Blunt dissection method using HiQ+ soft coagulation system for laparoscopic cholecystectomy in acute cholecystitis.

INTRODUCTION: During laparoscopic cholecystectomy for acute cholecystitis, it is often difficult to keep the surgical view dry because of inflammation-related tissue fragility and susceptibility to bleeding. The resulting inadequate surgical view can lead to bile duct or vascular injury. Soft coagulation systems are used to achieve hemostasis during various surgeries; however, the usefulness of soft coagulation during laparoscopic cholecystectomy for acute cholecystitis is unclear. We here demonstrate the usefulness and feasibility of blunt dissection and soft coagulation during this procedure. MATERIALS AND SURGICAL TECHNIQUE: We used blunt dissection and soft coagulation when performing laparoscopic cholecystectomy on two patients with acute cholecystitis. As with conventional laparoscopic cholecystectomy, four ports were inserted. After cutting the serosa by electrocautery, blunt dissection using soft coagulation was performed, exposing the inner subserosa. Maintaining this layer using blunt dissection with soft coagulation achieved a sufficiently clear view for safety. After resecting the cystic artery and duct, the gallbladder bed was also dissected by blunt dissection with soft coagulation. Blood loss was <20 mL in both patients. DISCUSSION: Blunt dissection with soft coagulation may be a useful and feasible means of keeping the surgical view dry and minimizing blood loss during laparoscopic cholecystectomy for acute cholecystitis.

Small Bowel Obstruction Due to Axial Torsion of Meckel's Diverticulum: A Case Report and Literature Review.

Meckel's diverticulum (MD) is a commonly encountered congenital gastrointestinal abnormality. Although the frequency of MD-related complications such as inflammation or bleeding is relatively high, small bowel obstruction induced by axial torsion of the MD is rare. Therefore, we herein report such a case along with a review of the literature. A 34-year-old female with right lower quadrant pain, nausea, and vomiting was admitted to our hospital with the diagnosis of adhesive small bowel obstruction due to a cesarean section performed five years previously. A long intestinal tube was placed, and the patient's clinical symptoms and X-ray findings showed relief of the small bowel obstruction. However, she developed severe right lower quadrant pain after contrast examination through the long intestinal tube despite the fact that the contrast agent had smoothly reached the terminal ileum. Blood tests and enhanced computed tomography (CT) showed a remarkable elevation of inflammatory markers, the appearance of ascites, and closed-loop-like and abscess-like appearances near the site of the caliber change. With a diagnosis of internal hernia, the patient underwent emergency laparotomy by means of a midline incision. Purulent ascites was observed within the abdominal cavity. Small bowel obstruction caused by a single band was observed in the right lower quadrant. Further exploration revealed an inflammatory MD with neck torsion and a mesodiverticular band (MDB). Simple mesodiverticular band resection by electrocautery and diverticulectomy by linear stapler were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day 7. In the case of juvenile-onset small bowel obstruction, axial torsion of the MD should be considered as a differential diagnosis. Herein, we report such a difficult diagnostic case and the first English literature review of small bowel obstruction due to axial torsion of the MD.

Single-incision clipless laparoscopic total colectomy for intractable slow transit constipation: a single surgeon's experience.

PURPOSE: In our institution, patients with intractable slow transit constipation (STC) have undergone single-incision clipless laparoscopic total colectomy (SCLTC) with ileorectal anastomosis (IRA) since 2011. We aimed to examine the feasibility and usefulness of SCLTC with IRA for patients with intractable STC. METHODS: From January 2011 to December 2018, twenty-two patients with intractable STC underwent SCLTC with IRA at Kashiwa Hospital, Jikei University, by a single surgeon, were retrospectively registered in this study. They consisted of the first 12 consecutive patients undergoing the double stapling technique (DST) with IRA (DST group) and the last 10 consecutive patients undergoing functional end-to-end anastomosis (FEEA) with IRA (FEEA group). RESULTS: The median surgical time was 185 (150-249) min for the FEEA group and 230 (180-266) min for the DST group. A significant difference was identified between the two groups (0.035). There were no significant differences between the groups with respect to the median age, sex, body mass index, constipation type, intraoperative blood loss, postoperative hospital stay, or no use of laxatives daily stool frequency 1 month after surgery. No postoperative complications, such as anastomotic leakage, bowel obstruction, or bleeding related to vessel sealing device, were encountered in either group more than 3 years after surgery. CONCLUSION: Our results suggest that SCLTC with IRA is feasible and safe for patients with intractable STC. SCLTC with IRA using FEEA is especially preferred to that using DST for patients with intestinal contents in the rectum that cannot be completely removed by pre- and intraoperative preparation.

