The patient was a 66-year-old man who underwent resection of malignant melanoma of the nasal cavityattheDepartmentofOtolaryngologyinourhospitalinJune2018.Afterthat,hehadbeenfollowed upbytheDepartmentofOtolaryngologyandHeadandNeckSurgeryintheneighboringuniversityhospital.HehadlocalrecurrenceintheposteriornaresinFebruary2019andunderwentendoscopicsinussurgery.Thenhewastreatedwithimmunotherapy,atotalof18coursesofnivolumabaspostoperativeadjuvantchemotherapy.Again,recurrenceofretropharyngeallymphnodeswasconfirmedinNovember2019 and he was converted to another immunotherapy with pembrolizumab, a total of 2 courses, followed by proton beam therapy.Then, he was referred to the Department of Gastroenterology in our hospital in June2020fortheexaminationofabdominalpainandprogressiveanemiawhichoccurredamonthearlier. Furtherexaminationrevealedanilealtumorabout100cmproximaltotheterminalileum,whichcouldnot bereachedbythepreoperativeendoscope.Hewasdiagnosedpreoperativelyashavingamalignanttumor of the small intestine, and laparoscopic partial ileal resection plus lymph node dissection was per-formedinJuly.Postoperativepathologicaldiagnosiswasmetastaticsmallboweltumorofmalignantmelanoma.Thepostoperativecoursewasuneventful.Immunotherapywithpembrolizumabwasresumedand isstillsustainedinanoutpatientsetting.
Objective: This study aimed to analyze the risk factors for leakage in laparoscopic rectal cancer surgery. Methods: We retrospectively examined 112 patients who underwent anastomosis with the double stapling technique in laparoscopic rectal cancer surgery at our hospital. To identify the risk factors, we analyzed age, sex, body mass index, diabetes, preoperative albumin level, preoperative bowel obstruction, tumor location, invasion depth of tumor, and Prognostic Nutritional Index as the patient factors. As the surgery factors, we analyzed operation time, amount of bleeding, number of firings for rectal transection, reduced port surgery, ligation of the inferior mesenteric artery root, size of the circular stapler, and covering stoma. Results: The median age of the 112 patients was 67 years. Twelve patients had anastomotic leakage. A significant difference was confirmed for circular staple size (31 mm or more) and operation time (400 minutes or longer). Multivariate analysis revealed that a circular staple size of 31 mm or more was an independent risk factor for anastomotic leakage.Conclusion: The findings of this study suggested that circular staple size is a risk factor for anastomotic leakage.
An85-year-oldwomanwasreferredtothedepartmentofplasticsurgeryofourhospitalfordetailed examinationwithacomplaintofanenlargedleftsubmandibularlymphnodeinOctober2019.Pathological diagnosisbyexcisionalbiopsyshowedmalignantlymphoma.Shewasfoundtohaveanemiaatthetimeof hospitalization.Onfurtherexamination,shewassuspectedtohaveconcomitantdescendingcoloncancer. InNovember,laparoscope-assistedlefthemicolectomyandD3lymphnodedissectionwereperformed.On pathologicaldiagnosisoftheresectedspecimen,thelesionsformedacollisiontumorofmoderatelydifferentiated tubular adenocarcinoma (invasion depth T3) and malignant lymphoma at the subserosal layer. Someofthemalignantlymphomaspreadsurroundingtheadenocarcinoma,whichisaveryrarepathological finding. Although metastasis of adenocarcinoma to the dissected regional lymph nodes was not observed, malignant lymphoma cells were detected in those lymph nodes. Postoperatively, chemotherapy formalignantlymphomaresultedincompleteremission.However,ametastaticlesionofthecentralner-voussystemappearedinMay2020.Palliativeradiationtherapywasperformed,andsymptomsattribut-abletothemetastaticlesionatthissitewerestableasofAugust2020.
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