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1.
Colorectal Dis ; 23(9): 2484-2486, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34058043

RESUMO

We present a stepwise approach to performing a laparoscopic right hemicolectomy along with D2 excision. The video illustrates a modular approach for set up and resection, performed on a 60-year-old male patient, with a cancer in the ascending colon. The procedure is divided into its key steps, which include patient position, port placement and anatomical exposure, medial to lateral dissection with vessel control, sub-ileal dissection, lateral mobilization, hepatic flexure mobilization and extraction with extracorporeal anastomosis. The key regional anatomy is highlighted alongside diagrams illustrating standard anatomy and common anatomical variants. We believe this video provides a valuable resource for trainee surgeons to expand their understanding regarding steps of the procedure and associated anatomy.


Assuntos
Neoplasias do Colo , Laparoscopia , Cirurgiões , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
2.
Surg Endosc ; 35(9): 5359-5364, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33978848

RESUMO

INTRODUCTION: Single-port laparoscopic extended right hemicolectomy with complete mesocolic excision and central vascular ligation is technically challenging, and a standardized procedure is needed to minimize technical hazards. TECHNIQUE: As a first step, the hepatic flexure is mobilized from the duodenum, and the third part of the duodenum and pancreatic head was exposed. Next, the ileocecal vessels are divided at the root using a medial-to-lateral approach, and the cecum is separated from the retroperitoneal space. This process completes the mobilization of the right colon. In the second step, the omental bursa is opened, and the inferior border of the pancreas is exposed. The mobilized right colon is turned around to the left of the superior mesenteric vein, continuing to separate the mesentery from right to left side, and the right colic vessels are divided at the roots. The inverted right colon is restored to its original position, and the mesenteric fat is dissected along the left edge of the superior mesenteric artery to the inferior border of the pancreas. RESULTS: A total of 57 consecutive patients with advanced hepatic flexure colon cancer (n = 24) and transverse colon cancer (n = 33) underwent S-ERHC. The conversion rate to open surgery was 5.3%. Operative time, blood loss, and number of harvested lymph nodes were 232 min (interquartile range [IQR], 184-277 min), 5 mL (IQR, 5-66 mL), and 30 (IQR, 22-38), respectively. According to the Clavien-Dindo classification, the grade ≥ 2 complication rate was 10.5%. Median duration of hospitalization was 9 days (IQR, 7-13 days). CONCLUSIONS: Single-port laparoscopic extended right hemicolectomy using a right colon rotation technique is safe, feasible, and useful. This technique of repeating the inversion and restoration of the right colon may help avoid bleeding and damage to other organs and facilitate reliable lymph node dissection.


Assuntos
Neoplasias do Colo , Laparoscopia , Mesocolo , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Ligadura , Excisão de Linfonodo , Mesocolo/cirurgia
4.
Gan To Kagaku Ryoho ; 48(2): 276-278, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33597380

RESUMO

We report a case of infected and incised wound cured by negative pressure wound therapy with instillation and dwelling (NPWTi-d)after right hemicolectomy for ascending colon cancer. The patient was a 72-year-old male. An ascending colon cancer with abdominal wall invasion and enterocutaneous fistula was found. We performed the right hemicolectomy and debridement of abdominal wall for the patients. However, the leakage of ileum-transverse colon anastomosis was found on postoperative day 3. We performed the resection of anastomosis and ileostomy. Nevertheless, 2 days after second operation, the abdominal wall of debridement became open by infection, and the small intestine was exposed. As the surgical treatment and NPWT was thought to be difficult because of infection, we started NPWTi-d on day 4 after second operation. 25 day after starting NPWTi-d, benign granulation covered the small intestine. NPWTi-d may be useful for wound dehiscence after surgery in infectious conditions.


