Background
There are only few reported cases of remnant gastric cancer with concomitant afferent loop syndrome. Emergency surgery is the standard treatment strategy for this disease. However, some ...afferent loop syndrome cases, especially those with complete obstruction, can lead to a septic state, which makes performing emergency surgery risky. We describe a case of remnant gastric cancer with complete afferent loop obstruction, which was successfully managed by radical surgery following percutaneous transhepatic cholangial drainage of the afferent loop.
Case presentation
A 71-year-old man presented with nausea and abdominal discomfort. When he was 27 years old, he had undergone distal gastrectomy for a benign gastric ulcer, with gastrojejunostomy (Billroth II reconstruction). Abdominal computed tomography revealed thickening of the anastomosis site and significant dilation of the afferent loop. Gastrointestinal fiberscopy revealed advanced remnant gastric cancer at the anastomosis site, and the stoma of the afferent loop was completely obstructed. We diagnosed the patient with remnant gastric cancer with afferent loop syndrome. Percutaneous transhepatic cholangial drainage was performed twice before surgery to decompress the afferent loop. This provided more time for the patient to recover. Radical surgery of total remnant gastrectomy and Roux-en-Y reconstruction were performed electively. There were no severe postoperative complications. The patient died 8 months following the operation owing to peritoneal dissemination recurrence.
Conclusion
We encountered a case of remnant gastric cancer with afferent loop obstruction, which was successfully managed by radical surgery following decompression of the afferent loop by percutaneous transhepatic cholangial drainage. Percutaneous transhepatic cholangial drainage effectively managed the afferent loop syndrome, resulting in the safe performance of elective surgery.
Background
Cardiac tamponade is a rare postoperative complication of esophageal cancer surgery, which leads to rapid hemodynamic changes and can be fatal if not treated properly and promptly. Herein, ...we report a case of cardiac tamponade after thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution for esophageal cancer that was successfully treated with surgical drainage.
Case presentation
An 86-year-old man with lower thoracic esophageal cancer underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution. No intra-operative complications were observed. On the first postoperative day, tachycardia and hypotension were observed, and pericardial effusion was identified on computed tomography images. The patient was diagnosed with obstructive shock secondary to cardiac tamponade. As percutaneous puncture drainage was not possible due to the presence of a retrosternal gastric tube, pericardiotomy with a small left anterior thoracotomy was performed, and a large amount of hematogenous fluid was drained, which instantly improved circulation. On the second postoperative day, the patient showed decreased pulse pressure, and computed tomography revealed a residual and enlarged hematoma around the right ventricle. The patient underwent surgical drainage and another pericardiotomy with a small right anterior thoracotomy was performed to drain the hematoma. At this time, multiple injuries to the fatty tissue, epicardium, and myocardium with active bleeding were observed on the anterior surface of the right ventricle near the root of the pulmonary artery. In this patient, the ascending aorta ran further to the right and dorsal sides than usual, causing the anterior wall of the right ventricle near the root of the pulmonary artery to be closer to the back of the sternum. This abnormality may have contributed to injury during the creation of the retrosternal pathway, leading to cardiac tamponade.
Conclusions
Cardiac tamponade after esophagectomy can occur because of manipulation during creation of the retrosternal route, with an anomaly in the aortic position being present in this case. Gentle manipulation and selection of the reconstruction route according to the patient’s condition are necessary in cases with such anatomical abnormalities.
Purpose
Exfoliated malignant cells, present along staple lines of anastomosis, may be responsible for anastomotic recurrence of colon cancer. We aimed to assess the impact of surgical bowel occlusion ...around the tumor and intraluminal lavage on the presence of exfoliated malignant cells at anastomosis sites in patients with colon cancer.
Methods
In this prospective study, 32 patients with colon cancer, requiring right hemicolectomy between January 2007 and September 2008, were randomly assigned to a control group (no surgical bowel occlusion; 18 patients) and a “no-touch” group that underwent surgical bowel occlusion around the tumor before tumor manipulation (14 patients). The fluid used intraoperatively to irrigate the portion of the bowel clamped distal to the tumor was examined cytologically, and exfoliated cells of cytological classes IV and V were considered malignant.
Results
In the control group, 2 (11.1%) and 10 (55.6%) of 18 patients had exfoliated malignant cells at the terminal ileum and distal colon anastomosis sites, respectively; however, only 1 (7.1%) of the 14 patients in the no-touch group had exfoliated malignant cells at both the sites. The frequency of exfoliated malignant cells at the distal colon anastomosis site was significantly lower in the no-touch group (
p
= 0.0024). No exfoliated malignant cells were found upon saline irrigation of 400 ml or more in either group.
Conclusion
Measures, such as surgical bowel occlusion around the tumor and intraluminal lavage, can prevent or eliminate exfoliated malignant cells at anastomotic sites in patients with colon cancer.
Successful resection of intra‐abdominal tumors using indocyanine green (ICG) fluorescence imaging has not been reported. Here, we report a rare case of an intra‐abdominal desmoid‐type fibromatosis ...successfully resected using this technique after intersphincteric resection (ISR) for rectal cancer. One year after ISR for rectal cancer in a 47‐year‐old man, computed tomography showed a 50‐mm intra‐abdominal tumor near the left common iliac vein. Surgical resection was performed. The tumor was located in the mesentery of the remnant rectum after ISR. ICG fluorescence imaging confirmed the blood supply to the mesentery of the distal remnant rectum after tumor excision. The anal canal was successfully preserved without creating a permanent colostomy. The tumor was safely resected with resection margins, diagnosed as desmoid‐type fibromatosis. No tumor recurrence was observed 6 months post‐resection. This was the first case report to demonstrate the utility of this technique for an intra‐abdominal tumor resection.
