Early experience of the compression anastomosis ring (CAR^(TM) 27) in left-sided colon resection

AIM:To evaluate clinical validity of the compression anastomosis ring(CARTM27) anastomosis in left-sided colonic resection. METHODS:A non-randomized prospective data collection was performed for patients undergoing an elective left-sided colon resection,followed by an anastomosis using the CARTM27 between November 2009 and January 2011.Eligibility criteria of the use of the CARTM27 were anastomoses between the colon and at or above the intraperitoneal rectum.The primary short-term clinical endpoint,rate of anastomotic leakage,and other clinical outcomes,including intraand postoperative complications,length of operation time and hospital stay,and the ring elimination time were evaluated. RESULTS:A total of 79 patients(male,43;median age,64 years) underwent an elective left-sided colon resection,followed by an anastomosis using theCARTM27.Colectomy was performed laparoscopically in 70 patients,in whom two patients converted to open procedure(2.9%) .There was no surgical mortality.As an intraoperative complication,total disruption of the anastomosis occurred by premature enforced tension on the proximal segment of the anastomosis in one patient.The ring was removed and another new CARTM27 anastomosis was constructed.One patient with sigmoid colon cancer showed postoperative anastomotic leakage after 6 d postoperatively and temporary diverting ileostomy was performed.Exact date of expulsion of the ring could not be recorded because most patients were not aware that the ring had been expelled.No patients manifested clinical symptoms of anastomotic stricture. CONCLUSION:Short-term evaluation of the CARTM27 anastomosis in elective left colectomy suggested it to be a safe and efficacious alternative to the standard hand-sewn or stapling technique.

Collision tumor of the rectum: A case report of metastatic gastric adenocarcinoma plus primary rectal adenocarcinoma

Collision tumors are thought to arise from the accidental meeting and interpenetration of two independent tumors. We report here a highly unusual case of a 61-year old man who had a unique tumor that was composed of a metastatic adenocarcinoma from the stomach to the rectum, which harbored a collision tumor of primary rectal adenocarcinoma. The clonalities of the two histologically distinct lesions of the rectal mass were confirmed by immunohistochemical and molecular analysis. Although histologic examination is the cornerstone in pathology, immunohistochemical and molecular analysis can provide evidence regarding whether tumors originate from the same clone or different clones. To the best of our knowledge, this is the fi rst reported case of such an occurrence.