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1
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Protective Stomy as a Complement to Anterior Rectal Resection. Analysis of Authors' Material and Literature Review

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Kruszewski W., Jasiński W., Szajewski M., Szefel J., Kawecki K., Ciesielski M., Pikiel P., Dilling P., Warężak C.
Polish Journal of Surgery
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2011
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vol. 83
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issue 3
150-154
EN
Anastomotic leak after anterior rectal resection for cancer is one of the most dangerous complications of the procedure. Protective stomy is a way to avoid life-threatening consequences of this complication. The procedure is still under evaluation.The aim of the study was to evaluate the usefulness of forming a protective stomy as part of anterior rectal cancer resection on the basis of an analysis of the authors' material.Material and methods. In 2008 - 2009, we treated 111 patients with rectal cancer. Thirty-two of those patients received preoperative radio(chemo)therapy. Eighty-four patients (76%) underwent resection of the primary tumour. In 20 patients (24%), we performed abdominoperineal or abdominosacral resection; in 6 (7%) cases the Hartmann procedure was used and in 58 (69%) cases anterior rectal resection was performed. In 53 of 58 cases, the resections were assessed as curative and in 5 as palliative. In 18 of 58 (31%) patients, anterior resections were defined as low anterior resections. Twelve (67%) of these patients were subjected to preoperative radio(chemo)therapy. Two of 58 patients, who underwent anterior resection, had been treated by stomy creation before the radical procedure. One of them required neoadjuvant radiotherapy. In the second patient with the stomy, we restored the intestinal continuity during the primary tumour resection. Among the remaining 40 patients, only one underwent protective stomy creation during the resective procedure. This patient did not require preoperative radiotherapy.Results. We have not found any clinical indications of anastomotic leak in the analysed group of 58 patients subjected to anterior rectal resection for cancer.Conclusions. Our modest experience reaffirms our conviction that anterior rectal cancer resection does not require routine protective stomy creation, also when low anterior resection follows preoperative radiotherapy.
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Low-Anterior-Resection Syndrome. How Does Neoadjuvant Radiotherapy and Low Resection of the Rectum Influence the Function of Anal Sphincters in Patients with Rectal Cancer? Preliminary Results of a Functional Assessment Study

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Romaniszyn M., Richter P., Walega P., Kenig J., Nowak M., Nowak W.
Polish Journal of Surgery
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2012
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vol. 84
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issue 4
177-183
EN
The aim of the study was to assess the influence of neoadjuvant radiotherapy and resection of the rectum on the functional parameters of anal sphincters.Material and methods. 20 patients with rectal cancer, qualified for low anterior rectal resection with neoadjuvant radiotherapy were enrolled in the study group. The study protocol included an anorectal manometry, electromyography and fecal incontinence questionnaire (FISI) before radiotherapy, after radiotherapy, and after the operation.Results. Of the 20 patients 12 were included in the final analysis, because 8 patients were re-qualified to abdomino-perineal resection of the rectum after neoadjuvant treatment. There were no significant changes in anal pressures assessed 5 to 8 days after radiotherapy. In 3 cases (25%) pathological changes in RAIR reflex were found in the manometric examination. After low anterior resection mean basal anal pressures were significantly lower, whereas squeeze anal pressures did not change significantly. In 7 patients (58%) the RAIR reflex was pathological or even absent after low anterior resection. Changes in manometric parameters correlated with FISI incontinence assessment after the operation. In electromyographic examination action potentials of motoric units of the external anal sphincter were still present both after radiotherapy, and after operation.Conclusions. Fecal incontinence after low anterior resection of the rectum seems to be caused mostly by changes in autonomic functionality of anal sphincters and lack of compliance of the neorectum, since the influence of neoadjuvant radiotherapy and the operation itself on the somatic innervation of anal sphincters seems to be minimal.
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Satisfaction with life and disease acceptance by patients with a stomy related to surgical treatment of the rectal cancer – determinants of quality of life?

