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In the last two decades, colorectal cancer (CRC) mortality has been decreasing in the United States. However, the mortality trends for the different subtypes of CRC, including different sides of colon, rectosigmoid, and rectal cancer remain unclear. We analyzed the mortality trends of different subtypes of CRC based on Centers for Disease Control and Prevention's Wide‐Ranging Online Data for Epidemiologic Research data from 1999 to 2020. We calculated age‐adjusted mortality rates (AAMR) per 100,000 individuals and examined the trends over time by estimating the average annual percent change (AAPC) using the Joinpoint Regression Program. Our study shows that the overall CRC rates decreased significantly from 26.42 to 15.98 per 100,000 individuals, with an AAPC of −2.41. However, the AAMR of rectosigmoid cancer increased significantly from 0.82 to 1.08 per 100,000 individuals, with the AAPC of +1.10. Men and Black individuals had the highest AAMRs respectively (23.90 vs. 26.93 per 100,000 individuals). The overall AAMR of CRC decreased for those aged ≥50 years but increased significantly from 1.02 to 1.58 per 100,000 individuals for those aged 15–49 years, with an AAPC of +0.75. Rural populations had a higher AAMR than the urban populations (22.40 vs. 19.60 per 100,000 individuals). Although overall CRC mortality declined, rising trends in young‐onset CRC and rectosigmoid cancer warrant attention. Disparities persist in terms of sex, race, and geographic region, and urbanization level, emphasizing the need for targeted public health measures. [ABSTRACT FROM AUTHOR]

Abstract Background Though our previous study has demonstrated that the single-incision plus one-port laparoscopic surgery (SILS + 1) is safe and feasible for sigmoid colon and upper rectal cancer and has better short-term outcomes compared with conventional laparoscopic surgery (CLS), the long-term outcomes of SILS + 1 remains uncertain and are needed to evaluated by an RCT. Methods Patients with clinical stage T1-4aN0-2M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The 3-year DFS, 5-year OS, and recurrence patterns were analyzed. Results Between April 2014 and July 2016, 198 patients were randomly assigned to either the SILS + 1 group (n = 99) or CLS group (n = 99). The median follow-up in the SILS + 1 group was 64.0 months and in CLS group was 65.0 months. The 3-year DFS was 87.8% (95% CI, 81.6–94.8%) in SILS + 1 group and 86.9% (95% CI, 81.3–94.5%) in CLS group (hazard ratio: 1.09 (95% CI, 0.48–2.47; P = 0.84)). The 5-year OS was 86.7% (95% CI,79.6–93.8%) in the SILS + 1 group and 80.5% (95% CI,72.5–88.5%) in the CLS group (hazard ratio: 1.53 (95% CI, 0.74–3.18; P = 0.25)). There were no significant differences in the recurrence patterns between the two groups. Conclusions We found no significant difference in 3-year DFS and 5-year OS of patients with sigmoid colon and upper rectal cancer treated with SILS + 1 vs. CLS. SILS + 1 is noninferior to CLS when performed by expert surgeons. Trial registration ClinicalTrials.gov: NCT02117557 (registered on 21/04/2014).

Background: Though our previous study has demonstrated that the single-incision plus one-port laparoscopic surgery (SILS + 1) is safe and feasible for sigmoid colon and upper rectal cancer and has better short-term outcomes compared with conventional laparoscopic surgery (CLS), the long-term outcomes of SILS + 1 remains uncertain and are needed to evaluated by an RCT. Methods: Patients with clinical stage T1-4aN0-2M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The 3-year DFS, 5-year OS, and recurrence patterns were analyzed. Results: Between April 2014 and July 2016, 198 patients were randomly assigned to either the SILS + 1 group (n = 99) or CLS group (n = 99). The median follow-up in the SILS + 1 group was 64.0 months and in CLS group was 65.0 months. The 3-year DFS was 87.8% (95% CI, 81.6–94.8%) in SILS + 1 group and 86.9% (95% CI, 81.3–94.5%) in CLS group (hazard ratio: 1.09 (95% CI, 0.48–2.47; P = 0.84)). The 5-year OS was 86.7% (95% CI,79.6–93.8%) in the SILS + 1 group and 80.5% (95% CI,72.5–88.5%) in the CLS group (hazard ratio: 1.53 (95% CI, 0.74–3.18; P = 0.25)). There were no significant differences in the recurrence patterns between the two groups. Conclusions: We found no significant difference in 3-year DFS and 5-year OS of patients with sigmoid colon and upper rectal cancer treated with SILS + 1 vs. CLS. SILS + 1 is noninferior to CLS when performed by expert surgeons. Trial registration: ClinicalTrials.gov: NCT02117557 (registered on 21/04/2014). [ABSTRACT FROM AUTHOR]

