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González-Kusjanovic N, Delgado Ochoa B, Vidal C, Campos M. Post-operative complications affect survival in surgically treated metastatic spinal cord compression. INTERNATIONAL ORTHOPAEDICS 2024; 48:1341-1350. [PMID: 38472466 DOI: 10.1007/s00264-024-06120-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 01/13/2024] [Indexed: 03/14/2024]
Abstract
PURPOSE The prevalence of metastatic epidural spinal cord compression (MESCC) is increasing globally due to advancements in cancer diagnosis and treatment. Whilst surgery can benefit specific patients, the complication rate can reach up to 34%, with limited reporting on their impact in the literature. This study aims to analyse the influence of major complications on the survival of surgically treated MESCC patients. METHODS Consecutive MESCC patients undergoing surgery and meeting inclusion criteria were selected. Survival duration from decompressive surgery to death was recorded. Perioperative factors influencing survival were documented and analysed. Kaplan-Meier survival analysis at one year compared these factors. Univariate and multivariate Cox proportional hazard regression analyses were performed. Additionally, univariate analysis compared complicated and uncomplicated groups. RESULTS Seventy-five patients were analysed. Median survival for this cohort was 229 days (95% CI 174-365). Surgical complications, low patient performance, and rapid primary tumour growth were significant perioperative variables for survival in multivariate analyses (p < 0.001, p = 0.003, and p = 0.02, respectively) with a hazard ratio of 3.2, 3.6, and 2.1, respectively. Univariate analysis showed no variables associated with complication occurrence. CONCLUSION In this cohort, major surgical complications, patient performance, and primary tumour growth rate were found to be independent factors affecting one year survival. Thus, prioritizing complication prevention and appropriate patient selection is crucial for optimizing survival in this population.
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Affiliation(s)
- Nicolás González-Kusjanovic
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Byron Delgado Ochoa
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Catalina Vidal
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile
| | - Mauricio Campos
- Orthopaedic Surgery Department, School of Medicine, Pontificia Universidad Católica de Chile, Diagonal Paraguay, 362, Santiago, Chile.
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2
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Hemminki K, Försti A, Liska V, Kanerva A, Hemminki O, Hemminki A. Long-term survival trends in solid cancers in the Nordic countries marking timing of improvements. Int J Cancer 2023; 152:1837-1846. [PMID: 36571455 DOI: 10.1002/ijc.34416] [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: 09/26/2022] [Revised: 11/12/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022]
Abstract
Survival studies are an important indicator of the success of cancer control. We analyzed the 5-year relative survival in 23 solid cancers in Denmark, Finland, Norway and Sweden over a 50-year period (1970-2019) at the NORDCAN database accessed from the International Agency for Research on Cancer website. We plotted survival curves in 5-year periods and showed 5-year periodic survival. The survival results were summarized in four groups: (1) cancers with historically good survival (>50% in 1970-1974) which include melanoma and breast, endometrial and thyroid cancers; (2) cancers which constantly improved survival at least 20% units over the 50 year period, including cancers of the stomach, colon, rectum, kidney, brain and ovary; (3) cancer with increase in survival >20% units with changes taking place in a narrow time window, including oral, oropharyngeal, testicular and prostate cancers; (4) the remaining cancers with <20% unit improvement in survival including lung, esophageal, liver, pancreatic, bladder, soft tissue, penile, cervical and vulvar cancers. For cancers in groups 1 and 2, the constant development implied multiple improvements in therapy, diagnosis and patient care. Cancers in group 3 included testicular cancers with known therapeutic improvements but for the others large incidence changes probably implied that cancer stage (prostate) or etiology (oropharynx) changed into a more tractable form. Group 4 cancers included those with dismal survival 50 years ago but a clear tendency upwards. In 17 cancers 5-year survival reached between 50% and 100% while in only six cancers it remained at below 50%.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center and Faculty of Medicine, Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Vaclav Liska
- Biomedical Center and Faculty of Medicine, Pilsen, Charles University in Prague, Pilsen, Czech Republic.,Department of Surgery, University Hospital Pilsen, Charles University, Pilsen, Czech Republic
| | - Anna Kanerva
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Otto Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Department of Urology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Translational Immunology Research Program, University of Helsinki, Helsinki, Finland.,Comprehensive Cancer Center, Helsinki University Hospital, Helsinki, Finland
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3
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Hansdotter P, Scherman P, Nikberg M, Petersen SH, Holmberg E, Rizell M, Naredi P, Syk I. Treatment and survival of patients with metachronous colorectal lung metastases. J Surg Oncol 2023; 127:806-814. [PMID: 36607235 DOI: 10.1002/jso.27188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION The lungs are the second most common site for metachronous metastases in colorectal cancer. No treatment algorithm is established, and the role of adjuvant chemotherapy is unclear. This study aimed to map pulmonary recurrences in a modern multimodal treated population, and to evaluate survival depending on management. METHODS Retrospective study based on the COLOFOL-trial population of 2442 patients, radically resected for colorectal cancer stage II-III. All recurrences within 5 years were identified and medical records were scrutinized. RESULTS Of 165 (6.8%) patients developing lung metastases as first recurrence, 89 (54%) were confined to the lungs. Potentially curative treatment was possible in 62 (37%) cases, of which 33 with surgery only and 29 with surgery and chemotherapy combined. The 5-year overall survival (5-year OS) for all lung recurrences was 28%. In patients treated with chemotherapy only the 5-year OS was 7.5%, compared with 55% in patients treated with surgery, and 72% when surgery was combined with chemotherapy. Hazard ratio for mortality was 2.9 (95% confidence interval 1.40-6.10) for chemotherapy only compared to surgery. CONCLUSION A high proportion of metachronous lung metastases after colorectal surgery were possible to resect, yielding good survival. The combination of surgery and chemotherapy might be advantageous for survival.
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Affiliation(s)
- Pernilla Hansdotter
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
| | - Peter Scherman
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Maziar Nikberg
- Department of Surgery, Centre for Clinical Research of Uppsala University, Västmanland's Hospital, Västerås, Sweden
| | - Sune H Petersen
- Department of Paediatrics & Adolescent Medicine, Section of Paediatric Haematology & Oncology, Copenhagen, Denmark
| | - Erik Holmberg
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Rizell
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Transplant Institute, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Peter Naredi
- Department of Surgery, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvar Syk
- Department of Surgery, Skåne University Hospital, Malmö, Sweden.,Institute of Clinical Sciences Malmö, Section of Surgery, Lund University, Lund, Sweden
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Andersson TML, Rutherford MJ, Møller B, Lambert PC, Myklebust TA. Reference adjusted loss in life expectancy for population-based cancer patient survival comparisons - with an application to colon cancer in Sweden. Cancer Epidemiol Biomarkers Prev 2022; 31:1720-1726. [PMID: 35700010 DOI: 10.1158/1055-9965.epi-22-0137] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/27/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The loss in life expectancy, LLE, is defined as the difference in life expectancy between cancer patients and that of the general population. It is a useful measure for summarising the impact of a cancer diagnosis on an individual's life expectancy. However, it is less useful for making comparisons of cancer survival across groups or over time, since the LLE is influenced by both mortality due to cancer and other causes and the life expectancy in the general population. METHODS We present an approach for making LLE estimates comparable across groups and over time by using reference expected mortality rates with flexible parametric relative survival models. The approach is illustrated by estimating temporal trends in LLE of colon cancer patients in Sweden. RESULTS The life expectancy of Swedish colon cancer patients has improved, but the LLE has not decreased to the same extent since the life expectancy in the general population has also increased. When using a fixed population and other-cause mortality, i.e. a reference-adjusted approach, the LLE decreases over time. For example, using 2010 mortality rates as the reference, the LLE for females diagnosed at age 65 decreased from 11.3 if diagnosed in 1976 to 7.2 if diagnosed in 2010, and from 3.9 to 1.9 years for women 85 years old at diagnosis. CONCLUSION The reference-adjusted LLE is useful for making comparisons across calendar time, or groups, since differences in other cause mortality are removed. IMPACT The reference-adjusted approach enhances the use of LLE as a comparative measure.
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Locally Advanced Rectal Cancer: What We Learned in the Last Two Decades and the Future Perspectives. J Gastrointest Cancer 2022; 54:188-203. [PMID: 34981341 DOI: 10.1007/s12029-021-00794-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/13/2022]
Abstract
The advancement in surgical techniques, optimization of systemic chemoradiotherapy, and development of refined diagnostic and imaging modalities have brought a phenomenal shift in the treatment of the locally advanced rectal cancer. Although each therapeutic option has shown substantial progress in their field, it is finding their ideal amalgamation which has baffled the clinician and researchers alike. In the effort to identifying the perfect salutary treatment plan, we have even shifted our attention from the trimodal approach to non-operative "watchful waiting" to more recent individualized care. In this article, we acknowledge the scientific progress in the management of locally advanced rectal cancer and compare the opportunities as well as the obstacles while implementing them clinically. We also explore the current challenges and controversies surrounding the multidisciplinary approach and highlight the new trends and recent advances with an ultimate goal to improve the patients' quality of life.
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6
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Hemminki K, Försti A, Hemminki A. Survival in colon and rectal cancers in Finland and Sweden through 50 years. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000644. [PMID: 34272211 PMCID: PMC8287611 DOI: 10.1136/bmjgast-2021-000644] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/11/2021] [Indexed: 01/28/2023] Open
Abstract
Objectives Global survival studies have shown favourable development in colon and rectal cancers but few studies have considered extended periods or covered populations for which medical care is essentially free of charge. Design We analysed colon and rectal cancer survival in Finland and Sweden over a 50-year period (1967–2016) using data from the Nordcan database. In addition to the standard 1-year and 5-year survival rates, we calculated the difference between these as a novel measure of how well survival was maintained between years 1 and 5. Results Relative 1-year and 5-year survival rates have developed favourably without major shifts for men and women in both countries. For Finnish men, 1-year survival in colon cancer increased from 50% to 82%, and for rectal cancer from 62% to 85%. The Swedish survival was a few per cent unit better for 1-year survival but for 5-year survival the results were equal. Survival of female patients for both cancers was somewhat better than survival in men through 50 years. Overall the survival gains were higher in the early compared with the late follow-up periods, and were the smallest in the last 10 years. The difference between 1-year and 5-year survival in colon cancer was essentially unchanged over the 50-year period while in rectal cancer there was a large improvement. Conclusions The gradual positive development in survival suggests a contribution by many small improvements rather than single breakthroughs. The improvement in 5-year survival in colon cancer was almost entirely driven by improvement in 1-year survival while in rectal cancer the positive development extended to survival past year 1, probably due to successful curative treatments. The current challenges are to reinvigorate the apparently stalled positive development and to extend them to old patients. For colon cancer, survival gains need to be extended past year 1 of diagnosis.
