Irreducible Indirect Inguinal Hernia Caused by Sigmoid Colon Cancer Entering Right Groin:A Case Report / 中国医学科学院学报

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.

Clinical Outcomes of Reduced-Port Laparoscopic Surgery for Patients With Sigmoid Colon Cancer: Surgery With 1 Surgeon and 1 Camera Operator

PURPOSE: This study compared the perioperative clinical outcomes of reduced-port laparoscopic surgery (RPLS) with those of conventional multiport laparoscopic surgery (MPLS) for patients with sigmoid colon cancer and investigated the safety and feasibility of RPLS performed by 1 surgeon and 1 camera operator. METHODS: From the beginning of 2010 until the end of 2014, 605 patients underwent a colectomy for sigmoid colon cancer. We compared the characteristics, postoperative outcomes, and pathologic results for the patients who underwent RPLS and for the patients who underwent MPLS. We also compared the clinical outcomes of single-incision laparoscopic surgery (SILS) and 3-port laparoscopic surgery. RESULTS: Of the 115 patients in the RPLS group, 59 underwent SILS and 56 underwent 3-port laparoscopic surgery. The MPLS group included 490 patients. The RPLS group had shorter operating time (137.4 ± 43.2 minutes vs. 155.5 ± 47.9 minutes, P < 0.001) and shorter incision length (5.3 ± 2.2 cm vs. 7.8 ± 1.2 cm, P < 0.001) than the MPLS group. In analyses of SILS and 3-port laparoscopic surgery, the SILS group showed younger age, longer operating time, and shorter incision length than the 3-port surgery group and exhibited a more advanced T stage, more lymphatic invasion, and larger tumor size. CONCLUSION: RPLS performed by 1 surgeon and 1 camera operator appears to be a feasible and safe surgical option for the treatment of patients with sigmoid colon cancer, showing comparable clinical outcomes with shorter operation time and shorter incision length than MPLS. SILS can be applied to patients with favorable tumor characteristics.

Comparison of the efficacy of two laparoscopic surgical procedures in patients with sigmoid colon cancer / 中国内镜杂志

Objective To compare the efficacy of traditional laparoscopic radical resection of sigmoid colon and rectal specimens without abdominal incision laparoscopic surgery. Methods From January 2015 to December 2016 in our hospital to implement selected laparoscopic assisted sigmoid colon cancer surgery patients in 34 patients with abdominal incision rectal specimens of laparoscopic sigmoid colon resection of colorectal cancer patients without abdominal incision group. As to the choice of 1 ~ 2 pairs in the same period of age, gender, as the control group were given laparoscopic assisted sigmoid colon body mass index similar to radical surgery in 68 patients with operation time. Comparing the two kinds of laparoscopic surgery, perioperative bleeding, postoperative exhaust time postoperative pain score, complications, surgery, postoperative hospital stay, additional analgesic treatment, length of bowel resection, proximal and distal margin, tumor size, lymph node dissection the number of pTNM staging. Results The abdominal surgery time without incision group of sigmoid colon cancer patients, intraoperative bleeding was significantly higher than control group, abdominal incision group of sigmoid colon cancer patients with postoperative exhaust time, postoperative pain awake score, postoperative 1 d pain score was significantly lower than the control group, there was statistical significance the difference (P < 0.05); the two group of sigmoid colon cancer patients with bowel resection length of proximal margin, tumor size, number of lymph node dissection, there was no significant difference in pTNM staging (P > 0.05). Abdominal incision group were followed up for 5~8 months, average 6 months; the control group were followed up for 6 ~ 9 months, an average of 7 in August, there were no tumor recurrence and metastasis. Conclusion Compared with traditional laparoscopic surgery, abdominal incision rectal specimens of laparoscopic radical resection of sigmoid colon cancer can significantly reduce the pain of patients, shorten the postoperative exhaust time, tumor root Treatment effect is similar

Feasibility of Hand-Assisted Laparoscopic Surgery as Compared to Open Surgery for Sigmoid Colon Cancer: A Case-Controlled Study

PURPOSE: The aim of this study was to evaluate short-term clinical outcomes by comparing hand-assisted laparoscopic surgery (HALS) with open surgery for sigmoid colon cancer. METHODS: Twenty-six patients who underwent a hand-assisted laparoscopic anterior resection (HAL-AR group) and 52 patients who underwent a conventional open anterior resection during the same period were enrolled (open group) in this study with a case-controlled design. RESULTS: Pathologic parameters were similar between the two groups. The incidences of immediate postoperative leukocytosis were 38.5% in the HAL-AR group and 69.2% in the open group (P = 0.009). There were no significant differences between the two groups as to leukocyte count, hemoglobin, and hematocrits (P = 0.758, P = 0.383, and P = 0.285, respectively). Of the postoperative recovery indicators, first flatus, sips of water and soft diet started on postoperative days 3, 5, 7 in the HALS group and on days 4, 5, 6 in the open group showed statistical significance (P = 0.021, P = 0.259, and P = 0.174, respectively). Administration of additional pain killers was needed for 1.2 days in the HAL-AR group and 2.4 days in the open group (P = 0.002). No significant differences in the durations of hospital stay and the rates of postoperative complications were noted, and no postoperative mortality was encountered in either group. CONCLUSION: The patients with sigmoid colon cancer who underwent a HAL-AR had a lower incidence of postoperative leukocytosis, less administration of pain killers, and faster first flatus than those who underwent open surgery. Clinical outcomes for patients' recovery and pathology status were similar between the two groups. Therefore, a HAL-AR for sigmoid colon cancer is feasible and has the same benefit as minimally invasive surgery.

