Clinicopathological features, postoperative survival and prognostic variables for cancer-related survival in patients with mucinous colorectal carcinoma.

PURPOSE: To investigate the clinicopathological features and postoperative survival of patients with mucinous colorectal carcinoma (MC) and to identify the factors related to long-term survival. METHODS: Twenty-three patients who had undergone resection for MC at Miyazaki University Hospital from 1991 to 2006 were followed up for at least 5 years or until death. The effects of the clinicopathological variables on the 5-year cancer-specific survival were assessed by the univariate analyses. These patients' clinicopathological data were compared with those of 403 non-mucinous carcinoma (NMC) patients (102 well-differentiated adenocarcinomas, 301 moderately differentiated adenocarcinomas). RESULTS: The 5-year cancer-specific survival rate was significantly worse in MC (56.2 %) than in NMC (73.8 %; p = 0.008) cases. Univariate analyses showed the T factor, lymph node metastases, liver metastases, metastases to the distant peritoneum, remote metastases and curative resection to be significant factors predicting the survival. However, there were no significant differences in the postoperative survival in patients with stage II-IV disease. The rates of metastases to the distant peritoneum, M1, T4, a tumor size ≥5 cm and non-curative resection were higher in MC than in NMC patients. CONCLUSIONS: Patients with MC had advanced stage cancer, especially with metastases to the distant peritoneum, more frequently than did the patients with NMC. To improve the survival of these patients, it is therefore important to detect MC at an early stage and to perform curative resection.

Clinical features and prognostic factors of bone metastases from colorectal cancer.

PURPOSE: To investigate the clinical features and prognoses of patients with diagnosed bone metastases from colorectal cancer (CRC). METHODS: This was a 16-year retrospective study of 32 patients with bone metastases secondary to CRC, who were seen at National Kokura Hospital between 1993 and 2008. The influence of clinical and pathologic variables on survival was assessed by univariate and multivariate analyses. RESULTS: The bone most commonly involved was the spinal column. The mean disease-free interval was 17.6 months and mean survival from the diagnosis of bone metastases was 9.3 months. On univariate analysis, the serum CEA level at the time of diagnosis of bone metastases (p = 0.020) and history of pulmonary metastases (p = 0.013) were significant. On multivariate analysis, a history of bone metastases in the ribs (hazard ratio 3.669, p = 0.025) and a history of pulmonary metastases (hazard ratio 3.854, p = 0.022) significantly affected survival. CONCLUSIONS: It is important to investigate for bone metastases in patients who complain of back pain and lumbago after CRC surgery.

Video monitoring and slide and video presentations as tools for surgical education.

BACKGROUND/AIMS: To provide medical students with good visualization and understanding of surgical procedures, we used video monitoring (Monitor) in the operating room and slide (Slide) and video (Video) presentation in the conferences. The purpose of this study was to evaluate the effect of these visual aids on surgical education. METHODOLOGY: One hundred and twenty-nine fifth- and sixth-year medical students completed a questionnaire regarding their visualization of, understanding of, and interest in all surgical procedures observed and procedures pertaining to their assigned patients. The score was collected on a Likert-type scores ranged from 1 for "poor" to 5 for "excellent". RESULTS: Visualization and understanding scores were significantly lower for direct observation than for Monitor (p<0.01 and p<0.001), Slide (p<0.001 and p<0.001) and Video (p<0.001 and p<0.001). Interest scores did not differ between observation methods. For all observation methods, understanding of and interest in the surgical procedures were significantly greater in relation to assigned patients than in relation to all patients observed. CONCLUSIONS: Video monitoring and slide and video presentations enhance students' understanding of and interest in surgical procedures. Contributing to the care of assigned patient also increases understanding of and interest in general surgery.

Medical students' attitudes to laparoscopic surgery.

BACKGROUND/AIMS: The purpose of the present study was to evaluate the attitude of medical students to laparosocopic surgery. METHODOLOGY: Two hundred and seven medical students completed a questionnaire regarding their visualization of, understanding of, and interest in observation of laparoscopic surgery via laparoscopic monitor (laparoscopic observation) and of open surgery, either directly (open direct observation), or via video monitor observation (open monitor observation). They were also asked about their willingness to become an operator (operator). Responses to each item were given as Likert-type scores ranging from 1 to 5. RESULTS: The visualization score was significantly lower for open direct observation than for open monitor observation (P<0.001) and laparoscopic observation (P<0.001), with the significantly lower score for open monitor observation than for laparoscopic observation (P<0.001). The understanding score was significantly lower for open direct observation than for open monitor observation (P<0.01) and laparoscopic observation (P<0.01). Interest scores did not differ between the three observation methods. The operator score was significantly higher for open surgery than for laparoscopic surgery. CONCLUSIONS: Laparoscopic surgery provides good visualization of the operative field. However, students' interest in laparoscopic surgery is similar to those of open surgery.

Factors influencing outcome after surgery for stage IV colorectal cancer.

