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1.
J Surg Oncol ; 123(1): 271-277, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33047338

RESUMO

BACKGROUND: The efficacy of pelvic floor peritoneum closure (PC) during endoscopic low anterior resection (E-LAR) of rectal cancer remains unclear. This study aimed to clarify whether pelvic floor PC affected short-term outcomes. METHODS: The study group comprised patients with the pathologically confirmed diagnosis of rectal cancer who underwent E-LAR with pelvic floor PC or with no PC (NPC) between January 2013 and December 2018 in Southwest Hospital. After propensity score matching (PSM), 584 patients (292 who underwent PC and 292 who underwent NPC) were evaluated. Postoperative indicators, including the rates of complications, anastomotic leakage (AL), reoperation, and inflammation, were observed in the two groups. RESULTS: No significant difference was observed in the rates of postoperative complications between the PC and NPC groups. The rates of AL were similar (11.3% vs. 9.2%, p = .414). However, the reoperation rate of patients in the PC group was significantly lower than that of patients in the NPC group after AL (36.4% vs. 11.1%, p = .025). The hospital costs were higher in the NPC leakage subgroup (p = .001). Additionally, the serum C-reactive protein levels were lower in the PC group on postoperative days (PODs) 1, 3, and 5, whereas procalcitonin levels on POD 1 and 3 were lower in the PC group but did not differ significantly on POD 5. CONCLUSION: Pelvic peritonization did not affect the rate of complications, especially AL; however, it effectively reduced the reoperation and inflammation rates and reduced hospitalization costs. Other short-term outcomes were similar, which warrant the increased use of pelvic peritonization in endoscopic surgery.


Assuntos
Anastomose Cirúrgica/métodos , Fístula Anastomótica/prevenção & controle , Diafragma da Pelve/cirurgia , Peritônio/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Neoplasias Retais/cirurgia , Endoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Diafragma da Pelve/patologia , Peritônio/patologia , Prognóstico , Pontuação de Propensão , Neoplasias Retais/patologia , Reoperação , Estudos Retrospectivos , Fatores de Risco
2.
J Surg Oncol ; 123(1): 278-285, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33022750

RESUMO

BACKGROUND: Mutation of the KRAS oncogene (mKRAS) in colorectal cancer has been associated with aggressive tumor biology, resistance to epidermal growth factor inhibitors, and decreased overall survival (OS). The aim of the current study was to analyze the association of mKRAS with pathologic complete response (pCR) and neoadjuvant rectal (NAR) score, and its impact on the survival of patients with locally advanced rectal cancer who were managed with multimodality therapy. METHODS: The National Cancer Database was queried for stage II-III rectal cancer patients with a known KRAS status who underwent neoadjuvant chemoradiation therapy (nCRT) and proctectomy between 2004 and 2015. RESULTS: In total, 1886 patients were identified; 12% had pCR and 36% had mKRAS. Patients with mKRAS were more likely to have advanced pathologic T stage, tumor deposits, perineural invasion, and elevated carcinoembryonic antigen levels (all p ≤ .05). After adjustment for available confounders, mKRAS status was not associated with pCR or NAR score. In multivariable analysis, patients with pCR and lower NAR score had better OS, whereas mKRAS was independently associated with a worse prognosis. CONCLUSION: In this cohort of locally advanced rectal cancer patients who underwent proctectomy after nCRT, mKRAS was not associated with lower pCR rates or NAR scores; however, these patients experienced worse survival.


Assuntos
Biomarcadores Tumorais/genética , Quimiorradioterapia Adjuvante/mortalidade , Mutação , Terapia Neoadjuvante/mortalidade , Proteínas Proto-Oncogênicas p21(ras)/genética , Neoplasias Retais/mortalidade , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/genética , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Estudos Retrospectivos , Taxa de Sobrevida
3.
J Surg Oncol ; 123(1): 286-292, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33022767

