Video-assisted thoracic surgery for esophagus for treating locally recurrent gastric cancer at the anastomotic site.

OBJECTIVE: To report a case of video-assisted thoracic surgery for esophagus (VATS-E) for the treatment of locally recurrent gastric cancer at the anastomotic site. CLINICAL PRESENTATION AND INTERVENTION: A 59-year-old man underwent total gastrectomy for gastric cancer. Histopathologically, it was mucinous adenocarcinoma [pT1(sm), pN1, sM0, PM(-), DM(-), stage IB]. Local recurrence was detected and he received chemotherapy and radiotherapy; histopathologically, it was identified as mucinous adenocarcinoma [pT1(sm), pN0, sM0, stage IA]. As the local recurrence was uncontrollable, he underwent VATS-E. At the 1-year follow-up, he was recurrence-free. CONCLUSION: The VATS-E minimally invasive surgery was a very useful technique for anastomotic recurrence after total gastrectomy in our patient.

Asymptomatic spontaneous cervical and mediastinal emphysema.

We report our experience with four patients presenting with spontaneous pneumomediastinum (SPM) within a 3-month period. The patients (three male and one female, aged 15-17 years) were hospitalised with SPM. All patients were kept under observation, successfully treated and followed up for several years, with no recurrences reported. Two patients had histories of asthma, while the other two developed SPM during sporting activities. SPM carries the possibility of being latent. For symptoms such as chest pain without evidence of pneumothorax in young people, it is necessary to always consider SPM and make the diagnosis accordingly.

Liver metastases of a minute rectal carcinoid less than 5mm in diameter: a case report.

We report a case of liver metastases of a minute rectal carcinoid less than 5mm in diameter, which was found during the postoperative follow-up course of a stomach cancer patient. For the early stomach cancer, laparoscope-assisted distal gastrectomy with lymph node dissection was performed on August 26, 1998. Later, abdominal CT revealed space-occupying lesions in the liver (S2). Metastatic tumors of the stomach cancer were suspected, but further examination revealed that the lesions were metastatic tumors due to a rectal carcinoid tumor. Ten months later, metastatic carcinoid tumors were found in the liver (S1, S5, S6, S7, S8). Subsegmentectomy of the liver (S7) and microwave coagulation therapy (S1, S5, S6, S8) were performed. Carcinoid tumors metastatic to the lymph nodes, liver, and other areas have been reported, but all were larger than 20mm in diameter. In this case, the primary tumor was less than 5mm in diameter, which is extremely rare. This patient was successfully treated with lateral segmentectomy, subsegmentectomy (S7), microwave coagulation therapy of the liver, and transanal extirpation. She is presently in a good condition and has had no recurrence of the carcinoid tumor from ten months after the last hepatectomy.