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Eric Rullier - One of the best experts on this subject based on the ideXlab platform.
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delayed Coloanal Anastomosis an alternative option for restorative rectal cancer surgery after high dose pelvic radiotherapy for prostate cancer
2020Co-Authors: Marcolivier Francois, Eric Rullier, Bertrand Celerier, Etienne Buscail, V Vendrely, Vincent Assenat, Jeanbaptiste Moreau, Quentin DenostAbstract:AIM Restorative total mesorectal excision (TME) for rectal cancer after high-dose pelvic radiotherapy for prostate cancer has been reported to provide an unacceptable rate of pelvic sepsis. In a previous publication we proposed that delayed Coloanal Anastomosis (DCAA) should be performed in this situation. The present study aimed to assess the feasibility and outcomes of this strategy. METHOD Between 2000 and 2018, 1094 men were operated on for rectal cancer in our institution. All men with T2/T3 mid and low rectal cancer with preoperative radiotherapy and restorative TME were considered for this study (n = 416). Patients with external-beam high-dose radiotherapy (EBHRT) for prostate cancer (70-78 Gy) were identified and compared with patients with conventional long-course chemoradiotherapy (CRT) followed by TME. We compared our already published historical cohort (2000-2012), including arm A (CRT + TME; n = 236) and arm B (EBHRT + TME; n = 12), with our early cohort (2013-2018), including arm C (CRT + TME; n = 158) and arm D (EBHRT + TME-DCAA; n = 10). The end-points were morbidity, pelvic sepsis, reoperation rate and quality of the specimen. RESULTS Overall morbidity was not significantly different between groups. Pelvic sepsis decreased from 50% (arm B) to 10% (arm D) with the use of DCAA (P = 0.074), and was similar between arms A, C and D. Quality of the specimen was not significantly different between the four groups. CONCLUSION Our results suggest that TME with DCAA in patients with previous EBHRT is feasible, with the same postoperative pelvic sepsis rate as conventional CRT.
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laparoscopic total mesorectal excision with Coloanal Anastomosis for rectal cancer
2015Co-Authors: Quentin Denost, J P Adam, Arnaud Pontallier, Bertrand Celerier, C Laurent, Eric RullierAbstract:Objective Oncologic and functional outcomes were compared between transanal and transabdominal specimen extraction after laparoscopic Coloanal Anastomosis for rectal cancer. Background Laparoscopic Coloanal Anastomosis is an attractive new surgical option in patients with low rectal cancer because laparotomy is not necessary due to transanal specimen extraction. Risks of tumor spillage and fecal incontinence induced by transanal extraction are not known. Methods Between 2000 and 2010, 220 patients with low rectal cancer underwent laparoscopic rectal excision with hand-sewn Coloanal Anastomosis. The rectal specimen was extracted transanally in 122 patients and transabdominally in 98 patients. End points were circumferential resection margin, mesorectal grade, local recurrence, survival, and functional outcome. Results The mortality rate was 0.5% and surgical morbidity rate was 17%. The rate of positive circumferential resection margin was 9% and the mesorectum was graded complete in 79%, subcomplete in 12%, and incomplete in 9%. After a follow-up of 51 months (range, 1-151), the local recurrence rate was 4% and overall survival and disease-free survival rates were 83% and 70% at 5 years, respectively. The continence score was 6 (range, 0-20). There was no difference of mortality rate, morbidity rate, circumferential resection margin, mesorectal grade, local recurrence (4% vs 5%, P = 0.98), and disease-free survival rate (72% vs 68%, P = 0.63) between transanal and transabdominal extraction groups. Continence score was also similar (6 vs 6, P = 0.92). Conclusions Transanal extraction of the rectal specimen did not compromise oncologic and functional outcome after laparoscopic surgery for low rectal cancer and seems as a safe option to preserve the abdominal wall.
