Right axillary lymph node metastasis of carcinoma of the cecum with histologically proven cutaneous lymphatic invasion by carcinoma cells: a case report.

Axillary lymph node metastasis from colorectal carcinoma is extremely rare, and this scarcity hinders understanding of its pathogenesis and, thus, the application of appropriate management. Here, we present a case with axillary lymph node metastasis of cecal carcinoma associated with macroscopic invasion of the skin of the abdominal wall with histological evidence of such invasion, findings which support our hypothesis that the axillary lymph node metastasis developed via the lymph channels in the skin of the abdominal wall. A 76-year-old woman with cecal carcinoma (T4N1M0), complicated with an abdominal wall abscess, underwent right hemicolectomy with partial resection of the abdominal wall.

Multiple primary malignancies involving primary sporadic colorectal cancer in Japan: incidence of gastric cancer with colorectal cancer patients may be higher than previously recognized.

Background: Improvement in the prognosis of colorectal cancer (CRC) patients has led to increasing occurrences of multiple primary malignancies (MPMs) alongside CRC but little is known about their characteristics. This study was undertaken to clarify the clinical and pathological features of MPMs, especially those at extra colonic sites, in patients with CRC.

Methods: We reviewed 1,111 patients who underwent operations for primary sporadic CRC in Saitama Medical Center, Jichi Medical University between April 2007 and March 2012.

Laparoscopic colectomy for obstructive colorectal carcinoma.

Laparoscopic surgery for obstructive colorectal carcinoma is a controversial issue. Defining the obstructive carcinoma as colonoscopic impassability, the patients with obstructive carcinoma were managed according to the treatment algorithm, by which the indication of open or laparoscopic surgery was determined. As a result, 31 patients with obstructive colorectal carcinoma underwent laparoscopic surgery.

Oncological 3-port laparoscopic colectomy by 1 surgeon and 1 camera operator: a preliminary report.

This retrospective study analyzed the short-term outcomes of oncological reduced-port laparoscopic colectomy (RPLC) using 3 ports performed by 1 surgeon and 1 camera operator. Patients who underwent laparoscopic colectomy for colorectal carcinoma in 2010 and 2011 were divided into 2 groups: the CLC group, which included 62 patients who underwent a conventional laparoscopic colectomy and the RPLC group, which included 28 patients who underwent reduced-port laparoscopic colectomy, respectively. There were no significant differences between the groups with regard to TNM stage, estimated blood loss, complications, conversion rate, pain score, the length of postoperative stay, or the number of harvested lymph nodes.

Comprehensive analysis of chemokines and cytokines secreted in the peritoneal cavity during laparotomy.

We recently found that chemokine-driven peritoneal cell aggregation is the primary mechanism of postoperative adhesion in a mouse model. To investigate this in humans, paired samples of peritoneal lavage fluid were obtained from seven patients immediately after incision (preoperative) and before closure (postoperative), and were assayed for the presence of 27 cytokines and chemokines using multiplex beads assay. As a result, IL-6 and CCL5 showed the most striking increase during operation.

Acute fulminant pseudomembranous colitis which developed after ileostomy closure and required emergent total colectomy: a case report.

Introduction: Pseudomembranous colitis is known to be caused by Clostridium difficile; and, in 3% to 8% of patients, it lapses into an aggressive clinical course that is described as fulminant. We present here a case of extremely rapid and fatal fulminant pseudomembranous colitis that developed after ileostomy closure, a minor surgical procedure. To the best of our knowledge, this is the first case report of fatal fulminant pseudomembranous colitis after closure of a diversion ileostomy in an adult.

Right colectomy with simultaneous vascular reconstruction for celiac and superior mesenteric arterial occlusion.

Introduction: Identification of the primary feeding vessel and its removal with corresponding lymphatics is crucial for oncologic bowel resection for colon cancer. However, this notion would be challenged if we encountered abnormal mesenteric vascular anatomy. We report a case of colon cancer with abnormal mesenteric circulation, for whom we performed oncologic colectomy with vascular reconstruction.

