bluuebunny/crossref_metadata_2025_split huggingface dataset:
Total mesorectal excision for rectal cancer – what can be achieved by a national audit?
Authors: Wibe A. , Eriksen M T. , Syse A. , Myrvold H E. , Søreide O. ,   on behalf of The Norwegian Rectal Cancer Group
Published: August 2003

AbstractObjective  The results of rectal cancer surgery in Norway have been poor. In a national audit for the period 1986–88, 28% of the patients developed local recurrence (LR) following treatment with a curative intent. Five‐year overall survival was 55% for patients younger than 75 years. The aim of this study is to report how an initiative focusing on better surgery can improve the prognosis for rectal cancer patients on a national level.Methods  In 1994, the Norwegian Rectal Cancer Group was founded. The aim of this initiative was to improve the surgical standard by implementing total mesorectal excision (TME) on a national level and to evaluate the results. A number of courses were arranged to teach the surgeons the TME technique, and pathologists were trained to increase the standard of both macroscopic and microscopic assessment of specimens. A rectal cancer registry was established, and all surgical departments treating rectal cancer were invited to transfer their clinical data to this registry. Each department regularly receives its own results together with the national average for comparison and quality control.Results  The Rectal Cancer Registry includes all patients with rectal cancer diagnosed since November 1993. From then until December 1999, 5382 patients had a tumour located within 16 cm from the anal verge, and 3432 patients underwent rectal resection with a curative intent. Of these, 9% had adjuvant radiotherapy, and 2% were given chemotherapy. There was a rapid implementation of the new technique, as 78% underwent TME in 1994, increasing to 96% in 1998. After 39 months mean follow‐up the rate of local recurrence was 8%, and 5‐year overall survival was 71% for patients younger than 75 years.Conclusions  An optimized surgical technique (TME) for rectal cancer can reduce the rate of local recurrence and increase overall survival. This improved surgical treatment can be implemented on a national level within a few years. Specialization of surgeons, feedback of results and a separate rectal cancer registry are thought to be major contributors to the improved treatment.
Surgery for locally recurrent rectal cancer
Authors: Wiggers T. , Mannaerts G. H. H. , Marinelli A. W. K. S. , Martijn H. , Rutten H. J. T. 
Published: August 2003

AbstractAfter the diagnosis of a locally recurrent rectal cancer, imaging is the first step to estimate the extent and location of the local tumour growth and the presence or absence of distant metastases. The aim of the treatment is a R0 resection (microscopically tumour free circumferential margin) by multimodality treatment consisting of pre‐operative radiation, extended resection and intra‐operative radiotherapy by either electron beam irradiation or with high dose rate brachytherapy. Filling the pelvic cavity with vital tissue such as an omentoplasty should considered carefully. With this treatment the overall three‐year survival rate of a group of 33 patients was 60% with a local control rate of 73%. The combination of chemotherapy as a radiosensitizer resulted in an increase of R0 resections by 20%. Introduction of TME surgery and pre‐operative radiotherapy has created a new situation with limited possibilities due to dose‐accumulation toxicity of the radiotherapy and extensive scarring of the tissues making estimation of the extent of the tumour growth more difficult. The prevention of local recurrence by proper selection of primary cases, the training of experienced surgeons and the optimal use of pre‐operative radiotherapy is the way forward to improve results.
Ultralow anterior resection with intersphincteric dissection –what is the limit of safe sphincter preservation?
Authors: Tiret E. , Poupardin B. , McNamara D. , Dehni N. , Parc R. 
Published: August 2003

