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  • 1
    Electronic Resource
    Electronic Resource
    Anorectal disease in neutropenic leukemic patients (1994)
    Springer
    Diseases of the colon & rectum 37 (1994), S. 1095-1099 
    Details
    ISSN: 1530-0358
    Keywords: Anorectal disease ; Leukemia ; Neutropenia ; Anorectal abscess
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was designed to evaluate the spectrum, clinical presentation, management, and outcome of anorectal disease in neutropenic leukemic patients and to compare operative and nonoperative management in neutropenic leukemic patients. METHODS: A retrospective review of hospital records was performed. RESULTS: One hundred fifty-one of 2,618 (5.8 percent) patients hospitalized with leukemia had concomitant symptomatic anorectal disease. Data from 81 patients were available for analysis. Fifty-two (64 percent) were treated nonoperatively and 29 (36 percent) underwent operative treatment. Fifty-seven (70.4 percent) had absolute neutrophil counts 〈1,000/ mm 3,and 54 (66.7 percent) were severely neutropenic (absolute neutrophil count 〈500/mm 3).Management and outcomes of 54 severely neutropenic patients were analyzed. In 20 patients who underwent surgery there were 4 deaths (20 percent) and 4 recurrences (20 percent), whereas in 34 patients managed nonoperatively there were 6 deaths (18 percent) and 4 recurrences (12 percent) (P 〉0.05). CONCLUSIONS: Symptomatic anorectal disease afflicted 5.8 percent of hospitalized leukemic patients. In these patients, anorectal sepsis was a major source of mortality. Our data suggest that anorectal abscesses in neutropenic leukemic patients may be safely drained. Because we did not observe excessive morbidity or mortality (20 percent vs. 18 percent) in the operated neutropenic leukemics as compared with the nonoperated patients, selected neutropenic leukemic patients should not be denied anorectal surgery when otherwise indicated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02049810
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  • 2
    Electronic Resource
    Electronic Resource
    p53 Nuclear overexpression may not be an independent prognostic marker in early colorectal cancer (1995)
    Springer
    Diseases of the colon & rectum 38 (1995), S. 1176-1181 
    Details
    ISSN: 1530-0358
    Keywords: Colorectal cancer ; p53 nuclear overexpression ; immunohistochemistry
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was designed to determine if p53 nuclear overexpression, as detected by immunohistochemistry, is a marker of prognostic significance in early (Stage I) colorectal cancer (CRC). METHODS: Tissue sections obtained from archival blocks of 66 patients with surgically treated Stage 1 CRC were stained immunohistochemically for p53 using a monoclonal antibody (PAB 1801-Ab2). Differences in survival between p53 positive (p53+) and p53 negative (p53−) groups were compared using Kaplan-Meier survival curves and the log-rank test. RESULTS: Thirtyfour patients (51.5 percent) were p53+ and 32 (48.5 percent) were p53−. There were significantly more p53+ tumors in females (23 of 34) compared with males (11 of 34) (P=0.01). Follow-up ranged from 1 to 128.5 (mean, 44.7; median, 38.2) months. Thirteen patients (197 percent) developed recurrence, of whom five died of disease. Univariate analysis of clinical and pathologic variables did not reveal any statistically significant differences between p53+ and p53− tumors. Mean actuarial survival was longer (48.2 months) in the p53− group compared with the p53+ group (41.5 months). However, comparison of survival curves using the log-rank test did not show a statistically significant difference in survival (log-rank chi-squared=0.2; P=0.6). CONCLUSION: p53 nuclear overexpression does not appear to be an independent marker of prognostic significance in surgically treated early CRC. Females were more likely to have p53+ tumors. The biologic significance of this finding is unknown.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02048333
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  • 3
    Electronic Resource
    Electronic Resource
    Clustering of colorectal cancer in families of probands under 40 years of age (1996)
    Springer
    Diseases of the colon & rectum 39 (1996), S. 1004-1007 
    Details
    ISSN: 1530-0358
    Keywords: Familial ; Colorectal cancer ; Clustering ; Young probands
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Although sporadic colorectal cancer (CRC) is relatively uncommon in the young, it may constitute an elevated genetic risk for CRC in these individuals. PURPOSE: This study was designed to determine extent of colorectal cancer in families of probands under 40 years of age. METHODS: Medical records of all consecutive patients, 40 years of age or younger at the time of CRC surgery, during the time period 1986 to 1994 were examined. Cases of familial adenomatous polyposis and ulcerative colitis were excluded.Via interviews of surviving probands or nearest relatives, dates of birth and death, causes of death, and diagnosis of cancer were recorded on all first-degree relatives (parents, siblings, and offspring), second-degree relatives (grandparents, aunts, and uncles), and any other relatives. RESULTS: A total of 