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PubMed1981

Ovarian involvement in adenocarcinoma of the colon and rectum.

Thirty-six of 998 female patients with carcinoma of the colon and rectum had ovarian involvement at the time of the initial operation. Resection of tumor of the colon and rectum was performed upon 882 patients. The ovarian tumors were removed in 30 of the 36 patients with ovarian involvement. Ovarian involvement was associated with a significantly worsened, p = 0.009, cancer specific five year survival rate; five year survival prospects for patients with, and without, ovarian involvement were 38 and 60 per cent, respectively. Ovarian involvement also significantly, p = 0.014, worsened the survival rate of the 25 patients treated by curative resection of the tumor of the colon and rectum and associated ovarian spread. The five year cancer specific survival rate for female patients without ovarian involvement was 72 per cent, whereas ovarian involvement reduced the survival rate to 50 per cent.

Adenocarcinoma↗
PubMed1981

Symptom duration and survival prospects in carcinoma of the rectum.

Between 1950 and 1978, 1,228 patients were operated upon by one of us for carcinoma of the rectum. Symptom duration data were available for 1,081 patients. Forty-five per cent of the patients had symptoms preoperatively for less than three months, 22 per cent for three to six months, 15 per cent for six to 12 months and 18 per cent for 12 months or longer. The frequency of major symptoms did not differ significantly with increasing symptom duration. Symptom duration was not related to sex, age, tumor site within the rectum or tumor stage distribution. The proportion of curative to palliative operative procedures performed was unrelated to the duration of symptoms. The cancer specific survival rate was better for the total patient series and for those treated by curative resection if symptoms had been present for 12 months or longer compared with those of less than three months' duration, p = 0.001 and p = 0.01, respectively. Survival prospects were also better for patients with symptoms of less than six months' duration compared with those of six months or longer, p = 0.01 and p = 0.04, respectively. These results indicate that earlier diagnosis during the symptomatic period of carcinoma of the rectum cannot be expected to improve cancer specific survival rates. They direct attention to the importance of preclinical diagnosis.

Adult↗
PubMed1980

[The therapy of the rectum-carcinoma of the aged (author's transl)].

Elder people are most treated on cancer of the rectum. Therapeutic chances could be used better. Unfortunately there is a delay between first symptoms and beginning of therapy, in 50% of the debit of the doctors. Simple examinations like digital inquiry could be done by each physician. In 40% of carcinoma of rectum there are regional lymphonodoli; they make the chance of healing sinking. Radical surgery is the best therapy, but often not possible. Above 10-12 cm a resection with end-to-end anastomosis should be done. Single distant metastases are no reason to prevent operation. Palliative transabdominal extirpation of the tumor should be attempted in most of the cases. Anus praeter should be least form of palliative therapy in surgery of rectum-cancer. Local recidives are particular property of colorectal Carcinoma, they make difficulties in many cases.

Age Factors↗
PubMed1981

Trends in the United States for the management of adenocarcinoma of the rectum.

Data from surveys conducted by the Commission on Cancer of the American College of Surgeons were examined to identify recent trends in the treatment of carcinoma of the rectum. Between 1973 and 1978, the stage of disease at diagnosis for the total series changed little, but significant upgrading in the stage of disease at diagnosis for the black patients was observed. There was increasing use of a multimodality approach to treatment combining operation with radiotherapy. The use of chemotherapy alone or in combination with other therapies, while never widely used, declined during the interval observed. Significant changes occurred in the type of operations performed for carcinoma in the upper two-thirds of the rectum. During this interval, abdominoperineal resection was increasingly being displaced by low anterior resection. The trend toward multimodality treatment and the use of effective sphincter preserving procedures represent significant changes noted in this survey in the therapy of carcinoma of the rectum.

Adenocarcinoma↗
PubMed1980

Villous adenomas of the rectum: the accuracy of clinical assessment.

