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In fecal incontinence the role of elastography has not yet been evaluated. We performed a trial to further characterize the internal and external anal sphincter in patients with fecal incontinence and compared a visual assessment scale with a computerized program for quantifying elastic properties of the anal sphincter.Fifty consecutive patients with fecal incontinence were studied (n = 31 following lower anterior resection, n = 8 with Crohn's disease, n = 9 following colon surgery, n = 2 others). Elastogram color distribution within the sphincter representing elastic properties was quantified using a visual analog scale and an off-line computerized area calculation program.The main finding was that the inner anal sphincter (IAS) differed significantly from the external anal sphincter (EAS) with regard to elastogram color distribution. There were no significant correlations with clinical and functional parameters. There was, however, a non-significant increase in the percentage of blue (hard) areas in the IAS in patients neoadjuvantly irradiated for rectal or cervical cancer compared to non-irradiated patients, which was accompanied by a significant decrease in the resting sphincter pressure (p0.009).The IAS, a smooth muscle, and the EAS, a striated muscle, have different elastogram color distributions, probably reflecting their different elastic properties. The absence of significant correlations with the major clinical and functional parameters suggests that in routine clinical practice ultrasound real-time elastography may not yield additional information in patients with fecal incontinence. There may be exceptions, particularly in irradiated patients.

Anastomotic leakage is a serious complication with significant morbidity and mortality. The popularity of endoscopic treatment (Endo-SPONGE) is increasing for distally located colorectal pouch-anal anastomotic leakages. This was a retrospective study of 15 cases involving the application of the Endo-SPONGE for anastomotic leakage following proctectomy between May 2009 and May 2014. Of the 15 cases, lower anterior resection occurred in 12 cases (80%), and pouch-anal anastomosis in 3 cases (18%). In 8 patients (55%), the endosponge was applied during the early term, and in 7 patients (45%) during the late term. The average number of applications was 2.2 (range, 1 to 5). Treatment was discontinued due to the progression of pelvic sepsis in 2 patients and due to bleeding in 1 patient. Lumen integrity was achieved in 12 cases. Lumen integrity after anastomotic leakages can be preserved by endoluminal vacuum therapy, which permits the closure of the stoma without requiring reconstructive surgery.

PURPOSE The purpose of this study was to explore the prevalence of fecal incontinence (FI) and its impact on health-related quality of life in rectal cancer patients following low anterior resection surgery for colorectal cancer. DESIGN Descriptive, cross-sectional study. SUBJECTS AND SETTING Patients who were diagnosed with rectal cancer and underwent low anterior resection were recruited from a 1264-bed hospital in southern Taiwan. Potential participants were mailed a questionnaire survey. They were followed up 8 to 16 months postoperatively. Some clinical data were collected via retrospective review of their medical records. METHODS Questionnaires were mailed to 172 patients, and 71 with colorectal cancer underwent low anterior resection and agreed to participate and completed questionnaires in the research, reflecting a return rate of 41%. Data were collected on demographic characteristics and disease-related variables. Participants were asked if they had experienced FI during the past week. Fecal incontinence health-related quality of life was measured using the Cleveland Clinic Incontinence Score (CCIS) and the Fecal Incontinence Quality of Life Index. Completion of the questionnaire required approximately 15 minutes. RESULTS More than half of the 71 participants (n = 45; 63.4%) experienced incontinence of flatus, 42.3% (n = 30) reported incontinence of liquid stool, and 14.1% (n = 10) stated that they experienced incontinence of solid stool. Based on mean CCIS scores, 35.2% (n = 25) experienced moderate to severe FI. One-third wore pads to contain FI and 21.1% changed daily activities because of FI. Nearly two-thirds reported FI during the week prior to completing the research questionnaire. The average Fecal Incontinence Quality of Life Index cumulative score was significantly lower in the FI group (2.62 ± 0.61) than in the without-FI group (3.32 ± 0.77; P < .001), as were all subscale mean scores (all P < .01-.001). CONCLUSIONS Fecal incontinence is prevalent among persons undergoing low anterior resection for colorectal cancer. Persons with FI report poor health-related quality of life compared to persons who retained fecal continence. Health care providers should assess these patients for FI and treat or refer those who experience this common problem.

