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1.
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
2.
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
3.
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
4.
Khirurgiia (Mosk) ; (11): 53-60, 2020.
Artigo em Russo | MEDLINE | ID: mdl-33210508

RESUMO

OBJECTIVE: To compare functional outcomes of various rectal reconstruction after total mesorectal excision. MATERIAL AND METHODS: A prospective randomized trial included 90 patients with mid-to-low rectal carcinoma who underwent total mesorectal excision. RESULTS: There were 22 patients after J-pouch surgery, 30 patients with side-to-end anastomoses and 38 patients with end-to-end anastomoses. Eight patients (26.6%) required conversion of J-P to E-E (7 patients) and S-E (1) anastomosis for technical reasons. Postoperative morbidity was similar (13.6, 16.7 and 34.2% in J-P, S-E and E-E groups, respectively, p=0.705). Sensory threshold, earliest and constant defecation urge and maximal tolerable volume were higher for J-P surgery within 3-6-12 months after surgery. Stool frequency was significantly lower after J-P surgery compared to S-E and E-E anastomoses within 3-6-12 months. Wexner scores were 3, 5, 6 after 6 months (p<0.05) and 0, 1, 1 after 12 months for J-P, S-E and E-E, respectively (p>0.05). Evacuation dysfunction was observed in 59.1% with J-P, 33.3% with S-E and 21.1% with E-E anastomoses in 6 months after stoma closure. CONCLUSION: J-pouch reconstruction demonstrates higher neorectal volume that ensures reduced stool frequency up to 12 months after stoma closure. However, technical challenges of J-pouch surgery and evacuation dysfunction restrain application of this procedure in clinical practice.


Assuntos
Bolsas Cólicas , Protectomia/efeitos adversos , Neoplasias Retais , Reto/cirurgia , Anastomose Cirúrgica/efeitos adversos , Anastomose Cirúrgica/métodos , Bolsas Cólicas/efeitos adversos , Defecação/fisiologia , Humanos , Mesentério/cirurgia , Protectomia/métodos , Estudos Prospectivos , Neoplasias Retais/cirurgia , Reto/fisiopatologia , Reoperação , Síndrome , Resultado do Tratamento
7.
Dis Colon Rectum ; 63(9): 1265-1275, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-33216497

