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1.
Surg Today ; 53(3): 386-392, 2023 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-35867163

RESUMEN

PURPOSE: Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease. METHODS: We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion. RESULTS: After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03). CONCLUSION: Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.


Asunto(s)
Enfermedades del Ano , Enfermedad de Crohn , Estomas Quirúrgicos , Humanos , Enfermedad de Crohn/cirugía , Enfermedad de Crohn/complicaciones , Enfermedades del Ano/complicaciones , Enfermedades del Ano/cirugía , Estudios Retrospectivos , Estomas Quirúrgicos/efectos adversos , Ileostomía/métodos , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/cirugía
2.
Nihon Shokakibyo Gakkai Zasshi ; 120(1): 72-79, 2023.
Artículo en Japonés | MEDLINE | ID: mdl-36631119

RESUMEN

The clinical course of 104 patients with ulcerative colitis who underwent primary surgery at ≥70 years was retrospectively examined. Pre- and postoperative patient conditions determined the choice of surgical procedure. Approximately half of the patients underwent restorative proctocolectomy, resulting in relatively good defecation function. In addition, the long-term outcomes of patients who underwent permanent ileostomy were favorable. However, the postoperative complication and mortality rates were high in all patients, including those with low preoperative performance status due to long-term hospitalization. In this patient population, surgery should be conducted before decreased performance status due to long-term hospitalization.


Asunto(s)
Colitis Ulcerosa , Proctocolectomía Restauradora , Humanos , Anciano , Anciano de 80 o más Años , Colitis Ulcerosa/complicaciones , Estudios Retrospectivos , Proctocolectomía Restauradora/efectos adversos , Proctocolectomía Restauradora/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/cirugía , Ileostomía/efectos adversos , Resultado del Tratamiento
3.
Nihon Shokakibyo Gakkai Zasshi ; 120(8): 680-688, 2023.
Artículo en Japonés | MEDLINE | ID: mdl-37558415

RESUMEN

A 57-year-old man presenting with severe ulcerative colitis (UC) complicated by disseminated intravascular coagulation (DIC) was referred to our hospital. Since it was difficult to improve DIC immediately with any medical treatment, total proctocolectomy, ileoanal canal anastomosis, and ileostomy were performed on the patient. Soon after the surgery, his platelet count and coagulability improved, and he recovered from DIC. Thus, when the cause of DIC is probably UC itself, and medical treatment has limited efficacy in improving the DIC, surgery should be performed as soon as possible to eliminate the cause of DIC, considering the general condition of the patient.


Asunto(s)
Colitis Ulcerosa , Coagulación Intravascular Diseminada , Proctocolectomía Restauradora , Masculino , Humanos , Persona de Mediana Edad , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/cirugía , Coagulación Intravascular Diseminada/complicaciones , Coagulación Intravascular Diseminada/cirugía , Proctocolectomía Restauradora/efectos adversos , Anastomosis Quirúrgica/efectos adversos
4.
BMC Gastroenterol ; 21(1): 168, 2021 Apr 13.
Artículo en Inglés | MEDLINE | ID: mdl-33849449

RESUMEN

PURPOSE: Colorectum diversion with a proximal stoma is often the preferred surgical approach in patients with Crohn's disease-related anorectal lesions or refractory colitis. To date, few studies have assessed the incidence and prognosis of cancer in the diverted anorectal segments. This study aimed to evaluate the clinical characteristics and prognosis of anorectal cancer associated with Crohn's disease following fecal diversion. METHODS: This was a retrospective study based on medical records of patients diagnosed with Crohn's disease between 1999 and 2020. It was conducted at Yokohama Municipal Citizen's Hospital. Patients diagnosed with anorectal cancer following fecal diversion were identified, and their prognosis was the primary outcome measure. RESULTS: Among 1615 patients, 232 patients (14%) underwent colorectum diversion. Of those 232 patients, 11 were diagnosed with anorectal cancer following fecal diversion, ten were diagnosed with advanced cancer, 10 underwent abdominoperineal resection, and eight died. 1 could not undergo resection due to multiple lung metastasis and died. The overall five-year survival rate in patients diagnosed with anorectal cancer following fecal diversion was 20%. CONCLUSION: Crohn's disease-associated anorectal cancer following fecal diversion was challenging to diagnose early, and patients had a poor prognosis even after curative resection. Early abdominoperineal resection may be considered for patients with Crohn's disease who cannot benefit from cancer screening and surveillance due to difficulty accessing the anorectal stricture via endoscopy.


