Simultaneous Laparoscopy-Assisted Resection for Colorectal Cancer and Metastases / 고신대학교의과대학학술지

With advancement of minimal invasive surgery, a simultaneous laparoscopy-assisted resection for colorectal cancer and metastasis has become feasible. Hence, we report three cases of simultaneous laparoscopic surgery for colorectal cancer with liver or lung metastasis. In the first case, laparoscopic right hemicolectomy and left lateral segmentectomy of liver was performed for ascending colon cancer and liver metastasis. In the second case, laparoscopic right hemicolectomy and wedge resection of right lower lung was performed for cecal cancer and lung metastasis. In the third case, laparoscopic right hemicolectomy and wedge resection of left lower lung was performed for ascending colon cancer and lung metastasis. In the first two cases, patients quickly returned to normal activity. In the third case, postoperative bleeding was observed, but spontaneously stopped. There was no postoperative mortality. Simultaneous laparoscopic surgery represents a feasible option for colorectal cancer with metastases on the other organs.

Factors Affecting Long Term Survival after Gastrectomy for Stage IV Gastric Cancer

PURPOSE: The prognosis of stage IV gastric cancer is poor, but some patients with stage IV gastric cancer survive for more than 5 years. We investigated the prognostic factors of the stage IV gastric cancer in the patients with survival for more than 5 years after resection of the primary lesion. METHODS: We retrospectively analyzed 194 patients that underwent resection of stage IV gastric cancer from January 1997 to June 2000 in our hospital. We investigated clinicopathological characteristics between patients surviving 5 years or more group (n=17) and less than 5 years group (n=177) with chi-square and T-test. We used univariate analysis with Kaplan-Meier method and Log-rank test, and multivariate analysis with Cox proportional hazard model to investigate prognositic factors for survival rate about each characteristic. RESULTS: In clinicopathological characteristics between the two groups, we observed statistical significance in regard to macroscopic findings (P=0.035), but not in the others. Curative resection (P=0.001) and intravenous chemotherapy (P=0.012) had statistically significant influence on 5-year survival curve. Multivariate analysis showed that curative resection was a significant factor for long-term survival rates (P=0.005), but chemotherapy and macroscopic type had no effect on survival rate. CONCLUSION: Although this study has the limitation of a retrospective study and total patient number in the 5-year survival group, curative resection may be important, as a prognostic factor, and active treatments should be performed for stage IV gastric cancer.

Laparoscopic Low Anterior Resection in a Rectal Cancer Patient with Situs Inversus Totalis: A Case Report / 대한내시경복강경외과학회지

Situs inversus totalis is a rare congenital condition with a mirror image of the thoracic and abdominal viscera. Although several cases of laparoscopic surgery for treating situs inversus have been reported, we believe that laparoscopic low anterior resection for the rectal cancer associated with situs inversus has not yet been reported on. We recently experienced a laparoscopic low anterior resection for rectal cancer and this was performed on a patient with situs inversus. The patient was a 66-year-old woman who presented with constipation for about 1 month. Chest X-rays showed dextrocardia, and the abdomen CT scans revealed situs inversus totalis with upper rectal cancer. She was successfully treated with laparoscopic low anterior resection even though the surgeon was not familiar with situs inversus totalis.

Positron Emission Tomography (PET)-Computed Tomography (CT) for Preoperative Staging of Colorectal Cancers

PURPOSE: The purpose of this study is to evaluate the usefulness of positron emission tomography (PET)-computed tomography (CT) for preoperative tumor staging in cases of colorectal cancer. METHODS: Between July 2006 and September 2007, seventy-six patients with a diagnosis of colorectal cancer (43 males and 33 females; mean age: 60.4+/-10.13 years; range: 34~82 years) selected prospectively were studied for staging by using Chest X-ray, abdominal CT and PET-CT. RESULTS: The sensitivities and the specificities for N-staging were 76.9% and 35.1% for CT, 61.8% and 66.7% for PET-CT, and both procedures showed a relatively low diagnostic accuracy (CT 57.9%, PET-CT 61.8%). In the PET-CT alone, six distant metastatic lesions and four multiple primary malignancies were found. The locations of the distant metastases were the liver, the axillary node, the common iliac node, the subclavicular node, the peritoneum, and the lung. The locations of the multiple primary maligancies in extracolonic sites were 3 in the thyroid and 1 in the nasopharynx. CONCLUSIONS: For N-staging, preoperative PET-CT is no more useful than CT, but PET-CT is required before surgery to find lesions that cannot be found with conventional studies.

Strangulated Small Bowel Hernia through a Drain Site

Herniation of the small bowel through a drain site is a rare complication of surgery. We report here on a case of strangulated small bowel hernia through the site of a drain placed in the right lower quadrant of the abdomen after abdominal surgery. A 70 year-old male underwent aneurysmoplasty for an abdominal aortic aneurysm through a midline abdominal incision. A silicone drain (a sump drain) with an external diameter of 15 mm was inserted through an 18 mm stab incision in the right lower quadrant of the abdomen. The drain was removed after 5 days. Two hours later, a 25 cm segment of small bowel herniated through the drain site and became strangulated. Segmental resection of the strangulated small bowel was performed through extended incision of the drain site wound. The patient recovered and he was discharged 17 days later without further complications.