The Japanese General Rules for Clinical and Pathological Studies on Cancers of the Colon, Rectum and Anus (JGR) in Japan and the TNM staging system of the American Joint Committee on Cancer/the Union Internationale Contrele Cancer (AJCC/UICC) in Europe and the United States are widely used for the staging of colorectal cancer. This study was aimed at clarifying the relationships between the JGR and TNM classifications of lymph nodes and the prognosis in patients with Dukes C colorectal cancer, and at examining which classification was more appropriate. The subjects were 386 Dukes C colorectal cancer patients who had undergone curative resection. The n-stage in JGR based on the anatomical sites of metastatic lymph nodes, the N-stage in the new TNM classification based on the number of metastatic lymph nodes, and the existing clinicopathological parameters (gender, age, tumor diameter, region occupied by tumor, histological type, depth of invasion, lymphangial invasion, and venous invasion) were analyzed for prognostic significance for survival by multivariate analysis. Univariate analysis showed that 6 factors, namely, tumor diameter, depth of invasion, lymphangial invasion, venous invasion, JGR (n-stage), and TNM (N-stage) were significant prognostic factors for 5-year survival. However, multivariate analysis showed that only the TNM classification of lymph node metastasis was an independent prognostic factor in patients with Dukes C colorectal cancer (p<0.0001, with an odds ratio of 2.876). In the Dukes C colorectal cancer patients who had undergone systemic lymph node dissection, the N-stage classification of TNM seemed more appropriate than the n-stage classification of JGR, which is based on the anatomical sites of metastatic lymph nodes.

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For inflammatory intestinal diseases such as ulcerative colitis and Crohn's disease, cases resistant to medical treatment require surgery. When multiple-stage surgery is performed, a temporary Heal stoma is constructed. A 38-year-old female with ulcerative colitis underwent rectal mucosectomy, H-type pouch anal anastomosis (IAA), and ileostomy, as the second stage of three-stage surgery. She was admitted for pain control of a skin ulcer at the stoma site.
Stoma care was intensively performed by invigation and application of various types of ointments and covering materials.
Finally, the third-stage operation could be successfully performed for the intractable skin ulcer associated with pyoderma gangrenosus developing around the stoma.

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We report a rare case of anal verrucous carcinoma. A 48-year-old man who had painful swelling of the front of the anus from the beginning of August 2002, was referred to our hospital. Preoperatively, we diagnosed the care as strangulated internal hemorrhoids, so we performed an emergency operation. Histopathologically, the diagnosis was anal verrucous carcinoma, so we carefully followed up, but the tumor recurred. We discussed how to treat it because the tumor recurred and became enlarged. After a detailed consideration, we decided that a partial resection would be better from the last histopathological findings, so we removed the tumor again with a 5mm surgical margin. Postoperative histopathological examination was the same as the previous findings, and it was diagnosed as anal verrucous carcinoma. We did not detect recurrence of a tumor for fifteen months after reoperation. Anal function is now good. We believe this is the first recorded case of anal verrucous carcinoma which was not based on condyloma acuminatum.

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A 53-year-old woman brought to the hospital by ambulance due to lower abdominal pain, fever, headache, and vomiting had bilateral hypochondrial tenderness. Abdominal CT showed low-density lesions in both hepatic lobes, yielding a diagnosis of liver abscess. Ultrasonic guided puncture and drainage of the abscess was done and the patient was hospitalized. After hospitalization, bloody spots were noted in the stools and more thorough examination disclosed sigmoid colon cancer. Upper gastrointestinal endoscopy showed a 0-IIc lesion on the greater curvature of the upper stomach classified as group 4 based on a biopsy. During surgery, we found the lateral side of the liver was adhered firmly to the stomach and sigmoid colon cancer had infiltrated into the rectum, necessitating total gastrectomy, extended lateral hepatic segmentectomy, and low anterior resection. Pathological examination showed no evidence of metastatic lesions in the liver and findings did not contradict diagnosis of an abscess.
Given that the incidence of colorectal cancer complicated by liver abscess is relatively rare, we speculated that transportal infiltration by colorectal cancer resulted in formation of the liver abscess.

