[A Case of Pathological Complete Response of Advanced Rectal Cancer with Direct Invasion of the Prostate and Extra-Regional Lymph Node Metastasis after Chemotherapy].

A 62-year-old man was diagnosed as having advanced rectal cancer with an invasive carcinoma of the prostate and the right inguinal lymph node metastasis. He received chemotherapy consisting of combination of 5-FU, oxaliplatin, Leucovorin (mFOLFOX6)and bevacizumab. After 5 courses of the chemotherapy, CT and MRI findings revealed the tumor shrinkage. After 6 courses of the chemotherapy, a laparoscopic abdominoperineal resection, bilateral lymph node dissection and a resection of right inguinal lymph node were performed. The pathological findings showed a pCR. NAC with mFOLFOX6 and bevacizumab may contribute to the reduction of the surgical stress for the patients and be an effective treatment for advanced rectal cancer with distant lymph node metastasis.

Small Bowel Obstruction Caused by Ileal Endometriosis with Appendiceal and Lymph Node Involvement Treated with Single-Incision Laparoscopic Surgery: A Case Report and Review of the Literature.

BACKGROUND Endometriosis is an ectopic proliferation of endometrial glands and interstitium outside the uterus. It usually affects the organs surrounding the uterus, and less often, involvement of extrapelvic organs, such as the intestines and urinary tract, is observed. CASE REPORT A 40-year-old woman had been experiencing intermittent right lower abdominal pain for years, which worsened months earlier. The patient was admitted for the worst pain ever accompanying nausea and vomiting. Contrast-enhanced computed tomography revealed a heterogeneously enhanced lesion that measured approximately 50×25×35 mm, and a caliber change of the ileum at the same site with dilated small bowel proximal to the caliber change were observed. Colonoscopy revealed that the ileocecal valve and the lumen of the terminal ileum protruded inward, suggesting an extramural compression by the lesion. Since the patient showed no improvement following conservative therapy, bowel resection through a single-incision laparoscopic surgery was successfully performed. Histopathological exploration showed patchy infiltration of endometrium-like tissues in the muscularis propria and subserosa layers of the ileum and appendix. Moreover, nearby lymph nodes resected for their firmness showed similar findings. CONCLUSIONS We report a case of recurrent intestinal obstruction due to ileal and appendiceal endometriosis with lymph node involvement, which was successfully treated by single-incision laparoscopic surgery. Careful follow-up is important because the prognosis for the intestinal endometriosis with lymph node involvement is still unclear.

Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases.

Here we report a case of advanced rectal and prostate cancer with synchronous lateral lymph node (LLN) metastases that was treated with laparoscopic surgery. A 71-year-old man presented with fecal occult blood and was diagnosed with rectal cancer. A metastatic right LLN was suspected after CT examination of a 19-mm lymph node (proximal internal iliac artery region) and a 13-mm lymph node (distal internal iliac artery region) in the right lateral region. We planned neoadjuvant chemotherapy to suppress local and distant recurrence. This treatment decreased the size of the primary rectal tumor. We performed laparoscopic abdominoperineal resection and right LLN dissection. The histopathological diagnosis was LLN metastases from the rectal and prostate cancers. It is rare for synchronous metastases from rectal and prostate cancers to be observed in the LLN. It may be difficult to determine an appropriate treatment strategy in cases like this.

Case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent girl with inguinal hernia in which open repair was effective.

Chronic pain after laparoscopic percutaneous extraperitoneal closure is very rare. Here, we report a case of chronic pain after laparoscopic percutaneous extraperitoneal closure in an adolescent patient with inguinal hernia who underwent open repair. A 15-year-old girl was diagnosed with a left indirect inguinal hernia, and laparoscopic percutaneous extraperitoneal closure was performed. However, 6 months later, after strenuous exercise, she developed localized pain around the hernia site. Her pain was well controlled by internal treatment but failed to completely resolve. The pain type was somatic, Tinel's sign was negative, and there was no recurrence of the inguinal hernia. Because she strongly wished to undergo surgery, the Potts procedure with removal of the ligature and excision of the round ligament was performed. Her pain improved after surgery, and further medical treatment was not required. The Potts procedure may be an effective treatment for chronic pain such as in this case.

Laparoscopic anterior resection for rectal cancer in a patient with a ventriculoperitoneal shunt.

Laparoscopic surgery has been relatively contraindicated in patients with ventriculoperitoneal shunts (VPS) because of concerns about the effect of the pneumoperitoneum on shunt function. However, there have been recent reports of laparoscopic surgery on the gallbladder and cecum. This is the first report of laparoscopic high anterior resection for rectal cancer without manipulation of the VPS catheter in a patient with VPS. We made a diagnosis of advanced rectal cancer in a 77-year-old man who had a VPS to treat hydrocephalus after a subarachnoid hemorrhage. We performed the procedure with the patient in a 15° head-down tilt and with 10-mmHg pneumoperitoneum pressure. There were no postoperative complications. We concluded that laparoscopic surgery for rectal cancer can be safely performed in patients with VPS.