128 patients, 40 years of age or less at time of CRC resection, were identified. Of these, 45 probands/families were reached by phone, and 45 detailed family histories were obtained. Age range of these 45 probands was 19 to 40 (mean, 33.1) years. In 25 families there was no history of CRC in first-degree, second-degree, or third-degree relatives. Eight of 45 probands (17.8 percent) had at least one first-degree relative with CRC, and three of these eight families fulfilled the Amsterdam criteria for hereditary nonpolyposis colorectal cancer (HNPCC). In all three families, inheritance of CRC appeared to segregate with the maternal side of the family. In addition, 5 of 43 non-HNPCC probands had at least one first-degree, second-degree, or third-degree relative less than 40 years of age, at time of CRC diagnosis. CONCLUSION: Ascertainment of a detailed family history in early age of onset CRC patients identifies frequent familial clustering of CRC and HNPCC in 17.8 percent of cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02054690
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  • 4
    Electronic Resource
    Electronic Resource
    Sphincter preservation of leiomyosarcoma of the rectum and anus with local excision and brachytherapy (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1296-1299 
    Details
    ISSN: 1530-0358
    Keywords: Leiomyosarcoma ; Rectal cancer ; Brachytherapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to determine the outcome of patients with leiomyosarcoma of the rectum or anus treated with local excision and brachytherapy. METHODS: Eight patients with leiomyosarcoma of the rectum (7 patients) or anus (1 patient) were treated with a transanal excision followed by a temporary iridium-192 interstitial implant to 4,500 cGy. Median tumor size was 4.2 (range, 1.5–5) cm. Margins were positive in six patients, negative in one patient, and close in one patient. RESULTS: With a median follow-up of 53 months, median survival time was 53 months and the three-year actuarial survival rate was 71 percent. The cumulative incidence of failure as a component of failure for local was 25 percent (2/8), for abdominal was 0 percent (0/8), and for distant was 25 percent (2/8). Four patients eligible for functional analysis all had excellent sphincter function (1–2 bowel movements per day, no soilage). CONCLUSION: In selected patients the use of conservative surgery followed by brachytherapy is a reasonable alternative to an abdominoperineal resection. However, more experience and longer follow-up are needed before this approach can be recommended routinely.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234218
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  • 5
    Electronic Resource
    Electronic Resource
    Abdominal wall recurrence after colorectal resection for cancer (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 628-632 
    Details
    ISSN: 1530-0358
    Keywords: Colorectal carcinoma ; Abdominal wall recurrence ; Surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Disease recurrence in the abdominal wall from a primary colorectal cancer is a poorly studied and little understood phenomenon that has received renewed attention after the recognition of port site metastases in patients after laparoscopic colorectal resections. The purpose of the present study was to define the clinical, pathologic, and management issues in patients with abdominal wall metastases from colorectal cancer. METHODS: Patients presenting to Memorial Sloan-Kettering Cancer Center with a diagnosis of colorectal cancer were entered into a prospective database beginning in 1986. Review of this database showed that 31 patients presenting with recurrent disease in the abdominal wall were managed surgically at the institution between 1986 and 1998. RESULTS: A total of 31 patients (19 males) with a median age of 67 (range, 45–86) years presented with recurrent disease between 7 and 183 (median, 24) months after primary surgery. Primary tumors were located in the right colon in 17 patients, left colon in 2 patients, sigmoid colon in 7 patients, and rectum in 3 patients. Nineteen percent of primary tumors were perforated, 45 percent were poorly differentiated, 92 percent were transmural (T3 or T4), and 51 percent had lymph node metastases at presentation. Twenty-two patients presented with a symptomatic abdominal wall mass, whereas recurrence in the abdominal wall was found incidentally in 9 patients undergoing laparotomy. Four patients had isolated abdominal wall disease, whereas the remaining 27 were found to have associated intra-abdominal disease. Six patients who were left with residual intra-abdominal cancer after abdominal wall resection had a median survival time of four months. Twenty-five patients underwent a histologically complete resection of recurrence restricted to the abdominal wall alone (n=4; median survival time, 18 months), abdominal wall and in continuity resection of adherent viscera (n=15; median survival time, 12.5 months), or resection of abdominal wall and intra-abdominal recurrence at a distant site (n=6; median survival time, 22 months, although only 1 patient remained alive with disease). The actual two-year and five-year disease-free survival rates were 16 and 3 percent, respectively. CONCLUSION: Abdominal wall metastases are often indicators of recurrent intra-abdominal cancer; however, aggressive resection in patients with disease restricted to the abdominal wall and associated adherent viscera can result in local disease control with little morbidity and no mortality.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02235576
