PURPOSE The survival advantage of preoperative radiotherapy in patients with rectal cancer is still a matter of debate, because its incremental benefit in the total mesorectal excision setting is unclear. This study was designed to evaluate early and long-term results of preoperative radiotherapy plus intraoperative radiotherapy in a homogeneous population of T3 middle and lower rectal cancer patients submitted to total mesorectal excision. METHODS A series of 113 patients with middle and lower T3 rectal cancer consecutively submitted to total mesorectal excision at a single surgical unit from 1991 to 1997 were divided into two groups according to type of neoadjuvant treatment: preoperative radiotherapy (38 Gy) plus intraoperative radiotherapy (10 Gy; n = 69), and no preoperative treatment (total mesorectal excision; n = 44). Standard statistical analyses were used to evaluate early (downstaging, intraoperative factors, hospital morbidity, and mortality rates) and long-term results (recurrence and
The study recently published in The Lancet Oncology, describes how this method has fewer adverse side effects than standard rectal cancer surgery without compromising efficacy.. Annually, approximately 2000 men and women are affected by rectal cancer in Sweden. In the early 1990s preoperative radiotherapy was introduced, leading to improved prognoses with a reduced risk of local recurrence for patients with rectal cancer.. However, due to the adverse reactions associated with radiotherapy, the optimal radiotherapy fractionation and the interval between it and the subsequent surgery has been a topic for debate. In this study, the researchers aimed to establish if the adverse effects associated with rectal cancer treatment can be reduced by increasing the duration of the course of radiation whilst administering lower doses or by increasing the time between radiation and surgery.. Rectal cancer patients were randomly allocated to one of three treatment arms; standard therapy (short-course (5×5 ...
The purpose of the present study was to investigate risk factors associated with local recurrence in patients with locally advanced rectal cancer who received preoperative chemoradiotherapy in combination with total mesorectal excision (TME). Rectal cancer patients who were treated with neoadjuvant chemoradiation with TME were studied. We compared 26 patients who developed local recurrence with 119 recurrence-free patients during the follow-up period. The median follow-up period was 52 months (range: 14â€"131 months). Based on the use of univariate and multivariate analyses, circumferential margin involvement ( p = 0.02), the presence of lymphovascular or perineural invasion ( p = 0.02), and positive nodal disease ( p = 0.03) were contributing factors for local recurrence. The local recurrence rate was different between ypN(+) patients and ypN(â€") patients with more than 12 nodes retrieved ( p = 0.01). There was no difference in local recurrence rates between ypN(+) patients and ...
Ji Won Park, MD, Young Suk Kim, MD, Dae Kyung Sohn, PhD, MD, Sung Chan Park, MD, Samin Hong, MD, Hyung Jin Kim, MD, Seong Taek Oh, PhD, MD, Jae Hwan Oh, PhD, MD. National Cancer Center, Goyang, Republic of Korea. Background: Single-port laparoscopic total mesorectal excision is challenging and technically demanding. Exposure and mobilization of the most distal part of rectum are especially difficult. The purpose of this study was to evaluate the feasibility of transanal approach to perform total mesorectal excision using laparoscopy in human cadavers.. Methods: A total of 12 cadavers underwent laparoscopic low anterior resection using transanal port combined with single-port laparoscopy through stoma site. The technique comprises the following: (1) full-thickness circumferential incision about 1cm above the dentate line; (2) rectal lumen was closed with a purse-string suture; (3) a multiple instrument access single-port was placed in the anus; (4) the rectum was mobilized cephalad with ...
TY - JOUR. T1 - Magnetic resonance imaging in rectal cancer. T2 - A surgeons perspective. AU - Saklani, Avanish P.. AU - Bae, Sung Uk. AU - Clayton, Amy. AU - Kim, Nam Kyu. PY - 2014/2/28. Y1 - 2014/2/28. N2 - Magnetic resonance imaging (MRI) in rectal cancer was first investigated in 1999 and has become almost mandatory in planning rectal cancer treatment. MRI has a high accuracy in predicting circumferential resection margin involvement and is used to plan neoadjuvant therapy. The accuracy of MRI in assessing mesorectal lymph nodes remains moderate, as there are no reliable criteria to assess nodal involvement. MRI seems to be good in assessing peritoneal involvement in upper rectal cancer; this however has been assessed in only a few studies and needs further research. For low rectal cancers, mesorectum is thin at the level of levator ani especially in relation to prostate; so predicting circumferential resection margin involvement is not easy. However high spatial resolution coronal imaging ...
