Ronggui Meng

Appropriate treatment of acute sigmoid volvulus in the emergency setting

AIM To investigate an appropriate strategy for the treatment of patients with acute sigmoid volvulus in the emergency setting. METHODS A retrospective review of 28 patients with acute sigmoid volvulus treated in the Department of Colorectal Surgery, Changhai Hospital, Shanghai from January 2001 to July 2012 was performed. Following the diagnosis of acute sigmoid volvulus, an initial colonoscopic approach was adopted if there was no evidence of diffuse peritonitis. RESULTS Of the 28 patients with acute sigmoid volvulus, 19 (67.9%) were male and 9 (32.1%) were female. Their mean age was 63.1 ± 22.9 years (range, 21-93 years). Six (21.4%) patients had a history of abdominal surgery, and 17 (60.7%) patients had a history of constipation. Abdominal radiography or computed tomography was performed in all patients. Colonoscopic detorsion was performed in all 28 patients with a success rate of 92.8% (26/28). Emergency surgery was required in the other two patients. Of the 26 successfully treated patients, seven (26.9%) had recurrent volvulus. CONCLUSION Colonoscopy is the primary emergency treatment of choice in uncomplicated acute sigmoid volvulus. Emergency surgery is only for patients in whom nonoperative treatment is unsuccessful, or in those with peritonitis.

Diffuse cavernous hemangioma of the rectosigmoid colon

AbstractDiffuse cavernous hemangioma of the rectosigmoid colon is an uncommon benign vascular lesion. We report 5 cases of diffuse cavernous hemangioma, focusing on the clinical features, diagnosis procedure and treatment. Five patients have undergone sphincter–saving procedures, 3 cases had coloanal sleeve anastomoses and 1 patient each had pull–through anastomosis and lower anterior resection. During the follow–up, which ranged from 3 to 10 years, 3 patients had no further anal bleeding and 2 patients had minor intermittent anal bleeding. Continence for normal stool was satisfactory in all patients. In conclusion, sphincter–saving procedure is most appropriate and curative approach for the treatment of diffuse cavernous hemangioma. Imaging study plays an important role in the diagnosis, preoperative staging and follow–up.

Colonoscopy is the first choice for early postoperative rectal anastomotic bleeding

BackgroundAnastomotic bleeding is rare but is one of the dangerous complications, with associated morbidity and mortality, at the early stage of rectal cancer surgery. The aim of this study was to report our experiences in the treatment of this emergency condition.MethodsWe retrospectively analyzed the general characteristics, treatment and outcome of patients with severe anastomotic bleeding after undergoing rectal cancer resection with stapled anastomosis at the Department of Colorectal Surgery of Changhai Hospital (China) between January 2011 and December 2013.ResultsAnastomotic bleeding occurred in six out of 2,181 patients (0.3%) who underwent anterior resection with stapled anastomosis due to rectal cancer. All patients’ bleeding was stopped with colonoscopic techniques. There were no anastomotic leakages or strictures in these six patients.ConclusionsAnastomotic bleeding was a very rare complication after rectal cancer resection with stapled anastomosis. Colonoscopic treatment, including electrocoagulation and clipping, were both safely and effectively used in the early postoperative period to cease persistent anastomotic bleeding.

Preoperative carcinoembryonic antibody is predictive of distant metastasis in pathologically T1 colorectal cancer after radical surgery

AIM To identify the predictors of distant metastasis in pathologically T1 (pT1) colorectal cancer (CRC) after radical resection. METHODS Variables including age, gender, preoperative carcinoembryonic antibody (CEA) level, tumor location, tumor size, lymph node status, and histological grade were recorded. Patients with and without metastasis were compared with regard to age, gender, CEA level and pathologic tumor characteristics using the independent t test or χ(2) test, as appropriate. Risk factors were determined by logistic regression analysis. RESULTS Metastasis occurred in 6 (3.8%) of the 159 patients during a median follow-up of 67.0 (46.5%) mo. The rates of distant metastasis in patients with pT1 cancer of the colon and rectum were 6.7% and 2.9%, respectively (P < 0.001). The rates of distant metastasis between male and female patients with T1 CRC were 6.25% and 1.27%, respectively (P < 0.001). The most frequent site of distant metastasis was the liver. Age (P = 0.522), gender (P = 0.980), tumor location (P = 0.330), tumor size (P = 0.786), histological grade (P = 0.509), and high serum CEA level (P = 0.262) were not prognostic factors for lymph node metastasis. Univariate analysis revealed that age (P = 0.231), gender (P = 0.137), tumor location (P = 0.386), and tumor size (P = 0.514) were not risk factors for distant metastasis after radical resection for T1 colorectal cancer. Postoperative metastasis was only significantly correlated with high preoperative serum CEA level (P = 0.001). Using multivariate logistic regression analysis, high preoperative serum CEA level (P = 0.004; odds ratio 15.341; 95%CI 2.371-99.275) was an independent predictor for postoperative distant metastasis. CONCLUSION The preoperative increased serum CEA level is a predictive risk factor for distant metastasis in CRC patients after radical resection. Adjuvant chemotherapy may be necessary in such patients, even if they have pT1 colorectal cancer.

Pull-through and conformal resection for very low rectal cancer: a more satisfactory technique for anal function after sphincter preserving operation

Background: The aim of this study was to investigate oncologically whether pull-through and conformal resection technique (PTCR) could replace abdominoperineal resection (APR) in selected patients with very low rectal cancer. Methods: This was a retrospective review of prospectively collected data. The study was conducted at a tertiary teaching hospital, Shanghai, China from January 2010 to December 2013. All patients who underwent operations because of very low rectal cancer were enrolled in this study. The primary outcome measured was the development of recurrence including distant metastasis and local recurrence. Anal function was assessed with the Wexner incontinence score and digital examination. Results: A total of 228 patients with very low rectal cancer underwent surgical treatment [coloanal anastomosis (CAA) group 126 patients, APR group 73 patients, and PTCR group 29 patients]. There was no difference in surgical complication rate among the three groups. There were no significant differences in daily fecal frequency, Wexner incontinence score, and rate of satisfactory fecal continence between the CAA and PTCR group. There were no differences in local recurrence and distant metastasis among CAA group, APR group and PTCR group. Conclusions: PTCR is an anus-preserved procedure with clean distal margin and satisfied anal function without compromising short-term oncological outcomes in selected patients with very low rectal cancer.