No abstract available.
Dreams* ; Intestinal Perforation*

No abstract available.
Korea*

A granular cell tumor (GCT) is an uncommon mesenchymal lesion that rarely occurs in the colon and the rectum. We describe the case of 51-year-old man with a 2-cm-sized rectal GCT 10 cm above the anal verge that was incidentally detected after a screening colonoscopy. Preoperative radiologic studies demonstrated a suspicious submucosal rectal mass with mesorectal fat infiltration, but without circumferential resection margin threatening, extramural vessel invasion, and regional lymph-node enlargement. The tumor was resected by using a transanal endoscopic operation (TEO) without immediate postoperative complications. The final pathology revealed that the tumor consisted of a GCT that had invaded the subserosa with clear margins. It had no other risk factors for malignancy according to Fanburg-Smith criteria. We systematically reviewed the English literature by using PubMed and Google Scholar. This report may be the first documented case in the literature to describe a TEO for a GCT that had invaded the subserosa in the rectum.
Colon ; Colonoscopy ; Gastrointestinal Tract ; Granular Cell Tumor* ; Humans ; Mass Screening ; Middle Aged ; Pathology ; Postoperative Complications ; Rectum* ; Risk Factors

PURPOSE: The circular stapled hemorrhoidectomy established by A. Longo involves reducing the mucous membrane prolapse and blocking the end branches of the upper hemorrhoidal artery through transverse incision of a suitable section of the mucosa between the rectum and the anal canal. This study was undertaken to determine the efficacy and the safety of a circular stapled hemorrhoidectomy by comparing it with a conventional Milligan-Morgan hemorrhoidectomy. METHODS: One hundred thirty (130) patients with prolapsed hemorrhoids underwent surgical treatment with either a conventional (n=66)(conventional group) or a circular stapled (n=64) (stapled group) hemorrhoidectomy. The operation time was recorded, and the resected specimen was examined. The patients assessed their postoperative pain. Time to first bowel movement, hospital stay, and postoperative complications were analyzed. All patients received follow-up examinations at the out-patient clinic, and the time to return to work and the degree of their satisfaction were checked. RESULTS: The stapled group had a shorter average operation time (19.2 min. vs 26.1 min., P=0.016). The postoperative pain score in the stapled group was significantly lower than it was in the conventional group (P<0.05). Time to first bowel movement and hospital stay were not significantly different between the groups. Return to work was significantly faster in the stapled group (6.5 days vs 15.8 days, P<0.05). The degrees of satisfaction for the two groups were similar, and postoperative complications in the two groups were both similar and acceptable (6.1% vs 11.0%, P>0.05). CONCLUSIONS: A circular stapled hemorrhoidectomy offers a significantly less painful alternative to the conventional technique and is associated with an earlier return to normal activity. However, the long-term outcome needs to be evaluated further.
Anal Canal ; Arteries ; Follow-Up Studies ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Length of Stay ; Mucous Membrane ; Outpatients ; Pain, Postoperative ; Postoperative Complications ; Prolapse ; Rectum ; Return to Work

PURPOSE: The optimal time between neoadjuvant chemoradiotherapy (CRT) and surgery for rectal cancer has been debated. This study evaluated the influence of this interval on oncological outcomes. METHODS: We compared postoperative complications, pathological downstaging, disease recurrence, and survival in patients with locally advanced rectal cancer who underwent surgical resection <8 weeks (group A, n = 105) to those who had surgery > or =8 weeks (group B, n = 48) after neoadjuvant CRT. RESULTS: Of 153 patients, 117 (76.5%) were male and 36 (23.5%) were female. Mean age was 57.8 years (range, 28 to 79 years). There was no difference in the rate of sphincter preserving surgery between the two groups (group A, 82.7% vs. group B, 77.6%; P = 0.509). The longer interval group had decreased postoperative complications, although statistical significance was not reached (group A, 28.8% vs. group B, 14.3%; P = 0.068). A total of 111 (group A, 75 [71.4%] and group B, 36 [75%]) patients were downstaged and 26 (group A, 17 [16.2%] and group B, 9 [18%]) achieved pathological complete response (pCR). There was no significant difference in the pCR rate (P = 0.817). The longer interval group experienced significant improvement in the nodal (N) downstaging rate (group A, 46.7% vs. group B, 66.7%; P = 0.024). The local recurrence (P = 0.279), distant recurrence (P = 0.427), disease-free survival (P = 0.967), and overall survival (P = 0.825) rates were not significantly different. CONCLUSION: It is worth delaying surgical resection for 8 weeks or more after completion of CRT as it is safe and is associated with higher nodal downstaging rates.
Chemoradiotherapy ; Disease-Free Survival ; Female ; Humans ; Male ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Postoperative Complications ; Preoperative Period ; Rectal Neoplasms ; Recurrence

PURPOSE: Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. METHODS: Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed. RESULTS: Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P < 0.001), and amount of blood loss (P = 0.003). All patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication. CONCLUSION: Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it.
Carcinoma ; Cetuximab ; Colorectal Neoplasms ; Cytoreduction Surgical Procedures ; Drug Therapy* ; Follow-Up Studies ; Hemorrhage ; Humans ; Mortality ; Neoplasm Metastasis ; Postoperative Complications ; Pseudomyxoma Peritonei ; Retrospective Studies ; Risk Factors ; Surgeons