AbstractIntroduction  In the treatment of low rectal cancer, the possibility of sphincter preserving surgery is increased by partial sphincteric resection which may allow an oncologically safe resection margin in some patients who would traditionally have been treated by abdominoperineal resection. The aim of this study is to evaluate the morbidity, mortality and the oncological and functional results of intersphincteric resection to determine whether the technique may be considered a safe means of sphincter preservation.Methods  Between May 1992 and December 1999, 26 patients (mean age 55 years, range 28–82) with adenocarcinoma of the rectum had partial sphincteric resection by an abdominal approach with a colonic J‐pouch anal anastomosis. The mean distance between the tumour and the anal verge 4.25 (range 3.1–5.25) cm. Four tumours were T1, 14 T2 (3 N+), 7 T3 (3 N+), and 1 T4 (N+). Neoadjuvant radiotherapy was used in 10 patients. The distal resection margin was positive in one patient who then proceeded to safe abdominoperineal resection (APR). In the remaining patient the mean distal resection margin on the fixed specimen was 1.6 (range 0.3–3.5) cm.Results  There were no deaths. Morbidity was 30% with an anastomotic leak rate of 11%. At mean follow‐up of 39 (range 11–93) months the local recurrence rate was 3.4%. Functional results were evaluated in 25 patients at mean follow‐up of 27 (8–66) months: 65% had 0–2 bowel motions per 24 h, 31% had 3–5 and 4% between 6 and 9. Nine patients (36%) had nocturnal defecation. Continence was normal in 50% with 23% reporting incontinence to gas and 27% reporting minor episodes of incontinence. None had major incontinence and 85% considered their outcome satisfactory.Conclusion  This study supports the current literature indicating that partial sphincteric resection is an oncologically and functionally safe alternative to abdominoperineal resection for some selected low rectal tumours.
Adjuvant vs. neoadjuvant radiochemotherapy for locally advanced rectal cancer: the German trial CAO/ARO/AIO‐94
Authors: Sauer R. , Fietkau R. , Wittekind C. , Rödel C. , Martus P. , Hohenberger W. , Tschmelitsch J. , Sabitzer H. , Karstens J.‐H. , Becker H. , Hess C. , Raab R. ,   for the German Rectal Cancer Group
Published: August 2003

AbstractAim  The standard treatment for patients with clinically resectable rectal cancer is surgery. Postoperative radiochemotherapy (RCT) is recommended for advanced disease (pT3/4 or pN+). In recent years, encouraging results of pre‐operative radiotherapy have been reported. This prospective randomized phase‐III‐trial (CAO/ARO/AIO‐94) compares the efficacy of neoadjuvant RCT to standard postoperative RCT. We report on the design of the study and first results with regard to toxicity of RCT and postoperative morbidity.Patients and methods  Patients with locally advanced operable rectal cancer (uT3/4 or uN+, Mason CS III/IV) were randomly assigned to pre or postoperative RCT: A total dose of 50.4 Gy (single dose 1.8 Gy) was applied to the tumour and the pelvic lymph nodes. 5‐FU (1000 mg/m2/d) was administered concomitantly in the 1th and 5th week of radiation as 120 h‐continuous infusion. Four additional cycles of 5‐FU‐chemotherapy (500 mg/m2/d, i.v.‐bolus) were applied. RCT was identical in both arms except for a small‐volume boost of 5.4 Gy postoperatively. The time interval between RCT and surgery was 4–6 weeks in both arms. Techniques of surgery were standardized and included total mesorectal excision. Primary endpoints of the study are 5‐year survival and local and distant control. Secondary endpoints include the rate of curative (R0) resection and sphincter saving procedures, toxicity of RCT, surgical complications and quality of life.Results  As of July 2002, 805 patients were randomized from 26 participating institutions. Acute toxicity (WHO) of RCT was low, with less than 15% of patients experiencing grade 3 or higher toxicity: The principal toxicity was diarrhea, with 12% in the postoperative RCT‐arm and 11% in the pre‐operative RCT‐arm having grade 3‐, and 1% in either arm having grade 4‐diarrhea. Erythema, nausea and leukopenia were the next common toxicities, with less than 3% of patients in either arm suffering grade 3 or greater leukopenia or nausea. Postoperative complication rates were similar in both arms, with 12% (postop. RCT) and 12% (pre‐op. RCT) of patients, respectively, suffering from anastomotic leakage, 3% (postop. RCT) and 3% (pre‐op. RCT) from postoperative bleeding, and 6% (postop. RCT) and 4% (pre‐op. RCT) from delayed wound healing.Conclusion  The patient accrual to the trial is satisfactory. Neoadjuvant RCT is well tolerated and bears no higher risk for postoperative morbidity.
Anal and rectal cancer in Crohn's disease
Authors: Sjödahl R. I. , Myrelid P. , Söderholm J. D. 
Published: August 2003