The management of rectal cancer has changed in many countries over the last two decades and resulted in improved survival for the majority of rectal cancer patients. In this thesis some surgical strategies and histopathological aspects to improve and clarify the management of rectal cancer patients are investigated.. Even in the era of TME surgery and radiotherapy, a higher local recurrence rate and shorter survival for rectal cancer patients operated with abdominoperineal resection is reported. In the first paper we describe a new strategy with partial anterior en bloc resection of either the prostate or the vagina, resulting in very low local recurrence rates and excellent long-term survival. Histopathological examination of the specimen lays the foundation for decision making on oncological therapy. A positive circumferential resection margin (CRM) has, in previous papers, been related to a high risk of local recurrence. In the second paper we show that a CRM ≤ 1 mm was not correlated with ...
OBJECTIVE: To analyze total mesorectal excision (TME) for rectal cancer by the laparoscopic approach during a prospective nonrandomized trial. SUMMARY BACKGROUND DATA: Improved local control and survival rates in the treatment of rectal cancer have been reported after TME. METHODS: The authors conducted a prospective consecutive series of 100 laparoscopic TMEs for low and mid-rectal tumors. All patients had a sphincter-saving procedure. Case selection, surgical technique, and clinical and oncologic results were reviewed. RESULTS: The distal limit of rectal neoplasm was on average 6.1 (range 3-12) cm from the anal verge. The mean operative time was 250 (range 110-540) minutes. The conversion rate was 12%. Excluding the patient who stayed 104 days after a severe fistula and reoperation, the mean postoperative stay was 12.05 (range 5-53) days. The 30-day mortality was 2% and the overall postoperative morbidity was 36%, including 17 anastomotic leaks. Of 87 malignant cases, 70 (80.4%) had a minimum ...
Aim: Despite advances in rectal cancer treatment, local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method: Local recurrence and survival rates of 4153 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results: The 5-year overall and cancer-specific survival rates were 45% and 62% respectively. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm and 6% at 11-15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0-5 cm: OR 0.50 (0.30-0.83), 6-10 cm: OR 0.42 (0.25-0.71), and 11-15 cm: OR 0.29 (0.13-0.64)]. Patients without preoperative RT had significantly higher LR ...
Purpose: To evaluate the efficacy of thin slice and small FOV MRI technique using body coil, performed after distending the rectum with saline solution in the preoperative staging of rectum cancer.. Materials and Methods: MR imaging of 36 patients with rectum cancer was done by distending the rectum with saline solution, using body coil, with thin slices and small FOV parameters. MR staging was done according to the TNM system by consensus of two radiologists using the MR findings of local tumoral invasion, distance to the mesorectal fascia and involvement of local and distant lymph nodes. 12 patients who werent operated were excluded from the study. 24 patients (13 men, 11 women) who underwent operation with total mesorectal excision technique were included in the study. Histopathologic staging of 24 patients were T1,2 and 3 in 2, 10 and 12; and N0,1 and 2 in 13, 7 and 4 patients, respectively. Comparing MR staging results with the histologic staging, sensitivity, specificity, accuracy and ...
Preoperative radiation therapy has shown to be of benefit for the prevention of local recurrence rates in rectal cancer patients (11, 12). Long-course preoperative chemoradiotherapy is of benefit in stage T3/T4 rectal cancer patients, and long-course preoperative chemoradiation is the standard of care in the United States (27). However, considering the extensive morbidity of preoperative radiation therapy (13-15), it is of great importance to identify patients with a low risk of local recurrence in which radiation therapy is redundant. With this intention, the current study was done in patients with stage III rectal cancer, as these patients are at the highest risk for local recurrence (12). Our results show that biochemical detection of caspase-3 levels can be used as a marker to identify patients with a very high probability for local cure with surgery alone.. To select patients who can be refrained from preoperative radiation therapy, a marker should provide accurate prediction of clinical ...
