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BACKGROUND: Single-incision laparoscopic surgery (SILS) and single-incision plus one-port laparoscopic surgery (SILS+1) for colorectal cancer are considered to require long operative times, experienced surgeons, and advanced surgical techniques. However, these procedures are advantageous because they require both fewer ports and fewer surgeons. PATIENTS AND METHODS: In the SILS procedure for colon cancer, a Lap Protector™ (LP; Hakkou Shoji, Japan) is inserted through a 2.5 cm transumbilical incision. Next, an EZ-Access (Hakkou Shoji, Japan) is mounted onto the LP, and three ports are made in the EZ-Access. In SILS+1 for rectal cancer, we use an extra incision in the lower quadrant for drainage from the beginning of the operation. Data from 849 patients who underwent elective surgery with SILS or SILS+1 for colorectal cancer were reviewed. RESULTS: In 808 patients who underwent a reduced-port procedure for colorectal cancer, the mean incision length was 2.91 cm. The average operative time was 198.2 minutes, and average intra-operative blood loss was 25.6 mL. Complications with a Clavien-Dindo classification of II or greater occurred in 63 patients (7.2%). Among 654 stage I-III colorectal cancer patients, 69 (10.6%) experienced postoperative relapse during the follow-up period of 42 months. CONCLUSIONS: Our cumulative findings support the use of SILS or SILS+1 in patients with colorectal cancer. The long-term oncologic outcomes make them acceptable technical alternatives to conventional multiport laparoscopic colectomy. Further trials are still needed to fully document the non-cosmetic benefits.
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Neoplasias Colorretais , Laparoscopia , Neoplasias Colorretais/cirurgia , Humanos , Tempo de Internação , Recidiva Local de Neoplasia , Duração da Cirurgia , Resultado do TratamentoRESUMO
PURPOSE: In surgery for colorectal cancer, dissection of the lymph nodes and fatty tissue around the root of the inferior mesenteric artery is important from an oncologic point of view. However, it is debatable whether it is better to preserve or remove the left colic artery (LCA). This study aimed to compare D3 lymphadenectomy with versus without LCA preservation in single-incision laparoscopic surgery for sigmoid and rectosigmoid cancer. METHODS: A total of 1138 patients underwent surgery for colorectal cancer between April 2011 and December 2018 at Fukui Prefectural Hospital. This propensity score-matched retrospective study analyzed the data of 163 patients: 42 patients with LCA preservation (group A) and 129 without LCA preservation (group B). Clinical and oncological outcomes were compared between the two groups. RESULTS: There were no significant differences between groups A and B in patient characteristics, surgical outcomes, including the 5-year overall survival rate (75% vs. 64.2%, hazard ratio [HR] 1.34, 95% confidence interval [CI] 0.37-4.30), 5-year disease-free survival rate (85.7% vs. 85.7%, HR 0.99, 95% CI 0.24-4.22), and 5-year cancer-specific survival rate (92.8% vs. 89.3%, HR 1.50, 95% CI 0.25-11.4). CONCLUSION: There were no significant differences in the short- and long-term outcomes of patients who underwent single-incision laparoscopic surgery with D3 lymphadenectomy with versus without LCA preservation. This suggests that LCA preservation is safe and feasible in single-incision laparoscopic surgery for sigmoid and rectosigmoid colon cancer.
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Laparoscopia , Neoplasias Retais , Neoplasias do Colo Sigmoide , Humanos , Artéria Mesentérica Inferior/cirurgia , Estudos Retrospectivos , Pontuação de Propensão , Excisão de Linfonodo , Neoplasias Retais/cirurgia , Neoplasias do Colo Sigmoide/cirurgiaRESUMO
A 65-year-old man presented to our hospital with complaints of diarrhea. Computed tomography showed a fistula with the small intestine, and a single incision laparoscopic low anterior resection for rectum with D3 dissection and partial resection of the small intestine were performed. Lymph node dissection, including a part of the inflow vessel area, was also performed because lymph node swelling was observed in the mesentery of the small intestine around the fistula. Histopathological analysis revealed that the lymph nodes in the small intestine were positive for metastasis. The patient was a 61-year-old woman who presented to our hospital with a chief complaint of diarrhea. A partial resection of the small intestine, including resection of the left hemicolectomy and lymph node dissection around the fistula, was performed at laparotomy. Histopathological examination revealed numerous lymph node metastases in the small intestinal mesentery.
