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Varlamos CJ, Sinco B, Van Weiren I, Regenbogen S, Gamboa AC, Silviera M, Abdel-Misih SRZ, Hawkins AT, Balch G, Hendren S. Close distal margin is associated with locoregional rectal cancer recurrence: A multicenter study. J Surg Oncol 2023; 128:1106-1113. [PMID: 37458131 DOI: 10.1002/jso.27401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The importance of the radial margin for rectal cancer resection is well understood. However, surgeons have deemphasized the distal margin, accepting very close distal margins to perform sphincter-preserving surgery. We hypothesized that distal margins < 1 cm would be an independent risk factor for locoregional recurrence. The objective was to determine whether close distal margins are associated with increased locoregional recurrence risk. METHODS This was a multi-institutional retrospective cohort study conducted at six academic medical centers including patients who received low anterior resection surgery for primary rectal cancer between 2007 and 2018. RESULTS Of 556 low anterior resection patients, the rate of close distal margin was 12.8% (n = 71), and the locoregional recurrence rate was 5.0% (n = 28). The locoregional recurrence rate for close distal margin cases was 9.9% (n = 7) compared to 4.3% (n = 21) for distal margins ≥1.0 cm. In multivariable analysis, the only factor significantly associated with locoregional recurrence was close distal margin (adjusted odds ratio: 2.80, confidence interval: 1.08-7.25, p = 0.035). CONCLUSIONS Rectal cancer patients with close distal margins (<1 cm) following low anterior resection had a significantly higher risk for locoregional recurrence. Therefore, the decision to perform low anterior resection with margins < 1 cm should be taken with caution.
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Affiliation(s)
| | - Brandy Sinco
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Inga Van Weiren
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott Regenbogen
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Adriana C Gamboa
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Silviera
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sherif R Z Abdel-Misih
- Department of Surgery (Surgical Oncology), Stony Brook University Hospital, Stony Brook, New York, USA
| | - Alexander T Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Glen Balch
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samantha Hendren
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
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2
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Řezáč T, Špička P, Zbořil P, Stašek M, Vrba R, Klos D. Effect of reinforcement suture on anastomotic healing in rectal and sigmoid tumor resections, single-center experience: a retrospective case-controlled study. Ann Coloproctol 2023; 39:139-146. [PMID: 35272450 PMCID: PMC10169550 DOI: 10.3393/ac.2021.00948.0135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/07/2022] [Accepted: 02/07/2022] [Indexed: 10/18/2022] Open
Abstract
PURPOSE Healing of colorectal anastomosis is burdened with a number of risk factors and the development of leak carries with it higher morbidity and mortality associated not only with worse quality of life but also worse oncological outcomes. The purpose of the study was an evaluation of the effect of reinforcement suture in the healing of stapler rectal anastomosis and risk factors for anastomotic leakage in mid, upper rectal and sigmoid tumors. METHODS A total of 357 patients who underwent curative resection for rectal or sigmoid tumor over 5 years were analyzed. Risk factors, baseline demographic and clinical data, and presence of leak were recorded. All statistical analyses were carried out at a significance level of P<0.05. RESULTS One hundred fifty-one patients met the inclusion criteria for the study. The overall incidence of leak was 2.8% in the group with reinforcement suture and 6.3% in the group without reinforcement suture. Because of the low incidence of leak the results were not statistically significant. Further results also show that none of the monitored parameters (age, weight, body mass index, tumor distance, preoperative radiotherapy, tumor stage, type of surgery) were significant predictors of anastomotic leakage. CONCLUSION Although the reinforcement suture is a safe and simple option for anastomosis protection after rectal or sigmoid resections, its statistical significance was not demonstrated in our study.
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Affiliation(s)
- Tomáš Řezáč
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Petr Špička
- Department of Surgery I, University Hospital Olomouc, Olomouc, Czech Republic
| | - Pavel Zbořil
- Department of Surgery I, University Hospital Olomouc, Olomouc, Czech Republic
| | - Martin Stašek
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
| | - Radek Vrba
- Department of Surgery I, University Hospital Olomouc, Olomouc, Czech Republic
| | - Dušan Klos
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic
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3
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Kassam Z, Lang R, Bates DDB, Chang KJ, Fraum TJ, Friedman KA, Golia Pernicka JS, Gollub MJ, Harisinghani M, Khatri G, Lall C, Lee S, Magnetta M, Nougaret S, Paspulati RM, Paroder V, Shaish H, Kim DH. SAR user guide to the rectal MR synoptic report (primary staging). ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:186-199. [PMID: 35754053 DOI: 10.1007/s00261-022-03578-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 01/21/2023]
Abstract
Rectal MR is the key diagnostic exam at initial presentation for rectal cancer patients. It is the primary determinant in establishing clinical stage for the patient and greatly impacts the clinical decision-making process. Consequently, structured reporting for MR is critically important to ensure that all required information is provided to the clinical care team. The SAR initial staging reporting template has been constructed to address these important items, including locoregional extent and factors impacting the surgical approach and management of the patient. Potential outputs to each item are defined, requiring the radiologist to commit to a result. This provides essential information to the surgeon or oncologist to make specific treatment deisions for the patient. The SAR Initial Staging MR reporting template has now been officially adopted by the NAPRC (National Accreditation Program for Rectal Cancer) under the American College of Surgery. With the recent revisions to the reporting template, this user guide has been revamped to improve its practicality and support to the radiologist to complete the structured report. Each line item of the report is supplemented with clinical perspectives, images, and illustrations to help the radiologist understand the potential implications for a given finding. Common errors and pitfalls to avoid are highlighted. Ideally, rectal MR interpretation should not occur in a vacuum but in the context of a multi-disciplinary tumor board to ensure that healthcare providers use common terminology and share a solid understanding of the strengths and weaknesses of MR.
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Affiliation(s)
- Z Kassam
- Western University, London, Canada
| | - R Lang
- Western University, London, Canada
| | | | | | - T J Fraum
- Mallinckrodt Institute of Radiology, St. Louis, USA
| | - K A Friedman
- University Hospitals Cleveland Medical Center, Cleveland, USA
| | | | | | | | - G Khatri
- University of Texas Southwestern, Dallas, USA
| | - C Lall
- University of Florida-Jacksonville, Jacksonville, USA
| | - S Lee
- University of California, Irvine, USA
| | | | - S Nougaret
- Montpellier Cancer Institute, U1194, Montpellier University, Montpellier, France
| | - R M Paspulati
- University Hospital, Case Western Reserve University, Cleveland, USA
| | - V Paroder
- Memorial Sloan Kettering, New York, USA
| | - H Shaish
- Columbia University Medical Center, New York, USA
| | - D H Kim
- Department of Radiology, University of Wisconsin Medical School, University of Wisconsin, E3/311 Clinical Science Center, 600 Highland Ave., Madison, WI, 53792-3252, USA.
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4
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Metwally IH, Zuhdy M, Hamdy O, Fareed AM, Elbalka SS. The Impact of Narrow and Infiltrated Distal Margin After Proctectomy for Rectal Cancer on Patients' Outcomes: a Systematic Review and Meta-analysis. Indian J Surg Oncol 2022; 13:750-760. [PMID: 36687255 PMCID: PMC9845496 DOI: 10.1007/s13193-022-01565-z] [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] [Received: 10/22/2021] [Accepted: 06/09/2022] [Indexed: 01/25/2023] Open
Abstract
Rectal cancer is a common tumor within a difficult anatomic constraint. Total mesorectal excision with longitudinal and circumferential free margins is considered imperative for good prognosis. In this article, the authors systematically reviewed all published literature with specific Mesh terms until the end of year 2019. Thereafter, retrieved articles were assessed using the Newcastle-Ottawa Scale and meta-analysis was conducted comparing local recurrence among 1-cm, 5-mm, and narrow (< 1-mm)/infiltrated margins. Thirty-nine articles were included in the study. Macroscopic distal margin < 1 cm carried a higher incidence of recurrence for those who did not receive neoadjuvant radiation, without affecting neither estimated overall nor disease-free survival. Less than 5-mm margin after radiation therapy is accepted oncologically. Infiltrated margins and narrow margins (< 1 mm) microscopically are associated with higher incidence of local recurrence and shorter overall and disease-free survival. Surgeons should aim at 1-cm safety margin in radiotherapy-naïve patients and microscopic free margin > 1 mm for those who received neoadjuvant therapy. The cost/benefit of reoperation for patients with infiltrated margins is still inadequately studied.
