Association between histological type of tumour growth and patient survival in t2-t3 lymph node-negative rectal cancer treated with sphincter-preserving total mesorectal excision. Pathol Oncol Res. 2010;16:201-206. [PMID: 19757194 DOI: 10.1007/s12253-009-9207-4]

Efficacy of laparoscopic surgery for rectal cancer and impact of surgeon's degree of specialization: A single center clinical study

AIM: To evaluate the clinical effects of laparoscopic surgery for rectal cancer and the impact of surgeon's degree of specialization.

METHODS: Clinical data for 210 patients who underwent treatment for rectal cancer at Shengjing Hospital Affiliated to China Medical University from January 2010 to march 2012 were reviewed. The patients were divided into a laparoscopic surgery group and an open surgery group, and surgical outcome and postoperative outcome were compared between the two groups. According to the doctor's professional degree, the patients were divided into a professional laparoscopic surgery group and a non-professional laparoscopic surgery group, a professional open surgery group and a non-professional open surgery group. Surgical outcome and postoperative outcome were compared between these groups.

RESULTS: The laparoscopic surgery group had less intraoperative blood loss, shorter time to first postoperative exhaust, shorter time to intake of liquid diets, and shorter hospital stay than the open surgery group (P < 0.01). In addition, the laparoscopic surgery group had a higher number of resected lymph nodes, earlier ambulation, shorter time to urethral catheter removal, and lower incision infection rate than the open surgery group (P < 0.05). The operation time were longer, resected specimen length was shorter, and the total cost was higher in the laparoscopic surgery group than in the open surgery group (P < 0.01). Time to intake of liquid diets was significantly shorter in the two professional groups than the two non-professional groups (P < 0.01). The professional open surgery group had a significantly lower incidence of intestinal fistula than the non-professional open surgery group (P < 0.05).

CONCLUSION: Laparoscopic surgery for rectal cancer has the advantages of less intraoperative bleeding, resecting more lymph nodes, faster postoperative recovery, shorter hospitalization time, and lower postoperative incision infection rate. The degree of doctor's degree of specialization has an impact on postoperative recovery of patients undergoing radical rectal operation.

Lymphovascular invasion is a significant prognosticator in rectal cancer patients who receive preoperative chemoradiotherapy followed by total mesorectal excision

PURPOSE

This study was designed to identify the significance of lymphovascular invasion as a prognosticator for tumor recurrence and survival in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and total mesorectal excision (TME).

METHODS

Between January 2003 and October 2010, the study included 328 patients with primary rectal cancer who had received preoperative CRT followed by TME. We analyzed the clinicopathologic factors that may be associated with survival, such as age, gender, carcinoembryonic antigen (CEA) value, pathologic T and N stage, tumor response, histologic grade, lymphovascular invasion (LVI), and perineural invasion.

RESULTS

Higher pathologic T and N stage, poor tumor response, high-grade histology, and positive LVI were adverse prognostic factors for both disease-free survival (DFS) and overall survival (OS) on the multivariate analysis. Perineural invasion was a significant adverse prognostic factor affecting DFS (P=0.046) but not OS (P=0.08). Increased T and N stage and distant recurrence, but not local recurrence, were significant factors associated with LVI. The LVI-negative group had a higher DFS (71.4 vs. 56.2%, P=0.012) and OS rate (86.7 vs. 63.4%, P=0.020) at 5 years than the LVI-positive group did.

CONCLUSIONS

Positive LVI had a negative impact on survival in patients with rectal cancer who received preoperative CRT and TME and is significantly associated with an increased chance of distant recurrence. Based on this finding, more tailored adjuvant chemotherapy is warranted for advanced rectal cancer patients with LVI to reduce the distant dissemination of tumor.