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Romo JA, Aguilera PA, López A, Pedraza M, Figueroa C. Experience in colorectal surgery at a quaternary care hospital in Bogotá, Colombia. Rev Gastroenterol Mex (Engl Ed) 2023; 88:214-219. [PMID: 35525791 DOI: 10.1016/j.rgmxen.2021.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 08/19/2021] [Indexed: 10/18/2022]
Abstract
INTRODUCTION AND AIMS Colorectal cancer is among the three most common cancers worldwide. Knowledge and identification of suboptimal outcome-associated factors enable comprehensive patient management. The aim of the present study was to present the results of the surgical management of colorectal cancer at a quaternary care university hospital. MATERIALS AND METHODS An observational, analytic, cross-sectional study was conducted. Information was collected on a retrospective cohort of patients diagnosed with colorectal cancer from 2013 to 2017 at the Hospital Universitario Mayor Méderi, Bogotá, Colombia. RESULTS Data on 452 patients, within the study period, were collected. A total of 48.5% of the patients were men, the overall complication rate was 24%, the surgical site infection (SSI) rate was 15.38%, anastomotic dehiscence occurred in 4.18% of the patients, bleeding required reoperation in 1.32%, and the intrahospital mortality rate was 7.47%. CONCLUSION Colorectal cancer management at a university hospital was as beneficial as that provided by other types of hospitals, showing a direct association with complete R0 dissections; low complication rates, according to international reports; and reduced overall morbidity.
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Affiliation(s)
- J A Romo
- Departamento Cirugía General, Universidad del Rosario, Bogotá DC, Colombia.
| | - P A Aguilera
- Departamento de Epidemiología, Hospital Universitario Mayor Méderi, Bogotá DC, Colombia
| | - A López
- Departamento de Medicina, Universidad del Rosario, Bogotá DC, Colombia
| | - M Pedraza
- Departamento Cirugía General, Universidad El Bosque, Bogotá DC, Colombia
| | - C Figueroa
- Departamento de Cirugía Colorrectal, Hospital Universitario Mayor Méderi, Bogotá DC, Colombia
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Gülbahar Ateş S, Bilir Dilek G, Uçmak G. Primary tumor heterogeneity on pretreatment 18F-FDG PET/CT to predict outcome in patients with rectal cancer who underwent surgery after neoadjuvant therapy. Rev Esp Med Nucl Imagen Mol 2023:S2253-8089(23)00001-0. [PMID: 36690032 DOI: 10.1016/j.remnie.2023.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 10/17/2022] [Revised: 01/02/2023] [Accepted: 01/03/2023] [Indexed: 01/21/2023]
Abstract
PURPOSE This retrospective study aimed to investigate the value of texture features of primary tumors in pretreatment 18F-FDG PET/CT in the prediction of response to treatment, progression, and overall survival in patients with rectal cancer who underwent surgery after neoadjuvant therapy(NAT). METHODS Patients with rectal cancer who had pretreatment 18F-FDG PET/CT, and underwent surgery after NAT were included in this study. Clinicopathologic features, date of last follow-up, progression, and death were recorded. Textural and conventional PET parameters(maximum standardized uptake value-SUVmax, metabolic tumor volume-MTV, total lesion glycolysis-TLG) were obtained from PET/CT images using LifeX program. Parameters were grouped using Youden index in ROC analysis. Factors predicting the pathological response to treatment, progression, and overall survival were determined using logistic regression and Cox regression analyses. RESULTS Forty-four patients (26(59%) male, 18(41%) female; 60.1±11.4 years) with rectal cancer were included in this study. The numbers of patients with responders and non-responders to NAT were 15(34.9%) and 28(65.1%), respectively. One patient' pathology report did not contain the response status to NAT. The median of follow-up duration was 29.9 months. 9(20.5%) showed disease progression, and 8(18.2%) died during the follow-up period. Difference entropyGLCM and correlationGLCM parameters were found as independent predictors for response to NAT. The positivity of surgical margin, intensity interquartile rangeCONV and AUC-CSHDISC texture parameters were independent predictors of progression, while normalized inverse differenceGLCM and LZLGEGLZLM parameters were independent predictors of mortality. CONCLUSION The texture parameters obtained from pretreatment 18F-FDG PET/CT have presented a more robust predictive value than conventional parameters in patients with rectal cancer who underwent surgery after NAT.
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Affiliation(s)
- Seda Gülbahar Ateş
- Department of Nuclear Medicine, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey.
| | - Gülay Bilir Dilek
- Department of Pathology, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Gülin Uçmak
- Department of Nuclear Medicine, Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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Aparicio-López D, Gascón-Ferrer I, Martínez-Germán A, Santero-Ramírez MP, Sánchez-Fuentes MN, Gracia-Roche C, Saudí-Moro S, Duque-Mallén MV. Application of the REAL-score prognostic index in decision making in rectal cancer surgery. CIR CIR 2023; 91:690-697. [PMID: 37844900 DOI: 10.24875/ciru.22000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/22/2022] [Indexed: 10/18/2023]
Abstract
BACKGROUND Colorectal anastomosis leak (AL) is the most feared complication of rectal cancer surgery (1-19%) as it increases morbidity and mortality and worsens oncological outcomes in terms of local recurrence and survival. The publication of the REAL-score index makes it possible to predict the risk of AL and compare the expected results with those obtained. METHOD Observational, descriptive, longitudinal and retrospective study of patients operated on for rectal cancer at the Miguel Servet University Hospital, in Zaragoza, Spain, in 2019. Statistical analysis of morbidity and mortality outcome variables and the REAL-score index using ROC curves. RESULTS Of 80 patients operated on for rectal cancer, colorectal anastomosis was performed in 52 and temporary ileostomy in 11 (21.2%). Morbidity was high (38.4%), but severe only in 7.7% (Clavien-Dindo IIIb), with no deaths. There were four dehiscences: one type B and three type C. A direct relationship between high risk of AL and the practice of temporary stoma is observed when the cut-off point of the REAL-score exceeds 14.74%. CONCLUSIONS REAL-score can help in decision-making in rectal cancer surgery. Above a cut-off point, the risk of AL would imply a selective ileostomy.
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Affiliation(s)
- Daniel Aparicio-López
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Isabel Gascón-Ferrer
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Antonio Martínez-Germán
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - María P Santero-Ramírez
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - María N Sánchez-Fuentes
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Carlos Gracia-Roche
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - Sef Saudí-Moro
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
| | - María V Duque-Mallén
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Universitario Miguel Servet, Zaragoza, España
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4
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López-Basave HN, Morales-Vázquez F, Miranda-Dévora G, Olmos-García JP, Hernández-Castañeda KF, Rivera-Mogollan LG, Muñoz-Montaño WR. Clinicopathological features of colorectal cancer patients under 30 years of age. CIR CIR 2023; 91:785-793. [PMID: 38096862 DOI: 10.24875/ciru.22000467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 10/15/2022] [Indexed: 12/18/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) is the second cause of cancer death in the world and is estimated to have been responsible for almost 935,000 deaths during 2020. OBJECTIVE Describe clinicopathological features, overall survival (OS) and progression-free survival (PFS) in CRC patients under 30 years. METHOD This is a retrospective cohort study in patients under 30 years diagnosed with CRC. RESULTS From 2017 to 2021, 1823 patients were diagnosed with CRC, of which 54 (2.96%) were under 30 years. The OS, during 4 years, was 41.5%. The clinical stage found IV (hazard ratio [HR]: 6.212; 95% confidence interval [95% CI]: 2.504-15.414; p < 0.001), giving neoadjuvant therapy (HR: 0.705; 95% CI: 0.499-0.996; p = 0.047) and no medical history of Lynch syndrome (HR: 3.925; 95% CI: 1.355-11.364; p = 0.012) are independent predictors of mortality. The PFS, during 4 years, was 21.3%. Clinical stage IV (HR: 2.418; 95% CI: 1.000-5.850; p < 0.050), and no diagnosis of Lynch syndrome (HR: 3.800; 95% CI: 1.398-10.326; p = 0.009) are independent predictors. CONCLUSIONS Younger patients are usually diagnosed with CRC in advanced stages. Early symptoms and evaluation, irrespective of age, are crucial.
