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Total mesorectal excision

X Serra-Aracil, A Zárate, L Mora, S Serra-Pla, A Pallisera, J Bonfill, J Bargalló, A Pando, S Delgado, E Balleteros, C Pericay
PURPOSE: Compared with the open approach, laparoscopic total mesorectal excision (TME) achieves faster patient recovery, reduces morbidity rates, and shortens hospital stay. However, in laparoscopic low anterior resection (L-LAR), conversion to open surgery is required in almost 20% of cases. Transanal TME (Ta-TME) combined with laparoscopy, also called hybrid natural orifice transluminal endoscopic surgery (NOTES), is a less invasive procedure that can overcome some of the limitations of laparoscopic rectal surgery...
March 16, 2018: International Journal of Colorectal Disease
Seo Hee Choi, Jee Suk Chang, Hong In Yoon, Dong-Su Jang, Nam Kyu Kim, Joon Seok Lim, Byung So Min, Hyuk Huh, Sang Joon Shin, Joong Bae Ahn, Woong Sub Koom
PURPOSE: Patterns of locoregional rectal cancer recurrences following total mesorectal excision (TME) were analyzed to define the irradiation volume, especially the lateral pelvic lymph node (LPLN). MATERIALS AND METHODS: Of 1243 patients who underwent TME without pelvic radiotherapy between 2005 and 2012, the data of 826 patients with rectal adenocarcinoma without distant metastases were analyzed for relapse patterns, categorized as distant and locoregional (anastomosis, mesorectum, presacral area, and LPLNs) failure...
March 15, 2018: Journal of Cancer Research and Clinical Oncology
Aeris Jane D Nacion, Youn Young Park, Nam Kyu Kim
Advancements in rectal cancer treatment have resulted in improvement only in locoregional control and have failed to address distant relapse, which is the predominant mode of treatment failure in rectal cancer. As the efficacy of conventional chemoradiotherapy (CRT) followed by total mesorectal excision (TME) reaches a plateau, the need for alternative strategies in locally advanced rectal cancer (LARC) has grown in relevance. Several novel strategies have been conceptualized to address this issue, including: 1) neoadjuvant induction and consolidation chemotherapy before CRT; 2) neoadjuvant chemotherapy alone to avoid the sequelae of radiation; and 3) nonoperative management for patients who achieved pathological or clinical complete response after CRT...
February 2018: Chinese Journal of Cancer Research, Chung-kuo Yen Cheng Yen Chiu
Juliane Kupsch, Thomas Jackisch, Klaus E Matzel, Joerg Zimmer, Andreas Schreiber, Anja Sims, Helmut Witzigmann, Sigmar Stelzner
PURPOSE: Severity of anorectal dysfunction after low anterior resection is associated with various patient- and treatment-related factors. We aimed to quantify anorectal dysfunction after treatment for rectal cancer using the low anterior resection syndrome (LARS) score. METHODS: We retrieved from a prospective database 331 eligible patients on whom anterior resection for rectal cancer had been performed from 2000 to 2014. All patients were sent a LARS score accompanied by a supplementary questionnaire...
March 15, 2018: International Journal of Colorectal Disease
Sohyun Kim
Purpose: Most patients with rectal cancer undergo a total mesorectal excision and a partial resection of the sigmoid colon to improve oncologic outcomes. The aim of this study was to assess the distribution of lymph nodes (LNs) in rectal cancer. Methods: The records of 54 patients with mid and low rectal cancer between April 2015 and March 2017 were reviewed, and 49 patients were enrolled in this study. All harvested LNs were analyzed according to the harvested area: the mesorectum area (MA), the vascular pedicle area (VA), and the sigmoid area (SA)...
February 2018: Annals of Coloproctology
Ki Young Lee, Jung Kyoung Shin, Yoon Ah Park, Seong Hyeon Yun, Jung Wook Huh, Yong Beom Cho, Hee Cheol Kim, Woo Yong Lee
Purpose: This study aimed to compare short-term postoperative and oncologic outcomes of a transanal endoscopic total mesorectal excision (TME) to those of a transabdominal robotic TME. Methods: A total of 62 patients with rectal cancer underwent transanal (n = 26) or robotic (n = 36) TME between June 2013 and December 2014. After case-matching by tumor location and TNM stage, 45 patients were included for analysis. The median follow-up period was 21.3 months. Operative, histopathologic and postoperative outcomes and recurrences were analyzed...
February 2018: Annals of Coloproctology
Hyuk Hur
No abstract text is available yet for this article.
