Surgery For Rectal Adenocarcinoma Research Articles

Incidental finding of synchronous neuroendocrine tumor of appendix and rectal adenocarcinoma. A case report and literature review

Abstract Objectives Colorectal cancers represent the predominant malignancies affecting the gastrointestinal tract. In contrast, appendiceal tumors occur less frequently. Among them, appendiceal neuroendocrine tumors (ANETs) account for approximately 50 % of cases and are often detected incidentally during unrelated procedures. Case presentation We present an extremely rare case of an incidental neuroendocrine tumor of the appendix discovered during surgery for rectal adenocarcinoma and provide a review of the relevant literature. A 70-year-old patient with radiologically and endoscopically diagnosed rectal cancer underwent a low anterior resection with total mesorectal excision and a temporary diverting ileostomy following preoperative chemotherapy and radiation therapy. Intraoperatively, a small appendiceal mass was discovered and excised. Histopathological examination confirmed a well-differentiated NET of the appendix measuring 0.4 cm in diameter. Conclusions This case report emphasizes the importance of thorough intraoperative examination during colorectal surgeries and highlights the need for increased awareness of appendiceal NETs among surgeons.

Role of surgical approach on LARS: LAR vs. TEM, TAMIS, transanal excision, TaTME

Despite advances in surgical techniques, low anterior resection syndrome (LARS) is common in patients after surgery for rectal adenocarcinoma. Fecal incontinence, urgency, and incomplete evacuation are frequent complaints. Anorectal function can be assessed by dynamic magnetic resonance imaging (MRI), anorectal manometry, and by several assessment tools including the LARS score. Despite their different approach to the pelvic dissection, both transabdominal low anterior resection (LAR) and transanal total mesorectal excision (TaTME) share a similar prevalence of LARS after surgery. Data regarding functional outcomes after transanal techniques are lacking, but the functional results seem to be favorable when compared to proctectomy. Pre-operative evaluation of anorectal function is recommended to provide a better estimate of functional outcomes post-operatively and to provide tailored recommendations for restorative versus non-restorative surgery.

On the road again: Travel patterns and outcomes in rectal cancer.

530 Background: Associations between high volume centers and outcomes have many advocating for centralization of cancer care, which can lead to increased travel, patient burden, and cost. There is, however, some conflicting data regarding outcomes for patients with more advanced disease. This study aims to explore factors associated with travel and the impact on survival for patients receiving surgery for rectal adenocarcinoma. Methods: All patients >18 years of age with rectal adenocarcinoma that had a surgical resection were identified using the National Cancer Database from 2004-2014. Univariate and multivariate (MV) regression analyses determined factors associated with increased travel distance (<50 miles, 50-100 miles, >100 miles) as well as the impact of travel on overall survival (OS). Results: Of 83,933 patients, those that traveled the furthest were more commonly younger, white non-Hispanic, insured, and with less comorbidities (all p<0.05 on MV analysis). Cancer stage, surgical approach, and type of surgery were not associated with travel distance (p=NS). Increased travel distance improved 5-year OS for stage IV disease (10%, p=0.002), and trended toward significance for stage II (4.0%, p=0.06) and stage 1 (4.3%, p=0.09) disease. After controlling for other factors, travel distance did not impact OS for stage II/III disease, but stage I and IV patients traveling 50-100 miles had an increased risk of death (stage I HR 1.16, CI 1.04-1.30; stage IV HR 1.19, CI 1.07-1.32). This was similar in the entire cohort where traveling 50-100 miles had an increased risk of death (HR 1.09; CI 1.03-1.14). Patients treated at non-low volume centers did have improved outcomes across all stages (p<0.01). Patients treated in academic hospitals had improved outcomes in stages I and IV (p=0.02). Conclusions: Younger, white, non-Hispanic patients are most likely to travel longer distances for rectal cancer treatment, regardless of stage. Increased hospital volume improves OS while travel and use of academic centers may impact patients with stage I/IV disease. Educating patients and providers regarding the influence of travel and hospital volume could help reallocate some resources, decrease financial toxicity, and ease the travel burden for patients.

