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Due to the overwhelming spread of SARS-CoV-2 and its disruption of the healthcare system, delays and reduced numbers were reported for colorectal cancer screening, colonoscopies, and surgery during the COVID-19 pandemic. This multicenter retrospective study investigated the still poorly understood impact of the COVID-19 pandemic on colorectal cancer treatment in Japan.This study was organized by the Clinical Study Group of Osaka University, which comprised 32 major institutions in Osaka. We retrospectively analyzed the number of surgeries and colonoscopies performed and the characteristics of patients who underwent surgery for colorectal cancer between March 2019 and February 2021. We compared data collected before and during the COVID-19 pandemic. We also assessed the methods used for detecting colorectal cancer, including fecal occult blood test, abdominal symptoms, and anemia.The COVID-19 pandemic caused reductions in the annual numbers of surgeries (3569 vs 3198) and colonoscopies (67 622 vs 58 183) performed in the 2020 fiscal year, compared to the 2019 fiscal year. During the COVID-19 pandemic, a significantly lower proportion of patients were treated for clinical stages ≤I (24.2% vs 26.9%;The COVID-19 pandemic reduced the number of colonoscopies and surgeries performed for colorectal cancer and hindered the detection of asymptomatic early-stage cancers, and its impact varied by hospital size.

Background: Defecation status is an important determinant of quality of life. Previous studies showed that postoperative defecation disorders occurred after open surgery for ulcerative colitis (UC)...

Stoma outlet obstruction (SOO) is much more common after total proctocolectomy (TPC) and ileal-pouch anal anastomosis (IPAA) for ulcerative colitis (UC) compared to after rectal surgery for cancer. Few prior reports have evaluated anatomical risk factors for SOO. In this study we aimed to clarify the risk factors for SOO after IPAA, focusing on the anatomical perspective.This study included 68 UC patients who underwent IPAA with diverting ileostomy. These cases were analyzed based on clinicopathological factors and computed tomography (CT)-based anatomical factors.SOO was identified in 18 patients (26.5%). We compared this SOO group with the non-SOO group. The two groups significantly differed in sex distribution, and patients in the SOO group tended to have a longer postoperative hospital stay. Regarding surgery-related factors, patients who underwent two-stage surgery and experienced high-output syndrome tended to develop SOO. Analysis of anatomical risk factors revealed that SOO was more common in patients with a longer distance between the root of their superior mesenteric artery and the bottom of the external anal sphincter (rSMA-bEAS). This tendency remained significant even with adjustment for patient height. In multivariate analyses, adjusted rSMA-bEAS (191.0 mm/m) and male sex were independent risk factors associated with SOO.A long rSMA-bEAS distance suggests that the mesentery is likely to be under tension. In such cases, surgeons should endeavor to avoid tension in the mesentery as much as possible.

It is highly controversial whether a lymphadenectomy for treating distant lymph nodes, such as the para-aortic lymph node, provides clinical benefit in colorectal cancer (CRC). This study aimed to investigate the benefit of a lymphadenectomy for para-aortic lymph node metastasis (PALM) in CRC, by evaluating the extent of dissection. This retrospective cohort study included 28 consecutive patients with pathologically positive PALMs in CRC that underwent lymphadenectomies from October 2001 to March 2018 at our institute. We analyzed the rates of 3-year recurrence-free survival (RFS), postoperative complications, and peri-operative death. We examined RFS in two groups with different operation types. One group received radical resections (radical group), defined as a systematic dissection of para-aortic lymph nodes, which removed the area under the renal vein and above the aortic bifurcation. The other group (targeted group) received targeted dissections, which removed specific swollen para-aortic lymph nodes. The radical group had a significantly better RFS than the targeted group. In addition, females had significantly better RFS prognoses than males. Univariate and multivariate Cox regression analyses identified two clinical factors significantly associated with RFS: sex (P = 0.0100) and surgical procedure (P = 0.0033). Postoperative complications after PALM resections occurred in 35.7% of patients. There was no postoperative mortality. Our study suggested that a radical lymphadenectomy for treating PALMs in CRC could be performed safely and could prolong the RFS. More studies are necessary to strengthen the evidence in support of this conclusion.

