Guidelines for Psychological Rehabilitation Intervention Combined Integrated Traditional Chinese and Western Medicine After Radical Surgery for Early and Middle Stage Colorectal Cancer / 中国实验方剂学杂志

In recent years， the incidence of colorectal cancer has been rising in China， and with the promotion of early screening and early diagnosis， most colorectal cancers are able to achieve long-term survival through timely diagnosis and treatment. Nevertheless， 30%-70% of patients with early to mid-stage colorectal cancer after radical surgery still have psychological problems such as anxiety， depression， and fear of recurrence and metastasis， and they hope to seek help from traditional Chinese medicine（TCM） treatment. In order to further standardize the integrated traditional Chinese and western medicine psychological rehabilitation interventions of stage Ⅰ-Ⅲ colorectal cancer after radical surgery， and to improve the diagnosis and treatment level， under the support of the pilot project of clinical collaboration between Chinese and western medicine for major and difficult diseases of National Administration of TCM， experts in oncology， integrated Chinese and western medicine， psychology， surgery， nursing， evidence-based medicine and other disciplines from 10 units nationwide participated in the work， led by Xiyuan Hospital，China Academy of Chinese Medical Sciences and Beijing Cancer Hospital. Based on the methodology and process of guideline development of the World Health Organization Handbook for Guideline Development and the Regulations for Group Standards of China Association of Chinese Medicine， the Guidelines for Psychological Rehabilitation Intervention Combined Integrated Traditional Chinese and Western Medicine After Radical Surgery for Early and Middle Stage Colorectal Cancer have been developed according to the current best evidence， extensive consultation with clinical experts and following the situation of current clinical practice. The guideline provides the psychological characteristics， the needs and willingness to accept psychological rehabilitation， the interventions for psychological rehabilitation， evaluation of efficacy， follow-up review， educational guidance and others of patients with stage Ⅰ-Ⅲ colorectal cancer after radical surgery. It can provide guidance for TCM（integrated Chinese and western medicine） clinicians and psychologists engaged in the psychological rehabilitation of integrated Chinese and western medicine oncology， especially for doctors in primary medical institutions.

Elastografía cualitativa por ultrasonido endoscópico en la reestadificación del tumor de recto irradiado / Qualitative elastography by endoscopic ultrasound in the restaging of the irradiated rectal tumor

Introducción: En la reestadificación del paciente con tumor de recto irradiado, la elastografía cualitativa por ultrasonido endoscópico puede identificar la fibrosis y diferenciarla del tumor residual. Objetivo: Determinar la utilidad de la elastografía cualitativa por ultrasonido endoscópico en la reestadificación del tumor de recto irradiado. Métodos: Estudio observacional y descriptivo (serie de casos), en 31 pacientes con tumor de recto irradiado, reestadificados mediante elastografía cualitativa por ultrasonido endoscópico. Para determinar la utilidad de la elastografía se calcularon: sensibilidad, especificidad, valor predictivo positivo, valor predictivo negativo, índice de Youden y concordancia diagnóstica según índice kappa, de la elastografía y del ultrasonido endoscópico por separado, estos resultados fueron comparados en ambas pruebas diagnósticas. El estudio histológico de la pieza quirúrgica fue el estándar de referencia. Resultados: El índice de concordancia del ultrasonido endoscópico (77,4 por ciento), por elastografía (87,1 por ciento). El ultrasonido endoscópico mostró mayor sensibilidad y valor predictivo negativo que la elastografía, por lo que la posibilidad de descartar presencia de tumor con un resultado negativo fue superior. La elastografía tuvo mayor especificidad (77,78 por ciento) y valor predictivo positivo (90,91 por ciento) que el ultrasonido endoscópico (22,22 y 75,86 por ciento); fue más útil para confirmar el diagnóstico de tumor. Conclusiones: La utilidad de la elastografía cualitativa asociada al ultrasonido endoscópico, en la reestadificación del tumor de recto irradiado, consiste en incrementar la especificidad del estudio y discernir mejor entre la fibrosis y el tumor residual(AU)

