Optimizing the selection of patients with low rectal cancer for intersphincteric resection by evaluating vertical invasion to the levator and external sphincter

2015 ◽  
Vol 17 (2) ◽  
pp. 133-140
Author(s):  
K. Narui ◽  
Y. Ichikawa ◽  
H. Ike ◽  
M. Ota ◽  
S. Saito ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
External Sphincter ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Selection Of Patients ◽  
Selection Of

Extended intersphincteric resection with quadrant resection of external sphincter after neoadjuvant mid-course chemoradiotherapy in the very low rectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14181-e14181
Author(s):  
Nahmgun Oh ◽  
Sanghwa Ko ◽  
Hyunsung Kim
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
External Sphincter ◽  
Postoperative Mortality ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Pelvic Cavity ◽  
Group I ◽  
Very Low Rectal Cancer ◽  
The Mean

e14181 Background: To evaluate the results of extended intersphincteric resection of T3 rectal cancer situated below 4cm from the anal verge, comparing the results of simple intersphincteric resection of T2 rectal cancer after mid-course chemoradiotherapy. Methods: Between 2000 Between 2000 and 2006, 67 patients with rectal cancer below 4cm from anal verge, underwent abdomino-intersphincteric resection reconstructed by inversion proctoplasty with a colonic J-pouch and diverting ileostomy. All patients received a total irradiation dose of 30 Gy with conventional fractions for 3 weeks. Capecitabine was administered 1000mg/m2 twice a day on 21 days during radiotherapy, followed curative surgery in a week without resting period. After preoperative radio-chemotherapy, patients with overt T2 lesion were 27 cases (40.3%) and received intersphincteric resection (Group I: simple intersphincteric resection), and patients with borderline cases or T3 lesion were 40 cases (59.7%) and received intersphincteric resection with quadrant resection of upper external sphincter and primary repair of the external sphincter as inversion proctoplasty (Group II: extended intersphincteric resection). Results: The mean patients age was 61.2 years. The mean location of cancer was at 3.2cm from anal verge (2-4cm). Anastomotic leakage was confirmed in 11 patients (16.4%). There was no postoperative mortality. The grade I, II of continence by Kirwan classification was 81.5%, 80.0% in Group I and II. Under 3 times stool frequency per day was 51.9%, 62.5% in Group I and II. Two patients (3.0%) experienced locoregional recurrence of pelvic cavity. 5-year overall survival rate was 83.6%. Conclusions: Simple and extended intersphincteric resection is seemed to be a safe and functionally acceptable procedure. And, neoadjuvant mid-course chemoradiotherapy using oral capecitabine 2,000 mg/m2/day on 21 days during 2 Gy radiation of each 15 weekdays is seemed to be a tolerable and effective modality, in patients with very low rectal cancer.

scholarly journals The Clinical Impact of MicroRNA-21 in Low Rectal Cancer Treated with High-Dose Chemoradiotherapy in the Organ Preserving Setting

2020 ◽  
Vol 2 (4) ◽  
pp. 378-384
Author(s):  
Caroline Brenner Thomsen ◽  
Rikke Fredslund Andersen ◽  
Lars Henrik Jensen ◽  
Anders Jakobsen ◽  
Torben Frøstrup Hansen
Keyword(s):  
Rectal Cancer ◽  
Intensity Modulated Radiotherapy ◽  
Complete Response ◽  
Clinical Impact ◽  
Low Rectal Cancer ◽  
Clinical Staging ◽  
High Dose ◽  
Incomplete Response ◽  
Selection Of Patients ◽  
Selection Of

