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J. coloproctol. (Rio J., Impr.) ; 41(2): 198-205, June 2021.
Article in English | LILACS | ID: biblio-1286989


Abstract Rectal cancer is an important cause of morbidity and mortality worldwide. The most effective and curative treatment is surgery, and the standard procedure is total mesorectal excision, initially performed by open surgery and posteriorly by minimally invasive techniques. Robotic surgery is an emerging technology that is expected to overcome the limitations of the laparoscopic approach. It has several advantages, including a stable camera platform with high definition three-dimensional image, flexible instrumentswith seven degrees of freedom, a third arm for fixed retraction, fine motion scaling, excellent dexterity, ambidextrous capability, elimination of physiological tremors and better ergonomics, that facilitate a steady and precise tissue dissection. The main technical disadvantages are the loss of tactile sensation and tensile feedback and the complex installation process. The aim of the present study is to review the importance and benefits of robotic surgery in rectal cancer, particularly in comparison with the laparoscopic approach. Intraoperative estimated blood loss, short and long-term outcomes as well as pathological outcomes were similar between robotic and laparoscopic surgery. The operative time is usually longer in robotic surgery and the high costs are still itsmajor drawback. Robotic surgery for rectal cancer demonstrated lower conversion rate to open surgery and benefits in urinary and sexual functions and has been established as a safe and feasible technique.

Resumo O cancro do reto é uma importante causa de morbidade e mortalidade em todo o mundo. O único tratamento curativo e mais eficaz é a cirurgia, sendo que o procedimento padrão é a excisão total do mesoreto, inicialmente realizada por cirurgia aberta e mais tarde por técnicas minimamente invasivas. A cirurgia robótica é uma tecnologia emergente que pretende ultrapassar as limitações da laparoscopia. As vantagens incluem plataforma de câmera estável, imagem tridimensional com alta definição, instrumentos flexíveis com sete graus de liberdade, terceiro braço para retração fixa, movimentos finos, excelente destreza, ambidestria, eliminação do tremor fisiológico e maior conforto ergonômico, que facilitam uma disseção firme e precisa dos tecidos. As principais desvantagens técnicas são a perda da sensação táctil e feedback tensional e o complexo processo de instalação. O objetivo deste estudo é fazer uma revisão bibliográfica da importância e dos benefícios da cirurgia robótica no cancro do reto, particularmente em comparação coma cirurgia laparoscópica. A perda estimada de sangue intraoperatória, os outcomes a curto e longo-prazo e os outcomes patológicos foram equivalentes entre a cirurgia robótica e laparoscópica. O tempo operatório é geralmente mais longo na cirurgia robótica e os elevados custos são a sua principal desvantagem. A cirurgia robótica no cancro do reto demonstrou menor taxa de conversão para cirurgia aberta e benefícios nas funções urinária e sexual e está estabelecida como uma técnica segura e viável.

Rectal Neoplasms/pathology , Colorectal Surgery/methods , Robotic Surgical Procedures , Rectal Neoplasms/surgery , Laparoscopy
Chinese Medical Journal ; (24): 2196-2204, 2021.
Article in English | WPRIM | ID: wpr-921123


BACKGROUND@#Previous studies have demonstrated different predominant sites of distant metastasis between patients with and without neoadjuvant chemoradiotherapy (NCRT). This study aimed to explore whether NCRT could influence the metastasis pattern of rectal cancer through a propensity score-matched analysis.@*METHODS@#In total, 1296 patients with NCRT or post-operative chemoradiotherapy (PCRT) were enrolled in this study between January 2008 and December 2015. Propensity score matching was used to correct for differences in baseline characteristics between the two groups. After propensity score matching, the metastasis pattern, including metastasis sites and timing, was compared and analyzed.@*RESULTS@#After propensity score matching, there were 408 patients in the PCRT group and 245 patients in the NCRT group. NCRT significantly reduced local recurrence (4.1% vs. 10.3%, P = 0.004), but not distant metastases (28.2% vs. 27.9%, P = 0.924) compared with PCRT. In both the NCRT and PCRT groups, the most common metastasis site was the lung, followed by the liver. The NCRT group developed local recurrence and distant metastases later than the PCRT group (median time: 29.2 [18.8, 52.0] months vs. 18.7 [13.3, 30.0] months, Z = -2.342, P = 0.019; and 21.2 [12.2, 33.8] vs. 16.4 [9.3, 27.9] months, Z = -1.765, P = 0.035, respectively). The distant metastases occurred mainly in the 2nd year after surgery in both the PCRT group (39/114, 34.2%) and NCRT group (21/69, 30.4%). However, 20.3% (14/69) of the distant metastases appeared in the 3rd year in the NCRT group, while this number was only 13.2% (15/114) in the PCRT group.@*CONCLUSIONS@#The predominant site of distant metastases was the lung, followed by the liver, for both the NCRT group and PCRT group. NCRT did not influence the predominant site of distant metastases, but the NCRT group developed local recurrence and distant metastases later than the PCRT group. The follow-up strategy for patients with NCRT should be adjusted and a longer intensive follow-up is needed.

