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The epithelial and mesenchymal features of colorectal adenocarcinoma (CRAC) cell lines were compared in two-dimensional (2D) and three-dimensional (3D) cultures. In 2D cultures, the three CRAC cell lines exhibited epithelial characteristics with high E-cadherin and low vimentin levels, whereas two exhibited mesenchymal traits with opposite expression patterns. In 3D cultures using low-attachment plates, mesenchymal cells from 2D cultures showed reduced vimentin mRNA levels. Morphologically, the five CRAC cell lines appeared similarly shaped in 2D culture but formed different structures in 3D culture. Epithelial DLD-1 and mesenchymal COLO-320 cells produced large granular spheres, whereas epithelial HCT-15 cells formed small solid spheres. Tubular structures were observed in epithelial CACO-2 and mesenchymal SW480 spheres. Desmosome-like structures developed in epithelial CRAC cells, whereas entosis was observed in CACO-2, HCT-15, and SW480 cells. The Ki-67-positive proliferating cell count varied in 2D and 3D cultures of epithelial cells but remained high and unchanged in mesenchymal cells. These findings suggest that while CRAC cells display distinct epithelial and mesenchymal properties in 2D cultures, they form diverse 3D structures, irrespective of these traits. [ABSTRACT FROM AUTHOR]

Aim: To investigate the impact of postoperative infection (PI), surgical site infection, and remote infection (RI), on long‐term outcomes in patients with colorectal cancer (CRC). Methods: The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 1817 curative stage I/II/III CRC patients from April 2013 to March 2015. Patients were divided into the No‐PI group and the PI group. We examined the association between PI and oncological outcomes for cancer‐specific survival (CSS) and overall survival (OS) using Cox proportional hazards models and propensity score matching. Results: Two hundred and ninety‐nine patients (16.5%) had PIs. The 5‐year CSS and OS rates in the No‐PI and PI groups were 92.8% and 87.6%, and 87.4% and 83.8%, respectively. Both the Cox proportional hazards models and propensity score matching demonstrated a significantly worse prognosis in the PI group than that in the No‐PI group for CSS (hazard ratio: 1.60; 95% confidence interval: 1.10‐2.34; P =.015 and P =.031, respectively) but not for OS. RI and the PI severity were not associated with oncological outcomes. The presence of PI abolished the survival benefit of adjuvant chemotherapy. Conclusions: These results suggest that PI after curative CRC surgery is associated with impaired oncological outcomes. This survival disadvantage of PI was primarily derived from surgical site infection, not RI, and PI induced lower efficacy of adjuvant chemotherapy. Strategies to prevent PI and implement appropriate postoperative treatment may improve the quality of care and oncological outcomes in patients undergoing curative CRC surgery. [ABSTRACT FROM AUTHOR]

Background: Appendicitis is classified as either complicated (CA) or uncomplicated (UA). Some authors have shown that the epidemiologic trends of CA and UA may differ. The aim of this study was to clarify differences in backgrounds and surgical outcomes between CA and UA patients. Methods: This study was a cohort study. We extracted case data from the Japanese Diagnosis Procedure Combination (DPC) database from January 2014 to December 2017. Patients were classified into three groups, depending on whether they underwent emergency appendectomy for CA (CA group), emergency appendectomy for UA (UA group), or elective appendectomy (EA group). We evaluated patient characteristics and surgical outcomes for each group. Results: We included 89,355 adult patients in the study, comprising 29,331 CA, 48,691 UA, and 11,333 EA patients. Old age, larger body mass index, smoking, and medication with antidiabetic drugs, oral corticosteroids, oral antiplatelet drugs, and oral anticoagulant drugs were independent risk factors for CA. The percentage of CA increased with age. In‐hospital mortality (0.15%, 0.02%, and 0.00%) and 30‐d mortality (0.09%, 0.01%, and 0.00%), respectively, of CA patients were significantly higher than those of the UA and EA groups. The duration of postoperative antibiotic administration, duration of fasting, and time before removal of a prophylactic drain were significantly longer in the CA group than in the UA and EA groups. Conclusion: Backgrounds and treatment outcomes of CA and UA patients after emergency surgery are entirely different. Thus, the treatment strategy of CA and UA patients should differ accordingly. [ABSTRACT FROM AUTHOR]

