scholarly journals Prevalence and Management of Cancer of the Rectal Stump after Total Colectomy and Rectal Sparing in Patients with Familial Polyposis: Results from a Registry-Based Study

Cancers ◽  
2022 ◽  
Vol 14 (2) ◽  
pp. 298
Author(s):  
Gaia Colletti ◽  
Chiara Maura Ciniselli ◽  
Stefano Signoroni ◽  
Ivana Maria Francesca Cocco ◽  
Andrea Magarotto ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Cancer Risk ◽  
Minimally Invasive ◽  
Total Colectomy ◽  
Early Stage ◽  
Rectal Stump ◽  
Case Series ◽  
Lower Rectal Cancer ◽  
P Value ◽  
Time Interval

Background: The balance between quality of life and colorectal cancer risk in familial adenomatous polyposis (FAP) patients is of primary importance. A cut-off of less than 30 polyps under 1 cm of diameter in the rectum has been used as an indication for performing ileo-rectal anastomosis (IRA) in terms of lower rectal cancer risk. This study aimed to assess clinical and surgical features of FAP patients who developed cancer of the rectal stump. Methods: This retrospective study included all FAP patients who underwent total colectomy/IRA from 1977 to 2021 and developed subsequent rectal cancer. Patients’ features were reported using descriptive statistics by considering the overall case series and within pre-specified classes of age (<20, 20–30, and >30 years) at first surgery. Results: Among the 715 FAP patients, 47 (6.57%, 95% confidence interval: 4.87; 8.65) developed cancer in the rectal stump during follow-up. In total, 57.45% of the population were male and 38.30% were proband. The median interval between surgery and the occurrence of rectal cancer was 13 years. This interval was wider in the youngest group (p-value: 0.012) than the oldest ones. Twelve patients (25.53%) received an endoscopic or minimally invasive resection. Amongst them, 61.70% were Dukes stage A cancers. Conclusions: There is a definite risk of rectal cancer after total colectomy/IRA; however, the time interval from the index procedure to cancer developing is long. Minimally invasive and endoscopic treatments should be the procedures of choice in patients with early stage cancers.

Rectal Cancer Risk and Survival after Total Colectomy for Inflammatory Bowel Disease

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Anders Mark-Christensen ◽  
Rune Erichsen ◽  
Katalin Veres ◽  
Søren Laurberg ◽  
Henrik Toft Sørensen
Keyword(s):  
Inflammatory Bowel Disease ◽  
Rectal Cancer ◽  
Cancer Risk ◽  
Bowel Disease ◽  
Total Colectomy ◽  
Inflammatory Bowel

Incidence of minimally invasive colorectal cancer (CRC) surgery in patients treated at NCCN institutions

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 6575-6575
Author(s):  
M. Weiser ◽  
D. Romanus ◽  
A. terVeer ◽  
A. Rajput ◽  
J. Skibber ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Open Surgery ◽  
Early Stage ◽  
Oncologic Outcome ◽  
Stage I ◽  
Invasive Approach ◽  
Conversion To Open Surgery ◽  
The North ◽  
Minimally Invasive Surgical

6575 Background: In May 2004 the Clinical Outcomes of Surgical Therapy Study Group published the results of the North American randomized trial demonstrating that oncologic outcome is similar for laparoscopic assisted and open surgery for CRC. This and other studies have shown quicker recovery with laparoscopic CRC surgery including earlier resolution of postoperative ileus, less discomfort, and earlier discharge from the hospital. The extent to which surgeons have adopted the minimally invasive surgical (MIS) approach in CRC is unknown. Methods: Using the NCCN Colon/Rectal Cancer Outcomes Project Database, 715 patients were identified who underwent CRC resection in 2005–6. The distribution of lesions included right colon (39%), left colon (31%), and rectum (30%). The incidence of MIS for CRC and clinicopathologic features associated with this approach were analyzed by logistic regression; results are reported as odd ratio (OR) with 95% confidence intervals (CI), and significance defined at p<0.05 level. Results: A total of 167 (23%) patients underwent MIS colorectal surgery (laparoscopy in 98% and robotic in 2%). Conversion to open surgery was noted in 33 cases (20%). Surgery was performed in outside institutions in 21% of cases prior to patients presenting to NCCN institutions for further treatment. The MIS approach was more common in colon than rectal cancer (30% vs.12%, OR 2.96, CI 1.94–4.51, p<0.0001). Within the colon cancer cohort, right sided lesions were more likely to be approached with MIS techniques rather than left sided lesions (32% vs. 25%; OR 1.42, CI 1.96–2.21, p<0.0001). Stage I tumors were also more likely to be managed with the less invasive approach: Stage I-41%; II-20%; III-21%; IV-19% (Stage I vs. IV, OR=3.00, CI 1.74–5.16 p<0.0001). No differences in surgical approach were noted based on age, gender, race, Charlson comorbidity score, insurance type, or location of surgery (NCCN vs outside facility). Conclusion: The majority of CRC surgery for patients presenting to NCCN institutions is performed by open techniques. Right sided and early stage CRCs were more likely treated with MIS, possibly related to the less demanding nature of the procedure. The adoption of MIS is expected to rise as surgeons become trained in MIS techniques for CRC. No significant financial relationships to disclose.

