RESUMEN
BACKGROUND: Colorectal cancer screening programmes have led to a shift towards early-stage colorectal cancer, which, in selected cases, can be treated using local excision. However, local excision followed by completion total mesorectal excision (two-stage approach) may be associated with less favourable outcomes than primary total mesorectal excision (one-stage approach). The aim of this population study was to determine the distribution of treatment strategies for early rectal cancer in the Netherlands and to compare the short-term outcomes of primary total mesorectal excision with those of local excision followed by completion total mesorectal excision. METHODS: Short-term data for patients with cT1-2 N0xM0 rectal cancer who underwent local excision only, primary total mesorectal excision, or local excision followed by completion total mesorectal excision between 2012 and 2020 in the Netherlands were collected from the Dutch Colorectal Audit. Patients were categorized according to treatment groups and logistic regressions were performed after multiple imputation and propensity score matching. The primary outcome was the end-ostomy rate. RESULTS: From 2015 to 2020, the proportion for the two-stage approach increased from 22.3% to 43.9%. After matching, 1062 patients were included. The end-ostomy rate was 16.8% for the primary total mesorectal excision group versus 29.6% for the local excision followed by completion total mesorectal excision group (P < 0.001). The primary total mesorectal excision group had a higher re-intervention rate than the local excision followed by completion total mesorectal excision group (16.7% versus 11.8%; P = 0.048). No differences were observed with regard to complications, conversion, diverting ostomies, radical resections, readmissions, and death. CONCLUSION: This study shows that, over time, cT1-2 rectal cancer has increasingly been treated using the two-stage approach. However, local excision followed by completion total mesorectal excision seems to be associated with an elevated end-ostomy rate. It is important that clinicians and patients are aware of this risk during shared decision-making.
Asunto(s)
Puntaje de Propensión , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Masculino , Femenino , Países Bajos/epidemiología , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Proctectomía/efectos adversos , Recto/cirugía , Estadificación de Neoplasias , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiologíaRESUMEN
A 51-year-old man with a medical history of recurrent anal carcinoma after chemoradiation underwent abdominoperineal resection in 2015. The patient presents with a bulging mass in the perineal zone, associated with pain. Physical examination and MRI during the workup reveal a large mass in the perineal region.
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Neoplasias del Ano , Herniorrafia , Hernia Incisional , Perineo , Proctectomía , Humanos , Masculino , Persona de Mediana Edad , Perineo/cirugía , Hernia Incisional/cirugía , Hernia Incisional/etiología , Herniorrafia/métodos , Neoplasias del Ano/cirugía , Proctectomía/métodos , Proctectomía/efectos adversos , Imagen por Resonancia MagnéticaRESUMEN
BACKGROUND: The incidence of rectal cancer is increasing worldwide, and surgery remains the primary treatment modality. With the advent of total mesorectal excision (TME) technique, the probability of tumor recurrence post-surgery has significantly decreased. Surgeons' focus has gradually shifted towards minimizing the impact of surgery on urinary and sexual functions. Among these concerns, the optimal dissection of the rectal lateral ligaments and preservation of the pelvic floor neurovascular bundle have become critical. To explore the optimal surgical technique for TME and establish a standardized surgical protocol to minimize the impact on urinary and sexual functions, we propose the eight-zone dissection strategy for pelvic floor anatomy. AIM: To compare the differences in surgical specimen integrity and postoperative quality of life satisfaction between the traditional pelvic floor dissection strategy and the innovative eight-zone dissection strategy. METHODS: We analyzed the perioperative data of patients who underwent laparoscopic radical resection of rectal cancer at Qilu Hospital of Shandong University between January 1, 2021 and December 1, 2023. This study included a total of 218 patients undergoing laparoscopic radical surgery for rectal cancer, among whom 109 patients underwent traditional pelvic floor dissection strategy, and 109 patients received the eight-zone dissection strategy. RESULTS: There were no significant differences in general characteristics between the two groups. Patients in the eight-zone dissection group had higher postoperative specimen integrity (88.1% vs 78.0%, P = 0.047). At the 3-month follow-up, patients in the eight-zone surgery group had better scores in urinary issues (6.8 ± 3.3 vs 5.3 ± 2.5, P = 0.045) and male sexual desire (2.2 ± 0.6 vs 2.5 ± 0.5, P = 0.047) compared to the traditional surgery strategy group. CONCLUSION: This study demonstrates that the eight-zone dissection strategy for laparoscopic lateral ligament dissection of rectal cancer is safe and effective. Compared with the traditional pelvic floor dissection strategy, this approach can reduce the risk of nerve injury and minimize the impact on urinary and sexual functions. Therefore, we recommend the clinical application of this strategy to better serve patients with rectal cancer.
