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Radiologic Evaluation of Clinically Benign Rectal Neoplasms May Not Be Necessary Before Local Excision. Dis Colon Rectum 2018; 61:1163-1169. [PMID: 30113341 DOI: 10.1097/dcr.0000000000001168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
BACKGROUND Local excision may be curative for benign and malignant rectal neoplasms. Because many early rectal cancers are discovered incidentally after local excision of clinically benign lesions, it is unclear whether preoperative imaging with transrectal ultrasound or MRI affects management. OBJECTIVE The purpose of this study was to determine the diagnostic characteristics and effect of preoperative imaging on the incidence of malignancy in benign rectal lesions undergoing local excision. DESIGN Prospective data from 2 institutions were included. Coarsened exact matching created a balanced cohort comparing imaging and no-imaging groups. SETTING The study was conducted at high-volume specialist referral hospitals. PATIENTS Adult patients undergoing local excision via transanal endoscopic surgery between 1997 and 2016 for clinically benign rectal neoplasms were included. INTERVENTION The study intervention included preoperative imaging with transrectal ultrasound and/or MRI. MAIN OUTCOME MEASURES We measured the incidence of malignancy and diagnostic accuracy of preoperative imaging. RESULTS A total of 620 patients were included (272 with preoperative imaging and 348 without). There were 250 patients undergoing transrectal ultrasound, and 24 patients undergoing MRI (2 patients underwent both). Transrectal ultrasound and MRI correctly identified malignant polyps in 50% (11/22) and 44% (8/18). Overall agreement for benign versus malignant polyps between preoperative imaging and final pathology was κ = 0.30 (95% CI, 0.18-0.41) for transrectal ultrasound and 0.29 (95% CI, 0.01-0.57) for MRI. In both the overall and unmatched cohorts, the incidence of malignancy, margin involvement, and proportion of patients requiring salvage surgery was similar. LIMITATIONS Data were obtained from 2 institutions with different equipment over a long time period. CONCLUSIONS Preoperative imaging did not accurately identify malignancy in clinically benign rectal lesions and did not affect the incidence of malignancy, margin involvement, or proportion of patients requiring salvage surgery. Therefore, preoperative imaging may not be necessary for clinically benign lesions undergoing local excision. See Video Abstract at http://links.lww.com/DCR/A695.
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Banerjee AK, Longcroft-Wheaton G, Beable R, Conti J, Khan J, Bhandari P. The role of imaging and biopsy in the management and staging of large non-pedunculated rectal polyps. Expert Rev Gastroenterol Hepatol 2018; 12:749-755. [PMID: 29940808 DOI: 10.1080/17474124.2018.1492377] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) are often used for benign and Sm1 large non-pedunculated rectal polyps (LNPRPs), although other surgical techniques including transanal endoscopic microsurgery (TEMS) and transanal minimal invasive surgery remain available. This review covers the role of pre-excisional imaging and selective biopsy of LNPRPs. Areas covered: Polyps between 2 and 3 cm with favorable features (Paris 1, Kudo III/IV pit patterns, and non-lateral spreading type [LST]) may have a one-stage EMR without biopsy and imaging, provided adequate expertise is available with other technologies such as magnifying chromoendoscopy. Higher-risk polyps (moderate/severe dysplasia, 0-IIa+c morphology, nongranular LST, Kudo pit pattern V or submucosal carcinoma, or those >3 cm) should have pre-EMR/ESD imaging with magnetic resonance imaging (MRI) and/or endorectal ultrasound (ERUS) ± biopsies and photographs prior to multidisciplinary team discussion. Expert commentary: In some centers, EMR and ESD are considered the primary modality of treatment, with TEMS as a back-up, while elsewhere, TEMS is the main modality for excision of significant polyps and early colorectal cancer lesions. Likewise, the exact roles of ERUS and MRI will depend on availability of local expertise, although it is suggested that the techniques are complementary.