Introduction: Qualitative endoscopic ultrasound elastography can identify fibrosis and differentiate it from residual tumor in the re-staging of patients with irradiated rectal tumors. Objective: To determine the usefulness of qualitative endoscopic ultrasound elastography in the re-staging of the irradiated rectal tumor. Methods: An observational and descriptive study (series of cases) was carried out in 31 patients with irradiated rectal tumor, restaged by means of Qualitative elastography by endoscopic ultrasound. To determine the usefulness of elastography, the following were calculated: sensitivity, specificity, positive predictive value, negative predictive value, Youden index and diagnostic agreement according to kappa, elastography and endoscopic ultrasound separately; these results were compared in both diagnostic tests. The histological study of the surgical specimen was the reference standard. Results: The concordance index of endoscopic ultrasound (77.4 percent), that obtained by elastography (87.1 percent). Endoscopic ultrasound showed greater sensitivity and negative predictive value than elastography, so the possibility of ruling out the presence of a tumor with a negative result was higher. Elastography had greater specificity (77.78 percent) and positive predictive value (90.91 percent) than endoscopic ultrasound (22.22 and 75.86 percent); it was most helpful in confirming the tumor diagnosis. Conclusions: The usefulness of qualitative elastography associated with endoscopic ultrasound, in the re-staging of the irradiated rectal tumor, consists in increasing the specificity of the study, thus allowing a better discernment between fibrosis and residual tumor(AU)

Robotic transanal ressection for rectal tumor: a description of the technique / Ressecção transanal robótica para tumor retal: uma descrição da técnica

ABSTRACT Introduction: Robotic transanal surgery (RTS) is the analog of TAMIS and represents a new focus for the advancement of transanal platforms robotic transanal surgery is sometimes referred to as robotic TAMIS. Though limited to only a few centers world-wide, experience with robotic transanal surgery has been encouraging. Most research with robotic transanal surgery has concentrated on local excision of rectal neoplasia, although more complex procedures such as transanal proctectomy are possible using the robotic approach. This article reports the surgical technique of R-TAMIS performed in the Brazilian National Cancer Institute (INCA, Rio de Janeiro). Methods: 71-year-old, female with cardiologic disease (heart failure), with a 1.5 cm rectal neoplasm at 4 cm from the anal verge in the right anterolateral position. Biopsy revealed neuroendocrine tumor. A compete colonoscopy revealed no evidence of synchronous lesions. Work-up included 3D endorectal ultrasonography and magnetic resonance imaging, which demonstrated the lesion to be uT1uN0. The patient was counseled about surgical options − local excision versus low anterior resection. Due to the cardiologic condition, the patient was elected to proceed with local excision with robotic transanal surgery. Conclusion: Robotic TAMIS is a safe and effective operative procedure for high selected cases of rectal neoplasm. It enhances surgeon ergonomics and facilitates tumor removal and suture in the transanal approach.

RESUMO Introdução: A cirurgia transanal robótica (RTS,Robotic Transanal Surgery) é análoga da TAMIS (cirurgia minimamente invasiva transanal) e representa um novo foco para o avanço das plataformas transanais. A cirurgia transanal robótica é algumas vezes chamada de TAMIS robótica. Embora limitada a apenas alguns centros em todo o mundo, a experiência com a cirurgia transanal robótica tem sido encorajadora. A maioria das pesquisas com cirurgia transanal robótica tem se concentrado na excisão local da neoplasia retal, embora procedimentos mais complexos, como a proctectomia transanal, sejam possíveis utilizando a abordagem robótica. Este artigo relata a técnica cirúrgica de R-TAMIS realizada no Instituto Nacional do Câncer (INCA, Rio de Janeiro). Métodos: paciente de 71 anos, sexo feminino, com doença cardiológica (insuficiência cardíaca), com neoplasia retal de 1,5 cm a 4 cm da borda anal em posição anterolateral direita. A biópsia revelou tumor neuroendócrino. Uma colonoscopia completa não revelou evidências de lesões sincrônicas. A investigação incluiu ultrassonografia endorretal em 3D e ressonância magnética, que demonstrou que a lesão era uT1uN0. A paciente foi aconselhada sobre as opções cirúrgicas - excisão localversus ressecção anterior baixa. Devido à condição cardiológica, optou-se por proceder à excisão local com cirurgia transanal robótica. Conclusão: A TAMIS robótica é um procedimento cirúrgico seguro e eficaz para casos altamente selecionados de neoplasia retal. Ela melhora a ergonomia do cirurgião e facilita a remoção do tumor e a sutura na abordagem transanal.