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Affiliation(s)
- Islam H. Metwally
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Mohammad Zuhdy
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Omar Hamdy
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Ahmed M. Fareed
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Saleh S. Elbalka
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
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Effects of surgical approach on short- and long-term outcomes in early-stage rectal cancer: a multicenter, propensity score-weighted cohort study. Surg Endosc 2022; 36:5833-5839. [PMID: 35122149 DOI: 10.1007/s00464-022-09033-z] [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: 06/03/2021] [Accepted: 01/03/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Randomized controlled trials have been unable to demonstrate noninferiority of minimally invasive surgery for rectal cancer. The aim of this study was to assess oncologic resection success, short- and long-term morbidity, and overall survival by operative approach in a homogenous early-stage rectal cancer cohort. METHODS This is a multicenter, propensity score-weighted cohort study utilizing deidentified data from the National Cancer Database. Individuals who underwent a formal proctectomy for early-stage rectal cancer (T1-2, N0, M0) from 2010 to 2015 were included. The primary outcome was a composite variable indicating successful oncologic resection stratified by operative approach, defined as negative margins with at least 12 lymph nodes evaluated. RESULTS Among 3649 proctectomies for rectal adenocarcinoma, 1660 (45%) were approached open, 1461 (40%) laparoscopically, and 528 (15%) robotically. After propensity score weighting, compared to open approach, there were no differences in odds of successful oncologic resection (ORadj = 1.07, 95% CI 0.9, 1.28 and ORadj = 1.28, 95% CI 0.97, 1.7). Open approach was associated with longer mean (± SD) length of stay compared to laparoscopic (7.7 ± 0.18 vs. 6.5 ± 0.25 days, p < 0.001) and robotic (7.7 ± 0.18 vs. 6.3 ± 0.35 days, p < 0.001) approaches. In regard to 90-day mortality, compared to open approach, laparoscopic (ORadj = 0.56, 95% CI 0.36, 0.88) and robotic (ORadj = 0.45, 95% CI 0.22, 0.94) approaches were associated with a reduced odd of 90-day mortality. This mortality benefit persists in the long-term for laparoscopic approach (p = 0.003). CONCLUSION For individuals with early-stage rectal cancer treated with proctectomy, successful oncologic resection can be achieved irrespective of technical approach. Minimally invasive approaches provide short-term reduction in morbidity. Surgical approach must be tailored to each patient based on surgeon experience and judgement in collaboration with a multi-disciplinary team.
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Hrebinko KA, Reitz KM, Mohammed MK, Nassour I, Watson AR, Cunningham KE, Medich DS, Celebrezze JP, Holder-Murray JM. Transanal excision with adjuvant therapy for pT1N0 rectal tumors with high-risk features offers equivalent survival to radical resection: A National Cancer Database analysis. J Surg Oncol 2021; 125:475-483. [PMID: 34705273 DOI: 10.1002/jso.26734] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 10/19/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Current guidelines favor transabdominal radical resection (RR) over transanal local excision (TAX) followed by adjuvant therapy (TAXa) for pT1N0 rectal tumors with high-risk features. Comparison of oncologic outcomes between these approaches is limited, although the former is associated with increased postoperative morbidity. We hypothesize that such treatment strategies result in equivalent long-term survival. METHODS A retrospective cohort study was conducted using the National Cancer Database (2010-2016) to identify patients with pT1N0 rectal adenocarcinoma with high-risk features who underwent TAX or RR for curative intent. The primary outcome was 5-year overall survival (OS), evaluated with log-rank and Cox-proportional hazards testing. RESULTS A total of 1159 patients (age 67.4 ± 12.9 years; 56.6% male; 83.3% White) met study criteria, of which 1009 (87.1%) underwent RR and 150 (12.9%) underwent TAXa. Patients undergoing TAXa had shorter lengths of stay (RR = 6.5 days, TAXa = 2.7 days, p < 0.001). The 5-year OS was equivalent between groups. TAX without adjuvant therapy was associated with an increased risk of mortality (hazard ratio 1.81, 95% confidence interval 1.17-2.78, p = 0.01). CONCLUSIONS This is the largest study to demonstrate equivalent 5-year OS between TAXa and RR for T1N0 rectal cancer with high-risk features. These findings may guide the development of prospective, randomized trials and influence changes in practice recommendations for early-stage rectal cancer.
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Affiliation(s)
- Katherine A Hrebinko
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Katherine M Reitz
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Maryam K Mohammed
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Ibrahim Nassour
- Division of Surgical Oncology, Department of Surgery, University of Florida, Gainesville, Florida, USA
| | - Andrew R Watson
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Kellie E Cunningham
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - David S Medich
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - James P Celebrezze
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Jennifer M Holder-Murray
- Division of Colon and Rectal Surgery, Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
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7
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Lau LW, Kethman WC, Bingmer KE, Ofshteyn A, Steinhagen E, Charles R, Dietz D, Stein SL. Evaluating disparities in delivery of neoadjuvant guideline-based chemoradiation for rectal cancer: A multicenter, propensity score-weighted cohort study. J Surg Oncol 2021; 124:810-817. [PMID: 34159619 DOI: 10.1002/jso.26572] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/26/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Despite guideline recommendations, some patients still receive care inappropriate for their clinical stage of disease. Identification of factors that contribute to variation in guideline base care may help eradicate disparities in the treatment of early and locally advanced rectal cancer. METHODS The American College of Surgeons National Cancer Database from 2010 to 2015 was analyzed with propensity score weighting to identify factors associated with delivery and omission of neoadjuvant guideline-based chemoradiation (GBC) for those with early and locally advanced rectal cancer. RESULTS Only 74% of patients with rectal cancer received stage-appropriate neoadjuvant chemoradiation; 4544 (88%) of those with early stage disease and 8675 (68%) in locally advanced disease. Chemotherapy and radiotherapy were not planned in 27% and 34% respectively, of those who did not receive GBC. Factors associated with receipt of non-guideline-based neoadjuvant chemoradiation were age >65 years, Medicare insurance, treatment at a community facility, West-South-Central geography, having locally advanced disease, and Charlson-Deyo score >3. Receipt of ideal guideline-based neoadjuvant chemoradiation conferred a survival benefit at 5 years. CONCLUSION Patient and non-patient factors contribute to disparities in guideline-based delivery of neoadjuvant chemoradiation in the treatment of rectal cancer. Identification of these risk factors are important to help standardize care and improve survival outcomes.
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Affiliation(s)
- Lung W Lau
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - William C Kethman
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Katherine E Bingmer
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Asya Ofshteyn
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Emily Steinhagen
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ronald Charles
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - David Dietz
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Sharon L Stein
- UH RISES: Research in Surgical Outcomes and Effectiveness, Department of Surgery, Division of Colorectal Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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8
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Perez RO, Julião GPS, Proscurshim I, Sabbagh C, Grzona E, Lynn PB, Gama-Rodrigues J. Total mesorectal excision and sphincter preservation — the early steps of rectal cancer surgery. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2013.12.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
AbstractThe treatment of rectal cancer has evolved significantly over the last 100 years. Standardization of total mesorectal excision and the development of techniques for sphincter preservation have resulted in significant improvements in the management of this disease. Still, local disease control and functional outcomes of sphincter preserving procedures remain a relevant issue. In this historical paper, the oncological and functional outcomes of patients with rectal cancer treated between 1960 and 1971 by a pioneer woman surgeon using a sphincter preserving approach and a technique resembling total mesorectal excision performed at that time are reported. The results reflect one of the earliest steps of partial intersphincteric resection and total mesorectal excision with good oncological outcomes (2% local recurrence) and acceptable functional outcomes in a highly selected group of patients.
