摘要:

PURPOSE:The Swedish Rectal Cancer Trial has unequivocally demonstrated that preoperative high‐dose (5 × 5 Gy) radiotherapy reduces local failure rates and improves overall survival. This will have an impact on the primary treatment of rectal cancer. This study investigates the effect of preoperative high‐dose radiotherapy on long‐term bowel function in patients treated with anterior resection.METHODS:A questionnaire was answered by 92 percent (203/220) of patients who were included in the Swedish Rectal Cancer Trial and who were alive after a minimum of five years. Thirty‐two patients were excluded, mainly because of postoperative stomas and dementia, which left 171 for analysis.RESULTS:Median bowel frequency per week was 20 in the irradiated group (n=84) and 10 in the surgery‐alone group (n=87;P<0.001). Incontinence for loose stools (P<0.001), urgency (P<0.001), and emptying difficulties (P<0.05) were all more common after irradiation. Sensory functions such as “discrimination between gas and stool” and “ability to safely release flatus” did not, however, differ between groups. Thirty percent of the irradiated group stated that they had an impaired social life because of bowel dysfunction, compared with 10 percent of the surgery‐alone group (P<0.01).CONCLUSIONS:The study indicates that high‐dose radiotherapy influences long‐term bowel function, thus emphasizing the need for finding predictive factors for local recurrence to exclude patients with a very high probability for cure with surgery alone and to use optimized radiation techniques.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Although adenomatous polyps and even adenocarcinomas have been found in the terminal ileum of patients with familial adenomatous polyposis, the prevalence of neoplastic changes in the pouches of patients who have undergone restorative proctocolectomy is unknown. The objective of this study was to determine the frequency of pelvic pouch neoplasia in famial adenomatous polyposis patients after restorative proctocolectomy.METHODS:Patients in a polyposis registry who had undergone restorative proctocolectomy were recruited. Demographic, surgical, pathologic, and endoscopic data were obtained from patient records. Video pouchoscopy was done after two enemas and representative biopsies were taken.RESULTS:Of 102 eligible patients, 26 (17 males and 9 females) participated. Median age at ileal pouch‐anal anastomosis was 31 (range, 12‐58) years. Median follow‐up period was 66 (11‐156) months. Adenomas were found in the pouch of 11 (42 percent) patients, in the terminal ileum above the pouch in 1 patient, and in the anal canal of 4 patients. Among patients with pouch polyps, three patients had one lesion, three patients had two lesions, and five patients had more than ten lesions. The incidence of polyps increased steadily with time from restorative proctocolectomy. There was no relation between the incidence of pouch polyposis and the severity of colonic or duodenal disease.CONCLUSIONS:Proctocolectomy and ileal pouch‐anal anastomosis is associated with a significant risk of pouch neoplasia in familial adenomatous polyposis patients. The severity of pouch adenomas was not related either to the severity of colonic or duodenal disease. The pelvic pouches of all patients with familial adenomatous polyposis who have undergone restorative proctocolectomy should be examined periodically.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Functional outcome after anterior resection for rectal cancer is improved by colonic J‐pouch reconstruction compared with straight anastomosis. The indications for colonic J‐pouch reconstruction have yet to be determined. Therefore, we attempted to determine the level at which J‐pouch reconstruction provides an advantage over straight anastomosis.METHODS:A total of 48 patients who underwent 5‐cm colonic J‐pouch reconstruction (J‐pouch group) and 80 patients who underwent straight anastomosis (straight group) underwent functional assessment one year postoperatively.RESULTS:The functional outcome in the J‐pouch group was significantly better than that in the straight group when the distance of the anastomosis from the anal verge was less than 8 cm. The difference was particularly obvious when the level of the anastomosis was below 4 cm. However, functional outcome in the straight group when the anastomosis was between 9 and 12 cm from the anal verge was also satisfactory and did not differ from that in the J‐pouch group when the anastomosis was between 5 and 8 cm from the anal verge.CONCLUSIONS:Colonic J‐pouch reconstruction is indicated when the distance of anastomosis from the anal verge is less than 8 cm, and it is essential when the distance is less than 4 cm.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Mouse mammary carcinoma tumors are established more easily and grow larger after sham laparotomy and open bowel resection than after CO2pneumoperitoneum and laparoscopic‐assisted bowel resection. The purpose of this study was to determine whether similar differences in tumor growth would be found when sham laparotomy and pneumoperitoneum were compared for the colon‐26 mouse adenocarcinoma and B‐16 mouse melanoma tumor lines.METHODS:In all three studies, a high‐dose injection of tumor cells was used, which resulted in tumors in almost all control mice. In Study 1, female BALB/C mice (n=127) were injected intradermally in the dorsal skin with 106colon‐26 cells in a 0.1‐ml volume before interventions. In Study 2, female C57 BL/6 mice (n=140) were inoculated similarly with 106B‐16 melanoma cells. Study 2 consisted of three separate trials conducted on different days. Study 3 was performed because considerable differences in mean tumor size were observed in each of these trials. In Study 3, the B16 experiment was repeated with a larger n (n=82) on a single day. In each study, after tumor cell injections, mice were randomly assigned to one of three groups: 1) anesthesia control (no procedure); 2) full laparotomy (4‐cm midline incision × 20 minutes, staple closure); or 3) CO2pneumoperitoneum (4‐6 mmHg × 20 minutes). Tumors were excised and weighed on postoperative day 12.RESULTS:In Studies 1 and 3, mean tumor sizes of the laparotomy groups were significantly larger than both the control group and pneumoperitoneum group lesions (Pvalues by Student'st‐test). In Study 2, laparotomy group tumors, although significantly larger than control group lesions, were not significantly larger than pneumoperitoneum group tumors. For all three studies, there was no significant difference between mean tumor sizes of the pneumoperitoneum and control groups.CONCLUSION:Both colon‐26 adenocarcinoma and B‐16 melanoma tumors grow larger after laparotomy than after pneumoperitoneum in a murine model. The mechanism of these postoperative tumor growth differences remains to be elucidated.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to evaluate the influence of perioperative blood transfusions on colorectal cancer recurrence.METHODS:All articles published up to December 1996 in English (or with an English abstract) were retrieved, both using MEDLINE and scanning their references, to be considered for this meta‐analysis.RESULTS:One hundred thirty‐one articles were identified, and 99 of them were excluded because they analyzed survival or mortality, were repetitive publications, or were reviews or letters. Thirty‐two original studies (9 were prospective) on 11,071 patients were included for further analysis; 20 showed a detrimental effect of perioperative blood transfusions. Nineteen articles used also multivariable techniques, and 11 found perioperative blood transfusions to be an independent prognostic factor. Pooled estimates of the effect of perioperative blood transfusions on colorectal cancer recurrence yielded an overall odds ratio of 1.68 (95 percent confidence interval, 1.54‐1.83) and a rate difference of 0.13 (95 percent confidence interval, 0.09‐0.17) against patients who received transfusions. Stratified meta‐analyses also confirmed these findings when stratifying patients by site and stage of disease. The effect of perioperative blood transfusion was observed in a dose‐related fashion, regardless of timing and type, although some heterogeneity was detected. Data on surgical techniques were not available for further analysis.CONCLUSIONS:A consistently detrimental association was discovered between the use of perioperative blood transfusion and colorectal cancer recurrence. Further studies are needed to confirm that blood transfusion has a causal association.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Anal sphincter damage can occur during vaginal delivery and may lead to impairment of fecal continence. The aim of this study was to determine the influence of irritable bowel syndrome on symptoms of fecal incontinence following first vaginal delivery.METHODS:A prospective, observational study was performed before delivery, six weeks, and six months following delivery in primiparous women. A bowel function questionnaire was completed, and anal vector manometry, mucosal electrosensitivity, pudendal nerve terminal motor latency, and anal endosonography were performed. A total of 208 women were assessed before and after delivery, and 104 primigravid women were studied after delivery only. A total of 34 of 312 (11 percent) had an existing diagnosis of irritable bowel syndrome.RESULTS:The prevalence of abnormal manometry or endosonography was similar in women with and without irritable bowel syndrome. However, six weeks after delivery, women with irritable bowel syndrome had a higher incidence of defecatory urgency (64 percent) and loss of control of flatus (35 percent) compared with those without (urgency, 10 percent,P<0.001; flatus, 13 percent,P=0.007). The incidence of frank fecal incontinence was similar in the two groups. Women with IBS had increased mucosal sensitivity to electrical stimulation of the upper anal canal both before and after delivery.CONCLUSION:Women with IBS are more likely to experience subjective alteration of fecal continence postpartum compared with the healthy primigravid population, but they are not at increased risk of anal sphincter injury.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Continence scores and anal manometry are commonly used to assess the effect of electrostimulation in fecal incontinence. This study determined the increase of muscular compound potentials in electroneurography of the pudendal nerve after three months of electrostimulation treatment.PATIENTS AND METHODS:Thirty women were tested; their average age was 46.8 (standard deviation, 9.82) years. Electrostimulation was applied twice daily for 15 minutes in each case.RESULTS:Before treatment, amplitudes were, on average, 0.54 mV (standard deviation, 0.2). After three months of electrostimulation, the amplitudes had increased to 0.84 mV (standard deviation, 0.2). The continence score was improved from 8.73 to 7.1 points.CONCLUSION:We believe that by electrostimulation the atrophic muscle can be trained to stabilize the pelvic floor, thus increasing anal pressure and, thereby, creating a basis for adequate voluntary contraction. Electrostimulation is, therefore, especially suitable for functional deficits of the external anal sphincter (insufficient voluntary contractions because of atrophic muscle) without identifiable muscular lesion.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID

摘要:

PURPOSE:Fecal incontinence has been a matter of concern for many years, but seepage is poorly understood, especially in men.METHODS:We compared the results of anorectal physiologic tests in a group of 16 male patients who complained of fecal soiling but had no previous history of anorectal surgery or disease and had normal clinical examinations with findings of 16 normal male controls. Physical examination and proctosigmoidoscopy were normal in each patient.RESULTS:Maximum anal resting pressure (median interquartile range) was 136 (120‐145) cm H2O in the “seepage” group and 104 (83‐112) cm H2O in controls (P<0.01). Inflation volumes at which patients and controls experienced rectal sensation were 45 (35‐80) and 90 (75‐100) ml of air, respectively (P<0.01). Maximum tolerated volumess in the rectum were 130 (85‐180) ml of air in the seepage group and 190 (140‐240) ml of air in controls (P<0.01). Median length of the anal sphincter was 3.75 (3.5‐4) cm in patients and 3 (3‐3.5) cm in controls (P<0.01). Maximum squeeze pressures, sensation in the anal canal, and sphincter relaxation in response to rectal distention were similar in the two groups.CONCLUSION:Male patients with “idiopathic” fecal seepage have a long anal sphincter with abnormally high resting tone.

ISSN:0012-3706    

出版商:OVID    

年代:1998

数据来源: OVID