Elastografía por ultrasonido endoscópico en el tumor de recto / Endoscopic ultrasound elastography in the rectal tumor

Introducción: Para definir una adecuada estrategia terapéutica en el cáncer de recto es preciso una correcta estadificación. El ultrasonido endoscópico es un método de estadiaje preciso que define la profundidad del tumor y el estado nodal. En los tumores tratados con radioterapia disminuye su rentabilidad por la fibrosis que se origina en la pared rectal; indistinguible de los elementos de malignidad. La elastografía brinda la posibilidad de resolver esta limitación. Objetivo: Ofrecer una actualización sobre la elastografía por ultrasonido endoscópico en el diagnóstico del paciente con tumor rectal. Desarrollo: La elastografía se basa en las alteraciones que en la elasticidad del tejido inducen la fibrosis y el cáncer. Determina si un tejido es maligno o benigno mediante el análisis de su dureza. Se obtienen imágenes que se expresan en un mapa de colores superpuestas a la imagen convencional del ultrasonido endoscópico. Muchas investigaciones demuestran su elevada sensibilidad y especificidad en tumores de páncreas y ganglios linfáticos, algunas en tumores de esófago, sin embargo muy pocas en el cáncer rectal. Conclusiones: La elastografía ha mejorado el diagnóstico y seguimiento oncológico del paciente con tumor rectal(AU)

Introduction: To define an adequate therapeutic strategy in rectal cancer, a correct staging is necessary. For this, advanced diagnostic means have been developed to evaluate the rectal wall. Endoscopic Ultrasound a fundamental technique; combines endoscopic image with ultrasound; in tumors treated with radiotherapy, its profitability decreases due to fibrosis that originates in the rectal wall; indistinguishable from the elements of malignancy. Elastography offers the possibility of resolving this limitation. Objective: To offer an update on elastography by endoscopic ultrasound in the diagnosis of the patient with rectal tumor. Development: Elastography is based on the alterations that fibrosis and cancer induce in the elasticity of the tissue. Determine if a tissue is malignant or benign by analyzing its hardness. Images are obtained that are expressed on a color map superimposed on the conventional endoscopic ultrasound image. Many investigations demonstrate its high sensitivity and specificity in tumors of the pancreas and lymph nodes, some in esophageal tumors, however very few in rectal cancer. Conclusions: Elastography has improved the diagnosis and oncological follow-up of the patient with rectal tumor(AU)

Actinomicosis pélvica: a propósito de un caso que simula un tumor de recto / Pelvic actinomycosis: from a case that simulates rectal tumor

Resumen Introducción: La actinomicosis, es una infección crónica rara producida por bacterias del género Actinomyces sp. La afectación pélvica es una de sus formas más infrecuentes y en gran parte de los casos se relaciona al uso de un dispositivo intrauterino de larga data o a una cirugía previa. Como otras enfermedades raras, la infección es conocida como "la gran imitadora" por su variada forma de presentación y particular comportamiento pudiendo simular una neoplasia. El tratamiento es fundamentalmente médico y de buenos resultados. Caso Clínico: Damos a conocer el caso de una paciente que se presentó con un cuadro compatible con un tumor de recto, pero que resultó ser actinomicosis. El diagnóstico se realizó en base a la tinción de Gram, el cuadro clínico y el antecedente de un dispositivo intrauterino abandonado por más de 25 años. Fue corroborado posteriormente mediante anatomía patológica y tratada en forma exitosa con antibióticos por un periodo extendido. Conclusión: Si bien la actinomicosis es una patología infrecuente, debe ser considerada en el diagnóstico diferencial de los pacientes que se presentan con tumores de la pelvis. Un alto índice de sospecha y una actitud diagnóstica activa son fundamentales para un tratamiento oportuno, seguro y eficaz de esta enfermedad.

