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Pelvic exenteration and rectal cancer

Tao Wu, Long Wen, Jixin Zhang, Yingchao Wu, Yong Jiang, Guowei Chen, Xin Wang, Shanjun Huang, Yuanlian Wan
OBJECTIVE: To investigate the value of neoadjuvant chemoradiotherapy (nCRT) combined with total pelvic exenteration (TPE) in the treatment of primary T4b rectal cancer. METHODS: A retrospective cohort study was conducted to analyze the clinicopathological data of 31 patients with primary T4b rectal cancer who underwent TPE from January 2008 to December 2015 at Peking University First Hospital. INCLUSION CRITERIA: preoperative clinical stage (cTNM) was defined as cT4b primary rectal cancer with only front wall Invasion; the lower edge of tumor was within 10 cm from the anal margin; TPE was performed; R0 resection was confirmed by pathology...
January 25, 2019: Zhonghua Wei Chang Wai Ke za Zhi, Chinese Journal of Gastrointestinal Surgery
Toshio Fujimoto, Fumie Tanuma, Noriyuki Otsuka, Soromon Kataoka
The present report describes a case of laparoscopic posterior pelvic exenteration of a primary adenocarcinoma of the rectovaginal septum (PARS) without associated endometriosis. A 49-year-old woman was admitted to hospital for rectal bleeding. Imaging studies showed a 7-cm solid tumor located in the rectovaginal septum, presenting with invasion to the posterior aspect of the uterine cervix and the anterior rectal wall. The patient received laparoscopic posterior exenteration and rectosigmoid anastomosis followed by chemotherapy...
January 2019: Molecular and Clinical Oncology
Adrian Bartos, Dana Bartos, Raluca Stoian, Bianca Szabo, Cristian Cioltean, Ioana Iancu, Calin Molnar, Nadim Al Hajjar, Cosmin Puia, Cornel Iancu, Caius Breazu
INTRODUCTION: Although multi-organ resections (MOR) are recommended by international guidelines for advanced colorectal cancer, the literature shows that the morbidity and mortality that accompanies these complex interventions limits the number of patients receiving this treatment. The purpose of our study was to analyse the immediate and remote results obtained after MOR and to identify potential factors that might influence the outcome. MATERIAL AND METHOD: Our study is a retrospective cohort which included patients surgically treated in our service for locally advanced colorectal cancer...
2018: Annali Italiani di Chirurgia
Gianluca Pellino, Sebastiano Biondo, Antonio Codina Cazador, José María Enríquez-Navascues, Eloy Espín-Basany, Jose Vicente Roig-Vila, Eduardo García-Granero
AIM: To identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database. METHODS: Few studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS)...
December 7, 2018: World Journal of Gastroenterology: WJG
Rajendra B Nerli, Shridhar C Ghagane, Prasanna Ram, S S Shimikore, Kumar Vinchurkar, Murigendra B Hiremath
Involvement of the bladder by colorectal cancer is sufficiently rare to be encountered by an individual surgeon on an infrequent basis. Extirpative procedures for advanced colorectal cancers can involve partial/total bladder resections. In patients without evidence of distant metastatic disease, a reasonable therapeutic effect can be expected when negative surgical margins are obtained. The decision to perform a bladder-sparing procedure or a total pelvic exenteration (TPE) will be based on the extent of the primary lesion as well as patient characteristics...
December 2018: Indian Journal of Surgical Oncology
E Platt, G Dovell, S Smolarek
BACKGROUND: Pelvic exenteration represents the best treatment option for cure of locally advanced or recurrent rectal cancer. This systematic review sought to evaluate current literature regarding short and long term treatment outcomes and long term survival following pelvic exenteration. METHODS: A systematic search of the MEDLINE, PubMed and Ovid databases was conducted to identify suitable articles published between 2001 and 2016. The article search was performed in line with Cochrane methodology and reported according to the Preferred Reporting Items for Systematic reviews and Meta-analyses statement...
November 2018: Techniques in Coloproctology
A M Mehta, G Hellawell, D Burling, S Littler, A Antoniou, J T Jenkins
BACKGROUND: Complete pathological resection of locally advanced and recurrent anorectal cancer is considered the most important determinant of survival outcome. Involvement of the retropubic space with cancer threatening or involving the penile base poses specific challenges due to the potential for margin involvement and blood loss from the dorsal venous plexus. In the present study we evaluate a new transperineal surgical approach to excision of anterior compartment organs involved or threatened by cancer which facilitates exposure and visualisation of the bulbar urethra and the deep vein of the penis caudal to the retropubic space and penile base...