Asunto(s)
Neoplasias del Ano , Enfermedad de Crohn , Neoplasias del Recto , Neoplasias del Ano/cirugía , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/cirugía , Humanos , Pronóstico , Neoplasias del Recto/cirugía , Estudios Retrospectivos
5.
Nihon Shokakibyo Gakkai Zasshi ; 118(8): 742-748, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-34373393

RESUMEN

OBJECTIVE: A few studies have focused on pregnancy and childbirth in patients with Crohn's disease (CD) who had a history of abdominal surgery. The objective of this study is to analyze the problems of pregnant patients with CD with a history of abdominal surgery. METHODS: The rates of pregnancy-related complications and adverse birth outcomes were retrospectively analyzed in 29 patients with CD (45 pregnancies) with previous intestinal surgery. RESULTS: In this study, the following outcomes were observed:normal births occurred in 55.6% of the pregnancies, preterm births in 13.3%, and spontaneous abortions in 20.0%. The vaginal birth and cesarean section rates were 45.7% and 40.0%, respectively. The rate of low-birth weight infants was 14.3%. CONCLUSION: Overall, patients with CD with previous abdominal surgery can conceive and give birth. However, care needs to be taken to avoid preterm birth, spontaneous abortion, low birth weight, and cesarean delivery.


Asunto(s)
Enfermedad de Crohn , Complicaciones del Embarazo , Nacimiento Prematuro , Cesárea/efectos adversos , Enfermedad de Crohn/cirugía , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Complicaciones del Embarazo/epidemiología , Complicaciones del Embarazo/cirugía , Nacimiento Prematuro/epidemiología , Nacimiento Prematuro/etiología , Estudios Retrospectivos
6.
Nihon Shokakibyo Gakkai Zasshi ; 118(11): 1079-1084, 2021.
Artículo en Japonés | MEDLINE | ID: mdl-34759105

RESUMEN

We report the case of a young female patient with Crohn's disease case who had vaginal delivery after abdominoperineal resection for severe perianal disease. The patient had Crohn's disease with anorectal complications for 13 years and underwent abdominoperineal resection for anorectal stenosis, complex anal fistula, and rectovaginal fistula in her early twenties. Seven years later, she got pregnant and gave birth to a healthy boy by vaginal delivery. No recurrence of Crohn's disease was observed during the perinatal period. There is no curative treatment for severe anorectal complications, which may be necessary for young patients to undergo abdominoperineal resection. Further studies are needed to determine the effects of Crohn's disease with anorectal complications on pregnancy and childbirth in affected patients.


Asunto(s)
Enfermedad de Crohn , Proctectomía , Fístula Rectal , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/cirugía , Parto Obstétrico , Femenino , Humanos , Masculino , Embarazo , Recurrencia , Resultado del Tratamiento
7.
Int J Colorectal Dis ; 35(10): 1887-1894, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-32514722

