Single-incision laparoscopic total colectomy using an organ retractor: A case report

Introduction: Single-incision laparoscopic surgery (SILS) has benefits, including less postoperative pain, a shorter incision, and improved cosmesis. However, SILS is technically difficult because of the limited movement. An organ retractor is an instrument that has the potential to overcome these limitations. Presentation of case: An 85-year-old woman with hematochezia was referred to our hospital. Emergency endoscopy showed diverticulosis of the entire colon and active bleeding from the ascending colon. Despite endoscopic clipping, the bleeding continued. SILS total colectomy using an organ retractor was performed due to uncontrollable diverticular bleeding. A 3-cm incision was placed in the umbilicus, and three conventional ports were inserted into the single umbilical incision. An organ retractor was used for hepatocolic ligament transection, transection of the ileocolic vessels, and transection of the mesentery of the sigmoid colon. For each transection, the tension was adjusted to provide a good operative view. The patient\u27s postoperative course was uneventful. Conclusion: An organ retractor was effective for SILS total colectomy to maintain an adequate operative view, which enabled safe dissection

Microsatellite instability status and its clinical significance in patients with colorectal cancer: a multicenter database study

Background: Microsatellite instability (MSI) testing is not only an indicator of immune checkpoint inhibitor (ICI) use but also offers an important test regarding the use of adjuvant chemotherapy. However, the percentage of MSI-high (MSI-H) among colorectal cancer patients is low, so few reports have examined actual treatment strategies and prognosis after detecting MSIH. The purpose of this report is to investigate the background characteristics, clinical significance, and prognosis of patients with MSI-H using a Japanese real-world multicenter database. Case presentation: Seventeen patients diagnosed with MSI-H were examined. Ten patients had metastatic or recurrent colorectal cancer, including 3 had metastatic disease (to the peritoneum, brain, and paraaortic lymph nodes), 7 had recurrent disease after curative resection (4 local recurrences, 2 in lymph nodes, and 1 in the peritoneum). CEA was elevated in 6 patients (60%) and CA19-9 was elevated in 3 patients (30%). Two patients (20%) showed KRAS mutations, and 5 patients (50%) were BRAF-positive. ICIs were administered to 9 patients (90%). Among these, 4 patients (44%) achieved complete response, 3 patients (33%) achieved partial response, and 2 patients (22%) showed stable disease. One patient treated with pembrolizumab developed interstitial pneumonia. All patients who received ICIs achieved progression-free survival. Seven patients were after curative colorectal cancer surgery. MSI was measured in 4 cases to investigate the likely utility of adjuvant therapy and in 3 cases to rule out familial colorectal cancer due to a family history of colorectal cancer. One patient with stage III received AC, but no other stage II patients received AC. All patients remain alive without recurrent disease as of the end of the study period. Conclusion: For patients with metastatic or recurrent colorectal cancer or after curative resection requiring adjuvant chemotherapy, it is important to ensure that MSI status is measured.Acta medica Nagasakiensia, 67(2), pp.75-80; 202

In Vitro Model for Simulating Drug Delivery during Balloon-Occluded Transarterial Chemoembolization

Background: Balloon-occluded transarterial chemoembolization (B-TACE) has emerged as a safe and effective procedure for patients with liver cancer, which is one of the deadliest types of cancer worldwide. B-TACE consist of the transcatheter intraarterial infusion of chemotherapeutic agents, followed by embolizing particles, and it is performed with a microballoon catheter that temporarily occludes a hepatic artery. B-TACE relies on the blood flow redistribution promoted by the balloon-occlusion. However, flow redistribution phenomenon is not yet well understood. Methods: This study aims to present a simple in vitro model (IVM) where B-TACE can be simulated. Results: By visually analyzing the results of various clinically-realistic experiments, the IVM allows for the understanding of balloon-occlusion-related hemodynamic changes and the importance of the occlusion site. Conclusion: The IVM can be used as an educational tool to help clinicians better understand B-TACE treatments. This IVM could also serve as a base for a more sophisticated IVM to be used as a research tool