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Yeo I, Yoo MW, Park SJ, Moon SK. [Postoperative Imaging Findings of Colorectal Surgery: A Pictorial Essay]. JOURNAL OF THE KOREAN SOCIETY OF RADIOLOGY 2024; 85:727-745. [PMID: 39130784 PMCID: PMC11310425 DOI: 10.3348/jksr.2021.0004n] [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: 12/31/2021] [Revised: 05/29/2023] [Accepted: 12/20/2023] [Indexed: 08/13/2024]
Abstract
Postoperative colorectal imaging studies play an important role in the detection of surgical complications and disease recurrence. In this pictorial essay, we briefly describe methods of surgery, imaging findings of their early and late complications, and postsurgical recurrence of cancer and inflammatory bowel disease.
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Zhou YM, Zang YW, Li ZY, Zhou MW, Wang ZH, Chen ZY, Ding JH, Xiang JB. Conformal sphincteric resection for ultra-low rectal cancer located below the dentate line: A pilot report. Colorectal Dis 2023; 25:2414-2422. [PMID: 37908184 DOI: 10.1111/codi.16776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/15/2023] [Accepted: 09/14/2023] [Indexed: 11/02/2023]
Abstract
AIM Sphincter-sparing surgery can be achieved in most cases of low rectal cancer with the development of intersphincteric resection. However, abdominoperineal resection is still inevitable for patients with tumours located below the dentate line. To address this, we have developed a procedure called conformal sphincteric resection (CSR) in which the corresponding part of the subcutaneous portion of the external anal sphincter and the perianal skin on the tumour side is removed to achieve a safe distal resection margin and lateral resection margin while the dentate line and the internal anal sphincter on the tumour-free side are preserved as much as possible, to achieve sphincter preservation without compromising oncological safety and functional acceptability, and to render tumour location no longer a contraindication for sphincter-sparing surgery. This is the first study to describe the concept, indication and surgical procedure of CSR and to report its preliminary surgical, oncological and functional results. METHODS This is a retrospective, single-centre, single-arm pilot study conducted at Huashan Hospital, Fudan University. Demographic, clinicopathological, oncological and functional follow-up data were collected from 20 consecutive patients with rectal tumours located below the dentate line who underwent laparoscopic CSR by the same surgical team from June 2018 to March 2022. RESULTS The mean distance of the tumour's lower edge from the anal verge was 13.1 ± 6.0 mm. The mean distal resection margin was 10.6 ± 4.3 mm. All circumferential resection margins were negative. There were no instances of perioperative mortality. The complication rate was 25% but all were Clavien-Dindo Grade I. Among the 20 cases, 17 were diagnosed with adenocarcinoma, one with squamous cell carcinoma and two with adenoma featuring high-grade intraepithelial neoplasia. Pathological TNM staging revealed two, seven, five, five and one case(s) in Stages 0, I, II, III and IV, respectively. The median follow-up period was 20 months (interquartile range 22 months), with no withdrawals. The overall and disease-free survival rates were both 95%. The mean Wexner incontinence score and low anterior resection syndrome score recorded 18 months following diverting ileostomy closure were 6.3 ± 3.8 and 27.3 ± 3.6, respectively. CONCLUSIONS This study has proposed the CSR procedure for the first time, which is a technically feasible, oncologically safe and functionally acceptable procedure for carefully selected patients with rectal tumours located below the dentate line.
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Affiliation(s)
- Yi-Ming Zhou
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Yi-Wen Zang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zhen-Yang Li
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Min-Wei Zhou
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zi-Hao Wang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Zong-You Chen
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jian-Hua Ding
- Department of Colorectal Surgery, Characteristic Medical Centre of PLA Rocket Force, Beijing, China
| | - Jian-Bin Xiang
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
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Lee MH, Kim DH. Low Rectal Cancers at Initial Staging MRI. Radiographics 2023; 43:e230080. [PMID: 37796727 DOI: 10.1148/rg.230080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
Low rectal cancers, which are associated with increased risk of local recurrent disease and poorer prognosis, have unique anatomic considerations and issues for staging and treatment that do not apply to mid and high rectal cancers. Although tumor histology help drive the staging and treatment of all rectal cancers, it is of particular importance in low rectal cancers, which may involve the anal canal, to help establish whether a low rectal mass should be staged and treated as a rectal cancer (ie, adenocarcinoma) or an anal cancer (ie, squamous cell carcinoma). Optimal staging and treatment of rectal cancer are contingent on tumor location and local extent, which help guide management decisions including neoadjuvant therapy and curative surgical treatment strategies. Tumor location in the low rectum and local involvement of the anal canal, sphincter, and pelvic floor help determine whether a patient can undergo sphincter-preserving resection such as a low anterior resection versus abdominoperineal resection to achieve negative surgical margins. Issues exist related to the anatomy and patterns of disease spread that are unique to the low rectum and include how to determine and stage anal sphincter involvement, mesorectal fascia status at the pelvic floor, and nodal status of extramesorectal nodes such as the external iliac and inguinal lymph nodes. For these reasons, it is imperative that radiologists who interpret rectal cancer staging MRI examinations feel comfortable with the unique anatomy of the low rectum and anal canal, nuances of low rectal cancer local disease spread, and treatment paradigms for low rectal cancer. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Gollub in this issue.
