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PubMed2001

[Coloanal pouch in surgery of rectal neoplasms].

BACKGROUND: The aim of this study was to evaluate the rate of complications and the functional result after construction of a coloanal J pouch during low anterior resection of the rectum for cancer. DESIGN: A retrospective study of medical records and interviews with patients at follow-up. RESULTS: 32 patients were followed-up for a median of 28 months (range 12-82 months). Two patients (6%) developed anastomotic leakage, one of whom died. Two patients developed rectovaginal fistula, one of whom was given a permanent colostomy. One patient died from complications after closure of the diverting ileostomy. In two patients, local cancer recurred and four died from distant metastases. At follow-up, the frequency of bowel movements was median 2/24 h (range 0.3-4). Three of 29 (10%) experienced intermittent incontinence, whereas none complained of evacuation problems. DISCUSSION: The complication rate was as expected after low anterior rectal resection, but there were unexpected severe complications after closure of the diverting stoma. The functional results were satisfactory and the construction of a colonic J pouch is recommended during low rectal resection, if the defecation pattern and the quality of life is to improve, especially within the first postoperative year.

Adenocarcinoma↗
PubMed1979

[Surgical treatment of rectal neoplasms in the very old patient].

Efforts and results of curative and palliative treatment of rectum carcinoma in the very aged (more than 75 years old) are shown by a follow-up study including 212 patients operated in our clinic. Establishing an absolute indication for radical resection of the malignant tumor the contraindications in this collective are pointed out. There is practically no difference between the results of curative and palliative treatment of rectum carcinoma in the very aged regarding letality and morbidity if contraindications are strictly considered and accurate pre- and postoperative treatment is guaranteed.

Aged↗
PubMed1991

[Endolymphatic polychemotherapy with local UHF hyperthermia in the surgical treatment of rectal neoplasms].

To reduce the risk of intraoperative metastases and increasing ablastic principles in radical surgical treatment of patients with cancer of the rectum the authors developed a scheme of preoperative treatment including endolymphatic polychemotherapy and UHF-hyperthermia. 5-fluorouracil and platidiam were used in the treatment of 30 patients with different histological types of adenocarcinomas of the rectum (grade III-IV). After treatment the viable epithelial component in the tumour was 26.5% as compared with 44.8% in the control. The effect of treatment was favourable both objectively and subjectively. The treatment was well tolerated.

Adult↗
PubMedDate not supplied

[Anastomotic complications in the surgical treatment of rectal neoplasms].

The authors review the problems relating to the healing of colorectal anastomotic complications following anterior resection. They report on their own experience with 328 anastomoses, 281 of which constructed manually and 47 using a mechanical suturing gun. Following manual anastomosis, the reported incidence of clinical dehiscence was 1%, as against a 10.3% incidence of radiologically detectable dehiscence. In the cases of mechanically produced anastomoses the incidence of clinical dehiscence was 6.4%. In 2 cases stenosis developed as a result of the clinically manifest dehiscence following manual anastomosis. In the patients undergoing mechanical anastomosis, occlusion occurred in one case and stenosis in another, without any concomitant peri-anastomotic inflammatory processes; these complications were caused by a membrane extending between the margins of the anastomosis. The authors ascribe the greater incidence of clinically important dehiscence following mechanical anastomosis to a greater sensitivity of the mechanical suture to colonic contamination compared to the manual suture. According to the authors, the stenosis is attributable to inflammatory processes resulting from the dehiscence in the manual anastomosis cases and from the anastomotic structure in the mechanical-suture case.

Anastomosis, Surgical↗
PubMed1985

Pre-operative staging of rectal neoplasm and its impact on clinical management.