Assessment for frailty is useful for predicting morbidity in elderly patients undergoing colorectal cancer resection whose comorbidities are already optimized.

Background: The clinical syndrome of frailty identified through the assessment of weight loss, gait speed, grip strength, physical activity, and physical exhaustion has been used to identify patients with reduced reserves. We hypothesized that frailty is useful in predicting adverse outcomes in optimized elective elderly colorectal surgery patients.

Methods: A prospective study was conducted at 2 centers (Singapore and Japan).

Interleukin-13 damages intestinal mucosa via TWEAK and Fn14 in mice-a pathway associated with ulcerative colitis.

Background & Aims: TWEAK, a member of the tumor necrosis factor (TNF) superfamily, promotes intestinal epithelial cell injury and signals through the receptor Fn14 following irradiation-induced tissue damage and during development of colitis in mice. Interleukin (IL)-13, an effector of tissue damage in similar models, has been associated with the pathogenesis of ulcerative colitis (UC). We investigated interactions between TWEAK and IL-13 following mucosal damage in mice.

Laparoscopic colorectal surgery in elderly patients: a case-control study of 15 years of experience.

Introduction: The aim of this study was to review the impact of age (≥75 years) on the short-term outcomes of laparoscopic colorectal surgery.

Methods: Three hundred seventy-nine patients under 70 years of age and 91 patients 75 years and older were analyzed. Quantification of comorbidities was performed using the Charlson Weighted Comorbidity Index.

First alert for recurrence during follow-up after potentially curative resection for colorectal carcinoma: CA 19-9 should be included in surveillance programs.

Background: The aim of this study was to evaluate the contribution of each examination included in the postoperative surveillance program, especially that of serum tumor markers.

Patients And Methods: Patients who underwent curative surgery for colorectal carcinoma (CRC) from January 2000 to December 2006 were enrolled. The postoperative surveillance program in our department includes tumor marker (carcinoembryonic antigen [CEA] and carbohydrate antigen [CA] 19-9) measurement every 3 months for 5 years, chest radiograph or chest computed tomography (CT) every 3 months for 2 years and then every 6 months until 5 years, and abdominal CT every 3 months for 2 years and then every 6 months until 5 years.

Patient's appetite is a good indicator for postoperative feeding: a proposal for individualized postoperative feeding after surgery for colon cancer.

Background: In modern postoperative management, early and enforced feeding has been implemented. The aim of this study is to determine the feasibility of individualized feeding according to the patient's appetite.

Methods: Patients who underwent elective surgery for colon cancer from January 2007 to December 2008 were studied.

Trainee surgeons do not cause more conversions in laparoscopic colorectal surgery if they are well supervised.

Introduction: This study was designed to look at the conversion rates and morbidity associated with laparoscopic operations performed by trainee surgeons ascending the learning curve when they are well supervised by staff surgeons.

Methods: A review of 204 consecutive cases was performed. We defined experienced staff surgeons as those who have performed more than 300 laparoscopic resection cases.

Colorectal carcinoma with extremely low CA19-9.

Aim: The aim of this study is to determine the significance of postoperative sequential measurements of serum CA19-9 in patients with extremely low serum level.

Patients And Methods: Serum level of CA19-9 of 1096 patients who underwent surgery was measured preoperatively and every three months after surgery for 5 years. Patients with CA19-9 level of less than 2 U/mL at the time of diagnosis were defined as Extremely Low CA19-9 (ELCA).

Diagnostic accuracy of CT colonography and optical colonoscopy evaluated using surgically resected specimens.

Objective: The aim of this study was to clarify the diagnostic ability of CT colonography (CTC) using surgically resected specimens to avoid inaccuracy associated with optical colonoscopy (OC).

Subjects And Methods: CTC and OC were performed in 152 consecutive patients with colorectal cancer. Forty patients had simultaneous lesions other than the ones for which the surgery was intended, and these lesions were used as the gold standard.

