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ABSTRACT: Summary Access to the sigmoid colon tumour by the conventional transanal technique has been hard to achieve. A transanal local excision procedure with an E type anal retractor and a stapler (minimally invasive transanal surgery, MITAS), combined with an invagination technique, was performed in a patient with a sigmoid colon tumour.
07/2009; 6(4):340-342.
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ABSTRACT: Mucinous adenocarcinoma associated with chronic anal fistula is extremely rare, and such tumors have often reached an advanced stage at the time of presentation. Here we report a case of mucinous adenocarcinoma associated with chronic anal fistula that involved repair with gracilis myocutaneous flaps and review other reported cases. A 67-year-old man with an approximate 30-year history of an anal fistula was referred to our hospital due to enlargement of the perianal induration accompanied by mucinous secretion and pain. Physical examination of the perianal region revealed an ulcerated and discharging lesion on the buttocks. Histologic examination of a biopsy specimen of the ulcerated lesion revealed mucinous adenocarcinoma. An abdominoperineal resection was performed with resection of the ischiorectal fossa, coccyx, part of the gluteus maximus, and the obturator internus. The extensive defect was repaired with bilateral gracilis myocutaneous flaps. The patient did not experience a decrease in the strength of hip adduction and survived for 58 months without recurrence until he died of pneumonia. The repair using myocutaneous flaps was considered to contribute to a physically active life without recurrence.
Techniques in Coloproctology 11/2006; 10(3):249-52. · 1.29 Impact Factor
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ABSTRACT: This study was designed to identify those patients with Dukes C rectal carcinoma below the peritoneal reflection who might benefit from lateral lymph node dissection.
The study involved 104 consecutive Dukes C patients who received total mesorectal excision with lateral lymph node dissection for rectal carcinoma below the peritoneal reflection between 1990 and 2002. The patients were retrospectively divided into three groups: patients without lateral spread (Group I: n = 52), patients with nodal involvement between the inferior hypogastric nerve and the internal iliac artery (Group II: n = 16), and patients with nodal involvement in the obturator space (Group III: n = 36). The patients also were divided into two groups according to the number of lateral nodes involved: less than four (n = 42) and at least four (lateral nodes involved: n = 10). Nodal involvement was determined histologically.
The local recurrence and overall five-year survival rates were 5.8 and 66.9 percent in Group I, 18.8 and 59.8 percent in Group II, and 33.3 and 23.6 percent in Group III, respectively. These outcomes did not differ significantly between Groups I and II, but they were significantly worse in Group III than in Groups I and II, with the survival being significantly better in the patients with less than four histologically positive lateral nodes involved (43.2 percent) than in those with at least four positive lateral nodes involved (0 percent).
Lateral lymph node dissection was effective for Dukes C rectal carcinoma below the peritoneal reflection with positive lateral nodes involved in the space between the autonomic nerve and the internal iliac artery and in patients with less than four positive lateral nodes.
Diseases of the Colon & Rectum 11/2006; 49(10 Suppl):S3-12. · 3.13 Impact Factor
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ABSTRACT: Prolapse is a common complication in patients with a transverse loop colostomy. In most cases, the prolapse can be managed conservatively awaiting time for closure eventually. However, loop stoma may also be intentionally permanent or the patient may be too fragile to have the colostomy closed and in these cases a laparotomy is required for correction of the prolapse. A simple method allowing local correction of the prolapsed loop stoma is described.
Techniques in Coloproctology 04/2004; 8(1):45-6. · 1.29 Impact Factor
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ABSTRACT: We evaluated functional and morphological outcomes of transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele.
Ten women (median 68 years) underwent transvaginal anterior levatorplasty with posterior colporrhaphy for symptomatic rectocele. Symptoms and continence were monitored before and after surgery. Manovolumetric study and defecography were performed in 9 of 10 patients before and 3-6 months after surgery. Twenty-one females without anorectal diseases were used as controls in manovolumetric study. The patients were followed up after a median of 89 months (range, 3-103).
