370 POSTER Risk factors for non radical resection, local recurrence, disease free survival and overall survival for rectal cancer in EORTC 22921 trial

2006 ◽  
Vol 32 ◽  
pp. S110
Author(s):  
M. den Dulk ◽  
L. Collette ◽  
C.A.M. Marijnen ◽  
J.F. Bosset ◽  
C.J.H. van de Velde
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Overall Survival ◽  
Local Recurrence ◽  
Disease Free Survival ◽  
Radical Resection ◽  
Free Survival ◽  
Disease Free

TP1.2.3Oncological Outcomes of Organ Preservation Strategies - Local Excision Procedures and ‘Watchful Waiting’ In Management of Low Rectal Cancers – A Systematic Review And Meta-Analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
A R Aspari ◽  
V Ramesh ◽  
G Kumar ◽  
S N Narayanasamy ◽  
A O Gumber ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Local Recurrence ◽  
Organ Preservation ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Free Survival ◽  
Rectal Cancers ◽  
Disease Free

Abstract Objective To evaluate local recurrence, metastases, and survival outcomes of `wait and watch’ (WW) strategy and local excision (LE) of tumours, in comparison to the present standard practice of total mesorectal excision (TME) for locally advanced rectal cancers. Data Sources MEDLINE, EMBASE, PubMed databases, and sources of Grey literature. Study Selection Randomised and non-randomised prospective studies, retrospective studies with propensity-score-matched analyses. Data Extraction and Synthesis These were carried out independently by two reviewers. A random-effects methodology was used for meta-analyses. Data was presented keeping with the 27-item PRISMA checklist. Main Outcomes The primary outcomes of interest were local recurrence, distant metastases, disease-free-survival and overall-survival, which were assessed in comparison to those associated with radical surgeries (TME). Results 7 of the 16 studies in the systematic review were included for the quantitative synthesis and meta-analysis. Local recurrence rates were comparable amongst patients in WW group and LE group to those undergoing TME. [Risk ratio (RR) 3.07/1.41; 95% Confidence Interval (CI) 0.86-10.95/0.66-3.01; P = 0.08/P=0.89 respectively]. Rates of distant metastases in the WW group and LE group were comparable to those undergoing TME [RR = 0.71/0.94; 95% CI 0.22-2.30/0.55-1.61; P = 0.56/ P = 0.83 respectively]. The median 3-year disease-free survival among patients undergoing WW, LE procedure, and TME were 88%, 80%, and 78.2% respectively; and the median 3-year overall survival among the three groups were 96%, 93%, and 89.5% respectively. Conclusions and Relevance Organ-preservation strategies appear to be a viable treatment option in the management of rectal-cancers. Further research is warranted to provide stronger levels of evidence on organ-preservation strategies.

Staged management of cardiac disease and concomitant early lung cancer: a 20-year single-center experience

2020 ◽  
Author(s):  
Jérémy Tricard ◽  
Daniel Milad ◽  
Anaëlle Chermat ◽  
Serge Simard ◽  
Yves Lacasse ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lung Cancer ◽  
Overall Survival ◽  
Disease Free Survival ◽  
Free Survival ◽  
Cardiac Procedure ◽  
Independent Risk Factors ◽  
Group 2 ◽  
Disease Free ◽  
Group 1

Abstract OBJECTIVES The association of unstable heart disease and resectable lung cancer is rare. The impacts of staged management, cardiac surgery with cardiopulmonary bypass (CPB) versus angioplasty, on long-term survival and cancer recurrence remain debated. We report our experience using staged management. METHODS From 1997 to 2016, 107 patients were treated at the Quebec Heart and Lung Institute: 72 underwent cardiac surgery with CPB (group 1), 35 were treated with angioplasty (group 2), followed by oncological pulmonary resection. RESULTS Two postoperative deaths (3%) and 1 ischaemic heart complication (1%) were reported in group 1. One death (3%) was reported in group 2. Two-year overall survival was 82% (59/72) in group 1 and 80% (28/35) in group 2; 5-year overall survival was 62% (33/53) in group 1 and 63% (19/30) in group 2. Two-year disease-free survival in group 1 was 79% (57/72) and 77% (27/35) in group 2; 5-year disease-free survival was 58% (31/53) in group 1 and 60% (18/30) in group 2. The independent risk factors for death after thoracic surgery were transfusions (P = 0.004) and grade ≥3 complications (P = 0.034). Independent risk factors for recurrence included the cancer stage (P < 0.001) and, paradoxically, a shorter delay between cardiac and lung procedures (P = 0.031). CONCLUSIONS When a staged management remains feasible after cardiac procedure, oncological outcomes of patients with cardiopathy and lung cancer are satisfactory. CPB does not seem to be deleterious. The delay between procedures should intuitively be as small as possible but not at the expense of good recovery after the cardiac procedure.

