Search results for "Total mesorectal excision"
showing 6 items of 36 documents
A Roadmap to the Pelvic Autonomic Nerves During Transanal Dissection
2019
Current international guidelines and consensus panels emphasize that nerve sparing is a crucial part of the total mesorectal excision (TME). The transanal approach (taTME) could be advantageous in this regard. However, even with taTME, pelvic autonomic nerve preservation requires perfect knowledge of the topographic and morphological aspects of the anatomy and requires surgeons to acquire specific skills. Unusual surgical topography presents a considerable risk of nerve injury, when attempting a TME with the “bottom-up” approach.
Is intraoperative neuromonitoring associated with better functional outcome in patients undergoing open TME?
2013
Aims: Intraoperative neuromonitoring (IONM) aims to control nerve-sparing total mesorectal excision (TME) for rectal cancer in order to improve patients’ functional outcome. This study was designed to compare the urogenital and anorectal functional outcome of TME with and without IONM of innervation to the bladder and the internal anal sphincter. Methods: A consecutive series of 150 patients with primary rectal cancer were analysed. Fifteen match pairs with open TME and combined urogenital and anorectal functional assessment at follow up were established identical regarding gender, tumour site, tumour stage, neoadjuvant radiotherapy and type of surgery. Urogenital and anorectal function was…
Adjuvant versus Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer A Progress Report of a Phase-III Randomized Trial (Protocol CAO/ARO/…
2001
The standard treatment for patients with clinically resectable rectal cancer is surgery. Postoperative radiochemotherapy is recommended for patients with advanced disease (pT3/4 or pN+). In recent years, encouraging results of preoperative radiotherapy have been reported. This prospective randomized phase-III trial (CAO/ARO/AIO-94) compares the efficacy of neoadjuvant radiochemotherapy to standard postoperative radiochemotherapy. We report on the design of the study and first results with regard to toxicity of radiochemotherapy and postoperative morbidity. Patients and Methods: Patients with locally advanced operable rectal cancer (uT3/4 or uN+, Mason CS III/IV) were randomly assigned to pr…
Impact of surgeon organization and specialization in rectal cancer outcome.
2001
Purpose The present study was designed to assess the differences in the outcome of patients with rectal cancer treated by a group of surgeons before and after being organized as a Coloproctology Unit at the same University Department of Surgery. Methods Comparison of two periods of rectal cancer surgery: I (1986–91) and II (1992–95). Period I: 94 patients were operated on by 14 general surgeons. Period II: 108 patients were operated on by only 4 surgeons of the same group organized as a Colorectal Surgery Unit after visiting referral centres abroad, adopting techniques such as total mesorectal excision (TME) for middle and low rectal cancer and washout of rectal stump. Mean follow-up during…
Die laterale Dissektion des Mesorektums ; ein Risiko für den Plexus hypogastricus inferior
2004
Lateral mesorectal dissection may injure parasympathetic and sympathetic pelvic nerves and a partial or complete lesion of the autonomic pelvic nerves leads to urogenital dysfunctions affecting patient’s quality of life after rectum resection for rectal carcinoma. The aim of the present prospective study was to clarify the significance for nerve damage during lateral dissection based on standardized assessment parameters. 15 Patients underwent total mesorectal excision for rectal carcinoma (UICC I/II/III/IV: 1/5/3/6). Within the scope of the stanardized intraoperative data collection it was demonstrated, whether a complete preservation of the autonomie pelvic nerves was successful. In 11 pa…
Rektumkarzinom: Behandeln wir zu häufig neoadjuvant? Vorschläge zu einer selektiveren, MRT-basierten Indikation
2006
The present-day optimised surgery (concept of total mesorectal excision) with quality assurance by standardized pathologic examination, advances in radiotherapy and the possibilities of high-spatial-resolution MR imaging require reconsideration of pros and contras of neoadjuvant therapy and respective data. According to the resulting new proposal neoadjuvant long-course radiochemotherapy is indicated for patients with 1) fixed questionably R0 resectable tumors, 2) mobile tumors with the MRT finding of tumor involving the mesorectal fascia or 1 mm or less from it, 3) low rectal tumors extending below the levator origin and invading beyond the muscularis propria. If a high risk of local recur…