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Lei Y, Lin L, Shao Q, Chen W, Liu G. Long-term efficacy of transanal local excision versus total mesorectal excision after neoadjuvant treatment for rectal cancer: A meta-analysis. PLoS One 2023; 18:e0294510. [PMID: 37983236 PMCID: PMC10659211 DOI: 10.1371/journal.pone.0294510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
AIM The purpose of this meta-analysis is to compare the long-term efficacy of transanal local excision (TLE) versus total mesorectal excision (TME) following neoadjuvant therapy for rectal cancer. METHOD The Web of Science, Pubmed, Medline, Embase, and the Cochrane Library were systematically searched for correlational research. The Newcastle-Ottawa Scale and the Cochrane risk of bias tool were used to assess the quality of cohort studies (CSs) and randomized controlled trials (RCTs), respectively. Statistically analyzed using RevMan5.4. RESULT A total of 13 studies, including 3 randomized controlled trials (RCTs) and 10 cohort studies (CSs), involving 1402 patients, were included in the analysis. Of these, 570 patients (40.66%) underwent TLE, while 832 patients (59.34%) underwent TME. In the meta-analysis of CSs, no significant difference was observed between the TLE group and TME group regarding 5-year overall survival (OS) and 5-year disease-free survival (DFS) (P > 0.05). However, the TLE group had a higher rates of local recurrence (LR) [risk ratio (RR) = 1.93, 95%CI (1.18, 3.14), P = 0.008] and a lower rates of 5-years local recurrence-free survival (LRFS) [hazard ratio (HR) = 2.79, 95%CI (1.04, 7.50), P = 0.04] compared to the TME group. In the meta-analysis of RCTs, there was no significant difference observed between the TLE group and TME group in terms of LR, 5-year OS, 5-year DFS, and 5-year disease-specific survival (P > 0.05). CONCLUSION After undergoing neoadjuvant therapy, TLE may provide comparable 5-year OS and DFS to TME for rectal cancer. However, neoadjuvant therapy followed by TLE may has a higher LR and lower 5-year LRFS compared to neoadjuvant therapy followed by TME, so patients should be carefully selected. Neoadjuvant therapy followed by TLE may be a suitable option for patients who prioritize postoperative quality of life. However, the effectiveness of this approach requires further research to draw a definitive conclusion.
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Affiliation(s)
- Yihui Lei
- The School of Clinical Medical, Fujian Medical University, Fuzhou, Fujian, China
| | - Li Lin
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
| | - Qiming Shao
- The School of Clinical Medical, Fujian Medical University, Fuzhou, Fujian, China
| | - Weiping Chen
- The School of Clinical Medical, Fujian Medical University, Fuzhou, Fujian, China
| | - Guoyan Liu
- Department of Gastrointestinal Surgery, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, Fujian, China
- Institute of Gastrointestinal Oncology, Medical College of Xiamen University, Xiamen, Fujian, China
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2
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Portale G, Bartolotta P, Azzolina D, Gregori D, Fiscon V. Prognostic role of platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte, and lymphocyte-to-monocyte ratio in operated rectal cancer patients: systematic review and meta-analysis. Langenbecks Arch Surg 2023; 408:85. [PMID: 36781510 DOI: 10.1007/s00423-023-02786-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 12/30/2022] [Indexed: 02/15/2023]
Abstract
BACKGROUND Inflammation plays an important role in tumor growth. Novel serum blood biomarkers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), have been proposed as useful prognostic indexes in cancer patients. However, their role in rectal cancer is controversial. METHODS A comprehensive literature review was conducted including MEDLINE/Pubmed, EMBASE, SCOPUS, and the Cochrane Database of Systematic Reviews through May 2022. The systematic review and meta-analysis were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) tool. Aim of the study was to summarize available literature on PLR, NLR, and LMR in patients with rectal cancer undergoing resection. RESULTS Forty-seven observational studies (14,205 patients) were included; there were 42 retrospective and 5 prospective cohort studies with an average MINORS score of 14.6 (range: 12-18). Worse overall survival was associated with high NLR (HR 1.81; 95%CI 1.52-2.15; p < 0.001), high PLR (HR 1.24; 95%CI 1.06-1.46; p = 0.009), and low LMR (HR 0.67; 95%CI 0.49-0.91; p = 0.01). High NLR and low LMR were also associated with disease-free-survival (HR 1.68; 95%CI 1.35-2.08; p < 0.001 and HR 0.71; 95%CI 0.58-0.87; p < 0.001, respectively). CONCLUSIONS NLR, PLR, and LMR are independent clinical predictors for overall survival in patients with rectal cancer treated with curative surgery. NLR and LMR are also good predictors for disease free survival. These biomarkers, which are readily available, appear optimal prognostic indexes and may help clinicians predict the prognosis of rectal cancer and develop individualized treatment strategies.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa Di Ricovero 40, 35013, Cittadella, Padua, Italy.