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comparison of functional results and quality of life between intersphincteric resection and conventional Coloanal Anastomosis for low rectal cancer
2004Co-Authors: Frederic Bretagnol, Frank Zerbib, Renaud Gontier, Eric Rullier, Christophe Laurent, Jean SaricAbstract:PURPOSE: The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional Coloanal anastomoses. METHODS: From 1990 to 2000, 170 patients underwent total mesorectal excision with Coloanal Anastomosis for low rectal tumors. Questionnaires were obtained from 77 patients alive without colostomy: 37 had a conventional Coloanal Anastomosis and 40 had intersphincteric resection. Both groups were similar according to age gender, anastomotic stenosis, colonic pouch, anastomotic leakage, preoperative radiotherapy, and follow-up (median, 56 months). Assessment included one functional and two quality-of-life questionnaires: the SF-36 Health Status and the Fecal Incontinence Quality of Life score. RESULTS: There was no difference in stool frequency, fragmentation, urgency, dyschesia, and alimentary restriction between patients with and without intersphincteric resection. Patients with intersphincteric resection had significantly worse continence (Wexner score, 10.8 vs. 6.9; P < 0.001) and needed more antidiarrheal drugs (60 vs. 35 percent; P = 0.04) than those without. Compared with conventional Coloanal anastomoses, quality of life was altered by intersphincteric resection for the subscale embarrassment (P < 0.01) in the Fecal Incontinence Quality of Life score, whereas no difference of quality of life was observed with SF-36. CONCLUSIONS: Compared with conventional Coloanal anastomoses, patients with intersphincteric resection have a higher risk of fecal incontinence and a slightly altered quality of life.
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comparison of functional results and quality of life between intersphincteric resection and conventional Coloanal Anastomosis for low rectal cancer
2004Co-Authors: Frederic Bretagnol, Frank Zerbib, Renaud Gontier, Eric Rullier, Christophe Laurent, Jean SaricAbstract:The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional Coloanal anastomoses. From 1990 to 2000, 170 patients underwent total mesorectal excision with Coloanal Anastomosis for low rectal tumors. Questionnaires were obtained from 77 patients alive without colostomy: 37 had a conventional Coloanal Anastomosis and 40 had intersphincteric resection. Both groups were similar according to age, gender, anastomotic stenosis, colonic pouch, anastomotic leakage, preoperative radiotherapy, and follow-up (median, 56 months). Assessment included one functional and two quality-of-life questionnaires: the SF-36 Health Status and the Fecal Incontinence Quality of Life score. There was no difference in stool frequency, fragmentation, urgency, dyschesia, and alimentary restriction between patients with and without intersphincteric resection. Patients with intersphincteric resection had significantly worse continence (Wexner score, 10.8 vs. 6.9; P < 0.001) and needed more antidiarrheal drugs (60 vs. 35 percent; P = 0.04) than those without. Compared with conventional Coloanal anastomoses, quality of life was altered by intersphincteric resection for the subscale embarrassment (P < 0.01) in the Fecal Incontinence Quality of Life score, whereas no difference of quality of life was observed with SF-36. Compared with conventional Coloanal anastomoses, patients with intersphincteric resection have a higher risk of fecal incontinence and a slightly altered quality of life.
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technical and oncological feasibility of laparoscopic total mesorectal excision with pouch Coloanal Anastomosis for rectal cancer
2003Co-Authors: Frederic Bretagnol, Eric Rullier, P Couderc, Anne Rullier, J SaricAbstract:Aim The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic total mesorectal excision (TME) with Coloanal Anastomosis for mid and low rectal cancer. Methods During a 2-year period, 50 patients underwent laparoscopic TME with Coloanal Anastomosis for rectal carcinoma located at a median of 4.5 (range 2–11) cm from the anal verge. Pre-operative radiotherapy was used in 46 patients. Intersphincteric dissection was combined with the laparoscopic procedure to achieve sphincter preservation. Results Conversion to a laparotomy was necessary in six patients. Postoperative mortality and morbidity were 2% and 28%, respectively. Morbidity was lower in patients operated on during the second part of the study, who had extraction of the rectal specimen through a small laparotomy incision, than in those operated on during the first part of the study when removal of the specimen was by transanal extraction. Oncological quality of excision was safe in 44 patients with intact or almost intact rectal fascia in 88% and R0 resection in 90%. At a median follow-up of 18 months, there was no local or port-site recurrence. Conclusion This study confirms our preliminary results of oncological feasibility of laparoscopic TME with sphincter preservation for mid and low rectal cancer, and showed that morbidity can be decreased by using a standardized surgical procedure.
