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Yu N, Lin S, Wang X, Hu G, Xie R, Que Z, Lai R, Xu D. Endoscopic obstruction predominantly occurs in right-side colon cancer and endoscopic obstruction with tumor size ≤ 5 cm seems poor prognosis in colorectal cancer. Front Oncol 2024; 14:1415345. [PMID: 38947895 PMCID: PMC11211365 DOI: 10.3389/fonc.2024.1415345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/23/2024] [Indexed: 07/02/2024] Open
Abstract
Background Endoscopic obstruction (eOB) is associated with a poor prognosis in colorectal cancer (CRC). Our study aimed to investigate the association between tumor location and eOB, as well as the prognostic differences among non-endoscopic obstruction (N-eOB), eOB with tumor size ≤ 5 cm, and eOB with tumor size > 5 cm in non-elderly patients. Methods We retrospectively reviewed the clinicopathological variables of 230 patients with CRC who underwent curative surgery. The multivariable logistic regression model was used to identify risk factors for eOB. The association between eOB with tumor size ≤ 5 cm and disease-free survival (DFS) was evaluated using multivariate cox regression analysis. Results A total of 87 patients had eOB while 143 had N-eOB. In multivariate analysis, preoperative carcinoembryonic antigen (p = 0.014), tumor size (p = 0.010), tumor location (left-side colon; p = 0.033; rectum; p < 0.001), and pT stage (T3, p = 0.009; T4, p < 0.001) were significant factors of eOB. The DFS rate for eOB with tumor size ≤ 5 cm was significantly lower (p < 0.001) in survival analysis. The eOB with tumor size ≤ 5 cm (p = 0.012) was an unfavorable independent factor for DFS. Conclusions The patients with eOB were significantly associated with right-side colon cancer as opposed to left-side colon cancer and rectal cancer. The eOB with tumor size ≤ 5 cm was an independent poor prognostic factor. Further studies are needed to target these high-risk groups.
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Affiliation(s)
- Nong Yu
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Shuangming Lin
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Union Hospital, Fujian Medical University, Fuzhou, China
| | - Guoxin Hu
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Run Xie
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Zhipeng Que
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Runsheng Lai
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
| | - Dongbo Xu
- Department of Gastrointestinal Surgery, Longyan First Affiliated Hospital, Fujian Medical University, Longyan, China
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Ralston C, Hainsworth A, de Naurois J, Schizas A, George M. Is an uncomplicated postoperative recovery following total pelvic exenteration a more important prognostic factor than achieving R0 in the first 2 years? Colorectal Dis 2024; 26:73-80. [PMID: 38071402 DOI: 10.1111/codi.16817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/30/2023] [Accepted: 10/18/2023] [Indexed: 01/28/2024]
Abstract
AIM Total pelvic exenteration (TPE) can achieve an R0 resection in locally advanced and recurrent rectal cancer (LARC and RRC) and remains the only curative option. The resultant high morbidity creates prolonged complex recoveries, rendering patients unfit for adjuvant chemotherapy. This study aims to evaluate the impact of this on overall survival (OS) and disease-free survival (DFS) as it has not been studied previously. METHOD This is a retrospective single-centre study from 2017 to 2021 evaluating patients with LARC or RRC who underwent a curative TPE. Demographics, oncological history, perioperative data [using Clavien-Dindo (CD) scoring], disease recurrence and mortality were analysed using multivariate Cox regression to assess the impact of variables on DFS and OS. RESULTS A total of 120 patients were included with a median follow-up of 3 years. 28% of patients received adjuvant chemotherapy, 27.5% had surgical follow-up and 44% missed systemic treatment. Missed treatment was predominantly due to prolonged recovery or poor performance status (59%). Patients who missed adjuvant chemotherapy experienced significantly higher CD scores (p = 0.0031), reintervention rates (p=0.0056) and further related surgeriesp (p = 0.0314). Missing adjuvant chemotherpy is a significant factor for poorer survival, with almost a three times higher mortality (p=0.0096, hazard ratio 2.7). R status was not a significant factor for OS following multivariate analysis (p = 0.336), indicating that another factor has an impact on survival within the first 2 years. CONCLUSIONS In the initial 2 years after exenteration, an uncomplicated postoperative recovery allows for the delivery of adjuvant chemotherapy, prolonging survival. R0/R1 status was not the main prognostic factor. Longer follow-up and further multivariate analysis may influence decisions about aggressive R0 resection balanced against the patient being fit for chemotherapy postoperatively.
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Affiliation(s)
| | | | | | | | - Mark George
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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3
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Kamel MK, Shchatsko A, Keane CA, Serpa E, Al-Qudah G, Rahouma M, Nituica C, Blebea J, Marar O. Is There a Role for Neoadjuvant Systemic Therapy for cT4bM0 Colon Cancer? A Propensity Score-Matched Analysis of the National Cancer Database. Dis Colon Rectum 2023; 66:1435-1448. [PMID: 36876973 DOI: 10.1097/dcr.0000000000002763] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2023]
Abstract
BACKGROUND Nonmetastatic T4b colon cancer has been traditionally treated with upfront surgery, often requiring technically challenging multiorgan resection. Neoadjuvant chemotherapy can potentially downsize these tumors and improve their resectability. OBJECTIVE This study aimed to explore trends and outcomes of neoadjuvant chemotherapy use compared to upfront surgery in patients with nonmetastatic T4b colon cancer. This study also sought to determine factors associated with increased neoadjuvant chemotherapy use and with overall survival. DESIGN Retrospective cohort study. SETTINGS Conducted using the National Cancer Database. PATIENTS Patients with nonmetastatic T4b colon cancer who underwent colectomy (2006-2016) were included in the study. Patients receiving neoadjuvant chemotherapy were propensity-matched (1:2) to those who underwent upfront surgery in either clinically node-negative or node-positive disease. MAIN OUTCOME MEASURES Postoperative outcomes (length of stay, 30-d readmission, 30/90-d mortality), oncologic resection adequacy (R0 rate, number of resected/positive nodes), and overall survival were the main outcome measures. RESULTS Neoadjuvant chemotherapy was used in 7.7% of the patients. Neoadjuvant chemotherapy use increased over the study period from 4% to 16% in the entire cohort, from 3% to 21% in patients with clinically node-positive disease, and from 6% to 12% in patients with clinically node-negative disease. Factors associated with increased use of neoadjuvant chemotherapy included younger age (OR 0.97; 95% CI, 0.96-0.98; p < 0.001), male sex (OR 1.35; 95% CI, 1.11-1.64; p = 0.002), recent diagnosis year (OR 1.16; 95% CI, 1.12-1.20; p < 0.001), academic centers (OR 2.65; 95% CI, 2.19-3.22; p < 0.001), clinically node-positive (OR 1.23; 95% CI, 1.01-1.49; p = 0.037), and tumor located in the sigmoid colon (OR 2.44; 95% CI, 1.97-3.02; p < 0.001). Patients who received neoadjuvant chemotherapy had significantly higher R0 resection compared with upfront surgery (87% vs 77%; p < 0.001). On multivariable analysis, neoadjuvant chemotherapy was associated with higher overall survival (HR 0.76; 95% CI, 0.64-0.91; p = 0.002). On propensity-matched analyses, neoadjuvant chemotherapy was associated with a higher 5-year overall survival compared to upfront surgery in patients with clinically node-positive disease (57% vs 43%; p = 0.003) but not in patients with clinically node-negative disease (61% vs 56%; p = 0.090). LIMITATIONS Retrospective design. CONCLUSION Neoadjuvant chemotherapy use for nonmetastatic T4b has increased significantly on the national level, more so in patients with clinically node-positive disease. Patients with node-positive disease treated with neoadjuvant chemotherapy had higher overall survival compared to those who underwent upfront surgery. See Video Abstract at http://links.lww.com/DCR/C228 . EXISTE LUGAR PARA LA TERAPIA SISTMICA NEOADYUVANTE PARA EL CNCER DE COLON CTBM UN ANLISIS EMPAREJADO DE PUNTAJE DE PROPENSIN DE LA BASE DE DATOS NACIONAL DEL CNCER ANTECEDENTES:El cáncer de colon T4b no metastásico se ha tratado tradicionalmente con cirugía inicial, que frecuentemente requiere de una resección multiorgánica técnicamente desafiante. La quimioterapia neoadyuvante puede potencialmente reducir el tamaño y mejorar la resecabilidad de esos tumores.OBJETIVO:Explorar las tendencias y los resultados del uso de quimioterapia neoadyuvante en pacientes con cáncer de colon T4b no metastásico, en comparación con la cirugía inicial. Determinar los factores asociados con el aumento del uso de quimioterapia neoadyuvante y con la supervivencia general.DISEÑO:Estudio de cohorte retrospectivo.AJUSTES:Utilizando de la Base de Datos Nacional del Cáncer.PACIENTES:Pacientes con cáncer de colon T4b no metastásico sometidos a colectomía (2006-2016). Los pacientes que recibieron quimioterapia neoadyuvante fueron emparejados por propensión (1:2) con aquellos sometidos a cirugía inicial, ya sea en enfermedad clínica con ganglios negativos o ganglios positivos.PRINCIPALES MEDIDAS DE RESULTADO:Resultados posoperatorios (duración de la hospitalización, reingreso a los 30 días, mortalidad a los 30/90 días), adecuación de la resección oncológica (tasa R0, número de ganglios resecados/positivos) y supervivencia general.RESULTADOS:La quimioterapia neoadyuvante se utilizó en el 7,7% de los pacientes. El uso de quimioterapia neoadyuvante aumentó durante el período de estudio del 4% al 16% en toda la cohorte; del 3% al 21% en pacientes con enfermedad clínica y ganglios positivos; y del 6% al 12% en pacientes con enfermedad clínica y ganglios negativos. Los factores asociados con un mayor uso de quimioterapia neoadyuvante incluyeron, edad más joven (OR 0,97, IC del 95 %: 0,96-0,98, p < 0,001), sexo masculino (OR 1,35, IC del 95 %: 1,11-1,64, p = 0,002), año de diagnóstico mas reciente (OR 1,16, 95% IC: 1,12-1,20, p < 0,001), centros académicos (OR 2,65, 95% IC: 2,19-3,22, p < 0,001), enfermedad clínica con ganglios positivos (OR 1,23, 95% IC: 1,01-1,49, p = 0,037), y tumor localizado en colon sigmoide (OR 2,44, 95% IC: 1,97-3,02, p < 0,001). Los pacientes que recibieron quimioterapia neoadyuvante tuvieron una resección R0 significativamente mayor en comparación con la cirugía inicial (87 % frente a 77 %, p < 0,001). En análisis multivariable, la quimioterapia neoadyuvante se asoció con una mayor supervivencia global (HR 0,76, IC del 95%: 0,64-0,91, p = 0,002). En los análisis de propensión pareada, la quimioterapia neoadyuvante se asoció con una mayor supervivencia general a los 5 años en comparación con la cirugía inicial en pacientes con enfermedad clínica con ganglios positivos (57% frente a 43%, p = 0,003), pero no en pacientes con enfermedad clínica y ganglios negativos (61% vs 56%, p = 0,090).LIMITACIONES:Diseño retrospectivo.CONCLUSIÓN:El uso de quimioterapia neoadyuvante para T4b no metastásico ha aumentado significativamente a nivel nacional, más aún en pacientes con enfermedad clínica y ganglios positivos. Los pacientes con enfermedad y ganglios positivos tratados con quimioterapia neoadyuvante tuvieron una mayor supervivencia general en comparación con la cirugía inicial. Consulte Video Resumen en http://links.lww.com/DCR/C228 . (Traducción-Dr. Fidel Ruiz Healy ).
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Affiliation(s)
- Mohamed K Kamel
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Anastasiya Shchatsko
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Charles A Keane
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Eduardo Serpa
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Ghaith Al-Qudah
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York
| | - Cristina Nituica
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - John Blebea
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
| | - Omar Marar
- Department of Surgery, Central Michigan University College of Medicine, Saginaw, Michigan
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Sun BJ, Daniel SK, Lee B. The Role of Prophylactic and Adjuvant Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Prevention of Peritoneal Metastases in Advanced Colorectal Cancer. J Clin Med 2023; 12:6443. [PMID: 37892582 PMCID: PMC10607874 DOI: 10.3390/jcm12206443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 09/28/2023] [Accepted: 10/08/2023] [Indexed: 10/29/2023] Open
Abstract
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a locoregional therapy that may be combined with cytoreductive surgery (CRS) to treat patients with colorectal cancer and peritoneal metastases (PM). In recent years, three randomized controlled trials (RCTs) have investigated the role of prophylactic or adjuvant HIPEC in preventing the development of PM in patients with high-risk colorectal cancer: PROPHYLOCHIP and COLOPEC evaluated adjuvant HIPEC, and HIPECT4 studied concurrent HIPEC and CRS. Although PROPHYLOCHIP and COLOPEC were negative trials, a great deal may be learned from their methodology, outcome measures, and patient selection criteria. HIPECT4 is the first RCT to show a clinical benefit of HIPEC in high-risk T4 colorectal cancer, demonstrating improved locoregional disease control with the addition of HIPEC to CRS with no increase in the rate of complications. This review critically examines the strengths and limitations of each major trial and discusses their potential impact on the practice of HIPEC. Several additional ongoing clinical trials also seek to investigate the role of HIPEC in preventing PM in advanced colorectal cancer.
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Affiliation(s)
| | | | - Byrne Lee
- Section of Surgical Oncology, Department of Surgery, Stanford University School of Medicine, Stanford, CA 94305, USA; (B.J.S.); (S.K.D.)
