Файловый архив студентов. Файловый архив студентов.
1327 вузов, 5482 предметов.
/ Регистрация
FAQ Обратная связь Вопросы и предложения
Добавил:
kiopkiopkiop18@yandex.ru t.me/Prokururor I Вовсе не секретарь, но почту проверяю Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Ростовский Государственный Медицинский Университет
Предмет:
Медицина общая
Файл:

Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1073_Библиотеки_им_академика_М_И_Перельмана

.pdf
Скачиваний:
0
Добавлен:
31.08.2026
Размер:
22 Мб
Скачать
☆
27 Reoperative Surgery forLocally Recurrent Rectal Cancer
https://t.me/medicina_free
consisted of 10–12.5Gy for R0 but close margins, 12.5–15Gy for R1 resections, and 15–20Gy for R2 resections. In patients who were re-irradiated with 30 Gy, IORT dose was 15–20Gy typically [42, 51]. This dosing pattern is in line with the European Society Radiation Oncology – The Advisory Committee for Radiation Oncology Practice IORT recommendations [52].
Data on the benet of IORT are all limited by the lack of any randomized trials comparing the receipt versus omission. The time between completion of neoadju­vant radiation and surgery with IORT has also been debated to maximize the chance of an R0 resection but minimize the chances of a local re-recurrence. In pooled data from Catharine Hospital and the Mayo Clinic of 565 patients, they identied 5–7weeks after completion of radiation as the optimal window. This window is based on prior analysis showing signicant downstaging of rectal cancers at 4–6 weeks after completion of chemoradiation [53–56] and an increase in local recurrence when surgery and IORT delivery was delayed past 7weeks [25].
321
Nutritional Status andPostoperative Morbidity
If a patient is to be considered a candidate for reoperative surgery, they must also be physiologically t enough to undergo reoperative surgery that often requires multi­visceral resection. The prevalence of malnutrition amongst cancer patients has become more evident in recent years [57], with malnutrition diagnosed in 15% to33% of patients with either locally advanced or recurrent rectal cancer set to undergo pelvic exenteration [58–60]. Major complications occur after up to 36% of exenterative surgery cases for recurrent rectal cancer and malnutrition is a leading risk factor [59]. There is limited data on specic complications after reoperation for recurrent rectal cancer but one study from 2003 found that the most common com­plications were pelvic abscesses, bowel obstructions, and perineal wound healing issues [8]. Perineal wound healing becomes a major source of morbidity due to the size of the perineal defect and the amount of radiation received preoperatively. Use of a tissue ap to ll the dead space in the pelvis and potentially reduce perineal wound issues is critical [61, 62]. Multiple ap options exist with omental aps and vertical rectus abdominis myocutaneous aps utilized most often [63, 64].
To further mitigate risk, prehabilitation before surgery is an option. Prehabilitation has been shown to reduce the risk of morbidity and length of stay after colorectal cancer operations but has not been studied in patients with recurrent rectal cancer [65, 66]. Given the high rates of major morbidity after pelvic exenteration, this area deserves further study. The neoadjuvant chemotherapy and radiation regimens for recurrent rectal cancer allow a natural window for prehabilitation to occur.
