ISR for T1-2 Low Rectal Cancer: A Japanese Approach

AbstractThe evolution over the past 20 years of anal preservation in rectal cancer surgery has been truly remarkable. Intersphincteric resection (ISR) reported by Schiessel in 1994 in Australia has been shown to enable anal preservation even for cancers quite close to the anus. In Japan, ISR via the detachment of the anal canal between the internal and external sphincters and excision of the internal sphincter first began to be practiced in the latter half of 1990. A multicenter Phase II trial of ISR in Japan suggested that 70% of the cases had relatively good function with less than 10 points of Wexner score but around 10% had severe incontinence that would not be improved for long term. The primary end point of the clinical study, 3-year local recurrence rate, was 13.2% across the overall cohort (T1, 0%; T2, 6.9%; and T3, 21.6%). When ISR is performed on T1/T2 rectal cancers, sufficient circumferential resection margin can be obtained even without preoperative chemoradiotherapy, and local recurrence rate was acceptably low. Based on these evidences, ISR is a currently important, standard treatment option among anal-preserving surgeries for T1/T2 low-lying rectal cancers. In Japan, a feasibility study (LapRC trial) of laparoscopic ISR on Stage 0 and Stage 1 low rectal cancer showed excellent outcomes. A prospective Phase II clinical trial targeting low rectal cancers within 5 cm from the anal verge (ultimate trial) is being performed and awaiting the results in near future.

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21. Positive CRM is associated with acceptable local recurrence rate but reduced survival in elective rectal cancer surgery

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2015.08.052 ◽

2015 ◽

Vol 41 (11) ◽

pp. S267

Author(s):

Philipos Sagias ◽

Nathan Curtis ◽

Sam Stefan ◽

Jamil Ahmed ◽

Amjad Parviaz ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Cancer Surgery ◽

Rectal Cancer Surgery

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Preoperative radiotherapy combined with simultaneous chemotherapy with capecitabine plus oxaliplatin versus surgery alone: A single-centered, phase II study in patients with mid/low rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.609 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 609-609

Author(s):

Fulong Wang ◽

Zhen-Hai Lu ◽

Zhizhong PAN ◽

Yuan-Hong Gao ◽

Gong Chen ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Preoperative Radiotherapy ◽

Group A ◽

Group B ◽

Anal Preservation ◽

Preservation Rate

609 Background: Though total mesorectal excision (TME) has proved to effectively decrease local recurrence rate of mid/low rectal cancer, the efficacy of preoperative radiotherapy in Asian patients remains unclear. The present study aimed to compare the efficacy of TME alone versus TME after preoperative radiotherapy and simultaneous chemotherapy with capecitabine plus oxaliplatin in Chinese patients with stage II and III mid/low rectal adenocarcinoma. Methods: Patients (n=192) aged between 18 and 70 years enrolled from March 23, 2008 to August 2, 2012 were randomly divided into two groups. Group A (n=97) received preoperative radiotherapy and simultaneous chemotherapy [46-50 GY/23-25 with oxaliplatin 100 mg/m2 (D1) and capecitabine 1,000 mg/m2 (bid, D1-15), repeated since D22], which was followed by TME; while patients in group B (n=95) underwent TME alone. While disease free survival (DFS) was the primary endpoint; the following were evaluated as secondary endpoints: pathological response rate, pathologic complete response (PCR) rate, anal preservation rate, local recurrence rate, distant metastasis rate, acute toxic effects, and late toxic effects. Results: Excluding the drop outs, 90 and 94 patients were analyzed in group A and B, respectively. The median follow-up time was 29 (range: 0 to 59) months. PCR was achieved for 32 patients (35.6%). The median survival time and overall survival (OS) rate in group A were 24 months and 92.5% (95% CI: 88.3-96.7), respectively; while the same were 34 months and 88.7% (95% CI: 84.8-92.6) in group B. The median DFS time was 22 and 31 months in group A and B, respectively; and the overall DFS was 86.1% (95% CI: 81.6-90.6%) and 80.6% (95% CI: 74.8-85.4%) in both groups. No significant differences were observed between groups in OS rate (p=0.323), overall DFS, (p=0.612), and anal preservation rate (p=0.849). Conclusions: Preoperative radiotherapy combined with chemotherapy of capecitabine plus oxaliplatin could result in higher PCR rate. However, studies with long follow up and large sample are recommended to demonstrate the efficacy of this treatment strategy over TME alone. Clinical trial information: ChiCTR-TRC-00000122.

