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Cerdán-Santacruz C, Cano-Valderrama Ó, Santos Rancaño R, Terés LB, Vigorita V, Pérez TP, Rosciano Paganelli JG, Paredes Cotoré JP, Carre MK, Flor-Lorente B, Antona FB, Martín EY, Tebar JC, Cao IA, Coltell ZB, Alonso MG, Paredes Cotoré JP, Prada López BL, Riesco AB, Cánovas NI, Sánchez CM, Serrat DR, Conde GA, Toscano MJ, Aira AC, Pérez MR, Petit NM, Espín Basany E, Carré MK, Pellino G, Retuerta JM, Saldaña AG, Laso CÁ, Allende IA, Álvarez DH, Cazador AC, Sánchez Bautista WM, Torres Sánchez MT, Bonito AC, Velázquez MC, Díaz OM, Fuentes NS, Olías MDCDLV, Pérez TP, Rosciano Paganelli JG, Lorente BF, Valderrama ÓC, Santos Rancaño R, Terés LB, Santacruz CC. "Long-term oncologic outcomes and risk factors for distant recurrence after pathologic complete response following neoadjuvant treatment for locally advanced rectal cancer. A nationwide, multicentre study". Eur J Surg Oncol 2023; 49:106962. [PMID: 37414628 DOI: 10.1016/j.ejso.2023.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 04/09/2023] [Accepted: 06/15/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND Pathologic complete response (pCR) after multimodal treatment for locally advanced rectal cancer (LARC) is used as surrogate marker of success as it is assumed to correlate with improved oncologic outcome. However, long-term oncologic data are scarce. METHODS This retrospective, multicentre study updated the oncologic follow-up of prospectively collected data from the Spanish Rectal Cancer Project database. pCR was described as no evidence of tumour cells in the specimen. Endpoints were distant metastases-free survival (DMFS) and overall survival (OS). Multivariate regression analyses were run to identify factors associated with survival. RESULTS Overall, 32 different hospitals were involved, providing data on 815 patients with pCR. At a median follow-up of 73.4 (IQR 57.7-99.5) months, distant metastases occurred in 6.4% of patients. Abdominoperineal excision (APE) (HR 2.2, 95%CI 1.2-4.1, p = 0.008) and elevated CEA levels (HR = 1.9, 95% CI 1.0-3.7, p = 0.049) were independent risk factors for distant recurrence. Age (years) (HR 1.1; 95%-CI 1.05-41.09; p < 0.001) and ASA III-IV (HR = 2.0; 95%-CI 1.4-2.9; p < 0.001), were the only factors associated with OS. The estimated 12, 36 and 60-months DMFS rates were 96.9%, 91.3%, and 86.8%. The estimated 12, 36 and 60-months OS rates were 99.1%, 94.9% and 89.3%. CONCLUSIONS The incidence of metachronous distant metastases is low after pCR, with high rates of both DMFS and OS. The oncologic prognosis in LARC patients that achieve pCR after neoadjuvant chemo-radiotherapy is excellent in the long term.