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Affiliation(s)
| | | | | | | | | | | | - Wendy R Muñoz-Montaño
- Departamento de Tórax, Oncología Médica. Instituto Nacional de Cancerología, Ciudad de México, México
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Liu Q, Qin G, Xiang T, Xiao W, Zhao Y, Pang Y. Laparoscopic radical resection for rectal cancer in a patient with uncorrected truncus arteriosus type IV: A case report. Rev Esp Anestesiol Reanim (Engl Ed) 2023; 70:56-59. [PMID: 36621567 DOI: 10.1016/j.redare.2021.05.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/23/2021] [Indexed: 01/07/2023]
Abstract
Persistent truncus arteriosus is a rare congenital heart malformation which if not corrected, results in the death of about 50% of the patients, while fewer than 20% of the patients survive the first year of life. Here, we report the successful anesthetic management of an adult patient with uncorrected truncus arteriosus who presented for the laparoscopic radical resection of rectal cancer.
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Affiliation(s)
- Q Liu
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China.
| | - G Qin
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - T Xiang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - W Xiao
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Y Zhao
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
| | - Y Pang
- Department of Anesthesiology, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan, China
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Lorenzo Liñán MÁ, García Armengol J, Martín Martín GP, Martínez Sanjuán V, Roig Vila JV. Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer. Cir Esp 2022; 100:772-779. [PMID: 36064169 DOI: 10.1016/j.cireng.2022.08.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/06/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Distance from anal verge of rectal tumours and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumours and if the pelvic MRI can substitute the classical instrumental methods. METHODS Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed. RESULTS 96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC = 103.5 mm, was significantly greater than others, which had similar values: pRR = 81.1; MRI = 77.4; iRR = 82.9 mm (P < .001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information. CONCLUSIONS There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumours of any location in the rectum.
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Affiliation(s)
- Miguel Ángel Lorenzo Liñán
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, Almería, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain.
| | - Juan García Armengol
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Gonzalo Pablo Martín Martín
- Cirugía, Centro Médico Teknon, Barcelona, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Vicente Martínez Sanjuán
- Servicio de Radiología y Resonancia Magnética, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - José Vicente Roig Vila
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, Spain; Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
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7
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Álvarez Sarrado E, Giner Segura F, Batista Domenech A, Garcia-Granero García-Fuster Á, Frasson M, Rudenko P, Flor Lorente B, Garcia-Granero Ximénez E. Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study. Cir Esp 2022; 100:488-495. [PMID: 35597413 DOI: 10.1016/j.cireng.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/15/2021] [Indexed: 06/15/2023]
Abstract
INTRODUCTION To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement. METHODS Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. RESULTS Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. CONCLUSIONS Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface.
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Affiliation(s)
| | - Francisco Giner Segura
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Adela Batista Domenech
- Sección de Abdomen, Servicio de Radiodiagnóstico, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | | | - Matteo Frasson
- Unidad de Coloproctología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Polina Rudenko
- Sección de Abdomen, Servicio de Radiodiagnóstico, Hospital Universitari i Politècnic La Fe, Valencia, Spain
| | - Blas Flor Lorente
- Unidad de Coloproctología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
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8
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Domínguez-Prieto V, León-Arellano M, Alvarellos-Pérez A, Ortega-López M, Pastor C. Necrotizing fasciitis as a complication of late anastomotic leak after anterior resection for rectal cancer. CIR CIR 2021; 89:80-83. [PMID: 34932541 DOI: 10.24875/ciru.20001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/17/2022]
Abstract
BACKGROUND Anastomotic leak is a serious complication of rectal cancer surgery that leads to increased morbidity and mortality. Its incidence is 3-21%, usually appearing 5-7 days after surgery, although there are cases of late presentation as chronic anastomotic fistulas or sinuses. CASE REPORT We present three cases of patients who underwent anterior resection for rectal cancer and developed necrotizing fasciitis due to late anastomotic leaks. CONCLUSIONS We believe that early and resolutive surgical treatment is recommended for chronic anastomotic fistulas or sinuses, even when asymptomatic, because of the associated risk of necrotizing fasciitis.
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Affiliation(s)
| | | | | | - Mario Ortega-López
- Unidad de Cirugía Colorrectal, H.U. Fundación Jiménez Díaz. Madrid, España
| | - Carlos Pastor
- Unidad de Cirugía Colorrectal, Clínica Universidad de Navarra. Madrid, España
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Castaño R, Molina-Meneses SP, Puerta JD, Palacios LJ, Jaramillo R, Piñeres A, Aristizábal F. Impact of intraoperative colonoscopy on anastomotic leakage detection and prevention in colorectal anastomosis for rectal cancer. Rev Gastroenterol Mex (Engl Ed) 2021; 87:312-319. [PMID: 34872887 DOI: 10.1016/j.rgmxen.2021.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 02/03/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION AND AIM The value of leakage testing during colorectal resections to identify anastomotic leaks or bleeding has not been established. Our aim was to compare the impact of intraoperative colonoscopy (IOC) versus insufflation with a syringe, as leakage testing in lower anterior resection (LAR) for rectal cancer, with respect to the incidence of postoperative leakage (PL). MATERIALS AND METHODS A retrospective study utilizing a prospective database of 426 patients with rectal cancer that underwent elective LAR, within the time frame of January 2015 and December 2019, was conducted. The anastomotic leak test was chosen by the surgeon. The incidence of postoperative leakage was compared between patients that underwent IOC and those that had the syringe leak test, utilizing the logistic regression analysis. Propensity score matching was included. RESULTS There were no significant differences in the clinical characteristics or morbidity and mortality rates between the two groups. Four patients were excluded, leaving a patient total of 422. Seventy patients with IOC were compared with 352 that had the syringe leak test. The incidence of postoperative leakage was 5.7% in the IOC group and 12.2% in the control group (p = 0.001). After propensity score matching (n = 221), balancing the characteristics between the groups, the incidence of postoperative leakage was 5.7% in the IOC group and 13.9% in the syringe leak test group (p = 0.001). CONCLUSION IOC was shown to be a safe method for evaluating the integrity of colorectal anastomosis and was associated with a higher percentage of protective stoma use, appearing to reduce the risk for PL.
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Affiliation(s)
- R Castaño
- Cirugía Gastrointestinal y Endoscopia, Grupo de Gastrohepatología, Universidad de Antioquia, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - S P Molina-Meneses
- Cirugía General, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia.
| | - J D Puerta
- Coloproctología, Clínica Las Américas, Universidad Pontificia Bolivariana, Medellín, Antioquia, Colombia
| | - L J Palacios
- Cirugía Oncológica, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - R Jaramillo
- Cirugía Oncológica, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - A Piñeres
- Cirugía Gastrointestinal y Endoscopia, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
| | - F Aristizábal
- Cirugía General, Instituto de Cancerología, Clínica Las Américas, AUNA, Medellín, Antioquia, Colombia
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Lorenzo Liñán MÁ, García Armengol J, Martín Martín GP, Martínez Sanjuán V, Roig Vila JV. Validation of pelvic magnetic resonance imaging as the method of choice to determine the distance to the anal margin in rectal cancer. Cir Esp 2021; 100:S0009-739X(21)00245-1. [PMID: 34493375 DOI: 10.1016/j.ciresp.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 03/17/2021] [Revised: 06/30/2021] [Accepted: 07/06/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Distance from anal verge of rectal tumors and their anatomical relationships contribute to determine the multidisciplinary therapeutic strategy based on the combination of radio-chemotherapy and radical surgery. Our aims are to investigate which is the most accurate method for the preoperative measuring of the distance from the anal verge in rectal tumors and if the pelvic MRI can substitute the classical instrumental methods. METHODS Prospective study of diagnostic precision between flexible colonoscopy (FC), preoperative rigid rectosigmoidoscopy (pRR) and pelvic MRI in patients scheduled to radical surgery. Rigid intraoperative rectoscopy (iRR) was considered the reference test. The correlations between the different techniques and their determination coefficient as well as the intraclass correlation coefficient and the degree of agreement between the different tests were analyzed. RESULTS 96 patients (65% males), mean age (SD): 68 (14.1) years were included. 72% received neoadjuvant treatment. The mean distance to the anal margin measured by FC=103.5mm, was significantly greater than others, which had similar values: pRR=81.1; MRI=77.4; iRR=82.9mm (P<.001). A significant intraclass correlation was observed and there was high agreement between all pre- and intraoperative measurements except for the performed by FC, which overestimated the results. MRI provided more individualized and accurate information. CONCLUSIONS There is variability between the measurement methods, being colonoscopy the least reliable. MRI offers objective, comparable, accurate and individualized values that can replace those obtained by pRR for tumors of any location in the rectum.
