In our hospital, artificial dermis (PELNAC G plus^®) was used at the time of initial surgery for patients with high-risk locally advanced breast cancer who did not wish to undergo breast reconstruction and were elderly, diabetic, or had complications from infection. After confirming negative margins, we performed two-stage meshed full-thickness skin grafting. In all five cases with artificial dermis, the all-layer grafts grew well. However, one of the three patients who underwent postoperative radiotherapy developed a refractory ulcer after radiotherapy, which was difficult to treat. Therefore, we changed the flap to a thoracoepigastric (TE) flap, which is a rotational skin valve that moves the abdominal skin to the skin defect. We have now reported two cases of thoracic wall reconstruction using the TE flap. Since the postoperative course was uneventful and early postoperative irradiation could be performed safely, we report on the usefulness of this technique.

A 73-year-old man with esophagogastric junction adenocarcinoma cT2N0M0 cStage I was determined to be unfit for surgery after geriatric assessment (GA) revealed comorbidities of severe chronic obstructive pulmonary disease (COPD) and sarcopenia. Therefore, chemotherapy was initiated. Concurrently, comprehensive interventions, including COPD medical therapy, nutrition therapy, and exercise therapy, were performed to improve respiratory function and nutritional status. After 3 months, his respiratory function and nutritional status improved, and he was deemed fit for surgery. Therefore, thoracoscopic subtotal esophagectomy was performed. He was discharged on postoperative day 26 without any postoperative complications. We managed a case of esophagogastric junction cancer with severe COPD who underwent radical surgery after comprehensive intervention through GA.

A 72-year-old woman presented to our hospital after experiencing a tightening chest pain and vomiting for a few days. A CT scan revealed that the stomach was located in the mediastinum, and an upper gastrointestinal endoscopy showed an obstruction of the prolapsed stomach (an attempt at reduction was unsuccessful). These findings prompted a diagnosis of Type Ⅲ esophageal hiatal hernia with an inverted upside-down stomach. Therefore, we decided on a laparoscopic repair. The hiatal hernia defect was closed with nonabsorbable sutures, and the crural repair site was reinforced with composite mesh. Additionally, Toupet fundoplication was performed. After these interventions, no recurrence of her symptoms occurred after a year. In most cases, laparoscopic surgery is the choice for repair of hiatal hernia with an inverted upside-down stomach, but the addition of fundoplication is controversial. We report a case of esophageal hiatal hernia showing an inverted upside-down stomach treated by laparoscopic mesh-repair with Toupet fundoplication.

A 73-year-old man was diagnosed with esophageal cancer during postoperative follow-up for hypopharyngeal cancer. He had undergone a laryngopharyngoesophagectomy with free jejunal reconstruction and had a tracheotomy. The CT scan revealed severe emphysema and chronic inflammatory changes, and respiratory function tests revealed a mixed pattern with obstructive and restrictive components. He was considered for radical operation. However，since he had a severe respiratory condition, transhiatal esophagectomy was performed to prevent respiratory complications. Abdominal cavity and mediastinum manipulations were performed laparoscopically, and neck manipulations were performed with consideration given to damage to the transplanted free jejunum and ischemia of the tracheostomy. The postoperative course was uneventful without any respiratory complications, anastomotic leakage, or tracheal necrosis. He was discharged on the 25th postoperative day. We report the case of a patient with esophageal cancer and comorbid respiratory disease after hypopharyngeal cancer surgery who underwent transhiatal esophagectomy with a favorable outcome.

A 57-year-old woman presenting with dysphagia was referred to our hospital. Following detailed assessment, the patient was diagnosed with esophageal cancer [MtLt] cT3r(AD)N1M0 cStage IIIA (Japanese Classification of Esophageal Cancer, 12th edition). Preoperative chemotherapy was considered difficult due to difficulty in oral intake, severe wasting, and decreased renal function. Therefore, surgery was indicated. Since esophagectomy using a right thoracic approach only was considered difficult due to the presence of a severe pectus excavatum, bilateral thoracoscopic esophagectomy was performed. The surgery was completed without any intraprocedural complications. Suture failure occurred after surgery but was cured conservatively. Thirty-five days after surgery, metastasis to the second lumbar vertebra was detected, prompting a posterior lumbar fusion on postoperative day 40. However, multiple liver metastases and increased bone metastases were observed, and her general condition deteriorated. On postoperative day 67, the patient passed. The patient developed distant metastases in the early postoperative period and died from the primary disease, but a safe esophagectomy with a good visual field was possible using a bilateral approach. Bilateral thoracoscopic esophagectomy may be a useful option for patients with esophageal cancer and severe pectus excavatum.

