RESUMEN
BACKGROUND: One of the approaches to distal sigmoid colon cancer surgical treatment is segmental colonic resection with vascular preservation of left colic artery (LCA). D3 lymph node dissection may technically vary according to different vascular anatomy. This study aims to show the approaches to D3 lymph node dissection with LCA preservation for distal sigmoid colon cancer according to different patterns of inferior mesenteric artery (IMA) branching. METHODS: CT angiography with 3D reconstruction was routinely performed to identify the IMA branching pattern. Laparoscopic distal sigmoid colon resection with D3 lymph node dissection and left colic artery preservation in standardized fashion was performed in all cases. Data, including clinical, intraoperative, and short-term surgical outcomes, is presented as median numbers (Me) and interquartile range (IQR). RESULTS: Twenty-six patients with distal sigmoid colon cancer were treated with laparoscopic distal sigmoid colon resection. The approach to D3 lymph node dissection varied according to different anatomical variations. There was one conversion (3.8%) and one anastomotic leakage (3.8%) in patients with high BMI. At the same time, there was a high apical lymph node count (Me 3 (IQR 2-5), min-max 0-10) due to the skeletonization of the IMA. CONCLUSIONS: The technical aspects of D3 lymph node dissection with left colic artery preservation may vary in different types of LCA and sigmoid artery branching patterns regardless of the standardized anatomical landmarks. The anatomical features should be considered when performing vascular-sparing lymph node dissection.
Asunto(s)
Colon Sigmoide , Laparoscopía , Escisión del Ganglio Linfático , Arteria Mesentérica Inferior , Neoplasias del Colon Sigmoide , Humanos , Escisión del Ganglio Linfático/métodos , Neoplasias del Colon Sigmoide/cirugía , Arteria Mesentérica Inferior/cirugía , Arteria Mesentérica Inferior/diagnóstico por imagen , Femenino , Masculino , Anciano , Laparoscopía/métodos , Persona de Mediana Edad , Colon Sigmoide/cirugía , Colon Sigmoide/irrigación sanguínea , Colectomía/métodos , Angiografía por Tomografía Computarizada , Tratamientos Conservadores del Órgano/métodos , Imagenología Tridimensional , Fuga Anastomótica/etiología , Fuga Anastomótica/prevención & control , Resultado del Tratamiento , Colon/irrigación sanguínea , Colon/cirugíaRESUMEN
BACKGROUND: Robotic three-dimensional magnified visual effects and field of view stabilization have enabled precise surgical operations. Intracorporeal anastomosis in right-sided colorectal cancer surgery is expected to shorten operation times, avoid paralytic ileus, and shorten wound lengths; however, there are few reports of intracorporeal anvil fixation for intestinal anastomosis in left-sided colorectal cancer surgery. Herein, we introduce a simple, novel procedure for using robotic purse-string suture (RPSS) in intracorporeal anastomosis with the double-stapling technique in rectal and sigmoid cancer surgery and report short-term outcomes. METHODS: From September 2022 to April 2024, 105 consecutive patients underwent robotic surgery with double-stapling technique anastomosis for rectal or sigmoid colon cancer at our institution. Their data were retrospectively analyzed. Intracorporeal anastomosis with the double-stapling technique using RPSS was performed in 26 patients (the RPSS group), while the double-stapling technique anastomosis with extracorporeal anvil fixation was performed in 79 patients (the EC group). A 1:1 propensity score-matched analysis was performed (matching criteria: sex, age, body mass index (BMI), tumor location and tumor size) using a caliper 0.3. In the RPSS group, after tumor-specific or total mesorectal excision, specimens were extracted from the umbilical wound with simultaneous anvil placement in the body cavity. The oral colonic stump was robotically excised and robotically circumferentially stitched with 3-0 Prolene in all layers. After anvil insertion into the stump, the bowel wall of the colon was completely sewn onto the central rod of the anvil. Reconstructions were anastomosed using the double-stapling technique. RESULTS: The matched cohort contained 23 patients in each group. The RPSS group had significantly less bleeding than the EC group (p = 0.038). Super-low anterior resection (SLAR) in the RPSS group had shorter total operative times than those in the EC group (p = 0.045). The RPSS group experienced no perioperative complications greater than Clavien-Dindo grade III or any anastomosis-related complications. CONCLUSIONS: The RPSS technique can be performed safely without any anastomosis-related complications and reduces the total operative times in SLAR and blood loss through total robotic surgery. This may be a useful modality for robotic colorectal surgery.