scholarly journals Minimally Invasive Versus Open Surgery for Radical Hysterectomy Followed By Adjuvant Radiotherapy in Intermediate- or High-Risk Early-Stage Cancer of The Cervix: A Retrospective Study

2021 ◽  
Author(s):  
Qi-ying Zhang ◽  
Zi Liu ◽  
Ya-li Wang ◽  
Jing Zhang ◽  
Wen Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Cancer ◽  
High Risk ◽  
Minimally Invasive ◽  
Cancer Patients ◽  
Radical Hysterectomy ◽  
Early Stage ◽  
Time Interval ◽  
Significant Difference ◽  
The Impact

Abstract Background Postoperative radiotherapy (RT) or chemoradiotherapy (CRT) improves outcomes of cervical cancer patients with risk factors. Minimally invasive surgery (MIS) has an inferior survival than open radical hysterectomy (ORH), however, the impact of MIS on postoperative RT remains uncertain. The study compared the impacts of MIS versus ORH on delivering of adjuvant RT or CRT for intermediate- or high-risk early-stage cervical cancer. Methods Data on stage IB1-IIA2 patients who underwent radical hysterectomy and postoperative RT/CRT in our institution, from 2014 to 2017, were retrospectively collected. Patients with high or intermediate-risk factors who met the Sedlis criteria received postoperative pelvic external beam radiotherapy (50Gy/25f) with platinum-based chemotherapy (0–6 cycles) according to guidelines. Disease-free survival (DFS) and overall survival (OS) were compared in the two surgical groups. Results One hundred and twenty-nine patients eligible for the study (68 in ORH; 61 in MIS groups) had similar clinicopathologic features except for the stage (highest in MIS was IB1; IIA1 in ORH) and presence of lymph vascular space invasion (higher in MIS group). The median time interval from surgery to chemotherapy and to RT was shorter in the MIS group. Three-year DFS and OS were similar in both groups. Further sub-analysis indicated that the DFS and OS in intermediate/high-risk groups had no significant difference. Cox-multivariate analyses found that tumor size > 4 cm and time interval from surgery to RT beyond seven weeks were adverse independent prognostic factors for DFS. Conclusions In early-stage (IB1-IIA2) cervical cancer patients with intermediate or high-risk factors who received postoperative RT or CRT, no matter they received ORH or MIS as their primary treatment, the DFS and OS had no significant difference, despite TI from surgery to postoperative adjuvant therapy being shorter in the MIS group than ORH.

Preferred place of death in paediatric, teenage and young adult haemato-oncology patients: a retrospective review

2020 ◽  
pp. bmjspcare-2019-002005
Author(s):  
Philippa Stilwell ◽  
Ankit Bhatt ◽  
Keval Mehta ◽  
Ben Carter ◽  
Maggie Bisset ◽  
...  
Keyword(s):  
Young People ◽  
End Of Life ◽  
Service Provision ◽  
Early Stage ◽  
Care Service ◽  
Case Series ◽  
Palliative Care Service ◽  
Place Of Death ◽  
P Value ◽  
At Home

ObjectivesIdentifying the preferred place of death for children/young people with cancer and determining whether this is achieved is pertinent to inform palliative care service provision. The aims of this retrospective case series review were to determine where children/young people with cancer want to die and whether their preferred place of death was achieved.MethodsClinical/demographic details, including preferred and actual places of death, were recorded for 121 patients who died between 2012 and 2016 at a tertiary haematology–oncology centre. A logistic regression model was used to determine the odds of achieving the preferred place of death in patient subgroups.Results74 (61%) patients had a documented discussion regarding place of death preference. Where a preferred location was identified, 72% achieved it. All patients who wanted to die in the hospital (n=17) or a hospice (n=9) did, but only 58% of patients who wanted to die at home (n=40) achieved this. Of the 42% (n=17) who wanted to die at home but did not, 59% of these were due to rapid deterioration in clinical status shortly after the discussion. Having supportive treatment in the last month of life was associated with increased odds of achieving the preferred place of death versus those who were undergoing chemotherapy/radiotherapy (OR 3.19, 95% CI 1.04 to 9.80, p value=0.04).ConclusionWhere hospice/hospital was chosen as the preferred place of death, this was always achieved. Achieving home as the preferred place of death was more challenging and frequently prevented by rapid clinical deterioration. Clinicians should be encouraged to address end-of-life preferences at an early stage, with information provided adequately. Further research should explore implications of these findings on both end-of-life experience and overall service provision.

