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1.
This study compared laparoscopic with open surgery for the cure of cancer of the rectosigmoid and rectum. Results of surgery,
postoperative recovery, and oncological follow-up were compared between 32 laparoscopic curative procedures (19 laparoscopic-assisted
anterior resections for cancer of the rectosigmoid or upper rectum and 13 laparoscopic abdominoperineal resections for low
rectal cancer) and 32 controls matched for age, UICC stage, tumor site, and type of resection who underwent open surgery during
the same observation period. Morbidity was identical after laparoscopic and open resection (31.3%). Surgery was equally radical
in the two groups regarding yield of lymph nodes and lateral and distal margins. Survival, recurrence, and cancer-related
mortality showed no statistical differences. There was no port-site recurrence. The benefits of laparoscopic surgery were
shown with a reduction in perioperative blood transfusion and earlier return of bowel function. However, the operative time
was significantly increased in the laparoscopic group. This study shows that laparoscopic surgery for the cure of colorectal
cancer is technically feasible, and that oncological short-term outcome does not differ from the results achieved by open
techniques. However, prospective randomized trials are mandatory to evaluate the definite role of laparoscopic surgery for
malignancy.
Accepted: 26 April 1999 相似文献
2.
Rationale:As the world''s population ages, the number of surgical cases of colovesical fistulas secondary to colon diverticulitis is also expected to increase. The key issue while performing laparoscopic surgery for these fistulas is the avoidance of iatrogenic ureteral injury. There are no reports of Near-infrared Ray Catheter being used in surgery for diverticulitis, which is one of the diseases with the highest risk of ureteral injury. We present a case of a male patient with colovesical fistulas secondary to sigmoid colon diverticulitis who underwent laparoscopic surgery with visualization of the ureter using a new surgical technique in laparoscopic surgery. Patient''s concern:An 82-year-old man presented to our urological department with general fatigue and air and fecal matter in the urine. Diagnoses:Cystography showed delineation of the sigmoid colon. Abdominal computed tomography findings revealed multiple sigmoid colon diverticula with thickened walls as well as large stones and a small amount of air in the bladder. He was diagnosed with a urinary tract infection with colovesical fistulas and bladder stones due to sigmoid diverticulitis. Interventions:After the creation of a transverse colostomy, we scheduled a laparoscopic anterior resection and cystolith removal. Outcomes:Severe inflammatory adhesions around the sigmoid colon and a high risk of ureteral injury were expected preoperatively. After induction of anesthesia, we inserted a Near-infrared Ray Catheter, a fluorescent ureteral catheter, which allowed us to easily identify and visualize the ureter in real-time. This allowed bowel dissection without concerns of ureteral injury. The operative time for the gastrointestinal part of the procedure was 150 minutes, and the patient was in a good general condition after the operation and was discharged on postoperative day 7. Lessons:The course of the ureter was easily and quickly identified by the green fluorescence from the ureteral catheter during laparoscopic surgery for fistulas associated with diverticulitis, where severe inflammation and dense fibrosis were present. Our technique is an easy and feasible approach that provides real-time urethral navigation during surgery for colovesical fistulas secondary to colon diverticulitis. 相似文献
3.
OBJECTIVES: To evaluate utilization of surgery, chemotherapy, and radiation therapy among patients with stage II or III colon cancer and stage II/III rectal or rectosigmoid cancer, as recommended by current national guidelines. METHODS: This cross-sectional study at the Michael E. DeBakey Veterans Affairs Medical Center (Houston, TX) used 1999-2003 administrative data to identify patients with a diagnostic code for colorectal cancer. Medical charts were then abstracted to identify an incident cohort with stage II or III cancer. Outcome of interest was receipt of recommended therapy defined as surgery only (stage II colon) or surgery with adjuvant chemo- or radiotherapy (stage III colon or stage II/III rectal/rectosigmoid cancer). Potential determinants of receipt of recommended therapy were analyzed using logistic regression. RESULTS: Among 197 incident cases diagnosed or treated, mean age of patients was 66 yr (SD, 11 yr), 64% were Caucasian, and 98.5% were men. A gastroenterologist diagnosed 72.5% tumors including 62 stage II colon, 62 stage III colon, and 73 stage II/III rectal cancers. Referral to oncology occurred in 76% of stage II colon, 92% of stage III colon, and 99% of rectal cancers. 87% of stage II and 71% of stage III colon cancer patients received recommended therapy, compared to only 42.5% of rectal cancer patients. Predictors of receipt of recommended therapy among rectal cancers included being married (OR, 5.3; 95% CI: 1.6-17.1), presentation at tumor board (OR, 3.6; 95% CI: 1.2-11.2), or age<65 yr (OR, 3.5; 95% CI: 1.3-9.3). When patient's comorbidity and physician's decision-making process were considered in the assessment of the outcome, only presentation at tumor board remained predictive of receipt of recommended therapy. CONCLUSIONS: Most colon cancer patients at a major VA medical center receive recommended therapy. Among rectal cancer patients, those presented at tumor board are most likely to receive recommended therapy. 相似文献
4.