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Anastomosis Quirúrgica , Puntaje de Propensión , Procedimientos Quirúrgicos Robotizados , Técnicas de Sutura , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Masculino , Anastomosis Quirúrgica/métodos , Femenino , Anciano , Estudios Retrospectivos , Persona de Mediana Edad , Técnicas de Sutura/instrumentación , Grapado Quirúrgico/métodos , Neoplasias del Recto/cirugía , Neoplasias del Colon Sigmoide/cirugía , Colon Sigmoide/cirugíaRESUMEN
This video vignette illustrates the application of the da Vinci Xi® robotic platform for robotic left colectomy and intracorporeal overlap anastomosis in a 51-year-old patient diagnosed with sigmoid-descending colon junction cancer. Emphasizing the advantages of robotic surgery in colorectal procedures, the video showcases a complete mesocolic excision, involving steps such as medial-to-lateral dissection, mobilization of the splenic flexure, ligation of the left colic and sigmoid arteries, and resection of an abdominal wall nodule. The presentation highlights the surgical precision and efficiency achieved, including minimal blood loss and no complications, with an operation time of 190 min. The postoperative outcome was favorable, with the patient discharged on the eighth day and subsequent management involving chemotherapy and hyperthermic intraperitoneal chemotherapy (HIPEC) for stage pT4bN1aM1c moderately differentiated adenocarcinoma. This case underscores the enhanced capabilities of robotic platforms in complex colorectal surgeries, particularly in achieving cytoreductive surgery (CRS) and ensuring anastomosis safety with improved R0 resection rates.
Asunto(s)
Anastomosis Quirúrgica , Colectomía , Procedimientos Quirúrgicos Robotizados , Neoplasias del Colon Sigmoide , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Colectomía/métodos , Persona de Mediana Edad , Anastomosis Quirúrgica/métodos , Neoplasias del Colon Sigmoide/cirugía , Adenocarcinoma/cirugía , Masculino , Colon Descendente/cirugíaRESUMEN
Although the safety and short-term outcomes of robotic surgery for sigmoid colon and rectal cancer patients are well-documented, there is limited research on the long-term survival outcomes of robotic colorectal surgery. This is a retrospective study that includes 502 patients who underwent either laparoscopic or robotic anterior resection and abdominoperineal resection for rectal or sigmoid colon cancer between August 2016 and September 2021. All patients were diagnosed with rectal or sigmoid colon adenocarcinoma. Propensity score matching (PSM) was implemented to minimize selection bias. Perioperative outcomes, complication rates, and pathological data were evaluated and compared. The 5-year overall survival rate and disease-free survival rate were calculated and compared. Before matching, patients in the robotic group had earlier pathological T and N stages and were more likely to have received neoadjuvant chemoradiotherapy compared to the laparoscopic group. After matching, most clinicopathological outcomes were similar between the two groups, but the robotic group had longer operative times and a lower conversion rate to open surgery compared with laparoscopic group. After matching for clinical factors, the 5-year DFS rates were 88.19% for the robotic group and 82.46% for the laparoscopic group (P = 0.122), and the OS rates were 90.5% and 79.5% (P = 0.342), showing no significant differences. In the stratified analysis, patients in the robotic surgery group had significantly higher 5-year DFS rates in the following subgroups: age < 65 years, TNM stage I-II, received neoadjuvant therapy, and primary tumor located in the rectum. The safety and efficacy of robotic surgery for sigmoid colon and rectal cancer were validated compared to laparoscopic surgery, with both groups of patients exhibiting comparable long-term prognoses.
