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PubMed1984

Abdominoperineal resection of the rectum for carcinoma at Groote Schuur Hospital, Cape Town, 1971-1982.

Abdominoperineal excision of the rectum remains the accepted treatment for the majority of lower rectal adenocarcinomas. Despite advances in surgery and anaesthesia, survival has not improved over the last 40 years. Over a 12-year period the overall 5-year survival rate for patients undergoing abdominoperineal excision for adenocarcinoma of the rectum at Groote Schuur Hospital, Cape Town, was 39%. The incidence of complications associated with the operation remains high (36%). The major causes of morbidity still originate in the urinary tract and the perineal wound. Further techniques which may improve the overall survival are briefly reviewed.

Adenocarcinoma↗
PubMed1984

[Anatomy and topography of the lymphatic vessels and regional lymph nodes of the rectum in newborn infants and children to 3 years of age].

In 30 corpses of newborns and children up to 3 years of age, by means of the intratissue and direct injection of the modified Gerota's mass, certain increase in number and size of the superficial inguinal lymph vessels belonging to the superior-medial group, as well as the pararectal and superior rectal lymph nodes has been noted. The diameter of both afferent and efferent lymphatic vessels in the nodes mentioned in children of 1-3 years of age is greater than in the newborns. The number of the afferent vessels running towards these nodes in most cases, regardless the age, prevail over the efferent ones, and the diameter of the latter is greater than in the afferent vessels. The pararectal lymph nodes in 80% of cases are the nodes of the first step for the lymph flowing from the rectum, in 15% - the nodes of the first and second steps, simultaneously, and in 5% - of the third and fourth steps. The superior pararectal lymph nodes in 80% of cases are the nodes of the third and fourth steps, and in 20% of cases - those of the first and second steps for the lymph flowing from the rectum.

Aging↗
PubMed1983

Management of foreign bodies and trauma of the rectum.

A series of 101 patients with trauma of the rectum, secondary to homosexual practices, presenting at this hospital and medical center is reviewed. Two patients were injured twice. Thirty-six patients had retained foreign bodies in the rectum, 55 had lacerations of the mucosa, two had disruptions of the anal sphincter and ten had perforations of the rectosigmoid. The majority of retained foreign bodies can be removed on an outpatient basis. If removal is not immediately possible, the patient should be admitted for observation and removal of the foreign body transanally under anesthesia. Routine sigmoidoscopic examination is performed after removal. Removal seldom requires laparotomy. Simple nonbleeding lacerations of the mucosa can be managed on an outpatient basis. Patients with abdominal pain, fever, continued bleeding, large lacerations or tear of the sphincter should be admitted and observed or operated upon, or both, as needed. Serious injuries, secondary to homosexual acts, can and do occur, as evidenced by the mortality reported in this series. Perforations of the rectosigmoid above the peritoneal reflection can be treated by laparotomy, repair of the perforation, removal of gross contamination by irrigation, proximal loop colostomy and appropriate antibiotic therapy. Perforations below the peritoneal reflection are challenging instances which require individualized management.

Adolescent↗
PubMed1983

[Posterior approach to the rectum. Technic, indications, complications. Apropos of 41 cases].

Certain lesions in the middle part of the rectal ampulla can only be approached with safety through the posterior surface of the rectum after resection of the coccyx and the last part of the sacrum. This approach was employed in 41 patients, with conservation of the sphincter in all cases. Operation was performed 39 times for excision of a large villous tumor, in 1 case for a polycystic lesion, and in 1 case for a localized epithelioma. Extensive tumors in 3 cases required rectal resection with end-to-end anastomosis, employing a circular mechanical suturing apparatus in 1 patient. Two patients died of causes unrelated to the operation, and 5 developed a fistula, three of these cases needing proximal colostomies. Delayed healing of the perineal wound was noted in 5 other patients, residual perineal pain being reported by 2 patients. The posterior approach to the rectum is an exceptional technique, mainly indicated when wide excision of a histologically doubtful tumor cannot be approached from above or below.

Adult↗
PubMed1978

[Measurement of the radiation load to bladder and rectum in gynecological brachytherapy with a mobile radiation source (author's transl)].

Measurement of the maximal radiation dose in bladder and rectum in intravaginal radiation therapy using a mobile source (afterloading technique) is only possible integrating with a multichannel dosimeter. For this purpose we apply a 5 mm plastic probe being equipped with five semiconductor dosimeter crystals; the latter are fixed within the probe at equidistances of 2 cm from each other. The dose maximum can be obtained by graphic interpolation using the five different values measured. The dosimeter employed is read immediately and permits observation of the doses delivered to the bladder and rectum during radiation therapy.

Female↗
PubMed1980

[Follow-up computer tomography in patients with carcinoma of the rectum (author's transl)].