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BACKGROUND: Although sacrococcygeal teratoma (SCT) is relatively common in children, it is rare in adults. The prognosis for malignant cases is poor, so prompt surgical resection is required. Transabdominal and transsacral approaches are common approaches for tumor resection. In recent years, there have been reports of tumor removal with laparoscopic assistance, but all have applied transabdominal approaches. CASE PRESENTATION: A 27-year-old woman visited our gynecology department because of abdominal pain and genital bleeding. Magnetic resonance imaging (MRI) revealed a 3-cm-sized cystic mass in the left retrorectal area, and she was referred to our department for detailed examinations and treatment. She was diagnosed with a presacral cystic tumor and decided to undergo surgery. We used a transsacral approach to perform tumor excision. Since it was difficult to confirm the deep part of the tumor through direct visualization, we used GelPOINT® Path (a transanal access platform) and AirSEAL® System (insufflation device) to remove the tumor endoscopically. The postoperative course was uneventful with no bladder or rectal dysfunction. Histopathological examination revealed a mature teratoma. CONCLUSIONS: When the tumor is relatively small and located in the lower sacrum, the endoscopically assisted transsacral approach can establish a stable field of view by expanding the depth of the surgical field. This method is useful considering its ability to perform excision without leaving residual tumor tissue and satisfactory safety and cosmetic results.
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INTRODUCTION: This study aims to evaluate the safety and feasibility of single-port laparoscopic colectomy (SPLC) in elderly patients with colon cancer. METHODS: During the study period, 344 patients underwent SPLC in our hospital. Among them, 87 patients were aged 80 years and older, and 257 patients were younger than 80 years. After 1:1 propensity-score matching, 87 elderly patients were compared with 87 young patients. RESULTS: Short-term clinical outcomes after SPLC were equivalent between the two groups, although the elderly group had a higher ASA score and more postoperative complications. The 5-year overall survival rates were 64.6% in the elderly group and 66.8% in control group. The 5-year cancer-specific survival rates were 78.0% in the elderly group and 70.9% in control group. There were no significant differences between the groups. CONCLUSION: Our results indicated that SPLC is technically feasible for operative teams that have adequately standardized the procedure, and it is oncologically safe in elderly patients with colon cancer.
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Colectomia/efeitos adversos , Neoplasias do Colo/cirurgia , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
INTRODUCTION: Enema examination is considered safe, but in rare cases, complications may result. Here, we report a rare case of iatrogenic bowel perforation during enema examination through a colostomy without leakage of contrast agent. PRESENTATION OF CASE: A 36-year-old man who had undergone a sigmoid loop colostomy was diagnosed with ulcerative colitis. A bowel enema through a colostomy was performed by nurses and radiological technologists. During the procedure, a balloon catheter was inserted into the proximal lumen of the colostomy, and the balloon was inflated. The patient developed severe abdominal pain a few minutes following withdrawal of the catheter. Computed tomography showed intraperitoneal free air, although contrast agent leakage into the intraperitoneal cavity was not observed. The patient underwent emergency laparotomy. Intraoperatively, there was a 3-cm bowel perforation just inside the colostomy where the inflated balloon was pressing. DISCUSSION: The perforation site may have been sealed by the inflated balloon during the enema examination. In addition, the patient maintained a supine position during and after the examination. This led to contrast agent accumulating on the dorsal side and not leaking out from the perforation site after the balloon was deflated. CONCLUSION: Iatrogenic bowel perforation can occur without leakage of contrast agent during enema examination through a colostomy, and the examination should be performed under the supervision of an attending doctor. In the case of an enema examination through a colostomy, clinicians must be aware of the possibility of bowel perforation even if leakage of contrast agent is not observed.