Asunto(s)
Laparoscopía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Neoplasias del Colon Sigmoide , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Laparoscopía/métodos , Estudios Retrospectivos , Neoplasias del Recto/cirugía , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Masculino , Femenino , Persona de Mediana Edad , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide/patología , Anciano , Resultado del Tratamiento , Tempo Operativo , Adenocarcinoma/cirugía , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Tasa de Supervivencia , Puntaje de Propensión , Terapia Neoadyuvante , Colon Sigmoide/cirugía , Supervivencia sin Enfermedad , AdultoRESUMEN
Robot-assisted laparoscopic anterior resection is a novel technique. However, evidence in the literature regarding the advantages of robot-assisted laparoscopic surgery (RLS) is insufficient. The aim of this study was to compare the outcomes of RLS versus conventional laparoscopic surgery (CLS) for the treatment of sigmoid colon cancer. We performed a retrospective study at the Northern Jiangsu People's Hospital. Patients diagnosed with sigmoid colon cancer and underwent anterior resection between January 2019 to September 2023 were included in the study. We compared the basic characteristics of the patients and the short-term and long-term outcomes of patients in the two groups. A total of 452 patients were included. Based on propensity score matching, 212 patients (RLS, n = 106; CLS, n = 106) were included. The baseline data in RLS group was comparable to that in CLS group. Compared with CLS group, RLS group exhibited less estimated blood loss (P = 0.015), more harvested lymph nodes (P = 0.005), longer operation time (P < 0.001) and higher total hospitalization costs (P < 0.001). Meanwhile, there were no significant differences in other perioperative or pathologic outcomes between the two groups. For 3-year prognosis, overall survival rates were 92.5% in the RLS group and 90.6% in the CLS group (HR 0.700, 95% CI 0.276-1.774, P = 0.452); disease-free survival rates were 91.5% in the RLS group and 87.7% in the CLS group (HR 0.613, 95% CI 0.262-1.435, P = 0.259). Compared with CLS, RLS for sigmoid colon cancer was found to be associated with a higher number of lymph nodes harvested, similar perioperative outcomes and long-term survival outcomes. High total hospitalization costs of RLS did not translate into better long-term oncology outcomes.
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Laparoscopía , Estadificación de Neoplasias , Puntaje de Propensión , Procedimientos Quirúrgicos Robotizados , Neoplasias del Colon Sigmoide , Humanos , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/economía , Laparoscopía/métodos , Laparoscopía/economía , Masculino , Femenino , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide/patología , Persona de Mediana Edad , Estudios Retrospectivos , Anciano , Resultado del Tratamiento , Tempo Operativo , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Colectomía/métodos , Colectomía/economía , Tasa de SupervivenciaRESUMEN
BACKGROUND: The territory of D3-D4 lymphadenectomy for upper rectal and sigmoid colon cancer varies, and its oncological efficacy is unclear. This prospective study aimed to standardize the surgical technique of robotic D3-D4 lymphadenectomy and clarify its oncologic significance. METHODS: Patients with upper rectal or sigmoid colon cancer with clinically suspected more than N2 lymph node metastasis were prospectively recruited to undergo standardized robotic D3-D4 lymphadenectomy. Immediately postsurgery, the retrieved lymph nodes were mapped