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Affiliation(s)
- Rodrigo O. Perez
- Colorectal Surgery Division, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil
| | | | | | | | - Esteban Grzona
- Angelita & Joaquim Gama Institute, São Paulo, SP, Brazil
| | | | - Joaqim Gama-Rodrigues
- Angelita & Joaquim Gama Institute, São Paulo, SP, Brazil
- Faculdade de Medicina, Universidade de São Paulo, SP, Brazil
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9
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Lim YJ, Song C, Jeon SH, Kim K, Chie EK. Risk Stratification Using Neoadjuvant Rectal Score in the Era of Neoadjuvant Chemoradiotherapy: Validation With Long-term Outcome Data. Dis Colon Rectum 2021; 64:60-70. [PMID: 33306532 DOI: 10.1097/dcr.0000000000001777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Despite the widespread use of neoadjuvant chemoradiotherapy, there is no prognostic surrogate marker established in locally advanced rectal cancer. OBJECTIVE This study evaluated the role of neoadjuvant rectal score as a prognostic factor to stratify individual-level risks of survival and tumor recurrence. DESIGN This is a retrospective study. SETTINGS This study was conducted at the Seoul National University Hospital. PATIENTS A total of 397 patients who underwent chemoradiotherapy plus total mesorectal excision were analyzed. INTERVENTIONS There was no intervention. MAIN OUTCOME MEASURES Harrell C statistic and receiver operating characteristic analysis, as well as Cox regression analysis, were used to assess the prognostic strength. RESULTS The low (<8), intermediate (8-16), and high (>16) neoadjuvant rectal score groups included 91 (23%), 208 (52%), and 98 patients (25%). A high neoadjuvant rectal score was independently associated with inferior overall survival and disease-free survival (p = 0.011 and 0.008). Regarding the prognostic models adjusted for neoadjuvant rectal score (I) and ypT/N stage (II), the c-index was higher in model I (0.799 and 0.787, p = 0.009 for overall survival; 0.752 and 0.743, p = 0.093 for disease-free survival). The predictive ability of the neoadjuvant rectal score was superior to tumor regression grade, ypT, and ypN in the receiver operating characteristic analyses (p < 0.05 for all). Adjuvant chemotherapy was associated with better overall and disease-free survival (p = 0.003 and 0.052) in the high neoadjuvant rectal score group. LIMITATIONS Potential selection bias attributed to the retrospective study design was a limitation. CONCLUSIONS We verified the applicability of the neoadjuvant rectal score to stratify the relapse risk at the individual level for patients with stage II/III rectal cancer undergoing neoadjuvant chemoradiotherapy. Additional studies are needed to validate the usability of neoadjuvant rectal score levels as a determinant of adjuvant strategy. See Video Abstract at http://links.lww.com/DCR/B354. ESTRATIFICACIÓN DE RIESGO UTILIZANDO LA PUNTUACIÓN RECTAL NEOADYUVANTE EN LA ERA DE LA QUIMIORRADIOTERAPIA NEOADYUVANTE: VALIDACIÓN CON DATOS DE RESULTADOS A LARGO PLAZO: A pesar del uso generalizado de la quimiorradioterapia neoadyuvante, no existe un marcador subrogado pronóstico establecido en el cáncer de recto localmente avanzado.Este estudio evaluó el papel de la puntuación rectal neoadyuvante como factor pronóstico para estratificar los riesgos a nivel individual de supervivencia y recurrencia tumoral.Este es un estudio retrospectivo.Este estudio se realizó en el Hospital de la Universidad Nacional de Seúl.Se analizaron un total de 397 pacientes que se sometieron a quimiorradioterapia más escisión mesorrectal total.No hubo intervención.El análisis estadístico C de Harrell y las características operativas del receptor, así como el análisis de regresión de Cox, se utilizaron para evaluar la fuerza pronóstica.Los grupos de puntaje rectal neoadyuvante bajo (<8), intermedio (8-16) y alto (> 16) incluyeron 91 (23%), 208 (52%) y 98 (25%) pacientes, respectivamente. Una puntuación rectal neoadyuvante alta se asoció independientemente con una supervivencia general y una supervivencia libre de enfermedad inferiores (p = 0.011 y 0.008, respectivamente). Con respecto a los modelos pronósticos ajustados por la puntuación rectal neoadyuvante (I) y el estadio ypT/N (II), el índice c fue mayor en el modelo I (0.799 y 0.787, p = 0.009 para la supervivencia general; 0.752 y 0.743, p = 0.093 para supervivencia libre de enfermedad). La capacidad predictiva de la puntuación rectal neoadyuvante fue superior al grado de regresión tumoral, ypT y ypN en los análisis de características operativas del receptor (p <0.05 para todos). La quimioterapia adyuvante se asoció con una mejor supervivencia global y libre de enfermedad (p = 0.003 y 0.052, respectivamente) en el grupo de puntaje rectal neoadyuvante alto.El sesgo de selección potencial debido al diseño retrospectivo del estudio fue la limitación.Verificamos la aplicabilidad de la puntuación rectal neoadyuvante para estratificar el riesgo de recurrencia a nivel individual para pacientes con cáncer rectal en estadio II/III sometidos a quimiorradioterapia neoadyuvante. Se necesitan más estudios para validar la usabilidad de los niveles de puntuación rectal neoadyuvante como determinante de la estrategia adyuvante. Consulte Video Resumen en http://links.lww.com/DCR/B354.
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Affiliation(s)
- Yu Jin Lim
- Department of Radiation Oncology, Kyung Hee University College of Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Changhoon Song
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Seung Hyuck Jeon
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyubo Kim
- Department of Radiation Oncology, Ewha University College of Medicine, Seoul, Republic of Korea
| | - Eui Kyu Chie
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Republic of Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
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10
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Haq I, Shakeel O, Amjad A, Ullah F, Ali H, Jamal A, Khattak S, Syed AA. Benefits of Outcomes of the Microscopic Examination of Anastomotic Donuts After Colorectal Resection for Oncological Purposes: A Medical Record-Based Study. Cureus 2020; 12:e7932. [PMID: 32494538 PMCID: PMC7265751 DOI: 10.7759/cureus.7932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective The objective of the study is to investigate the benefits of pathological assessment of donuts removed during coloanal anastomosis after anterior resection. Methodology During three years, 220 patients underwent circular stapled anastomosis. It is a retrospective study with convenient sampling. Involvement of donuts, the involvement of margins, length of donuts, and margins were primarily recorded. Ethical review approval was taken from the Institutional Review Board. Hospital electronic system was used to retrieve the data. Results Two hundred and twenty patients underwent circular end to end anastomosis (CEEA) stapled gun anastomosis. All had adenocarcinoma. Most of the patients had T3 disease (n=113). Low anterior resection was the most common procedure followed by anterior resection and sigmoid colectomy, respectively. We performed all rectal cancers anastomosis with a circular stapling gun. On histological analyses among 220 patients, only two patients were found to have a positive distal donut. No proximal donuts were positive. Both patients were also found to have positive distal margins. The mean length of the proximal donut was 1.79±0.45 cm. The mean length of the distal donut was 1.68±0.48 cm. Two distal margins and none of the proximal margins were positive for cancer. The mean length of the proximal margin was 8.69±4.48 cm. The mean length of the distal margin was 4.9±5.98 cm. Both patients had already received six months of pre-operative chemoradiotherapy and were not offered any additional treatment. Both patients were kept on close surveillance. Conclusion Routine analyses of the donuts after anterior resection has no impact on the management and outcome of the disease.
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Affiliation(s)
- Ihtisham Haq
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Osama Shakeel
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Awais Amjad
- Surgery, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, PAK
| | - Faizan Ullah
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Center, Karachi, PAK
| | - Hannan Ali
- Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Aun Jamal
- Surgical Oncology, Shaukat Khanum Memoiral 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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11
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Olson CH. Current Status of the Management of Stage I Rectal Cancer. Curr Oncol Rep 2020; 22:40. [PMID: 32240411 DOI: 10.1007/s11912-020-00905-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW To summarize the current available treatments for stage I rectal cancer and the evidence that supports them. RECENT FINDINGS Radical surgery, or total mesorectal excision (TME) without neoadjuvant therapy, reports excellent oncologic outcomes, with 5-year disease-free survival of approximately 95%. Alternative therapies include local excision, which has acceptable long-term outcomes in some low-risk T1 tumors; but overall local excision, with or without additional chemotherapy or radiation, generally reports 5-year disease-free survival less than TME alone. New research is showing complete clinical response rates of 67% with chemoradiation combined with additional consolidation chemotherapy in T2 lesions, making watch and wait a potential strategy for stage I tumors. Owing to its superior oncologic outcomes, radical surgery remains the mainstay of treatment for stage I tumors. Both local excision and watch and wait have advantages that may make them useful in individual patients and should be considered under the right circumstances.
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Affiliation(s)
- Craig Howard Olson
- Division of Colon and Rectal Surgery, University of Texas Southwestern, 1801 Inwood Blvd WA3.316, Dallas, TX, 75390, USA.
