scholarly journals Risk Factors For Long-Term Survival in Patients With ypN+M0 Rectal Cancer After Radical Anterior Resection

2021 ◽  
Author(s):  
Marcin Zeman ◽  
Władysław Skałba ◽  
Piotr Szymański ◽  
Grzegorz Hadasik ◽  
Dmytro Żaworonkow ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Prognostic Factor ◽  
Anterior Resection ◽  
Term Survival ◽  
Factors Affecting ◽  
Long Term Treatment ◽  
Multiple Factor

Abstract Background: Regional lymph node metastases are the main adverse prognostic factor in patients with rectal cancer without distant metastases. There are discrepancies, however, regarding additional risk factors in the group of ypN+M0 patients.The purpose of the study was to assess clinical and pathological factors affecting long-term oncological outcomes in the group of ypN+M0 patients after radical rectal anterior resection.Methods: 112 patients with ypN+M0 rectal cancer after neoadjuvant therapy and radical anterior resection were subject to a retrospective analysis. The effect of potential factors on survival was assessed with the use of Kaplan-Meier curves together with a log-rank test and multiple factor Cox proportional hazards model.Results: In the multiple factor Cox analysis, adverse factors affecting OS were: the use of angiotensin-converting enzyme inhibitors (ACEIs) (HR: 3.059, 95% CI: 1.349-6.934, p= 0.007) and past <=3 cycles of adjuvant chemotherapy (HR: 2.833, 95% CI: 1.289-6.229, p= 0.01). For DFS, significant adverse factors were: the use of ACEIs (HR: 3.11, 95%CI: 1.01-9.56, p= 0.047), presence of perineural invasion (HR: 7.27, 95% CI: 2.74-19.3, p< 0.001) and occurrence of postoperative complications (HR: 6.79, 95% CI: 2.09-22.11, p= 0.001), while a positive factor was the negative lymph node (NLN) count >7 (HR: 0.33, 95% CI: 0.12-0.88, p= 0.026). Conclusions: The use of ACEIs may have a negative effect on long-term treatment outcomes in patients with ypN+M0 rectal cancer. In this group of patients, the NLN count seems to be an important prognostic factor, as well.

scholarly journals Risk factors of symptomatic anastomotic leakage and its impacts on a long-term survival after laparoscopic low anterior resection for rectal cancer: a retrospective single-center study

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Xinyu Qi ◽  
Maoxing Liu ◽  
Kai Xu ◽  
Pin Gao ◽  
Fei Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
Prolonged Duration ◽  
Duration Of Operation

Abstract Background Postoperative symptomatic anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) for rectal cancer. AL can potentially affect short-term patient outcomes and long-term prognosis. This study aimed to explore the risk factors and long-term survival of symptomatic AL after laparoscopic LAR for rectal cancer. Methods From May 2009 to May 2015, 298 consecutive patients who underwent laparoscopic LAR for rectal cancer with or without a defunctioning stoma were included in this study. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for symptomatic AL. Survival analysis was performed using Kaplan–Meier curves, and log-rank tests were used for group comparisons. Results Among the 298 patients enrolled in this study, symptomatic AL occurred in eight (2.7%) patients. The univariate analysis showed that age of ≤65 years (P = 0.048), neoadjuvant therapy (P = 0.095), distance from the anal verge (P = 0.078), duration of operation (P = 0.001), and pathological tumor (T) category (P = 0.004) were associated with symptomatic AL. The multivariate analysis demonstrated that prolonged duration of operation (P = 0.010) was an independent risk factor for symptomatic AL after laparoscopic LAR for rectal cancer. No statistically significant differences were observed in the 3-year (P = 0.785) and 5-year (P = 0.979) overall survival rates. Conclusions A prolonged duration of operation increased the risk of symptomatic AL after laparoscopic LAR for rectal cancer. An impact of symptomatic AL on a long-term survival was not observed in this study; however, further studies are required. Trial registration This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033413) on May 31, 2020.

scholarly journals Risk Factors of Symptomatic Anastomotic Leakage and its Impacts on Long Term Survival after Laparoscopic Low Anterior Resection for Rectal Cancer: A Retrospective Single Center Study