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Affiliation(s)
- Kari Hemminki
- Biomedical Center, Faculty of Medicine and Biomedical Center in Pilsen, Charles University in Prague, Pilsen, Czech Republic .,Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 580, Heidelberg, Baden-Württemberg, Germany
| | - Asta Försti
- Hopp Children's Cancer Center (KiTZ), Heidelberg, Germany.,Division of Pediatric Neurooncology, German Cancer Research Center (DKFZ), German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Akseli Hemminki
- Cancer Gene Therapy Group, Helsingin yliopisto, Helsinki, Uusimaa, Finland.,Comprehensive Cancer Center, Helsingin yliopistollinen Keskussairaala, Helsinki, Uusimaa, Finland
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7
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Pooni A, Schmocker S, Brown C, MacLean A, Hochman D, Williams L, Baxter N, Simunovic M, Liberman S, Drolet S, Neumann K, Jhaveri K, Kirsch R, Kennedy ED. Quality indicator selection for the Canadian Partnership against Cancer rectal cancer project: A modified Delphi study. Colorectal Dis 2021; 23:1393-1403. [PMID: 33626193 DOI: 10.1111/codi.15599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 12/17/2022]
Abstract
AIM It is well established that (i) magnetic resonance imaging, (ii) multidisciplinary cancer conference (MCCs), (iii) preoperative radiotherapy, (iv) total mesorectal excision surgery and (v) pathological assessment as described by Quirke are key processes necessary for high quality, rectal cancer care. The objective was to select a set of multidisciplinary quality indicators to measure the uptake of these clinical processes in clinical practice. METHOD A multidisciplinary panel was convened and a modified two-phase Delphi method was used to select a set of quality indicators. Phase 1 included a literature review with written feedback from the panel. Phase 2 included an in-person workshop with anonymous voting. The selection criteria for the indicators were strength of evidence, ease of capture and usability. Indicators for which ≥90% of the panel members voted 'to keep' were selected as the final set of indicators. RESULTS During phase 1, 68 potential indicators were generated from the literature and an additional four indicators were recommended by the panel. During phase 2, these 72 indicators were discussed; 48 indicators met the 90% inclusion threshold and included eight pathology, five radiology, 11 surgical, six radiation oncology and 18 MCC indicators. CONCLUSION A modified Delphi method was used to select 48 multidisciplinary quality indicators to specifically measure the uptake of key processes necessary for high quality care of patients with rectal cancer. These quality indicators will be used in future work to identify and address gaps in care in the uptake of these clinical processes.
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Affiliation(s)
- Amandeep Pooni
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Selina Schmocker
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
| | - Carl Brown
- Department of Colorectal Surgery, St Paul's Hospital, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anthony MacLean
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - David Hochman
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
| | - Lara Williams
- Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
| | - Nancy Baxter
- University of Toronto, Toronto, ON, Canada.,Department of Surgery, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada
| | - Marko Simunovic
- Department of Surgery, St Joseph's Healthcare, McMaster University, Hamilton, ON, Canada
| | - Sender Liberman
- Department of Surgery, McGill University, Montreal, QC, Canada
| | - Sébastien Drolet
- Department of Surgery, Université Laval, Quebec City, QC, Canada
| | - Katerina Neumann
- Department of Surgery, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
| | - Kartik Jhaveri
- University of Toronto, Toronto, ON, Canada.,Joint Department of Medical Imaging, Mount Sinai Hospital and Women's College Hospital, University Health Network, Toronto, ON, Canada
| | - Richard Kirsch
- University of Toronto, Toronto, ON, Canada.,Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erin D Kennedy
- Department of Surgery, Mount Sinai Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, ON, Canada.,Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Toronto, ON, Canada
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8
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Abstract
Over the past 30 years, rectal cancer surgery has been standardized by total mesorectal excision. More recently, some have suggested that colon cancer surgery should be standardized by complete mesocolic excision (CME) with central vascular ligation (CVL), especially in Western countries. Surgeons undertaking CME with CVL report optimal outcomes. Sharp dissection within the embryological plane and high vascular ligation at the vessel origin are essential. In Japan, a similar concept, D3 dissection, has been adopted for decades. Although both surgical procedures are similar, distinct differences exist. Some surgeons are confused about the principles and practice of these two procedures. As well as overviewing the theory behind CME with CVL and D3 dissection, the technical details of both procedures are described.
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Affiliation(s)
| | - Nicholas P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St. James's, School of Medicine, University of Leeds, United Kingdom
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9
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Naeem A, Shakeel O, Ashraf I, Riaz S, Haq I, Shah MF, Anwer AW, Nasir IUI, Amjad A, Khattak S, Syed AA. Laparoscopic Curative Resection for Right-Sided Colonic Tumors: Initial Experience From a Specialized Cancer Hospital of a Developing Country. Cureus 2020; 12:e9465. [PMID: 32874795 PMCID: PMC7455377 DOI: 10.7759/cureus.9465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Introduction Laparoscopic colonic resection is increasingly becoming popular worldwide and aims to provide curative resection in addition to the inherent benefits of laparoscopic surgery. The aim of this study was to evaluate the long-term outcomes of laparoscopic right hemicolectomy in a Pakistani cohort of patients. Methods and procedures We retrospectively analyzed the medical records of all patients who presented to our hospital with the diagnosis of right-sided colon carcinoma from January 2010 to December 2018 and underwent laparoscopic right or extended right hemicolectomy. Demographics, operative findings, histopathology report, and follow-up of patients were recorded and the analysis was performed on Statistical Packages for the Social Sciences (SPSS) Version 20 (IBM Corp, Armonk, NY). Results Seventy-five patients were included, 56 (74.7%) of whom were males and 19 (25.3%) were females. The median age was 52 years (range 25-82 years). The median hospital stay was five days (Range 3-13 days). The median blood loss was 70 milliliters and the mean operative time was 195.5±77.6 minutes. Laparoscopic extended right hemicolectomy was performed in 23 (16.67%) patients and standard right hemicolectomy in 52 (83.33%) patients. Most (72%) of the patients had a pathological T3 tumor, and the majority (61.3%) of the patients had no nodal involvement (pN0). The mean number of lymph nodes removed was 20+8. The median numbers of involved lymph nodes were 1.14+2.19. All the patients had R0 resection. Postoperatively, two patients had pelvic collection, and there was no 30-day mortality. Local recurrence occurred in four patients and distant metastases were observed in nine patients. The median follow-up in our study was 40.5±18.35 months. The median disease-free survival was 42±2.17 months and the median overall survival was 44±2.16 months. Conclusion Our experience with laparoscopic right colon resections has confirmed the safety and feasibility of the procedure.
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Affiliation(s)
- Awais Naeem
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Osama Shakeel
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Ijaz Ashraf
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sheryar Riaz
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Ihtisham Haq
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad F Shah
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Abdul Wahid Anwer
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Irfan Ul Islam Nasir
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Awais Amjad
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Shahid Khattak
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Aamir Ali Syed
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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10
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Moriarty F, Ebell MH. A comparison of contemporary versus older studies of aspirin for primary prevention. Fam Pract 2020; 37:290-296. [PMID: 31751455 DOI: 10.1093/fampra/cmz080] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Recent aspirin trials have not shown similar benefits for primary prevention as older studies. OBJECTIVE To compare benefits and harms of aspirin for primary prevention before and after widespread use of statins and colorectal cancer screening. METHODS We compared studies of aspirin for primary prevention that recruited patients from 2005 onward with previous individual patient data (IPD) meta-analyses that recruited patients from 1978 to 2002. Data for contemporary studies were synthesized using random-effects models. We report vascular [major adverse cardiovascular events (MACE), myocardial infarction (MI) and stroke], bleeding, cancer and mortality outcomes. RESULTS The IPD analyses of older studies included 95 456 patients for CV prevention and 25 270 for cancer mortality, while the four newer studies had 61 604 patients. Relative risks for vascular outcomes for older versus newer studies follow: MACE: 0.89 [95% confidence interval (CI) 0.83-0.95] versus 0.93 (0.86-0.99); fatal haemorrhagic stroke: 1.73 (1.11-2.72) versus 1.06 (0.66-1.70); any ischaemic stroke: 0.86 (0.74-1.00) versus 0.86 (0.75-0.98); any MI: 0.84 (0.77-0.92) versus 0.88 (0.77-1.00); and non-fatal MI: 0.79 (0.71-0.88) versus 0.94 (0.83-1.08). Cancer death was not significantly decreased in newer studies (1.11, 0.92-1.34). Major haemorrhage was significantly increased (older studies RR 1.48, 95% CI 1.25-1.76 versus newer studies RR 1.37, 1.24-1.53). There was no effect on all-cause mortality, cardiovascular mortality, fatal stroke or fatal MI. CONCLUSIONS Per 1200 persons taking aspirin for primary prevention for 5 years, there will be 4 fewer MACEs, 3 fewer ischaemic strokes, 3 more intracranial haemorrhages and 8 more major bleeding events. Aspirin should no longer be recommended for primary prevention.
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Affiliation(s)
- Frank Moriarty
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Mark H Ebell
- College of Public Health, University of Georgia, Athens, GA, USA
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11
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Ho MLL, Ke TW, Chen WTL. Minimally invasive complete mesocolic excision and central vascular ligation (CME/CVL) for right colon cancer. J Gastrointest Oncol 2020; 11:491-499. [PMID: 32655927 DOI: 10.21037/jgo.2019.11.08] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Total mesorectal excision (TME) is the standard of care in rectal cancer surgery. Complete mesocolic excision and central vascular ligation (CME and CVL) are surgical concepts that are extrapolated from the principles of TME. Increasingly adopted by surgical units worldwide, laparoscopic CME/CVL for right sided colon cancer is a challenging procedure that requires meticulous dissection by the surgeon and detailed knowledge of the colonic vascular anatomy. This review article addresses the main issues pertaining to this surgical technique and also discusses steps on how to perform this operation safely.
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Affiliation(s)
- Ming Li Leonard Ho
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung.,Colorectal Service, Department of Surgery, Sengkang General Hospital, Singapore, Singapore
| | - Tao-Wei Ke
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung
| | - William Tzu-Liang Chen
- Division of Colorectal Surgery, Department of Surgery, China Medical University Hospital, Taichung.,Division of Colorectal Surgery, Department of Surgery, China Medical University Hsinchu Hospital, Zhubei City
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12
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Olmi S, Oldani A, Cesana G, Ciccarese F, Uccelli M, Giorgi R, Villa R, Maria De Carli S. Surgical Outcomes of Laparoscopic Right Colectomy with Complete Mesocolic Excision. JSLS 2020; 24:JSLS.2020.00023. [PMID: 32518478 PMCID: PMC7242021 DOI: 10.4293/jsls.2020.00023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Background and Objectives: Literature demonstrates that colorectal cancer is nowadays one of the most common malignancies. Laparoscopy and robotic surgery are progressively gaining popularity in the treatment of colorectal tumors. Complete mesocolic excision and central vascular ligation have been widely adopted with encouraging results in terms of an improvement of overall survival, but some studies in the literature seem to demonstrate a higher morbidity rate. Methods: We conducted a retrospective study from 01/01/2010 to 30/04/2019 on a series of 250 patients, 155 males (62%) and 95 females (38%) who underwent right colectomy with minimally invasive approach, complete mesocolic excision, central vascular ligation, and intracorporeal anastomosis. Results: No perioperative mortality occurred. Postoperative morbidity rate was 6%, including 10 cases of anastomotic leak (5%). Conversion rate was 2.5%. Mean hospital stay was 6 days (range, 4–25 days). Mean operative time was 70 minutes (range, 50–130 minutes). No cases of duodenal or pancreatic damages, no chronic pain or diarrhea, and no severe alteration of bowel function were recorded. We observed only 3 cases of transient delayed gastric emptying. Conclusions: Laparoscopic right colectomy with complete mesocolic excision, central vascular ligation and intracorporeal anastomosis leads to encouraging oncological mid- and long-term outcomes with low complications rates.
