Objectives: The albumin-bilirubin (ALBI) score and colon inflammatory index (CII) are new sensitive scoring systems for several cancers. However, their clinical significance in colorectal cancer remains unclear. This study investigated the significance of ALBI score and CII for prognosis after colorectal cancer surgery.

Methods: The present study analyzed data from patients who underwent curative resection for colorectal cancer. We investigated the association between preoperative ALBI score, CII, and disease-free and overall survival following surgery. Univariate and multivariate analyses were conducted to identify independent risk factors for poor prognosis in patients with colorectal cancer.

Results: A total of 234 patients were included in the present study. Kaplan-Meier analysis demonstrated that patients with higher ALBI scores and poor CII had significantly worse disease-free and overall survival. In multivariate analysis, ALBI score ≥ -2.45 (P = 0.002), CII poor (P < 0.001), and pathological N1-3 stage (P = 0.017) were independent predictors of disease-free survival. Similarly, ALBI score ≥ -2.45 (P < 0.001 ), CII poor (P = 0.003), and pathological N1-3 stage (P = 0.015) were independent predictors of overall survival.

Conclusions: ALBI score and CII were strong predictors of poor prognosis in patients who underwent curative resection for colorectal cancer, emphasizing their potential utility in clinical practice. Incorporating these markers into routine clinical practice may enhance individualized treatment strategies and postoperative surveillance.

Objectives: Minimally invasive surgery (MIS) is widely used for Crohn's disease (CD), but its feasibility in complex CD is still debated. This study aimed to evaluate short-term outcomes and identify factors associated with major complications following laparoscopic ileocecal resection in patients with complex CD.

Methods: A retrospective study was conducted on patients with complex CD who underwent laparoscopic ileocecal resection. Patients with prior intestinal surgery for CD were excluded to ensure a uniform cohort. Short-term outcomes, including operative time, blood loss, complications, and hospital stay, were compared between patients undergoing laparoscopic (LS) and open surgery (OS). Univariate analysis was performed to assess factors associated with major complications (Clavien-Dindo grade ≥3).

Results: A total of 101 patients were included (LS, n=21; OS, n=80). The LS group had significantly lower blood loss (140 vs. 222.5 mL, P=0.048) and shorter postoperative hospitalization (12 vs. 15 days, P=0.0068). No conversions to open surgery were required. There was no significant difference in the incidence of major complications (9.5% vs. 3.8%, P=0.57). Major complications occurred in 4.8% of cases overall. Univariate analysis showed that both preoperative abscess formation (P=0.048) and increased intraoperative blood loss (P=0.020) were significantly associated with major complications.

Discussion: Our findings support that laparoscopic ileocecal resection is both feasible and beneficial for complex CD, offering reduced blood loss and shorter hospital stays. However, both preoperative abscess formation and increased intraoperative blood loss were significantly associated with major complications, highlighting the importance of meticulous infection control and intraoperative hemostasis.

Objectives: In this study, we aimed to present the clinicopathological features of anal canal carcinomas based on differentiation and clarify whether differentiation affects prognosis.

Methods: We included 597 patients with adenocarcinoma registered in the multicenter colorectal cancer registry data of the Colorectal Cancer Study Group. We also included 151 patients with squamous cell carcinoma enrolled by the 47 medical affiliates of the Colorectal Cancer Study Group in a multicenter cohort study conducted in Japan. The clinicopathological features by differentiation and prognostic factors of each histological type were examined retrospectively.

Results: The clinicopathological features of adenocarcinoma were similar to those of rectal carcinoma by differentiation. In contrast, the clinicopathological features of squamous cell carcinoma did not differ according to differentiation. Differentiation was a prognostic factor in patients with adenocarcinoma (G3/4; hazard ratio: 1.91, 95% confidence interval: 1.22-3.01, p=0.0043) but not in patients with squamous cell carcinoma.

Conclusions: Differentiation was a prognostic factor for adenocarcinoma in anal canal carcinoma; thus, differentiation should be considered in the treatment strategy. However, differentiation was not a prognostic factor in squamous cell carcinoma. Further studies should explore the involvement of differentiation in squamous cell carcinoma treatment.

Objectives: This study aimed to assess the prognostic impact of the C-reactive protein-albumin-lymphocyte index in older patients with colorectal cancer and to evaluate the superiority of this new system.

Methods: Of the patients who received initial treatment for colorectal cancer at our hospital between 2014 and 2021 (n=269), older patients aged ≥65 years who had undergone curative resection for colorectal cancer during the study period were included. We retrospectively investigated the relationship between the preoperative C-reactive protein-albumin-lymphocyte index and overall and recurrence-free survival rates. Univariate and multivariate analyses were performed to identify the independent prognostic factors after curative resection in older patients with colorectal cancer.

