scholarly journals Benefit of extraperitonization to prevent septic intraabdominal complications after distal rectal cancer surgery

2016 ◽  
Author(s):  
Boyko Atanasov ◽  
Boris Sakakushev
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Colorectal Resection ◽  
Rectal Cancer Surgery ◽  
Routine Practice ◽  
Distal Rectal Cancer ◽  
Oncological Diseases ◽  
Protective Ileostomy ◽  
Brain Stroke ◽  
Rectum Resection

Colorectal cancer is one of the most common oncological diseases. Surgery is the main treatment modality and laparoscopic colorectal resection has been gaining popularity over the past two decades. Neoadjuvant therapy is considered standard treatment for 2nd and 3rd stage distal rectal cancer. We present our retrospective study of 127 patients with anterior rectum resection (ARR) and total mesorectal excision (TME) for low rectal cancer operated on between 2012 and 2015 in two surgical wards. In all 59 laparoscopic ARR neoadjuvant therapy, intraabdominal drainage and ileostomy was performed, while extra-peritonization was done in 21 and no pre-sacral drainage was used. In the conventional group of 68 ARR, 21 had neo-adjuvant therapy, everyone has had extra-peritonization, pre-sacral drainage and no protective ileostomy performed. Early postoperative complications were registered in 25 patients, 24 related to the operation and 1 due to a recurrent brain stroke, all classified from I to III by Clavien Dindo scale. There were 9 anastomosis insufficiences: 6 in conventional and 3 in laparoscopic operations. In 3 patients (2 conventional and 1 laparoscopic) with low ARR and signs of peritoneal contamination re-laparotomy was performed with successive outcome. All patients survived. Our routine practice of extra-peritonization and pre-sacral-perianal drainage in open ARR eliminate the possibility of postoperative peritonitis after anastomosis insufficiency, limiting the infection to low pelvic phlegmona and local intra-abdominal pelvic infection in overlooked cases.

scholarly journals The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Yu Mu ◽  
Linxian Zhao ◽  
Hongyu He ◽  
Huimin Zhao ◽  
Jiannan Li
Keyword(s):  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Meta Analysis ◽  
Operation Time ◽  
Postoperative Hospital Stay ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Anastomotic Leakage Rate ◽  
Protective Ileostomy ◽  
Clinically Significant

Abstract Background Protective ileostomy is always applied to avoid clinically significant anastomotic leakage and other postoperative complications for patients receiving laparoscopic rectal cancer surgery. However, whether it is necessary to perform the ileostomy is still controversial. This meta-analysis aims to analyze the efficacy of ileostomy on laparoscopic rectal cancer surgery. Methods Cochrane Library, EMBASE, Web of Science, and PubMed were applied for systematic search of all relevant literature, updated to May 07, 2021. Studies compared patients with and without ileostomy for laparoscopic rectal cancer surgery. We applied Review Manager software to perform this meta-analysis. The quality of the non-randomized controlled trials was assessed using the Newcastle-Ottawa scale (NOS), and the randomized studies were assessed using the Jadad scale. Results We collected a total of 1203 references, and seven studies were included using the research methods. The clinically significant anastomotic leakage rate was significantly lower in ileostomy group (27/567, 4.76%) than that in non-ileostomy group (54/525, 10.29%) (RR = 0.47, 95% CI 0.30–0.73, P for overall effect = 0.0009, P for heterogeneity = 0.18, I2 = 32%). However, the postoperative hospital stay, reoperation, wound infection, and operation time showed no significant difference between the ileostomy and non-ileostomy groups. Conclusion The results demonstrated that protective ileostomy could decrease the clinically significant anastomotic leakage rate for patients undergoing laparoscopic rectal cancer surgery. However, ileostomy has no effect on postoperative hospital stay, reoperation, wound infection, and operation time. The efficacy of ileostomy after laparoscopic rectal cancer surgery: a meta-analysis.