Aim Inadequate intestinal blood flow may contribute to anastomotic leakage accounting for substantial morbidity and mortality in colorectal surgery. Precise intraoperative assessment of microperfusion may have an impact on the surgeon0s intraoperative management and leakage rate. Method In this single center observational study we implemented and integrated intraoperative indocyanin green (ICG) based microperfusion assessment of anastomosis with Pinpoint Perfusion Imaging in a series of consecutive rectal cancer patients who underwent laparoscopic anterior and lower anterior resection with primary anastomosis during a 5-months period. Results We could demonstrate the feasibility and safety of intraoperative fluorescence angiography for colorectal microperfusion assessment. Technology implementation was immediately successful. No adverse effects have been documented related to fluorescent dye. Microperfusion angiography of the colon succeeded in all cases and assessment of perfusion imaging influenced surgical decision making in 28% of the patients, of which all patients showed primary healing of the anastomosis. We found a leakage rate of 6% with one leakage of a coloanal anastomosis in all patients. Conclusion Fluorescence angiography is an accurate tool for assessing microperfusion and is most likely associated with improved outcomes with regard to anastomotic healing.

We report a case of rectal cancer with microsatellite instability (MSI) that probably resulted from Lynch syndrome and that was diagnosed after Cesarean section. The patient was a 28-year-old woman (gravid 1, para 1) without a significant medical history. At 35 gestational weeks, vaginal ultrasonography revealed a 5 cm tumor behind the uterine cervix, which was diagnosed as a uterine myoma. The tumor gradually increased in size and blocked the birth canal, resulting in the patient undergoing an emergency Cesarean section. Postoperatively, the tumor was diagnosed as rectal cancer with MSI. After concurrent chemoradiation therapy, a lower anterior resection was performed. The patient’s family history revealed she met the criteria of the revised Bethesda guidelines for testing the colorectal tumor for MSI. Testing revealed that the tumor did indeed show high MSI and, combined with the family history, suggested this could be a case of Lynch syndrome. Our findings emphasize the importance of considering the possibility of Lynch syndrome in pregnant women with colorectal cancer, particularly those with a family history of this condition. We suggest that the presence of Lynch syndrome should also be considered for any young woman with endometrial, ovarian, or colorectal cancer.

We report a case in which l-Leucovorin/5-fluorouracil (l-LV/5-FU) therapy was remarkably effective for advanced rectal cancer as neoadjuvant chemotherapy (NAC). A 54-year-old man complained of bloody stool and constipation,and was diagnosed as having stage IIIB advanced rectal cancer with N2 lymphnode metastases on July 31, 2003. Two cycles of NAC by l-LV/5-FU therapy were performed. On abdominal computed tomography (micro CT), the primary lesion in the rectum decreased 82% and the metastatic lymphnodes had disappeared. As we established a diagnosis of the downstaging for stage II, a lower anterior resection with D3 lymphnode dissection was performed on December 5, 2003. The pathological examination demonstrated II, mod, 1.8 x 2.2 cm, a1, ly1,v0, ow(-), aw(-), n0, stage II. We could allow curability-A resection. The pathological effect of chemotherapy was grade 2 in which cancer cells became necrotic, suggesting apoptosis. The postoperative course was good. Postoperatively, 3 cycles of l-LV/5-FU therapy were performed. Although the patient had to be followed with internal use of 5-FU 200 mg/day as an outpatient from June 2, 2004, to date, there has been no sign of recurrence during the 12-month follow-up after the operation. Moreover, no adverse by chemotherapy was seen during the treatment. Thus, NAC by this therapy may be useful for patients with advanced rectal cancer.

