[A Case of Colitic Cancer with a Total Proctocolectomy in the Second Term].

The patient was 70-years-old women, 27 years ago, she was diagnosed with total colitis-type ulcerative colitis. Eighteen years after the diagnosis, she self-suspended his hospital visit because her condition was stable. After 4 years, ulcerative colitis rekindled, she resumed taking a 5-ASA. And 2 years later, colonoscopy revealed type 3 tumor in the descending colon. Tumor biopsy indicated an adenocarcinoma(tub1, tub2)derived from ulcerative colitis. Originally total proctocolectomy is necessary, but patient strongly hoped to leave the colon. We performed laparoscopic left hemicolonectomy(D2, SST). The pathological diagnosis was pT3, pN2, pM0, pStage Ⅲc. After the operation, chemotherapy(mFOLFOX6)was carried out for 6 months. We regularly checked tumor markers and followed up with a colonoscopy once every 6 months. But 3 years and 9 months after surgery, ulcerative colitis rekindled and adenocarcinoma in the transverse colon found by colonoscopy. We performed total proctocolectomy with ileal J-pouch anal-canal anastomosis. Four months after the second operation, advanced defecation disorder has not been observed.

[A Case Involving Successful Resection of Advanced Lower Rectal Cancer with Perineum Reconstruction after Preoperative Chemotherapy and Chemoradiotherapy].

A 58-year-old woman visited our hospital for diagnosis and treatment of rectal tumor. The tumor was diagnosed as adenocarcinoma metastasizing to the uterus and vagina. Using CT, metastases were detected in the lung, liver, and right inguinal lymph node. First, we performed sigmoid-loop-colostomy. Thereafter, the patient received chemotherapy(CapeOX plus Bev) for 8 courses and chemoradiotherapy(total 50 Gy plus S-1 therapy). Ten months after the initial examination, we performed abdominoperineal resection of the rectum combined with the resection of the posterior wall of the vagina, hysterectomy, and bilateral adnexectomy. Because of a large defect in the perineal region, we also performed reconstruction using the left gracilis muscle flap. The postoperative course was uneventful, and the patient was discharged 22 days after surgery. Once the wound healed, chemotherapy(CapeIRI plus Bev)was initiated. After 10 courses of chemotherapy, metastasis and local recurrence could no longer be detected. This suggests that preoperative chemotherapy, chemoradiotherapy, and perineum reconstruction could enable the radical resection of advanced rectal cancer.

[A Case Involved Successful Treatment of Cecum Colon Cancer with Idiopathic Thrombocytopenic Purpura(ITP)by Laparoscopic Resection].

A 91-year-old woman visited a local hospital with the chief complaint of bloody stool. The patient was noted that her platelet count is 1,000/µL, so she was referred to our hospital. Also after admission, she had bloody stool continuously. Then lower gastrointestinal endoscopy was done and it indicated that the reason for these symptoms is cecum colon cancer (cT3N0M0). We decided to perform an operation. Before the operation, in order to improve her platelet count to 100,000/µL high dose intravenous immunoglobulin, steroid therapy and platelet transfusion had done. The operation is laparoscopic ileocecal resection and the amount of bleeding is 10 g. The postoperative course was uneventful, and her platelet count became within normal range by platelet transfusion for 4 days. Until latest follow-up she has neither recurrence of the cancer nor thrombocytopenia. This case suggests that appropriate treatments make it impossible laparoscopic surgery for cecum colon cancer with ITP perform safety and resection for cancers may contribute to improve ITP.