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Affiliation(s)
- Miguel Ángel Lorenzo Liñán
- Servicio de Cirugía General y Digestiva, Hospital Universitario Torrecárdenas, , Almería, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España.
| | - Juan García Armengol
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Gonzalo Pablo Martín Martín
- Cirugía, Centro Médico Teknon, Barcelona, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - Vicente Martínez Sanjuán
- Servicio de Radiología y Resonancia Magnética, Consorcio Hospital General Universitario de Valencia, Valencia, España
| | - José Vicente Roig Vila
- Centro Europeo de Cirugía Colorrectal, Hospital Vithas Valencia 9 de Octubre, Valencia, España; La filiación de Miguel Ángel Lorenzo Liñán, Juan García Armengol, Gonzalo Pablo Martin Martin y José Vicente Roig Vila en el momento de la realización de este artículo era: Servicio de Cirugía General y del Aparato Digestivo, Consorcio Hospital General Universitario de Valencia, Valencia, España
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Pascual-Russo A, Milito D, Facio L, Furia M, Forestier V, Iseas S, Méndez G, Coraglio M, Lumi CM, Masciangioli G, Mauriño E, Vázquez H. Better quality of life and reduced fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy. Rev Gastroenterol Mex (Engl Ed) 2021; 86:340-347. [PMID: 34247991 DOI: 10.1016/j.rgmxen.2020.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Accepted: 07/06/2020] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. AIM To analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. MATERIALS AND METHODS Thirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). RESULTS Bowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p < 0.03). CONCLUSIONS The WW follow-up strategy in patients with locally advanced rectal cancer was associated with better quality of life and reduced fecal incontinence.
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Affiliation(s)
- A Pascual-Russo
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina.
| | - D Milito
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - L Facio
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Furia
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - V Forestier
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - S Iseas
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Méndez
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Coraglio
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - C M Lumi
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Masciangioli
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - E Mauriño
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - H Vázquez
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina; Investigador Asociado, Gobierno de la Ciudad de Buenos Aires, CABA, Argentina
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Vergara-Fernández O, Armillas-Canseco F, Sanjuán-Sánchez C, Sánchez-García-Ramos E, Medina-Franco H. Exenteración pélvica para cáncer de recto localmente avanzado y recurrente: resultados a largo plazo y factores pronósticos. CIR CIR 2021; 89:449-456. [PMID: 34352866 DOI: 10.24875/ciru.20000535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/17/2022]
Abstract
OBJETIVO El objetivo de este trabajo fue analizar los resultados perioperatorios y a largo plazo de los pacientes sometidos a exenteración pélvica para cáncer de recto en un centro de referencia en la Ciudad de México. MÉTODO Se incluyeron todos los pacientes que se sometieron a exenteración pélvica por cáncer de recto entre 1995 y 2019. Se analizaron variables demográficas, clínicas, quirúrgicas y patológicas. RESULTADOS Se incluyeron 18 pacientes operados por cáncer de recto (16 localmente avanzados y 2 recurrentes). La relación hombre: mujer fue de 1:3.5. La morbilidad mayor fue del 27.7%. El sangrado intraoperatorio ≥ 1000 ml se asoció con morbilidad (80 vs. 20%; p = 0,029) y mortalidad posoperatoria (100 vs. 0; p = 0.043). La mediana de sobrevida global fue 102 meses. Las sobrevidas global y libre de enfermedad a los 5 años fueron del 44.4% y el 38.8%, respectivamente. La invasión linfovascular fue un factor de mal pronóstico para sobrevida libre de enfermedad (p = 0.017). CONCLUSIONES La exenteración pélvica para el cáncer de recto es un procedimiento quirúrgico con altas morbilidad y mortalidad. La invasión linfovascular es un factor de mal pronóstico para la sobrevida libre de enfermedad. INTRODUCTION Pelvic exenteration is a radical treatment for locally advanced and recurrent pelvic tumors. The aim of this study was to analyze the perioperative and long-term outcomes of patients undergoing pelvic exenteration for rectal cancer at a referral center in Mexico City. METHOD We included all patients who underwent pelvic exenteration due to rectal cancer between 1995 and 2019. Demographic, clinical, surgical and pathological variables were analyzed. RESULTS 18 patients were included (16 locally advanced and 2 recurrent). The male-female ratio was 1:3.5. The highest morbidity was 27.7%. Intraoperative bleeding ≥ 1000 ml was associated with postoperative morbidity (80 vs. 20%; p = 0.029) and mortality (100 vs. 0; p = 0.043). The median overall survival was 102 months. Overall survival and disease free survival at 5 years after exenteration were 44.4% and 38.8%, respectively. Lymphovascular invasion of the tumor was a poor prognostic factor for disease free survival (p = 0.017). CONCLUSIONS Pelvic exenteration for rectal cancer is a surgical procedure with high morbidity and mortality. Lymphovascular invasion is a poor prognostic factor for disease-free survival.
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Affiliation(s)
- Omar Vergara-Fernández
- Departamento de Cirugía de Colon y Recto. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Francisco Armillas-Canseco
- Departamento de Cirugía de Colon y Recto. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Carlos Sanjuán-Sánchez
- Departamento de Cirugía de Colon y Recto. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Emilio Sánchez-García-Ramos
- Departamento de Cirugía de Colon y Recto. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
| | - Heriberto Medina-Franco
- Departamento de Cirugía Oncológica. Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, México
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Álvarez Sarrado E, Giner Segura F, Batista Domenech A, Garcia-Granero García-Fuster Á, Frasson M, Rudenko P, Flor Lorente B, Garcia-Granero Ximénez E. Rectal cancer at the peritoneal reflection. Preoperative MRI accuracy and histophatologic correlation. Prospective study. Cir Esp 2021; 100:S0009-739X(21)00157-3. [PMID: 33992317 DOI: 10.1016/j.ciresp.2021.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 02/01/2021] [Revised: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION To investigate magnetic resonance imaging (MRI) accuracy for determining the location of rectal tumors with respect to the peritoneal reflection (PR) and its potential involvement. METHODS Prospective study of 161 patients ongoing surgery for rectal cancer. A double-ink method has been aplied to examine surgical specimen, orange ink for the serosal surface and indian ink for the mesorrectal margin, and assess preoperative MRI accuracy. RESULTS Twenty-two tumors were located above, 65 at and 74 below PR. MRI accuracy was 90.6% for determining tumor's location with respect to the PR and 80.5% for defining peritoneal involvement. For classifying tumors according to their intra or extraperitoneal location an accuracy of 92.5% was set for MRI. Histophatologic peritoneal involvement was found in 28.7% of tumors located above or at the PR. CONCLUSIONS Magnetic resonance imaging accurately predicts the location of rectal tumors with respect to the PR and its potential involvement. The double-ink method is useful to assess serosal involvement (pT4a) and to distinguish mesorrectal fascia from the peritonealized surface.
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Affiliation(s)
| | - Francisco Giner Segura
- Servicio de Anatomía Patológica, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Adela Batista Domenech
- Sección de Abdomen, Servicio de Radiodiagnóstico, Hospital Universitari i Politècnic La Fe, Valencia, España
| | | | - Matteo Frasson
- Unidad de Coloproctología, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Polina Rudenko
- Sección de Abdomen, Servicio de Radiodiagnóstico, Hospital Universitari i Politècnic La Fe, Valencia, España
| | - Blas Flor Lorente
- Unidad de Coloproctología, Hospital Universitari i Politècnic La Fe, Valencia, España
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Zuhdy M, Metwally IH, Elmore U, Roshdy S, Rosati R. Electro-thermal bipolar vessel sealing versus clipping of the inferior mesenteric vessels during minimally invasive proctectomy. CIR CIR 2020; 88:738-744. [PMID: 33254177 DOI: 10.24875/ciru.19001745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/17/2022]
Abstract
Introduction The introduction of new energy vessel sealing devices in minimally invasive proctectomy led to better hemostatic effect, less blood loss, and shorter operating time. At present, the available evidence from literature about the use of electro-thermal bipolar vessel sealers (EBVS) in laparoscopic rectal cancer surgery is weak where most studies are retrospective with non-homogenous patient groups. Methods This is a retrospective cohort study where 40 rectal cancer patients operated by laparoscopic TME or laparoscopic assisted transanal total mesorectal excision were classified in two groups according to approach of inferior mesenteric vessels ligation (EBVS versus Clipping). Results The operative time was significantly longer and the blood loss was significantly more in the EBVS group. However, hospital stay, time to oral, time to starting stoma function, and number of retrieved lymph nodes were not significantly affected by the method of vascular control. Conclusion Both methods for control of vascular pedicle during minimally invasive rectal cancer surgery are safe, as such it is at the discretion of the operating surgeon to which method to use. Prospective well-designed trials are awaited to provide stronger evidence.
