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Samalavicius NE, Klimasauskiene V, Nausediene V, Miknevicius P, Kilius A, Dulskas A. Laparoscopic ventral mesh rectopexy for recurrent full-thickness rectal prolapse after failed Altemeier operation - A video vignette. Colorectal Dis 2024. [PMID: 38590008 DOI: 10.1111/codi.16980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 03/09/2024] [Indexed: 04/10/2024]
Affiliation(s)
- Narimantas E Samalavicius
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Health Research and Innovation Science Centre, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | | | - Vaida Nausediene
- Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
- Managment of Human Health Activities, Faculty of Health Sciences, Klaipeda University, Klaipeda, Lithuania
| | | | - Alfredas Kilius
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Audrius Dulskas
- Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Vilnius, Lithuania
- Department of Surgical Oncology, National Cancer Institute, Vilnius, Lithuania
- SMK College of Applied Sciences, Vilnius, Lithuania
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Bausys A, Kuliavas J, Dulskas A, Kryzauskas M, Pauza K, Kilius A, Rudinskaite G, Sangaila E, Bausys R, Stratilatovas E. Early versus standard closure of temporary ileostomy in patients with rectal cancer: A randomized controlled trial. J Surg Oncol 2019; 120:294-299. [PMID: 31042015 DOI: 10.1002/jso.25488] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/04/2019] [Accepted: 04/18/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND OBJECTIVES A significant proportion of patients undergoing rectal cancer surgery receive a temporary ileostomy because of its benefits in case of anastomotic dehiscence. However, the best timing for closure remains unclear. METHODS Early closure (EC; 30 days after creation) and standard closure (SC; 90 days after creation) of ileostomy were compared in a single-center randomized controlled trial conducted at National Cancer Institute (Vilnius, Lithuania). Patients with a temporary ileostomy who underwent rectal cancer surgery and did not have anastomotic leakage or other serious complications were randomized to early or standard ileostomy closure groups. Thirty days postoperative morbidity following ileostomy closure was the primary outcome of the study. RESULTS The trial was prematurely terminated due to the safety reason after 86 patients were randomized to EC (43 patients) and SC (43 patients) groups. The overall 30 days postoperative morbidity rate was dramatically higher in the EC group (27.9% vs 7.9%; P = 0.024). Moreover, severe complications (Clavien-Dindo ≥3) were present only after EC of ileostomy in five (11.6%) patients. CONCULSION Early closure of ileostomy at 30 days after radical rectal resection is not safe and should not be performed.
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Affiliation(s)
- Augustinas Bausys
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Clinic of Gastroenterology, nephrourology, and surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Justas Kuliavas
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Audrius Dulskas
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Clinic of Gastroenterology, nephrourology, and surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania
| | - Marius Kryzauskas
- Clinic of Gastroenterology, nephrourology, and surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kastytis Pauza
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Alfredas Kilius
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Giedre Rudinskaite
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Egidijus Sangaila
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Rimantas Bausys
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Clinic of Gastroenterology, nephrourology, and surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Eugenijus Stratilatovas
- Department of Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Clinic of Gastroenterology, nephrourology, and surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Dulskas A, Atkociunas A, Kilius A, Petrulis K, Samalavicius NE. Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis. Visc Med 2018; 35:151-155. [PMID: 31367611 DOI: 10.1159/000493281] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure which allows local excision of early-stage rectal cancer and can be used as an alternative treatment to radical surgery. Patients can undergo salvage total mesorectal excision (sTME) following TEM after finding of unfavourable histological features. This study aimed to compare results and possible complications of sTME following TEM and primary TME (pTME) procedures. Methods Between 2010 and 2017, early sTME was performed in 9 patients at the National Cancer Institute in Vilnius, Lithuania. These patients were compared with 18 patients who underwent pTME, matched according to gender, age, cancer stage, and operative procedure. Data were obtained from the patients' charts and reviewed prospectively. We recorded the demographics, tumour specifications, treatment, operation time, postoperative results complications, and oncological outcome. Fisher's exact test and student's T test was used to compare both groups. Results A total of 130 patients underwent TEM at our institution during the study period, of which 9 (6.92%) had to undergo sTME. The average age of the patients was 62.7 ± 7.07 years; 44.4% of the patients were male and 55.6% female. The average tumour size in the sTME group was 2.8 ± 1.05 cm (range 1.5-5) and 2.61 ± 1.36 cm (range 1-5) in the pTME group (p = 0.696). When comparing postoperative complications, statistically significant results were not found in either of the groups (p = 0.55). Operation time of pTME was significantly shorter on average, i.e. 43 min, compared to sTME (p < 0.0267). The average number of harvested lymph nodes was 12.44 ± 7.126 in the sTME and 12.5 ± 8.06 in the pTME group (p = 0.986). The circumferential resection margin (CRM) was negative in 92.6% (25/27) of specimens, while the CRM was positive in 2 cases (7.4%), both of which were from the sTME group. The average follow-up time was 22.8 months (8-80 months) for patients undergoing sTME and 19.33 months (2-88 months) for patients after pTME (p = 0.71). Conclusions TEM is a relatively safe method for treating patients with early rectal cancer without high-risk features. It can be used in exceptional cases with high-risk features when the patient is not fit for radical surgery.
