Esophageal squamous cell carcinoma is the sixth most common cause of cancer death in Japan. Surgery was previously the mainstay of treatment, but because of high rates of local and systemic recurrence, multidisciplinary management is being evaluated. In this article, we introduce the recent addition of neoadjuvant chemotherapy to the surgical management of resectable esophageal squamous cell carcinoma, clinical stage II and III, following the randomized control trial JCOG 9907. Neoadjuvant chemoradiotherapy has recently been approved for esophageal squamous cell carcinoma because it offers an opportunity for marginnegative resection, improved locoregional control, and increased survival rate. Less-invasive endoscopic procedures, such as thoracoscopic esophagectomy and laparoscopy-assisted gastric tube reconstruction, are options for the resection of noninvasive esophageal cancer. We performed thoracoscopic esophageal mobilization with the patient in the prone position. Compared with esophagectomy with right trans-thoracotomy, thoracoscopic esophagectomy has the advantage of a lower incidence of respiratory complications, which are a significant predictor of postoperative mortality. Additionally, other recent surgical treatments are described.

View full abstract

We report here a very rare case of six synchronous primary colorectal cancers. A 78-year-old male was admitted to our department for further examinations and treatment of rectal bleeding, anemia and general fatigue. Colonoscopy revealed an ulcerative and localized type tumor in the rectosigmoid. The tumor obstructed the lumen, and further observation of the oral side was not possible. The patient was preoperatively diagnosed as rectosigmoid cancer, and was operated. Besides the preoperatively diagnosed cancer, three tumors were detected in the sigmoid, descending and transverse colons, respectively. Subtotal colectomy was performed. Pathological examination revealed a total of six cancers. Such as in this case, advanced cancer of the distal colon sometimes prevents accurate diagnosis of the coexisting tumor in the proximal portion. Therefore, in this condition, we believe that careful palpation during the operation and intraoperative colonoscopy will contribute to accurate diagnosis and improving the prognosis of patients with synchronous multiple primary colorectal cancers.

View full abstract

View full abstract