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Je HJ, Cho SH, Oh HS, Seo AN, Park BG, Lee SM, Kim SH, Kim GC, Ryeom H, Choi GS. Response Prediction after Neoadjuvant Chemotherapy for Colon Cancer Using CT Tumor Regression Grade: A Preliminary Study. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2023; 84:1094-1109. [PMID: 37869127 PMCID: PMC10585072 DOI: 10.3348/jksr.2022.0124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 10/13/2022] [Accepted: 02/06/2023] [Indexed: 10/24/2023]
Abstract
Purpose To investigate whether CT-based tumor regression grade (ctTRG) can be used to predict the response to neoadjuvant chemotherapy (NAC) in colon cancer. Materials and Methods A total of 53 patients were enrolled. Two radiologists independently assessed the ctTRG using the length, thickness, layer pattern, and luminal and extraluminal appearance of the tumor. Changes in tumor volume were also analyzed using the 3D Slicer software. We evaluated the association between pathologic TRG (pTRG) and ctTRG. Patients with Rödel's TRG of 2, 3, or 4 were classified as responders. In terms of predicting responder and pathologic complete remission (pCR), receiver operating characteristic was compared between ctTRG and tumor volume change. Results There was a moderate correlation between ctTRG and pTRG (ρ = -0.540, p < 0.001), and the interobserver agreement was substantial (weighted κ = 0.672). In the prediction of responder, there was no significant difference between ctTRG and volumetry (Az = 0.749, criterion: ctTRG ≤ 3 for ctTRG, Az = 0.794, criterion: ≤ -27.1% for volume, p = 0.53). Moreover, there was no significant difference between the two methods in predicting pCR (p = 0.447). Conclusion ctTRG might predict the response to NAC in colon cancer. The diagnostic performance of ctTRG was comparable to that of CT volumetry.
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Hashimoto S, Tominaga T, Nonaka T, Shiraishi T, To K, Takeshita H, Fukuoka H, Araki M, Tanaka K, Sawai T, Nagayasu T. Mid-term outcomes of laparoscopic vs open colectomy for pathological T4 and/or N2 colon cancer patients: Multicenter study using propensity score matched analysis. Asian J Endosc Surg 2023; 16:400-408. [PMID: 36799190 DOI: 10.1111/ases.13171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 02/18/2023]
Abstract
OBJECTIVES We aimed to assess mid-term outcomes after laparoscopic surgery (LAP) vs open surgery (OP) for pathological T4 (pT4) and/or N2 (pN2) colon cancer. METHODS We retrospectively reviewed 255 primary tumor resections for pT4 and/or pN2 colon cancer performed from 2015 to 2020 at six hospitals, divided into LAP (n = 204) and OP groups (n = 51). After propensity score matching to minimize selection bias, 47 matched patients per group were assessed. RESULTS Before matching, the rate of males (53.9% vs. 37.3%, P = .042), left sided colon cancer (53.9% vs 37.3%, P = .042), D3 lymph node dissection (90.7% vs 68.6%, P < .001) and body mass index (kg/m2 ) (22.3 vs 21.8, P = .039) were significantly greater in the LAP group. The rate of pT4b (7.8% vs 40.4%, P < .001) was lower and pN2 was higher (57.4% vs 37.3%, P = .012) in the LAP group. After matching, preoperative characteristics and pathologic status were equivalent between the groups. The LAP and OP groups showed comparable overall survival (OS) (2-year OS, 84.5% vs 76.8%, P = .055) and recurrence-free survival (RFS) (2-year RFS, 73.9% vs 52.8%, P = .359). In the patients with pT4, OS (2-year OS, 79.4% vs 75.7%, P = .359) and RFS (2-year RFS, 71.3% vs 58.7%) were comparable. In the patients with pN2, OS (2-year OS, 83.4% vs 76.3%) and RFS (2-year RFS, 69.6% vs 36.2%) were also comparable. CONCLUSIONS LAP for pT4 and/or pN2 colon cancer showed comparable mid-term outcomes compared with OP. LAP was an acceptable surgical approach in this cohort.
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Affiliation(s)
- Shintaro Hashimoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Tetsuro Tominaga
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takashi Nonaka
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Toshio Shiraishi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kazuo To
- Department of Surgery, National Hospital Organization Ureshino Medical Center, Ureshino, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ohmura, Japan
| | | | - Masato Araki
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Kenji Tanaka
- Department of Surgery, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Terumitsu Sawai
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
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Arndt M, Lippert H, Croner RS, Meyer F, Otto R, Ridwelski K. Multivisceral resection of advanced colon and rectal cancer: a prospective multicenter observational study with propensity score analysis of the morbidity, mortality, and survival. Innov Surg Sci 2023; 8:61-72. [PMID: 38058778 PMCID: PMC10696939 DOI: 10.1515/iss-2023-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Accepted: 07/14/2023] [Indexed: 12/08/2023] Open
Abstract
Objectives In the surgical treatment of colorectal carcinoma (CRC), 1 in 10 patients has a peritumorous adhesion or tumor infiltration in the adjacent tissue or organs. Accordingly, multivisceral resection (MVR) must be performed in these patients. This prospective multicenter observational study aimed to analyze the possible differences between non-multivisceral resection (nMVR) and MVR in terms of early postoperative and long-term oncological treatment outcomes. We also aimed to determine the factors influencing overall survival. Methods The data of 25,321 patients from 364 hospitals who had undergone surgery for CRC (the Union for International Cancer Control stages I-III) during a defined period were evaluated. MVR was defined as (partial) resection of the tumor-bearing organ along with resection of the adherent and adjacent organs or tissues. In addition to the patients' personal, diagnosis (tumor findings), and therapy data, demographic data were also recorded and the early postoperative outcome was determined. Furthermore, the long-term survival of each patient was investigated, and a "matched-pair" analysis was performed. Results From 2008 to 2015, the MVR rates were 9.9 % (n=1,551) for colon cancer (colon CA) and 10.6 % (n=1,027) for rectal cancer (rectal CA). CRC was more common in men (colon CA: 53.4 %; rectal CA: 62.0 %) than in women; all MVR groups had high proportions of women (53.6 % vs. 55.2 %; pairs of values in previously mentioned order). Resection of another organ frequently occurred (75.6 % vs. 63.7 %). The MVR group had a high prevalence of intraoperative (5.8 %; 12.1 %) and postoperative surgical complications (30.8 % vs. 36.4 %; each p<0.001). Wound infections (colon CA: 7.1 %) and anastomotic insufficiencies (rectal CA: 8.3 %) frequently occurred after MVR. The morbidity rates of the MVR groups were also determined (43.7 % vs. 47.2 %). The hospital mortality rates were 4.9 % in the colon CA-related MVR group and 3.8 % in the rectal CA-related MVR group and were significantly increased compared with those of the nMVR group (both p<0.001). Results of the matched-pair analysis showed that the morbidity rates in both MVR groups (colon CA: 42.9 % vs. 34.3 %; rectal CA: 46.3 % vs. 37.2 %; each p<0.001) were significantly increased. The hospital lethality rate tended to increase in the colon CA-related MVR group (4.8 % vs. 3.7 %; p=0.084), while it significantly increased in the rectal CA-related MVR group (3.4 % vs. 3.0 %; p=0.005). Moreover, the 5-year (yr) overall survival rates were 53.9 % (nMVR: 69.5 %; p<0.001) in the colon CA group and 56.8 % (nMVR: 69.4 %; p<0.001) in the rectal CA group. Comparison of individual T stages (MVR vs. nMVR) showed no significant differences in the survival outcomes (p<0.05); however, according to the matched-pair analysis, a significant difference was observed in the survival outcomes of those with pT4 colon CA (40.6 % vs. 50.2 %; p=0.017). By contrast, the local recurrence rates after MVR were not significantly different (7.0 % vs. 5.8 %; both p>0.05). The risk factors common to both tumor types were advanced age (>79 yr), pT stage, sex, and morbidity (each hazard ratio: >1; p<0.05). Conclusions MVR allows curation by R0 resection with adequate long-term survival. For colon or rectal CA, MVR tended to be associated with reduced 5-year overall survival rates (significant only for pT4 colon CA based on the MPA results), as well as, with a significant increase in morbidity rates in both tumor entities. In the overall data, MVR was associated with significant increases in hospital lethality rates, as indicated by the matched-pair analysis (significant only for rectal CA).
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Affiliation(s)
- Michael Arndt
- Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
- Department of General and Abdominal Surgery, Municipal Hospital (“Klinikum Magdeburg GmbH”), Magdeburg, Germany
| | - Hans Lippert
- Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University at Magdeburg with University Hospital, Magdeburg, Germany
| | - Roland S. Croner
- Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University at Magdeburg with University Hospital, Magdeburg, Germany
| | - Frank Meyer
- Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
- Department of General, Abdominal, Vascular and Transplant Surgery, Otto-von-Guericke University at Magdeburg with University Hospital, Magdeburg, Germany
| | - Ronny Otto
- Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
| | - Karsten Ridwelski
- Institute for Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany
- Department of General and Abdominal Surgery, Municipal Hospital (“Klinikum Magdeburg GmbH”), Magdeburg, Germany
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Shukla A, Kalayarasan R, Gnanasekaran S, Pottakkat B. Appraisal of gastric stump carcinoma and current state of affairs. World J Clin Cases 2023; 11:2864-2873. [PMID: 37215417 PMCID: PMC10198071 DOI: 10.12998/wjcc.v11.i13.2864] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 03/21/2023] [Accepted: 03/30/2023] [Indexed: 04/25/2023] Open
Abstract
Gastric stump carcinoma, also known as remnant gastric carcinoma, is a malignancy arising in the remnant stomach following gastrectomy for a benign or malignant condition. Enterogastric reflux and preexisting risk factors in a patient with gastric cancer are the major contributors to the development of gastric stump carcinoma. The occurrence of gastric stump carcinoma is time-dependent and seen earlier in patients operated on for malignant rather than benign diseases. The tumor location is predominantly at the anastomotic site towards the stomach. However, it can occur anywhere in the remnant stomach. The pattern of lymph node involvement and the type of surgery required is distinctly different compared to primary gastric cancer. Gastric stump carcinoma is traditionally considered a malignancy with a dismal outcome. However, recent advances in diagnostic and therapeutic strategies have improved outcomes. Recent advances in molecular profiling of gastric stump carcinoma have identified distinct molecular subtypes, thereby providing novel therapeutic targets. Also, reports of gastric stump carcinoma following pancreatoduodenectomy and bariatric surgery highlight the need for more research to standardize the diagnosis, staging, and treatment of these tumors. The present review aims to provide an overview of gastric stump carcinoma highlighting the differences in clinicopathological profile and management compared to primary gastric carcinoma.
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Affiliation(s)
- Ankit Shukla
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Senthil Gnanasekaran
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Biju Pottakkat
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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Zaman S, Bhattacharya P, Mohamedahmed AYY, Cheung FY, Rakhimova K, Di Saverio S, Peravali R, Akingboye A. Outcomes following open versus laparoscopic multi-visceral resection for locally advanced colorectal cancer: A systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:98. [PMID: 36811741 DOI: 10.1007/s00423-023-02835-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 02/13/2023] [Indexed: 02/24/2023]
Abstract
BACKGROUND This meta-analysis aims to compare morbidity, mortality, oncological safety, and survival outcomes after laparoscopic multi-visceral resection (MVR) of the locally advanced primary colorectal cancer (CRC) compared with open surgery. MATERIALS AND METHODS A systematic search of multiple electronic data sources was conducted, and all studies comparing laparoscopic and open surgery in patients with locally advanced CRC undergoing MVR were selected. The primary endpoints were peri-operative morbidity and mortality. Secondary endpoints were R0 and R1 resection, local and distant disease recurrence, disease-free survival (DFS), and overall survival (OS) rates. RevMan 5.3 was used for data analysis. RESULTS Ten comparative observational studies reporting a total of 936 patients undergoing laparoscopic MVR (n = 452) and open surgery (n = 484) were identified. Primary outcome analysis demonstrated a significantly longer operative time in laparoscopic surgery compared with open operations (P = 0.008). However, intra-operative blood loss (P<0.00001) and wound infection (P = 0.05) favoured laparoscopy. Anastomotic leak rate (P = 0.91), intra-abdominal abscess formation (P = 0.40), and mortality rates (P = 0.87) were comparable between the two groups. Moreover the total number of harvested lymph nodes, R0/R1 resections, local/distant disease recurrence, DFS, and OS rates were also comparable between the groups. CONCLUSION Although inherent limitations exist with observational studies, the available evidence demonstrates that laparoscopic MVR in locally advanced CRC seems to be a feasible and oncologically safe surgical option in carefully selected cohorts.
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Affiliation(s)
- Shafquat Zaman
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Pratik Bhattacharya
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | | | - Fang Yi Cheung
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Kamila Rakhimova
- Institute of Cancer and Genomic Science, College of Medical and Dental Science, University of Birmingham, Edgbaston, Birmingham, UK
| | - Salomone Di Saverio
- Department of General Surgery, ASUR Marche, Hospital of San Benedetto del Tronto (AP), AV5, San Benedetto del Tronto, Italy
| | - Rajeev Peravali
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, West Midlands, UK
| | - Akinfemi Akingboye
- Department of General Surgery, The Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, UK
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10
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Bakkers C, van de Vlasakker VCJ, Rovers KPB, Lurvink RJ, Nienhuijs SW, Burger JWA, Creemers GJM, Bonhof CS, Mols F, de Hingh IHJT. The Impact of Cytoreductive Surgery and Hyperthermic Intraperitoneal Chemotherapy (CRS-HIPEC) versus Conventional Surgery on Patient-Reported Outcomes: A Comparative Cohort Study between the CAIRO6 Trial and the PROCORE Study. Cancers (Basel) 2023; 15:cancers15030788. [PMID: 36765746 PMCID: PMC9913313 DOI: 10.3390/cancers15030788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 02/01/2023] Open
Abstract
Purpose-To compare patient-reported outcomes (PROs) of patients undergoing cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) for colorectal peritoneal metastases to PROs of colorectal cancer (CRC) patients undergoing conventional surgery. Methods-Data were extracted from the CAIRO6 trial (CRS-HIPEC group) and the PROCORE study (conventional surgery group). Nine predefined PROs (derived from the EORTC QLQ-C30 questionnaire) were compared at baseline, in the early postoperative period and one year postoperatively, with correction for treatment with systemic therapy using linear mixed modeling. Results-In total, 331 patients were included: 71 in the CRS-HIPEC group and 260 in the conventional surgery group. All predefined PROs (fatigue, diarrhea, C30 summary score, Global Health Status, physical, role, emotional, cognitive, and social functioning) did not differ significantly between the groups at all three timepoints, and differential effects over time for all PROs did not differ significantly between the groups. Significant worsening of fatigue, C30 summary score, physical and role functioning (both groups), and cognitive and social functioning (conventional surgery group only) was present in the early postoperative period. All scores returned to baseline at one year postoperatively, except for physical and cognitive functioning in the conventional surgery group. Emotional functioning improved postoperatively in both groups compared to baseline. Conclusion-Despite a more extensive procedure with greater risk of morbidity, CRS-HIPEC in patients with colorectal peritoneal metastases did not have a greater negative impact on PROs than conventional surgery in patients with CRC. Further, systemic therapy did not affect these PROs. These findings may facilitate future patient counseling and shared decision making in clinical practice.
