[A Case of Repeat Liver Resection after Laparoscopic Resection of a Synchronous Liver Metastasis of Colon Cancer].

A 44-year-old woman with subileus was diagnosed with advanced sigmoid colon cancer with a synchronous liver metasta- sis (segmanet 5/8). Laparoscopic anterior resection was performed, and histological diagnosis was sigmoid colon cancer, 55×40 mm, type 2, tub2>por2, pT3, ly2, v2, pN1, M1a, Stage Ⅳ (Japanese Classification of Colorectal Carcinoma, Eighth edition). Four courses of neoadjuvant chemotherapy (FOLFIRI plus panitumumab) shrank the liver metastasis. Laparoscopic partial liver resection was performed for 285 minutes, with 350 g of blood loss. The patient was discharged 9 days after the operation. Two courses of oral adjuvant chemotherapy (S-1) was performed but discontinued owing to side effects. Seven months after the surgery, computed tomography revealed 2 small liver metastasis (segment 8). Although the sizes were 35 and 5 mm, respectively, the larger mass was closed to the middle and right hepatic vein. Therefore, open hepatectomy was performed for 285 minutes, with 525 g of blood loss. The patient was discharged 9 days after the operation without complication. The patient had no recurrence for 1 year after the last surgery.

[A case of recurrent transverse colon cancer invading the pancreas and duodenum successfully treated with biliary and duodenal stenting].

We report a case of recurrent transverse colon cancer invading the pancreas and duodenum that was successfully treated with biliary and duodenal stenting. A 46-year-old man underwent ascending colostomy for the treatment of obstructive transverse colon cancer with hepatic metastasis. Chemotherapy achieved a partial response, but the levels of tumor markers later began to rise again. He then underwent right hemicolectomy and partial hepatectomy. Post-operative chemotherapy was administered, but the recurrent tumor caused obstructive jaundice and duodenal obstruction. These were successfully treated with biliary and duodenal stenting, and the patient was able to remain at home and maintain his quality of life.

[A case of rectal endocrine cell carcinoma treated by laparoscopic assisted intersphincteric resection after neoadjuvant chemotherapy].

A 51-year-old male patient visited our hospital with a complaint of anal dysfunction and anal pain. Colonoscopy revealed a lower rectal cancer just above the dentate line, and its biopsy showed endocrine cell carcinoma. Enhanced computed tomography( CT) showed pararectal and right inguinal lymph node metastasis. Leucovorin, 5-fluorouracil, and oxaliplatin (FOLFOX) therapy was initiated first; then, after K-RAS was found to be wild type, 6 courses of FOLFOX plus panitumumab were administered. After the chemotherapy, the main tumor and the lymph node swelling reduced evidently. Its effect was judged as a partial response (PR). Laparoscopic assisted intersphincteric resection, right inguinal lymph node dissection, and temporary ileostomy were performed. The pathology revealed endocrine cell carcinoma (MP, ly2, v2, n0, stage II). Its pathological effect was judged as Grade 1b. Five months after the surgery, the ileostomy was closed.

[A case of advanced breast cancer in which quality of life was improved by Mohs' paste and hormone therapy].

We report a case of breast cancer hemorrhage locally controlled with zinc chloride paste (Mohs' paste), which is usually applied as a fixative for 24 h before micrographic surgery of cutaneous neoplasms. A 73-year-old woman was suffering from continuous bleeding from an advanced right breast cancer; this bleeding stopped after 15 min by hemostatic treatment with Mohs' paste. Long-term hemostasis and decreased exudates were maintained by weekly treatment. Although radical operation and chemotherapy were recommended, she rejected both without hormone therapy. The tumor size has been locally controlled for 2 years. This rapid treatment with Mohs' paste is effective for controlling bleeding and breast tumor exudates without adverse events, and improves the patients' quality of life.

[A case of recurrent gastric cancer successfully treated by a combination of CPT-11 and CDDP as the third-line chemotherapy].

We report a case of recurrent gastric cancer successfully treated by a combination of CPT-11 and CDDP as the third- line chemotherapy. A 78-year-old man with advanced gastric cancer underwent a curative distal gastrectomy. Three years later, the tumor marker level began to rise and computed tomography (CT) revealed lymph node metastasis invading the pancreas resulting in pancreatic duct dilatation. S-1 treatment was initiated but was discontinued because of a systemic exanthem. Paclitaxel was administrated as secondary chemotherapy. But, after 2 courses, a further increase in the tumor marker level and portal vein invasion were observed. Combination therapy of CPT-11 and CDDP was administered as the third-line chemotherapy. After 3 courses, the tumor marker level normalized, tumor size decreased, and the invasion was eliminated. Third-line chemotherapy against recurrent gastric cancer should be considered if patient performance status (PS) is maintained.

[A case of mediastinal lymph node metastasis from rectal cancer successfully treated by carbon ion radiotherapy].

