Objective: Due to the westernization of dietary habits and other factors, opportunities for treatment of sigmoid-vesical fistula with colon diverticulitis (SVFCD), once a relatively rare condition, are increasing. In general, partial resection of the colon and bladder is performed by open surgery, but recently laparoscopic surgery for SVFCD has been reported. The purpose of this study was to clarify the safety of laparoscopic surgery for SVFCD in our hospital.

Methods: We evaluated the outcomes of open (9 cases) and laparoscopic (7 cases) surgery for sigmoid cystostomy due to colonic diverticulum in 16 cases performed in our hospital from 2011 to 2021.

Results: There was no difference in operative time or duration of postoperative bladder catheter placement between the two groups (p=0.25, 0.05). In contrast, laparoscopic surgery for SVFCD resulted in significantly less intraoperative blood loss (p<0.01) and shorter postoperative hospital stay (p=0.04). Postoperative complications were observed in one patient in the laparoscopic surgery group and five patients in the open surgery group but were not significantly different (p=0.09).

Conclusion: Laparoscopic surgery for SVFCD appears to be feasible and safe.

Background: Few studies have compared the outcomes of robot-assisted intersphincteric rectal resection (Ro-ISR) and laparoscopic ISR (Lap-ISR) for the management of lower rectal cancer. This study aimed to compare the short-term outcomes of Ro-ISR and Lap-ISR. We conducted a retrospective analysis of the short-term outcomes of 101 patients who underwent ISR as the primary treatment for rectal cancer between 2005 and 2020.

Results: The Ro-ISR group comprised 55 patients, while the Lap-ISR group consisted of 46 patients. The distance from the anal verge to the lower margin of the tumor was 3.0 cm in the Ro-ISR group and 4.0 cm in the Lap-ISR group (p<0.01), indicating a significantly shorter distance in the Ro-ISR group. The mean operating time was 287 minutes for Ro-ISR and 320 minutes for Lap-ISR (p=0.04), with the Ro-ISR group demonstrating a significantly shorter duration. Additionally, the amount of blood loss was 24 mL in the Ro-ISR group and 48 mL in the Lap-ISR group (p=0.01), with the Ro-ISR group exhibiting significantly less blood loss.

Conclusion: Ro-ISR represents a valuable approach with favorable short-term outcomes.

In the case of neuroendocrine tumors (NETs), additional resection should be considered if the pathological examination shows positive for lymphovascular invasion, but there is not enough evidence on the long-term prognosis. Among patients with a NET G1 < 1 cm in diameter which was confined to the submucosal layer and treated endoscopically at our hospital between January 2005 and December 2021, 44 (27.8%) with vascular invasion were enrolled to investigate the lymph node/distant metastasis rate and the recurrence/mortality rate. Twelve patients were placed in the additional resection group (two with lymph node metastasis), and 32 were placed in the no additional treatment group (five with death from other causes). No distant metastasis, recurrence, or current death was observed in either group. There was also no recurrence of or death due to primary tumor among the patients with positive vascular invasion after endoscopic treatment of a NET G1 tumor < 1 cm in diameter. Colostomy was required in 75% of the patients who underwent an additional resection. Moreover, there were some cases of lymph node metastasis. The decision to perform an additional surgical resection should take into account the patient's wishes in terms of quality of life and the recurrence rate. How to stratify patients for follow-up remains an issue for future study.

Purpose: The aim of this study was to evaluate the criteria for non-construction of defunctioning stoma (DS) in patients who underwent transanal total mesorectal excision (TaTME).

Methods: This was a retrospective study that reviewed patients whose anastomoses were created with a stapler after TaTME for low rectal tumors. The criteria we established for non-construction of DS were a complete donut and negative air leakage test. Sixteen handsewn stiches were added to all round the stapler line to reinforce the anastomosis. The primary endpoint of this study was anastomotic leakage.

Results: Thirty patients met the inclusion criteria; 25 patients had primary cancer, 3 had neuroendocrine tumor, and 2 had anastomotic recurrence. DS was created in five patients. One of them developed anastomotic leakage, but improved following transanal drainage. DS was not created in 25 (83.3%) patients and anastomotic leakage was observed in two of them. Both cases were male, diabetic, and the onset was later than the 7th postoperative day.