RESUMEN

BACKGROUND: The role of apical lymph node (APN) metastasis in colorectal cancer remains controversial. The main purpose of this study is to explore the prognostic value of APN metastasis in patients with right colon cancer. METHODS: This is a retrospective study of patients with stage III right colon cancer between April 2007 and December 2016. Patients who underwent resection of right colon cancers with D3 lymph node dissection were divided into APN-positive (APN+) and APN-negative (APN-) groups according to the postoperative pathological presence or absence of APN metastasis. Relapse-free survival (RFS) and overall survival (OS) between groups were compared after Cox regression analysis and 1:1 propensity score matching (PSM). RESULTS: A total of 254 patients were included in this study: 28 (11.0%) were APN+ and 226 (89.0%) were APN-. Before matching, the rates of elevated carcinoembryonic antigen (CEA), T3-4 tumor invasion, and N2 lymph node metastasis were significantly higher in the APN+ group (CEA ≥ 5 ng/mL, 53.6% vs. 37.6%, p < 0.001; T3-4, 92.9% vs. 85.4%, p < 0.001; N2 metastasis, 57.1% vs. 20.4%, p < 0.001), and APN+ tumors were associated with significantly higher postoperative relapse rates (39.3% vs. 21.2%; p = 0.03), especially with lung metastases (14.3% vs. 4.0%; p = 0.019), which conferred worse RFS (p = 0.013), although OS was similar (p = 0.078). However, after PSM, there were no apparent between-group differences in RFS (p = 0.29) or overall survival rate (p = 0.637). The Cox regression analysis indicated that lymphatic vessel infiltration and depth of invasion were independent risk factors for OS, while APN+ status was not a significant predictor for RFS or OS. CONCLUSIONS: APN metastasis was not a prognostic indicator for RFS or OS in right colon cancer. However, APN+ patients with elevated CEA levels and deeper tumor invasion should be closely monitored for lung metastasis during postoperative follow-up.


Asunto(s)
Neoplasias del Colon , Recurrencia Local de Neoplasia , Neoplasias del Colon/patología , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Tasa de Supervivencia
8.
World J Surg Oncol ; 18(1): 54, 2020 Mar 11.
Artículo en Inglés | MEDLINE | ID: mdl-32160919

RESUMEN

BACKGROUND: It is not clear whether stage II colon and rectal cancer have the same risk factors for recurrence. Thus, the purpose of this study was to identify the risk factors for postoperative recurrence in stage II colorectal cancer. PATIENTS AND METHODS: We retrospectively analyzed the data of 990 patients who had undergone radical surgery for stage II colorectal cancer. Patients' pathological features and characteristics including age, sex, family history, body mass index, tumor diameter, gross type of tumor, infiltration degree (T3/T4), tumor grade, perineural invasion, vascular invasion, lymphatic invasion, pathologic examination of lymph node number, and preoperative carcinoembryonic assay (CEA) level was compared between patients with and without recurrence. Finally, the prediction of the left and right colons was analyzed. RESULTS: The mean ages of the colon cancer and rectal cancer patients were 69.5 years and 66.4 years, respectively. In total, 508 (82.1%) and 285 (76.8%) patients were treated laparoscopically for colon cancer and rectal cancer, respectively, with median follow-up periods of 42.2 months and 41.8 months, respectively. Forty-four recurrences occurred in both the colon cancer (7.1%) and rectal cancer (11.9%) groups. The preoperative serum CEA level and T4 infiltration were significantly higher in recurrent colorectal cancer patients. The postoperative recurrence rate of left colon cancer (descending colon, sigmoid colon) was higher than that of right colon cancer (cecum, ascending colon, transverse colon) (OR 2.191, 95% CI 1.091-4.400, P = 0.027). In COX survival factor analysis of colon cancer, the left colon is one of the independent risk factors (risk ratio 5.377, 95% CI 0.216-0.88, P = 0.02). In disease-free survival (DFS), the left colon has a relatively poor prognosis (P = 0.05). However, in the COX analysis and prognosis analysis of OS, no difference was found between the left colon and the right colon. CONCLUSION: Preoperative CEA and depth of infiltration (T4) are high-risk factors associated with recurrence and are prognostic factors in stage II colorectal cancer. Left colon is also a risk factor for postoperative recurrence of stage II colon cancer.


