Background

Sarcopenia is defined as a decline in skeletal muscle mass and whole-body physical function associated with aging. If only a decrease in skeletal muscle mass is observed, the term used is presarcopenia (PS). In this study, we retrospectively analyzed the clinical significance of PS in older patients with colorectal cancer aged ≥75 years.

Results

Of the 131 older patients with colorectal cancer, 33 were classified as PS group and 98 as non-PS group. Postoperative complications were more common in the PS group (P=0.051). In addition, Alb levels were lower in the PS group (Alb: P=0.069) and CRP-Alb ratio (CAR) was higher in the PS group (CAR: P = 0.069). The neutrophil-lymphocyte ratio (NLR) was higher in the PS group (NLR: P= 0.002).

Conclusion

PS in older patients with colorectal cancer was associated with an increased incidence of postoperative complications and longer hospital stay. Diagnosing PS before surgery may be useful as a screening tool for identifying patients at high risk of postoperative complications. Furthermore, PS was suggested to be associated with preoperative inflammation-related factors such as CAR and NLR.

Anal cystic lesions are extremely rare. From October 2011 to August 2023, 3 (0.12%) of the 2498 anal surgery cases performed in our hospital had cystic lesions. They were 38, 56, and 69 years old, all male, and cystic lesions were located anterior to the anus. The cysts were elastic and soft, and the preoperative diagnosis was thrombosed external hemorrhoids or cysts, but histopathologic examination revealed epidermal cysts in two cases and teratoma in one case. Teratomas in the anus show similar histological features to tailgut cysts and retrorectal cyst-hamartomas, and are thought to be rare cysts caused by the remnants of cloaca. They are usually located in the retrorectal space; cases located in the perianal region are extremely rare, and only four cases including ours have been reported in Japan. We present each case and report a case of teratoma in the anal region with a review of the literature.

A 74-year-old man visited a nearby hospital because of vomiting and abdominal pain. An abdominal CT scan revealed a tumor measuring 35mm in the terminal ileum, accompanied by calcification, as well as dilation of the proximal small bowel. Four years earlier, a similar tumor was incidentally pointed out, but no further investigation was conducted at that time. Although the size of the tumor had not increased since the previous examination, the patient had developed bowel obstruction, requiring surgical intervention after improvement of bowel distension. Since the possibility of malignancy could not be ruled out, a laparoscopic ileocecal resection was performed, including lymphadenectomy of the surrounding small bowel mesentery. Macroscopic examination of the resected specimen showed a yellowish, well-circumscribed lesion with calcification inside. The histopathological examination revealed a nodular lesion measuring 40×35×32 mm, primarily involving the muscularis propria in the terminal ileum. The tumor was positive for desmin and α-SMA, while c-kit was negative by immunohistochemical staining and leiomyoma was diagnosed. The patient was discharged on the 7th postoperative day. At the one-year follow-up, no recurrence of the leiomyoma was observed.

The patient was an 82-year-old woman who visited her previous physician for abdominal pain and was urgently admitted to the hospital with a diagnosis of ischemic enteritis. The next day, her abdominal pain increased, and she was transferred to our hospital. When she came to our hospital, her vital signs were stable and tenderness with muscular defense was observed in the entire abdomen. The contrast-enhanced CT scan of the abdomen by the previous physician showed that poor contrast enhancement in the entire colon, and no thrombus in the mesenteric vessels was noted. A diagnosis of ischemic colitis with necrosis of the entire colon was made, and emergency surgery was performed. The abdomen was opened through a median incision, and necrosis of the ascending colon to the sigmoid colon was observed. Total colon resection was performed, and a single-hole ileostomy was constructed. The patient was discharged home 38 days postoperatively. Necrotic ischemic colitis is infrequent, and necrosis of the entire colon has a high mortality rate and a poor prognosis. The survival rate is significantly reduced after 24 hours from the onset of the disease, and so surgery should be performed as soon as possible if the disease is suspected.

A 72-year-old woman was found by colonoscopy to have transverse colon cancer. She had a history of open total gastrectomy with ante-colic Roux-en-Y reconstruction for gastric cancer. We performed a laparoscopic extended right hemicolectomy. Intraoperatively, the tumor was located on the right-sided transverse colon. In order to keep a sufficient distal margin, it was necessary to release adhesions between the reconstructed jejunum and the left-sided transverse colon and mobilize the splenic flexure, while it was necessary to redo the esophago-jejunostomy if ischemic changes were caused by damage to the blood vessels of the reconstructed jejunum. Although we did not keep a sufficient distal margin, we planned to resect the transverse colon located 5 cm on the anal side from the tumor and perform intracorporeal anastomosis, which was end-to-end anastomosis between the ileum and the transverse colon using liner staplers. She was discharged without complications on the 11th postoperative day. Intracorporeal anastomosis has the advantage of requiring minimal mobilization of the colon. In cases of transverse colon cancer after total gastrectomy, we consider that intracorporeal anastomosis is one of the treatment options.

Introduction: Pilonidal sinus is an infectious disease in the natal cleft caused by insertion of loose hair under subcutaneous tissue. Surgical operation is considered standard therapy for pilonidal sinus. We had performed excision with midline closure or excision with open wound, but experienced dehiscence after the operation in many cases after excision with midline closure, and recurrence after excision with open wound.

Methods: We operated on 20 patients with pilonidal sinus in 2012-2022: 7 excision with midline closure, 4 excision with open wound, and 9 Karydakis flap. We evaluated the operating time, complete healing time, dehiscence, wound infection and recurrence in each group.

Result: In the excision with midline closure group, dehiscence occurred in all cases. Operating time was 38 minutes, complete healing time was 120 days, and there was one case of recurrence. In the excision with open wound group, the operating time was 24 minutes, complete healing time was 134 days, and there was one case of recurrence. In the Karydakis flap group, the operating time was 57 minutes, complete healing time was 37 days, and there were two cases of dehiscence and no cases of recurrence.

Conclusion: Shorter complete healing time and lower recurrence rate can be expected with Karydakis flap for pilonidal sinus, although the operation time is longer.