Main symptoms (defecatory disorders in 9 patients, vaginal mass in 6, perineal discomfort in 2) disappeared after surgery. Six patients performed digitation preoperatively and gave up digitation on defecation after surgery. Stool incontinence disappeared in 4 of 5 preoperatively incontinent patients (Cleveland clinic score, 5-12) and continence score improved from 5 to 2 in the remaining patient. Three patients with urinary cough incontinence preoperatively did not experience incontinence after surgery but cough incontinence occurred occasionally in an 81-year-old patient postoperatively. Rectocele demonstrated on defecography disappeared postoperatively in all 9 patients who underwent defecography. High threshold volume and maximum tolerable volume, which were observed preoperatively, decreased to control levels after surgery.
Transvaginal anterior levatorplasty with posterior colporrhaphy might be an option for symptomatic rectocele to improve anorectal and urinary dysfunctions with morphological disorders.
Techniques in Coloproctology 11/2003; 7(3):181-5. · 1.29 Impact Factor
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ABSTRACT: We investigated both pathogenesis and prevention of loop transverse stomal prolapse. Seven patients with reducible prolapsed stoma were studied under fluoroscopy after staining the prolapsed stoma and the colon by barium medium while prolapsing or reducing the stoma with or without the stomal wall pressed on to the abdominal wall of fascial plane. All prolapses occurred in the distal limbs of the loop stoma with the distal transverse colons redundant. The prolapse started around the mucocutaneous suture with the stoma inflated and the colon in it depressed and proceeded in accordance with an addition of abdominal pressure, but did not occur by pressing of the stomal wall. Prolapse of transverse loop stoma occurs when redundant colon invades the stoma with an abdominal pressure. Stomal prolapse might be prevented by fixation of the colon to the fascia.
Techniques in Coloproctology 08/2003; 7(2):108-11. · 1.29 Impact Factor
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ABSTRACT: We evaluated to what extent lateral lymph node dissection (LND) interferes with bladder and male sexual functions after radical rectal excision with adoption of careful total autonomic nerve preservation.
The study comprised 77 patients resected for mid-rectal or lower rectal cancer. Bladder and male sexual functions were studied by means of a questionnaire more than one year after surgery. Outcomes were compared between patients who received lateral LND (group 1, 65 patients) and those who did not (group 2, 12 patients).
Only minor disturbances of bladder function were reported in 10 patients (15%) of group 1, and in 3 patients (25%) of group 2. Ten out of 37 preoperatively sexually active patients (27%) in group 1 males and one of 5 patients (20%) in group 2 males had partial or total impotency after surgery and retrograde ejaculation occurred in 3 of 27 patients (11%) and one of 4 patients (25%), respectively. Erectile impotency occurred less frequently when patients were operated during the period 1993-1996 than during 1988-1992 (11% vs. 42%, p<0.05). The age was significantly greater among patients who had loss of ejaculation.
If lateral lymph node dissection should be used with the aim of improving radicality in rectal excision for cancer, it should be combined with careful nerve-preserving technique--which may reduce the risk of bladder and male sexual dysfunctions.
Techniques in Coloproctology 05/2003; 7(1):29-33. · 1.29 Impact Factor
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Journal of Hepato-Biliary-Pancreatic Surgery 01/2003; 10(6):455-456. · 1.60 Impact Factor
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ABSTRACT: OBJECTIVE: The lymphatic drainage from the rectum was studied to evaluate if the autonomic nerve sparing dissection may interfere with the operative radicality and might result in metastatic lymph nodes being overlooked and left in situ. PATIENTS AND METHODS: 50 consecutive patients had an extended extrafascial rectal excision resection for cancer. In 19 of the 50 patients activated carbon particles (CH40) were injected preoperatively into the rectum. The autonomic nerves with surrounding connective tissue were serially dissected from the resected specimen, carefully sliced at 5-mm intervals and collected for histological study. Lymph nodes along the axial and lateral drainage routes were examined, and the inclusion of CH40 in the nodes was microscopically studied according to the site of CH40 injection. RESULTS: Lymph nodes within the connective tissue along the dissected autonomic nerves were demonstrated in 47 of the 50 cases. Two of 50 cases had positive nodes along preaortic plexus or pelvic plexus, and a case with nodal involvement along the pelvic plexus had poor prognosis in spite of nerve excision. CH40 when injected into the rectum above the peritoneal reflection was demonstrated in the vast majority of the axial nodes, while in only one lymph node along the preaortic plexus when injected in the rectum above the peritoneal reflection. On the other hand when injected in the rectum below the peritoneal reflection, CH40 was demonstrated both in axial and lateral nodes as well as in lymph nodes along bilateral pelvic plexuses, right hypogastric nerve, superior hypogastric plexus, preaortic plexus and mesenteric plexus as well. CONCLUSIONS: When located above the peritoneal reflection a rectal carcinoma will spread preferentially along the upper axial route, while a carcinoma located below the peritoneal reflection will also spread laterally and along the autonomic nerves. It was inferred that lymphatic flow along the autonomic nerves came up from the rectum below the peritoneal reflection mainly through a so-called lateral ligament but its clinical significance was negligible. Therefore doing TME with autonomic nerve preservation does not imply a less radical surgery from the point of lymphatic spread.