Long-term Outcome of Triple Stapling Resection and J Pouch Anal Stapling Anastomosis for Ulcerative Colitis.

BACKGROUND: We previously reported laparoscopic total proctocolectomy with J pouch anal anastomosis, which was created at the dentate line by our original procedure using staplers, Triple Stapling Resection and J pouch Anal Stapling Anastomosis (TSRJASA), for ulcerative colitis (UC) patients. UC patients have undergone TSRJASA since it was introduced in our institution. However, the long-term outcome of TSRJASA for UC patients has not been elucidated. PATIENTS AND METHODS: From January 2014 to December 2018, fourteen patients with ulcerative colitis, including three cases of concomitant cancer, who underwent TSRJASA were enrolled in this study. Anal manometry was performed using the Pock Monitor GMMS-100 system (STAR MEDICAL, INC., Tokyo, Japan) one and two years after surgery. Maximum resting pressure, maximum squeeze pressure, and the length of the high-pressure zone were measured. Fecal incontinence was evaluated using the Wexner incontinence questionnaire. RESULTS: J pouch anal anastomosis was created at the dentate line in all patients. In a manometric examination two years after surgery, maximum resting pressure was 75.3 (54-88) mm Hg, maximum squeeze pressure was 125.0 (90-160) mm Hg, and the length of the high-pressure zone was 39.6 (35-42) mm. Wexner score was 2.8 (1-4). CONCLUSION: TSRJASA is a useful procedure for UC patients given its acceptable defecation function.

The Usefulness of Preoperative Evaluation for Intractable Slow Transit Constipation by Computed Tomography.

OBJECTIVES: Total colectomy with ileorectal anastomosis is the gold standard surgical procedure for patients with slow transit constipation (STC). This operation's outcomes are highly variable; however, predictors of postoperative outcomes after surgical treatment of intractable STC remain unclear. This study aimed to clarify the usefulness of preoperative evaluation for intractable STC by computed tomography (CT) in predicting postoperative outcomes. METHODS: From January 2011 to December 2018, 22 patients with intractable STC underwent laparoscopic total colectomy with ileorectal anastomosis at the Kashiwa Hospital, Jikei University. They were divided into two groups, eighteen patients in the colonic inertia type (CI) group, and four patients in the spastic constipation type (SC) group, by preoperative CT according to specific criteria. RESULTS: There were no significant differences in the mean age, gender, mean operation time, or mean intraoperative blood loss. The SC group's postoperative hospital stay was significantly longer than that of the CI group. Postoperative gastric outlet obstruction occurred in two patients (11%) who underwent distal partial gastrectomy with R-Y reconstruction after the surgery in the CI group but no patients in the SC group. Postoperative pelvic outlet obstruction occurred in all four patients who underwent ileostomy within a year after surgery in the SC group but no patients in the CI group. CONCLUSIONS: The outcomes of total colectomy in the treatment of intractable STC are highly variable. Preoperative evaluation for intractable STC by CT seems to be a useful predictor of postoperative outcomes.

Laparoscopic resection of a metachronous secondary lymph node metastasis in the mesentery of the ileum after surgery for sigmoid colon cancer with ileum invasion: a case report.

