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PubMed1983

Adjuvant postoperative radiation therapy for Dukes C adenocarcinoma of the rectum.

This study was designed to explore the effects of adjuvant postoperative radiation therapy on the course and survival of patients with Dukes C adenocarcinoma of the rectum. Moderate dose radiotherapy was offered to 64 patients. Twenty-four accepted and were treated, while the remainder refused. With a mean follow-up of 32.3 months, the overall survival rate was 63% (40/64) and the mean disease-free survival rate at the time of this report was 45%. The following variables were analyzed separately: operative procedure, distance of the tumor from the anal verge, tumor size, and transmural, vascular, lymphatic and perineural invasion of tumor. The most significant differences between irradiated and non-irradiated patients were found in the group of patients whose lesions were 6 cm or less from the anal verge. Of the 19 such patients with an average follow-up of 36.4 months, ten patients were irradiated and nine were not irradiated. The irradiated group had a 90% (9/10) survival rate and 70% (7/10) of them were disease free; the non-irradiated group had a 44% (4/9) survival rate and 22% (2/9) of them disease free. It is concluded that patients with adenocarcinoma of the rectum metastatic to lymph nodes, whose lesions' lower border is measured 6 cm or less from the anal verge, benefit significantly from adjuvant postoperative radiotherapy.

Actuarial Analysis↗
PubMed1989

Sphincter-saving procedures for distal carcinoma of the rectum.

Methods of sphincter preservation were developed more than a century ago. Combining these techniques with adequate anterior resection has permitted the resurrection of sphincter-saving procedures that are currently being applied in the therapy of cancer at every level of the rectum. Although Miles' abdominoperineal resection still remains the "gold standard" for the treatment of low rectal neoplasms, restorative resection may now be possible with equivalent oncologic disease control and survival. Further, current trends also suggest that the abdominoperineal resection is being used less frequently in the treatment of most rectal cancers and is being replaced with sphincter-preserving techniques that afford excellent functional results. In this review, the pertinent anorectal anatomy, current issues, and sphincter-saving surgical techniques presently available for the treatment of distal cancers of the rectum are presented.

Anal Canal↗
PubMed1992

Surgical treatment of tumors of the distal rectum with sphincter preservation.

One hundred one patients with villous adenoma or invasive carcinoma of the distal rectum treated with local excision or coloanal anastomosis were studied. Twenty-three (45%) of the 51 patients with villous adenomas had transanal excision, another 23 (45%) had a posterior proctotomy, and five (10%) had a coloanal anastomosis. Only two patients with a villous adenoma developed a recurrence requiring repeat local excision. Fifteen (30%) of the 50 patients with invasive cancer were treated by transanal excision. All had tumors confined to the submucosa or superficial muscularis. Eighteen (85%) of 21 patients having posterior proctotomy also had tumors with similar depth of invasion. Six (43%) of the 14 patients having coloanal anastomosis had Dukes' B tumors, six (43%) were Dukes' C, and another two (14%) underwent palliative resection. The overall actuarial 5-year survival was 77%. Only four patients treated by transanal excision or posterior proctotomy died of metastatic disease. In the coloanal group, two of 12 patients undergoing curative resection died of recurrent cancer, and another has a pelvic recurrence. Villous adenomas of the distal rectum and selected carcinomas may be treated with local excision and coloanal anastomosis with preservation of sphincter function with good results.

Adenocarcinoma↗
PubMed2001

Ex vivo sentinel node mapping in carcinoma of the colon and rectum.

OBJECTIVE: Increasing evidence supports that the sentinel node (SN) is at greatest risk for harboring metastatic disease. This study describes a novel technique to identify the SN in colorectal carcinoma. METHODS: Within 30 minutes of resection, colorectal specimens were injected submucosally with isosulfan blue in four quadrants. Blue lymphatic channels were identified in the mesentery and followed to the blue-stained SN(s), which were then harvested. The specimen was fixed in formalin and subsequently analyzed in the usual fashion. Blue-stained nodes that were negative by hematoxylin and eosin staining were further analyzed by immunohistochemical staining. RESULTS: During a 6-month period, 26 patients with adenocarcinoma of the colon and rectum undergoing routine resection were studied. There were 18 men and 8 women ranging in age from 29 to 86 years (median 66). Blue-stained SNs were identified in 24 of 26 specimens. The mean number of SNs identified per patient was 2.8 +/- 1.6. Seventy-three SNs were identified from a total of 479 lymph nodes harvested. The mean number of nodes identified per patient was 18.4 +/-7. A total of 67 lymph nodes in 12 patients were identified by hematoxylin and eosin staining to have evidence of metastatic disease. Fourteen (20%) of these nodes in six patients were stained blue. However, with immunohistochemical staining, only one blue node did not have evidence of metastatic tumor in a lymphatic basin with tumor present. Four patients (29%) whose lymphatic basins were negative by hematoxylin and eosin staining were upstaged by immunohistochemical staining of the SN. CONCLUSIONS: Ex vivo mapping of the colon and rectum is technically feasible and may provide a useful approach to the ultrastaging of colorectal carcinoma.