Background: This study evaluated the clinical value of a new American Joint Committee on Cancer (AJCC) tumor node metastasis (TNM) staging prediction model based on lymph node ratio (LNR) in rectosigmoid cancer (RSC). Methods: The analysis included 1444 patients with nonmetastatic RSC diagnosed pathologically between 2010 and 2016 who were collected from the National Cancer Institute Surveillance, Epidemiology, and Results database. The AJCC N-stage was redefined according to the LNR cutoff point, and the ability of the new staging system to predict prognosis was compared with that of the AJCC TNM staging system. Data from 739 patients from our hospital were used for external validation. Results: According to the number of examined lymph nodes and LNR, the N stage was divided into five groups (LNR0-5). The 5-year OS of patients divided according to the new T lymph node ratio M (TLNRM) staging into stage I (T1LNR1, T1LNR2), IIA (T1LNR3, T2LNR1, T2LNR2, T2LNR3, T1LNR4, T3LNR1), IIB (T2LNR4), IIC (T3LNR2, T4a LNR1, T1LNR5), IIIA (T3LNR3, T2LNR5, T4b LNR1, T4a LNR2, T3LNR4), IIIB (T3LNR5, T4a LNR3, T4a LNR4, T4b LNR2), and IIIC (T4b LNR3, T4a LNR5, T4b LNR4, T4b LNR5) was significantly different (P<0.05). Decision curve analysis showed that the net income of the new TLNRM staging system for different decision thresholds was higher than the prediction line of the traditional eighth TNM staging system. The smaller Akaike information criterion and Bayesian information suggested that the new staging system had a higher sensitivity for predicting prognosis than the traditional staging system. TLNRM II and III patients benefited from adjuvant chemotherapy, while adjuvant chemotherapy did not improve the prognosis of TNM II patients. These findings were confirmed by the external validation data. Conclusion: The new TLNRM staging system was superior to the eighth edition AJCC staging system for staging and predicting the prognosis of patients with RSC and may become an effective tool in clinical practice. [ABSTRACT FROM AUTHOR]

Background: Colorectal cancer (CRC) is the third leading cause of death in the world, accounting for 16% of all new cancer diagnoses. Patients with cancer should be closely monitored before making treatment decisions. Diagnosis of metastatic disease is especially important because it has a significant impact on the therapeutic approach. Magnetic resonance imaging (MRI) is considered a superior method for preoperative evaluation in colorectal cancer.Objectives: This study was performed to evaluate MRI findings in patients with rectosigmoid cancer in Golestan province, north of Iran in 2019 and 2020.Methods: This is a retrospective cross-sectional study that was performed on 43 patients with rectal cancer in Gorgan. Patients with other cancers, metastatic cancer, and a history of surgery were excluded. Demographic data (age, gender, and ethnicity) was obtained from patients 'electronic records and patients' MRI information was obtain through the picture archiving and communication system (PACS) of Gorgan MRI centers.Results: Among 43 patients with rectosigmoid cancer, 65.1% of them were male and the mean age was 58.58±14.73 years. The average mass length was 48.44 mm and the distance from Anal Verge was 69.81 mm. The most common morphology of patients' rectosigmoid mass in imaging was related to Semi Circumferncial (51.2%) and Circumferncial (32.6%). T1/T2, N2a, and M0 with the percentages of 41.9%, 39.5%, and 90.7%, respectively, had the highest frequency in patients. TNM Staging was not significantly related to gender or ethnicity. Peritoneal reflection was also more common in Sistani and Turkmen ethnic groups.Conclusion: The results of this study showed that high-resolution MRI under the imaging protocol for obtaining quality images can help to accurately regional staging necessary for optimal treatment.

