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Saudi Journal of Gastroenterology :... 2021With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
With acute obstruction due to rectal or recto-sigmoid cancer, the safety and success of deploying self-expandable metal stents has been controversial. The aim of this systematic review was to synthesize the existing evidence on the outcomes and complication rates of stent placement in these patients.
METHODS
We performed a literature search of PubMed by using appropriate keywords, and manual reference screening of included articles was done. The article screening, data extraction, and quality assessment was done by four independent reviewers. A meta analyses was performed for the main outcome measures: technical and clinical success and complication rates.
RESULTS
We identified 962 articles in the search. After applying inclusion and exclusion criteria, we included 32 articles in the meta-analysis. The pooled technical success rate across 26 studies that reported it was 97% [95% confidence interval (CI): 95%-99%] without evidence of significant heterogeneity (I = 0.0%, P = 0.84), and the clinical success rate across 26 studies that reported it was 69% (95% CI: 58%-79%) with evidence of significant heterogeneity (I = 81.7%, P < 0.001). The pooled overall complication rate across the 32 studies was 28% (95% CI: 20%-37%) with evidence of significant heterogeneity (I = 79.3%, P < 0.001).
CONCLUSION
The use of rectal stents in obstructing rectal or recto-sigmoid tumors seems to be technically feasible. A high rate of technical success, however, does not always translate into clinical success. A considerable complication rate is associated with this approach. Randomized controlled trials are needed to compare the outcomes of rectal stent placement with those of surgery.
Topics: Humans; Rectal Neoplasms; Self Expandable Metallic Stents; Stents; Treatment Outcome
PubMed: 33976008
DOI: 10.4103/sjg.sjg_506_20 -
BJR Case Reports Sep 2022Cavernous haemangiomas of the rectosigmoid colon are rare benign vascular neoplasms of the GI tract. Patients usually present at a younger age with various degree of...
Cavernous haemangiomas of the rectosigmoid colon are rare benign vascular neoplasms of the GI tract. Patients usually present at a younger age with various degree of rectal bleeding ranging from mild painless episodic bleeding to life-threatening hemorrhage. High index of suspicion and early diagnosis is crucial to avoid unnecessary biopsy and inappropriate management. We report a case of a 26-year-old male patient with a long history of recurrent rectal bleeding. Contrast-enhanced CT scan of the abdomen and pelvis and MRI confirmed the diagnosis of cavernous hemangioma. Further surgical treatment with rectosigmoid resection and colo-anal anastomosis represents the optimum path of management for our patient.
PubMed: 36211606
DOI: 10.1259/bjrcr.20220084 -
The Indian Journal of Surgery Feb 2018Primary squamous cell carcinoma of the rectum is extremely rare. Squamous cell carcinoma of the anorectum is a known entity evaluation and treatment protocols have been... (Review)
Review
Primary squamous cell carcinoma of the rectum is extremely rare. Squamous cell carcinoma of the anorectum is a known entity evaluation and treatment protocols have been well defined. The occurrence of squamous cell carcinoma of rectosigmoid in concurrence with squamous cell carcinoma of the anal canal is extremely rare and the first case to be reported in the literature. A 48-year-old male patient presented with difficulty in passing stools. The clinical examination, colonoscopy, and the histopathology revealed synchronous proctosigmoid and the anorectal neoplasm. A case like this will pose a diagnostic challenges; squamous cell carcinoma of the rectum is not defined in the medical literature; synchronous squamous cell carcinoma will pose both diagnostic dilemmas and treatment challenges like whether to conserve the sphincter or not. Because squamous cell carcinoma of the anorectum can be treated by chemoradiotherapy, even this case is initially thought of treating by neoadjuvant chemoradiotherapy followed by low anterior resection followed by adjuvant treatment. Since there was no medical literature to support this treatment, ultimately multidisciplinary tumor board decision was made for abdominoperineal resection. Patient was treated with abdominoperineal resection and adjuvant chemoradiation. The diagnostic dilemmas and the management issues have been discussed.
PubMed: 29581689
DOI: 10.1007/s12262-017-1716-x -
Thoracic Cancer Aug 2023Inflammation in non-small cell lung cancer (NSCLC) may impair the response to immune checkpoint inhibitors (ICIs) and can be indicated by peripheral blood inflammatory...
