Cecal Cancer Research Articles

孤立性脳転移で発症した盲腸癌の1例

孤立性脳転移で発症した盲腸癌の1例

超高齢者の盲腸癌による腸重積に対して待機的腹腔鏡下手術を施行した１例

超高齢者の盲腸癌による腸重積に対して待機的腹腔鏡下手術を施行した１例

Survival analysis for colon subsite and rectal cancers: Experience from a single surgeon

Purpose: The survival rates of patients with colorectal cancers have been well documented in many studies. Some studies have shown that proximal colon cancers have inferior survival rates when compared with distal colon cancers. However, the prognostic significance of tumor location with respect to survival remains controversial. By using data from a single physician, we analysed patient survival rates based on colon cancer subsite location, including rectal cancers. Methods: We retrospectively analysed 881 patients with colorectal cancers between 1987 and 2008. Colon subsite locations were defined as cecum, ascending colon, transverse colon, descending colon, sigmoid colon, and rectum. Subsite-specific survival analyses were performed using Kaplan-Meier analysis and Cox proportional hazards ratios. The median follow-up time was 93 months. Results: A total of 689 colorectal cancer cases were included in our analysis, of which 14 were cecum (2.0%), 95 were ascending colon (13.8%), 21 were transverse colon (3.0%), 25 were descending colon (3.6%), 129 were sigmoid colon (18.7%), and 405 were rectum (58.8%) cancers. The 5-year overall survival rates were 77.8% for all colorectal cancers, which consisted of 92.9% for cecal cancer, 69.5% for ascending colon cancer, 76.2% for transverse colon cancer, 84.0% for descending colon cancer, 82.2% for sigmoid colon cancer, and 77.5% for rectal cancer. Conclusion: Ascending colon cancer was associated with the poorest survival outcome, whereas descending colon cancer was associated with the best survival outcome except cecal cancer. Moreover, the survival rate associated with left colon cancer was better than the survival for right colon and rectal cancer.

Laparoscopic complete mesocolic excision with completely medial access by"page-turning"approach for right hemi-colon cancer

Objective To investigate the feasibility of laparoscopic complete mesocolic excision (CME) with completely medial access bypage-turningapproach (CMAPA). Methods The clinical data of 38 patients with right-sided colon cancer who were admitted to the Ruijin Hospital affiliated to Shanghai Jiaotong University School of Medicine between September 2011 and December 2014 were analyzed retrospectively. All the patients underwent laparoscopic CME with CMAPA. The CMAPA was conducted in theinside-to-outsideandbottom-to-topdirection, which adopted the strategy ofpoint-to-lineandline-to-plane. Observing indexes included the evaluation of surgical quality (according to the West grading system), intraoperative status (operation time, volume of intraoperative blood loss, extent and number of lymph node dissected and specimen length), postoperative recovery (time to anal exsufflation, time for fluid diet intake, duration of hospital stay and occurrence of complications) and postoperative pathological examination [tumor staging according to the 7th edition staging system of Union for International Cancer Control (UICC)]. The follow-up was regularly performed by telephone interview up to March 2015, including abdominal symptoms, urination and defecation, body weight, routine blood test, tumor markers of digestive tract, abdominal computed tomography (CT) and recurrence and metastasis of tumor. Measurement data with normal distribution and count data were presented as ±s and rate, respectively. Results The quality of right-sided colon cancer surgery in 38 patients showed 35 at the mesocolon with grade C and 3 inside the mesocolon with grade B. The operation time, volume of intraoperative blood loss, number of lymph node dissected and specimen length, time to anal exsufflation, time for fluid diet intake and duration of hospital stay were (128±36)minutes, (76±35)mL, 20±6, (22±6)cm, (2.5±1.8)days, (3.6±2.1)days and (12±5)days, respectively. Of 16 patients with tumors of hepatic flexure of colon, 2 had No 6 lymph node metastases and 1 had lymph node metastasis at the side of greater curvature of stomach and greater omentum. Of 3 patients with postoperative complications, 1 with anastomotic leakage was cured by lavage and drainage, 1 with hemorrhage at the side of greater curvature of stomach had a good recovery after reoperation and 1 with chyle leakage had improvement after symptomatic treatment. Of 38 patients with right-sided colon cancer, cecum cancer was detected in 8 patients, ascending colon cancer in 14 patients and cancer of hepatic flexure of colon in 16 patients. There were 10 low-differentiated adenocarcinomas, 18 moderate-differentiated adeno-carcinomas, 6 high-differentiated adenocarcinomas and 4 mucinous adenocarcinomas. The postoperative patho-logical examination showed that stage I was detected in 2 patients, stage II in 20 patients and stage III in 16 patients. Thirty-eight patients were followed up for a median time of 18 months (range, 3-36 months), with normal abdominal symptoms, urination and defecation, body weight, routine blood test, tumor markers of digestive tract and abdominal CT and without complications. Two patients had tumor metastases, including 1 of liver metastasis and 1 of pulmonary metastasis. No death occurred during the follow-up. Conclusion Laparoscopic CME with CMAPA is technically feasible and complies more with the principle of tumor radical surgery, giving satifactory short-term effect in patients. Key words: Colonic neoplasms; Rectal neoplasms; Complete mesocolic excision; Completely medial access; Page-turningapproach; Laparoscopy