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Local recurrence rate after resection of low rectal cancer: short-term outcomes of a single center

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.10.411 ◽

2019 ◽

Vol 45 (2) ◽

pp. e119

Author(s):

E. Efstathiou ◽

A. Terras ◽

N. Kopanakis ◽

G. Andreadakis ◽

A. Prodromidou ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Recurrence Rate ◽

Local Recurrence Rate ◽

Low Rectal Cancer ◽

Single Center ◽

Short Term

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Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

Techniques in Coloproctology ◽

10.1007/s10151-020-02229-2 ◽

2020 ◽

Vol 24 (10) ◽

pp. 1025-1034 ◽

Cited By ~ 1

Author(s):

G. Sun ◽

Z. Lou ◽

H. Zhang ◽

G. Y. Yu ◽

K. Zheng ◽

...

Keyword(s):

Rectal Cancer ◽

Rectal Wall ◽

Anal Verge ◽

Disease Free Survival ◽

Sphincter Preservation ◽

Low Rectal Cancer ◽

Anal Function ◽

Oncological Outcomes ◽

Rectal Cancers ◽

Very Low Rectal Cancer

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

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Patterns of Local Recurrence and Oncologic Outcomes in T3 Low Rectal Cancer (≤5 cm from the Anal Verge) Treated With Short-Course Radiotherapy With Delayed Surgery

Annals of Surgical Oncology ◽

10.1245/s10434-016-5604-6 ◽

2016 ◽

Vol 24 (1) ◽

pp. 219-226 ◽

Cited By ~ 10

Author(s):

Naohito Beppu ◽

Fumihiko Kimura ◽

Tsukasa Aihara ◽

Hiroshi Doi ◽

Naohiro Tomita ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Anal Verge ◽

Low Rectal Cancer ◽

Oncologic Outcomes ◽

Delayed Surgery ◽

Short Course ◽

Short Course Radiotherapy

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Initial Local Excision for Clinical T1 Rectal Cancer Showed Comparable Overall Survival Despite High Local Recurrence Rate: A Propensity-Matched Analysis

Annals of Coloproctology ◽

10.3393/ac.2021.00479.0068 ◽

2021 ◽

Author(s):

Jong Hee Hyun ◽

Mohamed K. Alhanafy ◽

Hyoung-Chul Park ◽

Su Min Park ◽

Sung-Chan Park ◽

...

Keyword(s):

Rectal Cancer ◽

Overall Survival ◽

Local Recurrence ◽

Recurrence Rate ◽

Local Excision ◽

Local Recurrence Rate ◽

T1 Rectal Cancer ◽

High Local Recurrence Rate

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The correlation of neutrophil/lymphocyte ratio and tumor reduction ratio in preoperative chermoradiotherapy for advanced rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.633 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 633-633

Author(s):

Koji Yasuda

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Blood Test ◽

Local Recurrence Rate ◽

Lower Rectal Cancer ◽

Test Results ◽

Blood Tests ◽

Tumor Reduction ◽

Rectal Cancers ◽

Reduction Effect

633 Background: Preoperative chemoradiotherapy (CRT) is widely used for the treatment of advanced lower rectal cancer and is considered to reduce the local recurrence rate and improve the anus preservation rate. However, the tumor reduction effect varies among patients, and thus far, no factor has yet been found to be effective in the prediction of therapeutic efficacy. Recent studies have shown tumor immunity in the tumor microenvironment to be involved in the anti-tumor effect of radiation and anti-cancer drugs. Among these studies, some show that the neutrophil/lymphocyte (NL) ratio in blood test results correlates with the therapeutic efficacy. We examined the correlation between the NL ratio based on blood test results and tumor-reducing effect of preoperative CRT on advanced lower rectal cancers. Methods: We included 30 advanced lower rectal cancer patients who underwent preoperative CRT during the period ranging from January 2008 to June 2013.For advanced lower rectal cancers classified as cT3orT4NXM0, preoperative CRT was conducted according to the following regimen: 50.4 Gy (1.8 Gy × 28 fr) + UFT (300 mg/day, LV [75 mg/day]) × 28 days. The neutrophil count and lymphocyte count were determined based on the blood tests conducted before and after CRT; the NL ratio was calculated, and the correlation between the value of the ratio and tumor reduction rate was examined. Results: Radical surgery was performed on 28 of the 30 patients who underwent preoperative CRT. One of the 28 patients showed local recurrence (rate, 3.6%). In addition, down stage tumors were found in 16 of the 28 patients, and the down stage rate was 57.1%. Significant differences (p < 0.0001) were found between the tumor reduction effect and NL ratio from blood tests before CRT, as well as between the tumor reduction effect and the ratio from blood tests after CRT. Conclusions: The above findings suggest anti-tumor immunity in the tumor microenvironment, particularly that lymphocytes might be involved in the antitumor effectiveness of preoperative CRT in advanced lower rectal cancers. In addition, NL ratio from blood tests could be a predictive factor of the tumor reduction effect.

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