Assuntos
Neoplasias do Colo , Tratamento de Ferimentos com Pressão Negativa , Idoso , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/complicações , Neoplasias do Colo/cirurgia , Humanos , Masculino , Titânio
5.
Int J Surg Oncol ; 2021: 8859879, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33604087

RESUMO

Results: The mean operative time was significantly longer in the LCME group than that in the OCME group with less mean intraoperative blood loss. Conversion was required in 4 patients (8.3%) in the LCME group. The use of laparoscopy increased the number of harvested lymph nodes compared to the open approach (39.81 ± 16.74 vs. 32.65 ± 12.28, respectively, P=0.010). The laparoscopic approach was associated with a shorter time interval to first flatus as well as shorter time interval to liquid and normal diet after surgery. The postoperative hospital stay was significantly shorter in the LCME group. The complication rate was slightly lower in the LCME (14.7%) than in the OCME group (27.2%) (P=0.252). The 3-year OS in the LCME group was similar to that in OCME (78.2% vs. 63.2%, respectively, P value = 0.423). The three-year DFS in the laparoscopic group was higher (74.5%) than the open group (60.0%), but did not reach statistical significance (P value = 0.266). Conclusions: In conclusion, laparoscopic CME right hemicolectomy is a technically feasible and safe procedure if surgeon expertise is present. LCME has long-term oncologic outcomes (recurrence and survival) comparable to open surgery for management of patients with stage II or III colon cancer.


Assuntos
Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia , Mesocolo/cirurgia , Idoso , Perda Sanguínea Cirúrgica , Colo Ascendente/cirurgia , Colo Transverso/cirurgia , Neoplasias do Colo/patologia , Conversão para Cirurgia Aberta , Intervalo Livre de Doença , Feminino , Humanos , Tempo de Internação , Excisão de Linfonodo , Linfonodos/patologia , Linfonodos/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Duração da Cirurgia , Recuperação de Função Fisiológica , Taxa de Sobrevida , Resultado do Tratamento
6.
Eur J Surg Oncol ; 47(6): 1357-1363, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33589240

RESUMO

INTRODUCTION: Neuroendocrine neoplasms (NEN) of the appendix are often incidentally discovered after appendectomy. Appropriate management is debated. The purpose was to characterize a cohort of 335 appendix NEN and evaluate the risk of recurrence. METHODS: Retrospective collection of data from 335 patients referred to the Neuroendocrine Tumor Center at Rigshospitalet 2000-2019. Appendix goblet cell carcinoids and mixed neuroendocrine non-neuroendocrine neoplasms were excluded. Patients were followed until December 31st, 2019. No patients were lost to follow-up. RESULTS: Sixty-three percent of the patients were female. The median (range) age at diagnosis was 34 (9-92) years. Median follow-up was 66 (1-250) months. Median tumor size was 7 (1-45) mm with 10 (3%) tumors >20 mm. In 18 specimens (5%) resection margins were positive. Mesoappendiceal invasion was found in 113 (35%). Sixty-three (19%) patients underwent right-sided completion hemicolectomy (RHC) after appendectomy according to ENETS guidelines. Among these, 11 (17%) had lymph node metastases in the resected tissue. Further, one patient who underwent initial RHC due to colonic adenocarcinoma had lymph node metastases. All lymph node metastases were detected in patients with serotonin positive tumors. No patients with glucagon positive tumors (n = 85) had lymph node metastases. Mesoappendiceal invasion >3 mm and positive resection margins were associated with presence of lymph node metastases. No recurrences were recorded. CONCLUSION: Following ENETS guidelines may lead to overtreatment of patients with respect to completion RHC. The risk of over- and undertreatment needs to be further evaluated.


Assuntos
Neoplasias do Apêndice/patologia , Neoplasias do Apêndice/cirurgia , Colectomia , Recidiva Local de Neoplasia/patologia , Tumores Neuroendócrinos/secundário , Tumores Neuroendócrinos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Neoplasias do Apêndice/metabolismo , Criança , Cromogranina A/metabolismo , Colo Ascendente/cirurgia , Dinamarca , Feminino , Seguimentos , Glucagon/metabolismo , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Margens de Excisão , Sobremedicalização , Pessoa de Meia-Idade , Invasividade Neoplásica , Tumores Neuroendócrinos/metabolismo , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Serotonina/metabolismo , Carga Tumoral , Adulto Jovem
9.
Eur J Surg Oncol ; 47(6): 1332-1338, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33004273

