The effect of coagulating-water-dropper device on local recurrence rates after hepatic surgery, what is the value of a R1 resection margin?

Abstract Aim High quality operations with low rates of tumour perforation and circumferential resection margin (CRM) positivity are associated with improved long-term outcomes following surgery for rectal cancer. Previous audit has demonstrated lower rates of tumour perforation and CRM positivity by a single surgeon compared to the published standards. Our aim is to re-audit this surgeons’ outcomes for curative rectal resections. Methods Data was collected retrospectively for all potentially curative rectal resections over a 5-year period performed by a single surgeon using a local database and electronic care records. The CRM status and tumour perforation status were considered. Other end points included the rate of local recurrence, survival and length of stay. Results Fifty-one patients underwent rectal resections with curative intent, with a median age of 67. Complete resection (R0) was achieved in 94.1% of cases; 3.92% were found to have nodes less than 1mm from the margin and 1.96% were found to have tumour deposit less than 1mm from the margin – these cases were considered to be an R1 resection. Tumour perforation was present in 3.92% of cases, all of which had occurred pre-operatively. Local recurrence was found in 5.88% of cases and 90-day mortality was 1.96%. Median length of hospital stay was 7 days. Conclusion Our data demonstrates sustained high quality surgical outcomes with low tumour perforation rates and CRM positivity rates which compare favourably with the published standards to date. Local recurrence rates are comparable to published standards and 90-day mortality continues to be low.

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Impact of The Distal Resection Margin On Local Recurrence After Neoadjuvant Chemoradiation and Rectal Excision For Locally Advanced Rectal Cancer

10.21203/rs.3.rs-478899/v1 ◽

2021 ◽

Author(s):

Seung Ho Song ◽

Jun Seok Park ◽

Gyu-Seog Choi ◽

An Na Seo ◽

Soo Yeun Park ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Resection Margin ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Preoperative Chemoradiotherapy ◽

Locally Advanced Rectal Cancer ◽

Distal Resection Margin ◽

Recurrence Rates ◽

Tumor Stages

Abstract We aimed to evaluate whether a short distal resection margin (< 1 cm) was associated with local recurrence in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Patients with rectal cancer who underwent preoperative chemoradiotherapy followed by curative surgery were divided into two groups based on the distal resection margin (≥ 1 cm and < 1 cm). In total, 507 patients were analyzed. The median follow-up duration was 48.9 months. The 3-year local recurrence rates were 2% and 8% in the ≥ 1 cm and < 1 cm groups, respectively (p < 0.001). Multivariable analysis revealed that a distal resection margin of < 1 cm was a significant risk factor for local recurrence (p = 0.008). Subgroup analysis revealed that a distal resection margin of < 1 cm was not an independent risk factor for local recurrence in the ypT0–1 group. However, among patients with tumor stages ypT2–4, the cumulative 3-year incidences of local recurrence were 2.3% and 9.8% in the ≥ 1 cm and < 1 cm groups, respectively (p = 0.001). A distal resection margin of < 1 cm might influence local recurrence rates in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy, especially in patients with tumor stages ypT2–4.

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Impact of the distal resection margin on local recurrence after neoadjuvant chemoradiation and rectal excision for locally advanced rectal cancer

Scientific Reports ◽

10.1038/s41598-021-02438-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Seung Ho Song ◽

Jun Seok Park ◽

Gyu-Seog Choi ◽

An Na Seo ◽

Soo Yeun Park ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Resection Margin ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Preoperative Chemoradiotherapy ◽

Locally Advanced Rectal Cancer ◽

Distal Resection Margin ◽

Recurrence Rates ◽

Tumor Stages

AbstractWe aimed to evaluate whether a short distal resection margin (< 1 cm) was associated with local recurrence in patients with locally advanced rectal cancer who underwent preoperative chemoradiotherapy. Patients with rectal cancer who underwent preoperative chemoradiotherapy followed by curative surgery were divided into two groups based on the distal resection margin (≥ 1 cm and < 1 cm). In total, 507 patients were analyzed. The median follow-up duration was 48.9 months. The 3-year local recurrence rates were 2% and 8% in the ≥ 1 cm and < 1 cm groups, respectively (P < 0.001). Multivariable analysis revealed that a distal resection margin of < 1 cm was a significant risk factor for local recurrence (P = 0.008). Subgroup analysis revealed that a distal resection margin of < 1 cm was not an independent risk factor for local recurrence in the ypT0–1 group. However, among patients with tumor stages ypT2–4, the cumulative 3-year incidences of local recurrence were 2.3% and 9.8% in the ≥ 1 cm and < 1 cm groups, respectively (P = 0.01). A distal resection margin of < 1 cm might influence local recurrence rates in patients with locally advanced rectal cancer undergoing preoperative chemoradiotherapy, especially in patients with tumor stages ypT2–4.

