We investigated the prognostic impact of preoperative and postoperative Prognostic Nutritional Index (PNI) values in elderly patients with colorectal cancer undergoing postoperative adjuvant chemotherapy. Onodera's PNI was used as the nutritional index. Although preoperative PNI values reflected long-term prognosis as reported in previous studies (p = 0.008), we also found that PNI values at the time of induction of adjuvant chemotherapy and at the time of confirmed recurrence may also reflect long-term prognosis (p = 0.049). In addition, patients with preoperative low PNI who had recovered at the time of induction of adjuvant chemotherapy had a good prognosis, whereas those who remained in a low PNI state had a very poor prognosis (p = 0.008, hazard ratio: 3.56). The results of this study suggest that nutritional intervention not only in the perioperative period but also in the mid- to long-term postoperative period may improve the prognosis of elderly colorectal cancer patients by improving their nutritional status.

Aim: The aim of this study was to evaluate the effect of surgical resection with para-aortic lymph node resection for para-aortic lymph node metastasis in colorectal cancer.

Methods: We retrospectively analyzed 22 patients with colorectal cancer who underwent surgical resection with para-aortic lymph node resection in our hospital. All patients were found to have positive para-aortic lymph node metastasis in the postoperative pathology.

Results: The 3-year overall survival rates (3yr-OS) for the 22 patients was 50.0%. The 3yr-OS of 12 patients without distant metastasis other than para-aortic lymph node metastasis was 70.7%. Among them, the 3yr-OS in patients with a preoperative CEA value of less than 9.0 ng/ml was 85.7% (p = 0.001), and the 3yr-OS in patients with three or fewer metastatic para-aortic lymph nodes was 100% (p = 0.001).

Conclusions: For colorectal cancer patients without distant metastasis other than para-aortic lymph node metastasis, especially for patients with a preoperative CEA value of less than 9.0 ng/ml and for patients with three or fewer metastatic para-aortic lymph nodes, radical surgical resection with para-aortic lymph node resection is expected to improve prognosis.

Although probiotics are frequently used in daily clinical practice, there are currently no guidelines for their use. Therefore, we created the “Hiroshima University Affiliated Hospital Probiotics Usage Guidelines.” Questions and problems in clinical practice were examined, and 7 (actually 10) clinical questions were determined. The strength of the recommendation and the quality of the evidence were shown in accordance with the “Minds Manual for Guideline Development 2020 ver.3.0”. In addition, there were few high-quality reports such as meta-analyses from Japan in this area, and there were many areas where we had no choice but to focus on the consensus of the committee members. The guidelines are based on the quality of the current evidence and are intended to support decision-making by patients and physicians in the clinical setting. It is necessary to respond flexibly according to individual patients.

The patient was a 64-year-old woman. She underwent laparoscopic abdominoperineal resection and right lateral lymph node dissection for lower rectal cancer after neoadjuvant chemoradiotherapy. Postoperatively, the perineal wound was dissected and there was a large amount of fluid drainage. Abdominal CT scan revealed encapsulated fluid close to a surgical clip in the area of the right lateral lymph node dissection. Based on the diagnosis of a postoperative lymphocele, CT-guided puncture drainage was performed. She was discharged and followed up in the outpatient clinic with a drainage tube. On the 56th postoperative day, she presented with abdominal pain and right groin pain. Abdominal CT scan revealed a drainage tube and enlargement of the lymphocele. After lymphangiography with lipiodol via the right inguinal lymph node was performed, the symptoms improved and she was discharged on the 15th day.

We report the usefulness of lymphangiography with lipiodol as a treatment for lymphocele after lateral lymph node dissection for rectal cancer, including a review of the literature.