to five N3-N4 nodal stations: the inferior mesenteric artery, para-aorta, inferior vena cava, infra-renal vein, and common iliac vessels. Patients were stratified according to their nodal metastasis status to compare their clinicopathological data and overall survival. Univariate and multivariate analyses were performed to determine the relative prognostic significance of the five specific nodal stations. Surgical outcomes and functional recovery of the patients were assessed using the appropriate variables. RESULTS: A total of 104 patients who successfully completed the treatment protocol were assessed. The standardized D3-D4 lymph node dissection harvested sufficient lymph nodes (34.4±7.2) for a precise pathologic staging. Based on histopathological analysis, 28 patients were included in the N3-N4 nodal metastasis-negative group and 33, 34, and nine patients in the single-station, double-station, and triple-station nodal metastasis-positive groups, respectively. Survival analysis indicated no significant difference between the single-station nodal metastasis-positive and N3-N4 nodal metastasis-negative groups in the estimated 5-year survival rate [53.6% (95% CI: 0.3353-0.7000) vs. 71.18% (95% CI: 0.4863-0.8518), P=0.563], whereas patients with double-station or triple-station nodal metastatic disease had poor 5-year survival rates (24.76 and 22.22%), which were comparable to those of AJCC/UICC stage IV disease than those with single-station metastasis-positive disease. Univariate analysis showed that the metastatic status of the five nodal stations was comparable in predicting the overall survival; in contrast, multivariate analysis indicated that common iliac vessels and infra-renal vein were the only two statistically significant predictors (P<0.05) for overall survival. CONCLUSIONS: Using a robotic approach, D3-D4 lymph node dissection could be safely performed in a standardized manner to remove the relevant N3-N4 lymphatic basin en bloc, thereby providing significant survival benefits and precise pathological staging for patients. This study encourages further international prospective clinical trials to provide more solid evidence that would facilitate the optimization of surgery and revision of the current treatment guidelines for such a clinical conundrum.
Asunto(s)
Escisión del Ganglio Linfático , Metástasis Linfática , Procedimientos Quirúrgicos Robotizados , Neoplasias del Colon Sigmoide , Humanos , Escisión del Ganglio Linfático/normas , Escisión del Ganglio Linfático/métodos , Femenino , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Robotizados/normas , Procedimientos Quirúrgicos Robotizados/métodos , Anciano , Estudios Prospectivos , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide/patología , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Ganglios Linfáticos/patología , Ganglios Linfáticos/cirugía , AdultoRESUMEN
We reported a case of sigmoid colon cancer with horseshoe kidney. A 79-year-old man had lower abdominal pain and underwent colonoscopy. The results of colonoscopy revealed sigmoid cancer. Preoperative computed tomography revealed horseshoe kidney. He underwent radical laparoscopic surgery. The histopathological diagnosis was pStage â ¡a(The 9th Edition). He has not recurred 22 months later after operation. Surgery for colorectal cancer with congenital anomalies of the urinary tract requires attention to intraoperative secondary injuries. Therefore, preoperative evaluation using 3D-CT is useful tool for safety. Operating the proper dissecting normal layer would make safe laparoscopic operation possible without unexpected injuries.
