Nevilleavila0358

Adjuvant chemotherapy was performed for 6 months, and there has been no relapse for 3 years since the operation.The patient was a 56-year-oldwoman. She presentedto a nearby doctor with a chief complaint of dysphagia andwas diagnosed with esophageal cancer by upper gastrointestinal endoscopy, resulting in a referral to our hospital. Upper gastrointestinal endoscopy revealeda semicircular type 1 lesion 29 to 32 cm from the incisors, andshe was diagnosedwith squamous cell carcinoma by biopsy. Computedtomography (CT)andpositron emission tomography(PET)scans revealedthe enlargement and accumulation of lymph nodes along the lesser curvature of the stomach; thus, she was diagnosed with metastasis. In addition, multiple accumulations were found in the 7th cervical vertebrae as well as in the 1st, 3rd, 4th, and 8th thoracic vertebrae, leading to the diagnosis of bone metastasis. She was finally diagnosed with middle intrathoracic esophageal cancer T2N1M1, Stage Ⅳ; thus, we performedchemorad iotherapy(CRT)with 5-FU andCDDP (FP). The main lesion was markedly reduced in upper gastrointestinal endoscopy after CRT, and no apparent malignancy was found in endoscopic biopsy, so the diagnosis was endoscopic complete response. The CT scan also showed marked reductions in both the main lesion and the lymph nodes. As for the bone metastasis, some areas of bone consolidation remained, but they were diagnosed as partial responses since they were shrunk. Since then, FP has been continuously administeredon a regular basis andit has been about 2 years without any appearance of new lesions or re-exacerbation.A 72-year-old woman was diagnosed with cecal cancer. Preoperative enhanced abdominal computed tomography(CT) and three-dimensional(3D)-CT angiographyrevealed a celiacomesenteric trunk(CMT). We performed a laparoscopic ileocecal resection without anyproblems owing to the obtained preoperative 3D-CT images. The postoperative course was uneventful. The celiac arteryhas manyanomalies, and 6 categories have been defined. Patients can be divided into 28 groups bycombining these anomalies with mutations in the hepatic artery, as explained byAdachi. Our case was a Type Ⅳ anomaly according to the Adachi classification, which accounts for 2.4% of all cases. We herein report this extremelyrare case.Although there are reports of goblet cell carcinoid(GCC)treated by chemotherapy using the treatment protocol for colon cancer, the benefit of chemotherapy for GCC remains controversial and unclear. Herein we report 2 cases of patients with GCC who were successfully treated by surgical resection and oxaliplatin-based adjuvant chemotherapy, without evidence of recurrence. Remdesivir clinical trial The first case was a 57-year-old man who underwent laparoscopic ileocecal resection after being diagnosed with adenocarcinoma of the appendix by biopsy via colonoscopy. Pathological and immunohistochemical analyses demonstrated the presence of signet-ring-like cells, chromogranin A-positive and synaptophysin-positive cells, leading to a diagnosis of GCC of the appendix. Folinic acid, fluorouracil, oxaliplatin(FOLFOX)was administered for 6 months as an adjuvant chemotherapy. The patient has shown no signs of systematic metastasis and has been alive for more than 3 years after the operation. The second case was a 41-year-old woman who presented to our hospital complaining of lower abdominal pain starting 2 months previously. A computed tomography(CT)scan indicated a pelvic tumor, and she underwent ileocecal resection and hystero-oophorectomy due to an appendix tumor and an ovarian metastatic tumor. Pathological and immunohistochemical analyses demonstrated the presence of signet-ring-like cells, chromogranin A-positive, and synaptophysin-positive cells, confirming the diagnosis of GCC of the appendix. The patient received capecitabine and oxaliplatin(CapeOX)as an adjuvant chemotherapy for 6 months. The patient has been free from recurrence for 22 months following surgery.We report 2 cases of advanced colorectal cancer achieving complete response by FOLFOXIRI plus bevacizumab. Case 1 was a 65-year-old male diagnosed with descending colon cancer with multiple liver metastases. Six courses of FOLFOXIRI plus bevacizumab were administered after laparoscopic-assisted left hemicolectomy. Ten partial hepatectomies and 1 radiofrequency ablation were performed as the liver metastases resolved. A pathological complete response was confirmed. Adjuvant chemotherapy was not administered, and recurrence-free survival was 21 months after hepatectomy. Case 2 was a 77-yearold male diagnosed with rectal cancer invading the pelvic wall and sacral foramen with bilateral lateral lymph node metastasis. Additionally, there was a cancer embolism in the right internal iliac vein. Six courses of FOLFOXIRI plus bevacizumab were administered, and the cancer tissue was absent on subsequent CT and MRI. The cancer was scarred by colonoscopy, and the biopsy showed no malignant cells. Six courses of FOLFIRI plus panitumumab were administered as second-line chemotherapy, and the patient survived without any recurrence after 12 months from initiation of chemotherapy.BACKGROUND Although the S-1 plus CDDP(SP)regimen is the standard treatment for advanced gastric cancer, hydration and admission have been recommended after cisplatin has been administered. In this study, short hydration(SH)method was used and SP was administered in outpatient settings. We evaluated renal toxicity of cisplatin in the SH-SP regimen at our hospital. METHODS Eleven of 16 patients(5 underwent only 1 course and so were excluded)received the SH-SP regimen between January 2012 and January 2018 to present and were included. Serum creatinine(Cr)and estimated glomerular filtration rate(eGFR)were used to assess renalfunction. RESULTS Median course was 5. Rate of 5-course accomplishment was 72.7%. Grade 1 Cr elevation was observed in only 3 patients and there was no severe