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Affiliation(s)
- Mohamed Zuhdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Ugo Elmore
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
| | - Sameh Roshdy
- Surgical Oncology Unit, Oncology Center Mansoura University (OCMU), Mansoura, Egypt
| | - Riccardo Rosati
- Department of Gastrointestinal Surgery, San Raffaele Scientific Institute, University Vita-Salute, Milan, Italy
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Pascual-Russo A, Milito D, Facio L, Furia M, Forestier V, Iseas S, Méndez G, Coraglio M, Lumi CM, Masciangioli G, Mauriño E, Vázquez H. Better quality of life and reduced fecal incontinence in rectal cancer patients with the watch-and-wait follow-up strategy. Rev Gastroenterol Mex (Engl Ed) 2020; 86:S0375-0906(20)30090-2. [PMID: 32868135 DOI: 10.1016/j.rgmx.2020.06.006] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 01/16/2023]
Abstract
INTRODUCTION The watch-and-wait (WW) strategy is an alternative to anterior resection in patients with rectal cancer (RC) that have had a complete clinical response to neoadjuvant treatment. Few reports describe the quality of life and functional anorectal disorders (FADs) in that population. AIM To analyze and compare the FADs and quality of life in patients with locally advanced adenocarcinoma of the rectum treated with neoadjuvant therapy, divided into two different strategy groups: group 1 (G1), WW; and group 2 (G2), anterior resection. MATERIALS AND METHODS Thirty patients (G1: n = 20 and G2: n = 10) that had finished neoadjuvant therapy at least 12 months prior were included. Mean patient age was 59.5 years (range: 41-79) and 15 of the patients were men. The FADs were evaluated through: a) clinical history, b) 21-day bowel diary, c) Jorge and Wexner fecal incontinence scale, d) anorectal manometry (ARM), and fecal incontinence quality of life scale (FIQL). RESULTS Bowel diary: fecal incontinence (40%) and urge to defecate (45%) in G1 vs. fecal incontinence (60%) and urge to defecate (30%) in G2, with no significant differences (p = NS). Fecal incontinence scale: fecal incontinence in G1 was significantly less severe than that in G2 (median 6.5 points vs. 13 points [p = 0.0142]). ARM: no differences between the two groups. Quality of life: significantly different between the two groups (FIQL/G1: 3.7 vs. FIQL/G2: 2.8; p < 0.03). CONCLUSIONS The WW follow-up strategy in patients with locally advanced rectal cancer was associated with better quality of life and reduced fecal incontinence.
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Affiliation(s)
- A Pascual-Russo
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina.
| | - D Milito
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - L Facio
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Furia
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - V Forestier
- Motilidad Digestiva, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - S Iseas
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Méndez
- Sección Oncología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - M Coraglio
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - C M Lumi
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - G Masciangioli
- Servicio de Proctología, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - E Mauriño
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina
| | - H Vázquez
- Departamento de Medicina, Hospital de Gastroenterología «Dr. Carlos Bonorino Udaondo», CABA, Argentina; Investigador Asociado, Gobierno de la Ciudad de Buenos Aires. CABA, Argentina
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Palacios-Fuenmayor LJ, Naranjo-Isaza AM, Serna-Ortiz CA, Mosquera-Castro DA, Arbeláez-Leon LM, Gómez-Wolff LR, García-García HI, Sánchez-Patiño LA. Evaluation of the pathologic response to neoadjuvant treatment in rectal cancer. Experience at the Instituto de Cancerología de Medellín (Colombia, 2011-2017). Rev Gastroenterol Mex (Engl Ed) 2020; 86:13-20. [PMID: 32173132 DOI: 10.1016/j.rgmx.2019.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Revised: 11/01/2019] [Accepted: 11/29/2019] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND AIMS Neoadjuvant therapy in rectal cancer is associated with a decrease in tumor size and is the therapeutic indication for patients with T3 or T4 tumors or lymph node involvement. Our aim was to describe the frequency of pathologic response and the survival rate in patients that underwent neoadjuvant therapy for rectal cancer. MATERIALS AND METHODS A retrospective follow-up study with a survival analysis was conducted. Patients with locally advanced rectal cancer that received neoadjuvant treatment and were operated on at the Instituto de Cancerología Las Américas (Medellín, Colombia) were analyzed. Survival was calculated using the Kaplan-Meier method. RESULTS A total of 152 patients were included. Mean patient age was 59 years (12.8 SD), 53.9% were men, and 58.6% of the patients were diagnosed with stage IIIB disease. The pathologic complete response (pCR) was achieved in 17% of the patients. A total of 146 (96.1%) patients received the chemoradiotherapy protocol. Fifty-two (34.2%) patients developed metastasis and/or relapse, and one (3.8%) of those patients had presented with pCR. The median follow-up period was 33 months (Q1-Q3: 20-45), with an overall survival rate of 79.5% (95% CI 70.9-85.8). The 5-year survival rate for the patients that had pCR was 80% (95% CI 20.3-96.9). CONCLUSIONS The frequency of pCR was similar to that in other published studies and disease recurrence was lower, compared with patients with no response. The 5-year survival rate in patients with pCR was high, albeit lower than that reported in other studies.
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Affiliation(s)
| | - A M Naranjo-Isaza
- Cirugía, Instituto de Cancerología (IDC) Las Américas, Medellín, Colombia
| | | | - D A Mosquera-Castro
- Radioterapia, Instituto de Cancerología (IDC) Las Américas, Medellín, Colombia
| | - L M Arbeláez-Leon
- Radioterapia, Instituto de Cancerología (IDC) Las Américas, Medellín, Colombia
| | - L R Gómez-Wolff
- Oncología Clínica, Instituto de Cancerología (IDC) Las Américas, Universidad de Antioquia, Medellín, Colombia
| | - H I García-García
- Unidad de Investigación, Instituto de Cancerología (IDC) Las Américas, Universidad de Antioquia, Medellín, Colombia.
| | - L A Sánchez-Patiño
- Unidad de Investigación, Instituto de Cancerología (IDC) Las Américas, Universidad de Antioquia, Medellín, Colombia
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Nahas SC, Nahas CSR, Bustamante-Lopez LA, Pinto RA, Marques CFS, Cecconello I. Outcomes of surgical treatment for patients with distal rectal cancer: A retrospective review from a single university hospital. Rev Gastroenterol Mex (Engl Ed) 2020; 85:180-189. [PMID: 32057523 DOI: 10.1016/j.rgmx.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 04/19/2019] [Accepted: 05/30/2019] [Indexed: 11/17/2022]
Abstract
INTRODUCTION AND AIM Surgery for distal rectal cancer (DRC) can be performed with or without sphincter preservation. The aim of the present study was to analyze the outcomes of two surgical techniques in the treatment of DRC patients: low anterior resection (LAR) and abdominoperineal resection (APR). METHODS Patients with advanced DRC that underwent surgical treatment between 2002 and 2012 were evaluated. We compared the outcomes of the type of surgery (APR vs LAR) and analyzed the associations of survival and recurrence with the following factors: age, sex, tumor location, lymph nodes obtained, lymph node involvement, and rectal wall involvement. Patients with distant metastases were excluded. RESULTS A total of 148 patients were included, 78 of whom were females (52.7%). The mean patient age was 61.2years. Neoadjuvant chemoradiation therapy was performed in 86.5% of the patients. APR was performed on 86 (58.1%) patients, and LAR on 62 (41.9%) patients. No differences were observed between the two groups regarding clinical and oncologic characteristics. Eighty-seven (62%) patients had pT3-4 disease, and 41 patients (27.7%) had lymph node involvement. In the multivariate analysis, only poorly differentiated tumors (P=.026) and APR (P=.009) correlated with higher recurrence rates. Mean follow-up time was 32 (16-59.9) months. Overall 5-year survival was 58.1%. The 5-year survival rate was worse in patients that underwent APR (46.5%) than in the patients that underwent LAR (74.2%) (P=.009). CONCLUSIONS Patients with locally advanced DRC that underwent APR presented with a lower survival rate and a higher local recurrence rate than patients that underwent LAR. In addition, advanced T/stage, lymph node involvement, and poor tumor differentiation were associated with recurrence and a lower survival rate, regardless of the procedure.