In the past three decades, several advancements including improvement in surgical techniques and the development of new therapeutic modalities have improved treatment outcomes of rectal cancers. Total mesorectal excision (TME) surgery, which was described by Heald and Ryall [1] in 1982, remarkably improves the clinical outcomes of patients with rectal cancer; thus it has served as the standard surgical procedure for such patients. A 5-year local recurrence rate of 5% in patients who undergone TME surgery alone was reported by MacFarlane et al. [2]. In addition, preoperative concurrent chemoradiotherapy (CCRT) considerably helps in improving the local recurrence rate in patients with locally advanced rectal cancer (LARC). A German study reported a considerable decrease in local recurrence in patients receiving preoperative CCRT [3, 4]. The similar results were also reported by other studies [5-7] and preoperative CCRT has been the recommended treatment for patients with LARC.. Laparoscopic rectal ...
Cancer Monthly. Rectal Cancer treatments. Biologic therapy. Chemotherapy. New York University Cancer Institute, New York, NY , United States. Compare therapy differences, longest survival rates, toxicity, side effects, hospitals.
Cancer Monthly. Rectal Cancer treatments. Chemotherapy. Surgery. Saint Johns Health Center, Santa Monica, California, United States. Compare therapy differences, longest survival rates, toxicity, side effects, hospitals.
All information about the latest scientific publications of the Clínica Universidad de Navarra. Rectal cancer treatment: Improving the picture
TY - JOUR. T1 - Current Concepts on the Distal Margin of Resection of Rectal Cancer Tumors after Neoadjuvant Chemoradiation. AU - Imran, Jonathan. AU - Yao, Jie J.. AU - Madni, Tarik. AU - Huerta, Sergio. PY - 2017/1/23. Y1 - 2017/1/23. N2 - Purpose of Review: The following review addresses concepts regarding the appropriate distal margin of resection for adenocarcinoma of the rectum in the era of preoperative chemoradiation. Recent Findings: The management of adenocarcinoma of the rectum continues to improve in all aspects of its tri-modality treatment (preoperative chemoradiation, surgery, and adjuvant therapy). The multidisciplinary approach to the management of this disease continues to evolve with a goal to provide better oncologic outcomes with less morbidity in patients affected by this disease. For locoregionally advanced disease, total mesorectal excision continues to be the standard of care for an intended cure for this cohort of patients. As we understand more regarding the oncologic ...
Patients with unresectable primary rectal cancer or with unresectable local recurrence without distant metastases are randomly allocated to control or experimental arm. The preoperative treatment in the control arm is conventionally fractionated chemoradiation with 50.4 Gy total dose in 28 fractions of 1.8 Gy over 5.5 weeks simultaneously with 5-Fu, leucovorin and oxaliplatin. Experimental group receive 25 Gy in 5 fractions of 5 Gy over 5 days and after one week interval - consolidating chemotherapy of 3 courses of FOLFOX4. Surgery should be curried out 10-11 weeks from beginning of radiation and at least 4 weeks from the last dose of fluorouracil or radiation. The study hypothesis is that the short-course preoperative radiotherapy with consolidating chemotherapy produce at least 10% increase of the rate of R0 resection compared to preoperative chemoradiation ...
TY - JOUR. T1 - Phase I trial of neoadjuvant concurrent chemoradiotherapy with S-1 and weekly irinotecan in locally advanced rectal cancer. AU - Choi, Hye Jin. AU - Kim, Nam Kyu. AU - Keum, Ki Chang. AU - Cheon, Seong Ha. AU - Shin, Sang Jun. AU - Baik, Seung Hyuk. AU - Choen, Jae Hee. AU - Rha, Sun Young. AU - Roh, Jae Kyung. AU - Jeung, Hei Cheul. AU - Chung, Hyun Cheol. AU - Ahn, Joong Bae. PY - 2008/6/1. Y1 - 2008/6/1. N2 - S-1 is a novel, oral fluoropyrimidine and a known radiosensitizer. We conducted a phase I trial to establish a schedule of S-1/irinotecan with standard pelvic radiotherapy as a preoperative treatment of locally advanced rectal cancer. Our findings suggest that this new combination is feasible and well tolerable.. AB - S-1 is a novel, oral fluoropyrimidine and a known radiosensitizer. We conducted a phase I trial to establish a schedule of S-1/irinotecan with standard pelvic radiotherapy as a preoperative treatment of locally advanced rectal cancer. Our findings suggest ...