The Role of Neoadjuvant Therapy in Sphincter-Saving Surgery for Mid and Distal Rectal Cancer

2009 ◽  
Vol 28 (3) ◽  
pp. 259-267 ◽  
Author(s):  
Tobias Leibold ◽  
José G. Guillem
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Distal Rectal Cancer ◽  
Sphincter Saving

Phenotypic subtypes and risk of local recurrence after radical resection for rectal cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 637-637
Author(s):  
Katrina Knight ◽  
Antonia K. Roseweir ◽  
James Hugh Park ◽  
Joanne Edwards ◽  
Donald C McMillan ◽  
...  
Keyword(s):  
At Risk ◽  
Rectal Cancer ◽  
Local Recurrence ◽  
Neoadjuvant Therapy ◽  
Vascular Invasion ◽  
Immune Cell ◽  
Tumor Grade ◽  
Radical Resection ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery

637 Background: Phenotypic subtypes for CRC are reported to stratify outcomes. The four subtypes are based on features within the consensus molecular subtypes (CMS): immune, canonical, latent and stromal. In 81 pts, we recently reported concordance between CMS and phenotypic subtypes. Of note, the stromal subtype matched the CMS4 subtype in 84%. Local recurrence (LR) after rectal cancer surgery remains a problem. Identifying those at risk determines who should receive neoadjuvant therapy (NT) and guides surgery. We evaluated whether phenotypic subtypes are associated with LR after radical treatment of rectal cancer. Methods: From a CRC database, pts with rectal cancer and phenotypic subtyping available were identified. Subtyping was performed based on immune cell infiltrate, stromal volume and tumor proliferation. LR was considered pelvic or peritoneal. Results: Between 1997-2007, 260 pts had surgery for rectal cancer. Most were > 65yrs (63%), male (58%) and TNM stage II (39%) or III (37%). 32 (13%) received NT. For phenotypic subtypes, 88 (35%) were Immune, 47 (19%) Canonical, 48 (19%) Latent and 67 (27%) Stromal. Median FU was 138 months (min 88). 70 pts (27%) developed recurrence: LR in 23 (8.8%) and systemic in 44 (16.9%). LR was associated with higher T stage (pT1-3 7% vs pT4 17%, p = 0.024), presence of vascular invasion (15% vs 6%, p = 0.018), serosal involvement (21% vs 6%, p = 0.001), margin involvement (22% vs 7%, p = 0.010), > 50% tumor stroma (18% vs 3%, p = 0.002) and phenotypic subtype (immune 5%, canonical 6%, latent 4% and stromal = 21%, p = 0.002). Similar LR rates were obtained after excluding pts who had NT: Immune (4%), canonical (4%), latent (5%) and stromal (23%). Of the 23 LRs, most were Stromal subtype (n = 14) vs Immune (n = 4), Canonical (n = 3) and Latent (n = 2). Apart from increased node positivity (50% vs 30-44% p < 0.05), there were no differences in rates of pT4 disease, tumor grade, vascular invasion, serosal involvement and margin positivity between stromal subtype and other groups. Conclusions: LR after rectal cancer surgery was associated with the stromal subtype. Validation is needed but pre-treatment tumor subtyping may identify subsets at risk of LR and have implications for patient selection for neoadjuvant therapy.

Transanal Inspection and Management of Low Colorectal Anastomosis Performed With a New Technique: the TICRANT Study

2017 ◽  
Vol 24 (5) ◽  
pp. 483-491 ◽  
Author(s):  
Francesco Crafa ◽  
Sebastian Smolarek ◽  
Giulia Missori ◽  
Mostafa Shalaby ◽  
Silvia Quaresima ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Coloanal Anastomosis ◽  
Anal Verge ◽  
Colorectal Anastomosis ◽  
Length Of Hospital Stay ◽  
Rectal Cancer Surgery ◽  
Universal Method ◽  
Initial Surgery ◽  
Protective Ileostomy ◽  
Robotic Surgeries

