Extended Radical Resection: The Choice for Locally Recurrent Rectal Cancer

Heriot, Alexander G.; Byrne, Christopher; Lee, Peter; Dobbs, B. R.; Tilney, H. S.; Solomon, Michael J.; Frizelle, Frank

doi:10.1007/s10350-007-9152-9

Cited by 233 publications

(192 citation statements)

References 31 publications

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“…Third, the follow‐up duration was relatively short. Although we thought that LR would generally be identified within 3 years after surgery35, 36, 37 and some RCT were also designed to compare the OS, DFS, or LR at this time point,6, 38, 39 longer follow up is required to confirm these results. We plan to follow up this cohort until 5 years after surgery.…”

Section: Discussionmentioning

confidence: 99%

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Okamura

Hida

Yamaguchi

et al. 2017

Annals of Gastroent Surgery

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Sphincter‐preserving procedures (SPPs) for surgical treatment of low‐lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II‐III rectal cancer between 2010 and 2011. Patients with tumors 2‐5 cm from the anal verge and clinical stage T3‐4 were eligible. Primary outcome was 3‐year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77‐1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3‐year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42‐1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.

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Section: Discussionmentioning

confidence: 99%

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Okamura

Hida

Yamaguchi

et al. 2017

Annals of Gastroent Surgery

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“…Local excision was specified as the primary surgical treatment in 13 studies; 2 of them 26,35 exclusively included patients who had undergone local excision, and the median local excision rate was 10% (range 6%-30%) in the remaining 11 studies. 4,7,17,20,25,29,34,40,44,45,47 Included patients had undergone EBRT as part of the primary treatment in a median of 28% (range 0%-100%) of cases in 43 studies (Table 1). Previous radiotherapy dose was specified in 10 studies, 4,7,9,12,19,27,28,41,55,57 with a total dose ranging from 10 to 110 Gy.…”

Section: Therapy For Primary Rectal Cancermentioning

confidence: 99%

“…Radiotherapy dose was specified in 28 studies. [3][4][5][6][7][8][9]11,18,19,28,29,30,[33][34][35][36][37]41,44,46,47,[50][51][52][53]56,57 Without prior EBRT, the total dose was 40-60 Gy in most studies, with an overall range of 15-80 Gy. Conventional fractionation (1.8-2.0 Gy per fraction) was uniformly applied in 13 studies, 3,6,7,9,11,18,19,28,30,36,46,50,52 and selective use of a hypofractionated schedule (fractions of 5 Gy) was described in 2 studies.…”

Section: Perioperative Treatment For Local Recurrencementioning

confidence: 99%

“…34 described the use of re-EBRT, 7 of which specified the rate. 3,19,28,40,42,47,52 The radiotherapy schedule was specified in 3 of these studies, 28,52,56 with a total dose ranging from 23.4 to 30.6 Gy in daily fractions of 1.2 or 1.8 Gy. External beam radiotherapy was part of a chemoradiotherapy regimen, mostly fluorouracil-based, in 27 studies (Table 2); routine use of chemoradiotherapy was reported in only 3 studies.…”

Section: Perioperative Treatment For Local Recurrencementioning

confidence: 99%

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

Tanis

Doeksen

Lanschot

2013

cjs

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Intentionally curative treatment of locally recurrent rectal cancer: a systematic reviewBackground: There is a lack of outcome data beyond local recurrence rates after primary treatment in rectal cancer, despite more information being necessary for clinical decision-making. We sought to determine patient selection, therapeutic modalities and outcomes of locally recurrent rectal cancer treated with curative intent. Methods:We searched MEDLINE (1990-2010) using the medical subject headings "rectal neoplasms" and "neoplasm recurrence, local." Selection of cohort studies was based on the primary intention of treatment and availability of at least 1 outcome variable. Results:We included 55 cohort studies comprising 3767 patients; 8 studies provided data on the rate of intentionally curative treatment from an unselected consecutive cohort of patients (481 of 1188 patients; 40%). Patients were symptomatic with pain in 50% (796 of 1607) of cases. Overall, 3088 of 3767 patients underwent resection. The R0 resection rate was 56% (1484 of 2637 patients). The rate of external beam radiotherapy was 100% in 9 studies, 0% in 5 studies, and ranged from 12% to 97% in 37 studies. Overall postoperative mortality was 2.2% (57 of 2515 patients). Five-year survival was at least 25%, with an upper limit of 41% in 11 of 18 studies including at least 50 resections. We found a significant increase in reported survival rates over time (r 2 = 0.214, p = 0.007). Conclusion:More uniformity in treatment protocols and reporting on outcomes for locally recurrent rectal cancer is warranted. The observed improvement of reported survival rates in time is probably related to better patient selection and optimized multimodality treatment in specialized centres.

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“…2 Heriot et al reported morbidity and mortality rates of 27% and 0.6% respectively. 3 These improvements can also be credited to developments in intraoperative and perioperative treatments, including a better patient selection, the routine use of prophylactic antibiotherapies, venous thromboembolism prevention, anesthesia monitoring, and the use of surgical devices such as the LigaSure TM vessel sealer and divider (Impact TM and Small Jaw TM ), which facilitates the dissection, reduces the blood loss, and shortens the surgical time. 4 Pelvic exenteration is an ultra-radical procedure characterized by en bloc resection of the pelvic organs and can be described on the three axes of the pelvis: antero-posterior, transversal and vertical.…”

Section: Introductionmentioning

confidence: 99%

Supralevator Total Pelvic Exenteration Without Colostomy — Case Report

Botoncea¹,

Varlam

Chiujdea³

et al. 2017

Journal of Interdisciplinary Medicine

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Background: Pelvic exenteration is an ultra-radical surgical procedure described by Brunschwig in 1948, which attempts to surgically cure patients with recurrent pelvic cancer after radiotherapy. Several variants of pelvic exenteration are described that allow a more limited or extensive resection, depending on the stage of the disease. Case report: We report the case of a 54-year-old woman, who was diagnosed with a tumoral rectovaginal fistula after a recurrent cervical cancer that had been treated with a total hysterectomy with bilateral adnexectomy and a left percutaneous nephrostomy, as well as interaortocaval lymph node resection. The patient had undergone a supralevator total pelvic exenteration with pelvic and interaortocaval lymphadenectomy. The reconstruction process included right ureterostomy, left nephrostomy, and colocutaneous anal anastomosis (Parks procedure). Conclusions: Supralevator total pelvic exenteration provides hope for cure in patients with pelvic malignancies that reappear after radiotherapy. The restoration of the digestive tract and avoiding colostomy with a colocutaneous anastomosis increases the quality of life in these cases.

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Extended Radical Resection: The Choice for Locally Recurrent Rectal Cancer

Abstract: Resection for recurrent rectal cancer results in good survival with acceptable morbidity, unaffected by the extent of resection. Extended radical resection to obtain clear resection margins is the appropriate management of locally recurrent rectal cancer.

Cited by 233 publications

References 31 publications

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Intentionally curative treatment of locally recurrent rectal cancer: a systematic review

Supralevator Total Pelvic Exenteration Without Colostomy — Case Report

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