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Prognostic importance of circumferential resection margin in the era of evolving surgical and multidisciplinary treatment of rectal cancer: A systematic review and meta-analysis. Surgery 2021; 170:412-431. [PMID: 33838883 DOI: 10.1016/j.surg.2021.02.029] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 01/20/2021] [Accepted: 02/13/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Circumferential resection margin is considered an important prognostic parameter after rectal cancer surgery, but its impact might have changed because of improved surgical quality and tailored multimodality treatment. The aim of this systematic review was to determine the prognostic importance of circumferential resection margin involvement based on the most recent literature. METHODS A systematic literature search of MEDLINE, Embase, and the Cochrane Library was performed for studies published between January 2006 and May 2019. Studies were included if 3- or 5-year oncological outcomes were reported depending on circumferential resection margin status. Outcome parameters were local recurrence, overall survival, disease-free survival, and distant metastasis rate. The Newcastle Ottawa Scale and Jadad score were used for quality assessment of the studies. Meta-analysis was performed using a random effects model and reported as a pooled odds ratio or hazard ratio with 95% confidence interval. RESULTS Seventy-five studies were included, comprising a total of 85,048 rectal cancer patients. Significant associations between circumferential resection margin involvement and all long-term outcome parameters were uniformly found, with varying odds ratios and hazard ratios depending on circumferential resection margin definition (<1 mm, ≤1 mm, otherwise), neoadjuvant treatment, study period, and geographical origin of the studies. CONCLUSION Circumferential resection margin involvement has remained an independent, poor prognostic factor for local recurrence and survival in most recent literature, indicating that circumferential resection margin status can still be used as a short-term surrogate endpoint.
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Ascertaining service quality and medical practitioners' sensitivity towards surgical instruments using SERVQUAL. BENCHMARKING-AN INTERNATIONAL JOURNAL 2021. [DOI: 10.1108/bij-04-2020-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PurposeService quality (SQ) has become an essential and indispensable component in healthcare and many other industries. SQ can deliver guaranteed stakeholder value and consequent consumer delight in the healthcare sector. The purpose of this study is to identify the relationships of various SERVQUAL elements with respect to the SQ of surgical instrument suppliers among surgeons.Design/methodology/approachData were collected from a sample of 112 surgeons working in the USA using the “snowball sampling” technique. A few standardised questionnaires, including SERQUAL, were used to collect the data. R-programming was used to perform structural equation modelling (SEM) analysis on the collected data.FindingsThe research study identified that service delivery factors and the SQ of surgical instruments contribute significantly towards medical practitioner sensitivity in the US healthcare industry. Word of mouth (WOM) did not have any significant impact on the medical practitioners' sensitivity.Originality/valueA review of related literature revealed that studies that examine the surgeon's perspectives of SQ are scarce. Thus, the present study is directed towards this gap in literature. The findings of the study are significant in nature and have made a substantial contribution to management literature.
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Rintala JM, Tahvonen PR, Vuolio ST, Typpö IT, Suokanerva KA, Huhta HI. The Effect of Laparoscopic Technique on the Surgical Outcome of Colorectal Cancer in a Small-Volume Rural Finnish Lapland Central Hospital. Gastrointest Tumors 2020; 8:16-24. [PMID: 33728292 DOI: 10.1159/000511104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/24/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Laparoscopic colorectal surgery has become widely used in treating colorectal cancer. Multicenter studies have shown that laparoscopy decreases postoperative complications and provides equivalent long-term oncological results compared to open surgery. Previous studies were conducted in high-volume institutions, with selected patients, which may influence the reported outcome of laparoscopy. Methods All patients with colorectal cancer that underwent surgery for a primary tumor between 2005 and 2015 in the Lapland Central Hospital were retrospectively collected. We retrieved data on the primary surgical outcome and complications within the first 30 days after surgery from patient records. We surveyed the national patient registry to determine long-term oncological results and patient survival. Results We identified 349 patients treated for colorectal cancer during 2005-2015. Of these, 219 patients (median age 71 years) underwent laparoscopy and 130 (median age 72 years) underwent open surgery. The 5-year disease-specific survival rates for stages I-III colon cancer were 83.3 and 87.7%, respectively. The 3-year disease-specific survival rates for stages I-III rectal cancer were 86.1 and 65.0%, respectively. Conclusion Our results showed that the introduction of laparoscopic colorectal surgery for treating cancer in a rural, small-volume hospital provided short- and long-term results comparable to findings from previous studies conducted in high-volume centers. Therefore, laparoscopy should be considered the treatment of choice for colorectal cancer in small, rural clinics.
