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1.
Anticancer Res ; 40(4): 2199-2208, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32234915

RESUMO

BACKGROUND/AIM: To date, there is no clear understanding whether preoperative long-course chemoradiotherapy combined with surgery for rectal cancer is detrimental to anorectal function. The purpose of this study was to clarify the influence of preoperative chemoradiotherapy and surgery for middle and lower rectal cancer on postoperative anorectal function. PATIENTS AND METHODS: Data of 113 patients with middle or lower rectal cancer treated with preoperative chemoradiotherapy plus surgery or surgery alone between January 2013 and December 2016 were analyzed. A total of 84 and 29 patients underwent low anterior resection and intersphincteric resection, respectively. In patients with T3 or deeper and with any N stage cancer below peritoneal reflection, surgery plus lateral lymph node dissection or preoperative radiation (total: 50.4 Gy/28 fractions) to the pelvis with chemoradiotherapy plus surgery was treated. Anorectal function was assessed prior to treatment and 6 and 12 months postoperatively. Specifically, maximum resting pressure and maximum squeezing pressures were measured. The Wexner score was recorded prior to treatment and 12 months postoperatively. RESULTS: maximum resting pressure and maximum squeezing pressure decreased post-surgery in both groups. Maximum resting pressure and maximum squeezing pressure at 12 months and the Wexner score at 12 months post-surgery were comparable among patients treated with chemoradiotherapy plus surgery and those treated with surgery alone. CONCLUSION: Preoperative chemoradiotherapy did not clearly impair postoperative anorectal function in patients who underwent low anterior resection and intersphincteric resection.


Assuntos
Canal Anal/fisiopatologia , Neoplasias Retais/cirurgia , Neoplasias Retais/terapia , Reto/fisiopatologia , Idoso , Canal Anal/patologia , Canal Anal/cirurgia , Quimiorradioterapia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/métodos , Avaliação de Resultados em Cuidados de Saúde/métodos , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Período Pré-Operatório , Reto/patologia , Reto/cirurgia
3.
Am J Surg ; 219(4): 592-597, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32209240

RESUMO

BACKGROUND: The aim of this study was to determine whether acute histologic inflammatory activity at the rectal margin predicts postoperative complications in children with ulcerative colitis following ileal pouch-anal anastomoses (IPAA). METHODS: Patients who underwent IPAA following previous total abdominal colectomy for ulcerative colitis between 2006 and 2014 were included. Data collected included demographics, operative and postoperative data, histologic grading of the rectal margin at time of IPAA, and stooling outcomes at one, six and 12 months following ileostomy closure. RESULTS: Twenty-seven patients were included. Acute inflammation scores ranged between 2 and 13. Unadjusted and adjusted models showed no statistically significant relationship between inflammation and presence of any postoperative complications, number of daily stools, nighttime stooling, soiling, or stool-altering medication usage. CONCLUSION: Acute histologic inflammatory activity at the rectal margin is not associated with increased rates of postoperative complications following IPAA creation in children, nor with poorer continence outcomes following ileostomy closure.


Assuntos
Colite Ulcerativa/patologia , Colite Ulcerativa/cirurgia , Mucosa Intestinal/patologia , Reto/patologia , Adolescente , Estudos de Coortes , Bolsas Cólicas , Eosinófilos/patologia , Incontinência Fecal/etiologia , Feminino , Humanos , Fístula Intestinal/etiologia , Mucosa Intestinal/cirurgia , Obstrução Intestinal/etiologia , Leucócitos Mononucleares/patologia , Masculino , Neutrófilos/patologia , Complicações Pós-Operatórias , Pouchite/etiologia , Proctocolectomia Restauradora , Reto/cirurgia , Estudos Retrospectivos
4.
BMC Infect Dis ; 20(1): 234, 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32192456

RESUMO

BACKGROUND: Herpes simplex virus (HSV) typically infects oral or anogenital squamous epithelium and causes blisters and ulcerations. Here we reported an unusual case of HSV induced exuberant rectal inflammatory pseudotumor with vascular endothelial involvement. CASE PRESENTATIONS: A 52-year old man with HIV presented with abdominal pain, rectal drainage and constipation. Proctoscopy and CT scans revealed an 8 × 5 × 4 cm circumferential, mid-lower rectal mass that was concerning for malignancy. PET-CT showed mild to moderate FDG uptake of the rectal mass. Repeated biopsies showed exuberant lymphoplasmacytic inflammation with rich eosinophils and necrosis in the submucosa and scattered single or multi-nucleated viral inclusions in vascular endothelial cells that were positive for HSV by immunostains. There was no evidence of malignancy on histology or by immunostains. The patient started valacyclovir for three weeks and symptoms resolved after the antiviral therapy. Follow-up CT and sigmoidoscopy with biopsy revealed no rectal mass or drainable collection. CONCLUSIONS: HSV may present as proctitis with exuberant inflammatory response and mass-like lesion, and damages vascular endothelial cells in patients with HIV. The HSV-associated mass-like lesion can be effectively treated by 3-week valacyclovir.


