Isolated splenic metastasis arising from colorectal carcinoma is very rare and there has been only 6 cases reported in the English literature. A new case is esented, and its possible pathogenesis was considered with previously reported ses. A 65-year-old male patient had received a right hemicolectomy for cending colon cancer 36 months earlier. He was followed up regularly with rial measurement of serum carcinoembryonic antigen (CEA). Rising serum CEA was scovered from 33 months postoperatively and CT revealed an isolated splenic tastasis. He therefore underwent splenectomy, which was proven to be a tastatic adenocarcinoma with similar histological feature to the original mor. As all reported cases showed elevated serum CEA at the time of tastasis, isolated splenic metastasis might be associated with CEA in regard its biological functions of immunosuppression and adhesion.
Adenocarcinoma/surgery ; Adenocarcinoma/secondary* ; Adenocarcinoma/pathology ; Adenocarcinoma/blood ; Aged ; Carcinoembryonic Antigen/blood ; Case Report ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/pathology* ; Colorectal Neoplasms/blood ; Human ; Male ; Splenic Neoplasms/surgery ; Splenic Neoplasms/secondary* ; Splenic Neoplasms/blood ; Tomography Scanners, X-Ray Computed

OBJECTIVE: To explore the technique and effect of liver hanging maneuver in anterior approach for isolated complete liver caudate lobectomy. METHODS: We recruited 17 patients with liver caudate lobe tumor (13 primary hepatocellular carcinoma, 3 cholangiocarcinoma and 1 liver metastasis from colorectal cancer). Isolated complete caudate lobectomy with liver hanging maneuver was performed in 17 patients. RESULTS: All 17 patients were successfully received the above-mentioned operation. The operative time was 166-427 (211.5 ± 20.1) min and the intraoperative blood loss was 372-1 208 (472.7 ± 83.6) mL. There was no operative death. The survival rates of follow up for 1, 3 and 5 years were 76.5%, 52.9% and 23.5%, respectively. CONCLUSION Liver hanging maneuver for isolated complete resection of the caudate lobe is an ideal approach for liver neoplasms resection.
Blood Loss, Surgical ; Carcinoma, Hepatocellular ; surgery ; Cholangiocarcinoma ; surgery ; Colorectal Neoplasms ; pathology ; Hepatectomy ; methods ; Humans ; Liver Neoplasms ; secondary ; surgery ; Survival Rate

PURPOSE: Emergency colorectal surgery has high rates of complications and mortality because of incomplete bowel preparation and bacterial contamination. The authors aimed to evaluate the surgical outcomes and the risk factors for the mortality and the complication rates of patients who underwent emergency surgery to treat colorectal diseases. METHODS: This is a prospective study from January 2014 to April 2016, and the results are based on a retrospective analysis of the clinical results for patients who underwent emergency colorectal surgery at Chosun University Hospital. RESULTS: A total of 99 patients underwent emergency colorectal surgery during the study period. The most frequent indication of surgery was perforation (75.8%). The causes of disease were colorectal cancer (19.2%), complicated diverticulitis (21.2%), and ischemia (27.2%). There were 27 mortalities (27.3%). The major morbidity was 39.5%. Preoperative hypotension and perioperative blood transfusion were independent risk factors for both morbidity and mortality. CONCLUSION: These results revealed that emergency colorectal surgeries are associated with significant morbidity and mortality. Furthermore, the independent risk factors for both morbidity and mortality in such patiients were preoperative hypotension and perioperative transfusion.
Blood Transfusion ; Colorectal Neoplasms ; Colorectal Surgery* ; Diverticulitis ; Emergencies* ; Humans ; Hypotension ; Ischemia ; Mortality ; Prospective Studies ; Retrospective Studies ; Risk Factors*

BACKGROUNDPolyunsaturated omega-3 fatty acids may beneficially influence healing processes and patient outcomes. The aim of this research was to study the clinical efficacy of fish oil enriched total parenteral nutrition in elderly patients after colorectal cancer surgery.

METHODSFifty-seven elderly patients with colorectal cancer were enrolled in this prospective, randomized, double-blind, controlled clinical trial. All patients received isocaloric and isonitrogenous total parenteral nutrition by continuous infusion (20 - 24 hours per day) for seven days after surgery. The control group (n = 28) received 1.2 g/kg soybean oil per day, whereas the treatment group (n = 29) received 0.2 g/kg fish oil and 1.0 g/kg soybean oil per day. Blood samples were taken pre-operatively, and at days one and eight after the operation. The plasma levels of CD4, CD8, CD4/CD8, interleukin 6 (IL-6) and tumor necrosis factor α (TNF-α) were measured. Clinical outcomes were then analysed.

