• Humans
• Colorectal Neoplasms/diagnosis
• Colorectal Neoplasms/prevention & control
• Colorectal Neoplasms/therapy
• China
• Early Detection of Cancer/methods

• colon
• rectum
• surgery
• radiology

• Gastrointestinal tract
• MRI
• Oncology
• Rectal adenocarcinoma
• Rectal cancer

• Humans
• Rectal Neoplasms/diagnostic imaging
• Rectal Neoplasms/therapy
• Anus Neoplasms/diagnostic imaging
• Anus Neoplasms/therapy
• Anus Neoplasms/pathology
• Rectum/pathology
• Neoplasm Staging
• Magnetic Resonance Imaging/methods
• Radiology

• P30 CA008748 NCI NIH HHS

• Local excision
• Minimally invasive transanal surgery
• Rectal cancer
• Rectal tumor
• Transanal surgery

• Humans
• Retrospective Studies
• Treatment Outcome
• Rectal Neoplasms/surgery
• Rectal Neoplasms/pathology
• Digestive System Surgical Procedures/methods
• Minimally Invasive Surgical Procedures/methods

Transanal endoscopic microsurgery (TEM) is an organ-preserving treatment alternative for patients with early rectal cancer. However, TEM alone is associated with greater risk of local recurrence and inferior survival in comparison with total meso-rectal excision (TME). As an important adjuvant therapy, radiotherapy can effectively reduce the local recurrence rate of rectal cancer. This study aimed to investigate whether TEM followed by radiotherapy can be a valid alternative to TME in T2N0M0 distal rectal cancer treatment.

We plan to recruit 168 participants meeting established inclusion criteria. Following informed consent, participants will randomly receive treatment protocols of TEM followed by radiotherapy (a total dose of 45–50.4 Gy given in 25–28 factions) or TME. Depending on post-operative pathology, the participants will receive either long-term follow-up or further treatment. The primary endpoint of this trial is 3-year local recurrence rate. The secondary end points include 3-year disease-free survival rate, 3-year overall survival rate, 3-year mortality rate, post-operative quality of life, post-operative safety index, intraoperative evaluation index and post-operative short-term evaluation index.

This trial is the first prospective randomized trial to investigate the rectum preserving treatment by using transanal local excision followed by radiotherapy.

The trial was prospectively registered at ClinicalTrials.gov NCT04098471 on September 20, 2019.

Colorectal malignant polyps (MP) are polyps with invasive cancer into the submucosa harboring a variable risk of lymph node involvement, which can be estimated through evaluation of morphological, endoscopic, and histologic features. The recent advances in imaging endoscopic techniques have led to the possibility of performing an optical diagnosis of T1 colorectal cancer, allowing the selection of the best therapeutic modality to optimize outcomes for the patient. When MP are diagnosed after endoscopic removal, their management can be challenging. Differentiating low- and high-risk histologic features that influence the possibility of residual tumor, the risk of recurrence and the risk of lymph node metastasis, is crucial to further optimize treatment and surveillance plans. While the presence of high-risk features indicates a need for surgery in the majority of cases, location, comorbidities and the patient’s preference should be taken in account when making the final decision. This is a particularly important issue in the management of low rectal MP presenting with high-risk features, where chemoradiotherapy followed by a watch-and-wait strategy has demonstrated promising results. In this review we discuss the important prognostic features of MP and the most modern approaches regarding their management.

• Colorectal malignant polyp
• colorectal cancer
• endoscopic resection
• surveillance

Anorectal melanoma is a rare neoplasm with a poor prognosis. The surgical approaches for anorectal melanoma can be categorized into local excision (procedures without lymph node removal and preservation of the rectum) and extensive resection (procedures with rectum and pararectal lymph node removal). The aim of this systematic review and meta-analysis was to compare the survival of patients who underwent extensive resection with that of patients who underwent local excision, stratifying patients according to tumour stage.

A literature review was performed according to PRISMA guidelines by searching MEDLINE/PubMed for manuscripts published until March 2021. Studies comparing survival outcomes in patients with anorectal melanoma who underwent local excision versus extensive resection were screened for eligibility. Meta-analysis was performed for overall survival after the different surgical approaches, stratified by tumour stage.

There were 347 studiesidentified of which 34 were included for meta-analysis with a total of 1858 patients. There was no significant difference in overall survival between the surgical approaches in patients per stage (stage I odds ratio 1.30 (95 per cent c.i. 0.62 to 2.72, P = 0.49); stage II odds ratio 1.61 (95 per cent c.i. 0.62 to 4.18, P = 0.33); stage I–III odds ratio 1.19 (95 per cent c.i. 0.83 to 1.70, P = 0.35). Subgroup analyses were conducted for the time intervals (<2000, 2001–2010 and 2011–2021) and for continent of study origin. Subgroup analysis for time interval and continent of origin also showed no statistically significant differences in overall survival.