Asunto(s)
Neoplasias del Colon/cirugía , Recurrencia Local de Neoplasia/etiología , Anciano , Antígeno Carcinoembrionario/sangre , Neoplasias del Colon/etiología , Neoplasias del Colon/mortalidad , Neoplasias del Colon/patología , Femenino , Humanos , Masculino , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos , Factores de Riesgo
9.
Nihon Shokakibyo Gakkai Zasshi ; 117(4): 321-326, 2020.
Artículo en Japonés | MEDLINE | ID: mdl-32281573

RESUMEN

An 86-year-old woman was diagnosed with ulcerative colitis (UC) in the 1970s. A colonoscopy performed 40 years thereafter revealed a 0-Is lesion in the upper rectum, and pathological examination showed well-differentiated adenocarcinoma. The lesion was diagnosed as colitic cancer based on the pathological findings and the 40-year interval since the diagnosis of total colitis type of UC. The patient was in good overall health with good anal function, based on the clinical examination and manometric study;she wished to undergo sphincter-preserving operation. Restorative proctocolectomy with ileal pouch-anal canal anastomosis that preserved the anal canal mucosa was performed. The postoperative course was good, with a defecation frequency of 4-5 times/day without fecal incontinence, and the patient resumed her preoperative lifestyle with very few alterations. Even in elderly patients aged >80 years who have UC, restorative proctocolectomy is feasible for those in good general health and with relatively good anal function, determined based on the daily defecation activity and anal manometry.


Asunto(s)
Colitis Ulcerosa , Reservorios Cólicos , Proctocolectomía Restauradora , Anciano , Anciano de 80 o más Años , Canal Anal , Anastomosis Quirúrgica , Femenino , Humanos
10.
Hinyokika Kiyo ; 64(12): 489-495, 2018 Dec.
Artículo en Japonés | MEDLINE | ID: mdl-30831664

RESUMEN

A 78-year-old man was referred to Tsukuba University Hospital for right hydronephrosis. He had undergone ureteroscopy and ureteral stenting in another hospital, but no tumor was revealed in renal pelvis and ureter. The urinary cytology was negative. Computed tomography (CT) revealed remarkable thickening of right renal pelvis and ureter wall. CT also showed para-aortic, iliac, supraclavicular and mediastinal lymph node (LN) swelling. 18F-fluoro-2-deoxy-D-glucose positron emission tomography (PET) revealed high uptake at thickened right renal pelvis and ureter wall and enlarged LNs. The soluble interleukin-2 receptor was elevated to 1,110 U/ml (normal range: 613 U/ml). Those findings suggested that the malignant lymphoma originated from the renal pelvis and ureter rather than urothelial cancer. Therefore we performed open biopsy of iliac LN and periureteral tissue. The pathological diagnosis was mucosa associated lymphoid tissue (MALT) lymphoma. The patient was trasferred to the department of hematology, and treated with rituximab and bendamustine. After 6 courses of chemotherapy, swelling of renal pelvis, ureter and LN was markedly reduced. The ureteral sent could be removed. MALT lymphoma of the upper urinary tract is extremely rare and pretreatment diagnosis is difficult. In 8 of 11 reported cases, the diagnosis was made by nephroureterectomy. In our cases, open biopsy could avoid nephroureterectomy.


Asunto(s)
Carcinoma de Células Transicionales , Hidronefrosis , Pelvis Renal , Linfoma de Células B de la Zona Marginal , Neoplasias Ureterales , Anciano , Carcinoma de Células Transicionales/patología , Carcinoma de Células Transicionales/terapia , Humanos , Pelvis Renal/patología , Linfoma de Células B de la Zona Marginal/patología , Linfoma de Células B de la Zona Marginal/terapia , Masculino , Uréter , Neoplasias Ureterales/patología , Neoplasias Ureterales/terapia
11.
Nihon Shokakibyo Gakkai Zasshi ; 115(1): 108-116, 2018.
Artículo en Japonés | MEDLINE | ID: mdl-29353847

RESUMEN

Recto-perineal-urethral fistula caused by Crohn's disease is a rare, for which fundamental treatment has not been established yet. We analyzed the clinical characteristics, diagnosis, treatment, and prognosis of six male patients with anorectal lesions caused by Crohn's disease. Three patients were treated with abdominoperineal resection and the other three with rectal excision without anastomosis. Excluding one case, which presented worsening immediately after surgery, symptoms of urethral fistula improved without urethral stenosis, dysuria, or sexual dysfunction. Recto-perineal-urethral fistula is currently treated with various treatment modalities, including colostomy and drug therapy. Although the evaluation of these modalities is required, abdominoperineal resection or rectal excision without anastomosis may be a valuable treatment option because these approaches improve the urethral fistula while sparing the urethra without any significant complications.