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Affiliation(s)
| | | | | | - Lara Blanco Terés
- Colorectal Surgery Department, Hospital de la Princesa, Madrid, Spain
| | - Vicenzo Vigorita
- Colorectal Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - Jesús Pedro Paredes Cotoré
- Colorectal Surgery Department, Hospital Clínico Universitario de Santiago, Santiago de Compostela, La Coruña, Spain
| | | | - Blas Flor-Lorente
- Colorectal Surgery Department, Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | | | | | | | - Inés Aldrey Cao
- Complejo Hospitalario Universitario de Ourense, Orense, Spain
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Kristensen HØ, Thyø A, Jøssing Emmertsen K, Smart NJ, Pinkney T, Warwick AM, Pang D, Furnée EJB, Verkuijl SJ, José Rama N, Domingos H, Maciel J, Solis-Peña A, Espín Basany E, Hidalgo-Pujol M, Biondo S, Sjövall A, Christensen P. Translation and international validation of the Colostomy Impact score. Colorectal Dis 2021; 23:1866-1877. [PMID: 33725386 DOI: 10.1111/codi.15635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022]
Abstract
AIM Optimal oncological resection in cancers of the lower rectum often requires a permanent colostomy. However, in some patients a colostomy may have a negative impact on health-related quality of life (HRQoL). The Colostomy Impact (CI) score is a simple questionnaire that identifies patients with stoma dysfunction that impairs HRQoL by dividing patients into 'minor' and 'major' CI groups. This aim of this study is to evaluate construct and discriminative validity, sensitivity, specificity and reliability of the CI score internationally, making it applicable for screening and identification of patients with stoma-related impaired HRQoL. METHOD The CI score was translated in agreement with WHO recommendations. Cross-sectional cohorts of rectal cancer survivors with a colostomy in Australia, China, Denmark, the Netherlands, Portugal, Spain and Sweden were asked to complete the CI score, the European Organization for Research and Treatment of Cancer (EORTC) quality of life 30-item core questionnaire, the stoma-specific items of the EORTC quality of life 29-item colorectal-specific questionnaire and five anchor questions assessing the impact of colostomy on HRQoL. RESULTS A total of 2470 patients participated (response rate 51%-93%). CI scores were significantly higher in patients reporting reduced HRQoL due to their colostomy than in patients reporting no reduction. Differences in EORTC scale scores between patients with minor and major CI were significant and clinically relevant. Sensitivity was high regarding dissatisfaction with a colostomy. Regarding evaluation of discriminative validity, the CI score relevantly identified groups with differences in HRQoL. The CI score proved reliable, with equal CI scores between test and retest and an intraclass correlation coefficient in the moderate to excellent range. CONCLUSION The CI score is internationally valid and reliable. We encourage its use in clinical practice to identify patients with stoma dysfunction who require further attention.
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Affiliation(s)
- Helle Ø Kristensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus N, Denmark
| | - Anne Thyø
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus N, Denmark
| | - Katrine Jøssing Emmertsen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus N, Denmark.,Surgical Department, Randers Regional Hospital, Aarhus N, Denmark
| | - Neil J Smart
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Thomas Pinkney
- Academic Department of Surgery, University of Birmingham, Birmingham, UK
| | - Andrea M Warwick
- Brisbane Academic Functional Colorectal Unit, QEII Hospital, Brisbane, QLD, Australia
| | - Dong Pang
- Peking University School of Nursing, Beijing, China
| | - Edgar J B Furnée
- Department of Surgery, Division of Abdominal Surgery, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Sanne J Verkuijl
- Department of Surgery, Division of Abdominal Surgery, University Medical Center, University of Groningen, Groningen, The Netherlands
| | - Nuno José Rama
- Surgery - Colorectal Unit, Centro Hospitalar de Leiria, Leiria, Portugal
| | - Hugo Domingos
- Colorectal Surgery Unit, Champalimaud Foundation, Lisboa, Portugal
| | - João Maciel
- Colorectal Surgery Unit, Instituto Português de Oncologia- Lisbon, Lisboa, Portugal
| | - Alejandro Solis-Peña
- Colorectal Surgery Unit, General Surgery Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Eloy Espín Basany
- Colorectal Surgery Unit, General Surgery Department, Hospital Vall d'Hebron, Universitat Autonoma de Barcelona, Barcelona, Spain
| | | | - Sebastian Biondo
- Colorectal Surgery Unit, Bellvitge University Hospital, Barcelona, Spain
| | - Annika Sjövall
- Division of Coloproctology, Department of Pelvic Cancer, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Peter Christensen