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Affiliation(s)
- Stefano Olmi
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Alberto Oldani
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Giovanni Cesana
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Francesca Ciccarese
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Matteo Uccelli
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Riccardo Giorgi
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Roberta Villa
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
| | - Stefano Maria De Carli
- Department of General Surgery and Oncological Surgery, Advanced Laparoscopic and Bariatric Surgery Center, Policlinico San Marco, Zingonia (BG), Italy
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13
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Efficacy and Safety of Complete Mesocolic Excision in Patients With Colon Cancer: Three-year Results From a Prospective, Nonrandomized, Double-blind, Controlled Trial. Ann Surg 2020; 271:519-526. [PMID: 30148752 DOI: 10.1097/sla.0000000000003012] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The aim of the study was to evaluate the oncological outcomes of complete mesocolic excision (CME) in colon cancer patients. SUMMARY BACKGROUND DATA CME is considered a standard procedure for colon cancer patients. However, previous evidence regarding the effect of CME on prognosis has fundamental limitations that prevent it from being fully accepted. METHODS Patients who underwent radical resection for colon cancer were enrolled between November 2012 and March 2016. According to the principles of CME, patients were stratified into 2 groups based on intraoperative surgical fields and specimen photographs. The primary outcome was local recurrence-free survival (LRFS). The clinicopathological data and follow-up information were collected and recorded. The final follow-up date was April 2016. The trial was registered in ClinicalTrials.gov (identifier: NCT01724775). RESULTS There were 220 patients in the CME group and 110 patients in the noncomplete mesocolic excision (NCME) group. Baseline characteristics were well balanced. Compared with NCME, CME was associated with a greater number of total lymph nodes (24 vs 20, P = 0.002). Postoperative complications did not differ between the 2 groups. CME had a positive effect on LRFS compared with NCME (100.0% vs 90.2%, log-rank P < 0.001). Mesocolic dissection (100.0% vs 87.9%, log-rank P < 0.001) and nontumor deposits (97.2% vs 91.6%, log-rank P < 0.022) were also associated with improved LRFS. CONCLUSIONS Our findings demonstrate that, compared with NCME, CME improves 3-year LRFS without increasing surgical risks.
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14
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Kim BC, Bae JH, Park SM, Won DY, Lee IK. Is ascites CEA a risk factor for peritoneal carcinomatosis in colorectal cancer?: a long-term follow-up study. Int J Colorectal Dis 2020; 35:147-155. [PMID: 31802190 DOI: 10.1007/s00384-019-03448-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE Our previous study reported that carcinoembryonic antigen (CEA) levels in peritoneal fluid were significantly correlated with the prevalence of peritoneal carcinomatosis (PC) in colorectal cancer (CRC). The purpose of this study was a long-term follow up of the author's previous study, as well as the identification of correlations with the known risk factors of PC and the comparison of the predictive power of PC in CRC. METHODS A total of 495 patients without PC who underwent CRC operations at St. Mary's Hospital, The Catholic University of Korea, from January 2006 to November 2014 were included in this study. Tumor markers of peritoneal fluid sampled at the beginning of each operation were prospectively analyzed and compared with the known risk factors for PC in CRC. RESULTS Multivariate analysis of PC revealed that T4 cancer (OR 5.143, 95% CI 1.400-18.897, p = 0.014), T3 mucinous cancer (OR 17.480, 95% CI 1.577-193.714, p = 0.020), obstructed tumors (OR 6.030, 95% CI 1.627-22.343, p = 0.007), and peritoneal fluid CEA above 5 ng/dl (OR 4.073, 95% CI 1.315-12.615, p = 0.015) were significant risk factors. T4 cancer, obstructed tumors, and peritoneal fluid CEA above 5 ng/dl showed correlations with cancer-free survival. Generally, higher CEA levels in peritoneal fluid were correlated with previously known risk factors for PC in CRC. CONCLUSION Peritoneal fluid CEA has predictive value for PC and prognostic value in CRC. Therefore, we recommend routinely performing ascites CEA analysis in colorectal cancer surgery.
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Affiliation(s)
- Byung Chul Kim
- Departments of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, 06591, Republic of Korea.,Graduate School of Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hoon Bae
- Departments of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sun Min Park
- Departments of Surgery, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae Youn Won
- Departments of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, 06591, Republic of Korea
| | - In Kyu Lee
- Departments of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seocho-gu, Seoul, 06591, Republic of Korea.
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D’Souza N, Shaw A, Lord A, Balyasnikova S, Abulafi M, Tekkis P, Brown G. Assessment of a Staging System for Sigmoid Colon Cancer Based on Tumor Deposits and Extramural Venous Invasion on Computed Tomography. JAMA Netw Open 2019; 2:e1916987. [PMID: 31808924 PMCID: PMC6902773 DOI: 10.1001/jamanetworkopen.2019.16987] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Preoperative TNM stratification of colon cancer on computed tomography (CT) does not identify patients who are at high risk of recurrence that could be selected for preoperative treatment. OBJECTIVE To evaluate the utility of CT findings for prognosis of sigmoid colon cancer. DESIGN, SETTING, AND PARTICIPANTS This prognostic study used retrospective data from patients who underwent bowel resection for sigmoid colon cancer between January 1, 2006, and January 1, 2015, at a tertiary care center receiving international and national referrals for colorectal cancer. Statistical analysis was performed in April 2019. MAIN OUTCOMES AND MEASURES Cox proportional hazards regression analysis was performed to investigate CT findings associated with disease recurrence. Kaplan-Meier survival plots were calculated for disease-free survival using CT staging systems. RESULTS Of the 414 patients who had sigmoid colon cancer (248 [60.0%] men; mean [SD] age, 66.1 [12.7] years), with median follow-up of 61 months (interquartile range, 40-87 months), 122 patients (29.5%) developed disease recurrence. On multivariate analysis, nodal disease was not associated with disease recurrence; only tumor deposits (hazard ratio [HR], 1.90; 95% CI, 1.21-2.98; P = .006) and extramural venous invasion (HR, 1.97; 95% CI, 1.26-3.06; P = .003) on CT were associated with disease recurrence. Significant differences in disease-free survival were found using CT-T3 substage classification (HR, 1.88; 95% CI, 1.32-2.68) but not CT-TNM (HR, 1.55; 95% CI, 0.94-2.55). The presence of tumor deposits or extramural venous invasion on CT (HR, 2.45; 95% CI, 1.68-3.56) had the strongest association with poor outcome. CONCLUSIONS AND RELEVANCE In this study, T3 substaging and detection of tumor deposits or extramural venous invasion on preoperative CT scans of sigmoid colon cancer were prognostic factors for disease-free survival, whereas TNM and nodal staging on CT had no prognostic value. T3 substaging and detection of tumor deposits or extramural venous invasion of sigmoid colon cancer was superior to TNM on CT and could be used to preoperatively identify patients at high risk of recurrence.
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Affiliation(s)
- Nigel D’Souza
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Annabel Shaw
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Amy Lord
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Svetlana Balyasnikova
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
| | - Muti Abulafi
- Department of Colorectal Surgery, Croydon University Hospital, London, United Kingdom
| | - Paris Tekkis
- Imperial College, London, United Kingdom
- Department of Colorectal Surgery, Royal Marsden Hospital, London, United Kingdom
| | - Gina Brown
- Imperial College, London, United Kingdom
- Department of Gastrointestinal Imaging, Royal Marsden Hospital, London, United Kingdom
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Abstract
Total mesorectal excision (TME) has been the miracle surgical technique which has since allowed the outcomes of rectal cancer to surpass that of colon cancer. Complete mesocolic excision (CME) attempts to adopt the same principles as that of TME and apply it to colon cancer surgery. Initial retrospective case series and comparative studies have shown promising oncological outcomes. CME entails the en bloc removal of a sufficient length of colonic specimen within an intact peritoneal envelop with extended lymphadenectomy through a high central ligation of vessels. This technique, standardizing the method for resection of right sided colon cancer, has witness promising perioperative and oncological data for both open and laparoscopic methods. However, most data available are mostly retrospective with a glaring lack of level 1 evidence. Despite the technique showing similar outcomes to that of conventional colectomy, parts of the procedure put the patient (and surgeon) at risk of potentially catastrophic complications. As promising as the initial results of CME has been, more well-designed randomized control trials are necessary to justify the increased risks taken and effort to mount the learning curve for CME.
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Affiliation(s)
- Frederick H Koh
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore
| | - Ker-Kan Tan
- Division of Colorectal Surgery, University Surgical Cluster, National University Hospital, National University Health Systems, Singapore, Singapore.,Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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17
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Parker RK, Mwachiro MM, Ranketi SS, Mogambi FC, Topazian HM, White RE. Curative Surgery Improves Survival for Colorectal Cancer in Rural Kenya. World J Surg 2019; 44:30-36. [DOI: 10.1007/s00268-019-05234-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Meta-analysis of oncological outcomes of sigmoid cancers: A hidden epidemic of R1 “palliative” resections. Eur J Surg Oncol 2019; 45:489-497. [DOI: 10.1016/j.ejso.2018.09.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 09/03/2018] [Indexed: 12/22/2022] Open
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To what extent is the low anterior resection syndrome (LARS) associated with quality of life as measured using the EORTC C30 and CR38 quality of life questionnaires? Int J Colorectal Dis 2019; 34:747-762. [PMID: 30721417 DOI: 10.1007/s00384-019-03249-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Treatment of rectal cancer often results in disturbed anorectal function, which can be quantified by the Low Anterior Resection Syndrome (LARS) score. This study investigates the association of impaired anorectal function as measured with the LARS score with quality of life (QoL) as measured with the EORTC-QLQ-C30 and CR38 questionnaires. METHODS All stoma-free patients who had undergone sphincter-preserving surgery for rectal cancer from 2000 to 2014 in our institution were retrieved from a prospective database. They were contacted by mail and asked to return the questionnaires. QoL was evaluated in relation to LARS and further patient- and treatment factors using univariate and multivariate analysis. RESULTS Of the eligible patients (n = 331), 261 (78.8%) responded with a complete LARS score. Mean score for global QoL according to the EORTC-QLQ-C30 questionnaire was 63 ± 21 for all patients. If major LARS was present, mean score decreased to 56 ± 19 in contrast to 67 ± 20 in patients with no/minor LARS (p < 0.001). In regression analysis, major LARS was furthermore associated with reduced physical, role, emotional, cognitive and social functioning as well as impaired body image, more micturition problems and poorer future perspective. It was not related to sexual function. The variance explained by major LARS in the differences of QoL was approximately 10%. CONCLUSION The presence of major LARS after rectal resection for cancer is negatively associated with global health as well as many other aspects of QoL. Preserving anorectal function and treatment of LARS are potential measures to improve QoL in this patient group.
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20
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Ho ML, Chong C, Yeo SA, Ng CY. Initial experience of laparoscopic right hemicolectomy with complete mesocolic excision in Singapore: a case series. Singapore Med J 2019; 60:247-252. [PMID: 30644524 DOI: 10.11622/smedj.2019008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Laparoscopic colorectal surgery is increasingly performed worldwide due to its multiple advantages over traditional open surgery. In the surgical treatment of right-sided colonic tumours, the latest technique is laparoscopic right hemicolectomy with complete mesocolic excision (lapCME), which aims to lower the rate of local recurrence and maximise survival as compared to standard laparoscopic right hemicolectomy (lapS). METHODS We conducted a retrospective analysis of our initial experience with lapCME in Singapore General Hospital between 2012 and 2015. All procedures were performed by a single surgeon. RESULTS Nine patients underwent lapCME and 16 patients underwent lapS. Indication for lapCME was cancer in the right colon. None of the patients required conversion to open surgery, and all were discharged well. The number of lymph nodes resected in the lapCME group was significantly greater than in the lapS group (29 ± 15 vs. 19 ± 6; p = 0.02) during the study period, and the mean operation time was significantly longer for lapCME (237 ± 50 minutes vs. 156 ± 46 minutes; p = 0.0005). There were no statistically significant differences in terms of demographics, tumour stage, time taken for bowel to open postoperatively, time taken for patient to resume a solid diet postoperatively and length of hospital stay. Two patients who underwent lapS were re-admitted for intra-abdominal collections - one patient required radiology-guided drainage, while the other patient was managed conservatively. CONCLUSION Our initial experience with lapCME confirms the feasibility and safety of the procedure.
