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Du Q, Yang W, Zhang J, Qiu S, Liu X, Wang Y, Yang L, Zhou Z. Oncologic outcomes of intersphincteric resection versus abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis. Int J Surg 2024; 110:2338-2348. [PMID: 36928167 PMCID: PMC11020000 DOI: 10.1097/js9.0000000000000205] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/20/2022] [Indexed: 03/18/2023]
Abstract
BACKGROUND The efficacy of intersphincteric resection (ISR) surgery for patients with lower rectal cancer remains unclear compared to abdominoperineal resection (APR). The aim of this study is to compare the oncologic outcomes for lower rectal cancer patients after ISR and APR through a systematic review and meta-analysis. MATERIALS AND METHODS A systematic electronic search of the Cochrane Library, PubMed, EMBASE, and MEDLINE was performed through January 12, 2022. The primary outcomes included 5-year disease-free survival (5y-DFS) and 5-year overall survival. Secondary outcomes included circumferential resection margin involvement, local recurrence, perioperative outcomes, and other long-term outcomes. The pooled odds ratios, mean difference, or hazard ratios (HRs) of each outcome measurement and their 95% CIs were calculated. RESULTS A total of 20 nonrandomized controlled studies were included in the qualitative analysis, with 1217 patients who underwent ISR and 1135 patients who underwent APR. There was no significant difference in 5y-DFS (HR: 0.84, 95% CI: 0.55-1.29; P =0.43) and 5-year overall survival (HR: 0.93, 95% CI: 0.60-1.46; P =0.76) between the two groups. Using the results of five studies that reported matched T stage and tumor distance, we performed another pooled analysis. Compared to APR, the ISR group had equal 5y-DFS (HR: 0.76, 95% CI: 0.45-1.30; P =0.31) and 5y-LRFS (local recurrence-free survival) (HR: 0.72, 95% CI: 0.29-1.78; P =0.48). Meanwhile, ISR had equivalent local control as well as perioperative outcomes while significantly reducing the operative time (mean difference: -24.89, 95% CI: -45.21 to -4.57; P =0.02) compared to APR. CONCLUSIONS Our results show that the long-term survival and safety of patients is not affected by ISR surgery, although this result needs to be carefully considered and requires further study due to the risk of bias and limited data.
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Affiliation(s)
- Qiang Du
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Wenming Yang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Jianhao Zhang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Siyuan Qiu
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Xueting Liu
- Department of Evidence-Based Medicine and Clinical Epidemiology
| | - Yong Wang
- Department of General Surgery, Division of Gastrointestinal Surgery
| | - Lie Yang
- Department of General Surgery, Division of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zongguang Zhou
- Department of General Surgery, Division of Gastrointestinal Surgery
- Institute of Digestive Surgery, State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Nitta T, Kataoka J, Ishii M, Ueda Y, Ohta M, Horiguchi K, Taki M, Senpuku S, Matsutani A, Ishibashi T. Bilateral laparosocopic lateral lymph node dissection by the totally extraperitoneal approach after intersphincteric resection of the lower rectum: report of a case. Ann Med Surg (Lond) 2023; 85:4589-4592. [PMID: 37663743 PMCID: PMC10473375 DOI: 10.1097/ms9.0000000000001100] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/15/2023] [Indexed: 09/05/2023] Open
Abstract
Introduction and Importance Lateral lymph node dissection (LLND) for recurrent lateral pelvic lymph node metastasis could be the only surgical treatment to improve its prognosis, but is difficult and challenging technically. Case Presentation A 75-year-old Japanese man who underwent a radical laparoscopic intersphincteric resection to treat double lower rectal cancer. Computed tomography and MRI showed lower rectal wall thickening and bilateral lateral lymph node swelling. The authors scheduled and performed the LLND for recurrent lateral pelvic lymph nodes after ISR by the totally extraperitoneal (TEP) approach. The bottom of the obturators lymph node (#263D) were positive for metastasis histologically. Clinical Discussion The TEP approach is an especially effective option for the treatment of bilateral LLND. Conclusion Herein, the authors introduce our surgical technique: successful challenging treatment of the LLND by the TEP approach after intersphincteric resection of the lower rectum.
