Right Hemicolectomy For Colon Cancer Research Articles

Intrabiliary growth type of metastasis from colon cancer, 12\u2009years after curative colectomy: a case report

BackgroundLiver is a common location of colorectal metastasis, but intrabiliary growth of liver metastasis is not well recognized. Furthermore, intrabiliary metastasis that discovered over 10 years after excision has rarely been described.Case presentationAn 80-year-old man was admitted due to the presence of a liver mass in segment 5 (S5) concomitant with elevated carcinoembryonic antigen (CEA), and carbohydrate antigen (CA) 19–9. He underwent right hemicolectomy for colon cancer 12 years prior. Enhanced computed tomography (CT) showed dilated bile ducts with periductal enhancement in S5; hence, cholangiocarcinoma was suspected. Upon anterior segmentectomy, we observed that the cut surface of the specimen exhibited a yellowish-white tumor within the bile ducts. Histologically, the tumor formed within the papillary process, extended along the lumen, and replaced the normal bile duct epithelium. Immunohistochemical studies showed that the liver tumor and primary colon cancer were negative for cytokeratin (CK) 7 and positive for CK20 and Caudal-type homeobox transcription factor 2 (CDX-2). In addition, both tumors showed a same KRAS mutation. We diagnosed the liver tumor as liver metastasis recurrence from colon cancer.ConclusionIntrabiliary growth type of metastasis (IGM) is difficult to distinguish from cholangiocarcinoma, and sometimes develops long after surgery; thus, careful examination of a patient’s history is needed in such cases.

Safety of Anastomoses in Right Hemicolectomy for Colon Cancer.

Introduction: Colorectal cancer is one of the most common malignant tumor of the digestive system, the incidence of this cruel disease has been increasing at a constant rate. Materials and methods: 236 patients diagnosed with right colon cancer were retrospectively reviewed. For all patients included in this study, right hemicolectomy or extended right hemicolectomy with ileo-colonic anastomosis was performed. Patients were divided in two groups, as follows: study group including patients which developed anastomotic leakage, and control group including patients without anastomotic leak. There were compared clinical, surgical, postoperative and anastomotic leakage (AL) related data within the two groups.The study investigates possible risk and protective factors for developing anastomotic leakage, furthermore the relationship between anastomotic leakage and mortality was analyzed. Results: risk factors for AL as advanced age, tumors of the right 1/3 of transvers colon, emergencysurgery, mechanical suture, S-E anastomosis, late start of bowel motility were identified during the current research. S-S anastomotic technique were identified as protective factor in the development of fistula. Conclusion: According to the results of the present research, in right colon tumors S-S anastomotic technique should be used, being linked with the lowest chances of anastomotic leakage.

A novel hand-assisted laparoscopic versus conventional laparoscopic right hemicolectomy for right colon cancer: study protocol for a randomized controlled trial

BackgroundAlthough conventional laparoscopic and hand-assisted laparoscopic surgery for colorectal cancer is widely used today, there remain many technical challenges especially for right colon cancer in obese patients. Herein, we develop a novel hand-assisted laparoscopic surgery (HALS) with complete mesocolic excision (CME), D3 lymphadenectomy, and a total “no-touch” isolation technique (HALS-CME) in right hemicolectomy to overcome these issues. According to previous clinic practice, this novel procedure is not only feasible and safe but has several technical merits. However, the feasibility, short-term minimally invasive virtues, long-term oncological superiority, and potential total “no-touch” isolation technique benefits of HALS-CME should be confirmed by a prospective randomized controlled trial.Methods/designThis is a single-center, open-label, noninferiority, randomized controlled trial. Eligible participants will be randomly assigned to the HALS-CME group or to the laparoscopic surgery with CME, D3 lymphadenectomy, and total “no-touch” isolation technique (LAP-CME) group, or to conventional laparoscopic surgery with CME and D3 lymphadenectomy (cLAP) group at a 1:1:1 ratio using a centralized randomization list. Primary endpoints include safety, efficacy, and being oncologically clear, and 3-year disease-free, progression-free, and overall survival. Second endpoints include operative outcomes (operation time, blood loss, and incision length), pathologic evaluation (grading the plane of surgery, length of proximal and distal resection margins, distance between the tumor and the central arterial high tie, distance between the nearest bowel wall and the same high tie, area of mesentery resected, width of the chain of lymph-adipose tissue, length of the central lymph-adipose chain, number of harvested lymph nodes), and postoperative outcomes (pain intensity, postoperative inflammatory and immune responses, postoperative recovery).DiscussionThis trial will provide valuable clinical evidence for the feasibility, safety, and potential total “no-touch” isolation technique benefits of HALS-CME for right hemicolectomy. The hypothesis is that HALS-CME is feasible for the radical D3 resection of right colon cancer and offers short-term safety and long-term oncological superiority compared with conventional laparoscopic surgery.Trial registrationClinicalTrials.gov, NCT02625272. Registered on 8 December 2015.

