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PubMed2002

Local recurrence and five year survival after abdominoperineal resection of the rectum due to rectal carcinoma.

In the period 01.01.1991-12.31.1996, 523 operations due to rectal carcinoma were performed on the First Surgical Clinic, the Third Department for Colorectal Surgery. Most common localization of tumor was in the distal third of the rectum 65.2%. In the middle third, there were 28.9% and in the upper, intraperitoneal third 5.9%. We performed 286 low anterior stapled resections, 93 anterior resections with hand-sewn anastomosis and 144 Abdominoperineal excisions of rectum (Miles procedure). Pathohistological examination revealed adenocarcinoma in all cases. In this study we analyzed local recurrence and five-year survival after long-term follow-up in the group where Miles procedure was carried out as a potentially curative procedure (except 4.9% cased with Dukes D stage). There were 74.3% males and 23.7% females median age 59.2 years. According to Dukes classification there were 4.9% in stage A, 47.2% in stage B, 43.1% stage C, and 4.9% stage D. There were 4(2.7%) postoperative deaths. Recurrence of the disease was registered in 44 (30.5%) patients. Local recurrence alone was found in 14 (9.7%) patients, while distant spread was registered in 30 (20.8%) patients. At present, the median follow-up is at 72.9 months. Analysis by the Kaplan-Meier's test shows cumulative survival of 61%, and disease free survival of 63.4% at 60 months of the follow-up. Dukes C is associated with a very poor prognosis; survival after 60 months of follow up shows cumulative Survival of 0.35 while Dukes B has far better prognosis (0.86). Analysis of disease free survival by Dukes stage shows that Dukes C has the worst prognosis (disease free survival 0.36 after 60 months), while stage B has much better prognosis (0.84). Local recurrence analysis by the Kaplan-Meier's test shows disease free survival of 84.9% at 60 months of follow-up. Analysis of local recurrence by Dukes stage shows 1.00% disease free survival for cases in stage A, 0.94 for Dukes B and 0.66 for Dukes C, while overall comparison between groups regarding local recurrence using the Wilcoxon (Gehan) statistic shows statistically significant difference (p-0.005). There is no statistical difference between Dukes A and Dukes B cases in distribution of local recurrence.

Adenocarcinoma↗
PubMed2006

Management of T1 carcinoma of the lower third rectum.

The earliest invasive carcinoma of colon and rectum is an invasion into the submucosa. For the TNM classification, these lesions are T1 Nx Mx. They present as an adenoma with invasive carcinoma, or a frank carcinoma. Local excision for T1 carcinoma of the rectum can be curative if the lesion is accessible for an adequate excision and if the lesion has not spread to the lymph nodes or distant metastasis. The key to success in local excision is selecting the lesions that have low risk of metastasis.

Carcinoma↗
PubMed1988

Lectin expression in neoplastic and non-neoplastic lesions of the rectum.

The expression of six lectins (Arachis hypogaea, B. simplicifolia I, concanavalin A, Dolichus biflorus, Triticum vulgaris, Lotus tetragonolobus) was studied in 24 adenocarcinomas, 24 adenomas, 20 metaplastic polyps, 17 specimens of mucosal prolapse (solitary ulcer syndrome) and 10 of normal mucosa, all taken from the rectum. Qualitative, quantitative and distributive differences in lectin expression were observed between adenocarcinoma and normal mucosa. These cancer-associated glycoprotein alterations were also observed, though to a lesser extent, in benign neoplastic and non-neoplastic lesions of the rectum. It appears therefore that the glycoprotein modifications associated with malignant transformation are not specific indicators of malignancy. It is suggested that the common denominator is a disturbance in the activities of enzymes, particularly the glycosyl-transferases and glycosidases, involved in the biosynthesis of glycoprotein. This disturbance can occur in situations where cells are less differentiated either through developmental immaturity, rapid cellular division or neoplastic de-differentiation. These changes are therefore more likely to reflect the state of differentiation rather than the malignant nature of the cells. It is shown that the greater the deviation of the lesion from normal the greater the glycoprotein alterations. The potential usefulness of lectin expressions as predictive indicators of biological behaviour of adenocarcinomas of the large bowel needs further studies.

Adenocarcinoma↗
PubMed1989

Results of surgery for cancer of the rectum with sphincter conservation. A randomized study on instrumental versus manual anastomosis.

We present results obtained in a group of patients included in a randomized study from 1979 to 1985 for evaluation of mechanical anastomosis after anterior resection for cancer of the rectum; 113 patients were operated on, 58 with manual and 55 with instrumental anastomosis. There was no significant difference in morbidity or mortality between the groups. The incidence of anastomotic fistulas (clinical and subclinical) was similar (12% vs. 15%), although a large number of tumors in the lower third of rectum was treated by manual anastomosis. Concerning late complications, more stenoses, although mainly asymptomatic, were detected after instrumental anastomosis (15% vs. 6%). The incidence of local recurrence within 3 years was quite similar in the 2 groups (about 15%), and usually occurred in patients who already had generalized disease.

