Background Prediction of nodal involvement in colorectal cancer is an important aspect of preoperative workup to determine the necessity of preoperative treatment and the adequate extent of lymphadenectomy during surgery. This study aimed to investigate newer multidetector-row computed tomography (MDCT) findings for better predicting lymph node (LN) metastasis in colorectal cancer. Methods Seventy patients were enrolled in this study; all underwent MDCT prior to surgery and upfront curative resection for colorectal cancer. LNs with a short-axis diameter (SAD) ≥ 4 mm were identified on MDCT images, and the following measures were recorded by two radiologists independently: two-dimensional (2D) SAD, 2D long-axis diameter (LAD), 2D ratio of SAD to LAD, 2D CT attenuation value, three-dimensional (3D) SAD, 3D LAD, 3D SAD to LAD ratio, 3D CT attenuation value, LN volume, and presence of extranodal neoplastic spread (ENS), as defined by indistinct nodal margin, irregular capsular enhancement, or infiltration into adjacent structures. Results Forty-six patients presented 173 LNs with a SAD ≥ 4 mm, while 24 patients exhibited pathologically confirmed LN metastases. Receiver operating characteristic analysis revealed that 2D LAD was the most sensitive measure for LN metastases with an area under the curve of 0.752 (cut-off value, 7.05 mm). When combined with CT findings indicating ENS, 2D LAD (> or ≤ 7 mm) showed enhanced predictive power for LN metastases (area under the curve, 0.846; p < 0.001). Conclusions LAD in axial MDCT imaging is the most sensitive measure for predicting colorectal LN metastases, especially when MDCT findings of ENS are observed.

No abstract

Geriatric patients often have cognitive decline which might cause postoperative complications, including delirium, therefore, it is very important to evaluate mental ability before surgery. The Flemish version of the triage Risk Screening Tool (fTRST), which focuses on the assessment of cognitive function, is reported to be useful for identifying patients with geriatric risks. The aim of our study is to predict postoperative delirium easily in geriatric patients with esophageal cancer (EC). Methods Patients aged ≥70 years old with EC were retrospectively included who received an operation at National Center for Global Health and Medicine from February 2016 to November 2019. The fTRST were administered to all patients. To evaluate objectively, Yamaguchi University Mental Disorder Scale (YDS), one of the famous exams to assess the patient’s cognitive function, were also performed. The impaired were defined as fTRST ≥2 and YDS ≤ 12. We evaluated postoperative delirium and compared the fTRST with YDS. Results Overall, 40 patients were included. Median age was 76 years (range, 70 to 89 years), and 37 patients (85%) were male. Twenty-three patients (58%) were fTRST impaired, 6 patients (15%) were YDS impaired. 21 patients (52%) had postoperative delirium. The abnormal fTRST (p = 0.001) and YDS (p = 0.02) were both at risk for postoperative delirium. In multivariable analysis, the abnormal fTRST was significantly associated with postoperative delirium (OR 5.96; CI 1.33–26.7, p = 0.02). Conclusion The fTRST is useful tools to predict postoperative delirium and prior to YDS in elderly patients with EC. Further studies are needed to design interventions to prevent postoperative delirium for those vulnerable patients.

A72-year-oldwomanwhopresentedwithdifficultyinoralingestionwasdiagnosedwithcancerof the lower thoracic esophagus ＜ UICC7th-cT3N3M1(#104R), cStage IV ＞. We performed 2 courses of 5-fluorouracil + cisplatin (FP therapy) as neoadjuvant chemotherapy, followed by esophagectomy via right thoracotomy and three-field lymph node dissection. Histopathology revealed UICC 7 th-pT3N2M1(#104R)pStageIV,thatappearedtosuggestahighriskofrecurrence.Consequently,additional radiation therapy (60 Gy) targetting #104R and #101R was conducted. PET-CT scan performed 7 monthsaftertheoperationshowedabnormallyhighaccumulationofFDGtotheposteriorthoracicparaaorticlymphnode.Recurrenceoftheesophagealcancerwasconsidered,andweperformedchemoradiationtherapy(60Gy+2coursesofFPtherapy).Thereafter2coursesofweeklypaclitaxeltherapywere added.Thepatienthasbeenfreefromanyrecurrenceasof61monthsaftertheoperation. Itisdifficulttomaketherapeuticguidelinesforrecurrencetotheposteriorthoracicparaaorticlymph nodeafterradicalsurgeryforesophagealcancer.Intreatingthispatient,weonceconsideredtoperform surgical resection, but our selection to employ multimodal therapy resulted in long-term survival. It mightbebeneficialforthetreatmentthattherecurrencehadinvolvedasolitarylymphnode.