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1.
Anticancer Res ; 41(10): 5097-5106, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34593460

RESUMO

AIM: D3 lymph node dissection (LND) for stage II and III colon cancer has been shown to improve prognosis, however, it generally increases surgical stress. Studies have reported that the C-reactive protein/albumin ratio (CAR) may be a useful inflammatory-nutritional biomarker to predict postoperative complications and poor prognosis for with various types of cancer. Our purposes were to assess the short- and long-term outcomes of D3 LND in patients with a high preoperative CAR (≥ 0.04). PATIENTS AND METHODS: This was a retrospective cohort analysis reviewing a prospectively collected database of Yokohama City University and three affiliated hospitals. A total of 449 patients with stage II or III colon cancer with high CAR who underwent primary resection with D2 or D3 LND were identified between 2008 and 2020. The primary and secondary outcomes of interests were the 3-year recurrence-free survival and postoperative complication rates. RESULTS: After propensity matching, 230 patients were evaluated. There was no significant difference between the D3 and D2 groups in the rate of postoperative complications overall (14.8% versus 11.3%, p=0.558), however, the incidence of anastomotic leakage tended to be greater in the D3 group (9.6% versus 2.6%, p=0.050). The long-term findings showed that there was no significant difference between the two groups (3-year recurrence-free survival rate: 77.2% versus 77.2%, p=0.880). CONCLUSION: D3 LND did not improve survival outcomes for patients with colon cancer with a poor CAR in this study. D2 LND may be a treatment option for patients with stage II-III colon cancer with a high preoperative CAR.


Assuntos
Albuminas/metabolismo , Biomarcadores Tumorais/metabolismo , Proteína C-Reativa/metabolismo , Neoplasias do Colo/mortalidade , Excisão de Linfonodo/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/metabolismo , Neoplasias do Colo/patologia , Neoplasias do Colo/cirurgia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Pontuação de Propensão , Estudos Prospectivos , Estudos Retrospectivos , Taxa de Sobrevida
2.
Gan To Kagaku Ryoho ; 48(10): 1284-1286, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34657065

RESUMO

We experienced a case of kidney metastasis of a gastric tumor. An 81-year-old man underwent distal gastrectomy with D2 lymph node dissection and partial hepatic resection for antral gastric tumor with hepatic infiltration in July 2019. A histological examination showed undifferentiated tubular adenocarcinoma. The final stage was pT4bN1P0H0M0, Stage ⅢB. He rejected the recommended adjuvant chemotherapy. Seven months after surgery, abdominal enhanced CT showed a hypovascular mass, 20 mm in diameter, on the right upper pole of kidney. Eleven months after surgery, CT showed that the mass had enlarged to 35 mm, infiltrated the renal pelvis, and advanced to para-aortic lymph node metastasis. We performed a retroperitoneoscopic partial right nephrectomy and diagnosed kidney metastasis of the gastric tumor. His right flank pain worsened, and radiotherapy(50 Gy)was performed for the mass and para-aortic lymph node metastasis. His right flank pain resolved. Kidney metastasis of the gastric tumor is very rare. Radiotherapy effectively relieves pain.


Assuntos
Neoplasias Gástricas , Idoso de 80 Anos ou mais , Gastrectomia , Humanos , Rim , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Masculino , Neoplasias Gástricas/cirurgia
3.
Gan To Kagaku Ryoho ; 48(10): 1293-1295, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34657068

RESUMO

A 65-year-old woman underwent distal gastrectomy with D2 lymph node dissection for advanced gastric cancer in November 2016. The histopathological diagnosis was pT3N0M0, pStage ⅡA, HER2-negative. In August 2019, transverse colon stenosis due to peritoneal dissemination was detected, and an ileum-transverse colon anastomosis was performed. Postoperatively, she received chemotherapy with S-1 plus oxaliplatin. After 6 courses, CT revealed an increase in ascites and dissemination nodules. We diagnosed her with progressive disease and initiated second-line chemotherapy, a ramucirumab plus nab-paclitaxel regimen. On the 20th day during the 5th course of treatment, she visited our hospital with acute abdominal pain. CT revealed free air, and we diagnosed acute panperitonitis with a gastrointestinal perforation. Emergency surgery was performed, and perforation of the appendix end and mild cloudy ascites were observed. We performed an appendectomy and intraperitoneal drainage. Histopathological examination revealed perforation of the appendix, possibly as an adverse effect of the ramucirumab. It should be noted that angiogenesis inhibitors may cause the fatal adverse effect of gastrointestinal perforation.


