جستجوی مقالات مرتبط با کلیدواژه "rectal cancer" در نشریات گروه "دامپزشکی"

The benefits of laparoscopy versus open surgery for patients with rectal cancer have been well established. This study evaluates the role of re-laparoscopy in patients who develop complications following laparoscopic rectal cancer surgery.

This is a retrospective case series of 22 (5.9%) re-laparoscopy cases of the 373 rectal cancer patients with rectal cancer who underwent laparoscopic primary surgery at Omid, Ghaem, and Razavi hospitals in Mashhad, Iran, between July 2011 and December 2020.

Twenty-two (5.9%) eligible patients with a mean± SD age of 50.9±10.4 years were included in the study, of which 15(68.2%) were male and 7(31.6%) were female. After 22 laparoscopic primary surgery, anastomosis-fail/peritonitis was the most common complication requiring re-laparoscopy (n = 9, 40.9%). Other complications included obstruction (n = 8, 36.4%), bleeding (n =3, 13.6%), and intestinal injury (n = 2, 9.1%). The complications of all patients (n =22) who underwent re-laparoscopy were successfully managed by re-laparoscopy.

In the case of available facilities and the presence of an experienced surgeon in the medical center, re-laparoscopy for managing complications following laparoscopic rectal cancer surgery appears to be safe and effective in selected patients.

Colorectal cancer is the 3rd most common cancer affecting males and females in most western countries and is leading cause of cancer related deaths. . Transanal total mesorectal excision (TaTME) was introduced for mid and lower rectal cancer and is proposed to allow a precise mesorectal dissection through better visualization in anatomically limited pelvis.

Obective:

 To check the feasibility of Transanal Total Mesorectal Excision in terms of:- Quality of TME, Circumferential resection margin positivity, Lymph node yield, Operation time, Mean blood loss, Postoperative complications, Conversion rate, Hospital stay.

Out of the total patients studied, 34 patients(97.2%) had normal distal resection margin and only 1patient(2.8%) had positive distal resection margin. only 2(5.8%) patients were having positive circumferential resection margin while rest of 33 patients(94.2%) CRM was normal. The mean average of the tumor distance from anal verge was 4.97 cm with minimum 3cm and maximum7cm. The mean average of lymph node yield was 7.86 with minimum number of lymph nodes 5 and maximum 11 and standard deviation 1.734. The average mean of operation time was 2.095 hours with maximum time 3.5 hours and minimum time 1.3 hours with standard deviation of 0.4608. Mean average blood loss was 48.57ml with maximum blood loss 80ml and minimum of 30ml only with standard deviation 11.917. 25 patients with no post op complications at 1 month (71.4%),3 patients with UTI(8.6%), Surgical site infections in 2 patients(5.7%),AKI 1(2.9%),Anastamotic leak 1(2.9%), Incontinence 1(2.9%), stromal retraction 1(2.9%) and recto vaginal fistula 1(2.9%) patient. Out of the total patient studied, 31 patients were having no complication at 3 months(88.6%) followed by Sub acute intestinal obstruction in 2(5.7%) and sexual dysfunction in 2 patients(5.7%).

The present study suggest that Transanal TME is a feasible method for oncologic resection of locally advanced mid- and distal-rectal cancer with curative intent.

Vaginal metastasis from colorectal adenocarcinoma can occur months after the resection of the primary tumor. Most of the time, bleeding is the bothersome symptom. The optimal treatment involves surgical excision followed by reconstruction to prevent the lymphatic networks in the rectovaginal septum serving as a potential route of spread. There have been a number of successful vaginal reconstructive options reported. We describe a 32-year-old woman who had previously undergone an abdominoperineal resection for rectal cancer and was now suffering with rectal adenocarcinoma vaginal metastases. An inferior gluteus perforator flap (IGAP) repair was carried out following posterior vaginectomy after a comprehensive multidisciplinary examination. This flap can be used to address perineal dead space as well as to reconstruct the neovaginal area, eliminating the need for a second flap and significantly reducing donor morbidity. The lesson from this case is that vaginal metastases can still develop even after the primary colorectal tumor has been removed. One-step surgical excision and perineal repair can result in an enhanced quality of life and a good prognosis.

