BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To...BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.METHODS We conducted a systematic search of the electronic databases PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and CINAHL from inception till August 2023.We analyzed outcomes including recurrence rate,en bloc resection,R0 resection rate,perforation rate,procedure length,and hospital stay length applying a random-effects inverse-variance model.We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.RESULTS We pooled data from 11 studies involving 1013 participants.We found similar recurrence rates,with a pooled odds ratio of 0.545(95%CI:0.176-1.687).En bloc resection,R0 resection,and perforation rate values were also similar for both ESD and TES.The pooled analysis for procedure length indicated a mean difference of-4.19 min(95%CI:-22.73 to 14.35),and the hospital stay was on average shorter for ESDs by about 0.789 days(95%CI:-1.671 to 0.093).CONCLUSION Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes.Our findings show that individualized patient and surgeon preferences,alongside specific clinical contexts,can be considered when selecting between these two techniques.展开更多
Rectal neuroendocrine tumours represent a rare colorectal tumour with a 10 fold increased prevalence due to incidental detection in the era of colorectal screening.Patient outcomes with early diagnosis are excellent.H...Rectal neuroendocrine tumours represent a rare colorectal tumour with a 10 fold increased prevalence due to incidental detection in the era of colorectal screening.Patient outcomes with early diagnosis are excellent.However endoscopic recognition of this lesion is variable and misdiagnosis can result in suboptimal endoscopic resection with subsequent uncertainty in relation to optimal long-term management.Endoscopic techniques have shown particular utility in managing this under-recognized neuroendocrine tumour.展开更多
BACKGROUND Endoscopic submucosal dissection(ESD)can be used for the en-bloc removal of superficial rectal lesions;however,the lack of a traction system makes the procedure long and difficult in the presence of extensi...BACKGROUND Endoscopic submucosal dissection(ESD)can be used for the en-bloc removal of superficial rectal lesions;however,the lack of a traction system makes the procedure long and difficult in the presence of extensive lesions.CASE SUMMARY A large polyp occupying 2/3 of the rectal circumference and extending 5 cm in length was removed by ESD with the help of laparoscopic forceps introduced via trans-anal rectoscopic assisted minimally invasive surgery,a disposable platform designed to aid in transanal minimally invasive surgery.Traction of the polyp by forceps during the operation was dynamic,and applied at various points and in various directions.The polyp was removed en-bloc without complications in 1 h and 55 min.A sigmoidoscopy performed 50 d later showed normal healing without polyp recurrence.CONCLUSION The technique presented here could overcome the issues caused by lack of traction during ESD for rectal lesions.展开更多
Gastrointestinal stromal tumour (GIST) is a rare tumour of the gastrointestinal tract which does not generally originate in the rectum. The authors describe a case of a 70-year-old man who underwent an anterior resect...Gastrointestinal stromal tumour (GIST) is a rare tumour of the gastrointestinal tract which does not generally originate in the rectum. The authors describe a case of a 70-year-old man who underwent an anterior resection of the rectum for a low-risk GIST. The patient was not given adjuvant chemotherapy with imatinib and is still disease-free 30 mo after surgery. The authors conclude that although rectal GIST is extremely uncommon, it should be included in differential diagnosis when a tumour in the rectum is detected. Biopsy of the tumour is essential, since this makes it possible to reach a sure preoperative diagnosis based on the immunohistological features of the CD117 and CD34. Although complete surgical resection with negative tumour margins is the principal curative procedure for primary and non-metastatic tumours, further studies are still needed for the determination of the most effective treatment strategy for patients with rectal GIST.展开更多
