Long-Term Outcomes After Extra-Levator Versus Conventional Abdominoperineal Excision for Low Rectal Cancer

Abstract PurposeExtralevator (ELAPE) and abdominoperineal excision (APE) are two major surgical approaches for low rectal cancer patients. Although excellent short-term efficacy is achieved in patients undergoing ELAPE, the long-term benefits have not been established. In this study we compared the survival outcomes in low rectal cancer patients who underwent ELAPE and APE.MethodsOne hundred fourteen patients were enrolled, including 68 in the ELAPE group and 46 in the APE group at the Beijing Chaoyang Hospital, Capital Medical University from January 2011 to December 2018. The baseline characteristics, overall survival (OS), progression-free survival (PFS), and local recurrence-free survival (LRFS) were calculated and compared between the two groups.ResultsDemographics and tumor stage were comparable between the two groups. The 5-year PFS (67.2 per cent versus 38.6 per cent, log-rank P = 0.008) and LRFS (87.0 per cent versus 62.3 per cent, log-rank P = 0.047) were significantly improved in the ELAPE group compared to the APE group, and the survival advantage was especially reflected in patients with pT3 tumors, positive lymph nodes or even those who have not received neoadjuvant chemoradiotherapy. Multivariate analysis showed that APE was an independent risk factor for OS (hazard ratio 3.000, 95 per cent c.i. 1.171 to 4.970, P = 0.004) and PFS (hazard ratio 2.730, 95 per cent c.i. 1.506 to 4.984, P = 0.001).Conclusion Compared with APE, ELAPE improved long-term outcomes for low rectal cancer patients, especially among patients with pT3 tumors, positive lymph nodes or those without neoadjuvant chemoradiotherapy.

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Neoadjuvant chemoradiotherapy for borderline resectable low rectal cancer: short- and long-term outcomes at a single Japanese center

Surgery Today ◽

10.1007/s00595-021-02419-x ◽

2022 ◽

Author(s):

Hitoshi Hino ◽

Akio Shiomi ◽

Hiroyasu Kagawa ◽

Shoichi Manabe ◽

Yusuke Yamaoka ◽

...

Keyword(s):

Rectal Cancer ◽

Neoadjuvant Chemoradiotherapy ◽

Low Rectal Cancer ◽

Long Term Outcomes ◽

Borderline Resectable ◽

Short And Long Term

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Transanal vs laparoscopic total mesorectal excision for rectal cancer: a multicenter randomized phase III clinical trial (TaLaR trial) protocol

Gastroenterology Report ◽

10.1093/gastro/goaa083 ◽

2020 ◽

Author(s):

Liang Kang ◽

Ziwei Zeng ◽

Shuangling Luo ◽

Hong Zhang ◽

Quan Wang ◽

...

Keyword(s):

Rectal Cancer ◽

Cancer Patients ◽

Digital Rectal Examination ◽

Low Rectal Cancer ◽

Phase Iii ◽

Resected Specimen ◽

Long Term Outcomes ◽

Multicenter Randomized Controlled Trial ◽

Specimen Quality

Abstract Background Total mesorectum excision (TME) is considered the standard surgical procedure for rectal-cancer treatment. Transanal TME (taTME) is a new procedure to treat low rectal cancer. Some published studies have proven that taTME can provide a better-quality resected specimen in low-rectal-cancer patients in comparison to the transabdominal procedure, yet long-term outcomes must be investigated. We designed this non-inferiority trial (TaLaR trial) to compare short-term and long-term outcomes between taTME and laparoscopic TME (lapTME) for rectal cancer. Methods The TaLaR trial is a phase III open-labeled multicenter randomized–controlled trial. Patients who are diagnosed with rectal cancer with no more than T3N0 or ycT3N2 stage, and with the tumor location below the peritoneal reflection by magnetic resonance imaging scan, digital rectal examination, or colonoscopy, qualify for this study. After calculating, a total of 1,114 patients (557 per group) will be randomly allocated to either the taTME or the lapTME group. Primary endpoints are the 3-year disease-free survival (DFS) rate and the 5-year overall survival (OS) rate. Secondary endpoints include specimen quality, perioperative results, pelvic and anal function, and quality of life. Discussion The TaLaR trial is expected to clarify whether taTME can achieve comparable oncological outcomes, as well as improve specimen quality and recovery conditions in rectal-cancer patients compared with lapTME.