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A comparative study of standard versus extralevator abdominoperineal resections

International Surgery Journal ◽

10.18203/2349-2902.isj20170921 ◽

2017 ◽

Vol 4 (4) ◽

pp. 1222 ◽

Cited By ~ 1

Author(s):

Masimba Nyandowe ◽

Alfred Egedovo ◽

Yik-Hong Ho

Keyword(s):

Local Recurrence ◽

Abdominoperineal Resection ◽

Medical Records ◽

Resection Margin ◽

Wound Complication ◽

Abdominoperineal Excision ◽

Wound Infection Rate ◽

Short Term ◽

Recurrence Rates ◽

Involvement Rate

Background: The aim was to compare short term outcomes between patients undergoing standard abdominoperineal resection (APR) with those that had an extralevator abdominoperineal excision (ELAPE).Methods: A retrospective study was done on 123 consecutive patients who underwent an abdominoperineal resection for low rectal cancer at the Townsville hospital between August 2003 and January 2015. Data was collected from medical records. Short term oncological outcomes were compared between the APR and ELAPE group.Results: The circumferential resection margin (CRM) involvement rate was significantly lower in the ELAPE group 13.2% versus 19.3% in the APR group. The local recurrence rates in the two groups were not significantly different: 16.8% in the ELAPE versus 17.4% in the APR group. Intraoperative perforations were lower in the ELAPE group 15.3% versus 23.2 % in the APR group. The post-operative wound infection rate was however higher in the ELAPE group 20.3% versus 12.4 % in the APR group.Conclusions: ELAPE was shown to be superior in the CRM and intraoperative perforation rate but the local recurrence rates were similar. ELAPE had a higher wound complication rate than APR.

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

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02223-4 ◽

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.

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Over view of clinical presentation, management and outcome of cervical cancer: A tertiary cancer centre experience

10.1055/s-0039-1685265 ◽

2016 ◽

Author(s):

H. Shukla ◽

K. Batra ◽

R. Sekhon ◽

S. Giri ◽

S. Rawal

Keyword(s):

Cervical Cancer ◽

Local Recurrence ◽

Radical Hysterectomy ◽

Gynecological Cancer ◽

Age Group ◽

Recurrence Rates ◽

Oncological Safety ◽

Robotic Radical Hysterectomy ◽

Time Period ◽

Hospital Registry

Objectives: (a) To understand the profile of cervical cancer patients attending our hospital from January 2011 till January 2015. (b) To audit the type of care given to the patients with respect to their stage at presentation. (c) To compare the outcomes of open v/s robotic radical hysterectomy done for cervical cancer. Methods: We prospectively analyzed all cases of cervical cancer from January 2011 to January 2015 presenting at our institute. Data was retrieved from patient’s records and institute’s tumor registry. We compared all patients undergoing open v/s robotic RH. All the data were analysed using SPSS version 21. Results: A total of 562 patients were treated for cervical cancer during the time period between 2011-2015. Of these there were 316 (56%) cases taken up for surgery-212 robotic RH, 104 open radical hysterectomy and rest 246 (44%) patients received definitive CCRT. Most common age group was 40-54 yrs. IB1 stage was most common presenting stage. SCC was most common histology (75%). Immediate post op complication and oncological safety in terms of local recurrence was same in both groups. However length of stay and post operative blood requirement was significantly lower in robotic RH group. 45% of all patients who underwent surgery did not require adjuvant therapy in post op period while 35% patient required post op RT and 20% CCRT. 2.2% patient had local recurrence and most of the patients were in stage IIA1 at presentation. Conclusion: Cervical cancer is the most common gynecological cancer in our hospital registry. Mostly women were in the age group of 40-54 years. Most common stage at presentation was 1B and the histology being SCC. Not many differences seen in open v/s robotic techniques of radical hysterectomy except for shorter hospital stay and less need of blood transfusion in the robotic group. Local recurrence rates are comparable in both open and robotic groups.

