Completely Abdominal Approach Laparoscopic Partial Intersphincteric Resection After Neoadjuvant Chemoradiation for Initial cT3 Juxta-Anal Rectal Cancer

Huang, Shenghui; Huang, Ying; Chi, Pan; H, Lin; Lu, Xingrong; Xu, Zongbin; Sun, Yanwu; Wang, Xiaojie

doi:10.1089/lap.2018.0606

Cited by 8 publications

(4 citation statements)

References 38 publications

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“…Prior abdominal surgery may increase tissue adhesion and fibrosis, and our study reaffirmed it as an independent predictor of surgical difficulty of LaTME, consistent with previous studies [13, 29]. ISR for low‐lying tumors is a technically demanding procedure, in which a distal dissection, transection, and anastomosis proceeding into the sphincter complex structures of the long “tube within a tube,” and even more challenging in patients with bulky tumors in a narrow pelvis [21, 30]. Not surprisingly, we herein demonstrated that laparoscopic ISR was independently correlated with high surgical difficulty of LaTME after PCRT.…”

Section: Discussionsupporting

confidence: 89%

Pelvimetric and Nutritional Factors Predicting Surgical Difficulty in Laparoscopic Resection for Rectal Cancer Following Preoperative Chemoradiotherapy

Sun

Chen

et al. 2021

World j. surg.

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Aim Laparoscopic total mesorectal excision (LaTME) following preoperative chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC) is technically demanding. The present study is intended to evaluate predictive factors of surgical difficulty of LaTME following PCRT by using pelvimetric and nutritional factors. Method Consecutive LARC patients receiving LaTME after PCRT were included. Surgical difficulty was classified based upon intraoperative (operation time, blood loss, and conversion) and postoperative outcomes (postoperative hospital stay and morbidities). Pelvimetry was performed using preoperative T2-weighted MRI. Nutritional factors such as albumin-toglobulin ratio (AGR) and prognostic nutritional index (PNI) were calculated. Multivariable logistic analysis was used to identify predictors of high surgical difficulty. A predictive nomogram was developed and validated internally. Results Among 294 patients included, 36 (12.4%) patients were graded as high surgical difficulty. Logistic regression analysis demonstrated that previous abdominal surgery (OR = 6.080, P = 0.001), tumor diameter (OR = 1.732, P = 0.003), intersphincteric resection (vs. low anterior resection, OR = 13.241, P \ 0.001), interspinous distance (OR = 0.505, P = 0.009), and preoperative AGR (OR = 0.041, P = 0.024) were independently predictive of high surgical difficulty of LaTME after PCRT. Then, a predictive nomogram was built (C-index = 0.867). Conclusion Besides previous abdominal surgery, type of surgery (intersphincteric resection), tumor diameter, and interspinous distance, we found that preoperative AGR could be useful for the prediction of surgical difficulty of LaTME after PCRT. A predictive nomogram for surgical difficulty may aid in planning an appropriate approach for rectal cancer surgery after PCRT.

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Section: Discussionsupporting

confidence: 89%

Pelvimetric and Nutritional Factors Predicting Surgical Difficulty in Laparoscopic Resection for Rectal Cancer Following Preoperative Chemoradiotherapy

Sun

Chen

et al. 2021

World j. surg.

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“…In addition, the present results highlighted the importance of clinical N stage as a potential indicator of SSPR. In addition to its value in predicting SSPR, our previous single-centre study suggested ypN1–2 stage as an independent poor prognostic factor for worse disease-free survival in low rectal cancer patients who underwent ISR 32 . A previous post hoc analysis of the CAO/ARO/AIO-04 randomized phase III trial showed that obesity was associated with an increased risk of APR 33 , which is congruent with the present findings.…”

Section: Discussionmentioning

confidence: 99%

Unraveling variations and enhancing prediction of successful sphincter-preserving resection for low rectal cancer: a post hoc analysis of the multicentre LASRE randomized clinical trial