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Affiliation(s)
- Checca Bakkers
- Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | | | - Koen P. B. Rovers
- Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Robin J. Lurvink
- Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Simon W. Nienhuijs
- Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Jacobus W. A. Burger
- Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Geert-Jan M. Creemers
- Department of Medical Oncology, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
| | - Cynthia S. Bonhof
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
| | - Floortje Mols
- Center of Research on Psychological and Somatic Disorders, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 19079, 3501 DB Utrecht, The Netherlands
| | - Ignace H. J. T. de Hingh
- Department of Surgery, Catharina Cancer Institute, P.O. Box 1350, 5602 ZA Eindhoven, The Netherlands
- Department of Research, Netherlands Comprehensive Cancer Organization, P.O. Box 19079, 3501 DB Utrecht, The Netherlands
- GROW—School for Oncology and Reproduction, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
- Correspondence: ; Tel.: +31-40-239-7150
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11
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Osseis M, Dahboul H, Mouawad C, Aoun R, Kassar S, Chakhtoura G, Noun R. Laparoscopic and robotic multivisceral resection in colorectal cancer: A case series and systematic review. Asian J Endosc Surg 2023. [PMID: 36599163 DOI: 10.1111/ases.13162] [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: 11/30/2022] [Revised: 12/21/2022] [Accepted: 12/25/2022] [Indexed: 01/05/2023]
Abstract
PURPOSE Multivisceral resection (MVR) with open approach is the standard surgical treatment for locally advanced colorectal cancer. However, the medical literature concerning the practice of minimally invasive MVR in order to reduce postoperative complications and hospital stay has been growing exponentially over the last years. The present study aimed to examine our experience and to provide a systematic review about the results and complications of minimally invasive MVR. METHODS Data of patients that underwent minimally invasive MVR for locally advanced colorectal cancer from 2015 to 2021 were retrospectively reviewed. The literature was searched for studies concerning minimally invasive MVR for colorectal cancer. RESULTS A total of 39 laparoscopic MVR were performed in our department. Complications occurred in 14 patients (35.9%) with major complications in five patients (18.82%) according to Clavien-Dindo classification. Conversion was required in one case (2.56%) with subsequent mortality (2.56%). Pathologic adjacent organs or structures invasion was observed in 30 patients (76.9%) and positive resection margin occurred in two cases (5.2%). Twenty-two studies including 1055 patients were identified after literature search. In these studies, laparoscopic surgery and robotic surgery were performed in 90.15% and 9.85% of the patients, respectively. R0 resection was established in 95% of cases, conversion rate varied between 0% and 41.7%, and postoperative mortality ranged between 0% and 7.7% in the included articles. CONCLUSION Minimally invasive approach may be a safe option for patients requiring MVR for locally advanced colorectal cancer, with equivalent oncological results and could result in better early postoperative outcomes to open approach. However, further studies on this topic are needed to confirm the results of the current study.
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Affiliation(s)
- Michael Osseis
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Houssam Dahboul
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Christian Mouawad
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Rany Aoun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Serge Kassar
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Roger Noun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, Saint Joseph University of Beirut, Beirut, Lebanon
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12
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Chen P, Zhou H, Chen C, Qian X, Yang L, Zhou Z. Laparoscopic vs. open colectomy for T4 colon cancer: A meta-analysis and trial sequential analysis of prospective observational studies. Front Surg 2022; 9:1006717. [DOI: 10.3389/fsurg.2022.1006717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
BackgroundTo evaluate short- and long-term outcomes of laparoscopic colectomy (LC) vs. open colectomy (OC) in patients with T4 colon cancer.MethodsThree authors independently searched PubMed, Web of Science, Embase, Cochrane Library, and Clinicaltrials.gov for articles before June 3, 2022 to compare the clinical outcomes of T4 colon cancer patients undergoing LC or OC.ResultsThis meta-analysis included 7 articles with 1,635 cases. Compared with OC, LC had lesser blood loss, lesser perioperative transfusion, lesser complications, lesser wound infection, and shorter length of hospital stay. Moreover, there was no significant difference between the two groups in terms of 5-year overall survival (5y OS), and 5-year disease-free survival (5y DFS), R0 resection rate, positive resection margin, lymph nodes harvested ≥12, and recurrence. Trial Sequential Analysis (TSA) results suggested that the potential advantages of LC on perioperative transfusion and the comparable oncological outcomes in terms of 5y OS, 5y DFS, lymph nodes harvested ≥12, and R0 resection rate was reliable and no need of further study.ConclusionsLaparoscopic surgery is safe and feasible in T4 colon cancer in terms of short- and long-term outcomes. TSA results suggested that future studies were not required to evaluate the 5y OS, 5y DFS, R0 resection rate, positive resection margin status, lymph nodes harvested ≥12 and perioperative transfusion differences between LC and OC.Systematic Review Registration:https://www.crd.york.ac.uk/PROSPERO/, identifier: CRD42022297792.
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13
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Imaizumi K, Homma S, Miyaoka Y, Matsui H, Ichikawa N, Yoshida T, Takahashi N, Taketomi A. Exploration of the advantages of minimally invasive surgery for clinical T4 colorectal cancer compared with open surgery: A matched-pair analysis. Medicine (Baltimore) 2022; 101:e29869. [PMID: 35960060 PMCID: PMC9371553 DOI: 10.1097/md.0000000000029869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The indications of minimally invasive surgery (MIS) for T4 colorectal cancer are controversial because the advantages of MIS are unclear. Therefore, we compared overall survival (OS) and recurrence-free survival (RFS) as the primary endpoint, and short-term outcome, alteration in perioperative laboratory data, and the interval of postoperative chemotherapy from operation as secondary endpoints, between MIS and open surgery (OPEN) using a matched-pair analysis. We explored the advantages of MIS for T4 colorectal cancer. In this retrospective single-institution study, we included 125 patients with clinical T4 colorectal cancer who underwent curative-intent surgery of the primary tumor between October 2010 and September 2019. Conversion cases were excluded. MIS patients were matched to OPEN patients (ratio of 1:2) according to tumor location, clinical T stage, and preoperative treatment. We identified 25 and 50 patients who underwent OPEN and MIS, respectively, including 31 with distant metastasis. Both groups had similar background characteristics. The rate of major morbidities (Clavien-Dindo grade > III) was comparable between the 2 groups (P = .597), and there was no mortality in either group. MIS tended to result in shorter postoperative hospitalization than OPEN (P = .073). Perioperative alterations in laboratory data revealed that MIS suppressed surgical invasiveness better compared to OPEN. Postoperative chemotherapy, especially for patients with distant metastasis who underwent primary tumor resection, tended to be started earlier in the MIS group than in the OPEN group (P = .075). OS and RFS were comparable between the 2 groups (P = .996 and .870, respectively). In the multivariate analyses, MIS was not a significant prognostic factor for poor OS and RFS. MIS was surgically safe and showed similar oncological outcomes to OPEN-with the potential of reduced invasiveness and enhanced recovery from surgery. Therefore, patients undergoing MIS might receive subsequent postoperative treatments earlier.
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Affiliation(s)
- Ken Imaizumi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Shigenori Homma
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
- * Correspondence: Shigenori Homma, MD, PhD, Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-Ku, Sapporo, Hokkaido 060-8638, Japan (e-mail: )
| | - Yoichi Miyaoka
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroki Matsui
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Nobuki Ichikawa
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tadashi Yoshida
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Norihiko Takahashi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Podda M, Pisanu A, Morello A, Segalini E, Jayant K, Gallo G, Sartelli M, Coccolini F, Catena F, Di Saverio S. Laparoscopic versus open colectomy for locally advanced T4 colonic cancer: meta-analysis of clinical and oncological outcomes. Br J Surg 2022; 109:319-331. [PMID: 35259211 DOI: 10.1093/bjs/znab464] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/11/2021] [Accepted: 12/17/2021] [Indexed: 09/11/2023]
Abstract
BACKGROUND The aim of this study was to review the early postoperative and oncological outcomes after laparoscopic colectomy for T4 cancer compared with open surgery. METHOD MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for any relevant clinical study comparing laparoscopic and open colectomy as treatment for T4 colonic cancer. The risk ratio (RR) with 95 per cent c.i. was calculated for dichotomous variables, and the mean difference (m.d.) with 95 per cent confidence interval for continuous variables. Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was implemented for assessing quality of evidence (QoE). RESULTS Twenty-four observational studies (21 retrospective and 3 prospective cohort studies) were included, analysing a total of 18 123 patients: 9024 received laparoscopic colectomy and 9099 underwent open surgery. Laparoscopic colectomy was associated with lower rates of mortality (RR 0.48, 95 per cent c.i. 0.41 to 0.56; P < 0.001; I2 = 0 per cent, fixed-effect model; QoE moderate) and complications (RR 0.61, 0.49 to 0.76; P < 0.001; I2 = 20 per cent, random-effects model; QoE very low) compared with an open procedure. No differences in R0 resection rate (RR 1.01, 1.00 to 1.03; P = 0.12; I2 = 37 per cent, random-effects model; QoE very low) and recurrence rate (RR 0.98, 0.84 to 1.14; P = 0.81; I2 = 0 per cent, fixed-effect model; QoE very low) were found. CONCLUSION Laparoscopic colectomy for T4 colonic cancer is safe, and is associated with better clinical outcomes than open surgery and similar oncological outcomes.
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Affiliation(s)
- Mauro Podda
- Department of Emergency Surgery, Cagliari University Hospital 'D. Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Adolfo Pisanu
- Department of Emergency Surgery, Cagliari University Hospital 'D. Casula', Azienda Ospedaliero-Universitaria di Cagliari, Cagliari, Italy
| | - Alessia Morello
- Department of Surgery, Maggiore Hospital, Crema, Italy
- Department of Surgery, San Matteo Hospital, University of Pavia, Pavia, Italy
| | | | - Kumar Jayant
- Department of Surgery, Chicago University Hospital, Chicago, Illinois, USA
| | - Gaetano Gallo
- Department of Medical and Surgical Sciences, University of Catanzaro, Catanzaro, Italy
| | - Massimo Sartelli
- Department of General and Emergency Surgery, Macerata General Hospital, Macerata, Italy
| | - Federico Coccolini
- Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy
| | - Fausto Catena
- Department of General, Emergency and Trauma Surgery, Bufalini Hospital, Cesena, Italy
| | - Salomone Di Saverio
- Department of Surgery, Madonna del Soccorso General Hospital, San Benedetto del Tronto, Italy
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15
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Is Complete Resection has a Better Survival in Remnant Gastric Cancer and What Are the Prognositic Factors Affecting These Results? Indian J Surg 2022. [DOI: 10.1007/s12262-021-02801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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16
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Jung F, Lee M, Doshi S, Zhao G, Lam Tin Cheung K, Chesney T, Guidolin K, Englesakis M, Lukovic J, O'Kane G, Quereshy FA, Chadi SA. Neoadjuvant therapy versus direct to surgery for T4 colon cancer: meta-analysis. Br J Surg 2021; 109:30-36. [PMID: 34921604 DOI: 10.1093/bjs/znab382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 09/26/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Despite persistently poor oncological outcomes, approaches to the management of T4 colonic cancer remain variable, with the role of neoadjuvant therapy unclear. The aim of this review was to compare oncological outcomes between direct-to-surgery and neoadjuvant therapy approaches to T4 colon cancer. METHODS A librarian-led systematic search of MEDLINE, Embase, the Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Inclusion criteria were primary research articles comparing oncological outcomes between neoadjuvant therapies or direct to surgery for primary T4 colonic cancer. Based on PRISMA guidelines, screening and data abstraction were undertaken in duplicate. Quality assessment was carried out using Cochrane risk-of-bias tools. Random-effects models were used to pool effect estimates. This study compared pathological resection margins, postoperative morbidity, and oncological outcomes of cancer recurrence and overall survival. RESULTS Four studies with a total of 43 063 patients met the inclusion criteria. Compared with direct to surgery, neoadjuvant therapy was associated with increased rates of margin-negative resection (odds ratio (OR) 2.60, 95 per cent c.i. 1.12 to 6.02; n = 15 487) and 5-year overall survival (pooled hazard ratio 1.42, 1.10 to 1.82, I2 = 0 per cent; n = 15 338). No difference was observed in rates of cancer recurrence (OR 0.42, 0.15 to 1.22; n = 131), 30-day minor (OR 1.12, 0.68 to 1.84; n = 15 488) or major (OR 0.62, 0.27 to 1.44; n = 15 488) morbidity, or rates of treatment-related adverse effects. CONCLUSION Compared with direct to surgery, neoadjuvant therapy improves margin-negative resection rates and overall survival.