PURPOSE: The aim of this study is to assess the effects of age on the short-term outcomes of a laparoscopic resection of colorectal cancer in elderly (> or =75 years old), as compared with younger (<75 years old), patients. METHODS: A retrospective analysis of patients who underwent laparoscopic surgery for colorectal cancer between January 2007 and December 2009 was performed. There were two groups: age <75 years old (group A) and age > or =75 years old (group B). The perioperative outcomes between group A and group B were compared. RESULTS: The study included 824 patients in group A and 92 patients in group B. The body mass index (BMI) and the American Society of Anesthesiologists (ASA) score were significantly different between group B and group A (BMI: 22.5 vs. 23.5, P = 0.002; ASA score: 1.88 vs. 1.48, P = 0.001). Mean operating times were similar between the groups (325.4 minutes vs. 351.6 minutes, P = 0.07). We observed a higher overall complication rate in group B than in group A (12.0% vs. 6.2%, P = 0.047), but the number of severe complications of Accordion Severity Classification > or =3 (those that required an invasive procedure) was not significantly different between the two groups (6.5% vs. 3.4%, P = 0.142). There was no significant difference in the length of hospital stay (13.0 days vs. 12.0 days, P = 0.053). CONCLUSION: Although the elderly patients had a significantly higher overall postoperative complication rate, no significant difference was seen in either the number of severe complications of Accordion Severity Classification > or =3 or in the length of hospital stay. A laparoscopic colorectal cancer resection in elderly patients, especially those aged 75 years or older, is safe and feasible.
Aged ; Body Mass Index ; Colorectal Neoplasms ; Humans ; Laparoscopy ; Length of Stay ; Postoperative Complications ; Retrospective Studies

The recent introduction of an intraoperative near infrared fluorescence (INIF) imaging system installed on the da Vinci Si(R) robotic system has enabled surgeons to identify intravascular NIF signals in real time. This technology is useful in identifying hidden vessels and assessing blood supply to bowel segments. In this study, we report 3 cases of patients with rectal cancer who underwent robotic low anterior resection (LAR) with INIF imaging for the first time in Asia. In September 2012, robotic-assisted rectal resection with INIF imaging was performed on three consecutive rectal cancer patients. LAR was performed in 2 cases, and abdominoperineal resection was performed in the third case. INIF imaging was used to identify the left colic branch of the inferior mesenteric artery and to assess blood supply to the distal rectum. We evaluated the utility of INIF imaging in performing robotic-assisted colorectal procedures. Our preliminary results suggest that this technique is safe and effective, and that INIF imaging may be a useful tool to colorectal surgeons.
Aged ; Digestive System Surgical Procedures/*methods ; Female ; Fluorescence ; Humans ; Image Processing, Computer-Assisted/instrumentation/*methods ; *Intraoperative Care ; Male ; Middle Aged ; Rectal Neoplasms/*surgery ; Rectum/*surgery ; Robotics/*methods ; Spectroscopy, Near-Infrared/*methods ; Treatment Outcome

Four consecutive cases of a colonic stricture following a da Vinci robot-assisted ultra-low anterior resection (LAR) with coloanal anastomosis and diverting ileostomy for the treatment of rectal cancer are reported. The colonic strictures developed after early proximal colonic ischemia without anastomotic site leakage or disruption. All patients were treated with preoperative chemoradiation therapy. During the postoperative recovery period, patients developed colonic ischemia, presenting with a high, spiking fever, but without any symptoms of peritonitis. Patients were treated with conservative management (antibiotic therapy) and discharged after two weeks when in good condition. Several months after discharge, all four patients developed a long-segment colonic stricture from the anastomosis site to the distal colon. Management of the colon strictures, including the anastomotic site, involved colonic dilation with a Hegar dilator in an outpatient clinic for several months. The ileostomies in three patients could not be closed.
Ambulatory Care Facilities ; Colon* ; Constriction, Pathologic* ; Fever ; Humans ; Ileostomy ; Ischemia* ; Peritonitis ; Rectal Neoplasms

PURPOSE: This study compared the perioperative and pathologic outcomes between an extralevator abdominoperineal resection (APR) in the prone position and a conventional APR. METHODS: Between September 2011 and March 2014, an extralevator APR in the prone position was performed on 13 patients with rectal cancer and a conventional APR on 26 such patients. Patients' demographics and perioperative and pathologic outcomes were obtained from the colorectal cancer database and electronic medical charts. RESULTS: Age and preoperative carcinoembryonic antigen (CEA) level were significantly different between the conventional and the extralevator APR in the prone position (median age, 65 years vs. 55 years [P = 0.001]; median preoperative CEA level, 4.94 ng/mL vs. 1.81 ng/mL [P = 0.011]). For perioperative outcomes, 1 (3.8%) intraoperative bowel perforation occurred in the conventional APR group and 2 (15.3%) in the extralevator APR group. In the conventional and extralevator APR groups, 12 (46.2%) and 6 patients (46.2%) had postoperative complications, and 8 (66.7%) and 2 patients (33.4%) had major complications (Clavien-Dindo III/IV), respectively. The circumferential resection margin involvement rate was higher in the extralevator APR group compared with the conventional APR group (3 of 13 [23.1%] vs. 3 of 26 [11.5%]). CONCLUSION: The extralevator APR in the prone position for patients with advanced low rectal cancer has no advantages in perioperative and pathologic outcomes over a conventional APR for such patients. However, through early experience with a new surgical technique, we identified various reasons for the lack of favorable outcomes and expect sufficient experience to produce better peri- or postoperative outcomes.
Carcinoembryonic Antigen ; Colorectal Neoplasms ; Demography ; Humans ; Postoperative Complications ; Prone Position* ; Rectal Neoplasms*