Rectal lymphoma is a rare colorectal tumor with incidence of 0.2% - 0.6%. We report a rare case of large rectal lymphoma. Our patient is a 48-year-old man, presented with 2 months history of per rectal bleed, altered ...Rectal lymphoma is a rare colorectal tumor with incidence of 0.2% - 0.6%. We report a rare case of large rectal lymphoma. Our patient is a 48-year-old man, presented with 2 months history of per rectal bleed, altered bowel habits and weight loss. Clinical examination, computed tomography scan and initial endoscopic mucosal biopsy were indistinguishable from Rectal Carcinoma. With high level of suspicion, we resorted to full thickness punch biopsy in lithotomy position for a good tissue sample. Ultimately, an immunohistochemical study confirmed Diffuse Large B-cells Lymphoma (DLBCL). This case highlighted the importance of high level of suspicion for lymphoma when dealing with a rectal tumor. Accurate diagnosis of rectal lymphoma affects the treatment modalities and prognosis of the patient.展开更多
AIM To define good and poor regression using pathology and magnetic resonance imaging(MRI) regression scales after neo-adjuvant chemotherapy for rectal cancer.METHODS A systematic review was performed on all studies u...AIM To define good and poor regression using pathology and magnetic resonance imaging(MRI) regression scales after neo-adjuvant chemotherapy for rectal cancer.METHODS A systematic review was performed on all studies up to December 2015, without language restriction, t h a t w e r e i d e n t i f i e d f r o m M E D L I N E, C o c h r a n e Controlled Trials Register(1960-2015), and EMBASE(1991-2015). Searches were performed of article bibliographies and conference abstracts. MeS H and text words used included "tumour regression", "mr TRG", "poor response" and "colorectal cancers". Clinical studies using either MRI or histopathological tumour regression grade(TRG) scales to define good and poor responders were included in relation to outcomes [local recurrence(LR), distant recurrence(DR), disease-free survival(DFS), and overall survival(OS)]. There was no age restriction or stage of cancer restriction for patient inclusion. Data were extracted by two authors working independently and using pre-defined outcome measures.RESULTS Quantitative data(prevalence) were extracted and analysed according to meta-analytical techniques using comprehensive meta-analysis. Qualitative data(LR, DR, DFS and OS) were presented as ranges. The overall proportion of poor responders after neo-adjuvant chemoradiotherapy(CRT) was 37.7%(95%CI: 30.1-45.8). There were 19 different reported histopathological scales and one MRI regression scale(mrT RG). Clinical studies used nine and six histopathological scales for poor and good responders, respectively. All studies using MRI to define good and poor response used one scale. The most common histopathological definition for good response was the Mandard grades 1 and 2 or Dworak grades 3 and 4; Mandard 3, 4 and 5 and Dworak 0, 1 and 2 were used for poor response. For histopathological grades, the 5-year outcomes for poor responders were LR 3.4%-4.3%, DR 14.3%-20.3%, DFS 61.7%-68.1% and OS 60.7-69.1. Good pathological response 5-year outcomes were LR 0%-1.8%, DR 0%-11.6%, DFS 78.4%-86.7%, and OS 77.4%-88.2%. A poor response on MRI(mr TRG 4,5) resulted in 5-year LR 4%-29%, DR 9%, DFS 31%-59% and OS 27%-68%. The 5-year outcomes with a good response on MRI(mrT RG 1,2 and 3) were LR 1%-14%, DR 3%, DFS 64%-83% and OS 72%-90%.CONCLUSION For histopathology regression assessment, Mandard 1, 2/Dworak 3, 4 should be used for good response and Mandard 3, 4, 5/Dworak 0, 1, 2 for poor response. MRI indicates good and poor response by mr TRG1-3 and mrT RG4-5, respectively.展开更多