RESUMO

INTRODUCTION: European Neuroendocrine Tumour Society (ENETS) recommends managing appendiceal neuroendocrine tumours (aNET) with appendicectomy and possibly completion right hemicolectomy (CRH). However, disease behaviour and survival patterns remain uncertain. MATERIALS AND METHODS: We retrospectively assessed the impact of lymph nodes and CRH on outcomes, including survival, in all aNET patients diagnosed between 1990 and 2016. RESULTS: 102 patients (52F, 50 M), median age 39.4 (range 16.3-81.1) years, were diagnosed with aNET. Mean tumour size was 12.7 (range 1-60) mm, most sited in appendiceal tip (63%). Index surgery was appendicectomy in 79% of cases while the remainder underwent colectomy. CRH performed in 30 patients at a median 3.2 (range 1.4-9.8) months post-index surgery yielded residual disease in nine: lymph nodes (n = 8) or residual tumour (n = 1). Univariate logistic regression showed residual disease was significantly predicted by tumour size ≥2 cm (p = 0.020). Four patients declined CRH, but did not suffer relapse or reduced survival. One patient developed recurrence after 16.5 years of follow-up and another patient developed a second neuroendocrine tumour after 18.8 years follow-up. There were 5 deaths; one being aNET-related. 5-year and 10-year overall survival were 99% and 92% respectively; 5-year and 10-year relapse-free survival were 98% and 92% respectively. Only 5-year relapse-free survival was affected by ENETS stage (p = 0.002). CONCLUSION: aNETs are indolent with very high rates of overall and relapse-free survival. Recurrence is rare, and in this series only occurred decades later, making a compelling case for selective surveillance and follow-up. The significance of positive lymph nodes and the necessity for completion right hemicolectomy remain unclear.


Assuntos
Neoplasias do Apêndice/cirurgia , Colectomia , Linfonodos/patologia , Recidiva Local de Neoplasia , Segunda Neoplasia Primária , Tumores Neuroendócrinos/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia , Neoplasias do Apêndice/patologia , Colo Ascendente/cirurgia , Feminino , Seguimentos , Humanos , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasia Residual , Segunda Neoplasia Primária/patologia , Tumores Neuroendócrinos/secundário , Reoperação , Estudos Retrospectivos , Taxa de Sobrevida , Carga Tumoral , Adulto Jovem
12.
BMC Gastroenterol ; 20(1): 345, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066743

RESUMO

BACKGROUND: Tunneled peritoneal drainage catheters are described as an effective and relatively safe method in the management of malignant and non-malignant refractory ascites. Therapeutic advantages, linked to their use, are self-management of ascites and palliative care at home. Complications occur rarely. We describe an ascending colon perforation after implantation of a peritoneal drainage in a patient with refractory ascites due to liver cirrhosis. CASE PRESENTATION: The 68-year-old male was admitted to the intensive care unit due to severe community acquired pneumonia. The ascites drainage was inserted in order to reduce the intra-abdominal pressure and enable appropriate ventilation. A few hours later, bowel content could be detected in the tube and an abdominal computed tomography confirmed the intestinal perforation. Notably, there was no pneumoperitoneum and peritonitis had not yet set in. The catheter was removed during an emergency laparotomy and sutured closure of both perforation sites was performed. CONCLUSION: Patients with septated ascites and intraperitoneal adhesions are at potential higher risk of bowel perforation during implantation of an indwelling peritoneal catheter. A mini-laparotomy is, therefore, necessary in order to ensure safe implantation and positioning of the catheter in those cases.


Assuntos
Colo Ascendente , Paracentese , Idoso , Ascite/etiologia , Ascite/cirurgia , Cateteres de Demora/efeitos adversos , Colo Ascendente/cirurgia , Drenagem , Humanos , Masculino
14.
Chirurgia (Bucur) ; 115(4): 493-504, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32876023

RESUMO

Introduction: The laparoscopic approach to right colectomy is gradually gaining a leading role in the surgical treatment of right colonic diseases. However, not all aspects of the procedure are standardized and the method of reconstruction of the digestive tract is still under debate. The present study critically evaluates the extracorporeal (EA) and intracorporeal (IA) techniques used for creation of the ileocolic anastomosis during a laparoscopic right colectomy. Material and Method: The EA and IA anastomotic techniques are described in detail. The peri operative data of a cohort of consecutive patients operated by our surgical team was retrospectively recorded and analyzed regarding type of anastomosis, the path for transition from EA to IA and the incidence of postoperative complications. Furthermore, an analysis of randomized clinical trials, reviews and meta-analyses that provided a comparative evaluation of EA versus IA was performed to provide a more in-depth integration of our own data into the literature. Results: EA was used at the beginning of our experience but was later replaced by IA which became the favorite anastomotic technique. There was no anastomotic fistula recorded in the EA or IA groups but in our cohort IA was unexpectedly associated with higher incidence of peritoneal drainage, prolonged ileus, surgical site infections, anastomotic bleeding and chyloperitoneum. However, IA allows better visualization of the ileal and colonic stumps, avoids twisting of the anastomosis, prevents extraction-related tearing of the mesocolon and reduces the risk of post operative hernia. Data from the literature also shows that IA is generally associated with earlier postoperative return of bowel function, less morbidity and less postoperative pain. Conclusions: Based on this study and the data currently present in the literature it can not be concluded that IA should be considered as the standard of care for laparoscopic right colectomy. The decision for an EA or IA anastomosis ultimately belongs to the surgeon and is influenced by his surgical skill and experience. The results of ongoing randomized controlled trials on large group of patients may bring more clarity on this issue in the future.