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Disección , Laparoscopía , Diafragma Pélvico , Proctectomía , Calidad de Vida , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Neoplasias del Recto/patología , Femenino , Laparoscopía/efectos adversos , Laparoscopía/métodos , Masculino , Persona de Mediana Edad , Disección/métodos , Disección/efectos adversos , Resultado del Tratamiento , Anciano , Diafragma Pélvico/cirugía , Proctectomía/efectos adversos , Proctectomía/métodos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/prevención & control , Complicaciones Posoperatorias/epidemiología , Recto/cirugía , Estudios Retrospectivos , AdultoRESUMEN
BACKGROUND: Despite the minimally invasive approach and early rehabilitation, abdominal-perineal resection (APR) remains a procedure with high morbidity, notably due to postoperative trapped bowel ileus and perineal healing complications. Several surgical techniques have been described for filling the pelvic void to prevent abscess formation and ileus by trapped bowel loop. OBJECTIVE: The aim of our study was to compare the post APR complications for cancer of two of these techniques, omentoplasty and cecal mobilization, in a single-center study from an expert colorectal surgery center. PATIENTS: From 2012 to 2022, 84 patients were included, including 58 (69%) with omentoplasty and 26 (31%) with cecal mobilization. They all underwent APR at Bordeaux University Hospital Center. SETTINGS: A propensity score was used to avoid confounding factors as far as possible. Patient and procedure characteristics were initially comparable. RESULTS: The 30-day complication rate was significantly higher in the cecal mobilization group (53.8% vs. 5.2% p < 0.01), as was the rate of pelvic abscess (34.6% vs. 0% p < 0.001). CONCLUSION: These findings suggest that, when feasible, omentoplasty should be considered the preferred method for pelvic reconstruction following APR.
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Ciego , Epiplón , Complicaciones Posoperatorias , Proctectomía , Puntaje de Propensión , Humanos , Femenino , Masculino , Epiplón/cirugía , Persona de Mediana Edad , Anciano , Ciego/cirugía , Proctectomía/efectos adversos , Proctectomía/métodos , Estudios Retrospectivos , Neoplasias del Recto/cirugía , Resultado del TratamientoAsunto(s)
Incontinencia Fecal , Humanos , Toxinas Botulínicas Tipo A/administración & dosificación , Toxinas Botulínicas Tipo A/uso terapéutico , Proctectomía/efectos adversos , Complicaciones Posoperatorias/tratamiento farmacológico , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Fármacos Neuromusculares/administración & dosificación , Fármacos Neuromusculares/uso terapéuticoRESUMEN
PURPOSE: Increasing importance has been attributed in recent years to the preservation of the pelvic autonomic nerves during rectal resection to achieve better functional results. In addition to improved surgical techniques, intraoperative neuromonitoring may be useful. METHODS: This single-arm prospective study included 30 patients who underwent rectal resection performed with intraoperative neuromonitoring by recording the change in the tissue impedance of the urinary bladder and rectum after stimulation of the pelvic autonomic nerves. The International Prostate Symptom Score, the post-void residual urine volume and the Low Anterior Resection Syndrome Score (LARS score) were assessed during the 12-month follow-up period. RESULTS: A stimulation-induced change in tissue impedance was observed in 28/30 patients (93.3%). In the presence of risk factors such as low anastomosis, neoadjuvant radiotherapy and a deviation stoma, an average increase of the LARS score by 9 points was observed 12 months after surgery (p = 0,04). The function of the urinary bladder remained unaffected in the first week (p = 0,7) as well as 12 months after the procedure (p = 0,93). CONCLUSION: The clinical feasibility of the new method for pelvic intraoperative neuromonitoring could be verified. The benefits of intraoperative pelvic neuromonitoring were particularly evident in difficult intraoperative situations with challenging visualization of the pelvic nerves.