Background and Objectives: To investigate critical prognostic factors for local recurrence in patients with rectal adenocarcinoma.. Methods: We enrolled 221 consecutive patients who had histologically confirmed adenocarcinoma of the rectum and underwent surgery in our hospital between January 2000 and December 2014. Total mesorectal excision was performed in all patients undergoing a sphincter-sparing procedure or abdominal perineal resection of rectal cancer. To evaluate prognostic factors for local recurrence, we performed univariate and multivariate Cox regression analyses of the local recurrence rate in all patients. Overall survival rates were calculated using the Kaplan-Meier method, and Kaplan-Meier survival curves were compared using the log-rank test.. Results: After the inclusion of only model variables of local recurrence with the highest or lowest univariate risk, a tumor size of ,5 cm, a negative circumferential margin, well-to-moderately differentiated adenocarcinoma, low anterior ...
Purpose: The aim of this study was to investigate the feasibility of short-course radiotherapy with oral capecitabine, hyperthermia and delayed surgery for neoadjuvant treatment of rectal cancer.Methods: Patients with clinically staged T2-3N0-2M0 primary rectal cancer were included. All patients received short-course 25Gy in 5Gy fractions radiotherapy with capecitabine, local hyperthermia and metronidazole. Capecitabine 1000mg/m(2) twice a day was given on days 1-14. Local hyperthermia, 41-45 degrees C for 60min, was performed on days 3-5. Metronidazole 10g/m(2) was administered per rectum on days 3 and 5. The time interval to surgery was not less than four weeks after neoadjuvant treatment. The primary end-point was pathological complete response (pCR). Secondary end-points included neoadjuvant treatment toxicity, tumour regression, surgical and oncological outcomes.Results: A total of 81 patients were included in the analysis. Ten (12.3%) patients had grade 3 toxicity and one (1.2%) patient ...
Shigeki Yamaguchi, MD, Seiichiro Yamamoto, MD, Junji Okuda, MD, Koki Otsuka, MD, Masanori Sugito, MD, Takashi Yamaguchi, MD, Yoshiharu Sakai, MD, Takatoshi Nakamura, MD, Kenichi Yoshimura, Masahiko Watanabe, MD. Saitama Medical University International Medical Center and the Japan Society of Laparoscopic Colorectal Surgery. INTRODUCTION: Gender is known as one of the risk factor of postoperative complication especially leakage after proctectomy. Multi-center prospective study had registered for 490 laparoscopic rectal cancer resections since 2008 to 2010. This study was accessed about difference of short term results between male and female for laparoscopic proctectomy.. PATIENTS AND METHODS: There were 281 males (M) and 110 females (F). Mean age was 59.6 each. BMI and prior abdominal operation were 23.3, 21.9 (p,0.01) and 16.4%, 32.5% (p,0.01), respectively. Mean tumor location from anal verge was 6.7 cm each. Procedures were anterior resection (AR): 79%, 86%, intersphincteric resection (ISR): ...
From 2010, a new strategy has been introduced in our institute which added 1 more cycle of chemotherapy in the resting period between completion of radiotherapy and operation. The former schedule was defined as conventional group and the schedule with additional cycle of chemotherapy was defined as intensified group. Our policy for locally advanced rectal cancers is to perform neoadjuvant CRT, curative surgery and adjuvant chemotherapy. Neoadjuvant CRT consists of 50 Gy of radiation (25 fraction) and concomitant 5-FU/LV infusion (5-FU 425 mg/m2/day and folic acid 20 mg/m2/day) being delivered in the first and last 5 days of radiation (conventional 2 cycles of chemotherapy). Curative surgery was performed 6-8 weeks after radiation completion. Total mesorectal excision was performed for mid and low rectal cancer and a tumor-specific mesorectal excision with a 5 cm distal margin was performed for upper rectal cancer. Within 6 weeks after rectal surgery, patients took adjuvant 4 cycles of 5-FU/LV ...
