In Europe and the United States, the standard treatment for squamous cell carcinoma of the anal canal is chemoradiotherapy (CRT), whereas it has been surgical therapy for many years in Japan. ...Therefore, there are only a few reports on the results of CRT treatment for Japanese patients. We evaluated the short- and long-term outcomes of CRT in 17 patients with squamous cell carcinoma of the anal canal from January 2008 to February 2019. Grade 3 or higher adverse events were diarrhea (5.9%), myelosuppression (47.1%), and dermatitis associated with radiation (53.0%). 13 patients had no recurrence, while four had local recurrence: among them, three underwent salvage surgery and one received interstitial brachytherapy (ISBT), resulting in the survival of two patients without recurrence. The 3-year disease-free survival rate was 76.5%, and the 3-year overall survival rate was 88.2%. Our results suggested that CRT for squamous cell carcinoma of the anal canal could be performed safely with acceptable oncological outcomes.
PURPOSE:Pelvic exenteration (PE) for locally advanced or recurrent colorectal cancer is often used to secure negative resection margins. The aim of this study was to evaluate the feasibility of ...laparoscopic PE.
MATERIALS AND METHODS:The clinical records of 24 patients (9, open; 15, laparoscopic) who underwent total or posterior PE for locally advanced or recurrent colorectal cancer between July 2012 and April 2016 at Osaka National Hospital were retrospectively reviewed. Operative factors were compared between the 2 groups.
RESULTS:The R0 resection rate was 100% in the laparoscopic group and 89% in the open group. The operative time and the incidence of postoperative complications were not significantly different between the 2 groups. The laparoscopic group showed less intraoperative blood loss (P=0.019), a lower C-reactive protein elevation on postoperative day 7 (P=0.025), and a shorter postoperative hospital stay (P=0.0009).
CONCLUSIONS:Laparoscopic PE is a safe and feasible procedure to reduce postoperative stress.
Objective: The aim of this study was to identify risk factors for bleeding complications in patients who receive Venous thromboembolism (VTE) prophylaxis with fondaparinux (FPX) after colorectal ...cancer surgery. Methods: Records of 546 patients who underwent VTE prophylaxis with intermittent pneumatic compression and FPX after colorectal cancer surgery between January 2009 and May 2014 were reviewed. Patient characteristics, surgical procedures, and patient laboratory data were examined to identify risk factors for bleeding complications using univariate and multivariate logistic regression. Results: We reviewed the records of 324 males and 222 females. Median age and BMI were 68.5 years and 22.7 kg/m2, respectively. The number of laparoscopic surgeries was 366. Median operative time and blood loss were 188.5 min and 20 ml, respectively. The incidence (%) of bleeding events was 5.3%. In univariate analysis, age ≥80 years, BMI ≥25.0 kg/m2, hypertension, and antithrombotic therapy were associated with a significantly higher incidence of bleeding events. Multivariate analysis identified age ≥80 years (odds ratio 5.814; 95% confidence interval 2.502-13.278) as an independent risk factor. Conclusion: Age ≥80 is a risk factor for bleeding in patients who receive FPX for VTE prophylaxis after colorectal cancer surgery.
Situs inversus totalis (SIT) is a rare anatomic anomaly in which organs in the chest and abdomen exist in a mirror image reversal of their normal positions. SIT can complicate surgical procedures, ...and few reports have described laparoscopic surgery for colorectal cancer in patients with SIT. Here, we report a case of successful laparoscopic surgery in a patient with SIT and sigmoid colon cancer. Laparoscopic sigmoidectomy involved colonic mobilization with high ligation of the inferior mesenteric vessels and complete mesocolic excision. The operating surgeon stood on the patient's left side, opposite the normal location for sigmoidectomy. By placing a 12‐mm trocar in the left iliac fossa and using an automatic endoscopic linear stapler, the operating surgeon was able to perform left‐handed colon resection without having to change position or move the laparoscopic monitor mid‐procedure. An automatic endoscopic linear stapler is useful for laparoscopic left‐side colon surgery in a patient with SIT.