Background It is unclear whether to preserve the left colic artery (LCA) for sigmoidectomy or not in cancer surgery. The objective of this study was to assess the value of preservation of LCA in sigmoidectomy in cancer surgery. Patients and methods A total of 55 patients with rectal and sigmoid cancer were admitted to the Menoufia University Hospital (General Surgery Department) and Al-Azhar University Hospital (General Surgery Department). Patients were randomized into two groups: group A included nonpreservation of LCA (28 patients), and group B included preservation of LCA (27 patients). Our oncologic considerations were the number of apical lymph nodes, overall recurrence, 1-year overall survival (disease-free survival), 30-day postoperative morbidity, 30-day postoperative mortality, anastomotic leakage, and urogenital and defecatory dysfunction. Results In our study, 55 individuals were included (28 received LCA nonpreservation surgery and 27 got LCA preservation surgery). Anastomotic leakage was much lower (3.7%) in the LCA preservation group compared with the nonpreservation group (10.7%). There were no significant differences between the LCA nonpreservation and LCA preservation groups in terms of sexual dysfunction, urine retention, the number of apical lymph nodes, short-term oncologic outcomes, operation time, blood loss, and perioperative morbidity and death. Conclusions LCA preservation revealed less anastomotic leakage than LCA nonpreservation in rectosigmoid cancer surgery. Future large volume carefully crafted randomized controlled studies are required to build solid evidence about this issue. [ABSTRACT FROM AUTHOR]

Background: There is controversy and limited data the management of rectosigmoid junction cancer (RSJC), especially the role of radiation. We aim to investigate the role of preoperative and postoperative radiation in RSJC and whether this cancer should be treated as a colon cancer or as a rectal cancer., Methods: The data were extracted from the Surveillance, Epidemiology, and End Results (SEER) database and identified from 2000 to 2018., Results: Of the 50,779 patients, 87% were ≥50 years old, 56.2% were male, 80.8% were White. Regarding tumor characteristics, 76% were Grade II, while 22.7% had distant-stage. 16.4% of patients were treated with multimodal therapy (surgery with chemoradiation), 47.9% surgery alone, 6.5% of patients received preoperative radiation, and 9.9% received postoperative radiation. Regarding prognostic significance of pre-operative and postoperative radiation factors, we evaluated factors, such as age, gender, race, tumor size, histologic variants of adenocarcinoma, and tumor grade. Patients with distant-staged tumors who received preoperative radiation had lower mortality compared to those who received postoperative radiation (95% CI, 0.73 - 0.97, (hazard ratio (HR) = 0.85, p = 0.04). There were no survival differences for localized or regional disease regarding pre and postoperative radiation, or when sub-stratifying for any other significant demographic or tumor characteristics., Conclusion: Surgery with adjuvant chemoradiation had the best prognosis for all demographic and tumor characteristics. Preoperative radiation had a good prognosis only in distant disease. However, further randomized evidence is required to demonstrate the efficacy of pre-and post-operative radiation in rectosigmoid junction cancer., Competing Interests: Disclosure The authors have stated that they have no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objectives: The necessary and sufficient length of the distal resection margin (l-DRM) for rectosigmoid cancer remains controversial. This study evaluated the validity of the 3-cm l-DRM rule for rectosigmoid cancer in the Japanese classification of colorectal cancer. Methods: We retrospectively reviewed 1,443 patients with cT3 and cT4 rectosigmoid cancer who underwent R0 resection in Japanese institutions between 1995 and 2004. We identified the optimal cutoff point of the l-DRM affecting overall survival (OS) rate using a multivariate Cox regression analysis model. Using this cutoff point, the patients were divided into two groups after balancing the potential confounding factors of the l-DRM using propensity score matching, and the OS rates of the two groups were compared. Results: A multivariate Cox regression analysis model revealed that the l-DRM of 4 cm was the best cutoff point with the greatest impact on OS rate (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.00-1.84; P = 0.0452) and with the lowest Akaike information criterion value. In the matched cohort study, the OS rate of patients who had l-DRM of 4 cm or more was significantly higher than that of patients who had l-DRM < 4 cm (n = 402; 5-year OS rates, 87.6% vs. 80.3%, respectively; HR, 1.60; 95% CI, 1.09-2.31; P = 0.0136). Conclusions: For cT3 and cT4 rectosigmoid cancer, l-DRM of 4 cm may be an appropriate landmark for a curative intent surgery, and we were unable to definitively confirm the validity of the Japanese 3-cm l-DRM rule.