Surgical practice patterns and long-term survival for early-stage rectal cancer.

2013 ◽  
Vol 31 (4_suppl) ◽  
pp. 459-459
Author(s):  
Karyn Beth Stitzenberg ◽  
Dolly Penn ◽  
Hanna Kelly Sanoff ◽  
Michael O. Meyers
Keyword(s):  
Rectal Cancer ◽  
Practice Patterns ◽  
Early Stage ◽  
Case Series ◽  
Cox Proportional Hazards ◽  
Stage I ◽  
Tumor Characteristics ◽  
Term Survival ◽  
To Receive

459 Background: Local excision (LE) is considered a standard option only for patients with T1N0 rectal cancer and those who are medically unfit for proctectomy. The growing numbers of case series suggest that use of LE may be increasing. The objectives of this study are to characterize practice patterns for surgical management of rectal cancer and determine the comparative effectiveness of LE versus proctectomy for overall survival (OS) for Stage I rectal cancer. Methods: National Cancer Database data were used to identify all patients with rectal cancer diagnosed from 1998-2010. Patient and tumor characteristics associated with procedure type were examined. Kaplan-Meier plots and Cox proportional hazards models, controlling for patient and tumor characteristics and receipt of radiation (XRT), were used to compare OS for Stage I cases from 1998-2005. Results: 147,553 (50%) of 296,068 cases were excluded due to prior malignancy, non-invasive disease, distant metastases, failure to receive definitive surgery, treatment indicated to be palliative, or receipt of neoadjuvant therapy. 76,756 (69%) cases were treated with proctectomy and 34,697 (31%) with LE. Use of LE steadily increased from 23% in 1998 to 41% in 2010, p<0.001. LE was most commonly used for Stage I cases. Women, older patients, patients with less comorbidities, black patients, uninsured patients, and those with T1 tumors were more likely to receive LE than other Stage I patients. Socioeconomic status and rurality were not associated with use of LE. Adjuvant XRT was used for 12% of T1 tumors and 46% of T2 tumors after LE and 5% of T1 tumors and 12% of T2 tumors after proctectomy. For patients with T1N0 tumors, adjusted OS was associated with receipt of proctectomy (HR 0.83; 95%CI 0.77, 0.89) but not XRT. For patients with T2N0 tumors, adjusted OS was associated with both proctectomy and XRT: LE only HR 1.0; proctectomy only HR 0.70; LE+XRT HR 0.70; proctectomy+XRT HR 0.70. Conclusions: Use of LE for rectal cancer is increasing. LE alone is associated with poorer long-term OS than proctectomy. For patients with larger tumors, those that receive adjuvant XRT in addition to LE have significantly better OS than those who receive LE alone.

scholarly journals A case of severe megacolon due to acquired isolated hypoganglionosis after low anterior resection for lower rectal cancer

2019 ◽  
Vol 13 (3) ◽  
pp. 328-333
Author(s):  
Tetsuro Tominaga ◽  
Satoshi Nagayama ◽  
Manabu Takamatsu ◽  
Shun Miyanari ◽  
Toshiya Nagasaki ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Ganglion Cells ◽  
Total Colectomy ◽  
Locally Advanced ◽  
Nerve Fibers ◽  
Lower Rectal Cancer ◽  
Stoma Closure ◽  
Isolated Hypoganglionosis

AbstractAcquired isolated hypoganglionosis is a rare intestinal neurological disease, which presents in adulthood with the clinical symptoms of chronic constipation. A 39-year-old man underwent laparoscopic low anterior resection and covering ileostomy for locally advanced-rectal cancer. A 6-month course of postoperative adjuvant chemotherapy was completed, followed by closure of the ileostoma. After the closure, he developed severe colitis which required 1-month of hospitalization. Mucosal erosions and pseudo-membrane formation were evident on colonoscopy and severe mucosal damage characterized by infiltration of inflammatory cells and crypt degeneration were pathologically confirmed. Even after the remission of the colitis, he suffered from severe constipation and distention. At 4 years after the stoma closure, he decided to undergo laparoscopic total colectomy. Histopathologically, the nerve fibers and ganglion cells became gradually scarcer from the non-dilated to dilated regions. Immunohistochemical staining examination confirmed that the ganglion cells gradually decreased and became degenerated from the normal to dilated region, thereby arriving at the final diagnosis of isolated hypoganglionosis. The patient recovered without any complications and there has been no evidence of any relapse of the symptoms. We present a case of acquired isolated hypoganglionosis-related megacolon, which required laparoscopic total colectomy, due to severe enterocolitis following stoma closure.