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Affiliation(s)
- S C Nahas
- División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil
| | - C S R Nahas
- División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil
| | - L A Bustamante-Lopez
- División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil.
| | - R A Pinto
- División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil
| | - C F S Marques
- División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil
| | - I Cecconello
- División de Cirugía Digestiva del Hospital de Clínicas, Departamento de Gastroenterología de la Escuela de Medicina de la Universidad de Sao Paulo, Sao Paulo, Brasil
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Rodríguez-Fraile M, Cózar-Santiago MP, Sabaté-Llobera A, Caresia-Aróztegui AP, Delgado Bolton RC, Orcajo-Rincon J, de Arcocha-Torres M, García-Velloso MJ, García-Talavera P. FDG PET/CT in colorectal cancer. Rev Esp Med Nucl Imagen Mol 2019; 39:57-66. [PMID: 31776063 DOI: 10.1016/j.remn.2019.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 05/10/2019] [Revised: 09/06/2019] [Accepted: 09/09/2019] [Indexed: 12/24/2022]
Abstract
Colorectal cancer is the third most frequent cancer worldwide. Although its incidence is increasing, mainly in those aged under50, mortality has decreased by 50% in the more developed countries, principally due to the adoption of new practices in prevention, diagnosis and treatment. In particular, the various diagnostic imaging modalities allow improved therapeutic decision-making, evaluation of the response and early detection of recurrence. The aim of this paper is to review the available scientific evidence on the value of positron emission tomography with 18F-FDG (18F-FDG PET/CT) in the colorectal cancer, with special emphasis on the indications of the guidelines and recommendations of the main international scientific associations regarding this imaging technique.
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Affiliation(s)
- M Rodríguez-Fraile
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular.
| | - M P Cózar-Santiago
- Servicio de Medicina Nuclear, ERESA-Hospital General Universitario de Valencia, Valencia, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - A Sabaté-Llobera
- Servicio de Medicina Nuclear-IDI, Hospital Universitario de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - A P Caresia-Aróztegui
- Servicio de Medicina Nuclear, Parc Taulí Hospital Universitari, Corporació Sanitària Parc Taulí, Sabadell, Barcelona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - R C Delgado Bolton
- Departamento de Diagnóstico por la Imagen y Medicina Nuclear, Hospital San Pedro-Centro de Investigación Biomédica de La Rioja (CIBIR), Logroño, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - J Orcajo-Rincon
- Servicio de Medicina Nuclear, Hospital General Universitario Gregorio Marañón, Madrid, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - M de Arcocha-Torres
- Unidad de Radiofarmacia, Hospital Universitario Marqués de Valdecilla, Santander, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - M J García-Velloso
- Servicio de Medicina Nuclear, Clínica Universidad de Navarra, Pamplona, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
| | - P García-Talavera
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, Salamanca, España; Grupo de Trabajo de Oncología de la Sociedad Española de Medicina Nuclear e Imagen Molecular
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Simó V, Arredondo J, Hernán C, Jiménez LM, Ielpo B, Fernández J, Villafañe A, Pastor E. Rectal cancer treatment by transanal total mesorectal excision: Results in 100 consecutive patients. Cir Esp 2019; 97:510-516. [PMID: 31351576 DOI: 10.1016/j.ciresp.2019.05.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/27/2019] [Revised: 05/27/2019] [Accepted: 05/30/2019] [Indexed: 01/04/2023]
Abstract
INTRODUCTION The aim of this study is to describe and evaluate our clinical short-term surgical results of laparoscopic transanal total mesorectal excision. METHODS Analysis of 100 consecutive patients with mid and lower rectal cancer who underwent transanal total mesorectal excision from November 2013 to September 2018. Main outcomes described are operative data, morbidities, mortality and quality of the specimen. A comparative analysis was done between gender and simultaneous vs. non simultaneous abdominal-perineal surgery. RESULTS Mean patient age was 67 years (56-75), and 67% were male. On MRI, 50% were stage T3 tumors, and 52% had positive nodes. Mean distance of the tumor from anal verge was 4.9±1.3cm. A total of 58% underwent neoadjuvant treatment. Mean operative time was 262±40.7min; it was shorter in females (P<.001) and in simultaneous 2-field surgery. Median specimen distal free margin was 1.5cm (0.5-2.4). A total of 89% of the specimens were with complete mesorectum, with better results when a simultaneous approach was used (P=.047). The mean number of retrieved lymph-nodes was 15.2±11.6, and 26% of patients had positive nodes. Median length of stay was 5.5 days (4-8). Morbidities occurred in 36% of cases, and one patient died. CONCLUSIONS According to our experience, laparoscopic transanal total mesorectal excision is safe and effective with adequate circumferential and distal free margins and high quality of the resected mesorectum specimen. Post-operative morbidity is acceptable, according to the current literature.
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Affiliation(s)
- Vicente Simó
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jorge Arredondo
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España.
| | - Cristina Hernán
- Servicio de Medicina Preventiva, Hospital Clínico Universitario de Valladolid, Valladolid, España
| | - Luís Miguel Jiménez
- Unidad de Coloproctología, Servicio de Cirugía General, Hospital General Universitario Gregorio Marañón, Madrid, España
| | - Benedetto Ielpo
- Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Jesús Fernández
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Amaya Villafañe
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
| | - Enrique Pastor
- Unidad de Coloproctología, Servicio de Cirugía General, Complejo Asistencial Universitario de León, León, España
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Planellas Giné P, Gil Garcia J, Farrés Coll R, Codina Cazador A. Transanal surgery: A tool in the colorectal anastomotic leakage. Cir Esp 2019; 97:590-593. [PMID: 31151743 DOI: 10.1016/j.ciresp.2019.04.015] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 04/03/2019] [Accepted: 04/14/2019] [Indexed: 01/27/2023]
Abstract
The treatment of anastomotic leakage after oncological surgery for rectal cancer is a surgical challenge. The goal of this study is to show how transanal surgery combined with the abdominal approach is a very useful tool to decide on individualized treatment depending on the degree of dehiscence and to assist us in its local management. We present three cases of patients with colorectal anastomotic dehiscence. In two, we demonstrate the treatment of acute colorectal leakage and how transanal surgery allows us to confirm its viability and rule out any underlying ischemia. Furthermore, it facilitates good drainage of the adjacent collection as well as the placement of a vacuum system, if necessary, and its subsequent replacements. The last case is a delayed dehiscence with chronic presacral sinus, and its treatment by transanal access for fenestration.
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Affiliation(s)
- Pere Planellas Giné
- Sección de Cirugía Colorrectal, Departamento de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España.
| | - Júlia Gil Garcia
- Sección de Cirugía Colorrectal, Departamento de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Ramon Farrés Coll
- Sección de Cirugía Colorrectal, Departamento de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
| | - Antoni Codina Cazador
- Sección de Cirugía Colorrectal, Departamento de Cirugía General y Digestiva, Hospital Universitario Dr. Josep Trueta, Girona, España
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Gómez Ruiz M, Cagigas Fernández C, Alonso Martín J, Cristobal Poch L, Manuel Palazuelos C, Barredo Cañibano FJ, Gómez Fleitas M, Castillo Diego J. Robotic Assisted Transanal Polypectomies: Is There Any Indication? Cir Esp 2017; 95:601-609. [PMID: 29146073 DOI: 10.1016/j.ciresp.2017.09.006] [Citation(s) in RCA: 3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Robotic assisted transanal polipectomy may have advantages compared with the conventional transanal minimally invasive surgery technique. We evaluate the safety, feasibility and advantages of this technique. METHODS Between February 2014 and October 2015, 9patients underwent robotic transanal polypectomy. We performed a retrospective study in which we analyse prospectively collected data regarding patient and tumor characteristics, perioperative outcomes, pathological report, morbidity and mortality. RESULTS A total of 5 male and 4 female patients underwent robotic TAMIS. Lesions were 6,22cm from the anal verge. Mean size was 15,8cm2. All procedures were performed in the lithotomy position. Closure of the defect was performed in all cases. Mean blood loss was 39,8ml. Mean operative time was 71,9min. No severe postoperative complications or readmissions occured. Median hospital stay was 2,5 days. CONCLUSIONS Robotic TAMIS is useful to treat complex rectal lesions. Our transanal platform allowed a wider range of movements of the robotic arms and to perform all procedures in the lithotomy position.
