Radiotherapy after local excision of rectal cancer may offer reduced local recurrence rates

2019 ◽  
Vol 21 (4) ◽  
pp. 451-459 ◽  
Author(s):  
H. J. S. Jones ◽  
S. Goodbrand ◽  
R. Hompes ◽  
N. Mortensen ◽  
C. Cunningham
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Local Excision ◽  
Recurrence Rates

scholarly journals Conjunctival melanoma treatment outcomes in 288 patients: a multicentre international data-sharing study

2020 ◽  
pp. bjophthalmol-2020-316293
Author(s):  
Puneet Jain ◽  
Paul T Finger ◽  
Maria Fili ◽  
Bertil Damato ◽  
Sarah E Coupland ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Local Excision ◽  
External Beam Radiotherapy ◽  
Staging System ◽  
Primary Treatment ◽  
Excision Biopsy ◽  
Conjunctival Melanoma ◽  
Recurrence Rates ◽  
Increased Risk ◽  
Eighth Edition

BackgroundTo relate conjunctival melanoma characteristics to local control.MethodsRetrospective, registry-based interventional study with data gathered from 10 ophthalmic oncology centres from 9 countries on 4 continents. Conjunctival melanoma patients diagnosed between January 2001 and December 2013 were enrolled in the study. Primary treatments included local excision, excision with cryotherapy and exenteration. Adjuvant treatments included topical chemotherapy, brachytherapy, proton and external beam radiotherapy (EBRT). Cumulative 5-year and 10-year Kaplan-Meier local recurrence rates were related to clinical and pathological T-categories of the eighth edition of the American Joint Committee on Cancer (AJCC) staging system.Results288 patients had a mean initial age of 59.7±16.8 years. Clinical T-categories (cT) were cT1 (n=218,75.7%), cT2 (n=34, 11.8%), cT3 (n=15, 5.2%), cTx (n=21,7.3%) with no cT4. Primary treatment included local excision (n=161/288, 55.9%) followed by excision biopsy with cryotherapy (n=108/288, 37.5%) and exenteration (n=5/288, 1.7%). Adjuvant therapies included topical mitomycin (n=107/288, 37.1%), plaque-brachytherapy (n=55/288, 19.1%), proton-beam (n=36/288, 13.5%), topical interferon (n=20/288, 6.9%) and EBRT (n=15/288, 5.2%). Secondary exenteration was performed (n=11/283, 3.9%). Local recurrence was noted in 19.1% (median=3.6 years). Cumulative local recurrence was 5.4% (3.2–8.9%), 19.3% (14.4–25.5%) and 36.9% (26.5–49.9%) at 1, 5 and 10 years, respectively. cT3 and cT2 tumors were twice as likely to recur than cT1 tumours, but only cT3 had statistically significantly greater risk of local recurrence than T1 (p=0.013). Factors such as tumour ulceration, plica or caruncle involvement and tumour thickness were not significantly associated with an increased risk of local recurrence.ConclusionThis multicentre international study showed that eighth edition of AJCC tumour staging was related to the risk of local recurrence of conjunctival melanoma after treatment. The 10-year cumulative local recurrence remains high despite current management.

EP.TU.370A 5-year re-audit of quality indicators for potentially curative rectal cancer resections by a single surgeon

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Jessica Lockhart ◽  
Damian McKay
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Resection Margin ◽  
Length Of Hospital Stay ◽  
Long Term Outcomes ◽  
Recurrence Rates ◽  
High Quality ◽  
Curative Intent ◽  
R1 Resection

Abstract Aim High quality operations with low rates of tumour perforation and circumferential resection margin (CRM) positivity are associated with improved long-term outcomes following surgery for rectal cancer. Previous audit has demonstrated lower rates of tumour perforation and CRM positivity by a single surgeon compared to the published standards. Our aim is to re-audit this surgeons’ outcomes for curative rectal resections. Methods Data was collected retrospectively for all potentially curative rectal resections over a 5-year period performed by a single surgeon using a local database and electronic care records. The CRM status and tumour perforation status were considered. Other end points included the rate of local recurrence, survival and length of stay. Results Fifty-one patients underwent rectal resections with curative intent, with a median age of 67. Complete resection (R0) was achieved in 94.1% of cases; 3.92% were found to have nodes less than 1mm from the margin and 1.96% were found to have tumour deposit less than 1mm from the margin – these cases were considered to be an R1 resection. Tumour perforation was present in 3.92% of cases, all of which had occurred pre-operatively. Local recurrence was found in 5.88% of cases and 90-day mortality was 1.96%. Median length of hospital stay was 7 days. Conclusion Our data demonstrates sustained high quality surgical outcomes with low tumour perforation rates and CRM positivity rates which compare favourably with the published standards to date. Local recurrence rates are comparable to published standards and 90-day mortality continues to be low.

