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A case of triple positive antiphospholipid syndrome in the setting of invasive adenocarcinoma of the rectosigmoid colon in a male.

Background Single-Site® port plus one conventional robotic port, a reduced-port robotic surgery (RPRS) for left-sided colorectal cancer, can enable lymphovascular dissection using the Endowrist® function; this allows safe rectal transection through an additional port and maintains the cosmetic advantage of single-incision laparoscopic surgery. Methods Between August 2014 and December 2014, the study group included 11 patients who underwent a RPRS for left-sided colon cancer. Results There was one (9.1%) case of descending colon cancer, six (54.5%) cases of sigmoid colon cancer, and four (36.4%) cases of rectosigmoid colon cancer. The mean total operation time and docking time were 289±77 and 17±7 min. The mean times to soft diet and possible length of stay were 5.6±0.8 and 7.4±0.7 days. The mean total number of lymph nodes harvested was 18.7±7.9. The mean proximal and distal resection margins were 7.8±4.7 and 4.7±2.4 cm. Conclusions Reduced-port robotic surgery for left-sided colon cancer using the Single-Site® system appears to be feasible and safe using the new robotic single-access platform. Copyright © 2015 John Wiley & Sons, Ltd.

Background: Laparoscopic lymphadenectomy around the inferior mesenteric artery (IMA) with preservation of the left colic artery (LCA) remains a controversial approach. The aim of the study was to investigate the clinical outcomes. Methods: This study analysed 211 patients who underwent laparoscopic resection of advanced (≥T3) sigmoid and rectosigmoid colon cancers with D3 lymphadenectomy including 91 high ligations of the IMA (HL) and 120 low ligations with preservation of the LCA (LL) from January 1998 to December 2009. Results: There were no significant differences in operative result between the groups. In stage II cancer, the overall survival rate (94.8% HL vs. 91.8% LL; 95% confidence interval (CI), -0.8 to 0.68, p = 0.920) and disease-free survival (93.0% HL vs. 87.6% LL; 95% CI, -0.8 to 0.40, p = 0.540) did not differ significantly between the two groups. A similar tendency in overall survival was observed in patients with stage III cancer (88.3% HL vs. 86.9% LL; 95% CI, -0.44 to 0.57, p = 0.989) and disease-free survival (71.4% HL vs. 69.8% LL; 95% CI, -0.38 to 0.40, p = 0.637). Conclusions: Laparoscopic lymphadenectomy around the IMA with preservation of the LCA resulted in acceptable clinical outcomes in patients with advanced sigmoid and rectosigmoid colon cancer.

This study aimed (1) to evaluate the impact of clinical factors, particularly operation by trainees, on the short-term outcomes of laparoscopic resection for sigmoid and rectosigmoid cancer, and (2) to determine patients suitable for operation by trainees.From a prospectively maintained single-institution database, we identified 133 patients who underwent laparoscopic resection for sigmoid or rectosigmoid cancer between 2007 and 2010. Gender, age, body mass index (BMI), previous abdominal surgery, tumor location, tumor size, tumor stage, extent of lymph node dissection, and primary surgeon were evaluated using univariate and multivariate analyses to determine the predictive significance of these variables on surgical outcomes including operative time, blood loss, complication, postoperative stay, and retrieved lymph nodes.Multivariate analysis showed that location of the tumor in the rectosigmoid (p0.001), higher BMI (p0.001), operation by trainees (p0.001), male gender (p = 0.002), and greater tumor depth (p = 0.011) were independently predictive of longer operative time. Larger tumor size (p = 0.025) and higher BMI (p = 0.040) were independently predictive of greater blood loss. Larger tumor size was also related to longer postoperative stay (p = 0.001) and a greater number of retrieved lymph nodes (p = 0.001).This study identified operation by trainees as an independent risk factor for longer operative time but with no negative impact on any of the other outcomes. Female patients with a low BMI, sigmoid cancer, shallow tumor depth, and/or small tumor are suitable for operation by trainees.

