Purpose In the present study, we focused on the accessory middle colic artery and aimed to increase the safety and curative value of colorectal cancer surgery by investigating the artery course and branching patterns. Methods We included 143 cases (mean age, 70.4 ± 11.2 years; 86 males) that had undergone surgery for neoplastic large intestinal lesions at the First Department of Surgery at Yamagata University Hospital between August 2015 and July 2018. We constructed three-dimensional (3D) computed tomography (CT) angiograms and fused them with reconstructions of the large intestines. We investigated the prevalence of the accessory middle colic artery, the variability of its origin, and the prevalence and anatomy of the arteries accompanying the inferior mesenteric vein at the same level as the origin of the inferior mesenteric artery. Results Accessory middle colic artery was observed in 48.9% (70/143) cases. This arose from the superior mesenteric artery in 47, from the inferior mesenteric artery in 21, and from the celiac artery in two cases. In 78.2% (112/143) cases, an artery accompanying the inferior mesenteric vein was present at the same level as the origin of the inferior mesenteric artery; this artery was the left colic artery in 92, the accessory middle colic artery in 11, and it divided and became the left colic artery and the accessory middle colic artery in 10 cases. Conclusion 3D CT angiograms are useful for preoperative evaluation. Accessory middle colic arteries exist and were observed in 14.9% of cases.
We aimed to evaluate the advantages and disadvantages of initial robotic surgery for rectal cancer in the introduction phase. This study retrospectively evaluated patients who underwent initial robotic surgery (n = 36) vs. patients who underwent conventional laparoscopic surgery (n = 95) for rectal cancer. We compared the clinical and pathological characteristics of patients using a propensity score analysis and clarified short-term outcomes, urinary function, and sexual function at the time of robotic surgery introduction. The mean surgical duration was longer in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (288.4 vs. 245.2 min, respectively; p = 0.051). With lateral pelvic lymph node dissection, no significant difference was observed in surgical duration (508.0 min for robot-assisted laparoscopy vs. 480.4 min for conventional laparoscopy; p = 0.595). The length of postoperative hospital stay was significantly shorter in the robot-assisted laparoscopy group compared with the conventional laparoscopy group (15 days vs. 13.0 days, respectively; p = 0.026). Conversion to open surgery was not necessary in either group. The International Prostate Symptom Score was significantly lower in the robot-assisted laparoscopy group compared with the conventional laparoscopy group. Moderate-to-severe symptoms were more frequently observed in the conventional laparoscopy group compared with the robot-assisted laparoscopy group (p = 0.051). Robotic surgery is safe and could improve functional disorder after rectal cancer surgery in the introduction phase. This may depend on the surgeon’s experience in performing robotic surgery and strictly confined criteria in Japan.
Background Transabdominal robotic surgery and transanal total mesorectal excision (TaTME) are newly introduced strategies for rectal cancer. These procedures might have many advantages in rectal cancer treatment in terms of improving oncological and functional outcomes, especially in cases involving advanced cancer or technical difficulty. In the present study, we aimed to clarify the advantages and disadvantages of transabdominal robotic surgery and laparoscopic TaTME as a hybrid surgery for rectal cancer. Materials and methods We retrospectively evaluated six patients who underwent hybrid surgery for rectal cancer from August 2018 to April 2020. Both clinical and pathological outcomes were assessed. Results Two patients showed circumferential margin involvement both before and after neoadjuvant therapy. Three patients were planned to undergo hybrid surgery with intersphincteric resection because of a narrow pelvis. One patient was planned to undergo hybrid surgery for a giant tumor of >10 cm. The median length of hospitalization was 17 days. No patients required conversion to an open procedure. All patients underwent formation of defunctioning ileostomies. Two patients had a stapled anastomosis and four had a hand-sewn coloanal anastomosis. Complications included one case of anastomotic leakage, which was managed conservatively with ultrasound- and computed tomography-guided drainage and antibiotics. Histological analysis revealed that all specimens had a negative radial margin and distal margin. The median number of lymph nodes harvested was 17.5. Two patients showed extensive lymph node metastases, including lateral node metastasis. Conclusion Hybrid surgery was performed safely and may improve oncological outcomes for rectal cancer. This technique has many potential benefits and would be alternative option in multimodal strategies for rectal cancer.
Background: Undifferentiated carcinoma of the colon is rare, and its prognosis is very poor. We report a case of undifferentiated carcinoma of the colon with rhabdoid features developed during treatment of non-small lung carcinoma (NSCLC) with pembrolizumab. Case presentation: A 58-year-old man was diagnosed with transverse colon cancer during chemotherapy with pembrolizumab for NSCLC. Laparoscopic right hemicolectomy was performed. The histopathological diagnosis was undifferentiated carcinoma with rhabdoid features and lymph node metastasis. Immunohistochemically, programmed death ligand 1 (PD-L1) showed positivity. The microsatellite instability (MSI) status was low. He continued to receive pembrolizumab for NSCLC, and there have been no signs of colon cancer recurrence and progression of NSCLC for 15 months. Conclusion: We present the case of an undifferentiated carcinoma of the transverse colon with rhabdoid features. The development of the tumor with the expression of PD-L1 during pembrolizumab might have been associated with the low MSI.
