Resultados perioperatorios de la implementación de la resección completa del mesocolon por vía laparoscópica en cáncer de colon derecho y transverso

Introducción: La técnica de resección completa del mesocolon (RCM) en la hemicolectomía derecha consiste en la disección por planos embriológicos para lograr la resección completa del envoltorio mesocolónico, además de una ligadura vascular central (LVC) con linfadenectomía D3, que no se realiza normalmente con la técnica estándar. Esta técnica se asocia a mejores resultados de sobrevida global y libre de enfermedad que la cirugía convencional en trabajos retrospectivos. Sin embargo, no existen datos de su implementación a nivel nacional. El objetivo de este estudio es evaluar los resultados perioperatorios de la implementación del RCM en un centro universitario en nuestro medio. Materiales y Método: Estudio retrospectivo de cohorte de pacientes consecutivos sometidos a hemicolectomía derecha laparoscópica con técnica de RCM-LVC entre Enero 2022 y Junio 2023. Se recopilaron variables demográficas, perioperatorias, postoperatorias e histopatológicas. Los resultados se analizaron utilizando estadística descriptiva. Resultados: En el periodo, 29 pacientes se sometieron a RCM laparoscópica (mediana de edad 66(57-76) y 15(52%) sexo femenino). La mediana del tiempo quirúrgico fue 202,9 minutos. No hubo casos de conversión, filtración anastomótica, ni mortalidad. Hubo morbilidad en 9 casos (31%) y de estos solo 1(3,4%) fue Clavien-Dindo III (hematoma Pfannenstiel reintervenido). No hubo lesiones vasculares intraoperatorias. Mediana de hospitalización de 3 días. Doce casos (41%) eran etapa II y 8(28%) etapa III. La mediana de linfonodos resecados fue 23(18-28). Conclusión: Esta serie demuestra que la implementación de la RCM-LVC por vía laparoscópica para el tratamiento del cáncer de colon derecho y transverso es factible en centros con experiencia en cirugía colorrectal laparoscópica avanzada.

Introduction: Complete mesocolic excision (CME) consists in the dissection on embryologic planes in order to achieve a complete resection of the mesocolic envelope and performing a central vascular ligation (CVL) with a D3 lymphadenectomy which is not routinely done for standard right colectomies. CME has been associated with better overall survival and disease-free survival in comparison with conventional surgery in retrospective studies. However, there is no data on its implementation in Chile. The aim of this study is to assess the perioperative results of the implementation of CME in our center. Methods: A retrospective cohort study was conducted. Consecutive patients undergoing a laparoscopic right hemicolectomy with CME-CVL between January 2022 and June 2023 were included. Demographic, perioperative, postoperative and histopathological data were collected. Results were analyzed using descriptive statistics. Results: During the study period, 34 patients underwent CME; 29 of them underwent laparoscopic CMECVL (median age 66 (57-76) and 15 (52%) female). The median operating time was 202,9 minutes. There were no cases of conversion, anastomotic leakage or mortality. There was morbidity in 9 cases (31%) and one of these (3,4%) was a Clavien-Dindo III morbidity (reoperation due to a Pfannenstiel haematoma). There were no intraoperative vascular injuries. The median length of stay was 3 days. Twelve cases (41%) were stage II and 8(28%) stage III. The median number of lymph nodes harvested was 23(18-28). Conclusion: This series demonstrate that the implementation of laparoscopic CME-CVL for right and transverse colon cancer is feasible in centers with experience in advanced laparoscopic colorectal cancer.

Streptococcus gallolyticus bacteremia detected in apheresis platelets and its link to colonic neoplasms

Introduction: Streptococcus gallolyticus belongs to theStreptococcus bovis complex, and it is a common bacterium colonizing the gastrointestinal tract. Its presence in the blood may suggest an underlying pathology such as a colonic neoplasm. We report herein a case of S. bovis bacteremia in an apheresis platelet donor, review similar cases in the literature, and suggest a flowchart for the management of similar cases in other blood donation centers. Case Presentation: A 61-year-old subject presented to a Hemotherapy Service to make an apheresis platelet donation. On quality control testing, S. gallolyticus was identified in hemoculture, and the donor was called back for follow-up. At first, a new hemoculture was requested, and the patient was referred to the outpatient department of infectious diseases to further investigate pathologies associated with S. gallolyticus. A subsequent colonoscopy investigation evidenced a polypoid structure in the ascending colon. Pathology reported the resected specimen as a low-grade tubular adenoma. Conclusion: Isolation of S. bovis in blood products requires further investigation and should be managed with precision by Hemotherapy Services. A standard protocol for the management of asymptomatic patients with S. bovis positive hemoculture, with the requests of a new blood culture, a colonoscopy, and an echocardiogram is crucial, as it may ensure early diagnosis and reduce morbidity and mortality. (AU)

