Medicine › Oncology

Colorectal Cancer Surgical Treatments

Works Count: 76137

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Description

This cluster of papers represents advancements in the research and treatment of colorectal cancer, focusing on topics such as preoperative and postoperative therapies, laparoscopic surgery, tumor markers, neoadjuvant therapy, and clinical practice guidelines. It covers a wide range of studies related to treatment strategies, surgical techniques, adjuvant therapies, and prognostic factors for colorectal cancer patients.

Keywords

Preoperative Chemoradiotherapy; Rectal Cancer; Adjuvant Chemotherapy; Laparoscopic Surgery; Tumor Markers; Total Mesorectal Excision; Neoadjuvant Therapy; Pathological Response; Anastomotic Leakage; Clinical Practice Guidelines

Minimally invasive colon resection (laparoscopic colectomy).

1991-09-01

Moisés Jacobs , Juan-Carlos Verdeja , Harold S. Goldstein

The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of … The successful application of laparoscopic surgery to gallbladder disease and acute appendicitis has encouraged clinical investigators to develop this technology further in an attempt to manage other pathologic disorders of the gastrointestinal (GI) tract. After gaining experience with various laparoscopic skills while performing clinical biliary tract surgery, appendectomy and then in a controlled animal laboratory, a pilot program for laparoscopic colonic surgery was initiated. Twenty patients with ages ranging from 43 to 88 years (mean age of 57 years) underwent laparoscope-assisted colon resection. In nine patients, a right hemicolectomy was performed and a sigmoid colectomy in eight. A low anterior resection, Hartman's procedure, and abdominal perineal resection were each performed in one patient. Indications for surgery were large villous adenomas or adenocarcinoma in 12, diverticular disease in 5, sigmoid endometrioma in 1, cecal volvulus in 1, and inflammatory bowel disease in 1. Eighty percent of patients were able to tolerate a liquid diet on the first postoperative day and 70% were discharged within 96 h eating a regular diet and having normal bowel movements. There were three operative complications: a 3 unit postoperative bleed managed without surgery, one patient developed marked edema of the rectosigmoid anastomosis requiring decompression with a rectal tube, and one individual with metastatic colon cancer was operated on for a mechanical small bowel obstruction 7 days after the initial laparoscopic surgery. Although laparoscope-assisted colonic surgery may still be considered a procedure in evolution, we feel that in time it has the potential to be as popular as laparoscopic cholecystectomy.

Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial

2005-06-22

Ruben Veldkamp , Esther Kuhry , Wim C.J. Hop +7 more

Improved Survival with Preoperative Radiotherapy in Resectable Rectal Cancer

1997-04-03

Swedish Rectal Cancer Trial

Adjuvant radiotherapy for rectal cancer has been extensively studied, but no trial has unequivocally demonstrated improved overall survival with radiotherapy, despite a reduction in the rate of local recurrence. Adjuvant radiotherapy for rectal cancer has been extensively studied, but no trial has unequivocally demonstrated improved overall survival with radiotherapy, despite a reduction in the rate of local recurrence.

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LOCAL RECURRENCE OF RECTAL ADENOCARCINOMA DUE TO INADEQUATE SURGICAL RESECTION

1986-11-01

Philip Quirke , Michael F. Dixon , P. Durdey +1 more

Effective Surgical Adjuvant Therapy for High-Risk Rectal Carcinoma

1991-03-14

James E. Krook , C G Moertel , Leonard L. Gunderson +7 more

Radiation therapy as an adjunct to surgery for rectal cancer has been shown to reduce local recurrence but has not improved survival. In a previous study, combined radiation and chemotherapy … Radiation therapy as an adjunct to surgery for rectal cancer has been shown to reduce local recurrence but has not improved survival. In a previous study, combined radiation and chemotherapy improved survival significantly as compared with surgery alone, but not as compared with adjuvant radiation, which many regard as standard therapy. We designed a combination regimen to optimize the contribution of chemotherapy, decrease recurrence, and improve survival as compared with adjuvant radiation alone.Two hundred four patients with rectal carcinoma that was either deeply invasive or metastatic to regional lymph nodes were randomly assigned to postoperative radiation alone (4500 to 5040 cGy) or to radiation plus fluorouracil, which was both preceded and followed by a cycle of systemic therapy with fluorouracil plus semustine (methyl-CCNU).After a median follow-up of more than seven years, the combined therapy had reduced the recurrence of rectal cancer by 34 percent (P = 0.0016; 95 percent confidence interval, 12 to 50 percent). Initial local recurrence was reduced by 46 percent (P = 0.036; 95 percent confidence interval, 2 to 70 percent), and distant metastasis by 37 percent (P = 0.011; 95 percent confidence interval, 9 to 57 percent). In addition, combined therapy reduced the rate of cancer-related deaths by 36 percent (P = 0.0071; 95 percent confidence interval, 14 to 53 percent) and the overall death rate by 29 percent (P = 0.025; 95 percent confidence interval, 7 to 45 percent). Its acute toxic effects included nausea, vomiting, diarrhea, leukopenia, and thrombocytopenia. These effects were seldom severe. Severe, delayed treatment-related reactions, usually small-bowel obstruction requiring surgery, occurred in 6.7 percent of all patients receiving radiation, and the frequencies of these complications were comparable in both treatment groups.The combination of postoperative local therapy with radiation plus fluorouracil and systemic therapy with a fluorouracil-based regimen significantly and substantively improves the results of therapy for rectal carcinoma with a poor prognosis, as compared with postoperative radiation alone.

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RECURRENCE AND SURVIVAL AFTER TOTAL MESORECTAL EXCISION FOR RECTAL CANCER

1986-06-01

Richard J. Heald , R. D. H. Ryall

Standardized surgery for colonic cancer: complete mesocolic excision and central ligation – technical notes and outcome

2008-11-06

Werner Hohenberger , Klaus Weber , Klaus E. Matzel +2 more

Total mesorectal excision (TME) as proposed by R.J. Heald more than 20 years ago, is nowadays accepted worldwide for optimal rectal cancer surgery. This technique is focused on an intact … Total mesorectal excision (TME) as proposed by R.J. Heald more than 20 years ago, is nowadays accepted worldwide for optimal rectal cancer surgery. This technique is focused on an intact package of the tumour and its main lymphatic drainage. This concept can be translated into colon cancer surgery, as the mesorectum is only part of the mesenteric planes which cover the colon and its lymphatic drainage like envelopes. According to the concept of TME for rectal cancer, we perform a concept of complete mesocolic excision (CME) for colonic cancer. This technique aims at the separation of the mesocolic from the parietal plane and true central ligation of the supplying arteries and draining veins right at their roots.Prospectively obtained data from 1329 consecutive patients of our department with RO-resection of colon cancer between 1978 and 2002 were analysed. Patient data of three subdivided time periods were compared.By consequent application of the procedure of CME, we were able to reduce local 5-year recurrence rates in colon cancer from 6.5% in the period from 1978 to 1984 to 3.6% in 1995 to 2002. In the same period, the cancer related 5-year survival rates in patients resected for cure increased from 82.1% to 89.1%.The technique of CME in colon cancer surgery aims at a specimen with intact layers and a maximum of lymphnode harvest. This is translated into lower local recurrence rates and better overall survival.

Role of circumferential margin involvement in the local recurrence of rectal cancer

1994-09-01

I. J. Adam , I.G Martin , Pj Finan +5 more

Lymph Node Evaluation and Survival After Curative Resection of Colon Cancer: Systematic Review

2007-03-20

G. J. Chang , Miguel A. Rodrı́guez-Bigas , J. M. Skibber +1 more

BackgroundAdequate lymph node evaluation for cancer involvement is important for prognosis and treatment of patients with colon cancer. The number of lymph nodes evaluated may be a measure of quality … BackgroundAdequate lymph node evaluation for cancer involvement is important for prognosis and treatment of patients with colon cancer. The number of lymph nodes evaluated may be a measure of quality in colon cancer care and appears to be inadequate in most patients treated for colon cancer. We performed a systematic review of the evidence for the association between lymph node evaluation and oncologic outcomes in patients with colon cancer.

The mesorectum in rectal cancer surgery—the clue to pelvic recurrence?

1982-10-01

Richard J. Heald , E M Husband , R. D. H. Ryall

Abstract Five cases are described where minute foci of adenocarcinoma have been demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer. In 2 … Abstract Five cases are described where minute foci of adenocarcinoma have been demonstrated in the mesorectum several centimetres distal to the apparent lower edge of a rectal cancer. In 2 of these there was no other evidence of lymphatic spread of the tumour. In orthodox anterior resection much of this tissue remains in the pelvis, and it is suggested that these foci might lead to suture-line or pelvic recurrence. Total excision of the mesorectum has, therefore, been carried out as a part of over 100 consecutive anterior resections. Fifty of these, which were classified as ‘curative’ or ‘conceivably curative’ operations, have now been followed for over 2 years with no pelvic or staple-line recurrence.

A Randomized Trial of Laparoscopic versus Open Surgery for Rectal Cancer

2015-04-02

H. Jaap Bonjer , Charlotte L. Deijen , Gabor A. Abis +7 more

Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was … Laparoscopic resection of colorectal cancer is widely used. However, robust evidence to conclude that laparoscopic surgery and open surgery have similar outcomes in rectal cancer is lacking. A trial was designed to compare 3-year rates of cancer recurrence in the pelvic or perineal area (locoregional recurrence) and survival after laparoscopic and open resection of rectal cancer.

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Definition and grading of anastomotic leakage following anterior resection of the rectum: A proposal by the International Study Group of Rectal Cancer

2009-12-12

Nuh N. Rahbari , Jürgen Weitz , Werner Hohenberger +7 more

Laparoscopic Colectomy for Cancer Is Not Inferior to Open Surgery Based on 5-Year Data From the COST Study Group Trial

2007-09-19

James W. Fleshman , Daniel J. Sargent , Erin Green +7 more

In Brief Purpose: Oncologic concerns from high wound recurrence rates prompted a multi-institutional randomized trial to test the hypothesis that disease-free and overall survival are equivalent, regardless of whether patients … In Brief Purpose: Oncologic concerns from high wound recurrence rates prompted a multi-institutional randomized trial to test the hypothesis that disease-free and overall survival are equivalent, regardless of whether patients receive laparoscopic-assisted or open colectomy. Methods: Eight hundred seventy-two patients with curable colon cancer were randomly assigned to undergo laparoscopic-assisted or open colectomy at 1 of 48 institutions by 1 of 66 credentialed surgeons. Patients were followed for 8 years, with 5-year data on 90% of patients. The primary end point was time to recurrence, tested using a noninferiority trial design. Secondary endpoints included overall survival and disease-free survival. (Kaplan–Meier) Results: As of March 1, 2007, 170 patients have recurred and 252 have died. Patients have been followed a median of 7 years (range 5–10 years). Disease-free 5-year survival (Open 68.4%, Laparoscopic 69.2%, P = 0.94) and overall 5-year survival (Open 74.6%, Laparoscopic 76.4%, P = 0.93) are similar for the 2 groups. Overall recurrence rates were similar for the 2 groups (Open 21.8%, Laparoscopic 19.4%, P = 0.25). These recurrences were distributed similarly between the 2 treatment groups. Sites of first recurrence were distributed similarly between the treatment arms (Open: wound 0.5%, liver 5.8%, lung 4.6%, other 8.4%; Laparoscopic: wound 0.9%, liver 5.5%, lung 4.6%, other 6.1%). Conclusion: Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on long-term oncologic endpoints from a prospective randomized trial. A multicenter prospective trial of 872 patients randomly assigned to undergo laparoscopic or open colectomy for curable cancer was performed. Laparoscopic colectomy for curable colon cancer is not inferior to open surgery based on 5-year overall survival, disease-free survival, and overall and site-specific rates of recurrence.

Defunctioning Stoma Reduces Symptomatic Anastomotic Leakage After Low Anterior Resection of the Rectum for Cancer

2007-07-23

Peter Matthiessen , Olof Hallböök , Martin Rutegård +2 more

The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were … The aim of this randomized multicenter trial was to assess the rate of symptomatic anastomotic leakage in patients operated on with low anterior resection for rectal cancer and who were intraoperatively randomized to a defunctioning stoma or not.

IIeal Pouch-Anal Anastomoses Complications and Function in 1005 Patients

1995-08-01

Victor W. Fazio , Yehiel Ziv , James M. Church +4 more

Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become an established surgery for patients with chronic ulcerative colitis and familial adenomatous polyposis.The authors report the results of an 11-year experience … Restorative proctocolectomy and ileal pouch-anal anastomosis (IPAA) has become an established surgery for patients with chronic ulcerative colitis and familial adenomatous polyposis.The authors report the results of an 11-year experience of restorative proctocolectomy and IPAA at a tertiary referral center.Chart review was performed for 1005 patients undergoing IPAA from 1983 through 1993. Preoperative histopathologic diagnoses were ulcerative colitis (n = 858), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 75), and miscellaneous (n = 10). Information was obtained regarding patient demographics, type and duration of diseases, previous operations, and indications for surgery. Data were collected on surgical procedure and postoperative pathologic diagnosis. Early (within 30 days after surgery) and late complications were noted. Follow-up included an annual function and quality-of-life questionnaire, physical examination, and biopsies of the pouch and anal transitional zone.Of the 1005 patients (455 women), postoperative histopathologic diagnoses were as follows: ulcerative colitis (n = 812), familial adenomatous polyposis (n = 62), indeterminate colitis (n = 54), Crohn's disease (n = 67), and miscellaneous (n = 10). During a mean follow-up time of 35 months (range 1-125 months), histopathologic diagnoses were changed for 25 patients. The overall mortality rate was 1% (n = 10 patients, early = 4, late = 6); one death (0.1%) was related to pouch necrosis and sepsis. The overall morbidity rate was 62.7% (1218 complications in 630 patients; early, n = 27.5%; late, n = 50.5%). Septic complication and reoperation rates were 6.8% and 24%, respectively. The ileal pouch was removed in 34 patients (3.4%), and it is nonfunctional in 11 (1%). Functional results and quality of life were good to excellent in 93% of the patients with complete data (n = 645) and are similar for patients with ulcerative colitis, familial adenomatous polyposis, indeterminate colitis, and Crohn's disease. Patients who underwent operations from 1983 through 1988 have similar functional results and quality of life compared with patients who underwent operations after 1988.Restorative proctocolectomy with an IPAA is a safe procedure, with low mortality and major morbidity rates. Although total morbidity rate is appreciable, functional results generally are good and patient satisfaction is high.