Assuntos
Apêndice , Divertículo , Neoplasias Gástricas , Idoso , Albuminas , Anticorpos Monoclonais Humanizados , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Gastrectomia , Humanos , Paclitaxel/uso terapêutico , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
4.
Gan To Kagaku Ryoho ; 48(10): 1296-1298, 2021 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-34657069

RESUMO

Chylothorax after esophagectomy is a relatively rare complication that can be difficult to manage. Here, we report a case of refractory chylothorax after surgery for esophageal cancer treated with lymphatic duct lipiodol imaging by inguinal lymph node puncture to confirm patency of the thoracic duct and thoracic duct ligation. A 71-year-old female with esophageal cancer(cT3N0M0)underwent video-assisted thoracoscopic esophagectomy with 2-field lymph node dissection, intrathoracic gastric tube reconstruction, and an enterostomy. A chylothorax appeared when we started enteral nutrition on the day after surgery. She became markedly dehydrated due to over 2,000 mL/day of drainage from the chest drain, and we managed her general condition in the ICU. We started octreotide acetate on postoperative day(POD)6 and etilefrine on POD 8, but neither was effective. Lymphatic duct lipiodol imaging by bilateral inguinal lymph node puncture was performed, and we confirmed leakage from the main thoracic duct. On POD 11, a thoracic duct ligation performed via a thoracotomy revealed that the volume of the chylothorax was remarkably decreased. The chest tube was removed on re-POD 12.


Assuntos
Quilotórax , Neoplasias Esofágicas , Idoso , Quilotórax/diagnóstico por imagem , Quilotórax/etiologia , Quilotórax/cirurgia , Neoplasias Esofágicas/cirurgia , Esofagectomia/efeitos adversos , Feminino , Humanos , Linfografia , Complicações Pós-Operatórias/cirurgia , Ducto Torácico/diagnóstico por imagem , Ducto Torácico/cirurgia
5.
In Vivo ; 35(6): 3483-3488, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34697185

RESUMO

BACKGROUND: Resection of the primary lesion with radical lymph node dissection is the most promising treatment avenue for patients with cancer. On the other hand, these procedures often induce excessive intraoperative blood loss (IBL) and require perioperative blood transfusion. The influence of IBL on the long-term postoperative outcomes of patients with digestive cancer is controversial. We investigated the impact of IBL on survival and recurrence after curative surgery in patients with colorectal cancer (CRC) in a single study group. PATIENTS AND METHODS: In total, 1,597 patients who underwent radical resection for CRC at three group hospitals between 2000 and 2019 were reviewed. Patients were classified into a group with high IBL (≥200 ml) or low IBL (<200 ml). The risk factors for disease-free (DFS) and overall (OS) survival were analyzed. RESULTS: A total of 489 and 1,108 patients were classified into the high and low IBL groups, respectively. The OS and DFS rates at 5 years after surgery were 89.3% and 63.4%, respectively, for the high IBL group and 96.9% and 77.8% for the low IBL group; these differences were statistically significantly (p<0.001). The multivariate analysis demonstrated that IBL was a significant independent risk factor for OS and DFS. CONCLUSION: The amount of IBL was associated with significant differences in the OS and DFS of patients with stage II/III CRC who received curative resection. The surgical procedure, surgical strategy, and perioperative care should be carefully planned to avoid causing IBL.


Assuntos
Perda Sanguínea Cirúrgica , Neoplasias Colorretais , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Intervalo Livre de Doença , Humanos , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Prognóstico , Estudos Retrospectivos
6.
Anticancer Res ; 41(5): 2617-2623, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33952492

