BACKGROUND:Only a few reports have exclusively assessed urinary function after laparoscopic rectal surgery, despite long-term investigations. OBJECTIVE:To investigate urinary function after laparoscopic low rectal cancer surgery using 3 types of questionnaires collected during a prospective clinical phase II trial (ULTIMATE trial) involving 47 Japanese hospitals. DESIGN:Prospective. SETTING:Japanese tertiary hospitals. PATIENTS:A total of 300 patients undergoing laparoscopic low rectal cancer surgery. MAIN OUTCOME MEASURES:Residual urine was measured twice daily on postoperative days 5 to 7. The International Prostate System Score, Overactive Bladder Symptom Score, and International Consultation on Incontinence Questionnaire-Short Form scoring were used to evaluate urinary disorders. RESULTS:Short-term voiding dysfunction was diagnosed in 78 patients and was associated with surgery duration, which was the only factor that affect voiding function in multivariate analysis. The differences in International Prostate System Score before and after surgery were significantly larger in patients who underwent abdominoperineal resection; in these patients, the urinary function did not recover over time. The mean International Prostate System Score in patients older than 75 years was significantly worse postoperatively than before surgery, and the difference was significantly larger in the older group than in the younger group. In the multivariate analysis, the type of surgery, abdominoperineal resection, and age older than 75 years were significant factors affecting the International Prostate System Score after surgery. There were no significant differences in the Overactive Bladder Symptom Score or International Consultation on Incontinence Questionnaire-Short Form score after surgery, even with respect to the clinical and operative variables. LIMITATIONS:The trial was limited only to early-stage rectal cancer and recruited patients from 47 hospitals with a range of surgical techniques. CONCLUSIONS:Our findings indicated urinary function deterioration in those who underwent abdominoperineal resection and those with advanced age after laparoscopic surgery for early low rectal cancer. See Video Abstract . CLINICAL TRIAL REGISTRATION:UMIN000011750. FUNCIN URINARIA DESPUS DE CIRUGA LAPAROSCPICA EN CNCER DE RECTO MUY BAJO:ANTECEDENTES:A pesar de las investigaciones a largo plazo, pocos estudios han evaluado exclusivamente la función urinaria tras la cirugía rectal laparoscópica.OBJETIVO:Investigar la función urinaria tras la cirugía laparoscópica de cáncer de recto bajo mediante tres tipos de cuestionarios recopilados durante un ensayo clínico prospectivo de fase II (ensayo ULTIMATE) en el que participaron 47 hospitales japoneses.DISEÑO:Prospectivo.ÁMBITO:Hospitales terciarios japoneses.PACIENTES:Un total de 300 pacientes sometidos a cirugía laparoscópica de cáncer de recto bajo.PRINCIPALES MEDIDAS DE RESULTADO:Se midió el volumen de orina residual dos veces al día entre los días 5 y 7 del postoperatorio. Para evaluar los trastornos urinarios, se utilizaron la Escala Internacional del Sistema Prostático, la Escala de Síntomas de Vejiga Hiperactiva y la versión corta del Cuestionario Internacional de Consulta sobre Incontinencia.RESULTADOS:Se diagnosticó disfunción miccional a corto plazo en 78 pacientes, la cual se asoció con la duración de la cirugía, siendo este el único factor que afectó la función miccional en el análisis multivariante. Las diferencias en la puntuación del Sistema Internacional de la Próstata (SIP) antes y después de la cirugía fueron significativamente mayores en los pacientes sometidos a resección abdominoperineal; en estos pacientes, la función urinaria no se recuperó con el tiempo. La puntuación media del SIP de los pacientes mayores de 75 años fue significativamente peor después de la cirugía que antes de la misma, y las diferencias fueron significativamente mayores en el grupo de mayor edad que en el grupo más joven. En el análisis multivariante, el tipo de cirugía, la resección abdominoperineal y la edad superior a 75 años fueron factores significativos que afectaron la puntuación del SIP después de la cirugía. No se observaron diferencias significativas en la puntuación de los síntomas de vejiga hiperactiva ni en la puntuación del Cuestionario Internacional de Consulta sobre Incontinencia (versión corta) después de la cirugía, incluso considerando las variables clínicas y quirúrgicas.LIMITACIONES:El estudio se limitó a pacientes con cáncer de recto en estadio temprano y reclutó pacientes de 47 hospitales con diversas técnicas quirúrgicas.CONCLUSIONES:Nuestros hallazgos indicaron un deterioro de la función urinaria en quienes se sometieron a resección abdominoperineal y en aquellos de edad avanzada tras una cirugía laparoscópica por cáncer de recto bajo en estadio temprano. (AI-generated translation )REGISTRO DEL ENSAYO CLÍNICO:UMIN000011750.