Bruce D Minsky - One of the best experts on this subject based on the ideXlab platform.
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evaluation of preoperative and postoperative radiotherapy on long term functional results of straight Coloanal Anastomosis
2003Co-Authors: Daniel R Nathanson, Bruce D Minsky, Warren E Enker, Jose G Guillem, Joseph N Espat, Garrett M Nash, Matthew Dalessio, Howard T Thaler, Douglas Wong, Alfred E CohenAbstract:PURPOSE: Preoperative radiotherapy for rectal cancer avoids radiation to the reconstructed rectum and may circumvent the detrimental effects on bowel function associated with postoperative radiotherapy. We compared the long-term functional results of patients who received preoperative radiotherapy, postoperative radiotherapy, or no radiotherapy in conjunction with low anterior resection and Coloanal Anastomosis to assess the impact of pelvic radiation on anorectal function. METHODS: One hundred nine patients treated by low anterior resection and straight Coloanal Anastomosis for rectal cancer between 1986 and 1997 were assessed with a standardized questionnaire at two to eight years after resection. All radiotherapy was given to a total dose of 4,500 to 5,400 cGy with conventional doses and techniques. Most patients received concurrent 5-fluorouracil–based chemotherapy. RESULTS: There were 39 patients in the preoperative radiotherapy group, 11 patients in the postoperative radiotherapy group, and 59 patients in the no radiotherapy group. The postoperative radiotherapy group reported a significantly greater number of bowel movements per 24-hour period (P < 0.01) and significantly more episodes of clustered bowel movements (P < 0.02) than either the preoperative radiotherapy group or the no radiotherapy group. No significant difference in anal continence or satisfaction with bowel function was found among the three groups. CONCLUSION: In this study of straight (nonreservoir) Coloanal anastomoses, postoperative pelvic radiotherapy had significant adverse effects on anorectal function, with higher rates of clustering and frequency of defecation than with preoperative radiotherapy. No differences in continence rates were demonstrated, perhaps because of the sample size of the compared groups. We attribute the adverse effects of postoperative radiotherapy to irradiation of the neorectum, which is spared when treatment is given preoperatively. The deleterious effects of adjuvant radiation on long-term anorectal function can be reduced by preoperative treatment.
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sphincter preservation in rectal cancer with preoperative radiation therapy and Coloanal Anastomosis long term follow up
1998Co-Authors: Raquel Wagman, Bruce D Minsky, Alfred M Cohen, Jose G Guillem, Philip P PatyAbstract:Abstract Background: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods: Thirty six patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/Coloanal Anastomosis. By preoperative assessment, all patients had invasive tumors (5,T 2; 31,T 3 ) involving the distal half of the rectum and clinically required an abdominoperineal resection. The median tumor size was 3.8 cm [range: 1.5–7 cm] and the median distance from the anal verge was 4 cm [range: 3–7 cm]. The whole pelvis received 46.80 Gy followed by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 56 months [range: 4–121 months]. Results: Of the 35 patients who underwent resection, 5 (14%) had a complete pathologic response and 27 (77%) were able to successfully undergo a low anterior resection/Coloanal Anastomosis. The incidence of local failure was crude: 17% and 5-year actuarial: 21%. The 5-year actuarial survival was 64%. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in the 27 patients who underwent a low anterior resection/Coloanal Anastomosis. Function was good or excellent in 85%. The median number of bowel movements/day was 2 (range: 0–8). Conclusions: Our data suggest that preoperative radiation therapy allows sphincter preservation in 77% of selected patients who would otherwise require an abdominoperineal resection, and 85% have good to excellent sphincter function. Given the moderate local failure rate, we now routinely use preoperative combined modality therapy plus postoperative chemotherapy for patients with clinical T 3 disease.