Long-term Survival After Chemoradiotherapy Without Surgery for Rectal Adenocarcinoma

Long-term Survival After Chemoradiotherapy Without Surgery for Rectal Adenocarcinoma

P10 Induction chemotherapy followed by chemoradiotherapy before surgery for rectal adenocarcinoma

P10 Induction chemotherapy followed by chemoradiotherapy before surgery for rectal adenocarcinoma

Overall survival and quality of life in elderly patients treated for rectal cancer: results of a five year follow-up

Background The study was conducted on a population of 74 patients undergoing surgery for rectal adenocarcinoma with 5-year follow-up. The aim is to evaluate the survival and Quality of Life (QoL) in two groups of patients: Y group with age <60 years and E group with age ≥ 60 years. QoL was determined by administration of C30 Quality of Life Questionnaire (QLQ C30) and the module ColoRectal-29 (CR-29) [1].

The extent of lymphadenectomy and overall survival depend on the timing of radiotherapy for rectal cancer.

540 Background: Accurate staging and local disease control depend on the extent of lymphadenectomy (LAD) in rectal cancer. Previous studies suggest that lymph node (LN) number varies with neoadjuvant therapies. Our objectives were to measure the impact of timing of radiotherapy on extent of LAD and to determine the prognostic role of LN number in rectal cancer. Methods: Patients undergoing curative-intent surgery for rectal adenocarcinoma (1988-2006) in Los Angeles County were identified from the Cancer Surveillance Program. Patients were grouped according to radiotherapy timing (neoadjuvant, adjuvant, or none). To measure prognostic significance, an optimal cutoff was assessed for patients with N0 disease by dichotomizing LN numbers from 3-7. Results: Query of the registry identified 6,358 patients. Of these, 20% (n = 1,280), 25% (n = 1,573), and 55% (n = 3,545) received neoadjuvant, adjuvant, and no radiotherapy, respectively. There was no difference in LN number in patients with and without radiotherapy (7 vs. 8 LNs, p = NS). However, within the radiotherapy cohort, there was significantly lower LNs in the neoadjuvant group (5 vs. 9 LNs, respectively; p &lt; 0.001). Survival differences favored the groups with higher LN number. The optimal LN cutoff with no survival difference was 7 in the adjuvant radiotherapy group; there was no optimal cutoff for neoadjuvant therapy patients. Conclusions: From our population-based cohort, we observed that patients receiving neoadjuvant radiotherapy had decreased LN retrieval and that LN number was non-prognostic. In contrast, the extent of LAD is a prognostic factor for overall survival in patients receiving adjuvant radiotherapy. [Table: see text] No significant financial relationships to disclose.

Stability of colon stem cell methylation after neo-adjuvant therapy in a patient with attenuated familial adenomatous polyposis

BackgroundMethylation at certain human CpG rich sequences increases with age. The mechanisms underlying such age-related changes are unclear, but methylation may accumulate slowly in a clock-like manner from birth and record lifetime numbers of stem cell divisions. Alternatively, methylation may fluctuate in response to environmental stimuli. The relative stability of methylation patterns may be inferred through serial observations of the same colon.Case presentationA 22 year-old male with attenuated familial adenomatous polyposis received neo-adjuvant chemotherapy and radiation prior to surgery for rectal adenocarcinoma. Colon crypt methylation patterns before and after neo-adjuvant therapy (62 days apart) were essentially identical with respect to percent methylation and diversity. Consistent with previous studies, methylation patterns recorded no evidence for enhanced colon crypt stem cell survival with a germline mutation (codon 215) proximal to the mutation cluster region of APC.ConclusionThe inability of neo-adjuvant therapy to significantly alter crypt methylation patterns suggests stem cells are relatively protected from transient environmental changes. Age-related methylation appears to primarily reflect epigenetic errors in stem cells that slowly accumulate in a clock-like manner from birth. Therefore, life-long human stem cell histories are potentially written within and may be read from somatic cell epigenomes.