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Lai YH, Chang YT, Chang YJ, Tsai JT, Li MH, Lin JC. Predictive Value of the Interaction between CEA and Hemoglobin in Neoadjuvant CCRT Outcomes in Rectal Cancer Patients. J Clin Med 2023; 12:7690. [PMID: 38137759 PMCID: PMC10744245 DOI: 10.3390/jcm12247690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/01/2023] [Accepted: 12/12/2023] [Indexed: 12/24/2023] Open
Abstract
The adoption of neoadjuvant concurrent chemoradiotherapy (CCRT) has reshaped the therapeutic landscape, but response prediction remains challenging. This study investigates the interaction between pre-CCRT carcinoembryonic antigen (CEA) and post-CCRT hemoglobin (Hb) levels in predicting the response of locally advanced rectal cancer (LARC) to CCRT. Retrospective data from 93 rectal cancer patients receiving neoadjuvant CCRT were analyzed. Univariate analyses assessed clinical factors associated with tumor regression grade (TRG) and T-stage outcomes. Machine learning identified predictive biomarkers. Interaction effects between CEA and Hb were explored through subgroup analyses. Post-CCRT Hb varied between pre-CCRT CEA groups. The interaction between pre-CCRT CEA and post-CCRT Hb influenced TRG. Males with normal pre-CCRT CEA and anemia showed better treatment responses. Females with elevated pre-CCRT CEA and post-CCRT anemia exhibited poorer responses. The interaction effect between them was significant, indicating that their relationship with TRG was not additive. Inflammatory biomarkers, WBC, neutrophil count, and post-CCRT platelet level correlated with CCRT response. Contrasting with previous findings, anemia was a predictor of better treatment response in males with normal pre-CCRT CEA. The interaction between pre-CCRT CEA and post-CCRT Hb levels predicts the response of LARC to CCRT. CEA, Hb, and sex should be considered when assessing treatment response. Inflammatory biomarkers contribute to response prediction. Understanding these complex relationships can enhance personalized treatment approaches in rectal cancer patients.
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Affiliation(s)
- Yi-Hsuan Lai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
| | - Yu-Tien Chang
- School of Public Health, National Defense Medical Center, Taipei 114201, Taiwan;
| | - Yu-Jia Chang
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
| | - Jo-Ting Tsai
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
- Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan;
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
| | - Ming-Hsien Li
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
| | - Jang-Chun Lin
- Department of Radiation Oncology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 235041, Taiwan; (Y.-H.L.); (J.-T.T.); (M.-H.L.)
- Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110301, Taiwan
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2
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Varlamos CJ, Sinco B, Van Weiren I, Regenbogen S, Gamboa AC, Silviera M, Abdel-Misih SRZ, Hawkins AT, Balch G, Hendren S. Close distal margin is associated with locoregional rectal cancer recurrence: A multicenter study. J Surg Oncol 2023; 128:1106-1113. [PMID: 37458131 DOI: 10.1002/jso.27401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 07/09/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND AND OBJECTIVES The importance of the radial margin for rectal cancer resection is well understood. However, surgeons have deemphasized the distal margin, accepting very close distal margins to perform sphincter-preserving surgery. We hypothesized that distal margins < 1 cm would be an independent risk factor for locoregional recurrence. The objective was to determine whether close distal margins are associated with increased locoregional recurrence risk. METHODS This was a multi-institutional retrospective cohort study conducted at six academic medical centers including patients who received low anterior resection surgery for primary rectal cancer between 2007 and 2018. RESULTS Of 556 low anterior resection patients, the rate of close distal margin was 12.8% (n = 71), and the locoregional recurrence rate was 5.0% (n = 28). The locoregional recurrence rate for close distal margin cases was 9.9% (n = 7) compared to 4.3% (n = 21) for distal margins ≥1.0 cm. In multivariable analysis, the only factor significantly associated with locoregional recurrence was close distal margin (adjusted odds ratio: 2.80, confidence interval: 1.08-7.25, p = 0.035). CONCLUSIONS Rectal cancer patients with close distal margins (<1 cm) following low anterior resection had a significantly higher risk for locoregional recurrence. Therefore, the decision to perform low anterior resection with margins < 1 cm should be taken with caution.