Metástasis en pene de un adenocarcinoma del colon / Metastasis in the penis of an adenocarcinoma of the colon

Introducción: Entre las lesiones malignas que se describen, se encuentra el cáncer de pene. Esta entidad constituye del 2 al 5 por ciento de los tumores urogenitales masculinos; la lesión metastásica es muy poco frecuente. Objetivos: Describir las características clínicas y evolución tórpida de un paciente con metástasis en el pene, de una neoplasia del colon. Caso clínico: Paciente de 54 años, antecedentes personales de salud, fumador, historia de hiperplasia prostática benigna y prostatitis crónica. Ingresa con dolor en hemiabdomen inferior y tumoración abdominal. Se diagnostica plastrón intraabdominal. Es intervenido quirúrgicamente; la biopsia de la lesión informa adenocarcinoma de colon. A los 7 días de evolución aparecen lesiones en el glande, que resultaron metástasis del adenocarcinoma de colon. Fallece por complicaciones de la enfermedad. Conclusiones: Las metástasis de las neoplasias del colon, en el pene, son infrecuentes; indican un estadio avanzado de la enfermedad, con un pronóstico desfavorable(AU)

Introduction: Among the malignant lesions described is penile cancer. This entity constitutes 2 percent to 5 percent of male urogenital tumors, and metastatic lesion is very rare. Objectives: To describe the clinical characteristics and torpid evolution of a patient with metastases in the penis from colon neoplasia. Clinical case: 54-year-old patient, personal health history. Smoker, history of benign prostatic hyperplasia and chronic prostatitis, which begins with pain in the lower abdomen and abdominal tumor, intra-abdominal plastron is diagnosed and is surgically intervened with a biopsy of the lesion that reports colon adenocarcinoma. At 7 days of evolution, lesions appeared on the glans that resulted in metastasis of colon adenocarcinoma. He dies from complications of the disease within six months. Conclusions: Colonic neoplasm metastases in the penis are infrequent, they indicate an advanced stage of the disease, with an unfavorable prognosis(AU)

Lead sulfide quantum dots for the near-infrared IIb window fluorescence imaging of colon cancer / 药学学报

The near-infrared-IIb (NIR-IIb, 1 500-1 700 nm) window fluorescence with long emission wavelength has reduced light scattering and tissue auto-fluorescent background, achieving deep tissue imaging with high spatial resolution. Herein, we prepared an NIR-IIb fluorescent quantum dots (QDs) composed of lead sulfide (PbS). The fluorescence spectrum of PbS QDs were adjusted by controlling the size of the PbS core. Cadmium sulfide (CdS) shell was synthesized by the cation exchange method to form the core/shelled lead sulfide/cadmium sulfide quantum dots (CSQDs). The surface of CSQDs was modified with polyethylene glycol (PEG) to increase their stability in aqueous solution. The resulting PEG-modified CSQDs (PEG-CSQDs) had the emission peak at ~1 550 nm with quantum yield of 7.2%. The animal procedures were approved by the Institutional Animal Care and Use Committee (IACUC) of Fudan University School of Pharmacy. At 2 h postinjection, PEG-CSQDs clearly delineated the tumor region of mice bearing orthotopic CT26-Luc colon cancer model in the NIR-IIb fluorescence imaging. The fluorescent intensity ratio of primary tumor and adjacent normal tissue was 42.3, and that of metastatic tumor and adjacent normal tissue was 22.3, which allowed to detect the primary tumor of 3.4 mm×2.5 mm in dimension and the metastatic tumor of 1.2 mm×0.9 mm in dimension, and accurately guided the excision of tumors. The PEG-CSQDs prepared in this study provided a new approach for the early diagnosis and guidance of surgical resection of colon cancer.

