Okayama Igakkai Zasshi (Journal of Okayama Medical Association)

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We report a successful laparoscopic resection of a cecal tumor in a 95-year-old Japanese man. The patient visited an initial hospital with a complaint of constipation in March 2014. Computed tomography scan and colonoscopy showed a stenotic ileocecal cancer with pericolic lymph node metastases, and he was referred to our department for management. Since his general condition was maintained, we performed a laparoscopic ileocecal resection with regional lymph node dissection for the patient. The operation achieved curative resection, and the tumor was diagnosed as a moderately differentiated adenocarcinoma and graded as pStage IIIa (pT3, pN0, pM0) according to the Japanese Classification of Colorectal Carcinoma, eighth edition. He was discharged on the 11th postoperative day without perioperative complications. Several large-scale randomized controlled trials （RCTs） revealed that laparoscopic surgeries for colorectal cancers have some advantages compared to open surgeries, including superior short-term outcomes and comparable long-term outcomes. Unfortunately, since these RCTs did not include enough elderly patients, the safety and feasibility of laparoscopic surgery for extremely elderly patients are still unknown. With respect to less-invasive procedures, these advantages of laparoscopic surgery are also thought to be the advantages for elderly colorectal cancer patients.

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We performed laparoscopic and endoscopic cooperative surgery (LECS) for partial colectomy with partial cystectomy in an 80-year-old woman with sigmoidovesical fistula secondary to sigmoid diverticulitis. LECS was designed for local resection of the stomach for gastric submucosal tumors using the endoscopic submucosal dissection (ESD) technique. While conventional open abdominal surgery is very invasive, LECS has enabled surgeons to perform minimally invasive surgery. Although there have been no reported cases in which the bladder was laparoscopically resected after sigmoidovesical fistula division, we were able to safely resect the fistula and preserve the urethral opening by performing laparoscopic and cystoscopic cooperative surgery. There are no previously reported cases in which LECS was performed for partial sigmoidectomy and partial cystectomy ; therefore, we report this as a valuable case, with a review of the literature. We hope that further studies involving more patients will lead to the establishment of this procedure.

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