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PubMed1994

[Comparative analysis of sutures and stapling for colorectal anastomosis in resection of the rectum in carcinoma].

In Clinic for general and vascular surgery - Military Medical Academy Belgrade since 1987 to 1993 in treatment of the rectal cancer it was done 326 low anterior resections. In 149 patients anastomosis was done with sutures and in 177 with stapler. Half of them were more then 60 years old, and in 40% of patients carcinoma was staged as Dukes C or D. In group I tumor was localised in the middle or distal third of rectum in 24.8% of patients while in group II this was in 75.7%. Anastomosis related complications where rare in stapler group, clinically evident anastomotic dehiscence was found in 11.4% patients in I group and in 99% in II group. Total mortality was 3.1%; 3.4% in the I group and 2.8% in the II group. In our comparative analysis of early complications after low anterior resection of rectum when colorectal anastomosis was done with suture or stapler technic we have found that stapler technic give opportunity for creating much more low colorectal anastomoses which are safe and with less complications and with the same oncologic control of disease.

Adult↗
PubMed1996

[Options in the surgical treatment of diffuse cavernous hemangioma of the rectum].

Cavernous haemangioma of the rectum is an unusual hamartomatous malformation. Patients usually present with painless massive rectal bleeding that generally begins at an early age and frequently surgery is necessary. To avoid abdominoperineal resection of the rectum in these patients, a procedure of colo-anal sleeve anastomosis, that includes a large rectal mucosectomy, has been described. However, in our opinion, if affectation of other pelvic organs can been excluded by MRI, it is easier to do a conservative proctectomy with colo-anal anastomosis. We present a case in a seventeen years old patient.

Adolescent↗
PubMed1996

[A continent urinary diversion with a detubularized rectum and sigmoid (sigmo-rectal pouch)].

BACKGROUND: The continent reservoir is an ideal urinary diversion in patients after cystectomy. The artificial closing mechanism construction in these reservoirs is rather complicated and the results are uncertain. The objective of the present work is to assess own experience with a relatively simple rectosigmoid reservoir created by a method described by M. Fisch. METHODS AND RESULTS: Since 1992 till 1995 the sigma-rectum detubularized reservoir was performed in 30 patients. The intricating bladder cancer was an indication for the operation in 27 patients and the other bladder diseases in 3 patients. The patients age ranged from 18 to 75 years. Diurnal continence was achieved in all 30 patients. 12 of them have to awake during the night to evacuate the reservoir 1 to 3 times. CONCLUSIONS: Sigma-rectum pouch is a good form of cintinent diversion in such patient, which are not suitable for orthoscopic neobladder because of oncologic limitation or bad general conditions. The patients tolerate the procedure very well, heal and adapt quickly to new evacuating mechanisms.

Adolescent↗
PubMed1997

Comparison between the colonic J pouch-anal anastomosis and healthy rectum: clinical and physiological function.

BACKGROUND: Colonic pouch anastomosis after restorative rectal excision obviates much of the early dysfunction which is commonly experienced with the traditional straight coloanal anastomosis. A disadvantage with colonic pouch reconstruction, however, appears to be impaired evacuation. METHODS: Distal bowel function was investigated in 30 patients with a colonic J pouch anastomosis at 1 year after surgery and in 39 control subjects. RESULTS: While the degree of urgency and incontinence were similar, the patients with a pouch experienced more difficult evacuation. The maximum volume of the pouch (median 235 ml) and rectum (221 ml) was similar, but the rectum was more compliant (3.5 versus 2.6 ml per cmH2O, P < 0.01). The sensory function in terms of initial sensation of filling, urge to defaecate and maximum distension pressure was impaired in those with pouches. The amplitude of the neorectal and anal canal motility pattern was threefold that of controls. Maximum volume of the pouch was significantly associated with degree of impaired evacuation; the larger the volume the more difficult the evacuation. CONCLUSION: To reduce evacuation difficulty the pouch should not be fashioned too large. No conclusion about optimal pouch size could be drawn. In spite of fundamental physiological differences between a pouch and healthy anorectum, patients with a colonic pouch will usually experience satisfactory clinical bowel function.