Introduction: Actinomycosis is a rare chronic infection caused by bacterias of the genus Actinomyces sp. Pelvic involvement is one of its most infrequent forms and in many cases it is related to the use of a longstanding intrauterine device or a previous surgery. Like other rare diseases, the infection is known as "the great imitator" because of its varied form of presentation and its particular behavior, which can simulate a neoplasm. The treatment is fundamentally medical with good results. Case Report: We present the case of a patient who presented with a rectal tumor but that turned out to be Actinomycosis. The diagnosis was made based on the Gram stain, the clinical presentation and the history of an intrauterine device left for more than 25 years. It was subsequently corroborated by pathological anatomy and successfully treated with antibiotics for an extended period. Conclusion: Although actinomycosis is an infrequent pathology, it should be considered in the differential diagnosis of patients who present with tumors of the pelvis. An active diagnostic attitude and a high index of suspicion are fundamental for the timely, safe and effective treatment of this disease.

Grading method of inhomogeneity of contrast-enhanced ultrasound for rectal tumors based on gray level co-occurrence matrix / 生物医学工程学杂志

Transrectal contrast-enhanced ultrasound (CEUS) is an important examination for rectal tumors. The inhomogeneity of the CEUS images has important clinical significance. However, there is no objective method to evaluate this index. In this study, a method based on gray-level co-occurrence matrix (GLCM) is proposed to extract texture features of images and grade these images according the inhomogeneity. Specific processes include compressing the gray level of the image, calculating the texture statistics of gray level co-occurrence matrix, combining feature selection and principal component analysis (PCA) for dimensionality reduction, and training and validating quadratic discriminant analysis (QDA). After ten cross-validation, the overall accuracy rate of machine classification was 87.01%, and the accuracy of each level was as follows: Grade Ⅰ 52.94%, Grade Ⅱ 96.48% and Grade Ⅲ 92.35% respectively. The proposed method has high accuracy in judging grade Ⅱ and Ⅲ images, which can help to identify the grade of inhomogeneity of contrast-enhanced ultrasound images of rectal tumors, and may be used to assist clinical doctors in judging the grade of inhomogeneity of contrast-enhanced ultrasound of rectal tumors.

Vaginal sling implant misdiagnosed as rectal subepithelial tumor

As cosmetic procedures receive increasing attention from the media, female genital cosmetic surgery (FGCS) has become quite popular in Korea. The safety and efficacy of these surgeries and procedures have yet to be thoroughly documented. We report a case of a 47-year-old woman who underwent a vaginal sling implantation, which resulted in the misdiagnosis of a rectal subepithelial tumor during endoscopic mucosal resection (EMR). This patient suffered an iatrogenic rectal perforation during the EMR, which necessitated an exploratory operation. The sling implant was removed via the vaginal approach, and a primary repair of the vaginal and rectal walls was performed. The patient subsequently showed no sign of complication at her 6-month follow-up. Patients need to be educated about the importance of reporting a history of FGCS prior to undergoing surgical or endoscopic procedures. Also, physicians have to check the medical history of patient thoroughly to avoid misdiagnoses and unnecessary treatment.

Clinicopathological differences in laterally spreading tumors between rectum and colon / 中南大学学报(医学版)

Objective:To investigate the clinicopathological differences in laterally spreading tumor (LST) from the rectum and colon.Methods:Clinicopathological records of 198 patients with LST (116 cases in rectum,82 cases in colon) from the Second Xiangya Hospital of Central South University between January 2012 and January 2017 were evaluated.Results:A total of 198 colorectal LST were included.According to the endoscopic classification,nodular mixed type (LST-GM),homogeneous type (LST-GH),flat elevated type(LST-FE) and pseudodepressed type (LST-PD) were 127(64.1％),13(6.6％),41(20.7％) and 17(8.6％),respectively.LST-GM was predominant in the rectum (71.7％),while LST-FE was predominant in the colon (78.0％),with significant difference (P＜0.01).The mean size of LST was (52.03±35.62) mm or (25.37±11.56) mm in the rectum or the colon,with significant difference between them (P＜0.01).High grade intraepithelial neoplasia frequency was higher in the rectum than that in the colon (31.0％ vs 18.3％),while the low grade intraepithelial neoplasia frequency was lower in the rectum than that in the colon (61.2％ vs 75.6％) (both P＜0.05).The mean size of LSTGM and LST-GH diameter were larger in the rectum than that in the colon,and the malignant potential of LST-GM was higher in the rectum than that in the colon.The percentage of high grade intraepithelial neoplasia + invasive carcinoma was 41.8％ and 22.2％,respectively (both P＜0.05).LST in colon was mostly treated with endoscopic mucosal resection,while LST in rectum was treated by endoscopic submucosal dissection predominantly.Conclu sion:LSTs from the rectum and colon show different clinicopathological characteristics to some extent.LST-GM is predominant in the rectum,while LST-FE is predominant in the colon.The malignant potential of LST-GM is higher in the rectum than that in the colon.