An Optimal Approach for Laparoscopic D3 Lymphadenectomy Plus Complete Mesocolic Excision (D3+CME) for Right-Sided Colon Cancer.

An Optimal Approach for Laparoscopic D3 Lymphadenectomy Plus Complete Mesocolic Excision (D3+CME) for Right-Sided Colon Cancer.

Postoperative mortality and morbidity in older patients undergoing emergency right hemicolectomy for colon cancer.

Even with the advances in surgical technique and perioperative care, morbidity and mortality after colorectal cancer surgery remain considerable, and patients (pt) who present as an emergency have an even higher mortality and morbidity rate. A total of 35 pt with caecum or ascending colon cancer between January 2007 and June 2015, three departments in Italy and in Poland, were included in the study. The intention of surgery in all cases was curative resection with ileo-colic anastomosis. Comparative statistical analysis was performed. Acute bowel obstruction was the major complication of CRC that led to an emergency hemicolectomy. Postoperative mortality and morbidity rates were in total 12.5 and 28.1%, respectively. All the deaths happened in Poland. Of the pt, 42.8% had morbidity in Poland and 16.6% in Italy. Out of the pt, 25% presenting with perforation: 25% died, 25% had wound dehiscence, 12.5% had pulmonary oedema, and 12.5% had an intra-abdominal abscess. The mean age of the pt with complications in Poland and in Italy was 79.3 and 72.0years, respectively. We observed that particularly lethal combination is older age, perforation with peritonitis and advanced stage of the cancer.

Intracorporeal versus extracorporeal anastomosis in right hemicolectomy: a systematic review and meta-analysis

BackgroundLaparoscopic right hemicolectomy for colon cancer is associated with substantial morbidity despite the introduction of enhanced recovery protocols and laparoscopic surgery. Laparoscopic right hemicolectomy with an intracorporeal anastomosis (IA) is less invasive than laparoscopic assisted hemicolectomy, possibly leading to further decrease in post-operative morbidity and faster recovery. The current standard technique includes an extracorporeal anastomosis with mobilization of the colon, mesenteric traction and a extraction wound located in the mid/upper abdomen with relative more post-operative morbidity compared to extraction wounds located in the lower abdomen.MethodsA systematic review of PubMed and Embase databases was performed on studies comparing the intracorporeal versus the extracorporeal performed anastomosis in laparoscopic right hemicolectomy. Primary outcomes were mortality, short-term morbidity and length of stay. For quality assessment, the MINORS checklist was used. Meta-analysis was performed using a random-effects model, and a subgroup analysis was performed for data regarding short-term morbidity and length of stay in studies published in 2012≥.ResultsA total of 2692 papers were identified, 12 non-randomized comparative studies were included in the analysis with a total number of 1492 patients. No significant change in mortality was found (OR 0.36, 95 % CI 0.09–1.46; I2 = 0 %). Short-term morbidity decreased significantly in favour of IA (OR 0.68, 95 % CI 0.49–0.93; I2 = 20 %). Length of stay was decreased, but with serious risk of heterogeneity (MD −0.77 days, 95 % CI −1.46 to −0.07; I2 = 81 %). Subgroup analysis for papers published in 2012≥ resulted in an even larger decrease in short-term morbidity (OR 0.65, 95 % CI 0.50–0.85; I2 = 0 %) and a significant decrease in length of stay with low risk of heterogeneity (MD −0.77 days, 95 % CI −1.17 to −0.37; I2 = 4 %).ConclusionIntracorporeal anastomosis in laparoscopic right hemicolectomy is associated with reduced short-term morbidity and decreased length of hospital stay suggesting faster recovery as shown in this meta-analysis.

