Abstract. In this study, a total of 108 patients with primary colorectal cancer who underwent hybrid 2-port hand-assisted laparoscopic surgery (HALS) were classified as 58 patients with colon cancer and 50 patients with rectal cancer. The mean operating time, mean blood loss, postoperative complications, and mean postoperative hospital stay were compared between the two groups. In patients who underwent colon cancer surgery, the mean operating time was 2 h and 26 min, the mean blood loss was 166.3 ml, and the postoperative complications were wound infection in 5/58 patients (8.6%), postoperative ileus in 3 patients (5.2%), and anastomotic stricture in 1 patient (1.7%). There was no anastomotic leakage and no conversion to conventional open laparotomy. The mean postoperative hospital stay was 12.6 days. In patients who underwent rectal cancer surgery, the mean operating time was 3 h and 38 min, the mean blood loss was 238.8 ml, and the postoperative complications consisted of wound infection in 6/50 patients (12.0%), anastomotic leakage in 3/35 patients (8.6%), anastomotic stricture in 3/47 patients (6.4%), postoperative ileus in 3/50 patients (6.0%), and conversion to conventional open laparotomy in 1/50 patients (2.0%). A covering stoma was constructed during surgery in 12/47 patients (25.5%). The mean postoperative hospital stay was 19.1 days. These results suggest that hybrid 2-port HALS (Mukai's operation) could become a standard method for the treatment of colorectal cancer, and that the long-term outcome should be compared in detail with that of standard laparotomy in the future. IntroductionLess invasive surgery such as laparoscopy-assisted colorectal surgery (LACS) has become popular in recent years, and its indications have expanded markedly from additional resection in patients with stage I colorectal cancer to radical resection in patients with stage II/III cancer and palliative surgery for patients with advanced stage IV disease (1-5). Unlike Western countries, where hand-assisted laparoscopic surgery (HALS) and hybrid HALS combined with open manipulation are performed (6-9), the main type of surgery employed in Japan is pure LACS with 5-6 ports including a camera port for manipulation and a small incision of 35-45 mm (10-12). However, at least 3 surgeons experienced with smooth camera operation are required for pure LACS since the operation is mostly performed by the operator and first assistant manipulating four forceps. Pure LACS has the following disadvantages compared with ordinary open laparotomy: i) poor palpation/tactile sensation, ii) limited applicability with respect to large and heavy tumors, ii) difficulty in assessing the total operating field, iv) a longer operating time as laparoscopic manipulation while observing the monitor is the main procedure, and v) a requirement to acquire specific skills and pass the certification exam in Japan. In addition, LACS cannot become the standard operation even at a relatively large general hospital since it requires several experienced surgeons to s...
Abstract. During the initial emergency operation, a temporary loop colostomy (TLC) was constructed at the oral border of the region for subsequent radical resection. Then, radical surgery was performed by hybrid 2-port HALS (Mukai's operation) using the TLC as the hand access site. Left hemicolectomy was done in three patients, sigmoidectomy in two cases, low anterior resection in one case, and Hartmann's operation in one case. Radical surgery was not done in one patient with multiple distant metastases. The mean operating time was 3 h and 7 min (ranging from 1 h and 55 min to 3 h and 47 min), the mean blood loss was 146.4 ml (7-354 ml), the mean