Anal Canal↗
PubMed1995

Mansonian schistosomiasis in rectum--report of a case.

Schistosomiasis is a snail-transmitted trematodiasis acquired by immersion in water which contains the cercariae. In Korea, six imported cases of urinary schistosomiasis by Schistosoma haematobium and one case of imported cerebral schistosomiasis by S. mansoni were reported. Herein we report a case of S. mansoni infecting rectum of a 46 year-old Korean male, who had been to Saudi Arabia for two years. On colonoscopy for routine physical check up, a 0.4 cm polyp in the rectum was detected and biopsy was done. Microscopically, rectal mucosa showed several granulomas which were composed of macrophages, lymphocytes, neutrophils and eosinophils. The center of each granuloma showed an ovoid egg often containing miracidium. The eggs measured 130 x 60 microns in average size. They had yellowish-brown transparent shell with the characteristic lateral spine. This is the 8th imported case of schistosomiasis in Korea and the second one infected by S. mansoni.

Animals↗
PubMed1995

Effects of cecal ligation and colostomy on motility of the rectum, ileum, and cecum in turkeys.

Motilities of the rectum, ileum, and ceca were examined in surgically prepared turkeys by using strain gauge transducers implanted on these sites after cecal ligation or colostomy. All birds were provided ad libitum access to feed and water throughout the study. Cecal ligation increased the frequency of small anti-peristaltic contractions in the proximal (P < .01) and distal (P < .05) rectum and the frequency of defecations (P < .05) compared with intact controls. Cecal ligation decreased the frequency of single contractions in the proximal ileum (P < .05) and that of all contractions in the distal ileum (P < .05), and ligation (P < .01) and colostomy (P < .05) increased the frequency of single contractions in the distal site. However, major and minor cecal contractions were not affected by colostomy in the proximal and distal cecum. The results suggest that the effects on contractile activities of the hindgut must be considered when interpreting responses to cecal ligation and colostomy.

Animals↗
PubMed1997

[Trans-sphincteric resection of the rectum].

On the base of long time watching of 16 patients treated by transsphincteric resection of the rectum authors believe that this operation has even nowadays still its justification among operations preserving continention. They have dominant position namely in indications for benign disease, where only a small part of patients require a more extent performance. On the contrary, at rectum carcinoma the operating performance is highly elective.

Digestive System Surgical Procedures↗
PubMed1999

[Excluded rectum during Crohn's diseases: what is the risk of dysplasia?].

OBJECTIVES: An excluded rectum may be at risk of carcinoma in the course of Crohn's disease. Surveillance of patients requires detection of dysplasia. The aim of our study was to determine the frequency of dysplasia from secondary proctectomy specimens in active rectal Crohn's disease. METHODS: Twenty three patients (13 women and 10 men, median age 38 years) were studied. The median duration of rectal exclusion was four years. Detection of dysplasia relied upon histopathology. Immunohistochemistry with MIB-1 (Ki-67) and anti-p53 (clone DO7) antibodies was performed as well. RESULTS: Frequency of dysplasia was 30%. This was low grade dysplasia, focally observed in proctectomy specimens. MIB-1 was positive on 46% of dysplastic cells. There was no expression of p53 protein. CONCLUSIONS: These results must be taken into account for decision of secondary proctectomy, in patients having an excluded rectum for Crohn's disease, when ileorectal anastomosis is not possible. Rectal endoscopic surveillance is advisable with multiple biopsies according to focal distribution of dysplasia.

Adolescent↗
PubMedDate not supplied

Dieulafoy-like lesions of colon and rectum in patients with chronic renal failure on long-term hemodialysis.

Two rare cases with Dieulafoy-like ulcer bleeding of the colon and rectum are reported. The patients have been suffering from chronic renal failure (CRF) on long-term hemodialysis (HD), and they were brought to Saiseikai Yahata General Hospital with anal bleeding. In both patients, colonoscopy was performed, showing arterial bleeding from a protuberant vessel on the mucosa of the rectum in Case 1 and gradual arterial bleeding from the protuberant vessel on the ascending colon in Case 2. For both cases, endoscopic clipping treatment was done for hemostasis and was successful.

Aged↗
PubMed2000

[Transanal resection of rectum with mesorectumectomy].

The possibility of sparing resection of the rectum in cancer is considered. The results of treatment in 27 patients with cancer of rectal lower ampulla (T1-10 patients, T2-12, T3-5) by transanal resection of distal part of the rectum are presented. The technique of operation, which provides the removal of all layers of rectal wall with surrounded tissues, e.g.--mesorectumectomy is described. The indications for this operation are formulated.

Adenocarcinoma↗
PubMed2000

[Method of the anterior resection of the rectum with formation of invagination colorectal anastomosis].

