Numerous studies have been conducted to compare the incidence of anastomotic leakage between aged and non-aged patients with colorectal cancer (CRC), although the patient background factors were not aligned in most studies.

Therefore, the aim of this study was to explore the influence of age on the risk of anastomotic leakage following surgery in patients with CRC.

We performed a comprehensive electronic search of the literature published until March 2020 to identify propensity score matching (PSM) studies conducted to compare the incidence of anastomotic leakage between aged and non-aged patients with CRC. A meta-analysis was also performed using random-effects models to calculate the risk ratio (RR) and 95％ confidence interval (CI), and heterogeneity was analyzed using I2 statistics.

Three studies involving a total of 1207 patients who had undergone surgery for CRC were included in this meta-analysis. The rate of postoperative anastomotic leakage was 6.5％ (34/523) in the aged patient group, and 4.7％ (32/684) in the non-aged patient group. The meta-analysis revealed no significant difference in the incidence of anastomotic leakage between the two age groups (RR, 1.26; 95％ CI, 0.80-2.00; P = 0.32; I2 = 0％).

Thus, this meta-analysis revealed no significant influence of age on the risk of anastomotic leakage in patients undergoing surgery for CRC.

Background: We undertook this retrospective study to evaluate the efficacy of adjuvant chemotherapy after resection of liver metastases from colorectal cancer (colorectal liver metastases) using propensity score matching analysis.

Methods: A total of 100 patients with colorectal liver metastases who had undergone hepatectomy between 2006 and 2019 were included in this study. The clinicopathological factors and long-term outcomes were compared between the patient group that had received adjuvant chemotherapy (Adj(+) group: n = 72) and the patient group that had not received adjuvant chemotherapy (non-adjuvant chemotherapy group; Adj(-) group: n = 28) following resection of the colorectal liver metastases. Propensity score matching was performed for clinicopathological factors, and 20 patients from each group selected.

Results: Analyses prior to the matching revealed that the 3-year relapse-free survival rate was significantly higher in the Adj(+) group than in the Adj(-) group (43％ vs. 20％ (p = 0.003)), while there was no significant difference in the 5-year cancer-specific survival rate between the two groups (67％ vs. 50％ (p = 0.122)). Analysis after propensity score matching revealed that the 3-year relapse-free survival rate was still significantly higher in the Adj(+) group (40％ vs. 8.3％ (p = 0.005)), and that while the 5-year cancer-specific survival rate also trended higher in the Adj(+) group, the difference did not reach statistical significance (65％ vs. 33％ (p = 0.067)).

Conclusion: Administration of adjuvant chemotherapy after resection of colorectal liver metastases was associated with a significantly prolonged relapse-free survival, but not cancer-specific survival.

Laparoscopic cholecystectomy (LC) is minimally invasive and its benefits are widely known, but there are few reports of its usefulness in the elderly. In this study, we evaluated the usefulness of LC for acute cholecystitis in the elderly. The study subjects were a total 205 patients with acute cholecystitis who had undergone emergency cholecystectomy between January 2012 and December 2020, and were divided by age into two groups, as follows: the elderly group, consisting of patients who were 80 years of age or older (n = 57) and the non-elderly group, consisting of patients who were less than 80 years old (n = 148). The serum albumin levels were significantly lower in the elderly group. The preoperative serum C-reactive protein levels, CCI and ASA, and the likelihood of being under anticoagulant/antiplatelet therapy were also higher in the elderly group, as was the proportion of patients with acute cholecystitis of moderate or greater severity. There were no differences in the surgical or postoperative factors between the two groups, but the length of hospital stay was significantly longer in the elderly group.

We considered that LC can be performed safely in elderly patients who have the ability to tolerate the procedure, but that intensive perioperative management and early rehabilitation intervention are necessary to avoid delayed postoperative recovery.

