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Marks JH, Yang J, Spitz EM, Salem J, Agarwal S, de Paula TR, Schoonyoung HP, Keller DS. A prospective phase II clinical trial/IDEAL Stage 2a series of single-port robotic colorectal surgery for abdominal and transanal cases. Colorectal Dis 2023; 25:2335-2345. [PMID: 37907449 DOI: 10.1111/codi.16788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/30/2023] [Accepted: 09/17/2023] [Indexed: 11/02/2023]
Abstract
AIM Slow laparoscopy adoption accelerated the uptake of robotic surgery. However, the current robotic platforms have limitations in transanal applications and multiple port sites. The da Vinci single-port (SP) robot is currently used on trial for colorectal surgery, and broad assessment of outcomes is needed. We aimed to report findings of a phase II clinical trial of SP robotic colorectal surgery. METHODS A sequentially reported prospective case series was performed on patients using SP robotics at a tertiary referral centre from 1 October 2018 to 31 August 2021. Cases were stratified into abdominal and transanal cohorts. Demographics, intra-operative variables and 30-day postoperative outcomes were evaluated. Univariate analysis was performed, with statistical process control for the docking process. Main outcomes were conversion rates, morbidity, mortality and point of standardization of docking. RESULTS In all, 133 patients were included: 93 (69.92%) abdominal and 40 (30.08%) transanal. The main diagnosis was rectal cancer (n = 59) and the procedure performed a robotic transanal abdominal transanal radical proctosigmoidectomy (n = 30). There were no conversions to open surgery. Two abdominal (2.15%) and three transanal cases (7.50%) were converted to laparoscopy. All colorectal adenocarcinomas had negative margins, proper lymph node harvest and complete mesorectal excision, as appropriate. Docking became a standardized process at cases 34 (abdominal) and 23 (anorectal). After surgery, bowel function returned on mean day 2 (abdominal) and 1 (transanal). The morbidity rate was 15.05% (abdominal) and 27.50% (transanal). There were two major morbidities in each cohort. Overall, there were three (2.65%) readmissions, one reoperation and no mortality. CONCLUSIONS Single-port robotics is feasible for all types of colorectal procedures, with good clinical and oncological outcomes. With this development in colorectal surgery, further studies can develop best practices with this novel technology.
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Affiliation(s)
- John H Marks
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jane Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Elizabeth M Spitz
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Jean Salem
- Department of Surgery, Saline Health System, Benton, Arkansas, USA
| | - Samir Agarwal
- Department of Surgery, Physician First Group, Sarasota Memorial Health Care System, Sarasota, Florida, USA
| | - Thais Reif de Paula
- Lankenau Institute for Medical Research, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Henry P Schoonyoung
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
| | - Deborah S Keller
- Lankenau Institute for Medical Research and Division of Colon and Rectal Surgery, Department of Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania, USA
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2
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Sutter A, Poylin V. Reducing Complications After Surgery for Benign Anorectal Conditions. Adv Surg 2022; 56:69-78. [PMID: 36096578 DOI: 10.1016/j.yasu.2022.05.001] [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] [Indexed: 06/15/2023]
Abstract
While generally perceived as mundane and low-risk procedures, anorectal surgeries by virtue of their anatomic real-estate-dense with nerves, blood supply, and structures critical to the quality of life-are fraught with the potential for complications. While these complications are generally not life-threatening, their impact to the quality of life can be severe. Furthermore, the sheer volume of anorectal procedures performed each year means that even low complication rates or less severe complications can have significant economic impact.
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Affiliation(s)
- Alton Sutter
- Wake Forest Baptist Hospital, Medical Center Boulevard, Winston-Salem, NC 27157, USA
| | - Vitaliy Poylin
- Division of Gastrointestinal and Oncologic Surgery, Feinberg School of Medicine, Northwestern Medical Group, 676 North St. Clair Street, Suite 650, Chicago, IL 60611, USA.
