A case of indirect inguinal bladder hernia treated with laparoscopic transabdominal preperitoneal repair with high peritoneal incisional approach.

BACKGROUND: Inguinal herniation of the urinary bladder is uncommon and those descending into the scrotum are even rarer. Although open anterior repair has been used for inguinal bladder hernia, the efficacy of laparoscopic herniorrhaphy has been reported in recent years. CASE PRESENTATION: A 63-year-old man presented with an irreducible right groin and scrotal bulge associated with voiding difficulty. Abdominal ultrasonography showed a dislocation of the urinary bladder descending into the right scrotum. Abdominal CT imaging revealed that a part of the bladder and small intestine was herniating into the scrotum through the internal inguinal ring and running laterally to the inferior epigastric artery. Under the diagnosis of indirect inguinal bladder hernia, the patient underwent trans-abdominal preperitoneal hernia repair (TAPP). The bladder herniated into the scrotum through the internal inguinal ring was replaced to the original position. Then the myopectineal orifice was exposed and covered with polypropylene mesh, where a horizontal peritoneal incision 4 cm above the hernia orifice, i.e., the high peritoneal incision approach (HPIA), allowed an easy peeling of the peritoneum and hernia sac. The patient's postoperative course was uneventful and the voiding difficulty resolved. The patient continued to do well without recurrence at 20 months after surgery. CONCLUSION: Preoperative evaluation with abdominal ultrasonography and CT scan allowed a precise diagnosis of a groin hernia with voiding difficulty. TAPP with HPIA was useful in the treatment of inguinal bladder hernia because this technique facilitated a quick confirmation of the hernia contents, secure dissection of the whole protruded bladder, and adequate replacement of the bladder to the original position without any injury.

[A case of pulmonary tuberculosis developed during chemotherapy for local advanced colon cancer].

We report a case of pulmonary tuberculosis developed during chemotherapy for colon cancer. A 78-year-old man with dyspnea was referred to our hospital for the treatment of transverse colon cancer with duodenal invasion. Chemotherapy was initiated for severe respiratory dysfunction associated with emphysema. After 3 months of chemotherapy, the patient required hospitalization because of severe general fatigue and appetite loss. Pneumonia occurred on the 9th hospital day. Antibiotic therapies with cefotiam hydrochloride or tazobactam/piperacillin were ineffective, his respiratory condition gradually decreased, and thus, endotracheal intubation was required. The patient was finally diagnosed with pulmonary tuberculosis by acid-fast staining of the sputum. Antituberculosis therapy with rifampicin, isoniazid, and streptomycin was effective, and acid-fast staining became negative after 2 weeks of antituberculosis therapy. However, he could not withdraw from the ventilator support and died of cancer progression on the 94th hospital day. Because chemotherapies induce immunosuppression, a targeted screening for latent tuberculosis infection should be performed in patients with colorectal cancer who are highly at risk for tuberculosis before starting chemotherapy, and pulmonary tuberculosis should be ruled out when a patient develops symptoms of pneumonia during chemotherapy.

Modulatory effects of supplementation of Lentinula edodes mycelia extract and l-arginine on the therapeutic efficacy of immunogenic chemotherapy in colon cancer-bearing mice.

Some chemotherapeutic drugs can induce cancer cell death and enhance antitumor T-cell immunity in cancer-bearing hosts. Immunomodulatory reagents could augment such chemotherapy-induced effects. We previously reported that oral digestion of Lentinula edodes mycelia (L.E.M.) extract or  l-arginine supplementation can augment antitumor T-cell responses in cancer-bearing mice. In this study, the effects of L.E.M. extract with or without  l-arginine on the therapeutic efficacy of immunogenic chemotherapy by 5-fluorouracil (5-FU)/oxaliplatin (L-OHP) and/or cyclophosphamide (CP) are examined using two mouse colon cancer models. In MC38 and CT26 cancer models, therapy with 5-FU/L-OHP/CP significantly suppressed tumor growth, and supplementation with L.E.M. extract halved the tumor volumes. However, the modulatory effect of L.E.M. extract was not significant. In the CT26 cancer model, supplementation with L.E.M. extract and  l-arginine had no clear effect on tumor growth. In contrast, their addition to chemotherapy halved the tumor volumes, although the effect was not significant. There was no difference in the cytotoxicity of tumor-specific cytotoxic T cells generated from CT26-cured mice treated by chemotherapy alone versus chemotherapy combined with L.E.M. extract/ l-arginine. These results indicate that the antitumor effects of immunogenic chemotherapy were too strong to ascertain the effects of supplementation of L.E.M. extract and  l-arginine, but these reagents nonetheless have immunomodulatory effects on the therapeutic efficacy of immunogenic chemotherapy in colon cancer-bearing mice.

