Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.
Humans ; Quality of Life ; Self Expandable Metallic Stents/adverse effects* ; Colonic Neoplasms/surgery* ; Stents/adverse effects* ; Intestinal Obstruction/surgery* ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Retrospective Studies

OBJECTIVE: To explore the clinical value of three-dimensional (3D) visualization technique in laparoscopic D3 radical resection of right colon cancer. METHODS: We retrospectively analyzed the clinical data of 73 patients with right colon cancer undergoing laparoscopic D3 radical operation in our hospital between May, 2019 and March, 2021. Among these patients, 41 underwent enhanced CT examination with 3D visualization reconstruction to guide the actual operation, and 32 underwent enhanced CT examination only before the operation (control group). In 3D visualization group, we examined the coincidence rate between the 3D visualization model and the findings in surgical exploration of the anatomy and variations of the main blood vessels, supplying vessels of the tumor, and the tumor location, and the coincidence rate between the actual surgical plan for D3 radical resection of right colon cancer and the plan formulated based on the 3D model. The operative time, estimated blood loss, unexpected injury of blood vessels, number of harvested lymph nodes, mean time of the first flatus, complications, postoperative hospital stay and postoperative drainage volume were compared between the two groups. RESULTS: The operative time was significantly shorter in 3D visualization group than in the control group (P < 0.05). The volume of blood loss, proportion of unexpected injury of blood vessel, the number of harvested lymph nodes, time of the first flatus, proportion of complications, postoperative hospital stay and postoperative drainage volume did not differ significantly between the two groups (P > 0.05). In the 3D visualization group, the 3D visualization model clearly displayed the shape and direction of the colon, the location of the tumor, the anatomy and variation of the main blood vessels and the blood vessels supplying the cancer, and showed a coincidence rate of 100% with the findings by surgical exploration. The surgical plan for D3 radical resection of right colon cancer was formulated based on the 3D model also showed a coincidence rate of 100% with the actual surgical plan. CONCLUSION The 3D visualization reconstruction technique allows clear visualization the supplying arteries of the tumor and their variations to improve the efficiency, safety and accuracy of laparoscopic D3 radical resection of right colon cancer.
Colonic Neoplasms/surgery* ; Flatulence/surgery* ; Humans ; Imaging, Three-Dimensional ; Laparoscopy/methods* ; Lymph Node Excision/methods* ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVE: To explore the feasibility of radical resection for cancer patients complicated with coronavirus disease 2019 (COVID-19). METHODS: The management and clinical outcome of a sigmoid cancer patient with COVID-19 were analyzed. RESULTS: The inflammation indicators and fever of this patient were effectively controlled and the lung lesions remained stable after active anti-viral treatment, then the radical colorectomy was performed after the viral negative conversion for twice. CONCLUSIONS The case indicates that radical resection can be performed in SARS-CoV-2 patients with twice-negative SARS-CoV-2 nucleic acid testing results.
Betacoronavirus ; isolation & purification ; Colonic Neoplasms ; complications ; surgery ; Coronavirus Infections ; complications ; therapy ; Disease Management ; Humans ; Pandemics ; Pneumonia, Viral ; complications ; therapy ; Treatment Outcome

OBJECTIVE: To explore the feasibility of surgical treatment for cancer patients complicated with corona virus disease 2019 (COVID-19). METHODS: The management and clinical outcome of a sigmoid cancer patient with COVID-19 were analyzed. RESULTS: The inflammation indicators and fever of this patient were effectively controlled and the lung lesions remained stable after active anti-viral treatment, then the radical colorectomy was performed after the viral negative conversion for twice. CONCLUSIONS The case indicates that it may feasible to undergo radical tumor surgery for cancer patients with COVID-19 after the virus nucleic acid testing turns negative and more studies are needed to confirm this conclusion.
Antiviral Agents ; therapeutic use ; Betacoronavirus ; Clinical Laboratory Techniques ; Colonic Neoplasms ; complications ; surgery ; virology ; Coronavirus Infections ; complications ; diagnosis ; drug therapy ; Fever ; Humans ; Nucleic Acid Amplification Techniques ; Pandemics ; Pneumonia, Viral ; complications ; diagnosis ; drug therapy

PURPOSE: Upfront systemic chemotherapy with target agents has been recommended for patients with stage IV colon cancer. Some with partial response are considered for curative resection. There is high risk of developing postoperative complications following upfront systemic chemotherapy. We aimed to evaluate short-term perioperative outcomes of curative surgery after upfront chemotherapy in comparison with upfront surgery in patients with metastatic colon cancer.METHODS: Between January 2010 and October 2015, 146 patients (80 in the surgery first group, 66 in the upfront chemotherapy group) who underwent surgical resection before or after systemic chemotherapy for metastatic colon cancer were included in the present study. All decisions for treatment were made through a multidisciplinary team. Postoperative clinical outcomes and complications were analyzed to compare the groups.RESULTS: There was no difference between the 2 groups in terms of postoperative clinical outcomes. Overall complication rates were not different between the groups (surgery first group: 46.3% vs. upfront chemotherapy group: 60.6%; P = 0.084). When classified according to the Clavien-Dindo method, there was no difference between the 2 groups in terms of major complications (grade 3 or more) (surgery first group: 18.9% vs. upfront chemotherapy group: 27.5%; P = 0.374).CONCLUSION: There was no significant increase in major postoperative complications in metastatic colon cancer patients who received upfront chemotherapy followed by curative surgery. Careful patient selection and treatment planning are important.
Antineoplastic Agents ; Colon ; Colonic Neoplasms ; Drug Therapy ; Humans ; Methods ; Neoplasm Metastasis ; Patient Selection ; Postoperative Complications