Application of dental floss traction assisted technique in endoscopic submucosal dissection for early rectal cancer and precancerous lesions / 中国内镜杂志

Objective?To investigate the efficacy and safety of dental floss traction assisted technique in endoscopic submucosal dissection (ESD) of early rectal cancer and precancerous lesions.?Methods?57 patients recived ESD for early colorectal cancer and precancerous lesions from September 2014 to June 2017 were randomly divided into dental floss traction group (n = 28) and routine group (n = 29). To compare the average operation time, the amount of supplementary submucosal injection, and frequency of supplementary submucosal injection, complete resection rate, R0 resection rate, complications and follow-up results of the two groups.?Results?All 57 cases were treated with ESD successfully. The average operation time, the amount of supplementary submucosal injection and the frequency of injection were significantly less in the dental floss traction group than in the conventional group [(55.11 ± 10.44) vs (74.72 ± 14.47) min; (5.80 ± 1.80) vs (10.00 ± 5.70) ml; frequency (1.10 ± 0.90) vs (1.70 ± 0.90)]. The average operation time (P = 0.000), the amount of supplementary submucosal injection (P = 0.001) and the frequency of supplementary submucosal injection (P = 0.022) were significantly different between the two groups. The complete resection rate and R0 resection rate were 100.0% in both groups. There was no bleeding or perforation in the dental floss traction group, and 1 cases (3.4%) in the conventional group had delayed bleeding after operation, and 2 cases (6.9%) perforation occurred during the operation, and there was no significant difference between the two groups (P > 0.05). No recurrence was found in the two groups during follow-up period.?Conclusions?Dental floss traction assisted technique can significantly shorten the operation time of ESD, reduce the amount and frequency of supplementary submucosal injection and ensure good therapeutic effect for early colorectal cancer and precancerous lesions.

The guidance of endoscopic ultrasonography for the selection with sphincter-preserving surgery in patients with low rectal cancer / 实用医学杂志

Objective To investigate the guidance of the endoscopic ultrasonography for the surgery selec-tion of patients with low rectal cancerthrough analyzing the accuracy of endoscopic ultrasonography in preoperative TN staging. Methods Eighty-seven cases with low rectal cancer received preoperative endoscopic ultrasonography examination,the preoperative staging and the postoperative pathologic comparison. The EUS accuracy of preopera-tive staging of rectal cancer was evaluated. Results The preoperative staging with endoscopic ultrasonography for patients with low rectal cancer,100% in T1 stage,96.0% in T2 stage,85.7% inT3 stage,and 100% in T4 stage. The preoperative staging and the postoperative pathologic comparison in T stage were consistent(Kappa = 0.903, P < 0.05). The preoperative staging with endoscopic ultrasonography for patients with low rectal cancer ,87.0% in N0 stage,78.6% in N1 stage,and 100% in N2. The preoperative and the postoperative pathologic comparisons in N stage were consistent(Kappa = 0.768,P < 0.05). Conclusion The endoscopic ultrasonography had a certain advantage in the clinical preoperative evaluation for patients with low rectal cancer ,especially for invasion depth and the judgment of lymph node metastasis ,with a higher accuracy.

Resección abdominoperineal isquioanal con reconstrucción de pared posterior de vagina con colgajo miocutáneo de músculo recto abdominal vertical / Ischioanal abdominoperineal resection with reconstruction of posterior wall of vagina with vertical rectus abdominis myocutaneous flap

El colgajo del recto abdominal miocutáneo vertical, es un excelente colgajo que rellena el gran defecto en la pelvis luego de una resección abdominoperineal isquioanal, siendo libre de tensión y reduciendo significativamente la incidencia de complicaciones de la herida perineal y la estancia hospitalaria, con el cual se puede reconstruir la pared posterior de la vagina. Se reporta aquí el primer caso en Costa Rica de una resección abdominoperineal isquioanal, con reconstrucción de pared posterior de vagina con colgajo del recto abdominal miocutáneo vertical, practicada con éxito en una paciente de 62 años, con un adenocarcinoma rectal localmente avanzado con infiltración de pared posterior de vagina.