Rationale:Few cases have been reported of the coexistence of tuberculosis and adenocarcinoma of the large bowel. We report a rare case of concurrent ascending colon adenocarcinoma and ileocecal tuberculosis, which were nearly indistinguishable from one another. Patient concerns:A 59-year-old man visited our clinic with dizziness and anorexia. Diagnosis:Computed tomography revealed a mass in the ascending colon with ill-defined nodules in the liver. A colon biopsy showed adenocarcinoma with multinucleated giant cells. The liver nodules were confirmed to be metastatic adenocarcinomas. Interventions:Ant tuberculosis medications were administered prior to surgery. Two weeks later, a laparoscopic right hemicolectomy and radiofrequency ablation of the liver were performed. Outcomes:The final pathology confirmed adenocarcinoma with chronic granulomatous inflammation and giant cells. Lessons:In this patient, the cancer was in an advanced stage and had no history of tuberculosis infection. Thus, in this case, the malignancy seemed to create the proper environment for either reactivation of a latent tuberculosis infection or, less likely, for the acquisition of a primary mycobacterial infection. In conclusion, clinicians should be aware of the possibility of concurrent colon adenocarcinoma and intestinal tuberculosis. 相似文献
5.
PURPOSE: Telerobotic surgery is a developing and promising modality that highly improves the laparoscopic dexterity. We have performed more than 100 laparoscopic and thoracoscopic procedures since December 2002 with the aid of the Da Vinci robotic system. This study was designed to assess the value of robots in colonic laparoscopic surgery. We present our first cases of robotic-assisted colectomies. METHODS: Two patients underwent a telerobotic-assisted sigmoidectomy for sigmadiverticulitis. One of these cases was complicated with a sigmoid-bladder fistula. Three other patients were submitted to a colon resection for cancer: sigmoidectomy (n = 2), and right colectomy (n = 1). A four-trocar technique was used for all operations. Tissue dissection of colonic adhesions, mobilization of the colon, management of the fistula, mesenteric dissection and division, and bowel resection were fully performed with the telerobotic system. RESULTS: Three operations were completed using the Da Vinci system without any problems in acceptable times. In two patients, the operation had to be converted to laparotomy because of severe adhesions and locally extended tumor growth. Postoperative courses of all patients were uneventful. Patients were discharged between postoperative Days 9 and 20, and were well six months later. CONCLUSIONS: Colonic telerobotic surgery can be performed safely. Benefits were seen during dissection of the rectum in the small pelvis. A major limitation is a lack of a large operation field especially if there is the need to dissect a colonic flexure in the upper abdomen. The enormous costs and the lack of appropriate instruments can be a major problem in the further expansion of the telerobotic surgery. 相似文献
6.
BackgroundPrevious studies investigating the impact of tumor location on colorectal cancer prognosis only compared two groups by location, e.g., ‘right-sided colon vs. left-sided colon,’ ‘colon vs. rectum,’ and ‘right-sided (right-sided colon) vs. left-sided (left-sided colon and rectum).’ This nationwide multicenter retrospective study aimed to clarify the prognostic impact of tumor location in patients with stage III colorectal cancer by classifying tumors into three groups: right-sided colon, left-sided colon, and rectum. MethodsSubjects were 9194 patients with stage III colorectal cancer who underwent curative surgery from 1997 to 2012. Relapse-free survival (RFS) after primary surgery and overall survival (OS) after recurrence were examined.