Long-term results of a randomized trial comparing preoperative short-course radiotherapy with preoperative conventionally fractionated chemoradiation for rectal cancer

2006-09-19

Krzysztof Bujko , Marek P. Nowacki , Anna Nasierowska‐Guttmejer +3 more

Abstract Background Neoadjuvant chemoradiotherapy does not alter anal sphincter preservation or postoperative complications compared with short-course radiotherapy alone in patients with clinical stage T3 or T4 resectable rectal cancer. The … Abstract Background Neoadjuvant chemoradiotherapy does not alter anal sphincter preservation or postoperative complications compared with short-course radiotherapy alone in patients with clinical stage T3 or T4 resectable rectal cancer. The aim of this study was to compare survival, local control and late toxicity in the two treatment groups. Methods The study randomized 312 patients to receive either preoperative irradiation (25 Gy in five fractions of 5 Gy) and surgery within 7 days or chemoradiation (50·4 Gy in 28 fractions of 1·8 Gy, bolus 5-fluorouracil and leucovorin) and surgery 4–6 weeks later. The median follow-up of living patients was 48 (range 31–69) months. Results Early radiation toxicity was higher in the chemoradiation group (18·2 versus 3·2 per cent; P &lt; 0·001). The actuarial 4-year overall survival was 67·2 per cent in the short-course group and 66·2 per cent in the chemoradiation group (P = 0·960). Disease-free survival was 58·4 versus 55·6 per cent (P = 0·820), crude incidence of local recurrence was 9·0 versus 14·2 per cent (P = 0·170) and severe late toxicity was 10·1 versus 7·1 per cent (P = 0·360) respectively. Conclusion Neoadjuvant chemoradiation did not increase survival, local control or late toxicity compared with short-course radiotherapy alone.

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Effect of the plane of surgery achieved on local recurrence in patients with operable rectal cancer: a prospective study using data from the MRC CR07 and NCIC-CTG CO16 randomised clinical trial

2009-03-01

Philip Quirke , R. Steele , John R.T. Monson +7 more

Effect of Laparoscopic-Assisted Resection vs Open Resection of Stage II or III Rectal Cancer on Pathologic Outcomes

2015-10-06

James W. Fleshman , Megan E. Branda , Daniel J. Sargent +7 more

IMPORTANCEEvidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease.OBJECTIVE To determine whether laparoscopic resection is noninferior to open resection, as … IMPORTANCEEvidence about the efficacy of laparoscopic resection of rectal cancer is incomplete, particularly for patients with more advanced-stage disease.OBJECTIVE To determine whether laparoscopic resection is noninferior to open resection, as determined by gross pathologic and histologic evaluation of the resected proctectomy specimen.DESIGN, SETTING, AND PARTICIPANTS A multicenter, balanced, noninferiority, randomized trial enrolled patients between October 2008 and September 2013.The trial was conducted by credentialed surgeons from 35 institutions in the United States and Canada.A total of 486 patients with clinical stage II or III rectal cancer within 12 cm of the anal verge were randomized after completion of neoadjuvant therapy to laparoscopic or open resection.INTERVENTIONS Standard laparoscopic and open approaches were performed by the credentialed surgeons. MAIN OUTCOMES AND MEASURESThe primary outcome assessing efficacy was a composite of circumferential radial margin greater than 1 mm, distal margin without tumor, and completeness of total mesorectal excision.A 6% noninferiority margin was chosen according to clinical relevance estimation. RESULTSTwo hundred forty patients with laparoscopic resection and 222 with open resection were evaluable for analysis of the 486 enrolled.Successful resection occurred in 81.7% of laparoscopic resection cases (95% CI, 76.8%-86.6%)and 86.9% of open resection cases (95% CI, 82.5%-91.4%)and did not support noninferiority (difference, -5.3%; 1-sided 95% CI, -10.8% to ϱ; P for noninferiority = .41).Patients underwent low anterior resection (76.7%) or abdominoperineal resection (23.3%).Conversion to open resection occurred in 11.3% of patients.Operative time was significantly longer for laparoscopic resection (mean, 266.2 vs 220.6 minutes; mean difference, 45.5 minutes; 95% CI, 27.7-63.4;P < .001).Length of stay (7.3 vs 7.0 days; mean difference, 0.3 days; 95% CI, -0.6 to 1.1), readmission within 30 days (3.3% vs 4.1%; difference, -0.7%; 95% CI, -4.2% to 2.7%), and severe complications (22.5% vs 22.1%; difference, 0.4%; 95% CI, -4.2% to 2.7%) did not differ significantly.Quality of the total mesorectal excision specimen in 462 operated and analyzed surgeries was complete (77%) and nearly complete (16.5%) in 93.5% of the cases.Negative circumferential radial margin was observed in 90% of the overall group (87.9% laparoscopic resection and 92.3% open resection; P = .11).Distal margin result was negative in more than 98% of patients irrespective of type of surgery (P = .91).CONCLUSIONS AND RELEVANCE Among patients with stage II or III rectal cancer, the use of laparoscopic resection compared with open resection failed to meet the criterion for noninferiority for pathologic outcomes.Pending clinical oncologic outcomes, the findings do not support the use of laparoscopic resection in these patients.

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Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer: 12-year follow-up of the multicentre, randomised controlled TME trial

2011-05-22

W. van Gijn , Corrie A.M. Marijnen , Irıs D. Nagtegaal +7 more

Mesorectal excision for rectal cancer

1993-02-01

John K. MacFarlane , R. D. H. Ryall , Richard J. Heald

Guidelines 2000 for Colon and Rectal Cancer Surgery

2001-04-18

H. Nelson , Nicholas J. Petrelli , Arthur M. Carlin +6 more

Background: Oncologic resection techniques affect outcome for colon cancer and rectal cancer, but standardized guidelines have not been adopted. The National Cancer Institute sponsored a panel of experts to systematically … Background: Oncologic resection techniques affect outcome for colon cancer and rectal cancer, but standardized guidelines have not been adopted. The National Cancer Institute sponsored a panel of experts to systematically review current literature and to draft guidelines that provide uniform definitions, principles, and practices. Methods: Methods were similar to those described by the American Society of Clinical Oncology in developing practice guidelines. Experts representing oncology and surgery met to review current literature on oncologic resection techniques for level of evidence (I–V, where I is the best evidence and V is the least compelling) and grade of recommendation (A–D, where A is based on the best evidence and D is based on the weakest evidence). Initial guidelines were drafted, reviewed, and accepted by consensus. Results: For the following seven factors, the level of evidence was II, III, or IV, and the findings were generally consistent (grade B): anatomic definition of colon versus rectum, tumor–node–metastasis staging, radial margins, adjuvant R0 stage, inadvertent rectal perforation, distal and proximal rectal margins, and en bloc resection of adherent tumors. For another seven factors, the level of evidence was II, III, or IV, but findings were inconsistent (grade C): laparoscopic colectomy; colon lymphadenectomy; level of proximal vessel ligation, mesorectal excision, and extended lateral pelvic lymph node dissection (all three for rectal cancer); no-touch technique; and bowel washout. For the other four factors, there was little or no systematic empirical evidence (grade D): abdominal exploration, oophorectomy, extent of colon resection, and total length of rectum resected. Conclusions: The panel reports surgical guidelines and definitions based on the best available evidence. The availability of more standardized information in the future should allow for more grade A recommendations.

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Adjuvant chemotherapy versus observation in patients with colorectal cancer: a randomised study

2007-12-01

Richard Gray , J. Barnwell , Christopher C. McConkey +3 more

Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial

2013-02-06

Martijn HGM van der Pas , Eva Haglind , Miguel A. Cuesta +4 more

Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203

2006-09-28

Jean‐Pierre Gérard , Thierry Conroy , Franck Bonnetain +7 more

In 1992, preoperative radiotherapy was considered in France as the standard treatment for T3-4 rectal cancers. The present randomized trial compares preoperative radiotherapy with chemoradiotherapy.Patients were eligible if they presented … In 1992, preoperative radiotherapy was considered in France as the standard treatment for T3-4 rectal cancers. The present randomized trial compares preoperative radiotherapy with chemoradiotherapy.Patients were eligible if they presented a resectable T3-4, Nx, M0 rectal adenocarcinoma accessible to digital rectal examination. Preoperative radiotherapy with 45 Gy in 25 fractions during 5 weeks was delivered. Concurrent chemotherapy with fluorouracil 350 mg/m2/d during 5 days, together with leucovorin, was administered during the first and fifth week in the experimental arm. Surgery was planned 3 to 10 weeks after the end of radiotherapy. All patients should receive adjuvant chemotherapy with the same fluorouracil/leucovorin regimen. The primary end point of the trial was overall survival.A total of 733 patients were eligible. Grade 3 or 4 acute toxicity was more frequent with chemoradiotherapy (14.6% v 2.7%; P < .05). There was no difference in sphincter preservation. Complete sterilization of the operative specimen was more frequent with chemoradiotherapy (11.4% v 3.6%; P < .05). The 5-year incidence of local recurrence was lower with chemoradiotherapy (8.1% v 16.5%; P < .05). Overall 5-year survival in the two groups did not differ.Preoperative chemoradiotherapy despite a moderate increase in acute toxicity and no impact on overall survival significantly improves local control and is recommended for T3-4, N0-2, M0 adenocarcinoma of the middle and distal rectum.

Oxaliplatin Combined With Weekly Bolus Fluorouracil and Leucovorin As Surgical Adjuvant Chemotherapy for Stage II and III Colon Cancer: Results From NSABP C-07

2007-05-01

J. Philip Kuebler , H. Samuel Wieand , Michael J. O’Connell +7 more

This phase III clinical trial evaluated the impact on disease-free survival (DFS) of adding oxaliplatin to bolus weekly fluorouracil (FU) combined with leucovorin as surgical adjuvant therapy for stage II … This phase III clinical trial evaluated the impact on disease-free survival (DFS) of adding oxaliplatin to bolus weekly fluorouracil (FU) combined with leucovorin as surgical adjuvant therapy for stage II and III colon cancer.Patients who had undergone a potentially curative resection were randomly assigned to either FU 500 mg/m2 intravenous (IV) bolus weekly for 6 weeks plus leucovorin 500 mg/m2 IV weekly for 6 weeks during each 8-week cycle for three cycles (FULV), or the same FULV regimen with oxaliplatin 85 mg/m2 IV administered on weeks 1, 3, and 5 of each 8-week cycle for three cycles (FLOX).A total of 2,407 patients (96.6%) of the 2,492 patients randomly assigned were eligible. Median follow-up for patients still alive is 42.5 months. The hazard ratio (FLOX v FULV) is 0.80 (95% CI, 0.69 to 0.93), a 20% risk reduction in favor of FLOX (P < .004). The 3- and 4-year disease-free survival (DFS) rates were 71.8% and 67.0% for FULV and 76.1% and 73.2% for FLOX, respectively. Grade 3 neurosensory toxicity was noted in 8.2% of patients receiving FLOX and in 0.7% of those receiving FULV (P < .001). Hospitalization for diarrhea associated with bowel wall thickening occurred in 5.5% of the patients receiving FLOX and in 3.0% of the patients receiving FULV (P < .01). A total of 1.2% of patients died as a result of any cause within 60 days of receiving chemotherapy, with no significant difference between regimens.The addition of oxaliplatin to weekly FULV significantly improved DFS in patients with stage II and III colon cancer. FLOX can be recommended as an effective option in clinical practice.

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Preoperative Versus Postoperative Chemoradiotherapy for Locally Advanced Rectal Cancer: Results of the German CAO/ARO/AIO-94 Randomized Phase III Trial After a Median Follow-Up of 11 Years

2012-04-24

Rolf Sauer , Torsten Liersch , Susanne Merkel +7 more

Purpose Preoperative chemoradiotherapy (CRT) has been established as standard treatment for locally advanced rectal cancer after first results of the CAO/ARO/AIO-94 [Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working … Purpose Preoperative chemoradiotherapy (CRT) has been established as standard treatment for locally advanced rectal cancer after first results of the CAO/ARO/AIO-94 [Working Group of Surgical Oncology/Working Group of Radiation Oncology/Working Group of Medical Oncology of the Germany Cancer Society] trial, published in 2004, showed an improved local control rate. However, after a median follow-up of 46 months, no survival benefit could be shown. Here, we report long-term results with a median follow-up of 134 months. Patients and Methods A total of 823 patients with stage II to III rectal cancer were randomly assigned to preoperative CRT with fluorouracil (FU), total mesorectal excision surgery, and adjuvant FU chemotherapy, or the same schedule of CRT used postoperatively. The study was designed to have 80% power to detect a difference of 10% in 5-year overall survival as the primary end point. Secondary end points included the cumulative incidence of local and distant relapses and disease-free survival. Results Of 799 eligible patients, 404 were randomly assigned to preoperative and 395 to postoperative CRT. According to intention-to-treat analysis, overall survival at 10 years was 59.6% in the preoperative arm and 59.9% in the postoperative arm (P = .85). The 10-year cumulative incidence of local relapse was 7.1% and 10.1% in the pre- and postoperative arms, respectively (P = .048). No significant differences were detected for 10-year cumulative incidence of distant metastases (29.8% and 29.6%; P = .9) and disease-free survival. Conclusion There is a persisting significant improvement of pre- versus postoperative CRT on local control; however, there was no effect on overall survival. Integrating more effective systemic treatment into the multimodal therapy has been adopted in the CAO/ARO/AIO-04 trial to possibly reduce distant metastases and improve survival.

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Chemotherapy with Preoperative Radiotherapy in Rectal Cancer

2006-09-13

Jean-François Bosset , Laurence Collette , G. Calais +7 more

Preoperative radiotherapy is recommended for selected patients with rectal cancer. We evaluated the addition of chemotherapy to preoperative radiotherapy and the use of postoperative chemotherapy in the treatment of rectal … Preoperative radiotherapy is recommended for selected patients with rectal cancer. We evaluated the addition of chemotherapy to preoperative radiotherapy and the use of postoperative chemotherapy in the treatment of rectal cancer.We randomly assigned patients with clinical stage T3 or T4 resectable rectal cancer to receive preoperative radiotherapy, preoperative chemoradiotherapy, preoperative radiotherapy and postoperative chemotherapy, or preoperative chemoradiotherapy and postoperative chemotherapy. Radiotherapy consisted of 45 Gy delivered over a period of 5 weeks. One course of chemotherapy consisted of 350 mg of fluorouracil per square meter of body-surface area per day and 20 mg of leucovorin per square meter per day, both given for 5 days. Two courses were combined with preoperative radiotherapy in the group receiving preoperative chemoradiotherapy and the group receiving preoperative chemoradiotherapy and postoperative chemotherapy; four courses were planned postoperatively in the group receiving preoperative radiotherapy and postoperative chemotherapy and the group receiving preoperative chemoradiotherapy and postoperative chemotherapy. The primary end point was overall survival.We enrolled 1011 patients in the trial. There was no significant difference in overall survival between the groups that received chemotherapy preoperatively (P=0.84) and those that received it postoperatively (P=0.12). The combined 5-year overall survival rate for all four groups was 65.2%. The 5-year cumulative incidence rates for local recurrences were 8.7%, 9.6%, and 7.6% in the groups that received chemotherapy preoperatively, postoperatively, or both, respectively, and 17.1% in the group that did not receive chemotherapy (P=0.002). The rate of adherence to preoperative chemotherapy was 82.0%, and to postoperative chemotherapy was 42.9%.In patients with rectal cancer who receive preoperative radiotherapy, adding fluorouracil-based chemotherapy preoperatively or postoperatively has no significant effect on survival. Chemotherapy, regardless of whether it is administered before or after surgery, confers a significant benefit with respect to local control. (ClinicalTrials.gov number, NCT00002523 [ClinicalTrials.gov].).

