Nihon Daicho Komonbyo Gakkai Zasshi
Online ISSN : 1882-9619
Print ISSN : 0047-1801
ISSN-L : 0047-1801
Volume 76, Issue 6
Displaying 1-8 of 8 articles from this issue
Original Article
  • Takeshi Ueda
    2023 Volume 76 Issue 6 Pages 413-419
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    Aim: The present study clarified the treatment policy decisions and outcomes and examined the problems in patients with colorectal cancer without distant metastasis who did not undergo radical surgery.

    Methods: We enrolled 348 patients diagnosed with primary colorectal cancer between April 2016 and March 2021. We retrospectively investigated the clinical background of 32 patients who were not resected, excluding those with cStage IV disease.

    Results: The median age was 89 (range: 70-98) years old. The median prognostic nutrition index was 36.9, the modified Glasgow prognostic score was 1.5, and the Charlson comorbidity index was 4; these findings indicate that the patients without resection had a poor nutritional status and many comorbidities. Eleven cases with obstructive symptoms underwent palliative surgery. The main reasons for non-resection were older age and the presence of comorbidities, such as dementia, such that 18 patients (56.3%) were unable to make a decision regarding resection. Deaths from other diseases were more common than tumor-related deaths.

    Conclusion: There was a tendency to refrain from treatment due to advanced tumors, comorbidities, and poor social background. To ensure adequate decision-making, individual judgment is required, and it is necessary to treat patients while keeping these findings in mind.

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  • Tatsunosuke Harada, Yasuhiro Ishiyama, Yume Minagawa, Shingo Ito, Masa ...
    2023 Volume 76 Issue 6 Pages 420-425
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    Aim: To evaluate the efficacy and safety of WING DRAIN, which was developed exclusively for a transanal drainage tube for preventing anastomotic leakage after surgery for rectal cancer.

    Subjects: Patients who underwent laparoscopic anterior resection for rectal cancer between March 2017 and October 2021 at our hospital were divided into two groups: the WING DRAIN implantation group (WD group) and the non-transanal drainage tube including WING DRAIN (NTD group).

    Results: During the study period, 105 patients underwent laparoscopic anterior resection for rectal cancer, 46 in the WD group and 59 in the NTD group. The WD group showed significantly lower anastomotic leakage rate (6.5% vs. 23.7%) and reoperation rate (0% vs. 10.2%). No drain-related complications were observed.

    Conclusion: WING DRAIN showed the potential to reduce the incidence of anastomotic leakage and reoperation rate.

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Clinical Study
  • Naoto Saigusa, Jun-ichi Saigusa
    2023 Volume 76 Issue 6 Pages 426-431
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    Objective: We determined the long-term prognosis and prognostic influencing factors in patients with Crohn's perianal fistulas who were treated with biological agents.

    Methods: Sixty-one bio naïve patients who received biologics from January 2009 to July 2022 were enrolled in this study. Among them, the remission achievement rate of fistulas was determined. An event of clinical relapse was defined as anal surgery or switch of biologics, and univariate and multivariate analyses were conducted using the Kaplan-Meier method for the following 10 clinical factors: 1) gender, 2) age at onset of anal fistula, 3) fistula type (simple/complex), 4) colorectal lesions, 5) anorectal stenosis, 6) intestinal lesions (early/advanced), 7) concomitant use of immunomodulator, 8) smoking, 9) period between onset of fistula and introduction of biologics and 10) fistula remission at 8 weeks after the induction of biologics.

    Results: The average follow-up period was 7.5 (0.5-17.4) years, and the overall remission achievement rate was 63.9% at 8 weeks and 88.5% eventually. Factor ♯10 was the only significant risk factor for clinical relapse (odds ratio; 2.817, p=0.023).

    Conclusion: Biologics had a certain effect for perianal fistulas in the bio naïve patients with Crohn's disease, and fistula remission at 8 weeks was an independent prognostic factor.