RESUMO

AIM: To compare the mid-term oncological results between patients with low rectal cancer who underwent minimally invasive laparoscopic surgery (MILS) and those who underwent open surgery (OS). PATIENTS AND METHODS: Overall, 262 matched patients who underwent primary resection for low rectal cancer between 2000 and 2019 were divided into MILS (n=131; n=107, conventional laparoscopic surgery; n=24, robotic surgery) and OS (n=131) groups. The short- and mid-term outcomes were compared. RESULTS: Similar baseline characteristics were noted. The operative time was longer and blood loss was lesser in the MILS group; the conversion rate was 3.8%. The incidence of postoperative complications was similar. The 2-year cumulative incidence of local recurrence was noted to be much lower in the MILS group (1.9%) than in the OS group (8.4%). MILS had a significantly low hazard ratio (0.208, p=0.036). CONCLUSION: MILS has potential benefits in reducing local recurrence of low rectal cancer.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Minimamente Invasivos , Recidiva Local de Neoplasia/cirurgia , Neoplasias Retais/cirurgia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia
7.
BMC Surg ; 21(1): 51, 2021 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-33478441

RESUMO

BACKGROUND: Most evidence regarding lateral lymph node dissection for rectal cancer is from expert settings. This study aimed to evaluate the safety and efficacy of this procedure in a practice-based cohort. METHODS: A total of 383 patients who were diagnosed with stage II-III mid-to-low rectal cancer between 2010 and 2019 and underwent primary resection with curative intent at a general surgery unit were retrospectively reviewed. After propensity matching, 144 patients were divided into the following groups for short- and long-term outcome evaluation: mesorectal excision with lateral lymph node dissection (n = 72) and mesorectal excision (n = 72). RESULTS: This practice-based cohort was characterized by a high pT4 (41.6%) and R1 resection (10.4%) rate. Although the operative time was longer in the lateral dissection group (349 min vs. 237 min, p < 0.001), postoperative complications (19.4% vs. 16.7%, p = 0.829), and hospital stay (18 days vs. 22 days, p = 0.059) did not significantly differ; 5-year relapse-free survival (62.5% vs. 66.4%, p = 0.378), and cumulative local recurrence (9.7% vs. 15.3%, p = 0.451) were also in the same range in both groups. In the seven locally recurrent cases in the lateral dissection group, four had undergone R1 resection. CONCLUSIONS: Lateral lymph node dissection was found to be safe in this practice-based cohort; however, the local control effect was not obvious. To maximize the potential merits of lateral lymph node dissection, strategies need to be urgently established to avoid R1 resection in clinical practice.


Assuntos
Excisão de Linfonodo/métodos , Neoplasias Retais , Adulto , Idoso , Idoso de 80 Anos ou mais , Dissecação , Feminino , Humanos , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prática Profissional , Pontuação de Propensão , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Estudos Retrospectivos , Resultado do Tratamento
8.
J Cancer Res Ther ; 16(Supplement): S95-S98, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33380660

RESUMO

Background: Intractable ascites secondary to malignant disease deteriorates patients' quality of life. The purpose of this study was to evaluate the safety and efficacy of percutaneous peritoneovenous (Denver) shunt in treating intractable malignant ascites in cancer patients. Materials and Methods: Thirty-five patients who had undergone Denver peritoneovenous shunt for the treatment of ascites associated with malignant tumor from October 2014 to 2017 were retrospectively analyzed. The demographic characteristics, laboratory values, and complications were recorded. Univariate and multivariate logistic regression analyses were performed. Results: The sites of primary tumor were pancreatic cancer in 19 patients, bile duct cancer in 8, gallbladder cancer in 5, breast cancer in 2, and peritoneal malignant mesothelioma in 1. Palliation of abdominal distention was achieved in 29 patients (82.9%). Postoperative complications of Grade 2 or higher were seen in 11 patients (31.4%), and Grade 5 complications were observed in three patients (8.6%). Patients with a high American Society of Anesthesiologists (ASA) grade and high ascites drainage volume had a significantly higher incidence of postoperative complications than a low ASA grade and low ascites drainage volume, and a multivariate logistic analysis showed that the intraoperative ascites drainage volume was an independent risk factor for all complications. Conclusions: The Denver shunt for malignant ascites is useful for improving patients' quality of life if the indications are selected properly. Drainage of intraoperative ascites was a risk factor for postoperative complications after the Denver shunt technique in cancer patients with malignant ascites. Further experience and discussion are necessary to establish the patient selection criteria.