Asunto(s)
Enfermedad de Crohn/diagnóstico , Fístula Rectal/diagnóstico , Fístula Urinaria/diagnóstico , Colostomía , Enfermedad de Crohn/complicaciones , Enfermedad de Crohn/terapia , Humanos , Masculino , Fístula Rectal/complicaciones , Fístula Rectal/terapia , Enfermedades Uretrales/complicaciones , Enfermedades Uretrales/diagnóstico , Enfermedades Uretrales/terapia , Fístula Urinaria/complicaciones , Fístula Urinaria/terapia
12.
Nihon Shokakibyo Gakkai Zasshi ; 113(11): 1901-1908, 2016.
Artículo en Japonés | MEDLINE | ID: mdl-27829602

RESUMEN

A case of Crohn's disease complicated with simultaneous double cancers of the small bowel is reported. The patient is a 66-year-old man who had suffered from Crohn's disease for 20 years. He underwent surgery to identify the source of repeated episodes of intestinal obstruction. Two short segments of strictures and proximal dilatations were found in the distal ileum. Therefore, we performed an en bloc resection of the two stenotic sections instead of strictureplasty. Histological examination of the resected specimen revealed not only Crohn's disease but also a well-differentiated adenocarcinoma within each of the two strictures. One had invaded to the muscular layer and the other to the subserosal layer. In cases of Crohn's disease with longstanding stenosis, the probability of carcinoma should be considered.


Asunto(s)
Enfermedad de Crohn/complicaciones , Neoplasias del Íleon/etiología , Obstrucción Intestinal/etiología , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Quimioterapia Adyuvante , Humanos , Neoplasias del Íleon/diagnóstico por imagen , Neoplasias del Íleon/tratamiento farmacológico , Neoplasias del Íleon/cirugía , Obstrucción Intestinal/diagnóstico por imagen , Obstrucción Intestinal/cirugía , Masculino , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
13.
J Anus Rectum Colon ; 5(3): 306-312, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34395944

RESUMEN

OBJECTIVES: Few studies have examined the correlations between the arteries and veins of the right colon. In this study, we aimed to use high-resolution CT scans to understand the vascular anatomy of Henle's gastrocolic trunk and review the terminology describing the arteries and veins of the right colon. METHODS: This retrospective study has examined patients who underwent laparoscopic colectomy for right colon cancer in a single institution in Japan. Scans from consecutive patients who underwent surgery between October 2017 and March 2020 (n = 165) were examined. Preoperative CT images were used to create multiplanar reformation images and volume rendering images. RESULTS: Among the 139 patients with Henle's gastrocolic trunk (GCT) present, arteries accompanying the accessory right colic vein (ARCV) were most common on the right branch of the middle colic artery (MCA) (71.2%), followed by the right colic artery (RCA) (19.4%); meanwhile, 9.4% of the patients had no accompanying arteries. Of patients with no accompanying arteries to the ARCV, RCA was present in 15.4%. Among the 26 patients with no GCT, the right colic vein (RCV) existed in 15 patients, with the artery accompanying the RCV most commonly being the right branch of the MCA (66.6%), followed by the RCA (33.3%). CONCLUSIONS: Irrespective of the presence of GCT, approximately 70% of the arteries accompanying the drainage vein from the right colon were the right branch of the MCA. We suggest that vascular branch formation be considered preoperatively in surgical management for right colon cancer.