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Affiliation(s)
- Flora Jung
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Michael Lee
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sachin Doshi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Grace Zhao
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Tyler Chesney
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, St Michael's Hospital, Toronto, Ontario, Canada
| | - Keegan Guidolin
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Marina Englesakis
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Jelena Lukovic
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Grainne O'Kane
- Division of Medical Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Fayez A Quereshy
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
| | - Sami A Chadi
- Department of Surgery, University of Toronto, Toronto, Ontario, Canada
- Division of Surgical Oncology, Department of Surgery, Princess Margaret Cancer Centre and University Health Network, Toronto, Ontario, Canada
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de Nes LCF, van der Heijden JAG, Verstegen MG, Drager L, Tanis PJ, Verhoeven RHA, de Wilt JHW. Predictors of undergoing multivisceral resection, margin status and survival in Dutch patients with locally advanced colorectal cancer. Eur J Surg Oncol 2021; 48:1144-1152. [PMID: 34810058 DOI: 10.1016/j.ejso.2021.11.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 11/01/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The aim of this nationwide observational study was to evaluate factors associated with multivisceral resection (MVR), margin status and overall survival in locally advanced colorectal cancer (CRC). MATERIAL AND METHODS Patients with (y)pT4, cM0 CRC between 2006 and 2017 were selected from the Netherlands Cancer Registry. Cox-proportional hazards modelling was used for survival analysis, stratified for T4a and T4b. Annual hospital volume cut-off was 75 for colon and 40 for rectal resections. RESULTS A total of 11.930 patients were included and 2410 patients (20.2%) underwent MVR. Factors associated with MVR for colon and rectal cancer besides cT4 category were more recent diagnosis (OR 3.61, CI 95% 3.06-4.25 (colon) and OR 2.72, CI 95% 1.82-4.08 (rectum)) and high hospital volume (OR 1.20, CI 95% 1.05-1.38 (colon) and OR 2.17, CI 95% 1.55-3.04 (rectum)). Patients ≥70 year were less likely to undergo MVR for colon cancer (OR 0.80, 95% CI 0.70-0.90). Risk factors for incomplete resection were cT4 (OR 3.08, CI 95% 2.35-4.04 (colon) and OR 1.82, CI 95% 1.13-2.94 (rectum)) and poor/undifferentiated tumors (OR 1.41, CI 95% 1.14-1.72 (colon) and OR 1.69, CI 95% 1.05-2.74 (rectum)). More recent diagnosis was independently associated with less incomplete resections in colon cancer (OR 0.58, CI 95% 0.40-0.76). Independent predictors of survival were age, resection margin, nodal status and adjuvant chemotherapy, but not MVR. CONCLUSION Treatment of locally advanced CRC with MVR at population level was influenced by year of diagnosis and hospital volume. Margin status in colon cancer improved substantially over time.
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Affiliation(s)
- L C F de Nes
- Maasziekenhuis Pantein, Department of Surgery, Beugen, the Netherlands; Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands.
| | | | - M G Verstegen
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands
| | - L Drager
- Ziekenhuis Gelderse Vallei Department of Surgery, Ede, the Netherlands
| | - P J Tanis
- Amsterdam UMC, Department of Surgery, University of Amsterdam, Cancer Centre Amsterdam, Amsterdam, the Netherlands
| | - R H A Verhoeven
- Netherlands Comprehensive Cancer Organisation, Department of Research & Development, Utrecht, the Netherlands
| | - J H W de Wilt
- Radboud University Medical Centre, Department of Surgery, Nijmegen, the Netherlands
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Saito S, Akagi T, Katayama H, Wakabayashi M, Inomata M, Yamamoto S, Ito M, Kinugasa Y, Egi H, Munakata Y, Kokuba Y, Bando H, Yasui M, Ikeda M, Nakajima K, Shida D, Kanemitsu Y, Kitano S. Identification of patient subgroups with unfavorable long-term outcomes associated with laparoscopic surgery in a randomized controlled trial comparing open and laparoscopic surgery for colon cancer (Japan Clinical Oncology Group Study JCOG0404). Ann Gastroenterol Surg 2021; 5:804-812. [PMID: 34755012 PMCID: PMC8560616 DOI: 10.1002/ags3.12475] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Previously, we conducted a randomized controlled trial (JCOG0404) for stage II/III colon cancer patients and reported that the long-term survival after open surgery (OP) and laparoscopic surgery (LAP) were almost identical; however, JCOG0404 suggested that survival of patients after LAP with tumors located in the rectosigmoid colon, cT4 or cN2 tumors, and high body mass index (BMI) might be unfavorable. AIM To identify the patient subgroups associated with poor long-term survival in the LAP arm compared with the OP arm. METHODS Patients aged 20-75, clinical T3 or deeper lesion without involvement of other organs, clinical N0-2 and M0 were included. The patients with pathological stage IV and R2 resection were excluded from the current analysis. In each subgroup, the hazard ratio for LAP (vs. OP) in overall survival (OS) from surgery was estimated using a multivariable Cox regression model adjusted for the clinical and pathological factors. RESULTS In total, 1025 patients (OP, 511 and LAP, 514) were included in the current analysis. Adjusted hazards ratios for OS of patients with high BMI (>25 kg/m2), pT4, and pN2 in LAP were 3.37 (95% confidence interval [CI], 1.24-9.19), 1.33 (0.73-2.41), and 1.74 (0.76-3.97), respectively. In contrast, that of rectosigmoid colon tumors was 0.98 (0.46-2.09). CONCLUSIONS Although LAP is an acceptable optional treatment for stage II/III colon cancer, the present subgroup analysis suggests that high BMI (>25 kg/m2), pT4, and pN2 except for RS were factors associated with unfavorable long-term outcomes of LAP in patients with colon cancer who underwent curative resection. (JCOG 0404: NCT00147134/UMIN-CTR: C000000105.).
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Affiliation(s)
- Shuji Saito
- Division of SurgeryGastrointestinal CenterYokohama Shin‐Midori General HospitalYokohamaJapan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Masashi Wakabayashi
- Japan Clinical Oncology Group Data Center/Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric SurgeryOita University Faculty of MedicineOitaJapan
| | | | - Masaaki Ito
- Department of Colorectal SurgeryNational Cancer Center Hospital EastChibaJapan
| | - Yusuke Kinugasa
- Department of Gastrointestinal SurgeryTokyo Medical and Dental UniversityTokyoJapan
| | - Hiroyuki Egi
- Department of Gastrointestinal Surgery and Surgical OncologyEhime University Graduate School of MedicineEhimeJapan
| | | | - Yukihito Kokuba
- Department of Gastroenterological SurgerySt. Marianna University Yokohama Seibu HospitalYokohamaJapan
| | - Hiroyuki Bando
- Department of Gastroenterological SurgeryIshikawa Prefectural Central HospitalKanazawaJapan
| | - Masayoshi Yasui
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Masataka Ikeda
- Division of Lower Gastrointestinal Surgery, Department of Gastroenterological SurgeryHyogo College of MedicineNishinomiyaJapan
| | | | - Dai Shida
- Division of Frontier SurgeryThe Institute of Medical ScienceThe University of TokyoTokyoJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
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Lee TH, Park H, Baek SJ, Kwak JM, Kim SH, Kim J. A Minimally Invasive Pelvic Multivisceral Resection Approach for Locally Advanced Primary Colorectal Cancers: A Single-Institution Experience. J Laparoendosc Adv Surg Tech A 2021; 32:727-732. [PMID: 34677096 DOI: 10.1089/lap.2021.0555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background: The role of minimally invasive surgery (MIS) in locally advanced colorectal cancers (CRCs) suspected of direct invasion to adjacent organs or structures remains controversial. The aim of this study is to verify the safety and feasibility of minimally invasive multivisceral resection (MVR) surgery for locally advanced CRCs compared with conventional open surgery. Materials and Methods: Prospectively collected data from patients who underwent MVR for locally advanced CRCs from 2007 to 2017 were retrospectively reviewed. Patients with preoperative clinically suspected T4b stage cancers were enrolled in the study. Results: There were 30 and 19 patients in the MIS and open surgery groups, respectively. Seven patients in the MIS group required conversion, and the most common reason for conversion was ureter and bladder invasion. Tumor sizes were significantly larger in the open group (5.46 cm versus 7.48 cm, P = .010), whereas the MIS group included more patients with rectal cancers (56.7% versus 21%, P = .021). No differences were observed between the two groups in terms of operation time, estimated blood loss, and postoperative hospital stay. Curative (R0) resection was achieved in all patients, and the median follow-up period was 23 months. The 3-year overall survival in the MIS group was 73.6% and 77.9% in the open group (P = .445), and the 3-year total disease-free survival (DFS) was 59.2% and 51.4%, respectively (P = .695). Three-year local DFS was 83.3% for the MIS group, and 51.4% for the open group (P = .120). Conclusion: MIS for primary T4b CRCs without urinary tract invasion is safe and feasible.
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Affiliation(s)
- Tae Hoon Lee
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyunmi Park
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jung-Myun Kwak
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seon-Hahn Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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20
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Purkayastha J, Singh PR, Talukdar A, Das G, Yadav J, Bannoth S. Feasibility and Outcomes of Multivisceral Resection in Locally Advanced Colorectal Cancer: Experience of a Tertiary Cancer Center in North-East India. Ann Coloproctol 2021; 37:174-178. [PMID: 34111348 PMCID: PMC8273713 DOI: 10.3393/ac.2020.06.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Revised: 05/18/2020] [Accepted: 06/03/2020] [Indexed: 12/03/2022] Open
Abstract
Purpose Locally advanced colorectal cancer may require an en bloc resection of surrounding organs or structures to achieve complete tumor removal. This decision must weigh the risk of complications of multivisceral resection against the potential survival benefit. The purpose of this study is to review a single-center experience of feasibility of en bloc multivisceral resections for locally advanced colorectal carcinoma and to examine the effect of surgical experience on immediate outcome and rate of R0 resections. Methods This is a study of 27 patients who underwent multivisceral resection for locally advanced colorectal carcinoma which was performed at our institute from January 2016 to December 2019. Among the 27 patients aged between 21 and 76 years (mean age, 48.67±7.3 years), 13 were males and 14 were females. Overall 18 patients had primary colon carcinoma and 9 had primary rectal carcinoma. All rectal cancer patients received neoadjuvant chemoradiation. All patients underwent surgery with curative intent. All patients underwent open surgery of which 66.7% underwent colectomy, 14.8% underwent anterior resection, 11.1% underwent Miles procedure, and 7.4% underwent pelvic exenteration. Results The mean operative time was 268.14±72.2 minutes and the median amount of blood units transfused was 2.07 units. The mean hospital stay was 13.67±3.4 days. Histologically, 44.4% of patients had well-differentiated adenocarcinoma and 55.6% had moderately differentiated adenocarcinoma. The final histopathological examinatio n revealed malignant infiltration of the adjacent organs in 19/27 patients (70.4%). Pathological complete response was seen in 2 patients. R0 resection rate achieved was 96.3%. Lymph node metastasis was seen in 66.7% of patients with colon cancer and 11.1% with rectal cancer with overall mean number of harvested lymph nodes being 12.44±3.01. Postoperative complications were identified in 7 patients (25.9%), while mortality was seen in 2 (7.4%). Conclusion Multivisceral resection for advanced colorectal cancer invading into the adjacent organ may be performed with acceptable morbidity and mortality.
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Affiliation(s)
- Joydeep Purkayastha
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Pritesh Rajeev Singh
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Abhijit Talukdar
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Gaurav Das
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Jitin Yadav
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
| | - Srinivas Bannoth
- Department of Surgical Oncology, Dr. B. Borooah Cancer Institute, Guwahati, India
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21
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Interventions and Outcomes for Neoadjuvant Treatment of T4 Colon Cancer: A Scoping Review. ACTA ACUST UNITED AC 2021; 28:2065-2078. [PMID: 34072615 PMCID: PMC8261638 DOI: 10.3390/curroncol28030191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/13/2021] [Accepted: 05/24/2021] [Indexed: 01/27/2023]
Abstract
While adjuvant treatment of colon cancers that penetrate the serosa (T4) have been well-established, neoadjuvant strategies have yet to be formally evaluated. Our objective was to perform a scoping review of eligibility criteria, treatment regimens, and primary outcomes for neoadjuvant approaches to T4 colon cancer. A librarian-led, systematic search of MEDLINE, Embase, Cochrane Library, Web of Science, and CINAHL up to 11 February 2020 was performed. Primary research evaluating neoadjuvant treatment in T4 colon cancer were included. Screening and data abstraction were performed in duplicate; analyses were descriptive or thematic. A total of twenty studies were included, most of which were single-arm, single-center, and retrospective. The primary objectives of the literature to date has been to evaluate treatment feasibility, tumor response, disease-free survival, and overall survival in healthy patients. Conventional XELOX and FOLFOX chemotherapy were the most commonly administered interventions. Rationale for selecting a specific regimen and for treatment eligibility criteria were poorly documented across studies. The current literature on neoadjuvant strategies for T4 colon cancer is overrepresented by single-center, retrospective studies that evaluate treatment feasibility and efficacy in healthy patients. Future studies should prioritize evaluating clear selection criteria and rationale for specific neoadjuvant strategies. Validation of outcomes in multi-center, randomized trials for XELOX and FOLFOX have the most to contribute to the growing evidence for this poorly managed disease.
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22
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De Robles MS, O'Neill RS, Mourad AP, Winn R, Putnis S, Kang S. Survival in stage IIB/C compared to stage IIIA rectal cancer: an Australian experience affirming that size does matter. ANZ J Surg 2021; 91:1866-1873. [PMID: 33825289 DOI: 10.1111/ans.16758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/01/2021] [Accepted: 03/08/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) is one of the most commonly diagnosed malignancies globally; however, a survival paradox has been observed unique to this malignancy. The aim of this study was to review survival outcomes of patients diagnosed with stage II and stage III rectal cancer, to determine whether a survival paradox is present in our centre and assess for patient-related factors that can explain the observed paradox or were predictors of prognosis. METHODS A retrospective review of data collected from 2006 to 2018 of patients diagnosed with rectal cancer in three separate centres was conducted. Percentages pertaining to patient and tumour characteristics, presentation, management and subsequent recurrence were reported. Preoperative and postoperative factors associated with survival were determined using univariable and multivariable logistic regression analysis. RESULTS Stage IIB/C patients had significantly higher carcinoembryonic antigen (CEA) levels compared to stage IIA and stage IIIA patients (P < 0.001). Stage IIB/C patients had significantly larger primary rectal tumour and were more symptomatic (i.e. rectal bleeding, altered bowel habits and obstruction) at the time of diagnosis (P = 0.007). Preoperative CEA was an independent prognostic factor for cancer-specific survival in patients diagnosed with stage IIB/C and stage IIIA disease (P = 0.008) on multivariable analysis. Overall survival was greatest in stage IIIA disease, which was significantly greater than stage IIB/C disease. CONCLUSION This study confirms the existence of a survival paradox in patients diagnosed with CRC in an Australian tertiary centre and adds further weight to the revision of the TNM staging to provide more emphasis on the T stage.