Diffuse cavernous hemangioma of the rectosigmoid colon is an uncommon benign vascular lesion. We report 5 cases of diffuse cavernous hemangioma, focusing on the clinical features, diagnosis procedure and treatment. Five patients have undergone sphincter-saving procedures, 3 cases had coloanal sleeve anastomoses and 1 patient each had pull-through anastomosis and lower anterior resection. During the follow-up, which ranged from 3 to 10 years, 3 patients had no further anal bleeding and 2 patients had minor intermittent anal bleeding. Continence for normal stool was satisfactory in all patients. In conclusion, sphincter-saving procedure is most appropriate and curative approach for the treatment of diffuse cavernous hemangioma. Imaging study plays an important role in the diagnosis, preoperative staging and follow-up.

Summary Background : Two surgical procedures with curative intent are available to patients with rectal cancer: lower anterior resection and abdominoperineal resection; however, lower anterior resection may improve quality of life and functional status. Aim : To examine temporal changes in after lower anterior resection and abdominoperineal resection between 1989 and 2000. Potential factors associated with the use of lower anterior resection were evaluated. Methods : Using national administrative data, we identified patients who received lower anterior resection or abdominoperineal resection. Logistic regression models examined the association between use of lower anterior resection and time period of surgical resection. Results : A total of 5201 rectal cancer patients underwent resection. The use of lower anterior resection increased from 40.0% (1989–91) to 50.1% (1998–2000) paralleled by a corresponding decline in abdominoperineal resection (60.1 to 49.9%; P

A male patient with lower-segment rectal carcinoma underwent laparoscopic radical resection and regional lymph node dissection. The extracorporeal rectoanal anastomosis was completed using transanal endoscopic microsurgery (TEMS) without requiring any additional abdominal incision. The pathological examination identified a clean margin. At the postoperative 6-month visit, the patient exhibited generally normal defecation, urination, and sexual function, but no sign of local recurrence or distant metastasis. TEMS integrating laparoscopy is a surgically and oncologically feasible, effective, and safe procedure for lower anterior resection.

Most surgeons suggest the use of fecal diversion in patients undergoing low anterior resections of rectal tumors at high risk for anastomotic leakage. We describe an exploratory study to evaluate the efficacy and safety of a new diversion method called a spontaneously closing cannula ileostomy, which was designed to protect rectal anastomoses in patients at high risk for anastomotic leakage. The outcomes of patients treated with cannula ileostomy were compared to those of patients treated with loop ileostomy.Outcomes included the rates of anastomotic leakage, reoperation and other complications, as well as length of hospital stay and cost.From January 2011 to December 2012, 294 patients undergoing low colorectal or coloanal anastomosis were treated with ileum diversion using cannula ileostomy or traditional loop ileostomy. Demographics, clinical features, and operational data were recorded.The anastomotic leakage rates were 8.1% (12/149) in the cannula ileostomy group and 8.3% (12/145) in the loop ileostomy group (p = 1.0). The reoperation rate was 3% (4/149) in patients treated with a cannula ileostomy and 3.4% (5/145) in those who underwent a loop ileostomy (p = 0.75). The median length of the hospital stay was 8.6 days in the cannula ileostomy group and 17.1 days (p0.01) in the loop ileostomy group, including time for the initial and reversal operations. In the cannula ileostomy group, the median time to defecation from the anus was 16.5 days after the operation. During the follow-up period, 13 patients in the loop ileostomy group retained their stoma, as compared to 2 in the cannula ileostomy group (p0.01).This study was a nonrandomized design and lacked contrast enema data to identify anastomotic leaks.Cannula ileostomy is a safe and effective diverting technique that protects low colorectal and coloanal anastomoses. Patients receiving a cannula ileostomy had shorter hospital stays and lower rates of permanent stoma than those receiving a loop ileostomy.