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Affiliation(s)
- Ming Li Ho
- Department of Surgery, Sengkang Health, Singapore
| | - Cheryl Chong
- Department of General Surgery, Singapore General Hospital, Singapore
| | - Shen Ann Yeo
- Department of Colorectal Surgery, Singapore General Hospital, Singapore
| | - Chee Yung Ng
- One Surgical Clinic and Surgery, Mount Elizabeth Novena Specialist Centre, Singapore
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Tahmasbi B, Abedi G, Moosazadeh M, Janbabai G, Farshidi F, Mansori K, Moradi Y, Khosravi Shadmani F, Parang S, Khazaei Z. Determining the Survival Rate of Colorectal Cancer in Iran: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2018; 19:3009-3018. [PMID: 30484985 PMCID: PMC6318383 DOI: 10.31557/apjcp.2018.19.11.3009] [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] [Indexed: 12/24/2022] Open
Abstract
Objective: Colorectal cancer is one of the most common causes of death in the world. Despite of remarkable advances in medical sciences, cancer is an important disease and the second cause of death after cardiovascular diseases. The present study was aimed at determining the survival rate of colorectal cancer in Iran. Methods: The present study is a systematic review of national and international electronic databases. Studies that had the inclusion criteria were included in the study, electronically published articles over December 2007 and March 2015 were retrieved. The collected data were analyzed by meta-analytic method through stata 11.0 Software, and the survival rate was measured. Results: The 1-, 2-, 3-, 4-, and 5-year survival rates of colorectal cancer in Iran were respectively calculated as 85, 75.10, 65, 55.40, and 52. The results indicated that there is a significant relationship between anatomic location of tumor and survival rate. According to the results of this examination, survival rate of the patients with rectal cancer was 41.9 times higher than those with colorectal cancer. Conclusion: Due to the relative high prevalence of this cancer among young people in Iran and the low survival rate, early diagnosis of colorectal neoplasms is necessary before they become symptomatic through more effective diagnosis programs of enhancing the patients’ health and survival rate. Moreover, it is necessary to conduct more specialized and relevant studies in order to determine genetic or environmental causes of cancer such as diet and cultural and behavioral habits at the national level and with different ethnicities.
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Affiliation(s)
- Bahram Tahmasbi
- Health Sciences Research Center, Departman of Public Health, Mazandaran University of Medical Sciences, Sari, Iran.
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Prevost GA, Odermatt M, Furrer M, Villiger P. Postoperative morbidity of complete mesocolic excision and central vascular ligation in right colectomy: a retrospective comparative cohort study. World J Surg Oncol 2018; 16:214. [PMID: 30376849 PMCID: PMC6208021 DOI: 10.1186/s12957-018-1514-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND To investigate morbidity and mortality following complete mesocolic excision (CME) and central vascular ligation (CVL) in patients undergoing right colectomy. METHODS Data from consecutive patients undergoing elective right colectomy at a university-affiliated referral centre were retrospectively analysed. Patients who underwent conventional right-sided colonic cancer surgery (January 2001-April 2009, n = 84) were compared to patients who underwent CME/CVL (May 2009-January 2015, n = 71). The primary end point was anastomotic leak. Secondary end points were delayed gastric emptying, severe respiratory failure, mortality and length of hospital stay. RESULTS No significant difference was found in the rate of anastomotic leak (1.2% in the conventional versus 5.6% in the CME/CVL group, p = 0.108). Patients in the CME/CVL group had a higher 90-day mortality rate (7.0% versus 0.0%, p = 0.019). Four out of five deceased patients suffered from aspiration with consecutive respiratory failure. There was a tendency towards delayed gastric emptying in the CME/CVL group (12.7% versus 7.1%, p = 0.246). Clavien-Dindo complication grades ≥ 2 were similar in both groups with 16 (19%) in the conventional and 15 (21.1%) in the CME/CVL group (p = 0.747). CME/CVL patients had a shorter mean length of stay with 11 versus 14 days (p < 0.001). CONCLUSIONS Complete mesocolic excision with central vascular ligation in right colectomy seems to have a higher aspiration rate leading to severe respiratory failure and to higher mortality compared to conventional resection methods. Patient selection for this procedure may therefore be crucial.
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Affiliation(s)
- Gian Andrea Prevost
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, CH-7000, Chur, Switzerland. .,Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
| | - Manfred Odermatt
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, CH-7000, Chur, Switzerland
| | - Markus Furrer
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, CH-7000, Chur, Switzerland.,Private University of the Principality of Liechtenstein, Triesen, Principality of Liechtenstein
| | - Peter Villiger
- Department of Surgery, Kantonsspital Graubünden, Loëstrasse 170, CH-7000, Chur, Switzerland
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Recurrence Risk After Up-to-Date Colon Cancer Staging, Surgery, and Pathology: Analysis of the Entire Swedish Population. Dis Colon Rectum 2018; 61:1016-1025. [PMID: 30086050 DOI: 10.1097/dcr.0000000000001158] [Citation(s) in RCA: 125] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Developments in the quality of care of patients with colon cancer have improved surgical outcome and thus the need for adjuvant chemotherapy. OBJECTIVE To investigate the recurrence rate in a large population-based cohort after modern staging, surgery, and pathology have been implemented. DESIGN This was a retrospective registry study. SETTINGS Data from patients included in the Swedish Colorectal Cancer Registry covering 99% of all cases and undergoing surgery for colon cancer stages I to III between 2007 and 2012 were obtained. PATIENTS In total, 14,325 patients who did not receive any neoadjuvant treatment, underwent radical surgery, and were alive 30 days after surgery were included. MAIN OUTCOME MEASURES Tumor and node classification and National Comprehensive Cancer Network-defined risk factors for recurrence were used to assess overall and stage-specific 5-year recurrence rates. RESULTS The median follow-up of nonrecurrent cases was 77 months (range, 47-118 mo). The 5-year recurrence rate was 5% in stage I, 12% in stage II, and 33% in stage III patients. In patients classified as having pT3N0 cancer with no or 1 risk factor, the 5-year recurrence rates were 9% and 11%. Risk factors for shorter time to recurrence were male sex, more advanced pT and pN classification, vascular and perineural invasion, emergency surgery, lack of central ligature, short longitudinal resection margin, postoperative complications, and, in stage III, no adjuvant chemotherapy. LIMITATIONS The registry does not contain some recently identified factors of relevance for recurrence rates, and some late recurrences may be missing. CONCLUSIONS The recurrence rate is less than that previously observed in historical materials, but current, commonly used risk factors are still useful in evaluating recurrence risks. Stratification by pT and pN classification and the number of risk factors enables the identification of large patient groups characterized by such a low recurrence rate that it is questionable whether adjuvant treatment is motivated. See Video Abstract at http://links.lww.com/DCR/A663.
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An MS, Baik H, Oh SH, Park YH, Seo SH, Kim KH, Hong KH, Bae KB. Oncological outcomes of complete versus conventional mesocolic excision in laparoscopic right hemicolectomy. ANZ J Surg 2018; 88:E698-E702. [PMID: 29895094 DOI: 10.1111/ans.14493] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 02/05/2018] [Accepted: 02/25/2018] [Indexed: 12/25/2022]
Abstract
BACKGROUND Complete mesocolic excision (CME) has been proposed for colon cancer to improve oncological outcomes. The risks and benefits of laparoscopic CME have not been examined fully. We compared short- and long-term outcomes of CME with a conventional mesocolic excision (non-CME) in laparoscopic right hemicolectomy (RHC) for right-sided colon cancer. METHODS In total, 115 patients who underwent laparoscopic RHC with stage I-III right-sided colon cancer at Busan Paik Hospital from August 2007 to October 2011 were enrolled in this case-control study. Three trained colorectal surgeons reviewed videos of the surgeries; patients were divided into two groups: those who underwent a CME (CME group, n = 34) and those who underwent a conventional mesocolic excision (non-CME group, n = 81). RESULTS There was no significant difference between the CME and non-CME groups in operative time, post-operative complications, or hospital stay. However, the CME group had more lymph nodes harvested (P < 0.001) and lower blood loss (P = 0.016) versus the non-CME group. There was no difference in 5-year disease-free survival rate between the groups, but 5-year overall survival rate was 100% in the CME group and 89.49% in the non-CME group (P < 0.05). CONCLUSIONS Laparoscopic RHC with CME is safe and associated with better 5-year overall survival rate than non-CME for patients with stage I-III right-sided colon cancer. Implementation of CME surgery might improve oncological outcomes for patients with right-sided colon cancer.
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Affiliation(s)
- Min Sung An
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - HyungJoo Baik
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Se Hui Oh
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Yo-Han Park
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Sang Hyuk Seo
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Kwang Hee Kim
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Kwan Hee Hong
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
| | - Ki Beom Bae
- Department of Surgery, Busan Paik Hospital, College of Medicine, Inje University, Busan, South Korea
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Innos K, Reima H, Baburin A, Paapsi K, Aareleid T, Soplepmann J. Subsite- and stage-specific colorectal cancer trends in Estonia prior to implementation of screening. Cancer Epidemiol 2018; 52:112-119. [PMID: 29294434 DOI: 10.1016/j.canep.2017.12.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 12/11/2017] [Accepted: 12/22/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The occurrence of colorectal cancer (CRC) in Estonia has been characterised by increasing incidence, low survival and no screening. The study aimed to examine long-term incidence and survival trends of CRC in Estonia with specific focus on subsite and stage. METHODS We analysed CRC incidence and relative survival using Estonian Cancer Registry data on all cases of colorectal cancer (ICD-10 C18-21) diagnosed in 1995-2014. TNM classification was used to categorise stage. RESULTS Age-standardized incidence of colon cancer increased both in men and women at a rate of approximately 1% per year. Significant increase was seen for right-sided tumours, but not for left-sided tumours. Rectal cancer incidence increased significantly only in men and anal cancer incidence only in women. Age-standardized five-year relative survival for colon cancer increased from 50% in 1995-1999 to 59% in 2010-2014; for rectal cancer, from 38% to 56%. Colon cancer survival improved significantly for left-sided tumours (from 51% to 62%) and stage IV disease (from 6% to 15%). For rectal cancer, significant survival gain was seen for stage II (from 58% to 75%), stage III (from 34% to 70%) and stage IV (from 1% to 12%). CONCLUSION In the pre-screening era in Estonia, increase in colon cancer incidence was limited to right-sided tumours. Large stage-specific survival gain, particularly for rectal cancer, was probably due to better staging and advances in multimodality treatment. Nonetheless, more than one quarter of new CRC cases are diagnosed at stage IV, emphasising the need for an efficient screening program.
