Japanese Journal of Cancer and Chemotherapy最新文献

The patient was a 67-year-old woman who presented to our hospital with abdominal pain. She was diagnosed with transverse colon cancer with obstructive colitis, pancreatic head, and gastric invasion(cT4bN1bM0, cStage ⅢC). After the placement of a colonic stent to relieve the obstruction, 5 courses of preoperative chemotherapy(FOLFOXIRI+bevacizumab) were administered for local control. Tumor shrinking was observed, and the response was judged to be a partial response. Following a rest period, radical surgery(extended right hemicolectomy and pancreaticoduodenectomy)was performed. Pathological findings showed pT4b(panc)N1bM0, pStage ⅢC, and R0 resection was achieved. In cases of colon cancer invading other organs, long-term survival may be achievable with R0 resection, and we believe that extended surgery should be considered proactively.

Introduction: Portal vein embolization(PVE)is a preoperative procedure that requires contrast media, making it contraindicated in patients with a history of contrast-induced anaphylaxis. We report a case of intrahepatic cholangiocarcinoma (ICC)in which laparoscopic right portal vein ligation(PVL)was performed as an alternative to PVE due to this contraindication.

Case: A 60-year-old woman was found to have a liver tumor during a health checkup. Further evaluation led to a diagnosis of ICC. The tumor was in close contact with the right and middle hepatic veins and the inferior vena cava(IVC) and showed enlarged hilar and para-aortic lymph nodes(#16b1). Surgery was initially deemed unfeasible at another hospital, and systemic chemotherapy(GEM+CDDP+durvalumab)was initiated, maintaining stable disease for approximately 1 year. She was referred for potential conversion surgery. Although PVE was indicated, it was contraindicated due to a history of contrast anaphylaxis. Therefore, laparoscopic right PVL was performed instead. On postoperative day 26, extended right hepatectomy with partial IVC resection, cholecystectomy, and lymphadenectomy(including #16b1 int & lat)was performed. Aside from autosensitization dermatitis, her postoperative course was uneventful, and she was discharged on day 17.

Conclusion: Laparoscopic PVL is a safe and effective alternative to PVE in patients with contrast contraindications.

In cases of colorectal cancer diagnosed as pT1 after endoscopic resection, surgical additional resection is considered due to the potential risk of lymph node metastasis. However, approximately 90% of such cases do not exhibit lymph node metastasis. Recently, the increase in the elderly population has led to a rise in patients with poor performance statu(s PS), complicating the decision-making process for additional resection. In this study, we retrospectively reviewed 35 cases that underwent surgical additional resection following endoscopic resection between January 2019 and December 2024 at our institution. Lymph node metastasis was observed in 3 cases(8.6%). Among 20 cases with multiple indications for additional resection, 3 cases(15.0%)had lymph node metastasis. Additionally, among the 8 cases with positive resection margins, 2 cases (25.0%)had lymph node metastasis. No recurrences were observed during the follow-up period. Given the higher incidence of lymph node metastasis in cases with multiple risk factors or positive resection margins, surgical additional resection is considered advisable in such cases.

We present the case of a 54-year-old woman who was treated with preoperative chemotherapy, surgery, postoperative radiotherapy, and endocrine therapy for estrogen receptor(ER)-positive HER2-negative breast cancer. Positron emission tomography(PET)-computed tomography(CT)performed 10 years post-surgery revealed accumulation in the cervical and mediastinal lymph nodes and right chest wall. Endocrine therapy was initiated for the treatment of recurrent ER-positive and HER2-negative breast cancer but was unsuccessful. Despite initiation of chemotherapy, the patient developed bilateral recurrent nerve palsy and underwent tracheotomy. At the time of tracheotomy, biopsy evaluation revealed that the metastatic left supraclavicular lymph nodes were ER- and HER2-positive; therefore, the treatment was switched to a trastuzumab, pertuzumab, and docetaxel(TPD)combination for HER2-positive recurrent breast cancer. However, PET-CT revealed increased accumulation in the recurrent lesions, and the treatment was switched to trastuzumab deruxtecan (T-DXd). The accumulation of recurrent foci became less pronounced and the patient continued to progress without further deterioration.

Background: In the context of Japan's rapidly aging population, establishing optimal treatment strategies for elderly patients with colorectal cancer(CRC)remains a pressing clinical concern. Colonic self-expandable metallic stent(SEMS) placement has gained recognition as a viable option for managing obstructive CRC, including in elderly individuals.

Methods: We conducted a retrospective analysis of 162 patients who underwent SEMS placement for primary obstructive CRC between 2015 and 2024. Patient demographics, clinical characteristics, and outcomes were compared between elderly and non-elderly cohorts.

Result: Elderly patients were more likely to have poor performance status and a history of dementia; however, the outcomes of SEMS placement and subsequent surgical intervention were comparable to those observed in non-elderly patients. Primary tumor resection following bridge to surgery (BTS) was associated with improved overall survival.

Conclusions: SEMS placement serves as a versatile and effective treatment strategy, particularly in elderly patients with diverse clinical profiles. Our findings suggest that primary tumor resection after BTS may contribute to improved survival, supporting the clinical significance of this treatment strategy.