A sophisticated staging technique (extended staging, ES) employing modern technology has been compared prospectively with conventional clinical assessment (initial staging, IS) in 45 patients with low rectal carcinoma (less than 12 cm from the anal verge) to determine its potential merit and its impact on clinical management. ES consisted of computerized tomography of liver and pelvis, ultrasound scan of liver, measurement of serum concentrations of carcinoembryonic antigen (CEA) and acute phase reactant proteins and multiple superficial and deep biopsies to determine not only the histological grade of the tumour but also its DNA cellular content as measured by flow cytometry. ES proved statistically superior to IS in the assessment of local spread and dissemination. Although histological grade proved to be more accurate on ES than IS this was only true when one specialist pathologist interpreted the slides. When several pathologists were involved interobserver variation made interpretation unreliable. Assessment of DNA content using flow cytometry, being quantitative, was more accurate and perhaps should be used in the future as a prognostic indicator. The improved accuracy of ES would have altered both pre- and intra-operative clinical decisions. It would have prevented some patients receiving inappropriate adjuvant therapy as well as selecting patients more accurately for the correct treatment.

Adult↗
PubMed1994

[Postoperative suppurative complications and immune status in the surgical treatment of rectal neoplasms].

The authors studied the course of the disease in the postoperative period in 308 patients with carcinoma of the rectum. The literature data and personal experience made it possible to reveal the high frequency of purulent complications among this category of patients. In view of this, the values of humoral and cellular metabolism were studied in some patients with uncomplicated forms of rectal carcinoma. Special attention was given for the first time to the peculiarities of local defence reactions of the peritoneum.

Adult↗
PubMed1993

[81 cancers of the rectosigmoid junction. Colonic or rectal neoplasms?].

With the aim of a better understanding of the cancer of the rectosigmoid junction the authors studied a series of 245 patients treated in Surgery Department 4 with the following distribution according to the localization: 113 in the sigmoid, 81 in the rectosigmoid junction and 51 in the superior rectum. The percentage of cases operated for intestinal obstruction in the rectosigmoid junction (37.0%) was higher than those in the superior rectum (7.8%) (p = 0.001) and the resectability rate of tumours located in the rectosigmoid junction (44.4%) was lower than that of those located in the sigmoid (68.1%) (p = 0.004). In the patients submitted to surgical resection the greater percentage of tumours in stage A and B (58.3%) and with venous invasion (34.4%) was observed in the rectosigmoid junction. Nevertheless, the differences according to the site and shape of the tumour, degree of differentiation, stage and venous invasion were not statistically significant. The 5-year survival rate in 101 cases submitted to resection was higher in patients with tumours in the superior rectum (75.9%) than in patients with carcinomas located in the rectosigmoid junction and in the sigmoid (51.5% and 36.8%, respectively). In summary, this study supported those who consider the rectosigmoid junction cancers as a specific group, based on the particular association of the high frequency of intestinal obstruction and the low resectability rate, apparently related with a special anatomic localization, in a curved segment of the large bowel and suggests that these carcinomas do not constitute, in fact, a colo-rectal independent histopathologic entity.

Aged↗
PubMed1975

[Bone metastases of colonic and rectal neoplasms. Apropos of 11 cases].

The authors report 11 personal cases and discuss the characteristics of bony metastases in carcinoma of the colon and rectum. The frequency of these metastases is fairly low (1.3% of all cases of bony metastases) as tumours of the large intestine do not tend to migrate to the bones. Sometimes bony metastases are the presenting symptom but, usually the metastases occur within 5 years of the diagnosis of the primary tumour. The clinical picture shows no special characteristics. Radiologically, these bony metastases may be either single or multiple. Their distribution recalls that of other metastases in the bones with a few differences, however. The special frequence of pelvic involvement, distal localisations (hands or feet) are not exceptional. Metastases usually give rise to osteolysis. The mixed appearances are, however, not rare, and usually give a pseudo-sarcomatous appearance, with invasion of the soft parts and very marked periosteal reaction. Sometimes, bony condensation may be noted. The treatment of rectal and colonic cancer with bony metastases, is disappointing as the disease is always fatal within a relatively short period, usually less than one year after the diagnosis of the bone involvement. The histological appearances of the bony lesions depend on differenciation of the tumour and the characteristics of the neighbouring bony abnormalities which, in our experience, usually include both osteolysis and osteogenesis.

Age Factors↗
PubMed1996

[Computerized tomography and magnetic resonance in the diagnosis of recurrent rectal neoplasms: comparison of reliability and errors of both methods].