RESUMO

BACKGROUND: Patients with IBD are at increased risk for developing colorectal cancer. However, overall survival and disease-free survival for rectal cancer alone in patients with IBD has not been reported. OBJECTIVE: This study aimed to determine overall survival and disease-free survival for patients with rectal cancer in IBD versus non-IBD cohorts. DESIGN: This is a retrospective cohort study. SETTING: This study was conducted at an IBD referral center. PATIENTS: All consecutive adult patients with IBD diagnosed with rectal cancer and at least 1 year of postsurgery follow-up were included and matched in a 1:2 fashion (age, sex, preoperative stage) with patients with rectal cancer who did not have IBD. MAIN OUTCOMES MEASURES: Five-year overall survival and disease-free survival, 30-day postoperative complication, readmission, reoperation, and mortality rates were measured. METHODS: Survival rates were calculated using Kaplan-Meier estimates. The association of risk factors and long-term outcomes was assessed using Cox proportion hazard models. RESULTS: A total of 107 study patients with IBD who had rectal cancer were matched to 215 control patients; preoperative stages were as follows: 31% with stage I, 19% with stage II, 40% with stage III, and 10% with stage IV. Differences were observed (IBD vs non-IBD) in neoadjuvant chemotherapy (33.6% vs 52.6%, p = 0.001) and preoperative radiotherapy (35.5% vs 53.5%, p = 0.003). Postoperative complication rates were similar. On surgical pathology, patients with IBD had more lymphovascular invasion (12.9% vs 5.6%, p = 0.04) and positive circumferential resection margins (5.4% vs 0.9%, p = 0.03). On multivariable analysis, the diagnosis of IBD did not significantly impact long-term mortality (HR, 0.91; 95% CI, 0.53-1.57; p = 0.73) or disease-free survival (HR, 1.36; 95% CI, 0.84-2.21; p = 0.22). LIMITATIONS: This study was limited by its retrospective design and the use of single-center data. CONCLUSIONS: Patients have rectal cancer with IBD and without IBD have similar long-term and disease-free survival, despite lower rates of neoadjuvant treatment and higher margin positivity in patients with IBD. See Video Abstract at http://links.lww.com/DCR/B271. ¿LA ENFERMEDAD INFLAMATORIA INTESTINAL ACARREA PEORES RESULTADOS EN PACIENTES CON CÁNCER RECTAL? UN ANÁLISIS DE CASOS-COINCIDENTES: Los pacientes con enfermedad inflamatoria intestinal (EII) tienen un mayor riesgo de desarrollar cáncer colorrectal. Sin embargo, no se ha informado la supervivencia general y la supervivencia libre de enfermedad para el cáncer rectal solo en pacientes con EII.Determinar la supervivencia general y la supervivencia libre de enfermedad para pacientes con cáncer rectal en cohortes con EII versus sin EII.Estudio de cohorte retrospectivo.Centro de referencia para enfermedad inflamatoria intestinal.todos los pacientes adultos con EII diagnosticados con cáncer rectal, consecutives, y al menos un año de seguimiento postoperatorio se incluyeron y se emparejaron de manera 1: 2 (edad, sexo, etapa preoperatoria) con pacientes con cáncer rectal sin EII.Se midieron la supervivencia general a cinco años y la supervivencia libre de enfermedad, complicaciones postoperatorias a los 30 días, reingreso, reoperación y tasas de mortalidad.Las tasas de supervivencia se calcularon utilizando estimaciones de Kaplan-Meier. La asociación de factores de riesgo y resultados a largo plazo se evaluó mediante modelos de riesgo de proporción de Cox.Un total de 107 pacientes con EII y cáncer rectal se compararon con 215 pacientes de control; las etapas preoperatorias fueron las siguientes: 31% de Etapa I, 19% de Etapa II, 40% de Etapa III y 10% de Etapa IV. Se observaron diferencias (EII versus no EII) en quimioterapia neoadyuvante (33.6% frente a 52.6%, p = 0.001) y radioterapia preoperatoria (35.5% frente a 53.5%, p = 0.003). Las tasas de complicaciones postoperatorias fueron similares. En la patología quirúrgica, los pacientes con EII tuvieron más invasión linfovascular (12.9% frente a 5.6%, p = 0.04) y márgenes de resección circunferencial positivos (5.4% frente a 0.9%, p = 0.03). En el análisis multivariable, el diagnóstico de EII no tuvo un impacto significativo en la mortalidad a largo plazo (HR 0.91; IC del 95%: 0.53-1.57, p = 0.73) o la supervivencia libre de enfermedad (HR 1.36; IC del 95%: 0.84-2.21, p = 0.22)Diseño retrospectivo, centro único de datos.Los pacientes con EII y sin EII con cáncer rectal tienen una supervivencia similar a largo plazo y libre de enfermedad, a pesar de las tasas más bajas de tratamiento sneoadyuvante y un mayor margen positivo en pacientes con EII. Consulte Video Resumen en http://links.lww.com/DCR/B271.


