Older patients with cancer are highly susceptible to sarcopenia. In this study, we investigated the impact of sarcopenia on short-term outcomes (up to 6 months postoperatively) in patients with gastric cancer who underwent gastrectomy at our hospital. Twelve out of 65 patients (18.5%) were diagnosed with sarcopenia using the Asian Working Group on Sarcopenia in Older People Algorithm. A significantly large number of these patients were older and female, with low weight. We also observed a significantly lower level of preoperative albumin in the sarcopenia group. However, in comparisons between preoperative and postoperative albumin levels, values were found to be significantly elevated after operation in the sarcopenia group. There was no significant difference between the groups in preoperative comorbidities and postoperative complications classified as ≧grade II in the Clavien–Dindo classification. However, the sarcopenia group included significantly more patients with complications classified as grade IVb (anastomotic leaks). This study suggests that perioperative management is efficacious in our hospital. It has been reported that sarcopenia adversely affects activities in daily life, nutritional status, muscle mass, and metabolism. We conclude that preoperative and postoperative, long-term medical interventions should be considered for the prevention of sarcopenia.

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The primary aim of the study was to evaluate whether hydroxyethyl starch (HES) 130/0.4 as an alternative to HES 70/0.5 for intravascular volume replacement during surgery reduces the intraoperative requirement for allogeneic blood transfusion and human albumin infusion in patients undergoing off-pump coronary artery bypass graft (OPCAB) surgery. Medical records were retrospectively reviewed for patients given HES 70/0.5 or HES 130/0.4 for intraoperative fluid management during OPCAB surgery between October 2012 and December 2014. In November 2013, HES 70/0.5 was replaced by HES 130/0.4 at our institution. Compared to the HES 70/0.5 group, more patients in the HES 130/0.4 group received HES solutions (p‹0.001) and fewer patients in the HES 130/0.4 group received intraoperative transfusion of packed red blood cells (p=0.024), fresh frozen plasma (p=0.011), and human albumin infusion (p=0.013). Use of HES 130/0.4 instead of HES 70/0.5 also resulted in a less positive fluid balance (p=0.003). No significant differences occurred between the two groups in the postoperative outcomes. In patients undergoing OPCAB surgery, the need for intraoperative allogeneic blood transfusion and human albumin infusion can be reduced by using HES 130/0.4 as an alternative to HES70/0.5.

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A 51-year-old man had an 8×9 cm tumor on the left side of his neck. A chest X-ray showed a shadow of a mass in the hilus of the left upper lung. The tumor started to regress the day after the first chest X-ray examination and it decreased in size to approximately 1 cm after 7 days. Left hilar lung cancer was confirmed by a CT scan. Excisional biopsy of the neck tumor showed lymph node metastasis of adenocarcinoma or squamous cell carcinoma. One week later, these lymph nodes increased in size again. The lymph nodes decreased in size following chemotherapy, but both chemotherapy and radiotherapy were ineffective in eradicating the primary lung cancer. The patient died of cancer 16 months later. One of the causes of the regression of palpable cervical lymph node metastasis of lung cancer was suggested to be the small dose of radiation from the chest X-ray.

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The patient was a 77-year-old man who underwent total gastrectomy and Roux-en-Y reconstruction for gastric cancer in June 2015. He presented to a hospital in early October 2017 with upper right quadrant pain. An abdominal computed tomography (CT) scan showed that the afferent loop was markedly dilated from the stapled end of the Roux-en-Y anastomosis to the duodenal stump. The patient was hospitalized with a diagnosis of intestinal obstruction. The next morning, we performed emergency surgery. On laparotomy, a strangulation of a segment of the afferent loop was identified. The anastomotic site was rotated 360° clockwise. Because manual release of the rotation did not restore blood flow to the strangulated intestine, we resected the strangulated intestine and performed reanastomosis. Afferent loop obstruction is a rare and occasionally fatal complication of gastrectomy with Billroth-Ⅱ or Roux-en-Y reconstruction. Diagnosis by CT scan is typically necessary for early diagnosis and treatment to improve outcomes.

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