Synchronous Lesions in Colorectal Cancer

PURPOSE: The detection and removal of synchronous cancer and polyps in colorectal surgery is important to prevent the future development of metachronous cancer. However, it is occasionally impossible to evaluate the entire colon with colonoscopy preoperatively due to luminal obstruction by tumors. The aim of this study is to evaluate the incidence of synchronous colorectal tumors and to emphasize the importance of their peri-operative detection through vigorous application of colonoscopy. METHODS: Three hundreds two patients underwent a potentially curative resection for colorectal cancer in Ilsan Paik Hospital from January 2000 to March 2005. Colonoscopy was performed preoperatively or intraoperatively. All the synchronous polyps detected by colonoscopy and contained in the surgical specimen were included in the analysis. The data on synchronous cancer and polyps were collected through medical records and colonoscopic databases. The incidence, the risk factors, and the effects of synchronous polyps on surgery were analyzed. RESULTS: A total of 268 polyps were detected in 112 patients (37%) when all types of polyp were included whereas true adenomatous polyps were present in 78 patients (26%) among 302 patients. Synchronous cancers were found in 14 patients (4.6%). The detection of polyps on preoperative colonoscopy changed the surgical strategy in 30 out of the 223 patients (13.5%) who had completed preoperative colonoscopy. Neither the age and the gender of the patient, the location and the stage of the tumor, nor the family history were related with increased risk of synchronous polyps. Seventeen among 46 intraoperative colonoscopy cases had synchronous lesions which were not known on preoperative evaluation. Another bowel resection was needed to remove the lesions in nine of them. CONCLUSIONS: Synchronous colorectal polyps or cancer is frequent, and preoperative detection is important. Intraoperative colonoscopy can provide valid information if a preoperative colonoscopic evaluation is not available.

Complete Single Stage Management of Left Colon Cancer Obstruction with a New Devices

Intraoperative antegrade colonic irrigation for single stage procedure in left colon cancer obstruction is a preferred technique recently however, synchronous pathology cannot be detected. A new device that enables easy intraoperative irrigation and colonoscopy before resection of tumor was devised. PURPOSE: To evaluate the efficacy of the new device for single stage procedure in left colon cancer obstruction. METHODS: The new device (NICI; MITech co., Ltd, Seoul, Korea) consists of a Y-shaped teflon tube of maximum diameter 2.9, 3.5 and 4.1 cm, one proximal end is designed to connect with the dilated colon just proximal to the lesion. Two distal branches are for drainage of fecal matter and for retrograde insertion of irrigation catheter and subsequent colonoscope respectively. RESULTS: There were 53 patients (27 male, median age 64, range; 28~82) who underwent this procedure. No extraintestinal leaks were encountered. The volume of saline used was 12 (range; 6 to 27) Liters over 14 (range; 9 to 22) minutes. Subsequent colonoscopic examination added 10 (range, 8 to 15) minutes to the entire operation in 28 patients. There were one anastomotic leakage and 2 wound infections, however, there was no operative mortality. On-table colonoscopy resulted in extended resection in 3 cases because of synchronous malignancy in frozen biopsy and found synchronous polyps in 13 of 28 cases. CONCLUSIONS: The new device enabled safe, simple and time saving single stage surgical management of left colon cancer obstruction. The ability to perform on-table colonoscopy enabled treatment of synchronous bowel pathology.