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[A Case of Advanced Gastric Cancer with Pancreatic Invasion Completely Resected after Chemotherapy].Gan To Kagaku Ryoho. Cancer &... Jul 2023An 80-year-old man with severe anemia was found to have a circumferential type 3 lesion with obstruction in the gastric pylorus during upper gastrointestinal endoscopy....
An 80-year-old man with severe anemia was found to have a circumferential type 3 lesion with obstruction in the gastric pylorus during upper gastrointestinal endoscopy. A contrast-enhanced CT scan of the abdomen showed severe invasion of the pancreatic head, and the diagnosis was gastric cancer L, Circ, cType 3, tub2, cT4b, N(+), M0, cStage ⅣA. The patient underwent laparoscopic gastrojejunostomy for gastrointestinal transit obstruction followed by 4 courses of SOX therapy as systemic chemotherapy. After chemotherapy, the invasion to the head of the pancreas was obscured, and pyloric gastrectomy and lymph node dissection were performed. The patient was recurrence-free as of 18 months after surgery. In this case, we performed gastric jejunal bypass surgery followed by chemotherapy with oral anticancer agents to achieve the downstaging of unresectable advanced gastric cancer with pancreatic invasion and pyloric stenosis in patients with poor general condition. As a result, the patient was able to undergo distal gastrectomy, which is one of the recommended multidisciplinary treatments.
Topics: Male; Humans; Aged, 80 and over; Stomach Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Pyloric Stenosis; Pancreas; Laparoscopy; Gastrectomy
PubMed: 37496228
DOI: No ID Found -
Clinical Journal of Gastroenterology Oct 2023A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to...
A 71-year-old woman underwent endoscopic submucosal dissection for early duodenal cancer at the second portion of the duodenum and developed acute peritonitis due to delayed duodenal perforation. Emergency laparotomy was performed. A huge perforation formed at the descending duodenum without ampulla involvement. Pancreas-sparing partial duodenectomy (PPD) with gastrojejunostomy was performed (250 min operative time) with 50 mL of intraoperative blood loss. She required intensive care for 3 days and was discharged on postoperative day 21 with no severe complications. Emergency treatment for a major duodenal injury or perforation remains challenging because of high morbidity and mortality. An appropriate treatment should be considered according to the nature of the defect. Although PPD is an acceptable procedure for patients with a duodenal neoplasm, its use in emergency surgery is rarely reported. PPD is more reliable than primary repair or anastomosis using a jejunal wall, and less invasive than pancreaticoduodenectomy, for emergency treatment. We performed PPD in this patient because the duodenal perforation was too large to reconstruct and did not involve the ampulla. PPD can be a safe and feasible alternative surgical procedure to pancreaticoduodenectomy for a major duodenal perforation, especially in patients with a duodenal perforation that does not involve the ampulla.
Topics: Female; Humans; Aged; Pancreaticoduodenectomy; Treatment Outcome; Pancreas; Duodenum; Duodenal Neoplasms; Duodenal Ulcer; Anastomosis, Surgical
PubMed: 37389799
DOI: 10.1007/s12328-023-01823-9 -
BMC Surgery Jun 2023The aim of this study was to evaluate the feasibility and efficacy of simultaneous resection of synchronous advanced esophageal and gastric cancers.
Reconstruction using the colon or jejunum in patients with synchronous advanced esophageal and gastric cancers: a retrospective study from a single institutional database.
PURPOSE
The aim of this study was to evaluate the feasibility and efficacy of simultaneous resection of synchronous advanced esophageal and gastric cancers.
METHODS
We retrospectively analyzed the clinical data of 16 patients who underwent resection of synchronous advanced esophageal squamous cell carcinoma (ESCC) and gastric adenocarcinoma from January 2009 to Dec 2021. Subtotal esophagectomy and total gastrectomy were performed using the Ivor-Lewis or McKeown approach. Reconstruction was performed using a pedicled jejunal graft or colon interposition. Perioperative and postoperative data of all patients were analyzed.
