From mininvasive to maxinvasive surgery in colorectal cancer: Modern evolution of oncologic specialized units

Ureteral involvement by metastatic malignant disease

Ureteral metastases from other primary cancers are very rare. Treatment of these metastases is difficult and outcomes are poor. A thorough literature review was done with the aim of finding characteristics that may influence survival rates of patients with ureteral metastases. Systematic literature searches of PubMed and Web of Science were performed in Jan 2019. A total of 79 papers that included 265 patients with cancer metastases to their ureters were finally considered for evidence synthesis. Prostate, bladder, breast, gut cancer and lymphoma were the predominant primary tumors. The median interval time from primary tumor diagnosis to ureter metastasis was 28.5 months. The median survival time after diagnosis of ureter metastasis was 18 months. Risk factors of survival were analyzed. Age, sex, hydronephrosis, ureter side, and segment were not associated with survival. Interval time and treatment were associated with overall survival. Further analysis indicated that patients who underwent surgery had better outcomes.

A novel approach for the resection of low rectal cancer

BACKGROUND

Our novel approach is a hybrid between cylindrical abdominoperineal resection and single-incision laparoscopic surgery (SILS). We report the clinical application of this technique and present preliminary data that shows this approach to be an effective tool for resection of low rectal cancer.

METHODS

Twenty patients with endoscopy-considered and biopsy-proven malignant lesions were required to undergo abdominal computed tomography examination for determining tumor stage. In addition, all patients had taken in digital rectal examination again on the surgery day. Perioperative management of patients was executed according to management of patients in fast-track surgery. First, cylindrical abdominoperineal resection was performed with the patients in the prone jackknife position to peritoneal reflection, then we turned the patients to the supine position and SILS was performed with the homemade single-port device.

RESULTS

The average distance from the anal verge was 2.60±1.14 cm and the mean tumor diameter confirmed by pathology measured to be 3.00±1.08 cm, and the circumferential margin was negative in all the specimens. The mean fabrication and set-up time of the homemade SILS device was 7.75±1.21 minutes and the average operating time was 138.55±9.32 minutes with minimal blood loss (20.5±5.83 mL). There were no conversions from SILS to conventional laparoscopy. On average, oral intake can often be successfully initiated 7.35±1.35 h after surgery, with the first passage of flatus from the colostomy occurring 2.55±0.76 d postoperation. Function hospital stay was 4.25±0.97 d with no undue sequelae. During the 6-month-long follow-up stage, no morbidity or mortality was observed except in 2 patients with poor union in perineum incision.

CONCLUSIONS

Cylindrical abdominoperineal decection combined with SILS is a feasible alternative for low rectal cancer, providing benefits like leaving enough exposure for operation, reducing trauma to surrounding organs, almost completely avoiding circumferential involvement, and allowing fast postoperative recovery.