A 70-year-old man undergoing treatment for diabetes presented with a cough and pyrexia that has lasted one week. Laboratory tests demonstrated evidence of inflammation. The patient was hospitalized and antibiotic treatment was initiated, but the condition of the patient did not improve. After 2 weeks, computerized tomography scanning demonstrated the presence of multiple small nodules in the lungs and a liver abscess. The patient also developed neck pain and numbness of the upper extremities and was then transferred to Tokai University Hachioji Hospital (Tokyo, Japan). Percutaneous transhepatic drainage (PTD) of the liver abscess was performed and antibiotic treatment was initiated. Detailed examination revealed there was pyogenic spondylitis of the cervical spine, therefore abscess drainage and an anterior cervical spinal fusion were performed. Culture of each lesion resulted in Klebsiella pneumoniae growth. While continuing antibiotic treatment and rehabilitation, the gastrointestinal tract was investigated and evidence of early rectal cancer was observed. The pulmonary nodules disappeared during treatment, indicating that these were multiple lung abscesses. Four weeks following abscess drainage and anterior cervical spinal fusion, lower anterior resection was performed. The present case report describes a patient who developed multiple abscesses associated with early rectal cancer and discusses the case with reference to the literature.

Aim This study was designed to evaluate the efficacy and toxicities of concomitant boost intensity-modulated radiation therapy (IMRT) along with capecitabine and oxaliplatin, followed by a cycle of Xelox, in neoadjuvant course for locally advanced rectal cancer. Materials and methods Patients with histologically confirmed, newly diagnosed, locally advanced rectal adenocarcinoma (cT3-T4 and/or cN+) located within 12 cm of the anal verge were included in this study. Patients received IMRT to the pelvis of 50 Gy and a concomitant boost of 5 Gy to the primary tumor in 25 fractions, and concurrent with oxaliplatin (50 mg/m2 d1 weekly) and capecitabine (625 mg/m2 bid d1–5 weekly). One cycle of Xelox (oxaliplatin 130 mg/m2 on d1 and capecitabine 1000 mg/m2 twice daily d1–14) was given two weeks after the completion of chemoradiation, and radical surgery was scheduled eight weeks after chemoradiation. Tumor response was evaluated by tumor regression grade (TRG) system and acute toxicities were evaluated by NCI-CTC 3.0 criteria. Survival curves were estimated using the Kaplan-Meier method and compared with Log-rank test. Results A total of 78 patients were included between March 2009 and May 2011 (median age 54 years; 62 male). Seventy-six patients underwent surgical resection. Twenty-eight patients underwent sphincter-sparing lower anterior resection and 18 patients (23.7%) were evaluated as pathological complete response (pCR). The incidences of grade 3 hematologic toxicity, diarrhea, and radiation dermatitis were 3.8%, 10.3%, and 17.9%, respectively. The three-year LR (local recurrence), DFS (disease-free survival) and OS (overall survival) rates were 14.6%, 63.8% and 77.4%, respectively. Initial clinical T stage and tumor regression were independent prognostic factors to DFS. Conclusion An intensified regimen of concomitant boost radiotherapy plus concurrent capecitabine and oxaliplatin, followed by one cycle of Xelox, can be safely administered in patients with locally advanced rectal cancer, and produces a high rate of pCR. A prognostic score model is helpful to distinguish different long-term prognosis groups in early stage.

In the current study, a case of recurrent desmoplastic small round cell tumor (DSRCT) is presented, which was successfully treated by repetitive debulking surgery. In May 2010, a 39-year-old male, with a history of surgical resection of intra-abdominal DSRCT, visited the Ibaraki Medical Center, Tokyo Medical University Hospital (Ami, Japan) with severe lower abdominal discomfort. Abdominal computed tomography revealed a large tumor in the pouch of Douglas with a small number of nodules in the abdominal cavity. The recurrent DSRCT was diagnosed and removed via lower anterior resection; however, complete resection was impossible due to multiple peritoneal metastases. One year later, the patient developed pain in the right groin due to the growth of metastasized tumor cells in the groin lymph nodes. The affected lymph nodes were removed utilizing an extra-peritoneal approach. At the time of writing, the patient continues to survive without any symptoms 60 months since the initial surgery. In conclusion, surgical debulking is a significant procedure for relieving patient symptoms as well as improving the survival time of patients with metastatic and recurrent DSRCT.

