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Okumura T, Hayashi T, Kudo S, Mochizuki K, Abe M, Sakurai T, Kouyama Y, Ogawa Y, Maeda Y, Toyoshima N, Misawa M, Kudo T, Wakamura K, Baba T, Ishida F, Miyachi H. Endoscopic submucosal dissection for colorectal neoplasms: Risk factors for local recurrence and long-term surveillance. DEN OPEN 2024; 4:e269. [PMID: 37404727 PMCID: PMC10315643 DOI: 10.1002/deo2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) is an effective procedure for the en bloc resection of colorectal neoplasms. However, risk factors for local recurrence after ESD have not been identified. This study aimed to evaluate such risk factors after ESD for colorectal neoplasms. Methods This retrospective study included 1344 patients with 1539 consecutive colorectal lesions who underwent ESD between September 2003 and December 2019. We investigated various factors associated with local recurrence in these patients. The main outcomes were the incidence of local recurrence and its relationship with clinicopathological factors during long-term surveillance. Results The en bloc resection rate was 98.6%, the R0 resection rate was 97.2%, and the histologically complete resection rate was 92.7%. Local recurrence was observed in 7/1344 (0.5%) patients and the median follow-up period was 72 months (range 4-195 months). The incidence of local recurrence was significantly higher in lesions ≥40 mm in diameter (hazard ratio [HR] 15.68 [1.88-130.5]; p = 0.011), piecemeal resection (HR 48.42 [10.7-218.7]; p < 0.001), non-R0 resection (HR 41.05 [9.025-186.7]; p < 0.001), histologically incomplete resection (HR 16.23 [3.627-72.63]; p<0.001), and severe fibrosis (F2; HR 9.523 [1.14-79.3]; p = 0.037). Conclusions Five risk factors for local recurrence after ESD were identified. Patients with such factors should undergo careful surveillance colonoscopy.
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Affiliation(s)
- Taishi Okumura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kenichi Mochizuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masahiro Abe
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Tatsuya Sakurai
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuta Kouyama
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yushi Ogawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yasuharu Maeda
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Naoya Toyoshima
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toyoki Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Fumio Ishida
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hideyuki Miyachi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
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Maurer CA, Walensi M, Mattiello D, Käser SA, Zarfl K, Egger C. Intraoperative esophageal washout reduces free intraluminal tumor cells during resection of carcinomas of the esophagus and cardia. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108017. [PMID: 38377885 DOI: 10.1016/j.ejso.2024.108017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Intraluminally shed viable tumor cells might contribute to anastomotic recurrence in cancer of the esophagus and the cardia. The study aimed to establish a method of esophageal washout and, hence, to reduce intraluminal cancer cells before esophageal anastomosis. METHODS Forty-eight consecutive patients with esophago-gastric resection for histologically proven cancer of the esophagus or the cardia were included in a prospective, interventional study. Before transection, the esophagus was clamped proximally to the tumor and rinsed with 1:10 diluted povidone-iodine-solution (10 × 30 ml) applied by a transorally inserted 24F-Foley catheter. The first, fifth and tenth portion of the lavage fluid were sent to cytological examination. RESULTS Intraoperative frozen sections confirmed clear proximal resection margins of the esophagus. The cytological examination of the fluid recovered from the esophageal washout revealed malignant cells in 13/48 patients (27%). The presence of malignant cells was significantly less likely in patients with neoadjuvant treatment than in patients without neoadjuvant treatment: 2/23 (9%) vs. 11/25 (44%) (p = 0.009). Repetitive washout reduced the probability of detectable malignant cells from 13 to 8 (62%) patients after 5, and further to 4 patients (30%) after 10 washout maneuvers. CONCLUSIONS Free malignant cells may be present in the esophageal lumen following intraoperative manipulation of cancers of the esophagus or cardia. Transoral washout of the esophagus is novel, feasible and enables reduction or even elimination of these tumor cells. The reliability of this procedure raises with increasing washout volume. Esophageal washout might be especially worthwhile in patients who do not receive neoadjuvant therapy.
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Affiliation(s)
- Christoph Andreas Maurer
- Visceral Surgery, HIRSLANDEN Private Hospital Group, Clinic Beau-Site, Bern, Switzerland; Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland.
| | - Mikolaj Walensi
- Clinical Trial Unit, HIRSLANDEN Private Hospital Group, Klinik Hirslanden, Zurich, Switzerland; Elisabeth-Hospital Essen, Department of Vascular Surgery and Phlebology Essen, Germany
| | - Diana Mattiello
- Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; Department of Surgery, Spital Limmattal, Schlieren, Switzerland
| | - Samuel Andreas Käser
- Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; soH Solothurner Spitäler AG, Department of General, Visceral, Thoracic and Vascular Surgery, Solothurn, Switzerland
| | - Kathrin Zarfl
- Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; Department of Surgery, Hospital of Dornbirn, Dornbirn, Austria
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3
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Ohki A, Takagi T, Kojima Y, Tsurumi M, Hashimoto Y, Takeuchi H, Kamma H, Sakamoto Y, Sunami E, Abe N. Intragastric free cancer cells may be attached to automatic staplers during anastomosis in patients with gastric cancer. World J Surg Oncol 2024; 22:9. [PMID: 38172834 PMCID: PMC10765920 DOI: 10.1186/s12957-023-03285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 12/21/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Automatic staplers are often used to reconstruct the digestive tract during surgeries for gastric cancer. Intragastric free cancer cells adhering to automatic staplers may come in contact with the laparoscopic port area and progress to port site recurrence. This study aimed to investigate the presence/absence of cancer cells adhering to automatic staplers during gastric cancer surgery using cytological examinations. We further determined the positive predictive clinicopathological factors and clinical implications of free cancer cells attached to automatic staplers. METHODS This study included 101 patients who underwent distal gastrectomy for gastric cancer. Automatic staplers used for anastomosis in gastric cancer surgeries were shaken in 150 ml of saline solution to collect the attached cells. Papanicolaou stains were performed. We tested the correlation between cancer-cell positivity and clinicopathological factors to identify risk factors arising from the presence of attached cancer cells to the staplers. RESULTS Based on the cytology, cancer cells were detected in 7 of 101 (6.9%) stapler washing fluid samples. Univariate analysis revealed that circular staplers, type 1 tumors, and positive lymph nodes were significantly associated with higher detection of free cancer cells adhering to staplers. No significant differences in other factors were detected. Of the seven cases with positive cytology, one developed anastomotic recurrence. CONCLUSIONS Exfoliated cancer cells adhered to the automatic staplers used for anastomoses in 6.9% of the staplers used for distal gastrectomies in patients with gastric cancer. Staplers used for gastric cancer surgeries should be handled carefully.
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Affiliation(s)
- Atsuko Ohki
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Taisuke Takagi
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yohei Kojima
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Masanao Tsurumi
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yoshikazu Hashimoto
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirohisa Takeuchi
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hiroshi Kamma
- Nasu Institute of Medical Sciences, 2-5 Daikokuchou, Nasushiobara, Tochigi, 325-0046, Japan
| | - Yoshihiro Sakamoto
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Eiji Sunami
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Nobutsugu Abe
- Department of Gastroenterological and General Surgery, Kyorin University Faculty of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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Vigneswaran J, Keskey RC, Morgan RB, Alverdy JC, Alpert L, Chang E, Weichselbaum R, Zaborina O, Shogan BD. Western Diet-induced Transcriptional Changes in Anastomotic Tissue Is Associated With Early Local Recurrence in a Mouse Model of Colorectal Surgery. Ann Surg 2023; 278:954-960. [PMID: 37522222 PMCID: PMC10775465 DOI: 10.1097/sla.0000000000006052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To determine the timeframe and associated changes in the microenvironment that promote the development of a diet-induced local-regional recurrence in a mouse model of colorectal surgery. BACKGROUND Postoperative recurrence and metastasis occur in up to 30% of patients undergoing attempted resection for colorectal cancer (CRC). The underlying mechanisms that drive the development of postoperative recurrences are poorly understood. Preclinical studies have demonstrated a diet and microbial-driven pathogenesis of local-regional recurrence, yet the precise mechanisms remain undefined. METHODS BALB/C mice were fed a western diet (WD) or standard diet (SD), underwent a colon resection and anastomosis, given an Enterococcus faecalis enema on postoperative day (POD) 1, and subjected to a CT26 cancer cell enema (mimicking shed cancer cells) on POD2. Mice were sacrificed between POD3 and POD7 and cancer cell migration was tracked. Dynamic changes in gene expression of anastomotic tissue that were associated with cancer cell migration was assessed. RESULTS Tumor cells were identified in mice fed either a SD or WD in both anastomotic and lymphatic tissue as early as on POD3. Histology demonstrated that these tumor cells were viable and replicating. In WD-fed mice, the number of tumor cells increased over the early perioperative period and was significantly higher than in mice fed a SD. Microarray analysis of anastomotic tissue found that WD-fed mice had 11 dysregulated genes associated with tumorigenesis. CONCLUSIONS A WD promotes cancer cells to permeate a healing anastomosis and migrate into anastomotic and lymphatic tissue forming viable tumor nodules. These data offer a novel recurrence pathogenesis by which the intestinal microenvironment promotes a CRC local-regional recurrence.