BACKGROUND: Extended excision of the permeation organ neighborhood is often performed in locally invasive colon cancer, and it is reported to have a survival benefit. In addition, some cases of secondary lymph node metastases in a permeation organ were reported. However, they are reports of synchronous secondary lymph node metastases, not metachronous secondary lymph node metastases. To the best of our knowledge, there are no cases of metachronous secondary lymph node metastases after the resection of a primary colorectal cancer in PubMed. CASE PRESENTATION: The case was a 67-year-old man who underwent colonoscopy because of weight loss. Sigmoid colon cancer with all circumference-related stenosis was found by examination, and the patient was transferred to our hospital for the purpose of scrutiny and treatment. The small intestine ileus caused by the invasion of sigmoid colon cancer developed after the transfer. Laparoscopic high anterior resection and extended excision of small intestine segmental resection was performed after the intestinal tract decompression with a nasal ileus tube. Histopathological analysis revealed a pathological diagnosis of pT4b (ileal submucosal invasion) N0 (0/11) M0 f Stage II, tub2, ly1, v2, PN0. Although adjuvant chemotherapy with capecitabine after the operation was planned for half a year, treatment was suspended in the first course by the patient's self-judgment. No recurrence was observed for a year after the operation, but metastasis recurrence in the para-aortic lymph node was found by a computed tomography (CT) one and a half years after the operation. 18 F-fluorodeoxyglucose (FDG) positron emission tomography revealed that FDG was accumulated only in the para-aortic lymph node. Laparoscopic metastasis lymphadenectomy was performed due to the diagnosis of metachronous metastasis to the para-aortic lymph node alone. Intraoperative findings revealed that lymph node metastasis occurred in the mesentery of the ileum. No adjuvant treatment was done after the secondary operation, and he is still alive with no recurrence 1 year and 9 months after the operation. CONCLUSIONS: We report a rare case of a laparoscopic resection of a metachronous secondary lymph node metastasis in the mesentery of the ileum after surgery for sigmoid colon cancer with ileum invasion.

Laparoscopic resection of a neuroendocrine tumor that almost fully replaced tailgut cysts: a case report.

BACKGROUND: Neuroendocrine tumors (NETs) originate from neuroendocrine cells, which are found throughout the body. NETs occur principally in the gastrointestinal tract (approximately 65%) and bronchopulmonary tract (approximately 25%) but rarely occur in the presacral space. Aside from primary and metastatic lesions, there have been reports of NETs occurring in the presacral space arising from tailgut cysts, teratomas, and imperforate anus. We herein report a rare case of laparoscopic resection of a NET in the presacral space, which almost fully replaced tailgut cysts. CASE PRESENTATION: A 68-year-old woman was referred to our hospital for surgery of a right inguinal hernia, but preoperative computed tomography revealed an asymptomatic 43-mm mass in the presacral space. Magnetic resonance imaging showed a multilocular solid mass with clear boundaries and a slightly high signal intensity on T1- and T2-weighted images. Positron emission tomography showed 18F-fluorodeoxyglucose uptake. Thus, we suspected a malignant tumor and performed laparoscopic resection to obtain a definitive diagnosis. Macroscopically, the tumor was 43 mm in size with clear boundaries, and the cut surface was a gray-white solid component. Histopathological findings revealed that the tumor was composed of relatively uniform cells with fine chromatin, with round to oval nuclei arranged in solid, trabecular, or rosette-like growth patterns. Small cysts lined with stratified squamous epithelium and columnar epithelium were observed along with solid components of the tumor, which is a feature of tailgut cysts. Therefore, the final diagnosis was NET Grade 1 arising from tailgut cysts. No recurrence was observed within 1 year after surgery. CONCLUSIONS: We performed en bloc laparoscopic resection of a NET arising from tailgut cysts in the presacral space without injury. In cases of a solid lesion in the presacral space, not only the primary disease but also the pathological condition with tissue transformation and replacement should be considered, as in this case.

CA19-9 Concentration After First-line Chemotherapy Is Prognostic Predictor of Metastatic Colon Cancer.

