We experienced a pancreatic cancer patient whose muscle cramp arose by using S-1 was improved by the administration of a Kampo formulation Goshajinkigan (GJG).
Eighty-year-old female was diagnosed as having unresectable pancreatic cancer and then chemotherapy with S-1 and gemcitabine was initiated. After 4th course, gemcitabine had been discontinued by the toxicity, and then single administration for two weeks of a dose of 80 mg of S-1 was continued every three weeks. She often experienced muscle cramp at low legs, and she visited the emergency room with complaint of gait disturbance due to worse of muscle cramps. Her biochemical study showed almost normal electrolytes levels. Then a Kampo formulation Shakuyaku-kanzo-to (SKT), which was thought to be rapid-acting for these symptoms, was administered because of her sustained marked symptoms. No effect of SKT on these symptoms was observed; therefore, GJG was selected by Kampo medicine physician in combination with her complaints and body status. The administration of GJG was started 2.5 g once a day and then dose escalation was scheduled because it might induce gastrointestinal disorders. Since dose was escalated 5 g twice a day 2 weeks after initiation, incidence of muscle cramp was reduced three times a week. After 7 weeks, symptoms were disappeared. At this moment, she can continue the chemotherapy with S-1 under control of adverse event by the administration of 5 g of GJG twice a day.
Background: The objective of this retrospective study was to clarify prognostic factors in pancreatic cancer patients treated with curative resection followed by adjuvant chemotherapy with S-1. Methods: Both overall survival (OS) and recurrence-free survival (RFS) were examined in 76 pancreatic cancer patients who underwent curative surgery and received adjuvant chemotherapy with S-1 after surgery between 2007 and 2014. Results: When the length of OS was evaluated according to the log-rank test, significant differences were observed in the pathological tumor size. In addition, univariate and multivariate Cox’s proportional hazards analyses demonstrated that the pathological tumor size was the only significant independent prognostic factor for both OS and RFS. The 5-year OS was 0% in the pathological tumor size ≥ 60 mm group and 30.4% in the pathological tumor size < 60 mm group (p=0.010). Moreover, similar results were observed for recurrence-free survival (p=0.008). Conclusions: The pathological tumor size is the most important prognostic factor for OS and RFS in patients with pancreatic cancer treated with curative resection followed by adjuvant chemotherapy with S-1. The present results suggest that adjuvant chemotherapy with S-1 is not sufficient, especially in patients with relevant risk factors.
Background: The benefit of resecting recurrent tumor after curative esophagectomy for esophageal cancer remains unclear, especially when it requires resection of multiple visceral organs. Case presentation: A 56-year-old male patient with previous history of surgical treatment for esophageal achalasia 21 years before was referred to our hospital for treatment of lower thoracic esophageal cancer. He underwent a thoracoscopic esophagectomy and laparoscopic gastric mobilization with curative intent. Nine months after the operation, abdominal computed tomography revealed an intraperitoneal abscess formed along the distal part of the splenic artery. Percutaneous drainage of the abscess and cytological examination diagnosed the tumor as recurrent squamous cell carcinoma from the esophageal cancer. For symptom alleviation and potential cure, the recurrent nodule together with the pancreatic tail, spleen, and left adrenal grand were resected. The pathological examination confirmed recurrent esophageal cancer at the splenic hilar. Three years later, the patient remains disease free. Conclusion: We experienced a case with metastatic recurrence of lower thoracic esophageal cancer to the hilar of the spleen. When tumor recurrence of esophageal cancer is solitary, an aggressive surgical treatment with multiple-organ resection potentially results in long-term disease-free survival in selected patients.
Reports suggest that jejunal pouch interposition (JPI) after proximal gastrectomy is superior in terms of food intake volume and prevention of reflux esophagitis early after surgery. However, the long-term results and late complications of the procedure are not well known. This case report describes an excessive pouch dilatation necessitating surgical intervention as a late complication of JPI. The patient was a 62-year-old woman with early gastric cancer who underwent proximal gastrectomy. Gastrointestinal continuity was restored with JPI. The patient’s postoperative course was uneventful and follow-up imaging studies showed no signs of tumor recurrence. However, the patient gradually started to experience difficulty eating food and complained of postprandial nausea and vomiting. Contrast radiography of the upper gastrointestinal tract revealed a dilated jejunal pouch, which eventually required surgical intervention. The jejunal pouch and remnant stomach were resected, followed by Roux-en-Y reconstruction. The postoperative course was uneventful and the symptoms subsided. The present case highlights the importance of a clinical study focusing on the long-term results of this surgical procedure.
