摘要:

PURPOSE:We report the downstaging, sphincter preservation, acute toxicity, and preliminary local control and survival results of preoperative 5‐fiuorouracil (5‐FU), low‐dose leucovorin (LV), and concurrent radiation therapy followed by postoperative LV/5‐FU for treatment of patients with clinically resectable T3 rectal cancer.MATERIALS AND METHODS:A total of 32 patients received two monthly cycles of preoperative LV/5‐FU (bolus daily×5). Radiation therapy (5,040 cGy) began concurrently on day 1. Postoperatively, patients received a median of two monthly cycles of LV/5‐FU (range, 0‐10).RESULTS:The complete response rate was 9 percent pathologic and 13 percent clinical, for a total of 22 percent. Total Grade 3+ acute toxicity during the preoperative combined modality segment was 25 percent (8/32). Of the 20 patients who were thought to initially require an abdominoperineal resection and for whom the intent of treatment was sphincter preservation, 17 (85 percent) were able to undergo sphincter‐preserving surgery. With a median follow‐up of 22 (3‐59) months, none have developed local failure, and the three‐year actuarial diseasefree survival rate was 60 percent.CONCLUSION:Our data reveal encouraging downstaging, sphincter preservation, and acute toxicity with this regimen. Additional follow‐up is needed to assess the long‐term local control and survival rates.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:Colorectal carcinoma in elderly patients has become a more common problem in the last decade. There are some physicians who tend to offer a less definitive treatment for these patients because of their chronologic age. The purpose of this study was to evaluate the long‐term survival of elderly patients (>70) who underwent surgery for colorectal carcinoma in comparison with a younger group of patients with the same disease.METHODS:Long‐term survival of patients with colorectal carcinoma who underwent surgery was prospectively evaluated. Long‐term survival was compared between an elderly group of patients (age, >70) and a younger group of patients.RESULTS:There was no significant difference in the five‐year survival between the two age groups. Patients' survival was influenced by stage of the disease and type of operation (emergencyvs.elective).CONCLUSIONS:Treatment decisions in elderly patients with colorectal carcinoma should not be influenced by the chronologic age of the patient.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:We sought to evaluate a new technique for creation of a continent perineal colostomy following abdominoperineal resection (APR) of the rectum for low rectal cancer.METHODS:Nine selected patients with low rectal cancer (two males; median age, 55.6 years; classified as Dukes A, 6 patients and as Dukes B, 3 patients) underwent APR. Following this, the original Lazaro da Silva technique was used as follows: 1) for performance of three circular myotomies in the distal sigmoid with a distance between each couple of no more than 8 cm; 2) repair of the myotomies, thus creating three circular colonic valves, the most distal of which remained extraperitoneally; 3) for construction of a perineal colostomy lying flush with the perineal skin; 4) after the patient starts consuming a regular diet, enemas through the perineal stoma are done, usually twice per week, to achieve defecation. Functional outcome was assessed by evaluation of bowel movements and neoanal continence.RESULTS:There were no deaths. From January 1994 until October 1995, no tumor recurrence has occurred, and fecal continence has been good. Four of the patients were able to defecate without enemas (2‐4 times per week), and in five patients the self‐administration of enemas (2‐4 times a week) were necessary to accomplish defecation.CONCLUSION:Initial results with the Lazaro da Silva technique have been encouraging.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE AND BACKGROUND:Qualitative and quantitative analysis of many flat early cancers that have been discovered during the last decade led us to recognize that a flat route of cancer developmentde novois as important a route as the polypoid one. We aim to prove through a longitudinal study that these flat early cancers indeed develop in flat mucosa and not in an adenomatous polyp.METHODS:From January 1, 1990, to July 31, 1994, 554 patients underwent at least two colonoscopies. These patients consisted of 364 males, and average age was 59 years. We searched for flat early cancers developing in polyp‐free colorectal mucosa on or after a second colonoscopy. Polyp‐free mucosa here means an intestinal segment proved to possess no adenomatous polyp during the preceding colonoscopies, irrespective of the presence of polyps else‐where.RESULTS:Four flat early cancers were found developing in polyp‐free colonic mucosa in four patients. Average age of the patients was 67 years. Locations of the cancers were the transverse (3) and descending colons (1). The shapes were all depressed, and average size of the lesions was 11 mm. Two lesions were endoscopically resected, and two by surgery.CONCLUSION:These four depressed cancers developing in polyp‐free mucosa show that flat early colorectal cancers do arisede novoand not from an adenomatous polyp having collapsed on itself.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The aim of this article is to determine the outcome of the pelvic pouch after the occurrence of a fistula.MATERIALS AND METHODS:From 1983 to 1995, 1,040 pelvic pouch surgeries were done at our institution. We reviewed the records of all patients with pouch‐related fistulas. Data were collected from chart reviews and our pouch registry.RESULTS:Among 59 patients (22 males) with fistulas, mean age was 33 (range, 19‐57) years. Preoperative diagnosis was mucosal ulcerative colitis (n=52), indeterminate colitis (n=6), and familial polyposis (n=1). Site of fistulas included pouch/vaginal (n=24), pouch/cutaneous (n=11), pouch/perineal (n=16), and pouch/presacral (n=8). Postoperative diagnosis was mucosal ulcerative colitis (n=40), Crohn's disease (n=14), indeterminate colitis (n=4), and familial polyposis (n=1). One hundred eleven (range, 1‐7) surgeries for treatment were performed. At a mean follow‐up of 26 (range, 1‐121) months, 19 pouches (32 percent) had been excised, 34 patients had functioning pouches and no fistula, 5 patients had a closed fistula but refused ileostomy closure, and 1 patient had died of unrelated causes (but the fistula was closed). Pouch type and preoperative diagnosis did not statistically affect pouch failure rates (P=0.43 and 0.10. respectively).CONCLUSION:Successful treatment of fistula from a pelvic pouch can be achieved in more than 60 percent of patients. However, multiple procedures may be needed for a successful outcome. Ultimately, 32 percent had their pouches excised.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:The aim of this study was to determine the outcome of pouch salvage operations and the factors that may influence successful reconstructions.METHODS:This retrospective review includes data from 198 patients who had undergone restorative proctocolectomy at a single institution during an 11‐year period. All patients who had undergone attempted pouch salvage and who still had a pouchin situwere reviewed by both postal questionnaire and at interview in the outpatients clinic.RESULTS:Of 198 patients who underwent restorative proctocolectomy and ileal pouch‐anal anastomosis, 27 (13.6 percent) presented with pouch‐specific complications requiring pouch salvage. A further five patients requiring pouch salvage were referred from other centers. Of 32 patients who underwent attempted pouch salvage, 16 (50 percent) had a successful outcome, 12 (37.5 percent) had pouch excision, and 3 (9 percent) are still defunctioned. There was one death (3 percent) in this series. Pelvic sepsis was a major cause of pouch failure, being present in 50 percent (8/16) of failed salvage procedures, and accounting for 58 percent (7/12) of pouch excisions.CONCLUSIONS:Salvage surgery for major complications following ileoanal pouch construction is worthwhile in the absence of major pelvic sepsis. Overall success rate is 50 percent, and these results may be acceptable to highly motivated patients.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

