[A Case of Neuroendocrine Carcinoma of the Ascending Colon That Responded Completely to Chemotherapy]

We report a case of effective treatment comprising mFOLFOX6 plus bevacizumab for neuroendocrine carcinoma of the ascending colon. A 60-year-old woman was admitted for diarrhea and abdominal pain. Colonoscopy showed a Type 2 tumor in the ascending colon. She was diagnosed with neuroendocrine cell carcinoma based on biopsy and immunostaining. CT and MRI showed liver metastasis and lymph node #12a metastasis. Right hemi-colectomy, lymphadenectomy, and partial hepatectomy were performed(T4a, N2, M1b, Stage IV). Neuroendocrine cell carcinoma(small-cell type)was finally diagnosed based on a histological examination because the nuclear fission image was 30(/10HPF)and the Ki-67 index was 42%. Three months after the surgery, multiple lymph node metastases were found using CT and MRI. mFOLFOX6 plus bevacizumab was initiated. After 4 courses of the chemotherapy, the metastases responded completely. A total of 10 courses of chemotherapy were administered. About 2 years and 6 months after the surgery, no recurrence is allowed.

[A Case of Stage IV Rectal Cancer Achieving Long-Term Stable Disease Treated with Chemotherapy and Residual Tumor Resection]

We herein report a Stage IV case ofrectal cancer in a patient who achieved stable disease and was treated monthly with fluorouracil(FU)monotherapy plus bevacizumab(Bmab)against relapse after residual tumor resection and withdrawal because ofref usal to continue chemotherapy, even though a marked response was obtained with standard chemotherapy. A 73-year-old woman visited a former hospital in 2014, and was diagnosed with rectal cancer with liver and lung metastases (diagnosed with Rb, T3, M1b[liver, lung]cStage IV). Chemotherapy(mFOLFOX6 plus Bmab)was initiated with a consideration of conversion. After 5 courses, she moved to our hospital. Since she was not aggressive to chemotherapy from the beginning, an imaging examination was performed after 9 courses. The primary lesion and lung metastases had disappeared, and there was only one liver metastasis. Partial hepatic resection was performed to attempt chemotherapy withdrawal following informed consent. Six months after surgery with no therapy, since relapse in the rectum and lungs was confirmed, laparoscopic rectal amputation was performed to control the primary tumor. Chemotherapy containing FU monotherapy plus Bmab was reinitiated after 15 months of withdrawal because liver and lung metastases increased 5 months after rectal amputation. Two months after resuming chemotherapy, the metastatic lesion decreased in size, and the tumor marker level normalized. The same regimen is continued monthly, and the response has been maintained for 17 months(infusions of 5-FU/LV plus Bmab, 18 courses).

[The Influence of Immunity, Nutrition, and Physical Function on the Onset of Pneumonia after Colorectal Cancer Resection]

PATIENTS AND METHODS

Four hundred and nineteen patients with colorectal cancer who underwent laparotomy were included in this study. Indicators that reflected immunity, nutrition, and physical function were selected, and risks associated with the presence of postoperative pneumonia were investigated. Cut-off values of factors affecting the occurrence of pneumonia were determined using the receiver-operating characteristic curve approach.

RESULTS

Pneumonia was observed in 2.9%of the patients, and PNI(C40.0), CONUT(B2), BMI(<18.5 kg/m2), PS(B1), %VC(<80.0%), and FEV1.0%(<70.0%)were identified as risk factors in multivariate analysis(p<0.05). %VC(<80.0%)was extracted as an independent factor. The cutoff value of %VC was determined to be 80.0%based on the incidence of postoperative pneumonia.

CONCLUSION

Low volume in %VC(<80.0%)may be a risk factor for pneumonia after resection of colorectal cancer.

[Analyses of Relapsed Cases after Oxaliplatin-Based Adjuvant Chemotherapy for Colorectal Cancer with Cur A Resection]

INTRODUCTION

There are few reports on the outcome of relapsed cases after curative resection for colorectal cancer(CRC) with adjuvant oxaliplatin-based chemotherapy. Thus, we analyzed such cases.

