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Protásio BM, de Castria TB, Natalino R, Mangone FR, Saragiotto DF, Sabbaga J, Hoff PM, Chammas R. Prognostic Impact of Primary Tumor Sidedness in Stage III Colorectal Cancer: Real-World Evidence from a Brazilian Cohort. Clin Colorectal Cancer 2024; 23:73-84. [PMID: 38151358 DOI: 10.1016/j.clcc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/06/2023] [Accepted: 12/07/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND Primary tumor sidedness (PTS) is an independent prognostic factor in patients with metastatic colorectal cancer (CRC), with a worse prognosis for right-sided tumors. There are limited data on the prognostic impact of PTS in stage III CRC. The main objective of this study was to analyze the prognostic impact of PTS in stage III CRC. PATIENTS AND METHODS A retrospective and uni-institutional cohort study was performed in an oncology reference center. Patients with stage III CRC treated with a 5-fluorouracil and oxaliplatin-based chemotherapy regimen (mFLOX regimen) from October 2007 to February 2013 were included. The primary outcome was the probability of overall survival (OS) at 5 years stratified by PTS. Secondary outcomes were the probability of disease-free survival (DFS) at 5 years and an analysis of the prognostic impact of clinical and molecular biomarkers. Kaplan‒Meier curves were used, and Cox models were used to evaluate prognostic factors associated with OS and DFS. RESULTS Overall, 265 patients were evaluated. Transverse colon tumors, multicentric tumors, and undetermined primary subsites were excluded, resulting in 234 patients classified according to PTS: 95 with right sidedness (40.6%) and 139 with left sidedness (59.4%). The median follow-up time was 66 months [interquartile range (IQR): 39-81]. The 5-year OS probabilities for right-sided and left-sided tumors were 67% (95% CI: 58%-77%) and 82% (75%-89%), respectively [hazard ratio (HR): 2.02, 95% CI: 1.18-3.46; P = .010]. The 5-year probabilities of DFS for right-sided and left-sided tumors were 58% (49%-69%) and 65% (58%-74%), respectively (HR: 1.29, 0.84-1.97; P = 0.248). CONCLUSION These data suggest that there may be a worse prognosis (inferior OS at 5 years) for resected right-sided stage III CRC patients treated in the real world. However, these data need to be confirmed by prospective studies with a larger number of participants.
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Affiliation(s)
- Bruno Medonça Protásio
- Programa de Pós-Graduação em Oncologia, Faculdade de Medicina da Universidade de São Paulo- FMUSP, Sao Paulo, Brazil; Núcleo de Oncologia da Bahia- NOB. Grupo Oncoclínicas, Salvador, Brazil.
| | | | - Renato Natalino
- Centro de Investigação Translacional em Oncologia- CTO. Instituto do Câncer do Estado de São Paulo-ICESP. Faculdade de Medicina da Universidade de São Paulo- FMUSP, Sao Paulo, Brazil
| | - Flávia R Mangone
- Centro de Investigação Translacional em Oncologia- CTO. Instituto do Câncer do Estado de São Paulo-ICESP. Faculdade de Medicina da Universidade de São Paulo- FMUSP, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de São Paulo, Sao Paulo, Brazil
| | - Daniel Fernandes Saragiotto
- Departamento de Oncologia do Hospital Santa Catarina Paulista, São Paulo, Brazil; Centro Brasileiro de Radioterapia, Oncologia e Mastologia- CEBROM. Grupo Oncoclínicas, Goiania, Brazil
| | - Jorge Sabbaga
- IDOR- Intituto D'Or de Pesquisa e Ensino, Sao Paulo, Brazil; Disciplina de Oncologia Clínica do Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo- FMUSP. Instituto do Câncer do Estado de São Paulo- ICESP, Sao Paulo, Brazil
| | - Paulo M Hoff
- IDOR- Intituto D'Or de Pesquisa e Ensino, Sao Paulo, Brazil; Disciplina de Oncologia Clínica do Departamento de Radiologia e Oncologia da Faculdade de Medicina da Universidade de São Paulo- FMUSP. Instituto do Câncer do Estado de São Paulo- ICESP, Sao Paulo, Brazil
| | - Roger Chammas
- Centro de Investigação Translacional em Oncologia- CTO. Instituto do Câncer do Estado de São Paulo-ICESP. Faculdade de Medicina da Universidade de São Paulo- FMUSP, Sao Paulo, Brazil; Comprehensive Center for Precision Oncology, Universidade de São Paulo, Sao Paulo, Brazil
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Ye L, Zhong JH, Liu YP, Chen DD, Ni SY, Peng FQ, Zhang S. Extensively infarcted giant solitary hamartomatous polyp treated with endoscopic full-thickness resection: A case report. World J Clin Cases 2023; 11:1782-1787. [PMID: 36969998 PMCID: PMC10037273 DOI: 10.12998/wjcc.v11.i8.1782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/17/2023] [Accepted: 02/15/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Solitary hamartomatous polyps (SHPs) are rare lesions. Endoscopic full-thickness resection (EFTR) is a highly efficient and minimally invasive endoscopic procedure that benefits from complete lesion removal and high safety.