Our work was aimed at assessing the accuracy of CT and MRI in the early identification of postoperative recurrences of rectosigmoid cancer, quantifying false positive and false negative ratios and questionable findings. A homogeneous series of 50 patients submitted to surgery for primary rectosigmoid carcinoma was studied with both CT and MRI and followed-up for up to 2 years: local recurrences were observed in 15 patients (30%) which occurred within the first year of surgery in 67% of cases and were in extraluminal site in 86% of cases. CT appeared to be a reliable and highly sensitive screening method, with 82% sensitivity: only 2 false negatives were observed, which were nevertheless followed-up because CT had yielded questionable, and not negative, findings. In contrast, CT had only 78% specificity, being unable to differentiate fibrosis, displaced normal structures and recurrences in 7 cases; its positive predictive value (PPV) was 66%, with 89% negative predictive value (NPV) and 80% accuracy. MRI had a complementary role to CT, because of its capabilities in discriminating all the questionable CT cases and in identifying all CT false positives, thanks to its higher specificity (100%). MRI had 74% sensitivity, which was lower than that of CT; MRI yielded 2 false negatives which, however, had been previously diagnosed with CT. MRI had 100% PPV, 89% NPV and 92% accuracy. Therefore, for the early detection of rectal cancer recurrences, the following diagnostic protocol is suggested: CT should be performed first, as a screening method, within 2-4 months of surgery, and repeated every 6-8 months during the first 2 years-together with CEA values monitoring. MRI should be reserved to the patients in whom CT findings were positive, questionable, or in disagreement with clinical symptoms and/or with increasing CEA values. If MRI fails to solve the diagnostic doubt, a CT-guided biopsy of the mass should be performed.

Adenocarcinoma↗
PubMed1984

[Rectal sonography--an expansion of the diagnosis of recurrent cervical neoplasms].

Rectal sonography--especially with the use of modern rotating scanners--provides major progress in the diagnosis of recurrent malignant tumours in the lower pelvis. Due to the high resolution and the possibility of exact localisation this method is less biassed, and hence rectal scanning can be used as a routine method in future in cases suspected of recurrences located at the pelvic wall. Sonography in general and its advantages are discussed in comparison to other techniques for the diagnosis of recurring cervical malignancies.

Diagnosis, Differential↗
PubMed1993

Transrectal ultrasound of rectal tumors.

Since preoperative staging of rectal tumors is important in planning treatment, we evaluated transrectal ultrasound (TRUS) staging of rectal neoplasms. In 35 consecutive rectal tumors, we compared TRUS staging results with final pathologic staging. TRUS predicted the degree of tumor invasion in 19 of 24 patients (79%) and the presence or absence of lymph node metastasis in 11 of 15 patients (73%). TRUS overestimated the degree of tumor invasion in four patients (17%) and underestimated invasion in one patient (4%). The depth of tumor invasion was correctly predicted in all 14 tumors located within 6 cm from the anal verge, but, beyond 6 cm, only 5 of 10 tumors (50%) were staged correctly (p = 0.005). In the group of 11 patients who underwent preoperative radiotherapy, pretreatment TRUS predicted the depth of tumor invasion in only six patients (55%) and overestimated tumor invasion in five patients (45%), suggesting that nearly half of these tumors were downstaged by radiotherapy. TRUS accurately predicts the degree of tumor invasion, especially in tumors closer to the anal verge, allowing for better treatment planning in patients with low to middle rectal neoplasms.

Adult↗
PubMed1991

Ovarian neoplasm mimicking rectal carcinoma. Report of a case and review of the literature.

We report a rare case of primary endometrioid carcinoma of the ovary which presented clinically with rectal bleeding mimicking a rectal cancer. The patient's pre-operative evaluation included radiographic and sero-immunologic findings which indicated a primary ovarian neoplasm. Only two other cases of ovarian carcinoma with this presentation have been reported in the literature. Gynecologic processes that can present as bleeding gastrointestinal lesions are reviewed.

Adult↗
PubMed2006

Radiation therapy and combined modality treatment of gastrointestinal carcinomas.

