Hiroka Kondo

Salvage Total Pelvic Exenteration with Bilateral V-Y Advancement Flap Reconstruction for Locally Recurrent Rectal Cancer

Total pelvic exenteration for locally recurrent rectal cancer typically requires extensive excision of the pelvic floor with perineal skin. Due to the extensiveness of the procedure and its non-curative nature, it is controversial as purely palliative therapy. A 66-year-old male patient who had undergone abdominoperineal resection at another hospital 8 years prior was admitted to our hospital. During radiation and chemotherapy for 2 years, he complained of perineal pain, discharge, cacosmia and bleeding from a recurrent tumor. The 10 × 8 cm recurrent tumor was exposed on the perineum and the patient suffered from serious discomfort in his daily life during walking or sitting. We performed total pelvic exenteration with partial sacrectomy, after which the large perineal defect was reconstructed with a bilateral V-Y gluteus maximus advancement flap in approximately 120 min. The patients postoperative course was satisfactory and his quality of life markedly improved.

Inferior oncological prognosis of surgery without oral chemotherapy for stage III colon cancer in clinical settings

BackgroundCancer patients not admissible for adjuvant chemotherapy are generally at high risk of considerably inferior prognosis. The aim of this retrospective study was to evaluate poorer survival without administration of oral adjuvant chemotherapy of stage III colon cancer patients in clinical settings.MethodsBetween April 2007 and September 2011, 259 patients with stage III colon cancer who underwent curative surgery were retrospectively assigned to the adjuvant chemotherapy group of 171 patients (66%) and the surgery alone group of 88 patients. Oral fluorouracil (5-FU) derivatives used in adjuvant chemotherapy, such as oral uracil and tegafur plus leucovorin (UFT/LV) or capecitabine, were the most commonly used.ResultsThe 3-year relapse-free survival (RFS) rates were 74.9% for all cases, 58.3% for the surgery alone group, and 83.4% for the adjuvant chemotherapy group (P = 0.0001). The chemotherapy group was associated with a dramatic improvement in survival for stage IIIB (surgery alone 57.7% versus adjuvant chemotherapy 83.9%; P = 0.0001) and stage IIIC (surgery alone 18.2% versus adjuvant chemotherapy 57.3%; P = 0.006) patients. There was a significant difference in the overall recurrence rate between groups (surgery alone 35.2% versus adjuvant chemotherapy 18.1%; P = 0.002). Multivariate analysis identified adjuvant therapy as an independent predictive factor of reduced recurrence (hazard ratio (HR): 3.231; P = 0.004) and improved RFS (HR: 2.653; P = 0.001).ConclusionIn clinical settings, adjuvant therapy was the only significant prognostic factor of survival. Since many patients prefer not to receive chemotherapy, it is critical to inform stage III colon cancer patients that chemotherapy raises their chances of survival by three-fold compared with curative surgery alone.

A comparative study on the short-term clinical outcomes of laparoscopic versus open Hartmann's procedure for high risk patients in colorectal cancer.

BACKGROUND/AIMS Patients with severe co-morbidities and oncological conditions would not be denied a reconstruction of anastomosis and Hartmanns procedure would be undertaken. The aim of this study is to examine the feasibility and safety of laparoscopic Hartmanns procedure compared to open Hartmanns procedure for high risk patients in colorectal cancer. METHODOLOGY Nine hundred and eighty five primary colorectal cancer resections were performed from April 2007 to December 2010. Thirty six patients (3.6%) who underwent Hartmanns procedure by the same surgical team were investigated retrospectively. RESULTS Twenty six patients (72%) in the open surgery (OS) and 10 patients (28%) in the laparoscopic surgery (LS) were undertaken Hartmanns procedure. The reason of selected Hartmanns procedure was defined as high risk with severe co-morbidities (OS 8: LS 8, n=16), oncological conditions (OS 14: LS 2, n=16), urgent situations (OS 4, n=4). The mean operation time was not significantly different (p=0.504). The median blood loss count was significantly different between both groups (OS 327.5g vs. LS 16.5g; p=0.0001). The incidence of postoperative complications was similar (OS 38% vs. LS 40%; p=0.763). The median postoperative hospital stay was not significantly different (OS 10.5 vs. LS 12; p=0.216). CONCLUSIONS Laparoscopic Hartmanns procedure is feasible and safe with a low invasiveness for high risk patients with colorectal cancer.

