Hiroyuki Tomioka

Feasibility of Laparoscopic Intersphincteric Resection for Patients with cT1-T2 Low Rectal Cancer

Aims: The purpose of this study was to assess the feasibility of laparoscopic intersphincteric resection (LAP-ISR) for rectal cancer in terms of morbidity, oncological outcomes, and functional results. Methods: Thirty-seven patients with primary low rectal cancer cT1-T2 underwent LAP-ISR. Surgical outcomes, pathological results, postoperative complications, oncological outcomes, and functional results were analyzed retrospectively. Results: Three patients (8.1%) had carcinoma in situ, 22 (59.5%) had pT1 tumor, and 11 (29.7%) had pT2 tumor. Eleven patients (29.7%) were diagnosed as being node positive, while 26 (70.3%) had node-negative disease. The median operative time was 315 min (range: 195-502). The median blood loss was 37 ml (range: 0-745). One case was converted to open surgery. Pathological complete resection was achieved in all cases. There was no surgical mortality. Postoperative complications of grade III-IV on the Clavien-Dindo classification were observed in 16.2% of the patients. The median follow-up period was 2.8 years (range: 187-2,241 days), and 3-year disease-free survival was 93.1%. No patient developed local recurrence. The functional result was objectively good. Conclusion: LAP-ISR can be recommended as a feasible, ultimate sphincter-preserving procedure with acceptable functional and intermediate-term oncological outcomes in patients with cT1-T2 very low rectal cancer.

Laparoscopic Sigmoid Colectomy for a Patient With Sigmoid Colon Cancer and Crossed-Fused Renal Ectopia: A Case Report

Crossed-fused renal ectopia (CFRE) is a very rare congenital renal malformation. This condition comprises several anatomic anomalies, including unilateral ureteral intersection of the midline, anteriorly-placed renal pelvises, and aberrant renal blood vessels, all of which increase the difficulty of colectomy. This report describes a case of laparoscopic sigmoidectomy with sufficient lymphadenectomy for a patient with sigmoid colon cancer and left-sided L-shaped CFRE. Preoperative computed tomography demonstrated that the origin of the inferior mesenteric artery (IMA) was free from anomalies and that the tumor did not invade surrounding organs. Therefore, we planned conventional laparoscopic sigmoid colectomy with D3 lymphadenectomy. Division of IMA at its origin and anterior colon resection was successfully performed by careful mobilization of the mesocolon to avoid exposing the retroperitoneal organs. To our knowledge, this is the first case report of laparoscopic colectomy for a patient with CFRE. Sufficient preoperative assessment of anatomic anomalies enabled successful surgery.