Hand-assisted laparoscopic surgery on a gigantic primary retroperitoneal mature cystic teratoma: A case report.

INTRODUCTION: Primary teratomas in the retroperitoneum are rare, incidentally identified in children, and resected using a laparoscopic approach. However, when it increases in size, the laparoscopic approach is technically demanding, leaving a large skin incision for tumor removal. PRESENTATION OF CASE: The patient was a 20-year-old woman who presented with chronic left flank pain. Abdominal and pelvic computed tomography (CT) revealed a 25-cm wide giant polycystic and solid retroperitoneal tumor containing calcification located in the upper portion of the left kidney, strongly compressing the pancreas and spleen. No other metastatic lesions were observed. Additionally, abdominal magnetic resonance imaging (MRI) revealed that the polycystic tumor consisted of serous fluid and fatty components, and bone and tooth components were found in the tumor center. Therefore, the patient was diagnosed with retroperitoneal mature teratoma and a hand-assisted laparoscopic surgery using bikini line skin incision was performed. The specimen was 27 × 25 cm in size, weighing 2512 g. Histology revealed that the tumor was a benign, mature teratoma without a malignant component. The postoperative course was uneventful and the patient was discharged on postoperative day 7. The patient remained healthy without any recurrence and the postoperative scar is barely visible under direct vision. DISCUSSION: Primary retroperitoneal mature teratomas can enlarge without initially causing symptoms and can be incidentally identified using imaging studies. CONCLUSION: A hand-assisted laparoscopic approach using a bikini line skin incision is safe, minimally invasive, and provides better cosmesis.

[A Case of Goblet Cell Adenocarcinoma Incidentally Diagnosed after Appendectomy That Required Additional Bowel Resection with Lymph Nodes Dissection].

A 54-year-old male presented to the clinic, complaining of dull lower abdominal pain that started a day ago. There was a tenderness on right lower quadrant on palpation and abdominal computed tomography(CT)showed that dilated appendix with a diameter of 12 mm. The patient was diagnosed with acute appendicitis and laparoscopic appendectomy was performed on the same day. The tip of the appendix was swollen and looked purple, gangrenous appendicitis findings were identified. However, histopathology detected GCA on resected appendix with positive surgical margin and additional tumor resection was indicated. Laparoscopic ileocecal resection with D3 lymph nodes dissection was performed 24 days after the first surgery. Resected specimen showed that the stump of the appendix was palpable as a mass in the orifice of the appendix and histopathology revealed the remnant of the appendiceal GCA. No lymph nodes tumor metastasis was identified. Chromogranin A and synaptophysin were positive and Ki-67 was approximately 50%. According to the guideline of neoadjuvant chemotherapy for colon cancer, oral 5-fluorouracil therapy was performed for half a year after the second surgery and the patient remains still healthy without recurrence 1 year after the surgery. Here, we experienced a rare case of GCA of the appendix that was detected incidentally after appendectomy for acute appendicitis.

[A Case of Monomorphic Epitheliotropic Intestinal T-Cell Lymphoma Causing Perforation of the Small Intestine].

Monomorphic epitheliotropic intestinal T-cell lymphoma(MEITL)is very rare and aggressive subtype of lymphoma with poor prognosis. A 60-year-old man complaining of abdominal pain was underwent partial resection of the jejunum for panperitonitis with a small intestinal perforation. The histopathological and immunohistochemical findings led to the diagnosis of MEITL. Postoperative course was uneventful. One month after the operation, the patient was scheduled for 6 courses of CHOP regimens. He presented with bowel obstruction twice during the 3 courses of CHOP. As the recurrence of MEITL could not be ruled out, diagnostic laparoscopy was performed. Laparoscopic findings revealed no recurrence and adhesive small bowel obstruction. The patient was followed closely without treatment after 6 courses of CHOP. The patient has been alive without recurrence 18 months after the resection. We reported a case of monomorphic epithelial intestinal T- cell lymphoma causing jejunal perforation.

