Long term analysis of recurrences in patients treated by multimodality approach for local treatment of early rectal cancer—Liverpool’s Experience

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 18539-18539 ◽  
Author(s):  
A. Sun Myint ◽  
F. Elam ◽  
A. McDonald ◽  
M. J. Hershman
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Salvage Surgery ◽  
Local Treatment ◽  
Early Rectal Cancer ◽  
Radical Radiotherapy ◽  
Mortality And Morbidity ◽  
Multimodality Approach

18539 Background: Local treatment of early rectal cancer with curative intent is highly controversial. Three years ago, we reported our results in 100 patients treated by multimodality approach. We have updated our results and analyse the pattern of recurrences in155 patients treated up to 2005 Methods: From Jan 1992 to Jan 2005, local treatment was offered to 155 patients with low rectal carcinoma. The majority of patients were elderly with the mean age of 76 years( range 33–101). There were 87 males and 68 females. 109 had surgery; TEM (79 patients) and TAR(30 patients). Forty six patients had radical radiotherapy alone.Locally treated patients were followed up regularly with DRE and sigmoidoscopy. CT and MRI scans were done at 0,12 and 24 months. Results: Local recurrence only occured in 13 patients (8.3%). Four patients had local and distant recurrence (2.5%). Overall local recurrence occured in 17 patients (10.8 %). Salvage surgery was carried out in 11 patients(10 APER and 1 local excision). Two had retreatment with Papillon. A total of 13 patients had salvage treatments (76.5%). At median follow-up of 40 months (range 12–168) only 72.7% of patients were still alive. Five patients (3.2%) developed distant metastases only and one had nodal recurrence. Cancer specific survival was 96% and colostomy free survival was 93%. Conclusions: Local treatment of early rectal cancer is a complex issue that needs to be address and discuss. As ageing populationis likely to increased in the next decade demands on local treatment will increase. It is important to balance the benefits of radical surgery in terms of lower local recurrence against increase mortality and morbidity from such procedures especially in elderly patients, versus slightly higher local recurrences and much lower mortality and morbidity from conservative treatments such as TEM and Papillon contact radical radiotherapy. Our study has shown that local treatment is safe and effective treatment for elderly patients with medical co morbidity. In our experience, salvage surgery can be offered for recurrences in the majority of patients but long term close follow-up is necessary. A careful case selection and multimodality treatment is essential for successful out come. No significant financial relationships to disclose.

scholarly journals EARLY RECTAL CANCER: LOCAL EXCISION OR TOTAL MESORECTAL EXCISION?

2018 ◽  
pp. 42-48 ◽  
Author(s):  
A. V. Semenov ◽  
E. S. Savicheva ◽  
D. E. Popov ◽  
S. V. Vasiliev
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Total Mesorectal Excision ◽  
Preoperative Staging ◽  
Early Rectal Cancer ◽  
Mesorectal Excision ◽  
Free Survival ◽  
Prospective Group ◽  
Oncological Results

AIM of this study was to improve treatment outcomes for early rectal cancer; to assess the accuracy of endorectal ultrasound (ERUS) in preoperative staging of early rectal cancer. MATERIAL AND METHODS. A total of 42 patients of the main prospective group with early rectal cancer underwent transanal local excision (LE). In control retrospective group 39 patients underwent radical resection with total mesorectal excision (TME). Operation time, perioperative, hospital stay duration long-term oncological results (overall and local recurrence-free survival, cancer-free survival, distant metastasis rate) were analyzed.. Comparison of ERUS preoperative staging for prospective group and pathological staging was performed to identify the accuracy of ERUS. RESULTS. Median follow-up for prospective group was 41 (from 10 to 60) months. In comparison with TME, LE was associated with fewer morbid (4,8 % vs 17,9 %, p=0,04). There was no hospital mortality in both groups. The accuracy of ERUS was 88,1 % for Tis and 78,6% for T1. There was no significant statistical difference in 1-year and 3-year in oncological outcomes between groups (p=1,0). There was one local recurrence (2,6%) in 6 months after LE in a patient with pT1sm3 who had previously refused surgery. This patient underwent TME. There was no detected distant metastasis in both groups. The 3-year overall survival was 100 % for LE and 97,4 % for TME. The 3-year cancer-specific survival was 100 % in both groups. CONCLUSIONS. LE has advantages over TME in short-term results; long-term oncological results after LE are comparable with TME. ERUS has a good diagnostic effectiveness in preoperative staging of early rectal cancer.

