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1.
Eur Radiol Exp ; 6(1): 19, 2022 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-35501512

RESUMO

BACKGROUND: Pathological complete response after neoadjuvant chemoradiotherapy in locally advanced rectal cancer (LARC) is achieved in 15-30% of cases. Our aim was to implement and externally validate a magnetic resonance imaging (MRI)-based radiomics pipeline to predict response to treatment and to investigate the impact of manual and automatic segmentations on the radiomics models. METHODS: Ninety-five patients with stage II/III LARC who underwent multiparametric MRI before chemoradiotherapy and surgical treatment were enrolled from three institutions. Patients were classified as responders if tumour regression grade was 1 or 2 and nonresponders otherwise. Sixty-seven patients composed the construction dataset, while 28 the external validation. Tumour volumes were manually and automatically segmented using a U-net algorithm. Three approaches for feature selection were tested and combined with four machine learning classifiers. RESULTS: Using manual segmentation, the best result reached an accuracy of 68% on the validation set, with sensitivity 60%, specificity 77%, negative predictive value (NPV) 63%, and positive predictive value (PPV) 75%. The automatic segmentation achieved an accuracy of 75% on the validation set, with sensitivity 80%, specificity 69%, and both NPV and PPV 75%. Sensitivity and NPV on the validation set were significantly higher (p = 0.047) for the automatic versus manual segmentation. CONCLUSION: Our study showed that radiomics models can pave the way to help clinicians in the prediction of tumour response to chemoradiotherapy of LARC and to personalise per-patient treatment. The results from the external validation dataset are promising for further research into radiomics approaches using both manual and automatic segmentations.


Assuntos
Neoplasias Retais , Reto , Quimiorradioterapia , Humanos , Imageamento por Ressonância Magnética/métodos , Terapia Neoadjuvante/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/patologia
2.
World J Gastroenterol ; 28(10): 1078-1084, 2022 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-35431493

RESUMO

BACKGROUND: Colorectal mucosa-associated lymphoid tissue lymphoma (MALToma), a rare kind of nongastric MALToma, lacks consensus on its endoscopic features and standard therapies. According to previous studies on the clinical characteristics and outcomes of colorectal MALToma, endoscopic resection remains a good therapeutic strategy. CASE SUMMARY: A 71-year-old woman suffered intermittent hematochezia for 1 mo, accompanied with abdominal pains but without weight loss, fever, chills or fatigue. Colonoscopy showed a massive hemispheric mass with rough and hyperemic mucosa in the lower rectum. Narrow-band imaging magnifying endoscopy detected some branching abnormal blood vessels and disappearance of glandular structure, which was similar with the tree-like appearance sign in gastric MALToma. Endoscopic ultrasonography revealed the lesion to be hypoechoic, boundary-defined, and echo uniform inside, originating from the muscularis propria. Abdominal enhanced computed tomography (CT) demonstrated a soft tissue mass with defined boundary. No enlarged superficial lymph nodes were detected by B-mode ultrasound. C13-urea breath test and serum Helicobacter pylori antibody were both negative. The patient underwent endoscopic full-thickness resection. Postoperative pathological analysis indicated colorectal MALToma. The patient remained asymptomatic after discharge, and follow-up positron emission tomography-CT and colonoscopy showed no residual lesion, remnants or lymph node metastasis. CONCLUSION: This case provides new information on the specific endoscopic features of colorectal MALToma and an alternative treatment for patients.


Assuntos
Neoplasias do Colo , Ressecção Endoscópica de Mucosa , Linfoma de Zona Marginal Tipo Células B , Neoplasias Gástricas , Idoso , Feminino , Humanos , Linfoma de Zona Marginal Tipo Células B/diagnóstico por imagem , Linfoma de Zona Marginal Tipo Células B/cirurgia , Reto/patologia , Neoplasias Gástricas/patologia
3.
Gan To Kagaku Ryoho ; 49(4): 453-455, 2022 Apr.
Artigo em Japonês | MEDLINE | ID: mdl-35444133

RESUMO

The patient was a 60s man, whose chief complaint of melena and weight loss. He visited our hospital, and further evaluation revealed rectal cancer(Rb)invading the prostate with obturator lymph node metastasis. The clinical diagnosis was T4b (prostate)N3M0, Stage Ⅲc. He was administered 4 courses of CAPOX plus bevacizumab. After chemotherapy the primary tumor and lymph nodes showed PR, the diagnosis of ycT4bN1bM0, Stage Ⅲc. We performed robot-assisted total pelvic exenteration. He has been cancer-free for 5 months.


