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Yoshiaki M, Minagawa N, Kato T, Okada N, Suzuki T, Ishizuka C, Fukuda A, Mori Y. Laparoscopic Resection of Transverse Colon Cancer with an Anomaly of the Middle Colic Artery Originating from the Splenic Artery: A Case Report. Case Rep Gastroenterol 2024; 18:105-109. [PMID: 38439819 PMCID: PMC10911783 DOI: 10.1159/000536672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 02/01/2024] [Indexed: 03/06/2024] Open
Abstract
Introduction We encountered a colon cancer case with a very rare anomaly of the middle colic artery (MCA) originating from the splenic artery (SA). Case Presentation A woman was referred to our hospital for transverse colon cancer. Three-dimensional computed tomography (3D-CT) angiography showed an anomalous MCA originating from the SA rather than from the superior mesenteric artery (SMA) as is typical. Laparoscopic left hemicolectomy with D3 lymph node dissection was performed. The lymph nodes around the SMA were dissected from the caudal view, confirming the absence of a typical MCA. An anomalous SA-originating MCA was identified just below the pancreas, where it was clipped and ligated; subsequently, total mesenteric excision was achieved. Conclusion As D3 lymph node dissection for transverse colon cancer is technically difficult, 3D-CT angiography is useful for identifying vascular anomalies preoperatively, thereby avoiding intraoperative injury. This is the first case report of laparoscopic colectomy associated with a SA-originating MCA anomaly.
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Affiliation(s)
- Maeda Yoshiaki
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Nozomi Minagawa
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Takuya Kato
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Naoki Okada
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Takuto Suzuki
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Chihiro Ishizuka
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Akihisa Fukuda
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
| | - Yoichi Mori
- Department of Gastrointestinal Surgery, Hokkaido Cancer Center, Sapporo, Japan
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Navarra A, Porcellini I, Mongelli F, Popeskou SG, Grass F, Christoforidis D. Long-term outcomes in elderly patients after elective surgery for colorectal cancer within an ERAS protocol: a retrospective analysis. Langenbecks Arch Surg 2023; 408:438. [PMID: 37978074 DOI: 10.1007/s00423-023-03179-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 11/09/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE The number of elderly patients with a diagnosis of colorectal cancer (CRC) is increasing. Considering short life expectancy and multiple comorbidities, surgery may not always be the best treatment option. METHODS We included all consecutive patients aged 80 years and older who underwent elective resection for CRC following Enhanced Recovery after Surgery (ERAS) protocol between January 2011 and May 2021. The primary endpoint was overall survival, secondary endpoints were 30-day morbidity, and the rate of return to pre-operative living conditions 3 months after surgery. RESULTS Ninety-four patients were included. Mean age was 84.6 ± 3.6 years, 49 patients (52%) were female. Most patients (77.6%) were ASA score ≥ 3. Laparoscopic resections were performed in 85 patients (90.4%), involving 69 (73.4%) colonic and 25 (26.6%) rectal resections. A stoma was constructed in 22 patients (23%), and reversed in 12 (54.5%). Twenty-two patients (23.4%) experienced a Clavien-Dindo ≥ 3 complication, and 2 patients (2.1%) died. The median length of hospital stay was 8 (interquartiles: 6-15) days. Sixty-six patients (70.2%) were discharged home directly and 26 (27.7%) to rehabilitation or postacute care institutes. At three months after surgery, eighty-two patients (96.5%) returned to their pre-operative living conditions directly or after short-term rehabilitation. Mean follow-up was 53 ± 33 months, estimated 5-year overall survival was 60.3% (95%CI 49.5-71.1%), and disease-free survival was 86.3% (95%CI 78.1-94.4%). CONCLUSIONS Our study suggests that elderly patients undergoing elective surgery have a high potential to return to preoperative living conditions and good overall- and disease-free survivals, despite significant postoperative morbidity.
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Affiliation(s)
- Andrea Navarra
- University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland
| | - Iride Porcellini
- Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Francesco Mongelli
- Department of Surgery, Ospedale Regionale Di Bellinzona E Valli, EOC, Via Ospedale 12, 6500, Bellinzona, Switzerland.
- Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland.
| | | | - Fabian Grass
- University of Lausanne, Quartier Centre, 1015, Lausanne, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
| | - Dimitri Christoforidis
- Department of Surgery, Ospedale Regionale Di Lugano, EOC, Via Tesserete 46, 6900, Lugano, Switzerland
- Faculty of Biomedical Science, Università Della Svizzera Italiana, Via La Santa 1, 6900, Lugano, Switzerland
- Department of Visceral Surgery, Centre Hospitalier Universitaire Vaudois (CHUV), Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Voutsadakis IA. Presentation, Molecular Characteristics, Treatment, and Outcomes of Colorectal Cancer in Patients Older than 80 Years Old. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1574. [PMID: 37763693 PMCID: PMC10535827 DOI: 10.3390/medicina59091574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/23/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
Abstract
Background: An increasing proportion of the population of patients with cancer presents at an advanced age, increasing the challenges of successful and well-tolerated treatments. In the older spectrum of the geriatric cancer patients, those older than 80 years old, challenges are even higher because of increasing comorbidities and decreasing organ function reserves. Methods: Studies regarding colorectal cancer presentation, treatment, and prognosis in patients older than 80 years old available in the literature were evaluated and were compiled within a narrative review. Molecular attributes of colorectal cancer in the subset of patients older than 80 years old in published genomic cohorts were also reviewed and were compared with similar attributes in younger patients. Results: Characteristics of colorectal cancer in octogenarians are in many aspects similar to younger patients, but patients older than 80 years old present more often with right colon cancers. Surgical treatment of colorectal cancer in selected patients over 80 years old is feasible and should be pursued. Adjuvant chemotherapy is under-utilized in this population. Although combination chemotherapy is in most cases not advisable, monotherapy with fluoropyrimidine derivatives is feasible and efficacious. Conclusions: Outcomes of colorectal cancer patients over the age of 80 years old may be optimized with a combination of standard treatments adjusted to the individual patient's functional status and organ reserves. Increased support for the older age group during their colorectal cancer treatment modalities would improve oncologic outcomes with decreasing adverse outcomes of therapies.
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Affiliation(s)
- Ioannis A. Voutsadakis
- Algoma District Cancer Program, Sault Area Hospital, 750 Great Northern Road, Sault Ste. Marie, ON P6B 0A8, Canada; or
- Section of Internal Medicine, Division of Clinical Sciences, Northern Ontario School of Medicine, Sudbury, ON P3E 2C6, Canada
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Cerdán Santacruz C, Merichal Resina M, Báez Gómez FD, Milla Collado L, Sánchez Rubio MB, Cano Valderrama Ó, Morales Rul JL, Sebastiá Vigatá E, Fierro Barrabés G, Escoll Rufino J, Sierra Grañón JE, Olsina Kissler JJ. "Optimal recovery" after colon cancer surgery in the elderly, a comparative cohort study: Conventional care vs. enhanced recovery vs. prehabilitation. Cir Esp 2022:S2173-5077(22)00197-1. [PMID: 35724876 DOI: 10.1016/j.cireng.2022.06.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Colon cancer in elderly patients is an increasing problem due to its prevalence and progressive aging population. Prehabilitation has experienced a great grown in this field. Whether it is the best standard of care for these patients has not been elucidated yet. METHODS A retrospective comparative cohort study of three different standards of care for elderly colon cancer patients (>65 years) was conducted. A four-weeks trimodal prehabilitation program (PP), enhanced recovery program (ERP) and conventional care (CC) were compared. Global complications, major complications (Clavien-Dindo ≥ 3), reinterventions, mortality, readmission and length of stay were measured. Optimal recovery, defined as postoperative course without major complications, no mortality, hospital discharge before the fifth postoperative day and without readmission, was the primary outcome measure. The influence of standard of care in optimal recovery and postoperative outcomes was assessed with univariate and multivariate logistic regression models. RESULTS A total of 153 patients were included, 51 in each group. Mean age was 77.9 years. ASA Score distribution was different between groups (ASA III-IV: CC 56.9%, ERP 25.5%, PP 58.9%; p = 0.014). Optimal recovery rate was 55.6% (PP 54.9%, ERP 66.7%, CC 45.1%; p = 0.09). No differences were found in major complications (p = 0.2) nor reinterventions (p = 0.7). Uneventful recovery favors ERP and PP groups (p = 0.046 and p = 0.049 respectively). CONCLUSIONS PP and ERP are safe and effective for older colon cancer patients. Fewer overall complications and readmissions happened in ERP and PP patients. Major complications were independent of the standard of care used.