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12
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Oncologic and Perioperative Outcomes of Laparoscopic, Open, and Robotic Approaches for Rectal Cancer Resection: A Multicenter, Propensity Score-Weighted Cohort Study. Dis Colon Rectum 2020; 63:46-52. [PMID: 31764247 DOI: 10.1097/dcr.0000000000001534] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Minimally invasive approaches have been shown to reduce surgical site complications without compromising oncologic outcomes. OBJECTIVE The primary aim of this study is to evaluate the rates of successful oncologic resection and postoperative outcomes among laparoscopic, open, and robotic approaches to rectal cancer resection. DESIGN This is a multicenter, quasiexperimental cohort study using propensity score weighting. SETTINGS Interventions were performed in hospitals participating in the American College of Surgeons National Surgical Quality Improvement Program. PATIENTS Adult patients who underwent rectal cancer resection in 2016 were included. MAIN OUTCOME MEASURES The primary outcome was a composite variable indicating successful oncologic resection, defined as negative distal and radial margins with at least 12 lymph nodes evaluated. RESULTS Among 1028 rectal cancer resections, 206 (20%) were approached laparoscopically, 192 (18.7%) were approached robotically, and 630 (61.3%) were open. After propensity score weighting, there were no significant sociodemographic or preoperative clinical differences among subcohorts. Compared to the laparoscopic approach, open and robotic approaches were associated with a decreased likelihood of successful oncologic resection (ORadj = 0.64; 95% CI, 0.43-0.94 and ORadj = 0.60; 95% CI, 0.37-0.97), and the open approach was associated with an increased likelihood of surgical site complications (ORadj = 2.53; 95% CI, 1.61-3.959). Compared to the laparoscopic approach, the open approach was associated with longer length of stay (6.8 vs 8.6 days, p = 0.002). LIMITATIONS This was an observational cohort study using a preexisting clinical data set. Despite adjusted propensity score methodology, unmeasured confounding may contribute to our findings. CONCLUSIONS Resections that were approached laparoscopically were more likely to achieve oncologic success. Minimally invasive approaches did not lengthen operative times and provided benefits of reduced surgical site complications and decreased postoperative length of stay. Further studies are needed to clarify clinical outcomes and factors that influence the choice of approach. See Video Abstract at http://links.lww.com/DCR/B70. RESULTADOS ONCOLÓGICOS Y PERIOPERATORIOS DE LOS ABORDAJES LAPAROSCÓPICOS, ABIERTOS Y ROBÓTICOS PARA LA RESECCIÓN DEL CÁNCER RECTAL: UN ESTUDIO DE COHORTE MULTICÉNTRICO Y PONDERADO DEL PUNTAJE DE PROPENSIÓN: Se ha demostrado que los enfoques mínimamente invasivos reducen las complicaciones del sitio quirúrgico sin comprometer los resultados oncológicos.El objetivo principal de este estudio es evaluar las tasas de resección oncológica exitosa y los resultados postoperatorios entre los abordajes laparoscópico, abierto y robótico para la resección del cáncer rectal.Este es un estudio de cohorte cuasi-experimental multicéntrico que utiliza la ponderación de puntaje de propensión.Las intervenciones se realizaron en hospitales que participan en el Programa Nacional de Mejora de la Calidad Quirúrgica del Colegio Americano de Cirujanos.Se incluyeron pacientes adultos que se sometieron a resección de cáncer rectal en 2016.El resultado primario fue una variable compuesta que indicaba una resección oncológica exitosa, definida como márgenes negativos distales y radiales con al menos 12 ganglios linfáticos evaluados.Entre 1,028 resecciones de cáncer rectal, 206 (20%) fueron abordadas por vía laparoscópica, 192 (18.7%) robóticamente y 630 (61.3%) abiertas. Después de ponderar el puntaje de propensión, no hubo diferencias sociodemográficas o clínicas preoperatorias significativas entre las subcohortes. En comparación con el abordaje laparoscópico, los abordajes abiertos y robóticos se asociaron con una menor probabilidad de resección oncológica exitosa (ORadj = 0.64; IC 95%, 0.43-0.94 y ORadj = 0.60; IC 95%, 0.37-0.97), y el abordaje abierto se asoció con una mayor probabilidad de complicaciones del sitio quirúrgico (ORadj = 2.53; IC 95%, 1.61-3.959). En comparación con el abordaje laparoscópico, el abordaje abierto se asoció con una estadía más prolongada (6.8 frente a 8.6 días, p = 0.002).Este fue un estudio de cohorte observacional que utilizó un conjunto de datos clínicos preexistentes. A pesar de la metodología de puntuación de propensión ajustada, la confusión no medida puede contribuir a nuestros hallazgos.Las resecciones que se abordaron por vía laparoscópica tuvieron más probabilidades de lograr el éxito oncológico. Los enfoques mínimamente invasivos no alargaron los tiempos quirúrgicos y proporcionaron beneficios de la reducción de las complicaciones del sitio quirúrgico y la disminución de la duración de la estadía postoperatoria. Se necesitan más estudios para aclarar los resultados clínicos y los factores que influyen en la elección del enfoque. Vea video resumen en http://links.lww.com/DCR/B70.
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13
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Comparison of Short-Term Clinical and Pathological Outcomes after Transanal versus Laparoscopic Total Mesorectal Excision for Low Anterior Rectal Resection Due to Rectal Cancer: A Systematic Review with Meta-Analysis. J Clin Med 2018; 7:jcm7110448. [PMID: 30463197 PMCID: PMC6262322 DOI: 10.3390/jcm7110448] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 11/14/2018] [Accepted: 11/15/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Transanal total mesorectal excision (TaTME) is a new technique that is designed to overcome the limits of the open and laparoscopic approach for rectal resections. Objective: This study is designed to compare TaTME with standard laparoscopic TME (LaTME). Methods: We searched Medline, Embase, and Scopus databases covering a up to October 2018. Inclusion criteria for study enrolment: (1) study comparing laparoscopic resection of rectal cancer vs. TaTME for rectal malignancy, (2) reporting of overall morbidity, operative time, or major complications. Results: Eleven non-randomized studies were eligible with a total of 778 patients. We found statistical significant differences in regard to major complications in favour of TaTME (RR = 0.55; 95% CI 0.31–0.97; p = 0.04). We did not found significant differences regarding overall complications intraoperative adverse effects, operative time, anastomotic leakage, intra-abdominal abscess occurrence, Surgical Site Infection, reoperations, Length of stay, completeness of mesorectal excision, R0 resection rate, number of harvested lymph nodes, circumferential resection margin, and distal resection margin. Conclusions: This meta-analysis shows benefits of TaTME technique regarding major postoperative complications. Regarding clinicopathological features transanal approach is not superior to LaTME. Currently, the quality of the evidence on benefits of TaTME is low due to lack of randomized controlled trials, which needs to be taken into consideration in further evaluation of the technique. Further evaluation of TaTME require conducting large randomized control trials.
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14
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Rubinkiewicz M, Zarzycki P, Czerwińska A, Wysocki M, Gajewska N, Torbicz G, Budzyński A, Pędziwiatr M. A quest for sphincter-saving surgery in ultralow rectal tumours-a single-centre cohort study. World J Surg Oncol 2018; 16:218. [PMID: 30404633 PMCID: PMC6223085 DOI: 10.1186/s12957-018-1513-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 10/17/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Despite the progress in the treatment of colorectal cancer, there is still no optimal strategy for tumours located adjacent to the anal sphincter. This study aims to evaluate oncological and functional results of surgery for rectal cancer in unfavourable locations in proximity to anal sphincters. MATERIALS AND METHODS Patients with rectal cancer, which was either initially infiltrating the anal sphincter or located in the close proximity of the sphincter, were included in the study. Patients were submitted to extralevator abdominoperineal resection (APR), intersphincteric resection, or transanal total mesorectal excision (TaTME). Primary outcomes were perioperative data: operative time, blood loss, complications, length of stay (LOS), and 30-day mortality. Secondary outcomes were pathological quality of the specimens and functional outcome 6 months after defunctioning ileostomy closure. RESULTS Among patients with cancer adjacent to the anal sphincter, 13 (25%) underwent APR, 14 (27%) patients were submitted to intersphincteric resection, and 25 (48%) patients were treated with the TaTME approach. Operative time was 240 (210-270 IQR) for APR, 212.5 (170-260 IQR) for intersphincteric resection, and 270 (240-330 IQR) for TaTME (p = 0.018). Perioperative morbidity was 31% for APR, 36% for intersphincteric resections, and 12% for the TaTME group (p = 0.181). Complete mesorectal excision was achieved in 92% of specimens in the TaTME group, 93% in intersphincteric resections, and 78% in the APR group (p = 0.72). Median circumferential resection margin in APR was 6 mm (4-7 IQR), in intersphincteric resections 7.5 mm (2.5-10 IQR), and in the TaTME group 4 mm (2.8-8 IQR). All patients after intersphincteric resections developed major low anterior resection syndrome (LARS). Four patients in the TaTME group developed minor LARS, and 21 had major LARS. CONCLUSION Sphincter-saving rectal resections are a feasible alternative to APR with good clinical, pathological, and oncological outcomes. Intersphincteric resections and TaTME seem to be equal in terms of clinicopathological results. The functional outcome is yet to be investigated. TRIAL REGISTRATION The study was retrospectively registered in Thai Clinical Trials Registry (23-07-2018, ID TCTR20180724001 ).