Assuntos
Endotélio Vascular/virologia , Granuloma de Células Plasmáticas/complicações , Infecções por HIV/complicações , Herpes Simples/complicações , Herpesvirus Humano 1/imunologia , Herpesvirus Humano 2/imunologia , Proctite/complicações , Reto/virologia , Antivirais/uso terapêutico , Células Endoteliais/virologia , Endotélio Vascular/patologia , Seguimentos , Granuloma de Células Plasmáticas/diagnóstico , Infecções por HIV/tratamento farmacológico , Herpes Simples/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Proctite/tratamento farmacológico , Proctite/virologia , Reto/patologia , Resultado do Tratamento , Valaciclovir/uso terapêutico
5.
Acta Cir Bras ; 34(12): e201901204, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32074166

RESUMO

PURPOSE: To examine the therapeutic effect of external adenosine on an acetic acid-induced acute ulcerative colitis model in rats. METHODS: Thirty male mature rats were divided into three groups as control, acute colitis (AC) and AC+adenosine group (AC+AD). AC was induced by rectal administration of 4% acetic acid (AA). 5mg/kg/day adenosine was performed i.p for 4 weeks to AC+AD group. Rectum and colon were excised for microscopic and histopathological histopathologic evaluations, and immunohistochemical analysis of nuclear factor kappa B (NF-kB). Blood samples were collected for biochemical detection of TNF-α, Pentraxin-3 and malondialdehyde (MDA) levels. RESULTS: AC group had generalized hyperemia and hemorrhage with increased macroscopic and histopathological scores compared with control (P <0.0001) while adenosine treatment decreased these scores significantly (P <0.001), with reduced distribution of disrupted epithelium, leukocyte infiltrates, and focal hemorrhage. AC group showed significantly increased immunoexpression of NF-kB in rectum, plasma and tissue levels of TNF-α, plasma Pentraxin-3 and MDA levels (P <0.0001) while adenosine reduced these levels (P < 0.05). CONCLUSION: Adenosine appears to promote healing of colon and rectum exposed to AA-induced AC, suggesting a boosting effect of adenosine on the intestinal immune system to cure ulcerative colitis.


Assuntos
Adenosina/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Colite Ulcerativa/tratamento farmacológico , Ácido Acético , Doença Aguda , Animais , Proteína C-Reativa/análise , Colite Ulcerativa/induzido quimicamente , Colite Ulcerativa/patologia , Colo/patologia , Ensaio de Imunoadsorção Enzimática , Imuno-Histoquímica , Masculino , Malondialdeído/sangue , NF-kappa B/análise , Ratos Sprague-Dawley , Reto/patologia , Valores de Referência , Reprodutibilidade dos Testes , Componente Amiloide P Sérico/análise , Substâncias Reativas com Ácido Tiobarbitúrico , Fatores de Tempo , Resultado do Tratamento , Fator de Necrose Tumoral alfa/análise
6.
Mymensingh Med J ; 29(1): 73-77, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31915339

RESUMO

Anterior resection (AR), especially low anterior resection (LAR), for low rectal cancer and colorectal anastomosis is a technical challenge to surgeons. But by using circular stapling devices now it is possible make more LARs technically feasible. A stapled end-to-end colorectal anastomosis is increasingly adopted following a low anterior resection for low rectal cancer. This descriptive cross-sectional study was carried out in the department of Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from December 2015 to December 2016. The ensuing doughnuts created from the stapling device are routinely sent for histological analysis. However, its efficacy remains debatable. This study aims to determine the role of sending distal doughnut for histological examination following a stapled end-to-end colorectal anastomosis done in low anterior resection for low rectal cancers.


Assuntos
Adenocarcinoma/cirurgia , Técnicas Histológicas , Neoplasias Retais/cirurgia , Reto/patologia , Grampeamento Cirúrgico , Adenocarcinoma/patologia , Anastomose Cirúrgica/métodos , Bangladesh , Estudos Transversais , Humanos , Neoplasias Retais/patologia , Reto/cirurgia , Grampeamento Cirúrgico/efeitos adversos
9.
Int J Cancer ; 146(2): 363-372, 2020 01 15.
Artigo em Inglês | MEDLINE | ID: mdl-31209889

