Impact of Perineural and Lymphovascular Invasion on Oncological Outcomes in Rectal Cancer Treated with Neoadjuvant Chemoradiotherapy and Surgery

2014 ◽  
Vol 22 (3) ◽  
pp. 916-923 ◽  
Author(s):  
J. A. Cienfuegos ◽  
F. Rotellar ◽  
J. Baixauli ◽  
C. Beorlegui ◽  
J. J. Sola ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymphovascular Invasion ◽  
Neoadjuvant Chemoradiotherapy ◽  
Oncological Outcomes

scholarly journals Histopathological, Radiological and Demographic Factors Predicting the Response to Neoadjuvant Therapy for Rectal Cancer

2021 ◽  
Author(s):  
Emine YILDIRIM ◽  
Sibel Bektas ◽  
Zekeriya Pelen ◽  
Irem Yanik ◽  
Ahmet Muzaffer Er ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Lymphovascular Invasion ◽  
Perineural Invasion ◽  
Early Stage ◽  
Anal Verge ◽  
Demographic Data ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Advanced Stage

Abstract Background/aimWhile the treatment for early stage rectal cancer is surgery, when a diagnosis is made at a locally advanced stage, it is recommended to start treatment with neoadjuvant chemoradiotherapy. Therefore, it is important to determine which patients will respond best to neoadjuvant treatment. The aim of this study was to investigate which hematological, histopathological, and radiological parameters can predict the response to chemoradiotherapy. Methods and materialsA retrospective examination was made of 43 patients who underwent surgery following neoadjuvant chemoradiotherapy because of locally advanced stage rectal cancer. Demographic data were collected from the patient files, and the radiological, histopathological and laboratory findings before neoadjuvant chemoradiotherapy were compared with the findings after treatment. ResultsIn the postoperative evaluation, a pathological complete response was determined in 25.50% of the patients. Lymphovascular invasion, perineural invasion and absence of necrosisis were seen to be statistically related to major response (p<0.05), and in patients where the tumor was closer than 6cm to the anal verge, the response was betterConclusionWhen the findings were examined, histopathological lymphovascular invasion, perineural invasion, the presence of necrosis, and the anal verge distance were evaluated as parameters predicting the response to neoadjuvant chemoradiotherapy in rectal cancer.

scholarly journals Anus-Preserving Surgery in Advanced Low-Lying Rectal Cancer: A Perspective on Oncological Safety of Intersphincteric Resection

Cancers ◽  
2021 ◽  
Vol 13 (19) ◽  
pp. 4793
Author(s):  
Guglielmo Niccolò Piozzi ◽  
Se-Jin Baek ◽  
Jung-Myun Kwak ◽  
Jin Kim ◽  
Seon Hahn Kim
Keyword(s):  
Rectal Cancer ◽  
Anal Verge ◽  
Neoadjuvant Chemoradiotherapy ◽  
Intersphincteric Resection ◽  
Surgical Approaches ◽  
Resection Margins ◽  
Oncological Safety ◽  
Anatomy And Physiology ◽  
Oncological Outcomes

The surgical management of low-lying rectal cancer, within 5 cm from the anal verge (AV), is challenging due to the possibility, or not, to preserve the anus with its sphincter muscles maintaining oncological safety. The standardization of total mesorectal excision, the adoption of neoadjuvant chemoradiotherapy, the implementation of rectal magnetic resonance imaging, and the evolution of mechanical staplers have increased the rate of anus-preserving surgeries. Moreover, extensive anatomy and physiology studies have increased the understanding of the complexity of the deep pelvis. Intersphincteric resection (ISR) was introduced nearly three decades ago as the ultimate anus-preserving surgery. The definition and indication of ISR have changed over time. The adoption of the robotic platform provides excellent perioperative results with no differences in oncological outcomes. Pushing the boundaries of anus-preserving surgeries has risen doubts on oncological safety in order to preserve function. This review critically discusses the oncological safety of ISR by evaluating the anatomical characteristics of the deep pelvis, the clinical indications, the role of distal and circumferential resection margins, the role of the neoadjuvant chemoradiotherapy, the outcomes between surgical approaches (open, laparoscopic, and robotic), the comparison with abdominoperineal resection, the risk factors for oncological outcomes and local recurrence, the patterns of local recurrences after ISR, considerations on functional outcomes after ISR, and learning curve and surgical education on ISR.

EP.TU.4973 year oncological outcomes of robotic-assisted versus laparoscopic rectal cancer resections – a single centre experience

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Lauren O'Connell ◽  
Sinead Ramjit ◽  
Tim Nugent ◽  
Paul Neary ◽  
Adnan Hafeez ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Final Analysis ◽  
Inclusion Criteria ◽  
Recurrence Rates ◽  
Robotic Assisted ◽  
Oncological Outcomes ◽  
Lymph Node Retrieval ◽  
Significant Difference