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Affiliation(s)
- Toshikatsu Nitta
- Division of Surgery Gastroenterological Center, Medico Shunju Shiroyama Hospital, Osaka, Japan
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Abstract
Background: To evaluate the safety and efficacy of left colic artery (LCA) preservation in laparoscopic anterior resection with D3 lymphadenectomy for lower rectal cancer. Methods: A total of 117 patients with lower rectal cancer who received laparoscopic anterior resection were retrospectively analyzed. Results: No differences were detected in terms of the numbers of harvested lymph nodes and metastatic lymph nodes, the intraoperative and postoperative complications or the postoperative recurrence and survival rates between the two groups (p > 0.05), but the LCA preservation group showed a lower anastomotic leakage rate than the LCA nonpreservation group (2/49 vs 12/68). Conclusion: LCA preservation may help reduce the incidence of anastomotic leakage without impairing surgical and oncological outcomes.
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Affiliation(s)
- Zonglin Li
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yejiang Zhou
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Linxia Xu
- Department of General Surgery (Gastrointestinal Surgery), The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Lingling Xie
- Department of Gynaecology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Treatment Center for Gynecologic & Breast Diseases (Gynecology), Luzhou, China
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Davies-Cousins M. From a Patient Choice Perspective: Nearly 20 Years on, Has Patient Choice Improved or Was I Just Lucky? Clin Oncol (R Coll Radiol) 2023; 35:130-1. [PMID: 36456436 DOI: 10.1016/j.clon.2022.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/26/2022] [Accepted: 11/07/2022] [Indexed: 11/30/2022]
Abstract
With Watch & Wait becoming a more recognised approach to the treatment of early-stage lower rectal cancers I wanted to look at what has changed in nearly 20 years from a patient's perspective. In 2003 I was diagnosed with a T3a tumour and offer radical surgery but found Papillon and was lucky that it worked and I'm still here. Since then, things have improved but I still have patients contacting me saying they are being given no options - so I pose the question: From a Patient Choice Perspective: Nearly 20 Years on, Has Patient Choice Improved or Was I Just Lucky?
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Wang J, Chang Y, Liu H, Wang W, Tang X, Jiang H, Li A, Lin M. Laparoscopic Lateral Lymph Node Dissection Based on Membrane Anatomy for Lower Rectal Cancer: Surgical Technique and Short-Term Outcomes. J Laparoendosc Adv Surg Tech A 2023; 33:497-502. [PMID: 36602513 DOI: 10.1089/lap.2022.0516] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background: Lateral lymph node dissection (LLND) is an effective treatment for metastatic lateral lymph nodes (LLNs) in lower rectal cancer, but with high complication rates due to a complicated procedure. This study aimed to introduce a new technique for LLND based on membrane anatomy to simplify the procedure and report short-term outcomes. Methods: Twenty-three patients with clinical stage II-III lower rectal cancer underwent three-dimensional (3D) laparoscopic total mesorectal excision (TME) plus LLND between July 2018 and December 2020. Demographic data, perioperative variables, and oncologic outcomes were recorded and analyzed. Complications were graded using the Clavien-Dindo (CD) score. Results: Based on the theory of "four fasciae and three spaces," we proposed a fascia-to-space surgical approach to perform LLND. 3D laparoscopic TME plus LLND was performed successfully in all patients. The mean operating time was 172 minutes with a mean blood loss of 85 mL. Postoperative complications were present in 5 (17.4%) patients (CD I-II), including a case of urinary retention. The median number of harvested LLNs was 9, and positive LLNs were detected in 7 (30.4%) patients. After a median follow-up of 26.5 months, 2 (8.7%) patients developed liver metastases, but no local recurrence. Conclusions: Laparoscopic LLND based on membrane anatomy is a safe, feasible, and reproducible procedure and thus worthy of clinical promotion. Further studies with long-term follow-up in larger patient series are still required.
