[Show abstract][Hide abstract] ABSTRACT: With advances in surgical procedures and perioperative management, hepato-biliary-pancreatic surgery, including hepatectomy and pancreaticoduodenectomy, has been employed for recurrent colon cancer. However, no report has described a case of major hepatectomy with the combined resection of hepaticojejunostomy following pancreaticoduodenectomy for locoregionally recurrent colon cancer. Here, such a case is reported. The patient, a 37-year-old woman, had undergone pancreaticoduodenectomy for lymph node recurrence along the extrahepatic bile duct from cecal cancer. Thirteen months later, a biliary stricture was found at the hepaticojejunostomy site and right hepatectomy was performed. The resected specimen showed a papillary tumor at the hepaticojejunostomy. Based on its histological features, the pathogenesis of this tumor was considered to be intramural recurrence via lymphatic vessels. Although she underwent resection of a lymph node recurrence at her mesentery 12 months later, she has remained well thereafter, without any sign of further recurrence during 5 years of follow-up after hepatectomy.
[Show abstract][Hide abstract] ABSTRACT: A resected case of hepatocellular carcinoma which extended into the right atrium after treatment with hepatic arterial infusion chemotherapy (HAIC) is described. An 81-year-old man presented with right hypochondralgia. CT demonstrated a hypervascular tumor 11.5 cm in diameter extending into the right atrium through the right hepatic vein. The patient underwent HAIC with 100 mg of cisplatin (CDDP IA-call®) particles three times every month. The tumor showed a marked shrinkage and an involution of the venous thrombus around the orifice of the right hepatic vein. Right hemihepatectomy with tumor thrombectomy was performed as a salvage surgery using a total hepatic vascular exclusion technique. Histologically, the tumor turned into diffuse necrosis and fibrosis, so viable tumor cells were encountered neither in the main tumor nor venous thrombus. The therapeutic effect of HAIC was pathological complete remission. The patient has been doing well for 6 years after the surgery without evidence of tumor recurrence. The salvage operation was safely achievable for the initially unresectable advanced hepatocellular carcinoma extending into the right atrium.
[Show abstract][Hide abstract] ABSTRACT: Rectourethral fistula is one of the complications that can occur after prostatectomy in the urologic discipline. However, a delayed-onset rectourethral fistula after intersphincteric resection (ISR) for low rectal cancer is extremely rare. Here, we report one such case in a 57-year-old man. After ISR for low rectal cancer with a diverting stoma (DS), the DS was closed. After approximately 1 year, frequent pneumaturia and right orchitis were observed. Results of contrast enemas and abdominal computed tomography examinations revealed a rectourethral fistula from an anastomosis to the urethra. The colonoscopic appearance revealed a pinhole fistula on the anastomotic line, with thick pus. We performed a transverse colostomy, and the pneumaturia and right orchitis were no longer observed. Two months later, colonoscopy, contrast enemas, and cystoscopy revealed no rectourethral fistula. To the best of our knowledge, our case is the first report of a delayed-onset rectourethral fistula after ISR.
[Show abstract][Hide abstract] ABSTRACT: We report the case of a 60-year-old male who was diagnosed with gastric cancer. Upper gastrointestinal endoscopy indicated advanced cancer in the posterior wall of the gastric body. Biopsy revealed poorly differentiated adenocarcinoma. Abdominal computed tomography demonstrated thickening of the gastric wall and enlargement of the regional lymph nodes and of the para-aortic lymph nodes (PAN). The involvement of the PAN extended from the celiac axis to the caudal area of the inferior mesenteric artery [cT3N3aH0P0M1(LYM), stage IV]. Systemic chemotherapy was initiated. After 3 courses of S-1 plus cisplatin combination chemotherapy, the primary lesion and the enlarged lymph nodes revealed marked regression except for a minute residual lesion in the lymph nodes. Upon obtaining informed consent, open distal gastrectomy, D2 lymphadenectomy with PAN dissection, and Roux-en-Y reconstruction were performed. The patient was discharged from the hospital 35 days after the operation. Histopathological examination of the resected samples revealed malignant cells only in the PAN, not in the stomach or in the regional lymph nodes [ypT0N0M1(LYM), stage IV]. Currently, the patient is undergoing postoperative adjuvant chemotherapy with S-1 and has remained well without any recurrence after 6 months following surgery.