September 2018: Techniques in Coloproctology
D Steffens, M J Solomon, J M Young, C Koh, R L Venchiarutti, P Lee, K Austin
Background: Pelvic exenteration (PE) is the preferred treatment available for selected patients diagnosed with locally advanced or recurrent cancer confined to the pelvis. Currently, the majority of the literature reports only on short-term survival and quality-of-life (QoL) outcomes. The aim of this prospective cohort study was to describe long-term survival and QoL outcomes following PE. Methods: This was a cohort study of consecutive patients undergoing PE from 1994 to 2016 at a major teaching hospital in Sydney, Australia...
September 2018: BJS open
Friederike Haidl, Axel Heidenreich
If prostate cancer recurs after primary treatment, deprivation therapy with LHRH analogues or antagonists is the treatment of choice in men with metastatic prostate cancer. However, this treatment only achieves palliative results. Median time to progression ranges between 11 and 78 months. After the introduction of Docetaxel as a first-line treatment in castration-resistant prostate cancer (CRPCA) and cabazitaxel as a second-line chemotherapy, several new drugs containing abiraterone, enzalutamide, radium 223 and sipuleucel-T have become available, which can lead to complete or partial remissions in metastasis, but do not have an effect on the prostate itself as has been shown recently...
September 2018: Aktuelle Urologie
J A W Hagemans, J Rothbarth, W J Kirkels, J L Boormans, E van Meerten, J J M E Nuyttens, E V E Madsen, C Verhoef, J W A Burger
BACKGROUND: Total pelvic exenteration (TPE) is a radical approach for locally advanced rectal cancer (LARC) and locally recurrent rectal cancer (LRRC) in case of tumour invasion into the urogenitary tract. The aim of this study is to assess surgical and oncological outcomes of TPE for LARC and LRRC in elderly patients compared to younger patients. METHODS: All patients who underwent TPE for LARC and LRRC between January 1990 and March 2017 were retrospectively analyzed...
October 2018: European Journal of Surgical Oncology
K Verma, R Engineer, V Ostwal, S Kumar, S Arya, A L Desouza, A P Saklani
AIM: Involvement of the anterior mesorectal fascia (iAMRF) after neoadjuvant treatment leads to either resection of the involved organ alone [extended resection of the rectum (ERR)] or total pelvic exenteration (TPE). The purpose of this study was to compare the rate of recurrence and survival of patients undergoing ERR or TPE for iAMRF after neoadjuvant treatment. The outcome of patients who underwent total mesorectal excision after downstaging was also compared. METHOD: This was a retrospective study of primary rectal cancer patients...
July 9, 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
G H van Ramshorst, S O'Shannassy, W E Brown, J G Kench, M J Solomon
AIM: Pelvic exenteration surgery remains the only curative option for recurrent rectal cancer. Microscopically involved surgical margins (R1) are associated with a higher risk of local recurrence and decreased survival. Our study aimed to develop a post hoc multidisciplinary case conference review and investigate its potential for identifying areas for improvement. METHOD: Patients who underwent pelvic exenteration surgery for recurrent rectal cancer with R1 resections at a tertiary referral centre between April 2014 and January 2016 were retrospectively reviewed from a prospectively maintained database...
November 2018: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Ashish Pokharkar, Praveen Kammar, Ashwin D'souza, Rahul Bhamre, Pavan Sugoor, Avanish Saklani
BACKGROUND: Since last two decades minimally invasive techniques have revolutionized surgical field. In 2003 Pomel first described laparoscopic pelvic exenteration, since then very few reports have described minimally invasive approaches for total pelvic exenteration. METHODS: We report the 10 cases of locally advanced rectal adenocarcinoma which were operated between the periods from March 1, 2017 to November 11, 2017 at the Tata Memorial Hospital, Mumbai. All male patients had lower rectal cancer with prostate involvement on magnetic resonance imaging (MRI)...
May 9, 2018: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
Tomohiro Yamaguchi, Yusuke Kinugasa, Akio Shiomi, Hiroyasu Kagawa, Yushi Yamakawa, Akinobu Furutani, Shoichi Manabe, Yusuke Yamaoka, Hitoshi Hino
BACKGROUND: The long-term outcomes of robotic-assisted laparoscopic lateral lymph node dissection (RALLD) have not been fully investigated. This study aimed to assess the oncological and long-term outcomes of RALLD for rectal cancer through comparison with those of open lateral lymph node dissection (OLLD) in a retrospective study. METHODS: Between September 2002 and October 2014, the medical data of 426 patients who underwent total mesorectal excision with lateral lymph node dissection for primary rectal cancer were collected...
