[A Case of Rectal Neuroendocrine Carcinoma That Developed Two Years after Curative Resection for Sigmoid Colon Cancer].

We report a rare case ofrectal neuroendocrine carcinoma(NEC)following sigmoidectomy of sigmoid colon cancer. NEC of the rectum is a rare disease. It has an extremely poor prognosis and a high potential for malignancy with hematogenous and lymph node metastases. A 90-year-old man who had carcinoma ofthe sigmoid colon 2 years ago was found to have rectal NEC based on endoscopy findings. He underwent the Hartmann operation. Histological and immunohistochemical analyses showed NEC. Four months after the surgery, he developed local recurrence with lymph node metastasis. He was not administered chemotherapy because ofhis old age. Although the patient needed strict outpatient care, he remained symptom-free 4 months after the Hartmann operation.

[A Case of Recurrent Jejunal Stenosis after Total Gastrectomy Treated with Self-Expandable Metallic Stent].

Case is a 66-year-old male. He was inserted covered self expandable metallic stent(SEMS)for jejunal stenosis due to gastric cancer recurrence. Migration was occurred after 4 days from stent replacement. We had removed SEMS by endoscopy, and re-inserted non-covered SEMS. Two months later, stent stenosis was occurred by tumor ingrowth. We tried to insert another stent in the stenotic stent. The patient was able to maintain oral intake without complication for 3 months. SEMS placement would improve a quality of life for selected patients with recurrent jejunal stenosis.

[Significance of Perioperative Neutrophil Lymphocyte Ratio(NLR)in Gastric Cancer and Colon Cancer].

BACKGROUND: We examined the significance of neutrophil lymphocyte ratio(NLR)in gastric cancer and colon cancer in the perioperative period. METHOD: There were 46 patients(21 with gastric cancer and 25 with colon cancer). We examined the association between preoperative NLR and other indicators of nutritional status, as well as the relationship between preoperative NLR and the incidence of postoperative complications(all complications/infectious complications). RESULT: NLR was higher in those with zinc<65 mg, prognostic nutritional index(PNI)≤40, and modified Glasgow prognostic score(mGPS)of 2 (p<0.05). NLR showed no difference among all patients with complications(12 cases), but was higher in patients with infectious complications(p<0.05). CONCLUSION: Preoperative NLR is correlated with PNI as a predictor of infectious complications.

[The case of a patient who experienced perforation related to sigmoid colon cancer, was bearing a hepatic metastasis, and who underwent radical resection for advanced colon cancer after a salvage operation for pan-peritonitis and chemotherapy].

Colorectal cancer associated perforation initially develops as pan-peritonitis but easily progresses to septic shock, which can be fatal. As such, it can be hard for patients to recover from this pathological condition. A 79-year-old man who was suffering from pan-peritonitis due to sigmoid colon cancer-associated perforation and also had a metastatic hepatic lesion was admitted to our hospital. He underwent an emergency operation in October 2012. Due to hemodynamic instability, peritoneal lavage and drainage, and stomal formation were performed during the operation. Polymyxin-B direct hemoperfusion (PMXDHP) and continuous hemodiafiltration (CHDF) were performed for septic shock and acute renal failure, respectively. The patient was administered 5 courses of chemotherapy consisting of capecitabine, oxaliplatin, and bevacizumab (Cape+L-OHP +Beva) with no severe adverse reactions; the primary colonic and metastatic hepatic lesions showed a good response to the chemotherapy. A radical resection for the sigmoid colon cancer, including a partial hepatic resection for the metastatic lesion, was performed in May 2013. Surveillance examinations have indicated that the patient is recurrence-free 13 months after radical resection.

[Examination of stent treatment and bypass surgery for unresectable advanced gastric cancer].

This study was conducted to analyze the outcomes of endoscopic stent placement (n=9) and bypass surgery (n=9) with regard to perioperative complications and dietary intake conditions in patients with unresectable advanced gastric cancer with stenosis. Regarding perioperative complications, 1 patient in the stent group experienced a stent failure and 1 patient in the bypass group developed an adhesive ileus. Dietary intake began from the first day in the stent group and from the fourth day in the bypass group, and it was continued for 55 and 113 days, respectively. There was no difference in the introduction of chemotherapy or length of treatment between the groups, and the survival period for the patients in the stent and bypass groups was 83 and 127 days, respectively. Endoscopic stent placement for unresectable advanced gastric cancer with stenosis is a safe and effective method for improving the quality of life( QOL) of patients.

[A case of a recurrent hepatic metastasis occurred after curative resection of ascending colon cancer and a hepatic metastasis responding completely to capecitabine plus bevacizumab].

Although hepatic resection is the most effective therapy for patients with liver metastasis from colorectal carcinoma, a subset of patients cannot undergo surgical treatment for several reasons, including age-related general health decline or poor conditions associated with coexisting diseases, even if the lesions are resectable. A 75-year-old man with a recurrent lesion in the liver underwent right hemicolectomy and partial hepatic resection to treat colonic cancer and a liver metastasis, followed by uracil and tegafur plus Leucovorin( UFT+LV) as adjuvant chemotherapy at 6 months after the initial surgery. Although the lesion was resectable, the patient preferred chemotherapy to surgery, and capecitabine plus oxaliplatin plus bevacizumab was administered; however, the treatment was stopped in the middle of the second course because of oxaliplatin -related toxicities. Capecitabine plus bevacizumab was introduced as the following chemotherapy regimen, and no adverse reactions were observed during this therapy. After 5 courses of administration, the lesion disappeared on CT examination, and no new lesions were found after 9 courses. Thus, the treatment response was classified as complete response (CR) and remains as such after 13 courses.

