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Park HM, Lee J, Lee SY, Kim CH, Kim HR. Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer. Int J Colorectal Dis 2024; 39:136. [PMID: 39164597 PMCID: PMC11335936 DOI: 10.1007/s00384-024-04708-6] [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] [Accepted: 08/14/2024] [Indexed: 08/22/2024]
Abstract
PURPOSE Debate persists regarding the feasibility of adopting an organ-preserving strategy as the treatment modality for clinical T2N0 rectal cancer. This study aimed to compare the outcomes of attempting organ-preserving strategies versus radical surgery in patients with clinical T2N0 mid to low rectal cancer. METHODS Patients diagnosed with clinical T2N0 rectal cancer, with lesions located within 8 cm from the anal verge as determined by pre-treatment magnetic resonance imaging between January 2010 and December 2020 were included. RESULTS Of 119 patients, 91 and 28 were categorized into the organ-preserving attempt group and the radical surgery group, respectively. The median follow-up duration was 48.8 months (range, 0-134 months). The organ-preserving attempt group exhibited a reduced incidence of stoma formation (44.0% vs. 75.0%; p = 0.004) and a lower occurrence of grade 3 or higher surgical complications (5.8% vs. 21.4%; p = 0.025). Univariate analyses revealed no significant association between treatment strategy and 3-year local recurrence-free survival (organ-preserving attempt 87.9% vs. radical surgery 96.2%; p = 0.129), or 3-year disease-free survival (79.6% vs. 84.9%; p = 0.429). Multivariate analysis did not identify any independent prognostic factors associated with oncologic outcomes. CONCLUSION Compared with radical surgery, attempted organ preservation resulted in lower incidences of stoma formation and severe surgical complications, whereas oncological outcomes were comparable. Attempting organ preservation may be a safe alternative to radical surgery for clinical T2N0 mid to low rectal cancer.
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Affiliation(s)
- Hyeung-Min Park
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Republic of Korea
| | - Jaram Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Republic of Korea
| | - Soo Young Lee
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Republic of Korea
| | - Chang Hyun Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Republic of Korea
| | - Hyeong Rok Kim
- Department of Surgery, Chonnam National University Hwasun Hospital and Medical School, Hwasun, Republic of Korea.
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Cantatore M, Jimeno Sandoval JC, Das S, Sesana A, Charlesworth T, Ryan T, Morello EM, Gobbetti M, Cinti F, Rossanese M. Submucosal resection via a transanal approach for treatment of epithelial rectal tumors - a multicenter study. Vet Surg 2022; 51:397-408. [PMID: 34997760 PMCID: PMC9303683 DOI: 10.1111/vsu.13766] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 11/12/2021] [Accepted: 12/18/2021] [Indexed: 01/06/2023]
Abstract
Objective To report complications and long‐term outcomes after submucosal resections of benign and malignant epithelial rectal masses. Study design Retrospective multicentric study. Sample population Medical records of 93 dogs at 7 referral hospitals. Methods Records were reviewed for surgical time, diagnosis, margins, complications, and recurrences. Survival of dogs was evaluated based on tumor types, categorized as benign, carcinoma in situ, and carcinoma. The Kaplan‐Meier survival curve and Cox proportional hazards analysis were used to determine the association of a range of variables with recurrence and survival time. Results Duration of follow up was 708 days (range, 25‐4383). Twenty‐seven dogs (29%) developed complications. Recurrence was identified in 20/93 (21%), with 12/20 recurrent masses treated with repeat submucosal resection. Median survival was not reached in any group. The 1‐,2‐, 5‐year survival rates for carcinomas were 95%, 89%, and 73% respectively. However, overall survival was longer for benign tumors than carcinomas (P = .001). Recurrence was more likely when complications (P = .032) or incomplete margins (P = .023) were present. Recurrence was associated with an increased risk of death (P = .046). Conclusion Submucosal resection of both benign and malignant rectal masses was associated with a low rate of severe complications and prolonged survival in the 93 dogs described here. Clinical significance Submucosal resection is a suitable technique for resection of selected rectal masses.