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3
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When is transanal endoscopic surgery appropriate? Surg Oncol 2022; 43:101773. [DOI: 10.1016/j.suronc.2022.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 04/07/2022] [Indexed: 11/23/2022]
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4
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Al-Sawat A, Bae JH, Kim HH, Lee CS, Han SR, Lee YS, Cho HM, Jang HS, Lee IK. Short- and long-term outcomes of local excision with adjuvant radiotherapy in high-risk T1 rectal cancer patients. Ann Surg Treat Res 2022; 102:36-45. [PMID: 35071118 PMCID: PMC8753379 DOI: 10.4174/astr.2022.102.1.36] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 10/28/2021] [Accepted: 11/12/2021] [Indexed: 11/30/2022] Open
Abstract
Purpose Methods Results Conclusion
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Affiliation(s)
- Abdullah Al-Sawat
- Department of Surgery, College of Medicine, Taif University, Taif, Saudi Arabia
| | - Jung Hoon Bae
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyun Ho Kim
- Division of Colorectal Surgery, Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Seung Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Rim Han
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yoon Suk Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Min Cho
- Division of Colorectal Surgery, Department of Surgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hong Seok Jang
- Department of Radiation Oncology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - In Kyu Lee
- Division of Colorectal Surgery, Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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5
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Yang J, Tian L, Niu L, Zhai C. Comparative analysis of modified Bacon operation and double stapler operation in the treatment of rectal cancer. Am J Transl Res 2021; 13:7235-7241. [PMID: 34306487 PMCID: PMC8290663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the efficacy of modified Bacon operation and double stapler operation in treating lower rectal cancer. METHODS A total of 73 patients with lower rectal cancer admitted to the general surgery department of our hospital from March 2016 to March 2017 were selected for the study. According to different operation methods, the patients were divided into an observation group and a control group. Modified Bacon operation was used in the observation group (39 cases), while double stapler operation was adopted for the control group (34 cases). The intraoperative and postoperative conditions and 3-year survival rates were observed. RESULTS The bleeding volume and anal exhaust time in the observation group were better than those in the control group, the difference being statistically significant (P<0.05). No significant difference was found between the two groups in terms of the operation time, abdominal drainage volume, anal extubation time, or the number of lymph node dissection (P>0.05). The anal function of the two groups was evaluated one month and six months after operation respectively, and no significant difference was found between the function of the two groups (P>0.05). There was no significant difference in postoperative complications, local recurrence, and distant metastasis between the two groups (P>0.05). The 3-year survival rate was 89.74% in the observation group and 91.18% in the control group. Our analysis found no significant difference in the cumulative survival rates between the two groups (P>0.05). CONCLUSION Modified Bacon operation and double stapler operation are effective treatment for lower rectal cancer, and the survival benefit of patients is obvious. The methods are worthy of clinical promotion.
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Affiliation(s)
- Jianyong Yang
- Department of Colorectal & Anal Surgery, Shanxi Provincial People's Hospital Taiyuan, Shanxi, China
| | - Lijun Tian
- Department of Colorectal & Anal Surgery, Shanxi Provincial People's Hospital Taiyuan, Shanxi, China
| | - Liyun Niu
- Department of Colorectal & Anal Surgery, Shanxi Provincial People's Hospital Taiyuan, Shanxi, China
| | - Chunbao Zhai
- Department of Colorectal & Anal Surgery, Shanxi Provincial People's Hospital Taiyuan, Shanxi, China
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6
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Campelo P, Barbosa E. Functional outcome and quality of life following treatment for rectal cancer. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Introduction Over the last decades, treatment for rectal cancer has substantially improved with development of new surgical options and treatment modalities. With the improvement of survival, functional outcome and quality of life are getting more attention.
Study objective To provide an overview of current modalities in rectal cancer treatment, with particular emphasis on functional outcomes and quality of life.
Results Functional outcomes after rectal cancer treatment are influenced by patient and tumor characteristics, surgical technique, the use of preoperative radiotherapy and the method and level of anastomosis. Sphincter preserving surgery for low rectal cancer often results in poor functional outcomes that impair quality of life, referred to as low anterior resection syndrome. Abdominoperineal resection imposes the need for a permanent stoma but avoids the risk of this syndrome. Contrary to general belief, long-term quality of life in patients with a permanent stoma is similar to those after sphincter preserving surgery for low rectal cancer.
