Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: A multicenter retrospective cohort study

AIM: To investigate the long-term oncologic outcomes and prognostic factors in patients with obstructive colorectal cancer(CRC) at multiple Japanese institutions.METHODS: We identified 362 patients diagnosed with obstructive colorectal cancer from January 1, 2002 to December 31, 2012 in Yokohama Clinical Oncology Group's department of gastroenterological surgery. Among them, 234 patients with stage Ⅱ/Ⅲ disease who had undergone surgical resection of their primary lesions were analyzed, retrospectively. We report the long-term outcomes, the risk factors for recurrence, and the prognostic factors.RESULTS: The five-year disease free survival and cancer-specific survival were 50.6% and 80.3%, respectively. A multivariate analysis showed the ASAPS(HR = 2.23, P = 0.026), serum Albumin ≤ 4.0 g/d L(HR = 2.96, P = 0.007), T4 tumor(HR = 2.73, P = 0.002) and R1 resection(HR = 6.56, P = 0.02) to be independent risk factors for recurrence. Furthermore, poorly differentiated cancers(HR = 6.28, P = 0.009), a T4 tumor(HR = 3.46, P = 0.011) and R1 resection(HR = 6.16, P = 0.006) were independent prognostic factors in patients with obstructive CRC.CONCLUSION: The outcomes of patients with obstructive CRC was poor. T4 tumor and R1 resection were found to be independent prognostic factors for both recurrence and survival in patients with obstructive CRC.

Novel technique of abdominal wall nerve block for laparoscopic colostomy: Rectus sheath block with transperitoneal approach

A 62-year-old man who had acute rectal obstruction due to a large rectal cancer is presented. He underwent emergency laparoscopic colostomy. We used the laparoscopic puncture needle to inject analgesia with the novel transperitoneal approach. In this procedure, both ultrasound and laparoscopic images assisted with the accurate injection of analgesic to the correct layer. The combination of laparoscopic visualization and ultrasound imaging ensured infiltration of analgesic into the correct layer without causing damage to the bowel. Twentyfour hours postoperatively, the patient's pain intensity as assessed by the numeric rating scale was 0-1 during coughing, and a continuous intravenous analgesic was not needed. Colostomy is often necessary in colon obstruction. Epidural anesthesia for postoperative pain cannot be used in patients with a coagulation disorder. We report the use of a novel laparoscopic rectus sheath block for colostomy. There has been no literature described about the nerve block with transperitoneal approach. The laparoscopic rectus sheath block was performed safely and had enough analgesic efficacy for postoperative pain. This technique could be considered as an optional anesthetic regimen in acute situations.

Preoperative Diagnosis of Thyroglossal Duct Cancer: A Case Report and Literature Review

Objective: To clarify the preoperative diagnostic rate and elucidate the morphological features of thyroglossal duct cancer through a literature search on cases reported in Japan. Methods: A search of a medical database (Japan Medical Abstracts Society) identified 40 studies on thyroglossal duct cancer in Japanese patients between 1976 and 2014. A total of 47 cases, including the present case, are summarized herein. Patient characteristics, preoperative diagnosis, and morphological features were reviewed and analyzed. Morphological features of the internal portions in the cystic lesions were classified using the previously reported Yokosuka Kyosai Hospital criteria for ultrasonography findings of thyroid cystic tumors. Results: Preoperative diagnosis was described for 43 of the 47 cases. Malignancy was suspected in 18 (41.9%) of the 43 cases on the basis of fine needle aspiration (FNA) cytology (presence of suspected papillary carcinoma cells) and imaging studies (presence of calcifications), 12 and 6 cases, respectively. Preoperative FNA was performed in 24 cases with a correct diagnosis obtained in only 12 (50%) cases. Morphological features were evaluated by preoperative imaging studies and/or postoperative histopathology. We found 6 cases (15%) with solid lesions, 32 cases (80%) with cystic lesions containing a solid part, and 2 cases (5%) with solo cystic lesions, respectively. Calcification was observed in 28 (72.5%) cases. We further examined the internal morphology of 32 cases with cystic lesions according to the criteria for ultrasonography findings of thyroid cystic tumors described in Methods. Of the 32 cases, 25 (62.5%) and 7 (17.5%) were classified as “eccentric acute angle type (Ea)” and “multiseptate type (M)”, respectively. The boundary between the solid part and the cystic part was irregular in all 7 “M” cases. No “eccentric and blunt angle type (Eb)” or “concentric type (C)” lesions were observed. Conclusions: The preoperative diagnostic rate for thyroglossal duct cancer using FNA is low, and it is important that diagnosis be performed in conjunction with imaging findings. The presence of solid parts or calcified lesions classified as “Ea” or “M with irregular boundaries” on the basis of imaging findings is suggestive of malignancy.

Treatment of Asthma in the Elderly: Questionnaire Survey in Japan

Introduction: The prevalence of asthma in the elderly has been increasing due to the aging of the global population. Appropriate treatment for asthma in the elderly is now a major issue, as the disease is often fatal and incurs high medical costs in the elderly population. There have been few recent reports on asthma treatment for the elderly in the real-world clinical settings. Objectives: This study was performed to assess how respiratory physicians manage asthma in elderly patients in clinical settings in Japan. Methods: Respiratory physicians in 16 Japanese hospitals responded to a questionnaire survey on asthma and COPD treatment between December 2014 and February 2015. The analysis was performed using data collected from medical records on 2041 asthma patients. Results: The mean patient age was 61.2 years, and 36.6% of the patients were men. In the breakdown by age, 1018 (49.9%) of the patients were elderly (≥ 65 years). Compared to the non-elderly, the elderly patients had a significantly lower BMI, greater smoking history in pack-years, and poorer pulmonary function. There were no significant differences between the elderly and non-elderly in the prescription rates of common medications such as inhaled corticosteroids, long-acting beta-agonists (LABA) administered via inhaler or transdermal patch, long-acting muscarinic antagonists, or leukotriene receptor antagonists. In contrast, mucoactive drugs (18.7% vs. 12.3%, P P P = 0.02). Conclusions: According to this survey, the prescription rates of mucoactive drugs, macrolides, and transdermal LABA were significantly higher in the elderly than in the non-elderly.