Chemoradiotherapy , Humans , Neoadjuvant Therapy , Neoplasm Recurrence, Local , Neoplasm Staging , Propensity Score , Rectal Neoplasms/pathology , Retrospective Studies , Treatment Outcome
Chinese Medical Journal ; (24): 821-828, 2021.
Article in English | WPRIM | ID: wpr-878109


BACKGROUND@#Colorectal cancer is harmful to the patient's life. The treatment of patients is determined by accurate preoperative staging. Magnetic resonance imaging (MRI) played an important role in the preoperative examination of patients with rectal cancer, and artificial intelligence (AI) in the learning of images made significant achievements in recent years. Introducing AI into MRI recognition, a stable platform for image recognition and judgment can be established in a short period. This study aimed to establish an automatic diagnostic platform for predicting preoperative T staging of rectal cancer through a deep neural network.@*METHODS@#A total of 183 rectal cancer patients' data were collected retrospectively as research objects. Faster region-based convolutional neural networks (Faster R-CNN) were used to build the platform. And the platform was evaluated according to the receiver operating characteristic (ROC) curve.@*RESULTS@#An automatic diagnosis platform for T staging of rectal cancer was established through the study of MRI. The areas under the ROC curve (AUC) were 0.99 in the horizontal plane, 0.97 in the sagittal plane, and 0.98 in the coronal plane. In the horizontal plane, the AUC of T1 stage was 1, AUC of T2 stage was 1, AUC of T3 stage was 1, AUC of T4 stage was 1. In the coronal plane, AUC of T1 stage was 0.96, AUC of T2 stage was 0.97, AUC of T3 stage was 0.97, AUC of T4 stage was 0.97. In the sagittal plane, AUC of T1 stage was 0.95, AUC of T2 stage was 0.99, AUC of T3 stage was 0.96, and AUC of T4 stage was 1.00.@*CONCLUSION@#Faster R-CNN AI might be an effective and objective method to build the platform for predicting rectal cancer T-staging.@*TRIAL ChiCTR1900023575;

Artificial Intelligence , Humans , Magnetic Resonance Imaging , Neoplasm Staging , Neural Networks, Computer , Rectal Neoplasms/pathology , Retrospective Studies
Arq. gastroenterol ; 57(2): 172-177, Apr.-June 2020. tab, graf
Article in English | LILACS | ID: biblio-1131660


ABSTRACT BACKGROUND: Hospital-based studies recently have shown increases in colorectal cancer survival, and better survival for women, young people, and patients diagnosed at an early disease stage. OBJECTIVE: To describe the overall survival and analyze the prognostic factors of patients treated for colorectal cancer at an oncology center. METHODS: The analysis included patients diagnosed with colon and rectal adenocarcinoma between 2000 and 2013 and identified in the Hospital Cancer Registry at A.C.Camargo Cancer Center. Overall 5-year survival was estimated using the Kaplan-Meier method, and prognostic factors were evaluated in a Cox regression model. Hazard ratios (HR) are reported with 95% confidence intervals (CI). RESULTS: Of 2,279 colorectal cancer cases analyzed, 58.4% were in the colon. The 5-year overall survival rate for colorectal cancer patients was 63.5% (65.6% and 60.6% for colonic and rectal malignancies, respectively). The risk of death was elevated for patients in the 50-74-year (HR=1.24, 95%CI =1.02-1.51) and ≥75-year (HR=3.02, 95%CI =2.42-3.78) age groups, for patients with rectal cancer (HR=1.37, 95%CI =1.11-1.69) and for those whose treatment was started >60 days after diagnosis (HR=1.22, 95%CI =1.04-1.43). The risk decreased for patients diagnosed in recent time periods (2005-2009 HR=0.76, 95%CI =0.63-0.91; 2010-2013 HR=0.69, 95%CI =0.57-0.83). CONCLUSION: Better survival of patients with colorectal cancer improves with early stage and started treatment within 60 days of diagnosis. Age over 70 years old was an independent factor predictive of a poor prognosis. The overall survival increased to all patients treated in the period 2000-2004 to 2010-2013.

RESUMO CONTEXTO: Estudos hospitalares recentes têm demonstrado aumento da sobrevida do câncer colorretal e melhor sobrevida para mulheres, jovens e pacientes diagnosticados em estágio precoce da doença. OBJETIVO: Descrever a sobrevida global e analisar os fatores prognósticos de pacientes tratados para câncer colorretal em um centro de oncologia. MÉTODOS: Foram incluídos pacientes com diagnóstico de adenocarcinoma de cólon e reto entre 2000 e 2013, identificados no Registro Hospitalar de Câncer do A.C.Camargo Cancer Center. A sobrevida global aos 5 anos foi estimada pelo método de Kaplan-Meier e os fatores prognósticos foram avaliados pelo modelo de Cox. As razões de risco (HR) são relatadas com intervalos de confiança (IC) de 95%. RESULTADOS: Dos 2.279 casos de câncer colorretal analisados, 58,4% eram de cólon. A taxa de sobrevida global aos 5 anos para pacientes com câncer colorretal foi de 63,5% (65,6% e 60,6% para câncer de cólon e retal, respectivamente). O risco de óbito foi elevado para pacientes na faixa etária de 50-74 anos (HR=1,24; IC95% =1,02-1,51) e ≥75 anos (HR=3,02; IC95% =2,42-3,78), para pacientes com câncer retal (HR=1,37; IC95% =1,11-1,69) e para aqueles cujo tratamento foi iniciado >60 dias após o diagnóstico (HR=1,22; IC95% =1,04-1,43). O risco diminuiu para pacientes diagnosticados em períodos recentes (2005-2009 HR=0,76; IC95% =0,63-0,91; 2010-2013 HR=0,69; IC95% =0,57-0,83). CONCLUSÃO: A sobrevida dos pacientes com câncer colorretal é maior naqueles em estágio inicial e com início do tratamento antes dos 60 dias.. Idade acima de 70 anos foi fator independente preditivo de mau prognóstico. A sobrevida global aumentou para todos os pacientes tratados no período de 2000-2004 a 2010-2013.