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Affiliation(s)
- Mateusz Rubinkiewicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Piotr Zarzycki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Agata Czerwińska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Michał Wysocki
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Natalia Gajewska
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Grzegorz Torbicz
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
| | - Andrzej Budzyński
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland
| | - Michał Pędziwiatr
- 2nd Department of General Surgery, Jagiellonian University Medical College, Kopernika 21 Street, 31-501, Kraków, Poland.
- Centre for Research, Training and Innovation in Surgery (CERTAIN Surgery), Kraków, Poland.
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15
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Kye BH, Kim JG, Cho HM, Kim HJ, Chun CS. Laparoscopic Abdominal Transanal Proctocolectomy with Coloanal Anastomosis Is a Good Surgical Option in Selective Patients with Low-Lying Rectal Cancer: A Retrospective Analysis Based on a Single Surgeon's Experience. J Laparoendosc Adv Surg Tech A 2018; 28:269-277. [DOI: 10.1089/lap.2017.0226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Bong-Hyeon Kye
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jun-Gi Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Min Cho
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Jin Kim
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chung-Soo Chun
- Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
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16
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A Distal Resection Margin of ≤1 mm and Rectal Cancer Recurrence After Sphincter-Preserving Surgery: The Role of a Positive Distal Margin in Rectal Cancer Surgery. Dis Colon Rectum 2017; 60:1175-1183. [PMID: 28991082 DOI: 10.1097/dcr.0000000000000900] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND There is little information about the prognostic value of a microscopically positive distal margin in patients who have rectal cancer. OBJECTIVE We aimed to investigate the influence of a distal margin of ≤1 mm on oncologic outcomes after sphincter-preserving resection for rectal cancer. DESIGN This is a retrospective cohort study. SETTINGS The study was conducted at 2 hospitals. PATIENTS A total of 6574 patients underwent anterior resection for rectal cancer from January 1999 to December 2014; 97 (1.5%) patients with a distal margin of ≤1 mm were included in this study. For comparative analyses, patients were matched with 194 patients with a negative distal margin (>1 mm) according to sex, age, BMI, ASA score, neoadjuvant treatment, tumor location, and stage. MAIN OUTCOME MEASURES The oncologic outcomes of the 2 groups were compared. RESULTS Perineural and lymphovascular invasion rates were significantly higher in patients with a positive distal margin (54.6% vs 28.9%; 67.0% vs 42.8%; both p < 0.001) compared with to patients with negative distal margin. Comparison between microscopically positive and negative distal margin showed worse oncologic outcomes in patients with a microscopically positive distal margin, including 5-year local recurrence rate (24.1% vs 12.0%, p = 0.005); 5-year distant recurrence rate (35.5% vs 20.2%, p = 0.011); 5-year disease-free survival (45.5% vs 69.5%, p < 0.001); and 5-year OS (69.2% vs 79.7%, p = 0.004). Among the 97 patients with a microscopically positive distal margin, the 5-year disease-free survival rate was higher in patients who received adjuvant therapy (52.0% vs 30.7%, p = 0.089). LIMITATIONS This is a retrospective study; bias may exist. CONCLUSIONS A distal margin of 1 mm is associated with worse oncologic results. Our data indicate the importance of achieving a clear distal margin in the surgical treatment of rectal cancer. Adjuvant therapy should be used in these patients to reduce recurrence. See Video Abstract at http://links.lww.com/DCR/A408.
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17
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Okamura R, Hida K, Yamaguchi T, Akagi T, Konishi T, Yamamoto M, Ota M, Matoba S, Bando H, Goto S, Sakai Y, Watanabe M, Watanabe K, Otsuka K, Takemasa I, Tanaka K, Ikeda M, Matsuda C, Fukuda M, Hasegawa J, Akamoto S, Shiozawa M, Tsuruta A, Akiyoshi T, Kato T, Tsukamoto S, Ito M, Naito M, Kanazawa A, Takahashi T, Ueki T, Hayashi Y, Morita S, Yamaguchi T, Nakanishi M, Hasegawa H, Okamoto K, Teraishi F, Sumi Y, Tashiro J, Yatsuoka T, Nishimura Y, Okita K, Kobatake T, Horie H, Miyakura Y, Ro H, Nagakari K, Hidaka E, Umemoto T, Nishigori H, Murata K, Wakayama F, Makizumi R, Fujii S, Sunami E, Kobayashi H, Nakagawa R, Enomoto T, Ohnuma S, Higashijima J, Ozawa H, Ashida K, Fujita F, Uehara K, Maruyama S, Ohyama M, Yamamoto S, Hinoi T, Yoshimitsu M, Okajima M, Tanimura S, Kawasaki M, Ide Y, Hazama S, Watanabe J, Inagaki D, Toyokawa A. Local control of sphincter-preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis. Ann Gastroenterol Surg 2017; 1:199-207. [PMID: 29863157 PMCID: PMC5881346 DOI: 10.1002/ags3.12032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022] Open
Abstract
Sphincter‐preserving procedures (SPPs) for surgical treatment of low‐lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II‐III rectal cancer between 2010 and 2011. Patients with tumors 2‐5 cm from the anal verge and clinical stage T3‐4 were eligible. Primary outcome was 3‐year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77‐1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3‐year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42‐1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.
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Affiliation(s)
| | - Koya Hida
- Department of Surgery Kyoto University Kyoto Japan
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan
| | - Michio Yamamoto
- Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan
| | - Mitsuyoshi Ota
- Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan
| | - Saori Goto
- Department of Surgery Kyoto University Kyoto Japan
| | | | - Masahiko Watanabe
- Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | | | - Kazuteru Watanabe
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Koki Otsuka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ichiro Takemasa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Keitaro Tanaka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masataka Ikeda
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Chu Matsuda
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Meiki Fukuda
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Junichi Hasegawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shintaro Akamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Manabu Shiozawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Atsushi Tsuruta
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takashi Akiyoshi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takeshi Kato
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shunsuke Tsukamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masaaki Ito
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masaki Naito
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Akiyoshi Kanazawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takao Takahashi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takashi Ueki
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yuri Hayashi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Satoshi Morita
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takashi Yamaguchi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masayoshi Nakanishi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hirotoshi Hasegawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ken Okamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Fuminori Teraishi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yasuo Sumi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Jo Tashiro
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Toshimasa Yatsuoka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yoji Nishimura
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Kenji Okita
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takaya Kobatake
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hisanaga Horie
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yasuyuki Miyakura
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hisashi Ro
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Kunihiko Nagakari
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Eiji Hidaka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takehiro Umemoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hideaki Nishigori
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Kohei Murata
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Fuminori Wakayama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ryoji Makizumi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shoichi Fujii
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Eiji Sunami
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hirotoshi Kobayashi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ryosuke Nakagawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Toshiyuki Enomoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shinobu Ohnuma
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Jun Higashijima
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Heita Ozawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Keigo Ashida
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Fumihiko Fujita
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Keisuke Uehara
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Satoshi Maruyama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masato Ohyama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Seiichiro Yamamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takao Hinoi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masanori Yoshimitsu
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masazumi Okajima
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shu Tanimura
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masayasu Kawasaki
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yoshihito Ide
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shoichi Hazama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Jun Watanabe
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Daisuke Inagaki
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Akihiro Toyokawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
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18
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Sugrue J, Dagbert F, Park J, Marecik S, Prasad LM, Chaudhry V, Blumetti J, Emmadi R, Mellgren A, Nordenstam J. No clinical benefit from routine histologic examination of stapler doughnuts at low anterior resection for rectal cancer. Surgery 2017; 162:147-151. [PMID: 28187868 DOI: 10.1016/j.surg.2016.12.035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Revised: 12/22/2016] [Accepted: 12/29/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the clinical utility and cost-effectiveness of routine histologic examination of the doughnuts from stapled anastomoses in patients undergoing a low anterior resection for rectal cancer. METHODS We performed a retrospective review of 486 patients who underwent a low anterior resection with stapled anastomosis for rectal cancer between 2002 and 2015 at 3 institutions. Pathologic findings in the doughnuts and their impact on patient management were recorded. Tumor characteristics that may influence how often doughnuts were included in the pathology report were analyzed. An approximate cost of histologic examination of doughnuts was also calculated. RESULTS A total of 412 patients (85%) had doughnuts included in their pathology reports. Two patients had cancer cells in their doughnuts, and both patients had a positive distal margin in their primary tumor specimen; 33 patients had benign findings in their doughnuts. Pathologic examination of the doughnut did not change clinical management in any patient. Patients with rectosigmoid tumors were less likely to have their doughnuts included in the pathology report compared to patients with low tumors (P = .003). Doughnuts were not bundled with the primary tumor specimen in 374 (77%) of our patients; in these patients, pathologic analysis of the doughnut added an additional cost of approximately $643 per specimen. CONCLUSION This study demonstrates no clinical benefit in sending anastomotic doughnuts for histopathologic evaluation after performing a low anterior resection with a stapled anastomosis for rectal cancer. Overall cost may be decreased if doughnuts are not analyzed or if they are bundled with the primary tumor specimen.
