A 64-year-old man with alcoholic cirrhosis was referred to our hospital because of wall thickening in the terminal ileum found by CT scan performed to investigate the cause of right lower abdominal pain and bloody stools. Capsule endoscopy and double-balloon endoscopy showed multiple submucosal tumors (SMTs) in the middle to lower small intestine. Histological examination of the SMTs demonstrated proliferation of atypical cells having round shaped nuclei and eosinophilic cytoplasm, arranged in a nested pattern. Neuroendocrine tumor (NET) in the ileum was diagnosed and surgery was performed. Intraoperative findings revealed multiple tumors located in the ileum 315 cm to 365 cm from the Treitz ligament, and partial resection of the small intestine was performed. In addition, intraoperative endoscopy showed tumors in six other locations, and so wedge resection of the tumors was performed to avoid nutritional disturbance and deterioration of liver function. Pathological findings of the resected specimens revealed that all tumors were NET (G1, G2). We describe here a rare case of multiple NETs involving the small intestine treated by laparoscopic surgery.
Objective: We assessed the optimal regions for central lymph node dissection while evaluating the safety of our standardized surgical procedure. The procedure involved dorsal mesenteric mobilization from the outside of the duodenojejunal flexure in patients with splenic flexure colon cancer. Methods: Fifty patients with splenic flexure colon cancer, who received surgical treatment between 2008 and 2020, were assessed. The individual distribution of feeding arteries and lymph nodes was compared according to tumor localization. Surgical outcomes were compared before (n=32) and after (n=18) standardization of the surgical procedure. Results: Tumors of the transverse colon had a wide variety of feeding arteries: 26.3% of tumors were fed by the left branch of the middle colic artery, 15.8% by the left colon artery (LCA), and 54.1% were fed by two or more vessels. The LCA alone fed 69% of the tumors in the descending colon. After standardizing procedures, surgical duration was significantly shortened (345 vs. 277 min; P=0.03). There was no difference in post-operative complications between the two groups. Conclusion: Our extensive anatomical knowledge on central lymph node dissection aided our standardized procedure, which was deemed a safe surgical treatment for splenic flexure colon cancer.
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