Assuntos
Adenocarcinoma/cirurgia , Doenças Inflamatórias Intestinais/complicações , Mortalidade , Complicações Pós-Operatórias/epidemiologia , Neoplasias Retais/cirurgia , Adenocarcinoma/complicações , Adenocarcinoma/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/uso terapêutico , Estudos de Casos e Controles , Quimioterapia Adjuvante , Estudos de Coortes , Intervalo Livre de Doença , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Terapia Neoadjuvante/estatística & dados numéricos , Invasividade Neoplásica , Estadiamento de Neoplasias , Readmissão do Paciente/estatística & dados numéricos , Prognóstico , Modelos de Riscos Proporcionais , Radioterapia/estatística & dados numéricos , Radioterapia Adjuvante , Neoplasias Retais/complicações , Neoplasias Retais/patologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Taxa de Sobrevida , Adulto Jovem
8.
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
9.
Niger J Clin Pract ; 23(11): 1514-1516, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33221774

RESUMO

Background: There are limited data describing different factors that influence survival rate of patients with rectal cancer. Aims: Our aim was to determine the influence of patient gender, American Society of Anesthesiologists (ASA) physical status, the location of the tumor and stage of the disease on the patient survival rates after excision of rectal cancer. Settings and Design: We included 385 patients who were operated between 2004 and 2014 in the University Clinical Center Maribor. The patients were treated due to rectal adenocarcinoma. We assessed survival rates according to gender, ASA physical status, the location of the tumor and stage of the disease with different statistical methods. Subjects and Methods: To find the extent of correlation between factors and survival rate, we used means and medians, Log Rank test, Breslow test and Tarone-Ware test. Results: According to patient gender, survival rate did not differ significantly (P > 0.05), however ASA physical status (P < 0.05), location of the tumor (P < 0.05) and stage of the disease (P < 0.05) significantly affected the survival rates. Conclusions: Our study showed that gender does not have a significant impact on survival rate as oposed to ASA physical status, the location of the tumor and stage of the disease.


Assuntos
Adenocarcinoma/mortalidade , Adenocarcinoma/cirurgia , Neoplasias Retais/mortalidade , Neoplasias Retais/cirurgia , Adenocarcinoma/patologia , Idoso , Idoso de 80 Anos ou mais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Neoplasias Retais/patologia , Estudos Retrospectivos , Fatores de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Análise de Sobrevida , Taxa de Sobrevida
10.
Gan To Kagaku Ryoho ; 47(9): 1383-1385, 2020 Sep.
Artigo em Japonês | MEDLINE | ID: mdl-33130706

RESUMO

A 70-year-old male with defecation difficulties was referred to our hospital. A colonoscopy and computed tomography revealed multiple advanced rectal cancers in the rectosigmoid and lower rectum with swollen lymph nodes. After 6 courses of neoadjuvant capecitabine and oxaliplatin and bevacizumab without radiotherapy(CapeOX plus BV therapy), a colonoscopy revealed that the tumors had significantly reduced. A low anterior laparoscopic resection with diverting ileostomy was performed. Histopathological examination showed no residual tumor cells or lymph node metastasis. A final diagnosis of pathological complete response was made. The patient has currently survived 1-year disease-free. Neoadjuvant CapeOX plus BV therapy can be a promising therapeutic option for locally advanced rectal cancer.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Capecitabina/uso terapêutico , Humanos , Masculino , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Reto
12.
Isr Med Assoc J ; 22(7): 426-430, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33236567

RESUMO

BACKGROUND: Transanal minimally invasive surgery (TAMIS) is a single port access platform used for full thickness local excision of rectal lesions. It is an appealing alternative to a radical resection of rectum that often can cause a significant bowel dysfunction described as low anterior resection syndrome (LARS). LARS is evaluated using a validated score. Functional outcomes of patients undergoing TAMIS has not yet been evaluated using the LARS score. OBJECTIVES: To evaluate long-term bowel function in patients who underwent TAMIS. METHODS: In this case series, all patients who underwent TAMIS in a single tertiary institute between 2011 and 2017 were retrospectively reviewed. We evaluated bowel function using the LARS score questionnaire through telephone interviews. RESULTS: The study consisted of 23 patients, average age of 67 ± 6.98 year; 72% were male. The median follow-up from the time of surgery was 5 years. Six patients (26.08%) had malignant type lesions. The average height of the lesion from the anal verge was 7.4 cm. The average size of the specimen was 4 cm. The total LARS score revealed that 17 patients (73.91%) had no definitive LAR syndrome following the surgery. Four patients (17.39%) fit the description of minor LARS and only two (8.69%) presented with major LARS. CONCLUSIONS: TAMIS provides relatively good long-term functional outcomes in terms of bowel function. Further randomized studies with larger cohorts are still needed to better evaluate the outcomes.


