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עמוד בית
Tue, 28.05.24

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January 2013
August 2011
D. Rosin, A. Lebedyev, D. Urban, D. Aderka, O. Zmora, M. Khaikin, A. Hoffman, M. Shabtai and A. Ayalon

Background: The treatment of rectal cancer has changed significantly over the last few decades. Advanced surgical techniques have led to an increase in the rate of sphincter-preserving operations, even for low rectal tumors. This was facilitated by preoperative oncologic treatment and the use of chemoradiation to downstage the tumor before resection. The introduction of total mesorectal excision further improved the oncologic outcome and became the standard of care. The use of laparoscopy for rectal resection is the most recent addition to this series of improvements, but in contrast to the use of laparoscopy in colon cancer its role is not yet well defined.

Objectives: To present our experience with laparoscopic surgery for upper and lower rectal tumors.

Methods: A database was used to prospectively collect all data on laparoscopic rectal surgery in our department since we started performing these procedures in 1997. Follow-up data were collected from outpatient clinic visits, oncology files and telephone interviews. Updated survival data were retrieved from the national census.

Results: Of 750 laparoscopic colorectal procedures performed over a 13 year period, 67 were for rectal cancer. Of these, 29 were resections for tumors in the upper rectum (1115 cm from the anal verge) and 38 for tumors at 10 cm or below. Surgery was performed in 24 patients after neoadjuvant chemoradiation. There were 54 sphincter-preserving operations and 13 abdominoperineal resections. The mean operative time was 283 minutes. Conversion to an open procedure was required in 22% of the cases. Anastomotic leaks occurred in 17% of cases. Postoperative mortality was 4.5%. Long-term follow-up was available for 77% of the group, for a mean period of 42 months. Local recurrence was diagnosed in 4.5% of the patients and overall 5 year survival was 68%.

Conclusions: Laparoscopic rectal resection is a demanding procedure. However, laparoscopy may become the preferred approach since it is a minimally invasive procedure and has an acceptable oncologic outcome that is comparable to the open approach. This conclusion, however, needs further validation.
 

March 2007
M. Khaikin, Y. Chowers and O. Zmora
Perianal Crohn's disease refers to the involvement of the anal region in this chronic inflammatory bowel disease. It most commonly presents with the formation of perianal abscesses and fistulas, although other forms of presentations such as fissures and skin tags may also be present. Perianal activity often parallels abdominal disease activity, but may occasionally be the primary site of active disease, and significantly compromises the quality of life in affected patients. The primary treatment of patients with perianal Crohn's disease combines medical and surgical management with the aim of improving quality of life and alleviating suffering. A multidisciplinary approach involving the patient, surgeon, gastroenterologist, radiologist, pathologist, nutritionist, and other specialists makes the successful treatment of PCD[1] possible. This paper reviews the management of patients with perianal Crohn's disease, focusing on contemporary medical and surgical treatments such as infliximab, endorectal advancement flap, instillation of fibrin glue, and the potential use of extracellular matrix plugs






[1] PCD = perianal Crohn's disease


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