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PubMed2000

[Unusually large stromal tumor of the rectum causing obstruction].

A male, 74 years old patient with perineal, sacral pain and with defecation disorders attended the outpatient clinic of HIETE. The origine of the complains was a retrorectal, fist like, rectum narrowing tumor. The tumor was covered by normal mucosa from rectal side. Preoperative examinations--endoscopy, CT, MRI transrectal US--detected a tumor with size 7 x 6 x 5 cm, growing from the muscular wall of the rectum, with no connection with the surrounding tissues. Deep biopsy revealed malignant mesenchymal tumor. After preoperative irradiation abdominoperineal rectum amputation was performed. The recovery was uneventful. The definitive hystological examination proved a gastrointestinal stromal tumor (GIST). This type of tumor rarely occurs in the large intestine or in the rectum, that why the publishing can be interesting.

Aged↗
PubMed2000

[Reconstruction of anus in low rectum cancer operation].

OBJECTIVE: While low rectum cancer being resected with Mile's operation, the anus was reconstructed in situ simultaneously. METHODS: Thirty cases of artificial anus were perfectly reconstructed in situ with transferring of the gracilis and invaginating of the end of the sigmoid for the outer and inner sphincter of the anus. The artificial rectum valve was used for the rectum angle. RESULTS: The rate of excellent and good operative results reached 90.63%. CONCLUSION: The results show that this method is suitable for radical operation of low rectum cancer and functional incapacitation of the anus from other diseases as well.

Adenocarcinoma, Mucinous↗
PubMed2001

Lymphovascular clearance in laparoscopic surgery of cancer in low rectum.

BACKGROUND: The success of laparoscopic biliary surgery has encouraged application of laparoscopic surgery in colorectal disease. There are some questions regarding laparoscopic colorectal surgery, especially for colorectal cancer. Most important is whether adequate resection of colorectal malignancy can be achieved. A retrospective study was performed to evaluate the pathology of resected specimens following laparoscopic surgery and that following open surgery in cancer of the low rectum. Comparing the number of lymph nodes in specimens, we could then prove whether laparoscopic surgery can provide adequate clearance as well as open surgery and if laparoscopic surgery has no difference in comparison with open surgery. METHODS: The retrospective study was performed to evaluate the pathology of resected specimens following laparoscopic surgery and that following open surgery in cancer of the low rectum. Data regarding patient details and tumor pathology were obtained by case-note review and from Taichung Veterans General Hospital from July, 1998 to April, 1999. There were nine patients with rectal carcinoma in the low rectum who received laparoscopic surgery, 7 male and 2 female. The control group had 8 patients, 7 male and 1 female, with similar tumor location who received similar operation with open method by the same surgical team in the same period. The average age was 67.7 years in the laparoscopic group and 67.4 years in the control group. The characteristics of tumor and the location of tumor were well matched between these two groups. RESULTS: All of the resected specimens in the two groups were free of tumor in margin of clearance. The average number of lymph nodes harvested was 13 in the laparoscopic group and 9.4 in the open group. CONCLUSIONS: Although the case number was not adequate, the clinical implication is obvious. Laparoscopic surgery in cancer of the low rectum allows lymphovascular clearance even better than that is afforded by open surgery.

Adult↗
PubMed1999

[Study of concurrent reconstruction of posterior wall of vagina with pedicled muscular flap of uterus after resection of rectum carcinoma].

OBJECTIVE: To investigate the reconstructional method of posterior wall of vagina after the resection of rectum carcinoma. METHODS: From August 1991 to March 1996, 10 patients with rectum carcinoma were adopted in this study, among them, there were 4 cases belong to B stage of Dukas, and 6 cases belong to C stage of Dukes. In operation, rectum carcinoma and posterior wall of vagina were resected, and concurrent reconstruction was finished by using pedicled muscular flap of uterus. RESULTS: The effect of operation were satisfactory except one case who was failed because of insufficient blood supply of the flap. Followed-up for 3-6 months, the posterior wall of vagina healed in 7 cases, the width of vagina was 2-3 fingers and the depth was 5-6 cm. CONCLUSION: Reconstruction of the posterior wall of vagina with pedicled muscular flap of uterus was available in clinic. For its simplicity and feasibility, it's suitable for the resection of rectum carcinoma in which the posterior wall of vagina was infiltrated.

