Initial experience of robot-assisted radical cystectomy with total intracorporeal urinary diversion: comparison with extracorporeal method.

PURPOSE: To report our surgical technique and initial experience with robot-assisted laparoscopic radical cystectomy (RARC) with total intracorporeal urinary diversion compared with an extracorporeal method. SUBJECTS AND METHODS: In total, 42 patients underwent RARC by a single surgeon at our institute for clinically localized bladder cancer. Among these, 4 patients underwent RARC with complete intracorporeal urinary diversion. An ileal conduit was achieved in 3 patients, and an orthotopic neobladder was created in 1 patient. Our surgical technique is presented in detail, and the intracorporeal cases were compared with 38 previous extracorporeal diversion cases for perioperative outcome, postoperative oncologic outcome, and complications. RESULTS: Three men and 1 woman underwent complete intracorporeal urinary diversion. In patients receiving ileal conduits the mean total operative time was 510 minutes, and the estimated blood loss was 400 mL. In the patient receiving an ileal neobladder the total operative time was 585 minutes, and the estimated blood loss was 500 mL. Mean time to flatus was 60 hours, and no intraoperative or postoperative major complications occurred. Surgical margins were negative with no positive lymph nodes. Compared with extracorporeal cases, the mean total operative time for RARC was significantly longer, but perioperative outcomes of estimated blood loss, time to flatus, and postoperative oncologic outcomes were not significantly different. CONCLUSIONS: Our initial experience showed that RARC with complete intracorporeal urinary diversion is feasible based on perioperative data and oncologic features. However, in this small case series, we observed no definite benefits associated with intracorporeal urinary diversion over extracorporeal urinary diversion except for better cosmesis. Long-term, large-scale, prospective comparative studies will be needed to demonstrate the benefit of intracorporeal urinary diversion.

Relationship between meat and cereal consumption and colorectal cancer in Korea and Japan.

BACKGROUND AND AIM: The incidence of colorectal cancer in Asian countries is increasing. The change to a more westernized diet is known to be related to these increases, and there are reports on the relationship between meat consumption and colorectal cancer in Japan. The aim of this study was to investigate the relationship between dietary change and colorectal cancer in Korea and Japan. METHODS: The data of meat and cereal consumption in Japan (1950-2002) and Korea (1970-2003), and the data of colorectal cancer incidence in Japan (1975-1998) and Korea (1992-2002) were investigated with a 20-year difference between the two countries. RESULT: We found that the changes in meat and cereal consumption, as well as the increases in the incidence of colon and rectal cancer, were similar between those two countries with a 20-year difference. CONCLUSION: These similarities between Korea and Japan could be helpful for predicting future colorectal cancer incidences for Korea and other Asian countries.

The prognostic significance of E-cadherin and liver intestine-cadherin expression in colorectal cancer.

PURPOSE: The significance of liver intestine-cadherin as a potential marker has been growing in the field of oncology, because of its unique features compared with classic cadherins. We investigated the coexpression patterns of E-cadherin and liver intestine-cadherin in colorectal cancer, and determined whether differences in expression patterns were associated with clinicopathologic parameters and also which relationship between these two adhesion molecules existed in colorectal cancer. METHODS: Expression pattern of E-cadherin and liver intestine-cadherin was investigated immunohistochemically in 207 colorectal cancers along with clinicopathologic parameters. RESULTS: Reduced expression of liver intestine-cadherin was detected in 51 percent (n = 105) of tumors. Such expression was found to be associated with tumoral dedifferentiation (P = 0.015) and in a multivariate analysis was associated with a significant worse overall survival after adjustment for tumor stage, differentiation, and E-cadherin status (hazard ratio, 1.951; 95 percent confidence interval, 1.06-3.592; P = 0.032). Fifteen percent (n = 32) of tumors showed reduced expression of E-cadherin and had relationship with tumoral dedifferentiation (P < 0.001), lymph node metastasis (P = 0.004), and advanced stage (P = 0.029). Reduced expression of E-cadherin was associated with short overall survival (P = 0.028); however, in a multivariate analysis, it was not statistically significant. CONCLUSIONS: Reduced expression of liver intestine-cadherin had a significant correlation with tumoral dedifferentiation and short overall survival in this series. In addition, early and frequent loss of liver intestine-cadherin expression might be a more sensitive indicator than E-cadherin to predict more aggressive tumoral behavior.

Simultaneous laparoscopic radical nephrectomy and laparoscopic sigmoidectomy for synchronous renal cell carcinoma and colonic adenocarcinoma.

Hand-assisted laparoscopic radical nephrectomy is an established therapeutic choice for localized renal cell carcinoma. Laparoscopic sigmoidectomy is becoming accepted for the treatment of locally advanced sigmoid colon cancer. Primary cancer may occur synchronously in two different organs, in which case simultaneous resection is recommended if possible. To our knowledge this is the first report of simultaneous laparoscopic resection of coexistent renal and colonic double primary malignant tumors.