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Rolland Parc - One of the best experts on this subject based on the ideXlab platform.
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Sutured Perineal Omentoplasty After Abdominoperineal Resection for Adenocarcinoma of the Lower Rectum
Diseases of the colon and rectum, 2005Co-Authors: E. De Broux, Emmanuel Tiret, Nidal Dehni, Yann Parc, F. Rondelli, Rolland ParcAbstract:PURPOSE:This study was designed to describe and evaluate the efficacy of sutured perineal omentoplasty on perineal wound healing after Abdominoperineal Resection for adenocarcinoma of the lower rectum.METHODS:Charts of patients who underwent Abdominoperineal Resection for adenocarcinoma of the rectu
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Oncologic results following Abdominoperineal Resection for adenocarcinoma of the low rectum.
Diseases of the colon and rectum, 2003Co-Authors: Nidal Dehni, Emmanuel Tiret, N. Mcfadden, Deborah A. Mcnamara, M. Guiguet, Rolland ParcAbstract:PURPOSE: The role of Abdominoperineal Resection for rectal cancer has changed because of advances in sphincter-preserving surgery. Our aim was to evaluate the results of this operation in the five-year period following introduction of the concept of total mesorectal excision METHODS: Data on all patients undergoing Abdominoperineal Resection for very low rectal cancer between 1992 and 1997 were collected prospectively. All patients had had total mesorectal excision. Curative Resection was defined as absence of macroscopic disease after Resection and local recurrence as any infiltration or tumor identified in the pelvis, alone or combined with distant disease. Survival and local recurrence rates were calculated using the Kaplan-Meier method and log-rank analysis. RESULTS: Of 165 Abdominoperineal Resections performed, 106 were for primary adenocarcinoma of the rectum. The male:female ratio was 50:56, with a median age of 65 (range, 33–85) years. There was one postoperative death. Twenty-seven patients received short-course preoperative radiotherapy (25 Gy over 1 week), whereas 22 had a longer course, with concomitant chemotherapy in 2. Postoperative chemotherapy was administered in 29, postoperative radiotherapy in 4, and combined therapy in 8. After curative Resection (n = 91), survival at five years was 76 percent and differed significantly by stage. Recurrence at any site was 7 percent (3/34) for Stage I, 27 percent (6/26) for Stage II, and 53 percent (16/31) for Stage III. Nine patients presented with local recurrence, with an overall rate at five years of 10 percent. Isolated locale recurrence was observed in only 5 percent of patients CONCLUSIONS: After Abdominoperineal Resection and total mesorectal excision, good rates of local control may be achieved provided surgical technique is meticulous.
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Results of salvage Abdominoperineal Resection for anal cancer after radiotherapy
Diseases of the Colon & Rectum, 1998Co-Authors: Marc Pocard, Emmanuel Tiret, Karen Nugent, Nidal Dehni, Rolland ParcAbstract:PURPOSE: Nonsurgical treatment of anal cancer by radiotherapy alone or combined with chemotherapy is the standard therapy for epidermoid carcinoma of the anal canal. Surgery is only recommended for treatment failures. Very few studies have been devoted to the outcome of this salvage surgery. The aim of this study is to evaluate these results. METHODS: A retrospective review from 1986 to 1995 revealed 21 patients with residual or recurrent anal canal carcinoma after initial radiotherapy, operated on by Abdominoperineal Resection. Patients were reviewed as to age, gender, initial treatment, any symptoms of recurrence, duration until recurrence, any diagnosis imaging, treatment, and outcome. RESULTS: None of these 21 patients had known lymph node involvement or metastases at radiotherapy or at salvage Abdominoperineal Resection. Eleven patients had residual disease (positive biopsy less than 6 months after the end of radiotherapy) and 10 had tumor recurrence (more than 6 months after cessation of treatment). Recurrence occurred at a mean of 15 (range, 9–41) months after radiotherapy. All 21 patients underwent an Abdominoperineal Resection. Pathologic examination of the 21 specimens showed complete excision in all cases except one and lymph node metastases in two cases. There was no perioperative mortality. The mean follow-up after surgery was 40 months; no patients were lost to follow-up. Of the 21 patients, 10 died and 11 lived, of whom 9 are disease free. The overall survival rate at three years after salvage Abdominoperineal Resection was 58 percent. The overall survival rate for patients with residual disease ( vs. recurrence) at three years was 72 percent ( vs. 29 percent) and at five years was 60 percent ( vs. 0 percent; P =0.06). CONCLUSIONS: Salvage Abdominoperineal Resection for anal cancer can be expected to yield a number of survivors from residual disease, but the low rate of survival after Abdominoperineal Resection for recurrent disease suggests the need for additional postoperative treatment if salvage Abdominoperineal Resection is performed.