Colorectal Disease 08/2002; 4(4):233-239. · 2.93 Impact Factor
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ABSTRACT: The aim of the present study was to investigate the effect of oral diazepam on anal incontinence after low anterior resection for rectal cancer. Five patients with persistent incontinence after low anterior resection for rectal cancer (median level of anastomosis was 4.0 cm from the anal verge) were treated with oral diazepam (2 mg/day) 9-90 months after surgery. Grade and frequency of anal incontinence, the need for a protective pad and changes of lifestyle were recorded to the Cleveland Clinic's continence grading scale; anorectal manometry was performed before and after 3 months of treatment. All patients improved on treatment although occasional minor soiling persisted in two patients. Continence score improved from 14 (median, range 9-16) to 0 (range 0-12) after taking diazepam. Improvement occurred within a week after administration of diazepam. Although the patients improved symptomatically, anorectal manometry failed to demonstrate any significant changes. In conclusion, oral administration of diazepam may be worthwhile in the attempt to improve anal continence after low anterior resection.
Techniques in Coloproctology 05/2002; 6(1):15-8. · 1.29 Impact Factor
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ABSTRACT: Local excision is often fully justified for rectal carcinoid tumors. However insufficient surgical field and difficult access to proximal tumors have been drawbacks in performing pre-existing local excision procedures. A novel local excisional technique called minimally invasive transanal surgery (MITAS) has been experimented for local removal of carcinoid tumors in the rectum. A specially designed anal retractor connected to the Octopus retractor holder was used and an ENDO-stapler allowed the simultaneous excision and anastomosis to be performed. Eight patients with carcinoid tumors in the rectum (4 tumors in the upper rectum) underwent MITAS. Median distance from anal verge to proximal tumor was 6.5 cm (range, 5-12 cm). The median diameter of the tumor was 9 mm. Median operative time was 18.5 minutes and blood loss was minimal. No analgesics were needed postoperatively, and there was no morbidity or mortality. Full-thickness excision of the rectum was accomplished and the tumors confined in the submucosa were demonstrated histologically to be with free surgical margins. No recurrences have been observed with a median follow-up period of 39 months. The technique facilitates total excisional biopsy for rectal carcinoid tumors and reduces operative time, blood loss and complications.
Techniques in Coloproctology 05/2002; 6(1):33-6. · 1.29 Impact Factor
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ABSTRACT: Most carcinoid tumors of the rectum are confined to the submucosa with a size less than 1-2 cm and are usually suitable for local excision, as metastasis to the regional nodes is limited. Endoscopic excision of carcinoid tumors has been performed for this entity as a least invasive method but incomplete resection and/or unclear surgical margin and curability have been reported to occur in 24-42% of cases because of a limited resection up to the submucosal layer and burn effect. Transanal local excision has often been applied for rectal carcinoid tumor as a least invasive method among local excision procedures to accomplish full thickness excision for determining the curability. However, it is often difficult to obtain free access with a sufficient surgical field by the conventional method. Transanal endoscopic microsurgery (TEM) has appeared as a useful option to access a high tumor with fine visibility but special caution has to be taken for tumors sited above the peritoneal reflection. To facilitate full thickness excision even for high tumors, novel local excisional technique called minimally invasive transanal surgery (MITAS) has been developed and used for local removal of carcinoid tumors in the rectum. A specially designed anal retractor connected to the Octopus retractor holder with several novel techniques facilitated excisional procedures around the anus with a sufficient fixed surgical field and an ENDO-stapler allowed the simultaneous excision and anastomosis to be performed. The technique facilitated total excisional biopsy with less operative time and blood loss, and no mobility or mortality in 12 patients with rectal carcinoid tumors.
