The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/ voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.
Rectum/pathology/*surgery ; Rectal Neoplasms/pathology/*surgery ; Pelvis/*surgery ; Magnetic Resonance Imaging ; Humans ; Dissection/methods

BACKGROUND/AIMS: While endoscopic resection could be considered as the best choice for the treatment of small rectal carcinoid, the colonoscopic biopsies performed at the time of detection may lead to scar and ulcer formation and cause unpredicted difficulty in the endoscopic resection. This study was evaluated to analyze the relationship between the post-biopsy scar and the limitation of submucosal elevation for the endoscopic resection of rectal carcinoids. METHODS: Twenty two cases of rectal carcinoid which received prior biopsies before the endoscopic resection were retrospectively compared with 20 non-biopsied cases. All two groups were treated by endoscopic resection from January 2000 to December 2007. There was no difference in the clinical characteristics and endoscopic findings such as size and location between the two groups. RESULTS: The limited submucosal elevation was experienced in 17 cases (77%) in the biopsy group, significantly more frequent than 9 cases (45%) in the non-biopsy group (p=0.03). The colonoscopic findings which contribute to difficult submucosal elevation were the depressive scar formation after biopsy, the size less than 5 mm in the biopsy group, active ulcer formation after biopsy. Regarding the resection method, endoscopic submucosal dissection was frequently adopted (23% vs. 5%) in the biopsy group. The frequency of endoscopic piecemeal resection in biopsy group was higher than non-biopsy group (23% vs 10%), and all cases were subsequently resected by other endoscopic methods. CONCLUSIONS: The post-biopsy scar can interfere with successful submucosal elevation for endoscopic resection of rectal carcinoids. The number of forcep biopsy should be minimized in the diagnostic colonoscopy when endoscopic resection is planned rectal carcinoids.
Adult ; Aged ; Biopsy ; Carcinoid Tumor/*pathology/surgery ; Cicatrix/pathology ; Colonoscopy ; Female ; Humans ; Intestinal Mucosa/surgery ; Male ; Middle Aged ; Rectal Neoplasms/*pathology/surgery ; Risk Factors

Locoregional failure of rectal cancer is a troublesome problem and a major cause of morbidity and mortality following curative surgery. The mesorectum has been regarded as an important site in local failure after surgery of rectal cancer. Total mesorectal excision (TME) has been raised by some colorectal surgeons to prevent early local recurrence. This study was performed to ascertain the incidence of metastatic lymph nodes in the distal mesorectum (DMR) of the colorectal cancer patient. We also examined the clinicopathologic risk factors of distal mesorectal metastasis. Eight of 53 patients had positive metastatic lymph nodes in DMR. Twenty-seven patients were Dukes B and 26 patients were Dukes C stage. Out of 26 Dukes C patients, 8 patients (30.8%) had metastatic lymph nodes in the DMR. However, there was no significant difference in risk factors between DMR positive and DMR negative patients with Dukes C stage. In conclusion, the incidence of metastatic lymph nodes in DMR was about 30.8%, therefore the mesorectum especially the DMR should be removed completely by total mesorectal excision to eradicate the metastatic lymph nodes which may cause local recurrence.
Aged ; Female ; Human ; *Lymphatic Metastasis ; Male ; Middle Age ; Neoplasm Invasiveness ; Postoperative Period ; Rectal Neoplasms/pathology/*surgery ; Rectum/*surgery

No abstract available.
Diagnosis, Differential ; Endosonography ; Female ; Humans ; Incidental Findings ; *Intestinal Mucosa/pathology/radiography/surgery ; Intestinal Polyps/*diagnosis/pathology/radiography/surgery ; Middle Aged ; Neoplasms, Fibroepithelial/*diagnosis/pathology/radiography/surgery ; Predictive Value of Tests ; Rectal Neoplasms/*diagnosis/pathology/radiography/surgery ; Tomography, X-Ray Computed

Multiple primary malignancy was reported firstly by Billroth in 1889. Recently, multiple primary malignancies are considered to increase due to improved survival rate of cancer patients, advanced diagnostic tools, and increased use of chemotherapy and radiotherapy. In Korea, several cases of triple primary malignancies were reported. However, four primary malignancies in gastro-intestinal tract was rarely reported. Recently, we experienced a 70 year-old male who was diagnosed with metachronous four primary malignancies in rectum, ascending colon, stomach, and ampulla of Vater. We report this rare case of metachronous four primary malignancies with a review of literature.
Adenocarcinoma/*diagnosis/pathology/surgery ; Adenocarcinoma, Mucinous/diagnosis/surgery ; Aged ; Ampulla of Vater/*pathology ; Colonic Neoplasms/diagnosis/surgery ; Common Bile Duct Neoplasms/*diagnosis/pathology/surgery ; Gastrointestinal Neoplasms/*diagnosis/pathology/radiography ; Humans ; Male ; Neoplasms, Second Primary/*diagnosis/pathology ; Rectal Neoplasms/diagnosis/surgery ; Stomach Neoplasms/diagnosis/pathology/surgery ; Tomography, X-Ray Computed

