1.Recent Progress in Diagnosis and Treatment of Rectal Cancer.
The Korean Journal of Gastroenterology 2006;47(4):245-247
Rectal cancer is an emerging health issue in Korea because its incidence is rapidly increasing with changes in life styles and diets. The optimal treatment of rectal cancer is based on multimodality. Among them, surgical treatment is the corner-stone. In the past, local recurrence rate has been reported as high as 30-40%, but the concept of total mesorectal excision (TME) lowered the rate of local recurrence down to less than 10%. TME focuses on sharp pelvic dissection and complete removal of rectal cancer with surrounding mesorectum inside the rectal proper fascia. TME is now considered as a standard procedure for surgical treatment of mid and low rectal cancer. With the introduction of pelvic magnetic resonance imaging (MRI) for preoperative staging of rectal cancer, risk factors for local recurrence can be predicted before surgery to distinguish patients who are in high risk for recurrence that requires preoperative neoadjuvant chemoradiation therapy. Early rectal cancer was assessed by transrectal ultrasonography (TRUS) and endorectal MRI with coil. Transanal local excision can be applied with anal sphincter preservation safely. Neoadjuvant chemoradiation therapy was performed in patients with locally advanced rectal cancer, and this resulted in tumor size reductions and histopathologic downstaging effect. As far as the quality of life is concerned, sexual and voiding function are much improved by techniques preserving nerve. Many experts have dealt with challenging practical problems of managing rectal cancer from diagnosis to quality of life. This issue contains recent progresses in the diagnosis and treatment of rectal cancer which will serve as a comprehensive reference for those who manage rectal cancer in their medical practice.
Humans
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Rectal Neoplasms/diagnosis/*therapy
3.A Case of Rectal Cancer in 12 year Old Boy.
Journal of the Korean Surgical Society 1997;52(4):615-618
Children's rectal cancer is a very rare condition and its reported incidence is below 0.5%. The prognosis is very poor due to the advanced stage at diagnosis and a higher malignant potential. Recently some authors treated rectal cancer of children with surgery and they have had a better prognosis. We experienced a case of rectal cancer in a 12 year old boy treated with surgery and chemotherapy and reviewed related literature.
Child*
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Diagnosis
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Drug Therapy
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Humans
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Incidence
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Male*
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Prognosis
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Rectal Neoplasms*
4.A Case of Primary Syphilis in the Rectum.
Sung Ho SONG ; Ick JANG ; Bum Sik KIM ; Eun Tak KIM ; Seung Hyo WOO ; Mee Ja PARK ; Chang Nam KIM
Journal of Korean Medical Science 2005;20(5):886-887
A 30-yr-old man was referred for suspicious rectal cancer because of ulcerated lesions in the rectum and a palpable mass in left inguinal area. Sigmoidoscopy showed two indurated masses and histologic evaluation of biopsy revealed obliterative endarteritis with heavy plasma cell infiltration. Both venereal disease research laboratories (VDRL) and fluorescent treponemal antibody absorption (FTA-ABS) tests were positive. After injection of penicillin G benzathine for 3 weeks, the rectal chancre and the palpable mass disappeared.
Adult
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Diagnosis, Differential
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Humans
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Male
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Rectal Diseases/*complications/drug therapy/*pathology
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Rectal Neoplasms/pathology
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Syphilis/*complications/drug therapy/*pathology
5.Current status, controversy and challenge in the neoadjuvant immunotherapy of colorectal cancer.
Chinese Journal of Gastrointestinal Surgery 2022;25(3):185-192
Neoadjuvant therapy for colorectal cancer is widely used in rectal cancer, locally advanced colon cancer, and resectable metastatic and recurrent colorectal cancer. Mismatch repair deficient(dMMR) and microsatellite instablity-high (MSI-H) colorectal cancer patients who benefit from the efficacy of immune checkpoint inhibitors are expected to further improve the efficacy of traditional neoadjuvant therapy based on radiotherapy and chemotherapy. In this paper, the current status of immunotherapy (with emphasis on immune checkpoint inhibitors) is elucidated, and the opportunities of its application in neoadjuvant therapy are analyzed, including poor sensitivity of dMMR tumors to traditional therapy, good immune response of early tumors, predictable, manageable and controllable toxicity of immune checkpoint inhibitors. Colorectal cancer patients have growing and diverse needs to be met. Current controversies and challenges are analyzed, and the future directions are pointed out, including active screening of benefit groups, exploration of efficacy prediction markers, optimization of neoadjuvant immunotherapy models, attention to efficacy evaluation and new therapeutic endpoints. Neoadjuvant therapy should be effective, moderate and accurate based on the treatment target. It is the prerequisite and basis to guarantee medical safety and improve therapeutic effect to attach importance to the standardization and safety of clinical research and to pay attention to patients' interests and legal and ethical demands.