A 50-year-old female who had undergone laparoscopic total hysterectomy at a local clinic owing to leiomyoma of the uterus was referred to our hospital after having dysuria, urgency, frequency, lower abdominal pain and right flank pain over several months. After routine examinations, cystoscopy, computed tomography and magnetic resonance imaging were performed, and non-ulcerative interstitial cystitis accompanied by postoperative fibrosis secondary to a previous surgery was suggested. Pentosan sulfuric polyester (Elmiron, Alza Pharmaceuticals, Mountain View, CA) reduced her severely debilitating symptoms and improved her quality of life. Both the hydronephrosis and the symptoms were relieved by ureteral stent insertion and percutaneous nephrostomy. However, a few days later, she presented with vaginal bleeding along with her previous symptoms, and punch biopsy of the vaginal stump resulted in a diagnosis of adenocarcinoma. Both ureterocutaneostomy with radical cystectomy and lower anterior resection for rectum invasion were conducted. After the slide review of the original specimen from the local clinic, she was diagnosed with recurrent cervical cancer of the vaginal stump.

AIM: To evaluate trans-anal reinforcing sutures in low anterior resection using the double-stapled anastomosis technique for primary rectal cancers performed at a single institution. METHODS: The data of patients who received trans-anal reinforcing sutures were compared with those of patients who did not receive them after low anterior resection. Patients who underwent laparoscopic low anterior resection and the double-stapled anastomosis technique for primary rectal cancer between January 2008 and December 2011 were included in this study. Patients with no anastomosis, a hand-sewn anastomosis, high anterior resection, or preoperative chemoradiation were excluded. The primary outcomes measured were the incidence of postoperative anastomotic complications and placement of a diverting ileostomy. RESULTS: Among 110 patients, the rate of placement of a diverting ileostomy was significantly lower in the suture group (SG) compared with the non-suture control group (CG) [SG, n = 6 (12.8%); CG, n = 19 (30.2%), P = 0.031]. No significant difference was observed in the rate of anastomotic leakage [SG, n = 3 (6.4%); CG, n = 5 (7.9%)]. CONCLUSION: Trans-anal reinforcing sutures may reduce the need for diverting ileostomy. A randomized prospective study with a larger population should be performed in the future to demonstrate the efficacy of trans-anal reinforcing sutures.

Invasive lobular carcinoma of the breast has similar patterns of metastatic disease when compared to invasive ductal carcinoma; however, lobular carcinoma metastasizes to unusual sites more frequently. We present a 65-year-old female with a history of invasive lobular breast carcinoma (T3N3M0) treated with modified radical mastectomy and aromatase-inhibitor therapy who underwent a surveillance PET scan, which showed possible sigmoid cancer. Colonoscopy with biopsy revealed a 3 cm sigmoid adenocarcinoma. The patient underwent a lower anterior resection. Pathology showed an ulcerated, invasive moderately differentiated adenocarcinoma extending into but not through the muscularis propria. However, six of seventeen paracolonic lymph nodes were positive for metastatic breast carcinoma (ER+/PR+), consistent with her lobular primary breast carcinoma; there was no evidence of metastatic colon cancer. This case highlights the unusual metastatic patterns of lobular carcinoma.

A 81-year-old female was admitted to our hospital to undergo endoscopical treatment for a gastric adenoma and received YAG-laser therapy. The gastric adenoma was completely removed by laser therapy. However, following treatment, she complained of having mucous feces. Although she had undergone a colonoscopy twice during the previous six month, we examined her large intestine using colonoscopy and barium enema. A colonoscopy revealed a large-flat elevated lesion of the same color as the surrounding mucosa and no transmucosal vascularity of the rectum. A well demarcated flat lesion 4 cm in size with conglomerated nodules on its surface was confirmed using the dye-spraying contrast method with 0.2% indigo carmine solution. A lower anterior resection of the rectal lesion was performed and the patient is now living and well 16 month following surgery. We believe that, if we encounter gastric adenomas, more careful observation and use of the dye-spraying contrast method are necessary for the detection of adenomas or cancers in the colon.