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Affiliation(s)
- Jeremy Sugrue
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL.
| | - Francois Dagbert
- Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - John Park
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Slawomir Marecik
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Leela M Prasad
- Division of Colon and Rectal Surgery, Advocate Lutheran General Hospital, Park Ridge, IL
| | - Vivek Chaudhry
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL; Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Jennifer Blumetti
- Division of Colon and Rectal Surgery, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Rajyasree Emmadi
- Department of Pathology, University of Illinois at Chicago, Chicago, IL
| | - Anders Mellgren
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL
| | - Johan Nordenstam
- Division of Colon and Rectal Surgery, University of Illinois at Chicago, Chicago, IL
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19
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Ding Z, Wang Z, Huang S, Zhong S, Lin J. Comparison of laparoscopic vs. open surgery for rectal cancer. Mol Clin Oncol 2016; 6:170-176. [PMID: 28357087 PMCID: PMC5351748 DOI: 10.3892/mco.2016.1112] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/04/2016] [Indexed: 12/13/2022] Open
Abstract
This study was conducted to evaluate the safety of laparoscopic radical resection for rectal cancer. A total of 64 cases of rectal cancer patients undergoing radical surgery between January, 1998 and March, 2010 were collected. The patients were divided into the laparoscopic rectal surgery group (LS group, n=31) and the open surgery group (OS group, n=33). Operation time, postoperative recovery, complications and tumor-free survival rate were compared between the two groups. The inclusion criteria were as follows: Standard Karnofsky score >70 prior to surgery, definitive pathological diagnosis and complete clinical data. The exclusion criteria were concomitant tumors affecting survival. With the Dixon operation, the LS group had a longer operation time compared with the OS group (271.2±56.2 vs. 216.0±62.7 min, respectively; P=0.036), and an earlier time of oral intake (3.0±0.9 vs. 4.7±1.0 days, respectively; P=0.000). There were no significant differences between the LS and OS groups in terms of intraoperative blood loss, number of lymph nodes retrieved, duration of postoperative hyperthermia and hospitalization time (P>0.05). With the Miles operation, there were no obvious differences between the LS and OS groups regarding operation time, intraoperative blood loss, number of lymph nodes retrieved, time of oral intake, duration of postoperative hyperthermia and hospitalization time (P>0.05). Furthermore, there were no significant differences between the LS and OS groups with the Dixon or Miles operation in terms of 3-year tumor-free survival rate (P>0.05). Thus, laparoscopic surgery appears to be a safe and feasible option for the treatment of rectal cancer.
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Affiliation(s)
- Zihai Ding
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Zheng Wang
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China; Department of General Surgery, Guangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Guangzhou, Guangdong 510800, P.R. China
| | - Shijie Huang
- Department of Gastrointestinal Surgery, The Fourth Affiliated Hospital of Jinan University, Guangzhou Red Cross Hospital, Guangzhou, Guangdong 510220, P.R. China
| | - Shizhen Zhong
- Anatomical Institute of Minimally Invasive Surgery, Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
| | - Jianhua Lin
- Department of Hepatobiliary Surgery, Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, Guangdong 510515, P.R. China
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20
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Grosek J, Velenik V, Edhemovic I, Omejc M. The Influence of the Distal Resection Margin Length on Local Recurrence and long- term Survival in Patients with Rectal Cancer after Chemoradiotherapy and Sphincter- Preserving Rectal Resection. Radiol Oncol 2016; 51:169-177. [PMID: 28740452 PMCID: PMC5514657 DOI: 10.1515/raon-2016-0030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2016] [Accepted: 04/10/2016] [Indexed: 12/28/2022] Open
Abstract
Background Low recurrence rates and long term survival are the main therapeutic goals of rectal cancer surgery. Complete, margin- negative resection confers the greatest chance for a cure. The aim of our study was to determine whether the length of the distal resection margin was associated with local recurrence rate and long- term survival. Patients and methods One hundred and nine patients, who underwent sphincter-preserving resection for locally advanced rectal cancer after preoperative chemoradiotherapy between 2006 and 2010 in two tertiary referral centres were included in the study. Distal resection margin lengths were measured on formalin-fixed, pinned specimens. Characteristics of patients with distal resection margin < 8 mm (Group I, n = 27), 8–20 mm (Group II, n = 31) and > 20 mm (Group III, n = 51) were retrospectively analysed and compared. Median (range) follow-up time in Group I was 89 (51–111), in Group II 83 (57–111) and in Group III 80 (45–116) months (p = 0.326), respectively. Results Univariate survival analysis showed that distal resection margin length was not statistically significantly associated with overall survival or local recurrence rate (p > 0.05). In a multiple Cox regression analysis, after adjusting for pathologic T and N stage (yT, yN), distal resection margin length was still not statistically significantly associated with overall survival. Conclusions Our study shows that close distal resection margins can be accepted as oncologically safe for sphincter-preserving rectal resections after preoperative chemoradiotherapy.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vaneja Velenik
- Department of Radiotherapy, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Ibrahim Edhemovic
- Department of Surgery, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Mirko Omejc
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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21
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Xynos E, Tekkis P, Gouvas N, Vini L, Chrysou E, Tzardi M, Vassiliou V, Boukovinas I, Agalianos C, Androulakis N, Athanasiadis A, Christodoulou C, Dervenis C, Emmanouilidis C, Georgiou P, Katopodi O, Kountourakis P, Makatsoris T, Papakostas P, Papamichael D, Pechlivanides G, Pentheroudakis G, Pilpilidis I, Sgouros J, Triantopoulou C, Xynogalos S, Karachaliou N, Ziras N, Zoras O, Souglakos J. Clinical practice guidelines for the surgical treatment of rectal cancer: a consensus statement of the Hellenic Society of Medical Oncologists (HeSMO). Ann Gastroenterol 2016; 29:103-26. [PMID: 27064746 PMCID: PMC4805730 DOI: 10.20524/aog.2016.0003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
In rectal cancer management, accurate staging by magnetic resonance imaging, neo-adjuvant treatment with the use of radiotherapy, and total mesorectal excision have resulted in remarkable improvement in the oncological outcomes. However, there is substantial discrepancy in the therapeutic approach and failure to adhere to international guidelines among different Greek-Cypriot hospitals. The present guidelines aim to aid the multidisciplinary management of rectal cancer, considering both the local special characteristics of our healthcare system and the international relevant agreements (ESMO, EURECCA). Following background discussion and online communication sessions for feedback among the members of an executive team, a consensus rectal cancer management was obtained. Statements were subjected to the Delphi methodology voting system on two rounds to achieve further consensus by invited multidisciplinary international experts on colorectal cancer. Statements were considered of high, moderate or low consensus if they were voted by ≥80%, 60-80%, or <60%, respectively; those obtaining a low consensus level after both voting rounds were rejected. One hundred and two statements were developed and voted by 100 experts. The mean rate of abstention per statement was 12.5% (range: 2-45%). In the end of the process, all statements achieved a high consensus. Guidelines and algorithms of diagnosis and treatment were proposed. The importance of centralization, care by a multidisciplinary team, adherence to guidelines, and personalization is emphasized.