80%
Nowicki A., Marciniak J., Farbicka P., Banaszkiewicz Z.
Polish Journal of Surgery
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2015
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vol. 87(9)
434-442
EN
Satisfaction with life and disease acceptance by patients with a stomy related to surgical treatment of the rectal cancer depend on multiple factors. Such factors as social support, life conditions and time that elapsed after stomy creation, are very important in this context. The aim of the study was to conduct an early evaluation of life satisfaction and disease acceptance by patients with a stomy related to surgical treatment of the rectal cancer. Material and methods. The study was conducted at Dr. Jan Biziel University Hospital No. 2 in Bydgoszcz and at the prof. F. Łukaszczyk Oncology Centre in Bydgoszcz in 2014. The final analysis included 96 subjects aged 41-87 years (median 59 years). Satisfaction With Life Scale (SWLS) and Acceptance of Illness Scale (AIS) adapted by Zygfryd Juczyński, were used in this study. Results. Most patients had satisfaction with life score of 5 or 6, 23 (24%) and 28 (29.2%) subjects, respectively. Twenty nine (30.2%) study subjects had low satisfaction level, while 16 (16.7%) had high satisfaction level. Average disease acceptance score was 23.2 points. Most patients, 71 (74%) had a moderate disease acceptance score, while the lowest number of subjects, 9 (9.4%), had high disease acceptance score. None of the study subjects who were under the care of a psychologist (14/100%) did not have a low acceptance level. Conclusions. Half of the study subjects had a moderate level of satisfaction with life. Most patients with stomy related to surgical treatment of the rectal cancer in an early postoperative period had moderate level of the disease acceptance. Patients with high level of satisfaction with life, accept the disease better. Few patients who used help by a psychologist, were two- and three-fold more likely to have higher level of satisfaction with life and disease acceptance, respectively.
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Intraoperative neuromonitoring of hypogastric plexus branches during surgery for rectal cancer – preliminary report

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Wałęga P., Romaniszyn M., Wałęga M., Szymon Świrta J., Nowak W.
Polish Journal of Surgery
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2017
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vol. 89(2)
69-72
EN
Aim: The aim of this study was to present our preliminary experience with intraoperative neuromonitoring during rectal resection. Materials and methods: We qualified 4 patients (2 women, 2 men; age 42 – 53 years) with rectal cancer for surgery with intraoperative neuromonitoring. In all patients, functional tests of the anorectal area were performed before surgery. Action potentials from the sphincter complex in response to nerve fiber stimulation were recorded with electrodes implanted before surgery. Moreover, we inserted a standard, 18FR Foley’s urinary catheter to which a T-tube was connected to allow urine outflow and measurement of pressure changes in the bladder induced by detrusor contractions during stimulation. Results: Setting up neuromonitoring prolonged surgery time by 30 to 40 minutes, or even by 60 to 80 minutes in the case of the first two patients. Neuromonitoring itself took additional 20 to 30 minutes during surgery. In all patients, we stimulated branches of the inferior hypogastric plexus in their anatomical position during dissection. In three patients, we evoked responses both from the bladder and the sphincter in all planes of stimulation. In one patient, there was no response from the left side of the bladder, and in the same patient, we observed symptoms of neurogenic bladder. Conclusions: Based on the available literature and our own experience, we state that monitoring of bladder pressure and electromyographic signals from rectal sphincters enables visualization and preservation of autonomic nervous system structures, both sympathetic and parasympathetic. Intraoperative signals seem to be correlated with clinical presentation and functional examinations after surgery. In order to objectify our results, it is necessary to perform functional examinations before and after surgery in a larger group of patients.
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Elective Resection of Rectal Cancer Primary Tumor in Patients with Stage IV Disease - Own Experiences

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Halczak M., Wojtasik P., Al-Amawi T., Kładny J.
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EN
Optimal management of asymptomatic generalized rectal cancer is still the matter of debate.The aim of the study was to review stage IV rectal cancer patients who were treated in our clinic since 2000 till 2008 in order to evaluate the effectiveness of surgery.Material and methods. Fifty-two generalized rectal cancer patients treated with elective resection of primary tumor were identified. Patients' age, sex, duration of hospital stay, modality of surgery, complications, postoperative mortality rate and survival rate were assessed.Results. Median survival was 16.3 months. Postoperative complications occurred in 29% patients. Postoperative mortality rate was 1.9%.Conclusions. In properly selected group of patients elective resection of primary tumor may cause low mortality rate and acceptable morbidity rate. This surgical modality allows to avoid potential complications of tumor local growth.
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Sexual dysfunctions following low anterior resection of the rectum in rectal cancer patients

