National Cancer Institute®
Last Modified: July 1, 2002
UI - 2591449
AU - Lennard TW; Harris AL; Hales J; Dickinson A; Wolstencroft R; Halcrow P;
TI - Shenton BK; McDonald M; Lawrence GF; Taylor RM A phase I study of immunostimulation and toxicity in patients with colorectal carcinoma using the immunomodulator 3,6-bis(2-piperidinoethoxy) acridine trihydrochloride (CL 246738).
SO - Eur J Cancer Clin Oncol 1989 Nov;25(11):1571-6
AD - Department of Surgery, University of Newcastle upon Tyne, U.K.
Seventeen patients with residual or recurrent colorectal carcinoma were given a new synthetic immunomodulator [3,6-bis(2-piperidinoethoxy) acridine trihydrochloride CL246738) as part of a phase I clinical trial. No patients had undergone previous immunotherapy or chemotherapy. Detailed immunological studies including interferon levels, interleukin 2 levels, natural killer cell function, mitogen responses of lymphocytes, immunoglobulin levels and lymphocyte subpopulation levels were analysed in the patients who received this drug in an attempt to find out whether there was any biological activity identifiable in humans. None of the subjects showed any significant increases in post treatment values of the immunological parameters studied. Toxic effects of the drug at high doses included nausea, diarrhoea and decreased levels of consciousness. In conclusion, no immunological effects were identified following the administration of CL 246738 in human subjects with recurrent or residual colorectal cancer.
UI - 12015743
AU - Hardy RG; Brown RM; Miller SJ; Tselepis C; Morton DG; Jankowski JA;
TI - Sanders DS Transient P-cadherin expression in radiation proctitis; a model of mucosal injury and repair.
SO - J Pathol 2002 Jun;197(2):194-200
AD - Department of Surgery, Clinical Research Institute, University of Birmingham, Birmingham, UK. firstname.lastname@example.org
Morphology at both cellular and glandular levels in the colon is dependent to an extent on cell-cell adhesion mediated by cadherin-catenin complexes. Alterations in the expression of E-cadherin, the cadherin normally present in colon, have been shown to be implicated in tissue remodelling within the gastrointestinal tract. Furthermore, it has previously been shown that P-cadherin, normally present only in stratified epithelia and placenta, is expressed in colitis and during neoplastic change in the colon. The morphological features of mucosal injury induced by pre-operative radiotherapy in the non-neoplastic rectal mucosa were studied in patients with rectal adenocarcinoma. Three characteristic phases of radiation proctitis were defined on histological grounds (acute injury, and early and late regenerative phases) essentially correlating with the time interval between radiotherapy and surgery; such features were mirrored by alterations in cadherin-catenin expression and localization in rectal crypts. On immunohistochemistry and western blotting, P-cadherin was highly expressed in the acute injury and early regenerative phases, with a decreased level of expression during late regeneration. E-cadherin and associated catenins were translocated from membrane to cytoplasm in degenerating crypts, with return of normal membranous expression in regenerating crypts. In conclusion, radiation-induced proctitis represents an in vivo model of mucosal injury and regeneration and provides a valid model in which to study events during epithelial injury and repair. Altered cadherin expression, in particular transient aberrant P-cadherin expression, is intimately associated with these processes. Copyright 2002 John Wiley & Sons, Ltd.
UI - 11914638
AU - Boyer CR; Karjian PL; Wahl GM; Pegram M; Neuteboom ST
TI - Nucleoside transport inhibitors, dipyridamole and p-nitrobenzylthioinosine, selectively potentiate the antitumor activity of NB1011.
SO - Anticancer Drugs 2002 Jan;13(1):29-36
AD - NewBiotics, Inc, San Diego, CA 92121, USA.
NB1011, a novel anticancer agent, targets tumor cells expressing high levels of thymidylate synthase (TS). NB1011 is converted intracellularly to bromovinyldeoxyuridine monophosphate (BVdUMP) which competes with the natural substrate, deoxyuridine monophosphate, for binding to TS. Unlike inhibitors, NB1011 becomes a reversible substrate for TS catalysis. Thus, TS retains activity and converts BVdUMP into cytotoxic product(s). In vitro cytotoxicity studies demonstrate NB1011's preferential activity against tumor cells expressing elevated TS protein levels. Additionally, NB1011 has antitumor activity in vivo. To identify drugs which interact synergistically with NB1011, we screened 13 combinations of chemotherapeutic agents with NB1011 in human tumor and normal cells. Dipyridamole and p-nitrobenzylthioinosine (NBMPR), potent inhibitors of equilibrative nucleoside transport, synergized with NB1011 selectively against 5-fluorouracil (5-FU)-resistant H630R10 colon carcinoma cells [combination index (CI)=0.75 and 0.35] and Tomudex-resistant MCF7TDX breast carcinoma cells (CI=0.51 and 0.57), both TS overexpressing cell lines. These agents produced no synergy with NB1011 in Det551 and CCD18co normal cells (CI > 1.1) lacking TS overexpression. Dipyridamole potentiated NB1011's cytotoxicity in medium lacking nucleosides and bases, suggesting a non-salvage-dependent mechanism. We demonstrate that nucleoside transport inhibitors, dipyridamole and NBMPR, show promise for clinically efficacious combination with NB1011.