Currently, neoadjuvant chemoradiation followed by total mesorectal excision through a low anterior- or abdominoperineal resection (APR) is considered the standard treatment approach in the vast majority of patients with locally advanced rectal cancer. Even though LAR allows for anatomic rectal preservation, APR led to significant morbidity and compromised quality of life in rectal cancer patients. Approximately 10-40% of patients achieve clinical complete response (CCR) following neoadjuvant chemoradiation. Meanwhile, the rate of pathologic complete response (PCR) is usually less than CCR rate. Complete response rate may be improved by escalating radiation dose and optimizing (total) neoadjuvant chemotherapy. Therefore, at least one-fifth of patients will have the chance of rectal preservation using the watch-and-wait strategy. In this therapeutic strategy, patients should be followed up by an active surveillance protocol to detect early tumor regrowth and salvage radical surgery and will, therefore, provide comparable oncologic outcomes to those achieved in patients who undergo initial radical surgery. This review aimed to present the largest reports and highlight the most recent evidence and guidelines for watch-and-wait therapeutic strategy in patients with rectal cancer.

Background Despite the low incidence rate, ureteral injuries can lead to significant morbidity. Urinary organs can be injured during open or laparoscopic surgery. This study aimed to assess whether a ureteral injury exists between laparoscopic and open surgery over 20 years in Shiraz. Methods This is a retrospective study and 779 patients of rectal cancer were evaluated in Shiraz from 2000 to 2021 by collecting data from the patients’ electronic charts. We evaluated the type of surgery, gender, age, body mass index (BMI), stage, appearance and size of the tumor, preoperative (chemo)-radio-therapy, recurrence, and metastasis. Ureteral injury was analyzed and urinary incontinence was recorded.Results A total number of 131 (22.2%) in laparoscopy surgeries and 42 (30.6%) in laparotomy surgeries had abdominoperineal (A-P) resection. The total number of 254 (43%) in laparoscopy surgeries and 61 (44.5%) of patients had low anterior resection in laparotomy surgeries. The incidence of ureteral injuries was 2.2% for open procedures and 1.5% for laparoscopic and 2.2% for conversion procedures. The rate of urinary incontinence was 65 (11.0%) in laparoscopy and 9 (6.6%) in laparotomy group. Conclusion It is concluded that the ureteral injury after laparotomy is more than laparoscopic surgeries. Although the number of side effects of these surgeries is low, it can be concluded that the possibility of damage to the ureter is less in laparoscopic surgery and that of damage to the nerves of the pelvic floor is more.

A 56 y old woman who is known case of rectal cancer (T3N0) with previous history of surgery and chemo radiotherapy referred for evaluation of anemia. During her routine follow up visits, her oncologist informed about anemia (HB 10.2mg/dL, MCV 86fM), so request a full evaluation of GI tract including upper endoscopy and colonoscopy. She had not any complain except some fatigue and paleness. Her endoscopy was completely normal. During colonoscopy, the remained colon including site of anastomosis, descending, transverse, ascending and cecum sow completely normal but upon withdrawal of scope, there was brisk bleeding beside surgical sutures. The patient questioned about any bleeding and she mention rectal bleeding after sessions of rectal physiotherapy and rectal probe insertion for biofeedback therapy to prevent incontinence. So the cause of anemia diagnosed as rectal physiotherapy and biofeedback and the patient reassured and managed with intra venous iron (Ferinject 500mg). Her next follow up was totally normal without any complain.

Low anterior resection syndrome (LARS) is a common debilitating problem faced by patients who underwent low or ultralow anterior resection. The management of LARS is complicated by the fact that our understanding of the pathophysiology of this disease is as yet unclear. In fact, our limitation in understanding is highlighted by the fact that only in 2020 has there been an international consensus on the definition of LARS (LARS international collaborative group).

A comprehensive review of the current literature on the pathophysiology, risk factors and management of LARS was performed.

In this review, we discuss the suspected pathophysiology of LARS, including damage to anatomy (sphincter, hiatal ligament, conjoint longitudinal ligamaent), loss of physiology (of rectum), and damage to nervous system (damage to hypogastric nerves, denervation of left colon, loss of recto-sigmoid brake). The risk factors for LARS are discussed, including neoadjuvant treatment, TME dissection, rectal stump height, anastomotic leak, as well as the protective role of a pouch formation in reducing the rate of LARS. Management of LARS involves management of symptoms, and management of underlying neurophysiology. The non operative measures include dietary restrictions, medications to reduce motility, pelvic floor exercises, colonic irrigations. Interventional approaches includes sacral nerve stimulation (SNS), and when bowel function becomes too debilitating a stoma may be created.

LARS is a significant and debilitating disorder. It has complex pathophysiology and there are some definite risk factors. Management involves non-operative and operative approaches, trans-anal irrigation and sacral nerve stimulation showing promise.

Pathologic complete response (pCR) after neoadjuvant chemoradiotherapy (NCRT) has a prognostic value in locally advanced rectal cancer (LARC). This study aimed to evaluate the ability to predict pCR using inflammatory markers, valuable to select the most adequate treatment strategy.

