BACKGROUND/AIM:The usefulness of robot-assisted surgery for elderly colorectal cancer patients remains controversial. The aim of this study was to examine the impact of the surgical approach on short-term prognosis in patients aged ≥80 years. PATIENTS AND METHODS:A total of 1,115 colorectal cancer patients aged ≥80 years who underwent surgery at 6 hospitals between 2016 and 2024 were included in the study. Patients were divided into three groups according to surgical approach: robotic surgery (R group, n=55), laparoscopic surgery (L group, n=910), and open surgery (O group, n=150). Patient characteristics and surgical outcomes were compared among the three groups. RESULTS:The O group had higher proportions of patients with a body mass index (BMI) <25 kg/m2 (R vs. L vs. O: 72.7% vs. 80.8% vs. 87.3%, p=0.040), a performance status ≥3 (9.1% vs. 18.6% vs. 27.3%, p=0.006), an operation time <240 min (47.3% vs. 59.1% vs. 79.3%, p<0.001), and postoperative complications (9.1% vs. 23.0% vs. 27.3%, p=0.022). Multivariable analysis demonstrated that robotic surgery [odds ratio (OR)=0.243, 95% confidence interval (CI)=0.088-0.668, p=0.006] and BMI <25 kg/m2 (OR=0.626, 95% CI=0.419-0.936, p=0.032) were associated with a reduced risk of postoperative complications. CONCLUSION:Robotic-assisted colorectal surgery in elderly patients is safe, with relatively few complications.
Surgical outcomes have improved remarkably through specialist experience and certification; however, regional physicians have limited opportunities to publish because of the lack of accessible databases. The aim of this study was to examine whether establishing a large-scale database in regional areas could enhance academic output and thus support specialist certification. The databases of a university hospital and several regional general hospitals were unified in 2016. The period before database unification was termed the early period (E period) and that after unification was termed the late period (L period). The number of specialist certifications acquired was compared between the periods. The numbers of the following increased from the E period to the L period: academic presentations (86 vs. 186), publication of original articles (3 vs. 64), cases analyzed (5 vs. 20), papers written by new authors (2 vs. 20), Endoscopic Surgical Skill Qualification System-certified surgeons (2 vs. 12), and Board-certified Surgeons in Gastroenterology (2 vs. 12). Moreover, the mean number of years of clinical experience that it took for specialist qualifications to be obtained decreased from 14 years in the E period to 9 years in the L period. Establishing a database across regional areas promoted the presentation and publication of research by early-career clinicians, thereby supporting the development of medical specialists.
Cholangiocarcinoma carries a poor prognosis, and surgical resection remains the only curative option. Microsatellite instability-high (MSI-H) is a rare molecular subtype in intrahepatic cholangiocarcinoma (ICC). Although immune checkpoint inhibitors (ICIs) are effective in MSI-H malignancies, responses are variable. We report a rare case of MSI-H ICC that developed hyperprogressive disease (HPD) following pembrolizumab. An 81-year-old man with a history of endoscopic submucosal dissection for esophageal cancer underwent surveillance computed tomography (CT), which revealed a liver mass with intrahepatic bile duct dilation. Tumor markers were elevated (CA19-9: 214.9 U/mL). Suspecting ICC, liver resection was performed, achieving R0 resection. However, recurrence in the liver and hilar lymph nodes occurred within months. Systemic chemotherapy was ineffective. Genomic profiling (FoundationOne® CDx) revealed MSI-H, and pembrolizumab was initiated. After two cycles, rapid tumor progression was observed, with a ≥ twofold increase in tumor growth rate, consistent with HPD, along with new liver, bone, and peritoneal metastases. The patient died shortly thereafter. This case highlights the paradoxical response to ICIs in ICC, demonstrating that MSI-H status does not preclude HPD. Further investigation of the tumor immune microenvironment is warranted.
Rheumatoid arthritis (RA) is a systemic rheumatic disease. Its most prominent characteristic is synovitis, which manifests clinically as arthritis, resulting in joint damage. Interstitial lung disease (ILD) is an extraarticular manifestation of RA that hinders therapeutic goals, affects life prognosis, and can be worsened by the administration of disease-modifying antirheumatic drugs (DMARDs). Therefore, proper management of ILD, including consideration of risk factors such as the systemic disease activity of RA and autoantibodies, and early detection with high-resolution computed tomography are required at the introduction of DMARDs. Methotrexate, a class of DMARD used as the anchor drug for RA treatment, has been recognized as likely to worsen RA-ILD. However, there are currently reports suggesting that methotrexate may have beneficial effects on RA-ILD. Conversely, several studies have also shown exacerbations of ILD with the administration of biological DMARDs, which are thought of as tolerable for patients with RA-ILD. Rheumatologists should be wary of emergence or changes in the activity of ILD and arthritis during treatment of any kind with DMARDs. Further studies are warranted to clarify underlying ethnic factors, such as the possible effects of antimelanoma differentiation-associated gene 5 antibodies on RA-ILD.
A 68-year-old female was admitted to our hospital because of a right-sided headache since one year, an inability to perform housework, and a decrease in speech since March of that year. Upon admission, higher brain dysfunctions, including attention disorder, aphasia, and apraxia, were observed. Contrast-enhanced MRI revealed dural thickening in the bilateral frontal to parietal lobes and FLAIR imaging revealed high signal intensities in the bilateral frontal brain sulcus. Blood tests revealed a high IgG4 level (273 mg/dl). Dural biopsy revealed infiltration of IgG4-positive plasma cells into the tissue, and IgG4-related hypertrophic pachymeningitis was diagnosed. Administration of prednisolone resulted in resolution of the dural thickening, an absence of FLAIR imaging high signal intensities of the cerebral sulcus, and a considerable improvement of the higher brain dysfunctions. In patients with headache and higher brain dysfunctions, hypertrophic pachymeningitis should be considered in the differential diagnosis.
