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Marks JH, Reif de Paula T, Saidi H, Ikner TP, Schoonyoung H, Marks G, Keller DS. Longitudinal Analysis of Local Recurrence and Survival After Transanal Abdominal Transanal Radical Proctosigmoidectomy for Low Rectal Cancer Treated With Neoadjuvant Chemoradiation Therapy. Dis Colon Rectum 2024; 67:377-386. [PMID: 38064243 DOI: 10.1097/dcr.0000000000003146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
BACKGROUND The transanal abdominal transanal radical proctosigmoidectomy was developed in 1984 as a sphincter preservation surgery in patients with low rectal cancers after preoperative radiation therapy. While serving as a catalyst for disruptive sphincter preservation surgery, it continues to be used and evolve. With the controversy over safety and local recurrence in other sphincter-preserving surgery, review of transanal abdominal transanal radical proctosigmoidectomy long-term oncologic outcomes is warranted. OBJECTIVE To assess local recurrence and survival after transanal abdominal transanal radical proctosigmoidectomy after neoadjuvant chemoradiation therapy. DESIGN Retrospective cohort study of a prospectively maintained database. SETTINGS Tertiary rectal cancer referral center. PATIENTS Patients with low adenocarcinoma (≤5 cm anorectal ring) receiving neoadjuvant chemoradiation therapy and then transanal abdominal transanal radical proctosigmoidectomy for curative resection between 1998 and 2021. MAIN OUTCOME MEASURES Local recurrence rates and overall survival rates. RESULTS Of 255 included patients, 67.8% were men (n = 173); the mean age was 58.7 years (SD 11.5) and the mean BMI was 27.1 (SD 5.4), with 50.2% (n = 128) having ASA class II and 49.8% (n = 127) having ASA class III/IV. The mean tumor size was 4.8 cm (SD 1.9), the majority of patients had clinical T3 disease (81.8%; n = 184), and 52.1% had nodal disease (n = 100). The median radiation dose was 5400 cGy, with 73.7% (n = 149) achieving good response and 90.2% (n = 230) receiving minimally invasive surgery. The complete total mesorectal excision rate was 94.3%, and 100% of patients (n = 255) had negative distal margins. The mean number of examined lymph nodes were 13.9 (SD 10.7). After a median follow-up of 55.4 months, 5.1% of patients (n = 13) developed local recurrence at a median time of 29.6 months. The 5-year overall survival was 84.1% (95% CI, 78.8-89.4). LIMITATIONS Retrospective review with risk of bias and lack of generalizability. CONCLUSIONS In this longitudinal study, the transanal abdominal transanal radical proctosigmoidectomy demonstrated excellent long-term locoregional control and survival in very low rectal cancers. The superior transanal abdominal transanal radical proctosigmoidectomy outcomes are durable over time, warranting expansion of the sphincter-preserving surgery technique. See Video Abstract . ANLISIS LONGITUDINAL DE LA RECURRENCIA LOCAL Y LA SUPERVIVENCIA DESPUS DE LA PROCTOSIGMOIDECTOMA RADICAL TRANSANAL ABDOMINAL TATA PARA EL CNCER DE RECTO BAJO TRATADO CON QUIMIORRADIACIN NEOADYUVANTE ANTECEDENTES:La proctosigmoidectomía radical transanal abdominal se desarrolló en 1984 como una cirugía de preservación del esfínter en cánceres de recto bajo después de la radiación preoperatoria. Si bien sirve como catalizador para la cirugía disruptiva de preservación del esfínter, continúa utilizándose y evolucionando. Con la controversia sobre la seguridad y la recurrencia local en otras cirugías que preservan el esfínter, se justifica la revisión de los resultados oncológicos a largo plazo de la proctosigmoidectomía radical transanal abdominal.OBJETIVO:Evaluar localmente después de Proctosigmoidectomía Radical Transanal Abdominal Transanal después de quimiorradiación neoadyuvante.DISEÑO:Estudio de cohorte retrospectivo de una base de datos mantenida de forma prospectiva.AJUSTES:Centro terciario de referencia para el cáncer de recto.PACIENTES:Adenocarcinoma bajo (=/
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Affiliation(s)
- John H Marks
- Lankenau Medical Center, Lankenau Institute for Medical Research, Wynnewood, Pennsylvania
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Maudsley J, Clifford RE, Aziz O, Sutton PA. A systematic review of oncosurgical and quality of life outcomes following pelvic exenteration for locally advanced and recurrent rectal cancer. Ann R Coll Surg Engl 2024. [PMID: 38362800 DOI: 10.1308/rcsann.2023.0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
INTRODUCTION Pelvic exenteration (PE) is now the standard of care for locally advanced (LARC) and locally recurrent (LRRC) rectal cancer. Reports of the significant short-term morbidity and survival advantage conferred by R0 resection are well established. However, longer-term outcomes are rarely addressed. This systematic review focuses on long-term oncosurgical and quality of life (QoL) outcomes following PE for rectal cancer. METHODS A systematic review of the PubMed®, Cochrane Library, MEDLINE® and Embase® databases was conducted, in accordance with the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Studies were included if they reported long-term outcomes following PE for LARC or LRRC. Studies with fewer than 20 patients were excluded. FINDINGS A total of 25 papers reported outcomes for 5,489 patients. Of these, 4,744 underwent PE for LARC (57.5%) or LRRC (42.5%). R0 resection rates ranged from 23.2% to 98.4% and from 14.9% to 77.8% respectively. The overall morbidity rates were 17.8-87.0%. The median survival ranged from 12.5 to 140.0 months. None of these studies reported functional outcomes and only four studies reported QoL outcomes. Numerous different metrics and timepoints were utilised, with QoL scores frequently returning to baseline by 12 months. CONCLUSIONS This review demonstrates that PE is safe, with a good prospect of R0 resection and acceptable mortality rates in selected patients. Morbidity rates remain high, highlighting the importance of shared decision making with patients. Longer-term oncological outcomes as well as QoL and functional outcomes need to be addressed in future studies. Development of a core outcomes set would facilitate better reporting in this complex and challenging patient group.
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Affiliation(s)
- J Maudsley
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, UK
- Division of Cancer Sciences, University of Manchester, UK
| | - R E Clifford
- Institute of Translational Medicine, University of Liverpool, UK
| | - O Aziz
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, UK
- Division of Cancer Sciences, University of Manchester, UK
| | - P A Sutton
- Colorectal and Peritoneal Oncology Centre, Christie NHS Foundation Trust, UK
- Division of Cancer Sciences, University of Manchester, UK
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Evaluation of ctDNA in the Prediction of Response to Neoadjuvant Therapy and Prognosis in Locally Advanced Rectal Cancer Patients: A Prospective Study. Pharmaceuticals (Basel) 2023; 16:ph16030427. [PMID: 36986526 PMCID: PMC10057108 DOI: 10.3390/ph16030427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
“Watch and wait” is becoming a common treatment option for patients with locally advanced rectal cancer (LARC) submitted to neoadjuvant treatment. However, currently, no clinical modality has an acceptable accuracy for predicting pathological complete response (pCR). The aim of this study was to assess the clinical utility of circulating tumor DNA (ctDNA) in predicting the response and prognosis in these patients. We prospectively enrolled a cohort of three Iberian centers between January 2020 and December 2021 and performed an analysis on the association of ctDNA with the main response outcomes and disease-free survival (DFS). The rate of pCR in the total sample was 15.3%. A total of 24 plasma samples from 18 patients were analyzed by next-generation sequencing. At baseline, mutations were detected in 38.9%, with the most common being TP53 and KRAS. Combination of either positive magnetic resonance imaging (MRI) extramural venous invasion (mrEMVI) and ctDNA increased the risk of poor response (p = 0.021). Also, patients with two mutations vs. those with fewer than two mutations had a worse DFS (p = 0.005). Although these results should be read carefully due to sample size, this study suggests that baseline ctDNA combined with mrEMVI could potentially help to predict the response and baseline ctDNA number of mutations might allow the discrimination of groups with different DFS. Further studies are needed to clarify the role of ctDNA as an independent tool in the selection and management of LARC patients.
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Piercey O, Tie J. Circulating tumour DNA in the evolving treatment landscape of locally advanced rectal cancer: where does it fit in? Ther Adv Med Oncol 2023; 15:17588359231160138. [PMID: 36936200 PMCID: PMC10017954 DOI: 10.1177/17588359231160138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Accepted: 02/03/2023] [Indexed: 03/16/2023] Open
Abstract
The management of locally advanced rectal cancer (LARC) requires multimodality treatment, typically with neoadjuvant chemoradiotherapy (CRT) followed by total mesorectal excision. However, the treatment landscape is rapidly evolving with total neoadjuvant therapy and non-operative management for selected patients emerging as other novel treatment approaches. With so many treatment options, there is a need for biomarkers to direct a more personalised treatment strategy for patients with LARC. In this review, we summarise the available data regarding the use of circulating tumour DNA (ctDNA) in patients with LARC, as both a marker of treatment response to neoadjuvant therapy and as a marker of minimal residual disease (MRD) after patients have completed definitive local treatment. To date, the ability of ctDNA status to predict for pathologic complete response at any timepoint during multimodality treatment has been variably reported. The most consistent finding across available studies is the ability of ctDNA to detect MRD after CRT and surgery, the presence of which confers a significantly poor prognosis, with increased risk of cancer recurrence and worse overall survival. It is yet to be determined if providing additional therapies to patients with MRD improves outcomes. The available studies assessing the potential utility of ctDNA in LARC are limited by significant heterogeneity in the choice of ctDNA assay, timepoint at which ctDNA was collected, treatment that patients received and length of follow-up, leading to uncertainties about how to implement it into daily clinical practice. As the treatment landscape evolves, larger randomised trials assessing the role of ctDNA in LARC are needed.
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Affiliation(s)
- Oliver Piercey
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Jiang XF, Zhang BM, Du FQ, Guo JN, Wang D, Li YE, Deng SH, Cui BB, Liu YL. Exploring biomarkers for prognosis and neoadjuvant chemosensitivity in rectal cancer: Multi-omics and ctDNA sequencing collaboration. Front Immunol 2022; 13:1013828. [PMID: 36569844 PMCID: PMC9780298 DOI: 10.3389/fimmu.2022.1013828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
Introduction This study aimed to identified the key genes and sequencing metrics for predicting prognosis and efficacy of neoadjuvant chemotherapy (nCT) in rectal cancer (RC) based on genomic DNA sequencing in samples with different origin and multi-omics association database. Methods We collected 16 RC patients and obtained DNA sequencing data from cancer tissues and plasma cell-free DNA before and after nCT. Various gene variations were analyzed, including single nucleotide variants (SNV), copy number variation (CNV), tumor mutation burden (TMB), copy number instability (CNI) and mutant-allele tumor heterogeneity (MATH). We also identified genes by which CNV level can differentiate the response to nCT. The Cancer Genome Atlas database and the Clinical Proteomic Tumor Analysis Consortium database were used to further evaluate the specific role of therapeutic relevant genes and screen out the key genes in multi-omics levels. After the intersection of the screened genes from differential expression analysis, survival analysis and principal components analysis dimensionality reduction cluster analysis, the key genes were finally identified. Results The genes CNV level of principal component genes in baseline blood and cancer tissues could significantly distinguish the two groups of patients. The CNV of HSP90AA1, EGFR, SRC, MTOR, etc. were relatively gained in the better group compared with the poor group in baseline blood. The CNI and TMB was significantly different between the two groups. The increased expression of HSP90AA1, EGFR, and SRC was associated with increased sensitivity to multiple chemotherapeutic drugs. The nCT predictive score obtained by therapeutic relevant genes could be a potential prognostic indicator, and the combination with TMB could further refine prognostic prediction for patients. After a series of analysis in multi-omics association database, EGFR and HSP90AA1 with significant differences in multiple aspects were identified as the key predictive genes related to prognosis and the sensitivity of nCT. Discussion This work revealed that effective combined application and analysis in multi-omics data are critical to search for predictive biomarkers. The key genes EGFR and HSP90AA1 could serve as an effective biomarker to predict prognose and neoadjuvant chemosensitivity.
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Affiliation(s)
- Xiu-Feng Jiang
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Bo-Miao Zhang
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Fen-Qi Du
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Jun-Nan Guo
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Dan Wang
- Department of Neurology, The Second Affiliated Hospital of Qiqihar Medical University, Qiqihar, China
| | - Yi-En Li
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China
| | - Shen-Hui Deng
- Department of Anesthesiology, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Bin-Bin Cui
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China,*Correspondence: Bin-Bin Cui, ; Yan-Long Liu,
| | - Yan-Long Liu
- Department of Colorectal Surgery, Harbin Medical University Cancer Hospital, Harbin, China,*Correspondence: Bin-Bin Cui, ; Yan-Long Liu,
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Metwally IH, Zuhdy M, Hamdy O, Fareed AM, Elbalka SS. The Impact of Narrow and Infiltrated Distal Margin After Proctectomy for Rectal Cancer on Patients' Outcomes: a Systematic Review and Meta-analysis. Indian J Surg Oncol 2022; 13:750-760. [PMID: 36687255 PMCID: PMC9845496 DOI: 10.1007/s13193-022-01565-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 06/09/2022] [Indexed: 01/25/2023] Open
Abstract
Rectal cancer is a common tumor within a difficult anatomic constraint. Total mesorectal excision with longitudinal and circumferential free margins is considered imperative for good prognosis. In this article, the authors systematically reviewed all published literature with specific Mesh terms until the end of year 2019. Thereafter, retrieved articles were assessed using the Newcastle-Ottawa Scale and meta-analysis was conducted comparing local recurrence among 1-cm, 5-mm, and narrow (< 1-mm)/infiltrated margins. Thirty-nine articles were included in the study. Macroscopic distal margin < 1 cm carried a higher incidence of recurrence for those who did not receive neoadjuvant radiation, without affecting neither estimated overall nor disease-free survival. Less than 5-mm margin after radiation therapy is accepted oncologically. Infiltrated margins and narrow margins (< 1 mm) microscopically are associated with higher incidence of local recurrence and shorter overall and disease-free survival. Surgeons should aim at 1-cm safety margin in radiotherapy-naïve patients and microscopic free margin > 1 mm for those who received neoadjuvant therapy. The cost/benefit of reoperation for patients with infiltrated margins is still inadequately studied.