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Impedancia Eléctrica , Humanos , Masculino , Estudios Prospectivos , Persona de Mediana Edad , Anciano , Femenino , Vejiga Urinaria/inervación , Vejiga Urinaria/fisiopatología , Pelvis/inervación , Monitorización Neurofisiológica Intraoperatoria/métodos , Neoplasias del Recto/cirugía , Monitoreo Intraoperatorio/métodos , Recto/cirugía , Recto/inervación , Adulto , Anciano de 80 o más Años , Vías Autónomas , Proctectomía/efectos adversosRESUMEN
BACKGROUND: Incontinence is not rare after rectal cancer surgery. Platelet-rich plasma may promote tissue repair and generation but has never been tested for the treatment of anal incontinence. This study evaluated the impact of platelet-rich plasma injection on the severity of incontinence and quality of life after low rectal cancer surgery. METHODS: This is a prospective cohort proof of concept study in a colorectal cancer institution. Patients had undergone low anterior or intersphincteric resection for low rectal cancer and had a Wexner score > 4. Ten milliliters of platelet-rich plasma were injected into the internal and external sphincters under endoanal ultrasound (EAUS) guidance. Primary outcome measure was > 2 point improvement in Wexner score (improved group). The patients were assessed with endo-anal ultrasound examination, manometry, the Wexner Questionnaire and SF-36 Health Surveys, and patients were asked whether they used pads and antidiarrheal medications before and 6 months after PRP injection. RESULTS: Of 20 patients included in the study, 14 (70%) were men, and the average age was 56.8 (SD = 9.5) years. No statistically significant difference was found in Wexner scores before and after PRP injection (p = 0.66). Seven (35%) patients experienced a > 2 point improvement in Wexner score. Rectal manometry demonstrated improved squeezing pressure (p = 0.0096). Furthermore, physical functioning scoring (p = 0.023), role limitation (p = 0.016), emotional well-being (p = 0.0057) and social functioning (p = 0.043) domains on the SF-36 questionnaire improved. One (5%) and three (15%) patients stopped using pads and antidiarrheal medications. CONCLUSION: Platelet-rich plasma injection does not restore Wexner scores, but more than one-third of patients may benefit from this application with an improvement of > 2 points in their scores. Platelet-rich plasma injection may improve squeezing pressure and certain life quality measures for incontinent patients after rectal cancer surgery.
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Canal Anal , Incontinencia Fecal , Manometría , Plasma Rico en Plaquetas , Calidad de Vida , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Incontinencia Fecal/etiología , Incontinencia Fecal/terapia , Canal Anal/cirugía , Anciano , Resultado del Tratamiento , Endosonografía/métodos , Encuestas y Cuestionarios , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Proctectomía/métodos , Proctectomía/efectos adversos , Adulto , InyeccionesRESUMEN
BACKGROUND: Needlescopic surgery is a minimally invasive procedure that uses thin trocars with 3-mm diameter. We used Turnbull-Cutait pull-through and delayed coloanal anastomosis in needlescopic surgery to avoid diverting ileostomy during intersphincteric resection for low rectal cancer. In this study, we aim to assess the diverting ileostomy avoidance rate and technical safety of this "minimal skin incision and no stoma" procedure. METHODS: This single-center retrospective study was conducted at the Cancer Institute Hospital, a tertiary referral center in Japan. Between January 2017 and December 2020, 11 patients underwent needlescopic intersphincteric resection with diverting ileostomy (NSI group), and 19 patients underwent needlescopic intersphincteric resection with delayed coloanal anastomosis (NSD group) for low rectal cancer. Data regarding patient backgrounds and short-term outcomes, including diverting ileostomy avoidance rate, pathological results, and postoperative defecatory function, were compared between the groups. RESULTS: There were no statistically significant differences between the NSI and NSD groups with respect to patient background, operation time (239 min versus 220 min, p = 0.68), estimated blood loss (45 g versus 25 g, p = 0.29), R0 resection rate (100% versus 100%, p = 1.00), and length of postoperative hospital stay (16 days versus 17 days, p = 0.42). The diverting ileostomy avoidance rate was 94.4% in the NSD group. The LARS and Wexner scores 12 months after surgery were not significantly different between the two groups. CONCLUSIONS: Needlescopic intersphincteric resection and delayed coloanal anastomosis can be safely performed in selected patients with a high rate of diverting ileostomy avoidance and comparable short-term outcomes.