RESUMO

Interindividual differences in DNA repair systems may play a role in modulating the individual risk of developing colorectal cancer. To better ascertain the role of DNA repair gene polymorphisms on colon and rectal cancer risk individually, we evaluated 15,419 single nucleotide polymorphisms (SNPs) within 185 DNA repair genes using GWAS data from the Colon Cancer Family Registry (CCFR) and the Genetics and Epidemiology of Colorectal Cancer Consortium (GECCO), which included 8,178 colon cancer, 2,936 rectum cancer cases and 14,659 controls. Rs1800734 (in MLH1 gene) was associated with colon cancer risk (p-value = 3.5 × 10-6 ) and rs2189517 (in RAD51B) with rectal cancer risk (p-value = 5.7 × 10-6 ). The results had statistical significance close to the Bonferroni corrected p-value of 5.8 × 10-6 . Ninety-four SNPs were significantly associated with colorectal cancer risk after Binomial Sequential Goodness of Fit (BSGoF) procedure and confirmed the relevance of DNA mismatch repair (MMR) and homologous recombination pathways for colon and rectum cancer, respectively. Defects in MMR genes are known to be crucial for familial form of colorectal cancer but our findings suggest that specific genetic variations in MLH1 are important also in the individual predisposition to sporadic colon cancer. Other SNPs associated with the risk of colon cancer (e.g., rs16906252 in MGMT) were found to affect mRNA expression levels in colon transverse and therefore working as possible cis-eQTL suggesting possible mechanisms of carcinogenesis.


Assuntos
Neoplasias do Colo/genética , Reparo do DNA/genética , Predisposição Genética para Doença , Neoplasias Retais/genética , Adulto , Idoso , Variação Biológica da População/genética , Carcinogênese/genética , Estudos de Casos e Controles , Colo/patologia , Neoplasias do Colo/patologia , Metilases de Modificação do DNA/genética , Enzimas Reparadoras do DNA/genética , Proteínas de Ligação a DNA/genética , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Proteína 1 Homóloga a MutL/genética , Polimorfismo de Nucleotídeo Único , Neoplasias Retais/patologia , Reto/patologia , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Proteínas Supressoras de Tumor/genética , Adulto Jovem
10.
Dis Colon Rectum ; 63(1): 30-38, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31804269

