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Background/aims: Although previous reports have shown similar recurrence rates and patterns between laparoscopic and open surgery for colorectal cancer, precise data regarding recurrent cases are lacking., Methodology: From January 2007 to December 2011, 137 Patients with colorectal cancer underwent laparoscopic surgery at our hospital. Of the 137 patients, 7 patients with recurrence were analyzed for oncological factors. Their outcomes were compared with those of 13 patients with recurrence of 160 patients who underwent open surgery for colorectal cancer between January 2005 and December 2006., Results: In the laparoscopic group, 1 of 37 patients (2.7%) with pathological Stage II (pStage) and 6 of 37 (16.2%) with pStage III experienced recurrence; in the open surgery group, 4 of 56 patients (7.1%) with pStage II and 9 of 63 patients (14.3%) with pStage III experienced recurrence. Although majority of recurrent patterns was distant metastasis, peritoneal metastasis was observed in 2 patients with pT3 tumors in the laparoscopic group. In contrast, all 3 patients with peritoneal recurrence in the open surgery group had pT4 tumors. In the laparoscopic group, 2 patients with peritoneal metastasis were pT3N1M0, and 1 of them revealed peritoneal carcinomatosis 6 months after surgery and developed chylous ascites as a postoperative complication., Conclusions: Although the recurrence rates and sites were similar between the laparoscopic and open surgery groups, peritoneal recurrence developed only in patients with pT3 tumors in the laparoscopic group. Exfoliation of tumor cells from divided lymphatic vessels might lead to development of peritoneal recurrence after laparoscopic surgery.

Introduction: Until now, no data have been available on the incidence of chylous ascites after laparoscopic colorectal surgery., Methods: From January 2007 to December 2011, 137 patients with colorectal cancer underwent laparoscopic surgery at our institution. The clinical data of the patients with postoperative chylous ascites were compared with those of the patients without chylous ascites., Results: Chylous ascites developed in 9 of the 137 patients (6.5%). Blood loss, operative time, tumor location, and extent of lymph node dissection were not associated with postoperative chylous ascites. Mean postoperative hospital stay for patients with chylous ascites was significantly longer than that for patients without any complications (14 days vs 10 days; P < 0.001). Recurrence was observed in two of the nine patients with chylous ascites; it developed locally and in the liver in one patient, and peritoneal dissemination was seen in the other. The recurrence rate in the chylous ascites group (22.2%) was significantly higher than that in the non-chylous ascites group (3.9%; P = 0.016). The 3-year disease-free survival in the chylous ascites group (76.2%) was significantly lower than that in the non-chylous ascites group (93.4%; P = 0.020); however, the 3-year overall survival rates did not differ between the groups (87.5% vs 94.4%, respectively; P = 0.332)., Conclusion: Chylous ascites are not a rare complication of laparoscopic colorectal surgery. It was managed conservatively in all cases but was associated with longer hospital stays. We recommend careful tissue dissection at a suitable plane and meticulous clipping during lymphadenectomy to prevent chyle leakage when lymphatic invasion is suspected., (© 2013 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.)

Lymphagenesis in gastrointestinal tumors is not well described. To clarify its presence and regulation, we assessed the microlymphatic count (MLC) in colorectal cancer patients. Lymphatic vessels were evaluated by enzyme-histochemistry for 5'-nucleotidase (5'-NA). Since vascular endothelial growth factor (VEGF)-C is reportedly associated with lymphagenesis, the expression of VEGF-C protein was immunohistochemically assessed by the catalyzed signal amplification (CSA) method. MLC of peritumoral lesions was significantly higher than that of non-cancer and intratumoral lesions (p<0.01); it increased where VEGF-C was highly expressed (p<0.01) and increased with the depth of invasion in peritumoral lesions. These results indicate significant findings at peritumoral lesion: that lymphagenesis may be elicited by tumor spread; that VEGF-C expression is associated with lymphagenesis and is a potent factor stimulating lymphagenesis.