[Adenocarcinoma in the Lung Detected Due to the Development of Perforative Peritonitis Caused by Small Intestinal Metastasis-A Case Report].

Previous studies have reported that perforations of the small intestine caused by metastatic tumors prior to the diagnosis of primary lung cancer are very rare. A 79-year-old man was admitted to our hospital with acute lower abdominal pain. Abdominal computed tomography revealed intraperitoneal free air around the bowel wall thickening in the small intestine.

[A Case of Trousseau Syndrome Complication during Chemotherapy for Advanced Gastric Cancer].

The pathological condition which causes cerebrovascular disease through hypercoagulability associated with malignant tumors is known as Trousseau syndrome. Here, we report the case of a patient with Trousseau syndrome which developed as a complication during chemotherapy for advanced gastric cancer. A 70-year-old woman with multiple lymph node metastases of gastric cancer underwent TS-1 plus CDDP chemotherapy before surgery.

[A Case That Was Complicated with Pulmonary Artery Thrombosis during Chemotherapy of the Regimen of CapeOX plus Bevacizumab against Recurrence of Colon Cancer].

An 80-year-old woman with peritoneal dissemination after laparoscopic right hemicolectomy for appendicular carcinoma (mucinous adenocarcinoma, pT4aN1M0, stage Ⅲa)underwent CapeOX plus bevacizumab chemotherapy. The patient achieved stable disease over 5 courses of the treatment. Subjective and objective symptoms were not observed; however, chest computed tomography findings revealed a thrombus in the pulmonary artery that was considered to be associated with bevacizumab.

[A Case of a Laparoscopically Resected Gastrointestinal Stromal Tumor of the Stomach].

During treatment for sigmoid colon diverticulitis, a 72-year-old man underwent abdominal computed tomography, which revealed a gastric tumor that was approximately 40mm in diameter. He then underwent a detailed examination after the remission of diverticulitis. The gastric mucosa was found to be unremarkable on gastrointestinal endoscopy.

[A Giant Appendiceal Mucinous Neoplasm Treated with Laparoscopic Surgery].

We encountered a case of giant appendiceal mucinous neoplasm that was treated with laparoscopic surgery. The patient was a 77-year-old man with constipation. Lower endoscopy demonstrated a giant SMT-like tumor in the cecum, and abdominal computed tomography revealed a giant appendiceal mucinous neoplasm and nearby lymph nodes swelling.

[A Giant Malignant Lymphoma of the Ileocecum Treated with Laparoscopic Surgery].

We experienced a case ofa giant malignant lymphoma ofthe ileocecum treated with laparoscopic surgery. A 78-year-old man presented with right flank pain. Lower endoscopy and abdominal computed tomography revealed a giant tumor in ileocecum.

Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes.

Purpose: The clinical impact of the directionality of lymph node (LN) metastasis was assessed in comparison with the staging by the Japanese Classification of Gastric Carcinoma (JCGC), a numerical LN staging system.

Methods: Two hundred forty-one gastric cancer patients who were diagnosed pathologically to have LN metastasis, and 54 patients who underwent preoperative multidetector-row computed tomography (MDCT) with an image thickness of 1 mm were classified into three groups (unidirectional [Uni-], bidirectional [Bi-], and tridirectional [Tri-] groups) depending on the directionality of their LN metastasis.

Results: The prognosis of the Uni-group was better than that of the Bi- or the Tri-group when assessed on the basis of the pathological findings of metastatic LN and also the preoperative MDCT findings.

Case involving long-term survival after esophageal cancer with liver and lung metastases treated by multidisciplinary therapy: report of a case.

A 57-year-old male with lower esophageal cancer underwent subtotal esophagectomy with lymphadenectomy. The histopathological diagnosis was poorly differentiated squamous cell carcinoma, pT2N1M0 pStageIIB. After one course of postoperative adjuvant chemotherapy involving low-dose CDDP/5FU, a PET-CT scan obtained 12 months after surgery revealed a solitary liver metastasis in the S2 area.