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Affiliation(s)
| | - Brandy Sinco
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Inga Van Weiren
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Scott Regenbogen
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
| | - Adriana C Gamboa
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Matthew Silviera
- Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sherif R Z Abdel-Misih
- Department of Surgery (Surgical Oncology), Stony Brook University Hospital, Stony Brook, New York, USA
| | - Alexander T Hawkins
- Division of General Surgery, Section of Colon and Rectal Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Glen Balch
- Department of Surgery, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Samantha Hendren
- Department of Surgery, University of Michigan Medicine, Ann Arbor, Michigan, USA
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3
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Zhao J, Zhao H, Jia T, Yang S, Wang X. Combination of Changes in CEA and CA199 Concentration After Neoadjuvant Chemoradiotherapy Could Predict the Prognosis of Stage II/III Rectal Cancer Patients Receiving Neoadjuvant Chemoradiotherapy Followed by Total Mesorectal Excision. Cancer Manag Res 2022; 14:2933-2944. [PMID: 36200095 PMCID: PMC9529229 DOI: 10.2147/cmar.s377784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Previous studies have shown that the levels of serum tumor markers CEA and CA19-9 were related to chemoradiotherapy. Therefore, it has been assumed that dynamic monitoring of these markers could predict the prognosis of stage II/III rectal cancer (RC). Therefore, this study proposed to evaluate the prognostic value of changes in serum tumor biomarkers for stage II/III RC patients undergoing neoadjuvant chemoradiotherapy (NCRT) followed by total mesorectal excision (TME). Methods A total of 217 patients with stage II/III RC receiving NCRT followed by TME were retrospectively analyzed. Serum CEA and CA199 levels were measured within one week before NCRT and one week before TME. The optimal cut-off points of ∆CEA% and ∆CA199% for prognosis prediction were calculated by receiver operating characteristics (ROC) analysis. Independent prognostic predictors were identified by univariate and multivariate Cox regression analyses. To avoid the efficiency of ∆CEA% and ∆CA199% on serum tumor biomarker change (STBC) score, two models including and excluding ∆CEA% and ∆CA199% were established separately in multivariate analysis. Results The optimal cut-off point for ∆CEA% and ∆CA199% were −30.29% and 20.30%, respectively. Univariate analysis showed that ∆CEA%, ∆CA199%, STBC score, ypT staging and yN staging could predict OS. ypT staging and STBC score could predict DFS. In multivariate analysis, only ∆CA199% (HR = 0.468, 95% CI: 0.220–0.994, p = 0.048), ypT staging (HR = 0.420, 95% CI: 0.182–0.970, p = 0.042), and STBC score (HR = 0.204, 95% CI: 0.078–0.532, p = 0.001) were independently related to OS; and STBC score (HR = 0.412, 95% CI: 0.216–0.785, p=0.007) and ypT staging (HR = 0.421, 95% CI: 0.224–0.792, p = 0.007) were independently related to DFS. Conclusion We established a combined STBC score to predict the prognosis of stage II/III RC patients receiving NCRT followed by TME. The predictive value of the combined score was stronger than a single marker alone and even stronger than several pathological indicators.
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Affiliation(s)
- Jieyi Zhao
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- West China Medical School, Sichuan University, Chengdu, People’s Republic of China
| | - Huamin Zhao
- West China Medical School, Sichuan University, Chengdu, People’s Republic of China
| | - Tingting Jia
- West China Medical School, Sichuan University, Chengdu, People’s Republic of China
| | - Shiru Yang
- West China Medical School, Sichuan University, Chengdu, People’s Republic of China
| | - Xiaoyu Wang
- Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, People’s Republic of China
- West China Medical School, Sichuan University, Chengdu, People’s Republic of China
- Correspondence: Xiaoyu Wang, Tel +86 18980605160, Email
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4
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Gao Z, Gu J. Surgical treatment of locally recurrent rectal cancer: a narrative review. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:1026. [PMID: 34277826 PMCID: PMC8267292 DOI: 10.21037/atm-21-2298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022]
Abstract
Objective To summarize the recent literature on surgical treatment of locally recurrent rectal cancer (LRRC). Background LRRC is a heterogeneous disease that requires a multidisciplinary treatment approach. The treatment and prognosis depend on the site and type of recurrence. Radical resection remains the primary method for achieving long-term survival and improving symptom control. Preoperative chemoradiotherapy can reduce tumor volume and improve the R0 resection rate. Surgeons must clearly understand pelvic anatomy, develop a detailed preoperative plan, adopt a multidisciplinary approach for the surgical resection of the tumor as well as any invaded soft tissues, vessels, and bones, and ensure proper reconstruction. However, extended radical surgery often leads to a higher risk of postoperative complications and a low quality of life. Methods We searched English-language articles with keywords “locally recurrent rectal cancer”, “surgery” and “multidisciplinary team” in PubMed published between January 2000 to October 2020. Conclusions LRRC is a complex problem. Long-term survival is not impossible following multidisciplinary treatment in appropriately selected LRRC patients. The management of LRRC relies on a specialist team that determines the biological behavior of the tumor and evaluates treatment options through multidisciplinary discussions, thereby balancing the surgical costs and benefits, alleviating postoperative complications, and improving patients’ quality of life.
