scholarly journals Robotic Partial Excision of Levator-Ani Muscle for Locally Advanced Low Rectal Cancer Invading Ipsilateral Pelvic Floor

2020 ◽  
Vol 36 (6) ◽  
pp. 415-416
Author(s):  
Seung Yoon Yang ◽  
Nam Kyu Kim
Keyword(s):  
Rectal Cancer ◽  
Resection Margin ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Levator Ani ◽  
Low Rectal Cancer ◽  
Levator Ani Muscle ◽  
Surgical Specimen ◽  
Alternative Treatment Option ◽  
Partial Excision

Tumors at the level of the anorectal junction had required abdominoperineal resection (APR) to achieve an adequate resection margin. However, in the cases of tumor invading ipsilateral levator-ani muscle (LAM), <i>en-bloc</i> resection of the rectum with LAM including tumor would be possible. This video is to show the critical anatomic steps of this procedure. A video was produced from the robotic right partial excision of LAM (PELM) performed in a 57-year-old female patient with rectal cancer at 3 cm from the anal verge, invading the ipsilateral anorectal ring, who had received neoadjuvant chemoradiotherapy. The patient discharged at postoperative day 8 without complication. The pathology of the surgical specimen revealed ypT3N1bM0. The secure resection margin from the tumor was achieved. Robotic PELM is the sphincter-preserving technique that can be an alternative treatment option for low rectal cancer invading the ipsilateral LAM, which has been an indication for APR or extralevator APR.

scholarly journals Prospective Analysis of18F-FDG PET/CT Predictive Value in Patients with Low Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Conservative Surgery

2014 ◽  
Vol 2014 ◽  
pp. 1-10 ◽  
Author(s):  
Artor Niccoli-Asabella ◽  
Corinna Altini ◽  
Raffaele De Luca ◽  
Margherita Fanelli ◽  
Domenico Rubini ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Fdg Pet ◽  
Odds Ratio ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Low Rectal Cancer ◽  
Predictive Tool ◽  
Pet Ct ◽  
Significant Difference ◽  
Fdg Pet Ct

This study prospectively assessed18F-FDG PET/CT in predicting the response of locally advanced low rectal cancer (LRC) to neoadjuvant chemoradiation (nCRT).Methods. 56 patients treated with chemoradiation underwent two18F-FDG PET/CT scans (baseline and 5-6 weeks post-nCRT).18F-FDG uptake (SUVmax and SUVmean) and differences between baseline (SUV1) and post-nCRT (SUV2) scans (ΔSUV and RI%) were evaluated. Results were related to the Mandard’s TRG and (y)pTNM.Results.18F-FDG PET/CT sensitivity, specificity, accuracy, PPV and NPV resulted in 88.6%, 66.7%, 83.92%, 90.7%, and 61.5%. SUV2 resulted in better than SUV1 to predict nCRT response by TRG, with no significant statistical difference between the SUVmax2 and SUVmean2 AUC (0.737 versus 0.736;P=0.928). The same applies to the (y)pTNM (0.798 versus 0.782;P=0.192). In relation to the TRG, RI values had a higher AUC than ΔSUV, with no significant difference between RImax and RImean (0.672 versus 0.695;P=0.292). The same applied to the (y)pTNM (0.742 versus 0.741;P=0.940). In both cases ΔSUV does not appear to be a good predictive tool. Logistic regression confirmed the better predictive role of SUVmax2 for the (y)pTNM (odds ratio = 1.58) and SUVmean2 for the TRG (odds ratio = 1.87).Conclusions.18F-FDG PET/CT can evaluate response to nCRT in LRC, even if more studies are required to define the most significant parameter for predicting pathologic tumor changes.

