再発大腸癌の治療の中で，長期生存がもっとも期待できるのは転移巣の完全切除であり，近年は腹腔内再発病変に対するre-do 手術も腹腔鏡手術で行われるようになってきた．しかし，再発病変のre-do 手術は，初回手術による剝離層の消失や高度の癒着のため手術難易度が格段に高くなる．特に直腸癌局所再発の手術では切除マージンを得るために拡大手術となり，術後合併症も多くなるため慎重なマネジメントが必要となる．当院におけるre-do 手術の工夫・治療成績を示す．

Our treatment strategy for acute type B aortic dissection （ABAD） included complicated type is as follows. Indications of thoracic endovascular aortic repair （TEVAR） for ABAD are rupture and organ ischemia, and TEVAR has been the 1st line central repair therapy since January 2009 in our institution. At the time of TEVAR for ruptured communicating type ABAD, we usually seal the proximal entry tear and cover the existing range of hematoma at descending aorta. Procedures for ABAD with malperfusion should be changed according to the patient’s condition such as branch vessel obstructions either dynamic type or static type. We select TEVAR for ABAD with malperfusion in order to prevent late aortic events as well as treat the dynamic malperfusion. For complicated ABAD patients with poor condition and hemodynamic instability, TEVAR achieving central repair rapidly and less-invasively is considered an advantageous procedure. We usually pay attention how to use TEVAR and how to combine with other therapies for complicated ABAD treatment.