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Affiliation(s)
- Islam H. Metwally
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Mohammad Zuhdy
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Omar Hamdy
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Ahmed M. Fareed
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
| | - Saleh S. Elbalka
- Surgical Oncology department, Oncology Center Mansoura University (OCMU), Geehan Street, Dakahlia Governorate 35516 Mansoura City, Egypt
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Nagano H, Kajitani R, Ohno R, Munechika T, Matsumoto Y, Takahashi H, Aisu N, Kojima D, Yoshimatsu G, Hasegawa S, Kobayashi H, Sugihara K. Comparison of oncological outcomes between low anterior resection and abdominoperineal resection for rectal cancer: A retrospective cohort study using a multicenter database in Japan. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2467-2474. [PMID: 35752499 DOI: 10.1016/j.ejso.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/16/2022] [Accepted: 06/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND It remains controversial whether the abdominoperineal resection (APR) procedure itself has a negative impact on prognosis compared with sphincter-saving surgery (SSS). The purpose of this study was to investigate whether the operation type affects the prognostic outcome in rectal cancer using a multicenter database in Japan. METHODS The study involved 2533 patients who underwent APR or SSS and were registered in the Japanese Society for Cancer of the Colon and Rectum database, which includes data from 74 centers, between 2003 and 2007. The primary endpoints were overall survival (OS) and relapse-free survival (RFS). The secondary endpoints were local recurrence rate (LRR) and pathological radial margin (pRM) status. RESULTS Multivariate analysis identified pathological tumor depth, lymph node status, and pRM status to be associated with oncological outcomes (OS, RFS, LRR). Although the oncological outcomes were worse after APR than after SSS in univariate analysis, there was no significant difference in OS (hazard ratio 1.08; 95% confidence interval [CI] 0.85-1.37) or RFS (hazard ratio 1.06; 95% CI 0.87-1.30) between APR and SSS. There was also no significant difference in LRR (odds ratio 1.11, 95% CI 0.70-1.77). Multivariate analysis showed that operation type was associated with positive pRM (odds ratio 3.13, 95% CI 0.18-0.56). CONCLUSIONS There was no significant difference in oncological outcomes between APR and SSS for rectal cancer. The risk of positive pRM was higher for APR and performing radial margin-negative surgery is an important factor in improving the oncological outcomes of APR.
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Affiliation(s)
- Hideki Nagano
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan.
| | - Ryuji Kajitani
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Ryo Ohno
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Taro Munechika
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Yoshiko Matsumoto
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hiroyuki Takahashi
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Naoya Aisu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Daibo Kojima
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Gumpei Yoshimatsu
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Suguru Hasegawa
- Department of Gastroenterological Surgery, Fukuoka University Hospital, 7-45-1 Nanakuma Jonan-ku, Fukuoka, 814-0180, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Mizonokuchi Hospital, 5-1-1 Futago Takatsu-ku, Kawasaki, Kanagawa, 213-8504, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima Bunkyo-ku, Tokyo, 113-8510, Japan
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Yan H, Wang PY, Wu YC, Liu YC. Is a Distal Resection Margin of ≤ 1 cm Safe in Patients with Intermediate- to Low-Lying Rectal Cancer? A Systematic Review and Meta-Analysis. J Gastrointest Surg 2022; 26:1791-1803. [PMID: 35501549 DOI: 10.1007/s11605-022-05342-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Accepted: 04/19/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND It is generally accepted that the distal resection margin of intermediate- to low-lying rectal cancer should be greater than 2 cm and at least 1 cm in special cases. This study intends to investigate whether a distal resection margin ≤ 1 cm affects tumor outcomes for patients with intermediate- to low-lying rectal cancer. METHODS A systematic review of the literature was conducted. Sixteen studies included data for distal resection margins ≤ 1 cm (1684 cases) and > 1 cm (5877 cases), and 5 studies included survival data. Meta-analysis was used to compare the local recurrence rate and long-term survival of patients with distal resection margins > or ≤ 1 cm. RESULTS The local recurrence rate in the ≤ 1-cm margin group (9.5%) was 2.3% higher than that in the > 1-cm margin group (7.2%) according to a fixed-effects model (RR [95% CI] 1.42 [1.18, 1.70], P < 0.001). The overall survival results of the five 1-cm margin studies showed an HR (95% CI) of 0.96 (0.75, 1.24) (P = 0.78). Subgroup analysis showed that the local recurrence rate in the subgroup with perioperative treatment was 1.2% lower in the ≤ 1-cm margin group (8.3%) than in the > 1-cm margin group (9.5%) (RR [95% CI] 0.97 [0.63, 1.49], P = 0.90). In the surgery alone subgroup, the local recurrence rate was 4.7% higher in the ≤ 1-cm margin group (12.4%) than in the > 1-cm group (7.7%) (RR [95% CI] 1.76 [1.09, 2.83], P = 0.02). CONCLUSIONS For patients with intermediate- to low-lying rectal cancer undergoing surgery alone, a distal resection margin ≤ 1 cm may be not safe.
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Affiliation(s)
- Han Yan
- Department of General Surgery, Peking University First Hospital, Xishiku Street No 8, Xicheng District, Beijing, China
| | - Peng-Yuan Wang
- Department of General Surgery, Peking University First Hospital, Xishiku Street No 8, Xicheng District, Beijing, China
| | - Ying-Chao Wu
- Department of General Surgery, Peking University First Hospital, Xishiku Street No 8, Xicheng District, Beijing, China.
| | - Yu-Cun Liu
- Department of General Surgery, Peking University First Hospital, Xishiku Street No 8, Xicheng District, Beijing, China.
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Wilkins S, Yap R, Mendis S, Carne P, McMurrick PJ. Surgical Techniques for Abdominoperineal Resection for Rectal Cancer: One Size Does Not Fit All. Front Surg 2022; 9:818097. [PMID: 35284486 PMCID: PMC8907259 DOI: 10.3389/fsurg.2022.818097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 01/31/2022] [Indexed: 11/13/2022] Open
Abstract
Abdominoperineal resection (APR) of rectal cancer is associated with poorer oncological outcomes than anterior resection. This may be due to higher rates of intra-operative perforation (IOP) and circumferential resection margin (CRM) involvement causing higher recurrence rates and surgical complications. To address these concerns, several centers advocated a change in technique from a standard APR to a more radical extra-levator abdominoperineal excision (ELAPE). Initial reports showed that ELAPE reduced IOP rates and CRM involvement but increased wound complications and longer surgical duration. However, many of these studies had unacceptable rates of IOP and CRM before retraining in ELAPE. This may indicate that it was a sub-optimal surgical technique, which improved upon training, that had influenced the high CRM and IOP rates rather than the technique itself. Subsequent studies demonstrated that the CRM involvement rate for ELAPE was not always lower than for standard APR and, in some cases, significantly higher. The morbidity of ELAPE can be high, with studies reporting higher adverse events than APR, especially in terms of wound complications from the larger perineal incision required in ELAPE. Whether ELAPE improves short- or long-term oncological outcomes for patients has not been clearly demonstrated. The authors propose that all centers performing rectal cancer surgery audit surgical outcomes of patients undergoing APR or ELAPE and examine CRM involvement, IOP rates, and local recurrence rates, preferably through a national body. If rates of adverse technical or oncological outcomes exceed acceptable levels, then retraining in the appropriate surgical techniques may be indicated.
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Affiliation(s)
- Simon Wilkins
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- *Correspondence: Simon Wilkins
| | - Raymond Yap
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - Shehara Mendis
- Department of Oncology Research, Cabrini Hospital, Malvern, VIC, Australia
| | - Peter Carne
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
- Colorectal Unit, Department of Surgery, Alfred Hospital, Melbourne, VIC, Australia
| | - Paul J. McMurrick
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
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3D printed drug-loaded implantable devices for intraoperative treatment of cancer. J Control Release 2022; 344:147-156. [PMID: 35217100 PMCID: PMC9373975 DOI: 10.1016/j.jconrel.2022.02.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 02/14/2022] [Accepted: 02/17/2022] [Indexed: 12/23/2022]
Abstract
Surgery is an important treatment for cancer; however, local recurrence following macroscopically-complete resection is common and a significant cause of morbidity and mortality. Systemic chemotherapy is often employed as an adjuvant therapy to prevent recurrence of residual disease, but has limited efficacy due to poor penetration and dose-limiting off-target toxicities. Selective delivery of chemotherapeutics to the surgical bed may eliminate residual tumor cells while avoiding systemic toxicity. While this is challenging for traditional drug delivery technologies, we utilized advances in 3D printing and drug delivery science to engineer a drug-loaded arrowhead array device (AAD) to overcome these challenges. We demonstrated that such a device can be designed, fabricated, and implanted intraoperatively and provide extended release of chemotherapeutics directly to the resection area. Using paclitaxel and cisplatin as model drugs and murine models of cancer, we showed AADs significantly decreased local recurrence post-surgery and improved survival. We further demonstrated the potential for fabricating personalized AADs for intraoperative application in the clinical setting.
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Jankowski M, Wysocki WM, Las-Jankowska M, Tkaczyński K, Wiśniewski D, Bała D, Zegarski W. Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study. World J Surg Oncol 2021; 19:308. [PMID: 34670554 PMCID: PMC8529797 DOI: 10.1186/s12957-021-02413-0] [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: 01/23/2021] [Accepted: 09/30/2021] [Indexed: 01/19/2023] Open
Abstract
Background Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis. Methods We performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR. Results During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy. Conclusions The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence. Supplementary Information The online version contains supplementary material available at 10.1186/s12957-021-02413-0.
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Affiliation(s)
- Michal Jankowski
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland. .,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland.
| | - Wojciech M Wysocki
- Department of Surgery, Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Gustawa Herlinga-Grudzińskiego 1 Street, 30-705, Kraków, Poland.,Department of General, Oncological and Vascular Surgery, 5th Military Clinical Hospital in Kraków, Wrocławska 1-3 Street, 30-901, Kraków, Poland.,National Institute of Oncology, Maria Skłodowska-Curie Memorial, Scientific Editorial Office, W.K. Roentgena 5 Street, 02-781, Warszawa, Poland
| | - Manuela Las-Jankowska
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Clinical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Karol Tkaczyński
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Dorian Wiśniewski
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Dariusz Bała
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
| | - Wojciech Zegarski
- Chair of Surgical Oncology, Ludwik Rydygier's Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.,Department of Surgical Oncology, Oncology Center-Prof Franciszek Łukaszczyk Memorial Hospital, Romanowskiej 2 Street, 85-796, Bydgoszcz, Poland
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12
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Sheng X, Li S, Zhang Y, Geng J, Wang H, Zhu X, Quan J, Li Y, Cai Y, Wang W. One to Two Cycles of Consolidation Chemotherapy With Capecitabine After Neoadjuvant Chemoradiotherapy Does Not Benefit Low-Risk Patients With Locally Advanced Middle-Low Rectal Cancer. Front Oncol 2021; 11:695726. [PMID: 34660266 PMCID: PMC8515850 DOI: 10.3389/fonc.2021.695726] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 09/06/2021] [Indexed: 12/21/2022] Open
Abstract
Background and Objective Organ preservation can enable locally advanced rectal cancer (LARC) patients with clinical complete response (cCR) after neoadjuvant treatment to maintain quality of life. In this study, we aimed to evaluate whether one or two cycles of capecitabine after neoadjuvant chemoradiotherapy (NCRT) without extending the interval between the end of NCRT and surgery could increase the complete response (CR) rate in low-risk middle-low LARC patients. Material and Methods We retrospectively evaluated middle-low LARC patients with low risk defined as clinical T2-3b, mesorectal fascia-clear, and extramural vascular invasion-negative by magnetic resonance imaging (MRI), treated between January 2015 and July 2019. Patients were divided into two groups according to whether consolidation chemotherapy was administered after NCRT. Patients in the consolidation chemotherapy group received one or two cycles of capecitabine (1000 mg/m2 twice daily from days 1 to 14). The main outcome was the CR rate, including pathological CR (pCR) and cCR. Results A total of 169 patients, 105 in the consolidation chemotherapy group and 64 in the non-consolidation chemotherapy group, were included in the study, and the median follow-up was 37.2 months (range, 0.4–71.2 months). Seventeen patients achieved cCR and the remaining 152 underwent surgery after neoadjuvant treatment. There was no significant difference in the CR rate (39.0% vs. 35.9%, p=0.686), ypT0-2N0 rate (65.2% vs. 63.3%, p=0.812), or ypN0 rate (83.7% vs. 88.3%, p=0.503) between the consolidation chemotherapy and non-consolidation chemotherapy groups. Among the patients achieved cCR, 3 (17.6%) experienced regrowth in the rectum and 2 (11.8%) experienced distant metastasis. There was also no significant difference in the 3-year disease-free survival (87.4% vs 85.9%, p=0.971) in patients who underwent surgery between the two groups. Multivariate logistic regression analysis indicated that normal Carcinoma Embryonic Antigen (CEA) levels (p = 0.001) were associated with a higher CR rate. Moreover, there were no significant differences in the incidences of grade ≥2 acute toxicities during neoadjuvant treatment. Conclusion Although there was no increase in treatment-related toxicities between the two groups, simply adding one or two cycles of capecitabine after NCRT might be insufficient to benefit low-risk middle-low LARC patients.