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BACKGROUND: Douche injury is a rare consequence of water recreation activities. Generally, this type of trauma occurs when people fall into the water in a sitting position during high-speed activities such as using a personal watercraft (PWC). Here, we report a rare case of anorectal injury caused by water jets from a PWC during sudden acceleration from rest. CASE PRESENTATION: A 21-year-old male passenger on a PWC fell off backward from the rear seat when the craft suddenly accelerated. He fell into the water in a supine position with his legs open, and the water jets of the PWC struck his perineum directly. Thereafter, bleeding from the anus was seen, and he was transferred to our hospital. On physical examination, there was a deep laceration interrupting the external anal sphincter in the posterior rectal wall. Abdominal computed tomography revealed a full-layer perforation of the posterior rectal wall and leakage of feces into the extraperitoneal space, but intraperitoneal free air was not seen. Laparoscopic sigmoid loop colostomy and primary suturing of the sphincter and mucosa were performed. He did not have any complications and was discharged from our hospital 16 days after the surgery. His anal function was almost perfectly preserved, and his diverting colostomy was closed 4 months later. CONCLUSION: Anorectal injuries related to PWCs can occur not only while traveling at high speeds, but also when suddenly accelerating from rest. A diverting colostomy should be performed for this type of trauma. In these trauma cases, clinicians must suspect complex and life-threatening anorectal injuries early.
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BACKGROUND: We retrospectively reviewed our consecutive experience from the introduction of single-port laparoscopic surgery (SPS) for colon cancer, and its 5-year oncological outcomes are evaluated. METHODS: A total of 288 patients (140 males) with a mean age of 71.5 years were treated with the single-port laparoscopic colectomy for stage I, II and III colon cancers. Exclusion criteria of SPS were patients with unresolved bowel obstruction, T4b tumour, tumour perforation and severe medical illness. RESULTS: In 20 patients (6.9%), we inserted an extra port mainly to transect the rectum. The median follow-up period was 52 months. The 5-year relapse-free survival rates in stage I, II and III patients were 95.8%, 80.2% and 61.6%, respectively. The 5-year overall survival rates for stage I, II and III patients were 97.4%, 85.3% and 72.9%, respectively. The 5-year cancer-specific survival rates in patients diagnosed pathologically T1, T2, T3 and T4 were 100%, 100%, 92.1% and 73.9%, respectively. CONCLUSIONS: SPS colectomy can be applied to the treatment of colon cancer with good long-term oncological outcomes. However, we should pay more attention when we treat the pathologically diagnosed T4 tumours.
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Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/efeitos adversos , Laparoscopia/tendências , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Feminino , Seguimentos , Humanos , Laparoscopia/métodos , Laparoscopia/mortalidade , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias/métodos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Portal venous gas has traditionally been considered an inevitable harbinger of death due to its association with bowel necrosis. Recently, an increasing number of cases of portal venous gas have been reported in patients with various clinical conditions and without bowel necrosis. We herein report the case of a patient in whom portal venous gas developed after transverse colon cancer surgery. CASE PRESENTATION: A 69-year-old man who had transverse colon cancer underwent insertion of a transanal ileus tube for decompression. Transverse colon resection was performed on the 11th day after the insertion of the transanal ileus tube. The patient had a high fever on the 6th day after the operation. Computed tomography showed portal venous gas over the entire area of the liver and pneumatosis intestinalis in the wall of the ascending colon. There were no signs of anastomotic leakage or bowel necrosis, so we decided to use conservative therapy with fasting and antibiotics. The portal venous gas disappeared on the 19th day after the operation. The patient was discharged in good condition on the 29th day after the operation. CONCLUSIONS: Conservative treatment for portal venous gas is reasonable for patients without signs of anastomotic leakage or bowel necrosis. However, it is important to carefully observe patients with portal venous gas during conservative treatment because portal venous gas may be life-threatening.