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Affiliation(s)
- Anjan K Banerjee
- a Department of Colorectal Surgery , Queen Alexandra Hospital , Portsmouth , UK.,b Department of Surgery and Endoscopy , Care UK North East London Treatment Centre, King Georges Hospital , Ilford , UK
| | - Gaius Longcroft-Wheaton
- c Department of Gastroenterology , Queen Alexandra Hospital , Portsmouth , UK.,f Department of Surgery and Endoscopy , University of Portsmouth , Portsmouth , UK
| | - Richard Beable
- e Department of Radiology , Queen Alexandra Hospital , Portsmouth , UK
| | - John Conti
- a Department of Colorectal Surgery , Queen Alexandra Hospital , Portsmouth , UK.,d Department of Surgery and Endoscopy , University of Southampton , Southampton , UK
| | - Jim Khan
- a Department of Colorectal Surgery , Queen Alexandra Hospital , Portsmouth , UK
| | - Pradeep Bhandari
- c Department of Gastroenterology , Queen Alexandra Hospital , Portsmouth , UK.,f Department of Surgery and Endoscopy , University of Portsmouth , Portsmouth , UK
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Akhter A, Walker A, Heise CP, Kennedy GD, Benson ME, Pfau PR, Johnson EA, Frick TJ, Gopal DV. A tertiary care hospital's 10 years' experience with rectal ultrasound in early rectal cancer. Endosc Ultrasound 2018; 7:191-195. [PMID: 28836512 PMCID: PMC6032707 DOI: 10.4103/eus.eus_15_17] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background and Objectives: Rectal endoscopic ultrasound (RUS) has become an essential tool in the management of rectal adenocarcinoma because of the ability to accurately stage lesions. The aim of this study was to identify the staging agreement of early RUS-staged rectal adenocarcinoma with surgical resected pathology and ultimately determine how this impacts the management of early rectal cancer (T1–T2). Methods: Retrospective chart review was performed from November 2002 to November 2013 to identify procedure indication, RUS staging data, surgical management, and postoperative surgical pathology data. Results: There were a total of 693 RUS examinations available for review and 282 of these were performed for a new diagnosis of rectal adenocarcinoma. There was staging agreement between RUS and surgical pathology in 19 out of 20 (95%) RUS-staged T1 cases. There was staging agreement between RUS and surgical pathology in 3 out of 9 (33%) RUS-staged T2 cases. There was significantly better staging agreement for RUS-staged T1 lesions compared to RUS staged T2 lesions (P = 0.002). Nearly 60% of T1N0 cancers were referred for transanal excisions (TAEs), and 78% of T2N0 cancers underwent low anterior resection. Conclusions: This study identified only a small number of T1–T2 adenocarcinomas. There was good staging agreement between RUS and surgical pathology among RUS-staged T1 lesions whereas poor staging agreement among RUS-staged T2 lesions. Although TAE is largely indicated by the staging of a T1 lesion, this approach may be less appropriate for T2 lesions due to high reported local recurrence.
