Faculty Profiles - OGURA Atsushi

Papers - OGURA Atsushi

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直腸癌局所再発・肝転移に対して積極的外科手術により得られた長期生存例に発症した下行結腸stoma部癌の一例

小倉淳司, 上原圭介, 相場利貞, 田中綾, 山東雅紀, 米川佳彦, 大原規彰, 渡辺伸元, 尾上俊介, 宮田一志, 山口淳平, 水野隆史, 深谷昌秀, 伊神剛, 横山幸浩, 江畑智希, 服部憲史, 中山吾郎, 小寺泰弘, 梛野正人

日本消化器病学会東海支部例会プログラム抄録集 Vol. 131回 page： 65 - 65 2019.11

Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota's fascia. International journal

Atsushi Ogura, Ryutaro Kobayashi, Satoru Kawai, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Tsukasa Aritake, Natsuki Nagano, Satoaki Kamiya

Surgical case reports Vol. 5 ( 1 ) page： 159 - 159 2019.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a "Goal" that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach. CASE PRESENTATION: A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota's fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a "Goal" at the inferior border of the pancreas for safe resection of the Gerota's fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota's fascia, and the resection margin was negative for cancer. CONCLUSIONS: The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota's fascia.

DOI： 10.1186/s40792-019-0720-8

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Cranial-first approach for laparoscopic surgery with splenic flexure mobilization. Reviewed

Ogura A, Kobayashi R, Aritake T, Maeda T, Kawai K, Takagi K, Kawai S, Kamiya S

Techniques in Coloproctology Vol. 23 ( 7 ) page： 693-694 2019.7

Cranial-first approach for laparoscopic surgery with splenic flexure mobilization.

Ogura A, Kobayashi R, Aritake T, Maeda T, Kawai K, Takagi K, Kawai S, Kamiya S

Techniques in coloproctology Vol. 23 ( 7 ) page： 693 - 694 2019.7

Complete Resection without Any Ostomies by Laparoscopic Extended Surgery for Locally Advanced T4 Sigmoid Colon Cancer Invading the Urinary Bladder and Ureter. Reviewed International journal

Atsushi Ogura, Tsukasa Aritake, Satoru Kawai, Shigeki Yamamoto, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Ryutaro Kobayashi, Natsuki Nagano, Satoaki Kamiya

Case reports in surgery Vol. 2019 page： 9598183 - 9598183 2019

Language：English Publishing type：Research paper (scientific journal)

The feasibility and safety of laparoscopic surgery for locally advanced colorectal cancer remain controversial due to the high rate of incomplete resection and conversion to open surgery. Especially for T4 colorectal cancer, laparoscopic techniques are still demanding mainly because of the difficulty in distinguishing between inflammation and tumor involvement, which often lead surgeons to do overtreatment in surgery. We believe laparoscopic magnified and multidirectional approach might be useful for pathologically complete resection and minimizing an unnecessary extended surgery for these cases. A 49-year-old man was diagnosed with locally advanced T4 sigmoid colon cancer invading the urinary bladder and ureter. We performed laparoscopic anterior resection with en bloc resection of the urinary bladder and the left ureter. Total operative time was 462 min, and the estimated blood loss was 50 ml. This patient was discharged on the 28th day after surgery without any ostomies and urinary functional disorders. The magnified view by laparoscopic techniques from multiple directions would enable surgeons to set surgical landmarks for another approach, which is the key for safe and feasible laparoscopic surgery in patients with locally advanced T4 colorectal cancer.

DOI： 10.1155/2019/9598183

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PubMed

Innovativeな大腸癌診断・治療　直腸癌に対する側方郭清の意義−術前（化学）放射線療法との比較 Invited Reviewed

小倉淳司、上原圭介、相場利貞、川井　覚、梛野正人

外科 Vol. 10 page： 1042 - 1049 2019

Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer

Schaap D. P., Ogura A., Nederend J., Maas M., Cnossen J. S., Creemers G. J., van Lijnschoten I., Nieuwenhuijzen G. A. P., Rutten H. J. T., Kusters M.

