It is reported that sarcopenia is a negative prognostic factor of patients with colorectal cancer, and obesity is associated with various cancers. This study aimed to evaluate the prognostic impact of sarcopenic obesity on patients with colorectal cancers. All 915 patients who underwent curative resection for colorectal cancers between January 2009 and December 2016 were included in this study. We used psoas muscle mass index (PMI) for evaluating sarcopenia and used body mass index or visceral fat area (VFA) for evaluating obesity. We defined patients with low PMI and high BMI or VFA as patients with sarcopenic obesity. When we used PMI and VFA, patients with sarcopenic obesity had significantly shorter overall survival and cancer-specific survival (CSS) than patients without sarcopenic obesity (p = 0.0434/0.0291). Univariate and multivariate analysis for CSS showed that sarcopenic obesity was an independent prognostic factor. It may be possible to improve the prognosis of patients with sarcopenic obesity by exercise and diet.

Objective: This study aimed to clarify the effect of the presence of the right colon artery (RCA) on the surgical outcomes of laparoscopic colectomy for ascending colon cancer, which has an ileocolic artery and/or RCA as the feeding artery (proximal ascending colon cancer [PACC]).

Methods: Laparoscopic colectomy for PACC was defined as laparoscopic right-colectomy (Lap-R). Ninety-six patients with PACC who underwent Lap-R with D3 lymph node (LN) dissection from April 2010 to March 2018 were divided into two groups according to the presence of RCA and compared for clinicopathological factors and short- and long-term outcomes.

Results: The RCA group (with RCA) and non-RCA group (without RCA) included 51 and 46 patients, respectively. The two groups had no difference in clinicopathological factors. While the RCA group showed longer operation time (p＝0.047) and more harvested LNs (p＝0.003) than the non-RCA group, the two groups had no difference in postoperative complication rate (≥ Clavien-Dindo Grade II, p＝0.327), relapse-free survival (p＝0.834), and overall survival (p＝0.664).

Conclusion: The safety and long-term outcomes of Lap-R for PACC were comparable between the RCA and non-RCA groups.

Objective: There is no consensus on the appropriate timing of undergoing Hartmann's reversal surgery (HR) after Hartmann's procedure (HP). This study aimed to investigate the association between the time interval (TI) from HP to HR and the treatment outcomes of HR.

Methods: We retrospectively reviewed 32 cases of HR from September 2009 to December 2021. Patient characteristics, TI from HP to HR, perioperative factors during HP and HR, and their association with treatment outcomes were evaluated.

Results: The median TI was 6 months. Postoperative complications (Clavien-Dindo classification ≥ Grade III) occurred in six patients (19%). Patient characteristics and perioperative factors during HP and HR were similar between the TI≤6 month and TI＞6 month groups. The TI＞6 month group had more patients with two or more comorbidities compared with the TI≤6 month group. The treatment outcomes did not differ between the two groups.

Conclusion: TI over 6 months from HP to HR did not improve the treatment outcomes of HR.

Objective: This study was designed to clarify the preoperative predictors of high-output stoma (HOS) in diverting ileostomy for rectal cancer surgery.

Methods: At Niigata City General Hospital, 107 patients with rectal cancer who underwent diverting ileostomy surgery between January 2008 and June 2021 were enrolled in the study. The relationships between high-output stoma and clinical factors including age, sex, psoas muscle index, nutritional laboratory data, and comorbidity; tumor factors including occupation, histological type, and stage; and surgical factors including procedure, operative time, and operative blood loss, were analyzed. HOS was diagnosed when the amount of stool discharged from the ileostomy was ≥2,000 mL per day.

Results: Eighteen patients (16.8%) had HOS. The frequency of HOS was affected by the preoperative prognostic nutritional index (PNI) of less than 45 (P = 0.010). In the multivariate analysis, a preoperative PNI of less than 45 was a predictor of HOS (odds ratio 4.86, 95% confidence interval 1.18-20.00, P = 0.029).

Conclusion: Preoperative PNI is a predictor of HOS. Patients with poor preoperative nutrition are highly susceptible to the development of HOS.

Transanal total mesorectal excision (TaTME) has clear advantages in securing the circumferential resection margin and the distal margin, reducing the operation time, and preserving autonomic nerves. However, the issues of technical training and securing the required number of people for a two-team approach, amongst other issues, may make its introduction difficult. This report describes the author's experience and the short-term results of introducing TaTME at the author's home institution, following a period of intensive training at a Japanese high-volume center. Prior to the introduction, we took certain measures, such as holding an orientation for anesthesiologists and operating room department staff, performing a simulation of the equipment set-up, and creating a standardized manual of the surgical procedure. For safe introduction, the first surgery was performed on a case of early-stage rectal cancer under the supervision of a proctor, and then we gradually expanded the indications. For the 22 cases of TaTME surgeries performed on primary rectal cancers, there were no complications typical of TaTME, Clavien-Dindo classification of IIIb or higher, or conversions to open surgery. TaTME was safely and successfully introduced by acquisition of the required surgical skills at a high-volume center, and careful preparation.

Neorectum mucosal prolapse at the site of anastomosis is a unique complication arising after intersphincteric resection (ISR) for lower rectal cancer. Once postoperative mucosal prolapse occurs, the patient's quality of living remarkably deteriorates. However, a standard treatment for neorectum mucosal prolapse following ISR has not yet been established. We performed the Delorme procedure for neorectum mucosal prolapse post ISR. ISR was performed on 36 patients with low rectal cancer between June 2010 and December 2020 at Juntendo University Hospital. Four cases (11.1%) had neorectal mucosal prolapse, three patients underwent the Delorme procedure before the closure of a diverting loop stoma, and no postoperative complications were observed. However, one case had a recurrence of neorectal mucosal prolapse, and a permanent colostomy was performed. The Delorme procedure is a good option for managing neorectal mucosal prolapse, however, there are also cases where mucosal prolapse recurs. Hence, further examination of the mechanism and operative method for neorectum mucosal prolapse is necessary.

A 59-year-old man visited our hospital due to left lower abdominal pain and fever. He had localized tenderness but no peritoneal irritation. White blood cell count was 16,200/μl, and c-reactive protein was 5.29 mg/dl. Abdominal computed tomography (CT) scan showed thickening of the sigmoid colon and free air around it. Sigmoid colon perforation and localized peritonitis were diagnosed, however, he declined surgery, so conservative treatment with antibiotics was performed. The general condition gradually improved, and a detailed examination was performed, yielding a diagnosis of sigmoid cancer.

Abdominal CT scan predicted that the tumor had nearly reached the left pelvic wall, and so a fluorescent ureteral stent was placed after induction of anesthesia. Laparoscopic surgery was performed, and the operative findings showed that the tumor had nearly reached the left ureter, however, it was unclear under normal light. The ureter could be visually recognized with near-infrared light, and the ureter was safely preserved. However, adhesion infiltration to the vas deferens was suspected, and so laparoscopic sigmoidectomy and vas deferens resection were performed. A fluorescent ureteral stent is considered to be useful for visualizing the position of the ureter during operation when there is a risk of ureter injury before the operation.