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Rectal cancer

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By Christian Zalai Colorectal surgeon based in Montreal
Lv-Jia Cheng, Jian-Hui Chen, Song-Yao Chen, Zhe-Wei Wei, Long Yu, Shao-Pu Han, Yu-Long He, Zi-Hao Wu, Chuang-Qi Chen
BACKGROUND: Rectal cancers have long been treated as a single-entity disease; however, whether the prognosis of high rectal cancer (inferior margin located 10.1 to 15.0 cm from the anal verge) differs from that of mid/low rectal cancer (0 to 10.0 cm) remains disputed. METHODS: Patients with stages I-III rectal adenocarcinomas undergoing curative-intent surgery were enrolled between 2007 and 2013 in this retrospective analysis. Exclusion criteria were neoadjuvant therapy or concurrent cancers...
January 7, 2019: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Katie E Rollins, Hannah Javanmard-Emamghissi, Austin G Acheson, Dileep N Lobo
OBJECTIVES: To compare the impact of the use of oral antibiotics (OAB) with or without mechanical bowel preparation (MBP) on outcome in elective colorectal surgery. SUMMARY BACKGROUND DATA: Meta-analyses have demonstrated that MBP does not impact upon postoperative morbidity or mortality, and as such it should not be prescribed routinely. However, recent evidence from large retrospective cohort and database studies has suggested that there may be a role for combined OAB and MBP, or OAB alone in the prevention of surgical site infection (SSI)...
December 3, 2018: Annals of Surgery
Rutger C H Stijns, Eelco J R de Graaf, Cornelis J A Punt, Iris D Nagtegaal, Joost J M E Nuyttens, Esther van Meerten, Pieter J Tanis, Ignace H J T de Hingh, George P van der Schelling, Yair Acherman, Jeroen W A Leijtens, Andreas J A Bremers, Geerard L Beets, Christiaan Hoff, Cornelis Verhoef, Corrie A M Marijnen, Johannes H W de Wilt
Importance: Treatment of rectal cancer is shifting toward organ preservation aiming to reduce surgery-related morbidity. Short-term outcomes of organ-preserving strategies are promising, but long-term outcomes are scarce in the literature. Objective: To explore long-term oncological outcomes and health-related quality of life (HRQL) in patients with cT1-3N0M0 rectal cancer who underwent neoadjuvant chemoradiotherapy (CRT) followed by transanal endoscopic microsurgery (TEM)...
October 10, 2018: JAMA Surgery
A M Mehta, G Hellawell, D Burling, S Littler, A Antoniou, J T Jenkins
BACKGROUND: Complete pathological resection of locally advanced and recurrent anorectal cancer is considered the most important determinant of survival outcome. Involvement of the retropubic space with cancer threatening or involving the penile base poses specific challenges due to the potential for margin involvement and blood loss from the dorsal venous plexus. In the present study we evaluate a new transperineal surgical approach to excision of anterior compartment organs involved or threatened by cancer which facilitates exposure and visualisation of the bulbar urethra and the deep vein of the penis caudal to the retropubic space and penile base...
September 2018: Techniques in Coloproctology
Ilya M Danelich, John R Bergquist, Whitney J Bergquist, Jennifer L Osborn, Sampaguita S Wright, Brittany J Tefft, Ashley W Sturm, Diana R Langworthy, Jay Mandrekar, Richard M Devine, Scott R Kelley, Kellie L Mathis, John H Pemberton, Adam K Jacob, David W Larson
BACKGROUND: Excessive perioperative fluid administration likely increases postoperative cardiovascular, infectious, and GI complications. Early administration of diuretics after elective surgery facilitates rapid mobilization of excess fluid, potentially leading to decreased bowel edema, more rapid return of bowel function, and reduced length of hospital stay. OBJECTIVE: This study aimed to evaluate the benefit of early diuresis after elective colon and rectal surgery in the setting of an enhanced recovery after surgery practice...
