[Intestinal amebiasis: endoscopic evaluation of tissue destruction and contributing factors].
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Adult↗
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Rectal exploration in rectal cancer. Double contrast enema vs rectoscopy: a comparison of present diagnostic accuracy.
The present role of rectal exploration in rectal cancer is defined. Indications and limitations of endoscopy and radiology in the study of colon relatively to the diagnosis and pre-treatment approach to rectal cancer, are reviewed. The need to establish definite parameters of tumor morphology indispensable to a correct surgical management, to a possible neoadjuvant therapy and to a precise assessment of the response to therapy, is emphasized. Compared results about the lengthwise tumor extent, the circumferential involvement of rectal walls and the distance from the internal anal sphincter, are reported. It is concluded that the two diagnostic examinations are complementary and that both represent excellent methods for the diagnosis and assessment of the extent of the disease.
Barium Sulfate↗
Screening for colon cancer in Germany.
UNLABELLED: Screening for colon cancer by fecal occult blood testing (Hemoccult) was started in Germany in 1977 as part of an annually offered cancer checkup. The results of the six years 1985-1990 are reviewed. Marked differences exist between male and female screenees regarding age and frequency of participation, test positivity and case finding rates. A total of some 1.500 colorectal cancers are traced annually in 4 million screenees. Test positivity and case finding rates depend in a characteristic pattern on the screening interval. A screening-out effect for colon cancer is evident in annually screened participants. Fecal occult blood testing has become part of the basic laboratory programme in the workup of patients in general medical practice. Compared to mass population screening, test positivity and case finding rates are higher, with positive predictive values 11% for cancer and 20% for large adenomatous polyps. CONCLUSIONS: Fecal occult blood testing is effective for screening and case finding of colon cancer. New tests specific for human hemoglobin could further improve this simple, inexpensive and generally available screening.
Age Distribution↗
Local excision of rectal tumours with transanal endoscopic microsurgery.
Transanal Endoscopic Microsurgery (TEM) is a novel technique, first introduced by Buess and coworkers in 1983 for the treatment of large sessile polyps of the rectum. Due to the excellent results the indication was then extended also for the removal of low risk early adenocarcinomas (pT1, G1-G2). TEM allows, by using an operative proctoscope of an outside diameter of only 4 cm., all the conventional surgical manoeuvers within the rectal lumen, up to 20 cm. from the anal verge. The Authors report a consecutive series of 53 patients submitted to TEM over a 37 month period; apart from 7 patients excluded for different reasons, postoperative diagnosis showed 30 adenocarcinomas (65.2%), 15 adenomas (32.6%) and 1 epidermoidal carcinoma (2.2%). The low recurrence rate observed both for adenomas (0%) and pT1 adenocarcinomas (9%) coupled with the optimum vision allowed by the 6-fold magnified stereoscopic view, make this technique the method of choice for selected patients with these kind of pathologies.
Adenoma↗
Improvement of colo-rectal cancer surgery following introduction of endoscopical approach.
In the period 1968-1993, we treated 399 patients for colo-rectal cancer. Up to 1980, preceding large scale use of endoscopy, 217 patients, out of the group of 399, were submitted to surgery; at time of diagnosis all patients had symptoms of advanced colonic tumor (intestinal obstruction; palpable mass; significant rectal bleeding); none of the lesions detected was in Dukes A or B1 groups; 56 patients were in Dukes B2 and stages C1 + C2 + D were detected in 161 cases. In period 1981-1993 we treated 182 patients; in all cases the diagnosis consisted of endoscopical examinations. Out of this group 69 patients underwent endoscopic resection of polyps with focal neoplastic degeneration: 44 did not require surgery according to Haggitt criteria. In the group of 138 patients who underwent surgery, 89 were in Dukes A + B1 + B2 groups and 49 were in Dukes C1 + C2 + D groups. In our experience endoscopy is not essential in the clear cut colonic neoplasms, however it is an invaluable screening test in early stages, in poor symptomatic population, in elderly patients (> 50 y.o.) and in patients with non specific symptoms. We wish to emphasize how endoscopy has improved the results of colonic cancer surgery.
Colonic Polyps↗
Endoscopic polypectomy reduces mortality from colorectal cancer.