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Affiliation(s)
- Audrius Dulskas
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Faculty of Health Care, University of Applied Sciences, Vilnius, Lithuania.,Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Alfredas Kilius
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Kestutis Petrulis
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Narimantas E Samalavicius
- Department of Abdominal and General Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania.,Department of Surgery, Klaipeda University Hospital, Klaipeda, Lithuania
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Samalavičius NE, Dulskas A, Petrulis K, Kilius A, Tikuišis R, Lunevičius R. Hybrid transanal and total mesorectal excision after transanal endoscopic microsurgery for unfavourable early rectal cancer: a report of two cases. Acta Med Litu 2017; 24:188-192. [PMID: 29217973 PMCID: PMC5709058 DOI: 10.6001/actamedica.v24i3.3553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Completion total mesorectal excision (TME) is a rare but complex procedure after transanal endoscopic microsurgery for early rectal cancer with unfavourable final histology. Two cases are reported when completion TME was performed after upfront transanal partial mesorectal dissection. Intact non-perforated TME specimens with negative and adequate distal and circumferential margins were created. The quality of both total mesorectal excisions was complete and distal margins were sufficient. We believe that our technique might be a way of approaching completion TME after TEM, especially in cases of low rectal cancer.
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Affiliation(s)
- Narimantas E Samalavičius
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, Vilnius, Lithuania.,Department of Surgery Klaipėda University Hospital, Klaipėda, Lithuania
| | - Audrius Dulskas
- General and Abdominal Surgery and Oncology Department, National Cancer Institute, Vilnius, Lithuania
| | - Kęstutis Petrulis
- General and Abdominal Surgery and Oncology Department, National Cancer Institute, Vilnius, Lithuania
| | - Alfredas Kilius
- General and Abdominal Surgery and Oncology Department, National Cancer Institute, Vilnius, Lithuania
| | - Renatas Tikuišis
- General and Abdominal Surgery and Oncology Department, National Cancer Institute, Vilnius, Lithuania
| | - Raimundas Lunevičius
- General Surgery Department, Aintree University Hospital NHS Foundation Trust, University of Liverpool, Liverpool, United Kingdom
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Samalavicius NE, Dulskas A, Aliukonis V, Rackauskas R, Kilius A. Hybrid transanal and laparoscopic hand-assisted total mesorectal excision for low rectal cancer. ANZ J Surg 2017; 87:953-954. [PMID: 29098779 DOI: 10.1111/ans.13838] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/09/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Narimantas E Samalavicius
- General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania.,General and Abdominal Surgery and Oncology, Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, National Cancer Institute, Vilnius, Lithuania
| | - Audrius Dulskas
- General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Vygintas Aliukonis
- General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Rokas Rackauskas
- General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
| | - Alfredas Kilius
- General and Abdominal Surgery and Oncology, National Cancer Institute, Vilnius, Lithuania
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Dulskas A, Kilius A, Petrulis K, Samalavicius NE. Transanal Endoscopic Microsurgery for Patients With Rectal Tumors: A Single Institution's Experience. Ann Coloproctol 2017; 33:23-27. [PMID: 28289660 PMCID: PMC5346777 DOI: 10.3393/ac.2017.33.1.23] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/11/2016] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to look at our complication rates and recurrence rates, as well as the need for further radical surgery, in treating patients with benign and early malignant rectal tumors by using transanal endoscopic microsurgery (TEM). METHODS Our study included 130 patients who had undergone TEM for rectal adenomas and early rectal cancer from December 2009 to December 2015 at the Department of Surgical Oncology, National Cancer Institute, Lithuania. Patients underwent digital and endoscopic evaluation with multiple biopsies. For preoperative staging, pelvic magnetic resonance imaging or endorectal ultrasound was performed. We recorded the demographics, operative details, final pathologies, postoperative lengths of hospital stay, postoperative complications, and recurrences. RESULTS The average tumor size was 2.8 ± 1.5 cm (range, 0.5-8.3 cm). 102 benign (78.5%) and 28 malignant tumors (21.5%) were removed. Of the latter, 23 (82.1%) were pT1 cancers and 5 (17.9%) pT2 cancers. Of the 5 patients with pT2 cancer, 2 underwent adjuvant chemoradiotherapy, 1 underwent an abdominoperineal resection, 1 refused further treatment and 1 was lost to follow up. No intraoperative complications occurred. In 7 patients (5.4%), postoperative complications were observed: urinary retention (4 patients, 3.1%), postoperative hemorrhage (2 patients, 1.5%), and wound dehiscence (1 patient, 0.8%). All complications were treated conservatively. The mean postoperative hospital stay was 2.3 days. CONCLUSION TEM in our experience demonstrated low complication and recurrence rates. This technique is recommended for treating patients with a rectal adenoma and early rectal cancer and has good prognosis.
