Quality of life after coloanal anastomosis and abdominoperineal resection for distal rectal cancers: sphincter preservation vs quality of life

Aim A permanent colostomy is considered to have an adverse impact on quality of life (QOL). However, functional outcomes following sphincter preservation also affect QOL. Our aim was to determine differences in QOL of patients undergoing coloanal anastomosis (CAA) or abdominoperineal resection (APR) for distal rectal cancer. Method Eighty‐five patients underwent CAA (72 with intestinal continuity and 13 with a stoma because of complications) and 83 patients underwent APR for a distal rectal cancer between 1995 and 2001 at a single institution and responded to our survey. QOL was evaluated using the EORTC QLQ‐C30 and QLQ‐CR38. Results Patients with CAA were younger than APR patients (mean age 57 vs 62 years, P < 0.001), but gender distribution, tumour stage and proportion of subjects receiving radiotherapy was not significantly different. Patients undergoing CAA had higher scores (better QOL) for physical functioning; lower scores (fewer symptoms) for fatigue, pain, financial difficulties, weight loss and chemotherapy side effects; and higher scores (more symptoms) for constipation and gastrointestinal symptoms compared with APR patients. CAA patients had higher scores (better QOL) for body image in men but not in women. Sexual functioning scores in men and women were lower (worse QOL) in CAA patients compared with APR patients. Conclusions QOL after APR is comparable to sphincter preservation, although there are some differences that need to be considered. QOL and functional results should be taken into account with the oncological outcome when devising management strategy for distal rectal cancer.     

Laparoskopische Operationen bei Rektumkarzinomen

Purpose

A number of minimally invasive techniques have now been described for rectal cancer resection. However, current outcome data for these approaches from high-volume single institutions remain limited. Our aim was to review outcomes in patients currently undergoing minimally invasive surgery for rectal cancer at our institution.

Methods

A retrospective analysis was performed to assess short-term benefits and oncologic outcomes in patients undergoing minimally invasive surgery for rectal cancer between 2004 and 2007.

Results

A total of 100 consecutive patients (61 men, median age 62) with a median follow-up of 1.8?years were identified. Of these, 67 underwent hand-assisted laparoscopic surgery (HALS) and 33 laparoscopic-assisted (LA) procedures. In all, 72 patients underwent anterior resection, 27 abdominal perineal resection, and one total proctocolectomy. Tumor stages were stage 1 (21%), stage 2 (17%), stage 3 (56%), and stage 4 (6%). A median of 16 lymph nodes were removed, while both a median distal margin of 3.4?cm and a 99% negative circumferential margin were achieved. The 3-year disease-free and overall survival rates were 86.2 and 94.5%, respectively. Three cases required conversion. Median time to both food intake and first bowel movement was 3?days, while the median length of stay was 5?days. Length of stay, time to soft diet, incision length, and pain scores were less using an LA approach compared to HALS (P<0.01). Overall morbidity was 26% with no mortality.

Conclusions

Both minimally invasive techniques used achieved excellent oncologic results in patients with rectal cancer. The LA approach had slightly better short-term outcomes.     

Natural history of breast cancer

Breast women cancer is a disease with a lot of paradigms; then, it is a big problem of health. It is important to know its nature history, because breast cancer has a multifactor onset; therefore, we have to understand its behavior, since its risks factors, until patient's death by metastatic disease in the host. In this work we made a bibliography, analytic review that brings up concepts related since theirs sources, evolution, preclinical horizon, and clinical symptoms to the dead of host.     

Intracranial microcapsule drug delivery device for the treatment of an experimental gliosarcoma model

Controlled-release drug delivery systems are capable of treating debilitating diseases, including cancer. Brain cancer, in particular glioblastoma multiforme (GBM), is an extremely invasive cancer with a dismal prognosis. The use of drugs capable of crossing the blood-brain barrier has shown modest prolongation in patient survival, but not without unsatisfactory systemic, dose-limiting toxicity. Among the reasons for this improvement include a better understanding of the challenges of delivery of effective agents directly to the brain tumor site. The combination of carmustine delivered by biodegradable polyanhydride wafers (Gliadel(?)), with the systemic alkylating agent, temozolomide, allows much higher effective doses of the drug while minimizing the systemic toxicity. We have previously shown that locally delivering these two drugs leads to further improvement in survival in experimental models. We postulated that microcapsule devices capable of releasing temozolomide would increase the therapeutic capability of this approach. A biocompatible drug delivery microcapsule device for the intracranial delivery of temozolomide is described. Drug release profiles from these microcapsules can be modulated based on the physical chemistry of the drug and the dimensions of the release orifices in these devices. The drug released from the microcapsules in these experiments was the clinically utilized chemotherapeutic agent, temozolomide. In vitro studies were performed in order to test the function, reliability, and drug release kinetics of the devices. The efficacy of the temozolomide-filled microcapsules was tested in an intracranial experimental rodent gliosarcoma model. Immunohistochemical analysis of tissue for evidence of DNA strand breaks via terminal deoxynucleotidyl transferase dUTP nick end labeling (TUNEL) assay was performed. The experimental release curves showed mass flow rates of 36?μg/h for single-orifice devices and an 88?μg/h mass flow rate for multiple-orifice devices loaded with temozolomide. In vivo efficacy results showed that localized intracranial delivery of temozolomide from microcapsule devices was capable of prolonging animal survival and may offer a novel form of treatment for brain tumors.     

Impact of pre- and postoperative multimodality therapy on rectal cancer

Surgery is the primary treatment of rectal cancer. However, variability in surgical outcomes led to development of combined therapies including pelvic radiation and systemic chemotherapy. The evolution of these therapies both individually and combined, their successes and limitations is discussed in the context of an evolving understanding of rectal cancer biology. The impact of standardized optimal surgery on the need for additional therapy and trends in treating complete responders to neoadjuvant therapy is also reviewed.