Laparoscopic Assisted Colectomies in Kidney Transplant Recipients with Colon Cancer

Laparoscopic Surgery for Sigmoid Colon Cancer in a Patient With a History of Two Renal Transplantations and Peritoneal Dialysis

The development of transplantation technology has improved the prognosis of transplantation surgery; however, the negative impact of immunosuppressive drugs has increased the number of patients with cancer after transplantation. Recently, minimally invasive surgery has become more common for cancer treatment. We report our experience of performing laparoscopic sigmoid colon resection for a patient with a history of two renal transplantations and peritoneal dialysis. A 42-year-old male patient who developed purpura nephropathy underwent renal transplantation at ages eight and 34 years. He had been on peritoneal dialysis for five years before the second transplantation. The patient was referred to our department with the chief complaint of sudden abdominal pain. After an examination of imaging, we obtained a diagnosis of sigmoid colon cancer. Despite a history of peritoneal dialysis, laparoscopic sigmoid colon resection was successfully performed without complications after confirming that there were no adhesions in the abdominal cavity. The left lower port position had to be adjusted because the transplanted kidney protruded into the left iliac fossa. No postoperative complications and graft loss occurred. In this case, laparoscopic surgery was effective in lowering the risk of damage to the transplanted kidney and safely performing the procedure. The number of colorectal cancer cases in renal transplant patients is expected to increase, and some of these patients will have a history of peritoneal dialysis, which may make surgery more difficult. The successful outcome of this case highlights that laparoscopic surgery could be viable for patients with such a complex medical history.

Laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation: a case report

Background

Although obstructive colitis with colon cancer is not a rare disease, most cases can be improved with conservative therapy. We report a case of a patient who underwent a laparoscopic two-stage operation for rectal cancer with refractory obstructive colitis after kidney transplantation.

Case presentation

The patient was a 71-year-old man taking immunosuppressants who had previously undergone right living kidney transplantation for chronic nephritis. He presented to hospital complaining of abdominal pain and was diagnosed as having rectal cancer with obstructive colitis. Although conservative therapy by fasting was continued for 5 weeks, his obstructive colitis did not improve. Therefore, we decided to perform a two-stage operation. First, we performed a laparoscopic Hartmann’s operation. It took 6 months for his obstructive colitis to improve after this operation, and then we performed a laparoscopic colorectal anastomosis. There were no postoperative complications in either operation.

Conclusion

A laparoscopic two-stage operation could be one of the operative options to reduce postoperative complications in patients with comorbidities such as taking immunosuppressants.

The impact of immunosuppression on postoperative graft function after graft-unrelated surgery: a retrospective controlled cohort study

Background

Physicians are faced with a growing number of patients after renal transplantation undergoing graft-unrelated surgery. So far, little is known about the postoperative restitution of graft function and the risk factors for a poor outcome.

Methods

One hundred one kidney transplant recipients undergoing graft-unrelated surgery between 2005 and 2015 were reviewed retrospectively. A risk analysis was performed and differences in creatinine, GFR and immunosuppressive treatment were evaluated. Additional, a comparison with a case-matched non-transplanted control group were performed.

Results

Preoperative creatinine averaged 1.88 mg / dl [0.62–5.22 mg / dl] and increased to 2.49 mg / dl [0.69–8.30 mg / dl] postoperatively. Acute kidney failure occurred in 18 patients and 14 patients had a permanent renal failure. Significant risk factors for the development of postoperative renal dysfunction were female gender, a preoperative creatinine above 2.0 mg / dl as well as a GFR below 40 ml / min and emergency surgery. Patients with tacrolimus and mycophenolate mofetil treatment showed a significant lower risk of renal dysfunction than patients with other immunosuppressants postoperatively. Contrary to that, the risk of patients with cyclosporine treatment was significantly increased. Transplanted patients showed a significantly increased rate of postoperative renal dysfunction.

Conclusions

The choice of immunosuppressant might have an impact on graft function and survival of kidney transplant recipients after graft-unrelated surgery. Further investigations are needed.

