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Rectal cancer

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By Christian Zalai Colorectal surgeon based in Montreal
Yun Yang, Ye Shu, Fangyu Su, Lin Xia, Baofeng Duan, Xiaoting Wu
BACKGROUND: Transanal decompression tube (TDT), an alternative intervention believed to have potential equivalent efficacy in reducing anastomotic leakage after rectal cancer surgery and lower complication rates compared to protective stoma, was sporadically applied in some medical centers during recent decade. The objective of this meta-analysis was to evaluate the effect of the TDT in preventing the anastomotic leakage after low anterior resection for rectal cancer. METHODS: The studies comparing TDT and non-TDT in rectal cancer were researched up to March 22, 2016 without language preference, in databases of PubMed, Web of Science, Cochrane library, International Clinical Trials Registry Platform, and National Clinical Trials Registry...
September 12, 2016: Surgical Endoscopy
Luigi Boni, Abe Fingerhut, Alessandro Marzorati, Stefano Rausei, Gianlorenzo Dionigi, Elisa Cassinotti
INTRODUCTION: Colorectal anastomoses after anterior resection for cancer carry a high risk of leakage. Different factors might influence the correct healing of anastomosis, but adequate perfusion of the bowel is highlighted as one of the most important elements. Fluorescence angiography (FA) is a new technique that allows the surgeon to perform real-time intraoperative angiography to evaluate the perfusion of the anastomosis and hence, potentially, reduce leak rate. AIM: The aim of this study was to evaluate the impact of FA of the bowel on postoperative complications and anastomotic leakage after laparoscopic anterior resection with total mesorectal excision (TME)...
August 23, 2016: Surgical Endoscopy
Amjad Shalabi, Simon Daniel Duek, Wisam Khoury
BACKGROUND: Diverting ileostomy is recommended in patients undergoing neoadjuvant chemoradiotherapy and low anterior resection for low-rectal cancer. Prior to ileostomy reversal, water-soluble enema is performed to assess the low colorectal anastomosis. The aim of this study was to assess whether performance of routine water-soluble enema prior to ileostomy takedown is necessary. MATERIALS AND METHODS: All mid-low rectal cancer patients who underwent low anterior resection with temporary diverting ileostomy after neoadjuvant chemoradiotherapy, between 2006 and 2013, were identified, retrospectively...
October 2016: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Muralidharan Parthasarathy, Martin Greensmith, David Bowers, Thomas Groot-Wassink
AIM: A large prospectively collected clinical database was analysed to determine the various pre- and intraoperative factors affecting anastomotic leakage (AL) in colorectal surgery. METHOD: Data on 17,518 patients having a colorectal resection with anastomosis from the 2013 American College of Surgeons National Surgical Quality Improvement Program database were included in the study. Multivariable logistic regression analysis was carried out to identify risk-adjusted predictive factors for AL...
July 30, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Svetlana Balyasnikova, James Read, Diana Tait, Andrew Wotherspoon, Ian Swift, David Cunningham, Paris Tekkis, Gina Brown
AIM: The study aimed to establish the oncological outcome of patients who opted for close surveillance with or without adjuvant chemoradiotherapy (CRT) rather than radical surgery after local excision (LE) of early rectal cancer (ERC) METHOD: The Royal Marsden Hospital Rectal Cancer database was used to identify rectal cancer patients treated by primary LE from 2006-2015. All patients were entered in an intensive surveillance programme. RESULTS: Twenty eight of 34 analysed patients had a high or very high risk of residual disease predicted by adverse histopathological features for which the recommendation had been radical surgery...
July 30, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Masafumi Kuramoto, Satoshi Ikeshima, Kenichiro Yamamoto, Keisuke Morita, Tomoyuki Uchihara, Rumi Itouyama, Shinichi Yoshimatsu, Shinya Shimada, Hideo Baba
The double stapling technique (DST) is an intestinal reconstruction technique that has been widely adopted in anterior resection (AR) for rectal cancer. However, anastomotic leakage (AL) after the operation remains a major concern for colorectal surgeons. The sharp-angled corner of the remnant rectum that is often created by the ordinary DST can be a risk factor for AL. We have developed a new method of performing intentional oblique transection DST (IOT-DST). Using this technique, the anal side of the rectum is intentionally obliquely transected with linear staplers, and the area of the sharp-angled edge is totally punched out with a circular stapler...
July 14, 2016: Surgery Today
Marco E Allaix, Giuseppe Giraudo, Alessia Ferrarese, Alberto Arezzo, Fabrizio Rebecchi, Mario Morino
BACKGROUND: Only few studies have compared laparoscopic total mesorectal excision (LTME) and open total mesorectal excision (OTME) for rectal cancer with follow-up longer than 5 years. The aim of this study was to compare 10-year oncologic outcomes after LTME and OTME for nonmetastatic rectal cancer. METHODS: We conducted a retrospective analysis of a prospective database of rectal cancer patients undergoing LTME or OTME. Statistical analyses were performed on an ''intention-to-treat'' basis and by actual treatment...
