD of the primary tumor. The patient has survived and remained in good condition for 23 months following the initial diagnosis.

[Four Cases of Hepatectomy for Liver Metastases of Intractable Hepatobiliary Pancreatic Cancers].

The treatment of recurrences that occur after radical resection of intractable hepatobiliary pancreatic cancers such as intrahepatic cholangiocarcinoma, pancreatic carcinoma, and biliary tract carcinoma is more difficult than the treatment of primary lesions. In our institute, chest and abdominal CT examinations after radical resection of intractable hepatobiliary pancreatic cancers are performed about 3 times a year in order to evaluate for the possible emergence of small nodules in the liver. Instead of performing hepatectomy immediately after detecting small nodules, we conduct observations essentially for 3 to 6 months. Meanwhile, if the number of metastatic lesions tends to increase and absence of spread to other organs is confirmed, we decide to perform hepatectomy. In particular, when the detected nodule is solitary and larger than 1 cm, immediate hepatectomy is considered. We present the following 4 cases of hepatectomy for liver metastases after radical resection of intractable hepatobiliary pancreatic cancers: intrahepatic cholangiocarcinoma (n=1), gallbladder carcinoma (n=1), and pancreatic carcinoma (n=2). Liver metastases were detected at 3 to 17 months after radical resection of the primary lesion. Hepatectomy for the liver metastases was performed 14 to 18 months after the primary resection. Survival after hepatectomy was 22 to 45 months. The median survival was more than 25 months. By carefully selecting the indication for surgery, good results were obtained after hepatectomy even in cases of intractable cancers.

[Treatments of Other Cancers and Liver Metastases after Hepatectomy for Liver Cancers].

We examined patients who were treated for another cancer during treatment for primary and recurrent liver cancer. Case 1: A 71-year-old man underwent hepatectomy for hepatocellular carcinoma (HCC). Ten months after the surgery, a pancreatic tumor and multiple liver metastases of HCC were observed. After transarterial chemoembolization was performed to control HCC, the pancreatic cancer was resected. Case 2: A 76-year-old woman underwent liver resection for HCC. Six months after the surgery, gastric cancer and multiple liver metastases of HCC were observed. Transarterial chemoembolization was performed to control HCC, and S-1 was administrated for the gastric cancer. These treatments were repeated for about 1 year with 1 course per 6 week. Case 3: A 59-year-old man underwent hepatectomy for HCC. One year after the surgery, thyroid cancer was detected and was resected. About 7 years after the first surgery, recurrent HCC was noted and resected. Case 4: A 69-year-old man underwent hepatectomy for intrahepatic cholangiocarcinoma (ICC). Two months after the surgery, esophagectomy was performed for synchronous esophageal cancer. Thereafter, hepatectomy was repeated or radiofrequency ablation was performed for liver metastases of ICC. Primary liver cancer is associated with a high recurrence rate. So long as the primary and recurrent liver cancer is properly controlled, treatment for other cancers is possible.

Simple diversion by duodenojejunostomy for a retroperitoneal perforation of the second portion of the duodenal diverticulum.

We herein describe that a Roux-en-Y duodenojejunostomy is a simple and secure procedure for perforated diverticulum in the second portion of the duodenum. The surgical technique for perforated duodenal diverticulum can be adaptable when it is difficult to achieve closure of the perforated site easily. Patients who undergo the operation may be able to eat meals, even if duodenal fistula occurs in the postoperative course.

[A case of recurrent colon cancer with improvement in prognosis and cancer pain after surgical intervention].

We report a case of recurrent colon cancer with improvement in prognosis and cancer pain after surgical intervention. A 47-year-old man underwent an emergency Hartmann procedure for colon obstruction from descending colon cancer. Histopathological findings confirmed adenocarcinoma (moderate to poor), pT4apN0cM0, pStage II, and Cur A. In October 2009, abdominal computed tomography examination detected a solitary intraperitoneal recurrent lesion. Multi-agent chemotherapy ( mFOLFOX6)was administered. A fentanyl patch was also placed for relieving cancer pain, but was removed 4 months later because the pain disappeared. From June 2010, multi-agent chemotherapy with FOLFIRI was replaced with bevacizumab because of the increase in recurrent lesion size. In August 2011, the recurrent lesion involving the abdominal wall, left side of the colon, iliopsoas muscle, and left side of the ureter was resected and the left ureter was reconstructed. No fentanyl patch was prescribed at this time. In October 2012, tumor relapse was detected along with lung metastasis, and multi-agent chemotherapy ( FOLFIRI+bevacizumab) was resumed. In January 2013, the cancer pain recurred, and a fentanyl patch was placed again. Since then, the fentanyl dosage has been gradually increased. In August 2013, the tumor in the abdominal wall was resected to manage the patients' pain in the left lower side of the abdomen. Histopathology revealed a tumor in the lymph nodes. In November 2013, multi-agent chemotherapy with FOLFIRI+cetuximab was initiated, but was ineffective. In January 2014, regorafenib was prescribed. The patient has survived for more than 6 years after the primary surgery. We conclude that a therapeutic strategy that combines surgical interventions and multi-agent chemotherapy needs to be considered for improving prognosis and cancer pain in recurrent colon cancer.

[Treatment of repeat TACE plus S-1 for multiple intrahepatic recurrence of hepatoma and gastric cancer].

We report here an experience treating a patient who developed gastric cancer at the same time as a multifocal intrahepatic recurrence of hepatocellular carcinoma (HCC). The patient was a 76-year-old woman who underwent partial liver resection after diagnosis of HCC in August 2008. Histopathological examination revealed moderately differentiated hepatocellular carcinoma and stage III pathology. Six months following surgery, an upper gastrointestinal endoscopy revealed a typeIIa+IIc gastric tumor in the angle of the stomach, which was pathologically diagnosed as adenocarcinoma(por2/sig) in the biopsy. Simultaneously, abdominal CT scan revealed multifocal intrahepatic recurrence of HCC, so Lip-TACE as performed. Eight days after TACE, S-1 (80 mg/body) was initiated. About one month after TACE, abdominal CT scan revealed multiple new hepat- ic lesions. The patient was repeatedly treated with a combination of Lip-TACE on day 1 and S-1 80 mg/body/day, administered on days 8 to 35 for 28 days, followed by a 7 day interval as 1 course. After 5 courses of medication of S-1, liver function had deteriorated and thrombocytopenia occurred. Although there was no progression of gastric cancer, medication of S-1 was discontinued. Lip-TACE was performed nine times. About one year after the initial TACE, the patient was admitted to our hospital in order to control ascites, 3 days after admission, she suffered a cerebral infarction and died 3 days later.

[A resected case of pancreatic carcinoma associated with multiple intrahepatic recurrence of hepatocellular carcinoma].

A 7 1-year-old man, diagnosed with hepatocellular carcinoma (HCC), underwent lateral segmentectomy of the liver and partial hepatectomies. Ten months after the hepatic resections, computed tomography imaging of the abdomen revealed a pancreatic tumor and multiple liver metastases of HCC. The patient underwent transcatheter arterial chemoembolization three times to manage the HCC. Subsequently, he underwent distal pancreatic resection. Although it was a non-curative surgery, the postoperative course was uneventful; he was free from cancer pain, and his diabetes improved. At the 7-month follow-up after the pancreatectomy, the patients' course remained uneventful. There have been no reports of resected cases of pancreatic carcinoma that developed during the treatment of multiple intrahepatic recurrence of HCC. In cases wherein recurrence of HCC is well controlled, aggressive treatment for pancreatic cancer can be considered.