Assessing the role of colonic and other anatomical sites uptake by [ F]FDG-PET/CT and immune-inflammatory peripheral blood indexes in patients with advanced non-small cell lung cancer treated with first-line immune checkpoint inhibitors.
BACKGROUND
Inflammation in non-small cell lung cancer (NSCLC) may impair the response to immune checkpoint inhibitors (ICIs) and can be indicated by peripheral blood inflammatory indexes. 2-deoxy-2-[ F]fluoro-D-glucose positron emission tomography/computed tomography ([ F] FDG-PET/CT) may be used as a marker of inflammation by measuring glucose metabolism in different colonic sites.
METHODS
This retrospective analysis aimed to investigate the correlation between [ F] FDGPET/CT SUV in six gastrointestinal districts, the spleen, the pharynx and the larynx alongside the most avid tumor lesion with peripheral blood inflammatory indexes, including the neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammatory index (SII, i.e., NLR times platelets) and lactate dehydrogenase (LDH), in patients with [ F] FDG-PET/CT staged IV NSCLC who received first-line immune checkpoint inhibitors (ICIs). The role of SUV and peripheral blood inflammatory indexes in predicting overall survival (OS) and progression-free survival (PFS) was then explored.
RESULTS
A total of 43 patients were treated with first-line ICI alone (58%) or in combination with chemotherapy (42%). A significant correlation was only found between the rectosigmoid SUV and NLR (p = 0.0465). NLR >5.5 and LDH > 333.5 were associated with a worse OS (p = 0.033 and p = 0.009, respectively). The SII was associated with a worse PFS in patients treated with ICI alone (p = 0.033). None of the SUV were significantly associated with OS or PFS, although a high left colon SUV showed a trend toward a worse PFS.
CONCLUSION
There was no significant correlation between [ F]FDG PET/CT uptake in different anatomical sites, and in the tumor, and systemic immune-inflammatory indexes. The prognostic role of high left colon SUV deserves further investigation.
Topics: Humans; Carcinoma, Non-Small-Cell Lung; Positron Emission Tomography Computed Tomography; Lung Neoplasms; Fluorodeoxyglucose F18; Immune Checkpoint Inhibitors; Retrospective Studies; Prognosis; Inflammation
PubMed: 37442801
DOI: 10.1111/1759-7714.15032 -
Life (Basel, Switzerland) Mar 2023A Hartmann operation, which is the intervention by which the lower part of the sigmoid and the upper part of the rectum are resected with the closing of the rectal stump...
BACKGROUND
A Hartmann operation, which is the intervention by which the lower part of the sigmoid and the upper part of the rectum are resected with the closing of the rectal stump and end colostomy, has as its indications: advanced or complicated rectosigmoid neoplasm, moderate biological condition of the patient, peritoneal sepsis, intestinal occlusion and fragile colonic wall, especially in the context of inflammatory changes. The Hartmann procedure can save lives even at the cost of a stoma reversal failure.
METHODS
The cases operated with the Hartmann procedure by an open approach or laparoscopic approach in our clinic, between 1 January 2016 and 31 December 2020, were admitted in this study and their medical records were reviewed, also making a comparison between the two types of approach. Univariate statistical comparisons but also a multivariate analysis was performed.
RESULTS
We performed 985 operations for intestinal and colonic occlusion (7.15% of the total operations in the clinic), 531 (54%) were non-tumor occlusions and 454 (46%) were occlusive tumors (88 Hartmann operations). Of these, 7.3% were laparoscopically performed (7 laparoscopic Hartmann operations and 23 diagnostic laparoscopies). A total of 11 cases (18%) also had colonic perforation. We compared laparoscopic Hartmann with open Hartmann and observed the benefits of laparoscopy for postoperative morbidity and mortality. The presence of pulmonary and cardiac morbidities is associated with the occurrence of general postoperative morbidities, while peritonitis is statistically significantly associated with the occurrence of local complications that are absent after the laparoscopic approach.
CONCLUSIONS
The Hartmann procedure is still nowadays an operation widely used in emergency situations. Laparoscopy may become standard for the Hartmann procedure and reversal of the Hartmann procedure, but the percentage of laparoscopy remains low due to advanced or complicated colorectal cancer, poor general condition both at the first and second intervention, and the difficulties of reversal of the Hartmann procedure.