To avoid an unnecessary radical operation, it is important for surgeons to identify a clinically benign villous tumor of the rectum, especially in the middle third area, where a transanal approach may not be feasible. If the high accuracy of this clinical impression can be achieved, alternative methods such as piecemeal snare excision, or electrocoagulation, or both are justified. To evaluate the diagnostic accuracy of a benign rectal villous tumor, 151 patients with totally excised rectal tumors were reviewed. All of these patients had soft and nonulcerated lesions and were judged to be benign. Induration and ulceration of the lesions signified malignancy and were excluded. One hundred and fourteen patients (76%) had benign villous adenomas, 23 patients (15%) had superficial carcinomas, and 14 patients (9%) had invasive carcinomas. Hence the accuracy of detecting a clinically benign villous tumor of the rectum was 91%. This is high enough to avoid a more radical procedure when the clinical impression is that of a benign villous tumor of the rectum.

Adenoma↗
PubMed1980

Leiomyosarcoma of the rectum: a case report.

A case of leiomyosarcoma of the rectum is reported. Repeated biopsies of the tumour had failed to reveal evidence of malignancy. Only after radical excision of the rectum had been performed and the entire tumour had been submitted to histological examination was the clinical impression of malignancy confirmed. The difficulties in the histological differentiation of simple from malignant smooth-muscle tumours of the rectum are discussed. The clinical features on which a diagnosis of malignancy can be made are described.

Humans↗
PubMed1981

Detection of carcinoma of the colon and rectum by air contrast enema.

In a retrospective review of 55 patients with carcinoma of the colon and rectum, air contrast enema detected 91 per cent of the Dukes' A and B lesions and 96 per cent of the Dukes' C and D lesions. This roentgenographic method is an effective diagnostic tool for use at all colorectal levels, including the rectum. Results suggest that the initial work-up of patients suspected o harboring early carcinoma of the colon and rectum can be done by air contrast enema and rigid proctosigmoidoscopic examination with reasonable detection accuracy. Controlled studies comparing these methods with routine flexible endoscopic examination are needed.

Air↗
PubMed1995

Survival impact of lymph node metastasis in TNM stage III carcinoma of the colon and rectum.

BACKGROUND: Node-positive (TNM stage III) adenocarcinoma of the colon and rectum consists of tumors with a widely variable prognosis. To predict the outcome of patients with stage III carcinoma, we assessed the survival impact of the number and level of lymph node metastasis and other clinicopathological variables. STUDY DESIGN: A retrospective study was performed on 538 patients with stage III carcinoma of the colon and rectum who underwent curative resection at Chang Gung Memorial Hospital between 1980 and 1989. Ten or more lymph nodes in each resected specimen were identified microscopically. Multivariate analysis was used to determine the independent variables. RESULTS: The relative survival rates at five and ten years were 52 and 42 percent, respectively. Tumor morphology, depth or tumor penetration, histologic grade, and the status (number and level) of nodal involvement were significant in the univariate analyses. Only grade and nodal status remained significant in the multivariate analysis. Based on the nodal status, these patients were separated into three groups: stage IIIA (one to three positive nodes and absence of pN3 metastasis), IIIB (four to nine nodes and absence of pN3), and IIIC (ten or more nodes or presence of pN3). The five-year survival rates for patients with stages IIIA, IIIB, and IIIC disease were 69, 44, and 29 percent, respectively. Compared with patients with stage IIIA disease, the odds of death for patients with stages IIIB and IIIC carcinoma were 2.1 (95 percent confidence interval: 1.5 to 2.8, p = 0.0001) and 3.3 (95 percent confidence interval 2.4 to 4.5, p = 0.001), respectively. CONCLUSIONS: We suggest that stage III adenocarcinoma of the colon and rectum be divided into three substages: IIIA (one to three positive nodes and absence of pN3 metastasis), IIIB (four to nine nodes and absence of pN3), and IIIC (ten or more positive nodes or presence of pN3.

Adenocarcinoma↗
PubMedDate not supplied

[Leiomyoma of the rectum].

Most of the 150 leiomyomas of the rectum reported since 1872 were no larger than 5 cm. The authors report 3 new observations of leiomyomas of the rectum measuring more than 5 cm. The diagnosis of leiomyoma is difficult. The physical examination and rectoscopy suggest a submucal tumour of the rectum and endoendoscopy helps, describe the relations with the urogenital tract and the sphincters. Due to the lack of distinctive pathology features of malignancy, a leiomyosarcoma cannot be totally eliminated. The prognosis is uncertain due to the rate of relapse and the short follow-up (less than one year) in the previously reported cases. A slow spontaneous clinical course is however possible. The treatment goal is complete surgical removal. While local exeresis is indicated in tumours less than 5 cm in size, echo-guided endorectal protectomy with or without amputation of the sphincter should be discussed for larger tumours.