Sigmoid Colon Cancer with Metastasis to the Right Spermatic Cord

Metastatic tumors involving the spermatic cord are very rare, and the prognosis for such patients is poor. The primary tumors that are frequently metastatic to the spermatic cord are gastric and colon carcinomas. We report a case of a 35-year-old male with a metastatic spermatic cord tumor following a palliative anterior resection for sigmoid colon cancer with peritoneal seeding. The patient complained of a tender mass in a right inguinal lesion. A right orchiectomy was performed, and the pathologic finding was a poorly differentiated adenocarcinoma similar to that of the sigmoid colon cancer.

Sigmoid Colon Cancer with Isolated Metastasis to the Left Kidney

We report the case of a 63-year-old female with sigmoid colon cancer and isolated metastasis to the left kidney at the time of initial diagnosis. An anterior resection of the sigmoid colon and a left nephrectomy were performed. Three cycles of adjuvant chemotherapy consisting of oxaliplatin, 5-fluorouracil, and leucovorin were given, but two months after the surgery, multiple metastases of the liver were detected on a CT scan. The patient refused further treatment and died 5 months after the discovery of an isolated metastasis. An isolated metastasis to the kidney is very rare in clinical practice. A nephrectomy for kidney metastasis has no effect on survival and quality of life, and a nephrectomy may also compromise the choice of chemotherapy agents that require renal clearance; thus, a careful evaluation of renal function is necessary before a nephrectomy. At present, kidney metastasis should be regarded as an advanced metastatic disease, and aggressive chemotherapy, including target therapy, should prolong survival and improve the quality of life. However, when a synchronous or a metachronous renal tumor is suspected, a nephrectomy should be performed for accurate diagnosis and treatment.

Surgical Treatments and Clinical Outcomes of Sigmoid Colon Cancer Adherent to Other Organs

Sigmoid colon cancer occasionally attaches to the adjacent viscera. It is estimated that such attachment occurs in 6% to 12% of all patients with colon carcinoma without distant metastases. This study was performed to identify the parameters to distinguish direct tumor invasion to adjacent organs from simple inflammatory adhesion in sigmoid colon cancer and to clarify the difference of survival and recurrence pattern between two groups. METHODS: Between 1989 and 1998, 415 patients underwent resection of sigmoid colon cancer in our clinic. Of these, 46 had tumors adherent to adjacent organs and confirmed as tumor direct invasion or simple inflammatory adhesion by pathologic examination. The mean age of 46 cases was 54.2+/-12.8 (mean+/-SD) years and median follow up was 21 (3~53) months. RESULTS: Among the clinical and pathologic parameters such as symptoms and laboratory findings presenting bowel obstruction, serum CEA levels, preoperative radiological findings, tumor size, differentiation, and stage, there was no specific one that was correlated with direct tumor invasion or inflammatory adhesion. Almost all cases with adhesion to adjacent organ were treated by an en bloc resection including mutivisceral resection. The group with direct invasion had inferior disease free survival rate and overall survival rate comparing with simple inflammatory adhesion group. CONCLUSIONS: In the situation that there was no valuable parameter suggesting direct tumor invasion, en bloc resection or multivisceral resection involving one tumor-free plane may be beneficial to the patients with sigmoid colon cancer adherent to adjacent organ.

The Role of Adjuvant Postoperative Radiotherapy in Curative Resectable Sigmoid Colon Carcinoma / 대한치료방사선과학회지

PURPOSE: To evaluate the role of postoperative radiation therapy after curative resection of sigmoid colon cancer MATERIALS AND METHODS: From 1988 to 1993, a total of 93 patients with curative resectable sigmoid colon cancer of modified Astler-Coller (MAC) stage B2, B3, C2, C3 was divided into two groups on the basis of those who received radiation treatment and those who did not. Forty-three patients who treated by surgery alone were classified as postop RT ( group. The remaining 50 patients who underwent postoperative radiotherapy were classified as postop RT (+) group. In all patients in postop RT (+) group, radiation therapy was delivered using 4 or 10 MV linear accelerators to treat the tumor bed with approximately 5cm margin to a total dose 50.4-61Gy (median 54Gy) in 1.8Gy per fraction. Thirty-two patients were treated with 5- Fluorouracil based adjuvant chemotherapy at least 3 cycles, but these was no significant difference between two groups. Treatment failure pattern, 5-year local failure-free survival rates (LFFS), and 5-year disease-free survival rates (DFS) were compared between two groups. RESULTS: Five year LFFS and DFS were 85.1%, 68.5%, respectively. In postop RT (-) group, LFFS was 76.2%, compared with 91.7% in postop RT (+) group. Improved LFFS and DFS were seen for patients with stage C3 sigmoid colon carcinoma with postoperative radiation therapy compared with postop RT (-) group (P=0.01, P=0.06 respectively). In stage B3, LFFS washigher in postop RT (+) group than that in postop RT (-) group, although it was not significant. Especially, local control was higher in stage T4 in postop RT (+) group than that in postop RT (-) group. CONCLUSION: This study showed significantly improved LFFS and DFS in MAC Stage C3 and improved tendency of LFFS and DFS in MAC Stage B3 disease. Large scale prospective study is required to verify the role of adjuvant radiation therapy in resectable sigmoid colon cancer.