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Successful resection of metachronous para-aortic, Virchow lymph node and liver metastatic recurrence of rectal cancer

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World Journal of Gastroenterology 2015年第44期21卷 12722-12728页

作者： Nobuyoshi Takeshita toru fukunaga Masayuki Kimura Yuji Sugamoto Kentaro Tasaki Isamu Hoshino Takumi Ota Tetsuro Maruyama Tomohide Tamachi Takashi Hosokawa Yo Asai Hisahiro Matsubara Department of Surgery Numazu City Hospital Department of Frontier Surgery Chiba University Graduate School of Medicine

A 66-year-old female presented with the main complaint of defecation trouble and abdominal distention. With diagnosis of rectal cancer, c SS, c N0, c H0, c P0, c M0 c Stage Ⅱ, Hartmann's operation with D3 lymph node dissection was performed and a para-aortic lymph node and a disseminated node near the primary tumor were resected. Histological examination showed moderately differentiated adenocarcinoma, p SS, p N3, p H0, p P1, p M1(para-aortic lymph node, dissemination) f Stage Ⅳ. After the operation, the patient received chemotherapy with FOLFIRI regimen. After 12 cycles of FOLFIRI regimen, computed tomography(CT) detected an 11 mm of liver metastasis in the posteroinferior segment of right hepatic lobe. With diagnosis of liver metastatic recurrence, we performed partial hepatectomy. Histological examination revealed moderately differentiated adenocarcinoma as a metastatic rectal cancer with cut end microscopically positive. After the second operation, the patient received chemotherapy with TS1 alone for 2 years. Ten months after the break, CT detected a 20 mm of paraaortic lymph node metastasis and a 10 mm of lymph node metastasis at the hepato-duodenal ligament. With diagnosis of lymph node metastatic recurrences, we performed lymph node dissection. Histological examination revealed moderately differentiated adenocarcinoma as metastatic rectal cancer in paraaortic and hepato-duodenal ligament areas. After the third operation, we started chemotherapy with modified FOLFOX6 regimen. After 2 cycles of modified FOLFOX6 regimen, due to the onset of neutropenia and liver dysfunction, we switched to capecitabine aloneand continued it for 6 mo and then stopped. Eleven months after the break, CT detected two swelling 12 mm of lymph nodes at the left supraclavicular region. With diagnosis of Virchow lymph node metastatic recurrence, we started chemotherapy with capecitabine plus bevacizumab regimen. Due to the onset of neutropenia and hand foot syndrome(Grade 3), we managed

关键词： Rectal cancer Surgical resection Virchow lymph nod

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Esophageal intramural pseudodiverticulosis of the residual esophagus after esophagectomy for esophageal cancer

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World Journal of Gastroenterology 2015年第30期21卷 9223-9227页

作者： Nobuyoshi Takeshita Naoki Kanda toru fukunaga Masayuki Kimura Yuji Sugamoto Kentaro Tasaki Masaya Uesato Tetsutaro Sazuka Tetsuro Maruyama Naohiro Aida Tomohide Tamachi Takashi Hosokawa Yo Asai Hisahiro Matsubara Department of Surgery Numazu City Hospital Department of Frontier Surgery Chiba University Graduate School of Medicine

A 91-year-old man was referred to our hospital with intermittent dysphagia. He had undergone esophagectomy for esophageal cancer(T3N2M0 Stage Ⅲ) 11 years earlier. Endoscopic examination revealed an anastomotic stricture; signs of inflammation,including redness,erosion,edema,bleeding,friability,and exudate with white plaques; and multiple depressions in the residual esophagus. Radiographical examination revealed numerous fine,gastrografinfilled projections and an anastomotic stricture. Biopsy specimens from the area of the anastomotic stricture revealed inflammatory changes without signs of malignancy. Candida glabrata was detected with a culture test of the biopsy specimens. The stricture was diagnosed as a benign stricture that was caused by esophageal intramural pseudodiverticulosis. Accordingly,endoscopic balloon dilatation was performed and antifungal therapy was started in the hospital. Seven weeks later,endoscopic examination revealed improvement in the mucosal inflammation; only the pseudodiverticulosis remained. Consequently,the patient was discharged. At the latest follow-up,the patient was symptomfree and the pseudodiverticulosis remained in the residual esophagus without any signs of stricture or inflammation.

关键词： Esophageal intramural pseudodiverticulosis Esophageal cancer Esophageal candidiasis Anastomoticstricture Esophagectomy Residual esophagus

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Effectiveness and safety of a laparoscopic training system combined with modified reconstruction techniques for total laparoscopic distal gastrectomy

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World Journal of Gastroenterology 2020年第13期26卷 1490-1500页

作者： Shun Zhang Hajime Orita Hiroyuki Egawa Ryota Matsui Suguru Yamauchi Yukinori Yube Sanae Kaji toru Takahashi Shinichi Oka Noriyuki Inaki Tetsu fukunaga Department of Gastroenterology and Minimally Invasive Surgery Juntendo University HospitalTokyo 113-8431Japan Department of Gastrointestinal Surgery Shanghai East HospitalTongji UniversityShanghai 200120China Department of Surgery Juntendo Urayasu HospitalJuntendo UniversityChiba 2790021Japan

BACKGROUND Total laparoscopic distal gastrectomy(TLDG)is increasing due to some advantages over open surgery,which has generated interest in gastrointestinal ***,TLDG is technically demanding especially for lymphadenectomy and gastrointestinal *** the course of training,trainee surgeons have less chances to perform open gastrectomy compared with that of senior *** To evaluate an appropriate,efficient and safe laparoscopic training procedures suitable for trainee *** Ninety-two consecutive patients with gastric cancer who underwent TLDG plus Billroth I reconstruction using an augmented rectangle technique and involving trainees were *** trainees were taught a laparoscopic view of surgical anatomy,standard operative procedures and practiced essential laparoscopic *** TLDG procedure was divided into regional lymph node dissections and gastrointestinal reconstruction for analyzing trainee *** surgical outcomes were compared between trainees and trainers to clarify the feasibility and safety of TLDG performed by *** curves were used to assess the utility of our training *** Five trainees performed a total of 52 TLDGs(56.5%),while 40 TLDGs were conducted by two trainers(43.5%).Except for depth of invasion and pathologic stage,there were no differences in clinicopathological *** performed more D2 gastrectomies than *** total operation time was significantly longer in the trainee *** time spent during the lesser curvature lymph node dissection and the Billroth I reconstruction were similar between the two *** difference was found in postoperative complications between the two *** learning curve of the trainees plateaued after five TLDG *** Preparing trainees with a laparoscopic view of surgical anatomy,standard operative procedures and practice in essential laparoscopic skills enabled trainees to perform TLDG sa

关键词： Gastric cancer Total laparoscopic gastrectomy Education system Trainees Augmented rectangle technique Standard procedure

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