July 14, 2016: World Journal of Surgery
Jacob Gehrman, Ingela Björholt, Eva Angenete, John Andersson, Jaap Bonjer, Eva Haglind
BACKGROUND: Previous studies regarding the comparative costs of laparoscopic and open surgery for rectal cancer provide ambiguous conclusions, and there are no large randomized trials or long-term follow-up. METHODS: A prospective cost-minimization analysis was carried out by using data of clinical resource use from the randomized controlled trial COLOR II. Some data needed for the health economic evaluation were not collected in the clinical trial; therefore, a retrospective data collection was made for COLOR II-patients operated at the largest participating Swedish hospital (n = 105)...
July 15, 2016: Surgical Endoscopy
S Atallah, M Albert, J R T Monson
Over the past 3 years, colorectal surgeons have begun to adapt the technique of transanal total mesorectal excision. As international experience has been quickly forged, an improved recognition of the pitfalls and the practical details of this disruptive technique have been realized. The purpose of this technical note was to express the various nuances of transanal total mesorectal excision as learned during the course of its clinical application and international teaching, so as to rapidly communicate and share important insights with other surgeons who are in the early adoption phase of this approach...
July 2016: Techniques in Coloproctology
Anne K Danielsen, Jennifer Park, Jens E Jansen, David Bock, Stefan Skullman, Anette Wedin, Adiela Correa Marinez, Eva Haglind, Eva Angenete, Jacob Rosenberg
OBJECTIVE: The objective was to study morbidity and mortality associated with early closure (8-13 days) of a temporary stoma compared with standard procedure (closure after > 12 weeks) after rectal resection for cancer. BACKGROUND: A temporary ileostomy may reduce the risk of pelvic sepsis after anastomotic dehiscence. However, the temporary ileostomy is afflicted with complications and requires a second surgical procedure (closure) with its own complications...
June 17, 2016: Annals of Surgery
Giacomo Ruffo, Giuliano Barugola, Roberto Rossini, Carlo Augusto Sartori
Improving the quality and effectiveness of care is a key priority of any health policy. The outcomes of health care can be considered as indicators of effectiveness or quality. The scientific literature that evaluates the association between the volume of activity and the outcome of health interventions has greatly developed over the past decade, but, for practical reasons, ethical and social issues, a few randomized controlled studies were made to evaluate this association, although there are numerous observational studies of outcome and systematic reviews of the studies themselves...
June 2016: Updates in Surgery
Min Ju Kim, Sung Chan Park, Tae Hyun Kim, Dae Yong Kim, Sun Young Kim, Ji Yeon Baek, Hee Jin Chang, Ji Won Park, Jae Hwan Oh
BACKGROUND: Little is known about the effect of lateral pelvic node dissection after preoperative chemoradiotherapy on rectal cancer patients with initially suspected lateral pelvic nodes. The purpose of this study was to identify a subgroup of patients receiving preoperative chemoradiotherapy who can benefit from lateral pelvic node dissection. METHODS: The study included 580 patients who underwent preoperative chemoradiotherapy and total mesorectal excision. The lateral pelvic node responses to preoperative chemoradiotherapy were divided: group I (no suspected lateral pelvic node), lateral pelvic node <5 mm pre- and post-chemoradiotherapy; group II (responsive lateral pelvic node), lateral pelvic node ≥5 mm pre-chemoradiotherapy but <5 mm post-chemoradiotherapy; and group III (persistent lateral pelvic node), lateral pelvic node ≥5 mm pre- and post-chemoradiotherapy...
August 2016: Surgery
Laura Q Mortensen, Jakob Burcharth, Kristoffer Andresen, Hans-Christian Pommergaard, Jacob Rosenberg
OBJECTIVE: To investigate the association between diverticulitis and colon cancer in a large, nationwide cohort study. BACKGROUND: Diverticulitis is a common disease, especially in the Western world. Previous articles have investigated the association between diverticulitis and colon cancer with inconclusive results. METHODS: We conducted a population-based cohort study based on longitudinal Danish national registers with data from the period 1995 to 2012...
May 17, 2016: Annals of Surgery
Shariq S Khwaja, Amit Roy, Stephanie Markovina, Todd A Dewees, Steven Hunt, Benjamin Tan, Robert J Myerson, Jeffrey R Olsen, Parag J Parikh
PURPOSE: A prospective phase 2 trial of short-course (SC) radiation therapy (RT) with 25 Gy over 5 fractions, followed by 4 cycles of 5-fluorouracil, oxaliplatin, and leucovorin (mFOLFOX6) before surgery was recently completed at our institution. We present here the patient-reported quality of life (QOL) outcomes from this trial. METHODS AND MATERIALS: Eighty patients with cT3/T4, any N, any M rectal adenocarcinoma planned for resection were enrolled between 2009 and 2012...
