Multivisceral, vascular and nodal resection for recurrent rectal cancer involving the left renal tract, left pelvic side wall and abdominal aorta

Abstract Background Local recurrence is common after curative resections for rectal cancer. Surgical intervention is among the best treatment choices. However, achieving a negative resection margin often requires extensive pelvic organ resections; thus, the postoperative complication rate is quite high. Recent studies have reported that the inflammatory index could predict postoperative complications. This study aimed to validate the correlation between clinical factors, including inflammatory markers, and severe complications after surgery for local recurrent rectal cancer. Methods This retrospective study included 99 patients that underwent radical resections for local recurrences of rectal cancer. Postoperative complications were graded according to the Clavien-Dindo classification. Grades ≥3 were defined as severe complications. Risk factors for severe complications were identified with univariate and multivariate logistic regression models and assessed with receiver-operating characteristic curves. Results Severe postoperative complications occurred in 38 patients (38.4%). Analyses of correlations between inflammatory markers and severe postoperative complications revealed that the strongest correlation was found between the prognostic nutrition index and severe postoperative complications. The receiver-operating characteristic analysis showed that the optimal prognostic nutrition index cut-off value was 42.2 (sensitivity: 0.790, specificity: 0.508). In univariate and multivariate analyses, a prognostic nutrition index ≤44.2 (Odds ratio: 3.007, 95%CI:1.171–8.255, p = 0.02) and a blood loss ≥2850 mL (Odds ratio: 2.545, 95%CI: 1.044–6.367, p = 0.04) were associated with a significantly higher incidence of severe postoperative complications. Conclusions We found that a low preoperative prognostic nutrition index and excessive intraoperative blood loss were risk factors for severe complications after surgery for local recurrent rectal cancer.

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455 Proton Beam Therapy in Rectal Cancer: A Systematic Review and Meta-Analysis

British Journal of Surgery ◽

10.1093/bjs/znab135.020 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

M Fok ◽

S Toh ◽

J E Maducolil ◽

H Fowler ◽

R Clifford ◽

...

Keyword(s):

Rectal Cancer ◽

Proton Beam ◽

Organs At Risk ◽

Meta Analysis ◽

Locally Advanced ◽

Significant Risk ◽

Proton Beam Therapy ◽

Recurrent Rectal Cancer ◽

Pelvic Bone ◽

Dosimetric Data

Abstract Introduction Radiotherapy for locally advanced rectal cancer is conventionally performed using photon-based radiotherapy (PBR), carrying significant risk of toxicity to organs at risk (OAR). Proton beam therapy (PBT) potentially delivers equivalent dosimetric radiation to the targeted tissue with improved sparing of OAR. We aimed to compare dosimetric irradiation of OAR for PBT versus PBR in patients with rectal cancer and assess any oncological outcomes. Method An extensive electronic literature search was performed from inception till April 2020 and subsequent meta-analysis performed. Results Six articles met the inclusion criteria. Dosimetric data of irradiation delivered to OAR for PBT and PBR were calculated for the same patients. PBT had significantly less irradiated small bowel compared to 3DCRT and IMRT, (MD -16.95, 95% CI [-24.03, -9.88], p < 0.00001) and (MD -6.96, 95% CI [-12.99, -0.94], p = 0.02) respectively. Similar results were observed for bladder and pelvic bone marrow. Two studies reported clinical and oncological results for PBT in recurrent rectal cancer with overall survival reported as 43% and 68%. Conclusions Dosimetric treatment plans have less irradiation of OAR for rectal cancer with PBT compared to PBR. There is a need for further research in PBT and rectal cancer, as promising results have been shown in recurrent rectal cancer.

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Treatment Outcomes of Re-irradiation in Locoregionally Recurrent Rectal Cancer and Clinical Significance of Proper Patient Selection

Frontiers in Oncology ◽

10.3389/fonc.2019.00529 ◽

2019 ◽

Vol 9 ◽

Cited By ~ 1

Author(s):

Seung Yeun Chung ◽

Woong Sub Koom ◽

Ki Chang Keum ◽

Jee Suk Chang ◽

Sang Joon Shin ◽

...

Keyword(s):

Rectal Cancer ◽

Treatment Outcomes ◽

Clinical Significance ◽

Patient Selection ◽

Recurrent Rectal Cancer ◽

Proper Patient Selection

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Intraoperative Electron Radiation Therapy (IOERT) in the management of locally recurrent rectal cancer

BMC Cancer ◽

10.1186/1471-2407-12-592 ◽

2012 ◽

Vol 12 (1) ◽

Cited By ~ 26

Author(s):

Falk Roeder ◽

Joerg-Michael Goetz ◽

Gregor Habl ◽

Marc Bischof ◽

Robert Krempien ◽

...

Keyword(s):

Rectal Cancer ◽

Radiation Therapy ◽

Recurrent Rectal Cancer ◽

Electron Radiation ◽

Locally Recurrent Rectal Cancer ◽

Locally Recurrent

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Sarcomatoid Carcinoma Manifesting as Recurrent Rectal Cancer and Mimicking Radiation-Induced Extraskeletal Osteosarcoma: A Case Report

International Journal of Surgical Pathology ◽

10.1177/1066896917715911 ◽

2017 ◽

Vol 25 (8) ◽

pp. 732-738 ◽

Cited By ~ 1

Author(s):

MiJo Lee ◽

Hyun-Jin Son ◽

Je-Ho Jang ◽

Hyun-Young Han ◽

Moon Hyang Park

Keyword(s):

Rectal Cancer ◽

Periodic Acid ◽

Neoadjuvant Chemoradiotherapy ◽

Sarcomatoid Carcinoma ◽

Gluteus Maximus ◽

Recurrent Rectal Cancer ◽

Extraskeletal Osteosarcoma ◽

Periodic Acid Schiff ◽

Calcified Tissue ◽

Radiation Induced

Here, we report an unusual case of sarcomatoid carcinoma mimicking extraskeletal osteosarcoma that manifested as recurrent rectal cancer. Five years earlier, a 76-year-old male patient had undergone neoadjuvant chemoradiotherapy followed by a laparoscopic low anterior resection due to adenocarcinoma of the rectum. He was admitted because of pain in the anus and left hip. He underwent abdominal computed tomography that revealed a newly developed left perirectal mass with gluteus maximus invasion measuring up to 8 cm, and therefore, an abdominoperineal resection was performed. Histologically, the tumor revealed sheets of spindled or epithelioid cells, an absence of gland formation, mucicarmine and periodic acid–Schiff stain negativity, and prominent intercellular deposits of osteoid-like calcified tissue. Tumor cells were diffusely immunoreactive for vimentin and cytokeratins. Ultrastructural examination demonstrated microvilli on the surface or within intercellular spaces. In this report, we also discuss the possible pathogenesis as well as the differential diagnosis.

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