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Volume 65, Issue 8
Displaying 1-8 of 8 articles from this issue
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Original Article
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Naohito Beppu, Munehumi Tomomatsu, Ryo Okamoto, Hidenori Yoshie, Humih ...2012 Volume 65 Issue 8 Pages 419-425
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSObjectives: Our objective was to evaluate the short-term outcomes for T3, N0-2, M0 low rectal cancer after neoadjuvant chemoradiotherapy by laparoscopic surgery. Methods: We divided the cases into two groups by period. One was open surgery (OS): 31 cases between January 2008 and July 2010, and the other was laparoscopic surgery (LAP): 30 cases between August 2010 and December 2011, and evaluated the baseline characteristics, surgery date, pathological characteristics of tumors, postoperative recovery and complications. Results: Blood loss was less and surgery time was longer in the laparoscopic group than in the open group. No significant statistical difference was seen in operation procedure, distal resection margin and postoperative recovery and complications. However, we experienced ileus frequently in the early period, and so examined the causes and made improvements. Conclusions: Laparoscopic surgery is safe for low rectal cancer after neoadjuvant chemoradiotherapy by making good use of open surgery and extending laparoscopic indications.View full abstractDownload PDF (710K)
Case Reports
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Ayano Murakata, Shoji Maruyama, Hideaki Tanami2012 Volume 65 Issue 8 Pages 426-430
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSA 62-year-old man was admitted to our hospital because of nausea, upper abdominal pain, diarrhea and weight loss. An upper gastrointestinal endoscopy showed a gastric ulcer and a fistula formation in the lower body of the stomach and the endoscope could be inserted into the colon through the fistula. Biopsies taken from the ulcer revealed no evidence of malignancy. An upper gastrointestinal series showed a fistula between the lower body of the stomach and the transverse colon. From these findings, the diagnosis of gastrocolic fistula due to gastric ulcer was made. At operation, the transverse colon had severely adhered to the lower body of the stomach. Distal gastrectomy and a partial resection of the transverse colon were preformed. Pathological examination showed that an ulcer in the lower body of the stomach had formed a fistula to the transverse colon, but there was no evidence of malignancy. We should take into account the possibility that a gastric ulcer may form a fistula to the colon.View full abstractDownload PDF (1699K) -
Masatoshi Kuroda, Eiji Ikeda, Seiji Yoshitomi2012 Volume 65 Issue 8 Pages 431-436
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSThe following describes the treatment of a patient who had rectal mucinous carcinoma with extramural progression. The patient was a 57-year-old female, who was referred by the department of gynecology which she had visited complaining of irregular vaginal bleeding and had been suspected of having rectum cancer with vaginal invasion. Lower endoscopy confirmed a type 2 tumor located 8 cm from the anal verge; CT and MRI scans showed an 8 × 6 cm tumor at the upper rectum, so invasion of the posterior wall of the urinary bladder and vagina was suspected. For the suspected rectum cancer accompanied with vesical and vaginal invasion, Hartmann's operation, partial cystectomy and combined resection of the vagina were performed. Pathological examination resulted in muc, AI, N0, H0, P0, M0 and stage II. No relapse has been reported for 17 months post-operation. Colorectal cancer with extramural progression has a strong tendency toward local advancement but possesses relatively low metastatic potential and therefore aggressive surgical therapy is essential for its treatment.View full abstractDownload PDF (2323K) -
Naohito Beppu, Munehumi Tomomatsu, Hidenori Yoshie, Tsukasa Aihara, Hu ...2012 Volume 65 Issue 8 Pages 437-441
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSChemotherapy for colon cancer has advanced and is applied to neoadjuvant chemotherapy for down-staging, expanding the application range of resection of liver metastasis which has been judged as unresectable at diagnosis and locally-advanced colon cancer. Neoadjuvant chemotherapy is being applied to more cases of resectable liver metastases in the expectation of decreasing the size of tumor and curing microscopic metastases.
Laparoscopic surgery is widely used as a surgical technique for rectal carcinoma as well as extirpation of liver at specialized facilities.
We report a case of locally-advanced rectal carcinoma with liver metastasis, 8 cm in diameter, across the internal to anterior segments and regional adenopathy. Following neoadjuvant chemotherapy and radiation treatment, we completely extirpated the primary tumor and liver metastases using laparoscopy.View full abstractDownload PDF (1506K) -
Nobuki Ichikawa, Shigenori Honma, Akihiko Kataoka, Norihiko Takahashi, ...2012 Volume 65 Issue 8 Pages 442-446
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSA 73-year-old woman presented to our hospital with perianal skin eruption as a chief compliant. The eruptic lesion was found to be almost well-circumscribed and 1 cm in diameter, while no tumor was found in the anal canal or in the distal part of the rectum. Skin biopsy revealed pagetoid cells in the perianal skin lesion. Further radiological examinations revealed no lymph node metastases or distant metastases. She underwent abdomino-perineal resection with D2 lymph node dissection for the occult carcinoma with pagetoid spread. Pathological examination revealed continuance within the epidermis between the small primary tumor deriving from an anal gland and the pagetoid lesion. Thus, we finally diagnosed anal gland carcinoma, invading into the submucosal lesion accompanied by pagetoid spread. No adjuvant chemotherapies were introduced postoperatively. No recurrence has been found for as long as 29 months so far.