RESUMO

BACKGROUND: In 2016, the American Society of Colon and Rectal Surgeons published a rectal cancer surgery checklist composed of the essential elements of preoperative, intraoperative, and postoperative care for patients undergoing rectal cancer surgery. OBJECTIVE: The purpose of this study was to assess whether compliance with preoperative checklist elements was associated with improved pathologic and 30-day postoperative outcomes after rectal cancer surgery. DESIGN: This was a retrospective cohort study. SETTINGS: The study involved North American hospitals contributing to the American College of Surgeons National Surgical Quality Improvement Program. PATIENTS: Adult patients who underwent elective rectal cancer surgery from 2016 to 2017 were included. INTERVENTION: The study encompassed checklist compliance with 6 preoperative elements from the checklist. MAIN OUTCOME MEASURES: Pathologic outcomes (circumferential resection margin status, distal resection margin status, and adequate lymph node harvest ≥12), 30-day surgical morbidity, and length of stay were measured. RESULTS: In total, 2217 patients were included in the analysis. Individual compliance with the 6 available preoperative checklist items was variable, including 91.3% for pretreatment documentation of tumor location within the rectum, 86.8% for complete colonoscopy, 84.0% for appropriate preoperative stoma marking, 79.8% for appropriate use of neoadjuvant radiotherapy, 76.6% for locoregional staging, and 70.8% for distant staging. Only 836 patients (37.7%) had all 6 checklist elements complete, whereas 1381 (62.3%) did not. Compared with patients without checklist compliance, patients with checklist compliance were younger (60.0 vs 63.0 y; p < 0.001) but otherwise had similar demographic characteristics. On multivariate regression, checklist compliance was associated with lower odds of circumferential resection margin positivity (OR = 0.47 (95% CI, 0.31-0.71); p < 0.001), higher odds of an adequate lymph node harvest ≥12 (OR = 1.60 (95% CI, 1.29-2.00); p < 0.001), reduced surgical morbidity (OR = 0.78 (95% CI, 0.65-0.95); p = 0.01), and shorter length of stay (ß = -0.87 (95% CI, -1.51 to -0.24); p = 0.007). The association between checklist compliance and reduced odds of circumferential resection margin positivity remained on sensitivity analysis (OR = 0.61 (95% CI, 0.42-0.88); p = 0.009) when adjusting for neoadjuvant radiation. LIMITATIONS: This study was limited by its absence of long-term oncologic data and missing variables. CONCLUSIONS: Compliance with 6 preoperative elements of the American Society of Colon and Rectal Surgeons rectal cancer surgery checklist was associated with significantly improved pathologic outcomes and reduced postoperative morbidity. See Video Abstract at http://links.lww.com/DCR/B80. EL CUMPLIMIENTO CON LOS ELEMENTOS PREOPERATORIOS DE LA LISTA DE VERIFICACIÓN DE CIRUGÍA PARA CÁNCER RECTAL DE LA SOCIEDAD AMERICANA DE CIRUJANOS DE COLON Y RECTO MEJORA LOS RESULTADOS HISTOPATOLÓGICOS Y POSTOPERATORIOS: En 2016, la Sociedad Americana de Cirujanos de Colon y Recto publicó una lista de verificación de cirugía de cáncer de recto que comprende los elementos esenciales de la atención pre, intra y postoperatoria para pacientes sometidos a cirugía de cáncer de recto.Evaluar si el cumplimiento con los elementos preoperatorios de la lista de verificación se asoció con mejores resultados histopatológicos y postoperatorios a 30 días después de la cirugía de cáncer rectal.Estudio de cohorte retrospectiva.Hospitales norteamericanos que contribuyen al Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos.Pacientes adultos que se sometieron a cirugía electiva de cáncer rectal entre 2016 y 2017.Cumplimiento de la lista de verificación con seis elementos preoperatorios de la lista de verificación.Resultados histopatológicos (estado del margen de resección circunferencial, estado del margen de resección distal, cosecha adecuada de ganglios linfáticos ≥12), morbilidad quirúrgica a 30 días y duración de la estadía.En total, 2,217 pacientes fueron incluidos en el análisis. El cumplimiento individual de los seis ítems disponibles de la lista de verificación preoperatoria fue variable: 91.3% para la documentación previa al tratamiento de la localización del tumor dentro del recto, 86.8% para colonoscopía completa, 84.0% para el marcado preoperatorio apropiado del sitio de estoma, 79.8% para el uso apropiado de radioterapia neoadyuvante, 76.6 % para estadificación locorregional y 70.8% para estadificación distante. Solo 836 (37.7%) pacientes tenían los seis elementos de la lista de verificación completos, mientras que 1,381 (62.3%) no. En comparación con los pacientes sin cumplimiento de la lista de verificación, los pacientes con cumplimiento de la lista de verificación eran más jóvenes (60.0 vs. 63.0 años, p <0.001), pero por lo demás tenían características demográficas similares. En la regresión multivariada, el cumplimiento de la lista de verificación se asoció con menores probabilidades de positividad en el margen de resección circunferencial (OR = 0.47; IC del 95%: 0.31-0.71, p <0.001), mayores probabilidades de una cosecha adecuada de ganglios linfáticos ≥12 (OR = 1.60, IC 95% 1.29-2.00, p <0.001), menor morbilidad quirúrgica (OR = 0.78, IC 95% 0.65-0.95, p = 0.01) y menor duración de estadía (ß = -0.87, IC 95% -1.51 - - 0.24, p = 0.007). La asociación entre el cumplimiento de la lista de verificación y las probabilidades reducidas de positividad del margen de resección circunferencial se mantuvo en el análisis de sensibilidad (OR = 0.61; IC del 95%: 0.42-0.88, p = 0.009) al ser ajustado con radiación neoadyuvante.Ausencia de datos oncológicos a largo plazo y variables faltantes.El cumplimiento de seis elementos preoperatorios de la lista de verificación de cirugía de cáncer rectal de la Sociedad Americana de Cirujanos de Colon y Recto se asoció con resultados histopatológicos significativamente mejores y una menor morbilidad postoperatoria. Vea el resumen en video en http://links.lww.com/DCR/B80.


Assuntos
Lista de Checagem , Colectomia/normas , Neoplasias do Colo/cirurgia , Fidelidade a Diretrizes , Melhoria de Qualidade , Neoplasias Retais/cirurgia , Sociedades Médicas , Idoso , Colo/patologia , Colo/cirurgia , Neoplasias do Colo/patologia , Procedimentos Cirúrgicos Eletivos/métodos , Procedimentos Cirúrgicos Eletivos/normas , Feminino , Seguimentos , Humanos , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Neoplasias Retais/diagnóstico , Reto/patologia , Estudos Retrospectivos , Estados Unidos
11.
Eur Radiol ; 30(1): 272-280, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31428827