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Affiliation(s)
- Ahmed Akhter
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Andrew Walker
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Charles P Heise
- Department of Surgery, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Gregory D Kennedy
- Department of Surgery, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Mark E Benson
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Patrick R Pfau
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Eric A Johnson
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Terrence J Frick
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
| | - Deepak V Gopal
- Division of Gastroenterology and Hepatology, University of Wisconsin Hospital and Clinic, Madison, WI 53705; Department of Medicin, University of Wisconsin Hospital and Clinic, Madison, WI 53705, USA
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Laghi A, Bellini D, Petrozza V, Piccazzo R, Santoro GA, Fabbri C, van der Paardt MP, Stoker J. Imaging of colorectal polyps and early rectal cancer. Colorectal Dis 2015; 17 Suppl 1:36-43. [PMID: 25511860 DOI: 10.1111/codi.12820] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- A Laghi
- Department of Radiological Sciences, Oncology and Pathology, "SAPIENZA" University of Rome, I.C.O.T. Hospital, Latina, Italy
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Use of a convex probe-endobronchial US endoscope in EUS of the rectum and FNA. Gastrointest Endosc 2013; 77:157-9. [PMID: 23261110 DOI: 10.1016/j.gie.2012.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Accepted: 08/27/2012] [Indexed: 12/11/2022]
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Boo SJ, Byeon JS, Park DH, Seo DW, Yang DH, Jung KW, Kim KJ, Ye BD, Myung SJ, Yang SK, Kim JH. EUS-guided fine needle aspiration and trucut needle biopsy for examination of rectal and perirectal lesions. Scand J Gastroenterol 2011; 46:1510-8. [PMID: 21936722 DOI: 10.3109/00365521.2011.615856] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Few studies have assessed the diagnostic efficacy of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) and/or trucut biopsy (TCB) in patients with rectal and perirectal lesions. We aimed to evaluate the diagnostic utility of EUS-FNA and/or TCB in patients with rectal and perirectal lesions. We also assessed their influence on the management and clinical course of these patients. MATERIAL AND METHODS We performed EUS-FNA and/or TCB in 11 consecutive patients (4 men and 7 women, 33-69 years) with rectal and perirectal lesions for whom conventional diagnostic tools could not provide definitive diagnoses. Patients with definite intraluminal cancer were excluded. RESULTS The 11 patients underwent 12 procedures, with 9 being EUS-FNA alone and 3 being EUS-FNA and TCB. Seven patients had rectal lesions and four had perirectal lesions. Initial EUS-FNA and/or TCB established a diagnosis of malignancy in five patients and of benign lesions in four. EUS-FNA plus TCB confirmed malignant lymphoma after diagnostic failure of initial EUS-FNA in one patient. In one other patient with suspicious secondary linitis plastica, EUS-FNA could not establish a definitive diagnosis. Correct diagnoses were obtained in 10 out of 11 patients who underwent EUS-FNA and/or TCB. EUS-FNA and/or TCB changed clinical courses, which included avoidance of unnecessary surgeries, having a chance of anal sphincter-saving surgeries, and timely administration of chemotherapy. No serious complications related to the use of EUS-FNA or TCB were evident. CONCLUSION EUS-FNA and/or TCB are useful in the diagnostic evaluation of and appropriate therapeutic plan in patients with rectal and perirectal lesions.
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Affiliation(s)
- Sun-Jin Boo
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Songpa-gu, Seoul, Korea
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Accuracy of endoscopic ultrasound in staging and restaging patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiation. Clin Res Hepatol Gastroenterol 2011; 35:666-70. [PMID: 21782549 DOI: 10.1016/j.clinre.2011.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2011] [Revised: 04/28/2011] [Accepted: 05/25/2011] [Indexed: 02/04/2023]
Abstract
BACKGROUND To date, the role of endoscopic ultrasound (EUS) in restaging locally advanced rectal cancer (LARC) after neoadjuvant chemoradiotherapy (NAT) have not been thoroughly investigated. AIM To evaluate accuracy and clinical usefulness of EUS for both staging and restaging LARC. METHODS According to EUS staging, patients with LARC were enrolled in the study. Those who underwent surgery directly represented a control group useful for evaluating the accuracy of EUS in staging LARC. In the study group, EUS was repeated seven weeks after NAT, before surgery. The results of EUS were compared with the corresponding pTN stages. RESULTS From 2000 to 2006, 212 consecutive patients with RC underwent EUS staging. Among them EUS diagnosed 162 LARC (M/F = 93/69; mean age: 60 years [range 40-80]). The final study group included 85 patients with LARC. EUS restaging had an overall accuracy of 61% and 59% for T and N-stage, respectively. In the control group, the accuracy of EUS in staging LARC was 86% and 58% for T and N-stage, respectively. CONCLUSION EUS accurately stages LARC and enables appropriate decision-making, with selection of those patients who need NAT. On the other hand, EUS restaging of LARC after NAT has low accuracy and should not be used in clinical practice.