BACKGROUND/AIM: To evaluate whether the serum levels of CEA or CA19-9 concentration is a useful predictor of survival in patients with metastatic colon cancer (mCC). PATIENTS AND METHODS: Between 2012 and 2015, 113 patients with mCC who underwent chemotherapy according to the Japanese Colorectal Cancer Treatment Guidelines at four Jikei University Hospitals were enrolled in this study. The two serum tumor makers, CEA and CA19-9 were measured before first-line chemotherapy and at four months thereafter. RESULTS: Serum CA19-9 concentration at four months after first-line chemotherapy (p=0.003, HR=3.761) and first-line chemotherapy including oxaliplatin (p=0.038, HR=0.312) were independent predictors of survival in patients with mCC. By excluding the transverse colon, only serum CA19-9 concentration at four months after first-line chemotherapy (p=0.005, HR=3.660) was identified as the predictor of survival. CONCLUSION: Serum CA19-9 concentration after first-line chemotherapy seems to be a useful predictor of survival in patients with mCC.

Respiratory Disorder at the End of Surgery for Peritonitis Due to Colorectal Perforation Is a Critical Predictor of Postoperative Sepsis.

BACKGROUND/AIM: The aim of this study was to identify a critical predictor of postoperative sepsis in patients with peritonitis due to colorectal perforation. PATIENTS AND METHODS: Between 2009 and 2014, fifty-three patients who underwent emergency surgery for peritonitis due to colorectal perforation in our hospital were examined retrospectively to identify the critical predictor of postoperative sepsis. Between 2016 and 2017, twelve patients with peritonitis due to colorectal perforation were enrolled in a prospective study to validate the critical predictor obtained by the previous retrospective study. RESULTS: Mechanical ventilation for more than two days after surgery seemed to be a critical predictor of postoperative sepsis. In the prospective study, six patients who were withdrawn from mechanical ventilation within one day after surgery did not develop sepsis. CONCLUSION: Respiratory disorders at the end of surgery for peritonitis due to colorectal perforation seem to be a critical predictor of postoperative sepsis.

Reevaluation of Preoperative Chemoradiotherapy for Clinical T3 Lower Rectal Cancer: A Multicenter Collaborative Retrospective Clinical Study.

AIM: This study aimed to re-evaluate the usefulness of preoperative chemoradiotherapy for clinical T3 lower rectal cancers without lateral lymph node metastasis. PATIENTS AND METHODS: Between 2010 and 2014, 132 patients with clinical T3 lower rectal cancer without lateral lymph node metastasis, 80 years of age or younger, who underwent curative resection at four Jikei University Hospitals were enrolled into this retrospective study. Of these, 22 patients received chemoradiotherapy (CRT) before surgery, 16 patients received intensive chemotherapy after surgery without preoperative CRT, and 94 patients underwent neither preoperative CRT nor intensive chemotherapy after surgery including 47 patients with postoperative oral chemotherapy for pathological diagnosis of stage III. RESULTS: The 3-year disease-free survival (DFS) of the 22 patients who received preoperative CRT was 95.5%, whereas that of the 94 patients who received neither preoperative CRT nor intensive chemotherapy was 72.0% (p=0.024). However, there was no significant difference in 5-year DFS between the two groups. No significant difference was identified in DFS between the 22 patients who received preoperative CRT and the 16 patients who received intensive chemotherapy after surgery without preoperative CRT. CONCLUSION: Intensive chemotherapy after surgery seems to yield a similar prognosis to preoperative CRT in patients with clinical T3 lower rectal cancer without lateral lymph node metastasis.

Preoperative Neutrophil-Lymphocyte Ratio Is a Predictor of Bowel Obstruction Due to Colorectal Cancer Growth.

