Elevated CEA Levels and Low Distance of the Tumor from the Anal Verge are Predictors of Incomplete Response to Chemoradiation in Patients with Rectal Cancer

2012 ◽  
Vol 20 (3) ◽  
pp. 864-871 ◽  
Author(s):  
Angelo Restivo ◽  
Luigi Zorcolo ◽  
Ivana Maria Francesca Cocco ◽  
Romina Manunza ◽  
Carla Margiani ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Incomplete Response

OUTCOME OF SPHINCTER PRESERVING RECTAL RESECTION FOR LOW RECTAL CANCER

2017 ◽  
pp. 36-40
Author(s):  
Vinh Quy Truong ◽  
Anh Vu Pham ◽  
Quang Thuu Le
Keyword(s):  
Rectal Cancer ◽  
Functional Outcomes ◽  
Low Anterior Resection ◽  
Rectal Resection ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Central Hospital ◽  
Mesorectal Excision ◽  
Pull Through ◽  
Stage T1

Purpose: To evaluate the functional outcome of sphincter-preserving rectal resection for low rectal cancer. Materials and Methods: From April 2009 to January 2016, there are 52 patients who underwent sphincter-preserving rectal resection with total mesorectal excision with low rectal cancer (<6cm from the anal verge) at Hue Central Hospital, Hue, Vietnam. Results: the average age 62.7 ± 12.8, the distance of tumor from anal verge include four group (≤ 3cm 1.9%; 3 to ≤ 4cm 17.3%; 4 to ≤ 5cm 34.6%; > 5 cm). T stage T1/ T2/T3: 1.9%/28.8%/69.2%. The following time is 33.8 ± 18.9 month. Overall recurrence was 13/18(27.1%), local recurrence was 5 (10.4%). Total survival was 40.5 ± 2.9 month. Technique: intersphincteric preservation 14 (26.9%), low anterior resection 17 (32.7%) and pull-through procedure 21 (40.4%). The distance of anatomosis from anal verge: from 1 to ≤ 2 cm:14 (26.9%); from 2 to ≤ 3cm: 21 (40.4%); from 3 to ≤ 4 cm: 17 (32.7%). Bowels movement of 3 month: 4.7 ± 3.2 and 12th month: 2.7 ± 1.6 (p< 0.01). Conclusions: Sphincterpreserving rectal resection using may provide a good continence and oncologic safety. The patients are acceptable with the results of functional outcomes. Key words: Low rectal cancer, sphincter-preserving

The Ferguson Operating Anoscope for Resection of T1 Rectal Cancer

2016 ◽  
Vol 82 (11) ◽  
pp. 1105-1108
Author(s):  
Kristin C. Turza ◽  
Thomas Brien ◽  
Steven Porbunderwala ◽  
Christopher M. Bell ◽  
Shauna Lorenzo-rivero ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Tertiary Care ◽  
Primary Lung Cancer ◽  
Disease Free Survival ◽  
Rectal Tumors ◽  
Salvage Operation ◽  
T1 Rectal Cancer

The Ferguson Operating Anoscope (FOA) is a surgical instrument, which can facilitate transanal excision of appropriate rectal tumors within 15 cm of the anal verge. Previous work showed low recurrence (4.3%) for favorable T1 tumors (no lymphovascular invasion, well/moderate differentiation, negative margins). This follow-up study evaluates outcomes in rectal cancer excised with FOA at a tertiary care center. T1 rectal cancer patients were identified in a prospectively maintained database. Tumor pathology and patient characteristics were reviewed. Primary outcomes include tumor recurrence and patient and disease-free survival. Secondary outcomes are quality of excision (intact specimen). Twenty-eight patients had pathologic stage T1 rectal cancer (average 8 ± 2.6 cm from the anal verge). Final path demonstrated 14 per cent to be well differentiated, 82 per cent moderately differentiated, and 93 per cent without angiolymphatic invasion. All specimens removed were intact. One patient had a true local recurrence and underwent a salvage operation 24 months after her index operation. Patient survival was 96.4 per cent (n = one death from primary lung cancer) at median follow-up 64 ± 35 months. With appropriate tumor selection and quality of initial resection, FOA has demonstrated utility in achieving optimal oncologic resection of T1 rectal tumors.

scholarly journals Pathological features of lymph nodes around inferior mesenteric artery in rectal cancer: a retrospective study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Chunhui Jiang ◽  
Ye Liu ◽  
Chunjie Xu ◽  
Yanying Shen ◽  
Qing Xu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Nodes ◽  
Mesenteric Artery ◽  
Inferior Mesenteric Artery ◽  
Anal Verge ◽  
T Stage ◽  
Pathological Type ◽  
Nerve Invasion ◽  
Independent Risk Factors

