Splenomegaly due to FOLFOX-associated hepatotoxicity can be predicted if the APR before FOLFOX is 0.17 or higher.

Cardiac metastasis from colorectal cancer is rare. Such metastasis is usually discovered during autopsy; antemortem diagnosis is rare. A 76-year-old woman in whom we had performed right hemicolectomy for ascending colon cancer was noted to have elevated tumor markers during a follow-up examination 4 months after the surgery. Chest CT indicated a cardiac tumor that was approximately 6 cm in diameter, and we suspected a metastatic cardiac tumor. Subsequently, obstructive jaundice developed as a result of lymph node metastases around an extrahepatic bile duct, and a stent was placed. The patient refused aggressive treatment and was simply followed up clinically. Within 2 months, the cardiac tumor enlarged enough to cause cardiac failure, and death ensued 7 months after the surgery. Autopsy revealed a myocardial tumor, approximately 7 x 5 cm, that extended from the right atrium to the right ventricle. The histopathologic diagnosis was cardiac metastasis from ascending colon cancer. We describe in detail this case of rapidly progressive cardiac metastasis that was discovered after surgical treatment of ascending colon cancer. In searching the medical literature, we found only 14 cases of metastasis of colorectal cancer to the heart. We describe our case in detail and review our experience in light of the available literature.

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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.

[Objective]Recognizing that the safety and efficacy of laparoscopic surgery for rectal cancers have not been fully established, we conducted a retrospective study to determine whether the percentage of the pelvic cavity occupied by a rectal tumor affects the difficulty of laparoscopic rectal surgery or the occurrence of postoperative complications.[Methods] Our study involved 100 patients with rectosigmoid (Rs), upper rectal (Ra), or lower rectal (Rb) cancer treated by laparoscopic surgery at our hospital. Pelvic volume (PV), rectal volume (RV), tumor volume (TV), and respective percentages of the pelvic cavity they occupied were determined on the basis of preoperative computed tomography colonography (CTC) reconstruction images. We analyzed the relation between these percentages and the time to resection, blood loss volume, and number of staples used on the rectal stump (as measures of surgical difficulty) and anastomotic leakage (as a postoperative complication).[Results] Univariate analysis revealed significant differences in age (P = 0.009), PV (P = 0.012), TV (P = 0.042), percentage of the pelvic cavity occupied by the tumor (P = 0.011), and percentage of the pelvic cavity by the tumor and rectum together (P = 0.003) in all patients who developed anastomotic leakage and those who did not. Significant differences were also found in PV (P = 0.029) and in the percentage of the pelvic cavity occupied by the tumor and rectum together (P = 0.041) between the Ra patients in whom anastomotic leakage occurred and those in whom it did not occur. The blood loss volume and number of staples used differed significantly between the high-percentage occupancy group and low-percentage occupancy group (P = 0.050 and P = 0.001, respectively). Further, the number of staples used differed significantly between the high-percentage occupancy Ra group and low-percentage occupancy Ra group (P = 0.019). The data point to increased surgical difficulty and to an increased risk of anastomotic leakage when the percentage of the pelvic cavity occupied by the tumor is high.[Conclusion] The percentages of the pelvic cavity occupied by the tumor and rectum are factors that influence surgical difficulty and the occurrence of complications and should be taken into consideration during the planning stages to ensure safe laparoscopic rectal cancer surgery.