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Canal Anal , Anastomosis Quirúrgica , Ileostomía , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Masculino , Femenino , Estudios Retrospectivos , Anastomosis Quirúrgica/métodos , Anastomosis Quirúrgica/efectos adversos , Anciano , Persona de Mediana Edad , Canal Anal/cirugía , Ileostomía/métodos , Ileostomía/efectos adversos , Ileostomía/instrumentación , Resultado del Tratamiento , Colon/cirugía , Tempo Operativo , Proctectomía/métodos , Proctectomía/efectos adversos , Factores de Tiempo , Defecación , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Anciano de 80 o más Años , JapónRESUMEN
BACKGROUND: Excessive tension at the anastomosis contributes to anastomotic leakage (AL) in low anterior resection (LAR). However, the specific tension has not been measured. We assessed whether "Bridging," characterized by the proximal colon resembling a suspension bridge above the pelvic floor, is a significant risk factor for AL following LAR for rectal cancer. METHODS: This retrospective study reviewed the medical records and laparoscopic videos of 102 patients who underwent laparoscopic LAR using the double stapling technique at Yachiyo Hospital between January 2014 and December 2023. Patients were classified based on whether they had Bridging (tight or sagging) or were in a Resting state of the proximal colon, and the association between Bridging and AL was examined. RESULTS: AL occurred in 31.3% of the Tight Bridging group, 20% of the Sagging Bridging group, and 2.2% of the Resting group (P = 0.002). The incidence of AL was significantly higher in patients with Bridging than in those without (23.2% vs. 2.2%, P = 0.003). Multivariate analysis revealed that Bridging is an independent risk factor for AL (odds ratio = 6.97; 95% confidence interval: 1.45-33.6; P = 0.016). CONCLUSIONS: The presence of Bridging is a significant risk factor for AL following LAR for rectal cancer, suggesting the need for implementing preventive measures in patients with this condition.
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Anastomosis Quirúrgica , Fuga Anastomótica , Laparoscopía , Neoplasias del Recto , Humanos , Fuga Anastomótica/etiología , Fuga Anastomótica/epidemiología , Femenino , Estudios Retrospectivos , Masculino , Factores de Riesgo , Neoplasias del Recto/cirugía , Persona de Mediana Edad , Anciano , Anastomosis Quirúrgica/efectos adversos , Anastomosis Quirúrgica/métodos , Laparoscopía/efectos adversos , Laparoscopía/métodos , Proctectomía/efectos adversos , Proctectomía/métodos , Grapado Quirúrgico/efectos adversos , Adulto , Anciano de 80 o más Años , Colon/cirugíaRESUMEN
Introduction: bowel dysfunction is the most common and disabling complication after anterior rectal resection (ARR) for cancer. We aimed to evaluate these complications in a cohort of Cameroonian patients, using the low anterior rectal syndrome (LARS) score. Methods: we conducted a descriptive and analytical cross-sectional study, in two university hospitals of Yaoundé (Cameroon). Prospectively, we collected the records of all patients aged at least 18 years who had an ARR indicated for rectal cancer from January 2015 to March 2018. Alive patients among them were subsequently received in consultation at 1 and 3 years after surgery, for short and long-term assessment of their digestive function using the LARS score. Results: during the study period, 28 patients underwent anterior rectal resection for rectal cancers. Short-term bowel function was evaluated in 23 patients. Their mean age was 48.42 ± 12.2 years and 14 were males. LARS was present in 10 of them (43.47%) and classified as "minor" in the majority of cases (n=6). The commonest bowel dysfunction at this term was splitting of stool (56.53%). Long-term digestive function was evaluated in 11 patients; LARS was found in 3 of them (27,27%) and classified as minor in all cases. Perfect continence was significantly improved (p=0.003) in the long term compared to the short-term status. Continence (p=0.049) and urgency (p=0.048) were better in patients who had a low colorectal anastomosis compared to those who had a colo supra-anal anastomosis. Conclusion: after ARR for cancer, there is a high prevalence of LARS in the short term with an improvement in the long term.
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Complicaciones Posoperatorias , Neoplasias del Recto , Humanos , Masculino , Camerún , Neoplasias del Recto/cirugía , Persona de Mediana Edad , Femenino , Estudios Prospectivos , Estudios Transversales , Adulto , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Síndrome , Anciano , Factores de Tiempo , Estudios de Cohortes , Proctectomía/efectos adversos , Proctectomía/métodos , Enfermedades del Recto/cirugía , Estudios de SeguimientoRESUMEN
BACKGROUND: Comparative outcomes of robotic low anterior resection (rTME) and trans-anal total mesorectal excision (TaTME) in patients with low rectal cancer were evaluated. METHODS: A systematic online search was conducted using the following databases: PubMed, Scopus, Cochrane database, The Virtual Health Library, Clinical trials.gov and Science Direct. Comparative studies of rTME versus TaTME for low rectal cancer were included. Primary outcomes were postoperative complications, including anastomotic leak, surgical site infection, and Clavien-Dindo complication rate. Total operative time, conversion to open surgery, intra-operative blood loss, intensive therapy unit (ITU) and total hospital length of stay (LOS), oncological outcomes and functional outcomes were the other evaluated outcome parameters. RESULTS: A total of 12 studies with a total number of 3025 patients divided between rTME (n = 1881) and TaTME (n = 1144) groups were included. There was no significant difference between the two groups for total operative time (P = 0.39), conversion to open surgery (P = 0.29) and intra-operative blood loss (P = 0.62). Clavien-Dindo ≥ 3 complication rate (P = 0.47), anastomotic leak (P = 0.89), rates of re-operation (P = 0.62) and re-admission (P = 0.92), R0 resections (P = 0.52), ITU LOS (P = 0.63) and total hospital LOS (P = 0.30) also showed similar results between the two groups. However, the rTME group had higher rates of total harvested lymph nodes (P = 0.04) and complete total mesorectal excision (TME) resections (P = 0.05). Albeit with a limited dataset, the Wexner and low anterior resection syndrome (LARS) scores showed better functional results in the rTME group compared with the TaTME group (P = 0.0009 and P = 0.00001, respectively). CONCLUSION: Compared with TaTME, rTME seems to provide better functional outcomes, higher lymph node yield and more complete TME resections with a similar post-operative complications profile.
