円周切除とは何ですか？
Circumferential Resection 円周切除 - Transanal TME (taTME) is a promising hybrid technique that was developed to mitigate the difficulties of operating in the low pelvis and to optimize the circumferential resection and distal margins. [1] Stenting should be avoided if complete strictures exist or a circumferential resection of the duct. [2] The types of venous resection consisted of tangential portal vein resection in four cases, circumferential portal vein resection with direct reanastomosis in one case and circumferential resection with graft placement in another four cases; postoperatively, one patient developed a vascular surgery-related complication consisting of graft thrombosis and thus necessitated prolonged anticoagulant therapy. [3] However, when we perform SCPL, circumferential resection of tracheal wall is limited because SCPL procedure itself needs releasing of tracheal length. [4] For noncircumferential resections, much evidence indicates local steroid injection is the best choice and is therefore widely used in clinical practice. [5] Non-circumferential resection and reconstruction used bronchial flap, which made it easier to perform under video-assisted thoracoscopic surgery conditions. [6] The procedure consisted of a circumferential resection of the stenosis, followed by a re-anastomosis with well-vascularized tissue. [7] Circumferential resection in one-single procedure (13. [8] Both pylorus-preserving gastrectomy (PPG) and segmental gastrectomy (SG) achieve the preservation of gastric cardia and pylorus through the circumferential resection of stomach, while concepts and surgical procedures of these two operations are obviously different. [9] 7% of our patients, circumferential resection by CO2 laser in 11. [10] 02], and in the case of circumferential resection [4. [11] A policy of vascular grafting in case of circumferential resection of a patent IVC or IV is rewarding. [12] If the extent of circumferential resection is more than 60% of esophageal circumference, risk of stricture rises to 70% to 80%. [13] Circumferential resection was compromised, suggesting the persistence of neoplasia in the patient even after the surgical approach, which would probably recommend the need for surgical approach. [14] Among these methods, local steroid injection is the most commonly used and is currently considered the standard method for noncircumferential resection. [15] No stricture occurred in 3 patients with noncircumferential resection, while stricture occurred in 50% (3/6) patients with circumferential resection. [16] However, there was no difference in hospital stay, positive range of circumferential resection and blood loss between the two study groups. [17]Transanal TME（taTME）は、低骨盤での手術の困難さを軽減し、円周切除と遠位端縁を最適化するために開発された有望なハイブリッド技術です。 [1] 完全な狭窄が存在する場合、またはダクトの円周方向の切除がある場合は、ステント留置を避ける必要があります。 [2] 静脈切除のタイプは、4例の接線門脈切除、1例の直接再吻合を伴う円周門脈切除、および別の4例の移植片配置を伴う円周切除から構成されていた。術後、1人の患者が移植片血栓症からなる血管手術関連の合併症を発症したため、長期の抗凝固療法が必要でした。 [3] ただし、SCPLを実行する場合、SCPL手順自体が気管の長さを解放する必要があるため、気管壁の円周方向の切除は制限されます。 [4] 非円周切除の場合、多くのエビデンスが局所ステロイド注射が最良の選択であり、したがって臨床診療で広く使用されていることを示しています。 [5] 非円周切除および再建では、気管支フラップを使用しました。これにより、ビデオ支援胸腔鏡下手術条件下での実行が容易になりました。 [6] 手順は、狭窄の円周方向の切除と、それに続く維管束組織の再吻合から構成されていた。 [7] 1回の手順での円周切除（13。 [8] 幽門温存胃切除術（PPG）と分節性胃切除術（SG）はどちらも、胃の円周切除によって胃噴門と幽門の温存を実現しますが、これら2つの手術の概念と外科的処置は明らかに異なります。 [9] 私たちの患者の7％、11年にCO2レーザーによる円周切除。 [10] 02]、および円周切除の場合[4。 [11] 特許 IVC または IV の全周切除の場合の血管移植のポリシーはやりがいがあります。 [12] 全周切除範囲が食道周囲の 60% を超える場合、狭窄のリスクは 70% ～ 80% に上昇します。 [13] 円周切除は危うく、おそらく外科的アプローチの必要性を推奨するであろう、外科的アプローチの後でも患者の腫瘍の持続性を示唆している。 [14] これらの方法の中で、局所ステロイド注射が最も一般的に使用されており、現在、非全周切除の標準的な方法と考えられています。 [15] 狭窄は 50% (3/6) の円周切除の患者で発生したが、狭窄は非円周切除の 3 人の患者で発生しませんでした。 [16] しかし、入院期間、全周切除の陽性範囲、および出血量には、2 つの研究グループ間で差はありませんでした。 [17]
