Laparoscopic subtotal proctocolectomy for synchronous triple colorectal cancers: a case report

A 42‐year‐old woman presented with abdominal pain. On the basis of CT results, we diagnosed her condition as bowel obstruction caused by advanced transverse colon cancer. Colonoscopy findings showed three lesions: (i) an advanced tumor in the transverse colon; (ii) a laterally spreading descending colon tumor; and (iii) a rectal polyp. The tumors and the polyp were all pathologically diagnosed as adenocarcinoma. After inserting a self‐expanding metallic stent into the main tumor of the transverse colon to decompress the bowel, we performed endoscopic submucosal dissection of the laterally spreading descending colon tumor. Pathological examination results showed submucosal invasion and a positive margin. Because we endoscopically identified that the rectal polyp was invading the submucosa, we performed laparoscopic subtotal proctocolectomy and ileorectal anastomosis with lymph node dissection along the surgical trunk; we also performed central vascular ligation of the ileocolic artery, right and left branches of the middle colic artery, and inferior mesenteric artery. The patient's postoperative course was uneventful. We present this case because there have been few reports on laparoscopic subtotal or total proctocolectomy for synchronous multiple colorectal cancers.     

Laparoscopic right hemicolectomy for a colon cancer patient with an ileal conduit

Here, we describe our experience of laparoscopic surgery in a colon cancer patient with an ileal conduit. To our knowledge, this is the second case presented in the English‐language literature. A 71‐year‐old woman with a history of both open anterior exenteration with ileal conduit reconstruction for bladder cancer and open cholecystectomy for cholecystitis was diagnosed with ascending colon cancer (cT3N1M0). Laparoscopic right hemicolectomy with conduit preservation was planned. After adhesiolysis, complete mesocolic excision and central vascular ligation were achieved laparoscopically without injury to the conduit or other structures. Laparoscopic surgery for patients with an ileal conduit can be technically demanding. A preoperative plan based on preoperative imaging and the patient’s previous operative record is crucial, especially when considering the optimal balance between oncological radicality and functional outcomes.     

Laparoscopic total pelvic exenteration with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy for advanced primary rectal cancer

Total pelvic exenteration (TPE) may be the only procedure that can cure T4 rectal cancer that directly invades the urinary bladder or prostate. Here, we describe our experience of laparoscopic TPE with en bloc lateral lymph node dissection for advanced primary rectal cancer. A 62‐year‐old man diagnosed with advanced lower rectal cancer (T4bN0M0) underwent laparoscopic TPE with en bloc lateral lymph node dissection after neoadjuvant chemoradiotherapy. Ligation of the dorsal vein complex was performed under direct visualization through the perineal approach, and the large perineal defect was reconstructed using bilateral V‐Y advancement of the gluteus maximus musculocutaneous flaps. The ileal conduit was constructed extracorporeally through an extended umbilical port that was extended to 4 cm. The total operative time was 831 min and estimated blood loss was 600 mL. Laparoscopic TPE appears to be safe and feasible in selected patients.     

Laparoscopic abdominoperineal resection with lateral lymph node dissection for advanced rectal and prostate cancer with synchronous lateral lymph node metastases

Here we report a case of advanced rectal and prostate cancer with synchronous lateral lymph node (LLN) metastases that was treated with laparoscopic surgery. A 71‐year‐old man presented with fecal occult blood and was diagnosed with rectal cancer. A metastatic right LLN was suspected after CT examination of a 19‐mm lymph node (proximal internal iliac artery region) and a 13‐mm lymph node (distal internal iliac artery region) in the right lateral region. We planned neoadjuvant chemotherapy to suppress local and distant recurrence. This treatment decreased the size of the primary rectal tumor. We performed laparoscopic abdominoperineal resection and right LLN dissection. The histopathological diagnosis was LLN metastases from the rectal and prostate cancers. It is rare for synchronous metastases from rectal and prostate cancers to be observed in the LLN. It may be difficult to determine an appropriate treatment strategy in cases like this.     