Prediction of Anastomotic Leakage After Laparoscopic Low Anterior Resection in Male Rectal Cancer by Pelvic Measurement in Magnetic Resonance Imaging.

Objective: Anastomotic leakage after laparoscopic low anterior resection in male rectal cancer patients with a narrow pelvis cannot be easily resolved. The objective of this study is to assess numerical information of narrow pelvis and to determine whether prediction of morbidity can be possible. Methods: Retrospective medical record review was performed. From July 2007 to January 2013, 43 consecutive male patients with low rectal cancer who underwent laparoscopic low anterior resection were divided into the anastomotic leakage–negative group and anastomotic leakage–positive group. Eleven anatomic parameters were measured from preoperative magnetic resonance imaging of pelvis and a new index called “pelvic index” was calculated. Results: The pelvic index (difference between the interspinous distance and the diameter of the mesorectum divided by the depth of the cavity of the lesser pelvis) in the leakage-positive group was significantly smaller than that in the negative group (P=0.038). Comparison between those 2 groups at the border of the cut-off value of the pelvic index (13.0) showed a significant difference. Conclusions: Preoperative assessment by the pelvic index can predict the narrow pelvis and risk of anastomotic leakage.

Oncologic Outcomes of Oral Adjuvant Chemotherapy Regimens in Stage III Colon Cancer: Tegafur–Uracil Plus Leucovorin Versus Capecitabine

Introduction: Although several major trials of treatment for stage III colon cancer have been reported, no study has compared oral adjuvant chemotherapy regimens using tegafur–uracil in combination with leucovorin (UFT/LV) and capecitabine (CAPE) alone. This study compared the oncologic outcomes of treatment with these 2 oral regimens. Patients and Methods: Records of patients with stage III colon cancer who underwent curative surgery and adjuvant chemotherapy from April 2007 and September 2014 were retrospectively reviewed. Results: A total of 258 patients with stage III colon cancer received oral adjuvant chemotherapy with UFT/LV (n = 157, 61%) and CAPE (n = 101, 39%). The overall rate of completion of scheduled treatment was 78.6%. Significantly fewer patients on UFT/LV completed the regimen compared with those on CAPE (117, 74.5% vs. 86, 85.1%; P < .01). There were no significant differences in oncologic outcome between UFT/LV and CAPE in terms of 3‐year overall survival rates (OS; 95.8% vs. 92.4%, P = .45) and 3‐year relapse‐free survival rates (RFS; 82.7% vs. 79.3%, P = .8). Conclusion: The 3‐year RFS and OS were similar for both regimens, yielding an excellent outcome. The selection of adjuvant chemotherapeutic regimens must be based on the patients status as well as considering the incidences of adverse events, medical cost, and administration convenience. &NA; This study compared the oncologic outcomes of treatment with oral adjuvant chemotherapy regimens, UFT/LV or capecitabine. Retrospectively, 258 patients were reviewed. 3‐year RFS and OS were not significantly difference. The outcomes also did not differ regardless of whether patients completed the scheduled total treatment dose. Treatment decisions can thus focus on other issues such as cost, convenience, and adverse effects.

Laparoscopic-assisted abdominoperineal resection combined with en-bloc prostatectomy using the trans-sacral approach for locally invasive rectal cancer: A case report: Lap APR combined with prostatectomy

Laparoscopic‐assisted abdominoperineal resection and en‐bloc prostatectomy using the trans‐sacral approach for locally invasive rectal cancer that invades only the prostate is useful in order to avoid total pelvic exenteration. The patient was a 63‐year‐old man with cT4b (prostate) N1M0, stage IIIC rectal cancer. Curative resection was performed. Histopathological findings did not indicate definitive invasion into the prostate gland. The patient was discharged from the hospital on postoperative day 32 with an anastomotic leak and a ureteral catheter. The patient is able to urinate and has had no cancer recurrence. Laparoscopic bladder‐preserving surgery for locally invasive rectal cancer can preserve postoperative quality of life and provides oncological curability.