[Role of peritoneovenous shunt therapy in end-of-life care of refractory malignant ascites cases].

The short- and long-term outcomes of 34 patients with refractory malignant ascites who underwent peritoneovenous shunt (PVS) therapy were retrospectively reviewed. The primary disease was gastrointestinal cancer in 31 patients and gynecologic cancer in 3 patients. Regarding performance status, 21 patients had Eastern Cooperative Oncology Group Performance Status (PS) 2 and 13 patients were PS 3;thus, many were in a poor general condition. After treatment, abdominal distention disappeared in 79.4% of patients, and appetite improved in 60.9%. The median postoperative survival time was 38 days (range, 1-294 days), and 18 patients (52.9%) were discharged. Disseminated intravascular coagulation with clinical symptoms was observed in 3 patients (8.8%), and heart failure was observed in 7 patients (20.6%). PVS therapy was useful in improving the subjective symptoms of patients with refractory malignant ascites and in enabling them to receive care at home. However, serious postoperative complications are a concern, and appropriate preoperative evaluation is necessary.

Duplicate left gastric artery identified during robot-assisted distal gastrectomy: a case report.

BACKGROUND: Duplicated left gastric artery (LGA) is a rare anomaly. With an incidence of only 0.4%, its clinical significance remains largely unrecognized. CASE PRESENTATION: A 65-year-old man underwent robot-assisted distal gastrectomy for early gastric cancer. After division of the left gastric vein in the left gastropancreatic fold, a slim LGA (LGA-1) was identified and dissected. Careful dissection of the left gastropancreatic fold toward the root of the celiac artery revealed another LGA (LGA-2), which was dissected without difficulty. Postoperative reevaluation of the three-dimensional-computed tomography (CT) angiography reconstructed using the preoperative CT scan identified a 2.7 mm LGA-1, branching from the splenic artery, and a 3.0 mm LGA-2, branching from the celiac artery. To the best of our knowledge, this is only the third reported case of a duplicate LGA in a patient who underwent laparoscopic gastrectomy. Our case is the first to report the use of robot surgery. CONCLUSIONS: Although duplicate LGA is rare and receives little clinical attention, surgeons should keep this vascular anomaly in mind during preoperative evaluation since there is an increased risk for intraoperative bleeding during gastrectomy.

Overlapping Esophagojejunostomy Using a Linear Stapler in Laparoscopic Total or Proximal Gastrectomy.