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Affiliation(s)
- Xueqing Sheng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Shuai Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yangzi Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jianhao Geng
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Hongzhi Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Xianggao Zhu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Jizhong Quan
- Department of Radiation Oncology, Jilin Guowen Hospital, Gongzhuling, China
| | - Yongheng Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Yong Cai
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, China
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13
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Yildirim E, Bektas S, Pelen Z, Yanik I, Er AM, Cengel F, Gumuskaya PÖ. Histopathological, Radiological, and Demographic Factors Predicting the Response to Neoadjuvant Therapy for Rectal Cancer. J Gastrointest Cancer 2021; 53:22-30. [PMID: 34472012 DOI: 10.1007/s12029-021-00697-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND/AIM While the treatment for early stage rectal cancer is surgery, when a diagnosis is made at a locally advanced stage, it is recommended to start treatment with neoadjuvant chemoradiotherapy. Therefore, it is important to determine which patients will respond best to neoadjuvant treatment. The aim of this study was to investigate which hematological, histopathological, and radiological parameters can predict the response to chemoradiotherapy. METHODS AND MATERIAL A retrospective examination was made of 43 patients who underwent surgery following neoadjuvant chemoradiotherapy because of locally advanced stage rectal cancer. Demographic data were collected from the patient files, and the radiological, histopathological, and laboratory findings before neoadjuvant chemoradiotherapy were compared with the findings after treatment. RESULTS In the postoperative evaluation, a pathological complete response was determined in 25.50% of the patients. Lymphovascular invasion, perineural invasion, and absence of necrosisis were seen to be statistically related to major response (p < 0.05), and in patients where the tumor was closer than 6 cm to the anal verge, the response was better CONCLUSION: When the findings were examined, histopathological lymphovascular invasion, perineural invasion, the presence of necrosis, and the anal verge distance were evaluated as parameters predicting the response to neoadjuvant chemoradiotherapy in rectal cancer.
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Affiliation(s)
- Emine Yildirim
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey.
| | - Sibel Bektas
- Department of Pathology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Zekeriya Pelen
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Irem Yanik
- Department of Pathology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Muzaffer Er
- Department of General Surgery, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Ferhat Cengel
- Department of Radiology, University of Health Sciences Turkey, Gaziosmanpasa Training and Research Hospital, Istanbul, Turkey
| | - Perihan Özkan Gumuskaya
- Department of İnternal Medicine, University of Health Sciences Turkey, Cemil Tascioglu City Hospital, Prof. Dr, Istanbul, Turkey
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14
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Zheng Z, Wang X, Liu Z, Lu X, Huang Y, Chi P. Individualized conditional survival nomograms for patients with locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy and radical surgery. Eur J Surg Oncol 2021; 47:3175-3181. [PMID: 34120806 DOI: 10.1016/j.ejso.2021.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/08/2021] [Accepted: 06/03/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Conditional survival (CS) considers the time already survived after surgery when estimating the survival probability, which may provide further useful prognostic information. OBJECTIVE To evaluate CS in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT) and to create CS nomograms predicting the conditional probability of survival after proctectomy. METHODS Consecutive patients with LARC who received nCRT followed by radical resection between 2011 and 2016 were identified. CS was defined as the probability of surviving y years after already surviving for x years. The formula used for CS was CS(x|y) = S(x + y)/S(x), where S(x) represents the survival at x years. Nomograms were constructed to predict the 5-year conditional overall survival (cOS) and conditional recurrence-free survival (cRFS). RESULTS A total of 785 patients were included. The median follow-up time was 65.5 months. The probability of achieving 5-year survival after surgery for cancer increases with additional survival time. Maximum tumor diameter, distance from the anal verge, preoperative CA19-9 level, ypTNM stage and perineural invasion were independent predictors of OS, while maximum tumor diameter, distance from the anal verge, ypTNM stage and perineural invasion were independent risk factors for RFS. The nomograms predicted 5-year cOS and cRFS using these predictors and the time already survived. The online calculator can be accessed at http://www.rectalcancer.top/webcalculator. CONCLUSION The proposed nomograms predict survival in patients after surgery, taking the time already survived into account.
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Affiliation(s)
- Zhifang Zheng
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaojie Wang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Zhun Liu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xingrong Lu
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying Huang
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
| | - Pan Chi
- Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, China; Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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15
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Sato K, Shimoda H, Miura T, Sakamoto Y, Morohashi H, Watanabe S, Narita H, Mitsuhashi Y, Umemura K, Hakamada K. Widespread anorectal lymphovascular networks and tissue drainage: analyses from submucosal India ink injection and indocyanine green fluorescence imaging. Colorectal Dis 2021; 23:1334-1345. [PMID: 33570769 PMCID: PMC8248146 DOI: 10.1111/codi.15582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 01/12/2021] [Accepted: 02/04/2021] [Indexed: 01/11/2023]
Abstract
AIM Abdominoperineal resection is associated with poor prognosis in patients with advanced lower rectal cancer. This study aimed to analyse the functional lymphovascular network and tissue drainage in the anorectal region. METHODS In this descriptive study, we performed microanatomical evaluations and intra-operative imaging analysis in a cadaver and patients with rectal cancer. Specimens with India ink injection were collected from a cadaver and from six patients who underwent abdominoperineal resection. Intra-operative indocyanine green fluorescence imaging was performed on four patients who underwent surgery for lower rectal cancer. India ink was injected into the submucosa at the dentate line of specimens. Tissue sections were examined by immunohistochemistry for D2-40 and CD31. Intra-operative indocyanine green was injected into the submucosa at the dentate line. Lymph flow was traced using a near-infrared camera system. RESULTS Fascia branching from the rectal longitudinal muscle layer extended to the posterior hiatal ligament and lateral endopelvic fascia connective tissue lamina on the surface of the levator ani muscle. The fascia contained veins labelled with ink in their lumina and initial lymphatics. Intra-operative indocyanine green fluorescence imaging revealed extensive lymph flow from the muscle layer of the anal canal to the hiatal ligament and endopelvic fascia along the longitudinal muscle layer fibres. CONCLUSIONS The anorectal region contained widespread venous and lymphatic networks in proportion to its specific connective tissue framework around the longitudinal-muscle-layer-extending muscle bundles, which provides extensive networks for tissue fluid and cells.
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Affiliation(s)
- Kentaro Sato
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan,Department of Anatomical ScienceGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Hiroshi Shimoda
- Department of Anatomical ScienceGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan,Department of Neuroanatomy, Cell Biology, HistologyGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Takuya Miura
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Yoshiyuki Sakamoto
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Hajime Morohashi
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Seiji Watanabe
- Department of Anatomical ScienceGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Hirokazu Narita
- Department of Anatomical ScienceGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Yuto Mitsuhashi
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan,Department of Anatomical ScienceGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Kotaro Umemura
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan,Department of Anatomical ScienceGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
| | - Kenichi Hakamada
- Department of Gastroenterological SurgeryGraduate School of MedicineHirosaki UniversityHirosakiAomoriJapan
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16
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Däster S, Shin JS, Loizides S, Steffens D, Koh CE, Solomon MJ. Pathology reporting of pelvic exenteration specimens for locally recurrent rectal cancer. Eur J Surg Oncol 2021; 47:2100-2107. [PMID: 33895021 DOI: 10.1016/j.ejso.2021.03.258] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/18/2021] [Accepted: 03/29/2021] [Indexed: 10/21/2022] Open
Abstract
INTRODUCTION Reporting of pelvic exenteration specimens for locally recurrent rectal cancer (LRRC) can be challenging for structured pathological analysis and currently, there is a lack of specific guidelines. The aim of this study was to assess the quality of pathology reporting in a cohort of patients who underwent pelvic exenteration for LRRC in a high-volume tertiary unit. MATERIALS AND METHODS In a retrospective analysis of histopathology reports of consecutive patients who underwent pelvic exenteration for LRRC from 1996 to 2018, the quality of pathology reporting was assessed using the Structure Reporting Protocol for Colorectal Cancer. The primary endpoint was the completeness of pathology reporting, secondary endpoints were the association between the reporting style (narrative versus synoptic), reporting period (the first half versus the second half), as well as the activity of the pathologists with the completeness of pathology reporting. RESULTS 221 patients who underwent pelvic exenteration for LRRC were included into the study. There was a high variability in completeness of pathology reporting within the cohort, ranging from 9.5% to 100%. Notably, microscopic clearance was reported in only 92.4% of the reports. Overall, a significantly higher rate of completeness was observed in synoptic reports when compared to narrative reports and in more recent compared to earlier reports. There was no significant association between the activity of pathologists and the completeness of reporting. CONCLUSIONS This study shows a significant variability in the quality of reporting in pelvic exenteration for LRRC. The use of synoptic reporting clearly resulted in more complete reports.
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Affiliation(s)
- Silvio Däster
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Joo-Shik Shin
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Sofronis Loizides
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Daniel Steffens
- Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia
| | - Cherry E Koh
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Michael J Solomon
- Department of Colorectal Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Surgical Outcomes Research Centre (SOuRCe), Sydney Local Health District and Faculty of Medicine and Health Sciences, University of Sydney, Sydney, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
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17
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Transanal total mesorectal excision for stage II or III rectal cancer: pattern of local recurrence in a tertiary referral center. Surg Endosc 2021; 35:7191-7199. [PMID: 33398553 DOI: 10.1007/s00464-020-08200-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 11/19/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND For mid and low rectal cancer, transanal total mesorectal excision (TaTME) has been established as an alternative approach to laparoscopic surgery. However, there are concerns about an unexpected pattern of local recurrence. This study aimed to analyze the pattern of local recurrence for patients treated with TaTME in a tertiary referral center. METHODS A retrospective single-center analysis was performed. Since 2011, all patients with rectal cancer undergoing TaTME with curative intent were prospectively included in a standardized database. Patients with tumors within 12 cm, clinical stage II or III were included. The primary endpoint of the study was the overall local recurrence rate, together with a critical analysis of the patterns of local failures. RESULTS Two hundred and five patients were included in this analysis. At the time of surgery, patients had a mean age of 67.1 years (SD 12.3), and 66.8% were male. Neoadjuvant therapy was administered in 73.7%. Mesorectal specimen quality was complete or near-complete in 98.5%, while circumferential resection margin was ≤ 1 mm (including T4 tumors) in 11.8%. After a median follow-up of 34.3 months (95% CI 30.1-38.5), 3.4% (n = 7) presented with local recurrent disease. Six out of the seven patients were also diagnosed with hematogenous metastases. Of the seven patients, three presented with at least one of the following risk factors: T4 tumor, N2 disease, incomplete mesorectal specimen, or positive CRM. Local failure was noted posteriorly (n = 3), laterally (n = 2), anteriorly (n = 1), and in the axial compartment (n = 1). Median time to relapse was 31.5 months (10.3-40.9). The median follow-up after local recurrence was 7.9 (95% CI 6.7-9.1) months, with an overall survival of 85.7%. CONCLUSIONS TaTME provided satisfactory local recurrence outcomes, and the most common patterns of failure were in the central pelvis.
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18
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Ichihara M, Ikeda M, Uemura M, Miyake M, Miyazaki M, Kato T, Sekimoto M. Feasibility and safety of laparoscopic lateral pelvic lymph node dissection for locally recurrent rectal cancer and risk factors for re-recurrence. Asian J Endosc Surg 2020; 13:489-497. [PMID: 31854108 DOI: 10.1111/ases.12778] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/18/2019] [Accepted: 11/26/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Lateral pelvic lymph node (LPLN) metastasis is considered a distant metastasis. It is often treated by systemic chemotherapy and/or radiation therapy, but complete radical resection of LPLN metastasis can sometimes achieve cure. However, the safety and efficacy of radical resection for recurrent LPLN after curative rectal surgery have not been well elucidated. Therefore, we evaluated the feasibility of laparoscopic radical surgery for recurrent LPLN compared with the conventional open approach and assessed oncological outcomes between patients with and without re-recurrence. METHODS We retrospectively reviewed 17 cases (4 open, 13 laparoscopic) who underwent radical resection for LPLN metastasis after curative rectal surgery between July 2012 and August 2016 at the National Hospital Organization Osaka National Hospital. Operative factors and short-term outcomes were compared. Oncological outcome was evaluated based on the pathologic response to preoperative adjuvant therapy. RESULTS The laparoscopic group's median blood loss and C-reactive protein elevation were lower than that of the open group on postoperative day 3. The laparoscopic group also had a shorter postoperative hospital stay. The median operative time, R0 resection rate, and morbidity rate were similar between the two groups. Local re-recurrence after LPLN resection occurred more frequently in pathologic non-responders than responders. CONCLUSION Laparoscopic surgery for LPLN metastasis is feasible and less invasive than open surgery. Laparoscopic radical resection of LPLN may be justified for curative intent. Patients with incomplete pathologic response to neoadjuvant therapy have a greater risk of re-recurrence.