PATIENTS AND METHOD

In total, 48 patients with CRC who received oxaliplatin-based postoperative adjuvant chemotherapy from 2012 were analyzed. The clinical course was examined in 9 cases ofrecurrence.

RESULTS

Stages II, III a, and III b(1, 3, and 5 cases, respectively)were judged as recurrence in 9 cases. Metastatic sites were the lungs, local sites, liver, and peritoneum(3, 3, 3, and 1 case[s], respectively). The median time to relapse was 390 days. There were 2 cases ofwild -type RAS and 7 cases ofmutant RAS. Although R0 resection was performed in 1 case, re-relapse was recognized. Another 8 cases involved induced chemotherapy. An oxaliplatin-based regimen was administered as first-line treatment in 4 of8 cases. At present, 5 patients died, and 3 of8 cases could not progress to second-line treatment. The overall survival(OS)after relapse was 475 days, and survival more than 3 years was not observed.

CONCLUSION

Recurrent cases after Cur A resection for CRC with oxaliplatin-based adjuvant chemotherapy were examined. Although the 3-year RFS and 5-year OS were relatively good, the prognosis after relapse was quite poor.

Subcuticular Suturing with Closed Suction Drainage for Wound Closure Following Stoma Reversal

Incisional surgical site infection (SSI) is a leading complication of stoma reversal procedures. This retrospective study was conducted to assess the incidence of incisional SSI and other wound complications when wound closure was achieved by subcuticular suturing and closed suction drainage following stoma reversal. We analyzed data from a total of 49 patients, all of whom had undergone insertion of a 10 Fr closed suction drainage tube in the fascia, following irrigation with approximately 300 mL of physiological saline. We then performed subcuticular suturing with 4-0 monofilament absorbable sutures. The median age of our patient population (34 men and 15 women) was 68 (range, 35-84) years. Six patients had an end stoma and 43 had a loop stoma. The wound category was 'contaminated' in 18 patients, while an incisional SSI was observed in one patient (2.0%). No wound disruptions, seromas, or drain infections were evident. Our data are reliable, but our study is limited in terms of general applicability; however, the low SSI rate indicates that the procedure is acceptable. Further research into this procedure will require a randomized trial design.

Worse Preoperative Status Based on Inflammation and Host Immunity Is a Risk Factor for Surgical Site Infections in Colorectal Cancer Surgery

OBJECTIVE

The modified Glasgow Prognostic Score (mGPS) is an inflammation-based measure of malnutrition that reflects a state of cachexia in cancer patients. We evaluated mGPS as an index to predict surgical site infection (SSI) incidence in patients undergoing colorectal cancer surgery.

SUBJECTS AND METHODS

We retrospectively analyzed 351 patients who underwent colon cancer resection. Factors correlated with the incidence of SSIs were identified by logistic analysis and stepwise selection.

RESULTS

SSIs were observed in 32 patients, with an incidence of 9.1%. Univariate logistic analysis revealed mGPS (Score 2), laparotomy, resection of other organs, colostomy, excessive blood loss (>423 mL), long duration of surgery (>279 minutes), pulmonary dysfunction, prognostic nutritional index (PNI) ≤40, neutrophil lymphocyte ratio (NLR)(>4), and controlling nutritional status (CONUT) ≥2 to be associated with an increased incidence of SSIs. Multivariate analysis with variables selected by the stepwise procedure also revealed mGPS (Score 2) (Odds ratio (OR) =3.55, 95% Confidence interval (CI) 1.30-9.56; p=0.01), colostomy (OR=6.56, 95%CI 1.60-31.38; p=0.01), excessive blood loss (OR=3.20, 95%CI 1.23-8.42; p=0.02), and NLR (>4)(OR=3.24, 95%CI 1.31-8.17; p=0.01) to be independent risk factors.

CONCLUSION

mGPS is an independent risk factor for SSIs. Our results suggest that cachexia before surgery in patients with colorectal cancer might predict the incidence of SSIs.