Abstract Objective This study aimed to explore the pathological characteristics of lymph nodes around inferior mesenteric artery in rectal cancer and its risk factors and its impact on tumor staging. Methods 485 rectal cancer patients underwent proctectomy surgery were collected in this study. Clinical features of patients, including gender, age, BMI, tumor size, pathological type, differentiation, nerve invasion, lymph nodes, tumor marker, and pathological examinations, were analyzed. Results A total of 485 cases were included in this study. There were 29 cases with IMA-LN metastasis; the metastasis rate was 5.98% (29/485). Positive IMA-LNs were associated with distance from anal verge, CEA, pathological type, differentiation, nerve invasion, T stage, and N stage. Multivariate analysis showed that distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. Conclusion Distance from anal verge, CEA level, differentiation, and T stage were independent risk factors for positive IMA-LNs. No skip metastasis occurred in IMA-LNs. We should choose the appropriate surgical methods to achieve better oncological results and reduce the incidence of postoperative complications.

scholarly journals Multimodal Treatment of cT3 Rectal Cancer in a Prospective Multi-Center Observational Study: Can Neoadjuvant Chemoradiation Be Omitted in Patients with an MRI-Assessed, Negative Circumferential Resection Margin?

2021 ◽  
pp. 1-8
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Observational Study ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Anal Verge ◽  
Final Analysis ◽  
Radical Resection ◽  
Distant Recurrence ◽  
Neoadjuvant Chemoradiation ◽  
Recurrence Rates

<b><i>Background/Aim:</i></b> Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. <b><i>Methods:</i></b> By means of a prospective nationwide registry (<i>n</i> = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer &#x3c;12 cm from the anal verge with a negative (&#x3e;1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, <i>n</i> = 25; nCRT+TME, <i>n</i> = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). <b><i>Results:</i></b> In the TME-alone group, tumors were located closer to the anal verge (<i>p</i> = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (<i>p</i> = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; <i>p</i> = 0.268). Local recurrences occurred at a similar rate in the TME-alone (<i>n</i> = 1; 5.3%) and nCRT+TME groups (<i>n</i> = 3; 5.5%) (<i>p</i> = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (<i>p</i> = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. <b><i>Conclusions:</i></b> In this cohort of patients with rectal cancer located &#x3c;12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

scholarly journals Can Pre-Treatment Inflammatory Parameters Predict the Probability of Sphincter-Preserving Surgery in Patients with Locally Advanced Low-Lying Rectal Cancer?

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 946
Author(s):  
Richard Partl ◽  
Katarzyna Lukasiak ◽  
Bettina Stranz ◽  
Eva Hassler ◽  
Marton Magyar ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Locally Advanced ◽  
Multivariable Analysis ◽  
Sphincter Preservation ◽  
Independent Predictive Factor ◽  
Lymphocyte Ratio ◽  
Inflammatory Parameters ◽  
Pre Treatment

There is evidence suggesting that pre-treatment clinical parameters can predict the probability of sphincter-preserving surgery in rectal cancer; however, to date, data on the predictive role of inflammatory parameters on the sphincter-preservation rate are not available. The aim of the present cohort study was to investigate the association between inflammation-based parameters and the sphincter-preserving surgery rate in patients with low-lying locally advanced rectal cancer (LARC). A total of 848 patients with LARC undergoing radiotherapy from 2004 to 2019 were retrospectively reviewed in order to identify patients with rectal cancer localized ≤ 6 cm from the anal verge, treated with neo-adjuvant radiochemotherapy (nRCT) and subsequent surgery. Univariable and multivariable analyses were used to investigate the role of pre-treatment inflammatory parameters, including the C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) for the prediction of sphincter preservation. A total of 363 patients met the inclusion criteria; among them, 210 patients (57.9%) underwent sphincter-preserving surgery, and in 153 patients (42.1%), an abdominoperineal rectum resection was performed. Univariable analysis showed a significant association of the pre-treatment CRP value (OR = 2.548, 95% CI: 1.584–4.097, p < 0.001) with sphincter preservation, whereas the pre-treatment NLR (OR = 1.098, 95% CI: 0.976–1.235, p = 0.120) and PLR (OR = 1.002, 95% CI: 1.000–1.005, p = 0.062) were not significantly associated with the type of surgery. In multivariable analysis, the pre-treatment CRP value (OR = 2.544; 95% CI: 1.314–4.926; p = 0.006) was identified as an independent predictive factor for sphincter-preserving surgery. The findings of the present study suggest that the pre-treatment CRP value represents an independent parameter predicting the probability of sphincter-preserving surgery in patients with low-lying LARC.

scholarly journals Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

2020 ◽  
Vol 24 (10) ◽  
pp. 1025-1034 ◽  
Author(s):  
G. Sun ◽  
Z. Lou ◽  
H. Zhang ◽  
G. Y. Yu ◽  
K. Zheng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Anal Verge ◽  
Disease Free Survival ◽  
Sphincter Preservation ◽  
Low Rectal Cancer ◽  
Anal Function ◽  
Oncological Outcomes ◽  
Rectal Cancers ◽  
Very Low Rectal Cancer

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

The impact of timing of stoma closure on low anterior resection syndrome in patient who underwent low anterior resection for rectal cancer

