Procedures for Rectal Cancer

2020 ◽  
Author(s):  
Bashar Safar ◽  
Jonathan Efron
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Early Stage ◽  
The United States ◽  
Surgical Anatomy ◽  
Recurrence Rates ◽  
Cancer Risk Factors ◽  
American Joint Committee ◽  
Patient Consent ◽  
Rectal Cancer Recurrence

Cancer of the large bowel is the third most common cancer diagnosed in both men and women in the United States with the exclusion of skin cancers. Surgery represents the mainstay of therapy in early-stage rectal cancer and is frequently warranted in advanced cases for palliation. Complete resection and retention of gastrointestinal continuity with low recurrence rates are the ultimate goal in treating localized disease. Local recurrence in rectal cancer essentially represents a failure of surgical therapy and is avoidable in most cases. Radiation has been shown to reduce local recurrences. This review covers the surgical anatomy of the rectum, factors to consider when evaluating patients with rectal cancer, choosing a therapeutic protocol, obtaining patient consent, preoperative considerations, and surgical technique. Local (transanal local excision, transanal endoscopic microsurgery) and radical procedures (anterior resection technique, abdominoperineal resection) are described. Laparoscopic and robotic approaches, key intraoperative concepts in rectal cancer, perioperative care, adjuvant therapy, and follow-up regimens are also detailed. Tables describe general medical issues for surgeons to review, vital knowledge for the colorectal surgeon, American Joint Committee on Cancer TNM Clinical Classification of Colorectal Cancer, American Joint Committee on Cancer Staging System for Colon Cancer, the multidisciplinary team for treating rectal cancer, risk factors associated with high rectal cancer recurrence rate, National Comprehensive Cancer Network 2013 Guidelines for Transanal Excision, and total mesorectal excision score as categorized by Quirke. Figures show procedures for local, anterior, and abdominoperineal resection. This review contains 11 figures, 9 tables, and 64 references. Keywords: rectoscope, resection, excision, anastomosis, radiation, stapler, abdominoperineal resection

scholarly journals Multidisciplinary Management of Early-Stage Rectal Cancer

2012 ◽  
Vol 10 (12) ◽  
pp. 1577-1585 ◽  
Author(s):  
John G. Phillips ◽  
Theodore S. Hong ◽  
David P. Ryan
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Therapy ◽  
Early Stage ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
The United States ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Current Standard ◽  
Recurrence Rates

Because patients with locally advanced rectal cancer are at high risk for both recurrence and distant disease, they require adjuvant therapy. In the United States, the current standard of care is neoadjuvant chemoradiation followed by surgery and adjuvant chemotherapy. Neoadjuvant chemoradiation has been shown to improve local recurrence rates and decrease toxicity. However in the era of total mesorectal excision surgery, no study has shown a survival benefit to either chemoradiation or postoperative chemotherapy. Newer biologic therapies, although promising in initial early trials, have yet to show a significant benefit in adjuvant therapy for rectal cancer.

Adjuvant and Neoadjuvant Management of Colorectal Cancer

2020 ◽  
Author(s):  
Christina E Bailey ◽  
Eduardo Vilar ◽  
Y. Nancy You
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Significant Proportion ◽  
Operative Management ◽  
The United States ◽  
Current Evidence ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Colon And Rectal Cancer

Colorectal cancer (CRC) is the third most common and lethal cancer in men and women in the United States. At presentation, a significant proportion of patients with CRC are able to undergo resection with curative intent, but up to 50% of these patients will develop recurrent disease. Fortunately, recurrence rates for both colon and rectal cancer have improved with the introduction of multimodality therapies, which include chemotherapy, chemoradiation therapy, and radiation therapy. These therapies are adjuncts to surgery and can be administered before (i.e. neoadjuvant) or after (i.e. adjuvant) surgery. This review summarizes the current evidence for the use of adjuvant and neoadjuvant therapies in colon and rectal cancer. This review contains 2 figures, 7 tables, and 77 references. Keywords: Colon cancer, rectal cancer, neoadjuvant therapy, adjuvant therapy, total neoadjuvant therapy, induction chemotherapy in rectal cancer, chemoradiation, organ preservation, non-operative management

scholarly journals Selection factors for local excision or abdominoperineal resection of early stage rectal cancer

