Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer

Introduction: Benign anastomosis stenosis may develop in postoperative or long term period due to many reasons such as anastomosis leakage and anastomosis ischemia after colorectal surgery. While surgical treatment was commonly used in benign anastomosis stenosis in the past, surgery has left its place to more minimally invasive methods such as endoscopic treatments. There is no gold standard treatment method in the management of benign anastomosis strictures in the literature. In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Material and Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Discussion and Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented. Keywords: Rectal Neoplasms, Stenosis, Laparoscopy, Anastomostic stenosis

Download Full-text

Non-operative Management of Benign Colorectal Anastomotic Stenosis in Patients Undergoing Elective Surgery for Non-Metastatic Primary Rectal Cancer

Journal of Contemporary Medical Sciences ◽

10.22317/jcms.v6i3.768 ◽

2020 ◽

Vol 6 (3) ◽

Author(s):

Ümit Mercan ◽

Ogün Erşen ◽

Ali Ekrem Ünal ◽

Sancar Bayar ◽

Salim Demirci

Keyword(s):

Rectal Cancer ◽

Elective Surgery ◽

Neoadjuvant Treatment ◽

Colorectal Anastomosis ◽

Circular Stapler ◽

Anastomotic Stenosis ◽

Treatment Modalities ◽

Etiological Factors ◽

Primary Rectal Cancer ◽

Anastomosis Leakage

Objective: In this study, we aimed to present our clinical experience in the treatment of benign anastomosis strictures in patients undergoing elective surgery for nonmetastatic primary rectal cancer. Methods: One hundred fifty-six (156) patients who underwent resection and colorectal anastomosis between January 2013 and January 2018 were included in the study. 22 patients developed benign anastomotic stenosis has been determined and etiological factors and treatment modalities applied has been compared retrospectively. Results: In 22 patients, 9 patients were treated with digital or balloon dilatation, at least 2 sessions and up to 5 sessions. Four patients were treated with dilatation followed by stenting. The remaining 9 patients were taken to surgical treatment. Among whole patients with stenosis, it has been determined that 15 of them had neoadjuvant therapy history, 5 had anastomosis leakage and in 16 of them 28 mm circular stapler have been used. Conclusion: Neoadjuvant treatment history, the presence of anastomosis leakage and the usage of 28 mm circular stapler have been detected to be the most important etiological factors in development of benign anastomotic stenosis. Endoscopic treatments should be tried primarily to treat benign anastomotic stenosis. High success rates can be achieved with endoscopic methods and patient quality of life can be improved. With this approach, the need for surgery will be reduced and possible postoperative complications can be prevented.

Download Full-text

Outcomes in the surgical treatment of low rectal cancer: does neoadjuvant treatment equalize results?

ANZ Journal of Surgery ◽

10.1111/ans.12786 ◽

2014 ◽

Vol 85 (3) ◽

pp. 140-144 ◽

Cited By ~ 1

Author(s):

William G. Pollett ◽

Peter Gibbs ◽

Stephen McLaughlin ◽

Jimmy Eteuati ◽

Michael Harold ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Neoadjuvant Treatment ◽

Low Rectal Cancer

Download Full-text

Surgical Treatment of Cholangiocellular Carcinoma

Swiss Surgery ◽

10.1024/1023-9332.5.3.111 ◽

1999 ◽

Vol 5 (3) ◽

pp. 111-115 ◽

Cited By ~ 1

Author(s):

Hanack ◽

Lorf ◽

Binder ◽

Braun ◽

Oestmann ◽

...

Keyword(s):

Liver Transplantation ◽

Surgical Treatment ◽

Early Stage ◽

Therapeutic Option ◽

Bile Duct Carcinoma ◽

Neoadjuvant Treatment ◽

Treatment Modalities ◽

Duct Carcinoma ◽

Treatment Protocols ◽

Primary Liver Tumor

Cholangiocarcinoma is a primary liver tumor arising from the small bile ducts within the liver. According to its different location, clinical features, frequency of metastases, treatment modalities and prognosis, intrahepatic cholangiocarcinoma should well be differentiated from proximal bile duct carcinoma. To date, there is no therapeutic measure with curative potential apart from surgical treatment. Partial hepatectomy is the treatment of choice. It is of overriding importance to achieve microscopically tumor-free margins. However, only few patients treated in an early stage have a prolonged recurrence-free survival or a chance for cure. Liver transplantation is not an alternative therapeutic option for unresectable cholangiocarcinoma, due to early tumor recurrence in almost all recipients. Liver transplantation has a place in preventing cholangiocarcinoma in primary sclerosing cholangitis, although the timing of replacement is still a matter of debate. Results of surgery need further improvement by adjuvant or neoadjuvant treatment protocols.