RESUMO

OBJECTIVES: Rectal cancer patients with a clinical complete response after chemoradiotherapy (CRT) may be followed with a 'watch-and-wait' (W&W) approach as an alternative to surgery. MRI plays an important role in the follow-up of these patients, but basic knowledge on what to expect from the morphology of the irradiated tumour bed during follow-up is lacking, which can hamper image interpretation. The objective was to establish the spectrum of non-suspicious findings during long-term (> 2 years) follow-up in patients with a sustained clinical complete response undergoing W&W. METHODS: A total of 1509 T2W MRIs of 164 sustained complete responders undergoing W&W were retrospectively evaluated. Morphology of the tumour bed was evaluated (2 independent readers) on the restaging MRI and on the various follow-up MRIs and classified as (a) no fibrosis, (b) minimal fibrosis, (c) full thickness fibrosis, or (d) irregular fibrosis. Any changes occurring during follow-up were documented. RESULTS: A total of 104 patients (63%) showed minimal fibrosis, 38 (23%) full thickness fibrosis, 8 (5%) irregular fibrosis, and 14 (9%) no fibrosis. In 93% of patients, the morphology remained completely stable during follow-up; in 7%, a minor increase/decrease in fibrosis was observed. Interobserver agreement was excellent (κ 0.90). CONCLUSIONS: Typically, the morphology as established at restaging remains completely unchanged. The majority of patients show fibrosis with the predominant pattern being a minimal fibrosis confined to the rectal wall. Complete absence of fibrosis occurs in only 1/10 cases. Once validated in independent cohorts, these findings may serve as a reference for radiologists involved in the clinical follow-up of W&W patients. KEY POINTS: • In rectal cancer patients with a sustained complete response after chemoradiation, the rectal wall morphology as established on restaging MRI typically remains unchanged during long-term MRI follow-up. • The vast majority of complete responders show fibrosis with the predominant pattern being a minimal fibrotic remnant that remains confined to the rectal wall; complete absence of fibrosis occurs in only 10% of the cases. • Once validated in independent cohorts, the findings of this study may serve as a reference for radiologists involved in the clinical follow-up of rectal cancer patients undergoing watch-and-wait.


Assuntos
Imagem por Ressonância Magnética/métodos , Neoplasias Retais/diagnóstico por imagem , Conduta Expectante/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Quimiorradioterapia , Feminino , Fibrose , Humanos , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Recidiva Local de Neoplasia/patologia , Neoplasias Retais/patologia , Reto/patologia , Indução de Remissão , Estudos Retrospectivos
12.
Environ Sci Pollut Res Int ; 27(7): 7596-7607, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31885060

RESUMO

Intestinal microflora plays a key role in maintaining the homeostasis between immune and host health. Here, we reported the fluoride-induced changes of rectal structure and microflora in mice. The morphology of rectal tissue was observed by hematoxylin and eosin staining. The rectal development parameters (the thickness of mucosa, intestinal gland and muscle layer) were evaluated. The proliferation of rectal epithelial cells was evaluated via BrdU labeling. The distribution of goblet, glycoprotein and mast cell were evaluated by specific staining. Rectal microflora was detected using 16S rRNA high-throughput sequencing. The results showed that the rectal structure was seriously damaged and the proliferation of rectal epithelial cells was significantly inhibited by fluoride. The distribution of goblet cells, glycoprotein and mast cells decreased significantly after fluoride exposure. The relative richness of microfloras was changed after fluoride treatment, such as increased Bacteroidetes and decreased Firmicutes. In summary, this study indicated that excessive fluoride damages the intestinal structure, disturbs the intestinal micro-ecology and causes intestinal microflora disorder in mice. Findings mentioned in the present study enrich a new scope for elucidating fluoride toxicity from intestinal homeostasis.


Assuntos
Fluoretos/efeitos adversos , Microbioma Gastrointestinal/efeitos dos fármacos , Mucosa Intestinal/efeitos dos fármacos , Reto/efeitos dos fármacos , Animais , Mucosa Intestinal/microbiologia , Mucosa Intestinal/patologia , Camundongos , RNA Ribossômico 16S , Reto/patologia
13.
Ceska Gynekol ; 84(5): 331-336, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31826628

RESUMO

OBJECTIVE: The aim of this prospective, unicentric, cohort study was to evaluate the effect of dienogest use in the therapy of symptomatic endometriosis of rectovaginal septum in patients of fertile age. STUDY DESIGN: Prospective, unicentric, cohort study. SETTING: Department of Obstetrics and Gynaecology, Brno University Hospital and Masaryk University Medical School, Brno. MATERIAL AND METHODS: Prospective analysis of the group of 32 patients in reproductive age who have previously been diagnosed with endometriosis of rectovaginal septum. These patients were treated conservatively with dienogest 2 mg per day during a 24-week period. Through questionnaires and clinical assessment, we have studied the presence of symptoms like dyspareunia, diffuse pelvic pain, Biberoglu-Behrman(B-B) score assessment and subjective pain perception using Visual Analogue Scale (VAS) of pain. Data were collected at the beginning of therapy, after 4, 12 and 24 weeks of dienogest use. RESULTS: Continual use of dienogest during the 24-week period diminishes symptoms of dyspareunia by 62% (p.


