Laparoscopic tme with sphincter preservation for rectal cancer: Five-year results

2020 ◽  
Vol 10 (5) ◽  
Author(s):  
Hữu Thịnh Nguyễn ◽  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Local Recurrence ◽  
Disease Free Survival ◽  
Oncologic Outcome ◽  
Distant Metastases ◽  
Sphincter Preservation ◽  
Laparoscopic Rectal Resection ◽  
Laparoscopic Tme ◽  
Radio Chemotherapy

Abstract Introduction: Laparoscopic surgery for rectal cancer has showed many advantages. Adjuvant chemotherapy can improve local recurrence, metastasis and survival. Materials and Methods: We reviewed rectal cancer patients who underwent laparoscopic rectal resection and adjuvant radio-chemotherapy at UMC from 11/ 2013 to 08/2016. Results: The local recurrence rate was 8,8%, the distant metastases was 19,3%. The 5 years overall survival (OS) and disease- free survival (DFS) were 82,7% and 74,6%, respectively. Conclusions: Laparoscopic resection and adjuvant radio-chemotherapy for rectal cancer was effective and safe on oncologic outcome, good results on survival. Keywords: Laparoscopic surgery, adjuvant therapy. Tóm tắt Đặt vấn đề: Phẫu thuật nội soi điều trị ung thư trực tràng có nhiều ưu điểm. Điều trị hỗ trợ sau mổ giúp cải thiện tỉ lệ tái phát tại chỗ, di căn xa và sống còn. Phương pháp nghiên cứu: Hồi cứu các người bệnh ung thư trực tràng được phẫu thuật nội soi cắt đoạn đại trực tràng và điều trị hoá - xạ trị sau mổ từ 11/2013 đến 08/2016 tại Bệnh viện Đại học Y dược TP. Hồ Chí Minh. Kết quả: Tỉ lệ tái phát tại chỗ 8.8%, di căn xa 19,3%. Tỉ lệ sống chung và sống không bệnh sau 5 năm lần lượt là 82,7% và 74,6%. Kết luận: Phẫu thuật nội soi cắt đoạn đại trực tràng và điều trị hỗ trợ trong ung thư trực tràng hiệu quả và an toàn về mặt ung thư học, kết quả tốt về mặt sống còn.

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.

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.

Analysis of recurrence pattern and survival in locally advanced rectal cancer treated with neoadjuvant chemoradiation and surgery: 25 years of experience.

2015 ◽  
Vol 33 (3_suppl) ◽  
pp. 744-744
Author(s):  
Javier A. Cienfuegos ◽  
Jorge Baixauli ◽  
Fernando Rotellar ◽  
Iosu Sola ◽  
Jorge Arredondo ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Neoadjuvant Chemoradiation ◽  
Pathological Response ◽  
Upper Third

744 Background: The standard treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiation (CRT) followed by total mesorectal excision (TME). Despite the significant reduction (~ 40%) in local recurrence, the overall survival (OS) and disease free survival (DFS) remain stable during last decade. We aimed to study the pattern of recurrence and it’s relationship with clinico-pathological data in 356 patients with LARC treated with CRT and TME in last 25 years. Methods: From a total of 621 patients, 356 with LARC were analyzed. In 55 (15.4%) the tumor was localized in upper third, in 120 (33.7%) in middle third and in 181 (50.8%) in distal third. The median dose of radiotherapy for the 3 groups was between 47.5 - 48.52 Gy. Chemotherapy was based on 5-FU or capecitabine combined with oxaliplatin. Type of surgery, pathological response grade, circumferential resection margin, lymphovascular invasion, colloid response, local recurrence incidence, distal relapse, OS and DFS were analyzed. Results: The median interval between the end of CRT and surgery was 40 days. 52 low anterior resection were carried-out in upper third (94.5%), 112 (93.3%) in middle third and 92 (50.8%) in distal third. Four patients from the middle third (3.3%) underwent abdominoperineal resection and 72 (39.8%) in the distal location. No differences were observed in number of lymphoid nodes, vascular perineural invasion, and pathological response grade. A pathological complete response was assessed in 5 patients (9.1%) in upper third, in 12 (10%) in middle third, as well in 32 (17.7%) in distal third. Median follow-up of 187 months. The 5-10 year DFS for the 3 groups was 75%, 76%, and 69%, and 75%, 71%, and 66% respectively. The local recurrence rate was 3.6%, 4.2%, and 6.1%. The distal recurrence was more frequent in the lung, 10.9%, 16.7%, 23.8%, with tendency to be significant (p<0.007) in distal third. Conclusions: In spite of the good local control with the association of preoperative CRT and TME in treatment of LARC, the development of distant metastases, especially in distal third, gives rise to new therapeutics schemes. Further research is warranted as to the benefits of adjuvant chemotherapy.

