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Surgical Excision of Ischiorectal Fossa Tumors

Surgical Science 2016年第10期7卷 461-465页

作者： javier die trill Juan Carlos García Irene Moreno Juan diego Pina Estela Tobaruela Jose Barquin Juan Ocaña Antonio Rey Department of Surgery Hospital Ramón y Cajal Madrid Spain

Background: Ischiorectal Fossa Tumors are rare and their management has not been protocolized. Patients: We retrospectively review four consecutive cases treated in our department, from January 2015 to July 2015. All of them were discussed in a multidisciplinary team meeting. None of them were secondary to an inflammatory process. Results: A Magnetic Resonance Imaging was performed in all the four patients, and as it was not a malignant diagnosis made in any of them, we proceeded to resecate the lesions. None biopsies were performed and the benign diagnoses were confirmed by the pathologist. All the patients underwent a local posterior or perineal approach, because all the lesions (epidermoid cyst, hamartoma, lipoma and an aggressive angiomyxoma) were localized purely in the ischiorectal fossa, under the levator ani muscle and not invading any adjacent structures. In all of them, an R0 resection was performed. Conclusions: Ischiorectal fossa tumors are rare and there are few cases already published. Non-inflammatory lesions located in the ischiorectal fossa, with none invasion of rectum or levator ani muscle, are mainly benign lesions prone to their complete excision by a posterior approach. Biopsy is not always necessary unless there’s a suspicion of a malignancy or invasion of adjacent structures, and only in that case a biopsy should be made, because in some of them, a neo-adjuvant treatment can be useful to reduce the tumor and to perform an R0 resection.

关键词： Ischiorectal Fossa Tumors Aggressive Angiomyxoma

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Watch and wait approach in rectal cancer:Current controversies and future directions

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World Journal of Gastroenterology 2020年第29期26卷 4218-4239页

作者： Fernando López-Campos Margarita Martín-Martín Roberto Fornell-Pérez Juan Carlos García-Pérez javier die-trill Raquel Fuentes-Mateos Sergio López-Durán JoséDomínguez-Rullán Reyes Ferreiro AlejandroRiquelme-Oliveira Asunción Hervás-Morón Felipe Couñago Department of Radiation Oncology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Radiology Hospital Universitario de BasurtoBilbao 48013VizcayaSpain Department of Surgery Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Medical Oncology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Gastroenterology and Hepatology Hospital Universitario Ramón y CajalMadrid 28034Spain Department of Medical Oncology Hospital Infanta CristinaMadrid 28034Spain Department of Radiation Oncology Hospital Universitario QuirónsaludMadrid 28003Spain Department of Radiation Oncology Hospital La LuzMadrid 28003Spain Universidad Europea de Madrid(UEM) Madrid 28223Spain

According to the main international clinical guidelines,the recommended treatment for locally-advanced rectal cancer is neoadjuvant chemoradiotherapy followed by ***,doubts have been raised about the appropriate definition of clinical complete response(cCR)after neoadjuvant therapy and the role of surgery in patients who achieve a *** resection is associated with significant morbidity and decreased quality of life(QoL),which is especially relevant given the favourable prognosis in this patient subset. Accordingly, therehas been a growing interest in alternative approaches with less morbidity,including the organ-preserving watch and wait strategy, in which surgery isomitted in patients who have achieved a cCR. These patients are managed with aspecific follow-up protocol to ensure adequate cancer control, including the earlyidentification of recurrent disease. However, there are several open questionsabout this strategy, including patient selection, the clinical and radiologicalcriteria to accurately determine cCR, the duration of neoadjuvant treatment, therole of dose intensification (chemotherapy and/or radiotherapy), optimal followupprotocols, and the future perspectives of this approach. In the present review,we summarize the available evidence on the watch and wait strategy in thisclinical scenario, including ongoing clinical trials, QoL in these patients, and thecontroversies surrounding this treatment approach.

关键词： Watch and wait Rectal cancer Clinical complete response Organ preservation Dose intensification

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