Risk factors for local recurrence and long term survival after minimally invasive intersphincteric resection for very low rectal cancer: Multivariate analysis in 161 patients

2021 ◽  
Author(s):  
G.N. Piozzi ◽  
H. Park ◽  
T.H. Lee ◽  
J.S. Kim ◽  
H.B. Choi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Multivariate Analysis ◽  
Local Recurrence ◽  
Minimally Invasive ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Term Survival ◽  
Very Low Rectal Cancer

Intersphincteric Resection for Low Rectal Cancer: Parameters Affecting Functional Outcomes and Survival Rates

2021 ◽  
Vol 39 ◽  
Author(s):  
Vusal Aliyev ◽  
◽  
Beslen Goksoy ◽  
Suha Goksel ◽  
Koray Guven ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Functional Outcomes ◽  
Survival Rates ◽  
Disease Free Survival ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Free Survival ◽  
Very Low Rectal Cancer ◽  
Disease Free

Introduction: The development of new surgical techniques and devices, as well as the improvements in neoadjuvant chemoradiotherapy enabled intersphincteric resection (ISR), has reduced permanent colostomy usage. The aim of this study was to assess the long-term oncological and functional outcomes of patients who underwent partial ISR for rectal cancer located less than 5cm from the anal verge. Materials and Methods: A series of 106 consecutive patients with very low rectal cancer underwent curative partial ISR from January 2006 to September 2019 were retrospectively evaluated. One-hundred-three (97%) of 106 patients received neoadjuvant chemo-radiotherapy. Overall survival (OS), disease-free survival (DFS), and local recurrence (LR) rates were calculated using Kaplan–Meier methods. The Wexner incontinence score and Kirwan classification were used to evaluate patients’ functional results. Results: The median follow up was 60 months (range, 18–174). The estimated five-year overall and disease-free survival rates were 89% and 81.6%, respectively. Five-year local recurrence and distant metastasis rates were 6.6% and 10.4%, respectively. There was no in-hospital and 30-day mortality. The median Wexner score was 9 (range, 0–20) for 72 patients. Age (<65 years, p=0.027) and gender (male, p=0.019) had a positive effect on functional outcomes after surgery. One and five years colostomy-free survival rates were 96% and 89%, respectively. Conclusion: Intersphincteric resection techniques are feasible for patients with very low rectal cancer, providing good oncological and functional outcomes.

scholarly journals The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
I-Li Lai ◽  
Jeng-Fu You ◽  
Yih-Jong Chern ◽  
Wen-Sy Tsai ◽  
Jy-Ming Chiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Local Recurrence ◽  
Distant Metastasis ◽  
Resection Margin ◽  
Radical Resection ◽  
Hazard Ratio ◽  
Low Rectal Cancer ◽  
Distal Resection Margin ◽  
Lymph Node Yield

Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

Safety and Feasibility of Laparoscopic Intersphincteric Resection for Very Low Rectal Cancer

2010 ◽  
Vol 14 (4) ◽  
pp. 645-650 ◽  
Author(s):  
Yoshiya Fujimoto ◽  
Takashi Akiyoshi ◽  
Hiroya Kuroyanagi ◽  
Tsuyoshi Konishi ◽  
Masashi Ueno ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Very Low Rectal Cancer ◽  
Laparoscopic Intersphincteric Resection

Extended intersphincteric resection with quadrant resection of external sphincter after neoadjuvant mid-course chemoradiotherapy in the very low rectal cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. e14181-e14181
Author(s):  
Nahmgun Oh ◽  
Sanghwa Ko ◽  
Hyunsung Kim
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
External Sphincter ◽  
Postoperative Mortality ◽  
Intersphincteric Resection ◽  
Low Rectal Cancer ◽  
Pelvic Cavity ◽  
Group I ◽  
Very Low Rectal Cancer ◽  
The Mean

e14181 Background: To evaluate the results of extended intersphincteric resection of T3 rectal cancer situated below 4cm from the anal verge, comparing the results of simple intersphincteric resection of T2 rectal cancer after mid-course chemoradiotherapy. Methods: Between 2000 Between 2000 and 2006, 67 patients with rectal cancer below 4cm from anal verge, underwent abdomino-intersphincteric resection reconstructed by inversion proctoplasty with a colonic J-pouch and diverting ileostomy. All patients received a total irradiation dose of 30 Gy with conventional fractions for 3 weeks. Capecitabine was administered 1000mg/m2 twice a day on 21 days during radiotherapy, followed curative surgery in a week without resting period. After preoperative radio-chemotherapy, patients with overt T2 lesion were 27 cases (40.3%) and received intersphincteric resection (Group I: simple intersphincteric resection), and patients with borderline cases or T3 lesion were 40 cases (59.7%) and received intersphincteric resection with quadrant resection of upper external sphincter and primary repair of the external sphincter as inversion proctoplasty (Group II: extended intersphincteric resection). Results: The mean patients age was 61.2 years. The mean location of cancer was at 3.2cm from anal verge (2-4cm). Anastomotic leakage was confirmed in 11 patients (16.4%). There was no postoperative mortality. The grade I, II of continence by Kirwan classification was 81.5%, 80.0% in Group I and II. Under 3 times stool frequency per day was 51.9%, 62.5% in Group I and II. Two patients (3.0%) experienced locoregional recurrence of pelvic cavity. 5-year overall survival rate was 83.6%. Conclusions: Simple and extended intersphincteric resection is seemed to be a safe and functionally acceptable procedure. And, neoadjuvant mid-course chemoradiotherapy using oral capecitabine 2,000 mg/m2/day on 21 days during 2 Gy radiation of each 15 weekdays is seemed to be a tolerable and effective modality, in patients with very low rectal cancer.

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