CASE SUMMARY A 47-year-old man was admitted to our hospital after experiencing hypogastric pain and constipation for over fifteen days. Computed tomography and endoscopy revealed a giant pedunculated polyp (approximately 18 cm long) in the descending and sigmoid colon. This is the largest SHP reported to date. Having considered the condition of the patient and mass growth, the polyp was removed using EFTR.
CONCLUSION On the basis of clinical and pathological evaluations, the mass was considered an SHP.
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Affiliation(s)
- Lu Ye
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Ji-Hong Zhong
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Yong-Pan Liu
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Dan-Dan Chen
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou 310053, Zhejiang Province, China
| | - Si-Yi Ni
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Fa-Quan Peng
- Department of Pathology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
| | - Shuo Zhang
- Department of Gastroenterology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 310005, Zhejiang Province, China
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Nakao T, Shimada M, Yoshikawa K, Tokunaga T, Nishi M, Kashihara H, Takasu C, Wada Y, Yoshimoto T, Yamashita S, Iwakawa Y. Vascular variations encountered during laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer: a retrospective cohort study. BMC Surg 2022; 22:170. [PMID: 35538458 PMCID: PMC9092770 DOI: 10.1186/s12893-022-01603-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 04/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Laparoscopic surgery for cancer located in the transverse colon or splenic flexure is difficult because of vascular variability in this region and adjacent vital organs such as the pancreas, spleen, and duodenum. METHODS This retrospective cohort study involved 51 patients who underwent laparoscopic surgery for colon cancer at Tokushima University Hospital from July 2015 to December 2020. Variations of the middle colic artery (MCA), left colic artery (LCA), middle colic vein (MCV), and first jejunal vein (FJV) and short-term outcomes of laparoscopic surgery in patients with each vascular variation were evaluated. RESULTS Variations of the MCA, LCA, MCV, and FJV were classified into four, three, five, and three patterns, respectively. The short-term outcomes of laparoscopic surgery for transverse colon cancer in patients with MCA variations and those with FJV variations were evaluated, and no significant difference was found in the operation time, blood loss, postoperative complication rate, time from surgery to start of dietary intake, or time from surgery to discharge among the different variations. Additionally, no significant differences were found in the short-term outcomes of laparoscopic surgery for descending colon cancer in patients with LCA variations. CONCLUSION Preoperative assessment of vascular variations may contribute to the stability of short-term outcomes of laparoscopic surgery for transverse colon, splenic flexure, and descending colon cancer.
