Sigmoid Carcinoma Research Articles

Using Intraoperative Radiation Therapy—A Case Study

The introduction of a mobile linear accelerator in the OR has made intraoperative radiation therapy (IORT) more plausible. An IORT treatment can deliver a single high dose of radiation to a tumor or tumor bed after surgical resection or surgical exposure of high risk areas. This article details a case study in which IORT was used on a patient with sigmoid carcinoma and the procedure outcomes.

Outcome of Rectal and Sigmoid Carcinoma Patients Receiving Adjuvant Chemoradiotherapy in Marmara University Hospital

Adjuvant chemoradiotherapy is the standard treatment in resected stage II/III rectosigmoid carcinoma. We report a retrospective analysis of 33 patients who received adjuvant chemoradiotherapy. Patients received 5-fluorouracil (375mg/m2/day × 5days) and calcium leucovorin (20mg/m2/day × 5days), q4weeks, two courses before and two courses after radiotherapy. The 5-fluorouracil dose was reduced to 225mg/m2/day given continuously as protracted short-term infusion on the first and last 3 days during radiotherapy. Radiotherapy was started at 7th week and 45-50.4 Gy was given to pelvic region. Median age was 63 years. Median follow- up was 38 months starting from the operation date. Four-year local and distant control rates were 78% and 69%, respectively. Four-year disease-free survival and overall survival were 60% and 62%, respectively. Protracted short-term infusion of 5-fluorouracil during pelvic irradiation is a safe treatment modality. Further studies are needed to improve the local control of high-risk rectal and sigmoid carcinomas.

Vaginal Metastasis of Colon Cancer

True vaginal metastases from colonic cancer are exceedingly rare. This often signals an ominous prognosis. More frequently the vagina is synchronously involved by direct contiguous spread from the colonic lesion. We present a case of sigmoid carcinoma with true metastasis to the vagina that was discovered after an interval of 3 weeks when vaginal discharge became evident. To our knowledge, there are only two other papers in the English language previously documenting this phenomenon.

Cystoprostatectomy and ileal neo‐bladder formation as a ‘no‐stoma’, definitive treatment for bladder extension of sigmoid carcinoma

Cystoprostatectomy and ileal neo‐bladder formation as a ‘no‐stoma’, definitive treatment for bladder extension of sigmoid carcinoma

LAPAROSCOPY-ASSISTED COLECTOMY FOR CARCINOMA OF THE SIGMOID COLON WITH SYSTEMATIC LYMPH NODE DISSECTION

In a recent 3-year period from January 1995 to December 1997, we performed laparoscopy-assisted colectomy for carcinoma of the sigmoid colon (LAC-S) with systematic lymph node dissection (D 3) for 25 cases. The following indications had to be satisfied for LAC-S: there was no evidence of liver metastasis and peritoneal dissemination, and tumors were not exposed on the serosal surface (MP). We performed D 3 lymph node dissection with the right side approach on the sigmoid mesocolon. It was considered that our procedure, which is different from the conventional sigmoidectomy in the right side approach on the sigmoid mesocolon, was rational in terms of dissecting lymph nodes and recognizing retroperitoneal surgical anatomies. In comparison with another 21 cases undergone open sigmoidectomy in the same period, there was no significant difference in operation time and number of dissected lymph nodes. But amount of blood loss significantly de-creased and the days for returning to normal life was significantly shortened in LAC-S group (p<0.0001, p value: Mann-Whitney U test). In this paper, the technical aspects of our laparoscopic procedure are presented, and we conclude that LAC-S may be the possible choice in the treatment for sigmoid carcinoma by selecting patients with appropriate indication.

An Unusual Implantation of a Rectosigmoid Adenocarcinoma into a Hemorrhoidectomy Scar

An Unusual Implantation of a Rectosigmoid Adenocarcinoma into a Hemorrhoidectomy Scar