October 2018: Diseases of the Colon and Rectum
Michele Pisano, Luigi Zorcolo, Cecilia Merli, Stefania Cimbanassi, Elia Poiasina, Marco Ceresoli, Ferdinando Agresta, Niccolò Allievi, Giovanni Bellanova, Federico Coccolini, Claudio Coy, Paola Fugazzola, Carlos Augusto Martinez, Giulia Montori, Ciro Paolillo, Thiago Josè Penachim, Bruno Pereira, Tarcisio Reis, Angelo Restivo, Joao Rezende-Neto, Massimo Sartelli, Massimo Valentino, Fikri M Abu-Zidan, Itamar Ashkenazi, Miklosh Bala, Osvaldo Chiara, Nicola De' Angelis, Simona Deidda, Belinda De Simone, Salomone Di Saverio, Elena Finotti, Inaba Kenji, Ernest Moore, Steven Wexner, Walter Biffl, Raul Coimbra, Angelo Guttadauro, Ari Leppäniemi, Ron Maier, Stefano Magnone, Alain Chicom Mefire, Andrew Peitzmann, Boris Sakakushev, Michael Sugrue, Pierluigi Viale, Dieter Weber, Jeffry Kashuk, Gustavo P Fraga, Ioran Kluger, Fausto Catena, Luca Ansaloni
ᅟ: Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). Methods: The literature was extensively queried for focused publication until December 2017...
2018: World Journal of Emergency Surgery: WJES
Jinshui Zeng, Guoqiang Su
BACKGROUND: The ideal level of ligation of the inferior mesenteric artery (IMA) during curative resection of sigmoid colon and rectal cancer is still controversial. The aim of this meta-analysis was to examine the impact of high ligation and low ligation of the IMA on anastomotic leakage, overall morbidity, postoperative mortality, and oncological outcomes in patients undergoing surgery for sigmoid colon and rectal cancer. METHODS: PubMed, EMBASE, Web of Science, and BioMed Central databases were searched to identify relevant articles published from May 1953 to March 2018...
August 2, 2018: World Journal of Surgical Oncology
Jeroen W A Leijtens, Thomas W A Koedam, Wernard A A Borstlap, Monique Maas, Pascal G Doornebosch, Tom M Karsten, Eric J Derksen, Laurents P S Stassen, Camiel Rosman, Eelco J R de Graaf, André J A Bremers, Jeroen Heemskerk, Geerard L Beets, Jurriaan B Tuynman, Kevin L J Rademakers
AIM: Transanal endoscopic microsurgery (TEM) is used for the resection of large rectal adenomas and well or moderately differentiated T1 carcinomas. Due to difficulty in preoperative staging, final pathology may reveal a carcinoma not suitable for TEM. Although completion total mesorectal excision is considered standard of care in T2 or more invasive carcinomas, this completion surgery is not always performed. The purpose of this article is to evaluate the outcome of patients after TEM-only, when completion surgery would be indicated...
May 23, 2018: Digestive Surgery
Heidi K Chua, Karl Sondenaa, Gregory G Tsiotos, Dirk R Larson, Bruce G Wolff, David M Nagorney
PURPOSE: Resection of hepatic metastases is the preferred treatment for selected patients after resection of primary colorectal carcinoma, but timing is controversial. This study was designed to compare outcomes of patients receiving concurrent resection of hepatic metastases and the primary colorectal tumor with those of patients receiving staged resection (within 6 months). METHODS: We retrospectively analyzed medical records (1986-1999) of 96 consecutive patients with synchronously recognized primary carcinoma and hepatic metastases who underwent concurrent (64 patients) or staged (32 patients) colonic and hepatic resections performed at our institution...
