Abstract:AIM:To evaluate the clinical significance of preand intra-operative colonoscopy for the detection of synchronous lesions in colon cancer.
METHODS:Two hundred and sixty-five pre-operative and 51 intra-operative colonoscopic evaluations were performed in 316 colorectal cancer patients who underwent curative resection from January 2001 to June 2006. The incidence and characteristics of synchronous lesions and their influence on surgery were evaluated.
RESULTS:Two hundred and eighty-two synchronous lesions were de… Show more
“…It is difficult to identify certain small tumors on CT, and sometimes complete examination of the large intestine cannot be conducted, due to intestinal lumen stenosis. The combined use of CT and colonoscopy has been reported as a useful tool for the preoperative evaluation of synchronous colorectal carcinoma (15,16). Colonoscopic examination may provide clear images of the whole colon.…”
Abstract. Synchronous colorectal cancers refer to the simultaneous occurrence of multiple colorectal tumors in a single patient, excluding any metastases from other organs. At present, radical surgery is considered the standard curative treatment; however, individualized surgical strategies depend on tumor location, the depth of invasion and the general health of the patient. In the present study, the case of a 52-year-old man who presented with a 2-month history of abdominal pain that was accompanied by intermittent hematochezia and weight loss is reported. The patient had no family history of cancer. Computed tomography (CT) of the abdomen revealed intestinal wall thickness in the transverse colon and volvulus in the hepatic flexure of colon. Colonoscopy identified 3 tumors: The first tumor was located in the descending colon with lumen stenosis ~60 cm from the anal verge, the second tumor was located in the hepatic flexure of the colon, and the third tumor was located in the sigmoid colon, 23 cm from the anal verge. Subsequently, laparoscopic subtotal colectomy was performed and all three tumors were removed, and the diagnosis was confirmed by histopathological examination. The patient did not undergo chemotherapy following surgery, due to personal reasons. Subsequent to 19 months of follow-up examinations using CT and colonoscopy every 6 months, the patient exhibited no signs of recurrence. Thus, laparoscopic subtotal colectomy represents an effective surgical approach for the treatment of synchronous colorectal cancer following imaging and endoscopic diagnosis.
“…It is difficult to identify certain small tumors on CT, and sometimes complete examination of the large intestine cannot be conducted, due to intestinal lumen stenosis. The combined use of CT and colonoscopy has been reported as a useful tool for the preoperative evaluation of synchronous colorectal carcinoma (15,16). Colonoscopic examination may provide clear images of the whole colon.…”
Abstract. Synchronous colorectal cancers refer to the simultaneous occurrence of multiple colorectal tumors in a single patient, excluding any metastases from other organs. At present, radical surgery is considered the standard curative treatment; however, individualized surgical strategies depend on tumor location, the depth of invasion and the general health of the patient. In the present study, the case of a 52-year-old man who presented with a 2-month history of abdominal pain that was accompanied by intermittent hematochezia and weight loss is reported. The patient had no family history of cancer. Computed tomography (CT) of the abdomen revealed intestinal wall thickness in the transverse colon and volvulus in the hepatic flexure of colon. Colonoscopy identified 3 tumors: The first tumor was located in the descending colon with lumen stenosis ~60 cm from the anal verge, the second tumor was located in the hepatic flexure of the colon, and the third tumor was located in the sigmoid colon, 23 cm from the anal verge. Subsequently, laparoscopic subtotal colectomy was performed and all three tumors were removed, and the diagnosis was confirmed by histopathological examination. The patient did not undergo chemotherapy following surgery, due to personal reasons. Subsequent to 19 months of follow-up examinations using CT and colonoscopy every 6 months, the patient exhibited no signs of recurrence. Thus, laparoscopic subtotal colectomy represents an effective surgical approach for the treatment of synchronous colorectal cancer following imaging and endoscopic diagnosis.
“…Huang et al did not observed any complications in 58 patients, in case of whom they performed intraoperational colonoscopy (13). Studies by Korean scientistKim, in case of 265 patients, who had colonoscopy performed during surgical procedure, a disjunction of intestinal anastomosis was observed in 1 patient (1.5%) and wound infection was observed in 3 patients (7.14%) (20). Brullet et al observed only two cases of complications (2.98%), lying in mucosa injuries (10).…”
The aim of the study was to present our experience with the use of intraoperative colonoscopy in patients with obstructing colon cancer in whom complete preoperative colonoscopy was not possible. Material and methods. We treated 480 patients with colon cancer from 2002 to 2008 in our department. In 80 patients (28 female and 52 male) we performed intraoperative colonoscopy due to obstructing colon cancer. Mean age of female patients was 67.8 yrs. (35-84 yrs.) and mean age of male patients was 66.5 yrs. (38-81 yrs.). In all of the patients preoperative complete colonoscopy was not possible. Results. Thanks to intraoperative colonoscopy we revealed new synchronous cancer lesions in 7 patients (8.75%) and therefore we extended the operation. In 28 patients (35%) we revealed polyps which, in 24 (85.7%) cases, were removed endoscopically and in 4 cases we decided to extend the operation. Conclusions. Intraoperative colonoscopy is effi cient method in diagnosis of colon cancer especially in patients with obstructing colon cancer. Thanks to intraoperative colonoscopy patients with synchronous lesions may benefi t from detection of lesions and avoid further operation.
“…The incidence of synchronous tumors in the colon ranges from 1.5 to 9% (average 5%) (12,13). Adenomatous polyp or polyps accompany primary colorectal tumors in 15-50% (14). Therefore, the entire colon should be endoscopically evaluated prior to surgery for colorectal tumors.…”
Objective: Intestinal obstruction due to colorectal tumors requires immediate surgical decompression. Endoscopic stent placement for acute malignant colonic obstruction is gaining widespread acceptance as an alternative to emergency surgery. Our aim in this study was to evaluate the success and complication rates of endoscopic stenting for malignant colonic obstruction.
Material and Methods:Patients with acute malignant colonic obstruction who underwent endoscopic stenting between 2011-2014 were retrospectively reviewed. Data included demographic features, localization of obstruction, endoscopic stenting indications, rate of technical and clinical success, complications, morbidity and mortality.Results: Endoscopic stent was successfully placed in 77 out of 82 procedures (93.9%). A colostomy was placed in five cases in which endoscopic stent could not be inserted. There were complications in seven patients with technically successful stents (9.0%). These included three stent migrations, one perforation, and rectal hemorrhage in three patients. There were no stent-related deaths.
Conclusion:The mortality rate of emergency surgery for malignant bowel obstruction is relatively high. The use of colonic stents can avoid surgery in patients who are not suitable for emergency surgery and may allow adequate time for preoperative preparation, counseling and staging for those who are suitable for further intervention. We believe that self-expandable metallic stent placement is a safe, effective, and minimal invasive alternative treatment method for malignant colonic obstruction.
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