RESULTS
There were no in-hospital mortalities following surgery, but 9 patients (56.3%) suffered major perioperative complications. Comparison of the groups that received reconstruction using the jejunum and the colon indicated similar incidences of perioperative complications, overall survival, and disease-free survival. Cox regression analysis indicated that lymph node metastasis of both cancers was independent risk factor for overall survival.
CONCLUSION
The existence of synchronous tumors of the esophagus and stomach is not unusual, the radical surgical treatment could be carried out whenever possible.
Topics: Humans; Retrospective Studies; Stomach Neoplasms; Esophageal Neoplasms; Esophagectomy; Esophageal Squamous Cell Carcinoma; Jejunum; Colon
PubMed: 37370053
DOI: 10.1186/s12893-023-02072-w -
Surgical Case Reports Jun 2023Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby...
Total pancreatectomy with remnant stomach preservation in a patient with a history of proximal gastrectomy and interposed jejunal reconstruction with right gastroepiploic conduit preservation: a case report.
BACKGROUND
Pancreatic head resection following proximal gastrectomy jeopardizes the blood flow of the remnant stomach owing to right gastroepiploic conduit sacrifice, thereby necessitating total gastrectomy. However, owing to its high invasiveness, concomitant remnant total gastrectomy with pancreatectomy should be avoided as much as possible. Herein, we describe our experience of total pancreatectomy with right gastroepiploic conduit preservation in a patient with a history of proximal gastrectomy and reconstruction by jejunum interposition.
CASE PRESENTATION
A 78-year-old woman with a history of gastric cancer was followed up at our institute for multiple intraductal papillary mucinous neoplasm, and main pancreatic duct stricture in the pancreatic head was newly detected. The cystic lesion was extended to the pancreatic body. Proximal gastrectomy and reconstruction by jejunal interposition were previously performed, and the mesenteric stalk of the interposed jejunum was approached through the retrocolic route. We planned total pancreatectomy with right gastroepiploic conduit preservation. Following adhesiolysis, the interposed jejunum and its mesentery lying in front of the pancreas were isolated. The arterial arcade from the common hepatic artery to the right gastroepiploic artery was detached from the pancreas. Furthermore, the right gastroepiploic vein was isolated from the pancreas. The pancreatic body and tail were pulled up in front of the remnant stomach, and the splenic artery and vein were resected. The pancreatic body and tail were pulled out to the right side, and the pancreatic head was divided from the pancreatic nerve plexus to the portal vein. The jejunal limb for entero-biliary anastomosis was passed through the hole behind the superior mesenteric artery and vein, and gastrointestinal anastomosis using the antecolic route and Braun anastomosis were performed.
CONCLUSIONS
To avoid remnant total gastrectomy, right gastroepiploic conduit preservation is an optional procedure for pancreatic head resection in patients who have undergone proximal gastrectomy with reconstruction by jejunal interposition.
PubMed: 37356046
DOI: 10.1186/s40792-023-01700-0 -
Molecular Imaging and Radionuclide... Jun 2023Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. Most of them are found in the gastrointestinal tract;...
Neuroendocrine tumors are slow-growing tumors originating from neuroendocrine cells and capable of metastasis. Most of them are found in the gastrointestinal tract; however, they can also be rarely seen in other organs. Testicular neuroendocrine tumors account for less than 1% of all testicular neoplasms. They may present as primary testicular or secondary tumors from extratesticular sources. Jejunal neuroendocrine tumor metastasis to the testis is extremely rare. We present the case of a 61-year-old man with a jejunal neuroendocrine tumor and metastases to bilateral testicles revealed on Gallium-68-DOTATATE positron emission tomography/computed tomography.
