Vlad Olimpiu Butiurca, Andrei Modiga, Ioan Teodor Bud, Paul Cristian Russu, Marian Botoncea, Calin Molnar, Simona Gurzu
George Emil Palade University of Medicine, Pharmacy, Sciences, and Technology, Targu Mures, Romania
Introduction: In patients with low rectal cancer, a proper surgical technique is aimed to confer a better quality of life following surgery and a longer time of disease-free survival. Aim: In this study, we presented the results obtained by a single surgical centre in the treatment of low rectal cancer, using two types of surgery: intersphincteric resections (ISR) and abdominoperineal resections (APR).
Material and methods: The paper was focused on the rate of complications after surgery for low rectal cancer, which was retrospectively evaluated in 132 consecutive patients who underwent surgery over a period of 5 years. The statistical comparison was done between two groups: group 1 – that underwent ISR (n=60) and group 2 – patients evaluated after APR (n=72).
Results: The quality of life, evaluated at the regular follow-up, did not show significant difference between the two groups. Clavien-Dindo grade I and above complications were registered in 9 patients (15%) from group 1 respectively 23 patients (38.33%) from the group 2.
Conclusion: ISR is a good option for surgical removal of a low rectal cancer, with a lower rate of complications, compared with APR technique.
1 Department of Surgery, Gheorgheni Hospital, Gheorgheni, Romania
2 Department of Internal Medicine, Gheorgheni Hospital, Gheorgheni, Romania
3 1st Surgery Clinic, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
Introduction: Regarding the rate of local recurrences, improvement of survival rates and quality of life, the treatment of rectal cancer has registered a remarkable progress during the last two decades. This was possible through multidisciplinary and gradual development of rectal cancer management, where surgical resection remains the “key factor” and all surgical interventions considered radical involve mesorectal excision. The status of lymph nodes is probably the only and most important marker of global survival in patients with rectal cancer, which is associated with the risk of systemic dissemination rather than local recurrence.
Material and method: The aim of this study was to analyze the importance of mesorectal lymph nodes, in case of rectal cancer disseminated locally and in remote organs, based on treated rectal cancer cases at the 1st Surgery Clinic, Tîrgu Mureș between January 2000 and December 2009. During this period, out of the 618 recorded rectal cancer cases, in 505 cases the patients underwent surgical intervention where besides the rectal tumor, the perirectal lymphatic tissue was also excised.
Results: The performed histopathological examinations revealed in 223 cases lymph node invasion (stage III and stage IV). We also studied different surgical interventions regarding lymph node excision performed during rectal cancer surgery, analyzed the average number of excised perirectal (mesorectal) lymph nodes and the average number of lymph nodes with histopathologically confirmed tumor metastasis resulted from rectal resection.
Conclusion: In our study, we found that in surgical interventions involving resection with anastomosis the average number of lymph nodes per specimen is biger than the number recorded subsequent to abdominoperineal rectal resection.Therefore the resection with mesorectal excision is the best option for rectal cancer surgery any time is possible.
Russu C, Molnar C, Pantiru C, Sărăcuț C, Gherghinescu M, Voidăzan S, Copotoiu C
Surgery Clinic I, County Emergency Clinical Hospital, Tîrgu Mureș, Romania
Background: Rectal cancer management has as its main component the surgical treatment. The purpose of the paper is to point out the advantages and disadvantages of sphincter saving techniques, respecting the oncological principles.
Material and method: A cross-sectional, retrospective study was performed on a group of 69 patients admitted and surgically treated for rectal cancers in the Surgical Clinic I of the County Emergency Clinical Hospital of Tîrgu Mureș, for a period of one year (April 2012 – April 2013) and to whom rectal resections were performed. We followed the immediate postoperative evolutions in these patients, making a comparative analysis between those with the sphincter saving surgery and those in which other operations were performed.
Results: From the total of 69 patients diagnosed with rectal cancer, sphincter saving procedures with restoration of digestive continuity by coloanal anastomosis were performed in 12 patients (17.39%) using the peranal or transanal approach; in 42 patients (60.86%) anterior recto-sigmoidian resections with low and very low colorectal anastomosis („very low” Dixon procedure) were performed. In 15 cases (21.74%) the Miles type of rectal resections, using the abdomino-perineal way, were performed. Out of the 12 cases with peranal or transanal anastomosis, 4 cases had postoperative complications.
Conclusions: Rectal resection procedures, which are restoring the digestive tract continuity using low anastomosis (colorectal, coloanal, peranal or transanal), are representing viable and „physiological” alternatives, if they respect the oncologic principles. In well selected cases, the immediate postoperative evolution is favorable, relieving the patient from the psychological and physical trauma due to the presence of a colostomy.
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