Aged↗
PubMed1976

[Surgical treatment of villous tumors of the rectum].

Out of 36 villous tumours observed in 31 patients, 50 p. 100 were sessile and 1/3rd were degenerated, their degeneration was much more frequent in the case of sessile villous tumours. There were 5 biopsy errors. Out of 23 villous tumours, class A, 11 underwent local removal with two relapses, 7 recto-sigmoidal resections and 3 amputations of the rectum and 2 Hartmann operations. Out of 12 villous tumours classified as B and C, 5 underwent local removal, 4 resections, 3 palliative amputations. In all, there were 5 relapses. Tumours class C are severe and have the same prognosis as carcinoma of the rectum. Certain benign villous tumours are very difficult to remove locally owing to their broad base and their volume, which may necessitate mutilation. The present therapeutic attitude of the authors is due to the severity of relapses which may be seen late and possible biopsy errors. Broad removal is recommended for benign villous tumours which are broadly implanted and very voluminous. If the villous tumour is above the pouch of Douglas, resection is preferable to local removal. On the other hand, local removal is justified for benign villous tumours placed above the pouch of Douglas, which may be pediculated or sessile with a narrow base and with normal neighbouring mucosa.

Adult↗
PubMedDate not supplied

[New methods of rectum and colon x-ray study in patients with constipation].

Rectal and colonic X-ray findings of 100 patients with constipation are presented. The study was performed by the authors' modified irrigoscopic procedure using barium enema. This made it possible not only to determine the shape, dimensions, and position of the rectum and colon, but to reveal a number of anatomic and functional changes in the rectum and pelvic floor (rectocele, rectal intussusception and prolapse, perineal descent, sigmoidocele), which was helpful in choosing a treatment policy for patients with colonic evacuatory dysfunction.

Adolescent↗
PubMed1998

[The functional results of abdomino-anal resection of the rectum with the formation of a reservoir from the large intestine].

Under study were clinical and functional results of 27 patients aged 36 to 68 years with adenocarcinoma (pT2-T3) of the ampullar part of the rectum who were submitted to abdomino-anal resection with the formation of J-shaped colonic reservoir. In the nearest postoperative period partial incompetence of the coloanal anastomosis, necrosis of the reservoir wall and its inflammation appeared in 4 patients. In 6 months after closure of the protective transversostomy full continence was noted in 24 patients. In 3 patients only there was a periodic incontinence of liquid stools and flatus. The formation of J-shaped colonic reservoir in patients requiring the formation of low colorectal or coloanal anastomoses gives considerably better functional results of total resection of the rectum.

Adenocarcinoma↗
PubMed1976

[Ureteral lesions after abdomino-perineal resection of the rectum].

Three ureter lesions in abdominoperineal rectum amputations are described. The surgical literature on this subject is discussed. Particularly dangerous points in the procedure of abdominoperineal rectum amputation concerning injuries of the ureter are accentuated. Possibilities of avoiding and recognizing early ureter injuries are indicated. More attention should be given to intraoperative lesions of the ureter.

Abdomen↗
PubMed1976

Preservation of the superior hemorrhoidal artery in resection of the colon and rectum.

As an alternative to anterior resection of the rectum requiring ligature of the inferior mesenteric artery at its origin, it is proposed to carry out this procedure preserving the inferior mesenteric artery and freeing it as far as the origin of the superior hemorrhoidal artery and its division into rectal branches to improve the blood supply to the rectal stump. The results of this new procedure were compared with those of anterior resection. Post-operatively, the blood supply of the rectum was studied by means of angiography. The results of 84 anterior resections for neoplastic disease of the colon were studied. In 56 patients, the inferior mesenteric artery was preserved and in 28 the inferior mesenteric artery was ligated. Postoperative complications due to leakage of the colorectal anastomosis rarely occurred in the first group and were frequent in the latter. In patients in whom the inferior mesenteric artery was preserved, arteriograms showed that vascularization of the preserved rectal stump is supplied essentially by the branches of the superior hemorrhoidal artery.

