scholarly journals THE RESULTS OF 600 TRANSANAL ENDOSCOPIC SURGERIES OF RECTAL ADENOMAS AND ADENOCARCINOMAS

2019 ◽  
Vol 18 (3(69)) ◽  
pp. 20-40
Author(s):  
E. A. Khomyakov ◽  
S. V. Chernyshov ◽  
E. G. Rybakov ◽  
O. A. Maynovskaya ◽  
Yu. A. Shelygin
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
R0 Resection ◽  
Safe Method ◽  
Mean Size ◽  
The Mean ◽  
Mean Time ◽  
Russian Medical ◽  
Selection Of Patients ◽  
Selection Of

AIM: transanal endomicrosurgery (TEM) is the method of choice for local excision of rectal cancer. The presented series of patients is collected prospectively and is the largest of the published in the Russian medical periodicals. PATIENTS AND METHODS: six-hundred patients [average age ±σ 59.8±9 (31-90) years old; 375/600 (62.5%) – women]with rectal adenomas and adenocarcinomas, who underwent TEM in 2011-2019. RESULTS: the mean size of the removed tumors was 3.4±1.5 cm (0.5-10.0). R0 resection was performed in 571/600 (95.2%) of the cases. The complication rate was 3.6% (22/600). Pathomorphological study of the removed specimens revealed adenoma in 450/600 (75.0%) patients, adenocarcinoma in 150/600 (25.0%) cases. The mean time of observation of patients with adenomas was 38.4±25.1 months, with adenocarcinomas – 33.4±23.8 months. The rate of local recurrence in adenomas was 4.5%. Loco-regional recurrence of adenocarcinoma pT1 after TEM was revealed in 6.8% of patients and 30% of pT2 patients without adjuvant treatment. CONCLUSION: TEM is an effective and safe method of treatment of rectal adenomas. With rectal cancer, a thorough selection of patients is required.

scholarly journals Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

2021 ◽  
Vol 73 (2) ◽  
pp. 495-502
Author(s):  
Francesco Bianco ◽  
Paola Incollingo ◽  
Armando Falato ◽  
Silvia De Franciscis ◽  
Andrea Belli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Coloanal Anastomosis ◽  
Functional Results ◽  
Anal Margin ◽  
Perioperative Mortality ◽  
The Mean ◽  
Pull Through ◽  
Protective Stoma

AbstractDespite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

scholarly journals Clinical Practice of Endoscopic Submucosal Dissection for Early Colorectal Neoplasms by a Colonoscopist with Limited Gastric Experience

2013 ◽  
Vol 2013 ◽  
pp. 1-5 ◽  
Author(s):  
Wen-Hsin Hsu ◽  
Meng-Shun Sun ◽  
Hoi-Wan Lo ◽  
Ching-Yang Tsai ◽  
Yu-Jou Tsai
Keyword(s):  
Endoscopic Submucosal Dissection ◽  
Colorectal Neoplasms ◽  
R0 Resection ◽  
En Bloc ◽  
Delayed Bleeding ◽  
Submucosal Dissection ◽  
Limited Experience ◽  
Mean Size ◽  
Delayed Perforation ◽  
The Mean

Objectives. Endoscopic submucosal dissection (ESD) for early colorectal neoplasms is regarded as a difficult technique and should commence after receiving the experiences of ESD in the stomach. The implementation of colorectal ESD in countries where early gastric cancer is uncommon might therefore be difficult. The aim is to delineate the feasibility and the learning curve of colorectal ESD performed by a colonoscopist with limited experience of gastric ESD.Methods. The first fifty cases of colorectal ESD, which were performed by a single colonoscopist between July 2010 and April 2013, were enrolled.Results. The mean of age was 64 (±9.204) years with mean size of neoplasm at 33 (±12.63) mm. The mean of procedure time was 70.5 (±48.9) min. The rates ofen blocresection, R0 resection, and curative resection were 86%, 86%, and 82%, respectively. Three patients had immediate perforation, but no patient developed delayed perforation or delayed bleeding.Conclusion. Our result disclosed that it is feasible for colorectal ESD to be performed by a colonoscopist with little experience of gastric ESD through satisfactory training and adequate case selection.

scholarly journals Progress in Rectal Cancer Treatment

2012 ◽  
Vol 2012 ◽  
pp. 1-15 ◽  
Author(s):  
Wim P. Ceelen
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Imaging Techniques ◽  
Dramatic Improvement ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Number Of Patients ◽  
Systemic Relapse ◽  
Selection Of Patients ◽  
Selection Of

The dramatic improvement in local control of rectal cancer observed during the last decades is to be attributed to attention to surgical technique and to the introduction of neoadjuvant therapy regimens. Nevertheless, systemic relapse remains frequent and is currently insufficiently addressed. Intensification of neoadjuvant therapy by incorporating chemotherapy with or without targeted agents before the start of (chemo)radiation or during the waiting period to surgery may present an opportunity to improve overall survival. An increasing number of patients can nowadays undergo sphincter preserving surgery. In selected patients, local excision or even a “wait and see” approach may be feasible following active neoadjuvant therapy. Molecular and genetic biomarkers as well as innovative imaging techniques may in the future allow better selection of patients for this treatment option. Controversy persists concerning the selection of patients for adjuvant chemotherapy and/or targeted therapy after neoadjuvant regimens. The currently available evidence suggests that in complete pathological responders long-term outcome is excellent and adjuvant therapy may be omitted. The results of ongoing trials will help to establish the ideal tailored approach in resectable rectal cancer.

