Resection Of Transverse Colon Research Articles

Risk factors and the management of anastomotic leakage after anus-preserving operation for rectal cancer

To investigate the risk factors and management of anastomotic leakage after radical resection for rectal cancer and preservation of anal sphincter. The clinical data of 190 rectal cancer patients, undergone sphincter preserving procedures from Jan. 2004 to Jan. 2006, were analyzed retrospectively. The incidence of anastomotic leakage among the 190 rectal cancer patients was 7.9% (15 patients). The leakage occurred from 2 to 17 days postoperatively and the average time of appearance was 5.8 days. Thirteen cases of anastomotic leakage were healed by conservative therapy. The treatment included nutritional support, catheter drainage of abdominal abscesses and the use of antibiotics. Healing time ranged from 10 to 60 days and the mean time was 21.8 days. The other 2 patients were healed by abdominal perineal resection and loop colostomy of transverse colon respectively. The complication of anastomotic leakage was associated with age (10.2% in older than 60 years versus 3.2% in younger than 60 years), physical status (20.7% in poor condition patients versus 5.6% in good condition patients), bowel obstruction (19.1% with obstruction versus 6.5% without obstruction), anastomotic procedure (12.2% in Parks' anastomosis versus 6.7% Dixon anastomosis), anastomotic location (9.2% for outside of peritoneal anastomosis versus 2.7 for inside of peritoneal anastomosis). The rates of anastomotic leakage in staple-line manual reinforce group and postoperative anorectal drainage group were significantly decreased than those in control groups (1.9% versus 11.4% and 2.9% versus 10.7%)(P<0.05). Elderly patients, poor general condition, preoperative tumor obstruction, outside of peritoneal anastomosis are independent risk factors for the development of anastomotic leakage. Manual staple-line reinforce after stapled anastomosis and postoperative placement of drainage in rectum may be effective in decreasing the rate of anastomotic failure. Early and active conservative approach should be considered as the main treatment of anastomotic leakage.

Clinical evaluation of 21 cases of total pancreatectomy

To evaluate the clinical outcome of 21 cases of total pancreatectomy. The clinical data of 21 cases of total pancreatectomy performed from April 2003 to June 2006 was retrospectively analyzed. Among the 21 patients, 1 case combined with transverse colon resection, 1 case with total gastrectomy, 9 cases with portal-superior mesentery vein resection with end-to-end anastomosis, 9 cases with portal-superior mesentery vein resection and grafts implantation, 8 cases with concomitant celiac axis resection, 4 cases with concomitant celiac axis and common hepatic artery resection, 1 case with concomitant celiac axis, portal vein and superior mesentery artery resection and reconstruction. Complications occurred in 12 cases (57.1%) post the operation and 5 cases (23.8%) died in 30 days after the operation. Insulin was given at the dose of 18 - 28 U daily post operation and blood glucose was maintained normal effectively. Sixteen cases were followed-up and median survival was 9.2 months (1.2 - 13.0 months). The median survival of tubular adenocarcinoma and intraductal papillary mucinous neoplasms of the pancreas (IPMNs) were 7 months (1.2 - 9.0 months) and 11.3 months (10.0 - 13.0 months), respectively. Total pancreatectomy could not improve survival and it increases the complications and death, but it could improve the quality of life. It's an operation of choice for IPMNs, but with pancreatic carcinoma, the warranty of operation should be considered. The blood glucose level could be maintained normal effectively after the operation.

Prognostic factors of young patients with colon cancer after surgery

To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninety six of them were 40 years old or younger.R0, R1 and R2 operations were performed in 69 (71.9%), 4(4.1%) and 23 patients(24%), respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. The operation mortality was 0%, 54 patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver,lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 +/- 5.01 mo and the overall 3-,5- and 10- year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis,patient age,type of operation, radical resection, blood transfusion, histological type, diameter of tumor,depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis,blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. Age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor,depth of tumor invasion, lymphatic invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery.

Application of radionics on primary and metastatic tumours of the liver

The aim of our study is to present our initial experience on the use of radiofrequency ablation (RFA) on hepatic tumours. Four patients with tumours of the liver were submitted to RFA. The first patient underwent an emergency left lobectomy due to rupture of a tumour of the left hepatic lobe. A synchronous tumour was detected on the right lobe. He has been submitted to four sessions of RFA. The second patient was submitted to transverse colon resection (adenocarcinoma) and a year later three metastatic tumours were detected. Two sessions of RFA have been applied in this case. The third patient, with adenocarcinoma of the sigmoid and one metastatic lesion on the right hepatic lobe, and the fourth patient with breast cancer and metastatic lesion of the liver, underwent one session of RFA each. The use of RFA on metastatic or primary tumours of the liver enriches the possibilities of therapeutic treatment.