scholarly journals LATE RESULTS OF TOTAL MESORECTUMECTOMY IN RECTAL CANCER AFTER OPEN AND LAPAROSCOPIC PROCEDURES

2019 ◽  
Vol 18 (3(69)) ◽  
pp. 41-48
Author(s):  
E. G. Azimov ◽  
S. A. Aliyev
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Cancer Patients ◽  
Recurrence Rate ◽  
Local Recurrence Rate ◽  
Distant Metastases ◽  
Late Results ◽  
Open Approach ◽  
Laparoscopic Tme ◽  
Disease Free

AIM: to evaluate late results for patients that had open and laparoscopic total mesorectumectomy (TME) surgery for rectal cancer. PATIENTS AND METHODS: prospective cohort study included 103 patients aged from 20 to 70 years with rectal cancer. Patients were divided into 2 groups: the 1st group included 47 patients after laparoscopic TME (LTME) and the 2nd group included 56 patients after open one (OTME). All tumors were adenocarcinomas. Late results were assessed by actual and disease-free 3- and 5-year survival in 97 (94.2%) patients. RESULTS: local recurrence rate after OTME and LTME was 11,5% (6 patients) and 11,1% (5 patients) (p>0.05). Distant metastases occurred in 4 (7,7%) and 3 (6,7%) cases, respectively (p>0.05). The actual survival after LTME was 80.0% (81.8% after OTME, p>0.05), the disease-free 3-year survival rate was 56,7% (60.6% after OTME, p>0.05), 5-year survival was 31.6% (31.8% after OTME, p>0.05). CONCLUSION: no significant differences were found between laparoscopic and open approach for rectal cancer in local recurrence rate and survival.

Randomized Trial of Laparoscopic-Assisted Resection of Colorectal Carcinoma: 3-Year Results of the UK MRC CLASICC Trial Group

2007 ◽  
Vol 25 (21) ◽  
pp. 3061-3068 ◽  
Author(s):  
David G. Jayne ◽  
Pierre J. Guillou ◽  
Helen Thorpe ◽  
Philip Quirke ◽  
Joanne Copeland ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Colon Cancer ◽  
Laparoscopic Surgery ◽  
Local Recurrence ◽  
Open Surgery ◽  
Disease Free Survival ◽  
Long Term Outcomes ◽  
The Uk ◽  
Laparoscopic Assisted

Purpose The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required. Methods The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis. Results Seven hundred ninety-four patients were recruited (526 laparoscopic and 268 open). Overall, there were no differences in the long-term outcomes. The differences in survival rates were OS of 1.8% (95% CI, −5.2% to 8.8%; P = .55), DFS of −1.4% (95% CI, −9.5% to 6.7%; P = .70), local recurrence of −0.8% (95% CI, −5.7% to 4.2%; P = .76), and QoL (P > .01 for all scales). Higher positivity of the circumferential resection margin was reported after laparoscopic anterior resection (AR), but it did not translate into an increased incidence of local recurrence. Conclusion Successful laparoscopic-assisted surgery for colon cancer is as effective as open surgery in terms of oncological outcomes and preservation of QoL. Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.

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.

