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Transanal Total Mesorectal Excision for Rectal Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
The first step in assessing a patient for taTME is a thorough history and physical examination. Many patients with rectal cancer are asymptomatic, but symptoms may include rectal bleeding, rectal pain, tenesmus, change in bowel habits or stool caliber, weight loss, nausea, or fatigue. Prior pelvic surgery, such as prostate or gynecological surgery, and/or pelvic radiation can affect TME dissection planes and increase the complexity of transanal dissection and the risk of wrong-plane surgery. Information about baseline urinary and sexual function are important to document because of the risks of pelvic autonomic nerve injury associated with TME. Likewise, a history of fecal incontinence is critical in preoperative evaluation, as fecal incontinence would preclude a patient from sphincter preservation surgery. A comprehensive medical history should identify other medical conditions that may warrant additional assessment to optimize the patient prior to surgery. Diabetes, obesity, immunosuppression, and smoking have been associated with anastomotic leak in taTME and should be addressed before surgery [20]. Laboratory studies should include complete blood count, electrolyte panel, coagulation studies, and type and screen. Serum carcinoembryonic antigen (CEA) should be obtained to facilitate postoperative surveillance.
Colorectal cancer
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Svetlana Balyasnikova, Gina Brown
In rectal cancer, the observation of morphological features currently provides the best method of staging tumours into distinct prognostic groups. The presence or absence of such features is predictive of local recurrence, distant metastatic disease, or both. Successful primary surgical removal of the tumour, with clear resection margins, is dependent on accurate staging. It also results in a reduction in local recurrence rates and improvement in survival by reducing or eliminating the metastatic potential of local recurrences (39,40).
Gastrointestinal cancers and stomas
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Timothy Pearman, Elizabeth L. Addington
GI cancers may be treated with surgery, chemotherapy, radiation therapy, or a combination of these approaches. Surgery is the most common treatment for early-stage colorectal cancer. Chemotherapy is often given either pre-surgery (neoadjuvant) or post-surgery (adjuvant) for patients whose cancer has penetrated the bowel wall or spread to lymph nodes. Chemotherapy is often combined with radiation therapy for rectal cancer. Treatment is similar for metastatic colorectal cancer but may be combined with targeted therapy or immunotherapy. Optimal therapy approaches for oesophageal cancer are still debated, but typically include multimodal treatment (e.g., chemotherapy and/or radiation therapy, sometimes followed by surgical resection) [5]. Additional information on GI cancer types and treatment, as well as their side effects, is provided in Recommended readings and in Handout 4.1.
CRCBaSe: a Swedish register-based resource for colorectal adenocarcinoma research
Published in Acta Oncologica, 2023
Caroline E. Weibull, Sol Erika Boman, Bengt Glimelius, Ingvar Syk, Peter Matthiessen, Karin E. Smedby, Caroline Nordenvall, Anna Martling
Table 2 shows some of the most important clinical and tumor characteristics for the CRC patients according to their first recorded diagnosis, stratified on localization (and for rectal cancer also on calendar period of diagnosis: 1995–2006/2007–2016). In 2007, colon cancer was added to the register, the number of registered variables increased substantially, and the name of the register was changed to SCRCR. The distribution of colon and rectal cancer across all years was similar, with 39,132 (51%) first colon and 37,699 (49%) first rectal cancers, whereas during the years where both tumor locations were included (2007–2016), the majority was colon cancers (67%). Among colon cancer patients, the stage distribution was 42% stage I–II, 27% stage III, and 26% stage IV. For rectal cancer patients diagnosed 2007–2016, stage was distributed as 42%, 23%, and 24% for stage I–II, III, and IV, respectively.
Outcomes of perineal wound closure techniques after abdominoperineal resections in rectal cancer: an NSQIP propensity score matched study
Published in Journal of Plastic Surgery and Hand Surgery, 2023
Jose L. Cataneo, Sydney A. Mathis, Diana D. del Valle, Alejandra M. Perez-Tamayo, Anders F. Mellgren, Gerald Gantt, Lee W. T. Alkureishi
Abdominoperineal resection (APR) is a prevalent surgical approach for low-lying rectal tumors when complete en bloc resection or sphincter-sparing resection is not feasible [1]. This technique requires removal of tissue from the sigmoid colon to the anal verge in addition to the surrounding perineal soft tissue through abdominal and perineal incisions [2,3]. Locally advanced rectal cancer is generally treated with neoadjuvant chemotherapy and radiation therapy with subsequent surgical resection [4]. Extensive excision can lead to complex pelvic defects that require advanced closure techniques from colorectal and plastic and reconstructive surgeons. Intra- and extra-abdominal approaches exist within the operative repertoire to aid in wound closure. Omental pedicle flaps and myocutaneous flaps serve to obliterate pelvic dead space and provide well-vascularized tissue to the defect to promote wound healing and mitigate postoperative complications [5].
Temporal Changes of Low Anterior Resection Syndrome Score after Sphincter Preservation: A Prospective Cohort Study on Repetitive Assessment of Rectal Cancer Patients
Published in Journal of Investigative Surgery, 2022
George E. Theodoropoulos, Artemis Liapi, Basileios G. Spyropoulos, Eleni Kourkouni, Maximos Frountzas, George Zografos
It is well documented that rectal cancer patients are the most vulnerable for gastrointestinal dysfunction symptoms among all patients who are operated for a large bowel malignancy [22]. However, functional restoration and preservation have long stopped being “overshadowed” by the improved oncologic results and have officially been incorporated among the goals of the “lege artis” rectal cancer radical resection. The need for maintaining an optimal postoperative bowel and pelvic function came as a continuum to the higher rates of sphincter preservation. Although sphincter function may be maintained, reduced neorectal and maximum tolerated volume, as well as increased frequency and urgency of bowel movements may predominate, leading to the LARS [23]. The availability of reporting tools for LARS, used independently and not “eclipsed” by recurrence and mortality-dependent oncologic outcomes have led to a more realistic estimation of the true burden and functional impact of LARS [10]. In the current study the accurate, brief and easily to apply LARS questionnaire, which synchronously scores the five most bothersome LARS symptoms, was utilized after its global acceptance and its validation in the Greek patients’ population [10]. LARS score symptoms are easily appreciated by patients, who are able to give a clear answer regarding their presence and their frequency; that was evident by our limited experience with the small percentage of patients’ interviews completed by phone, which, although may confer a bias, was accepted for the purpose of an uninterrupted completeness of the patients’ functional follow-up.