Intraoperative antegrade irrigation in complicated left-sided colonic cancer

Emergency one-stage surgery for acute, complicated, left-sided colonic cancer can be performed because of intraoperative antegrade irrigation of the large intestine. This procedure was performed in 17 patients: 15 patients with an obstructive, left-sided cancer and two patients with a perforated carcinoma. The age distribution ranged between 57 and 92 years. There were two postoperative septic complications: a small wound abscess and a partial abdominal wall dehiscence. One patient died because of massive upper gastrointestinal bleeding. This method permits the creation of a primary anastomosis in the left colon, obviating the necessity of a coeco- or colostomy, preternatural anus, or an extensive right-sided hemicolectomy. Several surgical interventions are avoided, resulting in a decrease of mortality, morbidity, duration of hospital stay, and costs. Moreover, intraoperative irrigation could be an attractive alternative for the usual preoperative mechanical bowel preparation, which is especially burdensome in elderly patients.     

肛门直肠支撑管在梗阻性左半结肠癌手术中的应用

目的 探讨肛门直肠支撑管在梗阻性结肠癌一期切除吻合术中的应用价值.方法 对32例左半结肠肿瘤合并急性梗阻患者实施一期根治性切除吻合术,放置肛门直肠支撑管持续减压及冲洗引流,术后平均住院时间12 d.结果 除1例术后第9天,出现吻合口瘘外,其余患者均顺利康复出院,无死亡病例,支撑管应用疗效确切满意.结论 肛门直肠支撑管应用于梗阻性结肠癌一期切除吻合术后,具有减压及引流的作用,确保吻合口顺利愈合,可以显著提高手术成功率,减少吻合口瘘的发生,避免了分流性结肠造瘘.     

结肠癌并发急性肠梗阻的外科治疗

目的 探讨结肠癌并发急性肠梗阻的外科治疗原则和Ⅰ期切除吻合的可能性。方法 分析1994－1998年收治的17例结肠癌并发急性肠梗阻的外科治疗情况,并收集同期国内正式发表的40篇有关此病的外科治疗报道,共计1889例,结合文献综合评价其外科治疗方法。结果 全组切口感染124例,占6．6％;肺部感染21例,占1．1％。1889例中,有1598例做切除吻合,发生吻合口瘘50例,占3．1％。手术死亡93例,占4．9％。术后5年生存率：Ⅰ期切除吻合者为26．0％＝48．0％,分期手术者为20．0％－38．0％。结论 结肠癌并发急性肠梗阻的处理需根据患者具体情况决定手术方式。Ⅰ期切除吻合有可能获得良好的效果,但必须注意手术技术,术中肠道灌洗、合理应用抗菌素和严格掌握适应证。     

结直肠癌并发急性肠梗阻手术方式的选择

目的探讨结直肠癌并发急性肠梗阻的外科治疗方法.方法分析1992年1月～2002年12月收治的108例结直肠癌并发急性肠梗阻的外科治疗情况.结果Ⅰ期切除吻合59例,切除肿瘤、双结肠造口6例,Hartmann手术20例,单纯结肠造口18例,肠捷径手术5例.全组切口感染8例(7.4%),肺部感染6例(5.5%),术后死亡2例(1.9%).无吻合口瘘发生.结论结直肠癌并发急性肠梗阻的手术方式应首选Ⅰ期切除吻合,对不宜Ⅰ期吻合者可采用双结肠造口或Hartmann手术以策安全.     

