[A Case of Obstructive Jaundice Caused by Recurrent Gastric Cancer Previously Treated with Distal Gastrectomy and Roux-en-Y Reconstruction Whose Obstruction Was Relieved by ERCP for Altered Gastrointestinal Anatomy Using Conventional Endoscopes].

There have been many reports on ERCP for patients with alteredgastrointestinal anatomy(AGA), using balloon-assisted enteroscopy(BAE); however, BAE is not commonly usedin practice because it requires special endoscopic systems and accessories, which are time-consuming to operate. For this reason, patients with AGA who suffer from obstructive jaundice (OJ)might receive PTBD in general practice during emergency situations. We report a case of OJ, caused by recurrent gastric cancer andpreviously treatedwith distal gastrectomy andRoux -en-Y reconstruction(DGRY). The obstruction was relieved by ERCP for AGA, using conventional endoscopes. A 74-year-oldwoman, who hadpreviously undergone DGRY for advanced gastric cancer(AGC)andhadbeen receiving first-line chemotherapy for AGC recurrence, was admitted to our hospital for treatment of OJ, causedby progression of recurrent AGC, in July 2016. ERCP for AGA was performedusing conventional endoscopes, andOJ was successfully relievedby the insertion of a self-expandable metallic stent. Subsequently, second-line chemotherapy was administeredandthe patient enteredPR after 2 courses of chemotherapy.

[Analysis of Palliative Stent Placement for Acute Malignant Colorectal Obstruction].

INTRODUCTION: Recently, endoscopic placement of self-expanding-metal stents (SEMS) has been widely performed for treatment of acute malignant colorectal obstruction. This study aimed to compare the efficacy of SEMS placement as palliative treatment with that of surgical treatment in patients presenting with acute malignant colorectal obstruction. MATERIALS AND METHODS: A retrospective review was performed for 20 patients with unresectable malignant colorectal obstruction who had received insertion of SEMS (n=9) or surgical treatment (n=11) for palliation between July 2006 and M ay 2014. RESULTS: Patients who had received SEMS were in poorer clinical condition regarding age and performance status. Duration of treatment was significantly lesser and the postoperative date of initial oral intake after intervention was statistically earlier in the SEMS group. SEMS-related morbidity was found in only 2 cases of obstruction due to tumor ingrowth; these patients were successfully treated by reinsertion of SEMS. The prognosis of both groups showed no statistical difference. CONCLUSION: Palliative SEMS placement for unresectable colorectal malignant obstruction in patients with more severe clinical condition relieved obstruction without severe morbidity. Palliative SEMS placement could be an alternative to surgery for the treatment of acute unresectable colorectal obstruction.

[Onodera's prognostic nutritional index(PNI)and the modified Glasgow Prognostic Score(mGPS)in colorectal cancer surgery].

UNLABELLED: We evaluated the significance of the prognostic nutritional index(PNI)and modified Glasgow Prognostic Score(mGPS)in colorectal cancer resection. METHODS: We classified 165 patients undergoing colorectal cancer excision according to PNI(>40 [n=141]and ≤40[n=24])and mGPS (A/B[n=95], C[n=44], and D [n=26]). We examined the incidence of postoperative complications, postoperative hospital stay, and survival. RESULTS: Both indices were associated with all complications, surgical site infection(SSI), and med ian postoperative hospital stay. RI was only associated with the mGPS, whereas a long postoperative hospital stay was associated with the PNI alone. Both indices showed a relationship with survival for each clinical stage. CONCLUSION: Both PNI and mGPS were useful clinical indices for patients undergoing colorectal cancer resection.

[Two cases of intrapelvic recurrence after radical resection of rectal cancer, treated with carbon ion radiotherapy].

We report two cases of intrapelvic recurrence after radical resection of rectal cancer, which were successfully treated with Carbon Ion Radiotherapy (C-ion RT). The first case is of a 71-year-old man who underwent abdominoperineal resection (APR) with D2 lymphadenectomy for rectal cancer in December 2010, followed by adjuvant chemotherapy with S-1 plus oxaliplatin. The patient was diagnosed with a recurrence on the left pelvic wall in August 2012, and underwent C-ion RT (73.6 Gray equivalent) for this lesion in October 2012. Three months after this treatment, the lesion had regressed significantly, as ascertained by computed tomography (CT). He remains alive with no signs of recurrence. The second case is of a 63-year-old man who underwent APR with D3 lymphadenectomy for rectal cancer, followed by adjuvant chemotherapy with uraciltegafur ( UFT). The patient was diagnosed with a recurrence on the right pelvic wall in January 2013, and underwent C-ion RT (73.6 Gray equivalent) for this lesion in March 2013. Three months after this treatment, the lesion reduced significantly, and the patient is alive with no signs of recurrence. Although the long-term outcomes need to be assessed, C-ion RT could be a safe and effective therapy.

[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.

[Successful resection of recurrent lesions in a patient with ovarian torsion diagnosed with rectal cancer].