Purpose To improve the handling characteristics of suture needles, two novel needle designs, the Bi-curve and the G-curve, were developed by modifying conventional curvature designs. Methods Ten surgeons with varying levels of experience performed standardized open and robotic suturing tasks using half-circle, Bi-curve, and G-curve needles in a simulation environment. Suturing times were evaluated under both conditions. Moreover, advanced laparoscopic suturing tasks were performed using a robotic system. Needle trajectory parameters, burst pressure resistance, and subjective assessments of manipulability were analyzed to assess technical performance and potential tissue impact. Results During open forward suturing, both the Bi-curve and G-curve needles reduced suturing time significantly from that required with the half-circle needle, whereas no significant differences were observed among needle types in robotic suturing tasks. In advanced laparoscopic tasks, needle-passage quality scores were significantly higher for the Bi-curve and G-curve needles. Needle trajectory metrics and burst pressure resistance were comparable for all needle designs. Subjective evaluations revealed that no surgeon rated the novel needles as inferior to the conventional needle in terms of manipulability. Conclusions In this exploratory study, the Bi-curve and G-curve needles demonstrated handling performance comparable to, and in some aspects favorable to, that of the conventional half-circle needle, without causing more tissue damage.

Aim:Circumferential resection margin (CRM) status is a well-established prognostic factor in rectal cancer surgery; however, its long-term oncological relevance has not been prospectively validated in Japan, where upfront surgery has long been widely used. This study assessed the prognostic impact of CRM in patients with locally advanced rectal cancer treated with minimally invasive surgery. Methods:The PRODUCT trial was a multicenter, prospective, observational study conducted at 18 institutions in Japan. Patients aged ≥ 20 years with clinical stage II or III rectal adenocarcinoma located within 12 cm from the anal verge and scheduled for laparoscopic or robotic surgery were enrolled. CRM positivity was defined as a margin of ≤ 1 mm. Long-term outcomes were analyzed using the Kaplan-Meier method and Cox proportional hazards regression models. Results:Among 303 eligible patients, CRM positivity was observed in 26 (8.6%). The 3-year recurrence-free survival (RFS) rate was significantly lower in the CRM-positive group than in the CRM-negative group (61.5% vs. 82.3%; log-rank p = 0.003). CRM positivity was independently associated with worse RFS (hazard ratio, 2.35; 95% confidence interval, 1.17-4.71; p = 0.016). In patients with pT3-T4 tumors, recurrence rates were significantly higher in CRM-positive cases than in CRM-negative cases (47.6% vs. 21.2%; p = 0.013). CRM status was not significantly associated with overall survival or cumulative incidence of local recurrence (p = 0.057 and p = 0.706, respectively). Conclusions:CRM positivity is an adverse prognostic factor in Japanese patients with locally advanced rectal cancer undergoing MIS, underscoring the clinical importance of standardized CRM assessment. Trial Registration:Clinical Trials Registry, Identification Number: UMIN00034365.

BACKGROUND AND OBJECTIVES:We evaluated associations between preoperative Clinical Frailty Scale (CFS) scores and minimally invasive rectal cancer surgery outcomes in older patients. METHODS:This single-center retrospective cohort study included patients aged ≥ 75 years with pathological stage I-III disease after R0 resection who underwent surgery within September 2012-2022, stratified by CFS score. Univariate and multivariate analyses assessed risk factors for postoperative complications. Cox proportional hazards models identified prognostic factors for overall survival (OS) and disease-specific survival (DSS). RESULTS:Among 109 patients (median age: 78 [interquartile range, 76-82]; 65.1% male), the CFS 5-7 group (n = 17) had a higher stoma creation rate (70.6% vs. 43.5%; p = 0.063) than the CFS 1-4 group (n = 92), and none in this group underwent lateral pelvic lymph node dissection. No independent risk factors were identified for postoperative complications with Clavien-Dindo grade ≥ II. CFS 5-7 was independently associated with worse OS (hazard ratio [HR] = 10.073; p < 0.001) and DSS (HR = 9.135; p = 0.003), and 3-year OS (63.6% vs. 85.6%, p < 0.001) and DSS (74.3% vs. 90.7%, p = 0.035) were significantly poorer. CONCLUSIONS:CFS provides a simple and effective preoperative assessment tool for evaluating patient frailty that significantly influences long-term outcomes in patients undergoing minimally invasive rectal cancer surgery.