A 60-year-old man was referred to our hospital for the evaluation and treatment of general malaise. Contrast-enhanced computed tomography detected sigmoid colon cancer that had invaded the bladder, ...multiple liver metastases, and a small intestinal tumor. Hartmann's procedure was performed, with partial bladder and small bowel resection. A pathological examination revealed that the patient had sigmoid colon cancer and a gastrointestinal stromal tumor. The biopsy findings of a tumor in segment 8 of the liver indicated the presence of adenocarcinoma, thereby indicating the origin of multiple liver metastases from sigmoid colon cancer. On chemotherapy, the tumors in liver segments 2/3 and 8 shrank. However, the tumor in segment 6 enlarged. Since radical resection of all metastatic liver tumors was possible, hepatectomy was performed 10 months after the initial surgery. A pathological examination revealed that the tumors in segments 2/3, 4, and 8 were adenocarcinomas and the tumors in segments 4, 6, and 7 had originated from the gastrointestinal stromal tumor. This suggested the coexistence of liver metastases from sigmoid colon cancer and the gastrointestinal stromal tumor. In cases involving multiple primary tumors, it is necessary to consider the possible coexistence of multiple metastases from different primary tumors.
Aim: Five hundred twenty-five patients undergoing defecography (297 females), with a median age of 68 (range, 17 - 93), were enrolled in this study.Results: The findings of each of (overlapping) ...rectocele, wide rectum, intussusception, sigmoidcele, paradoxical puborectalis contraction, puborectalis insufficiency of relaxation, stuck pelvic floor, poor anal canal opening, perineal descent, and serrated rectum were investigated. Regarding gender differences (female vs. male), females were more likely to have rectocele (p < 0.0001), wide rectum (p = 0.0309) and perineal descent (p < 0.0001). Meanwhile, males were more likely to have puborectalis insufficiency of relaxation (p < 0.0001) and stuck pelvic floor (p < 0.0001). In addition, when investigated separately for structural defecation disorder and functional defecation disorder, structural was more common in females (p < 0.0001), functional was more in males (p < 0.0001), and both of them were observed more commonly in females (p = 0.0006).Conclusion: It is considered that defecation disorder can be diagnosed only by defecography in females but in males, additional tests such as anorectal manometry are more needed.
A 66-year-old man with a history of frequent diarrhea was diagnosed with rectal cancer with obstruction and a pelvic abscess. Following a transverse colostomy, he was referred to our hospital. The ...initial diagnosis was rectal cancer(cT4a N1bM0, cStage Ⅲb)and a pelvic abscess due to tumor perforation. To address this condition, we performed neoadjuvant chemotherapy using a combination of 5-fluorouracil, Leucovorin, oxaliplatin, and irinotecan(FOLFOXIRI). Following 6 courses of FOLFOXIRI, the abscess disappeared and no signs of tumor progression and distant metastases were detected. Subsequently, we performed radical resection with D3LD2 lymph node dissection, leading to a pathological diagnosis of ypT3N1aM0, ypStage Ⅲb. The patient then underwent adjuvant chemotherapy with capecitabine and oxaliplatin(CAPOX). No recurrence was observed after 9 months of follow-up.
A 34-year-old woman presented with a complaint of swelling of the buttock. A physical examination indicated a subcutaneous soft elastic tumor. CT and MRI showed a 6-cm subcutaneous dumbbell-shaped ...cystic tumor in the buttock, extending into the pelvic cavity. Laparoscopic resection with a transsacral approach was performed without an accurate preoperative diagnosis. Laparoscopically we found a subcutaneous tumor in the buttock penetrating into the pelvic cavity on the dorsal side of the mesorectum, through the gap of the levator ani muscle around the coccygeal bone. The cystic tumor and coccygeal bone were totally resected. Pathological findings of the specimen revealed a cyst wall composed of squamous epithelium that contained atheromatous contents. The lesion was diagnosed as an epidermal cyst. The patient was discharged from hospital on the eighth postoperative day without any complications. There has been no recurrence of symptoms after surgery. An epidermal cyst is a benign tumor that is commonly experienced in daily medical practice. Malignant transformation of epidermal cysts are reported on rare occasions, and total resection of the tumor is recommended. This case shows that transsacral resection with laparoscopic surgery for cystic tumors extending from the buttocks into the pelvic cavity is a safe and appropriate surgical approach.
We investigated the present status of surgical site infection (SSI) in gastroenterological emergency surgery based on the surveillance data of our institute. The rate of SSI in the 217 patients ...studied was 31.3%, and it was significantly higher than that of the patients who underwent operations in scheduled procedures. Among the emergency procedures, the rate of SSI was more than 50% in the patients who were operated on for gastrointestinal perforation. The factors associated with SSI in the group of patients with gastrointestinal perforation were age and intraoperative blood loss, and age was the only independent risk factor for SSI in these patients according to a multiple logistic regression analysis.
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