Assuntos
Ascite/cirurgia , Cuidados Paliativos/métodos , Neoplasias Peritoneais/complicações , Derivação Peritoneovenosa/efeitos adversos , Adulto , Idoso , Ascite/etiologia , Ascite/mortalidade , Ascite/patologia , Neoplasias da Mama/mortalidade , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Feminino , Neoplasias da Vesícula Biliar/mortalidade , Neoplasias da Vesícula Biliar/patologia , Neoplasias da Vesícula Biliar/cirurgia , Mortalidade Hospitalar , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Neoplasias Pancreáticas/mortalidade , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Neoplasias Peritoneais/mortalidade , Neoplasias Peritoneais/secundário , Neoplasias Peritoneais/cirurgia , Derivação Peritoneovenosa/mortalidade , Complicações Pós-Operatórias/etiologia , Qualidade de Vida , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
9.
J Cancer Res Ther ; 16(Supplement): S116-S121, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33380664

RESUMO

Background: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on the pancreatic cancer survival and recurrence after curative surgery followed by adjuvant chemotherapy. Patients and Methods: This study included 155 patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer between 2005 and 2014. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. Results: An ACCI of 8 was regarded as the optimum critical point of classification considering the 1-, 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 25.7% and 19.0% in the ACCI-low group, respectively, and 7.6% and 0% in the ACCI-high group, which amounted to a statistically significant difference (P = 0.019). The RFS rates at 3 and 5 years after surgery were 17.3% and 13.8% in the ACCI-low group, respectively, and 7.1% and 0% in the ACCI-high group, which amounted to a marginally statistically significant difference (P = 0.104). A multivariate analysis showed that the ACCI was a significant independent risk factor for both the OS and RFS. Conclusions: The ACCI was a risk factor for the OS in patients who underwent curative surgery followed by adjuvant chemotherapy for pancreatic cancer. An effective plan is needed for determining the optimum surgical strategy according to the ACCI.


Assuntos
Antimetabólitos Antineoplásicos/uso terapêutico , Recidiva Local de Neoplasia/epidemiologia , Pancreatectomia , Neoplasias Pancreáticas/terapia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Comorbidade , Desoxicitidina/análogos & derivados , Desoxicitidina/uso terapêutico , Intervalo Livre de Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Neoplasias Pancreáticas/mortalidade , Prognóstico , Estudos Retrospectivos , Medição de Risco/métodos , Medição de Risco/estatística & dados numéricos , Fatores de Risco , Taxa de Sobrevida
10.
Anticancer Res ; 40(7): 4067-4074, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32620654

RESUMO

BACKGROUND: The aim of this study was to evaluate the impact of postoperative infectious complications on long-term outcomes after curative resection of gastric cancer. PATIENTS AND METHODS: Patients who underwent curative gastrectomy with lymphadenectomy for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015 were retrospectively selected from medical records. Clinicopathological factors between patients with and without infectious complications were compared. Prognostic factors of long-term survival were analyzed by univariate and multivariate Cox proportional hazards analyses. RESULTS: A total of 2,254 patients were eligible for inclusion in the present study. Fifty-eight patients had postoperative infectious complications (IC group); 2,196 had no postoperative infectious complications (NC group). In the IC group, the median age (p=0.031), body mass index (p=0.004), American Society of Anesthesiologists physical status (p=0.006) and percentage of male patients (p<0.001) were higher in comparison to the NC group. The operation time was longer (p<0.001) and the incidence of intestinal-type histology was higher (p=0.017) in the IC group. The 5-year overall survival rates of the IC and NC groups were 59.8% and 83.2%, respectively (p<0.001). Univariate and multivariate analyses demonstrated that postoperative infectious complications were a significant risk factor for poorer overall survival (hazard ratio=2.38; 95% confidence interval=1.47-3.85, p<0.001). CONCLUSION: Perioperative management is necessary to reduce the incidence of postoperative infectious complications and improve the survival of patients after curative resection of gastric cancer.