UI - 12068185
AU - Rouanet P; Saint-Aubert B; Lemanski C; Senesse P; Gourgou S; Quenet F;
TI - Ycholu M; Kramar A; Dubois J Restorative and nonrestorative surgery for low rectal cancer after high-dose radiation: long-term oncologic and functional results.
SO - Dis Colon Rectum 2002 Mar;45(3):305-13; discussion 313-5
AD - Department of Surgery, Montpellier Cancer Institute, France.
PURPOSE: This prospective, nonrandomized study evaluates, with a seven-year median follow-up, the morbidity and the functional and oncologic results of conservative surgery after high-dose radiation for cancer of the lower third of the rectum of patients who would otherwise treated by preoperative radiotherapy (40 + 20 Gy delivered with three fields) and curative surgery. The mean distance from the anal verge was 50 (range, 25-60) mm, and none of the tumors was fixed (15 percent T2N0, 53 percent T3N0, 32 percent T3N1). RESULTS: Postoperative mortality (2 percent) and morbidity (35 percent) were not increased by high-dose preoperative radiation. Conservative surgery was done in 30 patients (70 percent: 26 coloanal anastomoses and 4 low stapled anastomoses). After conservative surgery, long-term functional results showed 30 percent complete continence and 20 percent serious incontinence. Four patients had local recurrence as first development (13 percent). The seven-year overall survival rate was 53 percent, 62 percent after conservative surgery and 31 percent after abdominoperineal resection. The univariate analysis underscores the tumor response impact on long-term survival (pT<3 = 81 percent; pT3 = 35 percent; P = 0.0008). CONCLUSIONS: These long-term results confirm the feasibility of conservative surgery for low rectal carcinoma after high-dose radiation. A prospective reproducibility of these results.
UI - 12068187
AU - Kressner U; Graf W; Mahteme H; Pahlman L; Glimelius B
TI - Septic complications and prognosis after surgery for rectal cancer.
SO - Dis Colon Rectum 2002 Mar;45(3):316-21
AD - Department of Surgery, University Hospital, University of Uppsala, Sweden.
PURPOSE: The influence of septic complications on long-term prognosis after surgery for rectal cancer is controversial. This study was performed to investigate whether an abdominal or perineal septic complication was associated with rectal cancer recurrence. METHODS: A total of 228 patients who had undergone curative resection for rectal cancer from 1973 to 1992 were reviewed. The patients were divided into groups of those who developed either an intra-abdominal abscess or a perineal infection after surgery (infection group) and those who did not (noninfection group). RESULTS: There was no clear difference in the overall incidence of tumor recurrence between the infection group (19/53, 36 percent) and the noninfection group (46/175, 26 percent; P = 0.25). However, the incidence of local recurrence was higher in the infection group (12/53, 23 percent) than in the noninfection group (16/175, 9 percent; P = 0.02). This increased risk was restricted to patients with a perineal infection (10/30, 33 percent; P = 0.003 vs. the noninfection group), whereas patients with an abdominal infection (3/24, 13 percent) did not differ from the noninfection group. CONCLUSION: Patients with a perineal infection after an abdominoperineal resection have an increased incidence of local recurrence. However, there was no association between abdominal sepsis and prognosis after surgery for rectal cancer.
UI - 12068188
AU - Heah SM; Seow-Choen F; Eu KW; Ho YH; Tang CL
TI - Prospective, randomized trial comparing sigmoid vs. descending colonic J-pouch after total rectal excision.
SO - Dis Colon Rectum 2002 Mar;45(3):322-8
AD - Department of Colorectal Surgery, Singapore General Hospital.