total mesorectal excision 直腸間膜全切除
It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. [1] MRI has also been shown to predict involvement of the circumferential resection margin in total mesorectal excision surgery, which is extremely useful to surgeons who may otherwise have produced an R2 resection [2,3]. [2] Data analyzed included patient demographics, tumor characteristics, length of stay, post-operative outcomes, and pathologic surrogates of oncologic results, including total mesorectal excision (TME) quality, circumferential resection margin (CRM) involvement and lymph node (LN) yield. [3] Surgical and pathological outcomes such as quality of Total Mesorectal Excision (TME), free circumferential resection margins and number of lymph nodes dissected were also evaluated. [4] OBJECTIVE The aim of this study was to determine the incidence of, and preoperative risk factors for, positive circumferential resection margin (CRM) after transanal total mesorectal excision (TaTME). [5] Perioperative complication rates, harvested lymph nodes, positive circumferential resection margins, complete total mesorectal excision, first flatus, and length of stay did not differ significantly between approaches (P >. [6] Methods: We retrospectively analysed the oncological adequacy of LRR in terms of completeness of total mesorectal excision (TME), distal and circumferential resection margin (CRM) status and nodal harvest in patients with rectal cancer who underwent LRR between January 2016 and June 2018 at our centre. [7] CONCLUSIONS: The anterior surgical plane for total mesorectal excision should be reconsidered, and dissection posterior to Denonvilliers’ fascia is feasible and practicable for patients without risk of positive anterior circumferential resection margin. [8] Many investigations proved worst results in terms of circumferential resection margin (CRM) involvement compared to rectal anterior resection (RAR) with total mesorectal excision (TME). [9]適切な全直腸間膜切除術（TME）によって治療された切除可能な直腸間膜筋膜周縁切除縁（mrCRM）陰性直腸癌におけるnCRTが有益であるかどうかは不明である。 [1] MRIはまた、全直腸間膜切除手術における周縁切除縁の関与を予測することも示されています。これは、そうでなければR2切除を行った可能性のある外科医にとって非常に有用です[2,3]。 [2] nan [3] 全直腸間膜切除術（TME）の質、自由周縁切除縁、および切除されたリンパ節の数などの外科的および病理学的転帰も評価された。 [4] 目的 この研究の目的は、経肛門的全直腸間膜切除術 (TaTME) 後の円周切除断端陽性 (CRM) の発生率とその術前危険因子を決定することでした。 [5] 周術期の合併症率、採取されたリンパ節、全周切除断端陽性、直腸間膜の完全切除、最初の放屁、および入院期間は、アプローチ間で有意差はありませんでした (P >. [6] nan [7] nan [8] nan [9]
distal resection margin 遠位切除マージン
There were no significant differences between the two groups in intraoperative blood loss, conversion rate, morbidity of postoperative complications, positive rate of distal resection margin, positive rate of circumferential resection margin, and the number of resected lymph nodes (all P>0. [1] The circumferential resection margin and distal resection margin was involved in nine patients (2. [2] Requirements of oncologically successful TME include the surgical extirpation of a complete mesorectal specimen, with tumor-free circumferential resection margins (CRM), a tumor-free distal resection margin (DRM), and the removal of ≥12 lymph nodes. [3] Literature on the impact of acellular mucin (ACM) in circumferential resection margin (CRM) or distal resection margin (DRM) of proctectomy specimens on RC recurrence and outcomes is lacking. [4] The clinicopathological outcome reported 100% for complete or nearly complete specimen, 100% negative distal resection