Laparotomy wound and anastomotic recurrences after resection for cecum cancer: a case report.

We report herein the case of a 46-year-old man who developed recurrences in both the incisional laparotomy wound of the abdominal wall and the stapled anastomotic site following ileo-colonic resection for cecum cancer. The patient had initially undergone laparoscopic surgery but had converted to conventional open surgery. Intestinal reconstruction had been performed by stapled functional end-to-end anastomosis between the ileum and ascending colon. The implantation of exfoliated cancer cells during the operation may have caused recurrence.

Minilaparotomy approach for the resection of laterally spreading tumors of the colon.

PURPOSE: We report our experience of using the minimally invasive minilaparotomy approach to resect colonic laterally spreading tumors (LSTs) that could not be removed by colonoscopic snare polypectomy. METHODS: We prospectively examined 17 patients who underwent a minilaparotomy, defined as an incision less than 7 cm long, between 1997 and 2001, for a collective 19 colonic LSTs. RESULTS: Complete en bloc resection of the LSTs was successfully performed in all 17 patients. The resections included colotomy and polypectomy in four patients (four LSTs), limited colectomy in seven patients (nine LSTs), and colectomy with regional lymph node dissection in six patients (six LSTs). There was no mortality or morbidity. The mean +/- standard deviation (SD) length of the minilaparotomy was 6.7 (+/-0.8) cm, and the mean (+/-SD) operating time and blood loss were 139 (+/-39) min and 27 (+/-15) ml, respectively. Histology revealed 2 adenomas, 16 Tis carcinomas, and 1 T1 carcinoma. None of the patients had lymph node metastasis or positive resection margins. There have been no signs of tumor recurrence after a median follow-up period of 30.4 months. CONCLUSIONS: The minilaparotomy approach is appropriate for resecting LSTs that cannot be removed by colonoscopic snare polypectomy, and provides a minimally invasive alternative to conventional laparotomy.

Differences in prognosis of colorectal cancer patients based on the expression of sialyl Lewisa, sialyl Lewisx and sialyl Tn antigens in serum and tumor tissue.

PURPOSE: To clarify the differences in prognosis of colorectal cancer patients based on the expression of sialyl Lewisaa sialyl Lewisx and sialyl Tn antigens in serum and tumor tissue. PATIENTS AND METHODS: Preoperative serum levels (by radioimmunoassay) and tumor tissue expression (by immunohistochemistry) of these antigens were simultaneously determined in 52 patients. For each antigen, patients were classified into one of four groups: Group S-/T-, S-/T+, S+/T- and S+/T+. (S denotes serum, T denotes tumor tissue, and negative and positive represent expression). RESULTS: For sialyl Lewisa antigen, the survival time of Group S+/T+ was significantly shorter than Group S-/T- or Group S-/T+ (p=0.027 or p=0.032, respectively). For sialyl Lewisx antigen, the survival time of Group S-/T+ was significantly shorter than Group S-/T- (p=0.048). CONCLUSION: Increased expressions of sialyl Lewisa antigen in serum and sialyl Lewisx antigen in tumor tissue may be associated with poor prognosis in colorectal cancer patients.

Additional radical surgery after colonoscopic snare polypectomy for T1 colorectal cancer: use of the minilaparotomy approach.

An additional resection is indicated when colorectal polyps resected by colonoscopy reveal T1 carcinoma with unfavorable histology (no free margin or having risk factors for lymph node metastasis). We describe our experience with this type of surgery with the minilaparotomy approach (< or = 7 cm). This prospective study included 19 consecutive patients between 1997 and 2001. Specimens resected by colonoscopy revealed T1 carcinomas with one of the following histological types: inadequate excision (no free margin), lymph-vascular invasion, histologic grade III, or sm2/sm3 (submucosal invasion greater than 200-300 microm from the muscularis mucosa). The minilaparotomy approach included 15 colectomies and 4 anterior resections. Median length of minilaparotomy was 7 cm (range, 4-7 cm). Median number of lymph nodes removed was 11 (range, 7-21 lymph nodes). Median proximal and distal margins were 9.0 (range, 5.2-17.5 cm) and 8.5 cm (range, 2.0-11.5 cm), respectively. The patients quickly returned to normal function without morbidity and mortality. Five (26.3%) had a residual carcinoma within the bowel wall, and one (5.3%) had lymph node metastasis. At a median follow-up of 33.6 months, one patient (5.3%) developed local recurrence and subsequent distant metastasis. The minilaparotomy approach is suitable for an additional operation following colonoscopic polypectomy for T1 carcinoma, thus providing a minimally invasive alternative to conventional laparotomy.

Minilaparotomy approach for removal of a large colonic lipoma: report of two cases.

A minimally invasive surgical approach should be employed to resect symptomatic colonic lipomas whenever possible. We report two cases of large colonic lipomas that were successfully removed using a minimally invasive minilaparotomy approach. Patient 1 was a 53-year-old man with a 3.8-cm symptomatic submucosal lipoma in the ascending colon and patient 2 was a 57-year-old woman with a 4.2-cm symptomatic submucosal lipoma in the transverse colon. Both lipomas were successfully removed through a 5-7-cm minilaparotomy. Normal bowel function returned quickly without any postoperative complications. These case reports demonstrate that the minilaparotomy approach is a suitable alternative to conventional laparotomy to remove a large colonic lipoma.