RESULTSPatient characteristics were comparable between the two groups. At day eight post-surgery, IL-6, TNF-α and CD8 titres were lower in the treatment group when compared to the control group; these results reached statistical significance. In the treatment group, there were fewer infectious complications and incidences of systemic inflammatory response syndrome (SIRS), and shorter lengths of hospital stay were observed. The total cost of medical care was comparable for the two groups. No serious adverse events occurred in either group.

CONCLUSIONSFish oil 0.2 g/kg per day administrated to elderly patients after colorectal surgery was safe and may shorten the length of hospital stay and improve clinical outcomes.

Aged ; CD4 Antigens ; blood ; CD4-CD8 Ratio ; CD8 Antigens ; blood ; Colorectal Neoplasms ; blood ; surgery ; Colorectal Surgery ; Female ; Fish Oils ; therapeutic use ; Humans ; Interleukin-6 ; blood ; Male ; Middle Aged ; Parenteral Nutrition, Total ; methods ; Tumor Necrosis Factor-alpha ; blood

To establish stable methods for detecting plasma endotoxin level and endotoxin inactivation capacity in a normal population and general surgical patients and evaluate their perioperative changes. 50 healthy people and 50 patients receiving gastrointestinal operation were enrolled, their plasma endotoxin levels and plasma endotoxin inactivation capacity were assayed. Our results showed that plasma endotoxin levels were 0.044 +/- 0.009 EU/ml in the normal population and 0.044 +/- 0.023 EU/ml in the preoperative patients. Endotoxin level peaked 3 h after the operation (0.223 +/- 0.041 EU/ml), and then decreased rapidly on the first day after the operation (0.134 +/- 0.164 EU/ml). Endotoxin inactivation capacity also had the same time course as endotoxin level. Systemic inflammatory response syndrome and infection induced another elevation in the time course. It is concluded that establishing the endotoxin standard curve by using pyrogenic free water is better than by using plasma. Plasma endotoxin inactivation capacity can be used as an indirect indicator of postoperative immune depression. Plasma endotoxin level and endotoxin inactivation capacity peaked shortly after operation, indicating surgical stress is closely related with the changes.
Adult ; Aged ; Colorectal Neoplasms ; blood ; surgery ; Endotoxins ; blood ; Female ; Humans ; Limulus Test ; methods ; Male ; Middle Aged ; Postoperative Period ; Reference Values ; Stomach Neoplasms ; blood ; surgery ; Stress, Physiological ; blood ; Systemic Inflammatory Response Syndrome ; blood

OBJECTIVETo investigate the risk factors of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.

METHODSClinical data of 1 749 patients with colorectal cancer, of whom 50(2.8%) patients developed metastasis to bone after operation, in the Department of Colorectal Surgery, Changhai Hospital of The Second Military Medical University from January 2001 to December 2010 were analyzed retrospectively. Univariate and multivariate analysis were performed to find the risk factors of metachronous bone metastasis from colorectal cancer using Chi square test and Logistic regression, respectively.

RESULTSOf 50 colorectal cancer cases with bone metastasis, 29 were male and 21 were female. The age was ≥ 60 years old in 28 cases. Tumors of 36 cases were located in the rectum and of 14 cases located in the colon. Pathology examination showed 43 cases were adenocarcinomas, 7 cases were mucinous adenocarcinoma. Forty-two cases had T3-4 stage lesions, 30 cases had lymph node metastasis, 14 cases had pulmonary metastasis, and 5 cases had liver metastasis. Univariate Chi square test indicated that factors associated with the metachronous bone metastasis of colorectal cancer within 5 years were tumor site (χ=4.932, P=0.026), preoperative carbohydrate antigen 199 (CA199) level (χ=4.266, P=0.039), lymph node metastasis (χ=13.054, P=0.000) and pulmonary metastasis(χ=35.524, P=0.000). The incidence of bone metastasis in patients with rectal cancer (3.6%, 36/991) was higher compared to those with colon cancer (1.8%, 14/758). The incidence of bone metastasis in patients with higher(> 37 kU/L) preoperative serum CA199 level (4.9%, 12/245) was higher compared to those with lower serum CA199 level (2.5%, 38/1504). The incidence of bone metastasis in patients with lymph node metastasis(4.8%,30/627) and pulmonary metastasis (11.6%, 14/121) was significantly higher compared to those without lymph node metastasis (1.8%, 20/1122) and pulmonary metastasis(2.2%, 36/1628), respectively. Logistic multivariate analysis showed that rectal cancer(OR:0.508, 95%CI:0.268 to 0.963, P=0.038), lymph node metastasis (OR:2.291, 95%CI:1.273 to 4.122, P=0.006) and metachronous pulmonary metastasis(OR:4.796, 95%CI:2.473 to 9.301, P=0.000) were the independent risk factors of metachronous bone metastasis of colorectal cancer within 5 years.

