scholarly journals Neoadjuvant Chemotherapy for Locally Advanced T4 Colon Cancer: A Nationwide Propensity-Score Matched Cohort Analysis

2019 ◽  
Vol 37 (4) ◽  
pp. 292-301 ◽  
Author(s):  
Jan-Marie de Gooyer ◽  
Marlies G. Verstegen ◽  
Jorine ’t Lam-Boer ◽  
Sandra A. Radema ◽  
Rob H.A. Verhoeven ◽  
...  
Keyword(s):  
Colon Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Group Versus ◽  
Control Group ◽  
Complication Rates ◽  
Term Survival ◽  
T4 Colon Cancer

Introduction: Neoadjuvant chemotherapy (CT) for locally advanced colon cancer (LACC) could potentially lead to tumor shrinkage, eradication of micrometastases, and prevention of tumor cell shedding during surgery. This retrospective study investigates the surgical and oncological outcomes of preoperative CT for LACC. Methods: Using the Netherlands Cancer Registry, data of patients with stage II or III colon cancer, diagnosed between 2008 and 2016 was collected. A propensity score matching (PSM; 1:2) was performed and compared patients with clinical tumor (cT) 4 colon cancer who were treated with neoadjuvant CT to patients with cT4 colon cancer treated with adjuvant CT (Fig. 1). Results: A total of 192 patients treated with neoadjuvant CT were compared to 1,954 patients that received adjuvant CT. After PSM, 149 patients in the neoadjuvant group were compared to 298 patients in the control group. No significant differences were found in baseline characteristics after PSM. After neoadjuvant CT, a significant response was observed in 13 (9%) patients with 5 (4%) patients showing a complete response. Complete resection margins (R0) were achieved in 77% in the neoadjuvant group versus 86% in the adjuvant treated group (p = 0.037). Significantly less tumor positive lymph nodes were found in the neoadjuvant group (median 0 vs. 2, p < 0.001). Major complication rates and 5-year overall survival did not differ between both groups (67–65%, p = 0.87). Conclusion: Neoadjuvant CT seems safe and feasible with similar long-term survival compared to patients who are treated with adjuvant CT.

scholarly journals 207 Laparoscopic versus Open Surgery for Locally Advanced Colon Cancer: A Retrospective Cohort Study

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
P W L Tay ◽  
J L Xiao ◽  
W H Lim ◽  
N W Wong ◽  
C S Chong
Keyword(s):  
Colon Cancer ◽  
Retrospective Cohort ◽  
Open Surgery ◽  
Cohort Analysis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Right Hemicolectomy ◽  
Surgical Methods ◽  
Significant Difference ◽  
T4 Colon Cancer

Abstract Introduction While an increasing number of studies substantiate the non-inferiority of laparoscopy to open surgery for pT4 colon cancer, studies investigating its value specific to the subgroup pT4a in right hemicolectomies remain scarce. Method We performed a retrospective cohort analysis in National University Hospital of Singapore of patients who underwent a right hemicolectomy for pT4 colon cancer. Statistical analysis was performed using Wilcoxon rank sum test and chi square/fisher exact. Results In total, 65 patients had T4 colon cancer. 55 underwent right hemicolectomy and 10 underwent extended right hemicolectomy. Baseline demographics were similar in laparoscopic (n = 27) and open (n = 38) groups, with no significant difference in proportion of pT4a patients (p = 0.724). For pT4, 30-day mortality (7%, 5% respectively, p = 0.723), overall survival (p = 0.1903) and disease-free survival (p = 0.3476) did not differ significantly between laparoscopic and open groups. R0 resection rates were significantly higher in laparoscopic group (p = 0.039). pT4a subgroup analysis found similar observations. Other complications including postoperative wound infection and anastomotic bleed were not significantly different for both T4 and T4a analysis. Conclusions This study presented comparable safety and oncological outcomes between the two surgical methods for right hemicolectomy, suggesting laparoscopy to be a viable alternative approach for locally advanced right colon cancer.

scholarly journals Neoadjuvant chemoradiotherapy improves survival in locally advanced adenocarcinoma of esophagogastric junction compared with neoadjuvant chemotherapy: a propensity score matching analysis

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jing Li ◽  
Qun Zhao ◽  
Xueke Ge ◽  
Yuzhi Song ◽  
Yuan Tian ◽  
...  
Keyword(s):  
Neoadjuvant Chemotherapy ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Esophagogastric Junction ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
R0 Resection ◽  
Term Survival ◽  
Propensity Score Matching Analysis ◽  
Significant Difference

Abstract Background To analyze whether neoadjuvant chemoradiotherapy (nCRT) could improve the survival for patients with adenocarcinoma of the esophagogastric junction compared with neoadjuvant chemotherapy (nCT). Both neoadjuvant chemotherapy alone and chemoradiotherapy before surgery have been shown to improve overall long-term survival for patients with adenocarcinoma in the esophagus or esophagogastric junction compared to surgery alone. It remains controversial whether nCRT is superior to nCT. Methods 170 Patients with locally advanced (cT3-4NxM0) Siewert II and III adenocarcinoma of the esophagogastric junction (AEG) were treated with neoadjuvant chemotherapy consisting of capecitabine plus oxaliplatin with or without concurrent radiotherapy in the Fourth Hospital of Hebei Medical University. Intensity-modulated radiation therapy (IMRT) was used and delivered in 5 daily fractions of 1.8 Gy per week for 5 weeks (total dose of PTV: 45 Gy). 120 Patients were included in the propensity score matching (PSM) analysis to compare the effects of nCRT with nCT on survival. Results With a median follow-up of 41.2 months for patients alive after propensity score matching analysis, the 1- and 3-year OS were 84.8%, 55.0% in nCRT group and 78.3%, 38.3% in nCT group (P = 0.040; HR = 1.65, 95% CI 1.02–2.69). The 1- and 3-year PFS were 84.9%, 49.2% in nCRT group and 68.3%, 29.0% in nCT group (P = 0.010; HR = 1.80, 95% CI 1.14–2.85). The pathological complete response (pCR) was 17.0% in nCRT group and 1.9% in nCT group (P = 0.030). No significant difference was observed in postoperative complications between the two groups. Conclusion The nCRT confers a better survival with improved R0 resection rate and pCR rate compared with nCT for the patients with locally advanced AEG.

