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Sorrentino L, Daveri E, Belli F, Vigorito R, Battaglia L, Sabella G, Patti F, Randon G, Pietrantonio F, Vernieri C, Scaramuzza D, Villa S, Milione M, Gronchi A, Cosimelli M, Guaglio M. Management of patients with locally recurrent rectal cancer with a previous history of distant metastases: retrospective cohort study. BJS Open 2024; 8:zrae061. [PMID: 38869237 PMCID: PMC11170501 DOI: 10.1093/bjsopen/zrae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/23/2024] [Accepted: 04/29/2024] [Indexed: 06/14/2024] Open
Affiliation(s)
- Luca Sorrentino
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Elena Daveri
- Translational Immunology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filiberto Belli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Raffaella Vigorito
- Department of Radiology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Battaglia
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanna Sabella
- First Pathology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Patti
- Radiation Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Giovanni Randon
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Davide Scaramuzza
- Translational Immunology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sergio Villa
- Radiation Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Massimo Milione
- First Pathology Division, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessandro Gronchi
- Sarcoma Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Maurizio Cosimelli
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marcello Guaglio
- Colorectal Surgery Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Colletti G, Ciniselli CM, Sorrentino L, Bagatin C, Verderio P, Cosimelli M. Multimodal treatment of rectal cancer with resectable synchronous liver metastases: A systematic review. Dig Liver Dis 2023; 55:1602-1610. [PMID: 37277288 DOI: 10.1016/j.dld.2023.05.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Specific studies on stage IV rectal cancer are lacking. The aim of this study is to describe the current status of rectum-first approach (RFA), liver-first approach (LFA) and simultaneous approach (SA) in these patients. METHODS A systematic review was performed on PubMed, EMBASE and Cochrane including studies published from January 2005 to January 2021. Studies on colon cancer only, colon and rectal cancer without distinction, extrahepatic metastases at diagnosis, or case reports/letters were excluded. Main outcomes were 5-yr overall survival (OS) and treatment completion rates. RESULTS 22 studies were included for a total of 1,653 patients. 77% of the studies were retrospective and mainly (59%) reported one treatment approach. The primary endpoint was declared in 27% of the studies. Irrespective of treatment approaches, the 5-yr OS rate was reported in 72% of the studies. The 5-yr OS rates ranged from 38.5% to 75% for LFA, from 28% and 80% for RFA and from 28.2% to 77.3% for SA. Treatment completion rates ranged from 50% to 100% for LFA, from 37% to 100% for RFA, and from 66% to 100% for SA. CONCLUSION The wide heterogeneity of the results reflects that the therapeutic strategy in this setting is a case-by-case multidisciplinary decision and depends on several patient-specific features.
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Affiliation(s)
- Gaia Colletti
- Colorectal Surgery Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Chiara Maura Ciniselli
- Bioinformatics and Biostatistics Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Luca Sorrentino
- Colorectal Surgery Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy.
| | - Clara Bagatin
- Bioinformatics and Biostatistics Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Paolo Verderio
- Bioinformatics and Biostatistics Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
| | - Maurizio Cosimelli
- Bioinformatics and Biostatistics Unit, Fondazione IRCSS Istituto Nazionale dei Tumori, Via Giacomo Venezian, 1, 20133, Milan, Italy
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Keogh C, O’Sullivan NJ, Temperley HC, Flood MP, Ting P, Walsh C, Waters P, Ryan ÉJ, Conneely JB, Edmundson A, Larkin JO, McCormick JJ, Mehigan BJ, Taylor D, Warrier S, McCormick PH, Soucisse ML, Harris CA, Heriot AG, Kelly ME. Redo Pelvic Surgery and Combined Metastectomy for Locally Recurrent Rectal Cancer with Known Oligometastatic Disease: A Multicentre Review. Cancers (Basel) 2023; 15:4469. [PMID: 37760439 PMCID: PMC10527388 DOI: 10.3390/cancers15184469] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/29/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Historically, surgical resection for patients with locally recurrent rectal cancer (LRRC) had been reserved for those without metastatic disease. 'Selective' patients with limited oligometastatic disease (OMD) (involving the liver and/or lung) are now increasingly being considered for resection, with favourable five-year survival rates. METHODS A retrospective analysis of consecutive patients undergoing multi-visceral pelvic resection of LRRC with their oligometastatic disease between 1 January 2015 and 31 August 2021 across four centres worldwide was performed. The data collected included disease characteristics, neoadjuvant therapy details, perioperative and oncological outcomes. RESULTS Fourteen participants with a mean age of 59 years were included. There was a female preponderance (n = 9). Nine patients had liver metastases, four had lung metastases and one had both lung and liver disease. The mean number of metastatic tumours was 1.5 +/- 0.85. R0 margins were obtained in 71.4% (n = 10) and 100% (n = 14) of pelvic exenteration and oligometastatic disease surgeries, respectively. Mean lymph node yield was 11.6 +/- 6.9 nodes, with positive nodes being found in 28.6% (n = 4) of cases. A single major morbidity was reported, with no perioperative deaths. At follow-up, the median disease-free survival and overall survival were 12.3 months (IQR 4.5-17.5 months) and 25.9 months (IQR 6.2-39.7 months), respectively. CONCLUSIONS Performing radical multi-visceral surgery for LRRC and distant oligometastatic disease appears to be feasible in appropriately selected patients that underwent good perioperative counselling.
