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PubMed - Anal Cancer (93 unread)

Provinces weighing HPV vaccination of boys.

Fetched: May 24th, 2012, 11:00pm MDT

Provinces weighing HPV vaccination of boys.

CMAJ. 2012 Mar 20;184(5):E250-1

Authors: Eggertson L

PMID: 22371513 [PubMed - indexed for MEDLINE]

Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach.

Fetched: May 20th, 2012, 11:00pm MDT

Short-term outcomes of laparoscopic intersphincteric resection for lower rectal cancer and comparison with open approach.

Dig Surg. 2011;28(5-6):404-9

Authors: Yamamoto S, Fujita S, Akasu T, Inada R, Takawa M, Moriya Y

Abstract
BACKGROUND/AIMS: To evaluate the short-term surgical outcomes of laparoscopic intersphincteric resection (ISR) for lower rectal cancer, and to compare them with a case-control series of open ISR.
METHODS: Between July 2002 and March 2011, 29 patients with lower rectal cancer underwent laparoscopic ISR, and 22 of 29 patients who underwent laparoscopic ISR were compared with the control open ISR group of patients matched for age, gender, operative procedure and pathological stage.
RESULTS: There was no perioperative mortality, 8 complications occurred in 7 patients, and the morbidity rate was 24.1% (7/29). Leakage occurred in 1 patient (3.4%) in the laparoscopic ISR group. Regarding the matched case-control study, the operative time was significantly longer (p = 0.0007), but blood loss was significantly lower (p = 0.0003) in the laparoscopic ISR group. The median postoperative hospital stay was 8 days in the laparoscopic ISR group, which was significantly shorter than in the open ISR group (14 days). Postoperative complication rates were similar. In the laparoscopic ISR group, the levels of C-reactive protein on postoperative days 1-3 were significantly lower than in the open ISR group.
CONCLUSIONS: Laparoscopic ISR for lower rectal cancer provides benefits in the early postoperative period without increasing morbidity or mortality.

PMID: 22189000 [PubMed - indexed for MEDLINE]

Role of Positron Emission Tomography-Computed Tomography in the Management of Anal Cancer.

Fetched: May 19th, 2012, 11:00pm MDT

Role of Positron Emission Tomography-Computed Tomography in the Management of Anal Cancer.

Int J Radiat Oncol Biol Phys. 2012 May 15;

Authors: Mistrangelo M, Pelosi E, Bellò M, Ricardi U, Milanesi E, Cassoni P, Baccega M, Filippini C, Racca P, Lesca A, Munoz FH, Fora G, Skanjeti A, Cravero F, Morino M

Abstract
PURPOSE: Pre- and post-treatment staging of anal cancer are often inaccurate. The role of positron emission tomograpy-computed tomography (PET-CT) in anal cancer is yet to be defined. The aim of the study was to compare PET-CT with CT scan, sentinel node biopsy results of inguinal lymph nodes, and anal biopsy results in staging and in follow-up of anal cancer. METHODS AND MATERIALS: Fifty-three consecutive patients diagnosed with anal cancer underwent PET-CT. Results were compared with computed tomography (CT), performed in 40 patients, and with sentinel node biopsy (SNB) (41 patients) at pretreatment workup. Early follow-up consisted of a digital rectal examination, an anoscopy, a PET-CT scan, and anal biopsies performed at 1 and 3 months after the end of treatment. Data sets were then compared. RESULTS: At pretreatment assessment, anal cancer was identified by PET-CT in 47 patients (88.7%) and by CT in 30 patients (75%). The detection rates rose to 97.9% with PET-CT and to 82.9% with CT (P=.042) when the 5 patients who had undergone surgery prior to this assessment and whose margins were positive at histological examination were censored. Perirectal and/or pelvic nodes were considered metastatic by PET-CT in 14 of 53 patients (26.4%) and by CT in 7 of 40 patients (17.5%). SNB was superior to both PET-CT and CT in detecting inguinal lymph nodes. PET-CT upstaged 37.5% of patients and downstaged 25% of patients. Radiation fields were changed in 12.6% of patients. PET-CT at 3 months was more accurate than PET-CT at 1 month in evaluating outcomes after chemoradiation therapy treatment: sensitivity was 100% vs 66.6%, and specificity was 97.4% vs 92.5%, respectively. Median follow-up was 20.3 months. CONCLUSIONS: In this series, PET-CT detected the primary tumor more often than CT. Staging of perirectal/pelvic or inguinal lymph nodes was better with PET-CT. SNB was more accurate in staging inguinal lymph nodes.

PMID: 22592047 [PubMed - as supplied by publisher]

Permalink for 'Metabolomic analysis and identification of a role for the orphan human cytochrome P450 2W1 in selective oxidation of lysophospholipids.'

Metabolomic analysis and identification of a role for the orphan human cytochrome P450 2W1 in selective oxidation of lysophospholipids.

Fetched: May 19th, 2012, 11:00pm MDT

Metabolomic analysis and identification of a role for the orphan human cytochrome P450 2W1 in selective oxidation of lysophospholipids.

J Lipid Res. 2012 May 16;

Authors: Xiao Y, Guengerich FP

Abstract
Human cytochrome P450 (P450) 2W1 is still considered an orphan because its physiological function is not characterized. In order to identify its substrate specificity, the purified recombinant enzyme was incubated with colorectal cancer extracts for untargeted substrate searches, using an LC/MS-based metabolomic and isotopic labeling approach (Z. Tang et al. 2009. Anal. Chem. 81: 3071-3078). In addition to previously reported fatty acids, oleyl (18:1) lysophosphatidylcholine (LPC, lysolecithin) was identified as a substrate for P450 2W1. Other human P450 enzymes tested showed little activity with 18:1 LPC. In addition to the LPCs, P450 2W1 acted on a series of other lysophospholipids, including lysophosphatidylinositol, lysophosphatidylserine, lysophosphatidylglycerol, lysophosphatidylethanolamine, and lysophosphatidic acid but not diacylphospholipids. P450 2W1 utilized sn-1 18:1 LPC as a substrate much more efficiently than the sn-2 isomer, and we conclude that the sn-1 isomers of lysophospholipids are preferred substrates. Chiral analysis was performed on the 18:1 epoxidation products and showed enantio-selectivity for formation of (9S,10R) over (9R,10S). The kinetics and position specificities of P450 2W1-catalyzed oxygenation of lysophospholipids (16:0 LPC and 18:1 LPC) and fatty acids (C16:0 and C18:1) were also determined. Epoxidation and hydroxylation of 18:1 LPC are considerably more efficient than for the C18:1 free fatty acid.

PMID: 22591743 [PubMed - as supplied by publisher]

Getting to the bottom of it.

Fetched: May 19th, 2012, 11:00pm MDT

Getting to the bottom of it.

Posit Aware. 2011 Nov-Dec;23(7):43-4

Authors: Bucher G

PMID: 22558653 [PubMed - indexed for MEDLINE]

Anastomotic Leak Is Not Associated With Oncologic Outcome in Patients Undergoing Low Anterior Resection for Rectal Cancer.

Fetched: May 18th, 2012, 11:00pm MDT

Anastomotic Leak Is Not Associated With Oncologic Outcome in Patients Undergoing Low Anterior Resection for Rectal Cancer.

Ann Surg. 2012 May 11;

Authors: Smith JD, Paty PB, Guillem JG, Temple LK, Weiser MR, Nash GM

Abstract
OBJECTIVE:: To examine the association between anastomotic leak and oncologic outcome after anterior resection, stratifying for defunctioning stoma. BACKGROUND:: It has been hypothesized that anastomotic leak predisposes rectal cancer patients to local recurrence. Many have a defunctioning stoma to reduce risk of clinically significant leakage. METHODS:: The records of patients undergoing low anterior resection (1991-2010) for rectal adenocarcinoma (≤15 cm from anal verge) were retrospectively analyzed using a prospectively collected colorectal database. Data (age, gender, stage, defunctioning stoma, neoadjuvant treatment, distance from anal verge, anastomotic leak) were collected. Clinical leakage was defined as anastomotic complication requiring intervention or interventional radiology within 60 days of surgery. Estimated local recurrence, overall survival, and disease-specific survival were compared using log-rank method and Cox regression analysis. RESULTS:: 1127 patients were included, with 5.6-year median follow-up. The incidence of clinical anastomotic leak was 3.5%. Sixteen of 677 with defunctioning stoma (2.2%) developed clinical leak; 24 of 450 without stoma (6.3%) developed leak (P = 0.005). There were no perioperative deaths among patients with clinical leakage. When stratified for defunctioning stoma, there was no association between clinical leak and local recurrence, disease-free survival, or overall survival. On multivariable analysis, when controlling for neoadjuvant therapy, distance of tumor from anal verge, defunctioning stoma, and pathologic stage, clinical leak was not associated with time to local recurrence, disease-free survival, or overall survival. CONCLUSIONS:: In this cohort, anastomotic leakage was not associated with risk of local recurrence. Defunctioning stoma was associated with lower incidence of clinical leakage but not with difference in oncologic outcome. Careful patient selection for defunctioning stoma helps reduce risk of clinically significant anastomotic leak.

PMID: 22584695 [PubMed - as supplied by publisher]

[Chemoradiotherapy for anal squamous cell carcinoma].

Fetched: May 18th, 2012, 11:00pm MDT

[Chemoradiotherapy for anal squamous cell carcinoma].

Gan To Kagaku Ryoho. 2012 May;39(5):713-7

Authors: Sato H, Maeda K, Kobayashi H

Abstract
In the guidelines on American National Comprehensive Cancer Network, local excision with adequate margin is recommended as a primary treatment for patients with T1, N0, and well-differentiated anal margin cancers. Otherwise, concurrent chemotherapy using mitomycin C(10mg/m², day 1 and 29)and 5-FU(1, 000mg/m2day, continuous intravenous infusion, day 1-4 and 29-32)with radiation(total dose of 45-59 Gy)is the recommended primary treatment for all other stages of nonmetastatic anal margin and anal canal cancer. Abdominoperineal resection is performed for patients with local recurrent diseases or residual tumor after chemoradiotherapy. Chemotherapy, using cisplatin(100mg/m², day 2)and 5-FU(1, 000mg/m²/day, day 1-5)every four weeks, is recommended for patients with distant metastases, and radiotherapy can also be given for the local control of symptomatic anal lesions. Abdominoperineal resection has been performed in Japan; however, use of chemoradiotherapy is expected to increase for patients with anal squamous cell carcinoma. Clarification of the correct positioning of chemoradiotherapy using cisplatin, and the development of treatment using oral anticancer agents, are expected in the future by a clinical trial nowin progress.

PMID: 22584321 [PubMed - in process]

Do not forget to examine the genitals: a case of anal cancer and anogenital intraepithelial neoplasia in an immunocompetent man.

Fetched: May 18th, 2012, 11:00pm MDT

Do not forget to examine the genitals: a case of anal cancer and anogenital intraepithelial neoplasia in an immunocompetent man.

Int J STD AIDS. 2012 Apr;23(4):300-1

Authors: Buba A, Howard M, Stockford G, Farrands P, Richardson D

Abstract
A 46-year-old Caucasian heterosexual male was referred to a dedicated AIN clinic from colorectal multidisciplinary meeting (MDM) with AIN 3 following complete resection of anal squamous cell carcinoma (SCC). On further questioning, he revealed that he also had a lesion on his penis. Histology of the penile lesion demonstrated full thickness penile intraepithelial neoplasia (PIN 3). This case illustrates the importance of thorough genital examination in patients found to have one genital pathology.

PMID: 22581960 [PubMed - in process]

Anal human papillomavirus infection in a street-based sample of drug using HIV-positive men.

Fetched: May 18th, 2012, 11:00pm MDT

Anal human papillomavirus infection in a street-based sample of drug using HIV-positive men.

Int J STD AIDS. 2012 Mar;23(3):195-200

Authors: Cranston RD, Murphy R, Weiss RE, Da Costa M, Palefsky J, Shoptaw S, Gorbach PM

Abstract
HIV facilitates an increase in human papillomavirus (HPV)-associated conditions. HIV-positive men living in a substance use context in Los Angeles, USA, were recruited using respondent-driven sampling, completed a questionnaire and had biological samples including an anal HPV swab taken. A total of 316 evaluable men were enrolled in the study. The prevalence of any HPV, high-risk (HR) infection and multiple-type infection was highest for men who have sex with men (MSM) (93.9%, 64.6% and 29.7%, respectively). When any HPV and HR-HPV prevalence in all men was stratified by age, the youngest group had 100% and 68.2% prevalence, respectively, with similarly high rates maintained up to age 49 years. The individual's use of alcohol, marijuana, cocaine, methamphetamine or heroin was not significantly associated with anal HPV detection. In this marginalized population, high prevalence rates of anal HPV and HR-HPV occurring over a wide age range may increase the individual's risk for anal dysplasia and anal cancer.

PMID: 22581874 [PubMed - in process]

Anal margin cancer: current situation and ongoing trials.

Fetched: May 18th, 2012, 11:00pm MDT

Anal margin cancer: current situation and ongoing trials.

Curr Opin Oncol. 2012 May 11;

Authors: Jiang Y, Ajani JA

Abstract
PURPOSE OF REVIEW: To summarize the current treatment approach in managing anal margin cancer and to discuss potential emerging new strategies. RECENT FINDINGS: The management of anal margin cancer has been evolving over the past three decades. The treatment paradigm has been shifted from radical surgical resection to an organ-preservation approach. Multimodality strategies incorporating radiation or even chemoradiation are frequently considered in some cases. However, because of the rarity of the disease, the disease frequently remains an overlooked topic. At present, there is no prospective trial addressing the best clinical management of the disease. SUMMARY: The clinical course of squamous cell carcinoma of the anal margin is very different from that of the anal canal. The biology of anal margin cancer has not been actively explored and fully understood. There is a need to formulate a consensus approach for the clinical management of the disease. In addition, incorporation of new therapeutics in this disease especially in those with advanced stages should be explored.

PMID: 22581355 [PubMed - as supplied by publisher]

Permalink for 'Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes.'

Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes.

Fetched: May 18th, 2012, 11:00pm MDT

Right colon to rectal anastomosis (Deloyers procedure) as a salvage technique for low colorectal or coloanal anastomosis: postoperative and long-term outcomes.

Dis Colon Rectum. 2012 Mar;55(3):363-8

Authors: Manceau G, Karoui M, Breton S, Blanchet AS, Rousseau G, Savier E, Siksik JM, Vaillant JC, Hannoun L

Abstract
BACKGROUND: After extended left colectomy, it may be difficult to take down a well-vascularized colon into the pelvis and perform a tension-free colorectal or coloanal anastomosis. The Deloyers procedure comprising complete mobilization and rotation of the right colon while maintaining the ileocolic artery may be used in this circumstance.
OBJECTIVE: The aim of this study is to report postoperative and long-term outcomes after the Deloyers procedure as a salvage technique for colorectal anastomosis or coloanal anastomosis.
DESIGN: From a prospective database, we retrospectively reviewed all patients who underwent a Deloyers procedure.
SETTING: This study was conducted at the Colorectal Unit in a tertiary referral teaching hospital.
PATIENTS: Between 1998 and 2011, 48 consecutive patients underwent a Deloyers procedure. Indications were as following: Hartmann reversal (n = 17), previous colorectal anastomosis-related complications (n = 11), diverticular disease (n = 6), left colon cancer (n = 6), ischemic colitis (n = 3), iterative colectomy for cancer (n = 3), rectal cancer local recurrence (n = 1), and synchronous colon cancer (n = 1).
RESULTS: There were 38 men and 10 women (median age at surgery, 67 years). Colorectal anastomosis and coloanal anastomosis were performed in 38 and 10 patients. Thirty-one patients had defunctioning stoma. Mortality and early morbidity rate was 2% and 23%. Three patients (6%) had severe complications (Dindo ≥ 3). There was no anastomotic leakage. Reoperation was required in 2 patients for intra-abdominal hemorrhage. The median hospital stay was 12 days. The median follow-up was 26 months. All patients had their ileostomy closed. Twenty-three percent of patients developed late complications. The median number of bowel movements per day was 3 (range, 1-7), but 67% of patients had fewer than 3. One patient required an ileostomy refashioning because of poor functional results, and 23% of patients routinely take loperamide-based medication.
LIMITATION: The retrospective nature of the study was a limitation.
CONCLUSIONS: The Deloyers procedure is safe, associated with low morbidity and good long-term functional results. It represents a safe alternative to total colectomy and ileorectal anastomosis.

PMID: 22469806 [PubMed - indexed for MEDLINE]

The transpubic approach for the correction of complex anorectal and urogenital malformations.

Fetched: May 18th, 2012, 11:00pm MDT

The transpubic approach for the correction of complex anorectal and urogenital malformations.

J Pediatr Surg. 2011 Dec;46(12):2316-20

Authors: Peña A, Bischoff A, Levitt MA

Abstract
BACKGROUND: The transpubic approach has been used mainly to treat urethral injuries and prostate cancer. There are no reports describing this approach in anorectal malformations.
METHODS: Forty-two patients who underwent a transpubic approach for their genitourinary/colorectal reconstruction were reviewed. Indications, complications, and follow-up were analyzed. A midline infraumbilical incision was used. The pubic cartilage was divided with needle cautery. Institutional review board approval was obtained (IRB# 2008-1317).
RESULTS: The cases included complex malformations (16), covered exstrophy (15), long urogenital sinus with normal rectum (6), and reoperations in cloacas which had been left with persistent fistulae between vagina and urinary tract with normal rectum (5). Excellent exposure was achieved in all cases, allowing successful anatomical reconstruction. Functional results varied depending on the specific type of defect but were not expected to be good due to severe congenital or acquired anatomic defects. There were 3 complications related to the transpubic approach: pubic dehiscence, suspected osteomyelitis, and bleeding.
CONCLUSION: The transpubic approach should be considered for the repair of complex anorectal and urogenital malformations, especially when adequate exposure cannot be achieved with an abdominal, perineal, or posterior sagittal approach. Another ideal indication is in patients with a normal rectum who were born with a complex urogenital sinus or underwent a failed attempted repair but were left with problems requiring reoperation in a scarred and fibrotic pelvis.

