Objective: The aim of this study was to analyze the surgical outcomes of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal peritoneal dissemination.
Methods: A total of 127 cases of colorectal peritoneal dissemination were analyzed and the correlation between peritoneal cancer index (PCI), P classification in Japan, and survival rate was determined.
Results: The 5-year survival rate was 36% after CRS and HIPEC. A macroscopic complete resection (CC-0) was possible in 66% of the cases, and the 5-year survival rate for CC-0 cases was 50%. The 5-year survival rate for P1+P2 patients was 59%, and that for P3 patients was 24%. A total of 51% of P3 patients were able to undergo CC-0 resection, and the 5-year survival rate was 40%. In P3 patients with PCI 0-9, 10-19, 20-29, and 30-39, CC-0 resection was performed in 92%, 67%, 20%, and 0% of cases, respectively, and the 3-year survival rates were 53%, 36%, 17%, and 0%, respectively.
Conclusion: Long-term survival can be obtained even in P3 colorectal cancer patients by CRS and HIPEC. It is important to quantify detailed peritoneal dissemination by PCI and to select cases where a CC-0 resection is expected.
Recently, metastatic colorectal cancer (CRC) patients with a right-side primary tumor have been reported to have a significantly shorter survival period than those with a left-side primary tumor. However, the impact of the sidedness of the primary lesion on the survival outcomes of patients with resectable liver metastases of CRC has not yet been fully investigated. The subjects of this retrospective study were 61 consecutive patients who underwent a hepatectomy for CRC between 2013 and 2018 at our institution. The background data and survival times were compared between 13 patients whose primary lesions were located in the cecum to transverse colon (right-side group) and 48 patients whose primary lesions were located in the descending colon to rectum (left-side group). No significant differences in various clinicopathological variables were observed between the two groups. The 5-year overall rates after hepatectomy were 50.1% for the right-side group vs. 32.5% for the left-side group (p = 0.659). In the right group, there were many cases with progressed disease in both the primary and liver metastases, but there was no significant difference in the survival rate. In conclusion, colorectal liver metastasis should be resected regardless of the sidedness of the primary tumor.
Megacolon refers to the pathological enlargement of the large intestine without mechanical obstruction thereof. Here, we report a case of idiopathic chronic megacolon in which a bowel transit time test using a radiopaque marker was useful in determining the extent of colectomy.
The patient was a 67-year-old man. His past medical history included diabetes and mental illness. He visited a local clinic for vomiting and pain in the left lower abdomen, and a massive sigmoid colon compressing the diaphragm as well as fecal impaction were detected. After he was referred to and hospitalized in our hospital, he underwent defecation function tests, including a bowel transit time test, and gastrointestinal examinations while receiving conservative treatment. Although elective surgery was planned, he went into septic shock after disimpaction; thus, the scheduled Hartmann operation was performed. The postoperative course was uneventful with no requirement for laxatives.
The bowel transit time test can determine the presence or absence of small intestinal dysfunction depending on the marker distribution. This may useful in determining the extent of the intestinal tract that should be resected.
A 72-year-old male was referred to our hospital because of discharging pus from an anal fistula. He had undergone an operation for chronic perineal pyoderma and been cured completely 10 years earlier. On admission, CT and MRI findings showed a subcutaneous abscess with abnormal gas from the perineum to presacral space. Fournier's gangrene was diagnosed and debridement was performed. No evidence of recurrence or new lesion of the anal fistula was found after debridement. Chronic perineal pyoderma is mainly caused by chronic skin infection due to pore occlusion, and in many cases spreads in mainly one subcutaneous space. On the other hand Fournier's gangrene is commonly known as necrotizing fascitis which develops from an anorectal disease like an anal fistula, and spreads through the fascia. In this case, chronic perineal pyoderma in the subcutaneous space relapsed after a long time had probably progressed to Fournier's gangrene.
A 76-year-old man with a history of radical surgery for rectal cancer underwent follow-up contrast-enhanced abdominal computed tomography, which revealed an irregular mass in the right lower abdomen. Notably, 18F-fluorodeoxyglucose-positron emission tomography/computed tomography (FDG-PET/CT) revealed unusual accumulation of FDG in the appendix with a standardized uptake value of 3.57, and he was referred to our hospital.
We performed an appendectomy combined with partial resection of the cecum, including the appendiceal orifice. Histopathological examination of the resected specimen revealed adenoma but no malignancy. The patient's postoperative course was unremarkable, and he was discharged 6 days postoperatively.
Appendiceal adenoma is extremely rare and preoperative diagnosis is challenging. Our case report is the first to describe the diagnosis of this condition based on FDG-PET/CT. Compared with colonic lesions, appendiceal adenomas show high malignant potential, and early clinical diagnosis and total resection are important.
Calcium polystyrene sulfonate (CPS) is a cation exchange resin used for treating hyperkalemia in renal failure patients. This drug causes hard stool and constipation. As a serious side effect, intestinal tract perforation has been reported. We experienced two cases of sigmoid colon perforation in chronic renal failure patients who were taking CPS. Case 1 was an 88-year-old woman receiving hemodialysis, and Case 2 was a 73-year-old woman with chronic renal failure before introducing dialysis. In both cases, surgical intervention elucidated sigmoid perforation near the mesenteric side. Pathological diagnosis revealed CPS crystals accumulated around the intestinal wall of these perforation sites. In chronic renal failure patients, the intestinal wall is vulnerable due to chronic blood flow disturbance caused by uremia and arterial sclerosis. So, the risk of intestinal tract perforation is high due to increased intestinal pressure. Therefore, it is suggested that appropriate defecation control from the start of CPS intake is important for such patients.
Schwannoma occurs rarely in the retroperitoneum. The tumors can attain large sizes and cause surgical difficulties. The patient was a 43-year-old male who was incapacitated by a large pelvic tumor, associated with abdominal pain. The neurologic examination was unremarkable. MRI scan showed a 13 x 10 x 8 cm mass with a high signal on T2-weighted images. The stalk of the tumor continued to the left S4/5 intervertebral foramen. The patient underwent surgery with suspicion of schwannoma arising from the retroperitoneum. First, we separated the tumor from the sacral bone and sacral vessels by the transsacral approach in the prone position. Next, the patient was changed to the dorsosacral position. A huge retroperitoneal tumor was seen, however, we could separate the tumor from adjacent tissue with the caudal dissection line as a guide. The tumor was excised intact within its fibrous capsule. H-E stain showed Antoni A type with a palisade arrangement of cells. On immunohistochemistry, the tumor was positive for S-100 proteins. Finally, the patient was diagnosed with retroperitoneal schwannoma.