CONCLUSIONPatients with rectal cancer, lymph node metastasis and metachronous pulmonary metastasis are high risk groups of metachronous bone metastasis after radical resection of colorectal cancer within 5 years.

Adenocarcinoma ; surgery ; Aged ; Biomarkers, Tumor ; blood ; Bone Neoplasms ; epidemiology ; secondary ; Chi-Square Distribution ; Colonic Neoplasms ; surgery ; Colorectal Neoplasms ; surgery ; Colorectal Surgery ; statistics & numerical data ; Disease-Free Survival ; Female ; Humans ; Incidence ; Liver Neoplasms ; secondary ; Logistic Models ; Lung Neoplasms ; secondary ; Lymphatic Metastasis ; physiopathology ; Male ; Middle Aged ; Multivariate Analysis ; Prognosis ; Rectal Neoplasms ; surgery ; Retrospective Studies ; Risk Factors

The postoperative levels of carcinoembryonic antigen (CEA) and the actual half life (T1/2) of CEA were evaluated to ascertain their potency in predicting the recurrence of colorectal cancer after curative surgery in patients who had an abnormally high level of preoperative carcinoembryonic antigen (CEA, > or = 5 ng/ml). Ninety-four patients who underwent curative surgery were enrolled and 24 patients (25.5%) had recurrence during the follow-up period (median: 30 months, range: 2-69 months). T1/2 of CEA for all patients ranged from 1.2 days to 88.1 days, with a median of 4.4 days. T1/2 of CEA (mean +/- standard deviation) was 11.7 +/- 17.9 days in recurrent patients, whereas it was 6.2 +/- 4.9 days in patients without recurrence (p = 0.0224). The patients' age, gender, size of the tumor, location of the tumor, pre-, and postoperative CEA level, pathologic type of the tumor and Dukes stage had no significance in recurrence. The 1-year, 2-year, and 5-year disease-free survival rates were 95.1%, 81.1%, and 73.8% in patients with postoperative CEA levels less than 5 ng/ml (n = 62), respectively, and 71.4%, 64.8%, and 64.8% in patients with postoperative CEA levels higher than or equal to 5 ng/ml (n = 32), respectively (p = 0.04). Patients were divided into Group S (T1/2 of CEA < 4.4 days, n = 43) and Group L (T1/2 of CEA > or = 4.4 days, n = 51). The 1-year, 2-year, and 5-year disease-free survival rates were 95.3%, 85.1%, and 77.7% in Group S, respectively, and 80%, 67.5%, and 64.1% in Group L, respectively (p = 0.0261). In conclusion, the disease-free survival of colorectal cancer patients was prolonged in patients who had a short T1/2 of CEA or a low level of postoperative CEA. In high-risk colorectal cancer patients with an abnormally high level of preoperative CEA, recurrence may be predicted by checking an early postoperative CEA level and/or by a simple calculation of the actual half life of CEA.
Adolescence ; Adult ; Aged ; Aged, 80 and over ; Carcinoembryonic Antigen/blood* ; Colorectal Neoplasms/surgery* ; Colorectal Neoplasms/blood* ; Female ; Half-Life ; Human ; Male ; Middle Age ; Neoplasm Recurrence, Local ; Postoperative Period ; Predictive Value of Tests ; Retrospective Studies

PURPOSE: Mechanical bowel preparation aims to eliminate solid stool in the colon prior to colonoscopy and colorectal surgery. During colorectal surgery, a clean bowel has advantages such as a lower bacterial load, reduced chance of spillage of fecal content, and easiery handling of the bowel. The aim of this prospective trial was to compare polyethylene glycol (PEG) and sodium phosphate solutions for colorectal surgery according to patient's tolerance, side effects, cleansing quality, and postoperative complication. METHODS: Eighty patients prospectively received either a standard 4 liter PEG solution or a 90 ml oral sodium phosphate solution. Patient's tolerance for solution was assessed with a detailed questionnaire. Before and after bowel preparation, we checked the patient's body weight, blood pressure, pulse, and biochemical parameters such as hematocrit, serum electrolyte, blood urea nitrogen, and creatinine levels. The cleansing quality was checked by the surgeon during the operation. Statistical analysis was performed using the chi-square test for patient's tolerance, body weight, blood pressure, pulse, and postoperative complication and using the paired t-test for biochemical parameters with SPSS 11.0 version. RESULTS: The PEG and sodium phosphate solutions were each administered to 40 patients, separately. Thirty-seven patients (92.5%) had colorectal cancer in each group. The other underlying diseases were benign tumor, multiple polyps, diverticulitis, and familiar adenomatous polyposis. In comparing tolerance, there was no significant difference in the rate of patients who complained of difficulty on the questionnaire for discomfort (P=0.954), nor in the rate of patients who complained of severe subjective symptoms such as nausea, vomiting, abdominal pain, dizziness and sleep loss. The cleansing quality, body weight, blood pressure, pulse change and postoperative complication rates were not significantly different. In the PEG group, hematocrit (P=0.008), serum magnesium (P=0.03), phosphorus (P= 0.004), and blood urea nitrogen (P=0.001) were decreased and serum chloride (P=0.001) was increased. In the sodium phosphate group, serum sodium (P=0.001) was increased and serum potassium (P=0.018) was decreased. There was no significant changes in serum calcium (P=0.086) and phosphate (P=0.191) in the sodium phosphate group. CONCLUSION: In both groups, there was no significant difference in patient's tolerance, cleansing quality and postoperative complication rate. Though there were some biochemical changes between the two groups, they were not significant clinically. Therefore, the sodium phosphate solution can be substituted for the PEG solution in preoperative bowel preparation.
Abdominal Pain ; Bacterial Load ; Blood Pressure ; Blood Urea Nitrogen ; Body Weight ; Calcium ; Colon ; Colonoscopy ; Colorectal Neoplasms ; Colorectal Surgery ; Creatinine ; Diverticulitis ; Dizziness ; Hematocrit ; Humans ; Magnesium ; Nausea ; Phosphorus ; Polyethylene Glycols* ; Polyethylene* ; Polyps ; Postoperative Complications ; Potassium ; Prospective Studies* ; Surveys and Questionnaires ; Sodium* ; Vomiting

