Descending Colon Cancer Research Articles

A birth cohort analysis of the incidence of ascending and descending colon cancer in the United States, 1973-2008.

There is evidence indicating that the trends in colorectal cancer (CRC) incidence rates in the United States differ according to CRC subsites, including for ascending cancer which has shown a different pattern from the overall trends. We investigated the time trends for ascending and descending colon cancer in the United States by race and gender to identify the specific components that may account for the incidence trends. Using data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program for 1973-2008, we conducted age-period-cohort modeling to evaluate birth cohort patterns and evaluate age-period-cohort effects on incidence trends of colon cancer over time. A clear birth cohort pattern was observed for both ascending and descending colon cancer, and the incidence rates of ascending colon cancer in the more recent birth cohorts were higher compared to earlier cohorts particularly for black males and females. This increase was most obvious in the younger age groups and appeared to accelerate, especially for black females. For descending colon cancer, the study suggested an increase in the birth cohort slope in the later birth cohorts for all gender and race groups, after a period of decline in earlier birth cohorts. The increase in incidence rates of both ascending and descending colon cancer in more recent birth cohorts for blacks suggests the need for targeted public health strategies to increase CRC screening. Further, additional etiological studies are warranted to evaluate factors responsible for the observed trends in more recent birth cohorts, including differences by subsites, race, and/or gender.

Clinical outcomes of laparoscopic surgery for transverse and descending colon cancers in a community setting

The feasibility, safety and oncological outcomes of laparoscopic surgery for transverse and descending colon cancers in a community hospital setting were evaluated. Twenty-six patients with transverse or descending colon cancers who underwent laparoscopic surgery at our hospital were included in this retrospective analysis (group A). Their outcomes were compared with those of 71 patients who underwent laparoscopic surgery for colon cancer at other tumor sites (group B). There were no significant differences between the two groups in terms of operative time, estimated blood loss, postoperative hospital stay and morbidity rate. Extended lymphadenectomy was performed more frequently and the number of harvested lymph nodes was significantly higher in group B than in group A. However, no recurrence developed in group A, while recurrence occurred in four patients from group B. The 3-year disease-free survival rates were 100% for group A and 93.5% for group B. The 3-year overall survival rates were 100% for group A and 91.6% for group B. Laparoscopic surgery for transverse and descending colon cancers can be performed safely with oncological validity in a community hospital setting, provided there is careful selection of the patients and adequate lymphadenectomy considering the clinical stage of their disease.

下行結腸癌による腸重積症の１例

腸重積症は小児では多いが成人では比較的稀な疾患である．成人の腸閉塞では小腸に多く大腸は少ない．大腸の腸重積では大腸癌が原因となることが多い．下行結腸など後腹膜に固定された結腸では腸重積を起こしにくいと考えられている．今回90歳男性の下行結腸癌による腸閉塞の症例を経験し手術を施行した．原因となった腫瘍は２型で大きさは2.5×2.0cmであった．これまでの報告例と比べて腫瘍径が小さいと考えられた．高齢で組織がぜい弱で異常な蠕動が加わったため腸重積を起こしたと考えられた．

動静脈多発血栓症を伴った下行結腸癌の1例

症例は64歳，女性．2012年6月に上腹部痛を主訴に受診し，単純CT検査，下部消化管内視鏡検査にて下行結腸癌と診断した．翌日の造影CT検査にて動静脈多発血栓症と上腸間膜動脈血栓塞栓症を認め，緊急手術を施行した．術後抗凝固治療を行い，状態の安定化を得たのち待機的に左半結腸切除術を施行した．担癌患者が過凝固状態となり静脈血栓を伴いやすいことはTrousseau症候群として古くから知られているが，癌に対する治療前に動脈血栓を伴い，さらに上腸間膜動脈血栓塞栓症を発症した症例は極めて稀であると考えられたため，文献的考察を加えて報告する．

P3-037 - Anti-EGFR Antibody Treatment in KRAS G13D Mutation-Type Colorectal Cancers: Case Reports