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Affiliation(s)
- Jiaqi Wang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yi Chang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China
| | - Hailong Liu
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China
| | - Wenchao Wang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xuan Tang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Huihong Jiang
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China
| | - Ajian Li
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China
| | - Moubin Lin
- Department of General Surgery, Yangpu Hospital, Tongji University School of Medicine, Shanghai, China.,Institute of Gastrointestinal Surgery and Translational Medicine, Tongji University School of Medicine, Shanghai, China
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Song M, Wang H, Wang L, Li S, Zhang Y, Geng J, Zhu X, Li Y, Cai Y, Wang W. Dentate line invasion as a predictive factor of poor distant relapse-free survival in locally advanced lower rectal cancer with anal sphincter involvement. BMC Cancer 2022; 22:1196. [PMCID: PMC9675199 DOI: 10.1186/s12885-022-10299-8] [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: 05/31/2022] [Accepted: 11/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background While an important surgical landmark of the dentate line has been established for locally advanced lower rectal cancer (LALRC), the prognostic significance of dentate line invasion (DLI) has not been well defined. This study aimed to explore the impact of DLI on prognosis in LALRC patients with anal sphincter involvement after neoadjuvant chemoradiotherapy followed by surgery. Methods We analyzed 210 LALRC patients and classified them into DLI group (n = 45) or non-DLI group (n = 165). The exact role of DLI in survival and failure patterns was assessed before and after propensity-score matching(PSM). Finally, 50 patients were matched. Results Before matching, patients in the DLI group had poorer 5-year distant relapse-free survival (DRFS) (P < 0.001), disease-free survival (DFS) (P < 0.001), and overall survival (OS) (P = 0.022) than those in the non-DLI group, with the exception of local recurrence-free survival (LRFS) (P = 0.114). After PSM, the 5-year DRFS, DFS, OS, and LRFS were 51.7% vs. 79.8%(P = 0.026), 51.7% vs. 79.8%(P = 0.029), 71.6% vs. 85.4%(P = 0.126), and 85.7% vs. 92.0%(P = 0.253), respectively, between the two groups. DLI was also an independent prognostic factor for poor DRFS with (Hazard ratio [HR] 3.843, P = 0.020) or without matching (HR 2.567, P = 0.001). The DLI group exhibited a higher rate of distant metastasis before (44.4% vs. 19.4%, P < 0.001) and after matching (48.0% vs. 20.0%, P = 0.037) and similar rates of locoregional recurrence before (13.3% vs.7.9%, P = 0.729) and after matching (16.0% vs.12.0%, P = 1.000). Conclusions DLI may portend worse DRFS and distant metastasis in LALRC patients with anal sphincter involvement, and this may be an important variable to guide clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10299-8.
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Affiliation(s)
- Maxiaowei Song
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Hongzhi Wang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Lin Wang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department 3 of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Shuai Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Yangzi Zhang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Jianhao Geng
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Xianggao Zhu
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Yongheng Li
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Yong Cai
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
| | - Weihu Wang
- grid.412474.00000 0001 0027 0586Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital and Institute, Beijing, 100142 People’s Republic of China
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7
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Xiao H, Huang R, Li X, Wang Z. Laparoscopic Versus Open Extralevaor Abdominoperineal Excision for Lower Rectal Cancer: A Retrospective Cohort Study in Single Institute. J Laparoendosc Adv Surg Tech A 2020; 31:71-76. [PMID: 32706627 DOI: 10.1089/lap.2020.0352] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background: To explore the safety and efficacy of laparoscopic extralevator abdominoperineal excision (La-ELAPE) and open extralevator abdominoperineal excision (Op-ELAPE) for patients with lower rectal cancer. Materials and Methods: Consecutive 101 patients with lower rectal cancer who underwent La-ELAPE or Op-ELAPE in our institution from January 2014 and May 2018 were analyzed retrospectively. The patients' clinicopathological data and postoperative outcomes were compared between the two groups. Results: A total of 101 patients were enrolled in the study, 43 (42.6%) patients successfully underwent La-ELAPE and 58 (57.4%) Op-ELAPE. The Op-ELAPE group had more intraoperative blood loss (P = .03), and longer postoperative hospital stay (P = .01) compared with the La-ELAPE group. There were no significant differences between the two group in terms of the operation time (P = .08), circumferential resection margin positivity (P = 1.00), intraoperative perforation (P = .73), and number of positive lymph nodes (P = .91). There were no significant differences in postoperative complications such as colostomy-associated issues (P = .79), intestinal obstruction (P = 1.00), urinary retention (P = 1.00), perineal wound complications (P = .64), and chronic perineal pain (P = .70) between the two groups. According to the Kaplan-Meier survival analysis and log rank test, the overall survival rate and progression-free survival rate between the two groups also showed no significant difference. Conclusion: This study showed that La-ELAPE significantly reduced the intraoperative blood loss and the postoperative hospital stay without increasing postoperative morbidity for patients with lower rectal cancer when compared with Op-ELAPE. It suggests that La-ELAPE is safe and effective for patients with lower rectal cancer. For the experienced endoscopic surgeons, the La-ELAPE might be an alternative surgical treatment.