scholarly journals Reliability optimization on power systems network using genetic algorithm

2020 ◽  
Vol 2 ◽  
pp. 18-29
Author(s):  
A. E. Airoboman ◽  
Emmanuel A. Ogujor
Keyword(s):  
Genetic Algorithm ◽  
Power Systems ◽  
Inequality Constraints ◽  
Optimization Approach ◽  
Reliability Optimization ◽  
Equality And Inequality Constraints ◽  
The Mean ◽  
Mean Time ◽  
Reliability And Availability ◽  
Selection Of

In this study, reliability optimization of a non-linear transmission network using Genetic Algorithm (GA) based optimization approach is presented and proposed. A GA based algorithm was developed for Koko, Guinness, Nekpenekpen, Ikpoba-Dam, Switch station, Etete and GRA 33kV tertiary transmission feeders within Benin Metropolis, Nigeria and was used to determine the optimal performance of the feeders’ reliability and availability through the minimization of downtime and the Mean Time between Failure (MTBF) by the appropriate selection of the objective functions and constraints. The equality and inequality constraints for each feeder on the network were defined, thereafter, codes were written on the Matlab 2016a environment to optimize the selected parameters. The results from the study showed a reduction in downtime of 5.63%, 26.87%, 34.20%, 5.42% 8.37%, 5.18% and 10.97% and an increment increased in MTBF by 4.95%, 19.87%, 4.58%, 3.85%, 4.88%, 5.77% and 13.56% for Guinness, Etete, Nekpenekpen, GRA, Switch station and Ikpoba-Dam feeders respectively. The obtained results, therefore, yielded an average corresponding improvement on the network’s reliability and availability by 1.85% and 2.83% respectively. Conclusively, the desired result reached in this paper validates the robustness of the GA tool in reliability studies. However, conscious effort must be geared concerning the ways and manners the system is operated in order to achieve desired results.

Selection of Patients With Rectal Cancer for Preoperative Chemoradiotherapy

2019 ◽  
Vol 62 (4) ◽  
pp. 447-453 ◽  
Author(s):  
Amandeep Pooni ◽  
Eisar Al-Sukhni ◽  
Laurent Milot ◽  
Mark Fruitman ◽  
J. Charles Victor ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Selection Of Patients ◽  
Selection Of

MRI-based selection of patients with metastatic extramesorectal rectal cancer nodes for preoperative chemoradation.

2012 ◽  
Vol 30 (4_suppl) ◽  
pp. 570-570
Author(s):  
Monique Maas ◽  
Doenja MJ Lambregts ◽  
Freek Gillissen ◽  
Sanne ME Engelen ◽  
Max J Lahaye ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Patients ◽  
Poor Prognosis ◽  
Extensive Resection ◽  
Kaplan Meier ◽  
Expert Radiologist ◽  
Contrast Enhanced ◽  
Selection Of Patients ◽  
Selection Of

570 Background: 20% of rectal cancer patients have metastatic lymph nodes outside the mesorectum (EMRs). These EMR node positives are associated with poor prognosis. Accurate selection would help to tailor treatment and improve prognosis for these patients. Methods: Rectal cancer patients were included in a study in which treatment was based on (contrast-enhanced) MRI. EMR-status was predicted by an expert radiologist. Based on this prediction patients underwent chemoradiation (CRT) of the EMRs. 6-8 weeks after CRT EMRs were restaged. If still involved, the EMRs were resected. When the EMRs were sterilised by the CRT, they were not resected. Patients were followed 3 to 6-monthly after surgery by a combination of modalities. 3-year outcome was estimated with Kaplan-Meier curves. Results: 50 patients with suspected EMRs were included. Median follow-up was 26(0-50) months. In 13 patients EMRs were resected after CRT and in only 2/13 positive nodes were found. Of the remaining 37 patients 5 had a local recurrence (LR). In total 32+11=43 patients (86%) had no involved EMRs after CRT. Five patients had metastasis of whom 2 also had a LR. 3-year LR was 2.3%, 3-year DFS was 86% and 3-year OS was 90%. Conclusions: MRI-based selection of patients with EMRs for CRT provides adequate local control. Distant metastasis is the main cause of poor prognosis in these patients. When MRI is used for EMR identification and thus for identification of patients who need CRT also on the obturator regions, patients can be spared an extensive resection with associated morbidity.

Selection of patients with rectal cancer for neoadjuvant therapy using pre-therapeutic MRI - Results from OCUM trial

2021 ◽  
pp. 110113
Author(s):  
Sigmar Stelzner ◽  
Reinhard Ruppert ◽  
Rainer Kube ◽  
Joachim Strassburg ◽  
Andreas Lewin ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Selection Of Patients ◽  
Selection Of
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