Assuntos
Segunda Neoplasia Primária , Exenteração Pélvica , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Humanos , Masculino , Próstata/patologia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia
4.
Radiat Oncol ; 17(1): 78, 2022 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-35428267

RESUMO

BACKGROUND: Predicting pathological complete response (pCR) in patients affected by locally advanced rectal cancer (LARC) who undergo neoadjuvant chemoradiotherapy (nCRT) is a challenging field of investigation, but many of the published models are burdened by a lack of reliable external validation. Aim of this study was to evaluate the applicability of a magnetic resonance imaging (MRI) radiomic-based pCR model developed and validated in Europe, to a different cohort of patients from an intercontinental cancer center. METHODS: The original model was based on two clinical and two radiomics features extracted from T2-weighted 1.5 T MRI of 161 LARC patients acquired before nCRT, considered as training set. Such model is here validated using the T2-w 1.5 and 3 T staging MRI of 59 LARC patients with different clinical characteristics consecutively treated in mainland Chinese cancer center from March 2017 to January 2018. Model performance were evaluated in terms of area under the receiver operator characteristics curve (AUC) and relative parameters, such as accuracy, specificity, negative and positive predictive value (NPV and PPV). RESULTS: An AUC of 0.83 (CI 95%, 0.71-0.96) was achieved for the intercontinental cohort versus a value of 0.75 (CI 95%, 0.61-0.88) at the external validation step reported in the original experience. Considering the best cut-off threshold identified in the first experience (0.26), the following predictive performance were obtained: 0.65 as accuracy, 0.64 as specificity, 0.70 as sensitivity, 0.91 as NPV and 0.28 as PPV. CONCLUSIONS: Despite the introduction of significant different factors, the proposed model appeared to be replicable on a real-world data extra-European patients' cohort, achieving a TRIPOD 4 level.


Assuntos
Segunda Neoplasia Primária , Neoplasias Retais , Humanos , Imageamento por Ressonância Magnética/métodos , Espectroscopia de Ressonância Magnética , Terapia Neoadjuvante/métodos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/patologia , Estudos Retrospectivos
5.
Zhonghua Wei Chang Wai Ke Za Zhi ; 25(4): 309-314, 2022 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-35461198

RESUMO

Tumor spreading through the lymphatic drainage is an important metastatic pathway for rectum and sigmoid colon carcinoma. Regional lymph node dissection, as an important part of radical resection of colorectal cancer, is the main way for patients with colorectal cancer to achieve radical resection and acquire tumor-free survival. The regional lymph nodes of sigmoid cancer include paracolic lymph nodes, intermediate lymph nodes, and central lymph nodes locating at the root of blood vessel, and radical surgery should include lymph node dissection at the above three stations. The lymphatic pathways of metastasis for rectal cancer include longitudinal metastasis within the mesorectum and lateral metastasis beyond the mesorectum. The standard surgical method of rectal cancer is total mesorectal excision (TME) at present, and the resection range includes the metastatic lymph nodes within the mesorectum through the longitudinal pathway. However, there are many different opinions about lateral lymph node dissection(LLND) aiming at the metastatic lymph nodes locating at the lateral space of rectum. The range of lymph node dissection for rectum and sigmoid cancer is a vital factor that determines the prognosis of patients. Insufficient range of dissection can lead to residual metastatic lymph nodes and have serious impacts on the prognosis of patients. Excessive range of dissection can result in greater surgical trauma, prolonged operation time, more blood loss, and higher rate of complication without oncological benefits. Individualizating the appropriate resection range of rectum and sigmoid colon cancer on the basis of standardization and according to the clinical stage and invasion range of tumor demonstrates great significance of ensuring the radical operation, reducing trauma, promoting rehabilitation, protecting the function and improving the prognosis.


Assuntos
Neoplasias Retais , Neoplasias do Colo Sigmoide , Humanos , Excisão de Linfonodo/métodos , Linfonodos/patologia , Neoplasias Retais/patologia , Reto/patologia , Padrões de Referência , Neoplasias do Colo Sigmoide/cirurgia
6.
Radiat Oncol ; 17(1): 84, 2022 Apr 28.
Artigo em Inglês | MEDLINE | ID: mdl-35484597