PMID: 22152873 [PubMed - indexed for MEDLINE]

[PELVIS or LUMBAR syndrome: the same entity. Two case reports].

Fetched: May 14th, 2012, 11:00pm MDT

[PELVIS or LUMBAR syndrome: the same entity. Two case reports].

Arch Pediatr. 2012 Jan;19(1):55-8

Authors: Frade F, Kadlub N, Soupre V, Cassier S, Vazquez MP, Picard A

Abstract
INTRODUCTION: The association of a pelvic hemangioma and malformations in the pelvic region are described as SACRAL or PELVIS syndrome. More recently, the acronym of LUMBAR syndrome has been used to describe the association of lower-body hemangioma and other cutaneous defects, urogenital anomalies, ulceration, myelopathy, bony deformities, anorectal malformations, arterial anomalies, and renal anomalies. We report herein 2 representative cases.
PATIENTS: Two girls presented with infantile hemangioma associated with genital malformation. One case was associated with spinal anomalies and the other one with the anus in the genital position.
CONCLUSION: Segmented hemangiomas are commonly associated with extracutaneous abnormalities. By analogy with PHACE syndrome, PELVIS/SACRAL/LUMBAR syndromes describe the association of segmented hemangioma of the lower extremities associated with other trunk or lower-body malformations. The syndrome is often incomplete.

PMID: 22099696 [PubMed - indexed for MEDLINE]

Scrotal Buschke-Lowenstein tumor in an AIDS patient.

Fetched: May 14th, 2012, 11:00pm MDT

Scrotal Buschke-Lowenstein tumor in an AIDS patient.

Sex Transm Dis. 2012 Mar;39(3):236-7

Authors: Pacha O, Pickett MM, Hebert AA

Abstract
Giant condyloma acuminatum, also known as Buschke-Lowenstein tumor, is a slow-growing neoplasm notable for its size and presentation in the anogenital region. A viral etiology suggests it should be more common in the immunocompromised; however, few reports exist in the literature. The evaluation, treatment, and role of preventative measures are reviewed.

PMID: 22337113 [PubMed - indexed for MEDLINE]

The safe distal tumour-free margin after sphincter preserving resection for rectal cancer: an ongoing debate.

Fetched: May 11th, 2012, 11:00pm MDT

The safe distal tumour-free margin after sphincter preserving resection for rectal cancer: an ongoing debate.

Colorectal Dis. 2012 Feb;14(2):131-2

Authors: Penninckx F

PMID: 22233117 [PubMed - indexed for MEDLINE]

Permalink for 'What is a safe distal resection margin in rectal cancer patients treated by low anterior resection without preoperative radiotherapy?'

What is a safe distal resection margin in rectal cancer patients treated by low anterior resection without preoperative radiotherapy?

Fetched: May 11th, 2012, 11:00pm MDT

What is a safe distal resection margin in rectal cancer patients treated by low anterior resection without preoperative radiotherapy?

Colorectal Dis. 2012 Feb;14(2):e48-55

Authors: Bernstein TE, Endreseth BH, Romundstad P, Wibe A,

Abstract
AIM: The aim of this study was to examine what constitutes an acceptable distal resection margin (DRM) when performing sphincter-saving surgery for rectal cancer without preoperative radiotherapy.
METHOD: This national study consisted of 3571 patients for whom information on DRM was available and who were radically treated by anterior resection between 1993 and 2004. Of these, 3342 (93.5%) patients had not received preoperative radiotherapy. The DRM was measured on fixed specimens.
RESULTS: The 5-year local recurrence rate was 14.5% for patients with a DRM of 0-10 mm compared to 9.6% for patients with a DRM of 11-20 mm, 8.9% for a DRM of 21-30 mm, 7.0% for a DRM of 31-40 mm, 7.7% for a DRM of 41-50 mm and 8.7% for a DRM of > 50 mm. After adjustment for other independent prognostic factors, a DRM of 0-10 mm was found to have significant impact on local recurrence. The DRM had no impact on distant metastases or overall survival.
CONCLUSION: For rectal cancer patients treated without radiotherapy, a DRM of > 10 mm is recommended.

PMID: 21831170 [PubMed - indexed for MEDLINE]

Postoperative versus definitive chemoradiation in early-stage anal cancer : Results of a matched-pair analysis.

Fetched: May 11th, 2012, 11:00pm MDT

Postoperative versus definitive chemoradiation in early-stage anal cancer : Results of a matched-pair analysis.

Strahlenther Onkol. 2012 May 10;

Authors: Berger B, Menzel M, Breucha G, Bamberg M, Weinmann M

Abstract
BACKGROUND AND PURPOSE: The goal of the present study was to comparatively assess the results of definitive chemoradiation (CRT) with or without previous macroscopically complete resection in patients with early-stage node-negative (T1-2 N0) anal carcinoma. PATIENTS AND METHODS: A total of 20 patients with T1-2 N0 anal carcinoma who received radiotherapy (RT) with or without chemotherapy following incidental R0/1 tumor resection (S/CRT group) were selected. These were matched to 20 comparable patients who underwent definitive chemoradiation without previous surgery (CRT group). Major objectives of this analysis were treatment outcomes in terms of locoregional tumor control (LRC), overall survival (OS), colostomy-free survival, and toxicity. RESULTS: Patients treated postoperatively received significantly lower RT doses (median 54.0 Gy vs. 59.7 Gy; p < 0.001) and less frequently concomitant chemotherapy than those treated definitely. The 5-year LRC and 5-year OS rates were 97.5% and 90.0%, respectively, without significant differences between the S/CRT and the CRT groups. The distribution of acute and late toxicities was comparable, and the 5-year colostomy-free survival was 95% in both groups. CONCLUSION: This matched-pair comparison of incidental R0/1 resection plus dose-reduced CRT with standard definitive CRT of early-stage anal cancer shows similar treatment results. Thus, dose-reduced RT with or without chemotherapy may be considered in R0/1 resected patients with T1-2 N0 anal carcinoma.

PMID: 22569957 [PubMed - as supplied by publisher]

Permalink for 'Expression pattern, ethanol-metabolizing activities, and cellular localization of alcohol and aldehyde dehydrogenases in human large bowel: association of the functional polymorphisms of ADH and ALDH genes with hemorrhoids and colorectal cancer.'

Expression pattern, ethanol-metabolizing activities, and cellular localization of alcohol and aldehyde dehydrogenases in human large bowel: association of the functional polymorphisms of ADH and ALDH genes with hemorrhoids and colorectal cancer.

Fetched: May 10th, 2012, 11:00pm MDT

Expression pattern, ethanol-metabolizing activities, and cellular localization of alcohol and aldehyde dehydrogenases in human large bowel: association of the functional polymorphisms of ADH and ALDH genes with hemorrhoids and colorectal cancer.

Alcohol. 2012 Feb;46(1):37-49

Authors: Chiang CP, Jao SW, Lee SP, Chen PC, Chung CC, Lee SL, Nieh S, Yin SJ

Abstract
Alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH) are principal enzymes responsible for metabolism of ethanol. Functional polymorphisms of ADH1B, ADH1C, and ALDH2 genes occur among racial populations. The goal of this study was to systematically determine the functional expressions and cellular localization of ADHs and ALDHs in human rectal mucosa, the lesions of adenocarcinoma and hemorrhoid, and the genetic association of allelic variations of ADH and ALDH with large bowel disorders. Twenty-one surgical specimens of rectal adenocarcinoma and the adjacent normal mucosa, including 16 paired tissues of rectal tumor, normal mucosae of rectum and sigmoid colon from the same individuals, and 18 surgical mixed hemorrhoid specimens and leukocyte DNA samples from 103 colorectal cancer patients, 67 hemorrhoid patients, and 545 control subjects recruited in previous study, were investigated. The isozyme/allozyme expression patterns of ADH and ALDH were identified by isoelectric focusing and the activities were assayed spectrophotometrically. The protein contents of ADH/ALDH isozymes were determined by immunoblotting using the corresponding purified class-specific antibodies; the cellular activity and protein localizations were detected by immunohistochemistry and histochemistry, respectively. Genotypes of ADH1B, ADH1C, and ALDH2 were determined by polymerase chain reaction-restriction fragment length polymorphisms. At 33mM ethanol, pH 7.5, the activity of ADH1C*1/1 phenotypes exhibited 87% higher than that of the ADH1C*1/*2 phenotypes in normal rectal mucosa. The activity of ALDH2-active phenotypes of rectal mucosa was 33% greater than ALDH2-inactive phenotypes at 200μM acetaldehyde. The protein contents in normal rectal mucosa were in the following order: ADH1>ALDH2>ADH3≈ALDH1A1, whereas those of ADH2, ADH4, and ALDH3A1 were fairly low. Both activity and content of ADH1 were significantly decreased in rectal tumors, whereas the ALDH activity remained unchanged. The ADH activity was also significantly reduced in hemorrhoids. ADH4 and ALDH3A1 were uniquely expressed in the squamous epithelium of anus at anorectal junctions. The allele frequencies of ADH1C*1 and ALDH2*2 were significantly higher in colorectal cancer and that of ALDH2*2 also significantly greater in hemorrhoids. In conclusion, ADH and ALDH isozymes are differentially expressed in mucosal cells of rectum and anus. The results suggest that acetaldehyde, an immediate metabolite of ethanol, may play an etiological role in pathogenesis of large bowel diseases.

PMID: 21940137 [PubMed - indexed for MEDLINE]

Association of Human Papillomavirus Infection and Abnormal Anal Cytology among HIV-Infected MSM in Beijing, China.

Fetched: May 7th, 2012, 11:00pm MDT

Association of Human Papillomavirus Infection and Abnormal Anal Cytology among HIV-Infected MSM in Beijing, China.

PLoS One. 2012;7(4):e35983

Authors: Yang Y, Li X, Zhang Z, Qian HZ, Ruan Y, Zhou F, Gao C, Li M, Jin Q, Gao L

Abstract
BACKGROUND: In the recent years, dramatic increases in HIV transmission among men who have sex with men (MSM) have been observed in China. Human papillomavirus (HPV) infection related anal cancer is more common among HIV-infected MSM as compared to the general population. However, HPV infection and anal cytology has been rarely studied in HIV-infected MSM in China.
METHODS: HIV-infected MSM in Beijing, China were invited to participate in this study between January and April 2011. Anal swabs were collected for examining cytology and HPV genotypes.
RESULTS: Ninety-five eligible participants with complete questionnaire and laboratory data were included in the analyses. Thirty six of them (37.9%) showed abnormal anal cytology as follows: atypical squamous cells of undetermined significance (ASC-US) in 19 (20.0%), atypical squamous cells but cannot exclude HSIL (ASC-H) in 1 (1.1%), low-grade squamous intraepithelial lesion (LSIL) in 15 (15.8%), and high-grade squamous intraepithelial lesion (HSIL) in 1 (1.1%). HPV6 (20.0%), HPV16 (10.9%), HPV56 (10.9%), HPV52 (9.1%) and HPV39 (9.1%) were observed most frequently among those with normal anal cytology, while different distribution was found in the ones with abnormal anal cytology as HPV6 (19.4%), HPV16 (19.4%), HPV45 (16.7%), HPV52 (16.7%) and HPV18 (11.1%). In addition, HPV16, HPV45, HPV52 and HPV18 were the most frequent high-risk types in patients with abnormal anal cytology. HPV multiplicity was found to be significantly related to the prevalence of abnormal anal cytology (p for trend = 0.04).
CONCLUSIONS: High prevalence of HPV infection and abnormal anal cytology was observed among HIV-infected MSM in China. Infection of multiple HPV types or high-risk types was found to be associated with an increased risk of abnormal anal cytology.

PMID: 22558293 [PubMed - in process]

Rectal transection using a curved cutter stapler with an endo-Satinsky clamp during a laparoscopic low anterior resection.

Fetched: May 5th, 2012, 11:00pm MDT

Rectal transection using a curved cutter stapler with an endo-Satinsky clamp during a laparoscopic low anterior resection.

Langenbecks Arch Surg. 2012 May 3;

Authors: Hotta T, Takifuji K, Yokoyama S, Matsuda K, Yamaue H

Abstract
PURPOSE: A new rectal transaction method was developed using a combination of the curved cutter stapler and endo-Satinsky clamp because of the difficulty in performing rectal transection in the narrow pelvic cavity. METHODS: The endo-Satinsky clamp is inserted without a flexible trocar cannula by connecting the handle extra-abdominally with a shaft of the endo-Satinsky clamp through the left higher quadrant port via a retrograde course from a midline incision above the pubis symphysis. The endo-Satinsky clamp is used to clamp the rectal wall horizontally at the distal end of the tumor. The wrist of an elastic surgical glove fixed with the shaft of the curved cutter stapler is covered with a midline incision, and consequently, the stapler is inserted into the pelvic cavity. The curved head of the stapler is rotated to the left at the anal side of the endo-Satinsky clamp to insert the rectum between the jaws of the stapler. The stapler is closed and fired, and a rectal transection is thus performed with one firing using a single cartridge. RESULTS: This method was performed in 12 patients with rectal cancer. The median value and range of the tumor distance from the anal verge were 7.0 and 4.5-11.0 cm, respectively. The median duration of the operation was 252 min, and the median blood loss was 15 mL. Only one stapling cartridge was used for rectal transection in all cases, and no major complications were observed. CONCLUSIONS: We herein demonstrated a new transection method for rectal cancer.

PMID: 22552609 [PubMed - as supplied by publisher]

Cytologically atypical anal sac adenocarcinoma in a dog.

Fetched: May 5th, 2012, 11:00pm MDT

Cytologically atypical anal sac adenocarcinoma in a dog.

Vet Clin Pathol. 2012 May 2;

Authors: Sakai H, Murakami M, Mishima H, Hoshino Y, Mori T, Maruo K, Yanai T

Abstract
A 10-year-old intact female Shetland Sheepdog with tenesmus had a subcutaneous mass at the left ventral aspect of the anus. On cytologic examination, 2 types of cells were observed. Most of the cells were oval to polygonal and had elliptical or elongate nuclei and a moderate amount of pale to basophilic cytoplasm. The remaining cells had round to oval nuclei and pale to basophilic cytoplasm. Cells of both types were loosely adhered to each other and were arranged in rosette-like structures. Both neoplastic cell types had fine homogenous chromatin and either a small indistinct nucleolus or no visible nucleolus. Mild anisokaryosis and anisocytosis were observed. Histologically, the mass consists of glandular structures formed by cuboidal cells admixed with bundles of spindle cells. Eosinophilic PAS- and Alcian blue-positive secretory material was found in the center of some glandular structures. Both neoplastic cell types had positive staining with paradoxical concanavalin A and expressed cytokeratin, but not vimentin, S-100, α-smooth muscle actin, or desmin. Based on location and histologic and immunohistochemical features, the final diagnosis was adenocarconoma of the apocrine gland of the anal sac, which should be included as a cytologic differential diagnosis when spindle cells and typical epithelial cells are observed in masses in the region of the anal sac of dogs.

PMID: 22551298 [PubMed - as supplied by publisher]

A prophylactic quadrivalent vaccine for the prevention of infection and disease related to HPV-6, -11, -16 and -18.

Fetched: May 5th, 2012, 11:00pm MDT

A prophylactic quadrivalent vaccine for the prevention of infection and disease related to HPV-6, -11, -16 and -18.

Expert Rev Vaccines. 2012 Apr;11(4):395-406

Authors: Goldstone SE, Vuocolo S

Abstract
Human papillomavirus infection causes cervical cancer, a significant portion of anal, genital and oropharyngeal cancers, genital warts and recurrent respiratory papillomatosis. In June 2006, a quadrivalent human papillomavirus-6/11/16/18 vaccine (GARDASIL/SILGARD®; Merck, NJ, USA) was licensed in the USA; subsequent approval has been granted in the EU (September 2006). It has since been approved in 121 countries with over 74 million doses distributed globally as of March 2011.

PMID: 22551023 [PubMed - in process]

Permalink for 'Abdominoperineal resection without an abdominal incision for rectal cancer has the advantage of no abdominal wound complication and easier stoma care.'

Abdominoperineal resection without an abdominal incision for rectal cancer has the advantage of no abdominal wound complication and easier stoma care.

Fetched: May 3rd, 2012, 11:00pm MDT

Abdominoperineal resection without an abdominal incision for rectal cancer has the advantage of no abdominal wound complication and easier stoma care.

Am Surg. 2012 Feb;78(2):166-70

Authors: Hsu TC

Abstract
Abdominoperineal resection has been used for years for the management of low rectal cancer. However, the abdominal incision is associated with many complications and causes interference of the stoma care. If the abdominal incision can be avoided, it would be beneficial to the patient. The aim of the study is to evaluate the possibility and safety of performing abdominoperineal resection and the oncology result without an abdominal incision. From September 2001 to May 2010, 40 patients with rectal malignancies received excision of the rectum, anus, and perineum through a perineal incision and a skin hole created for stomy. No harmonic scalpel or laser was used during surgery. No laparoscope or hand port was used in the procedure. There were 19 males and 21 females. Age ranged from 31 to 87 years old (average, 62.9 years). There were 39 adenocarcinomas and one malignant gastrointestinal stromal cell tumor. There was no operative mortality. Six patients had postoperative complications; three patients had intestinal obstructions; and one patient each had bleeding, urinary tract infection, and colostomy separation from the skin. The lymph nodes in the specimens ranged from 9 to 33 cm (average, 16.8 cm). The survival is similar to the traditional abdominoperineal resection. This limited experience suggests that an abdominal incision is not necessary for radical resection of the rectum, anus, and perineum in patients with low-lying rectal cancer. It also offers the patient easier care of stoma without interference of the abdominal incision.