Prospective evaluation of ultrasonography in acute colonic diverticulitis

The clinical diagnosis of acute colonic diverticulitis (ACD) can be difficult and ultrasonography by experts is valuable in establishing the diagnosis. This prospective observational trial aimed to assess the diagnostic accuracy and clinical value of ultrasonography performed routinely by surgical residents in training. The clinical course of 187 unselected consecutive patients admitted with suspected ACD was studied prospectively. Patients who had surgery for generalized peritonitis were excluded, leaving 143 for evaluation. Ultrasonographic findings and clinical assessment on admission were correlated with the patient's clinicopathological data and discharge diagnosis respectively. Of 74 patients with proven ACD (prevalence 52 per cent) the diagnosis was made by ultrasonography in 62, with an accuracy of 88 per cent, sensitivity 84 per cent and specificity 93 per cent. Ultrasonography gave a false-negative result in 12 patients (negative predictive value (NPV) 84 per cent) and there were five false-positive findings (positive predictive value (PPV) 93 per cent). The final diagnosis in the latter five patients was colitis (two patients), caecal carcinoma (one), colonic ileus due to perforated sigmoid carcinoma (one) and suppurative pyosalpingitis with involvement of the sigmoid colon (one). The accuracy of clinical evaluation on admission was 71 per cent (sensitivity 82 per cent, specificity 55 per cent, PPV 72 per cent, NPV 68 per cent); however, in only 53 per cent of patients was the diagnosis considered clinically unequivocal. Ultrasonography is a useful and valid modality for imaging ACD and its differential diagnoses in the hands of sonographically trained surgeons. It is especially helpful when the clinical findings are equivocal.

Resected Sigmoid Carcinoma with 13-year Metastasis-Free Interval

Colorectal cancers rarely present with bone metastases. Regular postoperative monitoring after resection by conventional imaging techniques and carcinoembryonic antigen levels aids physicians in identifying such tumor recurrences. However, some recurrences might elude detection by bone scan, computed tomography, and magnetic resonance imaging, and newer tests such as immunoscintigraphy using radioimmune-tagged monoclonal antibodies may be more diagnostic. Here we report a case, presenting with delayed recurrence at a rare bony site, in which application of immunoscintigraphy helped in the definitive detection of the tumor recurrence.

Metal stents for palliation of rectal carcinoma: a preliminary report on 12 patients.

Laser therapy is often the only alternative to palliative surgery for elderly patients with advanced rectal carcinoma. In order to reduce the number of laser sessions required, we tried to insert metal stents after initial relief of the obstruction. In 12 patients (seven female, five male, aged 77-91 years) with rectal or rectosigmoid carcinomas, metallic self-expanding stents (length 5-10 cm, internal diameter 1-2 cm) were introduced. Initial treatments were performed with Nd:YAG laser (mean number of sessions 3.1) in order to allow free passage of an adult colonoscope. Endoscopic and clinical follow-up was carried out at regular intervals. Stent insertion was possible in 11 of the 12 patients. Failure occurred in one patient with sigmoid carcinoma with a distorted loop and diverticulosis. In three patients, the prostheses migrated due to the opening of the lumen being too large; after stent removal, a second stent was successfully placed. Seven patients have died since the beginning of the study, all from the initial disease, without symptoms of stent occlusion. Stenting allowed the number of laser sessions to be reduced. The interval between the laser sessions was extended from 5.1 weeks in a historical control group of 65 patients to the 9.7 weeks in these 11 patients with additional stenting. Stenting for rectal carcinoma is technically feasible and safe, and probably reduces the number of laser sessions required. However, better materials are required.

Differentiating sigmoid diverticulitis from carcinoma on CT scans: mesenteric inflammation suggests diverticulitis.

The purpose of this study was to analyze the usefulness of two specific CT signs of sigmoid mesenteric inflammation (fluid at the root of the mesentery and vascular engorgement) for identifying and differentiating sigmoid diverticulitis from carcinoma. CT scans of 69 patients with surgically proved sigmoid diverticulitis were retrospectively reviewed and compared with CT findings in 29 patients with surgically proved sigmoid carcinoma. Two specific patterns of inflammation of the sigmoid mesentery were analyzed: fluid at the root of the sigmoid mesentery and engorgement of the sigmoid mesenteric vessels. The CT findings were present more often in patients with sigmoid diverticulitis than in those with carcinoma (p < .001). Fluid at the base of the mesentery had a sensitivity, specificity, and positive predictive value for diverticulitis of 36%, 90%, and 89% respectively. Vascular engorgement alone had a sensitivity, specificity, and positive predictive value of 29%, 100%, and 100%, respectively. Our results suggest that CT findings of fluid at the root of the mesentery and vascular engorgement are useful in distinguishing sigmoid diverticulitis from carcinoma of the sigmoid.

Ischaemic colitis in association with sigmoid carcinoma: A report of two cases

The association of ischaemic colitis with a distal obstructing carcinoma is described in two patients. When a segment of colonic ischaemia is demonstrated on barium enema, it is important to consider an association with a distal tumour.

Diversion colitis and involution of the defunctioned anorectum.