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Gleeson FC, Clain JE, Rajan E, Topazian MD, Wang KK, Levy MJ. EUS-FNA assessment of extramesenteric lymph node status in primary rectal cancer. Gastrointest Endosc 2011; 74:897-905. [PMID: 21839439 DOI: 10.1016/j.gie.2011.05.040] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Accepted: 05/21/2011] [Indexed: 12/13/2022]
Abstract
BACKGROUND Preoperative staging is an essential factor in the multidisciplinary management of rectal cancer. The accuracy of imaging alone with CT, magnetic resonance imaging, or rigid endorectal US is poor. The addition of EUS-FNA may enhance extramesenteric lymph node metastases detection (M1 disease) and overall staging accuracy. OBJECTIVE To evaluate the frequency of extramesenteric lymph node visualization by EUS and the rate of extramesenteric lymph node metastases by FNA. Secondary goals were to evaluate the clinical, endoscopic, and sonographic features associated with extramesenteric lymph node metastases, disease progression, and overall mortality. DESIGN Retrospective cohort study. SETTINGS Tertiary referral center. RESULTS Forty-one of 316 patients (13%) with primary rectal cancer over a 6-year period had M1 disease by EUS-FNA. Significant clinical, endoscopic, and sonographic features associated with extramesenteric lymph node metastases included the serum carcinoembryonic antigen level, tumor length 4 cm and longer, annularity 50% or more, sessile morphology, and lymph node size. The sensitivity and specificity of CT for extramesenteric lymph node metastases were 44% and 89%, respectively. Twenty-three of 316 rectal cancer endosonographic procedures (7.3%) were up-staged by FNA, which established extramesenteric lymph node metastases. Over a 4-year follow-up, disease progression and overall mortality of patients with extramesenteric lymph node metastases was observed in 6 patients (14.6%) and 14 patients (34%), respectively. CONCLUSIONS Preoperative EUS-FNA identification of extramesenteric lymph node metastases outside of standard radiation fields or total mesorectal excision resection margins could affect medical and surgical planning.
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Affiliation(s)
- Ferga C Gleeson
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, MN, USA
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Hassan H, Vilmann P, Sharma V. Impact of EUS-guided FNA on management of gastric carcinoma. Gastrointest Endosc 2010; 71:500-4. [PMID: 20189507 DOI: 10.1016/j.gie.2009.10.044] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Accepted: 10/20/2009] [Indexed: 12/26/2022]
Abstract
BACKGROUND EUS is an integral part of the pretherapeutic evaluation program for patients with upper GI cancer. OBJECTIVE To evaluate the impact of EUS-guided FNA on the clinical management of patients with gastric cancer. DESIGN The study included patients with confirmed gastric carcinoma who were referred to the Department of Surgical Gastroenterology, Gentofte Hospital, Copenhagen University, Copenhagen, Denmark, during a 6-year period (2001-2007). SETTING The patients underwent standard pretherapeutic evaluation. If no signs of incurability were detected, the patients were offered EUS and EUS-guided FNA. EUS-guided FNA was performed when lymph nodes or lesions were considered to be distant metastases. A board of surgeons was asked to evaluate the management of the patients after the results obtained by EUS-guided FNA were revealed. PATIENTS This study involved 234 patients with gastric carcinoma. INTERVENTION EUS-guided FNA. MAIN OUTCOME MEASUREMENTS Number of patients with distant metastasis diagnosed by EUS-guided FNA, with the avoidance of unnecessary surgery. RESULTS A total of 81 consecutive patients underwent EUS-guided FNA. Ninety-nine lesions were targeted, and 61 (62%) of these lesions were found to be malignant. In 38 of 81 patients (42%) distant metastases were confirmed by EUS-guided FNA. As judged by the board of surgeons, EUS-guided FNA changed the management plan in 34 of 234 patients (15%). LIMITATION The positive EUS-guided FNA diagnoses were not surgically verified. CONCLUSION EUS-guided FNA is a very important modality and should be integrated as a routine procedure in the preoperative staging algorithm of gastric cancer.