AbstractSeveral epidemiological studies have been published regarding the risk of Crohn's disease‐ associated colorectal cancer. The findings are, however, contradictory and it has been particularly difficult to obtain indisputable information on the incidence of cancer limited to the rectum and the anus. During 1987–2000 rectal or anal cancer was diagnosed in 335 patients in Sweden (153 males, 182 females). In other words, approximately 3 Crohn patients per million inhabitants were diagnosed with rectal or anal cancer every year during that time period which is 1% of the total number of cases. At diagnosis of cancer 36% were aged below 50 years and 58% below 60 years. Corresponding figures for all cases of anal and rectal cancer were 5% and 18%, respectively.Present knowledge from the literature implies that there is an increased risk of rectal and anal cancer only in Crohn's disease patients with severe proctitis or severe chronic perianal disease. However, the rectal remnant must also be considered a risk factor. Multimodal treatment is similar to that in sporadic cancer but proctectomy and total or partial colectomy is added depending on the extent of the Crohn's disease. The outcome is the same as in sporadic cancer at a corresponding stage but the prognosis is often poor due to the advanced stage of cancer at diagnosis.We suggest that six high‐risk groups should be recommended annual surveillance after a duration of Crohn's disease of 15 years including extensive colitis, chronic severe anorectal disese, rectal remnant, strictures, bypassed segments and sclerosing cholangitis.
Aggressive surgical treatment for patients with T4 rectal cancer
Authors: Moriya Y. , Akasu T. , Fujita S. , Yamamoto S. 
Published: August 2003

AbstractObjective  To investigate the outcome of surgical treatment for patients with T4 rectal cancer and to evaluate prognostic factors influencing 5‐year disease‐free survival.Patients  Of 1600 rectal cancers seen between 1985 and 1998, there were 197 patients with T4 of whom 128 were treated with curative intent. In this retrospective study organ invaded, the type of treatment and outcome were analysed.Results  Of the 128 patients, 89% had visceral involvement and 11% had pelvic wall involvement. The most frequently involved organ was bladder, followed by prostate and vagina. Low anterior resection was performed in 52, abdomino‐perineal resection in 35 and total pelvic exenteration in 41 patients. Of 81 with urinary tract invasion, 50% were treated with bladder‐sparing surgery. Pathological examinations showed bladder involvement in only 44 of these and overall 5‐year disease‐free survivial was 57%. Multivariate analysis revealed that body mass index, lymph node metastasis and inflammatory reaction were significant predictors of survivial.Conclusion  Completeness of resection is the essential factor influencing oncological outcome.
Local curative treatment of rectal cancer by radiotherapy alone
Authors: Gérard J. P. , Romestaing P. , Baulieux J. , Benchimol  
Published: August 2003

AbstractThis paper is a short overview of the role of radiotherapy alone to locally control rectal cancer when surgery for any reason cannot be performed. High dose irradiation is necessary using endocavitary (contact X‐ray, iridium brachytheraphy) techniques. For T2‐3 lesions a combination of external beam radiotherapy and endocavitary irradiation can provide long term cure with limited toxicity.Surgery remains, by far, the main treatment of rectal cancer, preoperative radiotherapy may be used in low rectal cancer to improve the chance of sphincter saving procedure.
Managing rectal cancer: the Dutch experience
Authors: Peeters K. C. M. J. , Kapiteijn E. , Van De Velde C. J. H. ,   on behalf of the Dutch ColoRectal Cancer Group
Published: August 2003

AbstractOne of the major problems in the treatment of rectal cancer has been the inability to achieve local control. Traditional surgery, now outmoded, involves blunt digital dissection and was associated with a high incidence of local recurrence. In an attempt to improve local control and survival, many adjuvant treatment modalities have been investigated. In the context of conventional nonstandardized surgical procedures, pre‐operative radiotherapy has been shown to improve local control and overall survival.In recent years treatment outcome has been extensively improved by the introduction of the TME technique first described by Heald. This has resulted in such low recurrence rates and improved survival that the question had to be answered whether pre‐operative short‐term radiotherapy is still beneficial in TME treated patients. The question was answered in the TME trial set up by the Dutch ColoRectal Cancer Group that randomised between standardized and quality‐controlled TME surgery alone and TME surgery preceded by short‐term pre‐operative radiotherapy.This paper reviews the developments in the treatment of resectable rectal cancer, highlights the results from the Dutch TME trial, and considers future directions in improving outcome.
Resection of liver metastases from colorectal cancer – how can we improve results?
Authors: Nordlinger B. , Peschaud F. , Malafosse R. 
Published: August 2003