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Affiliation(s)
- Marie Shella De Robles
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Robert S O'Neill
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Ali P Mourad
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Robert Winn
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Soni Putnis
- Department of Colorectal Surgery, Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sharlyn Kang
- Department of Radiation Oncology, Illawarra Cancer Centre, Wollongong, New South Wales, Australia
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23
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Red blood cell transfusions and the survival in patients with cancer undergoing curative surgery: a systematic review and meta-analysis. Surg Today 2021; 51:1535-1557. [PMID: 33389174 DOI: 10.1007/s00595-020-02192-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/26/2020] [Indexed: 02/08/2023]
Abstract
Allogenic red blood cell transfusions exert a potential detrimental effect on the survival when delivered to cancer patients undergoing surgery with curative intent. We performed a systematic review and meta-analysis to assess the association between perioperative allogenic red blood cell transfusions and risk of death as well as relapse after surgery for localized solid tumors. PubMed, the Cochrane Library, and EMBASE were searched from inception to March 2019 for studies reporting the outcome of patients receiving transfusions during radical surgery for non-metastatic cancer. Risk of death and relapse were pooled to provide an adjusted hazard ratio with a 95% confidence interval [hazard ratio (HR) (95% confidence interval {CI})]. Mortality and relapse associated with perioperative transfusion due to cancer surgery were evaluated among participants (n = 123 studies). Overall, RBC transfusions were associated with an increased risk of death [HR = 1.50 (95% CI 1.42-1.57), p < 0.01] and relapse [HR = 1.36 (95% CI 1.26-1.46), p < 0.01]. The survival was reduced even in cancer at early stages [HR = 1.45 (1.36-1.55), p < 0.01]. In cancer patients undergoing surgery, red blood cell transfusions reduced the survival and increased the risk of relapse. Transfusions based on patients' blood management policy should be performed by applying a more restrictive policy, and the planned preoperative administration of iron, if necessary, should be pursued.
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24
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Huang CM, Huang CW, Ma CJ, Tsai HL, Su WC, Chang TK, Huang MY, Wang JY. Outcomes of neoadjuvant chemoradiotherapy followed by radical resection for T4 colorectal cancer. World J Gastrointest Oncol 2020; 12:1428-1442. [PMID: 33362913 PMCID: PMC7739149 DOI: 10.4251/wjgo.v12.i12.1428] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/10/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Patients with clinical T4 colorectal cancer (CRC) have a poor prognosis because of compromised surgical margins. Neoadjuvant therapy may be effective in downstaging tumors, thereby rendering possible radical resection with clear margins.
AIM To evaluate tumor downsizing and resection with clear margins in T4 CRC patients undergoing neoadjuvant concurrent chemoradiotherapy followed by surgery.
METHODS This study retrospectively included 86 eligible patients with clinical T4 CRC who underwent neoadjuvant concurrent chemoradiotherapy followed by radical resection. Neoadjuvant therapy consisted of radiation therapy at a dose of 45-50.4 Gy and chemotherapy agents, either FOLFOX or capecitabine. A circumferential resection margin (CRM) of < 1 mm was considered to be a positive margin. We defined pathological complete response (pCR) as the absence of any malignant cells in a specimen, including the primary tumor and lymph nodes. A multivariate logistic regression model was used to identify independent predictive factors for pCR.
RESULTS For 86 patients who underwent neoadjuvant chemoradiotherapy and surgery, the rate of pCR was 14%, and the R0 resection rate was 91.9%. Of the 61 patients with rectal cancer, 7 (11.5%) achieved pCR and 5 (8.2%) had positive CRMs. Of the 25 patients with colon cancer, 5 (20%) achieved pCR and 2 (8%) had positive CRMs. We observed that the FOLFOX regimen was an independent predictor of pCR (P = 0.046). After a median follow-up of 47 mo, the estimated 5-year overall survival (OS) and disease-free survival (DFS) rates were 70.8% and 61.4%, respectively. Multivariate analysis revealed that a tumor with a negative resection margin was associated with improved DFS (P = 0.014) and OS (P = 0.001). Patients who achieved pCR exhibited longer DFS (P = 0.042) and OS (P = 0.003) than those who did not.
CONCLUSION Neoadjuvant concurrent chemoradiotherapy engenders favorable pCR and R0 resection rates among patients with T4 CRC. The R0 resection rate and pCR are independent prognostic factors for patients with T4 CRC.
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Affiliation(s)
- Chun-Ming Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
| | - Ching-Wen Huang
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Cheng-Jen Ma
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
| | - Hsiang-Lin Tsai
- Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80145, Taiwan
| | - Wei-Chih Su
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
| | - Tsung-Kun Chang
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
| | - Ming-Yii Huang
- Department of Radiation Oncology, Kaohsiung Medical University Hospital, Kaohsiung 80145, Taiwan
| | - Jaw Yuan Wang
- Department of Surgery and Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
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25
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Favorable short-term oncologic outcomes following laparoscopic surgery for small T4 colon cancer: a multicenter comparative study. World J Surg Oncol 2020; 18:299. [PMID: 33187538 PMCID: PMC7666454 DOI: 10.1186/s12957-020-02074-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/29/2020] [Indexed: 12/14/2022] Open
Abstract
Background Laparoscopic surgery for T4 colon cancer may be safe in selected patients. We hypothesized that small tumor size might preoperatively predict a good laparoscopic surgery outcome. Herein, we compared the clinicopathologic and oncologic outcomes of laparoscopic and open surgery in small T4 colon cancer. Methods In a retrospective multicenter study, we reviewed the data of 449 patients, including 117 patients with tumors ≤ 4.0 cm who underwent surgery for T4 colon cancer between January 2014 and December 2017. We compared the clinicopathologic and 3-year oncologic outcomes between the laparoscopic and open groups. Survival curves were estimated using the Kaplan–Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards model. A p < 0.05 was considered statistically significant. Results Blood loss, length of hospital stay, and postoperative morbidity were lower in the laparoscopic group than in the open group (median [range], 50 [0–700] vs. 100 [0–4000] mL, p < 0.001; 8 vs. 10 days, p < 0.001; and 18.0 vs. 29.5%, p = 0.005, respectively). There were no intergroup differences in 3-year overall survival or disease-free survival (86.6 vs. 83.2%, p = 0.180, and 71.7 vs. 75.1%, p = 0.720, respectively). Among patients with tumor size ≤ 4.0 cm, blood loss was significantly lower in the laparoscopic group than in the open group (median [range], 50 [0–530] vs. 50 [0–1000] mL, p = 0.003). Despite no statistical difference observed in the 3-year overall survival rate (83.3 vs. 78.7%, p = 0.538), the laparoscopic group had a significantly higher 3-year disease-free survival rate (79.2 vs. 53.2%, p = 0.012). Conclusions Laparoscopic surgery showed similar outcomes to open surgery in T4 colon cancer patients and may have favorable short-term oncologic outcomes in patients with tumors ≤ 4.0 cm. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-020-02074-5.
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26
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Miyo M, Kato T, Takahashi Y, Miyake M, Toshiyama R, Hamakawa T, Sakai K, Nishikawa K, Miyamoto A, Hirao M. Short-term and long-term outcomes of laparoscopic colectomy with multivisceral resection for surgical T4b colon cancer: Comparison with open colectomy. Ann Gastroenterol Surg 2020; 4:676-683. [PMID: 33319158 PMCID: PMC7726680 DOI: 10.1002/ags3.12372] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/08/2020] [Accepted: 06/23/2020] [Indexed: 12/16/2022] Open
Abstract
AIM In response to the rising use of laparoscopic surgery, recent studies have shown that laparoscopic multivisceral resections for locally advanced colon cancer are safe, feasible, and provide acceptable oncological outcomes. However, the usefulness of laparoscopic multivisceral resection remains controversial. Here, we aimed to compare short-term and long-term outcomes between laparoscopic and open multivisceral resection approaches for treating locally advanced colon cancer. METHODS We retrospectively collected data on 1315 consecutive patients admitted to the National Hospital Organization, Osaka National Hospital, for surgical treatment of colorectal cancer between 2010 and 2017. We assessed invasiveness in terms of operating times, blood loss, and complications. Oncological outcomes included 5-year survival rates and recurrences. RESULTS We included 85 patients that underwent a colectomy with a multivisceral resection for locally advanced colon cancer; of these, 38 were treated with a laparoscopic approach and 47 were treated with an open approach. Compared to the open surgery group, the laparoscopic group had significantly less blood loss (median volume: 25 vs 140 mL, P <0.001), a lower complication rate (10.5% vs 29.8%, P = 0.036), and shorter hospital stays (12 vs 15 days, P = 0.028). After excluding patients with stage Ⅳ colon cancer, the groups showed similar pathologic outcomes and no significant differences in 5-year disease-free survival (73.9% vs 67.4%; P = 0.664) or 5-year overall survival (75.8% vs 67.7%; P = 0.695). CONCLUSION A laparoscopic approach for locally advanced colon cancer could be less invasive than an open approach without affecting oncological outcomes in selected patients.
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Affiliation(s)
- Masaaki Miyo
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Takeshi Kato
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Yusuke Takahashi
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Masakazu Miyake
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Reishi Toshiyama
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Takuya Hamakawa
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Kenji Sakai
- National Hospital Organization Osaka National HospitalOsakaJapan
| | | | - Atsushi Miyamoto
- National Hospital Organization Osaka National HospitalOsakaJapan
| | - Motohiro Hirao
- National Hospital Organization Osaka National HospitalOsakaJapan
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27
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El-Sharkawy F, Gushchin V, Plerhoples TA, Liu C, Emery EL, Collins DT, Bijelic L. Minimally invasive surgery for T4 colon cancer is associated with better outcomes compared to open surgery in the National Cancer Database. Eur J Surg Oncol 2020; 47:818-827. [PMID: 32951935 DOI: 10.1016/j.ejso.2020.09.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/26/2020] [Accepted: 09/01/2020] [Indexed: 01/02/2023] Open
Abstract
Minimally invasive surgery (MIS) is favored for T1-T3 colon cancer resection due to improved short and long-term outcomes. Recommendations regarding T4 cancers remain controversial due to a paucity of clinical trials or large datasets assessing outcomes. We aim to compare outcomes for pT4 colon cancer patients treated with MIS or open surgery (OS) in the National Cancer Database (NCDB). We analyzed adults having MIS or OS for stage II or III pT4 colon cancers between 2010 and 2014 using propensity-score matching, Cox and logistic regression modeling. Of 21 998 T4 patients, 7532 (34.2%) underwent MIS, 14 466 (65.8%) OS and 22.3% were MIS converted to OS. After propensity score matching, 5624 patients in each cohort were included. MIS was associated with improved postoperative mortality (3.4 vs. 7.2%, p > .001), surgical margins, optimal lymph node harvest, adjuvant chemotherapy use and 5-year survival (46% vs. 41%, P < .001). MIS was associated with improved short and long term outcomes for T4 colon cancers compared to OS on multivariate analysis. Based on these findings, well selected pT4 colon cancers can be considered appropriate for MIS however, prospective clinical trials are needed to better define the role of MIS in T4b colon cancer.
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Affiliation(s)
- Farah El-Sharkawy
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA
| | - Vadim Gushchin
- Department of Surgical Oncology, Mercy Medical Center, Baltimore, MD, USA
| | | | - Chang Liu
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Erica L Emery
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Devon T Collins
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA
| | - Lana Bijelic
- Department of Surgery, Inova Fairfax Medical Campus, Falls Church, VA, USA; Inova Schar Cancer Institute, Falls Church, VA, USA.
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Tominaga T, Nonaka T, Shiraisi T, Hamada K, Noda K, Takeshita H, Maruyama K, Fukuoka H, Wada H, Hashimoto S, Sawai T, Nagayasu T. Factors related to short-term outcomes and delayed systemic treatment following primary tumor resection for asymptomatic stage IV colorectal cancer. Int J Colorectal Dis 2020; 35:837-846. [PMID: 32103325 DOI: 10.1007/s00384-020-03550-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND The effectiveness of primary tumor resection (PTR) for asymptomatic stage IV colorectal cancer patients to continue prolonged and safe systemic chemotherapy has recently been re-evaluated. However, postoperative complications lead to a prolonged hospital stay and delay systemic treatment, which could result in a poor oncologic outcome. The objective of this study was to identify the risk factors for morbidity and delay of systemic chemotherapy in such patients. METHODS Between April 2016 and March 2018, 115 consecutive colorectal cancer patients with distant metastasis who had no clinical symptoms and underwent PTR in all participating hospitals were retrospectively reviewed. The patients were divided into two groups according to the presence (CD ≥ 2, n = 23) or absence (CD < 2, n = 92) of postoperative complications. RESULTS The proportion of combined resection of adjacent organs was significantly higher in the postoperative complication group (p = 0.014). Complications were significantly correlated with longer hospital stay (p < 0.001) and delay of first postoperative treatment (p = 0.005). Univariate and multivariate analyses showed that combined resection (odds ratio 4.593, p = 0.010) was the independent predictor for postoperative complications. Median survival time was 8.5 months. Postoperative complications were not associated with overall survival, but four patients (3.5%) could not receive systemic chemotherapy because of prolonged postoperative complications. CONCLUSIONS Although PTR for asymptomatic stage IV CRC patients showed an acceptable prognosis, appropriate patient selection is needed to obtain its true benefit.
