Survival outcomes of lung metastases from colorectal cancer treated with pulmonary metastasectomy or modern systemic chemotherapy: a single institution experience.

BACKGROUND: Although pulmonary metastasectomy is an accepted treatment strategy for resectable lung metastases (LM) from colorectal cancer (CRC), its survival benefits are controversial. In contrast, recent advancements in chemotherapy have significantly improved metastatic CRC prognosis. This study aimed to evaluate survival outcome of LM from CRC in the age of newly developed chemotherapy. METHODS: We retrospectively reviewed 50 patients who underwent complete resection and 22 patients who received chemotherapy as definitive treatment for LM from resected CRC at our hospital. The present study was limited to patients who started treatment for isolated LM after molecular targeted drugs became available in Japan. RESULTS: Overall survival (OS), cancer-specific survival (CSS), disease-free survival (DFS) rates after pulmonary resection were 64.5%, 66.4%, and 32.6% at five years, respectively. OS and CSS rates of chemotherapy patients were 26.8% and 28.3% at five years, with a median progression-free survival time of 10.0 months. When compared the characteristics of surgical and chemotherapy patients, patients with pN factors of CRC (p = 0.013), smaller size (p < 0.001), larger number (p < 0.001), and bilateral (p < 0.001) LM received chemotherapy. Univariate analysis showed that multiple LM and rectal lesions were poor prognostic factors for OS (p = 0.012) and DFS (p = 0.017) in surgical patients, and rectal lesions were a poor prognostic factor for OS (p = 0.013) in chemotherapy patients. CONCLUSIONS: Pulmonary metastasectomy showed a favorable survival in patients with LM from CRC. Despite the high recurrence rate after metastasectomy and recent advances in chemotherapy, surgical resection could still be considered as a valid option among multidisciplinary treatments. TRIAL REGISTRATION: The research plan was approved by the Institutional Review Board of Shinko Hospital (No. 2142) on February 7, 2022.

Effectiveness of Pelvic Floor Rehabilitation for Bowel Dysfunction After Intersphincteric Resection for Lower Rectal Cancer.

BACKGROUND: The aim of this study was to evaluate the effectiveness of pelvic floor rehabilitation (PFR) for patients with bowel dysfunction after intersphincteric resection (ISR) and to compare the treatment response to that of patients after low anterior resection (LAR). METHODS: Thirty patients with postoperative bowel dysfunction for more than 6 months were enrolled and treated with PFR for 6 months. RESULTS: In the ISR group, significant improvements in the number of bowel movements and the use of antidiarrheal medications were observed, but no significant improvement was observed in the Wexner score (WS) and the fecal incontinence severity index (FISI). Meanwhile, in the LAR group, WS and FISI were better post-treatment than pre-treatment (WS: 10.7-5.7; p = 0.01, FISI: 28-11; p = 0.01). In the assessment of fecal incontinence quality of life (FIQL), only the Coping/Behavior category was improved in the ISR group (1.56 before, 2.16 after PFR; p = 0.01), while all four categories were improved significantly in the LAR group. The anorectal manometric examination showed no significant increase in sphincter pressure and the tolerable volume in patients after ISR. CONCLUSIONS: PFR improved several clinical symptoms of patients after ISR. Compared with patients after LAR, patients after ISR showed an insufficient response to PFR in improving fecal incontinence. Considering the result of the generalized assessment of the quality of life scale, PFR may offer a therapeutic effect for several symptoms of patients after ISR.

[An Elderly Patient with Local Recurrence of Gastric Cancer Responding Completely to S-1 Monotherapy].

An 80-year-old man with a local recurrence of gastric cancer was treated with S-1 monotherapy leading to a complete response(CR).The patient was diagnosed with gastric cancer and underwent a distal gastrectomy with lymph node dissection. Pathological findings showed tub2>por1, pT3 (SS), pN2, pStage III A.Five months after surgery, the patient presented with redness of the abdominal skin.Computed tomography (CT) revealed massive tumors in the abdominal cavity with invasion to the abdominal wall. He was administered S-1, 80 mg/body/day for 14 days, followed by a 7-day rest.After 2 courses of treatment, CT showed a dramatic reduction of the tumors. After 6 months, the tumor tissue completely disappeared and he had a CR.Administration of S-1 was continued for 2 years and 6 months.There was no relapse for 3 years after discontinuation.S -1 monotherapy appears to be a feasible and effective therapy for elderly patients with recurrent gastric cancer.

[A Case of Ascending Colon Cancer Showing Marked Reduction of Ascites by Bevacizumab Combination Chemotherapy].

A 68-year-old woman presented to our hospital with abdominal fullness. Computed tomography(CT)revealed ascites and massive tumors in the abdominal cavity. She was diagnosed with ascending colon cancer with peritoneal dissemination and ovarian metastasis. After ileostomy, panitumumab plus mFOLFOX6 therapy was initiated, but it was discontinued due to adverse events. As the ascites rapidly increased, her chemotherapy was changed to bevacizumab(BV)plus FOLFIRI. BV combination therapy resulted in a dramatic decrease in ascites and improved her quality of life, whereas the therapy did not reduce the primary and metastatic lesions. Our case suggested that BV could decrease ascites by inhibiting vascular endothelial growth factor(VEGF)-induced vascular permeability.

Solitary fibrous tumor of the pleura with a minute malignant component and diaphragmatic vascular supply: report of a case.