Angiography↗
PubMed1998

[Sphincter-preserving operations in the treatment of carcinoma of the middle and lower third of the rectum].

The prerequisites for sphincter-salvaging interventions in the operative management of carcinoma of the middle and lower third of rectum are analyzed. Reference is made to 96 scientific publications of the issue, with due consideration given to the anatomical and physiological prerequisites for coloanal anastomoses. Updated knowledge of intramural diffusion of the neoplastic process in distal direction promotes the performing of ablastic surgical intervention with resection line 2 cm beneath the tumor. The practical implications of total mesorectal excision for reducing local recurrences are underscored. Analysis of the summed up literature data warrant the assumption that in the event of differentiated carcinoma of the rectum, located 1.5-2 cm above linea dentata, sphincter-salvaging operation should be undertaken with a priority given to direct manual coloanal, transanal anastomosis. This type of surgical interventions are attractive on account of the likelihood to preserve the anal sphincter complex--a fact having an essential practical bearing on the lifestyle of patients. Eventual local relapses lend themselves readily to diagnosis and treatment by abdominoperineal extirpation. Thus the latter may be deferred in time, and in most patients it may prove unnecessary altogether.

Anal Canal↗
PubMed1977

Treatment of carcinoma of the sigmoid colon and upper rectum. A comparison of local segmental resection and left hemicolectomy.

We report a retrospective study of 107 cases of carcinoma of the sigmoid colon and upper rectum treated for primary cure at the University of California at Los Angeles Hospital between 1955 and 1970. Excluded from this analysis were patients treated by abdominoperineal resection, local excision, fulguration, or abdominoperineal pull-through procedures. Ninety-one patients were treated by local segmental resection and 16 by left hemicolectomy. Both groups were similar in regard to patient age and general health, lesion size, location, and pathological Duke's classification. Five-year survival was 70.3% after local segmental resection and 56.3% after left hemicolectomy. Hospital mortality was 1% after the former and 6.2% after the latter. Rate of recurrence after local segmental resection was 41% of that seen after left hemicolectomy, while complications were one-third as great. The present results after local segmental resection are comparable to the results reported in the literature when hemicolectomy was the procedure used. The data presented suggest that local segmental resection is an effective cancer operation for carcinoma of the sigmoid and upper rectum, and is fraught with a lesser morbidity and mortality than a radical left hemicolectomy.

Adult↗
PubMed2000

Prognostic significance of mucinous carcinoma of colon and rectum: a prospective case-control study.

BACKGROUND AND OBJECTIVES: The clinical meaning of mucinous type of colonic and rectal carcinoma is still controversial. We used clinicopathological and follow-up data prospectively recorded for our series of colon and rectum cancer to compare 2 matched groups of mucinous and nonmucinous cancer patients. METHODS: Two-hundred-forty-eight patients operated for colon and rectum cancer between January 1986 and January 1997 were considered. Thirty-six patients showed mucinous pattern on histologic examination but only 29 (11.7%) had more than 50% of mucin-secreting acini and could be classified as mucinous type. The 29 mucinous cancer patients were compared with 212 nonmucinous cancer patients to evaluate differences in epidemiological and clinical features. A control group from the nonmucinous patients was sorted by matching for age, sex, location, and Dukes stage. RESULTS: In the case-control groups, survival was better for nonmucinous than for mucinous tumours. Many of the epidemiological findings already observed for mucinous carcinoma were also confirmed. CONCLUSIONS: The existence of prognostic, clinical, and epidemiological differences between mucinous and nonmucinous colorectal carcinoma, together with the preliminary reports about their difference as to genetic features, could support the hypothesis that mucinous type is a distinct biological entity.

Adenocarcinoma, Mucinous↗
PubMed1996

Manual dissection of adenocarcinoma of the lower third of the rectum specimens for detection of lymph node metastases smaller than 5 mm.