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Colonoscopy↗
Review: transanal endoscopic microsurgery (TEM).
Transanal endoscopic microsurgery (TEM) is performed with the use of a complex operative system, which allows the application of all surgical techniques for dissection and suturing inside the rectal cavity up to a height of 20 cm from the dentate line. Gas dilation and stereoscopic vision give an optimal overview during the procedure. In sessile adenomas and carcinomas within the region of the extraperitoneal rectum, full thickness excision is the standard procedure. The postoperative course is completely painless in all excisions at some distance from the dentate line. The complication rate is low compared with other procedures and the recurrence rate in sessile adenomas (3.5%) lower than in conventional surgery as a result of the precise dissection which is possible under the magnified stereoscopic vision. In PT1 low risk cancer we found one recurrence in 29 patients.
Adenoma↗
[Sphincter-conserving surgery in tumors of the middle and distal rectum: methods, indications and limitations].
The purpose of this review is to summarize new developments in the surgical treatment of benign and malignant tumors of the rectum, focusing on oncological requirements and postoperative functional aspects which affect the quality of life. One of the developments is the transanal endoscopic microsurgical (TEM) approach to resection of adenomas and low risk early cancers in the rectum. Another focus is total rectum resection with colo-anal reconstruction with a colon pouch. This procedure reconstructs anorectal anatomy and provides nearly normal function. The reconstruction exists in two forms, (a) the colon-J-pouch and (b) the ileocecal interposition pouch (cecum pouch), which was developed at our institution. The review includes 33 consecutive patients with a rectum tumor. Standardized tumor-specific and functional staging determines which technique is used. 12 patients were operated on using the transanal endoscopic approach, 3 patients had a posterior proctotomy, another patient a transanal local excision and 17 patients total rectum resection with colon pouch reconstruction as described above.
Aged↗
[Rectal exploration and transrectal ultrasound scanning of rectal cancer. A prospective, blind study].
Staging of rectal carcinoma before surgical treatment was performed in a prospective blind study, comparing digital rectal exploration and transrectal linear ultrasonography (TRUS) with the resulting pathological examination. TRUS underestimated the depth of penetration in three of 33 patients and overestimated it in nine of 74. The figures for digital examination were five of 18 and 20 of 76, respectively. Penetration of the rectal wall was correctly identified in 56 of 61 patients by digital rectal examination and in 59 of 61 by TRUS. Specimens without penetration of the rectal wall were identified in 26 of 33 patients by TRUS, but in no more than 13 of 33 by digital examination. Regional lymph node metastases were present in 19 patients; none were diagnosed by digital examination, but TRUS identified 11 of the 19. It is concluded that TRUS will result in more patients being given the possibility of curative local surgery.
Double-Blind Method↗
[Significance of rectoscopy as a diagnostic and therapeutic technic].
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Aged↗
[Differential diagnosis of non-epithelial rectal neoplasms].
Experience in the treatment of 118 patients with nonepithelial new growths of the rectum has been accumulated at the Scientific Research Institute of Proctology in the period from 1970 to 1991. They accounted for 1.5% of all benign and malignant tumors of this organ. Leiomyoma was diagnosed in 44, leiomyosarcoma in 18, lipoma in 30, fibroma in 17, neurinoma in 7 and rhabdomyoma in 2 of these patients. A differential diagnosis was made between benign and malignant tumors, as well as with other nonepithelial new growth of the rectum. On the basis of the clinical picture and the results of digital and instrumental (radiological, endoscopic, and ultrasonic) examination of the rectum the correct preoperative diagnosis may be established with certain probability. This influences directly the choice of the volume of the operative intervention in various types of nonepithelial rectal tumors. Morphological verification of the tumor is the principal method of examination in establishing the differential diagnosis in the preoperative and postoperative periods.
Adult↗
[Effectiveness of regular after-care in R0-resected rectal carcinoma].
