Purpose
The aim of this retrospective study was to establish a new prognostic staging system for pulmonary metastases from colorectal carcinoma (CRC).
Methods
The baseline characteristics and ...outcomes on 352 CRC patients who underwent complete pulmonary resection were collected from 19 institutions by the Japanese Society for Cancer of the Colon and Rectum (JSCCR) Study Group (group A). The clinical and pathological factors were entered into a multivariate analysis to identify independent variables that were helpful for accurately predicting the long-term prognosis after pulmonary resection. Using the selected variables in group A, we developed a new prognostic staging system (PSS). The new PSS was examined in a validation study in a series of 841 patients from 110 institutions of the JSCCR by the 78th society of the JSCCR (group B).
Results
We evaluated four variables selected in the multivariate analysis: the number of pulmonary metastases, the distribution, the disease-free interval and the lymph node metastases of primary cancer in group A. Using these four variables, we developed a new PSS. This PSS was found to significantly predict the prognosis in group B.
Conclusions
Our new PSS was useful for the selection of patients suitable for pulmonary resection.
Background Pedunculated polyps are more likely to be amenable to complete resection than non-pedunculated early colorectal cancers and rarely require additional surgery. We encountered a patient with ...a pedunculated early colorectal cancer that consisted of poorly differentiated adenocarcinoma with lymphatic invasion. We performed an additional bowel resection and found nodal metastasis. Case presentation A 43-year-old woman underwent colonoscopy after a positive fecal occult blood test. The colonoscopist found a 20-mm pedunculated polyp in the descending colon and performed endoscopic resection. Histopathologic examination revealed non-solid type poorly differentiated adenocarcinoma. The lesion invaded the submucosa (3500 mum from the muscularis mucosa) and demonstrated lymphatic invasion. In spite of the early stage of this cancer, the patient was considered at high risk for nodal metastasis. She was referred to our institution, where she underwent bowel resection. Although there was no residual cancer after her endoscopic resection, a metastatic lesion was found in one regional lymph node. The patient is undergoing postoperative adjuvant chemotherapy, and there has been no evidence of recurrence 3 months after the second surgery. Conclusions Additional bowel resection is indicated for patients with pedunculated polyps and multiple risk factors for nodal metastasis, such as poorly differentiated adenocarcinoma and lymphatic invasion. We encountered just such a patient who did have a nodal metastasis; herein, we report her case history with a review of the literature. Keywords: Early colorectal cancer, Poorly differentiated adenocarcinoma, Pedunculated polyp
Peritoneal carcinomatosis (PC) from colorectal cancer has been associated with poor survival but new approaches and postoperative chemotherapy have improved survival. The purpose of this study was to ...evaluate the clinical utility of imaging in cases of PC from colorectal cancer.
This is a retrospective single-institution study which examined 23 patients with colorectal cancer who underwent positron emission tomography (PET), computed tomography (CT) and received a final diagnosis PC in our institute between 2005 and 2010.
PET/CT detected PC in 19 of 23 cases (82.6%), whereas CT detected PC in 6 of 20 cases (30%). Four cases of PC were FDG-negative, all with maximal size <10mm, representing smaller tumors. FDG-negative PC was diffuse in 3 cases and nodular in 1. The distributed spotty uptake of FDG-negative PC was harder to detect. Diagnostic detection of PC was only achieved in 3 of 23 cases (13%). In the remaining cases, clinical diagnosis was metastasis to lymph nodes, recurrence, or normal FDG uptake by intestine.
PET/CT offers efficient detection of PC and has the potential to improve clinical diagnosis when coupled with an understanding of the pathways of flow for ascitic fluid and peritoneal seeding.
Background
A Japanese multicenter study disclosed four prognostic indicators of colorectal cancer liver metastases: ≥5 hepatic tumors (HT), HT size > 5 cm, nodal status (N2) of primary cancer, and ...the presence of extrahepatic metastases (EM). The Japanese classification was then defined as Stage A, HT1 (≤4 lesions and ≤5 cm) and N0/1; Stage B, HT2 (≥5 lesions or >5 cm) and N0/1, or HT1 and N2; and Stage C, HT2 and N2, HT3 (≥5 lesions and >5 cm) with any N, or EM1 (presence of EM) with any HT/N. This study aimed to validate the prognostic reliability in a recent population and to develop a modified staging system that divided Stage C patients.
Methods
A total of 1185 patients diagnosed with liver metastases between 2007 and 2008 were enrolled in the study. According to the classification, 358, 257, and 570 patients were categorized as Stages A, B, and C, respectively. Stage C was further divided into two groups: Stage C-I, HT3 and N0/1, HT2 and N2, or HT1 and EM1; and Stage C-II, HT3 and N2, or HT2/3 and EM1.
Results
Cumulative overall survival curves for Stages A, B, and C were significantly different between each two stages (
p
< 0.0001,
p
< 0.0001). The modified system discriminated patients with a relatively better outcome (Stage C-I) from desperate patients (Stage C-II) (
p
< 0.0001).