Assuntos
Adenocarcinoma/cirurgia , Infecções/etiologia , Complicações Pós-Operatórias , Neoplasias Gástricas/cirurgia , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Gastrectomia , Humanos , Infecções/mortalidade , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Gástricas/mortalidade , Análise de Sobrevida , Adulto Jovem
11.
Gan To Kagaku Ryoho ; 47(2): 259-261, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32381959

RESUMO

The effectiveness of lymph node dissection tends to be reduced clinically in elderly patients with colorectal cancer because of physical limitations, such as comorbidities and organ dysfunction. We investigated the influence of the level of lymph node dissection on the prognosis of elderly patients with colorectal cancer. A total of 137 patients with pT2 or more-advanced tumors or lymph node metastasis were retrospectively studied. The 5-year overall survival(OS)andrelapse free survival(RFS) rates were 74.1% and 63.9%, respectively. Lymph node dissection was an independent prognostic factor in the examination of prognostic factors of OS. In the propensity-matchedcohort, the 5-year OS rates were 87.2% and5 8.2%(p=0.02), and the 5-year RFS rates were 77.8% and4 6.4%(p=0.03)in the D3 andred ucedgroups, respectively. The D3 group hada significantly better prognosis than the reduced group. D3 lymph node dissection might contribute to the improvement of prognosis in elderly people with colorectal cancer.


Assuntos
Neoplasias Colorretais , Idoso , Neoplasias Colorretais/cirurgia , Humanos , Excisão de Linfonodo , Metástase Linfática , Estudos Retrospectivos
12.
Oncol Res Treat ; 43(4): 125-133, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32040953

RESUMO

OBJECTIVE: To investigate the prognostic values of the preoperative modified Glasgow Prognostic Score (mGPS) and carcinoembryonic antigen (CEA) alone and combined in elderly patients with colorectal cancer (CRC) planning to receive curative surgery. METHODS: We retrospectively analyzed 130 elderly patients (aged ≥80 years) with CRC who received curative surgery between 2008 and 2016. The preoperative mGPS and CEA levels were calculated. RESULTS: Elevated preoperative mGPS or CEA level was significantly associated with shorter relapse-free survival (p = 0.005, both) and cancer-specific survival (p = 0.011 and p < 0.001, respectively). Combined use of these two factors improved the predictive accuracy for tumor recurrence relative to that of either factor. CONCLUSION: Both mGPS and CEA were independent prognostic factors of CRC in elderly patients receiving curative surgery, but their combination was more accurate.


Assuntos
Antígeno Carcinoembrionário/sangue , Neoplasias Colorretais/sangue , Recidiva Local de Neoplasia/sangue , Fatores Etários , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/sangue , Neoplasias Colorretais/patologia , Neoplasias Colorretais/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Valor Preditivo dos Testes , Cuidados Pré-Operatórios/métodos , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida
13.
Indian J Surg Oncol ; 10(4): 582-586, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31857748

RESUMO

This study aimed to investigate the diagnostic power of preoperative imaging for lateral pelvic lymph node (LPLN) metastasis. A total of 79 patients with advanced lower rectal cancer were preoperatively examined with pelvic enhanced computed tomography and underwent primary resection and LPLN dissection (LPLD) from 2007 to 2014 in our institute. The maximum LPLN was selected to be measured in both the long- and short-axis diameters by picture archiving and communication system (PACS) and was compared with the histopathological results. Receiver operating characteristic (ROC) curves were used to identify the optimal cut-off scores, and we evaluated the accuracy of the thresholds. Twenty-one patients (26.6%) had LPLN metastasis. In the ROC analysis, the criterion of 7.6 mm or larger in the long-axis diameter was used as the optimal threshold for metastasis (area under the curve (AUC) = 0.938) and the criteria of 5.5 mm or larger in the short axis (AUC = 0.946). On the basis of these cut-off scores, the criteria in the long axis represented 95.2% sensitivity, 91.5% specificity, 83.3% positive predictive value (PPV), 98.2% negative predictive value (NPV), and 93.7% accuracy. In contrast, there was 95.2% sensitivity, 89.7% specificity, 76.9% PPV, 98.1% NPV, and 91.1% accuracy in the short axis. Preoperative PACS imaging was considered an optimal tool for diagnosing LPLN metastasis in patients with advanced lower rectal cancer. It is suggested to become the index for considering LPLD adaptation.

14.
Gan To Kagaku Ryoho ; 46(10): 1632-1634, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631158

RESUMO

We report a case of altered consciousness related to hyperammonemia due to FOLFIRI plus bevacizumab therapy in a patient with recurrent colorectal cancer and renal dysfunction.A 76-year-old man received third-line chemotherapy for left mediastinal lymph node metastasis.He complained of diarrhea on the evening of the same day, and mental confusion on day 3 of the first FOLFIRI therapy.He had a JCS of Ⅲ(200).The laboratory results revealed a marked hyperammonemia.5 - fluorouracil(5-FU)-induced hyperammonemia was diagnosed and the patient was ventilated and managed with branchedchain amino acid solutions, lactulose, and hemodialysis in the ICU.After hemodialysis, the blood ammonia level reduced to the normal limits, and the symptoms of encephalopathy resolved on the following day.He was discharged home on the 19th day of hospitalization.5 -FU-containing therapy should be carefully administered in patients with renal dysfunction.Herein, we report a case of 5-FU-induced hyperammonemia with literature considerations.