To measure the effects of defunction in the anorectum, 12 patients (seven men and five women aged 59 (44-81) years) were studied after the Hartmann operation. The operation was for septic complications of diverticular disease in nine and sigmoid carcinoma in three patients. Physiology studies were undertaken 1 and 3 months after surgery, and diversion colitis was assessed endoscopically and by mucosal biopsy at 3 months. There was no change in anal sphincter function by three months. Proctometrogram studies, however, showed an appreciable decrease in rectal volume in all cases, by a mean of 35% of the 1 month volume. The maximum tolerable volume at 1 month was 157 (111-210) ml and at 3 months 87 (71-145) ml; p < 0.01. There was no change in rectal sensation or compliance. Erythema and granularity without gross erosions or ulceration were found at endoscopy. Histology showed abnormalities in all cases by 3 months. The characteristic features were of a chronic inflammatory cell infiltrate with surface exudate, microscopic erosions, and lymphoid follicular hyperplasia. Crypt abscesses were not a feature at this stage and there was no distortion of crypt architecture. After defunction the previously normal rectum is affected by diversion colitis which, at 3 months, is mild but has characteristics that distinguish the changes from those of inflammatory bowel disease. It is associated with progressive rectal stump involution.

Spontaneous peripelvic extravasation of urine.

Spontaneous peripelvic extravasation of urine is relatively uncommon. We experienced 11 cases of spontaneous peripelvic extravasation. Urinary obstruction was caused by calculi in 9 cases, invasion by sigmoid carcinoma in 1 case and ureteral tumour (transitional cell carcinoma) in 1. Six patients presented with signs of peritonitis and 4 out of 9 with calculus did not develop microhaematuria. It is important to differentiate peripelvic extravasation from other acute abdominal conditions. We must pay special attention to patients with signs of peritonitis and normal urinalysis.

Incompletely resected rectum, recto-sigmoid, or sigmoid carcinoma: Results of postoperative radiotherapy and prognostic factors

Postoperative radiotherapy was given in 40 patients with gross or microscopic pathologically proven residual disease after surgical resection of rectum, recto-sigmoid, or sigmoid carcinoma. The radiotherapy target volume included the pelvis with (9 patients) or without (31 patients) the perineum. Median total dose of radiation was 50 Gy (range 30 – 60). One patient received 30 Gy, 10 received > 30 to 40 Gy, 13 received > 40 to 50 Gy, and 16 patients received > 50 to 60 Gy. The median follow-up in the survivors (16 patients) was 53 months (range: 16–85). Probability of survival with censoring for death due to intercurrent disease was 36% at 5 years. Survival for patients with microscopic residual disease (21 patients) was 40% at 5 years compared to 12% for those with gross residual disease (19 patients) (p = 0.09). Twenty-five patients relapsed. All but one relapse occurred earlier than 50 months after radiotherapy. Approximately half (12/25) of the relapses were observed within 6 months after radiotherapy. Local relapse inside the radiotherapy portals was observed in 9/40 (22%) patients. Therapy-related urogenital complications occurred in no patient and gastro-intestinal complications in three patients (7%). In one patient they were scored WHO grade 4 and in two patients WHO grade 3. Prognostic factors were analyzed using the Cox proportional hazards model. For survival differentiation, grade ( p < 0.001), stage ( p = 0.04), and perineal irradiation ( p = 0.03) were independent prognostic factors. With relapse-free survival as the endpoint, only stage ( p = 0.003) was a statistically significant prognostic factor. There was a trend toward a better relapse-free survival when the perineum was included in the radiation portals ( p = 0.09).

Increasing incidence of cecal and sigmoid carcinoma: Data from the connecticut tumor registry

We have studied both the distribution and incidence of colorectal cancer using The Connecticut Tumor Registry, the oldest tumor registry in the United States. During the time period 1973 to 1985, left-sided colon cancers accounted for 63% of the cancers, right-sided cancers 33%, and cancers with unspecified sites 4%. Indeed, this pattern of distribution has remained constant for 25 years. For the period 1935 to 1985, we calculated the sex-specific, age-adjusted (normalized to the 1970 U.S. Census) incidence. Age-adjusted incidence of rectal cancer has remained stable for 50 years: for men, 22.8 cases/100,000/year, and for women, 13.9 cases/100,000/year. During these 50 years, the age-adjusted incidence of cecal carcinoma for men has increased from 3.6 to 16.7 cases/100,000/year, while for women, it has increased from 4.9 to 14.2 cases/100,000/year. Sigmoid carcinoma for men has increased from 8.8 to 18.7 cases/100,000/year, and for women, it has increased from 7.7 to 12.8 cases/100,000/year. The incidence of colon cancer at each site has been and continues to be increasing at a constant rate. Age-adjusted incidence for all colorectal cancers has increased from 35.2 to 70.2 cases/100,000/year for men and from 32.1 to 49.2 cases/100,000/year for women. Thus, distribution of colorectal cancers by site in Connecticut has remained stable for 25 years. More importantly, however, the age-adjusted incidence of colon cancer has continued to increase for 50 years, whereas that of rectal cancer has remained relatively stable.