No significant survival benefit exists for patients with anorectal melanoma treated with local excision or extensive resection, independent of tumour stage.

• chemoradiation
• elderly patients
• geriatric oncology
• outcomes
• rectal cancer

We evaluated the predictive value of semiquantitative volumetric parameters derived from sequential PET/CT and developed a nomogram to predict pathological complete response (pCR) in patients with rectal cancer treated by neoadjuvant chemoradiotherapy (nCRT). From April 2008 to December 2013, among the patients who underwent nCRT, those who were taken sequential PET/CT before and after nCRT were included. MRI-based staging and semiquantitative parameters of PET/CT including standardized uptake value (SUV), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) were evaluated before and after nCRT. Multivariable analysis was performed to select significant predictors to construct a nomogram. Sensitivity, specificity, accuracy, and area under the receiver operating characteristics curve (AUC) of the model were evaluated to determine its performance. Among 137 eligible patients, 17 (12.4%) had pCR. All post-PET/CT parameters showed significant differences between pCR and non-pCR groups. Patients were randomly assigned to a training group (91 patients) and a validation group (46 patients). In multivariable analysis with the training group, post-CEA, post-MRI T staging, post-SUV_max, and post-MTV were significantly associated with pCR. There was no significant pre-nCRT variable for predicting pCR. Using significant predictors, a nomogram was developed. Sensitivity, specificity, accuracy, and AUC of the nomogram were 0.882, 0.808, 0.848, and 0.884 with the training group and 0.857, 0.781, 0.783, and 0.828 with the validation group, respectively. This model showed the better performance than other predictive models that did not contain PET/CT parameters. A nomogram containing semiquantitative post-PET/CT could effectively select candidates for organ-sparing strategies.

• PET/CT
• locally advanced rectal cancer (LARC)
• neoadjuvant chemoradiotherapy
• nomogram
• pathological complete response (pCR)

The transsacrococcygeal (TSC) approach in rectal gastrointestinal stromal tumour (GIST) resection is clinically challenging and controversial, and we evaluated its value in the present study.

We enrolled patients who underwent rectal GIST resection by the TSC approach during 2008–2018. The clinicopathological index, surgical outcome, and prognosis were analysed. Prognostic information was obtained from medical records and follow-up data. Anal function was evaluated by the low anterior resection syndrome (LARS) score.

Among 88 rectal GIST patients over the 10-year study period, 17 who underwent the TSC approach were analysed. The median age was 55 (range, 26–73) years. In total, 15 patients received preoperative imatinib neoadjuvant therapy for 232 (30–690) days. The tumours were exogenous in 14 patients and intramural in 3 patients. The mean initial tumour size and preoperative tumour size were 6.4±2.2 and 4.2±1.7 cm, respectively. The operative time and blood loss were 130.2±47.4 min and 44.6±36.0 mL, respectively. Of the 17 patients 7 had postoperative complications (within 30 days postoperatively), and the complications of 5 patients were cured by conservative treatment. Only 1 patient was lost to follow-up, and the others had a good oncological prognosis at recent follow-up evaluations. All patients had LARS scores ≤9 points at 1 year after the operation.

The TSC approach can result in a good oncological prognosis, usually does not affect anal function, and is particularly suitable for exogenous middle and low rectal GISTs. However, it might cause some controlled complications. Hence, careful patient selection is necessary for this operation.

• Rectal gastrointestinal stromal tumour (rectal GIST)
• prognosis
• resection
• surgery
• transsacrococcygeal approach (TSC approach)

• adenomatous polyps
• rectum
• transanal endoscopic surgery
• proctoscopes

• Adenoma/surgery
• Aged
• Anal Canal
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local
• Proctoscopes
• Rectal Neoplasms/surgery
• Treatment Outcome

• Radiotherapy (RT)
• rectal cancer
• review

• Lexicon
• MRI
• Rectal cancer
• Society of Abdominal Radiology Rectal & Anal Cancer Disease-Focused Panel
• Staging

• Anal Canal/anatomy & histology
• Anus Neoplasms/diagnostic imaging
• Anus Neoplasms/pathology
• Anus Neoplasms/therapy
• Consensus
• Humans
• Lymphatic Metastasis/diagnostic imaging
• Neoplasm Staging
• Rectal Neoplasms/diagnostic imaging
• Rectal Neoplasms/pathology
• Rectal Neoplasms/therapy
• Rectum/anatomy & histology
• Societies, Medical
• Terminology as Topic

• R01 CA212148 NCI NIH HHS

• Early rectal cancer
• local excision rectal cancer

• Rectal Neoplasms
• Transanal Endoscopic Microsurgery
• Transanal Minimally Invasive Surgery

• Chemoradiotherapy
• Rectal neoplasm
• Recurrence
• Total regression

• 1-day surgery
• Morbidity
• Risk factors
• TEM

A sentinel lymph node (SLN) tracer can gain multi-functionality by combining it with additional components. We developed a SLN tracer consisting of iodine and docetaxel and applied it as a theragnostic nanoparticle to simultaneously perform SLN computed tomography (CT) lymphography and locoregional chemotherapy of the draining lymphatic system.

