Regional differences in local recurrence rates after rectal cancer surgery

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.

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Phenotypic subtypes and risk of local recurrence after radical resection for rectal cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.4_suppl.637 ◽

2018 ◽

Vol 36 (4_suppl) ◽

pp. 637-637

Author(s):

Katrina Knight ◽

Antonia K. Roseweir ◽

James Hugh Park ◽

Joanne Edwards ◽

Donald C McMillan ◽

...

Keyword(s):

At Risk ◽

Rectal Cancer ◽

Local Recurrence ◽

Neoadjuvant Therapy ◽

Vascular Invasion ◽

Immune Cell ◽

Tumor Grade ◽

Radical Resection ◽

Cancer Surgery ◽

Rectal Cancer Surgery

637 Background: Phenotypic subtypes for CRC are reported to stratify outcomes. The four subtypes are based on features within the consensus molecular subtypes (CMS): immune, canonical, latent and stromal. In 81 pts, we recently reported concordance between CMS and phenotypic subtypes. Of note, the stromal subtype matched the CMS4 subtype in 84%. Local recurrence (LR) after rectal cancer surgery remains a problem. Identifying those at risk determines who should receive neoadjuvant therapy (NT) and guides surgery. We evaluated whether phenotypic subtypes are associated with LR after radical treatment of rectal cancer. Methods: From a CRC database, pts with rectal cancer and phenotypic subtyping available were identified. Subtyping was performed based on immune cell infiltrate, stromal volume and tumor proliferation. LR was considered pelvic or peritoneal. Results: Between 1997-2007, 260 pts had surgery for rectal cancer. Most were > 65yrs (63%), male (58%) and TNM stage II (39%) or III (37%). 32 (13%) received NT. For phenotypic subtypes, 88 (35%) were Immune, 47 (19%) Canonical, 48 (19%) Latent and 67 (27%) Stromal. Median FU was 138 months (min 88). 70 pts (27%) developed recurrence: LR in 23 (8.8%) and systemic in 44 (16.9%). LR was associated with higher T stage (pT1-3 7% vs pT4 17%, p = 0.024), presence of vascular invasion (15% vs 6%, p = 0.018), serosal involvement (21% vs 6%, p = 0.001), margin involvement (22% vs 7%, p = 0.010), > 50% tumor stroma (18% vs 3%, p = 0.002) and phenotypic subtype (immune 5%, canonical 6%, latent 4% and stromal = 21%, p = 0.002). Similar LR rates were obtained after excluding pts who had NT: Immune (4%), canonical (4%), latent (5%) and stromal (23%). Of the 23 LRs, most were Stromal subtype (n = 14) vs Immune (n = 4), Canonical (n = 3) and Latent (n = 2). Apart from increased node positivity (50% vs 30-44% p < 0.05), there were no differences in rates of pT4 disease, tumor grade, vascular invasion, serosal involvement and margin positivity between stromal subtype and other groups. Conclusions: LR after rectal cancer surgery was associated with the stromal subtype. Validation is needed but pre-treatment tumor subtyping may identify subsets at risk of LR and have implications for patient selection for neoadjuvant therapy.

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Local recurrence (LR) rates after operable rectal cancer surgery

International Journal of Surgery ◽

10.1016/j.ijsu.2012.06.130 ◽

2012 ◽

Vol 10 (8) ◽

pp. S24

Author(s):

Robert Nadler ◽

Daniel Brown ◽

Sue Hignett ◽

Carol Makin ◽

Goldie Khera

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Cancer Surgery ◽

Rectal Cancer Surgery

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A New Prediction Model for Local Recurrence After Curative Rectal Cancer Surgery

Diseases of the Colon & Rectum ◽

10.1097/dcr.0000000000000896 ◽

2017 ◽

Vol 60 (11) ◽

pp. 1168-1174 ◽

Cited By ~ 3

Author(s):

Koya Hida ◽

Ryosuke Okamura ◽

Soo Yeun Park ◽

Tatsuto Nishigori ◽

Ryo Takahashi ◽

...

Keyword(s):

Rectal Cancer ◽

Local Recurrence ◽

Prediction Model ◽

Cancer Surgery ◽

Rectal Cancer Surgery

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The importance of training and education in performing total mesorectal excision in rectal cancer surgery

Vojnosanitetski pregled ◽

10.2298/vsp150224187p ◽

2017 ◽

Vol 74 (4) ◽

pp. 349-353

Author(s):

Tomislav Petrovic ◽

Ferenc Vicko ◽

Dragana Radovanovic ◽

Nemanja Petrovic ◽

Milan Ranisavljevic ◽

...

Keyword(s):

Rectal Cancer ◽

Surgical Treatment ◽

Local Recurrence ◽

Anastomotic Leakage ◽

New Technologies ◽

Surgical Techniques ◽

Cancer Surgery ◽

Rectal Cancer Surgery ◽

Significant Difference ◽

Duration Of Surgery

Background/Aim. In the last two decades there has been a significant progress in rectal cancer surgery. Preoperative radiotherapy, the introduction of staplers and largely improved surgical techniques have greatly contributed to better treatment outcomes, primarily by reducing the frequency of early surgical complications and the rate of local recurrence. The aim of this study was to compare operative and postoperative results in the treatment of rectal cancer between the two groups of surgeons ? those who are closely engaged in colorectal surgery and those who deal with these issues sporadically. Methods. This retrospective study included 146 patients who had underwent rectal cancer surgery at the Institute of Oncology of Vojvodina in the period from January 1, 2008 to December 31, 2010. The patients were divided into two groups, the group N1 of 101 patients operated on by trained colorectal surgeons, and the group N2 of 45 patients operated on by surgeons without training in totalmesorectal excision (TME). Results. Preoperative chemoradiotherapy was received by 49 (33.56%) of the patients. A statistically significant difference between the two groups was noted in the duration of surgery and the need for blood transfusion during surgery. Anastomotic leakage occurred in 3 patients from the group N1 and in 10 patients from the group N2. Seven (4.79%) of the patients developed local recurrence after surgical treatment. There were significant differences in local recurrence rate and anastomotic leakage rate between the compared groups. Conclusion. It is necessary to continue education and training in surgery for rectal cancer to master new technologies and surgical techniques and to improve the results of surgical treatment.

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