2021 ◽  
Author(s):  
Xinyu Qi ◽  
Maoxing Liu ◽  
Kai Xu ◽  
Pin Gao ◽  
Fei Tan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Survival Analysis ◽  
Anastomotic Leakage ◽  
Anterior Resection ◽  
Low Anterior Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
Duration Of Operation

Abstract Background: Postoperative symptomatic anastomotic leakage (AL) is a serious complication after low anterior resection (LAR) for rectal cancer. AL can potentially affect short-term patient outcomes and long-term prognosis. This study aimed to explore the risk factors and long-term survival of symptomatic AL after laparoscopic LAR for rectal cancer.Methods: From May 2009 to May 2015, 298 consecutive patients who underwent laparoscopic LAR for rectal cancer with or without a defunctioning stoma were included in this study. Univariate and multivariate logistic regression analyses were used to explore independent risk factors for symptomatic AL. Survival analysis was performed using Kaplan–Meier curves, and log-rank tests were used for group comparisons.Results: Among the 298 patients enrolled in this study, symptomatic AL occurred in eight patients (2.7%). The univariate analyses showed that the age≤65 (P = 0.048), neoadjuvant therapy (P = 0.095), distance from the anal verge (P = 0.078), duration of operation (P = 0.001), and pathological tumor (T) category (P = 0.004) were associated with symptomatic AL. The multivariate analysis demonstrated that only the duration of operation (P = 0.010) was an independent risk factor for symptomatic AL after laparoscopic LAR for rectal cancer. In the survival analysis, no statistically significant differences in the 3-year (P = 0.785) and 5-year (P = 0.979) overall survival rates were observed.Conclusions: A prolonged duration of operation increased the risk of symptomatic AL after laparoscopic LAR for rectal cancer. An impact of symptomatic AL on long-term survival was not observed in this study, but it needs to be studied more.Trial registration: This study was registered in the Chinese Clinical Trial Registry (ChiCTR2000033413).

scholarly journals The assessment of risk factors for long-term survival outcome in ypN0 patients with rectal cancer after neoadjuvant therapy and radical anterior resection

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Marcin Zeman ◽  
Marek Czarnecki ◽  
Ewa Chmielik ◽  
Adam Idasiak ◽  
Władysław Skałba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Anterior Resection ◽  
Negative Impact ◽  
Oncologic Outcomes ◽  
Clinicopathological Factors ◽  
Significant Negative Impact

Abstract Background The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, and perineural invasion. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior resection. Methods A retrospective survival analysis was performed on a group of 195 patients. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL). Results In the univariate analysis, AL and CCI > 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI > 3 was a significant adverse risk factor for DFS (HR 5.78, 95% CI 2.15–15.51, p < 0.001), DSS (HR 7.25, 95% CI 2.25–23.39, p < 0.001), and OS (HR 3.9, 95% CI 1.72–8.85, p = 0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR 5.05, 95% CI 1.97–12.93, p < 0.001), DSS (HR 10.84, 95% CI 3.44–34.18, p < 0.001), and OS (HR 4.3, 95% CI 1.94–9.53, p < 0.001). Conclusions Late AL and CCI > 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.

scholarly journals Perioperative risk factors for survival outcomes in elective colorectal cancer surgery: a retrospective cohort study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Xing-Xing Liu ◽  
Jun Su ◽  
Yuan-yuan Long ◽  
Miao He ◽  
Zhao-Qiong Zhu
Keyword(s):  
Colorectal Cancer ◽  
Risk Factors ◽  
Cohort Study ◽  
Lymphovascular Invasion ◽  
Laparoscopic Resection ◽  
Term Survival ◽  
Long Term Survival ◽  
Factors Affecting ◽  
Independent Risk Factors