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Affiliation(s)
- Matthew H Lee
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI 53792
| | - David H Kim
- From the Department of Radiology, University of Wisconsin School of Medicine & Public Health, 600 Highland Ave, Madison, WI 53792
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Zhang M, Zhang Y, Jing H, Zhao L, Xu M, Xu H, Zhu S, Zhang X. Prognosis of Patients Over 60 Years Old With Early Rectal Cancer Undergoing Transanal Endoscopic Microsurgery – A Single-Center Experience. Front Oncol 2022; 12:888739. [PMID: 35774121 PMCID: PMC9239430 DOI: 10.3389/fonc.2022.888739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/12/2022] [Indexed: 11/13/2022] Open
Abstract
AimTransanal endoscopic microsurgery (TEM) is widely performed in early rectal cancer. This technique offers greater organ preservation and decreases the risk of subsequent surgery. However, postoperative local recurrence and distant metastasis remain challenges for patients with high-risk pathological factors. This single-center study reports the prognosis of early rectal cancer patients over 60 years old after TEM.MethodsThe data of the patients over 60 years old who underwent local anal resection were collected retrospectively. Moreover, the 5-year follow-up data were analyzed to determine the 5-year DFS and OS.Results47 early rectal cancer patients over 60 years old underwent TEM. There were 27 patients with high-risk factors and 20 patients without high-risk factors. Two patients underwent radical surgery after TEM and ten patients received adjuvant treatment. Local recurrence occurred in 7 patients, of which 4 underwent salvage surgery. The 5-year progression-free survival rate was 75.6%, which was lower in the high-risk patients group (69.6%) than in the non-high-risk patients group (83.3%) (P>0.05). The 5-year OS was 90.2%, but there was no statistically significant difference between the two groups (high-risk patients 87.0%, non-high-risk patients 94.4%). Furthermore, there was no significant difference in DFS and OS between people over and under 70 years old.ConclusionSome high-risk factor patients over 60 years old do not have inferior 5-year DFS and OS to the non-high-risk patients. TEM is an option for old patients with high surgical risks. Even if postoperative pathology revealed high-risk factors, timely surgical treatment after local recurrence would be beneficial to improve the 5-year DFS and OS.
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Affiliation(s)
- Mingqing Zhang
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
| | - Yongdan Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Haoren Jing
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Lizhong Zhao
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Mingyue Xu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Hui Xu
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
| | - Siwei Zhu
- Nankai University School of Medicine, Nankai University, Tianjin, China
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- *Correspondence: Siwei Zhu, ; Xipeng Zhang,
| | - Xipeng Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China
- Colorectal Cancer Screening Office, Tianjin Institute of Coloproctology, Tianjin, China
- The Institute of Translational Medicine, Tianjin Union Medical Center of Nankai University, Tianjin, China
- *Correspondence: Siwei Zhu, ; Xipeng Zhang,
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Cheah WH. Pictorial essay on MRI local staging of rectal carcinoma: An easy approach. Asia Pac J Clin Oncol 2022; 19:e80-e88. [PMID: 35437926 DOI: 10.1111/ajco.13782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 01/20/2022] [Accepted: 03/21/2022] [Indexed: 11/27/2022]
Abstract
Rectal cancer is common and accounts for more than one-third of colorectal tumors. It is associated with significant morbidity and mortality. Previously computed tomography scan is the key imaging modality in preoperative assessment to detect local invasion and distant metastasis. However, the advent of magnetic resonance imaging (MRI) has aided in local staging and prognosticates the outcome of rectal tumor. Here, the author briefly explains why rectal MRI has a comprehensive role and provides a simple and easy way in reporting an MRI rectal carcinoma, even for a non-radiologist.