A Case of Toxocariasis in a Patient with Cecal Cancer Mimicking Hepatic Metastasis

Toxocariasis is a common helminth infection and the most common cause of peripheral blood eosinophilia. The clinical presentation of liver toxocariasis is often confused with primary or metastatic hepatic tumors. Here, we report on a 52-year-old man admitted with cecal cancer and eosinophilia. Computerized tomography (CT) scans revealed multiple lesions with peripheral enhancement in the liver, and T1- and T2-weighted images revealed isointensity. The patient underwent right hemicolectomy and an exploratory laparotomy with a liver biopsy. Resection of the cecal specimen revealed an adenocarcinoma, while the liver biopsy revealed an eosinophilic abscess with no evidence of malignancy. A serologic test showed a marked increase in specific immunoglobulin G antibody concentrations against Toxocara canis and daily antiparasitic treatment with albendazole (800 mg per day for 7 days) was initiated. Follow-up CT scans indicated that all liver masses and eosinophilia were resolved. (Korean J Med 2015;89:714-718)

Cytokeratin 7-positive/cytokeratin 20-negative cecal adenocarcinoma metastatic to the uterine cervix: a case report

BackgroundThe vast majority of uterine cervical malignancies are primary carcinomas, and secondary neoplasms that metastasize to the uterine cervix from a distant organ are uncommon. Although relatively rare, metastases to the uterine cervix from a primary colon cancer have been reported. We report a rare case of metastatic carcinoma originating from a cecal adenocarcinoma with an unusual cytokeratin 7/cytokeratin 20 immunophenotype.Case presentationA 74-year-old postmenopausal Japanese woman was referred to our hospital for the evaluation of a uterine tumor. She had a past medical history of cecal cancer and had undergone laparoscopically assisted right hemicolectomy at the age of 69 years. During follow-up, she was found to have elevated levels of the tumor markers carbohydrate antigen 19-9 (179.7 IU/mL) and carcinoembryonic antigen (26.9 μg/L). Positron emission tomography/computed tomography showed a focus of high 18F-fluorodeoxyglucose uptake in her uterus. Examination of a cervical biopsy found a poorly differentiated adenocarcinoma that was immunopositive for cytokeratin (CK)7 and caudal-related homeobox 2 (CDX2) expression and immunonegative for cytokeratin 20 expression. The patient underwent radical hysterectomy and bilateral salpingo-oophorectomy. Histopathological examination found invasive growth of irregular and atypical ductal hyperplasia. Immunohistochemical staining of the tumor specimen revealed the same immunophenotype as the biopsy specimen. The cecal cancer specimen from her previous surgery was also examined and found to have the same immunophenotype. The histopathological diagnosis was cecal adenocarcinoma metastatic to the uterine cervix. The patient is currently receiving adjuvant chemotherapy and to date is without evidence of recurrent disease.ConclusionsOur report illustrates the importance of immunohistochemistry for the correct diagnosis of the origin of a uterine cervical adenocarcinoma in a patient with a medical history of colorectal cancer. Re-examination of a previous oncological specimen is critical for cases with a uterine lesion that is difficult to identify as primary or metastatic cancer.