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Affiliation(s)
- Matteo Cantatore
- Anderson Moores Veterinary Specialists, part of Linnaeus Veterinary Limited, Winchester, UK
| | | | - Smita Das
- Davies Veterinary Specialists, part of Linnaeus Veterinary Limited, Hitchin, UK
| | - Alberto Sesana
- Davies Veterinary Specialists, part of Linnaeus Veterinary Limited, Hitchin, UK
| | - Tim Charlesworth
- Eastcott Veterinary Referrals, part of Linnaeus Veterinary Limited, Swindon, UK
| | - Tony Ryan
- Southern Counties Veterinary Specialists, Ringwood, UK
| | | | | | - Filippo Cinti
- Eastcott Veterinary Referrals, part of Linnaeus Veterinary Limited, Swindon, UK.,Clinica Veterinaria Apuana, Anicura, Marina di Carrara (MS), Italy
| | - Matteo Rossanese
- Royal Veterinary College, Hatfield, UK.,University of Liverpool, Neston, UK
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Wan LJ, Liu Y, Peng WJ, Zou SM, Ye F, Ouyang H, Zhao XM, Zhou CW, Zhang HM. Submucosal Enhancing Stripe as a Contrast Material-enhanced MRI-based Imaging Feature for the Differentiation of Stage T0-T1 from Early T2 Rectal Cancers. Radiology 2020; 298:93-101. [PMID: 33170102 DOI: 10.1148/radiol.2020201416] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Accurate differentiation of stage T0-T1 rectal tumors from stage T2 rectal tumors facilitates the selection of appropriate surgical treatment. MRI is a recommended technique for local staging, but its ability to distinguish T1 from T2 tumors is poor. Purpose To explore the value of a submucosal enhancing stripe (SES), an uninterrupted enhancing band between the rectal tumor and the muscular layer on contrast material-enhanced T1-weighted images, as a potential imaging feature to differentiate T0-T1 from T2 rectal tumors. Materials and Methods This retrospective study included patients with pT0-T1 and pT2 rectal tumors who underwent pretreatment MRI and rectal tumor resection between January 2012 and November 2019. Two radiologists independently evaluated tumor characteristics (SES; status of muscularis propria [SMP]; and tumor shape, location, and size) at MRI. The associations of clinical and imaging characteristics with stage T0-T1 or T2 tumors were assessed, β values were calculated, and predictive models were built. The diagnostic accuracies for the differentiation of T0-T1 tumors from T2 tumors with SES and SMP were compared. Results Data from 431 patients (mean age, 60 years ± 10 [standard deviation]; 261 men) were evaluated. SES (β = 3.9; 95% CI: 3.1, 4.7; P < .001), SMP (β = 1.3; 95% CI: 0.7, 1.9; P < .001), and carpetlike shape (β = 1.6; 95% CI: 0.5, 2.8; P = .01) were independent factors distinguishing T0-T1 tumors from T2 tumors. The diagnostic accuracy was 87% (95% CI: 84, 90; 376 of 431) for SES and 67% (95% CI: 63, 72; 290 of 431) for SMP (P < .001). Conclusion Submucosal enhancing stripe (SES) at contrasted-enhanced MRI, status of muscularis propria (SMP) on T2-weighted images, and tumor shape can serve as independent imaging features to differentiate stage T0-T1 rectal tumors from stage T2 rectal tumors. Moreover, SES is a more accurate feature than is SMP. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Turkbey in this issue.
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Affiliation(s)
- Li-Juan Wan
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Yuan Liu
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Wen-Jing Peng
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Shuang-Mei Zou
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Feng Ye
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Han Ouyang
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Xin-Ming Zhao
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Chun-Wu Zhou
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
| | - Hong-Mei Zhang
- From the Departments of Radiology (L.J.W., Y.L., W.J.P., F.Y., H.O., X.M.Z., C.W.Z., H.M.Z.) and Pathology (S.M.Z.), National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
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Hannan E, Ryan J, Toomey D. Technical challenges and potential solutions for rectal and sigmoid tumours following previous radiation for prostate malignancy: A case series. Int J Surg Case Rep 2020; 74:15-18. [PMID: 32759040 PMCID: PMC7403872 DOI: 10.1016/j.ijscr.2020.07.039] [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: 04/18/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aftermath of pelvic radiotherapy for prostate cancer (PC) can pose a significant challenge for surgeons in the management of rectal and sigmoid tumours, resulting in extensive fibrosis and difficult anatomy. Higher rates of ureteric injuries and anastomotic leakage following anterior resection (AR) have been reported with no clear consensus for an optimal approach. We present three cases, each employing a different surgical approach tailored to the individual patient-specific and disease-specific factors. PRESENTATION OF CASE In each case, the patient had active radiation proctitis. Case 1 was a T3 rectal cancer 9 cm from the anal verge. A non-restorative procedure was performed with a permanent end colostomy, due to the extensive pelvic fibrosis encountered in a comorbid patient. In case 2, a large rectal polyp at 12 cm from the anal verge was managed using transanal minimally invasive surgery (TAMIS) with a covering loop ileostomy. In case 3, an elderly patient with dementia with a malignant sigmoid polyp underwent a segmental resection rather than standard oncological resection, thus avoiding either a stoma or rectal anastomosis in the context of active radiation proctitis. All three patients remain well at follow-up with no evidence of recurrence. DISCUSSION All three cases demonstrate an individualised approach, taking into account specific factors relating to both patient and disease. In all cases, the presence of active chronic radiation proctitis meant that primary colorectal anastomosis was not safe, thus, alternative approaches were taken. CONCLUSION It is essential to tailor treatment according to patient-specific and disease-specific factors.