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Affiliation(s)
- Cian Keogh
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
- School of Medicine, University of Queensland, Brisbane 4072, Australia
| | - Niall J. O’Sullivan
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Hugo C. Temperley
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Michael P. Flood
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Pascallina Ting
- Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - Camille Walsh
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Peadar Waters
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Éanna J. Ryan
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - John B. Conneely
- Department of Surgery, Mater Misericordiae University Hospital, D07 R2WY Dublin, Ireland
| | - Aleksandra Edmundson
- Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - John O. Larkin
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Jacob J. McCormick
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Brian J. Mehigan
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - David Taylor
- Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - Satish Warrier
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Paul H. McCormick
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
| | - Mikael L. Soucisse
- Department of Surgery, Hôpital Maisonneuve-Rosemont, Montreal, QC H1T 2M4, Canada
| | - Craig A. Harris
- Department of Surgery, Royal Brisbane and Women’s Hospital, Brisbane 4029, Australia
| | - Alexander G. Heriot
- Department of Surgery, Peter MacCallum Cancer Centre, Melbourne 3000, Australia
| | - Michael E. Kelly
- Department of Surgery, St. James’s Hospital, School of Medicine, Trinity College Dublin, D02 R590 Dublin, Ireland
- Trinity St. James Cancer Institute, D08 W9RT Dublin, Ireland
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van Rees JM, Nordkamp S, Harmsen PW, Rutten H, Burger JWA, Verhoef C. Locally recurrent rectal cancer and distant metastases: is there still a chance ofcure? EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2023; 49:106865. [PMID: 37002176 DOI: 10.1016/j.ejso.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 01/23/2023] [Accepted: 03/03/2023] [Indexed: 03/13/2023]
Abstract
INTRODUCTION Patients with locally recurrent rectal cancer (LRRC) generally have poor prognosis, especially those who have (a history of) distant metastases. The aim of this study was to investigate the impact of distant metastases on oncological outcomes in LRRC patients undergoing curative treatment. METHODS Consecutive patients with surgically treated LRRC between 2005 and 2019 in two tertiary referral hospitals were retrospectively analysed. Oncological survival of patients without distant metastases were compared with outcomes of patients with synchronous distant metastases with the primary tumour, patients with distant metastases in the primary-recurrence interval, and patients with synchronous LRRC distant metastases. RESULTS A total of 535 LRRC patients were analysed, of whom 398 (74%) had no (history of) metastases, 22 (4%) had synchronous metastases with the primary tumour, 44 (8%) had metachronous metastases, and 71 (13%) had synchronous LRRC metastases. Patients with synchronous LRRC metastases had worse survival compared to patients without metastases (adjusted hazard ratio: 1.56 [1.15-2.12]), whilst survival of patients with synchronous primary metastases and metachronous metastases of the primary tumour was similar as those patients who had no metastases. In LRRC patients who had metastases in primary-recurrence interval, patients with early metachronous metastases had better disease-free survival as patients with late metachronous metastases (3-year disease-free survival: 48% vs 22%, p = 0.039). CONCLUSION LRRC patients with synchronous distant metastases undergoing curative surgery have relatively poor prognosis. However, LRRC patients with a history of distant metastases diagnosed nearby the primary tumour have comparable (oncological) survival as LRRC patients without distant metastases.
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Affiliation(s)
- J M van Rees
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands.