Early cecal cancer adjacent to the appendiceal orifice successfully treated by endoscopic submucosal dissection

Early cecal cancer adjacent to the appendiceal orifice successfully treated by endoscopic submucosal dissection

Simultaneous Laparoscopy-Assisted Resection for Colorectal Cancer and Metastases

With advancement of minimal invasive surgery, a simultaneous laparoscopy-assisted resection for colorectal cancer and metastasis has become feasible. Hence, we report three cases of simultaneous laparoscopic surgery for colorectal cancer with liver or lung metastasis. In the first case, laparoscopic right hemicolectomy and left lateral segmentectomy of liver was performed for ascending colon cancer and liver metastasis. In the second case, laparoscopic right hemicolectomy and wedge resection of right lower lung was performed for cecal cancer and lung metastasis. In the third case, laparoscopic right hemicolectomy and wedge resection of left lower lung was performed for ascending colon cancer and lung metastasis. In the first two cases, patients quickly returned to normal activity. In the third case, postoperative bleeding was observed, but spontaneously stopped. There was no postoperative mortality. Simultaneous laparoscopic surgery represents a feasible option for colorectal cancer with metastases on the other organs.

Long-term survival case of a recurrent colon cancer owing to successful resection of a tumor at hepaticojejunostomy: report of a case.

With advances in surgical procedures and perioperative management, hepato-biliary-pancreatic surgery, including hepatectomy and pancreaticoduodenectomy, has been employed for recurrent colon cancer. However, no report has described a case of major hepatectomy with the combined resection of hepaticojejunostomy following pancreaticoduodenectomy for locoregionally recurrent colon cancer. Here, such a case is reported. The patient, a 37-year-old woman, had undergone pancreaticoduodenectomy for lymph node recurrence along the extrahepatic bile duct from cecal cancer. Thirteen months later, a biliary stricture was found at the hepaticojejunostomy site and right hepatectomy was performed. The resected specimen showed a papillary tumor at the hepaticojejunostomy. Based on its histological features, the pathogenesis of this tumor was considered to be intramural recurrence via lymphatic vessels. Although she underwent resection of a lymph node recurrence at her mesentery 12 months later, she has remained well thereafter, without any sign of further recurrence during 5 years of follow-up after hepatectomy.

腹腔鏡補助下結腸右半切除術を施行しえた盲腸癌を先進部とする成人腸重積症の１例

症例は100歳，女性．便潜血陽性にて近医を受診．腹部CT検査にて，横行結腸付近に腫瘍性病変が疑われ当科紹介となった．当院の腹部CT冠状断では，上行結腸から肝彎曲部に全周性の壁肥厚を認め，口側腸管が軽度拡張していたが，肝転移や腹水は認められなかった．肥厚部が肛門側腸管に陥入し，腸重積が疑われた．下部消化管内視鏡検査では，残渣のため腫瘍まで到達できなかった．以上より腸重積を伴った右側結腸癌も疑い腹腔鏡下に手術を施行した．術中所見では，回腸末端と重積された上行結腸が観察され，腸管壁は肥厚し挙上に難渋したが，腹腔鏡下に結腸右半切除を施行しえた．切除標本では盲腸のⅠ型腫瘍が上行結腸に重積していたが，腸管壊死は認められなかった．成人腸重積症の多くは緊急にて開腹手術となる症例が多いが，今回待機的かつ腹腔鏡下手術を施行しえた超高齢症例を経験したので報告する．