[A Case of Surgery after Chemotherapy for Cecal Cancer with Onset of the Stenosis of the Colostomy]

The patient was 55-year-old woman, undergoing Hartmann operation by the sigmoid colon diverticulum perforation, 2 years later visited our hospital with abdominal pain. Although lower endoscopy and histological examination could not be performed due to stoma stenosis, we diagnosed cecal carcinoma, liver metastasis, distant lymph node metastasis from CT and PET-CT, CapeOX plus Bmabtherapy and IRIS plus Bmabtherapy were performed. After that, repeated intestinal obstruction due to exacerbated stoma stenosis, metastatic lesion increased in CT examination, furthermore the patient had hope of stoma closure, we decided to resect the primacy tumor, performed subtotal colonectomy and stoma closure. Pathological diagnosis revealed RAS wild type. After surgery, Pmabplus CPT-11 therapy was performed and the metastatic lesion was temporarily shrunk but re-exacerbated, the patient died 2 years 2 months after the first treatment started, 7 months after the primary tumor resection. In the treatment of colorectal cancer, when metastatic lesion is unresectable, chemotherapy is often carried out except when the primary tumor is symptomatic. In our case, although the primary tumor was asymptomatic, an intestinal obstruction due to stoma stenosis was developed and it was necessary to examine whether to use anti-EGFR antibody drugs, therefore we performed operation.

[Investigation of Cases with Curative Resection for Recurrent Colorectal Cancer]

The aim of this study was to clarify the prognosis of cases with recurrent colorectal cancer that underwent curative resection in order to determine index for recurrent colorectal cancer treatment. Of the cases that exhibited recurrence after undergoing curative resection for primary colorectal cancer at our hospital between 1993 and 2013, this study targeted the 109 cases for which curative resection was possible. The sites of recurrence were the liver(58 cases), the lungs(27 cases), the peritoneum (11 cases), local sites(9 cases), lymph nodes(8 cases), and the anastomotic sites(6 cases). Of these, 10 cases exhibited metastasis to 2 organs. The median survival time after metastasectomy was 75.3 months, and the 5-year survival rate was 53.8%. The primary lesion histological type being a poorly differentiated adenocarcinoma/mucinous carcinoma, degree of progression upon initial onset being Stage III b or greater, and disease-free interval being less than 2 years were associated with poorpr ognosis. Specifically, histological type and disease-free interval were found to be independent factors that correlated with prognosis. Meanwhile, no differences were observed for prognosis related to the number of recurrent organs, the number of recurrent nodules, or the number of times curative resection was performed after recurrence. While the histological type and disease-free interval determine prognosis in cases with recurrent colorectal cancer performed curative resection, it appears that if curative resection is possible, aggressive resection should be pursued even for cases of multiple or repeated recurrence.

[A Case of Recurrence in the Posterior Wall of the Virginal after Radical Resection for Rectal Cancer Well Responded in a Long Period by Chemo-Radiotherapy]

We report a case of an advanced rectal cancer recurrence that responded completely to chemo-radiotherapy. The patient was an 80-year-old woman. Low anterior resection with D2(prxD3)lymph node dissection was performed. Sixteen months after operation, CEA level elevated but no recurrence foci were found in any image tests. Administration of TS-1 was initiated since recurrence was highly suspected. Twenty seven months after operation, PET-CT detected local recurrence in the posterior wall of the vagina. After construction colostomy, chemo-radiotherapy(60 Gy+oral UFT)was performed and CEA level dropped promptly to the normal value. No relapse was pointed out in CT scans or MRI tests. There were not any signs of recurrence through 112 months after chemo-radiotherapy.

[Preoperative Prognostic Nutrition Index Is a Predictive Factor of Complications in Laparoscopic Colorectal Surgery]

Paitients and methods: We retrospectively reviewed a database of 188 patients who underwent resection for colorectal cancer with laparoscopic surgery between July 2007 and March 2015. The prognostic nutrition index(PNI), modified Glas- gow prognostic score(mGPS), controlling nutritional status(CONUT), and neutrophil/lymphocyte ratio(N/L)were measured in these patients. We examined the association between postoperative complications and clinicopathological factors.