Aged↗
PubMed1994

[Proctectomy and colo-anal anastomosis after high-dose irradiation of cancers of the lower third of the rectum. Functional and oncological results].

This prospective study was designed to evaluate morbidity and functional and oncological outcomes in patients with carcinoma of the distal third of the rectum treated by high-dose radiation therapy followed by conservative surgery. Twenty-two patients with adenocarcinoma of the distal third of the rectum treated after June 1990 were included in the study. Mean distances separating the tumor from the upper edge of the levator ani muscle and from the anal verge were 17 mm and 47 mm, respectively. None of the tumors were fixed; preoperative stage, established by endoscopic ultrasound, was T2 in 12 patients and T3 in 10. Patients received induction radiation therapy in two series delivered three weeks apart (40 Gy on the pelvis, then 20 Gy on the tumor only) followed by surgical resection (proctectomy with colo-anal anastomosis in 17 cases and amputation in five). After radiation, two tumors were negative for malignant cells, 12 were Astler-Coller B1, two were B2, and six were C2. Mean safety margin after colo-anal anastomosis was 16.8 mm; all the resection margins were negative. Mortality and morbidity were not increased by the high-dose radiation protocol. Conservation of the sphincter was possible in 80% of patients. All the patients were continent. Functional outcome was rated good in 77% of cases, fair in 9% and poor in 4%. During the mean follow-up of 24 months, there were three disease-related deaths, including one due to a strictly regional recurrence; metastatic dissemination to the lungs occurred in two patients and the remaining 17 patients (80%) were disease-free. These data suggest that high-dose radiation therapy followed by conservative surgery ensures satisfactory functional outcomes in patients with carcinomas of the distal rectum. Evaluation of oncological outcomes will require a longer follow-up.

Adenocarcinoma↗
PubMed1994

Solitary plasmacytoma of the rectum: report of a case treated by endoscopic polypectomy and radiotherapy.

Solitary extramedullary plasmacytoma (EMP) of the rectum is an exceedingly rare entity. We report the fourth case of solitary EMP of the rectum and the first one treated by endoscopic polypectomy and radiotherapy. The patient showed no signs of local recurrence or dissemination of the disease after a 12-month follow-up. This case report is presented along with a review of the literature dealing with solitary plasmacytomas of the rectum.

Aged↗
PubMed1994

[Linear electronic intrarectal ultrasonography and cancer of the rectum. Results in 45 patients].

The aim of this study was to evaluate the preoperative staging of rectal carcinoma by intrarectal ultrasonography using linear probe or curved array transducer. Between October 1991 and July 1993, preoperative staging with endoscopic ultrasound was performed in 45 patients with rectal carcinoma. Twenty-four received preoperative radiation therapy. For carcinoma of the middle and the lower part of rectum, the distance between the inferior pole of the tumour and the levator ani muscle was systematically measured. The ultrasound results were compared with histological and surgical findings. The staging was accurately predicted in 82.2% of cases. The depth of cancer invasion was correct in 93.3% (95.2% when preoperative radiation therapy was not applied and 79.1% after radiation therapy). Presence or absence of lymph nodes metastasis was correctly determined in 84.4% (90.5% when preoperative radiation therapy was not applied and 79.1% after radiation therapy). The distance between the inferior pole of the tumour and the levator ani muscle was correctly determined in 29/31 carcinoma of the middle and the lower part of rectum. While the linear and sectorial technique is more difficult when the tumour was circular, the staging of the lower part of rectum carcinoma and anal canal was easier.

Adenocarcinoma↗
PubMed1993

Colonic pouch after low anterior resection of the distal third of the rectum.