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Affiliation(s)
- Wai-Hun Cheah
- Faculty of Medicine, Universiti Sultan Zainal Abidin, Kuala Terengganu, Malaysia
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Ou W, Wu X, Zhuang J, Yang Y, Zhang Y, Liu X, Guan G. Clinical efficacy of different approaches for laparoscopic intersphincteric resection of low rectal cancer: a comparison study. World J Surg Oncol 2022; 20:43. [PMID: 35193605 PMCID: PMC8862381 DOI: 10.1186/s12957-022-02521-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 02/14/2022] [Indexed: 11/26/2022] Open
Abstract
Background The operative results of different approaches for the laparoscopic intersphincteric resection (LAISR) of low rectal cancer vary, and the patient characteristics associated with the best outcomes for each procedure have not been reported. We compared the efficacy of different approaches for LAISR of low rectal cancer and discussed the surgical indications for each approach. Methods We retrospectively reviewed data from 235 patients with low rectal cancer treated via LAISR from October 2010 to September 2016. Patients underwent either the transabdominal approach for ISR (TAISR, n = 142), the transabdominal perineal approach for ISR (TPAISR, n = 57), or the transanal pull-through approach for ISR (PAISR, n = 36). Results The PAISR and TAISR groups exhibited shorter operation times and less intraoperative blood loss than the TPAISR group. The anastomotic distance was shorter in the PAISR and TPAISR groups than in the TAISR group. No differences in the ability to perform radical resection, overall complications, postoperative recovery, Wexner score recorded 12 months after ostomy closure, 3-year disease-free survival, local recurrence-free survival, distant metastasis-free survival, or overall survival (OS) were observed among the three groups. Conclusions TAISR, TPAISR, and PAISR have unique advantages and do not differ in terms of operation safety, patient outcomes, or anal function. TPAISR requires a longer time to complete and is associated with more bleeding and a slower recovery of anal function. PAISR should be considered when TAISR cannot ensure a negative distal margin and the tumor and BMI are relatively small; otherwise, TPAISR is required.
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Affiliation(s)
- Wenquan Ou
- Department of General Surgery, Affiliated Nanping First Hospital, Fujian Medical University, 317 Zhongshan Road, Nanping, 353000, Fujian, China
| | - Xiaohua Wu
- Department of General Surgery, Affiliated Nanping First Hospital, Fujian Medical University, 317 Zhongshan Road, Nanping, 353000, Fujian, China
| | - Jinfu Zhuang
- Department of Colorectal Surgery, Affiliated First Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Yuanfeng Yang
- Department of Colorectal Surgery, Affiliated First Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Yiyi Zhang
- Department of Colorectal Surgery, Affiliated First Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China
| | - Xing Liu
- Department of Colorectal Surgery, Affiliated First Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China. .,Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
| | - Guoxian Guan
- Department of Colorectal Surgery, Affiliated First Hospital, Fujian Medical University, 20 Chazhong Road, Fuzhou, 350005, Fujian, China. .,Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fujian Medical University, 29 Xinquan Road, Fuzhou, 350001, Fujian, China.
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Zhu P, Lu Z, Miao W, Li M, Cui L. A Multivariate Analysis of Anastomotic Stenosis After Anterior Resection for Rectal Carcinoma. Indian J Surg 2022. [DOI: 10.1007/s12262-021-03201-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Quezada-Diaz FF, Smith JJ. Options for Low Rectal Cancer: Robotic Total Mesorectal Excision. Clin Colon Rectal Surg 2021; 34:311-316. [PMID: 34512198 DOI: 10.1055/s-0041-1726449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Low rectal cancers (LRCs) may offer a difficult technical challenge even to experienced colorectal surgeons. Although laparoscopic surgery offers a superior exposure of the pelvis when compared with open approach, its role in rectal cancer surgery has been controversial. Robotic platforms are well suited for difficult pelvic surgery due to its three-dimensional visualization, degree of articulation of instruments, precise movements, and better ergonomics. The robot may be suitable especially in the anatomically narrow pelvis such as in male and obese patients. Meticulous dissection in critical steps, such as splenic flexure takedown, nerve-sparing mesorectal excision, and distal margin clearance, are potential technical advantages. In addition, robotic rectal resections are associated with lower conversion rates to open surgery, less blood loss, and shorter learning curve with similar short-term quality of life outcomes, similar rates of postoperative complications, and equivalent short-term surrogate outcomes compared with conventional laparoscopy. Robotic surgery approach, if used correctly, can enhance the skills and the capabilities of the well-trained surgeon during minimally invasive procedures for LRC.