Aged ; Aged, 80 and over ; Colon, Transverse ; surgery ; Colonic Neoplasms ; complications ; Female ; Humans ; Intestinal Obstruction ; surgery ; Male ; Middle Aged ; Palliative Care ; Retrospective Studies ; Stents

PURPOSE: The feasibility of reduced-port laparoscopic surgery (RPS) in colon cancer remains uncertain. This study aimed to compare the short-term outcomes of RPS and multiport surgery (MPS) in colon cancer using propensity score matching analysis. METHODS: A total of 302 patients with colon cancer who underwent laparoscopic anterior resection (AR) (n = 184) or right hemicolectomy (RHC) (n = 118) by a single surgeon between January 2011 and January 2017 were included. Short-term outcomes were compared between RPS and MPS. RESULTS: Seventy-three patients in the AR group and 23 in the RHC group underwent RPS. After propensity score matching, the RPS and MPS groups showed similar baseline characteristics. In the AR group, patients who underwent RPS (n = 72) showed a shorter operation time (114.4 ± 28.7 minutes vs. 126.7 ± 34.5 minutes, P = 0.021) and a longer time to gas passage (3.6 ± 1.7 days vs. 2.6 ± 1.5 days, P = 0.005) than MPS (n = 72). Similarly, in the RHC group, the operation time was shorter (112.6 ± 26.0 minutes vs. 146.5 ± 31.2 minutes, P = 0.005), and the time to first flatus was longer (2.7 ±1.1 days vs. 3.8 ± 1.3 days, P = 0.004) in the RPS group (n = 23) than in the MPS group (n = 23). Other short-term outcomes were similar for RPS and MPS in both the AR and RHC groups. CONCLUSION: The short-term outcomes of RPS were found to be acceptable compared to those of MPS in colon cancer surgery.
Colon* ; Colonic Neoplasms* ; Flatulence ; Humans ; Laparoscopy* ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; Propensity Score*

PURPOSE: Laparoscopic surgery (LS) is an alternative to colorectal cancer surgery. Little evidence supports LS for emergency reoperation after laparoscopic colorectal surgery. The aim of this study was to assess perioperative outcomes of LS as an emergency reoperation for early complications after LS for colorectal cancer. METHODS: From June 2006 through December 2016, 732 consecutive patients underwent elective LS for colorectal cancer at Kyung Hee University Hospital, Seoul, Korea. Among these patients, we retrospectively reviewed data on those who received emergency laparoscopic reoperations for complications within 30 days after surgery. Variables associated with perioperative outcomes were analyzed. RESULTS: After exclusion of 50 patients (6.8%) who needed conversion to open surgery during LS, 79 of 682 patients (11.6%) received reoperation for complications, recurrence, and other benign diseases. Among them, 22 patients underwent emergency laparoscopic reoperation for early complications. Mean age of the patients was 62 years, and most underwent low anterior resection as a primary operation (n=17, 77.3%). Anastomotic leakage was the most common reason for reoperation (n=14, 63.6%). Postoperative complication occurred in 6 patients (27.3%), but none required further surgical intervention. Patients had first bowel movements at 2.8 days after reoperation, and length of hospital stay was 17.2 days after reoperation. CONCLUSION: Laparoscopic reoperation showed acceptable outcomes. LS as a reoperation for complications seemed to be feasible after LS for colorectal cancer.
Anastomotic Leak ; Colonic Neoplasms ; Colorectal Neoplasms* ; Colorectal Surgery ; Conversion to Open Surgery ; Emergencies* ; Humans ; Korea ; Laparoscopy* ; Length of Stay ; Minimally Invasive Surgical Procedures ; Postoperative Complications ; Rectal Neoplasms ; Recurrence ; Reoperation ; Retrospective Studies ; Seoul

