Local Control in Rectal Cancer

Twomey, Patrick; Burchell, Mary; Strawn, Dale; Guernsey, James M.

doi:10.1001/archsurg.1989.01410100076013

Cited by 20 publications

(1 citation statement)

References 22 publications

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“…[1] In China, rectal cancer accounts for the largest proportion of colorectal cancer, and its treatment regimens are complex. [2] Local control, defined as an absence of tumor recurrence within the pelvic or perineal area, [3,4] has been considerably improved after the introduction of total mesorectal excision (TME) and neoadjuvant radiotherapy in the treatment of rectal cancer. [5,6] However, local recurrence (LR), with a range of 10% to 20% after surgery, remains a major problem.…”

Section: Introductionmentioning

confidence: 99%

Morphology of the anterior mesorectum: a new predictor for local recurrence in patients with rectal cancer

Wang

Zheng

Chen

et al. 2022

Chinese Medical Journal

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Background: Pre-operative assessment with high-resolution magnetic resonance imaging (MRI) is useful for assessing the risk of local recurrence (LR) and survival in rectal cancer. However, few studies have explored the clinical importance of the morphology of the anterior mesorectum, especially in patients with anterior cancer. Hence, the study aimed to investigate the impact of the morphology of the anterior mesorectum on LR in patients with primary rectal cancer. Methods: A retrospective study was performed on 176 patients who underwent neoadjuvant treatment and curative-intent surgery. Patients were divided into two groups according to the morphology of the anterior mesorectum on sagittal MRI: (1) linear type: the anterior mesorectum was thin and linear; and (2) triangular type: the anterior mesorectum was thick and had a unique triangular shape. Clinicopathological and LR data were compared between patients with linear type anterior mesorectal morphology and patients with triangular type anterior mesorectal morphology. Results: Morphometric analysis showed that 90 (51.1%) patients had linear type anterior mesorectal morphology, while 86 (48.9%) had triangular type anterior mesorectal morphology. Compared to triangular type anterior mesorectal morphology, linear type anterior mesorectal morphology was more common in females and was associated with a higher risk of circumferential resection margin involvement measured by MRI (35.6% [32/90] vs. 16.3% [14/86], P = 0.004) and a higher 5-year LR rate (12.2% vs. 3.5%, P = 0.030). In addition, the combination of linear type anterior mesorectal morphology and anterior tumors was confirmed as an independent risk factor for LR (odds ratio = 4.283, P = 0.014). Conclusions:The classification established in this study was a simple way to describe morphological characteristics of the anterior mesorectum. The combination of linear type anterior mesorectal morphology and anterior tumors was an independent risk factor for LR and may act as a tool to assist with LR risk stratification and treatment selection.

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Section: Introductionmentioning

confidence: 99%

Morphology of the anterior mesorectum: a new predictor for local recurrence in patients with rectal cancer

Wang

Zheng

Chen

et al. 2022

Chinese Medical Journal

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Potency, Cure, and Local Control in the Operative Treatment of Rectal Cancer

Enker¹

1992

Arch Surg

247

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Impotence due to parasympathetic nerve injury is one of the most feared consequences of operations for treatment of rectal cancer. Sharp dissection along the parietal pelvic fascia where the parasympathetic nerves are located significantly reduces the incidence of pelvic failure. Autonomic nerve-preserving pelvic sidewall dissections, which combined the benefits of en bloc parietal pelvic dissection with nerve preservation, were performed in 42 men who were undergoing sphincter-preserving operations for treatment of rectal cancer. Thirty-three (86.7%) of the 38 evaluable patients have remained potent, and 29 (87.9%) of the 33 patients have normal ejaculation. Deliberate sacrifice of the inferior hypogastric plexus caused only minor sexual dysfunction. Cancer recurred locally in only one patient (with stage D cancer). Autonomic nerve-preserving pelvic sidewall dissection combines the benefits of curative resection and local control with reduced morbidity, and it preserves potency.

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Adjuvant radiation therapy for colorectal cancer

Cummings

1992

Cancer

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Background. Despite apparently complete resection of cancers of the rectum or colon, many patients have recurrences in the area from which their primary cancer was excised and in more distant organs. Radiation therapy has been used either alone or in combination with chemotherapy as an adjuvant to surgery to reduce the risk of recurrence. Methods. The literature describing the results of adjuvant radiation treatment for colorectal cancer was reviewed. Results. In randomized studies in patients with moderately advanced rectal cancers (T2‐4 NO, MO or N1‐3, MO) adjuvant radiation therapy has often reduced the risk of pelvic recurrence, but has had little effect on survival rates or the risk of extrapelvic metastases. Recent reports show that combined radiation and chemotherapy can improve both disease‐free survival and survival rates. Such treatment has caused only moderate toxicity in most studies. Nonrandomized studies in patients in whom small superficial rectal cancers are treated by local excision suggest that adjuvant radiation therapy reduces the risk of pelvic recurrence after this limited surgery and allows anorectal function to be preserved. Strategies similar to those developed for the treatment of rectal cancer are being studied in patients with colon cancer. Conclusions. In moderately advanced rectal cancers, the combination of chemotherapy and radiation is more effective than radiation alone in reducing local recurrence and increasing survival rates. Additional trials are needed to improve results and to refine drug and radiation schedules. Radiation alone may be sufficient as an adjuvant treatment when combined with local excision of small rectal cancers. The role of radiation in the adjuvant treatment of colon cancer is investigational. There is a need to more accurately delineate the patients with colorectal cancer most likely to benefit from adjuvant therapy.

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Local Control in Rectal Cancer

Cited by 20 publications

References 22 publications

Morphology of the anterior mesorectum: a new predictor for local recurrence in patients with rectal cancer

Morphology of the anterior mesorectum: a new predictor for local recurrence in patients with rectal cancer

Potency, Cure, and Local Control in the Operative Treatment of Rectal Cancer

Adjuvant radiation therapy for colorectal cancer

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