Neo-adjuvant chemoradiotherapy and multivisceral resection to optimize R0 resection of locally recurrent adherent colon cancer

Hallet, Julie; Zih, Francis S.W.; Lemke, Madeline; Milot, Laurent; Smith, Andrew; Wong, C. Shun

doi:10.1016/j.ejso.2014.01.009

Cited by 31 publications

(22 citation statements)

References 19 publications

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“…Because of concerns regarding radiation toxicity, mainly to the small bowel, the use of chemoRT for LACC remains controversial. 30 Results of one study in which 33 patients were retrospectively analyzed suggested that neoadjuvant chemoRT combined with en bloc multivisceral resection results in high R0 resection proportions and excellent local control, with acceptable morbidity and mortality. 17 In 64% of these patients, the T4 tumor was located in the sigmoid; it was also the main tumor location (68%) in patients who received neoadjuvant chemoRT in the present study.…”

Section: Discussionmentioning

confidence: 99%

Locally Advanced Colon Cancer: Evaluation of Current Clinical Practice and Treatment Outcomes at the Population Level

Klaver

Gietelink

Bemelman

et al. 2017

J Natl Compr Canc Netw

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The goal of this study was to evaluate current clinical practice and treatment outcomes regarding locally advanced colon cancer (LACC) at the population level. Data were used from the Dutch Surgical Colorectal Audit from 2009 to 2014. A total of 34,527 patients underwent resection for non-LACC and 6,918 for LACC, which was defined as cT4 and/or pT4 stage. LACC was divided into those with multivisceral resection (LACC-MV; n=3,385) and without (LACC-noMV; n=1,595). Guideline adherence, treatment strategy, and short-term outcomes were evaluated. Guideline adherence was >90% regarding preoperative imaging and ≥80% regarding preoperative multidisciplinary team (MDT) discussion. In the elective setting, neoadjuvant chemoradiotherapy (chemoRT) was applied in 6.2% of the cT4 cases, and neoadjuvant chemotherapy in 4.0%. R0 resection rates were 99%, 91%, and 87% in patients with non-LACC, LACC-noMV, and LACC-MV, respectively (<.001). A postoperative complicated course occurred in 17%, 25%, and 29% of patients (<.001), and the 30-day/in-hospital mortality rate was 3.6%, 6.0%, and 5.4% (<.001) in the non-LACC, LACC-noMV, and LACC-MV groups, respectively. This population-based study suggests that there is room for improvement in the treatment of LACC, with regard to short-term surgical outcomes and oncologic outcomes (ie, radicality of resection). Improvement might be expected from optimized preoperative imaging, routine MDT discussions, and further specialization and centralization of care. Optimized use of neoadjuvant treatment strategies based on already available and upcoming evidence is likely to result in a better margin status and thereby a better long-term prognosis. Furthermore, lower R0 resection rates in an emergency setting suggest a potential role for bridging strategies in order to enable optimal staging, neoadjuvant treatment, and elective surgery by a surgical team most optimally qualified for the procedure.

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Section: Discussionmentioning

confidence: 99%

Locally Advanced Colon Cancer: Evaluation of Current Clinical Practice and Treatment Outcomes at the Population Level

Klaver

Gietelink

Bemelman

et al. 2017

J Natl Compr Canc Netw

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“…25 These recommendations are echoed by national treatment trends for patients with small bowel cancer with incomplete surgical resection, in whom aggressive locoregional strategies are used selectively in an attempt to improve outcomes. In the absence of robust data specific for small bowel adenocarcinoma, current National Comprehensive Cancer Network guidelines endorse treatment strategies in accordance with those for patients with colon cancer.…”

Section: Discussionmentioning

confidence: 99%

Adjuvant chemotherapy versus chemoradiotherapy in the management of patients with surgically resected duodenal adenocarcinoma: A propensity score‐matched analysis of a nationwide clinical oncology database

Ecker

McMillan

Datta

et al. 2016

Cancer

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“…Both Hallet et al and Cukier et al describe small numbers of patients receiving these treatments prior to MVR. 6,7 These authors report a 100% R0 resection rate as well as excellent 3-year and overall and diseasefree survival (85.9 and 73.7%, respectively). While the number of patients in these studies is quite small, it does suggest potential role for neoadjuvant treatment prior to MVR.…”

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confidence: 94%

Surgical Management of Complicated Colon Cancer

Lee-Kong

Lisle

2015

Clinics in Colon and Rectal Surgery

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The management of complicated colon cancer (locally invasive, obstructed, or perforated cancers) can pose diagnostic and therapeutic challenges to surgical management. Adherence to traditional surgical oncologic principles must often be balanced with the patients' clinical presentation and other parameters. While the goal of an R0 (no residual microscopic disease) resection must always be kept in mind, situations sometimes arise which can make this difficult to achieve. Recognition of complicated disease and availability of varied therapeutic modalities is important to ensure favorable patient outcomes. This review will discuss the surgical management of complicated colon cancer, with special focus on locally advanced disease.

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Neo-adjuvant chemoradiotherapy and multivisceral resection to optimize R0 resection of locally recurrent adherent colon cancer

Cited by 31 publications

References 19 publications

Locally Advanced Colon Cancer: Evaluation of Current Clinical Practice and Treatment Outcomes at the Population Level

Locally Advanced Colon Cancer: Evaluation of Current Clinical Practice and Treatment Outcomes at the Population Level

Adjuvant chemotherapy versus chemoradiotherapy in the management of patients with surgically resected duodenal adenocarcinoma: A propensity score‐matched analysis of a nationwide clinical oncology database

Surgical Management of Complicated Colon Cancer

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