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Affiliation(s)
- Janani Vigneswaran
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Robert C. Keskey
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Ryan B. Morgan
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - John C. Alverdy
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Lindsay Alpert
- The University of Chicago Medicine, Department of Pathology, Chicago, Illinois, United States
| | - Eugene Chang
- The University of Chicago Medicine, Department of Medicine, Chicago, Illinois, United States
| | - Ralph Weichselbaum
- The University of Chicago Medicine, Department of Radiation and Cellular Oncology, Chicago, Illinois, United States
| | - Olga Zaborina
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Benjamin D. Shogan
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
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5
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Matsuda A, Maruyama H, Akagi S, Inoue T, Uemura K, Kobayashi M, Shiomi H, Watanabe M, Arai H, Kojima Y, Mizuuchi Y, Yokomizo H, Toiyama Y, Miyake T, Yokoyama Y, Ishimaru K, Takeda S, Yaguchi Y, Kitagawa Y. Do postoperative infectious complications really affect long-term survival in colorectal cancer surgery? A multicenter retrospective cohort study. Ann Gastroenterol Surg 2022; 7:110-120. [PMID: 36643360 PMCID: PMC9831895 DOI: 10.1002/ags3.12615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/08/2022] [Indexed: 01/18/2023] Open
Abstract
Aim To investigate the impact of postoperative infection (PI), surgical site infection, and remote infection (RI), on long-term outcomes in patients with colorectal cancer (CRC). Methods The Japan Society for Surgical Infection conducted a multicenter retrospective cohort study involving 1817 curative stage I/II/III CRC patients from April 2013 to March 2015. Patients were divided into the No-PI group and the PI group. We examined the association between PI and oncological outcomes for cancer-specific survival (CSS) and overall survival (OS) using Cox proportional hazards models and propensity score matching. Results Two hundred and ninety-nine patients (16.5%) had PIs. The 5-year CSS and OS rates in the No-PI and PI groups were 92.8% and 87.6%, and 87.4% and 83.8%, respectively. Both the Cox proportional hazards models and propensity score matching demonstrated a significantly worse prognosis in the PI group than that in the No-PI group for CSS (hazard ratio: 1.60; 95% confidence interval: 1.10-2.34; P = .015 and P = .031, respectively) but not for OS. RI and the PI severity were not associated with oncological outcomes. The presence of PI abolished the survival benefit of adjuvant chemotherapy. Conclusions These results suggest that PI after curative CRC surgery is associated with impaired oncological outcomes. This survival disadvantage of PI was primarily derived from surgical site infection, not RI, and PI induced lower efficacy of adjuvant chemotherapy. Strategies to prevent PI and implement appropriate postoperative treatment may improve the quality of care and oncological outcomes in patients undergoing curative CRC surgery.
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Affiliation(s)
- Akihisa Matsuda
- Department of Gastrointestinal and Hepato‐Biliary‐Pancreatic SurgeryNippon Medical SchoolTokyoJapan,Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan
| | - Hiroshi Maruyama
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of SurgeryNippon Medical School Tama Nagayama HospitalTokyoJapan
| | - Shinji Akagi
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of SurgeryMazda HospitalHiroshimaJapan
| | - Toru Inoue
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of Gastroenterological SurgeryOsaka City General HospitalOsakaJapan
| | - Kenichiro Uemura
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of SurgeryGraduate School of Biochemical and Health Sciences, Hiroshima UniversityHiroshimaJapan
| | - Minako Kobayashi
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of Infection Control and PreventionNippon Medical School Musashikosugi HospitalKanagawaJapan
| | - Hisanori Shiomi
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of SurgeryNagahama Red Cross HospitalShigaJapan
| | - Manabu Watanabe
- Clinical Trial Committee of The Japan Society of Surgical InfectionTokyoJapan,Department of SurgeryToho University Ohashi Medical CenterTokyoJapan
| | - Hiroki Arai
- Department of SurgeryNippon Medical School Chiba Hokusoh HospitalChibaJapan
| | - Yutaka Kojima
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Yusuke Mizuuchi
- Department of Surgery and OncologyGraduate School of Medical Sciences, Kyushu UniversityFukuokaJapan
| | - Hajime Yokomizo
- Department of SurgeryTokyo Women's Medical University Adachi Medical CenterTokyoJapan
| | - Yuji Toiyama
- Division of Reparative Medicine, Department of Gastrointestinal and Pediatric SurgeryInstitute of Life Sciences, Mie University Graduate School of MedicineMieJapan
| | - Toru Miyake
- Department of SurgeryShiga University of Medical ScienceShigaJapan
| | - Yasuyuki Yokoyama
- Department of Digestive SurgeryNippon Medical School Musashikosugi HospitalKanagawaJapan
| | - Kei Ishimaru
- Department of Minimally Invasive GastroenterologyEhime University Graduate School of MedicineEhimeJapan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast and Endocrine SurgeryYamaguchi University Graduate School of MedicineYamaguchiJapan
| | | | - Yuko Kitagawa
- Department of SurgeryKeio University School of MedicineShinjukuJapan,The Japan Society of Surgical InfectionTokyoJapan
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6
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Waldenstedt S, Bock D, Haglind E, Sjöberg B, Angenete E. Intraoperative adverse events as a risk factor for local recurrence of rectal cancer after resection surgery. Colorectal Dis 2022; 24:449-460. [PMID: 34967100 PMCID: PMC9306731 DOI: 10.1111/codi.16036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 02/08/2023]
Abstract
AIM Failure to achieve a radical resection as well as intraoperative rectal perforation are important risk factors for local recurrence after rectal cancer surgery, but the importance of other intraoperative adverse events for the prognosis is unknown. The aim of this study was to assess the occurrence of intraoperative adverse events during rectal cancer surgery, and to determine whether these were associated with an increased risk of local recurrence. METHODS A retrospective population-based cohort study was undertaken, including all patients in Region Västra Götaland, Sweden, who had undergone primary resection surgery for rectal cancer diagnosed between 2010 and 2014, registered in the Swedish Colorectal Cancer Registry. Data were retrieved from the registry and through review of the medical records. RESULTS In total, 1208 patients were included in the study of whom 78 (6%) developed local recurrence during the follow-up period of at least 5 years. Intraoperative adverse events were common and occurred in 62/78 (79%) of patients with local recurrence compared to 604/1130 (53%) of patients without local recurrence. In multivariate analysis intraoperative adverse events were found to be an independent risk factor for local recurrence of rectal cancer, as were nonradical resection, a high pathological T stage, the presence of lymph node metastases, type of surgery and refraining from rectal washout during anterior resection and Hartmann's procedure. CONCLUSIONS Intraoperative adverse events were found to be an independent risk factor for local recurrence of rectal cancer and could possibly be used together with other known risk factors to select patients for intensified postoperative surveillance.
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Affiliation(s)
- Sophia Waldenstedt
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - David Bock
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Eva Haglind
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Björn Sjöberg
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Eva Angenete
- Department of SurgerySSORG – Scandinavian Surgical Outcomes Research GroupInstitute of Clinical SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden,Department of SurgeryRegion Västra GötalandSahlgrenska University HospitalGothenburgSweden
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7
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Solomon J, Majeed T, Magee C, Wilson J. The influence of intraoperative rectal washout on local recurrence of colorectal cancer following curative resection: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:403-409. [PMID: 35013821 DOI: 10.1007/s00384-021-04071-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the effectiveness of rectal washout in preventing local recurrence of distal colorectal cancer following curative resection. METHODS A systematic review and meta-analysis was performed after a literature search was conducted on MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the ISRCTN registry. The study was reported using PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after distal colonic and rectal cancer surgery. RESULTS After screening, 8 studies with a total sample size of 6739 patients were identified. At 5-year follow-up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51-0.78, Chi2 = 6.76, df = 7, p = 0.45). The relative risk reduction was 36.9%. To exclude a 36.9% relative risk reduction from 9.48 to 6.08% with a 5% significance level and 80% power a randomized control trial would require a total sample size of 1946 participants distributed equally between the two treatment arms. CONCLUSION It is safe to recommend the use of rectal washout for left sided and rectal tumour resections. It is a simple and safe step during colorectal surgery that appears to improve long-term oncological outcomes and was not reported to be associated with any complications.