Assuntos
Neoplasias Colorretais , Fluoruracila/efeitos adversos , Hiperamonemia , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica , Camptotecina , Estado de Consciência , Humanos , Hiperamonemia/induzido quimicamente , Leucovorina , Masculino , Recidiva Local de Neoplasia
15.
Gan To Kagaku Ryoho ; 46(10): 1638-1640, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631160

RESUMO

Appendiceal mucinous neoplasm has a risk for pseudomyxoma peritonei caused by appendiceal perforation.It has been reported that laparoscopic surgery is more risky than open surgery.We investigated 4 patients who underwent laparoscopic surgery for appendiceal mucinous neoplasm.The median age was 69.5(49-85).There were 3 males and 1 female.Three cases of partial laparoscopic resection of the cecum and 1 case of ileocecal resection with lymph node dissection were performed. The pathology was low-grade mucinous neoplasm in all cases.The median hospital stay was 6 days, and there were no postoperative complications(CD Grade 3 or higher)or hospital death.As for long-term results, peritoneal pseudomyxoma developed in 1 case, which had already ruptured at the time of surgery.There were no recurrences in other cases.This result suggests that laparoscopic surgery for appendiceal mucinous neoplasm is safe with optimal selection of the procedure and a protective technique.


Assuntos
Adenocarcinoma Mucinoso , Neoplasias do Apêndice , Laparoscopia , Neoplasias Peritoneais , Pseudomixoma Peritoneal , Adenocarcinoma Mucinoso/cirurgia , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Apêndice/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia
16.
Gan To Kagaku Ryoho ; 46(10): 1659-1661, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631167

RESUMO

A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.


Assuntos
Anormalidades do Sistema Digestório , Volvo Intestinal , Laparoscopia , Mesocolo , Neoplasias do Colo Sigmoide , Colo Sigmoide , Humanos , Masculino , Mesocolo/cirurgia , Pessoa de Meia-Idade , Neoplasias do Colo Sigmoide/cirurgia
17.
Gan To Kagaku Ryoho ; 46(10): 1662-1664, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631168

RESUMO

This case involved a 42-year-old woman who had no remarkable findings in terms of case history and family history. Upper gastrointestinal series performed during a medical examination revealed ulcerative lesions in the anterior wall of the stomach body. Upper gastrointestinal endoscopy was performed, and a submucosal tumor with a maximum diameter of 50mm accompanied by an ulcerative lesion was found in the anterior wall of the lower part of the stomach. She was diagnosed with a schwannoma based on endoscopic ultrasonography-guided fine needle aspiration, and we received consultation for surgical purpose. Surgery was performed with laparoscopic partial resection of the stomach and lymph nodes in the lesser curvature of the stomach. She was discharged on the 7th day after the surgery. The postoperative pathologic findings showed no nuclear fissure or atypia with a diagnosis of a schwannoma and no lymph node metastasis. Gastric schwannoma is a rare disease that arises from Schwann cells of the Auerbach's plexus of the gastric wall muscularis and comprises 0.1-0.2% of all stomach tumors. Preoperative diagnosis is often extremely difficult, and there are reports of malignancy. Treatments and surgical methods should be carefully considered. Herein, we encountered a case of a resected giant gastric schwannoma by laparoscopic surgery, which is reported with a literature review.