14.
Clin J Gastroenterol ; 14(5): 1437-1442, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34213760

RESUMEN

We report a 60-year-old male who was transferred to our hospital for the operation because of refractory ulcerative colitis (UC). He was diagnosed to be infected with COVID-19 for SARS-CoV-2 PCR test positive at the time of transfer. We determined emergency operation because his general condition was poor such as malnutrition and ADL decline due to exacerbation of UC and air embolization by central venous catheter removal. He underwent subtotal colectomy with a sigmoid mucous fistula and ileostomy. He was well postoperatively. This is a first case report in Japan who underwent an operation for UC with COVID-19 infection.


Asunto(s)
COVID-19 , Colitis Ulcerosa , Colectomía , Colitis Ulcerosa/complicaciones , Colitis Ulcerosa/cirugía , Humanos , Japón , Masculino , Persona de Mediana Edad , SARS-CoV-2
15.
Anticancer Res ; 41(2): 993-997, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33517306

RESUMEN

BACKGROUND/AIM: Surgery on hemodialysis patients requires special attention, as the tissue of these patients is vulnerable and hemorrhagic. This study explored the feasibility of laparoscopic surgery for colorectal cancer in hemodialysis patients. PATIENTS AND METHODS: This was a retrospective study of patients who underwent laparoscopic surgery for colorectal cancer in a single institute from April 2007 to December 2016. RESULTS: A total of 2668 patients were included: 24 (0.9%) were on hemodialysis, and 2644 (99.1%) were not. After 1:1 propensity score matching, there were no significant differences in the short-term postoperative results, the disease-free survival rate (p=0.0813) or the cancer-specific survival rate (p=0.555). However, the overall survival rate was significantly lower in hemodialysis patients than in non-hemodialysis patients (p=0.0135). CONCLUSION: Standard laparoscopic operative procedures can be safely performed for hemodialysis patients, and there was no marked difference in the long-term oncological outcomes between the two groups.


Asunto(s)
Neoplasias Colorrectales/cirugía , Laparoscopía/métodos , Puntaje de Propensión , Diálisis Renal/estadística & datos numéricos , Anciano , Neoplasias Colorrectales/mortalidad , Estudios de Factibilidad , Femenino , Humanos , Laparoscopía/efectos adversos , Masculino , Complicaciones Posoperatorias , Estudios Retrospectivos , Tasa de Supervivencia
16.
Asian J Surg ; 44(1): 105-110, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32295719

RESUMEN

AIM: The purpose of this study was to elucidate the differences in clinical pathology and prognosis between signet ring cell carcinoma component and adenocarcinoma in colorectal cancer. MATERIALS AND METHODS: From April 2007 to December 2016, a total of 4348 patients with colorectal cancer underwent surgery, of which 3283 were included in the study. One patient was diagnosed with signet ring cell carcinoma (SRCC); 16 were diagnosed with signet ring cell carcinoma component (SRCCc); and 3266 patients were diagnosed with adenocarcinoma (ADC). We matched SRCCc and ADC with a propensity score of 1:3 and analyzed overall survival rates (OS) and cancer-specific survival rate (CSS) between the 2 groups before and after matching. RESULTS: Before matching, patients in the SRCCc group had more advanced cancer (stage III-IV: 87.5% vs 45.6%; P < .001), more perineural invasion (75.0% vs 44.2%; P = .013), and higher lymphatic invasion (87.5% vs 42.4%; P < .001) than those in the ADC group. Consequently, the OS (P < .001) and CSS (P = .049) of the SRCCc group were worse than the ADC group. Peritoneal metastasis was found in 4 (57%) patients with stage IV disease. However, after tumor staging and all background factors were matched, there were no significant differences in prognosis for OS (P = .127) and CSS (P = .932) between the 2 groups. CONCLUSION: SRCCc is more likely to be associated with lymphatic invasion and perineural infiltration than ADC, leading to significantly poorer survival outcomes. However, when all background factors are matched with ADC, the prognosis of SRCCc is not worse than ADC. Improving the treatment outcomes of peritoneal metastasis may be pivotal in the treatment of SRCCc.