RESULTS

The study included 110 men and 78 women. Median age was 68 years. The site of the primary lesion was colon in 118 and rectum in 70 patients. Postoperative complications higher than Grade II(Clavien-Dindo classification)were reported in 24(12.8%)patients: Surgical site infection(SSI)in 12, remote infection in 7, ileus in 5, and others in 2 patients. Clinicopathological factors related to complications were rectal surgery, large amount of intraoperative bleeding, and long operative time. The related immunologic and nutritional factors were mGPS 2, PNI below 40, and N/L above 3. CONUT was not associated with complications in ourcases.

CONCLUSIONS

mGPS, PNI, and N/L are predictive factors for complications in laparoscopic colorectal surgery.

[Relationship between Surgical Site Infection(SSI)Incidence and Prognosis in Colorectal Cancer Surgery]

We examined the relationship between risk factors for surgical site infections(SSIs)and prognosis in 440 patients who underwent colon cancer surgery. We evaluated factors related to SSIs(GradeB II)and compared survival rates by stage. SSIs were observed in 36 patients. An increased SSI incidence was associated with pulmonary dysfunction, mGPS=2, CONUT≥2, PNI≤40, NLR>4.3, location(rectum), depth of tumor invasion(Bsubserosa, SS), lymph node metastasis, laparotomy, resection of other organs, colostomy, blood loss(large), and operative time(long). Survival rates were lower in Stage II/III patients with SSIs. Preoperative risk judgment is important in colorectal cancer surgery.

[Anti-EGFR Antibody Combination Chemotherapy Was Effective against Locally Advanced Ascending Colon Cancer as Well as a Recurrent Lesion - A Case Report]

Here we report a case in which a locally advanced ascending colon cancer was successfully treated with anti-EGFR immunotherapy combined with chemotherapy and curative resection, and recurrent cancer was treated with the same chemotherapy. A 71-year-old man was diagnosed with ascending colon cancer in our department. No distant metastasis was observed, but curative resection was considered impossible because of extensive local cancer invasion. Because a genetic analysis revealed the presence of the wild-type KRAS gene, 6 courses of mFOLFOX6 plus cetuximab were administered. A cPR was obtained and curative resection was performed. The final diagnosis was ypT3N1M0, ypStage III a colon cancer, and chemotherapy improved the cancer stage to Grade 1b. Six courses of FOLFOX6 were then administered, followed by observation. After 2 years 6 months, a tumor of approximately 5 cm in size was noted in the right buttock using surveillance CT and was diagnosed as recurrent colon cancer. We considered further curative resection difficult and therefore 6 courses of mFOLFOX6 plus panitumumab were administered, a cPR was obtained, and right hip tumor extirpation surgery was performed. These results suggest that chemotherapy combined with anti-EGFR antibody immunotherapy is effective in treating recurrent colon cancer.

[A Prognostic Factor Based on Inflammation, Nutrition, and Immune Status for fStage II/III Colorectal Cancer]

INTRODUCTION

We investigated whether the prognostic nutritional index(PNI), controlling nutritional status(CONUT), modified Glasgow prognostic score(mGPS), and the neutrophil count/lymphocyte number ratio(NLR)could be prognostic factors for fStage II/III colorectal cancer.

SUBJECTS AND METHODS

The subjects were 115 patients with fStage II/III colorectal cancer who underwent curative resection. We studied the relationship with 3-year disease-free survival(DFS)and 5-year survival rate(OS).

RESULTS

DFS and OS were 75.6% and 84.4%, respectively, and 81.3% and 69.6% for DFS and 82.4% and 84.4% for OS were in fStage II and III, respectively. Univariate analysis of DFS showed significant differences for sex, age, PNI, and NLR, but there was no difference in PS, location, adjuvant chemotherapy, CONUT, or mGPS. In multivariate analysis, sex(male)and NLR(>2)were independent prognostic factors(p=0.006 and p=0.01, respectively). As for OS, although significant differences were recognized for sex, age, PS, PNI, NLR, and CONUT, there was no difference in location, adjuvant chemotherapy, or mGPS. In multivariate analysis, PS(≥1)and NLR(>2)were independent prognostic factors(p=0.009 and p=0.006, respectively).

