Descending Colon Cancer Research Articles

Short- and long-term outcomes of subtotal/total colectomy in the management of obstructive left colon cancer.

Surgical management of obstructive left colon cancer (OLCC) is still a matter of debate. The classic Hartmann procedure (HP) has a disadvantage that requires a second major operation. Subtotal colectomy/total abdominal colectomy (STC/TC) with ileosigmoid or ileorectal anastomosis is proposed as an alternative procedure to avoid stoma and anastomotic leakage. However, doubts about morbidity and functional outcome and lack of long-term outcomes have made surgeons hesitate to perform this procedure. Therefore, this trial was designed to provide data for morbidity, functional outcomes, and long-term outcomes of STC/TC. This study retrospectively analyzed consecutive cases of OLCC that were treated by STC/TC between January 2000 and November 2020 at a single tertiary referral center. Perioperative outcomes and long-term outcomes of STC/TC were analyzed. Twenty-five descending colon cancer (45.5%) and 30 sigmoid colon cancer cases (54.5%) were enrolled in this study. Postoperative complications occurred in 12 patients. The majority complication was postoperative ileus (10 of 12). Anastomotic leakage and perioperative mortality were not observed. At 6 to 12 weeks after the surgery, the median frequency of defecation was twice per day (interquartile range, 1-3 times per day). Eight patients (14.5%) required medication during this period, but only 3 of 8 patients required medication after 1 year. The 3-year disease-free survival was 72.7% and 3-year overall survival was 86.7%. The risk of anastomotic leakage is low after STC/TC. Functional and long-term outcomes are also acceptable. Therefore, STC/TC for OLCC is a safe, 1-stage procedure that does not require diverting stoma.

Anastomotic Leak Rate and Prolonged Postoperative Paralytic Ileus in Patients Undergoing Laparoscopic Surgery for Colo-Rectal Cancer After Placement of No-Coil Endoanal Tube.

Colorectal cancer (CRC) is the second most common gastrointestinal tumor in men and the third in women. Left-hemicolectomy (LC) and low anterior resection (LAR) are considered the gold standard curative treatment. In this retrospective study, we evaluated the presence or absence of post-operative complications, in all patients who underwent Video-laparoscopic (VLS) LAR/LC with No Coil trans-anal tube positioning, and compared the data with the current literature on the topic. Thirty-nine patients diagnosed with CRC of the descending colon, splenic flexure, sigma, and rectum were recruited. LC was performed for sigmoid and descending colon cancers, while LAR was applied for tumors of the upper two-thirds of the rectum. The No Coil trans-anal tube (SapiMed Spa, Alessandria, Italy) was placed in all patients of the study at the end of surgical treatment. Eighteen patients received a LAR-VLS (46%) and 21 patients received a LC-VLS (54%). The average length of hospital stay after surgery was 7days. PPOI occurred in only one in 39 patients (2.6%) who had undergone LAR-VLS. As for complications, in no patient of the study did AL (0%) occur. In patients undergoing LAR-VLS and LC-VLS, we performed colorectal anastomosis and in the same surgical operation we introduced the No-Coil device. Although this is a preliminary study and subject to further investigation, we believe that the No Coil tube positioning may reduce the time of presence of first flatus and feces and the risk of AL.

Vascular variations encountered during laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer: a retrospective cohort study

BackgroundLaparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum.MethodsThis retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated.ResultsVariations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations.ConclusionPreoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.

Perirenal Infiltration of Signet Ring Cell Colon Carcinoma Shown by 68Ga-FAPI PET/CT

A soft tissue lesion surrounding the left kidney was detected in 18F-FDG PET/CT performed with suspicion of recurrence in a patient who was operated for descending colon cancer and showed mild FDG uptake. Intense fibroblast activation protein-specific inhibitor (FAPI) uptake in the perirenal soft tissue was observed in 68Ga-FAPI-04 PET/CT. Tru-cut biopsy of the left perirenal lesion revealed signet ring cell colon carcinoma metastasis. This case demonstrated that 68Ga-FAPI-04 PET/CT could be a promising radiopharmaceutical for the evaluation of signet ring cell colon carcinomas.