ResultsRectal cancer (n = 2922) was associated with worse RFS compared to right-sided colon cancer (n = 2362) (hazard ratio (HR) 0.65; 95% CI 0.59–0.72; p < 0.001) and left-sided colon cancer (n = 3910) (HR 0.72; 95% CI 0.66–0.78; p < 0.001) after adjusting for key clinical factors (i.e., sex, age, histological type, CEA, adjuvant therapy, T category, and N category). Among patients with recurrence (n = 2823), rectal cancer was associated with better OS compared to right-sided colon cancer (HR 1.23; 95% CI 1.08–1.40; p = 0.002) and worse OS compared to left-sided colon cancer (HR 0.88; 95% CI 0.79–0.99; p = 0.029). Twenty percent of right-sided colon cancer recurrences exhibited peritoneal dissemination, 42% of left-sided colon cancer recurrences were liver metastases, and 33% of rectal cancer recurrences were local recurrences. ConclusionsThe three tumor locations (right-sided colon, left-sided colon, rectum) had different prognostic implications for recurrence after curative resection and overall mortality, suggesting that tumor location serves as a prognostic biomarker in stage III colorectal cancer. 相似文献
7.
A 68-year-old man underwent laparoscopic low anterior resection for rectal carcinoma in December 2006. Nearly 19 mo after the operation, he developed recurrent rectal cancer with peritoneal metastasis. In September 2008, he subsequently underwent a laparotomy with a peritonectomy, omentectomy, splenectomy, and a Hartmann procedure. Hyperthermic intraperitoneal oxaliplatin 750 mg was administered. The patient was discharged with no postoperative complications and has been well with postoperative FOLFOX chemotherapy. 相似文献
8.
Background:Colorectal cancer is a malignant tumor second only to lung and breast cancer in the West. The liver is the main target organ for colorectal cancer metastasis, affecting the prognosis and survival. Surgical treatment has made great progress in colorectal cancer liver metastasis, including radiofrequency ablation (RFA), high-intensity focused ultrasound (HIFU) ablation. Object:Clinical treatments for colorectal cancer liver metastases are not the same. In order to clarify the impact of surgical resection, RFA and HIFU, we provided a decision-making basis for the clinical treatment of colon cancer liver metastasis through systematic reviews and network meta-analysis (NMA). Methods:We systematically searched the Chinese and English databases: PubMed, Embase, CENTRAL, CINAHL, Web of Science, CNKI, CBM, VIP, Wan Fang. Literature screening, data extraction, and quality evaluation were carried out by two researchers, and finally, use Stata to carry out meta-analysis. Results:This study is ongoing and the results will be submitted to a peer-reviewed journal for publication. Protocol registration number:INPLASY202150044. 相似文献
9.
Background: Colon gas volume analysis using abdominal radiographs is an objective and reproducible method for evaluating functional bowel disorders. The aim of this study was to clarify the relevance of colon gas distribution and transit time in rectosigmoid cancer patients after surgery. Methods: Segmental colon gas volume score was calculated using plain abdominal radiography and evaluated in 40 patients who had undergone sphincter-saving resection. Segmental colonic transit time was analysed using radiopaque markers in the same patients. Results: Transit times in the right colon (RCT) were 15.3 ± 1.1 h and in the left colon (LCT) 11.2 ± 1.1 h. Gas volume scores in the RCS and LCS were 1.10 ± 0.13% and 1.06 ± 0.14%, respectively. Neither colonic transit time nor colon gas volume score correlated with the operation methods for rectosigmoid colon cancer. A positive correlation of RCS and a negative correlation of LCS/RCS with ageing were noted in male patients but not in female patients. There was no correlation between RCT and RCS ( r = 0.028); however, LCT correlated with LCS ( r = 0.318, P < 0.05). The ratio of colonic transit time (LCT/RCT) was 0.84 ± 0.10, while that of colon gas volume score (LCS/RCS) was 1.29 ± 0.21. There was a significant correlation between LCT/RCT and LCS/RCS ( r = 0.541, P < 0.001). Conclusions: Analysis of colon gas volume is useful for evaluating colonic transit time in rectosigmoid cancer patients after sphincter-saving surgery. 相似文献
10.
