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The patient remains alive without recurrence 19 months after the operation. Patients with metastatic pancreatic adenocarcinoma have poor prognoses because they are no longer candidates for surgical therapy. We encountered a case of pancreatic body cancer with peritoneal dissemination, followed up for 15 months without recurrence.
This study was aimed at evaluating the oncologic outcomes of our preoperative treatment strategies for cStage Ⅱ/Ⅲ lower rectal cancer. At our hospital, neoadjuvant chemotherapy is administered for patients with bulky mesenteric lymph nodes on pretreatment imaging, and neoadjuvant chemoradiotherapy is administered for patients whose circumferential radial or distal margin cannot be secured because of strong local extension.
Thirty patients who underwent preoperative therapy followed by total mesorectal excision for cStage Ⅱ/Ⅲ lower rectal cancer were retrospectively analyzed from October 2010 to October 2015.
Twenty-five patients underwent neoadjuvant chemotherapy, and 5 patients underwent neoadjuvant chemotherapy. Tumor recurrence occurred in 10 patients at local(5 patients)and distant(5 patients)sites. The 5-year recurrence-free survival(5RFS)was 63.9%.
We performed preoperative therapy in poor-risk locally advanced lower rectal cancer and obtained good results.
We performed preoperative therapy in poor-risk locally advanced lower rectal cancer and obtained good results.
The standard treatment in Japan for advanced lower rectal cancer is total mesorectal excision(TME)plus lateral lymph node dissection(LLND). However, the standard treatment in Western countries is preoperative treatment plus TME. There have been some discussions on preoperative chemotherapy and chemoradiation therapy. This study was aimed at identifying the prognostic factors of recurrence after curative surgery for advanced lower rectal cancer.
A total of 54 patients with advanced lower rectal cancer who had undergone curative operation at our department from 2010 to 2015 were retrospectively analyzed, excluding patients with both LLND and preoperative therapy. The primary endpoint of this study was the 5-year recurrence-free survival(5RFS).
The overall 5RFS was 57.6%. The univariate analysis demonstrated that lymph node metastasis(p=0.038)and radial margin(RM, p=0.015)were significant risk factors, with a 5RFS of 39.7% and 0%, respectively. The multivariate analysis revealed that only RM significantly affected 5RFS(p= 0.009).
Our results suggest that securing an adequate circumferential resection margin together with proper surgical technique and preoperative therapy are important for decreasing postoperative recurrence rates of advanced lower rectal cancer.
Our results suggest that securing an adequate circumferential resection margin together with proper surgical technique and preoperative therapy are important for decreasing postoperative recurrence rates of advanced lower rectal cancer.A 60's woman was admitted to our hospital because of palpitations that occurred with exertion. Coronary angiography computed tomography(CT)of suspected angina detected a tumor in the pancreatic head region. Abdominal CT showed a poorly enhanced 40×32 mm solid tumor in the hepatoduodenal ligament that contained a fatty component and calcification. During surgery, the tumor was located in the hepatoduodenal ligament, adhered to the pancreatic head, common hepatic artery, gastroduodenal artery, portal vein and common bile duct. However, the tumor was resected by preserving them. The tumor contained stratified squamous epithelium, a sebaceous gland, nerve, a pancreatic gland, and an adrenal gland. The histological diagnosis was a mature cystic teratoma. The patient showed no recurrence in 2 years and 10 months post-surgery. Mature teratomas in the hepatoduodenal ligament are extremely rare. Some reports showed that combined resection was performed when the tumor was in contact with the common bile duct, portal vein, and arteries. However, in our case, the tumor was removed relatively safely without combined resection.
In recent years, the decision to discontinue chemotherapy has become more difficult, and there is a tendency for chemotherapy to continue until just before death. We investigated the current state of end-of-life(EOL)chemotherapy for solid cancer patients.
Patients who died of cancer during hospitalization between January and November 2018 were included. Patients were divided into 2 groups, those who received EOL chemotherapy within 30 days of death(Near group NG)and those who did not receive it(Far group FG). The contents of each treatment were compared retrospectively.
The number of patients were 46(32%)in the NG and 96(68%)in the FG. As EOL chemotherapy, the number of patients received cytotoxic drugs were 27(59%)and 68(71%), molecular targeted drugs were 6(13%)and 16(16%), immune-checkpoint inhibitors were 8(18%)and 12(12%), and hormone drugs were 0(0%)and 5(5%)in patients with NG and FG respectively(p<0.05).
Minimally invasive drugs were often selected for EOL chemotherapy. It was suggested that the advent of new drugs has expanded the options for EOL chemotherapy.
Minimally invasive drugs were often selected for EOL chemotherapy. It was suggested that the advent of new drugs has expanded the options for EOL chemotherapy.Here, we report a case of ascending colon cancer successfully treated with laparoscopic right hemicolectomy in a 74- year-old man with a medical history of hemophilia A. He was admitted to our hospital because of bloody stool and diagnosed with type 2 ascending colon cancer based on colonoscopy findings. Preoperatively, blood transfusion and administration of recombinant factor Ⅷ products were performed. Surgery involved laparoscopic right hemicolectomy plus group 3 lymph node dissection. No complications, such as bleeding, occurred during hospitalization. The patient was discharged on postoperative day 8. There have been a few reports of laparoscopic surgery for patients with hemophilia. Crenolanib However, this case suggests that it can be safely performed with planned factor Ⅷ supplementation in the perioperative period.
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