Colon, Sigmoid/surgery* ; Colostomy ; Humans ; Ostomy ; Prolapse ; Surgical Stomas

Humans ; Colon, Sigmoid ; Hamartoma/surgery* ; Schwann Cells ; Mucous Membrane

Anastomosis, Surgical ; Colon, Sigmoid/surgery* ; Colorectal Neoplasms/surgery* ; Humans ; Robotics

We reported a case of irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.The patient complained about a right groin mass for more than 60 years with progressive enlargement for 3 years and pain for half a month.Abdominal CT examination at admission showed rectum and sigmoid colon hernia in the right inguinal area and thickening of sigmoid colon wall.Electronic colonoscopy and pathological diagnosis showed sigmoid colon cancer.Therefore,the result of preliminary diagnosis was irreducible indirect inguinal hernia caused by sigmoid colon cancer entering the right groin.We converted laparoscopic exploration to laparotomy followed by radical sigmoidectomy and employed end-to-end anastomosis of descending colon and rectum in combination with repair of right inguinal hernia.The patient recovered well after operation and was discharged.
Colon, Sigmoid/surgery* ; Groin ; Hernia, Inguinal/surgery* ; Humans ; Laparoscopy ; Sigmoid Neoplasms/surgery*

PURPOSE: Although laparoscopic surgery is widely accepted in the treatment of colorectal cancer, conversion to open surgery is associated with the rate of unfavorable outcomes. The aim of this study was to determine the factors associated with open conversion from laparoscopic surgery for colorectal cancer.METHODS: A total of 3,002 patients who underwent laparoscopic colectomy as an initial plan for the treatment of colorectal cancer located from the sigmoid colon to the rectum were retrospectively evaluated between January 2009 and December 2018 at Samsung Medical Center in Korea. Risk factors significantly associated with open conversion were determined using univariate and multivariate regression models.RESULTS: Among the 3,002 patients, open conversion was performed in 120 patients (4%). Age >60 years (adjusted odds ratio [AOR], 2.370), preoperative bowel obstruction (AOR, 2.348), clinical T4 stage (AOR, 2.201), and serum carcinoembryonic antigen level >5 ng/mL (AOR, 2.289) were significantly associated with open conversion. Moreover, mucinous carcinoma was a significantly more frequent histopathologic type than adenocarcinoma (10.0% vs. 3.2%, P<0.001) in the open conversion group with an AOR of 2.549 (confidence interval, 1.259–5.159; P=0.009).CONCLUSION: The present study presented a novel finding, i.e. mucinous carcinoma as the histopathologic type could be an independent predictive factor for conversion from laparoscopic colectomy to open surgery. Identifying patients with mucinous carcinoma will help stratify the risk of open conversion preoperatively.
Adenocarcinoma ; Adenocarcinoma, Mucinous ; Carcinoembryonic Antigen ; Colectomy ; Colon, Sigmoid ; Colorectal Neoplasms ; Conversion to Open Surgery ; Humans ; Korea ; Laparoscopy ; Mucins ; Odds Ratio ; Rectum ; Retrospective Studies ; Risk Factors

Laparoscopic sigmoidectomy for cancer is considered as a simple surgical approach, which is suitable for primary laparoscopic surgery. However, the success of laparoscopic sigmoidectomy is closely related to the anatomical characteristics of the sigmoid colon. The length, adhesion and morphology of the sigmoid colon vary greatly. The differences of the length, width, adhesion and morphology of the mesentery are large. The distribution of vessels is diversified. The high ligation or the low ligation is still controversial. The location of the sigmoid colon cancer is also not constant. These problems have great influence on the operation. Before operation, the tumor must be accurately located and the anatomical characteristics of the sigmoid colon must be fully evaluated. The operation can be carried out smoothly and the complications during and after the operation can be reduced.
Colectomy ; Colon, Sigmoid ; anatomy & histology ; Humans ; Laparoscopy ; methods ; Sigmoid Neoplasms ; surgery ; Treatment Outcome