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preoperative radiation therapy followed by low anterior resection with Coloanal Anastomosis
1998Co-Authors: Bruce D MinskyAbstract:The advantage of preoperative therapy in patients with clinically resectable transmural rectal cancer is to increase sphincter preservation while obtaining a high likelihood of local control. In patients who undergo a prospective clinical assessment and are declared to require an abdominoperineal resection, preoperative radiation therapy, either alone or when combined with chemotherapy, allows approximately 80% of patients to undergo a low anterior resection with or without Coloanal Anastomosis. The majority have good-to-excellent sphincter function. This conservative approach may be an alternative to an abdominoperineal resection in selected patients.
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sphincter preservation with preoperative radiation therapy and Coloanal Anastomosis
1995Co-Authors: Bruce D Minsky, Alfred M Cohen, Warren E Enker, Philip B PatyAbstract:Purpose: To determine if preoperative radiation therapy allows sphincter preservation in the treatment of rectal cancer. Methods and Materials: Thirty patients with the diagnosis of invasive, resectable, primary adenocarcinoma of the rectum limited to the pelvis were enrolled on a Phase I/II trial of preoperative radiation therapy plus low anterior resection/Coloanal Anastomosis. By preoperative assessment, all patients had invasive tumors (2: T2,28: T3) involving the distal half of the rectum and required an abdominoperineal resection. The median tumor size was 4 cm (range: 1.5-6 em) and the median distance from the anal verge was 4 cm (range: 3-7 cm). The whole pelvis received 46.8 Gy follows by a 3.60 Gy boost to the primary tumor bed. The median follow-up was 43 months (range: 6-82 months). Results: Of the 29 patients who underwent resection, 3 (10%) had a complete pathologic response and 24 (83%) were able to successfully undergo a low anterior resection/Coloanal Anastomosis. The incidence of local failure was crude: 17% and 4-year actuarial: 23%. The 4-year actuarial survival was 75%. One patient developed a partial disruption of the Anastomosis and two developed recta1 stenosis. Analysis of sphincter function using a previously published scale was performed at the time of last follow-up in 22 of the 24 patients who underwent a low anterior resection/Coloanal Anastomosis. Function was good or excellent in 77%. The median number of bowel movements/ day was two (range: l-6). Conclusions: This technique may be an alternative to an abdominoperineai resection in selected patients. Continued follow-up is needed to determine if this approach ultimately has similar local control and survival rates as an a~ominoperineal resection.
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long term functional results of Coloanal Anastomosis for rectal cancer
1994Co-Authors: Philip B Paty, Bruce D Minsky, Alfred M Cohen, Warren E Enker, Hamutal FriedlanderklarAbstract:Abstract In a survey of patients treated with Coloanal Anastomosis for rectal cancer, 81 of 90 eligible patients responded to a questionnaire evaluating current anorectal function. Time from operation to assessment ranged from 1.3 to 12.3 years (median: 4.3 years). The median stool frequency was two per day; 22% of patients reported four or more stools per day. In the patients surveyed, fecal continence was complete in 51%, incontinence to gas only in 21%, minor leak in 23%, and significant leak in 5%. Complete evacuation of the neorectum was problematic in 32%. Overall function was excellent in 28%, good in 28%, fair in 32%, and poor in 12%. The impact of treatment variables on functional outcome was assessed by univariate and multivariate analyses. No surgical technique correlated with improved or impaired outcome. Time since surgery (reduced stool frequency) and use of post-operative adjuvant radiotherapy (increased stool frequency, increased difficulty with evacuation) did appear to influence functional outcome. We conclude that the functional results of Coloanal Anastomosis are good but not optimal. Continued investigation of the effects of surgical technique and adjuvant therapy is warranted.
