Single-incision plus one port laparoscopic anterior resection for rectal cancer as a reduced port surgery.

BACKGROUND: Only limited data in the literature about single-incision laparoscopic rectal surgery, because the laparoscopic stapler does not allow low rectal transection without sufficient distal margins from the umbilicus port. We have developed single-incision plus one port laparoscopic anterior resection of the rectum (SILS+1-AR) as a reduced port surgery in which we can utilize the incision for drainage as an additional access route for laparoscopic procedures including the transection the lower rectum. METHODS: A Lap protector (LP) mini was inserted through a 2.5 cm transumbilical incision, and an EZ-access was mounted to LP and three 5-mm ports were placed in EZ-access. A 12 mm port was inserted in right lower quadrant. Almost all the procedures were performed with usual laparoscopic instruments, and the operative procedures were much the same as in usual laparoscopic low anterior resection of the rectum using a flexible 5mm scope. The rectum was transected normally using only one endoscopic linear stapler inserted from the right lower quadrant port. RESULTS: We underwent modified SILS+1-AR in 16 patients with advanced rectal cancer. In all cases, there was no need to extend the skin incision. We transected the lower rectum with one laparoscopic stapler in all six cases. Postoperative follow-up did not reveal any umbilical wound complications or recurrences. CONCLUSIONS: The safety and feasibility of SILS+1-AR for advanced rectal cancer was established in this study. However, further studies are needed to prove the advantages of this procedure to conventional laparoscopic law anterior resection.

Invasive colorectal cancer detected up to 3 years after a colonoscopy negative for cancer.

BACKGROUND AND STUDY AIMS: Colonoscopy has replaced barium enema as the primary method for direct diagnosis of colorectal cancer, but detection may fail, and the reasons for this are not completely understood. PATIENTS AND METHODS: In order to analyze the accuracy of colonoscopy for detecting invasive colorectal cancer, 7365 colonoscopic examinations were matched with the most accurate local government population-based cancer registry in Japan. RESULTS: In 15 colonoscopic examinations, patients were not diagnosed as having invasive colorectal cancer, but disease of this type was detected within 3 years of the examinations (false-negative examinations). During the same period, 233 colonoscopies were identified as true-positive examinations. The false-negative rate for detecting invasive colorectal cancer with colonoscopy was 6% at 3 years. The false-negative rate was significantly higher in individuals between 60 and 69 years of age and in invasive cancers located to the right of the splenic flexure. CONCLUSIONS: Colonoscopists should receive adequate training in achieving easy cecal intubation, detecting small or flat lesions, and carrying out adequate biopsies.

Endoscopic surveillance for gastric remnant cancer after early cancer surgery.

BACKGROUND AND STUDY AIMS: The aims of this article were to clarify the incidence of gastric remnant cancer after surgery for early gastric cancer, and to develop surveillance programs for patients who have undergone partial gastrectomy in order to detect such lesions at an early stage. PATIENTS AND METHODS: A total of 642 patients with partial gastrectomy for early gastric cancer were enrolled in a surveillance program for gastric remnant cancer between 1985 and 1996. In 509 patients, the interval between endoscopic examinations was no more than 2 years. RESULTS: Among the 509 patients examined periodically, 15 patients were diagnosed as having gastric remnant cancer; in 12 patients, the cancers were detected at an early stage. All gastric remnant cancers were found distant from the site of the anastomosis, and in eight patients the cancers were located on the lesser curvature. The cumulative 5-year prevalence rate was estimated as 2.4 % and the 10-year prevalence rate as 6.1 %. The initial tumors in the patients with gastric remnant cancer were of the microscopically intestinal type, without exception. The interval between the preceding examination and diagnosis was shorter in the patients with early cancer than in those with advanced cancer ( P < 0.01). CONCLUSIONS: Periodical surveillance endoscopy for gastric remnant cancer is recommended after surgery for early gastric cancer, particularly in patients whose cancers are of the intestinal type. The examinations can be repeated at 2 - 3-year intervals, and special attention should be given to the lesser curvature away from the anastomotic site.

Detection of gastric cancer by repeat endoscopy within a short time after negative examination.

BACKGROUND AND STUDY AIMS: Although a large number of patients are examined using endoscopy in order to identify gastric cancer, it is unclear how individuals should be managed after they are not diagnosed as having gastric cancer at the time of their initial examinations. This study was conducted to identify the group at high risk for gastric cancer who should be examined by repeat endoscopy within a short time after obtaining negative results. PATIENTS AND METHODS: The study involved 3672 patients who were not diagnosed as having gastric cancer by endoscopy in 1993, but underwent re-examination by gastroscopy between January 1994 and December 1996. RESULTS: Among these participants, 32 patients (0.9%) were diagnosed as having gastric cancer. The incidence of gastric cancer was 2.0% in participants aged 60 to 69 and 2.7% in those with marked atrophy of the gastric mucosa. Multivariate analysis showed that the odds ratios (OR) for patients aged 60 to 69 and those with marked atrophy of the gastric mucosa were 3.092 and 3.255 (P < 0.01), respectively. Gastric cancer was detected in 17.2 % of patients who were previously diagnosed as having gastric adenoma and in 2.2% of those who were previously diagnosed as having gastric ulcer. The ORs for participants with these gastric lesions detected by the initial examination were 49.417 and 5.259 (P < 0.01), respectively. CONCLUSIONS: Groups at high risk for gastric cancer were identified by the initial endoscopy, when two findings (gastric lesions, atrophy) and age were combined. We emphasize the importance of repeat endoscopic examination for patients who are aged 60 to 69 or have marked atrophy of gastric mucosa, even if no lesions are detected on initial endoscopy. If gastric adenoma or ulcer are detected, endoscopic examination should be likewise repeated or these lesions should be treated by endoscopy or by other means.

[A study on pre-operative administration of 5'-DFUR in carcinomas of the gastric, breast, thyroid and colon].

Pre-operative chemotherapy for 7 days with 5'-DFUR (p.o.) were carried out in the patients with gastric, breast, thyroid and colon cancers. The concentration of 5-fluorouracil (5-FU) in tumor cells was higher than that in the normal tissue. In case of breast cancer, it was 10 times higher than normal tissue. The concentration of 5-FU at the metastatic lymph nodes in gastric cancer was considerably high. The pattern of DNA histogram changed when chemotherapy was applied, and we observed the G2 and M phase block.