Background: The short- and long-term results from several reports suggest that laparoscopic surgery (LAP) for elderly patients is expected to reduce the risk of complications due to its minimal invasiveness, However, little is known about the effect of LAP on long-term prognosis aside from cancer. Patients and Methods: Eighty-five cases over 80 years old with colorectal cancer whose primary lesions were resected consecutively were enrolled. Risk factors for complications were searched using categorized clinicopathological factors. The factors for death unrelated to cancer were analyzed in patients by excluding cancer-related death. Results: Incidence of all complications, those of Clavien–Dindo grade 2 or more, and surgical site infection were significantly lower in LAP-treated patients (p=0.0343, p=0.0015 and p=0.0015, respectively). By multivariate analysis, LAP (odds ratio=0.19, 95% confidence intervaI=0.05-0.75, p=0.0177) and no pulmonary dysfunction (odds ratio=0.24, 95% confidence intervaI=0.06-0.96, p=0.0441) were significantly associated with reduced risk of complications of Clavien–Dindo grade 2 or more. LAP, no pulmonary dysfunction and Eastern Cooperative Oncology Group performance status of 0 or 1 were also significantly associated with reduced risk for death from non cancer-related causes. Additionally, LAP was significantly associated with improved survival excluding cancer-related death in patients with pulmonary dysfunction (p=0.0020) or with poor performance status (p=0.0412). Conclusion: These results suggest that fewer complications and non cancer-related deaths were achieved in very elderly patients with colorectal cancer when treated by LAP.

Background: Benefit of chemotherapy for patients with metastatic colorectal cancer is well known, however, that for those patients with poor performance status is little known. Patients and methods: We retrospectively evaluated efficacy of chemotherapy with capecitabine and bevacizumab for patients with poor PS (PS 3). Results: Seven patients were included and the median age of the patients was 82 years (range, 65-91 years). The response was not ascertained; nonetheless, the disease control rate was 83.3%. The median PFS and OS were 10.0 and 25.8 months, respectively. Hand foot syndrome (HFS) was the most common toxicity observed (three patients; 42.9%). Grade 3 toxicities were found in one patient with proteinuria and one with hypertension. Conclusion: This limited study indicated that chemotherapy using capecitabine and bevacizumab for patients with poor PS may provide favorable OFS and OS. Needless to say, we should be careful not to impose extra burden to patients with poor PS.

Background/Aim: We investigated the clinical efficacy of inflammation-based indexes in predicting unfavourable relapse-free survival (RFS) in patients with stage II/III colorectal cancer (CRC) receiving oxaliplatin-based adjuvant chemotherapy. Patients and Methods: A retrospective analysis was performed on 45 patients who underwent curative resection for stage II/III CRC followed by oxaliplatin-based adjuvant chemotherapy after 8 weeks. Upon adjuvant chemotherapy initiation, all patients were evaluated for lymphocyte count (LC), neutrophil/lymphocyte ratio (NLR), lymphocyte/monocyte ratio (LMR), platelet/lymphocyte ratio (PLR), modified Glasgow Prognostic Score (mGPS) and prognostic nutritional index (PNI), after which their correlation with relapse was analysed. Results: Univariate analysis identified LC <1,350/mm3, NLR ≥2.03, LMR <5.15, PLR ≥209, mGPS 2, and early discontinuation of chemotherapy within two months as significant risk factors for RFS. Multivariate analysis identified LMR <5.15, PLR > 209 and mGPS 2 as significant independent risk factors for unfavourable RFS. Conclusion: Measurement of LMR, PLR, and mGPS upon adjuvant therapy initiation can be a useful tool for predicting recurrence after curative surgery for stage II/III CRC.

Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of incisional SSI and other wound complications when wound closure was achieved by subcuticular suturing and closed suction drainage following stoma reversal. We analyzed data from a total of 49 patients, all of whom had undergone insertion of a 10 Fr closed suction drainage tube in the fascia, following irrigation with approximately 300 mL of physiological saline. We then performed subcuticular suturing with 4-0 monofilament absorbable sutures. The median age of our patient population (34 men and 15 women) was 68 (range, 35-84) years. Six patients had an end stoma and 43 had a loop stoma. The wound category was 'contaminated' in 18 patients, while an incisional SSI was observed in one patient (2.0%). No wound disruptions, seromas, or drain infections were evident. Our data are reliable, but our study is limited in terms of general applicability; however, the low SSI rate indicates that the procedure is acceptable. Further research into this procedure will require a randomized trial design.

Introduction: The clinicopathological significance of poorly differentiated cluster (PDC) at the invasive front in colorectal cancer (CRC) has been reported. We analyzed whether PDC reflects malignant findings in patients with CRC invading beyond the muscle layer. Patients and methods: Sixty-eight patients who underwent surgery between January 2015 and June 2016 for CRC invading beyond the T3 (median observation period: 32.2 months) were enrolled. The relationship between PDC and clinicopathological factors was analyzed. PDC was graded based on the criteria described in a report by Ueno H et al. Results: Tumor location was at the proximal colon in 26 cases, distal colon in 34 cases, and rectum in eight cases. The number of cases with ly2,3 and v2,3 was 24 and 38, respectively. Thirty-eight cases had node positive and 11 cases had distant metastases, including 10 cases with hematogenous metastasis and four cases with peritoneal metastasis. The number of cases with stages II, III, and IV was 28, 28, and 12, respectively. The number of cases with PDC grades 1 (G1), 2 (G2), and 3 (G3) was 48, 15, and 5, respectively. A PDC G2 or G3 is a risk factor for lymph node and distant metastases. Cases with PDC G2 or G3 had significantly poor overall survival (OS) (p < 0.0001). In cases with curability (cur) A resection for stage II or III, disease-free survival (DFS) and OS were significantly poorer in cases with PDC G2 or G3 (p = 0.0022 and p = 0.0049, respectively). Conclusion: Analyses concerning PDC at the invasive front in cases with CRC invading beyond the muscle layer were performed. As the stage progresses, cases with PDC G2 and G3 increased significantly. In cases with PDC G2 and G3, the DFS and OS were significantly poorer. These results suggest that PDC is a malignant predictor in patients with CRC invading the T3 or deeper.