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Transanal Total Mesorectal Excision for Rectal Cancer
Published in Haribhakti Sanjiv, Laparoscopic Colorectal Surgery, 2020
Colorectal cancer is the third-most common cancer worldwide with an estimated 1.8 million new cases and over 860,000 deaths in 2018 [1]. Rectal cancer accounts for approximately 40% of these cancers. Surgery for rectal cancer is a challenge due to the difficulty in obtaining access to and exposure of the distal rectum, particularly in obese male patients. Surgical treatment of rectal cancer has progressed significantly since Miles described the abdominoperineal resection (APR) in 1908 [2]. In the 1980s, Heald popularized the technique of total mesorectal excision (TME), which has now become the gold standard for oncologic resections [3]. TME dissection along the fascia propria ensures an intact mesorectum with negative distal (DRM) and circumferential resection margins (CRM), both of which are associated with decreased locoregional recurrence and improved disease-free survival [4,5].
Gastrointestinal cancer
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
Abdominoperineal resection may be required for the lowest rectal tumours, but in many cases it can be avoided with current surgical techniques. In each case, the mesentery containing the regional lymph nodes is also resected.
The Large Bowel and the Anal Canal
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
In an attempt to improve the survival, Nigro and associates104 were the first to report on the use of preoperative chemoirradiation therapy in invasive epidermoid carcinoma of the anal canal. This preoperative program consists of the administration of 5-FU 1000 mg/m2 body surface over 24 hr by continuous i.v. infusion for 4 days, with i.v. bolus of mitomycin-C 15 mg/m2 on day #1. At the same time, the patient starts his irradiation course on day #1, receiving 200 rad/day, 5 days/week, to the primary tumor site, pelvis, and the inguinal lymph nodes. On days 29 through 32, another course of 5-FU is repeated. The patient then undergoes abdominoperineal resection which is to be performed 4 to 6 weeks after the last day of radiation therapy. Their results revealed that there was no residual tumor in the resected specimen, with a 78% survival rate. Such findings have been confirmed by others.105 Therefore, the new approach to epidermoid carcinoma of the anal canal is Nigro’s program followed by reevaluation. If no residual tumor can be detected clinically and by rebiopsy of the scar (the site of the previous biopsy), the patient can be closely observed. On the other hand, those found to have residual tumor should undergo surgery. This approach results in moderate to severe toxicity in the form of proctitis, leukopenia, and thrombocytopenia, but no serious complications were observed.
Should minimally invasive approaches in rectal surgery be regarded as a key element of modern enhanced recovery perioperative care?
Published in Acta Chirurgica Belgica, 2023
Petr Kocián, Filip Pazdírek, Petr Přikryl, Tomáš Vymazal, Jiří Hoch, Adam Whitley
Length of stay was significantly shorter in patients who had the combination of ERAS care and minimally invasive surgery. The median length of hospital stay for these patients was 9 days compared to 13 days for patients who underwent open surgery with standard care. Nonetheless, in comparison to other studies in the literature this length of hospital stay is relatively long. This is partially due to large proportion of abdominoperineal resections, protective ileostomies, and terminal colostomies performed: abdominoperineal resections constituted 21%, protective ileostomies 25%, and terminal colostomies 24% of the patients undergoing minimally invasive procedures. Abdominoperineal resection belongs to the most invasive of rectal procedures and has a longer reconvalescence period than other rectal procedures. The perineal wound is prone to healing complications, particularly in patients after neoadjuvant treatment [14]. In some centres, abdominoperineal resections are excluded from ERAS protocols [15]. Patients with stomas have to be educated by a stoma care nurse before discharge on how to take care of their stomas and patients with ileostomies are prone to electrolyte abnormalities for a variable period of time in the immediate postoperative period and can only be discharged after this has normalised. In contrast to studies with much shorter lengths of hospital stay our readmission rate was low and did not differ between the three patient groups [16–18]. This is a benefit of the longer hospitalisation rate; complications that would otherwise require re-hospitalisation happened during the primary hospital stay.
Short-term advantages of ELAPE over APR
Published in Acta Chirurgica Belgica, 2021
Géza Papp, Kristóf Dede, Attila Bursics
For a long time the standard surgical procedure of the low rectal cancers was abdominoperineal resection (APR) described by Miles [1]. Oncological definition of R0 resection is achieving tumour free circumferential resection margin (CRM) and the absence of the intraoperative tumour perforation (IOTP) during surgery [2]. A negative CRM and avoiding IOTP decrease the risk of local tumour recurrence and improve both overall survival (OS) and disease-free survival (DFS) [3,4]. Short-term goal is to minimise the perioperative complications. The possible complications are haemorrhage, injuries of the adjacent anatomical structures (urinary tract, vagina, pelvic nerves), other abdominal complications (bowel obstruction, haematoma formation) – but the most frequent complication is the perineal wound infection [5].
Outcomes with anti-EGFR monoclonal antibodies in metastatic and recurrent anal squamous cell carcinoma
Published in Expert Review of Anticancer Therapy, 2020
Jane E. Rogers, Alexandre A. A. Jácome, Aki Ohinata, Robert Wolff, Van K. Morris, Benny Johnson, Amir Mehdizadeh, Nicole D. Rothschild, Shahab U. Ahmed, Jennifer L. Guerra, Cathy Eng
Anal cancer occurs in 2.7% of all digestive system cancers with an estimated 8300 new cases diagnosed in 2019 in the United States [1,2]. Anal cancer is predominantly of squamous cell histology and is often associated with human papillomavirus (HPV) [1–3]. HPV remains a healthcare concern, as reports continue to show suboptimal vaccination completion rates (<50%) among female and male adolescents, therefore, HPV-driven malignancies will continue to occur for the next decade [4]. The majority of squamous cell carcinoma of the anal canal (SCCA) cases are diagnosed in the localized setting (48%), confined to the primary anal site, or to the locally advanced regional setting (32%), spread to regional lymph nodes [5]. These patients are candidates for curative intent with combined definitive chemoradiation (CRT) consisting of a fluoropyrimidine [5-fluorouracil (5-FU) or capecitabine] plus mitomycin or cisplatin [1,3]. Those with persistent or recurrent disease following CRT are recommended to proceed with salvage abdominoperineal resection. Five-year survival rates for local and locally advance regional disease are 81.7% and 64.9%, respectively [5].