J S Williamson, A J Quyn, P M Sagar
BACKGROUND: The management of lateral pelvic lymphadenopathy in low rectal cancer poses an oncological and technical challenge. Interpretation of the literature is confounded by different approaches to management in the East and West, and a lack of randomized data from which to draw accurate conclusions regarding the optimal approach. Recent collaboration between Eastern and Western centres has increased the standardization of care. Despite this, significant differences in international guidelines remain...
November 2020: British Journal of Surgery
Nathan J Curtis, Jake D Foster, Danilo Miskovic, Chris S B Brown, Peter J Hewett, Sarah Abbott, George B Hanna, Andrew R L Stevenson, Nader K Francis
IMPORTANCE: Complex surgical interventions are inherently prone to variation yet they are not objectively measured. The reasons for outcome differences following cancer surgery are unclear. OBJECTIVE: To quantify surgical skill within advanced laparoscopic procedures and its association with histopathological and clinical outcomes. DESIGN, SETTING, AND PARTICIPANTS: This analysis of data and video from the Australasian Laparoscopic Cancer of Rectum (ALaCaRT) and 2-dimensional/3-dimensional (2D3D) multicenter randomized laparoscopic total mesorectal excision trials, which were conducted at 28 centers in Australia, the United Kingdom, and New Zealand, was performed from 2018 to 2019 and included 176 patients with clinical T1 to T3 rectal adenocarcinoma 15 cm or less from the anal verge...
July 1, 2020: JAMA Surgery
Wang Qiaoli, Huang Yongping, Xiong Wei, Xu Guoqiang, Ju Yunhe, Liu Qiuyan, Li Cheng, Guo Mengling, Li Jiayi, Xiong Wei, Yang Yi
PURPOSE: Preoperative short-course radiotherapy (PSRT) and preoperative long-course radiotherapy (PLRT) are standard treatment regimens for locally advanced rectal cancer. However, whether the efficacy and safety of PSRT with delayed surgery (more than 4 weeks) are superior to those of PLRT remains unresolved and was explored in this meta-analysis. METHODS: Studies published in PubMed, Embase, the Cochrane Library, and databases were systematically searched...
December 2019: International Journal of Colorectal Disease
Xiangbing Deng, Ping Liu, Dan Jiang, Mingtian Wei, Xin Wang, Xuyang Yang, Yuanchuan Zhang, Bing Wu, Yanjun Liu, Meng Qiu, Hua Zhuang, Zongguang Zhou, Yunfeng Li, Feng Xu, Ziqiang Wang
OBJECTIVE: The aim of this study was to compare stage II/III rectal cancers with or without high-risk factors, and evaluate the effect of neoadjuvant radiotherapy (NRT) in these 2 cohorts. BACKGROUND: NRT is often used in stage II/III rectal cancers to improve local control, while not affecting overall survival. However, good-quality surgery without NRT may also achieve good local control in selected patients. METHODS: According to risk-stratification criteria and clinical staging, consecutive eligible participants of stage II/III rectal cancer were preoperatively classified into patients with (high-risk) or without (low-risk) high-risk factors...
December 2020: Annals of Surgery
Rodney E Wegner, Shaakir Hasan, Paul B Renz, Moses S Raj, Dulabh K Monga, Gene G Finley, Alexander V Kirichenko, James T McCormick
BACKGROUND: Surgery remains the standard of care in rectal cancer. Select patients will not undergo surgery for reasons such as medical inoperability or a watch-and-wait approach and instead are managed with definitive chemoradiation. OBJECTIVE: We used the National Cancer Database to identify overall survival and predictors thereof in the nonoperative management of patients with rectal cancer. DESIGN: This was a retrospective review. SETTINGS: This study used deidentified data from the National Cancer Database...