Management paradigms for tumours from the sigmoid colon to the lower rectum vary significantly. The upper rectum (UR) represents the transition point both anatomically and in treatment protocols. Above the UR is clearly defined and managed as colon cancer and below is managed as rectal cancer. This study compares outcomes between sigmoid, rectosigmoid and UR tumours to establish if differences exist in operative and oncological outcomes. Electronic databases were searched for published studies with comparative data on peri-operative and oncological outcome for upper rectal and sigmoid/rectosigmoid (SRS) tumours treated without neoadjuvant radiation. The search adhered to PRISMA guidelines (Preferred Reporting Items in Systematic Reviews and Meta-analyses) guidelines. Data was combined using random-effects models. Seven comparative series examined outcomes in 4355 patients. There was no difference in ASA grade (OR, 1.28; 95% CI, 0.99–1.67; P = 0.06), T3/T4 tumours (OR, 1.24; 95% CI, 0.95–1.63; P = 0.12), or lymph node positivity (OR, 0.97; 95% CI, 0.70–1.36; P = 0.87). UR cancers had higher rates of operative morbidity (OR, 0.72; 95% CI, 0.55–0.93; P = 0.01) and anastomotic leak (OR, 0.47; 95% CI, 0.31–0.71; P = 0.0004). There was no difference in local recurrence (OR, 0.63; 95% CI, 0.37–1.08; P = 0.10). SRS tumours had lower rates of distant recurrence (OR, 0.83; 95% CI, 0.68–1.0; P = 0.05). Rectosigmoid operative and cancer outcomes were closer to UR than sigmoid. Based on existing data, UR and rectosigmoid tumours have higher morbidity, leak rates and distant recurrence than more proximal tumours. • Upper rectal tumours have higher leak rates and morbidity to sigmoid tumours. • Upper rectal cancers have higher distant recurrence rates to sigmoid tumours. • Rectosigmoid tumours assessed alone appear to share similar outcomes to upper rectal cancers. [ABSTRACT FROM AUTHOR]

BACKGROUND: Rectosigmoidectomy usually leads to evacuation disorders and, depending on surgical aggressiveness, urinary and genito-sexual problems as well. OBJECTIVE: Comments on the sexual adversities resulting from rectosigmoidectomy, with emphasis on their etiopathogenesis and behavioral consequences. COMMENTARY: This article discusses the rectosigmoidectomy in its historical, present and future aspects. The impacts of the surgical and radiotherapy trauma on the genito-sexual structure were described, emphasizing their effects under anatomical, pathophysiological and behavioral point of view. CONCLUSION: The rectosigmoidectomy has been progressively less aggressive to sexual functions with better outcome, due to advances on the surgical techniques, which lead to lower response to trauma. [ABSTRACT FROM AUTHOR]

In this paper we present the case of a 91 years-old male patient who was admitted for motor weakness accompanied by neuropathic pain suggestive for a femoral mononeuropathy which onset and evolution was subacute – chronic. The clinical examination and laboratory investigations confirmed the diagnosis of femoral nerve mononeuropathy, but also showed others signs and symptoms suggestive for a disorder in the area in the lower digestive and urinary tracts, which finally allowed us the etiologic diagnosis of recto-sigmoid colon cancer. This case raises some problems related to the etiological differential diagnosis of a femoral nerve neuropathy which most often is not the consequence of a disco-vertebral pathology but, of other lesions located inside the pelvis as long as this nerve has its initial trajectory in the intra-abdominal region having different neighboring reports on the left and on the right side, which are also different according to the patient’s sex in particular with different segments of the lower digestive tract and in women also with the salpingian-ovarian structures. Comorbidities, in particular diabetes mellitus and also the particularities related to the patient’s age increase the complexity of the problem related to the etiological differential diagnosis.