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Affiliation(s)
- Toshihiro Nakao
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan.
| | - Mitsuo Shimada
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Kozo Yoshikawa
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Takuya Tokunaga
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Masaaki Nishi
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Hideya Kashihara
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Chie Takasu
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Yuma Wada
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Toshiaki Yoshimoto
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Syoko Yamashita
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
| | - Yosuke Iwakawa
- Department of Digestive and Transplant Surgery, Tokushima University Hospital, 3-18-15 Kuramoto-cho, Tokushima City, Tokushima, 7708503, Japan
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Song I, Park JW, Lim HK, Kim MJ, Kim MJ, Park SC, Oh JH, Oh HK, Kim DW, Kang SB, Ryoo SB, Jeong SY, Park KJ. The oncologic safety of left colectomy with modified complete mesocolic excision for distal transverse colon cancer: Comparison with descending colon cancer. Eur J Surg Oncol 2021; 47:2857-2864. [PMID: 34119379 DOI: 10.1016/j.ejso.2021.05.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 05/05/2021] [Accepted: 05/26/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The optimal surgical approach for distal transverse colon cancer has not been well established. This study aimed to evaluate the oncologic safety of left colectomy with a modified complete mesocolic excision for distal transverse colon cancer as compared with descending colon cancer. MATERIAL AND METHODS This study involved 383 patients who underwent left colectomy with modified complete mesocolic excision for non-metastatic distal transverse and splenic flexure colon (transverse group, N = 110) and descending colon cancer (descending group, N = 237) from 3 institutions. Recurrence-free survival (RFS) and overall survival (OS) were compared between the two groups. RESULTS Baseline characteristics between the two groups were similar except for the length of the distal margin (transverse group = 11.0 cm vs descending group = 9.0 cm, p = 0.004). During a median follow-up of 47.0 months, RFS and OS were not different between the transverse and descending groups (5-year RFS: 82% vs 71%, p = 0.139; 5-year OS: 83% vs 79%, p = 0.416, respectively). In multivariable analysis, RFS and OS were not different between the two groups (transverse group vs. descending group: adjusted hazard ratio [aHR] = 1.557, 95% CI = 0.786-3.084, p = 0.204; aHR = 1.251, 95% CI = 0.530-2.952, p = 0.609). CONCLUSION The oncologic outcomes of left colectomy with a modified complete mesocolic excision of distal transverse colon cancer were comparable to those of descending colon cancer. Left colectomy with a modified complete mesocolic excision can be an acceptable surgical treatment for distal transverse colon cancer.
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Affiliation(s)
- Inho Song
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea.
| | - Han-Kin Lim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Myung Jo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea; Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Gnansekaran D, Prashant SA, Veeramani R, Yekappa SH. Congenital positional anomaly of descending colon and sigmoid colon: Its embryological basis and clinical implications. Med J Armed Forces India 2021; 77:241-244. [PMID: 33867645 DOI: 10.1016/j.mjafi.2019.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 10/19/2019] [Indexed: 12/24/2022] Open
Abstract
The rotation of the midgut is essential for normal placement of intestines in the abdominal cavity. The process of midgut rotation and simultaneous retraction of the herniated intestinal loops pushes the hind gut to the left side of the abdominal cavity. So the descending colon and the sigmoid colon occupy the left side of the abdominal cavity. In this report, we document a male cadaver that revealed right-sided sigmoid colon. On further dissection, the descending colon was found lying in the midline with a small peritoneal fold stretching from the right side of sigmoid colon to ileocecal junction. There was also variation in the inferior mesenteric artery supplying the displaced descending colon and sigmoid colon. The possible embryological and molecular basis of this variation has been discussed. The anatomical knowledge of this variation is essential for interventional and diagnostic colonoscopy procedures and colonic surgeries.