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Single-incision laparoscopic surgery (SILS) has been developed with the aim to further reduce the invasiveness of conventional laparoscopy. Our experiences with more than 300 consecutive patients with SILS for colon cancer are reviewed, and its outcomes are evaluated to determine the midterm clinical and oncologic safety of SILS for colon cancer in a community hospital. A single surgeon's consecutive experience of SILS for colon cancer is presented. Three hundred and eight patients were treated with the SILS procedure for colon cancer between December 2010 and March 2015. Data were analyzed according to intention to treat. Of these 308 patients, 19 (6.2%) were converted to laparotomy. Intraoperative injury occurred in five patients. Postoperative complications occurred in 19 patients (6.2%). The 2-year relapse-free survival rates of patients with Stage I, Stage II, and Stage III were 97.8, 92.2, and 80.4 per cent, respectively, and the 2-year overall survival rates of patients with Stage I, Stage II, Stage III, and Stage IV were 100, 95.7, 93.0, and 74.4 per cent, respectively. Our initial experiences showed that SILS colectomy for cancer can be performed safely and with good short-term oncologic outcomes by a skilled surgeon.
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Adenocarcinoma/cirurgia , Colectomia/métodos , Neoplasias do Colo/cirurgia , Laparoscopia/métodos , Adenocarcinoma/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias do Colo/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
BACKGROUND: Intragastric surgery is accepted as a minimally invasive procedure for mucosal or submucosal lesions. Robotic surgery promises to extend the capabilities of the minimally invasive surgeon and many surgical specialties are applying this new technology. However, there is no report of robotic intragastric surgery. We describe the use of the da Vinci Surgical System for intraluminal mucosal resection of the stomach. METHODS: We developed our porcine intragastric surgery model using the Tuebingen MIS Trainer. We set a tentative lesion on the posterior wall near the esophagocardiac junction (ECJ) of the stomach and performed mucosal resection of the lesion using the da Vinci Surgical System. We also performed closure of the defect after mucosal resection and subsequent closure of the intentional gastric perforation. RESULTS: Using our porcine intragastric surgery model, we successfully performed mucosal resection of the tentative lesion. We also smoothly completed closure of the defect and closure of the perforation without any complications. The mean size of the mucosa was 6 cm and the mean duration of the procedure was only 12 min. CONCLUSIONS: The safety and efficacy of robotic intragastric surgery was preliminarily established in this study. However, further studies are needed to prove its practical feasibility in humans using the da Vinci Surgical System to make it an effective operation.
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Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Robótica/instrumentação , Gastropatias/cirurgia , Animais , Modelos Animais de Doenças , Desenho de Equipamento , Suínos , Resultado do TratamentoRESUMO
BACKGROUND: p16(INK4a) is a tumor suppressor gene frequently inactivated by aberrant promoter hypermethylation. In the present study, p16(INK4a) methylation was evaluated in non-small cell lung cancer (NSCLC) using a quantitative assay and the clinical significance of the methylation was explored. MATERIALS AND METHODS: A total of 244 tumor samples from formalin-fixed paraffin-embedded archives were examined in this study. p16(INK4a) methylation was analyzed by the fluorescence-based, real-time methylation-specific PCR assay, MethyLight. The quantitative methylation value was expressed as the percentage of methylated reference (PMR). RESULTS: The median level of p16(INK4) methylation was 0.55 PMR (range 0.00-503.4). The p16(INK4) methylation value was significantly higher in males (p = 0.005) and in squamous cell carcinoma (p = 0.018). Prognostic analysis using the Cox proportional hazard model showed that the p16(INK4a) methylation value was a significant prognostic factor (odds ratio, 1.005; 95% CI, 1.003 to 1.008; p < 0.0001). The p16(INK4a) methylation value remained a significant prognostic factor (p = 0.0004) in multivariate analysis including age, gender, histological type and clinical stage. Specimens were then classified into hypermethylated or non-hypermethylated groups based on the p16(INK4a) methylation value using various cut-offs from 1 to 100 PMR. There was no significant difference in prognosis between the two groups using a cut-off value of 1 PMR. On the other hand, there was a significant difference using 6 PMR or more as the cut-off value (p < 0.01). CONCLUSION: These results provide clear evidence for the prognostic significance of p16(INK4a) methylation in NSCLC using quantitative DNA methylation analysis. Careful assessment of DNA methylation is needed because qualitative methylation analysis may overestimate low levels of methylation, which have less clinical significance.