INTRODUCTION:Robotic Descending Colectomy Occasionally Requires Splenic Flexure (SF) and Sigmoid-Descending Junction (SDJ) Mobilization. In Multiport Robotic Surgery, This Bidirectional Mobilization Can Be Technically Demanding Because the Operative Field Extends in Two Directions, and Conventional Curved-Line or Stepped-Line Configurations May Limit Operative Envelope or Cause Arm Interference. MATERIALS AND SURGICAL TECHNIQUE:For lesions requiring continuous SF-SDJ access, an oblique-line configuration using the da Vinci Xi (DVXi) or the da Vinci SP (DVSP) system is typically required for an adequate operative envelope. This study describes the selection and use of curved-line, stepped-line, and oblique-line DVXi port configurations, with the DVSP system as a complementary option, based on lesion location and required mobilization direction. In the oblique-line configuration, the robotic ports are arranged diagonally from the right side of the round ligament of the liver toward the lower abdominal midline. DISCUSSION:The Oblique-Line Configuration Is Designed to Align the Camera Axis and Working Instruments With the Anticipated Direction of Mobilization, Whereas the DVSP System Provides Flexible Access Across Proximal and Distal Operative Fields. These Strategies May Help Surgeons Gain Stable Robotic Access Without Additional Port Insertion, Redocking, or Excessive Instrument Angulation.

BACKGROUND:Minimally invasive distal pancreatectomy (DP) leads to improved recovery compared with open DP; however, robotic DP recovery data are limited, based on small, expert-center studies. We aimed to compare perioperative outcomes of robotic, open, and laparoscopic DP for malignant disease in a nationwide cohort within a nationally credentialed implementation program. METHODS:Japanese National Clinical Database data were obtained, capturing >95% of all surgical procedures performed nationwide. Patients who underwent DP between 2019 and 2023 were identified, and outcomes of robotic, open, and laparoscopic DP were compared using propensity score matching. RESULTS:Among 12,124 DPs, 921 robotic-open and 920 robotic-laparoscopic matched pairs were analyzed. Compared with open DP, robotic DP showed a trend toward lower rates of overall Clavien-Dindo ≥ III complications (15.5% vs 18.5%; P = .09) and clinically relevant pancreatic fistula (16.9% vs 20.2%; P = .07), with reduced blood loss (67 vs 280 mL; P < .001) and longer operative time. Hospital stay was shorter; however, 30-day readmission was higher for robotic DP. Compared with laparoscopic DP, robotic DP exhibited lower conversion (2.6% vs 6.6%; P < .001), reduced blood loss (66 vs 100 mL; P < .001), longer operative time, comparable morbidity, and marginally shorter hospitalization periods. Deep venous thrombosis occurred more frequently after robotic DP in both comparisons. CONCLUSION:While robotic DP has been safely implemented nationwide, its advantages over laparoscopic DP appear limited, with clear benefits primarily in conversion reduction and reduced intraoperative blood loss. To justify its broader clinical adoption, evaluation of oncologic outcomes and economic implications is warranted.

