Controversies in the Treatment of Colorectal Cancer

Hall, Andrew W.; Moosa, A.; Block, George E.

doi:10.1016/s0039-6109(16)40845-5

Cited by 5 publications

(2 citation statements)

References 30 publications

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“…Înaintea utilizării suturilor mecanice pentru evitarea anusului iliac chirurgii au apelat la diverse tehnici chirurgicale: rezecţia rectosigmoidiană abdominotransanală cu intubare abdominoendoanală (abdominoanal pull-through), rezecţia abdomino-trans-sfincteriană, excizia transsfincteriană, rezecţia abdomino-sacrată, rezecţia trans-sacrată sau trans-coccigiană, anastomoza trans-anală, anastomoza coloanală cu îndepărtarea mucoasei anale; aceste tehnici sunt rar folosite sau chiar abandonate astăzi datorită preferinţei pentru anastomozele mecanice [12][13][14][15].…”

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“…În general, se consideră că SPA apare la pacienţii care au dezvoltat iniţial o DA postoperatorie, însă, în cazul suturilor mecanice, SPA poate apare de novo. Anastomoza colo-cutanată se stenozează progresiv, la 3-6 luni postoperator; acest tip de anastomoză permite introducerea dilatatorului Hegar pentru ca la 12 luni să constatăm stenoza acesteia; în comparaţie cu acestea SPA după sutura mecanică înregistrează o frecvenţă crescută la 3-6 luni postoperator, pentru ca incidenţa lor să scadă pe măsură ce ne îndepărtăm de momentul operator; rezultate similare au fost găsite şi în studiul efectuat de Luna-Perez în 2001 [15,16,19,22].…”

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The Place of Mechanic Sutures in Medium and Low Rectal Cancer

Oprescu¹,

Beuran²,

Nicolau³

et al. 2013

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BACKGROUND: For medium and low rectal cancer the most common surgical procedures are: low anterior resection with mechanical or manual colorectal anastomosis and transanal rectosigmiod resection with abdominoendoanal intubation. METHODS: We have conducted an observational, retrospective single-center study on a number of consecutive patients operated between January 1 st and June 31 st , 2011 for malign pathology of the middle and low rectum in The Clinical Emergency Hospital Bucureşti. We included patients with medium and low rectal cancer who had been previously treated by radiotherapy. We practiced rectal resection with mechanical colorectal anastomosis or abdominoendoanal intubation with anal mucous membrane removal. We assessed a number of parameters in relation to surgical procedure, such as: anastomosis dehiscence (AD), anastomotic stenosis (AS), the number of defecations in 24 hours, nocturnal incontinence, delayed bowel movement, flatulence continence, postoperative complications, local tumour recurrence and mortality. RESULTS: The study comprises 53 patients divided into 2 groups: the 1 st group, included 19 patients treated by rectal resection with abdominoendoanal intubation and anal mucous membrane removal, and the 2 nd group, included 34 patients treated by rectal resection with mechanical colorectal anastomosis. AD was found in 5.26% (1/19) in group 1, respectively 20.5% (7/34) in group nr 2. At 6 months follow-up, one patient from the 1 st group experienced AS (5.26%), as for the 2nd group, AS was present in 5 patients (14.7%); at 12 months after the procedure the number of patients with AS increased to 3 in group 1 (15.78%) and to 6 in group 2 (17.64%) respectively. After 12 months, the nocturnal incontinence evaluated between 11.00 pm and 06.00 am: 3 patients from group 1 had 1 night evacuation daily, in all days of the week; 1 patient from group 2 presented 2 night evacuations on week. After 12 months postoperative: 11 patients, (57.89%) from group 1 had complete continence and also 29 patients (85.29%) from group 2. Patients from group 1: 36.36% (4/11) needed evacuation clysters' and also 10.34% (3/29) for the group 2. In the case of group 1 mortality was 5.26% (1/19) and for group 2 was 8.82% (3/34). CONCLUSIONS: The intestinal transit disorders are quite frequent after colonal anastomosis."Achilles heel" of mechanical anastomosis is represented by postanastomotical stenosis.

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The Place of Mechanic Sutures in Medium and Low Rectal Cancer

Oprescu¹,

Beuran²,

Nicolau³

et al. 2013

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Das Rectumcarcinom

Martinoli¹,

Harder²,

Allgöwer³

et al. 1981

Chirurgische Gastroenterologie

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Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum

Adloff¹,

Arnaud²,

Schloegel³

et al. 1985

Diseases of the Colon &Amp; Rectum

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Pelvic and perineal recurrences of cancer after rectal amputation are frequent, often isolated, and thus directly responsible for a fatal outcome by local decompression accidents or infection. This study explores the patterns of recurrence after "curative" operation for rectal cancers. One hundred thirteen patients who underwent abdominoperineal resection are reviewed: there were 36 local recurrences, i.e., an incidence of 31.8 percent. About 70 percent of these recurrences occurred within two years after surgical treatment. Low level of tumor in the rectum, local spread into perirectal fat or serosa, lymph node involvement, and histologic grade of malignancy were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.

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Controversies in the Treatment of Colorectal Cancer

Cited by 5 publications

References 30 publications

The Place of Mechanic Sutures in Medium and Low Rectal Cancer

The Place of Mechanic Sutures in Medium and Low Rectal Cancer

Das Rectumcarcinom

Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum

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