Background: Anastomotic leakage is one of the most serious complications after rectal cancer surgery. Method: A prospective multicenter interventional study to assess a newly described technique of creating the colorectal and coloanal anastomosis. The primary outcome was to access the safety and efficacy of this technique in the reduction of anastomotic leak. Result: Fifty-three patients with rectal cancer who underwent low or ultra-low anterior resection were included in the study. There were 35 males and 18 females, with a median age of 68 years (range = 49-89 years). The median tumor distance from the anal verge was 8 cm (range = 4-12 cm), and the median body mass index was 24 kg/m2 (range = 20-35 kg/m2). Thirty patients underwent open, 16 laparoscopic, and 7 robotic surgeries. Multiple firing (2-charges) was required in 30 patients to obtain a complete rectal division. Forty-five patients had colorectal anastomosis, and 8 patients had coloanal anastomosis. The protective ileostomy was created in 40 patients at the time of initial surgery. There was no mortality in the first 30 days postoperatively, and only 10 (19%) patients developed complications. There were 3 anastomotic leakages (6%); 2 of them were subclinical with ileostomy created at initial operation and both were treated conservatively with transanal drainage and intravenous antibiotics. One patient required reoperation and ileostomy. The median length of hospital stay was 10 days (range = 4-20 days). Conclusion: Our technique is a safe and efficient method of creation of colorectal anastomosis. It is also a universal method that can be used in open, laparoscopic, and robotic surgeries.

scholarly journals Longer Intervals from Neoadjuvant Therapy to Rectal Cancer Surgery: The Clock is Ticking…

2019 ◽  
Vol 26 (7) ◽  
pp. 1957-1958 ◽  
Author(s):  
Laura Melina Fernandez ◽  
Rodrigo Oliva Perez
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery

scholarly journals An Old Method Turnbull Cutait; Using for Middle and Distal Rectal Cancer Surgery without Ileostomy. Oncological and Fuctional Late Outcomes

2020 ◽  
Vol 30 (2) ◽  
pp. 104-111 ◽  
Author(s):  
Osman Serhat Güner ◽  
Latif Volkan Tümay ◽  
Barış Gülcü ◽  
Abdullah Zorluoğlu
Keyword(s):  
Rectal Cancer ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Distal Rectal Cancer

scholarly journals Pelvic Anatomy for Distal Rectal Cancer Surgery

2021 ◽  
Author(s):  
Sanghyun An ◽  
Ik Yong Kim
Keyword(s):  
Rectal Cancer ◽  
Pelvic Floor ◽  
Surgical Techniques ◽  
Oncologic Outcome ◽  
Autonomic Nerve ◽  
Rectal Cancer Surgery ◽  
Pelvic Anatomy ◽  
Distal Rectal Cancer ◽  
Minimally Invasive Surgical ◽  
Pelvic Fascia

Worldwide, colorectal cancer is the third most common cancer and one of the leading causes of cancer-related deaths. Currently, total mesorectal excision (TME) is considered as the gold standard surgical procedure for rectal cancer. To achieve a good oncologic outcome and functional outcome after TME in distal rectal cancer, exact knowledge regarding the pelvic anatomy including pelvic fascia, pelvic floor, and the autonomic nerve is essential. Accurate TME along the embryologic plane not only reduces local recurrence rate but also preserves urinary and sexual function by minimizing nerve damage. In the past, pelvic floor muscles and autonomic nerves could not be visualized clearly, however, the development of imaging studies and improvements of minimally invasive surgical techniques such as laparoscopic and robotic surgery can clearly show the anatomy of the pelvic region. In this chapter, we will provide accurate anatomy of the rectum and the anal canal, pelvic fascia, and the pelvic autonomic nerve. This anatomical information will be an important indicator for performing an adequate operation for distal rectal cancer.

scholarly journals Prognostic factors after surgical treatment for locally recurrent distal rectal cancer