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Affiliation(s)
- Hazem Hassan
- Department of Surgical Gastroenterology, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
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Mezzi G, Arcidiacono PG, Carrara S, Perri F, Petrone MC, De Cobelli F, Gusmini S, Staudacher C, Del Maschio A, Testoni PA. Endoscopic ultrasound and magnetic resonance imaging for re-staging rectal cancer after radiotherapy. World J Gastroenterol 2009; 15:5563-7. [PMID: 19938195 PMCID: PMC2785059 DOI: 10.3748/wjg.15.5563] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To compare the sensitivity and specificity of two imaging techniques, endoscopic ultrasound (EUS) and magnetic resonance imaging (MRI), in patients with rectal cancer after neoadjuvant chemoradiation therapy. And we compared EUS and MRI data with histological findings from surgical specimens.
METHODS: Thirty-nine consecutive patients (51.3% Male; mean age: 68.2 ± 8.9 years) with histologically confirmed distal rectal cancer were examined for staging. All patients underwent EUS and MRI imaging before and after neoadjuvant chemoradiation therapy.
RESULTS: After neoadjuvant chemoradiation, EUS and MRI correctly classified 46% (18/39) and 44% (17/39) of patients, respectively, in line with their histological T stage (P > 0.05). These proportions were higher for both techniques when nodal involvement was considered: 69% (27/39) and 62% (24/39). When patients were sorted into T and N subgroups, the diagnostic accuracy of EUS was better than MRI for patients with T0-T2 (44% vs 33%, P > 0.05) and N0 disease (87% vs 52%, P = 0.013). However, MRI was more accurate than EUS in T and N staging for patients with more advanced disease after radiotherapy, though these differences did not reach statistical significance.
CONCLUSION: EUS and MRI are accurate imaging techniques for staging rectal cancer. However, after neoadjuvant RT-CT, the role of both methods in the assessment of residual rectal tumors remains uncertain.
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Evaluation of subepithelial abnormalities of the appendix by endoscopic ultrasound. DIAGNOSTIC AND THERAPEUTIC ENDOSCOPY 2009; 2009:295379. [PMID: 19920863 PMCID: PMC2777238 DOI: 10.1155/2009/295379] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2009] [Accepted: 08/26/2009] [Indexed: 01/29/2023]
Abstract
Background. The use of through-the-scope (TTS) miniprobe catheter endoscopic ultrasound is a valuable technique for evaluating subepithelial lesions in the proximal colon. Few reports include the evaluation of the appendix by EUS. Objective. To describe endoscopic and endosonographic characteristics of subepithelial lesions of the appendix. Methods. Retrospective case series in a single academic medical center. Adult patients referred for evaluation of subepithelial lesions of the appendix identified by colonoscopy between April 1, 2003 to February 29, 2008. Data were abstracted from an electronic endoscopic database for all patients undergoing miniprobe endoscopic ultrasound examination of the appendix. Medical records were reviewed for patient followup and outcomes. Results. Nine cases were identified. Seven (78%) patients were female. Seven (78%) utilized the 12 MHz miniprobe device and two (22%) used the 20 MHz device. Three mucoceles were described and confirmed by surgical resection. Cases also included one inverted appendix, one gastrointestinal stromal tumor, and one lipoma. In three cases, no abnormality was found. Conclusions. EUS evaluation of the appendix is feasible with standard miniprobe devices and may assist in the selection of patients who may benefit from surgical management.