November 2019: Diseases of the Colon and Rectum
Tenghui Ma, Qinghua Zhong, Wuteng Cao, Qiyuan Qin, Xiaochun Meng, HuaiMing Wang, Jianping Wang, Lei Wang
BACKGROUND: We demonstrated previously that radiation proctitis induced by preoperative radiotherapy is a predisposing factor for clinical anastomotic leakage in patients undergoing rectal cancer resection. Quantitative measurement of radiation proctitis is needed. OBJECTIVE: This study aimed to quantitate the changes of anatomic features caused by preoperative radiotherapy for rectal cancer and evaluate its ability to predict leakage. DESIGN: It was a secondary analysis of a randomized controlled trial (NCT01211210)...
November 2019: Diseases of the Colon and Rectum
É J Ryan, D P O'Sullivan, M E Kelly, A Z Syed, P C Neary, P R O'Connell, D O Kavanagh, D C Winter, J M O'Riordan
BACKGROUND: The current standard of care in locally advanced rectal cancer (LARC) is neoadjuvant long-course chemoradiotherapy (nCRT) followed by total mesorectal excision (TME). Surgery is conventionally performed approximately 6-8 weeks after nCRT. This study aimed to determine the effect on outcomes of extending this interval. METHODS: A systematic search was performed for studies reporting oncological results that compared the classical interval (less than 8 weeks) from the end of nCRT to TME with a minimum 8-week interval in patients with LARC...
September 2019: British Journal of Surgery
U O Gustafsson, M J Scott, M Hubner, J Nygren, N Demartines, N Francis, T A Rockall, T M Young-Fadok, A G Hill, M Soop, H D de Boer, R D Urman, G J Chang, A Fichera, H Kessler, F Grass, E E Whang, W J Fawcett, F Carli, D N Lobo, K E Rollins, A Balfour, G Baldini, B Riedel, O Ljungqvist
BACKGROUND: This is the fourth updated Enhanced Recovery After Surgery (ERAS® ) Society guideline presenting a consensus for optimal perioperative care in colorectal surgery and providing graded recommendations for each ERAS item within the ERAS® protocol. METHODS: A wide database search on English literature publications was performed. Studies on each item within the protocol were selected with particular attention paid to meta-analyses, randomised controlled trials and large prospective cohorts and examined, reviewed and graded according to Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system...
November 13, 2018: World Journal of Surgery
Constantinos Simillis, Nikhil Lal, Sarah N Thoukididou, Christos Kontovounisios, Jason J Smith, Roel Hompes, Michel Adamina, Paris P Tekkis
OBJECTIVE: To compare techniques for rectal cancer resection. SUMMARY BACKGROUND DATA: Different surgical approaches exist for mesorectal excision. METHODS: Systematic literature review and Bayesian network meta-analysis performed. RESULTS: Twenty-nine randomized controlled trials included, reporting on 6237 participants, comparing: open versus laparoscopic versus robotic versus transanal mesorectal excision. No significant differences identified between treatments in intraoperative morbidity, conversion rate, grade III/IV morbidity, reoperation, anastomotic leak, nodes retrieved, involved distal margin, 5-year overall survival, and locoregional recurrence...
July 2019: Annals of Surgery
Elena Orsenigo, Giulia Gasparini, Michele Carlucci
Many colorectal resections do not meet the minimum of 12 lymph nodes (LNs) recommended by the American Joint Committee on Cancer for accurate staging of colorectal cancer. The aim of this study was to investigate factors affecting the number of the adequate nodal yield in colorectal specimens subject to routine pathological assessment. We have retrospectively analysed the data of 2319 curatively resected colorectal cancer patients in San Raffaele Scientific Institute, Milan, between 1993 and 2017 (1259 colon cancer patients and 675 rectal cancer patients plus 385 rectal cancer patients who underwent neoadjuvant therapy)...
2019: Gastroenterology Research and Practice
Robert K Cleary, Arden M Morris, George J Chang, Amy L Halverson
BACKGROUND: Compared with open surgery, minimally invasive surgery for colon cancer has been shown to improve short-term outcomes and yield equivalent long-term oncologic results. It remains to be seen if oncologic outcomes for the minimally invasive approach for rectal cancer are equivalent to traditional open rectal resection. METHODS: We conducted a systematic review of Medline, SCOPUS, and Cochrane databases. Relevant studies were selected using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines...
