Metachronous adenocarcinoma occurring at a colostomy site after abdominoperineal resection for rectal carcinoma

Received: October 31, 2000 / Accepted: March 30, 2001     

Continent perineal colostomy after abdominoperineal resection

PURPOSE: For patients with distal rectal or anal tumors, quality of life can be compromised after abdominoperineal resection and iliac colostomy. This study examines our experience with a continent perineal colostomy constructed from a colonic smooth-muscle cuff wrap. METHODS: Between 1987 and 1996, 63 patients with distal rectal or anal tumors (0–5 cm from the anal verge) underwent abdominoperineal resection and construction of a colonic smooth-muscle cuff at the site of the perineal colostomy. Postoperatively, all patients required colonic irrigations daily or every two days. The complications, continence at 6 and 12 months, and degree of satisfaction were prospectively evaluated using a standard questionnaire. RESULTS: Early complications included partial perineal dehiscence in 14 (22.5 percent) patients, pelvic abscess in 2 (3 percent) patients, and colostomy necrosis in 1 (1.6 percent) patient. Late complications were colostomy stricture in 7 (11.8 percent) patients, perineal sinus tract in 4 (6.7 percent) patients, and mucosal prolapse in 12 (20 percent) patients. Satisfactory continence (complete continence to stool and incontinence to gas) at 6 and 12 months was achieved in 30 (55.6 percent) and 27 (59 percent) patients, respectively. Patient satisfaction was noted in 85 percent. CONCLUSION: Continent perineal colostomy can serve as an alternative to conventional iliac colostomy. Most patients were satisfied. The modest complication rate can be minimized with patient selection.     

Hand-assisted laparoscopic abdomino-perineal resection utilizing the planned end colostomy site

Background  

Aim of the study was to determine the feasibility and outcomes of utilizing the planned end colostomy site for placing the hand-assist device in performing hand-assisted laparoscopic abdominoperineal resections (HAL APR) in patients with low rectal cancer.     

Adenocarcinoma of a colostomy following abdominoperineal resection for squamous cell carcinoma of the anal canal: a case study

Malignant neoplasms presenting on a stoma, as well as the development of colorectal adenocarcinoma after previous treatment for squamous cell carcinoma (SCC) of the anal canal, are rare. The unique case is presented of an 81-year-old woman with parastomal bleeding and ulceration found to have a primary colorectal adenocarcinoma arising de novo on a colostomy, formed after salvage abdominoperineal resection (APR) 3 years earlier for recurrent anal SCC. This is the first reported case of a colonic adenocarcinoma on a colostomy formed after an APR for anal SCC. Although stomal neoplasia is rare, the appearance of a friable bleeding lesion on the stoma should be investigated to exclude metastatic cancer or a second primary malignancy.     

腹腔镜腹会阴联合切除术腹膜外结肠造口对比腹膜内造口治疗直肠癌的Meta分析

目的比较直肠癌行腹腔镜腹会阴联合切除术（LAPR）腹膜外结肠造口与腹膜内结肠造口的安全性与有效性,并确定直肠癌永久性结肠造口最为合适的造口方式。 方法检索Pubmed、Embase、The Cochrane Library、Web of Science、中国知网以及万方数据库等中英文数据库,收集2008年10月至2020年3月国内外公开发表的有关比较LAPR腹膜外造口与腹膜内造口治疗直肠癌的临床研究,由两位研究者按照纳入与排除标准筛选符合条件的文献,非随机对照研究采用Newcastle-Ottawa Scale（NOS）量表评价文献质量,评分>5分的研究纳入Meta分析,随机对照研究采用Jadad量表评估。提取文献基本信息及相关结局指标,数据采用RevMan5.3软件进行Meta分析。 结果最终纳入14篇文献,其中9篇临床对照研究,5篇随机对照研究,共计1 210例患者。其中腹膜外造口组594例,腹膜内造口组616例,Meta分析结果显示,与腹腔镜腹膜内造口相比,腹腔镜腹膜外造口组造口旁疝发生率（OR=0.14,95%CI：0.08~0.25;P<0.00001）,造口脱垂发生率（OR=0.15,95%CI：0.06~0.37;P<0.0001）,造口回缩发生率（OR=0.24,95%CI：0.09~0.63;P=0.004）均明显降低;术后住院时间缩短（MD=-0.82,95%CI：-0.97~-0.68;P<0.00001）,术后首次排气时间提前（MD=-0.71,95%CI：-0.88~-0.54;P<0.00001）,更容易获得排便感（OR=9.67,95%CI：4.40~21.23;P<0.00001）,但造口水肿发生率明显升高（OR=1.81,95%CI：1.13~2.92;P=0.01）,而两组造口狭窄发生率（OR=0.62,95%CI：0.25~1.50;P=0.29）、造口感染发生率（OR=0.57,95%CI：0.29~1.12;P=0.10）以及造口时间（MD=-0.94,95%CI：-5.69~3.81;P=0.70）的差异均无统计学意义。 结论LAPR腹膜外造口能明显降低造口相关并发症的发生率,加速患者康复,更容易获得排便感,具有一定的安全性和有效性,建议直肠癌LAPR永久性结肠造口首选腹膜外造口方式。     