• Gestational Throphoblastic Neoplasms (GTN) includes a spectrum of pregnancy-related disorders of either benign or malignant. • Gestational choriocarcinoma in a patient with a previous history of IBD could have occurred in three different scenarios. • Dedifferentiation is the most accepted mechanism introduced to explain development of primary choriocarcinoma of colorectal origin. • Surgical resection with lymph node dissection is the standard of treatment. • Colorectal choriocarcinoma is considered pathologically similar to choriocacinoma of GTN, thus chemotherapeutic regimens are the same. Primary rectal choriocarcinoma is an extremely rare malignancy. The association of these neoplasms in patients with inflammatory bowel disease (IBD) has not been reported. A 34-year-old female with history of Ulcerative Colitis (UC) gave birth to a male fetus. She had postpartum bleeding and high level of beta-human chorionic gonadotropin (βhCG) was detected. Although initial investigations failed to confirm molar pregnancy, abnormal uterine bleeding and high βhCG level necessitate chemotherapy administration. She did not respond to chemotherapy sessions accordingly. Meanwhile, the patient experienced rectorrhagia and colonoscopy revealed a firm submucosal polypoid lesion 8–10 cm from the anal verge. The multidisciplinary team candidate the patient for total proctocolectomy and ileal pouch anal anastomosis. Although postoperative course was uneventful and βhCG level dropped but it showed a rising pattern in follow ups. Chemotherapy was planned but there was not suitable response. Unfortunately, the patient passed away 20 months after the initial diagnosis. Pathology report indicated the coexistence of moderately differentiated tubular adenocarcinoma and choriocarcinoma. We assume previous history of UC might have put her at higher susceptibility to develop carcinoma and this poorly differentiated carcinoma has led to choriocarcinoma. Considering the fact that in most cases of colorectal choriocarcinoma, choriocarcinomatous differentiation was found alongside colonic adenocarcinoma made dedifferentiation theory to be the most acceptable explanation. The adenocarcinoma of the colon and rectum in the setting of IBD may become so dedifferentiated that gain some characteristics of germ cell tumors. [ABSTRACT FROM AUTHOR]

Objective: The objective of the study is to evaluate the short-term outcomes of single-incision plus one-port surgery (SILS + 1) compared with conventional laparoscopic surgery (CLS) for colonic cancer.Background: At present, single-incision laparoscopic colectomy remains technically challenging. The use of SILS + 1 as an alternative has gained increasing attention; however, its safety and efficacy remain controversial.Methods and Patients: Between April 2014 and July 2016, 198 patients with clinical stage T1-4aN0-2 M0 rectosigmoid cancer were enrolled. The participants were randomly assigned to either SILS + 1 (n = 99) or CLS (n = 99). The morbidity and mortality within 30 days, operative and pathologic outcomes, postoperative recovery course, inflammation and immune responses, and pain intensity were compared.Results: There was no significant difference in overall complications between the two groups (17.2 vs. 16.3%, P = 1.000). The total operating time for the SILS + 1 group was significantly shorter (100.8 ± 30.4 vs. 116.6 ± 36.6, P = 0.002). Blood loss was significantly greater in the CLS group (20 vs. 50, P < 0.001). Thirteen patients (14%) in the CLS group required additional postoperative analgesics, which was significantly more than four patients in the SILS + 1 group. Notably, on postoperative day three, the visual analogue scale score of the CLS group was greater than that of the SILS + 1 group (1.3 ± 1.1 vs. 1.7 ± 1.3, P = 0.023). Tumor diameter, pathologic stage, length of the proximal and distal margins, and number of lymph nodes harvested were similar, other values were also similar between the two groups.Conclusion: Our findings suggest that SILS + 1 might be safe and feasible for rectosigmoid cancer when performed by experienced surgeons. It offers minimal invasiveness without compromising oncologic treatment principles. Trial Registration This trial was registered on ClinicalTrials.gov (NCT02117557). [ABSTRACT FROM AUTHOR]

A patient with underlying rectosigmoid cancer presented with solitary bone lesion at left tibia. Eventhough, solitary bone metastasis particularly in the appendicular skeleton is rare in rectosigmoid cancer, it remained as the most likely initial diagnosis. However, after further characterisation by various imaging modalities and subsequent biopsy, the lesion proved to be an osteofibrous dysplasia like-adamantinoma (OFD-like adamantinoma), which is a subtype of adamantinoma. Being a rare primary bone tumour, adamantinoma and its subtypes are infrequently thought of in the initial working diagnosis of a patient with known malignancy who presents with solitary bone lesion. We present here a case of OFD-like adamantinoma in a patient with underlying rectosigmoid cancer, which mimic a metastastic bone lesion. [ABSTRACT FROM AUTHOR]