The patient was a 73-year-old man with a 40-mm pedunculated polyp and multiple liver masses. The polyp was suspected of being cancerous and the liver masses were suspicious. We performed sigmoidectomy with D3 lymph node dissection and partial hepatectomy for excisional biopsy. Pathological findings showed that the polyp represented tubulovillous adenoma with a minute area of adenocarcinoma on the stem. The adenocarcinoma had infiltrated to the submucosal layer and had invaded a small vein larger than a capillary. The resected liver mass was identified as a colonic adenocarcinoma metastasis, thus suggesting that the multiple liver masses were synchronous metastases from the adenocarcinoma. We report this rare case of minute early colon adenocarcinoma with synchronous multiple liver metastases. Pedunculated polyps anatomically have bundles of large vessels from the muscularis propria running through the stems, termed “stalk vessels.” Reportedly, the rate of colorectal liver metastasis is also closely correlated with the size of the invaded vein. We considered that the veins invaded by cancer in the present case were stalk vessels, which may have been related to the multiple liver metastases.

A man in his sixties underwent laparoscopic low anterior resection for rectosigmoid cancer. Histopathological examination revealed a tubular adenocarcinoma, moderately differentiated, int, INFb, Ly2, V2, pT3N2M0, pStage IIIb. After surgery, 9 courses of S1+Oxaliplatine (SOX) regimen were performed as adjuvant chemotherapy. Two years later, an enlarged para-aortic lymph node (PALN) with higher uptake of 18F-fluorodeoxyglucose was found. Lymph node dissection surgery for PALNs was performed, and histopathological metastases were found in all resected 7 lymph nodes. After surgery, 12 courses of FOLFIRI regimen were performed. Four years later, a single enlarged PALN was found and the patient underwent lymph node resection. Histopathological examination of the specimen confirmed the diagnosis of metastasis of adenocarcinoma. After surgery, capecitabine was administered for 6 months. The patient remains alive without recurrence 9 years after the initial surgery. In patients with PALN metastasis from colorectal cancer without metastasis to remote organs otherwise, aggressive surgical resection and appropriate chemotherapy may lead to long-term survival.

The patient was a 50-year-old woman. Colonoscopy revealed a 4.7-mm tumor at a distance of 5 cm from the anal verge, and a biopsy showed neuroendocrine neoplasm. Endoscopic submucosal resection with a ligation device was performed. Histopathological examination confirmed positive for both synaptophysin and chromogranin A (focal) and low mitotic rate (0/10) and low Ki67 index (1.1%). Based on these findings, we diagnosed neuroendocrine tumor (NET) G1 according to the WHO classification 2019. The histopathological examination confirmed Ly1, and we performed an additional robot-assisted low anterior resection with D3 lymph node dissection. The paracolic lymph nodes (#251: 2/13) were positive for lymph node metastases. We diagnosed pT1aN1M0 pStage IIIB according to the TNM classification, 8th edition. Herein, we report this case of robot-assisted low anterior resection of a 4.7-mm rectal NET G1 with lymph node metastases, with a review of the literature.

Case: 72-year-old male

History of present illness: Two months ago, he began to have diarrhea and continuous left lower quadrant pain. One month ago, his family doctor prescribed Shokenchutou (TJ-99) and Keishi-ka-shakuyaku-tou (TJ-60), which he took internally, but his diarrhea worsened to 20 times a day, so he came to our hospital. A lower gastrointestinal endoscopy revealed stenosis of the sigmoid colon with erosions, ulcers, edema, and vasodilation that prevented passage of a scope. Biopsy of the same area revealed nonspecific inflammation, and a diagnosis of stricture-type ischemic colitis was made. He was hospitalized and underwent conservative treatment with fasting, but his symptoms did not improve and so a transverse colostomy was constructed. After 1.5 months, CT and lower gastrointestinal endoscopy revealed reduced edema in the lesion, but the scope was impassable, so a laparoscopic-assisted low anterior resection was performed. Histopathological examination of the resected specimen revealed a diagnosis of idiopathic mesenteric venous sclerosis. Two months after surgery, the colostomy was closed and the patient was discharged from the hospital. Eight months after surgery, the patient is doing well.

Conclusion: We experienced a case of idiopathic mesenteric venous sclerosis without calcification with a sigmoid colon as the main locus refractory to conservative treatment.