CONCLUSIONS

NLR(>2)was an independent prognostic factor for DFS and OS among prognos- tic factors based on inflammation, nutrition, and immunity in fStage II/III colorectal cancer patients.

[Standard Chemotherapy with Bevacizumab as First-Line Therapy for Metastatic Colorectal Cancer with RAS Mutation]

AIM

We examined the outcome of treatment with first-line chemotherapy with bevacizumab(Bmab)formetastatic colorectal cancer in our hospital to clarify the outcome for RAS mutant patients.

SUBJECTS AND METHODS

From January 2013 to April 2016, 28 patients who initiated standard chemotherapy(2 chemotherapeutic agents)with Bmab as the first-line regimen for metastatic colorectal cancer were enrolled in this retrospective study. Time to treatment failure(TTF)and overall survival(OS)were analyzed.

RESULTS

The median age was 66.5(46-81)years old, including 16 men and 12 women, 11 cases with RAS wild type, and 17 cases with mutant type. The response rate was 30.8% in 2 cases of CR, 6 cases of PR, 14 cases of SD, 4 cases of PD, and 4 cases with conversion surgery after chemotherapy. TTF was 6.5 months and OS was 32.1 months. Among those with RAS mutations, 3 cases received conversion surgery. TTF of the mutant and wild type were 6.3 and 5.6 months, respectively, and OS was 35.8 and 32.1 months, respectively, without any significant difference. In addition, excluding conversion cases, the OS of mutant and wild type patients was 22.7 and 29.5 months, respectively.

CONCLUSION

The outcome of treatment using first-line chemotherapy with Bmab for metastatic colorectal cancer with RAS mutations was retrospectively analyzed. There was no difference in therapeutic effect between RAS mutated and not, and it seems that an OS of more than 20 months can be expected for those with RAS mutations with this choice of treatment.

[The Significance and Limitations of Curative Resection for Peritoneal Metastases of Colorectal Cancer]

The objectives of the present study were to investigate the treatment outcomes of curative resection in patients with peritoneal metastases from colorectal cancer and to clarify the significance and limitations thereof. The study included 38 patients with colorectal cancer who underwent curative resection of peritoneal metastases between 1996 and 2014. Peritoneal metastases were classified as follows: metachronous(n=9)and synchronous(n=29); P1(n=13)and P2(n=25); and ovarian(n=5). Thirty patients received postoperative chemotherapy, includingoxaliplatin -based regimens(n=14)and other regimens, such as 5-FU/Leucovorin(n=16). The 3-year survival rate amongall patients was 59.9%. There were no differences in survival rates accordingto gender, serum CEA levels, location, differentiation, depth of invasion of tumor, number of organs with distant metastases, severity of peritoneal metastasis, and types of postoperative chemotherapy. However, poor outcomes were observed in patients with more advanced lymph node disease and in patients with metachronous metastases compared to those with synchronous metastases. Although curative resection can contribute to long-term survival in colorectal cancer patients with peritoneal metastases, the therapeutic effect may be limited in patients with lymph node metastases and those with metachronous metastases.

[Preoperative Prognostic Nutritional Index in Elderly Patients Over 80 Years Old Who Underwent Curative Resection for Colorectal Cancer]

PATIENTS AND METHODS

From 2001, cases of 76 patients who underwent Cur A resection for colorectal cancer and preoperative prognostic nutritional index (PNI) assessment were analyzed in terms of clinicopathological factors, surgical outcomes, and prognosis.

RESULTS

Median age of the 36 men and 40 women included in the study was 83 years. Median PNI was 42.1. Twenty-four patients had a PNI below 40. There were 36 patients with pulmonary dysfunction, and 60 patients with D2 or wider LN dissection. Median operating time was 177 minutes. Postoperative complications were reported in 48 patients and SSI in 15 patients. Postoperative hospital stay was 16 days. During a median 30 month follow-up period, there were 16 deaths, including 8 from cancer-related causes and 8 from other disease-related causes. Patients with a PNI below 40 often had fewerD2 LN dissections(p=0.082)and significantly shorter operating times(p=0.015). First gait and first flatus were observed significantly later(p=0.0051, 0.0307). There were no significant differences in postoperative complication rates, SSI, postoperative hospital stay, cause of death, or survival.