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Affiliation(s)
- Evaghelos Xynos
- General Surgery, InterClinic Hospital of Heraklion, Greece (Evangelos Xynos)
| | - Paris Tekkis
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Paris Tekkis, Panagiotis Georgiou)
| | - Nikolaos Gouvas
- General Surgery, Metropolitan Hospital of Piraeus, Greece (Nikolaos Gouvas)
| | - Louiza Vini
- Radiation Oncology, Iatriko Center of Athens, Greece (Louza Vini)
| | - Evangelia Chrysou
- Radiology, University Hospital of Heraklion, Greece (Evangelia Chrysou)
| | - Maria Tzardi
- Pathology, University Hospital of Heraklion, Greece (Maria Tzardi)
| | - Vassilis Vassiliou
- Radiation Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Vassilis Vassiliou)
| | - Ioannis Boukovinas
- Medical Oncology, Bioclinic of Thessaloniki, Greece (Ioannis Boukovinas)
| | - Christos Agalianos
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, George Pechlivanides)
| | - Nikolaos Androulakis
- Medical Oncology, Venizeleion Hospital of Heraklion, Greece (Nikolaos Androulakis)
| | | | | | - Christos Dervenis
- General Surgery, Konstantopouleio Hospital of Athens, Greece (Christos Dervenis)
| | - Christos Emmanouilidis
- Medical Oncology, Interbalkan Medical Center, Thessaloniki, Greece (Christos Emmanouilidis)
| | - Panagiotis Georgiou
- Colorectal Surgery, Chelsea and Westminster NHS Foundation Trust, London, UK (Paris Tekkis, Panagiotis Georgiou)
| | - Ourania Katopodi
- Medical Oncology, Iaso General Hospital, Athens, Greece (Ourania Katopodi)
| | - Panteleimon Kountourakis
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Panteleimon Kountourakis, Demetris Papamichael)
| | - Thomas Makatsoris
- Medical Oncology, University Hospital of Patras, Greece (Thomas Makatsoris)
| | - Pavlos Papakostas
- Medical Oncology, Ippokrateion Hospital of Athens, Greece (Pavlos Papakostas)
| | - Demetris Papamichael
- Medical Oncology, Oncology Center of Bank of Cyprus, Nicosia, Cyprus (Panteleimon Kountourakis, Demetris Papamichael)
| | - George Pechlivanides
- General Surgery, Athens Naval & Veterans Hospital, Greece (Christos Agalianos, George Pechlivanides)
| | | | - Ioannis Pilpilidis
- Gastroenterology, Theageneion Cancer Hospital, Thessaloniki, Greece (Ioannis Pilpilidis)
| | - Joseph Sgouros
- Medical Oncology, Agioi Anargyroi Hospital of Athens, Greece (Joseph Sgouros)
| | | | - Spyridon Xynogalos
- Medical Oncology, George Gennimatas General Hospital, Athens, Greece (Spyridon Xynogalos)
| | - Niki Karachaliou
- Medical Oncology, Dexeus University Institute, Barcelona, Spain (Niki Karachaliou)
| | - Nikolaos Ziras
- Medical Oncology, Metaxas Cancer Hospital, Piraeus, Greece (Nikolaos Ziras)
| | - Odysseas Zoras
- General Surgery, University Hospital of Heraklion, Greece (Odysseas Zoras)
| | - John Souglakos
- Medical Oncology, University Hospital of Heraklion, Greece (John Souglakos)
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22
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Peritoneal Metastases: Prevention and Treatment. Indian J Surg Oncol 2016; 7:137-8. [PMID: 27065703 DOI: 10.1007/s13193-016-0493-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 01/07/2016] [Indexed: 12/19/2022] Open
Abstract
Colorectal cancer is a surgicaly curable disease. It requires multimodality of treatment in Localy advanced and metastatic disease. Molecular markers like RAS mutation has brought in change in the mangement of metastatic disease. Nearly 15 to 20 % presents with peritonieal surface metastasis. The debate continues with systomic vs Cyutoreductive surgery with are without HIPEC. This article highlights management of peritoneal metastasis with special reference to prevention and treatment.
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23
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Changing Operative Strategy from Abdominoperineal Resection to Sphincter Preservation in T3 Low Rectal Cancer after Downstaging by Neoadjuvant Chemoradiation: A Preliminary Report. World J Surg 2015; 39:1248-56. [DOI: 10.1007/s00268-014-2930-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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24
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Khoury W, Abboud W, Hershkovitz D, Duek SD. Frozen section examination may facilitate reconstructive surgery for mid and low rectal cancer. J Surg Oncol 2014; 110:997-1001. [DOI: 10.1002/jso.23758] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/18/2014] [Indexed: 11/05/2022]
Affiliation(s)
- Wisam Khoury
- Department of General Surgery; Colorectal Surgery Unit; Rambam Health Care Campus, and Bruce Rappaport School of Medicine, The Technion; Haifa Israel
| | - Wisam Abboud
- Department of General Surgery; Colorectal Surgery Unit; Rambam Health Care Campus, and Bruce Rappaport School of Medicine, The Technion; Haifa Israel
| | - Dov Hershkovitz
- Department of Human Pathology; Rambam Health Care Campus, and Bruce Rappaport School of Medicine, The Technion; Haifa Israel
| | - Simon D. Duek
- Department of General Surgery; Colorectal Surgery Unit; Rambam Health Care Campus, and Bruce Rappaport School of Medicine, The Technion; Haifa Israel
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25
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Perez RO, Habr-Gama A, Smith FM, Kosinski L, São Julião GP, Grzona E, Rawet V, Vianna MR, Proscurshim I, Lynn PB, Gama-Rodrigues J. Fragmented pattern of tumor regression and lateral intramural spread may influence margin appropriateness after TEM for rectal cancer following neoadjuvant CRT. J Surg Oncol 2014; 109:853-8. [DOI: 10.1002/jso.23571] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/15/2014] [Indexed: 01/11/2023]
Affiliation(s)
- Rodrigo O. Perez
- Angelita & Joaquim Gama Institute; São Paulo Brazil
- Colorectal Surgery Division; University of São Paulo School of Medicine; São Paulo Brazil
- Ludwig Institute for Cancer Research; São Paulo Brazil
| | - Angelita Habr-Gama
- Angelita & Joaquim Gama Institute; São Paulo Brazil
- University of São Paulo School of Medicine; São Paulo Brazil
| | - Fraser M. Smith
- Angelita & Joaquim Gama Institute; São Paulo Brazil
- North Cumbria University Hospitals NHS Trust; Whitehaven UK
| | - Lauren Kosinski
- Angelita & Joaquim Gama Institute; São Paulo Brazil
- Medical College of Wisconsin; Milwaukee Wisconsin
| | | | - Esteban Grzona
- Angelita & Joaquim Gama Institute; São Paulo Brazil
- Hospital Aleman & Fundación Sanatorio Güemes; Buenos Aires Argentina
| | | | | | | | | | - Joaquim Gama-Rodrigues
- Angelita & Joaquim Gama Institute; São Paulo Brazil
- University of São Paulo School of Medicine; São Paulo Brazil
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26
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Hida JI, Okuno K, Tokoro T. Distal dissection in total mesorectal excision, and preoperative chemoradiotherapy and lateral lymph node dissection for rectal cancer. Surg Today 2013; 44:2227-42. [PMID: 24363114 DOI: 10.1007/s00595-013-0811-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/05/2013] [Indexed: 01/26/2023]
Abstract
The local recurrence rate after total mesorectal excision (TME) appears to be markedly lower than that after conventional operations. We reviewed all relevant articles identified from the MEDLINE databases and clarified the rationale for TME. It is clear that distal intramural spread is rare. Even when present, such spread is not likely to extend beyond 2 cm. Data with attention to mesorectal cancer deposits suggest that mesorectal clearance of at least 4-5 cm distal to the tumor should be sufficient. TME should be performed for most tumors of the mid- and lower rectum. This does not mean that the gut tube needs to be divided at the same level in every case. Dissection of the distal mesorectum off the gut tube can be performed, so the distal line of division of the bowel wall can be made at a minimum of 2 cm below the tumor if such a maneuver would ensure that the sphincters are preserved. In cases with cancer in the upper third of the rectum, the mesorectum and gut tube can safely be divided 5 cm below the tumor without jeopardizing the recurrence rates. Our findings indicate that TME is an essential treatment approach for rectal cancer, and lateral lymph node dissection and preoperative chemoradiotherapy are additional therapies that should be considered for advanced rectal cancer.
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Affiliation(s)
- Jin-ichi Hida
- Department of Surgery, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan,
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27
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[Altering the therapeutic paradigm towards a distal bowel margin of < 1 cm in patients with low-lying rectal cancer: a systematic review and commentary]. Chirurg 2013; 84:701. [PMID: 23942963 DOI: 10.1007/s00104-013-2569-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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28
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Abstract
Colorectal cancer (CRC) is one of the most common malignancies worldwide. Due to a higher incidence of CRC in the western hemisphere a significant amount of research was carried out and majority of the controversies could be resolved as far as management of CRC is concerned. Recently a number of significant advances were made in the field of CRC related to surgery, systemic therapy and radiotherapy. During the last decade we have witnessed introduction of minimally invasive surgery, incorporation of more effective newer chemotherapeutic regimes and targeted therapies and refinements in radiotherapy protocols. The demographics and clinical picture of CRC seems to be different in developing countries and there is paucity of CRC related studies from developing countries. In-order to update the practicing surgeons a review of conventional controversies of CRC surgery was performed and an update on the recent developments in the field of CRC was also presented in this article.