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Affiliation(s)
- Josh Solomon
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK.
| | - Talal Majeed
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK
| | - Conor Magee
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK
| | - Jeremy Wilson
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK
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8
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Recurrence of gastric cancer caused by implantation of tumor cells after curative endoscopic submucosal dissection. Gastric Cancer 2021; 24:1160-1166. [PMID: 33860382 DOI: 10.1007/s10120-021-01189-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
A 93-year-old female underwent curative endoscopic submucosal dissection (ESD) for intramucosal gastric cancer (70 mm in diameter) in the antrum. The lesion showed an irregularly villous structure covered with mucus. En bloc resection was performed. The large resected specimen induced a longitudinal laceration on the right wall of the esophagogastric junction (EGJ) during retrieval. Unavoidably, we segmented the specimen in the stomach to facilitate retrieval. Histopathological evaluation of the specimen revealed well-to-moderately differentiated tubular and papillary adenocarcinoma. A new elevated lesion (15 mm in diameter) was found at the gastric side of the EGJ laceration scar 6 months after the first ESD, necessitating a second resection with ESD. Endoscopic, histopathological, and immunohistochemical features of the new lesion resembled those of the antral lesion. We assessed the new lesion as a recurrence of cancer caused by implantation of tumor cells in the mucosal laceration after ESD.We experienced recurrence caused by implantation of tumor cells in a mucosal laceration after curative gastric ESD. Endoscopist should be aware of the risk of implantation after gastric ESD.
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Montero-Mateos E, Del Carmen S, Sanz J, Rodriguez-García R, Alcázar JA, Sayagués JM, Abad M. Endoluminal tumor implant of a colorectal cancer in an anal fistula detected by FISH techniques: a case report. J Gastrointest Oncol 2021; 12:900-905. [PMID: 34012678 DOI: 10.21037/jgo-20-281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Intraluminal shedding of tumor cells is a rare infrequent sporadic colorectal cancer (sCRC) mechanism of spreading. Less than 30 cases of sCRC metastasis into anal fistula have been reported. Here, we study a 72-year-old male with an adenocarcinoma arising in an anal fistula. Subsequent studies revealed another tumor in the rectum without distant metastatic disease; therefore, a curative-intent abdominoperineal resection was performed. The histologic study showed a moderately differentiated adenocarcinoma in both locations. No perineural or lymphovascular invasion was observed, and all the lymphatic nodes resected were negative for malignancy. Both tumors showed positive CK20 and negative CK7 immunostaining, but KRAS G12D mutation was only detected in the rectal tumor. After those conventional studies, a cytogenetic profile of both tumors was performed by interphase fluorescence in situ hybridization (iFISH) techniques. The FISH study displayed an identical genetic profile in both tumors, loss of the chromosomes 8 and 18q, and no alteration in chromosome 7 and 13q. Based on pathological and genetic findings, we established the same clonal origin of both tumors. Currently, the diagnosis of an intraluminal CRC metastasis relies on histologic and immunohistochemistry findings. We suggest that genetic studies at the individual cell level by FISH techniques may be useful in order to differentiate synchronous from intraluminal metastasis.
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Affiliation(s)
- Enrique Montero-Mateos
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Sofía Del Carmen
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Julia Sanz
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Raquel Rodriguez-García
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - José Antonio Alcázar
- Servicio de Cirugía General y del Aparato Digestivo, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - José María Sayagués
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
| | - Mar Abad
- Servicio de Anatomía Patológica, Hospital Clínico Universitario de Salamanca e Instituto de Investigación Biomédica de Salamanca (IBSAL), Universidad de Salamanca, Salamanca, Spain
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10
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Teurneau-Hermansson K, Svensson Neufert R, Buchwald P, Jörgren F. Rectal washout does not increase the complication risk after anterior resection for rectal cancer. World J Surg Oncol 2021; 19:82. [PMID: 33740992 PMCID: PMC7980676 DOI: 10.1186/s12957-021-02193-7] [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] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background To reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer. Although RW is considered a safe practice, data on the complication risk are scarce. Our aim was to examine the association between RW and 30-day postoperative complications after AR for rectal cancer. Methods Patients from the Swedish Colorectal Cancer Registry who underwent AR between 2007 and 2013 were analysed using multivariable methods. Results A total of 4821 patients were included (4317 RW, 504 no RW). The RW group had lower rates of overall complications (1578/4317 (37%) vs. 208/504 (41%), p = 0.039), surgical complications (879/4317 (20%) vs. 140/504 (28%), p < 0.001) and 30-day mortality (50/4317 (1.2%) vs. 12/504 (2.4%), p = 0.020). In multivariable analysis, RW was a risk factor neither for overall complications (OR 0.73, 95% CI 0.60–0.90, p = 0.002) nor for surgical complications (OR 0.62, 95% CI 0.50–0.78, p < 0.001). Conclusions RW is a safe technique that does not increase the 30-day postoperative complication risk after AR with TME technique for rectal cancer.
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Affiliation(s)
| | | | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | - Fredrik Jörgren
- Department of Surgery, Helsingborg Hospital, Helsingborg, Lund University, Lund, Sweden
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11
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Baig M, Sayyed R, Nasim S, Khan S. Effect of rectal washout on local recurrence of rectal cancer in the era of total mesorectal excision: Meta-analysis. Surgeon 2021; 19:351-355. [PMID: 33583687 DOI: 10.1016/j.surge.2020.11.014] [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: 07/08/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Presence of intraluminal viable cancer cells implanting into the anastomosis has been proposed as a potential cause for developing local recurrence in patients undergoing anterior resection for rectal cancer. Rectal washout has been proposed as a method to prevent this from happening. There have been conflicting reports in literature regarding the effect of rectal washout on local recurrence. We aim to look at the role of rectal washout in preventing local recurrence of rectal cancer in patients undergoing total or tumor-specific mesorectal excision (TME). MATERIALS AND METHODS A literature review of studies evaluating the role of rectal washout on rectal cancer local recurrence was performed using PubMed, Scopus, EMBASE and non-English language literature search using CiNii (Japanese) and CNKI (Chinese). Inclusion criteria were use of TME, comparison of rectal washout with no washout, and evaluation of local recurrence as outcome. RESULTS Four studies were identified according to inclusion criteria. The meta-analysis showed a protective effect of rectal washout on local recurrence (OR 0.45 95% CI 0.45-0.75). However, one of the studies included had more than 90% weightage. Excluding this study from analysis showed no difference on local recurrence with rectal washout (OR 0.94, 95% CI 0.37-2.36). CONCLUSION The effect of rectal washout on rectal cancer local recurrence in patients who undergo TME is questionable and needs to be evaluated further by prospective studies.
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Affiliation(s)
- Mariam Baig
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, 7-A, Block R3, Johar Town, Lahore, Pakistan.
| | - Raza Sayyed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, 7-A, Block R3, Johar Town, Lahore, Pakistan
| | - Sana Nasim
- Department of Surgery, The Aga Khan University Hospital, National Stadium Road, Karachi, Sindh, Pakistan
| | - Sadaf Khan
- Department of Surgery, The Aga Khan University Hospital, National Stadium Road, Karachi, Sindh, Pakistan
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12
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Ishimaru K, Sato M, Akita S, Watanabe K, Kawamoto T, Kuwabara J, Tanigawa K, Nakagawa Y, Kikuchi S, Tatsuta K, Yoshida M, Koga S, Watanabe Y. Quantitative Assessment of Rectal Washout With Irrigation and Aspiration. J Med Device 2020. [DOI: 10.1115/1.4048114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Abstract
Local recurrence of rectal cancer is defined as any evidence of relapse within the small pelvis after surgical resection of the primary tumor. After removal of a rectal tumor, necrotic cellular debris and viable exfoliated cancer cells are present in the rectal lumen; using saline or povidone-iodine solution, many surgeons perform rectal washout beyond an occlusive clamp to remove these exfoliated malignant cells, which may lead to local recurrence. A meta-analysis showed that intraoperative rectal washout at the surgical anastomosis site can reduce the risk of local recurrence after rectal cancer resection. Therefore, intraluminal lavage is useful to prevent local recurrence. Although intraoperative rectal washing is considered to be important, there is probably room for improvement on this method. We described the idea of a new transanal irrigation and aspiration system for small rectal contents. The aim of this research was to investigate the effect of a new rectal washout system using a chemiluminescent imaging system. We attempted to evaluate and compare the washout efficiency between this new system and the conventional irrigation system using a cylindrical rectum model. Our results implied that, at the same volume of solution, the irrigation–aspiration rectal washout system was more effective than the irrigation washout system. This new rectal washout system was easy to use and allowed a good washout. To the best of our knowledge, this was the first report that evaluated the efficacy of a rectal washout system using quantitative data.