Hybrid laparoscopic Inokuchi shunt procedure for refractory pleural effusion and ascites associated with primary biliary cirrhosis: A case report.

INTRODUCTION: Portosystemic shunts associated with portal hypertension are generally treated using non-invasive procedures, with open surgery required for refractory cases. Herein, we present a case of refractory pleural fluid and ascites associated with primary biliary cirrhosis (PBC), successfully treated using a hybrid laparoscopic Inokuchi shunt procedure. CASE PRESENTATION: The patient was a 74-year-old woman with a history of PBC, presenting with breathing difficulty. Computed tomography revealed massive pleural fluid and ascites and engorged coronary and azygos veins, indicative of a portosystemic circulation shunt and a 3-cm wide hepatocellular carcinoma (HCC) on liver segment 2. The Child-Pugh score was 11. With the portosystemic shunt outflow considered as the cause of pleural fluid and ascites; therefore, we proceeded with a hybrid laparoscopic selective Inokuchi shunt procedure and tumor enucleation. Laparoscopically, the greater omentum was divided for devascularization, a 7-cm right subcostal skin incision was made, and the abdomen was opened for HCC enucleation under direct vision. The left gastric vein was divided at its junction with the portal vein and connected to the vena cava using a left external iliac vein graft through the omental foramen. After this procedure, the pleural effusion and ascites disappeared, blood ammonium level decreased to normal, and Child-Pugh score decreased to 9. DISCUSSION: Using the Inokuchi shunt procedure, the portosystemic shunt, via the left gastric vein, was closed to increase portal blood flow and improve liver function. CONCLUSION: As a less invasive procedure, hybrid laparoscopic approach should be considered for portosystemic shunt via the left gastric vein.

[A Case of Type 4 Gastric Cancer with Peritoneal Dissemination Successfully Treated with Conversion Surgery after Intensive S-1 plus Oxaliplatin Chemotherapy].

S-1 plus oxaliplatin(SOX)chemotherapy is now widely used for the treatment of unresectable gastric cancer but there are few case reports about conversion surgery following SOX. Hereby, we report a case of type 4 gastric cancer with peritoneal dissemination successfully treated with conversion surgery after intensive SOX chemotherapy. A 69-year-old female was diagnosed of type 4 gastric cancer by upper endoscopy(por1, HER2 negative)and peritoneal disseminations were identified on left diaphragm and mesentery under direct vision. After 11 courses of SOX chemotherapy, CT revealed that primary tumor markedly decreased in size. Therefore, staging laparoscopy was performed and peritoneal disseminated lesions disappeared. Peritoneal cytology also turned negative. Subsequently, total gastrectomy and splenectomy were performed. Histology revealed that tumor was categorized as por2, ypT2N3M0, ypStage ⅢA, and Grade 2 in histological evaluation criteria. SOX was continued as an adjuvant chemotherapy for another 6 months and the patients remain healthy without recurrence. Unresectable gastric cancer with peritoneal dissemination can be successfully treated with conversion surgery following SOX chemotherapy and staging laparoscopy was useful to evaluate peritoneal dissemination. When conversion surgery is indicated for gastric cancer with peritoneal dissemination, downstaging should be confirmed by staging laparoscopy.

[A Case of Multiple Metachronous Metastases from Hepatocellular Carcinoma to Thoracic Spine and Right Adrenal Invading Right Kidney with Tumor Thrombus in the Inferior Vena Cava That Was Treated with Chemotherapy, Radiotherapy, Intravascular Therapy, and Surgery].

For extrahepatic recurrence after primary hepatocellular carcinoma resection, molecular targeted therapy is the first- choice and no consensus is reached on the indication of surgical resection of extrahepatic metastasis. However, when the extrahepatic lesion extends to vena cava, tumor thrombus can cause acute pulmonary embolism that can lead to fatal consequences. Here, we experienced a case of multiple metachronous metastases from hepatocellular carcinoma to thoracic spine and right adrenal invading right kidney with tumor thrombus in the inferior vena cava. Local radiation therapy to thoracic vertebra, molecular targeted therapy, and transcatheter arterial chemoembolization were performed but tumor thrombus still occluded vena cava. Therefore, to prevent pulmonary embolism and to bridge to immunotherapy, right adrenalectomy, right nephrectomy, thrombectomy and replacement of inferior vena cava were performed. The patient remains healthy 6 months after the surgery and still receiving immunochemotherapy.