Adult↗
PubMed1998

[COLON AND RECTUM CANCER SURGERY]

In the last few years, an enormous progress has been achieved in the treatment of Colorectal Cancer due to a better know ledge of the biology, natural history, prevention and treatment of colon and rectum adenocarcinoma. Genetic alterations produce changes in thecolonic mucosa that lead to the formation of adenoma and eventually, its transformation into cancer. At present, it is well established that the Adenomatous Polyp preceeds Colorectal Cancer. The average span of time from normal mucosa to Adenomatous Polyp is about 5 years, and it takes around 5 more years for the Adenomatous Polyp to transform into cancer. The treatment of patients with Colorectal Cancer varies from Endoscopic Polypectomy or formal surgical resection to combined multidisciplinary strategies, according with the stage of the disease. Endoscopic Polypectomy has helped to avoid multiple operations that were performed in the past, it also reduces significantly the development of a second cancer in cured patients who had suffered Colon Cancer. The prognosis of node-negative patients is excellent with a 5 year survival of 80 per cent. Adjuvant chemotherapy has proven to be effective in node-positive Colon Cancer, improving the overall survival. In Rectum Cancer, the use of staplers and changes in the surgical technique have reduced the number of abdominoperineal resections, preserving the annal sphincter and improving the quality of life in patients. Adjuvant chemoradiation control groups and historical controls show a local recurrence of 20-45 per cent in node-positive Rectum Cancer, and 15-30 per cent in node-negative patients. Recently, the improvement of the lateral dissection reduces recurrence in 10 per cent, avoiding pelvic pain, although overall survival has not been improved. Local excision of early lesions from the rectum is an interesting choice in patients who have been carefully selected. We believe that in the following years, the clinical appearance of Colorectal Cancer can be prevented with a better knowledge of its molecular biology.

Journal Article↗
PubMed2005

[Laboratory-immunology indicators according as prognostic factors of patients with colon and rectum cancer].

INTRODUCTION: The occurrence of colon and rectum cancers has risen gradually in the past twenty years. In order to make a precise forecast about a patient's life expectancy and/or treatment, the factors of prognosis and outlook are used in oncology. These can be classified as clinical-surgical, pathological-histological and laboratory-immunology. PURPOSE OF THE WORK: To establish the significance of the laboratory-immunology indicators, carcino-embryonic antigen (CEA), proliferate nuclear antigen (PCNA) as well as Ki67 and p53 in the survival rate of patients who have colon or rectum cancer. PATIENTS AND METHODS: In "Sveti Vracevi" Hospital in Bijeljina 33 patients suffering from cancer of the left half of the colon and rectum received treatment from 1st January 2000 to 1st January 2003. They all had immunohistochemical analysis of CEA, PCNA, Ki67 and p53. RESULTS: The patients with positive immunohistochemical CEA, PCNA and p53 values had statistically shorter life expectancy in comparison with the patients with negative CEA, PCNA and p53 values. There was not statistically significant difference in the survival rate of patients with positive immunohistochemical Ki67 values in relation to the patients with the negative values. CONCLUSION: Immunohistochemical analysis is not used in the routine analysis of colon and rectum cancers. Establishing them gives enough information on the patient's survival rate.

Biomarkers, Tumor↗
PubMed1990

Risks associated with source of fiber and fiber components in cancer of the colon and rectum.

In this case-control study, we examined the food sources of fiber and fiber solubility to determine whether particular components of dietary fiber were differentially associated with risk of colon and rectal cancer. In Western New York, cases with pathologically confirmed, single, primary cancers of the colon and rectum as well as age-, sex- and neighborhood-matched controls were interviewed from 1975-1986. The sample included 428 colon case-control pairs (223 females, 205 males) and 422 rectal case-control pairs (145 females, 277 males). Subjects were interviewed regarding usual quantity and frequency of consumption of foods. For the colon, risk decreased with intake of grain fiber for both females and males and with intake of fruit/vegetable fiber for males only. Insoluble grain fiber was more strongly associated with risk than soluble grain fiber. For the rectum, fruit/vegetable fiber was associated with decreased risk, whereas grain fiber was not. There was no difference in risk for soluble and insoluble fiber components for the rectum. Analysis of risk associated with fiber by food source and by components of the fiber may provide insight into possible mechanisms of a fiber effect on cancer of the colon and rectum.