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Affiliation(s)
- Felipe F Quezada-Diaz
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York
| | - J Joshua Smith
- Department of Surgery, Colorectal Service, Memorial Sloan Kettering Cancer Center, New York, New York
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Hudson D, Entriken F, Hodder R, Warner M. Functional outcomes and local control are acceptable following hand-sewn colo-anal anastomoses for rectal cancer: Results of long-term follow-up. ANZ J Surg 2021; 92:390-396. [PMID: 34405511 DOI: 10.1111/ans.16968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/10/2021] [Accepted: 05/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rectal cancer that grows so close to the anal canal that an adequate distal margin cannot be achieved with a double-stapled anastomosis (DSA) has been managed with abdominoperineal resection. Inter-sphincteric dissection and hand-sewn colo-anal anastomoses (HSCAA) allows anastomosis in some cases where DSA is impossible. There are concerns that HSCAA may lead to complications, local recurrence and poor continence. Our aim was to assess our experience with HSCAA in terms of recurrence, complications, continence and quality of life. METHODS Consecutive patients at two metropolitan hospitals who underwent an ultra-low anterior resection with hand-sewn colo-anal anastomoses for low rectal cancer during a 10-year period were asked to complete a questionnaire which allowed continence and quality-of-life scores to be calculated. Recurrence and complication rates were obtained from a retrospective medical record review. RESULTS A total of 26 patients underwent HSCAA. Six patients were not sent a questionnaire (3 deaths, 1 with ileostomy, 1 with ileostomy reversal within 3 months and one who had transferred care to another hospital). Fifteen patients returned questionnaires. Local recurrence occurred in zero cases. Two developed systemic recurrence. Four patients developed anastomotic stricture and three had anastomotic leak. Median Faecal Incontinence Severity Index score was 28 and median FIQoL scores were 3.00, 2.78, 3.86 and 3.00. One patient wished that they had had a permanent stoma rather than anastomosis. CONCLUSION HSCAA delivered good local control of rectal cancer and high avoidance of permanent stoma. Faecal continence is impaired; however, the results are acceptable to the majority of patients.
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Affiliation(s)
- David Hudson
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Fiona Entriken
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Rupert Hodder
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Michael Warner
- Department of General Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Department of General Surgery, Hollywood Private Hospital, Perth, Western Australia, Australia
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Lemini R, Jabbal IS, Stanek K, Borkar SR, Spaulding AC, Kelley SR, Colibaseanu DT. Permanent stoma: a quality outcome in treatment of rectal cancer and its impact on length of stay. BMC Surg 2021; 21:163. [PMID: 33765978 PMCID: PMC7993534 DOI: 10.1186/s12893-021-01166-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 03/17/2021] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND This study aimed to identify socioeconomic predictors of permanent stoma in rectal cancer treatment and examine its association with length of stay at the treatment facility. METHODS Rectal cancer patients who underwent elective surgery between January 2015 and December 2018 were identified from the Agency for Health Care Administration Florida Hospital Inpatient Discharge Dataset. Multivariate regression models were utilized to identify demographic and socioeconomic factors associated with receiving a permanent stoma as well as the associated length of stay of these patients. RESULTS Of 2630 rectal cancer patients who underwent surgery for rectal cancer, 21% had a permanent stoma. The odds of receiving permanent stoma increased with higher Elixhauser score, metastatic disease, advanced age, having open surgery, residence in Southwest Florida, and having Medicaid insurance or no insurance/self-payers (p < 0.05). Patients with a permanent stoma had a significantly extended stay after surgery (p < 0.001). CONCLUSIONS Patients with a permanent stoma following cancer resection were more likely to have open surgery, had more comorbidities, and had a longer length of stay. Having permanent stoma was higher in patients living in South West Florida, patients with Medicaid insurance, and in the uninsured. Additionally, the payer type significantly affected the length of stay.
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Affiliation(s)
- Riccardo Lemini
- Division of Colon and Rectal Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Iktej S Jabbal
- Division of Colon and Rectal Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Krystof Stanek
- Division of Colon and Rectal Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA
| | - Shalmali R Borkar
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Aaron C Spaulding
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dorin T Colibaseanu
- Division of Colon and Rectal Surgery, Mayo Clinic, 4500 San Pablo Rd, Jacksonville, FL, 32224, USA.
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Campelo P, Barbosa E. Functional outcome and quality of life following treatment for rectal cancer. JOURNAL OF COLOPROCTOLOGY 2021. [DOI: 10.1016/j.jcol.2016.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Abstract
Introduction Over the last decades, treatment for rectal cancer has substantially improved with development of new surgical options and treatment modalities. With the improvement of survival, functional outcome and quality of life are getting more attention.
Study objective To provide an overview of current modalities in rectal cancer treatment, with particular emphasis on functional outcomes and quality of life.
Results Functional outcomes after rectal cancer treatment are influenced by patient and tumor characteristics, surgical technique, the use of preoperative radiotherapy and the method and level of anastomosis. Sphincter preserving surgery for low rectal cancer often results in poor functional outcomes that impair quality of life, referred to as low anterior resection syndrome. Abdominoperineal resection imposes the need for a permanent stoma but avoids the risk of this syndrome. Contrary to general belief, long-term quality of life in patients with a permanent stoma is similar to those after sphincter preserving surgery for low rectal cancer.
Conclusion All patients should be informed about the risks of treatment modalities. Decision on rectal cancer treatment should be individualized since not all patients may benefit from a sphincter preserving surgery “at any price”. Non-resection treatment should be the future focus to avoid the need of a permanent stoma and bowel dysfunction.
