RESUMEN
BACKGROUND: Intersphincteric resection can provide tumour-free margins for rectal tumours located 0-1 cm above the dentate line. However, the internal anal sphincter (IAS) is partially or totally resected and some degree of anal incontinence may develop. A novel technique of smooth muscle plasty of the IAS and colonic pouch construction is described, along with an assessment of morbidity, oncological results and functional outcome. PATIENTS AND METHODS: Between 1997 and 2002, 27 patients (16 men; median age 55 (range 26-75) years) were operated on for T2-3 N0-1 M0 rectal carcinoma located a median of 1.0 (range 0.5-1.5) cm from the dentate line. Resection of the IAS was performed transanally. A smooth muscle cuff, fashioned from the muscular layer of colon, and a colonic pouch were used for anorectal reconstruction. RESULTS: There were no perioperative deaths. Anastomotic leakage developed in two patients. After a median follow-up of 38 (range 14-66) months no local recurrence was detected. Distant metastases occurred in three patients, two of whom died. Perfect functional outcome was achieved in 22 of 26 patients. At 6 months after surgery the mean(s.d.) resting anal pressure was 49(8) mmHg. CONCLUSION: In selected patients intersphincteric resection does not compromise the oncological result. The suggested anorectal reconstruction may improve the functional outcome.
Asunto(s)
Órganos Artificiales , Reservorios Cólicos , Incontinencia Fecal/etiología , Músculo Liso/trasplante , Complicaciones Posoperatorias/etiología , Neoplasias del Recto/cirugía , Colgajos Quirúrgicos , Adulto , Anciano , Incontinencia Fecal/fisiopatología , Femenino , Estudios de Seguimiento , Humanos , Tiempo de Internación , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Presión , Neoplasias del Recto/fisiopatología , Resultado del TratamientoRESUMEN
Between 1972 and 1990, 36 patients with leiomyoma of the rectum underwent surgery at the Proctology Institute (Moscow). There were 13 male (36.1 percent) and 23 female (63.9 percent) patients. Their median age was 52.1 years. Electroexcision of the tumors measuring below 1 cm was performed through the endoscope in 12 patients. Leiomyomas with a diameter of 2.5 to 5 cm were removed transanally in 10 patients. Six patients underwent excision of the tumor through the pararectal approach, whereas leiomyomas located in the rectovaginal wall were removed through the vagina in one patient. Abdominoperineal extirpation and abdominoanal resection of the rectum was performed in seven patients with tumors measuring from 8 to 20 cm. Recurrences were noted in nine patients after transanal, pararectal, or transvaginal excision of leiomyomas. In seven of them, malignant transformation of the tumor occurred at terms ranging from 9 months to 9.5 years.
Asunto(s)
Leiomioma/cirugía , Neoplasias del Recto/cirugía , Adulto , Anciano , Transformación Celular Neoplásica , Electrocirugia , Femenino , Humanos , Leiomioma/patología , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia , Complicaciones Posoperatorias , Neoplasias del Recto/patologíaRESUMEN
The authors present a method of creation of a smooth-muscle cuff at the site of the perineal colostomy in 36 patients who have undergone extirpation for malignant neoplasms of the low ampulla recti. Creation of the smooth-muscle sphincter mechanism was performed during the process of removal of the rectum in 29 patients, whereas it was done two to eight years after extirpation of the rectum in seven patients. Inflammatory complications were observed in the perineal colostomy area during the early postoperative period in eight patients. These complications were accounted for by necrosis of the distal colon and transplanted muscle in two patients. There were no deaths. Satisfactory functional results were seen in 22 of 26 patients six months after surgery. Physiologic studies show that there is a functioning sphincter at the site of the perineal colostomy.
Asunto(s)
Colostomía/métodos , Músculo Liso/cirugía , Recto/cirugía , Adulto , Colostomía/efectos adversos , Defecación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Perineo , Neoplasias del Recto/cirugía , Recto/fisiologíaRESUMEN
During the period 1972 to 1987 inclusive, 313 multivisceral resections in advanced rectal cancer were performed, accounting for 10.3 percent of all radical surgical interventions for this disease. Of these resections, 71 were for distant metastases and 242 for tumor infiltration to adherent organs. The postoperative mortality was 5.4 percent, which was not significantly different from that in the total group of patients with rectal cancer (4.9 percent) operated upon during the same period. After multivisceral resections, 49.5 percent of patients developed postoperative complications. In the total group of patients with rectal cancer, the postoperative morbidity was 30.3 percent. Long-term results were assessed in 190 patients who had been operated upon more than five years ago. It has been established that 42.1 percent of patients lived more than five years after multivisceral resections. Hope is inspired by the fact that of 15 patients with hepatic metastases (26 percent) lived over five years following radical surgery. These data allow the conclusion that radical surgery for advanced rectal cancer is justifiable and advisable.
Asunto(s)
Neoplasias del Recto/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Invasividad Neoplásica , Metástasis de la Neoplasia , Complicaciones Posoperatorias , Pronóstico , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patologíaRESUMEN
The results of 12 observations over the patients subjected to resection of the cancer involved rectum, associated with segmental or edge resection of the liver in case of solitary metastatic foci in it, are reported. These patients survived, on an average, for 3 years after the operation. It is believed that the combination surgical intervention for rectal cancer with solitary metastases in the liver should be considered to be the operation of choice. Solitary focal changes in the liver in surgical treatment of rectal cancer should be verified morphologically in most cases.