PURPOSE: The aim of this study was to compare the bowel function of sigmoid vs. descending colonic J-pouches after ultralow anterior resection for rectal cancer. METHODS: A prospective, randomized trial patients undergoing ultralow anterior resection for cancers arising from 3 to 10 cm from the anal verge were recruited. Forty-eight patients were males; the mean ages (standard error of the mean) for patients with sigmoid and descending colon pouches, respectively, were 65.2 (3.1) years and 62.3 (3.1) years. A total of 46 patients were randomly assigned to each group. Two patients from each group were excluded; abdominoperineal resection was performed for two patients in the sigmoid pouch group and one patient in the descending pouch group. One patient in the descending pouch group had a transanal resection of a benign polyp. Dukes staging and use of postoperative chemoradiotherapy were statistically similar in both groups. All patients underwent a standardized ultralow anterior resection. A defunctioning loop ileostomy was used routinely. Anorectal physiology and bowel function questionnaires were performed at six weeks after ileostomy closure and again at 6 and 12 months after surgery. RESULTS: Median follow-up was 12 (range, 7 to 25) and 12 (range, 6 to 25) months, respectively, for sigmoid and descending pouch groups. Median tumor and anastomotic heights, time to ileostomy closure, operative time, and postoperative stay were statistically similar in both groups. There were no significant differences in stool frequency, incontinence, urgency, use of pads and antidiarrheals, sensation of incomplete evacuation, and anorectal physiology results between groups (P > 0.05). CONCLUSION: Pouches made from sigmoid or descending colon give similar bowel function after ultralow anterior resection for rectal cancers.
UI - 12068189
AU - Shitoh K; Konishi F; Miyakura Y; Togashi K; Okamoto T; Nagai H
TI - Microsatellite instability as a marker in predicting metachronous multiple colorectal carcinomas after surgery: a cohort-like study.
SO - Dis Colon Rectum 2002 Mar;45(3):329-33
AD - Department of Surgery, Jichi Medical School, Tochigi-ken, Japan.
PURPOSE: In case-control studies, it was reported that microsatellite instability might be helpful in predicting the development of metachronous multiple colorectal cancers. The purpose of this cohort-like study was to determine whether microsatellite instability is a novel independent marker in predicting metachronous colorectal carcinomas after colorectal cancer surgery. METHODS: Three hundred twenty-eight colorectal carcinoma patients were surveyed by periodic colonoscopy for at least three years after surgery. Among these, DNA from paraffin-embedded sections was available for 272 cases. DNA of these cases was studied for six microsatellite markers (five dinucleotide repeats, one mononucleotide repeat). Microsatellite instability phenotype was defined as alterations in one or more loci. RESULTS: Median follow-up period was 74 months, and the median number of colonoscopies was 4.6. The percentage of microsatellite instability-positive cases was 26.4 percent (72/272). Seventeen metachronous colorectal carcinomas were detected during the follow-up period. Incidences of metachronous colorectal carcinomas in microsatellite instability-positive and microsatellite instability-negative cases were 15.3 and 3 percent, respectively (P < 0.001). The cumulative five-year incidence of metachronous colorectal carcinomas was significantly higher in microsatellite instability-positive cases than in microsatellite instability-negative cases (12.5 vs. 2.5 percent, P < 0.0001). Logistic regression analysis of the relationship between incidence of metachronous colorectal carcinomas and possible risk factors (namely, coexistence of adenoma at the time of surgery, family history of colorectal carcinoma, history of extracolonic malignancy, and microsatellite instability status) showed that microsatellite instability and coexistence of adenoma were significant independent risk factors for the occurrence of metachronous colorectal carcinomas, with values of P = 0.001 and 0.02, respectively. CONCLUSION: These data indicate that microsatellite instability can be regarded as a novel independent and important marker for predicting the development of metachronous colorectal carcinoma after surgery.
UI - 12068199
AU - Duffy M; O'Mahony L; Coffey JC; Collins JK; Shanahan F; Redmond HP;
TI - Kirwan WO Sulfate-reducing bacteria colonize pouches formed for ulcerative colitis but not for familial adenomatous polyposis.
SO - Dis Colon Rectum 2002 Mar;45(3):384-8
AD - Department of Surgery, Cork University Hospital, Ireland.
PURPOSE: Ileal pouch-anal anastomosis remains the "gold standard" in surgical treatment of ulcerative colitis and familial adenomatous polyposis. Pouchitis occurs mainly in patients with a background of ulcerative colitis, although the reasons for this are unknown. The aim of this study was to characterize differences in pouch bacterial populations between ulcerative colitis and familial adenomatous pouches. METHODS: After ethical approval was obtained, fresh stool samples were collected from patients with ulcerative colitis pouches (n = 10), familial adenomatous polyposis (n = 7) pouches, and ulcerative colitis ileostomies (n = 8). Quantitative measurements of aerobic and anaerobic bacteria were performed. RESULTS: Sulfate-reducing bacteria were isolated from 80 percent (n = 8) of ulcerative colitis pouches. Sulfate-reducing bacteria were absent from familial adenomatous polyposis pouches and also from ulcerative colitis ileostomy effluent. Pouch Lactobacilli, Bifidobacterium, Bacteroides sp, and Clostridium perfringens counts were increased relative to ileostomy counts in patients with ulcerative colitis. Total pouch enterococci and coliform counts were also increased relative to ileostomy levels. There were no significant quantitative or qualitative differences between pouch types when these bacteria were evaluated. CONCLUSIONS: Sulfate-reducing bacteria are exclusive to patients with a background of ulcerative colitis. Not all ulcerative colitis pouches harbor sulfate-reducing bacteria because two ulcerative colitis pouches in this study were free of the latter. They are not present in familial adenomatous polyposis pouches or in ileostomy effluent collected from patients with ulcerative colitis. Total bacterial counts increase in ulcerative colitis pouches after stoma closure. Levels of Lactobacilli, Bifidobacterium, Bacteroides sp, Clostridium perfringens, enterococci, and coliforms were similar in both pouch groups. Because sulfate-reducing bacteria are specific to ulcerative colitis pouches, they may play a role in the pathogenesis of pouchitis.
