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Yoo RN, Mun JY, Cho HM, Kye BH, Kim HJ. Assessment of Colorectal Anastomosis with Intraoperative Colonoscopy: Its Role in Reducing Anastomotic Complications. Biomedicines 2023; 11:biomedicines11041162. [PMID: 37189780 DOI: 10.3390/biomedicines11041162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 04/03/2023] [Accepted: 04/11/2023] [Indexed: 05/17/2023] Open
Abstract
The use of intraoperative colonoscopy (IOC) to evaluate the integrity of newly created anastomosis has been advocated by some surgeons. However, whether direct visualization of fresh anastomosis can help reduce anastomotic problems is still unclear. This study investigates the impact of immediate endoscopic assessment of colorectal anastomosis on anastomotic problems. This is a retrospective study conducted at a single center. Among six hundred forty-nine patients who underwent stapled anastomosis for left-sided colorectal cancer, the anastomotic complications were compared between patients who underwent IOC and those who did not. Additionally, patients with subsequent intervention after the IOC were compared to those without the intervention. Twenty-seven patients (5.0%) developed anastomotic leakage, and six (1.1%) experienced anastomotic bleeding postoperatively. Of the patients with IOC, 70 patients received reinforcement sutures to secure anastomotic stability. Of 70 patients, 39 patients showed abnormal findings in IOC. Thirty-seven patients (94.9%) who underwent reinforcement sutures did not develop postoperative anastomotic problems. This study demonstrates that IOC assessment with reinforcement sutures does not imminently reduce the rate of anastomotic complications. However, its use may play a role in detecting early technical failure and preventing postoperative anastomotic complications.
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Affiliation(s)
- Ri-Na Yoo
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Ji-Yeon Mun
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Hyeon-Min Cho
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Bong-Hyeon Kye
- Department of Surgery, St. Vincent's Hospital, The Catholic University of Korea, Suwon 16247, Republic of Korea
| | - Hyung-Jin Kim
- Department of Surgery, Eunpyeong St. Mary's Hospital, The Catholic University of Korea, Seoul 03312, Republic of Korea
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Yu GY, Gao XH, Xia LJ, Sun DB, Liu T, Zhang W. Implantation metastasis from sigmoid colon cancer to rectal anastomosis proved by whole exome sequencing and lineage inference for cancer heterogeneity and evolution analysis: Case report and literature review. Front Oncol 2022; 12:930715. [PMID: 36203423 PMCID: PMC9530747 DOI: 10.3389/fonc.2022.930715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
It was estimated that 70% of patients with colorectal cancer were found to have viable exfoliated malignant cells in adjacent intestinal lumen. Exfoliated malignant cells had been reported to implant on raw surfaces, such as polypectomy site, anal fissure, anal fistula, hemorrhoidectomy wound, and anastomotic suture line. Tumors at anastomosis could be classified into four groups: local recurrence, local manifestation of widespread metastasis, metachronous carcinogenesis, and implantation metastasis. However, all of the previous studies only reported the phenomena of implantation metastasis at anastomosis. No study had proved the origin of anastomotic metastasis by genomic analysis. In this study, a 43-year-old woman presented with persistent hematochezia was diagnosed as having severe mixed hemorrhoids. She was treated by procedure for prolapse and hemorrhoids (PPH), without receiving preoperative colonoscopy. Two months later, she was found to have sigmoid colon cancer by colonoscopy due to continuous hematochezia and received radical sigmoidectomy. Postoperative histological examination confirmed the lesion to be a moderately differentiated adenocarcinoma (pT3N1M0). Six months later, she presented with hematochezia again and colonoscopy revealed two tumors at the rectal anastomosis of PPH. Both tumors were confirmed to be moderately differentiated adenocarcinoma without lymph node and distant metastasis and were finally removed by transanal endoscopic microsurgery (TEM). Pathological examination, whole exome sequencing (WES), and Lineage Inference for Cancer Heterogeneity and Evolution (LICHeE) analysis demonstrated that the two tumors at the rectal anastomosis were probably implantation metastases arising from the previous sigmoid colon cancer. This is the first study to prove implantation metastasis from colon cancer to a distal anastomosis by WES and LICHeE analysis. Therefore, it is recommended to rule out colorectal cancer in proximal large bowel before performing surgery with a rectal anastomosis, such as PPH and anterior resection. For patients with a suspected implanted tumor, WES and LICHeE could be used to differentiate implantation metastasis from metachronous carcinogenesis.