Adenocarcinoma↗
PubMed1989

Hemangiosarcoma of the rectum after chronic anorectal ulceration.

A 37-year-old man with a 30-year history of recurrent anorectal ulceration developed a hemangiosarcoma of the rectum. This diagnosis was made based on histology and immunocytochemistry. We believe this is the fifth reported case of hemangiosarcoma of the rectum and is another example of a rare granulation tissue sarcoma.

Adult↗
PubMed1994

Heterotopic gastric mucosa of the rectum with a review of the literature.

Heterotopic gastric mucosa has been identified in all levels of the gastrointestinal tract but is a rare finding in the rectum. We describe a patient with heterotopia found during a routine evaluation of persistent symptoms, possibly due to an irritable bowel syndrome, and provide a complete review of the literature through 1992. Of the 29 reported cases, the most common presentation was painless rectal bleeding, with the heterotopia usually identified on pathologic examination of a rectal polyp. The heterotopic tissue was frequently located in the posterolateral region of the rectum between 5 and 8 cm from the anal verge. The definitive treatment was excision, either by endoscopy or surgery, although H2 may also provide symptom relief. Our patient was treated with H2 with resolution of symptoms.

Adult↗
PubMed1979

Pelvic recurrence of cancer after abdominoperineal resection of the rectum.

Records of 122 patients with carcinoma of the rectum treated by abdominoperineal resection at M. D. Anderson Hospital and Tumor Institute between 1967 and 1972 were reviewed with regard to local pelvic recurrence and survival. Local recurrence rates for men were: stage IB, 14%; II, 23%; and III, 21%; and for women: IB, 6%; II, 15%; and III, 35%. Forty-one percent of the male patients and 54% of female patients had nodal metastasis at the time of their initial operation. The high pelvic recurrence rates in women may lend support to consideration of a posterior exenteration in all female patients with advanced carcinoma of the rectum.

Adenocarcinoma↗
PubMed1994

Egg consumption and cancer of the colon and rectum.

We systematically reviewed 15 previous case-control and cohort studies that examined egg consumption as a risk factor for cancers of the colon and rectum. Nine of the 11 studies of colon cancer reported risk estimates consistent with a positive association; in three of these studies the association was statistically significant. The positive association for egg consumption was generally stronger for females than for males, and for cancer of the proximal, rather than distal colon. Six of eight studies of cancer of the rectum reported risk estimates consistent with a positive association; in two of these studies the association was statistically significant. Notably, in every study that met specific design criteria (defined a priori), risk estimates were consistent with a positive association. Two studies reported seven- to eight-fold increases in risk with high egg consumption. In some studies, positive associations remained after adjustment for intakes of macronutrients or for other food groups. The presence of a variety of bioactive compounds, including cholesterol, lends biological plausibility to a role of egg consumption in the aetiology of colorectal cancer.

Adolescent↗
PubMed1996

Paneth cell-rich flat adenoma of the rectum: report of a case.

A patient having familiar adenomatosis polyposis and an ileo-rectal anastomosis developed a flat mucosal lesion in the rectum. A punch biopsy revealed a villous adenoma with high-grade dysplasia. The subsequent surgical specimen indicated that the flat villous adenoma was rich in Paneth cells. Special stains included lysozyme muramidase (to visualize Paneth cells), MIB1 proliferation monoclonal antibody and single and multilabel immunohistochemistry for Paneth cells. Other methods included transmission electron microscopy and quantification with an image quantifier (Program Optilab 2.1) of lysozyme-stained Paneth cells. The subjective evaluation of hematoxylin-eosin-stained preparations demonstrated that the Paneth cells were mainly located in the lower half of the villi. Sections labeled with a specific stain (lysozyme muramidase) revealed more Paneth cells in the villi and electron microscopy showed even more in lysozyme-negative areas. Obviously some migrating dysplastic Paneth cells had retained their characteristic granules on their way towards the tip of the villi. Quantitative studies indicated that the lysozyme muramidase-positive material accounted for 41% of the adenomatous tissue. MIB1 revealed intense cell proliferation at the base of the adenoma and in the entire slopes of the villi. Despite the wide distribution of Paneth cells in intestinal metaplasia of the stomach, in the normal small intestine and in the large bowel with chronic inflammatory diseases, it is surprising that tumors arising in Paneth cells are extremely rare. The causes of the apparent natural resistance of Paneth cells to tumor development deserve to be investigated. This is the first case of Paneth cell-rich flat adenoma of the rectum in the literature.