Very low anterior resection with construction of colo-anal anastomosis for carcinoma of the distal third of the rectum may result in an increased bowel frequency and urgency. These latter problems have been correlated directly with the decreased capacity and compliance of the neo-rectum. Clinical trials have shown a significant advantage of the colonic pouch-anal anastomosis over conventional colo-anal anastomosis in decreasing post-operative bowel frequency and urgency as the former increases neo-rectal capacity. Recent innovations in pouch design and construction with the ingenious use of mechanical stapling devices will enable the widespread use of the colonic pouch to benefit more patients who require very low anterior resection for carcinoma of the distal third of the rectum.

Colectomy↗
PubMed1977

Ths significance of metastases to the adrenal glands in adenocarcinoma of the colon and rectum.

A study to determine the frequency of metastases to the adrenal glands following carcinoma of the colon and rectum was undertaken. Patients with, or without, adrenal spread were compared regarding age, sex, race and survival time. The over-all metastatic pattern was analyzed to determine its usefulness for predicting the presence of metastases to the adrenal glands. Autopsy reports and clinical records of patients with adrenal spread were reviewed regarding the extent of tumor involvement in the glands and possible adrenal insufficiency. Of 457 patients with adenocarcinoma of the colon and rectum who underwent autopsy, 63 or 14% had metastasis to the adrenal glands. Of these, 29 had bilateral involvement. Patients with bilateral metastases had a lower median age than did those without adrenal spread. No correlation was found between adrenal metastatic status and sex or race. Although survival time was found to be shorter for patients with bilateral metastases of the adrenal glands, adrenal insufficiency did not seem to be the reason for this shorter survival time. In retrospect, however, the presence of adrenal insufficiency could not be ruled out in several of these patients. Eight sites were studied with regard to whether or not metastatic involvement in a specific site might indicate a higher risk for simultaneous metastases to the adrenal glands. It was found for all sites that, when involved, there was a higher frequency of metastases to the adrenals than if free of tumor. Metastases especially above the diaphragm indicated a considerable risk for adrenal involvement. Different sites were combined in groups and studied in the same way. It was found that the more sites involved, the higher the relative chance of metastases to the adrenals. It was suggested that the results presented may be useful in predicting the relative chance of adrenal metastases in patients with advanced carcinoma of the colon and rectum.

Adenocarcinoma↗
PubMed1996

Endoscopic Nd:YAG laser therapy for villous adenomas of the colon and rectum.

We reviewed 34 villous tumors of the colon and rectum treated endoscopically with neodymium:YAG laser therapy from 1983 to the present. Twenty-three tumors were benign, and 11 contained carcinoma in situ. Invasive carcinomas were excluded. Treatment locations included cecum (6), descending colon (1), sigmoid colon (2), and rectum (25). Fourteen males and 20 females with a mean age of 70 years (31-93) completed an average of 3.3 total treatments per patient under no sedation (9), intravenous demerol (24), or general anesthesia (1). Treated tumors ranged between 2-12 cm in greatest dimension, and one fourth were 50 to 100 per cent circumferential. Four patients presented with recurrent tumors subsequent to transanal excisions, done elsewhere. Five patients suffered complications of mild stricture (2), self-limited bleeding (2), and one pinhole colovaginal fistula. There was one incomplete treatment and one recurrence in the cecum that was carcinoma in situ at resection. There were no missed cancers during follow up that ranged from 1-120 months (average 32 months). The average total cost for the entire treatment per patient was $3627. Endoscopic neodymium:YAG laser therapy of villous tumors of the colon and rectum is a safe and effective outpatient procedure. The complication rate is lower than most reported series of operatively treated patients, and sphincter dysfunction, incontinence, or fecal fistula is avoided. With close follow up and repeated biopsy, invasive carcinoma can be ruled out. We believe this is the procedure of choice for management of these tumors.

Adenoma, Villous↗
PubMed1996

[Technique and results of laparoscopic rectum resection].