Electronic supplementary material

The online version of this article (10.1186/s12882-019-1358-2) contains supplementary material, which is available to authorized users.

Laparoscopic-Assisted Resection for Advanced Colorectal Cancer in Solid Organ Transplant Recipients

AIM

To evaluate the feasibility, short- and long-term outcomes, and safety of laparoscopic resection for advanced colorectal cancer (CRC) in solid organ transplant recipients.

METHODS

Between September 2001 and April 2016, five patients who underwent laparoscopic-assisted resection for CRC after solid organ transplantation were included in this study. Their clinical data were retrospectively analyzed with regard to patient demographics, immunosuppressive therapy, tumor characteristics, surgical outcomes, and follow-up data.

RESULTS

Four kidney and one heart transplant recipients were included. Laparoscopic-assisted low anterior resection was performed in four patients with rectal or rectosigmoid junction cancer, and sigmoidectomy was done in one with sigmoid colon cancer. One kidney transplant patient received a protective loop transverse colostomy. All resections achieved complete tumor removal with tumor-free margins and total mesorectal excision, with an average number of 14 lymph nodes harvested. Most tumors were in stage III (n = 3), one was in stage II, and one in stage IV. The mean duration of surgery, intraoperative blood loss, and postoperative hospital stay were 144 min, 105 mL, and 8.8 days, respectively. No major complications occurred and graft function stayed well. During a mean follow-up period of 62 months, two patients developed metastasis and died eventually.

CONCLUSION

Laparoscopic resection for advanced CRC in organ transplant recipients is technically feasible and therapeutically safe, and seems to have the advantages of few postoperative complications, short recovery time, and acceptable oncological outcomes.

Laparoscopic assisted low anterior resection for advanced rectal cancer in a kidney transplant recipient: A case report

INTRODUCTION

Development of de novo malignancy has become a major cause of late mortality in solid organ transplant recipients. Surgery is currently the most important treatment of choice for transplant patients with resectable CRC. However, conventional open surgery represents a great risk to these high-risk patients. They seem to benefit more from laparoscopic surgery, based on the favorable oncological outcome and remarkable short-term advantages of this approach.

PATIENT CONCERNS

In this study, we have reported a case of a 50-year-old man who had underwent kidney transplantation for 4 years. He presented with recurrent hematochezia and frequent loose stools for 1 year, and consulted a doctor for recent progressive general malaise and weight loss.

DIAGNOSES

Colonoscopy revealed a near-circumferential mass at the middle rectum about 8 cm from anal verge. Further biopsy confirmed a diagnosis of adenocarcinoma. Following computed tomography demonstrated peripheral lymph node metastasis, but no signs of distant metastasis.

INTERVENTIONS

The patient underwent a laparoscopic assisted low anterior resection with total mesorectal excision for rectal cancer. Concomitantly, a loop transverse colostomy was performed to prevent anastomotic leakage. The surgery was completed within 120 min with a blood loss of 100 mL, and immunosuppressive therapy was not stopped perioperatively. Considering the tumor stage of pT3N1M0, the patient also received adjuvant chemotherapy with a regimen of FOLFOX for 8 cycles.

OUTCOMES

Anastomotic bleeding occurred in this patient about 4 h after surgery, and a control of hemorrhage per anus was performed timely. The following postoperative course was uneventful without any complications, and graft function stayed well. After 4 months of follow-up period, the patient was in a good condition. No evidences of local recurrence and distant metastasis were found.

CONCLUSION

We have presented a case of successful laparoscopic resection for advanced rectal cancer in a kidney transplant recipient. We believe laparoscopic surgery for CRC in transplant recipients is technically feasible and oncologically safe, which could be a preferred option of surgical procedure in the near future.

