Background: Sarcopenia is known to have an important influence on postoperative complications in several diseases, and on the prognosis of patients with cancer. However, whether sarcopenia is associated with complications and prognosis after gastrectomy in patients with gastric cancer remains controversial. This study evaluated the impact of the preoperative muscle mass on postoperative complications of gastric cancer surgery. Materials and Methods: The muscle mass of 153 patients who underwent gastrectomy for gastric cancer from January 2014 to August 2016 was assessed before surgery by a multifrequency bioelectrical impedance analysis (In Body 3.0; Biospace, Tokyo, Japan) and was expressed as the muscle mass index (MMI). Sarcopenia was defined as an MMI value of one standard deviation or more below the gender-specific mean MMI. Complications of Clavien-Dindo grade 2 or more were defined as significant postoperative complications. The impact of preoperative sarcopenia on postoperative infectious complications was analyzed by univariate and multivariate analyses. Results: A total of 153 patients were analyzed, sarcopenia was present in 24 out of 153 patients (15.7%). Thirty (19.6%) patients developed postoperative complications, 20 (13.1%) of which were infectious complications. Sarcopenia was significantly associated with age, body mass index, serum albumin, pulmonary disease in comorbidities, operative time, surgical approach, and postoperative complications. The univariate analyses revealed that male sex, sarcopenia, total gastrectomy, laparotomy, and intraoperative blood loss were associated with postoperative infectious complications. In the multivariate analyses, sarcopenia and intraoperative blood loss ≥400 ml were independently associated with postoperative infectious complications. Conclusion: Preoperative sarcopenia was found to be an independent risk factor for postoperative infectious complications in gastric cancer patients.Despite recent advances in surgical procedures and perioperative management techniques, postoperative complications sometimes occur after gastrectomy in patients with gastric cancer. Several factors, such as older age and a low nutrition status, have been identified as risk factors for postoperative complications of gastric cancer surgery.Sarcopenia, a newly identified marker of frailty, is characterized by decreased muscle mass and a low muscle strength and function by the European Working Group on Sarcopenia in Older People (EWGSOP) (1). Sarcopenia is known to have an important influence on postoperative complications in several diseases (2-9) and on the prognosis of patients with cancer (2, 10-12).Bioelectrical impedance analysis (BIA) is a safe, easy and non-invasive method for evaluating body composition (13,14). The measurement of body composition by BIA is reported to be useful for evaluating the preoperative nutritional status of patients and in predicting outcomes (5, 15). However, few studies have evaluated the association between the preoperative muscle mass, as measure...

Water immersion increases the success rate of insertion through the sigmoid colon without loop formation. This practical technique, requiring only preparation of a cap and water, is useful without compromising cecal intubation rate, cecal intubation time, or polyp detection rate.

Background Esophageal cancer (EC) is associated with malnutrition in the vast majority of patients, and this often leads to sarcopenia, which is characterised by loss of skeletal muscle mass (SMM). Although sarcopenia could be one of the risk factors for postoperative pneumonia (PP), the optimal definition of sarcopenia using skeletal muscle mass index (SMI) by bioelectrical impedance analysis (BIA) remains unknown for predicting PP after esophagectomy in patients with EC. Therefore, this study aimed to identify high-risk patients for PP after esophagectomy through evaluating SMI by BIA and set an appropriate cut-off value for this purpose. Method A total of 73 patients with EC who underwent subtotal esophagectomy with lymph node dissection at Osaka City University Hospital between 2017 and 2019 were reviewed retrospectively. The association between PP and perioperative factors including SMI by BIA were analysed. When SMI was lower than the cut-off values proposed by two study groups (Asian Working Group for Sarcopenia (AWGS) and original European Working Group on Sarcopenia in Older People (EWGSOP)) or SMM was less than 90% of standard, the patient was diagnosed with sarcopenia. Receiver operating characteristic analysis was performed to set the appropriate cut-off value of SMI, and a new criterion (modified EWGSOP) was formulated by using the value. Clinicopathological factors and postoperative complications between sarcopenia and non-sarcopenia groups were compared, which were classified by four different criteria: (1) AWGS, (2) original EWGSOP, (3) \ 90% standard and (4) modified EWGSOP criteria. Results Nine patients (12.3%) were with PP grade III or higher. Total SMI as well as body mass index (BMI), transthyretin and % vital capacity (%VC) were found to be significantly associated with PP (Clavien-Dindo grade C III). BMI, total and appendicular SMI of sarcopenic patients were found to be lower than those of non-sarcopenic patients. Low serum albumin and %VC were significantly associated with sarcopenia defined by modified EWGSOP criteria. The rate of PP was significantly higher in sarcopenic patients when the original and modified EWGSOP criteria were used (p = 0.0079 and 0.0015, respectively). A multivariate analysis revealed that sarcopenic state by modified EWGSOP criteria was the significant independent predictive factor of PP [p = 0.0031, hazard ratio (HR) = 10.1; 95% confidential interval (CI): 2.12-76.9]. Conclusion Preoperative sarcopenia by modified EWGSOP criteria could be the best indicator using BIA for predicting PP after esophagectomy in patients with EC.

Background Mediastinal foreign bodies might cause mediastinal organ injury or mediastinal abscess. The prompt removal surgery of mediastinal foreign bodies is needed to prevent those complications. We report a case in which a mediastinal foreign body was removed by video-mediastinoscopy. Case presentation The patient, a 74-year-old man with a chief complaint of hoarseness, was referred to our department for surgical management of a wooden foreign body that had traumatically migrated into the superior mediastinum. During the surgery, the video-mediastinoscopy was introduced under the pneumomediastinal pressure. We could dissect the scar tissue and remove the azalea tree branch safely and carefully, without damaging the other mediastinal organs. He was discharged on postoperative day 5, with no complications. Conclusions Video-mediastinoscopic approach under pneumomediastinal pressure is minimally invasive and could provide wide surgical view. Therefore, we consider it useful and effective for removal of foreign bodies in the mediastinum.

Introduction: Sarcopenia is often observed in patients with esophageal cancer (EC). However, the influence of sarcopenia during neoadjuvant chemotherapy (NAC) on complications has not been fully investigated. Thus, we aimed to investigate the best way of evaluating sarcopenia for predicting complications, especially postoperative pneumonia (PP), in patients with EC undergoing NAC and esophagectomy. Methods: We retrospectively reviewed 36 patients. The skeletal muscle mass index (SMI) was evaluated by both BIA and CT. Patients were diagnosed with sarcopenia at pre-NAC and preoperatively. Different criteria were compared in terms of the predictability of PP. Next, we evaluated which factors were related to sarcopenia with best PP predictability. Finally, we investigated perioperative factors that were associated with SMI change during NAC. Results: PP occurred in three patients. Pre-NAC modified European Working Group on Sarcopenia in Older People (EWGSOP) criteria showed the best PP predictability. Low pre-NAC BMI and %VC were significantly associated with sarcopenia by the modified EWGSOP criteria. There was a trend that patients of the SMI non-increased group during NAC were more likely to develop PP. Conclusion: Pre-NAC sarcopenia by modified EWGSOP was a significant predictor of PP after esophagectomy. Appropriate interventions for these patients should be explored to prevent PP.