Prognostic factors in rectal carcinoma

Hermanek, P.; Guggenmoos-Holzmann, I.; Gall, F. P.

doi:10.1007/bf02554180

Cited by 104 publications

(19 citation statements)

References 16 publications

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“…Limfadenectomia necesită cunoaşterea anatomiei normale a limfaticelor şi a căilor de metastazare [16]. Limfadenectomia sistematică pentru cancer are ca scop prevenirea potenţialului metastatic în nodulii limfatici din teritoriul de drenaj al tumorii primare şi îmbunătăţirea prognosticului [20]. Efectuarea limfadenectomiei sistematice şi rezecţia extinsă este condiţia esenţială pentru stadializarea patologică a tumorii şi a instituirii tratamentului adjuvant.…”

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“…Invazia metastatică a staţiilor nodulilor limfatici depinde de profunzimea invaziei tumorale a peretelui colic [20]. În clasificarea U.I.C.C.…”

Section: Discuţiiunclassified

“…Scăderea numărului de noduli limfatici fără metastaze examinaţi după rezecţia chirurgicală se asociază cu creşterea supravieţuirii. Creşterea supravieţuirii este corelată cu creşterea numărului (peste 12) nodulilor limfatici extirpaţi şi examinaţi şi cu creşterea numărului limfonodulilor negativi [3][4][5][6][20][21][22][23][24][25][26][27][28][29]. Rata supravieţuirii la 5 ani este de 80-90% în absenţa metastazelor în nodulii limfatici şi de 40% când acestea sunt prezente.…”

Section: Discuţiiunclassified

“…Chirurgul trebuie să îndepărteze tot teritoriul de drenaj limfatic al tumorii până la originea vaselor sanguine, ştiind că nodulii limfatici, care drenează celulele neoplazice sunt mici, iar la pacienţii cu obezitate sunt greu de identificat. Recurenţa în nodulii limfatici regionali sau de la distanţă poate fi întâlnită şi după mult timp, după 95 până la 114 luni postoperator [12,20,21,32,33]. Absenţa sau prezenţa tumorii reziduale "R" este un factor foarte important de prognostic.…”

Section: Discuţiiunclassified

“…prezenţa metastazelor în nodulii limfatici regionali din stadiul clinic III se însoţeşte de supravieţuirea la 5 ani de 50% pentru pN 1 şi de 34% pentru pN 2 . Prezenţa metastazelor în nodulii limfatici regionali din stadiul clinic III se asociază supravieţuirii la cinci ani cu 50% pentru N 1 şi cu 34% pentru N 2 [12][13][14]20,[29][30][31][32][33][34][35][36]. Într-un studiu pe 2400 pacienţi, supravieţuirea la cinci ani a fost de 82,3% şi de 70,2% la zece ani, pentru stadiul I, dar a scăzut în stadiul III, pentru aceleaşi perioade la 48,8% şi respectiv 38,7% [27].…”

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Metastatic Lymphadenopathy in Colon Cancer

Păunescu¹,

Pop-Began²,

Pop-Began³

et al. 2013

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METASTATIC LYMPHADENOPATHY IN COLON CANCER (Abstract): INTRODUCTION:The incidence and prevalence of colon cancer is increasing in the last decades, in Romania. The aim of this paper is to evaluate the place of metastatic lymphadenopathy as risk factor for postoperative morbidity and mortality. MATHERIAL AND METHODS: We perfomed a prospective study; 126 patients with colon cancer were included and prospectively reviwed. RESULTS: The men / women ratio was 70 / 56. The mean age was 65.26 years old (range 20-89 years). Most cases were in stage III (n=72, 57.14%) and IV (n=49, 38.89%) with tumors located more frequently on the left colon (n=86, 68.25%) and especially on the sigmoid colon (n=64, 50.79%). 33.33% patients (n=42) were operated in emergency. Colic wall invasion depth (pT 3 =49, 38.9%, pT 4 =72, 57.1%) were accompanied by an increase in the number of affected regional lymph nodes (pN 1 =29, 23.0%, pN 2 =43, 34.1%). Postoperative complications occurred only in patients in stages III (n=11, 15.41%) and IV (n=15, 30.61%). The 30 days postoperative mortality rate was 19.04% (n=24), mostly in stage pT 4 tumors (n=18, 25%). Metastatic adenopathy was found as risk factor for postoperative mortality rate: 16.66% (n=4) deaths for pN 1 , 30.23% (n=13) for pN 2 and resoectively 13.07% (n=7) mortality rate for pN 0 . The five years survival rate was 100% for stage I, 59.64% for stage II, 33.57% for stage III and nul for stage IV. CONCLUSIONS: The presence of metastatic adenopathy is crucial in assessing the informational value of early and late postoperative evolution.