CONCLUSIONS

In the elderly aged over 80-years-old, because those with a PNI below 40 underwent resection with fewer LN dissections and shorter operating time, there were no significant differences in postoperative complications, cause of death, or prognosis. These results suggest that PNI could be a selection factor for surgical procedure in elderly patients aged over 80 years.

[Clinical Significance of Serum p53 Antibody Measurement in Colorectal Cancer Patients]

We investigated the significance of serum p53 antibody in colorectal cancer. The subjects included 239 patients with colorectal cancerwithout any history of priortr eatment. Patients with multiple cancerordouble cancerwer e excluded. Serum p53 antibodies and relationships with clinicopathological factors and prognosis were examined. The preoperative positive rate of serum p53 antibody was 28.9%. There was no relationship between p53 antibody and clinicopathological factors or degree of progression. Examination of a possible relationship with prognosis revealed that p53 antibody was not related to whether recurrence occurred, and there was no difference observed for survival rate. Examination of the cases in which serum p53 antibody was measured continuously after curative resection revealed that there was a tendency to find a low incidence of cancer recurrence in cases in which serum p53 antibody became negative postoperatively. Furthermore, cancer recurred at a low incidence in the cases in which p53 antibody was on the decrease postoperatively(p=0.0008). Thus, ourr esults show that serum p53 antibody in colorectal cancer cases is not related to clinicopathological factors or prognosis. However, in cases positive for preoperative serum p53 antibody, changes in postoperative levels of the titer could be a marker for recurrence.

[A Case of Early Anal Canal Cancer with Pagetoid Spread with Different Antitumor Effects of Chemotherapy on Different Metastatic Sites]

A 78-year-old man visited our hospital with a prolapsed hemorrhoid. He was referred to the dermatology unit due to the thickness and redness of the perianal skin. He was diagnosed as having extra mammary Paget's disease by skin biopsy. After a biopsy of the anal polyp was performed to investigate the primary site, he was diagnosed with early anal canal cancer with Pagetoid spread and underwent a radical operation. Abdominoperineal resection with skin(D2 prx D3 lymphadenectomy) was performed with perineal reconstruction using a gracilis muscle graft. Postoperative surveillance without adjuvant therapy was performed because the pathological stage was stage I. Two years and 2 months after surgery, multiple liver metastases were found, and the patient was diagnosed with multiple liver, bone, and lymph node metastases(K-ras and UGT1A1 wild type)on PET. XELOX plus bevacizumab was used as first-line treatment and the liver metastases showed remarkable shrinkage; however, disease progression occurred in the bone. IRIS plus bevacizumab was started as second-line therapy but grade 3 hematotoxicity was observed during the first course. After 4 courses, it was difficult to maintain the therapy due to toxicity and cancer-related pain. The liver metastases had almost disappeared but the patient died 11 months after the initiation of chemotherapy.

[A Case of Stage IV Colon Cancer Relapsed 10 Years after Curative Resection with Adjuvant Chemotherapy Using Long-Term, Low-Dose Leucovorin and 5-Fluorouracil(LV/5-FU)]

A 57-year-old woman had been diagnosed with sigmoid colon cancer at surgery for ovarian cancer, and underwent simultaneous radical resection. Because of the pathological diagnosis of sigmoid cancer with ovarian metastasis, adjuvant chemotherapy was scheduled, with Leucovorin(LV)25 mg. This was immediately followed with 5-fluorouracil(5-FU)500 mg, via a 2-hour systemic intravenous infusion daily for 5 consecutive days, with courses repeated at 5 weeks, followed by maintenance once every 1 or 2 weeks for 2 years. There had been no evidence of recurrence for 10 years after surgery; however, peritoneal recurrence and a thyroid tumor were found using computed tomography(CT)at the 10-yearsur veillance. Chemotherapy with mFOLFOX6+bevacizumab was initiated because the peritoneal recurrence was determined to be unresectable and because of the metastasis to the thyroid. Chemotherapy was maintained, except for oxaliplatin(L-OHP)due to toxicity, with shrinkage of the peritoneal tumor; however, it was difficult to maintain the chemotherapy due to toxicity. Eleven months after initiation of chemotherapy, lung and bone metastases were detected, and she subsequently died.