Humans , Male , Female , Aged , Aged, 80 and over , Rectal Neoplasms/mortality , Colorectal Neoplasms/mortality , Colonic Neoplasms/mortality , Prognosis , Rectal Neoplasms/pathology , Rectal Neoplasms/therapy , Survival , Severity of Illness Index , Brazil/epidemiology , Colorectal Neoplasms/pathology , Colorectal Neoplasms/therapy , Survival Analysis , Registries , Survival Rate , Retrospective Studies , Colonic Neoplasms/pathology , Colonic Neoplasms/therapy , Middle Aged , Neoplasm Staging , Antineoplastic Agents/therapeutic use
Rev. argent. coloproctología ; 31(1): 2-7, mar. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1100300


Introducción: El budding tumor (BT) es la presencia de células tumorales aisladas o en pequeños grupos situadas en el frente de invasión del tumor. Su hallazgo en alto grado es un factor de mal pronóstico independiente del cáncer colorrectal. El objetivo de este trabajo es determinar si el grado de BT está asociado con otros factores pronósticos del cáncer rectal. Material y métodos: Se incluyen las resecciones oncológicas de recto en el período 2013-2017. Los casos se agruparon según la densidad en la formación de los BT en 3 grupos, los de grado bajo, intermedio y alto. Se utilizó como valor estadístico el cálculo del odds ratio (OR). Resultados: Se analizaron las piezas de resección de 27 pacientes (15 mujeres y 12 hombres) con una media de edad de 68,4 años (40-86). Se calculó el OR para invasión ganglionar, vascular y recidiva en función del grado de budding tumoral. Discusión: Se observó una tendencia a la presencia de factores histológicos de mal pronóstico en relación al budding de alto grado, si bien el bajo número de casos no permitió demostrarlo en este estudio. Conclusiones: El análisis del grado de tumor budding es reproducible y podría ayudar a identificar pacientes con cáncer rectal de peor pronóstico. (AU)

Introduction: Tumor budding (BT) is defined as isolated or small groups of neoplastic cells located at the invasive front of the tumor. High-grade BT is a poor prognostic factor in colorectal cancer. Objective: To determine if the degree of BT is associated with other prognostic factors in rectal cancer. Materials and methods: Rectal oncological resections during the 2013-2017 period were included. Cases were stratified according to the density in the formation of BT in 3 groups: low, intermediate and high. The calculation of the odds ratio (OR) was used as a statistical value. Results: The resection specimens of 27 patients (15 women and 12 men) with a mean age of 68.4 years (40-86) were analyzed. OR for node metastases, vascular invasion and relapse was calculated according to tumor budding grade. Discussion: High-grade tumor budding seems to associate with the presence of poor prognostic factors. However, it was not possible to demonstrate it because of the small sample size. Conclusions: Tumor budding is a reproducible marker and could help to identify rectal cancer patients with a worse prognosis. (AU)

Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Rectal Neoplasms/pathology , Adenocarcinoma/pathology , Prognosis , Rectal Neoplasms/surgery , Adenocarcinoma/surgery , Data Interpretation, Statistical , Retrospective Studies , Follow-Up Studies , Neoplasm Invasiveness/pathology , Neoplasm Staging
Rev. argent. coloproctología ; 30(4): 97-103, dic. 2019. ilus, graf
Article in Spanish | LILACS | ID: biblio-1096796


Introducción: Los tumores ano-rectales del musculo liso son raros, la relación respecto de los de recto es de 0.1%, presentándose con un rango entre 40-70 años. El objetivo es analizar una serie de pacientes, el tratamiento empleado y actualización bibliográfica. Material y Método: Sobre una base de datos retrospectiva entre enero de 1983 y diciembre de 2018, sobre 421 pacientes operados por cáncer recto-anal, fueron extraídos 6 que correspondieron a tumores del musculo liso. Resultados: Correspondieron al sexo femenino 4, con edades entre 49 y 75 años (57.5 años); 4 de localización rectal, de ellos 3 fueron leiomiosarcoma, y 2 anales (leiomioma). En 2 se obtuvo diagnostico preoperatorio de certeza por punción mediante Tru-Cut. De 3 pacientes con leiomiosarcoma, a 2 se les realizo cirugía radical y al restante biopsia. Los 2 resecados recidivaron a los 6 meses y al año. Los 3 fallecieron entre los 2 y 16 meses por progresión de la enfermedad. La paciente con diagnóstico de leiomioma rectal, operada mediante cirugía radical, se encuentra sin recidiva a 18 meses. Los 2 pacientes resecados localmente por leiomioma de ano, presentaron en el postoperatorio absceso y fistula extraesfinteriana, uno de ellos con incontinencia severa. Ambos fueron re-operados y se encuentran asintomáticos, libres de recidiva a los 36 y 60 meses. Discusión: Los tumores del músculo liso ano-rectal son infrecuentes y presentan síntomas inespecíficos. La biopsia preoperatoria es imperiosa a fin de establecer una adecuada estrategia quirúrgica. Los malignos tienen alto índice de recidiva y mortalidad. (AU)

Introduction: Smooth muscle ano-rectal tumors are rare; the relation with respect to the rectum is 0.1%, in a patient's age range between 40-70 years. The objective is the analysis of a series of patients, the treatment used and bibliographic update. Material and method: On a retrospective, database between January 1983 and December 2018. About 421 patients operated for rectum-anal cancer, of which 6 corresponded to smooth muscle tumors. Results: Four were female, with ages between 49 and 75 years (57.5 years average); 4 were of rectal location, of which 3 were leiomyosarcoma, and 2 anal (leiomyoma). In two, a preoperative diagnosis of certainty was obtained by Tru-Cut. Two out of 3 patients with leiomyosarcoma, underwent radical surgery and the remaining one a biopsy. The two resected relapsed at 6 months and at one year. All 3 died between 2 and 16 months due to disease progression. The patient diagnosed with rectal leiomyoma, operated by radical surgery, is without recurrence at 18 months. The 2 patients resected locally for anus leiomyoma showed abscess and extrasphincteric fistula in the postoperative period, one of them with severe incontinence. Both were re-operated and are asymptomatic, free of recurrence at 36 and 60 months. Discussion: Ano-rectal smooth muscle tumors are uncommon and have nonspecific symptoms. Preoperative biopsy is imperative in order to establish an appropriate surgical strategy. Malignant tumors have a high rate of recurrence and mortality. (AU)