Background: Performing an intracorporeal esophagojejunostomy during laparoscopic-assisted total or proximal gastrectomy is challenging. We developed an ingenious method of overlapping esophagojejunostomy using a linear stapler to avoid stapler-related intraoperative complications. Methods: Following lymph node dissection, the esophagus was transected anterior-posteriorly. A linear stapler was used to divide the jejunum ∼20 cm distal to the Treitz ligament. A small enterotomy was then created 5 cm distal to the elevated jejunal stump to insert the linear stapler cartridge. An electronic knife was used to make a full-thickness incision, with the tip of the nasogastric tube (NGT) pressed against the posterior wall of the esophageal stump as a guide. Full-thickness sutures were placed on both the anterior and posterior walls of the entry hole in the esophageal stump to prevent the anvil fork from being misinserted into the submucosal layer of the esophagus. The thread on the posterior wall was guided through the port to the outside of the abdominal cavity, where the linear stapler was inserted to perform the side-to-side anastomosis. A 45-mm cartridge fork and an anvil fork were inserted into the elevated jejunum and esophageal stump entry holes, respectively, following which the esophageal stump was gently grasped. The thread on the posterior wall side was pulled from outside the abdominal cavity through the port. This step is necessary to close the gap between the esophageal and jejunal walls. After confirming that the anvil fork was not misinserted into the submucosal layer of the esophagus and that there was no gap between the esophagus and the elevated jejunum, the linear stapler was fired to create the anastomosis. The insertion hole was closed with hand-sewn sutures or linear staples to complete the esophagojejunostomy. Results: Eleven patients underwent this procedure with no anastomotic complications. Conclusions: This method enables us to perform an easier and more stable esophagojejunostomy.

Rational Gastric Conduit Stump Closure Method Using Endo GIA Radial Reload in End-to-Side Anastomosis of the Esophagogastric Conduit.

Background: The lack of tension at the anastomosis site and the blood flow of the gastric conduit are important to prevent anastomotic leakage in the anastomosis of the esophagogastric conduit. This study reports a gastric conduit stump closure method using Endo GIA™ Radial Reload in end-to-side anastomosis of the esophagogastric conduit, especially focusing on blood flow. Methods: A 4-cm conduit was created to ensure an intramural vascular network. The gastric conduit was elevated to the neck through the posterior mediastinal route, and end-to-side anastomosis of the esophagus and gastric conduit was performed using a circular stapler. Closure of the gastric stump with an Endo GIA Radial Reload was performed 2 cm proximal to the anastomosis on the end side of the esophagogastric conduit. The lesser curvature of the stump of the gastric conduit is the most frequent site of anastomotic leakage as it has the least blood flow, and the pressure is highest when the pressure inside the gastric conduit increases. Therefore, the gastric conduit stump was closed using the Endo GIA Radial Reload to resect the intersection of the gastric stump and lesser curvature from which the gastric conduit was created. The gastric conduit stump is gently curved; therefore, the pressure applied to the gastric conduit stump could be dispersed when the intragastric pressure increases. Results: No anastomotic leakage was observed among the 21 patients who underwent this method. Conclusion: This method is a novel anastomosis method to prevent anastomotic leakage in an end-to-side anastomosis of the esophagogastric conduit.

A modulatory effect of L-arginine supplementation on anticancer effects of chemoimmunotherapy in colon cancer-bearing aged mice.

Myeloid-derived suppressor cells (MDSCs) and regulatory T cells (Tregs) are increased in cancer-bearing aged hosts. Arginase-I in MDSCs degrades L-arginine, an amino acid required for T cell activation and proliferation. In this study, we compared the therapeutic efficacy of 5-fluorouracil (5-FU)/oxaliplatin (L-OHP) and cyclophosphamide (CP) between young and aged colon cancer-bearing mice. Therapy with 5-FU/L-OHP and CP significantly suppressed the in vivo growth of CT26 and MC38 colon carcinomas in syngeneic young mice, whereas this effect was attenuated in aged mice. L-arginine monotherapy showed no effect in aged mice. However, additional therapy with anti-programmed cell death (PD)-1 antibody and L-arginine supplementation boosted the effect of chemoimmunotherapy in aged mice, and some mice were cured. During all combination therapy, tumor-specific cytotoxic T lymphocytes (CTLs) were generated from mice with non-progressing tumor, but not from those with progressing tumor. Plasma L-arginine levels were lower in aged than young mice, and chemotherapy tended to decrease the plasma L-arginine levels in aged mice. Compared to young mice, CT26-bearing aged mice decreased arginase activity, arginase-I expression, and the proportion of monocytic MDSCs in tumor tissues, whereas contrasting results were observed in MC38-bearing aged mice. Importantly, the induction of tumor-specific CTLs was impaired at lower doses of L-arginine in vitro, and the infiltration of CTLs into CT26 tissues after chemoimmunotherapy was promoted by L-arginine administration in vivo. These results indicate that chemoimmunotherapy was less effective in cancer-bearing aged mice, but that L-arginine supplementation can modulate its therapeutic efficacy via its effect on tumor-specific CTLs.