RESUMO

BACKGROUND: To report on the discriminative ability of a simulation Computed Tomography (CT)-based radiomics signature for predicting response to treatment in patients undergoing neoadjuvant chemo-radiation for locally advanced adenocarcinoma of the rectum. METHODS: Consecutive patients treated at the Universities of Tübingen (from 1/1/07 to 31/12/10, explorative cohort) and Florence (from 1/1/11 to 31/12/17, external validation cohort) were considered in our dual-institution, retrospective analysis. Long-course neoadjuvant chemo-radiation was performed according to local policy. On simulation CT, the rectal Gross Tumor Volume was manually segmented. A feature selection process was performed yielding mineable data through an in-house developed software (written in Python 3.6). Model selection and hyper-parametrization of the model was performed using a fivefold cross validation approach. The main outcome measure of the study was the rate of pathologic good response, defined as the sum of Tumor regression grade (TRG) 3 and 4 according to Dworak's classification. RESULTS: Two-hundred and one patients were included in our analysis, of whom 126 (62.7%) and 75 (37.3%) cases represented the explorative and external validation cohorts, respectively. Patient characteristics were well balanced between the two groups. A similar rate of good response to neoadjuvant treatment was obtained in in both cohorts (46% and 54.7%, respectively; p = 0.247). A total of 1150 features were extracted from the planning scans. A 5-metafeature complex consisting of Principal component analysis (PCA)-clusters (whose main components are LHL Grey-Level-Size-Zone: Large Zone Emphasis, Elongation, HHH Intensity Histogram Mean, HLL Run-Length: Run Level Variance and HHH Co-occurence: Cluster Tendency) in combination with 5-nearest neighbour model was the most robust signature. When applied to the explorative cohort, the prediction of good response corresponded to an average Area under the curve (AUC) value of 0.65 ± 0.02. When the model was tested on the external validation cohort, it ensured a similar accuracy, with a slightly lower predictive ability (AUC of 0.63). CONCLUSIONS: Radiomics-based, data-mining from simulation CT scans was shown to be feasible and reproducible in two independent cohorts, yielding fair accuracy in the prediction of response to neoadjuvant chemo-radiation.


Assuntos
Terapia Neoadjuvante , Neoplasias Retais , Quimiorradioterapia , Humanos , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/patologia , Neoplasias Retais/terapia , Reto/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X/métodos
7.
Radiat Oncol ; 17(1): 64, 2022 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-35365170

RESUMO

PURPOSE: To examine the dosimetric feasibility of hypofractionated/dose escalated radiation therapy in patients with localized prostate carcinoma using simultaneous integrated boost intensity-modulated proton beam therapy (SIB-IMPT) in absence or presence of prostate-rectum spacer. METHODS: IMPT technique was implemented in 23 patients with intermediate- and high-risk prostate cancer treated at West German Proton Therapy Centre from March 2016 till June 2018, using SIB technique prescribing 60 GyRBE and 72 GyRBE in 30 fractions to PTV1 (prostate and seminal vesicle) and PTV2 boost (prostate and proximal seminal vesicle), respectively. In 15 patients, a transperineal injection of hydrogel was applied prior to radiotherapy to increase the distance between prostate and rectum. Planning and all treatments were performed with a 120 ml fluid-filled endorectal balloon customised daily for each patient. For each patient, 2 lateral IMPT beams were implemented taking a field-specific range uncertainty (RU) into account. Dose volume histograms (DVH) were analyzed for PTV2, PTV2 with range uncertainty margin (PTV2RU), rectum, bladder, right/left femoral heads, and penile bulb. For late rectal toxicities, the normal tissue complication probabilities (NTCP) were calculated using different biological models. A DVH- and NTCP-based dosimetric comparison was carried out between non-spacer and spacer groups. RESULTS: For the 23 patients, high-quality plans could be achieved for target volume and for other organs at risk (OARs). For PTV2, the V107% was 0% and the Dmax did not exceed 106.2% of the prescribed dose. The volume PTV2RU covered by 95% of the dose ranged from 96.16 to 99.95%. The conformality index for PTV2RU was 1.12 ± 0.057 and the homogeneity index (HI) was 1.04 ± 0.014. Rectum Dmax and rectal volume receiving 73-50 Gy could be further reduced for the spacer-group. Significant reductions in mean and median rectal NTCPs (stenosis/necrosis, late rectal bleeding ≥ 2, and late rectal toxicities ≥ 3) were predicted for the spacer group in comparison to the non-spacer group. CONCLUSION: Hypofractionated/dose escalated radiotherapy with SIB-IMPT is dosimetrically feasible. Further reduction of the rectal volumes receiving high and medium dose levels (73-50 Gy) and rectal NTCP could be achieved through injection of spacers between rectum and prostate.