Assuntos
Anastomose Cirúrgica/normas , Colectomia/normas , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Íleo/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/normas , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Colectomia/métodos , Humanos , Laparoscopia , Ensaios Clínicos Controlados Aleatórios como Assunto , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
15.
Clin J Gastroenterol ; 13(6): 1189-1195, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32780275

RESUMO

Guidelines recommend surveillance colonoscopy for patients with an ulcerative colitis (UC) duration of 8-10 years. We experienced a patient who had not undergone UC surveillance. A 35-year-old Japanese woman developed diarrhea and abdominal pain in January 2018 and was diagnosed with UC. She underwent medical therapy, and 18 months after onset of UC colonoscopy indicated that her UC activity was remission and showed no cancer lesions. Twenty-four months after onset, colonoscopy revealed a tumor in the ascending colon, and the biopsy revealed tubular adenocarcinoma. She had no family history of colorectal cancer. There were no findings of distant metastases or primary sclerosing cholangitis. Laparoscopy-assisted anus-preserving total proctocolectomy, the creation of a J-type ileal pouch, ileal pouch anal anastomosis, and the creation of an ileostomy were performed. The pathological report was type 3, 30 × 27-mm, adenocarcinoma (por2 > tub2), pT4a, Ly1a, V1a, budding grade 3, pN0, M0, Stage IIb. Some colitic cancers such as our patient's may not conform to the existing guidelines. When a colonoscopy is being performed for a UC patient, even if its timing is less < 8 years since the UC onset, suspicious lesions should be biopsied considering the possibility of cancer.


Assuntos
Colite Ulcerativa , Neoplasias do Colo , Bolsas Cólicas , Proctocolectomia Restauradora , Adulto , Colite Ulcerativa/complicações , Colite Ulcerativa/cirurgia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Feminino , Humanos
16.
Tech Coloproctol ; 24(11): 1207-1211, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32583146

RESUMO

BACKGROUND: Previous studies have demonstrated that pure transanal endoscopic surgery is safe and feasible in the treatment of rectal cancer. However, the role of pure transanal endoscopic colectomy in ascending colon cancer (ACC) treatment has not been evaluated. We report a case of transanal endoscopic surgery for ACC. METHODS: A 35-year-old woman was treated for ACC, using a transanal endoscopic surgery device as the operation platform, and pure transanal endoscopic right hemicolectomy without transabdominal assistance was safely performed. An instrument suture, side-to-side, ileocolic anastomosis was performed. Operative time was 245 min and intraoperative blood loss was 60 ml. RESULTS: The patient recovered well from the surgery. Compared with the traditional approach, this approach was less invasive and resulted in satisfactory outcomes and cosmesis (no scar). CONCLUSIONS: Application of pure transanal endoscopic colectomy without abdominal assistance to ACC appears to be feasible and safe.


Assuntos
Cirurgia Endoscópica por Orifício Natural , Neoplasias Retais , Cirurgia Endoscópica Transanal , Adulto , Colectomia , Colo Ascendente/cirurgia , Feminino , Humanos , Neoplasias Retais/cirurgia
18.
Chirurgia (Bucur) ; 115(1): 102-111, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155405

RESUMO

Goblet cell carcinoids (GCC) are extremelyrare neuroendocrine tumours, and characterised by their unique combination of two types of cancer cells âÃÂ" neuroendocrine (carcinoid) and epithelial (adeno-carcinoma). In spite of the fact that GCC is regarded as Neuro-Endocrine Tumour (NET), it does not illicit carcinoid syndrome. GCC usually arises in the appendix and accounting for less than 14% of all appendiceal tumours.Primary extra-appendiceal GCC have been reported as stomach, duodenum, small intestine, colon and rectum. The paper presents a rare case of GCC of the ascending colon in a 57-year-old male.