Comparison of long-term survival outcomes between laparoscopic and open surgery for mid or low rectal cancer treated with preoperative chemoradiotherapy: 7-year follow-up of COREAN trial.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 3518-3518
Author(s):  
Ji Won Park ◽  
Seung-Yong Jeong ◽  
Sung-Bum Kang ◽  
Jungnam Joo ◽  
Mi Kyung Song ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Local Recurrence ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Preoperative Chemoradiotherapy ◽  
Low Rectal Cancer ◽  
Free Survival ◽  
Disease Free

3518 Background: Laparoscopic surgery for rectal cancer has been used widely. However, recent two randomized trials raised concerns about short-term oncologic safety of laparoscopic surgery for rectal cancer. The aim of this study was to evaluate the long-term oncologic safety of laparoscopic surgery for rectal cancer based on 7-year data from the Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial. Methods: COREAN trial was a non-inferiority, randomized controlled trial. Between April, 2006, and Aug, 2009, eligible participants with mid or low rectal cancer treated with preoperative chemoradiotherapy were randomly assigned (1:1) to laparoscopic (n = 170) or open surgery (n = 170). Seven-year outcomes included overall and disease-free survival, and local recurrence. Log-rank test and stratified Cox regression analysis were used for survival analysis. Analysis was by intention to treat. Results: The median follow-up times were 84 months (IQR: 61.5-97.0). No differences were found between laparoscopic and open surgery group in terms of overall and disease-free survival, and local recurrence (7-year overall survival: 83.2% [laparoscopic] vs 77.3% [open], p = 0.48; 7-year disease-free survival: 71.6% [laparoscopic] vs 64.3% [open], p = 0.20; 7-year local recurrence: 3.3% [laparoscopic] vs 7.9% [open], p = 0.08). Stratified Cox regression analysis adjusted for ypT, ypN and tumor regression grade showed no significant difference between groups in terms of overall and disease-free survival, and local recurrence. The hazard ratios for overall survival, disease-free survival and local recurrence (open vs laparoscopic surgery) were 0.96 (95% CI = 0.58-1.57), 1.03 (95% CI = 0.70-1.53), and 2.28 (95% CI = 0.82-7.16), respectively. Conclusions: The 7-year analysis confirm the long-term oncological safety of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. The use of laparoscopic surgery does not compromise the long-term survival outcomes in rectal cancer. Clinical trial information: NCT00470951.

Can CRM status on MRI predict survival in locally advanced rectal cancers: Experience from the Indian subcontinent.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e15167-e15167
Author(s):  
Jay Rashmi Anam ◽  
Mihir Chandarana ◽  
Supreeta Arya ◽  
Ashwin Luis Desouza ◽  
Vikas S. Ostwal ◽  
...  
Keyword(s):  
Overall Survival ◽  
Local Recurrence ◽  
Predictive Value ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Free Survival ◽  
Mri Scans ◽  
Rectal Cancers ◽  
The Impact ◽  
Disease Free

e15167 Background: Neoadjuvant chemoradiation has become the standard approach for treatment of locally advanced rectal cancers. Magnetic Resonence Imaging (MRI) is the staging modality of choice in rectal carcinoma. Recent reports have studied the impact of MRI on local recurrence and survival both in treatment naïve and post treatment settings Methods: A retrospective analysis of prospective database was performed over a period of 1 year. All pretreatment patients with carcinoma of rectum were included in the study. The status of CRM on MRI was compared to that on the histopathology and as a predictor of recurrence and survival. For analysis, the MRI scans done for patients at presentation were labeled as MRIT. This included all patients irrespective of further treatment received. Patients who were treated with NACTRT had two MRI scans. The MRI at presentation in this subset of patients was labeled as MRI1 and the reassessment MRI after NACTRT was labeled as MRI2. Thus, MRI1 represented a subset of MRIT with locally advanced tumors treated with NACTRT. All the sets of MRI scans were analyzed separately for prediction of CRM involvement and for their effect on local recurrence and survival rates. Results: 221 patients were included with a median follow-up 30 months. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRIT, MRI1 and MRI2 to predict CRM status were 50%, 62.3%, 96.5%, 5.6% and 61.8%, 50%, 55%, 95%, 6% and 54.7% and 77.8%, 63.7%, 98%, 11%, 64.5% respectively. On multivariate analysis pathological positive margins alone predicted a poor overall survival (OS) whereas involved CRM on pathology and pretreatment MRI predicted poorer disease free survival and OS Conclusions: CRM status on pathology remains the most important prognostic factor to impact overall survival, disease free survival and local recurrence. CRM status on MRI at presentation alone has significant impact on disease free survival and local recurrence. Although MRI done after neoadjuvant treatment may not predict survival, it has a role in helping modify the surgical approach with a goal to achieve a negative CRM on pathology.