Background: Organ preservation in the treatment of rectal cancer has seen an increase in interest. Clinical complete response (cCR) after high-dose chemoradiotherapy (CRT) allows for non-surgical management (NSM), but the selection of patients is challenging and standard clinical staging insufficient. MicroRNA-21-5p (miR-21) is ubiquitously upregulated in cancer and has been associated with treatment response in rectal cancer treated with standard preoperative CRT. The aim of the present study was to investigate this association in low rectal cancer treated in the NSM setting. Methods: Forty-eight patients from our single-arm phase II trial (NCT00952926) were eligible for analysis. All patients had resectable T2 or T3, N0–N1 low adenocarcinoma and received intensity-modulated radiotherapy plus brachytherapy boost and oral tegafur–uracil. Patients with cCR six weeks after end of treatment assessed by clinical examination, magnetic resonance imaging, and biopsy, were referred to observation and close follow-up. The miR expression in the diagnostic biopsies was measured by qPCR. The relationship between miR-21 expression and cCR was assessed using the Wilcoxon rank-sum test. Results: Thirty-eight patients had cCR after treatment and were allocated to observation while 10 patients had incomplete response and underwent surgery. MicroRNA-21 was successfully analyzed in all samples. The median tumor expression of miR-21 was significantly higher in patients with incomplete response than in those with cCR, 24.3 (95% confidence interval (CI) 17.1–36.8) and 16.6 (95% CI 13.9–21.1), respectively, p = 0.03. Conclusions: The present study adds to the evidence of the clinical impact of miR-21 in rectal cancer treated with CRT. The findings are comparable with results seen in patients treated in the standard preoperative setting and may assist in the selection of patients for an organ preserving approach.

scholarly journals Comparison of Clinical Efficacy and Safety Between da Vinci Robotic and Laparoscopic Intersphincteric Resection for Low Rectal Cancer: A Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jie Zhang ◽  
Xingshun Qi ◽  
Fangfang Yi ◽  
Rongrong Cao ◽  
Guangrong Gao ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Clinical Efficacy ◽  
Da Vinci ◽  
Meta Analysis ◽  
Outcome Data ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Cochrane Library ◽  
Alternative Choice ◽  
Laparoscopic Intersphincteric Resection

Background and Aims: The intersphincteric resection (ISR) is beneficial for saving patients' anus to a large extent and restoring original bowel continuity. Laparoscopic ISR (L-ISR) has its drawbacks, such as two-dimensional images, low motion flexibility, and unstable lens. Recently, da Vinci robotic ISR (R-ISR) is increasingly used worldwide. The purpose of this article is to compare the feasibility, safety, oncological outcomes, and clinical efficacy of R-ISR vs. L-ISR for low rectal cancer.Methods: PubMed, EMBASE, Cochrane Library, and Web of Science were searched to identify comparative studies of R-ISR vs. L-ISR. Demographic, clinical, and outcome data were extracted. Mean difference (MD) and risk ratio (RR) with their corresponding confidence intervals (CIs) were calculated.Results: Five studies were included. In total, 510 patients were included, of whom 273 underwent R-ISR and 237 L-ISR. Compared with L-ISR, R-ISR has significantly lower estimated intraoperative blood loss (MD = −23.31, 95% CI [−41.98, −4.64], P = 0.01), longer operative time (MD = 51.77, 95% CI [25.68, 77.86], P = 0.0001), hospitalization days (MD = −1.52, 95% CI [−2.10, 0.94], P < 0.00001), and postoperative urinary complications (RR = 0.36, 95% CI [0.16, 0.82], P = 0.02).Conclusions: The potential benefits of R-ISR are considered as a safe and feasible alternative choice for the treatment of low rectal tumors.

scholarly journals Survival and functional and oncological outcomes following intersphincteric resection for low rectal cancer: short-term results

2018 ◽  
Vol 46 (4) ◽  
pp. 1617-1625 ◽  
Author(s):  
Călin Molnar ◽  
Butiurca Vlad-Olimpiu ◽  
Botoncea Marian ◽  
Togănel Cornelia ◽  
Gurzu Simona
Keyword(s):  
Rectal Cancer ◽  
Survival Rate ◽  
Functional Outcomes ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Study Patient ◽  
Reference Ranges ◽  
Short Term ◽  
Wexner Score ◽  
Oncological Outcomes

Objective This study was performed to evaluate the 1-year survival rate and functional outcomes of 20 patients who underwent intersphincteric resection (ISR) for low rectal cancer. Methods Twenty patients who underwent ISR for low rectal cancer were followed up for 1 year. Complications, functional outcomes objectified by the Wexner score, and oncological outcomes were assessed. Results The short-term survival rate was 100%. The median Wexner score was ≤10 in all patients at 12 months after surgery. Signs of local recurrence were absent, and antigen levels remained within the reference ranges 1 year postoperatively. Conclusions ISR is a feasible alternative in highly selected patients who primarily refuse a colostomy bag and present with type II or III tumors. In the present study, patient-reported continence was satisfactory, and the absence of a colostomy bag increased patients’ quality of life. The oncological outcomes were satisfactory at 1 year postoperatively.

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