TWO CASES OF LIPOMA OF THE TRANSVERSE COLON

Lipoma of the colon has been increasing with a recent progress in diagnostic techniques. We have experienced two cases of lipoma of the transverse colon which included one associated with sigmoid carcinoma and the other diagnosed preoperatively. In a 82-year-old male undergone transverse colostomy for sigmoid carcinoma, a submucosal tumor measuring 1×1cm in size was found at the artificial anus. Partial colectomy involving the tumor was performed. The pathological diagnosis was submucosal lipoma. In the other one, a 53-year-old male, a pendunculated tumor was detected in the transverse colon by barium enema. The fluoscopy demonstrated a squeeze sign and CT value of the tumor was low density. Based on the above findings, the tumor was diagnosed as lipoma, and locally excised. There has been 17 cases of colonic lipoma associated with colonic carcinoma in the Japanese literature. Careful attitude for clinical examinations such as barium enema and CT scanning is necessary remainding of probable association of the both diseases.

回盲部によるぼうこう形成術を加えたぼうこう浸潤Ｓ状結腸癌の１例

回盲部によるぼうこう形成術を加えたぼうこう浸潤Ｓ状結腸癌の１例

Preoperative and postoperative CT staging of rectosigmoid carcinoma.

This study reports a 4 year experience using CT for preoperative staging and for evaluation of patients with rectal and sigmoid carcinoma after surgery. All patients were evaluated on a GE 8800 scanner using 1 cm contiguous slices. Only 15 of the 25 preoperative patients were staged correctly. The other 10 patients were understaged by CT. The accuracy of detecting local invasion was 70%, but only seven (35%) of 20 patients had accurate assessment of lymph nodes. The overall accuracy of CT staging in the 46 postoperative patients was 87%, with a sensitivity of 91% and a specificity of 72%. Most recurrences were found in the pelvis; 16 patients had liver metastases, and metastatic disease obstructing the ureters was detected in eight patients. On the basis of these results, it was concluded that CT should not be used routinely to preoperatively stage patients with rectosigmoid carcinoma. However, all patients who have undergone resection for rectal or sigmoid carcinoma should have aggressive CT evaluation including a baseline study at 2-4 months and then follow-up studies at every 6 months for at least 2 years. All new or enlarging masses should have CT-guided biopsies. This approach may prolong survival by detecting early asymptomatic recurrences.

Adjuvant postoperative radiation therapy for colorectal carcinoma above the peritoneal reflection. I. Sigmoid colon.

From 1970-1981, 85 patients had curative sigmoid resections for adenocarcinoma and were eligible for postoperative adjuvant therapy. In a nonrandomized fashion, 10/28 B2,3 and 7/28 C2,3 patients received postoperative pelvic radiation therapy (4500-5100 rad/5-6 weeks). Compared to the 39 B2,3 or C2,3 patients not receiving adjuvant pelvic irradiation, those 17 who did demonstrated retrospectively an improved pelvic regional disease control rate (70 versus 91%) and an improved five-year survival for irradiated B2,3 cases versus unirradiated B2,3 cases. (100 versus 64%, P less than 0.05). C2,3 cases showed no survival advantage for pelvic irradiation. This retrospective analysis suggests that for sigmoid carcinoma patients, postoperative adjuvant pelvic irradiation may be beneficial in terms of improved regional disease control rates for B2,3 and C2,3 cases and also improved survival for B2,3 cases.

Long-term survivors after preoperative pelvic radiation therapy for locally unresectable rectal and sigmoid carcinoma: an assessment of late results.

From 1972 to 1976, 11 patients received moderate-dose pelvic preoperative radiation therapy (4500-4600 rad +/- 500 rad boost) for initially unresectable rectal or sigmoid carcinoma. Of six patients subsequently explored, five had radical surgery and are alive without disease at least five years later. Comparison of the present long-term follow-up series with prior (short-term follow-up) series suggests that moderate-dose preoperative pelvic radiation therapy can convert many of these lesions to being resectable ones for which long-term survival-without-disease can be achieved. Attention to irradiation dose and field size is stressed, and a suggestion is made that patients whose tumors at final pathology still demonstrate extrarectal extension receive postoperative small-field boost irradiation.