BACKGROUND:Total mesorectal excision (TME) with bilateral lateral lymph node dissection (BLLND) is a standard surgical approach for low advanced rectal cancer (LARC) in Eastern countries. Although robotic surgery has been increasingly adopted for rectal cancer, its impact on lateral lymph node recurrence (LLNR) after BLLND remains unclear. METHODS:We retrospectively reviewed 180 patients with pathological stage II/III LARC who underwent TME with BLLND between 2009 and 2019. Of these, 149 patients underwent open surgery and 31 underwent robotic surgery. Perioperative outcomes, long-term oncological outcomes, and patterns of LLNR were compared between the two groups. RESULTS:Robotic surgery was associated with a significantly longer operative time but resulted in markedly reduced blood loss, lower rates of wound infection and anastomotic leakage, and a shorter postoperative hospital stay compared with open surgery (p < 0.0001, p < 0.0001, p < 0.0001, p = 0.02, and p = 0.003, respectively). There were no significant differences between the two groups in 5-year overall survival or disease-free survival (p = 0.25 and p = 0.11, respectively). Notably, LLNR was observed exclusively in the open surgery group (16 patients), whereas no cases of LLNR occurred in the robotic surgery group. Recurrence sites in the open group were predominantly located in the distal internal iliac region (263D), followed by the proximal internal iliac (263P) and obturator (283) regions. CONCLUSION:Robotic TME with BLLND demonstrated favorable short-term outcomes and technical feasibility; however, definitive oncological superiority could not be established.

Objectives: Colorectal cancer (CRC) is a major global health concern, and surgical resection remains its primary treatment. However, the impact of different surgical procedures on gut microbiota and their influence on postoperative outcomes remain unclear. This study investigated changes in the gut microbiota following three types of CRC resections: right-sided colectomy (RSC), left-sided colectomy (LSC), and low anterior resection (LAR). Methods: Fecal samples were collected from 34 patients with CRC who underwent curative resection at Fujita Health University Hospital between April 2022 and December 2023. Bacterial profiling was performed using 16S rRNA gene amplicon sequencing. The results were compared with data from 85 healthy controls. Results: Significant alterations in gut microbiota composition were observed in surgical groups compared to the healthy control (Ctrl) group. The RSC group exhibited the greatest reduction in alpha diversity, likely because of ileocecal valve loss. Beta-diversity analysis revealed distinct microbial profiles between the Ctrl group and the surgical groups, with notable alterations in key bacterial species. The RSC group exhibited significant reduction in beneficial bacteria, including Faecalibacterium prausnitzii and Bifidobacterium spp., alongside increase in Escherichia coli, suggesting a shift toward a pro-inflammatory environment. In contrast, the LSC and LAR groups exhibited enrichment of Akkermansia muciniphila, which may promote gut barrier integrity and immune modulation. Conclusions: CRC resection induces site-specific changes in gut microbiota composition. These microbial alterations may affect postoperative inflammation, metabolism, and cancer recurrence risk. Further studies are necessary to explore microbiome-targeted strategies for improving postoperative outcomes in cases of CRC.

Accurate recurrence risk evaluation in patients with stage II and III colorectal cancer (CRC) remains difficult. Traditional histopathological methods frequently fall short in predicting outcomes after adjuvant chemotherapy. This study aims to evaluate the use of comprehensive genomic profiling combined with machine learning for prognostic risk stratification in patients with CRC. A machine learning model was developed using a training cohort of 52 patients with stage II/III CRC who underwent curative surgery at Fujita Health University Hospital. Genomic DNA was isolated from formalin-fixed, paraffin-embedded tissue sections and analyzed with a 160 cancer-related gene panel. The random forest algorithm was used to determine key genes affecting recurrence-free survival. The model was validated by developing a risk score with internal and external cohorts, including 44 patients from Keio University Hospital. Six key genes (KRAS, KIT, SMAD4, ARID2, NF1, and FBXW7) were determined as significant prognostic risk predictors. A risk score system integrating these genes with clinicopathological factors effectively stratified patients in both internal (p < 0.001) and external cohorts (p = 0.017). This study reveals that machine learning, combined with comprehensive genomic profiling, significantly improves prognostic risk stratification in patients with stage II/III CRC after adjuvant chemotherapy. This approach provides a promising tool for individualized treatment strategies, warranting further validation with larger cohorts.