Laparoscopic surgery for sigmoid colon cancer with complicated communication between the superior and inferior mesenteric arteries

To perform complete mesocolic excision with central vessel ligation, it is important to recognize the vessel anomaly and the location of the tumor. For left-sided colon cancer, the variations in the course of the left colic artery and accessary middle colic artery must be recognized preoperatively. Here, we describe our experience with a 57-year-old man who was diagnosed with sigmoid colon cancer with complicated inter-mesenteric connections between the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA), possibly due to median arcuate ligament syndrome. We performed laparoscopic sigmoidectomy with low ligation of the IMA to preserve the extremely enlarged left colic artery. The total operative time was 155 minutes, and the estimated total blood loss was 10 mL. The patient was discharged on postoperative day 9 without any postoperative complications. For patients with vascular anomalies in the left-sided mesocolon, preoperatively ruling out SMA stenosis by using angiography and 3-D CT might be important.     

Robot-assisted low anterior resection for a rectal cancer patient with ileal conduit: A case report

Surgery for rectal cancer patients with an ileal conduit after total cystectomy is difficult because adhesions in the pelvis and around the ileal conduit are expected. In the present case, we performed robot-assisted low anterior resection of the rectum in a 69-year-old male patient with rectal cancer who underwent ileal conduit diversion after total cystectomy. In this procedure, the port was inserted into the left upper abdomen as a first step, and two additional ports were added on the left side. Low anterior resection was performed using two left hands to create more space in the abdominal cavity for the ileal conduit. We present this minimally invasive robotic procedure that is extremely useful for dissection of adhesions in a narrow pelvic cavity.     

Small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit: A case report

A 74‐year‐old man presented at our hospital with complaints of abdominal pain, nausea, and vomiting. He had undergone laparoscopic radical cystectomy and ileal conduit for urinary bladder cancer 1 month earlier. The patient had abdominal distention, resonant sounds on percussion, and diffuse abdominal tenderness without rebound or guarding. Abdominal CT revealed dilated jejunal loops herniated through a cord‐like structure. Based on these findings, emergency surgery was performed, and intestinal dilatation into the space between the ureter, the ileal conduit, and the sacral bone was detected. The loops were released manually and were not resected. To the best of our knowledge, this is the first case report of small bowel obstruction due to internal hernia caused by the ureter after laparoscopic radical cystectomy and ileal conduit. Retroperitonealization and the minimum required mobilization of the ureters may be necessary when urinary diversion is constructed, especially in laparoscopic or robotic surgeries.     

Colonic ischemia developed after laparoscopic colectomy for rectosigmoid cancer with focal infrarenal aortic stenosis

A 69‐year‐old woman with focal infrarenal aortic stenosis was diagnosed with rectosigmoid cancer. Because radical resection for colon cancer required dissection of vessels that supplied blood flow to the legs, revascularization by aortic stent placement was performed before the colectomy. We subsequently performed laparoscopic low anterior resection without any complications. Two and a half years after colectomy, however, the patient developed colonic ischemia due to thrombosis of the dilated marginal artery that served as a collateral artery before stenting. We performed laparoscopic partial colectomy, including the resection of the dilated marginal artery filled with thrombus. An abnormally dilated ex‐collateral artery was thought to have caused vessel occlusion, presumably due to an imbalance in blood flow and vascular diameter.     

Case of laparoscopic right hemicolectomy for ascending colon cancer after aortic graft replacement and revascularization of the superior mesenteric artery

A 67‐year‐old man who presented with a bloody stool was diagnosed with ascending colon cancer. He had previously experienced thoracic and abdominal aortic dissections, which were treated with thoracic and abdominal aortic grafts and superior mesenteric artery revascularization. We performed a laparoscopic right hemicolectomy with a D3 lymph node dissection. During the laparotomy, we identified the superior mesenteric artery and an enlarged anterior superior pancreaticoduodenal artery. Injury to the latter artery could lead to severe ischemia in multiple organs; therefore, it was crucial to identify the primary feeding artery and vascular anatomy before and during surgery. We chose the laparoscopic right hemicolectomy to avoid injuring the anterior superior pancreaticoduodenal artery and the intra‐abdominal abscess. This case study was the first to describe a laparoscopic hemicolectomy after thoracic and abdominal aortic grafts and superior mesenteric artery revascularization.     