RESUMO

BACKGROUND: Neoadjuvant chemotherapy to treat locally advanced rectal cancer is an effective therapeutic strategy for the prevention of local recurrence and distant organ metastasis after surgery. OBJECTIVES: To assess the prognostic significance of histopathological tumor response in rectal cancer patients undergoing neoadjuvant chemotherapy. METHODS: This study included patients with operable rectal cancer who received neoadjuvant chemotherapy using the FOLFOX regimen (5-fluorouracil, l-leucovorin, and oxaliplatin) in a hospital between February 2012 and November 2017. The main outcome measure was disease-free survival with respect to histopathological response to neoadjuvant chemotherapy in resected specimens. RESULTS: The median follow-up was 32 months. Of 48 patients treated with neoadjuvant FOLFOX, 24 (50%) were classified as responders, which included two patients with pathological complete response and 22 patients with partial response. The remaining 24 patients (50%) were classified as nonresponders. Responders had a significantly better 3-year disease-free survival than nonresponders (86% vs. 62%, p = .02). CONCLUSIONS: Patients whose surgical specimens show a pathological complete response or partial response have good oncologic outcomes.


Assuntos
Adenocarcinoma/mortalidade , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Recidiva Local de Neoplasia/mortalidade , Neoplasias Retais/mortalidade , Adenocarcinoma/tratamento farmacológico , Adenocarcinoma/secundário , Adulto , Idoso , Ensaios Clínicos Fase II como Assunto , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Leucovorina/administração & dosagem , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Oxaliplatina/administração & dosagem , Prognóstico , Estudos Prospectivos , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Estudos Retrospectivos , Taxa de Sobrevida
4.
J Surg Oncol ; 123(1): 293-298, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33022797

RESUMO

BACKGROUND: Multimodal treatment is the standard of care for rectal adenocarcinoma, with a subset of patients achieving a pathologic complete response (pCR). While pCR is associated with improved overall survival (OS), long-term data on patients with pCR is limited. METHODS: This is a single institution retrospective cohort study of all patients with clinical stages II/III rectal adenocarcinoma who underwent neoadjuvant chemoradiation therapy and operative resection (January 1, 2004-December 31, 2017). PCR was defined as no tumor identified in the rectum or associated lymph nodes by final pathology. RESULTS: Of 370 patients in this cohort, 50 had a pCR (13.5%). For pCR patients, 5-year disease-free survival (DFS) was 92%, 5-year OS was 95%. Twenty-six patients had surgery > 10 years before the study end date, of which 20 had an OS > 10 years (77%) with median OS 12.1 years and 95% alive to date (19/20). Of the 50 pCR patients, there was a single recurrence in the lung at 44.3 months after proctectomy which was surgically resected. CONCLUSION: For patients with rectal adenocarcinoma that undergo neoadjuvant chemoradiation and surgical resection, pCR is associated with excellent long-term DFS and OS. Many patients live greater than 10 years with no evidence of disease recurrence.


Assuntos
Adenocarcinoma/mortalidade , Quimiorradioterapia Adjuvante/mortalidade , Procedimentos Cirúrgicos do Sistema Digestório/mortalidade , Terapia Neoadjuvante/mortalidade , Recidiva Local de Neoplasia/mortalidade , Neoplasias Retais/mortalidade , Adenocarcinoma/secundário , Adenocarcinoma/terapia , Adulto , Idoso , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/terapia , Prognóstico , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Estudos Retrospectivos , Taxa de Sobrevida
6.
Clin Nucl Med ; 46(1): e40-e43, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32804768

RESUMO

Sarcoidosis is a systemic disorder of unknown etiology characterized by development of noncaseating granulomas in more than 1 organ system. Development of sarcoidosis during or immediately after chemotherapy and immunotherapy is not uncommon. We present a 61-year-old woman in whom restaging F-FDG PET/CT detected asymptomatic sarcoidosis after neoadjuvant chemoradiotherapy for carcinoma rectum, which resolved spontaneously by the end of adjuvant chemotherapy with no specific treatment. Recognition of anatomic-metabolic pattern of sarcoidosis could prevent erroneous upstaging of the primary malignancy during restaging PET/CT following chemotherapy, and such lesions may show self-resolution.


