Objective: To examine a predictive model that incorporating high risk pathological factors for the prognosis of stage Ⅰ to Ⅲ colon cancer. Methods: This study retrospectively collected clinicopathological information and survival outcomes of stage Ⅰ~Ⅲ colon cancer patients who underwent curative surgery in 7 tertiary hospitals in China from January 1, 2016 to December 31, 2017. A total of 1 650 patients were enrolled, aged (M(IQR)) 62 (18) years (range: 14 to 100). There were 963 males and 687 females. The median follow-up period was 51 months. The Cox proportional hazardous regression model was utilized to select high-risk pathological factors, establish the nomogram and scoring system. The Bootstrap resampling method was utilized for internal validation of the model, the concordance index (C-index) was used to assess discrimination and calibration curves were presented to assess model calibration. The Kaplan-Meier method was used to plot survival curves after risk grouping, and Cox regression was used to compare disease-free survival between subgroups. Results: Age (HR=1.020, 95%CI: 1.008 to 1.033, P=0.001), T stage (T3:HR=1.995,95%CI:1.062 to 3.750,P=0.032;T4:HR=4.196, 95%CI: 2.188 to 8.045, P<0.01), N stage (N1: HR=1.834, 95%CI: 1.307 to 2.574, P<0.01; N2: HR=3.970, 95%CI: 2.724 to 5.787, P<0.01) and number of lymph nodes examined (≥36: HR=0.438, 95%CI: 0.242 to 0.790, P=0.006) were independently associated with disease-free survival. The C-index of the scoring model (model 1) based on age, T stage, N stage, and dichotomous variables of the lymph nodes examined (<12 and ≥12) was 0.723, and the C-index of the scoring model (model 2) based on age, T stage, N stage, and multi-categorical variables of the lymph nodes examined (<12, 12 to <24, 24 to <36, and ≥36) was 0.726. A scoring system was established based on age, T stage, N stage, and multi-categorical variables of lymph nodes examined, the 3-year DFS of the low-risk (≤1), middle-risk (2 to 4) and high-risk (≥5) group were 96.3% (n=711), 89.0% (n=626) and 71.4% (n=313), respectively. Statistically significant difference was observed among groups (P<0.01). Conclusions: The number of lymph nodes examined was an independent prognostic factor for disease-free survival after curative surgery in patients with stage Ⅰ to Ⅲ colon cancer. Incorporating the number of lymph nodes examined as a multi-categorical variable into the T and N staging system could improve prognostic predictive validity.
Male ; Female ; Humans ; Prognosis ; Neoplasm Staging ; Retrospective Studies ; Nomograms ; Lymph Nodes/pathology* ; Risk Factors ; Colonic Neoplasms/surgery*

Colectomy ; Colonic Neoplasms/surgery* ; Colonoscopy ; Humans ; Lymph Node Excision ; Lymph Nodes/pathology* ; Robotic Surgical Procedures

Splenic flexure colon cancer occurs at a relatively lower rate than colon cancer of other sites. It is also associated with more advanced disease and higher rate of acute obstruction. The splenic flexure receives blood supply from both superior and inferior mesenteric arteries (SMA and IMA), and therefore has lymphatic drainage to both areas. The blood supply is also highly variable, causing difficulties in determining the main feeding vessels and the main direction of lymph drainage. Few studies with limited cases focused on this specific tumor site with respect to the patterns of lymph node spread, especially the main lymph node status and the value of its dissection. The lack of information limits the development of a consensus on the extent of surgical resection and lymphadenectomy. Adequate mobilization of the colon facilitates a sufficient length of bowel resection and the high ligation of feeding arteries from both SMA and IMA. Further evidence on the chnoice of procedures and the extent of lymph node dissection need multicenter collaboration, with the use of modern techniques, including CT 3D reconstruction of the colon and angiography, as well as intraoperative fluorescent real-time imaging of lymph nodes.
Colon, Transverse/surgery* ; Colonic Neoplasms/surgery* ; Humans ; Laparoscopy ; Lymph Node Excision/methods* ; Lymph Nodes/pathology* ; Mesenteric Artery, Inferior/surgery*

Colonoscopy with endoscopic resection of detected colonic adenomas interrupts the adenoma-carcinoma sequence and reduces the incidence of colorectal cancer and cancer-related mortality. In the past decade, there have been significant developments in instruments and techniques for endoscopic polypectomy. Guidelines have been formulated by various professional bodies in Europe, Japan and the United States, but some of the recommendations differ between the various bodies. An expert professional workgroup under the auspices of the Academy of Medicine, Singapore, was set up to provide guidance on the endoscopic management of colonic polyps in Singapore. A total of 23 recommendations addressed the following issues: accurate description and diagnostic evaluation of detected polyps; techniques to reduce the risk of post-polypectomy bleeding and delayed perforation; the role of specific endoscopic resection techniques; the histopathological criteria for defining endoscopic cure; and the role of surveillance colonoscopy following curative resection.
Adenoma/surgery* ; Colonic Neoplasms/surgery* ; Colonic Polyps/surgery* ; Colonoscopy/methods* ; Colorectal Neoplasms/pathology* ; Humans ; Singapore ; United States