Adenoma↗
PubMed2005

Squamous cell carcinoma of the rectum: a case report and review of the literature.

Squamous cell carcinoma of the colon and rectum are extremely rare neoplasms. Many questions regarding their histogenesis and biological behaviour remain unanswered. Surgery is the most effective therapy, and adjuvant chemotherapy and radiotherapy should be considered, especially for node-positive patients. We present a patient with squamous cell carcinoma of the middle rectum who underwent abdominoperineal resection and postoperative adjuvant chemotherapy. The pertinent literature is reviewed.

Aged↗
PubMed1991

Primary malignant lymphoma of the rectum with diagnostic problems. Report of two cases with an analysis of gene rearrangement.

We present two similar cases of rectal B-cell lymphoma with diagnostic problems. Grossly, both tumors appeared as a well demarcated polypoid mass with eroded mucosa. In spite of their histologic resemblance to reactive lymphoid hyperplasia, including the presence of lymph follicles, fibrosis and polyclonal plasma cells, both cases were diagnosed as malignant lymphoma of low-grade malignancy because of the full-thickness involvement of the rectum with diffusely infiltrated small or medium-sized lymphoid cells showing rare mitoses. In one case, clonal proliferation of differentiated B cells was demonstrated by analysis of gene rearrangement. Therapeutic problems related to low-grade malignant lymphoma in the rectum are also discussed.

Adult↗
PubMed1995

Small cell neuroendocrine carcinoma of the rectum.

Poorly differentiated small cell neuroendocrine (NE) carcinoma of the colon and rectum is a rare primary epithelial malignancy at this location. A case of a highly aggressive NE tumor of small cell type, combined with non-invasive well-differentiated papillary adenocarcinoma in villous adenoma is reported. The patient died rapidly with massive and progressive liver metastasis. The tumor cells were argyrophilic and diffusely immunoreactive for neuronspecific enolase and synaptophysin. Ultrastructural analysis disclosed NE-type cored granules in most of the small tumor cells. NE tumors of the colon and rectum are briefly reviewed.

Adenocarcinoma, Papillary↗
PubMed1997

Morphogenesis and development of superficial spreading tumor of the colon and rectum.

The aim of this study was to clarify the morphogenesis and mechanism of a wide intramucosal extension of a superficial spreading (epithelial) tumor (SST; defined as an epithelial tumor with wide intramucosal spreading involving a diameter of 30 mm or more) in the colon and rectum. For this purpose favorable sites, histological components, and histological growth patterns were compared between 95 cases of SST (16 adenomas and 79 carcinomas) and 2356 non-SST cases, which served as controls. The frequency of SST was significantly higher in the cecum and rectum, and lower in the sigmoid colon when compared to the locations of the control. Among the SST cases, 82.3% of superficial spreading carcinoma (SSC) had an adenomatous component and 96.2% had a cytologically low-grade carcinoma (CAL). In intramucosal SSC, the adenomatous and/or CAL component was predominant, and the proportion of high-grade carcinoma (CAH) was significantly smaller in intramucosal SSC in comparison with the control group. In the mucosal spreading area of SST, 78.9% were tubulovillous in histological type and 86.3% showed a replacing growth pattern. These results indicate that an SST initially develops as an adenoma in at least 85.3% of cases and CAL in 14.7% cases at most; spreads superficially in the mucosa by a replacing growth mechanism that forms a tubulovillous and villous structure; and is affected by intestinal peristalsis less than non-SST.

Adenoma↗
PubMed2004

Local recurrence following surgical treatment for carcinoma of the lower rectum.

