Special Considerations of Anastomotic Leak in Patients with Rectal Cancer

AbstractAnastomotic leak in patients with rectal cancer has the potential to cause worse oncologic outcomes in addition to major morbidity and mortality risk of this dreaded complication. Anatomic location of the rectal cancer determines the ability to perform a restorative operation and the height of the anastomosis in relation to the anal canal. Clinical staging dictates the need for neoadjuvant treatment (such as chemotherapy and radiation) which may also contribute to anastomotic leak risk. In addition to oncologic outcomes, anastomotic leak can impact bowel function, the need for permanent stoma, and long-term quality of life. This study will discuss special considerations for anastomotic leak prevention and clinical implications of this complication in patients with rectal cancer.

Download Full-text

Long-term oncologic outcomes following anastomotic leak after anterior resection for rectal cancer: Less chemotherapy, more metastases

European Journal of Surgical Oncology ◽

10.1016/j.ejso.2018.07.040 ◽

2018 ◽

Vol 44 (10) ◽

pp. e10-e11 ◽

Cited By ~ 1

Author(s):

M.E. Allaix ◽

F. Rebecchi ◽

F. Famiglietti ◽

S. Arolfo ◽

M. Morino

Keyword(s):

Rectal Cancer ◽

Anastomotic Leak ◽

Anterior Resection ◽

Oncologic Outcomes

Download Full-text

Reliability and validity of a survey to measure bowel function and quality of life in long-term rectal cancer survivors

Quality of Life Research ◽

10.1007/s11136-014-0724-6 ◽

2014 ◽

Vol 23 (10) ◽

pp. 2831-2840 ◽

Cited By ~ 19

Author(s):

Christopher S. Wendel ◽

Marcia Grant ◽

Lisa Herrinton ◽

Larissa K. F. Temple ◽

Mark C. Hornbrook ◽

...

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Cancer Survivors ◽

Reliability And Validity ◽

Bowel Function

Download Full-text

Prognostic implications of surgical specimen quality on the oncological outcomes of open and laparoscopic surgery in mid and low rectal cancer

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02351-1 ◽

2021 ◽

Author(s):

Vicente Pla-Martí ◽

José Martín-Arévalo ◽

David Moro-Valdezate ◽

Stephanie García-Botello ◽

Leticia Pérez-Santiago ◽

...

Keyword(s):

Rectal Cancer ◽

Disease Free Survival ◽

Laparoscopic Approach ◽

Low Rectal Cancer ◽

Oncologic Outcomes ◽

Distal Margin ◽

Surgical Specimen ◽

Oncological Outcomes

Abstract Purpose Determine differences in pathologic outcomes between laparoscopic (LAP) and open surgery (OPEN) for mid and low rectal cancer and its influence in long-term oncological outcomes. Methods Retrospective case matched study at a tertiary institution. Adults with rectal cancer below 12 cm from the anal verge operated between January 2005 and September 2018 were included. Primary outcomes were quality of specimen, overall survival (OS), disease-free survival (DFS), and local recurrence (LR). Results The study included 311 patients, LAP = 108 (34.7%), OPEN = 203 (65,3%). A successful resection was accomplished in 81% of the LAP group and in 84.5% of the OPEN (p = 0.505). No differences in free distal margin (LAP = 100%, OPEN = 97.5%; p = 0.156) or circumferential resection margin (LAP = 95.2%, OPEN = 93.2%; p = 0.603) were observed. However, mesorectum quality was incomplete in 16.2% for LAP and in 8.1% for OPEN (p = 0.048). OS was 91.1% for LAP and 81.1% for OPEN (p = 0.360). DFS was 81.4% for LAP and 77.5% for OPEN (p = 0.923). Overall, LR was 2.3% without differences between groups. Conclusions Laparoscopic approach could affect the quality of surgical specimen due to technical aspects. However, if principles of surgical oncology are respected, minor pathologic differences in the quality of the mesorectum may not influence on the long-term oncologic outcomes.

Download Full-text

Multimodal Rectal Cancer Treatment: In Some Cases, Less May Be More

American Society of Clinical Oncology Educational Book ◽

10.1200/edbk_159221 ◽

2016 ◽

pp. 92-102 ◽

Cited By ~ 1

Author(s):

Julio Garcia-Aguilar ◽

Rob Glynne-Jones ◽

Deborah Schrag

Keyword(s):

Quality Of Life ◽

Rectal Cancer ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Oncologic Outcomes ◽

Clinical Staging ◽

Treatment Modalities ◽

Adjuvant Chemoradiotherapy

A series of clinical trials in the last several decades has resulted in the development of multimodality treatment of locally advanced rectal cancer that includes neoadjuvant (preoperative) chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemoradiotherapy. Owing to this regimen, patients with locally advanced rectal cancer have better survival rates than patients with colon cancer, but at the cost of substantial morbidity and reduced quality of life. The challenge is to identify treatment approaches that maintain or even improve oncologic outcomes while preserving quality of life. We have identified different tumor characteristics that are associated with recurrence and probability of survival for locally advanced rectal cancer. This risk stratification, based on baseline clinical staging and tumor response to chemoradiotherapy, has led us to question whether all patients with locally advanced rectal cancer require every component of the multimodal regimen. In this article, we will review recent evidence that some patients with locally advanced rectal cancer can be spared one or more treatment modalities without compromising long-term oncologic outcomes and while preserving quality of life.

Download Full-text