BACKGROUND: The question of whether manual dissection when searching for metastatic lymph nodes from rectal cancer (less than 5 mm) is a reliable method remains controversial. METHODS: We examined 50 consecutive cases of primary adenocarcinoma of the rectum treated with a sphincter-sparing total rectum resection, total mesorectum excision, and coloanal anastomosis. We used a manual method for the detection of lymph nodes. RESULTS: One thousand seven hundred ninety-three lymph nodes were found (mean, 36 per patient). One hundred seventy-four contained metastases. Seventy-nine (45.4%) of the affected lymph nodes were less than 5 mm in greatest dimension. The percentage of metastases to small lymph nodes was similar to the percentage reported by Kotanagi (50%), but lower than the report of Herrera (78%), who used a clearing technique to search for regional lymph nodes. CONCLUSIONS: A median 17 months follow-up in these patients demonstrated that metastases in small lymph nodes are important in the accurate staging of rectal tumors and that a manual method of searching for small lymph nodes is reliable.

Adenocarcinoma↗
PubMed1997

Coffee and tea intake and risk of cancers of the colon and rectum: a study of 3,530 cases and 7,057 controls.

The relationship between coffee, decaffeinated coffee and tea intake and risk of cancers of the colon and rectum was considered combining data from 2 case-control studies, one conducted between 1985 and 1991 in Northern Italy and the other between 1991 and 1996 in 6 Italian centers. Cases were patients below age 80, with histologically confirmed cancer of the colon (n = 2,166) or rectum (n = 1,364), and controls were 7,057 patients admitted to hospital for a wide spectrum of acute, non-neoplastic, non-digestive tract diseases. Compared with coffee non-drinkers, the risk of colon cancer was reduced in drinkers of 4 or more cups/day [multivariate odds ratios (ORs) 0.73; 95% confidence intervals 0.60-0.89), with a significant trend in risk with dose; no significant association emerged between coffee drinking and risk of rectal cancer (OR 1.00 for drinkers of 4 or more cups/day). Decaffeinated coffee was consumed in small amounts by about 4% of cases and controls and the OR was 0.92 for colon and 0.88 for rectal cancers. Tea consumption was generally limited to 1 cup/day or to occasional intake and did not substantially modify the risk of colon and rectal cancers. No significant heterogeneity was found for the inverse relationship between coffee intake and colon cancer risk across strata of age at diagnosis, sex, smoking status, total alcohol and meat and vegetable intake, while the protection of coffee was stronger in people eating 3 or more meals/day. Thus, our results confirm that coffee intake has a quantifiable protective effect on colon cancer risk.

Adult↗
PubMed1979

Staging of cancer of the colon and cancer of the rectum.

A retrospective analysis of 1,826 cases (924 colon, 902 rectal) from ten institutions provided the basis of this study on the staging of cancer of the colon and rectum. The general rules of the American Joint Committee on the relationship between times and the staging of cancer have been followed. These represent modifications of the originally formulated TNM system of the Union Internationale Contre Le Cancer (UICC) which has been designed as a clinical-diagnostic classification, not applicable to cancer of inaccessible sites or structures requiring postsurgical treatment pathologic assessment of therapeutically removed specimens. Inadequacies of the clinical data requested for our study required adoption of the pTNM evaluation method of classification. Multiple regression analysis of the data demonstrated a relationship between survival and the following: depth of penetration (T), status of regional lymph nodes (N), and presence or absence of distant metastasis (M). This was similar for both sites. Basically, for the rectum it was in consonance with the original Dukes' classification (A, B, and C), and was remarkably applicable to the colon. The survival data for the two sites were so similar as to suggest the use of one set of pTNM categories not only for the postsurgical-treatment pathologic evaluation, but also for the stage grouping definitions. Strongly recommended for cancer of all sites is the development of General Oncology Data Forms to be included in the clinical charts and records of all patients with cancer.

