AIMS: Intraoperative radiotherapy (IORT) for locally advanced rectal cancer as an integral part of multimodal treatment, may lead to reduced local recurrence but it is not routinely used. The aim of this paper is to describe our experience with IORT in the treatment of patients with locally advanced adenocarcinoma of the lower third of the rectum. MATERIAL AND METHODS: Laparoscopic abdominoperineal amputation of the rectum with intraoperative radiotherapy was performed on 17 patients, 13 men and 4 women, median age 64 years (49-75 years) between 2010-2011. All patients underwent complete therapy according to the treatment protocol. RESULTS: In one patient, the laparoscopic procedure had to be converted to an open resection. The duration of the surgical procedure with IORT was 185 to 345 min (median 285 min). In 14 cases, the intraoperative dose was 10 Gy and in two patients a dose of 12 Gy was used. There were no severe intraoperative complications. Blood loss ranged from 30 to 500 mL (median 100 mL). There were postoperative complications in 4 patients (23.5%); 2 necessitated surgical reintervention (11.8%). The duration of postoperative hospitalization was 6 to 35 days (median 7 days). In the follow-up of 2 to 16 months (median 12 months), no local recurrence or disease generalization have been found to date. CONCLUSIONS: The results show the technical feasibility of laparoscopically assisted abdominoperineal amputation of the rectum in combination with IORT in the treatment of locally advanced rectal carcinoma with an acceptable risk of postperative complications.
- MeSH
- adenokarcinom radioterapie chirurgie MeSH
- kombinovaná terapie MeSH
- laparoskopie * MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta radioterapie chirurgie MeSH
- peroperační péče MeSH
- senioři MeSH
- výsledek terapie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- Publikační typ
- abstrakt z konference MeSH
AIMS: The aim of this prospective study is to elucidate feasibility of protocol of neoadjuvant concomitant radiochemotherapy with capecitabine and long course radiotherapy with subsequent laparoscopic rectal resection. We assessed treatment toxicity, downstaging rate, pathological response to the neoadjuvant treatment, surgery complications, rate of conversions and sphincter-preserving surgical procedures, and intraoperative and early postoperative complications too. METHODS: We acquired data of 78 patients from 1 January 2005 to 31 December 2007 with a locally advanced rectal cancer in our study. All patients were indicated for the neoadjuvant concomitant chemoradiotherapy due to locally advanced tumor (T3 or T4) or lymph nodes involvement suspicion (N+). Both radiotherapy (to pelvic region) and chemotherapy (capecitabine) were administered. Rectal tumors were localized within 12 cm from the anocutaneous verge. The average follow-up time was 23.9 months. RESULTS: All patients completed their treatment according to the planned regimen and dose. The surgery was performed laparoscopicaly within 4-8 weeks following the concomitant chemoradiotherapy - in 17% cases was converted into conventional surgery. Downstaging was achieved in 69% of patients, pathological complete response in 10%, histologically negative lymph nodes were documented in 58% of patients. Grade 3 toxicity of the concomitant chemoradiotherapy was present in 3%; grade 2 in 29% of patients, particularly skin and gastrointestinal form. Intraoperative and early postoperative complications of the surgery were 18%. Re-operation was needed in 5% cases. CONCLUSIONS: We demonstrated safety and low toxicity of the concomitant chemoradiotherapy with capecitabine. Copyright (c) 2009 Elsevier Ltd. All rights reserved.
- MeSH
- časové faktory MeSH
- deoxycytidin analogy a deriváty aplikace a dávkování MeSH
- dospělí MeSH
- fluoruracil analogy a deriváty aplikace a dávkování MeSH
- kolektomie metody MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta farmakoterapie chirurgie patologie radioterapie MeSH
- následné studie MeSH
- neoadjuvantní terapie MeSH
- pooperační komplikace MeSH
- prekurzory léčiv MeSH
- prospektivní studie MeSH
- protinádorové antimetabolity aplikace a dávkování MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- staging nádorů MeSH
- výsledek terapie MeSH
- vztah mezi dávkou a účinkem léčiva MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- srovnávací studie MeSH
V prospektívnej unicentrickej štúdii zhodnotenie a porovnanie perioperačných výsledkov laparoskopickej resekcie karcinómu strednej a dolnej tretiny rekta v skupine pacientov indikovaných k primárnej operácii (PR) so skupinou pacientov operovaných po absolvovaní predoperačnej chemorádioterapie (CHRT). Materiál a metódy: V rokoch 2005–2007 bolo na chirurgickom oddelení Onkocentra J. G. Mendela a Nemocnice Nový Jičín operovaných 291 pacientov s karcinómom rekta. Do štúdie bolo zaradených 155 pacientov (49 žien a 106 mužov; vek 65 I 9,7; 27–87) s karcinómom strednej a dolnej tretiny rekta, u ktorých bola vykonaná laparoskopická resekcia. 74 pacientov bolo indikovaných k primárnej operácii a 81 pacientov absolvovalo predoperačnú chemorádioterapiu s následnou laparoskopickou resekciou. Výsledky: V oboch skupinách bola porovnateľná incidencia intraoperačných komplikácii (p = 0,632), pooperačných chirurgických (p = 0,179) aj nechirugických komplikácií (p = 0,654). Taktiež nebol zaznamenaný štatisticky signifikantný rozdiel v dĺžke operácie a pooperačnej hospitalizácie. Počet zhodnotených lymfatických uzlín bol výrazne vyšší v skupine pacientov s primárnou resekciou (p < 0,001). Záver: Porovnaním intraoperačných a krátkodobých pooperačných výsledkov laparoskopickej resekcie karcinómu strednej a dolnej tretiny rekta nebol zaznamenaný rozdiel v skupine PR v porovnaní so skupinou CHRT.
To evaluate and compare perioperative results of laparoscopic resection for low and middle third rectal cancer subgroup of patients intended for primary resection (PR) with those operated after chemoradiotherapy (CHRT). METHODS: 291 patients were operated for rectal cancer during the years 2005-2007 in Department of Surgery, J. G. Mendel Oncological Centre Nový Jicín. 155 patients (49 women and 106 men, mean age 65 +/- 9.7, range 27-87) having laparoscopic resection for low and middle rectal cancer were included in the present prospective single centre study. Primary surgical approach was adopted in 74 patients and 81 patients had a preoperative chemoradiotherapy. RESULTS: Both groups were comparable regarding intraoperative (p = 0.632) and postoperative surgical complications (p = 0.179) and nonsurgical complications (p = 0.654) too. Operative time and postoperative stay were similar in both groups. Number of harvested lymphnodes was higher for PR group (p < 0.001). CONCLUSION: In summary, after short term results evaluation, there is no significant difference for PR and CHRT groups in laparoscopic rectal resection. Neoadjuvant chemoradiotherapy did not lead to worsening of the perioperative results of our patients.
- MeSH
- dospělí MeSH
- kombinovaná terapie MeSH
- laparoskopie MeSH
- lidé středního věku MeSH
- lidé MeSH
- nádory rekta chirurgie terapie MeSH
- peroperační komplikace MeSH
- pooperační komplikace MeSH
- rektum chirurgie MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- ženské pohlaví MeSH
