Efficacy of endoscopic surveillance in the detection of local recurrence after radical rectal cancer surgery is limited? A retrospective study

Abstract Background Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical anterior resection with sigmoid-rectal anastomosis. Methods We performed an anterior resection in 228 patients with stages I‑III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with abdominal and pelvic imaging (abdominal ultrasound, computed tomography, magnetic resonance) and clinical examination. Sensitivities, specificities, positive likelihood ratios, negative likelihood ratios, and receiver operating characteristic curves were calculated to compare the value of colonoscopy versus imaging techniques for the diagnosis of LR. Results During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites. In the study group, endoscopy did not provide any additional benefit in patients who were receiving radiation therapy. Conclusions The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited and not superior to imaging techniques. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.

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Efficacy of Endoscopic Surveillance in the Detection of Local Recurrence After Radical Rectal Cancer Surgery is Limited: A Retrospective Study.

10.21203/rs.3.rs-163782/v1 ◽

2021 ◽

Author(s):

Michal Jankowski ◽

Wojciech M. Wysocki ◽

Karol Tkaczyński ◽

Dorian Wiśniewski ◽

Manuela Las-Jankowska ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Likelihood Ratio ◽

Positive Likelihood Ratio ◽

Negative Likelihood Ratio ◽

Endoscopic Surveillance ◽

Intestinal Lumen ◽

Rectal Cancer Surgery ◽

Pelvic Magnetic Resonance Imaging ◽

Initial Surgery

Abstract Background: Rectal cancer, one of most common neoplasms, is characterized by an overall survival rate exceeding 60%. Nonetheless, local recurrence (LR) following surgery for rectal cancer remains a formidable clinical problem. The aim of this study was to assess the value of postoperative endoscopic surveillance (PES) for the early detection of LR in rectal cancer after radical treatment.Methods: We performed an anterior resection in 228 patients with stage I-III rectal cancer who had undergone surgery from 2001 to 2008 in the Oncology Center in Bydgoszcz, Poland. Of these patients, 169 had perioperative radiotherapy or radiochemotherapy. All patients underwent PES with imaging (abdominal ultrasound or computed tomography scan, pelvic magnetic resonance imaging) and endoscopic examinations. The ratios of sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and receiver operating characteristic curve were calculated to compare the diagnostic value of colonoscopy versus imaging techniques. Results: During the 5-year follow-up, recurrences occurred in 49 (21%) patients; of these, 15 (6%) had LR, which was most often located outside the intestinal lumen (n = 10, 4%). Anastomotic LR occurred in 5 (2%) patients. The mean time to anastomotic LR was 30 months after initial surgery, similar to that of other locations (29 months). Both imaging and endoscopy were shown to be efficient techniques for the diagnosis of LR in anastomotic sites, and endoscopy did not provide any additional benefit in patients who were receiving radiation therapy.Conclusions: The benefit of PES for the detection of LR after curative treatment of rectal cancer is limited. It remains a useful method, however, for the histopathological confirmation of suspected or confirmed recurrence.

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The effect of rectal washout on local recurrence following rectal cancer surgery

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2017.0202 ◽

2018 ◽

Vol 100 (2) ◽

pp. 146-151 ◽

Cited By ~ 1

Author(s):

SR Moosvi ◽

K Manley ◽

J Hernon

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Anterior Resection ◽

High Volume ◽

Conclusive Evidence ◽

Rectal Cancer Surgery ◽

Single Institution ◽

Recurrence Rates ◽

Rectal Washout ◽

Significant Difference

Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Methods A total of 395 consecutive patients who underwent anterior resection with or without rectal washout for rectal cancer between January 2003 and July 2009 at a high volume single institution were analysed retrospectively. A standardised process for performing washout was used and all patients had standardised surgery in the form of total mesorectal excision. Neoadjuvant and adjuvant therapy was used on a selected basis. Patients were followed up for five years and local recurrence rates were compared in the two groups. Results Of the 395 patients, 297 had rectal washout and 98 did not. Both groups were well matched with regard to various important clinical, operative and histopathological characteristics. Overall, the local recurrence rate was 5.3%. There was no significant difference in the incidence of local recurrence between the washout group (5.7%) and the no washout group (4.1%). Conclusions Among our cohort of patients, there was no statistical difference in the incidence of local recurrence after anterior resection with or without rectal washout. This suggests that other factors are more significant in the development of local recurrence.