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Affiliation(s)
- Kaire Innos
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Heigo Reima
- Department of Surgical Oncology, Haematology and Oncology Clinic, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 51014 Tartu, Estonia.
| | - Aleksei Baburin
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Keiu Paapsi
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Tiiu Aareleid
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia.
| | - Jaan Soplepmann
- Department of Surgical Oncology, Haematology and Oncology Clinic, Tartu University Hospital, Puusepa 8, 51014 Tartu, Estonia; Institute of Clinical Medicine, University of Tartu, Puusepa 8, 51014 Tartu, Estonia.
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Rasulov AO, Malikhov AG, Rakhimov OA, Kozlov NA, Malikhova OA. [Short-term outcomes of complete mesocolic excision for right colon cancer]. Khirurgiia (Mosk) 2017:79-86. [PMID: 28805784 DOI: 10.17116/hirurgia2017879-86] [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] [Indexed: 02/06/2023]
Abstract
PURPOSE Complete mesocolic excision (CME) appears to be a relatively new concept for colon cancer. The purpose is to evaluate the results of CME with high vascular ligation (D3 lymph node dissection) for right colon cancer. The presented study identifies possible risks and advantages of the proposed method, as well as the role of the laparoscopic approach. MATERIAL AND METHODS The article included data from 39 patients with right colon cancer, TNM stage I-III, operated on between November 2015 and December 2016 in the oncoproctology Department of the Blokhin Cancer Research Center. The analysis of main intraoperative parameters, morbidity and mortality was carried out. RESULTS There was no postoperative mortality. 17 (43.6%) of operations were performed by open and 22 - by laparoscopic approach. The conversion for laparoscopic approach was 1 (4.5%) in 22. The median duration of the operation was 180 (130-260) minutes for laparoscopic approach and 120 (90-280) minutes for open approach, р=0.0056. Median intraoperative blood loss was 30 (30-300) ml for laparoscopic approach, and 300 (30-500) ml for open approach (р=0.0001). The duration of lymphorrhoea, time to first bowel movement, time to start liquid and solid food intake were 5.1±2.4, 1.3±0.5, 1.26±0.4 and 3.2±0.7 days, respectively. The median number of removed lymph nodes was 35.7 (6-68), the median number of metastatic lymph nodes was 1.9 (0-16). The median number of removed apical lymph nodes was 10.3 (0-24). Metastases did not affect any of the lymph nodes of the apical group. CONCLUSION Right mesocolic excision with D3 lymphadenectomy for right colon cancer is technically safe, and the laparoscopic approach provides all the benefits of minimally invasive surgery and excellent early treatment outcomes. Preliminary data shows no metastasis in apical lymphnodes for right colon cancer. Nonetheless, it is necessary to study the long-term results for the evaluation of oncological outcomes.
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Affiliation(s)
- A O Rasulov
- Proctology Department, Blokhin Russian Cancer Research Center, Health Ministry of Russia
| | - A G Malikhov
- Proctology Department, Blokhin Russian Cancer Research Center, Health Ministry of Russia
| | - O A Rakhimov
- Proctology Department, Blokhin Russian Cancer Research Center, Health Ministry of Russia
| | - N A Kozlov
- Department of Pathological Anatomy, Blokhin Russian Cancer Research Center
| | - O A Malikhova
- Endoscopic Department, Blokhin Russian Cancer Research Center, Health Ministry of Russia, Moscow, Russia
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Yang X, Wu Q, Jin C, He W, Wang M, Yang T, Wei M, Deng X, Meng W, Wang Z. A novel hand-assisted laparoscopic versus conventional laparoscopic right hemicolectomy for right colon cancer: study protocol for a randomized controlled trial. Trials 2017; 18:355. [PMID: 28747220 PMCID: PMC5530577 DOI: 10.1186/s13063-017-2084-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2016] [Accepted: 07/03/2017] [Indexed: 02/05/2023] Open
Abstract
Background Although conventional laparoscopic and hand-assisted laparoscopic surgery for colorectal cancer is widely used today, there remain many technical challenges especially for right colon cancer in obese patients. Herein, we develop a novel hand-assisted laparoscopic surgery (HALS) with complete mesocolic excision (CME), D3 lymphadenectomy, and a total “no-touch” isolation technique (HALS-CME) in right hemicolectomy to overcome these issues. According to previous clinic practice, this novel procedure is not only feasible and safe but has several technical merits. However, the feasibility, short-term minimally invasive virtues, long-term oncological superiority, and potential total “no-touch” isolation technique benefits of HALS-CME should be confirmed by a prospective randomized controlled trial. Methods/design This is a single-center, open-label, noninferiority, randomized controlled trial. Eligible participants will be randomly assigned to the HALS-CME group or to the laparoscopic surgery with CME, D3 lymphadenectomy, and total “no-touch” isolation technique (LAP-CME) group, or to conventional laparoscopic surgery with CME and D3 lymphadenectomy (cLAP) group at a 1:1:1 ratio using a centralized randomization list. Primary endpoints include safety, efficacy, and being oncologically clear, and 3-year disease-free, progression-free, and overall survival. Second endpoints include operative outcomes (operation time, blood loss, and incision length), pathologic evaluation (grading the plane of surgery, length of proximal and distal resection margins, distance between the tumor and the central arterial high tie, distance between the nearest bowel wall and the same high tie, area of mesentery resected, width of the chain of lymph-adipose tissue, length of the central lymph-adipose chain, number of harvested lymph nodes), and postoperative outcomes (pain intensity, postoperative inflammatory and immune responses, postoperative recovery). Discussion This trial will provide valuable clinical evidence for the feasibility, safety, and potential total “no-touch” isolation technique benefits of HALS-CME for right hemicolectomy. The hypothesis is that HALS-CME is feasible for the radical D3 resection of right colon cancer and offers short-term safety and long-term oncological superiority compared with conventional laparoscopic surgery. Trial registration ClinicalTrials.gov, NCT02625272. Registered on 8 December 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2084-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xuyang Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Chengwu Jin
- Department of Gastrointestinal Surgery, The Fifth People's Hospital of Chengdu, Chengdu, 611130, Sichuan Province, China
| | - Wanbin He
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Meng Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Tinghan Yang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Mingtian Wei
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Xiangbing Deng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Wenjian Meng
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Alley, Chengdu, 610041, Sichuan Province, China.
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28
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Snaebjornsson P, Jonasson L, Olafsdottir EJ, van Grieken NCT, Moller PH, Theodors A, Jonsson T, Meijer GA, Jonasson JG. Why is colon cancer survival improving by time? A nationwide survival analysis spanning 35 years. Int J Cancer 2017; 141:531-539. [PMID: 28477390 DOI: 10.1002/ijc.30766] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 03/26/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022]
Abstract
There is limited information present to explain temporal improvements in colon cancer survival. This nationwide study investigates the temporal changes in survival over a 35-year period (1970-2004) in Iceland and uses incidence, mortality, surgery rate, stage distribution, lymph node yield, tumor location and histological type to find explanations for these changes. Patients diagnosed with colon cancer in Iceland 1970-2004 were identified (n = 1962). All histopathology was reassessed. Proportions, age-standardized incidence and mortality, relative, cancer-specific and overall survival and conditional survival were calculated. When comparing first and last diagnostic periods (1970-1978 and 1997-2004), 5-year relative survival improved by 12% for men and 9% for women. At the same time surgery rate increased by 12% and the proportion of stage I increased by 9%. Stage-stratified, improved 5-year relative survival was mainly observed in stages II and III and coincided with higher lymph node yields, proportional reduction of stage II cancers and proportional increase of stage III cancers, indicating stage migration between these stages. Improvement in 1-year survival was mainly observed in stages III and IV. Five-year survival improvement for patients living beyond 1 year was minimum to none. There were no changes in histology that coincided with neither increased incidence nor possibly influencing improved survival. Concluding, as a novel finding, 1-year mortality, which previously has been identified as an important variable in explaining international survival differences, is in this study identified as also being important in explaining temporal improvements in colon cancer survival in Iceland.
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Affiliation(s)
- Petur Snaebjornsson
- Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Larus Jonasson
- Department of Pathology, National University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | - Pall H Moller
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Surgery, National University Hospital, Iceland
| | - Asgeir Theodors
- Department of Gastroenterology, National University Hospital, Iceland
| | - Thorvaldur Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Department of Surgery, National University Hospital, Iceland
| | - Gerrit A Meijer
- Department of Pathology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jon G Jonasson
- Department of Pathology, National University Hospital, Reykjavik, Iceland.,Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Icelandic Cancer Registry, Icelandic Cancer Society, Reykjavik, Iceland
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29
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Rasouli MA, Moradi G, Roshani D, Nikkhoo B, Ghaderi E, Ghaytasi B. Prognostic factors and survival of colorectal cancer in Kurdistan province, Iran: A population-based study (2009-2014). Medicine (Baltimore) 2017; 96:e5941. [PMID: 28178134 PMCID: PMC5312991 DOI: 10.1097/md.0000000000005941] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/19/2016] [Accepted: 12/27/2016] [Indexed: 01/05/2023] Open
Abstract
Colorectal cancer (CRC) survival varies at individual and geographically level. This population-based study aimed to evaluating various factors affecting the survival rate of CRC patients in Kurdistan province.In a retrospective cohort study, patients diagnosed as CRC were collected through a population-based study from March 1, 2009 to 2014. The data were collected from Kurdistan's Cancer Registry database. Additional information and missing data were collected reference to patients' homes, medical records, and pathology reports. The CRC survival was calculated from the date of diagnosis to the date of cancer-specific death or the end of follow-up (cutoff date: October 2015). Kaplan-Meier method and log-rank test were used for the univariate analysis of survival in various subgroups. The proportional-hazard model Cox was also used in order to consider the effects of different factors on survival including age at diagnosis, place of residence, marital status, occupation, level of education, smoking, economic status, comorbidity, tumor stage, and tumor grade.A total number of 335 patients affected by CRC were assessed and the results showed that 1- and 5-year survival rate were 87% and 33%, respectively. According to the results of Cox's multivariate analysis, the following factors were significantly related to CRC survival: age at diagnosis (≥65 years old) (HR 2.08, 95% CI: 1.17-3.71), single patients (HR 1.62, 95% CI: 1.10-2.40), job (worker) (HR 2.09, 95% CI: 1.22-3.58), educational level: diploma or below (HR 0.61, 95% CI: 0.39-0.92), wealthy economic status (HR 0.51, 95% CI: 0.31-0.82), tumor grade in poorly differentiated (HR 2.25, 95% CI: 1.37-3.69), and undifferentiated/anaplastic grade (HR 2.90, 95% CI: 1.67-4.98).We found that factors such as low education, inappropriate socioeconomic status, and high tumor grade at the time of disease diagnosis were effective in the poor survival of CRC patients in Kurdistan province; this, which need more attention.