Case Reports in Oncology 09/2015; 8(2):312-22. DOI:10.1159/000438698
[Show abstract][Hide abstract] ABSTRACT: We encountered two cases of primary squamous cell carcinoma that developed in the ascending colon. Case 1: A 73-year-old man could not move and was brought to our hospital by ambulance. He was anemic and a tumor of the ascending colon was diagnosed. We performed a right hemicolectomy with partial liver resection due to direct invasion of the liver. In the histopathological examination of the total segmentation of surgical specimens, adenocarcinomatous components were not detected, but slight keratinization was observed, from which squamous cell carcinoma was diagnosed. The patient is alive now at 34 months postoperatively with no evidence of recurrence. Case 2: A 50-year-old man complaining of right lower quadrant pain was given a diagnosis of an ascending colon cancer with retroperitoneal abscess and multiple liver metastases. We performed an ileocecal resection, but the radial margin was positive. The histopathological findings showed primary squamous carcinoma of the ascending colon. The patient died of liver metastasis in spite of intensive chemotherapy on postoperative day 53. Among colorectal carcinomas, pure squamous cell carcinomas are extremely rare, especially those arising in the colon. We present these cases with a review of the literature.
[Show abstract][Hide abstract] ABSTRACT: Abstract This study aimed to assess the pathogenic causes, clinical conditions, surgical procedures, in-hospital mortality, and operative death associated with emergency operations at a high-volume cancer center. Although many reports have described the contents, operative procedures, and prognosis of elective surgeries in high-volume cancer centers, emergency operations have not been studied in sufficient detail. We retrospectively enrolled 28 consecutive patients who underwent emergency surgery. Cases involving operative complications were excluded. The following surgical procedures were performed during emergency operations: closure in 3 cases (10.7%), diversion in 22 cases (78.6%), ileus treatment in 2 cases (7.1%), and hemostasis in 1 case (3.6%). Closure alone was performed only once for peritonitis. Diversion was performed in 17 cases (77.3%) of peritonitis, 4 cases (18.2%) of stenosis of the gastrointestinal tract, and 1 case (4.5%) of bleeding. There was a significant overall difference (P = 0.001). The frequency of emergency operations was very low at a high-volume cancer center. However, the recent shift in treatment approaches toward nonoperative techniques may enhance the status of emergency surgical procedures. The results presented in this study will help prepare for emergency situations and resolve them as quickly and efficiently as possible.
International surgery 11/2014; 99(6):719-22. DOI:10.9738/INTSURG-D-14-00122.1 · 0.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A 73-year-old man was referred to our hospital because of positive results on a fecal occult blood test. He had severe anemia, and abdominalcomputed tomography(CT)revealed a huge 18×11 cm tumor in the lower gastric corpus. Pathological analysis of a biopsy sample revealed a gastrointestinal stromal tumor(GIST). We improved the nutritionaland physical statuses via totalparenteraland enteralnutrition. At the same time, we initiated preoperative adjuvant chemotherapy with 300mg/day of imatinib. After 4 weeks' of treatment, CT revealed a drastic reduction in the tumor size, regarded a partial response(PR). The patient underwent partialgastrectomy, distalpancreatectomy, and partialresection of the transverse colon. His postoperative course was uneventful. The patient received postoperative treatment with imatinib for 1 year, and remained recurrence free for 10 months after surgery.
Gan to kagaku ryoho. Cancer & chemotherapy 09/2014; 41(9):1163-1166.
[Show abstract][Hide abstract] ABSTRACT: Radical resection with pancreaticoduodenectomy was performed for three cases of locally recurrent colon cancer. The times to recurrence were ten years, four years, and six months, respectively. Case three had a postoperative pancreatic fistula and was treated with drainage. Two cases are alive without recurrence, and the other case is receiving chemotherapy regularly in the outpatient department.Pancreatoduodenectomy is an invasive procedure, but it is now a comparatively safe operative procedure. Resections of local recurrences from colon cancer may be useful for prolonging the survival time of patients, if no other non-curative factors are present.