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Affiliation(s)
- Marcos Gómez Ruiz
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Carmen Cagigas Fernández
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Joaquín Alonso Martín
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Lidia Cristobal Poch
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Carlos Manuel Palazuelos
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Francisco Javier Barredo Cañibano
- Anestesiología en Cirugía General, Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Departamento de Innovación y Cirugía Robótica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio Castillo Diego
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
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Codina Cazador A, Biondo S, Espin Basany E, Enriquez-Navascues JM, Garcia-Granero E, Roig Vila JV, Buxó M; en representación de los centros participantes en el Proyecto del Cáncer de Recto de la Asociación Española de Cirujanos. Oncological results of the educational Rectal Cancer Project in Spain 10 years after its implementation. Cir Esp 2017; 95:577-87. [PMID: 29037748 DOI: 10.1016/j.ciresp.2017.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 07/07/2017] [Accepted: 08/20/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION The objective of this observational, prospective, multicenter and multilevel study was to evaluate the oncological outcomes (local recurrence, metastasis and overall survival) of the Rectal Cancer Project of the Spanish Association of Surgeons (AEC) 10 years after its initiation, comparing the results with Scandinavian registries. METHODS The AEC teaching project database includes 17,620 patients to date, of which 4,508 were operated on with a potentially curative resection between March 2006 and December 2010. All of them come from the first 59 hospitals included in the project, and therefore followed for at least 5 years, and are the subject of the present study. RESULTS The cumulative incidence of local recurrence was 7.3 (95% CI: 8.2-6.5), metastasis 21.0 (CI 95%: 22.4-19.7) and overall survival 72.3 (CI 95%: 80.3-77.6). The multilevel regression analysis with the hospital variable as a random effect, showed a significant variation among the hospitals for the cancer outcome variables: general survival, local recurrence and metastasis (δ2=0.053). CONCLUSIONS This study indicates that the results observed in the AEC' Rectal Cancer Project are inferior than those observed in the Scandinavian registries that we tried to emulate and that this is attributable to the variability of practice in some centers.
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Saralegui Y, Enríquez-Navascués JM, Ciria JP, Osorio M, Lacasta A, Elorza G, Garmendia M, Placer C. Results of short term radiotherapy followed by radical surgery for rectal cancer: A long-term unicenter observational study. Cir Esp 2017; 95:268-275. [PMID: 28583726 DOI: 10.1016/j.ciresp.2017.04.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 04/21/2017] [Accepted: 04/25/2017] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Short-term radiotherapy (STR) for rectal cancer (RC) has rarely been used in Spain. The aim of the present study is to describe oncological results after RTC and surgery for RC. METHODS This is a retrospective analysis of a consecutive series of patients treated with STR and surgery for RC (1999-2012). Epidemiological data, staging, complications of STR, STR-surgery interval, surgical approach, rate of anastomotic/perineal wound dehiscence, and pathological data (regression degree and staging) were collected. Global survival, disease free survival, local recurrence rate and incidence of toxicity, response and complications of combined treatment are reported. RESULTS Of 1229 patients treated, 209 patients received STR and surgery. The median follow-up was 6.2 years. Mean age was 68 years and 66% of the patients were men. A total of 88% were cT3-4 and 44% cN+17 (8.1%) patients had resectable synchronous metastases. Acute and chronic toxicity due to STR was <5%. In 75% of the cases the STR-surgery interval was <15 days, and in 9%> 4 weeks. Seven patients (3.3%) presented complete response. Nine (4.3%) patients presented an local recurrence rate. Global survival at 5, 10 and 15 years was 67.8, 49.2 and 37.5%, respectively. Disease free survival at 5, 10 and 15 years was 66.1, 47.1 and 33%, respectively. CONCLUSIONS The results compare favorably with multicentric historical series. STR offers certain advantages that could be increased by increasing the STR-surgery interval and/or interspersed with sequential chemotherapy.
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Affiliation(s)
- Yolanda Saralegui
- Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España.
| | - José M Enríquez-Navascués
- Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
| | - Juan Pablo Ciria
- Servicio de Oncología Radioterápica, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
| | - Mikel Osorio
- Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
| | - Adelaida Lacasta
- Servicio de Oncología Médica, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
| | - Garazi Elorza
- Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
| | - Maddi Garmendia
- Servicio de Anatomía Patológica, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
| | - Carlos Placer
- Sección de Cirugía Colorrectal, Servicio de Cirugía General y Digestiva, Hospital Universitario Donostia, UPV-EHU, San Sebastián, España
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Serra-Aracil X, Pericay C, Mora-Lopez L, Garcia Pacheco JC, Latorraca JI, Ocaña-Rojas J, Casalots A, Ballesteros E, Navarro-Soto S. Neoadjuvant therapy and transanal endoscopic surgery in T2-T3 superficial, N0, M0 rectal tumors. Local recurrence, complete clinical and pathological response. Cir Esp 2017; 95:199-207. [PMID: 28411888 DOI: 10.1016/j.ciresp.2017.03.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 01/22/2017] [Accepted: 03/20/2017] [Indexed: 01/14/2023]
Abstract
INTRODUCTION The association of preoperative chemoradiotherapy and transanal endoscopic surgery in T2 and superficial T3 rectal cancers presents promising results in selected patients. The main objective is to evaluate the long-term loco-regional and systemic recurrence and, as secondary objectives, to provide results of postoperative morbidity and the correlation between complete clinical and pathological response. METHODS This is a retrospective observational study including a consecutive series of patients with T2-T3 superficial rectal cancer, N0, M0 who refused radical surgery (2008-2016). The treatment consisted of preoperative chemotherapy (5-fluorouracil or capecitabine) combined with radiotherapy (50, 4Gy) and transanal endoscopic surgery after 8weeks. Preoperative, surgical, pathological and long-term oncologic results were analyzed. RESULTS Twenty-four patients were included in the study. Two of them required rescue radical surgery for unfavorable pathological results. A local recurrence (4.5%) was observed and 2patients presented systemic recurrence (9%), with a median follow-up of 45 months. A complete clinical tumor response was achieved in 12 patients (50%), and complete pathological tumor response in 9 patients (37.5%). Postoperative complications were observed in 5 patients (20.8%), and they were mild except one. There was no postoperative mortality. CONCLUSIONS In this stage of rectal cancer, our results seem to support this strategy, mainly when a complete pathological response is achieved. The complete clinical tumor response does not coincide with the pathological tumor response. Randomized prospective studies should be performed to standardize this treatment.
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Affiliation(s)
- Xavier Serra-Aracil
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España.
| | - Carlos Pericay
- Servicio de Oncología Médica, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona , Sabadell (Barcelona), España
| | - Laura Mora-Lopez
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España
| | - Juan Carlos Garcia Pacheco
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España
| | - José Isaac Latorraca
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España; Servicio de Oncología Médica, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona , Sabadell (Barcelona), España; Servicio de Anatomía-Patológica, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España; Servicio de Radiología, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España
| | - Julio Ocaña-Rojas
- Servicio de Oncología Médica, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona , Sabadell (Barcelona), España
| | - Alex Casalots
- Servicio de Anatomía-Patológica, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España
| | - Eva Ballesteros
- Servicio de Radiología, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España
| | - Salvador Navarro-Soto
- Unidad de Coloproctología, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Parc Taulí, Universidad Autónoma de Barcelona, Sabadell (Barcelona), España
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Ortiz H, Codina A, Ciga MÁ, Biondo S, Enríquez-Navascués JM, Espín E, García-Granero E, Roig JV. Effect of hospital caseload on long-term outcome after standardization of rectal cancer surgery in the Spanish Rectal Cancer Project. Cir Esp 2016; 94:442-52. [PMID: 27491271 DOI: 10.1016/j.ciresp.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 04/30/2016] [Revised: 05/26/2016] [Accepted: 06/05/2016] [Indexed: 10/21/2022]
Abstract
UNLABELLED INTRODUCCIóN: The purpose of this prospective multicentre multilevel study was to investigate the influence of hospital caseload on long-term outcomes following standardization of rectal cancer surgery in the Rectal Cancer Project of the Spanish Society of Surgeons. METHODS Data relating to 2910 consecutive patients with rectal cancer treated for cure between March 2006 and March 2010 were recorded in a prospective database. Hospitals were classified according to number of patients treated per year as low-volume, intermediate-volume, or high volume hospitals (12-23, 24-35, or ≥36 procedures per year). RESULTS After a median follow-up of 5 years, cumulative rates of local recurrence, metastatic recurrence and overall survival were 6.6 (CI95% 5.6-7.6), 20.3 (CI95% 18.8-21.9) and 73.0 (CI95% 74.7 - 71.3) respectively. In the multilevel regression analysis overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients (HR 0,727 [CI95% 0,556-0,951]; P=.02). The risk of local recurrence and metastases were not related to the caseload. Moreover, there was a statistically significant variation in overall survival (median hazard ratio [MHR] 1.184 [CI95% 1.071-1,333]), local recurrence (MHR 1.308 [CI95% 1.010-1.668]) and metastases (MHR 1.300 [CI95% 1.181; 1.476]) between all hospitals. CONCLUSIONS Overall survival was higher for patients treated at hospitals with an annual caseload of 36 or more patients. However, local recurrence was not influenced by caseload.