November 2018: Surgical Endoscopy
Charnjiroj Thiptanakit, Irin Chowchankit, Sirinya Panya, Prapon Kanjanasilp, Songphol Malakorn, Jirawat Pattana-Arun, Chucheep Sahakitrungruang
BACKGROUND: Pelvic exenteration carries significant risks of morbidity and mortality. Preoperative management is therefore crucial, and the exenteration procedure is usually performed in an elective setting. In cases of rectal cancer, however, tumor-related complications may cause a patient's condition to deteriorate rapidly, despite optimal management. Urgent pelvic exenteration then may be an option for these patients. OBJECTIVE: This study aims to compare the outcomes of pelvic exenteration between the urgent and elective settings...
May 2018: Diseases of the Colon and Rectum
(no author information available yet)
BACKGROUND: Pelvic exenteration for locally recurrent rectal cancer (LRRC) is associated with variable outcomes, with the majority of data from single-centre series. This study analysed data from an international collaboration to determine robust parameters that could inform clinical decision-making. METHODS: Anonymized data on patients who had pelvic exenteration for LRRC between 2004 and 2014 were accrued from 27 specialist centres. The primary endpoint was survival...
May 2018: British Journal of Surgery
Marilla Dickfos, Stephanie B M Tan, Andrew R L Stevenson, Craig A Harris, Rachel Esler, Matthew Peters, David G Taylor
BACKGROUND: Over one-third of primary rectal cancers are locally advanced at diagnosis, and local recurrence of rectal cancer occurs at a rate of 3-10% following primary curative resection. Extended resectional surgery, including pelvic exenteration, is the only proven therapy with curative potential in the treatment of these cancers along with many other pelvic malignancies. A microscopically clear resection margin (R0 resection) is the predominant prognostic factor affecting overall and disease-free survival...
March 6, 2018: ANZ Journal of Surgery
Tatsuya Matsumoto, Masayoshi Nakanishi, Mahito Miyamae, Koji Takao, Tomohiko Fukunaga, Eigo Otsuji
A 63-year-old man with bloody stools, anal incompetence, and feeling of fatigue was diagnosed as having a RAS mutanttype rectal cancer with abscess and rectovesical fistula. Computed tomography revealed that the tumor had invaded the seminal vesicle, prostate, and bladder and formed an abscess. In addition, his general condition was poor. Thus, we evaluated the lesion as unresectable. His nutritional status improved, and the infection was controlled after colostomy. Then, we performed chemotherapy with 5-fluorouracil, Leucovorin, and oxaliplatin(FOLFOX)plus bevacizumab...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Nobuhiro Takiguchi, Hiroaki Soda, Toru Tonooka, Atsushi Ikeda, Yoshihiro Nabeya, Isamu Hoshino, Ryotaro Teranaka, Tadamichi Denda
Preoperative chemotherapy has been performed for locally advanced colorectal cancer, to achieve cytoreduction, local control, and prevention of distant metastasis. The regimens of mFOLFOX6/XELOX plus bevacizumab for 3 months have been adopted to succeed curative resection for borderline resectable colorectal cancer. We examined treatment results for locally advanced colorectal cancer without distant metastasis. Thirty-four patients were examined and the mean age was 62.7 years old. The cohort comprised of 23 cases of rectal cancer and 11 of sigmoid colon cancer...
November 2017: Gan to Kagaku Ryoho. Cancer & Chemotherapy
Masatoshi Nomura, Hidekazu Takahashi, Naotsugu Haraguchi, Junichi Nishimura, Taishi Hata, Chu Matsuda, Hirofumi Yamamoto, Tsunekazu Mizushima, Yuichiro Doki, Masaki Mori
The patient was a 47-year-old man, whose chief complaint was melena. He visited a nearby hospital, and further evaluation showed rectal cancer invading the prostate, with multiple lung and liver metastases. The clinical diagnosis was cT4b(prostate), cN1, cM1b(H2, PUL2), cStage IV . We performed colostomy in the transverse colon prior to chemotherapy. He was administered 1 course of mFOLFOX6 plus bevacizumab and 7 courses of FOLFOXIRI plus bevacizumab. The primary tumor showed PR. The liver metastases were localized and shrunken, while the lung metastases disappeared...
January 2018: Gan to Kagaku Ryoho. Cancer & Chemotherapy
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