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Affiliation(s)
- Zhaoya Gao
- Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, China
| | - Jin Gu
- Department of Gastrointestinal Surgery, Peking University Shougang Hospital, Beijing, China.,Department of Gastrointestinal Surgery III, Peking University Cancer Hospital, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China
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5
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Farhat W, Azzaza M, Mizouni A, Ammar H, ben Ltaifa M, Lagha S, Kahloul M, Gupta R, Mabrouk MB, Ali AB. Factors predicting recurrence after curative resection for rectal cancer: a 16-year study. World J Surg Oncol 2019; 17:173. [PMID: 31660992 PMCID: PMC6819540 DOI: 10.1186/s12957-019-1718-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 10/03/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The recurrence after curative surgery of the rectal adenocarcinoma is a serious complication, considered as a failure of the therapeutic strategy. The aim of this study was to identify the different prognostic factors affecting the recurrence of adenocarcinoma of the rectum. METHODS A retrospective analysis of patients operated for adenocarcinoma of the rectum between January 2000 and December 2015 was conducted. The study of the recurrence rate and prognostic factors was performed through the Kaplan Meier survival curve and the Cox regression analysis. RESULTS During the study period, 188 patients underwent curative surgery for rectal adenocarcinoma, among which 53 had a recurrence. The recurrence rate was 44.6% at 5 years. The multivariate analysis identified four parameters independently associated with the risk of recurrence after curative surgery: a distal margin ≤ 2 cm (HR = 6.8, 95% CI 2.7-16.6, 6), extracapsular invasion of lymph node metastasis (HR = 4.4, 95% CI 1.3-14), tumor stenosis (HR = 4.3, 95% CI 1.2-15.2), and parietal invasion (pT3/T4 disease) (HR = 3, 95% CI 1.1-9.4). CONCLUSION The determination of the prognostic factors affecting the recurrence of rectal adenocarcinoma after curative surgery allows us to define the high-risk patients for recurrence. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03899870 . Registered on 2 February 2019, retrospectively registered.
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Affiliation(s)
- Waad Farhat
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Azzaza
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Abdelkader Mizouni
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Houssem Ammar
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mahdi ben Ltaifa
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Sami Lagha
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
| | - Mohamed Kahloul
- Department of Anesthesia and Intensive Care, Sahloul Hospital, Sousse, Tunisia
| | - Rahul Gupta
- Department of Gastrointestinal Surgery, Synergy Institute of Medical Sciences, Dehradun, India
| | | | - Ali Ben Ali
- Department of Gastrointestinal Surgery, Sahloul Hospital, Sousse, Tunisia
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6
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Manenti A, Roncati L, Salati M, Simonini E, Zizzo M, Farinetti A. Rectal cancer restaging after neoadjuvant chemoradiation: towards a down-staging score system. J Gastrointest Oncol 2017; 8:187-188. [PMID: 28280623 DOI: 10.21037/jgo.2016.10.04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Antonio Manenti
- Department of Surgery, Policlinico Hospital, University of Modena, Modena, Italy
| | - Luca Roncati
- Department of Pathology, Policlinico Hospital, University of Modena, Modena, Italy
| | - Massimiliano Salati
- Department of Oncology, Policlinico Hospital, University of Modena, Modena, Italy
| | - Emilio Simonini
- Department of Radiology, Policlinico Hospital, University of Modena, Modena, Italy
| | - Maurizio Zizzo
- Department of Surgery, Policlinico Hospital, University of Modena, Modena, Italy
| | - Alberto Farinetti
- Department of Surgery, Policlinico Hospital, University of Modena, Modena, Italy
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7
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Imran J, Yao JJ, Madni T, Huerta S. Current Concepts on the Distal Margin of Resection of Rectal Cancer Tumors after Neoadjuvant Chemoradiation. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0343-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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8
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Landi F, Espín E, Rodrigues V, Vallribera F, Martinez A, Charpy C, Brunetti F, Azoulay D, de'Angelis N. Pathologic response grade after long-course neoadjuvant chemoradiation does not influence morbidity in locally advanced mid-low rectal cancer resected by laparoscopy. Int J Colorectal Dis 2017; 32:255-264. [PMID: 27757541 DOI: 10.1007/s00384-016-2685-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/11/2016] [Indexed: 02/04/2023]
Abstract
