Topic
Rectum
About: Rectum is a research topic. Over the lifetime, 10823 publications have been published within this topic receiving 236370 citations. The topic is also known as: Rectal.
Papers published on a yearly basis
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Papers
TL;DR: The current status of the etiology and incidence of incontinence as well as the evaluation and treatment of this disabling condition are reviewed.
Abstract: Fecal incontinence is a challenging condition of diverse etiology and devastating psychosocial impact. Multiple mechanisms may be involved in its pathophysiology, such as altered stool consistency and delivery of contents to the rectum, abnormal rectal capacity or compliance, decreased anorectal sensation, and pelvic floor or anal sphincter dysfunction. A detailed clinical history and physical examination are essential. Anorectal manometry, pudendal nerve latency studies, and electromyography are part of the standard primary evaluation. The evaluation of idiopathic fecal incontinence may require tests such as cinedefecography, spinal latencies, and anal mucosal electrosensitivity. These tests permit both objective assessment and focused therapy. Appropriate treatment options include biofeedback and sphincteroplasty. Biofeedback has resulted in 90 percent reduction in episodes of incontinence in over 60 percent of patients. Overlapping anterior sphincteroplasty has been associated with good to excellent results in 70 to 90 percent of patients. The common denominator between the medical and surgical treatment groups is the necessity of pretreatment physiologic assessment. It is the results of these tests that permit optimal therapeutic assignment. For example, pudendal nerve terminal motor latencies (PNTML) are the most important predictor factor of functional outcome. However, even the most experienced examiner's digit cannot assess PNTML. In the absence of pudendal neuropathy, sphincteroplasty is an excellent option. If neuropathy exists, however, then postanal or total pelvic floor repair remain viable surgical options for the treatment of idiopathic fecal incontinence. In the absence of an adequate sphincter muscle, encirclement procedures using synthetic materials or muscle transfer techniques might be considered. Implantation of a stimulating electrode into the gracilis neosphincter and artificial sphincter implantation are other valid alternatives. The final therapeutic option is fecal diversion. This article reviews the current status of the etiology and incidence of incontinence as well as the evaluation and treatment of this disabling condition.
2,868 citations
TL;DR: On this evidence, it is often safe to limit mural clearance and thus preserve the anal sphincters, provided that the mesorectum is excised intact with the cancer.
2,678 citations
TL;DR: Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp‐cancer sequence although the majority of adenomas do not become cancerous during a normal adult life span.
Abstract: The malignant potential of adenomas of the colon and rectum varies with size, histological type and grade of epithelial atypia. The adenomatous polyp is usually small and has a low malignant potential, whereas tumors with a villous structure are usually larger and have a much higher cancer rate. Severe atypia is more common in villous adenomas than in adenomatous polyps. Evidence is presented which suggests that most cancers of the colon and rectum have evolved through the polyp-cancer sequence although the majority of adenomas do not becoma cancerous during a normal adult life span. The slow evolution of the polyp-cancer sequence is stressed. The implications of the polyp-cancer sequence for the design of cancer prevention programmes and the study of the aetiology of large bowel cancer are discussed.
2,170 citations
TL;DR: The scope and limitations of histological grading by Broders' method are discussed and the conclusions reached that grading of a tumour is also of value for prognosis, though not when applied to fragments removed for diagnosis.
Abstract: Cancers of the rectum can be divided into A B and C cases according to the extent of spread. A cases are those in which the growth is limited to the wall of the rectum: B cases those in which there is extrarectal spread but no lymphatic metastases; C cases those in which metastases are present in the regional lymph nodes. A striking difference is found in the operative mortality rate and in the survival period after operation in these three groups. There is reason to believe that in A cases the disease is completely eradicated by rectal excision and the excellent results of operative treatment confirms the opinion previously expressed that lymphatic metastases are not found until a rectal carcinoma has spread by direct continuity to the extrarectal tissues. A good prognosis is justified also in B cases, though slightly less favourable than in A. The results of surgical treatment in C cases are very disappointing. The scope and limitations of histological grading by Broders' method are discussed and the conclusions reached that grading of a tumour is also of value for prognosis, though not when applied to fragments removed for diagnosis.
1,546 citations
TL;DR: A panel of experts reviewed current literature on oncologic resection techniques for level of evidence and grade of recommendation to draft guidelines that provide uniform definitions, principles, and practices and reports surgical guidelines and definitions based on the best available evidence.
Abstract: Background Oncologic resection techniques affect outcome for colon cancer and rectal cancer, but standardized guidelines have not been adopted. The National Cancer Institute sponsored a panel of experts to systematically review current literature and to draft guidelines that provide uniform definitions, principles, and practices. Methods Methods were similar to those described by the American Society of Clinical Oncology in developing practice guidelines. Experts representing oncology and surgery met to review current literature on oncologic resection techniques for level of evidence (I-V, where I is the best evidence and V is the least compelling) and grade of recommendation (A-D, where A is based on the best evidence and D is based on the weakest evidence). Initial guidelines were drafted, reviewed, and accepted by consensus. Results For the following seven factors, the level of evidence was II, III, or IV, and the findings were generally consistent (grade B): anatomic definition of colon versus rectum, tumor-node-metastasis staging, radial margins, adjuvant R0 stage, inadvertent rectal perforation, distal and proximal rectal margins, and en bloc resection of adherent tumors. For another seven factors, the level of evidence was II, III, or IV, but findings were inconsistent (grade C): laparoscopic colectomy; colon lymphadenectomy; level of proximal vessel ligation, mesorectal excision, and extended lateral pelvic lymph node dissection (all three for rectal cancer); no-touch technique; and bowel washout. For the other four factors, there was little or no systematic empirical evidence (grade D): abdominal exploration, oophorectomy, extent of colon resection, and total length of rectum resected. Conclusions The panel reports surgical guidelines and definitions based on the best available evidence. The availability of more standardized information in the future should allow for more grade A recommendations.
1,371 citations
Related Topics (5)
Performance Metrics
| Year | Papers |
|---|---|
| 2026 | 1 |
| 2025 | 168 |
| 2024 | 392 |
| 2023 | 770 |
| 2022 | 1,274 |
| 2021 | 274 |