Higher modified Glasgow Prognostic Score and multiple stapler firings for rectal transection are risk factors for anastomotic leakage after low anterior resection in rectal cancer

Objective: Anastomotic leakage (AL) is one of the most devastating complications of rectal cancer surgery. Not only does AL result in reduced quality of life, extended hospitalization and impaired defecatory function, it also has a high local recurrence rate. In this study, we investigated risk factors for AL as it may help to decrease its occurrence and improve patient outcomes. Methods: This study was a retrospective, single-institution study of rectal cancer patients who underwent elective low anterior resection between April 2002 and February 2018 at Fukushima Medical University Hospital. Patients were divided into two groups according to the presence of AL. Patient-, tumor-, and surgery-related variables were examined using univariate and multivariate analyses. Results: One hundred sixty-one patients, average age 63.5±11.5 years, were enrolled in the study. The overall AL rate was 6.8% (11/161). In the univariate analysis, modified Glasgow Prognostic Score (mGPS)=2 (p=0.003), use of multiple staplers (≥3 firings) for rectal transection (p=0.001) and intraoperative bleeding (≥250 g) were significantly associated with AL incidence. Multivariate analysis identified that mGPS = 2 (odds ratio [OR]: 19.6, 95% confidence interval [CI]: 2.96-125.00, p=0.002) and multiple firings (OR: 18.19, CI: 2.31-111.11, p=0.002) were independent risk factors for AL. Conclusion: Higher mGPS score and multiple firings were independent risk factors for AL

Short-term outcomes of neoadjuvant chemotherapy with capecitabine plus oxaliplatin for patients with locally advanced rectal cancer followed by total or tumor-specific mesorectal excision with or without lateral pelvic lymph node dissection

Background: The standard strategy in Japan for locally advanced rectal cancer is total mesorectal excision plus adjuvant chemotherapy. However, large tumors significantly restrict pelvic manipulation of the distal side of the tumor during surgery;therefore, from an oncological point of view, it is better to shrink the tumor as much as possible preoperatively to optimize the circumferential resection margin. In recent years, advances in systemic chemotherapy have significantly improved the tumor reduction effect, enabling such drug therapy prior to surgery for locally advanced rectal cancer. We herein retrospectively evaluated the clinical, short-term outcomes of patients treated by neoadjuvant chemotherapy (NAC) using capecitabin and oxaliplatin (CAPOX), focusing on overall safety as well as clinical and pathological staging responses to NAC. Methods: We applied the preoperative chemotherapy protocol to T3-4, any N, M0 or M1a (with resectable metastases) (UICC 8th) Ra/Rb rectal cancers. The chemotherapy regimen consisted of four cycles of CAPOX. After NAC, curative intent surgery with total mesorectal excision/tumor-specific mesorectal excision with/without metastasectomy was performed. Adverse effects (AEs) and compliance with NAC, surgical complications, clinical and pathological staging were evaluated. All patients undergoing the protocol between January 2017 and June 2021 at Fukushima Medical University were enrolled. Results: Twenty cases were enrolled. No severe AEs were observed either preoperatively or perioperatively. Preoperative assessment of NAC showed no cases of progressive disease (PD). Radical resection was achieved in all cases. Histological therapeutic grading after NAC revealed one grade 3, four grade 2, three grade 1b, eleven grade 1a and one grade 0 among all cases. Conclusion: This study suggests that NAC for locally advanced rectal cancer is likely to be acceptable because there were no severe AEs pre- or perioperatively, radical resection was achieved in all cases, and there were no cases of PD

A case of annular pancreas in a male adult

Annular pancreas is a rare congenital anomaly, which consists of a ring of pancreatic tissue partially or completely encircling the descending portion of the duodenum. We reported a case of symptomatic annular pancreas in a 40 year old man admitted to our hospital complaining of abdominal pain, nausea and vomiting without body weight loss in January 2000. The patient underwent laparoscopic cholecystectomy for acalculous cholecystitis in September 1996. Initially, he was diagnosed with duodenal stenosis due to a duodenal ulcer scar, but laboratory data showed no abnormalities. His symptoms did not improve with medication or endoscopic balloon dilatation. Duodenograpy revealed a narrow segment with a smooth mucosal surface in the 2nd portion of the duodenal loop in the duodenum, and a computed tomography (CT) scan demonstrated a thickened pancreas head around this narrow segment. We were therefore able to diagnose annular pancreas. A duodeno-duodenostomy was performed in March 2000. The patient's postoperative course was uneventful, and he was discharged from our hospital on the 19th postoperative day. Although define diagnosis of annular pancreas is frequently made at laparotomy, the development of a recurrent imaging modality might assist in the preoperative diagnosis

