Comparison of the risk of appendiceal tumors in uncomplicated and complicated appendicitis.

BACKGROUND: Interval appendectomy or non-operative management is commonly performed for complicated appendicitis in adult patients. However, these treatments are still controversial because the incidence rate of appendiceal tumors recognized after interval appendectomy is reportedly higher than that after emergency appendectomy. Thus, this study aimed to compare the appendiceal tumor rates between uncomplicated and complicated appendicitis. METHODS: This study was a retrospective review of patients with appendicitis who underwent surgical removal at a single institution over 7.5 years. The primary objective was the comparison of the incidence rate of appendiceal tumors using propensity score matching, and the secondary objective was the same comparison among older patients, defined as patients aged ≥ 60 years. RESULTS: A total of 1277 patients were included. Of these patients, 297 (23.3%) were preoperatively diagnosed with complicated appendicitis. Moreover, 22 (1.7%) patients, including 14 cases of complicated appendicitis and 8 cases of uncomplicated appendicitis, were diagnosed with appendiceal tumors based on pathological examination. No significant difference was found in the incidence rate of appendiceal tumors between the two groups after matching for patients' background, including age, sex, and history of appendicitis by propensity score matching (P = 0.073). However, among patients aged ≥ 60 years, the incidence of appendiceal tumors was significantly higher in complicated than in uncomplicated appendicitis (P = 0.006). CONCLUSIONS: Although the overall risk of appendiceal tumors did not differ between complicated and uncomplicated appendicitis when analyzed by the propensity score matching, in older patients aged ≥ 60 years, the risk increased among those with complicated appendicitis. Therefore, although the incidence is low, complicated appendicitis, particularly, among older patients, should be examined carefully and be performed IA when unusual findings exist.

[A case of transverse colon cancer with multiple liver metastases and hepatic pedicle lymph node involvement showing pathological complete response by XELOX plus bevacizumab].

A 70-year-old woman was referred to our hospital because of abdominal pain. Abdominal computed tomography(CT)and colonoscopy revealed transverse colon cancer with multiple liver metastases, with involvement of the hepatic pedicle and superior mesenteric artery lymph nodes. The patient received eight courses of XELOX plus bevacizumab, and CT showed a decrease in the size of the liver metastases and hepatic pedicle lymphadenopathy. Right hemicolectomy, partial hepatectomy, and hepatic pedicle lymph node resection were performed. Histopathological examination of the resected tissue revealed no residual cancer cells, suggesting a pathological complete response. The patient remains well 7 months after operation, without any signs of recurrence. Surgical resection should be considered for patients with initially unresectable colon cancer with liver metastases and hepatic pedicle lymph nodes involvement if systemic chemotherapy is effective.

Laparoscopic incisionless stoma creation for patients with colorectal malignant stricture.

BACKGROUND: Minimally invasive techniques have been applied with increasing frequency to stoma creation. A recent focus in the field of minimally invasive surgery is laparoscopic single-site surgery. The aim of this study was to assess whether this procedure is a feasible option compared with other techniques of stoma creation. MATERIALS AND METHODS: We introduced laparoscopic surgery to fecal diversion in April 2010 at the Cancer Institute Hospital of the Japanese Foundation for Cancer Research. This technique was performed on 53 patients, including 15 laparoscopic single-site surgeries, from April 2010 to December 2011. RESULTS: Of these 15 cases, 8 ileostomies and 7 colostomies were created. The mean operative time was 65.9 minutes (range, 32 to 93 min). The estimated volume of blood loss was small in all cases. There were no intraoperative complications. All patients started an oral diet on the second postoperative day with the exception of 1 patient who suffered from prolonged paralytic ileus. CONCLUSIONS: A laparoscopic single-site approach to stoma creation may be a feasible option in fecal diversion.

Laparoscopic versus open multivisceral resection for primary colorectal cancer: comparison of perioperative outcomes.

BACKGROUND: The role of laparoscopic surgery for locally advanced colorectal cancer invading or adhering to neighboring organs is controversial. This study evaluated the safety and feasibility of laparoscopic multivisceral resection for colorectal cancer. METHODS: This study included 126 patients who underwent multivisceral resection for primary colorectal cancer invading or adhering to neighboring organs or structures between July 2005 and November 2012 at our institution. Perioperative outcomes were compared between laparoscopic and open resections. RESULTS: Laparoscopic and open multivisceral resections were performed in 60 and 66 patients, respectively. Conversion to open surgery occurred in 6.7 % of patients. The median operative time was significantly longer (271 vs. 227 min), but the median blood loss was significantly less (40 vs. 205 mL), in the laparoscopic compared with the open group. The R0 resection rate of the primary tumor (95 vs. 98.5 %), number of lymph nodes harvested (18 vs. 18), and postoperative complications (28 vs. 24 %) were comparable between the groups. The median length of hospital stay was significantly shorter (13.5 vs. 18 days) in the laparoscopic compared with the open group. CONCLUSIONS: Laparoscopic multivisceral resection for colorectal cancer invading or adhering to neighboring organs is safe and feasible in selected patients.

Colon cancer in the splenic flexure: comparison of short-term outcomes of laparoscopic and open colectomy.

BACKGROUND: Laparoscopic surgery for colon cancer in the splenic flexure (SF cancer) is technically demanding and has not been evaluated in randomized clinical trials. This study aimed to evaluate the safety and feasibility of laparoscopic surgery for SF cancer. METHODS: Thirty-three patients undergoing laparoscopic surgery for SF cancer (LAC group) were retrospectively compared with 22 patients undergoing open surgery for SF cancer (OC group) between April 2003 and June 2010. RESULTS: Left hemicolectomy was the most performed procedure in both groups (79% vs. 82%). Median operating time was significantly longer (209 vs. 178 min) and estimated blood loss was significantly lower (15 vs. 113 mL) in the LAC group than in the OC group. Conversion to open surgery was needed for 1 (3%) patient because of bleeding near the pancreas. Tumor stage was more advanced in the OC group than in the LAC group, but N stages were similar between groups. The median number of lymph nodes harvested was significantly higher in the LAC group than in the OC group (16 vs. 12). The rate of postoperative complications was significantly lower in the LAC group than in the OC group (6% vs. 36%). Time to flatus (1 vs. 3 d), time to liquid diet (2 vs. 5 d), and hospital stay (12 vs. 16 d) were significantly shorter in the LAC group than in the OC group. CONCLUSIONS: Laparoscopic surgery for SF cancer is feasible.