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Affiliation(s)
- Momoko Ichihara
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masataka Ikeda
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Division of Lower Gastrointestinal, Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Mamoru Uemura
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Masakazu Miyake
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Michihiko Miyazaki
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Takeshi Kato
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Mitsugu Sekimoto
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan.,Department of Surgery, Kansai Medical University, Hirakata, Japan
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19
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Huang WS, Kuan FC, Lin MH, Chen MF, Chen WC. Prognostic Significance of Neoadjuvant Rectal Scores in Preoperative Short-Course Radiotherapy and Long-Course Concurrent Chemoradiotherapy for Patients with Locally Advanced Rectal Cancer. Ann Surg Oncol 2020; 27:4309-4318. [PMID: 32794029 DOI: 10.1245/s10434-020-09018-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND This study aimed to investigate the prognostic factors and the utility of the neoadjuvant rectal (NAR) score for patients who have locally advanced rectal cancer (LARC) treated with preoperative short-course radiotherapy (SRT) or long-course concurrent chemoradiotherapy (CRT). METHODS Of 314 consecutive stage 2 or 3 rectal cancer patients enrolled from January 2006 to December 2017, 205 underwent preoperative SRT (2500 cGy/5 fractions), and 109 underwent preoperative CRT (4200-5080 cGy/21-28 fractions) after total mesorectal excision (TME). The study calculated NAR scores using the following equation: [5 pN - 3(cT - pT) + 12]2/9.61. RESULTS The multivariate analysis showed that age above 65 years, pT4, pN2, NAR scores higher than 16, and distance from anal verges (< 8 cm) were significant prognostic factors for overall survival (OS), whereas, pN2, NAR scores lower than 16, and distance from anal verges (< 8 cm) were significant prognostic factors for disease-free survival (DFS) and distant metastasis (DM). The patients with an NAR score higher than 16, had a 5-year OS rate of 67.6%, a DFS rate of 56.9%, a locoregional recurrence (LRR) rate of 7.7%, and a DM rate of 35% compared with corresponding rates of 87.6%, 76.7%, 5.4%, and 7.2% for the patients with an NAR score of 16 or lower (p < 0.001 for OS, < 0.001 for DFS, 0.25 for LRR, and < 0.001 for DM). CONCLUSIONS For patients who undergo SRT or CRT for LARC, a higher NAR score is associated with worse OS and DFS and higher DM rates at 5 years. The NAR score could be used as a short-term surrogate end point after neoadjuvant therapy for LARC.
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Affiliation(s)
- Wen-Shih Huang
- Department of Colon and Rectal Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Feng-Che Kuan
- Department of Hematology and Oncology, Chang Gung Memorial Hospital, Chiayi, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Tao-Yuan, Taiwan
| | - Meng-Hung Lin
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Miao-Fen Chen
- Graduate Institute of Clinical Medical Sciences, Chang-Gung University, Tao-Yuan, Taiwan. .,Department of Radiation Oncology, Chang Gung Memorial Hospital, Chia-Yi, Hsien, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Wen-Cheng Chen
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Chia-Yi, Hsien, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan.
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20
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Song KS, Park SC, Sohn DK, Oh JH, Kim MJ, Park JW, Ryoo SB, Jeong SY, Park KJ, Oh HK, Kim DW, Kang SB. Oncologic Risk of Rectal Preservation Against Medical Advice After Chemoradiotherapy for Rectal Cancer: A Multicenter Comparative Cross-Sectional Study with Rectal Preservation as Supported by Surgeon. World J Surg 2020; 43:3216-3223. [PMID: 31410512 DOI: 10.1007/s00268-019-05128-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Rectal preservation against medical advice after neoadjuvant chemoradiotherapy for rectal cancer may increase oncologic uncertainty. This study aimed to compare the oncologic outcomes of patients undergoing rectal preservation as intended by the surgeon, and the outcomes of patients refusing rectal resection against medical advice. METHODS The study population consisted of patients in whom the rectum was preserved after neoadjuvant chemoradiotherapy for clinical stage I-III mid or low rectal cancer between May 2003 and August 2017 (n = 2883); these patients were divided into those in whom rectal preservation was intended by their surgeon (intended rectal preservation, group A, n = 41) and those in whom the rectum was not resected against medical advice (unintended rectal preservation, group B, n = 101), defined as non-operative management or local excision. RESULTS The tumor distance, age, and performance status of patients were not significantly different between the groups, while the clinical T stage before chemoradiotherapy was lower in group A than in group B (P < 0.001). During the median follow-up period of 34 months (interquartile range 18.0-72.0 months), the 3-year overall survival in group B (59.7%) was worse than that in group A (90.1%; P < 0.001), and 80.2% of group B patients had residual or unknown disease status. CONCLUSIONS This study showed that unintended rectal preservation increases oncologic risk after neoadjuvant chemoradiotherapy for rectal cancer regardless of short-term follow-up. Therefore, these findings could be shared with rectal cancer patients who choose to ignore medical advice after chemoradiotherapy to preserve their rectum.
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Affiliation(s)
- Kwang-Seop Song
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Sung Chan Park
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Dae Kyung Sohn
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Jae Hwan Oh
- Center for Colorectal Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea
| | - Min Jung Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ji Won Park
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Bum Ryoo
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seung-Yong Jeong
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyu Joo Park
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Heung-Kwon Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Duck-Woo Kim
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Sung-Bum Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
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21
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Murahashi S, Akiyoshi T, Sano T, Fukunaga Y, Noda T, Ueno M, Zembutsu H. Serial circulating tumour DNA analysis for locally advanced rectal cancer treated with preoperative therapy: prediction of pathological response and postoperative recurrence. Br J Cancer 2020; 123:803-810. [PMID: 32565539 PMCID: PMC7462982 DOI: 10.1038/s41416-020-0941-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 05/12/2020] [Accepted: 05/26/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The "watch-and-wait" approach is a common treatment option amongst patients with locally advanced rectal cancer (LARC). However, the diagnostic sensitivity of clinical modalities, such as colonoscopy and magnetic resonance imaging to determine pathological response, is not high. We analysed the clinical utility of circulating tumour DNA (ctDNA) of patients with LARC to predict response to preoperative therapy and postoperative recurrence. METHODS A serial ctDNA analysis of 222 plasma samples from 85 patients with LARC was performed using amplicon-based deep sequencing on a cell-free DNA panel covering 14 genes with over 240 hotspots. RESULTS ctDNA was detected in 57.6% and 22.3% of samples at baseline and after preoperative treatment, respectively, which was significantly different (P = 0.0003). Change in ctDNA was an independent predictor of complete response to preoperative therapy (P = 0.0276). In addition, postoperative ctDNA and carcinoembryonic antigen (CEA) were independent prognostic markers for risk of recurrence after surgery (ctDNA, P = 0.0127 and CEA, P = 0.0105), with a combined analysis having cumulative effects on recurrence-free survival (P = 1.0 × 10-16). CONCLUSIONS Serial ctDNA analysis may offer clinically useful predictive and prognostic markers for response to preoperative therapy and postoperative recurrence in patients with LARC.
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Affiliation(s)
- Satoshi Murahashi
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takashi Akiyoshi
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Takeshi Sano
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Yosuke Fukunaga
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Tetsuo Noda
- Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Ueno
- Department of Gastrointestinal Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hitoshi Zembutsu
- Project for Development of Liquid Biopsy Diagnosis, Cancer Precision Medicine Center, Japanese Foundation for Cancer Research, Tokyo, Japan.
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22
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Al-Haidari G, Skovlund E, Undseth C, Rekstad BL, Larsen SG, Åsli LM, Dueland S, Malinen E, Guren MG. Re-irradiation for recurrent rectal cancer - a single-center experience. Acta Oncol 2020; 59:534-540. [PMID: 32056476 DOI: 10.1080/0284186x.2020.1725111] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background: There is no clear consensus on the use of re-irradiation (reRT) in the management of locally recurrent rectal cancer (LRRC). The aim of the present study was to investigate all reRT administered for rectal cancer at a large referral institution and to evaluate patient outcomes and toxicity.Material and methods: All patients with rectal cancer were identified who had received previous pelvic radiotherapy (RT) and underwent reRT during 2006-2016. Medical records and RT details of the primary tumor treatments and rectal cancer recurrence treatments were registered, including details on reRT, chemotherapy, surgery, adverse events, and long-term outcomes.Results: Of 77 patients who received ReRT, 67 had previously received pelvic RT for rectal cancer and were administered reRT for LRRC. Re-irradiation doses were 30.0-45.0 Gy, most often given as hyperfractionated RT in 1.2-1.5 Gy fractions twice daily with concomitant capecitabine. The median time since initial RT was 29 months (range, 13-174 months). Of 36 patients considered as potentially resectable, 20 underwent surgery for LRRC within 3 months after reRT. Operated patients had better 3-year overall survival (OS) (62%) compared to those who were not operated (16%; HR 0.32, p = .001). The median gross tumor volume (GTV) was 107 cm3, and 3-year OS was significantly better in patients with GTV <107 cm3 (44%) compared to patients with GTV ≥107 cm3 (21%; HR 0.52, p = .03).Conclusion: Three-year survival was significantly better for patients who underwent surgery after reRT or who had small tumor volume. Prospective clinical trials are recommended for further improvements in patient selection, outcomes, and toxicity assessment.
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Affiliation(s)
| | - Eva Skovlund
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Stein Gunnar Larsen
- Department of Gastrointestinal and Paediatric Surgery, Oslo University Hospital, Oslo, Norway
| | | | - Svein Dueland
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Eirik Malinen
- Department of Medical Physics, Oslo University Hospital, Oslo, Norway
- Department of Physics, University of Oslo, Oslo, Norway
| | - Marianne Grønlie Guren
- Department of Oncology, Oslo University Hospital, Oslo, Norway
- K.G. Jebsen Colorectal Cancer Research Centre, Oslo University Hospital, Oslo, Norway
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23
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Bacalbasa N, Balescu I, Vilcu M, Dima S, Brezean I. The Impact of the Preoperative Status on the Short-term Outcomes After Exenteration and Pelvic Reconstruction. In Vivo 2020; 33:2147-2152. [PMID: 31662550 DOI: 10.21873/invivo.11716] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The aim of this study was to analyse the influence of the preoperative status on the perioperative outcomes of patients submitted to pelvic reconstructions after exenteration. MATERIALS AND METHODS Between January 2017 and December 2018, pelvic exenteration was performed in 86 cases; patients were classified according to their age, nutritional status and association of reconstructive surgery. RESULTS The median age was 56 years, while the median level of serum albumin was 3.6 g/dl. Reconstructive surgery was more frequently performed in younger patients, while the rate of postoperative complications was similar between the two groups, while the rate of postoperative complications was significantly higher among cases with lower serum albumin levels. CONCLUSION Reconstructive surgery should be performed in selected patients. Elderly cases as well as those presenting a poorer nutritional status are at higher risk of developing postoperative complications.
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Affiliation(s)
- Nicolae Bacalbasa
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania.,"Fundeni" Clinical Institute - Center of Excellence in Translational Medicine, Bucharest, Romania
| | | | - Mihaela Vilcu
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
| | - Simona Dima
- "Fundeni" Clinical Institute - Center of Excellence in Translational Medicine, Bucharest, Romania
| | - Iulian Brezean
- "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania.,"I. Cantacuzino" Clinical Hospital, Bucharest, Romania
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24
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Clinical, pathological, and oncologic outcomes of robotic-assisted versus laparoscopic proctectomy for rectal cancer: A meta-analysis of randomized controlled studies. Asian J Surg 2020; 43:880-890. [PMID: 31964585 DOI: 10.1016/j.asjsur.2019.11.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 11/07/2019] [Indexed: 12/27/2022] Open
Abstract
Although several meta-analyses regarding robot-assisted proctectomy (RP) and laparoscopic proctectomy (LP) in patients with rectal cancer are constantly being published, meta-analyses considering randomized controlled trials (RCTs) are still rare. It is therefore necessary to conduct an appropriate meta-analysis to provide reliable evidence for clinical decision-making. Databases such as PubMed, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials (CCTR) and Cochrane Database of Systematic Reviews (CDSR) were used to collect RCTs assessing the effectiveness and safety of RP and LP. Article search was performed until August 2019. Data were extracted and the quality was evaluated by two reviewers independently, according to the inclusion and exclusion criteria. Data were analyzed using R software. Eight RCTs were included involving 999 patients, 495 of them underwent RP and 504 underwent LP. The results showed that the RP group had a longer operative time (P < 0.01), a lower conversion rate (P = 0.03), a longer distance to the distal margin (DDM) (P = 0.001), and a lower incidence of erectile dysfunction (P = 0.02). No significant differences were found in perioperative mortality, complication rates, PRM, number of harvested lymph nodes, length of hospital stay and time to first bowel movement between the two groups. Current evidence suggests that RP is superior to LP in short-term clinical outcomes, which is similar to LP regarding pathological outcomes and has better DDM outcomes. However, the comparison between RP and LP regarding long-term oncology outcomes still require further multi-center and large RCT samples to confirm our evidences.