TY - JOUR. T1 - Changes in fatigue in rectal cancer patients before and after therapy. T2 - a systematic review and meta-analysis. AU - Wen-Pei, Chang. AU - Hsiu-Ju, Jen. PY - 2020/6/1. Y1 - 2020/6/1. N2 - Purpose: Fatigue is a common problem among rectal cancer patients and can affect their quality of life. This study conducted a systematic review to better understand changes in fatigue severity in rectal cancer patients before, during, and after they undergo therapy. Methods: We used preset keywords to search the Cochrane Library, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PubMed, and ProQuest databases for relevant studies published between 2000 and 2018, and data analysis was performed using Comprehensive Meta-Analysis (CMA) software (version 2.2.048) and SPSS software (version 19.0). In total, nine articles with complete data were included in our meta-analysis. Results: Fatigue conditions were compared before the start of therapy (baseline) and at 1 month (time ...
Purpose: Radiotherapy has reduced local recurrence of rectal cancers, but the result is not satisfactory. Further biologic factors are needed to identify patients for more effective radiotherapy. Our aims were to investigate the relationship of cyclooxygenase-2 (Cox-2) expression to radiotherapy, and clinicopathologic/biologic variables in rectal cancers with or without radiotherapy. Methods and Materials: Cox-2 expression was immunohistochemically examined in distal normal mucosa (n = 28), in adjacent normal mucosa (n = 107), in primary cancer (n = 138), lymph node metastasis (n = 30), and biopsy (n = 85). The patients participated in a rectal cancer trial of preoperative radiotherapy. Results: Cox-2 expression was increased in primary tumor compared with normal mucosa (p < 0.0001), but there was no significant change between primary tumor and metastasis. Cox-2 positivity was or tended to be related to more p53 and Ki-67 expression, and less apoptosis (p ≤ 0.05). In Cox-2-negative cases of ...
Cancer stem cells are associated with metastatic potential, treatment resistance, and poor patient prognosis. Distant recurrence remains the major cause of mortality in rectal cancer patients with preoperative chemoradiotherapy (CRT). We investigated the role of three stem cell markers (CD133, OCT4, and SOX2) in rectal cancer and evaluated the association between these gene levels and clinical outcome in rectal cancer patients with preoperative CRT. Thirty-three patients with rectal cancer underwent preoperative CRT. Total RNAs of rectal cancer cells before and after CRT were isolated. Residual cancer cells after CRT were obtained from formalin-fixed paraffin-embedded (FFPE) specimens using microdissection. The expression levels of three stem cell genes were measured using real-time reverse-transcription polymerase chain reaction (RT-PCR). The association between these gene levels and radiation was evaluated using colon cancer cell lines. Immunohistochemical staining of these markers after CRT was also
While some progress has been made in the treatment of recurrent or progressive rectal cancer, the majority of patients still succumb to cancer and better treatment strategies are clearly needed. Future progress in the treatment of rectal cancer will result from continued participation in appropriate clinical trials. Patients with recurrent or progressive rectal cancer are usually included in clinical trials of colon cancer. Currently, there are several areas of active exploration aimed at improving the treatment of rectal cancer.. New Approaches to Treating Liver Metastases: Researchers continue to explore news ways to treat cancer that has spread to the liver. One approach that is being evaluated is radioembolization This strategy uses radioactive microspheres (small spheres containing radioactive material). The small spheres are injected into vasculature of the liver, where they tend to get lodged in the vasculature responsible for providing blood and nourishment to the cancer cells. While ...
Total mesorectal excision (TME) is a standard technique for treatment of colorectal cancer, first described in 1982 by Professor Bill Heald at the UKs Basingstoke District Hospital. A significant length of the bowel around the tumour is removed, as is the surrounding tissue up to the plane between the mesorectum and the presacral fascia (Healds "holy plane"). Dissection along this plane facilitates a straightforward dissection and preserves the sacral vessels and hypogastric nerves. It is possible to rejoin the two ends of the colon; however, most patients require a temporary ileostomy pouch to bypass the colon, allowing it to heal with less risk of perforation or leakage.[citation needed] TME has become the "gold standard" treatment for rectal cancer in the West. An occasional side effect of the operation is the formation and tangling of fibrous bands from near the site of the operation with other parts of the bowel. These can lead to bowel infarction if not operated on.[citation needed] TME ...