Internal hernia through mesocolon defect after left laparoscopic colectomy / Hérnia interna pelo defeito mesocólico após colectomia esquerda laparoscópica

ABSTRACT Introduction: The development of internal hernias due to the mesocolon defect after laparoscopic colectomy is a rare complication with only 39 cases described. There are controversies whether the closure of the defect of the mesocolon after resection of the colon could prevent the development of this complication. Objective: To describe a case of intestinal obstruction due to internal hernia through the mesocolon defect after laparoscopic rectosigmoidectomy and to perform a literature review. Case report: A 59-year-old woman was hospitalized for laparoscopic rectosigmoidectomy due to an adenocarcinoma located in the rectosigmoid junction. She underwent a rectosigmoidectomy by laparoscopy, with an extracorporeal mechanical anastomosis, without closure of the mesocolon defect. In the fifth postoperative day the patient presented an intestinal obstruction due to an internal hernia through the mesocolon defect confirmed by computerized tomography. During the exploratory laparotomy approximately 120 cm jejunum was identified through the mesocolon defect. The reduction of herniated small bowel was done without the need of intestinal resection. The mesocolon defect was corrected by continuous suture. After the reoperation, the patient presented a favorable recovery being discharged on the fifth day. Conclusion: Intestinal obstruction due to internal hernia after laparoscopic rectosigmoidectomy is a rare postoperative complication that can be avoided by the adequate closure of the mesocolon defect.

RESUMO Introdução: O desenvolvimento de hérnias internas pelo defeito mesocólico após a realização de colectomia laparoscópica é uma complicação rara com apenas 39 casos descritos. Existem controvérsias se fechamento do defeito após a ressecção do cólon preveniria o desenvolvimento desta complicação. Objetivo: Descrever um caso de obstrução intestinal por hérnia interna pelo defeito mesocólico, após retossigmoidectomia laparoscópica e revisar a literatura relacionada ao tema. Relato do caso: Mulher, 59 anos foi internada para realizar ressecção cirúrgica de adenocarcinoma localizado na junção retossigmoideana. Foi submetida à retossigmoidectomia laparoscópica, com confecção de anastomose mecânica extracorpórea. O defeito mesocólico não foi corrigido no final do procedimento. No quinto dia de pós-operatório, a doente apresentou quadro de obstrução intestinal cuja tomografia computadorizada identificou presença de hérnia interna pelo defeito do mesocólon. Na laparotomia exploradora identificou-se que aproximadamente 120 cm de alças jejunais estavam herniadas através do defeito mesocólico. Realizou-se a redução do intestino delgado herniado sem necessidade de ressecção intestinal. O defeito foi corrigido por sutura contínua. Após a reoperação a doente apresentou evolução favorável recebendo alta no quinto dia. Conclusão: Obstrução intestinal após retossigmoidectomia laparoscópica consequente à formação de hérnia interna é complicação pós-operatória rara, com alta mortalidade, que pode ser evitada pelo fechamento criterioso do defeito do mesocólico.

Pyogenic Liver Abscess Caused by Endoscopic Submucosal Dissection for Early Colon Cancer

Endoscopic submucosal dissection (ESD) is widely used for the treatment of colorectal neoplasia in patients who are candidates for endoscopic resection. In particular, pyogenic liver abscess (PLA), although rare, can occur. To our knowledge, there are no reports of PLA cases after ESD. Therefore, we report a rare case of PLA caused by ESD. A 76-year-old man was referred from a local clinic and admitted to our hospital for colonic ESD for a large polypoid mass. During colonoscopy, a 5-cm mass was seen in the cecum. ESD was performed. Four days after the procedure, he complained of myalgia and abdominal discomfort. Computed tomography revealed a 5.4-cm PLA in the medial segments of the liver. He was treated with antibiotics, and a percutaneous drainage catheter was inserted. Here, we report a very rare complication (PLA) after ESD. In conclusion, comprehensive awareness of the development of PLA is needed in ESD cases.