Perioperative antibiotic prophylaxis in laparoscopic right hemicolectomy for colon cancer: A 48-Hour regimen

Purpose: The standard protocol of perioperative antibiotic use in laparoscopic colectomy for colon cancer remains to be established. Given the ever-increasing number of antibiotic options available, as well as the growing problem of antibiotic resistance, there is a need for research on this important topic. Methods: We retrospectively reviewed the clinical data of 45 patients receiving laparoscopic right hemicolectomy for colon cancer to investigate the occurrence of perioperative infections following laparoscopic surgery. This study included 45 cases receiving laparoscopic right hemicolectomy from January 2013 to December 2014. A 48-hour treatment of antibiotic prophylaxis was used. results: The incidence of incisional surgical site infection (SSI), organ/space SSI, and remote infection was retrospectively investigated. Incisional SSI occurred in 1 (2.3%) patient. Organ/space SSI occurred in 1 (2.3%) patient. No remote infection occurred. conclusions: The incidence of incisional SSI and organ/space SSI was low using a 48-hour treatment of antibiotic prophylaxis after laparoscopic right hemicolectomy for colon cancer. Therefore, the 48-hour protocol of prophylactic antibiotic treatment seems to be adequate for preventing perioperative infections in laparoscopic right hemicolectomy.

Peer review report 2 on “A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer”

Peer review report 2 on “A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer”

Peer review report 1 on “A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer”

Peer review report 1 on “A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer”

A cost-minimization analysis of first intention laparoscopic compared to open right hemicolectomy for colon cancer.

BackgroundThe morbidity, mortality and survival following a laparoscopic right hemicolectomy for colon cancer are equivalent to an open operation. However, the cost of a longer operating time and consumables may offset savings from a shorter length of stay (LOS). A cost minimization study was undertaken to compare the relative costs.MethodsA retrospective cohort study of consecutive elective right hemicolectomies for colon cancer performed over 5 years by two teams. One team performed an open operation (OG), the other intended to perform all operations laparoscopically (LG). Clinical outcomes and relative costs were evaluated. Results expressed as mean ± SEM.ResultsThere were 58 patients in the open group and 56 in the first intention laparoscopic group, of which 77% were completed laparoscopically. There was no difference in age, gender or cancer stage. The complications, mortality and 5-year survival were similar. Anaesthetic (LG = 63 ± 3, OG = 62 ± 2 min) and surgical times (LG = 144 ± 8, OG = 143 ± 5 min) were similar. Consumables cost €571 more and the total theatre cost was €643 ± 256 higher in the laparoscopic group compared with the open group (p = 0.01). The LOS in the laparoscopic group (4.6 ± 0.5 days) was less than in the open group (8.3 ± 1 days, p < 0.01) saving €1960 ± 636 per patient. Overall, first intention laparoscopic right hemicolectomies saved €1316 ± 733 per patient. A probability sensitivity analysis indicated a 62% probability that a laparoscopic right hemicolectomy was cheaper than an open operation.ConclusionLaparoscopic right hemicolectomy is oncologically equivalent but less costly and should be considered the procedure of choice for right-sided colon cancer unless contraindicated.