Patients undergoing primary tumor resection after long-cycle NCRT at a single center (2012 to 2018) were retrospectively collected (n=130). Patient demographics, preoperative laboratory measurements, tumor characteristics, treatment strategy and postoperative anatomopathologic variables were collected. The association of factors to CPR was examined using binary logistic regression and odds ratio (OR) (95% confidence interval) and the discriminative capacity with ROC curve.

Out of 130 patients 42 pCRs occurred, a 32.3% of the sample. Variables identified as useful to predict pCR were total neutrophil count (

The absolute neutrophil count better predicts pCR than the rest of inflammatory indexes in selected patients with LARC who underwent long-cycle NCRT. The association of a neutrophil count less than 6400 cells/mm3, absence of diabetes and intravenous 5-FU NCRT strategy showed a relevant increase of the pCR.

Rectal cancer is a malignant tumor of the digestive tract and as it is a widespread condition it demands comprehensive research. At the time of the writing of the present study, COVID-19 infection rates are rising rapidly in Iran and the study attempts to make an evaluation of the country’s rectal cancer management during the pandemic.

83 patients were divided into two groups and closely studied. The first group underwent rectal cancer surgery during a 9 month period in 2019, while the second group underwent the same process during the same amount of time in 2020. Demographic data, surgery and outcomes after surgery were assessed and compared between the two groups. The data were analyzed by SPSS (statistical analyzer software, ver. 22).

The age, weight, height, BMI, size of tumor, and numbers of involved lymph nodes were not different between the two groups. The radiotherapy techniques were significantly different between two groups (p=0.012). Neoadjuvant long course chemoradiation therapy was changed to short-course radiation therapy during the pandemic and hospital stay for the patients was significantly longer during the pandemic (p=0.010). There is no difference in the recurrence or overall survival between the two groups. Metastasis was seen in six patients in the 2019 group,, whereas this phenomenon was not observed in the 2020 group. . The size of tumors were larger in the 2020 group, but it was not statistically different (p=0.064).

Cancer is a highly complicated and problematic decease which stresses the importance of immediate diagnosis and treatment; however during the COVID-19 pandemic, medical centers may need to take additional measures to protect their cancer patients.

Transanal Minimally invasive surgery (TAMIS) is indicated for benign lesions of the rectum distant up to 5 cm and not exceeding more than 1/3 of the rectal circumference; for early stage malignancies confined to the submucosa (T1 sm1 according to the Kikuchi classification); for cancers after complete response to neoadiuvant treatments or with T1 residue (due to a risk of mesorectal positive lymph node between 3-6%); for T2-T3 N0 in patients who cannot undergo major surgical resections due to a compromised general (rescue surgery). TAMIS is especially recommended for neoplasms located at a distance between 5 and 18 cm from the anal verge.

We performed TAMIS on a 72-year-old patient diagnosed with diffuse polyposis syndrome (FAP), with multimorbidity and a history of recurrences, all treated with surgical resection, AND with a new recurrence on the ileo-rectal anastomosis at about 25 cm from the anal verge. A rectoscopy and a total body CT were performed (anastomotic level; size 2 cm; staging: cT1-2, N0, M0; histology: adenocarcinoma). The final decision after multidisciplinary meeting was for TAMIS, due to high intra- and post-operative risk contraindicating major surgery. Data regarding total operating time, blood losses, length of stay, surgical and general intra and post-operative complications, resumption of nutrition and therapies (antibiotics and pain relievers) were collected. The operation was successful, with a total operating time of 55 minutes, and an estimated blood loss of 20 ml. The patient was rapidly mobilized and nutrition promptly resumed. The length of stay was 3 days. We did not observe any complications.

We showed for this patient the feasibility and safety of TAMIS resections at greater distances than those normally recommended.

Anterior resection is a commonly performed surgery for rectal cancer worldwide. It is associated with a wide spectrum of complications which include haemorrhage, pelvic sepsis, wound infection, anastomotic breakdown, deep vein thrombosis, peripheral nerves injury, impotence and urological dysfunction. However acute aortic thrombosis post anterior resection is a very rare complication.

We report a rare case of aortic thrombosis in a 67 year old gentleman following anterior resection for rectal cancer.

We also discuss its possible causes as there are many postulations to the cause of this devastating complication. Prolonged surgery, abnormal blood coagulation in cancer patient, lithotomy position and the presence of peripheral vascular disease are predisposing factors contributing to this rare acute aortic thrombosis in our patient. A standard routine neurovascular examination of the extremities should be done in the postoperative period to help detect early any neurovascular complication. The use of prophylactic anticoagulant such as fondaparinux, low molecular weight heparin or low dose unfractionated heparin are strongly recommended in high risk surgery patients undergoing a major surgery which helps prevent thromboembolic episode following surgery.