PMID: 22369824 [PubMed - indexed for MEDLINE]

Feasibility of transanal minimally invasive surgery for mid-rectal lesions.

Fetched: May 2nd, 2012, 11:00pm MDT

Feasibility of transanal minimally invasive surgery for mid-rectal lesions.

Surg Endosc. 2012 Apr 28;

Authors: Lim SB, Seo SI, Lee JL, Kwak JY, Jang TY, Kim CW, Yoon YS, Yu CS, Kim JC

Abstract
BACKGROUND: Transanal minimally invasive surgery (TAMIS) has emerged as an alternative to transanal endoscopic microsurgery. We assessed the feasibility of TAMIS for lesions located in the mid rectum. METHODS: From July 2010 to October 2011, 16 consecutive patients with rectal pathology underwent TAMIS. After a single-incision laparoscopic surgery port was introduced into the anal canal, pneumorectum was established with a laparoscopic device, followed by transanal excision with conventional laparoscopic instruments, including graspers, monopolar electrocautery, and needle drivers. Clinicopathological findings, surgical procedure results, and perioperative outcomes were determined prospectively. RESULTS: Of the 16 patients, 11 had rectal cancers (3 T1 lesions and 8 after preoperative chemoradiotherapy), 4 had neuroendocrine tumors, and 1 had a mucocele. The median length of the lesions from anal verge was 7.5 cm (range 4-10 cm). All procedures were completed laparoscopically without conversion to conventional transanal approach. The median operating time was 86 min (range 33-160 min), and the median estimated blood loss was 15 ml (range 0-150 ml) with no patient requiring intraoperative transfusions. There was no surgical morbidity or mortality, but one patient died during follow-up due to synchronous advanced gastric cancer. The median postoperative hospital stay was 3 days (range 2-6 days). CONCLUSIONS: TAMIS seems to be a feasible and safe treatment option for lesions located in the mid rectum.

PMID: 22543995 [PubMed - as supplied by publisher]

IMRT treatment of anal cancer with a scrotal shield.

Fetched: April 30th, 2012, 11:00pm MDT

IMRT treatment of anal cancer with a scrotal shield.

Med Dosim. 2012 Apr 24;

Authors: Hood RC, Wu QJ, McMahon R, Czito B, Willett C

Abstract
The risk of sterility in males undergoing radiotherapy in the pelvic region indicates the use of a shielding device, which offers protection to the testes for patients wishing to maintain fertility. The use of such devices in the realm of intensity-modulated radiotherapy (IMRT) in the pelvic region can pose many obstacles during simulation, treatment planning, and delivery of radiotherapy. This work focuses on the development and execution of an IMRT plan for the treatment of anal cancer using a scrotal shielding device on a clinical patient. An IMRT plan was developed using Eclipse treatment planning system (Varian Medical Systems, Palo Alto, CA), using a wide array of gantry angles as well as fixed jaw and fluence editing techniques. When possible, the entire target volume was encompassed by the treatment field. When the beam was incident on the scrotal shield, the jaw was fixed to avoid the device and the collimator rotation optimized to irradiate as much of the target as possible. This technique maximizes genital sparing and allows minimal irradiation of the gonads. When this fixed-jaw technique was found to compromise adequate coverage of the target, manual fluence editing techniques were used to avoid the shielding device. Special procedures for simulation, imaging, and treatment verification were also developed. In vivo dosimetry was used to verify and ensure acceptable dose to the gonads. The combination of these techniques resulted in a highly conformal plan that spares organs and risk and avoids the genitals as well as entrance of primary radiation onto the shielding device.

PMID: 22538113 [PubMed - as supplied by publisher]

ACIP immunization update.

Fetched: April 30th, 2012, 11:00pm MDT

ACIP immunization update.

J Fam Pract. 2012 Mar;61(3):150-2

Authors: Campos-Outcalt D

Abstract
Males ages 11 to 12 years should routinely receive quadrivalent vaccine against human papillomavirus; patients through age 59 years who have diabetes should receive HBV vaccine routinely.

PMID: 22393553 [PubMed - indexed for MEDLINE]

Permalink for 'Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer: a planning study with clinical implications.'

Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer: a planning study with clinical implications.

Fetched: April 30th, 2012, 11:00pm MDT

Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer: a planning study with clinical implications.

Radiother Oncol. 2012 Jan;102(1):30-7

Authors: Wolff HA, Wagner DM, Conradi LC, Hennies S, Ghadimi M, Hess CF, Christiansen H

Abstract
BACKGROUND AND PURPOSE: Ongoing clinical trials aim to improve local control and overall survival rates by intensification of therapy regimen for patients with locally advanced rectal cancer. It is well known that whenever treatment is intensified, risk of therapy-related toxicity rises. An irradiation with protons could possibly present an approach to solve this dilemma by lowering the exposure to the organs-at-risk (OAR) without compromising tumor response.
MATERIAL AND METHODS: Twenty five consecutive patients were treated from 04/2009 to 5/2010. For all patients, four different treatment plans including protons, RapidArc, IMRT and 3D-conformal-technique were retrospectively calculated and analyzed according to dosimetric aspects.
RESULTS: Detailed DVH-analyses revealed that protons clearly reduced the dose to the OAR and entire normal tissue when compared to other techniques. Furthermore, the conformity index was significantly better and target volumes were covered consistent with the ICRU guidelines.
CONCLUSIONS: Planning results suggest that treatment with protons can improve the therapeutic tolerance for the irradiation of rectal cancer, particularly for patients scheduled for an irradiation with an intensified chemotherapy regimen and identified to be at high risk for acute therapy-related toxicity. However, clinical experiences and long-term observation are needed to assess tumor response and related toxicity rates.

PMID: 22112780 [PubMed - indexed for MEDLINE]

Radiotherapy and oncology.

Fetched: April 30th, 2012, 11:00pm MDT

Radiotherapy and oncology.

Radiother Oncol. 2012 Jan;102(1):161-2; author reply 162

Authors: Glynne-Jones R

PMID: 21733591 [PubMed - indexed for MEDLINE]

[Influencing factors related to lymphatic matastasis of T2 rectal carcinoma].

Fetched: April 30th, 2012, 11:00pm MDT

[Influencing factors related to lymphatic matastasis of T2 rectal carcinoma].

Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Apr;15(4):382-4

Authors: Ye JX, Zhuang JF, Huang YJ, Zheng W, Chen SQ

Abstract
OBJECTIVE: To study the risk factors associated with lymphatic metastasis of T2 rectal carcinoma.
METHODS: A consecutive series of 122 patients with T2 rectal cancer who underwent radical surgery in the First Affiliated Hospital of Fujian Medical University from 2006 to 2011 were included for retorspective analysis. Risk factors associated with lymphatic metastasis were investigated.
RESULTS: The rate of lymph node metastasis was 21.3% (26/122). Distance to anal verge(P<0.05), morphological type(P<0.05), histological type(P<0.05), tumor differentiation(P<0.05), and depth of invasion(P<0.05) were risk factors for lymph node metastasis in T2 rectal cancer by univariate analysis. The depth of invasion remained statistically significant by multivariate analysis. The rate of lymph node metastasis was 13%(7/54) in patients with shallow muscularis propria involvement, and 28%(19/68) in those with deep muscularis involvement.
CONCLUSION: For T2 rectal cancer with shallow muscularis involvement, the risk of lymph node metastasis is low and transanal excision should be considered.

PMID: 22539387 [PubMed - in process]

[Association of early diarrhea after the low anterior resection of rectal cancer and anastomotic leakage].

Fetched: April 30th, 2012, 11:00pm MDT

[Association of early diarrhea after the low anterior resection of rectal cancer and anastomotic leakage].

Zhonghua Wei Chang Wai Ke Za Zhi. 2012 Apr;15(4):357-9

Authors: Li J, Han GS, Xu YC, Zhao YZ, Ren YK, Wang GC, Zhang J

Abstract
OBJECTIVE: To evaluate the association of early diarrhea(postoperative day 1 to 7) and anastomotic leakage after low anterior resection for rectal cancer.
METHODS: Clinical data of 192 cases (group A, tumor from the anal verge 4-7 cm) from May 2004 to May 2007 and 236 cases(group B) from July 2007 to May 2010 in our hospital who received low anterior resection of rectal cancer were analyzed retrospectively.
RESULTS: In group A, the incidence of early postoperative diarrhea was 19.3%(37/192), of which 9 cases were treated with anti-diarrhea drugs. The morbidity of anastomotic leakage in patients with diarrhea was significantly higher than those without early diarrhea(16.2% vs. 5.2%, P<0.05). In group B, the incidence of early postoperative diarrhea was 16.5%(39/236). All the patients were treated with anti-diarrhea drugs. There was no difference in the morbidity of anastomotic leakage between patients with diarrhea and those without early diarrhea(16.2% vs. 5.2%, P<0.05). There was no difference in early diarrhea between groups A and B(P>0.05). However, the incidence of anastomotic leakage in patients with early diarrhea was lower in group B(P<0.05).
CONCLUSIONS: Early diarrhea after the low anterior resection of rectal cancer may indicate anastomotic leakage. Treatment of early postoperative diarrhea may reduce the risk of anastomotic leakage.

PMID: 22539380 [PubMed - in process]

Permalink for 'Prevalence of high risk genotypes of human papillomavirus in anal samples from men who have sex with men with abnormal cytology in Madrid.'

Prevalence of high risk genotypes of human papillomavirus in anal samples from men who have sex with men with abnormal cytology in Madrid.

Fetched: April 28th, 2012, 11:00pm MDT

Prevalence of high risk genotypes of human papillomavirus in anal samples from men who have sex with men with abnormal cytology in Madrid.

Enferm Infecc Microbiol Clin. 2011 Dec;29(10):780-1

Authors: Mateos ML, Gabilondo G, Hellín T, Chacón J

PMID: 21737186 [PubMed - indexed for MEDLINE]

Portal vein thrombosis after restorative proctocolectomy for familial adenomatous polyposis and sigmoid cancer.

Fetched: April 27th, 2012, 11:00pm MDT

Portal vein thrombosis after restorative proctocolectomy for familial adenomatous polyposis and sigmoid cancer.

Case Rep Gastroenterol. 2012 Jan;6(1):124-30

Authors: Meshikhes AW, Al-Ghazal T

Abstract
Postoperative portal vein thrombosis (PVT) is rare, but has been described after various open as well as minimal access abdominal operations, especially splenectomy and colorectal surgical procedures. We report the case of a 39-year-old female who underwent restorative proctocolectomy and ileal pouch-anal anastomosis for familial adenomatous polyposis with sigmoid cancer. She presented 14 days later with vague upper abdominal pain, nausea, vomiting and high output stoma. Doppler ultrasonography confirmed PVT and therefore anticoagulant therapy was started. Her condition improved dramatically and she underwent closure of ileostomy after finishing adjuvant chemotherapy. She remained well at 3-year follow-up with good pouch function and no local or distant recurrence. A high index of suspicion is essential for early diagnosis and prompt treatment of postoperative PVT after restorative proctocolectomy. Early anticoagulation is essential to avoid subsequent complications.

PMID: 22532810 [PubMed - in process]

Detection of Human Papillomavirus in Small Cell Carcinomas of the Anus and Rectum.

Fetched: April 27th, 2012, 11:00pm MDT

Detection of Human Papillomavirus in Small Cell Carcinomas of the Anus and Rectum.

Am J Surg Pathol. 2012 Apr 22;

Authors: Cimino-Mathews A, Sharma R, Illei PB

Abstract
Small cell carcinomas represent <1% of colorectal/anal carcinomas and have a poor prognosis. Anorectal squamous cell carcinomas are often associated with high-risk human papillomavirus (HPV) infection, similar to squamous and small cell carcinomas of the uterine cervix. In HPV infection, the oncoprotein E7 inactivates the tumor suppressor Rb, leading to p16 upregulation; however, in small cell carcinomas, the Rb pathway is often blocked by other mechanisms; thus, increased p16 may not indicate HPV infection. P16 immunohistochemistry (IHC) may have a limited role in evaluating small cell carcinomas for HPV infection. Formalin-fixed, paraffin-embedded tissue sections of previously diagnosed small cell carcinomas of the anus (n=5) and rectum (n=11) were subjected to IHC for p16, CDX2, and p63, followed by in situ hybridization for high-risk HPV. All (100%) cases of anal and rectal small cell carcinomas were positive for p16, and 100% of anal and 82% of rectal small cell carcinomas were positive for high-risk HPV. The majority of cases showed low or very low HPV copy numbers. In 6 cases, HPV was detected only by using the HPV-16 genotype-specific assay detecting very low copy numbers (1 to 2 viral copies). The majority of tumors expressed p63, which was more pronounced in the anal tumors. CDX2 expression was observed predominantly in rectal tumors. High-risk HPV can be detected using in situ hybridization in the majority of anorectal small cell carcinomas, which are uniformly p16 positive by IHC. HPV-targeted therapy could result in better control of these aggressive neoplasms.

PMID: 22531171 [PubMed - as supplied by publisher]

What is your diagnosis? Anal mucosal melanoma.

Fetched: April 27th, 2012, 11:00pm MDT

What is your diagnosis? Anal mucosal melanoma.

Cutis. 2012 Mar;89(3):112, 116, 140

Authors: Shoo BA, Minor DS, Venna SS

PMID: 22530326 [PubMed - indexed for MEDLINE]

Permalink for 'Induction Chemotherapy and Dose Intensification of the Radiation Boost in Locally Advanced Anal Canal Carcinoma: Final Analysis of the Randomized UNICANCER ACCORD 03 Trial.'

Induction Chemotherapy and Dose Intensification of the Radiation Boost in Locally Advanced Anal Canal Carcinoma: Final Analysis of the Randomized UNICANCER ACCORD 03 Trial.

Fetched: April 27th, 2012, 11:00pm MDT

Induction Chemotherapy and Dose Intensification of the Radiation Boost in Locally Advanced Anal Canal Carcinoma: Final Analysis of the Randomized UNICANCER ACCORD 03 Trial.

J Clin Oncol. 2012 Apr 23;

Authors: Peiffert D, Tournier-Rangeard L, Gérard JP, Lemanski C, François E, Giovannini M, Cvitkovic F, Mirabel X, Bouché O, Luporsi E, Conroy T, Montoto-Grillot C, Mornex F, Lusinchi A, Hannoun-Lévi JM, Seitz JF, Adenis A, Hennequin C, Denis B, Ducreux M

Abstract
PURPOSEConcomitant radiochemotherapy (RCT) is the standard for locally advanced anal canal carcinoma (LAACC). Questions regarding the role of induction chemotherapy (ICT) and a higher radiation dose in LAACC are pending. Our trial was designed to determine whether dose escalation of the radiation boost or two cycles of ICT before concomitant RCT lead to an improvement in colostomy-free survival (CFS). PATIENTS AND METHODSPatients with tumors ≥ 40 mm, or < 40 mm and N1-3M0 were randomly assigned to one of four treatment arms: (A) two ICT cycles (fluorouracil 800 mg/m(2)/d intravenous [IV] infusion, days 1 through 4 and 29 to 32; and cisplatin 80 mg/m(2) IV, on days 1 and 29), RCT (45 Gy in 25 fractions over 5 weeks, fluorouracil and cisplatin during weeks 1 and 5), and standard-dose boost (SD; 15 Gy); (B) two ICT cycles, RCT, and high-dose boost (HD; 20-25 Gy); (C): RCT and SD boost (reference arm); and (D) RCT and HD boost.ResultsTwo hundred eighty-three of 307 patients achieved full treatment. With a median follow-up period of 50 months, the 5-year CFS rates were 69.6%, 82.4%, 77.1%, and 72.7% in arms A, B, C, and D, respectively. Considering the 2 × 2 factorial analysis, the 5-year CFS was 76.5% versus 75.0% (P = .37) in groups A and B versus C and D, respectively (ICT effect), and 73.7% versus 77.8% in groups A and C versus B and D, respectively (RT-dose effect; P = .067). CONCLUSIONUsing CFS as our main end point, we did not find an advantage for either ICT or HD radiation boost in LAACC. Nevertheless, the results of the most treatment-intense arm B should prompt the design of further intensification studies.

PMID: 22529257 [PubMed - as supplied by publisher]

A Stepwise Approach to Transanal Endoscopic Microsurgery for Rectal Cancer Using a Single-Incision Laparoscopic Port.

Fetched: April 27th, 2012, 11:00pm MDT

A Stepwise Approach to Transanal Endoscopic Microsurgery for Rectal Cancer Using a Single-Incision Laparoscopic Port.

Ann Surg Oncol. 2012 Apr 24;

Authors: Smith RA, Anaya DA, Albo D, Artinyan A

Abstract
BACKGROUND: Radical rectal resection with total mesorectal excision is the current standard of care for the operative treatment of rectal cancer. Local excision is an acceptable alternative in selected patients with early disease (T(is)0-T(1)) and low-risk features, in whom radical resection may be associated with unacceptably high morbidity. With recent data demonstrating favorable results in well-selected patients, the role of local excision for rectal cancer is expanding.1 (,) 2 Transanal endoscopic microsurgery (TEM), which requires the use of an operating anoscope, has been used for the local excision of mid-upper rectal tumors. We describe an alternative approach to TEM for rectal cancer. METHODS: We present a stepwise technique for TEM using a single-incision laparoscopic (SILS) port. The patient is a 64 year-old male with a right anterolateral rectal polyp 7 cm from the anal verge, which on snare polypectomy demonstrated in-situ carcinoma with positive margins. Endoscopic ultrasound demonstrated uT(1) disease with no lymphadenopathy. He opted for local excision and underwent TEM. Our stepwise approach includes: (1) delineation of excision margins, (2) full thickness incision of the rectal wall, (3) circumferential dissection, and full thickness excision, and (4) suture repair. RESULTS: The procedure was performed without intraoperative or postoperative complications. Final pathology revealed in-situ carcinoma with widely negative margins. At 1- and 3-week follow-up visits, the patient was pain free with normal bowel activity and no rectal bleeding or genitourinary dysfunction. DISCUSSION: TEM using a SILS port is an effective technique for the local excision of mid-upper rectal cancer in well-selected patients.