November 2018: Annals of Surgical Oncology
Teresa Draeger, Vinzenz Völkel, Valentin Schnitzbauer, Michael Gerken, Stefan Benz, Monika Klinkhammer-Schalke, Alois Fürst
INTRODUCTION: Rectal cancer is a frequently diagnosed tumor worldwide. Various studies have shown the noninferiority or even slight superiority of laparoscopic resection. However, there is no clear recommendation on whether age should influence the choice of surgical approach. MATERIALS AND METHODS: This study compared outcomes of laparoscopic and open surgery in rectal cancer patients. Perioperative mortality and 5-year overall, relative, and recurrence-free survival rates were analyzed separately for three age groups...
May 2019: International Journal of Colorectal Disease
Xubing Zhang, Qingbin Wu, Chaoyang Gu, Tao Hu, Liang Bi, Ziqiang Wang
PURPOSES: This study aimed to explore the effect of increased body mass index (BMI) values (overweight: BMI ≥ 25-30 kg/m2 ; obese: BMI ≥ 30 kg/m2 ) on surgical outcomes after radical resection for low rectal cancer (LRC). METHODS: Patients with LRC who underwent radical surgery from January 2009 to December 2013 were included. The patients were divided into three groups according to their BMI values (control group: BMI < 25 kg/m2 ; overweight group: BMI 25 to < 30 kg/m2 ; obese group: BMI ≥ 30 kg/m2 )...
May 2019: Surgery Today
Alexis G Antunez, Arielle E Kanters, Scott E Regenbogen
Importance: The American College of Surgeons National Accreditation Program for Rectal Cancer (NAPRC) promotes multidisciplinary care to improve oncologic outcomes in rectal cancer. However, accreditation requirements may be difficult to achieve for the lowest-performing institutions. Thus, it is unknown whether the NAPRC will motivate care improvement in these settings or widen disparities. Objectives: To characterize hospitals' readiness for accreditation and identify differences in the patients cared for in hospitals most and least prepared for accreditation...
June 1, 2019: JAMA Surgery
Lv-Jia Cheng, Jian-Hui Chen, Song-Yao Chen, Zhe-Wei Wei, Long Yu, Shao-Pu Han, Yu-Long He, Zi-Hao Wu, Chuang-Qi Chen
BACKGROUND: Rectal cancers have long been treated as a single-entity disease; however, whether the prognosis of high rectal cancer (inferior margin located 10.1 to 15.0 cm from the anal verge) differs from that of mid/low rectal cancer (0 to 10.0 cm) remains disputed. METHODS: Patients with stages I-III rectal adenocarcinomas undergoing curative-intent surgery were enrolled between 2007 and 2013 in this retrospective analysis. Exclusion criteria were neoadjuvant therapy or concurrent cancers...
July 2019: Journal of Gastrointestinal Surgery
Katie E Rollins, Hannah Javanmard-Emamghissi, Austin G Acheson, Dileep N Lobo
OBJECTIVES: To compare the impact of the use of oral antibiotics (OAB) with or without mechanical bowel preparation (MBP) on outcome in elective colorectal surgery. SUMMARY BACKGROUND DATA: Meta-analyses have demonstrated that MBP does not impact upon postoperative morbidity or mortality, and as such it should not be prescribed routinely. However, recent evidence from large retrospective cohort and database studies has suggested that there may be a role for combined OAB and MBP, or OAB alone in the prevention of surgical site infection (SSI)...
