Short- and long-term results of open vs laparoscopic multisegmental resection and anastomosis for synchronous colorectal cancer located in separate segments

BACKGROUND It remains unclear whether laparoscopic multisegmental resection and ana-stomosis(LMRA)is safe and advantageous over traditional open multisegmental resection and anastomosis(OMRA)for treating synchronous colorectal cancer(SCRC)located in separate segments.AIM To compare the short-term efficacy and long-term prognosis of OMRA as well as LMRA for SCRC located in separate segments.METHODS Patients with SCRC who underwent surgery between January 2010 and December 2021 at the Cancer Hospital,Chinese Academy of Medical Sciences and the Peking University First Hospital were retrospectively recruited.In accordance with the RESULTS LMRA patients showed markedly less intraoperative blood loss than OMRA patients(100 vs 200 mL,P=0.006).Compared to OMRA patients,LMRA patients exhibited markedly shorter postoperative first exhaust time(2 vs 3 d,P=0.001),postoperative first fluid intake time(3 vs 4 d,P=0.012),and postoperative hospital stay(9 vs 12 d,P=0.002).The incidence of total postoperative complications(Clavien-Dindo grade:≥II)was 2.9%and 17.1%(P=0.025)in the LMRA and OMRA groups,respectively,while the incidence of anastomotic leakage was 2.9%and 7.3%(P=0.558)in the LMRA and OMRA groups,respectively.Furthermore,the LMRA group had a higher mean number of lymph nodes dissected than the OMRA group(45.2 vs 37.3,P=0.020).The 5-year overall survival(OS)and disease-free survival(DFS)rates in OMRA patients were 82.9%and 78.3%,respectively,while these rates in LMRA patients were 78.2%and 72.8%,respectively.Multivariate prognostic analysis revealed that N stage[OS:HR hazard ratio(HR)=10.161,P=0.026;DFS:HR=13.017,P=0.013],but not the surgical method(LMRA/OMRA)(OS:HR=0.834,P=0.749;DFS:HR=0.812,P=0.712),was the independent influencing factor in the OS and DFS of patients with SCRC.CONCLUSION LMRA is safe and feasible for patients with SCRC located in separate segments.Compared to OMRA,the LMRA approach has more advantages related to short-term efficacy.

Gastrointestinal stromal tumor with multisegmental spinal metastases as first presentation:A case report and review of the literature

BACKGROUND Gastrointestinal stromal tumor(GIST)usually originates in the stomach,followed by the small intestine,rectum,and other parts of the gastrointestinal tract.The most common sites of metastasis are the liver and peritoneum,whereas spinal metastases from GIST are extremely rare.CASE SUMMARY We found a case of GIST with the first presentation of multilevel spinal metastases involving the thoracic and lumbar vertebrae.A 61-year-old Chinese man presented to our clinic because of pain in his lower back and hip for 10 d without cause.Subsequently,computed tomography(CT)and magnetic resonance imaging(MRI)revealed abnormal signals in the vertebral appendages of T12 and L4 accompanied by spinal canal stenosis,which was considered as tumor metastasis.As there were no metastases to vital organs,posterior thoracic and lumbar spinal decompression+adnexal mass resection+pedicle internal fixation was adopted to achieve local cure and prevent nerve compression.The results of histopathological studies were consistent with the metastasis of GIST.No local recurrence or new metastases were found at the 6-mo follow-up at the surgical site.The patient has no neurological symptoms at present.It is worth mentioning that a rectal mass was found and surgically removed 1 mo after the patient was discharged from hospital,and the pathological diagnosis of the mass was GIST.CONCLUSION By reviewing 26 previously reported cases of spinal metastasis in GIST,it was found that spinal metastasis of GIST has become more common in recent years,so the possibility of early spinal metastasis should be recognized.CT and MRI are of great value in the diagnosis of spinal metastatic tumors,and pathological biopsy is the gold standard for the diagnosis of metastatic tumors.It is safe and feasible to treat isolated spinal metastasis in GIST by excising metastatic masses,decompressing the spinal canal,and stabilizing the spine.