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Włodarczyk M., Sobolewska J., Nowak A., Szewczyk M., Kluska P., Dzika K., Darnikowska J., Mik-Wojtczak J., Włodarczyk J., Sobolewska-Włodarczyk A., Trzciński R., Dziki Ł.
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EN
Introduction. Low anterior resection of the rectum (LAR) is a treatment of choice in patients with diagnosed low rectal cancer. Rectal cancer surgery has a close relationship with the urinary-sexual organs and also with related nerves and nerve plexus. Thus, the sympathetic and parasympathetic nerves of the pelvic area may be damaged. As a result of this, the important point is the sexual function loss following rectal surgeries. The aim of the study was to investigate the sexual disorders in patients with rectal cancer who underwent LAR. Materials and methods. In this retrospective study the sexual activity, comfort of the experience, quality of sexual life (QoSL) during 3 periods were analyzed: before surgery, a month after and half a year after surgery. Analysis of demographic characteristics, comorbidities, previous surgeries, toumor characteristics and adjuvant therapy as was performed. Results. Most patients (64/100, 64%) expressed that LAR operation has strongly affected their QoSL, 32 patients reported the mild decrease in QoSL, while only 4 patients stated that did not experience any changes in QoSL. QoSL was assessed in 3 different periods of time: before the operation, 1 month after and 6 months after the operation (22,6±3.7 vs. 11.3±7,9 vs. 17,0±6.3; p<0.0001 respectively). The decreased QoSL one and six months after the surgery were significantly lower in patients with diagnosed hypertension and higher BMI (p=0.0283). Conclusions. Sexual disorders after LAR for rectal cancer are often underestimated and it is very important to be aware of them. In our study, it was determined that male sex, higher BMI and hypertension are related to impair of sexual dysfunction after LAR. We observed that the most severe complaints related to sexual activity occur one month after the procedure, after 6 months in most of the patients' sexual disorders were decreased approaching the initial state.
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Evaluation of risk factors for postoperative complications in rectal cancer patients

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Zeman M., Czarnecki M., Grajek M., Idasiak A., Tukiendorf A., Czarniecka A.
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EN
Introduction: The complications of surgical treatment for rectal cancer, particularly anastomotic leaks after anterior resection, are a significant clinical problem. We retrospectively analysed preoperative factors that may affect the occurrence of complications. Meterial and Methods: A total of 392 rectal cancer patients were included in a retrospective analysis. A total of 257 anterior resections (AR) and 135 abdominoperineal resections (APR) were performed. The risk factors for early postoperative complications were analysed by logistic regression and receiver operating characteristic curves. Results: The significant risk factors for severe complications (grade 3B and higher on the Clavien-Dindo scale) in the multivariate analysis were neutrophil to lymphocyte ratio > 5 (P = 0.047) in the AR group, age of the patients (P = 0.031) in the APR group, and coronary artery disease in both groups (P = 0.03, P = 0.011, respectively). There were no risk factors for anastomotic leaks in the AR group before the analysis was divided into early and late leaks. In the univariate analysis, the statistically significant risk factors for early leaks were preoperative neutrophil to lymphocyte ratio > 5 and peripheral blood platelet count, while late leaks were associated with coronary artery disease; however, in the multivariate analysis, these factors were not statistically significant. Conclusions: The risk factors for severe postoperative complications were neutrophil to lymphocyte ratio > 5, advanced age of the patients and coronary artery disease. The different risk factors for early and late anastomotic leaks after anterior resection may indicate their different aetiologies.
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Local Antibiotic Therapy in Rectal Cancer Surgery