Assuntos
Complicações Pós-Operatórias/fisiopatologia , Neoplasias Retais/cirurgia , Reto/fisiopatologia , Cirurgia Endoscópica Transanal , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade de Vida , Estudos Retrospectivos , Inquéritos e Questionários
13.
BMC Surg ; 20(1): 241, 2020 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-33066759

RESUMO

BACKGROUND: Lymph node (LN) harvest in colorectal cancer resections is a well-recognised prognostic factor for disease staging and determining survival, particularly for node-negative (N0) diseases. Extralevator abdominoperineal excisions (ELAPE) aim to prevent "waisting" that occurs during conventional abdominoperineal resections (APR) for low rectal cancers, and reducing circumferential resection margin (CRM) infiltration rate. Our study investigates whether ELAPE may also improve the quality of LN harvests, addressing gaps in the literature. METHODS: This retrospective observational study reviewed 2 sets of 30 consecutive APRs before and after the adoption of ELAPE in our unit. The primary outcomes are the total LN counts and rates of meeting the standard of 12-minimum, particularly for those with node-negative disease. The secondary outcomes are the CRM involvement rates. Baseline characteristics including age, sex, laparoscopic or open surgery and the use of neoadjuvant chemoradiotherapy were accounted for in our analyses. RESULTS: Median LN counts were slightly higher in the ELAPE group (16.5 vs. 15). Specimens failing the minimum 12-LN requirements were almost significantly fewer in the ELAPE group (OR 0.456, P = 0.085). Among node-negative rectal cancers, significantly fewer resections failed the 12-LN standard in the ELAPE group than APR group (OR 0.211, P = 0.044). ELAPE led to a near-significant decrease in CRM involvement (OR 0.365, P = 0.088). These improvements were persistently observed after taking into account baselines and potential confounders in regression analyses. CONCLUSION: ELAPE provides higher quality of LN harvests that meet the 12-minimal requirements than conventional APR, particularly in node-negative rectal cancers. The superiority is independent of potential confounding factors, and may implicate better clinical outcomes.


Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/normas , Excisão de Linfonodo , Linfonodos/cirurgia , Protectomia/normas , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Feminino , Humanos , Masculino , Protectomia/métodos , Neoplasias Retais/patologia , Estudos Retrospectivos
14.
Rinsho Shinkeigaku ; 60(11): 762-767, 2020 Nov 27.
Artigo em Japonês | MEDLINE | ID: mdl-33115991

RESUMO

A 59-year-old man with past histories of bronchial asthma and chronic sinusitis underwent transanal resection of anorectal malignant melanoma with general anesthesia. On the third day after surgery, he presented with subacute weakness with right dominant hypoesthesia in the bilateral lower limbs. Tendon reflexes were diminished without pathological reflexes. Blood examination showed increased eosinophils (2,058/µl) and elevated serum immunoglobulin E (675.0 IU/ml). Cerebrospinal fluid examination showed elevated protein (200 mg/dl) without pleocytosis (<5/µl). A nerve conduction study suggested multiple mononeuropathy with motor and axonal dominance in the right tibial, peroneal, and sural nerves. Because of eosinophilia and his past medical history (i.e., bronchial asthma and chronic sinusitis), we initially suspected eosinophilic polyangiitis granulomatosis (EGPA) as the cause of postoperative polyneuropathy. However, his neurological symptoms did not improve despite the decreased eosinophil count after tumor resection, which was inconsistent with EGPA. We biopsied the left sural nerve to exclude EGPA and make a diagnosis. Pathological findings revealed no demyelination, axonal degeneration, or eosinophil infiltration with granuloma formation; however, lymphocyte-dominated inflammation was observed around the epineurial small vessels. Thus, the patient was diagnosed with early onset post-surgical inflammatory neuropathy (PIN) based on his clinical course and the pathological findings. On post-surgery day 48, oral administration of prednisolone (40 mg/day) was started. His neurological symptoms improved quickly and remarkably. Our case suggests that, when multiple mononeuropathy develops early after surgery, PIN should be considered as a differential diagnosis to initiate appropriate treatment based on the pathological condition of neuropathy.