Patients Ineligible forCurative Surgery
In patients who are not candidates for a curative operation, attempts at operations that will result in an R2 resection should be avoided. Various options for palliation exist depending on the primary symptoms the patient is experiencing. Radiation and
322
https://t.me/medicina_free
Table 27.2 Summary of Outcomes after Neoadjuvant Treatment and Surgery for Recurrent Rectal Cancer
Patients, nIntervention and
Study Holman
etal. [25]
Harris etal. [27]
Dresen etal. [35]
Voogt etal. [38]
Voogt etal. [38]
Ansell etal. [42]
565 No preoperative
533 Surgical margin impact
147 Preoperative radiation
132 Pathologic response rate
132 3-year survival in
267 Survival for re-resection
outcome Results
R0 resection rate 26% versus treatment versus re-irradiation versus full-course radiotherapy and R0 resection rate
on 5-year survival
and survival
after induction chemotherapy and chemo(re)irradiation
complete versus non-complete responders
of positive intraoperative margins
43% versus 50%, p<0.0001
5-year survival 44% for R0
versus 26% and 10% for R1
and R2
3-year overall survival (full
course 49.3%, re-irradiation
47.6%, no radiation 25.0%) and
3-year local control (full course
69.0%, re-irradiation 48.9%, no
radiation 37.6%)
17% complete pathologic
response
92% vs 57% in complete versus
non-complete responders,
p=0.045
Overall survival 4.4years for
R0 versus 2.7years for R1 to
R0 and 2.9years for R1 to R1
N. P. McKenna and R. R. Cima
Quality of Evidence
Moderate
Moderate
Moderate
Moderate
Moderate
Moderate
re-irradiation have been shown to have favorable outcomes with respect to pain and pelvic symptoms while avoiding the morbidity of surgery [67]. For patients present­ing with malignant bowel obstruction and unresectable disease, both self-expanding metal stents and colonic diversion are options for palliation and choice depends on the specic clinical circumstances [68]. Again, as an R0 resection is the most con­sistent favorable prognostic factor, extensive operations should not be undertaken if this is not the likely outcome (Table27.2).
Recommendations Based ontheData
Recommendations on the workup and medical and surgical management of recur­rent rectal cancer are limited by the existing data, which are primarily retrospective, single institution studies. Fortunately, in the future with two randomized control trials actively recruiting, higher level evidence may be available on how to opti­mally treat patients preoperatively.
Work up of patients with suspected rectal cancer recurrence should include pel-
vic MRI to assess anatomical relationships of the recurrence. Patients also need a
27 Reoperative Surgery forLocally Recurrent Rectal Cancer
https://t.me/medicina_free
CT of the chest and abdomen to assess for distant metastases. For equivocal ndings on imaging, PET-CT and/or percutaneous biopsy can be performed. (Evidence: moderate; Recommendation: strong).
Based on the MRI nding and the patient symptoms, recurrence can be anatomi­cally dened based on the classication system of the surgeon’s choice. This will help determine the probability of an R0 resection and whether surgery is a potential eventual treatment option. (Evidence: moderate; Recommendation: strong).
Neoadjuvant chemotherapy should likely be administered to all patients based on increased rates of R0 resections and complete pathologic response. Patients who are radiologically naïve should receive 50.4Gy of chemoradiotherapy. Patients who received neoadjuvant chemoradiation before their initial surgery should be re­irradiated with up to 30Gy. (Evidence: weak; Recommendation: strong).
After completion of neoadjuvant therapy, re-staging should occur with surgery planned for 5–7weeks after completion of therapy if an R0 resection is felt to be possible. IORT can be planned if a threatened margin is likely. (Evidence: weak; Recommendation: strong).
R0 resections provide the best chance at long-term survival. IORT can supple­ment an R1 resection but does not provide equivalent survival to an R0 resection. R2 resections result in signicant morbidity with no survival benet and should not be pursued. (Evidence: moderate; Recommendation: strong).
Malnutrition is prevalent amongst patients with recurrent rectal cancer and is a major risk factor for postoperative morbidity. Prehabilitation may be able to reduce some of the associated morbidity, while myocutaneous aps to exclude the pelvis help with perineal wound healing issues. (Evidence: moderate; Recommendation: weak).
In patients with a recurrence that is unresectable or who are not candidates for curative surgery for physiologic reasons, palliation may be offered with a variety of modalities available depending on specic symptoms. (Evidence: moderate; Recommendation: strong).