Despite advances in medical treatments, most patients with Crohn's disease (CD) will still require surgery, with 20%-50% needing redo surgery within 10 years after the primary procedure. There is no consensus on the application of laparoscopic redo surgery for recurrent CD.This study included 107 patients with CD who underwent surgery from 2012 to 2020 at Osaka University Hospital. All procedures were laparoscopic. Patients were grouped based on whether the surgery was redo or primary for evaluation of the safety and feasibility of laparoscopic redo surgery.The study included 40 patients undergoing redo surgery and 67 having primary surgery. The median age at the time of the procedure was higher for those undergoing redo surgery (43 years vs 34 years,These results suggest that laparoscopic redo surgery is safe and feasible, with comparable conversion rates and postoperative complications in experienced institutions.

Approximately 90% of patients are thought to develop bowel dysfunction after low anterior resection (LAR). Although some prognostic factors have been reported, the volumes of defecation-related muscles have not been examined. This retrospective study investigated the association between the preoperative volume of defecation-related muscles and major LARS.Forty-six patients who underwent LAR for rectal cancer between 2013 and 2020 in our institution were analyzed. They had no local residual tumor or local recurrence at the time of the study and no problems with their defecation function pre-operatively. Defecation-related muscle volume measurements were made before surgery, and the patients answered a low anterior resection syndrome (LARS) score questionnaire after surgery. The muscle volume was adjusted by the patient's height squared.Twenty-seven patients (58.7%) developed major LARS. In the univariate analysis, sex, lateral lymph node dissection, and diverting ileostomy as well as muscle volume of the external anal sphincter, pubococcygeal + iliococcygeus muscle, and puborectal muscle were associated with major LARS. In a multivariate analysis, pubococcygeal + iliococcygeus muscle ( 5.96 ml/mMeasuring the volume of the defecation-related muscles may aid in predicting major LARS.

Current guidelines indicate that laparoscopic appendectomies are safe for pregnant patients with acute appendicitis. Recently, single- and reduced-port laparoscopic surgeries have gained popularity for nonpregnant patients, because they minimize abdominal wall trauma. Here, we describe a reduced-port laparoscopic appendectomy (RPLA) in a 31-year-old pregnant female performed at 27 weeks gestational age. Preoperative abdominal ultrasonography and computed tomography imaging showed an inflamed, swollen appendix and blood test results showed elevations in the white blood cell count and the C-reactive protein level. Accordingly, acute appendicitis was diagnosed. A surgical incision was performed at the umbilicus with an EZ-access device; an additional 5-mm trocar was placed at the right lower quadrant. Recovery was uneventful. The patient was discharged 8 days postoperatively. A vaginal delivery was achieved at term. The RPLA was a good surgical option for minimizing surgical invasiveness, without increasing the technical difficulty, in conditions where the uterus and fetus are growing.

The relevance of transvaginal specimen extraction (TVSE) combined with reduced port surgery (RPS) remains unknown. This study investigated the feasibility of TVSE with RPS according to short-term outcomes and cosmesis. This prospective multicenter study enrolled ten patients at three institutions. For the semi-quantification of each parameter, we administered questionnaires to assess pain (visual analogue scale), subjective/objective wound healing esthetics [photo series questionnaires (PSQ)], and quality of life (QOL). No operative complications occurred, except one case of urinary tract infection, which was promptly cured with antibiotics. On day 0, pain was rated at 2.3 ± 0.67 at rest and 4.9 ± 0.82 during sneezing; these ratings gradually declined over time. The PSQ showed that the patient ratings of wound esthetics after TVSE were not inferior to ratings from patients after conventional laparoscopy or single incision laparoscopic surgery, and they were significantly higher than the patient ratings of wounds after laparotomy (P