Colonic Neoplasms↗
PubMed1990

Synchronous carcinoma of the colon and rectum.

Reports on the incidence of synchronous carcinoma of the colon and rectum have varied from 2 to 11 per cent. The variability is a result of a lack of uniformity in criteria of diagnosis, differences in the population studied and differences in time period used. In this study, we evaluated the incidence and distribution of synchronous lesions during a recent time period before the use of colonoscopy became widespread. We reviewed the records of all patients with newly diagnosed adenocarcinoma of the colon and rectum who were operated upon at our institution between 1976 and 1981. In a total group of 1,000 patients of which 52 per cent were men, there were 54 patients or 5.4 per cent who had synchronous carcinomas. The group of patients with synchronous carcinomas were older than the group with nonsynchronous carcinomas (72.4 versus 68.8 years). There was also a higher incidence of associated benign polyps in the group with synchronous carcinomas (70 versus 30 per cent for a nonsynchronous carcinomas). The anatomic distribution of carcinomas of the colon and rectum in the group with synchronous lesions (111 in total) revealed a higher percentage of carcinomas located on the right side (29.7 versus 22.5 per cent), although the difference did not reach statistical significance. Synchronous carcinomas were located in nonadjacent segments of the colon in 37 per cent. There was no difference in stage between the groups with and without synchronous carcinomas. The preoperative identification of synchronous lesions by either colonoscopy or barium enema is important for the proper treatment of patients with carcinoma of the colon and rectum. Failure to locate these tumors may lead to the demise of the patient.

Adenocarcinoma↗
PubMed1990

[Immunohistochemical studies on Lewis blood group antigens in carcinomas and adenomas of the sigmoid colon and rectum].

The presence of Lewis blood group antigens (Lewis(a), Lewis(b)) was determined immunohistochemically in 75 carcinomas and 58 adenomas of the sigmoid colon and rectum. 1. The rate of positive Lewis(b) staining of adult normal mucosa was 100% in the ascending colon, 100% in the transverse colon, 25% in the sigmoid colon and 30% in the rectum, respectively. The incidence of Lewis(b) was high in the proximal colon but low in the sigmoid colon and rectum. 2. The rate of positive Lewis(b) staining was 97% in cancer, 57% in adenoma and 26% in normal mucosa, respectively. The difference between the incidence of positive Lewis(b) staining in normal mucosa, and those in cancer and adenoma was significant (p less than 0.01). 3. The rate of positive Lewis(b) staining was 42% in mild and moderate dysplastic adenoma and 68% in severe dysplastic adenoma. There was a significant difference between the percentage of Lewis(b) staining in mild or moderate dysplastic adenoma and that of severe dysplastic adenoma (p less than 0.05). The expression of Lewis(b) antigen correlated with the size of adenoma. These results suggest that Lewis(b) antigen has a cancer-associated nature and Lewis(b) staining might be useful as an indicator of malignant potential of adenoma of the sigmoid colon and rectum.

Adenocarcinoma↗
PubMed1988

Electrocoagulation of selected carcinoma of the rectum.

Abdominoperineal resection for the treatment of carcinoma of the rectum has been the benchmark for all other forms of therapy since Miles described the procedure in 1908. During the past 25 years, 81 patients have had carcinoma of the rectum treated curatively by electrocoagulation and have been observed for five years or more. Treatment was selectively applied to those patients whose tumors were less than 7.5 centimeters from the anal verge with less than 50 per cent of the rectum involved. All of the tumors were freely movable. The over-all five year survival rate was 47 per cent. Thirty-one of the 81 patients underwent conversion to abdominoperineal resection because of recurrence. The survival rate for those treated by electrocoagulation alone was 58 per cent and for those converted to abdominoperineal resection, 29 per cent. The survival rate was 65 per cent for those with lesions less than 4 centimeters in diameter versus 30 per cent for those with lesions more than 4 centimeters. The morbidity rate was 21.0 per cent and the mortality rate was 2.7 per cent. There were an additional 33 patients treated for palliation with only one five year survivor. Electrocoagulation for the treatment of carcinoma of the distal part of the rectum is a reasonable alterative to abdominoperineal resection when selectively applied.

