Effect of extent of anterior resection and sex on disease-free survival and local recurrence in patients with rectal cancer

Buhre, L. M. D.; Mulder, Nanno; Ruiter, A.; Loon, A.J. van; Verschueren, Rcj

doi:10.1002/bjs.1800810851

Cited by 20 publications

(11 citation statements)

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“…Perhaps a more important role is played by the structure of the pelvis, as well as adequate radial margins easier to obtain in women and greater oncological radicalism. This is supported by the results of studies by Buhre et al [10], showing significantly better overall and asymptomatic survival for women, as well as lower rates of locoregional recurrences. This means that the potential reasons for a better prognosis in women can be associated with more effective local control [5,11].…”

Section: Discussionsupporting

confidence: 59%

Five-year follow-up study of stage I-IV rectal cancer including EGFR immunoexpression and p21 immunoactivity

Kozłowska-Geller¹,

Głuszek²,

Lewitowicz³

2021

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Introduction: Both environmental and genetic factors increase the likelihood of developing rectal cancer. Aim: To assess the EGFR and p21 immunoreactivity in rectal cancer and to assess its relationship with the clinical outcome. Material and methods: Applying exclusion criteria, 102 patients with stage I-IV rectal cancer, who had undergone scheduled surgery during the period 2005-2011, were included in the study. There was a follow-up study with a span of 5 years from the date of the surgery. Immunohistochemistry using epidermal growth factor receptor (EGFR Ab10, Clone111.6) and antibodies against p21 (p21 WAF1 (Clone H252)) was performed to detect overexpression of the targeted receptor. Digital analysis of positive reactions of membranes and nuclei was performed utilizing Visiopharm.Results: The degree of EGFR intensity (log OR = 0.854, OR = 2.35, 95% CI: 1.14-4.85, p = 0.021) is a significant factor in the prognosis of death within 2 years after surgery. The OS curve showed a significant decrease after 40 months from the date of surgery in the cases where EGFR had high expression. The ROC curve for cancer stage, according to the UICC classification and EGFR expression, in order to predict 2-year RFS, reached a high specificity value (ROC = 0.81, p = 0.0408). The analysis showed no statistically significant differences in the survival curves of patients in groups with immunoreactivity of p21 protein at 0, 1, 2, 3 (p = 0.6453 in the log-rank test). Also, it is not a significant risk factor for death (HR = 0.915, p = 0.7842) or for tumor dissemination (HR = 0.94, p = 0.9426).Conclusions: The determination of EGFR immunoreactivity is important in the monitoring and treatment of patients with rectal cancer, as opposed to p21.

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Section: Discussionsupporting

confidence: 59%

Five-year follow-up study of stage I-IV rectal cancer including EGFR immunoexpression and p21 immunoactivity

Kozłowska-Geller¹,

Głuszek²,

Lewitowicz³

2021

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“…Da sie das Mesorectum samt dem zugehörigen lympho-vasculären System klar vom restlichen pelvinen Gewebe abgrenzt, besitzt sie, wie auch die ventral gelegene Denonvillier'sche Fascie eine wichtige natürliche Barrierefunktion gegenüber der Ausbreitung eines rectalen Tumors. Diese Fascienstrukturen sind wichtige Leitschienen bei der onkologisch korrekt durchgeführten Mobilisation des Rectums [2,4,11,25]. Vom funktionellen Standpunkt aus ist eine fasciennahe, scharfe Dissektion unter direkter Sicht eine Grundvoraussetzung für die Schonung autonomer Nerven, die sich den Fascien von auûen eng an-…”

Section: Mesorectale Hüllfascien Und Ihre Bedeutungunclassified

Schonung autonomer Nerven in der Rectumchirurgie Ergebnisse der Präparation an Leichen und fixierten Beckenpräparaten

Höer

Roegels

Prescher

et al. 2000

Chirurg

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Introduction: Preservation of sexual function and voiding capacity after rectal cancer surgery has increased after adopting the technique of nerve-sparing dissection and total mesorectal excision. Still the rate of sexual and urinary dysfunction ranges between 25 and 67 %. The precise locations where nerve damage occurs have not been looked at systematically. Material and methods: In ten human corpses and two formalinfixed human pelvises the autonomous pelvic nerves were isolated. Their relation according to surgical mobilization of the rectum were photodocumented. Results: Pelvic autonomous nerves are clearly defined structures with only minor interindividual variability. The inferior mesenteric plexus forms a dense network around the inferior mesenteric artery (AMI) to a distance of 5 cm from the aorta. The distance between the lateral rectum and the pelvic plexus is only 2±3 mm. The anterior rectum is almost directly adherent to the neurovascular bundle, separated only by Denonvillier's fascia. The parasympathetic branches of the sacral segments S2±S5 cannot be isolated using the standard surgical approach. Conclusion: (1) The nomenclature of fascias and the course of the autonomous pelvic nerves is not clearly defined in the literature; (2) a high tie of the AMI leads to damage of the sympathetic nerves; (3) the narrow space between the anterior and lateral rectum makes sharp dissection under direct vision necessary; (4) fascias and nerves can be used as guiding structures during mobilization; (5) a preservation of selected parasympathetic roots in the small pelvis is not feasible using the standard surgical approach.Keywords: Rectal surgery ± Autonomous nerval system ± Potency ± Continence.Schlüsselwörter: Rectumchirurgie ± autonomes Nervensystem ± Potenz ± Kontinenz.Die chirurgische Therapie des Rectumcarcinoms hat durch technische Modifikationen einen groûen Aufschwung erfahren. Ein hoher Prozentsatz von R0-Re- Klinik und ForschungAbb. 10. Blick von lateral ins kleine Becken mit Denonvillier'scher Fascie (rechter Bildrand caudal). 1 = Ureter, 2 = D. deferens, 3 = V. urinaria, 4 = Denonvillier'sche Fascie, 5 = unteres Rectumdrittel, 6 = nach ventral verlaufende autonome Nervenfasern Abb. 11. Sicht auf das neurovasculäre Bündel, zwischen Blase und Denonvillier'schen Fascie (violett). 1 = D. deferens, 2 = Ureter, 3 = V. urinaria, 4 = Denonvillier'sche Fascie, 5 = Rectum, 6 = PHI, 7 = neurovasculäres Bündel

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“…1), and the prospect of pelvic dissection in the pelvis of an overweight male of short stature may be daunting. A few studies report lower local recurrence rates and improved survival in females after rectal resection [8,13–15].…”

Section: Introductionmentioning

confidence: 99%

MRI assessment of the bony pelvis may help predict resectability of rectal cancer

Boyle¹,

Petty

Chalmers

et al. 2005

Colorectal Disease

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Effect of extent of anterior resection and sex on disease-free survival and local recurrence in patients with rectal cancer

Cited by 20 publications

References 10 publications

Five-year follow-up study of stage I-IV rectal cancer including EGFR immunoexpression and p21 immunoactivity

Five-year follow-up study of stage I-IV rectal cancer including EGFR immunoexpression and p21 immunoactivity

Schonung autonomer Nerven in der Rectumchirurgie Ergebnisse der Präparation an Leichen und fixierten Beckenpräparaten

MRI assessment of the bony pelvis may help predict resectability of rectal cancer

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