We report the successful resection of recurrent tumors, including brain metastasis, in a patient with StageIV rectal cancer. A 29-year-old female patient was admitted with lower abdominal pain to the gynecological department in April 2005. The patient underwent emergency surgery following the diagnosis of left ovarian torsion. She was transferred to the Department of Surgery with suspected rectal cancer based on a pathological diagnosis of a Krukenberg's tumor. She underwent surgery for local advanced cancer using high anterior resection, hysterectomy, right oophorectomy, partial ileal resection, and appendectomy. In September 2007, she underwent very low anterior resection for an anastomotic recurrence. The patient then received 6 courses of modified 5-fluorouracil Leucovorin oxaliplatin (mFOLFOX6) as adjuvant chemotherapy. In March 2009, left paresis was observed. She underwent tumor resection and g-knife radiosurgery for brain metastasis in the right temporal lobe. In December 2009, metastasis in the right rectal muscle was resected following diagnosis by computed tomography (CT). In September 2013, she underwent further surgical resection of a tumor recurrence in the right rectal muscle. The pathological diagnosis of each resected tumor was metastatic rectal cancer. The patient has been disease-free since the last operation.

[Assessment of host status in patients treated with mFOLFOX6 adjuvant chemotherapy after colorectal cancer surgery].

BACKGROUND: We examined the association of the physical, nutritional, and immune status with adverse events in patients treated with mFOLFOX6 adjuvant chemotherapy after colorectal cancer surgery. METHOD: This study included 17 patients, 7 male and 10 female. The median age was 62( range, 32-75) years. The median number of treatment cycles was 12 (range, 4-12). Age, performance status( PS), body mass index( BMI),serum albumin level( Alb),Onodera's prognostic nutritional index( PNI), controlling nutritional status( CONUT),Glasgow prognostic score( GPS),the granulocyte/lymphocyte ratio( G/L),neutrophil count, and the total lymphocyte count( TLC) were evaluated with regard to the nutrition and immunity status of the host before chemotherapy. The incidents of toxicity of greater than Grade 2 severity, excluding gastrointestinal events or gastrointestinal toxicities, were analyzed to determine the correlation with host status. RESULT: Any toxicities and toxicities without digestive symptoms were observed in 11 patients( 64.7%),and the number of incidents was significantly increased in patients with a PNI of <45. Gastrointestinal toxicities were observed in 4 patients (23.5%), but there were no significant correlations with any of the factors investigated. CONCLUSION: Toxicities are observed to a greater extent in patients with a PNI of <45 during adjuvant chemotherapy. These findings suggest that nutritional support may be required to safely administer mFOLFOX6 adjuvant chemotherapy.

[A study of nutrition screening for patients with surgically treated esophageal cancer].

PURPOSE: The present study was performed to investigate the effects of the nutrition screening index and pulmonary function test data for patients who underwent surgery for esophageal cancer, based on the incidence of postoperative complications and the duration of postoperative hospitalization. SUBJECTS AND METHODS: A total of 69 patients who received esophageal cancer resection were included in the study. It was determined how the parameters studied (ie, between ages, concomitant diabetes mellitus, body mass index( BMI), serum albumin level, Onodera's prognostic nutritional index, percentage of vital capacity(%VC), and forced expiratory volume[ FEV]1.0%) were related to the incidence of complications and the duration of postoperative hospital days, as expressed by the median days for all patients and the frequency of long-term hospitalization. RESULTS: The incidence of postoperative complications was significantly higher in patients aged 65 and above and those with a %VC value of less than 80%. The median duration of postoperative hospitalization was longer in those aged 65 and above and those with a FEV1.0% value of less than 70%, which was related to BMI. In addition, the frequency of long-term hospitalization was higher in those aged 65 and above, which was also related to BMI. CONCLUSIONS: The results of the present study confirm that postoperative complications and length of postoperative hospital stay in patients with surgically treated esophageal cancer were largely dependent on their pulmonary function as well as age and BMI used for the nutrition screening index. Nutrition screening combined with pulmonary function tests, using age, BMI, %VC, and FEV1.0%, is considered desirable to avoid postoperative complications associated with esophageal cancer.

[The significance of Onodera's prognostic nutritional index for the treatment of gastrointestinal cancer].

BACKGROUND: We evaluated the role of the prognostic nutritional index reported by Onodera (Onodera's PNI) in patients with gastrointestinal cancer regarding the occurrence of postoperative complications. METHOD: Subjects were 324 patients (42 with esophageal cancer, 107 with gastric cancer, and 175 with colon cancer). We classified them into the high risk group (< or = 40) and the non-high risk group (> 40) according to Onodera's PNI. We evaluated the rate of the occurrence of postoperative complications between the high risk group and the non-high risk group. RESULT: The rate of postoperative complications occurring in the high risk group was higher than that of the non-high risk group (p=0.04). CONCLUSION: Onodera's PNI is useful for patients with gastrointestinal cancer regarding the occurrence of postoperative complications.