PubMed: 37337848
DOI: 10.4274/mirt.galenos.2022.06926 -
International Journal of Surgery Case... Jul 2023An inflammatory myofibroblastic tumor (IMT) is an uncommon solid neoplasm of mesenchymal origin. They are usually seen in children and adolescents and commonly affect...
INTRODUCTION AND IMPORTANCE
An inflammatory myofibroblastic tumor (IMT) is an uncommon solid neoplasm of mesenchymal origin. They are usually seen in children and adolescents and commonly affect the lung, but they can nearly arise from every organ. The prevalence of IMT in the small bowel is very rare. The tumors have generally a benign clinical course, with some risk of local recurrence or distant metastasis.
PRESENTATION OF CASE
This is a 55-year-old male patient who presented with intermittent abdominal pain, vomiting of ingested matter and loss of appetite for 2 weeks duration. On physical examination, he had stable vital signs and the abdominal examination was non-revealing. Abdominal CT scan with contrast showed a long segment jejunojejunal intussusception. He underwent en-bloc resection of the mass and end-to-end anastomosis of the jejunum.
CLINICAL DISCUSSION
IMTs have a mesenchymal origin and are grouped into a mixture of fibroinflammatory disorders. They show a variable mix of inflammatory cells with spindle cells. The diagnosis of IMT preoperatively is challenging often mimicking malignant lesions. The diagnosis is often confirmed by histopathology after surgery. Complete excision with a negative margin is the preferred treatment. We report a rare case of jejunal IMT presenting with intussusception.
CONCLUSION
An intestinal IMT is a rare and an underdiagnosed entity, and should be considered in the differential diagnosis of small bowel intussusception. Surgery is still the most favored and effective treatment for intestinal IMT. Complete surgical excision with a negative margin has the least chance of disease recurrence.
PubMed: 37336176
DOI: 10.1016/j.ijscr.2023.108404 -
Immunological Medicine Mar 2024Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains... (Review)
Review
Small bowel adenocarcinoma (SBA) is a rare tumor with an unfavorable prognosis, and due to its rarity, few studies on its treatment are available. Chemotherapy remains the standard of treatment in advanced disease. Recently immunotherapy has demonstrated to be a valid therapeutic option for many solid tumors. We reviewed the data published in literature to understand the impact of immunotherapy in this cancer.
Topics: Humans; Intestine, Small; Jejunal Neoplasms; Ileal Neoplasms; Duodenal Neoplasms; Adenocarcinoma; Immunotherapy
PubMed: 37293784
DOI: 10.1080/25785826.2023.2220938 -
World Journal of Surgical Oncology Jun 2023A 60-year-old man presented with complaints of abdominal pain and melena. Patient had a history of colon cancer 16 years back and had undergone right hemi colectomy for... (Review)
Review
A 60-year-old man presented with complaints of abdominal pain and melena. Patient had a history of colon cancer 16 years back and had undergone right hemi colectomy for microsatellite instability (MSI) negative, mismatch repair (MMR) stable, T2N0 disease with no mutations on next-generation sequencing (NGS). Investigations revealed a second primary in stomach (intestinal type of adenocarcinoma) with no recurrent lesions in colon or distant metastasis. He was started on CapOx with Bevacizumab and developed gastric outlet obstruction. Total gastrectomy with D2 lymphadenectomy and Roux-en-Y oesophageao-jejunal pouch anastomosis was done. The histopathology showed intestinal type of adenocarcinoma with pT3N2 disease. NGS showed 3 novel mutations in KMT2A, LTK, and MST1R gene. The pathway enrichment analysis and Gene Ontology were carried out, followed by the construction of protein-protein interaction network to discover associations among the genes. The results suggested that these mutations have not been reported in gastric cancer earlier and despite not having a direct pathway of carcinogenesis they probably act through modulation of host of miRNA's. Further studies are needed to investigate the role of KMT2A, LTK, and MST1R gene in gastric carcinogenesis.