腸管切除を行わずに救命し得た消化管アミロイドーシスに非閉塞性腸管虚血を併発した1例

本邦では消化管アミロイドーシスと非閉塞性腸管虚血（non-occlusive mesenteric ischemia ;以下，NOMI と略記）の併発例が数例報告されており，消化管へのアミロイド沈着がNOMIの危険因子となる可能性が示唆されている。今回我々は，腸管切除を行わずに救命し得た消化管アミロイドーシスにNOMIを併発した1例を経験したため報告する。症例は81歳の男性で，吐血を主訴に当院に救急搬送された。来院時ショックバイタルを呈しており，腹部CT検査で腸管壁内ガス像，門脈ガス像を認めた。小腸壊死と診断し，緊急開腹手術を施行した。小腸，腸間膜にびまん性，非連続性の発赤を認めたが，全体的な腸管の色調や蠕動は良好であった。NOMIの所見として矛盾しないが不可逆的な腸管壊死には至っていないものと判断し，腸管切除は行わずに試験開腹のみで終了した。術後は体液管理行い，徐々に全身状態は改善を得，術後14日目に軽快退院した。退院後に下痢の訴えがあり，上部消化管内視鏡検査を施行したところ，胃および十二指腸の生検で消化管アミロイドーシスと診断され，NOMIと消化管アミロイドーシスの関連が疑われた。Several cases of gastrointestinal amyloidosis and non-occlusive mesenteric ischemia (NOMI) have been reported in Japan, suggesting that amyloid deposition in the gastrointestinal tract can be a risk factor for the development of NOMI. We herein present a case of NOMI complicated by gastrointestinal amyloidosis which was treated without intestinal resection. The patient was an 81-yearold man who came to our hospital with a complaint of hematemesis. Blood pressure reductions were observed, and an abdominal CT scan showed gas in the intestinal wall and portal vein. A diagnosis of intestinal necrosis was made, and an emergency laparotomy was performed. The intestinal tract and mesentery were reddish, but the overall intestinal color and peristalsis were fine. Despite the diagnosis of NOMI, it was judged that irreversible intestinal necrosis had not yet occurred, and the operation was completed only by exploratory laparotomy without intestinal resection. Post-operatively, the patient was admitted to the ICU for circulatory management. His general condition gradually improved, and he was discharged on post-operative day 14 from the hospital. After discharge from hospital, the patient complained of diarrhea, and an upper gastrointestinal endoscopy was performed. A diagnosis of gastrointestinal amyloidosis was made based on findings from biopsies of the stomach and duodenum and association of NOMI and gastrointestinal amyloidosis was suspected

The expression of FUT8 mRNA in multiple cohorts of colorectal cancer.

<p>(A) FUT8 mRNA expression was significantly upregulated in primary tumors compared to normal colon mucosa. (B) In five independent datasets of colorectal cancer, higher levels of FUT8 mRNA expression were consistently observed in tumors with wild-type p53 than those of mutant p53.</p

Representative images of immunohistochemistry for FUT8 and p53 expression in colorectal cancer.

<p>(A) FUT8 protein expression in colon carcinoma [T] and adjacent colon mucosa [N]. (B) FUT8 was not expressed by non-neoplastic colon mucosal cells. (C) FUT8 staining was typically found in cytoplasm of tumor cells. (D) Occasionally, concomitant cytoplasmic and membranous staining of FUT8 in tumor cells can be found. (E) p53-positive tumor showing strong nuclear staining in cancer cells. (F) p53-negative tumor showing no nuclear staining. Magnification: (A,E,F) x100; (B,C,D) x400.</p

Univariate and multivariate Cox regression analysis for disease-free survival in patients with stage II and III colorectal cancer according to FUT8 expression and the p53 status.

<p>Univariate and multivariate Cox regression analysis for disease-free survival in patients with stage II and III colorectal cancer according to FUT8 expression and the p53 status.</p

Clinicopathological characteristics of colorectal cancer patients according to FUT8 expression.

<p>Clinicopathological characteristics of colorectal cancer patients according to FUT8 expression.</p

Univariate and multivariate Cox regression analysis for disease-free survival in patients with stage II and III colorectal cancer.

<p>Univariate and multivariate Cox regression analysis for disease-free survival in patients with stage II and III colorectal cancer.</p