| | - Patrizia Bartolotta
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, 35121, Padua, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda Euganea ULSS 6, Via Casa Di Ricovero 40, 35013, Cittadella, Padua, Italy
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Wu D, Bian L, Chen Y, Zhang L, Qu H, Li Z, Chen X. A pilot study on preoperative vascular anatomy and clinical application in rectal cancer resection. Clin Radiol 2022; 77:701-707. [PMID: 35680447 DOI: 10.1016/j.crad.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/06/2022] [Indexed: 11/03/2022]
Abstract
AIM To assess the utility of preoperatively evaluating the vascular anatomy using multisection spiral computed tomography angiography (CTA) and image fusion technology in the treatment of obese patients undergoing laparoscopic radical resection for rectal cancer. MATERIALS AND METHODS This randomised prospective study included 56 patients who underwent laparoscopic surgery for rectal cancer. Patients were randomly divided into two groups: the fusion imaging group (preoperative CTA and image fusion reconstruction [n=28]) and the control group (not performed CTA and image fusion reconstruction before the operation [n=28]). Duration of surgery was defined as the primary endpoint, and the volume of bleeding, the number of lymph node dissections, conversion to laparotomy, time to recovery of postoperative flatus, length of hospitalisation as well as perioperative complications were defined as secondary endpoints. RESULTS Compared with the control group, the duration of surgery in the image fusion group was shorter, bleeding volume was reduced, and the number of lymph node dissections was greater (p<0.05); however, there was no significant differences between the two groups regarding time to postoperative flatus recovery, conversion to laparotomy, length of hospitalisation, and perioperative complications (p>0.05). CONCLUSIONS Preoperative assessment of the vascular anatomy was an effective method and avoided some invisible risks during surgery, and resulted in a better therapeutic effect.
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Affiliation(s)
- D Wu
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - L Bian
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Y Chen
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - L Zhang
- Department of Radiology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China.
| | - H Qu
- Department of General Surgery, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - Z Li
- Information Section, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
| | - X Chen
- Department of Pathology, The Affiliated Wuxi No. 2 People's Hospital of Nanjing Medical University, Wuxi, Jiangsu, China
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Role of robotic natural orifice specimen extraction surgery in colorectal neoplasms. Sci Rep 2021; 11:9818. [PMID: 33972632 PMCID: PMC8110763 DOI: 10.1038/s41598-021-89323-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 04/23/2021] [Indexed: 12/21/2022] Open
Abstract
Natural orifice specimen extraction surgery (NOSES) is especially suitable for colorectal surgery. Until now, most of the reports published were about laparoscopic NOSES, the reports about robotic NOSES are extremely rare. This study aims to explore the safety and feasibility of robotic NOSES for colorectal neoplasms. All patients underwent robotic NOSES from March 2016 to October 2019 in our hospital were enrolled for retrospective analysis. Clinicopathological data including patient characteristics, perioperative information and pathological information were collected and analyzed. According to the distance between tumor and anus or whether neoadjuvant chemoradiotherapy (nRCT) is performed, we grouped the cases and studied its influence on robotic NOSES. Also, we compared the previous reports on laparoscopic NOSES with our study and revealed advantages of robotic NOSES in terms of safety and feasibility. A total of 180 patients were enrolled. The average distance from the lower edge of the tumor to the anus was (8.64 ± 3.64) cm and maximum circumferential diameter (CDmax) of specimen was (3.5 ± 1.6) cm. In terms of safety, the average operation time, intraoperative blood loss, and postoperative hospital stay were (187.5 ± 78.3) min, (47.4 ± 34) mL, and (11.3 ± 7.5) days, respectively. In terms of feasibility, the average number of lymph node harvested was (14.8 ± 5). Robotic NOSES shows advantages in terms of safety and feasibility compared with laparoscopic NOSES. This procedure could not only be a safe procedure but also could achieve good oncological outcomes.
