Background
As an anus-preserving surgery for very low rectal cancer, intersphincteric resection (ISR), has advanced markedly over the last 20 years. We investigated long-term oncologic, functional, ...and quality of life (QOL) outcomes after ISR with or without partial external sphincter resection (PESR).
Methods
A series of 199 patients underwent curative ISR with or without PESR between 2000 and 2008, with 49 receiving preoperative chemoradiotherapy (CRT group) and 150 undergoing surgery first (surgery group). Overall survival (OS), disease-free survival (DFS), and local relapse-free survival (LFS) rates were calculated using Kaplan–Meier methods. Functional outcomes were assessed using the Wexner incontinence score. QOL was investigated using the Short-Form 36 questionnaire (SF-36) and modified fecal incontinence quality of life (mFIQL) scale.
Results
After a median follow-up of 78 months (range 12–164 months), estimated 7-year OS, DFS, and LFS rates were 78, 67, and 80 %, respectively. LFS was better in the CRT group than in the surgery group (
p
= 0.045). Patients with PESR or positive circumferential resection margins showed significantly worse survival. The median Wexner incontinence score at >5 years was 8 in the surgery group and 10 in the CRT group (
p
= 0.01). QOL was improved in all physical and mental subscales of the SF-36 at >5 years. Although the mFIQL showed a relatively good score in all groups at >5 years, a significant difference existed between the CRT and surgery groups (
p
= 0.008).
Conclusions
With long-term follow-up, oncologic, functional, and QOL results after ISR appear acceptable, although CRT is associated with disturbance.
Aim
We evaluated the effectiveness and safety of a transanal tube placed for the prevention of anastomotic leakage after rectal surgery.
Methods
Between 2007 and 2011, a total of 243 patients ...underwent anterior resection using the double stapling technique for rectal cancer at our institution. We excluded 67 patients with diverting stoma and divided the remaining patients into two groups: patients who did not receive a transanal tube and diverting stoma (
n
= 140; control group) and those who received a transanal tube (
n
= 36). We compared the rate of anastomotic leakage, evaluated the complications associated with the transanal tube, and analyzed the risk factors for anastomotic leakage.
Results
The following perioperative parameters were significantly different between the two groups as follows (control group vs. transanal tube group): diabetes mellitus (8 22 % vs. 12 8.5 % patients, respectively;
p
= 0.03), surgical duration (262 ± 54.1 min 171–457 vs. 233 ± 61.7 min 126–430, respectively;
p
< 0.01). The postoperative anastomosis leakage appeared significantly different between the two groups (1 2.7 % vs. 22 15.7 % patients, respectively;
p
= 0.04). Anastomotic leakage was significantly associated with the distance between the anastomosis line and the anal verge (odds ratio OR 8.58; 95 % confidence interval CI 1.53–48.0;
p
= 0.01) and non-use of a transanal tube (OR 11.1; 95 % CI 1.04–118;
p
= 0.04) in both univariate and multivariate analyses.
Conclusions
Placement of a transanal tube is effective in decreasing the rate of anastomotic leakage after anterior resection using the double stapling technique. However, complications associated with a transanal tube should be carefully considered.
Background
Peritoneal recurrence (PR) of colorectal cancer is a poor prognostic factor but may be treatable by curative resection. We investigated the efficacy of this treatment and identified risk ...factors for postoperative recurrence.
Methods
The subjects were patients who underwent radical surgery for colorectal cancer between January 2006 and March 2014. Those with PR were retrospectively reviewed. Prognostic factors for overall survival (OS) and risk factors for postoperative recurrence were identified.
Results
Among 2256 patients, 66 had PR (2.9%). Surgical resection of PR was performed in 41 patients. Curative resection was achieved macroscopically in 38 cases without diffuse metastases in the peritoneum distant from the primary tumor and with a peritoneal cancer index < 10. In multivariate analysis, curative resection was a significant prognostic factor hazard ratio (HR) 0.198 for better 5-year OS compared with cases without curative resection (68.7% vs. 6.3%,
P
< 0.001). In 28 cases with concurrent metastasis, curative resection significantly improved 5-year OS compared with no curative resection (78.7% vs. 0%,
P
= 0.008). In the 38 patients with curative resection, the 3-year recurrence-free survival rate was 21.4%. In multivariate analysis, concurrent metastasis was a significant risk factor HR 3.394 for postoperative recurrence, and cases with concurrent metastasis more frequently had recurrence within 2 years after curative resection.
Conclusions
Curative resection improved the prognosis in patients with limited and resectable PR of colorectal cancer with or without concurrent metastasis. However, recurrence after curative resection was common and concurrent metastasis was a risk factor for this recurrence.
Purpose
Whether indocyanine green fluorescence angiography (ICG-FA) during rectal surgery is effective in reducing anastomotic leakage remains unclear. This study aimed to investigate the effect of ...intraoperative ICG-FA on anastomotic leakage after sphincter-sparing surgery for malignant rectal tumors.
Methods
This was a retrospective, single-center cohort study conducted on 852 consecutive patients who underwent laparoscopic sphincter-sparing surgery from January 2007 to June 2017 at our institution. The incidence of anastomotic leakage was compared between patients who underwent ICG-FA to determine the proximal resection margin and those in whom this technique was not performed, using logistic regression analysis, including propensity score.
Results
A total of eight patients were excluded (one patient with previous low anterior resection and seven patients who underwent simultaneous resection for other primary cancers), resulting in 844 patients being analyzed. Before propensity score matching, 141 patients (16.7%) who underwent ICG-FA were compared with 703 patients (83.3%) in whom ICG-FA was not performed. The incidence of anastomotic leakage was 2.8% (4/141) in the ICG-FA group and 12.4% (87/703) in the control group (
p
= 0.001). After propensity score matching (
n
= 420), the patient characteristics between the two groups were well balanced, and the incidence of anastomotic leakage was 2.8% (4/141) in the ICG-FA group and 13.6% (38/279) in the control group (
p
= 0.001). Logistic regression analyses using propensity score showed that patients who underwent ICG-FA had significantly lower odds of anastomotic leakage.
Conclusion
Intraoperative ICG-FA is a promising method to reduce anastomotic leakage after laparoscopic rectal surgery.
Background
Data regarding anastomotic leakage (AL) following intersphincteric resection (ISR) are lacking. We aimed to evaluate the effect of AL on anal function in a retrospective review of patients ...who developed AL following ISR.
Methods
We evaluated 341 consecutive patients who underwent ISR between 2000 and 2012. Patients were classified into three groups: anastomotic dehiscence (AD), major AL (Clavien–Dindo grade III+), or control (<grade III or no AL). Functional assessment was performed at 3, 6, 12, and 24 months after defecation through the preserved anus, and the Wexner score was calculated.
Results
Among patients who underwent ISR for low rectal cancer (anal verge, 3.7 ± 1.3 cm), 59 (17%) developed AL. Of these, 13 patients were classified as AD and 36 as major AL. The rate of the 3-year stomal reversal was significantly lower in the major AL (78.6%) and AD groups (61.5%) than in the control group (88.7%;
p
< 0.01). Furthermore, the anastomotic stricture rate was higher in the AL and AD groups than in the controls (16.7 and 38.5 vs. 1.8%, respectively;
p
< 0.01). Wexner scores in the major AL group were poor during the early period, but were similar to the control group at the 2-year follow-up. In contrast, Wexner scores in the AD group remained high, even after 2 years.
Conclusions
Patients with major AL following ISR had poor anal function that recovered over 2 years, as long as AD was not present. These findings suggest that patients with major AL require a long-term follow-up for anal function.
Neoadjuvant chemoradiotherapy is regarded as the standard of treatment for locally advanced lower rectal cancer, although some of these cases are systemic, and distant control may be inadequate. ...Neoadjuvant chemotherapy could compensate for such shortcomings, potentially yielding better survival outcomes. We aimed to stratify patients into prognostic groups on the basis of preoperative factors, including response to neoadjuvant chemotherapy.
We retrospectively analyzed patients with locally advanced lower rectal adenocarcinoma (clinical stage II/III with high-risk features of distant metastasis) who were treated with neoadjuvant chemotherapy (without radiotherapy) followed by curative resection between 2010 and 2017. Reduction in tumor volume (before vs. after neoadjuvant chemotherapy) was measured using magnetic resonance imaging, and a reduction above 60% was defined as a good response. Recurrence and overall survival were evaluated.
The cohort comprised 102 patients. Good response to neoadjuvant chemotherapy was associated with better 5-year recurrence-free survival (good responders: 81.1%, poor responders: 49.0%; p = 0.001) and 5-year overall survival (good responders: 94.9%, poor responders: 80.6%; p = 0.06). In a multivariate analysis, extramural venous invasion on magnetic resonance imaging after neoadjuvant chemotherapy and a tumor volume reduction rate < 60 were found to be significantly and independently associated with worse recurrence-free survival (hazard ratio: 2.74, 95% confidence interval: 1.36-5.50, p = 0.005 and hazard ratio: 3.48, 95% confidence interval: 1.57-7.72, p = 0.002, respectively). Good responders without extramural venous invasion had the best 5-year recurrence-free and overall survival (89.0 and 93.8%, respectively). Poor responders with extramural venous invasion had the worst 5-year recurrence-free and overall survival (21.4 and 50.0%, respectively).
Reductions in tumor volume after neoadjuvant chemotherapy were associated with a better prognosis in patients with locally advanced lower rectal cancer. Extramural venous invasion was a preoperative prognostic factor.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
Few reports have evaluated the long-term outcomes of pathological T1 (pT1) lower rectal cancer (LRC), perhaps because pT1 LRC is classified as TNM stage I if lymph node metastasis (LNM) is ...absent and stage IIIA if LNM is present. Moreover, it is difficult to diagnose regional LNM preoperatively. This study aimed to clarify the long-term outcomes of radical surgery for pT1 LRC and risk factor(s) for LNM. Additionally, we examined whether preoperative computed tomography (CT) and magnetic resonance imaging (MRI) findings were predictive of LNM in pT1 LRC.
Methods
This was a retrospective analysis of the clinical characteristics, short-term operative outcomes, and long-term survival rates of 155 patients who received radical surgery and were diagnosed with pT1 LRC at our hospital between January 1993 and February 2017.
Results
Among patients with pT1 LRC, 5-year recurrence-free and overall survival rates were 94.0% and 95.8%, respectively. LNM status was not associated with statistically significant differences in recurrence-free or overall survival. Even in patients with LNM, the recurrence rate was only 9%. Among patients who lacked visible mesorectal lymph nodes on preoperative CT and MRI, LNM rates were 3.5% and 4.3%, respectively.
Conclusion
The long-term outcomes after radical surgery for pT1 LRC are satisfactory or good, regardless of the presence or absence of LNM. In patients with pT1 LRC, the absence of visible mesorectal lymph nodes on preoperative CT and MRI is associated with a reduced likelihood of LNM and has a high negative predictive value for LNM.
Aim
Transanal total mesorectal excision (TaTME) is expected to improve the quality of total mesorectal excision as well as preserve urinary function. We aimed to study the frequency and risk factors ...of urinary dysfunction in rectal cancer patients after TaTME. Moreover, we analysed the association between urinary function and resected pattern of the autonomic nerve system (ANS) in TaTME.
Method
We retrospectively analysed 231 patients who underwent TaTME at our hospital from 2013 to 2018. Independent risk factors for urinary dysfunction were assessed by multivariate analysis. Urinary dysfunction was defined as a condition that requires urethral catheterisation. We intraoperatively judged and classified the preserved or resected pattern of ANS into four categories.
Results
The rate of urinary dysfunction after TaTME was 12.1% at discharge. Multivariate analysis revealed that beyond TME and ANS resection were the two major independent risk factors for urinary dysfunction. Total ANS preservation had reduced rates of urinary dysfunction, and all patients were free from catheterisation 6 months post‐surgery. There was a higher rate of urinary dysfunction in total ANS resection than in partial ANS resection at 6 months post‐surgery.
Conclusion
This study showed that urinary function after TaTME was associated with resection of the ANS. Furthermore, the rate of urinary dysfunction and recovery time were closely related to the pattern of ANS resection.
Purpose
In abdominoperineal excision (APE), the advantages of the “down-to-up” approach are expected to be more obvious when performed as a two-team approach, including transperineal minimally ...invasive surgery (TpMIS). We investigated the efficacy of TpMIS with laparoscopic APE for lower rectal cancer.
Methods
Patients who underwent laparoscopic APE with (
n
= 20) or without (
n
= 30) TpMIS between December 2013 and April 2020 were retrospectively reviewed. Patient and tumor characteristics, intraoperative outcome, short-term outcome, and pathological findings were compared. Additional subgroup analyses were performed in technically challenging cases, including male patients, obese patients, and patients with tumors located at the anterior wall.
Results
There was no marked difference in the patient or tumor characteristics or short-term outcomes, including morbidity and mortality between the two groups. Pathological results were comparable, and the circumferential resection margin (CRM) positive rate was 10% in both groups. TpMIS achieved a significant reduction in operative time (
p
= 0.02). In a subgroup analysis, the amount of blood loss was also smaller in males (
p
= 0.02) and patients with a high BMI (> 25) (
p
= 0.005) than in others.
Conclusion
Simultaneously performing TpMIS and laparoscopic APE is feasible owing to the favorable complication and CRM-positive rates. In terms of operative time and blood loss, TpMIS is expected to be advantageous in both easy and challenging cases.
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