Asunto(s)
Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Carcinoma de Células en Anillo de Sello/mortalidad , Carcinoma de Células en Anillo de Sello/patología , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Neoplasias Peritoneales/secundario , Pronóstico , Puntaje de Propensión , Tasa de Supervivencia
17.
J Gastrointest Surg ; 25(7): 1866-1874, 2021 07.
Artículo en Inglés | MEDLINE | ID: mdl-33078319

RESUMEN

BACKGROUND: The indications for lateral lymph node dissection (LLND) in rectal cancer have been controversial. The purpose of this study was to clarify the significance of lateral lymph node metastasis in low rectal cancer. METHODS: This was a retrospective study at a high-volume cancer center in Japan. In this study, 40 patients with pathologically positive LLN (LLN+) were matched with 175 negative (LLN-) patients by propensity score matching (PSM). COX regression analysis was used to identify independent risk factors related to prognosis. The relapse-free survival rate (RFS) and overall survival rate (OS) of the 2 groups before and after matching were analyzed. RESULTS: Of the 64 patients undergoing LLND, 40 (62.5%) patients had LLN+ disease. The LLN+ patients showed deeper infiltration of the primary tumor than the LLN- patients (T3-T4: 87.5% vs. 72.0%; p = 0.044), a greater number of metastatic lymph nodes (N2: 75.0% vs. 35.4%; p < 0.001), and a higher rate of local recurrence (30% vs. 9.1%; p < 0.001). Adjuvant chemotherapy was more common in the 40 LLN+ patients than in the 175 LLN- patients (70.0% vs. 46.8%; p = 0.008). After relapse, the rate of first-line chemotherapy administration for LLN+ patients was higher than that for the LLN- patients (62.5% vs. 29.5%; p = 0.005). The RFS of LLN+ patients was shorter than that of the LLN- patients (p = 0.005). After PSM, although more LLN+ patients received adjuvant chemotherapy than the LLN- patients (70.0% vs. 40.0%; p = 0.007), the local recurrence rate remained higher (30% vs. 10%; p = 0.025). The differences between RFS (p = 0.655) and OS rates (p = 0.164) of the 2 patient groups were not significant. CONCLUSION: Even after LLND, patients with LLN+ low rectal cancer still showed an elevated local recurrence rate. Controlling local recurrence by adjuvant chemotherapy alone is difficult, and the additional strategic treatments are needed.


Asunto(s)
Recurrencia Local de Neoplasia , Neoplasias del Recto , Humanos , Japón , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Puntaje de Propensión , Neoplasias del Recto/cirugía , Estudios Retrospectivos
18.
Anticancer Res ; 40(8): 4365-4372, 2020 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32727764

RESUMEN

BACKGROUND/AIM: The purpose of this study was to explore the perioperative, short-term, and long-term prognostic differences in colorectal cancer (CRC) between young and older patients. PATIENTS AND METHODS: A total of 3095 patients were divided into young (≤45 years; n=139) and older (>45 years; n=2956) groups. Then, propensity score matching was performed for patients in stage I to III according to a ratio of 1:1. The clinicopathological factors and prognosis of the two groups were studied. RESULTS: Young patients with CRC account for 4.49% of the total number of patients with CRC. Younger patients with CRC in stage I to III showed better cancer-specific survival (CSS). Older age was an independent risk factor for CSS prognosis. The CSS of the younger group was significantly better in stage I to III as a whole, but there was no difference in stage I and II subgroups - only in stage III. The proportion of young patients with stage III disease receiving first-line adjuvant chemotherapy was significantly higher. When young patients relapsed, they were more likely to receive second-line adjuvant chemotherapy or reoperation than older patients. CONCLUSION: Younger patients with stage III colorectal cancer had better CSS rates.