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Affiliation(s)
- Hui Xiao
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Rui Huang
- Department of Key Laboratory, Capital Institute of Pediatrics, Beijing, People's Republic of China
| | - Xiangnan Li
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Zhenjun Wang
- Department of General Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
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Amano K, Fukuchi M, Kumamoto K, Hatano S, Ohno H, Osada H, Ishibashi K, Ishida H. Pre-operative Evaluation of Lateral Pelvic Lymph Node Metastasis in Lower Rectal Cancer: Comparison of Three Different Imaging Modalities. J Anus Rectum Colon 2020; 4:34-40. [PMID: 32002474 PMCID: PMC6989126 DOI: 10.23922/jarc.2019-022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 10/30/2019] [Indexed: 01/04/2023]
Abstract
Objectives: The pre-operative diagnostic value of detecting lateral pelvic lymph node (LPLN) metastasis with magnetic resonance imaging, multidirectory computed tomography, and positron emission tomography/computed tomography was investigated in lower rectal cancer patients. Methods: We retrospectively evaluated, using the three different modalities, the metastatic status of LPLNs in four regions, including both the internal iliac and the obturator, in 46 patients affected by lower rectal cancer patients who underwent LPLN dissection. The size inclusion criterion for LPLN metastasis was set at 6 mm in the short axis diameter. Histological examination was performed for determining the false positive and negative rate of LPLNs metastasis detection. Results: Among 184 LPLNs regions, 17 (9%) were positive for metastasis. The region-based sensitivity, specificity, and accuracy rate did not differ among the three tested diagnostic modalities. Moreover, a significant increase in these rates could not be observed when the modalities were combined. Of 184 regions, 8 (4.4%) were false negative, whereas 2 (1.1%) were false positive. The histological pattern of metastatic regions did not differ in 8 false negative LPLNs. Conclusions: Each modality had a similar detection power for LPLNs metastasis, with a cut-off value at 6 mm in the short axis diameter. However, the sensitivity of all the modalities was slightly low, along with the number of false negative LPLNs. Further reduction of the false negative rate with these modalities may be difficult because of an inherent limitation of current imaging technologies to accurately detect lymph node metastases.
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Affiliation(s)
- Kunihiko Amano
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Minoru Fukuchi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Kensuke Kumamoto
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Satoshi Hatano
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hitoshi Ohno
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hisato Osada
- Department of Radiology, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Keiichiro Ishibashi
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
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Takeda M, Kawahara H, Ogawa M, Suwa K, Eto K, Yanaga K. Reevaluation of Preoperative Chemoradiotherapy for Clinical T3 Lower Rectal Cancer: A Multicenter Collaborative Retrospective Clinical Study. Anticancer Res 2019; 39:3047-3052. [PMID: 31177147 DOI: 10.21873/anticanres.13438] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 04/01/2019] [Revised: 05/14/2019] [Accepted: 05/22/2019] [Indexed: 11/10/2022]
Abstract
AIM This study aimed to re-evaluate the usefulness of preoperative chemoradiotherapy for clinical T3 lower rectal cancers without lateral lymph node metastasis. PATIENTS AND METHODS Between 2010 and 2014, 132 patients with clinical T3 lower rectal cancer without lateral lymph node metastasis, 80 years of age or younger, who underwent curative resection at four Jikei University Hospitals were enrolled into this retrospective study. Of these, 22 patients received chemoradiotherapy (CRT) before surgery, 16 patients received intensive chemotherapy after surgery without preoperative CRT, and 94 patients underwent neither preoperative CRT nor intensive chemotherapy after surgery including 47 patients with postoperative oral chemotherapy for pathological diagnosis of stage III. RESULTS The 3-year disease-free survival (DFS) of the 22 patients who received preoperative CRT was 95.5%, whereas that of the 94 patients who received neither preoperative CRT nor intensive chemotherapy was 72.0% (p=0.024). However, there was no significant difference in 5-year DFS between the two groups. No significant difference was identified in DFS between the 22 patients who received preoperative CRT and the 16 patients who received intensive chemotherapy after surgery without preoperative CRT. CONCLUSION Intensive chemotherapy after surgery seems to yield a similar prognosis to preoperative CRT in patients with clinical T3 lower rectal cancer without lateral lymph node metastasis.