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Affiliation(s)
- Kei Ishimaru
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Mitsunori Sato
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Satoshi Akita
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Katsuya Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takayasu Kawamoto
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Jun Kuwabara
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kazufumi Tanigawa
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yusuke Nakagawa
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Satoshi Kikuchi
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Kyosuke Tatsuta
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Motohira Yoshida
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Shigehiro Koga
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yuji Watanabe
- Department of Gastrointestinal Surgery and Surgical Oncology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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13
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Shimizu H, Sudo M, Furuya S, Takiguchi K, Saito R, Maruyama S, Kawaguchi Y, Kawaida H, Kondo T, Ichikawa D. Is Intraluminal Washout Necessary for Patients with Sigmoid Colon Cancer to Eliminate Exfoliated Cancer Cells as in Patients with Rectal Cancer? A Pilot Study at a Single Institute. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:145-150. [PMID: 32743117 PMCID: PMC7390616 DOI: 10.23922/jarc.2020-030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Objectives: Rectal stump washout has been widely performed to prevent the implantation of exfoliated cancer cells (ECCs) in patients with rectal cancer. However, it remains unclear whether intraluminal washout before transection is required in patients with sigmoid colon cancer. Therefore, this pilot study was conducted to elucidate the necessity of intraluminal washout for sigmoid colon cancer patients in comparison with rectal cancer patients by cytological assessments. Methods: A total of 16 patients with sigmoid colon cancer and 24 patients with rectal cancer who underwent sigmoidectomy or anterior resection with anastomosis using double-stapling technique were enrolled. A transanal washout sample was collected before washout and after irrigation with 500 and 1,000 mL of saline. Cytological assessments were conducted according to the Papanicolaou classification, and class IV and V cells were defined as malignant. Results: Before washout, exfoliated cancer cells were found in 15 of 24 (62.5%) patients with rectal cancer and in 1 of 16 (6.2%) patients with sigmoid colon cancer (p < 0.001). Distal-free margin from the tumor was significantly shorter in patients with cancer cells (p = 0.002), and the length of the distal-free margin was significantly associated with the tumor location. After irrigation with 500 and 1,000 mL of saline, no cancer cell was found in all patients with sigmoid colon cancer, whereas ECCs were still found in five patients with rectal cancer (20.8%). Conclusions: Intraluminal washout with 1,000 mL may be sufficient for sigmoid colon cancer patients with longer distal-free margin. A large-scale, randomized controlled study is necessary to confirm these results.
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Affiliation(s)
- Hiroki Shimizu
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan.,Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Sudo
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Koichi Takiguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Ryo Saito
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Suguru Maruyama
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
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14
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Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC, Uyama I. Exfoliated cancer cells during intersphincteric resection for very low rectal cancer. Surg Today 2020; 50:1652-1656. [PMID: 32617675 DOI: 10.1007/s00595-020-02064-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the frequency of exfoliated cancer cells and the efficacy of rectal washout during intersphincteric resection (ISR) in patients not receiving chemoradiotherapy (CRT) for very low rectal cancer. METHOD The subjects of this prospective study were 16 consecutive patients who underwent ISR without CRT for very low rectal cancer. Brushing cytology of the posterior anorectal wall was performed twice in each step of the ISR procedure and the samples were sent for blind cytological examination to identify exfoliated cancer cells. RESULTS Exfoliated cancer cells were identified in 9 of 13 patients (69%) preoperatively. The number of cancer cells identified after abdominal total mesorectal dissection decreased significantly from 94% (15/16) to 25% (4/16) after transanal irrigation with 2000 mL saline (p < 0.001). No cancer cells were identified after swabbing the anal wall following transanal dissection with purse-string closure of the distal stump. No suture-line recurrence was found during a median follow-up duration of 6 years. CONCLUSION Exfoliated cancer cells, confirmed in 94% of patients after total mesorectal excision, could be eliminated by performing rectal irrigation after clamping the rectum proximal to the tumor and swabbing the anorectal wall during ISR.
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Affiliation(s)
- Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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15
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Backes Y, Seerden TCJ, van Gestel RSFE, Kranenburg O, Ubink I, Schiffelers RM, van Straten D, van der Capellen MS, van de Weerd S, de Leng WWJ, Siersema PD, Offerhaus GJA, Morsink FH, Ramphal W, Terhaar Sive Droste J, van Lent AUG, Geesing JMJ, Vleggaar FP, Elias SG, Lacle MM, Moons LMG. Tumor Seeding During Colonoscopy as a Possible Cause for Metachronous Colorectal Cancer. Gastroenterology 2019; 157:1222-1232.e4. [PMID: 31419435 DOI: 10.1053/j.gastro.2019.07.062] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND AND AIMS In patients who have undergone surgery for colorectal cancer (CRC), 3% have recurrence of (metachronous) CRC. We investigated whether tumor seeding during colonoscopy (iatrogenic implantation of tumor cells in damaged mucosa) increases risk for metachronous CRC. METHODS In a proof of principle study, we collected data from the Dutch National Pathology Registry for patients with a diagnosis of CRC from 2013 through 2015, with a second diagnosis of CRC within 6 months to 3.5 years after surgery. We reviewed pathology reports to identify likely metachronous CRC (histologically proven adenocarcinoma located elsewhere in the colon or rectum from the surgical anastomosis). For 22 patients fulfilling the inclusion criteria, we ascribed the most likely etiology to tumor seeding when endoscopic manipulations, such as biopsies or polypectomy, occurred at the location where the metachronous tumor was subsequently detected, after endoscopic manipulation of the primary tumor. We collected clinical data from patients and compared molecular profiles of the primary and metachronous colorectal tumors using next-generation sequencing. We then examined the source of seeded tumor. We tested whether tumor cells stay behind in the working channel of the endoscope after biopsies of colorectal tumors, and whether these cells maintain viability in organoid cultures. RESULTS In total, tumor seeding was suspected as the most likely etiology of metachronous CRC in 5 patients. Tumor tissues were available from 3 patients. An identical molecular signature was observed in the primary and metachronous colorectal tumors from all 3 patients. In 5 control cases with a different etiology of metachronous CRC, the molecular signature of the primary and metachronous tumor were completely different. Based on review of 2147 patient records, we estimated the risk of tumor seeding during colonoscopy to be 0.3%-0.6%. We demonstrated that the working channel of the colonoscope becomes contaminated with viable tumor cells during biopsy collection. Subsequent instruments introduced through this working channel also became contaminated. These cells were shown to maintain their proliferative potential. CONCLUSIONS In an analysis of primary and secondary tumors from patients with metachronous CRC, we found that primary tumor cells might be seeded in a new location after biopsy of the primary tumor. Although our study does not eliminate other possibilities of transmission, our findings and experiments support the hypothesis that tumor seeding can occur during colonoscopy via the working channel of the endoscope. The possibility of iatrogenic seeding seems low. However, our findings compel awareness on this potentially preventable cause of metachronous CRC.
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Affiliation(s)
- Yara Backes
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tom C J Seerden
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | - Rosanne S F E van Gestel
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Onno Kranenburg
- Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inge Ubink
- Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Raymond M Schiffelers
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Demian van Straten
- Laboratory of Clinical Chemistry and Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Malu S van der Capellen
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Simone van de Weerd
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Wendy W J de Leng
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - G Johan A Offerhaus
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Folkert H Morsink
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Winesh Ramphal
- Department of Gastroenterology and Hepatology, Amphia Hospital, Breda, The Netherlands
| | | | - Anja U G van Lent
- Department of Gastroenterology and Hepatology, OLVG, Amsterdam, The Netherlands
| | - Joost M J Geesing
- Department of Gastroenterology and Hepatology, Diakonessenhuis, Utrecht, The Netherlands
| | - Frank P Vleggaar
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Sjoerd G Elias
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Miangela M Lacle
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Leon M G Moons
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, Utrecht, The Netherlands.
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16
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Okada K, Sadahiro S, Kamei Y, Chan LF, Ogimi T, Miyakita H, Saito G, Tanaka A, Suzuki T. A prospective clinical study assessing the presence of exfoliated cancer cells and rectal washout including tumors in patients who receive neoadjuvant chemoradiotherapy for rectal cancer. Surg Today 2019; 50:352-359. [DOI: 10.1007/s00595-019-01883-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023]
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17
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Ohki A, Abe N, Yoshimoto E, Hashimoto Y, Takeuchi H, Nagao G, Masaki T, Mori T, Ohkura Y, Sugiyama M. Gastric washing by distilled water can reduce free gastric cancer cells exfoliated into the stomach lumen. Gastric Cancer 2018; 21:998-1003. [PMID: 29696405 DOI: 10.1007/s10120-018-0824-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/04/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE Intragastric free cancer cells in patients with gastric cancer have rarely been studied. The purpose of this study was to investigate the detection rate of intragastric free cancer cells in gastric washes using two types of solutions during endoscopic examination. We further clarified risk factors affecting the presence of exfoliated free cancer cells. METHODS A total of 175 patients with gastric cancer were enrolled. Lactated Ringer's solution (N = 89) or distilled water (DW; N = 86) via endoscopic working channel was sprayed onto the tumor surface, and the resultant fluid was collected for cytological examination. We compared the cancer-cell positivity rate between the two (Ringer and DW) groups. We also tested the correlation between cancer-cell positivity and clinicopathological factors in the Ringer group to identify risk factors for the presence of exfoliated cancer cells. RESULTS The cancer-cell positivity rate was significantly higher in the Ringer group than that in the DW group (58 vs 6%). Cytomorphology in the Ringer group was well maintained, but not in the DW group. The larger tumor size (≥ 20 mm) and positive lymphatic involvement were significant risk factors of exfoliated free cancer cells. CONCLUSIONS Cancer cells can be highly exfoliated from the tumor surface into the gastric lumen by endoscopic irrigation in large gastric cancer with lymphatic involvement. Gastric washing by DW can lead to cytoclasis of free cancer cells; therefore, it may minimize the possibility of cancer-cell seeding in procedures carrying potential risks of tumor-cell seeding upon transluminal communication, such as endoscopic full-thickness resection and laparoscopy-endoscopy cooperative surgery.
