Preoperative High C-Reactive Protein to Albumin Ratio Predicts Short- and Long-Term Postoperative Outcomes in Elderly Gastric Cancer Patients.

Individualized preoperative assessment of the general condition of elderly patients with gastric cancer is necessary for appropriate surgical treatment planning. This study investigated the efficacy of preoperative markers that could be easily calculated from preoperative peripheral blood to predict the short- and long-term postoperative outcomes of gastrectomy. In total, 571 patients who underwent R0 surgical resection for gastric cancer were enrolled. In the elderly patient group (≥65 years old), univariate analyses revealed that the incidence of postoperative complications was associated with poor performance status (p = 0.012), more comorbidities (p = 0.020), high C-reactive protein to albumin ratio (CAR, p = 0.003), total gastrectomy (p = 0.003), open approach (p = 0.034), blood transfusion (p = 0.002), and advanced cancer (p = 0.003). Multivariate analysis showed that a high CAR was associated with a high incidence of postoperative complications (p = 0.046). High CAR was also associated with poor OS (p = 0.015) and RFS (p = 0.035). However, these trends were not observed among younger patients (<65 years old). Preoperative CAR may play a significant role in predicting short- and long-term surgical outcomes, particularly in elderly patients with gastric cancer.

Intracystic papillary neoplasm diagnosis following an extended cholecystectomy: a case report and literature review.

We report a case of intracystic papillary neoplasms (ICPN) that was difficult to differentiate from adenocarcinoma of the gallbladder. A 64-year-old man visited our hospital for an examination of gallbladder tumors. At the preoperative examination, the tumor was revealed a papillary type of tumor in the body of the gallbladder without the findings that without the findings that suggested the tumor invasion into the deep subserosal layer. The patient underwent an extended cholecystectomy. Papillary lesions were observed mainly in the body of the gallbladder, with flattened elevated lesions at the gallbladder fundus. Within each of these tumors, cells corresponding to intraepithelial adenocarcinoma were irregularly interspersed, leading to a diagnosis of ICPN. The patient is currently undergoing follow-up with no recurrence postoperatively. The prognosis of ICPN is generally good; however, preoperative diagnosis remains challenging. Therefore, a treatment plan for gallbladder cancer should be applied.

Pathological complete response of multiple liver metastases from colon cancer successfully treated with conversion surgery: A case report.

INTRODUCTION AND IMPORTANCE: Recently, the successful long-term survival of patients with unresectable distant metastases from colorectal cancer, who underwent conversion surgery after systemic chemotherapy, have been documented. Herein, we present a patient afflicted with ascending colon cancer and multiple unresectable liver metastases, who underwent conversion surgery, resulting in the complete disappearance of the pathological liver metastases. PRESENTATION OF CASE: A 70-year-old woman visited our hospital with a chief complaint of weight loss. A diagnosis of ascending colon cancer (cT4aN2aM1a [H3]: TNM classification 8th edition) stage IVa with RAS/BRAF wild-type mutation was made (four liver metastases up to 60 mm in diameter were observed in both lobes). After 2 years and 3 months of systemic chemotherapy (capecitabine, oxaliplatin, and bevacizumab), the tumor marker levels had decreased to normal ranges and all liver metastases showed partial responses with remarkable shrinkage. After confirmation of a liver function and a preserved future liver remnant volume, the patient finally underwent hepatectomy, involving partial resection of S4 and subsegmentectomy of S8, along with a right hemicolectomy. Histopathologic examination revealed that all liver metastases had completely disappeared, while regional lymph node metastases had changed into scar tissue. However, the primary tumor failed to respond to chemotherapy, resulting in ypT3N0M0 ypStage IIA. The patient was discharged from the hospital on the 8th postoperative day without any postoperative complications. She is currently on the 6th month of follow-up without any recurring metastasis. CLINICAL DISCUSSION: Curative surgery is recommended for resectable liver metastases of colorectal cancer (CRLM), be it synchronous or heterochronous. Up until now, the efficacy of perioperative chemotherapy for CRLM is limited. Chemotherapy has a double-edged aspect, where some cases have shown successful improvement in the treatment stage. CONCLUSION: To obtain the maximum benefit from conversion surgery, it is critical to incorporate the appropriate surgical technique, at the correct stage, in order avoid the progression to chemotherapy-associated steatohepatitis (CASH) in the patient.