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Morawiec Z., Pawlak M., Kołacińska A., Dziki A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 12
613-617
EN
Infectious complications and their consequences are still key issues in rectal cancer surgery. Currently, intravenous antibiotic administration is a recognized method for lowering the rate of these complications. The aim of the study was to assess the efficacy of complementary application of a gentamicin-impregnated sponge in the perineal wound or in the vicinity of intestinal anastomosis after abdominoperineal resection or low anterior resection. Material and methods. 112 patients with primary rectal cancer were enrolled in this study. 42 patients were treated with a gentamicin sponge and drainage (group A) and 70 individuals were treated with drainage alone (group B). In the aforementioned groups a routine short-term regimen of antibiotic prophylaxis was used. We applied gentamicin-impregnated sponges in 27 patients in whom anterior resection was performed and in 15 patients from the abdominoperineal resection group (64% and 36%, respectively). In the control group, 44 anterior resections and 26 abdominoperineal resections were carried out (63% and 37%, respectively). Results. We did not observe statistically significant differences in the incidence of suppurative complications (intraabdominal abscess, perineal wound infection): 4 cases (9.52%) in group A and 9 (12.58%) in group B and anastomotic leakage with clinical manifestation after low anterior resection: 1 case (3.7%) in group A and 2 (4.5%) in group B. Postoperative fever of unknown origin was noted more often in group B: 23 patients (32.8%) versus 10 patients (23.8%) in group A and this difference was statistically significant (p<0.05). Hospitalization after surgery was also significantly longer in group B (9-37 days, median 11 days) as compared with group A (8-26 days, median 13 days) (p<0.05). Conclusions. Local antibiotic therapy in rectal cancer surgery lowered the incidence of postoperative fever of unknown origin and permitted shorter hospitalization after surgery. Local gentamicin application in rectal cancer surgery did not change significantly the rate of infectious complications.
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Multimodal Treatment of Rectal Cancer - Evaluation of Preoperative Radiotherapy

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Bury P., Zinkiewicz K., Ciechański A., Styliński R., Zgodziński W., Wallner G.
Polish Journal of Surgery
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2010
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vol. 82
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issue 12
657-665
EN
Colorectal cancer constitutes 10% of all malignant neoplasms and is the fourth most common cancer in men and the third most common cancer in women, worldwide (second most common in Poland). Unfortunately, despite large scale screening programs, changes in diet and lifestyle, colorectal cancer incidence rates for both male and female patients has increased.The aim of the study was to analyze the influence of preoperative radiotherapy (RTH) on the survival and local recurrence rate of patients with rectal cancer, subject to surgical treatment with postoperative (adjuvant) chemotherapy (CTH).Material and methods. The study group comprised 132 patients, including 53 females and 79 males. Patients were divided into the following groups: I - 70 patients treated by means of preoperative radiotherapy, II - 62 patients treated by means of surgery alone. Patients qualified to radiotherapy were diagnosed with stage B (39 patients) and stage C (31 patients) cancer, according to Duke's classification (CT).The patients received 5 Gy each day for a period of 5 days (25 Gy altogether), and underwent surgery. Postoperative pathomorphology demonstrated the following: group I comprised 39 patients with stage B and 31 patients with stage C cancer, whereas group II comprised 34 and 28 patients, respectively. Patients with stage B and C (both groups) received postoperative chemotheraphy - six courses of 5-FU 435 mg/kg/d with leucovorin 20 mg/m2.Results. Kaplan-Meier's survival analysis was applied in each group, according to the following: grade of tumor (pT), lymph node involvement (pN, pN "+",pN "-"), type of surgical resection, stage of cancer, administration of radiotherapy, and presence of local recurrence. Result analysis point to the existing correlation between radiotherapy and the five-year survival rate (p=0.031), and local recurrence (stage B: p=0.1; stage C: p=0.049).Conclusions. Preoperative radiotherapy, considering prospective studies and our own study render hope for better prospects of treating rectal carcinoma in the future, and better 5-year survival rates. Analysis of the five-year survival rates, local recurrences, and distant complications confirmed the effectiveness and safety of preoperative radiotherapy in the treatment of rectal cancer, considering B and C patients.
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Influence of Obesity on Anastomotic Leakage After Anterior Rectal Resectionperformed Due to Cancer