Clinical efficacy of three dividing lines in radical right hemicolectomy for right colon cancer

Objective To investigate the clinical efficacy of three dividing lines in radical right hemicolectomy for right colon cancer. Methods The clinical data of 166 patients with right colon cancer (including ileocecal cancer, ascending colon carcinoma and hepatic flexure of the colon) who were admitted to the Affiliated Tumor Hospital of Zhengzhou University from March 2009 to August 2014 were retrospectively analyzed. Eightythree patients who underwent radical right hemicolectomy via three dividing lines were allocated to the modified group and 83 patients who underwent radical right hemicolectomy via medial approach were allocated to the control group. The operation time, volume of intraoperative blood loss, number of lymph node dissection and processing time and volume of the superior mesenteric vein (surgical trunk) hemorrhage were analyzed between the 2 groups. Patients were followed up by outpatient examination and telephone interview till November 2014. The measurement data with normal distribution were presented as ±s. The comparison between groups was analyzed using t test. The count data were analyzed by the chi-square test. Results The operation time in the modified group and in the control group were (75 ± 7) minutes and (109 ± 13) minutes, respectively, with a significant difference ( t=–36.700, P 0. 05) . During D3 lymph node dissection, the incidence of hemorrhage of the superior mesenteric vein, processing time of hemostasis and volume of blood loss were 3. 6% (3/83) , (7 ± 3) minutes and (103 ± 25 ) mL in the modified group and 9.6% (8/83) , (20 ± 5 ) minutes and (209 ± 37) mL in the control group, respectively. There was no significant difference in the incidence of hemorrhage of the superior mesenteric vein between the 2 groups (χ2=2. 434, P>0. 05) . There were significant differences in the processing time of hemostasis and volume of blood loss between the 2 groups ( t =38. 100, 29. 200, P <0. 05) . The patients were followed up for 3 months to 5 years with a median time of 22 months. Of 166 patients, 23 died, 11 were loss to follow-up and others survived at the end of follow-up. Conclusion Three dividing lines is safe and feasible in radical right hemicolectomy for right colon cancer, with a good clinical efficacy. Key words: Colon neoplasms; Colectomy; Lymph node excision; Hemorrhage; Controllability

Laparoscopic radical right hemicolectomy via medial approach for colon cancer

Objective To explore the surgical techniques and key points of laparoscopic radical right hemicolectomy for colon cancer. Methods The clinical data of 84 patients with colon cancer who underwent laparoscopic radical right hemicolectomy at the General Hospital of Lanzhou Military Command from November 2012 to June 2014 were retrospectively analyzed. The tumors were located at the hepatic flexure of the colon, the ascending colon and the ileocecum. The inside-out and up-down medial approach was used as the main surgical approach, and D3 lymph node dissection based on a center of surgical trunk of the superior mesenteric vein was the key point of laparoscopic radical right hemicolectomy. The intraoperative and postoperative conditions of patients were observed. Patients were followed up by telephone interview, text message and examination of readmission till March 2015. Results Of 84 patients, 82 received laparoscopic radical right hemicolectomy and 2 were converted to open operation without perioperative death. The mean operation time, volume of intraoperative blood loss, number of lymph node dissection, postoperative gastrointestinal recovery time and duration of hospital stay were 125 minutes (range, 110-175 minutes) , 50 mL (range, 30-120 mL) , 17 (range, 13-20) , 52 hours (range, 24-72 hours) and 6 days (range, 5-10 days) , respectively. There were no complications such as ureter injury, duodenal injury, anastomotic fistula, abdominal abscess and surgery-related complications. Seventy-two patients were followed up for a median time of 21 months (range, 12-28 months) without the tumor metastasis of abdominal incision and sites of puncture. Conclusion Laparoscopic radical right hemicolectomy via the medial approach is safe and feasible as well as improving the prognosis of patients, and lymph node dissection based on a center of surgical trunk of the superior mesenteric vein is the key point of surgery. Key words: Colonic neoplasms; Laparoscopy; Surgical procedures, operative; Surgical key points