323
A Personal View oftheData
Patients referred to Mayo Clinic, Rochester for locally recurrent rectal cancer are initially evaluated with a musculoskeletal protocol MRI of the pelvis as well as a CT scan of the chest, abdomen, and pelvis. For equivocal cases on MRI, a PET-CT is obtained. The pelvic MRI will allow the recurrence to be classied by the surgeon’s system of choice. At Mayo Clinic, the Mayo Clinic system is used. This will guide the decision of whether a recurrence is potentially anatomically resectable to an R0 margin with acceptable postoperative outcomes. The chest, abdomen, and pelvis CT will identify any distant metastatic disease that may inuence the decision to oper­ate or not. The operation will likely require a multi-disciplinary team, so urology, gynecology, vascular surgery, radiation oncology, and plastic surgery should be coordinated as needed preoperatively depending on the tumor’s anatomic relationships.
324
https://t.me/medicina_free
N. P. McKenna and R. R. Cima
Like Catharina Hospital, we have begun administering 4cycles of FOLFOX to patients before restaging with pelvic MRI. External beam chemoradiotherapy is then used with the dose delivered based on prior receipt of radiation or not. For radiotherapy naive patients, long-course chemoradiotherapy with 50.4Gy is given. For patients who previously received chemoradiotherapy for their primary cancer, a reduced dose of 30Gy is given along with radiosensitizing chemotherapy. After an additional 5–7weeks, patients are again restaged, and if they are still appropriate for surgery, resection is undertaken. The decision to use IORT or not is based on nal margin status on intraoperative frozen pathology.
References
1. Swedish Rectal Cancer T, Cedermark B, Dahlberg M, Glimelius B, Pahlman L, Rutqvist LE, etal. Improved survival with preoperative radiotherapy in resectable rectal cancer. N Engl J Med. 1997;336(14):980–7.
2. Kapiteijn E, Marijnen CA, Colenbrander AC, Klein Kranenbarg E, Steup WH, van Krieken JH, etal. Local recurrence in patients with rectal cancer diagnosed between 1988 and 1992: a population-based study in the West Netherlands. Eur J Surg Oncol. 1998;24(6):528–35.
3. Sebag-Monteore D, Stephens RJ, Steele R, Monson J, Grieve R, Khanna S, et al. Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial. Lancet. 2009;373(9666):811–20.
4. MacFarlane JK, Ryall RD, Heald RJ. Mesorectal excision for rectal cancer. Lancet. 1993;341(8843):457–60.
5. Rhomberg W, Eiter H, Hergan K, Schneider B. Inoperable recurrent rectal cancer: results of a prospective trial with radiation therapy and razoxane. Int J Radiat Oncol Biol Phys. 1994;30(2):419–25.
6. Ito Y, Ohtsu A, Ishikura S, Boku N, Nihei K, Ogino T, etal. Efcacy of chemoradiother­apy on pain relief in patients with intrapelvic recurrence of rectal cancer. Jpn J Clin Oncol. 2003;33(4):180–5.
7. Palmer G, Martling A, Cedermark B, Holm T.A population-based study on the management and outcome in patients with locally recurrent rectal cancer. Ann Surg Oncol. 2007;14(2):447–54.
8. Hahnloser D, Nelson H, Gunderson LL, Hassan I, Haddock MG, O’Connell MJ, et al. Curative potential of multimodality therapy for locally recurrent rectal cancer. Ann Surg. 2003;237(4):502–8.
9. Nielsen MB, Laurberg S, Holm T. Current management of locally recurrent rectal cancer. Color Dis. 2011;13(7):732–42.
10. Harji DP, Grifths B, McArthur DR, Sagar PM.Current UK management of locally recurrent rectal cancer. Color Dis. 2012;14(12):1479–82.
11. Waldenstedt S, Haglind E, Angenete E. Symptoms and diagnosis of local recurrence after rectal cancer treatment. Acta Oncol. 2022;69:1043–9.
12. Wieldraaijer T, Bruin P, Duineveld LAM, Tanis PJ, Smits AB, van Weert H, etal. Clinical pattern of recurrent disease during the follow-up of Rectal carcinoma. Dig Surg. 2018;35(1):35–41.