Colorectal cancer causes many deaths worldwide and rectal cancer includes one-third of them. Surgical mesorectal excision along with preoperative neoadjuvant chemoradiotherapy is known as the standard treatment for rectal cancer. However, inaccurate preoperative staging is a main concern which leads to large number of patients not being treated with neoadjuvant therapy. Selection of the best treatment approach for these patients is controversial. Although significant better survival was observed is patients who received postoperative adjuvant chemoradiation compared with patients who treated with surgery alone, other studies did not find such results. Due to these contradictory results, this study was designed to further evaluate the survival outcomes in rectal cancer patients who received adjuvant chemoradiotherapy without neoadjuvant therapy.

Totally 197 rectal cancer patients who received adjuvant chemoradiation were included in this study. The demographic and clinico-pathological characteristics of the patients were evaluated by statistical analysis.

Based on the univariate cox regression, poor disease free survival (DFS) was significantly associated with male sex and T3 stage. Poor overall survival (OS) was also associated with stage II/III, T3/T4, NI/NII, grade II/III, positive node number (> 3), perineural invasion, lymphovascular invasion, and margin involvement. According to the multivariate cox regression, independent predictive factors for DFS were T3 andT4 stage, and for OS were also T3/ T4 stage, grade II/ III and lymphovascular invasion.

Taken together, obtained results indicated that combined adjuvant chemoradiation contributes to improve survival outcomes in the rectal cancer patients who did not received neoadjuvant therapy.

Rectal resection for cancer can be technically challenging, especially in the obese patient. While some have investigated the impact of laparoscopic surgery on rectal cancer, no study looked at the subgroup of morbidly obese patients..
Our goal was to evaluate feasibility and safety of laparoscopic rectal resection for cancer in this population..
All morbidly obese patients, defined as a body mass index (BMI) of 40 kg/m2 or greater, undergoing laparoscopic rectal cancer resection for primary cancer between January 2006 and July 2013, were identified using medical records in a single academic hospital center..
Thirteen patients underwent laparoscopic approach. The median BMI was 42.4 kg/m2. There were 4 conversions (30%). Anastomotic leak occurred in 2 patients (15.4%). TME was complete in only 9 patients (69.2%), with 3 patients with incomplete TME being also in the conversion group. There was no mortality. There was no recurrence..
This study suggests that laparoscopic rectal resection for cancer in morbidly obese patients is challenging and associated with a higher rate of conversion compared to patients with lower BMI. Mortality, morbidity and readmission rates are similar to the literature showing the same benefit for laparoscopic procedure..

Abdominoperineal resection (APR) along with permanent colostomy is the standard method of low rectal cancer operation and resection. The laparoscopic APR provides better visualization of pelvic structures compared to the open approach. Disadvantages of the laparoscopic approach have been reported as longer operation duration and requirement of expensive equipment Although this issue has been investigated extensively worldwide, data is limited from Iran.. The aim of this study was to compare short-term outcome of Laparoscopic Abdominoperineal Resection (APR) with open APR in patients with low rectal cancer in Shiraz, southern Iran..Patients and This was a non-randomized controlled trial study performed in Shahid Faghihi Hospital affiliated to Shiraz University of Medical Sciences from 2007 to 2012. We included all patients with rectal cancer who underwent laparoscopic or open APR with permanent colostomy. Both groups were evaluated regarding oncology results. Volume of intraoperative bleeding, short-term complications, operation to diet interval and duration of hospitalization were recorded and further compared between the laparoscopy and open APR groups.. Overall, 24 patients were included in this study of whom 11 underwent laparoscopy and 13 underwent open APR. The two study groups were comparable regarding age (P = 0.747), gender (P = 0.605), tumor stage (P = 0.116), tumor histopathology grade (P = 0.421) and distance from the anal verge (P = 0.711). The duration of operation was comparable between the groups (P = 0.336). Those who underwent laparoscopy had significantly lower intraoperative bleeding (485.5 ± 139.8 vs. 658.3 ± 183.2; P = 0.024), shorter operation-diet interval (2.27 ± 0.46 vs. 3.15 ± 0.37; P < 0.001) and shorter duration of hospitalization compared to the open APR group (4.09 ± 0.53 vs. 4.76 ± 0.59; P = 0.008).. Laparoscopic APR is associated with minimal perioperative bleeding, shorter operation-diet interval and shorter durations of hospitalization compared to open approach in patients with low rectal cancer who had not received neoadjuvant chemo radiotherapy. Oncologic results in this operation were comprisable to open procedure because the mesorectal, anus and sphincter complex excision are performed in the same method.. Therefore, laparoscopy could be the method of choice for APR..