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2014; 75(11):3108-3114. DOI:10.3919/jjsa.75.3108
[Show abstract][Hide abstract] ABSTRACT: Resection of cholangiocarcinoma often results in a positive ductal margin, from carcinoma in situ (CIS) near the main tumor; however, the biological behavior of the residual CIS after surgical resection remains equivocal. We report a case of late local recurrence of CIS, defined as long-term tumor progression from CIS residue at the ductal stump. The patient, a 73-year-old man, had undergone bile duct resection for distal cholangiocarcinoma, leaving positive ductal margins with CIS. A biliary stricture was found 10 years later at the site of anastomosis, and right hepatectomy with pancreatoduodenectomy was performed. Based on histological analogy and the evidence of remnant CIS, a final diagnosis of late local recurrence from the CIS foci was made. This uncommon mode of recurrence should be considered in patients with early-stage disease with expected favorable survival because salvage surgery is feasible for selected patients.
Surgery Today 05/2013; 44(5). DOI:10.1007/s00595-013-0578-5 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Locally advanced rectal cancer, invading the posterior wall of the vagina can be resected with abdominoperineal resection with resection of the posterior portion of the vagina. Total pelvic excision may be avoided by preservation of the anterior portion of the vagina which prevents damage of the bladder and urethra. So far invasive various flaps, such as rectus abdominus myocutaneous flap, gracilis myocutaneous flap, and tensor fascia lata musculocutaneous flap have been used for the reconstruction of the defected vaginal posterior wall. We encountered 3 cases using 'transposition flap' designed from the thigh to the defected posterior vaginal wall, which was easy to perform. The operation time for each case was 437 min, 423 min, 659 min, respectively, and about 120 min was needed for vaginal reconstruction. Postoperative complication was infection and partial dehiscence of the flap in 1 case, and neurogenic bladder in 1 case which had no relation to the reconstruction procedure. Long-term follow-up showed no local recurrence in all cases, except a liver metastasis in 1 case. The transposition flap is a less-invasive and easier method, because it can be completed in the same operative field in the perineum and concurrently performed the abdominal procedure.
[Show abstract][Hide abstract] ABSTRACT: To review our experiences with left-sided hepatectomy for perihilar cholangiocarcinoma, to compare left hepatectomy with left trisectionectomy, and to evaluate the clinical significance of left trisectionectomy from the viewpoint of surgical oncology.
Only 4 large case series have been reported on left trisectionectomy, with only a few patients diagnosed with perihilar cholangiocarcinoma. Therefore, the oncologic advantage of left trisectionectomy compared with left hepatectomy for perihilar cholangiocarcinoma is still unclear.
This study involved 201 patients who underwent left-sided hepatectomy for perihilar cholangiocarcinoma (86 trisectionectomies and 115 hepatectomies). Surgical outcome and survival were compared between the 2 types of hepatectomy. The length of the resected right posterior bile duct was also measured.
Patients who underwent trisectionectomy had more advanced tumors, thus requiring combined vascular and/or other organ resection. Operative time and blood loss were significantly greater in trisectionectomy than in hepatectomy; therefore, overall morbidity was significantly higher in the former (59.3% vs 33.0%, P < 0.001). Mortality was similar (1.2% vs 0.9%) in both techniques. The length of the resected supraportal right posterior bile duct was significantly longer in trisectionectomy than in hepatectomy (20.7 ± 6.4 vs 13.6 ± 5.2 mm, P < 0.001). However, there was no difference in length of the infraportal type right posterior bile duct. The percentage of negative radial and distal common bile duct margins was similar, but the percentage of negative right posterior bile duct margins was significantly higher in trisectionectomy than in hepatectomy (97.7% vs 89.6%, P = 0.027). Overall, R0 resection was achieved in 84.9% of patients with trisectionectomy and in 70.4% of patients with hepatectomy (P = 0.019). Survival rates were similar between patients with trisectionectomy and those with hepatectomy (36.8% vs 34.0% at 5-year), despite the fact that the former had more advanced disease.
Left trisectionectomy for perihilar cholangiocarcinoma, although technically demanding, can be performed with similar mortality rates as left hepatectomy. From an oncologic viewpoint, this operation can increase the number of negative proximal ductal margins, leading to a high proportion of R0 resection, and, in turn, to improved survival rates of patients with advanced left-sided perihilar cholangiocarcinoma.