The lengths of the surgical rectum and peritoneal reflection were important factors in treatment modality of rectal tumor. To evaluate the surgical length of rectum, we measured the length of the peritoneal reflections, sacral promontory and termination of the taenia coli from the anal verge by rigid sigmoidoscope in 23 male and 23 females during operation. The mean lengths of the sacral promontory were 16.5+/- 2.2 cm and 16.1+/-2.2 cm in the males and females, respectively. As for the peritoneal reflection, the results were anterior (8.8+/-2.2 cm, 8.1+/-1.7 cm), lateral (10.8 +/-2.7 cm, 11.4+/-1.9 cm) and posterior (13.8+/-2.5 cm, 14.0+/-1.9 cm), respectively. There were no statistically significant differences between male and female. And only height had a correlation with the length of sacral promontory both in male and female (p=0.015 and p=0.018, respectively). For all the estimated lengths, the length of the sacral promontory had a correlation with the lengths of the anterior (p<0.001 and p=0.001) and posterior (p<0.001 and p<0.001) peritoneal reflections in males and females, respectively. We suggest that the intra-operative lengths of the rectum and peritoneal reflection will be useful information for treatment modality of rectal tumor clinically in Korean.
Adult ; Aged ; Anal Canal/pathology/surgery ; Anthropometry ; Body Height ; Body Mass Index ; Female ; Humans ; Intraoperative Care/methods ; Korea ; Laparotomy ; Male ; Middle Aged ; Peritoneum/pathology/surgery ; Rectal Neoplasms/pathology/*surgery ; Rectum/*pathology/surgery ; Sex Factors

Among women with intestinal endometriosis, the sigmoid colon and rectum are the most commonly involved areas. Sometimes, the differential diagnosis of colorectal endometriosis from carcinoma of the colon and rectum is difficult due to similar colonoscopic and radiologic findings. From October 2002 to September 2007, we performed five operations with curative intent for rectal and sigmoid colon cancer that revealed intestinal endometriosis. Colonoscopic and radiologic findings were suggestive of carcinoma of rectum and sigmoid colon, such as rectal cancer, sigmoid colon cancer and gastrointestinal stromal tumor (GIST). Anterior resection was performed in two patients, low anterior resection was performed in one patient and laparoscopic low anterior resection was done in two patients. We suggest to consider also intestinal endometriosis in reproductive women presenting with gastrointestinal symptoms and an intestinal mass of unknown origin.
Adult ; Carcinoma/*diagnosis ; Diagnosis, Differential ; Endometriosis/*diagnosis/pathology/surgery ; Female ; Humans ; Middle Aged ; Rectal Neoplasms/*diagnosis ; Sigmoid Neoplasms/*diagnosis

Carcinoids are slow growing neuroendocrine tumors (NET) originating in the enterochromaffin cells of the gastrointestinal tract. In previous studies, rectal NET comprised only about 1% of all anorectal neoplasms; however, the incidence of rectal NET has shown a recent increase. Typically, rectal NET presents as a single subepithelial nodule, and multicentricity of rectal NETs is rare, with reported incidence of 2-4.5%. Due to the rarity of multiple rectal NETs, there is no consensus or guidelines for treatment of multiple rectal NETs. However, NETs of the rectum that are less than 10 mm in diameter and do not infiltrate the muscularis propria, without distant metastasis, can be removed by endoscopy, as with solitary rectal NET. We encountered five cases of multiple rectal NETs which were treated successfully by endoscopy.
Adult ; Aged ; Colonoscopy ; Female ; Humans ; Male ; Middle Aged ; Neuroendocrine Tumors/*diagnosis/pathology/surgery ; Positron-Emission Tomography ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Sigmoidoscopy ; Tomography, X-Ray Computed

Rectal schwannoma is a rare mesenchymal tumor originating from Schwann's cell. We experienced a 61- year-old female patient who complained of blood tinged and narrow calibered stool for several years, and found a 4 cm sized submucosal tumor with a central ulcer on the rectal wall during colonoscopy. She underwent transanal excision. Microscopically, the tumor was composed of fasciculating bundles of spindle cells with benign nuclear atypia and peripheral lymphoid cell cuffing. Tumor cells showed a diffuse strong immunoreactivity to S-100 protein, but not stain for CD 34, desmin and smooth muscle actin. This is the first case report of rectal schwannoma in Korea.
Colonoscopy ; Female ; Gastrointestinal Hemorrhage/*diagnosis ; Humans ; Middle Aged ; Neurilemmoma/*diagnosis/pathology/surgery ; Rectal Neoplasms/*diagnosis/pathology/surgery ; Rectum ; Tomography, X-Ray Computed ; Tumor Markers, Biological/analysis

BACKGROUND/AIMS: Well differentiated rectal carcinoid tumors which are less than 1cm in diameter can be treated by endoscopic resection. We aimed to evaluate the efficacy of endoscopic resection in treating small sized rectal carcinoids. METHODS: Medical records of 30 rectal carcinoid cases treated by endoscopic resection in Yonsei University College of Medicine, Severance Hospital between January 1995 and March 2007 were reviewed retrospectively. RESULTS: Mean age was 49.7 years and male to female ratio was 1:0.88. Mean size of tumor was 6.29+/-3.06 mm and 25 out of 30 patients (83.3%) had tumors of diameter less than 10 mm. Twenty-two out of 30 patients treated by conventional polypectomy, 6 by endoscopic mucosal resection using a transparent cap (EMR-C) and 2 by endoscopic submucosal dissection (ESD). Histological examination revealed that 9 patients had resection margin positive for tumor; 7 (31.8%) were in polypectomy group, 1 (16.7%) in EMR-C group, and 1 (50%) in ESD group (p=0.868). Five patients underwent transanal excision to remove residual tumor. No residual tumor was found in additionally resected tissue. Mean follow-up duration was 19. 3 months (range 0-122), and there were no recurrence. CONCLUSIONS: Endoscopic resection is an effective method in the treatment of small rectal carcinoids. However, long-term outcome remains to be elucidated by a large scaled prospective study.
Adult ; Aged ; Carcinoid Tumor/pathology/*surgery/therapy ; Demography ; *Endoscopy, Gastrointestinal ; Female ; Follow-Up Studies ; Humans ; Male ; *Microsurgery ; Middle Aged ; Rectal Neoplasms/pathology/*surgery/therapy ; Retrospective Studies ; Treatment Outcome