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Case Reports
  • Yoko Adachi, Yoshito Arisawa, Wenlin Du
    2023 Volume 76 Issue 6 Pages 432-437
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    A 70-year-old man who had positive occult blood results underwent colonoscopy which revealed a 0-Is+IIa lesion over 30 mm in size at the lower rectum diagnosed as cT1bN0M0 rectal cancer. Because he rejected surgical intervention and requested another treatment, we decided to administer chemoradiotherapy and adopt a “watch and wait” approach, provided clinical complete response had been achieved. Four weeks after CRT, colonoscopy showed that the tumor had shrunk to 25 mm in size and appeared to be LST-G. We offered low anterior resection with curative intent to the patient, but he adamantly refused radical surgery. Therefore, we performed ESD after a total of 8 weeks of chemoradiotherapy. The lesion was removed by piecemeal resection (3 pieces), but grossly complete resection of the tumor was performed. Pathological findings showed rectal cancer of tub1, pTis(M), ly0, v0, HMX, VM0. No recurrence was observed for 25 months after ESD. This case showed that ESD after chemoradiotherapy can be attempted in the case of T1-2 rectal cancer.

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  • Takanori Kurogochi, Satoshi Yamazaki, Ken Eto
    2023 Volume 76 Issue 6 Pages 438-442
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    The case was a 65-year-old man. He was scheduled to undergo lower gastrointestinal endoscopy to conduct a detailed examination after fecal occult blood test results were positive. However, the patient complained of abdominal pain and distension on the day of the endoscopy. Computed tomography scan of the abdomen indicated a change in caliber at the sigmoid colon. We suspected intestinal obstruction because of a stool mass and attempted to relieve the intestinal obstruction using an endoscope. However, his abdominal pain worsened during the endoscopic procedure and we had to perform emergency surgery. Intraoperative findings revealed a huge diverticulum. A stool mass had accumulated in the same area, thus causing the intestinal obstruction. We performed laparoscopic Hartmann's procedure and the stoma was closed 3 weeks after the surgery. We report this rare case along with a review of the literature.

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  • Yukiko Nonaka, Kay Uehara, Atsushi Ogura, Yuki Murata, Ryutaro Kobayas ...
    2023 Volume 76 Issue 6 Pages 443-446
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    A 75-year-old woman was referred to our hospital with a chief complaint of tiredness. She was diagnosed with cecum cancer, unresectable multiple liver metastases, and peritoneal dissemination. The companion gene test result showed that she was RAS mutant (KRAS G12V), BRAF V600E wild type, and microsatellite stable, and she was treated with FOLFOX + bevacizumab. Her cancer gene panel test revealed a BRCA1 pathological variant in the germline, and she was diagnosed with hereditary breast and ovarian cancer syndrome. With the increasing use of cancer gene panel testing, it is expected that the number of cases in which secondary findings in the germ line are unexpectedly detected, leading to the diagnosis of inherited diseases, will increase. Although this information is always included in the consent document, not only patients but also health care providers are often unaware of the importance of genetic counseling.

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  • Shunsuke Nakashima, Satoshi Narihiro, Mutsumi Kaji, Sayumi Kurita, Sat ...
    2023 Volume 76 Issue 6 Pages 447-451
    Published: 2023
    Released on J-STAGE: May 30, 2023
    JOURNAL FREE ACCESS

    A 67-year-old man was on peritoneal dialysis for end-stage renal failure. Four months after interruption, he came to our hospital with a complaint of left lower abdominal pain, and was urgently admitted on the same day with a diagnosis of intra-abdominal abscess caused by peritoneal dialysis catheter infection on CT scan of the abdomen. After antibacterial treatment and CT-guided drainage, the abscess cavity was reduced, but a peritoneal dialysis catheter had strayed into the rectum during lower gastrointestinal endoscopy. The patient was treated conservatively with an in-dwelling catheter, and was discharged from the hospital on the 47th day. Seven months have passed since the onset of the infection, and no recurrence of infection has been observed. In this report, we describe a case of medically-induced rectal perforation that was successfully treated conservatively without surgical intervention.

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