Assuntos
Neoplasias da Próstata , Terapia com Prótons , Estudos de Viabilidade , Humanos , Hidrogéis , Masculino , Próstata/patologia , Neoplasias da Próstata/patologia , Neoplasias da Próstata/radioterapia , Planejamento da Radioterapia Assistida por Computador/métodos , Reto/patologia
8.
Sci Rep ; 12(1): 6167, 2022 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-35418656

RESUMO

A feasibility study was performed to determine if CT-based radiomics could play an augmentative role in predicting neoadjuvant rectal score (NAR), locoregional failure free survival (LRFFS), distant metastasis free survival (DMFS), disease free survival (DFS) and overall survival (OS) in locally advanced rectal cancer (LARC). The NAR score, which takes into account the pathological tumour and nodal stage as well as clinical tumour stage, is a validated surrogate endpoint used for early determination of treatment response whereby a low NAR score (< 8) has been correlated with better outcomes and high NAR score (> 16) has been correlated with poorer outcomes. CT images of 191 patients with LARC were used in this study. Primary tumour (GTV) and mesorectum (CTV) were contoured separately and radiomics features were extracted from both segments. Two NAR models (NAR > 16 and NAR < 8) models were constructed using Least Absolute Shrinkage and Selection Operator (LASSO) and the survival models were constructed using regularized Cox regressions. Area under curve (AUC) and time-dependent AUC were used to quantify the performance of the LASSO and Cox regression respectively, using ten folds cross validations. The NAR > 16 and NAR < 8 models have an average AUCs of 0.68 ± 0.13 and 0.59 ± 0.14 respectively. There are statistically significant differences between the clinical and combined model for LRFFS (from 0.68 ± 0.04 to 0.72 ± 0.04), DMFS (from 0.68 ± 0.05 to 0.70 ± 0.05) and OS (from 0.64 ± 0.06 to 0.66 ± 0.06). CTV radiomics features were also found to be more important than GTV features in the NAR prediction model. The most important clinical features are age and CEA for NAR > 16 and NAR < 8 models respectively, while the most significant clinical features are age, surgical margin and NAR score across all the four survival models.


Assuntos
Segunda Neoplasia Primária , Neoplasias Retais , Humanos , Terapia Neoadjuvante/métodos , Segunda Neoplasia Primária/patologia , Prognóstico , Neoplasias Retais/diagnóstico por imagem , Neoplasias Retais/terapia , Reto/patologia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X
9.
BMC Gastroenterol ; 22(1): 173, 2022 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-35395754

RESUMO

BACKGROUND: Primary signet ring cell carcinoma of the colon and rectum (PSRCCR) is rare, usually diagnosed at advanced stage with poor outcomes. We aimed to find possible diagnostic clues in order to help diagnosis. METHODS: A retrospective study of PSRCCR patients from 1993 to 2018 was reviewed at a single tertiary center. Colorectal adenocarcinoma patients as control group with 1:4 ratio was also enrolled. RESULTS: 18 patients with PSRCCR were identified. The prevalence rate was 0.16% (18 of 11,515). The mean age was 50.2 years-old in PSRCCR group and 63 years-old in non-SRCC colorectal cancer patients (p < 0.001). Diagnosis tool depends on colonoscopy were much less in PSRCCR group than control group (44.4% vs 93%, p < 0.001). SRCC patients had higher level of CEA (68.3 vs 17.7 ng/mL, p = 0.004) and lower level of Albumin (3.4 vs 4.3 g/dL, p < 0.001). The majority of PSRCCR tumor configuration was ulcerative and infiltrative. More PSRCCR pathology presented as high-grade carcinoma (66.7 vs 1.4%, p < 0.001) and lymphovascular invasion (77.8 vs 44.4%, p = 0.011) than control group. More PSRCCR patients were diagnosed at advanced stage (88.8 vs 40.3%, p = 0.001). Higher mortality was also noticed in PSRCCR group than control group (72.2 vs 20.8%, p < 0.001). CONCLUSION: For young patients with long segment colonic stenosis and ulcerative/ infiltrative mucosa but endoscopic biopsy failed to identify malignant cells, earlier operation or non-colon site biopsy is suggested for diagnosing the PSRCCR.


Assuntos
Carcinoma de Células em Anel de Sinete , Neoplasias do Colo , Neoplasias Colorretais , Neoplasias Retais , Carcinoma de Células em Anel de Sinete/patologia , Estudos de Casos e Controles , Neoplasias do Colo/epidemiologia , Neoplasias do Colo/patologia , Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/epidemiologia , Humanos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Prognóstico , Neoplasias Retais/epidemiologia , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos
10.
BMC Surg ; 22(1): 147, 2022 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-35449005