盲腸癌に併存した肝reactive lymphoid hyperplasiaの1例

症例は57歳の女性．右下腹部腫瘤の精査で盲腸癌と診断された．術前の腹部超音波検査で肝S2に径10mmの境界明瞭で内部不均一な低エコー腫瘤を認めた．CT検査では淡い低吸収域として認め，造影効果は認めなかった．MRI検査ではT1強調で低信号，T2強調で軽度高信号を示し，superparamagnetic iron oxide（SPIO）造影後T2強調で明瞭な高信号として描出され，拡散強調画像で拡散の低下を認めた．盲腸癌・転移性肝癌と診断し，回盲部切除術と肝部分切除術を施行した．病理組織学的所見で肝reactive lymphoid hyperplasiaと診断された．術後8年再発なく経過している．肝reactive lymphoid hyperplasiaは良性疾患とされているが，術前検査で悪性腫瘍との鑑別が困難であり，外科的切除が行われることが多い．診断，治療の現状と問題点を考察した．

Metastatic Tumor of the Spermatic Cord in Adults: A Case Report and Review.

Metastatic spermatic cord (SC) tumor is extremely rare. Recently, we experienced a case of late-onset metastatic SC tumor from cecal cancer. This case is a 68-year-old man presenting with a painless right SC mass. He had undergone a right hemicolectomy for cecal cancer 6 years ago. Radical orchiectomy and adjuvant chemotherapy with S-1 were performed. No recurrence was found after one year of follow-up. We identified a total of 25 cases, including our case, on a literature search via PubMed from January 2000 to April 2015. The most frequent primary sites of the tumors metastasizing to the SC were the stomach (8 cases, 32%) and the colon (8 cases, 32%), next the liver (2 cases, 8%), and kidney (2 cases, 8%). The majority of the cases underwent radical orchiectomy for the metastatic tumors of the SC. Over half of the cases received adjuvant interventions based on the regimens for the primary tumors. Prognosis in the patients with metastatic tumor of the SC was unfavorable except for late-onset metastasis. In patients with a mass in the SC and a history of neoplasm, especially in gastrointestinal tract, the possibility of metastasis from the primary cancer should be considered.

盲腸癌術後に穿通を伴う小腸再発を認めた１例

盲腸癌術後に穿通を伴う小腸再発を認めた１例

腹腔鏡補助下切除を施行した腸回転異常症を伴う盲腸癌の1例

症例は65歳，男性．腸閉塞の精査にて盲腸に進行癌を認めた．イレウス管造影では回盲部に全周性の狭窄を認め，小腸が腹腔内右側に偏位していた．大腸内視鏡検査を施行し，大腸癌の診断となった．腹部造影CT検査でSMV rotation signを認めた．3D-CT angiographyで回結腸動脈は，上腸間膜動脈の左側から分岐し，上腸間膜静脈の腹側を走行していた．腸回転異常症を伴った大腸癌と診断し，腹腔鏡補助下結腸切除術を施行した．郭清は回結腸動脈を根部で切離しD3郭清を行った．腸回転異常を伴う大腸癌に対して腹腔鏡下手術を行う場合は，3D-CT angiographyなどの画像技術を駆使した術前評価で，解剖学的異常，腫瘍の位置と血管走行を十分に把握しておくことが重要である．

術後1年6カ月目に鼠径ヘルニア嚢転移をきたした盲腸癌の1例

67歳，女性．2011年盲腸癌に伴う腸重積に対して腹腔鏡補助下回盲部切除を施行．腹水，腹膜播種，遠隔転移は認めず，病理診断は中分化腺癌，se，med，n2，ly2，v0，INFa，Stage IIIbであった．術後補助化学療法としてmFOLFOX6を計12クール施行した．その後，明らかな再発は認めなかったが，1年6カ月後に右鼠径部腫瘤を主訴に来院し，鼠径部のリンパ節転移を疑い腫瘤摘出術を施行した．手術では鼠径管内の3cm大の腫瘤を切除した．腫瘤は鼠径管後壁から膨隆するII型ヘルニアの形態であり，病理組織学的検索では腹膜に浸潤する中分化腺癌であった．免疫組織学的検索ではCK7陰性，CK20陽性，CEA陽性，cdx2陽性，D2-40陰性であり，ヘルニア嚢内に浸潤増殖をきたした盲腸癌の腹膜転移と最終診断した．術後15カ月が経過する現在まで再発なく外来通院中である．