Abstract Background Surgical resection remains the best option for long-term survival in colorectal cancer (CRC); however, surgery can lead to tumor cell release into the circulation. Previous studies have also shown that surgery can affect cancer cell growth. The role of perioperative factors influencing long-term survival in patients presenting for CRC surgery remains to be investigated. Methods This retrospective single–center cohort study was conducted to collect the clinical data of patients who underwent elective laparoscopic resection for CRC from January 2014 to December 2015, namely clinical manifestations, pathological results, and perioperative characteristics. Survival was estimated using the Kaplan–Meier log-rank test. Univariable and multivariable Cox regression models were used to compare hazard ratios (HR) for death. Results A total of 234 patients were eligible for analysis. In the multivariable Cox model, tumor-node-metastasis (TNM) stage (stage IV: HR 30.63, 95% confidence interval (CI): 3.85–243.65; P = 0.001), lymphovascular invasion (yes: HR 2.07, 95% CI 1.09–3.92; P = 0.027), inhalational anesthesia with isoflurane (HR 1.96, 95% CI 1.19–3.21; P = 0.008), and Klintrup–Makinen (KM) inflammatory cell infiltration grade (low-grade inflammation: HR 2.03, 95% CI 1.20–3.43; P = 0.008) were independent risk factors affecting 5-year overall survival after laparoscopic resection for CRC. Conclusions TNM stage, lymphovascular invasion, isoflurane, and KM grade were independent risk factors affecting CRC prognosis. Sevoflurane and high-grade inflammation may be associated with improved survival in CRC patients undergoing resection.

scholarly journals Impact of postoperative complications on long-term survival of gastric cancer patients: results from a high-volume institution in China

2020 ◽  
Author(s):  
Hua-Yang Pang ◽  
Hui Wang ◽  
Lin-Yong Zhao ◽  
Xiao-Long Chen ◽  
Kai Liu ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Prognostic Factor ◽  
Postoperative Complications ◽  
Pulmonary Infection ◽  
Independent Prognostic Factor ◽  
Term Survival ◽  
Long Term Survival ◽  
Independent Risk Factors

Abstract BackgroundThis study was aimed to evaluate the impact of postoperative complications (POCs) on long-term survival for gastric cancer (GC) patients with curative resection.MethodsFrom January 2009 to December 2014, a total of 1667 GC patients with curative gastrectomy were analyzed. Patients with any complications Clavien–Dindo (CD) grade II or higher were divided into complication group. Independent risk factors for the development of POCs and the relationship between POCs and long-term survival (excluding death within 90 days after surgery) were analyzed.ResultsOverall POCs CD ≥ 2 were diagnosed in 285 (17.10%) patients including infectious complications (ICs) in 231 (13.9%) and noninfectious complications (NICs) in 78 (4.68%) patients. Age ≥ 65 (P = 0.003), presence of comorbidity (P = 0.019), extensive lymphadenectomy (P = 0.027) and perioperative blood transfusion (P = 0.040) were independent risk factors of POCs. Multivariate analysis identified that presence of POCs (P < 0.001) was an independent prognostic factor and further analysis by complication type demonstrated that the deteriorated overall survival was mainly caused by ICs (P = 0.007) rather than NICs (P = 0.075), moreover, among all complications, pulmonary infection (P < 0.001) was the only significant prognostic factor.ConclusionPOCs may be an independent prognostic factor for long-term survival of GC patients and the risk is mainly driven by ICs, particular pulmonary infection.

scholarly journals Prognostic impact of lymph node parameters in distal cholangiocarcinoma after pancreaticoduodenectomy

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Shaocheng Lyu ◽  
Lixin Li ◽  
Xin Zhao ◽  
Zhangyong Ren ◽  
Di Cao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Node Dissection ◽  
Lymph Node Metastases ◽  
Term Survival ◽  
Distal Cholangiocarcinoma ◽  
Node Metastasis ◽  
Node Metastases

