Sphincter Preservation for Distal Rectal Cancer

2008 ◽  
Vol 31 (2) ◽  
pp. 195-198 ◽  
Author(s):  
Maher A. Abbas
Keyword(s):  
Rectal Cancer ◽  
Sphincter Preservation ◽  
Distal Rectal Cancer

scholarly journals Preoperative Volumetric Modulated Arc Therapy With Simultaneous Integrated Boost for Locally Advanced Distal Rectal Cancer

2019 ◽  
Vol 18 ◽  
pp. 153303381882436 ◽  
Author(s):  
Yongqiang Yang ◽  
Qiteng Liu ◽  
Baoqing Jia ◽  
Xiaohui Du ◽  
Guanghai Dai ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Response Rate ◽  
Volumetric Modulated Arc Therapy ◽  
Sphincter Preservation ◽  
Pathological Response ◽  
Complete Pathological Response ◽  
Distal Rectal Cancer ◽  
Arc Therapy ◽  
Integrated Boost ◽  
Preservation Rate

The aim of this study was to evaluate the safety and clinical efficacy of a combined preoperative regimen consisting of volumetric modulated arc therapy–simultaneous integrated boost and capecitabine chemotherapy for distal rectal cancer. A total of 26 patients with locally advanced distal rectal cancer were enrolled from March 2015 to May 2016. The radiation dose fractionation was 58.75 Gy/25 fractions (2.35 Gy/fraction) for rectal tumor and pelvic lymph node metastasis and 50 Gy/25 fractions for pelvic lymph node stations, accompanied with simultaneous capecitabine chemotherapy. Completion of the simultaneous chemotherapy was ensued by 1 week of rest and then another cycle of induction chemotherapy with capecitabine. A radical rectal cancer surgery was performed 6 to 8 weeks after the simultaneous chemoradiotherapy. The primary end points were the complete pathological response rate and the postoperative sphincter preservation rate. All 26 patients completed the neoadjuvant chemoradiotherapy, among which 25 received surgical treatment. The postoperative complete pathological response rate was as high as 32% (8/25), while the sphincter preservation rate was 60% (15/25), the overall tumor/node (T/N) downstaging rate was 92% (23/25), and the R0 resection rate was 100%. During the chemoradiation, the most common adverse events were grade 1 and 2; grade 3 radiodermatitis occurred in 2 cases but no occurrence of acute adverse events occurred that were grade 4 and above. After the surgery, there was one case of ureteral injury and one case of intestinal obstruction, but no perioperative deaths occurred. In conclusion, the chemoradiation regimen of preoperative volumetric modulated arc therapy-simultaneous integrated boost (VMAT-SIB58.75Gy) and a single cycle of induction chemotherapy with capecitabine for patients with distal rectal cancer is safe and feasible with a satisfactory complete pathological response rate, sphincter preservation rate, and R0 resection rate.

Distal cT2N0 Rectal Cancer: Is There an Alternative to Abdominoperineal Resection?

2005 ◽  
Vol 23 (22) ◽  
pp. 4905-4912 ◽  
Author(s):  
Ramesh Rengan ◽  
Philip Paty ◽  
W. Douglas Wong ◽  
Jose Guillem ◽  
Martin Weiser ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Pathologic Complete Response ◽  
Rectal Adenocarcinoma ◽  
Sphincter Preservation ◽  
External Beam Radiation ◽  
Cancer Center ◽  
Beam Radiation ◽  
Pelvic Radiation ◽  
Distal Rectal Cancer

Purpose Patients with cT2N0 distal rectal cancer do not require adjuvant therapy. However, when a patient refuses an abdominoperineal resection (APR), is there an alternative? The purpose of this trial is to determine whether preoperative external-beam radiation therapy can increase the rate of sphincter preservation for patients with distal cT2N0 adenocarcinoma of the rectum. Patients and Methods Between April 1988 and October 2003, 27 patients with distal rectal adenocarcinoma staged T2 by clinical and/or endorectal ultrasound who were judged by the operating surgeon to require an APR were treated with preoperative pelvic radiation alone (50.4 Gy). Surgery was performed 4 to 7 weeks later. If pathologic positive pelvic nodes were identified, postoperative adjuvant chemotherapy was recommended. The median follow-up was 55 months (range, 9 to 140 months). Results The pathologic complete response rate was 15% and 78% of patients underwent a sphincter-sparing procedure. The crude incidence of local failure for patients undergoing a sphincter sparing procedure was 10% and the 5-year actuarial incidence was 13%. The actuarial 5-year survival for patients undergoing sphincter preservation was as follows: disease-free, 77%; colostomy-free, 100%; and overall, 85%. Using the Memorial Sloan-Kettering Cancer Center sphincter function score, 54% of those undergoing a sphincter-sparing procedure had good/excellent bowel function at 12 to 24 months after surgery, and 77% had good/excellent function at 24 to 36 months after surgery. Conclusion Our data suggest that for patients with cT2N0 distal rectal cancer who require an APR, preoperative pelvic radiation improves sphincter preservation without an apparent compromise in local control or survival.

