イ ジョウコウ ケッチョウ チョクチョウ ノ 3 チョウフクガン ニ タイシテ イッキテキ ニ フククウキョウカ シュジュツ オ シコウ シタ 1レイ

A ５１-years-old man was admitted with anemia. The upper gastrointestinal endoscopy revealed ０-IIa＋IIc lesion in the middle body of the stomach. The colonoscopy revealed type ３ lesion by Borrmann classification with advanced stenosis. Computed tomography of the abdomen revealed the tumor in the ascending colon. We diagnosed a synchronous gastric, ascending colon, and rectal cancer. After neoadjuvant chemotherapy, we performed the laparoscopic operation for the synchronous cancer. There were no remarkable complications due to the collaboration. Laparoscopic approach for synchronous triple cancer is feasible as safety and minimally invasive surgery

Trastuzumab/Capecitabine/Cisplatin HXP リョウホウ ニヨル 2ジ チリョウ ガ ユウコウ デアッタ シンコウ イガン ノ 1レイ

The case was a ６９-year-old man, and gastric cancer （papillary adenocarcinoma） was diagnosed by a close inspection of the abdominal pain in ２００８, and it was our department introduction. Show the type ０‐IIa＋IIc like advanced lesion of gastric middle body gastrointestinal endoscope, and CT showed no regional lymph node and distant metastases, and we diagnosed it as c-T２ （MP）, N０, M０, stageIB. We performed laparoscopic distal gastrectomy with D２ dissection, and in pathology, acknowledgment of severe lymph node metastases was obtained, and diagnosed it as T３ （SE）, N２, M０, stageIIIB. We gave adjuvant chemotherapy with S-１and Cisplatin for ５ cycles, and maintenance S-１alone up to ２４ months after surgery. There was no recurrence for ３９ months after surgery. But multiple metastases to lung recurrence was acknowledged and we performed S-１/Docetaxel therapy for ６ cycles, which lead to progressive disease. Then we performed Trastuzumab/Capecitabine/Cisplatin chemotherapy （HXP）, the anti-tumor effect was good, and after １４ months later, showed a liver metastasis, but the tolerability was good. Generally, it is said that the chemotherapy is poor at an effect after the second line treatment, but HXP may be useful even in the second line chemotherapy

Mesh-Airtight-Preperitoneum : a simple method for confirming mesh placement in transabdominal preperitoneal repair of inguinal hernia

We devised a method for confirming the position of mesh placed during transabdominal preperitoneal repair (TAPP) of an inguinal hernia. The preperitoneum is sufficiently detached, and the mesh is fixed in place as usual. Before completely closing the peritoneum, pressure is applied from outside the body and inside the abdominal cavity to remove as much air as possible from the detached preperitoneum ; the peritoneum is then sutured using a V-LocTM closure device so that it does not constrict. By releasing the pressure all at once, the airtightness of the preperitoneum is maintained, and the position of the mesh can be observed through the translucent peritoneum. This method, called Mesh-Airtight-Preperitoneum (MAPP), could become widely used as a simple technique for confirming mesh position in TAPP

Short-Term Outcomes of Laparoscopic Distal Gastrectomy for Advanced Gastric Cancer

The purpose of this study was to investigate the oncologic outcomes of laparoscopic distal gastrectomy (LDG) for advanced gastric cancer (AGC). Between April 2003 and March 2014, LDG was performed for 392 patients, 91 patients (23.2%) had histopathologically diagnosed AGC beyond T2 depth. The clinicopathological features, postoperative outcomes, mortality, morbidity, recurrence rate, and survivals of those patients were reviewed. The TNM stages of the tumor were IB in 26 patients (28.5%), IIA in 20 (21.9%), IIB in 18 (19.7%), IIIA in 13 (14.2%), IIIB in 6 (6.5%), IIIC in 6 (6.5%), and IV in 2 (2.1%). Major morbidity occurred in 14 patients (15.3%), with no postoperative mortality. Median follow-up was 24.5 months ; 10 patients developed recurrence during the follow-up period, and 10 patients died, including 6 cancer deaths. The 5-year overall and disease-free survival rates were 76.8% and 72.6%, respectively. By stage, OS/DFS was 92.3%/91.8% in stage IB, 85.4%/85.4% in stage II, and 49.3%/26.9% in stage III. Oncologic outcomes were good in patients with AGC, especially with stage IB-IIB, who underwent LDG. LDG appears to be an effective approach for treating stage IB and II gastric cancer

Endometriosis of the ileum treated by laparoscopic ileocecal resection

A ２９-year-old female was admitted due to abdominal pain. Abdominal computed tomography showed a tumor in terminal ileum and expanded jejunum, and colonoscopy showed a collection of lymph follicles. Biopsy finding showed a lymphoid tissue hyperplasia and no malignant finding. Therefore, we performed a laparoscopic ileocecal resection for diagnosis and treatment. Histopathological findings showed endometrial tissue in the muscular layer, and we diagnosed endometriosis of ileum. We performed a laparoscopic ileocecal resection with lymph node dissection, because the possibility of malignant tumor could not be ruled out. Laparoscopic operation is useful for the diagnosis and treatment of intestinal endometriosis, because it prevents the adhesion and abdominal wall destruction possibly

A autopsy case of biliary fistula to the retroperitoneal space

A seventies age man was admitted complaining of epigastric pain. Computed tomography of the abdomen showed the fluid collection and inflammation in the retroperitoneal space besides pancreas. We suspected acute pancreatitis, and started the treatment by the medications. However, the treatment was not effective. Because we suspected of perforation, we underwent the operation. In the operation, there was a large amount of bile in the retroperitoneal space. We performed intraperitoneal drainage because of uncertain cause. After the operation, he got worse, and died on the ５５th day. The autopsy showed the biliary fistula at right hepatic duct to the retroperitoneal space. The biliary fistula to the retroperitoneal space was very rare case, therefore we must understand the pathological condition due to save the life

ショクドウガン ジュツゴ ソウキ ニ キカン イカンロウ オ ガッペイ シタ 1レイ

The patient was a４５-year-old man. He had suffered from nephrotic syndrome at time of his twenties and had steroid salvage treatment. But he retired the treatment by himself. Esophageal tumor was suspected at the screening, and he was referred to our hospital. Preoperative diagnosis was the adenocarcinoma of the esophagogastric junction（cT２N０M０ stage Ⅱ）． Thoracoscopy assisted subtotal esophagectomy in prone position with D２dissection was performed. Gastric role was prepared in laparoscopic approach, and pulled up to the neck via posterior mediastinal route. Although early postoperative course was uneventful and esophageal fluoroscopy on the７th day showed no leakage, sudden dyspnea appeared on the８th day. CT examination and Bronchoscopy showed tracheoesophageal fistula. Unfortunately, the fistula didn’t get well, and we considered that it was difficult to close the fistula by only conservative treatment. Esophageal covered stent was inserted on the５６th day. After that, he could start ingestion intake and was discharged from hospital on the８５th day. Now, he is being followed up in our hospital