Increased serum levels of interleukin-6 in malnourished patients with colorectal cancer.

Peri-operative serum levels of interleukin-6 (IL-6) were determined in 62 patients who underwent resection of colorectal cancer to clarify the relationship between nutritional status and IL-6 response. Patients were divided into two groups based on creatinine height index: malnourished group (n=13) and normally nourished group (n=49). The preoperative median serum level of IL-6 in the malnourished group was significantly higher than in the normally nourished group (P=0.041). The postoperative median serum level of IL-6 in the malnourished group also tended to be higher. In conclusion, the peri-operative IL-6 response may be activated in malnourished colorectal cancer patients.

Surgical treatment for right pleural effusions caused by pancreaticopleural fistula.

A 56-year-old man with a history of alcohol abuse presented with exertional dyspnea. A chest radiography showed a massive right pleural effusion with sanguineous pleural fluid and an amylase level of 97,188 IU/L. Despite conservative treatment with no oral intake, total parenteral nutrition and repeated thoracentesis, the pleural effusion was persistent and intrathoracic infection was suspected. Surgical intervention was proposed and a preoperative endoscopic retrograde cholangiopancreatography revealed disruption of the mid pancreatic duct and a fistulous tract. A middle segment pancreatectomy was performed for removal of the disrupted portion of the main pancreatic duct and reconstruction of the distal pancreas was completed by end-to-side Rouxen-Y pancreatojejunostomy. The patient had a good postoperative course and was discharged on the 29th postoperative day. He has remained well during the 9 months of follow-up.

Successful resection of a duodenal fistula complicated with recurrent Crohn's disease at the site of previous ileocolonic anastomosis: report of a case.

A duodenal fistula complicated with Crohn's disease may present a difficult management problem. We herein report the case of a 22-year-old woman who developed a colo-ileo-duodenocutaneous fistula with recurrent disease at the ileotransverse anastomosis. The patient had previously undergone an ileoascending colectomy for Crohn's disease. Preoperative colonoscopy did not reveal any evidence of intrinsic duodenal Crohn's disease. Symptomatology was obstructive and a consequence of associated ileocolic lesions. The patient underwent a resection of the diseased bowel including the duodenal component of the fistula. Surgery included a simple closure of the duodenal defect with both omental pedicle graft wrapping and decompression of the duodenum via a gastrostomy tube. The patient had an uneventful postoperative course. The duodenal fistula was successfully cured. Our experience demonstrates that duodenal fistulas may be successfully treated when the duodenum is not involved with intrinsic Crohn's disease. Such treatment consists of a resection of the diseased bowel segment and a primary simple closure of the duodenal defect.

The relationship between circulating interleukin-6 and carcinoembryonic antigen in patients with colorectal cancer.

PURPOSE: The purpose of this study was to clarify whether or not preoperative serum levels of interleukin-6 (IL-6) correlate with well-established prognostic variables (serum level of carcinoembryonic antigen (CEA), stage, histological grade, lymphatic and venous invasion) in colorectal cancer patients. PATIENTS AND METHODS: Serum levels of IL-6 and CEA were determined in 62 patients who underwent resection of colorectal cancer. The patients were divided into two groups based on a selected cut-off value: high and low IL-6 and CEA groups. RESULTS: The median serum level of IL-6 in colorectal cancer patients was significantly higher than the median level in normal controls (p = 0.0014). Multivariate logistic regression analysis showed that a high serum level of CEA is an independent predictor for a high serum level of IL-6 (odds ratio, 4.10; p = 0.046). CONCLUSION: A high serum level of IL-6 is significantly associated with a high serum level of CEA in preoperative colorectal cancer patients.

Distal intramural spread is an independent prognostic factor for distant metastasis and poor outcome in patients with rectal cancer: a multivariate analysis.

BACKGROUND: The aim of this study was to clarify the prognostic value of distal intramural spread of tumor for survival and recurrence in patients with rectal cancer. METHODS: Microscopic distal intramural spread was examined in 134 consecutive specimens of resected rectal cancer. Correlations among distal intramural spread, established clinicopathologic factors, and patients' prognoses were examined by univariate and multivariate analyses. American Joint Committee on Cancer classification and stage groupings were used for tumor assessment. RESULTS: Thirty-three patients (24.6%) had distal intramural spread. Multivariate logistical regression analysis revealed that T3/T4 and M1 were independent predictive variables for the presence of distal intramural spread. Patients with distal intramural spread had a shorter disease-specific or disease-free survival time after curative surgery than those without distal intramural spread (P =.0003 and P =.0006, respectively). Most patients with distal intramural spread developed distant recurrence. Cox's regression with multiple covariates showed that distal intramural spread is an independent factor in predicting distant recurrence and worse outcomes after curative surgery in patients with rectal cancer. CONCLUSIONS: Distal intramural spread is an independent risk factor for distant metastasis and poor prognosis in patients with rectal cancer.