The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre

Kontovounisios, Christos; Tan, Ek Khoon; Pawa, Nikhil; Brown, Gina; Tait, Diana; Cunningham, David; Rasheed, Shahnawaz; Tekkis, Paris

doi:10.1111/codi.13517

Cited by 23 publications

(21 citation statements)

References 42 publications

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“…Only 9·8 per cent of patients who underwent abdominal resection had a total pelvic exenteration. This proportion is lower than in previous reports from tertiary centres dedicated to the treatment of locally advanced and recurrent rectal cancer. Today, pelvic exenteration is considered the best potentially curative procedure for many patients with locally advanced tumour in the pelvis.…”

Section: Discussioncontrasting

confidence: 62%

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Westberg

Palmer

Hjern

et al. 2019

British Journal of Surgery

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Background: Population-based studies of treatment of locally recurrent rectal cancer (LRRC) are lacking. The aim was to investigate the surgical treatment of patients with LRRC at a national population-based level.Methods: All patients undergoing abdominal resection for primary rectal cancer between 1995 and 2002 in Sweden with LRRC as a first event were included. Detailed information about treatment, complications and outcomes was collected from the medical records. The patients were analysed in three groups: patients who had resection of the LRRC, those treated without tumour resection and patients who received best supportive care only.Results: In all, 426 patients were included in the study. Of these, 149 (35⋅0 per cent) underwent tumour resection, 193 (45⋅3 per cent) had treatment without tumour resection and 84 (19⋅7 per cent) received best supportive care. Abdominoperineal resection was the most frequent surgical procedure, performed in 65 patients (43⋅6 per cent of those who had tumour resection). Thirteen patients had total pelvic exenteration. In total, 63⋅8 per cent of those whose tumour was resected had potentially curative surgery. After tumour resection, 62 patients (41⋅6 per cent) had a complication within 30 days. Patients who received surgical treatment without tumour resection had a lower complication rate but a significantly higher 30-day mortality rate than those who underwent tumour resection (10 versus 1⋅3 per cent respectively; P = 0⋅002). Of all patients included in the study, 22⋅3 per cent had potentially curative treatment and the 3-year survival rate for these patients was 56 per cent.Conclusion: LRRC is a serious condition with overall poor outcome. Patients undergoing curative surgery have an acceptable survival rate but substantial morbidity. There is room for improvement in the management of patients with LRRC.

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Section: Discussioncontrasting

confidence: 62%

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Westberg

Palmer

Hjern

et al. 2019

British Journal of Surgery

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“…The level of the lesion and its relationship to the anal sphincter and pelvic floor are primary considerations for proper technical assessment and oncology [10]. It is also important to evaluate the initial stage of the disease, the response to neoadjuvant therapy, the histology of the tumor, and the status of the resection margins.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Colorectal Cancer: a Multidisciplinary Approach

Anania

Resta

Marino

et al. 2018

J Gastrointest Canc

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“…Five-year survival is influenced by tumour stage, ranging from 90% in cancer confined to the primary site and 71% in those with local node involvement to 14% in Stage IV[3]. One-third of newly diagnosed rectal cancers in the United Kingdom will be locally advanced at the time of diagnosis, accounting for more than 4600 cases of cancer per year[4,5].…”

Section: Introductionmentioning

confidence: 99%

“…Pelvic exenteration (PE) is a technically demanding procedure involving “ en-bloc ” excision of the rectum and adjacent invaded organs, aiming at obtaining disease-free resection margins. Over time, contraindications to such a demolitive approach have been gradually reduced as a result of perioperative patient conditioning, increased surgical experience, and postoperative multidisciplinary management[5-7]. Surgery beyond the total mesorectal excision (TME) plane and involving sacrifice of other pelvic organs for locally recurrent or advanced rectal cancer has been analogous to a “sarcoma-like” procedure[6,8-10], during which several surgical teams and specialties need to be involved.…”

Section: Introductionmentioning

confidence: 99%

Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

Pellino

Biondo

Cazador

et al. 2018

WJG

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AIMTo identify short-term and oncologic outcomes of pelvic exenterations (PE) for locally advanced primary rectal cancer (LAPRC) in patients included in a national prospective database.METHODSFew studies report on PE in patients with LAPRC. For this study, we included PE for LAPRC performed between 2006 and 2017, as available, from the Rectal Cancer Registry of the Spanish Association of Surgeons [Asociación Española de Cirujanos (AEC)]. Primary endpoints included procedure-associated complications, 5-year local recurrence (LR), disease-free survival (DFS) and overall survival (OS). A propensity-matched comparison with patients who underwent non-exenterative surgery for low rectal cancers was performed as a secondary endpoint.RESULTSEight-two patients were included. The mean age was 61.8 ± 11.5 years. More than half of the patients experienced at least one complication. Surgical site infections were the most common complication (abdominal wound 18.3%, perineal closure 19.4%). Thirty-three multivisceral resections were performed, including two hepatectomies and four metastasectomies. The long-term outcomes of the 64 patients operated on before 2013 were assessed. The five-year LR was 15.6%, the distant recurrence rate was 21.9%, and OS was 67.2%, with a mean survival of 43.8 mo. R+ve resection increased LR [hazard ratio (HR) = 5.58, 95%CI: 1.04-30.07, P = 0.04]. The quality of the mesorectum was associated with DFS. Perioperative complications were independent predictors of shorter survival (HR = 3.53, 95%CI: 1.12-10.94, P = 0.03). In the propensity-matched analysis, PE was associated with better quality of the specimen and tended to achieve lower LR with similar OS.CONCLUSIONPE is an extensive procedure, justified if disease-free margins can be obtained. Further studies should define indications, accreditation policy, and quality of life in LAPRC.

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The selection process can improve the outcome in locally advanced and recurrent colorectal cancer: activity and results of a dedicated multidisciplinary colorectal cancer centre

Cited by 23 publications

References 42 publications

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Population-based study of surgical treatment with and without tumour resection in patients with locally recurrent rectal cancer

Treatment of Colorectal Cancer: a Multidisciplinary Approach

Pelvic exenterations for primary rectal cancer: Analysis from a 10-year national prospective database

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