Transverse colon cancer occurring at a colostomy site 35 years after colostomy: a case report

Colostomy-site carcinoma with primitive phenotype in a rectal cancer patient after achieving pathological complete response with neoadjuvant chemoradiotherapy

Herein, we report a rare case of a carcinoma with primitive phenotype (enteroblastic and/or hepatoid differentiation) occurring at a colostomy site. The patient was an elderly male who underwent neoadjuvant chemoradiotherapy for rectal cancer, followed by abdominoperineal resection. A biopsy specimen for the rectal carcinoma before neoadjuvant chemoradiotherapy was conventional tubular adenocarcinoma. Moreover, a pathological complete response was confirmed in the proctectomy specimen. However, a colostomy-site tumor appeared 6 months after the proctectomy, and it was resected 1 year after the initial proctectomy. The colostomy-site tumor comprised solid to focal glandular growth of atypical polygonal cells with clear to pale eosinophilic cytoplasm and was immunohistochemically positive for cytokeratin, spalt-like transcription factor 4, glypican-3, caudal type homeobox 2, and special AT-rich sequence-binding protein 2. Thus, the tumor was diagnosed as poorly differentiated adenocarcinoma with primitive phenotype, with suggested origin from the colorectal epithelium. Additionally, a multilocular cystic lesion comprising various types of epithelia was found adjacent to the tumor, suggestive of metaplasia or heterotopia. Changes in the histology and immunophenotype, and the findings of an adjacent cystic lesion suggest a metachronous tumor rather than a recurrence of the primary tumor.

Effects of comprehensive care on psychological emotions, postoperative rehabilitation and complications of colorectal cancer patients after colostomy

OBJECTIVE

This study aimed to explore the impacts of comprehensive care on psychological emotion, postoperative rehabilitation and complications of colorectal cancer patients after colostomy.

METHODS

From August 2018 to February 2020, a total of sixty colorectal cancer patients undergoing colostomy in our hospital were collected and randomly assigned to a control group to receive conventional care and a research group to receive comprehensive care, with 30 patients in each group. The two groups of patients were compared for postoperative recovery, complications, adverse psychological emotions, self-care ability, quality of life, and nursing satisfaction.

RESULTS

The first time of exhaust, food intake and the recovery of bowel sound in the research group were markedly earlier than those in the control group. Besides, the research group had notably lower incidence of postoperative complications, lower self-anxiety scale (SAS) and self-depression scale (SDS) scores at discharge, and higher average self-care ability than the control group, as well as higher quality of life score and nursing satisfaction.

CONCLUSION

Comprehensive care intervention can promote postoperative recovery of colorectal cancer patients after colostomy, relieve their negative emotions, reduce postoperative complications, improve quality of life and nursing satisfaction, which are all important and make this type of care worthy of promotion in clinical practice.

Surgical treatment of massive stoma site tumors after a curative operation for rectal cancer

OBJECTIVE

This study aimed to evaluate the clinical and oncological outcomes of selected rectal cancer patients with massive stoma site tumors who underwent radical resection and reconstruction.

METHODS

We reviewed 8 cases of massive stoma site tumors in patients who had permanent gastrointestinal stoma in the abdominal wall following radical resection of rectal cancer between March 2013 and May 2018 at the Peking University Cancer Hospital and Peking University Shougang Hospital.

RESULTS

There were seven males and one female patient, with a median age of 50.6 years. The average time between the initial surgery and the development of a malignant tumor at the stoma site was 5 years (range, 0.5-14 years). The average diameter of the stoma site tumors was 8.1 cm, and the diameter of the largest tumor was 12 cm. After tumor resection, the area of the largest abdominal wall defect was about 15 × 14 cm². Abdominal wall repair included the use of a tensor fasciae latae muscle flap, local fasciocutaneous rotational flap, and pedicled anterolateral thigh flap. No patient died in the 30 days following surgery. The longest follow-up period was 81 months, and 5 patients died.

CONCLUSIONS

Multidisciplinary clinical management fosters positive outcomes in treating massive stoma site tumors. Local R0 resection and abdominal wall reconstruction are safe and feasible, and function to removes local disease, allowing patients to live a higher quality of life.

Intestinal Stomas-Postoperative Stoma Care and Peristomal Skin Complications

Intestinal stomas are necessary for several colon and rectal conditions and represent a major change in the new ostomate's daily life. Though dehydration is the most frequent etiology requiring readmission, irritant contact dermatitis and a host of other peristomal skin conditions are more common complications for ostomates. Wound, ostomy, and continence nurses are invaluable resources to both ostomy patients and providers. A few simple interventions can prevent or resolve most common peristomal complications. Good stoma care is possible in a resource-poor environment.