July 2019: Annals of Surgery
Rutger C H Stijns, Eelco J R de Graaf, Cornelis J A Punt, Iris D Nagtegaal, Joost J M E Nuyttens, Esther van Meerten, Pieter J Tanis, Ignace H J T de Hingh, George P van der Schelling, Yair Acherman, Jeroen W A Leijtens, Andreas J A Bremers, Geerard L Beets, Christiaan Hoff, Cornelis Verhoef, Corrie A M Marijnen, Johannes H W de Wilt
IMPORTANCE: Treatment of rectal cancer is shifting toward organ preservation aiming to reduce surgery-related morbidity. Short-term outcomes of organ-preserving strategies are promising, but long-term outcomes are scarce in the literature. OBJECTIVE: To explore long-term oncological outcomes and health-related quality of life (HRQL) in patients with cT1-3N0M0 rectal cancer who underwent neoadjuvant chemoradiotherapy (CRT) followed by transanal endoscopic microsurgery (TEM)...
January 1, 2019: JAMA Surgery
A M Mehta, G Hellawell, D Burling, S Littler, A Antoniou, J T Jenkins
BACKGROUND: Complete pathological resection of locally advanced and recurrent anorectal cancer is considered the most important determinant of survival outcome. Involvement of the retropubic space with cancer threatening or involving the penile base poses specific challenges due to the potential for margin involvement and blood loss from the dorsal venous plexus. In the present study we evaluate a new transperineal surgical approach to excision of anterior compartment organs involved or threatened by cancer which facilitates exposure and visualisation of the bulbar urethra and the deep vein of the penis caudal to the retropubic space and penile base...
September 2018: Techniques in Coloproctology
Ilya M Danelich, John R Bergquist, Whitney J Bergquist, Jennifer L Osborn, Sampaguita S Wright, Brittany J Tefft, Ashley W Sturm, Diana R Langworthy, Jay Mandrekar, Richard M Devine, Scott R Kelley, Kellie L Mathis, John H Pemberton, Adam K Jacob, David W Larson
BACKGROUND: Excessive perioperative fluid administration likely increases postoperative cardiovascular, infectious, and GI complications. Early administration of diuretics after elective surgery facilitates rapid mobilization of excess fluid, potentially leading to decreased bowel edema, more rapid return of bowel function, and reduced length of hospital stay. OBJECTIVE: This study aimed to evaluate the benefit of early diuresis after elective colon and rectal surgery in the setting of an enhanced recovery after surgery practice...
October 2018: Diseases of the Colon and Rectum
Michele Pisano, Luigi Zorcolo, Cecilia Merli, Stefania Cimbanassi, Elia Poiasina, Marco Ceresoli, Ferdinando Agresta, Niccolò Allievi, Giovanni Bellanova, Federico Coccolini, Claudio Coy, Paola Fugazzola, Carlos Augusto Martinez, Giulia Montori, Ciro Paolillo, Thiago Josè Penachim, Bruno Pereira, Tarcisio Reis, Angelo Restivo, Joao Rezende-Neto, Massimo Sartelli, Massimo Valentino, Fikri M Abu-Zidan, Itamar Ashkenazi, Miklosh Bala, Osvaldo Chiara, Nicola De' Angelis, Simona Deidda, Belinda De Simone, Salomone Di Saverio, Elena Finotti, Inaba Kenji, Ernest Moore, Steven Wexner, Walter Biffl, Raul Coimbra, Angelo Guttadauro, Ari Leppäniemi, Ron Maier, Stefano Magnone, Alain Chicom Mefire, Andrew Peitzmann, Boris Sakakushev, Michael Sugrue, Pierluigi Viale, Dieter Weber, Jeffry Kashuk, Gustavo P Fraga, Ioran Kluger, Fausto Catena, Luca Ansaloni
ᅟ: Obstruction and perforation due to colorectal cancer represent challenging matters in terms of diagnosis, life-saving strategies, obstruction resolution and oncologic challenge. The aims of the current paper are to update the previous WSES guidelines for the management of large bowel perforation and obstructive left colon carcinoma (OLCC) and to develop new guidelines on obstructive right colon carcinoma (ORCC). METHODS: The literature was extensively queried for focused publication until December 2017...
2018: World Journal of Emergency Surgery: WJES
2018-09-03 12:47:33
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