Colorectal Neoplasms/diagnosis*
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Humans
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Immunotherapy
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Neoadjuvant Therapy
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Neoplasm Recurrence, Local
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Rectal Neoplasms
7.Correlation between pelvic relapses of rectal cancer after radical and R0 resection: A regression model-based analysis.
Peng GUO ; Liang TAO ; Chang WANG ; Hao Run LYU ; Yi YANG ; Hao HU ; Guang Xue LI ; Fan LIU ; Yu Xi LI ; Ying Jiang YE ; Shan WANG
Chinese Journal of Gastrointestinal Surgery 2023;26(3):277-282
Objective: To propose a new staging system for presacral recurrence of rectal cancer and explore the factors influencing radical resection of such recurrences based on this staging system. Methods: In this retrospective observational study, clinical data of 51 patients with presacral recurrence of rectal cancer who had undergone surgical treatment in the Department of Gastrointestinal Surgery, Peking University People's Hospital between January 2008 and September 2022 were collected. Inclusion criteria were as follows: (1) primary rectal cancer without distant metastasis that had been radically resected; (2) pre-sacral recurrence of rectal cancer confirmed by multi-disciplinary team assessment based on CT, MRI, positron emission tomography, physical examination, surgical exploration, and pathological examination of biopsy tissue in some cases; and (3) complete inpatient, outpatient and follow-up data. The patients were allocated to radical resection and non-radical resection groups according to postoperative pathological findings. The study included: (1) classification of pre-sacral recurrence of rectal cancer according to its anatomical characteristics as follows: Type I: no involvement of the sacrum; Type II: involvement of the low sacrum, but no other sites; Type III: involvement of the high sacrum, but no other sites; and Type IV: involvement of the sacrum and other sites. (2) Assessment of postoperative presacral recurrence, overall survival from surgery to recurrence, and duration of disease-free survival. (3) Analysis of factors affecting radical resection of pre-sacral recurrence of rectal cancer. Non-normally distributed measures are expressed as median (range). The Mann-Whitney U test was used for comparison between groups. Results: The median follow-up was 25 (2-96) months with a 100% follow-up rate. The rate of metachronic distant metastasis was significantly lower in the radical resection than in the non-radical resection group (24.1% [7/29] vs. 54.5% [12/22], χ2=8.333, P=0.026). Postoperative disease-free survival was longer in the radical resection group (32.7 months [3.0-63.0] vs. 16.1 [1.0-41.0], Z=8.907, P=0.005). Overall survival was longer in the radical resection group (39.2 [3.0-66.0] months vs. 28.1 [1.0-52.0] months, Z=1.042, P=0.354). According to univariate analysis, age, sex, distance between the tumor and anal verge, primary tumor pT stage, and primary tumor grading were not associated with achieving R0 resection of presacral recurrences of rectal cancer (all P>0.05), whereas primary tumor pN stage, anatomic staging of presacral recurrence, and procedure for managing presacral recurrence were associated with rate of R0 resection (all P<0.05). According to multifactorial analysis, the pathological stage of the primary tumor pN1-2 (OR=3.506, 95% CI: 1.089-11.291, P=0.035), type of procedure (transabdominal resection: OR=29.250, 95% CI: 2.789 - 306.811, P=0.005; combined abdominal perineal resection: OR=26.000, 95% CI: 2.219-304.702, P=0.009), and anatomical stage of presacral recurrence (Type III: OR=16.000, 95% CI: 1.542 - 166.305, P = 0.020; type IV: OR= 36.667, 95% CI: 3.261 - 412.258, P = 0.004) were all independent risk factors for achieving radical resection of anterior sacral recurrence after rectal cancer surgery. Conclusion: Stage of presacral recurrences of rectal cancer is an independent predictor of achieving R0 resection. It is possible to predict whether radical resection can be achieved on the basis of the patient's medical history.
Humans
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Neoplasm Recurrence, Local/diagnosis*
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Rectal Neoplasms/therapy*
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Retrospective Studies
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Pelvis/pathology*
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Recurrence
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Treatment Outcome
8.Evaluation strategy of complete response after neoadjuvant therapy for rectal cancer.
