Comparison of oncologic outcome of abdominoperineal resection versus sphincter saving resection for low lying rectal cancer

Purpose@#The present study compares the peri/postoperative and oncological outcomes of abdominoperineal resections (APR) and sphincter saving resection (SSR) for low lying rectal cancer. @*Methods@#Between January 2001 and December 2014, 176 patients who underwent SSR (n = 67) and APR (n = 109) for low rectal cancer, without stage IV, were retrieved from a retrospective database. @*Results@#With a median follow-up of 66.5 months. The mean total number of harvested lymph nodes was 16.7 (SSR) versus 17.1 (APR) (P = 0.801). The advanced T stage was higher in the APR group (82.6%) versus the SSR group (55.2%) (P = 0.006). The positive rate of lymph nodes after surgery was significantly higher in the APR group (45.9%) versus SSR group (25.4%) (P < 0.05). The 5-year overall survival rates for SSR and APR were 87.3% and 67.6%, respectively (P < 0.005). The 5-year disease-free survival rate (DFS) was 83.6% (SSR) versus 65.5% (APR) (P = 0.002). The recurrence rate was higher in the APR group (34.9%) versus the SSR group (14.9%) (P = 0.004). Local recurrence rate was not different between the two groups. However, distant recurrence rate was significantly higher in the APR group (26.6% vs. 11.9%, P = 0.023). In multivariate analysis, node positive (N0 vs. N1-2) was an independent prognostic factor for DFS (P < 0.005). @*Conclusion@#Based on the present data, SSR achieved better 5-year oncological outcome than APR. The positive lymph node ratio in the N stage after surgery was higher in the APR group and this seems to have an effect on the oncological outcomes of the APR group.

Surgery of multiple lymphangioma in small bowel: a rare case report of chronic gastrointestinal bleeding

Small bowel lymphangioma is a rare benign tumor of the lymphatic system, characterized by the presence of dilated lymphatic spaces and significant gastrointestinal bleeding. Small bowel lymphangiomas are rare in adults and case reports are few. Lymphangiomas in the jejunum or ileum are extremely rare and account for less than 1% of all lymphangiomas. The case reported herein is of an older patient (70-year-old male) with melena and chronic anemia (hemoglobin count < 5 g/dL) who had small-sized multiple lymphangiomas in his small bowel (jejunum). Surgical resection was performed after failure of treatment by gastroenteroscopy. Final pathological analysis revealed lymphangioma with thrombus and hemorrhage. After surgery, he no longer had decreased hemoglobin count, nor symptoms of anemia and melena. Also, at the last follow-up visit, the patient's hemoglobin count patient was normal and he returned to normal daily functions.

Long-term results of oncoplastic breast surgery with latissimus dorsi flap reconstruction: a pilot study of the objective cosmetic results and patient reported outcome

PURPOSE: The goal of oncoplastic breast surgery is to restore the appearance of the breast and improve patient satisfaction. Thus, the assessment of cosmetic results and patient-reported outcomes (PROs) using appropriately constructed and validated instruments is essential. The aim of the present study was to assess the long-term objective cosmetic results and corresponding PROs after oncoplastic breast surgery. METHODS: Cosmetic results were assessed by the patients, a medical panel, and a computer program (BCCT.core). PROs were assessed using BREAST-Q, a questionnaire that measures the perception of patients having breast surgery. The cosmetic results and PROs were analyzed in patients who underwent quadrantectomy and partial breast reconstruction utilizing the latissimus dorsi flap. RESULTS: The mean duration of the follow-up period was 91.6 months (range, 33.3-171.0 months), and mean age of the patients was 51 years old (range, 33-72 years). The mean tumor size was 2.1 cm (range, 0.9-5.5 cm). There was fair agreement between the medical panel and BCCT.core score (K = 0.32, P < 0.001), and a statistically significant correlation between the BCCT.core score and medical panel cosmetic results was identified (r = 0.606, P < 0.001). A better BCCT.core result was related to a higher PRO of each BREAST-Q domain-satisfaction with breasts (R2 = 0.070, P = 0.039), satisfaction with outcome (R2 = 0.087, P = 0.021), psychosocial well-being (R2 = 0.085, P = 0.023), sexual well-being (R2 = 0.082, P = 0.029), and satisfaction with information (R2 = 0.064, P = 0.049). CONCLUSION: Our long-term results of oncoplastic surgery achieved a high level of patient satisfaction with good cosmetic results. The medical panel and BCCT.core results correlated well with the PROs of the patients using valid, reliable, and procedure-specific measures.

Usefulness of an Open Cecostomy in the Treatment of a Distal Colon Obstruction

PURPOSE: Stoma formation has usually been used for bowel decompression or fecal diversion. For these, a cecostomy is rarely performed because of disadvantages such as incomplete fecal diversion or fatal complications. The aim of this study was to evaluate the usefulness of an open cecostomy in treating patients with colonic obstruction. METHODS: Between May 2005 and August 2008, 20 patients underwent an open cecostomy because of colonic obstruction. All information on the patients was reviewed retrospectively for underlying disease, obstruction site, diameter of the cecum and transverse colon, and complications. RESULTS: Of the 20 patients, 14 had colorectal cancer, 3 had stomach cancer, 1 had cervical cancer, 1 had a carcinoid tumor, and 1 had an osteosarcoma. The cause of the obstruction was the primary tumor in 7 patients, peritoneal carcinomatosis in 7 patients, local recurrence in 5, and tissue edema after cyberknife treatment in 1 patient. All patients, except for 1 patient with a hopeless discharge due to rapid disease progression, were discharged on the tenth day postoperatively. No fatal complication developed. In 2 patients, the cecostomy closed spontaneously at 5.5 mo postoperatively after the distal obstruction had been resolved. CONCLUSION: An open cecostomy may be a useful and simple method for the decompression of a colonic obstruction, even though the diversion may not be complete.