[Prognostic Factors in Elderly Patients with Stage II/III Colorectal Carcinomas with Invasion of pT3 or Deeper]

Three hundred and fourteen patients with pT3 or deeper, Stage II/IIIcolorectal carcinoma who underwent curative operation were divided into two groups: age 75 years and more(elderly)and 74 years and less(non-elderly), to identify prognostic factors and risk factors for postoperative complications. Higher comorbidity rates and poorer nutritional status where found in the elderly group, which led to a shorter operation time and less lymph node dissection. There were no significant differences in 5-year OS and 3-year RFS between the two groups. These results suggest that elderly patients with colorectal carcinoma can achieve outcomes equal to the non-elderly group by curative resection even if it is not standard radical resection.

[The Significance of Primary Tumor Resection in Unresectable Stage Ⅳ Colorectal Cancer]

The significance of primary tumor resection for unresectable Stage Ⅳcolorectal cancer is controversial. In the present study, we examined cases of unresectable Stage Ⅳ colorectal cancer treated in our department. The subjects were 78 patients with unresectable Stage Ⅳ colorectal cancer who received either resection of the primary tumor, intensive chemotherapy, or both, between 2006 and 2012. The patients were divided into 2 groups: the group that received primary tumor resection (67 patients) and the non-resection group (11 patients). No differences were noted between a history of primary tumor resection and various clinicopathological factors, but the prognoses in the primary tumor resection group were favorable. The subjects were divided into 3 groups based on the selection of primary tumor resection and chemotherapy. The median survival time was 21.6 months, 11.8 months, and 8.1 months for patients who underwent chemotherapy after primary tumor resection (52 patients), patients who received primary tumor resection only (15 patients), and patients who received only chemotherapy (11 patients), respectively. The prognoses of patients who received primary tumor resection were favorable in comparison with those who received only chemotherapy. The results of the present study suggest the possibility that primary tumor resection can improve the prognoses of patients who have unresectable Stage Ⅳ colorectal cancer.

[A Case of Peritoneal Metastasis in Which Colostomy Was Useful for Restenosis after Stenting]

We report a case of restenosis after performing stenting twice for ileus caused by peritoneal dissemination that occurred after surgery for sigmoid colon cancer, in which colostomy was performed to improve the patient's QOL. The patient was a 58-year-old woman who underwent sigmoidectomy for sigmoid colon cancer. She presented with a peritoneal recurrence 3 times, and the third surgery was a non-curative resection. Chemotherapy was administered but was discontinued because of severe adverse events, and the patient was followed up with the best supportive care. An anastomotic stricture occurred 4 years after the initial surgery, and despite performing stenting twice, stenosis occurred 3 times within a few months. The third stenosis occurred shortly after the second episode, and colostomy was therefore performed. The patient died from cancer 4 months after colostomy without having another episode of stenosis. Although stenting is effective for patients with malignant colon stenosis, colostomy appears to be more effective for repeated post-stenting stenosis, when the patient is in an eligible general condition.

[Immuno-Nutritional Factors Affecting the Incidence of Surgical Site Infection（SSI）after Rectal Cancer Surgery]

BACKGROUND

We analyzed immune nutritional factors that affected the incidence of SSI in rectal cancer surgery.

METHOD

A total of 103 patients who underwent rectal cancer resection were enrolled in this retrospective study. The risk factors (DM, BMI<18.5, ≥25.0, PNI≤40, G/L>2, CONUT≥2, mGPS D) for SSI (Grade≥Ⅱ) were analyzed.

RESULT

The factors that significantly affected SSI (in 13 cases) was PNI≤40 on univariate analysis. In the analysis adjusted by age and sex, mGPS D and PNI≤40 were significant factors. In the stepwise selection method, PNI≤40 was selected as an independent factor.

CONCLUSION

As a risk factor for SSI after rectal cancer surgery, PNI≤40 and mGPS were risk factors.