Tsunehiro Maeda

Management of obstructive colorectal cancer: evaluation of preoperative bowel decompression using ileus tube drainage

PurposeThis study evaluated a better treatment for patients with obstructive colorectal cancer (CRC) that have a poor prognosis.MethodThis study compared the outcomes of 138 patients with obstructive CRC, including 70 primary resections, 50 resections after bowel decompression using an ileus tube, and 18 delayed resections after colostomy.ResultsThe ileus tube and delayed resection groups included more left-sided primary lesions. The physiologic POSSUM, types 3–4, tumor size, CEA, and hospital stay of the delayed resection group were different, in comparison to both the primary resection and ileus tube groups. The histopathological type and depth of invasion of the delayed resection group included less well types and more T4 than those of the ileus tube group. The operative blood loss of the delayed resection group was more than that of the ileus tube group. There were no differences in the overall and disease-free survival among the three groups.ConclusionSeparately analyzing the data of the right-sided cancer group and the left-sided cancer group demonstrated that primary resection might be acceptable for right-sided obstructive CRC and delayed resection might be done for patients with poorer general conditions (high PPS) and poorer oncological prognostic factors such as more type3/type4 cases, a larger tumor size, a less well-differentiated histopathological type, more T4 cases, and a higher CEA level.

Two Case Reports of Resectable Cancer in the Remnant Pancreas after Pancreatectomy for Invasive Ductal Carcinoma of the Pancreas

Introduction: Pancreatic cancer has an extremely poor prognosis. There are several reports on resectable cancer in the remnant pancreas after pancreatectomy; however, few have compared K-ras mutation patterns to clarify recurrent or second primary cancers. Case presentations: Here, we report on two cases of cancer in the remnant pancreas after total pancreatectomy for invasive ductal carcinoma. Case 1: A 56-year-old man underwent pancreaticoduodenectomy for cancer of the pancreatic head. However, serum carbohydrate antigen (CA19-9) was again elevated 23 months later. A tumor in the pancreatic tail was detected on abdominal computed tomography (CT) and total pancreatectomy was performed. Histological examination of the tumors from both operations revealed moderately differentiated adenocarcinoma and the surgical margins of both resected specimens were free of cancerous cells. The K-ras gene mutation was detected at codon 12V of exon 1 in both cancers. Case 2: A 72-year-old woman underwent distal pancreatec...