Short-Term Clinical and Oncological Outcomes after Single-Incision Plus One Port Laparoscopic Anterior Resection for Rectal Cancer.

AIM: In the past, we developed and reported single-incision plus one port laparoscopic anterior resection (SILS + 1-AR) of the rectum. In this study, we reviewed our experiences with 141 consecutive patients admitted in a community hospital for undergoing SILS + 1-AR for rectal cancer and evaluated the short-term clinical and oncological outcomes. METHODS: A lap protector (LP) was inserted through a 2.5 cm transumbilical incision; an EZ-access was mounted to the LP and three 5-mm ports were placed. A 12-mm port was inserted in the right lower quadrant. RESULTS: One hundred thirty-six patients (96.5%) completed their treatment with SILA+1-AR. The number of tumor locations in the rectosigmoid, rectum area above the peritoneal reflection (Ra), and rectum area below the peritoneal reflection (Rb) were 44, 63, and 29 respectively. Six (5.6%) tumor recurrences or metastasis occurred in 107 patients with stages I-III disease with a median follow-up of 30 months. One patient with a positive surgical margin rejected additional resection of the positive margin and died of recurrent disease. CONCLUSION: Our initial experiences suggested that SILS + 1-AR is a feasible and a safe treatment option for rectal cancer patients treated by experienced surgeons specialized in SILS. However, further studies are needed to demonstrate the advantages of this procedure compared to the benefits of conventional laparoscopic AR.

[Surgical Case of the Composite Tumor of Primary Lung Cancer and Follicular Bronchiolitis].

A case was a 72-year-old female who was pointed out abnormal findings on her chest X-ray taken at the medical checkup. Chest computed tomography revealed a tumor with 3.1 cm in diameter at the right lower lobe and multiple small nodules in both lung lobes. We initially suspected lung cancer with intrapulmonary metastases. However, only tumor at the right lower lobe increased in size and the size of other small nodules was not changed. Therefore, we performed the right lower lobectomy with mediastinal nodal dissection and the partial resection of right middle lobe to establish the diagnosis. Pathological assessment revealed that the tumor at right lower lobe was adenocarcinoma with follicular bronchiolitis, and small nodules in the lower lobe were intrapulmonary lymph nodes, and the nodules in the middle lobe were lymph node infiltration with follicular bronchiolitis. The composite tumor of primary lung cancer and follicular bronchitis is very rare, and the cancer stage could be overdiagnosed.

Intrathoracic vagus nerve tumor: case report and review of the literature.

We present the case of a 23-year-old female with benign intrathoracic vagal neurofibroma associated with von Recklinghausen's disease. We reviewed 87 other neurogenic tumors of the intrathoracic vagus nerve and discuss the incidence rate of complications, especially the relationship between tumor location, tumor size, and preservation of the nerve in this case report.

Single-incision video-assisted thoracoscopic resection of a pedunculated solitary fibrous tumor of the pleura: case report.

In this report, we describe the surgical resection of a pedunculated solitary fibrous tumor of the pleura (SFTP) by single-incision thoracoscopic surgery (SITS). SITS may be a suitable surgical option for pedunculated SFTPs.

[Bevacizumab therapy for a colorectal cancer patient or hemodialysis with hepatic metastasis].

We report our experience with a case of colorectal cancer treated with chemotherapy for a liver metastasis patient on hemodialysis. The patient was a 67-year-old man with a history of chronic renal failure, who was on hemodialysis since 2005. High anterior resection was performed for sigmoid colon and rectal cancer in January, 2010. After starting chemotherapy while planning to use FOLFOX6+bevacizumab(BV)as a postoperative standard chemotherapy, in combination with hemodialysis three times a week while performing dose escalation, administration postponement was continued for myelosuppression that was considered to be the effect of oxaliplatin. Oxaliplatin was administered for only 2 courses, and was then changed to BV+sLV5FU2 therapy. We continued treating the metastases approximately on schedule. Imaging revealed, the liver metastases were CR because they had disappeared. The BV use case of the dialysis case had few reports, but was thought to be able to use it by careful administration safely.

[Effectiveness of postoperative adjuvant chemotherapy using S-1 plus CDDP for type 4 gastric cancer].

