Aim We examined the prognostic impact of osteopenia on the long‐term outcomes of patients with colorectal cancer after laparoscopic colectomy along with other nutritional factors, including sarcopenia or the Glasgow Prognostic Score. Methods This retrospective cohort study analyzed the data of 230 patients with stage Ⅰ–Ⅲ colorectal cancers who underwent surgical resection between November 2010 and December 2015. Osteopenia and sarcopenia were evaluated by measuring the average pixel density in the mid‐vertebral core of the 11th thoracic vertebra on enhanced computed tomography and the psoas muscle mass area at the third lumbar vertebra, respectively. The overall survival and disease‐free survival rates were analyzed using Cox proportional hazards model and Kaplan–Meier curves with the log‐rank test. Results Osteopenia was identified in 43 patients (18.7%). Univariate analysis showed that the disease‐free survival rate was significantly worse in patients with stage II–III cancers, vascular invasion, carcinoembryonic antigen (CA) >5.0 ng/mL, CA19‐9 > 37.0 U/mL, sarcopenia, and osteopenia (all P < .01). Multivariate analysis revealed that stage II–III cancers (P = .01), vascular invasion (P = .01), carcinoembryonic antigen >5.0 (P < .01), and osteopenia (P < .01) were significant independent disease‐free survival predictors. In univariate analysis, the overall survival rate significantly decreased in patients with stage II–III cancers (P = .03), carcinoembryonic antigen >5.0 (P < .01), CA19‐9 > 37.0 (P < .01), sarcopenia (P < .01), and osteopenia (P < .01). Multivariate analysis indicated that carcinoembryonic antigen >5.0 (P = .04), CA19‐9 > 37.0 (P = .05), and osteopenia (P < .01) were significant independent predictors of overall survival. Conclusion Preoperative osteopenia could be a strong predictor of long‐term outcomes in patients undergoing resection for colorectal cancer.

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Background Iatrogenic ureteral injury (UI) is a potentially serious complication of colorectal cancer surgery. Performing perioperative placement of ureteral stents or intraoperative fluorescence navigation surgery for the ureter using indocyanine green (ICG) has been employed as a method of preventing UI. However, transileal conduit stent placement has been considered challenging because it is difficult to identify the ureteral orifice due to the anatomical changes caused by a previous surgery. We report a case in which laparoscopic colectomy was safely performed using a combination of prophylactic transileal conduit ureteral catheter placement and intraoperative ICG fluorescence navigation surgery. Case presentation A 75-year-old man presented to our hospital complaining of vomiting and abdominal distension. He had a history of open total cystectomy and ileal conduit urinary diversion 11 years prior to admission. Computed tomography confirmed colon dilation with fecal impaction from the ascending colon to the sigmoid colon and wall thickening in the sigmoid colon. Colonoscopy during the transanal ileus tube insertion revealed a Borrmann type II tumor with circumferential stenosis 10 cm distal to the junction between the descending colon and the sigmoid colon. The patient was diagnosed with colorectal ileus due to obstructive sigmoid colon cancer and underwent transanal ileus tube insertion. Severe intra-abdominal adhesions were expected due to the previous total cystectomy, and the left ureter was near the sigmoid colon tumor; therefore, prophylactic retrograde transileal conduit ureteral catheter placement was performed one day before the elective surgery. During the operation, 20 ml (5.0 × 10–2 mg/ml) ICG was administered from the transileal conduit ureteral catheter, and ICG fluorescence of the ureter was observed in the retroperitoneum. Laparoscopic Hartmann's operation was successfully performed, confirming ureter fluorescence. The operation time was 231 min, with 5 mL of intraoperative bleeding. The ureteral catheter was removed 3 days after the operation. The patient’s postoperative course was good with no complications, and he was discharged on postoperative day 7. Conclusions Prophylactic transileal conduit ureteral catheter placement and ICG fluorescence navigation surgery were effective in performing laparoscopic colorectal surgery with severe adhesions after urinary diversion.