PURPOSE: According to the classification system of the Japanese Society for Cancer of the Colon and Rectum, Stage IV colorectal cancer is characterized by distant metastasis, which is defined by four factors: liver metastasis (H factor), metastasis to organs other than the liver (M factor), peritoneal dissemination (P factor), and distant lymph node metastasis (N factor). We conducted this study to investigate the postsurgical prognosis of patients with Stage IV colorectal cancer (CRC), in reference to each of these four factors. METHODS: We analyzed the medical records of 73 patients who underwent surgery for Stage IV CRC at our hospital between 1991 and 2001. RESULTS: Univariate analysis revealed that P0 or P1 CRC (P < 0.001), absence of the M factor (P = 0.024), well or moderately differentiated adenocarcinoma (P < 0.001), resection of the primary tumor (P < 0.001), and curability B surgery (P < 0.0001) were associated with a better prognosis than other types of Stage IV CRC. Multivariate analysis revealed that tumor differentiation and surgical curability affected cancer-specific survival significantly. CONCLUSION: Surgery with curative intent should be considered for patients with Stage IV CRC defined by the P1 factor or H factor.

Multiseptate gallbladder: report of a case.

A 53-year-old Japanese female was referred to Miyazaki University hospital for the surgical treatment of gastric cancer. She had no symptoms and the presence of the complex cystic gallbladder with multiple and linear hyperechogenic septa was incidentally found by ultrasonography. Multicystic lesion of gallbladder was also observed on DIC-CT and MRCP. Neither the bile duct nor the pancreatic duct was dilated. The papilla of the Vater was of normal appearance endoscopically. Pathological study of the biopsy specimen from the type 3 tumor of the stomach showed poorly differentiated adenocarcinoma. Distal partial gastrectomy and cholecystectomy were performed. The gross examination of the gallbladder confirmed the presence of multiple thin septa with honeycomb appearance. Cancer cells were not observed histologically and final diagnosis was the multiseptate gallbladder. The postoperative course was uneventful. We herein report a rare case of multiseptate gallbladder showing the findings on DIC-CT and MRCP.

Circular tumor growth: a prognostic factor in stage II colorectal carcinoma.

BACKGROUND/AIMS: Almost all patients with stage II colorectal cancer are spared adjuvant chemotherapy, yet a considerable number of these patients die from the disease. The aim of this retrospective study was to identify factors negatively affecting survival of patients with stage II colorectal cancer treated by curative resection. METHODOLOGY: Study subjects were 88 patients who had undergone curative resection for stage II colorectal cancers at Miyazaki University Hospital during the period from 1987-1999. Patients were followed up for a minimum of 5 years or until death. The influence of clinical and pathologic variables on 5-year cancer-specific survival was assessed by uni variate and multivariate analyses. RESULTS: The 5-year cancer-specific survival rate was 83.4%. Univariate analysis showed circular tumor growth to be significantly associated with decreased survival (p=0.0047). Furthermore, multivariate analysis showed that circular tumor growth significantly affected long-term cancer-specific survival of patients with stage II colorectal cancer (hazard ratio 1.184, p=0.025). CONCLUSIONS: Circular tumor growth is an independent prognostic factor for patients with stage II colorectal cancer. The long-term prognosis of stage II colorectal cancer patients with circular-type carcinoma appear to be poor.

Intraoperative enteroscopy in minimally invasive surgery.

PURPOSE: The purpose of this study was to assess the efficacy and safety of intraoperative enteroscopy (IOE) in patients undergoing minimally invasive surgery. METHODS: Twelve patients underwent minimally invasive surgery and IOE at Miyazaki University Hospital. Patients included 11 men and 1 woman. After extraction of the intestine via minilaparotomy, enterotomy was performed, and a sterilized enteroscope was inserted. RESULTS: Length of the skin incision was 5.7+/-0.2 cm (mean+/-standard error). Length of the small intestine observed enteroscopically was 334+/-19 cm. Distance from the ligament of Treitz to the orally observed jejunum was 11.8+/-3.6 cm. In 5 of 9 patients with Crohn disease, additional lesions were found by IOE that were not found by preoperative examination. One additional tumor was found in 1 patient with ileal tumor. Postoperative complications occurred in 2 patients. CONCLUSION: IOE is efficacious in patients undergoing minimally invasive surgery.

Internal herniation through the mesenteric opening after laparoscopy-assisted right colectomy: report of a case.

We discuss a rare complication in a patient who underwent laparoscopic colectomy. A 69-year-old woman underwent laparoscopy-assisted right colectomy for cancer of the ascending colon. Two months after the operation, bowel obstruction developed. Decompression with a long intestinal tube failed to resolve the obstruction. Thus, surgery was performed. Abdominal exploration revealed a strangulated ileal loop caused by herniation through the mesenteric opening at the anastomotic site. The mesenterium had not been sutured during the previous operation. The anastomotic segment had twisted semicircularly and adhered to the retroperitoneum, so the mesenteric opening had narrowed.