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“…Invazia metastatică a staţiilor nodulilor limfatici depinde de profunzimea invaziei tumorale a peretelui colic [20]. În clasificarea U.I.C.C.…”

Section: Discuţiiunclassified

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Metastatic Lymphadenopathy in Colon Cancer

Păunescu¹,

Pop-Began²,

Pop-Began³

et al. 2013

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Prognostic factors for patients with colon or rectal carcinoma treated with resection only: Five-year follow-up report

Tominaga

Sakaguchi

Koyama

et al. 1996

Cancer

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Validation of a new classification system for curatively resected colorectal adenocarcinoma

Sternberg

Sibirsky

Cohen

et al. 1999

Cancer

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BACKGROUND The parameters within which colorectal adenocarcinoma is currently staged are often insufficient for decisions regarding therapy after potentially curative surgery. Consequently, oncologists make frequent use of additional prognostic indicators when assessing individual prognosis and selecting patients for adjuvant systemic treatment. Follow‐up programs are generally uniform for all patients, regardless of disease stage and prognosis. As a result, patients with a favorable prognosis are needlessly subjected to stressful, costly follow‐up too early and too frequently. This study was conducted to validate a new classification system that is a superior predictor of individual prognosis following curative surgery and may serve as a guide for personalized, cost‐effective postoperative management and follow‐up. METHODS A total of 231 American colorectal carcinoma patients who underwent curative resection were retrospectively staged according to a new classification (containing 4 stage‐groups) for curatively resected colorectal adenocarcinoma. This classification is based on statistical analysis of the impact on prognosis of numerous characteristics of 363 consecutive Israeli colorectal carcinoma patients who underwent curative resection. All the patients in both cohorts had had surgery at least 5 years previously. The new classification is based on three histologic variables (venous invasion, depth of primary tumor penetration, and regional lymph node status) and a scoring system that correlates higher numeric score with worse prognosis. In both cohorts, the new classification was compared with the Dukes, Astler–Coller, and TNM staging systems for patient distribution and survival (both disease free and cancer‐related survival). RESULTS In both cohorts, the 4 stage‐groups of the new classification differed significantly in both the rate of and the time to first recurrence and cancer‐related death, with progression from Group 4 to Group 1. Groups of high risk lymph node negative patients were defined, and lymph node positive patients were subdivided according to prognosis. It is suggested that, by using this new classification as a guide, selection for adjuvant systemic treatment may be refined, and postoperative follow‐up may be personalized and therefore more cost‐effective. CONCLUSIONS The new classification for curatively resected colorectal adenocarcinoma, based on an analysis of the Israeli cohort and validated in the American cohort, is superior to the Dukes, Astler–Coller, and TNM staging systems as a predictor of individual prognosis, most probably because it incorporates the microscopic forerunner of distant, hematogenous spread (i.e., venous invasion) with the locoregional parameters of extent of disease (i.e., T and N values). It is suggested that the new classification may serve as a guide for more refined selection of patients for adjuvant systemic treatment and for individualized and more cost‐effective postoperative follow‐up. The new classification is simple and easy to use, requires...

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Prognostic factors in rectal carcinoma

Cited by 104 publications

References 16 publications

Metastatic Lymphadenopathy in Colon Cancer

Metastatic Lymphadenopathy in Colon Cancer

Prognostic factors for patients with colon or rectal carcinoma treated with resection only: Five-year follow-up report

Validation of a new classification system for curatively resected colorectal adenocarcinoma

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