Biomedecine [?] Pharmacotherapy 02/2002; 56 Suppl 1:222s-226s. · 2.00 Impact Factor
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ABSTRACT: The indications for low anterior resection are based mainly on tumor location, penetration depth, histology, macroscopic appearance, etc. Patients with tumors located 2 cm above the puborectal muscle by digital examination can undergo low anterior resection. Distal surgical margins should be at least 1 cm from the tumor in cases of differentiated cancer and localized tumors of stage T2 or less and more than 2 cm in poorly differentiated cancer and tumors of stage T3 or greater with total mesorectal excision (TME). Longer distal surgical margins should be provided in patients with unlocalized tumors and extensive node metastasis. The final decision on whether low anterior resection is appropriate should be made after mesorectal preparation down to the levator muscles with adequate surgical margins. Low anterior resection is contraindicated in patients with poor anorectal function and high age. A rectal stump 1 to 2 cm from the dentate line should be maintained for better postoperative anorectal function if radical excision can still be performed.
Nippon Geka Gakkai zasshi 07/2000; 101(6):449-53.
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ABSTRACT: In situ estrogen synthesis makes an important contribution to the high estrogen concentration found in breast cancer tissues. Steroid sulfatase which hydrolyzes several sulfated steroids such as estrone sulfate, dehydroepiandrosterone sulfate, and cholesterol sulfate may be involved. In the present study, we therefore, assessed steroid sulfatase mRNA levels in breast malignancies and background tissues from 38 patients by reverse transcription and polymerase chain reaction. The levels in breast cancer tissues were significantly increased at 1458.4+/-2119.7 attomoles/mg RNA (mean +/- SD) as compared with 535.6+/-663.4 attomoles/mg RNA for non-malignant tissues (P<0.001). Thus, increased steroid sulfatase expression may be partly responsible for local overproduction of estrogen and provide a growth advantage for tumor cells.
The Journal of Steroid Biochemistry and Molecular Biology 06/2000; 73(3-4):141-5. · 3.05 Impact Factor
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ABSTRACT: In order to evaluate the prognostic significance of cyclin D1 mRNA expression in mammary neoplasia, its levels were measured in 97 breast cancers by reverse transcription-polymerase chain reaction (PCR) using fluorescent primer and standard RNA along with estrogen receptor (ER). The median value of cyclin D1 mRNA was 1.60 amol/microg RNA (range, 0.01 to 5.63 amol/microg RNA). ER mRNA was detectable in 70 breast cancer samples (72.2%) and cyclin D1 mRNA levels were significantly higher in ER mRNA-positive than in ER mRNA-negative tumors (p = 0.009). Furthermore, cyclin D1 mRNA levels were significantly (p = 0.001) lower in patients who experienced a recurrence during the follow-up period (mean of 40.8 months, median of 39 months) compared with those with no evidence of recurrent disease (mean of 49.2 months, median of 48 months), and in those who died from disease (mean follow-up period of 30.5 months, median of 26 months) than in the survivors (mean of 50.5 months and median of 48 months) (p = 0.005). Setting the median value (= 1.60 amol/microg RNA) as the cutoff point, expression was significantly associated with relapse-free survival (p = 0.002). Similarly, a significant correlation was observed between the cyclin D1 mRNA level and overall survival (p = 0.015). The expression was found to be an independent factor for predicting relapse-free survival using multivariate analysis.
International Journal of Cancer 02/2000; 89(1):39-43. · 5.44 Impact Factor
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ABSTRACT: A new anal retractor connected to an Octopus retractor holder and automatic suture clamp were used for local excision of rectal tumors to obtain easy access to proximal tumors with an adequate surgical field and to avoid complications. Shortening techniques and invagination techniques were adopted to pull down proximal tumors. This surgical procedure resulted in shorter operating time, less bleeding, earlier oral intake, shorter hospital stay, and fewer complications.
Nippon Geka Gakkai zasshi 01/2000; 100(12):791-5.