PURPOSE: The aim of the present study was to evaluate the usefulness of indocyanine green (ICG) as a preoperative marking dye for laparoscopic colorectal surgery. METHODS: Between March 2013 and March 2015, 174 patients underwent preoperative colonoscopic tattooing using 1.0 to 1.5 mL of ICG and saline solution before laparoscopic colorectal surgery. Patients’ medical records and operation videos were retrospectively assessed to evaluate the visibility, duration, and adverse effects of tattooing. RESULTS: The mean age of the patients was 65 years (range, 34–82 years), and 63.2% of the patients were male. The median interval between tattooing and operation was 1.0 day (range, 0–14 days). Tattoos placed within 2 days of surgery were visualized intraoperatively more frequently than those placed at an earlier date (95% vs. 40%, respectively, P < 0.001). For tattoos placed within 2 days before surgery, the visualization rates by tattoo site were 98.6% (134 of 136) from the ascending colon to the sigmoid colon. The visualization rates at the rectosigmoid colon and rectum were 84% (21 of 25) and 81.3% (13 of 16), respectively (P < 0.001). No complications related to preoperative ICG tattooing occurred. CONCLUSION: Endoscopic ICG tattooing is more useful for the preoperative localization of colonic lesions than it is for rectal lesions and should be performed within 2 days before laparoscopic surgery.
Colon ; Colon, Ascending ; Colon, Sigmoid ; Colorectal Surgery* ; Humans ; Indocyanine Green* ; Laparoscopy ; Male ; Medical Records ; Rectum ; Retrospective Studies ; Sodium Chloride ; Tattooing*

OBJECTIVETo investigate the safety, feasibility and long-term outcomes of laparoscopic complete mesocolic excision for the transverse colon cancer.

METHODSClinical data of 61 patients who underwent laparoscopic complete mesocolic excision for transverse colon cancer (transverse group) in our department from January 2011 to January 2014 were retrospectively analyzed, which were compared with those of 155 patients undergoing laparoscopic complete mesocolic excision for ascending colon cancer (ascending group) and 230 patients undergoing laparoscopic complete mesocolic excision for sigmoid colon cancer (sigmoid group). Differences in operative details, postoperative recovery, postoperative complications and long-term survival among 3 groups were evaluated.

RESULTSNo significant differences in the baseline information were found among 3 groups(all P>0.05). The average operative time was significantly longer in transverse group as compared to ascending group and sigmoid group [(192.1±58.7) min vs. (172.2±54.7) min and (169.1±53.6) min]( P<0.05), while the blood loss [(89.7±63.6) ml, (86.3±66.3) ml, (82.6±61.5) ml], conversion rate [3.3%(2/61), 2.6%(4/155), 2.2%(5/230)], number of harvested lymph node (13.0±4.7, 14.4±6.5, 13.4±5.6), time to flatus [(2.7±1.1) d, (2.6±1.1) d, (2.5±1.0) d], time to liquid diet [(3.0±1.7) d, (2.8±1.5) d, (2.7±1.4) d], incidence of postoperative complication(6.6%, 9.0%, 11.7%), and hospital stay [(11.6±5.8) d, (10.7±5.8) d, (10.6±5.7) d] among 3 groups were not significantly different (all P>0.05). A total of 436 patients received postoperative follow-up of median 36 (5 to 67) months. The overall 5-year survival rate was 73.1%, 73.7% and 74.8%, and the 5-year disease-free survival rate was 71.5%, 71.1% and 72.7% in transverse, ascending and sigmoid colon cancer groups respectively, whose differences were not significant among 3 groups (all P>0.05).

CONCLUSIONLaparoscopic complete mesocolic excision for transverse colon cancer is safe and feasible with slightly longer operation time, and has quite good long-term oncologic efficacy.

Colectomy ; methods ; Colon, Ascending ; surgery ; Colon, Sigmoid ; surgery ; Colon, Transverse ; surgery ; Colonic Neoplasms ; surgery ; Comparative Effectiveness Research ; Disease-Free Survival ; Humans ; Laparoscopy ; methods ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Mesocolon ; surgery ; Operative Time ; Postoperative Complications ; Postoperative Period ; Retrospective Studies ; Survival Rate ; Treatment Outcome

OBJECTIVETo investigate the risk factors of postoperative urinary retention after rectal cancer surgery.

METHODSClinical data of 133 patients with rectal cancer undergoing radical surgery from January 2013 to September 2014 in the General Hospital of the PLA Rocket Force were retrospectively analyzed. Time to the first removal of urinary catheter, incidence of postoperative urinary retention, and time to re-insert indwelling catheter were recorded. Risk factors of urinary retention were analyzed.

