T2014 Local Recurrence Is No Longer a Problem in Rectal Cancer with Optmal Multidisciplinary Management

AbstractDespite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

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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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Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

Medicina ◽

10.3390/medicina57030286 ◽

2021 ◽

Vol 57 (3) ◽

pp. 286

Author(s):

Michał Jankowski ◽

Manuela Las-Jankowska ◽

Andrzej Rutkowski ◽

Dariusz Bała ◽

Dorian Wiśniewski ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Rectal Cancer Patient ◽

Radical Resection ◽

Single Center ◽

Curative Intent ◽

Immediate Surgery ◽

Histopathological Results ◽

Isolated Local Recurrence ◽

Recurrence Of Rectal Cancer

Background and Objectives: Despite advances in treatment, local recurrence remains a great concern in patients with rectal cancer. The aim of this study was to investigate the incidence and risk factors of local recurrence of rectal cancer in our single center over a 7-year-period. Materials and Methods: Patients with stage I-III rectal cancer were treated with curative intent. The necessity for radiotherapy and chemotherapy was determined before surgery and/or postoperative histopathological results. Results: Of 365 rectal cancer patients, 76 (20.8%) developed recurrent disease. In total, 27 (7.4%) patients presented with a local tumor recurrence (isolated in 40.7% of cases). Radiotherapy was performed in 296 (81.1%) patients. The most often used schema was 5 × 5 Gy followed by immediate surgery (n = 214, 58.6%). Local recurrence occurred less frequently in patients treated with 5 × 5 Gy radiotherapy followed by surgery (n = 9, 4%). Surgical procedures of relapses were performed in 12 patients, six of whom were operated with radical intent. Only two (7.4%) patients lived more than 5 years after local recurrence treatment. The incidence of local recurrence was associated with primary tumor distal location and worse prognosis. The median overall survival of patients after local recurrence treatment was 19 months. Conclusions: Individualized rectal cancer patient selection and systematic treatment algorithms should be used clinical practice to minimize likelihood of relapse. 5 × 5 Gy radiotherapy followed by immediate surgery allows good local control in resectable cT2N+/cT3N0 patients. Radical resection of isolated local recurrence offers the best chances of cure.

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

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2021.03.246 ◽

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

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Local Recurrence of Rectal Cancer After Total Mesorectal Excision Without Preoperative Radiotherapy

International Journal of Gastrointestinal Cancer ◽

10.1385/ijgc:34:2-3:129 ◽

2003 ◽

Vol 34 (2-3) ◽

pp. 129-134 ◽

Cited By ~ 18

Author(s):

Christiaan P. van Lingen ◽

Clark J. Zeebregts ◽

Jos J. G. M. Gerritsen ◽

H. Jan Mulder ◽

Walter J. B. Mastboom ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Total Mesorectal Excision ◽

Preoperative Radiotherapy ◽

Mesorectal Excision ◽

Recurrence Of Rectal Cancer

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LOCAL RECURRENCE AND RECTAL CANCER

The Lancet ◽

10.1016/s0140-6736(83)91133-9 ◽

1983 ◽

Vol 322 (8363) ◽

pp. 1371 ◽

Cited By ~ 2

Author(s):

J.J Stanek ◽

J.H Scurr ◽

H Ellis

Keyword(s):

Rectal Cancer ◽

Local Recurrence

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EP.TU.370A 5-year re-audit of quality indicators for potentially curative rectal cancer resections by a single surgeon

British Journal of Surgery ◽

10.1093/bjs/znab311.047 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Jessica Lockhart ◽

Damian McKay

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Resection Margin ◽

Length Of Hospital Stay ◽

Long Term Outcomes ◽

Recurrence Rates ◽

High Quality ◽

Curative Intent ◽

R1 Resection

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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