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Total mesorectal excision

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https://www.readbyqxmd.com/read/28346223/early-rectal-cancer-a-choice-between-local-excision-and-transabdominal-resection-a-review-of-the-literature-and-current-guidelines
#1
Giuseppe Pappalardo, Massimo Chiaretti
INTRODUCTION: Indication for Local Excision (LE) or Trans Abdominal Resections with Total Mesorectal Excision (TAR) in Early Rectal Cancer (ERC) are still controversial. MATERIAL OF STUDY: We reviewed meta-analyses, scientific societies guidelines, randomized and controlled clinical trials from 1999 to 2016 for a total of 146,231 patients. We included in our analysis the accuracy of different tools of investigation, the reliability of the endoscopic biopsies and compared the results of the various LE and TAR...
March 27, 2017: Annali Italiani di Chirurgia
https://www.readbyqxmd.com/read/28338156/-pay-attention-to-the-selective-lateral-pelvic-lymph-node-dissection-in-mid-low-rectal-cancer
#2
Wenjian Meng, Ziqiang Wang
Lateral pelvic lymph node metastasis is an important metastatic mode and a major cause of locoregional recurrence of mid-low rectal cancer. Recently, there is an East-West discrepancy in regard to the diagnosis, clinical significance, treatment and prognosis of lateral pelvic lymph node metastasis. In the West, lateral nodal involvement may represent systemic disease and preoperative chemoradiotherapy can sterilize clinically suspected lateral nodes. Thus, in many Western countries, the standard therapy for lower rectal cancer is total mesorectal excision with chemoradiotherapy, and pelvic sidewall dissection is rarely performed...
March 25, 2017: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
https://www.readbyqxmd.com/read/28335081/the-impact-of-body-mass-index-and-nuclear-%C3%AE-catenin-on-survival-in-locally-advanced-rectal-cancer-treated-with-preoperative-radiochemotherapy
#3
Jaime Gomez-Millan, Maria Isabel Queipo, Maria Del Mar Delgado, Lidia Perez-Villa, Alicia Roman, Fernando De la Portilla, Esperanza Torres, Vanessa De Luque, Eloisa Bayo, Jose Antonio Medina
BACKGROUND AND OBJECTIVE: We examined the prognostic value of obesity and nuclear β-catenin in patients with locally advanced rectal cancer. METHODS: We prospectively recruited a total of 98 eligible patients with locally advanced cancer for preoperative radiochemotherapy followed by total mesorectal excision. Patients' height and weight were reaorded before radiochemotherapy, and the immunohistochemical expression of nuclear β-catenin was analyzed. Disease-free survival (DFS) was analyzed using the Kaplan-Meier method and a Cox regression model was employed for the multivariate analysis...
March 2017: Journal of Surgical Oncology
https://www.readbyqxmd.com/read/28315018/influence-of-pelvic-volume-on-surgical-outcome-after-low-anterior-resection-for-rectal-cancer
#4
G Zur Hausen, J Gröne, D Kaufmann, S M Niehues, K Aschenbrenner, A Stroux, B Hamm, M E Kreis, Johannes C Lauscher
BACKGROUND: Low anterior resection (LAR) for rectal cancer is a potentially challenging operation due to limited space in the pelvis. CT pelvimetry allows to quantify pelvic space, so that its relationship with outcome after LAR may be assessed. Studies investigating this, however, yielded conflicting results. We hypothesized that a small pelvis is associated with a higher rate of incomplete mesorectal excision, anastomotic leakages, and increased rate of urinary dysfunction in patients operated for rectal cancer...
March 18, 2017: International Journal of Colorectal Disease
https://www.readbyqxmd.com/read/28314302/kras-mutant-status-may-be-associated-with-distant-recurrence-in-early-stage-rectal-cancer
#5
Michail Sideris, Jane Moorhead, Salvador Diaz-Cano, Amyn Haji, Savvas Papagrigoriadis
BACKGROUND/AIM: Total mesorectal excision combined with neo-adjuvant chemoradiotherary (CRT) and adjuvant chemotherapy, has been the standard treatment of locally advanced rectal cancer (LARC). Although TNM (Tumor, Node, Metastasis) classification for malignant Tumors is still the cornerstone in rectal cancer staging, there has been an effort to identify molecular biomarkers with additional prognostic or predictive value. MATERIALS AND METHODS: We retrospectively analyzed molecular biomarkers on prospectively collected histological specimens and clinical data from a cohort of 135 consecutive rectal cancer cases who underwent radical excision in a tertiary center between 2011-2014 (males=87, females=48, age range=22-89 years, mean=64,67 years, SD=13...