13. Schaefer O, Langer M.Detection of recurrent rectal cancer with CT.MRI and PET/CT Eur Radiol. 2007;17(8):2044–54.
14. Rokan Z, Simillis C, Kontovounisios C, Moran BJ, Tekkis P, Brown G.Systematic review of classication systems for locally recurrent rectal cancer. BJS Open. 2021;5(3)
15. Moore HG, Shoup M, Riedel E, Minsky BD, Alektiar KM, Ercolani M, etal. Colorectal cancer pelvic recurrences: determinants of resectability. Dis Colon Rectum. 2004;47(10):1599–606.
27 Reoperative Surgery forLocally Recurrent Rectal Cancer
https://t.me/medicina_free
16. Iversen H, Martling A, Johansson H, Nilsson PJ, Holm T.Pelvic local recurrence from colorec­tal cancer: surgical challenge with changing preconditions. Color Dis. 2018;20(5):399–406.
17. Zhao J, Du CZ, Sun YS, Gu J.Patterns and prognosis of locally recurrent rectal cancer follow­ing multidisciplinary treatment. World J Gastroenterol. 2012;18(47):7015–20.
18. Yamada K, Ishizawa T, Niwa K, Chuman Y, Akiba S, Aikou T.Patterns of pelvic invasion are prognostic in the treatment of locally recurrent rectal cancer. Br J Surg. 2001;88(7):988–93.
19. Kanemitsu Y, Hirai T, Komori K, Kato T.Prediction of residual disease or distant metastasis after resection of locally recurrent rectal cancer. Dis Colon Rectum. 2010;53(5):779–89.
20. Bird TG, Ngan SY, Chu J, Kroon R, Lynch AC, Heriot AG.Outcomes and prognostic factors of multimodality treatment for locally recurrent rectal cancer with curative intent. Int J Color Dis. 2018;33(4):393–401.
21. Suzuki K, Dozois RR, Devine RM, Nelson H, Weaver AL, Gunderson LL, etal. Curative reop­erations for locally recurrent rectal cancer. Dis Colon Rectum. 1996;39(7):730–6.
22. Valentini V, Morganti AG, De Franco A, Coco C, Ratto C, Battista Doglietto G, et al. Chemoradiation with or without intraoperative radiation therapy in patients with locally recur­rent rectal carcinoma: prognostic factors and long term outcome. Cancer. 1999;86(12):2612–24.
23. Boyle KM, Sagar PM, Chalmers AG, Sebag-Monteore D, Cairns A, Eardley I.Surgery for locally recurrent rectal cancer. Dis Colon Rectum. 2005;48(5):929–37.
24. Georgiou PA, Tekkis PP, Constantinides VA, Patel U, Goldin RD, Darzi AW, etal. Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic sur­gery for advanced colorectal cancer. Eur J Cancer. 2013;49(1):72–81.
25. Holman FA, Bosman SJ, Haddock MG, Gunderson LL, Kusters M, Nieuwenhuijzen GA, etal. Results of a pooled analysis of IOERT containing multimodality treatment for locally recur­rent rectal cancer: results of 565 patients of two major treatment centres. Eur J Surg Oncol. 2017;43(1):107–17.
26. You YN, Skibber JM, Hu CY, Crane CH, Das P, Kopetz ES, etal. Impact of multimodal ther­apy inlocally recurrent rectal cancer. Br J Surg. 2016;103(6):753–62.
27. Harris CA, Solomon MJ, Heriot AG, Sagar PM, Tekkis PP, Dixon L, et al. The outcomes and patterns of treatment failure after surgery for locally recurrent rectal cancer. Ann Surg. 2016;264(2):323–9.
28. Wo JY, Anker CJ, Ashman JB, Bhadkamkar NA, Bradeld L, Chang DT, et al. Radiation therapy for rectal cancer: executive summary of an ASTRO clinical practice guideline. Pract Radiat Oncol. 2021;11(1):13–25.