PubMed: 37109443
DOI: 10.3390/life13040914 -
Medicina (Kaunas, Lithuania) Apr 2022: For stage IIIb-IV ovarian cancer, bevacizumab-containing treatment is considered the standard of care. The purpose of this study was to evaluate the efficacy of...
: For stage IIIb-IV ovarian cancer, bevacizumab-containing treatment is considered the standard of care. The purpose of this study was to evaluate the efficacy of bevacizumab in combination with carboplatin and paclitaxel as a first-line treatment for advanced ovarian cancer. : Eligible patients had stage IIIc-IV ovarian cancer according to the International Federation of Gynecology and Obstetrics with no clinical signs or symptoms of gastrointestinal obstruction or a history of abdominal fistulae, gastrointestinal perforation, or intra-abdominal abscess or evidence of rectosigmoid involvement by pelvic examination, bowel involvement on computed tomography, or clinical symptoms of bowel obstruction in the previous 6 months. After debulking surgery, the patients received 175 mg/m paclitaxel and carboplatin (AUC 6) for the first six cycles and 7.5 mg/kg bevacizumab every three weeks up to 17 cycles until disease progression, unacceptable toxicity, or consent withdrawal. The primary endpoint was progression-free survival. The secondary endpoint was overall survival. : Between April 2017 and March 2020, 35 patients began study treatment. Bevacizumab was administered at 7.5 mg/kg in all the patients and for more than 7.5 months in 70% of them. The median progression-free survival was 20 months (95% CI: 16-23). The median overall survival was not reached. : This was, to our knowledge, the first trial in Serbia to show progression-free survival and overall survival of combination regimens in advanced ovarian cancer. Based on the observed progression-free survival, bevacizumab combined with chemotherapy should be considered as a standard option in advanced ovarian cancer.
Topics: Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols; Bevacizumab; Carboplatin; Female; Humans; Ovarian Neoplasms; Paclitaxel; Serbia
PubMed: 35630024
DOI: 10.3390/medicina58050607 -
Journal of the Egyptian National Cancer... Sep 2014The occurrence of colorectal cancer during pregnancy is rare and is associated with diagnostic and therapeutic challenges. Herein, we report such a case of rectal cancer... (Review)
Review
INTRODUCTION
The occurrence of colorectal cancer during pregnancy is rare and is associated with diagnostic and therapeutic challenges. Herein, we report such a case of rectal cancer in pregnancy and review the literature.
CASE REPORT
A 31-year-old multiparous, pregnant woman, in the 20th week of gestation, presented with rectal bleeding progressing to spasmodic abdominal pain and right flank vague pain. A flexible rectosigmoidoscopy showed a large ulcerative mass located in the rectosigmoid junction, 15 cm away from anal verge. Imaging studies and biopsy proved it to be rectal adenocarcinoma with single liver metastasis. The patient's pregnancy was terminated and neoadjuvant therapy followed by curative surgery was performed. She is currently receiving adjuvant systemic therapy to eradicate potential micrometastatic disease.
CONCLUSION
This case suggests that colorectal cancer can mimic the signs and the symptoms of pregnancy and tends to present at an advanced stage in pregnant women.
Topics: Adult; Biopsy; Female; Humans; Liver Neoplasms; Pregnancy; Pregnancy Complications, Neoplastic; Rectal Neoplasms; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 25150133
DOI: 10.1016/j.jnci.2014.03.003 -
Journal of B.U.ON. : Official Journal... 2019Right-sided colon cancers (RCCs) and left-sided colon cancers (LCCs) have different embryological, epidemiological, physiological, pathological, genetic, and clinical... (Comparative Study)
Comparative Study
PURPOSE
Right-sided colon cancers (RCCs) and left-sided colon cancers (LCCs) have different embryological, epidemiological, physiological, pathological, genetic, and clinical characteristics, which result in differences in the course, prognosis, and outcome of disease. This study aimed to compare RCCs and LCCs regarding clinicopathological and survival characteristics.
METHODS
The present retrospective study included data of patients who were followed-up and treated for colon cancer from 2008 through 2017. Rectosigmoid, descending colon, and splenic flexure tumors were considered LCC, whereas hepatic flexure and ascending colon tumors were considered RCC. Tumors were staged according to the American Joint Committee on Cancer classification.