Adenocarcinoma↗
PubMed1989

[Colon and rectum neoplasms in Chile: epidemiological characteristics].

A rising incidence and mortality rate from cancer of the colon and rectum has been observed in some Chilean regions. An estimated 1.350 hospital admissions and 650 deaths occurred in the last decade. Cumulative risk for developing these lesions is estimated at 0.75% under 60 and 1.52% under 75 years of age. Mean age at presentation was 65 years for colon cancer and 63 for cancer of the rectum. Both sexes were equally affected. Valid survival studies are not available in Chilean literature. The relation of number of deaths and admissions per year was 78.5% for colon cancer and 28.9% for the rectum. From 1965 to 1985 an 83% increase in the prevalence of rectum cancer and 7% for colon cancer was observed. This trend was most marked in the Magallanes region. A family history appears as a significant risk factor (1.4 to 49.1 odds ratio). Borderline significance as risk factors was observed for obesity and meat and relish consumption. No effect of smoking, alcohol intake, history of lithiasis or exposure to asbestus or ionizing radiation was observed.

Adolescent↗
PubMed1989

[Neoplasms of the rectum. A presentation of 588 cases and review of the literature].

We reviewed cancers of the rectum and rectosigmoid operated from 1970 to 1980 in the General Surgery Service of the Hospital La Fe of Valencia (Spain). Of a total of 588 patients, only 370 were resectable (62.9%), which reflects the advanced stage of the disease when these patients are seen. Of the 370 resections, 210 corresponded to lower rectum, 97 to middle rectum and 63 to upper rectum and rectosigmoid. In 80%, abdominoperineal amputation was practiced and in 20%, anterior resection; this was due to the predominance of lower tumors and the fact that at this time mechanical sutures were not in use, since these permit anterior resections that cannot be performed with normal sutures. The 5-year survival was 197 patients, 53.2%. Postoperative mortality affected 4.2%. We found complications and morbidity in 17.1%. The mean hospital stay was 18 days. In no case of anterior resection was discharge colostomy performed.

Adolescent↗
PubMed1989

Internal intussusception of the rectum: a changing perspective.

Internal intussusception of the rectum is the funnel-shaped infolding of the rectum during straining to defecate. Patients present with multiple symptoms; most commonly rectal pressure and pain in association with constipation and straining. Defecography (videofluoroscopy during defecation) is the method of choice for diagnosing this problem. Rectal mobility from the sacrum, infolding of the rectum and sphincter relaxation can be used to grade the findings on defecography (Grade I-IV). The optimal therapy for internal intussusception of the rectum is unknown because the cause of the problem is unknown. Conservative management is recommended in all but the most severely symptomatic patients.

Defecation↗
PubMed1978

Diet in the epidemiology of cancer of the colon and rectum.

We examined the diets as reported in interviews of 256 white male patients with cancer of the colon and of 330 white male patients with cancer of the rectum. Controls were 783 patients with nonneoplastic, nondigestive system diseases distributed by age similarly to the colon cancer patients and 628 patients with nonneoplastic, nondigestive diseases distributed by age like those with cancer of the rectum. We found no increase in risk for cancer of the colon or rectum regardless of the amounts of beef or other meats ingested. However, we found an increase in risk of colon cancer with decreases in the frequency with which vegetables were eaten. A study of 214 females with cancer of the colon and 182 females with cancer of the rectum yielded similar results. The decrease in risk we found associated with frequent ingestion of vegetables, and especially cabbage, Brussels sprouts, and broccoli, is consistent with the decreased numbers of tumors observed in animals challenged with carcinogens and fed compounds found in these same vegetables.

Animals↗
PubMed1986

[A case report of hepatic metastasis from leiomyosarcoma of the rectum with right hepatic lobectomy].

