Objective: The modified Glasgow Prognostic Score (mGPS) is an inflammation-based measure of malnutrition that reflects a state of cachexia in cancer patients. We evaluated mGPS as an index to predict surgical site infection (SSI) incidence in patients undergoing colorectal cancer surgery. Subjects and Methods:We retrospectively analyzed 351 patients who underwent colon cancer resection. Factors correlated with the incidence of SSIs were identified by logistic analysis and stepwise selection.Results: SSIs were observed in 32 patients, with an incidence of 9.1%. Univariate logistic analysis revealed mGPS (Score 2), laparotomy, resection of other organs, colostomy, excessive blood loss (>423 mL), long duration of surgery (>279 minutes), pulmonary dysfunction, prognostic nutritional index (PNI) ! 40, neutrophil lymphocyte ratio (NLR)(>4), and controlling nutritional status (CONUT) " 2 to be associated with an increased incidence of SSIs. Multivariate analysis with variables selected by the stepwise procedure also revealed mGPS (Score 2) (Odds ratio (OR)=3.55, 95% Confidence interval (CI) 1.30 9.56; p=0.01), colostomy (OR=6.56, 95%CI 1.60 31.38; p=0.01), excessive blood loss (OR=3.20, 95%CI1.23 8.42; p=0.02), and NLR (>4)(OR=3.24, 95%CI 1.31 8.17; p=0.01) to be independent risk factors.Conclusion: mGPS is an independent risk factor for SSIs. Our results suggest that cachexia before surgery in patients with colorectal cancer might predict the incidence of SSIs. (J Nippon Med Sch 2017; 84: 224 230)

Background:In decompensated liver cirrhosis, hypoalbuminemia still persists even after they have been treated with branched-chain amino acid (BCAA) granules. We prospectively evaluated whether BCAA enriched nutrient switched from BCAA granules would increase the serum albumin level, and consequently extend the survival time after hepatocellular carcinoma (HCC) treatment. Methods:This study included 77 patients treated for liver cirrhosis with HCC. After the nutritional assessment, all patients initially received BCAA granules. In patients with unchanged or decreased serum albumin levels, BCAA granules were discontinued and BCAA enriched nutrient was started. Transcatheter arterial chemembolization (TACE) for HCC were performed in those with an improved ChildPugh score.

Background/Aim: The aim of this study was to determine the association between post-esophagectomy pneumonia and the presence of pathogenic organisms in the sputum or pharynx and postoperative systemic inflammatory response syndrome (SIRS). Materials and Methods: This retrospective study included 98 patients diagnosed with esophageal cancer who had undergone esophagectomy. Results: Postoperative pneumonia was observed in 24 patients (24.5%). Of the total 98 patients, 45 (45.9%) were tested positive for pathogenic organisms preoperatively, and 16 of those (35.6%) developed postoperative pneumonia; postoperative pneumonia occurred at a higher rate in these patients compared to pathogenic organism-negative patients (p=0.019). Postoperative SIRS was observed in 62 patients (63.3%), and 21 of these (33.9%) developed postoperative pneumonia, a significantly higher rate compared to patients without SIRS (p=0.007). Conclusion: Postoperative pneumonia was significantly associated with the presence of pathogenic organisms in the sputum or pharynx and postoperative SIRS.

Objective:We evaluated the preoperative patient status including nutrition, immunity, and inflammation as a predictive factor of remote infection (RI) in colorectal cancer surgery. Subjects and Methods:A total of 351 patients who underwent colorectal cancer resection were retrospectively analyzed. Factors correlated with RI incidence were identified by logistic analysis and stepwise selection.Results: RI occurred in 27 patients, with an incidence of 7.7%. In univariate logistic analysis, a significantly high incidence of RI was associated with excessive blood loss (>423 mL), long duration of surgery (>279 minutes), ileus, pulmonary dysfunction, performance status (PS)"1, American Society of Anesthesiologists (ASA) classification>2, prognostic nutritional index (PNI)!40, and controlling nutritional status (CONUT)"2 , modified Glasgow Prognostic Score (mGPS) (Score 2). In multivariate analysis, pulmonary dysfunction (odds ratio=2.83; 95% CI: 1.14 6.97; p=0.02) and PNI!40 (odds ratio=3.87; 95% CI: 1.45 10.31; p=0.006) were independent risk factors of RI incidence.Conclusion: RI is caused by poor nutrition, immune system dysfunction and pulmonary dysfunction. (J Nippon Med Sch 2018; 85: 208 214)

Endoscopic gastric mucosal resection (EGMR) is increasingly employed in early gastric cancer to remove the tumour with the surrounding mucosa and part of the submucosa after submucosal saline injection and staining to define the extent of the lesion. This study presents preliminary experience with a modified EGMR technique in five patients which allows more precise targeting and resection of the lesions. The time required for this procedure was less than 30 minutes in each case. All lesions were completely removed. In two patients, however, tumour growth invaded the submucosa and these patients therefore underwent subsequent surgery. Three patients with carcinoma confined to the mucosa were tumour-free at follow-up with repeat endoscopy and biopsy after 7 to 23 months.