In the field of oncology in Japan, an important issue is to manage older cancer patients suffering from progressive physical and cognitive impairment. It is known that healthy ‘fit' senior cancer patients can tolerate standard therapy with anticipated results similar to non-elderly patients, whereas it is hard for ‘frail' patients to receive cancer treatment because their general condition is too poor to tolerate any anticancer therapy and only the best supportive care may be the preferred method of management. For a medical team, one of the most difficult issues is to manage ‘prefrail' patients whose condition lies between fit and frail, since they can only tolerate less intense cancer therapy because of potentially too much treatment toxicity. There is also no guideline for the treatment of such patients because of insufficient evidence. Thus, this project aimed to state provisional clinical opinions (PCO) recommended by experts of geriatrics, geriatric oncology and other stakeholders in order to establish future guidelines for managing these patients. We established five treatment working groups to state PCO for vulnerable elderly patients in colorectal cancer as a model case; this paper presents a definition of prefrail and the process of producing PCO discussed by the Overview and Geriatric Assessment Working Group.

Following the general statement for the management of prefrail elderly in colorectal cancer, the following six important clinical questions concerning the management of such patients were raised, discussed and recommended by the working group: 1) The purpose of cancer treatment is extension of both the overall and disability-free survival (healthy life expectancy); 2) The healthcare workers' team should respect patients' will and values, and should try to build a consensus on the treatment purpose with patients; 3) Patients who potentially have cognitive impairment need to be evaluated by appropriate tools and supported by the medical team to make a decision on selecting the treatment plan depending on their cognitive function; 4) Life expectancy will support shared decision-making on the treatment plan; 5) Quality of life measured before and after treatment is an important factor to evaluate healthy life expectancy; and 6) Geriatric assessment before starting the treatment is useful to predict the risk of developing adverse events, prolonged length of hospital stay and death. The prefrail elderly will eventually deteriorate to require nursing care despite cancer treatment. Close collaboration between medical and nursing care is recommended as soon as a diagnosis of cancer is made in those presenting with significant frailty.

Purpose: The purpose of this study was to evaluate the usefulness of a telephone support program by medical practitioners to reduce hand foot syndrome (HFS), an important adverse event of Capecitabine + Oxaliplatin (CapeOx) therapy.

Methods: For post-operative patients with colon cancer, medical staff provided telephone support five times during the initial three courses of CapeOX therapy. The primary endpoint was an HFS rate of Grade 3 or higher.

Results: Out of the 56 enrollments, 49 were considered, excluding 7 non-eligible cases. There was only 1 case (2%) of Grade 3 HFS, and 11 cases (22.4%) of Grade 2 or higher. There was no decrease in QOL in the comprehensive evaluation of the skin disease-specific scale. Finally, 33 patients (67.3%) were able to complete CapeOX therapy, with a 3-year recurrence-free survival rate of 93.9%.

Conclusion: Telephone support by medical practitioners was considered to be a promising tool for reducing the incidence of HFS and performing CapeOx therapy.

We report a case of an intussusception that was associated with a low-grade appendiceal mucinous neoplasm (LAMN). The patient was a 26-year-old man with lower abdominal pain and nausea. Computed tomography (CT) showed a cystic mass in the ascending colon. We performed surgery for the purpose of diagnosis and treatment, during which a cystic mass was diagnosed as intussusception. We performed laparoscopic cecum partial resection and intussuscept reduction. Histopathologically, the lesion was diagnosed as low-grade appendiceal mucinous neoplasm (LAMN), newly classified in the Japanese Classification of Colorectal Carcinoma (eighth edition). The postoperative recovery was favorable, and the patient was discharged on the seventh postoperative day. LAMN is difficult to diagnose preoperatively, and a treatment strategy for LAMN has not yet been established. In case of intussusception, the retroperitoneum and the ileum are loosely fixed and mobile, and the surgical technique of laparoscopy is relatively easy. We report this case with a review of the literature.

The lithotomy position is difficult for patients with severe kyphosis. We report a case of colon cancer in a patient with severe kyphosis, in which an “ultra shoulder positioner” was useful in maintaining the lithotomy position. An 88-year-old woman with severe kyphosis visited our hospital with a chief complaint of constipation from the previous day. Computed tomography showed a sigmoid tumor and dilation of the colon on the oral side of the tumor. The patient was diagnosed with obstructive colitis due to sigmoid colon cancer, and surgery was scheduled after placement of a colorectal stent. Since the supine position was difficult due to severe kyphosis, preoperative positioning simulation was performed. Because a magic bed was not effective, we used an “ultra shoulder positioner,” which made it possible to keep the spine positioned at a reasonable angle. After awake tracheal intubation in the left lateral decubitus position, the patient was repositioned to the supine lithotomy position according to the preoperative simulation. Preoperative positioning simulation was useful to change the position smoothly, and to shorten the operation time, and it eventually prevented the occurrence of postoperative low back pain and pressure ulcers.

A 60-year-old woman underwent laparoscopic-assisted low anterior resection for stage II rectal cancer. Although the post-operative course appeared uneventful, significant melena appeared 7 days postoperatively. Hemostasis was initially achieved with conservative therapy, but when oral ingestion was resumed, anal bleeding reoccurred. Pelvic contrast-enhanced CT showed a strongly-enhanced nodule consistent with the anastomotic site. In addition, colonoscopy revealed a beating nodule at the anastomosis site, and so the patient was diagnosed with bleeding from a pseudoaneurysm.

Endoscopic hemostatic and conservative treatment with interventional radiology (IVR) were considered difficult, so transanal hemostasis was performed. Pseudoaneurysm is a condition that requires urgent treatment because of the risk of rupture if left untreated. When anastomotic bleeding is observed, it is necessary to take prompt action with the formation of a pseudoaneurysm in mind, although this development is rare.