We report a case of mediastinal lymph node metastasis from rectal cancer successfully treated by carbon ion radiotherapy. A 65-year-old woman underwent sigmoid colostomy against unresectable rectal cancer. After chemoradiotherapy, primary rectal cancer became resectable and low anterior resection was performed. Curative local resection was done and chemoradiotherapeutic effect was grade 2. Chemotherapy after the operation wasn't effective enough and the size of the mediastinal lymph node increased. So she underwent carbon ion radiotherapy (52.8 Gy) which markedly decreased the lymph node size (-48%). Multi-modality therapy, such as radiation, chemotherapy, operation and carbon ion radiotherapy was applied. Successfully, locally advanced rectal cancer was resected and distant lymph node metastasis was controllable.

[A case of recurrent gastric cancer patient with peritoneal dissemination who obtained a long-term survival and QOL by multi-modality therapy].

We report a case of recurrent gastric cancer patient with peritoneal dissemination who obtained a long-term survival and QOL by multi-modality therapy. A 54-year-old woman underwent a total gastrectomy against type 4 gastric cancer (por 2 ss ly1 v1 n0, pT2 pN0 sH0 sP0 sCY0 sM0, fStage IB). After two years, multiple stenoses due to peritoneal dissemination occurred consecutively. Multi-modality therapy combining operation, chemotherapy, and IVR was applied. Symptoms due to stenoses were decreased and a long-term survival was successfully acquired.

[A case of advanced gastric cancer patient who died from meningitis carcinomatosa after S-1 + CDDP therapy with good response].

A 68-year-old male who had undergone a distal gastrectomy for gastric cancer in 1996 visited our hospital. Gastroscopy revealed a type 2 tumor at upper corpus, and its biopsy showed poorly differentiated adenocarcinoma. Because enhanced CT showed lymph node swelling at para aorta, S-1 (100 mg/day) was administered for 14 days and CDDP (20 mg/day) was administered for 4 days as 1 course. After 2 courses, the main tumor and lymph node swelling reduced evidently. A total gastrectomy was performed and the pathology revealed no cancer cells in the stomach and dissected lymph nodes. Two months after the operation, speech disturbance and numbness of the left hand appeared. CT showed 3 metastatic brain tumors, and radiation therapy was administered. Four months after the operation, headache appeared and cerebrospinal fluid examination showed adenocarcinoma cells. Although MTX (10 mg) was administered intrathecally, he was died 5 months after the operation.

[A case of lung metastases of colon cancer demonstrating complete response for more than five years after treatment with UFT].

A 77-year-old woman had a laparoscope assisted ileocecal resection for ascending colon cancer with multiple lung metastases in December 2003. The patient who had postoperative complication such as anastomotic leakage left the hospital in March 2004. UFT was administered from April 2004 to June 2006. One year after administration of UFT, CT showed the lung metastases had been disappeared and the level of CEA was decreased below normal. Recurrence was not observed for 62 months.

[A case of advanced gastric cancer responding completely treated with S-1 therapy].

A 61-year-old male complained of easy fatigue. Gastroscopy revealed a gastric carcinoma. CT showed No.3 and No.7 lymph nodes swelling. Distant metastasis was not found. S-1 (120 mg/day) was administered for 28 days followed by 14- day rest as one course. Total gastrectomy was performed for 2 weeks after the chemotherapy. Pathology revealed no cancer cells in the gastric wall and dissected lymph nodes. The pathological effect was judged as Grade 3. This case suggests that S-1 therapy may be useful for elderly patients and patients with poor renal function.

[Aiming for liaison nutrition support team].

Due to induction of DPC and shortening of average hospitalization, some of the patients of Nutrition Support Team (NST) were discharged without a nutritional improvement. In other words, a medical treatment of the patients has to be stopped. To solve this dilemma, we need to work on building of liaison NST. In 2008, we served 87 NST patients. As for the average hospitalization, it was a significantly prolonged 56-day in comparison with a 13-day of hospitalization as a whole. We confirmed that 12% of the discharged cases and 68% of hospital transfers were without a nutritional improvement. We offer a NST patient information sheet which includes the NST discharge summary and NST information sheet for a smooth discharge transition. We opened an NST outpatient department to make a nutritional assessment, deglutition assessment and discharge summary.

Adenocarcinoma of the rectosigmoid colon seeding into pre-existing anal fistula.

This paper reports a rare case of rectosigmoid colon carcinoma metastasizing to anal fistula. The patient is a 57-year old man with a 7-year history of a fistula in ano. Colonoscopy revealed a rectosigmoid carcinoma. He underwent high-anterior resection. Two years and 3 months later, a subcutaneous tumor was found at the external opening of fistula. Trans perineal tumor excision plus fistulectomy was performed. Pathology revealed that the colon cancer and the perianal tumor were both moderately differentiated adenocarcinoma. Many reports support the concept of tumor cell implantation in mucosa that have been altered or denuded by various factors. Sixteen reports could be found of implantation metastasis of colorectal cancer into anal fistula. In diagnosis, it is important to differentiate implantation of colorectal cancer in anal fistula from primary anal fistular adenocarcinoma. The histology of the perianal tumor in this patient closely resembles the tumor of the colon. Furthermore, immunohistochemistry for cytokeratins 7 and 20 was performed on tissues to distinguish colorectal adenocarcinoma from anal gland carcinoma. Both colorectal cancer and perianal tumor showed CK7-/CK20+.