In this paper we present the case of a 91 years-old male patient who was admitted for motor weakness accompanied by neuropathic pain suggestive for a femoral mononeuropathy which onset and evolution was subacute - chronic. The clinical examination and laboratory investigations confi rmed the diagnosis of femoral nerve mononeuropathy, but also showed others signs and symptoms suggestive for a disorder in the area in the lower digestive and urinary tracts, which fi nally allowed us the etiologic diagnosis of recto-sigmoid colon cancer. This case raises some problems related to the etiological differential diagnosis of a femoral nerve neuropathy which most often is not the consequence of a disco-vertebral pathology but, of other lesions located inside the pelvis as long as this nerve has its initial trajectory in the intra-abdominal region having different neighboring reports on the left and on the right side, which are also different according to the patient's sex in particular with different segments of the lower digestive tract and in women also with the salpingian-ovarian structures. Comorbidities, in particular diabetes mellitus and also the particularities related to the patient's age increase the complexity of the problem related to the etiological differential diagnosis. [ABSTRACT FROM AUTHOR]

Introduction There are few cases of synchronous rectal adenocarcinoma revealed by an anal fistula. The diagnosis of synchronous mucinous adenocarcinoma of the recto sigmoid and anal canal remains difficult. The chronic anal fistula can be mistaken as the common manifestation of a benign perianal abscess or fistula. Case presentation We present a rare case of a Greek Caucasian 79 year old male patient with anal fistula and a recurrent perianal abscess who subsequently was found to have developed synchronous rectosigmoid and perianal mucinous adenocarcinoma on biopsy. The histological exam revealed mucinous adenocarcinoma in two sites, representing two tumors, cells were immunopositive for cytokeratin 20 and negative in cytokeratin 7. The patient underwent “laparoscopic extralevator abdominoperineal excision ” with both lesions being resected. There is no recurrence after four years of follow up. Conclusions This case highlights the importance of high suspicion, further investigation and the need of biopsy in all anal fistulae. [ABSTRACT FROM AUTHOR]

Liquid biopsies are noninvasive tests using blood or body fluids to detect circulating tumor cells (CTCs) or the products of tumor cells, such as fragments of nucleic acids or proteins that are shed into biological fluids from primary tumor or its metastates. The analysis of published clinical studies provides coherent evidence that the presence of CTCs detected in peripheral blood is a strong prognostic factor in patients with colorectal carcinoma (CRC). The aim of the study was to implement size-based separation protocol of CTCs in CRC patients.~Introduction~Background~Patients diagnosed with different stages of CRC (n = 98) were included in the study. All patients have been diagnosed for colorectal adenocarcinoma by pathology examination, 45 patients with colon carcinoma and 53 with rectosigmoid cancer. A size-based separation method (MetaCell®) for viable CTC enrichment from peripheral blood was used to assess the presence of CTCs by cytomorphological evaluation using vital fluorescence microscopy.~Material and Methods~Methods~Cytomorphological analysis revealed that 81 (83%) tested samples were CTC-positive and 17 (17%) were CTC-negative. We report a successful isolation of CTCs with proliferation potential in patients with CRC. The CTCs were cultured in vitro for further downstream applications. Some of the isolated CTCs were able to grow in vitro for 6 months as a standard cell culture.~Results~Results~We established a reliable, inexpensive and relatively fast protocol for CTCs enrichment in CRC patients by means of vital fluorescence staining which enables their further analysis in vitro.~Conclusions~Conclusions [ABSTRACT FROM AUTHOR]

Implantation metastasis from a colorectal cancer into a perianal fistula is very rare. Such lesions are commonly mistaken as benign perianal abscesses or fistulas and diagnosed only after pathological analysis of surgically excised fistulas. Once diagnosed, the management of this condition remains controversial. We report a case of perianal fistula that was unexpectedly found to harbor adenocarcinoma on biopsy. Further investigation by colonoscopy and computed tomography scan revealed a sigmoid adenocarcinoma. Abdominoperineal resection was performed. Histology and immunohistochemical staining was identical in both primary and metastatic tumors. We herein review the literature on the metastasis of colorectal cancer to a benign perianal fistula presumably acquired through implantation of viable malignant cells shed from the primary tumor and discuss the approach to this rare scenario in colorectal cancer surgery. [ABSTRACT FROM AUTHOR]