Purpose Laparoscopic surgery of colon cancer has been accepted to be oncologically adequate compared with open resection. However,
the situation in rectal cancer remains unclear, because anatomy and complex surgical procedures might specifically influence
the long-term outcome. This study was designed to analyze perioperative and long-term outcome of patients with rectal cancer
after laparoscopic vs. open access surgery.
Methods A total of 389 patients (1998–2005) were prospectively analyzed; 114 patients had laparoscopic beginning, and 25 patients
had conversion and were separately analyzed. Eighty-nine patients remained in the laparoscopic group and 275 had open access
surgery.
Results Both groups were comparable regarding age, gender, tumor localization, stage, and complications. Differences were found in
harvested lymph nodes (laparoscopic 13.5/open access 16.9; P = 0.001) and hospitalization (15.1/18.7 days; P = 0.037). Local recurrence rate and metachronous metastasis were comparable. In patients with deep anterior resection with
total mesenteric excision, favorable long-term survival in the laparoscopic group was found ( P = 0.035, log-rank).
Conclusions Minimally invasive surgery is equivalent in the treatment of rectal cancer and shows advantages of shorter hospitalization
and faster recovery. Especially in patients with low rectal cancer, minimally invasive surgery with exact preparation of the
total mesenteric excision seems to be favorable compared with open access surgery. 相似文献
11.
Background Transanal intersphincteric resection (ISR) was introduced and has been increasingly performed as an ultimate surgical treatment
for extremely low rectal cancer. We considered that high quality and less invasive surgery could be achieved if ISR and laparoscopic
surgery were combined.
Methods Between December 2003 and June 2004, we performed laparoscope–assisted ISR for two patients with very low rectal cancer and
total colectomy for two patients with ulcerative colitis complicated by colorectal cancer. In all patients, the transanal
procedure was preceded by trans–abdominal laparoscopic rectal excision.
Results Preceding transanal dissection facilitated muscle layer–oriented curative dissection, and more importantly, made subsequent
laparoscopic rectal excision effortless as a result of penetrating to the dissected pelvic cavity. All patients showed favorable
recovery including postoperative anal function with no complication or recurrent disease.
Conclusions This procedure is feasible and has favorable short–term results for radical treatment of very low rectal disease, while preserving
anal function.
Presented at the 19th World Congress of the International Society for Digestive Surgery, Yokohama, Japan, 8–11 December 2004. 相似文献
12.
Background/purpose One-stage resection of primary colon cancer and synchronous liver metastases is considered an effective strategy of cure. A laparoscopic approach may represent a safe and advantageous choice for selected patients with the aim of improving the early outcome. Methods Between January 2008 and October 2008, 7 patients underwent one-stage laparoscopic resection for primary colorectal cancer combined with laparoscopic or robot-assisted liver resection. Results A total of five laparoscopic left-colon, one right-colon, and one rectal resections were performed. Three patients underwent preoperative left-colon stenting and two received neoadjuvant chemotherapy. The patient with rectal cancer underwent neoadjuvant radiotherapy. Liver procedures included one bisegmentectomy (segments 2, 3), 3 segmentectomies, 6 metastasectomies, and four laparoscopic ultrasound-guided radiofrequency ablations (LUG-RFAs). One patient with multiple liver metastases was managed by a two-stage hepatectomy partially conducted by a totally laparoscopic approach. The overall postoperative morbidity was null. The median hospital stay was 10 days (range 7–10 days). Conclusions This pilot study suggests that laparoscopic one-stage colon and liver resection is feasible and safe. Robot assistance may facilitate liver resection, increasing the number of patients who may benefit from a minimally invasive operation. 相似文献
13.