大肠癌并发急性肠梗阻的外科治疗

目的探讨大肠癌并发急性肠梗阻的外科治疗效果。方法选取2009年3月至2012年3月间收治的大肠癌并发急性肠梗阻病例76例,对其临床治疗资料进行回顾性分析。结果76例患者经外科治疗后,并发症的发生率为15．8％,围术期死亡率为2．6％,随访1年的生存率为92．1％,随访3年的生存率为64．5％。结论对大肠癌并发急性肠梗阻患者实施外科手术治疗时应遵循患者个体差异,给予有针对性的治疗手段,提高治愈率,减轻患者的痛苦。     

Intraoperative electron-beam radiotherapy and ureteral obstruction

PURPOSE: To quantify the risk of ureteral obstruction (UO) after intraoperative electron-beam radiotherapy (IOERT). METHODS AND MATERIALS: One hundred forty-six patients received IOERT of 7.5 to 30 Gy to 168 ureters; 132 patients received external radiotherapy. RESULTS: Follow-up ranged from 0.01 to 19.1 years (median, 2.1 years). The rates of clinically apparent type 1 UO (UO from any cause) after IOERT at 2, 5, and 10 years were 47%, 63%, and 79%, respectively. The rates of clinically apparent type 2 UO (UO occurring at least 1 month after IOERT, excluding UO caused by tumor or abscess and patients with stents) at 2, 5, and 10 years were 27%, 47%, and 70%, respectively. Multivariate analysis revealed that the presence of UO before IOERT (p < 0.001) was associated with an increased risk of clinically apparent type 1 UO. Increasing IOERT dose (p < 0.04) was associated with an increased risk of clinically apparent type 2 UO. UO rates in ureters not receiving IOERT at 2, 5, and 10 years were 19%, 19%, and 51%, respectively. CONCLUSIONS: Risk of UO after IOERT increases with dose. However, UO risk for ureters not receiving IOERT was also high, which suggests an underlying risk of ureteral injury from other causes.     

大肠癌急性梗阻的治疗

目的：探讨大吕急性梗阻的诊断。手术前处理及手术方式选择。方法：回顾１９９２年４月至１９９８年１１月２７例急性大肠癌梗阻进行总结分析。结果：Ⅰ期切除２１例占７７．８％（２１／２７），其中根治性切除１７例，死亡１例，其余２６例Ⅰ期恢复，无吻合口漏发生。结论：对急性大肠癌梗阻加强术前诊断和认识，完善术前术中处理，Ⅰ期切除术是安全可行的。     

Spread of tumor microenvironment contributes to colonic obstruction through subperitoneal fibroblast activation in colon cancer

We evaluated the influence of the cancer microenvironment formed by peritoneal invasion (CMPI) on clinical findings in colon cancer patients. In addition to the association with poor prognosis, we discovered a relationship with bowel obstruction. Detailed analysis revealed that clinical findings related to bowel obstruction occurred more frequently in patients with an elevated type tumor, which had peritoneal elastic laminal elevation to the tumor surface, compared to those with non‐elevated type tumors among those with elastic laminal invasion (ELI). Lateral tumor spread and increase of tumor annularity rate in ELI‐positive elevated type cases suggested the morphological progression from ELI‐positive non‐elevated type to elevated type. In addition, α‐smooth muscle actin expression was the highest in ELI‐positive elevated type, and prominent expressions were found not only in the deep tumor area but also in the shallow tumor area. Furthermore, contraction assays revealed the robust contractile ability of subperitoneal fibroblasts stimulated by cancer cell‐conditioned medium. Our findings suggest that CMPI spread into the luminal side of the colonic wall along with tumor progression, which caused bowel obstruction through the activation of subperitoneal fibroblasts. However, although the clinical outcome was not different between the two types, the clinical findings were affected by the spread of CMPI. We are the first to explore how the alteration of the tumor‐promoting microenvironment, along with tumor progression, contributes to the development of clinical findings.     

不同手术方法治疗老年结肠癌合并肠梗阻的疗效分析

目的探讨结肠癌合并肠梗阻老年患者不同时间内根据患者自身状况采用相应手术治疗的疗效。方法选取2012年10月至2015年10月间海南省昌江黎族自治县人民医院收治的68例患者,其中急诊手术患者26例,择期手术患者42例,行Ⅰ期肿瘤切除肠吻合术患者24例,行Ⅱ期肿瘤切除肠吻合术患者23例,行肠造瘘术患者21例。对比分析患者术后情况,和不同时间、不同手术方式并发症发生情况。结果 68例患者中,经手术治疗好转65例(95.6%),死亡3例(4.4%)。急诊手术后并发症发生率(30.8%)显著高于择期手术的并发症发生率4.8%),差异有统计学意义(P<0.05)。行Ⅰ期肿瘤切除肠吻合术的并发症发生率(33.3%)明显高于行Ⅱ期肿瘤切除肠吻合术(4.3%)和肠造瘘术(4.8%),组间差异有统计学意义(P<0.05)。结论针对结肠癌合并肠梗阻老年患者应根据患者的具体情况确定合理的手术时间及方式,做好并发症预防工作,提高治疗效果。     

Diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer: a case report

We reported a case of diaphragmatic hernia complicated with intestinal obstruction with colon perforation after surgery for esophageal cancer. In this case, the conservative treatment took too long, which delayed the diagnosis and treatment and resulted in colon perforation. After computed tomography confirmed the diagnosis, an emergency operation was performed. During the operation, we found colon perforation. Because pollution of thoracic cavity was serious, we performed proximal end colon neostomy. The patient recovered and discharged with active treatment 35 days after operation. We consider surgical repair of the diaphragmatic hernia is recommended to avoid the potentially disastrous complications, such as strangulation or perforation of the herniated contents, which can threaten the life of the patient if diagnosis is delayed.     

Bowel obstruction in patients with metastatic cancer

Background: Both surgical and nonsurgical options are available to treat bowel obstruction in patients with metastatic cancer. The goal is straightforward: to restore bowel patency and palliate the symptoms of obstruction. Yet the most appropriate management is often a challenging decision. Aim of the Study: We sought to review our experience in managing patients with metastatic cancer and bowel obstruction. Methods: A retrospective review was performed to identify all patients admitted at University of Wisconsin Hospital between 1993 and 2000 with the diagnoses of both bowel obstruction and metastatic cancer. Demographic data, type of management, postoperative complications, and outcome were analyzed. Results: A total of 114 patients with primarily colorectal or gynecologic malignancies were identified. Patients’ first bowel obstructions were managed in one of two ways: (1) definitive surgical intervention (n=47), or (2) conservative management (n=67). The median overall survival was 3 mo for the entire study group. There was no significant difference in overall or obstruction-free survival based on management, presence of recurrent bowel obstruction, or type of primary cancer. The only factor that was significant in predicting poor overall survival included a disease-free interval of less than 1 yr (time of diagnosis of primary cancer to time of bowel obstruction, p=0.002). Conclusions: Bowel obstruction in patients with metastatic cancer is a terminal event, with a 3-mo median survival. Because there is no difference in overall or obstruction-free survival based on management, the treatment for palliation of bowel obstruction in patients with metastatic cancer should be individualized.     

Intraoperative ultrasonography in liver cancer

IOUS has become increasingly important for surgical resection in patients with cirrhosis and healthy liver. IOUS is important in the diagnosis and staging of liver cancer and as an element of the surgical technique, and IOUS can now be considered a fundamental tool for hepatobiliary and other surgical procedures [3]. The American College of Surgeons has recently recognized the need for surgeons to have specific training in ultrasonography. Meanwhile, dedicated monographs on IOUS have been published in the United States, Chile, and Europe [39-42].     

Ureteral obstruction in patients with breast cancer

Six breast cancer patients were treated recently for renal insufficiency secondary to neoplasic involvement of the ureters. This complication usually occurs in long standing hormonal-dependent breast cancer with bone metastases. Diagnosis was performed by abdominal echography. Ureteral catheterization or percutaneous nephrostomy with or without irradiation always resulted in rapid recovery of renal function. Systemic chemotherapy could then be given, sometimes with antitumoral responses, allowing the removal of the endoureteral catheters.     

Intraoperative intraperitoneal chemotherapy with cisplatin in epithelial ovarian cancer

Objective

To assess retrospectively the feasibility of intraoperative intraperitoneal (IP) chemotherapy with cisplatin in epithelial ovarian cancer.