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Affiliation(s)
- Mohammad Aziz Rasouli
- Student Research Committee
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Ghobad Moradi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Daem Roshani
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
| | - Bahram Nikkhoo
- Department of Pathology, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Ebrahim Ghaderi
- Social Determinants of Health Research Center
- Department of Epidemiology and Biostatistics, Faculty of Medicine
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30
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Mehdawi L, Osman J, Topi G, Sjölander A. High tumor mast cell density is associated with longer survival of colon cancer patients. Acta Oncol 2016; 55:1434-1442. [PMID: 27355473 DOI: 10.1080/0284186x.2016.1198493] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Inflammatory cells and inflammatory mediators play an important role in colorectal cancer (CRC). Previous studies have shown that CRC patients with increased expression of cysteinyl leukotriene receptor 1 (CysLTR1) have a poorer prognosis, and Cysltr1-/- mice display fewer intestinal polyps. However, the role of mast cells (MCs) in colon cancer progression remains unclear. The aim of the present study was to explore the relevance of MCs in CRC. MATERIAL AND METHODS A tissue microarray from 72 CRC patients was stained with MC anti-tryptase and -chymase antibodies. Mouse colon tissue was stained with MC anti-tryptase antibody. Immunohistochemistry was used to identify MCs in patients and mice. RESULTS Patient colon cancer tissue had in comparison with normal colon tissue a reduced number of MCs, predominantly of chymase-positive cells. Further analysis revealed that patients with a relative high MCD in their cancer tissues showed significantly longer overall survival compared to those with a low MCD [hazard ratio (HR) 0.539; 95% confidence interval (CI), 0.302-0.961]. Similar results were observed in subgroups of patients with either no distant metastasis (p = 0.004), or <75 years (p = 0.015) at time of diagnosis. Multivariate Cox analysis showed that MCD independently correlated with reduced risk of death in colon cancer patients (HR 0.380; 95% CI 0.202-0.713). Additionally, a negative correlation was found between cytoplasmic CysLTR1 expression and number of MCs. In agreement, in the CAC mouse model, Cysltr1-/- mice showed significantly higher MCs in their polyp/tumor areas compared with wild-type mice. CONCLUSION A high MCD in cancer tissue correlated with longer patient survival independently from other risk factors for CRC. The concept that MCs have an anti-tumor effect in CRC is further supported by the findings of a negative correlation with CysLTR1 expression in patients and a high MCD in colon polyps/tumors from CysLTR1-/- mice.
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Affiliation(s)
- Lubna Mehdawi
- Division of Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Janina Osman
- Division of Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Geriolda Topi
- Division of Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Anita Sjölander
- Division of Cell and Experimental Pathology, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
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31
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Sugarbaker PH. Improving oncologic outcomes for colorectal cancer at high risk for local-regional recurrence with novel surgical techniques. Expert Rev Gastroenterol Hepatol 2016; 10:205-13. [PMID: 26643935 DOI: 10.1586/17474124.2016.1110019] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Despite innovation in surgical technology, colorectal adenocarcinoma is a disease process with a risk of local and regional progression of disease. This article seeks to identify patients with primary disease who are at high risk for minimal residual disease from cancer spread after resection. These are the patients who will profit from novel perioperative surgical treatments that will improve the clearance and containment of cancer cells disseminated prior to or at the time of the adenocarcinoma resection. Clinical factors that identify these patients at high risk for local recurrence and peritoneal metastases are presented. Data regarding novel surgical techniques that include perioperative cancer chemotherapy to provide more optimal treatment are described. The perioperative timing of the revised surgical options is emphasized.
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Affiliation(s)
- Paul H Sugarbaker
- a Center for Gastrointestinal Malignancies , MedStar Washington Hospital Center , Washington , DC , USA
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32
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Liska D, Stocchi L, Karagkounis G, Elagili F, Dietz DW, Kalady MF, Kessler H, Remzi FH, Church J. Incidence, Patterns, and Predictors of Locoregional Recurrence in Colon Cancer. Ann Surg Oncol 2016; 24:1093-1099. [PMID: 27812826 DOI: 10.1245/s10434-016-5643-z] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Locoregional recurrence (LR) in colon cancer is uncommon but often incurable, while the factors associated with it are unclear. The purpose of this study was to identify patterns and predictors of LR after curative resection for colon cancer. METHODS All patients who underwent colon cancer resection with curative intent between 1994 and 2008 at a tertiary referral center were identified from a prospectively maintained institutional database. The association of LR with clinicopathologic and treatment characteristics was determined using univariable and multivariable analyses. RESULTS A total of 1397 patients were included with a median follow-up of 7.8 years; 635 (45%) were female, and the median age was 69 years. LR was detected in 61 (4.4%) patients. Median time to LR was 21 months. On multivariable analysis, the independent predictors of LR were disease stage [hazard ratio (HR) for Stage II 4.6, 95% confidence interval (CI) 1.05-19.9, HR for Stage III 10.8, 95% CI 2.6-45.8], bowel obstruction (HR 3.8, 95% CI 1.9-7.4), margin involvement (HR 4.1, 95% CI 1.9-8.6), lymphovascular invasion (HR 1.9, 95% CI 1.06-3.5), and local tumor invasion (fixation to another structure, perforation, or presence of associated fistula, HR 2.2, 95% CI 1.1-4.5). Adjuvant chemotherapy was not associated with reduced LR in patients with either Stage II or Stage III tumors. CONCLUSIONS Adherence to oncologic surgical principles in colon cancer resection results in low rates of LR, which is associated with tumor-dependent factors. Recognition of these factors can help to determine appropriate postoperative surveillance.
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Affiliation(s)
- David Liska
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA.
| | - Luca Stocchi
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - Georgios Karagkounis
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - Faisal Elagili
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - David W Dietz
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - Matthew F Kalady
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - Hermann Kessler
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - Feza H Remzi
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
| | - James Church
- Department of Colorectal Surgery, Cleveland Clinic, Digestive Disease Institute, Cleveland, OH, USA
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33
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Sugarbaker PH. Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy in the management of gastrointestinal cancers with peritoneal metastases: Progress toward a new standard of care. Cancer Treat Rev 2016; 48:42-9. [PMID: 27347669 DOI: 10.1016/j.ctrv.2016.06.007] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/14/2022]
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34
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Solon JG, Cahalane A, Burke JP, Gibbons D, McCann JW, Martin ST, Sheahan K, Winter DC. A radiological and pathological assessment of ileocolic pedicle length as a predictor of lymph node retrieval following right hemicolectomy for caecal cancer. Tech Coloproctol 2016; 20:545-50. [PMID: 27231119 DOI: 10.1007/s10151-016-1483-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 04/12/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND In colon cancer, the number of harvested lymph nodes is critical for pathological staging. It has been proposed that the more central the mesenteric vascular ligation, the greater the nodal yield. The aim of the current study was to determine the association of radiological and pathological ileocolic pedicle length on nodal harvest following right hemicolectomy for caecal cancer. METHODS A series of 50 patients undergoing right hemicolectomy for adenocarcinoma underwent specimen evaluation. Preoperative computed tomography images were reconstructed and analysed to determine the direct (vessel origin to caecum) ileocolic pedicle length. RESULTS The median pathological distance from the tumour to the high vascular tie was 80 mm, and median nodal yield was 16.5 nodes. Radiological pedicle length did not correlate with the pathological distance from the tumour to the high vascular tie or nodal yield; however, the pathological pedicle length did correlate with the total nodal yield (r (2): 0.343, p = 0.015). The median pathologically determined length of colon resected (r (2): 0.153, p = 0.289), ileum resected (r (2): 0.087, p = 0.568) and total specimen length resected (r (2): 0.182, p = 0.205) did not correlate with the total nodal yield. An ileal specimen length ≤25 mm [hazard ratio (HR) 14.8, 95 % confidence interval (CI) 1.1-194.5, p = 0.040] and a well-differentiated tumour (HR 10.5, 95 % CI 1.1-95.9, p = 0.037) increased the likelihood of retrieving <12 lymph nodes. CONCLUSIONS Based on these data, pathologic pedicle length is a determining factor in lymph node retrieval. Preoperative radiological calculation of pedicle length does not help predict the number of lymph nodes retrieved.
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Affiliation(s)
- J G Solon
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - A Cahalane
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J P Burke
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D Gibbons
- Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - J W McCann
- Department of Radiology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - S T Martin
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - K Sheahan
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.,Department of Pathology, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - D C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland. .,Department of Colorectal Surgery, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland.
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35
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Differential effects of patient-related factors on the outcome of radiation therapy for rectal cancer. ACTA ACUST UNITED AC 2016; 5:279-286. [PMID: 27746859 DOI: 10.1007/s13566-016-0245-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The objective of this study was to investigate whether cancer specific survival in rectal cancer patients is affected by patient-related factors, conditional on radiation treatment. METHODS 359 invasive rectal cancer patients who consented and provided questionnaire data for a population-based case-control study of colorectal cancer in Metropolitan Detroit were included in this study. Their vital status was ascertained through to the population-based cancer registry. Hazard ratios (HR) for cancer specific and other deaths and 95% confidence intervals (CIs) were calculated according to selected patients' characteristics, stratified by radiation status, using joint Cox proportional hazards models. RESULTS A total of 159 patients were found to be deceased after the median follow-up of 9.2 years, and 70% of them were considered to be cancer specific. Smoking and a history of diabetes were associated with an increased probability of deaths from other causes (HR 3.20, 95% CI 1.72-5.97 and HR 2.02, 95% CI 0.98-4.16, respectively), while regular use of non-steroidal anti-inflammatory drugs (NSAIDs) was inversely correlated with cancer-specific mortality (HR 0.50, 95% CI 0.30-0.81). Furthermore, the associations of smoking and NSAIDs with the two different types of deaths (cancer vs others) significantly varied with radiation status (P-values for the interactions= 0.014 for both). In addition, we observed a marginally significantly reduced risk of cancer specific deaths in the patients who had the relative ketogenic diet overall (HR=0.49, 95% 0.23-1.02). CONCLUSION Further research is warranted to confirm these results in order to develop new interventions to improve outcome from radiation treatment.
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36
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Sammartino P, Biacchi D, Cornali T, Cardi M, Accarpio F, Impagnatiello A, Sollazzo BM, Di Giorgio A. Proactive Management for Gastric, Colorectal and Appendiceal Malignancies: Preventing Peritoneal Metastases with Hyperthermic Intraperitoneal Chemotherapy (HIPEC). Indian J Surg Oncol 2016; 7:215-24. [PMID: 27065712 DOI: 10.1007/s13193-016-0497-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/20/2016] [Indexed: 12/20/2022] Open
Abstract
An integrated treatment strategy using peritonectomy procedures plus hyperthermic intraperitoneal chemotherapy (HIPEC) is now a clinical standard of care in selected patients with peritoneal metastases and primary peritoneal tumors. This comprehensive approach can offer many patients, who hitherto had no hope of cure, a good quality of life and survival despite limited morbidity. The increasingly successful results and chance of interfering in the natural history of disease has prompted research to develop for some clinical conditions a therapeutic strategy designed to prevent malignant peritoneal dissemination before it becomes clinically evident and treat it microscopically (tertiary prevention). The main factor governing successful cytoreductive surgery and predicting outcome is the extent of peritoneal spread assessed with the peritoneal cancer index (PCI). In peritoneal metastases from colorectal and gastric cancer the PCI score acquires a specific role acting as the cut-off between patients who can undergo curative surgery or palliation. Long-term results show that the only group enjoying favorable results are patients with limited disease (a statistical minority). By applying to appropriately selected patients with primary malignancies a proactive management strategy including HIPEC we can treat patients with microscopic peritoneal dissemination and therefore at PCI 0. Among treated conditions pseudomyxoma peritonei enjoys the best results. But a major future advance comes from identifying among lesions at major risk of pseudomyxoma.