Adult↗
PubMed1979

Pathogenesis of colonic polyps in multiple juvenile polyposis: report of a case associated with gastric polyps and carcinoma of the rectum.

The pathogenesis of juvenile polyps of the colon was studied in a patient with multiple juvenile polyposis who underwent proctocolectomy for rectal carcinoma and antrectomy for associated polyps of the stomach. Numerous polyps up to 3 cm in diameter were present predominantly in the cecum and rectum, and in addition there was an adenocarcinoma in the rectum. Microscopically there were five categories of lesions: 1) Hyperplastic epithelial foci and small hyperplastic polyps; 2) Typical Juvenile polyps; 3) Juvenile polyps with focal adenomatous epithelium; 4) Adenomas; and 5) and adenocarcinoma. The five categories could represent a pathogenetic sequence, beginning with epithelial hyperplasia, leading to small hyperplastic polyps which become inflamed and enlarge, forming juvenile polyps. Focal adenomatous areas which develop in some juvenile polyps might give rise to adenomas and in turn lead to carcinoma. Although juvenile polyps are generally not considered to be premalignant lesions, this case demonstrates that neoplastic changes may occur in juvenile polyps in certain individuals, and raises the possibility that these may on occasion give rise to carcinoma.

Adenocarcinoma↗
PubMed1988

DNA distribution pattern of the so-called severe dysplasias and small carcinomas of the colon and rectum and its possible significance in the tumor progression.

The DNA distribution pattern was determined by cytofluorometry in 25 cases of colorectal small carcinoma and the so-called severe dysplasia. The colorectal carcinoma and "severe dysplasia" consisted of four principal stemlines as to DNA ploidy: diploidy, aneuploidy, and their respective polyploidies. These patterns appeared in various combinations in individual neoplasms. DNA distribution of the severe dysplasia was diploid-predominant (11 cases) or aneuploid-predominant (three cases), usually showing mosaicism in various degrees with respective first order polyploidy. Similar DNA distribution patterns also were found in submucosally invasive small carcinomas. The neoplastic cell populations of a higher polyploidy (second or third order), however, occurred only in the submucosally invasive carcinomas (three cases) regardless of their basic ploidy. The mitotic index tended to be higher in the aneuploid-predominant tumors than in the diploid-predominant tumors. In the current observation, there was no significant correlation between the DNA distribution pattern and histologic type of the "dysplasia" or carcinoma. We found that most of the so-called severe dysplasias of the colon and rectum already gained definitive characteristic of carcinoma in the DNA pattern, i.e., ploidy heterogeneity. Therefore, they can be identified as intramucosal carcinomas, distinct from the normal epithelia and adenomas of the colon and rectum.

Aneuploidy↗
PubMed1989

An assessment of the mucous component in carcinoma of the colon and rectum.

It has been said that the prognosis of mucinous carcinoma of the colon and rectum is unfavorable. To determine the clinicopathologic significance of carcinomatous lesions with marked mucous production, the ratio of the area where there was significant mucous production (mucous component [MC]) to the area of the whole tumor on a tissue slice (area ratio) was determine by measurement with a digitizer in 281 patients with carcinoma of the colon and rectum. The MC was observed in the largest cross-section of the tumor in 85 patients (30.2%). Of these 85 patients the MC area ratio was less than 10% in 42. In the 43 patients with an area ratio of 10% or more, no particular relationship was observed between the area ratio and the frequency of cases. If no MC was observed in the largest cross section of the tumor, the MC ratio in other regions of the tumor was almost 0. In the patients in whom the MC area ratio in the largest cross-section was less than 10%, the MC area ratios in other sites of the tumor showed only a small variance, but in the patients with an MC area ratio of 10% or more, a large variance was observed according to the site. The prognosis for patients with an area ratio of 10% or more was less favorable than that for patients with no MC and with an MC area ratio of less than 10% (P less than 0.05). These results suggest that it is reasonable to handle the patients with an MC area ratio of 10% or more as a group.

Adenocarcinoma↗