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M L Santangelo

Publications and source records attributed to M L Santangelo.

30 records · Page 2Linked to original sources
PubMedDate not supplied

[Functional results of colorectal and coloanal anastomosis with and without pouch].

In the last two decades one of the main targets of anorectocolonic surgery has been to develop sphincter saving procedure able to achieve good results with acceptable five-years survivals, optimal local control of the diseases and low rate of local cancer recurrence. Partially the development of new operative techniques such as low colorectal and coloanal anastomoses with or without pouch, the TME operation and the nerve sparing procedure have reach this target. In fact, often after these operations we can observe a functional syndrome called "Post Anterior Resection Syndrome". The basis of this syndrome have to researched in anatomical and physiological alterations that followed a reconstructive operation. It is characterized by frequency and fragmentation of the stool, feeling of incomplete evacuation, tenesmus and urgency. Fecal continence may be compromised to different levels: usually with alteration limited to soiling and impaired control of flatus, occasionally with loss of liquid stool, rarely with loss of solid stools. The anorectal function will be altered for long time following the surgical procedure and the stabilization of functional results may require 1-3 years. On the basis of these considerations, the authors examine the etiopathogenesis and clinical presentation of the "Post Anterior Resection Syndrome", suggesting some expedients to prevent the functional problems. Analysing our experience and a wide specific bibliography, they also underline the indispensable point to achieve a good functional results after a reconstructive procedure. The author conclude asserting that the absence of these points have to be carefully valued because, in these situations, a simply colostomy is able to guarantee a better quality of life that a colorectal/coloanal anastomoses with or without pouch but associated to functional problems.

Anal Canal↗
PubMedDate not supplied

Transanal excision and postoperative radiation therapy in selected patients with cancer of the low rectum.

Preliminary results of 24 patients (15 males, 9 females; age range 30-81 years) with localized low rectal cancer treated with transanal excision and postoperative radiation therapy are reported. Preoperative endosonographic staging was T1 (10), T2a (12) and T2b (2). All had negative resection margins, except one patient who underwent salvage major resection (no tumor found in the specimen). The mean follow-up was 33 months (range 29-61 months). Twenty patients (83.3%) are alive with no sign of local or distant failure. Two patients (9%) developed a local recurrence and were both salvaged with major surgery. Operative and radiotherapy-related morbidity was minor, with diarrhoea and perianal discomfort occurring in most patients following irradiation. Long-term sphincter function was satisfactory in 90% of cases. Rectal endosonography provided a reliable preoperative staging of T (100% correlation with histology) and, indirectly, N parameter, appearing as the key investigation in selecting candidates for conservative treatment. Postoperative radiotherapy might also be proposed after excision of T1 cancers as it produced few side effects and has the potential to control any residual disease. Additional experience is needed to determine long-term results of this combined radiosurgical approach.

Adenocarcinoma↗
PubMedDate not supplied

Pelvic recurrence following resection of rectal cancer: a multivariate predictive model.

Local recurrence of rectal cancer (LR) after "curative" surgery is a major clinical problem, with a low resectability rate and a dismal prognosis. Prediction of LR might permit more targeted postoperative surveillance with earlier diagnosis of recurrent disease and might help in selecting the patients to be assigned to the most suitable adjuvant treatment protocol. To evaluate if a simple multivariate model could predict the LR and survival probability in the single case, we retrospectively evaluated 118 consecutive patients (63 males, 55 females; mean age 62 +/- 12 years) operated on for rectal cancer and followed up for a minimum of 4 years (range 51-111 months). Local recurrence rate was 28%, with a 6% of local + distant failure. Age and sex of patients, type of surgery, location of tumour in the rectum, size, morphology and grading of the tumour were all unrelated to the event under investigation. At Cox regression, the Dukes' stage and the postoperative radiotherapy were the only independent prognostic factors for LR (p < 0.001). The multivariate model was able to correctly reclassify the patients and predict local recurrence in 86.2% of the cases. Prevention of LR by adequate surgery and adjuvant therapy as well as its early detection offer the best prospect of improving the results of surgery for rectal cancer.

Adenocarcinoma↗