Male sex and history of ischemic heart disease are major risk factors for anastomotic leakage after laparoscopic anterior resection in patients with rectal cancer.

Background: Anastomotic leakage (AL) is the most serious and common complication of surgery for rectal cancer, and associated risk factors remain unknown despite developments in laparoscopic surgery. The present study aimed to determine risk factors for AL after laparoscopic anterior resection (AR) of rectal cancer.

Methods: This retrospective cohort study extracted information from a prospective database of all consecutive colorectal resections that proceeded at Nippon Medical School Hospital between January 2011 and December 2015 (n = 865).

Combined use of preoperative lymphocyte counts and the post/preoperative lymphocyte count ratio as a prognostic marker of recurrence after curative resection of stage II colon cancer.

Purpose: Diagnostic markers for recurrence of colorectal cancer have not been established. The aim of the present study was to identify new diagnostic markers for recurrence after curative surgery of stage II colon cancer.

Materials And Methods: In this study, the prognostic values of the preoperative lymphocyte count and the post/preoperative lymphocyte count ratio (PPLR) were evaluated in 142 patients with localized colon cancer treated with surgery at a single medical center.

Primary small intestinal volvulus after laparoscopic rectopexy for rectal prolapse.

Primary small intestinal volvulus is defined as torsion in the absence of congenital malrotation, band, or postoperative adhesions. Its occurrence as an early postoperative complication is rare. A 40-year-old woman presented with rectal prolapse, and laparoscopic rectopexy was uneventfully performed.

Modified Marionette Technique for Laparoscopic Colorectal Surgery.

Introduction: Single-port laparoscopic surgery has some technical limitations with respect to control of the forceps inserted through the single-access site, which results in increased internal collisions due to coaxial alignment of the instruments, as well as and decreased range of motion and visualization. To overcome these limitations, we employ a "modified marionette technique" as a way to carry out laparoscopic colorectal surgery. Materials and Surgical Technique: The procedures for the modified marionette technique are performed as follows: An Internal Organ Retractor (IOR)™ and an atraumatic clip designed to firmly grasp tissue, with 1-0 nylon thread, are inserted through a 12-mm trocar and secured in place where adequate visualization and traction for cutting with a radio knife is required.

Efficacy and safety of neoadjuvant chemotherapy with oxaliplatin, 5-fluorouracil, and levofolinate for T3 or T4 stage II/III rectal cancer: the FACT trial.

Purpose: A multicenter phase II clinical study was performed in patients with T3 or T4 stage II/III rectal cancer to evaluate the efficacy and safety of neoadjuvant chemotherapy with 5-fluorouracil, levofolinate, and oxaliplatin (mFOLFOX6).

Methods: Patients received four 2-week cycles of mFOLFOX6 therapy (oxaliplatin at 85 mg/m + leucovorin at 200 mg/m + fluorouracil as a 400 mg/m bolus followed by infusion of 2400 mg/m over 46 h, all on Day 1). They were evaluated by computed tomography after completion of the fourth cycle.

Intestinal hemorrhage caused by Meckel's diverticulum with ectopic gastric mucosa on polypoid lesion: a case report.

Meckel's diverticulum may sometimes present as an intraluminal polypoid mass causing small bowel obstruction; however, gastrointestinal bleeding due to Meckel's diverticulum with a polypoid lesion is rare. A 14-year-old girl presented with tarry stool and syncope in our hospital. Laboratory examination showed iron-deficiency anemia with a low hemoglobin level of 5.

[A case of repeated small bowel perforations in a short period in a patient with cholesterol crystal embolism].

We report a case of jejunal perforation related to cholesterol crystal embolism (CCE) in a woman in her seventies. The jejunum was partially resected;histological examination of the resected tissue revealed that the perforation was caused by CCE. On postoperative day 12, computed tomography (CT) showed free air in the abdomen.

Utility of KRAS mutation detection using circulating cell-free DNA from patients with colorectal cancer.

In this study, we evaluated the clinical utility of detecting KRAS mutations in circulating cell-free (ccf)DNA of metastatic colorectal cancer patients. We prospectively recruited 94 metastatic colorectal cancer patients. Circulating cell-free DNA was extracted from plasma samples and analyzed for the presence of seven KRAS point mutations.

Rechallenge with 5-fluorouracil in a patient who developed encephalopathy caused by 5-fluorouracil for colon cancer.

We report a case involving a patient with colon cancer who underwent 5-fluorouracil (5-FU) rechallenge and maintained an oncological effect for a long period after encephalopathy caused by 5-FU. Our patient was a 61-year-old man who was diagnosed with adenocarcinoma of the ascending colon with direct liver invasion. He underwent right hemicolectomy with partial liver resection followed by adjuvant chemotherapy with modified FOLFOX6 (mFOLFOX6).

Successful Treatment of Necrotizing Fasciitis after Rectal Surgery with the Application of a Negative-pressure Wound Therapy: A Case Study.

Introduction: Necrotizing fasciitis (NF) is an aggressive soft tissue infection that involves the deep fascia and is characterized by the extensive deterioration of the surrounding tissue. Immediate recognition and aggressive treatment, including debridement and systemic antibiotics, are mandatory for the successful management of NF. Following radical debridement, closure of the remaining wound can pose significant reconstructive challenges.

[Skeletal Mass Depletion Is a Negative Prognostic Factor in Gastrointestinal Cancer Patients in the Terminal Stage].

Background: Skeletal mass depletion has been reported to be a prognostic factor for cancer patients. However, special and expensive devices are required to measure skeletal mass, and this is a major reason why skeletal mass is not used extensively for prognostic marker in clinical settings. We developed a new method to measure skeletal mass for use as a prognostic marker using CT images without special and expensive devices.