March 2017: Anticancer Research
https://www.readbyqxmd.com/read/28291841/prognosis-of-locally-advanced-rectal-cancer-can-be-predicted-more-accurately-using-pre-and-post-chemoradiotherapy-neutrophil-lymphocyte-ratios-in-patients-who-received-preoperative-chemoradiotherapy
#6
SooYoon Sung, Seok Hyun Son, Eun Young Park, Chul Seung Kay
PURPOSE: The neutrophil-lymphocyte ratio (NLR) has been suggested as an inflammation-related factor, but also as an indicator of systemic anti-tumor immunity. We aimed to evaluate the prognostic value of the NLR and to propose a proper cut-off value in patients with locally advanced rectal cancer who received preoperative chemoradiation (CRT) followed by curative total mesorectal excision (TME). METHODS: A total of 110 rectal cancer patients with clinical T3-4 or node-positive disease were retrospectively analyzed...
2017: PloS One
https://www.readbyqxmd.com/read/28288057/mesorectal-excision-with-or-without-lateral-lymph-node-dissection-for-clinical-stage-ii-iii-lower-rectal-cancer-jcog0212-a-multicenter-randomized-controlled-noninferiority-trial
#7
Shin Fujita, Junki Mizusawa, Yukihide Kanemitsu, Masaaki Ito, Yusuke Kinugasa, Koji Komori, Masayuki Ohue, Mitsuyoshi Ota, Yoshihiro Akazai, Manabu Shiozawa, Takashi Yamaguchi, Hiroyuki Bandou, Kenji Katsumata, Kohei Murata, Yoshihito Akagi, Nobuhiro Takiguchi, Yoshihisa Saida, Kenichi Nakamura, Haruhiko Fukuda, Takayuki Akasu, Yoshihiro Moriya
OBJECTIVE: The aim of the study was to confirm the noninferiority of mesorectal excision (ME) alone to ME with lateral lymph node dissection (LLND) in terms of efficacy. BACKGROUND: Lateral pelvic lymph node metastasis is occasionally found in clinical stage II or III lower rectal cancer, and ME with LLND is the standard procedure in Japan. ME alone, however, is the international standard surgical procedure for rectal cancer. METHODS: Eligibility criteria included histologically proven rectal cancer at clinical stage II/III; main lesion located in the rectum, with the lower margin below the peritoneal reflection; no lateral pelvic lymph node enlargement; Peformance Status of 0 or 1; and age 20 to 75 years...
March 10, 2017: Annals of Surgery
https://www.readbyqxmd.com/read/28281474/combined-laparoscopic-and-transanal-total-mesorectal-excision-for-rectal-cancer-initial-experience-and-early-results
#8
Morten Holt Thomsen, Henrik Ovesen, Jens Ravn Eriksen
INTRODUCTION: Incomplete specimens resulting in residual mesorectum in the patient and an increased risk of local recurrence remains a problem. We have introduced transanal-total mesorectal excision (Ta-TME) in our department to potentially overcome this problem due to more direct access to the lower pelvis in patients undergoing TME for rectal cancer and this article presents our initial experience with the new procedure. MATERIALS AND METHODS: Patients with a T1-T3 mid or low rectal cancer eligible for TME or intersphincteric abdominoperineal excision were selected for a combined transanal and transabdominal laparoscopic resection...
April 2017: Journal of Minimal Access Surgery
https://www.readbyqxmd.com/read/28281215/neoadjuvant-treatment-for-locally-advanced-rectal-cancer-new-concepts-in-clinical-trial-design
#9
REVIEW
Nitesh Rana, A Bapsi Chakravarthy, Lisa A Kachnic
Treatment for locally advanced rectal cancer has evolved from surgery alone to surgery plus adjuvant therapy. Preoperative 5-fluorouracil- or capecitabine-based chemoradiation with standard fractionated radiation, surgery utilizing total mesorectal excision, and further chemotherapy has become the standard of care in the USA. Preoperative adjuvant chemoradiation treatment sequencing has allowed for decreased toxicity, more sphincter-sparing surgery, and improved local control rates as compared to delivering the chemoradiation postoperatively...
February 2017: Current Treatment Options in Oncology
https://www.readbyqxmd.com/read/28271268/robotic-versus-laparoscopic-rectal-resection-for-sphincter-saving-surgery-pathological-and-short-term-outcomes-in-a-single-center-analysis-of-130-consecutive-patients
#10
Alain Valverde, Nicolas Goasguen, Olivier Oberlin, Magali Svreck, Jean-François Fléjou, Alain Sezeur, Henri Mosnier, Rémi Houdart, Renato M Lupinacci
BACKGROUND: Minimally invasive sphincter-saving rectal resection represents a challenging procedure. Robotic surgery for rectal cancer has several advantages over conventional surgery in performing precise dissection and was proved to be safe and effective in previous studies. However, comparison between laparoscopic and robotic rectal resection has drawn contradictory results. The aim of the present study was to compare robotic and laparoscopic sphincter-saving rectal resections for short-term and pathological outcomes...
