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Pan Chi
The efficacy of laparoscopic total mesorectum excision (TME) has been confirmed by many clinical trials and guidelines. But two issues on laparoscopic TME are still questioned, including the integrity of specimen membrane of TME and the incidence of postoperative sexual dysfunction. According to my experiences and the primary results of the multicenter clinical trial (LASRE, identifier: NCT01899547) conducted by me, the integrity of the specimen membrane of laparoscopic TME is not inferior to the open TME...
October 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Jun Watanabe, Mitsuyoshi Ota, Yusuke Suwa, Atsushi Ishibe, Hidenobu Masui, Kaoru Nagahori
INTRODUCTION: Single-incision laparoscopic colectomy is technically limited because of such factors as instrument crowding, in-line viewing, and insufficient countertraction. In particular, it is technically difficult to cut the distal rectum from the umbilicus using an articulating linear stapler in single-incision laparoscopic anterior resection. TECHNIQUE: After treating the mesorectum, the 5-mm trocar is replaced with a 12-mm trocar. The cartridge of the curved stapler is mounted while the shaft of the stapler is inserted into the 12-mm port extracorporeally...
November 2016: Diseases of the Colon and Rectum
Christoph A Maurer, Daniel Dietrich, Martin K Schilling, Urs Metzger, Urban Laffer, Peter Buchmann, Bruno Lerf, Peter Villiger, Gian Melcher, Christian Klaiber, Christian Bilat, Peter Brauchli, Luigi Terracciano, Katharina Kessler
PURPOSE: This study aimed to investigate in a multicenter cohort study the radicality of colorectal cancer resections, to assess the oncosurgical quality of colorectal specimens, and to compare the performance between centers. METHODS: One German and nine Swiss hospitals agreed to prospectively register all patients with primary colorectal cancer resected between September 2001 and June 2005. The median number of eligible patients with one primary tumor included per center was 95 (range 12-204)...
October 7, 2016: International Journal of Colorectal Disease
Peter Bondeven
Rectal cancer constitutes one-third of all colorectal cancers, and the incidence in Denmark increasing. In 2012, 1.400 cases were registered, and of these 38% were located in the upper rectum. There have been several key advances in the optimal management of rectal cancer during the past decades, primarily by standardisation and improvement of the surgical procedure. There is now general agreement that the optimal surgical treatment involves the concept of total mesorectal excision and that a resection with tumour-free margins is crucial...
October 2016: Danish Medical Journal
Zhikai Liu, Ke Hu, An Liu, Jie Shen, Xiaorong Hou, Xin Lian, Shuai Sun, Junfang Yan, Fuquan Zhang
The aim of this study was to investigate patterns and locations of lymph node metastasis in locally advanced cervical cancers.A total of 244 consecutive patients with stage IIb cervical cancer were retrospectively evaluated. Contrast-enhanced CT scans were used for lymph node grading. Lymph nodes with the shortest axis (>1 cm) were categorized as positive and those between 0.5 and 1 cm were categorized as suspicious. All lymph nodes (LNs) were also classified by their anatomic locations.Nine hundred thirty-one LNs (136 positive and 795 suspicious) were identified...
September 2016: Medicine (Baltimore)
L Shen, Y Sun, T Tong, H Zhang, L Liang, W Deng, G Li, J Zhu, Z Zhang
No abstract text is available yet for this article.
October 1, 2016: International Journal of Radiation Oncology, Biology, Physics
Chien-Hsin Chen, Po-Li Wei, Mao-Chih Hsieh, En-Kwang Lin, Jeng-Fong Chiou, Yen-Jung Lu, Szu-Yuan Wu
To investigate the outcomes of the selective neoadjuvant concurrent chemoradiotherapy (CCRT) in lower 3rd rectal cancer patients in different groups (with or without neoadjuvant CCRT), especially in survival rate, local recurrence rate, and sphincter preservation rate.From January 1999 to December 2012, 69 consecutive patients who had histologically proven adenocarcinoma of lower 3rd rectum, defined preoperatively as lower tumor margin within 7 cm from the anal verge as measured by rigid sigmoidoscopy, received total mesorectum excision (TME)...
September 2016: Medicine (Baltimore)
Bingchen Chen, Yuanchuan Zhang, Shuang Zhao, Tinghan Yang, Qingbin Wu, Chengwu Jin, Yazhou He, Ziqiang Wang
To evaluate the impact of visceral obesity on laparoscopic total mesorectal excision (TME) and decide the best index to reflect completion of mesorectum and perioperative outcomes.Patients with rectal cancer who underwent laparoscopic TME were enrolled. The data including body mass index (BMI), visceral fat area (VFA), visceral fat area/body surface area (VFA/BSA), mesorectum fat ratio (MFR), pelvic fat area (PFA), pelvic fat ratio (PFR), completion of mesorectum, and other perioperative outcomes were collected...