RESUMO

BACKGROUND: Determine whether robotic surgery is more effective than transanal and conventional laparoscopic surgery in preserving bowel and urinary function after total mesorectal excision (TME). METHODS: Of 79 lower rectal cancer patients who underwent function-preserving TME between 2016 and 2020, 64 patients consented to a prospective questionnaire-based functional observation study (52 responded). At 6 months post-resection or ileostomy closure, Wexner, low anterior resection syndrome (LARS), modified fecal incontinence quality of life, and international prostate symptom scores were used to evaluate bowel and urinary function, comparing robotic surgery (RTME) with transanal (taTME) or conventional laparoscopic surgery (LTME). RESULTS: RTME was performed in 35 patients (54.7%), taTME in 15 (23.4%), and LTME in 14 (21.9%). While preoperative bowel/urinary functions were similar in all three procedures, and the distance from the anal verge to tumor was almost the same, more hand-sewn anastomoses were performed and the anastomotic height from the anal verge was shorter in taTME than RTME. At 2 years post-resection, 8 patients (12.5%) had a permanent stoma; RTME showed a significantly lower rate of permanent stoma than taTME (2.9% vs. 40%, p < 0.01). Despite no significant difference, all bowel function assessments were better in RTME than in taTME or LTME. Major LARS was observed in all taTME and LTME cases, but only 78.8% of RTME. No clear difference arose between RTME and taTME in urinary function; urinary dysfunction was more severe in LTME than RTME (36.4% vs. 6.1%, p = 0.02). CONCLUSIONS: In function-preserving TME for lower rectal cancer, robotic surgery was suggested to be more effective than transanal and conventional laparoscopic surgery in terms of bowel and urinary functions.


Assuntos
Laparoscopia , Doenças Retais , Neoplasias Retais , Procedimentos Cirúrgicos Robóticos , Cirurgia Endoscópica Transanal , Humanos , Laparoscopia/métodos , Masculino , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/cirurgia , Estudos Prospectivos , Qualidade de Vida , Doenças Retais/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia , Síndrome , Cirurgia Endoscópica Transanal/métodos , Resultado do Tratamento
11.
Cesk Patol ; 58(1): 27-37, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35387455

RESUMO

Inflammatory bowel diseases (IBD) represent a group of chronic systemic inflammatory conditions with predilection to gastrointestinal tract and include Crohns disease and ulcerative colitis. If the IBD cannot be further specified, a term unclassified IBD is used. Histopathological diagnosis of IBD relies on identifying a chronic inflammatory pattern in proper topographic distribution, showing structural abnormalities of the intestinal mucosa and characteristic cellular composition of the inflammatory infiltrate. The intestinal involvement in Crohns disease is typically segmental, with predilection for terminal ileum and presence of epithelioid granulomas in histology. Ulcerative colitis shows a diffuse pattern of the inflammation and usually affects a rectum, with variable extension towards a terminal ileum. However, there is an expanding knowledge about etiopathogenesis, morphology and clinical presentation of IBD, which led to detailed phenotypic subclassification and defined many atypical variants. As a result, diagnosis of IBD became complex multidisciplinary process. The aim of this work is to present an overview of IBD morphology and to provide a base for histopathological diagnosis of IBD on both bioptic samples and surgical resections.


Assuntos
Colite Ulcerativa , Doença de Crohn , Doenças Inflamatórias Intestinais , Colite Ulcerativa/diagnóstico , Colite Ulcerativa/patologia , Doença de Crohn/diagnóstico , Humanos , Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/patologia , Mucosa Intestinal/patologia , Reto/patologia
12.
Surg Oncol Clin N Am ; 31(2): 183-218, 2022 04.
Artigo em Inglês | MEDLINE | ID: mdl-35351273

RESUMO

Efforts toward standardization of surgical techniques have facilitated adoption of oncologic resections for colorectal cancer with associated improvement in outcomes. With the introduction of laparoscopy, total mesorectal excision (TME) and complete mesocolic excision (CME) techniques were progressively adapted to the minimally invasive surgery (MIS) approach with significant benefits with regards to patient recovery and comparable oncologic outcomes when performed by surgeons beyond their learning curve. Anastomotic complications and functional disturbances following TME remain significant. Recent innovations include intracorporeal anastomosis, which avoids midline extraction sites, and transanal TME, which lowers conversion rates and facilitates sphincter preservation for low rectal tumors.


Assuntos
Laparoscopia , Neoplasias Retais , Cirurgia Endoscópica Transanal , Humanos , Laparoscopia/métodos , Complicações Pós-Operatórias/cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia , Cirurgia Endoscópica Transanal/métodos , Resultado do Tratamento
13.
Oncologist ; 27(5): 380-388, 2022 May 06.
Artigo em Inglês | MEDLINE | ID: mdl-35278070

