RESUMO
Radiation therapy followed by local excision results in local control rates that appear comparable to those of local excision alone (in highly selected patients) or local excision followed by adjuvant radiation therapy. A significant drawback of this approach, however, is the potential loss of important histological information, such as risk of lymph node metastasis, depth of tumor penetration, and presence of lymphatic or vascular invasion. Radiation therapy followed by local excision may be an option for treatment of more advanced T3 rectal cancers in patients who either refuse radical surgery or are medically unfit. The available data in the literature do not support the routine use of local excision after radiation therapy in otherwise healthy patients with locally advanced rectal cancer.
Assuntos
Canal Anal/fisiologia , Neoplasias Retais/radioterapia , Quimioterapia Adjuvante , Humanos , Metástase Linfática/patologia , Invasividade Neoplásica , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Seleção de Pacientes , Cuidados Pré-Operatórios , Radioterapia Adjuvante , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Indução de Remissão , Recusa do Paciente ao TratamentoRESUMO
PURPOSE: To evaluate transvaginal ultrasonography (US) as an alternative to transanal US for determining the anatomic cause of fetal incontinence in women. MATERIALS AND METHODS: Transvaginal US of the anal canal was performed in 28 women (aged 27-74 years) with fecal incontinence. A side-fire endorectal probe was inserted into the vagina and directed toward the posterior vaginal wall. RESULTS: The internal anal sphincter (IAS) and external anal sphincter muscles were imaged as independent bands in all 28 patients. The calculated mean thickness of the IAS in patients aged younger than 55 years was not significantly different from that in patients aged older than 55 years (P=.31). Posttraumatic anterior muscle disruptions were detected in 16 women; three also had rectovaginal fistulas. A rectal fistula with abscess was detected in one of 12 patients with intact muscles. All muscle disruptions, fistulas, and abscesses were surgically confirmed. CONCLUSION: Transvaginal US enables determination of the anatomic cause of fecal incontinence, allowing the surgeon to select patients who would benefit form surgical repair.