Hideo Ogata

Poor nutritional status before and during chemotherapy leads to worse prognosis in unresectable advanced or recurrent colorectal cancer.

OBJECTIVE This study aimed to clarify the relationship between host nutritional status prior to first-line chemotherapy and therapeutic effect, and, whether these nourishment indexes could become factors that predict long-term convalescence in unresectable advanced or recurrent colorectal cancer or not. Summary of Background Date: It has previously been reported that postoperative complications and long-term prognosis of patients with gastrointestinal malignancies may be affected by their nutritional status. But, there is little information regarding the relationship between prognosis, nutritional status and immunocompetence in unresectable progressive or recurrent colorectal cancer. METHODS Ninety patients who had measurable target lesions underwent resection for primary colorectal cancer in our institution, between April 2007 and March 2013. The indicators of host nutritional status was body weight (BW), body mass index (BMI), serum albumin, Onoderas prognostic nutritional index (OPNI) and Glasgow Prognostic Score (GPS). The indicators of host immunocompetence was total lymphocyte counts, total neutrophil counts, granulocytes/lymphocytes ratio (G/L ratio). RESULTS The median overall survival (OS) was 32.5 months, and the median progression-free survival was 10.9 months. The relative change of target lesions were associated with BW, BMI and OPNI. Furthermore, there was strong correlation between the change ratio of the serum CEA level before and after chemotherapy administration and BMI. BW, BMI, serum albumin level, OPNI and GPS were significantly associated with overall survival (OS). CONCLUSION Poor nutritional status and suppressive immunocompetence is associated with ineffective chemotherapy.

Base Excess and White Blood Cell Counts Predict Bowel Gangrene in Japanese Sigmoid Colon Volvulus Patients

Objective: This study aimed to investigate factors that predict bowel gangrene in sigmoid colon volvulus patients. Methods: Nine sigmoid colon volvulus cases were retrospectively analyzed for prediction of bowel necrosis. Laboratory parameters were extracted from medical records, and subsequently, a receiving operator curve for each parameter was drawn. Using these cut-off values, a comparison between the “with necrosis” and “without necrosis” groups was performed. Results: In the emergent cases, necrosis of the intestine was observed in 4 cases and not observed in 4 cases. The values of area under the curve were high in metabolic acidosis and white blood cell counts. For base excess, the cut off value was -2.4 mEq/L. A lower base excess is significantly associated with bowel gangrene (p = 0.029). For white blood cell count, the cut off value is 8400/mm3. A lower white blood cell counts is significantly associated with bowel gangrene (p = 0.029). Conclusions: In addition to physiological findings, blood gas analysis and white blood cell counts are useful to detect ischemia due to sigmoid volvulus.

Treatment outcome of obstructive colorectal cancer with bowel perforation.

Objective: We reported the analysis of long and short-term treatment outcomes of pa-tients with bowel perforation caused by obstructive colorectal cancer. Summary of Background Date: From April 2003 to March 2013, 15 patients with bowel perforation caused by obstructive colorectal cancer underwent emergent surgery in our hospital. Methods: Clinical outcomes were retrospectively analyzed by age, gender, tumor loca-tion, time to surgery from diagnosis, operative method, stage, postoperative complication, and preoperative severity score by APACHE II scoring system. We studied outcome of short-term outcomes and long-term prognosis used by overall survival. Results: The median age was 67.6 years. Male to female ratio was 10:5. The mortality rate was 20% and the median of APACHE II score was 15. The survival cases (n=11) showed significantly lower APACHE II score compared with fatal cases (n=4) (p=0.02). The median overall survival was 18.9 months in survival cases except for stage IV case. 5 patients had recur...