UI - 12068202
AU - Martinez-Santos C; Lobato RF; Fradejas JM; Pinto I; Ortega-Deballon P;
TI - Moreno-Azcoita M Self-expandable stent before elective surgery vs. emergency surgery for the treatment of malignant colorectal obstructions: comparison of primary anastomosis and morbidity rates.
SO - Dis Colon Rectum 2002 Mar;45(3):401-6
AD - Department of General Surgery, Getafe University Hospital, Madrid, Spain.
PURPOSE: At present there are not enough studies that demonstrate the usefulness of self-expandable stents in patients with left-sided malignant colon and rectal obstruction. We evaluated primary anastomosis and morbidity rates obtained with this method in comparison with the colorectal obstruction were enrolled. Forty-three patients were assigned to the study group (preoperative stent and elective surgical treatment or palliative stent, depending on the assessment of the stage of the tumor) and 29 to the control group (emergency surgical treatment). The resection was not indicated in 18 cases in the study group (after preoperative staging in 17 and intraoperative staging in 1) and in 3 cases in the control group. RESULTS: In the study group, the obstruction was relieved in 41 cases (95 percent) after the stent placement. Of 26 patients who underwent surgical treatment, a primary anastomosis was possible in 22 (84.6 vs. 41.4 percent in the control group, P = 0.0025), with lower need for a colostomy (15.4 vs. 58.6 percent in the control group). The anastomotic failure rate was similar and the reintervention rate was lower (0 vs. 17 percent, P = 0.014). The total stay (14.23 vs. 18.52 days; P = 0.047), the intensive care unit stay (0.3 vs. 2.9 days; P = 0.015), and the number of patients with severe complications (11.6 vs. 41.2 percent; P = 0.008) were significantly lower in the study group. CONCLUSIONS: In our patients with left-sided malignant colon and rectal obstruction, placement of a preoperative stent prevented 17 (94 percent) of 18 of unnecessary operations and a large number of colostomies after elective surgery. These results were obtained with a lower severe complication rate as well as a shorter hospital stay.
UI - 11829043
AU - Cheung YL; Molassiotis A; Chang AM
TI - A pilot study on the effect of progressive muscle relaxation training of patients after stoma surgery.
SO - Eur J Cancer Care (Engl) 2001 Jun;10(2):107-14
AD - Department of Surgery, Tseung Kwan O Hospital, Hong Kong.
Eighteen patients who had undergone stoma surgery were assessed with respect to their anxiety level and self-reported quality of life (QoL) on three occasions; namely, immediately after surgery, 5 weeks after surgery, and 10 weeks after surgery. The patients were randomised into a control group (n = 10) and an experimental group (n = 8). A 20-min set of audiotaped instructions on progressive muscle relaxation training (PMRT) was given to the patients in the experimental group for home practice. Assessment instructions included the Chinese State-Trait Anxiety Inventory (C-STAI), the Quality of Life Index for Colostomy (QoL-Colostomy) and the Hong Kong Chinese version of the World Health Organisation Quality of Life Scale (WHOQoL). Results indicated that there was a significant decrease in both the C-STAI score (F = 4.66, P < 0.05) and the WHOQoL score (F = 4.74, P < 0.05) in the experimental group. Among the domains of WHOQoL, a significant difference was shown in physical health/independence and general perception of QoL, with the experimental group demonstrating better functioning. For the QoL-Colostomy, however, there was no significant difference between the control and experimental groups. The results suggest that the use of PMRT could enhance quality of life and decrease state anxiety in patients after stoma surgery.
UI - 11829044
AU - Anderson H; Espinosa E; Lofts F; Meehan M; Hutchinson G; Price N; Heyes
TI - A Evaluation of the chemotherapy patient monitor: an interactive tool for facilitating communication between patients and oncologists during the cancer consultation.
SO - Eur J Cancer Care (Engl) 2001 Jun;10(2):115-23
AD - Christie Hospital, Manchester, UK.
