[Current Status and Prospects of Robot-Assisted Surgery in Colorectal Cancer].

The number of robot-assisted surgeries for rectal cancer has increased in Japan since the insurance coverage of robot-assisted surgery for rectal cancer in 2018. In addition, robot-assisted surgery for colon cancer has not been covered by insurance so far due to a lack of evidence showing its usefulness, but in April 2022, robot-assisted surgery for colon cancer was also be covered by insurance. At the same time, the surgeon requirements for the introduction of robotic surgery have been simplified, so the number of robotic surgeries will increase. Robotic-assisted surgery offers clear three-dimensional high definition images, motion scaling and anti-shake function, and stable forceps manipulation. This compensates for the disadvantages of laparoscopic surgery. Currently, the evidence for robot-assisted colectomy has not been established, but cohort and database studies have reported that robot-assisted colectomy has advantages in terms of open conversion rate, blood loss, and low complication rate. In this article, we summarize the evidence to date for robot-assisted surgery for colon cancer and discuss its future prospects.

[A Case of Severe Hyperammonemic Encephalopathy in a Dialysis Patient Following mFOLFOX6 Therapy].

A 69-year-old man on hemodialysis for chronic renal failure was diagnosed with ascending colon cancer, and received surgical resection. Multiple liver metastases were detected after surgery. He was administered modified FOLFOX6 therapy (reducing the dose to 50%), and showed severe disturbance of consciousness due to hyperammonemia on treatment day 6. After treatment with daily hemodialysis, branched-chain amino acid solutions, lactulose and rifaximin, his conscious level improved on day 9. Intensive chemotherapy in dialysis patients should be carefully performed considering the serious adverse events including hyperammonemia.

Small bowel fistula with colorectal cancer and mesenteric lymph node metastasis: a report of two cases.

A 65-year-old man presented to our hospital with complaints of diarrhea. Computed tomography showed a fistula with the small intestine, and a single incision laparoscopic low anterior resection for rectum with D3 dissection and partial resection of the small intestine were performed. Lymph node dissection, including a part of the inflow vessel area, was also performed because lymph node swelling was observed in the mesentery of the small intestine around the fistula. Histopathological analysis revealed that the lymph nodes in the small intestine were positive for metastasis. The patient was a 61-year-old woman who presented to our hospital with a chief complaint of diarrhea. A partial resection of the small intestine, including resection of the left hemicolectomy and lymph node dissection around the fistula, was performed at laparotomy. Histopathological examination revealed numerous lymph node metastases in the small intestinal mesentery.