目的评价超声结肠镜(EUS)在直肠肿瘤诊断中的作用。方法应用 EUS 检查10例直肠良恶性肿瘤,将其病变所在层次和淋巴结转移情况与病理结果进行比较。结果肿瘤所在层次 EUS 与病理符合率为90％,淋巴结转移情况 EUS 检查与病理符合率为83.3...目的评价超声结肠镜(EUS)在直肠肿瘤诊断中的作用。方法应用 EUS 检查10例直肠良恶性肿瘤,将其病变所在层次和淋巴结转移情况与病理结果进行比较。结果肿瘤所在层次 EUS 与病理符合率为90％,淋巴结转移情况 EUS 检查与病理符合率为83.3％。结论 EUS 是一项对直肠病变诊断及指导选择治疗方式有用的检查手段。展开更多
文摘BACKGROUND Endoscopic submucosal dissection(ESD)and transanal endoscopic submucosal dissection(TES)are widely employed surgical techniques.However,the comparative efficacy and safety of both remain inconclusive.AIM To comprehensively analyze and discern differences in surgical outcomes between ESD and TES.METHODS We conducted a systematic search of the electronic databases PubMed,Embase,Cochrane Central Register of Controlled Trials,Scopus,and CINAHL from inception till August 2023.We analyzed outcomes including recurrence rate,en bloc resection,R0 resection rate,perforation rate,procedure length,and hospital stay length applying a random-effects inverse-variance model.We assessed publication bias by conducting an Egger’s regression test and sensitivity analyses.RESULTS We pooled data from 11 studies involving 1013 participants.We found similar recurrence rates,with a pooled odds ratio of 0.545(95%CI:0.176-1.687).En bloc resection,R0 resection,and perforation rate values were also similar for both ESD and TES.The pooled analysis for procedure length indicated a mean difference of-4.19 min(95%CI:-22.73 to 14.35),and the hospital stay was on average shorter for ESDs by about 0.789 days(95%CI:-1.671 to 0.093).CONCLUSION Both ESD and TES displayed similar efficacy and safety profiles across multiple outcomes.Our findings show that individualized patient and surgeon preferences,alongside specific clinical contexts,can be considered when selecting between these two techniques.
文摘Rectal neuroendocrine tumours represent a rare colorectal tumour with a 10 fold increased prevalence due to incidental detection in the era of colorectal screening.Patient outcomes with early diagnosis are excellent.However endoscopic recognition of this lesion is variable and misdiagnosis can result in suboptimal endoscopic resection with subsequent uncertainty in relation to optimal long-term management.Endoscopic techniques have shown particular utility in managing this under-recognized neuroendocrine tumour.
文摘BACKGROUND Endoscopic submucosal dissection(ESD)can be used for the en-bloc removal of superficial rectal lesions;however,the lack of a traction system makes the procedure long and difficult in the presence of extensive lesions.CASE SUMMARY A large polyp occupying 2/3 of the rectal circumference and extending 5 cm in length was removed by ESD with the help of laparoscopic forceps introduced via trans-anal rectoscopic assisted minimally invasive surgery,a disposable platform designed to aid in transanal minimally invasive surgery.Traction of the polyp by forceps during the operation was dynamic,and applied at various points and in various directions.The polyp was removed en-bloc without complications in 1 h and 55 min.A sigmoidoscopy performed 50 d later showed normal healing without polyp recurrence.CONCLUSION The technique presented here could overcome the issues caused by lack of traction during ESD for rectal lesions.
文摘Gastrointestinal stromal tumour (GIST) is a rare tumour of the gastrointestinal tract which does not generally originate in the rectum. The authors describe a case of a 70-year-old man who underwent an anterior resection of the rectum for a low-risk GIST. The patient was not given adjuvant chemotherapy with imatinib and is still disease-free 30 mo after surgery. The authors conclude that although rectal GIST is extremely uncommon, it should be included in differential diagnosis when a tumour in the rectum is detected. Biopsy of the tumour is essential, since this makes it possible to reach a sure preoperative diagnosis based on the immunohistological features of the CD117 and CD34. Although complete surgical resection with negative tumour margins is the principal curative procedure for primary and non-metastatic tumours, further studies are still needed for the determination of the most effective treatment strategy for patients with rectal GIST.