March 7, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28271267/prior-experience-in-laparoscopic-rectal-surgery-can-minimise-the-learning-curve-for-robotic-rectal-resections-a-cumulative-sum-analysis
#11
Manfred Odermatt, Jamil Ahmed, Sofoklis Panteleimonitis, Jim Khan, Amjad Parvaiz
BACKGROUND: The learning curve for robotic colorectal surgery is ill-defined. This study aimed to investigate the learning curve of experienced laparoscopic rectal surgeons when starting with robotic total mesorectal excision (TME) using cumulative sum (CUSUM) charts. METHODS: This retrospective case series analysed patients who underwent curative and elective laparoscopic or robotic TMEs for rectal cancer performed by two surgeons. The first consecutive robotic TME cases of each surgeon were 1:1 propensity score matched to their laparoscopic TME cases using age, body mass index, American Society of Anesthesiologists grade, T stage (AJCC) and tumour location height...
March 7, 2017: Surgical Endoscopy
https://www.readbyqxmd.com/read/28265766/combined-transanal-total-mesorectal-excision-tatme-with-laparoscopic-instruments-and-abdominal-robotic-surgery-in-rectal-cancer
#12
R Bravo, J-S Trépanier, M C Arroyave, M Fernández-Hevia, A Pigazzi, A M Lacy
Laparoscopic surgery for rectal cancer can be technically challenging. We describe a hybrid technique combining abdominal robotic dissection and transanal total mesorectal excision. This procedure was performed in a 50-year-old man with rectal adenocarcinoma at 5 cm from the dentate lane. Preoperative staging was T2N0M0. Surgery went well without complications, and estimated blood loss was less than 50 mL. Robotic surgical time was 90 min, and total operative time was 160 min. The patient was discharged on postoperative day 3...
March 6, 2017: Techniques in Coloproctology
https://www.readbyqxmd.com/read/28237642/oncologic-relevance-of-magnetic-resonance-imaging-detected-threatened-mesorectal-fascia-for-patients-with-mid-or-low-rectal-cancer-a-longitudinal-analysis-before-and-after-long-course-concurrent-chemoradiotherapy
#13
Il Tae Son, Young Hoon Kim, Kyoung Ho Lee, Sung Il Kang, Duck-Woo Kim, Eun Shin, Keun-Wook Lee, Soyeon Ahn, Jae-Sung Kim, Sung-Bum Kang
BACKGROUND: The oncologic importance of threatened mesorectal fascia detected with magnetic resonance imaging is obscured by the heterogeneity of preoperative treatments. We evaluated the oncologic relevance of threatened mesorectal fascia detected with consecutive magnetic resonance imaging performed before and after long-course, concurrent chemoradiotherapy (LCRT) for mid or low rectal cancer. METHODS: We evaluated 196 patients who underwent total mesorectal excision with LCRT...
February 22, 2017: Surgery
https://www.readbyqxmd.com/read/28230017/comparison-of-perioperative-outcomes-between-laparoscopic-and-open-surgery-for-mid-low-rectal-cancer-with-total-mesorectal-excision-following-neoadjuvant-chemoradiotherapy
#14
COMPARATIVE STUDY
Weiping Chen, Qiken Li, Pengnian Qiu, Lai Jiang, Zhixuan Fu, Yongtian Fan, Dechuan Li, Peng Liu, Lilong Tang
OBJECTIVE: The objective of our study was to determine the feasibility and safety of laparoscopic total mesorectal excision (TME) for mid-low rectal cancer following neoadjuvant chemoradiotherapy (nCRT). METHODS: We retrospectively reviewed the records of 172 patients with locally advanced rectal cancer who underwent laparoscopic (n = 75) or conventional open (n = 97) surgery with TME following nCRT from June 2009 to October 2015. Perioperative outcomes and related clinical variables were collected and statistically analyzed...
December 2016: Journal of Cancer Research and Therapeutics
https://www.readbyqxmd.com/read/28177988/robotic-resection-is-a-good-prognostic-factor-in-rectal-cancer-compared-with-laparoscopic-resection-long-term-survival-analysis-using-propensity-score-matching
#15
COMPARATIVE STUDY
Jin Kim, Se-Jin Baek, Dong-Woo Kang, Young-Eun Roh, Jae Won Lee, Han-Deok Kwak, Jung Myun Kwak, Seon-Hahn Kim
BACKGROUND: Robotic total mesorectal excision for rectal cancer has rapidly increased and has shown short-term outcomes comparable to conventional laparoscopic total mesorectal excision. However, data for long-term oncologic outcomes are limited. OBJECTIVE: The aim of this study is to evaluate long-term oncologic outcomes of robotic total mesorectal excision compared with laparoscopic total mesorectal excision. DESIGN: This was a retrospective study...
