Transanal excision （TE）, endoscopic transanal resection （ETAR） and transanal endoscopic microsurgery （TEN） can be used to remove adenomatous polyps. However, their use is limited by the size or location of the t...Transanal excision （TE）, endoscopic transanal resection （ETAR） and transanal endoscopic microsurgery （TEN） can be used to remove adenomatous polyps. However, their use is limited by the size or location of the tumor. TE is limited to the lower rectum, TEN offers better access to lesions in the middle and upper rectum, and ETAR is used less frequently than it deserves for resection of rectal lesions.展开更多
To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low re...To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.展开更多
AIM： To complete a quality audit using recently pub- lished criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS： Consecutive colonoscopy reports of patients at averag...AIM： To complete a quality audit using recently pub- lished criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS： Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior col6rectal neoplasia （CRN） by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional da- tabase providing pathological results. Required documen- tation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a stan- dardized glossary with 10% independent data validation. Sample size calculations determined the number of re- ports needed.RESULTS： Two hundreds and fifty patients （63.2± 10.5 years, female： 42.8%, average risk： 38.5%, per- sonal/family history of CRN： 43.3%/20.2%） were scoped in June 2009 by 8 gastroenterologists and 3 surgeons （mean practice： 17.1 ± 8.5 years）. Procedural indica- tion and informed consent were always documented. 14% provided a previous colonoscopy date （past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness）. Most procedural indicators were recorded （exam date： 98.4%, medications： 99.2%, difficulty level： 98.8%, prep quality： 99.6%）. All reports noted extent of visualization （cecum： 94.4%, with landmarks noted in 78.8% - photodocu- mentation： 67.2%）. No procedural times were recorded. One hundred and eleven had polyps （44.4%） with ana- tomic location noted in 99.1%, size in 65.8%, morphol- ogy in 62.2%; removal was by cold biopsy in 25.2% （cold snare： 18%, snare cautery： 31.5%, unrecorded： 20.7%）, 84.7% were retrieved. Adenomas were noted in 24.8% （advanced adenomas： 7.6%, cancer： 0.4%） in this population with varying previous colonic investigations. CONCLUSION： This audit reveals lacking reported ite- ms, justifying additional research to optimize quality of reporting.展开更多
文摘Transanal excision （TE）, endoscopic transanal resection （ETAR） and transanal endoscopic microsurgery （TEN） can be used to remove adenomatous polyps. However, their use is limited by the size or location of the tumor. TE is limited to the lower rectum, TEN offers better access to lesions in the middle and upper rectum, and ETAR is used less frequently than it deserves for resection of rectal lesions.
文摘To assess the merits of currently available treatment options in the management of patients with low rectal cancer, a review of the medical literature pertaining to the operative and non-operative management of low rectal cancer was performed, with particular emphasis on sphincter preservation, oncological outcome, functional outcome, morbidity, quality of life, and patient preference. Low anterior resection (AR) is technically feasible in an increasing proportion of patients with low rectal cancer. The cost of sphincter preservation is the risk of morbidity and poor functional outcome in a significant proportion of patients. Transanal and endoscopic surgery are attractive options in selected patients that can provide satisfactory oncological outcomes while avoiding the morbidity and functional sequelae of open total mesorectal excision. In complete responders to neo-adjuvant chemoradiotherapy, a non-operative approach may prove to be an option. Abdominoperineal excision (APE) imposes a permanent stoma and is associated with significant incidence of perineal morbidity but avoids the risk of poor functional outcome following AR. Quality of life following AR and APE is comparable. Given the choice, most patients will choose AR over APE, however patients following APE positively appraise this option. In striving toward sphincter preservation the challenge is not only to achieve the best possible oncological outcome, but also to ensure that patients with low rectal cancer have realistic and accurate expectations of their treatment choice so that the best possible overall outcome can be obtained by each individual.
基金Supported by The Research Scholar (Chercheur National) of the Fonds de la Recherche en Santé du Québec
文摘AIM： To complete a quality audit using recently pub- lished criteria from the Quality Assurance Task Group of the National Colorectal Cancer Roundtable. METHODS： Consecutive colonoscopy reports of patients at average/high risk screening, or with a prior col6rectal neoplasia （CRN） by endoscopists who perform 11 000 procedures yearly, using a commercial computerized endoscopic report generator. A separate institutional da- tabase providing pathological results. Required documen- tation included patient demographics, history, procedure indications, technical descriptions, colonoscopy findings, interventions, unplanned events, follow-up plans, and pathology results. Reports abstraction employed a stan- dardized glossary with 10% independent data validation. Sample size calculations determined the number of re- ports needed.RESULTS： Two hundreds and fifty patients （63.2± 10.5 years, female： 42.8%, average risk： 38.5%, per- sonal/family history of CRN： 43.3%/20.2%） were scoped in June 2009 by 8 gastroenterologists and 3 surgeons （mean practice： 17.1 ± 8.5 years）. Procedural indica- tion and informed consent were always documented. 14% provided a previous colonoscopy date （past polyp removal information in 25%, but insufficient in most to determine surveillance intervals appropriateness）. Most procedural indicators were recorded （exam date： 98.4%, medications： 99.2%, difficulty level： 98.8%, prep quality： 99.6%）. All reports noted extent of visualization （cecum： 94.4%, with landmarks noted in 78.8% - photodocu- mentation： 67.2%）. No procedural times were recorded. One hundred and eleven had polyps （44.4%） with ana- tomic location noted in 99.1%, size in 65.8%, morphol- ogy in 62.2%; removal was by cold biopsy in 25.2% （cold snare： 18%, snare cautery： 31.5%, unrecorded： 20.7%）, 84.7% were retrieved. Adenomas were noted in 24.8% （advanced adenomas： 7.6%, cancer： 0.4%） in this population with varying previous colonic investigations. CONCLUSION： This audit reveals lacking reported ite- ms, justifying additional research to optimize quality of reporting.