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Krand O, Yalti T, Tellioglu G, Kara M, Berber I, Titiz MI. Use of smooth muscle plasty after intersphincteric rectal resection to replace a partially resected internal anal sphincter: long-term follow-up. Dis Colon Rectum 2009; 52:1895-901. [PMID: 19966639 DOI: 10.1007/dcr.0b013e3181b55507] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE Patients with very low rectal cancer were treated by intersphincteric rectal resection employing partial internal anal sphincter resection. They then underwent smooth muscle plasty to restore internal anal sphincter function. We assessed the functional and oncological outcomes. PATIENTS AND METHODS Patients were selected if their biopsies revealed well-differentiated or moderately well-differentiated very low rectal tumors with distal tumor margins that permitted preservation of part of the internal anal sphincter. Functional results after closing the loop ileostomy were assessed by use of a standardized questionnaire. Continence was evaluated by use of the Kirwan score. RESULTS Forty-seven patients with T2 to T3 very low rectal carcinomas underwent intersphincteric rectal resection and smooth muscle plasty that extended into the anal canal. All received neoadjuvant treatment. Postoperative morbidity was 38.3%. There were 46 R0 resections based on frozen section analysis; one patient achieved an R0 resection after reexcision of a positive distal margin on the frozen section. The median follow-up period was 67.2 months. One patient had local recurrence. The five-year overall and disease-free survival rates were 85% and 82%, respectively. Six months, one year, and two years after intersphincteric rectal resection, 80%, 87%, and 89%, respectively, had good continence (Kirwan I and II). Evacuation difficulty was detected in two patients with colonic S-pouches. CONCLUSION Providing neodjuvant treatment and preserving at least half of the functional internal anal sphincter mass produces acceptable oncological and functional outcomes in patients undergoing intersphincteric rectal resection for very low rectal cancer. However, whether smooth muscle plasty further improves postoperative continence should be tested by further studies.
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Affiliation(s)
- Osman Krand
- First General Surgery, Haydarpasa Numune Research Training Hospital, Istanbul, Turkey.
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Abstract
The success of pre-operative therapy over post-operative treatments means that a technique identifying prognostic factors pre-operatively is of potential benefit in modifying the intensity of pre-operative therapy according to risk of local or distant failure. Clinical trials incorporating robust and accurate assessment of prognostic factors and appropriate stratification of patients prior to therapy will enable objective comparison of treatment modalities and outcomes. Careful staging of rectal tumours results in selective pre-operative treatment strategies aimed at reducing local failure and distant failure in high risk patients.
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Affiliation(s)
- Gina Brown
- The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, Surrey SM2 5PT, UK.
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Bhutani MS. Endoscopic ultrasound in the diagnosis, staging and management of colorectal tumors. Gastroenterol Clin North Am 2008; 37:215-27, viii. [PMID: 18313547 DOI: 10.1016/j.gtc.2007.12.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Endoscopic ultrasound (EUS) has evolved as a useful technique for imaging and intervention in the colon and rectum. This article reviews the clinical applications of EUS for imaging and intervention in colorectal cancer, with an emphasis on the most recent clinical studies.
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Affiliation(s)
- Manoop S Bhutani
- Department of Gastroenterology, Hepatology and Nutrition, Unit 436, UT MD Anderson Cancer Center, Faculty Center Room 10.2028, 1515 Holcombe Boulevard, Houston, TX 77030-4009, USA.
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The changing role of endoluminal ultrasound in rectal cancer. COLORECTAL CANCER 2007. [DOI: 10.1017/cbo9780511902468.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Current Status of Endoscopic Ultrasonography. APOLLO MEDICINE 2007. [DOI: 10.1016/s0976-0016(11)60457-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Tierney WM, Adler DG, Chand B, Conway JD, Croffie JMB, DiSario JA, Mishkin DS, Shah RJ, Somogyi L, Wong Kee Song LM, Petersen BT. Echoendoscopes. Gastrointest Endosc 2007; 66:435-42. [PMID: 17640635 DOI: 10.1016/j.gie.2007.05.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Gan SI, Rajan E, Adler DG, Baron TH, Anderson MA, Cash BD, Davila RE, Dominitz JA, Harrison ME, Ikenberry SO, Lichtenstein D, Qureshi W, Shen B, Zuckerman M, Fanelli RD, Lee KK, Van Guilder T. Role of EUS. Gastrointest Endosc 2007; 66:425-34. [PMID: 17643438 DOI: 10.1016/j.gie.2007.05.026] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Bhutani MS. Recent developments in the role of endoscopic ultrasonography in diseases of the colon and rectum. Curr Opin Gastroenterol 2007; 23:67-73. [PMID: 17133088 DOI: 10.1097/mog.0b013e328011630b] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Endoscopic ultrasound has evolved as a useful technique for imaging and intervention in a variety of gastrointestinal and extraintestinal diseases including diseases of the colon and rectum. This paper will review recent developments in endoscopic ultrasound for colorectal diseases. RECENT FINDINGS Recent studies have shown significant clinical impact of endoscopic ultrasound in rectal cancer staging. Iliac lymph node evaluation by endoscopic ultrasound-guided fine needle aspiration may further expand the role of endoscopic ultrasound in rectal cancer. Three-dimensional endoscopic ultrasound may help decrease some of the errors of staging with two-dimensional endoscopic ultrasound and may further improve staging accuracy. Recent studies have confirmed continued problems with re-staging rectal cancer after chemoradiation. Endoscopic ultrasound-fine needle aspiration can be helpful in detecting local recurrence of rectal cancer and has been shown to be useful in evaluation of subepithelial masses of the colon and rectum and evaluation of rectosigmoid endometriosis. SUMMARY Endoscopic ultrasound continues to be useful for a variety of conditions of the colon and rectum with recent studies confirming its clinical impact as well as expanding its role into newer indications. Assessment for residual cancer after chemoradiation is still problematic and hopefully technological developments in ultrasound in the future may help in improving the accuracy of endoscopic ultrasound in this situation.
