Search

Background: The aim of the study was to analyze the clinical characteristics and outcomes of patients with de novo secondary adenocarcinoma arising in the operatively transposed colon not exposed to the fecal stream., Methods: Two investigators collected and reviewed papers from June 1938 to June 2019, reporting patients with adenocarcinoma arising in the transposed colon, not in contact with the fecal stream., Results: Overall, we identified 98 patients with a transposed colonic autograft, positioned as conduit but not in contact with the fecal stream, in whom a secondary de novo adenocarcinoma was diagnosed. In 50% of the patients, the secondary adenocarcinoma was diagnosed at an advanced stage, with a subsequent poor clinical outcome. Earlier diagnosis allowed local resection with long term success. The occurrence of the adenocarcinoma appeared to be closely related to aging, and to clinical evidence of chronic inflammation., Conclusions: Patients in whom the colon has been surgically transposed to different anatomic positions, away from the fecal stream, can develop a secondary colonic adenocarcinoma with. Aging and chronic inflammation seem to be risk factors for a secondary adenocarcinoma more than time from implant. Screening for polyps and adenocarcinomas in these patients should be considered., Competing Interests: Declaration of competing interest The authors have no conflcits of interest to disclose. Data are available on request and described in the supplement., (Copyright © 2020 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Background/aim: Endoluminal self-expanding metallic stents (SEMS) may overcome the risk of mortality and morbidity of acute intestinal obstruction because of stage IV colon (CC) or rectal (RC) cancer. We evaluated the QoL in these groups of patients., Patients and Methods: Forty-eight patients were enrolled in a prospective longitudinal cohort single-center trial to undergo SEMS positioning. Twenty-five patients had a CC and 23 RC. Karnofsky performance scale, Visual Analogue Scale and the EQ-5D- 5L™ questionnaire were administered before treatment and at 1, 3 and 6 months., Results: Harmonized to the Italian population, the index values showed a statistically significant deterioration of the QoL in patients with RC when compared to those with CC at 1-, 3- and 6-months (1 month: p=0.001; 3- month: p=0.001; 6-month: p=0.045). Similarly, Visual Analogue Scale showed variations at 1- (p=0.008), 3- (p=0.001) and 6-months (p=0.020). Rectal stent deployment was the only independent predictor for a worse QoL in all domains (p<0.017; OR=0.196; 95%CI=0.51-0.749)., Conclusion: Patients affected with stage IV CC had a better QoL after SEMS placement when compared to those affected with RC. The persistency of the primary tumor at the rectal level, even if irradiated, might negatively affect QoL.

Background : The current use of endoscopic stenting as a bridge to surgery is not always accepted in standard clinical practice to treat neoplastic colonic obstructions. Objectives: The role of colonic self-expandable metal stent (SEMS) positioning as a bridge to resective surgery versus emergency surgery (ES) for malignant obstruction, using all new data and available variables, was studied and we focused on short- and long-term results. Materials and Methods: A systematic review with meta-analysis was performed. PubMed, SCOPUS and Web of Science databases were included. The search comprised only randomized controlled trials (RCTs) investigating the interventions that included SEMS positioning versus ES. The primary outcomes were the rates of overall postoperative mortality, clinical and technical success. The secondary outcomes were the short- and long-term results. Results: A total of 12 studies were eligible for further analyses. A laparoscopic colectomy was the most common operation performed in the SEMS group, whereas the traditional open approach was commonly used in the ES group. Intraoperative colonic lavage was seldomly performed during ES. There were no differences in mortality rates between the two groups (RR 1.06, 95% CI 0.55 to 2.04; I 2 = 0%). In the SEMS group, the rate of successful primary anastomosis was significantly higher in of SEMS (69.75%) than in the ES (55.07%) (RR 1.26, 95% 245 CI 1.01 to 1.57; I 2 = 86%). Conversely, the upfront Hartmann procedure was performed more frequently in the ES (39.1%) as compared to the SEMS group (23.4%) (RR 0.61, 95% CI 0.45 to 0.85; I 2 = 23%). The overall postoperative complications rate was significantly lower in the SEMS group (32.74%) than in the ES group (48.25%) (RR 0.61, 95% CI 0.41 to 0.91; I 2 = 65%). Conclusions : In the presence of malignant colorectal obstruction, SEMS is safe and associated with the same mortality and significantly lower morbidity than the ES group. The rate of successful primary anastomosis was significantly higher than the ES group. Nevertheless, recurrence and survival outcomes are not significantly different between the two groups. The analysis of short- and long-term results can suggest the use of SEMS as a bridge to resective surgery when it is performed by an endoscopist with adequate expertise in both colonoscopy and fluoroscopic techniques and who performed commonly colonic stenting.

Background: A systematic review with a meta-analysis was performed to determine the prevalence and risk factors for secondary de novo adenocarcinoma in the colon used as a urinary diversion not exposed to the fecal stream., Methods: The systematic review of the literature identified 47 patients with secondary adenocarcinoma in a colonic urinary diversion not exposed to the fecal stream., Results: The diagnosis of secondary adenocarcinoma was determined due to the presence major local symptoms and because the cancer in half of the patients was detected at an advanced stage. Diagnosis at an earlier stage was associated with long-term cancer-free survival., Conclusions: The authors concluded that cystoscopy-colonoscopy screening as suggested by the American Gastroenterology Society for the general population should be applied to patients who have colon urinary diversion not exposed to the fecal stream. For patients with active high-grade inflammation, difficulty with self-catheterization, or symptoms, cystoscopy should be performed earlier. Resection of the tumor at an early stage offers better clinical outcomes with longer survival rates.