2016 ◽  
Vol 11 (4) ◽  
pp. 342-347
Author(s):  
Denis ASLAN ◽  
◽  
Adrian BORDEA ◽  
Razvan SCAUNASU ◽  
Ileana POPA ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Rectal Cancer ◽  
Surgical Treatment ◽  
Local Recurrence ◽  
Major Complication ◽  
Lower Rectal Cancer ◽  
Rectal Cancer Surgery ◽  
Related Factors ◽  
Distal Rectal Cancer

Objectives. Local recurrence after distal rectal cancer surgery is a major complication with an increased morbidity and mortality. The therapeutic strategy consists in a complex association of radiochemotherapy with surgical approach that may improve prognosis and quality of life. It is necessary to identify the risk factors for local recurrence and to have a highly-selected patients for oncological radical treatment. Materials and methods. The study included the analysis of 79 patients with middle and lower rectal cancer who were diagnosed and operated at Coltea Clinic Surgical Clinic Hospital, Bucharest, for a period of 4 years. Male patients were more frequent (64.4%). The average age was 65 years old. The surgical strategy included 33 patients (41.8%) who underwent abdominoperineal resection, 36 patients (45.6%) who underwent low anterior resection with stapled colorectal anastomosis and 10 patients (12.75) who underwent ultralow anterior resection. Results. Local recurrence rate was 12.7%. The mean time from surgery until the time of discovery of local recurrence was 14.5 months. Local recurrence was associated with advanced tumor stages T3 (10.1%) and T4 (2.5%). It was also associated with histopathological features related to serous infiltration (100%) and tumor invasion of the radial margins (3.8%). The surgical treatment strategy consisted of abdominoperineal resection, permanent colostoma and R2 resections. Discussion. The radical surgical resection is the most significant prognostic factor. There are a number of other patient-related factors and tumor-related factors that can significantly influence the evolution and overlall survival. Periodic clinical, imaging scans and colonoscopy follow-ups are able to early detect the tumor recurrence and to allow a curative cancer treatment. Conclusions. Local recurrence after mid and lower rectal cancer surgery is a major complication with direct impact on morbidity, mortality, prognosis and quality of life of these patients. The treatment strategy must be established by a multidisciplinary team in order to identify carefully-selected patients to undergo the optimal oncological therapy.

Complete neoadjuvant treatment for rectal cancer: A single institution experience.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 148-148
Author(s):  
John Baekey ◽  
Robert Brunault ◽  
Howard Safran ◽  
Rimini Breakstone ◽  
Matthew Vrees ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Clinical Stage ◽  
Pathologic Complete Response ◽  
Neoadjuvant Treatment ◽  
Complete Response ◽  
Preoperative Chemoradiation ◽  
Stage Ii ◽  
Routine Practice ◽  
Full Dose

148 Background: Full dose adjuvant chemotherapy following preoperative chemoradiation and surgery is poorly tolerated in stage II and III rectal cancer. We reviewed our institution’s experience with complete neoadjuvant treatment for rectal cancer since publication of the BrUOG R-224 trial results. Methods: After obtaining IRB approval, Data on patients with stage II and III rectal cancer who underwent complete neoadjuvant therapy were collected.. Patients who were planned to receive 8 cycles of modified FOLFOX6, chemoradiation with capecitabine 825 mg/m2 twice daily and 50.4 Gy intensity-modulated radiation therapy, then surgery were included. Results: Thirty-five patients were treated with complete neoadjuvant therapy between January 2014 and December 2017. Median age was 58 years (27 to 75 y); 1 patient (3%) was clinical stage II and 34 (97%) stage III. Twenty-seven patients (77%) received all 8 cycles of mFOLFOX6, of whom 24 completed subsequent chemoradiation. Therefore 69% of patients completed therapy according to the BrUOG R-224 protocol. Pathologic complete response (ypT0N0) was observed in 9 patients (26%). Treatment related toxicities resulted in dose reductions or treatment interruption in 57% and 29% of patients receiving chemotherapy and chemoradiation respectively. Conclusions: Complete neoadjuvant therapy for clinical stage II to III rectal cancer is well-tolerated in routine practice and offers an alternative to preoperative chemoradiation, surgery, then adjuvant full dose chemotherapy.

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