[A case of pelvic recurrence of rectal cancer successfully treated by surgical resection using the extraperitoneal approach].

Here, we report a case of recurrent rectal cancer successfully treated with resective surgery using the extraperitoneal approach. A 73-year-old man underwent the Miles operation for advanced rectal cancer (Rb-P, tub1, pMP, pN0, Stage I). At 20 months after the initial operation, computed tomography( CT) and magnetic resonance imaging( MRI) scans and 2-[fluorine-18] fluoro-2-deoxy-D-glucose (FDG)-positron emission tomography (PET) images showed a recurrent pelvic tumor( 20 mm in diameter) located in the lower presacral region. The tumor was surgically excised. The presacral space was easily exposed by the surgical procedure using the extraperitoneal approach, and the tumor was easily dissected and resected. We conclude that a surgical procedure using the extraperitoneal approach might be effective for the treatment of pelvic recurrence of rectal cancer.

[A case of rapidly progressing anorectal malignant melanoma].

We report here a case of rapidly progressing anorectal malignant melanoma. A 66-year-old man was admitted to our hospital due to bowel abnormalities and anal pain. Detailed gastrointestinal examination revealed a nigrities-like type 1 tumor that occupied a semicircle in the intestinal lumen from the lower rectum to the anatomical anal canal. We diagnosed anorectal malignant melanoma from a biopsy of the tumor. For the first time, we performed abdominoperineal resection. DAV-feron chemotherapy was administered from 18 days after the operation. However, multiple liver metastases, multiple lung metastases, and multiple skin metastases appeared in the early phase after the operation. Metastases increased rapidly and the patient died 138 days after the operation.

[A case of rectal cancer with interstitial pneumonia successfully treated with preoperative radiation therapy].

We report here a case of rectal cancer with interstitial pneumonia was successfully treated with preoperative radiation therapy. An 81-year-old man with complaints of constipation and melena was admitted to our hospital for the purpose of close inspection and medical treatment. In colonoscopic examination, we found a type-3 9 cm tumor in mainly occupied lower rectum (Rb), which developed all circumference-related stenosis. We diagnosed the tumor as Group V (adenocarcinoma) in biopsy. In abdominal computed tomography (CT) scan, the rectal tumor was directly invaded to the prostate and left internal obturator muscle. We diagnosed it to be cStage II rectal cancer (Rb) from various image findings. In addition, chest CT showed interstitial pneumonia. At first therapy, we did not perform pelvic evisceration nor chemotherapy because the patient was aged having interstitial pneumonia. We performed loop colostomy and preoperative radiation therapy (total 50 Gy). After the radiation therapy, there was a notable reduction in tumor, and a direct invasion to the prostate and left internal obturator muscle was not identified upon imaging. After the one year course of radiotherapy, we performed Mile's operation. After the operation, we did not perform adjuvant chemotherapy, but there has been no recurrence observed.

[A case of recurrent esophageal cancer successfully treated by combined therapies].

We report here a case of recurrent esophageal cancer successfully treated by cervical lymph node dissection and chemo-radiation therapy. A 66-year-old woman received esophagectomy for advanced esophageal cancer in February 2003. Cervical CT and ultrasonography revealed multiple lymph node metastases in February 2008. Surgical excision was performed to the lymph node recurrence. After the operation, she received radiation therapy combined with cisplatin and 5-FU. She is alive without recurrence for two years after the treatment. We conclude that surgery and chemo-radiation therapy may be effective for cervical lymph node recurrence of esophageal cancer.

[A case of rectal cancer with synchronous multiple liver metastases successfully treated with combined chemotherapy of modified FOLFOX6 and bevacizumab].

We report here a case of rectal cancer with synchronous multiple liver metastases successfully treated with a combined chemotherapy of modified FOLFOX6 (mFOLFOX6) and bevacizumab. A 49-year-old man was admitted to our hospital due to constipation and anorexia. Abdominal ultrasonography and abdominal computed tomography (CT) scan revealed a rectal tumor (Rs) and abdominal abscess and 11 mm hepatic nodular lesion in S3 and 21 mm and 14 mm hepatic nodular lesions in S4. We diagnosed the patient had penetrated rectal cancer (Rs) and multiple liver metastases. We underwent a low anterior resection with D3 lymphadenectomy for the first time. After the operation, an 8 mm new liver metastasis in S6 appeared. We performed a combined therapy of mFOLFOX6 and bevacizumab 16 days after post operation. After the 8th course, there were a notable reduction in S3 and S4 liver metastases, and S6 liver metastasis was unidentifiable upon imaging. At this point, we underwent liver left lobectomy using the Liver Hanging Maneuver Method. After the second operation, there has been no recurrence and same chemotherapy is being continued.

[A case of mediastinoscope-assisted transhiatal esophagectomy for thoracic esophageal cancer after radical operation for lung cancer].

We herein report a case of thoracic esophageal cancer operated on by mediastinoscope-assisted transhiatal esophagectomy after a right upper lobectomy for primary lung cancer. A 70-year-old male with non-small-cell lung cancer (T4N2M0, cStage III B) underwent chemo-radiation therapy followed by an upper lobectomy of the right lung with mediastinal lymph node dissection. The lung cancer histologically showed complete remission (CR), and no recurrence has been shown. Five years after the operation of lung cancer, esophageal cancer (T3N0M0, cStage II) was endoscopically detected in this patient. Partial remission was obtained after neoadjuvant FP chemotherapy for esophageal cancer. Therefore, mediastinoscope-assisted transhiatal esophagectomy was performed in consideration of a history of a right thoracotomy and of pulmonary dysfunction. Preventive tracheostomy was performed because of recurrent nerve paralysis, but no other severe postoperative complication has developed in this case. Histopathological findings showed a well differentiated squamous cell carcinoma (pT3 (Ad), pN0, M0, pStage II), with involvement at resection margin. He was alive for 11 months after the operation for esophageal cancer, although a local recurrence was observed. There are still many problems remained of the treatment for esophageal cancer patients who had previously undergone a radical operation for lung cancer. However, mediastinoscope-assisted transhiatal esophagectomy may become a procedure for surgical approach if it seems to be difficult to approach the esophageal cancer by thoracotomy again.

Prognostic significance of matrix metalloproteinase-7 (MMP-7) expression at the invasive front in gastric carcinoma.

To evaluate the clinicopathological significance of matrix metalloproteinase-7 (MMP-7) expression in gastric carcinoma, we investigated immunohistochemically MMP-7 expression in 214 gastric carcinomas, and examined its relations with the clinicopathologic parameters including patient prognosis. MMP-7 expressed predominantly in cancer cells, and MMP-7-positive tumor cells were preferentially found in deeply invading nests, especially at the invasive front. The mean MMP-7 labeling index (LI) at the invasive front was significantly higher in tumors invading or penetrating the muscularis propria and in stages II - IV than within the submucosal layer and in stage I, respectively (P < 0.001). Statistical analysis revealed that MMP-7 LI at the invasive front was related to lymph node metastasis, vascular invasion, and lymphatic permeation, when all 214 cases were examined as one group (P < 0.05 for all), and the cases with high MMP-7 expression at the invasive front showed significantly more unfavorable prognosis as compared with that of low MMP-7 expression tumors (P < 0.01). Multivariate analysis revealed that TNM stage and MMP-7 expression status at the invasive front were independent prognostic factors (P = 0.0017, relative risk (RR) = 3.12; P = 0.0019, RR = 2.67, respectively). Our findings indicated that expression of MMP-7 at the invasive front is closely associated with local invasiveness, and might be a reliable prognostic marker for patients with gastric carcinoma.