BACKGROUND Endoscopic ultrasound-guided fine needle aspiration(EUS-FNA)is a biopsy technique widely used to diagnose pancreatic tumors because of its high sensitivity and specificity.Although needle-tract seeding caused by EUS-FNA has been recently reported,dissemination of pancreatic cancer cells is generally considered to be a rare complication that does not affect patient prognosis.However,the frequency of dissemination and needle-tract seeding appears to have been underestimated.We present a case of peritoneal dissemination of pancreatic cancer due to preoperative EUS-FNA.CASE SUMMARY An 81-year-old man was referred to the Department of Surgery of our hospital in Japan owing to the detection of a pancreatic mass on computed tomography during medical screening.Trans-gastric EUS-FNA revealed that the mass was an adenocarcinoma;hence laparoscopic distal pancreatectomy with lymphadenectomy was performed.No intraoperative peritoneal dissemination and liver metastasis were visually detected,and pelvic lavage cytology was negative for carcinoma cells.The postoperative surgical specimen was negative for carcinoma cells at the dissected margin and the cut end margin;however,pathological findings revealed adenocarcinoma cells on the peritoneal surface proximal to the needle puncture site,and the cells were suspected to be disseminated via EUSFNA.Hence,the patient received adjuvant therapy with S-1(tegafur,gimeracil,and oteracil potassium);however,computed tomography performed 5 mo after surgery revealed liver metastasis and cancerous peritonitis.The patient received palliative therapy and died 8 mo after the operation.CONCLUSION The indications of EUS-FNA should be carefully considered to avoid iatrogenic dissemination,especially for cancers in the pancreatic body or tail. 相似文献
14.
Introduction:Isolated splenic metastasis emanating from colorectal cancer is an extremely rare finding, which usually indicates widely disseminated and multiple metastatic cancer. There have only been 39 cases of isolated splenic metastasis reported in the English literature to date. Patient concerns:An 84-year-old female patient presented to our department with dark-red bloody stool that had persisted for 1 month and with an increased serum carcinoembryonic antigen (CEA) level. Diagnoses:A colonoscopy showed a rectal mass located 3 cm from the anal margin, which was 45 mm in diameter. The patient was diagnosed with rectal cancer with splenic metastases by abdomen computed tomography. Interventions:The patient underwent a radical resection of rectal cancer and splenectomy, and the postoperative histopathology confirmed that the splenic lesions were derived from the adenocarcinoma of the rectum. Outcomes:After surgical treatment, the patient recovered well and was recommended for further chemotherapy. Conclusions:In addition to revealing a rare case, we also performed a literature review, including a brief discussion about the atypical isolated splenic metastasis from colorectal cancer. Our findings enrich the database of this rare clinical entity and provide experience in the management of splenic metastasis. 相似文献
15.
PurposeTo describe the postoperative surgical complications in patients with rectal cancer undergoing Hartmann’s procedure (HP).MethodsData were retrieved from the Swedish Colorectal Cancer Registry for all patients with rectal cancer undergoing HP in 2007–2014. A retrospective analysis was performed using prospectively recorded data. Characteristics of patients and risk factors for intra-abdominal infection and re-laparotomy were analysed.ResultsOf 10,940 patients resected for rectal cancer, 1452 (13%) underwent HP (median age, 77 years). The American Society of Anesthesiologists (ASA) score was 3–4 in 43% of patients; 15% had distant metastases and 62% underwent a low HP. The intra-abdominal infection rate was 8% and re-laparotomy rate was 10%. Multivariable logistic regression analysis identified preoperative radiotherapy (OR, 1.78; 95% CI, 1.14–2.77), intra-operative bowel perforation (OR, 1.99; 95% CI, 1.08–3.67), T4 tumours (OR, 1.68; 95% CI 1.04–2.69) and female gender (OR, 1.73; 95% CI, 1.15–2.61) as risk factors for intra-abdominal infection. ASA score 3–4 (OR, 1.62; 95% CI, 1.12–2.34), elevated BMI (OR, 1.05; 95% CI, 1.02–1.09) and female gender (OR, 2.06; CI, 1.41–3.00) were risk factors for re-laparotomy after HP. The rate of intra-abdominal infection was not increased after a low HP.ConclusionsDespite older age and co-morbidities including more advanced cancer, patients undergoing Hartmann’s procedure had low rates of serious postoperative complications and re-laparotomy. A low HP was not associated with a higher rate of intra-abdominal infection. HP seems to be appropriate for old and frail patients with rectal cancer. 相似文献
16.