PMID: 22526906 [PubMed - as supplied by publisher]

Permalink for 'Rationale for Reducing the Spread of Human Papillomavirus in Adolescents: Strategies to Improve Outcomes (CME Multimedia Activity).'

Rationale for Reducing the Spread of Human Papillomavirus in Adolescents: Strategies to Improve Outcomes (CME Multimedia Activity).

Fetched: April 27th, 2012, 11:00pm MDT

Rationale for Reducing the Spread of Human Papillomavirus in Adolescents: Strategies to Improve Outcomes (CME Multimedia Activity).

J Adolesc Health. 2012 May;50(5):IBC

Authors: Alexander K, Daley AM, Dempsey AF

Abstract
As detailed in this online CME activity [cmeaccess.com] human papillomavirus (HPV) infection is the cause of cervical cancer and neoplasias in women, and genital warts in men and women. In addition, 35%-85% of vaginal, vulvar, anal, penile, and oropharyngeal cancers are attributable to HPV. An estimated 80% of females and 50% of males in the United States will become infected at some point in their lives; however, the incidence of this highly prevalent infection peaks in adolescents and young adults. Owing to the importance of vaccination before this elevated risk of exposure, the Centers for Disease Control and Prevention recommends HPV vaccination for girls aged 11-12 years with either the bivalent or quadrivalent vaccine. Recently, the quadrivalent vaccine, which also protects against genital warts and anal neoplasias and cancer, was approved for use in boys as well. Although the coverage rate has increased steadily in the 5 years since the vaccine's introduction, it remains below 50%. To overcome barriers to vaccination, including lack of awareness about adolescents' HPV risk and challenges associated with preventive care in this age group in general, healthcare providers must be able to educate parents/patients about HPV and the vaccine, as well as maximize opportunities to vaccinate adolescents at every office visit.

PMID: 22525122 [PubMed - in process]

Permalink for 'Anal canal neuroendocrine carcinoma associated with squamous intraepithelial neoplasia: A human papillomavirus 18-related lesion.'

Anal canal neuroendocrine carcinoma associated with squamous intraepithelial neoplasia: A human papillomavirus 18-related lesion.

Fetched: April 27th, 2012, 11:00pm MDT

Anal canal neuroendocrine carcinoma associated with squamous intraepithelial neoplasia: A human papillomavirus 18-related lesion.

Pathol Int. 2012 May;62(5):356-9

Authors: Ohtomo R, Sekine S, Taniguchi H, Tsuda H, Moriya Y, Kushima R

Abstract
Neuroendocrine carcinoma (NEC) of the anal canal is exceedingly rare and its histogenesis is poorly understood. We present a case of small-cell NEC of the anal canal in a 70-year-old woman. The NEC appeared as a submucosal tumor at the dentate line and was associated with squamous intraepithelial neoplasia (SIN). The NEC was positive for neuroendocrine markers including synaptophysin, chromogranin A and CD56, whereas the SIN component did not express any of these markers. Both components exhibited p16 overexpression. A PCR analysis revealed that both the SIN and NEC components were positive for human papillomavirus (HPV) 18 DNA. Our observations imply that SIN may be a precursor of anal canal NEC and that HPV18 may play an important role in the histogenesis of anal canal NEC, similar to its role in cervical NEC.

PMID: 22524667 [PubMed - in process]

Clinical target volumes in anal cancer: Calculating what dose was likely to have been delivered in the UK ACT II trial protocol.

Fetched: April 27th, 2012, 11:00pm MDT

Clinical target volumes in anal cancer: Calculating what dose was likely to have been delivered in the UK ACT II trial protocol.

Radiother Oncol. 2012 Apr 20;

Authors: Aggarwal A, Gayadeen S, Robinson D, Hoskin PJ, Mawdsley S, Harrison M, Hughes R, Glynne-Jones R

Abstract
PURPOSE: Preliminary results of the UK Anal Cancer Trial (ACT) II trial in squamous cell carcinoma of the anus (SCCA) are promising, but 2-D planning with parallel-opposed fields provoked significant toxicity. We calculated likely doses delivered in the ACT II protocol to the planning target volume (PTV), nodal clinical target volumes (n-CTV) and organs at risk (OARs). METHODS AND MATERIALS: Original planning CT datasets of 33 consecutive patients with SCCA, included in the ACT II trial or treated to an identical protocol, enabled dose to the primary tumour, involved nodal PTV's, uninvolved nodal CTVs (inguino-femoral and pelvic lymph nodes) and femoral heads to be retrospectively calculated. RESULTS: The mean dose delivered to primary PTV was 51.37±1.68Gy (95% CI), with a maximum dose (D(max)) of 54.63±2.68Gy (95% CI). Involved inguinal nodes received a mean 51.41±3.08Gy, D(max) 54.17±2.84Gy (95% CI). Clinically uninvolved nCTVs received a mean 36.53±3.38Gy (inguinal nodes) and 34.15±5.59Gy (external/internal iliac nodes). Femoral heads received a D(max) of 47.32±3.45 (95% CI). Conclusion: Calculating the likely doses delivered in ACT II from chemoradiation to PTV, n-CTV and OARs facilitates specification of nodal doses and constraints for 3D-conformal/IMRT planning and allows rational dose-escalation for T3/T4 tumours, and potential dose-reduction for T1/T2 tumours.

PMID: 22521502 [PubMed - as supplied by publisher]

The dose-response of the anal sphincter region - An analysis of data from the MRC RT01 trial.

Fetched: April 27th, 2012, 11:00pm MDT

The dose-response of the anal sphincter region - An analysis of data from the MRC RT01 trial.

Radiother Oncol. 2012 Apr 18;

Authors: Buettner F, Gulliford SL, Webb S, Sydes MR, Dearnaley DP, Partridge M

Abstract
PURPOSE: Most studies investigating the dose-response of the rectum focus on rectal bleeding. However, it has been reported that other symptoms such as urgency or sphincter control have a large impact on quality-of-life and that different symptoms are related to the dose to different parts of the anorectal wall. In this study correlations between the 3D dose distribution to the anal-sphincter region and radiation-induced side-effects were quantified. MATERIALS AND METHODS: Dose-surface maps of the anal canal were generated. Next, longitudinal and lateral extent and eccentricity were calculated at different dose levels; DSHs and DVHs were also determined. Correlations between these dosimetric measures and seven clinically relevant endpoints were determined by assessing dosimetric constraints. Furthermore, an LKB model was generated. The study was performed using the data of 388 prostate patients from the RT01 trial (ISRCTN 47772397). RESULTS: Subjective sphincter control was significantly correlated with the dose to the anal surface. The strongest correlations were found for lateral extent at 53Gy (p=0.01). Outcome was also significantly correlated with the DSH and the mean dose to the anal surface. CONCLUSIONS: The dose to the anal sphincter region should be taken into account when generating treatment-plans. This could be done using shape-based tools, DSH/DVH-based tools or an NTCP model.

PMID: 22520267 [PubMed - as supplied by publisher]

Human Papillomavirus Infection in Men who have Sex with Men in Lima, Peru.

Fetched: April 27th, 2012, 11:00pm MDT

Human Papillomavirus Infection in Men who have Sex with Men in Lima, Peru.

AIDS Res Hum Retroviruses. 2012 Apr 21;

Authors: Quinn R, Salvatierra J, Solari V, Calderon M, Ton TG, Zunt J

Abstract
Human papillomarvirus (HPV) infection among men who have sex with men (MSM) is the primary risk factor for anal cancer. Of 105 Peruvian MSM examined, 77.1% were infected with HPV; of which 79.0% were co-infected with 2 or more types; and 47.3% were infected by a carcinogenic type. HPV types 53, 6, 16, and 58 were the most frequent HPV infections detected. High-risk HPV type infection was associated with sex work, HIV status, non-smoking status, and having rectal chlamydial or gonnorheal infection. These findings support broadening HPV vaccine coverage and increasing surveillance for the development of cancer in MSM infected with HPV.

PMID: 22519744 [PubMed - as supplied by publisher]

The dosimetric impact of leaf interdigitation and leaf width on VMAT treatment planning in Pinnacle: comparing Pareto fronts.

Fetched: April 22nd, 2012, 11:00pm MDT

The dosimetric impact of leaf interdigitation and leaf width on VMAT treatment planning in Pinnacle: comparing Pareto fronts.

Phys Med Biol. 2012 Apr 20;57(10):2943-2952

Authors: van Kesteren Z, Janssen TM, Damen E, van Vliet-Vroegindeweij C

Abstract
To evaluate in an objective way the effect of leaf interdigitation and leaf width on volumetric modulated arc therapy plans in Pinnacle. Three multileaf collimators (MLCs) were modeled: two 10 mm leaf width MLCs, with and without interdigitating leafs, and a 5 mm leaf width MLC with interdigitating leafs. Three rectum patients and three prostate patients were used for the planning study. In order to compare treatment techniques in an objective way, a Pareto front comparison was carried out. 200 plans were generated in an automated way, per patient per MLC model, resulting in a total of 3600 plans. From these plans, Pareto-optimal plans were selected which were evaluated for various dosimetric variables. The capability of leaf interdigitation showed little dosimetric impact on the treatment plans, when comparing the 10 mm leaf width MLC with and without leaf interdigitation. When comparing the 10 mm leaf width MLC with the 5 mm leaf width MLC, both with interdigitating leafs, improvement in plan quality was observed. For both patient groups, the integral dose was reduced by 0.6 J for the thin MLC. For the prostate patients, the mean dose to the anal sphincter was reduced by 1.8 Gy and the conformity of the V(95%) was reduced by 0.02 using the thin MLC. The V(65%) of the rectum was reduced by 0.1% and the dose homogeneity with 1.5%. For rectum patients, the mean dose to the bowel was reduced by 1.4 Gy and the mean dose to the bladder with 0.8 Gy for the thin MLC. The conformity of the V(95%) was equivalent for the 10 and 5 mm leaf width MLCs for the rectum patients. We have objectively compared three types of MLCs in a planning study for prostate and rectum patients by analyzing Pareto-optimal plans which were generated in an automated way. Interdigitation of MLC leafs does not generate better plans using the SmartArc algorithm in Pinnacle. Changing the MLC leaf width from 10 to 5 mm generates better treatment plans although the clinical relevance remains to be proven.

PMID: 22516969 [PubMed - as supplied by publisher]

Human papillomavirus-associated cancers - United States, 2004-2008.

Fetched: April 22nd, 2012, 11:00pm MDT

Human papillomavirus-associated cancers - United States, 2004-2008.

MMWR Morb Mortal Wkly Rep. 2012 Apr 20;61:258-61

Authors:

Abstract
Oncogenic human papillomavirus (HPV) has a causal role in nearly all cervical cancers and in many vulvar, vaginal, penile, anal, and oropharyngeal cancers. Most HPV infections clear within 1-2 years, but those that persist can progress to precancer or cancer. In the United States, public health prevention of cervical cancer includes both secondary prevention through cervical cancer screening and primary prevention through HPV vaccination. Transmission of HPV also can be reduced through condom use and limiting the number of sexual partners. Two vaccines (bivalent and quadrivalent) are available to protect against HPV types 16 and 18, which are responsible for 70% of cervical cancers. HPV 16 also is the most common HPV type found in the other five cancers often associated with HPV. To assess the incidence of HPV-associated cancers (i.e., cancers at specific anatomic sites and with specific cell types in which HPV DNA frequently is found), CDC analyzed 2004-2008 data from the National Program of Cancer Registries (NPCR) and the Surveillance, Epidemiology, and End Results (SEER) program. During 2004-2008, an average of 33,369 HPV-associated cancers were diagnosed annually (rate: 10.8 per 100,000 population), including 12,080 among males (8.1 per 100,000) and 21,290 among females (13.2). Multiplying the counts for HPV-associated cancers by percentages attributable to HPV, CDC estimated that approximately 26,000 new cancers attributable to HPV occurred each year, including 18,000 among females and 8,000 among males. Population-based cancer registries are important surveillance tools to measure the impact on cancer rates of public health interventions such as vaccination and screening.

PMID: 22513527 [PubMed - in process]

Natural orifice transluminal endoscopic surgery (NOTES) and colorectal cancer?

Fetched: April 22nd, 2012, 11:00pm MDT

Natural orifice transluminal endoscopic surgery (NOTES) and colorectal cancer?

Colorectal Dis. 2011 Nov;13 Suppl 7:47-50

Authors: Morino M, Verra M, Famiglietti F, Arezzo A

Abstract
Surgical techniques and technologies are rapidly evolving. In the field of colorectal surgery the transanal video-assisted approach was introduced by Buess, 30 years ago, with transanal endoscopic microsurgery (TEM). In more recent years different techniques and technologies have been proposed, including natural orifice specimen extraction (NOSE), natural orifice transluminal endoscopic surgery (NOTES) and single-access surgery. Furthermore, a better understanding of the prognostic and risk factors of rectal cancer has allowed TEM to expand its indications to local resection of selected tumours, and more recently there have been proposals for sentinel node biopsy in colon and rectal cancer.

PMID: 22098518 [PubMed - indexed for MEDLINE]

Totally transrectal endoscopic total mesorectal excision (TME).

Fetched: April 22nd, 2012, 11:00pm MDT

Totally transrectal endoscopic total mesorectal excision (TME).

Colorectal Dis. 2011 Nov;13 Suppl 7:43-6

Authors: Lacy AM, Adelsdorfer C

Abstract
Surgical treatment has been in constant evolution in the search for minimizing incisions regardless of the complexity of the operation. Natural Orifice Translumenal Endoscopic Surgery (NOTES) represents this progression of surgery to less invasive procedures. Transanal endoscopic microsurgery (TEM) is an ideal NOTES platform to access the peritoneal cavity endoscopically through the anus and specifically to allow colorectal resections be performed through smaller, or indeed without, abdominal incisions. Transanal rectosigmoidectomy with total mesorectal excision (TME) using TEM is a feasible and oncologically safe option. Such use of currently available combined hybrid laparoendoscopic systems provides a safe platform to define future clinical applications and advantages of NOTES. Furthermore, it stimulates the active development of technologies that will support and enable it.

PMID: 22098517 [PubMed - indexed for MEDLINE]

Extending the role of Transanal Endoscopic Microsurgery (TEM) in rectal cancer.

Fetched: April 22nd, 2012, 11:00pm MDT

Extending the role of Transanal Endoscopic Microsurgery (TEM) in rectal cancer.

Colorectal Dis. 2011 Nov;13 Suppl 7:32-6

Authors: Hompes R, Cunningham C

Abstract
Increasingly it is becoming clear that there is a role for local excision of early rectal cancer by Transanal Endoscopic Microsurgery (TEM) as part of an organ-preservation strategy. This role is based on careful preoperative assessment, thorough postoperative histopathological examination and standardized follow up, with recourse to completion or salvage radical surgery in the face of poor prognostic factors, or early concerns over recurrent disease. Additionally, TEM is also proposed in selected circumstances after neoadjuvant treatment for rectal cancer. This latter topic is even more controversial with clinical evidence still evolving, but specialist centres report impressive results that cannot be ignored in the modern management of rectal cancer.

PMID: 22098515 [PubMed - indexed for MEDLINE]

Abstracts of the 17th International Symposium on Bioluminescence and Chemiluminescence - (ISBC 2012).

Fetched: April 18th, 2012, 11:00pm MDT

Abstracts of the 17th International Symposium on Bioluminescence and Chemiluminescence - (ISBC 2012).

Luminescence. 2012 Mar;27(2):95-178

Authors:

PMID: 22505334 [PubMed - as supplied by publisher]

[A case of rectal hemorrhage during chemotherapy with bevacizumab for local recurrence of rectal cancer].

Fetched: April 18th, 2012, 11:00pm MDT

[A case of rectal hemorrhage during chemotherapy with bevacizumab for local recurrence of rectal cancer].

Gan To Kagaku Ryoho. 2012 Apr;39(4):675-7

Authors: Tsuchida K, Honjoh Y, Asari M, Osawa E, Numata K, Yoshida T, Osaragi T, Yoneyama K, Kasahara A, Yamamoto Y, Shibuya H, Takizawa K, Miura Y, Yoshie K, Rino Y, Masuda M

Abstract
Chemotherapy with bevacizumab(BV)has been one of the standard treatments for patients with metastatic colorectal cancer. However, emergent treatments are sometimes required because of severe adverse events associated with it. We experienced a case of massive rectal hemorrhage during BV treatment, and interventional radiology(IVR)successfully controlled it. An 81-year-old male visited our hospital, suffering from local recurrence of rectal cancer. He underwent colostomy for fecal diversion, and chemoradiation therapy was performed. Systemic chemotherapy with XELOX+BV was performed for the residual tumor. On the 27th day after the first administration of BV, the patient was hospitalized because of anal bleeding and a state of shock. The colonoscopic examination showed a dimple caused by tumor shrinkage, which was closed by clipping. However, a state of shock was caused by intermittent hemorrhages again afterwards. The hemorrhagic point was identified as the oral side of the dimple by angiography, and coil embolization led to immediate hemostasis. The colonoscopic examination revealed nothing abnormal besides the dimple. It is therefore suspected that the cause of rectal hemorrhage might be induced by BV. During combination chemotherapy with BV, bleeding is one of the severe adverse events requiring an emergent treatment regardless of BV dose. IVR may be an effective treatment when bleeding can not be controlled by endoscopic hemostasis. Therefore, we should construct a system for emergency hemostasis including IVR.

PMID: 22504701 [PubMed - in process]

Fluorescence Imaging Visualizes Three Sets of Regional Lymph Nodes in Patients with Lower Rectal Cancer.