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Affiliation(s)
- Pedro Campelo
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
| | - Elisabete Barbosa
- Universidade do Porto, Faculdade de Medicina, Porto, Portugal
- Centro Hospitalar São João, Departamento de Cirurgia Colorretal, Porto, Portugal
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Toyoshima A, Nishizawa T, Sunami E, Akai R, Amano T, Yamashita A, Sasaki S, Endo T, Moriya Y, Toyoshima O. Narrow pelvic inlet plane area and obesity as risk factors for anastomotic leakage after intersphincteric resection. World J Gastrointest Surg 2020; 12:425-434. [PMID: 33194091 PMCID: PMC7642346 DOI: 10.4240/wjgs.v12.i10.425] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/12/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Intersphincteric resection (ISR) has been increasingly used as the ultimate sphincter-preserving procedure in extremely low rectal cancer. The most critical complication of this technique is anastomotic leakage. The incidence rate of anastomotic leakage after ISR has been reported to range from 5.1% to 20%.
AIM To investigate risk factors for anastomotic leakage after ISR based on clinicopathological variables and pelvimetry.
METHODS This study was conducted at Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo, Japan, with a total of 117 patients. We enrolled 117 patients with extremely low rectal cancer who underwent laparotomic and laparoscopic ISRs at our hospital. We conducted retrospective univariate and multivariate regression analyses on 33 items to elucidate the risk factors for anastomotic leakage after ISR. Pelvic dimensions were measured using three-dimensional reconstruction of computed tomography images. The optimal cutoff value of the pelvic inlet plane area that predicts anastomotic leakage was determined using a receiver operating characteristic (ROC) curve.
RESULTS We observed anastomotic leakage in 10 (8.5%) of the 117 patients. In the multivariate analysis, we identified high body mass index (odds ratio 1.674; 95% confidence interval: 1.087-2.58; P = 0.019) and smaller pelvic inlet plane area (odds ratio 0.998; 95% confidence interval: 0.997-0.999; P = 0.012) as statistically significant risk factors for anastomotic leakage. According to the receiver operating characteristic curves, the optimal cutoff value of the pelvic inlet plane area was 10074 mm2. Narrow pelvic inlet plane area (≤ 10074 mm2) predicted anastomotic leakage with a sensitivity of 90%, a specificity of 85.9%, and an accuracy of 86.3%.
CONCLUSION Narrow pelvic inlet and obesity were independent risk factors for anastomotic leakage after ISR. Anastomotic leakage after ISR may be predicted from a narrow pelvic inlet plane area (≤ 10074 mm2).
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Affiliation(s)
- Akira Toyoshima
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
| | - Toshihiro Nishizawa
- Department of Gastroenterology, International University of Health and Welfare, Narita Hospital, Narita 286-8520, Japan
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
| | - Eiji Sunami
- Department of Surgery, The University of Kyorin, Tokyo 113-8655, Japan
| | - Ryuji Akai
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
| | - Takahiro Amano
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
| | - Akiyoshi Yamashita
- Department of Radiology, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
| | - Shin Sasaki
- Department of Colorectal Surgery, Japanese Red Cross Medical Center, Tokyo 150-8935, Japan
| | | | | | - Osamu Toyoshima
- Department of Gastroenterology, Toyoshima Endoscopy Clinic, Tokyo 157-0066, Japan
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Sun G, Lou Z, Zhang H, Yu GY, Zheng K, Gao XH, Meng RG, Gong HF, Furnée EJB, Bai CG, Zhang W. Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer. Tech Coloproctol 2020; 24:1025-1034. [PMID: 32361871 PMCID: PMC7522072 DOI: 10.1007/s10151-020-02229-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 04/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4-5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. METHODS Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. RESULTS A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3-4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3-0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12-45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. CONCLUSIONS For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.
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Affiliation(s)
- G Sun
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Z Lou
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - H Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - G Y Yu
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - K Zheng
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - X H Gao
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - R G Meng
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - H F Gong
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China
| | - E J B Furnée
- Department of Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - C G Bai
- Department of Pathology, Changhai Hospital, Shanghai, China
| | - W Zhang
- Department of Colorectal Surgery, Changhai Hospital, 168 Changhai Rd, Shanghai, 200433, China.
