Introductions: the advances in surgical technique and complementary therapy implemented in the last decade have seen important improvements in the treatment of neoplasm of the proximal middle and distal rectum. The use of abdominal amputation (AAP) although it was the treatment of choice in the 80s after the introduction of new technology has seen an increase in the preservation of the sphincters, up to 90% for the low localizations of the neoplasm., And an improvement of the quality of life. The purpose of the present study in relation to our case studies is to analyze the data obtained in our experience to assess the causes that led to the local recurrence, Materials and Methods: From January 2010 to December 2017 consulted the database of the polyclinic AOU University of Catania were observed in 25 cases of neoplasm to site in the rectum in 93 cases of colon neoplasm with headquarters: in the blind 3 n cases (3.5%), colon ds n 39 cases ( 41.5%), transverse colon n 4 cases (4.2%), colon sn n 41cases (44.6%), sigma n 6 cases (6.2%) Results: Interventions with preservation of the sphincters (fig 2 ) represent 95% of the cases ( n 112 cases) and of these in 24 cases (21%) there was an exitus in the postoperative period. In the remaining 69 patients, local recurrence developed in 14% (10 cases). Recurrence was associated in 6% (4 paz,) of cases with the presence of MTS at a distance. The disease-free interval averaged 18 months (range 22 to 16 months) Discussion: Ultra-low resections help diagnosis Due to the simple and easily accessible sphincter transfectional maneuver of the rectal abutment, the distinction between anastomoses and recurrent scar lesions is difficult, but with the help of by rectal ultrasound diagnostics and that for CT and RNM imaging it is possible to obtain a diagnosis. The limit shown by the instrumental mtetod is that of the remote MTs in which the radio immuoscintigraphy has been shown to aid in lesions of a size of 1 cm, while for the initial ones it remains difficult to diagnose. In the anastomoses sites the relapses are not easily resectable because often they affect the plan of the elevators of the anus, but in the recurrences involving l in the pre-sacral fascia it was possible to perform an AAP with resection extended to the muscular plane and to the genitourinary organs. Conclusions: In the data collected and analyzed, we highlight how a surgery that includes a correct excision of the middle rectum provides a high prevention of recurrences in addition to the correct approach to the neoplasm. A therapeutic program that includes radio and preoperative chemotherapy reduces recurrence as well a

Local recurrences after ultra low resection of the rectum

Graziano, G. M. P.;Di Cataldo, A.;Li Destri, G.;Graziano, A.
2018

Abstract

Introductions: the advances in surgical technique and complementary therapy implemented in the last decade have seen important improvements in the treatment of neoplasm of the proximal middle and distal rectum. The use of abdominal amputation (AAP) although it was the treatment of choice in the 80s after the introduction of new technology has seen an increase in the preservation of the sphincters, up to 90% for the low localizations of the neoplasm., And an improvement of the quality of life. The purpose of the present study in relation to our case studies is to analyze the data obtained in our experience to assess the causes that led to the local recurrence, Materials and Methods: From January 2010 to December 2017 consulted the database of the polyclinic AOU University of Catania were observed in 25 cases of neoplasm to site in the rectum in 93 cases of colon neoplasm with headquarters: in the blind 3 n cases (3.5%), colon ds n 39 cases ( 41.5%), transverse colon n 4 cases (4.2%), colon sn n 41cases (44.6%), sigma n 6 cases (6.2%) Results: Interventions with preservation of the sphincters (fig 2 ) represent 95% of the cases ( n 112 cases) and of these in 24 cases (21%) there was an exitus in the postoperative period. In the remaining 69 patients, local recurrence developed in 14% (10 cases). Recurrence was associated in 6% (4 paz,) of cases with the presence of MTS at a distance. The disease-free interval averaged 18 months (range 22 to 16 months) Discussion: Ultra-low resections help diagnosis Due to the simple and easily accessible sphincter transfectional maneuver of the rectal abutment, the distinction between anastomoses and recurrent scar lesions is difficult, but with the help of by rectal ultrasound diagnostics and that for CT and RNM imaging it is possible to obtain a diagnosis. The limit shown by the instrumental mtetod is that of the remote MTs in which the radio immuoscintigraphy has been shown to aid in lesions of a size of 1 cm, while for the initial ones it remains difficult to diagnose. In the anastomoses sites the relapses are not easily resectable because often they affect the plan of the elevators of the anus, but in the recurrences involving l in the pre-sacral fascia it was possible to perform an AAP with resection extended to the muscular plane and to the genitourinary organs. Conclusions: In the data collected and analyzed, we highlight how a surgery that includes a correct excision of the middle rectum provides a high prevention of recurrences in addition to the correct approach to the neoplasm. A therapeutic program that includes radio and preoperative chemotherapy reduces recurrence as well a
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/20.500.11769/370635
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