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1.  Treatment of hemorrhagic radiation-induced proctopathy with a 4% formalin application under perianal anesthetic infiltration 
AIM: To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application.
METHODS: A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed. Twenty-four (63.2%) patients underwent a single application, 10 (26.3%) patients underwent 2 applications, and 4 (10.5%) patients underwent 3 applications.
RESULTS: Two to 36 mo (average 12 ± 3 mo) following treatment, 34 patients were interviewed (four were lost to follow-up). Twenty (58.8%) subjects reported complete cure, 8 (23.5%) subjects reported significant improvement, and 6 (17.7%) subjects reported no change. One patient (who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy) was cured, and the colostomy was closed. One patient (2.6%) developed rectal mucosal damage after the second application.
CONCLUSION: A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple, reasonably safe, inexpensive, generally well tolerated, and effective.
PMCID: PMC3740424  PMID: 23946599
Formalin application; Radiation proctopathy; Rectal bleeding; Prostate cancer
2.  Clinical Outcomes of 103 Hand-Assisted Laparoscopic Surgeries for Left-Sided Colon and Rectal Cancer: Single Institutional Review 
Annals of Coloproctology  2013;29(6):225-230.
The laparoscopic colectomy is avoided principally because of its technical difficulty, steep learning curve, and increased operative time. Hand-assisted laparoscopic surgery (HALS) is an alternative technique that addresses these problems while preserving the short-term benefits of a laparoscopic colectomy. Our study was aimed to describe the characteristics of patients admitted due to left-sided colon and rectal cancer for HALS.
A prospectively maintained database was used to identify patients who underwent HALS at the Institute of Oncology, Vilnius University, from July 1, 2009, to October 1, 2012.
One hundred-three HALS colorectal resections were performed. The patients' mean age was 64 ± 13.4 years. There were 46 male and 57 female patients. The body mass index was 27.3 ± 5.8 kg/m2. Forty-three patients (41.8%) had experienced prior abdominal surgery. The mean HALS time was 105 minutes (range, 55-85 minutes). The conversion rate was 2.7% (3/103). The median of return of gastrointestinal function was 2.5 days (range, 2.2-4.5 days). The median length of hospital stay was 9 days. The postoperative complication and mortality rates were 10.7% and 0.97%, respectively. Four incisional hernias (3.9%) were seen at a mean follow-up of 7.0 ± 3.4 months. None of the patients had a trocar or a hand-port site recurrence.
A HALS colorectal resection is a safe and effective technique, and it provides all the benefits of minimally invasive surgery.
PMCID: PMC3895545  PMID: 24466536
Hand-assisted laparoscopy; Laparoscopic colectomy; Short-term outcomes
3.  Rhabdoid Carcinoma of the Rectum 
Annals of Coloproctology  2013;29(6):252-255.
Rhabdoid colonic tumors are very rare lesions with just a few publications describing such neoplasms. Even more unusual for these lesions are their primary rectal locations, with only two brief case reports having been published on that subject to date. We present a case of a composite rhabdoid rectal carcinoma in a 49-year-old male. The tumor behaved very aggressively, with rapid patient demise despite radical surgery and intensive postoperative chemotherapy (FOLFIRI [folinic acid {leucovorin}, fluorouracil {5-fluorouracil}, and irinotecan] and FOLFOX4 [folinic acid {leucovorin}, fluorouraci {5-fluorouracil}, and oxaliplatin]). Pathologic examination was supportive of a rhabdoid carcinoma, with a compatible immunohistochemical profile, demonstrating synchronous expression of vimentin and epithelial markers in the tumor cells. In addition, BRAF V600E gene mutation, together with a wild-type KRAS gene, was identified, and no evidence of microsatellite instability based on MLH1, MSH2, MSH6, and PMS2 immunophenotypes, i.e., no loss of expression for all 4 markers, was observed. Our reported case confirms previously published observations of the clinical aggressiveness and the poor therapeutic response for rhabdoid tumors.
PMCID: PMC3895550  PMID: 24466541
Rhabdoid tumor; Carcinoma; Rectum; BRAF; INI1
4.  Gracilis muscle interposition with primary rectal without urethral repair for moderate sized rectourethral fistula caused by brachytherapy for prostate cancer: a case report 
There is a 0.16% chance of a rectourethral fistula after prostate brachytherapy monotherapy using Palladium-103 or Iodine-125 implants. We present an unusual case report of a rectourethral fistula following brachyradiotherapy monotherapy for prostate adenocarcinoma. It was also associated with unusual management of the fistula.
