A Case of Lung Cancer: Malignant Pericardial Effusion Which Was Drained by Subcutaneously Placed Port System

Pericardial effusion due to malignancy often needs drainage, however, it is difficult to repeat to puncture, especially in the case of little effusion space. Here we report a case of non-small cell lung cancer, 71 years old male, who was diagnosed in 2012 and had malignant pericardial effusion as a post-operative recurrence in June 2018. After several chemotherapy regimens, he suffered from dyspnea on effort due to increasing pericardial effusion. We performed pericardial drainage, but 2 months later pericardial effusion had increased again. The need of repeating of pericardial drainage was estimated, so we placed subcutaneously placed port system into his pericardial space. Thereafter, we drained pericardial effusion through it on demand for his dyspnea. Gradually his circulatory status had been exacerbated and he died on 36th day after the procedure. In the case of malignant pericardial effusion, the subcutaneously placed port system may be useful because repeated aspiration can be done by single procedure of pericardial puncture. It may keep quality of life of patients and more cases should be experienced and assessed.

A comparison of clinical and surgical outcomes between laparo-endoscopic single-site surgery and traditional multiport laparoscopic surgery for adnexal tumors

OBJECTIVE: The purpose of this study was to compare clinical and surgical outcomes between laparo-endoscopic single-site (LESS) surgery and traditional multiport laparoscopic (TML) surgery for treatment of adnexal tumors. METHODS: Medical records were reviewed for patients undergoing surgery for benign adnexal tumors between January 2008 and April 2012 at our institution. All procedures were performed by the same surgeon. Clinical and surgical outcomes for patients undergoing LESS surgery using Glove port were compared with those patients undergoing TML surgery. RESULTS: A review of 129 patient cases undergoing LESS surgery using Glove port and 100 patient cases undergoing TML surgery revealed no significant differences in the baseline characteristics of the two groups. The median operative time was shorter in the LESS group using Glove port at 44 minutes (range, 19-126 minutes) than the TML group at 49 minutes (range, 20-196 minutes) (P=0.0007). There were no significant differences between in the duration of postoperative hospital stay, change in hemoglobin levels, pain score or the rate of complications between the LESS and TML groups. CONCLUSION: LESS surgery showed comparable clinical and surgical outcomes to TML surgery, and required less operative time. Future prospective trials are warranted to further define the benefits of LESS surgery for adnexal tumor treatment.

Risk factor for occlusion of central venous access port system in colon cancer patients

<b>Purpose</b>: It is critical to reduce complications associated with the central venous access port (CV-port) system for patients who were treated with chemotherapy or palliative care. <b>Methods</b>: From October 2006 to December 2011, 68 colon cancer patients who were treated with outpatient chemotherapy via a CV-port in the Center for Clinical Oncology, Okayama University Hospital, were analyzed retrospectively. <b>Results</b>: CV-port related complications occurred in 20 (29.4%) patients. No blood could be aspirated in 15 patients when treated via a CV-port. Among the patients with no blood aspiration from their CV-port, ten cases had no complications other than failure of blood aspiration, and anticancer agents have been successfully administered. However, the other five patients had their CV-port system replaced due to complications. Subclavian and left side insertions were the risk factors for catheter occlusion or inability to aspirate blood. <b>Conclusion</b>: Medical staffs should be aware that approximately one-third of the cases with no blood aspiration potentially have troubles with their CV-ports that need to be replaced.

Efficacy of Repeated Arterial Infusion of Cisplatin and 5-Fluorouracil via a Percutaneously Implantable Port System in Advanced Hepatocellular Carcinoma / 대한간학회지

BACKGROUND/AIMS: A prospective study was performed to evaluate the efficacy of low dose administration of cisplatin (CDDP) and 5-fluorouracil (5-FU) by repeated arterial infusion via a percutaneously implantable port system (PIPS) for advanced hepatocellular carcinoma (phase II trial). METHODS: Ten patients with hepatocellular carcinoma belonging to TNM stage IV, but without extrahepatic spread, were enrolled. Nine patients had main portal vein thrombosis. All the patients were positive for HBsAg. Patients were repeatedly treated with an arterial infusion of CDDP and 5-FU (10 mg and 250 mg, respectively, for 5 hours on days 1-5) via a PIPS at four week intervals. The response was assessed by dynamic CT after two courses of chemotherapy. RESULTS: Insertion of PIPS was successful in 8 of 10 patients. Two patients could not receive a second course of chemotherapy because one died of progressive hepatic failure and the other developed local infection and pseudoaneurysm formation. All the remaining 6 patients exhibited tumor progression after two courses of chemotherapy. The median survival time was 89 days (range, 59-204). The causes of death were progressive hepatic failure in one patient and uncontrolled esophageal variceal bleeding in one patient. CONCLUSIONS: Arterial infusion chemotherapy with CDDP and 5-FU via a PIPS was not an effective treatment for patients with advanced hepatocellular carcinoma.