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BMI May Be a Prognostic Factor for Local Advanced Rectal Cancer Patients Treated with Long-Term Neoadjuvant Chemoradiotherapy

Cancer Management and Research ◽

10.2147/cmar.s268928 ◽

2020 ◽

Vol Volume 12 ◽

pp. 10321-10332

Author(s):

Hengchang Liu ◽

Ran Wei ◽

Chunxiang Li ◽

Zhixun Zhao ◽

Xu Guan ◽

...

Keyword(s):

Rectal Cancer ◽

Prognostic Factor ◽

Cancer Patients ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

Local Advanced

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Robotic versus laparoscopic sphincter-saving total mesorectal excision for mid or low rectal cancer in male patients after neoadjuvant chemoradiation therapy: comparison of long-term outcomes

Journal of Robotic Surgery ◽

10.1007/s11701-019-01001-5 ◽

2019 ◽

Vol 14 (3) ◽

pp. 393-399 ◽

Cited By ~ 3

Author(s):

Oktar Asoglu ◽

Handan Tokmak ◽

Baris Bakir ◽

Vusal Aliyev ◽

Sezer Saglam ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Neoadjuvant Chemoradiation ◽

Chemoradiation Therapy ◽

Low Rectal Cancer ◽

Mesorectal Excision ◽

Long Term Outcomes ◽

Sphincter Saving ◽

Male Patients

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Long-Term Outcomes of Local Excision Following Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer

Annals of Surgical Oncology ◽

10.1245/s10434-020-09243-6 ◽

2020 ◽

Author(s):

Lucrezia D’Alimonte ◽

Quoc Riccardo Bao ◽

Gaya Spolverato ◽

Giulia Capelli ◽

Paola Del Bianco ◽

...

Keyword(s):

Local Excision ◽

Locally Advanced ◽

Neoadjuvant Chemoradiotherapy ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Recurrence Free Survival ◽

Long Term Outcomes ◽

Relapse Free Survival ◽

Free Survival

Abstract Background Local excision might represent an alternative to total mesorectal excision for patients with locally advanced rectal cancer who achieve a major or complete clinical response after neoadjuvant chemoradiotherapy. Methods Between August 2005 and July 2011, 63 patients with mid-low rectal adenocarcinoma who had a major/complete clinical response after neoadjuvant chemoradiotherapy were enrolled in a multicenter prospective phase 2 trial and underwent transanal full thickness local excision. The main endpoint of this study was to evaluate the 5- and 10-year overall, relapse-free, local, and distant relapse-free survival, which were calculated by applying the Kaplan–Meier method. The rate of patients with rectum preserved and without stoma were also calculated. Results Of 63 patients, 38 (60%) were male and 25 (40%) were female, with a median (range) age of 64 (25–82) years. At baseline, the following clinical stages were found: cT2, n = 21 (33.3%); cT3, n = 42 (66.6%), 39 (61.9%) patients were cN+. At a median (range) follow-up of 108 (32–166) months, the estimated cumulative 5- and 10-year overall survival, relapse-free survival, local recurrence-free survival, and distant recurrence-free survival were 87% (95% CI 76–93) and 79% (95% CI 66–87), 89% (95% CI 78–94) and 82% (95% CI 66–91), both 91% (95% CI 81–96), and 90% (95% CI 80–95) and 86% (95% CI 73–93), respectively. Overall, 49 (77.8%) patients had their rectum preserved, and 54 (84.1%) were stoma-free. Conclusion In highly selected patients, the local excision approach after neoadjuvant chemoradiotherapy is associated with excellent long-term outcomes, high rates of rectum preservation and absence of permanent stoma.

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Short- and long-term outcomes of transanal versus laparoscopic total mesorectal excision for mid-to-low rectal cancer: a meta-analysis

Surgical Endoscopy ◽

10.1007/s00464-018-6527-z ◽

2018 ◽

Vol 33 (3) ◽

pp. 972-985 ◽

Cited By ~ 12

Author(s):

Xuan Zhang ◽

Yi Gao ◽

XingLong Dai ◽

HongTao Zhang ◽

ZhongJun Shang ◽

...