Altemeier perineal rectosigmoidectomy with indocyanine green fluorescence imaging for a female adolescent with complete rectal prolapse: A case report.

BACKGROUND: Rectal prolapse in young women is rare. Although laparoscopic ventral mesh rectopexy is the standard procedure because of its lower recurrence rate, postoperative infertility is a concern. Perineal rectosigmoidectomy (Altemeier procedure) is useful for these patients. However, the risk of anastomotic leakage should be considered. Recently, the usefulness of fluorescence imaging with indocyanine green (ICG) to prevent anastomotic leakage was reported. We report a case of an adolescent woman with complete rectal prolapse who underwent ICG fluorescence imaging-assisted Altemeier rectosigmoidectomy. CASE SUMMARY: A 17-year-old woman who had a mental disorder was admitted to our hospital for treatment for water intoxication. The patient also suffered from rectal prolapse, approximately 3 mo before admission. She was referred to our surgical department because recurrent rectal prolapse could worsen her psychiatric disorder. Approximately 10 cm of complete rectal prolapse was observed. However, the mean maximum anal resting and constriction pressures were within normal limits on anorectal manometry. Because she had the desire to bear children in the future, she underwent Altemeier perineal rectosigmoidectomy to prevent surgery-related infertility. We performed ICG fluorescence imaging at the same time as surgery to reduce the risk of anastomotic leakage. Her postoperative course was uneventful, and the rectal prolapse was completely resolved. She continued to do well 18 mo after surgery, without recurrence of the rectal prolapse. CONCLUSION: ICG fluorescence imaging-assisted Altemeier perineal rectosigmoidectomy is useful in preventing postoperative anastomotic leakage in young as well as elderly patients.

Systemic Immune-Inflammation Index Predicts Overall Survival in Patients with Gastric Cancer: a Propensity Score-Matched Analysis.

BACKGROUND: The systemic immune-inflammation index (SII), integrated by peripheral lymphocyte, neutrophil, and platelet counts, is used as an objective biomarker that reflects the balance between host inflammatory and immune response status in cancer patients. Herein, we examined the prognostic significance of SII in gastric cancer patients. METHODS: We retrospectively reviewed data of 415 patients who underwent curative laparoscopic gastrectomy using propensity score-matched (PSM) analysis. The prognostic value of SII was compared between two groups based on SII values: low SII group (SII < 661.9) and high SII group (SII ≥ 661.9). RESULTS: In multivariate analysis, the American Society of Anesthesiologists physical status (ASA-PS) (p < 0.001), tumor differentiation (p = 0.019), pathological stage (p = 0.046), carcinoembryonic antigen (CEA) level (p < 0.001), SII (p = 0.006), and operative procedure (p = 0.009) were independent prognostic factors of overall survival (OS) in the overall PSM cohort. The log-rank test demonstrated that patients with a high SII had significantly worse OS than did those with low SII (p = 0.002). In age-stratified subgroups analysis (< 65/≥ 65 years), multivariate analysis revealed that ASA-PS (p < 0.001), tumor differentiation (p = 0.019), CEA level (p = 0.008), SII (p = 0.013), and operative procedure (p = 0.026) were independent prognostic factors of OS in the elderly group. Similarly, elderly patients with a high SII had significantly worse OS than did those with a low SII (p = 0.009). Meanwhile, SII was not an independent prognostic factor of OS, and no significant association was observed between SII and OS in non-elderly patients. CONCLUSIONS: SII was an independent prognostic indicator in gastric cancer patients, especially in the elderly population.

Prediction of postoperative complications and survival after laparoscopic gastrectomy using preoperative Geriatric Nutritional Risk Index in elderly gastric cancer patients.

