Purpose
The aim of this study was to examine the risk factors for and to evaluate strategies for preventing pouchitis as a postoperative complication of ulcerative colitis (UC).
Methods
A total of ...119 cases of UC in which restorative proctocolectomy with an ileal pouch-anal anastomosis (IPAA) was performed at our institution between 2000 and 2012 was investigated; nine patients in whom it was impossible to close the ileostomy due to an intractable anal fistula or pelvic abscess were excluded.
Results
The cumulative risk of developing pouchitis 5 years after IPAA with stoma closure was 31.0 %. Significant relationships with pouchitis were found for the surgical indication (
p
= 0.0126) and surgical method (
p
= 0.0214). A significant correlation was found between pouchitis and cuffitis. Pouchitis was significantly more common in the cases with cuffitis than in those without (
p
= 0.0002). There was also a significantly different cumulative incidence observed between the cases with and without cuffitis (
p
< 0.0001). In addition, pouchitis had a greater tendency to recur in the cases with cuffitis than in those without (
p
= 0.2730).
Conclusion
The cumulative incidence rate of pouchitis was 10.6 % at 1 year, 15.1 % at 2 years and 31.0 % at 5 years. Controlling cuffitis is important to prevent pouchitis.
Background
There is currently no consensus on the significance of Japanese D3 lymph node dissection in low rectal cancer with inferior mesenteric lymph node (IMLN) metastasis. This is partly because, ...despite a number of studies on the subject, cases of IMLN metastasis are relatively rare, and there are few cases of curative resection because of metastasis to other organs. A retrospective study involving a large number of patients was conducted.
Methods
The subjects were 2,743 patients registered in the national registry of the Japanese Society for Cancer of the Colon and Rectum. The data were analyzed for (1) prognostic factors for IMLN metastasis, and (2) outcomes in R0 cases with IMLN metastasis.
Results
In the control group, 67 patients (2.7 %) were considered positive for IMLN metastasis. The outcomes in the 35 R0 cases with IMLN metastasis were 50.8 % for 5-year relapse-free survival (RFS) and 61.9 % for 5-year overall survival (OS), which were each better than for R1+R2 cases (5-year RFS 16.1 %,
p
= 0.0001; 5-year OS 26.7 %,
p
= 0.0002). The outcomes for R0 cases (total metastatic lymph nodes ≥7) with IMLN metastasis (5-year RFS 53.9 %, 5-year OS 68.8 %) did not differ significantly from those for IMLN(−) cases (5-year RFS 54.6 %, 5-year OS 57.1 %) (RFS:
p
= 0.9515, OS:
p
= 0.4621).
Conclusions
It was confirmed that cases of IMLN metastasis in low rectal cancer tend to have a large total number of metastatic lymph nodes, but if curative resection can be performed, a good prognosis can be expected. These results demonstrate the value of radical Japanese D3 lymph node dissection in low rectal cancer with IMLN metastasis.
A 65-year-old male. One year following abdominoperineal rectal resection due to rectal cancer in 2010, parastomal hernia was observed and laparoscopic parastomal hernioplasty was carried out by the ...sugarbaker method using dual mesh two years postoperatively. Because swelling was observed around the stoma two months following the repair similarly as in the preoperational state and the small intestine was found to have penetrated into the hernia orifice upon CT scan, we made a diagnosis of recurrence of the hernia and carried out surgery once again. Due to this recurrence, surgery was carried out laparotomically and it was found that the mesh used for repairing outward from the head side of the soma was everted, with the hernia orifice observed at the same site. Because the mesh showed strong adhesion, the sandwich method, wherein the keyhole method is used in combination with the sugarbaker method, was carried out for repair with mesh. It has been reported that the recurrence of laparoscopic repair is often observed outside the stoma and thus it is believed that it is necessary to pay special attention to fixing the mesh and especially reinforcing it on the outside.