renal disorder. CONCLUSION The SHSP regimen could be administered in outpatient settings and was considered safe as it did not cause renal toxicity.Case 1 A 67-year-old male underwent distal gastrectomy for advanced gastric cancer. Postoperative histopathological examination indicated pT2a, pN2, M0, pStage ⅢA. He received 4 courses of TS-1 with paclitaxel chemotherapy and TS-1 chemotherapy for 2 years. Three years and 5 months after surgery, computed tomography suggested lymph node metastasis of the mediastinum, so TS-1 with cisplatin(CDDP)therapy was administered. Five years and 10 months after surgery, recurrence occurred and docetaxel and CPT-11 were administered with no response. Since HER2 was overexpressed in the primary tumor, he was treated with capecitabine, CDDP, and trastuzumab(XPT)therapy. After 1 year and 6 months, the patient was considered to have achieved a complete response(CR), and after further trastuzumab therapy for half a year, CR was maintained for 12 years and 3 months after surgery. Case 2 A 59-year-old female underwent total gastrectomy for advanced gastric cancer. Postoperative histopathological examination indicated pT3, pN3a, M0, pStageⅢB. She received TS-1 chemotherapy for 1 year and 8 months. Computed tomography suggested paraaortic lymph node metastasis, and XPT therapy was administered. The patients responded well, and alternate administration of XPT and capecitabine and docetaxel(XT) was performed. Three years and 5 months after surgery, recurrence of lymphadenopathy occurred and intensity-modulated radiation therapy in addition to XPT/XT alternate therapy was introduced, leading to a CR 5 years and 8months after surgery. XT therapy was continued afterward, and CR was maintained for 9 years and 2 months after surgery.BACKGROUND Surgical site infections(SSIs)occur at a high frequency in patients after rectal cancer surgery and are readily aggravated. Therefore, prophylactic measures for infections based on the evaluation of the patient's perioperative risk are very important. We investigated risk factors of SSI onset in patients after rectal cancer surgery. METHODS In total, 66 patients with rectal cancer who underwent resection in our department between January 2015 and December 2016 were retrospectively examined. RESULTS The patients in our study included 38 men and 28 women with a median age of 66 years and a median BMI of 21.3 kg/m2. Fifteen patients underwent laparotomy and 51 underwent laparoscopy. Among 66 patients, 24 had an artificial anus. The median operative time was 367 minutes, median bleeding loss was 100 mL, and median Controlling Nutritional Status(CONUT)score was 2. Twenty patients developed SSI after rectal cancer surgery. Univariate analysis demonstrated that operative time(p=0.004, OR 1.005, 95%CI 1.002-1.009)and CONUT score(p=0.035, OR 1.386, 95%CI 1.023-1.878) were significant risk factors for SSI development. Multivariate analysis also demonstrated that operative time(p=0.003, OR 1.006, 95%CI 1.002-1.010)and CONUT score(p=0.025, OR 1.508, 95%CI 1.053-2.161)were significant risk factors for SSI development. CONCLUSIONS The CONUT score was identified as a significant preoperative risk factor for SSI after rectal cancer surgery in both the univariate and multivariate analyses. Therefore, the preoperative evaluation using the CONUT score may be useful for predicting the risk of SSI in patients undergoing rectal cancer surgery.Case 1 A man in his 70s was referred to our hospital for further examination of a liver tumor(S3, 3 cm)detected by ultrasonography. Multimodal image examination showed a cystic lesion with solid papillary components located in the S4 accompanied by dilatation of the surrounding intrahepatic bile duct. Although biliary cytology did not indicate confirmed malignancy, the lesion was thought to be an intraductal papillary neoplasm of bile duct(IPNB)with malignant potential, and a left lobectomy was performed. Histopathological examination revealed a papillary tumor in the intrahepatic bile duct which consisted of atypical epithelial cells of pancreatobiliary type, and the lesion was diagnosed as an IPNB with high-grade intraepithelial neoplasia. Case 2 A woman in her 70s was referred to our hospital because of a liver tumor(S4, 8 cm)detected by ultrasonography. Multimodal image examination showed a cystic lesion localized to the liver(S3, 8 cm), and endoscopic retrograde cholangiopancreatography(ERCP)showed continuity of the cyst and the intrahepatic bile duct. The biliary cytology was positive, and the lesion was thought to be a malignant IPNB. After preoperative drainage of the cystic lesion, a left lobectomy was conducted. Histopathological examination showed that the papillary tumor localized to the bile duct and atypical epithelium cells of pancreatobiliary type were infiltrating into the surrounding matrix. We diagnosed this tumor as an IPNB with an associated invasive carcinoma.BACKGROUND This study examined the treatment outcomes of gastrectomy in patients aged less then 85 years who had gastric cancer(GC). METHODS The postoperative short- and long-term outcomes of 27 patients aged less then 85 years who underwent gastrectomy for GC at our institute were retrospectively investigated. RESULTS The median age was 87 years(range 85-94 years), and 17 patients(63%)had comorbidities. Total, distal, and proximal gastrectomies were performed for 12, 14, and 1 patient, respectively. Only 13 patients(48%)underwent standard lymph lymphadenectomy(LND), while R0, R1, and R2 were performed for 23, 2, and 2 patients, respectively. The overall, surgical, and non-surgical complication rates were 59%, 26%, and 44%, respectively, even though the incidence of GradeBⅢa complications was only 4%, and there was no mortality. The 1-, 2-, and 3-year overall survival rates(OSR)were 91.7%, 79.4%, and 63.2%, respectively. The 3-year OSRs of the patients who underwent R0, R1, and R2 were 76.2%, 35.4%, and 0%, respectively.