RESUMO

BACKGROUND: Total neoadjuvant therapy (TNT) improves tumor response in locally advanced rectal cancer (LARC) patients compared to neoadjuvant chemoradiotherapy alone. The effect of TNT on patient survival has not been fully investigated. MATERIALS AND METHODS: This was a retrospective case series of patients with LARC at a comprehensive cancer center. Three hundred and eleven patients received chemoradiotherapy (chemoRT) as the sole neoadjuvant treatment and planned adjuvant chemotherapy, and 313 received TNT (induction fluorouracil and oxaliplatin-based chemotherapy followed by chemoradiotherapy in the neoadjuvant setting). These patients then underwent total mesorectal excision or were entered in a watch-and-wait protocol. The proportion of patients with complete response (CR) after neoadjuvant therapy (defined as pathological CR or clinical CR sustained for 2 years) was compared by the χ2 test. Disease-free survival (DFS), local recurrence-free survival, distant metastasis-free survival, and overall survival were assessed by Kaplan-Meier analysis and log-rank test. Cox regression models were used to further evaluate DFS. RESULTS: The rate of CR was 20% for chemoRT and 27% for TNT (P=.05). DFS, local recurrence-free survival, metastasis-free survival, and overall survival were no different. Disease-free survival was not associated with the type of neoadjuvant treatment (hazard ratio [HR] 1.3; 95% confidence interval [CI] 0.93-1.80; P = .12). CONCLUSIONS: Although TNT does not prolong survival than neoadjuvant chemoradiotherapy plus intended postoperative chemotherapy, the higher response rate associated with TNT may create opportunities to preserve the rectum in more patients with LARC.


Assuntos
Segunda Neoplasia Primária , Neoplasias Retais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Quimioterapia Adjuvante , Intervalo Livre de Doença , Humanos , Quimioterapia de Indução/métodos , Terapia Neoadjuvante/métodos , Estadiamento de Neoplasias , Segunda Neoplasia Primária/patologia , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Reto/patologia , Estudos Retrospectivos
14.
BMC Surg ; 22(1): 117, 2022 Mar 27.
Artigo em Inglês | MEDLINE | ID: mdl-35346146

RESUMO

BACKGROUND: Robotic transanal minimally invasive surgery (R-TAMIS) is an appealing alternative to transanal minimally invasive surgery (TAMIS) and transanal endoscopic microsurgery (TEM) for benign and early malignant rectal lesions that are not amenable to traditional open transanal excision. However, no studies to our knowledge have directly compared the three techniques. This study sought to compare peri-operative and pathologic outcomes of the three approaches. METHODS: The records of 29 consecutive patients who underwent TEM, TAMIS, or R-TAMIS at a single academic center between 2016 and 2020 were reviewed. Intra-operative details, pathological diagnosis and margins, and post-operative outcomes were recorded. The three groups were compared using chi-square and Kruskal-Wallis tests. RESULTS: Overall, 16/29 patients were women and the median age was 57 (interquartile range (IQR): 28-81). Thirteen patients underwent TEM, six had TAMIS, and 10 had R-TAMIS. BMI was lower in the R-TAMIS patients (24.7; IQR 23.8-28.7), than in TEM (29.3; IQR 19.9-30.2), and TAMIS (30.4; IQR 26.6-32.9) patients. High grade dysplasia and/or invasive cancer was more common in TAMIS (80%) and R-TAMIS (66.7%) patients than in TEM patients (41.7%). The three groups did not differ significantly in tumor type or distance from the anal verge. No R-TAMIS patients had a positive surgical margin compared to 23.1% in the TEM group and 16.7% in the TAMIS group. Length of stay (median 1 day for TEM and R-TAMIS patients, 0 days for TAMIS patients) and 30-day readmission rates (7.7% of TEM, 0% of TAMIS, 10% of R-TAMIS patients) also did not differ among the groups. Median operative time was 110 min for TEM, 105 min for TAMIS, and 76 min for R-TAMIS patients. CONCLUSIONS: R-TAMIS may have several advantages over other advanced techniques for transanal excisions. R-TAMIS tended to be faster and to more often result in negative surgical margins compared to the two other techniques.


Assuntos
Neoplasias Retais , Cirurgia Endoscópica Transanal , Canal Anal/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Duração da Cirurgia , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia , Cirurgia Endoscópica Transanal/métodos
15.
Gan To Kagaku Ryoho ; 49(3): 312-314, 2022 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-35299190

RESUMO

We reported a case of rectal gastrointestinal stromal tumor(GIST)performed transanal surgery. A 46-year-old woman was pointed out uterinal cancer and lower rectal GIST. After operation for uterine cancer, GIST was treated. Because of the patent's opinion for anal preservation, chemotherapy with imatinib for 3 months was performed and local resection was done by transanal minimally invasive surgery(TAMIS). The histopathological diagnosis was low-grade GIST and immunostaining showed the tumor was positive for c-kit, CD34, DOG-1 and α-SMA. Because capsule of the GIST was damaged intraoperatively, imatinib therapy was started and she has no recurrence after 2 years.