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Affiliation(s)
- Manoop S Bhutani
- Center for Endoscopic Ultrasound, University of Texas Medical Branch, Galveston, Texas 77555, USA.
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Abstract
Significant advances have been made in all aspects of care relating to colorectal cancer. Although surgery will likely remain the mainstay of definitive treatment for the majority of colorectal malignancies, a better understanding of tumor progression and biology will help guide the choice of surgical therapy to best achieve a curative resection. Additionally, advances in the use of neoadjuvant and adjuvant therapies should continue to increase disease-free and overall survival when combined with appropriate operative resection. Although TNM staging remains our strongest tool at this point for establishing prognosis and directing therapy, expansion of our knowledge of the molecular events underlying colorectal tumorigenesis undoubtedly will lead to the refinement of our current staging and prognostic systems.
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Affiliation(s)
- Josh Kehoe
- Department of Surgery, University of California, Davis Cancer Center, 4501 X Street, Suite 3010, Sacramento, CA 95817, USA
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Warmath JR, Herline AJ. New Technologies in Rectal Cancer Management. SEMINARS IN COLON AND RECTAL SURGERY 2005. [DOI: 10.1053/j.scrs.2005.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shami VM, Waxman I. Technology Insight: current status of endoscopic ultrasonography. ACTA ACUST UNITED AC 2005; 2:38-45. [PMID: 16265099 DOI: 10.1038/ncpgasthep0085] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 12/09/2004] [Indexed: 12/11/2022]
Abstract
Endoscopic ultrasound (EUS) has become the most accurate imaging modality for locoregional cancer staging of the gastrointestinal tract. Fine-needle aspiration (FNA) has added a new level of accuracy for EUS in nodal staging, with reported numbers in the 90% range for luminal and pancreaticobiliary disease. In addition, new non-gastrointestinal applications are being evaluated, such as the role of EUS-FNA for the staging of non-small-cell lung cancer and exploration of the posterior mediastinum. Furthermore, the same techniques that make safe tissue sampling possible are being explored for their use as interventional applications, such as EUS-guided celiac plexus neurolysis, fine-needle injection, EUS-guided pseudocyst drainage, and EUS-guided cholangiography and pancreatography. This review describes the current clinical status of EUS in gastrointestinal oncology, as well as future and novel indications and therapeutic strategies for this technology.
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Affiliation(s)
- Vanessa M Shami
- Digestive Health Center of Excellence, The University of Virginia Health System, Charlottesville, VA, USA
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Abstract
Since first introduced over 20 years ago, endoscopic ultrasonography (EUS) has become established as an important tool in the staging of gastrointestinal malignancies and potentially resectable non-small cell lung cancer. This review describes the current roles of EUS in staging these tumours, highlighting interventional roles, current problem areas and future developments.
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Affiliation(s)
- E Henry
- Gastrointestinal Unit, Western General Hospital, Edinburgh EH4 2XU, UK
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