Vertical rectus abdominis myocutaneous flap, is an excellent flap that fills the large defect in the pelvis after an adominoperineal ischioanal resection; it is free from tension, significantly reduces the incidence of perineal wound complications and hospital stay and can be used to reconstruct the posterior wall of the vagina. We report the first case of Costa Rica abdominoperineal ischioanal resection with reconstruction of posterior vaginal wall with vertical rectus abdominis myocutaneous flap, successfully practiced in a patient of 62 years with locally advanced rectal adenocarcinoma infiltrating posterior wall of the vagina.

Resección de tumoración rectal mediante cirugía transanal mínimamente invasiva (TAMIS) / Rectal tumor resected by transanal minimally invasive surgery (TAMIS)

La microcirugía endoscópica transanal (TEM, por sus siglas en inglés) es una técnica que se ha desarrollado desde los años 80 y tiene múltiples indicaciones. La cirugía transanal mínimamente invasiva (TAMIS, por sus siglas en inglés) se ha introducido como un enfoque alternativo al TEM, con las mismas indicaciones y algunas ventajas. Se reporta aquí el primer caso en Costa Rica de TAMIS, practicada exitosamente en un paciente de 85 años con una tumoración rectal de 4 cm de diámetro.

Transanal Endoscopic Microsurgery (TEM, for its acronym in English) is a technique developed in the 80s, which has many uses. Transanal Minimally Invasive Surgery (TAMIS, for its acronym in English) has been introduced as an alternative approach to TEM, with the same indications and some advantages. The case of an 85-yearold male with a 4 cm in diameter rectal tumor successfully resected by TAMIS is herein reported, which is the first case treated in this manner in Costa Rica.

Effect of arterial perfusion of 3-bromopyruvate on transplanted rectal tumors：an experimental study in rabbits / 介入放射学杂志

Objective To investigate the effect of 3-bromopyruvate (3-BrPA) on transplanted rectal tumors in experimental rabbit models. Methods A total of 60 New Zealand white rabbits with transplanted rectal tumor were randomly and equally divided into low-dose (0.5 mmol/L), medium-dose (1.0 mmol/L), high-dose (2.0 mmol/L) treatment groups and saline control group with 15 rabbits in each group. Arterial perfusion of 10 ml 3-BrPA with concentration of 0.5 mmol/L, 1.0 mmol/L and 2.0 mmol/L via caudal mesenteric artery was respectively employed for the rabbits of the corresponding treatment group; the control group was perfused with equal amounts of saline. Four days later, rectal tumors were removed by vivisection. The necrosis degree of tumor cells was determined by microscopic examination, and the necrosis rate was calculated. The effect of different 3-BrPA concentrations on the rectal tumor was evaluated. Results The rectal tumor transplantation and transcatheter 3-BrPA or saline perfusion was successfully completed in all 60 experimental rabbits. Microscopically, tumor cells showed different degrees of damage in experimental rabbits. In low-dose (0.5 mmol/L) treatment group, gradeⅠnecrosis was observed in 3 rabbits, gradeⅡin 11 rabbits, and gradeⅢin one rabbit;the effective rate was 6.7%. In medium-dose (1.0 mmol/L) treatment group, gradeⅡnecrosis was seen in 2 rabbits, grade Ⅲ in 10 rabbits, and grade Ⅳ in 3 rabbits; the effective rate was 86.6%. In high-dose (2.0 mmol/L) treatment group, gradeⅢnecrosis was detected in 2 rabbits and gradeⅣin 13 rabbits;the effective rate was 100.0%. In the saline control group, grade I necrosis was observed in 15 rabbits. Statistically significant differences in tumor necrosis rate and effective rate existed between medium-dose (1.0 mmol/L) treatment group and high-dose (2.0 mmol/L) treatment group (P<0.05). Statistically significant differences in tumor necrosis rate also existed between each other among the four groups with necrosis of gradeⅠto gradeⅣ(P<0.05). 3-BrPA had obvious therapeutic effect, while it showed no damage to the normal intestinal tissue. Conclusion For the treatment of transplanted rectal tumor in rabbit models, arterial infusion of 3-BrPA has certain therapeutic effect. In the high-dose group, the necrosis rate and effective rate are the highest, and the therapeutic results are the most significant.

