RESUMO
Lymphatic spread of colon cancer usually occurs via mesenteric vessels (superior and inferior mesenteric vessels), but inguinal lymph node (LN) metastasis from colon cancer is extremely rare with only few reported cases in the literature. A case of a 35-year-old female patient with a history of sigmoid cancer underwent sigmoidectomy and left salpingo-oopherectomy in 2016 and received adjuvant chemotherapy then presented in 2023 with metastatic left inguinal LNs and underwent left inguinal LN dissection. We reported a rare case of isolated metachronous inguinal lymph node metastasis from colon cancer with a round ligament route of spread as the hypothesized mechanism. Surgical resection with inguinal LN dissection is the preferred treatment option for isolated inguinal lymph node metastasis from colon cancer followed by adjuvant chemotherapy, yet long term follow-up data is needed to support this strategy.
RESUMO
OBJECTIVE: The present study aimed to compare intraoperative and postoperative outcomes of laparoscopic-assisted distal gastrectomy versus totally laparoscopic distal gastrectomy (TLDG) Billroth I (BI) for gastric cancer and to assess the impact of the initial introduction phase of TLDG BI anastomosis. PATIENTS AND METHODS: The study analyzed the prospectively collected data of patients who underwent laparoscopic distal gastrectomy BI from 2014 to 2021 at Seoul National University Hospital. RESULTS: Among 1116 patients, laparoscopic-assisted distal gastrectomy BI was performed in 566 patients and TLDG BI was performed in 550 patients. The total laparoscopic arm had a faster mean operative time (190 vs 208 min; P < 0.001) and a shorter postoperative hospital stay (7.4 vs 7.9 d; P < 0.001). Local complications were higher in the total laparoscopic group (17.6% vs 9.9%; P = 0.008) during the early introduction phase. CONCLUSION: The total laparoscopic approach for BI reconstruction is safe and effective with faster operative time, shorter hospital stays, and less wound infection, but it may be associated with an increase in postoperative surgical complications and hospital stay in the early introduction phase.