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De Crignis L, Dupré A, Meeus P, Peyrat P, Rivoire M. Surgical outcomes in pelvic exenteration for advanced and recurrent malignancy: a high volume single institution experience. Langenbecks Arch Surg 2023; 408:221. [PMID: 37261533 DOI: 10.1007/s00423-023-02960-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 05/24/2023] [Indexed: 06/02/2023]
Abstract
PURPOSE Pelvic exenteration remains the only curative treatment for advanced pelvic malignancies. However, identification of predictive factors for successful surgical outcomes is still a controversial issue at present time. METHODS This retrospective study included data from all adult patients with colorectal or anal advanced pelvic malignancy registered for pelvic exenteration at the Leon Berard Cancer Center (Lyon, France). The primary endpoint was the surgical outcomes and aimed to define the predictive factors for postoperative complications. Secondary endpoints included overall survival and progression free survival in patients having experienced pelvic exenteration (PE). RESULTS Data from 141 patients with locally advanced tumor (N = 81) or recurrent malignancies (N = 60) diagnosed between May 1994 and November 2018 were collected. The median age was 63.3 years (95%CI 20.0-92.0). Malignancies included different locations (rectal: 69.5%, left colon: 17.0% and anal: 13.5%). Posterior pelvectomy was the most frequent surgery (81.6%). The median length of hospital stay was 23.3 days (95%CI 3.0-82.0). The major complication rate at 30 days was 24.8% and 38.1% at 90 days. The median overall survival was 54.5 months (95%CI 41.5-104.1) and the median PFS was 34.5 months (95%CI 19.6-NA). CONCLUSION In selected patients, pelvic exenteration is associated with good surgical and survival outcomes.
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Affiliation(s)
- Lucas De Crignis
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France.
| | - Aurélien Dupré
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
- Univ Lyon, Inserm, U1032 LabTau, 69003, Lyon, France
| | - Pierre Meeus
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Patrice Peyrat
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
| | - Michel Rivoire
- Department of Surgical Oncology, Centre Léon Bérard, 28 Rue Laennec, 69008, Lyon, France
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Milito P, Sorrentino L, Pietrantonio F, Di Russo A, Citterio D, Mazzaferro V, Cosimelli M. No benefit after neoadjuvant chemoradiation in stage IV rectal cancer: A propensity score-matched analysis on a real-world population. Dig Liver Dis 2021; 53:1041-1047. [PMID: 33487580 DOI: 10.1016/j.dld.2021.01.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Stage IV rectal cancer occurs in 25% of patients and locoregional control of primary tumor is usually poorly considered, since priority is the treatment of metastatic disease. AIMS This study evaluates impact of neoadjuvant chemoradiation followed by surgery (nCHRTS) vs. upfront surgery on locoregional control and overall survival in stage IV rectal cancer. METHODS All patients diagnosed with stage IV rectal carcinoma between 2009 and 2019, undergone elective surgery at the National Cancer Institute of Milan (Italy), were included. Propensity score-based matching was performed between the two study groups. Loco-regional recurrence-free survival (LRRFS) and overall survival (OS) were analysed using Kaplan-Meyer method. RESULTS A total of 139 patients were analyzed. After propensity score matching, 88 patients were included in the final analysis. The 3-yr LRRFS rates were 80.3% for nCHRTS vs. 90.4% for upfront surgery patients (p = 0.35). The 3-yr OS rates were respectively 81.8% vs. 58% (p = 0.36). KRAS mutation (HR 2.506, p = 0.038) and extra-liver metastases (HR 4.308, p = 0.003) were both predictive of worse OS in univariate analysis. CONCLUSION The present study failed to demonstrate a significant impact of nCHRTS on LRRFS or OS in stage IV rectal cancer.