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Affiliation(s)
- Atsuko Ohki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan.
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Eri Yoshimoto
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yoshikazu Hashimoto
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Hirohisa Takeuchi
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Gen Nagao
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Tadahiko Masaki
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Toshiyuki Mori
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
| | - Yasuo Ohkura
- Pathology and Cytology Center, PCL JAPAN, 1361-1 Matoba, Kawagoe, Saitama, 350-1101, Japan
| | - Masanori Sugiyama
- Department of Surgery, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo, 181-8611, Japan
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18
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Rondelli F, Santinelli R, Stella P, Bugiantella W, Ceccarelli G, Balzarotti RC, De Rosa M, Avenia N. A New Surgical Device for Anterograde Intraoperative Rectal Washout. Surg Innov 2018; 25:203-207. [PMID: 29473452 DOI: 10.1177/1553350618759767] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Colorectal cancer is the fourth most diffuse cause of death in the world and local recurrence is associated with a reduced long-term life expectancy, with a reduced quality of life. Rectal washout at the anastomosis site leads to a statistically significant reduction of local recurrences. METHODS We developed the idea of a new laparoscopic stapler with an integrated washout system that could decontaminate the rectal stump before resection, without the need to enlarge the standard surgical incision or even to distort the incision site, closing the rectal stump just below the inferior part of the cancer, and then proceeding with the resection and stapling of the distal part of the tumor. Combined with these canonical functionalities, the new device, equipped with a patented washout system (patent number EP 3103401A1) will also allow to inject in the closed bowel a physiologic saline liquid. RESULTS In force of the mechanical action of the liquid injected, carcinogenic exfoliated cells eventually floating in the affected region of the colonic lumen will be expelled through the anal orifice. The intraoperative rectal washout, both in minimally invasive and in traditional open surgery, thus becomes a simple, effective, and reproducible procedure. CONCLUSIONS We describe the technical features and the possible clinical applications of a potentially new surgical laparoscopic stapler coupled with an integrated irrigation system. We have patented the system and we are developing a prototype with the aim to start an experimental pilot study.
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Affiliation(s)
- Fabio Rondelli
- 1 "San Giovanni Battista" Hospital, Perugia, Italy.,2 University of Perugia, Perugia, Italy
| | | | - Paolo Stella
- 1 "San Giovanni Battista" Hospital, Perugia, Italy
| | | | | | | | | | - Nicola Avenia
- 2 University of Perugia, Perugia, Italy.,6 S. Maria University Hospital, Terni, Italy
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19
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Svensson Neufert R, Teurneau-Hermansson K, Lydrup ML, Jörgren F, Buchwald P. Rectal washout in rectal cancer surgery: A survey of Swedish practice – Questionnaire. INTERNATIONAL JOURNAL OF SURGERY OPEN 2018. [DOI: 10.1016/j.ijso.2018.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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20
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Hamid M, Majbar AM, Hrora A, Ahallat M. Perineal skin recurrence on the site of Lone Star Retractor: case report. Surg Case Rep 2017; 3:130. [PMID: 29282589 PMCID: PMC5745204 DOI: 10.1186/s40792-017-0405-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 12/03/2017] [Indexed: 01/29/2023] Open
Abstract
Background Local recurrence of colorectal cancer is a major cause of morbidity and mortality that usually implies a worse prognosis. Its etiopathogenesis is still a subject of debate. Recurrence on the perineal wound caused by anal retractor device is rarely reported. Case presentation We present the case of a 75-year-old woman with perineal skin recurrence on the site of Lone Star Retractor™ from rectal adenocarcinoma. The patient underwent a curative proctectomy followed by a hand-sewn coloanal anastomosis using Lone Star Retractor™ 2 years ago for a tumor of the lower rectum. The recurrence was most likely caused by the seeding of exfoliated tumor cells into the perianal skin which was abraded by the retractor. Conclusion This case is the fourth case reported in the literature and highlights the importance of the use of less traumatic endoanal retractors to prevent such perianal recurrence. Recurrence on the perineal wound caused by anal retractor device is rare but possible. Further studies are needed to define preventive measures able to reduce cutaneous implants.
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Affiliation(s)
- Mohamed Hamid
- Faculty of Medicine and Pharmacy of Rabat, Department of Surgery, Ibn Sina Hospital, Mohammed V University of Rabat, Rabat, Morocco.
| | - Anass Mohamed Majbar
- Faculty of Medicine and Pharmacy of Rabat, Department of Surgery, Ibn Sina Hospital, Mohammed V University of Rabat, Rabat, Morocco
| | - Abdelmalek Hrora
- Faculty of Medicine and Pharmacy of Rabat, Department of Surgery, Ibn Sina Hospital, Mohammed V University of Rabat, Rabat, Morocco
| | - Mohamed Ahallat
- Faculty of Medicine and Pharmacy of Rabat, Department of Surgery, Ibn Sina Hospital, Mohammed V University of Rabat, Rabat, Morocco
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Jung WB, Yu CS, Lim SB, Park IJ, Yoon YS, Kim JC. Anastomotic Recurrence After Curative Resection for Colorectal Cancer. World J Surg 2017; 41:285-294. [PMID: 27481350 DOI: 10.1007/s00268-016-3663-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND A precise understanding of anastomotic recurrence (AR) permits efficient surveillance and treatment strategies. This study aimed to evaluate the clinicopathologic characteristics of patients with AR undergoing curative resection for colorectal cancer (CRC), compare colonic with rectal tumors and investigate the risk factors related to AR. METHODS A single-institution, retrospective cohort of 9024 patients who underwent curative surgery for CRC between 2000 and 2010 was enrolled. Patients were classified into AR group (n = 53) or non-AR group (n = 8971) and were also characterized by tumor location. RESULTS The AR group was independently associated with old age (p = 0.046), advanced N stage (p = 0.003), the rectum (p = 0.001), a large tumor (p = 0.001) and mucinous differentiation (MU) (p = 0.026). In colon cancers, the AR group (n = 20) was independently associated with MU (p = 0.022) and lymphovascular invasion (LVI) (p = 0.001). In rectal cancers, the AR group (n = 33) was independently associated with N2 stage (p = 0.007) and a large tumor (p < 0.001). AR is a burden to patients and physicians because these tumors have a poor prognosis and more advanced pathologic stages than the primary tumors. However, N0 stage and curative resection of an AR tumor (p = 0.001 and p < 0.001, respectively) were found to be independently associated with improved survival in a Cox regression model. CONCLUSION AR is independently associated with the rectum. In colon cancers, MU and LVI are independent risk factors for AR. In rectal cancers, a large tumor and N2 stage are independent risk factors for AR. Although AR shows a poor prognosis, early detection and curative resection may lead to an improved survival.
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Affiliation(s)
- Won Beom Jung
- Department of Surgery, Haeundae Paik Hospital, College of Medicine, University of Inje, Busan, Republic of Korea
| | - Chang Sik Yu
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul, 05505, Republic of Korea.
| | - Seok Byung Lim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul, 05505, Republic of Korea
| | - In Ja Park
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul, 05505, Republic of Korea
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul, 05505, Republic of Korea
| | - Jin Cheon Kim
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil,Songpa-gu, Seoul, 05505, Republic of Korea
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Jörgren F, Johansson R, Arnadottir H, Lindmark G. The importance of rectal washout for the oncological outcome after Hartmann's procedure for rectal cancer: analysis of population-based data from the Swedish Colorectal Cancer Registry. Tech Coloproctol 2017; 21:373-381. [PMID: 28560479 PMCID: PMC5486462 DOI: 10.1007/s10151-017-1637-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 05/11/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND During rectal cancer surgery the bowel may contain viable, exfoliated cancer cells, a potential source for local recurrence (LR). The amount and viability of these cells can be reduced using intraoperative rectal washout, a procedure that reduces the LR risk after anterior resection. The aim of this study was to analyse the impact of washout on oncological outcome when performed in Hartmann's procedure (HP) for rectal cancer. METHODS A national cohort study on data for patients registered from 1995 to 2007 in the Swedish Colorectal Cancer Registry was carried out. The final analysis included patients belonging to TNM stages I-III who had undergone R0 HP with a registered 5-year follow-up. Multivariate analysis was performed. RESULTS A total of 1188 patients were analysed (686 washout and 502 no washout). No differences were detected between the washout group and the no washout group concerning rates of LR [7% (49/686) vs. 10% (49/502); p = 0.13], distant metastasis (DM) [17% (119/686) vs. 18% (93/502); p = 0.65], and overall recurrence (OAR) [21% (145/686) vs. 24% (120/502); p = 0.29]. For both groups, the 5-year cancer-specific survival was below 50%. In multivariate analysis, washout neither decreased the risk of LR, DM, or OAR nor increased overall or the cancer-specific 5-year survival. CONCLUSIONS The oncological outcome did not improve when washout was performed in HP for rectal cancer.