Assuntos
Fluordesoxiglucose F18 , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Sarcoidose/etiologia , Quimioterapia Adjuvante/efeitos adversos , Feminino , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Retais/terapia , Remissão Espontânea , Sarcoidose/patologia
7.
J Surg Oncol ; 123(1): 299-310, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33098678

RESUMO

BACKGROUND: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR). METHODS: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at surgery. SSR technique was standardized as mucosectomy (M) or partial (PISR)/complete (CISR) intersphincteric resection. RESULTS: Overall SSR rate was 85% (72% ISR), postoperative morbidity 27%, with no mortality. There were no significant differences between the HDR and RCT groups: 10-year overall survival (OS10) 70.1% versus 69.4%, respectively, 10.2% local recurrence (9.2%/14.5%) and 27.6% metastases (32.4%/27.7%). OS and disease-free survival were significantly longer for SSR (72.2% and 60.1%, respectively) versus APR (54.7% and 38.3%). No difference in OS10 between surgical approaches (M 78.9%, PISR 75.5%, CISR 65.5%) or tumour location (low 64.8%, ultralow 76.7%). CONCLUSION: GRECCAR 1 demonstrates the feasibility of safely changing an initial APR indication into an SSR procedure according to the preoperative treatment tumour response. Long-term oncologic follow-up validates this attitude.


Assuntos
Adenocarcinoma/cirurgia , Canal Anal/cirurgia , Tratamentos com Preservação do Órgão/métodos , Protectomia/métodos , Neoplasias Retais/cirurgia , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Canal Anal/patologia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Neoplasias Retais/patologia
8.
Clin Nucl Med ; 46(1): e6-e7, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32604103

RESUMO

Rectal leiomyoma is an exceedingly rare benign lesion. We here report a case with extraluminal leiomyoma of the middle and lower parts of the rectum showing aberrant hypermetabolism on F-FDG PET/CT in a 54-year-old man.


Assuntos
Fluordesoxiglucose F18 , Leiomioma/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Neoplasias Retais/diagnóstico por imagem , Diagnóstico Diferencial , Humanos , Leiomioma/patologia , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/patologia
9.
BMJ Case Rep ; 13(12)2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33370929

RESUMO

Syphilitic proctitis is a rare presentation of sexually transmitted infection that poses a diagnostic challenge as it mimics rectal cancer clinically, radiologically and endoscopically. We report a case of a 66-year-old male patient with a background of HIV infection presenting with obstructive bowel symptoms and initial diagnosis of rectal cancer on CT. Sigmoidoscopy and histopathology were non-diagnostic. A diagnosis of secondary syphilis was suspected after obtaining sexual history and diagnostic serology, avoiding planned surgical intervention.


Assuntos
Infecções por HIV , Obstrução Intestinal , Penicilinas/administração & dosagem , Proctite/diagnóstico , Neoplasias Retais/diagnóstico , Reto , Treponema pallidum , Idoso , Antibacterianos/administração & dosagem , Diagnóstico Diferencial , Infecções por HIV/complicações , Infecções por HIV/terapia , Humanos , Obstrução Intestinal/diagnóstico , Obstrução Intestinal/etiologia , Masculino , Proctite/etiologia , Proctite/fisiopatologia , Proctite/terapia , Reto/diagnóstico por imagem , Reto/microbiologia , Reto/patologia , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/terapia , Sigmoidoscopia/métodos , Sífilis/complicações , Sífilis/diagnóstico , Sífilis/terapia , Tomografia Computadorizada por Raios X/métodos , Treponema pallidum/imunologia , Treponema pallidum/isolamento & purificação
11.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1144-1148, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353267

RESUMO

Colorectal surgeons have focused on the lateral structure of rectum for a long time and lateral ligament is the common term to depict this structure. A better understanding of lateral rectal structure could be beneficial to performing the total mesorectum excision (TME) procedure and protecting patients' urinary, sexual and defecation function. The main controversies focus on two aspects: (1) Does the lateral ligament exist? (2) What dose it contain? Does the middle rectal artery exist? Up to now, anatomic studies have failed to reach consensus on the lateral rectal structure. However, surgeons do find the lateral rectal ligament during surgery and it may be the pathway for lateral lymph node metastasis in rectal cancer. The lateral rectal structure contains the middle rectal artery, nerve branches, lymphatics and adipose fibrous tissue around them. We summarize our clinical experience and conclude that the middle rectal artery appears in lateral ligament constantly but some of them are too small to be easily observed. Therefore, regarding the perspective of membrane anatomy, embryology and surgery, this structure may be more appropriate to be called the "lateral mesorectum". We propose this new term based on the previous literature and our own experience for the readers' reference.