Humans , Male , Female , Middle Aged , Aged , Anal Canal/pathology , Rectal Neoplasms/diagnosis , Rectal Neoplasms/pathology , Rectum/pathology , Biopsy, Needle , Leiomyosarcoma/diagnosis , Leiomyosarcoma/pathology , Postoperative Care , Rectal Neoplasms/surgery , Diagnostic Imaging , Immunohistochemistry , Retrospective Studies , Proctoscopy/methods , Drug Therapy, Combination , Leiomyosarcoma/surgery
Rev. argent. coloproctología ; 30(4): 75-79, dic. 2019. tab
Article in Spanish | LILACS | ID: biblio-1096672


Motiva esta presentación el hecho que desde el Relato "Opciones terapéuticas del Cáncer de Recto Inferior" en el año 2008 han pasado 10 años y por supuesto aparecieron algunos progresos y cambios. Se conoce gran heterogeneidad genética debido que puede desarrollarse por diferentes vías. Nuevos fármacos han aparecido para lograr terapia eficiente. La clasificación clínica TNM fue actualizada en el año 2018. Los métodos de diagnóstico siguen teniendo vigencia. La resección local endoanal se presenta como una conducta factible con resultados favorables debido al progreso instrumental. Combinado con R/T y Q mostró excelentes resultados ("Watch and Wait"). La escisión total de mesorecto sigue ocupando un lugar importante. En la amputación abdomino perineal debemos incluir la resección de ambos músculos elevadores del ano. La cirugía laparoscópica ocupa cada vez más lugar siendo tan segura como la convencional. Se adjuntan los algoritmos terapéuticos. Continuarán las investigaciones para mejorar los resultados. (AU)

The aim of this presentation is to update the one written in 2008 "Low rectal cancer therapeutic options" since some progress and changes have appeared after ten years. Great genetic heterogeneity is known because it can develop in different pathways. New drugs have appeared to achieve efficient therapy. The TNM clinical classification was updated in 2018. The diagnosis methods are still in effect. Endoanal local resection is presented as feasible behavior with favorable results due to instrumental progress. Combined with R/T and Ch showed excellent results (Watch and Wait). The total mesorectal continues to occupy an important place. The resection of both elevator muscles of anus must be included in the abdominoperineal amputation. Laparoscopic surgery is increasingly in place, being as safe as the conventional. Therapeutic algorithms are attached. Research will continue to improve results. (AU)

Humans , Rectal Neoplasms/therapy , Digestive System Surgical Procedures/instrumentation , Digestive System Surgical Procedures/methods , Colorectal Neoplasms/classification , Rectal Neoplasms/diagnosis , Rectal Neoplasms/pathology , Colorectal Neoplasms/epidemiology , Treatment Outcome
J. coloproctol. (Rio J., Impr.) ; 39(4): 365-372, Oct.-Dec. 2019.
Article in English | LILACS | ID: biblio-1056638


Abstract Introduction Colorectal cancer is amongst the most prevailing malignancies in the world and it is associated with a relatively high mortality rate. Rectal cancer occurs in 20-30% of all colorectal cancer cases, and 25% of this present synchronous metastatic disease. This study aims to review the current treatment approaches for rectal cancer patients with synchronous liver metastases, as there are no specific guidelines for the management of this group of patients. Methods A systematic literature search was performed on Pubmed database with a 10 year timeline limitation from 2008 to 2018. Results Currently, the only potentially curative approach remains to be the surgical resection. Conventionally, the classical strategy of these patients involves resection of rectal tumor, followed by liver resection, with chemotherapy sessions between the two procedures. However, recent studies have reported no inferiority, in safety and survival outcomes, when compared with other approaches (liver-first resection or simultaneous resection), except when symptoms of primary tumor are present. Hence, treatment strategy should be individualized based on the assessment of metastatic extent, primary tumor symptoms and the patient's overall clinical status. Chemotherapy and targeted agents have substantially contributed to overall survival improvements, allowing enhanced tumor down staging. Conclusion Complete resection of liver metastases is considered the major condition for a potential survival outcome in these patients. Management of these patients should include a multidisciplinary team with consideration of each individual specificities. Prospective randomized trials are needed to elucidate the optimal treatment strategy.

Introdução: O câncer colorretal está entre as neoplasias mais prevalentes no mundo, apresentando a uma taxa de mortalidade relativamente alta. Ele corresponde a 20% a 30% de todos os casos de câncer colorretal; 25% dos casos apresentam doença metastática síncrona. Este estudo teve como objetivo revisar as abordagens atuais de tratamento para pacientes com câncer retal com metástases hepáticas síncronas, uma vez que não existem diretrizes específicas para o manejo deste grupo de pacientes. Métodos: Uma busca sistemática da literatura foi realizada no banco de dados PubMed com uma limitação temporal de 10 anos (2008 a 2018). Resultados: Atualmente, a ressecção cirúrgica ainda é a única abordagem potencialmente curativa. Tradicionalmente, a estratégia clássica para o tratamento desses pacientes envolve a ressecção do tumor retal, seguida de ressecção hepática, com sessões de quimioterapia entre os dois procedimentos. No entanto, ao comparar a abordagem tradicional com outras técnicas (ressecção em primeiro plano do fígado ou ressecção simultânea), estudos recentes não relataram inferioridade nos desfechos de segurança e sobrevida, exceto quando sintomas de tumor primário estão presentes. Portanto, a estratégia de tratamento deve ser individualizada com base na avaliação da extensão metastática, nos sintomas primários do tumor e no estado clínico geral do paciente. A quimioterapia e os agentes dirigidos contribuíram substancialmente para as melhorias gerais na sobrevida, permitindo uma maior redução do estadiamento tumoral. Conclusão: A ressecção completa de metástases hepáticas é considerado o principal requisito para um possível resultado de sobrevida nesses pacientes. O manejo desses pacientes deve incluir uma equipe multidisciplinar e considerar as características específicas de cada paciente. Estudos prospectivos randomizados são necessários para elucidar a estratégia de tratamento ideal.

