A 69-year-old man with advanced esophageal cancer and 2 early gastric cancers received chemoradiotherapy and was scheduled to undergo subtotal esophagectomy after gastric endoscopic submucosal dissection(ESD). However...A 69-year-old man with advanced esophageal cancer and 2 early gastric cancers received chemoradiotherapy and was scheduled to undergo subtotal esophagectomy after gastric endoscopic submucosal dissection(ESD). However, left lower esophageal perforation induced by vomiting suddenly occurred, and he urgently underwent esophago-proximal gastrectomy and gastrostomy without reconstruction. The resected specimen showed a complete response of pretreatment for the esophageal cancer and radical resection of one gastric cancer. Radical resection of the other gastric lesion was necessary before reconstruction. The fistula of gastrostoma was gradually dilated from 6.7 to 9.3 mm in order to pass the endoscope. At nine months after emergent operation, gastric ESD was performed via only the gastrostoma. A hemoclip with thread was attached to the specimen, and the thread was pulled out of the gastrostoma. The specimen was able to be removed en bloc, resulting in radical resection. Gastric tube reconstruction through the posterior sternal route was performed at six months after the ESD. He has not developed recurrence of the esophageal or gastric cancer in the two years since the emergent operation.展开更多
A 65-year-old man with c T1 b N0M0 stage Ⅰ middle thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route after preoperative carbon-ion radi...A 65-year-old man with c T1 b N0M0 stage Ⅰ middle thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route after preoperative carbon-ion radiotherapy and chemotherapy in a clinical trial. Anastomotic leakage occurred,but it spontaneously improved. At six months after the operation,he was rehospitalized with a cough and dysphagia. An esophago-bronchiole fistula and stenosis of the gastric tube were observed. He first underwent stent placement in the gastric tube. Two weeks later,the syringeal epithelium was burned by argon plasma coagulation after stent removal. Endoscopic occlusion was then performed for the fistula with two guidewire-assisted silicone spigots. Two weeks later,he was discharged on an oral diet,and he has not developed recurrence of the fistula or cancer for three years. This is the first report of endoscopic occlusion with a guidewire-assisted silicone spigot through the esophagus.展开更多
BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rar...BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.展开更多
BACKGROUND The diagnosis of residual tumors using endoscopic ultrasound(EUS)after neoadjuvant therapy for esophageal cancer is considered challenging.However,the reasons for this difficulty are not well understood.AIM...BACKGROUND The diagnosis of residual tumors using endoscopic ultrasound(EUS)after neoadjuvant therapy for esophageal cancer is considered challenging.However,the reasons for this difficulty are not well understood.AIM To investigate the ultrasound imaging features of residual tumors and identify the limitations and potential of EUS.METHODS This exploratory prospective observational study enrolled 23 esophageal squamous cell carcinoma patients receiving esophagectomy after neoadjuvant therapy[15 patients after neoadjuvant chemotherapy(NAC)and 8 patients after chemoradiotherapy(CRT)]at the Department of Surgery,Chiba University Hospital,between May 2020 and October 2021.We diagnosed the T stage for specimens using ultrasound just after surgery and compared ultrasound images with the cut surface of the fixed specimens of the same level of residual tumor.The ratio of esophageal muscle layer defect measured by ultrasound was compared with clinicopathological factors.Furthermore,the rate of reduction for the muscle layer defect was evaluated using EUS images obtained before and after neoadjuvant therapy.RESULTS The accuracy of T stage rate was 61%(n=14/23),which worsened after CRT(38%,n=3/8)than after NAC(73%,n=11/15)because of overstaging.Moreover,pT0 could not be diagnosed in all cases.The detection rate of residual tumor for specimens using ultrasound retrospectively was 75%(n=15/20).There was no correlation between after-NAC(79%,n=11/14)and after-CRT(67%,n=4/6)detection rate.The detection of superficial and submucosal types was poor.The pathologic tumor size and pathological response were correlated.Tumor borders were irregular and echogenicity was mixed type after CRT.There was a correlation between the pT stage(pT0/1 vs pT2/3)and the length of muscle layer circumference(P=0.025),the length of muscle layer defect(P<0.001),and the ratio of muscle layer defect(P<0.001).There was also a correlation between the pT stage and the rate of muscle layer defect reduction measured by EUS(P=0.001).CONCLUSION Compared to pathological images,some tumors are undetectable by ultrasound.Focusing on the esophageal muscle layer might help diagnose the depth of the residual tumor.展开更多
文摘A 69-year-old man with advanced esophageal cancer and 2 early gastric cancers received chemoradiotherapy and was scheduled to undergo subtotal esophagectomy after gastric endoscopic submucosal dissection(ESD). However, left lower esophageal perforation induced by vomiting suddenly occurred, and he urgently underwent esophago-proximal gastrectomy and gastrostomy without reconstruction. The resected specimen showed a complete response of pretreatment for the esophageal cancer and radical resection of one gastric cancer. Radical resection of the other gastric lesion was necessary before reconstruction. The fistula of gastrostoma was gradually dilated from 6.7 to 9.3 mm in order to pass the endoscope. At nine months after emergent operation, gastric ESD was performed via only the gastrostoma. A hemoclip with thread was attached to the specimen, and the thread was pulled out of the gastrostoma. The specimen was able to be removed en bloc, resulting in radical resection. Gastric tube reconstruction through the posterior sternal route was performed at six months after the ESD. He has not developed recurrence of the esophageal or gastric cancer in the two years since the emergent operation.