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Affiliation(s)
- Audrius Dulskas
- Centre of Oncosurgery, National Cancer Institute, Vilnius, Lithuania
| | - Alfredas Kilius
- Centre of Oncosurgery, National Cancer Institute, Vilnius, Lithuania
| | - Kestutis Petrulis
- Centre of Oncosurgery, National Cancer Institute, Vilnius, Lithuania
| | - Narimantas E Samalavicius
- Centre of Oncosurgery, National Cancer Institute, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius, Lithuania
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Dulskas A, Klivickas A, Kilius A, Samalavicius NE, Sumauskas R, Markelis R. Multiple malignant inflammatory myofibroblastic tumors of the jejunum: A case report and literature review. Oncol Lett 2016; 11:1586-1588. [PMID: 26893784 DOI: 10.3892/ol.2015.4060] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 11/10/2015] [Indexed: 11/06/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) are rare neoplastic lesions with a tendency for locally aggressive behavior and recurrence. IMTs most frequently occur in the soft tissues of children and young adults, with the lungs being the most commonly affected site; however, it has been recognized that any anatomical location may be involved. IMT in the jejunum is extremely rare, with only one case previously reported in the literature. The current study describes the case of a 42-year-old woman presenting with intermittent abdominal pain and small bowel intussusception that was identified during a laparotomy. Surgical resection of the jejunum, revealing 3 exophytic tumors, provided specimens for analysis. Following histological examination, a diagnosis of IMT was made. A review of the literature regarding this rare disease is also presented to emphasize the risk of local recurrence and the importance of adequate long-term follow-up.
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Affiliation(s)
| | | | | | - Narimantas E Samalavicius
- National Cancer Institute, Vilnius 08406, Lithuania; Centre of Oncosurgery, National Cancer Institute, Clinic of Internal, Family Medicine and Oncology, Faculty of Medicine, Vilnius 08406, Lithuania
| | - Romualdas Sumauskas
- Department of Neurosurgery, Republican Vilnius University Hospital, Vilnius 04130, Lithuania
| | - Rytis Markelis
- Department of Surgery, Hospital of Oncology, Hospital of Lithuanian University of Health Sciences Kaunas Clinics, Kaunas 45434, Lithuania
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Baušys A, Klimas D, Kilius A, Pauža K, Rudinskaite˙ G, Sinkevičius Ž, Samalavičius N, Sangaila E, Baušys R. P-100 The Rhesus D - negative phenotype is one of the major risk factors for postoperative complications after gastrectomy for gastric carcinoma. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Baušys A, Klimas D, Kilius A, Pauža K, Rudinskaite˙ G, Samalavičius N, Sinkevičius Ž, Sangaila E, Baušys R. P-101 Tumor differentiation is a risk factor for lymph node metastasis in patients with gastric cancer. Ann Oncol 2015. [DOI: 10.1093/annonc/mdv233.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Kilius A, Samalavicius NE, Danys D, Zaldokas G, Seinin D. Asymptomatic heterotopic pancreas in Meckel's diverticulum: a case report and review of the literature. J Med Case Rep 2015; 9:108. [PMID: 25956067 PMCID: PMC4460693 DOI: 10.1186/s13256-015-0576-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 03/19/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Heterotopic pancreas is defined as pancreatic tissue without a real anatomical or vascular connection to the pancreas. It can be found in the stomach, duodenum, jejunum, ileum, Meckel’s diverticulum, colon gall bladder, umbilicus, fallopian tube, mediastinum, spleen and liver. Complications of heterotopic pancreas are inflammation, bleeding, obstruction, malignant transformation, carcinoid syndrome, jejunojejunal intussusception and ileus, but it is usually asymptomatic and diagnosed only during examinations for other diseases. Case presentation An 81-year-old Lithuanian woman was diagnosed with caecal cancer and had undergone elective surgery. A right hemicolectomy was performed and a Meckel’s diverticulum was observed and excised. Histological results showed a poorly differentiated G3 adenocarcinoma of her large intestine and heterotopic pancreas tissue in the Meckel’s diverticulum and mesenteric adipose tissue. Conclusions Asymptomatic heterotopic pancreas is rarely diagnosed, and usually found incidentally during surgical or diagnostic interventions. Although it has no symptoms, heterotopic pancreas found during surgical procedures should be excised.
