Anterior Resection for Rectal Cancer With Mesorectal Excision

Law, Wai Lun; Chu, Kin Wah

doi:10.1097/01.sla.0000133185.23514.32

Cited by 429 publications

(319 citation statements)

References 23 publications

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“…These include tumour level within the rectum 20 -22 , tumour size 23 , macroscopic morphology 24 , distal clearance 3,22,25 , circumferential clearance 26 -28 , depth of tumour invasion 28 -31 , lymph node metastasis 21,23,26,29 -31 , number of involved nodes 25,32 , tumour stage 3,6,20,22,24,33 -35 , grade of differentiation 20,23,26,28,32 , infiltrating tumour margin 26 , vascular invasion 3,6,22,26 , sex 22 , age 25,31 , intraoperative spillage of tumour cells 6,20 , anastomotic leakage 22,34 , experience and specialization of the surgeon 6,20 , surgical technique 3,22,35 , interhospital variability 20 and adjuvant therapy 6,23,31,33 . However, an extensive literature search by the authors failed to find any publications in which the position of the tumour was considered as a possible risk factor for local recurrence, although in one study position was found to be associated with cancer-specific mortality 36 .…”

Section: Discussionmentioning

confidence: 99%

Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

Chan

Bokey

Chapuis

et al. 2005

British Journal of Surgery

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Background: Mobilization of rectal cancer can be difficult if the tumour is located anteriorly and may result in a higher incidence of local recurrence. The aim of this study was to determine whether local recurrence and survival following curative resection of rectal cancer were associated with the position of the tumour. Conclusion:Anterior position is an independent negative prognostic factor for both local recurrence and survival after curative resection of rectal cancer.

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Section: Discussionmentioning

confidence: 99%

Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

Chan

Bokey

Chapuis

et al. 2005

British Journal of Surgery

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“…21 PNI has been studied in many malignancies, including prostate cancer, head and neck cancer, and cancer in the gastrointestinal tract, 9,[22][23][24] yet there is still no agreement on a clear definition of PNI-positive. A stringent definition of PNI requires that tumor cells be observed inside the perineurial layer, 7 but this definition would not include the situation of tumor cells existing within epineurium.…”

Section: Discussionmentioning

confidence: 99%

Perineural invasion in pT3N0 rectal cancer

Peng

Sheng

Huang

et al. 2010

Cancer

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BACKGROUND:The authors' purpose was to explore the incidence and prognostic significance of perineural invasion (PNI) in pT3N0 rectal cancer. METHODS: Pathologic materials from resected specimens of 173 patients with pT3N0 rectal cancer were retrospectively collected. PNI-positivity was categorized into 2 groups: surrounding the nerve sheath (SS-PNI) and invading through the nerve sheath (TS-PNI). The rate of PNI-positivity was compared with PNI as initially recorded in the original reports. Patients' outcome was studied in groups with different PNI status, and multivariate analysis was performed to determine its prognostic value. RESULTS: In this retrospective analysis, PNIpositivity was found in 24.3% of all cases, in which SS-PNI and TS-PNI were 11% and 13.3%, respectively, and was related to lymphovascular invasion. Only 7.5% of patients' specimens were reported as PNI-positive in the original reports. Detection of SS-PNI was likelier to be missed than TS-PNI. The rates of local recurrence, disease-free survival, and overall survival at 5 years were similar between the groups of SS-PNI and TS-PNI. The 5-year local recurrence rate was more than 2.5-fold higher in the PNI-positive group compared with the PNI-negative group (22.7% vs 7.9%, respectively; P ¼ .017). Multivariate analysis proved that PNI-positivity was the only independent risk factor for predicting 5-year local recurrence rate, whereas only sampled lymph nodes was related to 5-year disease-free survival and overall survival. CONCLUSIONS: PNI is a common pathologic feature in rectal cancer. The definition of PNI should include SS-PNI and TS-PNI. Rectal cancer patients who are PNI-positive are at higher risk of local recurrence and should be considered for more intensive treatment.

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“…1 The largest randomized trials of rectal cancer generally have used radical abdominal surgery with good results. [11][12][13][14] To our knowledge, there have not been large randomized trials comparing TAE and preoperative chemoradiotherapy to radical abdominal surgery. However, quality of life issues associated with radical abdominal …”

Section: Discussionmentioning

confidence: 99%

Transanal Excision with Radiation Therapy for Rectal Adenocarcinoma

Tennyson

Mendenhall

Morris

et al. 2012

Clinical Medicine & Research

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Objective: To evaluate the efficacy of transanal excision (TAE) combined with radiotherapy for rectal adenocarcinoma, assess the ability of pretreatment endoscopic ultrasound (EUS) to predict failures, and determine the prognostic value of downstaging and complete pathological response.Design: Retrospective outcomes study. Setting: Radiation oncology clinic.Participants: Thirty-eight patients with rectal adenocarcinoma. Methods:The medical records of patients treated with radiotherapy from 1998 to 2008 and followed for a median of 5.9 years were reviewed.Results: Kaplan-Meier estimates of freedom from selected endpoints at 5 years after treatment were: overall survival, 79%; cause-specific survival, 91%; local control, 90%; and freedom from distant metastasis, 76%. Seven patients (21%) had eventual abdominoperineal resection or lower anterior resection, four patients had local recurrence, and three patients had incomplete treatment or poor margins. T3 lesions clinically staged by EUS were a predictor of local failure (P=0.0110), but not distant metastasis (P=0.35). Patients with either a pathological or clinical T3 lesion did not have a significantly greater rate of metastasis (P=0.096). Patients who were downstaged did not have a significantly different rate of local recurrence or metastasis. Patients who experienced a complete pathological response did not have a significantly different rate of local control or distant metastasis. Conclusion:Patients with early-stage rectal lesions who undergo preoperative or postoperative radiation and TAE have similar outcomes to those who undergo abdominoperineal resection; local recurrence was higher for patients with T3 lesions when both were compared. Abdominal surgery should be considered for these patients. TAE is reasonable when patients are unwilling or unable to tolerate the morbidity of traditional transabdominal surgery.

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Anterior Resection for Rectal Cancer With Mesorectal Excision

Cited by 429 publications

References 23 publications

Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

Perineural invasion in pT3N0 rectal cancer

Transanal Excision with Radiation Therapy for Rectal Adenocarcinoma

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