February 2018: Annals of Coloproctology
Hisanaga Horie, Koji Koinuma, Homare Ito, Ai Sadatomo, Daishi Naoi, Yoshihiko Kono, Yoshiyuki Inoue, Mitsuaki Morimoto, Makiko Tahara, Alan K Lefor, Naohiro Sata, Takahiro Sasaki, Hideharu Sugimoto
INTRODUCTION: Laparoscopic lateral pelvic lymph node dissection (LPLD) is technically challenging because of the complicated anatomy of the pelvic wall. To overcome this difficulty, we introduced preoperative 3-D simulation. The aim of the study is to investigate the usefulness of preoperative 3-D simulation for the safe conduct of laparoscopic LPLD for rectal cancer. METHODS: After undergoing colonoscopy, patients were brought to the radiology suite where multi-detector row CT was performed...
March 12, 2018: Asian Journal of Endoscopic Surgery
Ai-Wen Wu, Yong Cai, Yong-Heng Li, Lin Wang, Zhong-Wu Li, Ying-Shi Sun, Jia-Fu Ji
BACKGROUND: The purpose of this study was to retrospectively analyze the pattern and the management of recurrence of rectal cancer treated with 22-fraction intensity-modulated radiation therapy (IMRT). PATIENTS AND METHODS: This study included patients who underwent IMRT with gross tumor volume of 50.6 Gy in 22 fractions with concurrent capecitabine treatment over a period of 30 days, after which the patients underwent total mesorectal excision at Peking University Cancer Hospital (2007-2015)...
March 7, 2018: Clinical Colorectal Cancer
Johannes Fritzmann, Pietro Contin, Christoph Reissfelder, Markus W Büchler, Jürgen Weitz, Nuh N Rahbari, Alexis B Ulrich
PURPOSE: The present study compared the prognostic value of the lymph node ratio (LNR) and the 6th and the 7th TNM edition as three different lymph node classifications for rectal cancer patients. METHODS: A total of 630 patients who underwent total mesorectal excision for primary rectal cancer between October 2001 and December 2007 were included. Prognostic factors of overall survival were analyzed using Cox proportional hazards models. RESULTS: The median follow-up was 36...
March 9, 2018: Langenbeck's Archives of Surgery
George Melich, Ajit Pai, Ramy Shoela, Kunal Kochar, Supriya Patel, John Park, Leela Prasad, Slawomir Marecik
BACKGROUND: Apprenticeship in training new surgical skills is problematic, because it involves human subjects. To date there are limited inanimate trainers for rectal surgery. OBJECTIVE: The purpose of this article is to present manufacturing details accompanied by evidence of construct, face, and content validity for a robotic rectal dissection simulation. DESIGN: Residents versus experts were recruited and tested on performing simulated total mesorectal excision...
April 2018: Diseases of the Colon and Rectum
William H Ward, Elin R Sigurdson, Andrew C Esposito, Karen J Ruth, Samuel M Manstein, Eric C Sorenson, Brian D Wernick, Jeffrey M Farma
BACKGROUND: Despite advances in the treatment of rectal adenocarcinoma, the management of locally advanced disease remains a challenge. The standard of care for patients with stages II and III rectal cancer includes neoadjuvant chemoradiation followed by total mesorectal excision and postoperative chemotherapy. Much effort has been dedicated to the identification of predictive factors associated with pathologic complete response (pCR). The aim of our study was to examine our institutional experience and determine whether any association exists between anatomic tumor location and the rate of pCR...
April 2018: Journal of Surgical Research
J X Zhang, Z Yang, P Fan, J J Zhang, L Xin, L N Hou, X S Du, X T Yang
Objective: To evaluate the predictive value of MRI features and pathological parameters on local recurrence, metastasis and progression free survival (PFS) for locally advanced rectal cancer after neoadjuvant chemoradiotherapy and subsequent total mesorectal excision surgery. Methods: A retrospective analysis of 95 patients with locally advanced rectal adenocarcinoma who underwent total mesorectal excision after neoadjuvant chemoradiotherapy was performed. Univariate and multivariate analyses were performed to evaluate the predictive value of MRI features before chemoradiation and postoperative pathological parameters on progression free survival...
February 23, 2018: Zhonghua Zhong Liu za Zhi [Chinese Journal of Oncology]
Ryo Ohta, Takahiro Inoue, Manabu Goto, Yuji Tachimori, Koji Sekikawa
INTRODUCTION: This report presents a case of anorectal malignant melanoma treated with combined laparoscopic abdomino-endoscopic perineal total mesorectal excision. PRESENTATION OF CASE: An 82-year-old female presented with hematochezia. Colonoscopy revealed a 5-cm tumor in the anorectal junction, and biopsy specimen showed malignant melanoma. Modified ransanal total mesorectal excision was performed to get the sufficient surgical resection margins. After lymph node dissection in usual manner, mobilizing the rectum to the level of levator ani muscle...