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Affiliation(s)
- Jukka M Rintala
- Cancer and Translational Medicine Research Unit, Medical Research Centre Oulu University of Oulu Oulu Finland, Oulu, Finland.,Department of Surgery Oulu University Hospital Oulu Finland, Oulu, Finland
| | - Pirita R Tahvonen
- Department of Radiology Lapland Central Hospital Rovaniemi, Rovaniemi, Finland
| | - Saija T Vuolio
- Department of Surgery Lapland Central Hospital Rovaniemi, Rovaniemi, Finland
| | - Ilpo T Typpö
- Department of Surgery Lapland Central Hospital Rovaniemi, Rovaniemi, Finland
| | - Kai A Suokanerva
- Department of Surgery Lapland Central Hospital Rovaniemi, Rovaniemi, Finland
| | - Heikki I Huhta
- Cancer and Translational Medicine Research Unit, Medical Research Centre Oulu University of Oulu Oulu Finland, Oulu, Finland.,Department of Surgery Oulu University Hospital Oulu Finland, Oulu, Finland
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Chiew KL, Sundaresan P, Jalaludin B, Vinod SK. A narrative synthesis of the quality of cancer care and development of an integrated conceptual framework. Eur J Cancer Care (Engl) 2018; 27:e12881. [PMID: 30028054 DOI: 10.1111/ecc.12881] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/17/2018] [Accepted: 05/31/2018] [Indexed: 12/11/2022]
Abstract
The general paradigms that exist to guide measures in quality of care do not sufficiently deal with the changing needs of cancer management. The aim of this study was to review the literature regarding the quality of cancer care and develop a conceptual framework relevant to current practice. A textual narrative review of the literature was conducted by searching electronic databases from the last 10 years. Articles were then screened and included if they were both relevant to the management of cancer and standards in quality of care. Thematic analysis of the included articles was performed. Eighty-three articles were included and 12 domains identified and integrated with current models to develop a conceptual framework. These included: healthcare delivery system; timeliness; access; appropriateness of care; multidisciplinary and coordinated care; patient experience; technical aspects; safety; patient-centred outcomes; disease-specific outcomes; innovation and improvement and value. We propose a conceptual framework for the quality of cancer care based on relevant and current oncology practice. This presents a more practical and comprehensive approach than general models, and can be used by healthcare providers, managers and policy makers to guide and identify the need for metrics for quality improvements.
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Affiliation(s)
- Kim-Lin Chiew
- Radiation Oncology, Sydney West Cancer Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia
| | - Puma Sundaresan
- Radiation Oncology, Sydney West Cancer Network, Crown Princess Mary Cancer Centre, Sydney, New South Wales, Australia.,Sydney Medical School, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
| | - Bin Jalaludin
- School of Public Health and Community Medicine, University of New South Wales, Sydney, New South Wales, Australia.,Ingham Institute for Applied Medical Research, Sydney, New South Wales, Australia.,Epidemiology, Healthy People and Places Unit, South Western Sydney Local Health District, Sydney, New South Wales, Australia
| | - Shalini K Vinod
- South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.,Radiation Oncology, Liverpool Cancer Therapy Centre, South Western Sydney Local Health District Cancer Services, Sydney, New South Wales, Australia
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Handgraaf HJM, Boogerd LSF, Verbeek FPR, Tummers QRJG, Hardwick JCH, Baeten CIM, Frangioni JV, van de Velde CJH, Vahrmeijer AL. Intraoperative fluorescence imaging to localize tumors and sentinel lymph nodes in rectal cancer. MINIM INVASIV THER 2015; 25:48-53. [PMID: 25950124 DOI: 10.3109/13645706.2015.1042389] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Tumor involvement at the resection margin remains the most important predictor for local recurrence in patients with rectal cancer. A careful description of tumor localization is therefore essential. Currently, endoscopic tattooing with ink is customary, but visibility during laparoscopic resections is limited. Near-infrared (NIR) fluorescence imaging using indocyanine green (ICG) could be an improvement. In addition to localize tumors, ICG can also be used to identify sentinel lymph nodes (SLNs). The feasibility of this new technique was explored in five patients undergoing laparoscopic low anterior resection for rectal cancer. Intraoperative tumor visualization was possible in four out of five patients. Fluorescence signal could be detected 32 ± 18 minutes after incision, while ink could be detected 42 ± 21 minutes after incision (p = 0.53). No recurrence was diagnosed within three months after surgery. Ex vivo imaging identified a mean of 4.2 ± 2.7 fluorescent lymph nodes, which were appointed SLNs. One out of a total of 83 resected lymph nodes contained a micrometastasis. This node was not fluorescent. This technical note describes the feasibility of endoscopic tattooing of rectal cancer using ICG:nanocolloid and NIR fluorescence imaging during laparoscopic resection. Simultaneous SLN mapping was also feasible, but may be less reliable due to neoadjuvant therapy.