BACKGROUND: Preoperative nutritional assessment of cancer patients is important to reduce postoperative complications. Several studies have reported the Geriatric Nutritional Risk Index (GNRI) to be useful in assessing underlying diseases and long-term outcomes of hospitalized patients. The present study aimed to evaluate the impact of preoperative GNRI on short- and long-term outcomes in elderly gastric cancer patients who underwent laparoscopic gastrectomy. METHODS: We retrospectively reviewed consecutive patients aged ≥ 65 years who underwent laparoscopy-assisted gastrectomy and had R0 resection for histologically confirmed gastric adenocarcinoma. The cutoff value for preoperative GNRI was determined to be 85.7 based on the incidence of postoperative complications. Patients were categorized into two groups: low GNRI group and normal GNRI group. RESULTS: Univariate analyses of the 303 patients revealed that the incidence of postoperative complications was significantly associated with the American Society of Anesthesiologists Physical Status classification (ASA-PS), C-reactive protein (CRP), GNRI (p < 0.001), and operative procedure. Multivariate analyses revealed that preoperative GNRI (odds ratio [OR] 2.716; 95% confidence interval [CI] 1.166-6.328; p = 0.021) and operative procedure (OR 2.459; 95% CI 1.378-4.390; p = 0.002) were independently associated with the incidence of postoperative complications. Univariate analyses showed that overall survival (OS) was significantly associated with ASA-PS, tumor size, tumor differentiation, pathological tumor node metastasis (TNM) stage, carcinoembryonic antigen (CEA), CRP, GNRI, and postoperative complications. Multivariate analysis demonstrated that ASA-PS (hazard ratio [HR], 3.755; 95% CI 2.141-6.585; p < 0.001), tumor differentiation (HR 1.898; 95% CI 1.191-3.025; p = 0.007), CEA (HR 1.645; 95% CI 1.024-2.643; p = 0.040), and GNRI (HR 2.093; 95% CI 1.105-3.963; p = 0.023) independently predicted OS. CONCLUSION: GNRI is an important predictor of postoperative complications and overall survival in elderly gastric cancer patients. It is a reliable and cost-effective prognostic indicator that should be routinely evaluated.

Immunogenic chemotherapy in two mouse colon cancer models.

Aside from the induction of cell death, some anticancer chemotherapeutic drugs can modulate antitumor immune responses. In this study, we examined the anticancer effects of 5-fluorouracil (5-FU) and oxaliplatin (L-OHP), which are standard chemotherapeutic drugs for colon cancer, combined with cyclophosphamide (CP) in two mouse colon cancer models (CT26 and MC38 colon adenocarcinoma models). In the CT26 model, two injections of 5-FU/L-OHP and CP significantly suppressed the growth of subcutaneously established CT26 tumors compared with either 5-FU/L-OHP or CP, without a significant loss of body weight. The anticancer effect was weakened in nude mice. Cured mice acquired protective immunity against CT26, and CT26-specific cytotoxic T cells (CTLs) were induced from their spleen cells. Analysis of tumor-infiltrating immune cells revealed that 5-FU/L-OHP treatment with or without CP increased the proportion of CD8+ T cells at tumor sites. The 5-FU/L-OHP treatment decreased the proportion of granulocytic myeloid-derived suppressor cells (MDSCs) and increased monocytic MDSCs in tumor sites, whereas the addition of CP treatment reversed these changes. In the MC38 model, although significant anticancer effects of the triple combination therapy were seen, additional treatment with anti-PD-1 antibody increased the number of cured mice. These mice exhibited protective immunity against MC38, and MC38-specific CTLs were generated from their spleen cells. Together, these results indicate that the antitumor effects of the combination of 5-FU/L-OHP and CP mainly depend on host T cells; moreover, the therapeutic efficacy can be effectively boosted by immune checkpoint blockade.

Comparison of the prognostic value of immunoinflammation-based biomarkers in patients with gastric cancer.