A 67-year-old woman had undergone partial mastectomy and axillary dissection for right breast cancer (pT1N1M0, pStage ⅡA) 16 years ago. The histopathological diagnosis was Invasive Ductal Carcinoma, Scirrhous type, ER: positive, PgR: positive, HER2: negative. After postoperative radiotherapy and postoperative chemotherapy, the patient took anastrozole for 10 years and had stopped visiting our hospital. She was referred to our hospital after an upper gastrointestinal endoscopy performed by her family physician revealed elevated lesions in the upper gastric region. After a repeat upper gastrointestinal endoscopic examination and biopsy of the lesion at our hospital, the patient was diagnosed as having intragastric metastasis from breast cancer and referred to our department. Contrast-enhanced CT showed enlarged right subclavian and mediastinal lymph nodes, and the patient was started on treatment with palbociclib + letrozole. After three months of treatment, the gastric lesions shrank in size and some fibrosis was observed histologically. The right subclavian and mediastinal lymph nodes also decreased in size. Based on the findings, the treatment response was judged as partial response. Evaluation after 24 months of treatment revealed no new metastatic lesions, and the patient was continued on treatment. Distant metastasis from breast cancer is believed to occur most frequently in the liver, lungs, and bones, and less frequently in the gastrointestinal tract. We report a case of partial response to palbociclib as first-line treatment in a patient with gastric metastasis from breast cancer that occurred 16 years after surgery.

A 53-year-old woman visited a previous doctor for anemia. Abdominal CT revealed prominent thickening of the stomach wall, and the patient was referred to our department for further examination. She gave a family history of total gastrectomy with a young gastric polyp. Esophagogastroduodenoscopy revealed multiple hyperplastic polyps throughout the stomach wall. We made the diagnosis of familial gastric juvenile polyposis syndrome, and observed her on an outpatient basis. However, she needed emergency hospitalization after she vomited blood and was found to have severe anemia and hypoproteinemia. She received conservative treatment for 3 days, but her general condition as well as anemia worsened. We determined that medical treatment might be inadequate, and performed temporary laparoscopic total gastrectomy and cholecystectomy. The patient was discharged on day 13 after the operation, without any perioperative complications. There are many cases of gastric juvenile polyposis syndrome with anemia and hypoproteinemia who require surgical resection and are at a high risk for developing complications such as suture failure. In general, the use of laparoscopic versus open surgery for total gastrectomy remains controversial, in terms of the risk of complications. However, with sufficient caution adopted for safe performance, total gastrectomy under laparoscopic guidance might be associated with reduced surgical risk in terms of smaller surgical wounds and less postoperative pain, and also reduced hospital stay.

The patient was a 70-year-old man who was referred to our hospital with the chief complaints of fever and right lower abdominal pain. Abdominal CT revealed a 7-cm abscess on the dorsal side of the ileocecal region, which was diagnosed as a retroperitoneal abscess secondary to perforation of the appendix. The patient was started on antibacterial therapy with meropenem, but the symptoms failed to improve. Gram staining of a pus smear from the abscess showed bacterial clumps with filamentous Gram-positive bacilli radiating around them, and based on the findings, we made the diagnosis of actinomycosis. The antibiotic treatment was changed to penicillin-based injectable antibiotics, which were administered until the 38th day of illness. After being discharged from the hospital on the 39th day of illness, the patient was continued on treatment with oral penicillin antibiotics for about 8 months after disease onset. The abscess did not recur, and an appendectomy was performed on day 312 after disease onset. Actinomycosis is difficult to diagnose prior to surgery, and is considered as an infectious disease that is likely to relapse in the absence of appropriate antibacterial therapy. This infection should be borne in mind in the differential diagnosis in appendicitis patients presenting with an abscess.

A 82-year-old man with a history of having undergone appendectomy for acute appendicitis at the age of 20 years was referred to our Department of Gastroenterology with a history of constipation. Colonoscopy revealed a dilated appendiceal opening, discharging mucus. A biopsy specimen obtained at the appendiceal opening revealed dilated glandular ducts and increased mucus production. A cystic tumor was observed at the site of the remnant appendix on CT; we suspected low-grade appendiceal mucinous neoplasm (LAMN) and performed laparoscopically assisted ileocecal resection. Based on the histopathological findings of well-differentiated adenocarcinoma with the depth classified as pTis at the opening of the appendix, with no lymph node metastasis, a final diagnosis of LAMN of the residual appendix was made. The patient was discharged on postoperative day 8, and until now, 1 year 10 months since the operation, no recurrence has been observed. LAMN of the remnant appendix is rare, and we report our case with a review of 12 cases reported in the literature.

A 73-year-old woman was diagnosed as having early sigmoid colon cancer close to the Sigmoid-Descending colon Junction (SDJ) by endoscopic examination performed as part of postoperative follow-up for cecal cancer, and endoscopic mucosal resection (EMR) was performed.

Histopathology revealed that the depth of invasion was pT1b (SM, 2,000 μm). Therefore, we scheduled additional partial colectomy (D2 dissection).