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Affiliation(s)
- Dhivyalakshmi Gnansekaran
- Resident (Anatomy), Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Pondicherry, 605006, India
| | - Sonali Adole Prashant
- Senior Resident (Anatomy), Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Pondicherry, 605006, India
| | - Raveendranath Veeramani
- Professor (Anatomy), Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Pondicherry, 605006, India
| | - Suma Hottigoudar Yekappa
- Additional Professor (Anatomy), Jawaharlal Institute of Postgraduate Medical Education and Research [JIPMER], Pondicherry, 605006, India
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Cha JW, Yang M, Mo A. Large cell neuroendocrine carcinoma in the unusual location of the descending colon. Radiol Case Rep 2020; 15:1841-1844. [PMID: 32817774 PMCID: PMC7424166 DOI: 10.1016/j.radcr.2020.07.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 11/16/2022] Open
Abstract
Neuroendocrine neoplasms are most often found in the small intestine, rectum, appendix, and stomach. The colon, excluding the appendix and the cecum, is a rare location for these neoplasms and often gives rise to highly proliferative, poorly differentiated tumors with aggressive features and dismal prognosis. A 32-year-old male presents with a large cell neuroendocrine carcinoma arising from an unusual location, the descending colon. The patient's clinical and imaging characteristics resembles those seen in the much more common neoplasm, colonic adenocarcinoma. Computed tomography and In-111 octreotide scan are limited in diagnosing large cell neuroendocrine carcinoma. Pathologic correlation of a surgical specimen is required to make the correct diagnosis.
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Affiliation(s)
- Jin-Whan Cha
- Larkin Community Hospital, 7031 SW 62nd Avenue, South Miami, FL 33143, USA
| | - Millet Yang
- Larkin Community Hospital, 7031 SW 62nd Avenue, South Miami, FL 33143, USA
| | - Alan Mo
- Larkin Community Hospital, 7031 SW 62nd Avenue, South Miami, FL 33143, USA
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Park JH, Park HC, Park SC, Oh JH, Kim DW, Kang SB, Heo SC, Kim MJ, Park JW, Jeong SY, Park KJ. Female Sex and Right-Sided Tumor Location Are Poor Prognostic Factors for Patients With Stage III Colon Cancer After a Curative Resection. Ann Coloproctol 2018; 34:286-291. [PMID: 30630302 PMCID: PMC6347333 DOI: 10.3393/ac.2018.10.29] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/29/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose Stage-IIIC colon cancer is an advanced disease; however, its oncologic outcomes and prognostic factors remain unclear. In this study, we aimed to determine the predictors of disease-free survival (DFS) in patients with stage-IIIC colon cancer. Methods From a multicenter database, we retrospectively enrolled 611 patients (355 men and 256 women) who had undergone a potentially curative resection for a stage-IIIC colon adenocarcinoma between 2003 and 2011. The primary end-point was the 5-year DFS. Results The median age was 62 years; 213 and 398 patients had right-sided colon cancer (RCC) and left-sided colon cancer (LCC), respectively. The 5-year DFS in all patients was 52.0%; median follow-up time was 35 months (range, 1–134 months). A multivariate Cox regression revealed that female sex (hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.19–1.90; P < 0.01), right-sided tumor location (HR, 1.65; 95% CI, 1.29–2.11; P < 0.01), lymphatic invasion (HR, 1.52; 95% CI, 1.08–2.15; P < 0.01) and a high (≥0.4) metastatic lymph node ratio (HR, 3.72; 95% CI, 2.63–5.24; P < 0.01) were independent predictors of worse 5-year DFS. Female patients with RCC were 1.79 fold more likely to experience recurrence than male patients with LCC. Conclusion Female sex and right-sided tumor location are associated with higher tumor recurrence rates in patients with stage-IIIC colon cancers. Aggressive treatment and close surveillance should be planned for patients in these groups.