ABSTRACT Anti-EGFR antibody is effective for Kras wild-type colorectal cancers (CRCs), but not effective for the Kras mutation-type. Recently, some reports have shown that it is effective for Kras G13D mutation-type CRCs. Herein, we reported two cases of Kras G13D mutation-type CRCs treated by anti-EGFR antibody with sufficient explanation and informed consent. Case 1: a 66-year-old female patient underwent left colectomy for descending colon cancer in January 2009. The clinical stage was IIIb. Although adjuvant chemotherapy was given, metastasis to para-aortic lymph nodes occurred in January 2010. After four cycles of xelox + bevacizumab and 17 cycles of FOLFIRI, the recurrent tumors showed progression in July 2011. The primary tumor had Kras G13D mutation, therefore, 6 cycles of Cetuximab administration was conducted. The serum level of CEA was decreased (from 45.5 to 18.9), and no deterioration of para-aortic lymph node metastasis was seen. However, new lesions of lymph node metastasis and hydronephrosis occurred, and chemotherapy was stopped. Case 2: A 62-year-old female patient underwent transverse colectomy and total hysterectomy + with bilateral salpingo-oophorectomy for transverse colon cancer and ovarian metastases in March 2009.Clinical stage was IV. Eight cycles of FOLFOX followed by four cycles of 5FU/LV and capecitabine monotherapy were given as adjuvant chemotherapy. In August 2010, peritoneal dissemination and lung metastasis were detected. After 14 cycles of FOLFOX + Bevacizumab, the recurrent tumors showed progression. The primary tumor had Kras G13D mutation; therefore, four cycles of panitumumab administration was conducted. Although the serum levels of tumor markers were decreased (CEA: from 328.2 to 267.2, CA19-9: from 55.2 to 28.8), the lung metastasis showed progression, and chemotherapy was stopped. Although the evidence level is still limited, anti-EGFR antibody treatment may be an option in Kras G13D mutation-type CRCs.

完全内臓逆位症に伴う胆石症，下行結腸癌に対し一期的に腹腔鏡下手術を施行した1例

完全内臓逆位症を伴う胆石症，進行上行結腸癌の74歳男性に胆嚢摘出術とリンパ節郭清を伴う下行結腸切除を腹腔鏡下に一期的に施行した．下血の精査として施行された大腸内視鏡検査で下行結腸に2型腫瘍を認めた．術前診断は臨床病期I(cMP，cN0，cH0，cP0，cM0)であった．CTで胆石症と肝後区域枝の総肝管への合流を認めたが，血管走行の異常はなかった．腹腔鏡下胆嚢摘出術，下行結腸切除術およびリンパ節郭清（D2）を施行した．術後経過は良好で術後14日目に退院した．病理組織検査で腫瘍は中分化腺癌，fMP，pN1，fH0，fP0，fM0，fStage IIIaであった．

肝転移を伴わない下行結腸癌門脈腫瘍栓の1例

肝転移を伴わない下行結腸癌門脈腫瘍栓の1例

A case of descending colon carcinoma metastasized to left spermatic cord, testis, and epididymis

We report a case of descending colon carcinoma metastasized to the left spermatic cord, testis, and epididymis.A 77-year old male patient underwent a left hemicolectomy for a descending colon cancer. He was referred to our department because of swelling and pain of the left scrotum two years and six months after surgery. High left orchiectomy was performed.Histological examination revealed a metastasis of the colon carcinoma within the spermatic cord and epididymis approaching the testicle.Reports on metastatic cancer of the testis are scarce, because this metastatic cancer is extremely rare.In general, testicular pain is rare in the elderly. We suggest that any elder presenting with testicular pain deserves a complete clinical and diagnostic evaluation.

A case of descending colon cancer with hemorrhagic shock

A case of descending colon cancer with hemorrhagic shock

結腸癌術後に劇症型<I>Clostridium difficile</I>腸炎と難治性感染症を伴った1例

症例は60歳，女性．下行結腸癌に対し結腸部分切除術を施行した．手術2週間前にセフメタゾール1g×2回/日2日間，術中にセフメタゾール計2gを投与した．術後3日目に突然，39度の発熱と腹痛を呈した．下痢はなかった．再手術を行ったが，明らかな縫合不全は認めなかった．著明に拡張した上行結腸に大量の緑色水様便が貯留しており，糞便検体からClostridium difficile toxinを検出した．メトロニダゾール内服で症状改善せず，バンコマイシン内服に変更した．その後，腹腔内膿瘍を形成し，経皮的膿瘍ドレナージとバンコマイシン/メロペネム点滴静注を要した．C. difficile感染症は再発・再燃を繰り返し，治療に難渋したが，術後94日目に軽快退院した．現在外来通院中であるが，再発はない．「適切な」抗菌薬使用について考えさせられた意義深い1例と考えられたので，報告する．

Clinical outcomes of laparoscopic surgery for advanced transverse and descending colon cancer: a single-center experience

BackgroundThe role of laparoscopic surgery in management of transverse and descending colon cancer remains controversial. The aim of the present study is to investigate the short-term and oncologic long-term outcomes associated with laparoscopic surgery for transverse and descending colon cancer.MethodsThis cohort study analyzed 245 patients (stage II disease, n = 70; stage III disease, n = 63) who underwent resection of transverse and descending colon cancers, including 200 laparoscopic surgeries (LAC) and 45 conventional open surgeries (OC) from December 1996 to December 2010. Short-term and oncologic long-term outcomes were recorded.ResultsThe operative time was longer in the LAC group than in the OC group. However, intraoperative blood loss was significantly lower and postoperative recovery time was significantly shorter in the LAC group than in the OC group. The 5-year overall and disease-free survival rates for patients with stage II were 84.9% and 84.9% in the OC group and 93.7% and 90.0% in the LAC group, respectively. The 5-year overall and disease-free survival rates for patients with stage III disease were 63.4% and 54.6% in the OC group and 66.7% and 56.9% in the LAC group, respectively.ConclusionUse of laparoscopic surgery resulted in acceptable short-term and oncologic outcomes in patients with advanced transverse and descending colon cancer.