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Affiliation(s)
- Pamela Milito
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luca Sorrentino
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna Di Russo
- Radiotherapy Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Citterio
- Department of Surgery, Division of HPB, General Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Vincenzo Mazzaferro
- Department of Surgery, Division of HPB, General Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori di Milano, Milan, Italy
| | - Maurizio Cosimelli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Tronstad PK, Simpson LVH, Olsen B, Pfeffer F, Karliczek A. Low rate of local recurrence detection by rectoscopy in follow-up of rectal cancer. Colorectal Dis 2020; 22:254-260. [PMID: 31556190 DOI: 10.1111/codi.14858] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 08/23/2019] [Indexed: 02/08/2023]
Abstract
AIM The main aim of this study was to examine the effectiveness of rectoscopy for detecting local recurrence of rectal cancer in patients following low anterior resection. METHOD This was a retrospective study of 201 patients, who underwent low anterior resection for rectal or rectosigmoid cancer between 2007 and 2009 and who were followed up with rigid rectoscopy and imaging. A total of 91 patients were excluded from the analysis for various reasons, leaving 110 patients eligible for analysis. RESULTS A total of 613 rectoscopies were performed, and 48 biopsies taken. Six local recurrences were detected in the 110 patients, three of which were first detected by rectoscopy and three by CT. Two of the local recurrences were detected outside the follow-up programme because of symptoms: one by rectoscopy and one by CT. Three of 613 (0.5%) rectoscopies led to detection of local recurrence. The sensitivity and specificity of rectoscopy to detect local recurrence was 0.50 and 0.93, respectively. Nineteen distant metastases were detected, and two patients had both local recurrence and distant metastasis. All local recurrences and distant metastases were detected within 48 months of surgery. CONCLUSION Rigid rectoscopy is poor at detecting local recurrence. Only 3 out of 613 rectoscopies (0.5%) detected local recurrence. Due to extramural growth of some recurrences, the sensitivity is also very low. Based on our results, routine rectoscopy in the surveillance of asymptomatic patients cannot be recommended.
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Affiliation(s)
- P K Tronstad
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - L V Hume Simpson
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - B Olsen
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - F Pfeffer
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.,Clinical Institute 1, University of Bergen, Bergen, Norway
| | - A Karliczek
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway.,Clinical Institute 1, University of Bergen, Bergen, Norway
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Shiba S, Okamoto M, Kiyohara H, Ohno T, Kaminuma T, Asao T, Ojima H, Shirabe K, Kuwano H, Nakano T. Prospective Observational Study of High-Dose Carbon-Ion Radiotherapy for Pelvic Recurrence of Rectal Cancer (GUNMA 0801). Front Oncol 2019; 9:702. [PMID: 31417874 PMCID: PMC6684773 DOI: 10.3389/fonc.2019.00702] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 07/15/2019] [Indexed: 11/13/2022] Open
Abstract
Background and purpose: Favorable clinical outcomes of carbon-ion radiotherapy for pelvic recurrence of rectal cancer have been described by previous prospective phase I/II and II studies; however, these studies were performed at a single institution. Therefore, we conducted a prospective observational study aimed at exploring whether carbon-ion radiotherapy for post-operative pelvic recurrence of rectal cancer provides a less invasive local treatment strategy with higher cure rates than other anticancer treatments. Materials and methods: Patients (1) with pelvic recurrence of rectal cancer, as confirmed by histology or diagnostic imaging; (2) without distant metastasis; (3) who had undergone curative resection of their primary disease and regional lymph nodes, without gross or microscopic residual disease; and (4) with radiographically measurable tumors were included in this study. The total carbon-ion radiotherapy dose for all patients was 73.6 Gy [relative biological effectiveness (RBE)] administered in 16 fractions once daily for 4 days a week (Tuesday to Friday). Results: A total of 28 patients were enrolled between October 2011 and July 2017. The median follow-up duration was 38.9 months. The 3-year overall survival, local control, and progression-free survival rates were 92, 86, and 31%, respectively. At the time of the analysis, 4 patients had local recurrence, and 7 had died of rectal cancer. None of the patients developed grade 3 or higher acute toxicities. Late toxicities occurred in 2 and 7 patients who developed grade 3 pelvic infection and grade 2 peripheral neuropathy, respectively. Conclusion: Carbon-ion radiotherapy for pelvic recurrence of rectal cancer showed favorable clinical outcomes and is a highly curative and less invasive local treatment.