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Affiliation(s)
- Jung Ho Park
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyoung-Chul Park
- Department of Surgery, Hallym University Sacred Heart Hospital, Anyang, Korea.,Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung Chul Heo
- Department of Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, Korea
| | - Min Jung Kim
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.,Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
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Schneider LV, Millet I, Boulay-Coletta I, Taourel P, Loriau J, Zins M. Right colonic diverticulitis in Caucasians: presentation and outcomes versus left-sided disease. Abdom Radiol (NY) 2017; 42:810-7. [PMID: 27847996 DOI: 10.1007/s00261-016-0958-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE To compare clinical features, computed tomography (CT) findings, and outcomes of right vs. left colonic diverticulitis (CD) in Caucasians. METHODS This single-center retrospective case-control study of patients seen between July 2005 and February 2013 included 30 consecutive cases of right CD and 70 controls taken at random from a consecutive cohort of patients with left CD. The final diagnosis was established by consensus between a gastrointestinal surgeon and a gastrointestinal radiologist. Clinical features, treatment, and follow-up data were collected. Two radiologists blinded to patient data reached a consensus about multiple CT criteria. Cases and controls were compared using appropriate statistical tests, and odds ratios (ORs) associated with clinically meaningful variables were computed using univariate logistic regression. RESULTS Median age was significantly lower in cases than in controls (48.5 years [IQR, 31-61] vs. 63.5 years [54-75], P < 0.0001). A body mass index <20 kg/m2 compared to >30 kg/m2 was associated with a higher risk of right than of left CD (OR 22.7, 95% confidence interval [95% CI], 2.6-200, P = 0.005). Compared to controls, cases more often had CT evidence of focal diverticular inflammation (86.7% [26/30] vs. 50% [35/70], P = 0.0006) and noncircumferential (≤180°) colonic wall thickening (66.7% [20/30] vs. 20% [14/70], P < 0.001). Complications were less common in the cases (6.7% [2/30] vs. 25.7% [18/70] than in controls, P = 0.03). CONCLUSION In Caucasians, right CD occurs in younger and thinner patients and carries a lower risk of complications compared to left CD. Focal diverticular inflammation by CT is more common in right than in left CD.
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Bagherzadeh Saba R, Sadeghi A, Rad N, Safari MT, Barzegar F. Colonic intussusception in descending colon: An unusual presentation of colon lipoma. Gastroenterol Hepatol Bed Bench 2016; 9:S93-S96. [PMID: 28224035 PMCID: PMC5310807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Lipomas of the colon are relatively rare benign soft tissue tumors derived from mature adipocytes of mesenchymatic origin. During colonoscopy, surgery or autopsy they are generally discovered incidentally. Most cases are asymptomatic, with a small tumor size, and do not need any special treatment. However, in the cases with larger in size of tumor some symptoms such as anemia, abdominal pain, constipation, diarrhea, bleeding, or intussusception may be presented. We reported a 47-year-old woman with colonic intussusception in the descending colon caused by colonic lipoma and diagnosed after surgical exploration for obstructive colonic mass.
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Affiliation(s)
- Reza Bagherzadeh Saba
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amir Sadeghi
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Neda Rad
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research institute for Gastroenterologyand Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Taghi Safari
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farnoush Barzegar
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Kar H, Karasu S, Bag H, Cin N, Durak E, Peker Y, Tatar FA. Case Report of the Descending Colon Located Completely in the Right Extraperitoneal Cavity and Sigmoid Colon Located in the Right Quadrant in a Patient with a Splenic Flexure Tumor: a Rare Anomaly. Indian J Surg 2016; 78:323-5. [PMID: 27574354 DOI: 10.1007/s12262-015-1407-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 11/10/2015] [Indexed: 12/24/2022] Open
Abstract
Cases in which congenital anomalies of the colon and colon tumors are observed together are very rare. The aim of this article is to present a splenic flexure tumor case, which possessed the anomaly of the descending colon in the right extraperitoneal space and the sigmoid colon located in the right quadrant. Similar findings have previously been reported in two cases in cadaveric studies.