There are different types of treatment for patients with rectal cancer.Different types of treatment are available for patients with rectal cancer. Some treatments are standard (the currently used treatment), and some are being tested in clinical trials. A treatment clinical trial is a research study meant to help improve current treatments or obtain information on new treatments for patients with cancer. When clinical trials show that a new treatment is better than the standard treatment, the new treatment may become the standard treatment. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.Four types of standard treatment are used:SurgerySurgery is the most common treatment for all stages of rectal cancer. The cancer is removed using one of the following types of surgery:Polypectomy: If the cancer is found in a polyp (a small piece of bulging tissue), the polyp is often removed during a
Evidence-based recommendations on transanal total mesorectal excision of the rectum for malignant or benign disease of the rectum (including rectal cancer)
Radiation oncologists in the US are less likely to offer neoadjuvant short-course radiotherapy over long-course chemoradiotherapy.
Colorectal epithelium is composed of absorptive, mucous and endocrine cells, all of which are considered to arise from a common stem cell located in the crypt base. However, the factors controlling the commitment to differentiate are poorly understood. This is partly due to the lack of in vitro model systems for the study of differentiation in colorectal epithelium. The HRA-19 cell line, established from a human rectal adenocarcinoma, has been shown to have multipotential characteristics with cloned HRA-19 cells able to differentiate into absorptive, mucous and endocrine cells when grown as xenografts. The lack of such differentiated cells in HRA-19 monolayers in vitro suggests that differentiation is controlled by extracellular matrix, stromal cells and/or soluble factors. Such observations show that differentiation in HRA-19 cells can be controlled by extrinsic factors and therefore provide a model system for studying control of differentiation in colorectal epithelium. Unfortunately, the ...
One hundred and seventy two patients with T2-3N + /-M0 distal rectal cancer had been enrolled. In Group 1 the number of patients was 127, in Group 2 - 45 patients. SSO in Group 1 comprised 43.3% in Group 2 - 91.1% (p> 0.05). A significant increase of SSO rates in women (64.5%) than men (48.9%) was observed (p = 0.04). Age, stage, tumor differentiation, the type of spread didnt affect the SSO rate. ...
Adult, Aged, Chi-Square Distribution, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Middle Aged, Neoplasm Recurrence; Local, Neoplasm Staging, Preoperative Care, Rectal Neoplasms/*radiotherapy/surgery, Registries, Research Support; Non-U.S. Govt, Statistics; Nonparametric, Survival Rate, Sweden, Treatment Outcome ...
About 60 patients with locally advanced rectal carcinoma (cT3, Nx, M0) of the lower and middle rectum will be recruited.. The radiotherapy is an essential part of therapy of the advanced rectal carcinoma and the additional administration of a chemotherapy will positively influence the effect of the therapy (downstaging-rate, rate of distant metastases, survival-rate). Probably a downsizing and downstaging (as per literature and by own experience) can be reached with an preoperative combined radiochemotherapy. ...
Locally advanced rectal cancer is regularly treated with trimodality therapy consisting of neoadjuvant chemoradiation, surgery and adjuvant chemotherapy. There is a need for biomarkers to assess treatment response, and aid in stratification of patient risk to adapt and personalise components of the therapy. Currently, pathological stage and tumour regression grade are used to assess response. Experimental markers include proteins involved in cell proliferation, apoptosis, angiogenesis, the epithelial to mesenchymal transition and microsatellite instability. As yet, no single marker is sufficiently robust to have clinical utility. Microarrays that screen a tumour for multiple promising candidate markers, gene expression and microRNA profiling will likely have higher yield and it is expected that a combination or panel of markers would prove most useful. Moving forward, utilising serial samples of circulating tumour cells or circulating nucleic acids can potentially allow us to demonstrate tumour
RATIONALE: Surgical resection and adjuvant therapy has become the main treatment for resectable local recurrent rectal cancer. However the efficacy and
The latest American Journal of Surgery examines the impact of short-course radiotherapy and low anterior resection on quality of life and bowel function in primary rectal cancer.. ...