scholarly journals The Survival after Laparoscopic Versus Open Curative Excision for Rectal Cancer

2020 ◽  
Vol 7 ◽  
Author(s):  
Turki Alshammari ◽  
Sulaiman Alshammari ◽  
Ali Alsaffar ◽  
Riyadh Hakami ◽  
Mohammed Alali ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Disease Free Survival ◽  
Research Centre ◽  
Long Term Outcomes ◽  
Free Survival ◽  
Distal Recurrence ◽  
Disease Free

Background: Management of rectal cancer has been evolved over the past two decades with the introduction of total mesorectal excision (TME) and laparoscopic resection. Objective: This study aims to assess the difference in the long term outcomes after laparoscopic and open resection for potentially curable, non-metastatic rectal cancer patients.Methods: This is a retrospective study which has been conducted in a single tertiary care center where the patients were recruited from the colorectal database of the Section of Colon and Rectal Surgery at King Faisal Specialist Hospital & Research Centre (KFSH&RC). It included all the patients who had non-metastatic rectal cancer and underwent laparoscopic or open curative resection regardless of their age or the comorbid status during the period from January 2012 – December 2015. We studied the long-term outcomes for those patients which included the completeness of resection of the tumor, overall 3-year survival, 3-year disease free survival, local recurrence and distal recurrence of the cancer.Results:120 patients were included in this study, 69 of them were males and 51 were females. 86 (71.7%) of them underwent open surgery while 34 (28.3%) underwent laparoscopic surgery. After a mean follow up of 32.4 months: 104 patients were alive, 7 deceased and 9 were lost of follow up. Local recurrence in the open approach (OA), and laparoscopic approach (LA) groups was 3/86 (3.5%) and 4/34 (11.8%) respectively. Distal recurrence occurred in 12/86 (14%) of OA and 5/34 (14.7%) of LA. Overall 3-years survival for OA and LA was 89% and 97% respectively and the 3-years disease free survival was 49% and 57% respectively.Conclusion: Laparoscopic and open rectal excision were similar in their outcome.  

Long-term outcomes following salvage surgery for locally recurrent rectal cancer: A 15-year follow-up study

2020 ◽  
Vol 46 (6) ◽  
pp. 1131-1137 ◽  
Author(s):  
David P. Cyr ◽  
Francis SW. Zih ◽  
Bryan J. Wells ◽  
Jossie Swett-Cosentino ◽  
Ronald L. Burkes ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Salvage Surgery ◽  
Recurrent Rectal Cancer ◽  
Long Term Outcomes ◽  
Follow Up Study ◽  
Locally Recurrent Rectal Cancer ◽  
Locally Recurrent

Swedish Rectal Cancer Trial: Long Lasting Benefits From Radiotherapy on Survival and Local Recurrence Rate

2005 ◽  
Vol 23 (24) ◽  
pp. 5644-5650 ◽  
Author(s):  
Joakim Folkesson ◽  
Helgi Birgisson ◽  
Lars Pahlman ◽  
Bjorn Cedermark ◽  
Bengt Glimelius ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Local Recurrence Rate ◽  
Preoperative Radiotherapy ◽  
Recurrence Rates ◽  
Curative Surgery ◽  
Cancer Specific Survival ◽  
Cancer Trial