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Affiliation(s)
- Héctor Ortiz
- Departamento Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.
| | - Antonio Codina
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Josep Trueta, Girona, España
| | - Miguel Á Ciga
- Unidad de Coloproctología, Departamento de Cirugía, Complejo Hospitalario de Navarra, Pamplona, España
| | - Sebastiano Biondo
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario de Bellvitge, Barcelona, España
| | - José M Enríquez-Navascués
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Donostia, Donostia, España
| | - Eloy Espín
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Vall D'Hebron, Barcelona, España
| | - Eduardo García-Granero
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario La Fe, Valencia, España
| | - José V Roig
- Unidad de Coloproctología. Hospital Nisa 9 de Octubre, Valencia, España
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Vaccaro CA, Yazyi FJ, Ojra Quintana G, Santino JP, Sardi ME, Beder D, Tognelli J, Bonadeo F, Lastiri JM, Rossi GL. Locally advanced rectal cancer: Preliminary results of rectal preservation after neoadjuvant chemoradiotherapy. Cir Esp 2016; 94:274-9. [PMID: 26980259 DOI: 10.1016/j.ciresp.2015.12.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 10/17/2015] [Accepted: 12/19/2015] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The standard treatment for locally advanced rectal cancer is total mesorectal excision. However, organ preservation has been proposed for tumors with good response to neoadjuvant treatment. The aim of this study was to evaluate the oncologic results of this strategy. METHODS This is a retrospective cohort study (2005-2014) including a consecutive series of patients with rectal adenocarcinoma with complete or almost complete clinical response after preoperative chemo-radiotherapy, that were treated according to a strategy of preservation of the rectum. RESULTS A total of 204 patients with rectal cancer received neoadjuvant therapy. Thirty (14.7%) had a good response and were treated with rectal preservation (23 «Watch and Wait» and 7 local resections). Median follow-up was 46 months (interquartile range: 30-68). In the group of «Watch & Wait», 4 patients had local recurrence before 12 months (actuarial local recurrence rate=18.5%). All of them underwent salvage surgery (2 with radical surgery and 2 local resections) without any further recurrence. Disease-free survival actuarial rate at 3 years follow-up was 94.1% (95% CI 82.9-100). None of the 7 patients that were treated by local excision had local recurrence. The organ preservation rate for the whole group was 93%. CONCLUSION The strategy of organ preservation in locally advanced rectal cancer is feasible in cases with good response to neoadjuvant therapy. When implemented in a highly selected group of patients this strategy is associated with satisfactory oncologic results.
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Affiliation(s)
- Carlos Alberto Vaccaro
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
| | - Federico Julio Yazyi
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Guillermo Ojra Quintana
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Juan Pablo Santino
- Servicio Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mabel Edith Sardi
- Servicio Oncología Radiante, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Damián Beder
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Joaquin Tognelli
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Fernando Bonadeo
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - José María Lastiri
- Servicio Oncología Radiante, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Gustavo Leandro Rossi
- Servicio Cirugía General, Sector de Coloproctología, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
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Ortiz H, Biondo S, Codina A, Ciga MÁ, Enríquez-Navascués J, Espín E, García-Granero E, Roig JV. [Hospital variation in anastomotic leakage after rectal cancer surgery in the Spanish Association of Surgeons project: The contribution of hospital volume]. Cir Esp 2016; 94:213-20. [PMID: 26875478 DOI: 10.1016/j.ciresp.2015.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2015] [Revised: 11/13/2015] [Accepted: 11/22/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVE This multicentre observational study aimed to determine the anastomotic leak rate in the hospitals included in the Rectal Cancer Project of the Spanish Society of Surgeons and examine whether hospital volume may contribute to any variation between hospitals. METHODS Hospital variation was quantified using a multilevel approach on prospective data derived from the multicentre database of all adenocarcinomas of the rectum operated by an anterior resection at 84 surgical departments from 2006 to 2013. The following variables were included in the analysis; demographics, American Society of Anaesthesiologists classification, use of defunctioning stoma, tumour location and stage, administration of neoadjuvant treatment, and annual volume of elective surgical procedures. RESULTS A total of 7231 consecutive patients were included. The rate of anastomotic leak was 10.0%. Stratified by annual surgical volume hospitals varied from 9.9 to 11.3%. In multilevel regression analysis, the risk of anastomotic leak increased in male patients, in patients with tumours located below 12 cm from the anal verge, and advanced tumour stages. However, a defunctioning stoma seemed to prevent this complication. Hospital surgical volume was not associated with anastomotic leak (OR: 0.852, [0.487-1.518]; P=.577). Furthermore, there was a statistically significant variation in anastomotic leak between all departments (MOR: 1.475; [1.321-1.681]; P<0.001). CONCLUSION Anastomotic leak varies significantly among hospitals included in the project and this difference cannot be attributed to the annual surgical volume.
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Affiliation(s)
- Héctor Ortiz
- Departamento Ciencias de la Salud, Universidad Pública de Navarra, Pamplona, España.
| | - Sebastiano Biondo
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario de Bellvitge, Barcelona, España
| | - Antonio Codina
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Josep Trueta, Gerona, España
| | - Miguel Á Ciga
- Unidad de Coloproctología, Departamento de Cirugía, Complejo Hospitalario de Navarra, Pamplona, España
| | - José Enríquez-Navascués
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Donostia, San Sebastián, España
| | - Eloy Espín
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario Vall d'Hebron, Barcelona, España
| | - Eduardo García-Granero
- Unidad de Coloproctología, Departamento de Cirugía, Hospital Universitario La Fe, Valencia, España
| | - José Vicente Roig
- Unidad de Coloproctología, Hospital Nisa 9 de Octubre, Valencia, España
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Reina Duarte A, Ferrer Márquez M, Rubio Gil FA, Belda Lozano R, Alvarez García A, Blesa Sierra I, Fuentes Porcel O, Vidaña Márquez E, Rosado Cobian R. What is being researched in rectal cancer? Cir Esp 2014; 93:S0009-739X(14)00299-1. [PMID: 25432403 DOI: 10.1016/j.ciresp.2014.09.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 09/03/2014] [Accepted: 09/12/2014] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Clinical evidence has a more significant role in medical specialties than in surgery. Rectal cancer (CR) is no exception. This paper explores what CR-related subjects are being investigated at the present time in a quantitative and qualitative way and analyzes this information to know what possible answers clinical research could give us in the future. METHODS The data collection was carried out in April 2014 and was based on 3 sources: 2 institutional clinical trials registries -American (clinicaltrials.gov) and European (EU Clinical Trials Register)- and a survey given to members of the Asociación Española de Coloproctología (AECP). The obtained studies were exported to a database designed especially for this review, which included a number of descriptive elements that would allow the cataloging of the different studies. The AECP survey results were analyzed separately. RESULTS There are currently 216 clinical trials ongoing related to CR. Two-thirds are primarily conducted by oncologists. Nearly a third are surgical. The research focuses on improving preoperative treatment: new drugs, new schemes of chemo-radiotherapy (usually induction or consolidation schemes) or optimization of radiotherapy and its effects. Surgical clinical trials are related to robotics, laparoscopy, stoma, low colorectal anastomosis, distal CR and local treatment. CONCLUSION Most of the current clinical trials ongoing on CR are analyzing aspects of chemo-radiotherapy and its effects. A third focus on purely surgical issues.