- Department of Surgery, Danish Cancer Society Centre for Research on Survivorship and Late Adverse Effects After Cancer in the Pelvic Organs, Aarhus University Hospital, Aarhus N, Denmark
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Codina Cazador A, Biondo S, Espín Basany E, Enríquez Navascues JM, Garcia Granero E, Roig Vila JV, Buxó M. A teaching project on rectal cancer and concentration of procedures: a comparison of oncological results between Catalonia and the rest of autonomous communities. Rev Esp Enferm Dig 2019; 111:519-529. [PMID: 31081668 DOI: 10.17235/reed.2019.5901/2018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION the goal of this study was to compare the oncological results (local recurrence, metastasis and overall survival) obtained by the Proyecto Docente del Cáncer de Recto of the Spanish Association of Surgeons (AEC) (Proyecto Vikingo, PV) in Catalonia versus the rest of Spanish autonomous communities. METHODS the PV database includes 4,508 patients who underwent a curative resection between March 2006 and December 2010, from the first 59 hospitals included in PV; 1,163 were from Catalonia and 3,345 were from the rest of Spain. There was a minimum follow-up of five years. RESULTS in Catalonia, the five-year cumulative incidence was 8% (95% CI: 6.4-9.9) for local recurrence, 17.7% (95% CI: 15.4-20.2) for metastasis and 75% (95% CI: 72.4-77.7) for overall survival. In the rest of autonomous communities, these figures were 7% (95% CI: 6.2-8.2) for local recurrence, 22.3% (95% CI: 20.7-23.9) for metastasis, and 71% (95% CI: 69.4-72.9) for overall survival. Variables associated with tumor recurrence in PV included Hartmann's procedure, intraoperative perforation and circumferential margin involvement. CONCLUSION the results obtained by the Proyecto Docente del Cáncer de Recto were homogeneous between Catalonia and the rest of the autonomous communities.
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Affiliation(s)
| | | | | | | | - Eduardo Garcia Granero
- Cirugía General y del Aparato Digestivo, Hospital Universitario y Politécnico La Fe, España
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Rivera Esteban JM, Espín Basany E, Santos Vicente J, Alonso-Cotoner C. Microcytic anemia due to ileocolic anastomotic ulcer. Gastroenterol Hepatol 2018; 42:111-112. [PMID: 29588085 DOI: 10.1016/j.gastrohep.2018.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 02/05/2018] [Accepted: 02/22/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Jesús Manuel Rivera Esteban
- Servicio de Aparato Digestivo, Laboratorio de Fisiología y Fisiopatología Digestiva, Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España.
| | - Eloy Espín Basany
- Servicio de Cirugía General, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España
| | - Javier Santos Vicente
- Servicio de Aparato Digestivo, Laboratorio de Fisiología y Fisiopatología Digestiva, Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España
| | - Carmen Alonso-Cotoner
- Servicio de Aparato Digestivo, Laboratorio de Fisiología y Fisiopatología Digestiva, Institut de Recerca (VHIR), Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, España
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Biondo S, Kreisler E, Fraccalvieri D, Basany EE, Codina-Cazador A, Ortiz H. Risk factors for surgical site infection after elective resection for rectal cancer. A multivariate analysis on 2131 patients. Colorectal Dis 2012; 14:e95-e102. [PMID: 21883813 DOI: 10.1111/j.1463-1318.2011.02798.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIM Surgical site infection (SSI) is the most common cause of morbidity after colorectal surgery. The aim of this study was to analyze risk factors for SSI in patients who had undergone surgery for rectal cancer. METHOD A multicentre observational study was carried out on 2131 patients operated on for rectal cancer between May 2006 and May 2009. Twenty-nine centres were involved. SSI included wound infection and organ space infection within 30 days after the operation. Univariate and multivariate analyses were carried out to study possible risk factors for SSI. RESULTS Wound infection and organ space infection were diagnosed in 8.9% and 10%, respectively, of patients. The anastomotic leakage rate was 8%. Multivariate analysis showed that wound infection was related to tumour stage, a converted laparoscopic procedure and open surgery. Organ space infection was related to Stage IV tumour, a tumour < 11 cm from the anal verge, low anterior resection and Hartmann's procedure. CONCLUSION Rectal surgery for malignant disease is associated with a considerable rate of SSI. Wound infection and organ space infection are related to different factors and therefore should be evaluated separately.
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Affiliation(s)
- S Biondo
- Department of General and Digestive Surgery, Colorectal Unit, Bellvitge University Hospital, University of Barcelona and IDIBELL, Barcelona, Spain.
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