BRITISH JOURNAL OF SURGERY Vol. 105 ( 13 ) page： 1844 - 1852 2018.12

Endoscopic criteria to evaluate tumor response of rectal cancer to neoadjuvant chemoradiotherapy using magnifying chromoendoscopy. International journal

Akiko Chino, Tsuyoshi Konishi, Atsushi Ogura, Hiroshi Kawachi, Hiroki Osumi, Toshiyuki Yoshio, Teruhito Kishihara, Daisuke Ide, Shoichi Saito, Masahiro Igarashi, Takashi Akiyoshi, Masashi Ueno, Junko Fujisaki

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Vol. 44 ( 8 ) page： 1247 - 1253 2018.8

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND AND AIMS: Precise endoscopic assessment of complete response to neoadjuvant chemoradiotherapy before surgery is important for optimizing surgical and non-surgical treatment. We prospectively evaluated the accuracy of the newly proposed endoscopic criteria to identify complete response, using magnifying chromoendoscopy. METHODS: New endoscopic criteria were created to define endoscopic complete response, near complete response and incomplete response, using magnifying chromoendoscopy. The criteria contained notable endoscopic findings, including shape of the scar, state of the ulcer, finding of white moss, presence of residual protruded nodules, regenerated pits of the scar, presence of neoplastic pit patterns, and extension of rectal wall. Seventy-nine patients with rectal cancer who received neoadjuvant chemoradiotherapy were prospectively evaluated 1-3 days before resection. Diagnostic accuracy to identify pathological complete response and interobserver agreement among a supervising colonoscopist and two trainees were investigated. RESULTS: Pathological complete response was obtained in 17 patients (21.5%). The diagnostic accuracy of endoscopic complete response was 85%, with a sensitivity of 47%, specificity of 97%, positive predictive value of 80% and negative predictive value of 77%. The kappa-value for interobserver agreement across 3 doctors was 0.57 (standard error, 0.74; 95% confidence interval, 0.39-0.76). CONCLUSION: The newly proposed endoscopic criteria using magnifying chromoendoscopy achieved excellent diagnostic accuracy to determine good responders to neoadjuvant chemoradiotherapy in rectal cancer, with fair interobserver agreement. The criteria could be clinically useful to select patients for non-surgical management.

DOI： 10.1016/j.ejso.2018.04.013

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Pretreatment Serum Carbohydrate Antigen 19-9 Concentration Is a Predictor of Survival of Patients Who Have Undergone Curative Resection of Stage IV Rectal Cancer. International journal

Hisanori Miki, Takashi Akiyoshi, Atsushi Ogura, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Hisashi Noma, Akio Saiura, Yosuke Fukunaga, Masashi Ueno

Digestive surgery Vol. 35 ( 5 ) page： 389 - 396 2018

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: To evaluate whether pretreatment carcinoembryonic antigen and carbohydrate antigen (CA)19-9 are useful predictors of survival in patients with stage IV rectal cancer who have undergone curative resection. METHODS: In this retrospective study, data on 73 patients who had undergone curative resection of stage IV rectal cancer were reviewed. Associations between various clinicopathological factors and survival outcomes were analyzed. RESULTS: According to univariate analysis, elevated pretreatment CA19-9 (p = 0.0028), R1 resection (p = 0.0318), and mucinous or poorly differentiated adenocarcinoma (p = 0.0228) were significantly associated with poor overall survival (OS), and lymph node metastasis (p = 0.0211) was significantly associated with poor disease-free survival (DFS). Multivariate analyses showed that elevated pretreatment serum CA19-9 concentration (hazard ratios [HR] 3.33; 95% CI 1.24-9.42; p = 0.0174) was an independent predictor for OS and lymph node metastasis (HR 2.26; 95% CI 1.15-4.82; p = 0.0164) was an independent predictor for DFS. Among 55 patients with recurrences after curative resection, the rate of complete resection of recurrences was significantly higher in patients with normal pretreatment CA19-9 than in those with elevated CA19-9 (p = 0.049). Post-recurrence survival was significantly worse in patients with elevated pretreatment CA19-9 than in those with normal CA19-9 (p = 0.0196). CONCLUSIONS: Pretreatment CA19-9 is good predictor of survival after curative resection of stage IV rectal cancer.