Totally Laparoscopic Left Colectomy With Preoperative Simulation Using 3D CT Angiography and Intraoperative Navigation Using the Indocyanine Green (ICG) Fluorescence Method

Introduction Laparoscopic reconstruction after left colectomy is mostly performed with functional end-to-end anastomosis through about 5–7 cm sized incision. However, this procedure poses some problems, including increased intestinal mobilization range and parietal destruction, insufficient blood flow to the intestinal tract due to arterial arch malformation, and dominant artery dissection. In this paper, we present a case of descending colon cancer for which totally laparoscopic surgery and intracorporeal anastomosis could be performed safely with preoperative simulation and intraoperative navigation. Case presentation A 34-year-old male was complaint fecal occult blood positive and a colonoscopy was performed. The patient was diagnosed with descending colon cancer cT2N0N0 Stage I. Preoperative CT angiography findings showed that the inferior mesenteric artery (IMA) branched into the left colic artery (LCA) and the sigmoid arteries (S1, S2) in order and showed LCA and S1 as the dominant arteries, and a totally laparoscopic descending colectomy (D2 dissection and S2 artery preserving) was scheduled. At his operation, for investigate blood flow of anastomotic region, ICG was used. After an intravenous injection of ICG, blood flow was evaluated and intestinal dissection was performed at the scheduled dissection line. Intracorporeal anastomosis was then performed using the overlap method and a linear stapler. Conclusion Although the intracorporeal anastomosis procedure has a high degree of difficulty, the use of preoperative simulation and intraoperative navigation may reduce the surgeon's intraoperative stress and enable safe and accurate intestinal dissection and anastomosis in the totally laparoscopic surgery.

Clinical Benefit of Preserving Inferior Mesenteric Vein in Laparoscopic Curative Resection for Descending and Splenic Flexure Colon Cancer: A Comparative Study of CT-based objective Evidence

Background: Although the presence of remnant long sigmoid colon after left hemicolectomy with inferior mesenteric vein (IMV) ligation is a major risk factor for venous ischemia, there is insufficient objective evidence to support the clinical benefit of IMV preservation in curative resection for distal transverse, descending and splenic flexure colon cancer. This study was to confirm the patency through CT after IMV preservation in laparoscopic left hemicolectomy for distal transverse, descending and splenic flexure colon cancer, and to analyze the clinical outcomes compared to the IMV ligation group.

Single-Incision Laparoscopic Complete Mesocolic Excision With Central Vascular Ligation for Descending Colon Cancer.

Single-incision laparoscopic complete mesocolic excision with central vascular ligation for descending colon cancer is technically challenging. Standardization of the surgical procedures is therefore needed. In a Trendelenburg position with left side elevated, the sigmoid mesocolon is mobilized using a medial-to-lateral approach, and the left colic artery and inferior mesenteric vein (IMV) are divided after radical lymphadenectomy along the inferior mesenteric artery, preserving the superior rectal artery. The descending mesocolon is mobilized from the retroperitoneal planes up to the dorsal surface of the pancreas using medial and lateral approaches. Next, changing the surgical position to a reverse Trendelenburg position with left side elevated, the omental bursa is opened, and the transverse mesocolon is separated from the inferior border of the pancreas. The splenocolic ligament and lateral attachment are then divided, matching the previous medial dissection of the retroperitoneum, and the splenic flexure is fully mobilized. The IMV is divided again at the inferior border of the pancreas. The left branch of the middle colic artery is also divided. Forty-seven consecutive patients with DCC underwent single-incision laparoscopic CME with CVL. One patient required an additional port. Median operative time, blood loss, and number of harvested lymph nodes were 240min (interquartile range [IQR], 195-257min), 5mL (IQR, 5-52mL), and 21 (IQR, 13-29), respectively. Morbidity rate was 5.9%. Median duration of hospitalization was 9days (IQR, 7-11days). Single-incision laparoscopic CME with CVL is safe and feasible for DCC.

FORECASTING THE DEVELOPMENT OF PURULENT-INFLAMMATORY POSTOPERATIVE COMPLICATIONS IN PATIENTS WITH OBSTRUCTIVE BOWEL OBSTRUCTION.

The aim: The purpose of the study is to improve the results of treatment of patients with acute intestinal obstruction of tumor origin by developing individualized surgical tactics considering the level of cryoglobulins. Materials and methods: 96 patients with ileus of tumor origin were studied. The mean age of patients was 54.7 ± 5.9 years. 30 patients were diagnosed with colorectal cancer, 35 patients - with sigmoid cancer, 13 patients - with cecum and ascending colon, 11 patients - with transverse colon cancer, and 7 patients with descending colon cancer. Isolation of cryoglobulins from blood serum was performed by the method of A. E. Kalovidoris with modifications. The content of Ig A, Ig M, Ig G, total Ig E in the serum was investigated using enzyme-linked immunosorbent assay systems "Granum-Ukraine", the content of allergen-specific Ig E was investigated using enzyme-linked immunosorbent assay systems produced by "Microgen". Results: As a result of treatment of 96 patients, it was found that the level of development of postoperative purulent complications was significantly influenced by the level of cryoglobulinemia and the volume of surgery (CMU, p <0.05). It was found that in patients with decompensated intestinal obstruction, the initial concentration of cryoglobulins was 16.4% higher than in the group with compensated intestinal obstruction (CMU, p <0,05). Conclusions: Determination of cryoglobulinemia on admission of patients with acute obstructive ileus of tumor origin is a simple and effective method for predicting the development of purulent-inflammatory complications in the postoperative period and can influence the choice of treatment tactics.