Temporal trends in geographic disparities in small-area-level colorectal cancer incidence and mortality in the United States

We examined the extent of changes in absolute and relative geographic disparities in six colorectal cancer (CRC) indicators using data about persons aged 50 and older from 195 counties in the 1988-2006 Surveillance, Epidemiology, and End Results Program database. County-level trends in six colorectal cancer indicators (overall CRC incidence, descending colon cancer incidence, proximal colon cancer incidence, late-stage CRC incidence, CRC mortality, and 5-year probability of CRC death) were summarized using the estimated annual percentage change. Observed county rates were smoothed using Bayesian hierarchical spatiotemporal methods to calculate measures of absolute and relative geographic disparity and their changes over time. During the study period, absolute disparity for all six indicators decreased (CRC incidence: 43.2%; proximal colon cancer: 31.9%; descending colon cancer: 52.8%; late-stage CRC: 50.0%; CRC mortality: 57.8%; 5-year CRC-specific probability of death: 12.2%). Relative disparity remained stable for all six indicators over the entire study period. Important progress has been made toward achieving the Healthy People 2010 and NCI strategic objectives for reducing geographic disparities, although absolute and relative disparities remain in CRC.

Fiebre en paciente portador de catéteres centrales

A 75-year old male, operated on three weeks earlier due to descending colon cancer and reoperated 9 days later due to suture dehiscence, began with fever without clinical focality suggestive of surgical bed infection. The patient has a bilumen catheter in the right jugular vein, through which he receives different medications and parenteral nutrition. How can catheter-related infection be diagnosed? What should be done with the catheter? When and which antibiotics are appropriate to begin treatment? What risk factors for resistant bacteria should be considered? How should S. aureus bacteraemia be treated? Is it possible to reduce the rates of catheter-related infection? These and other questions are answered in this article and a working algorithm is presented.

Application of hand-assisted laparoscopic surgery (HALS) in colectomy

To evaluate the safety and efficacy of hand-assisted laparoscopic surgery (HALS) in colorectal tumors. Clinical data of 70 patients with colorectal tumors were retrospectively analyzed. All the patients had received HALS colectomy in the Beijing Cancer Hospital. Lapdisc was used for the hand port at the umbilicus. Two additional trocars were used. There were 38 males and 32 females. The median age was 61(29-89) years. Diagnoses included sigmoid cancer(n=48), sigmoid adenoma(n=4), descending colon cancer (n=3), ascending colon cancer (n=1), rectal cancer (n=13), total colectomy(n=1). The operative time was (126.0±22.5) minutes. The intraoperative blood loss was (75.0±18.8) ml. The mean number of lymph node dissection was(16.8±4.2). The median postoperative hospital stay was 9.4 days. There were no perioperative deaths. One patient developed anastomotic stricture and two anastomotic leak, all of which were successfully managed with conservative treatment. HALS is a safe and effective technique for colectomy.

Pathological complete response of colorectal liver metastases following chemotherapy with S-1 and oxaliplatin (SOX) in combination with bevacizumab: A case report

Pathological complete response to systemic chemotherapy is associated with more favorable survival in patients with colorectal cancer liver metastases. We present a case of a 63-year-old man with multiple liver metastases from descending colon cancer. Following surgical resection of the primary tumor, the patient received systemic chemotherapy with S-1 and oxaliplatin in combination with bevacizumab. On achievement of a markedly favorable response to chemotherapy, surgical treatment of liver metastases was performed, and the liver tumors were successfully resected without any macroscopic residue. Histopathological analyses showed necrotic tissue in the complete absence of residual viable tumor cells. This is the first reported case of a patient with multiple liver metastases from descending colorectal cancer to achieve a pathological complete response following systemic chemotherapy with S-1 and oxaliplatin in combination with bevacizumab. This regimen is a systemic chemotherapy option to 'cure' liver metastasis from colorectal cancer.