Victor W Fazio - One of the best experts on this subject based on the ideXlab platform.
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preoperative radiotherapy is associated with worse functional results after Coloanal Anastomosis for rectal cancer
2009Co-Authors: Yann Parc, Massarat Zutshi, Stephane Zalinski, Rienhard Ruppert, A Furst, Victor W FazioAbstract:PURPOSE:This study was designed to evaluate functional outcome in patients treated with preoperative radiotherapy after low anterior resection and a Coloanal Anastomosis for low rectal cancer.METHODS:Functional outcome data from patients enrolled in a prospective randomized trial comparing 3 reconst
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outcomes following turnbull cutait abdominoperineal pull through compared with Coloanal Anastomosis
2009Co-Authors: Feza H Remzi, El G Gazzaz, Ravi P Kiran, Hasan T Kirat, Victor W FazioAbstract:Background: The Turnbull–Cutait abdominoperineal pull-through procedure (T-C) is used as a last resort to avoid permanent diversion in patients with complex anorectal conditions. The aim was to evaluate short- and long-term outcomes after T-C. Methods: Patients undergoing T-C from 1996 to 2007 were reviewed retrospectively in terms of demographics, diagnosis, indications and postoperative complications. Patients were contacted to obtain functional outcomes using a standardized questionnaire. Functional outcomes were compared with those in a matched group of patients undergoing handsewn Coloanal Anastomosis (CAA) for rectal cancer. Results: Sixty-seven patients (40 men) underwent T-C. Postoperative complications included stricture in 11 patients (16 per cent), fistula in five (7 per cent), prolapse of the colon in five (7 per cent) and leak in two (3 per cent). Mean follow-up was 5·6 (s.d. 3·2) years. The operation failed in 17 patients (25 per cent). Among 44 patients (66 per cent) who completed questionnaires, faecal (P = 0·121) and urinary (P = 0·073) incontinence, and sexual function (P = 0·063) were comparable to those in patients who had CAA. Conclusion: T-C is an option for patients with complex anorectal conditions that might otherwise require permanent diversion. Functional outcomes are comparable to those of CAA. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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meta analysis of colonic reservoirs versus straight Coloanal Anastomosis after anterior resection
2005Co-Authors: Alexander G Heriot, Paris P Tekkis, Vasilis Constantinides, Paraskeva Paraskevas, R J Nicholls, Ara Darzi, Victor W FazioAbstract:Background and methods: The comparative benefits and drawbacks of straight Coloanal Anastomosis (CAA), colonic -pouch and coloplasty Anastomosis after anterior resection are uncertain. Studies published between 1986 and 2005 of colonic -pouch versus transverse coloplasty or straight CAA were analysed. Endpoints included postoperative complications, and functional and physiological outcomes measured within 6 months, 1 year and 2 years or more after the procedure. A random-effect model was used to aggregate the study endpoints and assess heterogeneity. Results: Thirty-five studies containing 2240 patients (1066 straight CAA, 1050 -pouch and 124 coloplasty) were included. There was no significant difference in postoperative complications between the three groups. There was a significant reduction in the frequency of defaecation per day by 1·88, 1·35 and 0·74 motions at the three time intervals in the -pouch group compared with the straight CAA group. Faecal urgency was less prevalent in patients with a -pouch than those with a straight CAA (odds ratio 0·27 at 6 months or less and 0·21 at 1 year). There was no difference in functional outcome between -pouch and coloplasty Anastomosis. Conclusions: The colonic -pouch provided functional benefits over straight Anastomosis with no increase in postoperative complications. Coloplasty appeared to have similar benefits but further studies are required for validation. Copyright © 2005 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd
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proctectomy with Coloanal Anastomosis