RESULTSOf 133 patients, 70 were males and 63 were females, with a median age of 62 (20-79) years old. Distance from tumor lower margin to anal verge were ≤5 cm in 58 patients, >5 cm to 10 cm in 41 patients, and >10 cm to 15 cm in 34 patients. The postoperative TNM stage was recorded in 35 patients with stage I(, 34 with stage II(, 59 with stage III( and 5 with stage IIII(. Surgical procedures included anterior resection (AR) for 92 patients, abdominoperineal resection (APR) for 25 patients and intersphincteric resection (ISR) for 16 patients. Laparoscopic approach was performed in 89 patients compared with open operation in 44 patients. Time to the first removal of urinary catheter was 2-7 days after operation (median, 5 days) and 36 (27.1%) patients developed urinary retention. All the 36 patients achieved spontaneous voiding by re-inserting urinary catheter for 2-28 days (median, 6 days). Univariate analysis showed that elderly (>65 years) and laparoscopic approach had significantly higher incidence of urinary retention [37.5%(21/56) vs. 19.5%(15/77), χ=5.333, P=0.021; 34.8%(31/89) vs. 11.4%(5/44), χ=8.214, P=0.004; respectively]. Multivariate logistic analysis demonstrated that old age(OR=3.949, 95%CI:1.622 to 9.612, P=0.002), laparoscopic approach (OR=5.665, 95%CI:1.908 to 16.822, P=0.002), and abdominoperineal resection (OR=3.443, 95%CI:1.199 to 9.887, P=0.022) were independent risk factors of urinary retention after rectal cancer surgery.

CONCLUSIONSPatients undergoing rectal cancer surgery have a high risk of postoperative urinary retention. More attention should be paid to the old patients, especially those undergoing laparoscopic procedure or abdominoperineal resection, to prevent postoperative urinary retention and urinary dysfunction.

Adult ; Age Factors ; Aged ; Anal Canal ; surgery ; Colon, Sigmoid ; surgery ; Digestive System Surgical Procedures ; adverse effects ; methods ; statistics & numerical data ; Factor Analysis, Statistical ; Female ; Humans ; Laparoscopy ; adverse effects ; statistics & numerical data ; Male ; Middle Aged ; Postoperative Complications ; epidemiology ; Rectal Neoplasms ; classification ; surgery ; Rectum ; surgery ; Retrospective Studies ; Risk Factors ; Urinary Catheterization ; statistics & numerical data ; Urinary Retention ; epidemiology ; Urination ; physiology

OBJECTIVETo evaluate metastatic patterns of colorectal cancer following curative surgery based on primary tumor location in order to provide evidence for the decision of individualized adjuvant therapy and postoperative follow-up.

METHODSClinical and follow-up data of 904 patients who underwent curative colorectal cancer in The Affiliated Tumor Hospital of Zhengzhou University from October 2004 to October 2012 with complete follow-up data were analyzed retrospectively. A total 274 patients belonged to right-sided colon cancer group (cecum, ascending, hepatic flexure, and transverse colon), 243 belonged to left-sided colon cancer group(splenic flexure, descending, and sigmoid colon), and 387 belonged to rectal cancer group. The overall rate of distal metastasis and site-specific metastasis rates (liver, lung, and peritoneum) were compared among these 3 groups.

RESULTSThe cohort patients had a median follow-up of 37(4-122) months, and the median follow-up duration was similar in right-sided, left-sided, and rectal cancer groups with 39(5-119), 39(6-122) and 36(5-121) months(P=0.513). During the follow-up period, 44 patients (4.9%) had local recurrence alone, 137 (15.2%) distal metastasis alone, and 30(3.3%) local recurrence combined with distal metastasis. Compared to right-sided colon cancer group, rectal and left-sided cancer groups had significantly higher overall metastasis rates [23.5% (91/387), 17.3% (42/243) vs. 12.0% (33/274), P=0.000). With respect to specific regions, lung metastasis rate in rectal cancer group was 9.3%, which was significantly higher than that in left-sided(4.5%) and right-sided colon cancer group(2.6%)(P=0.001). Other sites of metastasis did not yield significant differences, including liver(P=0.130) and peritoneum(P=0.858).

CONCLUSIONSCancer location may be used as a reference of personalized adjuvant therapy and postoperative follow-up surveillance programs. Lower threshold for adjuvant therapy in rectal and left-sided colon cancers, and more aggressive surveillance for lung metastasis by chest X-ray or CT should be considered.

Aged ; Colon, Ascending ; Colon, Sigmoid ; Colon, Transverse ; Colorectal Neoplasms ; surgery ; Female ; Humans ; Lung Neoplasms ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local ; Retrospective Studies