Conventional X-ray examination, ultrasonography, and skeletal scintigraphy are insufficient diagnostic procedures in the follow-up of many cases after surgery of rectum carcinoma, since they do not allow early diagnosis of local relapses. A report is given, which shows, that in these cases computer tomography may help in diagnosis. Recurrent tumors of 1.5-2 cm diameter may be diagnosed by computer tomography with sufficient reliability; at the same time peritumorous tissue can be looked at and infiltrative growth as well as regional lymph node enlargement may be diagnosed. This will help the surgeon to decide about a second surgical intervention, or it may help the radiologist in localizing and estimating the volume of tumor relapse, which can be of value for X-ray therapy. Thus computer tomography does have its place without doubt in the follow-up of patients after resection of the rectum.

Carcinoma↗
PubMedDate not supplied

[Duplication of the anus and rectum in an adult. Report of 1 case].

It is reported a case of duplication of the anus and rectum. A 48 year old man, had two functioning rectae, one ending in its normal anatomical topography and the functioning but nor functional supernumerary rectum exteriorized in the left gluteal region trough a rudimentary anus. Histological studys demonstrated a rudimentary sphincter in the ectopic anus, and focal carcinamotous transformation of one of the four adenomatous polyps, encountered protruding through the normally located anus. The anal anomaly was associated with partial agenesis of the sacrum, absence of coccyx, sacral anterior meningomyelocele and hypoplasia of the twelve right rib. The frequency of the anomaly, its histology and embriology, as well as its classification within the malformations of the terminal gut, were revised in the medical bibliography. It is concluded that this type of anomaly has not been classified or describe, before.

Abnormalities, Multiple↗
PubMed1981

[Safe aboral distance in the sphincter-preserving resection of the rectum].

The correlation between the aboral margin of clearance and the end results after anterior and deep anterior resection of the rectum were analyzed for 293 patients documentated in the Erlangen clinical-pathological registry of colorectal cancers. The distance between the aboral margin of the carcinoma and the resection line was measured under standardized conditions. The best prognosis (age-corrected 5-year survival rate and frequency of local recurrence) is given if the margin of clearance is more than 30 mm on resected fresh specimen without tension. This distance corresponds with 50 mm on the mobilized rectum in situ. This rule applied to carcinomas of Dukes' stage A and/or grade 1 as well as to more advanced tumors or tumors with a higher grade of malignancy.

Carcinoid Tumor↗
PubMedDate not supplied

Colloid carcinoma of rectum in a 11 year old child.

The rarity of rectal carcinoma in children has prompted us to report this patient who presented with bleeding per rectum and constipation. Histopathological examination of biopsy revealed the growth to be a colloid carcinoma of rectum and it was inoperable on exploratory laparotomy. There are three factors which contribute to an overall poor prognosis of rectal carcinoma in children viz. delay in diagnosis, advanced stage of disease and poorly differentiated histology.

Adenocarcinoma, Mucinous↗
PubMed1995

Total mesorectal excision in the operative treatment of carcinoma of the rectum.

BACKGROUND: Total mesorectal excision (TME) is reported to reduce local recurrence and improve survival rates in patients with carcinoma of the rectum. STUDY DESIGN: Two hundred forty-six consecutive patients with Dukes' B (T3, N0, M0) and C (T(any), N1-2, M0) primary rectal carcinomas underwent operation according to the principle of TME. Kaplan-Meier estimates of survival and pelvic recurrence rates were calculated from a database of patients followed prospectively. RESULTS: The operative mortality rate was 0.8 percent (two of 246). The Kaplan-Meier five-year survival rate for patients with stages B and C was 74.2 percent; for patients with stage T3, N0, M0, 86.7 percent; for patients with stage T(any), N1-2, M0, 64.0 percent; and for patients with substage T3, N1-2, M0, 68.0 percent. Pelvic recurrences were observed in a total of 18 patients (7.3 percent) with or without metastases. In the 246 patients with Dukes' stages B and C, pelvic recurrence rates were 4.0 and 8.1 percent, respectively, in the presence or absence of distant metastases, and 3.0 and 5.8 percent, respectively, in the absence of distant spread. Statistically significant risk factors for pelvic recurrence were N2 disease and perineural invasion. Adjuvant radiation therapy was of no statistical benefit in preventing local recurrences. CONCLUSIONS: Total mesorectal excision cures carcinoma of the rectum and provides excellent local control through resection of the entire unit of regional spread that is excised, intact and with negative circumferential margins. Total mesorectal excision is compatible with autonomic nerve preservation and with sphincter preservation. The current role of combined modality adjuvant therapy, which is standard therapy following conventional surgery, should be reconsidered in patients who have undergone resection in accordance with TME.

Adult↗
PubMed1994

[Prevention of incompetence of sigmoid-rectal anastomosis after frontal resection of rectum in the treatment of cancer].

Planned anterior resection of the rectum for carcinoma was conducted in 111 patients, 38 of them underwent low resection. The formation of relieving transversostomy is suggested as a method for the prevention of early postoperative complications resulting from incompetence of the anastomosis. It was formed in 51.3% of cases. Besides, for preventing incompetence of sigmoidorectal anastomoses, connecting antimicrobial elements with kanmycin, dioxydin, and cephamezin were applied in 27 patients (26.2%). Incompetence of the anastomosis was not encountered in such cases. Complications occurred in the immediate postoperative period in 45 patients (40.5%), 14 of them (12.6%) had incompetence of the anastomosis suture. There were no fatal outcomes. The authors believe relieving transversostomy to be expedient mainly in low resection of the rectum and in patients with partial obstruction of the large intestine.