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Primary malignant melanoma of the anorectal region is a relatively rare entity and the prognosis is very poor. We experienced a case of malignant melanoma of the anorectal region. A 59-year-old man was found to have a blackish mass by endoscopic rectal examination. A biopsy specimen was histologically diagnosed as anorectal malignant melanoma. Abdomino-perineal resection with D2 dissection was performed 12 days after excisional biopsy. Macroscopic features were SM, P0, HO, M (-), N (-), Stage I. Microscopically, tumor cells with melanin granules had invaded into the submucosa. The patient has suvived for about 6 years since the operation without any sign of recurrence. We suggest that early detection and diagnosis of this disease are important for improving the prognosis.

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A rare case of transverse colon cancer metastasizing to the multiple gastric regional lymph nodes is reported. An 84-year-old female was admitted to our hospital complaining of anemia and right upper abdominal pain. An abdominal CT revealed enhancing tumor around 6.0×4.5 cm in size abutting to the pylorus of the stomach. Gastroendoscopy showed the submucosal tumor-like lesion on the pylorus and its direct invasion to the duodenum. A colonoscopy revealed a circumferential colon cancer at the hepatic flexure of the transverse colon. Right hemicolectomy and pancreaticoduodenoctomy with distal gastrectomy was performed. Pathological examination revealed T3 colon cancer and multiple metastases to the gastric regional lymph nodes (No.3, 6, 8a, 12a). Especially, pyloric tumor was diagnosed as a metastasis to the infrapyloric lymph node (No. 6) showing direct invasion to the duodenum and pancreas. The point of this case is that no lymph node metastasis was observed in colonic regional lymph nodes such as epicolic, paracolic and middle colic artery lymph node. In the case of right-side colon cancer, metastasis to the gastric regional lymph nodes is extremely rare, yet careful attention should be paid.

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We experienced a case of descending colon cancer accompanied by liver abscess. A 73-year-old man, who had been treated for chronic alcoholic pancreatitis, was admitted to our hospital because of pyrexia and vomiting and abdominal pain. Abdominal ultrasonography (US) and computed tomography (CT) showed a cystic mass of size 5 X 7 cm in the right lobe of the liver.
From the examination and clinical findings, we diagnosed his condition as liver abscess, and treatment was immediately started with antibiotics and percutaneous transhepatic abscess drainage (PTAD). Barium enema, which was performed for the evaluation of anemia, revealed a so-called "apple core lesion" in the descending colon. Colonoscopic examination confirmed colon cancer of well differentiated adenocarcinoma on biopsy. Resection of the descending colon was carried out after improvement of the liver abscess. The resected specimen revealed H0, P0, N0, in Stage II, ss, n0, lyl, v1 microscopically. Abdominal US and CT were valuable for the diagnosis of liver abscess and PTAD was highly effective for treating liver abscess.
Reports of colon cancer accompanied by liver abscess are rare, but it is important to conduct a full gastrointestinal study for the treatment of liver abscess.

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We report a case of liposarcoma located in the pararectal space. A 34-year-old woman was admitted to our hospital for rectal tumor in January 1994 after her obstetrician noticed it by chance when she delivered her second child in December 1993. Barium enema study and colonoscopy showed a submucosal lesion of the left side of the lower rectum or compression from the lesion outside the rectal wall. An abdominal CT scan showed a tumor with dense fatty tissue on the left side of the lower rectum. MRI showed that the tumor contained strands inside. Percutaneous fine needle aspiratiom biopsy cytology indicated liposarcoma. Resection of the tumor was performed. The tumor was covered with a thin capsule and there were no signs of involvement of other organs. The size of the tumor was 75×70×71 mm. Histological examination of the tumor showed liposarcoma myxoid type. She has been free from disease for 8 years after surgery without adjuvant therapy. Because of disease's high reccurrence rate, we must strictly follow up this case. A review of the literature of cases of retroperitoneal liposarcoma is described.