scholarly journals Differences in effectiveness and use of laparoscopic surgery in locally advanced colon cancer patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
M. Schootman ◽  
Matthew Mutch ◽  
T. Loux ◽  
J. M. Eberth ◽  
N. O. Davidson
Keyword(s):  
Colon Cancer ◽  
Length Of Stay ◽  
Cancer Patients ◽  
Postoperative Ileus ◽  
Locally Advanced ◽  
Composite Outcome ◽  
Improvement Program ◽  
Advanced Colon Cancer ◽  
Outcome Score ◽  
T4 Colon Cancer

AbstractPatients with locally advanced colon cancer have worse outcomes. Guidelines of various organizations are conflicting about the use of laparoscopic colectomy (LC) in locally advanced colon cancer. We determined whether patient outcomes of LC and open colectomy (OC) for locally advanced (T4) colon cancer are comparable in all colon cancer patients, T4a versus T4b patients, obese versus non-obese patients, and tumors located in the ascending, descending, and transverse colon. We used data from the 2013–2015 American College of Surgeons’ National Surgical Quality Improvement Program. Patients were diagnosed with nonmetastatic pT4 colon cancer, with or without obstruction, and underwent LC (n = 563) or OC (n = 807). We used a composite outcome score (mortality, readmission, re-operation, wound infection, bleeding transfusion, and prolonged postoperative ileus); length of stay; and length of operation. Patients undergoing LC exhibited a composite outcome score that was 9.5% lower (95% CI − 15.4; − 3.5) versus those undergoing OC. LC patients experienced a 11.3% reduction in postoperative ileus (95% CI − 16.0; − 6.5) and an average of 2 days shorter length of stay (95% CI − 2.9; − 1.0). Patients undergoing LC were in the operating room an average of 13.5 min longer (95% CI 1.5; 25.6). We found no evidence for treatment heterogeneity across subgroups (p > 0.05). Patients with locally advanced colon cancer who receive LC had better overall outcomes and shorter lengths of stay compared with OC patients. LC was equally effective in obese/nonobese patients, in T4a/T4b patients, and regardless of the location of the tumor.

Neoadjuvant chemotherapy in locally advanced colon cancer: a systematic review and meta-analysis

2021 ◽  
Author(s):  
Rathin Gosavi ◽  
Clemente Chia ◽  
Michael Michael ◽  
Alexander G. Heriot ◽  
Satish K. Warrier ◽  
...  
Keyword(s):  
Systematic Review ◽  
Colon Cancer ◽  
Neoadjuvant Chemotherapy ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Advanced Colon Cancer

scholarly journals Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

2020 ◽  
Author(s):  
Yun Xu ◽  
Cong Li ◽  
Charlie Zhi-Lin Zheng ◽  
Yu-Qin Zhang ◽  
Tian-An Guo ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Control Group ◽  
Sporadic Colorectal Cancer ◽  
Long Term Outcomes ◽  
Term Survival ◽  
Long Term Survival ◽  
Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

scholarly journals Minimally invasive mitral valve surgery. An anesthesiologist''s viewpoint

2015 ◽  
Vol 17 (2) ◽  
pp. 11 ◽  
Author(s):  
V. A. Shmyrev ◽  
A. V. Bogachev-prokofev ◽  
V. V. Lomivorotov ◽  
D. N. Ponomarev ◽  
P. P. Perovskiy
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Fatal Outcome ◽  
Median Sternotomy ◽  
Group Versus ◽  
Mitral Valve Surgery ◽  
Control Group ◽  
Complication Rates ◽  
Valve Repair ◽  
Invasive Group

We conducted a retrospective comparative analysis of 75 patients undergoing video-assisted mitral valve repair with right minithoracotomy over a period from November 2011 to August 2013. The control group comprised 71 patients operated on mitral valve by using median sternotomy during the same period. Median (25th; 75th) times of cardiopulmonary bypass and aortic cross-clamping were significantly longer in the minimally invasive group (180 [139; 224] and 111 [87; 145] min, respectively) as compared to the controls (84 [69; 117] and 62 [49; 81 ] min, respectively), p<0.01. Fatal outcome occurred in 2 (2.7%) cases in the minimally invasive group versus none in the controls. In both cases death resulted from intraoperative aortic dissection. While ventilation time and intensive care unit stay were comparable across the groups, postoperative respiratory failure occurred in 6 (8%) cases in the minimally invasive group versus none in the controls (p<0.05). No other significant differences in the postoperative course were observed between the groups. The results of the present study are generally consistent with the world's tendencies. On the other hand, complication rates observed in the minimally invasive group present a considerable economic burden and require substantial human resources in the postoperative period.

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