Conclusions
The Japanese classification system was adequately validated in a recent population, and the modified system is useful in risk stratification of Stage C cases.
Aim
To establish a new Japanese classification of synchronous peritoneal metastases from colorectal cancer.
Methods
This multi‐institutional, prospective, observational study enrolled patients who ...underwent surgery for colorectal cancer with synchronous peritoneal metastases. Overall survival rates were compared according to the various models using objective indicators. Each model was evaluated by Akaike's information criterion (AIC). The region of peritoneal metastases was evaluated by the peritoneal cancer index (PCI).
Results
Between October 2012 and December 2016, 150 patients were enrolled. The AIC of the present Japanese classification was 1020.7. P1 metastasis was defined as confined to two regions. The minimum AIC was obtained with the cutoff number of 10 or less for P2 metastasis and 11 or more for P3 metastasis. As for size, the best discrimination ability between P2 and P3 metastasis was obtained with a cutoff value of 3 cm. The AIC of the proposed classification was 1014.7. The classification was as follows: P0, no peritoneal metastases; P1, metastases localized to adjacent peritoneum (within two regions of PCI); P2, metastases to distant peritoneum, number ≤10 and size ≤3 cm; P3, metastases to distant peritoneum, number ≥11 or size >3 cm; P3a, metastases to distant peritoneum, number ≥11 and size ≤3 cm, or number ≤10 and size >3 cm; P3b, metastases to distant peritoneum, number ≥11 and size >3 cm.
Conclusion
This objective classification could improve the ability to discriminate prognosis in patients with synchronous peritoneal metastases from colorectal cancer.
The present study demonstrated a new objective classification for peritoneal metastasis from colorectal cancer.
Purpose
To make a Stage II colorectal cancer (CRC) sub-classification based on clinicopathological factors.
Methods
The subjects of this study were 422 patients with Stage II CRC, who underwent ...curative surgery with dissection of more than 12 lymph nodes. We used the logistic regression analysis or model and Cox’s proportional hazard regression model for analysis.
Results
Preoperative carcinoembryonic antigen (CEA) level (
p
= 0.0057), macroscopic type (
p
= 0.0316), and depth of invasion (
p
= 0.0401) were extracted as independent risk factors for recurrence, whereas the preoperative CEA level (
p
= 0.0045) and depth of invasion (
p
= 0.0395) were extracted as independent predictors of 5-year disease-free survival. We defined depth of invasion (pT4) and the preoperative CEA level (abnormal) as risk factors for recurrence, and classified Grade A as a normal CEA level regardless of depth invasion, Grade B as depth of invasion to pT3 and an elevated CEA level, and Grade C as depth of invasion to pT4 and an elevated CEA level. There were significant differences in cumulative 5-year disease-free survival rates among each grade (Grade A vs. Grade B,
p
= 0.0474; Grade A vs. Grade C,
p
< 0.0001; Grade B vs. Grade C,
p
= 0.0134).
Conclusion
The sub-classification of Stage II CRC, according not only to depth of invasion but also to preoperative CEA level, is important for predicting the prognosis.
Purpose
A prospective, multicenter, observational study was performed to investigate the risk factors of surgical site infection (SSI) in patients with ulcerative colitis (UC).
Methods
From 2009 to ...2010, perioperative clinicopathological data were collected from patients who had undergone surgery for UC within the research period, for up to 6 consecutive months in 13 hospitals in Japan. The primary outcome was the development of SSI.
Results
A total of 195 patients with UC who underwent colorectal surgery were enrolled. SSI was diagnosed in 38 (19.5 %) patients, in the form of incisional infection in 23 (11.8 %), organ/space infection in 16 (8.2 %), and both in 1 (0.5 %). There were no significant risk factors associated with an increased risk of development of incisional SSI. An American Society of Anesthesiologists physical status of ≥ 3 was indicated as the only significant risk factor for organ/space SSI (
P
= 0.02) compared with other factors, such as a neutrophil count of >100 × 10
2
/mm
3
, albumin level of <3.5 g/dl, perioperative packed red blood cell transfusion, fair or poor colonic cleanliness, and therapeutic use of antibiotics.
Conclusion
Poor general physical status was the significant independent risk factor for organ/space SSI in patients with UC in Japan.
The purpose of this multicenter study was to clarify the incidence and severity classification system (J Jpn Soc Coloproctol 64:853, 2011) of early stoma-related complications in gastrointestinal ...stoma in Japan. Among 2,502 patients who received gastrointestinal stoma construction at 50 institutes in Japan between January and December 2014, 365 patients (14.6%) experienced early stoma-related complications. The most common complications were mucocutaneus dehiscence (224 patients) and necrosis (116 patients). In terms of severity classification, 163 patients had grade 1, 147 patients had grade 2, 42 patients had grade 3, and 7 patients had grade 4 complications. Higher severity grades were significantly related to lower rate of stoma site marking, higher rate of emergent operation, and longer postoperative hospital stay. This study revealed the current status of early stoma-related complications in Japan and indicated the usefulness of this severity classification system of stoma-related complications.
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