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Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer

2004-10-20

Rolf Sauer , Heinz Becker , Werner Hohenberger +7 more

Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative chemoradiotherapy with … Postoperative chemoradiotherapy is the recommended standard therapy for patients with locally advanced rectal cancer. In recent years, encouraging results with preoperative radiotherapy have been reported. We compared preoperative chemoradiotherapy with postoperative chemoradiotherapy for locally advanced rectal cancer.We randomly assigned patients with clinical stage T3 or T4 or node-positive disease to receive either preoperative or postoperative chemoradiotherapy. The preoperative treatment consisted of 5040 cGy delivered in fractions of 180 cGy per day, five days per week, and fluorouracil, given in a 120-hour continuous intravenous infusion at a dose of 1000 mg per square meter of body-surface area per day during the first and fifth weeks of radiotherapy. Surgery was performed six weeks after the completion of chemoradiotherapy. One month after surgery, four five-day cycles of fluorouracil (500 mg per square meter per day) were given. Chemoradiotherapy was identical in the postoperative-treatment group, except for the delivery of a boost of 540 cGy. The primary end point was overall survival.Four hundred twenty-one patients were randomly assigned to receive preoperative chemoradiotherapy and 402 patients to receive postoperative chemoradiotherapy. The overall five-year survival rates were 76 percent and 74 percent, respectively (P=0.80). The five-year cumulative incidence of local relapse was 6 percent for patients assigned to preoperative chemoradiotherapy and 13 percent in the postoperative-treatment group (P=0.006). Grade 3 or 4 acute toxic effects occurred in 27 percent of the patients in the preoperative-treatment group, as compared with 40 percent of the patients in the postoperative-treatment group (P=0.001); the corresponding rates of long-term toxic effects were 14 percent and 24 percent, respectively (P=0.01).Preoperative chemoradiotherapy, as compared with postoperative chemoradiotherapy, improved local control and was associated with reduced toxicity but did not improve overall survival.

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Rectal Cancer

1998-08-01

Richard J. Heald , Brendan Moran , R. D. H. Ryall +2 more

To examine the role of total mesorectal excision in the management of rectal cancer.A prospective consecutive case series.A district hospital and referral center in Basingstoke, England.Five hundred nineteen surgical patients … To examine the role of total mesorectal excision in the management of rectal cancer.A prospective consecutive case series.A district hospital and referral center in Basingstoke, England.Five hundred nineteen surgical patients with adenocarcinoma of the rectum treated for cure or palliation.Anterior resections (n = 465) with low stapled anastomoses (407 total mesorectal excisions), abdominoperineal resections (n = 37), Hartmann resections (n = 10), local excisions (n = 4), and laparotomy only (n = 3). Preoperative radiotherapy was used in 49 patients (7 with abdominoperineal resections, 38 with anterior resections, 3 with Hartmann resections, and 1 with laparotomy).Local recurrence and cancer-specific survival.Cancer-specific survival of all surgically treated patients was 68% at 5 years and 66% at 10 years. The local recurrence rate was 6% (95% confidence interval, 2%-10%) at 5 years and 8% (95% confidence interval, 2%-14%) at 10 years. In 405 "curative" resections, the local recurrence rate was 3% (95% confidence interval, 0%-5%) at 5 years and 4% (95% confidence interval, 0%-8%) at 10 years. Disease-free survival in this group was 80% at 5 years and 78% at 10 years. An analysis of histopathological risk factors for recurrence indicates only the Dukes stage, extramural vascular invasion, and tumor differentiation as variables in these results.Rectal cancer can be cured by surgical therapy alone in 2 of 3 patients undergoing surgical excision in all stages and in 4 of 5 patients having curative resections. In future clinical trials of adjuvant chemotherapy and radiotherapy, strategies should incorporate total mesorectal excision as the surgical procedure of choice.

Randomized Trial of Laparoscopic-Assisted Resection of Colorectal Carcinoma: 3-Year Results of the UK MRC CLASICC Trial Group

2007-07-18

David Jayne , P J Guillou , H. Thorpe +5 more

The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results … The aim of the current study is to report the long-term outcomes after laparoscopic-assisted surgery compared with conventional open surgery within the context of the UK MRC CLASICC trial. Results from randomized trials have indicated that laparoscopic surgery for colon cancer is as effective as open surgery in the short term. Few data are available on rectal cancer, and long-term data on survival and recurrence are now required.The United Kingdom Medical Research Council Conventional versus Laparoscopic-Assisted Surgery in Colorectal Cancer (UK MRC CLASICC; clinical trials number ISRCTN 74883561) trial study comparing conventional versus laparoscopic-assisted surgery in patients with cancer of the colon and rectum. The randomization ratio was 2:1 in favor of laparoscopic surgery. Long-term outcomes (3-year overall survival [OS], disease-free survival [DFS], local recurrence, and quality of life [QoL]) have now been determined on an intention-to-treat basis.Seven hundred ninety-four patients were recruited (526 laparoscopic and 268 open). Overall, there were no differences in the long-term outcomes. The differences in survival rates were OS of 1.8% (95% CI, -5.2% to 8.8%; P = .55), DFS of -1.4% (95% CI, -9.5% to 6.7%; P = .70), local recurrence of -0.8% (95% CI, -5.7% to 4.2%; P = .76), and QoL (P > .01 for all scales). Higher positivity of the circumferential resection margin was reported after laparoscopic anterior resection (AR), but it did not translate into an increased incidence of local recurrence.Successful laparoscopic-assisted surgery for colon cancer is as effective as open surgery in terms of oncological outcomes and preservation of QoL. Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.

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Preoperative Radiotherapy Combined with Total Mesorectal Excision for Resectable Rectal Cancer

2001-08-30

Ellen Kapiteijn , Corrie A.M. Marijnen , Irıs D. Nagtegaal +7 more

Short-term preoperative radiotherapy and total mesorectal excision have each been shown to improve local control of disease in patients with resectable rectal cancer. We conducted a multicenter, randomized trial to … Short-term preoperative radiotherapy and total mesorectal excision have each been shown to improve local control of disease in patients with resectable rectal cancer. We conducted a multicenter, randomized trial to determine whether the addition of preoperative radiotherapy increases the benefit of total mesorectal excision.We randomly assigned 1861 patients with resectable rectal cancer either to preoperative radiotherapy (5 Gy on each of five days) followed by total mesorectal excision (924 patients) or to total mesorectal excision alone (937 patients). The trial was conducted with the use of standardization and quality-control measures to ensure the consistency of the radiotherapy, surgery, and pathological techniques.Of the 1861 patients randomly assigned to one of the two treatment groups, 1805 were eligible to participate. The overall rate of survival at two years among the eligible patients was 82.0 percent in the group assigned to both radiotherapy and surgery and 81.8 percent in the group assigned to surgery alone (P=0.84). Among the 1748 patients who underwent a macroscopically complete local resection, the rate of local recurrence at two years was 5.3 percent. The rate of local recurrence at two years was 2.4 percent in the radiotherapy-plus-surgery group and 8.2 percent in the surgery-only group (P<0.001).Short-term preoperative radiotherapy reduces the risk of local recurrence in patients with rectal cancer who undergo a standardized total mesorectal excision.

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Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial

2005-05-01

P J Guillou , Philip Quirke , H. Thorpe +5 more

Postoperative Adjuvant Chemotherapy or Radiation Therapy for Rectal Cancer: Results From NSABP Protocol R-011

1988-03-02

B. Fisher , Norman Wolmark , Howard E. Rockette +7 more

Information is presented from 555 patients with Dukes B and C rectal cancers treated by curative resection who were entered into the National Surgical Adjuvant Breast and Bowel Project (NSABP) … Information is presented from 555 patients with Dukes B and C rectal cancers treated by curative resection who were entered into the National Surgical Adjuvant Breast and Bowel Project (NSABP) protocol R-01 between November 1977 and October 1986. Their average time on study was 64.1 months. The patients were randomized to receive no further treatment (184 patients), postoperative adjuvant chemotherapy with 5-fluorouracil, semustine, and vincristine (MOF) (187 patients), or postoperative radiation therapy (184 patients). The chemotherapy group, when compared with the group treated by surgery alone, demonstrated an overall improvement in disease-free survival (P = .006) and in survival (P = .05). Employing the proportional hazards model, a global test was used to determine the presence of treatment interactions. Investigation of stratification variables employed in this study indicated that sex, and to a lesser extent age and Dukes stage, made individual contributions to the disease-free survival and the survival benefit from chemotherapy. When evaluated according to sex, the benefit for chemotherapy at 5 years, both in disease-free survival (29% vs. 47%; P < .001; relative odds, 2.00) and in survival (37% vs. 60%; P = .001; relative odds, 1.93), was restricted to males. When males were tested for age trend with the use of a logistic regression analysis, chemotherapy was found to be more advantageous in younger patients. When the group receiving postoperative radiation (4,600–4,700 rad in 26–27 fractions; 5, 100–5, 300 rad maximum at the perineum) was compared to the group treated only by surgery, there was an overall reduction in local-regional recurrence from 25% to 16% (P = .06). No significant benefit in overall disease-free survival (P = .4) or survival (P =.7) from the use of radiation has been demonstrated. The global test for interaction to identify heterogeneity of response to radiation within subsets of patients was not significant. In conclusion, this investigation has demonstrated a benefit from adjuvant chemotherapy (MOF) for the management of rectal cancer. The observed advantage was restricted to males. Postoperative radiation therapy reduced the incidence of local-regional recurrence, but it failed to affect overall disease-free survival and survival. [J Natl Cancer Inst 1988; 80: 21–29]

Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial

2008-12-14

M. Buunen , Ruben Veldkamp , Wim C.J. Hop +7 more

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Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial

2002-06-01

Antonio M. Lacy , Juan Carlos García‐Valdecasas , Salvadora Delgado +4 more

Preoperative radiotherapy versus selective postoperative chemoradiotherapy in patients with rectal cancer (MRC CR07 and NCIC-CTG C016): a multicentre, randomised trial

2009-03-01

David Sebag‐Montefiore , Richard Stephens , R. Steele +7 more

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Prognostic Significance of Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer

2005-10-26

Claus Rödel , Peter Martus , Thomas Papadoupolos +7 more

We assessed the impact of tumor regression grading (TRG) and its value in correlation to established prognostic factors in a cohort of rectal carcinoma patients treated by preoperative chemoradiotherapy (CRT).TRG … We assessed the impact of tumor regression grading (TRG) and its value in correlation to established prognostic factors in a cohort of rectal carcinoma patients treated by preoperative chemoradiotherapy (CRT).TRG was evaluated on surgical specimens of 385 patients treated within the preoperative CRT arm of the CAO/ARO/AIO-94 trial: 50.4 Gy was delivered, fluorouracil was given in the first and fifth week, and surgery was performed 6 weeks thereafter. TRG was determined by the amount of viable tumor versus fibrosis, ranging from TRG 4 when no viable tumor cells were detected, to TRG 0 when fibrosis was completely absent. TRG 3 was defined as regression more than 50% with fibrosis outgrowing the tumor mass, TRG 2 was defined as regression less than 50%, and TRG 1 was defined basically as a morphologically unaltered tumor mass. We performed an initially unplanned, hypothesis-generating analysis with respect to the prognostic value of this TRG system.TRG 4, 3, 2, 1, 0 was found in 10.4%, 52.2%, 13.8%, 15.3%, and 8.3% of the resected specimens, respectively. Five-year disease-free survival (DFS) after CRT and curative resection was 86% for TRG 4, 75% for grouped TRG 2 + 3, and 63% for grouped TRG 0 + 1 (P = .006). On multivariate analysis, the pathologic T category and the nodal status after CRT were the most important independent prognostic factors for DFS.In this exploratory analysis, complete (TRG 4) and intermediate pathologic response (TRG 2 + 3) suggested improved DFS after preoperative CRT. TRG assessment should be implemented in pathologic evaluation and prospectively validated in further studies.

Long-term outcome in patients with a pathological complete response after chemoradiation for rectal cancer: a pooled analysis of individual patient data

2010-08-08

Monique Maas , Patty J. Nelemans , Vincenzo Valentini +7 more

Colon Cancer Survival Is Associated With Increasing Number of Lymph Nodes Analyzed: A Secondary Survey of Intergroup Trial INT-0089

2003-07-28

Thomas E. Le Voyer , Elin R. Sigurdson , Alexandra L. Hanlon +4 more

To determine the relationship, in patients with adenocarcinoma of the colon, between survival and the number of lymph nodes analyzed from surgical specimens.Intergroup Trial INT-0089 is a mature trial of … To determine the relationship, in patients with adenocarcinoma of the colon, between survival and the number of lymph nodes analyzed from surgical specimens.Intergroup Trial INT-0089 is a mature trial of adjuvant chemotherapy for high-risk patients with stage II and stage III colon cancer. We performed a secondary analysis of this group with overall survival (OS) as the main end point. Cause-specific survival (CSS) and disease-free survival were secondary end points. Rates for these outcome measures were estimated using Kaplan-Meier methodology. Log-rank test was used to compare overall curves, and Cox proportional hazards regression was used to multivariately assess predictors of outcome.The median number of lymph nodes removed at colectomy was 11 (range, one to 87). Of the 3411 assessable patients, 648 had no evidence of lymph node metastasis. Multivariate analyses were performed on the node-positive and node-negative groups separately to ascertain the effect of lymph node removal. Survival decreased with increasing number of lymph node involvement (P =.0001 for all three survival end points). After controlling for the number of nodes involved, survival increased as more nodes were analyzed (P =.0001 for all three end points). Even when no nodes were involved, OS and CSS improved as more lymph nodes were analyzed (P =.0005 and P =.007, respectively).The number of lymph nodes analyzed for staging colon cancers is, itself, a prognostic variable on outcome. The impact of this variable is such that it may be an important variable to include in evaluating future trials.

Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

2013-09-27

Bengt Glimelius , Emmanuel Tiret , Andrés Cervantes +1 more

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The TME Trial After a Median Follow-up of 6 Years

2007-11-01

Koen Peeters , Corrie A.M. Marijnen , Irıs D. Nagtegaal +7 more

In Brief Objective: To investigate the efficacy of preoperative short-term radiotherapy in patients with mobile rectal cancer undergoing total mesorectal excision (TME) surgery. Summary Background Data: Local recurrence is a … In Brief Objective: To investigate the efficacy of preoperative short-term radiotherapy in patients with mobile rectal cancer undergoing total mesorectal excision (TME) surgery. Summary Background Data: Local recurrence is a major problem in rectal cancer treatment. Preoperative short-term radiotherapy has shown to improve local control and survival in combination with conventional surgery. The TME trial investigated the value of this regimen in combination with total mesorectal excision. Long-term results are reported after a median follow-up of 6 years. Methods: One thousand eight hundred and sixty-one patients with resectable rectal cancer were randomized between TME preceded by 5 × 5 Gy or TME alone. No chemotherapy was allowed. There was no age limit. Surgery, radiotherapy, and pathologic examination were standardized. Primary endpoint was local control. Results: Median follow-up of surviving patients was 6.1 year. Five-year local recurrence risk of patients undergoing a macroscopically complete local resection was 5.6% in case of preoperative radiotherapy compared with 10.9% in patients undergoing TME alone (P < 0.001). Overall survival at 5 years was 64.2% and 63.5%, respectively (P = 0.902). Subgroup analyses showed significant effect of radiotherapy in reducing local recurrence risk for patients with nodal involvement, for patients with lesions between 5 and 10 cm from the anal verge, and for patients with uninvolved circumferential resection margins. Conclusions: With increasing follow-up, there is a persisting overall effect of preoperative short-term radiotherapy on local control in patients with clinically resectable rectal cancer. However, there is no effect on overall survival. Since survival is mainly determined by distant metastases, efforts should be directed towards preventing systemic disease. The TME trial, a randomized controlled trial investigated the efficacy of preoperative short-term radiotherapy in patients with rectal cancer treated with TME surgery. After a median follow-up of 6 years, there is still a significant effect of radiotherapy on local recurrence rate, there is however no effect on overall survival.

Operative Versus Nonoperative Treatment for Stage 0 Distal Rectal Cancer Following Chemoradiation Therapy

2004-09-21

Angelita Habr‐Gama , Rodrigo Oliva Perez , Wladimir Nadalin +6 more

Report overall long-term results of stage 0 rectal cancer following neoadjuvant chemoradiation and compare long-term results between operative and nonoperative treatment.Two-hundred sixty-five patients with distal rectal adenocarcinoma considered resectable were … Report overall long-term results of stage 0 rectal cancer following neoadjuvant chemoradiation and compare long-term results between operative and nonoperative treatment.Two-hundred sixty-five patients with distal rectal adenocarcinoma considered resectable were treated by neoadjuvant chemoradiation (CRT) with 5-FU, Leucovorin and 5040 cGy. Patients with incomplete clinical response were referred to radical surgical resection. Patients with incomplete clinical response treated by surgery resulting in stage p0 were compared to patients with complete clinical response treated by nonoperative treatment. Statistical analysis was performed using chi2, Student t test and Kaplan-Meier curves.Overall and disease-free 10-year survival rates were 97.7% and 84%. In 71 patients (26.8%) complete clinical response was observed following CRT (Observation group). Twenty-two patients (8.3%) showed incomplete clinical response and pT0N0M0 resected specimens (Resection group). There were no differences between patient's demographics and tumor's characteristics between groups. In the Resection group, 9 definitive colostomies and 7 diverting temporary ileostomies were performed. Mean follow-up was 57.3 months in Observation Group and 48 months in Resection Group. There were 3 systemic recurrences in each group and 2 endorectal recurrences in Observation Group. Two patients in the Resection group died of the disease. Five-year overall and disease-free survival rates were 88% and 83%, respectively, in Resection Group and 100% and 92% in Observation Group.Stage 0 rectal cancer disease is associated with excellent long-term results irrespective of treatment strategy. Surgical resection may not lead to improved outcome in this situation and may be associated with high rates of temporary or definitive stoma construction and unnecessary morbidity and mortality rates.

Colon Cancer Survival Rates With the New American Joint Committee on Cancer Sixth Edition Staging

2004-10-05

J. B. O'Connell , Melinda A. Maggard , Clifford Y. Ko

Background: The recently revised American Joint Committee on Cancer (AJCC) sixth edition cancer staging system increased the stratification within colon cancer stages II and III defined by the AJCC fifth … Background: The recently revised American Joint Committee on Cancer (AJCC) sixth edition cancer staging system increased the stratification within colon cancer stages II and III defined by the AJCC fifth edition system. Using nationally representative Surveillance, Epidemiology, and End Results (SEER) data, we compared survival rates associated with colon cancer stages defined according to both AJCC systems. Methods: Using SEER data (from January 1, 1991, through December 31, 2000), we identified 119 363 patients with colon adenocarcinoma and included all patients in two analyses by stages defined by AJCC fifth and sixth edition systems. Tumors were stratified by SEER’s “extent of disease” and “number of positive [lymph] nodes” coding schemes. Kaplan–Meier analyses were used to compare overall and stage-specific 5-year survival. All statistical tests were two-sided. Results: Overall 5-year survival was 65.2%. According to stages defined by the AJCC fifth edition system, 5-year stage-specific survivals were 93.2% for stage I, 82.5% for stage II, 59.5% for stage III, and 8.1% for stage IV. According to stages defined by the AJCC sixth edition system, 5-year stage-specific survivals were 93.2% for stage I, 84.7% for stage IIa, 72.2% for stage IIb, 83.4% for stage IIIa, 64.1% for stage IIIb, 44.3% for stage IIIc, and 8.1% for stage IV. Under the sixth edition system, 5-year survival was statistically significantly better for patients with stage IIIa colon cancer (83.4%) than for patients with stage IIb disease (72.2%) (P<.001). Conclusions: The AJCC sixth edition system for colon cancer stratifies survival more distinctly than the fifth edition system by providing more substages. The association of stage IIIa colon cancer with statistically significantly better survival than stage IIb in the new system may reflect current clinical practice, in which stage III patients receive chemotherapy but stage II patients generally do not.

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A Comparison of Laparoscopically Assisted and Open Colectomy for Colon Cancer

2004-05-12

Heidi Nelson , Daniel J. Sargent , H Sam Wieand +7 more

Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper oncologic … Minimally invasive, laparoscopically assisted surgery was first considered in 1990 for patients undergoing colectomy for cancer. Concern that this approach would compromise survival by failing to achieve a proper oncologic resection or adequate staging or by altering patterns of recurrence (based on frequent reports of tumor recurrences within surgical wounds) prompted a controlled trial evaluation.

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Improving Adjuvant Therapy for Rectal Cancer by Combining Protracted-Infusion Fluorouracil with Radiation Therapy after Curative Surgery

1994-08-25

Michael J. OʼConnell , James A. Martenson , Harry S. Wieand +6 more

The combination of radiation therapy and chemotherapy with fluorouracil plus semustine after surgery has been established as an effective approach to decreasing the risk of tumor relapse and improving survival … The combination of radiation therapy and chemotherapy with fluorouracil plus semustine after surgery has been established as an effective approach to decreasing the risk of tumor relapse and improving survival in patients with rectal cancer who are at high risk for relapse or death. We sought to determine whether the efficacy of chemotherapy could be improved by administering fluorouracil by protracted infusion throughout the duration of radiation therapy and whether the omission of semustine would reduce the toxicity and delayed complications of chemotherapy without decreasing its antitumor efficacy.

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Effect of Robotic-Assisted vs Conventional Laparoscopic Surgery on Risk of Conversion to Open Laparotomy Among Patients Undergoing Resection for Rectal Cancer

2017-10-24

David Jayne , Alessio Pigazzi , Helen Marshall +7 more

<h3>Importance</h3> Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. <h3>Objective</h3> To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to … <h3>Importance</h3> Robotic rectal cancer surgery is gaining popularity, but limited data are available regarding safety and efficacy. <h3>Objective</h3> To compare robotic-assisted vs conventional laparoscopic surgery for risk of conversion to open laparotomy among patients undergoing resection for rectal cancer. <h3>Design, Setting, and Participants</h3> Randomized clinical trial comparing robotic-assisted vs conventional laparoscopic surgery among 471 patients with rectal adenocarcinoma suitable for curative resection conducted at 29 sites across 10 countries, including 40 surgeons. Recruitment of patients was from January 7, 2011, to September 30, 2014, follow-up was conducted at 30 days and 6 months, and final follow-up was on June 16, 2015. <h3>Interventions</h3> Patients were randomized to robotic-assisted (n = 237) or conventional (n = 234) laparoscopic rectal cancer resection, performed by either high (upper rectum) or low (total rectum) anterior resection or abdominoperineal resection (rectum and perineum). <h3>Main Outcomes and Measures</h3> The primary outcome was conversion to open laparotomy. Secondary end points included intraoperative and postoperative complications, circumferential resection margin positivity (CRM+) and other pathological outcomes, quality of life (36-Item Short Form Survey and 20-item Multidimensional Fatigue Inventory), bladder and sexual dysfunction (International Prostate Symptom Score, International Index of Erectile Function, and Female Sexual Function Index), and oncological outcomes. <h3>Results</h3> Among 471 randomized patients (mean [SD] age, 64.9 [11.0] years; 320 [67.9%] men), 466 (98.9%) completed the study. The overall rate of conversion to open laparotomy was 10.1%: 19 of 236 patients (8.1%) in the robotic-assisted laparoscopic group and 28 of 230 patients (12.2%) in the conventional laparoscopic group (unadjusted risk difference = 4.1% [95% CI, −1.4% to 9.6%]; adjusted odds ratio = 0.61 [95% CI, 0.31 to 1.21];<i>P</i> = .16). The overall CRM+ rate was 5.7%; CRM+ occurred in 14 (6.3%) of 224 patients in the conventional laparoscopic group and 12 (5.1%) of 235 patients in the robotic-assisted laparoscopic group (unadjusted risk difference = 1.1% [95% CI, −3.1% to 5.4%]; adjusted odds ratio = 0.78 [95% CI, 0.35 to 1.76];<i>P</i> = .56). Of the other 8 reported prespecified secondary end points, including intraoperative complications, postoperative complications, plane of surgery, 30-day mortality, bladder dysfunction, and sexual dysfunction, none showed a statistically significant difference between groups. <h3>Conclusions and Relevance</h3> Among patients with rectal adenocarcinoma suitable for curative resection, robotic-assisted laparoscopic surgery, as compared with conventional laparoscopic surgery, did not significantly reduce the risk of conversion to open laparotomy. These findings suggest that robotic-assisted laparoscopic surgery, when performed by surgeons with varying experience with robotic surgery, does not confer an advantage in rectal cancer resection. <h3>Trial Registration</h3> isrctn.org Identifier:ISRCTN80500123

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Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial

2020-12-07

Renu R. Bahadoer , Esmée A. Dijkstra , Boudewijn van Etten +7 more

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Colorectal cancer

2019-10-01

Evelien Dekker , Pieter J. Tanis , Jasper L.A. Vleugels +2 more

Adjuvant Therapy for Patients With Colon and Rectal Cancer

1990-09-19

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Prolongation of the Disease-Free Interval in Surgically Treated Rectal Carcinoma

1985-06-06

To assess the effects of postoperative radiation therapy and chemotherapy on tumor recurrence and patient survival, 227 patients (data on 202 of whom were analyzed) who had undergone "curative" surgical … To assess the effects of postoperative radiation therapy and chemotherapy on tumor recurrence and patient survival, 227 patients (data on 202 of whom were analyzed) who had undergone "curative" surgical resection for rectal adenocarcinoma were prospectively and randomly assigned to one of four treatments: no adjuvant therapy (concurrent controls, 58 patients), postoperative radiotherapy with 4000 or 4800 rad (50 patients), postoperative chemotherapy (fluorouracil and semustine [methyl-CCNU], 48 patients), or a combination of radiation therapy and chemotherapy (46 patients). Five years after the entry of the last patient and with a median follow-up of all survivors for 80 months, the recurrence rate was highest among the control patients (55 per cent) and lowest among the patients receiving a combination of adjuvant radiation and chemotherapy (33 per cent). Time to tumor recurrence differed significantly among the four treatment groups (P less than 0.04); it was significantly prolonged by combined radiation and chemotherapy as compared with resection alone (P less than 0.009). Overall survival did not differ significantly among the treatment groups. The superiority of the combined-modality regimen appeared to be attributable to the effects of radiation therapy and chemotherapy in controlling local and distant recurrences, respectively. We conclude that this study provides evidence supporting the use of postoperative radiation therapy in conjunction with chemotherapy in patients who have had "curative" resection of rectal cancer with involvement of perirectal fat or regional nodes or both (Stages B2 and C).

Prognostic impact and independent significance of tumor deposits in early-stage colon cancer: a population-based cohort study

2025-06-26

Bilal Turan , Ahmet Necati Şanlı , Deniz Esin Tekcan Şanlı +1 more | International Journal of Colorectal Disease

Tumor deposits (TD) are well-established prognostic markers in advanced-stage colorectal cancer (CRC), but their independent significance in early-stage disease remains unclear. Current staging systems do not account for TD in … Tumor deposits (TD) are well-established prognostic markers in advanced-stage colorectal cancer (CRC), but their independent significance in early-stage disease remains unclear. Current staging systems do not account for TD in node-negative CRC, despite emerging evidence suggesting a potential impact on survival. This study aimed to assess the prognostic impact of TD in early-stage (T1-T3, N0) colon cancer using a large population-based cohort and advanced statistical methods. A retrospective cohort study was conducted using the SEER database (2010-2021), including 111,106 patients with early-stage (T1-T3) colon cancer, of whom 4055 (3.6%) were TD-positive. To minimize baseline imbalances, propensity score matching (1:3 nearest-neighbor; caliper = 0.2) was applied. Overall survival (OS) and disease-specific survival (DSS) were assessed using the Kaplan-Meier analysis and compared with log-rank tests. Multivariate Cox regression was performed to evaluate the independent prognostic impact of TD status in both unmatched and matched cohorts. TD-positive patients demonstrated significantly worse overall survival (OS) and disease-specific survival (DSS) compared to TD-negative patients (log-rank p < 0.001). In the unmatched cohort, TD positivity was independently associated with reduced OS (HR: 1.56, 95% CI: 1.48-1.65) and DSS (HR: 2.33, 95% CI: 2.14-2.54; both p < 0.001). These associations remained significant after propensity score matching (OS: HR: 1.44, 95% CI: 1.35-1.54; DSS: HR: 2.17, 95% CI: 1.97-2.40; both p < 0.001). TD is an independent prognostic factor in early-stage colon cancer, warranting closer surveillance and reconsideration of treatment strategies. These findings suggest that TD should be integrated into risk stratification models, challenging current staging paradigms.

Anastomotic Leak Prevention

2025-06-25

Xueyan Shen , Xiang Xia , Zizhen Zhang | JAMA Surgery

Anastomotic Leak Prevention—Reply

2025-06-25

Juha Rinne , Heikki Huhta , Olli Helminen | JAMA Surgery

Incidence and Risk Factors for Surgical Site Infections in Diabetic Patients Undergoing Clean Surgeries: A Prospective Observational Study

2025-06-25

Vinny Ram | International Journal of Science and Research (IJSR)

[Camera inversion technique in laparoscopic sphincter-preserving surgery for mid to low rectal cancer].