腹腔镜下膀胱全切Bricker回肠膀胱术与Studer原位膀胱术的比较研究

目的比较腹腔镜下膀胱全切Bricker回肠膀胱术和Studer原位膀胱术的手术、肿瘤学等指标,探讨腹腔镜膀胱全切尿流改道术的最佳术式。方法腹腔镜下膀胱全切Bricker回肠膀胱术15例和Studer原位膀胱术12例,其中男性分别为14和10例,女性分别为1和2例,平均年龄分别为（64．47±11．31）和（69．33±10．46）岁,肿瘤平均直径分别为（4．79±1．82）和（2．63±1．00）cm。结果全部手术均顺利完成,无一例中转开腹。Bricker回肠膀胱术和Studer原位膀胱术的手术时间分别为（422．00±131．97）和（370．00±104．19）min,术中出血量分别为（623．33±377．43）和（575.00 ±491．52）ml,术中输血量分别为（314．26±357．03）和（320．00±413．12）ml,患者住院天数分别为（19．40±4．48）和（23．92±11．25）d。随访3～48个月,所有患者均无复发。Bricker回肠膀胱术组1例患者术后13个月因心脑血管意外死亡。Studer原位膀胱术组1例患者术后出现输尿管套叠,输尿管镜下将其顺利还纳。Studer原位膀胱术后3个月时,患者白天控尿率和夜间控尿率分别为83．33％和75．00％;术后6个月时,患者白天控尿率和夜间控尿率均为100％。术后病理类型,Bricker回肠膀胱术组低分级乳头状尿路上皮癌10例,高分级乳头状尿路上皮癌4例和腺癌1例;Studer原位膀胱术组低分级乳头状尿路上皮癌2例,高分级乳头状尿路上皮癌6例和腺癌4例。术后病理分期,Bricker回肠膀胱术组pT2aN0M05例,pT2bN0M09例,pT2bN00例,pT3aN0M01例;Studer原位膀胱术组pT2aN0M02例,pT2bN0M07例,pT2bN2M01例,pT3aN0M02例。结论腹腔镜膀胱全切Studer原位膀胱术与Bricker回肠膀胱术具有相似的手术和肿瘤学等方面的结果,但Studer原位膀胱术患者术后生活质量较高,是一种效果良好的膀胱全切尿流改道术式。     

Using indocyanine green fluorescent imaging to successfully resect metachronous regional lymph node recurrence of rectosigmoid cancer

A 39‐year‐old female patient underwent anterior resection with locoregional lymph node dissection for rectosigmoid cancer at another hospital. The procedure involved transection of the superior rectal artery just below the origin of the left colic artery. Postoperative diagnosis was stage III B. The patient received adjuvant chemotherapy with oxaliplatin plus capecitabine for 6 months. Sixteen months after the operation, PET‐CT scans revealed regional lymph node metastases around the root of the inferior mesenteric artery. The patient was referred to our hospital with a recurrence of rectosigmoid cancer. We performed laparoscopic lymph node dissection with real‐time indocyanine green fluorescent images superimposed on color images to prevent intraoperative vascular insufficiency. We were able to successfully observe the sufficient blood flow in the descending colon. Postoperative pathological findings showed lymph node recurrence after initial surgery. She was discharged 7 days after the operation. In the 8 months since the second operation, the patient has not had any indication of further recurrence.     

