[Objective] The aim of this study was to confirm the safety and economic benefits of laparoscopic-assisted colorectomy (LAC) in elderly patients with colorectal cancer.

[Methods] This propensity score-matched case-control study assessed patients aged ≥80 years with clinical stage I-III colorectal cancer over a 6-year period. The short-term outcomes of LAC and open colorectomy (OC) were compared.

[Results] Hospitalization was shorter (8 vs. 9 days), whereas freedom from complications (74.5% vs. 48.9%) and cost of hospitalization (441,194 vs. 476,410 yen) were better in the LAC than in the OC group.

[Conclusion] The short-term outcomes of colorectal cancer with low invasiveness were better with LAC than with OC.

A 78-year-old man, who was previously noted to have complete situs inversus, presented with a complaint of dark red stools at the Department of Gastroenterology of our hospital. Lower gastrointestinal endoscopic examination revealed a type 2 tumor in the descending colon. Biopsy resulted in a diagnosis of group 5 adenocarcinoma, and the patient was referred to our department for operative treatment. Using 3D-CT imaging, we confirmed the absence of any abnormality in the blood vessel distribution other than the inversion, and performed laparoscopic partial colectomy. The surgeon stood on the left side of the patient, and the port positioning was rotated 180°. Although the left-right inversion gave a sense of strangeness, we safely performed the operation without misidentification of anatomy. The postoperative progress was favorable, and the patient was discharged on postoperative day 12. To safely conduct laparoscopic colonic resection in cases of complete situs inversus, it is important to perform an anatomical evaluation using 3D-CT examination and a thorough preoperative simulation, and to perform the operation carefully while accurately identifying the anatomical positional relationships intraoperatively.

We report a rare case of lower rectal cancer with intramural abscess of the rectal wall after ALTA injection sclerotherapy. An 80-year-old male underwent polypectomy for rectal polyp and ALTA sclerotherapy for hemorrhoid at the same time. The pathological examination revealed well-differentiated adenocarcinoma focally invading the submucosa with resected margin positive, and he was referred to our department for surgical management. On colonoscopy, there was a wide scar in the lower rectum. Enhanced computed tomography (CT) and positron emission tomography-CT revealed an irregular mass at the anterior wall of the lower rectum, suggesting remnant cancer invading the prostate. Preoperative fine-needle aspiration and intra-operative pathological diagnosis of the lesion demonstrated no malignancy.

From these findings, the lesion was suspected to be an inflammatory change caused by ALTA sclerotherapy and so we performed laparoscopy-assisted abdominoperineal resection, preserving the prostate. The final pathological diagnosis revealed the formation of an intramural abscess in the rectal wall with no residual tumor cells. This case report highlights the diagnostic difficulty when an inflammatory change after ALTA sclerotherapy is adjacent to malignancy in the rectum and demonstrates that these simultaneous treatments should be avoided.

[Introduction] Debridement of Fournier's gangrene with an electrosurgical knife is characterized by a lack of swiftness and poor tissue selectivity. The hydrosurgery system (HS) is a new technique utilizing a high-pressure water jet for debridement, but on the other hand, negative pressure wound therapy (NPWT), a wound management technique that accelerates wound healing by maintaining negative pressure at the wound site, has hardly been used in the treatment of Fournier's gangrene for anatomical reasons.

[Case] A 56-year-old man with chief complaints of fever, perineal pain, and impaired consciousness was diagnosed with severe Fournier's gangrene through a physical examination. After debridement with HS, a sigmoid colostomy was performed on the 3rd postoperative day following cardiorespiratory stability. After NPWT for the treatment of a perineal wound, skin grafting was done on the 29th postoperative day. He was discharged in remission on the 48th postoperative day.

[Conclusion] It was possible to perform swift and tissue-selective debridement of Fournier's gangrene through HS. NPWT following HS was safe for wound bed preparation prior to skin grafting, and the patient had a good quality of life during NPWT.

We report two cases of treatment with over-the-scope-clip (OTSC) for anastomotic leakage after sigmoid colectomy for diverticulitis. Case 1 was a 52-year-old man who visited the hospital with lower abdominal pain and hematochezia and was diagnosed with sigmoid colon diverticulitis and mesenteric penetration by contrast CT. Sigmoid colectomy (end-to-side anastomosis) and diverting ileostomy were performed. On postoperative day 46, enterocutaneous fistula due to anastomotic leakage was diagnosed by fistulography and fistula closure using OTSC treatment was performed on postoperative day 121. After treatment of OTSC closure, the enterocutaneous fistula healed and the ileostomy was closed.

Case 2 was a 56-year-old man who visited the hospital with pneumatourea and was diagnosed with sigmoidvesical fistula by contrast CT. Sigmoid colectomy (end-to-side anastomosis) and diverting transverse colostomy were performed. The relapsing-remitting clinical course of SSI was observed repeatedly and enterocutaneous fistula due to anastomotic leakage was diagnosed with fistulography on postoperative day 221. Although we tried to use this OTSC approach for refractory fistula closure five times, we failed to close it and finally performed a surgical fistulectomy.

A woman in her 60s underwent sigmoidectomy. The post-operative clinical stage was pT4aN1M0, stage IIIb. One year after the sigmoidectomy, she was diagnosed with recurrence of colon cancer in the pelvic cavity. After 3.5 years of alternating chemotherapy with bevacizumab, panitumumab and cetuximab, she complained of nausea and anorexia.

An ossified nodule was seen on the abdominal wall. Combined partial resection of one-third of the small intestine was performed. Adenocarcinoma with ossification was found on pathological examination. After 1 year and 10 months, she died due to pelvic recurrence, liver metastases and pulmonary metastases.

An 84-year-old man was admitted to our hospital for a tumor arising in the right lower abdomen. He had undergone laparotomy twice: one was a gastrectomy for gastric cancer and the other was adhesiolysis and appendicostomy for repeated intestinal obstruction at 62 years of age. The appendicostomy was closed spontaneously for twenty years. Two years before admission, he had a subcutaneous abscess under the scar of the appendicostomy and was treated with drainage. However, the situation did not improve and a tumor was forming. Physical examination showed a necrotic tumor, 4 cm in diameter, on the right lower quadrant. Abdominal computed tomography showed a mass bulging into the cecum lumen through the abdominal wall.

Biopsy of the tumor revealed well-differentiated adenocarcinoma. At first he was diagnosed with cecum cancer invading the abdominal wall and skin, and ileocecal resection combined with abdominal wall was performed. The macroscopic finding revealed that the tumor originated from the appendicostomy. Histopathological examination confirmed a diagnosis of appendiceal cancer derived from the appendicostomy. We report this rare case of appendiceal cancer derived from an appendicostomy, with a review of the literature.

We report a case of intractable recto-vaginal fistula after rectal cancer cured by conservative treatment. The case was a woman in her 40s. Laparoscopic low anterior resection and double stapling technique (DST) anastomosis were performed for rectal cancer. Postoperatively, suture failure was found and ileostomy was performed. Recto-vaginal fistula was diagnosed by close examination for colostomy closure. Transvaginal fistula closure, endoscopic clip closure, and tissue adhesive injection into the fistula were ineffective. After taking estriol tablets for three years after the diagnosis, the fistula disappeared at 4 months of lower GI imaging. We performed closure of colostomy in the fifth year. No recurrence of recto-vaginal fistula was noted at the follow-up. It is considered non-invasive and one of the treatment options for recto-vaginal fistula.