Assuntos
Neoplasias do Ânus/cirurgia , Melanoma/cirurgia , Doenças do Sistema Nervoso Periférico/tratamento farmacológico , Polineuropatias/tratamento farmacológico , Complicações Pós-Operatórias/tratamento farmacológico , Neoplasias Retais/cirurgia , Administração Oral , Humanos , Inflamação , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/diagnóstico , Doenças do Sistema Nervoso Periférico/patologia , Polineuropatias/diagnóstico , Polineuropatias/patologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Prednisolona/administração & dosagem , Nervo Sural , Nervo Tibial , Resultado do Tratamento
16.
Anticancer Res ; 40(11): 6539-6543, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33109595

RESUMO

BACKGROUND: Omentoplasty is sometimes used to prevent perineal wound complications after abdominoperineal resection (APR) following neoadjuvant chemoradiotherapy (NACRT). However, recent studies have raised some controversy about its clinical benefit. PATIENTS AND METHODS: Outcomes for rectal cancer patients who received APR after NACRT were retrospectively compared between the groups with omentoplasty (n=28) and without omentoplasty (n=14). RESULTS: The operative time was significantly longer in the omentoplasty group (575 vs. 404 min, p<0.001). Laparoscopic surgery was performed more frequently in the omentoplasty group. Perineal wound problems including dehiscence and infection were significantly reduced in the omentoplasty group (46.4% vs. 78.6%, p<0.001). Univariate and multivariate analyses revealed that omentoplasty was the most important factor in reducing perineal wound complications (odds ratio=0.020, 95% confidence intervaI=0.001-0.393; p=0.001). CONCLUSION: Omentoplasty was useful in reducing perineal wound complications after APR following NACRT.


Assuntos
Complicações Pós-Operatórias/cirurgia , Protectomia/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Neoplasias Retais/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Humanos , Laparoscopia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Omento/fisiopatologia , Omento/cirurgia , Duração da Cirurgia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/prevenção & controle , Protectomia/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/radioterapia , Cicatrização
17.
Cancer Treat Rev ; 90: 102104, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33002819

RESUMO

BACKGROUND: The improved overall survival (OS) after short course preoperative radiotherapy (SCPRT) using 5 × 5 Gy reported in the early rectal cancer trials could not be replicated in subsequent phase III trials. This original survival advantage is attributed to poor quality of surgery and the large differential in local recurrence rates, with and without SCPRT. Immuno-modulation during and after SCPRT and its clinical implications have been poorly investigated. We propose an alternative explanation for this survival benefit in terms of immunological mechanisms induced by SCPRT and the timing of surgery, which may validate the concept of consolidation chemotherapy. MATERIAL AND METHODS: We reviewed randomized controlled trials (RCTs) and studies of SCPRT from 1985 to 2019. We aimed to examine the precise timing of surgery in days following SCPRT and identify evidence for immune modulation, neo-antigens and memory cell induction by radiation. RESULTS: Considerable variability is reported in randomised trials for median overall treatment time (OTT) from start of SCPRT to surgery (8-14 days). Only three early trials showed a benefit in terms of OS from SCPRT, although the level of benefit in preventing local recurrence was consistent across all trials. Different patterns of immune effects are observed within days after SCPRT depending on the OTT, but human leukocyte antigen (HLA)-1 expression was not upregulated. CONCLUSIONS: SCPRT has a substantial immune-stimulatory potential. The importance of the timing of surgery after SCPRT may have been underestimated. An optimal interval for surgery after 5 × 5 Gy may lead to better outcomes, which is possibly exploited in total neoadjuvant therapy schedules using consolidation chemotherapy. Individual patient meta-analyses from appropriate SCPRT trials examining outcomes for each day and prospective trials are needed to clarify the validity of this hypothesis. The interaction of SCPRT with tumour adaptive immunology, in particular the kinetics and timing, should be examined further.