Multiple mobile and firm subcutaneous nodules on bilateral shins

A 40-year-old woman presented with a 10-year history of multiple subcutaneous nodules on the lower extremities. The first subcutaneous nodule occurred on the left shin, and over the last year, had increased in number and spread to the proximal extremities. The general condition of the patient was otherwise healthy, except that she was diagnosed with descending colon cancer and underwent surgery 2 years ago. A physical examination revealed mobile, firm, subcutaneous and asymptomatic nodules symmetrically distributed over the bilateral shins. The size of these nodules ranged from 2 mm to 4 mm in diameter; the number of the nodules was more than 20 (Figure 1). One subcutaneous nodule was taken from the right shin for histological examination. The epidermis and dermis were unremarkable. There were well-demarcated, round-shaped nodules encapsulated by fibrous tissue (Figure 2). Lipo membranous fat necrosis appeared to be associated with focal calcification in the center of the nodule (Figure 3). The skin lesions persisted during a 6-month follow-up.

A Case of Severely Pigmented Erythroderma Associated with Descending Colon Cancer

A Case of Severely Pigmented Erythroderma Associated with Descending Colon Cancer

Tumor recurrence at a stapled-anastomosis after radical laparoscopic surgery for descending colon cancer treated successfully by laparoscopic colectomy: A case report

Anastomosis using linear staplers following colonic resection has been increasingly used due to its convenience and technical safety. However, there have been few reports of stapled-anastomotic recurrence after curative resection for colon cancer. Here, we report a rare case of suture-line recurrence after functional end-to-end anastomosis. A 78-year-old woman underwent radical laparoscopic colectomy for advanced descending colon cancer. A postoperative 1 year follow-up colonoscopy revealed that suture-line recurrence had occurred. After the detection of early stage recurrent cancer, the patient underwent laparoscopic partial colectomy. This rare case of suture-line recurrence in functional end-to-end anastomosis possibly occurred due to tumor implantation after curative laparoscopic surgery for advanced descending colon cancer. The follow-up colonoscopy was helpful in diagnosing the anastomotic recurrence in its early stages. In addition, laparoscopic surgery for primary colon cancer led to successful laparoscopic treatment for recurrent cancer as a result of reduced bowel adhesion.

Short-Term Outcomes of Laparoscopic Colectomy for Transverse Colon Cancer

BackgroundThe role of laparoscopic surgery for transverse colon cancer (TCC) remains controversial. This study aimed to evaluate the safety of laparoscopic resection of TCC. MethodsFifty-three patients undergoing laparoscopic resection of TCC (group A) were compared with 39 patients undergoing open resection of TCC (group B) and 200 patients undergoing laparoscopic resection of ascending or descending colon cancer (group C). ResultsMean operating time was longer (224 vs. 157 min), and mean estimated blood loss was lower (40 vs. 79 ml) in group A than in group B, but these were similar in groups A and C. The rates of conversion to open surgery were similar in groups A and C (1.9% vs. 1.0%). Tumor stage was more advanced in group B than in group A. All patients in groups A and B underwent pathologic R0 resection. The rates of postoperative complications did not differ significantly between groups (9.4% vs. 7.7% vs. 5.0%). Time to flatus (1.7 vs. 2.5 days), time to liquid diet (2.4 vs. 5.3 days), and hospital stay (12 vs. 15 days) were significantly shorter in group A than in group B, but similar in groups A and C. ConclusionsLaparoscopic resection for TCC can be performed safely with similar short-term postoperative outcomes seen for colon cancer at other sites. Laparoscopic resection may be associated with faster gastrointestinal recovery and shorter length of hospital stay, compared with open surgery.

Short-term Outcomes of a Laparoscopic Left Hemicolectomy for Descending Colon Cancer: Retrospective Comparison with an Open Left Hemicolectomy

PurposeMany randomized clinical trials have been performed to treat a colorectal neoplasm with the exclusion of descending colon cancer. The aim of the present study was to investigate the difference in surgical outcomes between a laparoscopic left hemicolectomy and a conventional open left hemicolectomy for descending colon cancer.MethodsA retrospective study of ninety patients with descending colon cancer, who underwent a laparoscopic (LAP) or open left hemicolectomy (OS) between May 1998 and December 2009 at Kyungpook National University Hospital, was performed. Clinicopathological and surgical outcomes were compared between the LAP and the OS for descending colon cancer.ResultsThe baseline characteristics, including age, gender, body mass index, history of prior abdominal surgical history and tumor location, were similar between the two groups. The mean operation time was 156.2 minutes for the LAP group and 223.2 minutes for the OS group (P < 0.001). Intraoperative blood loss was significantly greater in the OS group (37.5 mL vs. 80.4 mL; P = 0.039). The postoperative recovery in the LAP group was faster, as reflected by the shorter time to pass gas and the shorter hospital stay. Pathological examinations showed the surgery to be equally radical in the two groups. The median follow-up was 21 months and there were 3 distant metastases (8.5%) during follow-up in the LAP group, but no port-site or local recurrence.ConclusionA laparoscopic left hemicolectomy is a technically safe and feasible procedure for treating descending colon cancer. Prospective multi-center trials are necessary to establish the LAP as the standard treatment for descending colon cancer.