Background In the field of rectal cancer surgery, there remains ongoing debate on the merits of high ligation (HL) and low ligation (LL) of the inferior mesenteric artery (IMA) in terms of perfusion and anastomosis leakage. Recently, infrared fluorescence of indocyanine green (ICG) imaging has been used to evaluate perfusion status during colorectal surgery. Objective The purpose of this study is to compare the changes in perfusion status between HL and LL through quantitative evaluation of ICG. Methods Patients with rectosigmoid or rectal cancer were randomized into a high or LL group. ICG was injected before and after IMA ligation, and region of interest (ROI) values were measured by an image analysis program (HSL video©). Results From February to July 2020, 22 patients were enrolled, and 11 patients were assigned to each group. Basic demographics were similar between the two groups, except for albumin level and cardiac ejection fraction. There were no significant differences in F_max between the two groups, but T_max was significantly higher and Slope_max was significantly lower in the HL group than in the LL group. Anastomosis leakage was significantly associated with neoadjuvant chemoradiation and F_max. Conclusion After IMA ligation, T_max increased and Slope_max decreased significantly in the HL group. However, the intensity of perfusion status (F_max) did not change according to the level of IMA ligation.

Background: Colorectal cancer (CRC) is the fourth deadliest cancer, with approximately 900,000 deaths annually. CRC is a multifactorial disease in which a set of factors, including environmental, hereditary, and genetic factors, are integrated into cancer development.Studies have suggested an association between hereditary antigens in the human blood group system and the risk of different cancers. This study aimed to evaluate the relationship between blood groups and CRC risk. Methods:A record-based retrospective study was performed between January 2017 and August 2021. This study targeted patients diagnosed with CRC during the study period. Data of patients who agreed to participate were collected using a pre-structured checklist. The extracted data included patients' demographic blood groups and risk factors, including history of inflammatory bowel disease or CRC.Results: A total of 199 patients, aged 22 to 96 years (mean age: 61.6 ± 14.7 years), were included. The blood groups of 101 (50.8%), 59 (29.6%), 26 (13.1%), and 13 (6.5%) patients were O, A, B, and AB, respectively. Colon cancer was the most frequently reported cancer (155/199, 77.9%) across all blood groups and showed the highest frequency among patients with blood group O (74/155, 47.7%), without statistical significance (P = 0.111). Conclusion:Our study showed a statistically significant relationship between AB and non-O blood types and colon cancer compared to the O blood group.

Background: Although body composition (BC) can be measured easily using bioelectrical impedance analysis (BIA), there are few studies of serial BC measurements in colorectal cancer (CRC). The purpose of the present study was to observe the serial change of BC in patients with CRC surgery from the initiation to the end of chemotherapy and to evaluate its clinical usefulness. Methods: From July 2018 to November 2019, patients undergoing elective CRC surgery were enrolled. All clinical data were reviewed retrospectively. BIA data were collected prospectively at four time points (initial, discharge day, first chemotherapy, and 6 months later). BC was measured using a commercial BIA device. Results: A total of 160 patients were enrolled, and 110 (68.8%) patients were followed. Most BC measurements, such as weight, body mass index, skeletal muscle mass, skeletal muscle index, and fat mass index, were lowest at the first chemotherapy and rebounded after 6 months. Phase angle (PhA) and the ratio of extracellular water to total body water (ECW/TBW) were "V" shaped and inverted "V" shaped, respectively, and the peaks were on discharge days. This pattern of BC showed significant difference according to sarcopenia, old age (>70 years), and advanced stage (III or IV). The change of PhA and ECW/TBW sensitively pattern differences according to clinical aspect. Conclusions: Using BIA, serial BC measurements were taken to establish a pattern based on clinical characteristics. PhA showed the most sensitive change according to the patient's clinical aspect.

The aim of this study was to evaluate the safety and feasibility of applying enhanced recovery after surgery (ERAS) protocol in elderly colorectal cancer patients. Methods: The medical records of patients who underwent elective colorectal cancer surgery at our institution, from January 2017 to December 2017, were reviewed. Patients were divided into 2 groups: the young group (YG, patients aged 70 and under 70 years) and the old group (OG, patients over 70 years old). Perioperative outcomes and length of hospital stay were compared between both groups. Results: In total, 335 patients were enrolled; 237 were YG and 98 were OG. Despite the poorer baseline characteristics of OG, the perioperative outcomes were similar. Length of hospital stay was not different between the groups (YG, 5 days vs. OG, 5 days; P = 0.320). When comparing the postoperative complications using the comprehensive complication index (CCI), there was no significant difference (YG, 8.0 ± 13.2 vs. OG, 11.7 ± 23.0; P = 0.130). In regression analysis, old age ( > 70 years) was not a risk factor for high CCI in all patients. In multivariate analysis, C-reactive protein (CRP) level on postoperative day (POD) 3 to 4 was the only strong predictive factor for high CCI in elderly patients. Conclusion: Implementing the ERAS protocol in patients aged > 70 years is safe and feasible. High CRP ( ≥ 6.47 mg/dL) on POD 3 to 4 can be used as a safety index to postpone discharge in elderly patients.

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A reduced and limited number of myenteric ganglia and low acetylcholinesterase activity in the lamina propria characterizes an unusual form of intestinal innervation disorder known as acquired or adult-onset hypoganglionosis. Only a few cases have been observed in adults, while the majority are diagnosed in infancy or youth. We report a rare case of colonic hypoganglionosis that presented as sigmoid volvulus in a 25-year-old female brought in to the ER. She underwent endoscopic decompression but developed a massive sigmoid volvulus with proximal colon dilatation. It was decided to do a total colectomy with an end ileostomy. The diagnosis was confirmed by histopathology, which revealed acquired hypoganglionosis. In order to prevent delayed or emergency presentation and the development of a stoma, the diagnosis of hypoganglionosis must be confirmed with full-thickness biopsies from all affected parts of the large bowel. Hypoganglionosis is rarely present, so young patients with a history of chronic constipation must be treated with a high index of suspicion.

PurposeThis study aimed to compare the perioperative outcomes of wet gauze and conventional irrigation after laparoscopic appendectomy to determine whether wet gauze irrigation can help reduce surgical site infection (SSI).MethodsA total of 308 patients undergoing laparoscopic appendectomy were included in this study between December 2018 and May 2020. Of these, 132 (42.9%) received gauze irrigation (group 1), and 176 patients (57.1%) received conventional irrigation (group 2). Pre-operative outcomes and complications, including SSI, were compared after propensity score matching (PSM) to adjust for baseline differences and selection bias.ResultsAfter 1:1 PSM, 92 well-matched patients in each group were evaluated. Regarding perioperative outcomes between groups 1 and 2, the rate of severe complications (Clavien-Dindo Classification grades III, IV, and V), operative time, and readmission rate did not differ between the groups. Superficial/deep SSIs were observed more frequently in group 2 (8/92 cases) than in group 1 (1/92 cases; p = 0.017). The organ/space SSIs rate was not significantly different between the two groups (1/92 group 1 and 0/92 group 2, p = 0.316). However, post-operative hospital stay was significantly longer in group 2 (2.8 ± 1.3 days) than in group 1 (1.6 ± 1.2 days; p < 0.001). In the univariate analyses, wound irrigation using wet gauze was an independent protective factor for superficial or deep SSI (p = 0.044).ConclusionsWound irrigation using wet gauze after fascia closure has a significant beneficial effect on reducing post-operative superficial/deep SSI following laparoscopic appendectomy.