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For 7 years, 52 cases of colorectal cancer, infiltrating to the proper muscle layer, were examined and evaluated on the basis of clinicopathological findings. The extent of venous invasion was assessed using Elastica van Gieson stain, and the extent of carcinomas invading the mp was investigated on a 4-point rating scale (infiltration degree of mp).
Most of mp colorectal carcinomas were located in the sigmoid colon and the rectum. Infiltration degree of type 2 was deeper than that of type 1. No relationship was found between infiltration degree of mp on the one hand and tumor diameter, venous invasion, extent of tissue differentiation, and metastasis tolymph nodes on the other. Recurrence was seen in 3 cases. All cases were hematogenous metastasis. The rate of lymph node metastasis was 21.2%. All cases were nl. The positive rate of venous invasion was high in cases of budding and those revealing changes in tissue differentiation. Such cases may demand postoperative adjuvant chemotherapy.

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Evidence-based clinical pathway for colon cancer surgery has been created and introduced. The indication of the pathway is patients with American Society of Anaesthesia grades 1 and 2 undergoing elective surgery. The summary of the pathway consists of perioperative informed consent, no postoperative gastric tube, epidural analgesia, early mobilization, early feeding, and hospital discharge on the 6^th postoperative day. Clinical results of 42 patients applying the pathway (CP group) were compared with those of 42 patients who underwent surgery before the introduction of the pathway (Non CP group). There was no significant difference in age, sex, associated disease, operative time, blood loss, or surgical procedure between the groups. The patients with Dukes B in the CP group were significantly fewer than those in the Non CP group. No significant difference was found in postoperative complication between the groups. The median postoperative hospital stay in the CP group was significantly shorter than that in the Non CP group (6 days (3-31)vs. 20 days (8-100), P<0.0001). Postoperative hospital stay was decreased without increasing complication after introduction of the pathway.

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We have studied the efficacy of epidural opioid analgesics as a postoperative pain control in patients haemorrhoidectomy. The patients were prospectively divided into the following seven groups : 0.25% bolus epidural administration of bupivacaine group (B, n=28), continuous (for postop. 2 days) epidural administration of bupivacaine group (CB, n=22), continuous bupivacaine-morphine mixed group (CBM, n=22), continuous morphine (CM, n=21), continuous buprenorphine (CBP, n=18), continuous eptazocine group (CE, n=14) and diclofenac suppository group as a control group (CO, n=30). Efficacy was evaluated by VAS in postop. pain and patient acceptability classification. As a result, all epidural opioid analgesics were more effective in relieving pain than group CO (p<0.05). CBM was the lowest in VAS, but dysuria was frequent in CBM and CM. Nausea and/or vomiting were frequently observed in group CBP. Group CE was evaluated as most acceptable for patients due to fewer side effects. Epidural analgesics are highly effective in pain control if aggressively used, but, close attention should be paid to the appropriate selection of opioids.
We conclude that CE is most suitable for postoperative analgesia in patients undergoing haemorrhoidectomy.

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Ten cases of Crohn's disease complicating iliopsoas abscess were experienced. They were 8 males and 2 females and mean onset of Crohn's disease and iliopsoas abscess were 17 and 24 years old, respectively. Abscess was located in right side (8 cases) and left side (2 cases). Affected lesions responsible for abscess were ileitis (2 cases), ileocolitis (6 cases) and colitis (2 cases). Hydronephrosis was seen in 3 cases. and simultaneous entero-cutaneous fistula was seen in 3 cases. They noted back pain, pain in the thigh and gait disturbances. All the cases were treated with excision of the affected lesions and drainage of abscess. Symptoms were disappeared in a short period of time postoperatively. Ileopsoas abscess was not healed with the conservative therapies. Surgical excision of the responsible lesion and drainage were necessary to cure.

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