Case presentation
A 58-year-old Caucasian man underwent brachyradiotherapy monotherapy as definitive treatment for verified intracapsular prostate adenocarcinoma receiving 56 Iodine-125 implants using a transrectal ultrasound-guided technique. The patient started to complain of severe perineal pain and mild rectal bleeding 15Â months after brachyradiotherapy. A biopsy of mucosa of his anterior rectal wall was performed. A moderate sized rectourethral fistula was confirmed 23Â months after implantation of Iodine-125 seeds. Laparoscopic sigmoidostomy and suprapubic cystostomy were then performed. Long-term cortisone applications in combination with 30 sessions of hyperbaric oxygen therapy, and antibacterial therapies were initiated due to necrotic infection. A gracilis muscle interposition to create a partition between the patient's rectum and urethra in conjunction with primary rectal repair but without urethral repair were performed 6 months later. The 3cm rectal defect was repaired via a 3cm-long horizontal perineal incision. The 1.5cm urethral defect just below the prostate was not repaired. The patient underwent an optic internal urethrotomy 3Â months later for a 1.5cm-long urethral stricture. Several planned preventive urethral buginages were performed to avoid urethral stricture recurrence. At 12Â months postoperatively, there were no signs of a fistula and cancer recurrence. He now has a normal voiding and anal continence.
Severe rectal pain, bleeding, and local anterior necrotic proctitis are predictors of a rectourethral fistula. Urinary and fecal diversion is the first-step operation. Gracilis muscle interposition in conjunction with primary rectal repair but without urethral reconstruction is one of the reconstructive surgery options for moderate 2cm to 3cm rectourethral fistulas. Internal urethrotomy is a procedure for postoperative urethral strictures of 1.5cm in length.
PMCID: PMC3485089  PMID: 23009550
Brachytherapy; Gracilis interposition; Prostate cancer; Radiotherapy; Rectal repair; Rectourethral fistula
5.  The quality of life after a total gastrectomy with extended lymphadenectomy and omega type oesophagojejunostomy for gastric adenocarcinoma without distant metastases 
BMC Surgery  2012;12:11.
To evaluate the quality of life (QOL) in relation to age, sex, clinical stage, postoperative complication, and adjuvant chemotherapy in patients who underwent curative total gastrectomy with D2 lymphadenectomy and Omega type esophagojejunostomy for gastric adenocarcinoma.
69 patients were included. Lithuanian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Cancer 30 was sent to all of them from six months to two years after gastric surgery for self-completion. 34 questionnaires were filled and were used as material for further analysis. Influence of age (≥ 65 vs < 65), sex, clinical stage (I–II vs III), surgical complication, and adjuvant chemotherapy was assessed on QOL in this retrospective cross-sectional case series study.
The global health status was better in the group of patients aged over 65 (63.0 points vs 46.4, P = 0.0509). The functional scales were higher in the same group of patients. Significant difference was only observed on the social scale in favour of elders (P = 0.0039). Sex, clinical stage, surgical complications, and postoperative chemotherapy had no significant influence on any aspect of QOL.
The global QOL and the social functioning was better in patients aged 65 years and over, compared to patients under the age of 65 in the period of 6 to 18 months after a total gastrectomy with D2 lymphadenectomy and Omega esophagojejunostomy.
PMCID: PMC3407519  PMID: 22734678
Gastric cancer; Total gastrectomy; Extended lymphadenectomy; Omega esophagojejunostomy; Quality of life
6.  Extralobar pulmonary sequestration 
Prevalence of pulmonary sequestration accounts for up to 6.4% of all congenital pulmonary malformations. We report on a 40-year-old woman who underwent excision of an aberrant solid retroperitoneal mass in the left subdiaphragmatic area. The mass was identified to be an extralobar pulmonary sequestration. The diagnosis could be made without surgery by percutaneous tissue biopsy and imaging. We encourage keeping in mind pulmonary sequestration anomaly presenting as an aberrant retroperitoneal mass. The aim of this case report is to increase awareness about the condition and review the criteria for its definitive diagnosis and treatment.
PMCID: PMC3658232  PMID: 23754900
retroperitoneal aberrant mass; extralobar pulmonary sequestration

Results 1-6 (6)