A study of laparoscopic extraperitoneal sigmoid colostomy after abdomino-perineal resection for rectal cancer

Objective:To established a procedure for laparoscopic extraperitoneal ostomy after abdomino-perineal resection(APR)and study safety aspects and complications.Method:From July 2011 to July 2012,36 patients with low rectal cancer undergoing APR were included in the study and divided into extraperitoneal ostomy group(n=18)and intraperitoneal ostomy group(n=18).Short-and long-term complications were compared between the two groups.All patients were followed up and the median duration was 17 months(range:12-24).Results:The rates of short-term complication related to colostomies were comparable between the two groups,except the rate for stoma edema was higher in the extraperitoneal group(33.3%vs 0%;P=0.008).In the intraperitoneal ostomy group,two patients developed stoma prolapse,one had stoma stenosis,and two had parastomal hernia.In contrast,no long-term complications related to colostomies occurred in the extraperitoneal ostomy group.The rate of long-term complication was lower in the extraperitoneal ostomy group(0%vs 22.2%;P=0.036).Conclusion:The laparoscopic extraperitoneal ostomy is a relatively simple and safe procedure,with fewer long-term complications related to colostomy.However the follow-up period was not too long and needs to be extended.

Melanoma of the rectum: A rare entity

A 41-year-old man presented with a 6-mo history of changed defecation and rectal bleeding. A 3-cm polypoid tumor of the lower rectum was found at rectosigmoidos- copy, which proved to be a leiomyosarcoma upon biopsy. Dissemination studies did not show any metastases. He was underwent to an abdomino-perineal resection (APR). Histopathology of the specimen showed a melanoma (S-100 stain positive). Two years after the resection, me- tastases in the abdomen and right lung were found. He died one and half years later. Primary anorectal melano- ma is a rare and very aggressive disorder. According to current data, one should always perform a S-100 stain when anorectal sarcoma is suspected. A positive S-100 stain suggests the tumour to be most likely a melanoma. Subsequently, thorough dissemination studies need to be performed. Depending on the outcome of the dissemina- tion studies, a surgical resection has to be performed. Nowadays, a sphincter-saving local excision combined with adjuvant loco-regional radiotherapy should be pre- ferred in case of small tumors. The same loco-regional control is achieved with less "loss of function" compared to non-sphincter saving surgery. Only in the case of large and obstructing tumors an abdomino-perineal resection is the treatment of choice.