Fetched: April 18th, 2012, 11:00pm MDT

Fluorescence Imaging Visualizes Three Sets of Regional Lymph Nodes in Patients with Lower Rectal Cancer.

Hepatogastroenterology. 2012 Apr 12;59(117)

Authors: Ishizuka M, Nagata H, Takagi K, Iwasaki Y, Kubota K

Abstract
Background/Aims: To demonstrate the usefulness of a fluorescence imager (photodynamic eye; PDE) for observation of lymph flow in lower rectal cancer (LRC). Methodology: Between October 2006 and January 2010, PDE observations were performed in 14 patients with LRC. After induction of general anesthesia, a total of 2mL of indocyanine green (ICG) (2.5mg/mL) was injected into the submucosal layer on the dentate line or the anal margin of the LRC. Results: Preoperative PDE observation was able to demonstrate several lymph flows running to the bilateral inguinal areas from the perianal area immediately after ICG injection in 13 of the patients (92.9%). Although these flows were pooled in the bilateral inguinal areas, there was no pooling of such lymph flows in the perianal area. Intraoperative PDE observation was able to demonstrate not only mesenteric lymph nodes in all patients but also bilateral lateral lymph nodes in 13 patients (92.9%). Although 6 patients had undergone sphincter-preserving surgery (SPS), no local recurrence was observed in such patients during the observation period. Conclusions: PDE is able to visualize three sets of regional lymph nodes in patients with LRC, suggesting that it would be useful for determining the effectiveness of SPS for such patients.

PMID: 22499061 [PubMed - as supplied by publisher]

[Prognostic value of rectal cancer regression after preoperative chemoradiation therapy].

Fetched: April 18th, 2012, 11:00pm MDT

[Prognostic value of rectal cancer regression after preoperative chemoradiation therapy].

Vestn Rentgenol Radiol. 2011 Nov-Dec;(5):28-33

Authors: Rasulov AO, Shelygin IuA, Boĭko AV, Droshneva IV

Abstract
Despite the international experience enriched in the number of observations of combination treatment in patients with rectal cancer, many issues remain to be the subject-matter of the discussion. This also applies to the estimation of the value of tumor regression after neoadjuvant chemoradiation therapy in order to develop indications for sphincter-sparing operations depending on the site of a tumor in the organ and their impact on long-term treatment results. The authors have gained experience with combination treatment in 157 patients with rectal cancer (T2-4 N0-2 M0) receiving neoadjuvant chemoradiation therapy in a cumulative radiation dose of 39.5-47 Gy and radical surgery 4-6 weeks after radiation. The direct effect of chemoradiation therapy has been investigated using a set of studies involving ultrasonography, magnetic resonance imaging, endoscopic diagnosis, as well as the data of a postoperative morphological study of primary tumor and lymph nodes. The authors have evaluated the impact of preoperative chemoradiation therapy on the rate and degree of resorption of a primary tumor, including the depth of its invasion through the intestinal wall and exit into the cellular tissue, its localization in the organ and the distance to the anus, a difference in the preoperative estimation of stages and according to the data of pathomorphological studies of intraoperative specimens, etc. The degree of tumor resorption was comparatively analyzed with the long-term results and the rate of sphincter-sparing operations.

PMID: 22420208 [PubMed - indexed for MEDLINE]

Review of 20 years of HPV research in Slovenia.

Fetched: April 18th, 2012, 11:00pm MDT

Review of 20 years of HPV research in Slovenia.

Acta Dermatovenerol Alp Panonica Adriat. 2011 Sep;20(3):99-112

Authors: Poljak M

Abstract
BACKGROUND: Human papillomaviruses (HPV), remarkably diverse DNA viruses etiologically linked with various benign and malignant neoplastic lesions of mucosal and skin epithelium have been the subject of intensive research for the last 30 years worldwide.
OBJECTIVE: Briefly to review 20 years of HPV research in Slovenia by analyzing the articles published in journals indexed in peer-reviewed databases Medline/Pubmed, Science Citation Index/Web of Science, Embase and PsycINFO.
METHODS AND RESULTS: Up until October 2011, Slovenian researchers published 73 articles in journals indexed in peer-reviewed databases, which can be divided into 15 categories: detection of HPV in archival clinical specimens, development of novel HPV tests, evaluation of various commercial tests for the detection of high- and low-risk alpha-HPV, HPV and anogenital tumours, HPV testing in routine gynecological practice, HPV and laryngeal benign tumours, HPV and laryngeal epithelial hyperplastic lesions and laryngeal cancer, HPV and tumors in oral cavity, HPV and esophageal benign and malignant tumors, HPV and inverted papillomas, genomic diversity of selected HPV types, hair follicles as an important endogenous reservoir of HPV, identification and characterization of novel HPV types, HPV vaccination and HPV basic research. Until October 2011, Slovenian HPV papers received 473 citations (self-citation excluded) and their Hirsch index is currently h=13.
CONCLUSION: In the last 20 years, Slovenian HPV researchers have been actively and successfully incorporated in the international HPV community and have contributed small but significant achievements in the field.

PMID: 22131110 [PubMed - indexed for MEDLINE]

Permalink for 'A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer.'

A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer.

Fetched: April 18th, 2012, 11:00pm MDT

A novel approach of robotic-assisted anterior resection with transanal or transvaginal retrieval of the specimen for colorectal cancer.

Surg Endosc. 2009 Dec;23(12):2831-5

Authors: Choi GS, Park IJ, Kang BM, Lim KH, Jun SH

Abstract
BACKGROUND: The surgical robot (da Vinci S) is superior to conventional laparoscopy; it provides clearer, three-dimensional images and an extended range of motion for the instruments. We used this robot for laparoscopic surgery to perform a totally intracorporeal resection of the rectum and colorectal anastomosis, with transanal or transvaginal retrieval of specimens.
METHODS: We prospectively collected data on 13 patients who underwent robot-assisted rectal surgery by a single surgeon from January to March 2008. For low anterior resection (LAR), the splenic flexure was mobilized laparoscopically, followed by robotic rectal resection and anastomosis, and transanal removal of specimens in both male and female patients. We retrieved the specimen through the vagina in some female patients.
RESULTS: Eleven and two patients underwent LAR and anterior resection (AR), respectively. Mean operative time was 260.8 ± 62.9 (range 210-390) min with median robotic time of 118 ± 43.6 (range 122-186) min. There were three postoperative complications, in two patients. One patient had anastomotic bleeding and the other had anastomotic leakage following inferior mesenteric artery bleeding. The circumferential margins were clear. The tumor stage was I in four, II in two, and III in seven patients. In one patient, the distal resection margin was involved. The patients resumed an oral diet and were discharged on the third and seventh day after surgery.
CONCLUSION: Robotic-assisted laparoscopic methods were safe for AR in patients with colorectal cancer. This approach made it easier to perform a total mesorectal excision, anastomosis, and closure of the vaginal wall, and avoided the traditional abdominal incision.

PMID: 19440794 [PubMed - indexed for MEDLINE]

The early days of surgery for cancer of the rectum.

Fetched: April 14th, 2012, 11:00pm MDT

The early days of surgery for cancer of the rectum.

J Perioper Pract. 2012 Mar;22(3):103-4

Authors: Ellis H

Abstract
Long before being aware of tumours elsewhere along the alimentary canal, surgeons from the earliest days of the profession were all too familiar with cancer of the rectum. The vivid local symptoms of rectal bleeding and mucous discharge, bowel disturbance and then intractable local pain, and the ready detection of the growth by a finger inserted into the fundament made diagnosis all too easy and with it, of course, a hopeless outlook for the poor sufferer. Until quite recent times, treatment was entirely palliative, with the use of hot baths, emollient enemas and dilatations of the constricting growth with bougies. Opium and laudanum, (opium dissolved in alcohol), would be prescribed in advanced cases. Some bold surgeons would use the cautery--an iron heated to red heat--to burn down a fungating growth presenting at the anal margin.

PMID: 22493878 [PubMed - in process]

Colorectal complications of end-stage renal failure and renal transplantation: a review.

Fetched: April 14th, 2012, 11:00pm MDT

Colorectal complications of end-stage renal failure and renal transplantation: a review.

Colorectal Dis. 2012 Apr;14(4):403-15

Authors: Parnaby CN, Barrow EJ, Edirimanne SB, Parrott NR, Frizelle FA, Watson AJ

Abstract
AIM: End-stage renal failure (ESRF) and renal transplant recipients are thought to be associated with an increased risk of colorectal complications.
METHOD: A review of the literature was performed to assess the prevalence and outcome in both benign and malignant colorectal disease.
RESULTS: No prospective randomized studies assessing colorectal complications in ESRF or renal transplant were identified. Case series and case reports have described the incidence and management of benign colorectal complications. Complications included diverticulitis,infective colitis, colonic bleeding and colonic perforation. There was insufficient evidence to associated iverticular disease with adult polycystic kidney disease.Three population-based studies have shown up to a twofold increased incidence of colonic cancer but not rectal cancer for renal transplant recipients. Bowel cancer screening (as per the general population) by faecal occult blood testing appears justified for renal transplant patients; however, evidence suggests that consideration of starting screening at a younger age may be worthwhile because of an increased risk of developing colonic cancer.Two population-based studies have shown a threefold and 10-fold increased incidence of anal cancer for renal transplant recipients. A single case–control study demonstrated significant increased prevalence of anal human papilloma virus (HPV) and intraepithelial neoplasia (AIN)in patients with established renal transplants.
CONCLUSIONS: Despite the lack of high-level evidence,ESRF and renal transplantation were associated with colorectal complications that could result in major morbidity and mortality. Bowel cancer screening in this patient group appears justified. The effectiveness of screening for HPV, AIN and anal cancer in renal transplant recipients remains unclear.

PMID: 22493792 [PubMed - in process]

Anal Carcinoma, Version 2.2012: Featured Updates to the NCCN Guidelines.

Fetched: April 14th, 2012, 11:00pm MDT

Anal Carcinoma, Version 2.2012: Featured Updates to the NCCN Guidelines.

J Natl Compr Canc Netw. 2012 Apr 1;10(4):449-454

Authors: Benson AB, Arnoletti JP, Bekaii-Saab T, Chan E, Chen YJ, Choti MA, Cooper HS, Dilawari RA, Engstrom PF, Enzinger PC, Fakih MG, Fleshman JW, Fuchs CS, Grem JL, Leong LA, Lin E, May KS, Mulcahy MF, Murphy K, Rohren E, Ryan DP, Saltz L, Sharma S, Shibata D, Skibber JM, Small W, Sofocleous CT, Venook AP, Willett C, Freedman-Cass DA

Abstract
The workup and management of squamous cell anal carcinoma, which represents the most common histologic form of the disease, are addressed in the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) for Anal Carcinoma. These NCCN Guidelines Insights provide a summary of major discussion points of the 2012 NCCN Anal Carcinoma Panel meeting. In summary, the panel made 4 significant changes to the 2012 NCCN Guidelines for Anal Carcinoma: 1) local radiation therapy was added as an option for the treatment of patients with metastatic disease; 2) multifield technique is now preferred over anteroposterior-posteroanterior (AP-PA) technique for radiation delivery and the AP-PA technique is no longer recommended as the standard of care; 3) PET/CT should now be considered for radiation therapy planning; and 4) a section on risk reduction was added to the discussion section. In addition, the panel discussed the use of PET/CT for the workup of anal canal cancer and decided to maintain the recommendation that it can be considered in this setting. They also discussed the use of PET/CT for the workup of anal margin cancer and for the assessment of treatment response. They reaffirmed their recommendation that PET/CT is not appropriate in these settings.

PMID: 22491045 [PubMed - as supplied by publisher]

Giant condyloma acuminatum of the anorectum: successful radical surgery with anal reconstruction.

Fetched: April 14th, 2012, 11:00pm MDT

Giant condyloma acuminatum of the anorectum: successful radical surgery with anal reconstruction.

Tumori. 2011 Nov-Dec;97(6):805-7

Authors: Battaglia L, Vannelli A, Belli F, Rampa M, Milione M, Gasparini P, Leo E

Abstract
Buschke-Löwenstein tumor, or giant condyloma acuminatum, is a relatively uncommon lesion of the anus with aggressive local invasive behavior which may present as a large warty tumor of the genital region with expansive and destructive growth. Many sporadic reports have been published suggesting various therapeutic strategies. We report a case of Buschke-Löwenstein tumor treated with conservative surgery followed by reconstructive procedures without a loop colostomy

PMID: 22322850 [PubMed - indexed for MEDLINE]

Robot-assisted Low Anterior Resection for Situs Inversus Totalis: A Novel Technical Approach for an Uncommon Condition.

Fetched: April 12th, 2012, 11:00pm MDT

Robot-assisted Low Anterior Resection for Situs Inversus Totalis: A Novel Technical Approach for an Uncommon Condition.

Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):e87-90

Authors: Leong QM, Son DN, Cho JS, Amar AH, Kim SH

Abstract
INTRODUCTION: : Situs inversus totalis (SIT) is an uncommon condition, with an incidence of 1 in 10,000. Surgery for SIT patients is more difficult because of the uncommon anatomy. Experience in laparoscopic surgery for patients with SIT is very limited. Only a few cases of laparoscopic colorectal resections have been reported in the literature. We present the first robot-assisted low anterior resection for rectal cancer in a patient with SIT.
PATIENT: : A 70-year-old woman with SIT who presented with rectal bleeding underwent a colonoscopy and barium enema. This workup revealed a rectal cancer 10 cm from the anal verge. The magnetic resonance imaging scan revealed a T3/4 tumor in the rectum with perirectal lymph node involvement, whereas the computed tomography positron emission tomography scan did not reveal any distal metastasis. She underwent neoadjuvant chemoradiotherapy 6 weeks before surgery. Postoperatively, she made an uneventful recovery and was discharged on day 6.
SURGICAL TECHNIQUE: : After laparoscopic examination and displacement of the small bowel, 4 robot trocars were inserted into 4 quadrants of the abdomen. A fifth port was inserted and used by the assistant. The robot cart was docked from the right side with arms 1, 2, and 3 in the right upper quadrant (Cadiere grasper), left lower quadrant (bipolar Maryland grasper), and left upper quadrant (monopolar scissors), respectively, for colonic mobilization without splenic flexure takedown. For pelvic dissection, arms 1 and 3 were moved to the right upper quadrant and right lower quadrant, respectively. After adequate pelvic dissection, the robot cart was undocked, and a laparoscopic articulating linear stapler was used to transect the rectum from the left lower quadrant port. Bowel continuity was restored with a circular stapler. A loop ileostomy was created through the extraction site in the right lower quadrant.
CONCLUSIONS: : Robot-assisted low anterior resection for SIT patients can be performed safely and confers the benefits of laparoscopic low anterior resection with additional advantages unique to the da Vinci system.

PMID: 22487647 [PubMed - in process]

Permalink for 'Benefits of a Straight Laparoscopic Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis for Ulcerative Colitis: A Retrospective Case-matched Study.'

Benefits of a Straight Laparoscopic Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis for Ulcerative Colitis: A Retrospective Case-matched Study.

Fetched: April 12th, 2012, 11:00pm MDT

Benefits of a Straight Laparoscopic Restorative Proctocolectomy With Ileal Pouch Anal Anastomosis for Ulcerative Colitis: A Retrospective Case-matched Study.

Surg Laparosc Endosc Percutan Tech. 2012 Apr;22(2):118-21

Authors: Ozawa H, Nakamura T, Ikeda A, Naito M, Sato T, Onozato W, Ogura N, Watanabe M

Abstract
PURPOSES: : The aim of this study was to evaluate the benefit of straight laparoscopic restorative proctocolectomy (sLRP) with ileal pouch anal anastomosis for ulcerative colitis (UC).
METHODS: : Twenty patients underwent sLRP or open restorative proctocolectomy. The 2 groups were retrospectively well matched with respect to sex, body mass index, and American Society of Anesthesiologists' score.
RESULTS: : The median operative time was longer in the sLRP group (P=0.0003). The median operative blood loss was significantly less in the sLRP group (P=0.0054). The median analgesic drug usage during the first 7 days after surgery was lower in the sLRP group (P=0.038). There were no differences in morbidity rates and long-term functional outcome measures between the groups.
CONCLUSIONS: : An sLRP for UC has the advantage over an open restorative proctocolectomy of better short-term outcomes, and both groups have similar long-term outcomes. This procedure is acceptable for minimally invasive surgery in patients with UC.

PMID: 22487623 [PubMed - in process]

Successful Spontaneous Pregnancy after Pelvic Chemoradiotherapy for Anal Cancer.

Fetched: April 12th, 2012, 11:00pm MDT

Successful Spontaneous Pregnancy after Pelvic Chemoradiotherapy for Anal Cancer.

Clin Oncol (R Coll Radiol). 2012 Apr 7;

Authors: Hürmüz P, Sebag-Montefiore D, Byrne P, Cooper R

PMID: 22486987 [PubMed - as supplied by publisher]

Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas.

Fetched: April 11th, 2012, 11:00pm MDT

Pelvic Normal Tissue Contouring Guidelines for Radiation Therapy: A Radiation Therapy Oncology Group Consensus Panel Atlas.