PURPOSE Patients with locally advanced rectal cancer and pathologic complete response to neoadjuvant chemoradiation therapy have lower rates of recurrence compared to those who do not. However, the influences of the pathologic response on surgical complications and survival remain unclear. This study aimed to investigate the influence of neoadjuvant therapy for rectal cancer on postoperative morbidity and long-term survival. METHODS This was a comparative study of consecutive patients who underwent laparoscopic total mesorectal excision for rectal cancer in two European tertiary hospitals between 2004 and 2014. Patients with and without pathologic complete responses were compared in terms of postoperative morbidity, mortality, and survival. RESULTS Fifty patients with complete response (ypT0N0) were compared with 141 patients who exhibited non-complete response. No group differences were observed in the postoperative mortality or morbidity rates. The median follow-up time was 57 months (range 1-121). Over this period, 11 (5.8 %) patients, all of whom were in the non-complete response group, exhibited local recurrence. The 5-year overall survival and disease-free survival were significantly better in the complete response group, 92.5 vs. 75.3 % (p = 0.004) and 89 vs. 73.4 % (p = 0.002), respectively. CONCLUSIONS Postoperative complication rate after laparoscopic total mesorectal excision is not associated with the pathologic response grade to neoadjuvant chemoradiation therapy.
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Affiliation(s)
- Filippo Landi
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France. .,Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain. .,Universidad Autonoma de Barcelona UAB, Barcelona, Spain.
| | - Eloy Espín
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Universidad Autonoma de Barcelona UAB, Barcelona, Spain
| | - Victor Rodrigues
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Universidad Autonoma de Barcelona UAB, Barcelona, Spain
| | - Francesc Vallribera
- Unit of Colorectal Surgery, Department of General and Digestive Surgery, Vall d'Hebron University Hospital, Barcelona, Spain.,Universidad Autonoma de Barcelona UAB, Barcelona, Spain
| | - Aleix Martinez
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Cecile Charpy
- Department of Pathology. Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, Creteil, France
| | - Francesco Brunetti
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Daniel Azoulay
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
| | - Nicola de'Angelis
- Department of Digestive, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Henri Mondor Hospital, AP-HP, Université Paris Est, UPEC, 51 Avenue du Maréchal de Lattre de Tassigny, 94010, Creteil, France
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9
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Glynne-Jones R, Hughes R. Current Status of the Watch-and-Wait Policy for Patients with Complete Clinical Response Following Neoadjuvant Chemoradiation in Rectal Cancer. CURRENT COLORECTAL CANCER REPORTS 2017. [DOI: 10.1007/s11888-017-0344-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Gómez Del Pulgar T, Cebrián A, Fernández-Aceñero MJ, Borrero-Palacios A, Del Puerto-Nevado L, Martínez-Useros J, Marín-Arango JP, Caramés C, Vega-Bravo R, Rodríguez-Remírez M, Cruz-Ramos M, Manzarbeitia F, García-Foncillas J. Focal adhesion kinase: predictor of tumour response and risk factor for recurrence after neoadjuvant chemoradiation in rectal cancer. J Cell Mol Med 2016; 20:1729-36. [PMID: 27171907 PMCID: PMC4988282 DOI: 10.1111/jcmm.12879] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 03/21/2016] [Indexed: 12/28/2022] Open
Abstract
Rectal cancer represents about 30% of colorectal cancers, being around 50% locally advanced at presentation. Chemoradiation (CRT) followed by total mesorectal excision is the standard of care for these locally advanced stages. However, it is not free of adverse effects and toxicity and the complete pathologic response rate is between 10% and 30%. This makes it extremely important to define factors that can predict response to this therapy. Focal adhesion kinase (FAK) expression has been correlated with worse prognosis in several tumours and its possible involvement in cancer radio‐ and chemosensitivity has been suggested; however, its role in rectal cancer has not been analysed yet. To analyse the association of FAK expression with tumour response to CRT in locally advanced rectal cancer. This study includes 73 patients with locally advanced rectal cancer receiving standard neoadjuvant CRT followed by total mesorectal excision. Focal adhesion kinase protein levels were immunohistochemically analysed in the pre‐treatment biopsies of these patients and correlated with tumour response to CRT and patients survival. Low FAK expression was significantly correlated with local and distant recurrence (P = 0.013). Low FAK expression was found to be a predictive marker of tumour response to neoadjuvant therapy (P = 0.007) and patients whose tumours did not express FAK showed a strong association with lower disease‐free survival (P = 0.01). Focal adhesion kinase expression predicts neoadjuvant CRT response in rectal cancer patients and it is a clinically relevant risk factor for local and distant recurrence.