Impact of Patient’s Pain and Fatigue on Decision of Discharge After Laparoscopic Surgery for Colorectal Cancer

PURPOSE: Hospital stays after laparoscopic surgery for colorectal cancer tend to be much shorter than those after conventional open surgery. Many factors, including surgical outcomes and complications, are associated with patient discharge planning. However, few studies have analyzed the impact of patient subjective discomfort (including pain and fatigue) on the decision to discharge after surgery. Therefore, the purpose of this study was to determine how patient pain and fatigue play a role in the decision to discharge after laparoscopic surgery for colorectal cancer. METHODS: Between March 2014 and February 2015, we conducted a questionnaire survey of 91 patients who underwent laparoscopic surgery for colorectal cancer to estimate the expectation criteria for discharge and patient subjective discomfort at that time. Patients were divided into the following 2 groups: group A, those who complied with the medical professional’s decision to discharge; and group B, those who refused discharge despite the medical professional’s decision. The participants’ subjective factors were analyzed. RESULTS: Preoperatively, 78 of 91 patients (85.7%) identified activity level, amount of food (tolerance), and bowel movements as important factors that should be considered in the decision to discharge a patient postoperatively. Postoperatively, 17 patients (18.7%) refused discharge despite a discharge recommendation. Subjective pain and fatigue were significantly different in linear-by-linear association between the group of patients who agreed to be discharge and those who disagreed. Despite this difference, there was no significant difference in mean length of hospital stay between the 2 groups. CONCLUSION: A patient’s subjective feelings of pain and fatigue can impact their decision regarding hospital discharge.

Impact of tumor sidedness on survival and recurrence patterns in colon cancer patients

PURPOSE: Previous studies have reported conflicting results regarding the prognostic value of tumor sidedness in colon cancer. We investigated the oncologic impact of tumor location and examined whether recurrence patterns were related to tumor sidedness in colon cancer patients. METHODS: We identified stage I–III colon adenocarcinoma patients from a prospective colorectal cancer registry at Severance Hospital, Seoul, Korea, who underwent complete mesocolic excision between 2005 and 2012. Adjusted hazard ratios (HRs) and 95% confidence intervals (CI) for predictors of cancer-specific survival (CSS), recurrence-free survival (RFS), and cumulative recurrence at specific anatomic sites were examined using Cox proportional hazard regression analysis. RESULTS: Overall, 1,912 patients, 1,077 (56.3%) with left-sided colon cancer (LCC), and 835 (43.7%) with right-sided colon cancer (RCC), at a median follow-up of 59 months, were eligible and included in the study. In univariate analysis, similar 5-year CSS and RFS were observed for LCC and RCC in the total patient population, and when stratified by stage for stage I and II patients. For stage III patients, an adjusted Cox regression analysis indicated that RCC patients had a higher risk of cancer-specific mortality (HR, 1.75; 95% CI, 1.07–2.86; P = 0.024) and recurrence (HR, 1.78; 95% CI, 1.22–2.60; P = 0.003). Furthermore, RCC was an independent predictor of peritoneal recurrence (HR, 1.86; 95% CI, 1.05–3.29; P = 0.031) in stage III patients. CONCLUSION: RCC correlated with worse CSS and RFS than LCC. In stage III patients, RCC correlated with increased risk of peritoneal recurrence. The reasons for these differences remain to be investigated.

Effect of vitamin C on azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced colitis-associated early colon cancer in mice

BACKGROUND/OBJECTIVES: The objective of this study was to investigate the effects of vitamin C on inflammation, tumor development, and dysbiosis of intestinal microbiota in an azoxymethane (AOM)/dextran sulfate sodium (DSS)-induced inflammation-associated early colon cancer mouse model. MATERIALS/METHODS: Male BALB/c mice were injected intraperitoneally with AOM [10 mg/kg body weight (b.w)] and given two 7-d cycles of 2% DSS drinking water with a 14 d inter-cycle interval. Vitamin C (60 mg/kg b.w. and 120 mg/kg b.w.) was supplemented by gavage for 5 weeks starting 2 d after the AOM injection. RESULTS: The vitamin C treatment suppressed inflammatory morbidity, as reflected by disease activity index (DAI) in recovery phase and inhibited shortening of the colon, and reduced histological damage. In addition, vitamin C supplementation suppressed mRNA levels of pro-inflammatory mediators and cytokines, including cyclooxygenase-2, microsomal prostaglandin E synthase-2, tumor necrosis factor-α, Interleukin (IL)-1β, and IL-6, and reduced expression of the proliferation marker, proliferating cell nuclear antigen, compared to observations of AOM/DSS animals. Although the microbial composition did not differ significantly between the groups, administration of vitamin C improved the level of inflammation-related Lactococcus and JQ084893 to control levels. CONCLUSION: Vitamin C treatment provided moderate suppression of inflammation, proliferation, and certain inflammation-related dysbiosis in a murine model of colitis associated-early colon cancer. These findings support that vitamin C supplementation can benefit colonic health. Long-term clinical studies with various doses of vitamin C are warranted.