29. Youssef FF, Parikh PJ, DeWees TA, Mutch MG, Tan BR Jr, Grigsby PW, et al. Efcacy and toxicity of rectal cancer reirradiation using IMRT for patients who have received prior pelvic radiation therapy. Adv Radiat Oncol. 2016;1(2):94–100.
30. Ng MK, Leong T, Heriot AG, Ngan SY.Once-daily reirradiation for rectal cancer in patients who have received previous pelvic radiotherapy. J Med Imaging Radiat Oncol. 2013;57(4):512–8.
31. Das P, Delclos ME, Skibber JM, Rodriguez-Bigas MA, Feig BW, Chang GJ, et al. Hyperfractionated accelerated radiotherapy for rectal cancer in patients with prior pelvic irra­diation. Int J Radiat Oncol Biol Phys. 2010;77(1):60–5.
32. Wegner RE, Abel S, White RJ, Horne ZD, Hasan S, Kirichenko AV.Trends in intensity­modulated radiation therapy use for rectal cancer in the neoadjuvant setting: a National Cancer Database analysis. Radiat Oncol J. 2018;36(4):276–84.
33. Jabbour SK, Patel S, Herman JM, Wild A, Nagda SN, Altoos T, etal. Intensity-modulated radiation therapy for rectal carcinoma can reduce treatment breaks and emergency department visits. Int J Surg Oncol. 2012;2012:891067.
34. Tao R, Tsai CJ, Jensen G, Eng C, Kopetz S, Overman MJ, etal. Hyperfractionated acceler­ated reirradiation for rectal cancer: an analysis of outcomes and toxicity. Radiother Oncol. 2017;122(1):146–51.
35. Dresen RC, Gosens MJ, Martijn H, Nieuwenhuijzen GA, Creemers GJ, Daniels-Gooszen AW, etal. Radical resection after IORT-containing multimodality treatment is the most important determinant for outcome in patients treated for locally recurrent rectal cancer. Ann Surg Oncol. 2008;15(7):1937–47.
325
326
https://t.me/medicina_free
36. Fadel MG, Ahmed M, Malietzis G, Pellino G, Rasheed S, Brown G, etal. Oncological out­comes of multimodality treatment for patients undergoing surgery for locally recurrent rectal cancer: a systematic review. Cancer Treat Rev. 2022;109:102419.
37. Voogt ELK, van Zoggel D, Kusters M, Nieuwenhuijzen GAP, Bloemen JG, Peulen HMU, etal. Improved outcomes for responders after treatment with induction chemotherapy and chemo(re) irradiation for locally recurrent Rectal Cancer. Ann Surg Oncol. 2020;27(9):3503–13.
38. van Zoggel D, Bosman SJ, Kusters M, Nieuwenhuijzen GAP, Cnossen JS, Creemers GJ, etal. Preliminary results of a cohort study of induction chemotherapy-based treatment for locally recurrent rectal cancer. Br J Surg. 2018;105(4):447–52.
39. Wiig JN, Larsen SG, Dueland S, Giercksky KE.Clinical outcome in patients with complete pathologic response (pT0) to preoperative irradiation/chemo-irradiation operated for locally advanced or locally recurrent rectal cancer. J Surg Oncol. 2005;92(1):70–5.
40. Sorrentino L, Belli F, Valvo F, Villa S, Guaglio M, Scaramuzza D, et al. Neoadjuvant (re) chemoradiation for locally recurrent rectal cancer: impact of anatomical site of pelvic recur­rence on long-term results. Surg Oncol. 2020;35:89–96.
41. Yu SK, Bhangu A, Tait DM, Tekkis P, Wotherspoon A, Brown G.Chemoradiotherapy response in recurrent rectal cancer. Cancer Med. 2014;3(1):111–7.
42. Ansell J, Perry WRG, Mathis KL, Grass F, Yonkus JA, Hallemeier CL, et al. Re-resection of microscopically positive margins found on intraoperative frozen section analysis does not result in a survival benet in patients undergoing surgery and intraoperative radiation therapy for locally recurrent Rectal Cancer. Dis Colon Rectum. 2022;65(9):1094–102.
