Predictors of emergency abdominal surgery for patients aged 90 years or older: A retrospective study.

Background: With the aging of the population, more and more patients ≥90 years old are undergoing surgery. We retrospectively examined factors affecting morbidity and in-hospital mortality among patients ≥90 years old who underwent emergency abdominal operations. Materials and methods: Forty-six cases of emergency abdominal surgery for patients ≥90 years old who underwent surgery at our hospital between 2011 and 2022 were included in this study. Factors affecting morbidity and in-hospital mortality were analyzed statistically. Physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM)-predicted morbidity and Portsmouth-POSSUM (P-POSSUM)-predicted mortality were calculated. Results: Postoperative complications occurred in 30 patients (65.2 %) and 5 patients (10.8 %) died in the hospital. Factors affecting morbidity included American Society of Anesthesiologists physical status score, operative time and blood loss, and operative severity score. Multivariate analysis identified male sex, operative severity score, and length of hospital stay as factors affecting morbidity. Eastern Cooperative Oncology Group performance status and physiological score were identified as factors influencing mortality in hospital, and only physiological score was identified in the multivariate analysis. Area under the receiver operating characteristic (ROC) curve for POSSUM-predicted morbidity was 0.796 and area under the ROC curve for P-POSSUM-predicted mortality was 0.805, both of which were moderately accurate. Conclusion: Risk of emergency abdominal surgery in patients ≥90 years old may be predictable to some extent, and we are able to provide convincing explanations to patients and families based on these data.

A Case of Long-Term Survival with Recurrent Liver Metastases from Gastric Cancer Treated with Nivolumab.

Introduction: Improvements in overall survival from advanced gastric cancer have recently been reported with nivolumab. However, few reports have described long-term survival after discontinuing treatment. Case Presentation: A 67-year-old man diagnosed with advanced gastric cancer and abdominal aortic aneurysm initially underwent distal gastrectomy with D2 dissection. Histological examination revealed tub2 and T2N1M0 stage IIA. One month later, endovascular aneurysm repair was performed. Six weeks after gastrectomy, adjuvant chemotherapy with S-1 was started. Six months later, liver metastases were identified and liver segments S1 and S7 were resected. S-1 and oxaliplatin were added postoperatively, but multiple liver metastases recurred. Paclitaxel and ramucirumab, irinotecan, and docetaxel were administered. Liver metastases showed a temporary reduction in size, then enlarged again. Nivolumab was therefore administered and the liver metastases showed a significant reduction in size. The interval between doses gradually increased due to persistent general fatigue. At 28 months after starting nivolumab therapy, bronchitis and adrenal insufficiency appeared, so treatment was discontinued. As of 3.5 years after cessation of nivolumab immunotherapy, tumor regression continued to be maintained. The patient remains alive as of 8 years after recurrence of liver metastases. Conclusion: We encountered a case in which the patient received nivolumab therapy for recurrent liver metastases from gastric cancer and survived long term after discontinuing treatment.

Mucinous cystadenoma of the pancreas associated with pancreatic pseudocyst.

Mucinous cystadenoma of the pancreas is considered as a premalignant lesion, and resection is recommended. The majority of pancreatic cystic lesions are pancreatic pseudocysts, so differentiation between mucinous cystadenoma and pseudocyst is frequently required. We report a rare case of mucinous cystadenoma of the pancreas coexisting with pseudocyst. A 43-year-old woman presented with abdominal pain. Imaging examinations showed a large cystic lesion in the tail of the pancreas, and distal pancreatectomy and splenectomy were performed. Pathological examination revealed that the majority of the cystic wall comprised thick collagen fibrous connective tissue, while part of the cystic wall represented a single layer of columnar, mucin-producing epithelium without atypia. Those findings suggested mucinous cystadenoma with an inflammatory pseudocyst. The mixture of mucinous cystadenoma and pseudocyst within the same cystic lesion appears to be very rare. Complete resection of the cystic lesion seems to allow an excellent prognosis.

[The safety of docetaxel with cyclophosphamide (TC) therapy as adjuvant chemotherapy for Japanese women with operable breast cancer].

The safety of docetaxel (60 mg/m(2)) plus cyclophosphamide (600 mg/m(2)) every three weeks (TC) as adjuvant therapy for Japanese women with operable breast cancer was evaluated. Ehime TC Study Group initiated the randomized control study,which compared the effects of the TC course number (4 cycles versus 8 cycles) in the adjuvant setting on the treatment outcomes of breast cancer patients. Eight patients were investigated on the side effects of TC therapy, four of them were allocated to 4 cycles of TC, and four to eight cycles from May, 2004 to Feb. 2005. Leukocytopenia and neutropenia of grade 3 or 4 were seen in 50% and 63% of the cases, respectively. No febrile neutropenia was seen. Although the non-hematological side effects of grade 3 or 4 were not observed, alopecia, stomatitis, skin toxicities and edema of grade 2 were seen in 100%, 25%, 25%, 13% of cases, respectively. TC therapy was well tolerated. All anticancer drugs could be administered as scheduled. From these preliminary results, TC therapy seems to be able to be safely prescribed postoperatively for Japanese women operated for breast cancer.