Acute Abdomen With Colonic Necrosis Induced by Kayexalate-Sorbitol

Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalemia. Colonic necrosis was manifested as an acute abdomen within 24 hours of initial administration. Prompt surgical resection of the necrotic transverse colon permitted rapid recovery of bowel function. Although SPS crystals are seen microscopically in the necrotic bowel, experimental evidence implicates the sorbitol component of the SPS-sorbitol in the pathogenesis of colonic necrosis. A high index of suspicion for the unusual complication of colonic necrosis after oral or rectal administration of SPS-sorbitol may allow prompt recognition and surgical cure.

MALIGNANT GASTROINTESTINAL STROMAL TUMOR OF THE STOMACH WITH DISSEMINATION-A CASE REPORT-

A 68-year-old man was admitted to our hospital with complaints of tremor and bilateral arm numbness. An MRI of the head showed multiple cerebral infarctions. Abdominal CT scanning detected a cystic tumor of the upper abdomen and angiography revealed that the tumor was fed by the splenic artery. Intraoperative findings determined that the tumor originated from the stomach with signs of dissemination. Total gastrectomy, distal pancreatectomy, splenectomy, and transverse colon resection were performed. The resected specimen was 30×23×10cm with signs of central necrosis. Histological and immunohistochemical studies of the specimen disclosed many mitosis, and that it was negative for vimentin, s-100, SMA, some areas were partially positive for NSE, and positive for CD34. This tumor was identified as a maligmant gastrointestinal stromal tumor, uncommitted type.

ALPHA-FETOPROTEIN-PRODUCING CARCINOMA OF THE TRANSVERSE COLON-REPORT OF A CASE-

Alpha-fetoprotein (AFP) is a reliable tumor marker for the diagnosis and monitoring of primary hepatoceller carcinoma and yolk sac tumors. Elevated serum AFP levels have also been frequentlly reported in patients with carcinoma of the stomach, pancreas, bile duct, duodenum, colon and rectum. Though most of these disease are of the fore-gut derivations, colorectal lesions are hind-gut derivations and AFP-producing carcinoma of a colorectal lesions are rare. We report one case of AFP producing carcinoma that originated in the transverse colon. The patient is a 73-year-old man with a chief complaint of general fatigue. CT scanning determined a diagnosis of transverse colon cancer, therefore transverse colon resection, partial gastrectomy and partial ileum resection were performed. Histologic examination of the transverse colon showed poorly differentiated adenocarcinoma and immunohistochemical staining detected AFP-producing cells. To our knowledge, AFP-producing colorectal carcinoma were reported in 38 cases in the Japanese literature.

A CASE OF LAPAROSCOPY ASSISTED COLECTOMY WITH COMPLICATION OF POSTOPERATIVE PULMONARY EMBOLISM

A 63year-old man underwent a laparoscopy assisted partial resection of transverse colon for an early cancer of the transverse colon. Operation time was 230min and operative blood loss was 140g. On the second day postoperatively, hypo-oxemia was detected. He complained of no symptoms. He was diagnosed as to have pulmonary embolism with pulmonary perfusion scintigram. Immediately, anticoagulatory and fibrinolytic therapy was performed. Hypo-oxemia improved in a few days. He has been administered an oral anti coagulant, and no recurrent sign has been detected for more than a year. Laparoscopic surgery is rapidly popularized, and the risk for thrombosis of the lower extremities and pulmonary embolism by the disturbance of venous return due to the pneumoperitoneum has been pointed out. But, until now, few reports have been made about the incidence of pulmonary embolism related to laparoscopic surgery in Japan. We have reported here a case of laparoscopy assisted colectomy with complication of pulmonary embolism.

A nonfunctioning islet cell carcinoma with tumor thrombus in both the portal and splenic veins — a case report of successful resection

A rare case of nonfunctioning islet cell carcinoma associated with tumor thrombi in both the portal and splenic veins is reported. The patient, a 49-year-old male, had a 2-year history of occasional abdominal pain. Computed tomography (CT) disclosed a huge mass in the body of the pancreas, and celiac arteriogram showed a tumor stain in the body and tail of the pancreas. Percutaneous transhepatic portography (PTP) demonstrated an irregular filling defect, indicating intraportal tumor growth. Curative surgery, which included total pancreatectomy with combined resection (50 mm in length) and reconstruction of the portal vein, distal gastrectomy, and partial resection of the transverse colon, was performed. Histological examination of the surgical specimen led to a diagnosis of nonfunctioning islet cell carcinoma with a negative immunohistochemical stain for insulin, glucagon, somatostatin, and adrenocorticotropic hormone. The patient has been well for 38 months to date without any sign of tumor recurrence. Our experience with this case has introduced a radical resection for islet cell tumor of the pancreas, even if the tumor has extended into the portal vein.

Inhibition of hepatic regeneration after 70% partial hepatectomy by simultaneous resection of the bowel in rats.