Annals of surgery 02/2012; 255(4):754-62. DOI:10.1097/SLA.0b013e31824a8d82 · 8.33 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A mass at the tail of the pancreas was incidentally found during a routine health care check in a 57-year-old man with a past history of splenectomy for idiopathic thrombocytopenic purpura 40 years previously. He was asymptomatic and all laboratory data on admission, including serum hormone levels, were normal. CT showed a well-defined iso-density mass measuring 2.5 cm in the pancreatic tail, with central attenuation at the early phase and homogeneous attenuation in the late phase. MRI demonstrated a well-defined lesion with a low signal intensity on Tl, T2, and diffusion weighted images. The preoperative diagnosis was nonfunctioning pancreatic endocrine tumor and distal pancreatectomy was performed. On histological evaluation, the tumor consisted of extra-pancreatic splenic tissue circumscribed by fibrous tissue, although it was adjacent to the pancreatic tail. The lesion was definitively diagnosed as splenosis because of the lack of splenic Mum, poor formation of trabecules, and atrophic white pulp. In addition, iron deposition was microscopically remarkable in the splenosis, which accounted for the low signal intensity on T2 and diffusion weighted images on MRI.
[Show abstract][Hide abstract] ABSTRACT: We performed breast reconstruction surgery with mastectomy after neoadjuvant chemotherapy(NAC)for a patient with NAC indication desiring breast conservation. The case was a 34-year-old single woman. In March, 2007, she was aware of a lump in her left breast and visited our hospital. The diagnosis was solid-tubular carcinoma 3 cm in diameter from close examination. We performed preoperative chemotherapy with EC(epirubicin 90 mg/m(2), cyclophosphamide 600 mg/m(2))x4, followed by 3w-paclitaxel 175 mg/m(2)x4, and then performed mastectomy with axillary dissection and breast reconstruction surgery using the flap of latissimus dorsi at the same time. Pathologically, pCR was provided. We thought that there are many advantages to both treatment of breast cancer and the cosmetic characteristics. The patient was very satisfied. But further cumulative examinations are awaited because there is not much evidence at present.
Gan to kagaku ryoho. Cancer & chemotherapy 04/2009; 36(3):461-5.
[Show abstract][Hide abstract] ABSTRACT: We assessed the safety of laparoscopic subtotal cholecystectomy (LSC) in patients with complicated severe cholecystitis or fibrosis. Laparoscopic cholecystectomy was conducted in 750 patients during 3 years and 8 months. Of these 25 required LSC, because dissection of Calot's triangle would be dangerous. The gallbladder was divided from the liver bed fundus first, followed by subtotal gallbladder removal and closure of the remnant, using an endoscopic linear stapler (ELS) or using laparoscopic suture and ligation. The gallbladder was incised, at the level of Hartmann's pouch to confirm its location, to remove contents, or to conduct intraoperative cholangiography through the cystic duct orifice, when necessary. The gallbladder mucosa left on the liver bed was ablated. No cases required conversion to laparotomy. The gallbladder neck was closed by ELS in 19 and by laparoscopic suturing in 6. Mean operating time was 143 minutes, and mean postoperative hospitalization 5.2 days. We found a case of delayed bile leakage and another of choledocholithiasis due to residual gallstones. In one case, we found incidental gallbladder cancer. LSC for severe cholecystitis appears to be safe in avoiding serious complications, such as bile duct injury.
[Show abstract][Hide abstract] ABSTRACT: A 60 year-old man admitted for fever and epigastralgia was found in computed tomography to have a swollen gall bladder with a thickened wall located to the left of the umbilical portion and diagnosed as acute cholecystitis of the left-sided gall bladder. Direct cholangiography showed the aberrant right hepatic duct, draining into the cystic duct. After reducing inflammation by perctaneous transhepatic gall bladder drainage (PTGBD), we conducted laparoscopic cholecystectomy. The gall bladder wall was stiff and the gall bladder fundus was located to the left of the ligamentum teres. We dissected the liver bed, endeavoring to avoid umbilical injury. We stapled and closed the neck of the gall bladder, without approaching the cystic duct to avoid damaging the aberrant hepatic duct. The man was discharged on post operative day 6. We found no record of such a case in the Japanese literature.