Intersphincteric resection (ISR) is the ultimate sphincter-preserving surgical technique for low rectal cancer. To promote the standardized implementation of ISR, this review discusses the important issues regarding the clinical application of ISR with reference to the latest Chinese expert consensus on ISR. In terms of ISR-related pelvic anatomy of the rectum/anal canal, hiatal ligament is not identical with the anococcygeal ligament. At the level where the rectourethralis muscle continuously extends to the posteroinferior area of the membranous urethra from the rectum, the neurovascular bundle is identified between the posterior edge of rectourethralis muscle and the anterior edge of the longitudinal muscle of the rectum. This knowledge is crucial to detect the anterior dissection plane during ISR at the levator hiatus level. The indication criteria for ISR included: (1) stage I early low rectal cancer; (2) stage II-III low rectal cancer undergoing neoadjuvant treatment, and supra-anal tumors and juxta-anal tumors of stage ycT3NxM0, or intra-anal tumors of stage ycT2NxM0. However, signet ring cell carcinoma, mucinous adenocarcinoma and undifferentiated carcinoma should be contraindicated to ISR. For locally advanced low rectal cancer (especially anteriorly located tumor), neoadjuvant treatment should be carried out in a standardized manner. However, it should be recognized that neoadjuvant chemoradiotherapy was a risk factor for poor anal function after ISR. For surgical approaches for ISR, including transanal, transabdominal, and transanal transabdominal approaches, the choice should be based on oncological safety and functional consequences. While ensuring the negative margin, maximal preservation of rectal walls and anal canal contributs to better postoperative anorectal function. Careful attention must be paid to complications regarding ISR, with special focus on the anastomotic complications. The incidence of low anterior resection syndrome (LARS) was higher than 40%. However, this issue is often neglected by clinicians. Thus, management and rehabilitation strategies for LARS with longer follow-ups were required.
Humans ; Rectal Neoplasms/pathology* ; Postoperative Complications ; Laparoscopy/methods* ; Anal Canal/pathology* ; Anus Neoplasms/pathology* ; Anus Diseases/surgery* ; Low Anterior Resection Syndrome ; Carcinoma, Signet Ring Cell/pathology* ; Treatment Outcome

OBJECTIVETo summarize the clinicopathological characteristics of primary anorectal malignant melanoma (AMM).

METHODSClinical data of nine patients with AMM were reviewed retrospectively from January 1999 to March 2005.

RESULTSAnorectal malignant melanoma had a female predominance. The average age was 56 years old and average course of disease was 5.8 months. The onset of symptom was hematochezia, then anus prolapses. 94.7% of patients had AMM within 5 cm from anus margin; the average tumor size was (3.3+/- 2.1) cm. The polyp and ulcer were most common types. More than a half (54.5%) of the tumor was movable, 19.1% smooth surfaced, 6.6% soft textured. Synchronous metastasis was found in 14.0% of the patients, the first common metastasis was found in liver, the secondary was superficial inguinal lymph node metastasis. Half of the patients were misdiagnosed,and over 50% of patients were misdiagnosed as benign disease. Mile's operation was performed in most of patients (63%), while anal resection was performed in 30% of the patients.

CONCLUSIONSAnorectal malignant melanoma is often misdiagnosed,surgical procedure is the first choice for patients with AMM.

Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms ; diagnosis ; pathology ; surgery ; Female ; Humans ; Male ; Melanoma ; diagnosis ; pathology ; surgery ; Middle Aged ; Rectal Neoplasms ; diagnosis ; pathology ; surgery ; Retrospective Studies

PURPOSE: The aim of this study was to determine the necessity for routine pathologic evaluation of hemorrhoidectomy specimens. METHODS: Between March 1998 and February 2001, 280 patients (185 males, 95 females) underwent a hemorrhoidectomy at Seoul National University Hospital. All patients had grade III~IV hemorrhoids, and the mean age of the patients was 51 years (range: 21~74 years). All hemorrhoidectomy specimens were examined with a hematoxylin and eosin stain of one representative section by a pathologist. We performed a retrospective analysis regarding the pathologic results for the hemorrhoidectomy specimens. RESULTS: Two hundred sixty-seven specimens (267, 95.4%) had typical hemorrhoids reported as external and internal hemorrhoids, external hemorrhoids, hemorrhoidal varices, and thrombi. Ten patients (10, 3.2%) had additional benign pathologes such as fibroepithelial polyps (6 cases), a flat condyloma (1 case), hypertrophied papillae with a condyloma, like papillomatosis and keratosis (1 case), dyskeratotic squamous cells with koilocytotic atypia (1 case), and an inflammatory polyp (1 case). Interestingly, three patients (3, 1.1%) had carcinomas in the hemorrhoidectomy specimens. Two patients had squamous- cell carcinomas; one suffered from delayed wound healing after a previous hemorrhoidectomy, and the other had indurated lesions on the hemorrhoids. One patients who had under gone a low anterior resection due to stage-C rectal cancer 7 months before had a adenocarcinoma. CONCLUSIONS: Because of the possibility of unsuspected anal cancer, we recommend pathologic examination of hemorr hoidectomy specimens, especially in cases of suspected indurated lesions within the hemorrhoids, delayed wound healing after a previous hemorrhoidectomy, or previous history of colon cancer.
Adenocarcinoma ; Anus Neoplasms ; Colonic Neoplasms ; Eosine Yellowish-(YS) ; Hematoxylin ; Hemorrhoidectomy* ; Hemorrhoids ; Humans ; Keratosis ; Male ; Papilloma ; Pathology ; Polyps ; Rectal Neoplasms ; Retrospective Studies ; Seoul ; Varicose Veins ; Wound Healing