A 23-year-old woman with no significant medical history presented with epigastric pain. Upon thorough examination , a 2.5-cm cystic tumor continuous with the muscular layer of the stomach was identified in the anterior wall of the gastric fundus, raising suspicion of a gastric duplication. Subsequently, the patient underwent a laparoscopic local resection of the stomach. The gastric wall near the tumor was dissected between the muscular layer and submucosal layer and then excised. The muscular defect was closed using interrupted sutures and barbed sutures. No communication with the gastric lumen existed. Pathological assessment revealed the presence of gastric mucosa, including gastric fundic glandular epithelia and gastric body glands, continuous with the muscular layer within the cyst. Additionally, Langerhans islets were observed, confirming the diagnosis of gastric duplication.

Gastric duplication is a congenital disorder that can occur in any part of the gastrointestinal tract, from the tongue base to the anus. The most common site of occurrence is the ileum, accounting for approximately 35%-53% of cases, whereas cases of gastric duplication are rare, comprising only 3%-8%. Symptoms often manifest during childhood, with abdominal pain being a common presentation. Adult-onset cases are uncommon. Moreover, literature on laparoscopic surgery for adult cases of gastric duplication is limited. Therefore, we report this case of an adult gastric duplication, which was successfully resected by laparoscopy.

An 18-year-old man had bruises on his abdomen from a road traffic accident. On the next day, he was admitted to our emergency room after he had episodes of vomiting. Contrast-enhanced abdominal computed tomography (CT) revealed a low-density area in the descending and transverse portions of the duodenum. He was diagnosed with traumatic intramural hematoma of the duodenum complicated by duodenal obstruction and managed conservatively. However, an abdominal CT on admission day 11 revealed an enlargement of the hematoma towards the abdominal wall. The new CT findings warranted an ultrasound-guided percutaneous drainage, which quickly reduced the size of the hematoma. Most traumatic intramural duodenal hematomas are treated conservatively, but some of such lesions are difficult to treat because of duodenal obstruction. Percutaneous drainage has the advantages of the ability to puncture under ultrasound guidance, observe and clean the drainage, and easily replace the drainage tube. When no complication of injury to surrounding organs exists and a safe puncture route can be secured from the body surface, percutaneous drainage may be an effective option to shorten the treatment period. We report a case of traumatic intramural hematoma of the duodenum, which was effectively treated with percutaneous drainage.

A 59-year-old woman with a history of simple total hysterectomy, bilateral adnexectomy, and disseminated nodule resection for stage IIIC ovarian cancer (high-grade serous adenocarcinoma) received postoperative chemotherapy. Approximately 2 years after the operation, CA125 level was found to be elevated, and a PET-CT scan showed an accumulation in the ascending colon. A lower gastrointestinal endoscopy revealed a submucosal tumor-like protrusion in the ascending colon. A peritoneal nodule near the ascending colon was resected by laparoscopy, but the results were negative. A diagnosis of ascending colon metastasis from ovarian cancer was made, and a robot-assisted ileocecal resection and D3 dissection were performed. Histopathological assessment revealed cells that closely resembled the previous ovarian cancer. Additionally, three metastatic lesions were found in regional lymph nodes. Metastasis of ovarian cancer to the ascending colon is relatively rare in Japan; therefore, we report this case with a literature review.

A 71-year-old woman who underwent radical mastectomy for left breast cancer at the age of 49 years presented with vomiting and abdominal pain. Abdominal contrast-enhanced CT showed large bowel obstruction of the descending colon around the splenic flexure caused by a tumor. Bone scintigraphy showed an increased uptake in the thoracolumbar region, pelvis, left clavicle, humeral head, and right 6th rib. Interval laparoscopic-assisted colectomy was performed after intestinal decompression. The histological findings of the resected specimen indicated an invasive lobular carcinoma. She was diagnosed with peritoneal dissemination and multiple bone metastases of breast cancer. Recurrence of peritoneal dissemination after resection of breast cancer rarely causes intestinal obstruction, and late recurrence of breast cancer after >20 years is also relatively rare. We report a rare case for which laparoscopy-assisted surgery was performed and review the literature on peritoneal dissemination and multiple bone metastases of breast cancer.

A 76-year-old man underwent laparoscopic resection of the sigmoid colon and partial hepatectomy (S2) for sigmoid colon cancer and comorbid liver metastasis (S2). Postoperative adjuvant chemotherapy (four courses of XELOX + four courses of Xeloda) was administered. A year after surgery, abdominal EOB-MRI revealed new tumors in S2 and S6 of the liver. The patient was diagnosed preoperatively with multiple metachronous liver metastases of colorectal cancer (S2, S6) and could undergo laparoscopic partial hepatectomy (S2, S6), although the patient had undergone a repeat hepatectomy. Pathological findings revealed the S2 lesion to be a metastatic lesion from colorectal cancer, whereas the S6 lesion was a well-differentiated hepatocellular carcinoma. Although the differential diagnosis of liver tumors is often difficult, especially in the case of resected colorectal cancer, careful preoperative evaluation is important, considering the possibility of overlapping hepatocellular carcinoma.