BACKGROUND: The present paper examines the local recurrence rate following surgical treatment for carcinoma of the lower rectum with principally blunt dissection directed at tumour-specific mesorectal excision (including total mesorectal excision when appropriate). METHODS: During the period April 1987-December 1999, 123 consecutive resections for carcinoma of the middle and distal thirds of the rectum were performed. The patients had low anterior resection, ultra low anterior resection or abdomino-perineal resection. Ninety-six eligible patients underwent curative resection. The mean follow-up period was 66.8 months +/-44.3 (range 3-176 months). Data were available on all patients having been prospectively registered and retrospectively collated and computer coded. RESULTS: The overall rate of local recurrence was 5.2% (four recurrences following ultra low anterior resection and one following abdomino-perineal resection. No local recurrence occurred after low anterior resections.). Local recurrences occurred between 16 and 52 months from the time of resection, and the cumulative risk of developing local recurrence at 5 years for all patients was 7.6%. The overall 5-year cancer specific survival of the 96 patients was 80.8%, and the overall probability of being disease free at 5 years, including both local and distal recurrence, was 71.8%. CONCLUSION: The results of the present series confirm the safety of careful blunt techniques combined with sharp dissection for rectal mobilization along fascial planes resulting in extraction of an oncologic package with tumour-specific mesorectal excision (or total mesorectal excision when appropriate).

Adenocarcinoma↗
PubMed1980

Benign mesenchymal tumours of the colon and rectum: a retrospective study.

Sixteen patients were diagnosed as having a benign mesenchymal tumour of the colon of rectum at the Repatriation General Hospital, Concord, between 19 50 and 1979. There were six lipomas and ten leiomyomas. Lipomas occurred more commonly in the colon, while leiomyomas predominated in the rectum. The symptoms produced by the lipomas included abdominal pain, rectal bleeding and diarrhoea. Leiomyomas were found incidentally at sigmoidoscopy in six patients, while three presented with rectal bleeding and one with constipation. Lipomas were larger than leiomyomas and were associated with more complications. Both tumours, however, produced few physical signs.

Aged↗
PubMed1990

Morbidity, mortality and survival following resection for carcinoma of the rectum at Concord Hospital.

Colorectal cancer is the most common internal malignancy in Australia, and the rectum is the most common site. The morbidity, mortality and survival of 561 consecutive patients with rectal cancer who had a resection at Concord Hospital during the 16-year period 1971-86 were evaluated. More than half of the operations performed were low anterior resections (LAR), with total abdominoperineal excisions (APE) of the rectum comprising another third. There was a 5.1% mortality rate in LAR patients and a 3.1% mortality rate in the APE group. Respiratory complications, urinary tract infections and wound infections were the most common causes of morbidity in both LAR and APE. The median survival for patients treated by LAR and APE standardized for clinicopathological staging was 111.5 and 47.1 months (A), 79.0 and 65.5 months (B), 41.3 and 28.5 (C), and 14.7 and 12.4 (D), respectively.

Adult↗
PubMed1992

Management of the rectum following colectomy for acute colitis.

During a 6 year period, 31 consecutive patients under the care of one surgeon had emergency colectomies for complicated colitis. A selective policy of closing the rectum intraperitoneally to minimize the length of retained diseased bowel and to avoid a mucus fistula was used during the study period. One patient underwent proctocolectomy, 7 subtotal colectomy with mucus fistula and 23 total colectomies with intraperitoneal closure of the rectum. Two patients (8.9%) developed pelvic sepsis. Both had intraperitoneal closure of the rectal stump and were readily managed by drainage into the stump. Subsequent surgery in the 18 patients having rectal excision has been uncomplicated. Intraperitoneal closure of the rectal stump in emergency surgery for complicated colitis can be performed safely in most of these patients.

Acute Disease↗
PubMed1993

Leiomyosarcoma of the rectum and anal canal.

Leiomyosarcoma of the rectum and anal canal is rare and the optimal treatment is not clear. Eight patients with isolated anorectal leiomyosarcoma treated surgically were reviewed. The age ranged from 44 to 76 years (median 63 years) and the follow up ranged from 6 months to 4.5 years (median 2 years). All patients were symptomatic at presentation. All tumours involved the muscularis propria of the low and/or mid-rectum with three tumours also involving the anal sphincters. The tumour size ranged from 1.2 to 10 cm (median 4 cm). Mucosal involvement occurred in only three patients and there was no lymph node involvement. All showed microscopic infiltration at the advancing border, despite macroscopic circumscription. Only one patient was thought to have a tumour sufficiently small (3 cm) and localized on clinical and intrarectal ultrasound examinations (UST2N0) to be suitable for wide local excision. That patient remained tumour-free after 2 years. The remaining patients (88%) were treated by abdomino-perineal resection. The disease free interval in this latter group ranged from 3 months to 4.5 years. All recurrences were detected within 15 months of surgery and the mean interval from detection of recurrence to death was 9 months. Using a histological grading system that included tumour differentiation, mitotic count and amount of necrosis, high grade sarcomas were associated with a worse prognosis. Other factors associated with a poor outcome included large tumour size (> 6-7 cm) and prior incomplete local excision.

Adult↗