BACKGROUND: Bowel obstruction is commonly encountered in patients with advanced colorectal cancer; however, the cause of obstruction remains unknown. This study aimed to clarify a predictor of bowel obstruction due to colorectal cancer growth. MATERIALS AND METHODS: Between January 2005 and December 2013, the medical records of 140 patients with T3 or T4 colorectal cancer who underwent curative resection (R0) at our Hospital were investigated retrospectively. This study consisted of 26 patients with obstructive colorectal cancer (OCC) and 114 patients with non-obstructive colon cancer (non-OCC). RESULTS: Significant differences in clinicopathological factors including age, gender, T category, stage, primary tumor site, tumor diameter, macroscopic type, pathological type, lymphatic invasion, venous invasion, and lymph node metastasis were not observed between the two groups. Preoperative hematological/biochemical parameters including leukocyte count (p=0.004), neutrophil count (p=0.003), C-reactive protein (CRP) level (0.001), and neutrophil-to-lymphocyte ratio (NLR) (p=0.001) were significantly higher in the OCC group than in the non-OCC group. However, a significant difference in lymphocyte count was not observed between the two groups (p=0.634). Significant differences in the levels of the serum tumor markers CEA and CA19-9 were not observed between the two groups. CONCLUSION: Preoperative NLR seems to be a useful predictor of bowel obstruction due to colorectal cancer growth.

Preoperative Neutrophil-lymphocyte Ratio Is a Predictor of High-output Ileostomy After Colorectal Surgery.

BACKGROUND/AIM: High-output ileostomy (HOI) can affect quality of life, however, its primary cause remains unknown. This study aimed to identify a predictor of HOI after colorectal surgery. PATIENTS AND METHODS: The medical records of forty-five patients who had undergone colorectal surgery with temporary ileostomy without postoperative complications, such as intra-abdominal abscess, paralytic ileus, outlet obstruction, or suture rupture, at our hospital between January 2016 and December 2017 were retrospectively investigated. RESULTS: Significant differences in age, gender, operative situation, duration of operation, intraoperative blood loss, operation procedure, operation approach, preoperative body mass index, and preoperative hematological/biochemical parameters, such as leucocyte counts, hemoglobin, serum total protein, albumin, C-reactive protein, and preoperative complications, were not identified between the two groups. Preoperative neutrophil-to-lymphocyte ratio (NLR) of the HOI group was significantly higher than that of the non-HOI group (p=0.004). CONCLUSION: Preoperative NLR seems to be a useful predictor of HOI after colorectal surgery.

Anthropometric Assessment After Proctocolectomy Due to Ulcerative Colitis.

BACKGROUND: Postoperative changes in patient anthropometric and nutritional statuses after proctocolectomy due to ulcerative colitis (UC) are unclear. PATIENTS AND METHODS: Between January 2015 and December 2017, nine patients who underwent proctocolectomy with temporary ileostomy (PTI) for UC at our hospital were enrolled in this study. For the comparison group, eight patients who underwent low anterior resection (LAR) with temporary ileostomy for rectal cancer in the same period were recruited. Data, including body weight; body mass index (BMI); levels of total protein, albumin, cholinesterase, and hemoglobin; and lymphocyte counts, were analyzed. The changes in these parameters before surgery until 6 months after surgery were compared. RESULTS: Before surgery, the levels of total protein, albumin, cholinesterase, hemoglobin and lymphocyte counts in the PTI group were significantly worse than those in the LAR group. However, significant differences were not identified in these factors at 1 month after surgery. The BMI was significantly lower in the PTI group than in the LAR group until 3 months after surgery. An increase in body weight to greater than that prior to surgery was found from 4 months after surgery in the PTI group. The LAR group did not have any effect of surgery in terms of any factor. CONCLUSION: BMI appears to be the most useful predictor of clinical and nutritional changes postoperatively.

Serum Carcinoembryonic Antigen Levels Before the First Curative Hepatectomy for Metastatic Colorectal Cancer Is a Predictor of Recurrence.

