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Rectal cancer

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By Christian Zalai Colorectal surgeon based in Montreal
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: Official Journal of the Society for Surgery of the Alimentary Tract
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
Jinshui Zeng, Guoqiang Su
BACKGROUND: The ideal level of ligation of the inferior mesenteric artery (IMA) during curative resection of sigmoid colon and rectal cancer is still controversial. The aim of this meta-analysis was to examine the impact of high ligation and low ligation of the IMA on anastomotic leakage, overall morbidity, postoperative mortality, and oncological outcomes in patients undergoing surgery for sigmoid colon and rectal cancer. METHODS: PubMed, EMBASE, Web of Science, and BioMed Central databases were searched to identify relevant articles published from May 1953 to March 2018...
August 2, 2018: World Journal of Surgical Oncology
Jeroen W A Leijtens, Thomas W A Koedam, Wernard A A Borstlap, Monique Maas, Pascal G Doornebosch, Tom M Karsten, Eric J Derksen, Laurents P S Stassen, Camiel Rosman, Eelco J R de Graaf, André J A Bremers, Jeroen Heemskerk, Geerard L Beets, Jurriaan B Tuynman, Kevin L J Rademakers
AIM: Transanal endoscopic microsurgery (TEM) is used for the resection of large rectal adenomas and well or moderately differentiated T1 carcinomas. Due to difficulty in preoperative staging, final pathology may reveal a carcinoma not suitable for TEM. Although completion total mesorectal excision is considered standard of care in T2 or more invasive carcinomas, this completion surgery is not always performed. The purpose of this article is to evaluate the outcome of patients after TEM-only, when completion surgery would be indicated...
2019: Digestive Surgery
Heidi K Chua, Karl Sondenaa, Gregory G Tsiotos, Dirk R Larson, Bruce G Wolff, David M Nagorney
PURPOSE: Resection of hepatic metastases is the preferred treatment for selected patients after resection of primary colorectal carcinoma, but timing is controversial. This study was designed to compare outcomes of patients receiving concurrent resection of hepatic metastases and the primary colorectal tumor with those of patients receiving staged resection (within 6 months). METHODS: We retrospectively analyzed medical records (1986-1999) of 96 consecutive patients with synchronously recognized primary carcinoma and hepatic metastases who underwent concurrent (64 patients) or staged (32 patients) colonic and hepatic resections performed at our institution...
August 2004: Diseases of the Colon and Rectum
Cloë L Sparreboom, Zhouqiao Wu, Hester F Lingsma, Anand G Menon, Gert-Jan Kleinrensink, Joost J Nuyttens, Michel Wjm Wouters, Johan F Lange
BACKGROUND: Short-course preoperative radiotherapy is indicated in patients with resectable rectal cancer to control local recurrence. Although no clear evidence is available, short-course radiotherapy with operation within a week is common practice. The aim of this study was to investigate the impact of timing of operation for rectal cancer after short-course radiotherapy on anastomotic leakage. STUDY DESIGN: Data from the Dutch Colorectal Audit were used. All patients who received short-course preoperative radiotherapy and underwent elective operation within 14 days for rectal cancer between January 1, 2011 and December 31, 2016 were included...
August 2018: Journal of the American College of Surgeons
Marco Ettore Allaix, Edgar Furnée, Laura Esposito, Massimiliano Mistrangelo, Fabrizio Rebecchi, Alberto Arezzo, Mario Morino
BACKGROUND: Laparoscopic rectal resection (LRR) for cancer is a challenging procedure, with conversion to open surgery being reported in up to 30% of cases. Since only a few studies with short follow-up have compared converted LRR and open RR (ORR), it is unclear if conversion to open surgery should be prevented by preferring an open approach in those patients with preoperatively known risk factors for conversion. The aim of this study was to compare early postoperative outcomes and long-term survival after completed LRR, converted LRR or ORR for non-metastatic rectal cancer...
October 2018: World Journal of Surgery
Teresa Draeger, Vinzenz Völkel, Michael Gerken, Monika Klinkhammer-Schalke, Alois Fürst
BACKGROUND: An increasing number of rectal carcinoma resections in Germany and worldwide are performed laparoscopically. The recently published COLOR II trial demonstrated the oncologic safety of this surgical approach. It remains unclear whether these findings can be transferred to clinical practice. PATIENTS AND METHODS: This population-based retrospective cohort study aimed to evaluate 5-year overall, relative, disease-free, and local recurrence-free survival of rectal cancer patients treated by open surgery and laparoscopy...
October 2018: Surgical Endoscopy
2018-04-09 10:08:04
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