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Affiliation(s)
- Guan Yu Yu
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Xian Hua Gao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Li Jian Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, Ji'nan, Shandong, China
| | - De Bin Sun
- Department of Medicine, Genecast Biotechnology Co. Ltd, Wuxi, China
| | - Tao Liu
- Department of Anorectal Surgery, Zaozhuang Central Hospital, Shandong, China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
- *Correspondence: Wei Zhang,
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3
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Funahashi K, Goto M, Kaneko T, Ushigome M, Kagami S, Koda T, Nagashima Y, Yoshida K, Miura Y. What is the advantage of rectal amputation with an initial perineal approach for primary anorectal carcinoma? BMC Surg 2020; 20:22. [PMID: 32013929 PMCID: PMC6998343 DOI: 10.1186/s12893-020-0683-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Accepted: 01/21/2020] [Indexed: 01/21/2023] Open
Abstract
Background Rectal amputation (RA) remains an important surgical procedure for salvage despite advances in sphincter-preserving resection, including intersphincteric resection. The aim of this study was to compare short- and long-term outcomes of RA with an initial perineal approach to those of RA with an initial abdominal approach (conventional abdominoperineal resection (APR)) for primary anorectal cancer. Methods We retrospectively analyzed the short- and long-term outcomes of 48 patients who underwent RA with an initial perineal approach (perineal group) and 21 patients who underwent RA with an initial abdominal approach (conventional group). Results For the perineal group, the operation time was shorter than that for the conventional group (313 vs. 388 min, p = 0.027). The postoperative complication rate was similar between the two groups (43.8 vs. 47.6%, p = 0.766). Perineal wound complications (PWCs) were significantly fewer in the perineal group than in the conventional group (22.9 vs. 57.1%, p = 0.006). All 69 patients underwent complete TME, but positive CRM was significantly higher in the conventional group than in the perineal group (0 vs. 19.0%, p = 0.011). There were no significant differences in the recurrence (43.8 vs. 47.6%, p = 0.689), 5-year disease-free survival (63.7% vs. 56.7%, p = 0.665) and 5-year overall survival rates (82.5% vs. 66.2%, p = 0.323) between the two groups. Conclusion These data suggest that RA with an initial perineal approach for selective primary anorectal carcinoma is advantageous in minimizing PWCs and positive CRMs. Further investigations on the advantages of this approach are necessary.
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Affiliation(s)
- Kimihiko Funahashi
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan.
| | - Mayu Goto
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Tomoaki Kaneko
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Mitsunori Ushigome
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Satoru Kagami
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Takamaru Koda
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Yasuo Nagashima
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Kimihiko Yoshida
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
| | - Yasuyuki Miura
- Department of General and Gastroenterological Surgery, Toho University Omori Medical Center, 6-11-1 Omorinishi Otaku, Tokyo, 143-8541, Japan
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Agrusa A, Di Buono G, Buscemi S, Canfora I, Randisi B, Bonventre G, Gulotta L, Maienza E, Sorce V, Romano G, Gulotta G. Systemic schistosomiasis and large bowel perforation: An unexpected surgical urgency. Report of a case and literature review. Clin Case Rep 2019; 7:968-972. [PMID: 31110726 PMCID: PMC6509925 DOI: 10.1002/ccr3.2138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 03/10/2019] [Accepted: 03/12/2019] [Indexed: 12/28/2022] Open
Abstract
In the presence of suggestive clinical picture (high eosinophil count and multiple CT scan granuloma-like lesions), schistosomiasis should be taken into account in case of suspected bowel perforation even if common risk factors are not identified through anamnesis.