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Riñón Fusionado , Neoplasias del Colon Sigmoide , Humanos , Masculino , Anciano , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/complicaciones , Riñón Fusionado/complicaciones , Riñón Fusionado/cirugía , Tomografía Computarizada por Rayos X , Laparoscopía , ColonoscopíaAsunto(s)
Dolor Abdominal , Colonoscopía , Diarrea , Humanos , Femenino , Dolor Abdominal/etiología , Diarrea/etiología , Pólipos del Colon/patología , Pólipos del Colon/complicaciones , Pólipos del Colon/cirugía , Colon Sigmoide/patología , Colon Sigmoide/diagnóstico por imagen , Persona de Mediana Edad , Neoplasias del Colon Sigmoide/complicaciones , Neoplasias del Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/cirugía , Enfermedades del Sigmoide/patología , Enfermedades del Sigmoide/complicaciones , Enfermedades del Sigmoide/diagnóstico por imagenRESUMEN
BACKGROUND: The role of neoadjuvant chemotherapy (NAC) in advanced sigmoid colon carcinoma remains to be further characterized. Rationale for NAC includes downstaging on final pathology and optimization of microscopically negative margins (R0 resection). We investigated rates of neoadjuvant chemotherapy use in advanced sigmoid colon cancer at academic cancer centers and assessed factors associated with likelihood of NAC administration. METHODS: The National Cancer Database was queried from 2004 to 2017 for patients with clinical T3 or T4, N0-2, M0 sigmoid colon cancer who underwent surgical resection. Those with neoadjuvant radiation or metastatic disease were excluded. The outcomes of patients who did and did not receive neoadjuvant chemotherapy were evaluated for this retrospective cohort study. RESULTS: There were 23,597 patients of whom 364 (1.5%) received NAC. More patients received NAC at academic (41%, P < .001) and high-volume centers (27%, P < .001). Patients with Medicare/Medicaid (39%) and private insurance (52%) were more likely to receive NAC (P < .001). There was a significantly higher rate of N2 to N1 downstaging in the NAC group. Propensity-score matching demonstrated comprehensive community cancer programs (CCCP) were less likely to provide NAC (OR 0.4; 95% CI 0.23, 0.70, P < .001). There was no difference in survival (P = .20), R0 resection (P = .090), or 30-day readmission rates (P = .30) in the NAC cohort compared to the non-NAC cohort. CONCLUSIONS: Access to centers offering multi-disciplinary care with NAC prior to surgical resection is important. This care was associated with academic and high-volume centers and private or government-sponsored insurance. There was no difference in survival between NAC and non-NAC cohort.
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Terapia Neoadyuvante , Neoplasias del Colon Sigmoide , Humanos , Anciano , Estados Unidos/epidemiología , Colon Sigmoide/cirugía , Puntaje de Propensión , Neoplasias del Colon Sigmoide/tratamiento farmacológico , Neoplasias del Colon Sigmoide/cirugía , Estudios Retrospectivos , Estadificación de Neoplasias , MedicareRESUMEN
BACKGROUND: Though our previous study has demonstrated that the single-incision plus one-port laparoscopic surgery (SILS + 1) is safe and feasible for sigmoid colon and upper rectal cancer and has better short-term outcomes compared with conventional laparoscopic surgery (CLS), the long-term outcomes of SILS + 1 remains uncertain and are needed to evaluated by an RCT. METHODS: Patients with clinical stage T1-4aN0-2M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The 3-year DFS, 5-year OS, and recurrence patterns were analyzed. RESULTS: Between April 2014 and July 2016, 198 patients were randomly assigned to either the SILS + 1 group (n = 99) or CLS group (n = 99). The median follow-up in the SILS + 1 group was 64.0 months and in CLS group was 65.0 months. The 3-year DFS was 87.8% (95% CI, 81.6-94.8%) in SILS + 1 group and 86.9% (95% CI, 81.3-94.5%) in CLS group (hazard ratio: 1.09 (95% CI, 0.48-2.47; P = 0.84)). The 5-year OS was 86.7% (95% CI,79.6-93.8%) in the SILS + 1 group and 80.5% (95% CI,72.5-88.5%) in the CLS group (hazard ratio: 1.53 (95% CI, 0.74-3.18; P = 0.25)). There were no significant differences in the recurrence patterns between the two groups. CONCLUSIONS: We found no significant difference in 3-year DFS and 5-year OS of patients with sigmoid colon and upper rectal cancer treated with SILS + 1 vs. CLS. SILS + 1 is noninferior to CLS when performed by expert surgeons. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02117557 (registered on 21/04/2014).