September 2016: Medicine (Baltimore)
Junichiro Kawamura, Masaki Tani, Yuya Kida, Kimiaki Sumida, Ryotaro Ogawa, Junya Kawasoe, Takefumi Yazawa, Masahiro Yamada, Michihiro Yamamoto, Hideki Harada, Hidekazu Yamamoto, Masazumi Zaima
A solitary fibrous tumor is a ubiquitous mesenchymal fibroblastic tumor that was previously considered limited to the pleural cavity. Here, we report a rare case of a large solitary fibrous tumor of the mesorectum, which was successfully resected laparoscopically. A 56-year-old woman was referred to our hospital for a giant pelvic mass. Pelvic MRI showed a well-circumscribed mass, 12 cm in diameter, with heterogeneous signal intensity on T2 -weighted images. It was diagnosed as a benign mesorectal tumor of unknown origin...
September 5, 2016: Asian Journal of Endoscopic Surgery
D Moszkowicz, G Rougier, C Julié, K Nyangoh Timoh, A Beauchet, K Vychnevskaia, R Malafosse, B Nordlinger, F Peschaud
AIM: Whether or not nerve-sparing rectal-cancer surgery can effectively prevent removal of the pelvic autonomic nerves has not been substantiated microscopically. We aimed to analyse the quality of nerve preservation in female patients by quantifying residual nerve fibres in total mesorectal excision specimens, to analyse pro-erectile function of the nerve fibres removed and to determine risk factors for pelvic denervation. METHOD: Serial transverse sections from female patients, 64 ± 18 years of age, were studied after the mesorectal fascia was inked and studied histologically [using anti-S100 and anti-neuronal nitric oxide synthase (nNOS) antibodies]...
October 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Giovanni D Tebala
Ureteral injury is one of the possible complications of distal colectomies. It may be caused by misidentification of the anatomic landmarks during the left lateral dissection, due to factor pertaining to the patient, the disease, and the surgeon. The only way to reduce the risk of this avoidable complication is the perfect knowledge and identification of the anatomy of the left ureter. In this article, we describe an anatomic triangle that can be a valid help in the identification of the ureter in the area where higher is the risk of iatrogenic injury...
October 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Sofia Vitor, Alexandre Oliveira Ferreira, João Lopes, José Velosa
We present the case of an 18-year-old male patient that was referred to our gastrenterology department with history of intermittent painless hematochezia since childhood. During such instances, he was diagnosed with bowel intussusception, eosinophilic gastroenteritis and inflammatory bowel disease at 4, 6 and 8 years old, respectively. He underwent treatment with 5-aminosalicylic acid for two years, without improvement of symptoms. He was then lost to follow-up until our observation. His physical examination was unremarkable except for digital rectal examination which found a nodular compressible mass by the palpating finger...
August 2016: Revista Española de Enfermedades Digestivas
Liang Kang, Jianping Wang
Since the characteristics of metastasis and invasion of rectal cancer are confirmed gradually, the aim of surgical treatment in rectal cancer is to protect anal and reproductive function, and to minimize the damage of patients. With prominent advantages of identified lower tumor resection margin, enough circumference resection margin, more minimally invasive procedure and faster recovery, transanal total mesorectal excision(taTME) integrated with natural canal theory, transanal minimally invasive technique and TME can effectively solve the difficulties of transabdominal procedure and becomes the research hotspot in rectal cancer surgery worldwide...
August 25, 2016: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Rianne de Jong, Lotte Lutkenhaus, Niek van Wieringen, Jorrit Visser, Jan Wiersma, Koen Crama, Debby Geijsen, Arjan Bel
BACKGROUND AND PURPOSE: In radiotherapy for rectum cancer, the target volume is highly deformable. An adaptive plan selection strategy can mitigate the effect of these variations. The purpose of this study was to evaluate the feasibility of an adaptive strategy by assessing the interobserver variation in CBCT-based plan selection. MATERIAL AND METHODS: Eleven patients with rectum cancer, treated with a non-adaptive strategy, were selected. Five CBCT scans were available per patient...
August 2016: Radiotherapy and Oncology: Journal of the European Society for Therapeutic Radiology and Oncology
J Hoch, A Ferko, M Bláha, A Ryška, I Čapov, L Dušek, J Feit, M Grega, M Hermanová, E Hovorková, R Chmelová, Z Kala, D Klos, R Kodet, D Langer, D Hadži-Nikolov, J Örhalmi, J Páral, M Tichý, I Tučková, M Vjaclovský, P Vlček
INTRODUCTION: Tumour size and the quality of its complete surgical removal are the main prognostic factors in rectal cancer treatment. The number of postoperative local recurrences depends on whether the mesorectum has been completely removed - total mesorectal excision (TME) - and whether tumour-free resection margins have been achieved. The surgery itself and its quality depend on the accuracy of preoperative diagnosis and detection of risk areas in the rectum and mesorectum, on the surgeons skills, and finally on pathological assessment evaluating whether complete tumour excision has been accomplished including circumferential margins of the tumour, and whether mesorectal excision is complete...
