Kiyoka Hara

Does transumbilical incision increase incisional hernia at the extraction site of laparoscopic anterior resection

BACKGROUND It is unclear whether transumbilical incision for laparoscopic colectomy has a risk of incisional hernia at the extraction site similar to left lower incision. METHODS Consecutive patients who underwent laparoscopic sigmoid plus high and low anterior resection between August 2008 and February 2011 were included in the study. Incision for specimen extraction was changed from left lower to transumbilical incision in February 2010. The main outcome was the incidence of incisional hernia diagnosed by computed tomography. RESULTS One hundred and eighty-six patients underwent laparoscopic anterior resection (94 transumbilical incisions and 92 left lower transverse incisions). Three percent of patients had an incisional hernia at the extraction site, and the incidence of this phenomenon was not significantly different between the 2 groups. Surgical wound infection was lower in the transumbilical incision group than in the left lower incision group. CONCLUSIONS Extraction site for transumbilical incision may not affect the risk of incisional hernia.

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.

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.

Fibrin Glue Closure for Intractable Pancreatic Fistulae after Pancreaticoduodenectomy

CONTEXT Treatment of pancreatic fistulae after pancreaticoduodenectomy is extremely important because it determines the patients postoperative course. In particular, treatment of grade B cases should be conducted in a timely manner to avoid deterioration to grade C. OBJECTIVE We report the successful treatment of six cases of postoperative intractable, grade B pancreatic fistulae, in which fistula closure was achieved through the use of tissue adhesive. METHODS Six subjects presented at our hospital with grade B pancreatic fistulae after pancreaticoduodenectomy. In all cases, the drain amylase values were high immediately after the operation, and the replacement of the drain was enforced. Closure of the fistula was performed by pouring tissue adhesive into the fistula from the drain, after the fistula had been straightened. RESULTS Closure of the fistula was achieved in all six cases at the first attempt. The average fistula length was 13.2 cm, the average volume of pancreatic fluid discharge just before treatment was 63.3 mL, the average amylase value in the drainage was 40,338.5 IU/L, and the subjects were discharged from hospital an average of 8.8 days after treatment. There were no recurrences after treatment. CONCLUSION Intractable pancreatic fistulae can be effectively treated using the tissue adhesive method.

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.