Humans , Rectal Neoplasms/surgery , Liver Neoplasms/surgery , Neoplasms, Multiple Primary/surgery , Rectal Neoplasms/pathology , Rectal Neoplasms/drug therapy , Neoadjuvant Therapy , Proctectomy , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Neoplasms, Multiple Primary/drug therapy
Rev. Col. Bras. Cir ; 46(5): e20192276, 2019. tab, graf
Article in Portuguese | LILACS | ID: biblio-1057174


RESUMO Objetivo: avaliar os resultados perioperatórios e pós-operatórios relacionados à excisão total do mesorreto transanal, bem como, qualidade dos espécimes obtidos pela excisão total do mesorreto transanal através da análise histopatológica da qualidade do mesorreto, acometimento das margens proximal e distal e positividade da margem circunferencial. Métodos: estudo prospectivo, descritivo, em pacientes consecutivos portadores de adenocarcinoma de reto localizados até 10cm da borda anal, sem metástase à distância, submetidos ou não à quimioterapia e radioterapia neoadjuvantes. Foram avaliados a presença de dificuldades técnicas, índice de conversão para via abdominal, tempo cirúrgico e intercorrências intra e pós-operatórias. A qualidade do mesorreto foi classificada em ressecção completa, parcialmente completa ou incompleta. Resultados: entre dezembro de 2016 e maio de 2019, 41 pacientes foram submetidos à excisão total do mesorreto transanal, dos quais 75% foram classificados como estágio clínico III, 13% estágio clínico II e 12% estágio clínico I. A média de distância entre borda anal e borda inferior do tumor foi de 6,2cm. Quarenta por cento dos tumores encontravam-se na parede retal anterior e 17% foram classificados como circunferenciais. A média de tempo operatório foi de 189 minutos. A média de internação hospitalar foi de 4,6 dias. Não houve óbitos intra-hospitalares. Oitenta e dois por cento dos espécimes foram classificados como ressecção completa. Conclusão: a excisão total do mesorreto transanal demonstra adequada qualidade do mesorreto e adequadas margens cirúrgicas, estando associada a baixos índices de complicações perioperatórias, tempo cirúrgico aceitável e curto tempo de hospitalização.

ABSTRACT Objective: to assess the perioperative and postoperative results of transanal total mesorectal excision, as well as the quality of the specimens obtained by this technique. Methods: we conducted a prospective, descriptive study in consecutive patients with rectal adenocarcinoma located up to 10cm from the anal verge, without distant metastasis, subjected or not to neoadjuvant chemoradiotherapy. We evaluated the presence of technical difficulties, conversion to open abdominal route, surgical time and intra and postoperative complications. Through histopathological analysis, we assessed the quality of the mesorectum, involvement of the proximal and distal margins and positivity of the circumferential, classifying quality of the mesorectum as complete, partially complete or incomplete resection. Results: between December 2016 and May 2019, 41 patients underwent transanal total mesorectal excision, of which 75% were classified as clinical stage III, 13% clinical stage II and 12% clinical stage I. The average distance between the anal verge and the lower border of the tumor was 6.2cm. Forty percent of the tumors were in the anterior rectal wall and 17% were circumferential. The average operative time was 189 minutes. The average hospital stay was 4.6 days. There were no in-hospital deaths. Eighty-two percent of the specimens were classified as complete resection. Conclusion: transanal total mesorectal excision demonstrates adequate specimen quality and surgical margins, being associated with lower rates of perioperative complications, acceptable surgical time and short hospitalization.

Humans , Male , Female , Adult , Aged , Anal Canal/surgery , Rectal Neoplasms/surgery , Rectum/surgery , Digestive System Surgical Procedures/methods , Adenocarcinoma/surgery , Laparoscopy/methods , Anal Canal/pathology , Anal Canal/diagnostic imaging , Postoperative Period , Rectal Neoplasms/pathology , Rectal Neoplasms/diagnostic imaging , Specimen Handling , Magnetic Resonance Imaging , Adenocarcinoma/pathology , Adenocarcinoma/diagnostic imaging , Body Mass Index , Prospective Studies , Neoadjuvant Therapy , Perioperative Period , Middle Aged
Rev. Assoc. Med. Bras. (1992) ; 64(2): 119-126, Feb. 2018. tab, graf
Article in English | LILACS | ID: biblio-896427


Summary Introduction: The standard treatment for locally advanced rectal cancer (RC) consists of neoadjuvant chemoradiation followed by radical surgery. Regardless the extensive use of SUVmax in 18F-FDG PET tumor uptake as representation of tumor glycolytic consumption, there is a trend to apply metabolic volume instead. Thus, the aim of the present study was to evaluate a noninvasive method for tumor segmentation using the 18F-FDG PET imaging in order to predict response to neoadjuvant chemoradiation therapy in patients with rectal cancer. Method: The sample consisted of stage II and III rectal cancer patients undergoing 18F-FDG PET/CT examination before and eight weeks after neoadjuvant therapy. An individualized tumor segmentation methodology was applied to generate tumor volumes (SUV2SD) and compare with standard SUVmax and fixed threshold (SUV40%, SUV50% and SUV60%) pre- and post-therapy. Therapeutic response was assessed in the resected specimens using Dworak's protocol recommendations. Several variables were generated and compared with the histopathological results. Results: Seventeen (17) patients were included and analyzed. Significant differences were observed between responders (Dworak 3 and 4) and non-responders for SUVmax-2 (p<0.01), SUV2SD-2 (p<0.05), SUV40%-2 (p<0.05), SUV50%-2 (p<0.05) and SUV60%-2 (p<0.05). ROC analyses showed significant areas under the curve (p<0.01) for the proposed methodology with sensitivity and specificity varying from 60% to 83% and 73% to 82%, respectively. Conclusion: The present study confirmed the predictive power of the variables using a noninvasive individualized methodology for tumor segmentation based on 18F-FDG PET/CT imaging for response evaluation in patients with rectal cancer after neoadjuvant chemoradiation therapy.

