Concurrent laparoscopic right hemicolectomy and ultra-low anterior resection with colonic J-pouch anal anastomosis for synchronous carcinoma

Clinical outcomes of laparoscopic-assisted synchronous bowel anastomoses for synchronous colorectal cancer: initial clinical experience

The primary aim of this study was to explore the safety and feasibility of laparoscopic-assisted synchronous bowel anastomoses (LSBA) for synchronous colorectal cancer (SCRC). All patients who underwent LSBA for SCRC were retrospectively reviewed and analyzed for clinical and pathological features, technical feasibility and short-term as well as long-term oncological outcomes. Between July 2008 and January 2012, a series of 11 consecutive SCRC patients underwent LSBA. Six patients underwent laparoscopic-assisted right hemicolectomy and anterior resection. Five patients had laparoscopic-assisted right hemicolectomy and sigmoidectomy. There were no intraoperative complications that required open conversions. Mean operation time was 233 (range, 195–285) minutes, and mean estimated blood loss was 224 (range, 100–300) mL. The postoperative course of the patients was uneventful with the mean return to oral intake was 6.9 (range 5–12) days, and mean length of hospital stay was 12.6 (range 9–17) days. All surgical wounds showed good cosmetic outcome, and the mean incision length was 4.1 (range 3.5-5.0) cm. During a median follow-up period of 76 months, no local tumor recurrences were found. LSBA is a potentially feasible and safe procedure for SCRC when performed by an experienced surgeon. Further large clinical controlled trials are warranted to confirm the findings.

One-stage laparoscopy-assisted colectomy for synchronous double colorectal cancers

Synchronous multiple malignant colorectal lesions are rare, and there have been very few studies about one-stage laparoscopic operations in these cases. Here, we evaluated the short-term outcomes of laparoscopy-assisted colectomy (LAC) for synchronous double colorectal cancers. Seven patients underwent one-stage LAC that required two resections and anastomoses in our hospital from 2010 to 2014. We retrospectively examined each patient's background and subsequent surgical outcomes. The median age of patients was 78 years, and the median BMI was 19.8 kg/m² . The median operative time was 190 min, and blood loss was minimal. All resected specimens were extracted through a transumbilical incision. A radical operation was performed safely without procedural accidents or postoperative complications in all cases. The median postoperative hospital stay was 12.5 days. One-stage LAC is considered a safe and viable procedure for resecting synchronous double colorectal cancers. It involves minimal invasiveness and is similar to standard LAC.

Utility of Laparoscopic Surgery for Multiple Synchronous Colorectal Cancers With Two Anastomotic Sites

The frequency of multiple synchronous colorectal cancers is reported to be 2% to 7%. The surgical resection of 2 lesions and having 2 anastomotic sites are rare. According to previous studies, even if there are 2 anastomotic sites, the rate of complications associated with laparotomy will not increase. However, the number of studies confined to cases of laparoscopic surgery is limited. This study investigated effective methods for laparoscopic colorectal resection and their short-term results in cases of multiple synchronous colorectal cancers with 2 anastomotic sites. The safety of these methods were also evaluated. The study was comprised of 4 patients with multiple synchronous colorectal cancers who underwent resection using laparoscopy between January 2011 and March 2015. We retrospectively examined patients with 2 anastomosis sites. A total of 3 patients underwent multiport laparoscopic surgery (5-port) and 1 patient underwent single-port laparoscopic surgery. Complications due to the conversion to laparotomy or intraoperative or postoperative complications were not observed in any patient. Laparoscopic colorectal resection, resulting in 2 anastomosis sites, was performed safely. Compared to open colorectal resection with 2 anastomotic sites, laparoscopic resection was a smaller incision and minimally invasive. Therefore, laparoscopic colorectal resection with 2 anastomotic sites is regarded as a feasible and safe option for multiple synchronous colorectal cancers when tumors are located distantly from each other.

Two-stage laparoscopic curative resection for synchronous multiple colorectal cancers: A case report

A 75-year-old man tested positive for occult blood in the stool. A subsequent examination indicated concurrent locally advanced cancer (cT3) at the hepatic flexure and lower rectum cancer in the external anal sphincter. Because of the locally advanced rectal cancer (cT4), preoperative chemoradiotherapy was administered. First, laparoscopic right hemicolectomy and colostomy were performed at the sigmoid colon. Chemoradiotherapy for rectal cancer was initiated on day 18 after the surgeries. Seven weeks after chemoradiotherapy had been completed, laparoscopic abdominoperineal resection and right lateral pelvic lymph node dissection were performed. This case demonstrated that a second radical surgery for rectal cancer could be performed safely and laparoscopically after laparoscopic colectomy and colostomy.

