[Intestinal Occlusion Clip Device].

In laparoscopic sigmoidectomy and rectal resection, intestinal tract irrigation is performed after temporary intestinal occlusion to prevent the dissemination of cancer cells in the intestine and to ensure a clean anastomosis. At this time, a temporary intestinal occlusion clip is used, but it may be difficult to place it at a predetermined position. Therefore, we made a small hole at the tip of the clip, made a loop with a thread that passed through it, grasped it, and manipulated the clip, such that it was relatively easy to place the clip in the proper position.

[A Case of Metachronous Multiple Liver Metastases of AFP and PIVKA-â ¡ Producing Gastric Cancer, Responding to Transcatheter Arterial Chemoembolization].

We report a case of a 75-year-old man with a-fetoprotein(AFP)-producing gastric cancer accompanied by multiple large liver metastases. The patient underwent a total gastrectomy for gastric cancer(p-T3N3H0P0M0, fStage ⅢB). The patient then underwent chemotherapy(TS-1 80m g/day)following the radical operation. However, 5 months after the radical operation, he presented with multiple large liver tumors, which were subsequently biopsied. Based on immunohistochemical examination, the liver tumors were negative for AFP protein, but were similar to hepatoid adenocarcinoma, and no fibrosis was observed in the background liver. Therefore, we diagnosed the tumors as liver metastases of AFP producing gastric cancer and metachronous liver metastasis. The patient underwent transcatheter arterial chemoembolization(TACE). TACE decreased the AFP and PIVKA-Ⅱ levels and reduced the multiple huge liver metastases. Due to the increase in AFP and the multiple liver metastases, despite intensive hepatic infusion chemotherapy, he died 5 months after admission.

[A Case of Melena Caused by Peritoneal Dissemination, Treated with Interventional Radiology].

We reported a case of melena caused by perineal dissemination and treated with radiologic intervention. The patient was a 67-year-old woman, who underwent a partial duodenectomy for duodenal(4th portion)cancer in 2013. The pathological examination revealed that the tumor was tub2>por2 adenocarcinoma, SE, n+(10/20), M0. The patient received 2 courses of cisplatin(CDDP)plus S-1 and 8 courses of S-1 monotherapy. About 2 years postoperatively, the patient was hospitalized due to unauthorized bleeding. Metrorrhagia was diagnosed as intrapelvic dissemination based on abdominal computed tomography in April 2016. The patient underwent sigmoid colostomy because she developed bowel obstruction. Postoperatively, the patient received 6 courses of capecitabine plus oxaliplatin(CapeOX)plus bevacizumab. Three months later, a reduction in the recurrent lesion was observed. However, after 6 months, the patient was again hospitalized due to melena. Her condition improved after receivinga blood transfusion and infusinga hemostat. In order to control the hemorrhage, radiation therapy of 50 Gy/25 fractions to the intrapelvic dissemination was conducted. Bleedingcould not be controlled by conservative treatment with blood transfusion. Therefore, radiologic intervention was performed for melena caused by peritoneal dissemination. Neither rebleedingnor symptoms of possible ischemic complications were observed after the intervention until she died 3 months later.

[A Case of Angiosarcoma of the Breast Following Breast-Conserving Surgery with Radiotherapy for Breast Cancer].

We report a case of angiosarcoma of the breast following breast-conserving surgerywith radiotherapyfor breast cancer. The patient was 82-year-old woman, developed induration and eruption in the bilateral breast more than 8 years after the initial operation for breast cancer. The induration was diagnosed as angiosarcoma based on skin-biopsyand vacuum-assisted biopsy. The patient received simple mastectomy, and has been become recurrent condition about one month after simple mastectomy. We operated partial excision for recurrence tumor. She is still alive after rearly 1 year of past operation. There are no established therapies for angiosarcoma of the breast following breast-conserving surgerywith radiotherapyfor breast cancer. Although radiotherapy-induced sarcoma is rare, earlydetection of the tumor in the irradiation area is important, as radiotherapyis often performed for the breast cancer patients. This interesting case of angiosarcoma of the breast after breast-conserving surgeryfor breast cancer is reported.

[A case of portal vein stenting for portal vein stenosis due to pancreatic cancer recurrence after pancreatoduodenectomy].