Malakoplakia represents a chronic inflammatory disease associated with a broad spectrum of bacterial infections. On histopathology, Michaelis-Gutmann bodies are considered as pathognomonic histopathological findings. Rarity of the disease and wide variety of clinical presentation makes its diagnosis very challenging. We report herein the case of a 66-year-old woman who, having undergone lower anterior resection for rectal adenocarcinoma 3 and a half years ago, presented with urinary frequency and dull abdominal pain. CT scan revealed a soft tissue tumour infiltrating the preperitoneal fat over the urinary bladder, which was considered as recurrence of the rectal carcinoma. On laparotomy, a tumour invading the bladder, small intestine and the anterior abdominal wall was resected and the patient recovered uneventfully. On histopathology, malakoplakia of urinary bladder was revealed. Overstaging of patients’ malignancy due to malakoplakia is not uncommon, so its early identification can help avoid incorrect treatment.

We report a case of colonic metastasis from ovarian cancer presented as an intraluminal fungating mass mimicking primary colon cancer 8 years after surgery for ovarian cancer. A 70-year-old woman presented with constipation. She had undergone an extended total abdominal hysterectomy with bilateral salpingo-oophorectomy for an ovarian papillary serous cystadenocarcinoma 8 years earlier. Colonoscopy showed a large fungating mass 10 cm from the anal verge that was suspected to be colorectal cancer. A computed tomography scan showed a bulky intraluminal fungating mass in the rectosigmoid junction. After a lower anterior resection and a pathologic diagnosis, a diagnosis of a papillary serous adenocarcinoma due to metastasis from an ovarian tumor was made for this patient.

Background Rectovaginal fistula is uncommon after lower anterior resection for rectal cancer. The most leading cause of this complication is involvement of the posterior wall of the vagina into the staple line when firing the circular stapler. Case presentation A 50-year-old women underwent resection for obstructed carcinoma of the sigmoid colon with Hartmann procedure. Four months later she underwent restorative surgery with circular stapler. Following which she developed rectovaginal fistula. A transvaginal repair was performed but stool passing from vagina not per rectum. Laporotomy revealed colovaginal anastomosis, which was corrected accordingly. Patient had an uneventful recovery. Conclusion Inadvertent formation of colovaginal anastomosis associated with a rectovaginal fistula is a rare complication caused by the operator's error. The present case again highlights the importance of ensuring that the posterior wall of vagina is away from the staple line.

Purpose: Thepurposeof this study wastoinvestigatethe relationshipsbetweenanxiety, depression, low anterior resection syndrome, and qualityof life after lower anterior resectionfor rectal cancer. Methods:Theparticipants ofthisstudy were 105 rectal cancer patientswho visitedtheoutpatient departmentof a hospitalin Seoulfor treat- ment or follow-up consultations. Data were collected using self-reportedquestionnaires and clinical records. To measurethevariables, theHospital AnxietyandDepressionScale, Low Anterior ResectionSyndromeScore, and Qualityof LifeQuestionnaire-Core 30wereutilized. Dataweresubsequently analyzed usingtheSPSS/WIN 20.0 program. Results:Low anterior resectionsyndromewas more severeamong patientswhose cancer was located closerto theanus,andhad agreater rangeof resectioninthosewhoreceivedneoadjuvant treatment. Whenanxi- ety, depression, and low anterior resection syndrome score were higher, quality of life scores were lower. Conclusion: These results suggest that low anterior resection syndrome may negatively impact quality of life. Therefore, it is necessary to provide patients with symptom management support/assistance through evi- dence-basednursinginterventions, andevaluations oflow anterior resection syndrometo relieveanxietyandde- pression, and thus enhance quality of life.

Background: Procedures that involve resection of the distal rectum challenge the current limitations of laparoscopic technology, because of lack of compact articulating stapling instruments. Method: We improve the procedure with the aid of a Lap disk, an abdominal wall sealing device that was developed for hand-assisted manipulation. A linear stapler capable of changing its stop angle is inserted through the disk, and the rectum is transected by the disk during a second pneumoperitoneum. Results: The transection line becomes equivalent to that obtained with laparotomy. Conclusion: This new technique made laparoscopic lower anterior resection possible to transect the lower rectum in the same way as is done with laparotomy.