scholarly journals Intersphincteric Resection Pushing the Envelope for Sphincter Preservation

2017 ◽  
Vol 30 (05) ◽  
pp. 368-376 ◽  
Author(s):  
Quentin Denost ◽  
Eric Rullier
Keyword(s):  
Rectal Cancer ◽  
Surgical Treatment ◽  
Sphincter Preservation ◽  
Intersphincteric Resection ◽  
Technical Aspects ◽  
Oncological Outcomes ◽  
Distal Rectal Cancer ◽  
End Colostomy ◽  
Bowel Continuity ◽  
Restoration Of Bowel Continuity

AbstractDuring the last 15 years, a significant evolution has emerged in the surgical treatment of rectal cancer and restoration of bowel continuity has been one of the main goals. For many years the treatment of distal rectal cancer would necessarily require an abdominoperineal resection and end colostomy. The surgical procedure of intersphincteric resection has been proposed to offer sphincter preservation in patients with low rectal cancer and has been legitimized if executed according to adequate oncologic criteria. This article will discuss the best indications, technical aspects, functional, and oncological outcomes of intersphicteric resection in the management of rectal cancer.

Preoperative chemoradiotherapy permits <1 CM distal margin and sphincter preservation for distal rectal cancer

1998 ◽  
Vol 114 ◽  
pp. A1403
Author(s):  
B.W. Kuvshinoff ◽  
I. Magfoor ◽  
B. Miedema ◽  
J. Wilkes ◽  
S. Westgate ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Preoperative Chemoradiotherapy ◽  
Sphincter Preservation ◽  
Distal Margin ◽  
Distal Rectal Cancer

Sphincter Preservation for Distal Rectal Cancer: Paradise Lost?

1999 ◽  
Vol 6 (5) ◽  
pp. 413-415 ◽  
Author(s):  
Nicholas J. Petrelli ◽  
Thomas K. Weber
Keyword(s):  
Rectal Cancer ◽  
Paradise Lost ◽  
Sphincter Preservation ◽  
Distal Rectal Cancer

scholarly journals Can Pre-Treatment Inflammatory Parameters Predict the Probability of Sphincter-Preserving Surgery in Patients with Locally Advanced Low-Lying Rectal Cancer?

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 946
Author(s):  
Richard Partl ◽  
Katarzyna Lukasiak ◽  
Bettina Stranz ◽  
Eva Hassler ◽  
Marton Magyar ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Sphincter Preservation ◽  
Independent Predictive Factor ◽  
Lymphocyte Ratio ◽  
Inflammatory Parameters ◽  
Pre Treatment

There is evidence suggesting that pre-treatment clinical parameters can predict the probability of sphincter-preserving surgery in rectal cancer; however, to date, data on the predictive role of inflammatory parameters on the sphincter-preservation rate are not available. The aim of the present cohort study was to investigate the association between inflammation-based parameters and the sphincter-preserving surgery rate in patients with low-lying locally advanced rectal cancer (LARC). A total of 848 patients with LARC undergoing radiotherapy from 2004 to 2019 were retrospectively reviewed in order to identify patients with rectal cancer localized ≤ 6 cm from the anal verge, treated with neo-adjuvant radiochemotherapy (nRCT) and subsequent surgery. Univariable and multivariable analyses were used to investigate the role of pre-treatment inflammatory parameters, including the C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for the prediction of sphincter preservation. A total of 363 patients met the inclusion criteria; among them, 210 patients (57.9%) underwent sphincter-preserving surgery, and in 153 patients (42.1%), an abdominoperineal rectum resection was performed. Univariable analysis showed a significant association of the pre-treatment CRP value (OR = 2.548, 95% CI: 1.584–4.097, p < 0.001) with sphincter preservation, whereas the pre-treatment NLR (OR = 1.098, 95% CI: 0.976–1.235, p = 0.120) and PLR (OR = 1.002, 95% CI: 1.000–1.005, p = 0.062) were not significantly associated with the type of surgery. In multivariable analysis, the pre-treatment CRP value (OR = 2.544; 95% CI: 1.314–4.926; p = 0.006) was identified as an independent predictive factor for sphincter-preserving surgery. The findings of the present study suggest that the pre-treatment CRP value represents an independent parameter predicting the probability of sphincter-preserving surgery in patients with low-lying LARC.

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