Background: Although oncological results for resection of colon cancer with inferior mesenteric artery (IMA) ligation at its origin (high tie) or immediately below the left colic artery (low tie) are similar, injury of the superior hypogastric plexus may be caused when the IMA is tied at its origin, thus impairing defecatory functions., Aim: The importance of IMA tie location on defecatory dysfunction in patients undergoing laparoscopic sigmoidal resection without preoperative radiation therapy was studied., Patients and Methods: From February 2013 to December 2018, 56 consecutive patients submitted to curative laparoscopic resection for stage II and III, M0, sigmoidal cancer were randomized to a high or low tie of the IMA. All demographic data and information on symptoms and comorbidity, intra- and post-operative outcomes and defecatory function before and after surgery [according to the following scales: Fecal Incontinence Quality of Life (FIQL) scale, Jorge-Wexner incontinence and Agachan-Wexner constipation scores] were collected into a computerized database., Results: All patients completed the questionnaires. The educational and social status, and lifestyle habits (defined as active or sedentary) of our groups were similar. A significant difference in total score of FIQL scale was observed between the high and low tie groups at 1 month [88±6 and 93±7, p=0.005, confidence interval for the difference between mean values (CI Δ )=1.706-9.065] and 6 months (93±7 and 97±6, p=0.030, CI Δ =0.390-7.547). The Jorge-Wexner incontinence scores showed a significant decrease in patients of the high group (1 month: 0.59±0.76 and 6 months: 0.62±0.79, respectively) when compared to those of the low tie group (1 month 0.17±0.38 and 6 months 0.17±0.38, respectively) (p=0.008 and p=0.006 at 1 and 6 months, respectively). At 1, 6 and 12 months, the overall Agachan-Wexner constipation scores were significantly higher in patients of the high tie group when compared to those of the low tie group (1 month: 5.1±1.1 and 4.3±0.86, p=0.002, CI Δ =-1.350--0.316; 6 months: 7.4±1.4 and 6.2±1.4, p=0.003, CI Δ =-1.959--0.436; and 12 months: 7.2±1.3 and 6±1.1, p=0.001, CI Δ =-1.840--0.576, respectively)., Conclusion: Patients affected with stage II and III sigmoidal cancer had a better fecal continence at the short- to medium-term and less abdominal pain in the medium- to long-term when a low tie technique was utilized., (Copyright© 2020, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Patients who had esophagectomy with colon interposition for benign disease have long survivals. Adenocarcinoma arising in the interposed colon is a possible event. We describe a 65-year-old woman in whom we performed 37 years ago an esophagectomy with left colon interposition for lye-induced strictures. At endoscopy an obstructing adenocarcinoma in the interposed colon was detected. She underwent complete endoscopic removal of the tumor. The woman is in good general condition, with a regular diet and without evidence of recurrent disease, 5 years later., (Copyright © 2019 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Despite strong hereditary components, most cases of colorectal cancer are sporadic. The possibility to manipulate in the clinical setting the many presumed risk factors is almost impossible, and long-term epidemiological studies are the only reliable form for comparisons. We performed a systematic review to analyze the reports of de-novo adenocarcinoma arising in the transposed colon, used for conduit after esophagectomy, after total gastrectomy, and for vaginal reconstruction. In all these situations, the colon is transposed in different physiological conditions from its natural environment. We excluded patients in whom the colon was transposed as urinary conduit because the well known carcinogenic effect of the contact with urine. Overall 45 patients were identified with a de-novo adenocarcinoma arising in the transposed colon (36 after esophagectomy; 1 after total gastrectomy; 8 as neovagina). The only common risk factor in these different anatomic position was the possibility of active or chronic inflammation. There was not a close correlation between time after implantation and occurrence of the carcinoma. The occurrence of the de novo carcinoma was related to ageing, supporting the hypothesis of a major role of inflammation in facilitating deregulation of the immune system, associated with ageing., (Copyright © 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Aim: Isolated colon lipomas are rare benign tumors. We herein conducted a systematic review of the literature to identify clinical characteristic, diagnostic and treatment options., Materials and Methods: A search for relevant studies was conducted in Scopus, Embase and Medline databases until the end of May 2014. The search terms were "colonic lipoma and colon lipoma". Articles were included if they had information on symptoms, lipoma characteristics and type of procedure performed., Results: 88 articles describing 184 patients affected with colonic lipomas were found. One hundred and twenty-seven patients were selected for further analysis. The most common signs included abdominal pain, rectal bleeding and alteration in bowel habits. Colonic lipomas were frequently localized in the right colon (50%). The majority of patients had open surgery, whereas current treatment is laparoscopic resection., Conclusions: Laparoscopic surgery is the current standard-of-treatment of symptomatic colonic lipomas greater than 2 cm in diameter or when malignancy can not be preoperatively excluded., (Copyright© 2014 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.)

Background: Self-expanding metallic stent (SEMS) placement is a valid form of therapy for patients with obstructing colon rectal cancer. The procedure is not feasible for a minority of patients with a very low risk of bowel perforation. This report analyzes the results of a technical detail used for SEMS placement., Methods: In 43 patients with colon rectal obstruction, the SEMS apparatus was introduced through a guidewire passed above the obstruction in the channel of a pediatric nasogastroscope (diameter, 4.9 mm). The pediatric nasogastroscope was passed into the obstruction and above, allowing the anatomy of the colorectal lesion and the passage of the guidewire to be visualized directly., Results: The SEMS was inserted successfully in all cases without complications. In a previous series of 82 patients who had passage of the guidewire through the obstruction blindly, four technical failures occurred (nonsignificant difference)., Conclusions: A pediatric nasogastroscope can be useful for passing the colon rectal obstruction and guiding the passage of the guidewire under direct vision.