OBJECTIVETo investigate the minimal invasiveness of laparoscopic operation for colorectal carcinoma.

METHODSForty cases with pathologically proven colorectal carcinoma were divided into laparoscopic group (n=20) and open surgical group (n=20). Perioperative alterations of peripheral blood IL-6, IL-8, TNF-alpha, CRP, sICAM-1 and WBC CD11b were compared between the two groups. TNF-alpha, IL- 6, IL- 8 and sICAM-1 were determined by ELISA, CRP by scattered radiation turbidity comparison and WBC CD11b by flow cytometry with monoclonal antibody PS- CD11b, M2Ab.

RESULTSThe postoperative cytokine levels of TNF-alpha, IL-6 and IL-8 in open surgery group were significantly higher than those in laparoscopic group (P< 0.05). Dynamic level of sICAM-1 at 6 and 24 hours after operation in open surgery group were significantly higher than those in laparoscopic group. Peripheral WBC CD11b decreased to the lowest level at 6 hours after operation in open surgery group,significantly lower than that in laparoscopic group (P< 0.05).

CONCLUSIONLaparoscopic surgery for colorectal carcinoma exerts less effects on patients than traditional open surgery, and can maintain patients defense function,therefore it is less invasive.

Aged ; C-Reactive Protein ; metabolism ; Colorectal Neoplasms ; blood ; pathology ; surgery ; Female ; Humans ; Intercellular Adhesion Molecule-1 ; blood ; Interleukin-6 ; blood ; Interleukin-8 ; blood ; Laparoscopy ; Male ; Middle Aged ; Postoperative Period ; Tumor Necrosis Factor-alpha ; blood

OBJECTIVETo investigate the clinicopathological characteristics of advanced colorectal cancer which was 30 mm or smaller in diameter.

METHODSRetrospective analysis documented 80 patients with small advanced colorectal cancer from May 1985 to May 2002. According to the diameter of tumors, all patients were divided into three groups: Group A (10 mm or less), Group B (11-20 mm), Group C (21-30 mm). Considering the number of patients in Group A was smaller, we combined Group A with Group B as Group D. Then various clinicopathological characteristics were compared between Group C and Group D.

RESULTSThe most common site of small advanced colorectal cancer was sigmoid colon and rectum that accounted for 36.2% and 35.0% of all cases. The average diameter of total tumors was 23.3 mm. Type 2 was the most common macroscopic type (63.7%) and the moderate differentiation was seen in 77.5% of cases. Thirty-eight (47.5%) cases had lymph node metastasis. Three (3.8%) cases had liver metastasis and three (3.8%) cases had peritoneal metastasis. The frequency of lymph node metastasis was found significantly different between Group C and Group D (54.2% vs. 28.6%, P < 0.05) , as well as between the groups with different depth of invasion (P < 0.05). Curability A resection was performed in 69 (86.2%) cases.

CONCLUSIONSTumor size and depth of invasion are related to lymph node metastasis in small advanced colorectal cancer. However, the small size of tumor may not always be a reliable parameter for estimating the risk of lymph node metastasis. Small colorectal cancers also do not always mean the early stage. Surgeons should be aware of the features of small advanced colorectal cancers to select ideal management and perform perfect resection.

Aged ; Aged, 80 and over ; Carcinoembryonic Antigen ; blood ; Colorectal Neoplasms ; pathology ; surgery ; Female ; Humans ; Japan ; Laparotomy ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies