Total Mesorectal Excision Results in Low Local Recurrence Rates in Lymph Node-Positive Rectal Cancer

Cecil, Thomas D.; Sexton, Rosemary; Moran, Brendan; Heald, R. J.

doi:10.1007/s10350-004-0086-1

Cited by 57 publications

(68 citation statements)

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“…Therefore, radiotherapy alone or in combination with chemotherapy is used prior to surgery to reduce the tumor size. Extensive studies on the use of (chemo) radiotherapy for these tumors showed that preoperative radiotherapy decreases local recurrence rates by 50 to 60% as compared with surgery alone (43)(44)(45)(46)(47)(48)(49), and the addition of chemotherapy to radiotherapy has been shown to further increase local control (50)(51)(52)(53)(54). On the basis of these results, the current standard treatment of locally advanced rectal cancer consists of preoperative chemoradiation followed by total mesorectal excision surgery.…”

Section: Clinical-translational Advancesmentioning

confidence: 99%

Integration of Epidermal Growth Factor Receptor Inhibitors with Preoperative Chemoradiation

Debucquoy

Machiels

McBride

et al. 2010

Clinical Cancer Research

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In many different cancer cell types, the epidermal growth factor receptor (EGFR) pathway becomes hyperactivated because of overproduction of the ligand, overproduction of the receptor, or constitutive activation of the receptor. The overproduction of EGFR and its ligands correlates with poor prognosis in several solid tumors such as lung, colon, and ovary. These observations led to the development of EGFR inhibitors for anticancer treatment. In the last few years, promising results have been obtained in several tumor types, with EGFR inhibitors given as monotherapy or in combined treatments. In particular, cetuximab in combination with curative-intent radiotherapy in head and neck cancer increases median survival over radiation alone. Similarly, the same approach might benefit patients with locally advanced rectal cancer. Unfortunately, the first clinical studies combining chemoradiation with cetuximab in rectal cancer gave disappointing results. Translational research suggested that the low response rate observed might have been due to the strong antiproliferative effect of cetuximab that may have compromised the activity of chemotherapeutics that target proliferating cells. This result indicates the need for more translational research to unravel how the molecular mechanisms might be manipulated to optimize the combined treatment regimen and to identify biomarkers that can select those patients who will derive most benefit.

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Section: Clinical-translational Advancesmentioning

confidence: 99%

Integration of Epidermal Growth Factor Receptor Inhibitors with Preoperative Chemoradiation

Debucquoy

Machiels

McBride

et al. 2010

Clinical Cancer Research

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“…Lymph node metastases (LNM) of adenocarcinoma of the colon and rectum have been established as an independent prognostic factor [2]. Therefore, the radical resection of the local lymphdraining tissue led to a significant improvement of oncological results by lowering the local recurrence rate [3,4]. In addition, the histological identification of lymphovascular invasion (LVI) has long been recognized as a potential indication of LNM and prognostic indicator and predictor of patient outcome.…”

Section: Introductionmentioning

confidence: 99%

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

et al. 2013

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Adenocarcinomas of the colon and rectum are the most common gastrointestinal malignancy, and lymph node metastases are established as a prognostic factor. Lymphovascular invasion has been recognized as an indication of lymph node metastases. This prompted us to investigate the features of primary tumor that may serve as a risk factor for lymphovascular invasion in colorectal carcinoma. Clinical and pathologic tissue data of colorectal carcinoma treated in our hospital were retrieved from the computer files at Haydarpasa Numune Education and Research Hospital, from June 1998 to December 2010, retrospectively. We excluded all patients who have two-thirds distal rectal carcinoma to rule out neoadjuvant treatment bias. Tissues from the specimens were stained with standard hematoxylin and eosin. Clinical data including age and sex of patient, location and diameter of tumor, perineural invasion, peritumoral lymphocytic infiltration, tumor grade, lymphovascular invasion, Pathologic T level (pT), and lymph node metastasis were recorded. Lymphovascular invasion was present only in 43 patients out of 108. Only pT and lymph node metastases were found to be statistically significant related to lymphovascular invasion (p=0.04 and p<0.001). Perineural invasion, pT, and peritumoral lymphocytic infiltration are the factors with p<0.2 in the univariate analysis that were investigated with multivariate analysis, but no factor was found as an independent prognostic factor for lymphovascular invasion. Lymphovascular invasion is significantly related to lymph node metastases. Only pT is found as a factor that increases the lymphovascular invasion.

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“…Using TME technique for rectal cancer resection an optimal local control and improved survival can be achieved, also in lymph node-positive tumors (38). Due to these excellent results only limited use of adjuvant therapy is postulated by some; therefore, surgery alone as the treatment of choice is recommended (39).…”

Section: Discussionmentioning

confidence: 99%

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum

Szynglarewicz¹,

Matkowski²,

Forgacz³

et al. 2007

Oncol Rep

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Abstract. The aim of the study was to estimate the long-term results and the prognostic value of clinical and pathological factors following R0 anterior resection with total mesorectal excision (TME). Ninety-eight consecutive patients with histologically confirmed rectal cancer were studied prospectively with five-year follow-up. Survival was calculated using the Kaplan-Meier method and differences between curves were tested by the log-rank test. Multivariate analysis was performed using the Cox regression model. Recurrence-free survival (RFS) was 63.6%. Mean time of recurrence was 13.8 months (range 3-38). Local recurrence rate was 7.8% with the mean time of 12.7 months (range 3-25). In univariate analysis Dukes' stage (RFS for stage: A=93.2%; B=53.8%; C=26.3%) and preoperative CEA serum level (s-CEA) (for s-CEA ≤5 ng/ml RFS=93.8%; for s-CEA >5 ng/ml RFS = 5.9%) significantly influenced survival (P<0.005 and P<0.00001). These parameters were also found to be independent prognostic factors in multivariate analysis (P<0.05 and P<0.00001). Survival was worse in older female patients with low-localised poorly differentiated tumors; however, those variables had not significant impact on prognosis. Neither symptom duration nor mucinous histology was significantly related to survival. Using TME technique a low local recurrence rate resulting in improved survival can be achieved. Apart from clinicopathological staging, elevated s-CEA can identify patients with poor prognosis. In addition to TME adjuvant therapy for this high-risk group should be considered.

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Total Mesorectal Excision Results in Low Local Recurrence Rates in Lymph Node-Positive Rectal Cancer

Cited by 57 publications

References 0 publications

Integration of Epidermal Growth Factor Receptor Inhibitors with Preoperative Chemoradiation

Integration of Epidermal Growth Factor Receptor Inhibitors with Preoperative Chemoradiation

The Factors Effecting Lymphovascular Invasion in Adenocarcinoma of the Colon and Rectum

Clinical factors in prediction of prognosis after anterior resection with total mesorectal excision for carcinoma of the rectum

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