Optimal neoadjuvant strategy for signet ring cell carcinoma of the rectum—Is TNT the solution?

Kazi, Mufaddal; Jain, Divakar; Padhy, Amita Sekhar; Menon, Munita; Desouza, Ashwin; Sukumar, Vivek; Gori, Jayesh; Ostwal, Vikas; Ankathi, Suman Kumar; Saklani, Avanish

doi:10.1002/jso.26637

Cited by 16 publications

(15 citation statements)

References 27 publications

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“…Over 90% of the present cohort had margin negative resections, suggesting non-inferiority to the open operations in the PelvEx data [ 13 ]. The above figure is in spite of 30% poorly-differentiated or signet ring cell cancers that are known to have higher positive margins [ 23 ]. Only two patients were converted to open surgery from MIS; one for bleeding and the other for an inadvertent ureteric injury.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers

Kazi

Desouza

Nashikkar

et al. 2022

J Minim Invasive Surg

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Purpose: Trials comparing minimally invasive rectal surgery have uniformly excluded T4 tumors. The present study aimed to determine the safety of minimally invasive surgery (MIS) for locally-advanced rectal cancers requiring pelvic exenterations based on benchmarked outcomes from the international PelvEx database. Methods: Consecutive patients of T4 rectal cancers with urogenital organ invasion that underwent MIS exenterations between November 2015 and June 2022 were analyzed from a single center. A safety threshold was set at 20% for R1 resections and 40% for major complications (≥grade IIIA) for the upper limit of the 95% confidence interval (CI). Results:The study included 124 MIS exenterations. A majority had a total pelvic exenteration (74 patients, 59.7%). Laparoscopic surgery was performed in 95 (76.6%) and 29 (23.4%) had the robotic operation. Major complications were observed in 35 patients (28.2%; 95% CI, 20.5%-37.0%). R1 resections were found pathologically in nine patients (7.3%; 95% CI, 3.4%-13.4%). The set safety thresholds were not crossed. At a median follow-up of 15 months, 44 patients (35.5%) recurred with 8.1% local recurrence rate. The 2-year overall and disease-free survivals were 85.2% and 53.7%, respectively. Conclusion:MIS exenterations for locally-advanced rectal cancers demonstrated acceptable morbidity and safety in term of R0 resections at experienced centers. Longer follow-up is required to demonstrate cancer survival outcomes.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers

Kazi

Desouza

Nashikkar

et al. 2022

J Minim Invasive Surg

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“…No patient developed port site metastasis on follow-up. We know from prior published studies that T4b and signet ring cell cancers have higher propensity for peritoneal failures and are no longer offered ovarian transposition [11,21]. Traditionally ovarian metastasis was considered to be exclusively a part of transcoelomic spread.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic ovarian transposition in teenage and young women with locally advanced rectal cancer: Respite amidst cancer chaos

et al. 2022

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Aim Ovarian transposition is an established surgical technique to salvage ovaries in premenopausal women requiring pelvic radiation. The success rate of ovarian transposition varies widely depending on the route, technique of surgery, type of cancer and treatment. Here, we aimed to analyse the effectiveness of laparoscopic ovarian transposition (LOT) in teenage and young women prior to pelvic radiation in locally advanced rectal cancers (LARC). Methods Patients who underwent LOT for rectal cancers were retrieved from a prospectively maintained database from June 2013–September 2019. Disease characteristics, return of menstrual function and oncological outcomes were analysed. Results A total of 46 women with a mean age of 25.2 years who underwent LOT at the cancer centre were included in the study. Seventy percent were nulliparous. All patients were fit for discharge by 24 h. Mean time to start radiation was 19.6 days (range 3–47 days). Median follow‐up of patients was 42 months. A total of 41 patients were assessable for ovarian function, 65.5% had resumption of menses. Median ovarian survival was 79 months and 5‐year ovarian survival was 54%. Median overall survival from rectal cancer was 51 months. Conclusion Laparoscopic ovarian transposition is a safe and effective technique of ovarian protection from the gonadotoxic effects of pelvic radiation in LARC. It does not delay primary treatment and does not compromise oncological outcomes. Long‐term follow‐up is required to evaluate fertility and quality of life.

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“…В разных исследованиях показатель БРВ различен. Так, при исследовании опухолевой регрессии при ректальных карциномах 5-летняя БРВ была равна 88 % (р = 0,06) при достижении опухолевой регрессии 2-3 степени при применении неоадъювантной ХЛТ [12], в то время как оценка этого показателя среди пациентов с ПРПК показала, при применении ХЛТ этот показатель составил 56,5 % (р = 0,151) [13], что выше наших показателей.…”

Section: результатыunclassified

The efficacy of neoadjuvant radiotherapy in patients with signet ring cell carcinoma of the rectum: a retrospective case control study

Gordeev¹,

Zagidullina

Naguslaeva³

et al. 2022

Malignant Tumours

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Introduction: Signet ring cell carcinoma of the rectum (SRCCR) is a rare rectal tumor, therefore, only limited information is available on the management of patients with this diagnosis. Since literature data on the susceptibility of signet ring cell carcinoma to radiation therapy (RT) are controversial, one of the questions that specialists may have is whether the RT is effective as the first stage of treatment.Materials and methods: We conducted a retrospective analysis of medical records of patients with SRCCR treated at Research Institute FSBI «N. N. Blokhin Oncology Center» of the Ministry of Health of Russia from 1998 to 2020. The inclusion criteria were as follows: histologically confirmed primary SRCCR, disease stage I–III, use of RT or chemoradiotherapy at the first stage. A case control study design was used to select a control group of patients with rectal adenocarcinoma, and each case of the control group was compared with the study group by the following criteria: the year of treatment, the cT and cN clinical stage, the use of RT or CRT. The main endpoint was the rate of Dworak tumor regression grade 3–4; secondary endpoints included 5-year overall survival (OS) and progression-free survival (PFS) rates.Results: The study and control groups included 16 patients each. In each group, 14 (87,5 %) patients received CRT and 2 (12,5 %) received RT; cT3, cT4 stages were diagnosed in 7 (43,8 %) and 9 (56,3 %) patients, respectively; cN0 and cN1–2 stages were diagnosed in 3 (18,8 %) and 13 (81,2 %) patients, respectively. Eight (50 %) patients in the SRCCR group and 4 (25,0 %) patients in the control group had Dworak tumor regression grade 3–4 (p = 0.273), and one (6,3 %) patient in each group showed pathological complete response (p > 0.99). The 5-year OS in the SRCCR group and the control group was 34,9 % and 51,4 %, respectively (p = 0.833); the 5-year PFS was 30,8 % and 35,6 %, respectively (p = 0.094).Conclusions: SRCCR is at least as susceptible to RT / CRT as rectal adenocarcinoma, for which neoadjuvant RT / CRT is the standard of care; the use of combination therapy produces comparable long-term results.

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Optimal neoadjuvant strategy for signet ring cell carcinoma of the rectum—Is TNT the solution?

Cited by 16 publications

References 27 publications

Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers

Minimally invasive surgery for maximally invasive tumors: pelvic exenterations for rectal cancers

Laparoscopic ovarian transposition in teenage and young women with locally advanced rectal cancer: Respite amidst cancer chaos

The efficacy of neoadjuvant radiotherapy in patients with signet ring cell carcinoma of the rectum: a retrospective case control study

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