OBJECTIVE: To explore the safety and feasibility of the overlapped delta-shaped anastomosis (ODA) technique for cases undergoing totally laparoscopic right hemicolectomy (TLRH). METHODS: Clinical data of patients who underwent TLRH using the ODA technique or the modified delta-shaped anastomosis (MDA) technique at Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from January 2016 to December 2017 were retrospectively analyzed. INCLUSION CRITERIA: (1)diagnosed with adenocarcinoma by enteroscopy before operation; (2)cancer locating at ascending colon or transverse colon hepatic region and receiving TLRH surgery. EXCLUSION CRITERIA: (1) double or multiple primary colorectal cancers;(2)with complete or incomplete intestinal obstruction; (3) combined multiple organs resection; and (4) with unresectable distant metastases. The ileum and the transverse colon were sutured in an overlapped fashion about 8 cm away from the end of the ileum firstly, and then two small openings locating at the end of ileum and the corresponding site of the transverse colon were created in the ODA procedure, and the two small openings both locating at the end of ileum and the transverse colon were created in the MDA procedure. Statistical analysis was performed using SPSS 24.0 software and the general information, surgical and pathological results, and complications between two groups were compared. RESULTS: A total of 108 patients were enrolled in this study, including 52 patients in the ODA group and 56 patients in the MDA group. In the ODA group, 28 patients were male and 24 were female with age of (53.3±10.0) years and body mass index (BMI) of (24.2±2.7) kg/m. In the MDA group, 27 patients were male and 29 were female with a mean age of (54.5±9.4) years and body mass index of (23.8±2.4) kg/m. There were no significant differences between the two groups in terms of age, gender, BMI, history of previous abdominal surgery, scoring of American Society of Anesthesiologists, tumor location, pathological TNM stage, and number of dissected lymph node (all P>0.05). All the patients underwent R0 resection without conversion to open surgery or to extraperitoneal anastomosis. The time of anastomosis in the ODA group was shorter than that in the MDA group[(15.7±2.3) minutes vs.(18.6±3.6) minutes], and the difference was statistically significant (t=-5.017, P<0.001). There were no significant differences between two groups in total operative time[(160.7±17.8) minutes vs.(163.2±17.6) minutes], intraoperative blood loss [(77.7±28.3) ml vs.(75.9±31.8) ml], length of incision [(5.8±1.1) cm vs. (5.9±1.1) cm], time to first flatus [(1.8±0.2) days vs. (1.9±0.3) days], time to first oral intake [(1.9±0.5) days vs. (1.9±0.4) days], postoperative complications [3.8%(2/52) vs. 5.4%(3/56)], and postoperative hospital stay [(6.7±0.9) days vs. (6.8±0.8) days]. CONCLUSIONS The ODA technique is less time-consuming without increasing postoperative complications compared to the MDA technique, which is a safe and feasible technique in TLRH worth further promotion.
Adenocarcinoma ; surgery ; Anastomosis, Surgical ; Colectomy ; methods ; Colonic Neoplasms ; surgery ; Female ; Humans ; Laparoscopy ; Length of Stay ; Male ; Middle Aged ; Postoperative Complications ; Retrospective Studies ; Treatment Outcome

PURPOSE: To demonstrate the feasibility, safety, and technical strategies of hand-assisted laparoscopic complete mesocolic excision (HAL-CME) and to compare oncological outcomes between HAL-CME and the open approach (O-CME) for right colon cancers. METHODS: Patients who were scheduled to undergo a right hemicolectomy were divided into HAL-CME and O-CME groups. Measured outcomes included demographic variables, perioperative parameters, and follow-up data. Demographic variables included age, sex distribution, body mass index (BMI), American Society of Anesthesiologists (ASA) physical status classification, previous abdominal surgery, tumor localization, and potential comorbidities. Perioperative parameters included incision length, operative time, blood loss, conversion rate, postoperative pain score, postoperative first passage of flatus, duration of hospital stay, total cost, number of lymph nodes retrieved, TNM classification, and postoperative complications. Follow-up data included follow-up time, use of chemotherapy, local recurrence rate, distant metastasis rate, and short-term survival rate. RESULTS: In total, 150 patients (HAL-CME, 78; O-CME, 72) were included. The groups were similar in age, sex distribution, BMI, ASA classification, history of previous abdominal surgeries, tumor localization, and potential comorbidities. Patients in the HAL-CME group had shorter incision lengths, longer operative times, less operative blood loss, lower pain scores, earlier first passage of flatus, shorter hospital stay, higher total costs, similar numbers of lymph nodes retrieved, similar TNM classifications, and a comparable incidence of postoperative complications. The 2 groups were also similar in local recurrence rate, distant metastasis rate, and short-term survival rate. CONCLUSION: The results demonstrate that the HAL-CME procedure is a safe, valid, and feasible surgical method for right hemicolon cancers.
Body Mass Index ; Classification ; Colectomy ; Colonic Neoplasms ; Comorbidity ; Drug Therapy ; Flatulence ; Follow-Up Studies ; Hand-Assisted Laparoscopy ; Humans ; Incidence ; Laparoscopy ; Length of Stay ; Lymph Node Excision ; Lymph Nodes ; Mesocolon ; Methods ; Neoplasm Metastasis ; Operative Time ; Pain, Postoperative ; Postoperative Complications ; Recurrence ; Sex Distribution ; Survival Rate