Resumo Introdução: O câncer retal (RC) é uma doença de importância global, e o tratamento padrão para o câncer retal localmente avançado compreende quimiorradiação neoadjuvante seguida de cirurgia radical. Independentemente do uso extensivo da captação tumoral mais intensa do 18F-FDG (conhecida como SUVmax) como representativo do consumo glicolítico do tumor nas imagens de PET, há uma tendência para aplicar volume metabólico. Dessa forma, o objetivo do presente estudo foi avaliar um método não invasivo de segmentação tumoral utilizando a 18F-FDG PET para predizer a resposta à quimiorradioterapia neoadjuvante em pacientes com câncer de reto. Método: A amostra consistiu em pacientes com câncer retal em estádios II e III submetidos ao exame de 18F-FDG PET/CT antes e oito semanas após a terapia neoadjuvante. Foi aplicada uma metodologia de segmentação tumoral individualizada para gerar volumes tumorais (SUV2SD). A resposta terapêutica foi avaliada nos espécimes ressecados utilizando as recomendações do protocolo de Dworak. Várias variáveis foram geradas e comparadas com os resultados histopatológicos. Resultados: Dezessete (17) pacientes foram incluídos e analisados. Foram observadas diferenças significativas entre os respondedores (Dworak 3 e 4) e não respondedores para SUVmax-2 (p<0,01), SUV2SD-2 (p<0,05), SUV40%-2 (p<0,05), SUV50%-2 (p<0,05) e SUV60%-2 (p< 0,05). As análises ROC mostraram áreas significativas sob a curva (p<0,01) para a metodologia proposta, com sensibilidade e especificidade variando de 60% a 83% e 73% a 82%, respectivamente. Conclusão: O presente estudo confirmou o poder preditivo das variáveis utilizando uma metodologia não invasiva individualizada para segmentação tumoral baseada em imagens 18F-FDG PET/CT para avaliação da resposta em pacientes com câncer retal após tratamento com quimiorradiação neoadjuvante.

Humans , Male , Female , Adult , Aged , Rectal Neoplasms/therapy , Adenocarcinoma/therapy , Neoadjuvant Therapy/methods , Chemoradiotherapy/methods , Positron Emission Tomography Computed Tomography/methods , Rectal Neoplasms/metabolism , Rectal Neoplasms/pathology , Adenocarcinoma/metabolism , Adenocarcinoma/pathology , Predictive Value of Tests , Retrospective Studies , Sensitivity and Specificity , Treatment Outcome , Radiopharmaceuticals/administration & dosage , Fluorodeoxyglucose F18/administration & dosage , Tumor Burden , Middle Aged
Rev. argent. urol. (1990) ; 83(2): 50-54, 2018. ^etab, graf
Article in Spanish | LILACS, BINACIS, UNISALUD | ID: biblio-964087


Objetivos: Evaluar las características clínicas, patológicas y evolutivas en diferentes grupos etarios con cáncer renal. Materiales y métodos: Se llevó a cabo un análisis retrospectivo, descriptivo y analítico de 269 pacientes con carcinoma de células renales. Los pacientes fueron divididos en tres grupos de acuerdo con la edad al momento del diagnóstico: <50 años, entre 50 y 65 años y >65 años. En cada grupo se evaluaron características clínicas (edad, sexo, presencia de manifestaciones clínicas), patológicas (diámetro tumoral, tipo histológico, estadío patológico [TNM 2009], grado histológico, presencia de necrosis coagulativa, invasión microvascular, presencia de elementos sarcomatoides, compromiso de la grasa periférica, compromiso vascular macroscópico de vena renal o cava inferior e invasión ganglionar) y presencia de metástasis a distancia al diagnóstico. El análisis univariado de las variables categóricas fue realizado por el método de chi cuadrado o test de Fischer según correspondiera; las variables continuas fueron calculadas según el test de Student. Los puntos principales del trabajo, la sobrevida libre de metástasis y la sobrevida cáncer-específica fueron evaluados mediante el método de Kaplan-Meier y las diferencias entre los grupos fueron evaluadas por el Log-Rank test. Resultados: De los 269 pacientes estudiados, 40 (14,88%) corresponden a <50 años, 136 (50,55%) corresponden a pacientes entre 50 y 65 años y 93 (34,57%) corresponden a pacientes >65 años de edad. No existieron diferencias significativas al evaluar variables clínicas. Los pacientes <50 años presentaron mayor número de nefrectomías parciales (p=0,04), menor grado histológico (p=0,05), necrosis coagulativa (p=0,002), infiltración de la grasa periférica (p=0,02) y compromiso ganglionar (p=0,05). La sobrevida libre de metástasis a 5 años en pacientes <50 años fue del 95%; en los grupos entre 50-65 años y >65 años fue del 70% y el 71%, respectivamente, con diferencias significativas (Log-Rank test=0,004). De la misma manera, al comparar la sobrevida cáncerespecífica a 5 años entre los grupos se pudo evidenciar que las diferencias también fueron significativas a favor de pacientes <50 años (<50 años del 98%, 50-65 años del 79% y >65 años del 83%; Log-Rank test=0,02). Conclusiones: En nuestra serie, los pacientes >50 años de edad se asociaron a características patológicas y evolutivas desfavorables al ser comparados con pacientes de menor edad. Sin embargo, creemos que el seguimiento no debiera limitarse exclusivamente a la edad, sino que debiera incluir el resultado de todas las variables pronósticas de malignidad en cáncer renal (AU)