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Affiliation(s)
- Tetsuro Tominaga
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. .,Department of Surgical Oncology, Nagasaki University Graduate School of Biological Sciences, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
| | - Takashi Nonaka
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Toshio Shiraisi
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Kiyoaki Hamada
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Keisuke Noda
- Department of Surgery, Sasebo City General Hospital, Sasebo, Japan
| | - Hiroaki Takeshita
- Department of Surgery, National Hospital Organization Nagasaki Medical Center, Ōmura, Japan
| | | | | | - Hideo Wada
- Department of Surgery, Ureshino Medical Center, Saga, Japan
| | | | - Terumitsu Sawai
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
| | - Takeshi Nagayasu
- Departments of Surgical Oncology, Nagasaki University Graduate School of Biomedical Science, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan
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Frago R, McDermott F, Campillo B, Kreisler E, Biondo S. Post-operative and oncological 3-year follow-up outcomes in stage 2 colonic cancer in the emergency and elective setting: a cohort study. ANZ J Surg 2020; 91:E25-E31. [PMID: 32255271 DOI: 10.1111/ans.15876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 02/25/2020] [Accepted: 03/01/2020] [Indexed: 12/25/2022]
Abstract
BACKGROUND Stage 2 colonic cancer comprises a heterogeneous group of patients with a spectrum of disease, from invasion of the sub-serosa to tumour perforation into visceral peritoneum/adjacent organs. This study evaluates the post-operative outcomes and prognostic factors of patients with both emergency and elective presentations of stage 2 colonic cancer treated with curative intent. METHODS Retrospective analysis of a prospectively maintained database of adult patients (emergency and elective) who underwent curative surgery for stage 2 colonic cancer in a single tertiary referral centre between 2007 and 2016 was conducted. Multivariate analysis was performed to identify prognostic factors. Measured variables included demographics, complications, histology, disease-free survival and overall survival (OS). RESULTS A total of 428 patients with stage 2 colonic cancer received curative surgical resection, and negative resection margins were achieved in all cases: T3 group (stage 2A): 316 (73.8%); T4a group (stage 2B): 78 patients (18.2%); and T4b group (stage 2C): 34 (8%). There were 187 (45.7%) post-operative complications, 32 (7.5%) anastomotic leaks and eight (1.9%) 30-day mortalities. Eighty patients (19.3%) died during the follow-up. During the follow-up period, 45 patients developed recurrence (all distant). Multivariate analysis identified age >70 years, American Society of Anesthesiologists grades III-IV and male gender as factors associated with poor OS, while recurrence was higher in those aged over 70 years and with stages 2B-2C disease. CONCLUSION Surgical morbidity in patients with stage 2 colonic cancer who have undergone curative surgery is high. Older and more co-morbid patients have poorer OS. Stages 2B and 2C colon cancer patients have worse prognosis than those with stage 2A regarding recurrence. Future larger data sets are required to determine the role of transmural spread as a prognostic factor.
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Affiliation(s)
- Ricardo Frago
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Digestive Tract Pathology, IDIBELL, Barcelona, Spain
| | | | - Beatriz Campillo
- General Surgery Unit, Hospital Sant Joan de Deu Foundation, Martorell, Spain
| | - Esther Kreisler
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Digestive Tract Pathology, IDIBELL, Barcelona, Spain
| | - Sebastiano Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona, Barcelona, Spain.,Digestive Tract Pathology, IDIBELL, Barcelona, Spain
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Wasmann KATGM, Klaver CEL, van der Bilt JDW, Nagtegaal ID, Wolthuis AM, van Santvoort HC, Ramshorst B, D’Hoore A, de Wilt JHW, Tanis PJ. Subclassification of Multivisceral Resections for T4b Colon Cancer with Relevance for Postoperative Complications and Oncological Risks. J Gastrointest Surg 2020; 24:2113-2120. [PMID: 31749095 PMCID: PMC7441085 DOI: 10.1007/s11605-019-04426-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 09/30/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multivisceral resection for T4b colon cancer constitutes a heterogeneous group of surgical procedures. The purpose of this study was to explore clinically distinct categories of multivisceral resection, with subsequent correlation to postoperative complications and oncological outcomes. METHODS In this multicenter cohort study, all consecutive patients without metastases who underwent multivisceral resection for pT4bN0-2M0 colon cancer between 2000 and 2014 were included. Multivisceral resection was divided into four categories: (i) gastrointestinal (including the stomach), (ii) urologic ((partial) bladder and ureter), (iii) solid organ (spleen, kidney, liver, pancreas, and uterus), and (iv) abdominal wall/omentum/ovaries. The primary outcome was surgical complications and secondary outcomes were 5-year intra-abdominal recurrence, disease-free survival, and overall survival. RESULTS In total, 130 patients who underwent curative intent resection of pT4 colon cancer were included. Patients who underwent multivisceral resection within multiple categories were assigned to one of the categories based on hierarchy of clinical impact after exploratory analysis. For the primary endpoint, 55 patients were assigned to gastrointestinal, 14 to urologic, 14 to solid organ, and 47 to abdominal wall/omentum/ovaries multivisceral resection. Gastrointestinal multivisceral resection was independently associated with surgical complications (HR 3.9, 95% CI 1.4-10.6). Abdominal wall/omentum/ovaries multivisceral resection was significantly related with intra-abdominal recurrence (HR 7.8, 95% CI 1.0-57.8). The 5-year disease-free survival and overall survival showed no significant differences per multivisceral resection category. CONCLUSIONS Multivisceral resections for T4b colon cancer are heterogeneous procedures considering risk profiles. The proposed multivisceral resection subclassification needs validation, but might improve comparability between studies and hospitals (auditing).
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Affiliation(s)
- Karin A. T. G. M. Wasmann
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Charlotte E. L. Klaver
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
| | - Jarmila D. W. van der Bilt
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands ,grid.410569.f0000 0004 0626 3338Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Iris D. Nagtegaal
- grid.10417.330000 0004 0444 9382Department of Pathology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Albert M. Wolthuis
- grid.410569.f0000 0004 0626 3338Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Hjalmar C. van Santvoort
- grid.415960.f0000 0004 0622 1269Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - Bert Ramshorst
- grid.415960.f0000 0004 0622 1269Department of Surgery, St. Antonius Hospital, Nieuwegein, the Netherlands
| | - André D’Hoore
- grid.410569.f0000 0004 0626 3338Department of Abdominal Surgery, University Hospital Leuven, Leuven, Belgium
| | - Johannes H. W. de Wilt
- grid.10417.330000 0004 0444 9382Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pieter J. Tanis
- grid.7177.60000000084992262Department of Surgery, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands
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Vieira RADC, Lopes A, Soares FA, Coudry RA, Nakagawa WT, Latore MDRDDO. Is the non-metastatic, locally advanced colon adenocarinoma a distinct biological tumor variant? A study based on pathological evaluation, immunohistochemical panel and survival. ACTA ACUST UNITED AC 2019; 46:e20192098. [PMID: 31432981 DOI: 10.1590/0100-6991e-20192098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2018] [Accepted: 04/15/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE to evaluate the clinical and pathological differences between locally advanced colonic adenocarcinomas (LACA) with adhesions between adjacent organs or structures, and colonic adenocarcinomas with other clinical presentations. METHODS we conducted a retrospective study from a convenience sample of patients with colonic adenocarcinoma, pathological stage pT3, distributed according to clinical and pathological characteristics in three groups: locally advanced tumors (LACA), pT3 tumors without adhesions or distant metastases (SF) and tumors with metastatic disease (M1). We evaluated clinical and pathological characteristics and the expression of seven immunohistochemical markers related to proliferation/apoptosis, cell invasion/migration and metastasis. RESULTS we studied 101 patients: 30 LACA, 44 SF and 27 M1. Locally advanced tumors presented larger dimensions and were associated with increased lymphocyte infiltration rates, lower levels of bax expression, and CD 44v6 when compared with SF and M1 groups. We observed significant differences between LACA and M1 in relation to colonic location, histology, lymph node status and bax and CD44v6 expression. We found differences were observed between the three groups for tumor size and lymphocytic infiltrate. Survival was similar in the LACA and SF groups (p=0.66) and was lower in the M1 group (p<0.001). CONCLUSION the data suggest that locally advanced colonic adenocarcinomas with adhesions between adjacent organs or structures represent a distinct entity.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, Programa de Pós-Graduação em Oncologia, São Paulo, SP, Brasil
| | - Ademar Lopes
- Universidade de São Paulo, Faculdade de Medicina, Departamento de Radiologia, Programa de Pós-Graduação em Oncologia, São Paulo, SP, Brasil.,A.C. Camargo Cancer Center, Departamento de Cirurgia Pélvica, São Paulo, SP, Brasil
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Kondo A, Sasaki T, Kitaguchi D, Tsukada Y, Nishizawa Y, Ito M. Resection of the urinary bladder for locally advanced colorectal cancer: a retrospective comparison of partial versus total cystectomy. BMC Surg 2019; 19:63. [PMID: 31208384 PMCID: PMC6580572 DOI: 10.1186/s12893-019-0522-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 05/24/2019] [Indexed: 12/13/2022] Open
Abstract
Background The postoperative and survival outcomes of patients with primary advanced colorectal cancer who undergo partial versus total cystectomy have not been adequately compared, as studies of this topic are rare and comprise relatively small cohorts. This study aimed to investigate the short- and long-term outcomes of patients who underwent en bloc partial or total cystectomy for primary advanced colorectal cancer that was suspected of adhering to or invading the urinary bladder. Methods The study included 90 patients who underwent various degrees of cystectomy between 1993 and 2013 to treat locally advanced primary colorectal cancer that was suspected of involving the urinary bladder. Patients in whom total cystectomy was performed solely because of prostate-invading lower rectal cancer were excluded. Data on patient characteristics and their short- and long-term outcomes were collected retrospectively to evaluate differences between partial cystectomy (the P group; n = 72) and total cystectomy (the T group; n = 18). Postoperative and oncologic outcomes were also analyzed. Results The T group had significantly greater operating times than the P group (median, 572 vs. 346 min); blood loss volume was also greater in the T group (median, 3092 vs. 1112 mL). The postoperative overall complication rate was significantly greater in the T group than in the P group (94.4% vs. 51.4%). With a median follow-up duration of 62 months, local recurrences were observed in 22.2 and 6.9% of patients in the T and P groups, respectively. On multivariate Cox regression analyses using partial cystectomy as the reference, total cystectomy was independently associated with poorer local recurrence-free survival (hazard ratio [HR], 4.0 95% confidence interval [CI], 1.1–15.0), relapse-free survival (HR, 2.9; 95% CI, 1.2–6.9), and overall survival (HR, 2.1; 95% CI, 1.0–4.3). Conclusions Patients who undergo en bloc total cystectomy for locally advanced colorectal cancers have worse postoperative and oncologic outcomes than those who undergo partial cystectomy.
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Affiliation(s)
- Akihiro Kondo
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Daichi Kitaguchi
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Leijssen LGJ, Dinaux AM, Amri R, Kunitake H, Bordeianou LG, Berger DL. The Impact of a Multivisceral Resection and Adjuvant Therapy in Locally Advanced Colon Cancer. J Gastrointest Surg 2019; 23:357-366. [PMID: 30284199 DOI: 10.1007/s11605-018-3962-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 08/31/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multivisceral resection for locally advanced colon cancer is mandatory to achieve complete tumor resection. We aimed to determine if local multivisceral resections (LMR) for pT4 and pT3 tumors impact perioperative and long-term oncological outcomes. METHODS All stage II or III colon cancer patients who had surgery between 2004 and 2014 were identified. We analyzed patients with non-multivisceral resections (NMR) for pT4 tumors vs. pT4-LMR. In addition, outcomes were compared to both NMR and LMR pT3 patients. RESULTS LMR was performed in 55 (29.7%) of all patients with pT4 tumors and in 48 (8.9%) of all patients with pT3 tumors. The most commonly involved areas of extension were the abdominal wall and the small intestine. Transverse colon cancer was correlated with LMR. Morbidity rates were comparable between NMR and LMR, with the exception of higher rates of blood transfusion and postoperative ileus. Over one third of all pT4-NMR patients developed recurrent disease, which was higher compared to all other groups. Subsequently, overall and disease-specific survival, as well as disease-free survival (DFS), was worse for pT4-NMR, even after adjustment for pTN-staging, adjuvant therapy, and R0 resection. Furthermore, when analyzing only curative resections, radial margin < 1 cm along with nodal disease was independent predictor for worse DFS. Long-term outcomes were comparable between pT4-LMR and pT3 patients. CONCLUSIONS Multivisceral resection for locally advanced colon cancer preserves long-term oncological outcomes without increased postoperative morbidity. Moreover, LMR in pT3 tumors does not contribute to postoperative morbidity. Our study underlines the feasibility and importance of performing LMR when locally advanced cancer is suspected.
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Affiliation(s)
- Lieve G J Leijssen
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anne M Dinaux
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - R Amri
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Liliana G Bordeianou
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - David L Berger
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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Neoadjuvant radiation for clinical T4 colon cancer: A potential improvement to overall survival. Surgery 2019; 165:469-475. [DOI: 10.1016/j.surg.2018.06.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/04/2018] [Accepted: 06/04/2018] [Indexed: 12/29/2022]
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Short- and Long-term Outcomes of Minimally Invasive Versus Open Multivisceral Resection for Locally Advanced Colorectal Cancer. Dis Colon Rectum 2019; 62:40-46. [PMID: 30451746 DOI: 10.1097/dcr.0000000000001255] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Colorectal cancer invading the adjacent organs/structures is detected in 5% to 20% of all surgical interventions performed for the management of colorectal cancer. OBJECTIVE Our purpose is to verify the safety and feasibility of laparoscopic surgery for the treatment of locally advanced colorectal cancer invading the adjacent organs. DESIGN This is a retrospective study. SETTINGS The study was conducted at a single institution in Japan. PATIENTS We compared the morbidity, appropriate oncological resection, and disease-free survival of laparoscopic and open multivisceral resection in patients with colorectal carcinoma in the period between 2007 and 2015. MAIN OUTCOME MEASURES The primary outcome measures were curative resection rate, morbidity rate, and recurrence of laparoscopic and open multivisceral resection in patients with colorectal cancer. RESULTS Thirty-one patients received laparoscopic surgery, and 50 received open surgery. The amount of blood loss was smaller in the laparoscopic group than in the open group (60 vs 595 mL, p < 0.01). Curative surgery was performed in 46 patients of the open group (92.0%) and in 30 patients of the laparoscopic group (96.8%). Days until oral intake (5 vs 7 days, p < 0.01) and postoperative hospital stay (14 vs 19 days, p < 0.01) were shorter in the laparoscopic group. Overall morbidity was not different between the groups (22.5% vs 40.0%). Three-year disease-free survival rates were 62.7% in the open group and 56.7% in the laparoscopic group (p = 0.5776). LIMITATION This study was a retrospective small study conducted at a single institute. CONCLUSION Laparoscopic multivisceral resection may be a safe, less invasive alternative to open surgery, with less blood loss and shorter hospital stay, and was not inferior to open surgery based on long-term oncological end points. See Video Abstract at http://links.lww.com/DCR/A785.