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Tiempo de Internación , Tempo Operativo , Complicaciones Posoperatorias , Proctectomía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Cirugía Endoscópica Transanal , Humanos , Neoplasias del Recto/cirugía , Procedimientos Quirúrgicos Robotizados/métodos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/estadística & datos numéricos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Proctectomía/métodos , Proctectomía/efectos adversos , Tiempo de Internación/estadística & datos numéricos , Resultado del Tratamiento , Cirugía Endoscópica Transanal/métodos , Cirugía Endoscópica Transanal/efectos adversos , Femenino , Masculino , Persona de Mediana Edad , Recto/cirugía , Anciano , Fuga Anastomótica/etiología , Fuga Anastomótica/epidemiología , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Conversión a Cirugía Abierta/estadística & datos numéricos , AdultoRESUMEN
BACKGROUND: Perineal hernia (PH) is a late complication of abdominoperineal resection (APR) that may compromise a patient's quality of life. The frequency and risk factors for PH after robotic APR adopting recent rectal cancer treatment strategies remain unclear. METHODS: Patients who underwent robotic APR for rectal cancer between December 2011 and June 2022 were retrospectively examined. From July 2020, pelvic reinforcement procedures, such as robotic closure of the pelvic peritoneum and levator ani muscles, were performed as prophylactic procedures for PH whenever feasible. PH was diagnosed in patients with or without symptoms using computed tomography 1 year after surgery. We examined the frequency of PH, compared characteristics between patients with PH (PH+) and without PH (PH-), and identified risk factors for PH. RESULTS: We evaluated 142 patients, including 53 PH+ (37.3%) and 89 PH- (62.6%). PH+ had a significantly higher rate of preoperative chemoradiotherapy (26.4% versus 10.1%, p = 0.017) and a significantly lower rate of undergoing pelvic reinforcement procedures (1.9% versus 14.0%, p = 0.017). PH+ had a lower rate of lateral lymph node dissection (47.2% versus 61.8%, p = 0.115) and a shorter operative time (340 min versus 394 min, p = 0.110). According to multivariate analysis, the independent risk factors for PH were preoperative chemoradiotherapy, not undergoing lateral lymph node dissection, and not undergoing a pelvic reinforcement procedure. CONCLUSIONS: PH after robotic APR for rectal cancer is not a rare complication under the recent treatment strategies for rectal cancer, and performing prophylactic procedures for PH should be considered.