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K Takizawa, M Maruta,
K Maeda,
T Utsumi,
K Masumori,
M Matsumoto,
Y Koide,
H Aoyama,
K Senda,
O Ishihara,
H Matsuoka
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ABSTRACT: A weekly infusion of high dose 5-fluorouracil by way of the hepatic artery has been performed in 23 cases with synchronous metastasis from colorectal cancer since 1993. The prognosis in these cases was compared with 94 cases treated without infusion chemotherapy in 94 cases before 1992. The overall one-year and three-year survival rate was 64.8% and 30.2%, respectively, in cases with infusion chemotherapy. The one-year and three-year survival rate was 42.8% and 18.6%, respectively, in cases without infusion chemotherapy. Overall survival rate was significantly different between cases with and without infusion chemotherapy (p < 0.05). In conclusion, weekly infusion chemotherapy resulted in a better survival rate than without infusion chemotherapy.
Gan to kagaku ryoho. Cancer & chemotherapy 10/1999; 26(12):1718-20.
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ABSTRACT: Steroid sulfatase (STS) hydrolyzes several sulfated steroids such as estrone sulfate, dehydroepiandrosterone sulfate, and cholesterol sulfate. In the present study, we have measured STS mRNA levels in 97 breast cancers by reverse transcription-PCR using a fluorescent primer in the presence of an internal standard RNA and evaluated its association with disease-free and overall survival. The median value was 728.0 amol/ng RNA (range, 0-11,778 amol/ng RNA). Levels were significantly higher in tumors demonstrating lymph node metastasis than in those without nodal involvement (P = 0.033) and in patients who experienced a recurrence during the follow-up period (mean, 40.8 months; median, 39 months) compared with those with no evidence of further disease (mean, 49.2 months; median, 48 months; P = 0.029). No significant associations were found between STS mRNA expression and age, menopausal status, tumor size, histological grade, estrogen receptor status, or postoperative adjuvant therapy. High levels of STS mRNA proved to be a significant predictor of reduced relapse-free survival as a continuous variable (log STS mRNA; P = 0.028). As a dichotomous variable with an optimized cutoff point of 1,240 amol/ng RNA, expression was also associated with a significantly shorter relapse-free survival rate (P = 0.002), but no significant correlation was found between the STS mRNA level and overall survival. Expression was found to be an independent factor for predicting relapse-free survival on multivariate analysis. The results thus support a putative role of STS in breast cancer growth and metastasis.
Cancer Research 02/1999; 59(2):377-81. · 7.86 Impact Factor
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Y Okumura, M Maruta,
K Maeda,
T Utsumi,
K Tohyama,
H Sato,
K Masumori,
M Matsumoto,
Y Koide,
O Ishihara,
H Matsuoka,
M Nogaki
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ABSTRACT: A 65-year-old woman was admitted to our hospital for evaluation of multiple liver tumors following endoscopic polypectomy for rectal polyp a year earlier. The polypectomy specimen was reexamined and showed inclusion of a carcinoid tumor 3 mm in diameter. The perirectal lymph node was palpated by digital examination on readmission. The patient died one mouth after readmission due to liver failure. Autopsy revealed metastatic carcinoid tumor in the liver and perirectal nodes.
Gan to kagaku ryoho. Cancer & chemotherapy 08/1997; 24 Suppl 2:307-12.
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ABSTRACT: The expression of aromatase (estrogen synthetase) is tissue specifically regulated through the alternative use of multiple exons 1 and promotors. We have determined the amounts of aromatase messenger ribonucleic acid (mRNA) and which type of multiple exons 1 of the human aromatase gene is used in breast tissues of 49 patients with breast cancer by reverse transcription-PCR analysis. The aromatase mRNA levels in these breast cancer tissues (4.53 +/- 0.66 x 10(-3) attomoles/micrograms RNA) were significantly (P < 0.01) higher than those in 16 nonmalignant breast tissues (1.73 +/- 0.40 x 10(-3) amol/micrograms RNA). Aromatase mRNA in all nonmalignant breast tissue were transcribed from skin fibroblast/fetal liver-specific exon 1 (exon 1b) of the gene. In 23 breast cancer tissues, the utilization of multiple exons 1 in the aromatase mRNA was the same as that in nonmalignant breast tissues, whereas in the other 26 cases, it changed from exon 1b to ovary-specific exon 1 (exon 1c). Such switching of tissue-specific exons 1 may affect strict regulation of the tissue-specific expression of aromatase, leading to abnormal expression of the aromatase. The consequent overproduction of local estrogen might promote carcinogenesis or the proliferation of breast cancers.
Journal of Clinical Endocrinology & Metabolism 06/1996; 81(6):2344-9. · 6.50 Impact Factor