Primary adenoid cystic carcinoma in the peripheral lung: a cytological, histopathological and immunohistochemical report of two cases

Primary adenoid cystic carcinoma (ACC) of the peripheral lung is a rare entity. Here we report two cases of primary ACC. Case 1 is an 84-year-old male with a past-medical history of cecal cancer presented with a 10 mm left upper lung nodule. Case 2 is a 40-year-old female who presented with 30 mm right upper lobe. Intraoperative (Case 1) and pre-operative (Case 2) histopathologic and cytologic diagnoses were consistent with a primary peripheral lung ACC. An upper lobectomy±mediastinal lymph node dissection was performed and immunohistochemical staining with thyroid transcription factor (TTF)-1, c-KIT and MYB on the excision specimen confirmed our diagnosis.

Outcomes evaluation of laparoscopic radical coloproctectomy and hepatectomy for resectable colorectal cancer with liver metastases

To explore the feasibility and safety of laparoscopic radical coloproctectomy and hepatectomy for resectalble colorectal cancer with liver metastases (CRCLM), and evaluate the survival outcomes of short-middle term for these patients. Totally 36 cases of CRCLM which were evaluated to undergo laparoscopic coloproctectomy and hepatectomy preoperatively, were enrolled from January 2009 to January 2014, including 28 synchronous and 8 metachronous CLM respectively. Laparoscopic colorectal resection and hepatectomies were performed in 35 cases, including 24 male and 11 female patients, with a mean age of (64 ± 12) years and a median age of 67 years (ranging from 35 to 80 years). Management strategies were made by a board of multi-disciplinary team. Intra-operative ultrasonography was used to detect the metastases in all cases. Overall survival and disease free survival were calculated by Kaplan-Meier curve. Radical total colectomy, right hemicolectomy, left hemicolectomy, sigmoidectomy, and proctectomy and were performed in 1 case of familial adenomatous polyposis with transverse colon cancer, 5 cases of cecal or asending colon cancer, 1 case of descending colon cancer, 14 cases of sigmoid colon cancer, and 14 cases of rectal cancer respectively. Metastasectomy only, anatomic hepatectomy only, and metastasectomy plus anatomic hepatectomy were done in 21, 10 and 4 cases respectively. Totally 35 colorectal tumors and 62 liver lesions were removed. The mean blood loss of colorectal and liver surgery were (80 ± 32) and (212 ± 153) ml, the median blood loss was 70 ml and 150 ml respectively. Colorectal and hepatic specific complications were not observed in all cases except a case of biliary leakage following right hemihepatectomy. Relapses were observed in 15 cases during a mean follow-up of (26 ± 16) months (median follow-up of 22 months). Four cases died of late-stage cachexia. The 1- and 3-year cumulative overall survival rates were 92.9% and 79.4% respectively. The 1- and 3-year cumulative disease free survival rates were 61.1% and 49.4% respectively. Laparoscopic coloproctectomy and hepatectomy for resectable CRCLM in carefully selected cases is safe and feasible, which makes simultaneous surgery possible. The oncologic outcome of short-middle term is acceptable, and long-term survival is expected.

