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a Colonoscopy showing bowel obstruction with a malignant rectal tumor. b Self-expanding metallic stent placement through the malignant rectal obstruction using endoscopy. c Fluoroscopy showing a 2.8-cm constricted area due to tumor (black double-headed arrow) which of the upper end located at the anal side of the promontory (white long arrow)
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Background:
Approximately 20% of colorectal cancer patients show complete or incomplete bowel obstruction as an early symptom. Preoperative nonsurgical decompression such as placing a self-expanding metallic stent for malignant colorectal obstruction has been shown to be effective for reducing perioperative morbidity and mortality. However, there...
Contexts in source publication
Context 1
... computed tomography (CT) revealed a rectal tumor and obstruction with bowel distension on the oral side (Fig. 1). Emergency colonoscopy revealed obstruction due to a rectal malignant tumor; a biopsy specimen of the tumor was collected. Simultaneously, to decompress the distended bowel, an SEMS was emergently placed under endoscopy and fluoroscopy (Fig. 2a-c) using an 18 × 60-mm HANAROSTENT® Naturfit™ (Boston Scientific, Natick, MA, USA) stent. Endoscopy and fluoroscopy revealed that the lower end of the malignant tumor was located at a distance of 13 cm from the anal verge, whereas the upper end of the tumor was located at the anal side of the promontory. Thus, the location of the tumor ...
Context 2
... HANAROSTENT® Naturfit™ (Boston Scientific, Natick, MA, USA) stent. Endoscopy and fluoroscopy revealed that the lower end of the malignant tumor was located at a distance of 13 cm from the anal verge, whereas the upper end of the tumor was located at the anal side of the promontory. Thus, the location of the tumor was found to be the upper rectum (Fig. 2c). Histopathological examination showed the biopsy specimen to be a moderately differentiated tubular adenocarcinoma. After SEMS placement, decompression of the distended bowel and patency of SEMS was observed on a CT image, allowing for the oral intake of drugs, fluids, and diet (Fig. 3a). A contrast-enhanced CT image revealed a tumor ...
Citations
... In cases of resectable OLCC, SEMS can facilitate the performance of minimally invasive one-stage surgery safely and effectively, which is one of the major benefits of SEMS as a BTS. Enomoto et al [63] compared laparoscopic and open surgery after SEMS insertion for OCC. Blood loss in the laparoscopic surgery group was less than that in the open surgery group, whereas the operative time was significantly shorter in the open surgery group. ...
Colonic stenting has had a significant positive impact on the management of obstructive left-sided colon cancer (OLCC) in terms of both palliative treatment and bridge-to-surgery (BTS). Notably, many studies have convincingly demonstrated the effectiveness of stenting as a BTS, resulting in improvements in short-term outcomes and quality of life, safety, and efficacy in subsequent curative surgery, and increased cost-effectiveness, whereas the safety of chemotherapy after stenting and the long-term outcomes of stenting as a BTS are controversial. Several studies have suggested an increased risk of perforation in patients receiving bevacizumab chemotherapy after colonic stenting. In addition, several pathological analyses have suggested a negative oncological impact of colonic stenting. In contrast, many recent studies have demonstrated that colonic stenting for OLCC does not negatively impact the safety of chemotherapy or long-term oncological outcomes. The updated version of the European Society of Gastrointestinal Endoscopy guidelines released in 2020 included colonic stenting as a BTS for OLCC as a recommended treatment. It should be noted that the experience of endoscopists is involved in determining technical and clinical success rates and possibly oncological outcomes. This review discusses the positive and negative impacts of colonic stenting on OLCC treatment, particularly in terms of oncology.
In a narrow pelvic cavity, performing sufficient tumor-specific mesorectal excision (TSME) is difficult. Even in robot-assisted laparoscopic surgery (RALS), mesorectal division is difficult in a narrow pelvic cavity. To overcome this difficulty, we invented a novel method of mesorectal division. In this new approach, we switched the fenestrated bipolar forceps and the double-fenestrated forceps with each other so that both instruments were placed on the same (right) side of the patient. After the mesorectal fat and vessels were coagulated using the fenestrated bipolar forceps, coagulated tissues were divided using the monopolar scissors in the same direction. We named this technique the “simple switching technique (SST)”. We retrospectively collected data and evaluated the usefulness of SST in 24 consecutive patients who underwent RALS TSME between July 2018 and January 2020. Twelve patients underwent SST, and 12 patients underwent other conventional surgical methods (non-SST). The median operation time for mesorectal division was 809.5 s (range 395–1491 s) in the SST group and 985.5 s (range 493–2353 s) in the non-SST group. The coefficient of variation for non-SST was 0.545, which was > 1.5 times the coefficient of 0.360 for SST. Although no significant differences were found for operation time for mesorectal division, the operation time for mesorectal division by SST tended to be shorter than by non-SST (P = 0.157). No significant differences were found regarding short-term outcomes between the groups. SST is feasible and can be an optional method of mesorectal division in RALS TSME.