Malignant triton tumor of the duodenum: report of a case.

We report a case of malignant triton tumor of the duodenum, which is extremely rare. A submucosal malignant tumor was detected in the duodenum of a 49-year-old woman. The tumor was completely resected by performing pancreaticoduodenectomy. Pathological examination revealed that the lesion was a malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation, i.e., a malignant triton tumor. Long-term survival has been achieved with no recurrence at 8.5 years after surgery.

Open-label, randomized, comparative, phase III study on effects of reducing steroid use in combination with Palonosetron.

The purpose of this study is to compare the efficacy of a single administration of dexamethasone (DEX) on day 1 against DEX administration on days 1-3 in combination with palonosetron (PALO), a second-generation 5-HT3 receptor antagonist, for chemotherapy-induced nausea and vomiting (CINV) in non-anthracycline and cyclophosphamide (AC) moderately-emetogenic chemotherapy (MEC). This phase III trial was conducted with a multi-center, randomized, open-label, non-inferiority design. Patients who received non-AC MEC as an initial chemotherapy were randomly assigned to either a group administered PALO (0.75 mg, i.v.) and DEX (9.9 mg, i.v.) prior to chemotherapy (study treatment group), or a group administered additional DEX (8 mg, i.v. or p.o.) on days 2-3 (control group). The primary endpoint was complete response (CR) rate. The CR rate difference was estimated by logistic regression with allocation factors as covariates. The non-inferiority margin was set at -15% (study treatment group - control group). From April 2011 to March 2013, 305 patients who received non-AC MEC were randomly allocated to one of two study groups. Overall, the CR rate was 66.2% in the study treatment group (N = 151) and 63.6% in the control group (N = 154). PALO plus DEX day 1 was non-inferior to PALO plus DEX days 1-3 (difference, 2.5%; 95% confidence interval [CI]: -7.8%-12.8%; P-value for non-inferiority test = 0.0004). There were no differences between the two groups in terms of complete control rate (64.9 vs 61.7%) and total control rate (49.7% vs 47.4%). Anti-emetic DEX administration on days 2-3 may be eliminated when used in combination with PALO in patients receiving non-AC MEC.

[A patient in whom oral UFT/Leucovorin therapy proved markedly effective for lung metastasis after surgery for colon cancer].

A 78-year-old male with sigmoid colon cancer underwent sigmoidectomy. The lesion was se, p1(+), n1, and Stage IV. Oral UFT therapy was performed, but was replaced with oral S-1 therapy 1 year and 6 months after surgery. Three months later, lung metastases 2.0 x 1.5 cm and 0.6 x 0.6 cm were found by chest CT in right S10a and S5b, respectively. Since the patient did not wish surgery, the treatment was changed to oral UFT/Leucovorin(LV)therapy(UFT 300 mg/ LV 75 mg, 4-week administration and 1-week no-administration periods). After 2 courses, chest CT showed disappearance of both lung metastases, indicating complete remission. Oral UFT/LV therapy is convenient because of the oral route. Adverse reactions are few, and the therapeutic effect has been reported to be comparable to that of intravenous 5-FU/LV therapy. Also, in this patient, no adverse reaction was noted, and complete remission was maintained until the patient died of another disease 31 months after the beginning of oral UFT/LV therapy.

[Clinical evaluation of chemotherapy with irinotecan (CPT-11), l-leucovorin (l-LV), 5-fluorouracil (5-FU), and UFT for metastatic or recurrent colorectal cancer].

A clinical study has been conducted since August 2001 to investigate whether chemotherapy with CPT-11/l-LV/ 5-FU/UFT could be an effective regimen for advanced or recurrent colorectal cancer. The chemotherapy consisted of CPT-11 30 mg/m2 iv, as a 120-minute infusion, followed by l-LV 30 mg/m2, as a 60-minute infusion, followed by 5-FU 300 mg/m2, as a 120-minute infusion. This treatment was administered weekly for 6 weeks followed by a 2-week rest period and repeated every 8 weeks. UFT (250 mg/m2/day) was orally administered daily. All patients were evaluable for efficacy, 2 CR, 5 PR, 3 SD and 7 PD. The overall response rate was 41.1% with a median time to progression of 7.1 months and a median survival time of 12.0 months. No grade 3/4 toxicities were observed. The present study suggests that combination chemotherapy with CPT-11, l-LV, 5-FU, and UFT is well tolerated and might be a promising regimen for advanced or recurrent colorectal cancer.