Objectives Methods Results Conclusions This systematic review and meta‐analysis aimed to evaluate the diagnostic ability and examine the efficacy of countermeasures to adverse events of mucosal incision‐assisted biopsy (MIAB) for gastric subepithelial tumors (SETs).We performed a literature search and identified 533 relevant articles. Eleven articles, including 339 lesions, were ultimately used in the meta‐analysis. The primary end‐point was the pathological diagnostic rate of MIAB for gastric SETs, and the secondary end‐point was the incidence of adverse events. The efficacy of acid secretion inhibitors in preventing postoperative bleeding and that of local injection before incision to prevent perforation were also examined.Nine studies were conducted in Japan and two in South Korea, of which only two were prospective studies. The pooled pathological diagnostic rate of MIAB for gastric SETs was 87.8% (95% confidence interval [CI] 80.2–94.0; I2 = 68.7%). The adverse event rate of the pooled population was 0.2% (95% CI 0–1.4; I2 = 0%). The acid secretion inhibitors significantly reduced postoperative bleeding (odds ratio 0.06, 95% CI 0.01–0.66, P = 0.02). Perforation occurred in 0% and 2.6% of the local and nonlocal injection cohorts, respectively, and the pathological diagnostic rates were 50% and 66.7%, respectively.MIAB is a reliable technique with a favorable diagnostic rate and few adverse events. Acid secretion inhibitors may effectively prevent postoperative bleeding; however, the efficacy of local injection remains unclear. This technique could be an option for tissue sampling in gastric SETs. [ABSTRACT FROM AUTHOR]

Background: Collaborative surgery by both endoscopists and surgeons is considered effective for providing less invasive local resection of gastrointestinal tumors, to offset the limitations of either pure endoscopic treatments or surgical intervention. The clinical outcomes of collaborative surgery were evaluated to investigate the feasibility and safety of this approach., Methods: In this single-center retrospective observational study, we collected data from consecutive patients who underwent collaborative surgery for lesions located from the laryngopharynx to the anus. The completeness of collaboration, technical success, procedure time, postoperative hospitalization period, and occurrence of adverse events were analyzed., Results: Collaboration surgery was performed for 134 lesions (33 laryngopharyngeal, 2 esophageal, 89 gastric, 8 duodenal and 2 recto-anal) in 131 patients. Collaboration completeness was achieved in 129 lesions (96%). En bloc resection and pathological R0 resection of lesions were achieved in 127 (95%) and 124 (93%) lesions, respectively. The mean procedure time was 188 min. The mean time of discharge was the 11 th postoperative day. Five patients (4%) developed relevant postoperative adverse events., Conclusions: These results indicate that collaborative surgery by endoscopists and surgeons was feasible and safe, and may contribute to providing less invasive treatment than conventional surgery. Collaborative surgery is worth considering as a flexible and reliable surgical option, when cooperation may outperform either treatment alone., Competing Interests: Conflict of Interest: None, (Copyright: © 2024 Hellenic Society of Gastroenterology.)

Objectives: To explore the predictive performance on the need for surgical intervention in patients with adhesive small bowel obstruction (ASBO) using machine-learning (ML) algorithms and investigate the optimal timing for transition to surgery., Methods: One hundred and six patients with ASBO who initially underwent long transnasal intestinal tube (LT) decompression were enrolled in this retrospective study. Traditional logistic regression analysis and ML algorithms were used to evaluate the risk of need for surgical intervention., Results: Non-operative management (NOM) by LT decompression failed in 28 patients (26%). Multivariate logistic regression analysis identified a drainage volume ≥665 ml via LT on day 1, interval between ASBO diagnosis and LT intubation, and small bowel dilatation at 48 h after LT intubation to be independent predictors of transition to surgery (odds ratios 7.10, 1.42, and 19.81, respectively; 95% confidence intervals 1.63-30.94, 1.00-2.02, and 3.04-129.10; P -values 0.009, 0.047, and 0.002). The random forest algorithm showed the best predictive performance of five ML algorithms tested, with an area under the curve of 0.889, accuracy of 0.864, and precision of 0.667 in the test set. 97.4% of patients without transition to surgery (n=78) had passes of first flatus until three days., Conclusions: This is the first study to demonstrate that ML algorithm can predict the need for surgery in patients with ASBO. The guideline recommended period for initial NOM of 72 h seems to be reasonable. These findings can be used to develop a framework for earlier clinical decision-making in these patients., Competing Interests: Conflicts of Interest There are no conflicts of interest., (Copyright © 2024 The Japan Society of Coloproctology.)