Pushing the envelope beyond a centimeter in rectal cancer: Oncologic implications of close but negative margins.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 487-487
Author(s):  
T. L. Fitzgerald ◽  
J. Brinkley ◽  
E. E. Zervos
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Sphincter Preservation ◽  
Distal Margin ◽  
Recurrence Rates ◽  
Randomized Controlled Studies ◽  
Number Of Patients

487 Background: Advances in surgery, adjuvant therapy and understanding of the natural history of rectal cancer has enabled sphincter preservation surgery for most patients. A 1 cm margin is commonly accepted as minimal distal margin, when not achievable many are relegated to permanent colostomy. Our purpose was to determine if distal margins of < 1 cm is justified by the world's published experience. Methods: Studies were identified with a MEDLINE search using terms rectal cancer, colorectal cancer, margins and distal margins with an additional manual search. There were no restrictions on data type or year of publication. All studies were retrospective or prospective, none were randomized controlled. Studies were excluded if specific margins, local recurrence rates or case level data could not be extracted. Extracted variables included year of publication, time span, number of patients, standardized surgery, radiotherapy, margins, follow up, local recurrence rates and overall survival. Meta-analysis was performed using a random weighting scheme. Values were aggregated across studies to determine overall impact and p-values. Results: Seventeen studies reported margins with thirteen studies, 3,232 patients, reporting outcomes when < 1cm. Meta-analysis of all studies indicated a nonsignificant trend favoring greater margins. However, in order to understand distal margins in the context of current standards additional analyses were performed. Of the thirteen studies 4 reported neither TME nor use adjuvant radiotherapy and 9 studies reported use of one or both. When either total mesorectal excision and/or adjuvant radiotherapy was reported there was no significant increase in local recurrence with distal margins < 1 cm. In studies that used neither therapy > 1 cm margins were statistically less prone to recurrence. Conclusions: Sphincter preservation is possible with < 1 cm distal margin when optimal surgical and adjuvant therapy are applied. [Table: see text]

scholarly journals The effect of rectal washout on local recurrence following rectal cancer surgery

2018 ◽  
Vol 100 (2) ◽  
pp. 146-151 ◽  
Author(s):  
SR Moosvi ◽  
K Manley ◽  
J Hernon
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Anterior Resection ◽  
High Volume ◽  
Conclusive Evidence ◽  
Rectal Cancer Surgery ◽  
Single Institution ◽  
Recurrence Rates ◽  
Rectal Washout ◽  
Significant Difference

Introduction Local recurrence after surgery for rectal cancer is associated with significant morbidity and debilitating symptoms. Intraoperative rectal washout has been linked to a reduction in local recurrence but there is no conclusive evidence. The aim of this study was to evaluate whether performing rectal washout had any effect on the incidence of local recurrence in patients undergoing anterior resection for rectal cancer in the context of the current surgical management. Methods A total of 395 consecutive patients who underwent anterior resection with or without rectal washout for rectal cancer between January 2003 and July 2009 at a high volume single institution were analysed retrospectively. A standardised process for performing washout was used and all patients had standardised surgery in the form of total mesorectal excision. Neoadjuvant and adjuvant therapy was used on a selected basis. Patients were followed up for five years and local recurrence rates were compared in the two groups. Results Of the 395 patients, 297 had rectal washout and 98 did not. Both groups were well matched with regard to various important clinical, operative and histopathological characteristics. Overall, the local recurrence rate was 5.3%. There was no significant difference in the incidence of local recurrence between the washout group (5.7%) and the no washout group (4.1%). Conclusions Among our cohort of patients, there was no statistical difference in the incidence of local recurrence after anterior resection with or without rectal washout. This suggests that other factors are more significant in the development of local recurrence.