With regard to the second point about the therapeutic usefulness of sequential LLN dissection, the status of the LLN has not been fully established. In Japan, LLN metastasis is considered a local disease [16], and prophylactic LLN dissection is recommended [3]. This type of dissection does not appear to increase morbidity, mortality, or sexual dysfunction [17, 18]. In Western countries, LLN is categorized as a distant metastasis, and preoperative chemoradiotherapy, rather than prophylactic LLN dissection, has been administered to patients with advanced rectal cancers [l, 2]. However, therapeutic LLN dissection is recommended at the time of primary tumor resection for cases with clinically evident LLN metastasis, assuming that curative resection can be achieved [19]. Extended LLN dissection is recommended due to favorable oncologic outcomes in this situation [6, 7]. Table 2 lists the treatments and outcomes of the five cases of isolated LLN metastasis from T1 rectal cancer. In four cases, ...
Hypothesis: In France, approximately 12,000 new rectal cancers are diagnosed each year. Frequency is one and a half times higher in men than in w
Rectal cancer due to its frequent local invasion, high recurrence rate and metastatic potential is a serious health problem, leading to decreased life quality, severe complaints and death. Treatment for locally advanced, resectable rectal cancer improved over the years. Various chemotherapy protocols and combinations with radiation therapy and radical surgery - total mesorectal excision (TMA) - are the main elements of current therapy. Preoperative combined chemoradiation followed by surgery is the preferred treatment sequence. Radiation treatment in combination with fluoropyrimidines (infusional 5-fluorouracil [5-FU] or oral capecitabine) is recommended. Clinical trials with oxaliplatin-based neoadjuvant chemoradiation did not improve the pathologic complete response rate (pCR). Oxaliplatin-based treatment was more toxic as compared with 5-FU. The data concerning local recurrence rate and survival are controversial. Adjuvant chemotherapy in some studies improved survival, so - based on positive ...
This is the peer reviewed version of the following article:Brown G T, Cash B, Alnabulsi A, Samuel L M & Murray G I (2016) Histopathology 68, 556-566. The expression and prognostic significance of bcl-2-associated transcription factor 1 in rectal cancer following neoadjuvant therapy, which has been published in final form at DOI: 10.1111/his.12780. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving ...
Purpose: Although intraoperative radiotherapy (IORT) is known to be a method that can reduce local recurrence in locally advanced colorectal cancer, it is not widely used. The aim of this study was to report our experience with IORT for locally advanced rectal cancer. Methods: From 1991 to 1994, nine patients with locally advanced rectal cancer received IORT. External beam radiotherapy was given postoperatively in five patients and preoperatively in three. Seven patients received chemotherapy. IORT was done with 6-MeV or 9-MeV electrons, and 12 Gy was irradiated at the tumor bed. The median follow-up period was 84 months (range, 15 to 208 months). Results: The median age of patients was 51 years (range, 42 to 73 years). All patients had advanced clinical T-stage (cT3/4)cancer. The overall and the disease-free survival rates were 66.7% and 66.7% at 5 years, respectively. One patient developed a local recurrence near the anastomosis site, which was out of the IORT field. Four patients died before ...
In the period 01.01.1991-12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65.2%. In the middle third, there were 28.9% and in the upper, intraperitoneal third 5.9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4.9% cased with Dukes D stage). There were 74.3% males and 23.7% females median age 59.2 years. According to Dukes classification there were 4.9% in stage A, 47.2% in stage B, 43.1% stage C, and 4.9% stage D. There were 4(2.7%) postoperative deaths. Recurrence ...