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25
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Prone Compared With Lithotomy for Abdominoperineal Resection: A Systematic Review and Meta-analysis. J Surg Res 2019; 243:469-480. [DOI: 10.1016/j.jss.2019.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/09/2019] [Accepted: 07/03/2019] [Indexed: 12/15/2022]
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26
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Clinical impact of additional therapy for residual pancreatic cancer. Surg Today 2019; 50:440-448. [PMID: 31650262 DOI: 10.1007/s00595-019-01900-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 10/10/2019] [Indexed: 12/15/2022]
Abstract
PURPOSE This study aimed to explore the prognostic significance of the resection margin (R) status of pancreatic ductal adenocarcinoma (PDAC) patients receiving neoadjuvant therapy (NAT) or adjuvant chemotherapy (AC). METHODS We retrospectively reviewed 427 consecutive patients, and the overall survival (OS) and disease-free survival (DFS) were analyzed based on the R status by a propensity score analysis (PSA). RESULTS The R0 ratio of the NAT (+) group was significantly higher than that of the NAT (-) group (97.2% vs. 69.6%, P < 0.0001). Local recurrence was well controlled in the NAT (+) group compared to the NAT (-) group (15.3% vs. 34.1%, P = 0.0013). The PSA revealed no significant survival difference between R0 and R1 resection among those treated with AC (median survival time [MST]: 43.0 vs. 33.3 months, matching hazard ratio [HR]: 1.212, P = 0.5708). Furthermore, the DFS in R0 and R1 resection followed by AC was identical (MST: 20.6 vs. 17.7 months, matching HR: 1.020, P = 0.9482). CONCLUSIONS NAT was a significant predictor of R0 resection. When patients completed AC, there were no marked differences in the OS or DFS between R0 and R1 resection. Our results demonstrated that the clinical impact of the R1 status has waned in the current era of PDAC management.
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27
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Evolution of pelvic exenteration surgery- resectional trends and survival outcomes over three decades. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2019; 45:2325-2333. [PMID: 31303376 DOI: 10.1016/j.ejso.2019.07.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 06/04/2019] [Accepted: 07/06/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To examine the changes in exenterative surgery over three decades analysing oncological outcomes and whether changes in surgical approach have led to improved patient outcomes. BACKGROUND Advances in surgical technology, perioperative care and pattern of disease recurrence have coincided with an evolutionary change in exenterative surgery. METHODS A review of a prospectively maintained databases of pelvic exenteration surgery from 1988 to 2018 at two high volume specialised institutions. The total cohort was divided into three major time points (1988-2004, 2005-2010 and 2011 to 2018) to allow comparative analysis. Primary endpoints were overall survival in primary and recurrent disease at each time point. Secondary endpoints included anastomotic leak, blood transfusion, ileus, wound infection rates and evolution of case complexity. Data were analysed using R with a p < 0.05 considered significant. RESULTS Six hundred and seventy patients underwent exenterative surgery. In 2011-2018 there was an increase in resection of recurrent malignancy with a continuous increase in GI malignancies resected over each time period(p < 0.001,<0.01) and a reduction in gynaecological malignancy(p < 0.001). A significant increase in sacrectomy, pelvic sidewall resection and ileal conduit reconstruction was observed (p < 0.01,<0.001).In 2005-2010 patients had increased rates of ileus and anastomotic leak(p < 0.05). Patients undergoing resection for primary disease had improved overall survival at time points 1988-2004 and 2011-2018 compared to those with recurrent disease(p = 0.007,<0.001). Overall survival was significantly improved in patients with primary versus recurrent disease(p = 0.022). CONCLUSION There has been a significant improvement in survival in patients undergoing pelvic exenteration surgery from primary disease. Case complexity has increased without significant morbidity.
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28
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Boige V, Mollevi C, Gourgou S, Azria D, Seitz JF, Vincent M, Bigot L, Juzyna B, Miran I, Gerard JP, Laurent-Puig P. Impact of single-nucleotide polymorphisms in DNA repair pathway genes on response to chemoradiotherapy in rectal cancer patients: Results from ACCORD-12/PRODIGE-2 phase III trial. Int J Cancer 2019; 145:3163-3172. [PMID: 31107542 DOI: 10.1002/ijc.32417] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/09/2019] [Accepted: 04/17/2019] [Indexed: 01/07/2023]
Abstract
We examined whether 66 germline single-nucleotide polymorphisms (SNPs) in 10 candidate genes would predict clinical outcome in 316 patients with resectable locally advanced rectal cancer (LARC) enrolled in the ACCORD-12 phase III trial who were randomly treated with preoperative radiotherapy plus capecitabine (CAP45; n = 155) or dose-intensified radiotherapy plus capecitabine and oxaliplatin (CAPOX50; n = 161). The primary endpoint was tumor response according to the Dworak score. Multivariate logistic regression models adjusted on treatment arm and T stage determined the SNPs prognostic and predictive values for tumor response. In univariate analysis, five SNPs in ERCC2, XPA, MTHFR and ERCC1 were associated with the Dworak score in the CAPOX50 arm. In the overall population, interaction with treatment arm was significant for ERCC2 rs1799787 (pinteraction = 0.05) and XPA rs3176683 (pinteraction = 0.008), suggesting a predictive effect for response to oxaliplatin-based chemoradiotherapy (CRT). All but XPA rs3176683 had a prognostic effect on tumor response. In a multivariate model, interaction remained significant for XPA rs3176683 ([OR 7.33, 95% CI 1.40-38.23], pinteraction = 0.018) and the prognostic effect significant for ERCC2 rs1799787 ([OR 0.55, 95%CI 0.32-0.93], p = 0.027) and ERCC1 rs10412761 ([OR 0.57, 95%CI 0.34-0.98], p = 0.042). Patients with the T/G haplotype of rs1799787 and rs10412761 had a 60% decrease in odds of response (p < 0.001). None of the five SNPs were associated with toxicity, overall and disease-free survival. These data suggest that genetic variation in DNA repair genes influences response to preoperative CRT in LARC and identify patients who benefit from the addition of oxaliplatin to CRT.
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Affiliation(s)
- Valérie Boige
- Department of Oncologic Medicine, Gustave-Roussy, Villejuif, France.,Université Paris Descartes; Paris Sorbonne Cité INSERM UMR-S775, Paris, France
| | - Caroline Mollevi
- Biometry Unit, Institut du Cancer Montpellier, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, Université de Montpellier, Montpellier, France
| | - Sophie Gourgou
- Biometry Unit, Institut du Cancer Montpellier, Université de Montpellier, Montpellier, France.,Institut de Recherche en Cancérologie de Montpellier Inserm U1194, Université de Montpellier, Montpellier, France
| | - David Azria
- Department of Radiation Oncology, Institut du Cancer Montpellier, Univ Montpellier, Inserm U1194 IRCM, Montpellier, France
| | - Jean-François Seitz
- Department of Digestive Oncology, Aix-Marseille University, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Marc Vincent
- Université Paris Descartes; Paris Sorbonne Cité INSERM UMR-S775, Paris, France
| | - Ludovic Bigot
- Inserm U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | | | - Isabelle Miran
- Inserm U981, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Jean-Pierre Gerard
- Department of Radiation Oncology, Centre Antoine Lacassagne, Université Côte d'azur, Nice, France
| | - Pierre Laurent-Puig
- Université Paris Descartes; Paris Sorbonne Cité INSERM UMR-S775, Paris, France
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Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis. Int J Colorectal Dis 2019; 34:843-848. [PMID: 30790033 DOI: 10.1007/s00384-019-03267-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 02/04/2023]
Abstract
PURPOSE Low anterior resection with coloanal anastomosis (CAA) for low rectal cancer is a technically difficult operation with limited data available on oncologic outcomes. We aim to investigate overall survival and operative oncologic outcomes in patients who underwent CAA compared to abdominoperineal resection (APR). METHODS The National Cancer Database (2004-2013) was used to identify patients with non-metastatic rectal adenocarcinoma who underwent CAA or APR. Patients were 1:1 matched on age, gender, Charlson score, tumor size, tumor grade, pathologic stage, and radiation treatment with propensity scores. The primary outcome was overall survival. Secondary outcomes included 30-day mortality and resection margins. RESULTS Following matching, 3536 patients remained in each group. No significant differences in matched demographic, treatment, or tumor variables were seen between groups. There was no significant difference in 30-day mortality (1.24% vs. 1.39%, p = 0.60). Following resection, margins were more likely to be negative after CAA compared with APR (5.26% vs. 8.14%, p < 0.001). When stratified by pathologic stage, there was a significant survival advantage for individuals undergoing CAA compared to APR (stage 1 HR 0.72, [95% CI 0.62-0.85], p < 0.001; stage 2 HR 0.76, [95% CI 0.65-0.88], p < 0.001; stage 3 HR 0.76, [95% CI 0.67-0.85], p < 0.001). CONCLUSIONS Patients undergoing CAA compared with APR for rectal cancer have better overall survival and are less likely to have positive margins despite the technically challenging operation.
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30
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Draeger T, Völkel V, Schnitzbauer V, Gerken M, Benz S, Klinkhammer-Schalke M, Fürst A. Laparoscopic and open resection of rectal cancer-is age an effect modifier for short- and long-term survival? Int J Colorectal Dis 2019; 34:821-828. [PMID: 30778670 DOI: 10.1007/s00384-019-03265-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/06/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Rectal cancer is a frequently diagnosed tumor worldwide. Various studies have shown the noninferiority or even slight superiority of laparoscopic resection. However, there is no clear recommendation on whether age should influence the choice of surgical approach. MATERIALS AND METHODS This study compared outcomes of laparoscopic and open surgery in rectal cancer patients. Perioperative mortality and 5-year overall, relative, and recurrence-free survival rates were analyzed separately for three age groups. Data originate from 30 regional German cancer registries that cover approximately one quarter of the German population. All primary nonmetastatic rectal adenocarcinoma cases with surgery between 2005 and 2014 were eligible for inclusion. To compare survival rates, Kaplan-Meier analysis, a relative survival model, and multivariable Cox regression were used; a sensitivity analysis assessed bias by exclusion. RESULTS Ten thousand seven hundred fifty-four patients were included in the analysis. The mean laparoscopy rate was 23.0% and increased over time. Analysis of 30-day postoperative mortality rates revealed advantages for laparoscopically treated patients, although the significance level was not reached in any age group. Regarding 5-year overall survival, laparoscopy generally seems to be the superior approach, whereas for recurrence-free survival, an age-dependent gradient in effect size was observed: with a hazard ratio (HR) of 0.703 for laparoscopy, patients under 60 years benefitted more from the minimally invasive approach than older patients (septuagenarians, HR 0.923). CONCLUSION Laparoscopy shows similar results to the open approach in terms of postoperative survival in all age groups. Concerning long-term outcomes, younger patients benefitted most from the minimally invasive approach.
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Affiliation(s)
- Teresa Draeger
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany.
| | - Vinzenz Völkel
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | | | - Michael Gerken
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | - Stefan Benz
- Klinik für Allgemeine-, Viszeral- und Kinderchirurgie, Kliniken Böblingen, Bunsenstr. 120, 71032, Böblingen, Germany
| | - Monika Klinkhammer-Schalke
- Tumorzentrum Regensburg - Institut für Qualitätssicherung und Versorgungsforschung der Universität Regensburg, Am BioPark 9, 93053, Regensburg, Germany
| | - Alois Fürst
- Klinik für Allgemein-, Viszeral-, Thoraxchirurgie und Adipositasmedizin, Caritas Krankenhaus St. Josef Regensburg, Landshuter Str. 65, 93053, Regensburg, Germany
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31
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Wilkins S, Yap R, Loon K, Staples M, Oliva K, Ruggiero B, McMurrick P, Carne P. Surgical outcome after standard abdominoperineal resection: A 15-year cohort study from a single cancer centre. Ann Med Surg (Lond) 2018; 36:83-89. [PMID: 30425830 PMCID: PMC6224354 DOI: 10.1016/j.amsu.2018.10.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/23/2018] [Accepted: 10/24/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Abdominoperineal resection (APR) is associated with a poorer oncological outcome than anterior resection. This may be due to higher rates of intra-operative perforation and circumferential resection margin involvement. The aim of this study was to audit our short and long-term results of abdominoperineal resection performed using conventional techniques and to compare this with other published series. MATERIALS AND METHODS A retrospective review of all patients who had standard APR between January 2000 and December 2016 in a single institution, Cabrini Hospital, Melbourne, Australia. A total of 163 cases performed by nine different colorectal surgeons for primary rectal adenocarcinoma were identified, with their clinicopathological data analysed. RESULTS Using standard APR, only six patients (3.7%) were found to have a positive circumferential resection margin (CRM). There were two cases of intra-operative perforation (1.2%). Local recurrence rate was 5.6% of patients, with distant recurrence found in 24.9%. Disease-free survival at five years was 73.1%. Five-year overall survival was 66.7%, 67.9% of all deaths were cancer-related. CONCLUSION Short and long-term outcomes after standard APR in this study were comparable to previous published studies. The CRM rate of 3.7% compares favourably to published positive CRM rates for standard APR which ranged from 6 to 18%. Standard APR remains a viable technique for the treatment of rectal cancer. Patient selection and adequate training remain important factors.