BACKGROUND:Although the etiology of inflammatory bowel disease (IBD) is unknown, there is increasing evidence that genetic predisposition plays a major etiologic role. To provide the framework for gene identification using a positional cloning approach, ascertainment of families with multiple affected members and careful documentation of pedigrees are essential. Objective: To report the initial findings of the IBD Genetics Project of the Mount Sinai Hospital IBD Research Unit.METHODS:All records of patients with ulcerative colitis and Crohn's disease followed at the Mount Sinai Hospital IBD Unit were reviewed. A questionnaire was sent to all patients to ascertain those with a family history of IBD. Patients with a presumed family history were contacted by a research assistant, and after confirmation of diagnosis, relevant clinical information, pedigrees, and consent to contact family members were obtained. Blood for DNA and cell line preparation were collected from affected and nonaffected family members.RESULTS:Of 2,504 patients registered in the IBD database, 231 (9.2 percent) were found to have an affected family member: 96 of 964 (10 percent) with Crohn's disease (CD) and 135 of 1,540 (8.8 percent) with ulcerative colitis (UC). A mean of 2.4 family members were affected. In families in which the proband had CD, 82.3 percent had only two affected family members, 78.1 percent had only family members affected with CD, and 82.3 percent had only first‐degree family members affected. In families in which the proband had UC, 70.4 percent had only two affected family members, 71.1 percent had only family members affected with UC, and 65.2 percent had only first‐degree family members affected. In the 231 families, there were 103 sibling pairs: 46 percent with CD, 28 percent with UC, and 26 percent with CD/UC.CONCLUSION:These data suggest that approximately 10 percent of IBD patients have affected family members, with the rate being similar in UC and CD. Future research is directed to genome scanning and linkage analysis in this cohort of patients.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