BACKGROUNDAnorectal malignant melanoma was a rare disease with extremely poor prognosis. The aim of this study was to explore the clinical characteristic, diagnosis and treatment strategies of anorectal malignant melanoma.

METHODSThe data of 57 patients with anorectal malignant melanoma was collected and retrospectively analyzed.

RESULTSRectal bleeding and anal mass were found to be common symptoms of anorectal malignant melanoma. The preoperative diagnosis rate of anorectal malignant melanoma was 48.6%. The overall 3-year and 5-year survival rate was 38.0% and 21.3% respectively. The 3-year survival rates of stage I and II patients were 63.0% and 16.7% respectively (P = 0.000), and the 5-year survival rates were 33.3% and 11.1% (P = 0.001), which both had significant statistic differences. The 3-year survival rate of patients undergone abdmoninoperineal resection and patients undergone wide local excision were 36.7% and 53.0% respectively (P = 0.280), while the 5-year survival rate were 24.1% and 23.1% (P = 0.642), which both had no significant statistic differences.

CONCLUSIONSThis study identified no survival advantage to abdominoperineal resection in treatment of anorectal malignant melanoma, and we propose that wide local excision could be considered as the initial treatment of choice.

Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms ; diagnosis ; mortality ; pathology ; surgery ; Female ; Humans ; Male ; Melanoma ; diagnosis ; mortality ; pathology ; surgery ; Middle Aged ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Survival Rate

OBJECTIVETo explore the surgical treatment patterns and clinicopathological prognostic factors of anorectal malignant melanoma (ARMM).

METHODSThe medical records and follow-up data of 64 patients with anorectal malignant melanoma undergoing surgical treatment from August 1972 to December 2015 were collected and analyzed retrospectively. Distant metastasis was discovered in 4 patients when diagnosis, of whom 3 underwent abdominoperineal resection(APR), the other underwent wide local excision (WLE). In the other 60 cases, 46 underwent ARP(1 case received additional right inguinal lymph node dissection), the other 14 underwent WLE(1 case received additional right inguinal lymph node dissection).

RESULTSThe median follow-up time of 64 cases was 24(4 to 139) months. The 1-year, 3-year and 5-year overall survival rate was 70.3%, 35.3% and 18.4%, respectively. The 5-year survival rate of 60 patients without distant metastasis undergoing APR and WLE was 19.7% and 23.1%, and the median survival was 19.6 and 24.3 months, respectively(P =0.634), which was not significantly different. According to the Kaplan-Meier method for univariate analysis, involved margins (P=0.024), lymph metastasis (P=0.018) and clinical staging(P=0.003) had significant effects on overall survival. Multivariate analysis indicated that only the lymph node metastasis was significant predictive factor (RR=16.614, 95%CI:1.165 to 236.847, P=0.038).

CONCLUSIONSThe prognosis of ARMM is poor. The lymph node metastasis is the main predictive factors. Operation procedure (APR or WLE) has no obvious effect on prognosis.

Adult ; Aged ; Anus Neoplasms ; pathology ; therapy ; Female ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Male ; Melanoma ; pathology ; therapy ; Middle Aged ; Multivariate Analysis ; Prognosis ; Rectal Neoplasms ; pathology ; therapy ; Retrospective Studies ; Skin Neoplasms ; pathology ; therapy ; Survival Rate ; Treatment Outcome

Anus Neoplasms ; diagnosis ; etiology ; surgery ; Buschke-Lowenstein Tumor ; Carcinoma, Verrucous ; diagnosis ; etiology ; surgery ; Condylomata Acuminata ; etiology ; pathology ; surgery ; Human papillomavirus 16 ; Human papillomavirus 18 ; Humans ; Male ; Middle Aged ; Papillomavirus Infections ; complications ; Penile Neoplasms ; etiology ; pathology ; surgery ; Time Factors

OBJECTIVETo investigate the clinical features and treatment of anal canal adenocarcinoma.

METHODSClinical data of 49 patients with anal canal adenocarcinoma treated in our hospital from January 1965 to March 2002 were analyzed retrospectively.

RESULTSThe ratio of male to female was 1.3. The median age was 56 years old. Anal bleeding, tapering stool and anal lump were the most common symptoms. Chronic perianal diseases were complicated in 36.7% of the cases. The median follow-up was 66 months. Local recurrence and inguinal lymph node metastasis were found in 7 cases respectively, lung metastasis in 2, supraclavicular and mediastinal metastasis in 1 respectively. The 3-year survival rates in the patients with resection alone, radiochemotherapy alone, resection combined with radiochemotherapy, and without any treatment were 41.3%, 20.0%, 56.3% and 15.0%, respectively, and the 5-year survival rates were 34.4%, 0, 37.5%, 0, respectively.