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Affiliation(s)
- F Jörgren
- Department of Surgery, Helsingborg Hospital, Lund University, 251 87, Helsingborg, Sweden.
| | - R Johansson
- Regional Cancer Centre North, Department of Radiation Science, Oncology, Umeå University, Umeå, Sweden
| | - H Arnadottir
- Department of Surgery, Helsingborg Hospital, Lund University, 251 87, Helsingborg, Sweden
| | - G Lindmark
- Department of Surgery, Helsingborg Hospital, Lund University, 251 87, Helsingborg, Sweden
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Lee HJ, Ye BD, Byeon JS, Kim J, Park YS, Hong YS, Yoon YS, Yang DH. Unusual Local Recurrence with Distant Metastasis after Successful Endoscopic Submucosal Dissection for Colorectal Mucosal Cancer. Clin Endosc 2016; 50:91-95. [PMID: 27545276 PMCID: PMC5299978 DOI: 10.5946/ce.2016.054] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/28/2022] Open
Abstract
Intramucosal colorectal cancer (CRC) is thought not to metastasize because the colonic lamina propria lacks lymphatics. Only a few recent case reports have suggested lymph node metastasis from intramucosal CRC, but there is no clear evidence supporting the metastatic potential of intramucosal CRC. Hence, endoscopic resection is regarded as curative treatment for intramucosal CRC. This report describes two cases of unusual local recurrence with distant metastasis in patients who had previously undergone successful endoscopic submucosal dissection for intramucosal CRC. The recurrent colorectal lesions developed at the site of the previous endoscopic submucosal dissection scars in a relatively short-term period, and the pathologic findings showed an “undermining” invasion pattern without surrounding mucosal change. Based on the clinical course and pathological findings, we concluded that the second colorectal lesions were recurrences rather than de novo cancers.
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Affiliation(s)
- Hyo Jeong Lee
- Health Screening and Promotion Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Byong Duk Ye
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jeong-Sik Byeon
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jihun Kim
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sang Hong
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yong Sik Yoon
- Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hoon Yang
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Asai S, Takeshita K, Kano Y, Nakao E, Ichinona T, Fujimoto N, Akamine E, Mori T, Ogawa A. Implantation of esophageal cancer onto post-dissection ulcer after gastric endoscopic submucosal dissection. World J Gastroenterol 2016; 22:2855-2860. [PMID: 26973424 PMCID: PMC4778008 DOI: 10.3748/wjg.v22.i9.2855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 10/13/2015] [Accepted: 12/08/2015] [Indexed: 02/06/2023] Open
Abstract
A case in which implantation of esophageal squamous cell carcinoma onto a post-dissection gastric ulcer was strongly suspected is presented. A 72-year-old man with alcoholic liver cirrhosis underwent esophagogastroduodenoscopy (EGD). Esophageal cancer (EC) (Mt, 20 mm, 0-Is) and gastric cancer (GC) (antrum, 15 mm, 0-IIc) were identified. Biopsy specimens revealed moderately differentiated squamous cell carcinoma (SCC) and differentiated adenocarcinoma, respectively. The GC was resected by endoscopic submucosal dissection (ESD) [14 mm × 9 mm, type 0-IIc, tub1, pT1a(M), ly0, v0, HM(-), VM(-)]. Two months after ESD, radiation therapy was started for the EC, and an almost complete response was obtained. Nine months after the ESD, a follow-up EGD showed a submucosal tumor-like lesion with ulceration, located immediately under the post-ESD scar, and biopsy specimens showed moderately differentiated SCC. There were no similar lesions suggesting hematogenous or lymphatic metastasis in the stomach.
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25
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Siddiqi N, Abbas M, Iqbal Z, Farooq M, Conti J, Parvaiz A. Benefit of rectal washout for anterior resection and left sided resections. Int J Surg 2015; 25:106-8. [PMID: 26626366 DOI: 10.1016/j.ijsu.2015.11.041] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/24/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess the effectiveness of rectal wash out in preventing local recurrence for patients who undergo anterior resection for recto-sigmoid cancer. MATERIALS AND METHODS A best evidence topic was constructed according to a structured protocol. Medline 1948-2015 and EMBASE 1980 to 2015 using the OVID interface: ( Rectal) AND (Washout) AND (Anterior Resection). In addition, the reference lists of the relevant papers were searched. OUTCOMES Eight papers among the 17 relevant articles were identified as representing the best evidence including 3 prospective non-randomized studies, 1 retrospective non randomized study and 4 meta-analyses. CONCLUSIONS On the basis of current evidence, rectal washout does not stop local recurrence of cancer after anterior resection or left sided colonic resection, but it may reduce the rate of local recurrence. A randomised controlled trial to address this issue would formally answer this question.
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Affiliation(s)
- Najaf Siddiqi
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - Zafar Iqbal
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | | | - John Conti
- Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Amjad Parvaiz
- Queen Alexandra Hospital, Portsmouth, United Kingdom
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Inoue T, Fujii H, Koyama F, Nakamura S, Ueda T, Nishigori N, Kawasaki K, Obara S, Nakamoto T, Uchimoto K, Morita K, Nishikawa T, Ohbayashi C, Nakajima Y. Intraluminal lavage to remove exfoliated tumor cells after colorectal endoscopic submucosal dissection. Surg Endosc 2015; 30:2773-8. [DOI: 10.1007/s00464-015-4550-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2015] [Accepted: 09/01/2015] [Indexed: 11/30/2022]
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27
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Wang JF, Zhang PF, Xie Y, Hu L, Li CR, Li HL. Reasonable application of rectal washout in surgery for rectal cancer: Influence on prognosis and recurrence. Shijie Huaren Xiaohua Zazhi 2015; 23:3576-3581. [DOI: 10.11569/wcjd.v23.i22.3576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The growth of residual tumor cells may cause postoperative colorectal anastomotic recurrence, which mainly exists in the intestine; however, rectal washout can significantly reduce the number of free tumor cells in the intestinal cavity and decrease the local recurrence rate. Clinical application of rectal washout has been tried in operation, but the effect remains controversial. This paper mainly introduces the method of rectal washout, washout fluid type, amount of washout fluid, relation of rectal washout with local recurrence, with emphasis on the influence of reasonable application of rectal washout on prognosis and recurrence of rectal cancer after surgery.
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28
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Knol JJ, D'Hondt M, Souverijns G, Heald B, Vangertruyden G. Transanal endoscopic total mesorectal excision: technical aspects of approaching the mesorectal plane from below--a preliminary report. Tech Coloproctol 2015; 19:221-9. [PMID: 25702172 DOI: 10.1007/s10151-015-1275-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 01/27/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND Laparoscopic total mesorectal excision (TME) for low rectal cancer can be technically challenging. This report describes our initial experience with a hybrid laparoscopic and transanal endoscopic technique for TME in low rectal cancer. METHODS Between December 2012 and October 2013, we identified patients with rectal cancer < 5 cm from the anorectal junction (ARJ) who underwent laparoscopic-assisted TME with a transanal minimally invasive surgery (TAMIS) technique. A standardized stepwise approach was used in all patients. Resection specimens were examined for completeness and measurement of margins. Preoperative magnetic resonance imaging (MRI) characteristics and short-term postoperative outcomes were examined. All values are mean ± standard deviation. RESULTS Ten patients (8 males; median age: 60.5 (range 36-70) years) were included. On initial MRI, all tumors were T2 or T3, mean tumor height from the ARJ was 28.9 ± 12.2 mm, mean circumferential resection margin was 5.3 ± 3.1 mm , and the mean angle between the anal canal and the levator ani was 83.9° ± 9.7°. All patients had had preoperative chemoradiotherapy, TME via TAMIS, and distal anastomosis. There were no intraoperative complications, anastomotic leaks, or 30-day mortality. The pathologic quality of all mesorectal specimens was excellent. The distal resection margin was 19.4 ± 10.4 mm, the mean circumferential resection margin was 13.8 ± 5.1 mm, and the median lymph node harvest was 10.5 (range 5-15) nodes. CONCLUSIONS A combined laparoscopic and transanal approach can achieve a safe and oncologically complete TME dissection for low rectal tumors. This approach may improve clinical outcomes in these technically difficult cases, but larger prospective studies are needed.
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Affiliation(s)
- J J Knol
- Department of Abdominal Surgery, Jessa Hospital, Salvatorstraat 20, 3500, Hasselt, Belgium,
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Zhou C, Ren Y, Wang K, Liu J, He JJ, Liu PJ. Intra-operative rectal washout with saline solution can effectively prevent anastomotic recurrence: a meta-analysis. Asian Pac J Cancer Prev 2015; 14:7155-9. [PMID: 24460268 DOI: 10.7314/apjcp.2013.14.12.7155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Rectal washout with saline solution may theoretically prevent anastomotic recurrence in patients with resectable rectal cancer, although exact clinical effects have not yet been determined. In order to derive a more precise estimation of the relationship, the present meta-analysis was performed. METHOD Relevant studies were identified by a search of Medline, Embase and Google Website with no restrictions to September 1, 2013, and included in the systematic review and meta-analysis. RESULTS 5 trials (642 participants) were included to assess the association between rectal washout with saline solution and anastomotic recurrence. The rate of anastomotic recurrence (AR) was 6.23% (40/642), with the pooled OR derived from the five studies being 0.32 (95 % CI=0.15-0.70, P=0.004). The pooled OR derived from the TME and radical resection subgroups were 0.72 (95%CI=0.16-3.12, P=0.66) and 0.51 (95%CI=0.13-1.96, P=0.32), respectively. CONCLUSION Results from this analysis show that intra-operative rectal washout with mere saline solution largely reduces the risk of anastomotic recurrences in patients with resectable rectal cancer.