Hybrid laparoscopic pancreas-preserving subtotal duodenectomy for suspected early duodenal cancer: A case report.

INTRODUCTION: Non-ampullary duodenal adenomas rarely show malignant potential. However, such adenomas located in the periampullary area are suspected of being malignant and require surgical treatment. PRESENTATION OF CASE: A 75-year-old man presented with a 30-mm wide, endoscopically-unresectable laterally spreading tumor in the periampullary area. Biopsy showed a tubular adenoma; however, the size and color of the tumor strongly suggested malignancy. Therefore, a hybrid laparoscopic pancreas-preserving subtotal duodenectomy (HLPPSD) was performed. Laparoscopically, a Kocher maneuver was performed. The jejunum was divided 10 cm distal to the ligament of Treitz, and the duodenum was also divided at the supraduodenal-angle. The Shuriken method was applied, and the surgery converted to an open procedure. The common bile and pancreatic ducts were divided, and the subtotal duodenum and 10 cm of the jejunum were removed. Thereafter, the jejunal stump was hand-sutured to the duodenal stump. Cholangiojejunostomy and pancreatojejunostomy were performed under direct vision. Finally, an umbilicoplasty was performed. The histology revealed that the tumor was a carcinoma in situ. DISCUSSION: Endoscopic resection is the first-choice for duodenal adenoma suspected of malignant potential. When the endoscopically-unresectable tumor is located in periampullary area, pancreatoduodenectomy is generally selected because ampulla cannot be preserved. However, HLPPSD is an alternative option. CONCLUSIONS: Non-ampullary duodenal adenomas can be malignant when the tumor is large and red. In these cases, HLPPSD can be useful; less invasive than conventional pancreaticoduodenectomy; leaves only a 3-cm, round scar, in addition to the laparoscopic port scars; and combines the benefits of both open and laparoscopic surgeries.

[A Case of Solitary Right Adrenal Metastasis from Rectal Cancer].

An 86-year-old woman underwent laparoscopic high anterior resection for RS rectal cancer. Histological examination showed tub2-por, pT3, pN2a, Stage ⅢB disease. Given the age of the patient, adjuvant chemotherapy was not administered. Five months after the surgery, her carcinoembryonic antigen(CEA)level was elevated and a 42×25mm mass was detected in the right adrenalby computed tomography(CT). Metastasis from rectalcancer was suspected but no other lesions were detected by positron-emission tomography(PET)-CT. Nine months after the surgery, laparoscopic right adrenalectomy was performed. Histological examination revealed that the right adrenal tumor had moderately-differentiated adenocarcinoma very similar to the primary rectalcancer; therefore, the right adrenall esion was diagnosed as metastasis from the previous rectalcancer. The tumor marker levelreturned to normall evelafter the second surgery. The patient was discharged on the 8th post-operative day but declined adjuvant chemotherapy due to her age. Six months later, liver, lung, and peritoneal metastasis were identified by CT. We report this case of solitary adrenalmetastasis from rectalcancer resected by laparoscopic right adrenalectomy.

[Surgical Treatment Outcome of Patients with Colorectal Cancer Having Ulcerative Colitis].