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14
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Ivatury SJ, Kang R, Goldwag JL, Wilson MZ. Restorative reconstruction after total mesorectal excision for rectal cancer is associated with significant bowel dysfunction from initial presentation. Surg Open Sci 2020; 3:29-33. [PMID: 33554098 PMCID: PMC7848764 DOI: 10.1016/j.sopen.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/18/2020] [Accepted: 08/24/2020] [Indexed: 02/07/2023] Open
Abstract
Background Patients often desire restorative reconstruction following total mesorectal excision. Reconstruction has become synonymous with providing high-quality rectal cancer care. However, the bowel functional outcomes of restoration from presentation are unknown. We aimed to evaluate the bowel functional effects of rectal cancer treatment from presentation through surveillance. Methods This was a retrospective cohort study from 2014 to 2019 using prospectively collected data. Patients underwent treatment for rectal adenocarcinoma including restorative reconstruction. Patients completed the validated Colorectal Functional Outcome questionnaire during clinic visits (1) at presentation, (2) after neoadjuvant therapy, (3) after restoration of continuity, and (4) at surveillance. Scores range from 0 to 100 with a higher score indicating worse bowel function. Results Sixty-eight patients (age: 62 ± 12 years, 40% female) were included. The mean tumor height was 7 ± 4 cm with 85% symptomatic. Bowel function did not worsen from presentation to after neoadjuvant therapy in Total Colorectal Functional Outcome and most domain scores; there was improvement in frequency and stool-related aspects. Bowel function worsened in all scores from after neoadjuvant to restoration of continuity (mean anastomotic height: 5 ± 2 cm); there were similar findings between presentation and restoration of continuity. At surveillance, there was improvement in most domains compared with restoration of continuity. There remained significant worsening of incontinence, social impact, and need for medication scores at surveillance compared with presentation. Conclusion Restorative reconstruction after total mesorectal excision is associated with significant bowel dysfunction. For some patients, restorative reconstruction may not be high-quality rectal cancer care.
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Affiliation(s)
- Srinivas J Ivatury
- Dartmouth-Hitchcock Medical Center, Lebanon, NH.,Geisel School of Medicine, Hanover, NH
| | - Ravinder Kang
- Dartmouth-Hitchcock Medical Center, Lebanon, NH.,Geisel School of Medicine, Hanover, NH
| | - Jenaya L Goldwag
- Dartmouth-Hitchcock Medical Center, Lebanon, NH.,Geisel School of Medicine, Hanover, NH
| | - Matthew Z Wilson
- Dartmouth-Hitchcock Medical Center, Lebanon, NH.,Geisel School of Medicine, Hanover, NH
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15
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Santiago I, Figueiredo N, Parés O, Matos C. MRI of rectal cancer-relevant anatomy and staging key points. Insights Imaging 2020; 11:100. [PMID: 32880782 PMCID: PMC7471246 DOI: 10.1186/s13244-020-00890-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 06/26/2020] [Indexed: 02/14/2023] Open
Abstract
Rectal cancer has the eighth highest cancer incidence worldwide, and it is increasing in young individuals. However, in countries with a high human development index, mortality is decreasing, which may reflect better patient management, imaging being key. We rely on imaging to establish the great majority of clinical tumour features for therapeutic decision-making, namely tumour location, depth of invasion, lymph node involvement, circumferential resection margin status and extramural venous invasion. Despite major improvements in technique resulting in better image quality, and notwithstanding the dissemination of guidelines and examples of standardised reports, rectal cancer staging is still challenging on the day-to-day practice, and we believe there are three reasons. First, the normal posterior pelvic compartment anatomy and variants are not common knowledge to radiologists; second, not all rectal cancers fit in review paper models, namely the very early, the very low and the mucinous; and third, the key clinical tumour features may be tricky to analyse. In this review, we discuss the normal anatomy of the rectum and posterior compartment of the pelvis, systematise all rectal cancer staging key points and elaborate on the particularities of early, low and mucinous tumours. We also include our suggested reporting templates and a discussion of its comparison to the reporting templates provided by ESGAR and SAR.
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Affiliation(s)
- Inês Santiago
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal. .,Nova Medical School, Campo Mártires da Pátria 130, 1169-056, Lisbon, Portugal. .,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.
| | - Nuno Figueiredo
- Colorectal Surgery, Digestive Unit, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Oriol Parés
- Radiation Oncology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
| | - Celso Matos
- Radiology Department, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal.,Champalimaud Research, Champalimaud Foundation, Avenida Brasília, 1400-038, Lisbon, Portugal
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16
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Peng B, Lu J, Wu Z, Li G, Wei F, Cao J, Li W. Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer: A Meta-Analysis. Surg Innov 2020; 27:392-401. [PMID: 32390544 DOI: 10.1177/1553350620918414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Background. Abdominoperineal resection (APR) has been the standard surgery for ultra-low rectal cancer for a century. In recent years, intersphincteric resection (ISR) has been increasingly used to avoid the permanent colostomy. Up to now, there is no relevant meta-analysis comparing the clinical efficacy of ISR and APR. This meta-analysis aimed to compare the outcomes of these 2 procedures. Methods. A comprehensive search of online databases was performed on PubMed, EMBASE, and the Cochrane Library to obtain comparative studies of ISR and APR. Then the data from studies that met the inclusion criteria were extracted and analyzed. Results. A total of 12 studies covering 2438 patients were included. No significant differences were found between ISR and APR in gender, body mass index, distance from tumor to anal edge, operative time, and blood loss. In addition, hospital stay (weighted mean differences = -2.98 days; 95% confidence interval [CI] = -3.54 to -2.43; P < .00001) and postoperative morbidity (odds ratio [OR] = 0.76; 95% CI = 0.59 to 0.99; P = .04) were significantly lower in ISR group compared with APR group. However, patients who underwent ISR showed lower pathological T-stage (T3T4%, OR = 0.49; 95% CI = 0.28 to 0.86; P = .01) and lymph node metastasis rate (OR = 0.77; 95% CI = 0.59 to 1.01; P = .06) compared with those who underwent APR. Moreover, oncological outcomes were similar between the 2 groups. Conclusion. ISR may provide a safe alternative to APR, with shorter hospital stays, lower postoperative morbidity, and similar oncological outcomes. Well-designed randomized controlled trials are needed to confirm and update the findings of this analysis.