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Piecuch J., Wiewióra M., Szrot M., Jopek J., Krzak A., Haza S., Sosada K.
Polish Journal of Surgery
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2015
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vol. 87
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issue 3
124-128
EN
Anterior resection for rectal cancer carries the risk of serious complications, especially fistulas at the site of anastomosis. Numerous factors have been shown to impact anastomotic leakage. The results of studies on the influence of obesity on the frequency of anastomotic leakage after rectal resection performed due to cancer have been contradictory. The aim of the study was to evaluate the relationship between body mass index (BMI) and frequency of anastomotic leakage after anterior rectal resection performed due to cancer. Material and methods. This retrospective analysis included 222 subsequent patients who had undergone anterior resection due to cancer with an anastomosis formed with a mechanical suture. The patients were divided into 3 groups depending on their BMI quartile as follows: Group I, BMI < 23.8 kg/m2 (lower quartile); group II, BMI between 23.8 and 29.38 kg/m2 (middle quartile); and group III, BMI > 29.38 kg/m2 (upper quartile). Results. Anastomotic leakage occurred in 8 (3.6%) patients. Fistulas occurred in 4 out of 61 patients (6.56%) in group I, which was the highest incidence of fistulas for all 3 groups. In group II, fistulas occurred in 2 out of 55 patients (3.63%), and similarly, in group III, they occurred in 2 out of 106 patients (1.87%). The differences found in the frequency of fistulas between groups were not statistically significant (p=0.31). The logistic regression analysis did not show any relationship between leakage and age (p = 0.55; OR = 1.02; 95% CI: 0.95 - 1.1), sex (p = 0.97; OR = 0.97; 95% CI: 0.22 - 4.25) or BMI (p = 0.27; OR = 0.58; 95% CI: 0.22 - 1.53). Conclusions. The results of our study show that BMI did not have any influence on the frequency of anastomotic leakage after anterior rectal resection performed due to cancer.
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Evaluation of the Early Results of a Loop Stoma with a Plastic Rod in Comparison to a Loop Stoma Made with a Skin Bridge

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Dziki Ł., Mik M., Trzciński R., Buczyński J., Darnikowska J., Spychalski M., Wierzbicka A., Dziki A.
Polish Journal of Surgery
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2015
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vol. 87
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issue 1
31-34
EN
Loop stoma allows reducing the percentage of anastomotic leak and re-operation caused bythis complication. Our department has performed the loop stoma on a skin bridge since 2011. The aim of the study was to evaluate the early results of treatment after the skin bridge loop stoma creation in comparison with the stoma made on a plastic rod. Both groups had 20 patients. Material and methods. The study involved 40 patients with ileostomy, operated 2010-2013. We evaluated 20 patients with a loop ileostomy on a plastic rod, compared to 20 other patients with a skinbridge ileostomy. The study included 24 men and 16 women. Median age was 68.3. All evaluated patients were previously operated due to rectal cancer. Results. It has been shown that the surgical site infection is more common in the group with a plastic rod (5 vs 1 patient). Inflammation of the skin around the stoma occurred in 18 patients (90%) in the first group, while no such complication was found in patients in the second group. The average number of exchanged ostomy wafers was 2,9 per weekin the first group of patients, and 1,1 in the second group (p 0,05). Conclusions. The creation of the skin bridge stoma allows for tight fit of the ostomy appliance immediately after surgery completion. The equipment has stable and long-lasting contact with the skin, no skin inflammatory changes occur. Also the surgical site infection rates are lower in this group of patients. As perioperative patient does not require an increased number of ostomy appliance, the cost of treatment can be considered as an important aspect.
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Laparoscopic Abdominoperineal Resection Of The Rectum – How Is It Done; Initial Results

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Grous A., Uryszek M., Ciesielski A., Dib N., Tarnowski W.
Polish Journal of Surgery
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2013
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vol. 85
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issue 10
569-575
EN
The abdominoperineal resection of the rectum is a classical operation performed in case of patients diagnosed with rectal cancer. The development of laparoscopic techniques in recent years, introduced yet another method of treatment, considering patients with rectal cancer- laparoscopic abdominoperineal resection of the rectum. The aim of the study was to present initial treatment results considering the above-mentioned patients. Material and methods. The study group comprised 25 patients (16 male and 9 female) diagnosed with low-rectal cancer, subjected to surgery by means of the above-mentioned method. Mean patient age amounted to 66 years. Three (12%) patients required conversion to classical surgery (laparotomy), while one patient required reoperation, due to presacral vascular bleeding. Complications were observed in 10 (40%) patients. Average hospitalization was 7 days. In case of all patients the radial margin was negative, and mean number of removed lymph nodes amounted to 9.6. Mortality was not observed during the perioperative period. Due to the initial character of the study analysis (mean observation period in case of 68% of patients was shorter than 2 years), oncological results were not subject to evaluation. Conclusions. Laparoscopic abdominoperineal resections are considered as technically difficult operations, requiring significant experience of the operating team. However, they enable the patient to take advantage of the many assets of minimally invasive surgery, with comparable rates of postoperative complications.
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Transverse (Tram) rectus abdominis myocutaneous flaps for Rectovaginal and Rectovesical Fistulas Treatment after low Anterior rectal Resection due to Adenocarcinoma