We report a case of portal vein stenosis due to pancreatic cancer recurrence that was successfully treated with intravenous stent implantation. The patient was a 70-year-old man who had undergone a subtotal stomach-preserving pancreatoduodenectomy with the modified Child method for pancreatic cancer. He was readmitted due to melena, dorsal pain, and severe ascites 8 months after the operation. Computed tomography (CT) findings revealed that pancreatic cancer recurrence had narrowed the portal vein. Neither gastrointestinal nor colon endoscopy could locate the source of gastrointestinal bleeding. Bleeding from the varices increased, and a hepatopetal collateral was considered to be the cause. We therefore placed an intravenous stent at the site of portal vein stenosis, by the transileocolic portal vein. After the stent placement, no further gastrointestinal hemorrhagic episodes occurred.

[Use of the round ligament of the liver to prevent post-pancreatectomy hemorrhage].

Rupture of a pseudoaneurysm after pancreaticoduodenectomy is a fatal complication. To prevent this, we used the round ligament of the liver to separate the hepatic artery from pancreatic anastomosis, obtaining good results. The procedure involved detaching the round ligament of the liver from the abdominal wall during laparotomy and winding it from the proper and common hepatic artery mainly on a gastroduodenal artery stump after reconstruction. Postoperative computed tomography (CT) scan revealed that a thick layer of fat separated the hepatic artery from the abdominal abscess. We retrospectively analyzed 56 patients who had undergone pancreaticoduodenectomy at Tsubame Rosai Hospital from 2003 until 2012. The round ligament was used for 22 patients( ligament group) and was not used for 34 patients( non-ligament group). There was no difference in morbidity from intra-abdominal abscess and pancreatic fistula between the ligament and non-ligament group. Intra-abdominal hemorrhage occurred in 2 patients( 5.9%) in the non-ligament group but did not occur in the ligament group. We believe that this procedure is easy and useful for the prevention of post-pancreatectomy hemorrhage.

[Clinical outcomes of stenting for malignant bowel obstruction in terminally ill cancer patients].

We evaluated the effects of stenting for malignant bowel obstruction in terminally ill cancer patients. Six terminally ill cancer patients with malignant bowel obstruction underwent gastrointestinal stenting at our department from November 2010 to October 2012. Stent insertion was successful and abdominal symptoms improved in all cases. Oral intake improved in 4 cases. Descending colon perforation occurred in 1 case. The survival time ranged between 10 and 184 days( median, 71.5 days). The palliative performance status (PPS) improved in 4 cases, and the survival time was extended as assessed by the palliative prognostic index (PPI). In cases with a PPI of were more than 6.0, namely cases for which the estimated survival time was less than 3 weeks, survival time and oral intake did not change. These findings suggest that gastrointestinal stenting is clinically useful for malignant obstruction and improving the PPS and prognosis in terminally ill patients with malignant bowel obstruction.

[A case of recurrent breast cancer with pneumothorax treated by chest wall reconstruction].

We report a case of a 41-year-old woman who underwent mastectomy and axillary lymph node dissection for right breast cancer(T3N3cM0) in 2004. She was treated with chemotherapy for multiple bone metastases and recurrence in the iliopsoas from January 2008. Right chest wall recurrence was observed in May 2010 and it progressed to ulcer. She was admitted to our hospital complaining of dyspnea on December 2, 2011. We diagnosed open pneumothorax and inserted a chest tube, and then packed the ulcer. No recurrence was observed in the liver and lungs. After stabilization of her general condition, we performed chest wall resection and reconstruction with a latissimus dorsi flap. She was discharged 2 weeks after surgery without severe complications. Although there were distant metastases, this surgical procedure may be effective for patients with open pneumothorax from recurrent breast cancer in order to maintain quality of life.

[A case of pathological complete response after treatment with uracil/tegafur (UFT) and folinate (Leucovorin) for liver metastasis of colon cancer].

The patient is a 62-year-old female who underwent a right hemicolectomy for type-2 ascending colon cancer (moderately-differentiated adenocarcinoma, ss, n0, H0, P0, M0, stage II). Six months after the surgery, a solitary metastatic focus was expressed in the liver S3. Because schizophrenia was present concurrently, tegafur and uracil/folinate (UFT/Leucovorin) treatment was selected and performed for 3 months. Because the tumor shrank afterward, a partial hepatectomy was performed to obtain a curative resection. In a pathological examination of the resected focus, cicatricial/necrotic findings were observed, but no cancer cells were observed; hence, it was determined to be a pathological complete response (CR). In regard to chemotherapy for distant metastasis of colorectal cancer, many molecular-targeted agents are being introduced, thus resulting in more treatment options; however, depending on the patient's background, UFT/LV treatment can be an effective treatment option.