Effective communication between oncologists and patients with cancer is of paramount importance. The Chemotherapy Patient Monitor (CPM) is a novel tool designed to assist doctor-patient communication regarding patient concerns and side-effects. Initially, the CPM was assessed in a primary evaluation study of its use during consultations with 26 patients with advanced colorectal cancer (one consultation without, followed by two with, the CPM per patient). This led to a further dissemination/audit of 34 patients attending oncology centres in the UK, who had completed the survey prior to three consultations. The CPM contains a checklist of common side-effects of chemotherapy regimens used in advanced colorectal cancer, and other common concerns of patients with advanced colorectal cancer. The CPM records the presence of side-effects/concerns, the distress caused, whether patients wish to discuss them further, and actions taken as a result. Questionnaires explored the views of patients and oncologists in the UK and Spain regarding the effectiveness of consultations during a baseline visit conducted without the CPM, and then with the CPM in subsequent visits. These data were then complemented by the dissemination/audit study of the CPM across nine centres in the UK. All patients understood the CPM. The CPM was rated as useful by oncologists in 83% of consultations, and did not lengthen 82% of visits. Patients felt it had improved the visit in 95% of cases. Responses from patients (100%) and oncologists (84%) indicated willingness to use the CPM for at least some consultations in the future. The results of the dissemination/audit study supported these conclusions. We conclude that the CPM appears to be a useful new tool for improving patient-doctor communication during cancer consultations.
UI - 11995185
AU - Pector JC; Legendre H
TI - [Development of surgical treatment of primitive and metastatic rectal cancer]
SO - Bull Mem Acad R Med Belg 2001;156(7-9):410-7
AD - Departement de Chirurgie, Institut Jules Bordet, Bruxelles.
There are many ways by which the surgeon can optimize curative resection for rectal cancer. Appropriate margins with total mesorectal excision, should be the goals for tumors in the lower two-thirds of the rectum. Reconstruction should be performed, whenever technically possible, by a colonic J-pouch. Preservation of pelvic autonomic nerves is possible in most cases, reducing the risk of postoperative sexual and urinary dysfunction. New techniques increase the frequency of curative treatments of metastatic disease. Towards either the primary or the metastatic disease, the new therapeutic strategies offer an hope of cure, and a better quality of life, to an increasing number of patients.
UI - 11167877
AU - Wigmore SJ; McMahon AJ; Sturgeon CM; Fearon KC
TI - Acute-phase protein response, survival and tumour recurrence in patients with colorectal cancer.
SO - Br J Surg 2001 Feb;88(2):255-60
AD - Department of Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
INTRODUCTION: An acute-phase protein response (APPR) has been associated with reduced crude survival rates and increased recurrence following apparently curative resection in patients with colorectal cancer. This study investigated the prognostic significance of a preoperative and postoperative APPR in relation to disease-specific mortality rate. METHODS: Some 202 patients with colorectal cancer were followed for at least 5 years. C-reactive protein concentration, measured before and at 3 months after operation, was used as an index of the APPR. Univariate and multivariate analyses were performed on a number of potential prognostic factors. RESULTS: Thirty-six per cent of patients had an APPR and this was associated with a higher rate of local tumour invasion, fewer curative resections and a higher carcinoembryonic antigen (CEA) concentration. There was no difference in Dukes' stage between patients with or without an APPR. The most important prognostic factor related to both disease-specific and crude survival was Duke's stage (P < 0.0001). Subgroup analysis demonstrated that APPR had prognostic significance only in patients with advanced disease (P = 0.013). An APPR was present in a minority of patients (11 per cent) after operation and was not associated with increased likelihood of tumour recurrence. CONCLUSION: The APPR is increased in more than a third of patients presenting with colorectal cancer and is associated with more frequent local tumour invasion, fewer curative resections and a higher CEA level. An APPR at 3 months after operation does not have the prognostic significance reported by earlier studies.
UI - 12027979
AU - Law WL; Chu KW; Choi HK
TI - Randomized clinical trial comparing loop ileostomy and loop transverse colostomy for faecal diversion following total mesorectal excision.
SO - Br J Surg 2002 Jun;89(6):704-8
AD - Department of Surgery, Queen Mary Hospital, University of Hong Kong Medical Centre, 102 Pokfulam Road, Hong Kong.
BACKGROUND: The aim of this study was to compare loop ileostomy and loop transverse colostomy as the preferred mode of faecal diversion following low anterior resection with total mesorectal excision for rectal cancer. METHODS: Patients who required proximal diversion after low anterior resection with total mesorectal excision were randomized to have either a loop ileostomy or a loop transverse colostomy. Postoperative morbidity, stoma-related problems and morbidity following closure were loop ileostomy and 38 had a loop transverse colostomy constructed following low anterior resection. Postoperative intestinal obstruction and prolonged ileus occurred more commonly in patients with an ileostomy (P = 0.037). There was no difference in time to resumption of diet, length of hospital stay following stoma closure and incidence of stoma-related complications after discharge from hospital. A total of seven patients had intestinal obstruction from the time of stoma creation to stoma closure (six following ileostomy and one following colostomy; P = 0.01). CONCLUSION: Intestinal obstruction and ileus are more common after loop ileostomy than loop colostomy. Loop transverse colostomy should be recommended as the preferred method of proximal faecal diversion.