BACKGROUND/AIM: The aim of this study was to evaluate the usefulness of serum carcinoembryonic antigen (CEA) levels before the first curative hepatectomy for metastatic colorectal cancer as a predictor of recurrence. PATIENTS AND METHODS: Between 2003 and 2010, 66 patients (45 male and 21 female) who underwent a first curative hepatectomy for metastatic colorectal cancer in our hospital were evaluated retrospectively. The mean patient age was 65.2 years (range=31-80 years). A total of 28 patients had synchronous liver metastasis, and the other 38 patients developed metachronous liver metastasis. RESULTS: The 5-year relapse-free survival rate after the first hepatectomy of the 16 patients with normal serum CEA level was 61.1%, whereas that of the 50 patients with abnormal serum CEA level was 34.3% (p<0.001). Among patients whose serum CEA levels were abnormal, the 5-year relapse-free survival rate after the first hepatectomy of the 34 patients with serum CEA levels less than 50 ng/ml was 48.1%, whereas that of the 16 patients with serum CEA level equal to or greater than 50 ng/ml was 6.3% (p<0.001). All eleven patients whose serum CEA levels were at least 100 ng/ml developed recurrence within one year after hepatectomy. CONCLUSION: Serum CEA levels before the first curative hepatectomy for metastatic colorectal cancer seem to be a predictor of recurrence.

Usefulness of Fecoflowgram for Assessment of Defecation after Intersphincteric Resection.

AIM: We have developed an imaging functional assessment of defecation after partial intersphincteric resection (ISR) by fecoflowgram obtained by defecography. PATIENTS AND METHODS: Between January 2012 and December 2014, 6 patients with temporary ileostomy who underwent partial ISR for lower rectal cancer at our hospital were enrolled in this study. Defecography was performed 2 weeks after closure of the ileostomy. The defecation of all patients was evaluated by defecography and a fecoflowgram calculated from defecography. During the same period, the control group was comprised of 2 male and 2 female healthy volunteers. RESULTS: The descent of the perineum and linearization of the anorectal angle was observed relative to normal defecation in the healthy volunteers. All barium was discharged by a single abdominal pressure within 5 s in the controls. In patients after partial ISR, all barium could not be discharged by a single abdominal pressure. The time course of pressure distribution after ISR was lower than that of healthy volunteers, which could not be evaluated by defecography. Defecation time in patients following ISR was longer than that of healthy volunteers. CONCLUSION: Fecoflowgrams calculated from defecography seem to be useful for functional assessment of defecation after rectal resection.

Usefulness of TAS-102 as Third-line Chemotherapy for Metastatic Colorectal Cancer.

BACKGROUND/AIM: The feasibility and oncological outcomes of treatment with TAS-102, that is recommended as third-line chemotherapy for patients with metastatic colorectal cancer (mCRC), remain unknown. PATIENTS AND METHODS: Between 2013 and 2015, seven patients (five males, two females) with mCRC who were administered TAS-102 as third-line chemotherapy at our Institution were retrospectively studied. During the same period, seven patients with mCRC with Kirsten rat sarcoma viral oncogene homolog (KRAS) wild-type primary lesions who were administered irinotecan with panitumumab comprised the control group. RESULTS: The duration of third-line chemotherapy in the TAS-102 group was 217.0 (range=136-337) days compared to 226.9 (range=122-335) days in the control group, with no significant difference in the duration of administration between the two groups. No significant difference in overall survival was identified between the two groups No serious adverse effects were encountered in either group. CONCLUSION: TAS-102 may be suitable as third-line chemotherapy for patients with mCRC.

Cuff-less J Pouch Anal Stapling Anastomosis for Ulcerative Colitis.

BACKGROUND/AIM: For ulcerative colitis, J pouch anal anastomosis with preserved rectal cuff had been popularized with its acceptable defecation function. However, some complications associated with rectal cuff after surgery have been reported. We are performing a novel procedure, laparoscopic cuff-less J pouch anal stapling anastomosis. PATIENTS AND METHODS: From January 2014 to December 2016, ten patients with ulcerative colitis, including three with concomitant cancer underwent this procedure. J pouch anal anastomosis was performed at the dentate line in all patients by our original procedure. In a manometric examination of all patients more than one year after the operation, maximum resting pressure was 68.0 (52-84) mmHg, maximum squeeze pressure was 101.7 (87-121) mmHg, length of high-pressure zone was 32.3 (30-35), and none had observed rectoanal reflex. Good defecation was confirmed by defecography. CONCLUSION: Cuff-less J pouch anal stapling anastomosis seems to be a useful procedure for patients with ulcerative colitis.