Assuntos
Ligamentos/anatomia & histologia , Artéria Mesentérica Inferior/anatomia & histologia , Mesentério/anatomia & histologia , Neoplasias Retais , Reto/anatomia & histologia , Humanos , Ligamentos/irrigação sanguínea , Ligamentos/cirurgia , Linfonodos/anatomia & histologia , Linfonodos/cirurgia , Artéria Mesentérica Inferior/cirurgia , Mesentério/irrigação sanguínea , Mesentério/cirurgia , Pelve/anatomia & histologia , Pelve/cirurgia , Neoplasias Retais/cirurgia , Reto/irrigação sanguínea , Reto/cirurgia
12.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1159-1163, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353270

RESUMO

Objective: To explore the predictive factors of pathological complete response (pCR) after neoadjuvant chemoradiotherapy for middle-low rectal cancer. Methods: A case-control study was conducted. The inclusion criteria were as follows: (1) colonoscopy, digital examination or magnetic resonance imaging (MRI) showed a distance from the lower edge of the tumor to the dentate line of no more than 10 cm; (2) complete clinicopathological data were available; (3) preoperative biopsy revealed adenocarcinoma; (4) preoperative pelvic MRI or endorectal ultrasonography was performed; (5) no distant metastasis was found. Exclusion criteria: (1) preoperative radiotherapy and chemotherapy were not administrated according to the standard; (2) simultaneous multiple primary cancer and familial adenomatous polyposis were observed. According to the above criteria, clinicopathological data of 245 patients with middle-low rectal cancer undergoing preoperative neoadjuvant chemoradiotherapy in Changhai Hospital of Navy Medical University from January 2012 to December 2019 were retrospectively collected. Univariate analysis and multivariate logistic analysis were used to identify the clinical factors predicting pCR. pCR is defined as complete disappearance of cancer cells under the microscope in cancer specimens (including lymph nodes) after neoadjuvant chemoradiotherapy. Results: A total of 72 patients with pCR were enrolled in this study. Univariate analysis showed that preoperative T stage, tumor circumference, tumor morphology, carbohydrate antigen (CA) 19-9, interval between the end of neoadjuvant therapy and operation were associated with pCR (all P<0.05). The above 5 variables were included in multivariate logistic analysis and the results revealed that the T stage (OR=5.743, 95% CI: 2.416-13.648, P<0.001), tumor circumference (OR=7.754, 95% CI: 3.822-15.733, P<0.001), tumor morphology (OR=0.264, 95% CI: 0.089-0.786, P=0.017) and the interval between the end of neoadjuvant therapy and operation (OR=0.303, 95% CI: 0.147-0.625, P=0.001) were independent predictive factors of pCR, while CA 19-9 level was not an independent factor (OR=1.873, 95% CI:0.372-9.436, P=0.447). Conclusion: By knowing the clinical features of preoperative T stage, tumor circumference, tumor morphology and the interval between neoadjuvant chemoradiotherapy and operation, patients with higher likelyhood of pCR after neoadjuvant chemoradiotherapy may be identified.


Assuntos
Quimiorradioterapia , Terapia Neoadjuvante , Neoplasias Retais , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Estudos de Casos e Controles , Humanos , Estadiamento de Neoplasias , Protectomia , Prognóstico , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Indução de Remissão , Estudos Retrospectivos , Resultado do Tratamento
13.
Zhonghua Wei Chang Wai Ke Za Zhi ; 23(12): 1170-1176, 2020 Dec 25.
Artigo em Chinês | MEDLINE | ID: mdl-33353272