Int J Radiat Oncol Biol Phys. 2012 Apr 6;

Authors: Gay HA, Barthold HJ, O'Meara E, Bosch WR, El Naqa I, Al-Lozi R, Rosenthal SA, Lawton C, Lee WR, Sandler H, Zietman A, Myerson R, Dawson LA, Willett C, Kachnic LA, Jhingran A, Portelance L, Ryu J, Small W, Gaffney D, Viswanathan AN, Michalski JM

Abstract
PURPOSE: To define a male and female pelvic normal tissue contouring atlas for Radiation Therapy Oncology Group (RTOG) trials. METHODS AND MATERIALS: One male pelvis computed tomography (CT) data set and one female pelvis CT data set were shared via the Image-Guided Therapy QA Center. A total of 16 radiation oncologists participated. The following organs at risk were contoured in both CT sets: anus, anorectum, rectum (gastrointestinal and genitourinary definitions), bowel NOS (not otherwise specified), small bowel, large bowel, and proximal femurs. The following were contoured in the male set only: bladder, prostate, seminal vesicles, and penile bulb. The following were contoured in the female set only: uterus, cervix, and ovaries. A computer program used the binomial distribution to generate 95% group consensus contours. These contours and definitions were then reviewed by the group and modified. RESULTS: The panel achieved consensus definitions for pelvic normal tissue contouring in RTOG trials with these standardized names: Rectum, AnoRectum, SmallBowel, Colon, BowelBag, Bladder, UteroCervix, Adnexa_R, Adnexa_L, Prostate, SeminalVesc, PenileBulb, Femur_R, and Femur_L. Two additional normal structures whose purpose is to serve as targets in anal and rectal cancer were defined: AnoRectumSig and Mesorectum. Detailed target volume contouring guidelines and images are discussed. CONCLUSIONS: Consensus guidelines for pelvic normal tissue contouring were reached and are available as a CT image atlas on the RTOG Web site. This will allow uniformity in defining normal tissues for clinical trials delivering pelvic radiation and will facilitate future normal tissue complication research.

PMID: 22483697 [PubMed - as supplied by publisher]

Identification of consensus-based quality end points for colorectal surgery.

Fetched: April 11th, 2012, 11:00pm MDT

Identification of consensus-based quality end points for colorectal surgery.

Dis Colon Rectum. 2012 Mar;55(3):294-301

Authors: Manwaring ML, Ko CY, Fleshman JW, Beck DE, Schoetz DJ, Senagore AJ, Ricciardi R, Temple LK, Morris AM, Delaney CP

Abstract
BACKGROUND: : Process and outcome measures for quality assessment of colorectal surgical care are poorly defined.
OBJECTIVE: : The aim of this study was to develop candidate end points for use in surgeon-specific registries designed for case reporting and quality improvement program development.
DESIGN: : The study design was based on modified Delphi-based development of consensus quality end points.
SETTING: : This study was undertaken by the American Society of Colon and Rectal Surgeons Executive Council, Quality Committee, and by the ColoRectal Education System Template Committee, American Board of Colon and Rectal Surgery.
PATIENTS: : No patients were included in this study.
INTERVENTIONS: : Six areas of colorectal surgery were defined by members of the American Society of Colon and Rectal Surgeons' Executive Council and the American Board of Colon and Rectal Surgery to cover areas of importance for colorectal surgeons. These included colectomy, rectal cancer, hemorrhoidectomy, anal fistula and abscess, colonoscopy, and rectal prolapse. Relevant American Society of Colon and Rectal Surgeons' committee members through a series of 4 panel discussions identified important demographic, process, and outcome measures in each of these 6 areas that might be suitable for the American College of Surgeons case log. Panel size was sequentially expanded from 8 members to 28 members to include all active committee members. Panelists contributed additional process and outcome measures for inclusion during each discussion. Modified Delphi methodology was used to generate consensus, and, after each panel discussion, members rated the relative importance of each end point from 1 (least important) to 4 (most important).
MAIN OUTCOME MEASURES: : The mean rating for each process and outcome measure after each round was recorded with the use of standardized definitions for relevant variables.
RESULTS: : Eighty-nine process and outcome measures were compiled and rated. Mean scores following the final round ranged from a low of 1.3 (anal fistula/abscess, preoperative imaging) to a high of 4.0 (colectomy-anastomotic leak).
LIMITATIONS: : The limitations of this study involved the use of consensus, small study size, and the fact that no end points were excluded.
CONCLUSIONS: : With the use of modified Delphi methodology, a consensus-derived ranked list of 89 process and outcome measures was developed in 6 key areas of colorectal surgery. These data provide a framework for development of guideline standards for case-reporting program development initiatives for colon and rectal surgery.

PMID: 22469796 [PubMed - in process]

Mortality and anastomotic leakage after anterior resection for rectal cancer.

Fetched: April 11th, 2012, 11:00pm MDT

Mortality and anastomotic leakage after anterior resection for rectal cancer.

Hepatogastroenterology. 2012 May-Jun;59(115):721-3

Authors: Piecuch J, Wiewiora M, Jopek J, Szrot M, Mazur I, Zurawinski W, Sosada K

Abstract
Background/Aims: The aim of the study was to analyze the mortality and symptomatic anastomotic leak following stapled anastomosis after anterior resection for rectal cancer. Methodology: We analyzed retrospectively 161 patients subjected to elective anterior resection of the rectum. There were 102 (63.3%) men and 59 (37.7%) women. The patients were divided into two groups according to tumor location: group I - 129 (80.1%) patients with tumor located >6cm from the anal verge and group II - 32 (19.9%) patients with tumor located =6cm. Results: Anastomotic leak was found in 5 (3.1%) patients, three (2.3%) from group I and two (6.2%) from group II (p<0.26). Anastomotic leak was found more often in patients with renal failure (p<0.0023) and in those who had undergone RBC concentrate transfusion (p<0.0045). Seven (4.3%) patients died in the postoperative period. Deaths occurred more frequently in patients with valvular heart disease (p<0.00002), renal failure (p<0.0047) and in those given concentrates of RBC (p<0.045). Conclusions: Incidence of postoperative surgical complications after resection for rectal cancer is not high and is acceptable; however, there is an increased risk of leakage after low anterior resection. Renal failure as well as RBC concentrate transfusion have an influence on mortality and anastomotic leak.

PMID: 22469714 [PubMed - in process]

Anal fistula.

Fetched: April 11th, 2012, 11:00pm MDT

Anal fistula.

Colorectal Dis. 2012 May;14(5):535

Authors: Nicholls J

PMID: 22469475 [PubMed - in process]

Permalink for 'A systematic review of prognosis and therapy of anal malignant melanoma: a plea for more precise reporting of location and thickness.'

A systematic review of prognosis and therapy of anal malignant melanoma: a plea for more precise reporting of location and thickness.

Fetched: April 11th, 2012, 11:00pm MDT

A systematic review of prognosis and therapy of anal malignant melanoma: a plea for more precise reporting of location and thickness.

Am Surg. 2012 Jan;78(1):28-35

Authors: Kanaan Z, Mulhall A, Mahid S, Torres ML, McCafferty M, McMasters KM, Hornung C, Galandiuk S

Abstract
Anal malignant melanoma (AMM) is a rare tumor with poor prognosis. We performed a systematic review of reports on wide local excision (WLE) and abdominoperineal resection (APR) for treatment of AMM in an attempt to define a precise set of reporting measures for outcomes of treatment of AMM. A systematic review of the literature was performed. Demographic data, surgical treatment, pathology, and survival rates were recorded. We compared WLE versus APR in terms of the overall survival time, the disease-free survival, and overall survival at 60 months. Twenty-one reports met the inclusion criteria. Notably, of these, 10 did not specify thickness of the primary melanoma. Interestingly, groin lymph node status was described in 19 of 21 reports, whereas location was specified in only 12 papers and thickness (depth in mm) in only 11. The median survival times of patients undergoing WLE (n = 324) and those undergoing APR (n = 369) are comparable (20 and 21 months, respectively). The mean median survival at 60 months was 15 per cent for WLE and 14 per cent for APR. The mean disease-free survival at 60 months was found to be 10 per cent for WLE and 6 per cent for APR. Patient selection for such a rare neoplasm yields very similar outcomes for both conservative and radical treatments. There is a wide variation in the reporting of both clinical and treatment outcomes. More uniformity of reporting of pathologic features and node status is essential before rational assessment of results can be done.

PMID: 22273299 [PubMed - indexed for MEDLINE]

Prophylactic human papillomavirus vaccines: past, present and future.

Fetched: April 11th, 2012, 11:00pm MDT

Prophylactic human papillomavirus vaccines: past, present and future.

Pathology. 2012 Jan;44(1):1-6

Authors: Anderson LA

Abstract
Human papillomavirus (HPV) is a highly transmissible infection responsible for a range of diseases in women including cervical carcinomas, vulval carcinomas, anogenital carcinomas and genital warts. In men it is associated with penile carcinomas, anogenital carcinomas and oropharyngeal carcinomas. The history of the development of HPV vaccines includes a significant Australian input and represents a tremendous advancement in our understanding of HPV virology as well as further elucidating the overall contribution of viruses to carcinogenesis. Prophylactic HPV vaccines were licensed for use in Australia in 2007 in order to protect against development of future cases of cervical carcinoma and early results are promising. The benefit of the vaccine will not be restricted to cervical lesions and cross protection amongst a variety of HPV subtypes is described. The development of the HPV vaccine and its ultimate incorporation into our National Immunisation Schedule is reviewed.

PMID: 22157686 [PubMed - indexed for MEDLINE]

High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-infected Women Screened for Anal Cancer.

Fetched: April 4th, 2012, 11:00pm MDT

High Prevalence of High Grade Anal Intraepithelial Neoplasia in HIV-infected Women Screened for Anal Cancer.

J Acquir Immune Defic Syndr. 2012 Mar 29;

Authors: Hou JY, Smotkin D, Grossberg R, Suhrland M, Levine R, Smith HO, Negassa A, McAndrew TC, Einstein M

Abstract
ABSTRACT: There is no consensus on optimal screening for anal cancer (AC) in HIV+ women. 715 unique asymptomatic women in a high-prevalence HIV+ community were screened for AC with anal cytology and triage to high-resolution anoscopy (HRA) after routine screening was implemented in a large urban hospital system. Of these, 75(10.5%) had an abnormal anal cytology and 29(38.7%) with an abnormality had high grade AIN. Women with poorly-controlled HIV were significantly more likely to have high grade AIN (p=0.03). Given the high rate of AIN in screened HIV-infected women, routine AC screening in all HIV-infected women should be strongly considered.

PMID: 22466085 [PubMed - as supplied by publisher]

Permalink for 'Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis.'

Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis.

Fetched: March 31st, 2012, 11:00pm MDT

Anal human papillomavirus infection and associated neoplastic lesions in men who have sex with men: a systematic review and meta-analysis.

Lancet Oncol. 2012 Mar 22;

Authors: Machalek DA, Poynten M, Jin F, Fairley CK, Farnsworth A, Garland SM, Hillman RJ, Petoumenos K, Roberts J, Tabrizi SN, Templeton DJ, Grulich AE

Abstract
BACKGROUND: Men who have sex with men (MSM) are at greatly increased risk of human papillomavirus (HPV)-associated anal cancer. Screening for the presumed cancer precursor, high-grade anal intraepithelial neoplasia (AIN), followed by treatment in a manner analogous to cervical screening, has been proposed. We aimed to assess available data for anal HPV disease that can inform pre-cancer screening programmes. METHODS: We searched PubMed, OVID Medline, and Embase for all studies published before Nov 1, 2011, that reported prevalence and incidence of anal HPV detection, AIN, and anal cancer in MSM. We calculated summary estimates using random-effects meta-analysis. FINDINGS: 53 studies met the inclusion criteria, including 31 estimates of HPV prevalence, 19 estimates of cytological abnormalities, eight estimates of histological abnormalities, and nine estimates of anal cancer incidence. Data for incident HPV and high-grade AIN were scarce. In HIV-positive men, the pooled prevalence of anal HPV-16 was 35·4% (95% CI 32·9-37·9). In the only published estimate, incidence of anal HPV-16 was 13·0% (9·6-17·6), and clearance occurred in 14·6% (10·2-21·2) of men per year. The pooled prevalence of histological high-grade AIN was 29·1% (22·8-35·4) with incidences of 8·5% (6·9-10·4) and 15·4% (11·8-19·8) per year in two estimates. The pooled anal cancer incidence was 45·9 per 100 000 men (31·2-60·3). In HIV-negative men, the pooled prevalence of anal HPV-16 was 12·5% (9·8-15·4). Incidence of HPV-16 was 11·8% (9·2-14·9) and 5·8% (1·9-13·5) of men per year in two estimates. The pooled prevalence of histological high-grade AIN was 21·5% (13·7-29·3), with incidence of 3·3% (2·2-4·7) and 6·0% (4·2-8·1) per year in two estimates. Anal cancer incidence was 5·1 per 100 000 men (0-11·5; based on two estimates). There were no published estimates of high-grade AIN regression. INTERPRETATION: Anal HPV and anal cancer precursors were very common in MSM. However, on the basis of restricted data, rates of progression to cancer seem to be substantially lower than they are for cervical pre-cancerous lesions. Large, good-quality prospective studies are needed to inform the development of anal cancer screening guidelines for MSM. FUNDING: Australian Government Department of Health and Ageing.

PMID: 22445259 [PubMed - as supplied by publisher]

Screening for anal cancer: endpoints needed.

Fetched: March 31st, 2012, 11:00pm MDT

Screening for anal cancer: endpoints needed.

Lancet Oncol. 2012 Mar 22;

Authors: Wentzensen N

PMID: 22445258 [PubMed - as supplied by publisher]

IMRT for locally advanced anal cancer: clinical experience of the Montpellier Cancer Center.

Fetched: March 31st, 2012, 11:00pm MDT

IMRT for locally advanced anal cancer: clinical experience of the Montpellier Cancer Center.

Radiat Oncol. 2012 Mar 23;7(1):45

Authors: Vieillot S, Fenoglietto P, Lemanski C, Llacer Moscardo C, Gourgou S, Dubois JB, Ailleres N, Azria D

Abstract
ABSTRACT: Purpose To assess outcomes of patients with carcinoma of the anal canal (CAC) treated with intensity-modulated radiation therapy (IMRT). Method and materials From August 2007 to January 2011, seventy-two patients suffering from CAC were treated with IMRT. Concurrent chemotherapy was added in case of locally advanced tumors. Radiation course consisted in delivering an initial plan to the PTV1 defined as the primary tumor and the risk area including pelvic and inguinal nodes. Forty-five Gy in daily 1.8 Gy-daily fractions were delivered five days a week. A second plan of 14.4-20 Gy to the primary tumor (PTV2) was administered in 1.8-2 Gy-daily fractions, 5 days a week. We present here the results of dosimetry, toxicities, and clinical outcome of the first 39 patients with a median follow-up of 24 months. RESULTS: Thirty-one women and eight men were included in the present analysis. Tumors were classified as stages I, II, III and IV in 2, 7, 27 and 2 patients, respectively. Median age was 59 years (range, 38-85). Radiotherapy alone (RT) or combined with chemotherapy (RCT) were delivered in 6 (15%) and 33 (85%) patients, respectively. Six patients (15%) required a treatment break [greater than or equal to] 3 days, and median time for treatment break was 8 days (range, 3-14 days). Acute grade 3 gastrointestinal (GI) and genitourinary (GU) toxicities were seen in 10 and 5% of patients, respectively. Grade 4 toxicity was only hematologic and occurred in 12% patients receiving RCT. With a median follow-up of 24 months, no patient experienced any late grade 4 toxicity. The 2-year overall survival rate was 89%, the 2-year local relapse free survival was 77% and the 2-year colostomy-free survival rate was 85%. CONCLUSION: IMRT is well tolerated with acceptable treatment interruption allowing dose escalation.

PMID: 22445137 [PubMed - as supplied by publisher]

Chemoradiotherapy of Anal Carcinoma: Survival and Recurrence in an Unselected National Cohort.

Fetched: March 31st, 2012, 11:00pm MDT

Chemoradiotherapy of Anal Carcinoma: Survival and Recurrence in an Unselected National Cohort.

Int J Radiat Oncol Biol Phys. 2012 Mar 19;

Authors: Bentzen AG, Guren MG, Wanderås EH, Frykholm G, Tveit KM, Wilsgaard T, Dahl O, Balteskard L

Abstract
PURPOSE: To evaluate treatment results, elucidate whether national guidelines were followed, and identify areas demanding further treatment optimization. METHODS AND MATERIAL: Between July 2000 and June 2007, 328 patients were treated with curatively intended chemoradiotherapy (CRT) for nonmetastatic squamous cell carcinoma of the anal region, according to national treatment guidelines based on tumor stage. RESULTS: Complete response after CRT was obtained in 87% of patients, rising to 93% after salvage surgery. Chemotherapy, elective irradiation of the groin and salvage surgery were performed to a lesser extent in elderly patients, mainly because of frailty and comorbidity. Recurrence occurred in 24% of the patients, resulting in a 3- and 5-year recurrence-free survival (RFS) of 79% and 74%, respectively. Locoregional recurrences dominated, most commonly in the primary tumor site. Recurrence was treated with curative intent in 45% of the cases. The 3- and 5-year overall survival were 79% and 66%, and cancer-specific survival (CSS) were 84% and 75%, respectively. The risk of adverse outcome increased significantly with more locally advanced tumors and for male gender in multivariable analyses for RFS and CSS. CONCLUSIONS: The treatment results are in accordance with similar cohorts. The primary treatment control rate was high, but there was a significant risk of locoregional recurrence in advanced tumors. The loyalty to national guidelines was broad, although individual adjustments occurred. However, caution to avoid toxicity must not lead to inadequate treatment. Male gender seems to have inferior outcome.

PMID: 22436791 [PubMed - as supplied by publisher]

Condylomata, cytological abnormalities and human papillomavirus infection in the anal canal in HIV-infected men.

Fetched: March 31st, 2012, 11:00pm MDT

Condylomata, cytological abnormalities and human papillomavirus infection in the anal canal in HIV-infected men.

