[Laparoscopic Gastrectomy for Gastric Adenocarcinoma of the Fundic Gland Type].

Case 1: A 66-year-old man underwent esophagogastroduodenoscopy(EGD), which showed a slightly elevated lesion at the greater curvature of the cardia. We diagnosed gastric adenocarcinoma(tub1, 2)as a result of the biopsy. Endoscopic submucosal dissection(ESD)was performed. The pathological examination revealed a gastric adenocarcinoma of the fundic type(GA-FG), with a tumor depth of SM2. Consequently, laparoscopic gastrectomy was additionally performed. Case 2: A 65-year-old woman underwent EGD, which revealed a slightly elevated lesion at the posterior wall of the upper body. We made a diagnosis of GA-FG as on the basis of biopsy resuit. ESD was performed. A pathological examination revealed that the tumor depth was SM2. Consequently, laparoscopic gastrectomy was additionally performed. GA-FG rarely demonstrates metastasis and recurrence. Most cases undergo ESD, few reports of surgical resection exist. We report our experience of laparoscopic gastrectomy for GA-FG.

[The Clinical Effect of Ramucirumab in the Treatment of Advanced Gastric Cancer in Our Hospital].

Ramucirumab(RAM)was approved for unresectable advanced gastric cancer in March 2015. Recent Japanese gastric cancer treatment guidelines recommended RAM plus paclitaxel(PTX)and RAM alone in the treatment of patients with advanced gastric cancer who had been previously treated with chemotherapy. In this retrospective study, we evaluated the safety and efficacy of RAM alone and PTX plus RAM in these patients. Patients who were administered RAM or PTX plus RAM between March 2015 and December 2016 were enrolled in this study. We compared the clinical outcome of RAM alone(RAM group, n=11)with that of PTX plus RAM(PTX plus RAM group, n=10). The RAM group contained more patients with poor performance status than the PTX plus RAM group. More cases of Grade 3 or 4 adverse events were found in the PTX plus RAM group than in the RAM group. The response rate was 9% in the RAM group and 30% in the PTX plus RAM group. The progression-free survival was 2 months in the RAM group and 3.75 months in the PTX plus RAM group. The overall survival was not reached in the RAM and PTX plus RAM groups. We considered that RAM and PTX plus RAM are safe and effective therapies for advanced gastric cancer patients.

[A Case of Goblet Cell Carcinoid of the Appendix Invading Directly into the Sigmoid Colon].

A 73-year-old man underwent a screening colonoscopy, and a depressed lesion in the sigmoid colon was detected. Biopsy revealed a Group V lesion, and he was diagnosed with sigmoid colon cancer. During surgery, there was dense adhesion of the appendix to the sigmoid colon, and sigmoidectomy combined with appendectomy was performed. However, pathological examination revealed goblet cell carcinoid of the appendix with direct invasion into the sigmoid colon. To the best of our knowledge, no similar cases have been reported in Japan. Additional surgery with lymph node dissection was recommended, but it was rejected by the patient. For adjuvant chemotherapy, a total of 8 courses of capecitabine plus oxaliplatin therapy were administered. To date, the patient is alive without recurrence 2 years postoperatively. Postoperative adjuvant chemotherapy for goblet cell carcinoid of the appendix is a useful option for cases in which additional surgery cannot be performed.

[Analysis of Oxaliplatin Combination Therapy for Unresectable or Recurrent Gastric Cancer].

We analyzed 26 cases of unresectable or recurrent gastric cancer treated with oxaliplatin(OX)combination therapy between September 2014 and January 2016. The number of unresectable gastric cancer cases was 14 and there were 12 recurrent cases. The number of patients receiving S-1 plus OX(SOX), SOX plus trastuzumab(Tmab), capecitabine(Cape)plus OX(CapeOX), and CapeOX plus Tmab was 17, 1, 6, and 2, respectively. The starting dose of OX was 130mg/m2 in 12 patients and 100mg/m2 in 14. The median follow-up duration from the first treatment was 6 months(1-14). The median number of treatment cycles was 5(1-19). Dose reductions occurred in 14 cases, and treatment delay occurred in 13 cases. Grade 3 adverse events occurred in 2 cases(8%); thrombocytopenia and stomatitis occurred in 1 case. The response rate was 23%, the disease control rate was 69%, and the median relapse-free survival time was 4 months(1-14). OX combination therapy for unresectable or recurrent gastric cancer was feasible in terms of safety and might be effective for disease control.