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Perineo , Complicaciones Posoperatorias , Proctectomía , Neoplasias del Recto , Procedimientos Quirúrgicos Robotizados , Humanos , Estudios Retrospectivos , Procedimientos Quirúrgicos Robotizados/efectos adversos , Procedimientos Quirúrgicos Robotizados/métodos , Masculino , Femenino , Factores de Riesgo , Persona de Mediana Edad , Perineo/cirugía , Anciano , Proctectomía/efectos adversos , Proctectomía/métodos , Neoplasias del Recto/cirugía , Incidencia , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Hernia/etiología , Hernia/prevención & control , Hernia/epidemiología , Hernia Incisional/etiología , Hernia Incisional/prevención & control , Hernia Incisional/epidemiologíaRESUMEN
BACKGROUND: Laparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery. AIMS: We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery. MATERIALS & METHODS: Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups. RESULTS: Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches. CONCLUSION: Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
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Laparoscopía , Neoplasias del Recto , Humanos , Laparoscopía/métodos , Laparoscopía/efectos adversos , Márgenes de Escisión , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Proctectomía/métodos , Proctectomía/efectos adversos , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias del Recto/cirugía , Neoplasias del Recto/mortalidad , Neoplasias del Recto/patología , Resultado del TratamientoRESUMEN
BACKGROUND: Low anterior resection syndrome (LARS) is a distressing condition that affects approximately 25-80% of patients following surgery for rectal cancer. LARS is characterized by debilitating bowel dysfunction symptoms, including fecal incontinence, urgent bowel movements, and increased frequency of bowel movements. Although biofeedback therapy has demonstrated effectiveness in improving postoperative rectal control, the research results have not fulfilled expectations. Recent research has highlighted that stimulating the pudendal perineal nerves has a superior impact on enhancing pelvic floor muscle function than biofeedback alone. Hence, this study aims to evaluate the efficacy of a combined approach integrating biofeedback with percutaneous electrical pudendal nerve stimulation (B-PEPNS) in patients with LARS through a randomized controlled trial (RCT). METHODS AND ANALYSIS: In this two-armed multicenter RCT, 242 participants with LARS after rectal surgery will be randomly assigned to undergo B-PEPNS (intervention group) or biofeedback (control group). Over 4 weeks, each participant will undergo 20 treatment sessions. The primary outcome will be the LARS score. The secondary outcomes will be anorectal manometry and pelvic floor muscle electromyography findings and the European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire-Colorectal 29 (EORTC QLQ-CR29) scores. Data will be collected at baseline, post-intervention (1 month), and follow-up (6 months). DISCUSSION: We anticipate that this study will contribute further evidence regarding the efficacy of B-PEPNS in alleviating LARS symptoms and enhancing the quality of life for patients following rectal cancer surgery. TRIAL REGISTRATION: Chinese Clincal Trials Register ChiCTR2300078101. Registered 28 November 2023.
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Biorretroalimentación Psicológica , Incontinencia Fecal , Estudios Multicéntricos como Asunto , Nervio Pudendo , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Neoplasias del Recto , Estimulación Eléctrica Transcutánea del Nervio , Humanos , Biorretroalimentación Psicológica/métodos , Resultado del Tratamiento , Estimulación Eléctrica Transcutánea del Nervio/métodos , Incontinencia Fecal/terapia , Incontinencia Fecal/fisiopatología , Incontinencia Fecal/etiología , Neoplasias del Recto/cirugía , Neoplasias del Recto/terapia , Femenino , Persona de Mediana Edad , Síndrome , Masculino , Adulto , Diafragma Pélvico/fisiopatología , Diafragma Pélvico/inervación , Recuperación de la Función , China , Defecación , Anciano , Proctectomía/efectos adversos , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/terapia , Electromiografía , ManometríaRESUMEN
PURPOSE: The aim of this study was to assess the effect of early stoma closure on bowel function after low anterior resection (LAR) for rectal cancer. METHODS: Patients participating in the FORCE trial who underwent LAR with protective stoma were included in this study. Patients were subdivided into an early closure group (< 3 months) and late closure group (> 3 months). Endpoints of this study were the Wexner Incontinence, low anterior resection syndrome (LARS), EORTC QLQ-CR29, and fecal incontinence quality of life (FIQL) scores at 1 year. RESULTS: Between 2017 and 2020, 38 patients had received a diverting stoma after LAR for rectal cancer and could be included. There was no significant difference in LARS (31 vs. 30, p = 0.63) and Wexner score (6.2 vs. 5.8, p = 0.77) between the early and late closure groups. Time to stoma closure in days was not a predictor for LARS (R2 = 0.001, F (1,36) = 0.049, p = 0.83) or Wexner score (R2 = 0.008, F (1,36) = 0.287, p = 0.60) after restored continuity. There was no significant difference between any of the FIQL domains of lifestyle, coping, depression, and embarrassment. In the EORTC QLQ-29, body image scored higher in the late closure group (21.3 vs. 1.6, p = 0.004). CONCLUSION: Timing of stoma closure does not appear to affect long-term bowel function and quality of life, except for body image. To improve functional outcome, attention should be focused on other contributing factors.
