Makio Mike

Laparoscopic surgery for colon cancer: a review of the fascial composition of the abdominal cavity

Laparoscopic surgery has generally been performed for digestive diseases. Many patients with colon cancer undergo laparoscopic procedures. The outcomes of laparoscopic colectomy and open colectomy are the same in terms of the long-time survival. It is important to dissect the embryological plane to harvest the lymph nodes and to avoid bleeding during colon cancer surgery. To date, descriptions of the anatomy of the fascial composition have mainly involved observations unrelated to fundamental embryological concepts, causing confusion regarding the explanations of the surgical procedures, with various vocabularies used without definitions. We therefore examined the fascia of the abdominal space using a fascia concept based on clinical anatomy and embryology. Mobilization of the bilateral sides of the colon involves dissection between the fusion fascia of Toldt and the deep subperitoneal fascia. It is important to understand that the right fusion fascia of Toldt is divided into the posterior pancreatic fascia of Treitz dorsally and the anterior pancreatic fascia ventrally at the second portion of the duodenum. A comprehensive understanding of fascia composition between the stomach and transverse colon is necessary for dissecting the splenic flexure of the colon. As a result of these considerations of the fascia, more accurate surgical procedures can be performed for the excision of colon cancer.

Laparoscopic-assisted low anterior resection of the rectum--a review of the fascial composition in the pelvic space.

IntroductionOutcomes of rectal cancer treatment depend on the operative technique, and complication rates vary. Complications can occur during mobilization of the rectum, with damage to the ureter, autonomic nerves, and the rectum itself. Frequencies of these complications can be reduced by careful dissection of the correct tissue plane in the pelvic space.MethodologyThis paper reviews the fascial composition of the rectum for low anterior resection of the rectum. To date, fascial composition of the pelvic space has been considered based on clinical anatomy and histological examination of cadaveric specimens. However, clarification of fascial composition is clearly limited, to a certain extent, in histological examinations compared with clinical anatomy.ConclusionsFirst, some degree of dissociation must exist between the histological examination and clinical anatomy. Second, surgeons should not consider fascia encountered intraoperatively as an artifact. To address these difficult issues, consideration should be made purely from the perspective of clinical anatomy. Originally, the trunk was embryologically regarded as a multi-layered structure (like an onion). Understanding the fascial composition of the abdomen is comparatively easy when approached from this perspective. If this theory is adapted to the pelvic space in order to avoid antilogy, an understanding of the fascial composition of the pelvic space should also be possible. We review previous papers based on this theory.

Reappraisal of the Vascular Anatomy of the Colon and Consequences for the Definition of Surgical Resection

Introduction: Databases of information on surgical treatment for colorectal cancer have been created in various countries and data have started to be released. The most important facets of research for statistical processing include the methodology and firm definitions of content. However, for trials involving colorectal cancer, the applicable terminology has not been defined, and much bias is frequently encountered. Starting from definitions of the colon and vascular system of the colon, we propose definitions of surgical procedures for colorectal cancer. Methodology: This paper reviews the colon segments and vascular anatomy of the colon. If surgical treatment of colon cancer is considered from this perspective, we can see that definitions for these surgical procedures are lacking. The definition of surgical treatment would also allow clarification of the range of lymph node dissection. In general, surgical procedures and the area of surgical lymph node dissection are both defined according to the basic structure of the associated arteries. However, the existing descriptions are not based on a definition of the arteries. We therefore tried to establish the most useful nomenclature for the arterial system of the large intestine for colorectal surgeons and reviewed the frequency of important arterial variations. Using the resulting definitions, we provided consistent definitions for colon cancer surgery. Conclusion: The segments of the colon need to be defined. In surgery, procedures are performed using the arteries as indicators, so vessels originating from the superior and inferior mesenteric arteries are referred to as arteries, with others are referred to as branches. Surgical treatment of colon cancer can be defined from the relationship between these arteries. For the first time, this may allow proper application of statistics for the treatment of colon cancer.

