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Atthaphorn Trakarnsanga MD Mithat Gonen PhD Jinru Shia MD Karyn A. Goodman MD Garrett M. Nash MD Larissa K. Temple MD José G. Guillem MD Philip B. Paty MD Julio Garcia-Aguilar MD Martin R. Weiser MD FACS 《Annals of surgical oncology》2013,20(4):1179-1184
Background
The circumferential resection margin (CRM) is highly prognostic for local recurrence in rectal cancer surgery without neoadjuvant treatment. However, its significance in the setting of long-course neoadjuvant chemoradiotherapy (nCRT) is not well defined.Methods
Review of a single institution’s prospectively maintained database from 1998 to 2007 identified 563 patients with locally advanced rectal cancer (T3/T4 and/or N1) receiving nCRT, followed after 6 weeks by total mesorectal excision (TME). Kaplan-Meier, Cox regression, and competing risk analysis were performed.Results
The authors noted that 75 % of all patients had stage III disease as determined by endorectal ultrasound (ERUS) and/or magnetic resonance imaging (MRI). With median follow-up of 39 months after resection, local and distant relapse were noted in 12 (2.1 %) and 98 (17.4 %) patients, respectively. On competing risk analysis, the optimal cutoff point of CRM was 1 mm for local recurrence and 2 mm for distant metastasis. Factors independently associated with local recurrence included CRM ≤1 mm, and high-grade tumor (p = 0.012 and 0.007, respectively). CRM ≤2 mm, as well as pathological, nodal, and overall tumor stage are also significant independent risk factors for distant metastasis (p = 0.025, 0.010, and <0.001, respectively).Conclusion
In this dataset of locally advanced rectal cancer treated with nCRT followed by TME, CRM ≤1 mm is an independent risk factor for local recurrence and is considered a positive margin. CRM ≤2 mm was associated with distant recurrence, independent of pathological tumor and nodal stage. 相似文献2.
Atthaphorn Trakarnsanga Suthinee Ithimakin Martin R Weiser 《World journal of gastroenterology : WJG》2012,18(39):5521-5532
Rectal cancers extending through the rectal wall, or involving locoregional lymph nodes (T3/4 or N1/2), have been more difficult to cure. The confines of the bony pelvis and the necessity of preserving the autonomic nerves makes surgical extirpation challenging, which accounts for the high rates of local and distant relapse in this setting. Combined multimodality treatment for rectal cancer stage Ⅱ and Ⅲ was recommended from National Institute of Health consensus. Neoadjuvant chemoradiation using fluoropyrimidine-based regimen prior to surgical resection has emerged as the standard of care in the United States. Optimal time of surgery after neoadjuvant treatment remained unclear and prospective randomized controlled trial is ongoing. Traditionally, 6-8 wk waiting period was commonly used. The accuracy of studies attempting to determine tumor complete response remains problematic. Currently, surgery remains the standard of care for rectal cancer patients following neoadjuvant chemoradiation, where-as observational management is still investigational. In this article, we outline trends and controversies associated with optimal pre-treatment staging, neoadjuvant therapies, surgery, and adjuvant therapy. 相似文献
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Daniel R. Perez MD Atthaphorn Trakarnsanga MD Jinru Shia MD Garrett M. Nash MD Larissa K. Temple MD Philip B. Paty MD Jose G. Guillem MD MPH Julio Garcia-Aguilar MD PhD Danielle Bello MD Charlotte Ariyan MD Richard D. Carvajal MD Martin R. Weiser MD 《Annals of surgical oncology》2013,20(7):2339-2344
Background
The effect of lymph node metastasis on local tumor control and distant failure in patients with anorectal melanoma has not been fully studied. Understanding the significance of lymphatic dissemination might assist in stratifying patients for either organ preservation or radical surgery.Methods
A retrospective review of all patients with anorectal melanoma who underwent surgery at our institution between 1985 and 2010. Abdominoperineal resection (APR) was performed in 25 patients (39 %), and wide local excision (WLE) in 40 (61%). Extent of primary surgery and locoregional lymphadenectomy (mesorectal vs. inguinal vs. none) and pattern of treatment failure were analyzed. Recurrence-free survival (RFS) and disease-specific survival (DSS) were calculated.Results
In patients undergoing APR, DSS was not associated with presence (29 %) or absence (71 %) of metastatic melanoma in mesorectal lymph nodes. There was a trend toward improved DSS in patients with clinically negative inguinal lymph nodes (n = 17) compared with patients with proven inguinal metastasis (n = 6; P = 0.12). Type of surgery (WLE vs. APR) was not associated with subsequent development of distant disease. Twelve patients (18 %) had synchronous local and distant recurrence. Synchronous recurrence was not associated with surgical strategy used to treat primary tumor (P = 0.28). Perineural invasion (PNI) was significantly correlated with RFS (P = 0.002).Conclusions
Outcome following resection of anorectal melanoma is independent of locoregional lymph node metastasis; lymphadenectomy should be reserved for gross symptomatic disease. PNI is a powerful prognostic marker warranting further exploration in clinical trials. 相似文献4.