Abstract only
773
Background: The aim of this study was to investigate the age-specific prognostic factors for overall survival (OS) and disease-free interval (DFI) after pulmonary metastasectomy for ...colorectal cancer (CRC). Methods: We performed a retrospective analysis of 1,179 patients who underwent lung resection for colorectal metastases from 2001 to 2012 in 109 affiliated institutions of the Japanese Society for Cancer of the Colon and Rectum study group. The patients were divided into three groups by the age at pulmonary resection: Group A (GA) comprised of 396 patients who underwent lung resection under the age of 60 years old; Group B (GB) comprised of 604 patients who underwent lung resection between the ages of 61 and 74 years old; Group C (GC) comprised of 179 patients who underwent lung resection over the age of 75 years old. We used the Cox proportional hazard regression to identify independent prognostic factors for OS and DFI. Results: Median OS times after pulmonary resection were 45 months, 43 months, and 43 months for GA, GB, and GC, respectively. Two-year and 5-year overall survival rates were 73% and 54% for GA, 77% and 63% for GB, and 82% and 68% for GC, respectively. The independent unfavorable prognostic factors were recurrence after pulmonary resection (p<0.0001) in GA, detection of liver metastases before lung resection (p=0.0126), a high level of carcinoembryonic antigen (p=0.0003), and recurrence after pulmonary resection (p<0.0001) in GB, and recurrence after pulmonary resection (p<0.0001) in GC. Median DFI times were 11 months in all groups. The independent unfavorable prognostic factor was a removal of mediastinal lymph node (p=0.0335) in GB. Conclusions: Elder patients (GC) showed nearly the same OS rate compared with non-elder patients (GB), while younger patients (GA) showed poor OS rate. Recurrence after pulmonary resection revealed to be a poor prognostic factor in all groups.
Abstract only
530
Background: The current Japanese Classification of Colorectal Carcinoma defines inferior mesenteric lymph nodes (IMLN) and lateral lymph nodes (LLN) as regional lymph nodes in ...rectal cancer. It states that these lymph nodes should be dissected when performing D3 dissection for rectal cancer. However, there is currently no consensus on the significance of Japanese D3 lymph node dissection in low rectal cancer. A retrospective study involving a large number of patients was conducted. Methods: The subjects were 2,743 patients registered in the multi-institutional registry of the Japanese Society for Cancer of the Colon and Rectum. The data were analyzed for outcomes in R0 cases with IMLN and/or LLN metastasis (IMLN(+)LLN(-) or IMLN(-)LLN(+) or IMLN(+)LLN(+)). Results: In the control group, 67 patients (2.7%) were considered positive for IMLN metastasis, 181 patients (7.4%) for LLN metastasis, and 34 patients (1.4%) for IMLN + LLN metastasis. The outcomes in the R0 cases with IMLN and/or LLN metastasis were 52.8% for 5-year RFS and 63.1% for 5-year OS, which were each better than for R1+R2 cases (5-year RFS 26.2%, p<0.0001; 5-year OS 30.5%, p<0.0001). Including only those with a total of seven or more metastatic lymph nodes, the outcomes in the R0 cases with IMLN and/or LLN metastasis were 53.6% for 5-year RFS and 64.9% for 5-year OS, which did not differ significantly from those for IMLN(-)LLN(-) cases (5-year RFS 54.4%, 5-year OS 55.2%) (RFS: p=0.9718, OS: p=0.4049). Conclusions: We confirmed that cases of IMLN and/or LLN metastasis in low rectal cancer tend to have a large total number of metastatic lymph nodes, but a good outcome can be expected if curative resection can be performed. These results demonstrate the value of radical Japanese D3 lymph node dissection in low rectal cancer with IMLN and/or LLN metastasis.