August 2004: Diseases of the Colon and Rectum
Cloë L Sparreboom, Zhouqiao Wu, Hester F Lingsma, Anand G Menon, Gert-Jan Kleinrensink, Joost J Nuyttens, Michel Wjm Wouters, Johan F Lange
BACKGROUND: Short-course preoperative radiotherapy is indicated in patients with resectable rectal cancer to control local recurrence. Although no clear evidence is available, short-course radiotherapy with operation within a week is common practice. The aim of this study was to investigate the impact of timing of operation for rectal cancer after short-course radiotherapy on anastomotic leakage. STUDY DESIGN: Data from the Dutch Colorectal Audit were used. All patients who received short-course preoperative radiotherapy and underwent elective operation within 14 days for rectal cancer between January 1, 2011 and December 31, 2016 were included...
August 2018: Journal of the American College of Surgeons
Marco Ettore Allaix, Edgar Furnée, Laura Esposito, Massimiliano Mistrangelo, Fabrizio Rebecchi, Alberto Arezzo, Mario Morino
BACKGROUND: Laparoscopic rectal resection (LRR) for cancer is a challenging procedure, with conversion to open surgery being reported in up to 30% of cases. Since only a few studies with short follow-up have compared converted LRR and open RR (ORR), it is unclear if conversion to open surgery should be prevented by preferring an open approach in those patients with preoperatively known risk factors for conversion. The aim of this study was to compare early postoperative outcomes and long-term survival after completed LRR, converted LRR or ORR for non-metastatic rectal cancer...
October 2018: World Journal of Surgery
Teresa Draeger, Vinzenz Völkel, Michael Gerken, Monika Klinkhammer-Schalke, Alois Fürst
BACKGROUND: An increasing number of rectal carcinoma resections in Germany and worldwide are performed laparoscopically. The recently published COLOR II trial demonstrated the oncologic safety of this surgical approach. It remains unclear whether these findings can be transferred to clinical practice. PATIENTS AND METHODS: This population-based retrospective cohort study aimed to evaluate 5-year overall, relative, disease-free, and local recurrence-free survival of rectal cancer patients treated by open surgery and laparoscopy...
October 2018: Surgical Endoscopy
Aaron L Womer, Justin T Brady, Kevin Kalisz, Nilam D Patel, Raj M Paspulati, Harry L Reynolds, Timothy M Pawlik, Scott R Steele
BACKGROUND: Increasingly, patients with multiple co-morbidities undergo surgery for rectal cancer. We aimed to evaluate if decreased psoas muscle area and volume, as measures for sarcopenia, were associated with postoperative morbidity. METHODS: Retrospective review of patients undergoing rectal cancer resection at a tertiary medical center (2007-2015). Variables included demographics, co-morbidities, preoperative psoas muscle area and volume, and postoperative complications...
March 2018: American Journal of Surgery
Katrin M Sjoquist, Lindsay A Renfro, R John Simes, Niall C Tebbutt, Stephen Clarke, Matthew T Seymour, Richard Adams, Timothy S Maughan, Leonard Saltz, Richard M Goldberg, Hans-Joachim Schmoll, Eric Van Cutsem, Jean-Yves Douillard, Paulo M Hoff, Joel Randolph Hecht, Christophe Tournigand, Cornelis J A Punt, Miriam Koopman, Herbert Hurwitz, Volker Heinemann, Alfredo Falcone, Rainer Porschen, Charles Fuchs, Eduardo Diaz-Rubio, Enrique Aranda, Carsten Bokemeyer, Ioannis Souglakos, Fairooz F Kabbinavar, Benoist Chibaudel, Jeffrey P Meyers, Daniel J Sargent, Aimery de Gramont, John R Zalcberg
Background: Estimating prognosis on the basis of clinicopathologic factors can inform clinical practice and improve risk stratification for clinical trials. We constructed prognostic nomograms for one-year overall survival and six-month progression-free survival in metastatic colorectal carcinoma by using the ARCAD database. Methods: Data from 22 674 patients in 26 randomized phase III clinical trials since 1997 were used to construct and validate Cox models, stratified by treatment arm within each study...