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Affiliation(s)
- Baifu Peng
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiabao Lu
- Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Zixin Wu
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Guanwei Li
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Fang Wei
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Jie Cao
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
| | - Wanglin Li
- Guangzhou First People's Hospital, South China University of Technology, Guangzhou, Guangdong, China
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17
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Comparison of Transanal Minimally Invasive Surgery (TAMIS) and Transanal Endoscopic Operations (TEO). Indian J Surg 2019. [DOI: 10.1007/s12262-019-01943-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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18
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Trends and outcomes of sphincter-preserving surgery for rectal cancer: a national cancer database study. Int J Colorectal Dis 2019; 34:239-245. [PMID: 30280252 DOI: 10.1007/s00384-018-3171-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/25/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE Previous studies have shown that sphincter-preserving surgery is associated with better quality of life in postsurgical rectal cancer patients. However, the factors predicting the likelihood of undergoing sphincter-preserving surgery have not been well-described. The aim of this study was to report the factors that determined the likelihood of undergoing sphincter-preserving surgery. METHODS Characteristics of 24,018 rectal cancer patients undergoing sphincter-preserving surgery and abdominoperineal resection diagnosed from 2008 to 2012 from the National Cancer Database were investigated retrospectively for rate, pattern, and differences in mortality. Cox proportional hazards models were used to calculate hazard ratios for assessing mortality. Odds ratios were calculated using logistic regressions models for outcome sphincter-preserving surgery. RESULTS Eighteen thousand four hundred fifty-two (77%) patients had sphincter-preserving surgery. Majority of sphincter-preserving surgery patients were aged < 70 (74%), had private insurance (52%), and got treatment at a comprehensive community cancer program (54%). Multivariable analysis showed that patients with age ≥ 70 (OR 0.87, 95% CI 0.80-0.95), male gender (OR 0.90, 95% CI 0.84-0.96), having Medicare (OR 0.83, 95% CI 0.76-0.90), Medicaid (OR 0.72, 95% CI 0.63-0.81), and poorly differentiated grade (OR 0.78, 95% CI 0.71-0.85) were less likely to undergo sphincter-preserving surgery. Multivariable analysis showed that patients having abdominoperineal resection have higher likelihood of mortality than sphincter-preserving surgery (HR 1.26, 95% CI 1.16-1.36). CONCLUSIONS We were able to identify several patient and tumor-related factors impacting the likelihood of undergoing sphincter-preserving surgery. Patients undergoing non-sphincter sparing surgery had a higher mortality that sphincter preservation.
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19
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Nacion AJD, Park YY, Yang SY, Kim NK. Critical and Challenging Issues in the Surgical Management of Low-Lying Rectal Cancer. Yonsei Med J 2018; 59:703-716. [PMID: 29978607 PMCID: PMC6037599 DOI: 10.3349/ymj.2018.59.6.703] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 04/18/2018] [Accepted: 05/10/2018] [Indexed: 12/19/2022] Open
Abstract
Despite innovative advancements, the management of distally located rectal cancer (RC) remains a formidable endeavor. The critical location of the tumor predisposes it to a circumferential resection margin that tends to involve the sphincters and surrounding organs, pelvic lymph node metastasis, and anastomotic complications. In this regard, colorectal surgeons should be aware of issues beyond the performance of total mesorectal excision (TME). For decades, abdominoperineal resection had been the standard of care for low-lying RC; however, its association with high rates of tumor recurrence, tumor perforation, and poorer survival has stimulated the development of novel surgical techniques and modifications, such as extralevator abdominoperineal excision. Similarly, difficult dissections and poor visualization, especially in obese patients with low-lying tumors, have led to the development of transanal TME or the "bottom-to-up" approach. Additionally, while neoadjuvant chemoradiotherapy has allowed for the execution of more sphincter-saving procedures without oncologic compromise, functional outcomes remain an issue. Nevertheless, neoadjuvant treatment can lead to significant tumor regression and complete pathological response, permitting the utilization of organ-preserving strategies. At present, an East and West dualism pervades the management of lateral lymph node metastasis, thereby calling for a more global and united approach. Moreover, with the increasing importance of quality of life, a tailored, individualized treatment approach is of utmost importance when taking into account oncologic and anticipated functional outcomes.