Ronald Bleday - One of the best experts on this subject based on the ideXlab platform.
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Risk factors for perineal wound complications following Abdominoperineal Resection
Diseases of the colon and rectum, 2005Co-Authors: Caprice K. Christian, Mary R. Kwaan, Rebecca A. Betensky, Elizabeth Breen, Michael J. Zinner, Ronald BledayAbstract:PURPOSE:Perineal wound complications are common following Abdominoperineal Resection. This study investigates the factors contributing to these complications.METHODS:Patients undergoing Abdominoperineal Resection at our institution from June 1997 to May 2003 were reviewed. Significant predictors ass
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risk factors for perineal wound complications following Abdominoperineal Resection
Diseases of The Colon & Rectum, 2005Co-Authors: Caprice K. Christian, Mary R. Kwaan, Rebecca A. Betensky, Elizabeth Breen, Michael J. Zinner, Ronald BledayAbstract:Perineal wound complications are common following Abdominoperineal Resection. This study investigates the factors contributing to these complications. Patients undergoing Abdominoperineal Resection at our institution from June 1997 to May 2003 were reviewed. Significant predictors associated with minor (separation 2 cm of separation, reoperation required, or readmission) wound complications were ascertained. Of 153 patients, there were 22 major (14 percent) and 32 minor (24 percent) wound complications. Patients with anal cancer had a higher rate of major complications than those with rectal cancer or inflammatory bowel disease. Minor wound complications were more common in patients with anal cancer and inflammatory bowel disease than those with rectal cancer. Factors associated with a higher rate of major wound complications included flap closure, tumor size, body mass index, diabetes, and indication for the procedure. When the subset of patients with rectal cancer was considered, higher rates of major wounds were associated with increased body mass index, diabetes, and stage. Minor complications were associated with a two-team approach and increasing body mass index. This is currently the largest review of perineal wound complications following Abdominoperineal Resection. Patients with anal cancer and inflammatory bowel disease were at higher risk for perineal wound complications than those with rectal cancer. Preoperative radiation and primary closure were not associated with increased complications following Abdominoperineal Resection for rectal cancer.
Alfred M. Cohen - One of the best experts on this subject based on the ideXlab platform.
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Abdominoperineal Resection for rectal cancer at a specialty center.