February 22, 2018: International Journal of Surgery Case Reports
Kwan Mo Yang, Seok-Byung Lim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Chang Sik Yu, Jin Cheon Kim
PURPOSE: Among individuals who respond well to preoperative chemoradiation therapy (CRT) for ypT0-1, local excision (LE) could provide acceptable oncological outcomes. However, in ypT2 cases, the oncological safety of LE has not been determined. This study aimed to compare oncological outcomes between LE and total mesorectal excision of ypT2-stage rectal cancer after chemoradiation therapy and investigate the oncological safety of LE in these patients. METHODS: We included 351 patients who exhibited ypT2-stage rectal cancer after CRT followed by LE (n = 16 [5%]) or total mesorectal excision (TME) (n = 335 [95%]) after preoperative CRT between January 2007 and December 2013...
February 21, 2018: International Journal of Colorectal Disease
Hong-Peng Jiang, Yan-Sen Li, Bo Wang, Chang Wang, Fan Liu, Zhan-Long Shen, Ying-Jiang Ye, Shan Wang
BACKGROUND: Since 2010, comparative studies on transanal and laparoscopic total mesorectal excision (TME) have been published and it remains unclear about the oncological benefit from transanal total mesorectal excision (taTME). METHODS: We have searched English databases to identify all taTME studies published between January 2010 and August 2017. Pathological outcomes included circumferential resection margin (CRM), positive CRM (< 1 M), length of distal resection margin (DRM), positive DRM, quality of mesorectum (complete mesorectum), harvested lymph node, and length of the specimen...
February 20, 2018: Surgical Endoscopy
Hye Jin Kim, Gyu-Seog Choi, Jun Seok Park, Soo Yeun Park, Chun Seok Yang, Hee Jae Lee
AIM: Quality of life (QoL) and functional outcomes are at risk of being impaired after rectal surgery, but there has been no thorough QoL assessment according to surgical approach in a large, prospective study. We have investigated the impact of laparoscopic and robotic total mesorectal excision (TME) on quality of life (QoL) and functional outcomes. METHODS: Patients undergoing laparoscopic or robotic TME for rectal cancer between 2009 and 2013 were prospectively included in this questionnaire-based survey of QoL, together withvariations in urinary and sexual function...
February 20, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Takeru Matsuda, Yasuo Sumi, Kimihiro Yamashita, Hiroshi Hasegawa, Masashi Yamamoto, Yoshiko Matsuda, Shingo Kanaji, Taro Oshikiri, Tetsu Nakamura, Satoshi Suzuki, Yoshihiro Kakeji
PURPOSE: The clinical significance of preoperative chemoradiotherapy (CRT) and lateral lymph node dissection (LLND) for locally advanced rectal cancer remains unclear. We have employed total mesorectal excision and selective LLND following preoperative CRT for patients with locally advanced rectal cancer. The validity of our strategy was evaluated. METHODS: A total of 45 patients with locally advanced rectal cancer who underwent curative surgery after CRT from November 2005 to September 2016 were retrospectively analyzed...
February 13, 2018: International Journal of Colorectal Disease
G Grimaldi, Chiara Eberspacher, A M Romani, D Merletti, A Maturo, S Pontone, D Pironi
AIM: The incidence of rectal cancer continues to rise. The functional results after complete Total Mesorectal Excision (TME) depend on the segment of colon used for reconstruction of colonic continuity and the form, the volume and the functional proprieties of the "neorectum". The aim of our study is evaluate the efficacy of our Modified Transverse Coloplasty Pouch (MTCP) after the treatment of low rectal cancer in terms of functional outcomes and quality of life. PATIENTS AND METHODS: The study included 136 patients, underwent TME from January 2007 to December 2016 with diagnosis of extraperitoneal carcinoma of the rectum...
November 2017: Il Giornale di Chirurgia
Yankai Meng, Yuchen Zhang, Di Dong, Chunming Li, Xiao Liang, Chongda Zhang, Lijuan Wan, Xinming Zhao, Kai Xu, Chunwu Zhou, Jie Tian, Hongmei Zhang
BACKGROUND: Locally advanced rectal cancer (LARC) patient stratification by clinicoradiologic factors may yield variable results. Therefore, more efficient prognostic biomarkers are needed for improved risk stratification of LARC patients, personalized treatment, and prognostication. PURPOSE/HYPOTHESIS: To compare the ability of a radiomic signature to predict disease-free survival (DFS) with that of a clinicoradiologic risk model in individual patients with LARC...
February 13, 2018: Journal of Magnetic Resonance Imaging: JMRI
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