Conclusion All patients should be informed about the risks of treatment modalities. Decision on rectal cancer treatment should be individualized since not all patients may benefit from a sphincter preserving surgery “at any price”. Non-resection treatment should be the future focus to avoid the need of a permanent stoma and bowel dysfunction.
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Affiliation(s)
- Pedro Campelo
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Elisabete Barbosa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
- Centro Hospitalar São João, Departamento de Cirurgia Colorretal, Porto, Portugal
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7
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Ren X, Chen B, Hong Y, Liu W, Jiang Q, Yang J, Qian Q, Jiang C. The challenges in colorectal cancer management during COVID-19 epidemic. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:498. [PMID: 32395542 PMCID: PMC7210180 DOI: 10.21037/atm.2020.03.158] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
It has been over 2 months since the start of the Coronavirus disease 2019 (COVID-19) outbreak. The epidemic stage of COVID-19 has brought great challenges to the diagnosis and management of colorectal cancer (CRC) patients. Symptoms, such as fever and cough caused by cancer, and the therapeutic process (including chemotherapy and surgery) should be differentiated from some COVID-19 related characteristics. Besides, clinical workers should not only consider the therapeutic strategy for cancer, but also emphasize COVID-19's prevention. Moreover, the detailed therapeutic regimens of CRC patients may be different from the usual. Also, treatment principles may various for CRC patients with or without severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, as well as patients with or without an emergency presentation. In this paper, we want to discuss the above-mentioned problems based on previous guidelines, the current working status and our experiences, to provide a reference for medical personnel.
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Affiliation(s)
- Xianghai Ren
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Baoxiang Chen
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Yuntian Hong
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Weicheng Liu
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Qi Jiang
- Department of Pathology and Pathophysiology, Hubei Provincial Key Laboratory of Developmentally Originated Disease, School of Basic Medical Sciences, Wuhan University, Wuhan 430071, China
| | - Jingying Yang
- Department of Anesthesia Surgery, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan 430071, China
| | - Qun Qian
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
| | - Congqing Jiang
- Department of Colorectal and Anal Surgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
- Clinical Center of Intestinal and Colorectal Diseases of Hubei Province, Wuhan 430071, China
- Hubei Key Laboratory of Intestinal and Colorectal Diseases (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Colorectal and Anal Disease Research Center of Medical School (Zhongnan Hospital of Wuhan University), Wuhan 430071, China
- Quality Control Center of Colorectal and Anal Surgery of Health Commission of Hubei Province, Wuhan 430071, China
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8
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Govil D, Dhankhar D, Gupta R, Kumar S. Gastrointestinal cancer surgery during COVID times. APOLLO MEDICINE 2020. [DOI: 10.4103/am.am_79_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Brown CJ, Hochman D, Raval MJ, Moloo H, Phang PT, Bouchard A, Williams L, Drolet S, Boushey R. A multi-centre randomized controlled trial of open vs closed management of the rectal defect after transanal endoscopic microsurgery. Colorectal Dis 2019; 21:1025-1031. [PMID: 31081281 DOI: 10.1111/codi.14689] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/12/2019] [Indexed: 01/17/2023]
Abstract
AIM Transanal endoscopic microsurgery (TEM) is a technically challenging strategy that allows expanded indications for local excision of rectal lesions. Transluminal suturing is difficult, so open management of the resultant defect is appealing. Expert opinion suggests there is more pain when the defect is left open. The aim of this study was to determine if closure of the defect created during full thickness excision of rectal lesions with TEM leads to less postoperative pain compared to leaving the defect open. METHOD At the time of surgery, patients undergoing a full thickness TEM were randomized to sutured (TEM-S) or open (TEM-O) management of the rectal defect. At five Canadian academic colorectal surgery centres, experienced TEM surgeons enrolled patients ≥ 18 years treated by full thickness TEM. The primary outcome was postoperative pain measured by the visual analogue scale. Secondary outcomes included postoperative pain medication use and 30-day postoperative complications, including bleeding, infection and hospital readmission. RESULTS Between March 2012 and October 2013, 50 patients were enrolled and randomized to sutured (TEM-S, n = 28) or open (TEM-O, n = 22) management of the rectal defect. There was no difference between the two study groups in postoperative pain on postoperative day 1 (2.8 vs 2.6, P = 0.76), day 3 (2.8 vs 2.1, P = 0.23) and day 7 (2.8 vs 1.7, P = 0.10). CONCLUSION In this multicentre randomized controlled trial, there was no difference in postoperative pain between sutured or open defect management in patients having a full thickness excision with TEM.
