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BJS Open Aug 2019The presence of extraintestinal manifestations may be associated with the development of pouchitis in patients with ulcerative colitis after ileal pouch-anal... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The presence of extraintestinal manifestations may be associated with the development of pouchitis in patients with ulcerative colitis after ileal pouch-anal anastomosis. The aim of this study was to assess this correlation.
METHODS
A systematic literature search was performed using MEDLINE and the Cochrane Library. Studies published in English up to 22 May 2017 investigating the association between extraintestinal manifestations and development of pouchitis in adults with ulcerative colitis were included. Case reports were excluded. The association of extraintestinal manifestations with the development of overall and chronic pouchitis was investigated using a random-effects model.
RESULTS
Of 1010 citations identified, 22 observational studies comprising 5128 patients were selected for analysis. The presence of extraintestinal manifestations was significantly associated with both chronic pouchitis (odds ratio 2·28, 95 per cent c.i. 1·57 to 3·32; = 0·001) and overall pouchitis (odds ratio 1·96, 1·49 to 2·57; < 0·001).
CONCLUSION
The presence of extraintestinal manifestations is associated with development of pouchitis after ileal pouch-anal anastomosis.
Topics: Cholangitis, Sclerosing; Colitis, Ulcerative; Humans; Postoperative Complications; Pouchitis; Proctocolectomy, Restorative; Risk Factors
PubMed: 31463422
DOI: 10.1002/bjs5.50149 -
The British Journal of Surgery Dec 2020The risks of local recurrence and treatment-related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta-analysis was to... (Meta-Analysis)
Meta-Analysis
BACKGROUND
The risks of local recurrence and treatment-related morbidity need to be balanced after local excision of early rectal cancer. The aim of this meta-analysis was to determine oncological outcomes after local excision of pT1-2 rectal cancer followed by no additional treatment (NAT), completion total mesorectal excision (cTME) or adjuvant (chemo)radiotherapy (aCRT).
METHODS
A systematic search was conducted in PubMed, Embase and the Cochrane Library. The primary outcome was local recurrence. Statistical analysis included calculation of the weighted average of proportions.
RESULTS
Some 73 studies comprising 4674 patients were included in the analysis. Sixty-two evaluated NAT, 13 cTME and 28 aCRT. The local recurrence rate for NAT among low-risk pT1 tumours was 6·7 (95 per cent c.i. 4·8 to 9·3) per cent. There were no local recurrences of low-risk pT1 tumours after cTME or aCRT. The local recurrence rate for high-risk pT1 tumours was 13·6 (8·0 to 22·0) per cent for local excision only, 4·1 (1·7 to 9·4) per cent for cTME and 3·9 (2·0 to 7·5) per cent for aCRT. Local recurrence rates for pT2 tumours were 28·9 (22·3 to 36·4) per cent with NAT, 4 (1 to 13) per cent after cTME and 14·7 (11·2 to 19·0) per cent after aCRT.
CONCLUSION
There is a substantial risk of local recurrence in patients who receive no additional treatment after local excision, especially those with high-risk pT1 and pT2 rectal cancer. The lowest recurrence risk is provided by cTME; aCRT has outcomes comparable to those of cTME for high-risk pT1 tumours, but shows a higher risk for pT2 tumours.
Topics: Chemoradiotherapy, Adjuvant; Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Proctectomy; Rectal Neoplasms; Treatment Outcome
PubMed: 32936943
DOI: 10.1002/bjs.12040 -
In Vivo (Athens, Greece) 2020Stomal metastases from a primary rectal adenocarcinoma are rare, therefore, clear guidelines on treatment options are limited. We performed a systematic review including...
BACKGROUND/AIM
Stomal metastases from a primary rectal adenocarcinoma are rare, therefore, clear guidelines on treatment options are limited. We performed a systematic review including a case report on this subject with the primary objective of identifying the total number of cases in the literature. The secondary objective was to assess median survival.
MATERIALS AND METHODS
A 59-year-old woman presented to our institution with anal incontinence to mucus leakage. Flexible sigmoidoscopy identified a carpet adenoma from the dentate line to the rectosigmoid junction. An abdomino-perineal resection (APR) was performed using the transanal total mesorectal excision technique (TaTME). No adjuvant chemotherapy was offered. Twenty-one months following the operation a stomal recurrence was identified. Palliative radiotherapy was commenced and the patient is alive 6 months later with no visible recurrence at the site of the stoma. A systematic review was performed in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.
RESULTS
The systematic review identified 19 individual cases of either metachronous or true metastatic recurrence, including our own case. Median survival was 30 months in the 8 cases where further treatment was offered and accepted.
CONCLUSION
Stomal metastases or metachronous colorectal cancer is uncommon. The causes for this pattern of spread are not clear. Long-term survival from cutaneous recurrence is generally poor. For carefully selected patients, redo surgery is an option with satisfactory results.
Topics: Female; Humans; Middle Aged; Neoplasm Recurrence, Local; Rectal Neoplasms; Rectum; Surgical Stomas
PubMed: 32871741
DOI: 10.21873/invivo.12029 -
International Journal of Radiation... Dec 2019The goal of treatment for early stage rectal cancer is to optimize oncologic outcome while minimizing effect of treatment on quality of life. The standard of care...
The goal of treatment for early stage rectal cancer is to optimize oncologic outcome while minimizing effect of treatment on quality of life. The standard of care treatment for most early rectal cancers is radical surgery alone. Given the morbidity associated with radical surgery, local excision for early rectal cancers has been explored as an alternative approach associated with lower rates of morbidity. The American Radium Society Appropriate Use Criteria presented in this manuscript are evidence-based guidelines for the use of local excision in early stage rectal cancer that include an extensive analysis of current medical literature from peer-reviewed journals and the application of a well-established consensus methodology (modified Delphi) used by a multidisciplinary expert panel to rate the appropriateness of imaging and treatment procedures. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. These guidelines are intended for the use of all practitioners and patients who desire information regarding the use of local excision in rectal cancer.
Topics: Alpha Particles; Antineoplastic Agents; Chemoradiotherapy, Adjuvant; Consensus; Delphi Technique; Evidence-Based Practice; Humans; Magnetic Resonance Imaging; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Selection; Postoperative Complications; Proctectomy; Proctoscopy; Quality of Life; Rectal Neoplasms; Societies, Medical; Standard of Care; Treatment Outcome; United States; Watchful Waiting
PubMed: 31445109
DOI: 10.1016/j.ijrobp.2019.08.020