The impact of anti-tumor necrosis factor alpha (TNFα) treatment for Crohn’s disease (CD) on surgical outcomes is still controversial. The aim of this study was to assess the feasibility of laparoscopic surgery for CD patients treated preoperatively with anti-TNFα agents. We investigated, retrospectively, the clinical features and surgical outcomes of 35 consecutive CD patients who underwent laparoscopic surgery after receiving scheduled anti-TNFα treatment preoperatively. We compared the surgical outcomes of an “early surgery group”, comprised of patients who underwent surgery less than 3 years after the initiation of anti-TNFα treatment, with those of a “late surgery group”, comprised of patients who underwent surgery more than 3 years after the initiation of anti-TNFα treatment. The mean operating time and blood loss were 203 min and 259 mL, respectively. The rates of conversion to open surgery and postoperative complications were 8.6 and 11.4 %, respectively. Operating time and blood loss were correlated with the interval between the initiation of anti-TNFα agent treatment and the time of surgery. The proportion of patients with acquired resistance to anti-TNFα agents and the rate of conversion to open surgery were higher and operating times were longer in the late surgery group than in the early surgery group. Laparoscopic surgery can be performed safely for CD patients treated preoperatively with anti-TNFα agents, although operating times may be longer and estimated blood loss (EBL) greater for those who have been on prolonged anti-TNFα treatment.

In 2009, the Centers for Disease Control and Prevention published Guidelines for the Prevention of Catheter-Associated Urinary Tract Infections, which limited the indications for perioperative urinary catheter use. We conducted this study to evaluate the safety of elective laparoscopic cholecystectomy (LC) without urinary catheter placement and to investigate whether it reduces the incidence of urinary complications. Of 244 patients who underwent elective LC between March, 2010 and April 2011, 192 patients fulfilled the eligibility criteria and underwent surgery without urinary catheterization (non-catheterized group). We compared the clinical features and surgical outcomes of the non-catheterized group with those of an historical control of 90 patients who underwent LC with routine urinary catheterization. The operating times were similar in the two groups and there was no case of conversion to open surgery. The postoperative hospital stay was slightly shorter and the incidence of urinary complications was significantly lower in the non-catheterized group. Three patients in the non-catheterized group suffered urinary retention, which resolved after temporary catheterization. Our study demonstrated that elective LC without urinary catheter placement is feasible for most patients and might reduce the incidence of perioperative urinary complications.

Spindle cell carcinoma is a rare malignant tumour that shows biphasic proliferation of squamous cell carcinoma components and sarcomatoid components of spindle-shaped cells in the same tissue. In addition, cases that a malignant tumour of the head and neck region metastasizes to the thyroid gland are extremely rare. We report an extremely rare case that spindle cell carcinoma of the tongue metastasized to the thyroid gland. A 59-year-old female presented with a polypoid mass in the right margin of the tongue. Based on histopathological diagnosis of spindle cell carcinoma of clinical staging II, a partial glossectomy was performed. Thyroid mass appeared at 5 months after the surgery. She was diagnosis with thyroid gland cancer and a total thyroidectomy was performed. A histopathological diagnosis revealed thyroid gland metastasis. However, a thyroid tumour recurred in the neck at 4 months after the thyroid surgery. The tumour was untreatable, and the patient expired 13 months after the primary resection.

Renal osteodystrophy (ROD) is one of the most common complications affecting patients with chronic renal failure both before and after the initiation of maintenance dialysis, but macrognathia secondary to ROD is rare. Usually, enlarged jaws due to ROD do not return to their normal contours after the treatment of hyperparathyroidism. To the authors' knowledge, this article describes the second case of macrognathia secondary to dialysis-related ROD treated successfully by parathyroidectomy. Immunohistochemical study of the maxilla confirmed that parathyroidectomy could stop maladaptive parathyroid hormone stimulation, which leads not only to the formation of osteoblastic progenitors that become fibroblast-like cells but also to osteoclast formation.