Abstract Background Pancreaticoduodenectomy is the only definitively curative therapy for the long-term survival of distal cholangiocarcinoma patients. Lymph node metastasis is widely accepted as an important prognostic factor for distal cholangiocarcinoma. The latest American Joint Committee on Cancer (AJCC) TNM classification system for distal cholangiocarcinoma has divided the lymph node metastasis patients into N1 and N2 by lymph node metastasis number. However, some studies suggested that the lymph node metastasis ratio may be better than the lymph node metastasis number. Therefore, we develop a program to analyze the correlation between lymph node parameters (lymph node dissection number, lymph node metastasis number, and lymph node metastasis rate) and long-term prognosis. Methods We retrospectively reviewed 123 distal cholangiocarcinoma patients after pancreatoduodenectomy from January 2011 to December 2019. The patients were grouped according to lymph node metastases and tumor-free and overall survival rates which were investigated with the Kaplan-Meier analysis. The logistic regression models were used for multivariate analysis to determine the risk factors for lymph node metastases. And the X-tile program was used to calculate the cutoff values for the lymph node parameters that discriminated survival. Results The 1-year, 3-year, and 5-year overall survival rates of patients with distal cholangiocarcinoma after pancreatoduodenectomy were 75.2%, 37.1%, and 31.5%, respectively. And the 1-year, 3-year, and 5-year overall survival rates of patients without and with lymph node metastasis were 83.0%, 50.7%, and 42.5% and 63.5%, 19.0%, and 19.0% (p = 0.000), respectively. Logistic regression showed CA19-9 and portal vein system invasion as independent risk factors for lymph node metastases. The receiver operating characteristic curve showed the optimal cutoff value of CA19-9 to predict the lymph node metastases was 75.5 U/mL. Determined by the X-tile software, the optimal cutoff values of the lymph node dissection number were 24 (p = 0.021), the lymph node metastasis number were 1 and 7 (p = 0.504), and the lymph node metastasis rate were 0.13 (p = 0.002). Conclusion Lymph node metastasis is an important factor affecting the long-term survival of distal cholangiocarcinoma patients.CA19-9 and portal vein system invasion are independent risk factors for lymph node metastasis. Besides, the lymph node dissection number and lymph node metastasis rate can predict the long-term survival better than lymph node metastasis number.

The Assessment of Risk Factors for Long-term Survival Outcome in ypN0 Patients With Rectal Cancer After Neoadjuvant Therapy and Radical Anterior Resection

2021 ◽  
Author(s):  
Marcin Zeman ◽  
Marek Czarnecki ◽  
Ewa Chmielik ◽  
Adam Idasiak ◽  
Władysław Skałba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Lymph Node ◽  
Neoadjuvant Therapy ◽  
Negative Impact ◽  
Oncologic Outcomes ◽  
Clinicopathological Factors ◽  
Significant Negative Impact ◽  
The Impact

Abstract Background: The main negative prognostic factors in patients with rectal cancer after radical treatment include regional lymph node involvement, lymphovascular invasion, perineural invasion, the mucinous component of the tumor and poor differentiation. However, some patients still develop cancer recurrence despite the absence of the above risk factors. The aim of the study was to assess clinicopathological factors influencing long-term oncologic outcomes in ypN0M0 rectal cancer patients after neoadjuvant therapy and radical anterior rectal resection.Methods: A retrospective survival analysis was performed on a group of 195 patients treated between 2008 and 2016. We assessed clinicopathological factors which included tumor regression grade, number of lymph nodes in the specimen, Charlson comorbidity index (CCI), and colorectal anastomotic leakage (AL).Results: In the univariate analysis, AL and CCI> 3 had a significant negative impact on disease-free survival (DFS), disease-specific survival (DSS), and overall survival (OS). After the division of ALs into early and late ALs, it was found that only patients with late ALs had a significantly worse survival. The multivariate Cox regression analysis showed that CCI> 3 was a significant adverse risk factor for DFS (HR:5.78, 95%CI:2.15-15.51, p<0.001), DSS (HR:7.25, 95%CI:2.25-23.39, p<0.001), and OS (HR:3.9, 95%CI:1.72-8.85, p=0.001). Similarly, late ALs had a significant negative impact on the risk of DFS (HR:5.05, 95%CI:1.97-12.93, p<0.001), DSS (HR:10.84, 95%CI:3.44-34.18, p<0.001) and OS (HR:4.3, 95%CI:1.94-9.53, p<0.001).Conclusions: Late AL and CCI> 3 are the factors that may have an impact on long-term oncologic outcomes. The impact of lymph node yield on understaging was not demonstrated.

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