Clinical significance of definite muscle layer in TUR specimen for evaluating progression rate in T1G3 bladder cancer: multicenter retrospective study by the Sapporo Medical University Urologic Oncology Consortium (SUOC)

Purpose

To evaluate the clinical impact on progression and recurrence according to presence and absence of a muscle layer, we conducted a retrospective, multicenter study.

Methods

We retrospectively reviewed 247 patients who received transurethral resection (TUR) of bladder tumors and were pathologically diagnosed as having T1G3 bladder cancer from 1990 to 2009. We ruled out 8 patients who received immediate cystectomy and analyzed the remaining 239 T1G3 patients. Patients who had invasion to the prostatic urethra and patients who underwent a second TUR were not included.

Results

TUR specimens from 194 patients were confirmed to have a definite muscle layer and those from 45 did not. The median follow-up period was 53 months, ranging from 3 to 181 months. The progression-free survival rates at 5 years after TUR were 91.1 % for patients who had a muscle layer in their specimen and 77.3 % for those who did not (p = 0.005, log-rank test). Multivariate analysis indicated that the absence of a muscle layer was a risk factor for progression (p = 0.006, Cox proportional hazards analysis).

Conclusions

Patients without a muscle layer in the specimen had high risk for progression. The initial TUR must have a muscle layer in the specimen. Variations of progression rates in previous studies might be due to different proportions of patients who had a muscle layer in TUR specimens.     

Intraluminal exfoliated cancer cells and effectiveness of bowel ligatures during sigmoidectomy for sigmoid colon cancer

Purposes

To establish the efficiency of bowel ligatures in colon cancer surgery, focusing on the extent to which exfoliated cancer cells are shed in the colonic lumen during sigmoidectomy.

Methods

Twenty consecutive patients who underwent sigmoidectomy for sigmoid colon cancer were prospectively randomized into two groups: the “ligatures group”, in which bowel ligatures were placed, 3, 5, 10 cm from the tumor proximally and distally before dissection; and the “no ligatures group”, in which the corresponding sites were ligated only immediately before taking the specimen out. Each colonic segment ligated was irrigated with saline and samples were sent for blind cytological examination.

Results

Cancer cells were found in the colonic segment where the tumor was located, in 18 of 20 samples. The frequency of free cancer cells decreased from 50 to 0 % (p < 0.04) in the distal 3–5 cm colonic segment and from 80 to 20 % (p < 0.03) in the proximal colonic segment after performing bowel ligatures. Free cancer cells were confirmed in 1 of 10 samples at both colonic segments 5–10 cm from the tumor, even after bowel ligatures.

Conclusions

Intraluminal exfoliated cancer cells could be eliminated by placing bowel ligatures during sigmoidectomy. Measures should be considered to eliminate exfoliated cancer cells during colectomy, even after placing bowel ligatures.     

Short-term outcomes of local correction of stoma prolapse with a stapler device

Background

The aim of the present study was to classify the short-term outcomes of local correction of stoma prolapse with a stapler device.

Methods

The medical records of 11 patients undergoing local correction of stoma prolapse using a stapler device were retrospectively reviewed.

Results

No mortality or morbidity was observed after the surgery. Median operative time was 35 min (range 15–75 min), and blood loss was minimal. Median duration of follow-up was 12 months (range 6–55 months). One of the 11 patients had a recurrent stoma prolapse.

Conclusions

This technique can be a feasible, safe and minimally invasive correction procedure for stoma prolapse.     

Habitual intake of lactic acid bacteria and risk reduction of bladder cancer

INTRODUCTION: A kind of lactic acid bacteria, Lactobacillus casei strain Shirota, shows antitumor activity in experimental animals. One clinical trial using L. casei showed a significant decrease in the recurrence of superficial bladder cancer. So, to assess the preventive effect of the intake of L. casei, widely taken as fermented milk products in Japan, against bladder cancer, we conducted a case-control study. METHODS: A total of 180 cases (mean age: 67 years, SD 10) were selected from 7 hospitals, and 445 population-based controls matched by gender and age were also selected. Interviewers asked them 81 items. The conditional logistic regression was used to estimate adjusted odds ratios (OR). RESULTS: The OR of smoking was 1.61 (95% confidence interval: 1.10-2.36). Those of previous (10-15 years ago) intake of fermented milk products were 0.46 (0.27-0.79) for 1-2 times/week and 0.61 (0.38-0.99) for 3-4 or more times/week, respectively. CONCLUSION: It was strongly suggested that the habitual intake of lactic acid bacteria reduces the risk of bladder cancer.     

A case of locally extended rectal cancer responding to intra-arterial infusion therapy via the internal iliac artery

Chemotherapy with combined administration of 5-FU and l-Leucovorin has been reported to be effective for advanced rectal cancer. A 61-year-old woman with a huge, locally extended advanced rectal cancer was treated with intra-arterial infusion therapy via internal iliac artery. Catheters were inserted from the bilateral femoral arteries to the opposite internal iliac arteries and the bilateral upper and lower gluteal arteries and lateral sacral artery were embolized with a metallic coil. The port was positioned under the skin of her lower abdominal wall. The chemotherapy regimen was 5-FU (500 mg/body) and l-Leucovorin (250 mg/m2), administered over 5 hours once weekly to bilateral reservoirs through an infuser pump. After 5 sessions of the chemotherapy, the perineal pain decreased and the patient no longer needed morphine. Following 34 administrations (at 10 months) of this regimen, reductions of tumor size on pelvic CT and CEA level were confirmed. Side effects of the intra-arterial infusion chemotherapy were pygal dermatitis, leg desensitization, infection of circumferential reservoir and obstruction of the catheter due to flection were observed. Local intra-arterial infusion chemotherapy via the internal iliac artery appears to be effective for local advanced rectal cancer.     

“On Table” Positioning for Optimal Access for Cancer Excision in the Lower Rectum

Poor visualization and restricted access often make tumor lesions in the lower rectum difficult to excise, particularly in a narrow male pelvis. The aim of this study was therefore to study whether (and if so to what extent) different positions of the patient on the operating table might improve accessibility. Twenty consecutive patients (men and women) undergoing laparotomy with surgery of the lower rectum were studied. The geometric configuration of the pelvis was studied and compared on lateral radiographs obtained at the operating table in each of four positions. Compared with the conventional lithotomy position, the thighs-flat position caused significant extension movement of the lumbosacral joint. Augmentation of the lumbar lordosis widened the pelvic view and enabled a more vertical view of the lower rectum (27.5 degrees in lithotomy position, 13.0 degrees in the thighs-flat position). Insertion of a lumbar pad contributed further to the augmentation (7 degrees). When compared on radiographic studies, the thighs-flat position is preferable to the conventional lithotomy position in terms of facilitating low rectal surgery by improving both visibility and accessibility to the pelvic cavity.