2025-06-25

Ruixue Hou , G B Li , Xiaoyuan Qiu +2 more | PubMed

Objective: To explore the application of the camera inversion technique in laparoscopic sphincter-preserving surgery for mid to low rectal cancer. Methods: A retrospective study with historical controls was conducted on … Objective: To explore the application of the camera inversion technique in laparoscopic sphincter-preserving surgery for mid to low rectal cancer. Methods: A retrospective study with historical controls was conducted on patients with non-metastatic mid to low rectal cancer which received laparoscopic total mesorectal excision at Peking Union Medical College Hospital from January 2019 to June 2024. The experimental group (2021.7-2024.6) utilized the camera inversion technique (rotating the lens 180° to position the bevel upward and switching the system to reverse display mode for improved visualization and operative angles) during key surgical steps (such as intraoperative mobilization of the mid-to-lower rectum and anastomosis), while the control group (2019.1-2021.6) did not. Clinical data and surgical videos were collected to analyze indicators like operative time, blood loss, mesorectal integrity, surgical complications, and postoperative hospital stay. Results: A total of 624 patients with non-metastatic mid to low rectal cancer were included, including 412 males and 212 females, with an average age of 59.8 years and an average tumor distance of 5.6 cm from the anal verge. The experimental group comprised 301 patients, while the control group had 323 patients.The proportion of abdominal ISR (intersphincteric resection) was significantly higher in the experimental group [19.3% (58/301) vs. 10.2%(33/323), χ2=10.140, P=0.001], with a reduction in operative time [(161.8±67.8) minutes vs. (150.2±68.5) minutes, t=2.134, P=0.033] and a decrease in postoperative hospital stay [(7.8±2.1) days vs. (8.3±3.4) days, t=2.003, P=0.046]. The experimental group also demonstrated advantages in intraoperative blood loss, mesorectal integrity rate, and postoperative complications such as urinary retention, though these differences were not statistically significant (all P>0.05). Conclusion: In laparoscopic surgery for mid to low rectal cancer, using camera inversion technique during distal rectum dissection and transanal anastomosis can provide better surgical field exposure, facilitate precise operations within the correct anatomical plane, and minimize collateral damage. The camera inversion technique is safe and effective.

[Pathogenesis, risk factors and treatment of low anterior resection syndrome after colon surgery].

2025-06-25

Y C Guo , Hong Zhao , Q Wang | PubMed

Low anterior resection syndrome (LARS) is a series of symptoms of intestinal dysfunction, and its research is mainly focused on patients with low rectal surgery. However, with the deepening understanding … Low anterior resection syndrome (LARS) is a series of symptoms of intestinal dysfunction, and its research is mainly focused on patients with low rectal surgery. However, with the deepening understanding of postoperative LARS, surgeons found that LARS not only exists among patients who have undergone low anterior resection of rectum, but also plagues a considerable number of patients who have undergone non-rectal (mainly colon) surgeries. This article aims to elaborate on the incidence and treatment of LARS after colon surgery. Through a comprehensive analysis of relevant studies, it is found that the incidence of LARS after colon surgery is approximately 20%-30%, and the incidence is relatively higher in patients undergoing right hemicolectomy. Its pathogenesis is related to multiple factors, including surgical methods, resection range, changes in intestinal flora, patient age, gender, and underlying diseases. Treatment methods include conservative treatments such as dietary adjustment, drug therapy, transanal irrigation, and rehabilitation training. Single treatment methods have limited effect, while comprehensive treatment can effectively improve patients' symptoms and quality of life. The current LARS scoring system has not been effectively verified in the application after colon cancer surgery, and it is necessary to develop a more targeted scoring system.

[Analysis of the incidence and risk factors of low anterior resection syndrome after radical sphincter-preserving surgery for locally advanced rectal cancer treated with neoadjuvant immunotherapy: a single-center retrospective study].

2025-06-25

Yuliang Huang , Xiaofeng Xie , Minghe Zhao +5 more | PubMed

Objective: To explore the impact of neoadjuvant immunotherapy on the occurrence of low anterior resection syndrome (LARS) in patients with locally advanced rectal cancer who underwent restorative anterior resection, and … Objective: To explore the impact of neoadjuvant immunotherapy on the occurrence of low anterior resection syndrome (LARS) in patients with locally advanced rectal cancer who underwent restorative anterior resection, and to analyze associated risk factors. Methods: This study was an observational study. Patients with adenocarcinoma, mucinous adenocarcinoma, or signet ring cell carcinoma of the rectum located 0-10 cm from the anal verge who received neoadjuvant immunotherapy followed by curative restorative anterior resection at Peking University Cancer Hospital between November 2019 and February 2024 were retrospectively examined. Exclusion criteria were as follows: (1) metastasis detected preoperatively;(2) follow-up <1 year or stoma closure <6 months; (3) local recurrence or metastasis during follow-up; and (4) stoma without closure or stoma re-creation. The Chinese version of the LARS questionnaire was used to assess bowel function by telephone interview, and patients were classified based on score into no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The incidence of LARS, major LARS, and associated risk factors were analyzed. Results: A total of 52 patients (34 men) were included for analysis. Mean age was 58.0 ± 9.8 years and mean body mass index was 25.1 ± 2.6 kg/m2. Median follow-up was 27.5 months (range, 12.0-63.7). Median LARS score was 21 (range, 1-41). Twenty-six patients (50.0%) developed LARS after surgery, and half of these (13 cases) were classified as major LARS. Stool clustering (repeated defecation within 1 hour) was observed in 80.8% (42/52) of patients. Distance between the tumor edge and the dentate line [odds ratio (OR), 3.597; 95% confidence interval (CI), 1.140-11.360; P=0.026], management of the left colic artery (OR, 0.133; 95% CI, 0.026-0.691; P=0.008), and interval of stoma closure (OR, 5.250; 95%CI, 1.381-19.960; P=0.011) were significantly associated with LARS. Interval of stoma closure was significantly associated with major LARS (OR, 4.200; 95%CI, 1.064-16.584; P=0.040). In multivariate logistic regression, ≤3.5 cm between the tumor edge and the dentate line (OR, 7.407; 95%CI, 1.377-40.000; P=0.020), non-preservation of the left colic artery (OR, 8.403; 95%CI, 1.183-58.823; P=0.033) and interval of stoma closure >6 months (OR, 10.865; 95% CI, 2.039-57.896; P=0.005) were independent risk factors for LARS. Interval of stoma closure >6 months (OR, 4.356; 95% CI, 1.105-17.167; P=0.035) were independent risk factors for major LARS. Conclusion: Patients with locally advanced rectal cancer treated with neoadjuvant immunotherapy experienced a high incidence of LARS after curative surgery, with stool clustering as the predominant symptom. Tumor edge-dentate line distance ≤3.5 cm, non-preservation of the left colic artery, and interval of stoma closure >6 months were risk factors for LARS.

[Short-term outcomes and cost-effectiveness of laparoscopic and open loop ileostomy reversal].

2025-06-25

Z Y Li , Yida Zhang , Simiao Xu +1 more | PubMed

Objective: To compare the short-term outcomes and cost-effectiveness of laparoscopic and open ileostomy reversal. Methods: A retrospective cohort study was adopted. Clinical data of patients who underwent loop ileostomy reversal … Objective: To compare the short-term outcomes and cost-effectiveness of laparoscopic and open ileostomy reversal. Methods: A retrospective cohort study was adopted. Clinical data of patients who underwent loop ileostomy reversal at the department of Colorectal Tumor Surgery of Shengjing Hospital Affiliated with China Medical University from January 2021 to November 2023 were reviewed. After excluding those who did not undergo reversal within 3 to 6 months of the initial surgery, patients with complications such as parastomal hernia requiring additional procedures, and those who underwent laparoscopic-to-open conversion, 150 were included for analysis. Patients were grouped according to type of reversal: open surgery (92 patients) and laparoscopic (58 patients). The primary outcome was cost-effectiveness. The success rate of ileostomy reversal was used as the health outcome. Hospitalization costs were collected via the hospital information system. The willingness-to-pay (WTP) threshold was set at three times the per capita gross domestic product. Differences in cost and success rates between open and laparoscopic procedures were compared. Incremental cost per successful reversal of ileostomy reversal and incremental cost-effectiveness ratios (ICER) were calculated (ICER < WTP indicates that laparoscopic ileostomy reversal is more cost-effective than open). Results: Compared with open reversal, the intraoperative blood loss volume was lower[ (35.5±12.6) ml vs.(57.7±19.0) ml,t=7.874, P<0.001] ; adhesion release rate was higher [82.8%(48/58) vs.46.7%(43/92), χ2=19.341, P<0.001]; time to first flatus [(99.4±32.4) hours vs.(115.0±35.3) hours, t=2.734, P=0.007] and time to unassisted ambulation [42(18-71) hours vs. 51(25-78) hours, Z=-6.440, P<0.001] were earlier; postoperative hospitalization was shorter [(12.0±3.4) days vs.(15.0±3.6) days, t=5.010, P<0.001] ; visual analog scale pain score on postoperative day 2 was lower [3(3-4) vs. 4(4-4), Z=-6.488, P<0.001;3(2-3) vs. 3(3-4), Z=-4.810, P<0.001]; and incidence of postoperative complications was lower [8.6%(5/58) vs. 21.7%(20/92), χ2=4.408, P=0.036] in the total laparoscopic group. The ICER of the total cost of the laparoscopic group relative to the open group was 38 221.89 CNY. Univariate sensitivity analysis showed that the success rate of laparoscopic reversal had the greatest impact on the results. The cost-effectiveness acceptability curve showed that when the WTP was 257 094 CNY, the probability of laparoscopic reversal being economical was 84.9%. Conclusion: Laparoscopic ileostomy reversal is more cost-effective than open and has superior short-term outcomes.

[Comparative study of clinical characteristics and prognosis between early- and late-onset rectal cancer].

2025-06-25

Hyun Pyo Hong , Aiqun Huang , Jingyi Shi +1 more | PubMed

Objective: To investigate the differences in clinical characteristics and prognosis between early- and late-onset rectal cancer (EORC and LORC, respectively), and to analyze the adverse factors affecting outcomes in EORC … Objective: To investigate the differences in clinical characteristics and prognosis between early- and late-onset rectal cancer (EORC and LORC, respectively), and to analyze the adverse factors affecting outcomes in EORC patients. Methods: This retrospective cohort and propensity score matching (PSM) study examined 904 rectal cancer patients who underwent radical resection at Peking University Shougang Hospital between 2017 and 2022. Prior to comparison, patients in the EORC group (<50 years old) and LORC group (≥50 years old) were matched at a 1:2 ratio to control for the following confounders: sex; neoadjuvant therapy; T, N, and M stage; and adjuvant treatment. Cox regression was used to identify independent risk factors for poor overall and progression-free survival (OS and PFS, respectively). Restricted cubic splines were used to analyze the association between age and clinical outcome. Results: A total of 199 EORC and 705 LORC patients were included for analysis. Prior to PSM, the proportions of patients with stage T4 [27.6%(55/199) vs.12.9%(91/705),χ2=30.12,P<0.001] and M1 disease [24.6%(49/199) vs. 15.7% (111/705),χ2=8.40,P=0.004], and the proportions of patients who received neoadjuvant [79.9% (159/199) vs. 62.3%(439/705), χ2=21.54, P<0.001] and adjuvant therapy [62.8%(125/199) vs. 50.8% (358/705), χ2=9.03, P=0.003] were significantly higher in the EORC group. Mean OS (57.8 vs. 51.9 months; P=0.011) and PFS (53.6 vs. 44.5 months; P=0.001) were also significantly longer in the LORC group. However, after PSM, the intergroup differences in OS and PFS were not significant (P=0.450 and 0.180, respectively). Multivariate Cox regression in the EORC cohort identified carcinoembryonic antigen concentration ≥5 μg/L [hazard ratio (HR), 3.79; 95% confidence interval (CI), 1.34-10.69; P=0.012] and presence of perineural invasion (HR, 7.27; 95%CI, 1.77-29.88; P=0.006) as independent risk factors for overall mortality; the only independent risk factor for cancer progression was carcinoembryonic antigen concentration ≥5 μg/L (HR, 2.56; 95%CI, 1.06-6.17; P=0.037). Restricted cubic spline analysis showed a U-shaped relationship between age and clinical outcome. After PSM, OS and PFS did not show a significant association with age in the < 60 years old group. Conclusion: Compared with LORC, EORC is more likely to be diagnosed at a later stage and has a worse outcome. Early diagnosis and timely treatment improve outcome in EORC patients.

[Effect of side-to-end anastomosis on postoperative bowel function in rectal cancer surgery: a prospective single-center randomized controlled trial].

2025-06-25

Chao Wang , Fan Liu , Sen Hou +7 more | PubMed

Objective: To compare bowel function 12 months after surgery between side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) groups of patients who had undergone rectal cancer resection. Methods: This single-center, prospective, … Objective: To compare bowel function 12 months after surgery between side-to-end anastomosis (SEA) and end-to-end anastomosis (EEA) groups of patients who had undergone rectal cancer resection. Methods: This single-center, prospective, open-label, phase III randomized controlled trial was approved by the Ethics Committee of Peking University People's Hospital (2018PHB040-01) and registered at ClinicalTrials. org (NCT03669237). Inclusion criteria were as follows: (1) histologically confirmed rectal adenocarcinoma; (2) tumor located 0 to 12 cm from the anal verge; (3) age≥18 years; and (4) planned R0 resection with primary reconstruction. Exclusion criteria included: (1) emergency surgery; (2) cognitive impairment; (3) non-primary anastomosis; (4) history of left-sided colonic or anorectal surgery; and (5) preexisting chronic defecation dysfunction. Eligible rectal cancer patients scheduled for elective sphincter-preserving surgery at Peking University People's Hospital were prospectively enrolled between October 2018 and March 2021 and randomly assigned to either the EEA group or the SEA group via computer-generated numbers prior to entering the operating room. All patients underwent standard radical tumor resection. Bowel function was evaluated by the low anterior resection syndrome (LARS) questionnaire. It consists of five single-choice questions and yields a total score ranging from 0 to 42. Defecation function is categorized into three levels: no LARS (0-20 points), minor LARS (21-29 points), and major LARS (30-42 points). The primary endpoint was the LARS score 12 months after surgery. Secondary endpoints included LARS scores from 1 to 11 months and during long-term follow-up(>12 months). The final follow-up was completed in July 2022. All randomized patients were included in the intention-to-treat set (ITTS). The full analysis set (FAS) was defined as ITTS patients with valid outcome data. All primary statistical analyses were performed in the FAS, and results were further compared in the per-protocol set (PPS) based on the actual treatment received. Results: A total of 323 patients underwent eligibility assessment, of whom 71 did not meet the inclusion criteria and 52 declined to participate. Ultimately, 200 patients were randomized. Median age was 64 years and 85 were women. The SEA and EEA groups comprised 102 and 98 patients, respectively. A total of 181 patients (90.5%) were included in the FAS, and 170 (85.0%) were included in the PPS. Among these, the 12-month LARS score was evaluated in 178 patients (98.3%) in the FAS and in 167 (98.2%) in the PPS. Median LARS score at 1-12 months were significantly lower in the SEA group in both the FAS dataset [12 months:8 (interquartile range [IQR], 0-22) vs. 14 (IQR, 8-29); Z=2.687, P=0.007] and the PPS dataset [12 months: 8 (IQR, 0-22) vs. 14 (IQR, 6-29); Z=2.543, P=0.011]. During long-term follow-up, the median LARS score was also significantly lower in the SEA group in the FAS dataset [2 (IQR, 0-4) vs. 11 (IQR, 2-23); Z=2.968, P=0.003] and the PPS dataset [2 (IQR, 0-14) vs. 11 (2, 27); Z=2.687, P=0.007]. Conclusion: Compared with the EEA group, bowel function was superior in the SEA group 1 year after surgery and during long-term follow-up.