Keyword(s):

Rectal Cancer ◽

Total Mesorectal Excision ◽

Meta Analysis ◽

Low Rectal Cancer ◽

Laparoscopic Total Mesorectal Excision ◽

Mesorectal Excision ◽

Long Term Outcomes ◽

Short And Long Term

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Neoadjuvant chemoradiotherapy for locally advanced rectal cancer: Predicting long-term outcomes based on response to treatment.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.621 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 621-621

Author(s):

Kirsten Elizabeth Jean Laws ◽

Christina Wilson ◽

David McIntosh ◽

Stephen Harrow

Keyword(s):

Rectal Cancer ◽

Locally Advanced ◽

Preoperative Staging ◽

Neoadjuvant Treatment ◽

Neoadjuvant Chemoradiotherapy ◽

Combined Modality Treatment ◽

Long Term Outcomes ◽

Node Positive ◽

Long Course

621 Background: Neoadjuvant long course chemoradiotherapy is well recognised as a standard treatment in locally advanced, margin threatening rectal cancer, in order to downstage and reduce local recurrence. We investigated retrospectively whether long term outcomes could be predicted by response to neoadjuvant treatment, and which factors specifically seemed to predict a risk of poorer outcome. Methods: All patients treated with long course chemoradiotherapy between January 2008 and December 2009 were identified retrospectively. Patients were excluded if the treatment indication was for inoperable disease, postoperative, recurrence, or palliative intent. A total of 231 patients were analysed with retrospective analysis of all electronic records and case notes. The following information was collated: preoperative staging, chemoradiotherapy treatment planned and received, operation performed, postoperative pathology (including nodal status, margins, presence of LVSI, and evidence of response to neoadjuvant treatment), disease free survival, and overall survival. Results: Kaplan Meier curves are presented showing patients with either a complete or partial response to neoadjuvant treatment appear to have a statistically significant improvement in long term outcomes, compared to those with no response (Mean survival 55 months, 56 months and 43months respectively, p<0.01). Furthermore, those who remain node positive or have evidence of LVSI following neoadjuvant treatment appear to have a statistically significant poorer outcome. Conclusions: Our study further develops on previous work looking at the prediction of outcomes following response to neoadjuvant treatment in rectal cancer. It appears that those who respond to initial treatment will have a better outcome than those who do not, including those who remain node positive or with LVSI following treatment. This study is limited because it is retrospective. Randomised controlled trial data is required to enable identification of poor risk imaging and pathology features that might suggest the need for adjuvant therapy following combined modality treatment with neoadjuvant chemoradiotherapy and surgery.

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Comparison of long-term survival outcomes between laparoscopic and open surgery for mid or low rectal cancer treated with preoperative chemoradiotherapy: 7-year follow-up of COREAN trial.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.3518 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. 3518-3518

Author(s):

Ji Won Park ◽

Seung-Yong Jeong ◽

Sung-Bum Kang ◽

Jungnam Joo ◽

Mi Kyung Song ◽

...

Keyword(s):

Rectal Cancer ◽

Laparoscopic Surgery ◽

Local Recurrence ◽

Open Surgery ◽

Disease Free Survival ◽

Preoperative Chemoradiotherapy ◽

Low Rectal Cancer ◽

Free Survival ◽

Disease Free

3518 Background: Laparoscopic surgery for rectal cancer has been used widely. However, recent two randomized trials raised concerns about short-term oncologic safety of laparoscopic surgery for rectal cancer. The aim of this study was to evaluate the long-term oncologic safety of laparoscopic surgery for rectal cancer based on 7-year data from the Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial. Methods: COREAN trial was a non-inferiority, randomized controlled trial. Between April, 2006, and Aug, 2009, eligible participants with mid or low rectal cancer treated with preoperative chemoradiotherapy were randomly assigned (1:1) to laparoscopic (n = 170) or open surgery (n = 170). Seven-year outcomes included overall and disease-free survival, and local recurrence. Log-rank test and stratified Cox regression analysis were used for survival analysis. Analysis was by intention to treat. Results: The median follow-up times were 84 months (IQR: 61.5-97.0). No differences were found between laparoscopic and open surgery group in terms of overall and disease-free survival, and local recurrence (7-year overall survival: 83.2% [laparoscopic] vs 77.3% [open], p = 0.48; 7-year disease-free survival: 71.6% [laparoscopic] vs 64.3% [open], p = 0.20; 7-year local recurrence: 3.3% [laparoscopic] vs 7.9% [open], p = 0.08). Stratified Cox regression analysis adjusted for ypT, ypN and tumor regression grade showed no significant difference between groups in terms of overall and disease-free survival, and local recurrence. The hazard ratios for overall survival, disease-free survival and local recurrence (open vs laparoscopic surgery) were 0.96 (95% CI = 0.58-1.57), 1.03 (95% CI = 0.70-1.53), and 2.28 (95% CI = 0.82-7.16), respectively. Conclusions: The 7-year analysis confirm the long-term oncological safety of laparoscopic surgery for rectal cancer treated with preoperative chemoradiotherapy. The use of laparoscopic surgery does not compromise the long-term survival outcomes in rectal cancer. Clinical trial information: NCT00470951.

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