The element magnesium (Mg) is involved in various metabolic reactions within the human body, and its deficiency is considered a risk factor for several diseases. In this study, we investigated the relationship between serum Mg levels and mortality in a community-based population. We prospectively assessed the association between serum Mg levels at enrollment and all-cause mortality in 1,314 participants who underwent a community health examination. The mean serum Mg level was 2.4 (60.2) mg/dL. Patients with serum Mg levels #2.3 mg/dL constituted the low Mg group, while those with serum Mg $2.4 mg/ dL constituted the high Mg group. Ninety-three (7.1%) patients died during the 10-y follow-up period. Kaplan-Meier analysis revealed that all-cause mortality was significantly higher in the low Mg group (log-rank p,0.05). Cox proportional hazards analysis revealed a significant association in the unadjusted model (hazard ratio [HR] 1.72, 95% confidence intervals [CI] 1.14-2.58, p,0.01) and in the fully adjusted model (HR 1.73, p,0.05). This association was particularly strong in males (HR 2.08, 95% CI 1.19-3.63, p,0.05). Low serum Mg levels were significantly associated with the risk of all-cause mortality among males in a community-based Japanese population.
Purpose We delineated the learning phases of robot-assisted laparoscopic surgery for rectal cancer and compared the surgical and clinical outcomes between robot-assisted laparoscopic surgery and conventional laparoscopic surgery. Methods In total, 210 patients underwent rectal cancer surgery at Sendai Medical Center from 2015 to 2020. Conventional laparoscopic surgery was performed in 110 patients, while robot-assisted laparoscopic surgery was performed in 100 patients. The learning curve was evaluated using the cumulative summation method, risk-adjusted cumulative summation method, and logistic regression analysis. Results The risk-adjusted cumulative summation learning curve was divided into three phases: phase 1 (cases 1–48), phase 2 (cases 49–80), and phase 3 (cases 81–100). The length of hospital stay (13.1 days vs. 18.0 days, respectively; p = 0.016) and the surgical duration (209.1 minutes vs. 249.5 minutes, respectively; p = 0.045) were significantly shorter in the robot-assisted laparoscopic surgery group (phase 3) than in the conventional laparoscopic surgery group. The volume of blood loss was significantly lower in the robot-assisted laparoscopic surgery group (phase 1) than in the conventional laparoscopic surgery group (17.7 ml vs. 79.7 ml, respectively; p = 0.036). The International Prostate Symptom Score was significantly lower (indicating less severe symptoms) in the robot-assisted laparoscopic surgery group (p = 0.0131). Conclusions Robot-assisted laparoscopic surgery for rectal cancer was safe and demonstrated better surgical and clinical outcomes, including a shorter hospital stay, less blood loss, and a shorter surgical duration, than conventional laparoscopic surgery. Tactile familiarity can be acquired from visual information beyond 80 cases.
安次富裕哉 1) 渡邊 利広 1) 菅原秀一郎 1) 蘆野 光樹 1) 髙橋 良輔 1) 中野 亮 1) 樺澤 崇允 2) 木村 理 1) 1) 山形大学医学部外科学第一講座 2) 山形大学医学部病理診断学講座 症例は 78 歳の女性で,肝胆道系酵素の上昇のため当院へ紹介された.CT で十二指腸乳頭部に低濃度腫 瘤を認め,動脈相では一部が高濃度に造影された.また,下膵頭後部に造影される腫大リンパ節を認めた. 超音波内視鏡検査で主膵管内に高エコー腫瘤,膵頭部背側に腫大リンパ節を認めた.ERCP で主膵管内に 腫瘍による透亮像があり,膵管内超音波検査では主膵管内腫瘍は乳頭部に連続していた.十二指腸乳頭開 口部には露出腫瘤型の腫瘍があり,生検で tubulovillous adenoma であった.十二指腸乳頭部内分泌腫瘍も しくは十二指腸乳頭部癌の主膵管内進展として膵頭十二指腸切除術を施行した.病理組織学的検査ではリ ンパ節転移を伴う十二指腸乳頭部神経内分泌腫瘍と主膵管型膵管内乳頭粘液性腺腫が併存していた.この ような症例は非常にまれと考えられ,術前診断も困難であった. キーワード:神経内分泌腫瘍,膵管内乳頭粘液性腫瘍,リンパ節転移 はじめに 十二指腸乳頭部神経内分泌腫瘍(neuroendocrine tumor;以下,NET と略記)はまれであるが,1 cm 以下 の微小腫瘍であってもリンパ節転移を来す可能性は決して低くない 1 ) .その一方で膵管内乳頭粘液性腫瘍 (intraductal papillary mucinous neoplasm;以下,IPMN と略記)や通常型膵管癌に NET が併存していたとい う報告 2 )~ 4 ) は散見され,膵内・外分泌腫瘍の発生においては相互に関連がある可能性が指摘 5 ) されている が,十二指腸乳頭部 NET と IPMN の併存に関する報告はない.今回,我々はリンパ節転移を伴う微小十二 指腸乳頭部 NET に,乳頭部から連続する主膵管型 IPMN を伴った非常にまれな 1 例を経験したので報告す る. 症 例 患者:78 歳,女性 主訴:なし. 既往歴:高血圧症(18 歳) ,卵巣囊腫(24 歳) ,うつ病(58 歳) ,急性膵炎(75 歳) 現病歴:近医で肝胆道系酵素の上昇を指摘され,腹部 US,単純 CT で十二指腸乳頭部癌が疑われ,精査 加療目的に当院へ紹介された. 入院時現症:身長 153 cm,体重 42.4 kg,体温 36.9°C,血圧 109/66 mmHg,脈拍 80 回/分. 〈2019 年 3 月 27 日受理〉別刷請求先:安次富裕哉 〒 990-9585 山形市飯田西 2-2-2 山形大学医学部外科学第一講座 日本消化器外科学会雑誌.2019;52(8):456-464 症例報告 Key Words: neuroendocrine tumor, intraductal papillary mucinous neoplasm, lymph node metastasis [Jpn J Gastroenterol Surg. 2019;52(8):456-464]
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.