duration from TLC to HALS was 11.3 days (8-16 days), and the mean hospital stay after HALS was 13.9 days (9-20 days). Mild wound infection occurred postoperatively in 2/7 patients and ileus occurred in one patient. However, there was no anastomotic leakage/stricture or conversion to conventional laparotomy. These results suggest that 2-stage treatment (Mukai's method with Mukai's operation) is also applicable to large obstructing left colon or rectal cancers. This method is safe, less invasive, and achieves excellent results, including a good cosmetic outcome. IntroductionIn recent years, minimally invasive laparoscopy-assisted colorectal surgery (LACS) has become common, and its indications have expanded considerably from additional resection for early stage I colorectal cancer to radical curative resection of advanced stage II/III cancer and palliative surgery for stage IV patients (1-5). Unlike Western countries, where hand-assisted laparoscopic surgery (HALS) and hybrid-HALS combined with surgery under direct vision are popular (6-9), pure LACS performed via 5-6 ports together with a small incision of 35-45 mm has become the mainstream procedure in Japan (10,11). However, the use of pure LACS is limited in patients with complete bowel obstruction due to left colon cancer, which is an oncologic emergency, and those who need partial resection of tumors infiltrating other organs such as the bladder. In addition, it has been pointed out that the operating time is relatively long (5,(12)(13)(14). In order to solve these problems, we devised hybrid 2-port HALS (Mukai's operation), which involves HALS using a small incision of 45-55 mm as the hand access site, combined with manipulation under direct vision (15). The features of this surgical procedure include the following: i) full grasping manipulation, as well as palpation, can be done with the left hand, enabling protective and smooth handling of even large and heavy tumors; ii) there is little difficulty for anesthesiologists and operating room staff since the procedure is an extension of conventional laparotomy and takes less time than pure LACS and; iii) it is less demanding for surgeons and less time is required to master the procedure, a supervised surgeon who only has experience of standard laparotomy is able to perform it without difficulty. Due to such advantages, hybrid 2-port HALS is applicable to all colorect...
Abstract. The aim of this study was to retrospectively evaluate the effect of adding CPT-11 to postoperative chemotherapy for stage III colorectal cancer. The subjects were 94 patients, including 60 in stage IIIa (≤3 positive nodes) and 34 in stage IIIb (≥4 positive nodes), who underwent curative resection. The clinical outcome was compared between patients receiving 5-FU/LV plus CPT-11 (FLC group) and patients receiving 5-FU/LV alone (FL group). The FLC group (54 patients) had a 3-year relapse-free survival (3Y-RFS) of 68.7%, a 5Y-RFS of 68.7% and a 5Y-OS of 67.1%, while the FL group (40 patients) had a 3Y-RFS of 67.5% (n.s.), a 5Y-RFS of 64.9% (n.s.), and a 5Y-OS of 77.3% (n.s.). There were no significant differences of these parameters between the two groups. For stage IIIa patients, the corresponding survival rates were 92.4, 92.4 and 90.9% in the FLC group (29 patients) vs. 64.5% (p=0.024), 61.1% (p=0.018), and 77.1% (n.s.) in the FL group (31 patients). For stage IIIb patients, the rates were 36.6, 36.6 and 24.8% in the FLC group (25 patients) vs. 77.8% (n.s.), 77.8% (n.s.), and 77.8% (n.s.) in the FL group (9 patients). These results suggest that the 3Y-RFS and 5Y-RFS of patients with stage IIIa colorectal cancer were significantly improved by adjuvant chemotherapy with 5-FU/LV plus CPT-11.