Conclusion: Our criteria for non-construction of DS resulted in two (2/25, 8%) cases of anastomotic leakage. The establishment of stricter criteria and improvement of anastomosis and reinforcement methods are warranted.

Objective: To determine the impact of perianal fistula (PAF) on the daily activities of patients with Crohn's disease (CD).

Methods: A web-based questionnaire was performed to compare the quality of life (QOL) and work productivity using the Short Inflammatory Bowel Disease Questionnaire (SIBDQ) and the Work Productivity and Activity Impairment Questionnaire respectively, between 30 patients with CD and PAF (PAF+ group) and 60 patients with CD but without PAF (PAF- group).

Results: Although the PAF+ group was younger and had more severe CD compared with the PAF- group, the employment rates of the two groups were similar. The mean SIBDQ total scores for the PAF+ and PAF- groups were 3.9 and 4.9, respectively (p < 0.001), indicating that the QOL of patients with PAF was significantly lower than that of patients without PAF. Regarding work productivity, the mean percentage of overall work impairment was 57% for the PAF+ group and 38% for the PAF- group (p = 0.035), suggesting that the work productivity of patients with PAF was also significantly lower than that of patients without PAF.

Conclusion: Patients with CD have low QOL and work productivity, which are further reduced for patients with CD and PAF.

Low-grade appendiceal mucinous neoplasm (LAMN) is an appendiceal mucinous tumor that is sometimes noted after appendectomy. As there are no established surgical procedures or postoperative follow-up methods for LAMN, we performed surveillance for three patients with myxoma of the appendix for 60 months according to the 2014 Edition of the Colorectal Cancer Treatment Guidelines. Case 1 was a 63-year-old woman who visited our hospital with a chief complaint of appendiceal enlargement. She underwent laparoscopic ileocecal resection for suspected appendiceal myxoma. Case 2 was a 27-year-old man who presented with a chief complaint of right lower quadrant pain and underwent laparoscopic appendectomy for a diagnosis of acute appendicitis. Case 3 was a 74-year-old man in whom elective laparoscopic cecectomy was performed following conservative treatment for acute appendicitis. The postoperative pathological diagnosis was LAMN in all three cases, and the margins were negative in all three. No recurrence of LAMN was observed during surveillance for up to 60 months. As no consensus has been reached regarding the method and duration of surveillance for LAMN, we report our experience with these cases along with a review of the literature.

Resection of multiple organ metastasis of breast cancer is rare. We experienced a case of breast cancer with resection of metachronous metastases to the colon and heart.

The case was a 76-year-old woman with a complaint of epigastric pain. Nineteen years ago, she had undergone radical mastectomy for right breast cancer. Endoscopic examination revealed a stenosis in the transverse colon which was diagnosed by a biopsy specimen as metastasis from breast cancer. Enhanced CT scan revealed a mass of the right ventricle which was suspected to be cardiac metastasis. We decided on surgical resection initially, and performed laparoscopy assisted colectomy for resection of the transverse colon in September 2021. Pathological diagnosis was colonic metastasis from breast cancer. After discharge, she underwent adjuvant therapy. Because the cardiac tumor had grown, cardiac tumor was resected at another hospital in January 2022. Pathological diagnosis was cardiac metastasis from breast cancer. She had no recurrence for 14 months after colectomy.

We report two cases of adenosquamous carcinoma of the colon. The first case was a 45-year-old man with the diagnosis of carcinoma of the upper rectum. We performed lower anterior resection and lymph node dissection. The histopathology of the tumor demonstrated adenosquamous carcinoma and the degree of progression was pT3N2bM0 pStageIIIc. Although postoperative adjuvant chemotherapy was performed, metastasis to the lungs, pelvis, and abdominal wall was detected 9 months after the operation. Systemic chemotherapy was administered up to the fourth line of treatment. The patient received best supportive care and died 28 months after surgery. The second case was a 67-year-old man with the diagnosis of carcinoma of the transverse colon. We performed right hemicolectomy and lymph node dissection. The histopathology of the tumor demonstrated adenosquamous carcinoma and the degree of progression was pT1bN0M0 pStageI. Follow up examination at 3 months after surgery revealed multiple liver tumors. Systemic chemotherapy was started, but the tumors continued to progress. The patient received best supportive care for 9 months after the operation. We report these two cases of adenosquamous carcinoma of the colon with a review of the literature.