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Multimodal Treatment of cT3 Rectal Cancer in a Prospective Multi-Center Observational Study: Can Neoadjuvant Chemoradiation Be Omitted in Patients with an MRI-Assessed, Negative Circumferential Resection Margin?

Visceral Medicine ◽

10.1159/000514800 ◽

2021 ◽

pp. 1-8

Author(s):

Henry Ptok ◽

Frank Meyer ◽

Ingo Gastinger ◽

Benjamin Garlipp

Keyword(s):

Rectal Cancer ◽

Observational Study ◽

Circumferential Resection Margin ◽

Resection Margin ◽

Anal Verge ◽

Final Analysis ◽

Radical Resection ◽

Distant Recurrence ◽

Neoadjuvant Chemoradiation ◽

Recurrence Rates

Background/Aim: Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. Methods: By means of a prospective nationwide registry (n = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer <12 cm from the anal verge with a negative (>1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, n = 25; nCRT+TME, n = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). Results: In the TME-alone group, tumors were located closer to the anal verge (p = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (p = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; p = 0.268). Local recurrences occurred at a similar rate in the TME-alone (n = 1; 5.3%) and nCRT+TME groups (n = 3; 5.5%) (p = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (p = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. Conclusions: In this cohort of patients with rectal cancer located <12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

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Radiation-Associated Angiosarcoma of the Breast and Chest Wall Treated with Thermography-Controlled, Contactless wIRA-Hyperthermia and Hypofractionated Re-Irradiation

Cancers ◽

10.3390/cancers13153911 ◽

2021 ◽

Vol 13 (15) ◽

pp. 3911

Author(s):

Markus Notter ◽

Emanuel Stutz ◽

Andreas R. Thomsen ◽

Peter Vaupel

Keyword(s):

Local Recurrence ◽

Background Radiation ◽

Definitive Treatment ◽

Resection Margins ◽

Recurrence Rates ◽

Rate Dependent ◽

Angiosarcoma Of The Breast ◽

Positive Resection Margins ◽

Locally Recurrent ◽

Tumor Extent

Background: Radiation-associated angiosarcoma of the breast (RAASB) is a rare, challenging disease, with surgery being the accepted basic therapeutic approach. In contrast, the role of adjuvant and systemic therapies is a subject of some controversy. Local recurrence rates reported in the literature are mostly heterogeneous and are highly dependent on the extent of surgery. In cases of locally recurrent or unresectable RAASB, prognosis is very poor. Methods: We retrospectively report on 10 consecutive RAASB patients, most of them presenting with locally recurrent or unresectable RAASB, which were treated with thermography-controlled water-filtered infrared-A (wIRA) superficial hyperthermia (HT) immediately followed by re-irradiation (re-RT). Patients with RAASB were graded based on their tumor extent before onset of radiotherapy (RT). Results: We recorded a local control (LC) rate dependent on tumor extent ranging from a high LC rate of 100% (two of two patients) in the adjuvant setting with an R0 or R2 resection to a limited LC rate of 33% (one of three patients) in patients with inoperable, macroscopic tumor lesions. Conclusion: Combined HT and re-RT should be considered as an option (a) for adjuvant treatment of RAASB, especially in cases with positive resection margins and after surgery of local recurrence (LR), and (b) for definitive treatment of unresectable RAASB.

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Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

British Journal of Ophthalmology ◽

10.1136/bjophthalmol-2020-316293 ◽

2020 ◽

pp. bjophthalmol-2020-316293

Author(s):

Puneet Jain ◽

Paul T Finger ◽

Maria Fili ◽

Bertil Damato ◽

Sarah E Coupland ◽

...

Keyword(s):

Local Recurrence ◽

Local Excision ◽

External Beam Radiotherapy ◽

Staging System ◽

Primary Treatment ◽

Excision Biopsy ◽

Conjunctival Melanoma ◽

Recurrence Rates ◽

Increased Risk ◽

Eighth Edition

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.

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P036. Audit of breast local recurrence rates in a District General Hospital

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2015.03.074 ◽

2015 ◽

Vol 41 (6) ◽

pp. S37

Author(s):

Marianne Rice ◽

Justin Ong ◽

J. McGregor ◽

Helen Mathers

Keyword(s):

Local Recurrence ◽

General Hospital ◽

District General Hospital ◽

Recurrence Rates

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