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29
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Platell C, Spilsbury K. Influence of local recurrence on survival in patients with rectal cancer. ANZ J Surg 2013; 84:85-90. [PMID: 23731220 DOI: 10.1111/ans.12214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2013] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent trials on rectal cancer have demonstrated significant improvements in local recurrence without improvements in overall survival. The aim of this paper was to define the influence of local recurrence on survival in a prospective series of patients who underwent R0 or R1 resections for rectal cancer. METHODS Patients presenting with rectal cancer from 1996 to 2012 were prospectively audited. The study included patients who underwent an R0 or R1 resection. Local recurrence was defined as cancer regrowth detected in the pelvis regardless of whether or not new metastases were found elsewhere. Kaplan-Meier curves, smoothed hazard functions and Cox models using both time since diagnosis and age as the time scale were used to define the influence of local recurrence on overall survival. RESULTS The study involved 483 patients, of mean age 66 years (standard deviation = 13) and a median follow-up of 5.2 years. The results at 5 years were overall survival 71% (95% confidence interval (CI) 66-75), local recurrence 7% (95% CI 5-10) and distant recurrence 18% (95% CI 14-22). Patients diagnosed with local recurrence died faster than patients diagnosed with either distant recurrence or no recurrence, and this was particularly obvious for younger patients (local hazard ratio (HR) 54, 95% CI 12-253 and distant HR19, 95% CI 4-80). Local recurrence that developed early following surgery also had worse survival outcomes. CONCLUSIONS Within this cohort of rectal cancer patients, the early development of local recurrence was the single most important indicator of a reduced survival, and carried a worse prognosis than the development of distant metastases alone.
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Affiliation(s)
- Cameron Platell
- Colorectal Cancer Unit, St John of God Hospital Subiaco, Perth, Western Australia, Australia; School of Surgery, University of Western Australia, Perth, Western Australia, Australia
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30
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Laparoscopic resection of rectal cancer results in higher lymph node yield and better short-term outcomes than open surgery: a large single-center comparative study. Dis Colon Rectum 2013; 56:679-88. [PMID: 23652740 DOI: 10.1097/dcr.0b013e318287c594] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Prognosis in rectal cancer is closely related to mesorectal integrity, margin status, and adequate lymph node dissection. The impact of laparoscopy on the pathologic and short-term outcomes remains controversial. OBJECTIVE We aim to compare the pathologic and short-term outcomes of laparoscopic and open resections for rectal cancer. DESIGN This is a large single-center retrospective comparative study using a prospective database. PATIENTS All patients who underwent primary resections for rectal cancer from January 2007 to September 2011 were identified. MAIN OUTCOME MEASURES Pathologic (nodal harvest, mesorectal integrity, circumferential, and distal margins) and operative outcomes were measured. RESULTS Two hundred thirty-four (mean age, 61 years; 65% male) patients underwent resections for primary rectal cancer, including 118 laparoscopic (99 restorative proctectomies, 19 abdominoperineal resections) and 116 open (69 restorative proctectomies, 47 abdominoperineal resections) resections. Both groups were similar in demographics, comorbidities, and tumor characteristics. The laparoscopic group had significantly more lymph nodes (26 vs 21, p = 0.02) than the open group, with no differences in circumferential margins, proportion of distal resection margins <l cm, and completeness of total mesorectal excision. The impact of laparoscopic resection on lymph nodes was also observed for restorative proctectomy (27 vs 21, p = 0.03). Furthermore, obese and laparoscopic-converted patients had equivalent pathologic outcomes for laparoscopic and open resection. Laparoscopy was associated with longer operative time (245 vs 213 minutes, p = 0.002); less blood loss (284 vs 388 mL, p = 0.01); shorter incisions (8 vs 20 cm, p = 0.0001) and hospital stay (7 vs 8 days, p = 0.05); and lower rates of 30-day morbidity (25% vs 43%, p = 0.04) and wound infections (9 vs 20%, p = 0.04). On multivariate regression, laparoscopic resection and year of surgery were the only independent predictors of greater lymph node harvest. CONCLUSIONS Laparoscopy for primary rectal cancer is associated with a greater number of lymph nodes as well as short-term benefits.
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Abstract
BACKGROUND Surgical treatment of low rectal cancer is controversial, and one of the reasons is the lack of definition and standardization of surgery in low rectal cancer. OBJECTIVE We classified low rectal cancers in 4 groups with the aim of demonstrating that most patients with low rectal cancer can receive conservative surgery without compromising oncologic outcome. DESIGN Patients with low rectal cancer <6 cm from anal verge were defined in 4 groups: type I (supra-anal tumors: >1 cm from anal ring) had coloanal anastomosis, type II (juxta-anal tumors: <1 cm from anal ring) had partial intersphincteric resection, type III (intra-anal tumors: internal anal sphincter invasion) had total intersphincteric resection, and type IV (transanal tumors: external anal sphincter invasion) had abdominoperineal resection. Patients with ultra-low sphincter-preserving surgery (types II-III) were compared with those with conventional sphincter-preserving surgery (type I). OUTCOME MEASURES Postoperative mortality, morbidity, surgical margins, local and distant recurrence, and survival were analyzed. RESULTS Of 404 patients with low rectal cancer, 135 were type I, 131 type II, 55 type III, and 83 type IV. There was no difference in local recurrence (5% to 9% vs 6%), distant recurrence (23% vs 23%), and disease-free survival (70%-73% vs 68%) at 5 years between ultra-low (types II-III) and conventional (type I) sphincter-preserving surgery. Predictive factors of survival were tumor stage and R1 resection but not the type of tumor or type of surgery. LIMITATIONS This study is limited by the retrospective analysis of a database, obtained from a single institution and covering a 16-year period. CONCLUSION Classification of low rectal cancers and standardization of surgery permitted sphincter-preserving surgery in 79% of patients with low rectal cancer without compromising oncologic outcome. This new surgical classification should be used to standardize surgery and increase sphincter-preserving surgery in low rectal cancer.
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Pahlman L, Bujko K, Rutkowski A, Michalski W. Altering the therapeutic paradigm towards a distal bowel margin of < 1 cm in patients with low-lying rectal cancer: a systematic review and commentary. Colorectal Dis 2013; 15:e166-74. [PMID: 23331717 DOI: 10.1111/codi.12120] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 09/04/2012] [Indexed: 12/13/2022]
Abstract
AIM The 1-cm rule of distal bowel clearance in patients with low-lying rectal cancer undergoing anterior resection is based mainly on pathological data showing distal intramural spread. Because clinical data are contradictory, a review that includes only cancers located ≤ 5 or ≤ 6 cm from the anal verge was carried out. METHOD A systematic review of the literature identified seven studies that presented results in relation to a margin of ≤ 1 cm (n = 293) vs > 1 cm (n = 315). In six studies, pre- or postoperative radiotherapy was implemented, and in one study patients were treated with surgery alone. Three studies, all implementing radiotherapy, reported results related to a margin of ≤ 5 mm (n = 51) vs > 5 mm (n = 125). RESULTS In none of the studies were the differences in local recurrence rate between the small and large margin groups statistically significant. The pooled analysis of six studies, in which patients received perioperative radiotherapy, showed a 1.2% [95% confidence interval (Cl) -4.5-7.0%] higher local recurrence rate in the ≤ 1 cm margin group compared with the > 1 cm margin group (P = 0.6). The corresponding figures for the ≤ 5 mm cut-off point were 0.5% (95% CI -7.6-8.7%, P = 0.9). The 5-year local recurrence rate in the only study in which radiotherapy had not been used was 8.6% higher in the ≤ 1 cm margin group compared with the > 1 cm margin group (P = 0.09). CONCLUSION Clinical evidence does not support the 1-cm rule in patients with low-lying rectal cancer undergoing pre- or postoperative radiotherapy.
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Affiliation(s)
- L Pahlman
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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Is tailoring treatment of rectal cancer the only true benefit of long-course neoadjuvant chemoradiation? Dis Colon Rectum 2013; 56:264-6. [PMID: 23303157 DOI: 10.1097/dcr.0b013e318277e8e4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Fitzgerald TL, Biswas T, O’Brien K, Zervos EE, Wong JH. Neoadjuvant Radiotherapy for Rectal Cancer: Adherence to Evidence-Based Guidelines in Clinical Practice. World J Surg 2012; 37:639-45. [DOI: 10.1007/s00268-012-1862-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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