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Affiliation(s)
- Mitsumasa Takeda
- Department of Surgery, Kashiwa Hospital, the Jikei University School of Medicine, Chiba, Japan
| | - Hidejiro Kawahara
- Department of Surgery, Kashiwa Hospital, the Jikei University School of Medicine, Chiba, Japan
| | - Masaichi Ogawa
- Department of Surgery, Katsushika Medical Center, the Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhito Suwa
- Department of Surgery, the Third Hospital, the Jikei University School of Medicine, Tokyo, Japan
| | - Ken Eto
- Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, the Jikei University School of Medicine, Tokyo, Japan
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Maeda K, Shibutani M, Otani H, Fukuoka T, Iseki Y, Matsutani S, Nagahara H, Inoue T, Tachimori A, Nishii T, Miki Y, Hosono M, Ohira M. Neoadjuvant Radiotherapy with Capecitabine Plus Bevacizumab for Locally Advanced Lower Rectal Cancer: Results of a Single-institute Phase II Study. Anticancer Res 2018; 38:4193-4197. [PMID: 29970549 DOI: 10.21873/anticanres.12713] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/09/2018] [Revised: 05/30/2018] [Accepted: 06/04/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM A single-arm phase II clinical trial was conducted to evaluate the safety and efficacy of adding bevacizumab to standard capecitabine-based neoadjuvant chemoradiotherapy (CRT) for the treatment of locally advanced rectal cancer (LARC). PATIENTS AND METHODS Twenty-five patients were enrolled. Patients received capecitabine-based CRT for 5 weeks and 3 days. Bevacizumab was administered every 2 weeks during CRT. Within 6-10 weeks after completion of CRT, surgery was performed. RESULTS With regard to CRT-related acute toxicities, most of the adverse events were limited to grade 1. A pathological complete response was obtained in four (16%) patients. In total, six patients (24%) developed postoperative complications. Six out of five (83%) patients healed without the need for surgical intervention. CONCLUSION Although acute toxicity during CRT with bevacizumab was minimal and postoperative complications do not seem to increase, the addition of bevacizumab apparently offers no clinically-significant benefit for patients with LARC.
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Affiliation(s)
- Kiyoshi Maeda
- Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan .,Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masatsune Shibutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Otani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tatsunari Fukuoka
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yasuhito Iseki
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Shinji Matsutani
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hisashi Nagahara
- Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toru Inoue
- Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Akiko Tachimori
- Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Takafumi Nishii
- Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
| | - Yoshitaka Miki
- Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masako Hosono
- Department of Radiology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masaichi Ohira
- Gastroenterological Surgery, Osaka City General Hospital, Osaka, Japan
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11
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Ohue M, Iwasa S, Kanemitsu Y, Hamaguchi T, Shiozawa M, Ito M, Yasui M, Katayama H, Mizusawa J, Shimada Y. A Phase II/III randomized controlled trial comparing perioperative versus postoperative chemotherapy with mFOLFOX6 for lower rectal cancer with suspected lateral pelvic node metastasis: Japan Clinical Oncology Group Study JCOG1310 (PRECIOUS study). Jpn J Clin Oncol 2016; 47:84-87. [PMID: 27655905 PMCID: PMC5421580 DOI: 10.1093/jjco/hyw140] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 08/31/2016] [Accepted: 09/04/2016] [Indexed: 01/28/2023] Open
Abstract
A randomized phase II/III trial was started in May 2015 comparing perioperative versus postoperative chemotherapy with modified infusional fluorouracil and folinic acid with oxaliplatin for lower rectal cancer patients with suspected lateral pelvic node metastasis. The standard arm is total mesorectal excision or tumor-specific mesorectal excision with lateral pelvic node dissection (LND) followed by postoperative chemotherapy (modified infusional fluorouracil and folinic acid with oxaliplatin; 12 cycles). The experimental (perioperative chemotherapy) arm is six courses of modified infusional fluorouracil and folinic acid with oxaliplatin before and six courses after total mesorectal excision with lateral pelvic node dissection. The aim of this trial is to confirm the superiority of perioperative chemotherapy. A total of 330 patients will be enrolled over 7 years. The primary endpoint in Phase II part is proportion of R0 resection and that in Phase III part is overall survival. Secondary endpoints are progression-free survival, local progression-free survival, etc. This trial has been registered in the UMIN Clinical Trials Registry as UMIN000017603 [http://www.umin.ac.jp/ctr/index-j.htm].