43. Babar L, Bakalov V, Abel S, Ashraf O, Finley GG, Raj MS, etal. Retrospective review of total neoadjuvant therapy. World J Gastrointest Oncol. 2019;11(10):857–65.
44. Denost Q, Frison E, Salut C, Sitta R, Rullier A, Harji D, etal. A phase III randomized trial evaluating chemotherapy followed by pelvic reirradiation versus chemotherapy alone as pre­operative treatment for locally recurrent rectal cancer– GRECCAR 15 trial protocol. Color Dis. 2021;23(7):1909–18.
45. PelvEx C.Induction chemotherapy followed by chemoradiotherapy versus chemoradiotherapy alone as neoadjuvant treatment for locally recurrent rectal cancer: study protocol of a multicen­tre, open-label, parallel-arms, randomized controlled study (PelvEx II). BJS Open. 2021;5(3)
46. Kishan AU, Voog JC, Wiseman J, Cook RR, Ancukiewicz M, Lee P, etal. Standard fraction­ation external beam radiotherapy with and without intraoperative radiotherapy for locally recurrent rectal cancer: the role of local therapy in patients with a high competing risk of death from distant disease. Br J Radiol. 2017;90(1076):20170134.
47. Hyngstrom JR, Tzeng CW, Beddar S, Das P, Krishnan S, Delclos ME, etal. Intraoperative radiation therapy for locally advanced primary and recurrent colorectal cancer: ten-year insti­tutional experience. J Surg Oncol. 2014;109(7):652–8.
48. Alektiar KM, Zelefsky MJ, Paty PB, Guillem J, Saltz LB, Cohen AM, etal. High-dose-rate intraoperative brachytherapy for recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2000;48(1):219–26.
49. Lindel K, Willett CG, Shellito PC, Ott MJ, Clark J, Grossbard M, etal. Intraoperative radia­tion therapy for locally advanced recurrent rectal or rectosigmoid cancer. Radiother Oncol. 2001;58(1):83–7.
50. Mirnezami R, Chang GJ, Das P, Chandrakumaran K, Tekkis P, Darzi A, etal. Intraoperative radiotherapy in colorectal cancer: systematic review and meta-analysis of techniques, long­term outcomes, and complications. Surg Oncol. 2013;22(1):22–35.
51. Haddock MG, Miller RC, Nelson H, Pemberton JH, Dozois EJ, Alberts SR, etal. Combined modality therapy including intraoperative electron irradiation for locally recurrent colorectal cancer. Int J Radiat Oncol Biol Phys. 2011;79(1):143–50.
52. Calvo FA, Sole CV, Rutten HJ, Dries WJ, Lozano MA, Cambeiro M, etal. ESTRO/ACROP IORT recommendations for intraoperative radiation therapy inlocally recurrent rectal cancer. Clin Transl Radiat Oncol. 2020;24:41–8.
53. Horn A, Morild I, Dahl O.Tumour shrinkage and down staging after preoperative radiation of rectal adenocarcinomas. Radiother Oncol. 1990;18(1):19–28.
N. P. McKenna and R. R. Cima
27 Reoperative Surgery forLocally Recurrent Rectal Cancer
https://t.me/medicina_free
54. Berger C, de Muret A, Garaud P, Chapet S, Bourlier P, Reynaud-Bougnoux A, et al. Preoperative radiotherapy (RT) for rectal cancer: predictive factors of tumor downstaging and residual tumor cell density (RTCD): prognostic implications. Int J Radiat Oncol Biol Phys. 1997;37(3):619–27.
55. Randomised trial of surgery alone versus surgery followed by radiotherapy for mobile cancer of the rectum. Medical Research Council Rectal Cancer working party. Lancet. 1996;348(9042):1610–4.
56. Lim SB, Choi HS, Jeong SY, Kim DY, Jung KH, Hong YS, et al. Optimal surgery time after preoperative chemoradiotherapy for locally advanced rectal cancers. Ann Surg. 2008;248(2):243–51.