Asunto(s)
Laparoscopía , Neoplasias del Recto , Neoplasias del Colon Sigmoide , Herida Quirúrgica , Humanos , Resultado del Tratamiento , Tiempo de Internación , Neoplasias del Recto/cirugía , Neoplasias del Colon Sigmoide/cirugíaRESUMEN
PURPOSE: This study aimed to identify the risk factors impacting long-term outcomes in patients diagnosed with sigmoid colon cancer with urinary bladder involvement. METHODS: A comprehensive analysis was conducted on a retrospective cohort of 118 patients who underwent multivisceral resection for sigmoid colon cancer with urinary bladder involvement between June 2002 and May 2017. Univariate and multivariate analyses were employed to identify risk factors associated with long-term outcomes. RESULTS: Among the included patients, 10 (8.5%) experienced grade III-IV complications according to Clavien-Dindo classification, with 4 (3.4%) presenting anastomotic leaks. The postoperative mortality was 0.8%. R0 resection was achieved in 108 (91.6%) patients. Adjuvant chemotherapy was administrated to only 31 patient (26.3%). Local recurrence was observed in 8 (6.8%) cases. Risk factors for local recurrence-free survival and disease-free survival were CCI>3, grade III-IV postoperative complications according to Clavien-Dindo classification, positive resection margins, stage III of the disease, additional resected organs (excluding colon and bladder) and the absence of adjuvant chemotherapy. The same risk factors, with the exception of CCI, were associated with overall survival. CONCLUSION: This study highlights that negative resection margins, a postoperative period without grade III-IV complications, and the implementation of adjuvant chemotherapy are crucial factors contributing to improve overall, disease-free and local recurrence-free survival in patients with sigmoid colon cancer with urinary bladder involvement.
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Neoplasias del Colon Sigmoide , Humanos , Neoplasias del Colon Sigmoide/cirugía , Vejiga Urinaria , Estudios Retrospectivos , Márgenes de Escisión , Supervivencia sin Enfermedad , Complicaciones Posoperatorias/epidemiología , Recurrencia Local de Neoplasia , Factores de RiesgoRESUMEN
PURPOSE: The purpose of this study was to investigate the effect of laparoscopic left colectomy (LLC) and laparoscopic sigmoidectomy (LSD) on short-term outcomes and prognosis of sigmoid colon cancer (SCC) patients using propensity score matching (PSM). METHODS: In this retrospective study, the SCC patients who underwent LLC or LSD surgery were collected from a single clinical center from Jan 2011 to Dec 2019. Short-term outcomes and prognosis were compared between patients who received LSD surgery and LLC surgery. RESULTS: A total of 356 patients were included in this study. After 1:1 PSM analysis, there were 50 patients who underwent LLC surgery and 50 patients who underwent LSD surgery left in this study. No significant difference was found in baseline characteristics after PSM (P > .05). In comparison with the LLC surgery group, the LSD surgery group had shorter operation time (P = .003) after PSM. Moreover, the surgical procedure was not an independent predictor for overall survival (OS) (P = .918, 95% CI = .333-2.688) and disease-free survival DFS (P = .730, 95% CI = .335-2.150), but age (OS: P = .009, 95% CI = 1.010-1.075; DFS: P = .014, 95% CI = 1.007-1.061) and tumor stage (OS: P = .004, 95% CI = 1.302-3.844; DFS: P < .01, 95% CI = 1.572-4.171) were the independent risk factors for OS and DFS in SCC patients. CONCLUSION: There was no significant difference between the two surgical procedures for prognosis of SCC patients. However, the possible reasons for changing the surgical procedures should be cautious by surgeons.