The incidence of pulmonary thromboembolism (PTE) has been increasing, although it remains lower in Japan than in Western countries. We report a case of PTE after free flap reconstruction in a patient with left tongue cancer (T2N2bM0) treated in May 2004.We performed tracheostomy, hemiglossectomy, and neck dissection. The tongue defect was repaired with a free radial forearm flap using a microsurgical vascular anastomosis. Although antithrombolytic therapy with prostaglandin El was started during microsurgery, circulatory disorders of the free flap occurred 2 days after operation. Therefore, we tried removing the intravenous thrombus and performed re-anastomosis, followed by anticoagulant and thrombolytic therapy. However, total necrosis of the flap occurred 5 days after re-operation. We therefore discontinued the anticoagulant and thrombolytic therapy. The following day PTE developed, but we saved the patient's life by immediate treatment, administered by cardiologists and other specialists.Our experience indicates that preventative treatment such as low-dose unfractionated heparin and using elastic stockings or intermittent pneumatic compression until the patient can walk after surgery may be necessary when there is a high risk of PTE.

Necrotizing fasciitis is a severe bacterial infection of the soft tissues that is characterized by rapid extension along fascial planes and soft tissue necrosis. We present a case of cervical necrotizing fasciitis resulting from pericoronitis of the mandibular third molar.A 72-year-old man was admitted to our hospital because of increasing swelling and pain in the left mandibular region. Local examination revealed a large swelling with redness and tenderness, extending from the left side of the mandible to the neck. There was a malodorous necrotic ulcer at the site of the left mandibular third molar. Cultures revealedPeptostreptococcus sp., Bacteroides sp., Prevotella intermedia, α-Streptococcus, andEubacterium lentum. Fasciitis and skin necrosis spread from the left mandible to the upper arm. We made an incision and drained and debrided the obviously nonviable tissue. The patient was ischarged after 104 days. The key to successful management of such an infection is aggressive surgical intervention.

Multiple primary cancers of the oral and maxillofacial area were found in 19 (6.6%) of 288 patients presenting to the Department of Oral Surgery of Kawasaki Medical School between April 1974 and March 1996. The study group consisted of 14 males and 5 females. Two patients had triple cancers, and one had multiple cancers of the oral cavity. The average interval between diagnosis of the first primary cancer and that of the second primary tumor was 5 years 9 months, and the median interval was 4 years 1 month. Three patients were in stage I, 8 in stage II, 2 in stage M, and 6 in stage N. We performed radical or multidisciplinary treatment in 16 patients, and 12 died. Eight of the 12 patients had metastasis to other organs, particularly the gastrointestinal tract and liver. Therefore, consultation with other medical specialists is essential.

This retrospective study was carried out to clarify whether interstitial radiotherapy is effective in the management of carcinoma of the tongue. The subjects were 65 previously untreated patients with invasive squamous cell carcinoma of the anterior two-thirds of the tongue who received mainly interstitial radiotherapy using137Cs needles with or without external irradiation between 1977 and 1993. The local control rate was 80% for T1, 73% for T2, 57% for T3 and 73% overall. Thirteen of 16 patients for whom local control failed achieved good control by salvage surgery. The local control rates were slightly lower with combined radiotherapy (64%) than with the interstitial radiotherapy alone (78%), but there was no significant difference between external radiation (≤30 Gy) and external radiation (>30 Gy). Cervical lymph node metastases developed in 26% of patients with T1-3 NO. Neck control was achieved in 20 (74%) of 27 patients in whom pathologically positive nodes were found. Twenty-two patients developed soft tissue or/and mandibular complications for a total of 28 cases. Soft tissue complications were more likely to occur in patients who received interstitial radiotherapy alone. On the other hand, mandibular complications were likely to occur in patients who received external irradiation. The cumulative 5-year survival rate was 92% for T1, 72% for T2 and 33% for T3. The 5-year survival rate of patients with subsequent cervical node metastases was 41%, whereas in patients without subsequent cervical node metastases it was 89% (P