57. McKenna NP, Bews KA, Al-Refaie WB, Colibaseanu DT, Pemberton JH, Cima RR, et al. Assessing malnutrition before major oncologic surgery: one size does not t all. J Am Coll Surg. 2020;230(4):451–60.
58. Beaton J, Carey S, Solomon MJ, Tan KK, Young J.Preoperative body mass index, 30-day post­operative morbidity, length of stay and quality of life in patients undergoing pelvic exenteration surgery for recurrent and locally-advanced rectal cancer. Ann Coloproctol. 2014;30(2):83–7.
59. van Rees JM, Visser E, van Vugt JLA, Rothbarth J, Verhoef C, van Verschuer VMT.Impact of nutritional status and body composition on postoperative outcomes after pelvic exenteration for locally advanced and locally recurrent rectal cancer. BJS Open. 2021;5(5)
60. Hogan S, Steffens D, Vuong K, Rangan A, Solomon M, Carey S.Preoperative nutritional status impacts clinical outcome and hospital length of stay in pelvic exenteration patients– a retrospective study. Nutr Health. 2022;28(1):41–8.
61. Spasojevic M, Mariathasan AB, Goscinski M, Thorgersen EB, Solbakken AM, Gullestad HP, etal. Vertical rectus abdominis musculocutaneous ap repair improves perineal wound heal­ing after abdominoperineal resection for irradiated locally advanced rectal cancer. Ann Surg Oncol. 2018;25(5):1357–65.
62. Houdek MT, Bakri K, Tibbo ME, Wagner ER, Rose PS, Sim FH, etal. Outcome and complica­tions following vertical rectus abdominis myocutaneous ap surgery to reconstruct sacrectomy defects. Plast Reconstr Surg. 2018;142(5):1327–35.
63. Killeen S, Devaney A, Mannion M, Martin ST, Winter DC.Omental pedicle aps following proctectomy: a systematic review. Color Dis. 2013;15(11):e634–45.
64. Witte DYS, van Ramshorst GH, Lapid O, Bouman MB, Tuynman JB.Flap reconstruction of perineal defects after pelvic exenteration: a systematic description of four choices of surgical reconstruction methods. Plast Reconstr Surg. 2021;147(6):1420–35.
65. Lambert JE, Hayes LD, Keegan TJ, Subar DA, Gaffney CJ.The impact of Prehabilitation on patient outcomes in hepatobiliary, colorectal, and upper gastrointestinal Cancer surgery: a PRISMA-accordant meta-analysis. Ann Surg. 2021;274(1):70–7.
66. Bojesen RD, Grube C, Buzquurz F, Miedzianogora REG, Eriksen JR, Gogenur I.Effect of modifying high-risk factors and prehabilitation on the outcomes of colorectal cancer surgery: controlled before and after study. BJS Open. 2022;6(3)
67. Cameron MG, Kersten C, Vistad I, Fossa S, Guren MG.Palliative pelvic radiotherapy of symp­tomatic incurable rectal cancer– a systematic review. Acta Oncol. 2014;53(2):164–73.
68. Ronnekleiv-Kelly SM, Kennedy GD.Management of stage IV rectal cancer: palliative options. World J Gastroenterol. 2011;17(7):835–47.