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Affiliation(s)
- C J Brown
- Department of Surgery, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Hochman
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - M J Raval
- Department of Surgery, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - H Moloo
- Department of Surgery, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - P T Phang
- Department of Surgery, University of British Columbia and St Paul's Hospital, Vancouver, British Columbia, Canada
| | - A Bouchard
- Department of Surgery, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - L Williams
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - S Drolet
- Department of Surgery, CHU de Québec - Université Laval, Quebec City, Quebec, Canada
| | - R Boushey
- Department of Surgery, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
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10
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Abstract
BACKROUND A common consensus for the definition for early rectal cancer does not exist. This item is used in cases of histological findings including pTis, pT1 or pT2 tumors. The term early rectal cancer is not mentioned in the German S3 guidelines on colorectal cancer. The pTis tumors are located at the mucosa level of the intestinal wall and they have nearly no tendency to develop metastases but pT2 tumors have a high risk of local metastases; therefore, the term early rectal cancer is not adequate for pT2 tumors. OBJECTIVE This focus of this article is exclusively on pT1 rectal cancer. Following the histological definition, pT1 tumors of the rectum are located at the level of the mucosa and submucosa of the intestinal wall. CONCLUSION With respect to the nature of the tumor (e.g. size, grading, invasion of lymphatic and/or blood vessels, Kikuchi classification) local methods (endoscopic procedure, surgical techniques) or radical resections are recommended. Tumor budding is of increasing interest and importance. Depending on the severity of the tumor budding classification (bd1-bd3) there is an association with a more frequent occurrence of lymph node metastases and should therefore be taken into consideration in treatment decisions in the future.
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Jones HJS, Goodbrand S, Hompes R, Mortensen N, Cunningham C. Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates. Colorectal Dis 2019; 21:451-459. [PMID: 30585677 DOI: 10.1111/codi.14546] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 11/26/2018] [Indexed: 02/08/2023]
Abstract
AIM Early rectal cancer can be managed effectively with local excision, which is now the standard of care for many T1 lesions. However, the presence of unexpected adverse histopathological factors may indicate an increased risk of local recurrence, prompting consideration of completion radical surgery. Many patients are unfit or prefer to avoid radical surgery, relying instead on surveillance and early detection of recurrent disease. Recently, radiotherapy has shown promise as an adjuvant therapy in this group. This study assesses local recurrence rates after local excision with adjuvant radiotherapy at a single centre. METHOD This was a retrospective review of a prospective database of all patients undergoing transanal endoscopic microsurgery (TEM) in a single institution. Data covering a 10-year period were analysed. RESULTS Of 197 patients undergoing TEM for rectal cancer, 33 (17%) had adjuvant radiotherapy because of adverse histopathological features. At 3.2 years' median follow-up, there were three instances of local recurrence (9.1%). Estimated local recurrence at 1 and 3 years was 0% and 6.9%, compared to 16.8% and 21.2% in a propensity-score-matched group who were followed by surveillance alone. Local recurrence was diagnosed at a median of 23 months post-TEM in the radiotherapy group, compared to 8 months in the matched group. CONCLUSION Radiotherapy after TEM is associated with a trend towards a reduced rate of local recurrence, even for high-risk disease. Radiotherapy would appear to offer a viable alternative to radical completion surgery in the presence of unforeseen adverse histopathological features, as long as a meticulous surveillance programme is in place.