RESUMO

Objective: Presacral recurrence of rectal cancer have altered the adjacent structures of original pelvic organs due to the previous radical surgery of rectal cancer, and the boundary between recurrent tumor tissues and pelvic internal structures is not clear. Conventional CT examination has poor soft tissue resolution, which makes it difficult to accurately delineate the target area of radiotherapy. This study aimed to explore the guiding role of magnetic resonance imaging (MRI) in delineating the target area of presacral recurrence after radical resection of rectal cancer. Methods: A descriptive case series research method was adopted. From May 2014 to May 2019, the clinical data of 30 patients with presacral recurrence after radical resection of rectal cancer were collected, who were admitted to Peking University People's Hospital, confirmed by pathology or discussed by multidisciplinary team (MDT), with complete MRI, CT and case information. According to the gross tumor volume (GTV) with presacral recurrence outlined in CT and MRI images, including presacral recurrent lesions (GTVT) and metastatic lymph nodes (GTVN), the GTV volume was calculated, and the tumor boundary and diameter were measured. The differences between MRI and CT were compared. Results: The volume of GTVT-CT was larger than that of GTVT-MR in all the 30 patients. The median volume of GTVT-CT was 67.86 (range 5.12-234.10) cm(3), which was significantly larger than 43.02 (range 3.42-142.50) cm(3) of GTVT-MR with statistically significant difference (Z=-4.288, P<0.001). The mean volume of GTVN outlined by CT and MRI was (0.43±0.11) cm(3) and (0.40±0.10) cm(3) respectively without statistically significant difference (t=1.550, P=0.132). The mean values of boundary and radial line of the presacral lesions on CT images were all longer than those on MRI images. The vertical diameter of GTVT on CT and MRI images was (6.66±2.92) cm and (5.17±2.40) cm (t=5.466, P<0.001); the anterior boundary was (3.24±2.51) cm and (2.69±2.48) cm (t=4.685, P<0.001); the anteroposterior diameter was (4.92±2.02) cm and (4.04±1.57) cm (t=6.210, P<0.001); the left boundary was (3.05±1.00) cm and (2.64±0.78) cm (t=2.561, P=0.016); the right boundary was 2.66 (0.00-4.23) cm and 1.82 (-1.10-3.59) cm (Z=-3.950, P<0.001); the transverse diameter was (5.01±1.78) cm and (3.82±1.29) cm (t=4.648, P<0.001), respectively, whose differences were all statistically significant. MRI was superior to CT in judging the involvement of anterior organs, such as intestine, prostate, bladder and the posterior sacrum. Fifteen patients received radiotherapy according to the target area guided by MRI and 10 patients obtained clinical symptom relief. Conclusion: Compared with CT, the GTV of postoperative presacral recurrence of rectal cancer outlined in MRI images is smaller, and MRI can determine the boundary between tumor and surrounding normal tissues more precisely, so it can show the invasion range of tumor more accurately and guide the accurate implementation of radiotherapy.


Assuntos
Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética , Recidiva Local de Neoplasia , Planejamento da Radioterapia Assistida por Computador/métodos , Neoplasias Retais , Humanos , Masculino , Invasividade Neoplásica/diagnóstico por imagem , Recidiva Local de Neoplasia/diagnóstico por imagem , Recidiva Local de Neoplasia/radioterapia , Período Pós-Operatório , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Sacro/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Carga Tumoral
15.
Gan To Kagaku Ryoho ; 47(12): 1719-1721, 2020 Dec.
Artigo em Japonês | MEDLINE | ID: mdl-33342991

RESUMO

A 63-year-old asymptomatic woman was diagnosed with multiple liver tumors and a left pulmonary tumor by CT. Colonoscopy( CS)showed a Type 2, quarter circular tumor on Rb. The diagnosis was cT3N1aM1b(H3, PUL1), cStage Ⅳb rectal cancer. She was administered 8 courses of induction-adjuvant chemotherapy with CAPOX and bevacizumab(BEV). After the chemotherapy, CT and CS revealed shrinkage(up to 50%)of the metastatic liver tumor and primary tumor, and decreasing tumor marker levels. Laparoscopic abdominoperineal resection and partial hepatectomy(S5/6, S8)were performed. After the operation, she was administered 2 courses of chemotherapy with UFT and LV, after which thoracoscopy-assisted upper lobectomy of the left lung was performed. Currently, at 1 and a half years after treatment, no recurrence has been observed, and she is being followed up as an outpatient.