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Laparoscopía , Neoplasias del Colon Sigmoide , Humanos , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide/etiología , Resultado del Tratamiento , Puntaje de Propensión , Estudios Retrospectivos , Colectomía/efectos adversos , Colectomía/métodos , Pronóstico , Laparoscopía/métodosRESUMEN
A 63-year-old woman, who were in a nursing house, visited our hospital with complaints of bloody stools and anemia. Some investigations were performed, CS and CT revealed her diagnosis with sigmoid colon cancer(cT3N0M0)and rectosigmoid adenoma with situs inversus(SI). Laparoscopic low-anterior resection was performed. Postoperative course was good without any complications, and she discharged our hospital at the day 7 after the operation. In surgery, we had to be conscious of mirror image and set operative equipment and operative staffs inversely from normal setting. Some previous reports suggested that some surgical process such as cutting and separating with left hand(non-dominant hand), especially at interior separation, were effective in laparoscopic surgery for SI patients. However, in our operation, we used ultrasonic coagulator with short-pitched incision with surgeon's right hand(dominant hand)instead of left-handed process, and it could be useful for laparoscopic surgery for SI patients. In intrapelvic processes, we proceeded with the surgery as usual because of the symmetric structure of intrapelvic organs. We could complete the laparoscopic low-anterior resection for SI patient with several ingenuity for operative processes.
Asunto(s)
Laparoscopía , Neoplasias del Colon Sigmoide , Situs Inversus , Humanos , Femenino , Persona de Mediana Edad , Neoplasias del Colon Sigmoide/complicaciones , Neoplasias del Colon Sigmoide/cirugía , Laparoscopía/métodos , Situs Inversus/complicaciones , Situs Inversus/cirugía , AbdomenRESUMEN
An inflammatory myofibroblastic tumour (IMT) is an uncommon neoplasm composed of inflammatory cells and myofibroblasts in a fibrous stroma. They are mostly seen in the lungs and rarely involve the gastrointestinal tract. An 8-month-old infant presented with a history of lower abdominal lump for 2 months. Her CT scan confirmed a large, lobulated mass in the retroperitoneum arising from the pelvis. The mass was found to be arising from the sigmoid colon on laparotomy which was excised. Histopathology showed a cellular tumour composed of spindle cells and inflammatory lymphocytic infiltrate. Immunohistochemistry revealed positive staining for anaplastic lymphoma kinase and smooth muscle actin, confirming the diagnosis of IMT. The patient is doing well at her 6-month follow-up. Ours is the youngest case of sigmoid IMT among the only other series of eight cases reported in the literature indicating its rarity.
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Granuloma de Células Plasmáticas , Neoplasias del Colon Sigmoide , Lactante , Femenino , Humanos , Proteínas Tirosina Quinasas Receptoras , Colon Sigmoide/cirugía , Colon Sigmoide/patología , Neoplasias del Colon Sigmoide/diagnóstico , Neoplasias del Colon Sigmoide/cirugía , Neoplasias del Colon Sigmoide/patología , Miofibroblastos/patología , Inmunohistoquímica , Granuloma de Células Plasmáticas/diagnóstico por imagen , Granuloma de Células Plasmáticas/cirugíaRESUMEN
Increasing evidence based on the safety and benefits of robot-assisted surgery indicates the disadvantage of the lack of tactile feedback. A lack of tactile feedback increases the risk of intraoperative complications, prolongs operative times, and delays the learning curve. A 40-year-old female patient presented to our hospital with a positive fecal occult blood test. A colonoscopy revealed type 2 advanced cancer of the sigmoid colon, and histological examination showed a well-differentiated adenocarcinoma. Furthermore, abdominal contrast-enhanced computed tomography revealed a tumor in the sigmoid colon and several swollen lymph nodes in the colonic mesentery without distant metastases. The patient was diagnosed with cStage IIIb (cT3N1bM0) sigmoid cancer and underwent sigmoidectomy using the Saroa Surgical System, which was developed by RIVERFIELD, a venture company at the Tokyo Medical and Dental University, and the Tokyo Institute of Technology. Based on adequate simulation, surgery was safely performed with appropriate port placement and arm base-angle adjustment. The operating time was 176 min, with a console time of 116 min and 0 ml blood loss. The patient was discharged 6 days postoperatively without complications. The pathological diagnosis was adenocarcinoma, tub1, tub2, pT2N1bM0, and pStage IIIa. Herein, we report the world's first surgery for sigmoid cancer using the Saroa Surgical System with tactile feedback in which a safe and appropriate oncological surgery was performed.