Transanal Assisted Resection with Closure of Anal Canal for Lower Rectal Diseases.

BACKGROUND/AIM: Abdominoperineal resection (APR) has been performed for lower rectal cancer, anal cancer and inflammatory diseases, but is associated with postoperative complications such as inflammation of pelvic dead space or perineal wound infection. We are performing a novel procedure (transanal assisted resection with closure of anal canal, TARC) that resects the intestine by using transanal assist and close the anal canal for patients who do not require resection of the anus and anal canal. PATIENTS AND METHODS: From January 2015 to March 2017, nine patients (seven males, two females) underwent this procedure in our hospital for rectal cancer, recurrent rectal cancer, postoperative refractory pouchitis, and cervical cancer invaded to the rectum. The three patients diagnosed with rectal cancer underwent this procedure by a completely laparoscopic abdominal approach. RESULTS: None developed postoperative dead space inflammation or perineal wound infections. CONCLUSION: TARC seems to allow improved postoperative quality of life as compared to APR.

Laparoscopic surgical challenge for T4a colon cancer.

For patients with T4a colon cancer, the risk of peritoneal dissemination after surgery remains unclear. Seven hundred and eleven patients with T3 or T4a colon cancer, 80 years of age or younger, underwent curative resection (open surgery in 512 and laparoscopic surgery in 199) at the four Jikei University hospitals between 2006 and 2012. Their risk factors for peritoneal dissemination after surgery were evaluated retrospectively. Number of lymph node metastases, postoperative liver metastases and postoperative peritoneal dissemination events in the T4a group were significantly greater than the number in the T3 group. Peritoneal dissemination after surgery developed in four patients (0.7%) in the T3 group and in six patients (5%) in the T4a group. Risk factors for peritoneal dissemination consisted of macroscopic type (P = 0.016), serosal invasion (P = 0.017) and number of lymph node metastases (P = 0.009) according to the Cox proportional hazards regression model. However, tumor diameter and surgical approach (laparoscopic vs open) were not significant factors for peritoneal dissemination. There were no significant differences between the postoperative relapse-free survival rates for each surgical approach within the T3 or T4a group. Because of comparable postoperative peritoneal dissemination in T3 and T4a colon cancer by the surgical approach (laparoscopic or open), laparoscopic surgery for patients with T4a colon cancer seems justified.

Feasibility of Single-incision Laparoscopic Surgery plus One Assist Port for Anterior Resection.

BACKGROUND: We previously reported single-incision laparoscopic surgery plus one assist port (SPO) in 2010 as a type of reduced-port surgery for anterior resection. However, the feasibility and usefulness of SPO for patients with rectal cancer has not been elucidated. PATIENTS AND METHODS: Between January 2009 and December 2011, 49 patients with rectal cancer underwent laparoscopic surgery, 36 of these patients underwent multiport surgery (MPS) and the remaining 13 patients underwent SPO at the Kashiwa Hospital, Jikei University. RESULTS: The mean surgical time was 178.5 (range: 115.0-245.0) min for SPO, and 173.3 (110.0-240.0) min for MPS. The mean intraoperative bleeding was 7.7 (0-60) ml for SPO, and 11.4 (0-70) ml for MPS. The postoperative hospital stay was 10.3 (9-12) days for SPO, 10.8 (6-12) days for MPS. There were no significant differences between the groups with respect to surgical time, intraoperative blood loss, and postoperative hospital stay. No postoperative complications or postoperative recurrences were encountered in either group. CONCLUSION: Although single-incision laparoscopic surgery cannot be easily introduced for anterior resection, SPO for the treatment of rectal cancer yields outcomes comparable to MPS and is feasible, safe, and oncologically acceptable.