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Affiliation(s)
- S. Wilkins
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - R. Yap
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - K. Loon
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - M. Staples
- Monash Department of Clinical Epidemiology, Cabrini Hospital, Malvern, VIC, Australia
| | - K. Oliva
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - B. Ruggiero
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - P. McMurrick
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
| | - P. Carne
- Cabrini Monash University Department of Surgery, Cabrini Hospital, Malvern, VIC, Australia
- Colorectal Unit, Department of Surgery, Alfred Hospital, Melbourne, VIC, Australia
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32
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Mahalingam S, Seshadri RA, Veeraiah S. Long-Term Functional and Oncological Outcomes Following Intersphincteric Resection for Low Rectal Cancers. Indian J Surg Oncol 2017; 8:457-461. [PMID: 29203973 PMCID: PMC5705496 DOI: 10.1007/s13193-016-0571-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 10/18/2016] [Indexed: 12/17/2022] Open
Abstract
Surgery for low rectal cancer often involves a permanent stoma. Intersphincteric resection (ISR) with colo-anal anastomosis is a valuable sphincter sparing surgical procedure that avoids the need for permanent stoma in patients with low rectal cancer. The aim of this study was to analyze the long-term functional and oncological outcomes following ISR. This was a retrospective analysis of patients with low rectal cancer who underwent ISR with colo-anal anastomosis in our institution between 2007 and 2015. All patients had a diversion stoma. Bowel function outcomes were assessed prospectively using Wexner incontinence score, low anterior resection syndrome score (LARS), and the Cancer Institute Quality of Life (QoL) questionnaire. The histological reports were reviewed to assess the oncological adequacy of the surgery. Patterns of recurrence and survival were analyzed in this group of patients. Thirty-three patients who underwent an ISR were eligible for this study. Laparoscopic resection was performed in five patients. All the patients received neoadjuvant chemoradiation except the two who received short course radiation and one who did not receive any neoadjuvant treatment. The median distance from the anal verge to the distal edge of the tumor was 3 cm (range 1.5-5 cm). Distal resection margins and circumferential resection margins were negative in all the patients. The 30-day post-operative mortality rate was 3.03%. In 20 patients with a median follow-up of 48 months, the 3-year overall survival was 95%. One patient had recurrence in the para-aortic nodes. No patient had a local recurrence. Bowel function was assessed in 18 patients who had a minimum stoma free period of 1 year. After a median of 43 months following stoma closure, the median Wexner score was 3.56 (range 0-19), median LARS score was 4.78 (range 0-33), and the mean Cancer Institute QoL score was 151.56 ± 15.741. The QoL was average to very high with an overall acceptable quality of life. In this study, ISR was associated with acceptable long-term functional and oncological outcomes. It can be considered as a safe alternative to a permanent stoma in selected patients with low rectal cancer.
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Affiliation(s)
- Sivakumar Mahalingam
- Department of Surgical Oncology, Cancer Institute (WIA), Dr. S. Krishnamurthy Campus, No.18, Sardar Patel Road, Guindy, Chennai, 600036 India
| | - Ramakrishnan Ayloor Seshadri
- Department of Surgical Oncology, Cancer Institute (WIA), Dr. S. Krishnamurthy Campus, No.18, Sardar Patel Road, Guindy, Chennai, 600036 India
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33
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Yamashita H, Ishihara S, Nozawa H, Kawai K, Kiyomatsu T, Okuma K, Abe O, Watanabe T, Nakagawa K. Comparison of volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with conventional radiotherapy in preoperative chemoradiation for rectal cancers: a propensity score case-matched analysis. Radiat Oncol 2017; 12:156. [PMID: 28934968 PMCID: PMC5607844 DOI: 10.1186/s13014-017-0894-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background and purpose The aim of this retrospective study was to compare volumetric-modulated arc therapy using simultaneous integrated boosts (SIB-VMAT) of 45 Gy/55 Gy in 25 fractions with three-dimensional conformal radiotherapy (3D–CRT) in preoperative chemoradiation for rectal cancers. Methods and materials In the propensity score-matching analysis of 1:2, we selected 60 patients from the SIB-VMAT group and 120patients from the 3D–CRT group matched pairings out of 145 patients between 2005 and 2015. The regimen of concurrent combined chemotherapy was oral uracil/tegafur plus leucovorin with/without irinotecan. Results There were no significant differences between the two groups, in pathological complete response rates (pCR) (11% in the 3D–CRT group vs. 17% in the SIB-VMAT group, P = 0.39), pathological response rates (44% vs. 60%, P = 0.77), disease-free survival (P = 0.32), or local control (P = 0.52). The SIB-VMAT method marginally improved the rate of pathological grade 2–3 effects and the OS was significantly better in patients with grade 2–3 effects. Recurrence was seen in 36 patients (30%) in the 3D–CRT group and 19 patients (32%) in the SIB-VMAT group. The first distant recurrence site in the SIB-VMAT group was liver in 6 patients and lung in 8 patients. The obvious radiation-induced late toxicity in the SIB-VMAT group was recto-vesical fistula in two patients. Conclusions The SIB-VMAT may be a promising method for preoperative CRT of rectal cancer.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan.
| | - Soichiro Ishihara
- Department of Surgical Oncology, University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Tomomichi Kiyomatsu
- Department of Surgical Oncology, University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Kae Okuma
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Osamu Abe
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Toshiaki Watanabe
- Department of Surgical Oncology, University of Tokyo Hospital, Bunkyo-ku, Japan
| | - Keiichi Nakagawa
- Department of Radiology, University of Tokyo Hospital, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
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34
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Okamura R, Hida K, Yamaguchi T, Akagi T, Konishi T, Yamamoto M, Ota M, Matoba S, Bando H, Goto S, Sakai Y, Watanabe M, Watanabe K, Otsuka K, Takemasa I, Tanaka K, Ikeda M, Matsuda C, Fukuda M, Hasegawa J, Akamoto S, Shiozawa M, Tsuruta A, Akiyoshi T, Kato T, Tsukamoto S, Ito M, Naito M, Kanazawa A, Takahashi T, Ueki T, Hayashi Y, Morita S, Yamaguchi T, Nakanishi M, Hasegawa H, Okamoto K, Teraishi F, Sumi Y, Tashiro J, Yatsuoka T, Nishimura Y, Okita K, Kobatake T, Horie H, Miyakura Y, Ro H, Nagakari K, Hidaka E, Umemoto T, Nishigori H, Murata K, Wakayama F, Makizumi R, Fujii S, Sunami E, Kobayashi H, Nakagawa R, Enomoto T, Ohnuma S, Higashijima J, Ozawa H, Ashida K, Fujita F, Uehara K, Maruyama S, Ohyama M, Yamamoto S, Hinoi T, Yoshimitsu M, Okajima M, Tanimura S, Kawasaki M, Ide Y, Hazama S, Watanabe J, Inagaki D, Toyokawa A. Local control of sphincter-preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis. Ann Gastroenterol Surg 2017; 1:199-207. [PMID: 29863157 PMCID: PMC5881346 DOI: 10.1002/ags3.12032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/10/2017] [Indexed: 12/13/2022] Open
Abstract
Sphincter‐preserving procedures (SPPs) for surgical treatment of low‐lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II‐III rectal cancer between 2010 and 2011. Patients with tumors 2‐5 cm from the anal verge and clinical stage T3‐4 were eligible. Primary outcome was 3‐year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77‐1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3‐year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42‐1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.
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Affiliation(s)
| | - Koya Hida
- Department of Surgery Kyoto University Kyoto Japan
| | - Tomohiro Yamaguchi
- Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan
| | - Tomonori Akagi
- Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan
| | - Tsuyoshi Konishi
- Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan
| | - Michio Yamamoto
- Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan
| | - Mitsuyoshi Ota
- Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan
| | - Shuichiro Matoba
- Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan
| | - Hiroyuki Bando
- Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan
| | - Saori Goto
- Department of Surgery Kyoto University Kyoto Japan
| | | | - Masahiko Watanabe
- Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | | | - Kazuteru Watanabe
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Koki Otsuka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ichiro Takemasa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Keitaro Tanaka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masataka Ikeda
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Chu Matsuda
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Meiki Fukuda
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Junichi Hasegawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shintaro Akamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Manabu Shiozawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Atsushi Tsuruta
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takashi Akiyoshi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takeshi Kato
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shunsuke Tsukamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masaaki Ito
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masaki Naito
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Akiyoshi Kanazawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takao Takahashi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takashi Ueki
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yuri Hayashi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Satoshi Morita
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takashi Yamaguchi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masayoshi Nakanishi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hirotoshi Hasegawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ken Okamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Fuminori Teraishi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yasuo Sumi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Jo Tashiro
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Toshimasa Yatsuoka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yoji Nishimura
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Kenji Okita
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takaya Kobatake
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hisanaga Horie
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yasuyuki Miyakura
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hisashi Ro
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Kunihiko Nagakari
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Eiji Hidaka
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takehiro Umemoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hideaki Nishigori
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Kohei Murata
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Fuminori Wakayama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ryoji Makizumi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shoichi Fujii
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Eiji Sunami
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Hirotoshi Kobayashi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Ryosuke Nakagawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Toshiyuki Enomoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shinobu Ohnuma
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Jun Higashijima
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Heita Ozawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Keigo Ashida
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Fumihiko Fujita
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Keisuke Uehara
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Satoshi Maruyama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masato Ohyama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Seiichiro Yamamoto
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Takao Hinoi
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masanori Yoshimitsu
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masazumi Okajima
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shu Tanimura
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Masayasu Kawasaki
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Yoshihito Ide
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Shoichi Hazama
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Jun Watanabe
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Daisuke Inagaki
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
| | - Akihiro Toyokawa
- Department of Surgery Kyoto University Kyoto Japan.,Division of Colon and Rectal Surgery Shizuoka Cancer Center Hospital Shizuoka Japan.,Department of Gastroenterological and Pediatric Surgery Oita University Faculty of Medicine Oita Japan.,Department of Gastroenterological Surgery Cancer Institute Hospital of the Japanese Foundation for Cancer Research Tokyo Japan.,Department of Data Science Institute for Advancement of Clinical and Translational Science Kyoto University Hospital Kyoto Japan.,Gastroenterological Center Yokohama City University Medical Center Kanagawa Japan.,Department of Gastroenterological Surgery Toranomon Hospital Tokyo Japan.,Department of Gastroenterological Surgery Ishikawa Prefectural Central Hospital Ishikawa Japan.,Department of Surgery Kitasato University School of Medicine Kanagawa Japan
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Lee DJK, Sagar PM, Sadadcharam G, Tan KY. Advances in surgical management for locally recurrent rectal cancer: How far have we come? World J Gastroenterol 2017; 23:4170-4180. [PMID: 28694657 PMCID: PMC5483491 DOI: 10.3748/wjg.v23.i23.4170] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 03/31/2017] [Accepted: 05/09/2017] [Indexed: 02/06/2023] Open
Abstract
Locally recurrent rectal cancer (LRRC) is a complex disease with far-reaching implications for the patient. Until recently, research was limited regarding surgical techniques that can increase the ability to perform an en bloc resection with negative margins. This has changed in recent years and therefore outcomes for these patients have improved. Novel radical techniques and adjuncts allow for more radical resections thereby improving the chance of negative resection margins and outcomes. In the past contraindications to surgery included anterior involvement of the pubic bone, sacral invasions above the level of S2/S3 and lateral pelvic wall involvement. However, current data suggests that previously unresectable cases may now be feasible with novel techniques, surgical approaches and reconstructive surgery. The publications to date have only reported small patient pools with the research conducted by highly specialised units. Moreover, the short and long-term oncological outcomes are currently under review. Therefore although surgical options for LRRC have expanded significantly, one should balance the treatment choices available against the morbidity associated with the procedure and select the right patient for it.
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36
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Dayde D, Tanaka I, Jain R, Tai MC, Taguchi A. Predictive and Prognostic Molecular Biomarkers for Response to Neoadjuvant Chemoradiation in Rectal Cancer. Int J Mol Sci 2017; 18:ijms18030573. [PMID: 28272347 PMCID: PMC5372589 DOI: 10.3390/ijms18030573] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Revised: 02/17/2017] [Accepted: 03/02/2017] [Indexed: 12/16/2022] Open
Abstract
The standard of care in locally advanced rectal cancer is neoadjuvant chemoradiation (nCRT) followed by radical surgery. Response to nCRT varies among patients and pathological complete response is associated with better outcome. However, there is a lack of effective methods to select rectal cancer patients who would or would not have a benefit from nCRT. The utility of clinicopathological and radiological features are limited due to lack of adequate sensitivity and specificity. Molecular biomarkers have the potential to predict response to nCRT at an early time point, but none have currently reached the clinic. Integration of diverse types of biomarkers including clinicopathological and imaging features, identification of mechanistic link to tumor biology, and rigorous validation using samples which represent disease heterogeneity, will allow to develop a sensitive and cost-effective molecular biomarker panel for precision medicine in rectal cancer. Here, we aim to review the recent advance in tissue- and blood-based molecular biomarker research and illustrate their potential in predicting nCRT response in rectal cancer.
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Affiliation(s)
- Delphine Dayde
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Ichidai Tanaka
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Rekha Jain
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Mei Chee Tai
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
| | - Ayumu Taguchi
- Departments of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA.