Background: Systemic immune-inflammation index (SII)-comprising platelet, neutrophil, and lymphocyte count-is an objective and reliable biomarker for predicting the prognosis in cancer patients because it comprehensively reflects the balance between host inflammatory and immune responses. In this study, we clarified the prognostic impact of immunoinflammation-based indices, i. e. SII, neutrophil/lymphocyte ratio (NLR), and platelet/lymphocyte ratio (PLR), in gastric cancer patients. Results: In multivariate analysis, the American Society of Anesthesiologists physical status (ASA-PS) (hazard ratio [HR]: 3.366, p < 0.001), tumor differentiation (HR: 1.705, p = 0.020), pathological Tumor, Node, Metastasis (pTNM) stage (HR: 2.160, p = 0.008), and carcinoembryonic antigen (CEA) (HR: 1.964, p = 0.003) were independent prognostic factors for OS in all patients. Further, multivariate analysis revealed that age (HR: 2.088, p = 0.040), ASA-PS (HR: 2.339, p = 0.043), tumor differentiation (HR: 1.748, p = 0.044), and pTNM stage (HR: 2.114, p = 0.024) were independent prognostic factors for OS among patients without inflammation; SII was not a prognostic factor for OS. Meanwhile, body mass index (HR: 5.055, p = 0.011), ASA-PS (HR: 3.403, p = 0.007), and SII (HR: 4.208, p = 0.026) were independent prognostic factors for OS among patients with inflammation. Materials and Methods: We performed a retrospective review of 412 patients who underwent curative laparoscopic gastrectomy. The prognostic value of SII was compared between a low SII group (SII<661.9) and high SII group (SII≥661.9). We analyzed the predictive ability of immunoinflammation-based indices for overall survival (OS) based on a C-reactive protein (CRP) level of 0.5. Conclusions: Compared to NLR and PLR, SII is the most significant prognostic biomarker for OS, especially in gastric cancer patients with inflammation.

Case of inflammatory granuloma in inguinal hernia sac after hysterosalpingography with oily contrast medium.

INTRODUCTION: The foreign body reaction caused by oil contrast medium, Lipiodol, is rare. We present a rare case of inflammatory granuloma in the inguinal hernia sac after hysterosalpingography with lipiodol. PRESENTATION OF CASE: A 30-year-old woman who had left inguinal growing mass for 7 months after hysterosalpingography with Lipiodol for examination of infertile. About 3 cm soft mass was palpable on the left inguinal region, and plane CT scan showed a multifocal cystic mass with metal concentration. Thus, laparoscopic herniorrhaphy was performed to repair the inguinal hernia and to confirm the contents of cystic lesion. The hernia sac filled with mucinous contents. Pathological examination revealed that inflammatory granuloma due to numerous lipid droplets and phagocytic images of leukocytes in the hernia capsule. DISCUSSION AND CONCLUSION: Although oil contrast medium is safety agent, there is rear complication which need the surgical treatment. Complete resection of granuloma, including hernia sac, is important to prevent recurrence.

Supplementation of l-arginine boosts the therapeutic efficacy of anticancer chemoimmunotherapy.

Myeloid-derived suppressor cells (MDSCs) play a crucial role in immunosuppression in tumor-bearing hosts. MDSCs express arginase-I and indoleamine 2,3-dioxygenase; they suppress T-cell function by reducing the levels of l-arginine and l-tryptophan, respectively. We examined the anticancer effects of supplementation of these amino acids in CT26 colon carcinoma-bearing mice. Oral supplementation of l-arginine or l-tryptophan (30 mg/mouse) did not affect tumor growth, whereas oral supplementation of d-arginine was lethal. Supplementation of l-arginine showed a tendency to augment the efficacy of cyclophosphamide (CP). CP reduced the proportions of granulocytic MDSCs and increased the proportions of monocytic MDSCs in the spleen and tumor tissues of CT26-bearing mice. l-Arginine supplementation alone did not affect the MDSC subsets. CP treatment tended to reduce the plasma levels of l-arginine in CT26-bearing mice and significantly increased the number of tumor-infiltrating CD8+ T cells. In addition, l-arginine supplementation significantly increased the proportions of tumor peptide-specific CD8+ T cells in draining lymph nodes. Importantly, additional supplementation of l-arginine significantly increased the number of cured mice that were treated with CP and anti-PD-1 antibody. Totally, l-arginine supplementation shows promise for boosting the therapeutic efficacy of chemoimmunotherapy.