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Krakowczyk Ł., Maciejewski A., Wierzgoń J., Szumniak R., Grajek M., Dobrut M., Półtorak S.
Polish Journal of Surgery
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2010
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vol. 82
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issue 5
279-282
EN
The rectovaginal or rectovesical fistula is a rare complication after low anterior resection for rectal cancer. Treatment is difficult and the result is often unsatisfactory.The aim of this paper was to present results of treatment with transverse rectus abdominis myocutaneous flaps of rectovaginal and rectovesical fistulas as complication of low anterior rectal resection due to adenocarcinoma.Material and methods. We report six patients with rectovaginal or rectovesical fistulas as a postoperative complication after low anterior resection of rectal cancer in Department of Oncological and Reconstructive Surgery in 2006-2008. Transverse rectus abdominis myocutaneous flaps are used for rectovaginal and rectovesical fistulas treatment.Results. In the follow-up period from 4 to 30 months no rectovaginal or rectovesical fistula recurrences and any postoperative complications were noted in all cases.Conclusions. Transverse (TRAM) rectus abdominis myocutaneous flaps are an effective, surgical method for rectovaginal or rectovesical fistulas treatement, especially in patients who recived pre or postoperative radiotherapy.
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Preliminary Results of the First Quality Assurance Project in Rectal Cancer in Poland

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Mroczkowski P., Hać S., Mik M., Berut M., Dziki Ł., Kube R., Śledziński Z., Lippert H., Dziki A.
Polish Journal of Surgery
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2011
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vol. 83
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issue 3
144-149
EN
When compared with other EU countries, Poland is in the last place in terms of efficacy of rectal cancer treatment. In order to remedy this situation, in 2008 Polish centres were given the opportunity to participate in an international programme for evaluating the treatment efficacy.The aim of the study was to present the results obtained during the first two years of research.Material and methods. The study protocol covered 71 questions concerning demographic data, diagnostics, risk factors, peri- and post-operative complications, histopathology, and treatment plan at discharge. The patient and unit data were kept confidential.Results. From 1 January 2008 to 30 December 2009, there were 709 patients recorded, of which 55.9% were males. At least one risk factor was found in approx. 3/4 of patients, while approx. 1/3 of patients were classified to group 3 and 4 according to ASA. The mean distance of the tumour from the anal margin was 8.5 cm; approx. 70% of patients were in the clinical stages cT3 and cT4; metastases were observed in 18.8%. Transrectal endoscopic ultrasonography (TREUS) was performed in 23.7% of patients, magnetic resonance imaging (MRI) in 2.5% and computed tomography (CT) scan - in 48.1%. In close to half of the patients, anterior or low anterior resection of the rectum was performed, and abdominoperineal resection in 1/4 of the patients. Anastomotic leakage was seen in 3.8% of patients, while 1.8% died during hospitalisation.Conclusions. It should be strived after that all the centres undertaking the treatment of rectal cancer should participate in the quality assurance programme. This should enable the achievement of good therapeutic results in patients with rectal cancer treated in Polish centres.
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Risk of Permanent Stoma After Resection of Rectal Cancer Depending on the Distance Between the Tumour Lower Edge and Anal Verge

