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Purpose: To establish if it is appropriate to treat the inguinal lymph node (LN) of anal canal adenocarcinoma (ACA) as the intermediate LN according to the Japanese classification. Methods: The characteristics of 346 ACA patients were examined from the nationwide registry. The effect of LN dissection was evaluated using the therapeutic value index (TVI). Furthermore, the prognostic classification ability of N factors and stage was evaluated using Akaike's information criterion (AIC), the concordance index (C-index), and the 5-year overall survival (OS) rate. Results: The rate of metastasis of the inguinal LN was 7.5% and the TVI was 3.05. Evaluation using AIC and the C-index showed better results when the inguinal LN was treated as the intermediate LN. The 5-year OS rate for 66 patients with perirectal or intermediate LN metastasis, 7 with inguinal LN metastasis, and 13 with inguinal and perirectal or intermediate LN metastasis were 49.2%, 68.6%, and 47.6%, respectively. When inguinal LN metastases were treated as N3, the 5-year OS rates were 66.7% for those with T1N3 and T2N3 disease, and 49.2% for those with T3N3 disease. Conclusions: The inguinal LN of ACA was evaluated and staged as the intermediate LN to devise an appropriate treatment strategy. [ABSTRACT FROM AUTHOR]

Purpose: This study evaluated the risk of metachronous colorectal cancer (CRC) after resection of index (first) rectal cancer in patients with Lynch syndrome (LS). Methods: Clinicopathological data of patients with genetically proven LS were retrospectively analyzed in this multicenter Japanese study. The cumulative incidence of metachronous CRC and the overall survival were compared between patients with index rectal cancer (rectal group) and those with index colon cancer (colon group). Results: The median age at index CRC surgery was lower in the rectal group than in the colon group (37 vs. 46 years old, P = 0.01). The cumulative 5-, 10-, and 20-year incidences of metachronous CRC were 3.5%, 13.9%, and 21.1%, respectively, in the rectal cancer group and 14.9%, 22.0%, and 57.9%, respectively, in the colon cancer group (P = 0.02). The overall survival curves were not significantly different between two groups (P = 0.23). Conclusion: This is the first report from an East Asian country to report the risk of metachronous CRC after resection of index rectal cancer in patients with LS. Despite this study having several limitations, we cannot recommend extended resection, such as total proctocolectomy, for index rectal cancer as a standard surgical treatment in patients with LS. [ABSTRACT FROM AUTHOR]

Purpose: Perineural invasion (PN) diagnosed by hematoxylin-eosin (HE) staining is an important prognostic factor after curative-intent surgery in patients with colorectal cancer. However, the clinical significance of PN diagnosed by immunohistochemistry (IHC) has not been investigated. The present study assessed the clinical significance of PN diagnosed by IHC with an anti-S100 antibody in patients with colorectal cancer. Methods: We retrospectively enrolled 184 consecutive patients with stage I-III colorectal cancer who had undergone curative-intent surgery. We analyzed the absence/presence of PN diagnosed by HE staining (HE-PN) compared to that diagnosed by IHC with the anti-S100 antibody (S100-PN). Potential prognostic factors were identified by univariate and multivariate analyses of the overall and relapse-free survival. The $$\kappa$$ statistics were used to assess the inter-observer reproducibility. Results: The incidence of HE-PN and S100-PN among the 184 patients was 60 patients (32.6 %) and 113 patients (61.4 %), respectively ( P < 0.001). A multivariate Cox proportional hazards regression model analysis indicated that S100-PN was an independent prognostic factor for both the overall and relapse-free survival. The $$\kappa$$ value was 0.77 for S100-PN and 0.47 for HE-PN. Conclusion: PN diagnosed by IHC is an important prognostic factor in patients with colorectal cancer. An inter-observer assessment showed superior judgment reproducibility for S100-PN compared with HE-PN. [ABSTRACT FROM AUTHOR]

Staple-line recurrence is an important pattern of recurrence after colorectal carcinoma surgery, occurring in approximately 1% of patients. We report the case of a 44-year-old woman who underwent resection of carcinoma recurrence in a circular-staple-line twice within 34 months. Initially, she underwent sigmoidectomy for carcinoma of the sigmoid colon, followed by end-to-end anastomosis, done using a circular stapler. Subsequently, she underwent an anterior resection, then a low anterior resection, 12 and 34 months after the initial operation, respectively, both to treat a circular-staple-line recurrence of the tumor. Histological examination of all resected specimens revealed moderately differentiated adenocarcinoma with clear surgical margins and no lymph node metastasis. The patient remains well with no evidence of disease 48 months after her initial operation. To our knowledge, this is the first reported case of curative surgical resection being performed twice for circular-staple-line recurrence of colorectal carcinoma. Based on our experience and our review of the literature, early detection by follow-up colonoscopy and surgical resection may improve the prognosis of patients with a staple-line recurrence after the resection of colorectal carcinoma.