Diseases of the colon and rectum, 2001Co-Authors: Aviram Nissan, Jose G. Guillem, Philip B. Paty, W. Douglas Wong, Bruce D. Minsky, Leonard Saltz, Alfred M. CohenAbstract:PURPOSE: Although sphincter-preservation procedures have replaced Abdominoperineal Resection as the treatment of choice for rectal cancer, a subset of patients with rectal cancer will still require Abdominoperineal Resection. The use of adjuvant radiotherapy has been shown to reduce local recurrence, and combined modality therapy (chemoradiation) improves survival. Sharp mesorectal excision compared with the classic teaching of blunt retrorectal dissection is also an important component of local control. The primary aim of the present study was to evaluate the postoperative complications associated with neoadjuvant therapy in patients requiring complete rectal excision. Oncologic outcomes for all patients with Abdominoperineal Resection are also provided. METHODS: A prospective database of 5,634 patients who underwent surgery for colorectal cancer at Memorial Sloan-Kettering Cancer Center between the years 1987 and 1997 was reviewed. Patients with primary adenocarcinoma of the rectum who underwent Abdominoperineal Resection were identified. In 1,622 patients who were operated on for primary rectal cancer, 292 patients (18 percent) underwent Abdominoperineal Resection and the rest had a sphincter-preserving procedure. Ten patients were excluded from the study because of prior pelvic irradiation for other cancer (8 patients) and insufficient radiation dose (
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Abdominoperineal Resection for rectal cancer at a specialty center
Diseases of The Colon & Rectum, 2001Co-Authors: Aviram Nissan, Jose G. Guillem, Philip B. Paty, Bruce D. Minsky, Leonard Saltz, Douglas W Wong, Alfred M. CohenAbstract:PURPOSE: Although sphincter-preservation procedures have replaced Abdominoperineal Resection as the treatment of choice for rectal cancer, a subset of patients with rectal cancer will still require Abdominoperineal Resection. The use of adjuvant radiotherapy has been shown to reduce local recurrence, and combined modality therapy (chemoradiation) improves survival. Sharp mesorectal excision compared with the classic teaching of blunt retrorectal dissection is also an important component of local control. The primary aim of the present study was to evaluate the postoperative complications associated with neoadjuvant therapy in patients requiring complete rectal excision. Oncologic outcomes for all patients with Abdominoperineal Resection are also provided. METHODS: A prospective database of 5,634 patients who underwent surgery for colorectal cancer at Memorial Sloan-Kettering Cancer Center between the years 1987 and 1997 was reviewed. Patients with primary adenocarcinoma of the rectum who underwent Abdominoperineal Resection were identified. In 1,622 patients who were operated on for primary rectal cancer, 292 patients (18 percent) underwent Abdominoperineal Resection and the rest had a sphincter-preserving procedure. Ten patients were excluded from the study because of prior pelvic irradiation for other cancer (8 patients) and insufficient radiation dose (<4,000 cGy; 2 patients). Neoadjuvant radiotherapy was given to 123 patients and postoperative adjuvant radiotherapy to 65 patients, whereas 94 did not receive radiotherapy. Intraoperative radiotherapy combined with preoperative radiotherapy was administered to 23 of the 123 patients given neoadjuvant radiotherapy. RESULTS: The duration of the operation was significantly longer in both neoadjuvant radiotherapy and intraoperative radiotherapy groups compared with the nonradiotherapy group (P=0.01 andP<0.0001, respectively). Estimated blood loss, mean number of blood units transfused per patient, and the percentage of patients being transfused were similar among the groups. Early postoperative complications were significantly higher in the neoadjuvant radiotherapy groups compared with the nonradiotherapy group. Late complications, overall survival, disease-free survival, and local recurrence were not significantly different among the groups. CONCLUSIONS: In patients with cancer of the lower one-third of the rectum, sharp pelvic dissection can result in a low rate of local recurrence even without radiotherapy. The role of preoperative radiotherapy, although associated with higher perineal wound complications, is important in increasing resectability and sphincter-preservation rate. Randomized, prospective trials will be needed to establish the role of adjuvant radiotherapy in patients undergoing sharp mesorectal excision for rectal cancer.
Slawomir J. Marecik - One of the best experts on this subject based on the ideXlab platform.
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Combining all forces: Abdominoperineal Resection in an obese male.