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Franke AJ, Skelton WP, George TJ, Iqbal A. A Comprehensive Review of Randomized Clinical Trials Shaping the Landscape of Rectal Cancer Therapy. Clin Colorectal Cancer 2020; 20:1-19. [PMID: 32863179 DOI: 10.1016/j.clcc.2020.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2020] [Revised: 07/18/2020] [Accepted: 07/20/2020] [Indexed: 12/31/2022]
Abstract
Colorectal carcinoma is the second leading cause of cancer-related deaths in the United States, with rectal cancer accounting for approximately one third of newly diagnosed cases. Surgery remains the cornerstone of curative therapy, with total mesorectal excision being the standard of care. Although minimally invasive procedures might be appropriate for a subset of patients with early-stage, superficial tumors, the standard of care for medically operable patients with nonmetastatic rectal cancer includes a comprehensive multimodality approach of neoadjuvant chemoradiotherapy, surgery with total mesorectal excision, and systemic chemotherapy. However, the morbidity and mortality related to both local and distant organ relapse have remained challenging. In the present review, we have discussed the trial-level evidence that has shaped the current clinical practice patterns in the treatment of curable, nonmetastatic rectal cancer. In addition, we have discussed the anticipated results of ongoing clinical trials and outlined pragmatic opportunities for future investigation to optimize the current status quo and, hopefully, provide prospective validation of novel approaches in the treatment of rectal cancer.
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Affiliation(s)
- Aaron J Franke
- Department of Hematology and Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | - William Paul Skelton
- Department of Hematology and Oncology, H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Tampa, FL
| | - Thomas J George
- Department of Medicine, Division of Hematology and Oncology, University of Florida College of Medicine, Gainesville, FL
| | - Atif Iqbal
- Section of Colorectal Surgery, Department of Surgery, Baylor College of Medicine, Houston, TX.
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Comparison of the transanal surgical techniques for local excision of rectal tumors: a network meta-analysis. Int J Colorectal Dis 2020; 35:1173-1182. [PMID: 32447481 DOI: 10.1007/s00384-020-03634-7] [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] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In order to assess the various surgical modalities for local resection of rectal tumors, a systematic review of the current literature and a network meta-analysis (NMA) was designed and conducted. METHODS The present study adhered to the PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions principles. Scholar databases (Medline, Scopus, Web of Science) were systematically screened up to 23/12/2019. A Bayesian NMA, implementing a Markov chain Monte Carlo analysis, was introduced for the probability ranking of the available surgical methods. Odds ratio (OR) and weighted mean difference (WMD) of the categorical and continuous variables, respectively, were reported with the corresponding 95% confidence interval (95%CI). RESULTS Overall, 16 studies and 2146 patients were introduced in our study. Transanal minimal invasive surgery (TAMIS) displayed the highest performance regarding the overall postoperative morbidity, the perioperative blood loss, the length of hospitalization, and the peritoneal violation rate. Transanal endoscopic microsurgery (TEM) was the most efficient modality for resecting an intact specimen. Although transanal local excision (TAE) had the highest ranking considering operative duration, it was associated with a significant risk for positive resection margins and tumor recurrence. CONCLUSIONS In conclusion, TEM and TAMIS display superior oncological results over TAE. Due to several limitations, validation of these results requires further RCTs of a higher methodological level.
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Sevak S, Gregoir T, Wolthuis A, Albert M. How can we utilize local excision to help, not harm, geriatric patients with rectal cancer? Eur J Surg Oncol 2020; 46:344-348. [PMID: 31983488 DOI: 10.1016/j.ejso.2019.12.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/12/2019] [Accepted: 12/13/2019] [Indexed: 01/24/2023] Open
Abstract
A majority of the morbidity and mortality burden of rectal cancer is distributed within the geriatric age group. Current surgical and medical treatment modalities pose significant challenges in treating complications specifically in the already pre-disposed senior population with baseline dysfunction. This chapter reviews the work-up, management, current data and oncologic outcomes of treating rectal cancer in the senior adult.
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Affiliation(s)
- Shruti Sevak
- Center for Colon and Rectal Surgery, AdventHealth, Orlando, FL, USA.
| | - Tine Gregoir
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 48, 3000, Leuven, Belgium
| | - Albert Wolthuis
- Department of Abdominal Surgery, University Hospital Leuven, Herestraat 48, 3000, Leuven, Belgium
| | - Matthew Albert
- Center for Colon and Rectal Surgery, AdventHealth, Orlando, FL, USA
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