Lymph node metastasis of gastric cancer is more common, metastatic lymph nodes are often around the stomach, and metastasis is carried out in a certain order, but gastric cancer metastasis to axillary lymph nodes is very rare. Due to the small number of patients with this kind of metastasis, its clinical features and treatment are not very clear. We initially thought that the enlarged axillary lymph nodes were inflammatory lesions. Axillary lymph node biopsy was later diagnosed as gastric cancer metastases to axillary lymph nodes. The patient refused further treatment and died 11 months after the second operation because of multiple systemic metastases. We believe that metastasis of gastric cancer to axillary lymph nodes is rare and the prognosis is poor. In clinical work, the possibility of metastatic lymph nodes should be considered in patients with a history of gastric cancer with enlarged axillary lymph nodes.

We describe a case of intrahepatic cholangiocarcinoma with gastric metastasis misdiagnosed as primary gastric cancer. In addition, combined with the literature, we summarized the clinical and imaging features of gastric metastasis of intrahepatic cholangiocarcinoma in order to improve the understanding of the preoperative diagnosis. Positron emission tomography/computed tomography (PET/CT) is accurate in evaluating the primary tumor, lymph node metastasis, and distant metastasis of patients. In addition, immunohistochemical staining can determine the primary site of metastatic adenocarcinoma. For patients who can not determine the location of the primary tumor, the rigorous preoperative examination is necessary, it can improve the accuracy of diagnosis and avoid excessive treatment of patients.

Introduction: At present, there is no convincing evidence-based medical basis for the placement of prophylactic drain after gastrectomy.This meta-analysis aimed to analyze the incidence of complications and the recovery of gastrointestinal function after gastrectomy in the drain group and the no-drain group. Methods: Data were retrieved from electronic databases PubMed, EMBASE, Medline, Cochrane Library, CNKI, Wanfang and VIP databases up to December 2022, including the outcomes of individual treatment after gastrectomy. Complication related index:Incidence of Postoperative Complications, Anastomotic leak，Intra-abdominal bleeding, Wound Infection, Hospital mortality, Pulmonary infection, Intra-abdominal abscess, Abdominal infection, Readmission, Reoperation, Drain related complications etc. Recovery of gastrointestinal function related index: Passage of flatus, Initiation of soft diet, Hospital stay after surgery. The Jadad score and Newcastle-Ottawa scale were used to assess the quality of the included studies. Results: After screening, 20 literatures were finally included, including 4984 patients. Meta-analysis results showed that the passage of flatus（WMD=0.32, 95%CI=0.07~0.58, P=0.01）and initiation of soft diet（WMD=0.45, 95%CI=0.20~0.71, P=0.0005）in the no-drain group were better than those in the drain group. The drain group was not superior to the no-drain group in hospital stay after surgery, postoperative complications, wound infection, pulmonary infection, anastomotic leakage, intra-abdominal abscess, intra-abdominal bleeding, intra-abdominal infection, mortality, reoperation, readmission, and drainage-related complications. Conclusions: Prophylactic placement of the peritoneal drainage tube did not reduce the incidence of early complications but delayed recovery of gastrointestinal function. Abdominal drainage is not required after radical gastrectomy, but is recommended for high-risk patients with anastomotic fistula and intraperitoneal bleeding.

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BackgroundGastric cancer and colon cancer are rarely seen in clinic, but there are still related reports. For gastric cancer and simultaneous colon cancer, surgical resection is the main treatment. Traditional surgery requires an incision from xiphoid process to pubic symphysis. With the progress of minimally invasive technology, laparoscopic surgery is also used in the treatment of gastric cancer, but also in the abdominal incision to remove specimens and in vitro anastomosis of digestive tract. Taking specimens through the natural cavity as a new surgical method can not only reduce the abdominal incision, but also reduce the occurrence of wound-related complications. Here, we report a patient with gastric cancer and colon cancer who was treated in our hospital.Case SummaryWe report a series of patients with gastric cancer and colon cancer. upper abdominal pain was treated in our hospital for 6 months. electronic gastroscopy showed large irregular ulcers on the lesser curvature of the gastric antrum and biopsy showed poorly differentiated adenocarcinoma of the gastric antrum. The enhanced CT of abdomen and pelvis showed irregular thickening of gastric antrum wall, irregular thickening of sigmoid colon wall and no obvious enlarged lymph nodes around. Further electronic enteroscopy showed that the sigmoid colon showed cauliflower protuberance, the intestinal cavity was slightly narrow, the intestinal wall was stiff, and the biopsy pathology showed moderately differentiated adenocarcinoma of the sigmoid colon. No obvious abnormality was found in serological tumor indexes. We diagnosed gastric cancer with sigmoid colon cancer and the patient received Laparoscopic subtotal gastrectomy and sigmoidectomy combined with natural orifice specimen extraction surgery. At present, 12 months after operation, no clear tumor recurrence was found in the metastasis.ConclusionWe should improve the understanding of gastric cancer and sigmoid cancer and combine examination with pathology to avoid misdiagnosis as metastatic cancer. Laparoscopic subtotal gastrectomy should be performed for tumors with no serosa invasion, body mass index <30 and tumor diameter <6.5 cm. Sigmoidectomy combined with natural nostril sampling is feasible.