Evaluation of the Expression of the Inhibitor of Apoptosis Protein Family and Human Telomerase Reverse Transcriptase in Patients With Advanced Colorectal Adenoma

BACKGROUND: It has been reported that the expression of the inhibitor of apoptosis protein (IAP) family increases in patients with colon cancer. We evaluated the expression of the IAP family and human telomerase reverse transcriptase (hTERT) in normal colon mucosa from patients with advanced colorectal adenoma and investigated their features according to characteristics of advanced colorectal adenoma. METHODS: While resections of polyps were performed in patients (n = 80) diagnosed with advanced colorectal adenoma or carcinoma in situ, additional normal tissues were obtained from the sigmoid colon. In healthy patients (n = 16), blind biopsies were performed on the sigmoid colon. The expression of the IAP family, including survivin, XIAP, cIAP1, and cIAP2, and hTERT, were analyzed by real-time PCR in both groups. RESULTS: A total of 80 advanced colorectal adenoma patients (71.3% male, mean age of 60.4 years) and 16 control patients were enrolled in this study. The mean ranking of cIAP2 was higher in the control group (68.88 vs. 44.43, P = 0.001). The expression levels of hTERT, survivin, XIAP, and cIAP from both groups showed no differences. The expression of survivin, XIAP, cIAP1, cIAP2, and hTERT depending on certain factors of advanced adenoma, including the number (two or fewer vs. three or more), size (smaller than 1 cm vs. larger than 1 cm), grade of dysplasia (low grade adenoma vs. high grade adenoma), pathology (tubular adenoma vs. villous adenoma), and presence of endometrial intraepithelial neoplasms, showed no significant correlations in the Mann-Whitney U-test. CONCLUSIONS: The expression of the IAP family and hTERT, except cIAP2, in the normal mucosa of patients with advanced colorectal adenoma were not different from those of the control group. There were no differences in the IAP family and hTERT according to the characteristics of advanced adenoma.

Quality of life changes during adjuvant chemotherapy in patients with colon cancer

PURPOSE: The survival of advanced colon cancer patients has increased due to the development of surgical techniques and adjuvant chemotherapy. The administration of adjuvant chemotherapy after curative resection is generally accepted as a standard of care. The primary endpoint of chemotherapy should include not only tumor response and survival, but also impact on the quality of life (QoL). We evaluated changes in QoL during adjuvant chemotherapy in patients with colon cancer.METHODS: Between October 2009 and February 2012, 56 patients with stage II and III colon cancer received the combination adjuvant chemotherapy 5-flurouracil/folinic acid with oxaliplatin (FOLFOX). Patients were asked to complete the QoL questionnaire QLQ-C30 version 3 before and after 6 cycles of adjuvant chemotherapy.RESULTS: There was no significant difference in the QoL between the start of chemotherapy and after the completion of 6 cycles. After completion of 6 cycles, global QoL was worse in patients >70 years of age. The functional scale score was low in patients with chemotherapy schedules delayed more than 2 times due to adverse events. Patients with body weight increases greater than 5% scored lower on symptom scales. Interestingly, patients with peripheral neuropathy scored higher on symptom scales.CONCLUSION: QoL changes during adjuvant chemotherapy did not show significant differences. After the sixth chemotherapy, QoL was affected by age, body weight gain, delay of the scheduled chemotherapy, and peripheral neuropathy. Therefore, the proper attitude of physicians focused on reassurance and education of patients is very important during chemotherapy.

The impact of obesity on the outcomes of laparoscopic colectomy: An observational study