Assuntos
Neoplasias Retais/radioterapia , Neoplasias Retais/cirurgia , Ensaios Clínicos Fase II como Assunto , Ensaios Clínicos Fase III como Assunto , Humanos , Terapia Neoadjuvante , Ensaios Clínicos Controlados Aleatórios como Assunto , Tempo para o Tratamento
18.
J Cancer Res Ther ; 16(5): 979-989, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-33004738

RESUMO

Aim: This study aimed to compare clinical and oncological outcomes of robot-assisted and laparoscopic surgery for rectal cancer. Materials and Methods: We searched PubMed/Medline, Embase, the Cochrane Library, Yahoo, and Google Scholar databases for relevant articles published up to 2017. Studies based on comparability between robot-assisted and laparoscopic surgery for rectal cancer were designated. Clinical outcomes included operative time, conversion to open surgery, estimated blood loss (EBL), bowel function recovery time, length of hospital stay (LOS), anastomosis leak, and postoperative complications. Oncological outcomes comprised the number of lymph nodes extracted, the positive circumferential margin (PCRM), and the distal resection margin (DRM). Results: Twenty studies were designated totaling 5496 patients, comprising a robot-assisted surgery patient group (n = 2168, 39.4%) and a laparoscopic surgery patient group (n = 3328, 60.6%). The robot-assisted surgery group was associated with longer operative time (odds ratio [OR] 0.48, 95% confidence interval [CI]; 0.14, 0.82), lower conversion to open surgery rate (OR 0.55, 95% CI; 0.44, 0.69), shorter LOS (OR - 0.15, 95% CI; -0.30, 0.00), faster bowel function recovery (OR - 0.38, 95% CI; -0.74, -0.02), and lower postoperative complications (OR 0.79, 95% CI; 0.65, 0.97). EBL, anastomosis leak rate, and oncological outcomes including the number of lymph nodes extracted, the DRM, and the PCRM showed no significant differences between groups. Conclusion: Robot-assisted surgery for rectal cancer showed longer operative time, lower conversion, faster bowel function recovery rates, and shorter hospital stay, and similar oncological outcomes compared to laparoscopic surgery.


Assuntos
Laparoscopia/métodos , Tempo de Internação/estatística & dados numéricos , Duração da Cirurgia , Complicações Pós-Operatórias , Neoplasias Retais/cirurgia , Procedimentos Cirúrgicos Robóticos/métodos , Humanos , Margens de Excisão , Neoplasias Retais/patologia , Resultado do Tratamento
19.
Artigo em Russo | MEDLINE | ID: mdl-33054009