Total pancreatectomy for pancreatic carcinoma: evaluation of safety and efficacy.

Background/aims: To determine the safety and the efficacy of total pancreatectomy for the curative treatment of pancreatic carcinoma.

Methodology: Retrospective analysis was performed using 10 patients receiving total pancreatectomy.

Results: The median duration of the operative procedure was 8.

A case of a superficial carcinoma of the esophagus with isolated lymph node metastasis around the abdominal aorta.

Superficial carcinoma of the esophagus with isolated para-aortic lymph node metastasis is quite rare. A 56-year-old female demonstrated a type 0-IIa+IIb lesion in the middle thoracic esophagus on endoscopic examination. Enhanced computed tomography and positron emission tomography demonstrated two swollen lymph nodes on the right side of the inferior vena cava, but did not demonstrate either a primary lesion or regional lymph node metastasis.

[A case with juvenile hepatocellular carcinoma without hepatitis underwent right hepatic Trisegmentectomy].

A 20-year-old man with juvenile hepatocellular carcinoma (HCC) without HBV, nor HCV infections. A complaint of pain in the right abdomen, wherein a bulky hepatic tumor occupying a large area of the right lobe as well as tumors that were 20 mm and 10 mm in size in liver regions S2 and S3, respectively, were observed via an abdominal CT scan. A biopsy resulted in a diagnosis of well-differentiated hepatocarcinoma.

[A case report of cholangiectasis with cholangiocarcinoma].

This is a case report of cholangiectasis with cholangiocarcinoma in a 37-year-old female. Both computed tomography (CT) and endoscopic retrograde cholangio-pancreatography (ERCP) demonstrated gallstone, and intrahepatic bile duct dilatation with the stone. The diagnosis was intrahepatic cholangiectasis without common bile duct-dilatation.

Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally.

Advances in diagnostic and surgical techniques have improved the prognosis of esophageal cancer, but there is growing concern about gastric tube cancer after esophagectomy. Gastric carcinoma arising in tubes that were reconstructed retrosternally is usually resected through a median sternotomy; however, this is invasive and carries a risk of osteomyelitis after suture-line failure. We performed video-assisted gastric tube resection, eliminating the need for sternotomy by using a sternal lifting method, on a 71-year-old man who had previously undergone esophagectomy and reconstruction retrosternally.

Clinicopathologic features and risk factors for extrahepatic recurrences of hepatocellular carcinoma after curative resection.

Background: The aim of this study was to clarify the clinicopathologic features of hepatocellular carcinoma (HCC) patients with extrahepatic metastasis after the removal of primary HCC, and the risk factors of extrahepatic recurrence.

Methods: Clinicopathologic data were available for 264 HCC patients who underwent an R0 resection for HCC. Twenty-six patients who developed extrahepatic recurrence during the follow-up period (EXT group) were compared with patients who remained free from recurrence for at least 5 years after resection (n = 46) (No R group) or had only intrahepatic recurrences (n = 193) (INT group).

Use of multidetector-row computed tomography to evaluate branch duct type intraductal papillary mucinous neoplasms of the pancreas: influence on surgical decision-making.

Background/aims: The purpose of this study was to evaluate factors predictive of the malignant grade associated with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) using multidetectorrow computed tomography (MDCT).

Methodology: We reviewed the morphological features of 26 BDIPMNs using MDCT. Tumor size, caliber of the main pancreatic duct, number of mural nodules, diameter of the largest mural nodule and volume of the largest mural nodule were assessed and correlated with the pathological findings.

Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: report of a case.

Although there have been several reports about salvage esophagectomy after definitive chemoradiotherapy (CRT), the effectiveness of lymphadenectomy for lymph node recurrence after CRT has not been fully evaluated. Radiation-induced tissue injury and fibrosis make lymphadenectomy after CRT difficult, therefore the choice of surgical approach should be considered carefully. We performed lymphadenectomy via a cervical approach in a 76-year-old man with upper mediastinal lymph node recurrence.