Surgical Specimens of Colorectal Cancer Fixed with PAXgene Tissue System Preserve High-Quality RNA.

Background: RNA analysis of surgical specimens is one of the most useful methods for exploring biomarkers of advanced cancer. The most readily available source for RNA is formalin-fixed, paraffin-embedded (FFPE) specimens, but RNA isolated from FFPE tissue is of limited use. The PAXgene Tissue (PAX) system is a formalin-free system designed to improve the quality of molecular analysis without diminishing the quality of histopathological analysis.

A Case of Portal Venous Gas after Rectal Surgery without Anastomotic Leakage or Bowel Necrosis.

Portal venous gas has traditionally been considered an indicator of a poor prognosis due to bowel necrosis. Portal venous gas has recently been detected in patients with various clinical conditions, such as Crohn's disease, chemotherapy, and blunt abdominal injury without bowel necrosis. We herein report the first case of a patient with rectal cancer in whom portal venous gas developed after low anterior resection without anastomotic leakage or bowel necrosis.

Superior mesenteric artery syndrome treated with single-incision laparoscopy-assisted duodenojejunostomy.

Superior mesenteric artery (SMA) syndrome is an uncommon disease resulting from compression and partial obstruction of the third portion of the duodenum from the SMA. A 77-year-old man, who did not have a history of surgery, experienced repeated vomiting and developed abdominal distension. Abdominal CT showed a narrowed third portion of the duodenum, with a distended stomach and proximal duodenum.

[A case of multiple primary small intestinal adenocarcinomas].

A 62-year-old woman, with a past history of long-term non-steroidal anti-inflammatory drug use and gastric ulcer, was hospitalized for intestinal obstruction in April 2012. Two stenoses were identified in the ileum in association with small intestinal ulcers, and she underwent partial resection of the small intestine. Histologically, the two lesions were poorly differentiated adenocarcinomas; metastatic small intestinal cancer was suspected, but whole body examination revealed no other lesions.

Dysmotility by mechanical bowel preparation using polyethylene glycol.

Background: The effects of mechanical bowel preparation (MBP) on morbidity (e.g., anastomotic leakage and surgical site infection) have been evaluated.

Gene profiling and bioinformatics analyses reveal time course differential gene expression in surgically resected colorectal tissues.

It has previously been reported that gene profiles in surgically-resected colorectal cancer tissues are altered over time possibly due to the different tissue-acquisition methods and sample extraction timing that were used. However, the changes that occur are still not clearly understood. In the present study, time-dependent changes in gene expression profiling in colorectal surgical specimens were analyzed.

[Reduction in oxaliplatin-related neurotoxicity by the administration of Keishikajutsubuto(TJ-18)and powdered processed aconite root].

Oxaliplatin (L-OHP)is an important chemotherapeutic drug for the treatment of colorectal cancer. Peripheral neuropathy was observed in 90% of patients who received L-OHP.Neuropathy often results in the discontinuation of treatment or a decrease the quality of life(QOL).

Objective assessment of postoperative gastrointestinal motility in elective colonic resection using a radiopaque marker provides an evidence for the abandonment of preoperative mechanical bowel preparation.

Background: It has been suggested that mechanical bowel preparation (MBP) has no benefit in terms of anastomotic healing, infection rate, or improvement in the postoperative course in patients undergoing elective colorectal surgery, and that it should be abandoned. However, the effect of MBP on postoperative gastrointestinal motility has been assessed subjectively. In this randomized trial, we objectively assessed the effect of MBP on postoperative gastrointestinal motility and mobility in elective colonic resection.

Success rate of collagen gel droplet-embedded culture drug sensitivity test in colorectal cancer: are antibiotics a prerequisite for specimen irrigation?

The collagen gel droplet-embedded culture drug sensitivity test (CD-DST) is one of the best chemosensitivity tests owing to its high success rate. However, CD-DST is often a culture method, and contamination is a serious problem, especially in the case of colorectal cancer, which is contaminated by enteric bacteria. It has been reported that the success rate of CD-DST is 64.

A case of an intramesosigmoid hernia.

We report an extremely rare case of an intramesosigmoid hernia with small bowel herniation in a defect on the right (medial) leaf of the mesosigmoid. A 46-year-old man was admitted to the hospital complaining of lower abdominal pain, nausea, and vomiting for 6 days. He had undergone an operation for a right inguinal hernia and an appendectomy during childhood.

Case of an inflammatory fibroid polyp of the cecum.

An inflammatory fibroid polyp (IFP) is a rare benign lesion, originating in the submucosa of the gastrointestinal tract. It is histopathologically characterized by distinctively arranged fibrous connective tissue and blood vessels with inflammatory cell infiltration. It typically arises in the stomach and small intestine but also arises infrequently in the colon.

An improvement in the quality of life after performing endoscopic balloon dilation for postoperative anastomotic stricture of the rectum.

A 55-year-old woman underwent a low anterior resection for rectal cancer 7 years earlier at a different hospital. Thereafter, she often had such symptoms as abdominal pain, frequent bowel movements, and constipation. We considered postoperative bowel adhesion to be the cause of these symptoms, and a laparoscopic adhesiotomy was therefore performed twice.

Does impaired TH1/TH2 balance cause postoperative infectious complications in colorectal cancer surgery?

Background: Recent studies have shown that the Th1/Th2 balance shifts toward Th2 dominance in cancer-bearing state or under surgical stress. This study was designed to investigate whether perioperative impaired Th1/Th2 balance is associated with the occurrence of postoperative infection following colorectal cancer surgery.

Methods: From 53 patients with colorectal cancer, peripheral blood samples were collected, before surgery, and on the 3rd, 7th, and 14th postoperative days.