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Lu J, Dong B, Yang Z, Song Y, Yang Y, Cao J, Li W. Clinical Efficacy of Laparoscopic Surgery for T4 Colon Cancer Compared with Open Surgery: A Single Center's Experience. J Laparoendosc Adv Surg Tech A 2018; 29:333-339. [PMID: 30256704 DOI: 10.1089/lap.2018.0214] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Laparoscopic surgery for T4 colon cancer remains controversial according to many colorectal cancer guidelines. The aim of this study was to compare short- and long-term outcomes in patients who underwent T4 colon cancer resection by laparoscopy versus open surgery. METHODS Patients who underwent T4 colon cancer resection either by laparoscopy or by open surgery between January 2012 and January 2017 were included and used to perform a retrospective cohort analysis. Demographics, patient characteristics, short-term outcomes, and long-term oncological outcomes were compared between two groups. Multivariate analyses were used to define prognostic factors of overall survival. RESULTS Groups were comparable in terms of preoperative characteristics and demographics. Intraoperative blood loss (127.3 versus 226.1 mL, P = .001) and hospital stay (11.6 versus 14.8 days, P = .001) were significantly reduced in the laparoscopic group compared with the open group. Operative time, bowel movement, time to soft diet, and lymph nodes harvested did not significantly differ between the two groups. R0 resection achieved 100% in both the groups. Similarly, the overall survival rate and disease-free survival rate in stage II and stage III disease showed no significant differences. Multivariate analyses showed that intraoperative blood loss was a significantly independent factor related to a poor prognosis. CONCLUSIONS This study suggests that laparoscopy for T4 colon cancer can be safely performed with superior short-term outcomes, such as less intraoperative blood loss and shorter time of hospital stay compared with open surgery, and with similar long-term oncological outcomes. Therefore, laparoscopic procedure could be a viable option in selected patients.
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Affiliation(s)
- Jiabao Lu
- 1 Department of Colorectal Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Boye Dong
- 1 Department of Colorectal Surgery, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Zhipeng Yang
- 2 School of Public Health, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yixian Song
- 3 Nanshan College, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yang Yang
- 3 Nanshan College, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jie Cao
- 4 Department of General Surgery, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Wanglin Li
- 4 Department of General Surgery, Guangzhou Digestive Disease Center, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
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Right and Transverse Colonic Multi-Visceral Resections for Locally Advanced Cancers-a Single-Center Experience. Indian J Surg Oncol 2018; 9:199-203. [PMID: 29887701 DOI: 10.1007/s13193-018-0762-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 04/10/2018] [Indexed: 10/17/2022] Open
Abstract
Locally advanced colorectal tumors constitute to about 5-22% of all colorectal cancers at the time of presentation. Multi-visceral resection is usually required for such cases in order to achieve curative resection (R0). We aim to present our experience of right and transverse colonic en bloc resections and their outcomes. Retrospective review of a prospective database between February 2008 and December 2014. Case notes, operative findings, histopathology results, and follow-up records were analyzed. A total of 23 patients underwent en bloc multi-visceral resections for locally advanced right-sided or transverse colonic cancers. There were 11 males and 12 females. The mean age was 75 years. Fifteen patients were operated electively and eight were done as emergency. Median follow-up was 36 months. Eleven out of 23 (47%) had more than one organ resected. 78.3% had R0 resections, 17.4% were R1, and 4.3% were indeterminate. The average lymph node yield was 22 [range 5-45]. Senior trainees under supervision did 65% of procedures. Twelve-month disease-free survival was 90% and the 5-year survival was 65%. Right-sided and transverse colonic tumors have a propensity to become locally advanced making curative resections challenging. This is especially relevant when these patients present as an emergency or if the surgeon is less experienced and may opt for a palliative procedure, thus leading to suboptimal outcomes. Multi-visceral resections for locally advanced tumors can be feasible in the district general hospital setting with acceptable outcomes. Multi-disciplinary meeting (MDM) process, adequate training, and experience are vital.
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Krishnamurty DM, Hawkins AT, Wells KO, Mutch MG, Silviera ML, Glasgow SC, Hunt SR, Dharmarajan S. Neoadjuvant Radiation Therapy in Locally Advanced Colon Cancer: a Cohort Analysis. J Gastrointest Surg 2018; 22:906-912. [PMID: 29427227 DOI: 10.1007/s11605-018-3676-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Accepted: 01/03/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND A paucity of data exists in the use of neoadjuvant chemoradiation therapy (NRT) for T4, non-metastatic colon cancer. This study was conducted to determine the effect of NRT on outcomes after resection for T4 colon cancer. METHODS All patients with non-metastatic resected clinical T4 colon cancer from 2000 to 2012 at a tertiary care center were included. The cohort was divided into two groups-those that received NRT and those that did not (non-NRT). The primary outcomes were margin-negative resection and overall survival (OS). RESULTS One hundred and thirty-one consecutive patients with non-metastatic clinical T4 colon cancer with a mean age of 65 years were included. NRT was used in 23 patients (17.4%). NRT group was noted to have non-statistically significant improvement in R0 resection rate (NRT 95.7% vs non-NRT 88.0%; p = 0.27) and local recurrence (NRT 4.3% vs non-NRT 15.7%; p = 0.15). There was a significant difference in T-stage downstaging between the two groups (NRT 30.4% vs non-NRT 6.5%; p = 0.007). In a bivariate analysis, NRT was associated with improved 5-year OS (NRT 76.4% vs non-NRT 51.5%; p = 0.03). This relationship did not persist in a Cox proportional hazard analysis that included age and comorbidity (HR 2.19; 95% CI 0.87-5.52; p = 0.09). CONCLUSIONS The use of NRT in locally advanced T4 colon cancer is safe and associated with increased downstaging. While there was a trend toward improvement in local recurrence and the ability to obtain margin-negative resections in the NRT group, this was not significant. Significantly improved overall survival was not observed in a multivariable analysis.
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Affiliation(s)
- Devi Mukkai Krishnamurty
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Alexander T Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Katerina O Wells
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Matthew G Mutch
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Mathew L Silviera
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
| | - Sean C Glasgow
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA.
| | - Steven R Hunt
- Division of General Surgery, Section of Colon and Rectal Surgery, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO, 63110, USA
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Adenocarcinoma of the Colon Disguised as Abdominal Wall Abscess: Case Report and Review of the Literature. Case Rep Surg 2018; 2018:1974627. [PMID: 29623229 PMCID: PMC5829352 DOI: 10.1155/2018/1974627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 01/01/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction Abdominal wall invasion by cancerous cells arising from the colon with an overlying secondary infection that presents as an abdominal wall abscess has been encountered previously, but such a symptom is rarely the first presentation of colon cancer. There are very few cases reported in the literature. Case Presentation In this case report, we present a case of a 66-year-old male presenting with abdominal wall abscess that was refractory to treatment. The patient later was found to have an abdominal wall invasion by an underlying colonic carcinoma. Conclusion The purpose of this review is to set forth the proper approach when encountering such cases and emphasize on the significance of keeping a high index of suspicion. We also highlight the need for utilizing proper diagnostic imaging modalities prior to invasive intervention.
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Wang H, Chen X, Liu H, Mou T, Deng H, Zhao L, Li G. Laparoscopy-assisted colectomy as an Oncologically safe alternative for patients with stage T4 Colon Cancer: a propensity-matched cohort study. BMC Cancer 2018; 18:370. [PMID: 29615004 PMCID: PMC5883638 DOI: 10.1186/s12885-018-4269-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 03/20/2018] [Indexed: 12/21/2022] Open
Abstract
Background It is still controversial whether laparoscopy-assisted colectomy (LAC) is suitable for patients with stage T4 colon cancer. This study aimed to compare the short- and long-term outcomes of LAC and open colectomy (OC) for patients with pathologic T4 colon cancer. Methods Data of eligible patients with colon cancer in our institution from March 2004 to September 2014 were retrospectively reviewed. The patients were followed up to September 2016. Propensity score matching was performed to control the bias. Results Two hundred and forty two patients were selected by propensity score matching, with 121 patients in the LAC group and 121 in the OC group. Mean operating time and rate of intraoperative blood transfusion were similar between two groups. In LAC group, shorter time to first flatus and first liquid intake were observed in patients with pT4b stage disease, but not for patients with pT4a stage disease. Less blood loss and shorter length of postoperative hospital stay were examined in LAC group, including pT4a and pT4b stages. Conversion was required in 9.1% (11 out of 121) cases. DFS and OS were similar between LAC and OC groups. The 5-year DFS rate was 64.2% for pT4a stage and 35.5% for pT4b stage in LAC group, and 62.9% and 33.7% in OC group for pT4a (p = 0.374) and pT4b (p = 0.385) stage respectively. For 5-year OS rates, two groups did not differ in pT4a stage (LAC 69.2% vs. OC 66.0%, p = 0.151) and pT4b stage (LAC 37.5% vs. OC 38.1%, p = 0.510). Conclusions Laparoscopic colectomy appears to be safe for selected patients with pT4 colon cancer in centres with expertise in minimally invasive surgery.
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Affiliation(s)
- Hao Wang
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Xiaoyu Chen
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Hao Liu
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Tingyu Mou
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Haijun Deng
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China
| | - Liying Zhao
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China.
| | - Guoxin Li
- Department of General Surgery, Nanfang Hospital, Southern Medical University, Guangdong Provincial Engineering Technology Research Center of Minimally Invasive Surgery, Guangzhou, 510515, China.
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Abstract
BACKGROUND Locally advanced colon cancer invading surrounding organs or structures is challenging to surgeons and oncologists. Multivisceral resections with tumor removal en bloc with invaded tissues provide the best chance for cure. OBJECTIVE We aimed to assess the management and outcomes after multivisceral resections in patients with clinically infiltrative, locally advanced primary colon cancer. DESIGN This is a descriptive retrospective cohort study. SETTINGS A total of 121 consecutive patients with locally advanced primary colon cancer underwent en bloc multivisceral resections at a tertiary referral unit for colorectal cancer between 2007 and 2014. MAIN OUTCOME MEASURES Patient demographics, surgical details, histopathological findings, and outcomes were analyzed through registry data and reviews of patient files. RESULTS An R0 resection was achieved in 112 patients (92.6%), and an R1 resection was achieved in 9 patients (7.4%). Actual tumor cell infiltration in resected tissues was found in 77 patients (63.6%), and inflammation was found in 44 patients (36.4%). The estimated 5-year overall survival was 60.8% and 86.9%. Survival was significantly better after R0 than after R1 resections. After a median follow-up of 28 months, recurrent disease was diagnosed in 25 patients (20.7%). Female sex, low tumor stage, and adjuvant chemotherapy, but not tumor infiltration per se, were independently associated with better overall survival in a multivariate analysis. LIMITATIONS The main limitations of the study are the retrospective design and the fact that all patients were operated on at 1 institution by a small number of surgeons. CONCLUSIONS Patients with locally advanced colon cancer can be cured with an R0 resection. All involved surrounding tissues should be removed en bloc with the primary tumor. See Video Abstract at http://links.lww.com/DCR/A548.
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Liu Q, Luo D, Lian P, Yu W, Zhu J, Cai S, Li Q, Li X. Reevaluation of laparoscopic surgery's value in pathological T4 colon cancer with comparison to open surgery: A retrospective and propensity score-matched study. Int J Surg 2018; 53:12-17. [PMID: 29555522 DOI: 10.1016/j.ijsu.2018.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/08/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE In spite of the unique advantages of minimally invasive treatment, laparoscopic surgery is not recommended in T4 colon cancer patients with the concern of technical feasibility and suboptimal oncologic outcomes. We used the database of our center to reevaluate laparoscopic surgery's value in T4 colon cancer and compared with open surgery in both short- and long-term outcomes. METHODS We conducted a retrospective and propensity score-matched study of pathological T4 colon cancer patients who received laparoscopic surgery or open surgery from March 2011 to August 2015. RESULTS A total of 411 pathological T4 colon cancer patients were identified. Propensity score matching (PSM) resulted in 86 patients in laparoscopic group and 86 patients in open group. Our study showed longer operation time, less blood loss and less length of postsurgical stay compared with open surgeries (167 ± 56 min vs. 111 ± 50.1 min, P < 0.001; 72 ± 61.5 mL vs. 113 ± 113.9 mL, P = 0.004; 7.3 ± 2.1 days vs. 7.9 ± 2.1 days, P = 0.046, respectively). 7 (8.2%) patients underwent conversions to open surgery. 5-years of DFS and OS showed no statistic difference between the two groups. The 1-, 3-, and 5-years OS rates were 89.4%, 77.5% and 73.2% for laparoscopic surgery and 95.2%, 82.7% and 73.9% for open surgery (P = 0.618). The 1-, 3-, and 5-years OS rates were 89.5%, 77.2% and 61.7% for laparoscopic surgery and 91.7%, 75.3% and 66.8% for open surgery (P = 0.903). CONCLUSION Our analysis demonstrates that there is no statistic difference in short- and long-oncologic outcomes in our center and it is a reliable evidence to support the clinical application of laparoscopic surgery in T4 colon cancer patients. Still, considering the lack of randomized controlled trails, conducting large prospective multi-center population-based studies is not only required, but also pressing.