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Affiliation(s)
- Teresa Gómez Del Pulgar
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Arancha Cebrián
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Maria Jesús Fernández-Aceñero
- Pathology Department, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Aurea Borrero-Palacios
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Laura Del Puerto-Nevado
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Javier Martínez-Useros
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Juan Pablo Marín-Arango
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Cristina Caramés
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Ricardo Vega-Bravo
- Pathology Department, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - María Rodríguez-Remírez
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Marlid Cruz-Ramos
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Félix Manzarbeitia
- Pathology Department, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
| | - Jesús García-Foncillas
- Translational Oncology Division, Oncohealth Institute, Health Research Institute FJD-UAM, University Hospital "Fundacion Jimenez Diaz", Madrid, Spain
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11
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Manenti A, Bonetti LR, Farinetti A, Sani F. The lymphatic anatomy of the mesorectum helps to understand rectal cancer recurrence. Am J Surg 2016; 212:800. [PMID: 27156188 DOI: 10.1016/j.amjsurg.2015.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Accepted: 11/30/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Antonio Manenti
- Departments of Surgery, Pathology and Radiology, University of Modena, Modena, Italy.
| | - Luca Reggiani Bonetti
- Departments of Surgery, Pathology and Radiology, University of Modena, Modena, Italy
| | - Alberto Farinetti
- Departments of Surgery, Pathology and Radiology, University of Modena, Modena, Italy
| | - Francesco Sani
- Departments of Surgery, Pathology and Radiology, University of Modena, Modena, Italy
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12
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Akiyoshi T, Nagata J, Nagasaki T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M. Laparoscopic salvage lateral pelvic lymph node dissection for locally recurrent rectal cancer. Colorectal Dis 2015; 17:O213-6. [PMID: 26277783 DOI: 10.1111/codi.13088] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 05/22/2015] [Indexed: 12/13/2022]
Abstract
AIM The lateral pelvic lymph nodes are one of the major sites and sources of local recurrence (LR) after surgery for rectal cancer. Salvage lateral pelvic lymph node dissection (LPLD) is potentially curative, but the value of laparoscopic surgery in such cases is unknown. Our aim was to report the technical details of laparoscopic salvage LPLD for LR at these nodes after rectal cancer surgery. METHOD The study was based on nine patients who underwent laparoscopic salvage LPLD for LR at the lateral pelvic lymph nodes after surgery for rectal cancer. The safety and feasibility of this procedure were determined. RESULTS The median operation time was 381 min and the median estimated blood loss was 130 ml. There were no conversions. Adjacent structures removed en bloc were the pelvic plexus in four patients, the internal iliac artery in seven patients and the seminal vesicle in one patient. The median number of metastatic lymph nodes was 1 (range 1-11). CONCLUSION Our novel technique of laparoscopic salvage LPLD for LR at the lateral pelvic lymph nodes is safe and feasible.
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Affiliation(s)
- T Akiyoshi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - J Nagata
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Nagasaki
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - T Konishi
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Fujimoto
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - S Nagayama
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Y Fukunaga
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - M Ueno
- Gastroenterological Center, Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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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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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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