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Carcinoma Pulmonar de Células não Pequenas/genética , Inibidor p16 de Quinase Dependente de Ciclina/genética , Metilação de DNA , Neoplasias Pulmonares/genética , Idoso , Carcinoma Pulmonar de Células não Pequenas/patologia , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Prognóstico , Regiões Promotoras Genéticas , Análise de SobrevidaRESUMO
A 35-year-old woman with taxane and anthracycline-resistant recurrent breast cancer with multiple lung metastasis and carcinomatous lymphangitis was treated with CMF as third-line chemotherapy. A complete response was achieved,and the toxicities were tolerable. We thought that CMF could be a useful regimen as third-line chemotherapy for metastatic breast cancer.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias da Mama/tratamento farmacológico , Neoplasias Pulmonares/tratamento farmacológico , Neoplasias Pulmonares/secundário , Adulto , Antraciclinas/farmacologia , Antineoplásicos Hormonais/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Neoplasias da Mama/patologia , Neoplasias da Mama/cirurgia , Hidrocarbonetos Aromáticos com Pontes/farmacologia , Quimioterapia Adjuvante , Ciclofosfamida/administração & dosagem , Esquema de Medicação , Resistencia a Medicamentos Antineoplásicos , Feminino , Fluoruracila/administração & dosagem , Humanos , Linfangite/etiologia , Metotrexato/administração & dosagem , Qualidade de Vida , Indução de Remissão , Tamoxifeno/administração & dosagem , Taxoides/farmacologiaRESUMO
A 59-year-old man presenting with fecal occult blood visited our hospital. He was diagnosed with advanced lower rectal cancer, which was contiguous with the prostate and the left seminal vesicle. There were no metastatic lesions with lymph nodes or other organs. We performed laparoscopic total pelvic exenteration (LTPE) using transanal minimal invasive surgery technique with bilateral en bloc lateral lymph node dissection for advanced primary rectal cancer after neoadjuvant chemoradiotherapy. The total operative time was 760 min, and the estimated blood loss was 200 ml. LTPE is not well established technically, but it has many advantages including good visibility of the surgical field, less blood loss, and smaller wounds. A laparoscopic approach may be an appropriate choice for treating locally advanced lower rectal cancer, which requires TPE.
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MYOD1 promoter methylation occurs in various malignancies including colorectal cancer. We analyzed MYOD1 methylation in 80 colorectal cancer and 74 adjacent normal tissues using MethyLight, which enabled quantitative DNA methylation analysis. The measured methylation value was expressed as a percentage of methylated reference (PMR). The results were compared with clinicopathological features and patient prognosis in order to investigate whether MYOD1 methylation may serve as an independent prognostic factor of colorectal cancer. MYOD1 promoter methylation was detectable in all samples and was significantly higher in tumor compared to normal mucosa, where the median level of methylation was 5.3 PMR (range 0.03-133.4) in normal mucosa and 42.3 PMR (range 0.44-742.9) in tumor. The methylation value of MYOD1 was higher with elder patients both in normal colonic mucosa (p=0.034) and in cancer tissues (p=0.0012). Patients without MYOD1 hypermethylation showed significantly longer survival than those with hypermethylation (p=0.0077). In multivariate analysis of prognostic factors, MYOD1 hypermethylation was a significant prognostic factor (p=0.015) independent to patients' age. These results suggest that MYOD1 hypermethylation plays an important role in colorectal cancer and may be a novel prognostic factor. In addition, quantitative methylation analysis by MethyLight is encouraged for other genes showing age-related and non-cancer-specific methylation.