[Adjuvant chemotherapy with capecitabine for colon cancer - a case series].

We examined the treatment condition; adverse events, especially hand-foot syndrome (HFS); and prognosis in 65 patients with colon cancer who received adjuvant chemotherapy with capecitabine. The treatment completion rate was 75.4%; however, only 15.4% of patients completed treatment without dose reduction or treatment interruption. HFS occurred in 78.5% of all cases. The 3-year relapse-free survival rate was 73.8% for all cases, 80.8% for treatment-completed cases, and 51.1% for treatment-discontinued cases; however, there were no differences in relapse-free survival rates for cases that required dose reduction or treatment interruption. We conclude that adjuvant chemotherapy with capecitabine is effective in colon cancer and that completing treatment (even with dose reduction or dose interruption) improves prognosis.

[A case of an elderly patient with recurrent GIST, which was effectively treated with low-dose imatinib mesylate].

The recommended dose of imatinib for recurrent gastrointestinal stromal tumors (GIST) is 400mg/day. However, adverse effects limit the use of the standard dose in elderly patients. We report a case of an elderly patient with recurrent GIST, where long-term control of the disease was achieved with low-dose imatinib therapy. An 86-year-old man presenting with tarry stool was admitted to the hospital; upper GI endoscopy revealed a gastric submucosal tumor of the stomach at the posterior wall of the cardia. Partial gastrectomy was performed laparoscopically. The submucosal lesion was histopathologically diagnosed as malignant GIST. Administration of imatinib was initiated 17 months after surgery because of recurrence of GIST. The initial dose of imatinib was 400mg/day, which was later adjusted to 200mg or 300 mg/day because of adverse effects. Though imatinib was withdrawn several times due to strong side effects, the disease was well controlled for 6 years after surgery.

[A case report of goblet cell carcinoid tumor of the appendix].

Goblet cell carcinoid (GCC) tumor of the appendix is rare, and the prognosis is considered poor compared to classical carcinoid tumor. We present a case of a 60-year old woman who underwent appendectomy for acute appendicitis. Histopathological studies revealed a GCC tumor with submucosal invasion. Based on the malignancy of this tumor and the possible risk of regional lymph node metastases, we performed laparoscopic ileocecectomy with lymph node dissection. Histologically, no residual tumor or lymph node metastases were found. The patient remains well without any sign of recurrence.

[A case report of long-term survival in the patient with anorectal malignant melanoma].

Malignant melanoma of the anorectal region is rare, and the prognosis is considered to be poor. We present a case of long-term survival in a 56-year-old patient with primary malignant melanoma in the anorectal area, who complained of anal bleeding. Barium enema showed an elevated lesion in the anorectal region. Colonoscopy revealed a 3 cm sessile tumor with focal pigmentation, and a satellite nodule, 1 cm in diameter. Based on diagnosis of malignant melanoma by biopsy, abdominoperineal resection with lateral node dissection was performed. Pathologically the tumor remained in the mucosa, and no lymph node metastasis was found. This patient refused any adjuvant chemotherapy after the operation, and remains well without any sign of recurrence for seven years.

A sodium hyaluronate carboxymethylcellulose bioresorbable membrane prevents postoperative small-bowel adhesive obstruction after distal gastrectomy.

PURPOSE: It is predictable that since distal gastrectomy (DG) with Billroth I anastomosis involves no procedures caudal to transverse colon, the effects of the surgical wound are the main cause of adhesive obstruction. Thus, it is an appropriate operation to test the efficiency of a synthetic absorbable adhesion barrier (Seprafilm). METHODS: The subjects were 282 patients diagnosed with gastric cancer who underwent open DG with Billroth I anastomosis between 2001 and August, 2005. Seprafilm was not used in any patients operated on before April, 2003 (n = 169), but it was used in all patients operated on from May 2003 onward (n = 113). We retrospectively compared the incidences of adhesive obstruction in the Seprafilm group and the non-Seprafilm group. RESULTS: The cumulative incidence of adhesive obstruction was significantly lower in the Seprafilm group than in the non-Seprafilm group (P = 0.021). The respective incidences of adhesive obstruction 2 years after surgery were 0.9% and 6.5%. Multivariate analysis of the occurrence of adhesive obstruction revealed no significant differences in sex, age, body mass index, operation time, blood loss, or degree of lymph-node dissection; however, it revealed a significant difference in relation to the use of Seprafilm (P = 0.049). CONCLUSION: In this series, Seprafilm reduced the incidence of adhesive obstruction after DG significantly; however, a prospective randomized study will be necessary to confirm this result.