[Study of decreased oral intake in patients receiving neoadjuvant chemotherapy for esophageal cancer].

Patients often experience decreased oral intake due to primary systemic therapy (DCF [docetaxel, cisplatin, and fluorouracil ] therapy) administered during the treatment of esophageal carcinoma; measures to cope with this problem have been sought. We therefore examined the relationship between the presence or absence of decreased oral intake and blood biochemistry( serum albumin[ Alb] level, white blood cell[ WBC] count, neutrophil count, and serum sodium[ Na] level) during the 12 courses of DCF therapy administered as primary systemic therapy to 6 patients with esophageal carcinoma. Decreased oral intake occurred frequently from day 6 to day 12 after the initiation of DCF therapy. During this period, decreased serum Alb levels were observed in patients with decreased oral intake but not in patients without decreased oral intake. The incidence of decreased oral intake was 100% in patients whose serum Alb levels decreased to <3.5 g/dL, but it did not exceed 33.3% in patients whose serum Alb levels were ≥3.5 g/dL. The serum Na level, WBC count, and neutrophil count were less affected than the serum Alb level, suggesting that decreased oral intake was associated with decreased serum Alb level.

[Evaluation of pre-operative chemotherapy with S-1 plus CDDP against advanced gastric cancer with paraaortic lymph node metastasis].

We evaluated the effectiveness of pre-operative chemotherapy with S-1 plus CDDP against advanced gastric cancer with paraaortic lymph node metastasis. 8 patients received pre-operative chemotherapy with S-1 plus CDDP, according to the following regimen: S-1, 80 mg/m(2), was administered for 21 consecutive days followed by a 14-day rest period, and CDDP, 60 mg/m(2), was administered on day 8. The adverse event rate was 50%. However, a grade greater than 3 was not revealed. There were 5 partial responses (PR) and 3 stable diseases (SD). We performed 7 total gastrectomies and one distal gastrectomy, and the surgical curability (cur) resulted in 6 cases of cur B and two cases of cur C. The histological antitumor effect was grade 2 in three cases. The median overall survival rate was 623 days and the one-year survival rate was 75%. Analyzing for overall survival with antitumor effect and operative curability, both groups of PR and cur B prolonged survival. Pre-operative chemotherapy with S-1 plus CDDP, when used against advanced gastric cancer with paraaortic lymph node metastasis, might be an effective treatment.

[A case of advanced gastric cancer showing pathological CR after neoadjuvant chemotherapy with docetaxel, cisplatin and S-1 combination].

A 69-year-old man suffering from heart-burn was referred to our hospital, and diagnosed as type 3 advanced gastric cancer with lymph node metastasis. Neoadjuvant chemotherapy (NAC) with docetaxel, cisplatin and S-1 was attempted. After two courses of chemotherapy were completed, distal gastrectomy with D2 lymphadenectomy was performed. Pathologically, there were no viable cancer cells remaining in the primary lesion and lymph nodes. The pathological response of NAC was judged to be grade 3. The postoperative course was uneventful, and the patient is currently visiting our outpatient clinic for treatment with S-1 as postoperative adjuvant chemotherapy.

Additional Surgery After Non-curative Resection of ESD for Early Gastric Cancer.

AIM: The appropriate additional surgery after non-curative resection of Endoscopic Mucosal Resection (ESD) for early gastric cancer is herein discussed. PATIENTS AND METHODS: Data on 54 patients after non-curative resection of ESD were evaluated. These patients were broadly classified according to the risk of lymph node metastasis with lesions into group A (without risk) (n=26) and group B (with risk) (n=28). Their treatment results were evaluated. RESULTS: The incidence of residual lesion was 7.7% in group A and 14.3% in group B. Risk factors were piecemeal resection, involvement of the horizontal margin (HM1) or unclear involvement of the horizontal margin (HMX) and with ulceration. Lymph node metastasis was detected in one patient with lymphatic invasion, total diameter of 3 cm or more and submucosal invasion over 0.5 mm (SM2). The 5-year survival rate was 93% and none of the patients died of gastric cancer. CONCLUSION: Follow-up observation was reasonable in group A. Patients who are judged as having undergone piecemeal resection, HM1 or HMX and with ulceration, should be treated by additional surgery and patients judged with SM2 or total diameter of 3 cm or more or lymphatic invasion should be treated by additional surgery with lymphadectomy in group B.

Granulocyte-colony stimulating factor (G-CSF)-producing esophageal squamous cell carcinoma: a case report.

There are very few reports of esophageal G-CSF-producing cancer. This report describes a case of G-CSF-producing esophageal squamous cell carcinoma we recently encountered. A 70-year-old male patient had Stage III esophageal squamous cell carcinoma. The patient received preoperative chemotherapy, and therapeutic response for the primary lesion was rated as complete response and that of the lymph node metastasis as stable disease. A radical operation was then performed. A relapse to neutrophilia occurred as liver metastasis recurred postoperation, and serum G-CSF level was high. Immunohistochemical staining of the resected specimen with anti-G-CSF antibody was positive. The patient died about 1 year after the operation. According to our search of the literature, there are 22 cases of esophageal G-CSF-producing cancer. Carcinosarcoma was more frequent as compared to esophageal non-G-CSF-producing cancer. The prognosis was graver in those cases of G-CSF-producing squamous cell carcinoma, relative to cases of non-G-CSF-producing esophageal squamous cell carcinoma.