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The patient was a 51-year-old woman who presented with nausea, vomiting, and abdominal pain. Detailed examination revealed a carcinoma of the descending colon with simultaneous hepatic metastasis. Because the carcinoma comprised a circumferential stenotic lesion and resection of the hepatic metastasis was feasible, combined left hemicolectomy and hepatectomy were initially performed. During postoperative adjuvant chemotherapy, the hepatic metastasis was observed to increase in size, and therefore, a second hepatectomy was performed approximately 2 years and 6 months after the initial surgery. Adjuvant chemotherapy was subsequently continued for approximately 1 year. A metastatic ovarian tumor was identified on abdominal computed tomography (CT) approximately 1 year after chemotherapy was discontinued. Bilateral salpingo-oophorectomy was performed approximately 3 years and 6 months after the initial surgery. Histopathological examination revealed the lesion to be a colon carcinoma metastasis.

There is no standard approach for second-line chemotherapy after a failure of the first-line regimen, fluorouracil and cisplatin -based chemotherapy in patients with unresectable or recurrent esophageal cancer. We have treated with biweekly nedaplatin (CDGP 40 mg/m²) in combination with docetaxe (l DOC 30 mg/m²) as second-line chemotherapy and investigated its efficacy and safety. Fifteen patients were retrospectively assessed in this study. Response rate (RR) and disease control rate (DCR) were 0 and 6.7%, respectively. Median time to progression( TTP) and median survival time( MST) were 2.1 and 7.0 months. Neutropenia and thrombocytopenia of grade 3 were seen in 4 (26.7%) and 1 (6.7%) patients, but no other serious adverse effects were detected. Based on the results, a biweekly nedaplatin/docetaxel regimen was safely received on an outpatient basis but not enough to provide a significant survival benefit. Quality of life and minimization of adverse effects are key considerations in second-line chemotherapy. Thereby, future trials should assess a quality of life in conjunction with different combination of active drugs and doses.

A 70-year-old man was found to have advanced gastric cancer with a deep ulcer and multiple lymph-node metastases. Although the tumor was resectable, we predicted that the patient would have a poor outcome. We therefore administered neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1 to improve the prognosis before curative resection. On day 15 of chemotherapy, sudden abdominal pain occurred, and we performed an emergency surgery for a diagnosis of panperitonitis due to gastric cancer perforation. The defect in the gastric wall was about 2 cm in diameter and was located in the anterior wall of the antrum, consistent with the center of the tumor. The operative findings suggested that the perforation was caused by chemotherapy-induced necrosis of gastric cancer cells. We saved the patient's life, but intensive care with high-dose catecholamine therapy was needed for several days after the surgery. Gastric cancer perforation induced by neoadjuvant chemotherapy appeared to be more severe than perforation caused by other factors. The adverse effects of chemotherapy apparently increased the severity. Our findings suggest that the risk of gastric cancer perforation should be borne in mind when we administer neoadjuvant chemotherapy to patients who have advanced gastric cancer with a deep ulcer.

Because gastric submucosal tumors can be treated by local resection without lymph-node dissection, laparoscopic local resection is widely used to manage relatively small tumors less than 5 cm in diameter. On the other hand, single-incision laparoscopic surgery (SILS) to perform laparoscopic cholecystectomy was feasible. SILS requires only a single incision in the umbilical region; it has better cosmetic outcomes than conventional laparoscopic surgery. The relative difficulty and ease of local gastric resection depends to a large part on tumor location and morphologic characteristics. Extraluminal submucosal tumor of the stomach can be locally resected by SILS using an automated suturing device regardless of tumor location. Intraluminal tumor located in the greater curvature of the gastric body can be treated by SILS, whereas intraluminal lesions located in the lesser curvature and near the gastric cardia or pylorus are difficult to manage by SILS. Laparoscopic and endoscopic cooperative surgery (LECS) is useful for resecting an appropriate amount of tissue at any site. In patients with lesions located near the gastric cardia or pylorus, closure with an automatic suture device may be difficult. Such patients should be switched to reduced-port surgery with a coaxial port, and hand-sewn closure is useful.