Small bowel metastasis of uterine cervical adenocarcinoma

A few cases of small bowel metastasis from uterine cervical cancer have been previously reported. All reported cases were connected to squamous cell carcinoma, while none were associated with cervical adenocarcinoma. This report is of a rare case of cervical adenocarcinoma that haematogenously metastasised to the small intestine, and which caused a perforation and small bowel obstruction metachronously. An 84-year-old woman was admitted to our hospital with vaginal bleeding. She was diagnosed with FIGO stage III cervical adenocarcinoma by imaging and pathohistological examinations. Three months after receiving radiation therapy to control the bleeding, surgery was performed twice; the first operation for small bowel perforation and the second for small bowel obstruction. She was then diagnosed with haematogenous metastasis of cervical adenocarcinoma to the ileum according to the operative, histopathological and immunopathological findings.

Giant hematoma on the thoracic wall: Report of two cases

HEMATOMA ON THE THORACIC WALL is very rare. Recently we encountered 2 such cases. The first case was a rapidly growing tumor on the thoracic wall in a man with a history of a traffic accident 4 years previously. The second was a tumor on the thoracic wall that had grown slowly for more than 10 years in a man with no history of trauma or illness. We also present a review of the literature of such hematomas. CASE REPORT

An exophytic hepatic metastasis of mucinous colon cancer.

A 67-year-old woman with a chief complaint of abdominal mass was found to have an elastic-hard irregular tumour in her right lower quadrant on physical examination. Laboratory results indicated mild anaemia and elevated carcinoembryonic antigen and carbohydrate antigen 19-9 levels. Colonoscopy revealed a 40-mm adenocarcinoma in her ascending colon. Computed tomography incidentally detected a low-attenuation hepatic tumour projecting from the left lateral segment, with rim enhancement under contrast imaging (Fig. 1, arrow). Ultrasonography revealed a homogeneously hypoechoic mass without through-transmission or hyperechoic rim. The mass appeared as low intensity on T1-weighted (Fig. 2A, arrowhead), high intensity with internal septation on T2-weighted (Fig. 2B, arrowhead) and low intensity on diffusion-weighted magnetic resonance imaging. Fluorodeoxyglucose (FDG)-positron emission Figure 1. Figure 2.

Differentiating a large abdominal cystic lymphangioma from multicystic mesothelioma: report of a case.

We report a case of retroperitoneal cystic lymphangioma in a 30-year-old woman who presented with abdominal distention and pain. Imaging studies revealed a large, thin-walled multicystic mass occupying the whole abdomen. Based on a preoperative diagnosis of multicystic mesothelioma, we performed laparotomy, which revealed a tumor arising from the gastropancreatic ligament in the posterior wall of the omental bursa. We resected the tumor completely, without the adjacent viscera. The final pathological diagnosis was cystic lymphangioma, based on the immunohistochemical findings of positive CD31 and CD34 expression, the presence of smooth muscle confirmed by smooth muscle antigen and desmin, and negative calretinin, WT-1 and cytokeratins 5/6 expression. Multicystic mesotheliomas and cystic lymphangiomas are so similar in morphology that immunohistochemical staining should be fully utilized to differentiate them.

Reduction of Adult Intussusception: More Benefit than Harm: Reply.

Dear Sir, Thank you for your feedback regarding our manuscript. With regard to postoperative complications among our 41 surgeries, there were three cases of superficial surgical site infection (SSI), two cases of postoperative ileus (POI), and one case of transient renal failure. Thirty-four cases included surgical anastomosis, but there were no cases of anastomotic leakage. Among those 34 cases, one case required covering stoma because of intestinal edema. Next, we would like to respond to points (a) and (b). As we described in the ‘‘Discussion’’ section, careful radiologic or endoscopic evaluation can detect strangulated intussusception that is impossible to reduce preoperatively. In other words, we should not be too aggressive in our efforts to reduce intussusception. We do not mean ‘‘we should reduce intussusception preoperatively and intraoperatively,’’ but rather, ‘‘we should attempt to reduce intussusception preoperatively and intraoperatively, and should know when to stop our attempts to reduce intussusception.’’ In fact, some of the cases involved emergent surgery, and in 12 cases, it was impossible to reduce intussusception. When preoperative reduction is successful, this affords time for the intestinal edema to resolve, thereby reducing the need for emergency surgery and reducing the chances of postoperative complications. No studies have reported that successful reduction of intussusception is harmful.