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Affiliation(s)
- Paolo Sammartino
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Daniele Biacchi
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Tommaso Cornali
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Maurizio Cardi
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Fabio Accarpio
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Alessio Impagnatiello
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Bianca Maria Sollazzo
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
| | - Angelo Di Giorgio
- Department of Surgery P. Valdoni, University of Rome "Sapienza", Viale del Policlinico 155, 00186 Rome, Italy
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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 416] [Impact Index Per Article: 52.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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Adams K, Higgins L, Beazley S, Papagrigoriadis S. Intensive surveillance following curative treatment of colorectal cancer allows effective treatment of recurrence even if limited to 4 years. Int J Colorectal Dis 2015; 30:1677-84. [PMID: 26320020 DOI: 10.1007/s00384-015-2356-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/02/2015] [Indexed: 02/04/2023]
Abstract
BACKGROUND Current evidence suggests a survival benefit to post-operative surveillance following curative colorectal cancer resection; however, there is still no consensus on the optimal duration and form. OBJECTIVES The objective is to prospectively audit outcomes of an intensive colorectal cancer follow-up scheme for time to recurrence and survival. METHODS We used a surveillance protocol designed to incorporate regular clinical, biochemical, radiological and endoscopic measures at pre-defined intervals. SETTING The setting was a Department of Colorectal Surgery in a Tertiary Academic Centre. Follow-up was led by specially trained colorectal nurses in conjunction with surgeons. PATIENTS Consecutive patients who had undergone curative treatment for colorectal cancer were included in this study. MAIN OUTCOMES Outcomes were measured in terms of overall survival and disease recurrence. RESULTS There were 436 patients entered into follow-up, all treated with curative intent. Mean age 65.9 years (SD 12.9 years) and 240 male (55.0 %). Ninety-four patients (21.5 %) with stage I disease, 119 (27.3 %) stage IIa, 30 (6.9 %) stage IIb, 18 (4.1 %) stage IIIa, 78 (17.9 %) stage IIIb, 45 (10.4 %) stage IIIc and 52 (11.9 %) stage IV. Overall median survival was 37.5 months for all patients, (range 0.0-207.8 months). Ninety-two (21.1 %) cancer-related deaths were recorded during the course of the study. The overall 5-year actuarial cancer-related survival was 81.7 %. There was a 40.3 % 5-year actuarial survival was recorded in patients with 39 a recurrence, 57.7 % in patients treated with further curative 40 intent and 27.7 % in patients who received palliative treatment 41 (P < 0.001). Ninety-seven percent of recurrences were detected within 4 years of curative treatment. CONCLUSIONS This follow-up protocol confers an 81 % overall 5-year actuarial survival. Our study suggests that surveillance after curative resection can be limited to 4 years, which would lead to detection of over 97 % of all recurrences.
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Affiliation(s)
- Katie Adams
- Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK
| | - Lynne Higgins
- Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK
| | - Stella Beazley
- Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK
| | - Savvas Papagrigoriadis
- Department of Academic Colorectal Surgery, King's College Hospital, 2nd Floor Hambledon Wing, Denmark Hill, London, SE5 9RS, UK.
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Sugarbaker PH, Sammartino P, Tentes AA. Eradication of minimal residual disease in the perioperative period in primary colon cancer. COLORECTAL CANCER 2015. [DOI: 10.2217/crc.15.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Colon adenocarcinoma is a disease process with a risk of local and regional treatment failure. This review seeks to identify the subset of patients with advanced primary disease who are at high risk for minimal residual disease after resection. These are the patients who may benefit from perioperative chemotherapy treatment that will improve the clearance of a small number of cancer cells disseminated prior to or at the time of the adenocarcinoma cancer resection. The selection factors for identifying these patients at high risk for local recurrence and peritoneal metastases and the special treatments they require are presented in this manuscript.
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Affiliation(s)
- Paul H Sugarbaker
- Center for Gastrointestinal Malignancy, MedStar Washington Hospital Center, Washington, DC 20010, USA
| | - Paolo Sammartino
- Department of Surgery ‘Pietro Valdoni 6’, Azienda Policlinico Umberto I, Sapienza University of Rome, Viale del Policlinico 155, 00155, Rome, Italy
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Fischer J, Hellmich G, Jackisch T, Puffer E, Zimmer J, Bleyl D, Kittner T, Witzigmann H, Stelzner S, Jörg Z, Bleyl D, Dorothea B, Kittner T, Thomas K, Witzigmann H, Helmut W, Stelzner S, Sigmar S. Outcome for stage II and III rectal and colon cancer equally good after treatment improvement over three decades. Int J Colorectal Dis 2015; 30:797-806. [PMID: 25922143 DOI: 10.1007/s00384-015-2219-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to investigate the outcome for stage II and III rectal cancer patients compared to stage II and III colonic cancer patients with regard to 5-year cause-specific survival (CSS), overall survival, and local and combined recurrence rates over time. METHODS This prospective cohort study identified 3,355 consecutive patients with adenocarcinoma of the colon or rectum and treated in our colorectal unit between 1981 and 2011, for investigation. The study was restricted to International Union Against Cancer (UICC) stages II and III. Postoperative mortality and histological incomplete resection were excluded, which left 995 patients with colonic cancer and 726 patients with rectal cancer for further analysis. RESULTS Five-year CSS rates improved for colonic cancer from 65.0% for patients treated between 1981 and 1986 to 88.1% for patients treated between 2007 and 2011. For rectal cancer patients, the respective 5-year CSS rates improved from 53.4% in the first observation period to 89.8% in the second one. The local recurrence rate for rectal cancer dropped from 34.2% in the years 1981-1986 to 2.1% in the years 2007-2011. In the last decade of observation, prognosis for rectal cancer was equal to that for colon cancer (CSS 88.6 vs. 86.7%, p = 0.409). CONCLUSION Survival of patients with colon and rectal cancer has continued to improve over the last three decades. After major changes in treatment strategy including introduction of total mesorectal excision and neoadjuvant (radio)chemotherapy, prognosis for stage II and III rectal cancer is at least as good as for stage II and III colonic cancer.
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Affiliation(s)
- Joern Fischer
- Department of General and Visceral Surgery, Dresden-Friedrichstadt General Hospital, Teaching Hospital of the Technical University of Dresden, Dresden, Germany
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Andersson TML, Dickman PW, Eloranta S, Sjövall A, Lambe M, Lambert PC. The loss in expectation of life after colon cancer: a population-based study. BMC Cancer 2015; 15:412. [PMID: 25982368 PMCID: PMC4493988 DOI: 10.1186/s12885-015-1427-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Accepted: 05/06/2015] [Indexed: 12/03/2022] Open
Abstract
Background To demonstrate how assessment of life expectancy and loss in expectation of life can be used to address a wide range of research questions of public health interest pertaining to the prognosis of cancer patients. Methods We identified 135,092 cases of colon adenocarcinoma diagnosed during 1961–2011 from the population-based Swedish Cancer Register. Flexible parametric survival models for relative survival were used to estimate the life expectancy and the loss in expectation of life. Results The loss in expectation of life for males aged 55 at diagnosis was 13.5 years (95 % CI 13.2–13.8) in 1965 and 12.8 (12.4–13.3) in 2005. For males aged 85 the corresponding figures were 3.21 (3.15–3.28) and 2.10 (2.04–2.17). The pattern was similar for females, but slightly greater loss in expectation of life. The loss in expectation of life is reduced given survival up to a certain time point post diagnosis. Among patients diagnosed in 2011, 945 life years could potentially be saved if the colon cancer survival among males could be brought to the same level as for females. Conclusion Assessment of loss in expectation of life facilitates the understanding of the impact of cancer, both on individual and population level. Clear improvements in survival among colon cancer patients have led to a gain in life expectancy, partly due to a general increase in survival from all causes. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1427-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Therese M-L Andersson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden.
| | - Paul W Dickman
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden.
| | - Sandra Eloranta
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden.
| | - Annika Sjövall
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Center of Surgical Gastroenterology, Karolinska University Hospital, Stockholm, Sweden.
| | - Mats Lambe
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden. .,Regional Cancer Centre, Uppsala University Hospital, Uppsala, Sweden.
| | - Paul C Lambert
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Box 281, SE-171 77, Stockholm, Sweden. .,Department of Health Sciences, University of Leicester, Leicester, UK.
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Hoeffel C, Mulé S, Laurent V, Pierredon-Foulogne MA, Soyer P. Current imaging of rectal cancer. Clin Res Hepatol Gastroenterol 2015; 39:168-73. [PMID: 25178833 DOI: 10.1016/j.clinre.2014.07.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 02/04/2023]
Abstract
Recent advances in rectal cancer surgery and treatment as well as new developments in magnetic resonance imaging (MRI) technique have led to extensive research in the field of preoperative imaging of rectal cancer and to an abundant literature. Pelvic MRI has indeed become an important part of the decision-making process for patients with rectal cancer. The aim of this article is to give current guidelines in terms of which imaging method to perform and also to review the role of imaging, with emphasis on MRI, not only for tumor primary staging but also for reevaluation of the tumor after neoadjuvant therapy, highlighting the role of new so-called "functional MR techniques". Future trends are also discussed.
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Affiliation(s)
- Christine Hoeffel
- Department of Radiology, hôpital Robert-Debré, CHU de Reims, rue du Général-Kœnig, 51100 Reims, France.
| | - Sébastien Mulé
- Department of Radiology, hôpital Robert-Debré, CHU de Reims, rue du Général-Kœnig, 51100 Reims, France.
| | - Valérie Laurent
- Department of Adult Radiology, hôpitaux de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandœuvre-lès-Nancy cedex, France.
| | - Marie-Ange Pierredon-Foulogne
- Department of Medical Imaging, Saint-Éloi Hospital, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier, France.
| | - Philippe Soyer
- Department of Abdominal Imaging, hôpital Lariboisière, Assistance publique-Hôpitaux de Paris, 2, rue Ambroise-Paré, 75010 Paris, France.
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Brännström F, Bjerregaard JK, Winbladh A, Nilbert M, Revhaug A, Wagenius G, Mörner M. Multidisciplinary team conferences promote treatment according to guidelines in rectal cancer. Acta Oncol 2015; 54:447-53. [PMID: 25291075 DOI: 10.3109/0284186x.2014.952387] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Multidisciplinary team (MDT) conferences have been introduced into standard cancer care, though evidence that it benefits the patient is weak. We used the national Swedish Rectal Cancer Register to evaluate predictors for case discussion at a MDT conference and its impact on treatment. MATERIAL AND METHODS Of the 6760 patients diagnosed with rectal cancer in Sweden between 2007 and 2010, 78% were evaluated at a MDT. Factors that influenced whether a patient was discussed at a preoperative MDT conference were evaluated in 4883 patients, and the impact of MDT evaluation on the implementation of preoperative radiotherapy was evaluated in 1043 patients with pT3c-pT4 M0 tumours, and in 1991 patients with pN+ M0 tumours. RESULTS Hospital volume, i.e. the number of rectal cancer surgical procedures performed per year, was the major predictor for MDT evaluation. Patients treated at hospitals with < 29 procedures per year had an odds ratio (OR) for MDT evaluation of 0.15. Age and tumour stage also influenced the chance of MDT evaluation. MDT evaluation significantly predicted the likelihood of being treated with preoperative radiotherapy in patients with pT3c-pT4 M0 tumours (OR 5.06, 95% CI 3.08-8.34), and pN+ M0 (OR 3.55, 95% CI 2.60-4.85), even when corrected for co-morbidity and age. CONCLUSION Patients with rectal cancer treated at high-volume hospitals are more likely to be discussed at a MDT conference, and that is an independent predictor of the use of adjuvant radiotherapy. These results indirectly support the introduction into clinical practice of discussing all rectal cancer patients at MDT conferences, not least those being treated at low-volume hospitals.