The initial literature search identified 7,453 studies. We excluded 1,931 duplicates and excluded 5,504 studies by title screening because they did not meet the eligibility criteria. Eighteen randomized controlled trials were selected for full-text review, and 15 papers were discarded; 6 trials compared surgery alone and surgery plus postoperative radiation, 2 compared surgery alone and preoperative longcourse radiation plus surgery, 6 compared surgery alone and preoperative short-course radiation and surgery, and one was long-term results of a previous reported trial. Three randomized trials comparing preoperative CRT with postoperative CRT in resectable stage II-III rectal cancer were finally identified; Park et al. [9] in 2011, Roh et al. [10] in 2009, and Sauer et al. [5] in 2004 (Fig. 1). All patients in both preoperative and postoperative arms received conventionally fractionated radiotherapy of 50-54 Gy with 1.8-2 Gy per fraction for 5-6 weeks. Concurrent chemotherapy of intravenous ...
TY - JOUR. T1 - Local excision of T1 and T2 rectal cancer. T2 - Proceed with caution. AU - Elmessiry, M. M.. AU - Van Koughnett, J. A M. AU - Maya, A.. AU - Dasilva, G.. AU - Wexner, S. D.. AU - Bejarano, P.. AU - Berho, M.. PY - 2014/1/1. Y1 - 2014/1/1. N2 - Aim: This study aimed to compare the clinical outcome between local excision (LE) and total mesorectal excision (TME) for early rectal cancer. Method: After Institutional Review Board approval, charts of patients with T1 or T2 N0M0 rectal adenocarcinoma treated by curative LE or TME without preoperative radiotherapy from 2004 to 2012 were reviewed. Categorical and continuous variables were compared using chi-square analysis and the ANOVA test. Kaplan-Meier analysis compared survival rates. Results: The study included 153 patients: 79 underwent TME and 74 LE. Postoperative infection was more common after TME (P = 0.009). There was tumour involvement of the margins in 13.5% after LE compared with 0% after TME (P = 0.001). Of the patients ...
The study protocol was approved by the institutional review board. From a prospectively collected database of all patients undergoing colorectal surgery in our department, 46 consecutive patients were selected who underwent laparoscopic surgery after preoperative chemoradiation for rectal cancer from January 2009 to June 2014. All patients were diagnosed with adenocarcinoma in the rectum with tumors ,15 cm from the anal verge. Preoperative assessment included digital rectal examination, colonoscopy with biopsy, rectal ultrasound, abdominopelvic computed tomography (CT), chest x-ray, and laboratory data including complete blood cell count, biochemical profiles, serum carcinoembryonic antigen (CEA), and cancer antigen (CA 19-9).. Patients with CTs showing locally advanced tumor (i.e., penetrating through the rectal wall, T3), and/or tumor with lymph node involvement without evidence of distant metastasis were given the option of preoperative chemoradiation therapy. As preoperative chemoradiation ...
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Rectal cancer is a disease in which malignant (cancer) cells form in the tissues of the rectum. The rectum is part of the body's digestive system. The digestive system takes in nutrients (vitamins, minerals, carbohydrates, fats, proteins, and water) from foods and helps pass waste material out of the body. The...
Rectal cancer is bowel cancer that is situated in the lower part of the bowel within 15cms (6 inches) of the skin. Low rectal cancers - those within 6 cm of the anal verge - require careful consideration and discussion. They are not straightforward due to their position so low in the body. Each treatment decision has to suit each individual patient. Therefore Pelican has been running the Low Rectal Cancer Research Study and the LOREC development programme to ensure that the most recent research results and surgical techniques can be shared with colorectal cancer teams throughout England.. Every bowel cancer is discussed by the multi-disciplinary cancer team (MDT). This group includes at least the clinical nurse specialist (CNS), surgeon, radiologist, oncologist and pathologist.. Bowel cancer patients all have different needs and preferences as well as additional health issues (co-morbidities) to consider. Therefore it is very important that the CNS, and preferable that the surgeon, sees the ...
Colorectal cancer is the second leading cause of mortality in the West, and rectal cancer accounts for about 25% of the colon cancers. The concept of total mesothelial excision (TME) was the most important event in surgery for rectal cancer of the last two decades, because even without a curative approach, it reduced local recurrence and extended 5-year survival. [Med Arch 2017; 71(6.000): 434-438]. Keywords: rectal cancer, TME, mesorectum, CRM, Circumferential Resection Line. >>Full text PDF >>Abstract >>(10.5455/medarh.2017.71.434-438). ...