Previous studies have reported that progressive muscle loss, known as sarcopenia, has a negative impact on colon cancer treatment. However, the majority of studies have analyzed on patients undergoing open resection, and the association of sarcopenia with clinical outcomes is not clear for patients with colon cancer undergoing laparoscopic surgery. Thus, the aim of this study was to evaluate the impact of sarcopenia on clinical outcomes after laparoscopic surgery for colon cancer. Methods: A total of 423 patients who underwent laparoscopic surgery for colon cancer between November 2010 and October 2014 were included. Body composition was assessed by measuring muscle and fat areas at the third lumbar vertebra (L3) on preoperative computed tomography. The L3 skeletal muscle area was used to calculate the skeletal muscle index and to assess for sarcopenia. Results: Sarcopenia was identified in 54 patients (12.8%). The median time to first flatus (3 days), median time to tolerable soft diet (4 days), and median length of hospital stay (7 days) were not significantly different between patients with and without sarcopenia. However, sarcopenia was an independent risk factor for postoperative complications in the logistic regression multivariate analysis (P = 0.015). Sarcopenia was not associated with overall or disease-free survival. Conclusion: Sarcopenia was not negatively associated with functional recovery, hospital stay, and oncologic outcomes in patients with colon cancer who underwent laparoscopic surgery. However, sarcopenia was associated with postoperative complications after laparoscopic surgery for colon cancer.
Middle hepatic vein (MHV) reconstruction with interposition vessel graft has been established as a standard procedure for living donor liver transplantation (LDLT). Unwanted migration of a synthetic vascular graft into the hollow viscus has been sporadically reported. We herein present a case of Hemashield graft migration into the duodenum following LDLT. A 64-year-old male patient presented with LDLT due to liver cirrhosis and hepatocellular carcinoma. The MHV openings in the right liver graft were reconstructed with a 10 mm-sized Hemashield graft, which was anastomosed to the common opening of the recipient middle-left hepatic vein trunk. The patient had uneventful recovery after LDLT surgery. Computed tomography (CT) scans taken at one year and two years showed no abnormal finding. However, gastroduodenoscopic examination at two years revealed accidental migration of the Hemashield graft into the duodenal bulb. The patient had no signs or symptoms and no problems with diet. The Hemashield graft migration was identified by retrospective review of 1-year and 2-year CT scans probably due to no radio-opacity of Hemashield graft. Because of the potential risk of Hemashield graft migration-associated complications, surgical removal was recommended, but the patient wished to observe more. The patient has been doing well for two years six months after LDLT. In conclusion, every synthetic vascular graft can penetrate adjacent organs and soft tissues, and its incidence is not negligibly low. Lifelong surveillance is necessary to detect unexpected rare complications in LDLT recipients who have MHV reconstruction using synthetic vascular grafts.
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