Regular follow-up programs after radical resections of rectal carcinoma have been introduced in numerous hospitals. The main goal of a regular follow-up program is the early diagnosis of tumor recurrence in the asymptomatic stage to allow further radical resection. We evaluated the efficiency (quote of further resections of asymptomatic tumor recurrences) of regular follow-up after resection of 288 rectal carcinomas. 88 patients developed recurrent disease (47 primary locoregional recurrence, 27 distant metastasis, 14 locoregional and distant recurrence). Only 31 patients were asymptomatic at the time of recurrence (metastasis 55.6%, locoregional recurrence 31.9%, local and distant recurrence 7.1%; p < 0.05). In 31 patients (13 asymptomatic, 18 symptomatic) further R0-resection was possible. Locoregional recurrences were resected more often following anterior resection than after abdominal perineal resection. With 13 radical resections of asymptomatic recurrence the efficiency of regular follow-up was only 4.5%. Therefore efficiency alone does not justify regular follow-up examinations. Follow-up still makes sense for psychosocial support, diagnosis of metachronous colonic carcinoma, treatment of postoperative complications and critical evaluation of the results of surgery. Furthermore the follow up data can be used to plan adjuvant therapy studies.
Aftercare↗
[The clinical case. Suspicion of rectal carcinoma in a male basset hound].
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Adenocarcinoma↗
[Endoscopic treatment of colorectal cancer].
Endoscopic polypectomy should be applied only for early colorectal carcinomas. Intramucosal carcinoma do not have a risk of lymph node metastases. However, there is an about 10% risk of lymph node metastases among carcinomas showing submucosal invasion (sm carcinoma). When risk factors revealed to be positive after polypectomy, subsequent surgical resection of the large bowel with lymph nodes dissection is needed, because these sm carcinomas are considered to have a high risk of lymph node metastases. Therefore, accurate diagnosis of depth of invasion is essential to prevent subsequent surgical resection following endoscopic polypectomy. Endoscopy, barium enema and endoscopic ultrasonography (EUS) are all considered to be effective for an accurate diagnosis of depth of invasion. Endoscopic polypectomy includes hot biopsy, snare polypectomy and endoscopic mucosal resection (EMR). Appropriate maneuver must be chosen, considering the characteristics of the lesion. Major complications after endoscopic polypectomy are bleeding and perforation of the large bowel. Including an establishment of a new risk factors, further efforts must be made to prevent unnecessary additional surgical resection of the large bowel following endoscopic polypectomy.
Aged↗
Transanal endoscopic microsurgery.
Transanal endoscopic microsurgery is a minimally invasive technique for local excision of tumours in the rectum and lower sigmoid colon. It allows precise transanal dissection and suturing, and enables sphincter-preserving local resection to be performed without an abdominal or perineal incision.
Electrocoagulation↗
Indications and technique for TEM (transanal endoscopic microsurgery).
Transanal Endoscopic Microsurgery (TEM) was introduced into clinical practice by the Buess group in 1983. Since then vast experience has been gained in removing tumours of the rectum by the operative rectoscope. Though the indication in benign lesions for TEM as a local resection therapy is undisputed, the indication for resection of T1 or advanced carcinomas has to be evaluated. By using a 40 mm operating rectoscope sealed with a gastight working insert to prevent pressure loss after creation of a pneumorectum and a stereoscopic optic with sixfold magnification, exact visualisation of a rectal tumour can be achieved. The insertion of endoscopic surgical instruments like the high frequency knife, forceps, scissors, and suction device allows precise excision of the lesion as well as suture closure of the wound. Recently a bipolar multifunctional combination instrument has been developed for more precise dissection, less blood loss and shorter operation times.
Anal Canal↗
TEM results of the Tuebingen group.
From August 1st 1989 to May 1st 1993, 190 rectal adenomas and 75 carcinomas were locally excised with the TEM technique. The mortality was 0.4%, the rate of complications which required surgical re-intervention was 3% in adenomas and 8% in carcinomas. The final histology of the removed carcinomas revealed 44 pT1, 23 pT2 and eight pT3 stages. In two of the eight re-resected patients with pT1 low-risk tumours, residual primary tumour but no lymph node metastases were found. In contrast to this, three of the eleven re-resected patients with pT2 low-risk tumours had already developed lymph node metastases. After an average follow-up time of 14 months, two recurrences were observed in the group of the only locally treated patients with pT1 low-risk carcinomas. Both underwent a secondary procedure for cure but in late tumour stages. No recurrence was diagnosed so far among the re-resected patients.
Adult↗