2005Co-Authors: Victor W Fazio, Alexander G HeriotAbstract:Surgical management tends to evolve over time as a result of contributions from multiple physicians. The management of carcinoma of the rectum is a good example of this. Developments in understanding of the pathology and spread of the tumor, combined with technical advances, have altered significantly the surgical approach, from radical ablative surgery at the start of the twentieth century to restorative sphincter-preserving surgery at the start of the twenty-first century [1]. This is combined with increased awareness of the value of functional outcome and oncologic outcome. In 1908, radicality was considered the key, and Ernest Miles proposed abdominoperineal resection (APER) as the appropriate approach to rectal cancer, based on Halstead’s principles of radical surgery to excise potential areas of lymph node spread, which he considered to be proximal and distal to the tumor [2]. Despite high morbidity and mortality associated with APER, the procedure was supported by William Mayo [3], who believed that sphincter preservation increased morbidity. APER remained the approach of choice for the next 30 years and replaced the posterior approach to rectal tumors that had been advocated by Kraske [4]. Restorative resection for rectal cancer was first performed in the United States by Balfour in 1910 but gained increasing popularity from the 1940s onwards. It was initially applied only to rectosigmoid tumors, with some units still performing APER for rectal tumors into the 1960s. Developments in pathology with respect to the limits of distal rectal cancer spread supported reduction of resection margin distal to the tumor. Because of the need for a permanent colostomy with APER, along with genitourinary dysfunction, numerous techniques for colorectal and Coloanal Anastomosis were described during the twentieth century. The pull-through
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colonic coloplasty novel technique to enhance low colorectal or Coloanal Anastomosis
2000Co-Authors: Victor W Fazio, Christopher R Mantyh, Tracy L HullAbstract:After low colorectal or Coloanal Anastomosis, bowel dysfunction may exist. A colonic J-pouch has been proposed to reduce bowel dysfunction. We present an alternative technique to augment the reservoir function of the neorectum and reduce bowel dysfunction.
M Kitajima - One of the best experts on this subject based on the ideXlab platform.
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long term outcome of per anum intersphincteric rectal dissection with direct Coloanal Anastomosis for lower rectal cancer
2005Co-Authors: J H Yoo, Hirotoshi Hasegawa, Yoshiyuki Ishii, H Nishibori, Masahiko Watanabe, M KitajimaAbstract:Objective The authors have performed per anum intersphincteric rectal dissection. With direct Coloanal Anastomosis for cases of lower rectal cancer in which the distal surgical margin is difficult to secure by the double stapling technique. The aim of this study was to evaluate the long-term outcome and to clarify the surgical indications for this operation. Patients and methods Between 1993 and 2002, 31 patients underwent per anum intersphincteric rectal dissection with direct Coloanal Anastomosis. Of these, two patients (one stage 0 and one stage IV) were excluded from the analysis of oncological outcome. The remaining 29 patients formed the basis of this study. The median follow-up was 57 months (range 6–106 months). Results Local recurrence and distant metastasis developed in 9 and 3 patients, respectively. Local recurrence rate for pT1 was significantly lower than that for pT2/T3 disease. The local recurrence rate cases with tumours less than 3 cm was significantly lower than that for tumours sized 3 cm or more. The distant metastasis rate for cases with lymph node metastasis was significantly higher than that for cases without lymph node metastasis. There was an association between distant metastasis and TNM or pT stage. The overall survival rates for stage I, II and III were 85%, 80% and 89%, respectively. No significant defference was seen in total Cleveland Clinic incontinence score between per anum intersphincteric rectal dissection with direct Coloanal Anastomosis and the double stapling technique. Conclusion The surgical indications of this operation should be limited to patients with T1 rectal cancer or tumours less than 3 cm.