Delays in adjuvant chemotherapy following AP resection for low rectal cancer: Audit results and implications for clinical practice.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 562-562
Author(s):  
S. S. Nimalasena ◽  
A. M. Gaya
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Neoadjuvant Chemoradiotherapy ◽  
Wound Dehiscence ◽  
Low Rectal Cancer ◽  
Wound Complications ◽  
Phase Ii Studies

562 Background: Abdominoperineal resection (APR) remains the surgical procedure of choice for low rectal cancer. Historically, it has been associated with high rates of postoperative haemorrhage, infection, and wound dehiscence. The perineal wound is particularly at risk, with rates of 16-41% reported. This may delay adjuvant chemotherapy and adversely affect survival. Methods: Patients who underwent APR in our cancer network between March 2009 and June 2010 were identified. Records were reviewed with respect to complications and any impact on adjuvant chemotherapy. Results: 28 patients underwent APR. The majority had Duke's C (68%) and Duke's B (14%) tumors. All received neoadjuvant chemoradiotherapy (CRT) to 45-54Gy with capecitabine 825 mg/m2 BD. Adjuvant chemotherapy (CAPOX, FOLFOX or capecitabine) was planned in 25/28 (89%) patients. 2 declined, and of the remaining 23, 12 patients (52%) could not receive chemotherapy (Table). Of patients who received adjuvant chemotherapy, the average delay in starting was 2 weeks. At the time of reporting, 25/28 (86%) patients are alive without disease recurrence. One patient who did not receive adjuvant chemotherapy due to wound dehiscence, has recurrent pelvic disease, and is receiving best supportive care. Two patients died of metastatic disease; one could not receive adjuvant chemotherapy due to wound infection. Conclusions: Our audit has highlighted that a significant proportion of patients undergoing APR do not receive adjuvant chemotherapy on time due to wound complications. Often the time taken for wound healing exceeds 3 months, by which time the benefit of chemotherapy is negligible. Phase II studies of neoadjuvant chemotherapy prior to CRT for locally advanced rectal cancer have shown impressive progression-free and overall survival rates, with good compliance rates and favorable toxicity profiles. Further studies are needed. Patients with low rectal tumours who require APR, should be considered for a neoadjuvant chemotherapy approach. [Table: see text] No significant financial relationships to disclose.

scholarly journals Sphincter Saving Surgery in Locally Advanced Low Rectal Cancer after Neoadjuvant Chemoradiotherapy

2018 ◽  
Vol 86 (March) ◽  
pp. 187-193
Author(s):  
ISMAIEL A. MOURAD, M.D. HISHAM A. EL-HOSSIENY, M.D. ◽  
ABDEL-HAMID H. EZZAT, M.D. IHAB S. HUSSEIN, M.D. ◽  
MOHAMMAD T. FOUAD, M.Sc. RASHA M. ALLAM, M.D.
Keyword(s):  
Rectal Cancer ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Low Rectal Cancer ◽  
Sphincter Saving

scholarly journals Predictive Response Value of Pre- and Postchemoradiotherapy Variables in Rectal Cancer: An Analysis of Histological Data

2016 ◽  
Vol 2016 ◽  
pp. 1-9 ◽  
Author(s):  
Marisa D. Santos ◽  
Cristina Silva ◽  
Anabela Rocha ◽  
Carlos Nogueira ◽  
Eduarda Matos ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Predictive Factors ◽  
Predictive Value ◽  
Univariate Analysis ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Neoadjuvant Chemoradiotherapy ◽  
Mitotic Count ◽  
Curative Surgery ◽  
Surgical Specimen

Background. Neoadjuvant chemoradiotherapy (nCRT) followed by curative surgery in locally advanced rectal cancer (LARC) improves pelvic disease control. Survival improvement is achieved only if pathological response occurs. Mandard tumor regression grade (TRG) proved to be a valid system to measure nCRT response. Potential predictive factors for Mandard response are analyzed. Materials and Methods. 167 patients with LARC were treated with nCRT and curative surgery. Tumor biopsies and surgical specimens were reviewed and analyzed regarding mitotic count, necrosis, desmoplastic reaction, and inflammatory infiltration grade. Surgical specimens were classified according to Mandard TRG. The patients were divided as “good responders” (Mandard TRG1-2) and “bad responders” (Mandard TRG3-5). According to results from our previous data, good responders have better prognosis than bad responders. We examined predictive factors for Mandard response and performed statistical analysis. Results. In univariate analysis, distance from anal verge and ten other postoperative variables related with nCRT tumor response had predictive value for Mandard response. In multivariable analysis only mitotic count, necrosis, and differentiation grade in surgical specimen had predictive value. Conclusions. There is a lack of clinical and pathological preoperative variables able to predict Mandard response. Only postoperative pathological parameters related with nCRT response have predictive value.

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