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The study aimed to evaluate the impact of sarcopenia on short- and long-term outcomes for laparoscopic colorectal cancer surgery.Study participants were 209 patients who underwent laparoscopic surgery for any stage of colorectal cancer between 2016 and 2017. Skeletal muscle indices were calculated with preoperative computed tomography. Patients were divided into sarcopenic and non-sarcopenic groups based on index cut-off values and variables were compared.The prevalence of sarcopenia was 41.1%. Sarcopenic patients experienced shorter operative times and a lower incidence of surgical site infections; however, the incidence of severe postoperative complications and readmission were increased for this group. Although the 3-year disease-free survival rate was not statistically different between groups, sarcopenic patients had a significantly worse 3-year overall survival rate compared with than the non-sarcopenic group.Sarcopenia has both favorable and unfavorable effects on patients who underwent laparoscopic colorectal cancer surgery.

Background: Stoma-related obstruction (SRO) is defined as small bowel obstruction occurring around the limbs of diverting ileostomy (DI). This study was aimed to investigate the incidence, risk factors, and management of SRO after laparoscopic colorectal surgery with DI creation. Methods: This study included 155 patients who underwent laparoscopic colorectal surgery with DI creation for rectal cancer (n = 138), ulcerative colitis (UC) (n = 14), and familial adenomatous polyposis (FAP) (n = 3) between 2011 and 2019. Univariate and multivariate analyses were performed to identify the risk factors of SRO. Results: The incidence of SRO was 7.7% (n = 12), and it was significantly lower (P

Highlights • The patient with Parkinson’s disease had stoma prolapse after Hartmann’s procedure. • Local procedure had failed, and stoma reversal was considered to be favorable. • We assumed that stoma reversal alone led to worsening of concomitant constipation. • We performed resection of the remnant colon with ileorectal anastomosis. • It may be an optimal treatment for patients with concomitant colonic motility disorder., Introduction Treatment strategy for recurrent stoma prolapse has not been well-established because of the rarity and complexity of the condition. We report a case of recurrent stoma prolapse that was successfully managed using unique surgical treatments. Presentation of case A 72-year-old man with a history of Parkinson's disease presented with transverse (T3N0M0) and sigmoid (T3N0M0) colon cancer. Considering the status of large bowel obstruction, Hartmann's procedure was indicated. Four months after surgery, stoma prolapse occurred, which became irreducible. Six months after surgery, local resection of the prolapsed bowel was performed. The patient continued to receive laxatives for bowel movement control and his abdomen remained distended. Ten months later, stoma prolapse recurred with evident bowel dilatation. Initially, we planned Hartmann’s reversal. However, as the patient had intractable constipation secondary to Parkinson’s disease, resection of the proximal colon and ileorectal anastomosis were considered as the treatment choices. Therefore, we performed right colectomy with ileorectal anastomosis. At 1.5 years after the last surgery, complications such as small bowel obstruction, difficulty in defecation, or fecal incontinence were not detected. Discussion The cause of stoma prolapse is generally ascribed to various anatomical factors such as redundant intestine, high intra-abdominal pressure, and intraperitoneal route. Stoma prolapse is also influenced by other factors, including old age, obesity, and the severity of illness that necessitated stoma creation. In this case, the decision regarding surgical management was complicated by colonic motility disorder with concomitant Parkinson’s disease. Conclusion We suggest that ileorectal anastomosis may be an optimal surgical treatment for patients with recurrent stoma prolapse and concomitant colonic motility disorder who have undergone Hartmann’s procedure.

Background and aim: Patients with stage T3 or T4 rectal cancer are candidates for neoadjuvant chemoradiation therapy. The aim of this study is to clarify the usefulness of circumferential tumor extent determined by computed tomography (CT) colonography in differentiating T3 or T4 from T1 or T2 rectal cancer. Methods: Seventy consecutive rectal cancer patients who underwent curative-intent surgery were enrolled in this study. All patients underwent colonoscopy and CT colonography on the same day. The circumferential tumor extent was estimated in 10% increments. The pathological T stage was used as the reference. Results: The median circumferential tumor extent evaluated by colonoscopy for T1 (n = 6), T2 (n = 21), and T3/T4 (n = 43) were 10%, 30%, and 80%, respectively (T1/T2 vs. T3/T4, p