Assuntos
Endometriose/tratamento farmacológico , Antagonistas de Hormônios/uso terapêutico , Nandrolona/análogos & derivados , Dor Pélvica/etiologia , Estudos de Coortes , Endometriose/patologia , Feminino , Humanos , Nandrolona/uso terapêutico , Medição da Dor , Estudos Prospectivos , Qualidade de Vida , Reto/patologia , Resultado do Tratamento , Vagina/patologia
14.
Rev. argent. coloproctología ; 30(4): 97-103, dic. 2019. ilus, graf
Artigo em Espanhol | LILACS | ID: biblio-1096796

RESUMO

Introducción: Los tumores ano-rectales del musculo liso son raros, la relación respecto de los de recto es de 0.1%, presentándose con un rango entre 40-70 años. El objetivo es analizar una serie de pacientes, el tratamiento empleado y actualización bibliográfica. Material y Método: Sobre una base de datos retrospectiva entre enero de 1983 y diciembre de 2018, sobre 421 pacientes operados por cáncer recto-anal, fueron extraídos 6 que correspondieron a tumores del musculo liso. Resultados: Correspondieron al sexo femenino 4, con edades entre 49 y 75 años (57.5 años); 4 de localización rectal, de ellos 3 fueron leiomiosarcoma, y 2 anales (leiomioma). En 2 se obtuvo diagnostico preoperatorio de certeza por punción mediante Tru-Cut. De 3 pacientes con leiomiosarcoma, a 2 se les realizo cirugía radical y al restante biopsia. Los 2 resecados recidivaron a los 6 meses y al año. Los 3 fallecieron entre los 2 y 16 meses por progresión de la enfermedad. La paciente con diagnóstico de leiomioma rectal, operada mediante cirugía radical, se encuentra sin recidiva a 18 meses. Los 2 pacientes resecados localmente por leiomioma de ano, presentaron en el postoperatorio absceso y fistula extraesfinteriana, uno de ellos con incontinencia severa. Ambos fueron re-operados y se encuentran asintomáticos, libres de recidiva a los 36 y 60 meses. Discusión: Los tumores del músculo liso ano-rectal son infrecuentes y presentan síntomas inespecíficos. La biopsia preoperatoria es imperiosa a fin de establecer una adecuada estrategia quirúrgica. Los malignos tienen alto índice de recidiva y mortalidad. (AU)


Introduction: Smooth muscle ano-rectal tumors are rare; the relation with respect to the rectum is 0.1%, in a patient's age range between 40-70 years. The objective is the analysis of a series of patients, the treatment used and bibliographic update. Material and method: On a retrospective, database between January 1983 and December 2018. About 421 patients operated for rectum-anal cancer, of which 6 corresponded to smooth muscle tumors. Results: Four were female, with ages between 49 and 75 years (57.5 years average); 4 were of rectal location, of which 3 were leiomyosarcoma, and 2 anal (leiomyoma). In two, a preoperative diagnosis of certainty was obtained by Tru-Cut. Two out of 3 patients with leiomyosarcoma, underwent radical surgery and the remaining one a biopsy. The two resected relapsed at 6 months and at one year. All 3 died between 2 and 16 months due to disease progression. The patient diagnosed with rectal leiomyoma, operated by radical surgery, is without recurrence at 18 months. The 2 patients resected locally for anus leiomyoma showed abscess and extrasphincteric fistula in the postoperative period, one of them with severe incontinence. Both were re-operated and are asymptomatic, free of recurrence at 36 and 60 months. Discussion: Ano-rectal smooth muscle tumors are uncommon and have nonspecific symptoms. Preoperative biopsy is imperative in order to establish an appropriate surgical strategy. Malignant tumors have a high rate of recurrence and mortality. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Canal Anal/patologia , Neoplasias Retais/diagnóstico , Neoplasias Retais/patologia , Reto/patologia , Biópsia por Agulha , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Cuidados Pós-Operatórios , Neoplasias Retais/cirurgia , Diagnóstico por Imagem , Imuno-Histoquímica , Estudos Retrospectivos , Proctoscopia/métodos , Quimioterapia Combinada , Leiomiossarcoma/cirurgia
16.
Cir. Esp. (Ed. impr.) ; 97(9): 510-516, nov. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-187627