A Case of Rectal Leiomyosarcoma Presenting as a Semipedunculated Polypoid Mass / 대한소화기내시경학회지

Rectal leiomyosarcoma is an extremely rare disease. Anal bleeding, rectal pain and a sensation of pressure in the anus are the most common symptoms. It tends to form a polypoid intraluminal mass and commonly originates from the muscularis propria, but may arise from the muscularis mucosa, or in the walls of the blood vessels. Characteristically, leiomyosarcoma has very high mitotic activity and is, on immunohistochemical staining, positive for actin and desmin, but negative for c-kit and S-100. We experienced a case of a rectal leiomyosarcoma in a 54 year-old man who presented with anal bleeding. Colonoscopic examination revealed a 4.5 cm-sized semipedunculated polypoid mass at mid-rectum. We confirmed that it was a leiomyosarcoma histologically by endoscopic resection with mechanical snaring. Low anterior resection followed by radiation therapy was performed. We report here on this case with a review of the relevant literature.

Tumores retrorrectales: revisión a propósito de un caso / Retro-rectal tumors: a case review of a case

Se realiza una revisión de la literatura médica nacional e internacional actualizada sobre el tema, a propósito del diagnóstico de un tumor quístico retrorrectal en una paciente de 15 años con antecedentes de operaciones anteriores por esta causa y enfermedad de 10 años de evolución. Tras la exéresis quirúrgica total y mediante estudio anatomopatológico, se concluyó el diagnóstico de hamartoma quístico retrorrectal.

A review of national and international medical literature was made on this topic related to diagnosis of retro-rectal cystic tumor in a patient aged 15 presenting backgrounds of previous surgeries by this cause, and a disease of 10 years of evolution. After total surgical exeresis and by means of anatomic-pathological study, it is included diagnosis of retro-rectal cystic hamartoma.

Effects of Ginseng Polysaccharide Injection in Chemotherapy for Patients with Rectal Cancer / 中国药房

OBJECTIVE:To evaluate the effects of Ginseng polysaccharide injection in chemotherapy for patients with rectal cancer.METHODS:A total of eighty-five patients with rectal cancer were divided into treatment group(n=43 cases)and control group(n=42 cases):the patients in the treatment group were given ginseng polysaccharide injection(30 mg?d-1)via intravenous drip plus routine chemotherapy,and the patients in control group were given routine chemotherapy only.RESULTS:There were significant differences between the treatment group and the control group in the karnofsky scores for evaluation of life quality,62.8%(27/43)vs.38.1%(16/42)scored more than 70(P0.05),but the incidence of nausea and vomi-ting at above Ⅱ degree was lower in the treatment group than in the control group [20.9%(9/43)vs.42.9%(18/42),P

Tumor height from the anal verge before and after complete mobilization of the rectum

Rectal tumor height has been observed to increase after complete mobilization.OBJECTIVES: 1.) to measure tumor height in resectable rectal cancers before and after complete mobilization, 2.) to describe changes in tumor height measurements at different levels of the rectum, and 3.) to determine the probability of a two centimeter increase in tumor height after mobilization in low rectal cancers. METHODS: Prospective cross-sectional series including all resectable rectal cancer treated at our hospital from January to December, 2003. Proctoscopy measurements of rectal tumor height after induction of anesthesia were compared to measurements done after complete rectal mobilization. Logistic curve fitting was used to calculate the probability of a two centimeter increase in tumor height for low rectal cancers after complete mobilization.RESULTS: In the 12-month period, 37 patients with adenocarcinoma of the rectum were seen. Ages of patients ranged from 26 to 86, with mean age of 57.8 years. Thirty-three patients had resectable rectal cancer. Tumor height ranged from zero to 11 cm, with mean height of 5.7 cm. After complete mobilization, tumor height increased in 50 percent of upper rectal cancers, 92 percent of mid-rectal cancers, and 32 percent of low rectal cancers. Logistic curve fitting showed probability of a two-centimeter increase in tumor height was 52 percent at seven centimeters, 40 percent at six centimeters, 28 percent at five centimeters, and 19 percent at four centimeters. DISCUSSION: The decision to perform APR for low rectal cancers must not be based solely in pre-operative tumor height measurements since pre-operative measurements of rectal tumor height can increase when the rectum is completely mobilized.

