The impact of surgical quality on prognosis in patients undergoing rectal carcinoma surgery after preoperative chemoradiation

Kiehlmann, Marcus; Weber, Klaus; Göhl, J.; Fietkau, Rainer; Agaimy, Abbas; Hohenberger, Werner; Merkel, Susanne

doi:10.1007/s00384-015-2421-5

Cited by 9 publications

(10 citation statements)

References 14 publications

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“…Remarkably, despite this variety, results are comparable, in terms of technical and oncological quality, to other published series. 11,[29][30][31] For instance, anastomotic leakage rate represents a reliable technical surrogate marker for quality control, and Boyce et al 32 have reported a leakage rate of 12.9% following laparoscopic rectal resection with anastomoses below 6 cm. Indeed, a comparable leakage rate (12.1%) was also observed in our study.…”

Section: Discussionmentioning

confidence: 99%

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Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision

et al. 2019

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Objective: To compare, in a phase 3, prospective, randomized, multi-center clinical trial functional outcome of reconstruction procedures following total mesorectal excision (TME). Summary Background Data: Intestinal continuity reconstruction following TME is accompanied by postoperative defecation dysfunctions known as ''anterior resection syndrome.'' Commonly used reconstruction techniques are straight colorectal anastomosis (SCA), colon J-pouch (CJP), and side-toend anastomosis (SEA). Comparison of their functional outcomes in prospective, randomized, multi-center studies, including long-term assessments, is lacking. Methods: Patients requiring TME for histologically proven rectal tumor, with or without neoadjuvant treatment, age ! 18 years, normal sphincter function without history of incontinence, any pretreatment staging or adenoma, expected R0-resection, were randomized for standardized SCA, CJP, or SEA procedures. Primary endpoint was comparison of composite evacuation scores 12 months after TME. Comparison of composite evacuation and incontinence scores at 6, 18 and 24 months after surgery, morbidity, and overall survival represented secondary endpoints. Analysis was based on ''per protocol'' (PP) population, fully complying with trial requirements, and intention-to treat (ITT) population. Results: Three hundred thirty-six patients from 15 hospitals were randomized. PP population included 257 patients (JCP ¼ 63; SEA ¼ 95; SCA ¼ 99). Composite evacuation scores of PP and ITT populations did not show statistically significant differences among the 3 groups at any time point. Similarly, composite incontinence scores for PP and ITT populations showed no statistically significant difference among the 3 trial arms at any time point. Conclusions: Within boundaries of investigated procedures, surgeons in charge may continue to perform reconstruction of intestinal continuity following TME at their technical preference.

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Section: Discussionmentioning

confidence: 99%

“…1). The 4 university centers, 4 referral centers, and 7 peripheral clinics contributed 104 (5-40), 152 (27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44), and 80 (1-33) patients, respectively. One hundred twelve patients were randomized to each treatment arm.…”

Section: Patient Population and Data Acquisitionmentioning

confidence: 99%

Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision

et al. 2019

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“…Nowadays, the completeness of the TME, and with that the quality of surgical tumor removal, may be expressed as the pathologic circumferential resection margin (pCRM). An intact and complete pCRM has been identified to lower local recurrence rates, whereas it may not impact on the development of distant metastases [17,18]. …”

Section: Current Surgical Treatment Strategies For Colorectal Cancermentioning

confidence: 99%

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

et al. 2016

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Background: Although colorectal surgery is long established as the mainstay treatment for colon cancer, certain topics regarding technical fine-tuning to increase postsurgical recurrence-free survival have remained a matter of debate throughout the past years. These include complete mesocolic excision (CME), treatment strategies for metastatic disease, significance of hyperthermic intraperitoneal chemotherapy (HIPEC), and surgical techniques for the treatment of colorectal cancer recurrence. In addition, new surgical techniques have been introduced in oncologic colorectal surgery, and their potential to provide sufficiently radical resection has yet to be proven. Methods: A structured review of the literature was performed to identify the current state of the art with regard to the mentioned key issues in colorectal surgery. Results: This article provides a comprehensive review of the current literature addressing the above-mentioned current challenges in colorectal surgery. The focus lies on the impact of CME and, in relation to this, on lymph node dissection, as well as on treatment of metastatic disease including peritoneal spread, and finally on the treatment of recurrent disease. Conclusion: Uniformly, the current literature reveals that surgery aiming at complete malignancy elimination within multimodal treatment approaches represents the fundamental quantum leap for the achievement of long-term tumor-free survival.

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“…Leonard et al 18 found that patients who did not show downstaging after long-course chemoradiotherapy (CRT) had a higher incidence of MPR than patients who showed downstaging ( P = 0.0005). Kiehlmann et al 28 analyzed the prognosis of patients who underwent preoperative long-term CRT and TME and found that the 5-year LRR was 6.7% in patients with either an MRR or an IMR compared with the LRR of 50% in the patients with an MPR ( P = 0.015). Therefore, neoadjuvant radiotherapy could improve the local prognosis of patients planned to undergo resection.…”

Section: Prognostic Significance Of Mamementioning

confidence: 99%

“…However, even after neoadjuvant CRT, it should not be ignored that the quality (completeness) of the mesorectum still has a strong influence on local recurrence in patients with rectal carcinoma. 28 …”

Section: Prognostic Significance Of Mamementioning

confidence: 99%

The quality of total mesorectal excision specimen: A review of its macroscopic assessment and prognostic significance

Song

Pan

et al. 2018

Chronic Diseases and Translational Medicine

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As a surgical procedure which could significantly lower the recurrence rate of cancers, total mesorectal excision (TME) has been the gold standard for middle and lower rectal cancer treatment. However, previous studies have shown that the procedure did not achieve the ideal theoretical local recurrence rates of rectal cancers. Some researchers pointed out it was very likely that not all so-called TME treatments completely removed the mesorectum, implying that some of these TME surgical treatments failed to meet oncological quality standards. Therefore, a suitable assessment tool for the surgical quality of TME is necessary. The notion of “macroscopic assessment of mesorectal excision (MAME)” was put forward by some researchers as a better assessment tool for the surgical quality of TME and has been confirmed by a series of studies. Besides providing rapid and accurate surgical quality feedbacks for surgeons, MAME also effectively assesses the prognosis of patients with rectal cancer. However, as a new assessment tool used for TME surgical quality, MAME has an only limited influence on the current guidelines and is yet to be widely applied in most countries. The aims of this review are to provide a detailed introduction to MAME for clinical practice and to summarize the current prognostic significance of MAME.

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The impact of surgical quality on prognosis in patients undergoing rectal carcinoma surgery after preoperative chemoradiation

Abstract: Even after preoperative chemoradiation, the surgical quality still has a strong impact on local control in patients with rectal carcinoma.

Cited by 9 publications

References 14 publications

Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision

Clinical Outcome After Rectal Replacement With Side-to-End, Colon-J-Pouch, or Straight Colorectal Anastomosis Following Total Mesorectal Excision

Surgery for Colorectal Cancer - Trends, Developments, and Future Perspectives

The quality of total mesorectal excision specimen: A review of its macroscopic assessment and prognostic significance

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