Background and purpose: This study aimed to evaluate whether we can predict tumor response prior to neoadjuvant chemoradiotherapy (NACR) with concurrent radiofrequency (RF) thermal therapy for rectal cancer. Material and Methods: This study included 80 patients with primary rectal adenocarcinoma localized in the rectum (up to 12 cm from the anal verge) and who received NACR intensity-modulated radiotherapy (IMRT) once daily 5 times/week, 50 Gy delivered to the planning target volume (PTV) in 25 fractions, capecitabine 1700 mg/m2 per day for 5 days per week, and thermic treatment (once a week for 5 weeks with 50 min irradiation). In order to further minimize RF-related complications, we used an initial time of 0 min for the time at which an output limiting symptom occurred as a predicted initial RF output (IRO) and compared this to the tumor response and target volumes (TVs) as defined by computed tomography (CT), magnetic resonance imaging (MRI), and/or 18F-fluorodeoxyglucose positron emission tomography/CT (FDG-PET/CT) findings. A receiver operating characteristic (ROC) curve analysis was used in this study to identify the best-fitted cut-off value for predicted initial radiofrequency output (IRO) and TVs. Results: Gross tumor volume (GTV) correlated significantly with tumor stages, lymph node stages, and pretreatment TNM stages, but not clinical tumor volume (CTV) and PTV. GTV was a better imaging parameter than CTV and PTV for prediction of treatment response in this modality. Patients with predicted IRO ≥ 669.4 Watt, increased body temperature by RF thermal therapy and had a GTV ≤ 31.2 cm3 showed a good indication for this modality. Conclusions: We will be able to select rectal cancer patient prior treatment who respond to chemoradiation therapy with concurrent thermal therapy.
Background and study aims: Benign esophageal stricture has major deleterious effects on a patient’s quality of life and is often refractory. This study aims were to prepare the animal model and to investigate the mechanism of esophageal stricture in the view point of histological and biomechanical evaluation. Material and method: Nine beagle dogs were enrolled in this study. Under general anesthesia, circumferential endoscopic submucosal dissection was carried out 5 cm length in thoracic esophagus for preparing stricture models. The process of stricture formation was evaluated by the endoscopic observation and histological findings. Immunohistochemical staining was performed for collagen I or collagen III. In the biomechanical evaluation, rectangular-shaped specimens were obtained from the esophageal samples. The failure load and linear stiffness were measured using a tensile tester and compared healed tissue with normal. Results: The dogs developed severe stricture. The macroscopic appearance showed a deep ulcer formation and severe mucosal constriction. No esophageal glands or muscularis mucosae were evident, and instead, they were replaced with condensed granulation tissue that were composed type I and III collagen fibers. The inner circular muscular layer of the muscularis propria showed partial atrophy and fibrosis in the center of the lesion. The failure load and linear stiffness were significantly decreased in the healed tissue. Conclusion: The cause of benign esophageal stricture might have been the biomechanical deterioration that was caused the change of the collagen components in the submucosal layers or atrophic changes of inner circular muscles.
Background: Gallstone impaction, which is the result of gallstone migration into the digestive tract through a biliary-enteric fistula, is a well-known but rare cause of mechanical ileus. In this report, we describe an interesting case of gallstone ileus, in which surgical intervention was eventually necessary due to a delay in stone evacuation, and spontaneous closure of the biliary-enteric fistula occurred early after enterolithotomy. Case presentation: A 61-year-old woman was referred to our hospital for the treatment of vomiting. Computed tomography revealed a distended upper gastrointestinal tract, pneumobilia, and impaction with an oval mass measuring 3.2 × 2.5 cm in size within the intestinal lumen, leading to a diagnosis of gallstone ileus. The patient was initially treated conservatively with volume resuscitation, continuous hemodialysis for acute renal failure, and an ileus tube. Although the patient’s condition improved, evacuation of the stone was not observed 5 days after admission. The patient then underwent enterolithotomy and the initial diagnosis was confirmed surgically. The postoperative course was uneventful and follow-up endoscopy revealed spontaneous closure of the biliary-enteric fistula. Conclusion: Spontaneous resolution of gallstone ileus after conservative treatment has been increasingly reported. However, our experience suggests that swift transition to surgical intervention is necessary when conservative treatment is not effective. Although spontaneous closure of the fistula may occur early after enterolithotomy, long term result, including cancer development, remains unknown.
Although several advances in medical therapy have been made to reduce the incidence and severity of postoperative bowel dysfunction, it commonly occurs after abdominal surgery and increases the duration of hospital stay. The present study determined whether daikenchuto, a traditional Japanese medication, decreases the time to resumption of gastrointestinal transit after abdominal open surgery. We conducted a pooled analysis of data from three randomized controlled trials performed by the Japanese Foundation for Multidisciplinary Treatment of Cancer. Here we report our study concept.