Background/aim: To explore the survival benefit of adjuvant chemotherapy for obstructive colorectal cancer (OCRC) managed by self-expandable metallic stent (SEMS) placement as a bridge to surgery (BTS)., Patients and Methods: One hundred twenty-nine patients with pathological stage II/III OCRC who underwent BTS using a SEMS were included in this multicenter retrospective study. Patients were divided into the no-adjuvant chemotherapy group (No-Adj group) (n=52) and adjuvant chemotherapy group (Adj group) (n=77), and relapse-free survival (RFS) was compared., Results: The No-Adj group had more fragile patient background factors, such as higher age, higher American Society of Anesthesiologists score, and lower preoperative albumin compared with the Adj group. The 3-year RFS rates for the overall cohort were significantly different between the No-Adj and Adj groups (56.4% and 78.5%, respectively; p=0.003). Significant RFS benefits of adjuvant chemotherapy were observed in both pathological stage II and III cancer. Characteristics of more advanced cancer, such as high carcinoembryonic antigen (CEA), pathological T4, and lymphovascular invasion, were associated with survival improvement by adjuvant chemotherapy. T4 and adjuvant chemotherapy were significantly associated with RFS in the multivariate Cox proportional analysis., Conclusion: To our knowledge, this is the first study to show a survival benefit of adjuvant chemotherapy in patients with OCRC undergoing BTS using a SEMS. Adjuvant chemotherapy is basically recommended regardless of the cancer stage and is strongly recommended with more advanced characteristics, such as high CEA, T4, and lymphovascular invasion., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

A peritoneal loose body (PLB) is tissue completely separated from other intraperitoneal organs. It is rare and usually found incidentally during laparotomy, examination, or autopsy. PLBs are usually located free in the peritoneal cavity and not in the extraperitoneal space. They are thought to originate when epiploic appendices are released into the abdominal cavity after ischemic necrosis. We report a case of a giant PLB outside the peritoneal cavity, adjacent to the rectovesical excavation, that was identified preoperatively inan asymptomatic 83-year-old man undergoing evaluation for cholecystolithiasis. Computed tomography revealed a mass with well-defined margins in the rectovesical excavation. The mass (diameter, 60 mm) consisted of a calcified core and peripheral soft tissue and did not appear to invade adjacent organs. Although there were no symptoms or tumor growth over time, we scheduled a laparoscopic extraction for definitive diagnosis. On laparoscopic exploration, a white ovoid mass was found in the rectovesical excavation; there was no invasion of adjacent organs. We diagnosed a giant PLB. Postoperative recovery was uneventful. Most PLBs are asymptomatic and do not require surgery, except when symptoms are present, when the PLB is large, or when malignancy is suspected. PLB is rarely extraperitoneal and is usually freely mobile; however, in our patient, it was fixed and outside the abdominal cavity, near the rectovesical fossa. Although it could not be diagnosed preoperatively as being extraperitoneal, imaging findings were typical of PLB; thus, it was possible to remove the mass laparoscopically without bowel resection.