Objectives: To evaluate clinical, pathological and evolutionary characteristics in different age groups with renal cancer. Materials and methods: A retrospective, descriptive and analytics analysis of 269 patients with renal cell cancer was made. Patients were divided in three groups according to age at the moment of diagnosis: <50 years old, between 50 y 65 years old and >65 years old. In each group clinical (age, sex, presence of clinical manifestations), pathological (tumor diameter, histological type, pathological stage (TNM2009), histological grade, presence of coagulative necrosis, microvascular invasion, presence of sarcomatoid elements, peripheral fat compromise, renal vein or inferior cava vein macroscopic vascular compromise, and nodes invasion) characteristics and presence of distance metastasis at diagnosis were evaluated. Univariated analysis of categorical variables was made by Chi square or Fischer test just as correspond; continuous variables were calculated by Student test. Main points, metastasis free and cancer-specific survival, were evaluated by Kaplan-Meier method and differences between groups by the Log-Rank test. Results: Of 269 patients studied, 40 (14.88%) were <50 years old group, 136 (50.55%) between 50 and 65 years old group and 93 (34.57%) >65 years old group. There are no significative differences when we evaluate clinical variables. Patients in <50 years old group had higher number of nephron-sparing surgery (p=0.04), lower histological grade (p=0.05), coagulative necrosis (p=0.002), peripheral fat invasion (p=0.02) and node invasion (p=0.05). Metastasis free survival at 5 years in this group was 95%; in 50-65 years old group and >65 years old group was 70% and 71%, respectively, with significant differences (Log-Rank test=0.004). Likewise, when we compared cancer-specific survival at 5 years between groups, we demonstrate that differences are significant in favor of patients younger than 50 years old (<50 years old 98%, 50-65 years old 79% and >65 years old 83%; Log-Rank test=0.02). Conclusions: In our series, age >50 years old is associated with unfavorable pathological and evolutionary characteristics to be compared with younger patients. However, we believe that the follow-up should not be limited only to the age but should include the results of all prognostic variables of malignancy in kidney cancer. (AU)

Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Rectal Neoplasms/pathology , Carcinoma, Renal Cell/surgery , Carcinoma, Renal Cell/pathology , Age Factors , Kidney Neoplasms/surgery , Prognosis , Survival Rate , Retrospective Studies , Nephrectomy
Yonsei Medical Journal ; : 35-42, 2018.
Article in English | WPRIM | ID: wpr-742507


PURPOSE: To investigate the association of cancer stem-cell markers [octamer-binding transcription factor 4 (OCT4), sex determining region Y-box 2 (SOX2), and Nanog homebox (NANOG)] expression with clinicopathological properties and overall survival (OS) in operative rectal cancer (RC) patients receiving adjuvant therapy. MATERIALS AND METHODS: 153 patients with primary RC receiving surgery were enrolled. Tumor tissue and paired adjacent normal tissue sample were collected, and OCT4, SOX2, and NANOG expressions were assessed by immunofluorescent staining. The median follow-up duration was 5.2 years, and the last follow-up date was August 2016. RESULTS: Tumor tissue OCT4 (p < 0.001), SOX2 (p=0.003), and NANOG (p < 0.001) expressions were higher than those in adjacent tissue. OCT4 expression was positively correlated with pathological grade (R=0.185, p=0.022), tumor size (R=0.224, p=0.005), and N stage (R=0.170, p=0.036). NANOG expression was positively associated with tumor size (R=0.169, p=0.036). Kaplan-Meier suggested that OCT4+ was associated with worse OS compared with OCT4− (p < 0.001), while no association of SOX2 (p=0.121) and NANOG expressions (p=0.195) with OS was uncovered. Compared with one or no positive marker, at least two positive markers were associated with shorter OS (p < 0.001), while all three positive markers were correlated with worse OS compared with two or less positive markers (p < 0.001). Multivariate Cox's analysis revealed that OCT4+ (p < 0.001) and N stage (p=0.046) were independent factors for shorter OS. CONCLUSION: Tumor tissue OCT4 expression was correlated with poor differentiation, tumor size, and N stage, and it can serve as an independent prognostic biomarker in operative patients with RC receiving adjuvant therapy.

Aged , Biomarkers, Tumor/metabolism , Female , Humans , Male , Multivariate Analysis , Nanog Homeobox Protein/metabolism , Neoplastic Stem Cells/metabolism , Octamer Transcription Factor-3/metabolism , Prognosis , Rectal Neoplasms/metabolism , Rectal Neoplasms/pathology , Rectal Neoplasms/surgery , SOXB1 Transcription Factors/metabolism , Survival Analysis
Rev. méd. Chile ; 145(10): 1342-1348, oct. 2017. graf
Article in Spanish | LILACS | ID: biblio-902449


Primary colorectal lymphoma is a rare form of presentation of gastrointestinal tract lymphomas. Inflammatory bowel disease and its treatment are risk factors for its development. We report a 47-year-old male patient with Ulcerative Colitis of two years of evolution, treated initially with azathioprine and later on with infliximab. Due to a relapse in symptoms after the second dose of infliximab, a new coloncoscopy was performed showing a rectal ulcerative lesion, corresponding to a large cell Non-Hodgkin's Lymphoma. The patient was successfully treated with RCHOP chemotherapy (Rituximab cyclophosphamide doxorubicin vincristine prednisone). He is currently in disease remission.