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Affiliation(s)
- Alfredas Kilius
- Center of Oncosurgery, National Cancer Institute, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania.
| | - Narimantas Evaldas Samalavicius
- Center of Oncosurgery, National Cancer Institute, Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania.
| | - Donatas Danys
- Center of Oncosurgery, National Cancer Institute, Vilnius University, 1 Santariskiu Street, LT-08406, Vilnius, Lithuania.
| | - Gytis Zaldokas
- Vilnius University, Medical Faculty, Vilnius, Lithuania.
| | - Dmitrij Seinin
- National Center of Pathology, P. Baublio 5, Vilnius, LT-08406, Lithuania.
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Samalavicius N, Ambrazevicius M, Kilius A, Petrulis K. Transanal endoscopic microsurgery for early rectal cancer: single center experience. Wideochir Inne Tech Maloinwazyjne 2014; 9:603-7. [PMID: 25561999 PMCID: PMC4280406 DOI: 10.5114/wiitm.2014.44138] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/03/2014] [Accepted: 04/02/2014] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The use of transanal endoscopic microsurgery (TEM) is increasing due to the ability to perform minimally invasive local treatment with large full-thickness local excision under improved vision. AIM To evaluate the initial experience with TEM for early rectal cancer in a single center. MATERIAL AND METHODS From February 2010 to November 2013 a total of 20 patients underwent TEM for early rectal cancer. Nine were women and 11 men, age range 39 to 88 years (median: 71 years). The postoperative surveillance protocol, which includes rigid proctoscopy, carcinoembryonic antigen (CEA) and endorectal ultrasound every 3 months during the first 2 years, was applied to all patients after TEM. RESULTS Final histology revealed 14 (70%) lesions to be T1 and 6 (30%) T2 cancers. There were no postoperative complications. All 6 patients in the pT2 group and those in the pT1 group with unfavorable histology were offered adjuvant chemoradiotherapy or immediate radical surgery. Patients were followed up from 2 to 35 months (median: 21 months). There was one local recurrence (5%) in a patient who refused to undergo abdominoperineal excision for T1 low rectal cancer, had unfavorable histology after TEM, and for which reason underwent postoperative chemoradiation. The patient had abdominoperineal resection 7 months after TEM (rpT2N0M0). One patient was lost to follow-up. The rest of the patients are alive and disease-free. CONCLUSIONS In our hands, TEM was an alternative to total mesorectal excision in patients with low-risk early rectal cancer. Further follow-up is necessary to evaluate recurrence and survival rates after TEM for patients with invasive rectal cancer.
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Affiliation(s)
- Narimantas Samalavicius
- Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania
- Clinic of Internal Diseases, Family Medicine and Oncology of Medical Faculty, Vilnius University, Vilnius, Lithuania
| | - Marijus Ambrazevicius
- Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Alfredas Kilius
- Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania
| | - Kestutis Petrulis
- Center of Oncosurgery, Institute of Oncology, Vilnius University, Vilnius, Lithuania
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Samalavicius NE, Dulskas A, Kilius A, Petrulis K, Norkus D, Burneckis A, Valuckas KP. Treatment of hemorrhagic radiation-induced proctopathy with a 4% formalin application under perianal anesthetic infiltration. World J Gastroenterol 2013; 19:4944-4949. [PMID: 23946599 PMCID: PMC3740424 DOI: 10.3748/wjg.v19.i30.4944] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Revised: 04/05/2013] [Accepted: 05/08/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the results of hemorrhagic radiation proctopathy treatment with a 4% formalin application.
METHODS: A prospective study was performed. Over a three-year period, 38 patients underwent 4% formalin application under perianal anesthetic infiltration for hemorrhagic radiation proctopathy. All patients included in the study were irradiated for prostate cancer. The patients ranged in age from 56-77 years (average 70 ± 5 years). All of the patients were referred for formalin therapy after noninvasive management had failed. Twenty-four (63.2%) patients underwent a single application, 10 (26.3%) patients underwent 2 applications, and 4 (10.5%) patients underwent 3 applications.
RESULTS: Two to 36 mo (average 12 ± 3 mo) following treatment, 34 patients were interviewed (four were lost to follow-up). Twenty (58.8%) subjects reported complete cure, 8 (23.5%) subjects reported significant improvement, and 6 (17.7%) subjects reported no change. One patient (who underwent a colostomy at a regional hospital with no specialized services available for previous bleeding episodes from radiation proctopathy) was cured, and the colostomy was closed. One patient (2.6%) developed rectal mucosal damage after the second application.
CONCLUSION: A 4-min application of 4% formalin for hemorrhagic radiation-induced proctopathy under perianal anesthetic infiltration in patients who have received external radial radiation therapy for prostate cancer is simple, reasonably safe, inexpensive, generally well tolerated, and effective.
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