Background Guidelines for rectal cancer treatment differ in Japan, Europe, and the United States. Neoadjuvant chemoradiotherapy (CRT) has been used to control lateral lymph nodes (LLNs) in the West. The usefulness of LLN dissection (LLND) has been discussed in Japan, and a randomized study stated the possible advantage of local control. However, it is still unclear whether adding LLND to CRT is beneficial. Methods To investigate the effectiveness of LLND on rectal cancer patients who underwent neoadjuvant CRT, we retrospectively collected magnetic resonance images (MRIs) in a cohort of 1500 patients with cStage II/III lower rectal cancer below the peritoneal reflection and centrally reviewed MRIs. We measured short-axis LLN sizes on pre- and post-CRT images and evaluated patients’ prognosis according to LLN size and whether LLND was performed. Results MRIs were collected from 752 patients, of whom 189 underwent neoadjuvant CRT. Both pre- and post-CRT MRIs were available in 155 patients, of whom 66 underwent LLND (LLND group) and 89 did not (non-LLND group). The LLND and non-LLND group showed the following differences: positive circumferential resection margin by MRI after CRT: 53.0% vs. 32.6%; positive extramural venous invasion: 36.4% vs. 24.7%; laparoscopic surgery: 39.4% vs. 88.8%; and mean pre-CRT LLN size: 5.2 mm vs. 3.6 mm. Five-year relapse-free survival (5y-RFS) was 73.8% and 66.1% in the LLND and non-LLND groups, respectively (p = 0.38). Two local recurrences occurred in the LLND group. In stratified analysis, 5y-RFS of 40 patients whose LLN size was ≥5 mm in pre-CRT images was 77.8% in the LLND group and 46.2% in the non-LLND group (p = 0.06). On the other hand, 115 patients whose LLN size was Conclusions Our data indicated that adding LLND to CRT may have survival benefits on those who had LLN size of ≥ 5 mm before CRT. Stratification by short-axis LLN size using pre-CRT MRIs may facilitate optimal multidisciplinary treatment strategies for low rectal cancer. Legal entity responsible for the study Department of Surgery, Kyoto University Graduate School of Medicine. Funding The Japanese Foundation for Research and Promotion of Endoscopy, The Japan Society of Clinical Oncology, and Kondou Kinen Medical Foundation. Disclosure All authors have declared no conflicts of interest.

In vitro assessment of chemosensitivity are important for experiments evaluating cancer therapies. The Scepter 2.0 cell counter, an automated handheld device based on the Coulter principle of impedance-based particle detection, enables the accurate discrimination of cell populations according to cell size and volume. In this study, the effects of SN-38, the active metabolite of irinotecan, on the colon cancer cell lines HCT116 and HT29 were evaluated using this device. The cell count data obtained with the Scepter counter were compared with those obtained with the (3)H-thymidine uptake assay, which has been used to measure cell proliferation in many previous studies. In addition, we examined whether the changes in the size distributions of these cells reflected alterations in the frequency of cell cycle arrest and/or apoptosis induced by SN-38 treatment. In our experiments using the Scepter 2.0 cell counter, the cell counts were demonstrated to be accurate and reproducible measure and alterations of cell diameter reflected G2/M cell cycle arrest and apoptosis. Our data show that easy-to-use cell counting tools can be utilized to evaluate the cell-killing effects of novel treatments on cancer cells in vitro.

