Crohn's Disease-Associated Anorectal Cancer Has a Poor Prognosis With High Local Recurrence: A Subanalysis of the Nationwide Japanese Study

INTRODUCTION

Colorectal cancer (CRC) is one of the major life-threatening complications in patients with Crohn's disease (CD). Previous studies of CD-associated CRC (CD-CRC) have involved only small numbers of patients, and no large series have been reported from Asia. The aim of this study was to clarify the prognosis and clinicopathological features of CD-CRC compared with sporadic CRC.

METHODS

A large nationwide database was used to identify patients with CD-CRC (n = 233) and sporadic CRC (n = 129,783) over a 40-year period, from 1980 to 2020. Five-year overall survival (OS), recurrence-free survival (RFS), and clinicopathological characteristics were investigated. The prognosis of CD-CRC was further evaluated in groups divided by colon cancer and anorectal cancer (RC). Multivariable Cox regression analysis was used to adjust for confounding by unbalanced covariables.

RESULTS

Compared with sporadic cases, patients with CD-CRC were younger; more often had RC, multiple lesions, and mucinous adenocarcinoma; and had lower R0 resection rates. Five-year OS was worse for CD-CRC than for sporadic CRC (53.99% vs 71.17%, P < 0.001). Multivariable Cox regression analysis revealed that CD was associated with significantly poorer survival (hazard ratio 2.36, 95% confidence interval: 1.54-3.62, P < 0.0001). Evaluation by tumor location showed significantly worse 5-year OS and RFS of CD-RC compared with sporadic RC. Recurrence was identified in 39.57% of CD-RC cases and was mostly local.

DISCUSSION

Poor prognosis of CD-CRC is attributable primarily to RC and high local recurrence. Local control is indispensable to improving prognosis.

Original methods to move femoral head medially and caudally after rotational acetabular osteotomy: especially to use ceramic spacer

The operative procedures chosen to treat arthrosis in patients with severe acetabular dysplasia vary among orthopaedic surgeons, particularly in younger patients. We operated on 450 hips with acetabular dysplasia by using the rotational acetabular osteotomy (RAO) method of Ninomiya and Tagawa by Ninomiya (Clin Orthop 247:127-137, 1989). In this report, we describe our technique of performing RAO with hydroxyapatite tricalcium phosphate-composite (HAP-TCP) blocks to achieve good acetabular coverage and the results of this procedure in 16 hips with severe dysplasia, including nine with advanced arthrosis. Adequate coverage of the osteotomized acetabulum was maintained and symptoms, especially pain, showed marked improvement at the latest follow up.

Transfemoral approach for revision total hip arthroplasty

We performed revision total hip arthroplasty on 12 patients via the transfemoral approach because difficulty with surgery was anticipated preoperatively. The total hip score improved in all of the patients. Radiographically, there were no radiolucent lines around the acetabular and femoral components, but one hip still showed sinking of the stem by 2 cm. Although the transfemoral approach might seem very aggressive, this is actually a relatively simple method that allows rapid removal of the prosthesis and cleaning of the medullary canal.

Young's interference of electrons in field emission patterns

We have observed interference fringes of electrons in field emission patterns from multiwalled carbon nanotubes at 60 K. The observed fringe pattern is reproduced by calculations based on the formula of Young's interference of two beams. Three-beam interference has also been detected over short time periods. We discuss the reason why Young's interference appears in the electron emission pattern in accelerating fields.

[Simulation with a pre-clinical training system. 1. Practice in operative dentistry using an experimental manequin articulator, jaw model, and artificial teeth]

Clinical practice with patients is the most important part of education for dental students. However there are considerable difference between lecture, basic practice, and clinical practice. Therefore it is difficult to go from basic practice to clinical practice. To overcome this, we developed and introduced a Pre-Clinical Training system using a newly designed manequin, articulater, jaw model, and artificial teeth. This manequin is very similar to patients in appearance. The mandibular part used a semi-adjustable arcon type articulator. The artificial teeth were made of two types of synthetic resins with different hardness for use in operative dentistry. The teeth also have caries areas made of soft black resin. Using this system, the students practiced oral examination, cavity preparation and restoration in operative dentistry.