Assuntos
Tumores do Estroma Gastrointestinal , Neoplasias Retais , Cirurgia Endoscópica Transanal , Feminino , Tumores do Estroma Gastrointestinal/tratamento farmacológico , Tumores do Estroma Gastrointestinal/patologia , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib/uso terapêutico , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Neoplasias Retais/cirurgia , Reto/patologia , Reto/cirurgia
16.
Rev Prat ; 72(2): 193-197, 2022 Feb.
Artigo em Francês | MEDLINE | ID: mdl-35289534

RESUMO

UPDATE ON BOWEL ENDOMETRIOSIS Endometriosis is a relatively common female disease with increasing incidence, probably because of better diagnostic tools and a better understanding of the pathology. We will focus our subject on bowel endometriosis, specially the recto-sigmoid localization, whose diagnostic and therapeutic management is multidisciplinary. Bowel endometriosis is rare, still not completely understood in gastroenterology consultations, that is why it seems interesting to make an update on this pathology, probably widely underestimated.


L'ENDOMÉTRIOSE DIGESTIVEL'endométriose est une maladie féminine relativement fréquente, dont l'incidence augmente avec le temps, probablement du fait de techniques diagnostiques plus performantes et de l'amélioration des connaissances. La prise en charge de l'endométriose digestive, dont la localisation la plus fréquente est rectosigmoïdienne, doit être pluridisciplinaire. Il semble important de s'intéresser à cette affection, assez rarement rencontrée en consultation de gastroentérologie et probablement largement sous-estimée.


Assuntos
Endometriose , Endometriose/diagnóstico , Endometriose/epidemiologia , Endometriose/terapia , Feminino , Humanos , Reto/patologia
17.
Rev Prat ; 72(1): 50-54, 2022 Jan.
Artigo em Francês | MEDLINE | ID: mdl-35258254

RESUMO

Rectal cancer: is the era for de-escalation arrived? The reference treatment of rectal cancer relies on carcinologic resection including total mesorectal excision. In patients with locally advanced rectal cancer (cT3T4 and/or cN+), preoperative treatment is used to improve outcome and includes radiochemotherapy to optimize local control and systemic chemotherapy to decrease metastatic recurrence. The combination of these treatments with rectal cancer surgery induces short term and long-term toxicities potentially leading to treatment related sequelae on digestive and genitourinary function. Lastly, time is coming for de-escalation for the treatment to rectal cancer. For patients with small tumors (cT2T3 inférieur 4 cm) who respond to radiochemotherapy, organ preservation avoiding rectal resection can be discussed. In patients with locally advanced resectable rectal cancer, preoperative chemotherapy without pelvic irradiation could be used before total mesorectal excision to decrease the risk of long-term side effects. In patients with more advanced, primarily non resectable rectal cancer, a tailored strategy based on tumor response to chemotherapy could be used to rationalize the use of preoperative irradiation. New treatment strategies are constantly proposed and the optimal treatment option should be decided on a per patient basis during multidisciplinary discussion.


PERSPECTIVES: vers une désescalade thérapeutique dans le cancer du rectum ? Le traitement de référence des cancers du rectum repose sur l'exérèse carcinologique (exérèse totale du mésorectum). En cas de tumeur localement évoluée (cT3T4 et/ou N+), une radiochimiothérapie précédée ou suivie d'une chimiothérapie est utilisée en préopératoire pour améliorer le contrôle local et réduire le risque de récidive métastatique ; sa combinaison à une chirurgie lourde est associée à une toxicité à court et à long termes, avec un risque de séquelles fonctionnelles digestives et génito-urinaires. Actuellement, la prise en charge évolue vers une désescalade thérapeutique. En cas de tumeur T2T3 de petite taille (inférieure à 4 cm) répondant bien au traitement, une stratégie de préservation rectale évitant la chirurgie d'exérèse peut se discuter. Pour les tumeurs plus évoluées, une chirurgie d'exérèse précédée d'une chimiothérapie, sans irradiation pelvienne, pourrait limiter les séquelles à long terme. En cas de tumeur non résécable d'emblée, une démarche personnalisée, fondée sur l'intensité de la réponse tumorale à la chimiothérapie, permettrait un recours sélectif à l'irradiation pelvienne. Compte tenu des nombreuses nouvelles approches qui peuvent être proposées, une discussion pluridisciplinaire est absolument nécessaire pour optimiser la prise en charge des patients.


Assuntos
Protectomia , Neoplasias Retais , Quimiorradioterapia , Humanos , Terapia Neoadjuvante/efeitos adversos , Recidiva Local de Neoplasia/tratamento farmacológico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia
18.
BMJ Case Rep ; 15(3)2022 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-35288433

RESUMO

A man in his 70s presented with narrowing of his stool calibre and a palpable mass on rectal examination. Colonoscopy revealed a submucosal bulge without a mucosal lesion. CT and MRI demonstrated an 8×5.4×7 cm mass in lower rectum. Biopsy of the mass confirmed a rectal gastrointestinal stromal tumour (GIST). It was moderately sensitive to neoadjuvant imatinib and radiotherapy, which slightly downsized the tumour. He required abdominal perineal resection with curative intent. Uncommonly found in the rectum, when located here, GISTs are typically aggressive and are a rare cause of stool calibre narrowing. Rectal GISTs should be considered in patients presenting with this symptom.