DOI： 10.1159/000480247

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Skeletal muscle loss is an independent negative prognostic factor in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy. International journal

Yasuhiro Takeda, Takashi Akiyoshi, Kiyoshi Matsueda, Hironori Fukuoka, Atsushi Ogura, Hisanori Miki, Yukiharu Hiyoshi, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Yosuke Fukunaga, Masashi Ueno

PloS one Vol. 13 ( 4 ) page： e0195406 2018

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The impact of body composition on the short- or long-term outcomes of patients with surgically treated advanced rectal cancer after neoadjuvant chemoradiotherapy remains unclear. This study examined the correlation between low skeletal muscle mass and morbidity and survival in patients with advanced lower rectal cancer. METHODS: We enrolled 144 clinical stage II/III patients with advanced lower rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative resection between 2004 and 2011. The cross-sectional skeletal muscle area at the third lumbar vertebra (L3) level was evaluated by computed tomography before chemoradiotherapy, and this was normalized by the square of the height to obtain the skeletal muscle index. Low skeletal muscle mass was defined as the sex-specific lowest quartile of the L3 skeletal muscle index. The association between low skeletal muscle mass and morbidity, relapse-free survival, or overall survival was assessed. RESULTS: Low skeletal muscle mass was identified in 37 (25.7%) patients. Age and body mass index were associated with low skeletal muscle mass. By multivariate analysis, we found that low skeletal muscle mass was independently associated with poor overall survival (hazard ratio = 2.93; 95%CI: 1.11-7.71; p = 0.031) and relapse-free survival (hazard ratio = 2.15; 95%CI: 1.06-4.21; p = 0.035), but was not associated with the rate of postoperative complications. CONCLUSIONS: Low skeletal muscle mass is an independent negative prognostic factor for relapse-free and overall survival in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy.

DOI： 10.1371/journal.pone.0195406

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A Case of Early Gallbladder Carcinoma with Acute Cholecystitis Caused by Tumor Impaction in the Neck

UNO Masanori, KAMIYA Satoaki, KAWAI Satoru, TAKAGI Kenji, MAEDA Takashi, OGURA Atsushi, MATSUURA Akihiro

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 79 ( 11 ) page： 2346 - 2349 2018

Language：Japanese Publisher：Japan Surgical Association

A 64-year-old woman was admitted to our hospital with epigastralgia and nausea. Physical examination revealed mild tenderness in the right upper abdomen. CT revealed edematous thickening of the gallbladder wall, and we diagnosed the patient as having acute cholecystitis. Because a mass was found in the gallbladder neck, we considered that the acute cholecystitis was caused by impaction of the mass. Although we started the patient on antibiotic treatment, the right upper abdominal pain and inflammatory findings only worsened. Emergency laparotomy was performed on the third day of hospitalization. We incised the cystic duct near the junction of the common bile duct and resected the gallbladder. In the resected specimen, a soft pedunculated tumor measuring 3 cm in diameter was found in the gallbladder neck. No additional resection or lymph node dissection was performed. Histopathological examination revealed early gallbladder carcinoma and no cancer progression in the cystic duct stump. Gallbladder carcinoma often manifests with non-specific subjective symptoms, and early cancer cases are often found incidentally in specimens obtained after cholecystectomy performed for cholelithiasis. This report describes a rare case of early gallbladder carcinoma with acute cholecystitis caused by tumor impaction in the neck, with a review of the literature.