HIV Med. 2012 Mar 21;

Authors:

Abstract
BACKGROUND: Genital infections with low-risk (LR) and high-risk (HR) human papillomavirus (HPV) genotypes are associated with ano-genital condylomata and anal squamous cell cancer. HPV-related pathologies in HIV-infected men are a serious concern. In this study, the prevalence of anal condylomata and their association with cytological abnormalities and HPV infection in the anal canal in HIV-infected men [men who have sex with men (MSM) and heterosexuals] were estimated. METHODS: This was a cross-sectional study based on the first visits of patients in the Can Ruti HIV-positive Men (CARH·MEN) cohort. Anal condylomata were assessed by clinical and proctological examination. Samples from the anal canal were collected for HPV genotyping and cytological diagnoses. RESULTS: A total of 640 HIV-infected men (473 MSM and 167 heterosexuals) were included in the study. The overall prevalence of anal condylomata was 25% [157 of 640; 95% confidence interval (CI) 21-28%]; in MSM it was 28% and in heterosexuals it was 15% [odds ratio (OR) 2.2; 95% CI 1.4-3.5]. In patients with anal condylomata, HPV infection in the anal canal was more prevalent (92% vs. 67% in those without anal condylomata; OR 8.5; 95% CI 3.2-22). This higher HPV prevalence involved at least two HPV genotypes (OR 4.0; 95% CI 2.2-7.1), mainly HR genotypes (OR 3.3; 95% CI 1.7-6.4). Similarly, the cumulative prevalence of HPV-6 and HPV-11 was higher in patients with anal condylomata (63% vs. 19% in those without anal condylomata). Having anal condylomata was associated with higher prevalences of cytological abnormalities (83% vs. 32% in those without anal condylomata; OR 6.9; 95% CI 3.8-12.7) and high-grade squamous intraepithelial lesions (HSILs) (9% vs. 3% in those without anal condylomata; OR 9.0; 95% CI 2.9-28.4) in the anal canal. CONCLUSIONS: HIV-infected men with anal condylomata were at risk of presenting HSILs and harbouring multiple HR HPV infections in the anal canal. Although MSM presented the highest prevalence of anal condylomata, heterosexual men also had a clinically important prevalence. Our findings emphasize the importance of screening and follow-up for condylomata in the anal canal in HIV-infected men.

PMID: 22435501 [PubMed - as supplied by publisher]

Genital warts and risk of cancer - a Danish study of nearly 50,000 patients with genital warts.

Fetched: March 31st, 2012, 11:00pm MDT

Genital warts and risk of cancer - a Danish study of nearly 50,000 patients with genital warts.

J Infect Dis. 2012 Mar 15;

Authors: Blomberg M, Friis S, Munk C, Bautz A, Kjaer SK

Abstract
BackgroundWe conducted a large national cohort study to examine the risk of cancer among men and women with GW.MethodsUsing the Danish National Patient Register we identified 16,155 men and 32,933 women diagnosed with GW during 1978-2008. Standardized incidence ratios (SIR) were computed as estimates of the relative risk of specific cancers or sites.ResultsA diagnosis of GW was strongly related to anal (SIR(men), 21.5; SIR(women), 7.8), vulvar (SIR, 14.8), vaginal (SIR, 5.9), cervical (SIR, 1.5), penile (SIR, 8.2) and head and neck cancer (SIR, 2.8), including subsites of head and neck cancer with confirmed HPV-association (SIR(men), 3.5; SIR(women), 4.8). The risks remained elevated for more than 10 years following GW diagnosis. In addition, we found moderately increased SIR estimates for non-melanoma skin cancer, smoking-related cancers, Hodgkin and non-Hodgkin lymphoma.ConclusionsIndividuals with GW have a long-term increased risk of anogenital cancers and head and neck cancers. The elevated risks of non-melanoma skin cancers might indicate an association with HPV, while excess risks of other cancers could point to differences in other risk factors between individuals with GW and the general population.

PMID: 22427679 [PubMed - as supplied by publisher]

The burden of hospitalizations for anus and penis neoplasm in Spain (1997-2008).

Fetched: March 31st, 2012, 11:00pm MDT

The burden of hospitalizations for anus and penis neoplasm in Spain (1997-2008).

Hum Vaccin Immunother. 2012 Feb 1;8(2)

Authors: Gil-Prieto R, Ester PV, Alvaro-Meca A, Rodríguez MS, de Miguel AG

Abstract
An epidemiological retrospective study has been performed to assess the burden of hospitalization by anus and penis neoplasm in the general population in Spain. All hospital discharges and deaths related to anal malign neoplasm and penile malign neoplasm from 1997 to 2008 in Spain were obtained. A total of 19,608 hospital admissions were recorded during the study period: 11,965 were related to anal malign neoplasm (4,992 in women and 6,973 in men) and 7,643 to penis malignant neoplasm. This corresponds to a hospitalization rate of 1.97 (CI 95%: 1.91-2.02) hospitalizations per 100,000 women/ year, 2.84 (CI 95%: 2.77-2.91) hospitalizations per 100,000 men/ year and 3.11 (CI 95%: 3.04- 3.18) hospitalizations per 100,000 men/ year, respectively during the study period. The hospitalization rate increased significantly during the study period in all locations. It also increased significantly with age for all locations. Hospitalization and mortality rates in men were 50% higher than in women A total of 530 deaths related to penis malignant neoplasm and 738 deaths related to anus malignant neoplasm in men and 488 in women were reported during the 12-y study period. Although a decrease in smoking prevalence has led to a decrease in the incidence of cancers in the last decade, the hospitalizations due to anal and penile malign neoplasm have not declined in our study. This might be attributed to a high prevalence of HPV infection in these particular genital malign neoplasms.

PMID: 22426377 [PubMed - as supplied by publisher]

Permalink for 'Internal anal sphincter parasympathetic-nitrergic and sympathetic-adrenergic innervation: a 3-dimensional morphological and functional analysis.'

Internal anal sphincter parasympathetic-nitrergic and sympathetic-adrenergic innervation: a 3-dimensional morphological and functional analysis.

Fetched: March 31st, 2012, 11:00pm MDT

Internal anal sphincter parasympathetic-nitrergic and sympathetic-adrenergic innervation: a 3-dimensional morphological and functional analysis.

Dis Colon Rectum. 2012 Apr;55(4):473-81

Authors: Moszkowicz D, Peschaud F, Bessede T, Benoit G, Alsaid B

Abstract
BACKGROUND: : Little detailed information is available concerning morphological and functional autonomic nerve supply to the internal anal sphincter. However, denervation of the sphincter potentially affects anal function after rectal surgery for cancer.
OBJECTIVE: : The aim of this study was to identify the location and type (nitrergic, adrenergic, and cholinergic) of nerve fibers in the internal anal sphincter and to provide a 3-dimensional representation of their structural relationship in the human fetus.
MATERIALS AND METHODS: : serial transverse sections were obtained from 14 human fetuses (7 male, 7 female, 15-31 weeks of gestation) and were studied histologically and immunohistochemically; digitized serial sections were used to construct a 3-dimensional representation of the pelvis.
MAIN OUTCOMES MEASURES: : The location and type of internal anal sphincter nerves were assessed qualitatively.
RESULTS: : Posteroinferior fibers originating from the inferior hypogastric plexus posteroinferior angle projected to the posterolateral and posterior rectal wall and internal anal sphincter, forming the inferior rectal plexus. The inferior rectal plexus contained vesicular acetylcholine transporter-positive (cholinergic), tyrosine hydroxylase-positive (adrenergic/sympathetic), and neural nitric oxide synthase-positive (nitrergic) fibers. The intrasphincteric vesicular acetylcholine transporter-positive fibers included both neural nitric oxide synthase-negative fibers and neural nitric oxide synthase-positive fibers (nitrergic-parasympathetic).
LIMITATIONS: : The study focused on topographic and functional anatomy, so that quantitative data were not obtained. A small number of fetal specimens were available.
CONCLUSIONS: : We report the precise location and distribution of the autonomic neural supply to the internal anal sphincter. This description contributes to the understanding of neurogenic postoperative sphincteric dysfunction. Three-dimensional cartography of pelvic-perineal neurotransmitters provides an anatomical and physiological basis for the selection and development of pharmacological agents to be used in the treatment of primary or postoperative continence and evacuation disorders.

PMID: 22426273 [PubMed - in process]

Short-term effects of neoadjuvant chemoradiotherapy on internal anal sphincter function: a human in vitro study.

Fetched: March 31st, 2012, 11:00pm MDT

Short-term effects of neoadjuvant chemoradiotherapy on internal anal sphincter function: a human in vitro study.

Dis Colon Rectum. 2012 Apr;55(4):465-72

Authors: Lorenzi B, Brading AF, Martellucci J, Cetta F, Mortensen NJ

Abstract
BACKGROUND: : Neoadjuvant chemoradiotherapy is recommended in the treatment of locally advanced rectal cancer. Studies have suggested that chemoradiotherapy adversely affects anorectal function. However, the functional implication and the underlying neuromyogenic changes involved in radiation-induced damage are poorly understood.
OBJECTIVE: : This study evaluated the functional changes following chemoradiotherapy on the internal anal sphincter.
DESIGN AND PATIENTS: : This article describes an in vitro study on the internal anal sphincter collected from patients undergoing abdominoperineal resection or proctectomy. Five patients were treated by surgery alone (control group), and 6 received preoperative chemoradiotherapy (treatment group). Sphincter strips were mounted in organ bath, and the responses to electrical field stimulation and drugs were monitored.
SETTINGS: : The study was performed at the University of Oxford.
MAIN OUTCOME MEASURES: : The end points of this study were to investigate whether chemoradiotherapy has any significant effects on internal anal sphincter function and, subsequently, to establish the type of injury induced.
RESULTS: : Chemoradiotherapy strips developed similar tone, but significantly lower spontaneous activity (p = 0.001) than controls. Electrical field stimulation induced relaxation, followed by contraction. At 50 Hz, electrical field stimulation produced 25.6 ± 4.9% (mean ± SE) of maximum relaxation followed by a contraction of 5.5 ± 0.9% of basal tone in chemoradiotherapy strips i9n comparison with 47.0 ± 6.2% (p = 0.009) and 17.7 ± 4.0% (p = 0.007) in controls. Relaxation was significantly attenuated by N-nitro-L-arginine. Significant differences were found in responses to carbachol (p = 0.018) and phenylephrine (p = 0.022), but not to sodium nitroprusside.
LIMITATIONS: : This work was limited by the relatively small number of patients enrolled, because of the difficulty of finding human tissue for laboratory studies, and the lack of long-term results.
CONCLUSIONS: : Chemoradiotherapy significantly impairs internal anal sphincter function and intrinsic nerves seem more susceptible than smooth muscle. The exclusion of anal canal from the radiation field is recommended, when oncologically safe.

PMID: 22426272 [PubMed - in process]

Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer.

Fetched: March 31st, 2012, 11:00pm MDT

Comparative quality of life in patients following abdominoperineal excision and low anterior resection for low rectal cancer.

Dis Colon Rectum. 2012 Apr;55(4):400-6

Authors: How P, Stelzner S, Branagan G, Bundy K, Chandrakumaran K, Heald RJ, Moran B

Abstract
BACKGROUND: : It is widely believed that quality of life is worse after abdominoperineal excision then after low anterior resection. However, this view is not supported unequivocally.
OBJECTIVE: : The aim of this study was to compare quality of life in patients 1 year following low anterior resection and abdominoperineal excision for low rectal cancer.
DESIGN: : Data were collected prospectively on 62 patients undergoing low anterior resection (32) and abdominoperineal excision (30) for low rectal adenocarcinoma within 6 cm of the anal verge. Patients with metastatic disease were excluded. Quality of life was assessed by the use of the European Organization for Research and Treatment of Cancer's QLQ-C30 and QLQ-CR38 modules and Coloplast stoma quality-of-life questionnaire. Bowel function was assessed by using the St Mark's bowel function questionnaire. Quality of life in patients who had low anterior resection was compared with those who had abdominoperineal excision both preoperatively and 1 year after surgery.
SETTINGS: : This study was conducted at 3 centers in the United Kingdom and 1 center in Europe.
PATIENTS: : Included were consecutive patients with rectal cancer within 6 cm of the anal verge, all of whom provided written consent for participation.
MAIN OUTCOME MEASURES: : Mann-Whitney U test comparisons of QLQ-C30 and QLQ-CR38 module scores for patients undergoing low anterior resection and abdominoperineal excision were the main outcomes measured.
RESULTS: : Patients undergoing low anterior resection were younger (median age, 59.5 vs 67, p = 0.03) with higher tumors (4 vs 3, p < 0.001) and less likely to receive neoadjuvant therapy (p = 0.02). At 1 year postoperatively, global quality-of-life ratings were comparable, but patients undergoing abdominoperineal excision reported better cognitive (100 vs 83, p = 0.018) and social (100 vs 67, p = 0.012) function, and less symptomatology with respect to pain (0 vs 17, p = 0.027), sleep disturbance (0 vs 33, p = 0.013), diarrhea (0 vs 33, p = 0.017), and constipation (p = 0.021). Patients undergoing low anterior resection reported better sexual function (33 vs 0, p = 0.006), but 72% experienced a degree of fecal incontinence.
LIMITATIONS: : This study was limited by its relatively small sample size.
CONCLUSION: : Abdominoperineal excision should not be regarded as an operation that is inferior to low anterior resection in the management of low rectal cancer on the basis of quality of life alone.

PMID: 22426263 [PubMed - in process]

HPV-related (pre)malignancies of the female anogenital tract in renal transplant recipients.

Fetched: March 31st, 2012, 11:00pm MDT

HPV-related (pre)malignancies of the female anogenital tract in renal transplant recipients.

Crit Rev Oncol Hematol. 2012 Mar 16;

Authors: Hinten F, Meeuwis KA, van Rossum MM, de Hullu JA

Abstract
Renal transplantations (RTs) are performed routinely in many countries. After RT, the administration of lifelong immunosuppressive therapy is required. As a consequence, renal transplant recipients (RTRs) have a high risk to develop virus-associated (pre)malignancies, such as Human papillomavirus (HPV) related anogenital (pre)malignancies. It is known that the majority of the RTRs are infected with HPV and that these women have a 14-fold increased risk of cervical cancer, up to 50-fold of vulvar cancer and up to 100-fold of anal cancer. Often, treatment of these lesions requires concessions and may be suboptimal as radiation therapy and extensive surgery may damage the renal transplant. Therefore, prognosis may be compromised due to inadequately treated malignancies. Especially for these immunocompromised patients prevention is of utmost importance. Yearly cervical cancer screening for RTRs is advised, but appears to be executed poorly. For the future, optimizing screening and prevention of anogenital (pre)malignancies is an important issue for women after RT. This review gives a broad overview of all aspects regarding HPV-related (pre)malignancies of the female anogenital tract in RTRs.

PMID: 22425015 [PubMed - as supplied by publisher]

Permalink for 'Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients.'

Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients.

Fetched: March 31st, 2012, 11:00pm MDT

Morbidity risk factors after low anterior resection with total mesorectal excision and coloanal anastomosis: a retrospective series of 483 patients.

Ann Surg. 2012 Mar;255(3):504-10

Authors: Bennis M, Parc Y, Lefevre JH, Chafai N, Attal E, Tiret E

Abstract
OBJECTIVE: To report postoperative morbidity after low anterior resection (LAR) and coloanal anastomosis (CAA) for rectal cancer and identify possible risk factors of complications.
BACKGROUND: Coloanal anastomosis after total mesorectal excision (TME) is associated with significant morbidity. Precise data on the specific morbidity and the risk factors are lacking.
METHODS: We analyzed retrospectively 483 consecutive LARs with TME and CAA carried out in a single center between 1996 and 2005. All complications occurring up to 3 months after LAR and up to 3 months after closure of the diverting stoma were graded according to the Dindo classification.
RESULTS: Of 483 patients, 164 (33.9%) suffered at least 1 complication, leading to death in 2 (0.4%) patients. Grade III/IV complications occurred in 69 of 483 (14.2%) patients. Thirty-four (7.0%) patients developed leakage of the CAA and 3 patients had leakage of the small bowel anastomosis after stoma closure. Ileostomy closure was carried out after a mean of 88.7 days (36-630) after LAR. The stoma was not closed in 4 of 456 (0.6%) patients. In multivariate analysis, male sex (P = 0.0216) and postoperative transfusion (P = 0.0025) were associated with complications. Medical complications were furthermore associated with previous thrombembolic events (P = 0.0012) and associated surgery at the time of LAR (P = 0.0010). Circumferential tumor localization was predictive of surgical complications (P = 0.0015). The only factor associated with a risk of leakage was transfusion (P = 0.0216).
CONCLUSIONS: In this series morbidity occurred in 34% and dehiscence of the CAA in 7.0%. Transfusion requirement was an independent risk factor for postoperative complications and anastomotic leakage.

PMID: 22281734 [PubMed - indexed for MEDLINE]

Histopathologic outcomes and clinical correlations for high-risk patients screened with anal cytology.

Fetched: March 31st, 2012, 11:00pm MDT

Histopathologic outcomes and clinical correlations for high-risk patients screened with anal cytology.

Acta Cytol. 2012;56(1):62-7

Authors: Zhao C, Domfeh AB, Austin RM

Abstract
OBJECTIVE: Anal cytologic testing is being increasingly used as a preventive screening test in high-risk populations. We document anal cytology results, correlating HIV test results, and histopathologic follow-up outcomes from a large integrated health system which recently implemented anal screening.
STUDY DESIGN: Anal Pap tests between May 2007 and August 2009 were studied and correlated with HIV test histories and follow-up histopathologic diagnoses.
RESULTS: 688 anal cytologic tests were identified with 7.4% reported as unsatisfactory; 72% of anal cytologic tests were abnormal; 91% of patients were HIV positive. The HIV-positive rate and likelihood of high viral load were both significantly greater among patients with abnormal anal cytology than among patients with negative anal cytology, but did not vary significantly among patients with different categories of abnormal anal cytology. For 459 patients with abnormal anal cytology, 198 had anal biopsies. For patients with abnormal anal cytology findings of ASC-US (atypical squamous cells of undetermined significance), LSIL (low-grade squamous intraepithelial neoplasia), ASC-H (atypical squamous cells, cannot exclude high-grade squamous lesion), and HSIL (high-grade squamous intraepithelial neoplasia), histopathologic intraepithelial neoplasia (AIN)2/3 or 2/3+ diagnoses were established in 46.5, 56.6, 65, and 80.8%, respectively.
CONCLUSIONS: Patients with any level of abnormal anal cytology result are at significant risk of the presence of histopathologically verifiable high-grade anal intraepithelial lesions. More specific markers for identifying patients at highest risk of progression to invasive anal carcinoma are needed.