Purpose To evaluate the long-term effects on survival and recurrence rates of preoperative radiotherapy in the treatment of curatively operated rectal cancer patients. Patients and Methods Of 1,168 randomly assigned patients in the Swedish Rectal Cancer Trial between 1987 and 1990, 908 had curative surgery; 454 of these patients had surgery alone, and 454 were administered preoperative radiotherapy (25 Gy in 5 days) followed by surgery within 1 week. Follow-up was performed by matching against three Swedish nationwide registries (the Swedish Cancer Register, the Hospital Discharge Register, and the Cause of Death Register). Results Median follow-up time was 13 years (range, 3 to 15 years). The overall survival rate in the irradiated group was 38% v 30% in the nonirradiated group (P = .008). The cancer-specific survival rate in the irradiated group was 72% v 62% in the nonirradiated group (P = .03), and the local recurrence rate was 9% v 26% (P < .001), respectively. The reduction of local recurrence rates was observed at all tumor heights, although it was not statistically significant for tumors greater than 10 cm from the anal verge. Conclusion Preoperative radiotherapy with 25 Gy in 1 week before curative surgery for rectal cancer is beneficial for overall and cancer-specific survival and local recurrence rates after long-term follow-up.

scholarly journals Short stump and high anastomosis pull-through (SHiP) procedure for delayed coloanal anastomosis with no protective stoma for low rectal cancer

2021 ◽  
Vol 73 (2) ◽  
pp. 495-502
Author(s):  
Francesco Bianco ◽  
Paola Incollingo ◽  
Armando Falato ◽  
Silvia De Franciscis ◽  
Andrea Belli ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Coloanal Anastomosis ◽  
Functional Results ◽  
Anal Margin ◽  
Perioperative Mortality ◽  
The Mean ◽  
Pull Through ◽  
Protective Stoma

AbstractDespite advances in coloanal anastomosis techniques, satisfactory procedures completed without complications remain lacking. We investigated the effectiveness of our recently developed ‘Short stump and High anastomosis Pull-through’ (SHiP) procedure for delayed coloanal anastomosis without a stoma. In this retrospective study, we analysed functional outcomes, morbidity, and mortality rates and local recurrence of 37 patients treated using SHiP procedure, out of the 282 patients affected by rectal cancer treated in our institution between 2012 and 2020. The inclusion criterion was that the rectal cancer be located within 4 cm from the anal margin. One patient died of local and pulmonary recurrence after 6 years, one developed lung and liver metastases after 2 years, and one experienced local recurrence 2.5 years after surgery. No major leak, retraction, or ischaemia of the colonic stump occurred; the perioperative mortality rate was zero. Five patients (13.51%) had early complications. Stenosis of the anastomosis, which occurred in nine patients (24.3%), was the only long-term complication; only three (8.1%) were symptomatic and were treated with endoscopic dilation. The mean Wexner scores at 24 and 36 months were 8.3 and 8.1 points, respectively. At the 36-month check-up, six patients (24%) had major LARS, ten (40%) had minor LARS, and nine (36%) had no LARS. The functional results in terms of LARS were similar to those previously reported after immediate coloanal anastomosis with protective stoma. The SHiP procedure resulted in a drastic reduction in major complications, and none of the patients had a stoma.

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.

Fifteen-minute consultation: how to identify and treat children with acute kidney injury

2021 ◽  
pp. edpract-2020-319928
Author(s):  
Maura Scott ◽  
Grace McCall
Keyword(s):  
Acute Kidney Injury ◽  
Fluid Management ◽  
Kidney Injury ◽  
Case Presentation ◽  
Mortality And Morbidity ◽  
Fluid Status ◽  
Close Observation ◽  
Long Term Follow Up

Acute kidney injury (AKI) is under-recognised in children and neonates. It is associated with increased mortality and morbidity along with an increased incidence of chronic kidney disease in adulthood. It is important that paediatricians are able to recognise AKI quickly, enabling prompt treatment of reversible causes. In this article, we demonstrate an approach to recognising paediatric AKI, cessation of nephrotoxic medication, appropriate investigations and the importance of accurately assessing fluid status. The mainstay of treatment is attempting to mimic the kidneys ability to provide electrolyte and fluid homeostasis; this requires close observation and careful fluid management. We discuss referral to paediatric nephrology and the importance of long-term follow-up. We present an approach to AKI through case-presentation.

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