Conversion during laparoscopic anterior resection for rectal cancer with a congenital solitary pelvic kidney: A case report

A 54‐year‐old female patient was hospitalized with a chief complaint of anal discomfort. Based on biopsy results, she was diagnosed with highly differentiated adenocarcinoma, and colonoscopy findings indicated a type 3 rectal tumor. We observed a right pelvic kidney on enhanced abdominal CT. We began a laparoscopic operation but converted to an open operation after resecting the right pelvic renal artery by mistake. After low anterior resection, urologists performed angioplasty of the right renal pelvic artery. The patient was discharged on postoperative day 16, after the preservation of right renal function had been confirmed. This case strongly suggests that it is important to understand the positional relationship of the inferior mesenteric and renal arteries by preoperative assessment using either 3‐D CT angiography or magnetic resonance angiography.     

A case of ileocolic intussusception from renal cell carcinoma

We report a case of ileal metastasis of renal cell carcinoma (RCC) in a 58-year-old male. The patient had a history of radical nephrectomy for a right RCC, and 2 years later underwent bilateral partial pneumonectomy for metastatic disease of the lung. A period of 1 year after the partial pneumonectomy, he developed bloody stools. Colonoscopy revealed an ileocolic intussusception caused by a polypoid tumor in the ileum, and the tumor was observed to be protruding into the ascending colon. The histological features of the tumor biopsy specimen confirmed the diagnosis of metastatic RCC. Metastasis of RCC in the small bowel is a rare disease clinically. To our knowledge, this is the first reported case with ileal metastasis of RCC, which has been definitively diagnosed by colonoscopy.     

Minimally invasive surgery for esophageal cancer after esophageal perforation

Both esophageal rupture and esophageal cancer are life‐threatening diseases. We report a case of esophageal cancer that occurred after esophageal rupture was treated with thoracoscopic and laparoscopic surgery. A 76‐year‐old man presented with vomiting followed by epigastric pain and was diagnosed with spontaneous esophageal rupture. Laparoscopic and thoracoscopic surgery were performed. Primary closure was completed with a fundic patch, and thoracic lavage was performed. Ten months later, his condition was diagnosed as squamous cell carcinoma of the abdominal esophagus. He underwent thoracoscopic esophageal resection in the prone position, and a gastric conduit was created laparoscopically. The pathological finding was superficial esophageal carcinoma without lymph node metastasis. The patient's postoperative course was uneventful, and there was no recurrence at 21 months of follow‐up.     

Laparoscopic colectomy after self‐expanding metallic stent placement through the ileocecal valve for right‐sided malignant colonic obstruction: A case report

A 78‐year‐old man with a history of open sigmoidectomy for sigmoid cancer presented with abdominal pain and vomiting. Abdominal multi‐detector CT revealed an obstructive ileocecal tumor with distended small bowel on the oral side. We performed emergency drainage using a transnasal decompression tube, and 2 days later, we conducted a colonoscopic examination, which lead to a provisional diagnosis of obstruction with a malignant tumor invading the ileocecal valve. We then placed a self‐expanding metallic stent (SEMS) through the ileocecal valve. We confirmed patency of the ileocecal valve and removed the transnasal decompression tube 2 days after SEMS placement. We then performed elective laparoscopic colectomy 8 days after SEMS placement. To the best of our knowledge, there has been only one previous report of laparoscopic colectomy after decompression with SEMS placement through the ileocecal valve for right‐sided malignant colonic obstruction.     

Middle mesenteric artery visualized by computed tomographic angiography

The middle mesenteric artery, a third mesenteric artery arising from the aorta that principally feeds the transverse colon, is an extremely rare anomaly. We identified a middle mesenteric artery branching into the ileocolic artery and into the right, middle, and accessory middle colic arteries. It supplied the cecum and the entire ascending and transverse colon. This anomaly was detected with computed tomographic angiography.     

腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗浸润性膀胱癌

目的探讨腹腔镜根治性膀胱全切+原位回肠新膀胱术的手术方法和经验。方法回顾分析2011年3月-2014年10月该院14例浸润性膀胱癌患者的临床资料。结果 13例成功施行了腹腔镜根治性膀胱全切+原位回肠新膀胱术,1例因术中膀胱内肿瘤出血增加术野无法显露而中转开放手术。12例在直视下行新膀胱尿道间断吻合,2例在腹腔镜下采用单针连续缝合法行新膀胱尿道吻合。手术平均时间444 min,术中平均出血量490 ml。术后病理提示12例为膀胱尿路上皮癌,其中1例伴部分鳞状细胞癌,2例为膀胱腺癌。2例患者术后出现尿漏,经保守治疗后治愈,1例术后出现尿失禁。术后随访6~56个月,3例死于肿瘤远处转移,1例目前发生肿瘤颅内转移。其余10例目前仍无瘤生存,其中1例术后1年出现尿道内口狭窄,经行尿道狭窄内切开术后治愈。10例患者目前控尿功能恢复良好,新膀胱容量约300 ml。结论腹腔镜根治性膀胱全切+原位回肠新膀胱术治疗膀胱癌疗效确切、安全、创伤小及术后恢复快,可作为临床浸润性膀胱癌的首选治疗方法。     

Intra‐abdominal desmoid tumor after laparoscopic low anterior resection for rectal cancer: A case report

Desmoid tumors are monoclonal fibroblastic proliferations arising from soft tissue classified as intra‐abdominal, extra‐abdominal and abdominal wall types. We present a patient with an intra‐abdominal desmoid tumor diagnosed 20 months after laparoscopic resection of rectal cancer. A 70‐year‐old woman with hematochezia was diagnosed with advanced rectal cancer. Preoperative chemoradiotherapy followed by laparoscopic low anterior resection was performed. During follow‐up, a nodular soft‐tissue density measuring 28 mm was detected in the presacral region. Metastasis from rectal cancer was diagnosed and four courses of chemotherapy were given, including capecitabine, oxaliplatin and bevacizumab. Computed tomography scan showed that the mass slightly decreased in size and surgical resection was performed. Histopathological examination revealed a proliferation of spindle‐shaped cells and collagenous stroma diagnosed as a desmoid tumor. This report highlights the possibility of a desmoid tumor in the differential diagnosis of an intra‐abdominal mass found during follow‐up after resection of colorectal cancer including following laparoscopic resection.     

Two‐stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report

A 75‐year‐old man tested positive for occult blood in the stool. A subsequent examination indicated concurrent locally advanced cancer (cT3) at the hepatic flexure and lower rectum cancer in the external anal sphincter. Because of the locally advanced rectal cancer (cT4), preoperative chemoradiotherapy was administered. First, laparoscopic right hemicolectomy and colostomy were performed at the sigmoid colon. Chemoradiotherapy for rectal cancer was initiated on day 18 after the surgeries. Seven weeks after chemoradiotherapy had been completed, laparoscopic abdominoperineal resection and right lateral pelvic lymph node dissection were performed. This case demonstrated that a second radical surgery for rectal cancer could be performed safely and laparoscopically after laparoscopic colectomy and colostomy.     

Laparoscopic anterior pelvic exenteration for locoregionally advanced rectal cancer directly invading the urinary bladder: A case report of low anterior resection with en bloc cystectomy for sphincter preservation

Laparoscopic multi‐visceral resection in patients with T4 colorectal cancer remains controversial. A 73‐year‐old man was admitted to the hospital for rectosigmoid cancer directly invading the urinary bladder trigone without distant metastasis. We successfully performed complete resection by laparoscopic anterior pelvic exenteration while preserving the anus. After laparoscopic mobilization of the rectum, urinary bladder, and prostate, the urethra and urethral catheter were dissected to reveal the lower rectum. By pulling the urethral catheter toward the head, the prostate was excised retrogradely from the lower rectum anterior wall. The lower rectum was resected and anastomosed by the double stapling technique with a safe distal margin from the tumor. Pathological findings of the resected specimen indicated no residual tumor in the surgical margin. There was no evidence of recurrence 34 months after surgery. En bloc, R0, laparoscopic anterior pelvic exenteration for T4 rectal cancer is feasible. However, further studies with long‐term follow‐up are required to resolve oncological outcomes.