Background:Although extensive research has been conducted on early anastomotic leakage (AL) after sphincter-sparing surgery, the status of late anastomotic complications (post-30 days) has received limited attention. These late complications significantly affect a patient's quality of life and often lead to permanent stoma creation. Methods:This study conducted a sub-analysis of a phase II trial assessing the outcomes of laparoscopic surgery for cStage I lower rectal adenocarcinoma (the ultimate trial). This study included 278 patients who underwent intestinal anastomosis and investigated the frequency, timing, and risk factors of late anastomotic complications (stenosis, fistula, and intestinal prolapse). Results:Anastomotic stenosis occurred in 27 patients (9.7%), and the median time of occurrence was 274 days (range, 70-1226 days). Only early AL (p = 0.004) was identified as an independent risk factor. A late anastomotic fistula was observed in five patients (1.8%), and 18 patients (6.4%) requiring permanent stomas. A short distance from the lower tumor margin to the anal verge (AV) (p = 0.004) and the presence of stenosis or fistula (p < 0.0001) were independent risk factors.Intestinal prolapse occurred in eight cases (3%), with a median occurrence of 221 days (range, 122-725 days). Intersphincteric resection (ISR) (p = 0.02) and splenic flexure takedown (p < 0.0001) were independent risk factors. Conclusion:Anastomotic stenosis and late fistula formation frequently emerge as secondary consequences of early AL and represent significant complications linked to permanent stoma creation, often proving resistant to treatment. Intestinal prolapse is a characteristic anastomotic complication of ISR that can be caused by excessive intestinal mobilization.

Aim:The use of minimally invasive surgery, including laparoscopic and robotic surgery, for gastrointestinal cancer has been rapidly increasing. This study aimed to clarify whether differences in minimally invasive surgery outcomes are associated with regional and patient characteristics. Methods:A total of 123 771 right hemicolectomy and 126 965 low anterior resection cases performed between 2013 and 2019 were selected from the National Clinical Database for analysis. Patients were stratified by regional and economic variables, and open and minimally invasive surgical outcomes were evaluated. Results:In secondary medical regions characterized by urban settings and numerous designated cancer care hospitals, the observed 30-day mortality of low anterior resections was lower only in the minimally invasive surgery group. For right hemicolectomies in regions with many designated cancer care hospitals, the observed incidence of postoperative complications was also lower in the minimally invasive group. Residents of high-income areas undergoing low anterior resection had a lower frequency of 30-day reoperation regardless of the type of surgery and a lower 30-day mortality in the minimally invasive group. For both right hemicolectomy and low anterior resection, patients with longer travel distances had fewer postoperative complications and lower 30-day reoperation rates in the minimally invasive group than in the open surgery group. Conclusion:This study found regional and patient characteristic disparities in minimally invasive surgical outcomes; national policies should be implemented to address these inequities.

Colorectal cancer (CRC) is well characterized in terms of genetic mutations and the mechanisms by which they contribute to carcinogenesis. Mutations in APC, TP53, and KRAS are common in CRC, indicating key roles for these genes in tumor development and progression. However, for certain tumors with low frequencies of these mutations that are defined by tumor location and molecular phenotypes, a carcinogenic mechanism dependent on BRAF mutations has been proposed. We here analyzed targeted sequence data linked to clinical information for CRC, focusing on tumors with a high tumor mutation burden (TMB) in order to identify the characteristics of associated mutations, their relations to clinical features, and the mechanisms of carcinogenesis in tumors lacking the major driver oncogenes. Analysis of overall mutation frequencies confirmed that APC, TP53, and KRAS mutations were the most prevalent in our cohort. Compared with other tumors, TMB-high tumors were more frequent on the right side of the colon, had lower KRAS and higher BRAF mutation frequencies as well as a higher microsatellite instability (MSI) score, and showed a greater contribution of a mutational signature associated with MSI. Ranking of variant allele frequencies to identify genes that play a role early in carcinogenesis suggested that mutations in genes related to the DNA damage response (such as ATM and POLE) and to MSI (such as MSH2 and MSH6) may precede BRAF mutations associated with activation of the serrated pathway in TMB-high tumors. Our results thus indicate that TMB-high tumors suggest that mutations of genes related to mismatch repair and the DNA damage response may contribute to activation of the serrated pathway in CRC.