BACKGROUND: Our aim was to evaluate postoperative adjuvant chemotherapy using S-1 plus cisplatin(S-1/CDDP)for type 4 gastric cancer. METHODS: We investigated 18 patients who had undergone curative operations for type 4 gastric cancer. They were classified into two groups of patients, one using S-1/CDDP(group A: 9)and one using S-1 alone(group B: 9), after surgery between 2000 and 2010. Median survival time(MST)and survival rates were reported retrospectively. Patients as- signed to group A were treated with the following regimen: S-1, 80-120mg/day(body surface area 1. 25m2>: 80mg/day, 1. 25-1. 5m2: 100mg/day, 1. 5m2<: 120mg), was administered for 21 consecutive days followed by a 14-day rest period, and CDDP, 60mg/m2, was administered on day 8 for 5 courses. After this course, S-1 80mg/m2 was given for 18 months. S- 1(80-120mg/day, body surface area 1. 25m2>: 80mg/day, 1. 25-1. 5m2: 100mg/day, 1. 5m2<: 120mg)was administered for 28 days followed by 14-day rest as one course. RESULTS: MST differed significantly between group A and group B (MST; group A: 1, 603 vs group B: 955 days). The overall survival rate at 5 years was 64. 8% in group A and 13% in group B, and the overall survival rate in group A was statistically better than that in group B(p=0. 02). CONCLUSION: Postoperative adjuvant chemotherapy using S-1/CDDP for resected type 4 gastric cancer contributes to prolonged life, compared with using S-1 in overall survival.

Case of resected small-cell neuroendocrine carcinoma of the extrahepatic bile duct.

Neuroendocrine carcinomas (NECs) arising from the extrahepatic bile duct (EHBD) are extremely rare, and their preoperative diagnosis is difficult. A small number of resected cases of EHBD NECs has been reported, and their prognosis is usually poor. A 62-year-old man presented with obstructive jaundice and liver disease. Radiological imaging revealed wall thickness and stricture of the distal common bile duct (CBD); however, lymph node or distant metastasis was not detected. Adenocarcinoma was detected on biopsy, and surgery was performed with a preoperative diagnosis of cholangiocarcinoma of the distal CBD. Pathological examination revealed adenocarcinoma of the CBD mucosa (20%) and NEC of the CBD wall (80%). The final pathological diagnosis was small-cell NEC of the EHBD. His post-operative course was good, and there was no recurrence for 4 months after surgery. Herein, we report a case of resected EHBD NEC and a literature review.

[Type 4 advanced gastric cancer responding to histological complete response after neoadjuvant S-1 combined with CDDP therapy-report of a case].

A 75-year-old man with type 4 advanced gastric cancer was referred to our hospital. We diagnosed the tumor as cStage III B(cT4a, cN2, cM0)gastric cancer. We selected neoadjuvant S-1 combined with CDDP therapy for him. After 2 courses of chemotherapy, the extension of the gastric wall improved. After an additional 2 courses of chemotherapy, the primary tumor revealed a partial response(PR), judged from a barium meal study and upper GI endoscopic findings, and a total gastrectomy with lymph node dissection was performed. The pathological specimens showed no cancer cells in the gastric wall and lymph nodes, so the histological effect was judged as Grade 3.

[A case of advanced gastric cancer with tumor embolus in the portal vein successfully treated with S-1 and CDDP therapy].

A 50-year-old man with advanced gastric cancer and a tumor embolus in the portal vein was referred to our hospital. We diagnosed the tumor as cStage III B (cT3, cN2, cH0, P0, M0) gastric cancer, and selected neoadjuvant S-1 (80 mg/m2) and CDDP (60 mg/m2) therapy for him. After 2 courses of chemotherapy, the embolus in the portal vein disappeared. After additional chemotherapy, the primary tumor and regional lymph node revealed a partial response (PR), and judging from the results from the barium meal study, upper GI endoscopic findings and CT scan, a total gastrectomy with lymph node dissection was performed.

[Lung adenocarcinoma originated from bulla wall accompanying spontaneous hemopneumothorax; report of a case].

A 68-year-old male was referred to our hospital for treatment of left hemopneumothorax. Chest X-ray film and chest computed tomography scans showed emphysematous bulla at the apical portion of the left lung, pleural effusion and atelectasis of the lingular segment and lower lobe of the left lung. He underwent bullectomy and decortication. On the 9 post operative days, the patient was discharged without complication. Pathological diagnosis was lung adenocarcinoma originated from bulla wall. We must recognize that cystic lung disease is a high risk factor of the lung cancer.

A case of portal venous gas after obstructive transverse colon cancer surgery.

BACKGROUND: Portal venous gas has traditionally been considered an inevitable harbinger of death due to its association with bowel necrosis. Recently, an increasing number of cases of portal venous gas have been reported in patients with various clinical conditions and without bowel necrosis. We herein report the case of a patient in whom portal venous gas developed after transverse colon cancer surgery. CASE PRESENTATION: A 69-year-old man who had transverse colon cancer underwent insertion of a transanal ileus tube for decompression. Transverse colon resection was performed on the 11th day after the insertion of the transanal ileus tube. The patient had a high fever on the 6th day after the operation. Computed tomography showed portal venous gas over the entire area of the liver and pneumatosis intestinalis in the wall of the ascending colon. There were no signs of anastomotic leakage or bowel necrosis, so we decided to use conservative therapy with fasting and antibiotics. The portal venous gas disappeared on the 19th day after the operation. The patient was discharged in good condition on the 29th day after the operation. CONCLUSIONS: Conservative treatment for portal venous gas is reasonable for patients without signs of anastomotic leakage or bowel necrosis. However, it is important to carefully observe patients with portal venous gas during conservative treatment because portal venous gas may be life-threatening.