[Expert consensus on the protection of pelvic organ function in rectal cancer surgery (version 2025)].

2025-06-25

| PubMed

With the development of surgical techniques, adjuvant therapy and neoadjuvant therapy, the survival time of rectal cancer patients after surgery has been significantly improved, but organ dysfunction is still an … With the development of surgical techniques, adjuvant therapy and neoadjuvant therapy, the survival time of rectal cancer patients after surgery has been significantly improved, but organ dysfunction is still an important problem affecting the quality of life of patients after surgery. With the continuous deepening of clinical research and practice and the updating of relevant theories, more detailed and reliable evidence-based medical evidence has been accumulated in the field of pelvic organ function protection in rectal cancer surgery, and has been continuously verified in the clinical real world at home and abroad. In order to further improve the awareness of domestic physicians on the protection of organ function during the treatment of rectal cancer, standardize the evaluation methods and surgical methods, reduce the incidence of organ dysfunction, and thus improve the quality of life of patients, Society of Colon & Rectal Surgeons of Chinese College of Surgeons of Chinese Medical Doctor Association, Section of Colorectal Surgery of Branch of Surgery of Chinese Medical Association, National Health Commission Capacity Building and Continuing Education Center Colorectal Surgery Committee, and Colorectal and Anal Function Surgeons Committee of China Sexology Association organized the discussion among relevant experts. On the basis of the 2021 edition of the Chinese Expert Consensus on the Protection of Pelvic Organ Function in Rectal Cancer Surgery, the recent evidence-based medical evidence was analyzed and summarized, and the definition, risk factors, evaluation methods, prevention and other issues of organ dysfunction after rectal cancer surgery were analyzed with reference to relevant domestic and foreign studies and combined with clinical practice. Proposed the diagnosis, evaluation and treatment of pelvic organ dysfunction in rectal cancer surgery, and finally formed the "Chinese expert Consensus on the protection of pelvic organ function in rectal cancer surgery (version 2025)".

[Preoperative anal function assessment in sphincter-preserving surgery for rectal cancer: clinical significance and strategies].

2025-06-25

Fan Liu , Y J Ye | PubMed

Sphincter-preserving surgery has become the mainstream approach for mid-to-low rectal cancer, yet postoperative anal dysfunction (low anterior resection syndrome, LARS) occurs in 30%-50% of patients, significantly impacting quality of life. … Sphincter-preserving surgery has become the mainstream approach for mid-to-low rectal cancer, yet postoperative anal dysfunction (low anterior resection syndrome, LARS) occurs in 30%-50% of patients, significantly impacting quality of life. This review systematically elaborates the clinical value of preoperative anal function assessment (mainly digital rectal examination), proposing a multidimensional evaluation system integrating anatomical (including high-resolution anorectal MRI, 3D transrectal ultrasound and dynamic contrast-enhanced ultrasound), physiological (anorectal amnometry and anal electromyography), and neurological assessments (including Parks scale, Wexner score, MSK-BFI scale and LARS score), alongside innovative strategies such as artificial intelligence and gut microbiome analysis. We advocate incorporating preoperative functional assessment into quality control standards for sphincter preservation, promoting a paradigm shift from "anatomical preservation" to "functional preservation".

The role of indocyanine green fluorescence angiography in the perioperative period for patients after colorectal surgery: a meta-analysis of propensity score-matched studies with trial sequential analysis

2025-06-24

Xianhao Yi , Hao Hu , Hao Shi +4 more | Surgical Endoscopy

Multimodal Preoperative Management of Rectal Cancer: A Review of the Existing Guidelines

2025-06-24

Ionuţ Negoi | Medicina

Rectal cancer management necessitates a rigorous multidisciplinary strategy, emphasizing precise staging and detailed risk stratification to inform optimal therapeutic decision-making. Obtaining an accurate histological diagnosis before initiating treatment is essential. … Rectal cancer management necessitates a rigorous multidisciplinary strategy, emphasizing precise staging and detailed risk stratification to inform optimal therapeutic decision-making. Obtaining an accurate histological diagnosis before initiating treatment is essential. Comprehensive staging integrates clinical evaluation, thorough medical history analysis, assessment of carcinoembryonic antigen (CEA) levels, and computed tomography (CT) imaging of the abdomen and thorax. High-resolution pelvic magnetic resonance imaging (MRI), utilizing dedicated rectal protocols, is critical for identifying recurrence risks and delineating precise anatomical relationships. Endoscopic ultrasound further refines staging accuracy by determining the tumor infiltration depth in early-stage cancers, while preoperative colonoscopy effectively identifies synchronous colorectal lesions. In early-stage rectal cancers (T1–T2, N0, and M0), radical surgical resection remains the standard of care, although transanal local excision can be selectively indicated for certain T1N0 tumors. In contrast, locally advanced rectal cancers (T3, T4, and N+) characterized by microsatellite stability or proficient mismatch repair are optimally managed with total neoadjuvant therapy (TNT), which combines chemoradiotherapy with oxaliplatin-based systemic chemotherapy. Additionally, tumors exhibiting high microsatellite instability or mismatch repair deficiency respond favorably to immune checkpoint inhibitors (ICIs). The evaluation of tumor response following neoadjuvant therapy, utilizing MRI and endoscopic assessments, facilitates individualized treatment planning, including non-operative approaches for patients with confirmed complete clinical responses who comply with rigorous follow-up. Recent advancements in molecular characterization, targeted therapies, and immunotherapy highlight a significant evolution towards personalized medicine. The effective integration of these innovations requires enhanced interdisciplinary collaboration to improve patient prognosis and quality of life.

Comparing Wafi ileostomy to Brooke ileostomy in stage 3 rectal cancer: a prospective cohort study

2025-06-24

W Attallaah , Mahir Gachabayov , A Bulut +6 more | Updates in Surgery

Assessing the pathway and timing for ileostomy reversal in rectal cancer: A retrospective cohort study

2025-06-24

M. Boyer , Totadri Dhimal , Bailey K. Hilty Chu +7 more | Surgery

Letter to the Editor: Intraoperative Blood Loss Predicts Local Recurrence After Curative Resection for Stage I–III Colorectal Cancer

2025-06-24

Uday Singh Dadhwal | World Journal of Surgery

ASO Visual Abstract: Compliance and Toxicity of Total Neoadjuvant Therapy in Locally Advanced Rectal Cancer: A Systematic Review and Network Meta-analysis

2025-06-24

Warren Seow , Ishraq Murshed , Zachary Bunjo +3 more | Annals of Surgical Oncology

Factores de riesgo para dehiscencia de anastomosis en cáncer colorrectal

2025-06-24

Álvaro J. Montiel‐Jarquín , Angélica Porras-Juárez , Arturo García-Galicia +6 more | Anales Médicos de la Asociación Médica del Centro Médico ABC

Total neoadjuvant therapy integrating long-course radiotherapy with trifluridine/tipiracil for locally advanced rectal cancer: a single-arm, multicenter phase 2 trial

2025-06-24

Xia Dou , Lina Zhao , Zhenyu Ma +7 more | EClinicalMedicine

Fragility Index analysis for robustness of evidence in <scp>Randomized Controlled Trials</scp> in National Comprehensive Cancer Network (<scp>NCCN)</scp> guidelines for rectal cancer

2025-06-23

Nir Horesh , Justin Dourado , Peter Rogers +6 more | International Journal of Cancer

Abstract Robustness of evidence from randomized controlled trials (RCTs) is crucial for guiding clinical decisions in rectal cancer. We evaluated the reliability of RCTs cited by the National Comprehensive Cancer … Abstract Robustness of evidence from randomized controlled trials (RCTs) is crucial for guiding clinical decisions in rectal cancer. We evaluated the reliability of RCTs cited by the National Comprehensive Cancer Network (NCCN) guidelines for rectal cancer using the Fragility Index (FI) that quantifies the stability of trial outcomes. RCTs referenced in the latest NCCN guidelines for rectal cancer were reviewed. Data from eligible trials were extracted. FI was calculated to assess the robustness of evidence across different treatment modalities. Sixty‐seven RCTs (published: 1987–2022) involving 16,990 patients were analyzed. Most studies (58.2%) were conducted in Europe. Common treatment areas included metastatic liver disease (28.9%) and neoadjuvant chemotherapy (14.9%). Primary outcomes were disease‐free survival and overall survival (OS) in 15 studies each (22.4%), local recurrence rates in 6 (9%), and tumor response in 5 (7.5%). The median FI was 9 (interquartile range [IQR] 2–20). Studies on surgical interventions had the highest median FI (21 [IQR 7–27]) followed by studies on neoadjuvant radiotherapy (19 [IQR 14–25]). Neoadjuvant immunotherapy studies had the lowest median FI of 0, indicating less robust evidence. Notably, surgical intervention studies showed the largest gap between FI and patients lost to follow‐up (21 vs. 13.5), while neoadjuvant immunotherapy studies showed more patients lost to follow‐up than the median FI (0 vs. 5), highlighting the need for stronger evidence. In conclusion, evidence supporting most treatments for rectal cancer in the NCCN guidelines is robust, although neoadjuvant immunotherapy requires further scrutiny due to its low FI. FI offers a nuanced perspective on the reliability of trial outcomes.

Can 3D Imaging Improve Results in Colorectal Cancer Laparoscopic Surgery?

2025-06-23

Juan Cintas-Catena , Andrea Balla , Javier Valdés-Hernández +3 more | Journal of Clinical Medicine

Objective: The aim of this prospective comparative study is to report our experience with 3D laparoscopy in terms of surgeon’s discomfort with 3D vision, and to compare clinical outcomes with … Objective: The aim of this prospective comparative study is to report our experience with 3D laparoscopy in terms of surgeon’s discomfort with 3D vision, and to compare clinical outcomes with 2D laparoscopy in oncological colorectal surgery. Methods: From 2016 to 2017, all consecutive patients who underwent elective colorectal surgery for malignancy were enrolled. Based on surgery, patients were grouped as follows: group A, right hemicolectomy; group B, left hemicolectomy; group C, sigmoidectomy; and group D, anterior resection of the rectum. Results: In total, 171 patients were included, of which 61 were in group A (45 3D and 16 2D), 18 in group B (15 3D and 3 2D), 44 in group C (30 3D and 14 2D) and 48 in group D (36 3D and 12 2D). The surgeon’s discomfort did not occur due to the 3D vision. Complication rate and mean length of hospital stay (LOS) were lower in the 3D group in comparison to 2D, even if without statistically significant differences, in group B (6.6% versus 66.6% and LOS 6.1 ± 5.2 versus 23 ± 21 days), C (6.7% versus 21.4% and LOS 5.9 ± 2.5 versus 9 ± 8.4 days) and D (27.8% versus 50% and LOS 11.9 ± 16 versus 13 ± 11.8 days), respectively. Conclusions: Despite the lack of statistically significant differences between 2D and 3D laparoscopy, this study reports promising trends in favor of 3D laparoscopy, particularly for complex procedures such as anterior resection. Further randomized prospective studies with larger sample sizes and longer follow-up are necessary to conclusively determine the clinical impact of 3D laparoscopy in colorectal surgery.

Limitations and Disadvantages of Invasive Techniques in Colorectal Cancer Diagnosis

2025-06-23

J. Vijay Jayachandran , Arunkumar Radhakrishnan , Shruthi Nagainallur Ravichandran +2 more | CRC Press eBooks

Development of a prognostic model based on positive lymph node ratio for yp stage III colorectal cancer

2025-06-23

Kunjian Xia , Lin Wang , Ning Tang | Updates in Surgery

ASO Visual Abstract: Oncological Outcomes of Neoadjuvant Chemotherapy Versus Upfront Surgery in Locally Advanced Colon Cancer: A Systematic Review, Meta-analysis, and Sequential Analysis

2025-06-23

Richard Sassun , Annaclara Sileo , Jyi Cheng Ng +5 more | Annals of Surgical Oncology

The learning curve for single-incision laparoscopic colectomy for colon cancer: succession of surgical techniques for novice surgeons

2025-06-22

Mitsuyoshi Tei , Yozo Suzuki , Makoto Fujii +7 more | Surgery Today

Risk prediction models for permanence of temporary stoma after radical surgery of rectal cancer: a systematic review

2025-06-20

Wenjing Tan , Shubing Cai , Juanqin Wu +6 more | World Journal of Surgical Oncology

To methodologically assess the prediction model for temporary stoma permanence in patients with rectal cancer and provide evidence-based guidance for the construction and clinical application of related models. From launch … To methodologically assess the prediction model for temporary stoma permanence in patients with rectal cancer and provide evidence-based guidance for the construction and clinical application of related models. From launch to January 3, 2025, computer searches were performed in nine databases. Two researchers independently searched the literature, and the Critical Appraisal and Data Extraction Checklist for Systematic Evaluation of Predictive Modelling was used to extract data. The Predictive Modelling Research Risk of Bias Assessment Tool was used to assess the studies' applicability and risk of bias. Nine studies were incorporated, exhibiting AUC/C-index values between 0.612 and 0.942, signifying good predictive efficacy in some models. Nonetheless, the included studies showed restricted applicability and a high risk of bias, especially regarding the selection of research populations and data analysis. The predominant determinants across models encompassed T-stage, neoadjuvant chemoradiotherapy, American Society of Anesthesiologists score, carcinoembryonic antigen level, distant metastasis, lymph node metastasis, anastomotic leakage, and age. Current prediction models for temporary stoma permanence in rectal cancer patients exhibit significant limitations. In order to improve the accuracy of clinical predictions and inform clinical decision-making, future research should improve study design and reporting standards, as well as build and verify a prediction model that is highly applicable to real-world clinical demands and has a low risk of bias. PROSPERO: CRD420250637947.