March 2017: Diseases of the Colon and Rectum
https://www.readbyqxmd.com/read/28161008/genito-urinary-sequelae-after-carcinological-rectal-resection-what-to-tell-patients-in-2017
#16
A Abdelli, X Tillou, A Alves, B Menahem
Although we have seen revolutionary changes with multi-disciplinary management of patients with rectal cancer, the evaluation of genito-urinary sequelae remains of great concern. Precise pre-operative evaluation with validated scores allows detection of urinary disorders in 16 to 23% of patients, and sexual disorders in nearly 35% of men and 50% of women. Regardless of the surgical approach, it is fundamental to respect the autonomic innervation during total mesorectal excision in order to prevent these sequelae...
February 1, 2017: Journal of Visceral Surgery
https://www.readbyqxmd.com/read/28141746/tumor-size-as-an-independent-risk-factor-for-postoperative-complications-in-laparoscopic-low-anterior-resection-for-advanced-rectal-cancer-a-multicenter-japanese-study
#17
Masayoshi Yasui, Ichiro Takemasa, Yuichiro Miyake, Taishi Hata, Masataka Ikeda, Yasuhiro Miyake, Junichi Hasegawa, Hirofumi Ota, Chu Matsuda, Tsunekazu Mizushima, Yuichiro Doki, Masaki Mori
This study aimed to identify the risk factors for postoperative complications after laparoscopic low anterior resection for the treatment of advanced rectal cancers. A prospectively maintained database was retrospectively analyzed. Oncological parameters in resected specimens and clinical risk factors for postoperative complications, including anastomotic leakage, were examined in patients with clinical stage II and III upper rectal cancer who underwent laparoscopic low anterior resection, including total mesorectal excision...
January 30, 2017: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
https://www.readbyqxmd.com/read/28122969/reduced-pelvic-field-sparing-anastomosis-for-postoperative-radiotherapy-in-selected-patients-with-mid-upper-rectal-cancer
#18
Seo Hee Choi, Jee Suk Chang, Nam Kyu Kim, Joon Seok Lim, Byung So Min, Hyuk Hur, Sang Joon Shin, Joong Bae Ahn, Yong Bae Kim, Woong Sub Koom
The aim of this study was to report the clinical results of reduced pelvic field radiotherapy (RT), excluding the anastomotic site, after total mesorectal excision in selected patients with rectal cancer. Between 2011 and 2014, 99 patients underwent upfront surgery for clinically less-advanced tumors but were finally diagnosed as pT3/N+. Among them, 50 patients with mid-upper rectal cancer who received postoperative RT with a reduced pelvic field were included in this retrospective review. This group was composed of patients with high seated tumors, complete resection with a clear circumferential resection margin, and no complication during surgery...
January 24, 2017: Journal of Radiation Research
https://www.readbyqxmd.com/read/28120325/predictive-factors-for-survival-in-neoadjuvant-radiochemotherapy-for-advanced-rectal-cancer
#19
A Reig Castillejo, I Membrive, P Foro, J Quera, X Sanz, N Rodriguez, E Fernández-Velilla, O Pera, A Ortiz, M Algara
INTRODUCTION: Neoadjuvant radiochemotherapy followed by radical surgery is the standard approach in advanced rectal carcinoma. Tumor response is determined in histological specimen. OBJECTIVE: To assess predictive factors for survival in 115 patients. PATIENTS AND METHOD: 115 patients treated with neoadjuvant radiochemotherapy followed by radical surgery with total mesorectal excision, in our hospital from January 2007 to December 2014. All patients received pelvic radiotherapy with concomitant chemotherapy, followed by radical surgery and in some adjuvant chemotherapy...
January 24, 2017: Clinical & Translational Oncology
https://www.readbyqxmd.com/read/28118954/does-circumferential-tumor-location-affect-the-circumferential-resection-margin-status-in-mid-and-low-rectal-cancer
#20
Byung Mo Kang, Yong-Koo Park, Sun Jin Park, Kil Yeon Lee, Chang Woo Kim, Suk-Hwan Lee
BACKGROUND/OBJECTIVE: The purpose of this study was to assess the impact of circumferential tumor location on circumferential resection margin (CRM) status and the depth of tumor invasion in mid and low rectal cancer. METHODS: We retrospectively analyzed whole-mount slides of 58 patients who underwent total mesorectal excision for mid and low rectal cancer. The rate of tumor-positive CRM was compared according to the circumferential tumor location. In 31 patients, morphometric analyses of whole-mount specimens were performed to measure the depth of tumor invasion according to circumferential tumor location...
January 21, 2017: Asian Journal of Surgery
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