RESUMO

Introducción: El objetivo de este estudio es analizar los resultados quirúrgicos a corto plazo de la escisión completa del mesorrecto por vía transanal laparoscópica. Métodos: Análisis en 100 pacientes con cáncer de recto medio e inferior, intervenidos consecutivamente entre noviembre de 2013 y septiembre de 2018. Se describen los datos operatorios, la morbimortalidad y la calidad de la pieza quirúrgica. Se realiza un análisis comparativo entre sexos y la cirugía a uno y a 2 campos simultáneos. Resultados: La mediana de edad fue de 67 años (56-75), siendo el 67% varones. El 50% fueron tumores T3 y el 52% con afectación ganglionar, por RMN. La media de distancia al margen anal fue de 4,9 ± 1,3 cm. El 58% recibió neoadyuvancia. La media de tiempo quirúrgico fue de 262 ± 40,7 min, siendo menor en mujeres (p < 0,001) y en la cirugía simultánea a 2 campos (p = 0,008). La mediana de margen distal fue de 1,5cm (0,5-2,4). Se obtuvo un mesorrecto completo en el 89%, con mejores resultados en la cirugía a 2 campos (p = 0,047). La media de ganglios aislados fue de 15,2 ± 11,6. El 26% de los pacientes tuvieron afectación ganglionar. La mediana de estancia fue de 5,5 días (4-8). Hubo una morbilidad del 36% y un paciente falleció. Conclusiones: La escisión completa del mesorrecto por vía transanal laparoscópica es segura, consiguiendo un adecuado margen circunferencial y distal, con una alta calidad del mesorrecto. Ofrece una morbilidad aceptable para el tipo de intervención quirúrgica, según la literatura actual


Introduction: The aim of this study is to describe and evaluate our clinical short-term surgical results of laparoscopic transanal total mesorectal excision. Methods: Analysis of 100 consecutive patients with mid and lower rectal cancer who underwent transanal total mesorectal excision from November 2013 to September 2018. Main outcomes described are operative data, morbidities, mortality and quality of the specimen. A comparative analysis was done between gender and simultaneous vs. non simultaneous abdominal-perineal surgery. Results: Mean patient age was 67 years (56-75), and 67% were male. On MRI, 50% were stage T3 tumors, and 52% had positive nodes. Mean distance of the tumor from anal verge was 4.9 ± 1.3cm. A total of 58% underwent neoadjuvant treatment. Mean operative time was 262 ± 40.7 min; it was shorter in females (P < .001) and in simultaneous 2-field surgery. Median specimen distal free margin was 1.5 cm (0.5-2.4). A total of 89% of the specimens were with complete mesorectum, with better results when a simultaneous approach was used (P = .047). The mean number of retrieved lymph-nodes was 15.2 ± 11.6, and 26% of patients had positive nodes. Median length of stay was 5.5 days (4-8). Morbidities occurred in 36% of cases, and one patient died. Conclusions: According to our experience, laparoscopic transanal total mesorectal excision is safe and effective with adequate circumferential and distal free margins and high quality of the resected mesorectum specimen. Post-operative morbidity is acceptable, according to the current literature


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Neoplasias Retais/cirurgia , Reto/cirurgia , Cirurgia Endoscópica Transanal/métodos , Canal Anal/cirurgia , Laparoscopia/métodos , Margens de Excisão , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Duração da Cirurgia , Neoplasias Retais/mortalidade , Reto/patologia , Estudos Retrospectivos , Cirurgia Endoscópica Transanal/efeitos adversos
18.
Medicine (Baltimore) ; 98(42): e17570, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31626124

RESUMO

Perineural invasion (PNI) is a prognostic factor in patients with colorectal cancer. Neurotrophic factors, molecular determinants of PNI, are altered in their expression levels in patients with ulcerative colitis. In this study, we evaluated the frequency of PNI in colitis-associated cancer (CAC) and sporadic cancer.We retrospectively reviewed 778 colorectal cancers with pathological T3-T4 in 761 patients all of whom were surgically resected without preoperative treatment. The lesions were classified into either CAC or sporadic cancer based on the clinical information. Clinicopathological findings including PNI were compared between CACs and sporadic cancers. Moreover, we analyzed the risk factors for positive PNI by multivariate analysis using a logistic regression model.Ten of the cancers (1.3%) were diagnosed as CACs, and the remaining 768 as sporadic cancers. CACs were characterized by being nonobstructive and predominantly located in the rectum. The CACs had a larger size and more frequent undifferentiated histology than sporadic cancers. PNI was observed more frequently in CACs (90%) than in sporadic cancers without obstruction (45%, P = .007). On multivariate analysis, CAC was one of the significant factors associated with PNI (odds ratio: 9.05, P = .040).Our results suggest that CAC was more likely to exhibit PNI than sporadic colorectal cancer.