&NA;Ileosigmoid fistulas are found in Crohn's disease and may present a surgical dilemma.PURPOSE:This study was designed to examine surgical practice to determine types of intervention, enumerate complications, and elicit guidelines for surgical management.METHOD:The medical records of patients with ileosigmoid fistula and Crohn's disease from 1975 to 1995 were reviewed.RESULTS:Ninety patients (44 men) were studied. A preoperative diagnosis of ileosigmoid fistula was made in 77 percent of patients. Sigmoidrepairwas performed in 43 patients (47.8 percent), sigmoidresectionin 32 patients (35.6 percent), 12 patients (13.3 percent) underwent more extensive procedures, and 3 patients (3.3 percent) either had surgery elsewhere or were observed. The fistula was never directly responsible for a stoma. Therepairandresectiongroups were similar with respect to age, length of Crohn's disease, and preoperative symptoms. There was no significant difference between groups in the incidence of postoperative complications; there were no postoperative deaths. Average length of stay was 8.3 days following repair and 9.9 days after resection. Reasons for resection included significant purulence or inflammation, a large fistula defect, a defect on the mesenteric border of the sigmoid, and active sigmoid Crohn's disease. Surgeon's assessment of the presence of Crohn's disease in the sigmoid correlated with pathologic examination and was aided by knowledge of recent endoscopic appearance and biopsy results; intraoperative frozen section and colonoscopy were helpful in distinguishing serosal inflammation from active Crohn's disease.CONCLUSION:Contrast studies identified 77 percent of ileosigmoid fistulas preoperatively. Performing repair rather than resection does not increase the risk of complications, if standard surgical principles are followed. Preoperative or intraoperative endoscopy assists the surgical evaluation of the sigmoid.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

PURPOSE:This study was undertaken to compare functional results, complications, preoperative durations of disease, and rates of dysplasia and neoplasia between older and younger chronic ulcerative colitis patients undergoing restorative proctocolectomy (RPC) with mucosectomy.METHODS:A total of 392 patients with a preoperative diagnosis of chronic ulcerative colitis underwent elective RPC with mucosection and handsewn ileoanal anastomosis. Pathologic reports were reviewed, with specific reference to findings of dysplasia or cancer. Functional results concerning the number of bowel movements per 24 hour period and the incidence of fecal soilage were obtained by direct or telephone patient interview.FINDINGS:Group I consisted of 326 patients aged 5 to 49 (mean, 30.9) years and 160 women. Group II comprised 66 patients aged 50 to 74 (mean, 56.9) years and 29 women. Duration of disease was significantly longer in the older group (6.2vs.15.6 years;P<0.001). The older group had significantly higher rates of dysplasia (29/326vs.19/66;P<0.0001) and malignancy (14/326vs.9/66;P=0.003). Rates of complication, hospital days following RPC, and total hospital days for all causes were comparable between groups. Perfect daytime continence was observed in 81.6 percent of Group I and 80 percent of Group II patients (213/261vs.40/50;P= 0.79). Perfect continence during sleep was observed in 65.1 percent of Group I and 62 percent of Group II patients (170/261vs.31/50;P=0.67). Mean number of bowel movements per 24 hour period for Group I was 6.3±0.2 and for Group II was 7.4±0.5. Mean difference, one movement per 24 hours, was not significant (95 percent confidence interval, −0.02 to 2.1;t=1.95,P=0.055).CONCLUSIONS:We conclude that patients older than 50 years are suitable candidates for RPC with mucosectomy. Functional results and complication rates are similar to those observed among younger patients. Patients older than 50 years have a significantly higher rate of concurrent dysplasia and malignant degeneration than younger patients, most probably because of a longer duration of disease. RPC with mucosal excision potentially lowers this risk by elimination of all colorectal mucosa.

ISSN:0012-3706    

出版商:OVID    

年代:1997

数据来源: OVID