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37
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Warschkow R, Ebinger SM, Brunner W, Schmied BM, Marti L. Survival after Abdominoperineal and Sphincter-Preserving Resection in Nonmetastatic Rectal Cancer: A Population-Based Time-Trend and Propensity Score-Matched SEER Analysis. Gastroenterol Res Pract 2017; 2017:6058907. [PMID: 28197206 PMCID: PMC5286526 DOI: 10.1155/2017/6058907] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 12/15/2016] [Indexed: 12/13/2022] Open
Abstract
Background. Abdominoperineal resection (APR) has been associated with impaired survival in nonmetastatic rectal cancer patients. It is unclear whether this adverse outcome is due to the surgical procedure itself or is a consequence of tumor-related characteristics. Study Design. Patients were identified from the Surveillance, Epidemiology, and End Results database. The impact of APR compared to coloanal anastomosis (CAA) on survival was assessed by Cox regression and propensity-score matching. Results. In 36,488 patients with rectal cancer resection, the APR rate declined from 31.8% in 1998 to 19.2% in 2011, with a significant trend change in 2004 at 21.6% (P < 0.001). To minimize a potential time-trend bias, survival analysis was limited to patients diagnosed after 2004. APR was associated with an increased risk of cancer-specific mortality after unadjusted analysis (HR = 1.61, 95% CI: 1.28-2.03, P < 0.01) and multivariable adjustment (HR = 1.39, 95% CI: 1.10-1.76, P < 0.01). After optimal adjustment of highly biased patient characteristics by propensity-score matching, APR was not identified as a risk factor for cancer-specific mortality (HR = 0.85, 95% CI: 0.56-1.29, P = 0.456). Conclusions. The current propensity score-adjusted analysis provides evidence that worse oncological outcomes in patients undergoing APR compared to CAA are caused by different patient characteristics and not by the surgical procedure itself.
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Affiliation(s)
- Rene Warschkow
- Department of Surgery, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland
- Institute of Medical Biometry and Informatics, University of Heidelberg, 69120 Heidelberg, Germany
| | - Sabrina M. Ebinger
- Department of Surgery, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland
- Department of Surgery, Hospital of Thun, 3600 Thun, Switzerland
| | - Walter Brunner
- Department of Surgery, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland
| | - Bruno M. Schmied
- Department of Surgery, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland
| | - Lukas Marti
- Department of Surgery, Cantonal Hospital of St. Gallen, 9007 St. Gallen, Switzerland
- Department of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, University of Heidelberg, 68167 Mannheim, Germany
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Herrinton LJ, Altschuler A, McMullen CK, Bulkley JE, Hornbrook MC, Sun V, Wendel CS, Grant M, Baldwin CM, Demark-Wahnefried W, Temple LKF, Krouse RS. Conversations for providers caring for patients with rectal cancer: Comparison of long-term patient-centered outcomes for patients with low rectal cancer facing ostomy or sphincter-sparing surgery. CA Cancer J Clin 2016; 66:387-97. [PMID: 26999757 PMCID: PMC5618707 DOI: 10.3322/caac.21345] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 01/13/2016] [Accepted: 02/09/2016] [Indexed: 12/14/2022] Open
Abstract
For some patients with low rectal cancer, ostomy (with elimination into a pouch) may be the only realistic surgical option. However, some patients have a choice between ostomy and sphincter-sparing surgery. Sphincter-sparing surgery has been preferred over ostomy because it offers preservation of normal bowel function. However, this surgery can cause incontinence and bowel dysfunction. Increasingly, it has become evident that certain patients who are eligible for sphincter-sparing surgery may not be well served by the surgery, and construction of an ostomy may be better. No validated assessment tool or decision aid has been published to help newly diagnosed patients decide between the two surgeries or to help physicians elicit long-term surgical outcomes. Furthermore, comparison of long-term outcomes and late effects after the two surgeries has not been synthesized. Therefore, this systematic review summarizes controlled studies that compared long-term survivorship outcomes between these two surgical groups. The goals are: 1) to improve understanding and shared decision-making among surgeons, oncologists, primary care providers, patients, and caregivers; 2) to increase the patient's participation in the decision; 3) to alert the primary care provider to patient challenges that could be addressed by provider attention and intervention; and 4) ultimately, to improve patients' long-term quality of life. This report includes discussion points for health care providers to use with their patients during initial discussions of ostomy and sphincter-sparing surgery as well as questions to ask during follow-up examinations to ascertain any long-term challenges facing the patient. CA Cancer J Clin 2016;66:387-397. © 2016 American Cancer Society.
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Affiliation(s)
- Lisa J Herrinton
- Senior Research Scientist, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Andrea Altschuler
- Senior Consultant, Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Carmit K McMullen
- Investigator, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Joanna E Bulkley
- Senior Research Associate, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Mark C Hornbrook
- Chief Scientist, Center for Health Research, Kaiser Permanente Northwest, Portland, OR
| | - Virginia Sun
- Assistant Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Christopher S Wendel
- Research Instructor, Arizona Center on Aging, University of Arizona College of Medicine, Tucson, AZ
| | - Marcia Grant
- Distinguished Professor, Division of Nursing Research and Education, Department of Population Sciences, City of Hope, Duarte, CA
| | - Carol M Baldwin
- Professor Emerita and Southwest Borderlands Scholar, College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ
| | - Wendy Demark-Wahnefried
- Professor and Webb Endowed Chair of Nutrition Sciences, Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL
| | - Larissa K F Temple
- Colorectal Surgical Oncologist, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Robert S Krouse
- Staff General and Oncologic Surgeon, Professor of Surgery, Southern Arizona Veterans Affairs Health Care System and University of Arizona College of Medicine, Tucson, AZ
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Tong T, Sun Y, Cai S, Zhang Z, Gu Y. Extramural depth of rectal cancer tumor invasion at thin-section MRI: predicting treatment response to neoadjuvant chemoradiation. Oncotarget 2016; 6:30277-86. [PMID: 26309163 PMCID: PMC4745797 DOI: 10.18632/oncotarget.4623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 07/27/2015] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess whether the maximal extramural depth (EMD) of T3 tumor spread on magnetic resonance imaging(MRI) correlates with tumor response parameters and whether it can predict tumor response to neoadjuvant chemoradiation. METHODS 111 rectal cancer patients with American Joint Committee on Cancer (AJCC) T3 tumors underwent MRI staging before neoadjuvant chemoradiotherapy were included. Tumor EMD was measured as mm tumor beyond the muscular and compared between the following groups by Kruskal-Wallis test: pathological complete response(pCR) versus nonpCR, good regression versus poor regression, downstage versus nondownstage. RESULTS The final study population consisted of the 111 patients (79 male, 32 female). Median age was 56 years (range, 23-75 years). The EMD was significantly higher in nonpCR patients (7.8 ± 3.2 mm) than in pCR patients(6.1 ± 1.8 mm) (p = 0.033). According to good regression (tumor regression grade(TRG) 0-1 vs. TRG 2-3) and downstaging (ypStage 0-I vs. ypStage II-III), the difference was not significant. Receiver operating characteristic curve analysis revealed a good value for the area under the curve (0.775) and the cutoff value for EMD to predict pCR was 5.6 mm. Compared with patients with a EMD ≥ 5 mm, more patients with EMD <5 mm showed pCR (p = 0.019), while there was no correlation between EMD and good regression or downstaged. CONCLUSIONS EMD value obtained on initial staging MRI may serve as an imaging biomarker which predicts patients that have an incomplete response pathological response after standard neoadjuvant therapy.
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Affiliation(s)
- Tong Tong
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Yiqun Sun
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Sanjun Cai
- Department of Colorectal Surgery, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Zhen Zhang
- Department of Radiotherapy, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
| | - Yajia Gu
- Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China
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Perineural Invasion is a Strong Prognostic Factor in Colorectal Cancer: A Systematic Review. Am J Surg Pathol 2016; 40:103-12. [PMID: 26426380 DOI: 10.1097/pas.0000000000000518] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Perineural invasion (PNI) is a possible route for metastatic spread in various cancer types, including colorectal cancer (CRC). PNI is linked to poor prognosis, but systematic analyses are lacking. This study systematically reviews the frequency and impact of PNI in CRC. A literature search was performed using PubMed database from inception to January 1, 2014. Data were analyzed using Review Manager 5.3. A quality assessment was performed on the basis of modified REMARK criteria. Endpoints were local recurrence (LR), 5-year disease-free survival (5yDFS), 5-year cancer-specific survival (5yCSS), and 5-year overall survival (5yOS). Meta-analysis was performed in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). In this meta-analysis, 58 articles with 22,900 patients were included. PNI was present in 18.2% of tumors. PNI is correlated with increased LR (RR 3.22, 95% CI, 2.33-4.44) and decreased 5yDFS (RR 2.35, 95% CI, 1.66-3.31), 5yCSS (RR 3.61, 95% CI, 2.76-4.72), and 5yOS (RR 2.09, 95% CI, 1.68-2.61). In multivariate analysis PNI remains an independent prognostic factor for 5yDFS, 5yCSS, and 5yOS (HR 2.35, 95% CI, 1.97-3.08; HR 1.91, 95% CI, 1.50-2.42; and HR 1.85, 95% CI, 1.63-2.12, respectively). We confirmed the strong impact of PNI for LR and survival in CRC. The prognostic value of PNI is similar to that of well-established prognostic factors as depth of invasion, differentiation grade, lymph node metastases, and lymphatic and extramural vascular invasion. Therefore, PNI should be one of the factors in the standardized reporting of CRC and might be considered a high-risk feature.
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Jung JH, An HJ, Kim HJ, Lee J, Lee KM, Kim SH, Cho HM, Shim BY. Evaluation of treatment response and tissue necrosis as prognostic indicators following neoadjuvant chemoradiotherapy in rectal cancer patients. Korean J Intern Med 2016; 31:134-44. [PMID: 26767867 PMCID: PMC4712417 DOI: 10.3904/kjim.2016.31.1.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 11/11/2014] [Accepted: 12/05/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS The objective of this study was to assess the prognostic roles of treatment response and tissue necrosis after chemoradiotherapy (CRT) in locally advanced rectal cancer. METHODS A total of 243 patients with locally advanced rectal cancer who underwent neoadjuvant CRT were included. Three treatment response groups were classified by their pathological stage results: complete treatment response (CTR), intermediate treatment response (ITR), and poor treatment response (PTR). Three tissue necrosis groups were classified based on tissue pathological results: complete necrosis response (CNR), intermediate necrosis response (INR), and poor necrosis response (PNR). RESULTS Overall survival (OS) and recurrence-free survival (RFS) rate at three years were 74.5% and 61.3%, respectively. The 3-year OS rates of the CTR, ITR, and PTR groups were 83.7%, 75.9%, and 69.7%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 69.0%, and 52.1%, respectively (p < 0.001). The 3-year OS rates of the CNR, INR, and PNR groups were 83.7%, 80.6%, and 61.8%, respectively (p < 0.001); the 3-year RFS rates were 76.7%, 68.9%, and 44.3%, respectively (p < 0.001). When compared to CTR/CNR, PTR/PNR was strongly related to an increased risk of recurrence (hazard ratio [HR], 5.53; 95% confidence interval [CI], 2.01 to 15.23 vs. HR, 6.37; 95% CI, 2.29 to 17.74, respectively) in univariate Cox regression. Both PTR and PNR were strongly associated with shorter RFS and OS when compared with CTR and CNR in the multivariate Cox regression. CONCLUSIONS Tissue necrosis is an equally important prognostic marker as treatment response for oncologic outcomes in locally advanced rectal cancer.
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Affiliation(s)
- Ji-Han Jung
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Jung An
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung-Jin Kim
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jonghoon Lee
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang-Moon Lee
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sung Hwan Kim
- Department of Radiation Oncology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyeon-Min Cho
- Department of General Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Byoung Yong Shim
- Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Correspondence to Byoung Yong Shim, M.D. Department of Internal Medicine, College of Medicine, St. Vincent's Hospital, The Catholic University of Korea, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea Tel: +82-31-249-8153 Fax: +82-31-253-8898 E-mail:
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NPTX2 is associated with neoadjuvant therapy response in rectal cancer. J Surg Res 2015; 202:112-7. [PMID: 27083956 DOI: 10.1016/j.jss.2015.12.042] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/08/2015] [Accepted: 12/23/2015] [Indexed: 11/22/2022]
Abstract
BACKGROUND Neoadjuvant chemoradiation (CRT) is recommended for locally advanced rectal cancer. Tumor response varies from pathologic complete response (pCR) to no tumor regression. The mechanisms behind CRT resistance remain undefined. In our previously generated complementary DNA microarrays of pretreatment biopsies from rectal cancer patients, neuronal pentraxin 2 (NPTX2) expression discriminated patients with pCR from those with residual tumor. As tumor response is prognostic for survival, we sought to evaluate the clinical relevance of NPTX2 in rectal cancer. MATERIALS AND METHODS Real-time quantitative polymerase chain reaction was used to evaluate NPTX2 messenger RNA expression in individual rectal cancers before CRT. Tumors with NPTX2 expression <50% of normal rectum were defined as NPTX2-low and those with >50% were defined as NPTX2-high. NPTX2 levels were compared to response to therapy and oncologic outcomes using Mann-Whitney, Kruskal-Wallis, chi-square, and Mantel-Cox (log-rank) tests, as appropriate. RESULTS Rectal cancers from 40 patients were included. The mean patient age was 56.8 years, and 30% were female. pCR was achieved in eight of 40 patients (20%). In these patients, messenger RNA NPTX2 levels were significantly decreased compared to those with residual cancer (fold change 30.4, P = 0.017). Patients with NPTX2-low tumors (n = 13) achieved improved response to treatment (P = 0.012 versus NPXT2-high tumors), with 38.5% and 46.1% of patients achieving complete or moderate response, respectively. Of patients with NPTX2-high tumors (n = 27), 11.1% and 18.5% achieved complete or moderate response, respectively. No recurrence or death was recorded in patients with NPTX2-low tumors, reflecting more favorable disease-free survival (P = 0.045). CONCLUSIONS Decreased NPTX2 expression in rectal adenocarcinomas is associated with improved response to CRT and improved prognosis. Further studies to validate these results and elucidate the biological role of NPTX2 in rectal cancer are needed.