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Affiliation(s)
- Can Zhou
- Department of Centre of Translational Medicine, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China E-mail :
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Collin Å, Jung B, Nilsson E, Påhlman L, Folkesson J. Impact of mechanical bowel preparation on survival after colonic cancer resection. Br J Surg 2014; 101:1594-600. [PMID: 25204295 DOI: 10.1002/bjs.9629] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/28/2014] [Accepted: 07/14/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND A randomized study in 1999-2005 of mechanical bowel preparation (MBP) preceding colonic resection found no decrease in postoperative complications. The aim of the present study was to evaluate the long-term effect of MBP regarding cancer recurrence and survival after colonic resections. METHODS The cohort of patients with colonic cancer in the MBP study was followed up for 10 years. Data were collected from registers run by the National Board of Health and Welfare. Register data were validated against information in patient charts. Cox proportional hazards model was used for multivariable analysis of factors predictive of cancer-specific survival. RESULTS Register analysis showed significantly fewer recurrences, and better cancer-specific and overall survival in the MBP group. After validation, 839 of 1343 patients remained for analysis (448 MBP, 391 no MBP). Eighty (17·9 per cent) of 448 patients in the MBP group and 88 (22·5 per cent) of 391 in the no-MBP group developed a cancer recurrence (P = 0·093). The 10-year cancer-specific survival rate was 84·1 per cent in the MBP group and 78·0 per cent in the no-MBP group (P = 0·019). Overall survival rates were 58·8 and 56·0 per cent respectively (P = 0·186). CONCLUSION Patients receiving MBP before elective colonic cancer surgery had significantly better cancer-specific survival after 10 years.
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Affiliation(s)
- Å Collin
- Department of Surgical Science, Uppsala University, Uppsala, Sweden
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Yao X, Williamson C, Adalsteinsson VA, D'Agostino RS, Fitton T, Smaroff GG, William RT, Wittrup KD, Love JC. Tumor cells are dislodged into the pulmonary vein during lobectomy. J Thorac Cardiovasc Surg 2014; 148:3224-31.e1-5. [PMID: 25172322 DOI: 10.1016/j.jtcvs.2014.06.074] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/29/2014] [Accepted: 06/13/2014] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Intraoperative tumor shedding may facilitate tumor dissemination. In earlier studies, shed tumor cells were defined primarily by cytomorphological examination, and normal epithelial cells could not always be distinguished from tumor cells. We sought to accurately identify tumor cells using single-cell sequencing and determine whether these cells were mobilized into the circulation during pulmonary lobectomy. METHODS Forty-two blood samples collected from the tumor-draining pulmonary vein at the end of lobectomy procedures were analyzed. Arrays of nanowells were used to enumerate and retrieve single EpCAM(+) cells. Targeted sequencing of 10 to 15 cells and nested polymerase chain reaction of single cells detected somatic mutations in shed epithelial cells consistent with patient-matched tumor but not normal tissue. RESULTS The mean number of EpCAM(+) cells in video-assisted thoracoscopy (VATS) lobectomy (no wedge) specimens (n = 16) was 165 (median, 115; range, 0-509) but sampling cells from 3 patients indicated that only 0% to 38% of the EpCAM(+) cells were tumor cells. The mean number of EpCAM(+) cells in VATS lobectomy (wedge) specimens (n = 12) was 1128 (median, 197; range, 47-9406) and all of the EpCAM(+) cells were normal epithelial cells in 2 patients sampled. The mean number of EpCAM(+) cells in thoracotomy specimens (n = 14) was 238 (median, 22; range, 9-2920) and 0% to 50% of total EpCAM(+) cells were tumor cells based on 4 patients sampled. CONCLUSIONS Surgery mobilizes tumor cells into the pulmonary vein, along with many normal epithelial cells. EpCAM alone cannot differentiate between normal and tumor cells. On the other hand, single-cell genetic approaches with patient-matched normal and tumor tissues can accurately quantify the number of shed tumor cells.
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Affiliation(s)
- Xiaosai Yao
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Mass; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Mass
| | - Christina Williamson
- Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Viktor A Adalsteinsson
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Mass; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Mass; Broad Institute of MIT and Harvard, Cambridge, Mass
| | - Richard S D'Agostino
- Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Torin Fitton
- Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Gregory G Smaroff
- Department of Thoracic and Cardiovascular Surgery, Lahey Hospital and Medical Center, Burlington, Mass
| | - Robert T William
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Mass
| | - K Dane Wittrup
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Mass; Department of Biological Engineering, Massachusetts Institute of Technology, Cambridge, Mass; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Mass
| | - J Christopher Love
- Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, Cambridge, Mass; Department of Chemical Engineering, Massachusetts Institute of Technology, Cambridge, Mass; Broad Institute of MIT and Harvard, Cambridge, Mass.
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Laparoscopic salvage surgery for locally recurrent rectal cancer. J Gastrointest Surg 2014; 18:1319-26. [PMID: 24838997 DOI: 10.1007/s11605-014-2537-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/05/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgical treatment for locally recurrent rectal cancer is challenging, and the value of laparoscopic surgery in such cases is unknown. The purpose of this study was to compare the feasibility of laparoscopic surgery with that of open surgery for locally recurrent rectal cancer. METHODS Thirty patients with local rectal cancer recurrence at the anastomotic site or lateral pelvic lymph nodes were evaluated. Perioperative outcomes were compared between the laparoscopic (n = 13) and open (n = 17) groups. RESULTS The median operation time was significantly longer (381 vs. 241 min) but the median estimated blood loss tended to be smaller (110 vs. 450 mL) in the laparoscopic than in the open group. There was only one converted case (7.7%). The R0 resection rate (100 vs. 94%) and postoperative complications (31 vs. 24%) were not significantly different between the two groups. The median times to flatus (1 vs. 2 days), first stool (2 vs. 5 days), and oral intake (2 vs. 5 days) were significantly shorter in the laparoscopic than in the open group. CONCLUSION Laparoscopic surgery for locally recurrent rectal cancer has short-term benefits over open surgery and has potential as a treatment option for locally recurrent rectal cancer.
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Association between irrigation fluids, washout volumes and risk of local recurrence of anterior resection for rectal cancer: a meta-analysis of 427 cases and 492 controls. PLoS One 2014. [PMID: 24824812 DOI: 10.1371/journal.pone.0095699.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Rectal washout can prevent local recurrence after anterior resection of rectal cancer. Few studies have focused particularly on the association between irrigation fluids volume or agents and the risk of local recurrence after anterior resection of rectal cancer. OBJECTIVE To estimate the association between irrigation fluids types, volumes of rectal washout and risk of local recurrence after anterior resection for cancer. DATA SOURCES Relevant studies were identified by a search of Medline, Embase, Wiley Online Library, China National Knowledge Infrastructure, Cochrane Oral Health Group Specialized Register, Wanfang databases and Google Website from their inception until October 18,2013. STUDY SELECTION Studies reporting the association between rectal washout types and volumes and risk of local recurrence after anterior resection for cancer were included. INTERVENTIONS Eligible studies used rectal washout. Control groups were defined as no washout. STUDY APPRAISAL AND SYNTHESIS METHODS Random-effects model were used to obtain summary estimates of RR and 95% CI, with Stata version 11 and RevMan 5.2.5 softwares used. The quality of report was appraised in reference to the MINORS item. RESULTS Of the 919 rectal cancer patients in 8 included studies, a total of 61(6.64%) cases of local recurrence were reported, with a pooled RR 0.51 (95%CI = 0.28-0.92, P = 0.03). The RRs 0.37 and 0.39 in normal saline and washout volume (≥ 1500 ml normal saline) subgroup, respectively, indicated that rectal washout with normal saline, or ≥ 1500 ml in volume could significantly reduce local recurrence (LR) rate (95% CI = 0.17-0.79, P = 0.01; 95% CI = 0.18-0.87, P = 0.02) after anterior resection for cancer. LIMITATION The included studies were non-randomized observational studies, with diversity of study designs. CONCLUSION Rectal washout with normal saline alone can reduce the risk of local recurrence in patients with resectable rectal cancer, and 1.5 liters rectal washout in volume is recommended.