The incidence of breast cancer in nonagenarians and older patients has been increasing with the aging population. We retrospectively analyzed 9 patients aged ≥90 years who underwent breast cancer surgery at our institution between 2016 and 2024, examining patient characteristics, pathological factors, treatment modalities, complications, and postoperative outcomes. The median age was 92 years, with a median invasive tumor size of 18 mm(T2 or higher in 4 cases). All patients had comorbidities, with polypharmacy observed in 5 cases and dementia leading to difficulty in treatment decision-making in 4 cases. All surgeries were performed under general anesthesia. Although serious complications occurred in 3 patients, there was no significant prolongation of postoperative hospital stay. Adjuvant endocrine therapy was initiated in 6 patients but continued in only 4 cases. No patients received chemotherapy or radiotherapy. During the follow-up period, no recurrence or cancer-related deaths were observed. These findings suggest that with appropriate patient selection considering overall health status, functional assessment, and living environment, surgery can be performed relatively safely for nonagenarians with breast cancer. Postoperative management should involve individualized treatment decisions utilizing regional medical cooperation networks based on each patient's specific circumstances.

Recently, modified Blumgart pancreaticojejunostomy has been reported. In this method, close suture of the pancreatic parenchyma and jejunal serosal muscle layer is considered to be important. On the other hand, there is no settled method for anastomosis of the pancreatic duct and jejunum. There are reports of 6 to 12 stitches for anastomosis of the pancreatic duct and jejunum depending on the diameter of the pancreatic duct, but there are no reports of 4 stitches for anastomosis of the pancreatic duct and jejunum(hereafter referred to as the 4-stitches method), which is a simpler method. The pancreatic jejunal anastomosis was performed by the 4 stitches method in 22 patients regardless of the diameter of the pancreatic duct. 21 patients had postoperative pancreatic fistula Grade(ISGPS classification)of Grade A or less, and 1 patient had Grade B. The important features of the 4 stitches method are that the pancreatic duct and jejunum can easily be attached as a plane and the drainage hole is not easily narrowed. I think that the technique is simple and easily reproducible anastomosis method.

A man in his 40s presented with fever and right lower abdominal pain. Laboratory data showed elevated inflammatory markers. Abdominal CT showed a 3 cm mass in the mid-lower abdomen with fluid retention and gas continuity with the small bowel, consistent with diverticulitis. Multiple hepatic nodules were also noted. After antibiotic therapy, laparoscopic surgery was performed on hospital day 3. Intraoperatively, a firm mass was found approximately 30 cm proximal to the ileocecal valve, with extensive adhesions to the mesentery and omentum. Multiple white nodules were observed in both hepatic lobes. We performed partial small bowel resection(approximately 60 cm)and partial liver resection for liver biopsy. The pathological diagnosis was adenocarcinoma arising from Meckel's diverticulum with multiple liver metastases(pT3pN1bpM 1a, pStage Ⅳa). We decided to introduce systemic chemotherapy similar to that used for colorectal cancer in small bowel cancer, and we started systemic chemotherapy with mFOLFOX6 at 8 weeks after surgery. Bevacizumab was added from the fourth course due to progressive liver metastasis on CT imaging. After 15 courses, a partial response(PR)of the liver metastases was achieved with no local recurrence or new lesions. Meckel's diverticular adenocarcinoma is extremely rare, and no standard chemotherapy has been established. We have observed relatively good results with mFOLFOX6 plus bevacizumab in this setting.

Surgical resection is the standard treatment for resectable colorectal cancer; however, patients with locally advanced colorectal cancer may face challenges, such as difficulty for the surgeon to achieve R0 resection and a high risk of postoperative recurrence. Although, in the Japanese guidelines, neoadjuvant chemotherapy(NAC)is not recommended for patients with resectable colorectal cancer, clinical studies conducted in Western countries have suggested its clinical benefits. In the FOxTROT trial, NAC was reported to promote tumor regression, contributing to a higher R0 resection rate in patients with locally advanced colorectal cancer. In addition, some reports have indicated that NAC can be performed safely and is not associated with increased postoperative complications. In this case, a patient with sigmoid colon cancer with rectal invasion (cT4b, N1b, M0)received 2 courses of capecitabine-oxaliplatin(CapeOX)therapy as NAC and experienced tumor regression, which enabled the patient to undergo minimally invasive surgery. We report this case because the clinical course suggests the significance of considering the clinical benefits of NAC for locally advanced colorectal cancer, even though NAC is not recommended in Japan.

Oncotype DX is performed to predict prognosis and the added benefit of chemotherapy in hormone receptor-positive, HER2-negative breast cancer, with the goal of individualizing chemotherapy decisions. Here, we report 2 cases of early- stage hormone receptor-positive, HER2-negative breast cancer with lymph node metastases in which the oncotype DX test was performed but yielded inconclusive results. Case 1:A 53-year-old woman was diagnosed with left breast cancer following bloody nipple discharge. She underwent total mastectomy and axillary lymph node dissection. Two positive lymph nodes were identified;however, it was difficult to assess the invasive component of the primary tumor. When oncotype DX was performed, it was deemed inconclusive due to insufficient tumor tissue. Case 2:A 46-year-old woman was diagnosed with right breast cancer during routine follow-up at our department. She underwent total mastectomy and axillary lymph node dissection. Although the primary tumor was widely spread within the breast, assessment of the invasive component was challenging. Three lymph node metastases were identified. Oncotype DX was performed but was judged inconclusive due to insufficient tumor tissue.