DOI： 10.3919/jjsa.79.2346

CiNii Research

The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis. International journal

Atsushi Ogura, Takashi Akiyoshi, Yukiko Takatsu, Jun Nagata, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

Asian journal of surgery Vol. 40 ( 4 ) page： 254 - 261 2017.7

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND/OBJECTIVE: The significance of extended lymphadenectomy for colorectal cancer with extraregional lymph node metastasis, such as para-aortic lymph node metastasis, has not been established. The purpose of this study was to evaluate the significance of extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis. METHODS: Between July 2004 and December 2013, 16 patients with synchronous extraregional lymph node metastasis without other organ metastases underwent curative resection and extended lymphadenectomy (R0 group). The clinical characteristics and survival outcomes of the R0 group were compared with those of 12 patients with extraregional lymph node metastasis who underwent palliative surgery (control group). RESULTS: In the R0 group, the 5-year cancer-specific survival (CSS) rate was 70.3% and the 5-year relapse-free survival (RFS) rate was 60.5%. The 5-year CSS differed significantly between the R0 and control groups (70.3% vs. 12.5%; p = 0.0003). Univariate analyses revealed that the total numbers of metastatic lymph nodes and metastatic regional lymph nodes present were significantly associated with RFS (p = 0.019 for both). CONCLUSION: Findings from our study suggest that extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis might be effective in carefully selected patients.

DOI： 10.1016/j.asjsur.2015.10.003

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Does the depth of mesorectal invasion have prognostic significance in patients with ypT3 lower rectal cancer treated with preoperative chemoradiotherapy? International journal

Atsushi Ogura, Takashi Akiyoshi, Noriko Yamamoto, Hiroshi Kawachi, Yuichi Ishikawa, Hisashi Noma, Masato Nagino, Yosuke Fukunaga, Masashi Ueno

International journal of colorectal disease Vol. 32 ( 3 ) page： 349 - 356 2017.3

Language：English Publishing type：Research paper (scientific journal)

PURPOSE: The prognostic significance of the depth of mesorectal invasion (DMI) in patients with ypT3 rectal cancer who undergo preoperative chemoradiotherapy (CRT) is unclear. The purpose of this study was to evaluate the prognostic significance of DMI in ypT3 rectal cancer. METHODS: A total of 168 (y)pT3 patients were evaluated, of whom 93 received preoperative CRT and 75 underwent surgery alone. Patients were subdivided into two groups according to the DMI (T3ab = DMI ≤5 mm and T3cd = DMI >5 mm). Oncologic outcomes were compared between the T3ab and T3cd groups and the ypT3ab and ypT3cd groups. RESULTS: Relapse-free survival was significantly different between the pT3ab and pT3cd groups (74.1 vs 38.5%, P = 0.0192) but not between the ypT3ab and ypT3cd groups (65.9 vs 61.5%, P = 0.513). Multivariate analysis showed that DMI was an independent predictor of recurrence in pT3 patients (hazard ratio [HR] = 2.980, 95% confidence interval [CI] 1.227-7.025; P = 0.0169) and that ypN+ was an independent predictor of recurrence in ypT3 patients (HR = 3.487, 95% CI 1.570-8.827; P = 0.0016). CONCLUSIONS: DMI was not a significant predictive factor for recurrence in patients with ypT3 rectal cancer who underwent preoperative CRT, and ypN+ was the only independent predictive factor for recurrence.

DOI： 10.1007/s00384-016-2716-1

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Feasibility of Laparoscopic Total Mesorectal Excision with Extended Lateral Pelvic Lymph Node Dissection for Advanced Lower Rectal Cancer after Preoperative Chemoradiotherapy. International journal

Atsushi Ogura, Takashi Akiyoshi, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno, Hiroya Kuroyanagi

