Yong Geul Joh

Laparoscopic resection for rectal cancer: a prospective analysis of thirty-month follow-up outcomes in 312 patients

BackgroundThis study aimed to prospectively evaluate operative safety and mid-term oncologic outcomes of laparoscopic rectal cancer resection performed by a single surgeon.MethodsThree hundreds twelve patients (male, 181) were enrolled in this analysis. 257 patients (82.4%) had tumors located below 12 cm from the anal verge. Distribution of TNM stages was 0:I:II:III:IV = 4.2%:17.9%:32.4%:37.2%:8.3%. 225 patients (71.1%) had T3/T4 lesions. Pre- and post-operative radiation was given in 6 and 20 patients, respectively.ResultsSphincter-preserving operation was performed in 85.9%. Mean operating time was 212 minutes. Conversion rate was 2.6%. Overall morbidity rate was 21.1%. Anastomotic leakage occurred in 6.4%. Operative mortality rate was 0.3%. Mean number of harvested nodes was 23. Mean distal tumor-free margin was 2.8 cm. The circumferential resection margin was positive in 13 patients (4.2%). With a mean follow-up of 30 months in the stage I–III patients, the local recurrence rate was 2.9%. Systemic recurrence occurred in 11.7%. No port-site recurrence was observed.ConclusionLaparoscopic resection of rectal cancer provided safe operative parameters and adequate mid-term oncologic outcomes. When considering a high volume of advanced and low-lying cancers but rather narrow indication to radiotherapy, the 2.9% local recurrence rate seems promising data. Long-term follow-up is mandatory to draw conclusion.

Anastomotic Leakage after Laparoscopic Protectomy can be Managed by a Minimally Invasive Approach

PURPOSE: This study was designed to identify the clinical features of anastomotic leakage after laparoscopic resection of rectal cancer and to evaluate the outcomes of laparoscopic management for this problem. METHODS: Prospectively collected data were obtained from 307 patients with rectal cancer who underwent laparoscopic proctectomy and primary anastomosis. Age, sex, tumor location, tumor stage, body mass index, comorbidities, ileostomy, conversion, intraoperative blood loss, operative time, previous abdominal operation, and hospital stay were analyzed for patients with or without anastomotic leakage. Management and outcome of anastomotic leakage also were analyzed. RESULTS: Anastomotic leakage occurred in 29 patients (9.4 percent). Diverting ileostomy was initially fashioned in 65 patients (21.2 percent). Leakage was related to young age, male sex, lower tumor location, and longer operation time. Ten patients (34.5 percent) were successfully managed with conservative treatment. Seventeen patients (58.6 percent) were managed via a laparoscopic approach. Open surgery was performed in two patients who showed diffuse fecal soiling or had previous conversion, respectively. There was no mortality. CONCLUSIONS: When leakage occurs, laparotomy or colostomy is not needed routinely. For surgical intervention, the abdominal cavity should be explored first by laparoscopic visualization because the majority of patients can be successfully managed with laparoscopy and ileostomy.

Clinical results of intraoperative radiation therapy for patients with locally recurrent and advanced tumors having colorectal involvement.

BACKGROUND Intraoperative radiation therapy (IORT) may be useful in the treatment of patients who have a locally advanced primary and recurrent abdominopelvic neoplasm with colorectal involvement. METHODS A retrospective review of colorectal cancer patients treated since 1999 with IORT using the Mobetron device. RESULTS Forty patients underwent colectomy or proctectomy with IORT. All patients had evidence of local extension to contiguous structures and based on preoperative staging were deemed by the operating surgeon as being likely to have incomplete resection. IORT was selected as an alternative to sacrectomy or exenteration for an expected close margin in 10 patients. Mean survival was 35 +/- 26 months, and 1 patient had local recurrence. CONCLUSIONS The introduction of IORT has allowed a selective treatment approach to locally advanced primary and recurrent neoplasms, which traditionally would have been deemed unresectable. Using IORT, extended resections may be avoided in selected high-risk patients with low risk of local recurrence and minimal morbidity.

Relaparoscopy for Salvage Surgery in Anastomotic Recurrence of Rectal Cancer: Feasible and Safe

AbstractLaparoscopic approach to rectal cancer is technically challenging even for experienced laparoscopic surgeons. Therefore, in a locally recurrent rectal cancer not many surgeons would be keen to adopt the relaparoscopy approach. In this video article, we present a case of salvage laparoscopic abdominoperineal resection performed for an isolated anastomotic recurrence developed 13 months after a laparoscopic ultralow anterior resection.

Laparoscopic colorectal surgery using low-pressure pneumoperitoneum combined with abdominal wall lift by placement of anchoring sutures around the camera port

BackgroundThis study aimed to evaluate the feasibility of low-pressure pneumoperitoneum in laparoscopic colorectal surgery.MethodsThe authors designed low-pressure (8 mmHg) laparoscopy combined with abdominal wall lift simply by placement of anchoring sutures around the camera port.ResultsThe operative indications were 176 colon cancers, 297 rectal cancers, and 45 benign diseases. The average blood loss was 92 ml (range, 20–1200 ml), and the mean operating time was 204 min (range, 23–525 min). Conversion to an open procedure was required in eight cases (1.5%). Two patients experienced intraoperative complications. The mean number of removed lymph nodes was 28.9 in the colon cancer cases and 23.1 in the rectal cancer cases. The mean length of resected specimen was 27.3 cm (range, 8.5–136 cm). Postoperatively, cardiopulmonary complications developed in five patients (0.9%).ConclusionsAbdominal wall lifting by anchoring sutures around the camera port in addition to low-pressure pneumoperitoneum is a simple, safe, and effective method for laparoscopic colorectal procedure.

Distribution and Impact of the Visceral Fat Area in Patients With Colorectal Cancer.

Purpose The purposes of this study were to investigate the distribution of the visceral fat area (VFA) and general obesity and to compare visceral and general obesity as predictors of surgical outcomes of a colorectal cancer resection. Methods The prospectively collected data of 102 patients with preoperatively-diagnosed sigmoid colon or rectal cancer who had undergone a curative resection at Pusan National University Yangsan Hospital between April 2011 and September 2012 were reviewed retrospectively. Men with a VFA of >130 cm2 and women with a VFA of >90 cm2 were classified as obese (VFA-O, n = 22), and the remaining patients were classified as nonobese (VFA-NO, n = 80). Results No differences in morbidity, mortality, postoperative bowel recovery, and readmission rate after surgery were observed between the 2 groups. However, a significantly higher number of harvested lymph nodes was observed in the VFA-NO group compared with the VFA-O group (19.0 ± 1.0 vs. 13.5 ± 1.2, respectively, P = 0.001). Conclusion Visceral obesity has no influence on intraoperative difficulties, postoperative complications, and postoperative recovery in patients with sigmoid colon or rectal cancer.