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Ethun CG, Kooby DA. The importance of surgical margins in pancreatic cancer. J Surg Oncol 2015; 113:283-8. [PMID: 26603829 DOI: 10.1002/jso.24092] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 10/10/2015] [Indexed: 12/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive disease with a grim prognosis. Surgical resection offers the best chance for long-term survival, yet recurrence rates are high and outcomes are poor. The influence of margin status in PDAC is controversial, as conflicting data have been plagued by a lack of standardization in margin definitions, pathologic analysis, and reporting. Despite recent efforts, international consensus is still needed for this disease.
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Affiliation(s)
- Cecilia G Ethun
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
| | - David A Kooby
- Department of Surgery, Division of Surgical Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia
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Richardson B, Preskitt J, Lichliter W, Peschka S, Carmack S, de Prisco G, Fleshman J. The effect of multidisciplinary teams for rectal cancer on delivery of care and patient outcome: has the use of multidisciplinary teams for rectal cancer affected the utilization of available resources, proportion of patients meeting the standard of care, and does this translate into changes in patient outcome? Am J Surg 2015; 211:46-52. [PMID: 26601650 DOI: 10.1016/j.amjsurg.2015.08.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Revised: 07/27/2015] [Accepted: 08/02/2015] [Indexed: 02/09/2023]
Abstract
BACKGROUND We hypothesized that mandatory multidisciplinary team (MDT) participation improves process evaluation, outcomes, and technical aspects of surgery for rectal cancer in a stable practice of colorectal surgery. METHODS A retrospective review of MDT data was conducted of all patients with colorectal cancer since 2010. Demographic, clinical stage, process evaluation, quality of surgery, and outcome data were collected. Total mesorectal excision and MDT required participation started 2013. RESULTS One hundred thirty patients were included in this study: 47 patients in 2014; 41 patients in 2013; and 42 patients pre-MDT. Improvements were seen in 12 of the 14 preoperative process variables, 6 significantly. Improvement in the completeness of total mesorectal excision (0% to 76%) was significant. Local recurrence occurred in 10% of the pre-MDT group, and follow-up is ongoing in the MDT groups. CONCLUSIONS MDT participation improves care of patients with rectal cancer. Preoperative clinical staging, multimodality treatment, pathologic staging, and technical aspects of surgery have improved.
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Affiliation(s)
- Bradford Richardson
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - John Preskitt
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - Warren Lichliter
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - Stephanie Peschka
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA
| | - Susanne Carmack
- Department of Pathology, Baylor University Medical Center, Dallas, TX, USA
| | - Gregory de Prisco
- Department of Radiology, Baylor University Medical Center, Dallas, TX, USA
| | - James Fleshman
- Department of Surgery, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX, 75246, USA.
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Yang Y, Huang X, Sun J, Gao P, Song Y, Chen X, Zhao J, Wang Z. Prognostic value of perineural invasion in colorectal cancer: a meta-analysis. J Gastrointest Surg 2015; 19:1113-22. [PMID: 25663635 DOI: 10.1007/s11605-015-2761-z] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 01/21/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognostic value of perineural invasion (PNI) in colorectal cancer (CRC) does not reach a consensus. METHODS A comprehensive literature search for relevant reports published up to October 2014 was performed using the electronic databases: PubMed, Embase, and Web of Science. The pooled hazard ratio (HR) with 95 % confidence intervals (CI) was used to estimate the prognostic effects. RESULT Thirty-eight studies comprising 12,661 CRC patients were analyzed. Our results showed that PNI is significantly associated with poor prognosis in OS (overall survival) (HR = 2.07, 95 % CI = 1.87-2.29, P < 0.01) and DFS (disease-free survival) (HR = 2.23, 95 % CI = 1.79-2.78, P < 0.01). There was no significant prognostic difference in DFS between stage II CRC patients with PNI(+) and stage III patients (HR = 1.67, 95 % CI = 0.53-5.25, P = 0.38). Further subgroup analysis revealed that the significance of the association between PNI and worse prognosis in CRC patients is not affected by many factors, including geographic setting, PNI positive rate, treatment, TNM stage, tumor site, and quality of the study. CONCLUSIONS The meta-analysis indicates that PNI is a poor prognostic factor in CRC patients. The postoperative survival of stage II CRC patients with PNI(+) is probably more similar to that of stage III patients. Currently available adjuvant therapy should be considered in stage II CRC patients with PNI(+).
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Affiliation(s)
- Yuchong Yang
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, 155 North Nanjing Street, Heping District, Shenyang City, 110001, People's Republic of China
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Souadka A, Majbar MA, El Harroudi T, Benkabbou A, Souadka A. Perineal pseudocontinent colostomy is safe and efficient technique for perineal reconstruction after abdominoperineal resection for rectal adenocarcinoma. BMC Surg 2015; 15:40. [PMID: 25888423 PMCID: PMC4406037 DOI: 10.1186/s12893-015-0027-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 03/23/2015] [Indexed: 01/13/2023] Open
Abstract
Background The aim of this study was to evaluate oncologic results and satisfaction rate results of pseudocontinent perineal colostomy (PCPC) using Schmidt’s technique in patients undergoing abdominoperineal resection (APR) for managing low rectal adenocarcinoma. Methods From January 1993 and December 2007, One hundred and forty six patients underwent successfully PCPC after abdominoperineal resection for lower rectal adenocarcinoma. There were 75 women, with an average age of 47 years old. All patients received neoadjuvant radiotherapy with or without chemotherapy. Long-term oncological results and satisfaction rate were evaluated. Results After a median follow up of 36 months (range 12–156) months, the five-year overall survival and disease free survival rate were 74.6% and 60.3% respectively. Local and distant recurrences occurred respectively in 10 (6,8%) and 29 (20%) patients. Seventy-seven percent (77%) of the patients were highly satisfied with this technique and only one patient was unsatisfied. However, none of them accepted the conversion to an abdominal colostomy neither would have changed PCPC for an iliac colostomy at first intent. Conclusion This study showed that pseudocontinent perineal colostomy is a safe and reliable pelvic reconstruction technique after abdominoperineal resection for low rectal adenocarcinoma. It provides high degree of patient satisfaction without compromising oncological results. It is a good option in selected patients, especially in Muslim countries.
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Affiliation(s)
- Amine Souadka
- Surgical Department, National Institut of Oncology, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco.
| | - Mohammed Anass Majbar
- Department of General Surgery, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco
| | - Tijani El Harroudi
- Surgical Department, National Institut of Oncology, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco
| | - Amine Benkabbou
- Surgical Department, National Institut of Oncology, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco
| | - Abdelilah Souadka
- Surgical Department, National Institut of Oncology, University Mohammed Vth Souissi, Rabat, Medical School, Rabat, Morocco.,Surgical Department, Al Azhar Oncological Center, Rabat, Morocco
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Engineer R, Basu T, Chopra S, Arya S, Patil P, Mehta S, Ramadwar M, Deodhar K, Shrivastava SK. Factors influencing response to neoadjuvant chemoradiation and outcomes in rectal cancer patients: tertiary Indian cancer hospital experience. J Gastrointest Oncol 2015; 6:155-64. [PMID: 25830035 DOI: 10.3978/j.issn.2078-6891.2014.111] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 11/30/2014] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In the treatment of rectal cancers several randomized trials have demonstrated benefits of neoadjuvant chemoradiotherapy (NACRT) in downstaging as well as survival among these patients. We investigated the patient and tumor related variables dictating the outcomes in these patients. METHODS Biopsy proven treatment naive 182 rectal cancer patients underwent NACRT from June 2006 to December 2010. The entire patients received long course conventionally fractionated external beam radiotherapy with concurrent oral Capecitabine. At 6 weeks from completion of NACRT clinico-radiological assessment was carried out for surgical feasibility. All patients were given postoperative adjuvant chemotherapy either single agent or multi drug regimen depending upon biopsy report. RESULTS Among 182 patients, 131 (72%) underwent surgery and initial T stage and signet ring cell morphology were major determinant of operability. Among the 131 operated patients at median follow up of 36 months, 94 (72%) are alive and disease free. With a median follow up of 42 months the 5-year disease free survival (DFS) and overall survival (OS) was 60% and 77%. The majority of the failures were distal but with more advanced disease at presentation both local and distal failures were similar. While assessing survival by multivariate analysis patients having positive nodes post-surgery had a significantly poorer DFS (P=0.001), while signet ring cell morphology and pre-treatment carcino-embryonic antigen (CEA) levels strongly influenced OS (P=0.03). CONCLUSIONS The outcome of our patients were similar to World Literature and signet ring cell morphology, pre-treatment CEA level, and pathological nodal staging all were influential in determining survival. Besides this, the study also highlights the fact that tumours with signet ring cell morphology appearing in younger population with poor survival needs prospective evaluation for more intense CRT regimen and aggressive surgical resections.
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Affiliation(s)
- Reena Engineer
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Trinanjan Basu
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Supriya Chopra
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Supreeta Arya
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Prachi Patil
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Shaesta Mehta
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Mukta Ramadwar
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Kedar Deodhar
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
| | - Shyam Kishore Shrivastava
- 1 Department of Radiation Oncology, 2 Department of Radiology, 3 Department of Medical Oncology, 4 Department of Pathology, Tata Memorial Hospital, Mumbai 400012, India
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Sheth RA, Bittencourt LK, Guimaraes AR. Diffusion-weighted imaging of the male pelvis. Magn Reson Imaging Clin N Am 2015; 22:145-63, v. [PMID: 24792675 DOI: 10.1016/j.mric.2014.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Diffusion-weighted (DW) imaging is playing an increasingly important role in disease detection, prognostication, and monitoring of treatment response. Particularly in the realm of oncology, the potential applications for DW imaging continue to expand. In this article, the authors detail the role of DW imaging for pathologic processes involving the male pelvis. The authors describe the current data, new insights, and ongoing controversies regarding DW imaging of the male pelvis with a particular emphasis on oncologic applications. The authors also discuss imaging techniques and common pitfalls for DW imaging in this anatomic region.
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Affiliation(s)
- Rahul A Sheth
- Department of Radiology, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA
| | - Leonardo K Bittencourt
- Abdominal and Pelvic Imaging, Clinica de Diagnostico por Imagem (CDPI), Department of Radiology, Rio de Janeiro Federal University, Av das Americas 4666, Sala 325, Rio de Janeiro 22640902, Brazil
| | - Alexander R Guimaraes
- Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, MA 02129, USA.
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De Nardi P, Summo V, Vignali A, Capretti G. Standard Versus Extralevator Abdominoperineal Low Rectal Cancer Excision Outcomes: A Systematic Review and Meta-analysis. Ann Surg Oncol 2015; 22:2997-3006. [DOI: 10.1245/s10434-015-4368-8] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Indexed: 12/22/2022]
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Gawad W, Fakhr I, Lotayef M, Mansour O, Mokhtar N. Sphincter saving and abdomino-perineal resections following neoadjuvant chemoradiation in locally advanced low rectal cancer. J Egypt Natl Canc Inst 2014; 27:19-24. [PMID: 25496990 DOI: 10.1016/j.jnci.2014.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 11/12/2014] [Accepted: 11/16/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The improvement in surgical techniques alongside neoadjuvant chemoradiation enabled more patients with low rectal cancer to have sphincter preservation. STUDY AIM To compare the oncologic and functional outcome in patients with locally advanced low rectal cancer treated by neoadjuvant chemoradiation followed by sphincter saving resection (SSR) against those who underwent abdomino-perineal resection (APR). PATIENTS AND METHODS A total of 111 patients with low rectal cancer were included in the study. Sixty-one consented patients who prospectively underwent SSR, from Jan 2008 to Jan 2013, and a retrospective group, formed of 50 patients, selected from cases seen at NCI, with comparable demographic, clinical and pathologic criteria, who underwent APR from Jan 2003 to Jan 2008. All lesions were <5 cm from anal verge. All 111 patients received preoperative chemoradiation and total mesorectal excision. RESULTS All tumors were located at a median of 3.6 cm (range 2.5-4.5 cm) for the SSR group, and 3.5 cm (range 2.5-4.6 cm) for the APR group, from the anal verge. The median follow-up was 34 months (range 1-60 months) for both groups. The difference in disease recurrence and OS between the APR and SSR groups were both statistically insignificant. CONCLUSION In low rectal cancer, the sphincter preservation appears to have nearly the same oncologic outcome compared to APR, this might be attributed to the small sample size and short follow up period. However, patients with sphincter preservation have certainly demonstrated an indisputable better functional outcome, in terms of stoma avoidance and adequate continence.
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Affiliation(s)
- W Gawad
- Surgical Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Fom-El-Khalig, Egypt
| | - I Fakhr
- Surgical Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Fom-El-Khalig, Egypt.
| | - M Lotayef
- Radiation Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Fom-El-Khalig, Egypt
| | - O Mansour
- Medical Oncology Department, National Cancer Institute (NCI), Cairo University, Cairo, Fom-El-Khalig, Egypt
| | - N Mokhtar
- Pathology Department, National Cancer Institute (NCI), Cairo University, Cairo, Fom-El-Khalig, Egypt
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