Left atrial myxoma complicated with acute embolism of left ulnar artery

A 74-year-old woman presented to the emergency department with acute onset of pallor, pain and numbness over her left hand. She had a history of right hemicolectomy for colon cancer. There was no history of trauma or recent fever. On examination, paleness, coldness and weak pulses were noted along the ulnar side of her left forearm and hand (Figure 1A). Radial artery pulses at the wrist were normal. The neurologic …

PTH-102 Preliminary Evidence for a Role of the Renin Angiotensin System in Intestinal Fibrosis in Crohn’S Disease Using Angiotensin Receptor Immunohistochemistry

IntroductionFibrosis is a major limitation to successful non-surgical treatment of Crohn’s disease (CD) and is a cause of significant morbidity. The pathophysiological determinants of intestinal fibrosis in CD remain uncertain....

Unilateral renal cystic disease in the right kidney

A 51-year-old man was referred from on-cology department with incidental detection of unilateral multiple renal cysts on computed to-mography (CT) during evaluation of colon can-cer (Figure-1). Abdominal CT revealed enlarged right kidney with variable-sized round, well--marginated multiple cysts without capsule for-mation or solid content, while the left kidney was normal. Family history was negative for kidney disease. Ultrasound imaging of the parents, five adult siblings, one son and two daughters sho-wed normal kidneys. He received chemotherapy with 5-flurouracil plus leucovorin after laparos-copic right hemicolectomy for colon cancer. The relevant laboratory data were as follows: white blood cell count, 7000/mm3; hemoglobin level, 15.9 g/dL; platelet count, 174,000/mm3; blood urea nitrogen level, 15.5 mg/dL; creatinine level, 0.8 mg/dL and no proteinuria or hematuria. We did not introduce specific therapy for the unila-teral cyst and follow-up was made with magne-tic resonance image (MRI) six month after hemi-colectomy. The exam showed numerous cysts in the right kidney with no changes according to previous CT (Figure-2). This patient has unilateral renal cystic disease (URCD), a rare entity characterized by multiple cysts in one kidney or a portion of one

Short- and long-term outcomes of intracorporeal versus extracorporeal ileocolic anastomosis in laparoscopic right hemicolectomy for colon cancer

We assessed the short- and long-term outcomes of intracorporeal ileocolic anastomosis (IA) in laparoscopic right hemicolectomy for colon cancer compared with extracorporeal anastomosis (EA). A retrospective chart review of 86 consecutive patients who underwent laparoscopic right hemicolectomy for colon cancer from March 2005 to June 2010 was performed. There were 51 and 35 patients who underwent intracorporeal and extracorporeal anastomosis, respectively. The two groups were demographically comparable. The conversion rate to open surgery was 8.6 % in the EA group, but none in the IA group (p = 0.064). There was no significant difference in operative time, estimated blood loss, complications (intra-abdominal abscess, anastomotic leak, ileus, and wound infection), and length of hospital stay between the groups. There was no perioperative mortality in both groups. There was no significant difference in median number of retrieved lymph node. The overall survival and the disease-free survival at 3 years were not different between the groups. Compared with the extracorporeal anastomosis technique, intracorporeal ileocolic anastomosis produces comparable short- and long-term outcomes in laparoscopic right hemicolectomy for colon cancer.

Laparoscopic Versus Open Right Hemicolectomy for Colon Cancer: A Meta-analysis

This meta-analysis was designed to assess the feasibility and safety of laparoscopic right hemicolectomy for colon cancer. A systematic search of the MEDLINE, EMBASE, and Cochrane databases identified 12 studies that met the inclusion criteria for data extraction. Publications that compared laparoscopic right hemicolectomy and open right hemicolectomy for treatment of colon cancer in the past 20 years were collected for review. The primary outcomes used for meta-analysis were operating time, blood loss, number of harvested lymph nodes, time to first flatus, postoperative hospital stay, postoperative complications, mortality, and rate of recurrence. Twelve studies that included 1057 patients were examined. Of these patients, 475 and 582 had undergone laparoscopic right hemicolectomy and open right hemicolectomy, respectively. There were significant reductions in blood loss, time to first flatus, postoperative hospital stay, and rate of wound but a operating time for laparoscopic right hemicolectomy compared with open right hemicolectomy. Other outcome variables such as number of harvested lymph nodes, postoperative complications except wound infection, mortality, and rate of recurrence were not found to be statistically significant for either group. Compared with open right hemicolectomy, laparoscopic right hemicolectomy has the advantages of minimal invasion, faster recovery, and a lower rate of wound infection, and it can achieve the same degree of radicality and short-term prognosis as open right hemicolectomy. The drawback is that the operative time is longer.