CONCLUSIONSAnal canal adenocarcinoma is a rare and fatal malignancy. Abdomino-perineal resection combined with postoperative radiochemotherapy is the principal treatment.

Adenocarcinoma ; diagnosis ; mortality ; pathology ; therapy ; Adult ; Aged ; Aged, 80 and over ; Anal Canal ; pathology ; Anus Neoplasms ; diagnosis ; mortality ; pathology ; therapy ; Combined Modality Therapy ; Female ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Retrospective Studies ; Survival Rate ; Young Adult

PURPOSE: The clinical features, treatment modality approaches in clinical practice, and prognostic factors for anal canal carcinoma patients were retrospectively analyzed. MATERIALS AND METHODS: Between October 1994 and December 2005, 50 patients with anal canal cancer were treated at Samsung Medical Center, Seoul, Korea. RESULTS: After a median follow up of 37.8 months (range, 6.6-136.1 months), the 5-year and 10-year survival rates for the 38 patients with early and locally advanced squamous and cloacogenic carcinoma (squamous cell carcinoma and cloacogenic carcinoma) were 74.8% and 66.5%, respectively. The 5-year survival and disease-free survival rates (DFS) of the 31 patients who received chemoradiation therapy (CRT) were 83.6% and 74.3%, respectively. The overall and DFS could not be determined for the adenocarcinoma group due to the small number of cases (n=8). Univariate analysis showed that tumor size (p=0.04) and inguinal node status (p=0.04) significantly influenced patient survival in patients with squamous cell and cloacogenic carcinomas. Furthermore, univariate analysis also showed that, inguinal node status influenced patient survival in the adenocarcinoma group. Multivariate analysis showed that inguinal node metastasis is a single independent prognostic variable for survival (p=0.04) in patients with squamous cell and cloacogenic carcinomas. CONCLUSION: Combined CRT has been adopted as standard treatment with outcomes that are comparable to those reported in randomized clinical trials. Due to the rarity and complexity of anal canal carcinoma, interdepartmental cooperation is required for disease treatment. Thus, proper treatment of patients should incorporate a team-approach and should be available to as many patients as possible.
Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms/diagnosis/pathology/*therapy ; Carcinoma/diagnosis/pathology/*therapy ; Chemotherapy, Adjuvant ; Combined Modality Therapy ; Female ; Hospitals ; Humans ; Korea ; Male ; Middle Aged ; Prognosis ; Radiotherapy, Adjuvant ; Retrospective Studies ; Treatment Outcome

Adenocarcinoma ; metabolism ; secondary ; surgery ; Anal Canal ; chemistry ; pathology ; surgery ; Anus Neoplasms ; metabolism ; pathology ; surgery ; Carcinoembryonic Antigen ; analysis ; Diagnosis, Differential ; Humans ; Immunohistochemistry ; Keratin-20 ; analysis ; Male ; Middle Aged ; Mucin-1 ; analysis ; Paget Disease, Extramammary ; metabolism ; secretion ; surgery ; Skin Neoplasms ; metabolism ; secretion ; surgery

OBJECTIVETo explore the expressions of P33ING1, P53 and their relationships with apoptosis in anal canal carcinoma (ACC).

METHODSThe expressions of P33ING1, P53 proteins were measured by immunohistochemistry method (SP method), and apoptosis was detected in 42 cases with ACC, 36 cases with anal canal adenoma (ACA) or anal canal papilloma (ACP), and 40 cases with paraanal inflammatory mass(PAIM).

RESULTSThe positive expression rates of P33ING1 and P53 proteins were 40.5% (17/42), 97.2% (35/36) and 97.5% (39/40), 50.0% (21/42), 22.2% (8/36) and 27.5% (11/40) respectively, and the average apoptosis indexes(AI) were (10.27+/- 1.23) per thousand, (42.75+/- 0.98) per thousand and (42.67+/- 1.04) per thousand respectively in ACC, ACA or ACP and PAIM. There were significant differences in the positive expression rates of P33ING1, P53 and apoptosis index between ACC and the other two groups respectively (P< 0.05). Among 21 cases of ACC with positive expression of P53 protein,there were 18 cases with P33ING1 negative expression.

CONCLUSIONSP33ING1 expression decrease in ACC, which may play an important role in the carcinogenesis and progression of ACC. P33ING1 and P53 may have an synergistic effect of suppressing cell growth and accelerating cell apoptosis.

Adult ; Aged ; Aged, 80 and over ; Anus Neoplasms ; metabolism ; pathology ; Apoptosis ; Carcinoma ; metabolism ; pathology ; Female ; Humans ; Immunohistochemistry ; Inhibitor of Growth Protein 1 ; Intracellular Signaling Peptides and Proteins ; metabolism ; Male ; Middle Aged ; Neoplasm Staging ; Nuclear Proteins ; metabolism ; Tumor Suppressor Protein p53 ; metabolism ; Tumor Suppressor Proteins ; metabolism