BACKGROUND: Ionizing radiation (IR) is a potent agent in enhancing tumor control of locally advanced cancer and has been shown to improve disease-free and overall survival in several entities. However, the role of radiotherapy (RT) in the treatment of gastrointestinal tumors remains controversial because of the marked radiation sensitivity of neighboring organs frequently compromising application of high doses of ionizing radiation. METHODS: The Medline and the Cochrane Library from 1980 until 2005 were searched using subject heading (MeSH) terms including "esophageal neoplasm", "gastric neoplasm", "pancreatic neoplasm" and "rectal neoplasm", in combination with the subheadings "radiotherapy", "chemotherapy". The term, "randomized controlled trial", was used to identify randomized trials. The proceedings of the annual meeting of the American Society for Therapeutic Radiology and Oncology from 1999 to 2004 and the annual meeting of the American Society of Clinical Oncology from 1999 until 2005 were searched. Ongoing trials were identified through the Physician Data Query database (www.cancer.gov/search/clinical_trials). RESULTS: RT in combination with surgery enhances tumor control of locally advanced cancer disease and has been shown to improve disease-free and overall survival in rectal cancer. In esophageal adenocarcinoma, survival was prolonged with pre-operative chemo-radiation in a meta-analysis. In gastric cancer, post-operative chemo-radiation can be considered after limited lymphadenectomy. Evidence for improving survival remains to be shown for pancreatic cancer and hepatobiliary carcinoma. In colon cancer, post-operative chemotherapy has proven to prolong survival. The impact of RT seems to be most prominent in the pre-operative setting in patients treated with curative intent. CONCLUSIONS: Pre-operative RT or pre-operative chemo-radiation may be considered in individual cases, but should not be used routinely for gastro-intestinal carcinoma, except for rectal carcinoma. In many studies, pre-operative radiotherapy/chemo-radiation yielded promising results and merits validation in large controlled trials.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

[Perioperative complications in traditional surgery of the rectum].

The authors report their experience of 136 operations for rectal neoplasms, on all of 652 colo-rectal neoplasms, treated from January 1987 to May 1994. In detail the perianastomotic complications have been tested after "traditional" rectal operations: Anterior Resection (RA), Abdomino-perineal amputation (AAP) and Hartmann's procedure. A series of 24 AAP (18%), 81 RA (60%) and 7 Hartmann's procedure have been considered; conversely 18 final and palliative colostomies (13%) and 7 trans-anal operations haven't been taken in to account. Perioperative mortality was comparatively reasonable: 2.7%. No patient died after AAP. The most common complication proved to be anastomotic leak (17.3%), after RA; otherwise the rate of further complications was very moderate. It is feasible to avoid anastomotic leaks, by carrying out a temporary colostomy.

Aged↗
PubMed1979

[Ultrastructural observations on transitional cloacogenic carcinomas of the ano-rectal region (author's transl)].

The clinical and pathological features of four transitional cloacogenic carcinomas (TCC) are presented with particular reference to electron microscopy. The incidence of this tumour is 1.4% of all ano-rectal neoplasms. Three cases showed a gross appearance similar to the common rectal neoplasms. One tumour presented without an intraluminal lesion, but infiltrated the bowel wall and the anal glands. TCC show a distinct histological pattern. The degree of differentiation of the basic transitional cell component determines the "grading" of the lesion. We distinguish between grade I, II and III. Grade I lesions show uniform polygonal cells with only occasional mitotic figures. There is distinct palisading of the nuclei of the peripheral tumour cell layers. Grade II lesions are characterized by partial or total loss of the peripheral palisading. Grade III lesions are extremely anaplastic ("oat cell" carcinoma). This histological classification correlates well with the prognosis. Electron microscopic investigation of TCC revealed the ultrastructural features of basal cells. The uniform tumour cells with large nuclei contain tonofibrils, desmosomes and hemi-desmosomes, free ribosomes, and relatively few other organelles. We did not find keratinocytes or keratohyalin granules in these four cases of TCC. It is emphasized that TCC of the ano-rectal region differ fundamentally from the basalcell carcinomas of the skin in their biological behaviour.

Aged↗