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Affiliation(s)
| | | | | | | | | | | | - John V Frangioni
- c 3 Department of Radiology, Beth Israel Deaconess Medical Center , Boston, MA, USA.,d 4 Division of Hematology/Oncology, Department of Medicine, Beth Israel Deaconess Medical Center , Boston, MA, USA.,e 5 Curadel, LLC , Worcester, MA, USA
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Bhatti ABH, Waheed A, Hafeez A, Akbar A, Syed AA, Khattak S, Kazmi AS. Can Induction Chemotherapy before Concurrent Chemoradiation Impact Circumferential Resection Margin Positivity and Survival in Low Rectal Cancers? Asian Pac J Cancer Prev 2015; 16:2993-8. [PMID: 25854395 DOI: 10.7314/apjcp.2015.16.7.2993] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Abu Bakar Hafeez Bhatti
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan E-mail :
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Chen YS, Bo XB, Gu DY, Gao WD, Sheng WZ, Zhang B. Outcomes of laparoscopic abdominoperineal resection in low rectal cancer using different pelvic drainages. Asian Pac J Cancer Prev 2015; 16:153-5. [PMID: 25640343 DOI: 10.7314/apjcp.2015.16.1.153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to establish the feasibility and efficiency of different pelvic drainage routes after laparoscopic abdominoperineal resection (LAPR) for rectal cancer by assessing short-term outcomes. MATERIALS AND METHODS Clinicopathological data of 76 patients undergoing LAPR for very low rectal cancer were reviewed retrospectively between June 2005 and June 2014. Outcomes were evaluated considering short- term results. RESULTS Of 76 relevant patients at our institution in the period of study, trans-perineal drainage of the pelvic cavity was performed in 17 cases. Compared with the trans-perineal group, the length of hospital stay was shorter in the trans-abdominal group, while the duration of drainage and the infection rates of the perineal wounds between two groups showed no significant differences. CONCLUSIONS The outcomes of this study suggest that trans-abdominal drainage of pelvic cavity is a reliable and feasible procedure, the duration of drainage, infection rates and the healing rates of the perineal wounds being acceptable. Trans-abdominal drainage has a more satisfactory effect after laparoscopic abdominoperineal resection for rectal carcinoma.
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Affiliation(s)
- Yu-Sheng Chen
- Associate Professor, General Surgery Department, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Xuhui District, Shanghai, China E-mail :
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Pramateftakis MG, Raptis D, Kanellos D, Christoforidis E, Tsoulfas G, Kanellos I, Lazaridis C. Abdominoperineal resection for rectal cancer: is the pelvic drain externalization site an independent risk factor for perineal wound healing? Int J Surg Oncol 2012; 2012:156935. [PMID: 22611493 PMCID: PMC3352578 DOI: 10.1155/2012/156935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 02/14/2012] [Indexed: 02/05/2023] Open
Abstract
Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders.
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Affiliation(s)
- M. G. Pramateftakis
- 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exochi, 57010 Thessaloniki, Greece
| | - D. Raptis
- 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exochi, 57010 Thessaloniki, Greece
| | - D. Kanellos
- Surgical Department, European Medical Center, Pilea, 55236 Thessaloniki, Greece
| | - E. Christoforidis
- 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exochi, 57010 Thessaloniki, Greece
| | - G. Tsoulfas
- Surgical Department, European Medical Center, Pilea, 55236 Thessaloniki, Greece
| | - I. Kanellos
- 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exochi, 57010 Thessaloniki, Greece
- Surgical Department, European Medical Center, Pilea, 55236 Thessaloniki, Greece
| | - Ch. Lazaridis
- 4th Surgical Department, Aristotle University of Thessaloniki, G. Papanikolaou General Hospital, Exochi, 57010 Thessaloniki, Greece
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