A case of hepatic metastasis from leiomyosarcoma of the rectum submitted to right hepatic lobectomy is presented. Surgery for hepatic metastasis from intestinal leiomyosarcoma is rarely possible. The patient was a 67-year-old woman who was diagnosed as leiomyosarcoma of the rectum and underwent abdominoperineal excision of the rectum in fifteen months. Hepatic metastasis was detected by US, CT and angiography. Right hepatic lobectomy was performed, and the resected hepatic lesions were histologically identified as metastasis from leiomyosarcoma of the rectum. The patient is still alive 10 months after the second operation with no lesions of the liver.

Aged↗
PubMed1985

[A case of leiomyosarcoma of the rectum with widespread lymph node metastases].

A case of leiomyosarcoma of is reported. A 78-year-old man was admitted with a history of constipation and deformation of the stools. Barium contrast study and sigmoidoscopy showed a submucosal tumor of the rectum. On computed tomography and angiography, the tumor was suspected of being leiomyosarcoma. Abdominoperineal resection was performed. Microscopic examination revealed a leiomyosarcoma of the rectum and widespread lymph node metastases were found. Leiomyosarcoma of the rectum is an uncommon tumor. In our country, 89 cases have been reported. Six had lymph node metastases initially and another six subsequently. We have referred to the literature on leiomyosarcoma of the rectum.

Aged↗
PubMed1982

Long term results of restorative resection and total excision for carcinoma of the middle third of the rectum.

Restorative resection for carcinoma of the middle third of the rectum has been facilitated by the recent introduction of the staplers. Before restorative resection with end-to-end anastomosis can become the treatment of choice, it must be proved that survival prospects after restorative resection are similar to those obtained after total abdominoperineal excision. The results of curative restorative resection and total excision in 417 patients with a single carcinoma of the middle third of the rectum managed by one of us are examined. Between 1950 and 1980, the proportion of patients treated by restorative resection for carcinoma of the middle third of the rectum increased from 26 to 93 per cent. Distribution by sex, age, tumor stage and tumor differentiation did not differ significantly between the two groups of patients operated upon. Cancer specific survival did not differ significantly between patients treated by restorative resection or total excision. Ten year survival rates were 60 and 59 per cent, respectively. Survival related to tumor stage and differentiation was not influenced by the type of operation. Tumor size, greater--p less than 0.04--in patients managed by total excision, had no significant influence on survival prospects. The results justify sphincter preservation and suggest that increased usage of restorative resection by stapling technique is not likely to lessen survival prospects in patients with carcinoma of the middle third of the rectum.

Adenocarcinoma↗
PubMed1981

Analysis of recurrence patterns following curative resection for carcinoma of the colon and rectum.

The records of 525 patients with adenocarcinoma of the colon and rectum were reviewed. Two hundred and eighty-five patients were evaluable following complete curative resections. These patients were evaluated for patterns of recurrence. The over-all recurrence rate was 78 of 285, 27 per cent. The over-all recurrence rate by site was 24.0, 10.0, 11.5 and 35.0 per cent for the right, transverse and left colon, the sigmoid and the rectum, respectively. The over-all failure rate by stage was 13 per cent for Stage A, 11 per cent for Stage B1, 32 per cent for Stage C1, 37 per cent for Stage B2-3 and 56 per cent for Stage C2-3. The over-all failure rate as related to Stages A, B1, C1, B2-3 and C2-3 and to site of primary disease was: right--zero, 9, 33, 28 and 43 per cent, sigmoid--11, 15, 40, 52 and 62 per cent; rectal group--29, 14, 40, 46 and 60 per cent as related to respective stages. There was one failure among the five patients with Stage B2-3 disease in the transverse group and two failures among the nine patients with Stage B2-3 and one failure in the one patient with Stage C2-3 within the left colon group. Individual types of failure were compiled. Lesions involving the rectum and sigmoid colon had a significant local-regional component to relapse. Tumors of the right, transverse and the left colon had a significant distant recurrence rate. Factors of primary site, age at diagnosis, extent of disease and histology were reviewed as to the over-all recurrence and specific failure sites. From this analysis, a schema involving patterns of failure as related to primary site and stage within the colon, rectum and sigmoid were developed.

Adenocarcinoma↗