August 1, 2016: International Journal of Radiation Oncology, Biology, Physics
M Penna, J J Knol, J B Tuynman, P P Tekkis, N J Mortensen, R Hompes
Transanal total mesorectal excision (TaTME) is a novel approach pioneered to tackle the challenges posed by difficult pelvic dissections in rectal cancer and the restrictions in angulation of currently available laparoscopic staplers. To date, four techniques can be employed in order to create the colorectal/coloanal anastomosis following TaTME. We present a technical note describing these techniques and discuss the risks and benefits of each.
March 2016: Techniques in Coloproctology
Elisabeth C McLemore, Christina R Harnsberger, Ryan C Broderick, Hyuma Leland, Patricia Sylla, Alisa M Coker, Hans F Fuchs, Garth R Jacobsen, Bryan Sandler, Vikram Attaluri, Anna T Tsay, Steven D Wexner, Mark A Talamini, Santiago Horgan
BACKGROUND: With increasing interest in natural orifice surgery, there has been a dramatic evolution of transanal and endoluminal surgical techniques. These techniques began with transanal endoluminal surgical removal of rectal masses and have progressed to transanal radical proctectomy for rectal cancer. The first transanal total mesorectal excision (taTME) was performed in 2009 by Sylla, Rattner, Delgado, and Lacy. The improved visibility and working space associated with the taTME technique is intriguing...
September 2016: Surgical Endoscopy
P H Chapuis, A Kaw, M Zhang, G Sinclair, L Bokey
AIM: Confusion remains as to what is meant by Denonvilliers' fascia. This review searched the literature on pelvic surgical anatomy to determine whether there is agreement with Denonvilliers' original description and its implication in defining the correct anterior plane of dissection when mobilising the rectum. METHOD: The original French description of the fascia was translated into English and then compared both to French and English studies identified by searching Pubmed, Medline and Scopus from 1836 to June 2015...
March 30, 2016: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
In J Park, Y Nancy You, John M Skibber, Miguel A Rodriguez-Bigas, Prajnan Das, Cathy Eng, Scott Kopetz, Robert A Wolff, Christopher H Crane, Sunil Krishnan, Bruce Minsky, Chung-Yuan Hu, Sa Nguyen, George J Chang
OBJECTIVE: Obesity is a major health concern and risk factor for colorectal cancer that may also impact cancer treatment and outcomes. Rectal cancer response to chemoradiotherapy (CXRT) is associated with long-term survival and sphincter preservation. The purpose of this study was to evaluate the impact of obesity on treatment outcomes after neoadjuvant CXRT for rectal cancer. METHODS: A retrospective cohort study of patients diagnosed (1993 to 2010) with cT3-4 or cN+ (by endorectal ultrasound, computed tomography, or magnetic resonance imaging) rectal carcinoma and treated with CXRT and total mesorectal excision was performed...
March 29, 2016: American Journal of Clinical Oncology
Verena N N Kornmann, Marieke S Walma, Marnix A J de Roos, Djamila Boerma, Henderik L van Westreenen
PURPOSE: Fecal incontinence is a major concern, and its incidence increases with age. Quality of life may decrease due to fecal incontinence after both sphincter-saving surgery and a rectal resection with a permanent stoma. This study investigated quality of life, with regard to fecal incontinency, in elderly patients after rectal-cancer surgery. METHODS: All patients who underwent elective rectal surgery with anastomosis for rectal cancer between December 2008 and June 2012 at two Dutch hospitals were eligible for inclusion...
February 2016: Annals of Coloproctology
Dominick Bossé, Jamison Mercer, Soundouss Raissouni, Kristopher Dennis, Rachel Goodwin, Di Jiang, Erin Powell, Aalok Kumar, Richard Lee-Ying, Julie Price-Hiller, Daniel Y C Heng, Patricia A Tang, Anthony MacLean, Winson Y Cheung, Michael M Vickers
BACKGROUND: The PROSPECT trial (N1048) is evaluating the selective use of chemoradiation in patients with cT2N1 and cT3N0-1 rectal cancer undergoing sphincter-sparing low anterior resection. We evaluated outcomes of PROSPECT-eligible and -ineligible patients from a multi-institutional database. PATIENTS AND METHODS: Data from patients with locally advanced rectal cancer who received chemoradiation and low anterior resection from 2005 to 2014 were retrospectively collected from 5 Canadian centers...
September 2016: Clinical Colorectal Cancer
2016-03-19 18:18:27
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