A multicenter retrospective study was undertaken to assess the efficacy and safety of laparoscopy in colon and rectal surgery. To minimize potential bias in interpretation of the results, all data were registered with an independent observer, who did not participate in any of the surgical procedures. Sixty-six patients underwent a laparoscopic procedure. Operations performed included sigmoid colectomy (19), right hemicolectomy (15), low anterior resection (6), colectomy with ileal pouch-anal anastomosis (IPAA) (5), and abdominoperineal resection (APR) (3). The conversion rate from laparoscopic colectomy to celiotomy was 41 percent. Major morbidity and mortality were 24 percent and 0 percent, respectively. Length of stay, hospital costs, and lymph node harvest were compared between the sigmoid resection and right hemicolectomy subgroups. Data from traditional sigmoid colectomies and right hemicolectomies were obtained from the same institutions for comparison. Mean postoperative stay for laparoscopically completed sigmoid and right colectomies was significantly less than that for either the converted or the traditional groups ( P
<0.02). Total hospital cost for traditional right hemicolectomy was significantly less than that for the converted group ( P
< 0.05) but not the laparoscopic group. Laparoscopic sigmoid resection showed no significant total hospital cost difference among traditional, converted, and laparoscopic groups. Lymph node harvest in resections for carcinoma was comparable in all groups. These preliminary data suggest that laparoscopic colon and rectal surgery can be accomplished with acceptable morbidity and mortality when performed by trained surgeons. Length of stay is shorter, but there is no proven total hospital cost benefit. Appropriate registries will be necessary to adequately assess long-term outcome.Read at the meeting of The American Society of Colon and Rectal Surgeons, San Francisco, California, June 7 to 12, 1992. Winner of the William C. Bernstein, M.D. Award of the Midwest Society of Colon and Rectal Surgeons. 相似文献
17.
BACKGROUND/AIMS: To investigate the recurrence patterns and interval from initial surgery in patients with curatively resected colorectal cancer followed for a minimum of 10 years. METHODOLOGY: We retrospectively reviewed 418 patients who had undergone curative resection for colon cancer (n = 246) or rectal cancer (n = 169). Follow-up periods ranged from 10 to 23 years. Main outcome measures were interval until recurrence, site of first recurrence, and influence of adjuvant chemotherapy. RESULTS: 26 (6%) had been lost to follow-up by 10 years and 143 (34%) had died. The most common site of recurrence was liver in colon cancer and locoregional in rectal cancer. The cumulative recurrence rate in colon cancer was 100% at 4 years. In rectal cancer, it was 89% at 5 years, 98% at 7 years and 100% at 10 years. The interval until recurrence was longer in rectal cancer (26.0 +/- 24.2 months) than in colon cancer (17.1 +/- 11.0 months) (p = 0.03). It was also longer in patients receiving than in those not receiving adjuvant chemotherapy (p < 0.01). The interval until lung metastasis was longer than that until liver metastasis in colon cancer (p = 0.04), and longer than that until locoregional recurrence in rectal cancer (p = 0.03). The interval until recurrence in the colon cancer was shorter for stage III than for stage II (p = 0.02). CONCLUSIONS: Surveillance for recurrences, particularly for relapses in the liver and lung, should be performed for at least 4 years in colon cancer patients. Patients with rectal cancer should be followed for a longer period than those with colon cancer, focusing on locoregional, liver and lung recurrence. It is particularly noteworthy that adjuvant chemotherapy may prolong the interval until recurrence and the interval until lung metastasis is relatively longer. 相似文献
18.
AIM: To compare the clinicopathological features of patients with non-schistosomal rectosigmoid cancer and schistosomal rectosigmoid cancer.METHODS: All the patients with rectosigmoid carcinoma who underwent laparoscopic radical surgical resection in the Shanghai Minimally Invasive Surgical Center at Ruijin Hospital affiliated to Shanghai Jiao-Tong University between October 2009 and October 2013 were included in this study. Twenty-six cases of colonic schistosomiasis diagnosed through colonoscopy and pathological examinations were collected. Symptoms, endoscopic findings and clinicopathological characteristics were evaluated retrospectively.RESULTS: There were no significant differences between patients with and without schistosomiasis in gender, age, CEA, CA19-9, preoperative biopsy findings or postoperative pathology. Patients with rectosigmoid schistosomiasis had a significantly higher CA-125 level and a larger proportion of these patients were at an early tumor stage ( P = 0.003). Various morphological characteristics of schistosomiasis combined with rectosigmoid cancer could be found by colonoscopic examination: 46% were fungating mass polyps, 23% were congestive and ulcerative polyps, 23% were cauliflower-like masses, 8% were annular masses. Only 27% of the patients were diagnosed with rectal carcinoma preoperatively after the biopsy. Computed tomography (CT) scans showed thickened intestinal walls combined with linear and tram-track calcifications in 26 patients.CONCLUSION: Rectosigmoid carcinoma combined with schistosomiasis is associated with higher CA-125 values and early tumor stages. CA-125 and CT scans have a reasonable sensitivity for the accurate diagnosis. 相似文献
19.