UI - 12027989
AU - Nakagoe T; Ishikawa H; Sawai T; Tsuji T; Tanaka K; Ayabe H
TI - Surgical technique and outcome of gasless video endoscopic transanal rectal tumour excision.
SO - Br J Surg 2002 Jun;89(6):769-74
AD - First Department of Surgery, Nagasaki University School of Medicine and Department of Surgery, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan. email@example.com
BACKGROUND: Transanal endoscopic microsurgery (TEM) is unpopular because of its high cost and most surgeons' unfamiliarity with microscopic surgery. This report describes an experience with a modification of TEM, gasless video endoscopic transanal rectal tumour excision (gasless VTEM), which incorporates a standard laparoscopic video camera and requires no carbon dioxide insufflation system. METHODS: One hundred and one patients with 105 rectal tumours underwent gasless VTEM between 1993 and 2000.RESULTS: Histological examination revealed 18 adenomas, 75 carcinomas (Tis, 47; T1, 23; T2, five), 11 carcinoid tumours and one lymphoma. The median height above the dentate line and maximum tumour diameter was 5.0 (range 2-14) cm and 2.0 (range 0.4-8.0) cm respectively. The peritoneal cavity was opened intraoperatively in two patients. The median operating time was 53 (range 15-202) min. Bleeding, suture dehiscence and transient incontinence developed after operation in four patients. There was no operative death. Median hospital stay was 5 (range 1-21) days. Eleven patients with T1/T2 staging underwent subsequent radical resection. The median duration of follow-up was 52.3 months. One patient with a carcinoma developed a recurrence. CONCLUSION: Gasless VTEM is a feasible, safe and minimally invasive procedure for the treatment of selected rectal adenomas and early carcinomas. The suggested modifications may make the procedure more widely available.
UI - 12072621
AU - Lindsey I; George B; Kettlewell M; Mortensen N
TI - Randomized, double-blind, placebo-controlled trial of sildenafil (Viagra) for erectile dysfunction after rectal excision for cancer and inflammatory bowel disease.
SO - Dis Colon Rectum 2002 Jun;45(6):727-32
AD - Department of Colorectal Surgery, John Radcliffe Hospital, Oxford, United Kingdom.
PURPOSE: Controlled trials have demonstrated the efficacy of sildenafil for "mixed etiology" erectile dysfunction, but this may not be the case if there is underlying pelvic parasympathetic nerve damage. We aimed to determine the efficacy of sildenafil after rectal excision for rectal cancer and inflammatory bowel disease. METHODS: Patients with erectile dysfunction after rectal excision were randomly assigned in a double-blind manner to sildenafil or placebo groups. After unblinding, placebo patients crossed over to open sildenafil. Primary end points were improvement in erectile function on a global efficacy question and erectile function questionnaire scores. Secondary end points were frequency and severity of side effects. RESULTS: Thirty-two patients were randomly assigned, and two dropped out before randomization. Fourteen received sildenafil, and 18 received placebo. Eleven (79 percent) of 14 responded to sildenafil, on global efficacy assessment, compared with 3 (17 percent) of 18 taking placebo (mean difference, 61.9 percent; 95 percent confidence interval, 34.4 to 89.4 percent; P = 0.0009). Sildenafil improved both erectile function domain scores (mean difference, 13.3; 95 percent confidence interval, 7.9 to 18.7; P = 0.0001) and total International Index of Erectile Function scores (mean difference, 30.6; 95 percent confidence interval, 18.7 to 42.6; P < 0.0001) from pretreatment baseline scores. Placebo did not produce improvement in either erectile function (mean difference, 1.7; 95 percent confidence interval, -0.8 to 4.2; P = 0.16) or total International Index of Erectile Function scores (mean difference, 5; 95 percent confidence interval, -1.1 to 11.1; P = 0.1). Ten (100 percent) of 10 crossover patients not responding to placebo did respond to sildenafil (difference, 100 percent; P < 0.0001). Sildenafil improved both erectile function domain scores (mean difference, 16.8; 95 percent confidence interval, 9.7 to 24; P = 0.002) and total International Index of Erectile Function scores (mean difference, 29.5; 95 percent confidence interval, 15.8 to 43.2; P = 0.003) from precrossover baseline scores. Seven (50 percent) of 14 patients on sildenafil compared with 4 (22 percent) of 18 on placebo experienced side effects (difference, 28 percent; 95 percent confidence interval, -4.4 to 60.4 percent; P = 0.14), 91 percent of which were mild and well tolerated. CONCLUSION: Sildenafil completely reverses or satisfactorily improves postproctectomy erectile dysfunction in 79 percent of patients. Side effects are usually mild and well tolerated. The damage incurred by the pelvic nerves after proctectomy, less profound than after prostatectomy, is likely to result in a partial parasympathetic nerve lesion.