Assuntos
Tumor Carcinoide/patologia , Tumor Carcinoide/cirurgia , Colo Ascendente/patologia , Neoplasias do Colo/patologia , Colectomia , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
19.
Ann R Coll Surg Engl ; 102(2): e39-e41, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31532226

RESUMO

Approximately 5% of intestinal obstruction cases are caused by internal herniation. Caecal herniation through the foramen of Winslow is considered a rare event. The management of caecal herniation remains challenging due to the lack of literature highlighting this pathology. A 66-year-old woman was admitted with a 24-hour history of epigastric pain radiating to the back. The pain was associated with nausea and vomiting of gastric contents. On examination, the abdomen was soft with mild tenderness but no signs of peritonism or distension. The abdominal x-ray and a computed tomography were in keeping with caecal volvulus and confirmed that the caecum was not in the right iliac fossa. In a midline laparotomy procedure, the ileum, caecum and ascending colon were noted to be herniating into the foramen of Winslow. A right hemicolectomy with a handsewn anastomosis was performed. The foramen of Winslow was not closed. No postoperative complications occurred. A literature review showed a lack of similar cases with no agreed management consensus. The laparotomy approach is comparable to the laparoscopic approach and no caecal herniation recurrence after open/laparoscopic surgical procedures were identified. Awareness of caecal herniation allows early diagnosis and timely surgical management is needed in prevent patient morbidity and mortality.


Assuntos
Ceco/diagnóstico por imagem , Colo Ascendente/diagnóstico por imagem , Hérnia Abdominal/diagnóstico por imagem , Idoso , Doenças do Ceco/diagnóstico por imagem , Doenças do Ceco/cirurgia , Ceco/cirurgia , Colo Ascendente/cirurgia , Feminino , Hérnia Abdominal/cirurgia , Herniorrafia/métodos , Humanos , Obstrução Intestinal/diagnóstico por imagem , Obstrução Intestinal/cirurgia , Radiografia Abdominal , Tomografia Computadorizada por Raios X
20.
Surg Endosc ; 34(2): 557-563, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31011862

RESUMO

BACKGROUND: Laparoscopic right hemicolectomy is a commonly performed procedure. Little is known on how to perform the enterotomy closure after stapled side-to-side intracorporeal anastomosis. METHOD: A multicentric case-controlled study has been designed to compare different ways to fashion enterotomy closure: double layer versus single layer, sewn versus stapled, and robotic versus laparoscopic approach. Furthermore, additional characteristics including sutures' materials, interrupted versus running suture and the presence of deep corner suture has been investigated. RESULTS: We collected data for 1092 patients who underwent right hemicolectomy at ten centers. We analyzed 176 robotic against 916 laparoscopic anastomosis: no significant differences were found in terms of bleedings (p = 0.455) and anastomotic leak (p = 0.405). We collected data from 126 laparoscopic sewn single-layer versus 641 laparoscopic sewn double-layer anastomosis: a significant reduction was recorded in terms of leaks in double-layer group (p = 0.02). About double-layer characteristics, we found a significant reduction of bleedings (p = 0.008) and leaks (p = 0.017) with a running suture; similarly, a reduction of bleedings (p = 0.001) and leaks (p = 0.005) was observed with the usage of deep corner closure. The presence of a barbed suture thread seemed to significantly reduce both bleedings (p = 0.001) and leaks (p = 0.001). We found no significant differences in terms of bleedings (p = 0.245) and anastomotic leak (p = 0.660) comparing sewn versus stapled anastomosis. CONCLUSIONS: Fashioning a stapled ileocolic intracorporeal anastomosis, we can recommend the adoption of a double-layer enterotomy closure using a running barbed suture in the first layer. Totally, stapled closure and robotic assistance have to be considered a non-inferior alternative.


Assuntos
Anastomose Cirúrgica , Colectomia/métodos , Colo Ascendente/cirurgia , Neoplasias do Colo/cirurgia , Íleo/cirurgia , Técnicas de Sutura , Técnicas de Fechamento de Ferimentos , Idoso , Fístula Anastomótica/cirurgia , Estudos de Casos e Controles , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Procedimentos Cirúrgicos Robóticos , Grampeamento Cirúrgico
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