Chinese Journal of Surgery 2023;61(9):738-743
Currently, the standard of clinical complete response (cCR) after neoadjuvant chemoradiotherapy (nCRT) for local advanced rectal cancer generally lacks pathological examination, the cCR judged by the current standard is still far from the real pathological complete response. After nCRT, due to the presence of tissue edema and fibrosis, MRI is highly uncertain in determining the staging of local lesions. The precision of colonoscopy biopsy is generally low because residual cancer foci exist primarily in the muscular layer, which limits the determination of cCR by colonoscopy biopsy. Local excision through the anus can resect the whole intestinal wall tissue, which is relatively accurate and close to the real state of remission of the lesion, but there are many problems, such as affecting anal function, high rate of complications, and increased difficulty of following radical surgery. Based on the present diagnosis of cCR, the authors put forward the concept of modified cCR (m-cCR) which combined with the pathological standard of transanal multipoint full-layer puncture biopsy. It is possible to improve the accuracy of cCR, and improve the safety of cCR patients who receive wait-and-watch therapy without increasing complications or affecting anal function. The exact conclusion needs to be confirmed by further studies.
Humans
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Neoadjuvant Therapy
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Treatment Outcome
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Neoplasm Recurrence, Local/diagnosis*
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Watchful Waiting
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Rectal Neoplasms/surgery*
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Chemoradiotherapy
9.Imaging evaluation of response of rectal cancer to preoperative chemoradiotherapy.
Xiao-peng ZHANG ; Ying-shi SUN
Chinese Journal of Gastrointestinal Surgery 2011;14(11):830-833
In recent years, preoperative therapy has become the standard procedure to improve radical resection rate and local control for advanced rectal cancer. Tumor responses to chemoradiotherapy, however, vary considerably, thus increasing the demand for both functional and morphologic radiologic evaluation of response to chemoradiotherapy to distinguish responders from nonresponders. MR imaging is considered the most accurate tool for the primary staging of tumor extent, and can be used to evaluate the efficacy of chemoradiotherapy. Functional imaging modalities including DW-MRI and PET-CT have shown promising prospect in the early evaluation of the response of rectal cancer to preoperative chemoradiotherapy. However, wide clinical application will take some time.
Chemoradiotherapy
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Humans
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Magnetic Resonance Imaging
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Neoadjuvant Therapy
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Rectal Neoplasms
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diagnosis
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drug therapy
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radiotherapy
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Tomography, X-Ray Computed
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Treatment Outcome
10.The Results of Postoperative Radiation Therapy in the Rectal Cancer.
Mi Ryeong RYU ; Hong Seok JANG ; Sei Chul YOON ; Su Mi CHUNG ; Yeon Shil KIM ; Se Kyung KIM ; In Chul KIM ; Kyung Sub SHINN
Journal of the Korean Cancer Association 1997;29(1):111-116
PURPOSE: This study was designed to evaluate the prognostic factors, survival rate and local recurrence rate of the patients with rectal cancer who received postoperative radiation therapy. METHODS & MATERIALS: Seventy patients with rectal cancer received postoperative radiation therapy after curative surgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, Catholic University Medial College between May 1984 and April 1993. Of the seventy patients, sixty-four evaluable patients were analysed retrospectively. There were 34 men and 28 women. Age at diagnosis ranged from 23 to 74 years. The distribution of stage according to the modified Astler-Coller (MAC) system was as follow: 12 in B2+3, 2 in C1, and 50 in C2+3. Postoperative adjuvant therapy included pelvic radiotherapy in all cases and chemotherapy in addition in 55 cases. A total dose of 45 to 60 Gy (median dose: 55.8Gy) was delivered in a period of 5 to 6 weeks and the follow-up period ranged from 26 to 133 months with a median of 55 months. RESULTS: Overall two-year and five-year actuarial survival rate were 70.3% and 51.4%, 90.9% and 90.9% in stage B2+3, and 68.2% and 53.6% in stage C. Local failure occurred in 13 (20.3%) of the 64 patients and distant failure rate was 18.8% (12/64). Severe late complication was small bowel obstruction in 4 patients and surgery was required in 3 patients (5%). The significant prognostic factors were stage (p=0.0019) and histologic differentiation (p=0.0046). CONCLUSION: This study suggested a potential adjuvant role for radiation. However, the possible reduction in local failure rates in this study compared with historic control groups must be verified in randomized trial.
Diagnosis
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Drug Therapy
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Female
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Follow-Up Studies
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Humans
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Male
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Radiation Oncology
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Radiotherapy
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Rectal Neoplasms*
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Recurrence
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Retrospective Studies
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Survival Rate