Download Full-text

Assessment of the non-surgical treatment of patients with rectal cancer who underwent neoadjuvant treatment with chemotherapy and radiotherapy at the oncology department

Journal of Coloproctology ◽

10.1016/j.jcol.2018.10.015 ◽

2019 ◽

Vol 39 (2) ◽

pp. 127-131

Author(s):

Meyline Andrade Lima ◽

Eduardo Dias de Moraes ◽

Elisa Yumi Saito ◽

Daniela Galvao Barros ◽

Pamela Souza Almeida Malta ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Neoadjuvant Treatment ◽

Non Surgical Treatment

Download Full-text

Individualizing surgical treatment based on tumour response following neoadjuvant therapy in T4 primary rectal cancer

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2016.09.004 ◽

2017 ◽

Vol 43 (1) ◽

pp. 92-99 ◽

Cited By ~ 8

Author(s):

Q. Denost ◽

C. Kontovounisios ◽

S. Rasheed ◽

R. Chevalier ◽

R. Brasio ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Neoadjuvant Therapy ◽

Tumour Response ◽

Primary Rectal Cancer

Download Full-text

High expression of CD34 protein in stage IIA rectal cancer is independently associated with better prognosis

British Journal of Surgery ◽

10.1093/bjs/znab202.017 ◽

2021 ◽

Vol 108 (Supplement_4) ◽

Author(s):

A Lalos ◽

A Wilhelm ◽

S Staubli ◽

A Posabella ◽

B Weixler ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Tumor Microenvironment ◽

Cox Regression ◽

Vascular Endothelial Cells ◽

Tnm Classification ◽

Neoadjuvant Treatment ◽

High Expression ◽

Treatment Modalities ◽

Highly Qualified

Abstract Objective Colorectal cancer (CRC) remains the third most common cause of death from malignancies, while 30% of all these tumors develop in the rectum. The proximity of the rectum to vital structures, and in some cases the use of neoadjuvant treatment, make the surgical resection of this tumor a great challenge even for highly qualified surgeons. Understanding the mechanisms of rectal cancer (RC) development could lead to new concepts in the approach of diagnosis, prognosis, and eventually treatment of this disease. Despite the fact that TNM classification represents the gold standard tool for the staging of RC, a significant number of studies has recently focused on the association between the tumor microenvironment and RC. CD34 is a transmembrane phosphoglycoprotein expressed on human hematopoietic progenitor and vascular endothelial cells, as well in malignant tissues. It has also been shown to be involved in tumor invasion and angiogenesis. Because of the controversial data , we examined the expression of CD34 protein in RC specimens after stratifying the patients according to their UICC stage. Methods In our retrospective study, we included 364 patients with unselected, clinically annotated primary RC specimens. We analyzed a tissue microarray (TMA) of these specimens by immunohistochemistry (IHC) for the expression of CD34 protein by tumor cells. Results After stratifying the patients in nodal negative and positive groups, we found that the patients with Stage IIA tumors and high expression of CD34 protein had a favorable 5-year overall survival rate (53%; 95%CI = 40.0 – 65.1%) compared to tumors without expression of CD34 protein (26%; 95%CI = 10.7 – 44.6%, p = 0.003). Univariate and multivariate Hazard Cox regression survival analysis revealed that the combined the expression of CD34 protein was an independent, favorable, prognostic marker for overall survival in the stage IIA RC (HR = 0.39, 95%CI = 0.19 – 0.79; p = 0.009). Conclusion Our data show that the expression of CD34 protein represents an independent, favorable, prognostic condition in nodal negative stage IIA RC. Thereby, we provide novel insights into the prognostic role of the tumor microenvironment in RC that might help in the development of novel treatment modalities by its modification.

Download Full-text

Surgical Resection of Anastomotic Stenosis after Rectal Cancer Surgery Using a Circular Stapler and Colostomy with Double Orifice

Case Reports in Surgery ◽

10.1155/2019/2898691 ◽

2019 ◽

Vol 2019 ◽

pp. 1-6

Author(s):

Toru Imagami ◽

Satoru Takayama ◽

Yohei Maeda ◽

Taku Hattori ◽

Ryohei Matsui ◽

...

Keyword(s):

Rectal Cancer ◽

Anterior Resection ◽

Balloon Dilation ◽

Circular Stapler ◽

Anastomotic Stenosis ◽

Endoscopic Balloon Dilation ◽

Oral Side ◽

Double Stapling ◽

Double Orifice ◽

Endoscopic Balloon

The double stapling technique has greatly facilitated intestinal reconstruction, particularly for anastomosis after anterior resection. However, anastomotic stenosis may occur, which sometimes requires surgical treatment. Redo surgery with reresection and reanastomosis presents a high risk of complications. Treatment methods need to be selected depending on the degree and location of stenosis. In an effort to propose a new resolution, reporting new cases and sharing valid experiences are necessary. An 82-year-old man diagnosed with rectal cancer had undergone laparoscopic anterior resection. Endoscopic balloon dilation performed for anastomotic stenosis had failed. Therefore, colostomy with double orifice was constructed on the oral side at 10 cm from the stenosis. Approaching from the anal and stoma side, the anastomotic stenosis was resected using a circular stapler. The colostomy was closed 1 month after surgery. Stenosis resection using a circular stapler requires the following steps: (1) passing the center shaft through the stenosis, (2) inserting the anvil head into the oral side of the stenosis, and (3) attaching the anvil head to the center shaft. This method can resect the stenosis using a circular stapler without being affected by postoperative adhesion in the pelvis. Compared to endoscopic balloon dilation, resection of the stricture by the circular stapler is thought to be reliable. This technique is particularly effective for localized stenosis, including anastomotic stenosis. It is considered that this method is minimally invasive and is low risk for complications. This method can contribute to the useful surgical option for refractory anastomotic stenosis after anterior resection.

Download Full-text