各種の遊離皮弁による舌, 口底再建19症例を対象として術後会話機能, 咀嚼機能, 嚥下機能を切除範囲別に評価し, 遊離皮弁再建術が術後機能に及ぼす影響を検討した。会話機能は切除範囲や遊離皮弁による影響が少なく, 咀嚼機能は切除範囲や皮弁よりも下顎再建に影響を受けた。嚥下機能は舌亜全摘型および中咽頭合併切除型で低下し, videofluorographyにより咽頭通過時間の延長および誤嚥を認めた。また咽頭通過時間の分析より前腕皮弁は前外側大腿皮弁や腹直筋皮弁よりも残存舌運動への影響が大きいことが示唆された。皮弁の選択は残存舌運動の保持と大きな欠損の充填効果が期待できる前外側大腿皮弁や腹直筋皮弁が適応する。

Treatment of a case of widespread superficial oral squamous cell carcinoma with external beam irradiation, followed by high dose rate Microselectron mould radiotherapy, is reported. The tumor disappeared macroscopically after treatment, but there was infield recurrence in the buccogingival sulcus where the radiation dose might have been inadequate. Apart from some radiation mucositis within the treated area, edema and a superficial ulcer were observed in the tongue. These were considered to be due to radiation overdose. Although there is room for improvement, this mode of treatment has something to offer patients with hard-to-cure cancer.

A 17-year-old girl with a 5-month history of idiopathic thrombocytopenia (ITP) was referred to the authors because she was unable to bring her anterior teeth together without trismus or arthralgia. The patient had been treated with increasing doses of prednisolone up to 60 mg/day. The anterior open bite had begun after prednisolone medication. The problem was treated successfully with a separated type of intermaxillary elastic traction appliance. Magnetic resonance imaging scans disclosed internal and erosive damage to the condyles without disk displacement, but showed no sign of adaptive changes or functional remodeling. This is the first reported case of steroid-induced damage to the condyles caused by treatment for ITP.

A triple combined anterolateral thigh flap, anteromedial thigh flap, and vascularized iliac bone graft was used for reconstruction of a full-thickness defect of the mental region after wide resection of advanced tongue cancer. The distal end of the pedicle vessels of these double skin flaps, i.e., the lateral circumflex femoral system, was directly anastomosed in tandem to the pedicle of the iliac bone graft, which was enveloped by these flaps. The advantages of this iliac osteocutaneous flap are as follows: It can be transferred within a shorter surgical time because the flaps can be obtained in the supine position simultaneously with tumor resectioning; and its skin components can be separated from the bone because each component has its own pedicle vessels, has a longer vascular pedicle (10 cm), and has a thicker crest of the bone graft. This flap is believed to be suitable for reconstruction of large full-thickness defects in various sizes of the mandibular and maxillary regions of the face.

Mycosis fungoides (MF) is a T-cell lymphoma that predominantly affects the skin. Involvement of the oral tissues in MF is rare. A case of MF with involvement of the maxillary gingiva and cervical lymph nodes is presented. Electron-beam radiation with 40 Gy and systemic chemotherapy with vincristine and interferon γ produced almost complete remission of the oral lesion while the persistent pain was relieved.

A 1. 4-year-old child presented to our clinic complaining of an infraauricular mass. After admission, we performed CT scan, PPD testing, Ga-scintigraphy and ultrasound. The final diagnosis was based on the histological findings of the surgical specimen and on the PPD test. The treatment was superficial parotidectomy and antibiotic therapy.Combination therapy with INH, RFP and SM was administered for six months, and no recurrence has been noted to date.

The authors gained fine postoperative results from closure, by tongue flap against the palatal fistula, and of a bilateral cleft lip and palate, in a case which could not be improved by two previous palatoplasties. The patient was a 20-year-old woman with a large fistula of the hard palate, measuring 25×25mm. An operation was performed to reconstruct the nasal side by mucoperiosteal flaps of the nasal septum and the nasal floor with free skin graft, and the oral side by an anteriorly based median dorsal tongue flap.