PURPOSE: The impact of obesity on the surgical outcomes of Asian patients undergoing laparoscopic colon surgery is not clear. The purpose was to evaluate the outcome of laparoscopic surgery in obese Asian patients with colon cancer.METHODS: We retrospectively reviewed the prospectively collected data of 1,740 consecutive patients who underwent laparoscopic surgery for colon cancer between January 2008 and December 2010. Patients were classified according to the categories proposed by the International Obesity Task Force, Non-obese (body mass index [BMI]<25.0 kg/m2), Obese-I (BMI, 25.0–29.9 kg/m2), and Obese-II (BMI≥30 kg/m2). Surgical outcomes, including open conversion, operative time, and postoperative hospital stay, were compared in the Non-obese, Obese-I, and Obese-II patients.RESULTS: Of the 1,192 patients in the study, 812 (68.1%), 360 (30.2%), and 20 (1.7%), were classified as Non-obese, Obese-I, and Obese-II, respectively. The Obese-II group had higher conversion rates (10.0% vs. 3.6% and 1.6%, P=0.008) and, longer operative times (180.35 vs. 162.54 and 147.84 minutes, P<0.001) than the Obese-I and Non-obese group. However, the other postoperative outcomes were not significantly different. The overall survival and disease-free survival were not significantly different between groups (P=0.952). Multivariate analysis showed that the independent risk factor for conversion were BMI, total operative time, previous operative history, and cancer perforation.CONCLUSION: The outcomes of laparoscopic colon surgery in obese patients are similar to those of non-obese patients, offering all the benefits of a minimally invasive approach. However, the conversion rate was higher in obese patients. It is therefore very important for surgeons to be aware of these risks during laparoscopic colon surgery in obese patients.

Robotic Low Ligation of the Inferior Mesenteric Artery for Rectal Cancer Using the Firefly Technique

PURPOSE: By integrating intraoperative near infrared fluorescence imaging into a robotic system, surgeons can identify the vascular anatomy in real-time with the technical advantages of robotics that is useful for meticulous lymphovascular dissection. Herein, we report our initial experience of robotic low ligation of the inferior mesenteric artery (IMA) with real-time identification of the vascular system for rectal cancer using the Firefly technique. MATERIALS AND METHODS: The study group included 11 patients who underwent a robotic total mesorectal excision with preservation of the left colic artery for rectal cancer using the Firefly technique between July 2013 and December 2013. RESULTS: The procedures included five low anterior resections and six ultra-low anterior resections with loop ileostomy. The median total operation time was 327 min (226-490). The low ligation time was 10 min (6-20), and the time interval between indocyanine green injection and division of the sigmoid artery was 5 min (2-8). The estimated blood loss was 200 mL (100-500). The median time to soft diet was 4 days (4-5), and the median length of stay was 7 days (5-9). Three patients developed postoperative complications; one patients developed anal stricture, one developed ileus, and one developed non-complicated intraabdominal fluid collection. The median total number of lymph nodes harvested was 17 (9-29). CONCLUSION: Robotic low ligation of the IMA with real-time identification of the vascular system for rectal cancer using the Firefly technique is safe and feasible. This technique can allow for precise lymph node dissection along the IMA and facilitate the identification of the left colic branch of the IMA.

Oncologic outcomes of early adjuvant chemotherapy initiation in patients with stage III colon cancer

PURPOSE: Although adjuvant chemotherapy reduces the risk of disease recurrence in stage III colon cancer patients, published guidelines do not specify when it should be initiated. This study aimed to assess the effect of adjuvant chemotherapy initiation time on disease recurrence and survival in stage III colon cancer patients undergoing curative surgical resection. METHODS: The medical records of stage III colon cancer patients undergoing curative resection between February 2004 and December 2009 were reviewed. RESULTS: Of the 133 enrolled patients, 27 (20.3%) began adjuvant chemotherapy within 3 weeks of surgery, whereas 106 (79.7%) did after 3 weeks following surgery. Patients receiving chemotherapy within 3 weeks of surgery were less likely to experience recurrences than those beginning treatment later (11.1% vs. 33%, P = 0.018). The mean disease-free survival of patients receiving adjuvant therapy earlier was 54.6 months, whereas that of patients with later treatment was 43.5 months (P = 0.014). However, no significant differences in overall survival were observed between the 2 groups. CONCLUSION: Adjuvant chemotherapy should be initiated as soon as a patient's clinical condition allows. Patients with stage III colon cancer may benefit from adjuvant chemotherapy initiated within 3 weeks of surgery.