Comprehensive Analysis of Red Blood Cell Distribution Width as a Preoperative Prognostic Predictor in Gastric Cancer.

BACKGROUND/AIM: The aim of the current study was to investigate the impact of the preoperative red cell distribution width (RDW) value on the overall survival (OS) and cancer-specific survival (CSS) of gastric cancer patients. PATIENTS AND METHODS: A total of 366 gastric cancer patients who underwent curative gastrectomy were retrospectively reviewed. Among them, RDW was evaluated in 165 non-elderly and 201 elderly patients. RESULTS: Multivariate analysis revealed that pathological stage (pStage), RDW, and carcinoembryonic antigen (CEA), were independent prognostic factors of OS, while pStage and RDW were independent prognostic factors of CSS. In non-elderly patients, based on the multivariate analysis, pStage, adjuvant chemotherapy, and RDW were identified as independent prognostic factors of OS. In elderly patients, RDW was identified as independent prognostic factors of OS and CSS. CONCLUSION: Preoperative RDW is a promising independent prognostic factor in gastric cancer.

Controlling Nutritional Status (CONUT) as a prognostic immunonutritional biomarker for gastric cancer after curative gastrectomy: a propensity score-matched analysis.

BACKGROUND: In clinical practice, it is not unusual to treat oncologic patients whose tumor markers are within normal range, even with advanced cancer. The Controlling Nutritional Status (CONUT) score could provide a useful nutritional and immunological prognostic biomarker for cancer patients. In this study, we assessed the prognostic value of the CONUT score for patients with gastric cancer, including a subgroup analysis with stratification based on serum carcinoembryonic antigen (CEA) level. METHODS: We retrospectively reviewed the medical records of 368 consecutive patients who underwent curative laparoscopy-assisted gastrectomy. The prognostic value of the CONUT score was compared between patients with a low (≤ 2) and high (≥ 3) score, with propensity score matching (PSM) used to control for biasing covariates (Depth of tumor, Lymph node metastasis, pathological TNM (pTNM) stage). RESULTS: Overall survival (OS) among all patients was independently predicted by the tumor stage (hazard ratio (HR): 2.231, p = 0.001), the CONUT score (HR: 2.254, p = 0.001), and serum CEA level (HR: 1.821, p = 0.025). Among patients with a normal preoperative serum CEA level, tumor stage (HR: 2.350, p = 0.007), and the CONUT score (HR: 1.990, p = 0.028) were independent prognostic factors of OS. In the high serum CEA level group, tumor size (HR: 2.930, p = 0.015) and the CONUT score (HR: 3.707, p = 0.004) were independent prognostic factors of OS. CONCLUSIONS: It is advantageous to use both CEA level and the CONUT score to assess the prognosis of patients with gastric cancer, which reflect both tumor-related factors and host-related factors, respectively.

Preoperative Prognostic Nutritional Index Predicts Long-term Outcome in Gastric Cancer: A Propensity Score-matched Analysis.

BACKGROUND/AIM: Recent evidence suggests that preoperative malnutrition may lead to poor survival in cancer patients. This study aimed to determine the ability of the prognostic nutritional index (PNI) to predict survival in gastric cancer patients. PATIENTS AND METHODS: Two hundred and eighteen patients who had undergone laparoscopic gastrectomy were retrospectively reviewed via propensity score-matched analysis. RESULTS: In multivariate analysis of overall patients, pTNM stage, carcinoembryonic antigen, and PNI were independent predictors of overall survival (OS), and pTNM stage and PNI were independent predictors of cancer-specific survival (CSS). Among the 92 non-elderly patients, pTNM stage and PNI were independent predictors of OS, and pTNM stage, PNI, and adjuvant chemotherapy were independent predictors of CSS in multivariate analysis. On the other hand, among the 126 elderly patients, low PNI value was identified as a significant predictor of shorter OS in univariate analysis. CONCLUSION: PNI is associated with OS and CSS in gastric cancer patients, especially non-elderly patients.