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Rutkowski A., Chwaliński M., Zajâc L., Nowecki Z., Nowacki M.
Polish Journal of Surgery
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2011
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vol. 83
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issue 11
588-596
EN
The distance between the anal verge and lower edge of rectal cancer is one of the most important factors affecting the feasibility of sphincter-preserving resection.The aim of the study was to assess the risk of permanent stoma after resection of rectal tumour depending on the distance between the tumour and the anal verge.Material and methods. The retrospective analysis covered 884 patients after resection of rectal cancer. The distance between the anal verge and the lowest edge of the tumour was measured during endoscopic examination. Surgical technique was similar in all cases. For statistical analysis, the chi-square test and Fisher exact test were used.Results. The overall rate of sphincter-preserving procedures was 71.8%, 90.1% of which were anterior resections. The greatest differences between the rate of anterior resections were noted for the segment between the 4th and the 5th centimetres: 30.1% for 4 cm vs 66.7% for 5 cm, p = 0.005. Overall, in 328 patients (37.1%) surgical treatment resulted in a permanent stoma. The number included: 246 (75.0%) patients after abdominosacral resection, 44 (13.4%) patients after the Hartmann procedure, three (0.9%) patients after proctocolectomy, and 28 (8.5%) patients after anterior resection, with a permanent stoma as a result of anastomotic leak. The overall rate of anastomotic leak was 11.7%. Formation of a defunctioning stoma in patients with a low-lying (6 cm from the anal verge) tumour reduced the risk of symptomatic anastomotic leak: 6.3% vs 20.5%; p = 0.049.Conclusions. Anterior resection of tumours located 6 cm from the anal verge is feasible in 90%. Anastomotic leak that requires reoperation increases the risk of permanent colostomy. In selected cases, formation of a defunctioning stoma after resection of low-lying rectal cancer can reduce the risk of permanent colostomy.
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Chemotherapy with trifluridine/tipiracil prolongs progression-free survival time and improves quality of life A case report of 59-year-old woman with metastatic rectal cancer

70%
Kania-Zembaczyńska B.
OncoReview
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2020
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vol. 10
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issue 1
18-22
EN
The paper presents a clinical case of a patient with a long-term response to IV line chemotherapy with trifluridine/tipiracil. The treatment allowed to maintain a good quality of life with acceptable side effects.
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Is the Surgeon's Experience an Independent Prognostic Factor in Rectal Cancer?

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Kładny J., Al-Amawi T., Kozłowski M., Wojtasik P., Świder-Al-Amawi M.
Polish Journal of Surgery
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2007
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vol. 79
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issue 6
403-409
EN
The aim of the study was to evaluate the influence of the surgeons' caseload on the results of therapy in rectal cancer.Material and methods. 286 consecutive patients (155 males and 131 females) were enrolled and operated on for rectal cancer stage T2 (112 patients) and T3 (174 patients) in 8 surgical centers of Szczecin between January 1993 and December 1997. Studied group included about 79% of radically operated patients due were to rectal cancer in analyzed period.Results. The patients were assigned to one of two groups with regard to the surgeon's caseload. The first group was comprised of 116 patients (including 72 stage T3 and 54 stage T2 patients) operated on by surgeons more experienced in rectal surgery and the second group was comprised of 160 patients operated on by 36 surgeons with fewer caseloads. The surgeon's experience in rectal surgery was measured by the surgeon's caseload throughout the entire study period. We considered surgeons with greater than 25 cases over the study period experienced.Analysis of survival with regard to the managing center revealed significant differences for stage T3, with 5-year-survival rates ranging from 14% to 60%. Distinct differences were also noted for survival rates in stage T2 (5-year-survival rates ranged from 38% to 86%); however, these differences were not statistically significant. Analysis of the influence of surgeon's caseload on outcomes in rectal cancer revealed a significant influence in stage T3 and a lack of influence in stage T2.Conclusion. The surgeon's experience is an independent prognostic factor for stage T3 rectal cancer patients.
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Does the Choice of Hospital Increase a Chance of Survival in Rectal Cancer?