Impact of epidural anesthesia with levobupivacaine at different concentrations combined with general anesthesia on colon surgery / 实用医学杂志

Objective To evaluate the impact of epidural anesthesia with levobupivacaine combined with general anesthesia on colon surgery. Methods Sixty patients undergoing elective radical procedure for colon carcinoma were randomLy divided into four groups: saline group (group S), 0.125% levobupivacaine group (group L1), 0.25% levobupivacaine group (group L2), and 0.5% levobupivacaine group (group L3). Group S received normal saline of 10 mL epidurally and then infusion of 5 mL·h-1 until the procedure was finished; groups L1, L2, and L3 received levobupivacaine instead. Anesthetic induction was performed after epidural puncture. Mean blood pressure and heart rate were recorded at 8 time points including 5 min after entering into the operation room, 1 min after intubation, skin incision, abdominal exploration, 1 h after skin incision, completion of operation, extubation, and leaving PACU; meanwhile blood glucose and cortisol were detected, anesthesia time, time to PACU stay, bleeding, transfusion volume, adverse reaction, and doses of propofol, remifentanil, ephedrine, and fentanyl were noted. Results Time to PACU stay was longer in S group than in other 3 groups. Doses of remifentanil and fentanyl were larger in L1 group than in L2 group and L3 group. Ephedrine dose in L3 group was larger than in other 3 groups. Blood sugar in L1 group was higher than L2 group and L3 group. Cortisol in S group was higher than in other 3 group. Cortisol in L1 group was higher than in L3 group. The number of patients with hypotension was greater in L3 group than other 3 groups. Conclusions Continue epidural infusion of 0.25%levobupivacaine can reduce stress response and opioid uses, shorten PACU stay, whereas it does not increase use of ephedrine.

Comparative study of oncologic outcomes for laparoscopic vs. open surgery in transverse colon cancer

PURPOSE: Laparoscopic resection for transverse colon cancer is a technically challenging procedure that has been excluded from various large randomized controlled trials of which the long-term outcomes still need to be verified. The purpose of this study was to evaluate long-term oncologic outcomes for transverse colon cancer patients undergoing laparoscopic colectomy (LAC) or open colectomy (OC). METHODS: This retrospective review included patients with transverse colon cancer who received a colectomy between January 2006 and December 2010. Short-term and five-year oncologic outcomes were compared between these groups. RESULTS: A total of 131 patients were analyzed in the final study (LAC, 84 patients; OC, 47 patients). There were no significant differences in age, gender, body mass index, tumor location, operative procedure, or blood loss between groups, but the mean operative time in LAC was significantly longer (LAC, 246.8 minutes vs. OC, 213.8 minutes; P = 0.03). Hospital stay was much shorter for LAC than OC (9.1 days vs. 14.5 days, P < 0.01). Postoperative complication rates were not statistically different between the two groups. In terms of long-term oncologic data, the 5-year disease-free survival and overall survival were not statistically different between both groups, and subgroup analysis according to cancer stage also revealed no differences. CONCLUSION: LAC for transverse colon cancer is feasible and safe with comparable short- and long-term outcomes.

Effect of abnormal Hedgehog signaling pathway on multidrug resistance of human colon adenocarcinoma cells / 肿瘤

Objective: To investigate the correlation between Hedgehog (Hh) signaling pathway and multidrug resistance of human colon adenocarcinoma cells. Methods: Human colon adenocarcinoma cell line HCT-8 and its vincristine (VCR)-resistant variant HCT-8/VCR cells were treated by agonist SAG or antagonist GANT61 of Hh signaling pathway, respectively. Four groups were designed for the purpose of this study: HCT-8 group, HCT-8/VCR group, HCT-8+SAG group (treated with 3 nmol/L SAG for 48 h), and HCT-8/VCR+GANT61 group (treated with 5 μmol/L GANT61 for 48 h). Then CCK-8 (cell counting kit-8) assay was used to detect the multidrug resistance and the survival rate of the cells. The expression levels of Hh signaling members Smo (Smoothened protein) and Gli1 (Gloma-associated oncoprotein-1) and P-gp (P-glycoprotein) mRNAs and proteins were determined by real-time fluorescence quantitative PCR and Western blotting, respectively. Results: The expressions of Smo, Gli1 and P-gp mRNAs and proteins in HCT-8/VCR group were higher than those in HCT-8 group (P < 0.05). Compared with HCT-8 group, the survival rate and the mRNA and protein expression levels of Smo, Gli1 and P-gp in HCT-8+ SAG group were significantly up-regulated (P < 0.05). Compared with HCT-8/VCR group, the survival rate and the mRNA and protein expression levels of Smo, Gli1 and P-gp in HCT-8/VCR+GANT61 group were significantly down-regulated (P < 0.05). Conclusion: The multidrug resistance of human colon adenocacinoma cells may be correlated with abnormal activation of Hh signaling pathway. Copyright © 2012 by TUMOR.