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per anum intersphincteric rectal dissection with direct Coloanal Anastomosis for lower rectal cancer the ultimate sphincter preserving operation
1997Co-Authors: Tatsuo Teramoto, Masahiko Watanabe, M KitajimaAbstract:PURPOSE: The most important goal of sphincter-preserving operations for rectal cancer is to secure a distal surgical margin of safety and the anal sphincter. However, it is not always easy to transect the rectum and to secure a distal surgical margin of safety through the abdominal approach for tumors situated extremely low in the rectum. The aim of this study was to describe and to evaluate a new technique ofper anumintersphincteric rectal dissection and Coloanal Anastomosis. METHODS: The rectum, including the entire width of the internal anal sphincter, is transected circum ferentiallyviathe anal route to secure the surgical margin of safety under direct vision and is mobilized proximally as far as possible through the intersphincteric plane.Per anumColoanal Anastomosis is performed following transabdominal resection of the rectum. RESULTS: This technique has been used in 12 patients. There have been no instances of short-term or long-term anastomotic complications. CONCLUSIONS: This technique is safe when Anastomosis must be performed at the dentate line. It is the best sphincter-preserving operation for lower rectal cancer and does not result in serious postoperative anal dysfunction.
Frederic Bretagnol - One of the best experts on this subject based on the ideXlab platform.
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redo surgery for failed colorectal or Coloanal Anastomosis a valuable surgical challenge
2011Co-Authors: Jeremie H Lefevre, Frederic Bretagnol, Leon Maggiori, Mathieu Ferron, Arnaud Alves, Yves PanisAbstract:Background Redo surgery (RS) in patients with failed Anastomosis is a rare procedure, and data about this surgery are lacking. The aim of this study was to examine the operative results and long-term outcomes of RS. Methods All patients who underwent RS between 1999 and 2008 were included. Data were analyzed from a prospective colorectal database. Failure of the procedure was defined as the inability to perform the RS or the inability to close the defunctioning stoma. Results Thirty-three patients (22 men) underwent the first surgery at a mean age of 53.4 years. Twenty-four had a colorectal Anastomosis (CRA) and nine a Coloanal Anastomosis (CAA). The reasons for performing RS were stricture ( n = 17), prior Hartmann procedure for complication on initial Anastomosis ( n = 6), chronic fistula ( n = 5) or miscellaneous ( n = 5). RS was impossible for 2 patients due to extensive adhesions. The mean operating time was 279 min (133–480) and the overall postoperative morbidity rate was 55%. The rate of anastomotic leakage and/or isolated pelvic abscess was 27%. After a mean delay of 3.9 months (0.3–16), 26 patients (79%) had a stoma closure. The mean number of stools per day was 3.2. The failure rates after new handsewn CAA and new stapled CRA were 33% (4/12) and 5% (1/19), respectively ( P = .0385). The type of the former Anastomosis influenced the success rate of restoring the intestinal continuity: failure rate after prior CAA was 56% and 8% after prior CRA ( P = .0031). Conclusion Redo surgery for failure of previous CRA or CAA is feasible but requires a demanding surgical procedure with high short-term morbidity.
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comparison of functional results and quality of life between intersphincteric resection and conventional Coloanal Anastomosis for low rectal cancer
2004Co-Authors: Frederic Bretagnol, Frank Zerbib, Renaud Gontier, Eric Rullier, Christophe Laurent, Jean SaricAbstract:PURPOSE: The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional Coloanal anastomoses. METHODS: From 1990 to 2000, 170 patients underwent total mesorectal excision with Coloanal Anastomosis for low rectal tumors. Questionnaires were obtained from 77 patients alive without colostomy: 37 had a conventional Coloanal Anastomosis and 40 had intersphincteric resection. Both groups were similar according to age gender, anastomotic stenosis, colonic pouch, anastomotic leakage, preoperative radiotherapy, and follow-up (median, 56 months). Assessment included one functional and two quality-of-life questionnaires: the SF-36 Health Status and the Fecal Incontinence Quality of Life score. RESULTS: There was no difference in stool frequency, fragmentation, urgency, dyschesia, and alimentary restriction between patients with and without intersphincteric resection. Patients with intersphincteric resection had significantly worse continence (Wexner score, 10.8 vs. 6.9; P < 0.001) and needed more antidiarrheal drugs (60 vs. 35 percent; P = 0.04) than those without. Compared with conventional Coloanal anastomoses, quality of life was altered by intersphincteric resection for the subscale embarrassment (P < 0.01) in the Fecal Incontinence Quality of Life score, whereas no difference of quality of life was observed with SF-36. CONCLUSIONS: Compared with conventional Coloanal anastomoses, patients with intersphincteric resection have a higher risk of fecal incontinence and a slightly altered quality of life.
