Smaller incisions may be the major reason for reduced invasiveness of laparotomy. The aim of this study was to clarify the feasibility and safety of a minimal skin incision for colorectal cancer resection. Between April 2005 and February 2008, 122 consecutive patients (56 women, 66 men) were enrolled in this prospective study and scheduled to undergo resection for colorectal cancer using a single minimal skin incision. All of the operations were performed by a single surgeon. The patients were grouped into “small-incision” (≤7 cm), “medium-incision” (>7 and ≤14 cm), and “large-incision” (>14 cm) for comparison. The small-incision, medium-incision, and large-incision groups included 64 (52.5%), 38 (31.1%) and 20 (16.4%) patients, respectively. The median length of laparotomy incision in the small-incision and medium-incision groups (102 patients) was 7 (interquartile range 7-10) cm. There was no operative mortality. The group with larger length of skin incision had longer operation time, greater operative blood loss, higher rate of postoperative complications and longer postoperative stay. Failure of the small-incision was significantly associated with tumor location (splenic flexure/rectum) and tumor characteristics (adhesion/invasion of tumor into adjacent organs, and/or tumor diameter ≥6.0 cm). This experience suggests that the majority of colorectal cancer resection can be safely accomplished via a median length of skin incision of 7 (interquartile range 7-10) cm.

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OBJJECTIVE: To determine the genotypes of four candidate genes in Japanese women with a history of preeclampsia, and in a control group of parous woman. STUDY DESIGN: Fifty-two pregnant women with a history of preeclampsia in their first pregnancy and 113 normotensive gravid women were studied. All subjects were Japanese women with singleton gestations. Genomic DNA was extracted, and genotypes of angiotensinogen (AGT), methyleneteterahydofolate reductase (MTHFR), factor V Leiden, and prothrombin genes were analyzed. RESULTS: The frequencies of homozygous AGT gene mutation and homozygous MTHFR gene mutation in preeclampsia were significantly higher than that in control. The calculated risk associated with the presence of both mutations did not exceed the risk with polymorphism of each gene. None of the examined cases showed polymorphism of factor V Leiden and prothrombin G20210A genes. CONCLUSION: In Japanese patients with preeclampsia, the angiotensinogen gene and particularly MTHFR gene may play a role in the pathogenesis of preeclampsia.

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A 69-year-old man was admitted to our hospital with loss of appetite, constipation and diarrhea. Upper gastrointestinal barium study and endoscopy revealed a Borrmann type III-like gastric cancer. Biopsy specimens showed poorly differentiated adenocarcinoma. Total gastrectomy with lymph nodes dissection was performed. The tumor histologically consisted of diffuse proliferation of large and round cells presenting as an organoid, trabecular or sheet-like structure accompanied by a small amount of multinuclear giant cells. The tumor cells were histochemically positive for Grimelius stain and were immunohistochemically, extensively and diffusely positive for chromogranin A. These findings led us to a diagnosis of large cell neuroendocrine carcinoma (LCNEC). This entity of the stomach is not clearly recognized at present. Clinicopathological characteristics of LCNEC of the stomach must be defined so that an appropriate treatment can be developed.

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Background : Meckel's diverticulum is a congenital anomaly of the gastrointestinal tract and is situated 40-130 cm from the ileocecal junction. Thus, it is difficult to detect endoscopically prior to surgery. However, double-balloon enteroscopy (DBE) enables the entire small intestine to be examined.Case Report : A 29-year-old man presented with a 4-day history of melena without abdominal pain. Upper gastrointestinal endoscopy, colonoscopy, abdominal contrast-enhanced computed tomography, radiolabeled red cell scintigraphy, and technetium(Tc) 99m pertechnetate scintigraphy did not detect the source of bleeding. However, on retrograde DBE, a Meckel's diverticulum, which had a small ulcer, was found in the distal part of the ileum. The diverticulum was resected laparoscopically. The patient's postoperative course was uneventful; the patient continues to be in complete remission.Conclusions : This is the case of the Meckel's diverticulum that was preoperatively diagnosed using DBE.

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A minilaparotomy approach (≤ 7 cm) for colorectal cancer resection is feasible and safe. Such minilaparotomy generally employs a small vertical incision. A low transverse abdominal incision (a Küstner incision) has been shown to be associated with cosmetic advantage, less postoperative pain, and fewer wound-complications than the midline incision. We report three cases (75-year-old female, 64-year-old male, and 74-year-old female) who underwent anterior resection of rectal cancer via a minilaparotomy approach employing the Küstner incision. No hand-port or laparoscope was used. The median body mass index was 18.9 (range, 18.3-19.3) kg/m². The rectal tumors were located in the rectosigmoid and the upper rectum. There were no intraoperative complications. The median operating time and operative blood loss were 160 (range, 159-162) min and 80 (range, 30-90) ml, respectively. All tumors were curatively resected. The patients quickly returned to normal function without morbidity or mortality. No patients developed wound-related complications. During a median follow-up period of 27.4 (range, 26.8-29.0) months, all patients are alive without tumor recurrence. In addition, neither incisional hernia nor nerve damage developed. We conclude that the minilaparotomy approach employing a Küstner incision is a less invasive and an attractive method with a cosmetic advantage for rectal cancer resection in selected patients.

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