Metástase de adenocarcinoma de cólon para região selar: relato de caso / Metastatic colonic adenocarcinoma from sellar region: case report

A hipófise e a região selar podem ser acometidas por uma série de tumores. Nesse contexto, metástase é um diagnóstico diferencial raro, porém plausível. O diagnóstico de metástase para região selar é desafiador. Assim, espessamento da haste hipofisária, invasão de seio cavernoso e esclerose ao redor da sela são detalhes sutis que, apesar de não serem conclusivos, podem sugerir esse diagnóstico. Neste artigo os autores descrevem um caso de um paciente sem antecedentes oncológicos e com RM e TC sugestivas de macroadenoma hipofisário. Inesperadamente, a lesão era um adenocarcinoma metastático de cólon. Metástases cerebrais de câncer colorretal são raras, principalmente para região selar e normalmente aparecem após o diagnóstico da lesão primária. Nosso objetivo é descrever um caso de metástase de cólon para região selar e sua evolução e rever dados de literatura.

The pituitary gland and sellar region may be a site for a number of tumors. In this context a rare but feasible differential diagnosis is metastasis. The diagnosis of metastasis in the sellar region is challenging. Therefore, thickening of the pituitary stalk, invasion of the cavernous sinus and sclerosis around the sella, although not conclusive, may suggest this diagnosis. In this article the authors describe a case of a patient without any oncological history and with MRI and CT-scan suggestive of pituitary macroadenoma. Surprisingly the tumor was an metastatic colonic adenocarcinoma. Colonic and rectal metastasis to the brain are rare, particularly to the sellar region and normally appear after the primary lesion is already diagnosed. Our goal is to describe a case of colonic metastasis to the sellar region and its evolution and review literature data.

Adenocarcinoma primário multicêntrico com 12 focos: relato de caso e revisão da literatura / Multicenter primary adenocarcinoma with 12 foci: case report and literature review

Relata-se caso raro de adenocarcinoma primário multicêntrico sincrônico em intestino delgado, apêndice cecal e intestino grosso, em homem de 82 anos, com quadro de abdome agudo inflamatório. Foi submetido à laparotomia exploradora, observando-se lesão intestinal estenosante e infiltrativa no ângulo hepático e múltiplas aderências entre as alças do intestino delgado. Foi realizada hemicolectomia direita. O estudo anatomopatológico mostrou 12 focos de adenocarcinomas primários comprometendo intestino delgado (oito focos), válvula ileocecal, apêndice cecal e intestino grosso (cólon ascendente e transverso).

A rare case of synchronous multicenter primary adenocarcinoma in the small intestine, cecal appendix and large intestine, in an 82-year-old man with a condition of acute abdominal inflammation, is reported. He underwent exploratory laparotomy, and a stenosing and infiltrative intestinal lesion was seen in the hepatic angle, along with multiple adherences between the loops of the small intestine. Right hemicolectomy was performed. The anatomopathological evaluation showed 12 foci of primary adenocarcinomas affecting the small intestine (eight foci), ileocecal valve, cecal appendix and large intestine (ascending and transverse colon).

Nasopharyngeal Metastasis from Colon Cancer / 대한내과학회지

Metastatic adenocarcinoma from the gastrointestinal tract to the nasopharynx is rare. The histological morphology of this lesion is indistinguishable from the colonic variant of primary head and neck adenocarcinoma or intestinal-type adenocarcinoma (ITAC) of the nasal cavity. This is a report of metastatic adenocarcinoma of colorectal origin to the nasopharynx in a 58-year-old man who was previously treated for adenocarcinoma of the sigmoid colon. A histopathological study of the specimen from the nasopharynx demonstrated a tumor that was identical to the patient's previous primary tumor from the colon. There was no tumor mass in the nasal cavity or paranasal sinuses. The nasopharyngeal tissue expressed cytokeratin 20 and CDX-2, but not cytokeratin 7. The patient received palliative radiation after the diagnosis. Distinguishing metastatic adenocarcinoma from the gastrointestinal tract from ITAC can be difficult. The clinical manifestation is important in differentiating these conditions. It is important to recognize these as metastatic lesions because treatment is primarily palliative.