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Affiliation(s)
- Shintaro Shiba
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.,Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Masahiko Okamoto
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroki Kiyohara
- Department of Radiation Oncology, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Tatsuya Ohno
- Gunma University Heavy Ion Medical Center, Maebashi, Japan
| | - Takuya Kaminuma
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takayuki Asao
- Big Data Center for Integrative Analysis, Gunma University Initiative for Advanced Research, Maebashi, Japan
| | - Hitoshi Ojima
- Department of Gastroenterological Surgery, Gunma Prefectural Cancer Center, Maebashi, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroyuki Kuwano
- Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Takashi Nakano
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan
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Su QB, Wang LY, Wei GN, Liao LZ, Zhao J, Liu HJ, Shi YL, Li LP, Li CS. Livin serves as a prognostic marker for mid-distal rectal cancer and a target of mid-distal rectal cancer treatment. Oncol Lett 2018; 14:7759-7766. [PMID: 29344221 PMCID: PMC5755131 DOI: 10.3892/ol.2017.7230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Accepted: 08/23/2017] [Indexed: 11/26/2022] Open
Abstract
Livin is a novel member of the inhibitor of apoptosis protein family, which has been identified to be expressed in various malignancies and is suggested to be associated with poor prognostic significance. However, no data are available concerning the significance of livin in mid-distal rectal cancer. In the present study, livin expression, and its association with clinicopathological characteristics and prognosis was examined in patients with mid-distal rectal cancer. Apoptotic susceptibility, invasion capacity and chemosensitivity of LoVo cells were investigated using small interfering RNA (siRNA)-mediated knockdown of livin. It was revealed that livin was highly expressed in mid-distal rectal cancer tissues compared with the normal rectal mucosal tissues. Livin expression was associated with pathological grade, extent of invasion (T stage) and extent of lymph node metastasis (N stage) of tumor, contributing to poor prognosis of mid-distal rectal cancer following surgery. The data suggest that aggressive surgery should be applied in patients with mid-distal rectal cancer with high expression of livin. It was also revealed that knockdown of livin by siRNA increased the apoptotic rate, suppressed invasion of LoVo cells, and decreased the half-maximal inhibitory concentration of oxaliplatin and 5-fluorouracil by ~50% in LoVo cells significantly compared with control groups. The data suggested that a combination of downregulation of livin and anticancer drugs may significantly decrease the toxicity of anticancer drugs. Taken together, the present study indicated that livin may be a promising target in clinical therapy of mid-distal rectal cancer.