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Affiliation(s)
- H J S Jones
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - S Goodbrand
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - N Mortensen
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
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12
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Abstract
BACKGROUND Local excision is now accepted as a standard treatment option for certain patients with early rectal cancer. However, there is a higher risk of local recurrence than after radical surgery with total mesorectal excision. Adjuvant radiotherapy after local excision may reduce this excess risk, and yet retain the benefits of local excision, with rectal preservation. METHODS A review of the literature pertaining to the use of adjuvant radiotherapy after local excision of rectal cancer and a discussion of current practice. RESULTS We first considered local excision as a treatment option for early rectal cancer, looking at technical developments and the risks and benefits of organ preservation, in particular, the advantages for quality of life and the risk of leaving residual disease which may result in local recurrence. We then looked at reported outcomes for studies using adjuvant radiotherapy after local excision. Few of the studies routinely used modern endoscopic methods of local excision and only the recent used chemoradiation. Local recurrence rates after adjuvant radiotherapy have improved over time, with rates of around 3.5% in the recent studies. Adverse effects of adjuvant radiotherapy are not commonly described, but generally, they are relatively mild when described. We then discussed current practice regarding adjuvant radiotherapy, including pathological criteria, discussion of local recurrence risk with the patient and the importance of a surveillance regime to detect any recurrence at an early stage. CONCLUSION We conclude that the current state of knowledge regarding adjuvant radiotherapy after local excision suggests a potential role in decreasing the risk of local recurrence but further studies are required to better define this effect, clarify which patients will gain the most benefit from this pathway, and identify those who should avoid exposure to the risks of radiotherapy.
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Affiliation(s)
- H. J. S. Jones
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
| | - C. Cunningham
- Department of Colorectal Surgery, Oxford University Hospitals, Oxford, UK
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13
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Chen N, Peng YF, Yao YF, Gu J. Trans-anal minimally invasive surgery for rectal neoplasia: Experience from single tertiary institution in China. World J Gastrointest Oncol 2018; 10:137-144. [PMID: 29988893 PMCID: PMC6033710 DOI: 10.4251/wjgo.v10.i6.137] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 04/26/2018] [Accepted: 05/30/2018] [Indexed: 02/05/2023] Open
Abstract
AIM To evaluate the feasibility and safety of trans-anal minimally invasive surgery (TAMIS) from single institute in China.
METHODS A retrospective review was conducted for patients with rectal neoplasia, who underwent TAMIS using single incision laparoscopic surgery-Port from January 2013 till January 2016 by a group of colorectal surgeons from Gastrointestinal Center Unit III, Peking University Cancer Hospital. Patients’ demographic data, surgical related information, post-operational pathology, as well as peri-operative follow-up were all collected.
RESULTS Twenty-five patients with rectal neoplasia were identified consequently. Complete full-thickness excision was achieved in all cases without conversion. 22 (88%) cases had rectal malignancies [6 were adenocarcinomas and 16 were neuroendocrine tumors (NET)], while 3 patients had adenomas. Mean surgical duration was 61.3 min, and mean post-operative stay were 2.7 d. Post-operational examination demonstrated 5 cases had positive resection margin: 2 adenocarcinoma cases and 1 NET case with positive lateral margin, and the other 2 NET cases with positive basal margin. The curve of operation time for TAMIS cases suggested a minimum of 10 cases for a laparoscopic surgeon proficient with this technique.
CONCLUSION TAMIS was demonstrated to be reproducible and safe, with a relatively short learning process for laparoscopic surgeons in selected cases for rectal neoplasia. Long-term oncological outcome needs to be determined by further investigation.