Local recurrence after rectal cancer resection is strongly related to the plane of surgical dissection and is further reduced by pre-operative short course radiotherapy. Preliminary results of the Medical Research Council (MRC) CR07 trial

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 3512-3512 ◽  
Author(s):  
P. Quirke ◽  
D. Sebag-Montefiore ◽  
R. Steele ◽  
S. Khanna ◽  
J. Monson ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Disease Free Survival ◽  
Rank Test ◽  
Surgical Specimen ◽  
Free Survival ◽  
Short Course ◽  
Quality Of Surgery ◽  
Disease Free

3512 Background: The MRC CR07 trial compared routine short course pre-operative radiotherapy (PRE) with selective post-operative chemo-radiation if there was involvement of the circumferential resection margin (CRM) (POST) and included a prospective pathological assessment of the quality of resection of the surgical specimen. Methods: A total of 1350 patients were randomised from 52 centres between March 1998 and August 2005. Median follow-up is 3 years. Trial pathologists were trained in histopathological assessment and reporting of the involvement of the CRM and plane of surgery (PoS) according to pre-set criteria describing the plane of dissection (Grade 1-muscularis plane: 2-intramesorectal plane: 3-mesorectal plane). 1232 patients were prospectively assessed for CRM and 1119 for PoS. Results: The CRM was involved (tumour ≤1mm) in 139 (11%) of resected specimens, and for these patients the 3-year local recurrence (LR), disease-free survival (DFS) and overall survival rates were 18%, 50% and 57%. For the 1093 patients with CRM-ve the respective rates were 7%, 81% and 84%. LR and DFS rates were associated with PoS (log-rank test p=0.0019 and p=0.0506 respectively), and in addition there was clear evidence of a reduction in LR and improvement in DFS rates in favour of PRE for all grades of quality of surgical assessment as shown in the table . Conclusions: The results indicate a strong association between the quality of surgery and the rates of local recurrence and disease-free survival, as well as a clear benefit from the addition of PRE to all grades of surgical dissection. Thus for patients with rectal cancer short-course pre-operative radiotherapy and good quality surgery can almost completely eliminate local recurrence. [Table: see text] No significant financial relationships to disclose.

Conjunctival and uveal melanoma: Survival and risk factors following orbital exenteration

2021 ◽  
pp. 112067212199513
Author(s):  
Sven Holger Baum ◽  
Henrike Westekemper ◽  
Nikolaos Emmanouel Bechrakis ◽  
Christopher Mohr
Keyword(s):  
Risk Factors ◽  
Overall Survival ◽  
Uveal Melanoma ◽  
Disease Free Survival ◽  
Orbital Exenteration ◽  
Free Survival ◽  
The Mean ◽  
Disease Free ◽  
Worse Prognosis

Purpose: This study aims to analyse disease-free survival, overall survival and risk factors after orbital exenteration in patients with conjunctival and uveal melanoma. Methods: Patients who underwent orbital exenteration due to conjunctival and uveal melanoma were included in this retrospective study (March 2000 to March 2018). Results: A total of 76 patients were enrolled in this study: 60 patients had a conjunctival melanoma and 16 had a uveal melanoma. In conjunctival melanoma, the mean age was 68.4 years. The overall survival rate was 82% after 1 year and 52% after 5 years. Univariate analysis of overall survival found that the following parameters were predictive of a worse prognosis: gender, extent of the primary tumour, lymph node metastases, distant metastases, adjuvant chemotherapy or radiotherapy and relapse. In multivariate analysis, relapse and adjuvant radiotherapy appeared to contribute to a significantly worse prognosis. In uveal melanoma, the mean age was 63.6 years. Eleven patients died during follow-up (mean follow up 30.7 months). The overall survival and disease-free survival rates after 1 year were 62% and 57%, respectively. An analysis of risk factors was not possible due to the small number of cases. Conclusion: Orbital exenterations in conjunctival and uveal melanoma are rarely necessary, but can be performed as an ultima ratio treatment with curative intent. Disease-free survival and overall survival are significantly lower for both groups due to the advanced stage of the disease compared to patients treated without exenteration in the literature. If a recurrence occurs after exenteration, the prognosis is poor in both groups.

