Introduction: Previous reports of laparoscopic surgery in patients with

Extracellular adenosine triphosphate (ATP) released by mucosal immune cells and by microbiota in the intestinal lumen elicits diverse immune responses that mediate the intestinal homeostasis via P2 purinergic receptors, while overactivation of ATP signaling leads to mucosal immune system disruption, which leads to pathogenesis of intestinal inflammation. In the small intestine, hydrolysis of luminal ATP by ectonucleoside triphosphate diphosphohydrolase (E-NTPD)7 in epithelial cells is essential for control of the number of T helper 17 (Th17) cells. However, the molecular mechanism by which microbiota-derived ATP in the colon is regulated remains poorly understood. Here, we show that E-NTPD8 is highly expressed in large-intestinal epithelial cells and hydrolyzes microbiota-derived luminal ATP. Compared with wild-type mice, Entpd8−/− mice develop more severe dextran sodium sulfate–induced colitis, which can be ameliorated by either the depletion of neutrophils and monocytes by injecting with anti–Gr-1 antibody or the introduction of P2rx4 deficiency into hematopoietic cells. An increased level of luminal ATP in the colon of Entpd8−/− mice promotes glycolysis in neutrophils through P2x4 receptor–dependent Ca2+ influx, which is linked to prolonged survival and elevated reactive oxygen species production in these cells. Thus, E-NTPD8 limits intestinal inflammation by controlling metabolic alteration toward glycolysis via the P2X4 receptor in myeloid cells.

Objectives: In the 9th edition of the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma (JCCRC), ovarian metastasis is classified as distant metastasis. We assessed the significance of resection of ovarian metastases and the validity of this 9th edition of JCCRC for ovarian metastases from colorectal cancer (CRC). Methods: We retrospectively analyzed the clinicopathological factors and overall survival of 17 patients with ovarian metastases from CRC who underwent resection and 110 female CRC patients with Stage IV (M1a) disease. Results: The patients with only ovarian metastases who underwent resection had a longer median survival time than patients with both ovarian and peritoneal metastases who underwent resection (45.4 months vs. 9.3 months, P = 0.029). The 5-year overall survival of the patients with only ovarian metastases who underwent R0 resection was as long as that of the female Stage IV (M1a) CRC patients after R0 resection (50% vs. 48%, P = 0.334). Conclusions: We found that, after resection, patients with only ovarian metastases had significantly better prognoses than patients with ovarian and peritoneal metastases. R0 resection of ovarian metastasis indicated as good prognosis as R0 resection of metastasis to one distant organ without ovaries. So the 9th edition of JCCRC, which classifies ovarian metastasis from CRC as distant metastasis, is appropriate.

Surgical site infection (SSI) is a frequent complication after stoma closure. The aim of this study was to assess the usefulness of wound cleaning after stoma closure. Sixty-five patients who underwent stoma closure between September 2008 and September 2018 were included in this study. Thirty-four patients started wound cleaning a few days after stoma closure, and 31 patients did not. The overall SSI rate was 10.8%. The incidence of SSI of patients with wound cleaning (2.9%) was remarkably lower than that of patients without wound cleaning (9.4%).

Background: Anti-TNFα antibody is effective for controlling inflammation caused by Crohn's disease. However, an increasing number of patients have recently undergone surgery after loss of response during maintenance therapy with anti-TNFα antibody. Aims: The purpose of this study was to examine how preoperative treatment using anti-TNFα antibody affects postoperative recurrence. Methods: Between January 2002 and June 2020, we retrospectively analyzed 90 patients with Crohn's disease who underwent bowel resection with anastomosis and received endoscopic evaluation within 18 months after surgery.Results: Fifty-seven patients had used anti-TNF antibodies preoperatively, and 33 had not. Of the 57 patients, 31 underwent surgery after loss of response. At the time of the first postoperative endoscopy, endoscopic recurrence occurred in 20 patients (35.1%) who used anti-TNFα antibody and 5 patients (15.2%) who did not use anti-TNFα antibody (p = 0.0419). The median symptomatic recurrence-free duration was 8 months in patients with loss of response and 44 months in patients without a loss of response (p = 0.0108). Conclusions: Patients who received anti-TNFα antibody preoperatively were prone to endoscopic recurrence. In addition, patients who experienced inefficacy before their surgeries were more likely to have recurrence, even after resuming post-operative anti-TNFα antibody treatment.