Meshless repair of perineal hernia after abdominoperineal resection: case report

Perineal hernia is a rare complication after major pelvic surgery. Placing non–biodegradable mesh across the pelvic inlet is the best method of repair. A 72–year–old man presented with a perineal hernia 8 years after undergoing an abdominoperineal resection because of rectal cancer. During the repair operation, intestinal spillage occurred, making it impossible to place permanent mesh as planned. Instead, we used the bladder to cover the pelvic inlet. The patient recovered well and after 35 months of follow–up, there was no evidence of hernia recurrence. When mesh placement is not feasible, this bladder mobilization technique can replace it.     

Single-port versus multiport laparoscopic ileocecal resection for Crohn's disease

Background and AimsSeveral case series have demonstrated the feasibility of single-port laparoscopic ileocecal resection in Crohn's disease. However, only a few studies compared the single-port with a multiport laparoscopic ileocecal approach. The aim of this study was to compare short term surgical outcome parameters between single-port and multiport laparoscopic ileocecal resections for Crohn's disease.MethodsTwenty-one patients who underwent single-port laparoscopic ileocecal resection between March 2010 and September 2012 were prospectively registered. A matched comparison on a 1:2 basis was performed with patients who underwent multiport laparoscopic ileocecal resection from January 1999 to March 2010. Matching parameters were BMI, length of diseased bowel resected and the presence of fistulas. Endpoints were the length of postoperative hospital stay, operative time, conversions, complications, postoperative pain scores and postoperative analgesia consumption.ResultsTwenty-one patients undergoing single-port resection were matched to 42 patients undergoing multiport resection. The postoperative stay (4 days, iqr 4–5 vs. 5 days, iqr 4–6; p = 0.033), operative time (103 min, iqr 94.0–121.0 vs. 123.5 min, iqr 100.0–157.0; p = 0.036) and morphine use on the first postoperative day (12.5 mg, iqr 5.0–33.3 vs. 28 mg, 15.0–50.0; p = 0.012) differed significantly. Postoperative pain scores and complications were similar in both groups. This study was limited by potential selection bias.ConclusionsSingle-port laparoscopic ileocecal resection is safe and feasible in Crohn's disease and is associated with less need for pain medication postoperatively as opposed to multiport laparoscopic ileocecal resection.     

Basal-cell carcinoma originating at the colostomy site: Report of a case

An unusual case of basal-cell carcinoma originating at the site of a long-standing colostomy is presentedmirritation and frequent ulceration around the colostomy site as a result of bad hygiene and reluctance to use colostomy appliance by the patient may have caused this tumor. A long-term cure for more than 37 years was obtained following radiation therapy for carcinoma of the rectum. Radiation therapy should be attempted for palliation or possible cure, despite adverse indications, whenever surgical excision of the carcinoma of the rectum is not possible.     

Telerobotic-assisted laparoscopic abdominoperineal resection for low rectal cancer： Report of the first case in Hong Kong and China with an updated literature review

Telerobotic surgery is the most advanced development in the field of minimally invasive surgery. The da Vinci surgical system, which is currently the most widely used telerobotic device, was approved by the Food and Drug Administration of the United States of America for clinical use in all abdominal operations in July 2000. The first da Vinci surgical system in China was installed in November 2005 at our institution. We herein report the first telerobotic-assisted laparoscopic abdominoperineal resection using the 3-arm da Vinci surgical system for low rectal cancer in Hong Kong and China, which was performed in August 2006. The operative time and blood loss were 240 min and 200 mL, respectively. There was no complication, and the patient was discharged on postoperative day five. An updated review of published literature on telerobotic-assisted colorectal surgery is included in this report, with special emphasis on its advantages and limitations.     

Submucosal mucous cysts at a colostomy site: Relationship to colitis cystica profunda and report of a case

Summary A unique case of submucosal mucuscontaining cysts of the colon occurring at a colostomy site is described. The cysts appear to have been the result of surgery eight years previously, and were due to either implantation of colonic mucosa into the submucosa or entrapment of mucosa following healing of postsurgical ulceration. Because these cysts are identical to the lesions seen in colitis cystica profunda, this case provides additional support for the hypothesis that colitis cystica profunda is an acquired disease, and illustrates that it may occur as a rare complication of colonic surgery.     

Simple technique for pelvic drain placement in laparoscopic abdominoperineal resection

The placement of a pelvic drain after abdominoperineal resection of the rectum is a routine practice. We present a simple technique for laparoscopic placement of such a drain through the abdominal wall following laparoscopic abdominoperineal resection.