The general principles of oncologic operations for colorectal cancer are the same for both open and laparoscopic surgery. Isolation of the tumor by occlusion of the intestinal lumen, early blockage of venous outflow, complete resection of the lymph node bearing mesenterium, high ligation of the artery and prevention of tumor cell dissemination during extirpation of the specimen are the most important factors. We present our technique for laparoscopic abdominoperineal resection, which fulfills the above mentioned criteria. From June 1993 to October 1994 we operated on 19 patients (median age 68 [47-91] years; male/female ratio 10/9). Laparoscopic abdominoperineal resection of the rectum was palliative in 3 patients and curative in 16. Tumors were located 3 (1-8) cm from the anal verge. In 3 patients the operation was converted to open surgery. Intraoperative complications were encountered in 3 patients. Median operation time was 300 (200-400) minutes and postoperative morbidity 8/19 (42%) leading to reoperation in one patient. 30-day mortality was nil. Three patients died 5, 8, and 14 months postoperatively due to metastatic disease (all 3 after initial palliation). One patient had local recurrence and liver metastasis and died 14 months after operation. Another patient died from liver metastases. In one patient a single liver metastasis was successfully removed. 14 patients were tumor-free after a median follow-up of 10 (3-14) months. There was no implantation metastasis on a trocar site. Laparoscopic abdominoperineal resection of the rectum is feasible and the results are comparable with those of open surgery. Local recurrence rate and incidence of liver metastases are comparable with open surgery after this short follow-up. However, 5-year survival is needed to judge the oncological radicality of laparoscopic abdominoperineal resection of the rectum.

Adenocarcinoma↗
PubMedDate not supplied

Case report of primary squamous carcinoma of the rectum.

PURPOSE: To report a patient with primary squamous carcinoma of the rectum. CASE REPORT: A 40-year-old woman with hematochezia and change in bowel habits was studied. The main laboratory finding was a mild anemia. A barium enema and a proctoscopy revealed a rectal neoplasm at eight cm from the anal verge. A transendoscopic biopsy demonstrated an squamous rectal carcinoma. A transrectal ultrasound and CT scan of the abdomen revealed a big rectal mass with transmural affection and possible involvement of the lymph nodes. The carcinoembriogenic antigen (CEA) was high (32 ng/mL). The patient underwent radiotherapy with 46 Gy, and 5-fluorouracil as radiosensitizer. Three months later, a new CT scan showed significant reduction of the size of the mass, and the patient underwent a very low anterior resection with double-stapled anastomosis. The analysis of the specimen showed a squamous carcinoma of the mid-rectum, invading through the wall without lymph node affection and with proximal, distal, and radial margins free of tumor. The CEA returned to normal after surgery (1.3 ng/mL). The patients is alive and without evidence of disease 18 months after the operation. CONCLUSION: Primary squamous carcinoma of the rectum is a rare disease, and surgery seems to be a good option of treatment, with the possibility of sphincter preservation depending upon the location of the tumor.

Adult↗
PubMed1997

Management of the pelvic space with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum: a prospective multicenter study. The French Association for Surgical Research.

OBJECTIVE: To compare perineal healing with or without omentoplasty after abdominoperineal resection for carcinoma of the rectum. DESIGN: Prospective multicentre study. SETTING: 15 centres (three university, nine non-university teaching hospitals and three private clinics), France. SUBJECTS: 186 consecutive patients (between January 1983 and August 1990): 21 were withdrawn because of protocol violation leaving 165 for analysis. INTERVENTIONS: Abdominoperineal resection for adenocarcinoma of the distal third of the rectum followed by omentoplasty (n = 64) to the pelvic space or not (n = 101). MAIN OUTCOME MEASURES: Number of healed perineums at one month, and the time interval to complete healing. RESULTS: 7 patients (4%) died, 4 of whom had had omentoplasty and 3 who had not (one perineal abscess). The number who developed immediate postoperative complications (11/64, 17% and 18/101, 18%) and median duration of hospital stay (21 days, range 8-191, and 22 days, range 8-132) were similar. The median time to complete healing (20 and 21 days), the rate of healed perineums at one month (42/62 and 67/99, both 68%) and the number of persisting sinuses at 12 months were also similar. The number of dehiscences of the perineum was significantly higher (p = 0.04) in the no omentoplasty group (16 compared with 3). There were 3 late deaths in the omentoplasty group and 7 in the no omentoplasty group, 1 and 5 with local recurrence, respectively. There were more recurrences in the no omentoplasty group but not significantly so. CONCLUSIONS: Although this study was not randomised, the results suggest that omentoplasty to the pelvic space promotes perineal healing after abdominoperineal resection for carcinoma of the rectum by significantly reducing the need for secondary opening.

Adenocarcinoma↗