Assuntos
Neoplasias Hepáticas , Preparações Farmacêuticas , Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Feminino , Hepatectomia , Humanos , Neoplasias Hepáticas/tratamento farmacológico , Neoplasias Hepáticas/cirurgia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia
16.
Anticancer Res ; 40(12): 7053-7056, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33288602

RESUMO

BACKGROUND: The synchronous diagnosis of two or more primary malignancies in a patient is overall rare. CASE REPORT: We report such a case of a 67-year-old male smoker with a history of laryngeal squamous cell carcinoma. He was incidentally identified through follow up computed tomography to have three masses in the lung, rectum and jejunum, respectively. Biopsies were performed and demonstrated synchronous lung small cell carcinoma (pT1bN0) and rectal adenocarcinoma. The patient underwent fractionated stereotactic radiation (FSRT) to the pulmonary tumor and chemotherapy with cisplatin and etoposide followed by laparoscopic rectum low anterior resection and small bowel segmental resection. Final pathology diagnoses confirmed synchronous microsatellite stable (MMS) moderately differentiated adenocarcinoma of the rectum (pT3N1b) and jejunal gastrointestinal stromal tumor (GIST), spindle cell type (pT2N0). At 8 months follow up postsurgery, the patient was doing well and no tumor recurrences were identified. CONCLUSION: To the best of our knowledge, this is the first documented case of synchronous primary small cell lung carcinoma, rectal adenocarcinoma, and GIST in the English literature. The rarity, diagnosis and treatment challenges of these entities are discussed.


Assuntos
Adenocarcinoma/etiologia , Tumores do Estroma Gastrointestinal/etiologia , Jejuno/patologia , Neoplasias Laríngeas/complicações , Neoplasias Retais/etiologia , Carcinoma de Pequenas Células do Pulmão/etiologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/complicações , Adenocarcinoma/patologia , Idoso , Tumores do Estroma Gastrointestinal/patologia , Humanos , Neoplasias Laríngeas/patologia , Masculino , Neoplasias Retais/patologia , Carcinoma de Pequenas Células do Pulmão/patologia , Carcinoma de Células Escamosas de Cabeça e Pescoço/patologia
17.
PLoS One ; 15(11): e0242597, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33253194

RESUMO

BACKGROUND AND PURPOSE: Few tools are available to predict tumor response to treatment. This retrospective study assesses visual and automatic heterogeneity from 18F-FDG PET images as predictors of response in locally advanced rectal cancer. METHODS: This study included 37 LARC patients who underwent an 18F-FDG PET before their neoadjuvant therapy. One expert segmented the tumor from the PET images. Blinded to the patient´s outcome, two experts established by consensus a visual score for tumor heterogeneity. Metabolic and texture parameters were extracted from the tumor area. Multivariate binary logistic regression with cross-validation was used to estimate the clinical relevance of these features. Area under the ROC Curve (AUC) of each model was evaluated. Histopathological tumor regression grade was the ground-truth. RESULTS: Standard metabolic parameters could discriminate 50.1% of responders (AUC = 0.685). Visual heterogeneity classification showed correct assessment of the response in 75.4% of the sample (AUC = 0.759). Automatic quantitative evaluation of heterogeneity achieved a similar predictive capacity (73.1%, AUC = 0.815). CONCLUSION: A response prediction model in LARC based on tumor heterogeneity (assessed either visually or with automatic texture measurement) shows that texture features may complement the information provided by the metabolic parameters and increase prediction accuracy.


Assuntos
Fluordesoxiglucose F18/análise , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Idoso , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Tomografia por Emissão de Pósitrons , Radioterapia , Neoplasias Retais/cirurgia , Resultado do Tratamento
18.
Surg Technol Int ; 37: 99-101, 2020 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-33245140

RESUMO

The circular stapler has played a critical role in fashioning colorectal anastomoses following low anterior resection for rectal cancer. One of the greatest benefits of the circular stapler has been the feasibility of constructing ultra-low anastomoses, thereby decreasing permanent colostomy rates. A notable US innovation to the original design was the addition of disposable cartridges of various sizes, which greatly decreased assembly time and made the instrument more versatile. Another important modification was the ability to detach the anvil from the stapler shaft. This markedly simplified the construction of anastomoses by negating the need for a double purse-string and avoiding an open rectal stump. An additional modification to facilitate transanal stapler extraction was the tilted-top anvil, which flipped parallel to the shaft once the stapler was fired. The circular stapler continues to evolve while maintaining the basic elements of Hültl's brilliant concept from over a century ago.


Assuntos
Neoplasias Retais , Reto , Anastomose Cirúrgica , Humanos , Neoplasias Retais/cirurgia , Reto/cirurgia , Grampeadores Cirúrgicos
19.
Arq Bras Cir Dig ; 33(2): e1507, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-33237159

RESUMO

BACKGROUND: Myocutaneous flap of the rectus abdominis filling the perineal defect after APR.. Abdominoperineal excision of the rectum (APR) remains the only potential curative treatment for very low rectal adenocarcinoma and squamous cell carcinoma of the anus. Yet, it implies a significant perineal exenteration and has set the attention on the perineal reconstruction. AIM: To present technique used in one case of APR for anal cancer, with resection of the vaginal posterior wall with large perineal defect which has called for the necessity of a flap for reconstruction. METHOD: To cover the large perineal defect and reconstruct the posterior vaginal wall was perform a standardized and reproducible surgical technique using oblique rectus abdominis myocutaneous (ORAM) flap. The overlying skin of this flap is thick and well vascularized by both superficial branches and perforators of the superior epigastric artery and the deep inferior epigastric artery which serves as the vascular pedicle for the ORAM flap. RESULTS: This procedure was applied in a 65-year-old woman with recurrent squamous cell carcinoma of the anus infiltrating the posterior wall of the vagina. Was performed an APR with en-bloc resection of the vaginal posterior wall in order to achieve tumor-free margins. Postoperative course was uneventful and she was discharged home at postoperative day 9. Final pathological report confirmed the oncological adequacy of the procedure (R0) and showed a rypT4N0 lesion. CONCLUSION: Flap reconstruction is an effective way to cover the perineal wound reducing both perineal complication rate and wound healing delay. The ORAM is particularly interesting for female whose tumors require resection and subsequent reconstruction of the posterior wall of the vagina.


Assuntos
Retalho Miocutâneo , Protectomia , Procedimentos Cirúrgicos Reconstrutivos , Neoplasias Retais , Idoso , Feminino , Humanos , Recidiva Local de Neoplasia , Períneo/cirurgia , Neoplasias Retais/cirurgia , Reto/cirurgia , Reto do Abdome/cirurgia
20.
Dis Colon Rectum ; 63(9): 1185-1189, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33216489

RESUMO

CASE SUMMARY: A 65-year-old man underwent colonoscopy to evaluate rectal bleeding and was found to have a low rectal mass. Biopsy revealed moderately differentiated microsatellite stable adenocarcinoma. The tumor was palpable at the fingertip in the anterior rectum with the inferior border 5 cm from the anal verge by rigid proctoscopy. CEA was 0.8 ng/mL. CT imaging of the chest, abdomen, and pelvis showed no evidence of distant metastases. MRI confirmed a 5-cm mass with one 8-mm mesorectal lymph node metastasis and no extramural venous invasion. The tumor penetrated the mesorectal fat to a depth of 4 mm, and the circumferential margin was estimated to be 1 mm from the tumor (). He was presented at the multidisciplinary tumor board conference and interviewed and examined at the multidisciplinary clinic. He was dismayed at the prospect of his surgical options, a low anterior resection versus abdominoperineal resection, and wished to keep the options for organ preservation available. Standard long-course chemoradiation was initiated, with resolution of his bleeding after 2 weeks. He then completed 6 cycles of folinic acid, fluorouracil, and oxaliplatin (FOLFOX) chemotherapy (consolidation total neoadjuvant therapy (TNT)). The tumor was no longer palpable on office examination. A complete clinical response (cCR) was confirmed by flexible sigmoidoscopy () and MRI (). He was entered into the nonoperative management program with intense surveillance scheduling and has no evidence of recurrent disease almost 2 years after completion of TNT.


Assuntos
Adenocarcinoma/terapia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Linfonodos/patologia , Mesentério/patologia , Terapia Neoadjuvante/métodos , Tratamentos com Preservação do Órgão , Neoplasias Retais/terapia , Conduta Expectante , Adenocarcinoma/diagnóstico por imagem , Adenocarcinoma/patologia , Idoso , Colectomia , Fluoruracila/uso terapêutico , Humanos , Leucovorina/uso terapêutico , Linfonodos/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Mesentério/diagnóstico por imagem , Invasividade Neoplásica , Estadiamento de Neoplasias , Compostos Organoplatínicos/uso terapêutico , Protectomia , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Indução de Remissão
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