In order to prevent complications associated with incompetent sutures of the anastomosis in performing frontal resection of the rectum the invaginational immersion of the one-row catgut interintestinal anastomosisis was performed into the lumen of the inferioampullar portion of the rectum to a depth of 15-20 mm by means of traction by a plastic ring which was fixed when applying the anastomosis on the side of its lumen to the suture knots. The method was used in 12 patients without complications due to incompetence of the anastomosis sutures.

Anastomosis, Surgical↗
PubMed1975

Extraperitoneal perforation of the rectum during barium enema.

During barium enema, barium pentrated the rectum to the perirectal extraperitoneal tissue in six patients. Four of these died, and the two survivors have permanent colostomies. The incidence of this rare complication may be further reduced if barium enema is postponed after instrumentation of the rectum, the enema can not lifted more than one meter, the balloon not distended too much, the tip of the balloon catheter made very short, and the personnel in the radiological department made aware of the complication. The complication is probably best treated by prompt diverting colostomy, drainage of perirectal tissue, and antibiotics.

Aged↗
PubMed2001

[Injury of the rectum with a porcelain cup].

The authors present the case-history of a 33-year-old man who injured his rectum by a foreign body. He attended treatment only after decubital necrosis of the intestinal wall and development of peritonitis. Extraction of the foreign body from the rectum was performed and treatment of the abdominal cavity, drainage with sigmoideostomy which was submerged in the second stage. The patient is 9 months after the second operation and does not suffer from any disorders as regards defaecation.

Adult↗
PubMed2001

[Carcinoma of the lower half of the rectum].

Authors analyze the group of patients surgically treated for rectal carcinoma during ten-years long period. While the surgical tactic in upper part of the rectum is solved by the resection with straight anastomosis, in carcinomas of lower part of the rectum there is an open question there, to use the deep pelvic anastomosis after radical resection or to perform the rectal extirpation with saving of sphincters and using the coloanal anastomosis. The necessary requirement is complex preoperative examination of the tumor and of pelvic fundus physiology. For application of coloanal anastomosis the rigid indications are determined. Authors used this method in 107 patients of the monitored group. Early and delayed complications of these interventions are analysed, indication for temporary stomy and application of pouchs. In the group of patients with coloanal anastomosis no local recurrence was noted, in the group with deep pelvic anastomosis the locoregional anastomosis was found in 8% of patients.

Anastomosis, Surgical↗
PubMed2001

[Laparoscopic resection of the rectum].

Improving the laparoscopic equipments and the techniques have spreaded the repertoire of the laparoscopic procedures. In the beginning, it was performed the laparoscopic-assisted resection of the rectum, and later was performed the entire laparoscopic procedures on the colon. It had presented a patient, 71 years old man with diagnosis of the adenocarcinoma recti. After preoperately prepare carried out the laparoscopic procedure with T-T anastomosis by EEA stapler. We presented the first case of the laparoscopical performed resection of the rectum with desire to show possibilities and advantages of the laparoscopic surgery in the relation with conventional surgery and with hope that this techniques would be found the application in our land.

Adenocarcinoma↗
PubMedDate not supplied

[Primary lymphoma of the rectum: a case report and review of the literature].

A case of primary malignant lymphoma of the rectum is presented and the literature reviewed. The authors recommend a complete diagnostic evaluation to assess the unifocal nature of the tumour and stage it, as well as in order to exclude systemic disease. Surgical therapy combined with chemo- and radiotherapy is the best choice when the disease is confined to the rectum, with a better prognosis than those cases treated by chemo- and radiotherapy alone. Because of the extreme rarity of the disease it is impossible to find randomised studies and any evaluation of prognosis can only be done on the basis of the small case series reported in the literature.

Aged↗
PubMed2000

Radio-contrast imaging of the rectum prior to colostomy closure for rectal trauma--is routine use still justified?

This retrospective study was undertaken to assess the yield of radio-contrast imaging of the rectum before closure of colostomy following extraperitoneal rectal trauma. Sixty-nine patients (63 males) underwent colostomy closure in 36 months. All radio-contrast studies (colograms) performed before closure of colostomy were normal, and there were no deaths following closure. This study demonstrated that the yield from pre-closure radio-contrast imaging of the rectum after rectal trauma was negligible and did not influence colostomy closure. We conclude that while it may be appealing to suggest abandonment of its routine use, this investigation needs to be further evaluated prospectively with special attention given to injury to associated structures such as bone, bladder and vagina.

Adolescent↗
PubMed2003

[About classification of anterior resections of the rectum].

Results of anterior resections of rectum are analyzed. It is demonstrated that results of treatment and surgical policy depend on level of resection and anastomosis creation. Own classification of anterior resections of rectum are developed. This classification may be used as the base of coherent treatment policy.

Anastomosis, Surgical↗