Journal of visualized surgery, 2016Co-Authors: Fahad Alsabhan, Saleh M. Eftaiha, Ajit Pai, John J. Park, Leela M. Prasad, Slawomir J. MarecikAbstract:Background: In patients with rectal cancer, pelvic dissection is challenging. A complete total mesorectal excision (TME) is particularly difficult in a narrow and long pelvis often encountered in males. This difficulty is compounded in the obese. In addition to the open approach being morbid, laparoscopy has often proven difficult secondary to rigid instruments along with a steep learning curve. Robot assistance offers an advantage, however limitations are observed in abdominal colon dissection outside of the pelvis. As these individual modalities have their disadvantages, they each can contribute unique aspects in a combined or a hybrid approach to rectal tumors. Therefore, a multi-modal, combined approach, involving hand assist, laparoscopic, and robotic assistance, to a 5-cm tumor at the anal verge was applied to an Abdominoperineal Resection in an obese, male patient. Methods: An obese 58-year-old male, BMI of 36 kg/m 2 , with a 5-cm anal canal squamous cell carcinoma which recurred after Nigro protocol treatment, underwent a multi-modal Abdominoperineal Resection. Results: The approach to recurrent anal cancer is as that for rectal cancer. Hence, a hand port was placed to assist in colon mobilization, visceral mesenteric dissection, and to facilitate the laparoscopic division of the inferior mesenteric artery (IMA) at its origin. The robot was used for deep pelvic dissection and TME. The levators were divided in the perineal phase. A complete mesorectal excision was achieved and a cylindrical specimen was extracted. Conclusions: An Abdominoperineal Resection with a multi-modal approach (hand assist, laparoscopic, and robotic) is safe and effective in Resection of low rectal cancers especially in the narrow, obese, and male pelvis.
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Robot-Assisted Abdominoperineal Resection: Clinical, Pathologic, and Oncologic Outcomes.
Diseases of the colon and rectum, 2016Co-Authors: Saleh M. Eftaiha, Ajit Pai, Suela Sulo, John J. Park, Leela M. Prasad, Slawomir J. MarecikAbstract:BACKGROUND:The extralevator approach to Abdominoperineal Resection is associated with a decreased incidence of rectal perforation and circumferential Resection margin positivity translating to lower recurrence rates. The Abdominoperineal Resection, as such, is an operation associated with poorer out
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Robotic cylindrical Abdominoperineal Resection with transabdominal levator transection
Diseases of the colon and rectum, 2011Co-Authors: Slawomir J. Marecik, John J. Park, Marek Zawadzki, Ashwin L. Desouza, Herand Abcarian, Leela M. PrasadAbstract:PURPOSE:The extralevator approach to Abdominoperineal Resection is an emerging surgical option for patients with low rectal cancer. This technique involves a wide excision of the levator muscles that could reduce the high incidence of circumferential margin positivity associated with conventional ab
John R. T. Monson - One of the best experts on this subject based on the ideXlab platform.
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Selection and Outcomes in Abdominoperineal Resection.
Frontiers in oncology, 2020Co-Authors: Norbert Garcia-henriquez, Daniel J. Galante, John R. T. MonsonAbstract:Since the initial descriptions of the Abdominoperineal Resection by Sir William Ernest Miles which was then followed by the perfection of the total mesorectal excision by Professor Bill Heald, the surgical management of rectal cancer has made tremendous strides. However, even with the advent and sophistication of neoadjuvant therapy, there remains a formidable amount of patients requiring an Abdominoperineal Resection. The purpose of this review is to delineate the indication and selection process by which patients are determined to require an Abdominoperineal Resection, as well as the oncologic and overall outcomes associated with the operation.
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Laparoscopic rectal-Abdominoperineal Resection.
Surgical oncology clinics of North America, 2001Co-Authors: B.j. Mehigan, John R. T. MonsonAbstract:In this article, the authors describe the current status of laparoscopic Abdominoperineal Resection for rectal cancer. Consideration is given to the surgical technique used and some discussion of the authors results is included. A review of the published literature is used to discuss the current status of the operation within the field of colorectal cancer surgery, as well as debating some of the existing controversies.