margin, and the circumferential resection margin was positive in 5. [5] Noninferiority margins (&Dgr;NI) for circumferential resection margin (CRM), plane of mesorectal excision (PME), distal resection margin (DRM), and a composite outcome (“successful resection”) were based on the consensus of 58 worldwide experts. [6] There were no significant differences in the postoperative circumferential resection margin, distal resection margin, number of dissected lymph nodes, successful resection rate, and quality of mesorectum between the two groups (P > 0. [7] Patients with positive circumferential resection margin or distal resection margin were 205 (11. [8] Outcomes of sphincter preserving surgery for distal rectal cancers improve with clear circumferential resection and distal resection margin. [9]術中の失血、転換率、術後合併症の罹患率、遠位切除縁の陽性率、円周切除縁の陽性率、および切除リンパ節の数において、2つのグループ間に有意差はありませんでした（すべてP> 0）。 [1] 周縁切除縁と遠位切除縁は9人の患者に関与していた（2。 [2] 腫瘍学的に成功する TME の要件には、腫瘍のない円周切除縁 (CRM)、腫瘍のない遠位切除縁 (DRM)、および 12 個以上のリンパ節の除去を伴う、完全な直腸間膜標本の外科的摘出が含まれます。 [3] 直腸切除標本の円周切除縁 (CRM) または遠位切除縁 (DRM) における無細胞ムチン (ACM) が RC 再発および転帰に及ぼす影響に関する文献は不足しています。 [4] nan [5] nan [6] nan [7] nan [8] nan [9]
extramural venous invasion
II: Pathological factors: circumferential resection margin and extramural venous invasion The prognostic value of the circumferential margin (CRM) after neoadjuvant chemoradiotherapy (nCRT) is not well defined yet. [1] An extramural venous invasion positive tumor was evident with a positive circumferential resection margin at 4 o' clock. [2] Additionally, confidence was assessed for essential components of pelvic MRI including T- and N-stage, circumferential resection margin (CRM), extramural venous invasion (EMVI), and pelvic anatomy. [3] Nodal staging is less accurate than other MRI-detected prognostic markers such as circumferential resection margin status, extramural venous invasion and T stage. [4] The most important emerging variables taken currently into account are the distance from mesorectal fascia, circumferential resection margin, extramural venous invasion and intersphincteric plane, all of which can be evaluated using the MRI examination. [5] Tumors included in the analysis were ranging from T1 to T3b according to TNM staging, with free circumferential resection margin (CRM), distance form mesorectal fascia more than 5 mm, negative intersphincteric plane and also negative extramural venous invasion (EMVI), while the N stage was not decisive. [6]II: 病理学的要因: 円周切除縁と壁外静脈浸潤 ネオアジュバント化学放射線療法 (nCRT) 後の円周縁 (CRM) の予後的価値はまだ十分に定義されていません。 [1] 壁外静脈浸潤陽性の腫瘍が明らかであり、4 時の周囲切除縁が陽性でした。 [2] nan [3] nan [4] nan [5] 分析に含まれる腫瘍は、TNM病期分類に従ってT1からT3bの範囲であり、自由円周切除縁（CRM）、直腸間膜筋膜からの距離が5 mmを超え、括約筋間平面が陰性で、壁外静脈浸潤（EMVI）も陰性であった。ステージは決定的ではありませんでした。 [6]
extramural vascular invasion 血管外浸潤
The circumferential resection margin, presence of extramural vascular invasion, and nodal involvement must also be addressed on restaging. [1] However, in addition to the present risk factors, we need to further examine the extramural vascular invasion (EMVI) status and circumferential resection margin (CRM) using magnetic resonance imaging (MRI) findings. [2] Rectal MRI can accurately evaluate the tumor location, tumor stage, invasion depth, extramural vascular invasion, and circumferential resection margin. [3] Pelvic MRI has an undeniable role in the therapeutic management of rectal cancer, particularly for the determination of the circumferential resection margin (CRM), evaluation of sphincter invasion, and assessment of the extramural vascular invasion. [4]再ステージングでは、周縁切除縁、壁外血管侵襲の存在、および結節の関与にも対処する必要があります。 [1] ただし、現在の危険因子に加えて、磁気共鳴画像法（MRI）の所見を使用して、壁外血管浸潤（EMVI）の状態と周縁切除縁（CRM）をさらに調べる必要があります。 [2] nan [3] nan [4]