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Laparoscopic Curative Resection for Rectal Cancer: A Cohort Study on Long-term Outcome. Surg Laparosc Endosc Percutan Tech 2018; 28:318-323. [DOI: 10.1097/sle.0000000000000565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Portale G, Cavallin F, Valdegamberi A, Frigo F, Fiscon V. Platelet-to-Lymphocyte Ratio and Neutrophil-to-Lymphocyte Ratio Are Not Prognostic Biomarkers in Rectal Cancer Patients with Curative Resection. J Gastrointest Surg 2018; 22:1611-1618. [PMID: 29687424 DOI: 10.1007/s11605-018-3781-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 04/09/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Actual predictors of survival and recurrence for rectal cancer patients undergoing curative resection mostly come from pathological data of surgical specimen. Recently, novel blood biomarkers have been proposed as useful tools in cancer patient management, but few and conflicting data have been reported in rectal cancer. We evaluated the prognostic relevance of preoperative platelet-to-lymphocyte (P/L) ratio and neutrophil-to-lymphocyte (N/L) ratio on survival and recurrence in patients undergoing laparoscopic curative resection for rectal cancer. METHODS All consecutive patients who referred for primary rectal disease to the Department of General Surgery in Cittadella (Italy) from June 2005 to September 2015 were retrospectively evaluated. Patients with metastatic disease at surgery were excluded. P/L and N/L ratios were calculated. For patients undergoing neoadjuvant chemo-radiotherapy, pre-treatment data were considered. Follow-up data were updated at December 2016. RESULTS One hundred fifty-two patients were included in the study, 49 (32%) received neoadjuvant chemo-radiotherapy. Both P/L and N/L ratios showed poor discriminative performance on 5-year OS and DFS. Time-dependent ROC curves showed no improvements in discriminative performance of P/L and N/L ratios when considering different time endpoints. Multivariable analysis identified CEA-rather than P/L or N/L ratios-as independent predictor of OS and DFS, adjusting for age, tumor stage, and postoperative morbidity. CONCLUSION Neither P/L nor N/L ratios were associated with survival after rectal cancer surgery. Further studies on large series might provide insights on the role of these inexpensive blood biomarkers in rectal cancer.
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Affiliation(s)
- Giuseppe Portale
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy.
| | | | - Alessandro Valdegamberi
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| | - Flavio Frigo
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
| | - Valentino Fiscon
- Department of General Surgery, Azienda ULSS 6, Cittadella, Via Casa di Ricovero, 40, 35013, Cittadella, Padova, Italy
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Merchea A, Ali SM, Kelley SR, Duchalais E, Alabbad JY, Dozois EJ, Larson DW. Long-Term Oncologic Outcomes of Minimally Invasive Proctectomy for Rectal Adenocarcinoma. J Gastrointest Surg 2018; 22:1412-1417. [PMID: 29594912 DOI: 10.1007/s11605-018-3751-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Accepted: 03/17/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Long-term oncologic outcomes after minimally invasive surgery (MIS) for rectal adenocarcinoma compared to open surgery continue to be debated. We aimed to review our high-volume single-institution outcomes in MIS rectal cancer surgery. METHODS A retrospective review of a prospectively collected database was completed of all consecutive adult patients with rectal adenocarcinoma treated from January 2005 through December 2011. Stage IV or recurrent disease was excluded. Demographics and operative and pathologic details were reviewed and reported. Primary endpoints include survival and recurrence. RESULTS A total of 324 patients were included and median follow-up was 54 months (IQR = 37.0, 78.8). The mean age was 58.2 ± 14.1 years. Tumors were in the upper rectum in 111 patients, mid-rectum in 113 patients, and lower rectum in 100 patients. Stage III disease was most common (49.4%). Overall conversion to open procedure rate was 13.9%. The circumferential radial margin was positive in only 1 patient (0.3%) and the mean lymph node yield was 24.7 ± 17.2. Cancer recurred in 42 patients (13%), 10 (2.5%) patients developed local recurrence, 32 (9.8%) developed distant metastasis, and 2 (0.6%) patients had both. The 5-year overall survival for stage 0, 1, 2, and 3 disease is 96, 91, 80, and 77%, respectively (p = 0.015). CONCLUSION In carefully selected rectal cancer patients treated with MIS, long-term outcomes of survival and recurrence appear to compare favorably to previously published series.