Humans , Male , Middle Aged , Rectal Neoplasms/etiology , Rectal Neoplasms/pathology , Colitis, Ulcerative/drug therapy , Lymphoma, Large B-Cell, Diffuse/etiology , Lymphoma, Large B-Cell, Diffuse/pathology , Immunosuppressive Agents/adverse effects , Rectal Neoplasms/diagnostic imaging , Azathioprine/adverse effects , Vincristine/administration & dosage , Biopsy , Gastrointestinal Agents/adverse effects , Prednisone/administration & dosage , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Doxorubicin/administration & dosage , Lymphoma, Large B-Cell, Diffuse/diagnostic imaging , Cyclophosphamide/administration & dosage , Rituximab/administration & dosage , Infliximab/adverse effects , Positron Emission Tomography Computed Tomography
J. coloproctol. (Rio J., Impr.) ; 37(1): 50-54, Jan.-Mar. 2017. ilus
Article in English | LILACS | ID: biblio-841303


ABSTRACT Lipomas are a growth of fat cells in a fibrous capsule. They are most common in noncancerous tissues. Lipoma of rectum is uncommon and the most common sit of its origin is the perinanal region. Rarely they could cause rectal bleeding. In this study, we have reported a 53-yrs old man who had been referred to the hospital with symptoms of abdominal pain, rectal bleeding and the problem in bowel movement. Rectal prolapsed with solitary rectal were observed during the clinical observation. Colonoscopy, CT-Scan and MRI were performed for the patient and the results showed a mass suggestive to lipoma which was located in recto/sigmoid region. He underwent the surgery. Intra operative findings showed several soft masses in rectum and a large mass with dimension of 10 cm × 10 cm in sigmoid. Low anterior resection was performed for him and pathology diagnosis was lipoma.

RESUMO Lipomas são um crescimento de adipócitos em uma cápsula fibrosa. Essas formações são mais comuns em tecidos não cancerosos. O lipoma do reto é de rara ocorrência, e o local mais comum para sua origem é a região perianal. Raramente essas formações podem causar sangramento retal. Nesse estudo, descrevemos um paciente, homem, 53 anos, que foi encaminhado ao hospital com sintomas de dor abdominal, sangramento retal e problemas nos movimentos intestinais. Ao exame clínico, foram observados prolapso retal com solitária do recto. Foi realizada uma colonoscopia e obtidos estudos de TC e IRM; os resultados demonstraram uma massa sugestiva de lipoma, localizada na região retossigmoide. O paciente foi encaminhado à cirurgia. Os achados intraoperatórios demonstraram várias massas macias no reto e uma grande massa que media 10 cm × 10 cm no sigmoide. Foi realizada a ressecção anterior e o diagnóstico da patologia foi lipoma.

Humans , Male , Middle Aged , Rectal Neoplasms/pathology , Rectal Prolapse/diagnosis , Lipoma/pathology
S. Afr. gastroenterol. rev ; 15(2): 23-24, 2017.
Article in English | AIM, AIM | ID: biblio-1270145


A fifty-four year old woman underwent colonoscopy due to symptoms of altered bowel habit and weight loss. There was a malignant looking lesion at her rectosigmoid junction [Fig. 1a] which was confirmed histologically to be a moderately differentiated adenocarcinoma. Although the blood results were normal, her CT scan and MRI [Fig 2a] showed an apple core lesion at rectosigmoid junction which was deemed to be Stage IIIC (T4aN2aM0)

Gastroenterology , Neoadjuvant Therapy , Rectal Neoplasms/pathology
Oncol. clín ; 22(1): 13-19, 2017. ilus, tab, graf
Article in Spanish | LILACS | ID: biblio-882200


El objetivo fue evaluar si existe asociación entre la presencia del signo de invasión vascular extramural constatado por resonancia magnética (IVErm) con el período libre de enfermedad (PLE) a los 3 años, en pacientes con cáncer de recto (CR). Se realizó un estudio de cohorte retrospectiva. Se incluyeron 64 pacientes seguidos en nuestra institución con diagnóstico histológico de CR, evaluados inicialmente con RM, los cuales recibieron esquema de quimio-radioterapia neoadyuvante y cirugía curativa. Se analizó, mediante un análisis multivariable a través de una regresión de Cox, para ajustar por potenciales variables de confusión como la estadificación por tamaño tumoral (Trm) en la resonancia magnética (RM) basal, la asociación entre IVErm y el PLE a los tres años. Treinta pacientes (49.5%) sufrieron progresión o recaída, de los cuales 20 (60.6%) presentaron signos de IVErm. La presencia de IVErm se asoció con duplicación del riesgo de mala evolución (HR: 2.11; p = 0.054; IC: 1.00 - 4.51). Luego de ajustar por Trm esta tendencia se mantuvo. La presencia del signo IVErm se asocia con disminución del PLE a 3 años. Es mandatorio incorporarlo en los informes radiológicos a fin de contribuir al manejo de dicho grupo de pacientes (AU)

The aim was to evaluate whether there is an association between the presence of extramural vascular invasion sign found in the magnetic resonance (mrEMVI) and three years' disease-free survival (DFS) in patients with rectal cancer (RC). A retrospective cohort study was performed. Sixty four patients with proven RC, who had been initially evaluated with magnetic resonance (MR), had undergone neoadjuvant chemoradiotherapy and curative surgery, and had been followed for at least 3 years at our institution were included. Association between mrEMVI and reduced DFS was analyzed by logistic regression. Thirty patients (49.5 %) had reduced DFS, of whom 20 (60.6%) had signs of mrEMVI. The presence of mrEMVI duplicated the odds of reduced prognosis (HR: 2.11; 95% CI: 1.00 - 4.51; p < 0.054). The mrEMVI increases the likelihood of reduced DFS in patients with RC (AU)

Humans , Magnetic Resonance Imaging/methods , Rectal Neoplasms/diagnostic imaging , Rectal Neoplasms/pathology , Cohort Studies , Disease-Free Survival , Prognosis