≤ 1 mm ≦1mm
Furthermore, there was no significant survival disadvantage for patients with R0 resection but circumferential resection margin invasion (≤ 1 mm; CRM+; 10. [1] 5%, while circumferential resection margin was ≤ 1 mm (including T4 tumors) in 11. [2] 8%) with involved circumferential resection margins (≤ 1 mm). [3] Two definitions of a positive circumferential resection margin (CRM) in esophageal cancer coexist: one by the College of American Pathologists (CAP) (CRM = 0 mm) and another by the Royal College of Pathologists (RCP) (CRM ≤ 1 mm). [4]さらに、R0切除を行った患者では、生存率に重大な不利益はありませんでしたが、周縁切除縁の浸潤（≤1mm; CRM +;10）がありました。 [1] 5％、11では円周切除マージンは≤1mm（T4腫瘍を含む）でした。 [2] 8％）関連する円周切除マージン（≤1mm）を伴う。 [3] nan [4]
tumor regression grade
On univariate analysis, residual tumor size, ypT category, ypN category, ypTNM stage, downstage, tumor regression grade, lymphatic invasion, perineural invasion, venous invasion, and circumferential resection margin (CRM) were significantly associated with recurrence free survival (RFS) or/and cancer-specific survival (CSS) (all p<0. [1] The sensitivity and specificity of restaging MRI in determining tumor regression grade, T category, N category, circumferential resection margin, and extramural vascular invasion were calculated with pathologic results as the reference standard. [2] Accuracy, sensitivity, specificity, positive, and negative predictive value for local staging regarding T-stage, N-stage, circumferential resection margin, and MRI tumor regression grade (ymriTRG) were calculated, and inter-test agreements were assessed. [3]単変量解析では、残存腫瘍サイズ、ypT カテゴリー、ypN カテゴリー、ypTNM ステージ、ダウンステージ、腫瘍退縮グレード、リンパ管浸潤、神経周囲浸潤、静脈浸潤、および円周切除縁 (CRM) が、無再発生存期間 (RFS) または無再発生存期間と有意に関連していました。 /およびがん特異的生存率 (CSS) (すべて p<0. [1] 腫瘍退縮グレード、T カテゴリー、N カテゴリー、円周切除縁、および壁外血管浸潤を決定する際の再病期 MRI の感度と特異性は、病理学的結果を参照基準として計算されました。 [2] nan [3]
locally advanced rectal 局所進行直腸
For locally advanced rectal cancers (T3-4 and all N+ irrespective of T), the following scenarios can be envisaged: for initially resectable tumors (T3N0, T1-T3N+, circumferential resection margin>2mm), neoadjuvant chemotherapy alone aims to minimize the risk of local recurrence while avoiding the sequelae of radiotherapy. [1] We conclude that taTME with low-energy X-rays IORT may not only benefit the circumferential resection margin (CRM) but also improve the local control (LC) for the patient with locally advanced rectal cancer. [2] OBJECTIVE To evaluate the impact of neoadjuvant multi-agent systemic chemotherapy and radiation (TNT) vs neoadjuvant single-agent chemoradiation (nCRT) and multi-agent adjuvant chemotherapy on overall survival (OS), tumor downstaging, and circumferential resection margin (CRM) status in patients with locally advanced rectal cancer. [3]局所進行直腸癌（T3-4およびTに関係なくすべてのN +）の場合、以下のシナリオが想定されます：最初に切除可能な腫瘍（T3N0、T1-T3N +、周縁切除マージン> 2mm）の場合、ネオアジュバント化学療法のみがリスクを最小限に抑えることを目的としています放射線療法の後遺症を避けながら局所再発の。 [1] 低エネルギーX線IORTを使用したtaTMEは、周縁切除マージン（CRM）に役立つだけでなく、局所進行直腸癌患者の局所制御（LC）も改善する可能性があると結論付けています。 [2] nan [3]
Positive Circumferential Resection 積極的な全周切除