Clinical Results of Transanal Endoscopic Microsurgery (TEM)

PURPOSE: Local treatment of rectal tumors have become an alternative to the classic radical operation. However, conventional transanal procedures are limited to tumors located in the lower rectum and the precision of the excision is restricted by the limitation of the surgeon's visualization during the procedure. This report will present our surgical management and functional results after TEM, a new minimally invasive technique for the treatment of rectal tumors. METHODS: From December 1994 to January 2000, 136 patients underwent TEM. All patients were evaluated preoperatively with sigmoidoscopy or colonoscopy with biopsy. The indications for TEM were benign rectal tumors and T1 and T2 malignant rectal tumors with well or moderately differentiation. All patients were followed up 1 month postoperatively and every 3 months thereafter. RESULTS: The mean operation time was 56.5 minutes (25~150 minutes) and the mean postoperative hospital stay was 3.6 days (2~10 days). On the basis of the postoperative evaluations, 56 of the 136 patients proved to have benign tumors while the remaining 80 patients had malignant tumors. One hundred thirty five patients were removed with adequate resection margins. One patient had cancer cell involvement at the resection margin. There were no serious complications. After a mean observation time of 29 months (12~42 months), there were five noted recurrences. Functional results were excellent; 24 of the 136 patients complained of impaired continence or defecation disorders in a review one month postoperatively. These problems improved during the first 6 months after the surgery. CONCLUSIONS: We feel that TEM is an adequate method for removal of benign rectal tumors, and properly selected early rectal cancers.

Histopathologic support of the 2 cm distal resection margin for rectal carcinoma

Recent evidence has shown that a five-centimeter distal margin is not required for cancers of the rectum. These findings proved significant in that selected patients with low rectal lesions can be offered curative operations that can preserve normal sphincter function, an intact route of defecation, and have a better quality of life. From August 2000 to July 2001, we began our series of examining specimens after rectal resection to determine the negative distal margin. The specimens for pathologic examination were cut at 0.5 cm intervals up to 2.0 cm from the raised distal edge of the tumor. The objective of this paper is to determine the distance of intramural tumor spread of rectal cancer from the macroscopic tumor edge. During the one-year period, a total of 11 specimens from rectal cancer patients were examined, ages of the patients ranged from 29 to 77 years. Eighty-two percent of patients had locally advanced (T3 and T4) lesions. Lymph node involvement was seen in 72 percent. Analysis of distal margins showed the following: five of 11 (45 percent) were positive for malignant cells at 0.5 cm from the tumor edge, four of 11 (36 percent) positive at 1.0 cm, one of 11 (nine percent) positive at 1.5 cm, and no malignant cells were seen at 2.0 cm distal margin. Our early results support the adequacy of a 2 cm distal resection margin for rectal cancer surgery. (Author)

Two Cases of Multiple Carcinoid Tumors of the Rectum / 대한소화기내시경학회지

Carcinoid tumors of the rectum are relatively uncommon and comprise only about one percent of all rectal neoplasms. Typically, rectal carcinoids present as small, solitary submucosal nodules and have benign course. But, multicentricity is rare. The frequency of an associated second malignancy is about 13%. The explanation of the high frequency of other neoplasms associated with carcinoid tumors is still unclear. We have experienced two cases of multiple carcinoid tumors of the rectum, one was coexisted with adenocarcinoma of the sigmoid colon. They presented with mass on the right inguinal area and hematochezia. Carcnoids was found incidentally. Because the tumors measured 15 mm or less in diameter, did not infiltrate beyond the submucosal layer and had no histological atypia, carcinoids was treated by endoscopic polypectomy and mucosal resection. Thereafter, one underwent surgery for adenocarcinoma of the sigmoid colon. Herein we present our experience with reviewed literatures.