文摘A 65-year-old man with c T1 b N0M0 stage Ⅰ middle thoracic esophageal cancer underwent subtotal esophagectomy and gastric tube reconstruction through the posterior mediastinal route after preoperative carbon-ion radiotherapy and chemotherapy in a clinical trial. Anastomotic leakage occurred,but it spontaneously improved. At six months after the operation,he was rehospitalized with a cough and dysphagia. An esophago-bronchiole fistula and stenosis of the gastric tube were observed. He first underwent stent placement in the gastric tube. Two weeks later,the syringeal epithelium was burned by argon plasma coagulation after stent removal. Endoscopic occlusion was then performed for the fistula with two guidewire-assisted silicone spigots. Two weeks later,he was discharged on an oral diet,and he has not developed recurrence of the fistula or cancer for three years. This is the first report of endoscopic occlusion with a guidewire-assisted silicone spigot through the esophagus.
文摘BACKGROUND The commonest sites of extrahepatic metastases from hepatocellular carcinoma(HCC)are the lungs,bones,adrenal glands,and regional lymph nodes.Hematogenous metastasis to the gastrointestinal(GI)tract is a rare condition in patients with HCC,and the prognosis is usually poor.We report,herein,an extremely rare case of a patient with intussusception due to hematogenous metastasis of HCC to the ileum and his long-term survival with multidisciplinary therapy.CASE SUMMARY The patient was a 71-year-old man with a history of chronic hepatitis B,who had undergone three surgeries for HCC.He was treated with sorafenib for peritoneal metastases of HCC.He was admitted to our hospital with chief complaints of abdominal pain and vomiting.Abdominal contrast-enhanced computed tomography imaging revealed a small intestinal tumor,presenting with intussusception and small bowel obstruction.Conservative treatment was started,but due to repeated exacerbation of symptoms,surgery was planned on the 28th d of hospitalization.Partial ileal resection without reducing the intussusception and end-to-end anastomosis was performed.On histological examination,tumor cells were not observed on the serosal surface,but intravascular invasion of tumor cells was seen.Immunohistochemistry was positive for immunohistochemical markers,and a diagnosis of hematogenous metastasis of HCC to the ileum was made.He remains alive 82 mo after the first surgery.CONCLUSION Prognosis of HCC patients with GI tract metastasis is usually poor,but in some cases,multidisciplinary therapy may prolong survival.
文摘BACKGROUND The diagnosis of residual tumors using endoscopic ultrasound(EUS)after neoadjuvant therapy for esophageal cancer is considered challenging.However,the reasons for this difficulty are not well understood.AIM To investigate the ultrasound imaging features of residual tumors and identify the limitations and potential of EUS.METHODS This exploratory prospective observational study enrolled 23 esophageal squamous cell carcinoma patients receiving esophagectomy after neoadjuvant therapy[15 patients after neoadjuvant chemotherapy(NAC)and 8 patients after chemoradiotherapy(CRT)]at the Department of Surgery,Chiba University Hospital,between May 2020 and October 2021.We diagnosed the T stage for specimens using ultrasound just after surgery and compared ultrasound images with the cut surface of the fixed specimens of the same level of residual tumor.The ratio of esophageal muscle layer defect measured by ultrasound was compared with clinicopathological factors.Furthermore,the rate of reduction for the muscle layer defect was evaluated using EUS images obtained before and after neoadjuvant therapy.RESULTS The accuracy of T stage rate was 61%(n=14/23),which worsened after CRT(38%,n=3/8)than after NAC(73%,n=11/15)because of overstaging.Moreover,pT0 could not be diagnosed in all cases.The detection rate of residual tumor for specimens using ultrasound retrospectively was 75%(n=15/20).There was no correlation between after-NAC(79%,n=11/14)and after-CRT(67%,n=4/6)detection rate.The detection of superficial and submucosal types was poor.The pathologic tumor size and pathological response were correlated.Tumor borders were irregular and echogenicity was mixed type after CRT.There was a correlation between the pT stage(pT0/1 vs pT2/3)and the length of muscle layer circumference(P=0.025),the length of muscle layer defect(P<0.001),and the ratio of muscle layer defect(P<0.001).There was also a correlation between the pT stage and the rate of muscle layer defect reduction measured by EUS(P=0.001).CONCLUSION Compared to pathological images,some tumors are undetectable by ultrasound.Focusing on the esophageal muscle layer might help diagnose the depth of the residual tumor.
