[A Case of Surgical Resection for Ascending Colon Cancer with Protein-Losing Gastroenteropathy].

An 84-year-old man visited our department for further examination of anemia and elevation of tumor marker levels. Colonoscopy revealed a huge circumferential type 3 tumor in the ascending colon. Significant hypoalbuminemia was observed at 1.1 g/dL, and prolonged hypoalbuminemia was considered to be caused by protein-losing gastroenteropathy due to the large tumor. In this case, we performed right hemicolectomy, and performed single-stage anastomosis. The resected specimen showed a huge type 3 lesion with a diameter of 140×120 mm in the ascending colon, which directory invaded to the cecum and ileum. After the operation, there were no particular complications, and albumin levels gradually improved. Although hypoalbuminemia is one of the risks of anastomotic leakage, there are many reports with one-stage anastomosis and with a good course, including our case. Therefore, it was considered necessary to examine each case regarding the surgical procedure.

[Impact of Muscle Mass Reduction on Postoperative Adjuvant Chemotherapy and Long-Term Prognosis in Patients with Gastric Cancer].

BACKGROUND: Measuring the area of the psoas muscle on computed tomography is useful for the evaluation of skeletal muscle mass. The skeletal muscle is thought to be involved in weight loss after gastric surgery, and weight loss causes a decrease in compliance with chemotherapy continuity. PATIENTS AND METHODS: The psoas muscle index(PMI)was determined in 33 patients undergoing surgery for Stage Ⅱ-ⅢB gastric cancer. The rate of change in PMIwas calculated, and patients were classified into maintained and reduced muscle groups using a cutoff of -0.23 month-1. Relationships between the rate of PMIchanges and prognosis and chemotherapy continuity were examined. RESULTS: The rate of PMIchanges was significantly associated with recurrence-free survival in univariate(maintained vs reduced muscle: p=0.002)and multivariate(p= 0.0018)analyses. A reduction in the muscle mass was associated with dropout from adjuvant chemotherapy and was a predictor of a poor prognosis. CONCLUSION: The rate of PMIchanges is related to the period of adjuvant chemotherapy and is an independent prognostic factor after surgery for StageⅡ-ⅢB gastric cancer.