TP1.2.3Oncological Outcomes of Organ Preservation Strategies - Local Excision Procedures and ‘Watchful Waiting’ In Management of Low Rectal Cancers – A Systematic Review And Meta-Analysis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
A R Aspari ◽  
V Ramesh ◽  
G Kumar ◽  
S N Narayanasamy ◽  
A O Gumber ◽  
...  
Keyword(s):  
Systematic Review ◽  
Overall Survival ◽  
Local Recurrence ◽  
Organ Preservation ◽  
Meta Analysis ◽  
Disease Free Survival ◽  
Distant Metastases ◽  
Free Survival ◽  
Rectal Cancers ◽  
Disease Free

Abstract Objective To evaluate local recurrence, metastases, and survival outcomes of `wait and watch’ (WW) strategy and local excision (LE) of tumours, in comparison to the present standard practice of total mesorectal excision (TME) for locally advanced rectal cancers. Data Sources MEDLINE, EMBASE, PubMed databases, and sources of Grey literature. Study Selection Randomised and non-randomised prospective studies, retrospective studies with propensity-score-matched analyses. Data Extraction and Synthesis These were carried out independently by two reviewers. A random-effects methodology was used for meta-analyses. Data was presented keeping with the 27-item PRISMA checklist. Main Outcomes The primary outcomes of interest were local recurrence, distant metastases, disease-free-survival and overall-survival, which were assessed in comparison to those associated with radical surgeries (TME). Results 7 of the 16 studies in the systematic review were included for the quantitative synthesis and meta-analysis. Local recurrence rates were comparable amongst patients in WW group and LE group to those undergoing TME. [Risk ratio (RR) 3.07/1.41; 95% Confidence Interval (CI) 0.86-10.95/0.66-3.01; P = 0.08/P=0.89 respectively]. Rates of distant metastases in the WW group and LE group were comparable to those undergoing TME [RR = 0.71/0.94; 95% CI 0.22-2.30/0.55-1.61; P = 0.56/ P = 0.83 respectively]. The median 3-year disease-free survival among patients undergoing WW, LE procedure, and TME were 88%, 80%, and 78.2% respectively; and the median 3-year overall survival among the three groups were 96%, 93%, and 89.5% respectively. Conclusions and Relevance Organ-preservation strategies appear to be a viable treatment option in the management of rectal-cancers. Further research is warranted to provide stronger levels of evidence on organ-preservation strategies.

Long-term oncologic outcome after laparoscopic surgery for rectal cancer

2013 ◽  
Vol 28 (4) ◽  
pp. 1119-1125 ◽  
Author(s):  
Ayman Agha ◽  
Volker Benseler ◽  
Matthias Hornung ◽  
Michael Gerken ◽  
Igors Iesalnieks ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Oncologic Outcome

Pushing the envelope beyond a centimeter in rectal cancer: Oncologic implications of close but negative margins.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 487-487
Author(s):  
T. L. Fitzgerald ◽  
J. Brinkley ◽  
E. E. Zervos
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Adjuvant Therapy ◽  
Adjuvant Radiotherapy ◽  
Meta Analysis ◽  
Sphincter Preservation ◽  
Distal Margin ◽  
Recurrence Rates ◽  
Randomized Controlled Studies ◽  
Number Of Patients

487 Background: Advances in surgery, adjuvant therapy and understanding of the natural history of rectal cancer has enabled sphincter preservation surgery for most patients. A 1 cm margin is commonly accepted as minimal distal margin, when not achievable many are relegated to permanent colostomy. Our purpose was to determine if distal margins of < 1 cm is justified by the world's published experience. Methods: Studies were identified with a MEDLINE search using terms rectal cancer, colorectal cancer, margins and distal margins with an additional manual search. There were no restrictions on data type or year of publication. All studies were retrospective or prospective, none were randomized controlled. Studies were excluded if specific margins, local recurrence rates or case level data could not be extracted. Extracted variables included year of publication, time span, number of patients, standardized surgery, radiotherapy, margins, follow up, local recurrence rates and overall survival. Meta-analysis was performed using a random weighting scheme. Values were aggregated across studies to determine overall impact and p-values. Results: Seventeen studies reported margins with thirteen studies, 3,232 patients, reporting outcomes when < 1cm. Meta-analysis of all studies indicated a nonsignificant trend favoring greater margins. However, in order to understand distal margins in the context of current standards additional analyses were performed. Of the thirteen studies 4 reported neither TME nor use adjuvant radiotherapy and 9 studies reported use of one or both. When either total mesorectal excision and/or adjuvant radiotherapy was reported there was no significant increase in local recurrence with distal margins < 1 cm. In studies that used neither therapy > 1 cm margins were statistically less prone to recurrence. Conclusions: Sphincter preservation is possible with < 1 cm distal margin when optimal surgical and adjuvant therapy are applied. [Table: see text]

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