A retrospective follow-up study of all children treated for Hirschsprung's disease over the last 45 years at the Department of Pediatric Surgery, Children's Hospital, Bremen was done to evaluate the results of Rehbein's procedure. A total of 416 children underwent Rehbein's lower anterior resection. The postoperative outcome was analysed in detail for early and late complications like wound infection, pelvic abscess, anastomotic stenosis, anastomotic insufficiency, postoperative enterocolitis, persistence of constipation, fecal and urinary incontinence, recurrent achalasia, need for reoperation, adhesion ileus and mortality. On the basis of the data analysed and review of literature it was concluded that Rehbein's procedure is a well-established method in the treatment of Hirschsprung's disease with excellent results and few complications.

Methods: This prospective study was performed for 8 months (Apr. to Nov. 2009). We studied 200 patients who underwent colorectal surgery. They were divided into 6 groups, according to the type of the operation; Partial colectomy, AR (Anterior resection), LAR (Lower anterior resection), TC (Total colectomy), Ileostomy, and Colostomy. For each type of the operation, we investigated the change of the body weight, intake, and lab. parameters preand post-operatively, at one month. Results: The mean weight loss for one month was 3.47±1.9 kg (5%); Ileostomy (5.9±3.5 kg) showed the largest weight loss, and followed by TC (5.4±3.3 kg). There was no significant difference in serum albumin and hemoglobin, which was in normal range. Nutritional intake was recovered to more than 80% of daily demand in one month after the operation. Yet, calorie intake was significantly low in the TC group; 72.4±20.4% of demand, and protein intake in Ileostomy group was significantly low, with 71.2±21.9% of demand. Excluding the ostomy groups, in comparison to the number of defecation at one month after the operation, the LAR group revealed the highest with significance; a mean of 7.8±0.7 times per day, and followed by TC (4.6±0.6). Although there was no statistical significance, the more frequency of defecation, the more loss of body weight was observed and there is less of a tendency for nutritional intake. Conclusion: In the cases which underwent colorectal surgery, the rate of malnutrition was low. However, since the rate of malnutrition can be increased in the case of frequent defecation after LAR, and after Ileostomy, as well as TC itself, nutritional management should be performed separately, according to the type of operation.

Purpose: To present a rare case of Muir-Torre syndrome characterized by the association of sebaceous skin tumors and systemic malignancies. Case summary: A 65-year-old female visited our clinic with an irregular nodular mass of the right lower eyelid, which developed 1 year earlier. An excisional biopsy and lower lid reconstruction with Tenzel’s semicircular rotational flap was performed under local anesthesia. Histopathologic examination showed well-differentiated sebaceous cells, consistent with sebaceous adenoma. The patient had undergone total abdominal hysterectomy and lower anterior resection due to endometrial cancer and sigmoid colon cancer 5 years before, and nephroureterectomy due to papillary urothelial carcinoma 3 years before. Based on the history of systemic malignancy and sebaceous skin cancer, a diagnosis of Muir-Torre syndrome was made. Conclusions: When a sebaceous gland tumor of the eyelids is detected, Muir-Torre syndrome should be included in the differential diagnosis, and systemic work-up for the internal malignancy must be performed. J Korean Ophthalmol Soc 2011;52(3):355-358

Approximately one-third of all patients with renal cell carcinoma have metastasis at the time of diagnosis. Metastatic lesions of renal cell carcinoma are most commonly seen in the lung, and they are frequently seen in the bone and liver. However, spleen and rectal metastases are extremely rare. A 63-year-old man had undergone left radical nephrectomy for renal cell carcinoma. About 22 months later, computed tomography revealed multiple enhanced masses in the spleen. Spleen metastasis was suspected and splenectomy was then performed. One year later, the patient visited with complaints of voiding difficulty. A huge pelvic mass was detected by performing prostate ultrasonography and MRI. The mass was 13cm in diameter and it was between the rectum and the prostate. Removal of the pelvic mass and lower anterior resection with end colostomy was done. Histologically, the resected specimens were diagnosed as metastases from the renal cell cancer. Herein, we report on a case of metachronous splenic and rectal metastasis from renal cell carcinoma.