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Pawlak M., Morawiec Z., Dziki Ł., Morawiec J., Kolacińska A., Dziki A.
Polish Journal of Surgery
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2012
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vol. 84
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issue 12
638-645
EN
was to assess the impact of hospital caseload on long-term outcomes of rectal cancer patients. We posed two questions: 1. Does the number of operations carried out in the surgical department influence five year survival and local recurrence rates? 2. Does surgery alone without adjuvant therapy performed in the particular department affect long-term results? Material and methods. 215 consecutive rectal cancer patients treated in six hospitals of the Łódź district between 1994 and 1998 were enrolled into this prospective study. We analyzed patients in whom local excision, low anterior resection, abdominoperineal resection and Hartmann’s procedure were performed. 27 percent of patients received adjuvant therapy such as radio- or chemotherapy or both. Long-term results were compared between high and low volume institutions by means of local recurrence and five year survival rates. Results. In high volume departments; 69.2% of five year survival rates were obtained versus 46.6% for low volume institutions (p=0.00433). Similar differences were noted comparing local recurrence rates between the aforementioned groups: 19.7% versus 36.5%, respectively (p=0.00430). In surgically treated patients who did not receive adjuvant therapy statistically significant differences were found: 76.5% of patients operated on in high volume hospitals survived five years as compared with 42.9% for low caseload institutions (p=0.00013). Local recurrence rates were 15.5% for high caseload institutions and 38.5% for low caseload hospitals (p=0.00042). Conclusions. High volume hospitals achieved better results in rectal cancer patients with regard to five year survival and local recurrence rates. Better outcomes were also obtained in high caseload departments regarding surgically treated patients who did not receive adjuvant therapy.
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Adaptation of Quality of Life Module EORTC QLQ-CR29 for Polish Patients with Rectal Cancer - Initial Assessment of Validity and Raeliability

70%
Nowak W., Tobiasz-Adamczyk B., Brzyski P., Sałówka J., Kuliś D., Richter P.
Polish Journal of Surgery
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2011
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vol. 83
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issue 9
502-510
EN
Heath related quality of life has been an important object of interest in the clinical practice, focused on assessment of treatment effects from patient's point of view, with particular emphasis placed on effect of treatment on daily patient functioning. Concept of health-related quality of life needs valid and reliable instruments.The aim of the study was to present the process of validation of a new version of EORTC QLQ-CR29 module in Polish patients suffering from rectal cancer.Material and methods. EORTC QLQ-CR29 module comprises 29 questions, and was adapted to Polish cultural conditions based on EORTC procedure. Data collected from 20 patients were analyzed, their agreement with theoretical and empirical structure was assessed. Convergent and discriminant validity were analyzed with multi trait scaling.Reliability was assessed with Cronbach alpha coefficient. Known group validity was assessed in terms of differences between men and women, and between stoma and non-stoma patients. Exact Mann-Whitney test was used. P values lower than 0.05 were considered significant.Results. Scales built on bases of empirical model of module had higher validity and reliability than those based on theoretical model.There were no significant differences between men and women in health-related quality of life. Significantly higher values were observed in non-stoma patients on body image scale and for leakage of stool item. Reversed relationship was observed in case of abdominal and buttocks pain, as well as embarrassment because of bowel movements.Conclusions. Module CR29 is a valid and reliable tool, which enables standardized measurement of treatment effects, suggested for use as main tool measuring impact of disease itself and applied treatment on health-related quality of life of rectal cancer patients.
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Content available

A systematic review and meta-analysis of laparoscopic versus robotic rectal surgery with primary anastomosis

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Rubinkiewicz M., Witowski J., Zbroja K., Rozmus K., Krzywoń J., Truszkiewicz K.
Polish Journal of Surgery
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2020
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vol. 92(1)
5-11
EN
Purpose: Rectal cancer is one of the most common malignancies of the gastrointestinal tract. The gold standard method is surgical resection. The approach to rectal cancer is still controversial. Nowadays, robotic approach gains popularity in comparison to traditional laparoscopy. However, there is lack of studies assessing rectal resections with primary anastomosis. Methods: We performed a systematic review and meta-analysis according to the PRISMA guidelines. The primary outcomes of interest were morbidity and short-term complications. Results: An initial reference search yielded 1250 articles. Finally, we chose six studies covering 1580 patients that we included in the quantitative analysis. In our study, we demonstrated that laparoscopic and robotic surgery are non-inferior to one another in terms of morbidity (RR=1.1 95% CI: 0.89-1.39), major complication rate (RR=1.01, 95% CI: 0.60-1.69) or in length of hospitalization (MD=0,15 95% CI: -0.60−0.90). The latter has slight advantage in quality of mesorectal excision (RD = -0.19, 95% CI: -0.35 − -0.03. I2=69%) and anastomotic leakage rate (OR=2.25, 95% CI: 1.23-4.09, I2=0%). Conclusion: In certain cases Robotic Surgery provide better quality of resected specimen and lower leakage ratio, nevertheless due to heterogeneity the results are uncertain. There is substantial need for large randomized controlled studies.
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