Surgical Outcomes of Colorectal Cancer Surgery for ≥ 85-year-old Patients in Our Hospital: Retrospective Comparison of Short- and Long-term Outcomes with Younger Patients.

OBJECTIVES: To evaluate future problems in colorectal cancer surgery for elderly patients. METHODS: We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the ≥ 85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis. RESULTS: We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were ≥ 85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively). CONCLUSIONS: Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.

Fusobacterium nucleatum detected simultaneously in a pyogenic liver abscess and advanced sigmoid colon cancer.

Fusobacterium nucleatum is an invasive, adherent, and pro-inflammatory anaerobic bacterium involved in various infections and colorectal cancer. We report a case with pyogenic liver abscess, diagnosed with advanced sigmoid colon cancer, in whom F. nucleatum was simultaneously detected. In this patient, F. nucleatum was systematically analyzed using the molecular biological techniques of metagenome analysis, conventional PCR, and microbial fluorescence in situ hybridization.

Appendiceal Abscesses Reduced in Size by Drainage of Pus from the Appendiceal Orifice during Colonoscopy: A Report of Three Cases.

Interval appendectomy (IA) for appendiceal abscesses is useful for avoiding extended surgery and preventing postoperative complications. However, IA has problems in that it takes time before an abscess is reduced in size in some cases and in that elective surgery may result in a delay in treatment in patients with a malignant tumor of the appendix. In order to rule out malignancy, we performed colonoscopy on three patients with an appendiceal abscess that did not decrease in size 5 or more days after IA. After malignancy had been ruled out by examination of the area of the appendiceal orifice, the appendiceal orifice was compressed with a colonoscope, and a catheter was inserted through the orifice. Then, drainage of pus was observed from the appendiceal orifice into the cecal lumen. Computed tomography performed 3 days after colonoscopy revealed a marked reduction in abscess size in all patients. No endoscopy-related complication was noted. Colonoscopy in patients with an appendiceal abscess may not only differentiate malignant tumors, but also accelerate reduction in abscess size.

Splenomegaly in FOLFOX-naïve stage IV or recurrent colorectal cancer patients due to chemotherapy-associated hepatotoxicity can be predicted by the aspartate aminotransferase to platelet ratio before chemotherapy.

BACKGROUND: Chemotherapy-associated hepatotoxicity is a common cause of postoperative complications after major hepatectomy. Splenomegaly may indicate portal hypertension due to chemotherapy. To identify chemotherapy-naïve patients with liver damage, the splenic volume (SV) and aspartate aminotransferase to platelet ratio (APR) were investigated. METHODS: Seventy-one patients receiving FOLFIRI, FOLFOX, or FOLFOX plus bevacizumab as first-line chemotherapy were included in this study. The SV measurement was performed by helical computed tomography volumetry, and the SV index (SVI) was calculated during 6 cycles of chemotherapy. The APR was used as an indicator of liver injury and the APR index (APRI) was calculated. RESULTS: The SVI and APRI were significantly higher in the FOLFOX group than in the FOLFIRI group. In the FOLFOX group, the maximum APR during FOLFOX administration was significantly higher in the subjects with SVI ≥ +30% than in those with SVI < +30% (p < 0.01). The incidences of grade 3 or 4 adverse events and grade 2 or greater histopathological sinusoidal injury were significantly higher in the SVI ≥ +30% than in the SVI < +30% group. Interestingly, the SVI was significantly higher in the group with APR ≥ 0.17 before FOLFOX than in the subjects with an APR < 0.17 before FOLFOX (p < 0.05). CONCLUSION: Splenomegaly due to FOLFOX-associated hepatotoxicity can be predicted if the APR before FOLFOX is 0.17 or higher.

[A case of unknown primary cancer responding to chemotherapy selected based on the results of an anticancer drug sensitivity test].

CASE: The patient was a 64-year-old man. In 1998, he underwent proximal gastrectomy for gastric cancer. In September 2007, follow-up CT revealed multiple tumors around the hilum of the spleen, and he was referred to our hospital. On the initial consultation, the marked retention of ascites was noted. The levels of tumor markers such as PIVKA-II and a-fetoprotein were markedly increased. Despite various examinations, the primary focus could not be determined. In November 2007, an exploratory laparotomy was performed, but the primary focus was unclear, so one of the nodules of the major omentum was excisionally biopsied. An anticancer drug sensitivity test showed that the specimen was sensitive to 5-FU and CDDP. Therefore, the combined chemotherapy with 5-FU and CDDP was performed. The patient responded to this therapy. Ascites and tumor markers remarkably decreased, and the performance status improved from 3 to 1. CONCLUSION: These results suggest the usefulness of an anticancer drug sensitivity test in the treatment of cancer in which the primary focus is unclear.

[A case report of complete response to RPMI regimen for multiple lymph node metastases following rectal cancer surgery].

A 78-year old man underwent low anterior resection for Stage IIIb rectal cancer(Ra). After surgery, he underwent the Roswell Park Memorial Institute(RPMI)regimen for 6 months followed by oral UFT for 8 months. Since liver metastasis(S6)recurred 2 years and 2 months after surgery, he underwent S6 subsegmentectomy. Four years and 4 months later, he developed multiple lymph node metastases(the Virchow, paraaortic, and intrapelvic lymph nodes), for which FOLFIRI therapy was started, but converted to the RPMI regimen because of strong gastrointestinal side effects. After 3 courses of this regimen, tumor markers returned to normal, and imaging studies showed that the metastases had disappeared. This was interpreted as a complete response(CR). The patient has maintained the complete response for 1 year and 4 months since the start of the RPMI regimen.