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Neoplasias Colorretais/genética , Metilação de DNA , DNA de Neoplasias/química , DNA de Neoplasias/genética , Proteína MyoD/genética , Idoso , Neoplasias Colorretais/química , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reação em Cadeia da Polimerase/métodos , Prognóstico , Regiões Promotoras GenéticasRESUMO
We report here a very rare case of pneumomediastinum due to spontaneous tracheal rupture with tracheobronchomalacia. The patient was a 74-year-old woman who had suffered nocturnal dyspnea due to productive cough for five days prior to admission and had been treated with corticosteroids for five years at another hospital after being diagnosed with bronchial asthma. Computed tomographic scanning of the chest demonstrated over 1 cm longitudinal small air collections behind the upper trachea. Crescent-type tracheobronchomalacia was diagnosed by emergency bronchoscopy. At the right side of the upper trachea, a 1-cm laceration was revealed. Fibrin glue (Bolheal, Kaketsuken, Kumamoto, Japan) was sprayed on the laceration through an instrument of our design for endoscopic gluing and she was intubated for three days. Furthermore, treatment including administration of antibiotics, an antitussive agent, and a mucolytic agent, in addition to pulmonary physical therapy involving pursed lip breathing exercises and smoking cessation improved her complaints one month after admission.
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Broncopatias/complicações , Enfisema Mediastínico/etiologia , Traqueia/lesões , Doenças da Traqueia/complicações , Idoso , Broncopatias/diagnóstico , Feminino , Humanos , Enfisema Mediastínico/diagnóstico , Ruptura Espontânea , Doenças da Traqueia/diagnósticoRESUMO
PURPOSE: Checking bowel viability is difficult but important during surgery for ischemic bowel disease or jejunal autotransplantation. We investigated the effectiveness of two-wavelength near-infrared spectroscopy (NIRS) to quantify tissue oxygen saturation (StO(2)), which can affect bowel viability during reconstruction of the cervical esophagus using a free jejunal graft. METHODS: Free jejunal autotransplantation was performed after resection of the hypopharynx, larynx, and cervical esophagus in 12 pigs. The arterial blood flow and StO(2) of the graft were measured before harvesting the graft and after reperfusion. We analyzed the measurement site of the graft and the anastomotic method as possible factors influencing StO(2). We also examined the relationship between the blood flow and StO(2) of the autograft. RESULTS: The StO(2) at the distal site of the graft was significantly lower than that at the midpoint of the graft (P < 0.05). There was a correlation between the blood flow of the graft artery, measured by the transonic volume flowmeter, and the StO(2) of the graft, measured by NIRS. CONCLUSIONS: Tissue oxygen saturation of the free jejunal graft can be safely and reliably measured with two-wavelength NIRS. Therefore, NIRS is a promising new method for evaluating the viability of the gastrointestinal tract.
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Jejuno/irrigação sanguínea , Jejuno/transplante , Consumo de Oxigênio/fisiologia , Procedimentos de Cirurgia Plástica/métodos , Espectroscopia de Luz Próxima ao Infravermelho , Animais , Modelos Animais de Doenças , Esofagectomia/efeitos adversos , Esofagectomia/métodos , Feminino , Hemodinâmica/fisiologia , Cuidados Pós-Operatórios/métodos , Probabilidade , Análise de Regressão , Sensibilidade e Especificidade , Suínos , Transplante AutólogoRESUMO
We report a rare case of a congenital sternal cleft. The patient was a full-term baby girl with a superior incomplete sternal cleft with patent ductus arteriosus (PDA). A primary repair of the sternum and ligation of the PDA were performed during the neonatal period without cardiac compression. Primary repair during the neonatal period is the optimal procedure for cases of congenital sternal cleft.