UI - 12072624
AU - Ono C; Yoshinaga K; Enomoto M; Sugihara K
TI - Discontinuous rectal cancer spread in the mesorectum and the optimal distal clearance margin in situ.
SO - Dis Colon Rectum 2002 Jun;45(6):744-9; discussion 742-3
AD - Department of Digestive Surgery, Tokyo Medical and Dental University Graduate School, Tokyo, Japan.
PURPOSE: We examined the frequency, mode, and extent of discontinuous spread of rectal cancer in the mesorectum to determine the optimal distal clearance margin in situ. METHODS: Forty consecutive patients with rectal cancer undergoing locally curative resection were studied prospectively. Discontinuous cancer spread in the mesorectum and the extent of distal spread was examined microscopically. A tissue shrinkage ratio comparing the distal clearance margin measured before transection to that measured after fixation in each case, was used to convert microscopically measured extent of distal spread to extent in situ. RESULTS: Discontinuous cancer spread in the mesorectum was observed in 17 cases (43 percent); lymph node metastasis in 15 cases (38 percent) and small deposits other than nodal metastases in 8 cases (20 percent). Distal cancer spread (either intramural or mesorectal) was observed in 6 cases (15 percent). The mean distal clearance margin before transection and after fixation was 3.2 cm and 2 cm, respectively. The mean tissue shrinkage ratio was 60 percent. The maximum extent of microscopic distal spread and adjusted distal spread in situ were 20 and 24 mm, respectively. CONCLUSIONS: Excising the mesorectum with fascia propria circumferentially intact is essential for rectal surgery. The optimal distal clearance margin for the rectal wall as well as the mesorectum in situ can be reduced to 3 cm with a right angle.
UI - 12072640
AU - Kouraklis G
TI - Reconstruction of the pelvic floor using the rectus abdominis muscles after radical pelvic surgery.
SO - Dis Colon Rectum 2002 Jun;45(6):836-9
AD - Second Department of Propedeutic Surgery, Medical School of University of Athens, Greece.
PURPOSE: To support the small intestine out of the pelvic cavity, many methods have been described to reconstruct the pelvic floor after radical pelvic surgery. I describe a new technique using the rectus abdominis muscles for pelvic floor reconstruction. METHODS: The posterior rectus sheath and peritoneum are opened. The rectus muscles are exposed at both sides and they are divided between paired clamps at the level of the umbilicus. Then, the rectus muscles are carefully retracted downward, and the edges are sutured posteriorly to the promontorium and laterally around the linea terminalis. RESULTS: This method was used in 11 patients who underwent radical pelvic surgery. Seven of 11 patients had radiation therapy started 4 weeks postoperatively. The patients were followed up for two years. No patient showed any complication such as adhesive obstruction of the bowel or radiation enteritis, even in the patients who underwent radiotherapy. CONCLUSIONS: Reconstruction of the pelvic floor using the rectus abdominis muscles after radical pelvic surgery is an easy and safe technique that avoids complications and serves as a barrier to radiation injury. Therefore, we believe that this method is a promising proposal requiring further investigation in a larger number of patients.
UI - 12065560
AU - Etienne MC; Chazal M; Laurent-Puig P; Magne N; Rosty C; Formento JL;
TI - Francoual M; Formento P; Renee N; Chamorey E; Bourgeon A; Seitz JF; Delpero JR; Letoublon C; Pezet D; Milano G Prognostic value of tumoral thymidylate synthase and p53 in metastatic colorectal cancer patients receiving fluorouracil-based chemotherapy: phenotypic and genotypic analyses.
SO - J Clin Oncol 2002 Jun 15;20(12):2832-43
AD - Centre Antoine Lacassagne and Centre Hospitalier Universitaire, Nice, France.
PURPOSE: The aim of this multicenter prospective study was to evaluate the role of intratumoral parameters related to fluorouracil (FU) sensitivity in 103 metastatic colorectal cancer patients receiving FU-folinic acid. PATIENTS AND METHODS: Liver metastatic biopsy specimens were obtained for all patients and primary tumor biopsy specimens for 54 patients. Thymidylate synthase (TS), folylpolyglutamate synthetase, and dihydropyrimidine dehydrogenase were measured by radioenzymatic assays; TS promoter polymorphism (2R/2R v 2R/3R v 3R/3R) was determined by polymerase chain reaction; and p53 protein and mutations were analyzed by immunoluminometric assay and denaturing gradient gel electrophoresis, respectively. RESULTS: p53 mutations were observed in 56.7% of metastases. TS activity was significantly higher in 2R/3R tumors as compared with 2R/2R or 3R/3R. TS activity in metastasis was the only parameter linked to clinical responsiveness (responders exhibited the lower TS, P =.047). Univariate Cox analyses demonstrated that TS activity in primary tumor (the greater the TS, the poorer the survival; P =.040), TS promoter polymorphism in primary tumor (risk of death of 2R/3R v 2R/2R, 2.68; P =.035), and p53 stop mutation in metastasis (risk of death of stop mutations v wild type, 3.14; P =.018) were the only significant biologic predictors of specific survival. Stepwise analysis did not discriminate between TS activity and TS polymorphism. CONCLUSION: Present results confirm the value of tumoral TS activity for predicting FU responsiveness, point out the importance of detailed p53 mutation analysis for predicting survival, and suggest that TS genotype in primary tumor carries a prognostic value similar to that of TS activity.