Results: One-hundred-seventy-eight patients underwent initial curative resection during the study period. The median survival times for patients with C-reactive protein-albumin-lymphocyte (CALLY) indices <1.2 and ≥1.2 were 42.6 and 68.3 months, respectively (p=0.01). Multivariate analysis identified the following independent risk factors associated with poor prognosis: age ≥75 years (hazard ratio 1.64, 95% confidence interval 1.03-2.62, p=0.03), T stage 3 or 4 (hazard ratio 1.66, 95% confidence interval 1.06-2.61, p=0.02), laparotomy surgical approach (hazard ratio 2.09, 95% confidence interval 1.29-3.38, p<0.01), and C-reactive protein-albumin-lymphocyte index <1.2 (hazard ratio 1.75, 95% confidence interval 1.05-2.92, p=0.03).

Conclusions: Our study suggests that the CALLY index is an independent prognostic factor in older patients with colorectal cancer and may facilitate multidisciplinary decision-making.

Objectives: Growing evidence suggests that cancer prognosis is influenced by the host's immune-inflammatory environment. The inflammatory burden index (IBI) is a newly established, potent inflammation-based marker easily calculated from laboratory findings. We evaluated the prognostic significance of IBI in patients with nonmetastatic obstructive colorectal cancer (OCRC) who underwent curative surgery following insertion of a self-expandable metallic stent as a bridge to curative surgery.

Methods: Eighty-six patients with pathological stages I-III OCRC were retrospectively analyzed to investigate the association between IBI and short- and long-term results.

Results: This study included 50 males and 36 females. The median age was 71.5 years, and the median follow-up time was 43 months. There were 34 postoperative complications, including 17 infectious complications. Sixty-three patients were classified as pre-stenting IBI-high using a cutoff of 0.9. Multivariate analyses revealed that high IBI was independently correlated with poorer disease-free survival (DFS) [hazard ratio (HR) = 4.10, 95% confidence interval (CI) 1.37-12.28, P = 0.012] and overall survival (OS) (HR = 9.32, 95% CI 1.15-75.63, P = 0.037). Moreover, patients with a high IBI had significantly more postoperative (P = 0.013) and infectious complications (P = 0.034). The preoperative IBI values had no prognostic significance.

Conclusions: A high pre-stenting IBI was independently associated with poor DFS and OS. Additionally, it serves as a robust predictor of postoperative and infectious complications. Given that IBI can be easily derived from routine laboratory tests, its clinical utility is readily applicable in daily practice.

Objectives: Hemorrhoids commonly occur worldwide, and surgical intervention is required in severe cases. However, a method for postoperative pain control is yet to be established. In this study, we developed a caudal epidural anesthesia tube placement method and demonstrated its meaningful outcomes.

Methods: We postoperatively analyzed 85 patients who underwent hemorrhoid surgery at the Sapporo Ishiyama Hospital. Using a computer-generated method, patients were assigned to the caudal epidural tube placement group (E group; n = 47) or without tube placement group (N group; n = 38) and compared using a numeric rating scale (NRS).

Results: Goligher classification grade ≥3 severe hemorrhoids were found in 93% of patients in the study. Anal cushion lifting (ACL), a surgical technique requiring no hemorrhoid resection with or without excision (e.g., Milligan-Morgan hemorrhoidectomy), was used. Swelling was observed in 15% of overall patients, but it was controlled with conservative treatment. Postoperative bleeding occurred in one patient in the N group. The mean duration of caudal epidural tube placement was 33.7 h, and there were no adverse events such as infection. The NRS results showed that the E group had a significantly lower mean NRS score at postoperative 24 and 48 h compared with the N group. No apparent rebound pain after tube removal occurred, and the transition to an oral analgesic was smooth and successful.

Conclusions: Our novel method may contribute to the pain management during early periods following hemorrhoidectomy.

Objectives: Postoperative infectious complications in colorectal cancer prolong hospital stays and increase the risk of recurrence. Given that risk factors may vary depending on the surgical procedure-namely, right-sided colon, left-sided colon, and rectal cancer-we aimed to identify both common and procedure-specific risk factors.

Methods: This retrospective multicenter study included 2,636 patients who underwent elective colorectal cancer surgery between April 2015 and March 2023 at three affiliated institutions. The primary endpoint was the incidence of Clavien-Dindo grade ≥2 infectious complications by surgical site. Multivariate logistic regression analyses were performed to identify common and procedure-specific risk factors across the three anatomical groups.

