Radical Hemicolectomy Research Articles

Intestinal Intussusception in Adults: A Diagnostic Challenge

Intussusception, a rare cause of intestinal obstruction in adults, accounts for only 1% of obstruction cases and 5% of all intussusceptions. Its global incidence is 1-3 cases per million per year. Early identification is challenging, which can lead to significant morbidity and mortality. In adults, intussusception is often associated with benign or malignant lesions, with primary adenocarcinoma being the principal cause. Preoperative diagnosis can be complex, and computed tomography (CT) is considered the preferred imaging modality. Most cases require surgical intervention, and the decision on whether to reduce before resection depends on the type and location of the lesion. Both laparoscopic and open surgeries are valid options, depending on clinical conditions and the surgical team's experience. We present the case of a patient in their fourth decade of life with a 15-day history, who presented to the emergency room with symptoms of intestinal obstruction secondary to intussusception. An emergency laparotomy was performed, revealing intussusception from the ascending colon to the transverse colon with a neoplastic-looking lesion in the cecum. A right radical hemicolectomy with intestinal diversion was performed. Histopathological examination revealed a moderately differentiated grade 2 adenocarcinoma.

Paracetamol-induced hepatotoxicity in a malnourished patient: A case report

Abstract Acetaminophen, an analgesic and antipyretic with a favorable safety profile, is used globally. However, excessive doses can lead to severe hepatotoxicity and acute liver failure. We present a case report that describes the unfortunate demise of a 48-year-old male patient with colon carcinoma who developed severe hepatotoxicity attributed to the administration of paracetamol following right radical hemicolectomy. Despite the patient receiving paracetamol at a dosage below the recommended limit under medical supervision, he experienced a rapid deterioration in liver function, leading to a cascade of life-threatening complications. The intricate interplay between medication administration and patient-specific factors emphasizes the ongoing need for the medical community to evolve and optimize treatment strategies for improved patient outcomes.

Value of different anastomoses in laparoscopic radical right hemicolectomy for right-sided colon cancer: retrospective study and literature review

BackgroundThis study aimed to analyze the safety of circular lateral anastomosis and cross-lateral anastomosis in laparoscopic radical resection of right-sided colon cancer.MethodsFrom January 2018 to March 2021, 147 patients with right-sided colon cancer were admitted to the Department of General Surgery, Cancer Hospital, Zhengzhou University. The experimental group comprised patients with circular lateral anastomosis, whereas the control group comprised patients with cruciform lateral anastomosis. The general clinical data, intraoperative features, and postoperative results of the two groups were compared and analyzed.ResultsBoth groups successfully underwent laparoscopic lateral ileocolic anastomosis, with significant differences in anastomotic leakage (χ2=4.520, P < 0.05). By contrast, body mass index (t = 1.568, P = 0.119), histological typing (χ2 = 2.067, P = 0.559), intraoperative bleeding (t = 0.418, P = 0.677), and intestinal obstruction (χ2 = 2.564, P = 0.109) were not significantly different between the groups (P > 0.05).ConclusionsIn laparoscopic-assisted radical hemicolectomy for right-sided colon cancer, the incidence of postoperative anastomotic leakage was lower with circular lateral anastomosis than with cross-lateral anastomosis, and circular lateral anastomosis was superior to cross-lateral anastomosis in terms of reducing the length of hospital stay and improving patients' postoperative quality of life.

Giant De-Differentiated Liposarcoma of the Ascending Colon – A Rare Entity

Background: Liposarcoma is one of the common malignant mesenchymal tumors of the retroperitoneum and soft tissue of the extremities. Liposarcoma primarily arising from the colon is extremely rare. De-differentiated liposarcoma, a high grade variant has high local recurrence and distant metastatic potential. At present no standard treatment guidelines are established for the colonic liposarcoma in view of the rarity of the condition. Case Presentation: In this article we report a case of 46-year-old female who presented with a large right sided abdominal lump. On cross sectional imaging, she was found to have a large heterogenous exophytic mass arising from the ascending colon. Colonoscopy showed a submucosal lesion of the ascending colon with luminal narrowing. She underwent a right radical hemicolectomy. Histopathology of the resected specimen was reported as a de-differentiated liposarcoma arising from the ascending colon, which is an extremely rare occurrence. Patient made an uneventful recovery and is under follow-up. Conclusion: Liposarcoma is a rare disease of large intestine. It should be considered in the differential diagnosis when there is a large, submucosal colonic swelling with no lymph nodal or peritoneal disease. Complete surgical resection with clear margins is the standard of treatment. Evidence on the benefits of adjuvant chemotherapy and radiotherapy in improving survival in liposarcoma of colon is currently evolving.