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Survival and local recurrence after anterior resection and abdominoperineal excision for rectal cancer

European Journal of Surgical Oncology ◽

10.1016/s0748-7983(95)95520-8 ◽

1995 ◽

Vol 21 (6) ◽

pp. 640-643 ◽

Cited By ~ 16

Author(s):

Jörg Tschmelitsch ◽

Peter Kronberger ◽

Rupert Prommegger ◽

Gilbert Reibenegger ◽

Karl Glaser ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Anterior Resection ◽

Abdominoperineal Excision

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The Effect of Surgical Treatment for Local Recurrence after Rectal Cancer Surgery: An Analysis based on the Preoperative Imaging Studies

The Japanese Journal of Gastroenterological Surgery ◽

10.5833/jjgs.39.1787 ◽

2006 ◽

Vol 39 (12) ◽

pp. 1787-1796 ◽

Cited By ~ 2

Author(s):

Kazunari Misawa ◽

Tomoyuki Kato ◽

Yukihide Kanemitsu ◽

Koji Komori ◽

Takashi Hirai

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Local Recurrence ◽

Cancer Surgery ◽

Preoperative Imaging ◽

Rectal Cancer Surgery ◽

Imaging Studies

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Quality of life after rectal cancer surgery (systematic review)

Koloproktologia ◽

10.33878/2073-7556-2021-20-1-59-67 ◽

2021 ◽

Vol 20 (1) ◽

pp. 59-67

Author(s):

A. B. Serebriy ◽

E. A. Khomyakov ◽

I. O. Nafedzov ◽

O. Yu. Fomenko ◽

E. G. Rybakov

Keyword(s):

Quality Of Life ◽

Risk Factors ◽

Rectal Cancer ◽

Anterior Resection ◽

Low Anterior Resection ◽

Life Quality ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Low Anterior Resection Syndrome

Aim: search for modifiable and unmodifiable risk factors affecting the quality of life of patients after rectal cancer surgery.Materials and methods: the literature search was done according to the keywords: quality of life, rectal cancer, low anterior resection syndrome. Twelve prospective randomized studies, 2 cohort studies, and 2 meta-analyses are included in the study. The quality of life was assessed in the analyzed studies by using questionnaires for cancer patients and updated questionnaires for colorectal cancer: EORTC QLQ-CR29, QLQ-C30, QLQ-CR38, BIQ.Results: the literary data on influence of gender, age, surgery, stoma, and chemoradiotherapy on life quality of patients after rectal cancer surgery was analyzed.Conclusion: the most significant factor affecting the life quality of patients with rectal cancer is a violation of the body image if it is necessary to form the stoma on the anterior abdominal wall. The manifestations of the low anterior resection syndrome and the urination problems are significant risk factors in the case of restoration of bowel continuity.

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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 ◽

10.1371/journal.pone.0095699 ◽

2014 ◽

Vol 9 (5) ◽

pp. e95699 ◽

Cited By ~ 7

Author(s):

Can Zhou ◽

Yu Ren ◽

Juan Li ◽

Ke Wang ◽

Jianjun He ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Anterior Resection ◽

Meta Analysis

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ISR for T1-2 Low Rectal Cancer: A Japanese Approach

Clinics in Colon and Rectal Surgery ◽

10.1055/s-0040-1714240 ◽

2020 ◽

Vol 33 (06) ◽

pp. 361-365

Author(s):

Masaaki Ito

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Recurrence Rate ◽

Phase Ii ◽

Local Recurrence Rate ◽

Anal Verge ◽

Low Rectal Cancer ◽

Rectal Cancer Surgery ◽

Rectal Cancers ◽

Anal Preservation

AbstractThe evolution over the past 20 years of anal preservation in rectal cancer surgery has been truly remarkable. Intersphincteric resection (ISR) reported by Schiessel in 1994 in Australia has been shown to enable anal preservation even for cancers quite close to the anus. In Japan, ISR via the detachment of the anal canal between the internal and external sphincters and excision of the internal sphincter first began to be practiced in the latter half of 1990. A multicenter Phase II trial of ISR in Japan suggested that 70% of the cases had relatively good function with less than 10 points of Wexner score but around 10% had severe incontinence that would not be improved for long term. The primary end point of the clinical study, 3-year local recurrence rate, was 13.2% across the overall cohort (T1, 0%; T2, 6.9%; and T3, 21.6%). When ISR is performed on T1/T2 rectal cancers, sufficient circumferential resection margin can be obtained even without preoperative chemoradiotherapy, and local recurrence rate was acceptably low. Based on these evidences, ISR is a currently important, standard treatment option among anal-preserving surgeries for T1/T2 low-lying rectal cancers. In Japan, a feasibility study (LapRC trial) of laparoscopic ISR on Stage 0 and Stage 1 low rectal cancer showed excellent outcomes. A prospective Phase II clinical trial targeting low rectal cancers within 5 cm from the anal verge (ultimate trial) is being performed and awaiting the results in near future.

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