A Case of Descending Colon Cancer with Ossification Presented with Intussusception

症例は83歳の高齢男性．左側腹部痛を主訴に当院へ紹介となり，下行結腸癌腸重積と診断された．腹部症状が軽度であったため，待機的に腹腔鏡下結腸切除術を行った．術中所見で重積は自然解除されていた．機能的端々吻合で再建し，術後経過に問題なく退院となった．最終診断はStage IIであり，術後補助療法は行わずに経過観察の方針となった．現在まで，特に再発なく経過している．術前の画像評価で腫瘍部に石灰化を有していたが，術後病理検査で同部に骨形成が確認された．骨形成を伴う大腸癌は全体の0.4％程度と非常に稀とされる．また，成人の腸重積は全腸重積症例の6％と報告されており，中でも後腹膜に固定された臓器である下行結腸の重積は少ない．これまでに下行結腸癌の腸重積に骨形成を伴った症例は報告されていない．貴重な1例と考えられたため，報告する．

Asymptomatic fecal immunochemical test-negative and positron emission tomography-negative descending colon cancer concomitant with small bowel gastrointestinal stromal tumor detected by abdominal ultrasonography during a health checkup: A Case Report

Asymptomatic fecal immunochemical test-negative and positron emission tomography-negative descending colon cancer concomitant with small bowel gastrointestinal stromal tumor detected by abdominal ultrasonography during a health checkup: A Case Report

A Case of Superior Mesenteric Artery Syndrome Developed after Surgery for Young-onset Descending Colon Cancer with Intussusception

A Case of Superior Mesenteric Artery Syndrome Developed after Surgery for Young-onset Descending Colon Cancer with Intussusception

Successful endoscopic removal of a partially covered self-expandable metallic stent that had migrated to the oral side of the tumor

An 83-year-old man with vomiting visited our hospital. Computed tomography revealed wall thickening of the descending colon and dilated proximal colon. Colonoscopy revealed obstructive descending colon cancer (CROSS 0, cT3N0M0 cStage IIa). We inserted a partially covered self-expandable metallic stent (SEMS). Two months after SEMS placement, he was admitted to our hospital because of difficulty in passing stool. While we were attempting to resolve the obstruction, the SEMS migrated to the oral side of the tumor. We successfully removed the SEMS using the sliding tube of a single balloon endoscope.

A Case of Long-Term Recurrence-Free Survival after Surgery for Synchronous Ovarian Metastasis of Descending Colon Cancer with Pseudo-Meigs Syndrome in a Young Patient

A Case of Long-Term Recurrence-Free Survival after Surgery for Synchronous Ovarian Metastasis of Descending Colon Cancer with Pseudo-Meigs Syndrome in a Young Patient

Splenic Tumor in a Patient After Liver Transplantation

Question: A 38-year-old man who underwent a liver transplant due to primary sclerosing cholangitis 9 years ago and a colectomy for descending colon cancer and ulcerative colitis 3 years ago was admitted for a regular checkup. Of note, his liver transplant procedure was complicated by splenic artery steal syndrome immediately after surgery, for which an early relaparotomy with splenic artery ligation was performed with normalization of flow in the hepatic artery and liver function tests. His immunosuppressive regimen consisted of tacrolimus and azathioprine once daily.

The oncologic safety of left colectomy with modified complete mesocolic excision for distal transverse colon cancer: Comparison with descending colon cancer

BackgroundThe optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer. Material and methodsThis study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. ResultsBaseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786–3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530–2.952, p = 0.609). ConclusionThe oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer.