Methods

IP chemotherapy during optimal staging surgery was performed in 10 patients who were diagnosed with primary epithelial ovarian cancers between April 2008 and February 2011. Cisplatin (70 mg/m² in 1 L normal saline solution) was administered in the abdominal cavity for 24 hours postoperatively and then adjuvant chemotherapy was started 2-4 weeks after surgery. Perioperative toxicity of the combined treatment was evaluated until the initiation of postoperative adjuvant chemotherapy.

Results

A total of 23 adverse events were observed in 9 of 10 patients (grade 1, 7; grade 2, 13; grade 3, 3; grade 4, 0). In descending order of frequency, adverse events affected the gastrointestinal system (n=14), hematologic system (n=6), pulmonary system (n=2), and genito-urinary system (n=1). The adverse events did not affect adjuvant systemic chemotherapy schedules. One patient experienced disease recurrence in the liver 16 months after surgery. The remaining 9 patients have been well controlled by chemotherapy and/or observation during the follow-up period of 4 to 39 months after surgery.

Conclusion

Intraoperative IP chemotherapy with cisplatin during surgical procedures is considered feasible for the treatment of primary epithelial ovarian cancer. Further studies, including long-term, prospective and comparative trials, are needed to validate the efficacy of this combined therapy.     

Ovarian carcinoma complicated by gastric outlet obstruction

Two patients with gastric outlet obstruction secondary to ovarian carcinoma are presented. The importance of considering this complication in an obstructed patient with known ovarian carcinoma is emphasized. Treatment of this condition by gastroenterostomy can lead to significant palliation, as well as allow further treatment of the primary disease by other modalities such as chemotherapy.     

Intraoperative complications in lung cancer surgery

Lung cancer surgery is burdened by complications often related to the performed procedure. An accidental damage to thoracic structures may be caused by the surgeon's incorrect operative management. Elective thoracic surgery for lung cancer includes technically well-known operations. However, thoracic anatomy is characterized by a number of variants which a thoracic surgeon should know to be able to tackle serious situations. In this review the major variants and hazards which may be the cause of operative problems are presented. An approach to control hiatrogenic damages while performing lung resection for neoplastic lesions is suggested. It is stressed that surgical injuries, especially in thoracic surgery, should be prevented rather than repaired.     

Expandable metallic stent for the treatment of left-sided colonic obstruction with malignant disease

Recently, it was reported that an EMS (expandable metallic stent) was useful for treatment of colorectal obstruction. In our department, EMSs were used for seven patients with left-sided colonic obstruction with unresectable malignant disease. After these treatments with EMS, their symptoms were improved and they were able to intake food. Stomal formation was avoided except in one patient with severe soiling. In conclusion, EMS is thought to be useful for the improvement of quality of life in the patients with unresectable malignant colonic obstruction.     

Postoperative complications in colonic cancer patients

The immediate results of radical surgery in 367 cases of colonic cancer were analysed. The rate of postoperative complications was found to be in correlation with the surgical procedure and certain indexes of homeostasis. Complications developed in 50.4% of cases, pyo-inflammatory ones--in 162 cases. 71.2% of cases of postoperative peritonitis were due to failure of intestinal anastomosis.     

结肠癌伴肠梗阻的临床治疗

目的探讨结肠癌伴肠梗阻的外科处理方法及临床疗效。方法回顾性分析2005年1月至2013年5月间66例结肠癌伴肠梗阻的临床资料。结果 66例患者中,30例右半结肠癌伴梗阻患者采取Ⅰ期切除吻合术,24例左半结肠伴梗阻患者行Ⅰ期切除吻合术,10例患者行Ⅰ期切除近端造瘘,远端关闭术,2例患者行单纯横结肠造瘘。术后有62例患者康复出院,3例患者自动出院,1例患者转上级医院再次手术痊愈。结论手术治疗结肠癌继发急性肠梗阻临床疗效明显,Ⅰ期切除吻合手术治疗右半结肠癌伴梗阻是可行的,预后良好,值得临床推广。左半结肠癌伴梗阻则需要根据术中的情况采取个性化的治疗原则。