Assuntos
Adenocarcinoma/patologia , Colite Ulcerativa/complicações , Neoplasias Colorretais/patologia , Estadiamento de Neoplasias , Neoplasias do Sistema Nervoso Periférico/patologia , Reto/patologia , Adenocarcinoma/epidemiologia , Adenocarcinoma/etiologia , Adulto , Idoso , Colite Ulcerativa/diagnóstico , Neoplasias Colorretais/epidemiologia , Neoplasias Colorretais/etiologia , Feminino , Seguimentos , Humanos , Incidência , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Invasividade Neoplásica , Neoplasias do Sistema Nervoso Periférico/epidemiologia , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Taxa de Sobrevida/tendências
19.
BMC Cancer ; 19(1): 960, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619203

RESUMO

BACKGROUND: Neuroendocrine tumors (NETs) are heterogeneous, widely distributed tumors arising from neuroendocrine cells. Gastrointestinal (GI)-NETs are the most common and NETs of the rectum represent 15, 2% of gastrointestinal malignancies. Poorly differentiated neuroendocrine carcinomas of the GI tract are uncommon. We report a rare case of poorly differentiated locally advanced rectal neuroendocrine carcinoma with nodal and a subcutaneous metastasis, with a cytoplasmic staining positive for Synaptophysin and Thyroid Transcription Factor-1. CASE PRESENTATION: A 72-year-old male presented to hospital, due to lumbar, abdominal, perineal pain, and severe constipation. A whole-body computed tomography scan showed a mass of the right lateral wall of the rectum, determining significant reduction of lumen caliber. It also showed a subcutaneous metastasis of the posterior abdominal wall. Patient underwent a multidisciplinary evaluation, diagnostic and therapeutic plan was shared and defined. The pathological examination of rectal biopsy and subcutaneous nodule revealed features consistent with small-cell poorly differentiated neuroendocrine carcinoma. First line medical treatment with triplet chemotherapy and bevacizumab, according to FIr-B/FOx intensive regimen, administered for the first time in this young elderly patient affected by metastatic rectal NEC was highly active and tolerable, as previously reported in metastatic colo-rectal carcinoma (MCRC). A consistent rapid improvement in clinical conditions were observed during treatment. After 6 cycles of treatment, CT scan and endoscopic evaluation showed clinical complete response of rectal mass and lymph nodes; patient underwent curative surgery confirming the pathologic complete response at PFS 9 months. DISCUSSION AND CONCLUSIONS: This case report of a locally advanced rectal NEC with an unusual subcutaneous metastasis deserves further investigation of triplet chemotherapy-based intensive regimens in metastatic GEP NEC.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Bevacizumab/uso terapêutico , Carcinoma Neuroendócrino/tratamento farmacológico , Carcinoma Neuroendócrino/patologia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Idoso , Biópsia , Carcinoma Neuroendócrino/secundário , Carcinoma Neuroendócrino/cirurgia , Fluoruracila/uso terapêutico , Humanos , Irinotecano/uso terapêutico , Masculino , Oxaliplatina/uso terapêutico , Neoplasias Retais/secundário , Neoplasias Retais/cirurgia , Reto/patologia , Sinaptofisina/metabolismo , Fator Nuclear 1 de Tireoide/metabolismo , Resultado do Tratamento
20.
Zhonghua Wei Chang Wai Ke Za Zhi ; 22(10): 920-925, 2019 Oct 25.
Artigo em Chinês | MEDLINE | ID: mdl-31630487

RESUMO

The theory of membrane surgery actually holds the same concepts as that of traditional cancer surgery, which believes that tumor spread is regarded as an isotropic process but the tumor is confined by the block of the membrane. Therefore, the radical resection can be achieved by complete mesentery excision along the membrane plane. The surgical practice derived from these conceptions is extended excision and lays emphasis on tumor-free margins. But the theory is controversial in the view of the existence of mesorectal fascial envelope and the feasibility of complete excision of mesorectum along the "holy plane". Based on ontogenetic anatomy, the compartment theory suggeststhat tumor spread is not isotropic, and it is locally confined within the ontogenetic compartment derived from a common primordium for a relatively long phase during their natural course. Local tumor is suppressed by the boundary instead of fascia. The anatomical territory developing from each anlage primordium may be separated morphologically. Consequently, ontogenetic compartment theory states that optimal local control of cancer is achieved by whole compartment resection, irrespective of margin width. The compartment model of tumor spread provides explanations for total mesorectal excision (TME) which excises the complete rectum compartment including the rectum and its surrounding vascular and ligamentous mesenteries. The compartment theory may set up the new principles for surgical tumor treatment, namely the resection of the tumor bearing compartment rather than target organ.


Assuntos
Mesentério/patologia , Mesentério/cirurgia , Protectomia/métodos , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Colectomia/métodos , Colectomia/normas , Fáscia/patologia , Humanos , Margens de Excisão , Mesocolo/patologia , Mesocolo/cirurgia , Invasividade Neoplásica , Metástase Neoplásica , Protectomia/normas , Reto/anatomia & histologia , Reto/patologia
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