World journal of surgery Vol. 41 ( 3 ) page： 868 - 875 2017.3

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: The feasibility of additional lateral pelvic lymph node dissection (LPLND) compared with total mesorectal excision (TME) alone in patients treated with preoperative chemoradiotherapy (CRT) is controversial, especially in laparoscopic surgery. This study was performed to evaluate the feasibility of adding laparoscopic LPLND to TME in patients with advanced lower rectal cancer and swollen LPLNs treated with preoperative CRT. METHODS: We reviewed 327 patients with lower rectal cancer without distant metastasis who underwent preoperative CRT followed by laparoscopic TME. Laparoscopic LPLND was added in patients with swollen LPLNs before CRT. Outcomes were compared between patients with (n = 107) and without (n = 220) LPLND. RESULTS: LPLN metastasis was found in 26 patients (24.3 %) in the LPLND group. The operation time was significantly longer, and total blood loss was significantly greater in the LPLND than TME group (461 vs. 298 min and 115 vs. 30 mL, respectively; P < 0.0001). The major complication rate was similar in the LPLND and TME groups (9.3 vs. 5.5 %, respectively; P = 0.188), and there were no conversions to open surgery. The LPLND and TME groups also showed a similar 3-year relapse-free survival rate (84.7 vs. 82.0 %, respectively; P = 0.536) and local recurrence rate (3.2 vs. 5.2 %, respectively; P = 0.569) despite significantly more patients with pathological lymph node metastasis in the LPLND than TME group (37.4 vs. 22.3 %, respectively; P < 0.0001). CONCLUSIONS: Additional laparoscopic LPLND is feasible in patients with advanced lower rectal cancer and clinically swollen LPLNs treated with preoperative CRT, with no significant increase in major complications compared with TME alone.

DOI： 10.1007/s00268-016-3762-0

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Report of a Case with Appendiceal Intussusception Induced by Appendiceal Endometriosis

Takeda Yasuhiro, Nagasaki Toshiya, Fukuoka Hironori, Ogura Atsushi, Miki Hisanori, Hiyoshi Yukiharu, Akiyoshi Takashi, Konishi Tsuyoshi, Fujimoto Yoshiya, Nagayama Satoshi, Fukunaga Yosuke, Ueno Masashi

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 70 ( 7 ) page： 463 - 468 2017

Language：Japanese Publisher：The Japan Society of Coloproctology

A 45-year-old female was admitted to our hospital suffering from bloody stool and lower abdominal pain. Colonoscopy showed a solid tumor with a diameter of 30 mm, like a submucosal tumor, located at the appendiceal orifice. Enhanced abdominal CT scan showed the enhanced tumor located at the base of the appendix and two swollen lymph nodes in the mesocolon.<BR>Laparoscopic ileocecal resection was performed as a diagnostic therapy. The resected specimen revealed the findings of complete intussusception of the appendix. Histopathological examination showed the presence of endometrial tissue within the submucosal and muscular layers of the appendix. We report this very rare case with appendiceal intussusception induced by appendiceal endometriosis, and review the relevant literature.

DOI： 10.3862/jcoloproctology.70.463

CiNii Research

Pathological Complete Response after Preoperative Systemic Chemotherapy and Chemoradiotherapy for Anal Canal Adenocarcinoma with Pagetoid Spread:A Case Report

Fukuoka Hironori, Nagasaki Toshiya, Miki Hisanori, Hiyoshi Yukiharu, Ogura Atsushi, Akiyoshi Takashi, Fujimoto Yoshiya, Nagayama Satoshi, Fukunaga Yosuke, Takamatsu Manabu, Ueno Masashi

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 70 ( 2 ) page： 81 - 87 2017

Language：Japanese Publisher：The Japan Society of Coloproctology

A 50-year-old woman presented with swollen right inguinal lymph nodes. Physical examination revealed an anorectal tumor and a reddish flat elevated lesion that had spread to the perianal skin. Histological examination of biopsy specimens from the anorectal tumor and perianal skin revealed anal canal adenocarcinoma with pagetoid spread, and imaging findings showed right lateral pelvic lymph node metastases and right inguinal lymph node metastases. The patient underwent preoperative systemic chemotherapy and chemoradiotherapy. After treatment, she underwent laparoscopic abdominoperineal resection with right lateral pelvic lymph node dissection, right inguinal lymph node dissection, and flap transplantation for reconstruction of the perineal wound. Pathological examination revealed no remnant cancer cells, and the patient was diagnosed as pathological complete response. Anorectal adenocarcinoma with pagetoid spread is relatively rare and has a poor prognosis. The optimal therapeutic strategy for the disease has not been established. Therefore, we suspect that preoperative systemic chemotherapy and chemoradiotherapy should be considered as therapeutic options for anorectal adenocarcinoma with pagetoid spread.