Stent Graft Treatment of AAA With Preservation of the Inferior Mesenteric Artery

Coverage of the inferior mesenteric artery is standard in stent graft treatment of an infrarenal abdominal aortic aneurysm (AAA). Complications of colonic ischemia are rare, but risk factors include poor collateral flow from prior colonic surgery or from severe pelvic arterial occlusive disease. Preservation of inferior mesenteric artery (IMA) flow may prevent such complications in patients deemed to be at high risk for intestinal/pelvic ischemic complications. We have performed two unique cases of aortic stent grafting with preservation of IMA flow, comprising one IMA fenestration and one IMA snorkel. Record reviews of these two patients with details on the indications, technical details, and outcomes were recorded. A 53-year-old woman with a recent right hemicolectomy for cecal cancer also an enlarging AAA at 4.5 cm and a right iliac aneurysm of 3.8 cm. Given the recent colonic resection, the need to occlude the right internal iliac artery, and a stenotic left internal iliac artery, her risk for colonic ischemia was thought to be significantly higher than the average. To avoid this, a single fenestration was made with a back table modification of a Zenith graft (Cook Inc, Bloomington, Ind) and a Viabahn stent (W. L. Gore, Flagstaff, Ariz) and was used to fenestrate the IMA. On follow-up, the patient had no complications with no evidence of colonic ischemia and successful treatment of her AAA (Fig 1). The second patient was a 61-year-old man with a history a left iliac stent placed previously for calf claudication who developed severe, progressive hip claudication and impotence. Computed tomography angiography showed 3.5-cm iliac aneurysms and a 3.7-cm distal aortic aneurysm with preocclusive right and totally occluded left internal iliac arteries. There was a 7-mm-diameter inferior mesenteric artery coming off the AAA with severe stenosis at its origin. An Endologix AFX stent graft (Endologix, Irvine, Calif) was used to treat the aortoiliac aneurysmal disease with a long Viabahn snorkel stent placed into the IMA. Both iliac limbs were extended to the externals. Follow-up computed tomography showed complete exclusion of the aortoiliac aneurysms with no endoleak, and the patient had resolution of his hip claudication and impotence (Fig 2). Preservation of IMA flow with modified stent graft techniques is feasible and may reduce complications of colonic and pelvic ischemia in highly selected patients.Fig 1Fenestration technique. CTA, Computed tomography angiography; IMA, inferior mesenteric artery.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

The Use of Ertapenem in Postoperative Polymicrobial Peritonitis - case report

A 59 year-old male patient diagnosed with cecal cancer, surgically treated - right hemicolectomy with ileotransverse anastomosis suddenly presented in the 5th postoperative day fever, hypotension, abdominal pain, and vomiting faeces. The intraoperatory diagnosis was postoperative peritonitis due to anastomotic leak; exploratory laparotomy, segmental colectomy, transverse ileostomy, lavage and drainage were performed. Before surgical reintervention, blood cultures were performed and empirical antiinfective therapy was started using ertapenem, vancomycin and fluconazole. A postoperative ICU admission was decided due to septic shock and MODS: acute respiratory failure, acute cardio-circulatory failure, coagulopathy and metabolic acidosis, which required complex treatment: ventilatory support, haemodynamic optimization, antibiotics, analgesia, deep venous thromboembolism prophylaxis, nutrition. In the 3rd day after reintervention, microbiological examination of the intraoperatory collected peritoneal fluid identified a triple germ association: Escherichia coli, Enterococcus faecalis and Proteus mirabilis, which were sensitive to the chosen antibiotics; the blood cultures were sterile. After 3 days of severe evolution, the multiple organ dysfunction gradually improved and the patient was discharged from ICU 10 days later.

Single-incision laparoscopic surgery for colon cancer in patient with situs inversus totalis: report of a case.

A preliminary experience with single-incision laparoscopic colectomy for colon cancer with situs inversus totalis (SIT) is reported. An 87-year-old man was admitted because of a fecal occult blood. A colonoscopy revealed cecal cancer. An air-barium and a computed tomography contrast enema showed the right-sided descending colon and the left-sided ascending colon and cecum. The surgical procedures were as follows: First, a Lap protector was inserted through a 2.5-cm transumbilical incision. Three 5-mm ports were placed in the Lap protector. We successfully performed ileocolectomy with lymph node dissection by using a single-incision laparoscopic approach without any technical problems. The operative time was 125min, and blood loss was negligible. Postoperative follow-up did not reveal any umbilical wound complications and recurrences.