Pathological predictors for lymph node metastasis in T1 colorectal cancer.

Purpose: To clarify pathological predictor for lymph node metastasis in T1 colorectal cancer.

Methods: One hundred and sixty-four patients who underwent surgery for single T1 colorectal cancer were reviewed. The pathological differentiations of non-well differentiation, invasion depth (> or =2 000 microm), lymphatic channel involvement, venous invasion, and tumor budding were selected as candidate predictors.

Visceral obesity predicts surgical outcomes after laparoscopic colectomy for sigmoid colon cancer.

Purpose: This study was designed to assess whether visceral obesity is a more useful predictor of surgical outcomes compared with body mass index after laparoscopic colectomy.

Methods: A total of 133 consecutive patients who underwent elective laparoscopic colectomy for sigmoid colon cancer between April 2001 and April 2007 were included. Obesity was defined by visceral fat area > or = 130 cm(2) or body mass index > or = 25 kg/m(2), and the variables were compared for obese and nonobese patients.

Colonoscopic stigmata of 1 mm or deeper submucosal invasion in colorectal cancer.

Purpose: This study was designed to identify colonoscopic stigmata, indicating substantial invasion into the submucosa by T1 colorectal cancer with sessile morphology, including both flat and protruded types.

Methods: A total of 111 Tis or T1 colorectal cancers were studied retrospectively. The lesions were divided into two groups: Group A (n = 83), Tis or T1 cancers with <1 mm submucosal invasion; and Group B (n = 28), T1 cancers with a >/=1 mm submucosal invasion.

Pelvic drainage for anterior resection revisited: use of drains in anastomotic leaks.

Background: Although routine pelvic drainage in colorectal surgery has not been justified in randomized controlled trials, nevertheless, many surgical institutes routinely use pelvic drains after anterior resection. Some reports have focused mainly on the effect of a pelvic drain on anastomotic complications. The purpose of this study was to assess the effectiveness of pelvic drainage in the management of anastomotic leak following anterior resection.

Long-term efficacy of preoperative radiotherapy for locally advanced low rectal cancer.

Background And Aims: The purpose of this study was to assess the long-term efficacy of preoperative radiotherapy for locally advanced low rectal cancer.

Materials And Methods: Between April 1990 and June 2005, all patients who underwent surgery for low rectal cancer with a pretreatment diagnosis of T3 or resectable T4 without distant metastasis were enrolled. The total dose of radiation was 45 Gy.

cDNA array analysis for prediction of hepatic metastasis of colorectal carcinoma.

Purpose: Distant metastasis is a significant prognostic factor of colon carcinoma. Adjuvant chemotherapy has been shown to decrease its recurrence. However, there are no definitive methods for the diagnosis of hepatic recurrence after potentially curative surgery.

Clinicopathological characteristics of colorectal cancers with loss of imprinting of insulin-like growth factor 2.

Loss of imprinting (LOI), the biallelic expression of an imprinting gene, of insulin-like growth factor 2 (IGF2) has been reported to be associated with colorectal carcinogenesis because of its high prevalence in normal colorectal mucosa as well as cancerous tissue in patients with colorectal cancer. However, the characteristics of colorectal cancer associated with IGF2 LOI have not been clearly demonstrated. In this study, we investigated the IGF2 LOI status of tumor and normal mucosa in 255 consecutive patients with colorectal cancer.

Distribution of lymph node metastasis in T1 sigmoid colon carcinoma: should we ligate the inferior mesenteric artery?

Objective: In standard oncological sigmoid colectomy, the inferior mesenteric artery is ligated either at its origin or at the level of the left colic artery. However, in patients with early-stage carcinoma, the distribution of metastatic nodes may be limited. The aim of this study was to clarify the prevalence and distribution of lymph node metastasis in T1 sigmoid colon carcinoma and to determine the adequate range of lymph node dissection.