Integrated access by page-turning approach for laparoscopic-assisted right radical hemicolectomy

目的： 探讨联合入路翻页式腹腔镜辅助右半结肠癌根治术的有效性及安全性。 方法： 采用回顾性队列研究方法。选取2017年6月至2018年6月期间，于南方医科大学珠江医院普通外科行腹腔镜辅助右半结肠癌根治术的80例患者临床资料，所有患者均在术前经CT和电子结肠镜确诊为右半结肠癌。根据手术入路的不同，分为改良联合入路组（40例）和传统中间入路组（40例）。比较两组围手术期情况和随访情况。 结果： 两组基线资料的比较，差异均无统计学意义（均P>0.05）。与传统中间入路组比较，改良联合入路组的手术时间较短[（162.8±21.2）min比（188.5±19.5）min，t=-5.658，P<0.001]，术中失血量较少[（40.9±20.1）ml比（81.0±27.3）ml，t=-7.491，P<0.001]，术后排气时间较短[（44.4±7.3）h对比（48.6±10.5）h，t=-2.077，P=0.041]。两组的术中淋巴结清扫数目、切除肠管长度以及术后并发症发生率、术后住院天数和总费用的差异无统计学意义（均P>0.05）。全组患者中位随访6.2（2.1~12.2）个月，两组均未发现局部复发及死亡患者出现。 结论： 联合入路翻页式腹腔镜辅助右半结肠癌安全可行，且具有手术难度低、缩短手术时间、减少术中出血以及加快术后康复的优势。.

Developing Surgical Oncology Services in Resource Constrained Settings: Results of a Systematic and Motivated Approach

Background: General surgeons trained in surgical oncology and working in a general service hospital can offer and provide a wide variety of oncological services although significant limitations exist compared with a true tertiary cancer care center in developed high income countries. Providing optimal and standard of care surgical oncology services is truly demanding and limitations in ancillary and support services can potentially limit the quality of care provided in resource constrained settings like ours. Aim: The aim of this study was to analyze the patterns of care, surgical outcomes in terms of morbidity and mortality, quality of resection in terms of margins and nodal yield over a period of 08 weeks in a general service hospital with resource constrained setting and with two trained and motivated surgical oncologists. Methods: Data of 22 patients with solid organ cancers who underwent major operative treatment both curative and palliative under the surgical oncology services were analyzed retrospectively. All patients were evaluated clinically, imaging as required and pathologic tissue diagnosis of cancer obtained as was possible and after adequate preoperative preparation were operated upon. Results: Four patients of carcinoma rectum underwent low anterior resection with diverting ileostomy, one patient with rectal cancer had APR with permanent end colostomy, two patients underwent total thyroidectomy for papillary thyroid cancer, eight patients underwent modified radical mastectomy for carcinoma breast, two patients had optimal cytoreductive surgery for carcinoma ovary -one patient upfront and another as interval cytoreduction, two cases of soft tissue tumor underwent limb salvage surgery, one case of carcinoma stomach underwent subtotal gastrectomy, one case of carcinoma cecum underwent classic right radical hemicolectomy. Two patients underwent emergency exploration for acute abdomen who were otherwise metastatic for palliation. All but one case received neoadjuvant therapy prior to surgery in carcinoma rectum, one case of carcinoma ovary and carcinoma breast were operated after neoadjuvant chemotherapy. Overall there was only one margin positive resection after low anterior resection who was operated upfront due to impending obstruction. The average nodal yield in all cases of colorectal carcinomas and breast cancer cases were as per current NCCN standards. Morbidities included seroma collection in 3 patients, minor surgical site infection in 2 patients, peristomal allergy in two patients, there were no deaths in elective cases. Conclusion: Providing quality surgical oncology services in a resource constrained general service hospital is challenging. Through an aggressive, well planned and motivated approach with a good surgical oncology training background and with available resources it is possible to achieve a varied spectrum, quality care and an improved and sustainable healthcare oncology systems for better outcomes even in these settings.

