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 Adjuvant Radiotherapy after Surgical Excision in Keloids

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 730
Author(s):  
Jeong Won Lee ◽  
Ki Ho Seol
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Adjuvant Therapy ◽  
Local Control ◽  
Adjuvant Radiotherapy ◽  
Surgical Excision ◽  
Recurrence Rates ◽  
High Tendency ◽  
Advantages And Disadvantages

Keloids are a benign fibroproliferative disease with a high tendency of recurrence. Keloids cause functional impairment, disfigurement, pruritus, and low quality of life. Many therapeutic options have been used for keloids. However, the high recurrence rates have led to the use of adjuvant therapy after surgical keloid excision. There are different radiotherapy regimens available, and the advantages and disadvantages of each are still unclear. The aim of this review is to explain the appropriate radiotherapy regimen for keloids as well as discuss the recent reports on keloid management with radiotherapy. Adjuvant radiotherapy after surgical excision for keloids yields excellent local control with tolerable side effects. Hypofractionated radiotherapy with a BED of more than 28 Gy (α/β value of 10) after excision is recommended in the light of its biologic background.

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.

Meta-analysis of the influence of surgical margin and adjuvant radiotherapy on local recurrence after resection of sporadic desmoid-type fibromatosis

2017 ◽  
Vol 104 (4) ◽  
pp. 347-357 ◽  
Author(s):  
M. L. Janssen ◽  
D. L. M. van Broekhoven ◽  
J. M. M. Cates ◽  
W. M. Bramer ◽  
J. J. Nuyttens ◽  
...  
Keyword(s):  
Local Recurrence ◽  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Surgical Margin

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 Medical Adjuvant Therapy in Reducing Thrombosis With Arteriovenous Grafts and Fistulae Use: A Meta-Analysis of Randomized Controlled Trials

2021 ◽  
Vol 27 ◽  
pp. 107602962110638
Author(s):  
Kaleem Ullah ◽  
Maham Bashir ◽  
Noor Ul Ain ◽  
Azza Sarfraz ◽  
Zouina Sarfraz ◽  
...  
Keyword(s):  
Adjuvant Therapy ◽  
Adjuvant Treatment ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Graft Thrombosis ◽  
Av Fistula ◽  
Number Of Patients ◽  
Long Term Follow Up ◽  
Stage Renal Disease ◽  
End Stage

Hemodialysis is required for patients with end-stage renal disease (ESRD) that require arteriovenous (AV) grafts or fistulas for vascular access. These access points are prone to thrombosis. To determine the effect of medical adjuvant therapy on AV graft/fistula patency among patients with ESRD on hemodialysis. Adhering to the PRISMA 2020 statement, a systematic search was conducted until August 20, 2021, with keywords including arteriovenous graft, fistula, patency, thrombosis, hemodialysis, adjuvant treatment. The following databases were searched: PubMed, Scopus, Web of Science, CINAHL Plus, and Cochrane. A random-effects model was employed using Review Manager 5.4 for data analysis. The meta-analysis pooled in 1985 participants with 1000 (50.4%) in the medical adjuvant treatment group. At a snapshot, medical adjuvant therapy reduced the risk for graft thrombosis (RR = 0.64, P = .02). Notable medications included aspirin for graft thrombosis (RR = 0.36, P = .006) and ticlopidine for fistula thrombosis (RR = 0.53, P = .01). Certain antiplatelet therapies (aspirin and ticlopidine) reduced the number of patients with AV fistula/graft thrombosis among patients with high heterogeneity among the trials. Other therapies (fish oil, sulfinpyrazone, clopidogrel, and aspirin/dipyridamole) did not demonstrate significant improvement but may be promising once concrete evidence is available. Potential benefits of anti-platelet therapies may be explored to maintain the potency of AV grafts/fistulas through well-designed placebo-controlled trials and long-term follow-up.

scholarly journals An individual patient data meta-analysis of adjuvant therapy with uracil–tegafur (UFT) in patients with curatively resected rectal cancer

2007 ◽  
Vol 96 (8) ◽  
pp. 1170-1177 ◽  
Author(s):  
J Sakamoto ◽  
C Hamada ◽  
S Yoshida ◽  
S Kodaira ◽  
M Yasutomi ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data

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.

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