Surgical treatment for rectal cancer: An international perspective on what the medical gastroenterologist needs to know

Lindsetmo, Rolv-Ole; Joh, Yong Geul; Delaney, Conor P.

doi:10.3748/wjg.14.3281

Cited by 34 publications

(24 citation statements)

References 57 publications

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“…In all cases the oncological principles of rectal surgery were applied. To improve the local recurrence control, total mesorectal excision was practiced and a minimal 2 cm distal margin of resection was obtained, as a standard procedure [8,9]. For all cases free distal margins were confirmed by the pathology laboratory.…”

Section: Discussionmentioning

confidence: 99%

Sphincter Saving Techniques in Low Rectal Cancer Surgical Treatment: Results, Perspectives

Russu¹,

Copotoiu²,

Bud³

et al. 2015

Acta Medica Marisiensis

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Objective: Sphincter saving techniques in low rectal cancer represents a challenge for the surgeons in their attempt to preserve the sphincter function and also to respect the principles of oncological surgery, in order to improve the quality of the patient’s life. The paper’s aim is to compare different sphincter saving techniques in regards to the early postoperative results. Methods: An observational, retrospective study was performed on 76 patients (N = 76) operated for low rectal cancer in the Surgical Clinic no.1 of the Targu Mures Emergency Clinical County Hospital, between January 2010 and October 2014, to whom the rectal resection was followed by a primary restorative technique for preservation of the sphincter function. The immediate postoperative results after different types of sphincter saving procedures were analyzed and compared. Results: From the studied patients, in 41 cases (53.94%) an anterior rectal resection with low colorectal anastomosis was done („very low” Dixon procedure), for 29 patients (38.15%) a sphincter saving technique with a peranal anastomosis was performed and in 6 cases (7.89%) an intersphinteric rectal resection with coloanal anastomosis was made. Conclusions: Sphincter saving techniques, if oncological principles are respected, represents a viable option in the treatment of low rectal cancer and brings hope for improving the quality of the patients’ life.

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Section: Discussionmentioning

confidence: 99%

Sphincter Saving Techniques in Low Rectal Cancer Surgical Treatment: Results, Perspectives

Russu¹,

Copotoiu²,

Bud³

et al. 2015

Acta Medica Marisiensis

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“…The introduction of neoadjuvant therapy to the multimodal treatment of advanced rectal cancer has meant that the sphincter can be preserved in a greater number of patients, and that the number of local recurrences has decreased while survival rates have increased (1,15). On the other hand, local excision is also now an alternative to radical surgery in early lesions (16).…”

Section: Discussionmentioning

confidence: 99%

“…Rectal cancer is understood at this time as a differentiated oncologic entity due to the peculiar characteristics of its diagnosis and treatment. In these last few years, a multi-disciplinary approach to this entity, with individualized treatment, has achieved substantial improvement in terms of local recurrence, quality of life and survival (1). In this sense, the optimal results of this treatment are directly connected to the precision with which the preoperative study is made (2).…”

Section: Introductionmentioning

confidence: 99%

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study

Ramírez-Rodríguez

Palacios-Fanlo

Ortego-Fernández-de-Retana

et al. 2011

Rev. esp. enferm. dig.

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Objective: the accuracy of preoperative endorectal ultrasound in the status evaluation of lymph nodes is around 50-70%, with a lack of eco-morphological patterns of clinical use. Since, accurate local staging is of great value in prognosis and decision-making we decided to analyze the referenced eco-morphological parameters in an attempt to find a proper predictive tool of clinical help that could improve the accuracy of rectal ultrasound.Material and method: the resected specimens of 24 patients that were operated on by radical surgery because rectal cancer, without preoperative radiotherapy, were suspended in warm water and ultrasound scanned (360° circular probe with a transducer of 10 MHz). All suspicious nodes were recorded and marked for the definitive histological report.Results: from the 24 specimens, 318 nodes were imaged (210 benign and 100 involved). All ultrasound parameters analyzed were significant but only lobulation, echogenicity and hilar reflection were independent values. An score system was design with the addition of all parameters that showed a sensitivity of 98% and specificity of 99,1%.Conclusions: our study shows that a careful study of ultrasound lymph node images can get a high level of accuracy and better help in tailoring the treatment of any particular case.Key words: Rectal cancer. Endorectal ultrasound. Lymph node. INTRODUCTIONColo-rectal carcinoma is the most common malign digestive neoplasm in countries with comparable geographical and socio-economic conditions to ours. Half of these tumors are located in the rectum and the recto-sigmoid junction. Rectal cancer is understood at this time as a differentiated oncologic entity due to the peculiar characteristics of its diagnosis and treatment. In these last few years, a multi-disciplinary approach to this entity, with individualized treatment, has achieved substantial improvement in terms of local recurrence, quality of life and survival (1). In this sense, the optimal results of this treatment are directly connected to the precision with which the preoperative study is made (2).In rectal cancer, this loco-regional preoperative evaluation refers us both to the state of the primary tumor as well as to the situation of the meso-rectal lymph nodes, which are important in the prognosis of the patient and are influential in the taking of decisions (3).Although in the last few decades diagnostic imaging techniques have improved greatly -e.g. magnetic resonance (MR) or computerized tomography (CT)-, endorectal ultrasound (E-R U/S) continues to be the most effective loco-regional pre-operative evaluation for cancer of the rectum (4,5). Even though this is the case, the efficiency of evaluating lymph nodes is between 50 and 70% in most studies (6,7). Since it has great negative predictive value, these results are due mostly to the inability of E-R U/S to differentiate metastatic from inflammatory nodes. There are no generally accepted echo-morphological patterns for lymphatic invasion and those which do exist are difficult to put into pract...

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“…Association with chemotherapeutic agents, to increase tumor radiosensitivity, has been shown to be benefi cial in improving local control, but was reported to have no eff ect upon survival [3].…”

Section: Discussionmentioning

confidence: 99%

“…Th e management of rectal cancer requires a multimodal treatment approach [2]. As a part of this treatment, surgery is the only method to off er cure for rectal cancer [3].…”

Section: Introductionmentioning

confidence: 99%

Rectal Cancer - Sphincter Saving Techniques

Russu¹,

Molnar²,

Pantiru³

et al. 2014

Acta Medica Marisiensis

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Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles. Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012 -April 2013 and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed. Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior rectosigmoidian resections with low and very low colorectal anastomosis ("very low" Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications. Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and "physiological" alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.

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Surgical treatment for rectal cancer: An international perspective on what the medical gastroenterologist needs to know

Cited by 34 publications

References 57 publications

Sphincter Saving Techniques in Low Rectal Cancer Surgical Treatment: Results, Perspectives

Sphincter Saving Techniques in Low Rectal Cancer Surgical Treatment: Results, Perspectives

Predictive ultrasound factors of lymphatic invasion in rectal cancer: "extra-corporeal" study

Rectal Cancer - Sphincter Saving Techniques

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