Cancer ◽  
1994 ◽  
Vol 73 (11) ◽  
pp. 2716-2720 ◽  
Author(s):  
Christopher G. Willett ◽  
Carolyn C. Compton ◽  
Paul C. Shellito ◽  
Jimmy T. Efird
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Local Excision ◽  
Early Stage ◽  
Selection Factors

Gene Signature Is Associated with Early Stage Rectal Cancer Recurrence

2010 ◽  
Vol 211 (2) ◽  
pp. 187-195 ◽  
Author(s):  
Matthew F. Kalady ◽  
Kathryn Dejulius ◽  
James M. Church ◽  
Ian C. Lavery ◽  
Victor W. Fazio ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Early Stage ◽  
Cancer Recurrence ◽  
Gene Signature ◽  
Rectal Cancer Recurrence

Adjuvant and Neoadjuvant Management of Colorectal Cancer

2020 ◽  
Author(s):  
Christina E Bailey ◽  
Eduardo Vilar ◽  
Y. Nancy You
Keyword(s):  
Colorectal Cancer ◽  
Rectal Cancer ◽  
Neoadjuvant Therapy ◽  
Significant Proportion ◽  
Operative Management ◽  
The United States ◽  
Current Evidence ◽  
Recurrence Rates ◽  
Curative Intent ◽  
Colon And Rectal Cancer

Colorectal cancer (CRC) is the third most common and lethal cancer in men and women in the United States. At presentation, a significant proportion of patients with CRC are able to undergo resection with curative intent, but up to 50% of these patients will develop recurrent disease. Fortunately, recurrence rates for both colon and rectal cancer have improved with the introduction of multimodality therapies, which include chemotherapy, chemoradiation therapy, and radiation therapy. These therapies are adjuncts to surgery and can be administered before (i.e. neoadjuvant) or after (i.e. adjuvant) surgery. This review summarizes the current evidence for the use of adjuvant and neoadjuvant therapies in colon and rectal cancer. This review contains 2 figures, 7 tables, and 77 references. Keywords: Colon cancer, rectal cancer, neoadjuvant therapy, adjuvant therapy, total neoadjuvant therapy, induction chemotherapy in rectal cancer, chemoradiation, organ preservation, non-operative management

Higher tamoxifen use as chemoprophylaxis in patients with ductal carcinoma in situ (DCIS) in the last decade.

2012 ◽  
Vol 30 (27_suppl) ◽  
pp. 191-191
Author(s):  
Erin E. Roesch ◽  
Lai Wei ◽  
Bhuvaneswari Ramaswamy
Keyword(s):  
Hormone Therapy ◽  
Ductal Carcinoma ◽  
Early Stage ◽  
Treatment Options ◽  
Retrospective Chart Review ◽  
Breast Conserving Surgery ◽  
The United States ◽  
Recurrence Rates ◽  
Chi Square ◽  
Significant Difference

191 Background: The incidence of DCIS over the last two decades has increased, with over 62,000 new cases diagnosed annually in the United States. Tailored management of DCIS is still a work in progress and currently treatment options are varied. We sought to identify changes in patterns of care in individual and physician choices for surgery and chemoprophylaxis over the last two decades at our institution. Methods: We performed a retrospective chart review and identified 773 eligible patients using the James Cancer Registry and the NCCN database at The Ohio State University between 1990 and 2010. We compared the proportion of patients undergoing mastectomy vs breast conserving surgery (BCT), use of radiation and hormone therapy, and recurrence rates between the years 1990-2000 and 2001-2010 using Chi-square test. Results: There was no significant difference in race (p=0.21) or age (p=0.09) among patients diagnosed with DCIS between 1990-2000 (Group A, N=462) and 2001-2010 (Group B, N=311). There was no significant difference in mastectomy rates between the two groups (31% vs. 27%, p= 0.26). Patients less than 50 years old were more likely to undergo mastectomy in both groups (p=0.02). Use of radiation therapy following BCT was similar between the two groups (52% vs. 53%, p=0.76). Interestingly more patients received hormone therapy during 2001-2010 than 1990-2000 (48% vs. 26%, p < 0.0001). Patients undergoing mastectomy were less likely to receive radiation (2% vs. 74%, p<0.0001) and hormone therapy (25% vs. 39%, p<0.0001). There was no significant correlation between race and type of surgery. We are in the process of comparing recurrence rates between the two groups which will be reported. Conclusions: Previously published studies have reported higher rates of mastectomy among patients with early stage breast cancer in the recent years. Data from our institution over the last two decades did not corroborate this finding, although interestingly we have found increasing use of tamoxifen therapy for DCIS in the second decade. Understanding current practices is helpful in designing future studies for management of DCIS using novel prognostic assays such as Oncotype Dx assay.