A 69-year-old man was referred to our hospital for investigation of leukocytosis and a persistent fever of 38°C, but we could find no evidence of a specific infection. The leukocyte count was 18 ...000/mm
3
, and the serum granulocyte colony-stimulating factor (G-CSF) and α-fetoprotein (AFP) levels were both elevated, at 66.3 pg/ml and 1,495 ng/ml, respectively. Computed tomography (CT) showed a gallbladder tumor and we performed extended cholecystectomy. Postoperatively, the fever subsided and the leukocyte count, serum G-CSF and AFP level normalized. Histologically, the tumor was a carcinosarcoma of the gallbladder. Immunohistochemical staining of the tumor cells was positive for AFP, but negative for G-CSF. This is the first report of a carcinosarcoma of the gallbladder producing AFP. The laboratory findings and clinical course strongly suggested that the tumor produced not only AFP, but also G-CSF.
INTRODUCTION: Gastrointestinal perforation caused by angiogenesis inhibitors administered as chemotherapy for metastatic colorectal cancer (mCRC) is a potentially fatal adverse event. OBJECTIVE: To ...determine the frequency of and most appropriate treatment for gastrointestinal perforation developing during chemotherapy for mCRC. METHODS: We retrospectively investigated the incidence of gastrointestinal perforation (CTCAE v3.0 Grade 3 or higher) developing in patients who received chemotherapy for mCRC at our center between January 2020 and February 2022. RESULTS: A total of 55 patients were included in the study. The median age was 63.5 (36-89) years, and the male/female ratio was 31/24; the PS at the start of chemotherapy was 0/1/2 in 44/9/2 cases. There were 2 (3.6％) cases of Grade 3 or higher gastrointestinal perforation. One of the patients was managed conservatively with antimicrobial agents, while the other was treated by surgery with omental plugging and drainage. Both patients had received treatment with angiogenesis inhibitors. There were no cases of treatment-related death. CONCLUSION: We report two cases of chemotherapy-induced gastrointestinal perforation: one of the patients was successfully managed conservatively, while the other required surgery.
The authors describe the case of a small liver cyst (2 cm in diameter) causing obstructive jaundice that was treated with aspiration and therapeutic sclerosis. The procedure was performed with use of ...a microcatheter and wire system to access the cyst, which was injected with minocycline hydrochloride. At present, 9 months after treatment, the levels of hepatobiliary enzymes are within normal ranges, and no sign of cyst regrowth has been detected on imaging.
Background
Intra-thoracic stomach (ITS) is a rare type of hiatal hernia. Laparoscopic surgery for ITS is technically demanding due to the distorted surgical anatomy. We incorporated assistive ...esophagoscopy during laparoscopic surgery for ITS. In this study, we assessed the clinical value of esophagoscopy in laparoscopic surgery.
Methods
A retrospective data analysis of 11 consecutive patients with ITS was conducted. Laparoscopic surgery was conducted using a standard five-port technique, with the combination of carbon dioxide insufflating flexible esophagoscopy. The main indications for esophagoscopy were, (1) to demonstrate the course of esophagus and stomach during trans-hiatal mediastinal dissection, (2) to identify important anatomic landmarks, e.g., esophago-gastric junction, and (3) to calibrate the esophageal lumen during cruroplasty and/or fundoplication. Data included patient demographics, types of procedures, rate of conversion and/or complications, and surgical outcome.
Results
Among 11 patients (9 females, 2 males, median age 75 years), 6 had gastric volvulus. Laparoscopic reduction of ITS with cruroplasty was completed in all cases without intraoperative complications. Six cases required prosthesis. Concomitant procedures were Nissen fundoplication in 9, Collis gastroplasty in 2, and sutured gastropexy in 5 cases. Flexible esophagoscopy enhanced the conduct and completion of these procedures, without any endoscopy-related complications. The median operation time was 247 min, and blood loss was minimal. The postoperative course was uneventful except for transient postoperative dysphagia in 2 cases. No relapse was noted within a median follow-up period of 11 months.
Conclusions
Assistive intraoperative esophagoscopy facilitated laparoscopic surgery for ITS, suggesting it could potentially improve the surgical outcome by providing a better view during surgery.
Neoadjuvant chemotherapy (NAC) followed by surgery is a promising treatment strategy for patients with advanced gastric cancer. Severe toxicity associated with the treatment may reduce the dose ...intensity of chemotherapy, resulting in the effect of chemotherapy being attenuated. Recently, skeletal muscle mass has been reported to be associated with the treatment outcomes of cancer patients. The purpose of this study was to clarify whether pretreatment skeletal muscle mass is a predictor of adverse events as well as the relationship between changes in skeletal muscle mass and adverse events during NAC.
This study included 41 advanced gastric cancer patients who were treated with NAC followed by surgery. Body composition was assessed before and after NAC. The relationship between the pre-NAC body composition and adverse events was investigated as well as the relationship between changes in body composition and adverse events.
Univariate and multivariate analyses revealed that low pre-NAC skeletal muscle mass was the only factor significantly associated with severe diarrhea (p = 0.03). There was no significant difference in body weight before and after NAC, but skeletal muscle mass was significantly reduced after NAC (-5.93 ± 7.69%, p < 0.01). Furthermore, patients who experienced severe diarrhea showed significantly greater relative skeletal muscle decrease than those who did not (p = 0.03).
Pre-NAC low skeletal muscle mass was a useful predictor of severe diarrhea. Prevention of severe adverse events may contribute to maintaining the skeletal muscle mass.
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