A 50-year-old Chinese man presented with abdominal pain associated with bloody mucoid stools, loss of appetite and weight loss. Contrast-enhanced computed tomography of the abdomen and pelvis revealed a colocolic intussusception secondary to a lipoma. The patient subsequently underwent a left hemicolectomy. Clinical and imaging findings of intussusception in adults are discussed in this article.
Colectomy ; Colonic Diseases ; complications ; diagnostic imaging ; pathology ; surgery ; Colonic Neoplasms ; diagnostic imaging ; Humans ; Intussusception ; complications ; diagnostic imaging ; pathology ; surgery ; Lipoma ; complications ; diagnostic imaging ; Male ; Middle Aged ; Singapore

PURPOSE: Although there is a consensus about the need for surveillance colonoscopy after endoscopic resection, the interval remains controversial for large sessile colorectal polyps. The aim of this study was to evaluate the long-term outcome and the adequate surveillance colonoscopy interval required for sessile and flat colorectal polyps larger than 20 mm. MATERIALS AND METHODS: A total of 204 patients with large sessile and flat polyps who received endoscopic treatment from May 2005 to November 2011 in a tertiary referral center were included. RESULTS: The mean age was 65.1 years and 62.7% of the patients were male. The mean follow-up duration was 44.2 months and the median tumor size was 25 mm. One hundred and ten patients (53.9%) received a short interval surveillance colonoscopy (median interval of 6.3 months with range of 1-11 months) and 94 patients (46.1%) received a long interval surveillance colonoscopy (median interval of 13.6 months with range of 12-66 months). There were 14 patients (6.9%) who had local recurrence at the surveillance colonoscopy. Using multivariate regression analysis, a polyp size greater than 40 mm was shown to be independent risk factor for local recurrence. However, piecemeal resection and surveillance colonoscopy interval did not significantly influence local recurrence. CONCLUSION: Endoscopic treatment of large sessile colorectal polyps shows a favorable long-term outcome. Further prospective study is mandatory to define an adequate interval of surveillance colonoscopy.
Adult ; Aged ; Colonic Neoplasms/*diagnosis/pathology/surgery ; Colonic Polyps/*diagnosis/pathology/surgery ; *Colonoscopy ; Endoscopic Mucosal Resection ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Recurrence, Local/*diagnosis ; Prospective Studies ; Time Factors ; Watchful Waiting/*methods

PURPOSE: Colonoscopic polypectomy and surveillance are important to prevent colorectal cancer and identify additional relative risk factors for adequate surveillance. In this study, we evaluated risk factors related to recurrent high-risk polyps during the surveillance of patients with high-risk polyps. MATERIALS AND METHODS: We included 434 patients who had high-risk polyps (adenoma > or =10 mm, > or =3 adenomas, villous histology, or high-grade dysplasia) on the baseline colonoscopy and underwent at least one surveillance colonoscopy from 2005 to 2011 at Severance Hospital. Data regarding patient characteristics, bowel preparation and polyp size, location, number, and pathological diagnosis were retrospectively collected from medical records. Patients with recurrent high-risk polyps were compared with patients with low-risk or no polyps during surveillance. RESULTS: Patients were predominantly male (77.4%), with a mean age of 61.0+/-8.6 years and mean follow-up of 1.5+/-0.8 years. High-risk polyps recurred during surveillance colonoscopy in 51 (11.8%) patients. Results of multivariate analysis showed that male gender, poor bowel preparation, and a larger number of adenomas were independent risk factors for recurrent high-risk polyps (p=0.047, 0.01, and <0.001, respectively). Compared with high-risk polyps found during initial colonoscopy, high-risk polyps on surveillance colonoscopy had higher proportions of small adenomas, low-risk pathology, and fewer adenomas overall, but there was no difference in location. CONCLUSION: Male patients and those with poor bowel preparation for colonoscopy or higher numbers of adenomas were more likely to experience recurrent high-risk polyps.
Adenomatous Polyps/pathology/*surgery ; Aged ; *Colectomy ; Colonic Neoplasms/*pathology ; Colonic Polyps/pathology/*surgery ; *Colonoscopy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local/*diagnosis ; Retrospective Studies ; Risk Factors