This study aimed to evaluate the surgical treatment outcome of patients with colorectal cancer having ulcerative colitis (UC). METHODS: We examined 112 patients who underwent the surgery from 1998 to 2016. Among the 112 patients, 14 were complicated with malignant tumor(9 with colorectal cancer and 5 with dysplasia-assciated lesion or mass)We performed group comparison between patients with(group A)and without(group B)colorectal cancer. RESULTS: The median age in group A was 58.1 years, which was significantly older than that in group B. The duration of disease in group A was 13.2 years, which was significantly longer than that in group B. Surgical procedures in group B were as follows; 5 cases had ileoanalanastomosis (IAA), 4 cases had ileo-analcanalanastomosis (IACA), 2 cases had ileorectal anastomosis(IRA), and 1 case had interspincteric resection(ISR) and abdominoperinealresection (APR)Laparoscopic sigmoid colectomy was performed in a patient aged 52 years because he was diagnosed with sporadic sigmoid colon cancer. Periodic endoscopic screening was not performed in 5 patients with pT2 colorectalcancer in group B. endoscopic submucosaldissection (ESD)was performed in 2 patients aged>70 years with rectal pTis cancer. CONCLUSION: Elderly patients with UC were often complicated with colorectalcancer, and these patients are indicated for surgicalprocedures other than IAA to preserve defecation function. Patients with UC should undergo periodic endoscopic screening for early detection of malignant tumor and definitive surgicalresection.

[A Case of Metachronous Ascending Colon Metastasis from Gastric Cancer That Was Difficult to Diagnose].

A 60s man with a history of laparoscopic distal gastrectomy(LDG)of gastric cancer in January 2015was followed up in an outpatient clinic. He remained healthy without recurrence for about 2 years, but in February 2017, colonoscopy identified an elevated lesion that covered one-third of the circumference in the ascending colon. Biopsy revealed that this lesion had poorly differentiated adenocarcinoma. No other metastatic lesions were noted on thoraco-abdominal CT, and tumor markers were not elevated in a blood test. Right hemicolectomy with D3 nodal dissection was performed on March 2017. Although regional lymph node metastasis was noted during surgery, distant metastasis was not identified. Histological examination revealed that the ascending colon tumor had poorly differentiated adenocarcinoma very similar to that of the primary gastric cancer, and the lesion was diagnosed as metastasis from previous gastric carcinoma. Pathological findings showed pPM0, pDM0, pRM0, pCY0, and definitive surgical treatment was confirmed. However, 2 months after the surgery, ascites caused by peritoneal and bilateral supraclavicular lymph node metastases were detected on CT. He passed away 6months after the last surgery. We report a case of metachronous ascending colon metastasis from gastric cancer that was difficult to preoperatively diagnose.

[Assessment of Long-Term Sexual Function after Radical Resection for Lower Rectal Cancer].

The aim of this study was to evaluate the long-term sexual function and risk factors of dysfunction after the autonomic nerve preserving operation for lower rectal cancer. METHODS: We evaluated postoperative sexual function assessed by IIEF5 in 91 patients who responded to the questionnaire by mail. RESULTS: After a median follow-up of 5.5 years, univariate analysis identified 4 risk factors associated with poor sexual function: the elder, over 3 years after surgery, pathological stage III , and lateral lymph node dissection(both side). Poor sexual function assessed by multivariate analysis was significantly associated with the elder(over 60 years). CONCLUSION: From the viewpoint of sexual dysfunction, the autonomic nerve preserving operation( AN4)should be considered for elderly people.

Risk Factors for the Development of Desmoid Tumor After Colectomy in Patients with Familial Adenomatous Polyposis: Multicenter Retrospective Cohort Study in Japan.

BACKGROUND: Desmoid tumor (DT) is the primary cause of death in patients with familial adenomatous polyposis (FAP) after restorative proctocolectomy. This study aimed to identify risk factors for DT in a Japanese population. METHODS: Clinical data for 319 patients with FAP undergoing first colectomy from 2000 to 2012 were reviewed retrospectively. RESULTS: Two hundred seventy-seven FAP patients were included in this study. Thirty-nine (14.1 %) patients developed DT. Occurrence sites were the intraperitoneal region in 25 (64.1 %) cases, intraperitoneal region and abdominal wall in three (7.7 %), and abdominal wall in nine (23.1 %). The mean period from surgery to DT development was 26.3 months (range 4-120 months). Gender (female vs. male, p = 0.03), age at surgery (>30 vs. ≤30 years, p = 0.02), purpose of surgery (prophylactic vs. cancer excision, p = 0.01), and surgical procedure (proctocolectomy [ileoanal anastomosis (IAA), ileoanal canal anastomosis (IACA), total proctocolectomy (TPC)] vs. total colectomy [ileorectal anastomosis, partial colectomy]; p = 0.03) significantly influenced the estimated cumulative risk of developing DT at 5 years after surgery. Conversely, approach (laparoscopic vs. open, p = 0.17) had no significant effect on the increased risk of DT occurrence. In multivariate analysis, female gender, with a hazard ratio of 2.2 (p = 0.02,) and proctocolectomy (IAA, IACA, TPC), with a hazard ratio of 2.2 (p = 0.03), were independent risk factors for DT incidence after colectomy. CONCLUSIONS: Female gender and proctocolectomy (IAA, IACA, TPC) were independent risk factors for developing DT after colectomy in patients with FAP.

Prevalence of laparoscopic surgical treatment and its clinical outcomes in patients with familial adenomatous polyposis in Japan.

BACKGROUND: Laparoscopic surgery is becoming the preferred technique for most colorectal interventions. This study aimed to clarify the time trend of surgical treatment for familial adenomatous polyposis (FAP) and its relevance to clinical outcomes in Japan over a 13-year period. METHODS: This was a multicenter retrospective cohort study comprising 23 specialist institutions for colorectal disease and a cohort of 282 FAP patients who underwent total colectomy or proctocolectomy during 2000-2012. Patient clinical backgrounds and surgical outcomes were compared between the first and second halves of the study period. RESULTS: The proportion of surgical types adopted over the entire study period was 46, 21, 30, and 3 % for ileoanal anastomosis (IAA), ileoanal canal anastomosis, ileorectal anastomosis, and permanent ileostomy, respectively. FAP patients undergoing laparoscopic surgery have increased since 2008 and reached 74 % in the past 3 years. In particular, the number of patients undergoing laparoscopic proctocolectomy with IAA increased approximately four-fold from the first to the second half of the study period. A laparoscopic approach was increasingly used in patients with coexisting colorectal malignancies. Despite this trend, surgical results of the laparoscopic approach between the two study periods showed similar morbidity, pouch operation and stoma closure completion rates. No postoperative mortality was observed in this series, and laparoscopic surgery was comparable to open surgery in terms of stoma closure rate, incidence of intra-abdominal/abdominal desmoid tumors, and postoperative survival rate in both study periods. CONCLUSION: Laparoscopic approach is increasingly being adopted for prophylactic FAP surgery in Japan and may provide clinically acceptable practical outcomes.

Clinicopathological significance of vascular endothelial growth factor, thymidine phosphorylase and microvessel density in colorectal cancer.

Colorectal cancer is a common malignant disease, the incidence of which is increasing worldwide, therefore, identifying novel prognostic factors to improve adjuvant therapeutic strategies or postoperative monitoring is required. Angiogenesis, which is assessed by microvessel density (MVD), is significant in tumor growth and metastasis. However, the association between angiogenesis and clinical outcome remains controversial. In the present study, 84 surgically resected cases of colorectal cancer were examined to clarify the clinicopathological significance of vascular endothelial growth factor (VEGF), thymidine phosphorylase (TP) and cluster of differentiation (CD)34 expression levels. VEGF expression was identified to be significantly correlated with TP expression (r=0.45; P<0.0001) and MVD in the high VEGF expression group was observed to be significantly greater than that in the low VEGF expression group (P=0.0194). In the Dukes' stage D group, the MVD in the high TP expression group was significantly greater than that in the low TP expression group (P=0.0149). High VEGF expression was subsequently correlated with a short overall survival rate for patients exhibiting lymph node metastasis (P=0.0128); however, there was no significant difference in overall survival rate regarding the expression levels of TP and CD34. The results of the present study indicate that VEGF expression may serve as a prognostic factor for colorectal cancer patients exhibiting lymph node metastasis. Furthermore, angiogenesis, as assessed by MVD, is an important prognostic factor for tumor growth at the primary site.