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Affiliation(s)
- Qi Liu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Dakui Luo
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Peng Lian
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Wencheng Yu
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Ji Zhu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China
| | - Qingguo Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
| | - Xinxiang Li
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Shanghai, China; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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S1 Sacrectomy for Re-recurrent Rectal Cancer: Our Experience with Reconstruction Using an Expandable Vertebral Body Replacement Device. Dis Colon Rectum 2018; 61:261-265. [PMID: 29337783 DOI: 10.1097/dcr.0000000000000935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION R0 resection is achieved by high sacrectomy for local recurrence of colorectal cancer, but significant rates of perioperative complications and long-term patient morbidity are associated with this procedure. In this report, we outline our unique experience of using an expandable cage for vertebral body reconstruction following S1 sacrectomy in a 66-year-old patient with re-recurrent rectal cancer. We aim to highlight several key steps, with a view to improving postoperative outcomes. TECHNIQUE A midline laparotomy was performed with the patient in supine Lloyd-Davies position, demonstrating recurrence of tumor at the S1 vertebral body. Subtotal vertebral body excision of S1 with sparing of the posterior wall and ventral foramina was completed by using an ultrasonic bone aspirator. Reconstruction was performed using an expandable corpectomy spacer system. The system was assembled and expanded in situ to optimally bridge the corpectomy. The device was secured into the L5 and S2 vertebrae by means of angled end plate screws superiorly and inferiorly. Bone grafts were positioned adjacent to the implant after this. RESULTS Total operating time was 266 minutes with 350 mL of intraoperative blood loss. There were no immediate postoperative complications. The patient did not report any back pain at the time of discharge, and no neurological deficit was reported or identified. Postoperative CT scan showed excellent vertebral alignment and preservation of S1 height. CONCLUSION We conclude that high sacrectomy with an expandable metal cage is feasible in the context of re-recurrent rectal cancer when consideration is given to the method of osteotomy and vertebral body replacement.
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Nishikawa T, Ishihara S, Emoto S, Kaneko M, Murono K, Sasaki K, Otani K, Tanaka T, Kiyomatsu T, Hata K, Kawai K, Nozawa H, Watanabe T. Multivisceral resections for locally advanced colorectal cancer after preoperative treatment. Mol Clin Oncol 2018; 8:493-498. [PMID: 29564129 DOI: 10.3892/mco.2018.1559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 01/17/2018] [Indexed: 12/27/2022] Open
Abstract
Multivisceral resection for colorectal cancer invading into the adjacent organs may often be difficult and may involve serious complications. Preoperative therapy may facilitate resection with safe margins. Between August 2007 and July 2016, 23 patients with colorectal cancer invading into the adjacent organs treated with preoperative treatment (chemoradiotherpay, chemotherapy, radiotherapy) were retrospectively investigated. All 23 patients received surgery with curative intent. Four patients had distant metastases at the time of diagnosis. Two patients had distant metastasis after preoperative treatment. The mean operative time was 535.3±185.5 min and the median amount of blood loss was 1,050 ml. Histopathological examination revealed malignant infiltration of the adjacent organs in 14 patients (60.9%). R0 resection rate was 73.9%. Postoperative complications were identified in nine patients (39.1%) and a high incidence of infectious complications was observed. Patients with curative resection showed a significantly better survival than patients with R1 or R2 resection (P<0.01). Multivisceral resection for locally advanced colorectal cancer invading into the adjacent organ after preoperative treatment may be performed with acceptable morbidity and minimal mortality. R0 resection improves the prognosis of patients with locally advanced colorectal cancer invading into the adjacent organ after preoperative treatment.
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Affiliation(s)
- Takeshi Nishikawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Manabu Kaneko
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Koji Murono
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kensuke Otani
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Keisuke Hata
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, The University of Tokyo, Tokyo 113-8655, Japan
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Yamanashi T, Nakamura T, Sato T, Naito M, Miura H, Tsutsui A, Shimazu M, Watanabe M. Laparoscopic surgery for locally advanced T4 colon cancer: the long-term outcomes and prognostic factors. Surg Today 2017; 48:534-544. [PMID: 29288349 PMCID: PMC5880863 DOI: 10.1007/s00595-017-1621-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 12/15/2017] [Indexed: 12/14/2022]
Abstract
Purpose For locally advanced pathological T4 (pT4) colon cancer, the safety and feasibility of laparoscopic procedures remain controversial. Therefore, this study aimed to assess short-term and long-term outcomes and to identify the prognostic factors in laparoscopic surgery for pT4 colon cancer. Methods The study group included 130 patients who underwent laparoscopic radical resection for pT4 colon and rectosigmoid cancer from January 2004 through December 2012. The short-term outcomes, long-term outcomes, and prognostic factors in pT4 colon cancer were analyzed. Results The median operative time was 205 min, with a median blood loss of 10 ml. The conversion rate was 3.8%, and 13 patients (10.0%) had postoperative complications. The radial resection margin was positive in 1 patient (0.8%). The median follow-up time was 73 months. The 5-year overall survival (OS) and recurrence-free survival (RFS) were 77.2 and 63.5%, respectively. On a multivariate analysis, a male sex [hazard ratio (HR) 3.09, p < 0.001], lymph node ratio ≥ 0.06 (HR 2.35, p = 0.021), tumor diameter < 38 mm (HR 2.57, p = 0.007), and right-sided colon cancer (HR 2.11, p = 0.047) were significantly related to a poor OS. Conclusions These results suggest that laparoscopic surgery for pT4 colon cancer is safe and feasible, and the oncological outcomes are acceptable. Based on the present findings, select patients with locally advanced colon cancer should not be excluded from laparoscopic surgery.
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Affiliation(s)
- Takahiro Yamanashi
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takatoshi Nakamura
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Takeo Sato
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masanori Naito
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Hirohisa Miura
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Atsuko Tsutsui
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masashi Shimazu
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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Dinaux AM, Leijssen LGJ, Bordeianou LG, Kunitake H, Berger DL. Effects of local multivisceral resection for clinically locally advanced rectal cancer on long-term outcomes. J Surg Oncol 2017; 117:1323-1329. [PMID: 29205364 DOI: 10.1002/jso.24947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/07/2017] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Multivisceral resection is occasionally needed to obtain clear margins in patients with transmural rectal cancer. Most series demonstrate equivalent outcomes between those patients who undergo multivisceral resections and those who do not, provided an R0-resection is achieved. This study focuses solely on patients who received neoadjuvant treatment for clinically transmural rectal cancers and underwent a local multivisceral R0-resection. METHODS A retrospective, single center analysis of consecutive series of patients who received a surgical R0-resection after neoadjuvant treatment for a clinically transmural, non-metastatic, primary rectal cancer. All patients were operated on between 2004 and 2015. RESULTS A total of 279 patients was included, of whom 29 patients underwent a local multivisceral R0-resection (LMVR). These patients were more often female and less often diagnosed through screening. Pathologic AJCC-staging was significantly lower for non-LMVR patients, with more favorable tumor characteristics. LMVR patients demonstrated higher rates of distant disease recurrence, and impaired survival, even after adjusting for disease stage. CONCLUSION An R0-resection after neoadjuvant therapy led to comparative local control of disease; however, patients with multivisceral resection had more distant recurrence and impaired survival, compared to those did not undergo a multivisceral resection. Further research should determine optimal postoperative care.
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Affiliation(s)
- Anne M Dinaux
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lieve G J Leijssen
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Liliana G Bordeianou
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroko Kunitake
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David L Berger
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Leon P, Iovino MG, Giudici F, Sciuto A, de Manzini N, Cuccurullo D, Corcione F. Oncologic outcomes following laparoscopic colon cancer resection for T4 lesions: a case-control analysis of 7-years' experience. Surg Endosc 2017; 32:1133-1140. [PMID: 28842796 DOI: 10.1007/s00464-017-5784-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Accepted: 07/28/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND According to many Societies' guidelines, patients presenting with clinical T4 colorectal cancer should conventionally be approached by a laparotomy. Results of emerging series are questioning this attitude. METHODS We retrospectively analysed the oncologic outcomes of 147 patients operated on between June 2008 and September 2015 for histologically proven pT4 colon cancers. All patients were treated with curative intent, either by a laparoscopic or open "en bloc" resection. RESULTS Median operative time, blood loss and hospital length of stay were significantly reduced in the laparoscopic group. Postoperative surgical complication rate and 30-day mortality did not significantly differ between the two groups ( p = 0.09 and p = 0.99, respectively). R1 resection rate and lymph nodes harvest, as well, did not remarkably differ when comparing the two groups. In the laparoscopic group, conversion rate was 19%. Long-term outcomes were not affected in patients who had undergone conversion. Five-year overall survival and disease-free survival did not significantly differ between the two groups (44.6% and 40.3% vs. 39.4% and 38.9%). Locally advanced stages (IIIB-IIIC) and R1 resections were detected as independent prognostic factors for overall survival. CONCLUSION Laparoscopic approach might be safe and acceptable for locally advanced colon cancer and does not jeopardize the oncologic results. Conversion to open surgery should be a part of a strategy as it does not seem to adversely affect perioperative and long-term outcomes. We consider laparoscopy, in expert hands, the last diagnostic tool and the first therapeutic approach for well-selected locally advanced colon cancers. Larger prospective studies are needed to widely assess this issue.
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Affiliation(s)
- Piera Leon
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University of Trieste, Trieste, Italy.
| | - Michele Giuseppe Iovino
- Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
| | - Fabiola Giudici
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University of Trieste, Trieste, Italy
| | - Antonio Sciuto
- Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
| | - Nicolò de Manzini
- Department of Medical, Surgical and Health Sciences, General Surgery Clinic, University of Trieste, Trieste, Italy
| | - Diego Cuccurullo
- Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
| | - Francesco Corcione
- Department of General Surgery, Azienda Ospedaliera Dei Colli, Monaldi Hospital, Naples, Italy
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The Feasibility of Hand-assisted Laparoscopic and Laparoscopic Multivisceral Resection Compared With Open Surgery for Locally Advanced Colorectal Cancer. Surg Laparosc Endosc Percutan Tech 2017; 27:e57-e65. [DOI: 10.1097/sle.0000000000000428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Short- and long-term outcomes following pelvic exenteration for gynae-oncological and colorectal cancers: A 9 year consecutive single-centre cohort study. Int J Surg 2017; 43:38-45. [PMID: 28529192 DOI: 10.1016/j.ijsu.2017.05.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 05/04/2017] [Accepted: 05/16/2017] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Radical pelvic exenteration can be undertaken for locally invasive or recurrent disease in both colorectal and gynaecological malignancies. In the UK this procedure is usually undertaken by the respective surgical specialties who have undergone divergent surgical training. This study describes and compares outcomes between colorectal and gynae-oncological teams following pelvic exenteration for primary and recurrent gynaecological and colorectal cancers in a single-centre multi-disciplinary team. METHOD A retrospective review of consecutive pelvic exenteration patients undertaken over a nine-year period in a tertiary referral centre. Analyses comparing short- and long-term morbidity and mortality outcomes were undertaken by chi-square test for categorical variables and Mann-Whitney U for continuous variables. Cumulative survival rates were calculated according to the Kaplan-Meier method and factors associated with recurrence and survival determined using a Cox regression model. RESULTS Thirty-four exenterations were undertaken; fourteen colorectal and twenty gynae-oncological. Morbidity was seen in 50% of colorectal and 75% of gynae-oncological patients. Recurrence was seen earlier and with greater frequency in the gynaeoncology group (44.4% and median time 11 months) than the colorectal group (21.4%, median time 41 months; p > 0.05). Survival in the gynae-oncology group was also lower than the colorectal group at 1-year (69.6% vs. 92.9%) and 5-years (58.0% vs. 92.9%; p = 0.115). The majority of gynae-oncological mortality occurred within 3-years of surgery, whilst the majority of mortality in the colorectal group was after 5-years. CONCLUSION Long-term patient outcome measures, including disease recurrence and 5-year survival, for colorectal exenteration appear better than for gynaeoncology patients, however, no statistical significant difference exists between short-term outcome measures between specialties. This is likely to be caused by different baseline pathologies and disease pattern influencing longer term prognosis but may also be a function of differing surgical thresholds and patient selection bias between specialties. Peri-operative and short-term morbidity appear equivalent despite divergent surgical backgrounds and training.
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Takahashi R, Hasegawa S, Hirai K, Hisamori S, Hida K, Kawada K, Sakai Y. Safety and feasibility of laparoscopic multivisceral resection for surgical T4b colon cancers: Retrospective analyses. Asian J Endosc Surg 2017; 10:154-161. [PMID: 28124830 DOI: 10.1111/ases.12355] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 11/28/2016] [Accepted: 12/05/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Laparoscopic (Lap) surgery has not been established as a standard procedure for locally advanced colon cancers. Here, we evaluated the safety and feasibility of Lap multivisceral resection (MVR) for tumors that had invaded adjacent organs (T4b). METHODS We performed retrospective analyses using a single institutional database. Eighty-four patients who underwent Lap or open MVR for surgical T4b primary colon cancers satisfied the inclusion criteria. RESULTS Among the 84 patients, 48 underwent Lap MVR and 36 underwent open MVR. More patients in the open group were clinical T4b and were receiving neoadjuvant chemotherapy. Patients in the open group had worse performance status (P = 0.037) and tumors of greater diameter. Lap completion was achieved in 42 cases (87.5%); the conversion rate was highest in cases involving the urinary tract (40.0%). Lap reconstruction of the bladder or ureter was extremely challenging, and therefore, adjacent organ reconstruction influenced Lap completion. Regarding perioperative outcomes, Lap was superior to open surgery in terms of intraoperative blood loss, morbidity, and postoperative hospital stay. Conversion was required in six cases; five were strategic conversions, and conversion was not associated with severe morbidity. The microscopic positive surgical margin rate was not higher in the Lap group than in the open group. Kaplan-Meier analyses of overall and disease-free survival were comparable between the groups. Cox regression analyses revealed that the operative approach did not have a significant adverse effect on long-term outcomes. CONCLUSION The Lap approach could be considered for surgical T4b cancers, except for urinary tract invasion cases that require complicated reconstruction.
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Affiliation(s)
- Ryo Takahashi
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Faculty of Medicine, Fukuoka University, Fukuoka, Japan
| | - Kenjiro Hirai
- Department of Surgery, Otsu Municipal Hospital, Shiga, Japan
| | - Shigeo Hisamori
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koya Hida
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kenji Kawada
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshiharu Sakai
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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