Laparoscopic Observation of Adhesive Rectal Fixation after Gant-Miwa-Thiersch Procedure for Rectal Prolapse: A Case Report.

In our previous report, we have noted an increase of computed tomography (CT) attenuation values in perirectal fat tissue after Gant-Miwa-Thiersch (GMT) procedure for rectal prolapse. Based on these results, we hypothesized that the GMT procedure may have a rectal fixation effect due to inflammatory adhesions extending to the mesorectum. Herein, we report a case of laparoscopic observation of perirectal inflammation after GMT. A 79-year-old woman with a history of seizures, stroke, subarachnoid hemorrhage, and spondylosis underwent the GMT procedure under general anesthesia in the lithotomy position for rectal prolapse measuring 10 cm in length. But rectal prolapse recurred 3 weeks after surgery. Therefore, an additional Thiersch procedure was performed. However, rectal prolapse still recurred, and laparoscopic suture rectopexy was performed 17 weeks after initial surgery. During rectal mobilization, marked edema and rough membranous adhesions were observed in the retrorectal space. The average CT attenuation value obtained 13 weeks after initial surgery was found to be significantly elevated in the mesorectum compared with the subcutaneous fat, especially in the posterior side (P < 0.05). These findings suggest that the extension of inflammation to the rectal mesentery after the GMT procedure may have strengthened adhesions in the retrorectal space.

Effect of the Gant-Miwa-Thiersch Procedure for Rectal Prolapse on the Mesorectum.

Rectal prolapse (RP) most commonly occurs among elderly women and is caused by vulnerable suspensory tissue in the pelvis. In Japan, the Gant-Miwa-Thiersch procedure (GMT) is recommended for elderly people with poor general health. We retrospectively analyzed clinical data from 12 patients who underwent GMT at our hospital from September 2005 to July 2021 and investigated the effect of GMT on the mesorectum using abdominal-pelvic computed tomography (CT) performed for other diseases. The median age of the cohort was 82 years, and 92% of the subjects were women. The median RP length was 5 cm, and the median follow-up period was 60 months. Recurrence was observed in 1 of 12 patients (8.0%). CT conducted before and more than 6 months after GMT revealed no abnormal findings in the mesorectum, whereas CT within 5 months after GMT revealed hyperdense fat in the mesorectum in all three patients (100%; P < 0.05). The RP recurrence rate after the GMT was low. The mechanism of the effect of GMT may involve not only a direct mucosal plicating effect but also adhesional rectosacral fixation due to the presence of inflammation extending to the mesorectum.

[A resected case of gastric regional lymph node metastasis from ascending colon cancer].

A 67-year-old man underwent right hemi-colectomy for ascending colon cancer in 2007. One year later, he was diagnosed as early gastric cancer, and endoscopic submucosal dissection was performed. Pathologically, cancer cells were detected on the vertical margin, so we conducted distal gastrectomy. A dissected lymph node around the hepatic artery was histologically proved to contain adenocarcinoma cells. The cancer cells were positive for CK20. Colon cancer cells were also positive for CK20 but gastric cancer cells were focally positive for CK20. This pattern of CK staining suggested the ascending colon cancer metastasized to a gastric regional lymph node.

[A resected case of locally invasive rectal cancer successfully treated with neoadjuvant capecitabine, oxaliplatin, bevacizumab and radiation therapy].

A 57-year-old man was admitted to our hospital with a complaint of perineal pain. He was diagnosed as advanced rectal cancer with an invasion of prostate, and we conducted neoadjuvant capecitabine, oxaliplatin, bevacizumab and radiation therapy. After chemoradiation therapy, the tumor regressed to an ulcerative lesion without invasion of the prostate. Abdominoperineal resection was then performed without radical resection. The tumor regressed to an ulcer and only a few cancer cells were detected in the submucosal layer pathologically.

Is primary tumor location an independent prognostic factor in stage IV colon cancer?

OBJECTIVES: To determine whether primary tumor location is an independent prognostic factor in stage IV colon cancer, focusing on its relationship with chemotherapy and/or sex. METHODS: We retrospectively analyzed clinicopathological data from 255 patients with stage IV colon cancer from two treatment eras according to the year of starting multidrug combination chemotherapy: period A was from 1985 to 2005 and period B from 2006 to 2013. Propensity score matching (1:1) was performed to assess overall survival(OS). RESULTS: Right-sided colon cancer tended to be more common in elderly females with large-sized tumors, exhibiting mucinous histology or peritoneal dissemination. After propensity score matching, 130 patients were identified. There was no difference in OS between left-sided and right-sided tumors in either period A or B. The prognosis of patients receiving chemotherapy in either period was superior to that of those without chemotherapy. Better outcome of chemotherapy was seen only in female left-sided patients from both periods (p < 0.05). By multivariate analysis, liver metastasis, peritoneal dissemination, and chemotherapy were found to be independent risk factors in period A, whereas only liver metastasis and chemotherapy were the independent factors in period B. CONCLUSIONS: Primary tumor location is not an independent prognostic factor, but seems to be a chemotherapy effect modifier.

[A case of metastatic rectal cancer showing a sustained complete response to chemotherapy with FOLFIRI followed by UFT].

The FOLFIRI regimen (irinotecan in combination with bolus and continuous infusion of 5-FU and l-LV) and FOLFOX regimen (oxaliplatin/5-FU/LV therapy) are now standard chemotherapy for metastatic colorectal cancer in Western countries. Combining those regimens, a median overall survival time (MST) of over 20 months has been reached. However, adverse reactions related to those regimens have included deteriorating patient quality of life (QOL). Here, we report a case of metastatic rectal cancer showing a complete response (CR) to cycle 4 in FOLFIRI regimen, while maintaining a CR status for over 11 months and good QOL, as a result of chemotherapy with 4 cycles of FOLFIRI followed by UFT.

Irinotecan plus low-dose cisplatin for alpha-fetoprotein-producing gastric carcinoma with multiple liver metastases: report of two cases.

Alpha-fetoprotein (AFP)-producing gastric carcinoma generally causes multiple liver metastases and has an extremely poor prognosis. There is no standard chemotherapy for this disease. Two recent consecutive patients who had AFP-producing gastric carcinoma were treated with a novel chemotherapy regimen: irinotecan hydrochloride (100 mg/body over 90 min) plus low-dose cisplatin (10 mg/body) by intravenous infusion. Treatment was done weekly during admission and once every 2 weeks on an outpatient basis. Both patients had multiple liver metastases with high serum levels of AFP, and one demonstrated resistance to 5-fluorouracil. In both patients, liver metastases showed a dramatic complete response to chemotherapy, and the serum AFP levels returned to normal. No significant toxicities were observed. These preliminary results suggest that the present regimen may cause fewer side effects while retaining its synergistic antitumor activity. This regimen may therefore be worth trying as first-line chemotherapy for patients with metastatic AFP-producing gastric carcinoma.