scholarly journals Local Recurrence in Patients with Upper Third Rectum Cancer Treated with Surgery Alone Compared with Surgery Plus Chemoradiotherapy

2020 ◽  
pp. 1-6
Author(s):  
Uriel Martinez ◽  
Beatriz Mota ◽  
David Rayas ◽  
Jesús Sansón ◽  
Manuel Martínez ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Multimodal Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Rectum Cancer ◽  
Historical Cohort ◽  
Free Survival ◽  
Upper Third ◽  
Disease Free

Background: Colorectal cancer is the third most common neoplasm in Mexico, rectal cancer is the 16th most common neoplasm [1]. Due to the different behavior and prognostic factors of locally advance disease, manage should be tailored by a multidisciplinary approach. In tumors that rise in the upper third rectum cancer scenario there are no studies comparing the oncological results of multimodal treatment vs surgery alone. Objective: To compare the disease-free survival in patients with upper third rectal cancer treated with surgery alone vs multimodal treatment. Material and Methods: We conducted a descriptive, retrospective, longitudinal study using an historical cohort. Analysis was based from the information in patient`s records from diagnosed with cancer of the upper third rectum from 2011 to 2016. All patients with diagnosis of upper third rectum cancer were set in to two groups according to the treatment modality recited: Surgery alone and neoadjuvant chemotherapy. The records of patients diagnosed with cancer of the upper third rectum were reviewed and divided into two groups: with and without neoadjuvant chemoradiotherapy, both treated with surgery. Results: A total of 64 patient`s record were eligible, 48 of them were treated with surgery alone and 16 with a multimodal approach. The mean age was 65.5 years in those treated with surgery and 69 in the multimodal management group. The most frequent procedure was anterior resection, 45 cases (70.3%) in the group treated with surgery and 12 cases (18.7%) in the multimodal group. A case of complete pathological response was reported after a follow up of two years. Conclusion: The data suggests that there are no statistically significant differences in the local recurrence and disease-free survival with the use of neoadjuvant chemoradiotherapy.

scholarly journals Local Recurrence and Disease-Free Survival After Transanal Total Mesorectal Excision: Results From the International TaTME Registry

2021 ◽  
Author(s):  
Sapho X. Roodbeen ◽  
Marta Penna ◽  
Susan van Dieren ◽  
Brendan Moran ◽  
Paris Tekkis ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Resection Margin ◽  
Disease Free Survival ◽  
Transanal Total Mesorectal Excision ◽  
Mesorectal Excision ◽  
Free Survival ◽  
International Registry ◽  
Independent Risk Factors ◽  
Disease Free

Background: The oncologic safety of transanal total mesorectal excision (TaTME) for rectal cancer has recently been questioned, with high local recurrence (LR) rates reported in Dutch and Norwegian experiences. The objective of this study was to evaluate the oncologic safety of TaTME in a large cohort of patients with primary rectal cancer, primarily in terms of LR, disease-free survival (DFS), and overall survival (OS). Patients and Methods: This was a prospective international registry cohort study, including all patients who underwent TaTME for primary rectal adenocarcinoma from February 2010 through December 2018. The main endpoints were 2-year LR rate, pattern of LR, and independent risk factors for LR. Secondary endpoints included 2-year DFS and OS rates. Kaplan-Meier survival analysis was used to calculate actuarial LR, DFS, and OS rates. Results: A total of 2,803 patients receiving primary TaTME were included, predominantly men (71%) with a median age of 65 years (interquartile ratio, 57–73 years). After a median follow-up of 24 months (interquartile ratio, 12–38 months), the 2-year LR rate was 4.8% (95% CI, 3.8%–5.8%) with a unifocal LR pattern in 99 of 103 patients (96%). Independent risk factors for LR were male sex, threatened resection margin on baseline MRI, pathologic stage III cancer, and a positive circumferential resection margin on final histopathology. The 2-year DFS and OS rates were 77% (95% CI, 75%–79%) and 92% (95% CI, 91%–93%), respectively. Conclusions: This largest TaTME cohort to date supports the oncologic safety of the TaTME technique for rectal cancer in patients treated in units that contributed to an international registry, with an acceptable 2-year LR rate and a predominantly unifocal LR pattern.

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