We conclude that perianal skin lesions should be carefully examined, taking pagetoid spread into account. Furthermore, we should consider that extramucosal adenocarcinoma such as anal gland carcinoma, although rare, may cause pagetoid spread.View full abstractDownload PDF (2579K) -
Eiji Tamoto, Tomoo Okushiba, Masanobu Kusano2012 Volume 65 Issue 8 Pages 447-452
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSOxaliplatin (L-OHP) in combination with fluorouracil and leucovorin (FOLFOX) has been often used for colorectal cancer. The increasing use of oxaliplatin for chemotherapy has led to an increased incidence of oxaliplatin-related anaphylactic reactions. We report two cases of anaphylactic reaction produced by L-OHP. Case 1: A 63-year-old man who had suffered from metastatic appendix cancer was treated with a FOLFOX4 regimen. After an interval due to peripheral neuropathy as an adverse effect of L-OHP, he was retreated with a FOLFOX4 regimen. During the second L-OHP reinfusion (eleventh infusion cumulatively), anaphylactic reaction occurred. Case 2: A 71-year-old male was diagnosed as metastatic sigmoid colon cancer. He received treatment with a FOLFIRI regimen as a first-line chemotherapy and then L-OHP was administered (mFOLFOX6) as a second-line chemotherapy. Thirteen cycles passed uneventfully, but 55 minutes after the beginning of the fourteenth cycle of 2-h infusion of L-OHP, anaphylaxis developed. It is difficult to predict the occurrence of anaphylactic reaction to L-OHP, so we should prepare for it by using the clinical pathway during the infusion of L-OHP. If anaphylactic reaction develops, appropriate treatment should be performed immediately.View full abstractDownload PDF (965K) -
Hisae Hiratsuka, Nobutaka Yasui, Koutaro Maeda2012 Volume 65 Issue 8 Pages 453-457
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSThe patient was a 65-year-old female who had been diagnosed with rectal cancer (RS-Ra 1/3 circumferential type 2 with invasion deeper than SS). During preoperative testing, multiple systemic abscesses including a liver abscess, a right emphysema, a right iliopsoas abscess, and an abscess in the left abdominal muscle layer were observed. Furthermore, CT revealed pyogenic spondylitis in lumbar vertebra L3-4. Klebsiella pneumonia was detected in the patient's blood, urine, and abscess cultures. We assumed this to be because of retroperitoneal penetration and bacteremia caused by the rectal cancer and therefore initiated antibiotic administration. Subsequently, the patient's physical status improved. We performed low anterior resection and anterior lumbar surgical fixation one month later. Postoperative histopathology revealed a well-differentiated adenocarcinoma (SS, N0, H0, M0, P0, Stage II). Since the specimen was non-penetrating, we thought that the systemic abscesses were because of the portal vein routes from the rectal cancer, arteriovenous pathways associated with pressure elevation, and the decreased immunity of the cancer patient.View full abstractDownload PDF (3112K) -
Kazuhiro Toyota, Tadateru Takahashi, Masahiro Ikeda, Manabu Kurayoshi, ...2012 Volume 65 Issue 8 Pages 458-462
Published: 2012
Released on J-STAGE: July 30, 2012
JOURNAL FREE ACCESSWe describe the case of a patient with a coloduodenal fistula who underwent post-chemotherapy resection of advanced colon cancer. A 42-year-old man underwent upper and lower gastrointestinal endoscopy and computed tomography (CT) for a detailed examination of anemia. Ascending colon cancer with direct invasion to the duodenum and coloduodenal fistula formation were diagnosed, and he was referred to our department. CT findings showed that the tumor was adjacent to the inferior vena cava, thereby suggesting direct invasion, and thus, the patient was subjected to preoperative chemotherapy with a FOLFIRI regimen. Although the coloduodenal fistula remained upon the completion of 5 chemotherapy courses, CT examination showed that the tumor had shrunk and that it did not directly invade the inferior vena cava; therefore, it was considered resectable. Right hemicolectomy, pancreatoduodenectomy, and D3 lymph node dissection were performed. The pathological findings were poorly differentiated adenocarcinoma, SI (duodenum), N0, stage II, and curability A. There have been no signs of recurrence for more than 4 years postoperatively. We believe that colon cancer should be completely resected even if it has invaded other organs. If invasion to the duodenum is found, pancreatoduodenectomy may be needed, and surgical invasion may increase. Prognostic improvement after concomitant resection of other organs can be expected.View full abstractDownload PDF (1708K)
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