Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis

Fields, Adam C.; Scully, Rebecca E.; Saadat, Lily V.; Lu, Pamela; Davids, Jennifer S.; Bleday, Ronald; Goldberg, Joel

doi:10.1007/s00384-019-03267-5

Cited by 10 publications

(7 citation statements)

References 24 publications

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“…In this study of patients with low rectal cancer, the overall survival rate was better in the SPS group than in the APR group and was similar to the survival rate in a previous study of rectal cancer [27] . In a propensity-matched analysis of patients included in the National Cancer Database, APR was associated with worse overall survival outcomes than coloanal anastomosis [30] . The worse oncological outcomes in the APR group may have been attributable to the presence of more advanced tumours, which are more likely to perforate intraoperatively [28] , or more positive circumferential margins [ 28 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

“…In a propensity-matched analysis of patients included in the National Cancer Database, APR was associated with worse overall survival outcomes than coloanal anastomosis [30] . The worse oncological outcomes in the APR group may have been attributable to the presence of more advanced tumours, which are more likely to perforate intraoperatively [28] , or more positive circumferential margins [ 28 , 30 ]. However, in our study, the surgical method was not a prognostic factor after adjustments were made for confounders, although the overall survival of patients with pathological stage 2–3 was better in the SPS group.…”

Section: Discussionmentioning

confidence: 99%

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Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study

Kang¹,

Cho²,

Jeong

et al. 2021

The Lancet Regional Health - Western Pacific

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Background: The long-term effects of radical resection on quality of life may influence the treatment selection. The objective of this study was to determine whether abdominoperineal resection has a better effect on the quality of life than sphincter preservation surgery at 3 years after surgery Methods: This prospective, cohort study included patients who underwent radical resection for low rectal cancer. The primary outcomes were European Organisation for Research and Treatment of Cancer QLQ-C30 and CR38 quality of life scores 3 years after surgery, which were compared with linear generalised estimating equations, after adjustment for baseline values, a time effect, and an interaction effect between time and treatment. The secondary outcomes included sexual-urinary functions and oncological outcomes. The study was registered with ClinicalTrials.gov (NCT01461525). Findings: Between December 2011 and August 2016, 342 patients were enrolled: 268 (78 • 4%) underwent sphincter preservation surgery and 74 (21 • 6%) underwent abdominoperineal resection. The global quality of life scores did not differ between sphincter preservation surgery and abdominoperineal resection groups (adjusted mean difference, 4 • 2 points on a 100-point scale; 95% confidence interval [CI], −1 • 3 ✩ Registry URL: https://clinicaltrials.gov/ct2/show/NCT01461525?term=abdominoperineal+resection&cond=rectal+cancer&draw=2&rank=3 ✩✩ Study Acronym: ASPIRE, A bdominoperineal resection versus SP hincter preservation surgery I n low RE ctal cancer * Corresponding author.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study

Kang¹,

Cho²,

Jeong

et al. 2021

The Lancet Regional Health - Western Pacific

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“…In the ACOSOG Z6051 trial, factors that negatively impacted DFS after the resection of rectal cancer were APR, low position of the tumor in the rectum, rectal perforation during the resection, and unsuccessful operation based on CRM positivity [ 17 ]. In the National Cancer Database (2004–2013) propensity matched analysis, patients undergoing LAR with coloanal anastomosis compared with APR for rectal cancer had better OS and were less likely to have positive margins despite the technically challenging operation [ 34 ]. The reasons for worse overall outcomes of APR mentioned in that study were the selection of more advanced tumors, which are more likely to perforate intraoperatively, inablility to obtain negative CRM with APR, and lymph node spread, which may not be adequately treated with APR.…”

Section: Discussionmentioning

confidence: 99%

The Safety and Feasibility of Laparoscopic Surgery for Very Low Rectal Cancer: A Retrospective Analysis Based on a Single Center’s Experience