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Affiliation(s)
- Fredrik Brännström
- Department of Surgical and Perioperative Sciences, Umeå University , Sweden
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Melich G, Jeong DH, Hur H, Baik SH, Faria J, Kim NK, Min BS. Laparoscopic right hemicolectomy with complete mesocolic excision provides acceptable perioperative outcomes but is lengthy--analysis of learning curves for a novice minimally invasive surgeon. Can J Surg 2015; 57:331-6. [PMID: 25265107 DOI: 10.1503/cjs.002114] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Associated with reduced trauma, laparoscopic colon surgery is an alternative to open surgery. Furthermore, complete mesocolic excision (CME) has been shown to provide superior nodal yield and offers the prospect of better oncological outcomes. METHODS All oncologic laparoscopic right colon resections with CME performed by a single surgeon since the beginning of his surgical practice were retrospectively analyzed for operative duration and perioperative outcomes. RESULTS The study included 81 patients. The average duration of surgery was 220.0 (range 206-233) minutes. The initial durations of about 250 minutes gradually decreased to less than 200 minutes in an inverse linear relationship (y = -0.58x × 248). The major complication rate was 3.6% ± 4.2% and the average nodal yield was 31.3 ± 4.1. CumulativeSum analysis showed acceptable complication rates and oncological results from the beginning of surgeon's laparoscopic career. CONCLUSION Developing laparoscopic skills can provide acceptable outcomes in advanced right hemicolectomy for a surgeon who primarily trained in open colorectal surgery. Operative duration is nearly triple that reported for conventional laparoscopic right hemicolectomy. The slow operative duration learning curve without a plateau reflects complex anatomy and the need for careful dissection around critical structures. Should one wish to adopt this strategy either based on some available evidence of superiority or with intention to participate in research, one has to change the view of right hemicolectomy being a rather simple case to being a complex, lengthy laparoscopic surgery.
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Affiliation(s)
- George Melich
- The Jewish General Hospital, McGill University, Montréal, Que
| | - Duck Hyoun Jeong
- The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyuk Hur
- The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Seung Hyuk Baik
- The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Julio Faria
- The Jewish General Hospital, McGill University, Montréal, Que
| | - Nam Kyu Kim
- The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea
| | - Byung Soh Min
- The Department of Surgery, Yonsei University College of Medicine, Seoul, South Korea, and the Robot and Minimally Invasive Surgery Center, Yonsei University Health System, Seoul, South Koreaa
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Rawat N, Evans MD. Paradigm shift in the management of rectal cancer. Indian J Surg 2015; 76:474-81. [PMID: 25614723 DOI: 10.1007/s12262-014-1089-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Accepted: 04/23/2014] [Indexed: 12/15/2022] Open
Abstract
Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).
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Affiliation(s)
- Nihit Rawat
- Advanced Pelvic Oncology Fellow, Swansea Colorectal Unit, Swansea, UK
| | - Martyn D Evans
- Swansea Colorectal Unit, Colorectal Surgeon, Morriston Hospital, Heol Maes Eglwys,, Morriston, Swansea, SA6 6NL UK
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Tsar'kov PV, Efetov SK, Tulina IA, Kravchenko AY, Fedorov DN, Efetov SV. [Survival rate after D3-lymphadenectomy for right-sided colic cancer: case-match study]. Khirurgiia (Mosk) 2015:72-79. [PMID: 26978766 DOI: 10.17116/hirurgia20151272-79] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
UNLABELLED The aim of the study was to compare the effectiveness of D3-lymphadenectomy in compliance with «no-touch» principle and mesocolectomy with traditional hemicolectomy in patients with right-sided colon cancer. MATERIAL AND METHODS It is retrospective-prospective comparative case-match study. From prospectively collected database patients with right-sided colon cancer stage I-III treated in 2009-2013 without adjuvant chemotherapy were selected. Patients who underwent conventional right-sided hemicolectomy with D2-lymphadenectomy in the regional oncologic dispensary formed the first group. The second group included patients after right-sided hemicolectomy with D3-lymphadenectomy, «no-touch» principle and mesocolectomy performed in academic hospital of the third level. From both groups 'case-match' patients by gender, age, stage and location of primary tumor were selected. Each group consisted of 50 patients. RESULTS Overall and cancer-related 5-year survival was significantly higher in the second group - 80.9% vs. 56.0% (p=0.01) and 93.4% vs. 59.8% (p=0.01), respectively. CONCLUSION D3-lymphadenectomy and mesocolectomy for right-sided colon cancer stage I-III without adjuvant chemotherapy provides significantly better overall and cancer-related 5-year survival compared with conventional right-sided hemicolectomy. Thus, D3-lymphadenectomy and mesocolectomy in compliance with «no-touch» principle for right-sided colon cancer is reproducible and effective in Russian conditions.
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Affiliation(s)
- P V Tsar'kov
- Chair of Coloproctology and Endoscopic Surgery, I.M. Sechenov First Moscow State Medical University
| | - S K Efetov
- Chair of Coloproctology and Endoscopic Surgery, I.M. Sechenov First Moscow State Medical University
| | - I A Tulina
- Chair of Coloproctology and Endoscopic Surgery, I.M. Sechenov First Moscow State Medical University
| | - A Yu Kravchenko
- Chair of Coloproctology and Endoscopic Surgery, I.M. Sechenov First Moscow State Medical University
| | - D N Fedorov
- Department of Pathological Anatomy, acad. B.V. Petrovsky Russian Research Center of Surgery of RAS, Moscow
| | - S V Efetov
- Department of Abdominal Oncology, V.M. Efetov Clinical Oncology Dispensary, Simferopol, Republic of Crimea
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Chow CFK, Kim SH. Laparoscopic complete mesocolic excision: West meets East. World J Gastroenterol 2014; 20:14301-14307. [PMID: 25339817 PMCID: PMC4202359 DOI: 10.3748/wjg.v20.i39.14301] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 04/07/2014] [Accepted: 06/13/2014] [Indexed: 02/07/2023] Open
Abstract
Complete mesocolic excision is a relatively new concept in western literature. It follows the same concept of total mesorectal excision and units’ routinely performing complete mesocolic excisions have good pathological results as well as good improvements in overall survival, disease free survival and local recurrence. And yet unlike total mesorectal excision, uptake in the West has been relatively slow with many units sceptical of the true benefits gained by taking up a more technically challenging and potentially more morbid procedure when there is a paucity of literature to support these claims. This article reviews complete mesocolic excision for colon cancer, attempting to identify the risks and benefits of the technique and particularly looking at the reasons why its uptake has not been universal. It also discusses the similarities of a complete mesocolic excision to a colon resection with a D3 lymphadenectomy as well as the role of a laparoscopic approach to this technique. Considering a D3 lymphadenectomy has been the standard of care for stage II and III colon cancers in many of our Asian neighbours for over 20 years, combining this data with data on complete mesocolic excision may provide enough evidence to support or refute the need for complete mesocolic excisions. Maybe there might be lessons to be learnt from our colleagues in the east.
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West NP, Kennedy RH, Magro T, Luglio G, Sala S, Jenkins JT, Quirke P. Morphometric analysis and lymph node yield in laparoscopic complete mesocolic excision performed by supervised trainees. Br J Surg 2014; 101:1460-7. [PMID: 25139143 DOI: 10.1002/bjs.9602] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 06/04/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Complete mesocolic excision with central vascular ligation (CME) produces an optimal colonic cancer specimen. The ability of expert laparoscopic surgeons to produce equivalent specimens is unknown. METHODS Fresh specimen photographs and clinicopathological data from patients undergoing laparoscopically assisted CME at St Mark's Hospital, Harrow, were submitted for independent pathological review. Surgery was performed by a mixture of consultant specialists and trainees under consultant specialist supervision, between February 2010 and July 2011. The planes of surgery were graded and tissue morphometry was performed using standard methods. The results were compared with published data from open CME and non-CME surgery. RESULTS In total, 69 patients were identified, and in 96 per cent resection was performed completely or partially by surgical trainees. Laparoscopic CME produced a similar specimen to open CME. The laparoscopic mesocolic plane resection rate was similar to that for open surgery (90 versus 88 per cent). The distance between the bowel wall and site of vascular division was similar for laparoscopic and open right-sided CME (92 versus 95 mm respectively). The corresponding values for left-sided CME were also similar (103 versus 107 mm). Compared with values from two non-CME series, laparoscopic CME had a higher mesocolic plane rate (90 versus 40 and 48 per cent), and resected more tissue between the bowel wall and the vascular division (right-sided: 92 versus 72 and 76 mm; left-sided: 103 versus 85 and 70 mm). The lymph node yield remained low following laparoscopic CME compared with open CME (median 18 versus 32; P < 0·001) and identical to that of non-CME surgery (median 18). CONCLUSION Laparoscopic CME can be performed to the same standard as open surgery by supervised trainees. However, this did not increase the lymph node yield.
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Affiliation(s)
- N P West
- Pathology and Tumour Biology, Leeds Institute of Cancer and Pathology, School of Medicine, University of Leeds, St James's University Hospital, Leeds, UK
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Breugom A, Boelens P, van den Broek C, Cervantes A, Van Cutsem E, Schmoll H, Valentini V, van de Velde C. Quality assurance in the treatment of colorectal cancer: the EURECCA initiative. Ann Oncol 2014; 25:1485-92. [DOI: 10.1093/annonc/mdu039] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Nakajima K, Inomata M, Akagi T, Etoh T, Sugihara K, Watanabe M, Yamamoto S, Katayama H, Moriya Y, Kitano S. Quality control by photo documentation for evaluation of laparoscopic and open colectomy with D3 resection for stage II/III colorectal cancer: Japan Clinical Oncology Group Study JCOG 0404. Jpn J Clin Oncol 2014; 44:799-806. [PMID: 25084776 DOI: 10.1093/jjco/hyu083] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE The quality of surgery with D3 resection in randomized controlled clinical trial [Japan Clinical Oncology Group study (JCOG0404)] was assessed by evaluation of the photo documentation of both open and laparoscopic surgeries. METHODS A multi-institutional randomized-controlled trial (JCOG0404) was conducted to evaluate open and laparoscopic D3 resection (complete mesocolic excision + ligation and dissection at the root of the main vessels) for Stage II/III colon cancer (UMIN-CTR number C000000105). A total of 1057 (open, 528; laparoscopic, 529) eligible patients were enrolled. For quality control, it was ensured that the surgeries were performed by accredited surgeons, and a central committee reviewed each surgery on the basis of the submitted photographs of the resected field, specimen and skin incision. RESULTS For right-sided tumors, the rate of D3 resection was 98.5% (131/133) in the open arm and 100% (136/136) in the laparoscopic arm, and for left-sided tumors, they were 97.9% (322/329) and 98.2% (320/326), respectively. Sufficient length of the resected longitudinal margin was ensured in all cases. The skin incisions made in all the cases were <8 cm as defined in the protocol in laparoscopic arm. CONCLUSIONS Completion of high quality surgery with D3 resection was confirmed in JCOG0404 by central peer review of photographs of the surgical procedures in addition to operator regulations. This study suggests that the central review of the photo documentation is one of the important tools to assure a quality control of surgical technique in the Phase III randomized-controlled study.
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Affiliation(s)
- Kentaro Nakajima
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Oita
| | - Kenichi Sugihara
- Department of Surgical Oncology, Tokyo Medical and Dental University, Tokyo
| | | | | | - Hiroshi Katayama
- JCOG Data Center, Multi-institutional Clinical Trial Support Center, National Cancer Center, Tokyo
| | - Yoshihiro Moriya
- Division of Colorectal Surgery, National Cancer Center Hospital, Tokyo
| | - Seigo Kitano
- Oita University Faculty of Medicine, Oita, Japan
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