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Affiliation(s)
- Antonino Agrusa
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Giuseppe Di Buono
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Salvatore Buscemi
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Ilaria Canfora
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Brenda Randisi
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Giulia Bonventre
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Leonardo Gulotta
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Elisa Maienza
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Vincenzo Sorce
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Giorgio Romano
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
| | - Gaspare Gulotta
- Section of General and Urgent Surgery, Department of Surgical, Oncological and Oral SciencesUniversity of PalermoPalermoItaly
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Yin L, Fan L, Tan R, Yang G, Jiang F, Zhang C, Ma J, Yan Y, Zou Y, Zhang Y, Wang Y, Zhang G. Bowel symptoms and self-care strategies of survivors in the process of restoration after low anterior resection of rectal cancer. BMC Surg 2018; 18:35. [PMID: 29866087 PMCID: PMC5987619 DOI: 10.1186/s12893-018-0368-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 05/24/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The purpose of this research is to identify the bowel symptoms and self-care strategies for rectal cancer survivors during the recovery process following low anterior resection surgery. METHODS A total of 100 participants were investigated under the structured interview guide based on the dimensions of "symptom management theory". RESULTS 92% of participants reported changes in bowel habits, the most common being the frequent bowel movements and narrower stools, which we named it finger-shaped consistency stools. The 6 most frequently reported bowel symptoms were excessive flatus (93%), clustering (86%), urgency (77%), straining (62%), bowel frequency (57%) and anal pendant expansion (53%). Periodic bowel movements occurred in 19% participants. For a group of 79 participants at 6 to 24 months post-operation, 86.1% reported a significant improvement of bowel symptoms. Among 68 participants of this subgroup with significant improvements, 70.5% participants reported the length of time it took was at least 6 months. Self-care strategies adopted by participants included diet, bowel medications, practice management and exercise. CONCLUSIONS It is necessary to educate patients on the symptoms experienced following low anterior resection surgery. Through the process of trial and error, participants have acquired self-care strategies. Healthcare professionals should learn knowledge of such strategies and help them build effective interventions.
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Affiliation(s)
- Lishi Yin
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Ling Fan
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Renfu Tan
- Medical University of Chongqing, Chongqing City, 400000 China
| | - Guangjing Yang
- Nursing Department, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Fenglin Jiang
- Department of Cardiovascular, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Chao Zhang
- Department of Nephrology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Jun Ma
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Yang Yan
- Department of Hepatology, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Yanhong Zou
- Science and Education Department, Chongqing Hospital of Traditional Chinese Medicine, Chongqing City, 400000 China
| | - Yaowen Zhang
- Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Road Panxi seven branch, Chongqing City, 400000 China
| | - Yamei Wang
- Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Road Panxi seven branch, Chongqing City, 400000 China
| | - Guifang Zhang
- Department of Emergency and the Intensive Care Unit, Chongqing Hospital of Traditional Chinese Medicine, No. 6 Road Panxi seven branch, Chongqing City, 400000 China
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Ishii M, Yamamoto M, Tanaka K, Asakuma M, Masubuchi S, Hamamoto H, Akutagawa H, Egashira Y, Hirose Y, Okuda J, Uchiyama K. Intestinal endometriosis combined with colorectal cancer: a case series. J Med Case Rep 2018. [PMID: 29378641 DOI: 10.1186/s13256-017-1537-3.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intestinal endometriosis is a common benign disease among menstruating women that affects the intestinal tract. CASE PRESENTATION This case report presents seven Japanese cases of intestinal endometriosis with colorectal cancer treated by laparoscopic surgery. Five of the seven cases reported here are women presenting with bowel obstruction due to colorectal endometriosis with colorectal cancer. It can be confused with serious lesions such as advanced colorectal cancer with peritoneal involvement or invasion of adjacent organs (T4). CONCLUSIONS Therefore, we should consider the probability that the cause of bowel obstruction is not T4 but intestinal endometriosis. For surgical treatment, we recommend laparoscopic surgery for colorectal resection because of its benefits of differential diagnosis of T4, preserving fertility, and preventing excessive surgical stress. We performed laparoscopic resection in seven patients with intestinal endometriosis and colorectal cancer. These cases demonstrate the difficulty of establishing a differential diagnosis of intestinal endometriosis with colorectal cancer from T4.