Assuntos
Antineoplásicos , Tumores do Estroma Gastrointestinal , Neoplasias Retais , Antineoplásicos/uso terapêutico , Tumores do Estroma Gastrointestinal/diagnóstico por imagem , Tumores do Estroma Gastrointestinal/cirurgia , Humanos , Mesilato de Imatinib/uso terapêutico , Masculino , Neoplasias Retais/tratamento farmacológico , Neoplasias Retais/cirurgia , Reto/diagnóstico por imagem , Reto/patologia , Reto/cirurgia
19.
Dis Colon Rectum ; 65(5): 628-640, 2022 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-35143429

RESUMO

BACKGROUND: Completion total mesorectal excision is recommended when local excision of early rectal cancers demonstrates high-risk histopathological features. Concerns regarding the quality of completion resections and the impact on oncological safety remain unanswered. OBJECTIVE: This study aims to summarize and analyze the outcomes associated with completion surgery and undertake a comparative analysis with primary rectal resections. DATA SOURCES: Data sources included PubMed, Cochrane library, MEDLINE, and Embase databases up to April 2021. STUDY SELECTION: All studies reporting any outcome of completion surgery after transanal local excision of an early rectal cancer were selected. Case reports, studies of benign lesions, and studies using flexible endoscopic techniques were not included. INTERVENTION: The intervention was completion total mesorectal excision after transanal local excision of early rectal cancers. MAIN OUTCOME MEASURES: Primary outcome measures included histopathological and long-term oncological outcomes of completion total mesorectal excision. Secondary outcome measures included short-term perioperative outcomes. RESULTS: Twenty-three studies including 646 patients met the eligibility criteria, and 8 studies were included in the meta-analyses. Patients undergoing completion surgery have longer operative times (standardized mean difference, 0.49; 95% CI, 0.23-0.75; p = 0.0002) and higher intraoperative blood loss (standardized mean difference, 0.25; 95% CI, 0.01-0.5; p = 0.04) compared with primary resections, but perioperative morbidity is comparable (risk ratio, 1.26; 95% CI, 0.98-1.62; p = 0.08). Completion surgery is associated with higher rates of incomplete mesorectal specimens (risk ratio, 3.06; 95% CI, 1.41-6.62; p = 0.005) and lower lymph node yields (standardized mean difference, -0.26; 95% CI, -0.47 to 0.06; p = 0.01). Comparative analysis on long-term outcomes is limited, but no evidence of inferior recurrence or survival rates is found. LIMITATIONS: Only small retrospective cohort and case-control studies are published on this topic, with considerable heterogeneity limiting the effectiveness of meta-analysis. CONCLUSIONS: This review provides the strongest evidence to date that completion surgery is associated with an inferior histopathological grade of the mesorectum and finds insufficient long-term results to satisfy concerns regarding oncological safety. International collaborative research is required to demonstrate noninferiority. REGISTRATION NO: CRD42021245101.


Assuntos
Laparoscopia , Protectomia , Neoplasias Retais , Cirurgia Endoscópica Transanal , Humanos , Laparoscopia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Protectomia/métodos , Neoplasias Retais/patologia , Reto/patologia , Reto/cirurgia , Estudos Retrospectivos , Cirurgia Endoscópica Transanal/métodos , Resultado do Tratamento
20.
Internist (Berl) ; 63(5): 551-555, 2022 May.
Artigo em Alemão | MEDLINE | ID: mdl-35171302

RESUMO

A 61-year-old male patient underwent a colonoscopy for cramp-like upper abdominal pain of 3 weeks duration. An endoscopically irresectable ulcerated mass was seen in the transverse colon. The patient spontaneously excreted in the feces a tumor node measuring 4.1â€¯× 3.5â€¯× 2.8 cm with the histological features of a submucosal lipoma 4 days after the colonoscopy. A benign lipoma confined to the submucosa was operatively confirmed. It is extremely rare for a tumor node to be shed in feces. If the benign nature of the entire lesion is doubtful, standard oncological procedures are advocated.


Assuntos
Neoplasias do Colo , Lipoma , Dor Abdominal , Neoplasias do Colo/diagnóstico , Neoplasias do Colo/cirurgia , Colonoscopia , Humanos , Lipoma/patologia , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Reto/patologia
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