| | - S Nordkamp
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - P W Harmsen
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
| | - H Rutten
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands; GROW: School for Oncology and Reproduction, Maastricht University, Maastricht, the Netherlands
| | - J W A Burger
- Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
| | - C Verhoef
- Department of Surgical Oncology and Gastrointestinal Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands
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Murata Y, Uehara K, Ogura A, Ishigaki S, Aiba T, Mizuno T, Kokuryo T, Yokoyama Y, Yatsuya H, Ebata T. Impact of combined resection of the internal iliac artery on loss of volume of the gluteus muscles after pelvic exenteration. Surg Today 2022:10.1007/s00595-022-02635-z. [DOI: 10.1007/s00595-022-02635-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
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Minimum radial margin in pelvic exenteration for locally advanced or recurrent rectal cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2502-2508. [PMID: 35768314 DOI: 10.1016/j.ejso.2022.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/27/2022] [Accepted: 06/13/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE The aim of this study was to clarify the suitable radial margin (RM) for favourable outcomes after pelvic exenteration (PE), focusing on the discrepancy between the concepts of circumferential resection margin (CRM) and traditional R status. METHODS Seventy-three patients with locally advanced (LARC, n = 24) or locally recurrent rectal cancer (LRRC, n = 49) who underwent PE between 2006 and 2018 were retrospectively analysed. Patients were histologically classified into the following 3 groups; wide RM (≥1 mm, n = 45), narrow RM (0-1 mm, n = 10), and exposed RM (n = 18). The analysis was performed not only in the entire cohort but also in each disease group separately. RESULTS The rates of traditional R0 (RM > 0 mm) and wide RM were 75.3% and 61.6%, respectively, resulting in the discrepancy rate of 13.7% between the two concepts. Preoperative radiotherapy was given in 12.3%. In the entire cohort, the local recurrence and overall survival (OS) rates for narrow RMs were significantly worse than those for wide RMs (p < 0.001 and p = 0.002), but were similar to those for exposed RMs. In both LARC and LRRC, RM < 1 mm resulted in significantly worse local recurrence and OS rates compared to the wide RMs. Multivariate analysis showed that RM < 1 mm was an independent risk factor for local recurrence in both LARC (HR 15.850, p = 0.015) and LRRC (HR 4.874, p = 0.005). CONCLUSIONS Narrow and exposed RMs had an almost equal impact on local recurrence and poor OS after PE. Preoperative radiotherapy might have a key role to ensure a wide RM.
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Hu S, Xing X, Liu J, Liu X, Li J, Jin W, Li S, Yan Y, Teng D, Liu B, Wang Y, Xu B, Du X. Correlation between apparent diffusion coefficient and tumor-stroma ratio in hybrid 18F-FDG PET/MRI: preliminary results of a rectal cancer cohort study. Quant Imaging Med Surg 2022; 12:4213-4225. [PMID: 35919050 PMCID: PMC9338373 DOI: 10.21037/qims-21-938] [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: 09/21/2021] [Accepted: 05/17/2022] [Indexed: 11/06/2022]
Abstract
Background To explore possible correlations between the tumor-stroma ratio (TSR) and different imaging features of fluorine-18-fluorodeoxyglucose positron emission tomography/magnetic resonance imaging (18F-FDG PET/MRI) in untreated rectal cancer patients. Methods A patients with rectal cancer were included in this study. All participants were examined preoperatively with whole-body 18F-FDG PET/MRI. Two pathologists evaluated the TSR of tumors together. Apparent diffusion coefficient (ADC) values and PET-related parameters of the primary lesions were measured and compared between the stroma-high and stroma-low groups. Pearson's correlation or Spearman's rank correlation were used to evaluate the correlation between the ADC values, PET-related parameters, and pathological indices. Results Our results showed that in the untreated rectal cancer patients, the ADC mean values correlated with the TSR (r=0.327; P=0.007), and stroma-high (low TSR) rectal cancer corresponded to relatively lower ADC mean values (813.54±88.68 vs. 879.92±133.18; P=0.018). The ADC mean and ADC minimum (ADCmin) values were found to be negatively correlated with the pathological T stages (r=-0.384, P=0.001; r=-0.416, P=0.001, respectively) as well as the largest tumor diameters (r=-0.340, P=0.005; r=-0.314, P=0.010, respectively) of rectal cancer. In addition, the pathological T stages correlated with all PET-related metabolic parameters, including mean standard uptake value (SUV), maximum SUV (SUVmax), metabolic tumor volume (MTV), and total lesion glycolysis (TLG) (r=0.338, P=0.006; r=0.350, P=0.004; r=0.326, P=0.007; and r=0.472, P<0.001, respectively). Our results also identified associations between the ADCmin values and SUVmean, SUVmax, and TLG (r=-0.335, P=0.006; r=-0.343, P=0.005; and r=-0.343, P=0.005, respectively). However, there were no statistical correlations between the PET/MRI parameters and the immunohistochemical (IHC) results. Conclusions This study indicated that the intratumoral heterogeneity measured by PET/MRI may reflect characteristics of the tumor microenvironment. Hence, PET/MRI parameters might be helpful in predicting tumor aggressiveness and prognosis.
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Affiliation(s)
- Shidong Hu
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaowei Xing
- Department of Hernia and Abdominal Wall Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jiajin Liu
- Department of Nuclear Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xi Liu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Radiology, Peking University Cancer Hospital and Institute, Beijing, China
| | - Jinhang Li
- Department of Pathology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Wei Jin
- Department of Pathology, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Songyan Li
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yang Yan
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Da Teng
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Boyan Liu
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Yufeng Wang
- Department of Hospital Management, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Baixuan Xu
- Department of Nuclear Medicine, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xiaohui Du
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
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