UI - 12088248
AU - Poletti P; Pinotti G; Rosati G; Luppi G; Ibrahim T; Marinozzi C; Pucci
TI - F; Pancera G; Biasco G; Barni S; Garufi C; Martignoni G; Visona G; Labianca R "Misura" project: a retrospective survey on the use of 5fluorouracil in the treatment of colorectal cancer in 24 Italian clinical centers.
SO - Tumori 2002 Mar-Apr;88(2):104-9
AD - Unita Operativa di Oncologia Medica, Ospedali Riuniti, Bergamo, Italy.
The "Misura" project is a retrospective survey, with the aim to evaluate how 5FU is used in the treatment of colorectal cancer in clinical practice in Italian oncology departments. Twenty-four centers participated. Patients seen in the second half of 1998 with colorectal cancer and treated with 5FU were analyzed. Observed patients were 664, 45.9% of patients presented metastatic disease. Biochemical modulation with folinic acid and bolus 5FU was the most used schedule (59%). The De Gramont (LV 5FU2) regimen, alone or with other cytotoxic drugs, was the second most chosen schedule (14%). The most frequent side effect observed was gastrointestinal toxicity. No hematological toxicity was demonstrated in 68.8% of patients. Cutaneous toxicity occurred in 21.1% of patients. 5FU is widely used independently by the stage of disease. In palliative treatment a variety of schedules were administered by the Italian centers, lacking a standard therapy. There are very few surveys investigating oncology clinical practice. A larger survey on this issue is auspicable.
UI - 12004205
AU - Shoup M; Guillem JG; Alektiar KM; Liau K; Paty PB; Cohen AM; Wong WD;
TI - Minsky BD Predictors of survival in recurrent rectal cancer after resection and intraoperative radiotherapy.
SO - Dis Colon Rectum 2002 May;45(5):585-92
AD - Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York 10021, USA.
PURPOSE: This study was designed to determine predictors of survival after surgery and intraoperative radiotherapy for recurrent rectal cancer. METHODS: From a prospective database, 634 patients undergoing were identified. Of these, 111 received intraoperative radiotherapy with curative intent, and 100 were available for follow-up. Clinicopathologic variables from both the primary and recurrent operations were evaluated as predictors of disease-free and disease-specific survival by multivariate Cox regression and log-rank test. RESULTS: There were 54 males and 46 females, with a median age of 57 (range, 37-83) years. With a median follow-up of 23.2 months, 60 patients (60 percent) recurred: 20 (33 percent) locally, 27 (45 percent) distantly, and 13 (22 percent) at both sites. Of all variables analyzed, only complete resection with microscopically negative margins and the absence of vascular invasion in the recurrent specimen predicted improved disease-free and disease-specific survival (P < 0.01 for all). Median disease-free survival and median disease-specific survival were 31.2 and 66.1 months, respectively, for complete resection compared with 7.9 and 22.8 months for resection with microscopic or grossly positive margins (P < 0.01 for both). Median disease-free survival and median disease-specific survival were 6.4 and 16.1 months, respectively, in the presence of vascular invasion in the recurrent specimen compared with 23.3 and 57.3 months in the absence of vascular invasion (P < 0.01 and P < 0.05, respectively). Complete resection and the absence of vascular invasion were the only predictors of improved local control as well (P < 0.05 and P < 0.01, respectively). CONCLUSION: Resection with negative microscopic margins and absence of vascular invasion are independent predictors of local control and improved survival after resection and intraoperative radiotherapy for recurrent rectal cancer.
UI - 12004207
AU - Kennedy ML; Lubowski DZ; King DW
TI - Transanal endoscopic microsurgery excision: is anorectal function compromised?
SO - Dis Colon Rectum 2002 May;45(5):601-4
AD - Colorectal Unit, St. George Hospital, Sydney, Australia.
PURPOSE: Transanal endoscopic microsurgery is a new technique that has not yet found its place in routine practice. The procedure results in dilation of the anal sphincter with a large-diameter operating sigmoidoscope, sometimes for a prolonged period. The purpose of the present study was to assess the effect of transanal endoscopic microsurgery on anorectal function. METHODS: Eighteen consecutive p