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Affiliation(s)
- Nan Chen
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Yi-Fan Peng
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Yun-Feng Yao
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
| | - Jin Gu
- Department of Gastrointestinal Center Unit III, Peking University Hospital and Institute, Beijing 100142, China
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14
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Durán-Martínez M, Medina-Fernández FJ, Martínez-Dueñas JL, Díaz-López C, Briceño-Delgado J. Endoanal resection of a giant villous adenoma in the middle rectum - a video vignette. Colorectal Dis 2018; 20:357. [PMID: 29364560 DOI: 10.1111/codi.14032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 01/11/2018] [Indexed: 02/08/2023]
Affiliation(s)
- M Durán-Martínez
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain
| | - F J Medina-Fernández
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain.,Unit of Coloproctology, Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain
| | - J L Martínez-Dueñas
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain.,Unit of Coloproctology, Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain
| | - C Díaz-López
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain.,Unit of Coloproctology, Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain
| | - J Briceño-Delgado
- Department of General and Digestive Surgery, Reina Sofia University Hospital, Cordoba, Spain
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15
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James DRC, Hogan A, Hompes R, Cunningham C. The Gelpoint ® Path Mini for transanal resection of rectal polyps - a video vignette. Colorectal Dis 2017; 19:785-786. [PMID: 28618156 DOI: 10.1111/codi.13762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Accepted: 04/12/2017] [Indexed: 02/08/2023]
Affiliation(s)
- D R C James
- Department of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | - A Hogan
- Department of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | - R Hompes
- Department of Colorectal Surgery, Churchill Hospital, Oxford, UK
| | - C Cunningham
- Department of Colorectal Surgery, Churchill Hospital, Oxford, UK
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The surgical defect after transanal endoscopic microsurgery: open versus closed management. Surg Endosc 2016; 31:1078-1082. [PMID: 27387173 DOI: 10.1007/s00464-016-5067-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 06/20/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND To determine whether closure of the defect created during full thickness excision of a rectal lesion with transanal endoscopic microsurgery (TEM) leads to fewer complications when compared to leaving the defect unsutured. METHODS This is a single-center cohort study using a prospectively maintained database. All patients ≥18 years old treated with full thickness TEM with no compromise of the peritoneal cavity were included. Two cohorts were established: patients with the defect sutured and patients with the defect left open. Demographic, operative, and pathologic data were compared. The main outcome analyzed was early (<30 day postoperative) complications, including bleeding that required investigation and readmission, infection, and reoperation. RESULTS Between 2007 and 2014, data for all patients treated with TEM have been maintained in the St. Paul's Hospital TEM database. Overall, 236 patients had the TEM defect sutured (TEM-S) and 105 patients had the defect left open (TEM-O). There were no differences between the groups in patient age, gender, tumor size or underlying tumor histology. There was no difference in OR time between the groups, but the most experienced TEM surgeon performed significantly more of the TEM-S procedures (61 vs. 39 %, p < 0.01). There were 40 postoperative complications, affecting 11.7 % of the cohort. The complication rate was higher in the TEM-O group (8.4 vs. 19.0 %, p = 0.03). There was no statistically significant difference in bleeding complications (4.7 vs. 7.6 %, p = 0.27) or infections (2.1 vs. 6.7 %, p = 0.05). Readmissions were less common in the TEM-S group (4.7 vs 12.4 %, p = 0.01). CONCLUSION The St. Paul's Hospital TEM experience suggests that while it is safe to leave rectal defects open when a robust mesorectal fat layer is present, there appears to be fewer postoperative complications when the defect is sutured closed.
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Bartel MJ, Brahmbhatt BS, Wallace MB. Management of colorectal T1 carcinoma treated by endoscopic resection from the Western perspective. Dig Endosc 2016; 28:330-41. [PMID: 26718885 DOI: 10.1111/den.12598] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2015] [Revised: 12/21/2015] [Accepted: 12/25/2015] [Indexed: 12/13/2022]
Abstract
Detection of early colorectal cancer is expected to rise in light of national colorectal cancer screening programs. This The present review article delineates current endoscopic risk assessments, differentiating invasive from non-invasive neoplasia, for high likelihood of lymph node metastasis in early colorectal cancer, also termed high-risk early colorectal cancer, and endoscopic and surgical resection methods from a Western hemisphere perspective.
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