[Assessment of Functional Results after Sphincter-Preserving Surgery in Elderly Patients with Low Rectal Cancer].

The aim of this study was to evaluate postoperative dysfunction and potential problems after a sphincter-preserving operation in elderly patients with low rectal cancer. METHODS: Between 2000 and 2012, 307 consecutive patients with low rectal cancer underwent curative sphincter-preserving surgery. We evaluated postoperative anal and urinary dysfunction in 190 patients who responded to a questionnaire by mail. RESULTS: After a median follow-up of 5.7 years, there was no significant difference between the elderly and a younger group in the Wexner incontinence score. Poor anal function assessed by modified FIQL was significantly associated with the elderly. Poor urinary function assessed by the IPSS score was significantly associated with the elderly, diabetes mellitus, and autonomic nerve preservation(AN2-3). CONCLUSION: From the viewpoint of urinary function, sphincter-preserving surgery with all autonomicnerve preservation(AN4)should be considered for elderly people and patients with diabetes.

[Regrowth of Isolated Local Residual Tumor Effectively Treated with Chemoradiotherapy More Than Five Years after a Resection for Pancreatic Cancer with an Involvement of the Portal Vein].

A 55-year-old man who presented with abdominal pain was diagnosed with pancreatic head cancer involving the portal vein. He underwent pylorus-preserving pancreaticoduodenectomy without a resection of the portalvein, resulting in a macroscopic residualtumor, because radicalresection was impossible owing to the severe localinvasion. Postoperative chemotherapy( GEM plus S-1)was administered. The tumor size decreased and CA19-9 values normalized. Five years after the resection, chemotherapy was stopped. The regrowth of an isolated local residual tumor without a distant metastasis was diagnosed 65 months after the resection. He underwent chemoradiotherapy(CRT)with S-1. The size of the tumor remained stable, but FDG-PET demonstrated a disappearance of high FDG uptake in the tumor and CA19-9 values normalized. We reported a case in which CRT was an effective treatment for the regrowth of localresidualtumor after resection for pancreatic cancer.

Risk Factors for Anastomotic Leakage After Intersphincteric Resection Without a Protective Defunctioning Stoma for Lower Rectal Cancer.

BACKGROUND: Intersphincteric resection (ISR) is performed as an alternative to abdominoperineal resection for super-low rectal cancer. The purpose of this study was to evaluate risk factors for anastomotic leakage (AL) after ISR without a defunctioning stoma for lower rectal cancer. METHODS: Between 1995 and 2012, 135 consecutive patients with lower rectal cancer underwent curative ISR without a protective defunctioning stoma. Univariate and multivariate analyses were performed to determine the risk factors for AL. RESULTS: The radiological and symptomatic AL rate was 17.0 % (23/135). Univariate analysis demonstrated that male sex (P = 0.030), preoperative chemotherapy (P = 0.016), partial ISR (P < 0.001), lateral lymph-node dissection (P = 0.042), distal tumor distance from the dentate line (P = 0.007), and straight reconstruction (P < 0.001) were significantly associated with AL. Severe AL requiring re-laparotomy developed in 13 (9.6 %) patients. Univariate analysis demonstrated that male sex (P = 0.006), partial ISR (P < 0.001), distal tumor distance from the dentate line (P = 0.002), and straight reconstruction (P < 0.001) were significantly associated with AL requiring relaparotomy. Multivariate analysis demonstrated that partial ISR [odds ratio (OR) 6.701; P = 0.001] and straight reconstruction (OR 5.552; P = 0.002) were independently predictive of AL. CONCLUSIONS: Partial ISR and straight reconstruction increased the risk of AL after ISR without a protective defunctioning stoma. A defunctioning stoma might be mandatory in patients with the risk factors identified in this analysis.

[Treatment Strategy for Stage â £ Rectal Cancer].