In silico transcriptomic analysis of ascending colon cancer unearths known and novel genes and gene sets regard to characteristic features of colon cancer

Objectives: Colon cancer emerges as a serious health problem in both men and women. Cancers in the colon have different genotypes and phenotypes according to the anatomical region. Tumors in ascending colon are usually diagnosed later, but it is more malignant than the descending and transverse colon, and the survival rates of patients are lower than other regions. The purpose of this study was to determine significantly high or low expressed genes in the ascending colon tumors by comparing all genome information obtained from cancer samples of ascending, transverse and descending colon. In concordance with all this information, another aim of the study was to identify the pathways to which the genes obtained from the colon in the large intestine and to determine their relationship with each other and to correlate them with the characteristics of cancer. Methods: Gene expression values for three subtypes of colon cancer as ascending, transverse, and descending were obtained from GEO (Gene Expression Omnibus) (GSE41258). Data included a total of 47 ascending, 18 transverse and 31 descending colon cancer patient samples. Linear regression analysis was performed to determine differentially expressed genes. Gene Cluster 3.0 was used in order to cluster the genes hierarchically. In addition to linear regression and hierarchical clustering, network analysis with multivariable genes was performed in Cytoscape application 3.8.2 using GeneMANIA. GSEA 4.1.0 (Gene Set Enrichment Analysis) was performed to understand the different genes among the specified groups. Results: As a result of these analyses, it was determined that there were 85 genes with high expression and 139 genes with low expression in the ascending colon tumor samples. It has been shown that these genes can differentiate tumor samples in the ascending colon better than tumor samples in other colon regions. Conclusion: Our findings are important for understanding the genome of ascending colon tumors; if these findings are confirmed in vitro and clinically, it may have potential to be revealed that the identified genes also have biomarker properties for tumors in the ascending colon.

Synchronous Onset of Two Complications in Colon Cancer: A Case Report

As one of the most frequent malignancies in the world’s population, colorectal cancer is also associated with its complications (perforation, obstruction and bleeding). Their incidence is common (2.6-50%), but synchronous occurrence of two of them in a patient is a rare condition and it is reported in small series or as a case report in the literature. We present a case of the descending colon cancer in a female patient that presented with perforation on tumor site with consecutive retroperitoneal and lumbar abscess and simultaneous presentation of large bowel obstruction. The patient was admitted and operated the same day, the abscess was opened and drained and bowel resection was performed with colostomy creation. The postoperative recovery was uneventful and the patient was discharged on postoperative day 10. Due to the high morbidity/mortality in cases of colon cancer emergencies, Hartman’s procedure is often a reasonable option. Timely diagnosis of the colon cancer can reduce the complication rate of the disease worldwide. J Med Cases. 2021;12(6):248-250 doi: https://doi.org/10.14740/jmc3684

Genome sequence and annotation of Bacteroides sp aff. Thetaiotaomicron strain isolated from blood.

This study is focused on genome sequence and annotation of the Bacteroides strain isolated from the blood of a patient with descending colon cancer. According to a comparison of the 16S ribosomal RNA sequence with the National Center for Biotechnology Information database, this strain was identified as Bacteroides sp. aff. Thetaiotaomicron. The next-generation sequencing of the strain was performed in a GENEWIZ laboratory (Jiangsu, China) on Illumina HiSeq device. According to CAZy classification, metabolic pathways related to carbohydrate metabolism of this strain engage the following enzymes: 427 glycosylhydrolases, 277 glycosyltransferases, 137 carbohydrate-binding modules, 48 carbohydrate esterases, and 24 polysaccharide lyases. According to the KEGG pathway database, Bacteroides sp. aff thetaiotaomicron strain is reported to incorporate 199 pathway associated genes. Bacteroides sp. aff. Thetaiotaomicron exposes the capacity of metabolizing a variety of polysaccharides. Its genome is enriched with an expanded repertoire of enzymes for the hydrolysis of glycosidic bonds and, thus, likely to hydrolyze most of glycosidic bonds in biological polysaccharides. The advanced capabilities of the studied strain to recognize and respond to environmental signals are expressed in the rich representation of one- and two-component signal transduction systems.

A Patient with Descending Colon Cancer and Concurrent Abdominal Aortic Aneurysm who Showed Hemodynamic Changes and was Treated with Laparoscopic Surgery

A Patient with Descending Colon Cancer and Concurrent Abdominal Aortic Aneurysm who Showed Hemodynamic Changes and was Treated with Laparoscopic Surgery

A Case of Long-term Survival after Resections of Twice Anastomotic and Solitary Peritoneal Recurrence after Radical Surgery for Descending Colon Cancer

A Case of Long-term Survival after Resections of Twice Anastomotic and Solitary Peritoneal Recurrence after Radical Surgery for Descending Colon Cancer