Severe esophageal bleeding in colorectal cancer due to antitumor therapy: A case report

Colorectal cancer is the third most common type of cancer worldwide, with >1 million cases diagnosed each year. Gastrointestinal bleeding is a common complication of colorectal cancer and is usually associated with the erosion and hemorrhage of the primary tumor. However, in patients who undergo a radical hemicolectomy and do not develop local recurrence, gastrointestinal bleeding may be a result of medical treatments or comorbidities. Esophageal bleeding in such patients is rare. Here, a case of severe esophageal bleeding due to anti-angiogenesis therapy with bevacizumab, and chemotherapy with the FOLFIRI regimen (irinotecan, folinic acid and 5-fluorouracil) in a patient with colorectal cancer is reported, and the possible pathogenesis of this event is analyzed based on the existing literature, in order to provide a reference for such cases.

Colitis Cystca Profunda causing colo-colic intussusceptions in an adult

A 62 years old male with colo-colic intussusception caused by colitis cystica profunda is reported. Patient was admitted with features of complete intestinal obstruction. Patient had the history of altered bowel habits and per rectal discharge of altered blood and mucous for six months. Contrast enhanced CT abdomen showed a transverse colonic mass with colocolic intussusception. With provisional diagnosis of carcinoma colon as a causative lesion, left radical hemicolectomy was performed. Intussuscepted segment had colitis cystic profunda histopathologically. The diagnosis of this entity is important as it can mimic mucin-secreting adenocarcinoma and therefore may result in radical surgical resection

Malignant Coloduodenal Fistulas-Review of Literature and Case Report

Colo-duodenal fistula is an uncommon complication of malignant and inflammatory bowel disease. Presentation varies from upper abdominal pain, feculent vomiting and diarrhea associated with foul eructation's. Occasionally patients presents with gastro-intestinal bleed. The contact of duodenal bile salts with colonic mucosa frequently leads to diarrhea, so also duodenal colonization with colonic pathogens frequently leads to malabsorption and severe foul eructations. The diagnosis is established either by gastrointestinal contrast studies or contrast enhanced C. T. Scan. Gastroduodenoscopy can demonstrate the fistulous communication or direct invasion and it can also be helpful in obtaining a histological diagnosis. Surgical treatment includes Right Radical hemicolectomy combined with Pancreatico duodenectomy in operable patients and Intestinal bypass for inoperable ones. Right Radical hemicolectomy combined with wedge excision of Duodenum is a suitable alternative in select cases. We report an unusual case of locally advanced carcinoma hepatic flexure of colon with direct invasion of duodenum. Extended right radical hemicolectomy with wedge excision of second part of duodenum was done as an alternative to combined radical hemicolectomy with Pancreatico duodenectomy.

Influence of surgical techniques on survival in patients with colorectal cancer.

This review was undertaken in an attempt to accumulate and critically evaluate all evidence that suggests that special techniques may alter survival rates of patients undergoing surgery for large-bowel cancer. Data suggesting reduced survival with a distal margin of resection less than 5 cm in patients undergoing anterior resection were found to be inconsistent. En bloc removal of the primary tumor and an adhesed adjacent structure seemed important, for 30 to 60 per cent survival has been reported using this approach, and adhesions were found to contain malignant cells at the interface of the primary tumor and adjacent structure in 40 to 100 per cent of patients. No statistically significant differences in survival rates were found in studies comparing conservative segmental bowel resection with radical hemicolectomy. This was true for colonic as well as rectal resections; while patient morbidity was not markedly increased for radical colectomy, it was found to be much greater with radical rectal resections. No data to support the use of "no-touch techniques" could be uncovered. Data to support the use of techniques for control of intraluminal tumor cells were sparse; however, because these maneuvers cost the patient little in terms of added morbidity, they should be used. Important aspects of the techniques for large-bowel surgery need to be investigated by prospective controlled clinical trials.