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comparison of functional results and quality of life between intersphincteric resection and conventional Coloanal Anastomosis for low rectal cancer
2004Co-Authors: Frederic Bretagnol, Frank Zerbib, Renaud Gontier, Eric Rullier, Christophe Laurent, Jean SaricAbstract:The technique of intersphincteric resection permits sphincter preservation with good oncologic results in very low rectal cancer. This study aimed to investigate functional results and quality of life after intersphincteric resection compared with conventional Coloanal anastomoses. From 1990 to 2000, 170 patients underwent total mesorectal excision with Coloanal Anastomosis for low rectal tumors. Questionnaires were obtained from 77 patients alive without colostomy: 37 had a conventional Coloanal Anastomosis and 40 had intersphincteric resection. Both groups were similar according to age, gender, anastomotic stenosis, colonic pouch, anastomotic leakage, preoperative radiotherapy, and follow-up (median, 56 months). Assessment included one functional and two quality-of-life questionnaires: the SF-36 Health Status and the Fecal Incontinence Quality of Life score. There was no difference in stool frequency, fragmentation, urgency, dyschesia, and alimentary restriction between patients with and without intersphincteric resection. Patients with intersphincteric resection had significantly worse continence (Wexner score, 10.8 vs. 6.9; P < 0.001) and needed more antidiarrheal drugs (60 vs. 35 percent; P = 0.04) than those without. Compared with conventional Coloanal anastomoses, quality of life was altered by intersphincteric resection for the subscale embarrassment (P < 0.01) in the Fecal Incontinence Quality of Life score, whereas no difference of quality of life was observed with SF-36. Compared with conventional Coloanal anastomoses, patients with intersphincteric resection have a higher risk of fecal incontinence and a slightly altered quality of life.
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technical and oncological feasibility of laparoscopic total mesorectal excision with pouch Coloanal Anastomosis for rectal cancer
2003Co-Authors: Frederic Bretagnol, Eric Rullier, P Couderc, Anne Rullier, J SaricAbstract:Aim The aim of this study was to evaluate the technical and oncological feasibility of laparoscopic total mesorectal excision (TME) with Coloanal Anastomosis for mid and low rectal cancer. Methods During a 2-year period, 50 patients underwent laparoscopic TME with Coloanal Anastomosis for rectal carcinoma located at a median of 4.5 (range 2–11) cm from the anal verge. Pre-operative radiotherapy was used in 46 patients. Intersphincteric dissection was combined with the laparoscopic procedure to achieve sphincter preservation. Results Conversion to a laparotomy was necessary in six patients. Postoperative mortality and morbidity were 2% and 28%, respectively. Morbidity was lower in patients operated on during the second part of the study, who had extraction of the rectal specimen through a small laparotomy incision, than in those operated on during the first part of the study when removal of the specimen was by transanal extraction. Oncological quality of excision was safe in 44 patients with intact or almost intact rectal fascia in 88% and R0 resection in 90%. At a median follow-up of 18 months, there was no local or port-site recurrence. Conclusion This study confirms our preliminary results of oncological feasibility of laparoscopic TME with sphincter preservation for mid and low rectal cancer, and showed that morbidity can be decreased by using a standardized surgical procedure.