Background:Preserving anorectal function while achieving oncological success is crucial in the treatment of lower rectal cancer near the anal canal. Despite advancements in laparoscopic surgery that facilitate anal preservation, post-operative anorectal dysfunction considerably affects quality of life. Both hand-sewn and stapled anastomoses are suitable options for tumors located 4-5 cm from the anus. However, evidence comparing the functional outcomes and complications associated with both anastomosis methods is lacking. Methods:This multicenter, single-arm prospective study included patients with cT1-T2/N0/M0 adenocarcinoma located 4-5 cm from the anal verge, scheduled for upfront laparoscopic surgery. Anorectal function, post-operative complications, urinary and male sexual function, and oncological outcomes were assessed using the validated scores. Results:A total of 135 patients were analyzed and divided into hand-sewn (n = 65) and stapled (n = 70) groups. The patient characteristics were similar, except for the tumors in the hand-sewn group located 1 mm closer to the anal verge. No significant differences were observed in the post-operative complications. Anorectal function, measured using Wexner scores, worsened at 3 months postoperatively and gradually improved in both groups. At 3, 6, 12, 24, and 36 months, the stapled group consistently showed better Wexner scores than the hand-sewn group. Urinary function, sexual function, and oncological outcomes were similar in both groups. Conclusion:Stapled anastomosis may provide better anorectal function with comparable safety and oncological outcomes to hand-sewn anastomosis. Therefore, stapled anastomosis may be preferred for tumors located 4-5 cm from the anal verge to ensure oncological safety. Trial Registration:This study was registered in the UMIN Clinical Trials Registry System (UMIN 000011750).

Robotic surgery for rectal cancer has grown popular in recent years and has primarily used the da Vinci Surgical System (Intuitive Surgical, CA, USA; da Vinci). In 2020, Japan introduced the hinotori™ Surgical Robot System (Medicaroid, Kobe, Japan; hinotori). We report our initial surgical experiences with robotic surgery using hinotori for rectal cancer and its feasibility and safety comparing with da Vinci. A single-institution retrospective study was conducted. Between November 2022 and November 2023, 38 and 96 patients with rectal cancer underwent robotic surgery using hinotori and da Vinci, respectively. The primary endpoint was the incidence of postoperative complications of the Clavien–Dindo classification (CD) grade ≥ II within postoperative 30 days. Secondary endpoints included surgical and console time, blood loss, conversion to other approaches, number of dissected lymph nodes, and postoperative hospital stay. A propensity score matching (PSM) analysis was used to adjust for imbalance in baseline characteristics. After PSM, a total of 76 patients (hinotori: 38, da Vinci: 38) were included. Compared to the da Vinci group, the hinotori group showed a similar postoperative complication rate of CD ≥ II (15.8

Objective:. This study investigated whether digital polymerase chain reaction (dPCR)-based circulating tumor DNA (ctDNA) monitoring can allow longer intervals between computed tomography (CT) scans during postoperative surveillance of colorectal cancer (CRC). Background:. Practical guidelines still recommend intensive postoperative surveillance of CRC using periodical CT scans and serum carcinoembryonic antigen testing. Methods:. The longitudinal dynamics of ctDNA for 52 patients with CRC as measured by dPCR using probes targeting 87 individual tumor-specific mutations (1–5 per patient) were compared with results from conventional (ie, clinical) surveillance using serum tumor markers and CT. Results:. A total of 382 CT procedures were carried out for the patient cohort (3.3/year per patient) and the median lead time from ctDNA relapse to clinical relapse was 182 days (range, 0–376 days). If the CT interval was annual, potential delays in the detection of clinical relapse would have occurred for 7 of the 10 patients who experienced clinical relapse (9 of 13 events), with a median delay of 164 days (range, 0–267 days). If annual CT surveillance was performed together with ctDNA monitoring, 218 (57.1%) CTs would not have been needed to detect the first clinical relapse. In addition, the ctDNA monitoring would have provided a lead time of 339 days for detection of clinical relapse (range, 42–533 days). Conclusions:. Our findings suggest that the ctDNA monitoring as part of postoperative surveillance and clinical relapse detection for patients with CRC could allow the CT interval to be lengthened. Trial Registration:. This trial was registered with University Hospital Medical Information Network Clinical Trial Registry (UMIN000045114).