Objective: To study the reliability of CT scan interpretation in pre- and post-operative chemoradiation of rectosigmoid cancer. Methods: Retrospective review CT scan of 12 patients with diagnosis of rectosigmoid cancer stage 3 or more in pre and post operative chemoradiation were done by 2 radiologists. Data analysis included maximum wall thickness, distance of lesion above anal verge, perirectal involvement, regional node, distant metastasis. Chest radiograph (CXR), endorectal ultrasound (ERUS), barium enema (BE), colonoscopy and treatment information were reviewed. Results: Reliability of TNM staging by CT scan interpretation were .66, .50 and .75, respectively total reliability is .75 and overall validation of CT scan staging is .40 with statistic significant at .05 reference with pathological staging. Conclusion: There was CT scan interpretation reliability in pre- and post- chemoradiation for rectosigmoid cancer patients.

Colonic adenocarcinoma revealed by metastatic anorectal fistula is rare, with few cases in the literature. Such lesions can be taken for the more common manifestation of a benign perianal abscess or fistula. Once diagnosed, the management of such conditions remains controversial. We herein report two cases with perianal fistula that were subsequently found to have developed perianal adenocarcinoma on biopsy. Further colonic investigation revealed a rectosigmoid adenocarcinoma. Histology and immunohistochemical staining was identical in both primary and metastatic tumors. Preoperative chemoradiation with further rectal low anterior resection and local excision of metastatic anal fistula was performed. There is no recurrence after 3 years of follow-up. [ABSTRACT FROM AUTHOR]

Abstract: Background: Colonoscopic localization of rectal and rectosigmoid tumors may be inaccurate. Rigid proctosigmoidoscopy has been suggested as an adjunctive technique to accurately localize rectal tumors as it may alter treatment options. Methods: A retrospective review was performed of patients with rectal and rectosigmoid cancer from 2001 to 2006. Patients were stratified into 1 of 4 anatomic regions based on colonoscopic localization of the tumor. The distances of the tumor from the anal verge by colonoscopy were compared with distances obtained via rigid proctosigmoidoscopy. Results: Rigid proctosigmoidoscopy localization likely changed the treatment options in 21% of lower rectal tumors, 14% of middle rectal tumors, 38% of upper rectal tumors, and 29% of rectosigmoid tumors. Overall, this modality impacted 25% of patients. Conclusions: Rigid proctosigmoidoscopy localization of rectal tumors can significantly change treatment options and should be performed on all patients with colonoscopic localization of a cancer thought to be in the rectosigmoid or rectum. [Copyright &y& Elsevier]

Background: This study aimed to clarify and compare the short- and midterm surgical outcomes of laparoscopic surgery for rectal and rectosigmoid cancer.Methods: Between June 1992 and December 2004, 131 selected patients with cancer of the rectum (n = 60) and rectosigmoid (n = 71) underwent laparoscopic surgery. The indications for laparoscopy included a preoperative diagnosis of T1/T2 tumor in the rectum and T1-T3 tumors in the rectosigmoid.Results: The mean follow-up period was 42 months. The procedures included anterior resection for 117 patients, abdominoperineal resection for 11 patients, Hartmann's procedure for 1 patient, and restorative proctocolectomy for 1 patient. Conversion to an open procedure occurred for four patients (3.1%). Postoperative complications developed in 29 patients (22.1%), including anastomotic leakage in 14 patients (11.8%). The length of hospital stay for the rectal cases was significantly longer than for the rectosigmoid cases (10 vs 7 days; p = 0.0049). The tumor node metastasis (TNM) stages included 0 (n = 14), I (n = 72), II (n = 15), III (n = 29), and IV (n = 1). Recurrences were experienced by 13 patients, including local recurrence (n = 7) and recurrences involving the liver ((n = 2), lung (n = 3), and distant lymph nodes (n = 1). The 5-year disease-free and overall survival rates were, respectively 91.7% and 97.9% for stage I, 86.7% and 90.9% for stage II, and 77.1% and 90.0% for stage III.Conclusions: Laparoscopic surgery is feasible and safe for selected patients with rectal or rectosigmoid cancer. The selected patients in this study experienced favorable short- and midterm outcomes. [ABSTRACT FROM AUTHOR]