Single-Incision Laparoscopic Colectomy for Colon Cancer: Experiences with 308 Consecutive Cases.

Single-incision laparoscopic surgery (SILS) has been developed with the aim to further reduce the invasiveness of conventional laparoscopy. Our experiences with more than 300 consecutive patients with SILS for colon cancer are reviewed, and its outcomes are evaluated to determine the midterm clinical and oncologic safety of SILS for colon cancer in a community hospital. A single surgeon's consecutive experience of SILS for colon cancer is presented. Three hundred and eight patients were treated with the SILS procedure for colon cancer between December 2010 and March 2015. Data were analyzed according to intention to treat. Of these 308 patients, 19 (6.2%) were converted to laparotomy. Intraoperative injury occurred in five patients. Postoperative complications occurred in 19 patients (6.2%). The 2-year relapse-free survival rates of patients with Stage I, Stage II, and Stage III were 97.8, 92.2, and 80.4 per cent, respectively, and the 2-year overall survival rates of patients with Stage I, Stage II, Stage III, and Stage IV were 100, 95.7, 93.0, and 74.4 per cent, respectively. Our initial experiences showed that SILS colectomy for cancer can be performed safely and with good short-term oncologic outcomes by a skilled surgeon.

The Use of the EndoGrab™ Port-Free Endocavity Retractor in Single-Incision Laparoscopic Right Hemicolectomy.

The EndoGrab™ Port-Free Endocavity Retractor is an internally anchored retracting device that enables surgeons to reduce not only the number of ports and incisions but also the number of assistant surgeons. Our institution performs single-incision laparoscopic colectomy (SILC) as a routine procedure. Forty-nine patients underwent a single-incision laparoscopic right hemicolectomy. In this procedure, we use this retractor to the mesenteric tissue, including the ileocolic vessels and the mesentery of the transverse colon, and overcame the technical problems related to SILC and showed excellent short-term outcomes. To perform SILC safely while maintaining the minimal invasiveness and the quality, the use of this retractor is essential, especially in difficult situations, such as an unfavorable visual field when performing a lymph node dissection around the middle colic vessels in right hemicolectomy.

Reduced Port Thoracoscopic Surgery for Mediastinal and Pleural Disease: Experiences in a Single Institution.

The purpose of this study was to present our current experience with reduced port thoracoscopic surgery (RPTS) for the treatment of mediastinal and pleural disease and thereafter discuss its indications and technical challenges. A total of 11 patients underwent surgery by the RPTS approach for the following conditions: thymoma (n = 2), bronchogenic cyst (n = 2), metastatic pleural tumor, thymic cyst, solitary fibrous tumor, pulmonary sequestration, pericardial cyst, neurinoma, and malignant lymphoma (n = 1). An Endo Relief forceps (Hope Denshi Co, Ltd, Chiba, Japan) was used for three of the surgical procedures. The elements of the data set consisted of gender, age, duration of operation, drain placement, hospital stay, mass location, and mass size. The median surgical time was 45 min (range, 40-78 min). There were no intraoperative complications and no need for a second surgery to open additional ports. The duration until chest tube removal was 1 day for all the cases. The median hospital stay was 4 days (range, 3-6 days). The median mass size was 2.2 cm (range, 1.2-4.2 cm). The median length of skin incision was 2.0 cm (range, 2.0-3.5 cm). In conclusion, RPTS for mediastinal and pleural disease may be a possible alternative approach to conventional multiportal video-assisted thoracoscopic surgery (VATS). Although it is technically plausible and feasible for selected cases, the issues of patient acceptability and cosmetic and oncological results remain to be determined in the future with randomized-controlled trials and long-term follow-up.

Single-incision laparoscopic surgery for colorectal cancer.