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Thawatchai Akaraviputh Satida Arunakul Varut Lohsiriwat Cherdsak Iramaneerat Atthaphorn Trakarnsanga 《World journal of gastroenterology : WJG》2010,16(6):745-748
AIM:To characterize clinical features,surgery,outcome,and survival of malignant melanoma(MM) of the gastrointestinal(GI) tract in a surgical training center in Bangkok,Thailand. METHODS:A retrospective review was performed for all patients with MM of the GI tract treated at our institution between 1997 and 2007. RESULTS:Fourteen patients had GI involvement either in a metastatic form or as a primary melanoma. Thirteen patients with sufficient data were reviewed. The median age of the patients was 66 years(r... 相似文献
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Endoscopic tattooing is one of the most useful tools for the localization of small colorectal lesions especially in the laparoscopic setting.This is a minimally invasive endoscopic procedure without risk of major complications.However,many studies have revealed complications resulting from this procedure.In this article,several topics are reviewed including the accuracy,substance preparation,injected techniques and complications related to this procedure. 相似文献
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Atthaphorn Trakarnsagna Vitoon Chinswangwatanakul Asada Methasate Jirawat Swangsri Chainarong Phalanusitthepha Thammawat Parakonthun Voraboot Taweerutchana Thawatchai Akaraviputh 《International journal of surgery case reports》2014,5(11):868-872
INTRODUCTION
Inguinal hernia is one of the most surgical common diseases. Giant inguinal hernia is more unusual and significantly challenging in terms of surgical management. It is defined as an inguinal hernia that extends below the midpoint of inner thigh when the patient is in standing position.PRESENTATION OF CASE
A 67-year-old male presented with giant right-side inguinal hernia with symptoms of partial colonic obstruction and significant weight loss. Barium enema revealed ascending colon, cecum and ileum contained in hernia sac without significant lesions of large bowel. He underwent hernia repair with omentectomy. Hernioplasty with polypropylene mesh was performed without any complications. He recovered uneventfully.DISCUSSION
There were several repair techniques suggested by published articles such as resection of the content and increased intraabdominal volume procedure. Many key factors for management of the giant inquinal hernia were discussed. A new classification of the giant inquinal hernia was described.CONCLUSION
Surgical repair for the giant inquinal hernia is challenging and correlated with significant morbidity and mortality due to increased intra-abdominal pressure. 相似文献9.
Santi Krittiyanitsakun Chawisa Nampoolsuksan Thikhamporn Tawantanakorn Tharathorn Suwatthanarak Nicha Srisuworanan Voraboot Taweerutchana Thammawat Parakonthun Chainarong Phalanusitthepha Jirawat Swangsri Thawatchai Akaraviputh Asada Methasate Vitoon Chinswangwatanakul Atthaphorn Trakarnsanga 《World Journal of Clinical Cases》2023,11(2):357-365
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