To develop an educational program that enables young surgeons to safely perform laparoscopic transabdominal preperitoneal repair (TAPP). This retrospective study comprised 365 patients who underwent elective TAPP performed by surgical residents (SRs; n = 145 patients) and board-certified surgeons (BCSs; n = 220 patients) from January 2018 to December 2023. An educational program for SRs has been underway since April 2021 to facilitate efficient learning and ensure the safe performance of TAPP. This program comprises four steps and highlights the two points mentioned, including understanding technical principles and acquiring fundamental skills. The surgical outcomes of laparoscopic TAPP performed by SRs and BCSs were compared retrospectively. A total of 43 operators (16 SRs and 27 BCSs) performed the laparoscopic TAPP. The SRs demonstrated longer operative times (median 126 vs. 98 min; p < 0.01). No significant differences in the rates of seroma (7.6

Pelvic arteriovenous malformation (AVM) is a rare vascular condition with diverse clinical manifestations. Treatment-related decision-making is difficult for concurrent AVMs and colon cancer. Interventional radiology is effective for colon cancer patients with pelvic AVM. Herein, a 77-year-old man presented with fatigue. Computed tomography revealed thickening of the sigmoid colon wall without lymph node swelling or distant metastasis, confirming irregularly dilated pelvic blood vessels. Preoperative transcatheter embolization of the AVM was initially performed. Then, laparoscopic sigmoidectomy was performed without complications following confirmation of AVM shrinkage via computed tomography. The patient was discharged without complications. Thus, preoperative pelvic AVM embolization in patients with sigmoid colon cancer may facilitate safe minimally invasive surgery.

AIM:Abdominoperineal resection with permanent colostomy has historically been performed for very low rectal cancer located near the anal canal. Anus-preserving surgeries, such as intersphincteric resection (ISR) and low anterior resection (LAR), have recently become more common. However, postoperative anal function is a concern in these surgeries when the anastomosis is very low. The aim of this study was to examine changes in anal function and factors that worsen anal function after surgery for rectal cancer. METHOD:A multicentre (47 facilities), non-randomized, single-arm phase II trial was conducted prospectively using the Wexner score questionnaire between 2014 and 2017. A total of 278 patients who underwent laparoscopic surgery for clinical Stage I very low rectal cancer were analysed using a mixed-effects model. RESULTS:Anal function temporarily worsened 3 months after surgery, but gradually recovered and spontaneously returned to an acceptable level in 3 years. In a comparison of surgical procedures, anal function was significantly better after LAR than after any type of ISR. There was little difference in anal function after total ISR, subtotal ISR and partial ISR. In the mixed-effects model analysis, ISR and older age (≥75 years) were identified as independent factors that worsened postoperative anal function. CONCLUSIONS:The results showed early deterioration of anal function followed by gradual improvement to an acceptable level after surgery. There is a higher risk of poor postoperative anal function after ISR and in older patients, and these risk factors should be communicated to patients when obtaining consent for the surgery.

AIM:Laparoscopic low anterior resection is widely used for treating rectal cancer; however, postoperative complications frequently result in a marked deterioration in the patients' quality of life (QOL). This study aimed to investigate the trajectory of QOL recovery and identify the risk factors affecting QOL in patients undergoing laparoscopic surgery for very low rectal cancer. METHOD:This prospective, multi-institutional, single-arm, phase-II trial examined the outcomes of laparoscopic surgery in patients with very low rectal cancer (<5 cm from the anus). The Short Form 36 Health Survey questionnaire was used to assess QOL preoperatively and at 3 and 6 months and 1, 2 and 3 years postoperatively. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for impaired QOL. RESULTS:Overall, 259 patients were analysed, of whom 63% underwent intersphincteric resection. The physical component summary (PCS) score declined postoperatively but gradually recovered, whereas the mental component summary score showed sustained improvement. The role component summary (RCS) score significantly declined at 3 months but improved over time. Multivariate analysis identified stage III cancer as a risk factor for prolonged PCS decline (p = 0.0084) and Wexner score ≥9 at 1 year after surgery as a predictor of lower RCS score (p = 0.0116). CONCLUSION:QOL after laparoscopic surgery for low-lying rectal cancer is generally acceptable. Patients with stage III cancer experience prolonged physical challenges, whereas those with bowel dysfunction struggle with role/social domains of QOL. Targeted interventions should be implemented to address these issues.