Small bowel cancer arising from a scar site more than 60 years after ileostomy closure: a case report.

Although small bowel cancer is rare, cases of carcinoma arising from the abdominal wall have not been reported. We report a case of a tumor arising from a stoma scar site, following ileostomy closure that was performed 60 years earlier. The tumor was resected for both therapeutic and diagnostic purposes and was found to be a primary cancer of the small intestine. The small intestinal mucosa survived long-term at the stoma scar site and developed carcinoma. No similar reports of small bowel cancer arising from the mucosa at the stoma scar site (on the abdominal wall) exist. After tumor resection, the patient received chemotherapy for lung metastases and has survived, thus far, for 2 years since the surgery.

Surgical treatment of hepatic xanthogranuloma arising from a giant hepatic cyst causing gastrointestinal obstruction: a case report.

Hepatic cysts are benign liver lesions and are often asymptomatic. Large hepatic cysts may cause jaundice and portal hypertension; however, they rarely cause gastrointestinal obstruction. Symptomatic cysts require treatment, and when malignancy is suspected, cyst puncture for pathological examination of the fluid may pose a risk of dissemination. Herein, we describe a case of xanthogranuloma arising from a large hepatic cyst that was causing duodenal obstruction. Thus, cyst puncture was performed for emergency decompression. Cytological examination of the puncture fluid revealed no malignant findings. Hence, laparoscopic deroofing was performed to treat the hepatic cyst. As the cyst and duodenal wall were firmly adherent, the cyst wall was left behind without dissection from the duodenum. A two-stage approach of cyst puncture followed by surgery may be an option for patients requiring urgent treatment for potentially malignant hepatic cysts.

A case of effective Delorme's procedure for colonic mucosal prolapse after intersphincteric resection.

Recent surgical technical improvements, such as endoscopic surgery with intersphincteric resection (ISR), could help avoid a permanent colostomy for patients with low-lying rectal tumors. However, the problems associated with anal dysfunction following ISR remain unresolved. We performed ISR and temporary ileostomy in a patient with low-lying rectal cancer. After evaluating the stability of the anastomosis, we planned to close the ileostomy, but the patient developed post-operative colonic mucosal prolapse (CMP). Although there are treatment methods available for CMP, there is no consensus on the treatment for post-operative CMP. In this case, we performed Delorme's procedure because the method has been reported to have advantages in terms of improving post-operative anal function. Post-operative anorectal manometry showed improvement in maximum squeeze pressure, and the patient's anal function improved; subsequently, ileostomy closure was performed. Delorme's procedure may be useful for patients with CMP after ISR to achieve good post-operative anal function.

Mixed neuroendocrine-non-neuroendocrine neoplasms of ascending colon: A case report.

INTRODUCTION: Neuroendocrine tumor (NET) that develops in the right-sided colon is relatively rare. Coexistence of adenocarcinoma and NET is extremely rare, and such cases are called mixed neuroendocrine-non-neuroendocrine neoplasm (MiNEN). PRESENTATION OF CASE: Colonoscopy in an 85-year-old woman for an anemia examination indicated laterally spreading tumor-nongranular (LST-NG) in the transverse colon. Colonoscopy and endoscopic ultrasonography (EUS) showed that the depth of the tumor invasion was deep submucosal. The tumor localization was diagnosed as transverse colon close to the hepatic curvature by enema. Computed tomography (CT) showed no obvious lymph node or distant metastasis. Based on these findings, laparoscopic transverse colectomy with D2 lymphadenectomy was performed. Pathologically, most of the tumor was well-differentiated tubular adenocarcinoma, but some solid follicles of polygonal tumor cells with poor nuclear atypia were observed. Immunostaining was positive for synaptophysin and diagnosed as NET G1. This tumor consisted of adenocarcinoma and neuroendocrine tumor, so we diagnosed it as MiNEN and classified the tumor as fT1N0M0 fStage I (TNM Classification of Malignant Tumors, 8th Edition). Since it was an early stage cancer, postoperative adjuvant therapy was not performed. No recurrence has yet been noted. DISCUSSION: Although MiNEN is extremely rare, the detailed pathological specimen observation and diagnosis are important because long-term follow-up after surgery is needed, as is the adequate selection of postoperative adjuvant therapy. CONCLUSION: It is important to elucidate the mechanisms involved in the coexistence of NET and adenocarcinoma and to apply these findings to future medical care.