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Affiliation(s)
- Masayuki Ohue
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo
| | | | - Tetsuya Hamaguchi
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Chiba
| | - Masayoshi Yasui
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center, Tokyo
| | - Junki Mizusawa
- JCOG Data Center/Operations Office, National Cancer Center, Tokyo
| | - Yasuhiro Shimada
- Clinical Oncology Division, Kochi Health Sciences Center, Kochi, Japan
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Sajid MS, Farag S, Leung P, Sains P, Miles WFA, Baig MK. Systematic review and meta-analysis of published trials comparing the effectiveness of transanal endoscopic microsurgery and radical resection in the management of early rectal cancer. Colorectal Dis 2014; 16:2-14. [PMID: 24330432 DOI: 10.1111/codi.12474] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [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: 03/30/2013] [Accepted: 07/16/2013] [Indexed: 12/12/2022]
Abstract
AIM A systematic analysis was conducted of trials comparing the effectiveness of transanal endoscopic microsurgery (TEMS) with radical resection (RR) for T1 and T2 rectal cancer. METHOD An electronic search was carried out of trials reporting the effectiveness of TEMS and RR in the treatment of T1 and T2 rectal cancers. RESULTS Ten trials including 942 patients were retrieved. There was a trend toward a higher risk of local recurrence (odds ratio 2.78; 95% confidence interval 1.42, 5.44; z = 2.97; P < 0.003) and overall recurrence (P < 0.01) following TEMS compared with RR. The risk of distant recurrence, overall survival (odds ratio 0.90; 95% confidence interval 0.49, 1.66; z = 0.33; P = 0.74) and mortality was similar. TEMS was associated with a shorter operation time and hospital stay and a reduced risk of postoperative complications (P < 0.0001). The included studies, however, were significantly diverse in stage and grade of rectal cancer and the use of neoadjuvant chemoradiotherapy. CONCLUSION Transanal endoscopic microsurgery appears to have clinically measurable advantages in patients with early rectal cancer. The studies included in this review do not allow firm conclusions as to whether TEMS is superior to RR in the management of early rectal cancer. Larger, better designed and executed prospective studies are needed to answer this question.
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Affiliation(s)
- M S Sajid
- Department of General and Laparoscopic Colorectal Surgery, Western Sussex Hospitals NHS Trust, Worthing Hospital, Worthing, UK
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Ogawa S, Itabashi M, Hirosawa T, Hashimoto T, Bamba Y, Kameoka S. Lateral pelvic lymph node dissection can be omitted in lower rectal cancer in which the longest lateral pelvic and perirectal lymph node is less than 5 mm on MRI. J Surg Oncol 2013; 109:227-33. [PMID: 24165955 DOI: 10.1002/jso.23478] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [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: 06/20/2013] [Accepted: 10/07/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES The goal of the study was to examine the use of magnetic resonance imaging (MRI) for identification of patients with lower rectal cancer who may benefit from lateral pelvic lymph node dissection (LPLD). METHODS Diagnoses and oncological outcomes were examined in 160 cases. Patients in whom the long-axis diameter of the longest detected lymph node was < 5 mm or ≥ 5 mm were classified as LPLN(-) (n = 102) and LPLN(+) (n = 58), respectively. RESULTS Diagnostic results gave a 21.6% positive predictive value (PPV) and a 95.0% negative predictive value (NPV) for the LPLN. These values were 59.6% and 91.5%, respectively, for the perirectal lymph node (PRLN). Multivariate analysis showed that a pathologic PRLN (pPRLN)(+) status was an independent prognostic factor for relapse-free survival (RFS) (P = 0.0424) in the LPLN(-) group. The 5-year RFS did not differ significantly between cases that did not and did undergo LPLD (90.0% vs. 83.8%) in the LPLN(-) and pPRLN(-) groups. CONCLUSIONS The low PPV and high NPV indicate that it is difficult to identify patients who may benefit from LPLD. However, the results show that LPLD has no benefit in LPLN(-) and PRLN(-) cases and that these cases can be identified based on MRI findings.
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Affiliation(s)
- Shimpei Ogawa
- Department of Surgery II, Tokyo Women's Medical University School of Medicine, Japan
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