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Affiliation(s)
- Masatsugu Ishii
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan.
| | - Masashi Yamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Keitaro Tanaka
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Mitsuhiro Asakuma
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Shinsuke Masubuchi
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Hiroki Hamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | | | - Yutaro Egashira
- Department of Pathology, Osaka Medical College, Osaka, Japan
| | | | - Junji Okuda
- Cancer Center, Osaka Medical College, Osaka, Japan
| | - Kazuhisa Uchiyama
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
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7
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Ishii M, Yamamoto M, Tanaka K, Asakuma M, Masubuchi S, Hamamoto H, Akutagawa H, Egashira Y, Hirose Y, Okuda J, Uchiyama K. Intestinal endometriosis combined with colorectal cancer: a case series. J Med Case Rep 2018; 12:21. [PMID: 29378641 PMCID: PMC5789683 DOI: 10.1186/s13256-017-1537-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/05/2017] [Indexed: 12/19/2022] Open
Abstract
Background Intestinal endometriosis is a common benign disease among menstruating women that affects the intestinal tract. Case presentation This case report presents seven Japanese cases of intestinal endometriosis with colorectal cancer treated by laparoscopic surgery. Five of the seven cases reported here are women presenting with bowel obstruction due to colorectal endometriosis with colorectal cancer. It can be confused with serious lesions such as advanced colorectal cancer with peritoneal involvement or invasion of adjacent organs (T4). Conclusions Therefore, we should consider the probability that the cause of bowel obstruction is not T4 but intestinal endometriosis. For surgical treatment, we recommend laparoscopic surgery for colorectal resection because of its benefits of differential diagnosis of T4, preserving fertility, and preventing excessive surgical stress. We performed laparoscopic resection in seven patients with intestinal endometriosis and colorectal cancer. These cases demonstrate the difficulty of establishing a differential diagnosis of intestinal endometriosis with colorectal cancer from T4.
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Affiliation(s)
- Masatsugu Ishii
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan.
| | - Masashi Yamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Keitaro Tanaka
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Mitsuhiro Asakuma
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Shinsuke Masubuchi
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | - Hiroki Hamamoto
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
| | | | - Yutaro Egashira
- Department of Pathology, Osaka Medical College, Osaka, Japan
| | | | - Junji Okuda
- Cancer Center, Osaka Medical College, Osaka, Japan
| | - Kazuhisa Uchiyama
- Departments of General and Gastroenterological Surgery, Osaka Medical College, Osaka, Japan
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Gan J, Bryant C, Arul D, Parmar C. Intestinal spirochaetosis mimicking acute appendicitis with review of the literature. BMJ Case Rep 2017; 2017:bcr-2017-221574. [PMID: 29103010 DOI: 10.1136/bcr-2017-221574] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Human intestinal spirochaetosis is a well-established micro-organism existing in the colon. It is less commonly seen in the appendix, and rarely presents as acute appendicitis. We present a case of a man presenting with symptoms consistent with acute appendicitis. The literature on spirochaetosis presenting as acute appendicitis is also reviewed.