scholarly journals Evaluation of minimally invasive fixation with ESIN in the management of displaced mid-shaft clavicle fractures: a case series with minimum of 2 years follow-up

2016 ◽  
Vol 3 (1) ◽  
pp. 86 ◽  
Author(s):  
Sourabh Chachan ◽  
Biswajit Sahu
Keyword(s):  
Minimally Invasive ◽  
Operative Treatment ◽  
Functional Outcomes ◽  
Case Series ◽  
Minimally Invasive Technique ◽  
Invasive Technique ◽  
P Value ◽  
Complication Rates ◽  
Intramedullary Pinning ◽  
Clavicle Fractures

<p class="abstract"><strong>Background:</strong> Over the last few years, operative treatment has become the standard for treatment of clavicle fractures. Both plating and intra-medullary pinning techniques are available for treating clavicle fractures. The aim of the study was to evaluate the role of minimally invasive technique using elastic stable intramedullary nailing (ESIN) in surgical treatment of displaced mid-shaft clavicle fractures<span lang="EN-IN">.</span></p><p class="abstract"><strong>Methods:</strong> It is a prospective case series study conducted at the Department of Orthopaedics of a tertiary care centre. 44 cases of acute displaced mid-shaft clavicle fractures with a mean age of 32.7 years were treated by intramedullary pinning with titanium elastic stable nails and were followed-up for a mean period of 30.6 months(range= 24-40 months). Functional outcomes were evaluated by using Constant Shoulder score. The results obtained were analysed using student’s t-test.<strong></strong></p><p class="abstract"><strong>Results:</strong> Union was achieved in all except one case which showed delayed union. 7 cases were complicated by telescoping (incidence= 15.9%) and 6 out of these 7 cases also had medial nail protrusion (incidence= 13.6%) simultaneously. 9 cases had shortening of less than 1cm and 2 had shortening of more than 1cm.  No other complication was reported from any of the case. Mean constant shoulder scores improved from 15 to 85.6 (p value &lt;0.001) after 12 months from surgery. However, no further improvement was seen after 12 months of surgery, with no statistical difference (p value= 0.789) between the mean scores at 12 (85.6) and 24 (85.7) months<span lang="EN-IN">. </span></p><p class="abstract"><strong>Conclusions:</strong> ESIN offers the advantages of treating displaced mid-shaft clavicle fractures with minimal incision and decreased surgery time with minimal intra-operative blood loss. The results were excellent in terms of functional outcomes. The complication rates were low and return to normal activity was quiet fast. ESIN is a minimally invasive technique with good cosmetic and functional results. This method should be seen as an alternative to plate fixation and non-operative treatment<span lang="EN-IN">.</span></p>

scholarly journals Transanal minimally invasive surgery for total mesorectal excision (ETM) through transanal approach (TaETM) with robotic and Transanal Endoscopic Operations (TEO) combined access: step by step surgery

2015 ◽  
Vol 28 (2) ◽  
pp. 117-120 ◽  
Author(s):  
Carlos Ramon Silveira MENDES ◽  
Marcus VALADÃO ◽  
Rodrigo ARAÚJO ◽  
Eduardo LINHARES ◽  
José Paulo JESUS
Keyword(s):  
Rectal Cancer ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Anal Verge ◽  
Rectal Adenocarcinoma ◽  
Invasive Procedure ◽  
Oncological Outcome ◽  
Lower Rectal Cancer ◽  
Mesorectal Excision ◽  
Transanal Resection

RATIONAL: In the treatment of colorectal cancer, from 1982 Heald proposed standardization of the total mesorectal excision, with a significant reduction in the recurrence rate. But the treatment of lower rectal lesions is still a challenge. AIM: To describe the association of robotic low anterior resection- TATA (Transanal Abdominal Transanal Resection), with transanal access using Transanal Endoscopic Operations - TEO in the treatment of lower rectal cancer. METHOD: The TATA performs robotic abdominal approach and the TEO performs the perineal approach, developing total mesorectal excision (TME) transanally (TaETM). RESULT: The TaETM technique was applied in a woman with rectal adenocarcinoma 5 cm from the anal verge that had been submitted to chemoradiation. The procedure was performed with satisfatory operative time and favorable oncological outcome (grade 3 mesorectal excision). CONCLUSION: This is a promising minimally invasive procedure in the armamentarium of rectal cancer treatment, specially in challenging scenarios such as narrow pelvis, obesity and very low rectal tumors.

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