Results: Infectious complications occurred in 18.5% of patients. The incidence significantly differed by surgical site: 11.7% in right-sided colon, 14.6% in left-sided colon, and 22.0% in rectal cancer (P < 0.001). Operative time was the only risk factor common to all procedures. Right-sided colon cancer was associated with additional risks including advanced age, low BMI, male sex, and open surgery. Rectal cancer, in contrast, showed younger age and male sex as contributing factors. Both male sex and higher BMI correlated significantly with longer operative times in all groups.

Conclusions: Prolonged operative time appears to be a consistent and independent risk factor for postoperative infectious complications across various colorectal cancer procedures. In contrast, other factors such as age, body mass index, sex, and surgical approach showed associations that varied depending on the type of procedure.

Objectives: The purpose of this study was to identify factors associated with conversion to an open procedure during laparoscopic colectomy in patients with body mass index (BMI) ≥25 kg/m². The effects of conversion on long-term outcomes were evaluated.

Methods: In a multicenter cohort study conducted under the auspices of the Japan Society of Laparoscopic Colorectal Surgery, clinicopathological data were examined for 887 patients with BMI ≥25 kg/m² who underwent laparoscopic surgery for colon cancer. Risk factors for conversion to an open procedure were estimated using a logistic model after parameter selection using a least absolute shrinkage and selection operator (lasso) model. Long-term outcomes were compared after inverse probability weighting (IPW) estimation.

Results: Among the 887 patients who underwent laparoscopic colectomy, 31 patients (3.5%) required conversion to an open procedure. In multivariate analysis, preoperative BMI ≥27.5 kg/m², comorbidity-hypertension, blood loss, and simultaneous resection of adjacent organs were independent factors for conversion. After IPW estimation, there were no significant differences in recurrence-free, cancer-specific and overall survival between the conversion (+) and (-) groups.

Conclusions: In obese patients with the factors identified in this study, surgeons should consider the possibility of conversion to open surgery. Long-term outcomes in patients with BMI ≥25 kg/m² did not differ between patients who underwent conversion and those who did not. Therefore, conversion to an open procedure was not detrimental in Japanese patients with BMI ≥25 kg/m².

Objectives: We investigated the characteristics of colorectal cancer (CRC) in older patients (≥ 65 years) and the immune-inflammation indexes.

Methods: This study included 149 patients aged ≥ 65 years with advanced colorectal cancer, who underwent radical surgery (R0 resection). Four immune-inflammation indexes (C-reactive protein-to-albumin ratio (CAR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), and neutrophil-to-lymphocyte ratio (NLR) ) were calculated. We analyzed the association between immune-inflammation indexes and clinicopathological features or prognosis.

Results: Tumor depth and lymph node metastasis were independent prognostic factors for recurrence-free survival (RFS) in multivariate analysis (p=0.03, hazard ratio [HR] 2.095, 95% confidence interval (CI) 1.225-3.982 and p=0.008, HR 2.209, 95% CI 1.225-3.982, respectively). Lymphatic invasion and CAR were also independent prognostic factors for overall survival (OS) in multivariate analysis (p=0.04, HR 2.197, 95% CI 1.042-4.632 and p=0.04, HR 2.174, 95% CI 1.032-4.58, respectively). Lymphatic invasion and CAR were independent prognostic factors for cancer specific survival (CSS) in the multivariate analysis (p=0.03, HR 3.004, 95% CI 1.11-8.13 and p=0.03, HR 3.087, 95% CI 1.135-8.394, respectively).

Conclusions: CAR is a useful immune-inflammation index for predicting the prognosis after radical resection for advanced CRC in older patients.

Objectives: Colorectal cancer (CRC) is a major global health concern, and surgical resection remains its primary treatment. However, the impact of different surgical procedures on gut microbiota and their influence on postoperative outcomes remain unclear. This study investigated changes in the gut microbiota following three types of CRC resections: right-sided colectomy (RSC), left-sided colectomy (LSC), and low anterior resection (LAR).

Methods: Fecal samples were collected from 34 patients with CRC who underwent curative resection at Fujita Health University Hospital between April 2022 and December 2023. Bacterial profiling was performed using 16S rRNA gene amplicon sequencing. The results were compared with data from 85 healthy controls.

Results: Significant alterations in gut microbiota composition were observed in surgical groups compared to the healthy control (Ctrl) group. The RSC group exhibited the greatest reduction in alpha diversity, likely because of ileocecal valve loss. Beta-diversity analysis revealed distinct microbial profiles between the Ctrl group and the surgical groups, with notable alterations in key bacterial species. The RSC group exhibited significant reduction in beneficial bacteria, including Faecalibacterium prausnitzii and Bifidobacterium spp., alongside increase in Escherichia coli, suggesting a shift toward a pro-inflammatory environment. In contrast, the LSC and LAR groups exhibited enrichment of Akkermansia muciniphila, which may promote gut barrier integrity and immune modulation.