Tailored-Surgery for Locally Advanced Rectal Cancer Based on 3D Mathematical Reconstruction Surgical Planner: Prospective Multicenter Study

2025-06-20

Álvaro García‐Granero , Sebastián Jerí‐McFarlane , Gianluca Pellino +7 more | Annals of Surgery Open

Objective: To evaluate the feasibility of a 3D image processing and reconstruction system (3D-IPR) based on pelvic magnetic resonance imaging (MRI) for surgical planning of locally advanced rectal cancer (LARC) … Objective: To evaluate the feasibility of a 3D image processing and reconstruction system (3D-IPR) based on pelvic magnetic resonance imaging (MRI) for surgical planning of locally advanced rectal cancer (LARC) and recurrent pelvic rectal cancer (PRCR). Background: Achieving R0 resection is critical for prognosis in LARC and PRCR, but 2D imaging often limits precise surgical planning in complex pelvic anatomy. 3D reconstruction may enhance visualization and decision-making. Methods: In this prospective feasibility multicenter study, 37 patients with LARC or PRCR and threatened circumferential resection margins on MRI underwent surgical planning using 3D-IPR. This tool provides information on tumor localization, infiltration volume, and precise spatial relationships with adjacent structures. Outcomes included surgeon satisfaction, changes in surgical approach, and perioperative results. Results: A total of 56.7% of cases were primary rectal cancer and 43.2% were recurrent cancer. Satisfaction percentage of 3D-IPR to select the best surgical route was 100%. Minimally invasive techniques were employed in 40% of the surgeries. In 37.8% of cases, it was considered that the 3D-IPR changed the decision on the surgical attitude with respect to the neighboring organ with suspicion of infiltration. R0 resection was achieved in 75.7% of cases, with no perioperative mortality and a severe complication rate of 27%. Conclusions: A surgical planner based on 3D reconstruction using mathematical algorithms from pelvic MRI is feasible for performing tailored surgery for locally advanced rectal cancers and pelvic recurrence. Further research will show if this new tool reduces the morbidity and mortality rates, increasing the probability of R0 surgery, and increasing survival.

A commentary“predicting disease-free survival following curative-intent resection of right-sided colon cancer using a pre-and post-operative nomogram: a prospective observational cohort study”

2025-06-20

Lingqin Zhou , Lingling Ren , Shuyuan Zhu +5 more | International Journal of Surgery

Personalized Treatment Modalities for Rectal Cancer: Advances in Neoadjuvant Treatment

2025-06-20

Nussara Pakvisal , Leontios Pappas , Bennett Adam Caughey +2 more | Journal of Clinical Medicine

Locally advanced rectal cancer treatment has shifted toward personalized, risk-adapted strategies that balance oncologic control with functional preservation while minimizing toxicity. A multidisciplinary team approach is essential, tailoring treatment guided … Locally advanced rectal cancer treatment has shifted toward personalized, risk-adapted strategies that balance oncologic control with functional preservation while minimizing toxicity. A multidisciplinary team approach is essential, tailoring treatment guided by individual patient risk factors and priorities. Traditional neoadjuvant chemoradiation and subsequent total mesorectal excision has improved local control, but concerns remain regarding systemic failure and treatment-related morbidity. Total neoadjuvant therapy is now widely considered a preferred approach for more advanced tumors, enhancing systemic control, improving chemotherapy compliance, and facilitating organ preservation in select patients. Recent studies highlight that response-based treatment adaptation allows for better patient stratification, with selected patients who respond well to preoperative chemotherapy potentially omitting radiation without compromising outcomes and omitting surgery for patients with complete clinical responses to chemoradiation and chemotherapy. Advances in molecular profiling, particularly in mismatch repair deficiency or microsatellite instability-high tumors, have enabled the implementation of immune checkpoint inhibitors, permitting select patients to avoid both radiation and surgery, thereby reducing treatment-related toxicities. Future research should focus on validating predictive biomarkers, such as circulating tumor DNA, refining patient selection, and optimizing treatment monitoring while also developing novel therapeutic strategies to further personalize locally advanced rectal cancer management.

Ex Vivo and Simulation Comparison of Leakage in End-to-End Versus End-to-Side Anastomosed Porcine Large Intestine

2025-06-20

Youssef Fahmy , Mohamed B. Trabia , Brian C. Ward +2 more | Bioengineering

Anastomotic leaks after colorectal resection are serious surgical complications. We have compared the integrity of two common colorectal anastomosis techniques, end-to-side (ES) and end-to-end (EE), to control specimens using a … Anastomotic leaks after colorectal resection are serious surgical complications. We have compared the integrity of two common colorectal anastomosis techniques, end-to-side (ES) and end-to-end (EE), to control specimens using a novel experimental setup that mimics anastomotic air leak tests, which are typically performed during surgeries. Freshly harvested porcine colonic sections from 23 F1 cross-species pigs were used. Pressure measurements and video imaging were used to monitor the ex vivo experiments on EE, ES, and Control specimens. Using EE (n = 16), ES (n = 12), and Control (n = 22) specimens, leak pressure was 282.6 ± 3.0 mm Hg for EE, 282.8 ± 2.6 mm Hg for ES, and 294.4 ± 12.1 for the Control. Time to leakage was 106.3 ± 28.1 s for EE, 263.9 ± 2127.0 s for ES, and 194.5 ± 90.2 s for the Control. We found that, while EE and ES have nearly identical leak pressures, ES was superior in terms of time to leakage and tissue expansion, which may explain why ES anastomoses have a lower clinical anastomotic leak rate. Two dependent variables representing stress and strain of colonic tissues were introduced. These variables showed ES was comparable to the Control. The experiments were simulated successfully using the finite element method (FEM). This research provides a reproducible ex vivo system with a corresponding FEM system to study the differences between anastomosis techniques and may help design anastomoses with lower leak rates and improve patient outcomes in colorectal surgeries.

Long-term results of emergency and planned surgical interventions performed for cancer of the left half of the colon in elderly and senile patients

2025-06-19

С. Н. Щаева , А. Г. Эфрон , L. I. Volynets | Surgery and Oncology

Aim . To evaluate the 3-year disease-free survival (DFS) of elderly and senile patients who underwent emergency and planned operations for cancer of the colon left half. Materials and methods … Aim . To evaluate the 3-year disease-free survival (DFS) of elderly and senile patients who underwent emergency and planned operations for cancer of the colon left half. Materials and methods . A retrospective cohort study with pseudorandomization included 514 patients divided into 2 groups. The 1 st group (n = 257) included patients who underwent emergency operations in surgical departments of clinical hospitals in Smolensk during the period from 10.10.2014 to 03.04.2023. Using the pseudorandomization procedure by comparison 1:1 the closest neighbor matching method, the 2nd group (n = 257) was formed from the database maintained prospectively which included patients having been operated routinely during the same period at the Smolensk Regional Oncological Clinical Dispensary. Inclusion criteria: 1) age 70–89 years; 2) patients with stage II–III cancer of the left colon, who underwent emergency surgery for acute obstructive obstruction, and patients with uncomplicated colon cancer having been operated in a planned manner; 3) histological type of tumor – adenocarcinoma. Non-inclusion criteria: 1) uncomplicated stage I colon cancer; 2) stage IV and/or locally advanced process; 3) emergency resection intervention in connection with other urgent complications; 4) non-epithelial malignancy, carcinoid. 3-year DFS was prospectively studied and factors of poor prognosis were identified. Results . The groups were matched for sex, age, Charlson comorbidity index, cancer location, and stage. The Charlson comorbidity index in both groups was ≥7 in most observations. Statistically significant differences in 3-year DFS were observed between the 2 study groups (p = 0.0014). The median follow-up in both groups was 30 months. In the subgroup analysis, statistically significant differences in 3-year DFS were found between patients who underwent emergency colonic resection at stage 1 according to the type of Hartmann operation (n = 145) and patients who developed decompression colostomy at the emergency stage, and stage 2, radical, was carried out after their condition was stabilized (n = 112) (p = 0.042). The median DFS for patients with Hartmann surgery was 24 months, patients with decompression colostomy was 28 months. Using a univariate analysis followed by confirmation in a multivariate analysis, factors of negative influence on the 3-year DFS indicators were determined: emergency resection intervention (hazard ratio (HR) 1.58; 95 % confidence interval (CI) 1.18–1.85; p < 0.001); local tumor status T4 (HR 1.22; 95 % CI 1.05–1.41; p < 0.001); step N+ (HR 1.36; 95 % CI 1.07–1.68; p < 0.001); resection R1 (HR 1.42; 95 % CI 1.04–1.51; p = 0.033); lymphovascular and perineural invasion (HR 1.55; 95 % CI 1.39–1.81; p < 0.001). Conclusion . The 3-year DFS of elderly and senile patients with left-sided localization of colon cancer is affected by surgical tactics, especially in an emergency. In the case of acute obturation obstruction, the formation of decompression colostomy is associated with higher DFS rates comparable to those of elective surgery.

Prospective Evaluation of the Influence of Chemoradiotherapy and Stoma on Functional and Symptomatic Outcomes in Rectal Cancer Patients

2025-06-19

Michael Schenker , Luiza Cristiana Bițînă , Ramona Adriana Schenker +7 more | Cancers

Rectal cancer is a major cause of morbidity and mortality worldwide, and although current therapeutic protocols have improved survival, treatment-related toxicities may significantly affect patients' daily functioning and emotional well-being. … Rectal cancer is a major cause of morbidity and mortality worldwide, and although current therapeutic protocols have improved survival, treatment-related toxicities may significantly affect patients' daily functioning and emotional well-being. This study aimed to prospectively assess the impact of radiotherapy with concurrent capecitabine on functional and symptomatic outcomes in patients with rectal cancer, with a particular focus on the presence of a stoma and treatment strategy. From 165 patients initially assessed, 64 were included in this study after applying eligibility criteria. All received pelvic radiotherapy (50.4 Gy in 28 fractions); 62.5% also received CAPOX chemotherapy. The quality of life was assessed using EORTC QLQ-C30 and QLQ-CR29 questionnaires administered at three time points: before treatment, mid-treatment (day 15), and post-treatment. A statistically significant deterioration was observed in physical, emotional, social, and role functioning over the course of treatment, along with an increase in symptom scores for fatigue, pain, gastrointestinal, and urinary complaints. The presence of a stoma was significantly associated with worse gastrointestinal symptoms and emotional functioning. No significant differences were noted between patients with or without chemotherapy. Despite symptom worsening, global quality-of-life scores remained relatively stable. These findings highlight the complex interplay between treatment toxicity and patient adaptation. The presence of a stoma and other clinical or demographic factors significantly influence patients' experience during therapy. Integrating routine assessment of functional and symptomatic burden into clinical practice could support individualized interventions aimed at maintaining daily functioning and psychological resilience during treatment.

Pathophysiology of anastomotic stricture following rectal anastomosis: Insights into mechanisms, risk factors, and preventive strategies

2025-06-19

Ahmet Yavuz , Hikmet Pehlevan Özel , Mesut Tez | World Journal of Gastrointestinal Pathophysiology

Anastomotic stricture (AS) remains a significant complication following rectal anastomosis, with an incidence ranging from 5% to 30% depending on surgical technique, patient factors, and postoperative management. This review aims … Anastomotic stricture (AS) remains a significant complication following rectal anastomosis, with an incidence ranging from 5% to 30% depending on surgical technique, patient factors, and postoperative management. This review aims to elucidate the pathophysiology of AS, exploring the underlying mechanisms that contribute to its development, including ischemia, inflammation, fibrosis, and impaired healing. Key risk factors such as low anterior resection, preoperative radiotherapy, and anastomotic leakage are critically analyzed based on recent clinical and experimental evidence. The article synthesizes current insights into the molecular and cellular processes, such as excessive collagen deposition and myofibroblast activation, that drive stricture formation. Furthermore, preventive strategies, including optimized surgical techniques (e.g., tension-free anastomosis), enhanced perioperative care, and emerging therapeutic interventions (e.g., anti-fibrotic agents), are discussed with an emphasis on translating research into clinical practice. By integrating findings from preclinical studies, clinical trials, and meta-analyses, this review highlights gaps in current knowledge and proposes future directions for research, such as the role of personalized medicine and novel biomaterials in reducing AS incidence. This comprehensive analysis underscores the need for a multidisciplinary approach to mitigate this challenging postoperative complication.

Quantitative proteomics analysis of radiation-induced rectal injury in rectal cancer patients undergoing radiotherapy

2025-06-19

Huajun Cai , Yanwei Lai , Biao Zhu +6 more | Journal of Proteomics

Podcast: ASCO25 Recap: CHALLENGE, DESTINY-Breast09, and More

2025-06-19

| Default Digital Object Group

Single-layer vs Double-layer Intestinal Anastomosis: A Prospective Comparative Study

2025-06-18

Ajaz Ahmad Malik , Munir Ahmad Wani , Shahnawaz Bashir +5 more | Euroasian Journal of Hepato-Gastroenterology

Importance of the diameter of the mechanical suture in rectal surgery in relation to benign anastomotic stenosis. Cross-sectional observational study

2025-06-18

Núria Llorach-Perucho , Ladislao Cayetano-Paniagua , Xavier Serra‐Aracil | Techniques in Coloproctology

Abstract Background Postoperative benign anastomotic rectal stenosis (BAS) has a significant incidence rate (2–30%). Recently, it has been shown that its incidence decreases with a larger anastomotic diameter (≥ 31 … Abstract Background Postoperative benign anastomotic rectal stenosis (BAS) has a significant incidence rate (2–30%). Recently, it has been shown that its incidence decreases with a larger anastomotic diameter (≥ 31 mm). The level of awareness of this data and the interest in creating an intraoperative anastomotic dilation system remain unknown. The aim of the study is to evaluate, using a survey sent to Spanish colorectal surgeons, the knowledge of postoperative strictures in rectal surgery as well as the use of methods to prevent them. Methods An observational cross-sectional study was conducted using a survey sent to 101 colorectal surgeons from 49 colorectal surgery units in Spanish hospitals in June 2024. Results Eighty-seven responses were obtained (86.1%); 39 (44.8%) were aware of their BAS rate, 41 (47.1%) recognized it as similar to the rate reported by our group (16.3%), and 82 (94.3%) considered this rate too high. Regarding mechanical sutures, none used 25-mm sutures, 43/87 (49.4%) used 28–29-mm sutures, 39/87 (44.8%) used 31-mm sutures, and only 5/87 (5.7%) used 33-mm sutures; 72.4% (63/87) were unaware of the existence of dilation mechanisms, while 15 (17.2%) knew about or used some type of device. In an ideal dilation situation, mechanical dilation (60%) predominated over pneumatic, although the same number of surgeons would choose to use dilators (21/87) as would opt not to use them (22/87). Forty-three of 87 (43.9%) would tend to use larger anastomotic diameters (31 mm). Conclusions There is a significant lack of knowledge about the incidence of BAS and its relationship with the anastomotic diameter. Increased awareness of these issues is needed, aiming to use the widest possible mechanical sutures (> 31 mm) and considering the need for dilation devices to reduce the incidence of BAS.