Currently in Japan, breast-conserving therapy, consisting of breast-conserving surgery and post-operative radiation therapy, is performed frequently for the treatment of invasive breast cancer. It ...has been demonstrated that radiation therapy not only prevents recurrence in the preserved breast, but that it also contributes to improved patient survival. The present study describes the case of a 37-year-old woman with radiation recall dermatitis that occurred 6 years and 4 months after breast-conserving surgery. Erythema with a relatively distinct border was observed at the irradiated site on the left breast; eczema was diagnosed by a dermatologist. Inflammatory breast cancer was ruled out, since chest X-ray, abdominal ultrasound and bone scintigraphy were negative. Following ~1 month of topical corticosteroid application and oral second generation antihistamine treatment, the erythema was alleviated and the subjective symptoms also disappeared. Only a few cases of radiation recall dermatitis have been described in the fields of radiology and dermatology, but not yet in the surgical field. In the future, the incidence of radiation recall dermatitis is predicted to increase due to the increasing number of patients undergoing breast-conserving therapy. Whether in the surgical, radiological or dermatological field, if erythema is detected at the irradiated site during post-operative follow-up, routine care should be provided, keeping in mind the possibility of radiation recall dermatitis and inflammatory breast cancer.
Abstract only
590
Background: Resection of hepatic or pulmonary metastases (HPM) has been accepted as appropriate therapy. However whether aggressive surgery of both hepatic and pulmonary metastases ...from colorectal cancer (CRC) is of value has not been verified in detail. Methods: 1,179 patients undergone complete pulmonary resection were collected from 110 institutions by the 78
th
Congress of the Japanese Society of Cancer of the Colon and Rectum. Data on 209 of 1,179 patients who had undergone resection of HPM from CRC were included in this study. Results: (1) Outcome of surgery: In 970 patients undergoing pulmonary resection alone, 5-year relapse free survival and 5-year survival after pulmonary resection were 41.9% and 65.3%. In 209 patients undergoing hepatic and pulmonary resection, 5-year relapse free survival and 5-year survival after pulmonary resection were 33.5% (p = 0.0016) and 57.8% (p = 0.0021). The outcomes after resection were significantly better in patients with sequentially detected metastases (5-year survival of 71.6%) than in those with simultaneously detected ones (5-year survival of 41.5%) (p = 0.0016). (2) Prognostic factor:Univariate analysis revealed three variables. These were the disease free interval less than 2 years from CRC surgery to pulmonary resection (DFI) (p = 0.005), lymph node metastases of original site (p = 0.01) and extent of hepatic metastases (p = 0.01). The other factors were not statistically significant for prognosis. Multivariate analysis revealed two variables that were major prognostic factors. These were DFI (p = 0.003), and lymph node metastases of original site (p = 0.0019). Conclusions: Resection of HPM from CRC may help to prolong the survival. Independent, significant prognositic factors were lymph node metastases of original site and the DFI from CRC surgery to pulmonary resection.
To validate the conventional Japanese grading of liver metastasis for no residual tumor resection in Stage IV colorectal cancer (CRC) with liver metastasis and to identify risk factors for ...postoperative recurrence.
The subjects of this study were 1792 Stage IV CRC patients with liver metastasis.
In 1792 cases, including unresectable cases, there was a significantly different prognosis by grade (P < 0.0001). In 421 R0 cases, there was no significant difference between Grade A and Grade B (P = 0.8527). In 381 cases without extra-hepatic metastasis, the prognosis was not significantly different among three grades. On multivariate analysis, carcinoembryonic antigen within 3 months from R0 operation (3M-CEA) was an independent risk factor regardless of extrahepatic metastasis. There was a significantly different prognosis (P < 0.0001) among Grade A', defined as a normal 3M-CEA level, Grade B', defined as Grade A or B and an abnormal 3M-CEA level, and Grade C', defined as Grade C and an abnormal 3M-CEA level.
The postoperative CEA level is an important risk factor during follow-up after curative resection in patients with liver metastatic colorectal carcinoma. The combination of the 3M-CEA level and conventional grading of liver metastasis is useful for follow-up of R0 resection cases.
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