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Affiliation(s)
- Angel Reina Duarte
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España.
| | - Manuel Ferrer Márquez
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Francisco A Rubio Gil
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Ricardo Belda Lozano
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Antonio Alvarez García
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Isabel Blesa Sierra
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Orlando Fuentes Porcel
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Elisa Vidaña Márquez
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
| | - Rafael Rosado Cobian
- Unidad de Cirugía Colorrectal, UGC Cirugía, Complejo Hospitalario Torrecárdenas y AGS Norte de Almería, Almería, España
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Gumbau V, García-Armengol J, Salvador-Martínez A, Ivorra P, García-Coret MJ, García-Rodríguez V, Roig JV. Impact of a diverting stoma in an enhanced recovery programme for rectal cancer. Cir Esp 2014; 93:18-22. [PMID: 24874996 DOI: 10.1016/j.ciresp.2014.03.016] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2014] [Revised: 03/15/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The association of a loop ileostomy decreases the severity of complications after rectal surgery but can increase the postoperative stay. The aim of this study is to investigate if a diverting ileostomy influences the postoperative outcomes in a series of patients included in a multimodal rehabilitation program (MMRP). METHODS We analyzed a series of 104 patients that underwent elective surgery with primary anastomosis for rectal adenocarcinoma using a MMRP: 66 men and 38 women, with a median age of 64 (IQR: 55-75) years. Group A included patients with an associated loop ileostomy, and Group B, those without a protective stoma. RESULTS Group A = 58, group B = 46 patients without differences in age, ASA, BMI and other risk factors, nor in the surgical approach (laparoscopic in 34%), although there were more neoadjuvant treatments in group A: 77.5 vs. 36.9%; P=.001. In group A, the most common operation was total mesorectal excision (96%) and in the B, a subtotal mesorectal excision (90%). There were no differences in postoperative complications (Group A 34.4 vs. group B28.2%; P=.322), anastomotic leaks (8.3 vs. 10.8%; P=.475), or postoperative ileus (20.7 vs. 10.9%; P=.140), neither in postoperative stay (7.9 vs. 6.9 days; P= .058, readmissions (7 vs. 13.6%; P= .22), or postoperative stay, including readmissions (8.4 vs. 9.1 days; P= .49). CONCLUSIONS The association of a loop ileostomy does not extend the length of stay nor increases the rate of complications in patients that underwent a rectal resection with anastomosis included in a MMRP.
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Affiliation(s)
- Verónica Gumbau
- Unidad de Coloproctología, Consorcio Hospital General Universitario, Valencia, España
| | - Juan García-Armengol
- Unidad de Coloproctología, Consorcio Hospital General Universitario, Valencia, España; Unidad de Coloproctología, Hospital Nisa 9 de Octubre, Centro Europeo de Cirugía Colorrectal, Valencia, España
| | | | - Purificación Ivorra
- Unidad de Coloproctología, Consorcio Hospital General Universitario, Valencia, España
| | | | | | - José Vicente Roig
- Unidad de Coloproctología, Consorcio Hospital General Universitario, Valencia, España; Unidad de Coloproctología, Hospital Nisa 9 de Octubre, Centro Europeo de Cirugía Colorrectal, Valencia, España.
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Errasti Alustiza J, Espín Basany E, Reina Duarte A. Rare tumors of the rectum. Narrative review. Cir Esp 2014; 92:579-88. [PMID: 24629769 DOI: 10.1016/j.ciresp.2013.06.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 05/23/2013] [Accepted: 06/02/2013] [Indexed: 02/06/2023]
Abstract
Most rectal neoplasms are adenocarcinomas, but there is a small percentage of tumors which are of other histological cell lines such as neuroendocrine tumors, sarcomas, lymphomas and squamous cell carcinomas, which have special characteristics and different treatments. We have reviewed these rare tumors of the rectum from a clinical and surgical point of view.
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Gómez Ruiz M, Palazuelos CM, Martín Parra JI, Alonso Martín J, Cagigas Fernández C, del Castillo Diego J, Gómez Fleitas M. New technique of transanal proctectomy with completely robotic total mesorrectal excision for rectal cancer. Cir Esp 2014; 92:356-61. [PMID: 24589418 DOI: 10.1016/j.ciresp.2013.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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: 12/02/2013] [Accepted: 12/19/2013] [Indexed: 12/15/2022]
Abstract
Anterior resection with total mesorectal excision is the standard method of rectal cancer resection. However, this procedure remains technically difficult in mid and low rectal cancer. A robotic transanal proctectomy with total mesorectal excision and laparoscopic assistance is reported in a 57 year old male with BMI 32 kg/m2 and rectal adenocarcinoma T2N1M0 at 5 cm from the dentate line. Operating time was 420 min. Postoperative hospital stay was 6 days and no complications were observed. Pathological report showed a 33 cm specimen with ypT2N0 adenocarcinoma at 2 cm from the distal margin, complete TME and non affected circumferential resection margin. Robotic technology might reduce some technical difficulties associated with TEM/TEO or SILS platforms in transanal total mesorectal excision. Further clinical trials will be necessary to assess this technique.
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Affiliation(s)
- Marcos Gómez Ruiz
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Carlos Manuel Palazuelos
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - José Ignacio Martín Parra
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Joaquín Alonso Martín
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Carmen Cagigas Fernández
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio del Castillo Diego
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Servicio de Cirugía General y Aparato Digestivo, Unidad de Cirugía Colorrectal, Hospital Universitario Marqués de Valdecilla, Santander, España
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Luján J, Gonzalez A, Abrisqueta J, Hernandez Q, Valero G, Abellán I, Frutos MD, Parrilla P. The learning curve of laparoscopic treatment of rectal cancer does not increase morbidity. Cir Esp 2014; 92:485-90. [PMID: 24462270 DOI: 10.1016/j.ciresp.2013.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 02/27/2013] [Accepted: 03/15/2013] [Indexed: 01/27/2023]
Abstract
INTRODUCTION The treatment of rectal cancer via laparoscopy is controversial due to its technical complexity. Several randomized prospective studies have demonstrated clear advantages for the patient with similar oncological results to those of open surgery, although during the learning of this surgical technique there may be an increase in complications and a worse prognosis. OBJECTIVE Our aim is to analyze how the learning curve for rectal cancer via laparoscopy influences intra- and postoperative results and oncological markers. A retrospective review was conducted of the first 120 patients undergoing laparoscopic surgery for rectal neoplasia. The operations were performed by the same surgical team with a wide experience in the treatment of open colorectal cancer and qualified to perform advanced laparoscopic surgery. We analyzed sex, ASA, tumour location, neoadjuvant treatment, surgical technique, operating time, conversion, postoperative complications, length of hospital stay, number of lymph nodes, stage and involvement of margins. RESULTS Significant differences were observed with regard to surgical time (224 min in the first group, 204 min in the second group), with a higher rate of conversion in the first group (22.5%) than in the second (11.3%). No significant differences were noted for rate of conservative sphincter surgery, length of hospital stay, post-surgical complications, number of affected/isolated lymph nodes or affected circumferential and distal margins. CONCLUSIONS It is possible to learn this complex surgical technique without compromising the patient's safety and oncological outcome.
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Codina Cazador A, Farres Coll R, Olivet Pujol F, Martin Grillo A, Pujadas de Palol M, Gómez Romeu N, Julia Bergkvist D, Ortiz Duran R, Diez Gómez E. [Clinical and oncological results of the pathological complete response in rectal cancer after neoadjuvant treatment]. Cir Esp 2013; 91:417-23. [PMID: 23453426 DOI: 10.1016/j.ciresp.2012.07.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 07/10/2012] [Accepted: 07/25/2012] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Neoadjuvant chemo-radiotherapy is the treatment of choice for rectal cancer in order to reduce local recurrence. Patients with a pathological complete response (PCR) have a better prognosis. The aim of this study was to determine the influence of PCR on the oncological outcomes in our patients. METHODS All patients with stage ii/iii rectal cancer treated with neoadjuvant chemo-radiotherapy and radical resection between 2007 and 2011 were identified from a prospective database, and grouped based on whether they achieved PCR or not (non-PCR). Clinical, histological and oncological outcome data were compared. RESULTS A total of 162 patients were included (62% men), with a mean age of 65 years. In terms of pre-operative TNM staging, 82 patients (50%) were T2, 75 (46%) were T3, and 5 (3%) were T4. Forty-two patients (25%) were N1, and 87 (53%) were N2. Low anterior resection and abdominoperineal resection were performed in 125 (77%) and 25 (15%) patients. Forty-three patients (26.5%) had postoperative morbidity. PCR was achieved in 19 patients (11.7%). After a median follow-up of 26 months, there are no recurrences in the PCR group, and in the non-PCR group, local recurrence was 1.4% (P=.78), and distant metastasis was 8.4% (P=.21). Overall survival (P=.39) and survival free of diseases (P=.23) were better in the PCR group, but the differences were not significant. CONCLUSION Patients with pathological complete response have better oncological outcome.
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