A positive circumferential resection margin was found in 3, corresponding to the positive rate of 9. [1] MAIN OUTCOME MEASURES Proportion of restorative procedure, positive circumferential resection margin, and postoperative complications. [2] 11 out of 12 patients with a positive circumferential resection margin (CRM +) were ctDNA positive (p=0. [3] The advantages are especially important in rectal cancer, as they could potentially result in a more precise distal dissection, lower rate of positive circumferential resection margins, and increase the rate of sphincter-sparing procedures. [4] Subgroup analysis of patients with (y)pT3–4 tumours showed fewer positive circumferential resection margins with TaTME (0 versus 18. [5] However, the number of removed lymph nodes, positive circumferential resection margin, as well as complications after surgery showed significant differences between the 2 groups. [6] Independent risk factors for LR were male sex, threatened resection margin on baseline MRI, pathologic stage III cancer, and a positive circumferential resection margin on final histopathology. [7] Positive circumferential resection margin was equal (3. [8] Two definitions of a positive circumferential resection margin (CRM) in esophageal cancer coexist: one by the College of American Pathologists (CAP) (CRM = 0 mm) and another by the Royal College of Pathologists (RCP) (CRM ≤ 1 mm). [9] BACKGROUND: Positive circumferential resection margin is a predictor of local recurrence and worse survival in rectal cancer. [10] No differences were observed in incidence of anastomotic leakage, mortality, rate of positive circumferential resection margins, conversion rate, and duration of operation by study design. [11] A positive circumferential resection margin (CRM) was not significantly different between the double-team groups (2, 5. [12] Rates of positive circumferential resection margins (CRMs) were the primary endpoint. [13] The influence of hospital volume on sphincter-preservation rates and short-term outcomes (anastomotic leakage (AL), positive circumferential resection margin (CRM), 30- and 90-day mortality rates) were also analysed. [14] It is important to stick to the TME principle to avoid perforating the tumor; violating the mesorectal fascia, thus resulting in positive circumferential resection margin (CRM); or causing injury to the autonomic nerves, especially if the tumor is located anteriorly. [15] OBJECTIVE The aim of this study was to determine the incidence of, and preoperative risk factors for, positive circumferential resection margin (CRM) after transanal total mesorectal excision (TaTME). [16] Perioperative complication rates, harvested lymph nodes, positive circumferential resection margins, complete total mesorectal excision, first flatus, and length of stay did not differ significantly between approaches (P >. [17] Open surgery was favoured in obese patients with an extra-peritoneal tumor and a positive circumferential resection margin (CRM) or T4 tumor when a restorative resection was planned. [18] The positive circumferential resection margins (CRM) is significantly lower for 3D (P = 0. [19] The positive circumferential resection margins (CRMs) were significantly lower for the 3D group (P = 0. [20] However, for patients with a risk of positive circumferential resection margin, open surgeryis still recommended. [21] Late stage at diagnosis, positive circumferential resection margins, neural and vascular invasion, as well as three or more nodal metastases were all associated with statistically significant worsened outcome. [22] Secondary outcomes included positive circumferential resection (CRM+) and 30-day complicated postoperative course. [23] BACKGROUND The aim of the present study was to assess the prognosis of patients with esophageal or gastroesophageal junction (E/GEJ) adenocarcinoma extending beyond the muscularis propria layer (≥ypT3) and positive circumferential resection margin (CRM), post neoadjuvant chemotherapy. [24] Background