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Affiliation(s)
- Carlos Cerdán Santacruz
- Colorectal Surgery Department at Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain. https://twitter.com/DrCarlosCerdan
| | | | | | - Lucía Milla Collado
- Thoracic Surgery Department, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
| | | | | | | | | | | | - Jordi Escoll Rufino
- Colorectal Surgery Department at Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
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Conversion to Open Surgery in Laparoscopic Colorectal Cancer Resection: Predictive Factors and its Impact on Long-Term Outcomes. A Case Series Study. SURGICAL LAPAROSCOPY, ENDOSCOPY & PERCUTANEOUS TECHNIQUES 2021; 32:28-34. [PMID: 34369479 DOI: 10.1097/sle.0000000000000986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 06/18/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laparoscopic resection is the treatment of choice for colorectal cancer. Rates of conversion to open surgery range between 7% and 30% and controversy exists as to the effect of this on oncologic outcomes. The objective of this study was to analyze what factors are predictive of conversion and what effect they have on oncologic outcomes. METHODS From a prospective database of patients undergoing laparoscopic surgery between 2000 and 2018 a univariate and multivariate analyses were made of demographic, pathologic, and surgical variables together with complementary treatments comparing purely laparoscopic resection with conversions to open surgery. Overall and disease-free survival were compared using the Kaplan-Meier method. RESULTS Of a total of 829 patients, 43 (5.18%) converted to open surgery. In the univariate analysis, 12 variables were significantly associated with conversion, of which left-sided resection [odds ratio (OR): 2.908; P=0.02], resection of the rectum (OR: 4.749, P=0.014), and local invasion of the tumor (OR: 6.905, P<0.01) were independently predictive factors in the multiple logistic regression. Female sex was associated with fewer conversions (OR: 0.375, P=0.012). The incidence and pattern of relapses were similar in both groups and there were no significant differences between overall and disease-free survival. CONCLUSIONS Left-sided resections, resections of the rectum and tumor invasion of neighboring structures are associated with higher rates of conversion. Female sex is associated with fewer conversions. Conversion to open surgery does not compromise oncologic outcomes at 5 and 10 years.
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Tamai K, Okamura S, Kitahara T, Minoji T, Takabatake H, Watanabe N, Yamamura N, Fukuchi N, Ebisui C, Yokouchi H, Tsuda M, Mizote I, Kinuta M. Laparoscopic colectomy after transcatheter aortic valve implantation in an elderly patient with obstructive descending colon cancer and severe aortic stenosis: a case report. Surg Case Rep 2019; 5:102. [PMID: 31236739 PMCID: PMC6591332 DOI: 10.1186/s40792-019-0662-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 06/12/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The demand for laparoscopic colectomy is increasing due to greater number of elderly colon cancer patients, and it is important to evaluate existing comorbidities to ensure perioperative safety. Aortic stenosis (AS) is one of the most common heart diseases in the elderly, and elderly cancer patients with severe AS may be considered ineligible for optimal cancer treatment if they cannot endure surgical aortic valve replacement (SAVR). Recently, transcatheter aortic valve implantation (TAVI) has become a valid option in patients who are high risk for SAVR. We herein present the first case of an elderly cancer patient with severe AS who underwent laparoscopic colectomy after TAVI. CASE PRESENTATION An 87-year-old woman with a history of multiple cardiovascular diseases was diagnosed with obstructive descending colon cancer and initially underwent colonic stenting. However, as preoperative echocardiography revealed severe AS, she underwent TAVI prior to the colectomy to reduce perioperative risk. TAVI was chosen instead of SAVR due to high SAVR mortality risk, and laparoscopic colectomy was performed 22 days after TAVI. Her postoperative course was uneventful, and she was discharged 14 days later without any deterioration in general condition. No recurrence was observed at more than 1 year, even without adjuvant therapy. CONCLUSION TAVI facilitated subsequent laparoscopic colectomy in an elderly cancer patient with severe AS. Our case report shows that TAVI may enable further cancer treatment even in patients with severe AS, who may otherwise be considered not suitable for such treatments.
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Affiliation(s)
- Koki Tamai
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Shu Okamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan.
| | - Tomohiro Kitahara
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Takayuki Minoji
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Hiroyuki Takabatake
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Noriyuki Watanabe
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Noriyuki Yamamura
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Nariaki Fukuchi
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Chikara Ebisui
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Hideoki Yokouchi
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
| | - Masaki Tsuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Isamu Mizote
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Yamadaoka 2-2, Suita, Osaka, 565-0871, Japan
| | - Masakatsu Kinuta
- Department of Surgery, Suita Municipal Hospital, Kishibeshinmachi 5-7, Suita, Osaka, 564-8567, Japan
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