We resected a fist-sized, solitary fibrous tumor of the pleura (SFTP) with a minute malignant component, following percutaneous embolization of its feeding artery. The tumor had macroscopic characteristics of a benign SFTP, and most parts of it were microscopically benign. However, further careful pathological examination revealed a minute malignant component in its periphery. We report this case to show that large and mostly benign SFTPs may contain malignant components, which can be overlooked. Thus, large SFTPs should be resected in consideration of this possibility.

Retrospective study of patients with pathologic N1-stage II non-small cell lung cancer.

The population of patients with N1-stage II disease is small among non-small cell lung cancer patients and there have been relatively few studies regarding prognostic factors for the disease. We retrospectively evaluated the clinicopathological features of the disease to identify prognostic factors. The clinical records of 85 patients with N1-stage II non-small cell lung cancer who underwent lobectomy or pneumonectomy with systematic lymph node dissection or sampling were retrospectively reviewed. The study population comprised 64 men and 21 women, among whom 49 had adenocarcinoma, six had squamous cell carcinoma and two had large cell carcinoma. The prognosis was significantly better for p0 vs. p2-3 disease (P=0.029), pneumonectomy vs. lobectomy (P=0.027) and direct extension vs. metastasis to N1 lymph nodes (P=0.015). On the other hand, there was no significant difference in survival regarding the number or level of the involved lymph node stations. A multivariate analysis for prognostic factors revealed that status of lymph node involvement as well as gender and pleural factor was a significant independent prognostic factor (P=0.026). Our results have revealed that direct extension to N1 lymph nodes is an independent favorable prognostic factor as opposed to metastasis for surgically-treated patients with N1-stage II disease.

Solitary fibrous tumor associated with non-islet cell tumor hypoglycemia.

A 79-year-old man presented with abnormal fluttering movements of his extremities early in the morning. Fasting hypoglycemia was believed to be the cause of the movements. A computed tomographic scan showed a large mass in the left inferior hemithorax. Non-islet cell tumor hypoglycemia was suspected, and the mass was resected while the patient was under glucose supplementation therapy. The plasma glucose level became stable shortly after tumor excision. The resected tumor was diagnosed as a solitary fibrous tumor producing insulin-like growth factor II. In the follow-up examination approximately 2 years after the surgery, no recurrence of the tumor was observed, and the plasma glucose level was stable.

Clinical relevance of intraoperative pleural lavage cytology in non-small cell lung cancer.

BACKGROUND: Intraoperative pleural lavage cytology for patients with lung cancer has been reported to be useful in detecting subclinical pleural dissemination. However, this procedure is not necessary for the staging of lung cancer in the current TNM staging system. METHODS: Clinical records of 1025 patients with non-small cell lung cancer who underwent surgery were retrospectively reviewed and evaluated for the clinical relevance of intraoperative pleural lavage cytology. RESULTS: Specimens of 37 patients (3.6%) were positive for pleural lavage cytology (PLC). Patients were categorized into three groups: positive PLC group, 27 patients with positive PLC without malignant pleural effusion or pleural dissemination; pleural dissemination (PD) group, 21 patients with malignant pleural effusion or PD; negative PLC group, 977 patients with negative PLC or negative PLC without PD. The positive PLC group had a significantly higher ratio of adenocarcinomas than the negative PLC group (p = 0.014). There was a significant difference in distribution of pleural factors between the positive and negative PLC groups (p < 0.001). Survival in the positive PLC group was significantly worse than in the negative PLC group (p = 0.007), especially in pathologic stage I (p = 0.001), but significantly better than in the PD group (p = 0.038). PLC status was found to be a significant independent prognostic factor in the multivariate analysis (p = 0.016). CONCLUSIONS: The present study demonstrates the clinical relevance of intraoperative PLC in early stage non-small cell lung cancer. The result of intraoperative PLC should be involved in the staging system of lung cancer.

Congenital bronchial atresia associated with spontaneous pneumothorax.

A 36-year-old woman presented with left chest pain and frequent symptoms of upper respiratory infection. Chest roentgenograms revealed a left pneumothorax and apical bulla, and hyperlucency in the left pulmonary field. She was diagnosed with congenital bronchial atresia associated with a left spontaneous pneumothorax. A thoracoscopy-assisted left superior segmentectomy was performed. There was no recurrence of the pneumothorax or symptoms of recurrent upper respiratory infection at the 1-year follow-up examination. Bulla formation was believed to have resulted from emphysematous changes in the peripheral lung due to congenital bronchial atresia. The pneumothorax may have occurred due to rupture of the bulla.

[Pulmonary thromboembolism in patients after surgery for pulmonary malignant tumor].

From January 1994 to December 2004, 6 of 1,034 patients (0.58%) with pulmonary malignant tumor developed pulmonary thromboembolism (PTE) after surgery in our department. Five of 6 patients had primary lung cancer, and 1 had metastatic lung tumor. The surgeries for the 6 patients contain 1 exploration thoracotomy, 1 wedge resection, 3 lobectomies, and 1 pneumonectomy. The length of time between operation and making diagnosis of PTE was 2-7 days. All 6 patients initially showed symptoms of desaturation and tachycardia. Chest computed tomography (CT) was the most useful diagnostic method. In all cases, we started intravenous administration of unfractionated heparin sodium immediately after making diagnosis. In 2 cases, we needed to add thrombolysis by urokinase because of their serious condition. One patient in whom the establishment of diagnosis took longer time died on the postoperative day 9, in spite of the removal of the thrombus by percutaneous approach. The other 5 patients made a recovery and observed no signs of recurrence of PTE after 6-month anticoagulant therapy by warfarin potassium. PTE can be treated only with anticoagulant therapy if we confirm the diagnosis and start the treatment immediately after the first episode.