The role of adjuvant radiotherapy in patients with microscopically positive circumferential resection margins (CRM), R1 specimen, in oesophageal resections for cancer with curative intent remains unclear. [25] 003) and rates of positive circumferential resection margin involvement (risk ratio: 0. [26] While the prognostic implications of positive circumferential resection margins (CRM) have been established for rectal cancer, its significance in colon cancer has not been well defined. [27] An extramural venous invasion positive tumor was evident with a positive circumferential resection margin at 4 o' clock. [28] The evidence regarding the prognostic impact of a positive circumferential resection margin (CRM) in oesophageal cancer is conflicting, and there is global variability in the definition of a positive CRM. [29] The positive circumferential resection margin (P = 0. [30] This potentially could result in a more accurate distal dissection with a lower rate of positive circumferential resection margins, increasing the rate of sphincter-saving procedures. [31] 32nd NATCON IASO National Annual Conference 2018 20th-23rd September 18 The Leela Kovalam, Trivandrum Title:Outcomes of Patients With Positive Circumferential Resection Margin After Neoadjuvant Chemoradiation In RectalCancer – Does Addition Of Induction Chemotherapy Work Category: 08: GIT Authors: Balu Mahenda K. [32] 12), positive circumferential resection margin (OR =0. [33] 18); positive circumferential resection margins (HR 2. [34] A positive circumferential resection margin (CRM) has been associated with higher rates of locoregional recurrence and worse survival in oesophageal cancer. [35] After adjustment for patient, tumor, and institutional characteristics, MIS approaches were associated with significantly decreased risk of positive circumferential resection margins (OR 0. [36] OBJECTIVE This study aimed to identify risk factors for positive circumferential resection margin in patients undergoing surgery for rectal cancer with special emphasis on surgical approach. [37] The LLND and non-LLND group showed the following differences: positive circumferential resection margin by MRI after CRT: 53. [38] A recent study demonstrated that transanal TME (TaTME) may provide reduced positive circumferential resection margin (CRM) rate, that is well-known indicator of prognosis in rectal cancer [3]. [39] Patients with positive circumferential resection margin or distal resection margin were 205 (11. [40] In one of the cases, we reported positive circumferential resection margin. [41] The positive circumferential resection margin was detected in 2 cases in each group (P = 0. [42] Compared the operative time, intraoperative blood loss, intraoperative laparotomy, first ventilation time, postoperative hospital stays, complications, distance from the distant margin of the tumor, number of positive circumferential resection margins, number of lymph nodes removed, and other outcoms between two groups. [43] The operation time, number of lymph nodes harvested, and rate of positive circumferential resection margin were similar intergroup. [44] Positive circumferential resections are associated with local disease recurrence and reduced survival in rectal cancer. [45]正の周縁切除マージンが3で見つかり、正の率9に対応します。 [1] 主な結果の測定 修復処置の割合、正の周縁切除断端、および術後合併症。 [2] nan [3] nan [4] nan [5] nan [6] nan [7] nan [8] nan [9] nan [10] nan [11] nan [12] nan [13] nan [14] nan [15] 目的 この研究の目的は、経肛門的全直腸間膜切除術 (TaTME) 後の円周切除断端陽性 (CRM) の発生率とその術前危険因子を決定することでした。 [16] 周術期の合併症率、採取されたリンパ節、全周切除断端陽性、直腸間膜の完全切除、最初の放屁、および入院期間は、アプ