Minimally Invasive Colorectal Resection in Kidney Transplant Recipients: Technical Tips, Short- and Long-Term Outcomes

Aim. To prove the safety and feasibility of minimally invasive (laparoscopic and robotic) colorectal resection in kidney recipients by evaluating the technical protocol and reviewing short- and long-term outcomes. Methods. Between May 2007 and August 2012, a retrospective review of ten kidney transplant patients diagnosed with colorectal cancer was evaluated for technical tips, short- and long-term outcomes. Results. The mean patients' age was 56.8 ± 9.91 years and 50% of them were male. Anterior and low anterior resections were performed in 40% of the patients each; 20% and 10% of the patients underwent right and left hemicolectomy, respectively. Most (90%) procedures were performed laparoscopically and 10% were performed robotically. No open conversions. Mean operating time was 192.5 ± 15 min, blood loss was 30 ± 50 mL, and mean hospital stay was 9.7 ± 5.5 days. Two (20%) patients had postoperative complications: wound seroma and chyloperitoneum. Over a mean follow-up period of 31.4 ± 21.57 months, no mortality or kidney rejection occurred. Among the six patients followed up for a mean of 43.5 ± 9.84 months, 83.3% were 3-year disease-free and the overall survival rate was 100%. Conclusion. Minimally invasive colorectal resection is likely to be safe and feasible, with fewer complications and acceptable short- and long-term outcomes, in kidney transplant recipients.

Colorectal complications of end-stage renal failure and renal transplantation: a review

AIM

End-stage renal failure (ESRF) and renal transplant recipients are thought to be associated with an increased risk of colorectal complications.

METHOD

A review of the literature was performed to assess the prevalence and outcome in both benign and malignant colorectal disease.

RESULTS

No prospective randomized studies assessing colorectal complications in ESRF or renal transplant were identified. Case series and case reports have described the incidence and management of benign colorectal complications. Complications included diverticulitis,infective colitis, colonic bleeding and colonic perforation. There was insufficient evidence to associated iverticular disease with adult polycystic kidney disease.Three population-based studies have shown up to a twofold increased incidence of colonic cancer but not rectal cancer for renal transplant recipients. Bowel cancer screening (as per the general population) by faecal occult blood testing appears justified for renal transplant patients; however, evidence suggests that consideration of starting screening at a younger age may be worthwhile because of an increased risk of developing colonic cancer.Two population-based studies have shown a threefold and 10-fold increased incidence of anal cancer for renal transplant recipients. A single case–control study demonstrated significant increased prevalence of anal human papilloma virus (HPV) and intraepithelial neoplasia (AIN)in patients with established renal transplants.

CONCLUSIONS

Despite the lack of high-level evidence,ESRF and renal transplantation were associated with colorectal complications that could result in major morbidity and mortality. Bowel cancer screening in this patient group appears justified. The effectiveness of screening for HPV, AIN and anal cancer in renal transplant recipients remains unclear.

De novo colorectal cancer: five-year survival is markedly lower in transplant recipients compared with the general population

INTRODUCTION

The biological behavior of most solid tumors in transplant recipients has not been adequately compared to the general population. The purpose of the present study was to compare outcomes in de novo colorectal cancer (CRC) following solid organ transplantation to those observed in the general population (SEER) database.

METHODS

All transplant recipients with de novo CRC in the Israel Penn International Transplant Tumor Registry were identified and analyzed and the data were compared to CRC patients in the SEER National Cancer Institute (NCI) database.

RESULTS

One hundred and fifty transplant recipients with de novo CRC were identified, among which were 93 (62%) kidney, 29 (19.3%) heart, 27 (18%) liver, and 1 (0.7%) lung recipients. Median age of transplant recipients was 54 years, compared to a median age of 72 years for patients in the SEER NCI database. However, compared to patients from the SEER NCI database, recipients with Duke's A through C stage disease were noted to experience a significant decrease in 5-year survival. The results in Duke's C patients were particularly dismal.

CONCLUSIONS

The early age at presentation of CRC in transplant recipients suggests that the development of de novo CRC may be effected by immunosuppression. Decreased 5-year survival rates in transplant recipients compared to the general population suggest that CRC in transplant patients is biologically more aggressive. These data cannot distinguish whether the lower survival rates are because the CRC are inherently biologically more aggressive or whether immunosuppression allows for more aggressive clinical behavior of CRC.