Solitary Bulky Mediastinal Lymph Node Metastasis from Colon Cancer

A 75 year-old man underwent right hemicolectomy for colon cancer 3 yrs and 6 months ago, followed by chemotherapy with capecitabine. One year and 10 months later, solitary liver metastasis was resected. Five months later, a bulky mediastinal mass of 6 cm in diameter was detected by chest computed tomography and he was referred to our department. The tumor was successfully extirpated by videothoracoscopy-assisted right axillary approach. Histopathology disclosed poorly-differentiated tubular adenocarcinoma and diagnosed as metastatic mediastinal lymph node from the colon cancer. He was discharged on the day 5 and alive without disease 13 months after the mediastinal surgery.

Oncologic Outcomes of a Laparoscopic Right Hemicolectomy for Colon Cancer: Results of a 3-Year Follow-up.

PurposeThe purpose of the study is to evaluate the oncologic outcomes of a laparoscopic-assisted right hemicolectomy for the treatment of colon cancer and compare the results with those of previous randomized trials.MethodsFrom June 2006, to December 2008, 156 consecutive patients who underwent a laparoscopic right hemicolectomy with a curative intent for colon cancer were evaluated. The clinicopatholgic outcomes and the oncologic outcomes were evaluated retrospectively by using electronic medical records.ResultsThere were 84 male patients and 72 female patients. The mean possible length of stay was 7.0 ± 1.5 days (range, 4 to 12 days). The conversion rate was 3.2%. The total number of complications was 30 (19.2%). Anastomotic leakage was not noted. There was no mortality within 30 days. The 3-year overall survival rate of all stages was 93.3%. The 3-year overall survival rates according to stages were 100% in stage I, 97.3% in stage II, and 84.8% in stage III. The 3-year disease-free survival rate of all stages was 86.1%. The 3-year disease-free survival rates according to stage were 96.2% in stage I, 90.3% in stage II, and 75.6% in stage III. The mean follow-up period was 36.3 (3 to 60) months.ConclusionA laparoscopic right hemicolectomy for the treatment of colon cancer is technically feasible and safe to perform in terms of oncologic outcomes. The present data support previously reported randomized trials.

Laparoscopic Right Hemicolectomy for Colon Cancer: Technically Feasible and Safe to Perform in Terms of Oncologic Outcomes

See Article on Page 42-48 It has already proved that laparoscopic surgery is not any less inferior to conventional open surgery in terms of its safety and efficacy to treat colon cancer [1, 2]. From this point of view, this study reviewed the outcomes of laparoscopic right hemicolectomy retrospectively as a treatment of colon cancer. The study was considered to be significant as the outcome of a single surgery although it was not the randomized prospective study with large scale of samples. In South Korea, the outcomes of laparoscopic surgery for colon cancer have been reported but they have not been extensive yet. Therefore, the outcomes of a single surgery such as laparoscopic right hemicolectomy performed by the author of this study are judged to be a good evidence to support the outcomes of laparoscopic surgeries. Nevertheless, this study had several flaws to demonstrate the advantages of laparoscopic right hemicolectomy perfectly comparing to conventional open right hemicolectomy. It is mainly because this study is not prospective study and there aren't control groups as well as the sample size was too small. However, data is collecting prospectively with a larger scale of sample and more solid evidence is expected to be produce with this data. In addition to this, if more surgeons are participated in researches expanding the range of subjects, more reliable evidence will be constructed.