ABSTRACT
BACKGROUND: Laparoscopic approaches for colorectal surgery have been improved recently; however, it is often difficult to achieve total mesorectal excision (TME) for lower rectal cancer laparoscopically because of a narrow pelvis and a thickened mesentery. METHODS: TME was successfully performed in 6 patients (4 men, 2 women) with dissection of the rectum transanally from the anal side of the tumor. The preoperative stage was T3N1M0 in 1 patient and T3N0M0 in 5 patients. The mean body mass index was 29.8 kg/m(2) (range, 28.7-31.2 kg/m(2)), and the mean tumor size was 46.5 mm (range, 30-60 mm). RESULTS: The mean duration of the anal portion of the operation was 64 minutes (56 minutes in women, 79 minutes in men). No complications occurred during surgery or postoperatively. CONCLUSION: This technique is a simple and effective procedure for successfully performing laparoscopic TME of lower rectal cancer in patients with bulky tumors, narrow pelvises, and thickened mesenteries.
Subject(s)
Colectomy/methods , Laparoscopy/methods , Rectum/surgery , Anal Canal , Dissection , Female , Humans , Male , Middle Aged , Rectal Neoplasms/surgeryABSTRACT
BACKGROUND: Anastomotic recurrence is often experienced at colocolic or colorectal anastomoses. Tumor cell implantation has been reported as the mechanism of anastomotic recurrence. However, anastomotic recurrence occurring repeatedly after curative surgery is rare. We herein report a rare case of repeated anastomotic recurrence after curative surgery for sigmoid colon cancer. CASE PRESENTATION: A 51-year-old man underwent radical surgery for sigmoid colon cancer. However, anastomotic recurrence developed three times during three years and six months after the initial operation in spite of irrigation with 5% povidone-iodine before anastomosis. The serum carcinoembryonic antigen (CEA) level had been within normal limits after sigmoidectomy. Finally, the patient underwent abdominoperineal resection. The clinico-pathological findings revealed that possible tumor cell implantation caused these anastomotic recurrences. The patients survived without recurrence during the follow-up period of seven years and nine months. CONCLUSION: We experienced a rare case of repeated anastomotic recurrence due to possible tumor implantation after curative surgery for sigmoid colon cancer; however the prognosis was ultimately very good. CEA monitoring was insensitive for detection of anastomotic recurrence in this case.
ABSTRACT
A 69-year-old female with unresectable hepatocellular carcinoma was treated with continuous arterial infusion of low-dose cisplatin (10 mg/body/day) and 5-fluorouracil (250 mg/body/day). The regimen was continued for 5 days then discontinued for 2 days, and repeated for 4 weeks. The portal tumor thrombus almost disappeared and HCC was smaller than before chemotherapy. Tumor marker (AFP and PIVKA-II) decreased remarkably. As tumor markers increased again 2 months later, the same regimen chemotherapy was performed once more. The patient was treated with arterial chemotherapy as an outpatient. The present case of hepatocellular carcinoma with portal tumor thrombus was effectively treated by arterial infusion chemotherapy with low dose cisplatin and 5-fluorouracil.