文摘Rectal lymphoma is a rare colorectal tumor with incidence of 0.2% - 0.6%. We report a rare case of large rectal lymphoma. Our patient is a 48-year-old man, presented with 2 months history of per rectal bleed, altered bowel habits and weight loss. Clinical examination, computed tomography scan and initial endoscopic mucosal biopsy were indistinguishable from Rectal Carcinoma. With high level of suspicion, we resorted to full thickness punch biopsy in lithotomy position for a good tissue sample. Ultimately, an immunohistochemical study confirmed Diffuse Large B-cells Lymphoma (DLBCL). This case highlighted the importance of high level of suspicion for lymphoma when dealing with a rectal tumor. Accurate diagnosis of rectal lymphoma affects the treatment modalities and prognosis of the patient.
基金Supported by the Royal Marsden Hospital United Kingdom National Institute for Health Research Biomedical Research Centre(to Brown G)the Yorkshire Cancer Research and Pathological Society of Great Britain and Ireland(to West NP)
文摘AIM To define good and poor regression using pathology and magnetic resonance imaging(MRI) regression scales after neo-adjuvant chemotherapy for rectal cancer.METHODS A systematic review was performed on all studies up to December 2015, without language restriction, t h a t w e r e i d e n t i f i e d f r o m M E D L I N E, C o c h r a n e Controlled Trials Register(1960-2015), and EMBASE(1991-2015). Searches were performed of article bibliographies and conference abstracts. MeS H and text words used included "tumour regression", "mr TRG", "poor response" and "colorectal cancers". Clinical studies using either MRI or histopathological tumour regression grade(TRG) scales to define good and poor responders were included in relation to outcomes [local recurrence(LR), distant recurrence(DR), disease-free survival(DFS), and overall survival(OS)]. There was no age restriction or stage of cancer restriction for patient inclusion. Data were extracted by two authors working independently and using pre-defined outcome measures.RESULTS Quantitative data(prevalence) were extracted and analysed according to meta-analytical techniques using comprehensive meta-analysis. Qualitative data(LR, DR, DFS and OS) were presented as ranges. The overall proportion of poor responders after neo-adjuvant chemoradiotherapy(CRT) was 37.7%(95%CI: 30.1-45.8). There were 19 different reported histopathological scales and one MRI regression scale(mrT RG). Clinical studies used nine and six histopathological scales for poor and good responders, respectively. All studies using MRI to define good and poor response used one scale. The most common histopathological definition for good response was the Mandard grades 1 and 2 or Dworak grades 3 and 4; Mandard 3, 4 and 5 and Dworak 0, 1 and 2 were used for poor response. For histopathological grades, the 5-year outcomes for poor responders were LR 3.4%-4.3%, DR 14.3%-20.3%, DFS 61.7%-68.1% and OS 60.7-69.1. Good pathological response 5-year outcomes were LR 0%-1.8%, DR 0%-11.6%, DFS 78.4%-86.7%, and OS 77.4%-88.2%. A poor response on MRI(mr TRG 4,5) resulted in 5-year LR 4%-29%, DR 9%, DFS 31%-59% and OS 27%-68%. The 5-year outcomes with a good response on MRI(mrT RG 1,2 and 3) were LR 1%-14%, DR 3%, DFS 64%-83% and OS 72%-90%.CONCLUSION For histopathology regression assessment, Mandard 1, 2/Dworak 3, 4 should be used for good response and Mandard 3, 4, 5/Dworak 0, 1, 2 for poor response. MRI indicates good and poor response by mr TRG1-3 and mrT RG4-5, respectively.
文摘目的评价超声结肠镜(EUS)在直肠肿瘤诊断中的作用。方法应用 EUS 检查10例直肠良恶性肿瘤,将其病变所在层次和淋巴结转移情况与病理结果进行比较。结果肿瘤所在层次 EUS 与病理符合率为90％,淋巴结转移情况 EUS 检查与病理符合率为83.3％。结论 EUS 是一项对直肠病变诊断及指导选择治疗方式有用的检查手段。