Asunto(s)
Incontinencia Fecal , Calidad de Vida , Neoplasias del Recto , Estomas Quirúrgicos , Humanos , Neoplasias del Recto/cirugía , Masculino , Femenino , Estomas Quirúrgicos/efectos adversos , Anciano , Persona de Mediana Edad , Incontinencia Fecal/etiología , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Resultado del Tratamiento , Factores de Tiempo , Proctectomía/efectos adversos , Proctectomía/métodosRESUMEN
OBJECTIVE: To investigate fecal incontinence and defecatory, urinary, and sexual functional outcomes after transanal total mesorectal excision (taTME). BACKGROUND: Proctectomy for rectal cancer may result in alterations in defecatory, urinary, and sexual function that persist beyond 12 months. The recent multicenter phase II taTME trial demonstrated the safety of taTME in patients with stage I to III tumors. METHODS: Prospectively registered self-reported questionnaires were collected from 100 taTME patients. Fecal continence [Fecal Incontinence Quality of Life (FIQL), Wexner], defecatory function [Colorectal Functional Outcome (COREFO)], urinary function (International Prostate Symptom Score), and sexual function (Female Sexual Function Index-female, International Index of Erectile Function-male) were assessed preoperatively (PQ), 3 to 4 months postileostomy closure (FQ1), and 12 to 18 months post-taTME [postoperative questionnaire 2 (FQ2)]. RESULTS: Among 83 patients who responded at all 3 time points, FIQL, Wexner, and COREFO significantly worsened postileostomy closure. Between FQ1 and FQ2, FIQL lifestyle and coping, Wexner, and COREFO incontinence, social impact, frequency, and need for medication significantly improved, while FIQL depression and embarrassment did not change. International Prostate Symptom Score did not change relative to preoperative scores. For females, Female Sexual Function Index declined for desire, orgasm, and satisfaction between PQ and FQ1, and did not improve between FQ1 and FQ2. In males, International Index of Erectile Function declined with no change between FQ1 and FQ2. CONCLUSIONS: Although taTME resulted in initial decline in defecatory function and fecal continence, most functional domains improved by 12 months after ileostomy closure, without returning to preoperative status. Urinary function was preserved while sexual function declined without improvement by 18 months post-taTME. Our results address patient expectations and inform shared decision-making regarding taTME.
Asunto(s)
Incontinencia Fecal , Proctectomía , Calidad de Vida , Neoplasias del Recto , Humanos , Masculino , Femenino , Neoplasias del Recto/cirugía , Estudios Prospectivos , Persona de Mediana Edad , Anciano , Incontinencia Fecal/etiología , Proctectomía/métodos , Proctectomía/efectos adversos , Complicaciones Posoperatorias , Resultado del Tratamiento , Cirugía Endoscópica Transanal/métodos , Adulto , Encuestas y Cuestionarios , Disfunciones Sexuales Fisiológicas/etiologíaRESUMEN
To analyze the risk factors for intraperitoneal sigmoid stoma complications after abdominoperineal resection (APR) surgery to guide clinical practice. Patients who were diagnosed with rectal cancer and underwent APR surgery from June 2013 to June 2021 were retrospectively enrolled. The characteristics of the stoma complication group and the no stoma complication group were compared, and univariate and multivariate logistic analyses were employed to identify risk factors for sigmoid stoma-related complications. A total of 379 patients who were diagnosed with rectal cancer and underwent APR surgery were enrolled in this study. The average age of the patients was 61.7â ±â 12.1 years, and 226 (59.6%) patients were males. Patients in the short-term stoma complication group were younger (55.7 vs 62.0, Pâ <â .05) and had a more advanced tumor stage (Pâ <â .05). However, there was no significant difference between the long-term stoma complication group and the no stoma complication group. Multivariate logistic regression analysis revealed that operation time was an independent risk factor (Pâ <â .05, ORâ =â 1.005, 95% CIâ =â 1.000-1.010) for short-term stoma complications. Both the short-term and long-term stoma complication rates in our institution were low. A longer operation time was an independent risk factor for short-term stoma complications after APR surgery.
Asunto(s)
Complicaciones Posoperatorias , Proctectomía , Neoplasias del Recto , Estomas Quirúrgicos , Humanos , Masculino , Femenino , Persona de Mediana Edad , Factores de Riesgo , Neoplasias del Recto/cirugía , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Estomas Quirúrgicos/efectos adversos , Proctectomía/efectos adversos , Anciano , Tempo Operativo , Colon Sigmoide/cirugía , Modelos LogísticosRESUMEN
BACKGROUND/AIM: Anterior resection is the gold standard surgery for high and middle rectal tumors. In cases where anterior resection is not feasible, the surgeon resorts to a non-restorative approach such as Hartmann's procedure or abdominoperineal resection. It is not well studied how Hartmann's procedure impacts quality of life. This cross-sectional cohort study compares the long-term quality of life after Hartmann's procedure with anterior resection and abdominoperineal resection. PATIENTS AND METHODS: Patients operated for high- or middle rectal cancer in the southern healthcare region of Sweden between 2007 and 2017 were identified and data were extracted from the Swedish Colorectal Cancer Registry. Further clinical variables were retrieved from medical charts. Quality of life was evaluated by SF-12-, EQ-5D-5L- and EORTC QLQ - CR29 questionnaires. RESULTS: Out of 521 patients included, 51 had undergone Hartmann's procedure, 381 anterior resection and 89 abdominoperineal resection. Hartmann patients were significantly older with more comorbidities. Median follow-up time was 104 months. There were no differences between groups in overall quality of life. Patients subjected to Hartmann's procedure reported inferior mobility, self-care, daily activities and reduced estimation of general health compared to those who had anterior resection. Abdominoperineal resection was associated with more impotence compared to Hartmann's procedure. CONCLUSION: Overall long-term QoL after Hartmann's procedure was comparable to anterior resection and abdominoperineal resection. In certain symptoms patients with Hartmann's procedure for rectal cancer scored worse compared to anterior resection, but patients were older and frailer making causal inference impossible.