To demonstrate the usefulness of hydrogel-CT for detecting and staging of rectosigmoid colon cancer.Fifty-four patients with rectosigmoid colon cancers underwent routine CT without (n=27) and with (n=27) rectum distension using a sonographic gel. Rectum distensibility and tumor visualization were evaluated. T and N stages on CT independently recorded by two radiologists were correlated with pathologic staging. Staging accuracies were compared using Fisher's exact test. Diagnostic performances in differentiatingT3 from ≥T3 and N0 from ≥N1 were evaluated using areas under the receiver operating characteristic curves (AZ).Rectum distensibility (3.52) and tumor visualization (3.70) were significantly more scored in the distended group than in the control group (1.44 and 2.04) (P0.0001). Pathologic and CT staging were more correlated in the distended group in both reviewers. Accuracy for staging was higher in the distended group (T: 50-85.2%/N: 59.3-92.6%) than in the control group (T: 45.5-62.5%/N: 33.3-59.3%) without statistical significance except N staging for reviewer 2 (P=0.0091). AZ values for T and N staging in the distended group (T: 0.827-0.989/N: 0.858-0.980) were also higher than in the control group (T: 0.817-0.907/N: 0.544-0.654).Hydrogel-CT can provide better diagnostic performance for T and N staging of rectosigmoid colon cancer.

Aggressive radical R0 resection is necessary for good prognosis in colorectal cancer with adjacent organ invasion. According to the location of the tumor, various pelvic organs are removed in en-block resection. However, en-block resection may be challenging in case with vascular invasion such as external iliac vessels because vascular specialist should be involved and vascular reconstruction is complex procedure than any other surgical procedure. We report the case of a 53-year-old man who underwent curative surgery for rectosigmoid colon cancer invading the left external iliac artery (EIA) and vein (EIV). En-bloc resection of the tumor including external iliac vessels and ureter was performed, and the resected EIA and EIV were reconstructed using the internal iliac artery and vein. This procedure is more physiologic than extra-anatomic bypass and eliminates the need of artificial graft. Consequently, its use may improve patency and decrease the risk of graft infection.

Intussusception in adults is a rare phenomenon involving the colon in approximately 20% of cases. A 65-year-old man was hospitalized with anorexia, anemia, dehydration, and melena. Digital rectal examination revealed a palpable mass approximately 5 cm from the anal verge. The mass moved between the rectosigmoid colon and the rectum below the peritoneal reflection during radiographic examinations and during sigmoidoscopy. We strongly suspected a rectosigmoid pedunculated tumor and performed a low anterior resection. Intraoperatively we observed intussusception of the rectosigmoid colon with easy manual reduction. The tumor was palpable in the rectosigmoid colon. The postoperative course was uneventful. This case illustrates intussusception of a rectosigmoid type 1 colon adenocarcinoma mimicking a pedunculated tumor.

This paper describes a rare clinical case of a successful treatment of a patient with cancer of the rectosigmoid portion of the colon complicated by a urinary bladder and large intestinal fistula., В статье приведен редчайший клинический случай успешного лечения больного раком ректосигмоидного отдела толстой кишки, осложненного мочепузырно-толстокишечным свищем., У статті наведено рідкісний клінічний випадок успішного лікування хворого на рак ректосигмоїдного відділу товстої кишки, ускладнений сечоміхурово-товстокишковою норицею.

See Article on Page 77-82 In colorectal surgery, safe anastomosis following complete tumor removal is an essential element. Colorectal surgeons inevitably encounter anastomosis-related complications, such as leakage, stenosis, or bleeding. Anastomosis leakage is associated with not only poorer short-term clinical outcomes, but also unfavorable oncologic outcomes [1]. In addition, anastomosis stenosis compromises the patient's quality of life. The use of the circular stapler has facilitated sphincter-preserving surgery for sigmoid colon or rectal cancer, and the stapling technique has become popular. However, that stapler device does not always guarantee a 100% safe colo-colic or colo-rectal anastomosis. In this regard, a compression anastomosis device (Colon Anastomosis Ring-ColonRing, NiTi Surgical Solutions, Netanya, Israel) has been introduced. However, small-scale animal and human studies have shown comparable results between stapled and compression anastomosis [2]. In this issue of the Annals of Coloproctology, Kwag et al. [3] published their retrospective data. The authors evaluated the safety and efficacy of the compression anastomosis device in 67 colon cancer patients and observed that the compression anastomosis device did not increase the incidence of anastomosis-related complications. This type of study, which investigates a new surgical device, always deserves to be applauded as new techniques carry unknown risks and a learning curve. However, this study was based on a retrospective, small series and only included data on colon cancer patients. In a recent study, Kang et al. [4] evaluated a total of 20 cases of compression anastomosis (anterior resection, 11; low anterior resection, 9) and experienced one anastomosis leakage in patients with rectosigmoid colon cancer. The compression anastomosis technique needs more large-scale clinical studies and more data on rectal cancer surgery before it will be accepted. A bad workman finds fault with his tools. For good gastrointestinal anastomosis, strict adherence to operative principles may be more important than the type of surgical device used. These principles include adequate exposure of the surgical field, the use of well-vascularized tissue, absence of tension, no fecal contamination, watertight closure, mucosal apposition and meticulous technique [5].