2016: Rozhledy V Chirurgii: Měsíčník Československé Chirurgické Společnosti
Vincenzo Picardi, Francesco Deodato, Alessandra Guido, Lucia Giaccherini, Gabriella Macchia, Maria A Gambacorta, Alessandra Arcelli, Andrea Farioli, Francesco Cellini, Dajana Cuicchi, Francesca DI Fabio, Gilberto Poggioli, Andrea Ardizzoni, Giovanni Frezza, Savino Cilla, Luciana Caravatta, Vincenzo Valentini, Lorenzo Fuccio, Alessio G Morganti
AIM: The aim of this study was to evaluate the pathological response of locally advanced rectal cancer after preoperative concurrent two-drug chemotherapy and intensified radiation therapy (RT) with concomitant boost. PATIENTS AND METHODS: Patients with T4 tumor or local recurrence were included. A trial based on two-stage Simon's design was planned. RT was performed with 3D-conformal technique. The dose to the mesorectum and pelvic lymph nodes was 45 Gy (1.8 Gy/fraction)...
August 2016: Anticancer Research
Akiyo Matsumoto, Kaida Arita
BACKGROUND: The gold standard of rectal surgery is TME and DST anastomosis.1 (-) 6 The division of mesorectum in tumor-specific mesorectal and total mesorectal excisions is one of the most difficult procedures of anterior dissection. We have developed a laparoscopic-assisted anterior dissection technique using the simple Rectum Catcher device (RC) with an intraoperative colonoscopy (CF).7 (,) 8 METHODS: Surgical and oncological outcomes were compared between 99 patients undergoing a laparoscopic approach with the RC and a CF (RCF) and 104 patients undergoing the laparoscopic approach without the RC and without a CF (NRCF)...
November 2016: Annals of Surgical Oncology
W A A Borstlap, P J Tanis, T W A Koedam, C A M Marijnen, C Cunningham, E Dekker, M E van Leerdam, G Meijer, N van Grieken, I D Nagtegaal, C J A Punt, M G W Dijkgraaf, J H De Wilt, G Beets, E J de Graaf, A A W van Geloven, M F Gerhards, H L van Westreenen, A W H van de Ven, P van Duijvendijk, I H J T de Hingh, J W A Leijtens, C Sietses, E J Spillenaar-Bilgen, R J C L M Vuylsteke, C Hoff, J W A Burger, W M U van Grevenstein, A Pronk, R J I Bosker, H Prins, A B Smits, S Bruin, D D Zimmerman, L P S Stassen, M S Dunker, M Westerterp, P P Coene, J Stoot, W A Bemelman, J B Tuynman
BACKGROUND: Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5-20 %) suggesting that local excision alone is not sufficient, while completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients...
2016: BMC Cancer
Vincenzo Picardi, Gabriella Macchia, Alessandra Guido, Lucia Giaccherini, Francesco Deodato, Andrea Farioli, Savino Cilla, Gaetano Compagnone, Andrea Ardizzoni, Dajana Cuicchi, Maria Antonietta Gambacorta, Francesco Cellini, Giovanni Frezza, Gilberto Poggioli, Vincenzo Valentini, Lorenzo Fuccio, Alessio Giuseppe Morganti
PURPOSE: The aim of this study was to investigate the efficacy and toxicity of volumetric modulated arc therapy (VMAT)-simultaneous integrated boost (SIB) in preoperative combined treatment of locally advanced rectal cancer. METHODS: Radiation therapy was performed using the VMAT-SIB technique. The dose to mesorectum and pelvic lymph nodes was 45 Gy (1.8 Gy/fraction). A concomitant boost was delivered on GTV + 2-cm margin with a total dose of 57.5 Gy (2.3 Gy/fraction)...
June 23, 2016: Clinical Colorectal Cancer
Jérémie H Lefevre, Laurent Mineur, Salma Kotti, Eric Rullier, Philippe Rouanet, Cécile de Chaisemartin, Bernard Meunier, Jafari Mehrdad, Eddy Cotte, Jérome Desrame, Mehdi Karoui, Stéphane Benoist, Sylvain Kirzin, Anne Berger, Yves Panis, Guillaume Piessen, Alain Saudemont, Michel Prudhomme, Frédérique Peschaud, Anne Dubois, Jérome Loriau, Jean-Jacques Tuech, Guillaume Meurette, Renato Lupinacci, Nicolas Goasgen, Yann Parc, Tabassome Simon, Emmanuel Tiret
PURPOSE: A pathologic complete response (pCR; ypT0N0) of a rectal tumor after neoadjuvant radiochemotherapy (RCT) is associated with an excellent prognosis. Several retrospective studies have investigated the effect of increasing the delay after RCT. The aim of this study was to evaluate the effect of increasing the interval between the end of RCT and surgery on the pCR rate. METHODS: GRECCAR6 was a phase III, multicenter, randomized, open-label, parallel-group controlled trial...
July 18, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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