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Zhou C, Ren Y, Li J, Wang K, He J, Chen W, Liu P. Association between irrigation fluids, washout volumes and risk of local recurrence of anterior resection for rectal cancer: a meta-analysis of 427 cases and 492 controls. PLoS One 2014; 9:e95699. [PMID: 24824812 PMCID: PMC4019500 DOI: 10.1371/journal.pone.0095699] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 03/31/2014] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Rectal washout can prevent local recurrence after anterior resection of rectal cancer. Few studies have focused particularly on the association between irrigation fluids volume or agents and the risk of local recurrence after anterior resection of rectal cancer. OBJECTIVE To estimate the association between irrigation fluids types, volumes of rectal washout and risk of local recurrence after anterior resection for cancer. DATA SOURCES Relevant studies were identified by a search of Medline, Embase, Wiley Online Library, China National Knowledge Infrastructure, Cochrane Oral Health Group Specialized Register, Wanfang databases and Google Website from their inception until October 18,2013. STUDY SELECTION Studies reporting the association between rectal washout types and volumes and risk of local recurrence after anterior resection for cancer were included. INTERVENTIONS Eligible studies used rectal washout. Control groups were defined as no washout. STUDY APPRAISAL AND SYNTHESIS METHODS Random-effects model were used to obtain summary estimates of RR and 95% CI, with Stata version 11 and RevMan 5.2.5 softwares used. The quality of report was appraised in reference to the MINORS item. RESULTS Of the 919 rectal cancer patients in 8 included studies, a total of 61(6.64%) cases of local recurrence were reported, with a pooled RR 0.51 (95%CI = 0.28-0.92, P = 0.03). The RRs 0.37 and 0.39 in normal saline and washout volume (≥ 1500 ml normal saline) subgroup, respectively, indicated that rectal washout with normal saline, or ≥ 1500 ml in volume could significantly reduce local recurrence (LR) rate (95% CI = 0.17-0.79, P = 0.01; 95% CI = 0.18-0.87, P = 0.02) after anterior resection for cancer. LIMITATION The included studies were non-randomized observational studies, with diversity of study designs. CONCLUSION Rectal washout with normal saline alone can reduce the risk of local recurrence in patients with resectable rectal cancer, and 1.5 liters rectal washout in volume is recommended.
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Affiliation(s)
- Can Zhou
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yu Ren
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Juan Li
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Ke Wang
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Jianjun He
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Wuke Chen
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Peijun Liu
- Department of Translational Medicine Center, the First Affiliated Hospital, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
- * E-mail:
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Young PE, Womeldorph CM, Johnson EK, Maykel JA, Brucher B, Stojadinovic A, Avital I, Nissan A, Steele SR. Early detection of colorectal cancer recurrence in patients undergoing surgery with curative intent: current status and challenges. J Cancer 2014; 5:262-71. [PMID: 24790654 PMCID: PMC3982039 DOI: 10.7150/jca.7988] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Despite advances in neoadjuvant and adjuvant therapy, attention to proper surgical technique, and improved pathological staging for both the primary and metastatic lesions, almost half of all colorectal cancer patients will develop recurrent disease. More concerning, this includes ~25% of patients with theoretically curable node-negative, non-metastatic Stage I and II disease. Given the annual incidence of colorectal cancer, approximately 150,000 new patients are candidates each year for follow-up surveillance. When combined with the greater population already enrolled in a surveillance protocol, this translates to a tremendous number of patients at risk for recurrence. It is therefore imperative that strategies aim for detection of recurrence as early as possible to allow initiation of treatment that may still result in cure. Yet, controversy exists regarding the optimal surveillance strategy (high-intensity vs. traditional), ideal testing regimen, and overall effectiveness. While benefits may involve earlier detection of recurrence, psychological welfare improvement, and greater overall survival, this must be weighed against the potential disadvantages including more invasive tests, higher rates of reoperation, and increased costs. In this review, we will examine the current options available and challenges surrounding colorectal cancer surveillance and early detection of recurrence.
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Affiliation(s)
- Patrick. E. Young
- 1. Department of Medicine, Division of Gastroenterology, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
- 3. Department of Medicine, Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Craig M. Womeldorph
- 2. Department of Medicine, Division of Gastroenterology, San Antonio Military Medical Center, San Antonio, TX, USA
- 3. Department of Medicine, Uniformed Services University of Health Science, Bethesda, MD, USA
| | - Eric K. Johnson
- 4. Department of Surgery, Madigan Army Center, Tacoma, WA, USA
| | - Justin A. Maykel
- 5. Division of Colorectal Surgery, University of Massachusetts Memorial Medical Center, Worcester, MA, USA
| | | | | | | | - Aviram Nissan
- 7. Department of Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Scott R. Steele
- 4. Department of Surgery, Madigan Army Center, Tacoma, WA, USA
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Inoue T, Fujii H, Koyama F, Nakagawa T, Uchimoto K, Nakamura S, Ueda T, Nishigori N, Kawasaki K, Obara S, Nakamoto T, Nakajima Y. Local recurrence after rectal endoscopic submucosal dissection: a case of tumor cell implantation. Clin J Gastroenterol 2014; 7:36-40. [PMID: 24523830 PMCID: PMC3915078 DOI: 10.1007/s12328-013-0445-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 12/08/2013] [Indexed: 12/12/2022]
Abstract
We report a case of local recurrence of cancer after rectal endoscopic submucosal dissection (ESD). A 52-year-old male underwent a curative resection with ESD for rectal intramucosal cancer. Seventy-four months after ESD, surveillance colonoscopy showed an elevated lesion on the ESD scar, suspicious of a recurrence. The patient subsequently underwent a low anterior resection (intersphincteric) with lymph node dissection. Pathology revealed a well-differentiated adenocarcinoma, similar to the ESD specimen. We suspected that the local recurrence was caused by implantation of tumor cells during the ESD, due to surgical manipulation performed with the tumor in an exposed setting for a long period of time.
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Affiliation(s)
- Takashi Inoue
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Hisao Fujii
- Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan
| | - Fumikazu Koyama
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
- Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan
| | - Tadashi Nakagawa
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Kazuaki Uchimoto
- Department of Endoscopy and Ultrasound, Nara Medical University Hospital, Kashihara, Japan
| | - Shinji Nakamura
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Takeshi Ueda
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Naoto Nishigori
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Keijiro Kawasaki
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Shinsaku Obara
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Takayuki Nakamoto
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
| | - Yoshiyuki Nakajima
- Department of Surgery, Nara Medical University, 840 Shijocho, Kashihara, Nara 634-8522 Japan
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Zhou C, Ren Y, Li J, Li X, He J, Liu P. Systematic review and meta-analysis of rectal washout on risk of local recurrence for cancer. J Surg Res 2014; 189:7-16. [PMID: 24630520 DOI: 10.1016/j.jss.2014.01.030] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/05/2014] [Accepted: 01/16/2014] [Indexed: 01/01/2023]
Abstract
BACKGROUND It has been shown that intraluminal washout (WO) can prevent local recurrence (LR) of rectal cancer. This meta-analysis was to evaluate the association of rectal WO and the risk of LR after anterior resection in patients with rectal cancer. METHODS The relevant studies were identified by a search of the MEDLINE, Embase, Wiley Online Library, and Cochrane Oral Health Group Specialized Register with no restrictions on October 18, 2013, and these studies were included in a systematic review and meta-analysis. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated in fixed effects model. RESULTS A total of nine studies were included in our study, yielding a total of 5519 patients, and pooled ORs for overall LR in corresponding subgroups were calculated. Rectal WO was associated with a lower risk for LR (240/4176, 5.75% versus 9.75%, 131/1343, OR = 0.53, 95% CI = 0.42-0.68, and P < 0.00001) in patients with anterior resection, having total mesorectal excisions (234/3942, 5.93% versus 9.34%, 97/1039, OR = 0.59, 95% CI = 0.46-0.75, and P < 0.00001), and after radical resection (RR; 122/2665, 4.99% versus 8.90%, 74/831, OR = 0.56, 95% CI = 0.41-0.78, and P = 0.0005), with an overall LR rate of 6.72% (371/5519). But, the stability of RRs is not high in the total mesorectal excisions or RR subgroup by sensitivity analysis. CONCLUSIONS The use of rectal WO decreases risks of LR in patients after anterior resection of cancer.
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Affiliation(s)
- Can Zhou
- Department of Translational Medicine Center, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China; Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Yu Ren
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Juan Li
- Department of Translational Medicine Center, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Xiao Li
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Jianjun He
- Department of Surgical Oncology, the First Affiliated Hospital, School of Medicine of of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China
| | - Peijun Liu
- Department of Translational Medicine Center, the First Affiliated Hospital, School of Medicine of Xi'an Jiaotong University, Xi'an, Shaanxi Province, China.
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Matsuda A, Uchida E. Reply to "Commentary to Matsuda et al., Ann Surg Oncol (2013) 20:856-863," by Karl Kodeda and Richard J. Heald (doi:10.1245/s10434-013-2951-4). Ann Surg Oncol 2013; 20:3704. [PMID: 23525732 DOI: 10.1245/s10434-013-2952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Indexed: 11/18/2022]
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Kodeda K, Heald RJ. Commentary to Matsuda et Al., Ann Surg Oncol, Sep 18, 2012 [epub ahead of print]. Ann Surg Oncol 2013; 20:3702-3. [PMID: 23525705 DOI: 10.1245/s10434-013-2951-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Indexed: 11/18/2022]
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