DOI： 10.3862/jcoloproctology.70.81

CiNii Research

Patient-centered outcomes to decide treatment strategy for patients with low rectal cancer. International journal

Michitaka Honda, Takashi Akiyoshi, Hisashi Noma, Atsushi Ogura, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

Journal of surgical oncology Vol. 114 ( 5 ) page： 630 - 636 2016.10

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: For patients with low-lying rectal cancer, the feasibility of anus-preserving surgery in combination with neoadjuvant chemoradiotherapy (NACRT) has been not well established from the perspective of patient-centered outcomes. METHODS: We investigated 278 patients with low-lying rectal adenocarcinoma from 2005 to 2012. We compared their symptoms and QOL scores of patients who underwent anus-preserving surgery with (n = 88) and without (n = 143) NACRT according to the Wexner scale, EORTC QLQ C-30, CR29, and the modified fecal incontinence quality life scale (mFIQL). Furthermore, to assess the rationale for intersphincteric resection (ISR) with NACRT, we also compared QOL of patients who underwent ISR with NACRT (n = 31) and abdominoperineal resection (APR, n = 47). RESULTS: The adjusted mean differences of the Wexner score estimates of the patients who underwent ISR and very low anterior resection (VLAR) with or without NACRT were 5.29 (P = 0.004) and 2.67 (P = 0.009), respectively. No significant difference was observed in the QOL scores of two treatment groups. Furthermore, there were no significant differences in the QOL or function scores of patients who underwent ISR with NACRT and APR. CONCLUSION: The incontinence was significantly worse in patients who receive NACRT. However, there were no significant differences in their QOL or function scores. J. Surg. Oncol. 2016;114:630-636. © 2016 Wiley Periodicals, Inc.

DOI： 10.1002/jso.24376

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Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. Reviewed

Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M.

World Journal of Surgery Vol. 2016 ( 40 ) page： 1236-1243 2016.5

Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies.

4. Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M.

World Journal of Surgery Vol. 40 ( 5 ) page： 1236-1243 2016.5

Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. International journal

Atsushi Ogura, Takashi Akiyoshi, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

World journal of surgery Vol. 40 ( 5 ) page： 1236 - 43 2016.5

Language：English Publishing type：Research paper (scientific journal)

BACKGROUND: Although the feasibility of laparoscopic surgery for colorectal cancer has been demonstrated, the safety of laparoscopic pelvic exenteration (PE) with urinary diversion for colorectal malignancies remains poorly studied. The present study aimed to examine the safety and feasibility of laparoscopic PE in patients with colorectal malignancies. METHODS: Thirty-one consecutive patients who underwent anterior or total PE with urinary diversion for colorectal malignancies between July 2004 and April 2015 at our institution were included in the study. Perioperative outcomes were compared between patients undergoing laparoscopic (n = 13) and open (n = 18) PE. RESULTS: There were no conversions to open surgery. The estimated blood loss (930 vs. 3003 ml; P = 0.001) and total volume of blood transfusion (0 vs. 1990 ml; P = 0.002) were significantly lower in patients undergoing laparoscopic compared with open PE. R0 resection was performed in all patients. The operation time (laparoscopic, 829 min vs. open, 875 min; P = 0.660), complication rate (laparoscopic, 61.5 % vs. open, 83.3 %; P = 0.171), and postoperative hospital days (laparoscopic, 29 days vs. open, 33 days; P = 0.356) were similar in both groups. Three patients undergoing laparoscopic PE readmitted within 30 days due to ileus, although the rate of readmission did not differ significantly (laparoscopic, 23.1 % vs. open, 5.6 %; P = 0.284). CONCLUSION: Laparoscopic PE performed by experienced laparoscopic pelvic surgeons should be considered as a safe and preferred option in selected patients with colorectal malignancies, with a significant advantage in terms of reduced blood loss compared with open surgery.

DOI： 10.1007/s00268-015-3364-2

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