Factors predictive of high-output ileostomy: a retrospective single-center comparative study.

PURPOSE: High-output syndrome (HOS) is a complication of ileostomy, which can affect quality of life significantly; however, its exact cause remains unknown. The aim of this study was to establish the frequency, as well as the preoperative and intraoperative factors predictive of HOS. METHODS: The subjects of this study were 164 consecutive patients who underwent colorectal cancer surgery with ileostomy construction at our institute between January, 2011 and August, 2018. Thirteen patients with postoperative complications reported as causes of HOS, including intraperitoneal abscess, paralytic ileus, and outlet obstruction, were excluded. We used a logistic regression analysis to identify the factors predictive of HOS. RESULTS: HOS developed in 36 of the 151 patients (23.8%). There were significantly more diabetic patients in the HOS group (P = 0.03), but other patient factors such as age, gender, body mass index, and use of daily laxatives were not significantly different between the groups. The HOS group had significantly more cases of total proctocolectomy (P = 0.04), but other surgical factors such as operative time, and blood transfusion were not significantly different between the two groups. CONCLUSIONS: These results indicate that diabetes and total proctocolectomy are preoperative predictors of HOS, allowing for the possibility of early intervention via post-surgical treatment.

Clinical Assessment of Reconstruction Involving Gastric Pull-Up Combined with Free Jejunal Graft After Total Pharyngolaryngoesophagectomy.

BACKGROUND: Total pharyngolaryngoesophagectomy (PLE) is used as a curative treatment for synchronous laryngopharyngeal and thoracic esophageal cancer or for multiple cancers in the cervical and thoracic esophagus. Gastric pull-up is commonly used after PLE, but postoperative complications are common. The present study evaluated these procedures in patients with esophageal cancer. METHODS: Fourteen patients (7 with synchronous pharyngeal and thoracic esophageal cancer, 4 with synchronous cervical and thoracic esophageal cancer, and 3 with cervicothoracic esophageal cancer) underwent reconstructive surgery after PLE involving gastric pull-up combined with free jejunal graft between 2004 and 2015. RESULTS: Esophagectomy via right thoracotomy was performed in 9 patients, and transhiatal esophagectomy was used in 5. The posterior mediastinal route was used in 13 patients, excluding one patient with early gastric cancer. Interposition of a free jejunal graft included microvascular anastomosis using two arteries and two veins in all patients. Anastomotic leakage and graft necrosis did not occur in any of the 14 patients who underwent the above surgical procedures. Tracheal ischemia close to the tracheostomy orifice occurred in 4 patients (28.6%), but none of these patients developed pneumonia. No hospital deaths were recorded. CONCLUSIONS: The results indicate that gastric pull-up combined with free jejunal graft is a feasible reconstructive surgery after PLE. This procedure is a promising treatment strategy for synchronous pharyngeal and thoracic esophageal cancer or multiple cancers in the cervical and thoracic esophagus. Larger series are needed to show the distinct advantages of this procedure in comparison with conventional methods of reconstruction after PLE.

Clinical Assessment of Sarcopenia and Changes in Body Composition During Neoadjuvant Chemotherapy for Esophageal Cancer.

AIM: The aim of this study was to assess changes in body composition during neoadjuvant chemotherapy (NAC) and investigate whether chemotherapy-related toxicities affect body composition in patients with esophageal cancer. PATIENTS AND METHODS: In ninety-four patients who underwent NAC for esophageal cancer, body composition was assessed before and after NAC. Associations between the incidence of toxicities and change in body composition during NAC were investigated. RESULTS: Forty-four (46.8%) and 50 (53.2%) out of 94 patients were defined as having sarcopenia before and after NAC, respectively. There was no significant difference in the incidence of any toxicity pre-treatment between patients with sarcopenia and those without sarcopenia. No significant reduction in skeletal muscle mass or fat mass was observed in the patients during NAC (p=0.501 and p=0.072). However, patients who experienced grade 4 neutropenia or febrile neutropenia during NAC showed a significantly larger decrease in change of skeletal muscle mass compared to patients who did not experience those toxicities (p=0.013 and 0.036, respectively). CONCLUSION: The incidence of serious adverse events such as febrile neutropenia and grade 4 neutropenia is associated with a significant reduction of skeletal muscle mass during NAC. We should make an effort to reduce the incidence of adverse events in order to maintain an appropriate body composition during NAC.

[Comparison of early clinical outcomes between laparoscopic total gastrectomy and open total gastrectomy for early-stage gastric cancer].

BACKGROUND/AIMS: Recently, laparoscopic distal gastrectomy has become one of the standard therapies for early gastric cancer. However, there are still some obstacles in performing laparoscopic total gastrectomy (LTG) as a standard therapy due to the difficulties in surgical techniques. We have performed LTG for patients with early gastric cancer in the upper portion of the stomach since 2010. In this study, we compared early clinical outcomes of LTG with those of open total gastrectomy (OTG) for patients with cT1N0 gastric cancer. METHODOLOGY: We reviewed 69 patients who had gastric cancer of cStage IA between January 2010 and December 2013. We performed a comparative study of short-term clinical outcomes, quantity of dissected lymph nodes, and in-hospital costs between patients undergoing LTG (n=34) and those undergoing OTG (n=35). RESULTS: The clinical characteristics of patients were well matched in the LTG and OTG groups. The median operating time was significantly longer for the LTG group (p<.0001). The estimated blood loss was significantly reduced in the LTG group (p< 0.0001). The postoperative morbidity rate was 14.7% in the LTG group and 14.2% in the OTG group with no significant difference. There were no differences in the total cost for hospital stay between the LTG and OTG groups. CONCLUSIONS: We were able to perform LTG safely and successfully for early gastric cancer in our institute. The total cost of the treatment was almost the same between LTG and OTG. We conclude that LTG is a potential alternative in the management of early gastric cancer.