Introduction Abdominoanal pull-through procedure is an alternative procedure for lower rectal cancer in which double-stapling technique
is difficult to apply and/or the adequate distal safety margin (>2 cm) cannot be achieved in a very narrow male pelvis. The
present study is to examine if the pull-through procedure can be effectively performed by laparoscopic approach for male lower
rectal cancer downstaged by concurrent chemoradiation therapy.
Methods A total of 14 male patients with advanced lower rectal cancer (Stage II: n = 6; Stage III: n = 8, by tumor, node, and metastasis staging system of International Union Against Cancer) and successfully downstaged by
preoperative concurrent chemoradiation therapy were accrued for this study. All patients underwent three-staged operation
including: transverse-colostomy creation before concurrent chemoradiation therapy, laparoscopic pull-through procedure and
closure of colostomy. The details of laparoscopic pull-through procedure were shown in the video including: total mobilization
for rectum in the fashion of total mesorectal excision, retrieval and transection of bowel through an incision over dentate
line, and coloanal anastomosis. The surgical outcome of the patients were prospectively evaluated.
Results Although the dissection plane is a little blurred by preoperative concurrent chemoradiation therapy, the laparoscopic pull-through
procedure was preformed with acceptable operation time (274.6 ± 52.4 minutes, mean±standard deviation) and little blood loss
(104.5 ± 32.0 ml) through 5 small wounds of abdominal ports. The number of dissected lymph node was 17.0 ± 3.0. The distal
safety margin of all patients was more than 2 cm. The patients have quick functional recovery, as evaluated by the length
of postoperative ileus (48.0 ± 8.0 hours), hospitalization (9.0 ± 1.0 days), and degree of postoperative pain (3.5 ± 0.5,
visual analog scale). There were no major postoperative complications yet postoperative fever developed in one patient and
wound infection in the other one. Besides the expenses covered by the National Bureau of Health Insurance in Taiwan, the patient
had to pay extra expenses of NT$25000.0 ± 3500.0 (1.0 US dollars = 32.0 NT$). During the follow-up periods (median: 10 months,
range, 4 to 16 months), one patient developed a recurrent lung metastasis.
Conclusion In view of the good functional recovery and fine short-term oncologic results, laparoscopic pull-through procedure was thus
a good choice for downstaged male lower rectal cancer in terms of sphincter-preservation and enough distal section margin
of tumor.
Electronic Supplementary Material This multimedia article (video) has been published online and is available for viewing at . Its abstract is presented here. As a subscriber to Diseases of the Colon & Rectum you have access to our SpringerLink electronic service, including Online First.
Video presentation in Yonsei Colorectal Cancer International Symposium, Seoul, South Korea, May 28, 2005.
Grant support from 94S040, National Taiwan University Hospital.
Reprints are not available. 相似文献
20.
Rationale:Primary periampullary duodenal cancer accounts for 3% to 17% of periampullary cancers. There are no previous reports of metachronous primary colon and periampullary duodenal cancer. Patient concerns:We present a case of primary periampullary duodenal cancer that occurred metachronously after colon cancer. Diagnoses:Imaging and endoscopic examinations, serum tumor marker levels, and pathology confirmed metachronous colon and periampullary duodenal cancer, with 14-month interval between the diagnoses of the 2 malignancies. Intervention:The patient received right hemicolectomy combined with mFOLFOX6 chemotherapy for colon cancer and pancreatoduodenectomy for periampullary duodenal cancer. Outcomes:The patient has been followed up for 6 years since the pancreatoduodenectomy and shows no signs of recurrence or metastasis. Lessons:The risk of developing a second malignancy may be associated with the site of the first tumor. Patients with right colon cancer may have particularly high risk of developing small intestinal cancer, including duodenal cancer. Early detection and active surgical treatments can improve prognosis. Long-term regular follow-up is necessary to detect new malignancies occurring after the diagnosis colon cancer. 相似文献
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