Risk factors for suboptimal laparoscopic surgery in rectal cancer patients

Abstract Background Studies reporting the results of associated factors of pathological completed response (PCR) and tumor regression response in patients with rectal cancer following neoadjuvant chemoradiation therapy (nCRT) are inconsistent. The purpose of this study was to identify the prognostic factors of tumor response and outcome in rectal cancer patients.Methods The study was a retrospective analysis. Patients with locally advanced rectal cancer underwent nCRT followed by surgery from 2010 to 2014 with 5 years of follow-up. The primary outcomes were associated factors of pathological completed response and downstaging. The risk factors of survival outcome and disease recurrence were also observed.Results A total of 169 rectal cancer patients were included. The PCR rate was 17.8%, and the downstaging rate was 60.9%. Patients with a histology type of adenocarcinoma associated with PCR, and patients positive for clinical N stage were associated with downstaging. Kaplan-Meier analysis showed the PCR group performed better to a statistically significant level both in overall survival and disease recurrence free survival than the no PCR group (p= 0.033 & 0.025, respectively). Patients with a downstaging response also showed better overall survival benefits and disease recurrence free survival benefits than their counter-parts (both p<0.001). After controlling confounding variables, the risk factors of overall survival were downstaging [Hazard Ratio (HR): 0.40, 95% CI: 0.21-0.74], male, abnormal post-nCRT CEA level and abnormal Hb level. In addition, the protective factors of recurrence were downstaging and having adjuvant chemotherapy.Conclusions Among rectal cancer patients who received the neoadjuvant therapy, histology type and clinical N stage were associated with PCR and downstaging, respectively. Downstaging was an important protective factor for better overall survival and recurrence free survival.

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A nomogram to predict risk factors of frequent defecation early after ileostomy reversal for rectal cancer patients

Annals of Translational Medicine ◽

10.21037/atm-21-4660 ◽

2021 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Jiaxin Deng ◽

Mingli Su ◽

Jiancong Hu ◽

Dezheng Lin ◽

Juan Li ◽

...

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Cancer Patients ◽

Ileostomy Reversal

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Lower Extremity Lymphedema in Gynecologic Cancer Patients: Propensity Score Matching Analysis of External Beam Radiation versus Brachytherapy

Cancers ◽

10.3390/cancers11101471 ◽

2019 ◽

Vol 11 (10) ◽

pp. 1471 ◽

Cited By ~ 1

Author(s):

Won Ick Chang ◽

Hyun-Cheol Kang ◽

Hong-Gyun Wu ◽

Hak Jae Kim ◽

Seung Hyuck Jeon ◽

...

Keyword(s):

Risk Factors ◽

Radiation Therapy ◽

Laparoscopic Surgery ◽

Propensity Score ◽

Lower Extremity ◽

Cancer Patients ◽

Gynecologic Cancer ◽

External Beam Radiation ◽

External Beam ◽

Beam Radiation

The goal of this study is to compare the risk of lower extremity lymphedema (LEL) between pelvic external beam radiation therapy (EBRT) and vaginal brachytherapy, and to identify risk factors for LEL in gynecologic cancer patients treated with adjuvant radiation therapy (RT) after radical surgery. A total of 263 stage I–III gynecologic cancer patients who underwent adjuvant RT were retrospectively reviewed. One-to-one case-matched analysis was conducted with propensity scores generated from patient, tumor, and treatment characteristics. Using the risk factors found in this study, high- and low-risk groups were identified. With a median follow-up of 36.0 months, 35 of 263 (13.3%) patients developed LEL. In multivariate analysis, laparoscopic surgery (HR 2.548; p = 0.024), harvesting more than 30 pelvic lymph nodes (HR 2.246; p = 0.028), and para-aortic lymph node dissection (PALND, HR 2.305; p = 0.014) were identified as independent risk factors for LEL. After propensity score matching, the LEL incidence of the brachytherapy group was significantly lower than the EBRT group (p = 0.025). In conclusion, high-risk patients with risk factors such as laparoscopic surgery, harvesting more than 30 pelvic lymph nodes, PALND, and adjuvant pelvic EBRT require closer observation for LEL.

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