Large hydrocele of the canal of Nuck diagnosed and treated using conventional and laparoscopic methods.

A 49-year-old woman presented to the hospital with a right inguinal swelling. On examination, we suspected hydrocele of the canal of Nuck (HCN) or an appendiceal or retroperitoneal tumor. Surgery for diagnosis and removal of the mass revealed that it was large and located in the preperitoneal cavity, extending into the inguinal ring; so, it was difficult to observe the entire outline of the mass solely using the laparoscopic approach. Therefore, we added the conventional approach with an inguinal incision. This combination of conventional and laparoscopic approaches helped in safe removal of the tumor. The HCN is an unusual developmental condition in women among whom it might cause an inguinal swelling infrequently. In a case with a large HCN, a combined approach using conventional and laparoscopic methods is suggested for better observation of the abdomen and successful resection without perforation of the mass than when using a single approach.

Multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases: a case report.

Most cases of peritoneal dissemination of colorectal cancers are from T3 or T4 tumors. A 61-year-old woman was admitted for examination of a positive fecal occult blood test. Colonoscopy showed an ascending colon tumor that was diagnosed as an adenocarcinoma with massive submucosal invasion. Imaging modality revealed numerous nodules throughout the abdominal cavity. Peritoneal dissemination of the ascending colon or ovarian cancer and pseudomyxoma peritonei were considered in the preoperative differential diagnoses, and laparoscopic ileocecal resection was performed. Intraperitoneal observation revealed numerous white nodules in the peritoneum, omentum and Douglas fossa. Both the nodules and tumor were diagnosed as mucinous carcinoma based on a pathology report. The tumor invasion depth was limited to muscularis propria, and no regional lymph node metastasis was detected. Peritoneal dissemination of the ascending colon cancer was considered. We report a rare case of multiple peritoneal dissemination of T2 colorectal cancer without lymph node metastases.

Inguinal bladder hernia treated using transabdominal preperitoneal approach: A case report.

INTRODUCTION: Inguinal bladder hernia (IBH) is a rare condition that is difficult to diagnose preoperatively based only on physical examination; 16% of IBHs are diagnosed postoperatively due to complications. PRESENTATION OF CASE: We report the case of a 56-year-old man who presented with left inguinal swelling and increased frequency of urination since eight years. Physical examination demonstrated a 6 × 4 cm non-reducible left inguinal bulge with mild tenderness on palpation. Computed tomography revealed a left inguinal hernia containing a portion of the urinary bladder. He was diagnosed with IBH and transabdominal preperitoneal (TAPP) repair was performed. We confirmed a left internal inguinal hernia and incised the peritoneum from the outside of the left inguinal ring. The preperitoneal space was dissected toward the Retzius space, and the prolapsed bladder was examined. The adhesion with the surroundings was carefully dissected and the bladder was reduced into the abdomen. Indigo carmine was injected through a urinary catheter, which confirmed that no bladder damage had occurred. After the mesh was positioned to cover the myopectineal orifice, it was fixed to the Cooper's ligaments, interior side, lateral side, and ventral side. The postoperative course was uneventful, and the patient is now free of symptoms and recurrence two months after surgery. CONCLUSION: TAPP repair is a useful treatment for IBH. Preoperative diagnosis of IBH is important to lessen postoperative complications.

Rectal Arteriovenous Malformation Treated by Transcatheter Arterial Embolization.

An 86-year-old man who presented with frequent hematochezia with mild anemia on blood tests was admitted to our hospital. Colonoscopy exhibited a submucosal tumor-like lesion in the lower rectum. CT and MRI showed blood flow into the lesion, but not tumor component. Angiography of the superior rectal artery and left internal iliac artery showed vascular hyperplasia and nidus. Thus, rectal arteriovenous malformation was diagnosed. If bleeding from arteriovenous malformation was out of control, surgical resection was necessary. However, due to the age of the patient, we performed transcatheter arterial embolization and abdominoperineal resection was not needed. Embolization from the left superior rectal artery, middle rectal artery and inferior rectal artery was performed to control the bleeding and to avoid surgery. After embolization, he was followed up for 10 months in our hospital without recurrence.