Prognostic significance of red cell distribution width in esophageal squamous cell carcinoma.

BACKGROUND: Red cell distribution width (RDW) is routinely assessed as part of the complete blood count (CBC) to gather information on the heterogeneity in the size of circulating erythrocytes. RDW is a more sensitive screening marker for anemia, inflammation, and nutritional deficiencies. The purpose of this study was to explore the prognostic value of RDW in esophageal squamous cell carcinoma (ESCC) patients. METHODS: We conducted a retrospective study of data from 148 ESCC consecutive patients who underwent potentially curative esophagectomy and analyzed the correlation of RDW with various clinicopathological factors. RESULTS: Multivariate analyses identified a high RDW (HR, 2.061; P = 0.0286) as a significant risk factor for cancer-specific survival (CSS). Kaplan-Meier analysis and the log-rank test demonstrated that patients with a high RDW had a significantly worse prognosis in terms of CSS than those with a low RDW (P = 0.0011). In multivariate analysis, there was no significant relationship between RDW and CSS in pathological tumor node metastasis stage I or II patients. However, a high RDW (HR, 2.386; P = 0.0471) was confirmed to be an independent worse prognostic factor for CSS in pathological tumor node metastasis stage III cancer patients. Kaplan-Meier analysis and the log-rank test showed a significant relationship between RDW and CSS in patients with pathological tumor node metastasis stage III (P = 0.0175). CONCLUSIONS: The RDW was a significant and independent predictor of poor survival in ESCC patients after curative esophagectomy. RDW may aid clinicians in detecting signs of recurrence very early and effectively customize treatment regimens. RDW is thus a convenient, cost-effective, and readily available biomarker to predict survival in ESCC.

Complete abdominal wound and anastomotic leak with diffuse peritonitis closure achieved by an abdominal vacuum sealing drainage in a critical ill patient: a case report.

BACKGROUND: Negative pressure wound therapy (NPWT) is a widely accepted technique to treat local infectious wounds of the skin, subcutaneous tissue, fascia, or muscle. Recently, several reports describing the efficacy of NPWT for various types of fistulas and anastomotic leaks have been published. We herein describe a patient with an open abdominal wound due to colonic anastomotic leakage and diffuse peritonitis, in whom abdominal vacuum sealing (AVS) as a modified NPWT was useful for the management of this complex wound. CASE PRESENTATION: A 32-year-old man was admitted to our hospital with late presenting traumatic diaphragmatic hernia and strangulated ileum complicated by necrosis of the ileum and transverse colon. He had a history of cervical spinal cord injury due to suicide attempt 14 years earlier and, as a result of cervical spinal cord injury, he was paralyzed in the lower body. The patient underwent an urgent hernia repair and bowel resection. Postoperatively, he developed severe septic shock. On postoperative day (POD) 6, wound dehiscence due to colonic anastomotic leakage with diffuse peritonitis was diagnosed, but he was unable to undergo re-operation because of refractory severe septic shock combined with neurogenic shock due to the cervical cord injury. The patient was treated with AVS therapy. He gradually recovered from septic shock, and the anastomotic leakage healed after a 2-month period. The wound dehiscence was also reduced. The patient resumed oral intake on POD 112 and was discharged on POD 190. CONCLUSIONS: Although surgical repair would be the best method for the treatment of diffuse peritonitis due to gastrointestinal perforation or anastomotic leakage, our case suggests that AVS with 'conventional' drainage is a treatment of choice for open abdominal wounds even in the presence of diffuse peritonitis caused by intestinal anastomotic leakage, especially in patients with poor general medical condition.