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Affiliation(s)
- Qi-Biao Su
- College of Health Science, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P.R. China
| | - Lai-You Wang
- College of Pharmacy, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P.R. China
| | - Gui-Ning Wei
- Department of Pharmacology, Guangxi Institute of Chinese Medicine and Pharmaceutical Science, Nanning, Guangxi 530022, P.R. China
| | - Li-Zhen Liao
- College of Health Science, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P.R. China
| | - Jie Zhao
- College of Health Science, Guangdong Pharmaceutical University, Guangzhou, Guangdong 510006, P.R. China
| | - Hong-Jun Liu
- Department of Pharmacology, Guangxi Institute of Chinese Medicine and Pharmaceutical Science, Nanning, Guangxi 530022, P.R. China
| | - Yu-Long Shi
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Le-Ping Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
| | - Chen-Sheng Li
- Department of Gastrointestinal Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong 250021, P.R. China
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Garcia-Granero A, Biondo S, Espin-Basany E, González-Castillo A, Valverde S, Trenti L, Gil-Moreno A, Kreisler E. Pelvic exenteration with rectal resection for different types of malignancies at two tertiary referral centres. Cir Esp 2017; 96:138-148. [PMID: 29229359 DOI: 10.1016/j.ciresp.2017.11.001] [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: 08/20/2017] [Revised: 09/28/2017] [Accepted: 11/04/2017] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Pelvic exenteration (PE) offers the best chance of cure for locally advanced primary or recurrent pelvic organ malignancies invading adjacent organs. The aims of this study were to analyse results for any pelvic exenteration that includes rectal resection and the analysis of results of fecal and urinary reconstruction. METHOD From January 2000 to April 2014, 111 PE with rectal resection for any pelvic cancer were analysed retrospectively at two national tertiary referral centers. RESULTS Thirty-six colorectal anastomosis were performed. Urologic reconstructions performed were 30 double barrelled wet colostomy (DBWC), 14 Bricker ileal conduit (BIC), and 2 ureterocutaneostomies. Postoperative complications occurred in 71 patients (64%). Six deaths (5.4%) occurred within 30 postoperative days. Five-year overall survival following R0 resection was 62.6%; R1: 42.7%; R2: 24.2% (P=.018). The resection margin status was associated with overall survival, local recurrence and distant recurrence. CONCLUSION Pelvic exenterations for any cause need to be performed in referral centers and by specialized surgeons. Anastomosis after modified supralevator pelvic exenteration for ovarian cancer, is safe. DBWC can be considered a valid option for urologic reconstruction. The most important prognostic factor after pelvic exenteration for malignant pelvic tumors is the status of surgical margins.
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Affiliation(s)
- Alvaro Garcia-Granero
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Sebastiano Biondo
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España.
| | - Eloy Espin-Basany
- Servicio de Cirugía General y Digestiva, Unidad Colorrectal, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Ana González-Castillo
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Silvia Valverde
- Servicio de Cirugía General y Digestiva, Unidad Colorrectal, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Loris Trenti
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
| | - Antonio Gil-Moreno
- Servicio de Ginecología, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Barcelona, España
| | - Esther Kreisler
- Servicio de Cirugía General y Digestiva, Unidad de Cirugía Colorrectal, Hospital Universitario de Bellvitge, Universidad de Barcelona e IDIBELL, Hospitalet de Llobregat, Barcelona, España
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Igreja-Junior HJS, Batista VL, Carvalho BDSV, Tavares LS, Coelho JG. LAPAROSCOPIC ABDOMINOPERINEAL RESECTION WITH SACRECTOMY: TECHNICAL DETAILS AND PITFALLS. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2017; 30:290-291. [PMID: 29340558 PMCID: PMC5793152 DOI: 10.1590/0102-6720201700040016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 06/16/2017] [Indexed: 01/22/2023]
Affiliation(s)
| | - Vilson Leite Batista
- Service of General and Oncological Surgery, Portuguese Society of Charity of Campos, Campos dos Goytacazes, RJ, Brazil
| | | | - Lucas Simões Tavares
- Service of General and Oncological Surgery, Portuguese Society of Charity of Campos, Campos dos Goytacazes, RJ, Brazil
| | - Juliana Gonçalves Coelho
- Service of General and Oncological Surgery, Portuguese Society of Charity of Campos, Campos dos Goytacazes, RJ, Brazil
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Cuicchi D, Lecce F, Dalla Via B, De Raffele E, Mirarchi M, Cola B. Mortality and Morbidity. Updates Surg 2016. [DOI: 10.1007/978-88-470-5767-8_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Affiliation(s)
- J J Tuech
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France.
| | - L Schwarz
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - J Coget
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
| | - V Bridoux
- Département de chirurgie digestive, CHU de Rouen, 1, rue Germont, 76031 Rouen cedex, France
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