Background & Aims: Methylation of the h MLH 1 promoter region is frequently observed in microsatellite instability (MSI)-positive sporadic colorectal carcinomas. We studied h MLH 1 promoter methylation in peripheral blood lymphocytes of 87 index patients representing 29 cases of hereditary nonpolyposis colorectal cancers (HNPCCs), 28 cases of atypical HNPCCs, and 30 sporadic cases of the development of early-onset colorectal carcinomas or multiple primary cancers. Methods Methylation of the h MLH 1 promoter region was analyzed by Na-bisulfite polymerase chain reaction/single-strand conformation polymorphism analysis or methylation-specific polymerase chain reaction. MSI, allelic status of the h MLH 1 locus, and loss of hMLH1 protein expression were examined in cases for which tumor tissues were available. Results Extensive methylation of the h MLH 1 promoter was detected in peripheral blood lymphocytes of 4 of 30 patients with sporadic early-onset colon cancer, among whom multiple primary cancers (1 colon and 1 endometrial cancer) developed in 2 cases. This methylation was not detected in analyses of HNPCC or atypical HNPCC groups or healthy control subjects. MSI was positive, and extensive methylation was detected in both cancers (colon and endometrial cancer) and normal tissues (colon, gastric mucosa, endometrium, and bone marrow) in all of the examined cases (3 of 3). Analysis of a polymorphic site in the h MLH 1 promoter in 2 informative cases showed that methylation was hemiallelic. In 1 case, the unmethylated allele was lost in the colon cancer but not in the metachronous endometrial cancer. Conclusions Constitutive, hemiallelic methylation of the h MLH 1 promoter region was shown to be associated with carcinogenesis in sporadic, early-onset MSI-positive colon cancers.

Ten to 20 percent of patients with colorectal cancer with unresectable liver metastases meet the criteria for resection after chemotherapy, leading to improved prognosis. In this “Conversion therapy”, however, it remains unclear which patients will have long-term survival. Therefore, we examined the outcomes of such patients to identify characteristics of long-term survivors after “Conversion therapy”. Methods: Multidisciplinary treatment conferences conducted by radiology, digestive surgery and clinical oncology have evaluated patients for possible conversion therapy since 2006. Preoperative chemotherapy included: mFOLFOX6, FOLFIRI or Xelox (+Bevacizumab). Patients were evaluated for resectability every twomonths. Adjuvant chemotherapy with six months ofmFOLFOX6was administered. Results: Thirty-three patients were enrolled in this study, including 4 patients with a complete remission (CR) (12%) and 17 with a partial response (PR) (52%). Eleven patients underwent hepatic resection (33%; 11/33), including 1 with relapse after CR. Of these 11 patients (7 male, 4 female), age 48-74 years (median 57), 8 had simultaneous lesions, and 3 had metachronous lesions, 4-13 courses of chemotherapy were given before surgery (7). Ten patients underwent an R0 operation. In one patient, tumor nodules were not identified by intra-operative ultrasound, followed by hepatic re-resection after several months. Four of 11 patients are alive without recurrence. Overall survival is 18-55 months (42.5), with 13-40 months after hepatectomy (36), and re-hepatectomy in one case. Lesions disappeared on imaging after chemotherapy in all 4 cases. Pathological CR lesions in the resected specimens were present in 3 cases. Four patients are alive with recurrence. Survival is 4357 months (45.5), along with 6-27 months after relapse (16). Relapse-free survival was more than 12 months after hepatectomy in all 4 cases. Three patients died, with survival of 15-24 months (23), along with 3-8 months after relapse (6). In total, 7 of 11 patients (64%) survivedmore than 40months. All the patients originally had tubular adenocarcinoma. Conclusions: Hepatic lesions with a CR (clinically or pathologically) after chemotherapy, along with the pathology of well to moderately differentiated adenocarcinoma, may be favorable factors to predict long-term survival. Long-term relapse-free patients after first hepatectomy (> 12 months) showed long-term survival (> 40 months) even with recurrent cancer. Early recurrence after hepatic resection was associated with a poor prognosis, similar to patients receiving chemotherapy alone.

Peccent MSI status Location LN metastasis MSI status vadance H (12) vs. L(19) vs. R + ('12) vs. -(22); L (14) vs, Category L+S (29) (21); NA (1) NA (7) H+8 (27) % Component 3 0.0005 7.04 Component 5 0.0178 4.53 Component 6 0.0012 3,87 Component 10 0.0039 2.49 Table. The projections of the tumors on the principat components were identified, and correlations between groups of tumors and clinco-molecular features were per~rmed. Component 3 strongly correlated with MSI-H status, and component 10 correlated with MSI-L status. Anatomical location (fight vs. left colon) was associated with component 5 and lymph node metastasis was associated with component 6. Abbreviations: H MSI-H, L MSI-L, Snon-MSI, L left, Rright, + positive, negative, LN lymph node.