Asunto(s)
Factores de Edad , Neoplasias Colorrectales/patología , Puntaje de Propensión , Análisis de Supervivencia , Adulto , Humanos , Japón , Persona de Mediana Edad , Pronóstico
19.
J Anus Rectum Colon ; 4(3): 137-144, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32743116

RESUMEN

OBJECTIVES: Japan is facing an aging society. Elderly individuals are generally more prone to comorbidities and have weaker immune defenses, with ominous prognostic implications if postoperative complications arise. The aim of this study was to explore scoring systems for predicting postoperative morbidity risk in super elderly patients (≥85 years old) after colorectal surgery for cancer. METHODS: A population of elderly patients (n = 145) surgically treated for primary colorectal cancer within our department between April 2007 and December 2018 was examined retrospectively, assessing the capacities of various indices, such as Estimation of Physiologic Ability and Surgical Stress (E-PASS), neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), prognostic nutritional index (PNI), and modified Glasgow Prognostic Score (mGPS), to predict postoperative complications. RESULTS: NLR, PLR, and mGPS did not differ significantly in the presence or absence of complications, whereas PNI tended to be lower if complications developed. The E-PASS system showed no group-wise differences in preoperative risk score (PRS), but the surgical stress score (SSS) and the comprehensive risk score (CRS; a composite of PRS and SSS) was significantly higher in patients with complications. Based on the cutoff value calculated from the Receiver operating curve (ROC) for the E-PASS CRS (-0.0580), patients were stratified into low-scoring and high-scoring (HSG) groups. Although not significantly different, the overall survival in the HSG tended to be lower by comparison. CONCLUSIONS: The E-PASS scoring system may be a useful predictor of postoperative complications in super elderly patients requiring colorectal cancer surgery.

20.
In Vivo ; 34(5): 2981-2989, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32871841

RESUMEN

BACKGROUND: Unlike the tumor nodes metastasis (TNM) lymph node classification, based solely on counts of nodal metastases, the Japanese system of classifying colorectal carcinoma (CRC) focuses on regional lymph node spread. In this study, we explored the prognostic utility of inferior mesenteric artery (IMA) apical lymph node (APN) metastasis. PATIENTS AND METHODS: This was a retrospective study of patients with stage III left-sided CRC. All enrollees were subjected to D3 resection between April 2007 and December 2016 at the International Medical Center of Saitama Medical University and then stratified by histologic presence (APN+ group) or absence (APN- group) of tumor in APNs examined postoperatively. Ultimately, propensity score matching was invoked (1:2) and COX regression analysis was conducted, determining group rates of relapse-free survival (RFS) and cancer-specific survival (CSS). RESULTS: A total of 498 patients were studied, grouped as APN+ (19/498, 3.8%) or APN- (479/498, 96.2%). Prior to matching, the APN+ (vs. APN-) group showed significantly more lymphatic involvement (73.7% vs. 47.8%; p=0.023), deep (T3/T4) tumor infiltration (100% vs. 78.9%; p=0.024), and nodal metastasis (N2: 84.2% vs. 27.6%; p<0.001). In addition, para-aortic nodal recurrences were significantly increased (15.7% vs. 2.0%; p<0.001), conferring worse RFS (p<0.001) and CSS (p=0.014) rates. Once baseline factors were matched, the two groups appeared similar in RFS (p=0.415) and CSS (p=0.649). Multivariate regression analysis indicated that elevated carcinoembryonic antigen (CEA) level and deep tumor infiltration were independent risk factors for RFS, whereas postoperative complications and tumor-positive node counts were independent risk factors for CSS. APN+ status was not a significant risk factor for RFS or CSS. CONCLUSION: APN positivity may thus constitute a regional rather than systemic manifestation. The TNM staging based on the number of metastatic lymph nodes seems to be more reasonable than the regional lymph node classification method.


Asunto(s)
Neoplasias Colorrectales , Recurrencia Local de Neoplasia , Neoplasias Colorrectales/patología , Humanos , Escisión del Ganglio Linfático , Ganglios Linfáticos/patología , Metástasis Linfática , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Pronóstico , Estudios Retrospectivos
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