Conclusions: CRC resection induces site-specific changes in gut microbiota composition. These microbial alterations may affect postoperative inflammation, metabolism, and cancer recurrence risk. Further studies are necessary to explore microbiome-targeted strategies for improving postoperative outcomes in cases of CRC.

Anal fistulas with intrafistulous calculi are extremely rare. Enterolithiasis generally occurs due to the precipitation, aggregation, and calcification of non-digestible materials; however, its occurrence within anal fistulas remains poorly understood. Here, we report two cases of low intersphincteric anal fistulas with intrafistulous calculi, diagnosed via endoanal ultrasonography and treated surgically. We discuss the possible pathophysiological mechanisms, imaging characteristics, and clinical significance of these calculi.

The role of surgical resection in stage IV appendiceal goblet cell adenocarcinoma remains unclear. We report a case of a 44-year-old woman who underwent left adnexectomy for an ovarian tumor at another hospital. Pathological examination revealed not only an ovarian mature cystic teratoma but also goblet cell adenocarcinoma in the ovarian stroma, later diagnosed as appendiceal goblet cell adenocarcinoma with ovarian metastasis. Further evaluation suggested tumor invasion or metastasis to the rectosigmoid colon. Given the feasibility of curative resection, laparoscopic surgery was performed. Intraoperative findings confirmed rectal metastasis rather than direct invasion from appendiceal goblet cell adenocarcinoma. Peritoneal seeding to the greater omentum was confirmed intraoperatively, leading to total proctocolectomy with Hartmann's procedure, omentectomy, and right adnexectomy. Macroscopically, R0 resection was achieved. Pathological examination confirmed Grade 1 appendiceal goblet cell adenocarcinoma with metastases to the right ovary, rectosigmoid colon, and peritoneum. The patient received adjuvant chemotherapy and remains recurrence-free at 33 months postoperatively. This case highlights the importance of precise pathological assessment in ovarian tumors and suggests that aggressive surgical management may contribute to long-term survival, even in stage IV appendiceal goblet cell adenocarcinoma.

The BEACON regimen, comprising cetuximab, encorafenib, and binimetinib, is a critical treatment for BRAF-mutant metastatic colorectal cancer (mCRC). While effective, this regimen may be associated with a high frequency of serous retinal detachment (SRD) as an ocular toxicity, which is a less recognized risk in colorectal cancer. Here, we report three patients with mCRC who developed SRD shortly after starting BEACON therapy. Each patient experienced acute visual disturbances, and optical coherence tomography (OCT) confirmed SRD without other retinal abnormalities. Temporary discontinuation of therapy improved the OCT findings in all patients. Two patients resumed treatment with a doublet regimen (excluding binimetinib) and maintained stable vision without irreversible damage. The third patient continued binimetinib with an adjusted dosing schedule of 1 week administration and 1 week off, with no ocular toxicity; the other two drugs were continued. None of the patients experienced permanent vision impairment. These cases highlight the importance of early recognition and proactive management of ocular toxicity in patients receiving BEACON therapy. Regular ophthalmological monitoring and appropriate dose adjustments are essential to prevent visual damage while maintaining treatment efficacy.

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms of mesenchymal origin, most commonly originating from the pleura. The discovery of the NAB2-STAT6 gene fusion has enabled more accurate diagnosis, particularly in extrapleural locations. We report a rare case of a 50-year-old woman presenting with localized abdominal pain, who showed a 46-mm heterogeneous mass in the left abdomen on contrast-enhanced CT; laparoscopic exploration identified a pedunculated tumor arising from the jejunal mesentery, located 50 cm distal to the ligament of Treitz. Segmental resection of 15 cm of the jejunum with the associated mesentery was performed. The tumor measured 55 × 45 × 30 mm and was confined to the mesentery, with no invasion of the bowel wall. Histopathological examination revealed proliferation of spindle cells within a collagenous stroma, and immunohistochemistry confirmed strong nuclear STAT6 and cytoplasmic CD34 positivity, while c-Kit, DOG1, Desmin, and S-100 were negative, establishing the diagnosis of SFT. The patient's abdominal pain resolved completely following resection. This case highlights the diagnostic challenges of mesenteric SFTs and underscores the importance of complete surgical resection with intact borders and immunohistochemical analysis in securing an accurate diagnosis and favorable outcome.