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Shrivastava P, Tuli A, Kaur S, Raheja S. Right sided descending and sigmoid colon: its embryological basis and clinical implications. Anat Cell Biol 2013; 46:299-302. [PMID: 24386604 PMCID: PMC3875849 DOI: 10.5115/acb.2013.46.4.299] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/25/2013] [Accepted: 10/14/2013] [Indexed: 12/18/2022] Open
Abstract
Anatomical variations of the colon are described by various authors, but the occurrence of right sided descending and sigmoid colon is rare and has not been reported. We found that the anomalous right-sided descending and sigmoid colon had four parts. The proximal segment of the first part consisted of the descending colon extending across the midline from the splenic flexure to the portion supplied by the left colic artery. The distal segment was supplied by the superior sigmoid artery. The second and third parts formed a loop in the right lumbar region anterior to the lumbar cecum. The fourth part was in the lesser pelvis, extending from right sacroiliac joint to the third sacral body. Parts two, three, and four were supplied by the inferior sigmoid artery, which arose from the right side of the inferior mesenteric artery. The ascending and transverse colon was normally placed. This is a rare anomaly that has not been reported so far in adults and is of immense importance to interventional radiologists and colorectal surgeons. The embryological basis of such an anomaly is defective fixation occurring as early as the 12th-17th week of intrauterine life.
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Affiliation(s)
- Preeti Shrivastava
- Department of Anatomy, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Anita Tuli
- Department of Anatomy, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Sohinder Kaur
- Department of Anatomy, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
| | - Shashi Raheja
- Department of Anatomy, Lady Hardinge Medical College and SSK Hospital, New Delhi, India
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Manyacka Ma Nyemb P, Ndoye JM, Ndiaye AB, Diakhate I, Dia A. [Anatomical radiology of the descending colon in the left pararenal space: about 1084 cases]. Morphologie 2013; 97:48-53. [PMID: 23791296 DOI: 10.1016/j.morpho.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Revised: 05/11/2013] [Accepted: 05/17/2013] [Indexed: 10/26/2022]
Abstract
AIMS Due to the severity of colonic injuries and their frequency on the left side, we study relationships between the left kidney and the descending colon to identify subjects at risk of colonic perforation during percutaneous surgery of the left kidney. MATERIAL AND METHODS Over a period of 3 years we exploited abdominal CT scans for 1084 patients in both sexes without any visceral or parietal lesions. We studied the situation and relationships of the lumbar part of the descending colon in the left pararenal space using a conventional grid technique. RESULTS The preferential site of the colon in both sexes was laterorenal in 55.8% of cases. We also found the descending colon in a posterolateral situation in 21.1% of cases, and in an anterolateral situation in 14.8% of cases. In women, the posterolateral situation was twice more common than in men, but we did not observe any post-renal situation. Laterorenal and posterolateral situations were the most frequent in patients less than 50 years; while beyond this age 70.1% of subjects had a laterorenal type. CONCLUSION Sex and age affect topographic variations of the lumbar part of the descending colon in the left pararenal space. Although they are rare or aberrant, some locations exist and should not be ignored by the operator. These locations are risk factors of colonic lesion during percutaneous approach of the left kidney.
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Affiliation(s)
- P Manyacka Ma Nyemb
- Laboratoire d'anatomie, UFR des sciences de la santé, université Gaston Berger, Saint-Louis, Sénégal.
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Abstract
This is a case report on a stercoral perforation of the descending colon that was not adequately treated in the first operation. Re-operation was required in order to revise the primary repair site and to remove the impacted fecaloma.
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Affiliation(s)
- Jeonghyun Kang
- Department of Surgery, Gachon University Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
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Xia CF, Li YF, Li Q, Pan DG, Feng R. Diagnosis and treatment of primary malignant melanoma in the descending colon: a report of one case. Shijie Huaren Xiaohua Zazhi 2009; 17:3765-3767. [DOI: 10.11569/wcjd.v17.i36.3765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Malignant melanoma arises from melanocytes. As blood or lymph node metastasis occurs in the early stage of malignant melanoma, the disease has a poor prognosis. The anorectum, behind the skin and eyes, is the third most frequent site of malignant melanoma. Primary malignant melanoma of the colon is a rare clinical condition. Here, we report a case of primary malignant melanoma in the colon in a 66-year-old female. She was definitely diagnosed as primary malignant melanoma in the descending colon after radical resection and lymph node dissection. Postoperative systemic chemotherapy and immunotherapy achieved good effects. The patient is still alive five years postoperatively.
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