Objectives: The perianal manual compression method (PMCM) is a form of pelvic floor support used to facilitate defecation. Although PMCM is included in the Rome IV diagnostic criteria for functional constipation as a manual maneuver to facilitate defecation, it has rarely been investigated. This study aimed to investigate age- and sex-related differences in the prevalence of PMCM use and to evaluate its clinical effectiveness in patients with evacuation difficulty (ED). Methods: A retrospective survey of 1,400 patients scheduled for hemorrhoid surgery, stratified by age and sex, was conducted to assess the prevalence of PMCM use. In addition, the clinical effectiveness of PMCM was retrospectively evaluated in patients with ED. Results: Of 1,380 eligible patients, 94 (6.8%) reported using PMCM. PMCM use was significantly more common in women than in men (9.1% vs. 4.5%, p = 0.0006) and increased with age, particularly in those aged >50 years. Sixty-two patients with ED (median age: 77 years; 30 men) received standardized instruction in PMCM. Of them, 55 were also prescribed laxatives, but 12 did not use PMCM because their symptoms improved with laxatives alone. Of the remaining 50 patients, PMCM was effective in 35 (70%), with 22 (44%) showing marked improvement. The median follow-up period was 2.0 months, and no adverse events related to PMCM were observed. Conclusion: PMCM is a simple and noninvasive maneuver that may represent a useful adjunctive therapy for patients with ED who are refractory to laxative therapy.
Indocyanine green (ICG) fluorescence imaging is increasingly used in colorectal surgery, but reliable intraoperative subserosal injection for lymphatic mapping remains technically challenging because puncture depth control and prevention of dye spillage are essential. We developed a standardized subserosal ICG mapping technique using an adjustable laparoscopic injection needle under direct laparoscopic or robotic visualization. The serosa adjacent to the tumor is punctured with the needle tip adjusted to local bowel wall thickness, and ICG is delivered using a saline–ICG–saline sandwich technique. To minimize contamination, the outer sheath of a suction tube is positioned close to the puncture site as a protective guide for the injection needle, allowing immediate re-sheathing after injection; laparoscopic gauze is added when necessary. Fluorescence imaging is then performed to visualize lymphatic flow and fluorescent nodal basins. In our initial 10-patient experience, detection was achieved in 9 patients without puncture-related complications.
Background: The COVID-19 pandemic disrupted elective endoscopy and non-urgent procedures, but its impact on inpatient colorectal cancer (CRC) treatment in Japan remains incompletely quantified. Methods: We conducted an interrupted time series analysis using the Diagnosis Procedure Combination (DPC) inpatient database. Eligible admissions were patients hospitalized between April 2018 and December 2021 with colorectal cancer codes from the International Classification of Diseases, 10th Revision (ICD-10; C18, C19, and C20) who underwent endoscopic submucosal dissection (ESD) or colorectal surgery. We excluded planned chemotherapy readmissions, recurrence cases, admissions with multiple non-ESD surgeries, and records with missing tumor-node-metastasis (TNM) information. Three periods were defined: Period 1 (Apr 2018–Apr 2020), Period 2 (May 2020–Apr 2021), and Period 3 (May 2021–Dec 2021). Monthly inpatient case volumes were modeled using segmented regression with Prais–Winsten estimation and seasonal adjustment. Results: Of 276,458 eligible admissions, 260,919 were analyzed. At the start of Period 2, adjusted inpatient cases decreased significantly for ESD (−26%; 887 adjusted vs 1,194 predicted; p<0.001) and colectomy (−6%; 2,746 vs 2,928; p=0.043), whereas rectal resection/abdominoperineal resection showed no significant level change (−5%; p=0.189). In stage-stratified analyses limited to surgical resections, Stage I surgical volume decreased significantly at the start of Period 2 (−13%; p=0.010) with no clear reduction for Stages II–IV. Conclusion: In Japan, the early COVID-19 period was associated with short-term reductions in inpatient ESD and Stage I surgical volume, whereas surgical treatment volumes for more advanced disease showed no clear immediate reduction after the first emergency declaration. Because this was an administrative, inpatient-only analysis, the study does not directly assess diagnostic delays, stage migration, or downstream oncological outcomes.
Objective: Although the prognostic immune and nutritional index (PINI) has attracted increasing attention as a prognostic marker for various cancers, its clinical significance in older patients has not been fully clarified. This retrospective single-center study aimed to investigate the association among PINI, long-term prognosis, and postoperative complications in older patients with colorectal cancer (CRC). Methods: We analyzed 181 patients aged 75 years with pathological stage I–III CRC who underwent curative surgery at our institution between 2015 and 2023. Results: Overall survival (OS) (p < 0.001) and cancer-specific survival (CSS) (p < 0.001) rates in patients with low PINI were significantly worse than those in their counterparts. Low PINI was an independent prognostic factor for OS (hazard ratio [HR] = 5.22, 95% confidence interval [CI]: 2.45–11.1, p < 0.001) and CSS (HR = 2.94, 95% CI: 1.03–8.36, p = 0.042). Moreover, low PINI was an independent risk factor for postoperative complications (odds ratio = 2.90, 95% CI: 1.10-7.82, p = 0.030). Additionally, patients with low PINI had a significantly higher recurrence rate for locoregional metastasis than those with high PINI (2.79% vs. 22.6%, p < 0.001); no significant differences were observed in the recurrence rates for other patterns. Conclusions: Low PINI was an independent risk factor for postoperative complications and poor prognosis in older patients with CRC. Preoperative inflammatory and immunonutritional assessments using the PINI may contribute to comprehensive risk stratification and individualized perioperative management in this vulnerable population.
Objectives: Graft-versus-host disease (GVHD) of the gut and cytomegalovirus (CMV) colitis are common and severe adverse events of allogeneic hematopoietic stem cell transplantation (HSCT). The diagnosis of gut-GVHD and CMV colitis using colonoscopy is crucial for deciding treatment strategies. Endoscopy could help to rapidly diagnose CMV colitis; however, endoscopic findings characteristic of CMV colitis remain unclear. Therefore, we aimed to determine whether endoscopic findings can help predict pathologically diagnosed CMV colitis. Methods: We retrospectively analyzed the data of 271 of 340 patients who underwent biopsy during colonoscopy for colitis or diarrhea after allogeneic HSCT between May 2007 and December 2018. The pathological results of the biopsies were categorized as follows: (1) nonspecific findings, (2) CMV colitis, (3) gut-GVHD, and (4) both CMV colitis and gut-GVHD. Moreover, (2) and (4) were defined as pathologically diagnosed CMV colitis. We analyzed the association between each endoscopic finding and pathological CMV colitis using logistic regression and developed a predictive model for CMV colitis. Results: We identified 59 patients with pathologically diagnosed CMV colitis (21.8%). Univariate analysis showed a significant association between pathologically diagnosed CMV colitis and ulceration, erosion, erythema, and shedding mucosa in the terminal ileum and colon. Multivariate analysis revealed that ulceration and erosion were independent predictive factors for CMV colitis. The area under the curve of the model based on endoscopic findings was 0.71. Conclusions: Ulceration and erosion are independent predictive factors for pathologically diagnosed CMV colitis after allogeneic HSCT. Endoscopic findings may facilitate earlier initiation of CMV colitis treatment.
