Minimally Invasive Surgery for Colorectal Cancer During the COVID-19 Pandemic in a Tertiary Medical Facility in Japan.

BACKGROUND/AIM: The coronavirus disease 2019 (COVID-19) pandemic has reduced hospital visits due to concerns regarding infection and also resulted in cancer screening delays. These changes may have had an impact on the progression of colorectal cancer (CRC). Therefore, the present study investigated the effects of the COVID-19 pandemic on minimally invasive surgery (MIS) for CRC using a correlation analysis of clinical outcomes before and during the COVID-19 pandemic. PATIENTS AND METHODS: The present study targeted CRC patients who underwent MIS between January 2018 and December 2019 (pre-COVID-19) and between April 2020 and March 2021 (COVID-19). A comparison analysis of clinical, surgical, and pathological findings between the pre-COVID-19 and COVID-19 groups was performed. RESULTS: Ninety-one patients underwent MIS for CRC pre-COVID-19 and 67 during COVID-19. The number of CRC cases detected by fecal occult blood tests was slightly higher in the pre-COVID-19 group than that in the COVID-19 group. Re-evaluations of laparoscopic videos revealed that the number of cases of surgical T4 CRC resected with the combined resection of the adjacent organs was significantly higher in the COVID-19 group than that in the pre-COVID-19 group (16.4 vs. 4.4%, p=0.010). Furthermore, surgical times were significantly longer in the COVID-19 group than those in the pre-COVID-19 group (p<0.001). Pathological findings showed that the number of pT4 cases was significantly higher in the COVID-19 group than that in the pre-COVID-19 group (p=0.026). CONCLUSION: The number of T4 CRC cases was higher during than before the COVID-19 pandemic, with increases in the surgical difficulty of MIS.

[Endoscopic closure of an esophago-pleural fistula resulting from a perforated esophageal ulcer due to systemic sclerosis:filling and shielding using polyglycolic acid sheets and fibrin glue].

A woman in her 70s with systemic sclerosis experienced dyspnea, and consequently, she was diagnosed with an esophago-pleural fistula, which was caused by a perforated esophageal ulcer. We administered conservative treatments including continuous pleural drainage and total parenteral nutrition. The fistula was closed but recurred, at which point we attempted to close the fistula by filling and shielding using polyglycolic acid (PGA) sheets and fibrin glue (FG). We were able to safely and smoothly fill and shield the fistula using the PGA sheets with a guidewire. We show that endoscopic closure of an esophago-pleural fistula using this technique is an effective, low-invasive treatment for gastrointestinal perforation and refractory fistulas.

[A Case of Curatively Resected Rectosigmoid Colon Cancer That Invaded the Urinary Bladder after Neoadjuvant Chemotherapy].

The patient was a 65-year-old man. His complaints included bloody stools and pain on urination. A detailed examination suggested vesical wall invasion, leading to a diagnosis of rectosigmoid cancer(cT4b, N+, M0). For R0 surgery, total cystectomy was considered necessary. To maintain vesical function, tumor-reducing chemotherapy was selected. After colostomy for the sigmoid colon, 4 courses of mFOLFOX6 plus bevacizumab therapy were administered. There was a marked reduction in the tumor size; therefore, 3 courses of mFOLFOX6 plus panitumumab therapy were administered as preoperative chemotherapy before resection. Partial response(PR)was achieved, and there was no urinary bladder infiltration. Therefore, surgery was performed. There was no tumor invasion to any other organ. High anterior rectal resection was performed. The pathological diagnosis also confirmed the efficacy of chemotherapy. We report about a patient in whom extended surgery could be avoided by administering chemotherapy for advanced rectosigmoid cancer with urinary bladder invasion.

[A Case of Solid Pseudopapillary Neoplasm of the Pancreas in a Male Patient].

The patient was a 50-year-old man. Abdominal ultrasound performed as part of a regular check-up suggested the presence of a tumor in the left kidney, and he was referred to our hospital for further examination. Computed tomography(CT) and magnetic resonance imaging(MRI)revealed the presence of a cystic neoplasm of the pancreas with partial calcification. The tumor had a maximum diameter of approximately 12 cm. Based on these findings, the patient was diagnosed with solid pseudopapillary neoplasm(SPN)and underwent distal pancreatectomy and splenectomy. Pathological findings indicated that a large proportion of the tumor was composed of cells with clear cytoplasm and small, oval nuclei, while some parts of the tumor were composed of atypical cells. Immunohistochemistry further demonstrated that the tumor expressed vimentin, nuclear b-catenin, and CD10. These findings confirmed the diagnosis of SPN. Atypical cells in the tumor were p53-positive, and some were exposed with damaged membranes. The patient has been followed up due to the possibility of tumor recurrence. The tumor has not recurred for approximately 32 months since surgery. Previous studies demonstrated that SPN is more common in women. We report the case of SPN in a male patient and discuss the literature.

Studying anti-oxidative properties of inclusion complexes of α-lipoic acid with γ-cyclodextrin in single living fission yeast by confocal Raman microspectroscopy.

α-lipoic acid (ALA) is an essential cofactor for many enzyme complexes in aerobic metabolism, especially in mitochondria of eukaryotic cells where respiration takes place. It also has excellent anti-oxidative properties. The acid has two stereo-isomers, R- and S- lipoic acid (R-LA and S-LA), but only the R-LA has biological significance and is exclusively produced in our body. A mutant strain of fission yeast, Δdps1, cannot synthesize coenzyme Q10, which is essential during yeast respiration, leading to oxidative stress. Therefore, it shows growth delay in the minimal medium. We studied anti-oxidant properties of ALA in its free form and their inclusion complexes with γ-cyclodextrin using this mutant yeast model. Both free forms R- and S-LA as well as 1:1 inclusion complexes with γ-cyclodextrin recovered growth of Δdps1 depending on the concentration and form. However, it has no effect on the growth of wild type fission yeast strain at all. Raman microspectroscopy was employed to understand the anti-oxidant property at the molecular level. A sensitive Raman band at 1602cm-1 was monitored with and without addition of ALAs. It was found that 0.5mM and 1.0mM concentrations of ALAs had similar effect in both free and inclusion forms. At 2.5mM ALAs, free forms inhibited the growth while inclusion complexes helped in recovered. 5.0mM ALA showed inhibitory effect irrespective of form. Our results suggest that the Raman band at 1602cm-1 is a good measure of oxidative stress in fission yeast.