Esophageal carcinosarcoma is a rare malignant tumor composed of both carcinomatous and sarcomatous elements. We report a case of esophageal carcinosarcoma in a 56-year-old woman with dysphagia. Esophageal ulcerative tumors were detected by endoscopy and resected by thoracoscopic esophagectomy. Carcinosarcoma was confirmed by the presence of both carcinomatous and sarcomatous tumor components. On immunohistochemistry, the sarcomatous area was positive for keratin staining, while the sarcomatous area was positive for vimentin staining. The tumor reportedly had a better prognosis than SCC of the esophagus, especially in terms of survival rate. The patient’s disease was classified as ypT3N0M0, ypStage II. No definitive diagnosis was made preoperatively. We report this case along with a review of the literature.

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Infection of urachal remnant may cause recurrent abscesses. In the current case report, we describe a urachal remnant infection leading to a retroperitoneal abscess, which is an extremely rare condition. In such cases, the recommended treatment is urachal remnant resection.

Cholangiocarcinoma has a very poor prognosis, with no specific tumor markers or clear prognostic factors. The red blood cell distribution width (RDW) was recently suggested as an independent prognostic factor in cancer patients; however, no report has examined the association with distal cholangiocarcinoma. In this retrospective analysis of 38 patients who underwent pancreaticoduodenectomy for distal cholangiocarcinoma at Nagasaki Medical Center in Japan from January 2011 to December 2020, we explored whether or not the preoperative RDW was a prognostic factor in distal cholangiocarcinoma. Patients were divided into two groups (RDW-high: n = 20 vs. RDW-low: n = 18) according to the median preoperative RDW (13.6%). The T-Bil (1.75 vs. 0.9 mg/dl, p = 0.022) and CEA (2.95 vs. 1.95 ng/ml, p = 0.043) values were higher and the ALB (3.35 vs. 3.95 g/dl, p = 0.007) value was lower in the RDW-high group than in the RDW-low group. The RDW-high group had a poorer survival than the RDW-low group. The overall survival for the RDW-high group was 29.1 months, and that for the RDW-low group was 37.9 months (p = 0.042). However, there was no significant difference in the recurrence-free survival between the groups (p = 0.140). In conclusion, the preoperative RDW was suggested to be a possible prognostic factor in distal cholangiocarcinoma. Highlights

692 Background: Patients with ampulla of Vater carcinoma with lymph node metastasis reportedly have a poor prognosis and require postoperative adjuvant therapy. However, due to the small number of published cases, the efficacy of postoperative adjuvant therapy has not yet been established with a high level of evidence. Objective: The aim of this study was to describe the outcome of patients surgically treated for ampulla of Vater carcinoma in our department, evaluate the effectiveness of adjuvant chemotherapy (AC), and clarify which patient groups may benefit from AC. Methods: The study cohort comprised 46 patients who underwent surgery for ampulla of Vater carcinoma in our department from October 2005 to March 2022. We evaluated the clinicopathological background characteristics (tumor size, gross morphology, pancreatic/duodenal invasion, peripancreatic head lymph node metastasis), overall survival (OS), and relapse-free survival (RFS), and compared the OS and RFS in patients with versus without AC. We then analyzed the factors related to the long-term outcome of patients treated for ampulla of Vater carcinoma. Results: During a median observation period of 33.7 months, the 5-year OS and RFS were 63.1% and 61.7%, respectively. Recurrence was observed in 14 patients (30%), with recurrence occurring less than 1 year postoperatively in seven patients (15%). Fifteen patients received AC (chemotherapy regimen: S-1 in 11 patients, GEM in four). The 5-year OS rates with and without AC were 70.3% and 48.2%, respectively (p=0.093). The 5-year RFS rates with and without AC were 72.5% and 42.8%, respectively (p=0.058). Univariate analysis of the total patient cohort showed that the factors related to 5-year RFS were pancreatic invasion (p=0.01), duodenal invasion (p=0.03), and N+ (p=0.004). In multivariate analysis, the only factor related to 5-year RFS was N+ (HR 3.53; 95% CI, 0.99–12.6; p=0.03). The 5-year OS rates in patients with and without N+ were 77.1% and 42.7%, respectively (p=0.04). The 5-year RFS rates in patients with and without N+ were 80.4% and 32.1%, respectively (p=0.004). Conclusions: AC showed a tendency to be effective in preventing postoperative recurrence of ampulla of Vater carcinoma. AC may be particularly beneficial in N+ cases.