Gut-Microbiome Signatures Predicting Response to Neoadjuvant Chemoradiotherapy in Locally Advanced Rectal Cancer: A Systematic Review

2025-06-18

Ielmina Domilescu , Bogdan Miuţescu , Florin George Horhat +6 more | Metabolites

Rectal cancer management increasingly relies on watch-and-wait strategies after neoadjuvant chemoradiotherapy (nCRT). Accurate, non-invasive prediction of pathological complete response (pCR) remains elusive. Emerging evidence suggests that gut-microbiome composition modulates radio-chemosensitivity. … Rectal cancer management increasingly relies on watch-and-wait strategies after neoadjuvant chemoradiotherapy (nCRT). Accurate, non-invasive prediction of pathological complete response (pCR) remains elusive. Emerging evidence suggests that gut-microbiome composition modulates radio-chemosensitivity. We systematically reviewed primary studies that correlated baseline or on-treatment gut-microbiome features with nCRT response in locally advanced rectal cancer (LARC). MEDLINE, Embase and PubMed were searched from inception to 30 April 2025. Eligibility required (i) prospective or retrospective human studies of LARC, (ii) faecal or mucosal microbiome profiling by 16S, metagenomics, or metatranscriptomics, and (iii) response assessment using tumour-regression grade or pCR. Narrative synthesis and random-effects proportion meta-analysis were performed where data were homogeneous. Twelve studies (n = 1354 unique patients, median sample = 73, range 22-735) met inclusion. Four independent machine-learning models achieved an Area Under the Receiver Operating Characteristic curve AUROC ≥ 0.85 for pCR prediction. Consistently enriched taxa in responders included Lachnospiraceae bacterium, Blautia wexlerae, Roseburia spp., and Intestinimonas butyriciproducens. Non-responders showed over-representation of Fusobacterium nucleatum, Bacteroides fragilis, and Prevotella spp. Two studies linked butyrate-producing modules to radiosensitivity, whereas nucleotide-biosynthesis pathways conferred resistance. Pooled pCR rate in patients with a "butyrate-rich" baseline profile was 44% (95% CI 35-54) versus 21% (95% CI 15-29) in controls (I2 = 18%). Despite heterogeneity, convergent functional and taxonomic signals underpin a microbiome-based radiosensitivity axis in LARC. Multi-centre validation cohorts and intervention trials manipulating these taxa, such as prebiotics or live-biotherapeutics, are warranted before clinical deployment.

Transanal Transection and Single Stapled Anastomosis as A Reliable Technique for Distal Rectum Transection in Patients Undergoing Low Anterior Resection for Rectal Cancer

2025-06-18

Ayman Hanafy , Helmy Fekry , Mirza Ali +1 more | Research Square (Research Square)

<title>Abstract</title> Purpose To evaluate the safety, feasibility, and oncological and functional outcomes of the TTSS technique in rectal cancer surgery. Methods This retrospective study included 23 patients who underwent TTSS … <title>Abstract</title> Purpose To evaluate the safety, feasibility, and oncological and functional outcomes of the TTSS technique in rectal cancer surgery. Methods This retrospective study included 23 patients who underwent TTSS for rectal cancer. Data on demographics, tumor characteristics, perioperative variables, and postoperative outcomes were collected. Oncological parameters, anastomotic integrity, and functional outcomes were assessed. Short-term complications and early functional results were evaluated. Results The mean patient age was 48.87 ± 15.91 years, with a mean BMI of 25.22 ± 4.86 kg/m². Laparoscopic surgery was performed in 91.3% of cases, with no conversions to open surgery. The anastomotic leakage rate was 4.3%, managed conservatively. Anastomotic strictures developed in 13% of cases, requiring endoscopic dilation. The average operative time was 287.83 ± 38.70 minutes, and estimated blood loss was 195.65 ± 82.45 ml. The 30-day complication rate was 17.4%, with no major surgical re-interventions. Pathological complete response was achieved in 26.1% of cases, and 87% had negative lymph node involvement. Among patients who underwent ileostomy closure, 85% had complete continence, while 15% experienced minor incontinence symptoms. Conclusion TTSS is a feasible and safe technique for rectal cancer surgery, demonstrating favorable oncological outcomes, a low anastomotic leakage rate, and promising functional results.

The Importance of Screening and Early Diagnosis for a Good Outcome in Patients with Colorectal Cancer

2025-06-18

Mihai Tanase , Jessica O. Cirstea , Bianca S. Irava +1 more | Romanian Journal of Military Medicine

: Colorectal cancer (CRC) ranks third worldwide in terms of morbidity and second in mortality. In Romania, CRC represents the second leading cause of malignancy, accounting for 13.3% of all … : Colorectal cancer (CRC) ranks third worldwide in terms of morbidity and second in mortality. In Romania, CRC represents the second leading cause of malignancy, accounting for 13.3% of all diagnosed cancers and associated with a five-year survival rate close to 50%. Despite the availability of effective CRC screening programs proven to reduce incidence and mortality, low participation rates contribute to a high occurrence of advanced disease complications. As a result, bowel obstruction develops in approximately 25% of colorectal cancer cases, significantly worsening patient outcomes. This review aims to highlight the role of screening in reducing the incidence of such complications and to assess the outcomes associated with surgical management of malignant bowel obstruction. A comprehensive review of current literature was conducted, focusing on the incidence, clinical presentation, and management of intestinal obstructions in CRC patients. Emphasis was placed on studies evaluating screening programs, risk factors, and surgical interventions. Data indicate a continuous rise in emergency presentations due to obstructive CRC, correlating with low screening uptake. Early detection through organized screening significantly lowers the risk of obstruction and improves outcomes. Enhanced screening programs and early identification of high-risk individuals are crucial in preventing advanced CRC complications. Timely diagnosis not only reduces emergency surgical interventions but also improves prognosis and overall survival rates.

Self-Expanding Metal Stents as an Alternative to Palliative Surgery in Advanced Obstructive Colorectal Cancer—A Systematic Review and Meta-Analysis

2025-06-18

Vlad Rotaru , Elena Chitoran , Giuseppe Gullo +2 more | Journal of Clinical Medicine

The diagnosis of colorectal cancer in more advanced stages, especially in younger patients where the diagnosis usually occurs because of obstructive complications, has prompted the development of less invasive, more … The diagnosis of colorectal cancer in more advanced stages, especially in younger patients where the diagnosis usually occurs because of obstructive complications, has prompted the development of less invasive, more rapid and well tolerated methods of decompression as an alternative to the standard surgical approach. As such, self-expanding metal stents (SEMSs) have gained wide acceptance for the palliative alleviation of obstructive symptoms in patients with advanced colorectal cancer. The purpose of this study was to evaluate SEMS placement against various forms of palliative surgical procedures in terms of effectiveness, morbidity, mortality and oncologic results. We conducted a systematic search of PubMed, Web of Science, Cochrane Library and Medline for articles describing patients with incurable locally advanced obstructive colorectal cancer who underwent surgery or self-expanding metal stent placement as a palliative procedure for the alleviation of symptoms. Eighteen studies (1606 patients) were included in a pooled meta-analysis. In the surgery group the clinical success was slightly higher (98.62% vs. 94.92%; OR = 0.35, 95%CI [0.16-0.73], p = 0.005) and the late complications rate was lower (13.9% vs. 24.0%; OR = 3.01, 95%CI [2.06-4.39], p < 0.00001). The SEMS placement was associated with a lower early complication (11.3% vs. 28.1%; OR = 0.34, 95%CI [0.19-0.58], p = 0.0001) and a shorter length of hospital stay (SMD = -1.94, 95%CI [-2.76, -1.12], p < 0.00001). In terms of the oncologic results, surgery was significantly associated with an increased overall survival regardless of the type of procedure (OR = 1.24, 95%CI [1.08-1.42], p = 0.002). Although having lower early morbidity and mortality rates, SEMS placement was associated with an increased chance of late complications and a worse overall survival, thus making them avoidable when patients have longer life expectancies. Due to the lower early complications rates, SEMSs might still have a place in the management of selected cases with bowel obstruction.

High- versus low-intensity knowledge translation interventions for surgeons and rates of local tumour recurrence after rectal cancer surgery: an Ontario study

2025-06-18

Marko Šimunović , Christine Fahim , Vanja Grubac +4 more | Canadian Journal of Surgery

Given that diagnostic, neoadjuvant treatment, and surgical approaches to rectal cancer have changed markedly in the last 25 years, knowledge translation (KT) may be useful to optimize rectal cancer surgery … Given that diagnostic, neoadjuvant treatment, and surgical approaches to rectal cancer have changed markedly in the last 25 years, knowledge translation (KT) may be useful to optimize rectal cancer surgery and improve patient outcomes. We sought to evaluate the impact of surgeon-directed KT to improve the quality of rectal cancer surgery on local tumour recurrence in Ontario. Ontario's 14 health regions were previously categorized into 2 high-intensity and 12 low-intensity KT regions, based on KT methods (e.g., theory, audit, feedback), applied from 2006 to 2012 to improve the quality of rectal cancer surgery. In the high-intensity regions, efforts encouraged preoperative magnetic resonance imaging, appropriate radiation, and optimal surgical technique. We abstracted hospital chart data from across Ontario for a random sample of cases from 2010 to 2012 based on the respective population of a region and the relative hospital case volume within their region. The main study outcome was local tumour recurrence. In the high-intensity and low-intensity KT regions, we reviewed data from 523 (48.6%) and 557 (51.4%) patients, respectively. Descriptive variables (e.g., age, sex, tumour stage) were similar between groups. In the high- and low-intensity regions, the proportion of patients with a permanent stoma was 31.4% and 26.4% (p = 0.08), the proportion with positive radial margins was 8.0% and 6.1% (p = 0.2), and the proportion with local tumour recurrence was 6.3% and 5.2% (p = 0.2), respectively. The adjusted risk of time to local recurrence was similar in the high- and low-intensity KT regions (hazard ratio 0.72, 95% confidence interval 0.50-1.05). The use of resource-intense methods was not associated with improved patient outcomes, including local tumour recurrence. New approaches are needed to optimize the population-level quality of rectal cancer surgery.

A Review of Local Consent Practices for Colorectal Surgery With a Focus on Postoperative Bowel Dysfunction

2025-06-18

Mehul Sampat , Sanaa Elgaddal | Cureus

Pathomorphological quality assessment of complete mesocolonectomy in right colon cancer

2025-06-18

Inga Reznik , V. A. Avdeenko , A. A. Nevolskikh +4 more | Russian Journal of Archive of Pathology

Complete mesocolonectomy (CME) is the current standard of treatment for colon cancer patients. At the same time, there are currently no clear standards for the pathomorphological assessment of CME quality, … Complete mesocolonectomy (CME) is the current standard of treatment for colon cancer patients. At the same time, there are currently no clear standards for the pathomorphological assessment of CME quality, allowing for a comprehensive and independent assessment of the quality of surgical treatment. Objective. Creation of a standardized system of pathomorphological assessment of the quality of TMCE based on the developed set of universal criteria. Material and methods. The prospective study included the results of treatment of patients with adenocarcinomas of the right half of the colon, who underwent surgical interventions in the volume of right-sided hemicolectomy (RSHE) in the period from 2022 to 2024. The method of pathomorphological examination included mandatory photo documentation, as well as mesocolonectomy quality assessment using the classification of N. West et al., visual assessment of CME quality using the classification of S. Benz et al., standard microscopic examination to determine the presence of metastatic lymph nodes (LN) lesions, dividing them into groups according to the Japanese classification. Results. The study included 142 patients, 116 (81.7%) of whom underwent laparoscopic interventions, while 105 (73.9%) had D3 lymphodissection. According to the pathomorphological study, the most common (65 cases — 45.8%) tumors were located in the ascending section of the transverse colon, multicentric tumor growth within the colon was detected in 3 (2.1%) cases. The overwhelming majority of patients had stage III (92 patients — 64.9%) and IV (25 patients — 17.6%) clinical stages of the disease. The median of the studied LN was 48 (12—225), affected — 3 (1—51) LN. LN lesion was detected in 79 patients (55.6%). Damage to the apical LN was found in 9 (6.3%) cases. Unfavorable prognosis factors (perineural growth, lympho- and angiovascular invasion, the presence of tumor deposits and metastases in the lung) were identified in 92 (64.7%) patients. Good quality of mesocolic fascia isolation (Grade 3) according to West was found in 101 cases (71.1%), true CME (Type 0 according to Benz) was performed in 74 cases (52.1%). Conclusion. The quality assessment of the removed specimen after RSHE should be based on a detailed examination of all removed lymph nodes with division into groups in accordance with the Japanese Clinical Classification, assessment of the plane of intestinal resection according to N. West and the quality of CME according to S. Benz.

Isoperistaltic Side-to-side Anastomosis in Colorectal Surgery: Outcomes and Comparative Insights from Bahrain

2025-06-18

Mirza Faraz Saeed , Isam M Juma , Ahmed Taymour Algahiny +5 more | Euroasian Journal of Hepato-Gastroenterology

Robot-assisted laparoscopic surgery confers improved oncological outcomes

2025-06-17

Peter Sidaway | Nature Reviews Clinical Oncology

Robotic Versus Laparoscopic Surgery for Colorectal Cancer: A Trial Sequential Meta-Analysis of Randomized Trials

2025-06-17

Bernardo Fontel Pompeu , Luís Eduardo Braz de Moraes Alves , Beatriz D’Andrea Pigossi +5 more | Journal of Laparoendoscopic & Advanced Surgical Techniques

Background: Laparoscopic surgery (LS) is widely recognized as the standard minimally invasive method for colorectal cancer. Although robotic surgery (RS) has seen increased adoption, its clinical and economic advantages over … Background: Laparoscopic surgery (LS) is widely recognized as the standard minimally invasive method for colorectal cancer. Although robotic surgery (RS) has seen increased adoption, its clinical and economic advantages over LS remain uncertain. Methods: A systematic search was carried out across PubMed, Scopus, and the Cochrane Central Register up to March 2025. Only randomized controlled trials (RCTs) directly comparing RS and LS were included. Pooled risk ratios (RRs) and mean differences (MDs) with 95% confidence intervals (CIs) were calculated using random-effects models. Heterogeneity was assessed via the I2 statistic. Trial sequential analysis (TSA) was applied to assess the robustness of the cumulative evidence. Results: Fourteen RCTs encompassing 2867 patients were included. Compared with LS, RS significantly lowered the conversion rate to open surgery (RR = 0.54; 95% CI: 0.36-0.80; P = .002), time to first stool (MD = -0.33 days; 95% CI: -0.60 to -0.06; P = .016), and positive circumferential resection margin (CRM) (RR = 0.65; 95% CI: 0.46-0.93; P = .017). Sensitivity analysis revealed a slight benefit for RS in time to first flatus (MD = -0.13 days; P = .03). RS was associated with a longer surgery duration (MD = +49.4 minutes; 95% CI: 18.0-80.7; P = .002). No significant differences were observed for intraoperative blood loss, postoperative complications, or cancer recurrence. TSA confirmed definitive findings for selected outcomes, while others remained underpowered. Conclusions: RS and LS showed equivalent results for postoperative complications and cancer-related outcomes. RS was advantageous in reducing conversion and CRM positivity, despite longer operative time.

Impact of adjuvant chemotherapy on survival outcomes in older and non-older patients with high-risk stage II colorectal cancer

2025-06-17

Takuya Shiraishi , Chika Katayama , Yuta Shibasaki +7 more | Surgery Today

Impact of sex differences on risk factors for postoperative complications in transanal endoscopic surgery for rectal cancer: a large-scale Japanese multicenter cohort study

2025-06-17

Toru Miyake , Takeru Matsuda , Ichiro Takemasa +7 more | Surgical Endoscopy