Chung

Kim

et al. 2021

Biomedicines

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In this work we intend to validate the long-term oncologic outcomes for very low rectal cancer over the past 20 years and to determine whether laparoscopic procedures are useful options for very low rectal cancer. A total of 327 patients, who electively underwent laparoscopic rectal cancer surgery for a lesion within 5 cm from the anal verge, were enrolled in this study and their long-term outcomes were reviewed retrospectively. Of 327 patients, 70 patients underwent laparoscopic low anterior resection (LAR), 164 underwent laparoscopic abdominal transanal proctosigmoidocolectomy with coloanal anastomosis (LATA), and 93 underwent laparoscopic abdominoperineal resection (APR). The conversion rate was 1.22% (4/327). The overall postoperative morbidity rate was 26.30% (86/327). The 5-year disease free survival (DFS), 5-year overall survival (OS), and 3-year local recurrence (LR) were 64.3%, 79.7%, and 9.2%, respectively. The CRM involvement was a significant independent factor for DFS (p = 0.018) and OS (p = 0.042) in multivariate analysis. Laparoscopic APR showed poorer 5-year DFS (47.8%), 5-year OS (64.0%), and 3-year LR (17.6%) than laparoscopic LAR (74.1%, 86.4%, 1.9%) and laparoscopic LATA (69.2%, 83.6%, 9.2%). Laparoscopic procedures for very low rectal cancer including LAR, LATA, and APR could be good surgical options in selective patients with very low rectal cancer.

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“…LPLN metastasis was found in 26 patients (24.3 %) in the LPLND group (19). Furuhata et al (2015) the mean number of harvested lateral pelvic lymph nodes was 16.9 (7-27), and five patients (27.8 %) had lymph node metastases [20] .…”

Section: Ogura Et Al (2017)mentioning

confidence: 99%

Evaluation of Total Mesorectal Excision With or Without Lateral Pelvic Lymph Nodes Dissection for Middle and Lower Rectal Cancer

2021

AJSRR

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Background: The most important prognostic factor in colorectal cancer is nodal status, and lymph node metastasis is a determining factor for adjuvant chemotherapy and subsequently key to predicting disease free and overall survival. Methods: A descriptive prospective study was conducted on 40 patients presenting with middle and low rectal cancer to the outpatient clinic of Menoufia University Hospitals. All patients in the study will require resection of their tumors by total mesorectal excision by open and laparoscopic techniques. Patients will be divided into 2 groups: Group A: was operated without lateral pelvic lymph nodes dissection. Group B: was operated with lateral pelvic lymph nodes dissection during the period between November 2018 and November 2020. Results: The main presentation of patients was bleeding per rectum 12 (30%), 12 (30%) patients have constipation. 28 patients with adenocarcinoma (70%) and 8 mucinous (20 %) and 4 (10%) with signet ring. Sixteen patients undergo Low ant resection (40%), 16 patients with AP. resection (40 %) and 8 patients with Intersphencteic resection (20%). Regarding intraoperative data, with a mean operative time was (90.00 ± 3.84 min.) for without Lateral pelvic L.N dissection and (122.91±4.89 min.) for with Lateral pelvic L.N dissection. Conclusion: Surgical mortality of LPLD is low, but there is an increase of morbidities in the form of prolonged operative time, intraoperative blood loss and genito-urinary malfunction. For avoiding the drawbacks of LPLD extended lymphadenectomies with sparing of the pelvic nerves is recommended. Lateral pelvic lymph node involvement is a regional disease that is curable. LPLD was effective to control recurrence at lateral nodes sites.

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Oncologic outcomes for low rectal adenocarcinoma following low anterior resection with coloanal anastomosis versus abdominoperineal resection: a National Cancer Database propensity matched analysis

Cited by 10 publications

References 24 publications

Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study

Quality of life after sphincter preservation surgery or abdominoperineal resection for low rectal cancer (ASPIRE): A long-term prospective, multicentre, cohort study

The Safety and Feasibility of Laparoscopic Surgery for Very Low Rectal Cancer: A Retrospective Analysis Based on a Single Center’s Experience

Evaluation of Total Mesorectal Excision With or Without Lateral Pelvic Lymph Nodes Dissection for Middle and Lower Rectal Cancer

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