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Affiliation(s)
- Jason Gan
- Department of Surgery, Whittington Hospital, London, UK
| | | | - Dhili Arul
- Department of Surgery, Whittington Hospital, London, UK
| | - Chetan Parmar
- Department of Surgery, Whittington Hospital, London, UK
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9
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Okkabaz N, Haksal M, Atici AE, Altuntas YE, Gundogan E, Gezen FC, Oncel M. J-pouch vs. side-to-end anastomosis after hand-assisted laparoscopic low anterior resection for rectal cancer: A prospective randomized trial on short and long term outcomes including life quality and functional results. Int J Surg 2017; 47:4-12. [DOI: 10.1016/j.ijsu.2017.09.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/07/2017] [Accepted: 09/11/2017] [Indexed: 02/08/2023]
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Rottoli M, Vallicelli C, Boschi L, Poggioli G. Outcomes of pelvic exenteration for recurrent and primary locally advanced rectal cancer. Int J Surg 2017; 48:69-73. [PMID: 28987560 DOI: 10.1016/j.ijsu.2017.09.069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 09/06/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pelvic exenteration is the only radical treatment for locally advanced (ARC) or recurrent (RRC) rectal cancers. The long-term results of the procedure are variably reported in the literature, with recent series suggesting similar survival between ARC and RRC. The study aimed to analyze and compare the long-term survival and perioperative outcomes of patients undergoing pelvic exenteration for ARC and RRC in a tertiary center. MATERIALS AND METHODS This was a retrospective analysis of prospectively collected data. Comparison of variables was performed using Chi-square, Fisher's exact or Wilcoxon rank sum test as appropriate. The Kaplan Meier method was used to analyze the disease-free survival (DFS) and the log-rank test to compare the two groups. RESULTS Since 2002, 46 patients underwent pelvic exenteration for ARC (28, 60.9%) and RRC (18, 39.1%). The groups had comparable characteristics, perioperative results, including postoperative complications, and rate of adjuvant chemotherapy. A R0 resection was obtained in 71.4% and 55.6% (p 0.41) and a T4 stage was diagnosed in 75% and 94.4% (p 0.22) of ARC and RRC patients, respectively. After a median follow-up time of 32.5 and 56.6 months (p 0.01), the 5-year DFS was significantly lower in the RRC group (23.6 vs 46.2%, p 0.006), even after exclusion of R1 cases (30 vs 54.5%, p 0.044). CONCLUSION The long-term disease free survival of patients undergoing pelvic exenteration is significantly worse when the procedure is performed for RRC, regardless of the tumor involvement of the resection margins.
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Affiliation(s)
- Matteo Rottoli
- Surgery of the Alimentary Tract, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Carlo Vallicelli
- Surgery of the Alimentary Tract, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Luca Boschi
- Surgery of the Alimentary Tract, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Gilberto Poggioli
- Surgery of the Alimentary Tract, Sant'Orsola - Malpighi Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
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Bailon-Cuadrado M, Blanco-Alvarez JI, Velasco-Lopez R, Rodriguez-Lopez M. Second isolated anastomotic recurrence after curative surgery for colorectal cancer. Ann R Coll Surg Engl 2016; 99:e56-e57. [PMID: 27791414 DOI: 10.1308/rcsann.2016.0318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Introduction The two mechanisms postulated for cancer recurrence at the anastomosis site ('anastomotic recurrence' (AR)) after curative surgery for colorectal cancer are: (i) intraluminal dissemination of viable cancer cells; (ii) metachronous carcinogenesis related with changes in the local milieu provoked by the materials employed to carry out the anastomosis. Case History We describe a 79-year-old female who underwent a left hemicolectomy due to a stenotic lesion shown on colonoscopy: an adenocarcinoma (pT3NO, G2). One year after surgery, control colonoscopy revealed an AR, so a new resection was carried out. Pathology showed it to be a recurrent adenocarcinoma over the staple line (pT3N0, G2). One year after the second surgical procedure, control colonoscopy evinced a new AR, resulting in a new resection. Pathology revealed a new AR. Conclusions This is only the second time that a second isolated AR after curative resection for colorectal cancer has been reported.
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