June 1, 2018: Journal of the National Cancer Institute
Aleix Martínez-Pérez, Maria Clotilde Carra, Francesco Brunetti, Nicola de'Angelis
AIM: To review evidence on the short-term clinical outcomes of laparoscopic (LRR) vs open rectal resection (ORR) for rectal cancer. METHODS: A systematic literature search was performed using Cochrane Central Register, MEDLINE, EMBASE, Scopus, OpenGrey and register for randomized clinical trials (RCTs) comparing LRR vs ORR for rectal cancer and reporting short-term clinical outcomes. Articles published in English from January 1, 1995 to June, 30 2016 that met the selection criteria were retrieved and reviewed...
November 28, 2017: World Journal of Gastroenterology: WJG
J B Mitchem, C Stafford, T D Francone, P L Roberts, D J Schoetz, P W Marcello, R Ricciardi
AIM: An airtight anastomosis on intra-operative leak testing has been previously demonstrated to be associated with a lower risk of clinically significant postoperative anastomotic leak following left-sided colorectal anastomosis. However, to date, there is no consistently agreed upon method for management of an intra-operative anastomotic leak. Therefore, we powered a noninferiority study to determine whether suture repair alone was an appropriate strategy for the management of an intra-operative air leak...
February 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Ailin C Rogers, Guy S Handelman, J Gemma Solon, Deborah A McNamara, Joseph Deasy, John P Burke
BACKGROUND: The effect of obesity on the clinicopathological characteristics of colorectal cancer (CRC) has not been clearly characterized. This meta-analysis assesses the pathological and perioperative outcomes of obese patients undergoing surgical resection for CRC. METHODS: Meta-analysis was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for studies reporting outcomes for obese and non-obese patients undergoing primary CRC resection, based on body-mass index measurement...
December 2017: Cancer Epidemiology
J Park, A K Danielsen, E Angenete, D Bock, A C Marinez, E Haglind, J E Jansen, S Skullman, A Wedin, J Rosenberg
BACKGROUND: A temporary ileostomy may reduce symptoms from anastomotic leakage after rectal cancer resection. Earlier results of the EASY trial showed that early closure of the temporary ileostomy was associated with significantly fewer postoperative complications. The aim of the present study was to compare health-related quality of life (HRQOL) following early versus late closure of a temporary ileostomy. METHODS: Early closure of a temporary ileostomy (at 8-13 days) was compared with late closure (at more than 12 weeks) in a multicentre RCT (EASY) that included patients who underwent rectal resection for cancer...
February 2018: British Journal of Surgery
I S Bakker, A N Morks, H O Ten Cate Hoedemaker, J G M Burgerhof, H G Leuvenink, J B van Praagh, R J Ploeg, K Havenga
BACKGROUND: Anastomotic leakage is a potential major complication after colorectal surgery. The C-seal was developed to help reduce the clinical leakage rate. It is an intraluminal sheath that is stapled proximal to a colorectal anastomosis, covering it intraluminally and thus preventing intestinal leakage in case of anastomotic dehiscence. The C-seal trial was initiated to evaluate the efficacy of the C-seal in reducing anastomotic leakage in stapled colorectal anastomoses. METHODS: This RCT was performed in 41 hospitals in the Netherlands, Germany, France, Hungary and Spain...
July 2017: British Journal of Surgery
K J Gash, O Baser, R P Kiran
BACKGROUND: Tumour response to neo-adjuvant radiotherapy for rectal cancer varies significantly between patients, as classified by Tumour Regression Grade (TRG 0-3), with 0 equating to pathological complete response (pCR) and 3 denoting minimal/no response. pCR is associated with significantly better local recurrence rates and survival, but is achieved in only 20-30% of patients. The literature contains limited data reporting factors predictive of tumour response and corresponding outcomes according to degree of regression...
November 2017: European Journal of Surgical Oncology
2017-09-28 09:55:50
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