Sphincter saving surgeries for locally advanced low rectal cancer after neoadjuvant chemoradiation

Rectal cancer accounts for the largest distribution within one anatomical region of the large bowel, with approximately one third of all CRC located within the rectum. The Golden standard treatment of primary rectal cancer is curative surgical resection; however, affine balance remains between disease cure and restoration of gastrointestinal continuity. Combined modality has proven efficacy in many malignant tumors with advantage of organ preservation. Forty nine [49] patients with low rectal carcinoma were included in a prospective study, between Jan 2007 and Jan 2012. Preoperative chemoradiation was administrated to all patients and subjected to different techniques of sphincter saving surgery. Stage I and Stage IV disease at diagnosis were excluded from the study. Forty nine patients were included in the study. 27 [55%] patients were male and 22 [45%] were female the age range from 23 years to 70 years with the median age 46 years. The main presenting symptoms were bleeding per rectum and tenesmus. Stage II 18 patients [36.7%,], stage III 31 patients [63.3%. Complete clinical and pathological response in 3 patients [6%], and complete clinical response with only microscopically residual carcinoma in 20 patients [41%], partial response in 18 patients [36.7%], and no significant response in 8 patients [16%] 7 from 8 were mucoid carcinoma. Low anterior resection [LAR] in 22 patients [44.9%], Hartman 's procedure in 4 patients [8.1%], Coloanal pull-through [COP] was done in 19 patients [38.9%] and perineal colostomy in 4 patients [8.1%]. For patients with cola-anal pull-through technique complete dehiscent and retraction observed in 2 cases, Major leakage in one case, stenosis in 4 cases. There is tendency of colorectal cancers to affect younger groups. Most patients presented in advanced stage. Neadjuvant chemo radiation is an excellent tool in sphincter saving surgery. Coloanal pull- through technique is not wide spread technique for low rectal cancer with good oncological safety and acceptable functional outcome

Role of multislice computed tomography in evaluation of colo-rectal neoplasm

Computed tomographic [CT] colonography is a noninvasive, rapidly evolving technique that has been shown in some studies to be comparable with conventional colonoscopy for the screening of colorectal cancer. The addition of intravenous contrast material to CT colonography can aid differentiation of true colonic masses from pseudolesions such as residual stool and improves the depiction of enhancing masses that might otherwise be obscured by residual colonic fluid. The aim of this study is to assess the role of multi detector computed tomographic colonography in staging of colo-rectal neoplasm and detection of synchronous lesons such as adenomatous polyp. The study included fifty-five patients with suspected colo-rectal neoplasm and underwent MDCT colonography and fibro-optic colonoscopy on the same day. The MDCT colonography with IV contrast media has 94% accuracy for identifying tumor wall invasion by colorectal carcinoma and 71% accuracy for identifying regional lymph nodes involvement and the sensitivity of both MDCT colonography and fibro-optic colonoscopy equal in detection of polyps more than 5 mms. The contrast enhanced MDCT colonography is an excellent investigating tool in staging of colo-rectal neoplasm in detection of synchronous adenomatous polyps more than 5 mms

Comparison of pancreatic remnant reconstruction methods after pancreatoduodenectomy

Surgery remains the main-stay therapy for periampullary carcinoma [PC] and provides the only chance of cure. Improvements of surgical technique, increased surgical experience and advances in anesthesia, intensive care and parenteral nutrition have substantially decreased surgical complications and increased the survival. We evaluate the safety and feasibility of 3 reconstruction methods of pancreatic remnant after Pancreatoduodenectomy [PD] such as Telescoping, Duct-to-mucosa pancreaticojejunostomy or pancreaticogastrortomy. This is Comparative prospective study of reconstruction methods of pancreatic remnant after PD was conducted on periampullary carcinoma patients admitted to South Egypt Cancer Institute from Nov.2008 to July 2012. Forty -one patients with periampullary carcinoma consisted of 23 men and 18 women with age ranged between 17-70 years, with a median age of 56 years. Characteristics of patients in the three groups were compared with Chi-square test. A variable was analysed with the Logistic Regression test. Survival rate was analyzed by use Kaplan-Meier test. P-value < 0.05 was considered statistically significant. 9 patients underwent duct-to-mucosa PJ, 17 patients Telescoping of pancreas into the jejunum and 15 patients PG, 30 stenting of pancreatic duct. There was a significant difference between 3 variable methods of reconstruction in leakage rate, operative time, technical difficulty and between stenting and non stenting pancreatic duct. Duct-to-mucosa PJ was least leakage rate, least post operative complication but associated with the longer reconstructive time and same resection time and it was the somewhat difficult. Duct-t-mucosa-PJ safe, least leakage, least blood loss; however PG is associated with more functional deterioration