Analysis of Surgical Salvage After Failure of Primary Therapy in Rectal Cancer: Results From Intergroup Study 0114

2003 ◽  
Vol 21 (19) ◽  
pp. 3623-3628 ◽  
Author(s):  
J.E. Tepper ◽  
M. O’Connell ◽  
D. Hollis ◽  
D. Niedzwiecki ◽  
E. Cooke ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Surgical Resection ◽  
Recurrent Disease ◽  
The United States ◽  
Single Site ◽  
Primary Therapy ◽  
Rectal Cancer Recurrence ◽  
Surgical Salvage ◽  
Single Organ

Purpose: Intergroup Study 0114 was designed to study the effect of various chemotherapy regimens delivered after potentially curative surgical resection of T3, T4, and/or node-positive rectal cancer. A subset analysis was undertaken to investigate the prevalence and influence of salvage therapy among patients with recurrent disease. Patients and Methods: Adjuvant therapy consisted of two cycles of fluorouracil (FU)-based chemotherapy followed by pelvic irradiation with chemotherapy and two more cycles of chemotherapy after radiation therapy. A total of 1,792 patients were entered onto the study and 1,696 were assessable. After a median of 8.9 years of follow-up, 715 patients (42%) had disease recurrence, and an additional 10% died without evidence of disease. Five hundred patients with follow-up information available had a single organ or single site of first recurrence (73.5% of all recurrences). Results: A total of 171 patients (34% of those with a single organ or single site of recurrence) had a potentially curative resection of the metastatic or locally recurrent disease. Single-site first recurrences in the liver, lung, or pelvis occurred in 448 patients (90% of the single-site recurrences), with 159 (35%) of these undergoing surgical resection for attempted cure. Overall survival differed significantly between the resected and nonresected groups (P < .0001), with overall 5-year probabilities of .27 and .06, respectively. Controlling for worst performance status at the time of recurrence does not alter this relationship. Patients who underwent salvage surgery had significantly increased survival (P < .001) for each site. Conclusion: Attempted surgical salvage of rectal cancer recurrence is performed commonly in the United States. The chance of a long-term cure with such intervention is approximately 27%.

Comparison of Sphincter Saving Resection (SSR) & Sphincter Losing Abdominoperineal Resection (APR) in Very Low Rectal Cancer

2019 ◽  
Vol 11 (1) ◽  
pp. 3-8
Author(s):  
Jawhar Lal Singha ◽  
Sami Ahmad ◽  
Nadim Ahmed ◽  
ABM Muksudul Alam
Keyword(s):  
Rectal Cancer ◽  
Abdominoperineal Resection ◽  
Anal Verge ◽  
Low Rectal Cancer ◽  
Similar Distribution ◽  
Lower Margin ◽  
Recurrence Rates ◽  
Sphincter Saving Resection ◽  
Sphincter Saving ◽  
Very Low Rectal Cancer

Oncological outcomes of sphincter-saving resection (SSR) and sphincter losing abdominoperineal resection (APR) in 210 consecutive patients with very low-lying rectal cancer (i.e. lower margin of tumor is within 3.5 cm from the anal verge) were studied and compared. 54 (25.71%) patients underwent SSR and 156 (74.28%) patients underwent SLR-APR. The APR group comprised higher proportions of men (61.53% vs 55.5%, P =.049) and advanced-stage disease (P <.001). Preoperative chemoradiotherapy (PCRT) was administered in both the group with almost similar distribution (62.82 % vs 59.25%, P <.001). Overall, (the systemic and local) recurrence rates were almost similar i.e. 33.31% in SSR and 33.32% in APR. On stratification according to PCRT and pathologic stage, the mode of surgery did not affect the recurrence type. Moreover, recurrence-free survival (RFS) did not differ according to the mode of surgery in different cancer stages. Patients who were stratified according to cancer stage and PCRT also showed no differences in RFS according to the mode of surgery. The results of the study demonstrate that, regardless of PCRT administration, SSR is an effective treatment for very low rectal cancer. J Shaheed Suhrawardy Med Coll, June 2019, Vol.11(1); 3-8  

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