RESULTS
The study included 1725 patients (female, 58.7%) having colon cancer with a mean age of 64±12 years. Of the patients, 83.2% (n=1436) had LCC and 16.8% (n=289) had RCC. The rate of patients aged ≥65 years and the rate of patients with a family history of colon cancer were higher in the RCC patients. The rate of metastatic patients was 29.1% in the RCC group and 23.2% in the LCC group (p=0.087). The median follow-up period was 18 months in the RCC group and 23 months in the LCC group (p=0.011). Although the median survival time was higher in the LCC group (62 vs. 43 months), no significant difference was determined between the RCC and LCC groups in terms of survival.
CONCLUSIONS
There are numerous clinicopathological differences between RCC and LCC and these differences are reflected in prognostic and survival differences among certain subgroups.
Topics: Adenocarcinoma; Adult; Aged; Aged, 80 and over; Biomarkers, Tumor; Colonic Neoplasms; Female; Humans; Male; Middle Aged; Mutation; Neoplasm Staging; Retrospective Studies; Risk Factors; Time Factors; Young Adult
PubMed: 31786846
DOI: No ID Found -
Endocrinology, Diabetes & Metabolism... 2016McKittrick-Wheelock syndrome (MWS) is a rare consequence of severe dehydration and electrolyte depletion due to mucinous diarrhoea secondary to a rectosigmoid villous...
UNLABELLED
McKittrick-Wheelock syndrome (MWS) is a rare consequence of severe dehydration and electrolyte depletion due to mucinous diarrhoea secondary to a rectosigmoid villous adenoma. Reported cases of MWS commonly describe hypersecretion of mucinous diarrhoea in association with dehydration, hypokalaemia, hyponatraemia, hypochloraemia and pre-renal azotemia. Hyperglycaemia and diabetes are rarely reported manifestations of MWS. Herein we describe the case of a 59-year-old woman who presented with new-onset diabetes and severe electrolyte derangement due to a giant rectal villous adenoma. Subsequent endoscopic resection of the tumour cured her diabetes and normalised electrolytes. This case describes a rare cause of 'curable diabetes' and indicates hyperaldosteronism and/or whole-body potassium stores as important regulators of insulin secretion and glucose homeostasis.
LEARNING POINTS
McKittrick-Wheelock syndrome (MWS) is typically characterised by the triad of pre-renal failure, electrolyte derangement and chronic diarrhoea resulting from a secretory colonic neoplasm.Hyperglycaemia and new-onset diabetes are rare clinical manifestations of MWS.Hyperaldosteronism and/or hypokalaemia may worsen glucose tolerance in MWS.Aggressive replacement of fluid and electrolytes is the mainstay of acute management, with definitive treatment and complete reversal of the metabolic abnormalities being achieved by endoscopic or surgical resection of the neoplasm.
PubMed: 27252863
DOI: 10.1530/EDM-16-0013 -
JPMA. the Journal of the Pakistan... Jun 2023This case series evaluated morbidity following rectosigmoid resection during cytoreductive surgery for advanced ovarian cancer at the Shaukat Khanum Memorial Cancer...
This case series evaluated morbidity following rectosigmoid resection during cytoreductive surgery for advanced ovarian cancer at the Shaukat Khanum Memorial Cancer Hospital, Lahore. The data of 20 female patients with complications corresponding to the Clavien-Dindo classification was included; the patients received treatment between January 2016 and January 2021. The mean age was 45.05± 13.11 years. Complications were observed in 3 (15.0%) cases, i.e., urinary complications in 2 (66.7%), and intra-abdominal abscess in 1 (33.3%) case. Clavien-Dindo classification grade II was noted in 2 (66.7%), while grade III-B in 1 (33.3%) case. Surgical risk factors were noted as appendectomy in 6 (66.7%) cases, bowel resection in 1 (11.1%), left colectomy in 1 (11.1%), sigmoid colectomy in 1 (11.1%), and stoma formation in 11 (55.0%) cases. In this reported case series, significant complications were observed in women undergoing rectosigmoid resection as cytoreductive surgery for advanced ovarian cancer.
Topics: Female; Humans; Adult; Middle Aged; Ovarian Neoplasms; Cytoreduction Surgical Procedures; Retrospective Studies; Proctocolectomy, Restorative; Morbidity; Postoperative Complications
PubMed: 37427631
DOI: 10.47391/JPMA.6012