Docetaxel could be loaded in iodine emulsions at a drug-to-surfactant weight ratio as high as that in the drug formulation Taxotere^®. The particle size and drug concentration were stable during storage for up to 3 months in optimized nanoemulsions. Popliteal LN enhancement on CT was observed in all healthy rabbits (n=3) and VX2 tumor-implanted rabbits (n=6) 12 hours after injection. The rate of SLN metastasis was significantly lower in the treatment group (29.4%, 5/17) than in the non-treatment group (70.6%, 12/17) (P=0.038).

We prepared a nanoemulsion carrying both iodine and docetaxel in a single structure by optimizing the composition of surfactants surrounding the inner iodized oil core. CT was performed 12 hours after subcutaneous injection of the emulsion in healthy rabbits (n=3) and VX2 tumor-implanted rabbits (n=6) for SLN imaging. Next, we tested the effect of treatment by histopathologically assessing the popliteal LN metastasis rate in VX2 tumor-implanted rabbits 7 days after subcutaneous injection of the emulsion (treatment group, n=17) and comparing it with that of non-treatment group rabbits (n=17).

We developed an iodine-docetaxel emulsion and demonstrated that it can be applied to simultaneously achieve CT SLN imaging and local chemotherapy against nodal metastasis.

• computed tomography (CT)
• iodine-docetaxel emulsion
• locoregional chemotherapy
• lymph node metastasis
• sentinel lymph node

• EMR
• ESD
• TEMS
• early colorectal cancer
• full-thickness resection

• Colonic polyps
• Colorectal polyps
• Endoscopic mucosal resection
• Endoscopy
• Surgery

• diversion
• drainage
• rectal trauma
• rectum
• trauma

Over the last decade, with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer, there has been a significant increase in the literature regarding treatment options available to patients affected by this disease. That treatment related decisions should be made at a high volume multidisciplinary tumor board, after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision (TME) are accepted standard of care. More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders, which may be appropriate in 20% of patients. Patients with early T1 rectal cancers and favorable pathologic features can be cured with local excision only, with transanal minimal invasive surgery (TAMIS) because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon, emerging as the leading option. Recent trials have raised concerns about the oncologic outcomes of the standard “top-down” TME hence transanal TME (TaTME “bottom-up”) approach has gained popularity as an alternative. The challenges are many, with a dearth of evidence of the oncologic superiority in the long-term for any given option. However, this review highlights recent advances in the role of chemoradiation only for complete pathologic responders, TAMIS for highly selected early rectal cancer patients and TaTME as options to improve cure rates whilst maintaining quality of life in these patients, while we await the results of further definitive trials being currently conducted.

• Rectal cancer
• Watchful waiting
• Transanal minimal invasive surgery
• Transanal total mesorectal excision

• Early rectal cancer
• Rectal adenoma
• Recurrence
• Transanal endoscopic microsurgery

Trans-anal endoscopic operation (TEO) has developed to facilitate proper tumor location and ensure excision safely.

We reviewed 92 patients enrolled in our database between 2006 and 2014 who were diagnosed with early rectal tumors and who underwent conventional trans-anal excision (TAE) or TEO. Clinical data were collected prospectively to compare safety and feasibility between two techniques.

Ninety-two patients underwent trans-anal local excision for lower rectal tumors. TEO and TAE were performed in 48 and 44 patients, respectively. Age, sex, and comorbidities were similar. There was no significant difference in tumor diameter (1.6 ± 1.68 cm vs. 1.17 ± 1.17, respectively). Tumor height, however, was higher in the TEO (7.46 ± 3 cm) than the TAE group (3.84 ± 1.88 cm, p < 0.001). Four complications, perianal abscess, and two perforations, occurred in the TEO group, whereas no major complications occurred in the TAE. Seven patients (14.6%) underwent TEO underwent a salvage operation compared to only a single patient in TAE group (2.3%, p = 0.039). Eight patients (17.4%) diagnosed with adenocarcinoma developed recurrence, four in each group. Disease-free survival was similar between groups (TEO – 41.8 months, 95% RI 39.4–44.1; TAE 79.7 months, 95% RI 72.2–87.3). However, more TAE patients (n = 7, 15.9%) than TEO patients (n = 2, 4.2%) underwent chemotherapy.

TEO treatment of local rectal tumors is safe and feasible and can achieve an adequate resection margin. Local recurrence was similar in both groups. However, the numbers of salvage operations and minor complications were higher in the TEO group.

•

TEO is treatment modality of choice in addressing lower rectal lesions.

• Rectal tumors
• Trans-anal endoscopic operation
• Trans-anal excision operation