327
https://t.me/medicina_free
Intensive vs Conservative Management
https://t.me/medicina_free
ofPatients withLow Grade Squamous
28
Intraepithelial Lesions
RayRamirez, NellMaloneyPatel, andJosephTerlizzi
Introduction
Anal cancer is preceded by anal intraepithelial neoplasia (AIN) in the same way that cervical intraepithelial neoplasia precedes cervical cancer. A classication system, similar to that of cervical pathology, has been developed using the Bethesda system terminology AIN I, II, and III, where AIN 1 is “low-grade squamous intraepithelial lesion (LSIL)” and AIN II and III is “high grade squamous intraepithelial lesions (HSIL)” [1]. While HSIL, the direct anal squamous cell carcinoma precursor is considered premalignant, LSIL is not. However, LSIL is a marker for concurrent HSIL and the development of HSIL in the future. It has been hypothesized that LSIL is associated with low-risk HPV genotypes and HSIL is associated with high­risk HPV genotypes [1, 2]. While the risk of anal cancer is low overall, it is signi­cantly increased in certain populations. These populations include people with high-risk sexual behaviors (men who have sex with men (MSM), receptive anal intercourse, or a history of multiple sexual partners), persons living with HIV (PLHIV), other immunocompromised individuals such as solid organ transplant recipients (SOTRs) or those with autoimmune diseases, and women diagnosed with HPV-related gynecological (pre)cancers [3]. AIN is a disease with an overall
R. Ramirez (*) Rutgers Robert Wood Johnson Medical School, Surgery, New Brunswick, NJ, USA e-mail: rr1156@rwjms.rutgers.edu
N. M. Patel Rutgers Robert Wood Johnson Medical School, Colon and Rectal Surgery, Westeld, NJ, USA e-mail: malonene@rutgers.edu
J. Terlizzi Mount Sinai School of Medicine, Surgery, New York, NY, USA
© The Author(s), under exclusive license to Springer Nature Switzerland AG 2023 K. Umanskiy, N. Hyman (eds.), Difcult Decisions in Colorectal Surgery, Difcult Decisions in Surgery: An Evidence-Based Approach,
https://doi.org/10.1007/978-3-031-42303-1_28
331
332
https://t.me/medicina_free
Table 28.1 Incidence of anal cancer in high risk populations [3]
Population Incidence rates of anal cancer MSM with HIV 85/100,000 py (95% CI=82–89) Non-MSM with HIV 32/100,000 py (95% CI=30–35) Females with HIV 22/100,000 py (95% CI=19–24) HIV-negative MSM 19/100,000 py (95% CI=10–36) Women with Cervical Cancer 9/100,000 py (95% CI=8–12) Women with Precancerous Cervical Lesions 6/100,000 py (95% CI=5–7) Women with Vulvar Cancer 48/100,000 py (95% CI=38/61) Women with Vaginal Cancer 10/100,000 py (95% CI=3–30) Solid Organ Transplant Recipients 13/100,000 py (95% CI=12–15) Autoimmune Disorders 10/100,000 py (95% CI=5–19) Ulcerative Colitis 6/100,000 py (95% CI=3–11) Crohn’s Disease 3/100,000 py (95% CI=2–4)
Table 28.2 PICO question
Patients Patients with low grade
squamous anal intraepithelial neoplasia
Intervention Comparator
Topical therapy and/or local ablative therapy
Surveillance Progression to
R. Ramirez et al.
Outcome
high-grade AIN
predicted incidence of approximately 1–2 cases per 100,000 person-years (py) [3], it is often difcult to study and assess (Table28.1).
Because AIN remains relatively rare and requires a level of expertise to diag­nose and treat, it is currently recommended that patients with AIN be referred to expert centers for high resolution anoscopy and any associated treatments [1] (Table28.2).
Search Strategy
A comprehensive literature search of Cochrane Database of Collected Research, EMBASE, and PubMed was performed to identify all of the English-language publications related to management of patients with low grade squamous intraepi­thelial lesions and recurrence from 2000 to 2022. Because of the low volume of studies looking specically at LSIL, anal cancer and HSIL were included. Key search terms included the following: “AIN low-grade, “anal LSIL”, “anal HSIL,” and “anal cancer.” Studies were excluded if they had no mention of LSIL or treat­ment of LSIL/HSIL.Only the most recent study was included if similar studies from the same institution were encountered. The references of the included stud­ies were reviewed to identify additional studies that were incorporated as appropriate.
Соседние файлы в папке Библиотека им академика М.И. Перельмана
Помощь Обратная связь Вопросы и предложения Пользовательское соглашение Политика конфиденциальности