Introduction: CT angiography has gained widespread acceptance for preoperative

No abstract

Objectives: To evaluate future problems in colorectal cancer surgery for elderly patients. Methods: We conducted a retrospective review of patients receiving colorectal cancer surgery in our hospital from January 2010 to December 2018. Patients were divided into the !85-year-old patient group and the younger patient group. We compared patient backgrounds, surgical outcomes (surgical procedure, reduction of lymph node dissection range, operative duration, and blood loss), postoperative short-term outcomes (mortality, morbidity, and postoperative length of stay) and prognosis. Results: We performed colorectal cancer surgery on 1,240 patients during the study period. Of them, 109 (8.7%) were !85 years old, and 1,131 (91.2%) were < 85 years old. The American Society of Anesthesiologists physical status (ASA-PS) was significantly poorer in the elderly group than in the younger group and patients with a history of cardiac disease and anticoagulant use were significantly more in the elderly group. The rate of reduction of lymph node dissection range was significantly higher in the elderly group (16.8% vs. 3.8%, p < 0.05). Overall morbidity was significantly higher in the elderly group (42.2% vs. 21.9%, p < 0.05), as were the respective frequencies of pneumonia and thromboembolism (8.2% vs. 0.7%, p < 0.05 and 3.6% vs. 0.8%, p < 0.05, respectively). Postoperative hospital stay was significantly longer in the elderly group (17 vs. 12 days, p < 0.05). Overall survival was significantly lower in the elderly group (p < 0.05), but relapse-free survival and colorectal cancer-specific survival were not statistically different between the groups (p = 0.05 and p = 0.15, respectively). Conclusions: Prevention of postoperative pneumonia and thromboembolism remains a problem. After proper assessment and careful management of peri-operative surgical risks, surgery can be indicated in elderly patients.

Objectives: Colonic stent insertion as a bridge to surgery (BTS) has the advantage of avoiding emergency colostomy and is reported to have a lower postoperative complication rate than emergency resection or resection after stoma construction. Nevertheless, there is no consensus on the long-term prognosis; moreover, there are reports of stent insertion adversely affecting pathological findings. To clarify the influence of colorectal stent insertion on short-term postoperative results, pathological findings, and prognosis, we conducted this study. Methods: Patients who had undergone resection of the primary tumor for primary colorectal cancer at our hospital between January 2012 and December 2020 and had preoperative colorectal obstruction (Colorectal Obstruction Scoring System [CROSS]) 0-2 were included. Patient were divided into two groups: those with and without preoperative colonic stent insertion. The background, surgical course, histopathological findings, shortterm postoperative outcomes, and the prognosis of both groups were retrospectively examined. Results: There were 197 cases, 55 with preoperative colorectal stent insertion (stent group) and 142 without stent insertion (non-stent group). The rate of open surgery was significantly higher and postoperative hospital stay was longer in the non-stent group. There were no significant differences regarding histopathology findings, 3-year overall survival, and recurrences. Conclusions: The short-term postoperative results of patients with stent insertion were favorable, and it seems reasonable to continue stent insertion for the purpose of BTS; however, further study is required regarding prognosis.

A 51-year-old woman underwent a CT scan performed that revealed a neoplastic lesion in the upper abdomen, and she was referred to our surgical department. Abdominal CT showed a tumor of about 50 mm lying between the posterior wall of the gastric minor curvature and the pancreas. Continuity with the surrounding tissue was not clear. Ultrasonography showed that the tumor was mobile on postural change, and it was considered to originate from the mesentery. In addition, PET scanning showed mild accumulation, and MRI showed limited diffusion, suggesting the possibility of malignancy. Laparoscopic tumor resection was performed as a diagnostic treatment. Intraoperative findings showed tumor continuity only with the lesser omentum, and the patient was judged to have a primary tumor of the lesser omentum. Histopathological findings showed proliferation of myofibroblasts and lymphocyte infiltration, and the patient was thus diagnosed as having an inflammatory myofibroblastic tumor. Inflammatory myofibroblastic tumor as a primary tumor of the lesser omentum is rare and is reported here along with a literature review.