AbstractResection of liver metastases due to large bowel cancer has become an important part of treatment. In recent years, there have been advances in technique and the selection of patients has been extended. Surgery is the only modality which currently offers the possibility of long‐term survival. Resection combined with chemotherapy may offer improved survival, but more data are needed. Chemotherapy may cause regression of metastases to permit resection where initially they were considered unresectable. The data available from such studies are presented.
Predicting risk and diminishing the consequences of anastomotic dehiscence following rectal resection
Authors: Alberts J. C. J. , Parvaiz A. , Moran B. J. 
Published: August 2003

AbstractAnastomotic dehiscence is a serious, life‐threatening complication of any rectal anastomosis and may be associated with an increased risk of local cancer recurrence. The leak rate following low anterior resection is in the region of 10% as supported by the recent randomised Dutch rectal cancer trial. Although accurate prediction of risk is impossible, certain factors are known to influence leak rates. There is an inverse relationship between the height of anastomoses from the anal verge and leak rate, with the lower anastomoses carrying the highest risk. Proximal defunctioning mitigates the consequences of leakage but does not abolish risk. There is little difference in rates of dehiscence between stapled and sutured colorectal anastomoses. A short colon pouch may reduce the chance of leakage. The highest risks are in unprotected anastomoses less than 5 cm from the anal verge in men who smoke and/or drink excessively, particularly if they have received pre‐operative chemotherapy or chemo‐radiotherapy. A high index of suspicion is required in detecting the early nonspecific signs of a leak and urgent surgical intervention is usually required to avert a life‐threatening situation. Judicious use of faecal diversion should never be regarded as surgical timidity.
Endorectal ultrasound in rectal cancer
Authors: Hünerbein M. 
Published: August 2003

AbstractAccurate staging of rectal carcinoma is crucial for planning surgery and the indication for adjuvant therapy. Although computed tomography and magnetic resonance imaging are very sensitive in the detection metastastic disease, local staging of rectal cancer with these techniques has been disappointing.Endorectal ultrasound (EUS) remains the most accurate method for staging of rectal cancer. High accuracy rates in the assessment of the depth of infiltration (T stage) (80–90%) and in the determination of the lymph node status (70–80%) have been confirmed in several studies. Continued research and development has made the instrumentation for EUS more accurate and user‐friendly. New techniques that have contributed significantly to the evolution of EUS include three‐dimensional EUS, high‐frequency miniprobes and transrectal ultrasound‐guided biopsy techniques. Further improvement can be expected by contrast enhancement with microbubbles and colour Doppler imaging.
FGD‐PET in the follow‐up of recurrent colorectal cancer
Authors: Selvaggi F. , Cuocolo A. , Sciaudone G. , Maurea S. , Giuliani A. , Mainolfi C. 
Published: August 2003

AbstractObjective  The current methods of detection of recurrent colorectal cancer after surgical treatment are inaccurate using conventional imaging. This study set out to detect early recurrence by means of PET in patients treated surgically for colorectal cancer by curative resection.Methods  Thirty‐one disease‐free patients were recruited and underwent FDG‐PET. The results were verified by clinical, surgical and radiological follow up and/or biopsy to evaluate the accuracy for detecting recurrence.Results  PET detected 6 sites of increased activity in 5 patients. Three of these underwent surgery. One was false positive with no evident tumour and two underwent an hepatic resection with removal of a homental metastasis. The sensitivity was 100% and specificity 83.3%. Clinical management was altered in two cases (6.4%).Conclusions  This study demostrates that PET is more accurate than conventional imaging for the evaluation of recurrence in colorectal cancer patients. FDG‐PET should be considered in the follow‐up of patients after treatment for colorectal cancer in addition to other imaging methods.
MRI in rectal cancer: the T stage and circumferential resection margin
Authors: Beets‐Tan R. G. H. 
Published: August 2003

