PET-CT revealed no other areas suspected of recurrence, so remaining adrenalectomy was performed through the retroperitoneal area. Revolutionary resection wasn’t achieved because adhesions and scarring from the past surgery were extreme. Paclitaxel plus Ramucirumab had been started and after 10 courses, the disappearance associated with the cyst shadow was seen on enhanced CT, and PET-CT. 36 months and a couple of months Terephthalic datasheet after the initial surgery and 1 year and 8 months after resection of adrenal metastasis, the individual is alive without recurrence.A 59-year-old woman who has HER2-negative advanced gastric cancer with peritoneal dissemination ended up being addressed with nivolumab plus SOX therapy as primary therapy, and hemorrhagic cystitis occurred in the 28th day after the 6 courses. From the twenty-first day following the 7 courses, right knee arthralgia appeared, as well as on the 26th time, she was accepted into the hospital because of a fever of 39℃ and anorexia. After entry, frequent diarrhoea occurred and brand new apparent symptoms of throat discomfort and left leg arthralgia appeared. Abdominal CT showed increased adipose tissue thickness across the sigmoid colon, and wall surface thickening and contrast enhancement of the mucosal surface of the kidney. Lower gastrointestinal endoscopy disclosed the diffuse redness and erosions in certain areas, and lymphocytic infiltration within the epithelium of the crypts was seen in biopsy through the erosions. The hemorrhagic cystitis ended up being aseptic pyuria. Therefore, we suspected that the series of signs were immune-related bad events(irAE)and began prednisolone 50 mg(1 mg/kg/day), which quickly relieved the diarrhea, cystitis and arthralgia. As a result, the individual was identified as having irAE. We report an incident of advanced gastric disease just who practiced multiple irAE with nivolumab plus SOX therapy, with a few conversation associated with literature.A 77-year-old man provided to our hospital with diarrhoea and weight reduction. Upper gastrointestinal endoscopy revealed advanced Type 3 gastric cancer tumors measuring 40 mm in the lower better curvature associated with stomach. Biopsy from a gastric tumefaction disclosed reasonably differentiated tubular adenocarcinoma overexpressing HER2. Abdominal contrast-enhanced computed tomography(CT)showed multiple liver metastases in S3 and S5. We identified HER2-positive gastric cancer with liver metastasis. Systemic chemotherapy was administrated, with a complete of 13 classes of combination treatment with S-1, oxaliplatin and trastuzumab. After chemotherapy, the main tumor had been considerably decreased and liver metastases were almost invisible. Laparoscopic distal gastrectomy and partial hepatectomy were performed as conversion surgery. The individual had been discharged in the 9th day without any postoperative problems. Postoperative pathological results showed no recurring tumor in a choice of gastric and hepatic specimens, additionally the healing aftereffect of chemotherapy was diagnosed as pathological complete reaction. We report an instance of HER2-positive advanced gastric cancer tumors with several liver metastases that accomplished a pathologically total response to chemotherapy accompanied by transformation surgery. Laparoscopic surgery will be one of a fruitful selection for transformation surgery.Laparoscopic and endoscopic cooperative surgery(LECS)for gastric gastrointestinal stromal tumor(GIST)has become a popular surgery with both curability and practical conservation. In this research, we examined the outcomes of 14 patients who underwent traditional LECS or CLEAN-NET in our medical center. Until March 2022, classical LECS ended up being done in customers with intraluminal growth tumors or tumors close to the gastroesophageal junction. After April 2022, traditional LECS ended up being done in patients with intraluminal development Protein Purification tumors without ulceration, and CLEAN-NET was done Hydrophobic fumed silica in patients with ulceration or intramural development tumors. There have been 10 men and 4 females with a median age 80.5 many years. Intraluminal growth cyst had been 8 patients, close to the gastroesophageal junction tumefaction were 3, and intramural development tumefaction had been 4, correspondingly. Five among these customers had tumors with ulceration. Classical LECS was performed in 10 patients and CLEAN-NET in 4 customers, and the median operative time had been 165.5 mins. All patients underwent R0 resection, and no postoperative complications or recurrences had been observed. LECS was done safely, and it is essential to select the surgical procedure based on the tumefaction website and growth type.We report an instance of regional recurrence of intrahepatic bile duct disease which was successfully treated using chemotherapy and radiation therapy. A guy in the 80s underwent hepatic resection for intrahepatic cholangiocarcinoma, and abdominal CT 11 months after surgery revealed neighborhood recurrence across the dissected area. He had been identified as having an area recurrence of intrahepatic cholangiocarcinoma and began systemic chemotherapy(GEM plus CDDP plus S-1). After 11 courses of chemotherapy, stereotactic body radiation therapy(SBRT)was administered towards the same website at 50 Gy/10 Fr, whilst the regional recurrence location had increased, although no distant metastases had been detected on imaging. The individual was then begun on chemotherapy( GEM plus S-1), but after 2 classes, 8 programs of GEM alone had been administered during the person’s demand. No escalation in cyst markers had been observed, but a rise in the low-absorption area was observed on imaging. Thereafter, the routine was altered to S-1. 3 months later on, exactly the same area ended up being reduced in dimensions and obscured on imaging evaluation.