[Thymic basaloid carcinoma].

This is a case of a 72-year-old male whose chest computed tomography (CT) revealed a 2.0 x 1.6 cm anterior mediastinal solid tumor during follow-up of an abnormal shadow of the lung. The tumor increased its size during preoperative follow-up, and multilocular cyst was also observed. Radical thymectomy was performed, and histopathologically the tumor was diagnosed as thymic basaloid carcinoma. Thymic basaloid carcinoma is a rare tumor and is often associated with multilocular thymic cyst. There are only 32 cases reported both locally and internationally. Surgical resection is the general treatment for this disease. Adjuvant radiotherapy can be considered in cases of incomplete resection and invasive tumor. In our case, no recurrence of the tumor was noted 12 months post-operative. Generally, the malignancy of thymic basaloid carcinomas are regarded as low-grade compared with other thymic carcinomas, however, since mortality and recurrence have been reported, careful follow-up is required.

[Third-line CPT-11 chemotherapy for gastric cancer cases of non-curative gastrectomy or recurrence].

BACKGROUND: There have been few case reports of 3rd-line chemotherapy for gastric cancer. So we reported the results of CPT-11 therapy as the 3rd-line chemotherapy for gastric cancer. PATIENTS AND METHODS: 549 cases underwent gastrectomy from Jan. 2004 to Aug. 2007 in our hospital. In 76 of these cases, which underwent non-curative resection or evidenced a recurrence until July 2009, were analyzed in this study. CPT -11 3rd-line chemotherapy was administered to 11 cases. RESULTS: The mean survival time of non-curative or recurrent cases was 16.9 months. Mean survival times of the non-chemotherapy group, the group administered only 1st-line chemotherapy, the group administered until 3rd-line chemotherapy, the group administered 3rd-line chemotherapy were 7.9 , 11.3 , 21.4 and 28.9 months, respectively(p=0.000 ). Adverse effects occurred in 90.9% of 3rd-line CPT-11, however, all cases were categorized in GradeI. CONCLUSION: The group administered 3rd-line chemotherapy survived the longest. It is probably correct to administer 3rd-line chemotherapy, if the patient maintains a good performance status.

Laparoscopic gastrectomy for early gastric cancer targeting as a less invasive procedure.

BACKGROUND: Since only a few extensive reports are available on the less invasive nature of laparoscopic gastrectomy, we compared postoperative changes over time in vital signs and hematological parameters between this surgery and laparotomic gastrectomy. METHODS: Of 188 patients who underwent distal gastrectomy for preoperatively diagnosed early gastric cancer between January 2004 and September 2006, 87 underwent laparoscopy-assisted distal gastrectomy (LADG) and 101 underwent laparotomic distal gastrectomy (DG). The invasiveness of the two procedures was evaluated in 164 patients with no postoperative complications (82 cases of LADG and 82 cases of DG by measuing vital signs daily and performing hematological examination on postoperative days (POD) 1, 4, 7, and 10. RESULTS: For body temperature, heart rate, and blood pressure, significantly lower values were obtained with LADG on 3 and 4 POD, 4 POD, and 3 and 4 POD, respectively. For white blood cell counts (WBC) and C-reactive protein (CRP), significantly lower values were obtained with LADG on 7 and 10 POD, and 10 POD, respectively. For serum protein levels and lymphocyte counts, significantly higher values were obtained with LADG on 1, 4, 7, and 10 POD, and 4 and 10 POD, respectively. Body temperature, WBC, and CRP showed no significant difference immediately after surgery but earlier recovery occurred with LADG. For protein levels and lymphocyte counts, higher values were obtained immediately after surgery. There seemed to be two patterns of less invasiveness in the parameters: the early recovery found for body temperature, WBC and CRP, and the smaller shift immediately after surgery in protein level and lymphocyte count, and probably, heart rate and blood pressure. The complication rate was 18.8% for DG and 5.7% for LADG. CONCLUSIONS: LADG is a less-invasive surgical procedure as it produces early normalization or smaller shifts in various parameters and exhibits a low prevalence of complications.