AbstractDifferent stages of rectal cancer show differing degrees of risk for local recurrence. Paramount for the selection and differentiated treatment of the different risk groups is a reliable preoperative test that can distinguish between these subgroups. There is recent evidence suggesting that MRI can serve for this purpose, because it accurately predicts the circumferential resection margin. In this article the role of MRI in the preoperative management of rectal cancer patients will be discussed.
Palliative therapy of colorectal carcinoma: stent or surgery?
Authors: Bhardwaj R. , Parker M. C. 
Published: August 2003

Abstract“Surgical” palliation of obstructing colorectal carcinomas may involve resection with or without stoma formation, formation of a stoma alone, a colonic bypass procedure, or no procedure at all. Palliative surgical procedures confer a significant morbidity and mortality. Factors associated with increased mortality for colorectal cancer include advancing age of patient, advancing stage of the disease and the necessity for an emergency procedure. Advanced obstructing malignant lesions pose a clinical dilemma as the risks and time of recovery from surgery have to be balanced against providing a dignified quality of remaining life. Self expanding metal stents (SEMS) for acutely obstructing advanced colorectal carcinomas provide a cost effective option that avoids surgery in a usually frail group of patients. They can be inserted under sedation, rapidly decompress the colon and lead to an early return of colonic function. The procedure is carried out endoscopically with radiological assistance to determine a lumen and to confirm adequate stent placement. SEMS are not suitable for low rectal lesions and are more difficult to place in those that traverse colonic flexures. Complications from successful SEMS placement include migration and stent occlusion. The morbidity associated with SEMS is associated with migration or perforation of the colon during placement, pain and less commonly haemorrhage. Despite these problems most patients can be successfully decompressed without further endoscopic or surgical reintervention and allow satisfactory palliation.
How to treat the persistent perineal sinus after rectal excision
Authors: Pemberton J. H. 
Published: August 2003

AbstractAs surgery for more advanced and complex pelvic malignancies continues to expand to include larger and more exenterative techniques, dealing with the resulting pelvic and perineal defect has become an increasingly frequent necessity. The goal is both to close the defect and to accomplish complete healing. Methodology for managing the perineal wound, which results after proctocolectomy for cancer and more recently, after exenterative resection of the rectum, sacrum, uterus, vagina, bladder and larger areas of soft tissue (i.e. perineum), varies between simple closure on one hand and creation of complex gluteal and rectus abdominus flaps on the other. We examined these methodologies in terms of indications, technical details, complications and outcomes. Finally, the newest techniques for eliminating persistent perineal sinus tracts are detailed.
Technical and oncological feasibility of laparoscopic total mesorectal excision with pouch coloanal anastomosis for rectal cancer
Authors: Bretagnol F. , Rullier E. , Couderc P. , Rullier A. , Saric J. 
Published: August 2003

AbstractAim  The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic total mesorectal excision (TME) with coloanal anastomosis for mid and low rectal cancer.Methods  During a 2‐year period, 50 patients underwent laparoscopic TME with coloanal anastomosis for rectal carcinoma located at a median of 4.5 (range 2–11) cm from the anal verge. Pre‐operative radiotherapy was used in 46 patients. Intersphincteric dissection was combined with the laparoscopic procedure to achieve sphincter preservation.Results  Conversion to a laparotomy was necessary in six patients. Postoperative mortality and morbidity were 2% and 28%, respectively. Morbidity was lower in patients operated on during the second part of the study, who had extraction of the rectal specimen through a small laparotomy incision, than in those operated on during the first part of the study when removal of the specimen was by transanal extraction. Oncological quality of excision was safe in 44 patients with intact or almost intact rectal fascia in 88% and R0 resection in 90%. At a median follow‐up of 18 months, there was no local or port‐site recurrence.Conclusion  This study confirms our preliminary results of oncological feasibility of laparoscopic TME with sphincter preservation for mid and low rectal cancer, and showed that morbidity can be decreased by using a standardized surgical procedure.