This study was aimed to evaluate bow simultaneous resection of the bowel influences hepatic regeneration after partial hepatectomy (HTX). Two hundred and sixty-four rats underwent 70% partial HTX, ileocecal resection (ICR), transverse colon resection (TR), colon amputation and simulatenous resection of the liver and the bowel (HTX+ICR, HTX+TR). Hepatic DNA synthesis was remarkably suppressed by simultaneous resection compared with the 70% HTX group (p < 0.01). In simultaneous resection groups, delayed enhanced hepatic protein synthesis (HPS) was observed after the operation as compared with the 70% HTX group, which showed an early postoperative peak of HPS. Postoperative anastomosis leakage occurred more frequently and survival rates were significantly lower in simultaneous resection groups. Higher plasma endotoxin levels of the portal and the peripheral veins were found in simultaneous resection groups as compared with other groups (p < 0.01-0.001). This study suggested that simultaneous resection of the bowel with partial HTX might inhibit hepatic regeneration and result in the increased risk of anastomosis leakage and high surgical mortality rate by increased plasma endotoxin levels and delayed enhanced HPS.

A CASE OF PRIMARY DUODENAL CANCER WHICH WAS SUCCESSFULLY RESECTED FOLLOWING CHEMOTHERAPY

We report a case of primary duodenal carcinoma which had partial responce by preoperative chemotherapy. A 65-year-old man visited a near clinic with the chief complaint of lower abdominal pain. Inspection, palpation and upper gastrointestinal barium studies showed that the patient had a duodenal abnormality. Ulcerative lesion of the duodenum and colon carcinoma were suspected and refersed to our hospital. After admission the abdominal tumor became larger and jaundice developed. From preoperative endoscopy of the duodenum and biopsy, malignant lymphoma was considered most probable and chemotherapy (CHOP) was started. After 2 courses of chemotherapy, significant decrease in the abdominal tumor mass was noted. Pancreatoduodenectomy with partial resection of transverse colon was performed. Postoperative course was uneventful and additional chemotherapy was done. The patient is closely followed on ambulant basis.

A FREE PERFORATION OF THE COLON IN CROHN'S DISEASE

A 44-year-old woman has been followed with Crohn's disease was admitted with the complaint of acute abdominal pain. An emergency operation was performed with the diagnosis of GI tract perforation. A free perforation of the transverese colon was observed. Partial resection of transverse colon was carried out. Pathological examination revealed Crohn's disease of the colon. Postoperatively a fistula of the anastomosis and an abcess of the ascending colon occurred, so the parts of the colon with abnormal lesions were resected in a two-stepapproach. A free perforation of the colon in Crohn's disease is uncommon and 9 cases have been reported in Japan.

A CASE OF REMNANT GASTRIC CANCER 10 YEARS AFTER DISTAL GASTRECTOMY FOR ADVANCED GASTRIC CANCER, AND REVIEW OF THE SIMILAR SIX CASES IN OUR HOSPITAL

A case of early remnant gastric cancer 10 years after distal gastrectomy for advanced gastric cancer is reported. A 71-year-old man complained of discomfort of the epigastric region and diagnosed early remnant gastric cancer. The total gastrectomy was performed. There were 6 cases of remnant gastric cnacer after distal gastrectomy in our hospital. We have experienced a total of six cases of remnant gastric cancer after distal gastrectomy, that occurred with an incidence of 1.5% in our all operative gastric cnacer. The mean age was 66.1 years and all patients were male. The diseases caused the first operation were gastric ulcer in four, duodenal ulcer and gastric cancer in each one case. The reconstruction of the first operation were Billroth 2 for four patients and Billroth 1 for two. The mean duration between the first operation and the diagnosis of remnant gastric cancer was 14 years. The chief complaints included dysphagia in two patients, epigastralgia and palpable tumor in one, hematmesis and tarry stool in one, and discomfort of the epigastric region in one. Only one patient who diagnosed at the adult mass screening for gastric cancer was no complaint. Operative procedure for remnant stomach were subtotal gastrectomy for three patients and total gastrectomy for three patients. Transverse colon resection was performed for two patients and pancreas tail resection and splenectomy for two. There were three patients in stage III, one in stage IV, and two in stage I in conformity with The General Rules for the Gastric Cancer Study in Japan. There were one Borrmann 1 type, one Borrmann 2 type, three Borrmann 3 type, and one IIa type early gastric cancer. Three cases are now surviving for 10 months, 1 year and 1 month, and 5 years respectively with no evidence of recurrence.

II. Carcinoma of the Colon under Twenty Years of Age-Report of Two Cases with Reference of Japanese Literature-

Carcinoma of the colon is an exceedingly rare occurence in persons under 20 years of age. Only 21 of these cases have been reported in the Japanese literatures. Two additional cases were reported.Case 1. A 19-year-old female with a complaint of bloody stool and pain in the left lower abdomen. Preoperative diagnosis was cercinoma of the descending colon. At surgery there was no evidence of metastasis and she was treated with resection of distal transverse colon, and proximal sigmoid colon. No recurrence has been odserved during 12 years after surgery.Case 2. A 19-year-old female with a complaint of diarrhea. Preoperative diagnosis was carcinoma of the transverse colon. Liver metastasis and extensive mesentrial lymph node involvement were found on exploration of the abdomen. She received right hemico-lectomy but died of the disease 26 months after surgery. Histologically, both cases were well differentiated adenocarcinoma.