PMID: 22236747 [PubMed - indexed for MEDLINE]

HPV vaccine is now routinely indicated for males.

Fetched: March 31st, 2012, 11:00pm MDT

HPV vaccine is now routinely indicated for males.

J Fam Pract. 2012 Jan;61(1):38-40

Authors: Campos-Outcalt D

PMID: 22220294 [PubMed - indexed for MEDLINE]

[A case report of chemoradiotherapy combined with S-1 responding to squamous cell carcinoma of the anal canal].

Fetched: March 31st, 2012, 11:00pm MDT

[A case report of chemoradiotherapy combined with S-1 responding to squamous cell carcinoma of the anal canal].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2280-2

Authors: Baba H, Kuwabara H, Wakabayashi M, Nakamura H, Sanada T, Baba H, Nakajima K, Goseki N

Abstract
A 79-year-old woman was reffered to our hospital with the chief complaint of hematochezia. Type-2 tumor was found on anal canal by colonoscopy, and pathologic examination revealed a poorly differentiated squamous cell carcinoma. Computed tomography of the abdomen demonstrated obturatory node metastasis. The patient was diagnosed as having squamous cell carcinoma of the anal cana (l cStage III). After four months from chemoradiation (66 Gy/33 Fr plus S-1), the ulcer side was improved completely to epithelization, and abdominal CT scan showed a remarkable reduction of obturatory node metastasis. She was obtained a complete response. Now the patient is disease-free for ten months after chemoradiation.

PMID: 22202355 [PubMed - indexed for MEDLINE]

[Multidisciplinary treatment including pneumonectomy for squamous cell carcinoma of the anal canal-a case report].

Fetched: March 31st, 2012, 11:00pm MDT

[Multidisciplinary treatment including pneumonectomy for squamous cell carcinoma of the anal canal-a case report].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2277-9

Authors: Aoyagi H, Kaneko J, Kamiya A, Isogai J, Iwata N, Katsuta E, Takahata T, Hasegawa K, Teduka K, Higuchi T, Maejima S

Abstract
In August 2008, a 52-year-old woman presented to our hospital with a complaint of bleeding upon defecation. The patient underwent lower gastrointestinal endoscopy with biopsy. PRb indicated a type 2 lesion in one-third of the circumference. The patient was diagnosed with squamous cell carcinoma by biopsy. Imaging did not reveal any metastasis to other organs. In September, she underwent an abdominoperineal resection of the rectum. Postoperative histopathological findings were PRb, type 2, A, N3, H0, P0, M0, and Stage III b. Adjuvant chemotherapy of oral S-1 was started. In January 2009, contrast-enhanced abdominal CT revealed a pelvic recurrence, and the patient underwent chemoradiotherapy. In October, chest CT showed a 5-mm solitary pulmonary metastasis in the right apex of the lung. In March 2010, chest CT showed a slight enlargement of the tumor in the right apex, but no other metastatic lesion was observed. In April, the patient underwent a thoracoscopic partial pneumonectomy. It has been 16 months postoperatively, and no recurrence has been observed. In the present report, we describe a case of squamous cell carcinoma of the anal canal that underwent multidisciplinary treatment including pneumonectomy. We also include a brief literature review.

PMID: 22202354 [PubMed - indexed for MEDLINE]

[A case of perianal squamous cell carcinoma attaining a complete response over five years with chemoradiotherapy].

Fetched: March 31st, 2012, 11:00pm MDT

[A case of perianal squamous cell carcinoma attaining a complete response over five years with chemoradiotherapy].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2119-21

Authors: Imada S, Ohue M, Noura S, Shingai T, Motoori M, Kishi K, Miyashiro I, Nishiyama K, Yano M, Ishikawa O

Abstract
We report a case with perianal squamous cell carcinoma, which showed a complete response more than five years after chemoradiotherapy. A 69-year-old-man was introduced to our hospital for the diagnosis of squamous cell carcinoma [T3 (8.0 × 8.0 cm) N0M0, Stage II]. The patient was treated by chemoradiotherapy, which consisted of 5-FU 750 mg/m²/ day (continuous intravenously) on days 1-5 and 29-33, and mitomycin C 10 mg/m² on days 1 and 29 and radiation at 2 Gy/day for 5 days per week (total dose 60 Gy). The patient tolerated this treatment with no severe adverse effects. Tumor disappeared completely 1 month after this treatment with no adjuvant therapy. The patient has been alive with no sign of recurrence for 6 years.

PMID: 22202302 [PubMed - indexed for MEDLINE]

[Anal squamous cell carcinoma-a report of 6 cases].

Fetched: March 31st, 2012, 11:00pm MDT

[Anal squamous cell carcinoma-a report of 6 cases].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2116-8

Authors: Yonaiyama S, Koyama M, Tsutsumi S, Morohashi H, Sakamoto Y, Murata A, Hakamada K, Hatayama Y, Kawaguchi H

Abstract
In Japan, surgical therapy is utilized as the main treatment modality for anal squamous cell carcinoma (SCC). Subjects were 6 patients with anal SCC treated at our hospital from 2000-2010, and a study was made on the treatment. In the early 3 cases (Stage IIIA, IIIB, IIIB), chemoradiotherapy (CRT) was used as adjuvant therapy on the premise of surgery. All of them were considered as stable disease, and they all experienced postoperative complications. The average length of the hospital stay was 45 days. Two cases are still surviving without recurrence, but the other one developed a distant metastasis. In contrast, we selected CRT with curative intent in the late 3 cases(Stage II, IIIA, IIIB). Two cases were considered as complete response (CR), and the other one considered as partial response (PR) was performed a salvage operation. Two cases are still surviving without recurrence, but the other case metastasized to the internal iliac lymph nodes. CRT with curative intent for anal SCC demonstrated a good antitumor effect. Salvage operation was safely performed, and showed a good prognosis.

PMID: 22202301 [PubMed - indexed for MEDLINE]

[Squamous cell carcinoma of the anal canal showing pathological complete response after S-1 plus radiotherapy -a case report].

Fetched: March 31st, 2012, 11:00pm MDT

[Squamous cell carcinoma of the anal canal showing pathological complete response after S-1 plus radiotherapy -a case report].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2110-2

Authors: Hata T, Ohara N, Masuike Y, Okamoto K, Hata T, Fujino S, Yanagawa T, Kitahara T, Oshima K, Nagai K, Noda T, Miyake M, Kawanishi K, Morita S, Fujita J, Iwazawa T, Akagi K, Dono K, Kitada M

Abstract
The patient was a 53-year-old woman who underwent colonoscopy for anal pain and melena. We diagnosed her with Stage I (T2N0M0) anal canal squamous cell carcinoma by biopsy specimen and CT scan. We recommended chemo-radiotherapy because she hoped to keep her anus. For this patient, we planned an S-1 administration at a dose of 120 mg/ body/day for consecutive 14 days followed by 7 days of rest period with whole pelvis and bilateral inguinal radiation (total 45 Gy/25 Fr). Then we added a booster radiation (14 Gy/7 Fr) to a local area for 5 days followed by 2 days of rest period. After 2 weeks of chemo-radiotherapy, we could not detect any tumors by colonoscopy. We diagnosed it as a pathological complete response for biopsy specimen.

PMID: 22202299 [PubMed - indexed for MEDLINE]

[Preoperative chemoradiation (XELOX/RT) therapy for anal canal adenocarcinoma with the metastasis to inguinal lymph node].

Fetched: March 31st, 2012, 11:00pm MDT

[Preoperative chemoradiation (XELOX/RT) therapy for anal canal adenocarcinoma with the metastasis to inguinal lymph node].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2048-50

Authors: Makino S, Ide Y, Murata K

Abstract
For a woman with poorly-differentiated anal canal adenocarcinoma in acknowledgment of metastasis to right inguinal lymph node, we gave radiotherapy combined with capecitabine as chemotherapy. Then the next two months, we performed XELOX therapy. Subsequently, we performed laparoscopic rectal amputation+D1 dissection+right groin lymph node dissection. The effect of preoperative chemoradiotherapy and pathological examination of the main tumor was Grade 2. And the right inguinal lymph node showed only a mucous persistence. Capecitabine was given as an adjuvant postoperative treatment and did not show a recurrence for five months after the operation. For a treatment for anal canal adenocarcinoma in acknowledgment of metastasis to inguinal lymph node, preoperative chemoradiotherapy may be effective.

PMID: 22202280 [PubMed - indexed for MEDLINE]

[A case report of long-term survival in the patient with anorectal malignant melanoma].

Fetched: March 31st, 2012, 11:00pm MDT

[A case report of long-term survival in the patient with anorectal malignant melanoma].

Gan To Kagaku Ryoho. 2011 Nov;38(12):2045-7

Authors: Yokota K, Takahashi M, Okada K, Ishizu H, Masuko H, Tanaka K, Hata T, Kawamura H, Yamagami H, Watarai H, Tanioka T

Abstract
Malignant melanoma of the anorectal region is rare, and the prognosis is considered to be poor. We present a case of long-term survival in a 56-year-old patient with primary malignant melanoma in the anorectal area, who complained of anal bleeding. Barium enema showed an elevated lesion in the anorectal region. Colonoscopy revealed a 3 cm sessile tumor with focal pigmentation, and a satellite nodule, 1 cm in diameter. Based on diagnosis of malignant melanoma by biopsy, abdominoperineal resection with lateral node dissection was performed. Pathologically the tumor remained in the mucosa, and no lymph node metastasis was found. This patient refused any adjuvant chemotherapy after the operation, and remains well without any sign of recurrence for seven years.

PMID: 22202279 [PubMed - indexed for MEDLINE]

[Treatment of early rectal carcinoma by transanal resection-a case report].

Fetched: March 31st, 2012, 11:00pm MDT

[Treatment of early rectal carcinoma by transanal resection-a case report].

Gan To Kagaku Ryoho. 2011 Nov;38(12):1972-4

Authors: Yabe N, Murai S, Shimizu H, Fukushima H, Minagawa T, Ishida T, Shoji T, Amemiya T, Hasegawa H, Kitagawa Y

Abstract
A 55-year-old female was admitted to Ogikubo Hospital for severe anemia and prolapse of a tumor from the anus, which had developed over 2 years. Rectal examination revealed a giant soft tumor. Endoscopic study revealed a lobulated giant tumor with a granular surface. Gastrografin-enema study showed a giant tumor, which was full of the rectum. Pathological examination showed a well differentiated carcinoma. No other prominent metastatic lesions were demonstrated. The transanal diagnostic resection of rectal cancer was performed in October 2010. This correct diagnosis showed both well differentiated adenocarcinoma and intramucosal carcinoma. We therefore recommend that a tumor of the lower rectum should undergo a diagnostic excision by means of either a local excision, ESD or TEM.

PMID: 22202256 [PubMed - indexed for MEDLINE]

Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer.

Fetched: March 31st, 2012, 11:00pm MDT

Self-care strategies for the management of bowel symptoms following sphincter-saving surgery for rectal cancer.

Clin J Oncol Nurs. 2011 Dec;15(6):E105-13

Authors: Landers M, Savage E, McCarthy G, Fitzpatrick JJ

Abstract
The primary aim of this article is to identify the self-care strategies that patients use to manage bowel symptoms experienced following sphincter-saving surgery for rectal cancer. Comparisons will be made with self-care strategies used by patients to manage chronic fecal incontinence and the bowel symptoms associated with other chronic bowel diseases, such as irritable bowel syndrome and inflammatory bowel disease. Published studies and conceptual literature from 2000-2010 were the data sources. Three major themes emerged from the literature reflecting the self-care strategies used by patients to manage bowel symptoms: functional self-care strategies (e.g., taking medication), social activity-related self-care strategies (e.g., planning social events), and alternative self-care strategies (e.g., complementary therapies). An analysis of studies highlighted that, through the process of trial and error, patients learned the strategies that were most effective in the management of their bowel symptoms. Knowledge of such strategies will be beneficial to healthcare professionals when educating patients about effective management of bowel symptoms following sphincter-saving surgery.

PMID: 22119985 [PubMed - indexed for MEDLINE]

Transanal endoscopic microsurgery for T1 rectal cancer: size matters!

Fetched: March 31st, 2012, 11:00pm MDT

Transanal endoscopic microsurgery for T1 rectal cancer: size matters!

Surg Endosc. 2012 Feb;26(2):551-7

Authors: Doornebosch PG, Zeestraten E, de Graaf EJ, Hermsen P, Dawson I, Tollenaar RA, Morreau H

Abstract
BACKGROUND: Transanal endoscopic microsurgery (TEM) is considered a curative option for selected T1 rectal cancer. Although TEM is safe, local recurrence (LR) rates after TEM are unacceptably high. Evidence on selection criteria, however, is not abundant. To expand evidence on low- versus high-risk T1 rectal cancer with respect to LR, this study aimed to identify predictive histopathologic factors in a selected group of T1 rectal cancers treated with TEM only.
METHODS: The study enrolled 62 patients for whom specimens of the primary tumor containing an invasive T1 carcinoma could be reevaluated. Tumors were scored according to predefined criteria, and analysis of predictive factors for locoregional failure was performed.
RESULT: Local recurrence rates at 3 years for tumors 3 cm in size or smaller were significantly lower than for tumors larger than 3 cm (16 vs. 39%; P < 0.03). Combining smaller tumors with submucosal invasion depth and budding led to identifying tumors that likely will not recur (3-year LR rates, 7 and 10%, respectively).
CONCLUSIONS: The findings showed that low- and high-risk criteria are too robust for identifying tumors at risk for LR. Tumor size alone or in combination with submucosal invasion depth or tumor budding appeared to be a significant predictive factor for locoregional failure after TEM for T1 rectal cancer.

PMID: 21993932 [PubMed - indexed for MEDLINE]

[Early detection of anal intraepithelial neoplasia in high-risk patients].

Fetched: March 31st, 2012, 11:00pm MDT

[Early detection of anal intraepithelial neoplasia in high-risk patients].

Actas Dermosifiliogr. 2011 Dec;102(10):754-6

Authors: Ferrándiz-Pulido C

PMID: 21943877 [PubMed - indexed for MEDLINE]

[Early detection of anal intraepithelial neoplasia in high-risk patients].

Fetched: March 31st, 2012, 11:00pm MDT

[Early detection of anal intraepithelial neoplasia in high-risk patients].

Actas Dermosifiliogr. 2011 Dec;102(10):757-65

Authors: Sendagorta E, Herranz P, Guadalajara H, Zamora FX

Abstract
The incidence of anal squamous cell carcinoma has increased alarmingly, particularly in high-risk groups such as men who have sex with men and immunosuppressed patients. Infection with an oncogenic strain of the human papillomavirus in the anal canal or perianal skin leads to anal intraepithelial neoplasias (AIN), progressive dysplastic intraepithelial lesions that are the precursors of anal squamous cell carcinoma. AIN can be diagnosed through cytological screening and biopsy guided by high-resolution anoscopy and can be treated using a range of procedures in an effort to prevent progression to invasive anal carcinoma. Given the recent advances in the understanding of this disease, and the increasing calls from experts for the establishment of screening programs to identify AIN, we review current knowledge on the condition, its diagnosis, and treatment from the point of view of dermatology.

PMID: 21764027 [PubMed - indexed for MEDLINE]

S-1-based therapy versus 5-FU-based therapy in advanced gastric cancer: a meta-analysis.

Fetched: March 31st, 2012, 11:00pm MDT

S-1-based therapy versus 5-FU-based therapy in advanced gastric cancer: a meta-analysis.

Med Oncol. 2011 Dec;28(4):1004-11

Authors: Huang J, Cao Y, Wu L, Liao C, He Y, Gao F

Abstract
We set out to evaluate the efficacy and safety of S-1-based therapy versus fluorouracil (5-FU)-based therapy in advanced gastric cancer (AGC). Eligible studies were identified from Pubmed, EMBASE, and Cochrane Library. Additionally, abstracts presented at American Society of Clinical Oncology (ASCO) conferences held between January 2000 and November 2009 were searched to identify relevant clinical trials. The outcome included overall survival (OS), overall response rate (ORR), and grade 3/4 advent events. Four randomized controlled trials (one full text and three abstracts) with 2,115 participants in AGC were identified in our analysis(1,065 patients were in the S-1-based group, 1,050 patients were in the 5-FU-based group). Meta-analysis showed there was significant OS benefit in favor of S-1-based therapy (hazard ratio [HR]=0.87, 95% confidence interval [CI]: 0.79 to 0.96). Pooled estimate for ORR showed no significant difference between S-1-based group and 5-FU-based group (OR=1.25, 95%CI: 0.31 to 5.09). Lower incidence of grade 3/4 neutropenia was observed in patients with S-1-based therapy (OR=0.33, 95%CI: 0.25 to 0.44). With regard to grade 3/4 anemia (OR=1.20, 95%CI: 0.74 to 1.96), leucopenia (OR=1.09, 95%CI: 0.43 to 2.74), stomatitis (OR=2.65, 95%CI: 0.12 to 58.89), diarrhea (OR=0.53, 95% CI: 0.00 to 229.10), nausea (OR=1.36, 95%CI: 0.68 to 2.72), and treatment-related deaths (OR=1.84, 95%CI: 0.95 to 3.54), equivalent frequencies were found between groups. S-1-based therapy significantly improved OS in relation to 5-FU-based therapy. ORR and safety profile were considerable between two groups. These results needed to be confirmed by high-quality trials and further studies in the West.

PMID: 20552300 [PubMed - indexed for MEDLINE]

Rare Cancer News & Clinical Trials » PubMed - Anal Cancer

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PubMed - Anal Cancer (93 unread)

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