Aged↗
PubMed1995

[Leiomyosarcoma of the rectum].

The distinction between leiomyoma and high differentiated leiomyosarcoma can be difficult. The most important distinguishing feature is the number of mitoses. Additionally the tightness of the cells, the number of necroses and cell atypias and the size of the tumor are significant. The most common therapy for large and low differentiated leiomyosarcomas of the rectum are the abdomino-perineal resection or the low anterior resection. In high graded tumors of less than 2.5 cm the radicality of the surgical treatment is questioned. Some authors recommend a wide local excision, but in this case a high local recurrence rate has to be expected. This is the reason for a more radical treatment of all leiomyosarcomas of the rectum. Chemotherapy and radiotherapy are generally not effective. The prognosis is poor.

Adult↗
PubMed1993

Laparoscopic abdominoperineal excision of the rectum with high ligation of the inferior mesenteric artery in the management of rectal carcinoma.

Extended lymph node dissection, creation of a safe anastomosis and specimen retrieval pose the greatest problems in laparoscopic colorectal surgery. A safe technique for the performance of extended lymph node dissection with high vessel ligation has been developed on the basis of experimental studies. Abdominoperineal excision of the rectum is ideal for laparoscopic colorectal surgery because this procedure requires no anastomosing, and the specimen is retrieved perianally. From January to August 1992, we performed a laparoscopic excision of the rectum with high ligation of the inferior mesenteric artery in ten patients with low carcinomas. This paper presents clinical and technical data.

Carcinoma↗
PubMed1993

[Use of mechanical suture in anterior resection of the rectum].

Anterior resection of carcinoma of the rectum was carried out in 129 patients. Hand-sutured anastomoses were formed in 73 and stapled anastomoses in 56 patients. There were 7 leaks after sutured anastomoses (9.6%) and 2 leaks after stapled anastomoses (3.57%). No late leaks or strictures were encountered in either group. Stapled anastomoses are advantageous for the following reasons: they are standardized; they can be created at a lower level than those formed by hand sutures, thus avoiding abdominoperineal resection in many patients; the incidence of anastomotic leakage is lower; time is saved. The EEA stapler is recommended for routine use in anastomoses of the rectum.

Aged↗
PubMed1993

Laparoscopic anterior resection of the rectum using a triple stapled intracorporeal anastomosis in the pig.

Laparoscopic anterior resection of the rectum was performed in the porcine model. Colorectal anastomosis was accomplished with a closed triple staple technique using a circular stapler. The anvil and shaft were passed beyond the level of resection and retrieved through the proximal transverse linear cutter staple line. The stapler post was passed through the distal rectal staple line transanally. The resulting stapled anastomosis contained portions of three staple lines. There were no anastomotic leaks or strictures at one month follow-up autopsy. The triple-stapled anastomosis via a laparoscopic approach after an anterior resection of the rectum in a pig is a safe, reliable technique.

Anastomosis, Surgical↗
PubMed1996

Anastomoses involving the colon and rectum: an 8-year experience.

From January 1987 to May 1995, 214 anastomoses involving the rectum or colon were fashioned using single-layer, interrupted serosubmucosal 3/0 braided polyamide. There were six deaths, one clinically evident anastomotic leak, and one wound infection. These results lend further support to the use of a single layer of serosubmucosal sutures for anastomoses involving the colon and rectum.

Adult↗
PubMed1996

Male and female sexual and urinary function after total mesorectal excision with autonomic nerve preservation for carcinoma of the rectum.

BACKGROUND: We performed a study to assess sexual and urinary function after total mesorectal excision with autonomic nerve preservation for primary carcinoma of the rectum. STUDY DESIGN: We studied retrospectively postoperative sexual and urinary function in 136 (78 percent) of 175 eligible patients (82 males and 54 females) who responded to a standardized questionnaire. RESULTS: The ability to engage in intercourse was maintained by 86 percent of the patients younger than 60 years of age, and by 67 percent of patients 60 years and older. Eighty-seven percent of male patients maintained their ability to achieve orgasm. The type of surgery (abdominoperineal resection compared to low anterior resection), and age equal to or greater than 60 years were significantly associated with male sexual dysfunction. Of the female patients, 85 percent were able to experience arousal with vaginal lubrication and 91 percent could achieve orgasm. The majority of patients had few or no complaints related to urinary function. Serious urinary dysfunction such as neurogenic bladder was not encountered. CONCLUSIONS: Autonomic nerve preservation in association with total mesorectal excision reduces the operative morbidity rate and is successful in minimizing sexual and urinary dysfunction in the operative treatment of patients with carcinoma of the rectum.

Adult↗