Intraoperative real-time cholangiography and C-tube drainage in donor hepatectomy reduce biliary tract complications.

Background: In living-donor liver transplantation, biliary tract complications are a serious problem for recipients and donors.

Methods: We applied intraoperative real-time cholangiography using a C-arm and/or C-tube drainage to reduce biliary tract complications in donor hepatectomy. From 2003 to 2010, intraoperative real-time cholangiography and C-tube drainage was applied to 39 and 19 donor cases, respectively.

Risk factors for postoperative pancreatic fistula in distal pancreatectomy.

Background/aims: The purpose of this study was to identify risk factors related to severe pancreatic fistula in patients who underwent distal pancreatectomy (DP).

Methodology: From 2000 to 2008, 63 patients underwent DP. We retrospectively identified the risk factors for Grade B or C postoperative pancreatic fistula (POPF) occurring after DP.

Long-term survival of a patient with common bile duct cancer after Virchow's node recurrence: Report of a case.

A 62-year-old male patient with common bile duct (CBD) cancer underwent pancreaticoduodenectomy with lymphadenectomy in 2002. Histological examinations revealed moderately differentiated tubular adenocarcinoma with lymph node metastasis around the pancreas head and hepatoduodenal ligament. No adjuvant chemotherapy was performed, due to the risk of side effects.

Clinical evaluation of JCGC and TNM staging on multidetector-row computed tomography in preoperative nodal staging of gastric cancer.

Background/aims: Multidetector row computed tomography (MDCT) has emerged as a new diagnostic technology in various cancers. The aim was to evaluate its clinical compatibility with the 13th Japanese Classification of Gastric Carcinoma (JCGC), the 6th TNM and the new 14th JCGC/ 7th TNM systems in preoperative nodal staging (N-stage) of gastric cancer.

Methodology: Between January 2005 and December 2007, 92 consecutive patients with gastric cancer underwent preoperative MDCT at a slice thickness of 1.

Long-term survivors of esophageal carcinoma with distant lymph node metastasis.

Background/aims: Clinical extra-regional lymph node metastasis, M1 lymph node metastasis (M1 LYM), has been recognized as a far advanced condition in esophageal cancer. However, some patients with M1 LYM survive long-term. The purpose of this study was to identify the clinicopathological features of those patients with M1 LYM achieving long-term survival.

Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis.

Background/aims: Bile leakage frequently causes major complications after hepatic resection. We investigated perioperative risk factors and management of postoperative bile leakage after hepatic resection without extrahepatic biliary resection and reconstruction.

Methods: We included 247 consecutive patients who underwent elective hepatic resection without bilioenteric anastomosis at our institution between 2002 and 2009.

Prognostic impact of cancer-related symptoms in recurrent gastric cancer patients.

Background/aims: Although routine postoperative follow-up is generally performed for early detection of recurrences, there is no evidence that the periodic follow-up improves survival in patients with gastric cancers. This study aimed to assess the prognostic impact of cancer-related symptomatic status during postoperative followup in gastric cancer patients.

Methodology: A total of 81 gastric cancer patients, who developed recurrences after curative surgery, were retrospectively evaluated for clinicopathological findings with regard to the relationship to cancer-related symptoms at the time recurrences were diagnosed.

Optimal surgical treatment for patients with pT2 gallbladder cancer.

Background/aims: Wall invasion is one of the significant prognostic factors of gallbladder cancer (GBC). Even extended surgery associated with hepatectomy does not always improve the prognosis of pathological T2 (pT2) (the tumor invades perimuscular connective tissue pathologically) GBC patients. The purpose of this study was to identify factors associated with long-term survival of pT2 GBC patients.

Prognostic impact of histological blood vessel invasion in patients with ampullary adenocarcinoma.

Backgrounds/aims: Ampullary adenocarcinoma (AmpCA) has a greater overall survival (OS) rate than other periampullary cancers such as pancreatic cancer or bile duct cancer. Nevertheless, the OS of AmpCA is still poor. In the present study we evaluated the clinicopathologic features of AmpCA with respect to its impact on OS.