Abstract Background Robotic-assisted minimally invasive surgery (MIS) for rectal cancer is a relatively new technique. Studies to date suggest that short term outcomes including TME quality, margin status, lymph node retrieval and 30-day morbidity and mortality are equivalent in robotic-assisted and laparoscopic MIS for rectal cancer. By contrast, there is a paucity of data on the medium and long-term oncologic safety of robotic-assisted comparative to laparoscopic surgery for rectal cancer. Methods A retrospective review was conducted of all robotic-assisted (n = 31) and laparoscopic (n = 23) rectal cancer cases performed at our institution between January 2016 to December 2018. Inclusion criteria were patients scheduled electively for a laparoscopic or robotic-assisted resection of rectal cancer (anterior resection or abdomino-perineal resection). Patients with distant metastases at presentation, those who proceeded to surgery as an emergency and those with a non-colorectal primary were excluded from analysis. Results A total of 54 (n = 54) cases met the inclusion criteria and were included in the final analysis. The median follow-up was 34 months. Of the 54, 21 patients received neoadjuvant chemoradiotherapy prior to definitive surgery. No significant difference was detected in local recurrence rates (p = 0.5), overall survival (p = 0.7) or disease-free survival (p = 0.8) between the robotic-assisted and laparoscopic cohorts. Conclusion In this series, robotic-assisted rectal cancer resections were associated with equivalent medium term oncological outcomes as laparoscopic procedures. However, given the small numbers in this cohort, outcomes from larger scale datasets will be required to confirm these results.

scholarly journals Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review

2021 ◽  
Vol 37 (6) ◽  
pp. 382-394
Author(s):  
Min Chul Kim ◽  
Jae Hwan Oh
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Lateral Pelvic Lymph Node ◽  
Oncological Outcomes

Purpose: We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).Methods: We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.Results: The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).Conclusion: This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

Prognosis Comparisons of Laparoscopy versus Open Surgery for Rectal Cancer Patients after Preoperative Chemoradiotherapy: A Meta-Analysis

2021 ◽  
Vol 44 (5) ◽  
pp. 261-268
Author(s):  
Jin-Wei Niu ◽  
Wu Ning ◽  
Zhi-Ze Liu ◽  
Dong-Po Pei ◽  
Fan-Qiang Meng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Open Surgery ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Current Evidence ◽  
Open Thoracotomy ◽  
Oncological Outcomes ◽  
Duration Of Surgery

<b><i>Aim:</i></b> We aimed to compare the oncological outcomes of laparoscopy and open resection for patients with rectal cancer following neoadjuvant chemoradiotherapy (NCRT). <b><i>Methods:</i></b> We searched the publications that compared the efficacy of laparoscopic surgery and open thoracotomy in treatment outcomes of rectal cancer after NCRT. All trials analyzed the summary hazard ratios of the endpoints of interest, including survival and individual postoperative complications. <b><i>Results:</i></b> Totally, 10 trials met our inclusion criteria. The pooled analysis of 3-year disease-free survival (OR 1.39, 95% CI 0.93–2.06; <i>p</i> = 0.11) and 3-year overall survival (OR 1.01, 95% CI 0.70–1.45; <i>p</i> = 0.97) showed that laparoscopic surgery did not achieve beneficial effects compared with open thoracotomy. The pooled result of duration of surgery indicated that laparoscopic surgery was associated with a trend for longer surgery time (SMD 27.53, 95% CI 1.34–53.72; <i>p</i> = 0.04), shorter hospital stay (SMD –1.64, 95% CI –2.70 to –0.58; <i>p</i> = 0.002), more postoperative complications (OR 0.77, 95% CI 0.60–0.99; <i>p</i> = 0.04), and decreased blood loss (SMD –49.87, 95% CI –80.61 to –19.14; <i>p</i> = 0.001). However, the number of removed lymph nodes, positive circumferential resection margin, as well as complications after surgery showed significant differences between the 2 groups. <b><i>Conclusions:</i></b> We focused on current evidence and reviewed the studies indicating that similar oncological outcomes were associated with laparoscopic surgery following NCRT for patients with locally advanced lower rectal cancer in comparison with open surgery.

Impact of perineural and lymphovascular invasion on oncological outcomes in rectal cancer treated with neoadjuvant chemoradiotherapy and surgery.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 695-695
Author(s):  
Javier A. Cienfuegos ◽  
Fernando Rotellar ◽  
Jorge Baixauli ◽  
Carmen Beorlegui ◽  
Iosu Sola ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Prognostic Factor ◽  
Lymphovascular Invasion ◽  
Tumor Regression ◽  
Locally Advanced ◽  
Prognostic Significance ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Tumor Regression Grade ◽  
Grade 3

695 Background: The prognostic significance of perineural and/or lymphovascular invasion (PLVI) and its relationship with tumor regression grade (TRG) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (CRT) and surgery. Methods: A total of 324 patients with LARC treated with CRT were operated on between January 1992 and June 2007. Tumors were graded using a quantitative 5-grade TRG classification, and the presence of PLVI was studied histologically. Results: At a median follow-up of 79.0 months (range 3–250 months), a total of 80 patients (24.7%) relapsed. The observed 5- and 10-year overall survival (OS) was 83.2% and 74.9% respectively. The 5- and 10-year disease-free survival (DFS) was 75.1% and 71.4%, respectively. A significant correlation was found between the TRG and survival (log rank, p<0.001). The 10-year OS and DFS was 32.7% and 31.8% for grade 1; 63.8% and 58.6% for grade 2; 75.0% and 70.4% for grade 3; 90.4% and 88.4% for grade 3+, and 96.0% and 97.1% for grade 4. In patients with PLVI, the TRG had no impact on survival. When excluding patients with PLVI, TRG was an independent prognostic factor for OS and DFS. Conclusions: The presence of PLVI is a more powerful prognostic factor than TRG in LARC patients treated with neoadjuvant CRT followed by surgery. PLVI denotes an aggressive phenotype, suggesting that these patients may benefit from adjuvant systemic therapy.

Sign in / Sign up

Export Citation Format

Share Document