Regional differences in local recurrence rates after rectal cancer surgery

2009 ◽  
Vol 12 (10Online) ◽  
pp. e206-e215 ◽  
Author(s):  
K. Kodeda ◽  
E. Holmberg ◽  
G. Steineck ◽  
S. Nordgren
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Regional Differences ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery ◽  
Recurrence Rates

Improved Outcomes for Rectal Cancer in the Era of Preoperative Chemoradiation and Tailored Mesorectal Excision: A Series of 338 Consecutive Cases

2013 ◽  
Vol 79 (2) ◽  
pp. 151-161
Author(s):  
Fabio Pacelli ◽  
Alejandro M. Sanchez ◽  
Marcello Covino ◽  
Antonio P. Tortorelli ◽  
Maurizio Bossola ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Clinical Stage ◽  
Neoadjuvant Treatment ◽  
Intraoperative Radiotherapy ◽  
Disease Free Survival ◽  
Long Term Results ◽  
Mesorectal Excision ◽  
Recurrence Rates ◽  
Neoadjuvant Radiotherapy

Neoadjuvant chemoradiation (CRT), tailored mesorectal excision, and intraoperative radiotherapy (IORT) have become the leading measures for rectal cancer treatment. The objective of this study was to evaluate early and long-term results of a multimodal treatment model for rectal cancer followed by curative surgery. Prospectively collected hospital records of 338 patients surgically treated for rectal cancer between January 1998 and December 2008 were retrospectively reviewed. Patients with high rectum level cancers and those with middle and low rectum cancers with clinical stage T1 to T2 underwent surgery, whereas those with T3 to T4 and N1 disease at the middle and low rectum received neoadjuvant CRT in 96.2 per cent of cases. Short-course neoadjuvant radiotherapy was not considered for neoadjuvant treatment. Postoperative major complications and mortality rates were 12.7 and 2.3 per cent, respectively. Overall 5-year disease-specific and disease-free survival were 80 and 73.1 per cent, respectively, whereas local recurrence rate was 6.1 per cent. At multivariate analysis, nodal status and circumferential margin status were independently associated with poor survival; local recurrence rates were independently affected by nodal and marginal status and tumor stage. The extent of mesorectal excision should be tailored depending on tumor location and the use of neoadjuvant chemotherapy, combined with IORT in advanced middle and low rectal cancer, leading to remarkable tumor downstaging with excellent prognosis in responding patients.

Surgical Treatment of Stage I Rectal Cancer

2020 ◽  
Author(s):  
Julio Garcia-Aguilar
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Minimally Invasive ◽  
Total Mesorectal Excision ◽  
Local Excision ◽  
Neoadjuvant Chemoradiotherapy ◽  
Transanal Excision ◽  
Resection Margins ◽  
Rectal Tumors ◽  
Mesorectal Excision

For treatment of early-stage rectal cancer, local (transanal) excision offers the advantages of lower rates of morbidity, mortality, and functional impairment in comparison with radical surgery such as total mesorectal excision (TME). Minimally invasive platforms facilitate removal of rectal tumors that are beyond the reach of conventional transanal excision techniques. The main drawback of local excision is the higher risk of local recurrence compared with TME. The risk of local recurrence is higher in patients with close resection margins, tumors penetrating beyond the submucosa, or tumors with unfavorable histologic features. In these patients, outcomes for immediate proactive TME are generally better than observation followed by reactive salvage TME in case of local recurrence. The use of neoadjuvant chemoradiotherapy may make local excision a viable option for T2 rectal tumors. As chemoradiation and local excision are being increasingly used for later-stage tumors, advances in imaging technologies will play a crucial role in facilitating careful patient selection.   This review contains 5 figures, 5 tables and 37 references Key words: endocavitary contact radiotherapy, local excision, local recurrence, rectal cancer, salvage surgery, total mesorectal excision, transanal endoscopic operation, transanal excision, transanal minimally invasive surgery  

Local Recurrence After Local Excision of Early Rectal Cancer

1993 ◽  
pp. 541-543
Author(s):  
Yasuhisa Yamamoto ◽  
Tsutomu Mure ◽  
Sueharu Iwamoto ◽  
Kaiso Sano
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Local Excision ◽  
Early Rectal Cancer
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