Laparoscopic colectomy near the SDJ usually requires mobilization of the splenic flexure. However, we used intracorporeal anastomosis for performing the laparoscopic colectomy procedure while avoiding splenic flexure mobilization.

We consider intracorporeal anastomosis as a minimally invasive procedure for lesions close to the SDJ.

We report a case of squamous cell carcinoma of the rectosigmoid colon. A 77-year-old woman found to have a liver tumor during a follow-up MRI examination for a pancreatic nodule. Colonoscopy performed subsequently revealed a tumor in the rectosigmoid colon, which was histopathologically diagnosed as a squamous cell carcinoma. CT and MRI revealed invasion of the uterus by the rectosigmoid tumor and a metastasis in the left ovary; based on the findings, the patient was diagnosed as having rectosigmoid colon cancer with multiple organ metastases.

We performed rectosigmoid colon resection, also resecting the liver and left ovarian metastases. Histopathological examination of these tumors showed squamous cell carcinoma, and the clinical stage was categorized as Stage IVb. Cancer cells were detected by lavage cytology during the operation; therefore, curative surgery was not possible. The patient was discharged 27 days after the surgery. Although she subsequently received chemotherapy, she died 8 months postoperatively due to cancerous peritonitis.

SCC of the colon and rectum are rarely reported. The prognosis is not always unsatisfactory and few reports on some established therapies for this type of malignancy have been presented so far.

A 77-year-old man presented to our hospital with a nodular lesion in the anal canal and skin redness around the anus. Based on the findings of biopsy of the lesion, we diagnosed the patient as having adenocarcinoma of the anal canal. After preoperative mapping biopsy by a dermatologist, we performed laparoscopic abdominal perineal resection for the anal canal cancer. Histopathologically, the resection margin was negative, and the features were consistent with the diagnosis of anal canal adenocarcinoma with pagetoid spread. Pagetoid spread is a relatively rare condition, in which the cancer migrates to adjacent organs through the epithelium and reaches the epidermis, presenting the appearance of intraepidermal cancer. In most cases of anal cancer with pagetoid spread, an abdominal perineal resection including the skin lesions is performed, and depending on the extent of the excision, a skin flap may be required for reconstruction. We report a case of radical resection without skin valvuloplasty based on the findings of preoperative mapping biopsy.

Our patient was a 59-year-old man who presented with the complaint of orbital pain, and he visited our hospital because his symptoms did not improve. Plain abdominal computed tomography (CT) revealed a tumor lesion with calcification in the pancreatic body. Endoscopic ultrasonography (EUS) revealed that the mass was vascular, and a pseudo-aneurysm due to rupture of a splenic aneurysm was suspected. Abdominal contrast-enhanced CT was performed, which revealed an arteriovenous malformation spreading throughout the pancreas. Hence, total pancreatic resection was deemed necessary. However, the orbital pain reappeared when the patient was waiting for the surgery to commence, and CT revealed a splenic aneurysmal hemorrhage, which improved with conservative treatment, while total pancreatectomy and splenectomy were performed electively. The pancreatic border was difficult to peel off as inflammation and abnormal angiogenesis were recognized. Moreover, the bleeding increased during the detachment. In addition, since the mass was lumped together with portal vein, it was necessary to reconstruct the portal vein. The patient required treatment for stenosis of the bile ductal-jejural anastomosis after the operation; however, the patient was discharged home on the 46th postoperative day. Histological examination revealed a collection of blood vessels, large and small, and atrophy and fibrosis of the peripheral pancreatic erocrine glands. The findings were consistent with pancreatic arteriovenous malformation.

The patient was a 56-year-old man with multiple system atrophy who was referred to our hospital for gastrostomy. Endoscopic gastrostomy was not possible due to the presence of a segment of the intestine between the stomach and abdominal wall, necessitating gastrostomy under general anesthesia. There were no significant findings on preoperative examination. We performed gastrostomy in the anterior wall of the lower gastric body via laparotomy. No abnormal findings were found in the abdominal cavity, and there were no changes in the blood pressure or body temperature during the operation. His general condition was stable, but blood biochemical examination showed abnormally elevated levels of AST/ALT (1929/1771 IU/l), LDH (1559 IU/l), and CPK (1413 IU/l) on postoperative day 1. Abdominal CT showed no significant abnormalities, and the patient was discharged from the hospital on postoperative day 5. In this case, it was concluded that the liver dysfunction and hyperCPKemia were caused by the immediate reaction of rhabdomyolysis as part of the propofol injection syndrome.