AIM: To determine the effect of single-incision laparoscopic colectomy (SILC) for colorectal cancer on short-term clinical and oncological outcomes by comparison with multiport conventional laparoscopic colectomy (CLC). METHODS: A systematic review was performed using MEDLINE for the time period of 2008 to December 2014 to retrieve all relevant literature. The search terms were "laparoscopy", "single incision", "single port", "single site", "SILS", "LESS" and "colorectal cancer". Publications were included if they were randomized controlled trials, case-matched controlled studies, or comparative studies, in which patients underwent single-incision (SILS or LESS) laparoscopic colorectal surgery. Studies were excluded if they were non-comparative, or not including surgery involving the colon or rectum. A total of 15 studies with 589 patients who underwent SILC for colorectal cancer were selected. RESULTS: No significant differences between the groups were noted in terms of mortality or morbidity. The benefit of the SILC approach included reduction in conversion rate to laparotomy, but there were no significant differences in other short-term clinical outcomes between the groups. Satisfactory oncological surgical quality was also demonstrated for SILC for the treatment of colorectal cancer with a similar average lymph node harvest and proximal and distal resection margin length as multiport CLC. CONCLUSION: SILC can be performed safely with similar short-term clinical and oncological outcomes as multiport CLC.

Single incision laparoscopic surgery for multiple colorectal cancers.

INTRODUCTION: The aim of this study was to evaluate short-term outcomes of single-incision surgery with two segmental colorectal resections and anastomoses for multiple synchronous colorectal cancers. METHODS: Ten patients with multiple colorectal cancers underwent two synchronous segmental colorectal resections and anastomoses. The methodology of the procedures, operative results, and postoperative outcomes were evaluated. RESULTS: The median operative time was 270 min (range, 146-427 min), and the median blood loss was 70 mL (range, 10-260 mL). No conversions to open surgery or intraoperative complications occurred. Four cases needed additional ports, and one case required a diverting stoma. CONCLUSION: SILS with two segmental colorectal resections and anastomoses was safely performed in all cases without severe postoperative complications. This procedure seems to be a feasible option for resecting multiple synchronous colorectal cancers.

A New Laparoscopic Rectal Transection Method via Umbilical Incision Using Endo GIA™ Radial Reload.

We have developed a new laparoscopic rectal transection method via umbilical incision using Endo GIA™ Radial Reload with a Tri-Staple™ Technology (RR) (Covidien, New Haven, CT) stapler. A 65-year-old woman with a rectal carcinoid tumor underwent a laparoscopic low anterior resection. We successfully performed a rectal transection via umbilical incision using this stapler. The postoperative course was uneventful. The possibility of a rectal transection via umbilical incision was demonstrated in the current case. However, further studies are needed to confirm the safety and feasibility of this procedure.

Single-incision laparoscopic surgery for colon cancer in patient with situs inversus totalis: report of a case.

A preliminary experience with single-incision laparoscopic colectomy for colon cancer with situs inversus totalis (SIT) is reported. An 87-year-old man was admitted because of a fecal occult blood. A colonoscopy revealed cecal cancer. An air-barium and a computed tomography contrast enema showed the right-sided descending colon and the left-sided ascending colon and cecum. The surgical procedures were as follows: First, a Lap protector was inserted through a 2.5-cm transumbilical incision. Three 5-mm ports were placed in the Lap protector. We successfully performed ileocolectomy with lymph node dissection by using a single-incision laparoscopic approach without any technical problems. The operative time was 125 min, and blood loss was negligible. Postoperative follow-up did not reveal any umbilical wound complications and recurrences.

Single-incision video-assisted thoracic resection for extrapulmonary sequestration: a case report.

We describe surgical resection of an extralobar pulmonary sequestration via single-incision thoracoscopic surgery (SITS), which we recommend as a suitable surgical option. A 45-year-old Japanese woman was admitted to our hospital for further examination of chest abnormal shadow. A rigid 5-mm 30° video-thoracoscope, an endograsper and an electric cautery were passed within the same single small incision. The tumor was suspended using articulating endograspers and resected after clipping and ligation of the anomalous vessel. The final pathology was determined an extrapulmonary sequestration.

Single-incision laparoscopic surgery for stage IV colon cancer.

AIM: : The safety and efficacy of single-incision laparoscopic resections for patients with stage IV colorectal cancer have not been examined explicitly. This article describes our experience with single-incision laparoscopic procedures for patients with stage IV colorectal cancer. METHODS: Seventy-seven patients who underwent single-incision laparoscopic colectomy between August 2010 and January 2012 were investigated retrospectively. Eleven patients were in clinical stage IV (ST4 group) and were compared with 66 patients in clinical stages 0 to III (control group). RESULTS: There were no differences in the intraoperative and the postoperative complications, the 30-day mortality rate, the number of the lymph nodes harvested, and the duration of postoperative hospital stay between the 2 groups. CONCLUSIONS: Our initial experiences suggested that single-incision laparoscopic colectomy is feasible for stage IV colon cancer patients. This is a good start comparing the outcomes of single-incision colectomy in stage IV patients with open and traditional laparoscopic colectomy.