2021 ◽  
pp. 126-134
Author(s):  
Hemn Hussain Kaka Ali ◽  
Qalandar Hussein Abdulkarim ◽  
Karzan Seerwan ◽  
Barham M. M .Salih
Keyword(s):  
Rectal Cancer ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Anal Verge ◽  
Loop Ileostomy ◽  
Low Anterior Resection Syndrome ◽  
Anterior Resection Syndrome ◽  
Closure Of Ileostomy ◽  
The Mean ◽  
The Impact

This is a multi-center retrospective study of patients underwent low anterior resection for rectal cancer. Ileostomy had been done to protect low lying Colo-rectal anastomosis, closure of ileostomy had been delayed in some patients due to patient own will, surgical complications (anastomotic leak) or coarse of chemotherapy. This study aimed to find the effect of temporary ileostomy on post-operative bowel defunction which is called Low anterior resection syndrome (LARS), and include; urgency, difficulty in emptying of bowel, and incontinence for feces and flatus.  A total of 50 patients included in this study, the age ranges from the 19 to 80 years old with a mean age of 51.96 years. The total number of males was (33, %66). Majority of patients were overweight (21, 42%). The distance of tumors from the anal verge were less than 10 cm in (31,62%). The mean duration of fecal diversion was 7.17 months. Loop ileostomy were closed before six months in (27,54%). The mean duration of diversion of patients developed no LARS was 6.87 months which is shorter than those of developed LARS (7.31). Lower BMI patients are more prone to develop LARS, while Obese patients are more susceptible to develop major LARS. Nineteen cases developed LARS among those patient’s ileostomy closed before six months, and 15 cases developed LARS in those ileostomies closed after six months.    

Phẫu thuật bảo tồn hậu môn điều trị ung thư trực tràng thấp tại Bệnh Viện Ung Bướu TPHCM

2020 ◽  
Author(s):  
Cuong Pham Hung
Keyword(s):  
Rectal Cancer ◽  
Rectal Carcinoma ◽  
Early Stage ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Resection Rate ◽  
Sphincter Saving Resection ◽  
Sphincter Saving ◽  
Surgery Department ◽  
Significant Increment

Purpose: To analyse changes in performing sphincter-saving resection procedures for low rectal cancer in HCMC Oncology Hospital in the last 15 years (2004-2019). Patients and Methods: Medical records of 17 cases of low rectal carcinoma operated on from January through Juin, 2019 in Surgery Department No 2, HCMC Oncology Hospital were studied retrospectively. Data were compared to that of cases of low rectal carcinoma also operated on in HCMC Oncology Hospital from January, 2000 through December, 2004 (2004 group). Results: Compared with 2004 group, the sphincter-saving resection rate significantly increased (53% vs 4%, p<0.001); although there were higher proportions of men (77% vs 36%, p=0.003) and of early stage patients (29% stage I vs 4%, p<0.001). Sphincter-saving resection procedures were performed for 53% low rectal cancer patients (95% CI: 28-77%). All patients with tumors more than 3cm from the anal verge were operated on with sphincter-saving resection procedures. Conclusion: There was a significant increment of sphincter-saving resection for low rectal cancer in HCMC Oncology Hospital in the last 15 years (2004-2019). It was not different from worldwide trends.

scholarly journals ISR for T1-2 Low Rectal Cancer: A Japanese Approach

2020 ◽  
Vol 33 (06) ◽  
pp. 361-365
Author(s):  
Masaaki Ito
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Recurrence Rate ◽  
Phase Ii ◽  
Local Recurrence Rate ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Rectal Cancer Surgery ◽  
Rectal Cancers ◽  
Anal Preservation

AbstractThe evolution over the past 20 years of anal preservation in rectal cancer surgery has been truly remarkable. Intersphincteric resection (ISR) reported by Schiessel in 1994 in Australia has been shown to enable anal preservation even for cancers quite close to the anus. In Japan, ISR via the detachment of the anal canal between the internal and external sphincters and excision of the internal sphincter first began to be practiced in the latter half of 1990. A multicenter Phase II trial of ISR in Japan suggested that 70% of the cases had relatively good function with less than 10 points of Wexner score but around 10% had severe incontinence that would not be improved for long term. The primary end point of the clinical study, 3-year local recurrence rate, was 13.2% across the overall cohort (T1, 0%; T2, 6.9%; and T3, 21.6%). When ISR is performed on T1/T2 rectal cancers, sufficient circumferential resection margin can be obtained even without preoperative chemoradiotherapy, and local recurrence rate was acceptably low. Based on these evidences, ISR is a currently important, standard treatment option among anal-preserving surgeries for T1/T2 low-lying rectal cancers. In Japan, a feasibility study (LapRC trial) of laparoscopic ISR on Stage 0 and Stage 1 low rectal cancer showed excellent outcomes. A prospective Phase II clinical trial targeting low rectal cancers within 5 cm from the anal verge (ultimate trial) is being performed and awaiting the results in near future.

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