Assuntos
Laparoscopia , Neurilemoma , Neoplasias Gástricas , Adulto , Endoscopia do Sistema Digestório , Feminino , Humanos , Neurilemoma/cirurgia , Neoplasias Gástricas/cirurgia
18.
Gan To Kagaku Ryoho ; 46(10): 1668-1670, 2019 Oct.
Artigo em Japonês | MEDLINE | ID: mdl-31631170

RESUMO

BACKGROUND: Laparoscopic surgery in patients with retroperitoneal fibrosis has been reported to be difficult due to mesenteric and retroperitoneal fibrotic thickening. Here, we report a case of laparoscopic surgery with IgG4-related disease. CASE PRESENTATION: A 60-year-old man with IgG4-related kidney disease and autoimmune pancreatitis was diagnosed with cecal cancer. Laparoscopic ileocecal resection was performed. Preoperative CT showed no evidence of retroperitoneal fibrosis but showed a localized fibro-inflammatory lesion between the retroperitoneum and mesentery in front of the right kidney due to interstitial nephritis. Intraoperative findings revealed focal adhesions in the duodenal front within the range consistent with CT findings. CONCLUSIONS: This report shows that the degree and extent of fibrosis were similar between preoperative CT and actual surgical findings. Thus, it is possible that tissue fibrosis in patients with IgG4-related disease could be predicted by preoperative CT.


Assuntos
Neoplasias do Ceco , Doença Relacionada a Imunoglobulina G4 , Laparoscopia , Fibrose Retroperitoneal , Neoplasias do Ceco/complicações , Humanos , Imunoglobulina G , Doença Relacionada a Imunoglobulina G4/complicações , Masculino , Pessoa de Meia-Idade
19.
In Vivo ; 33(4): 1301-1306, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31280222

RESUMO

BACKGROUND/AIM: We investigated the impact of Beppu's nomogram on colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. PATIENTS AND METHODS: This study included 43 patients who underwent primary hepatic resection for colorectal liver metastasis at the Kanagawa Cancer Center from June 2006 to March 2011. The patients were classified as having a Beppu's nomogram score ≤9 (low-risk group) or ≥10 (high-risk group). The risk factors for the disease-free survival (DFS) were identified. RESULTS: The respective DFS rates at 1, 2, and 3 years after surgery were 72.0%, 43.3%, and 17.3% in the low-risk group and 27.8%, 16.7%, and 8.3% in the high-risk group, the difference being significant (p=0.009). The multivariate analysis showed that Beppu's nomogram score ≥10 was a significant independent risk factor for the DFS. CONCLUSION: Beppu's nomogram score was an independent prognostic factor for colorectal liver metastasis in patients receiving perioperative chemotherapy and/or targeted therapy. Thus, Beppu's nomogram might be a useful tool for predicting the risk of recurrence after hepatectomy, even in the era of newly-developed chemotherapy.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/secundário , Neoplasias Hepáticas/terapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante/efeitos adversos , Quimioterapia Adjuvante/métodos , Terapia Combinada , Intervalo Livre de Doença , Feminino , Humanos , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/mortalidade , Masculino , Pessoa de Meia-Idade , Terapia de Alvo Molecular , Estadiamento de Neoplasias , Nomogramas , Assistência Perioperatória , Resultado do Tratamento
20.
Anticancer Res ; 39(5): 2671-2678, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31092467

RESUMO

BACKGROUND/AIM: Postoperative pneumonia after esophageal cancer can lead to additional pain, prolonged hospital stay, and respiratory failure. These adverse events might lead to early recurrence and/or death. We investigated the influence of postoperative pneumonia on the esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into: i) those with postoperative pneumonia (pneumonia group) and ii) those without postoperative pneumonia (non-pneumonia group). The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. RESULTS: Postoperative complications were found in 34 of the 122 patients (27.9%). The OS rate at 5 years following surgery was 28.2% in the pneumonia group and 55.1% in the non-pneumonia group (p=0.006). The RFS rate at 5 years after surgery was 18.9% in the pneumonia group and 49.2% in the non-pneumonia group (p=0.061). A multivariate analysis showed that postoperative pneumonia was a significant independent risk factor for OS. CONCLUSION: The development of postoperative pneumonia was a risk factor for a decreased overall survival in patients who underwent curative surgery for esophageal cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned in order to avoid postoperative pneumonia.


Assuntos
Neoplasias Esofágicas/epidemiologia , Recidiva Local de Neoplasia/epidemiologia , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Idoso , Sobreviventes de Câncer , Intervalo Livre de Doença , Neoplasias Esofágicas/complicações , Neoplasias Esofágicas/patologia , Neoplasias Esofágicas/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Pneumonia/etiologia , Pneumonia/patologia , Pneumonia/cirurgia , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/cirurgia , Fatores de Risco
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