Asunto(s)
Calidad de Vida , Neoplasias del Recto , Humanos , Neoplasias del Recto/cirugía , Masculino , Femenino , Anciano , Persona de Mediana Edad , Encuestas y Cuestionarios , Estudios Transversales , Suecia , Anciano de 80 o más Años , Proctectomía/métodos , Proctectomía/efectos adversos , Resultado del Tratamiento , Abdomen/cirugíaRESUMEN
PURPOSE: Coloanal anastomosis with loop diverting ileostomy (CAA) is an option for low anterior resection of the rectum, and Turnbull-Cutait coloanal anastomosis (TCA) regained popularity in the effort to offer patients a reconstructive option. In this context, we aimed to compare both techniques. METHODS: PubMed, Cochrane, and Scopus were searched for studies published until January 2024. Odds ratios (RRs) with 95% confidence intervals (CIs) were pooled with a random-effects model. Statistical significance was defined as p < 0.05. Heterogeneity was assessed using the Cochran Q test and I2 statistics, with p-values inferior to 0.10 and I2 >25% considered significant. Statistical analysis was conducted in RStudio version 4.1.2 (R Foundation for Statistical Computing). Registered number CRD42024509963. RESULTS: One randomized controlled trial and nine observational studies were included, comprising 1,743 patients, of whom 899 (51.5%) were submitted to TCA and 844 (48.5%) to CAA. Most patients had rectal cancer (52.2%), followed by megacolon secondary to Chagas disease (32.5%). TCA was associated with increased colon ischemia (OR 3.54; 95% CI 1.13 to 11.14; p < 0.031; I2 = 0%). There were no differences in postoperative complications classified as Clavien-Dindo ≥ IIIb, anastomotic leak, pelvic abscess, intestinal obstruction, bleeding, permanent stoma, or anastomotic stricture. In subgroup analysis of patients with cancer, TCA was associated with a reduction in anastomotic leak (OR 0.55; 95% CI 0.31 to 0.97 p = 0.04; I2 = 34%). CONCLUSION: TCA was associated with a decrease in anastomotic leak rate in subgroups analysis of patients with cancer.
Asunto(s)
Anastomosis Quirúrgica , Ileostomía , Neoplasias del Recto , Humanos , Anastomosis Quirúrgica/métodos , Ileostomía/métodos , Ileostomía/efectos adversos , Neoplasias del Recto/cirugía , Colon/cirugía , Canal Anal/cirugía , Proctectomía/métodos , Proctectomía/efectos adversos , Fuga Anastomótica/etiología , Fuga Anastomótica/epidemiología , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiologíaRESUMEN
Transanal total mesorectal excision (taTME) has improved the laparoscopic dissection for rectal cancer in the narrow pelvis. Although taTME has more clinical benefits than laparoscopic surgery, such as a better view of the distal rectum and direct determination of distal resection margin, an intraoperative urethral injury could occur in excision ta-TME. This study aimed to determine the feasibility and efficacy of the ta-TME with IRIS U kit surgery. This retrospective study enrolled 10 rectal cancer patients who underwent a taTME with an IRIS U kit. The study endpoints were the safety of access (intra- or postoperative morbidity). The detectability of the IRIS U kit catheter was investigated by using a laparoscope-ICG fluorescence camera system. Their mean age was 71.4±6.4 (58-78) years; 80 were men, and 2 were women. The mean operative time was 534.6 ± 94.5 min. The coloanal anastomosis was performed in 80%, and 20% underwent abdominal peritoneal resection. Two patients encountered postoperative complications graded as Clavien-Dindo grade 2. The transanal approach with IRIS U kit assistance is feasible, safe for patients with lower rectal cancer, and may prevent intraoperative urethral injury.