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Affiliation(s)
- Aeris Jane D Nacion
- Department of Surgery, Eastern Visayas Medical Center, Tacloban, Philippines
| | - Youn Young Park
- Department of Surgery, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Yoon Yang
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Nam Kyu Kim
- Division of Colorectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.
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20
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Martinez-Useros J, Moreno I, Fernandez-Aceñero MJ, Rodriguez-Remirez M, Borrero-Palacios A, Cebrian A, Gomez del Pulgar T, del Puerto-Nevado L, Li W, Puime-Otin A, Perez N, Soengas MS, Garcia-Foncillas J. The potential predictive value of DEK expression for neoadjuvant chemoradiotherapy response in locally advanced rectal cancer. BMC Cancer 2018; 18:144. [PMID: 29409457 PMCID: PMC5801838 DOI: 10.1186/s12885-018-4048-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 01/24/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Limited data are available regarding the ability of biomarkers to predict complete pathological response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer. Complete response translates to better patient survival. DEK is a transcription factor involved not only in development and progression of different types of cancer, but is also associated with treatment response. This study aims to analyze the role of DEK in complete pathological response following chemoradiotherapy for locally advanced rectal cancer. METHODS Pre-treated tumour samples from 74 locally advanced rectal-cancer patients who received chemoradiation therapy prior to total mesorectal excision were recruited for construction of a tissue microarray. DEK immunoreactivity from all samples was quantified by immunohistochemistry. Then, association between positive stained tumour cells and pathologic response to neoadjuvant treatment was measured to determine optimal predictive power. RESULTS DEK expression was limited to tumour cells located in the rectum. Interestingly, high percentage of tumour cells with DEK positiveness was statistically associated with complete pathological response to neoadjuvant treatment based on radiotherapy and fluoropyrimidine-based chemotherapy and a marked trend toward significance between DEK positiveness and absence of treatment toxicity. Further analysis revealed an association between DEK and the pro-apoptotic factor P38 in the pre-treated rectal cancer biopsies. CONCLUSIONS These data suggest DEK as a potential biomarker of complete pathological response to treatment in locally advanced rectal cancer.
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Affiliation(s)
- J. Martinez-Useros
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - I. Moreno
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | | | - M. Rodriguez-Remirez
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - A. Borrero-Palacios
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - A. Cebrian
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - T. Gomez del Pulgar
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - L. del Puerto-Nevado
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - W. Li
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
| | - A. Puime-Otin
- Department of Pathology, University Hospital “Fundación Jiménez Díaz”-UAM, Madrid, Spain
| | - N. Perez
- Department of Pathology, University Hospital “Fundación Jiménez Díaz”-UAM, Madrid, Spain
| | - M. S. Soengas
- Melanoma Research Group, Spanish National Cancer Research Centre, Madrid, Spain
| | - J. Garcia-Foncillas
- Translational Oncology Division, OncoHealth Institute, Health Research Institute - University Hospital “Fundación Jiménez Díaz”-UAM, Av. Reyes Católicos 2, 28040 Madrid, Spain
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21
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Plummer JM, Leake PA, Albert MR. Recent advances in the management of rectal cancer: No surgery, minimal surgery or minimally invasive surgery. World J Gastrointest Surg 2017; 9:139-148. [PMID: 28690773 PMCID: PMC5483413 DOI: 10.4240/wjgs.v9.i6.139] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 03/06/2017] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Over the last decade, with the acceptance of the need for improvements in the outcome of patients affected with rectal cancer, there has been a significant increase in the literature regarding treatment options available to patients affected by this disease. That treatment related decisions should be made at a high volume multidisciplinary tumor board, after pre-operative rectal magnetic resonance imaging and the importance of total mesorectal excision (TME) are accepted standard of care. More controversial is the emerging role for watchful waiting rather than radical surgery in complete pathologic responders, which may be appropriate in 20% of patients. Patients with early T1 rectal cancers and favorable pathologic features can be cured with local excision only, with transanal minimal invasive surgery (TAMIS) because of its versatility and almost universal availability of the necessary equipment and skillset in the average laparoscopic surgeon, emerging as the leading option. Recent trials have raised concerns about the oncologic outcomes of the standard “top-down” TME hence transanal TME (TaTME “bottom-up”) approach has gained popularity as an alternative. The challenges are many, with a dearth of evidence of the oncologic superiority in the long-term for any given option. However, this review highlights recent advances in the role of chemoradiation only for complete pathologic responders, TAMIS for highly selected early rectal cancer patients and TaTME as options to improve cure rates whilst maintaining quality of life in these patients, while we await the results of further definitive trials being currently conducted.
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