Topics: Male; Humans; Middle Aged; Stomach Neoplasms; Gastrectomy; Colonic Neoplasms; Anastomosis, Roux-en-Y; Neoplasms, Second Primary; Adenocarcinoma; Carcinogenesis
PubMed: 37287033
DOI: 10.1186/s12957-023-03057-y -
ORL; Journal For Oto-rhino-laryngology... 2023Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However,... (Observational Study)
Observational Study
INTRODUCTION
Free jejunal flap (FJF) reconstruction is a standard procedure for pharyngeal and cervical esophageal defects resulting from head and neck cancer resection. However, improvements in patients' quality of life after surgery require a further statistical approach.
METHODS
An observational, retrospective, multivariate analysis was designed to report the incidence of postoperative complications and their association with clinical factors in 101 patients who underwent total pharyngo-laryngo-esophagectomy and FJF reconstruction for head and neck cancer at a university hospital between January 2007 and December 2020.
RESULTS
Postoperative complications were observed in 69% of patients. In the reconstructive site, anastomotic leak, observed in 8% of patients was associated with vascular anastomosis in the external jugular vein system (age-adjusted odds ratio [OR]: 9.05, p = 0.044) and anastomotic stricture, observed in 11% of patients was associated with postoperative radiotherapy (age-adjusted OR: 12.60, p = 0.02). Cervical skin flap necrosis was the most common complication (34%) and was associated with vascular anastomosis on the right cervical side (age- and sex-adjusted OR: 4.00, p = 0.005).
CONCLUSION
Although FJF reconstruction is a useful procedure, 69% of patients suffer a postoperative complication. We suppose that anastomotic leak is related to the low blood flow resistance of the FJF and inadequate drainage of the external jugular venous system, and anastomotic stricture is related to the vulnerability of the intestinal tissue to radiation. Furthermore, we hypothesized that the location of the vascular anastomosis may affect the mesenteric location of the FJF and the dead space in the neck, leading to the development of cervical skin flap necrosis. These data contribute to increasing our knowledge about postoperative complications related to FJF reconstruction.
Topics: Humans; Esophagectomy; Anastomotic Leak; Retrospective Studies; Constriction, Pathologic; Quality of Life; Head and Neck Neoplasms; Postoperative Complications; Necrosis; Esophageal Neoplasms
PubMed: 37285823
DOI: 10.1159/000530920 -
Journal of Comparative Pathology Jul 2023A 6-year-old male intact pet rabbit was evaluated for chronic weight loss. A large mass was detected by palpation in the mid-abdomen and ultrasound examination suggested...
A 6-year-old male intact pet rabbit was evaluated for chronic weight loss. A large mass was detected by palpation in the mid-abdomen and ultrasound examination suggested a jejunal location. Explorative laparotomy revealed a nodular mass within the jejunal wall. Histological examination of a biopsy revealed mycobacterial granulomatous enteritis with an atypical lymphoblastic proliferation suggestive of lymphoma. Neoplastic lymphocytes were immunopositive for Pax-5 but negative for CD3, which is diagnostic of a B-cell neoplasm. Numerous acid-fast bacteria were seen within histiocytes and identified by polymerase chain reaction as Mycobacterium genavense, which is a non-tuberculous and opportunistic mycobacterium with zoonotic potential. To the best of our knowledge, this is the first documented case of a concurrent B-cell lymphoma and M. genavense infection in a rabbit. Concomitant mycobacteriosis and lymphoma have been rarely described in animals and the coexistence of neoplasia and mycobacterial infection within the jejunum suggests a potential pathogenetic association. Interestingly, the rabbit owner worked in an anti-tuberculosis clinic, and an anthropic origin of the mycobacterial infection could not be excluded.
Topics: Male; Rabbits; Animals; Mycobacterium; Nontuberculous Mycobacteria; Mycobacterium Infections; Lymphoma, B-Cell; Mycobacterium Infections, Nontuberculous
PubMed: 37269779
DOI: 10.1016/j.jcpa.2023.04.007