Purpose Surgery is the primary curative treatment for colorectal cancer; however, it remains a frightening procedure that can cause stress and pain in affected patients. Therefore, patients typically experience significant anxiety during the preoperative period, which has been associated with poorer outcome after surgery. This study aimed to evaluate the effect of an Internet-based informational video on preoperative anxiety level in patients with colorectal cancer. Methods This prospective, single-arm, observational study included patients scheduled to undergo elective colorectal cancer surgery, who did not have a history of previous surgery or major cognitive impairment. The primary outcome measure was the change in Amsterdam Preoperative Anxiety and Information Scale - Anxiety (APAIS-A) before and after watching a 5-min informational video ( https://youtu.be/VzhtOMPUe4Q ) during the preoperative period. Secondary outcome measures were the change in Hospital Anxiety and Depression Scale (HADS), length of postoperative hospital day, and postoperative morbidity. Results Thirty-two patients were enrolled. Anxiety was significantly decreased after watching the video (APAIS-A score: from 10.8 ± 3.7 to 8.2 ± 3.2, P < 0.001, mean reduction: 22.2%). HADS score was also significantly decreased (from 5.8 ± 4.4 to 4.0 ± 3.3, P = 0.001, mean reduction: 26.5%). All preoperative anxiety level did not significantly differ between patients who developed postoperative complication and those who did not. Conclusion The informational video was an effective tool to reduce preoperative anxiety. Viewing this video may confer a higher level of confidence and realistic expectations, as well as reducing patients' preoperative anxiety.

BACKGROUND Compared with colorectal adenocarcinoma, basaloid squamous cell carcinomas (BSCCs) arising in the colorectum are rare and have very poor prognosis. To date, only nine cases have been reported. Most BSCCs are extensively involved in metastasis to the lymph node, liver, and lung at diagnosis. Despite many clinicians attempting to effectively treat BSCCs, therapeutic consensus has not been established due to lack of information. CASE SUMMARY A 58-year-old woman presented with abdominal pain, diarrhea, fever, and hematochezia. She was referred from a department of gynecology and was diagnosed with a suspicious leiomyosarcoma of the rectum or a pedunculated myoma of the uterus. An exophytic growing mass at the right lateral wall of the rectum with an internal cystic portion and hemorrhage was observed on magnetic resonance imaging. The patient underwent low anterior resection and total hysterectomy with bilateral salphingo-oophorectomy. Histopathological findings revealed a cellular mass with a solid growth pattern and few glandular structures, many foci of intratumoral necrosis, and a palisading pattern. The pathologist diagnosed tumor as a BSCC, and the patient received chemotherapy with fluorouracil/leucovorin without radiotherapy. The patient is currently alive 8 years after the surgery with no manifestations of metastatic colon cancer. CONCLUSION Our case suggest that curative resection and chemotherapy play important roles in improving survival, and radiotherapy may be an option to avoid radiation-associated enteritis.

Rationale: Gangliocytic paraganglioma (GP) is a rare tumor that mostly develops in the duodenum and is composed of the following 3 cell types: epithelioid endocrine, spindle-like, and ganglion-like cells. It manifests as symptoms such as abdominal pain, gastrointestinal bleeding, and weight loss; however, occasionally, it is incidentally detected on endoscopic or radiologic examinations. Although GP is usually benign, it can metastasize to the lymph nodes, and distant metastases have been reported in some cases.Patient concerns: A 46-year-old woman presented with anemia on health surveillance examination. She had no other specific symptoms, and her physical examination did not reveal any abnormal finding.Diagnosis: Endoscopic ultrasound-guided fine-needle aspiration biopsy was performed, and the endoscopist obtained samples from the inner side of the ampullary mass. Pathological examination suggested GP or a neuroendocrine tumor.Interventions: Initially, we planned transduodenal ampullectomy with lymph node excision. However, there was severe fibrosis around the duodenum, and an examination of a frozen biopsy sample from the periduodenal lymph node showed atypical cells in the lymph node. Therefore, we performed pylorus-preserving pancreaticoduodenectomy with lymph node dissection.Outcomes: The final pathological diagnosis was GP located in the ampulla of Vater. The GP showed lymphovascular and perineural invasion and invaded the duodenal wall. Furthermore, 4 out of 18 harvested lymph nodes showed metastasis.Lessons: We described a case of GP confined to the ampulla with regional lymph node metastasis and reviewed published literature on ampullary GP with lymph node metastasis.

Background: Preoperative chemoradiotherapy (CRT) has been established as a treatment of choice for locally advanced rectal cancer. However, the responses to CRT range very widely and there is no specific molecular marker definitively proven to be predictive of responses to CRT. We aimed to investigate the relationship between the expression of ATP-binding cassette (ABC) transporters and cancer stem cell (CSC) markers in pretreatment biopsy samples and pathological response to CRT in rectal cancer. Methods:The immunohistochemical expression of three ABC transporters (ABCG2, ABCC2, and ABCC3) and two CSC markers (SOX2 and LGR5) was determined in 76 biopsy specimens from rectal cancer patients who underwent preoperative CRT. The association between protein expression and pathologic tumor regression grade was statistically analyzed.Results: Fifty-eight (76.3%) cases were classified as chemoradio-resistant group and 18 (23.7%) cases as chemoradio-sensitive group and pathological complete remission was found in 8 (10.5%) cases. ABCG2 was frequently expressed in chemoradio-sensitive group (P=0.042), while expression of ABCC2 was found in chemoradio-resistant group (P=0.014). Low expression of ABCC2 was associated with pathologic complete remission (P=0.008).Conclusions: Immunohistochemical expression of ABCC2 and ABCG2 was associated with tumor regression after preoperative CRT in rectal cancer. In particular, ABCC2 was associated with resistance to CRT of rectal cancer. These markers might be used as biomarkers for predicting response against CRT in rectal cancer.