Abstract.Lymph nodes from patients with colorectal cancer were immunohistochemically stained for cytokeratin to investigate the relationship between the presence of occult neoplastic cells (ONCs) and recurrence/metastasis. A total of 80 patients with stage III/Dukes' C colorectal cancer were divided into 16 patients who developed recurrence/metastasis (recurrence group) and 64 patients without recurrence (nonrecurrence group). ONCs were compared between the two groups with respect to i) single cells (≥3 floating ONCs), ii) clusters of cells (1 or more floating aggregates of 2-20 ONCs) and iii) single cells + clusters. When single cells were detected, the sensitivity for recurrence was 87.5% (14/16, p=0.002), the positive predictive value (PPV) was 32.6% (14/43), the specificity was 54.7% (35/64) and the negative predictive value (NPV) was 94.6% (35/37). For clusters, the sensitivity was 87.5% (14/16, p<0.001), PPV was 41.2% (14/34), specificity was 68.8% (44/64) and NPV 95.7% (44/46). With single cells + clusters, the values were 87.5% (14/16, p<0.001), 48.3% (14/29), 76.6% (49/64) and 96.1% (49/51), respectively. These results suggest that the detection of single cells + clusters is a sensitive indicator of a high risk of recurrence/metastasis, while ONCs are useful for identifying the low-risk group of patients with stage III colorectal cancer. IntroductionThe 5-year survival rate of Japanese patients who have stage II/ Dukes' B colorectal cancer without lymph node metastasis and receive curative resection is approximately 80% (colon, 84.5±2.8%; rectum, 79.8±4.0%), whereas the 5-year survival rate is considerably lower at approximately 60% (colon, 74.0±3.5%; rectum, 64.7±4.3%) for patients with stage III/ Dukes' C colorectal cancer and lymph node metastasis who undergo curative resection (1-4). Thus, recurrence/metastasis develops in 30-40% of stage III/Dukes' C patients after curative resection and can be fatal (2,4). According to the pathological concept of breast cancer, positive lymph node metastasis indicates systemic disease with the potential for metastasis to other organs and the presence or absence of lymph node metastasis is considered to be one of the most important clinical markers (5,6). Hematogenous metastasis to the liver or the lungs in patients with lymph node metastasis who undergo curative resection is presumed to occur when cancer cells circulating in the blood during the perioperative period, escape the immune system enter the microcirculation of the liver or the lungs, and find appropriate microenvironment for growth and proliferation (7-10). Various reports have been published about the close relationship between recurrence/metastasis of cancer and detection of occult neoplastic cells (ONCs) positive for cytokeratin immunohistochemical staining and floating in the sinuses of lymph nodes distant from the primary tumors (11-15). ONCs can be semiquantified by a relatively simple immunostaining method and represent floating tumor cells target trapped in the microcirculation of the lymph node...
Abstract. the 5-year relapse-free survival rate (5y-rFs) and the 5-year overall survival rate (5y-os) were calculated for 972 patients (stage I, 206 IntroductionIn recent years, the outcome of patients with primary colorectal cancer in Japan has shown marked improvement with the development of more effective surgical techniques and adjuvant modalities such as chemotherapy and radiation therapy. It has been reported that the 5-year survival rate of patients after curative resection of Dukes' B/stage II colorectal cancer without lymph node metastases is approximately 80-85% (colon, 84.5±2.8%; rectum, 79.8±4.0%) (1-3). on the other hand, the 5-year survival rate of patients with Duke's c/ stage III cancer and lymph node metastases is approximately 60-70% (colon, 74.0±3.5%; rectum, 64.7±4.3%) (1-3). even after curative resection, approximately 30-40% of these patients eventually suffer the life-threatening development of distant metastasis/recurrence. According to the tnM classification, colorectal cancer patients with lymph node metastasis are classified as stage III, which is further divided into stage IIIA (T1/2N1, ≤3 metastatic nodes), stage IIIB (T3/4aN1) and stage IIIc based on the number of metastatic nodes (4). In the 7th edition of the general rules for clinical and pathological studies on cancer of the colon, rectum and Anus (grcpsc; Japanese classification) published in 2006, considerable changes have been made. thus, instead of the Japanese classification being based on the sites of lymph node metastasis, a more specific classification based on the number of lymph node metastases is now employed. According to the revised rules, N1 patients (≤3 nodes) and N2 patients (≥4 nodes) are classified as stage IIIa and IIIb, respectively, regardless of their t factor (5). lymph node metastasis in breast cancer patients is generally considered to be a manifestation of systemic disease, therefore breast cancer stages are subcategorized according to the number of involved lymph nodes. this also reflects the viewpoint that, in various cancers, the number of lymph node metastases is an important prognostic factor that determines the outcome and the survival of the patient (4,6-8). Abbreviations: 5y-rFs, 5-year relapse-free survival; 5y-os, 5-year overall survival; grcpsc, general rules for clinical and pathological studies on cancer of the colon, rectum and Anus;
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