Wang,

Jiang,

Deng

et al. 2024

International Journal of Surgery

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Background: Accurate prediction of successful sphincter-preserving resection (SSPR) for low rectal cancer enables peer institutions to scrutinize their own performance and potentially avoid unnecessary permanent colostomy. The aim of this study is to evaluate the variation in SSPR and present the first artificial intelligence (AI) models to predict SSPR in low rectal cancer patients. Study design: This was a retrospective post hoc analysis of a multicenter, noninferiority randomized clinical trial (LASRE, NCT XXXXXX) conducted in 22 tertiary hospitals across China. A total of 604 patients who underwent neoadjuvant chemoradiotherapy (CRT) followed by radical resection of low rectal cancer were included as the study cohort, which was then split into a training set (67%) and a testing set (33%). The primary end point of this post hoc analysis was SSPR, which was defined as meeting all the following criteria: (1) sphincter-preserving resection; (2) complete or nearly complete TME, (3) a clear CRM (distance between margin and tumor of 1 mm or more), and (4) a clear DRM (distance between margin and tumor of 1 mm or more). Seven AI algorithms, namely, support vector machine (SVM), logistic regression (LR), extreme gradient boosting (XGB), light gradient boosting (LGB), decision tree classifier (DTC), random forest (RF) classifier, and multilayer perceptron (MLP), were employed to construct predictive models for SSPR. Evaluation of accuracy in the independent testing set included measures of discrimination, calibration, and clinical applicability. Results: The SSPR rate for the entire cohort was 71.9% (434/604 patients). Significant variation in the rate of SSPR, ranging from 37.7% to 94.4%, was observed among the hospitals. The optimal set of selected features included tumor distance from the anal verge before and after CRT, the occurrence of clinical T downstaging, post-CRT weight and clinical N stage measured by magnetic resonance imaging. The 7 different AI algorithms were developed and applied to the independent testing set. The LR, LGB, MLP and XGB models showed excellent discrimination with AUROC values of 0.825, 0.819, 0.819 and 0.805, respectively. The DTC, RF and SVM models had acceptable discrimination with AUROC values of 0.797, 0.766 and 0.744, respectively. LR and LGB showed the best discrimination, and all 7 AI models had superior overall net benefits within the range of 0.3-0.8 threshold probabilities. Finally, we developed an online calculator based on the LGB model to facilitate clinical use. Conclusions: The rate of SSPR exhibits substantial variation, and the application of AI models has demonstrated the ability to predict SSPR for low rectal cancers with commendable accuracy.

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“…A total/near-total transabdominal ISR was described by Kim et al [ 35 ], Park et al [ 47 ], and Huang et al [ 69 ]. This technique allows to fully embrace the technological superiority of the robotic platform by allowing the dissection through the intersphincteric plane and then into the anal canal lumen with a so-called bird’seye view [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes

Piozzi

Kim

2021

Ann Coloproctol

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Intersphincteric resection (ISR) is the ultimate anus-sparing technique for low rectal cancer and is considered an oncologically safe alternative to abdominoperineal resection. The application of the robotic approach to ISR (RISR) has been described by few specialized surgical teams with several differences regarding approach and technique. This review aims to discuss the technical aspects of RISR by evaluating point by point each surgical controversy. Moreover, a systematic review was performed to report the perioperative, oncological, and functional outcomes of RISR. Postoperative morbidities after RISR are acceptable. RISR allows adequate surgical margins and adequate oncological outcomes. RISR may result in severe bowel and genitourinary dysfunction affecting the quality of life in a portion of patients.

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Completely Abdominal Approach Laparoscopic Partial Intersphincteric Resection After Neoadjuvant Chemoradiation for Initial cT3 Juxta-Anal Rectal Cancer

Cited by 8 publications

References 38 publications

Pelvimetric and Nutritional Factors Predicting Surgical Difficulty in Laparoscopic Resection for Rectal Cancer Following Preoperative Chemoradiotherapy

Pelvimetric and Nutritional Factors Predicting Surgical Difficulty in Laparoscopic Resection for Rectal Cancer Following Preoperative Chemoradiotherapy

Unraveling variations and enhancing prediction of successful sphincter-preserving resection for low rectal cancer: a post hoc analysis of the multicentre LASRE randomized clinical trial

Robotic Intersphincteric Resection for Low Rectal Cancer: Technical Controversies and a Systematic Review on the Perioperative, Oncological, and Functional Outcomes

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