• Nineteen patients with middle and lower rectal carcinomas were operated on, with abdominoperineal resection in 10 patients, lower anterior resection with coloanal anastomosis in 6 patients, and colorectal anastomosis in 3 patients. The distance of the lower margin of the tumor to insertion of the levator ani on the rectal wall was correctly evaluated by computed tomography in 12(63%) of 19 patients and by magnetic resonance imaging in 13 (68%) of 19 patients, while digital examination correctly assessed the distance in 15(79%) of 19 patients. Computed tomography and magnetic resonance imaging were unable to assess extension through the rectal wall. No significant difference was observed between computed tomography and magnetic resonance imaging in assessing extension to the perivesical fat, adjacent organs, pelvic side wall, or lymph nodes. According to the TNM classification, magnetic resonance imaging correctly staged 74% (14/19) of carcinomas, while computed tomography correctly staged 68% (13/19). ( Arch Surg. 1990;125:385-388)

On the past experiences of our clinics, surgical methods how to treat the cancers at the early stage were discussed."Local excision" such as polypectomy, transanal or transsphincteric removal of the tumor may be well enough curable foe these cases in which the cancer growths are limited within the mucosa. But, at those cases the cancer involved into the submucosal layer, one must carry out such larger and radical operations as segmental colectomy, lower anterior resection, pull through procedure or abdominoperineal resection.

A clinical and statistical study was done for 123 patients with histologically proven colorectal malignant tumor from 1983 to 1986 at the department of anatomical pathology. Yeung Nam University Hospital. The results were as follows: 1. Ratio between male and female was 1.6:1 and incidence was most prevalent in 7th decades comprising 29.3%. 2. Location of tumor was the most frequent in rectum(65%). 3. Frequent symptoms and signs in case of right colon were pain, abdominal mass and bowel habit change. In left colon, they were pain, bowel habit change and bloody stool or melena. In rectum, they were bloody stool or melena, bowel habit change and pain. 4. Duration of symptom was 1 to 3 months(33.3%). 5. The most frequent histological type was adenocarcinoma(82.9%). 6. According to Dukes's classification, 32.9% of the tumor were stage . 7. Operative procedures were Mile's operation(47.0%), right hemicolectomy(19.8%) and lower anterior resection(11.7%). 8. Polyps were the most frequent associated disease. 9. The most common complication was wound infection(11.1%).

Materials and methods We have evaluated 69 consecutive patients (39 male and 30 female) operated for rectal cancer in our ward. The preoperative investigation includes, according to guidelines for CRC treatment: pancolonscopy, chest radiography and a CT scan of the abdomen. The most appropriate surgical treatment was chosen depending on the results of the preoperative study (Table 1). A standard questionnaire investigating the quality of life was administered to all the patients in the preoperative time (t0), in the early postoperative time(t1) and 3 (t2), 6 (t3), 9 (t4) and 12 (t5) months after the operation. Our questionnaire, the same as EORTC QLQ-C30 [1], QLQ-C38 [2] and SF-36 [3], is composed of the items described in Table 2. Results All the patients enrolled in the study answered our questionnaire. 31 of the patients underwent anterior resection of the rectum with total mesorectal excision(ARR), 24 underwent lower anterior resection (Low ARR), 9 underwent ultra-low anterior resection (Ultra-low ARR), 1 underwent Hartmann resection, 1 underwent abdominoperineal resection sec. Miles and 3 patients were treated by endoscopical resection (Table 3). A temporary stoma was made in 32 patients, and a definitive one in 2 patients. The stoma was made only in the patients with an elevated risk of anastomotic leakage. The overall complication rate was 20.2%, interesting 14 patients of the total as described in the table 4.