Eighteen consecutive patients who underwent rectal resection following preoperative chemotherapy for cStage Ⅳ rectal cancer at our institute, between 2009 and 2014, were retrospectively assessed. Preoperative chemotherapy with mFOLFOX6, SOX, XELOX, and other anticancer agents was administered to 8, 5, 3, and 2 patients, respectively. Combined molecular targeted therapy was administered to 12 patients. The response evaluation showed that an antitumor effect was observed in 10 and 8 patients with local tumors who achieved a partial response (PR) and stable disease (SD), respectively, and in 9 and 9 patients with distant metastases who achieved a PR and SD, respectively. The operative procedures included high/low anterior resection (n=12), intersphincteric resection (n=2), and abdominoperineal resection/Hartmann's operation (n=4). An ileostomy was performed in 6 patients before chemotherapy. Postoperative complications occurred in 6 patients. Two patients with an ileostomy had anastomotic insufficiency, but recovered without reoperation. There was no significant difference in overall survival (p=0.382) when these patients were compared with 45 cStage Ⅳ rectal cancer patients who underwent surgery without preoperative chemotherapy. However, the rate of curability B was higher in patients who received preoperative chemotherapy (44.4%) compared to those who did not (26.7%). The results of this study are inconclusive and have not determined whether preoperative chemotherapy results in better long-term survival for cStage Ⅳ rectal cancer patients. However, preoperative chemotherapy might contribute to higher operative curability.

Long-term clinical and functional results of intersphincteric resection for lower rectal cancer.

BACKGROUND: Intersphincteric resection (ISR) is an alternative to abdominoperineal resection (APR) for super-low rectal cancer. The aim of this study was to evaluate the long-term curability after ISR over an average 6-year observational period, to compare the postoperative functional outcomes for ISR with those for low anterior resection (LAR), and to determine whether ISR is a function-preserving surgery. METHODS: Between 2000 and 2007, a total of 77 consecutive patients with low rectal cancer underwent curative ISR. The curability outcomes for ISR, LAR, and APR were compared. We evaluated the postoperative defecation functions, Wexner incontinence score (WIS), and defecation quality of life (QOL) for a between-groups comparison (ISR/LAR). RESULTS: The 5-year survival rate after ISR was 76.4 %, and the outcome was better than for APR (APR 51.2 %, LAR 80.7 %). Local recurrence after ISR occurred in 7.8 % of patients (APR 12.1 %, LAR 11.7 %). The average daily frequency of defecation was 3.7 times for the ISR patients and 3.2 times for the LAR patients, indicating no significant difference between the groups. Moreover, there were no significant differences between the groups for defecation functions. The WIS was 8.1 for ISR and 4.9 for LAR, and the defecation QOL for ISR and LAR was not significantly different (modified fecal incontinence QOL score: ISR 34.3, LAR 26.5). CONCLUSIONS: The long-term clinical and functional results suggest that ISR may be the optimal sphincter-preserving surgery for patients with lower rectal cancers who cannot be treated with a double-stapling technique.

[Surgical treatment outcomes of multimodality therapy for locally recurrent rectal cancer].

The aim of this study was to clarify the status of multimodality therapy for locally recurrent rectal cancer. Between 2000 and 2012, 27 patients with locally recurrent rectal cancer underwent surgical resection. We examined 18 patients treated with preoperative chemo-radiotherapy (CRT group) and 9 patients treated with surgery alone (surgical group). The rate of R0 - resection was 89% in the CRT group and 78% in the surgical group. The mean operative durations for the CRT and surgical groups were 323 min and 289 min, respectively. The mean amount of bleeding was 1,462 g for the CRT group and 2,846 g for the surgical group. There was no significant difference in the rate of postoperative complications between both groups (CRT group: 78%, surgical group: 78%). Regarding local recurrences, the recurrence rate of the CRT group was 28%, whereas that of the surgical group was 67%. The 3-year and 5-year overall survival rates of the CRT group were 71%and 44%, respectively, whereas those of the surgical group were 58% and 22%, respectively. These results showed that CRT treatment was associated with an improvement in prognosis. Preoperative CRT and surgical resection should be the standard treatment for patients with local recurrence.