Laparoscopy-assisted versus open surgery for multiple colorectal cancers with two anastomoses: a cohort study

Laparoscopy-assisted surgery has been widely accepted in the treatment of colorectal cancer. The aim of the present study was to investigate the feasibility and outcomes of laparoscopy-assisted combined resection for multiple colorectal cancers in comparison to open surgery. We retrospectively reviewed patients with synchronous multiple colorectal cancers who underwent combined resection resulting in two anastomotic sites by either open or laparoscopy-assisted surgery in the University of Tokyo Hospital between April 2005 and March 2015. Nine patients underwent laparoscopic surgery using five ports, whereas 16 underwent open surgery. Blood loss was less (median 65 vs 295 mL, p = 0.0015), but the operative time was longer (median 429 vs 310 min, p = 0.09) in the laparoscopic surgery group than in the open surgery group. No intergroup difference was observed in the number of lymph nodes retrieved (median 32 vs 27, p = 0.50). The frequency of clinically significant postoperative complications was also similar between the two groups. Our results suggest that laparoscopy-assisted combined resection is an acceptable alternative to open surgery for multiple colorectal cancers.

Single incision laparoscopic surgery for multiple colorectal cancers

INTRODUCTION

The aim of this study was to evaluate short-term outcomes of single-incision surgery with two segmental colorectal resections and anastomoses for multiple synchronous colorectal cancers.

METHODS

Ten patients with multiple colorectal cancers underwent two synchronous segmental colorectal resections and anastomoses. The methodology of the procedures, operative results, and postoperative outcomes were evaluated.

RESULTS

The median operative time was 270 min (range, 146-427 min), and the median blood loss was 70 mL (range, 10-260 mL). No conversions to open surgery or intraoperative complications occurred. Four cases needed additional ports, and one case required a diverting stoma.

CONCLUSION

SILS with two segmental colorectal resections and anastomoses was safely performed in all cases without severe postoperative complications. This procedure seems to be a feasible option for resecting multiple synchronous colorectal cancers.

Surgery for synchronous colorectal cancers with double colonic anastomoses: A comparison of laparoscopic and open approaches

INTRODUCTION

The aim of this study was to evaluate the safety of laparoscopic double colon resection and synchronous anastomosis for synchronous colorectal cancer.

METHODS

We reviewed 42 consecutive patients who underwent double colon resection and synchronous anastomosis for synchronous colorectal cancer between 2000 and 2014. Clinical characteristics and short-term outcomes were compared between laparoscopic (n = 27) and open (n = 15) groups.

RESULTS

There was no conversion to open surgery in the laparoscopic group. Operating time in the laparoscopic group was significantly longer than in the open group (373 vs 292 min), but estimated blood loss was significantly lower (40 vs 179 mL). Time to first flatus (1 vs 3 days) and length of hospital stay (12 vs 17 days) were significantly shorter in the laparoscopic group. The rate of postoperative complications was similar in both groups (19% vs 27%). The anastomotic leakage rate was 3.7% in the laparoscopic group and 20.0% in the open group.

CONCLUSION

Laparoscopic surgery with double colon resection and synchronous anastomosis for synchronous colorectal cancers is safe and has greater short-term benefits than open surgery. It should be considered as a treatment option under optimal conditions.

Hand-Assisted Laparoscopic (HAL) Multiple Segmental Colorectal Resections: Are They Feasible and Safe?

The objective of this study was to evaluate the short-term outcomes of synchronous hand-assisted laparoscopic (HAL) segmental colorectal resections. The surgical options for synchronous colonic pathology include extensive colonic resection with single anastomosis, multiple synchronous segmental resections with multiple anastomoses, or staged resections. Traditionally, multiple open, synchronous, segmental resections have been performed. There is a lack of data on HAL multiple segmental colorectal resections. A retrospective chart review was compiled on all patients who underwent HAL synchronous segmental colorectal resections by all the colorectal surgeons from our Group during the period of 1999 to 2014. Demographics, operative details, and short-term outcomes are reported. During the period, 9 patients underwent HAL synchronous multiple segmental colorectal resections. There were 5 women and 4 men, with median age of 54 (24-83) years and median BMI of 24 (19.8-38.7) kg/m(2). Two patients were on long-term corticosteroid therapy. The median operative time was 210 (120-330) minutes and median operative blood loss was 200 (75-300) mLs. The median duration for return of bowel function was 2 days and the median length of stay was 3.5 days. We had 2 minor wound infections. There were no deaths. Synchronous segmental colorectal resections with anastomoses using the hand-assisted laparoscopic technique are safe. Early conversion to open and use of stomas are advisable in challenging cases.

Simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach

Laparoscopic resection of rectal cancer or gastric cancer has been advocated for the benefits of a reduced morbidity, a shorter treatment time, and similar outcomes. However, simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy for synchronous carcinoma of rectum and stomach are rarely documented in literature. Endoscopic examination revealed a synchronous carcinoma of rectum and stomach in a 55-year-old male patient with rectal bleeding and epigastric discomfort. He underwent a simultaneous laparoscopy-assisted low anterior resection and distal gastrectomy with regional lymph nodes dissected. The operation time was 270 min and the estimated blood loss was 120 mL. The patient required parenteral analgesia for less than 24 h. Flatus was passed on postoperative day 3, and a solid diet was resumed on postoperative day 7. He was discharged on postoperative day 13. With the advances in laparoscopic technology and experience, simultaneous resection is an attractive alternative to a synchronous gastrointestinal cancer.