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  • 6
    Electronic Resource
    Electronic Resource
    Factors predictive of persistent or recurrent Crohn's disease in excluded rectal segments (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 768-772 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Excluded rectum ; Anal Crohn's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The fate of the excluded rectal segment after surgery for Crohn's colitis remains poorly defined. To determine prognostic factors relating to the fate of the rectal segment, records of 47 patients who underwent creation of an excluded rectal segment were studied. Disease developed in 33 patients (70 percent) in the excluded rectal segment by five years; 24 patients (51 percent) had completion proctectomy by 2.4 years; and 9 patients (19 percent) retained a rectum with disease at a median follow-up period of five years (range, 2–13 years). At a median follow-up time of six years (range, 2–21 years), 14 patients were without clinical disease. The three groups were equivalent with respect to sex, duration of preoperative disease, indication for operation, distribution of disease, and histologic involvement of the proximal rectal margin. The median age of patients in the proctectomy group at diagnosis tended to be younger than that of patients with a retained excluded rectal segment (22, 30, and 31 years for patients having proctectomy, patients with a diseased excluded rectal segment, and patients with a normal excluded rectal segment, respectively). Neither initial involvement of the terminal ileum nor endoscopic inflammatory changes seen in the rectum predicted eventual disease of the excluded rectal segment. However, initial perianal disease complicating Crohn's colitis was predictive of persistent excluded rectal segment disease and often required proctectomy. Therefore, because the presence of perianal disease and Crohn's colitis predicts persistent or recurrent excluded rectal segment disease, primary total proctocolectomy or early completion proctectomy may be indicated in this subgroup of patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050327
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  • 7
    Electronic Resource
    Electronic Resource
    Preliminary results of preoperative 5-fluorouracil, low-dose leucovorin, and concurrent radiation therapy for clinically resectable T3 rectal cancer (1997)
    Springer
    Diseases of the colon & rectum 40 (1997), S. 515-522 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Radiation therapy ; Preoperative therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: We report the downstaging, sphincter preservation, acute toxicity, and preliminary local control and survival results of preoperative 5-fiuorouracil (5-FU), low-dose leucovorin (LV), and concurrent radiation therapy followed by postoperative LV/5-FU for treatment of patients with clinically resectable T3 rectal cancer. MATERIALS AND METHODS: A total of 32 patients received two monthly cycles of preoperative LV/5-FU (bolus daily×5). Radiation therapy (5,040 cGy) began concurrently on day 1. Postoperatively, patients received a median of two monthly cycles of LV/5-FU (range, 0–10). RESULTS: The complete response rate was 9 percent pathologic and 13 percent clinical, for a total of 22 percent. Total Grade 3+ acute toxicity during the preoperative combined modality segment was 25 percent (8/32). Of the 20 patients who were thought to initially require an abdominoperineal resection and for whom the intent of treatment was sphincter preservation, 17 (85 percent) were able to undergo sphincter-preserving surgery. With a median follow-up of 22 (3–59) months, none have developed local failure, and the three-year actuarial diseasefree survival rate was 60 percent. CONCLUSION: Our data reveal encouraging downstaging, sphincter preservation, and acute toxicity with this regimen. Additional follow-up is needed to assess the long-term local control and survival rates.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02055370
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  • 8
    Electronic Resource
    Electronic Resource
    Major 20th-century advancements in the management of rectal cancer (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 563-578 
    Details
    ISSN: 1530-0358
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Conclusions At the beginning of the century, rectal cancer was a deadly disease treated simply by perineal excision. With advances in pathologic staging, preoperative assessment, surgical technique, and CMT made in the last century, we have witnessed improved oncologic and functional results after treatment of rectal cancer. As we look to the future, the use of molecular markers may help identify patients with node-negative disease yet aggressive biology in need of adjuvant therapy. It is also anticipated that improvements in various imaging modalities may better select patients for local procedures or preoperative adjuvant therapy. Further-more, ongoing progress in our understanding of pelvic anatomy and neurophysiology should improve preservation of both genitourinary and sphincter function.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234129