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Affiliation(s)
- Amit Merchea
- Division of Colon and Rectal Surgery, Mayo Clinic, Jacksonville, FL, 32224, USA.
| | - Shahzad M Ali
- Department of Surgery, Mayo Clinic, Rochester, MN, USA
| | - Scott R Kelley
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Emilie Duchalais
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Jasim Y Alabbad
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Eric J Dozois
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - David W Larson
- Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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唐 小, 熊 清, 崇 杨, 王 道. 达芬奇机器人在直肠癌手术中泌尿生殖功能保护的系统回顾. Shijie Huaren Xiaohua Zazhi 2017; 25:1368-1374. [DOI: 10.11569/wcjd.v25.i15.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
目的 研究达芬奇机器人在直肠癌术后中对于患者盆部神经功能的保护相比于腹腔镜手术的优势.
方法 利用计算器检索关于国内外发表的机器人和腹腔镜直肠癌手术的对比研究, 研究采用的方法为国际公认的国际前列腺症状评分量表和国际勃起功能指数量表, 对纳入文献进行综合分析.
结果 最终纳入7篇文献, 共673例患者, 行机器人手术患者311例, 平均年龄62.7岁, 行腹腔镜手术362例, 平均年龄69.6岁. 两种手术方式的患者术后泌尿性功能均有一定程度的下降, 但机器人手术组患者的下降程度明显低于腹腔镜手术组, 且恢复至术前水平的速度更快.
结论 达芬奇机器人相比与腹腔镜手术在直肠癌患者术后的泌尿性功能保护方面具有一定优势.
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Trépanier JS, Fernandez-Hevia M, Lacy AM. Transanal total mesorectal excision: surgical technique description and outcomes. MINIM INVASIV THER 2016; 25:234-40. [PMID: 27336195 DOI: 10.1080/13645706.2016.1199434] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Minimally invasive techniques (MIS) have been evolving quickly in colorectal surgery during the last two decades. Transanal total mesorectal excision (taTME) was developed as a combination of skills acquired from different MIS approaches such as Transanal Endoscopic Microsurgery (TEM), Transanal Minimally Invasive Surgery (TAMIS) and Natural Orifices Transluminal Endoscopic Surgery (NOTES). TaTME allows for a better visualization of surgical planes of dissection and achievement of rectal resection following oncologic principles. We here present the standardized taTME technique in use at the Hospital Clínic de Barcelona and our published outcomes in rectal cancer.
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Affiliation(s)
- Jean-Sébastien Trépanier
- a Gastrointestinal Surgery Department, Hospital Clínic de Barcelona , Barcelona , Spain ;,b General Surgery Department, Hôpital Maisonneuve-Rosemont, Université de Montréal , Montréal , Québec , Canada
| | - María Fernandez-Hevia
- a Gastrointestinal Surgery Department, Hospital Clínic de Barcelona , Barcelona , Spain
| | - Antonio M Lacy
- a Gastrointestinal Surgery Department, Hospital Clínic de Barcelona , Barcelona , Spain
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Pozo ME, Fang SH. Watch and wait approach to rectal cancer: A review. World J Gastrointest Surg 2015; 7:306-312. [PMID: 26649153 PMCID: PMC4663384 DOI: 10.4240/wjgs.v7.i11.306] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2015] [Revised: 09/08/2015] [Accepted: 09/30/2015] [Indexed: 02/06/2023] Open
Abstract
In 2014, there were an estimated 136800 new cases of colorectal cancer, making it the most common gastrointestinal malignancy. It is the second leading cause of cancer death in both men and women in the United States and over one-third of newly diagnosed patients have stage III (node-positive) disease. For stage II and III colorectal cancer patients, the mainstay of curative therapy is neoadjuvant therapy, followed by radical surgical resection of the rectum. However, the consequences of a proctectomy, either by low anterior resection or abdominoperineal resection, can lead to very extensive comorbidities, such as the need for a permanent colostomy, fecal incontinence, sexual and urinary dysfunction, and even mortality. Recently, trends of complete regression of the rectal cancer after neoadjuvant chemoradiation therapy have been confirmed by clinical and radiographic evaluation-this is known as complete clinical response (cCR). The “watch and wait” approach was first proposed by Dr. Angelita Habr-Gama in Brazil in 2009. Those patients with cCR are followed with close surveillance physical examinations, endoscopy, and imaging. Here, we review management of rectal cancer, the development of the “watch and wait” approach and its outcomes.
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