Surgical site infections (SSIs) remain one of the most common serious surgical complications and are the second most frequent healthcare-associated infection. Patients with SSIs have a significantly increased postoperative length of hospital stay, hospital expenses, and mortality risk compared with patients without SSIs. The prevention of SSI requires the integration of a range of perioperative measures, and approximately 50% of SSIs are preventable through the implementation of evidence-based preventative strategies. Several international guidelines for SSI prevention are currently available worldwide. However, there is an urgent need for SSI prevention guidelines specific to Japan because of the differences in the healthcare systems of Japan versus western countries. In 2018, the Japan Society for Surgical Infection published SSI prevention guidelines for gastroenterological surgery. Although evidence-based SSI prevention guidelines are now available, it is important to consider the appropriateness of these guidelines depending on the actual conditions in each facility. A systemic inflammatory host response is a hallmark of bacterial infection, including SSI. Therefore, blood inflammatory markers are potentially useful in SSI diagnosis, outcome prediction, and termination of therapeutic intervention. In this review, we describe the current guideline-based perioperative management strategies for SSI prevention, focusing on gastroenterological surgery and the supplemental utility of blood inflammatory markers.

Kyphosis complicates abdominal surgery. Here, we report a case of rectal cancer in a patient with kyphosis who underwent successful laparoscopic surgery after a preoperative simulation. An 81-year-old woman with rectal cancer was admitted to our department, and laparoscopic surgery was planned. Physical examination revealed severe kyphosis. To ensure successful laparoscopic surgery, we conducted a detailed preoperative simulation, including three-dimensional CT simulations of port arrangement and anatomy, simulation of body position, selection of surgical instruments, and preoperative discussion with the anesthesiologist. We planned to insert the first port in the umbilical region for pneumoperitoneum and the camera port in the ventral region under pneumoperitoneum. We planned to insert the ports on the right side of the patient's body from the caudal regions, after considering the location of the inferior mesenteric artery and the limitations in degrees and space attributable to the costal arch and promontorium. Beach chair position was planned. We used a fan-shaped retractor and sponge retractor to remove the small intestine from the surgical view. In preoperative discussions with the anesthesiologist, we decided to maintain pneumoperitoneum pressure at less than 8 mm Hg during the operation, to safeguard respiratory function. Lower anterior resection with D2 lymph node dissection was performed, without intraoperative complications. At 2 years postoperatively, the patient was healthy with no signs of recurrence. Laparoscopic surgery appears to be a suitable choice for patients with kyphosis. We believe that preoperative simulation will result in successful outcomes.

Objective: To examine the potential of peripheral circulating cell-free DNA(cfDNA)as a predictor of response in patients undergoing neoadjuvant chemotherapy(NAC)for advanced colon cancer., Methods: We compared histological response, background factors, and cfDNA molecular volume changes in cT4 and cT3N+ colon cancer patients., Results: Six of 11 patients responded. The patients with muc and pap histology were non-responders. There was no relationship between CEA or cfDNA levels and response. Responders showed >50% change in DNA integrity index(=cfDNA long fragment/ short fragment ratio), while non-responders showed <50% change(p=0.015)., Conclusion: Our results suggest that the variability rate in DNA integrity index of peripheral blood cfDNA may be useful in predicting the therapeutic efficacy of colon NAC.

Late-stage elderly patients have low tolerance to chemotherapy, and they have difficulties when they are treated with standard chemotherapy. We report a case of a late-stage elderly patient who had a long-term response to UFT/UZEL/bevacizumab( Bev)therapy for lung metastasis after surgery for early-stage colon cancer. He was 82-years-old and underwent laparoscopy-assisted sigmoid colectomy for sigmoid colon cancer at another hospital. The pathological diagnosis was pT1b, ly1, v0, N0, M0, pStage Ⅰ. Six months after the surgery, a small nodule was noted in the middle lobe of the right lung. It grew five months later and was definitely diagnosed as lung metastasis. Considering his physical condition and tumor size, we opted to introduce less invasive chemotherapy instead of standard chemotherapy. UFT/UZEL/Bev was started 14 months after surgery. Although he required dose reduction due to anorexia, he safely continued the treatment with partial response (PR), which was maintained for 2 years and 6 months. While UFT/UZEL/Bev has no convincing evidence, it may be an option for vulnerable patients, especially those with non-life-threatening disease.