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  • 9
    Electronic Resource
    Electronic Resource
    Colonoscopic screening for neoplasms in asymptomatic first-degree relatives of colon cancer patients (1992)
    Springer
    Diseases of the colon & rectum 35 (1992), S. 523-529 
    Details
    ISSN: 1530-0358
    Keywords: Colonoscopy ; Asymptomatic ; Adenomas ; Familial ; Prospective ; Controlled study
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Individuals with a family history of colorectal cancer are believed to be at an increased risk of developing colorectal neoplasia. To estimate this risk and the potential yield of screening colonoscopy in this population, we recruited and prospectively colonoscoped 181 asymptomatic first-degree relatives (FDR) of colorectal cancer patients and 83 asymptomatic controls (without a family history of colorectal cancer). The mean ages for the FDR and control groups were 48.2 ± 12.5 and 54.8 ± 11.0, respectively. Adenomatous polyps were detected in 14.4 percent of FDRs and 8.4 percent of controls. Although 92 percent of our FDRs had only one FDR afflicted with colon cancer, those subjects with two or more afflicted FDRs had an even higher risk of developing colonic adenomas (23.8 percent) than those with only one afflicted FDR (13.1 percent). A greater proportion of adenomas was found to be beyond the reach of flexible sigmoidoscopy in the FDR group than in the controls (48 percent vs.25 percent, respectively). Logistic regression analysis revealed that age, male sex, and FDR status were independent risk factors for the presence of colonic adenomatous polyps (RR=2.32, 2.86, and 3.49, respectively;P 〈0.001). Those at greatest risk for harboring an asymptomatic colonic adenoma are male FDRs over the age of 50 (40 percent ts.20 percent for age-matched male controls). Based on probability curves, males with one FDR afflicted with colon cancer appear to have an increased risk of developing a colonic adenoma beginning at 40 years of age. Our results document, for the first time, an increased prevalence of colonoscopically detectable adenomas in asymptomatic first-degree relatives of colon cancer patients, as compared with asymptomatic controls, and support the use of colonoscopy as a routine screening tool in this high-risk group.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02050530
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  • 10
    Electronic Resource
    Electronic Resource
    All patients with small intramural rectal cancers are at risk for lymph node metastasis (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 881-885 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Metastasis ; Lymph nodes ; Local excision
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Although local excision can be curative in patients with early-stage rectal cancer, approximately 20 percent of patients will develop local recurrence, many as a result of unrecognized and unresected regional lymph node metastases. Our objective was to determine if standard pathologic factors can predict lymph node metastases in small intramural rectal cancers and provide a basis for patient selection for nonradical surgery. METHODS: Between June 1986 and September 1996, 318 patients with T1 or T2 rectal cancers underwent radical resection at our institution. Of these, 159 patients (48 T1 and 111 T2) were potentially eligible for curative local excision (≤4 cm in size, ≤10 cm from the anal verge, no synchronous metastases), and the prevalence of lymph node metastases based on T stage and other pathologic factors was analyzed in this group. RESULTS: The overall frequency of lymph node metastasis was 15 percent (24/159 patients). T stage (T1, 10 percent; T2, 17 percent), differentiation (well-differentiated or moderately differentiated, 14 percent and poorly differentiated, 30 percent), and lymphatic vessel invasion (lymphatic vessel invasion-negative, 14 percent and lymphatic vessel invasion-positive, 33 percent) influenced the risk of lymph node metastasis. However, only blood vessel invasion (blood vessel invasion-negative, 13 percent and blood vessel invasion-positive, 33 percent) reached statistical significance as a single predictive factor (P=0.04). Tumors with no adverse pathologic features (low-risk group) had a lower overall frequency of lymph node metastasis (11 percent) compared with the remaining tumors (high-risk group, 31 percent;P=0.008). However, even in the most favorable group (T1 cancers with no adverse pathologic features) lymph node metastases were present in 7 percent of patients. CONCLUSION: In rectal cancer patients potentially eligible for local excision, the overall risk of undetected and untreated lymph node metastases is considerable (15 percent). The use of pathologic factors alone after local excision does not reliably assure the absence of lymph node metastases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237095
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