BACKGROUND/AIMS: Colorectal adenomas that are > or =10 mm have villous histology or high-grade dysplasia, or that are associated with > or =3 adenomas are considered high-risk for metachronous advanced neoplasia. We evaluated the cumulative incidence of metachronous advanced neoplasia according to the total number of high-risk findings detected on baseline colonoscopy. METHODS: This was a retrospective cohort study performed in 862 patients who underwent removal of colorectal adenomas between 2005 and 2009. At least one surveillance colonoscopy had been conducted at Konkuk University Medical Center, Seoul, Korea. RESULTS: The cumulative incidence of metachronous advanced neoplasia in patients with 0, 1, 2, and 3-4 high-risk findings at 1 year were 0.7%, 1.3%, 2.8%, and 8.0%; at 3 years, those were 5.9%, 11.9%, 15.5%, and 24.7%; and at 5 years, those were 8.5%, 18.7%, 26.3%, and 37.2%, respectively. In a multivariate model, the risk of metachronous advanced neoplasia was significantly higher for the multiple high-risk findings group when compared with the 0 high-risk findings group (1 high-risk (+): hazard ratio, 1.86 [95% confidence interval, 1.00-3.44]; 2 high-risk (+): 1.84 [0.88-3.84]; and 3-4 high-risk (+): 3.29 [1.54-7.01]; ptrend=0.020). CONCLUSIONS: The presence of overlapping multiple high-risk findings was associated with an increased risk of advanced neoplasia during surveillance.
Adenoma/epidemiology/*etiology/pathology ; Aged ; Colonic Polyps/complications/surgery ; *Colonoscopy ; Colorectal Neoplasms/epidemiology/*etiology/pathology ; Early Detection of Cancer/methods ; Female ; Humans ; Incidence ; Male ; Middle Aged ; Neoplasm Grading ; Neoplasms, Second Primary/epidemiology/*etiology/pathology ; Population Surveillance/methods ; Proportional Hazards Models ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Time Factors ; Tumor Burden

Lipomas are common benign tumors of mature adipose tissue, enclosed by thin fibrous capsules. They can occur on any part of the body; however, peritoneal lipoma is extremely rare. We encountered a case of a 75-year-old man presenting with intermittent abdominal pain, who had undergone right hemicolectomy due to colon cancer. Abdominal computerized tomography showed a well-defined heterogenous fatty mass measuring 4.5x3.5 cm in size, suggesting fat necrosis located in the abdominal wall. Laparotomy showed a very large soft mass of peritoneum. Pathologically, the tumor was diagnosed as lipoma containing fat necrosis located in parietal peritoneum not fixed to any organs, but with small bowel adhesion. Due to its rare etiologic origin and obscure cause of development, we report on a case of lipoma of parietal peritoneum causing abdominal pain.
*Abdominal Pain ; Aged ; Colonic Neoplasms/surgery ; Humans ; Lipoma/*diagnosis/pathology/surgery ; Male ; Peritoneum/*pathology ; Tomography, X-Ray Computed

OBJECTIVETo assess the effect of laparoscopic colectomy on the exfoliated cancer cells in peritoneal cavity, recurrence and metastasis of patients with colonic carcinoma.

METHODSOne hundred and fifty-nine patients with colonic cancer proven by colonoscopy and pathology were divided into two groups based on patient's preference: laparoscopic group (n=74) and open group (n=85). The positive rate of exfoliated cancer cells in peritoneal cavity was compared by cytological detection before and after cancer resection. Recurrence, metastasis rate and 3-year survival were compared between the two groups.

RESULTSThe positive rates of exfoliated cancer cells in peritoneal cavity were 12.2% (9/74) in the laparoscopic group and 15.3% (13/85) in the open group before cancer resection without significant difference (P=0.718); 20.3% (15/74) and 30.6% (26/85) after cancer resection without significant difference (P=0.138). The follow-up ranged from 4 to 45 months. The 3-year local recurrence rates were 13.6% (8/59) and 8.8% (6/68) (P=0.455), the 3-year distal metastasis rates were 11.9% (7/59) and 17.6% (12/68) (P=0.416) and the 3-year survival rates were 79.7% and 80.0% (P=0.998), and the differences were not statistically significant.

CONCLUSIONThe laparoscopic operation does not increase the recurrence and metastasis rate and results in similar survival in patients with colonic cancer as compared to open procedure.

Adult ; Colonic Neoplasms ; diagnosis ; surgery ; Female ; Humans ; Laparoscopy ; adverse effects ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; etiology ; Peritoneal Cavity ; pathology ; Prognosis ; Survival Rate