RESUMO

Surgical treatment of rectal cancer and sphincter-preserving low anterior resection results to evacuation disorders («low anterior resection syndrome¼ - LARS). There are no clinical recommendations for the treatment of patients with LARS as well as a rehabilitation program for them. OBJECTIVE: To develop a rehabilitation program for patients with low anterior resection syndrome. MATERIAL AND METHODS: The investigation was performed at 2 stages. During the first stage, 29 patients with LARS (17 (58.6%) men, mean age of the participants' 61.5±9.5 years), 12 (41.4%) women (mean age 61.2±7.8 years) were examined and received the course of conservative treatment with the use of biofeedback-therapy performed by the standard protocol. On the second stage, 17 patients (mean age 61.4±12.7 years) - 9 (52.9%) men, 8 (47.1%) women received biofeedback therapy in combination with tibial neuromodulation (TNM). Functional state of the rectum and the locking apparatus in all patients were evaluated by anorectal manometry: sphincterometry and studies of the reservoir function of the rectum before and after treatment. RESULTS: The developed complex of rehabilitation measures led to improved treatment results for patients with rectal cancer by improving the quality of life after low anterior resection, reducing the manifestations of LARS (by 47.8%). Stable positive results of treatment were maintained in 36.4% of patients, positive dynamics from the treatment according to the LARS scale decreased slightly in 54.5%, deterioration of indicators in 3-6 months after conservative rehabilitation was registered in 9.1% of cases. At the first stage maximal squeeze pressure improvement was reached in the whole cohort (p=0.047), at the second stage these trend was seen only for women for the pressure values at rest (p=0.01) and during squeeze (p=0.025). The data obtained allowed us to recommend a repeat course of treatment to 63.6% of patients. The authors modified and optimized a special complex of physical therapy for the rehabilitation of patients both in a medical institution and at home. These exercises are aimed at improving the functional state of the pelvic floor muscles and sphincter apparatus. CONCLUSION: Rehabilitation program for patients with low anterior resection syndrome should include: 1) biofeedback therapy to improve the holding function; 2) biofeedback therapy aimed at improving the reservoir function and sensitivity of the rectum to filling; 3) tibial neuromodulation. This program may help improving the contractility of the anal sphincter and reservoir function of the rectum, as well as the appearance of the urge to defecate.


Assuntos
Complicações Pós-Operatórias , Qualidade de Vida , Neoplasias Retais , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Retais/cirurgia , Reto , Síndrome
20.
PLoS One ; 15(10): e0240742, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33064768

RESUMO

BACKGROUND: This aim of this study was to evaluate the effects of time interval between the completion of radiotherapy and robotic-assisted surgery on the outcomes among patients with rectal cancer undergoing preoperative concurrent chemoradiotherapy (CCRT). METHODS: In total, 116 patients with stage I-III rectal cancer who underwent preoperative CCRT and robotic-assisted surgery between September 2013 and February 2019 were enrolled. Patients were categorized into two groups based on the time interval: group A (10-12 weeks) and group B (≥ 12 weeks). RESULTS: Among the 116 enrolled patients, 98 (84.5%) had middle and lower rectal cancers. Two (1.7%) patients underwent abdominoperineal resection with a sphincter preservation rate of 98.3%. Thirty-seven (31.9%) patients had a pathologic complete response (pCR). The circumferential resection margin and distal resection margin were positive in 2 (1.7%) and 1 (0.9%) patients, respectively. Therefore, the R0 resection rate was 97.4%. A total of 24 (22.4%) patients experienced postoperative relapse and 12 (10.3%) patients died; these were slightly more common in group B than in group A (28.8% vs 15.8% and 15.3% vs 5.3%, respectively; both P > 0.05); however, this difference was nonsignificant. Three-year disease-free survival (DFS) and overall survival (OS) were 75% and 89%, respectively, among all patients. Non-significant trend of favorable 3-year DFS, 3-year OS, 3-year locoregional control rate and 3-year distant metastasis control rate were observed in group A compared with group B (all P > 0.05). CONCLUSION: Robotic-assisted surgery after a longer interval is safe and feasible for patients with rectal cancer undergoing preoperative CCRT. The present study's results suggested that the time interval of 10-12 weeks can be considered because comparable clinical and perioperative outcomes and preferable oncological outcomes were observed for interval of this length. However, future prospective randomized clinical trials are required to verify the present finding.


Assuntos
Quimiorradioterapia , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Procedimentos Cirúrgicos Robóticos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Complicações Pós-Operatórias/etiologia , Cuidados Pré-Operatórios , Neoplasias Retais/cirurgia , Fatores de Tempo , Resultado do Tratamento
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