The Role of the Laparoscopy on Circumferential Resection Margin Positivity in Patients With Rectal Cancer (original) (raw)
Related papers
Annals of Surgery, 2018
Objective: To determine the disease free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. Background: This randomized clinical trial (ACOSOG (Alliance) Z6051), performed between 2008-2013, compared LAP and OPEN resection of Stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2 year DFS and recurrence were secondary endpoints of Z6051. Methods: The DFS and recurrence were not powered and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12 and every 6 months thereafter using carcinoembryonic antigen, physical exam, computed tomography and colonoscopy. 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP=240 and OPEN=222). Median follow up is 47.9 months. Results: 2 year DFS was LAP 79.5% (95%CI, 74.4-84.9) and OPEN 83.2% (95% CI, 78.3-88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN. DFS was impacted by unsuccessful resection (HR 1.87, 95% CI, 1.21-2.91): (composite of incomplete specimen (HR 1.65, 95% CI, 0.85-3.18); positive circumferential resection margins (HR 2.31, 95% CI, 1.40-3.79); positive distal margin (HR 2.53, 95% CI, 1.30-3.77). Conclusion: Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence.
Longterm and Perioperative Outcomes of Laparoscopic and Open Surgery for Rectal Cancer
SiSli Etfal Hastanesi Tip Bulteni / The Medical Bulletin of Sisli Hospital, 2018
C olorectal cancers are common worldwide. According to the 2014 Turkish Statistical Institute, it is the fourth most common cancer type in Turkey. The biological structure of colorectal cancers may vary according to their location in the colon. [1] It is recommended that colorectal cancers be examined into two separate groups, as rectum tumors metastasize to the lymph nodes more frequently than colon tumors, and complications, such as anastomosis leakage after rectal surgery, are more frequent. [2, 3] The treatment of rectum cancers has always been challenging. With the use of laparoscopic surgery, the necessity of comparing open surgery with oncologic results arises. In Objectives: The necessity of comparing oncologic results with the use of minimally invasive surgery in rectal cancer has arisen. The aim of the present study was to evaluate the treatment approach in rectal cancer and to compare the outcomes of laparoscopic and open surgery. Methods: Patients who underwent surgery for rectal carcinoma between January 2006 and January 2016 in our institution were evaluated. The results were compared between the two groups according to open or laparoscopic surgery. Clinical characteristics, preoperative and postoperative results, pathological examination results, and disease-free survival rates were compared after the surgical procedure. Results: A total of 121 patients were included in the study. Of the patients, 50 underwent open, and 71 underwent laparoscopic surgery. The median follow-up times were 56.75 months in the open surgery group and 55.2 months in the laparoscopic surgery group. Pathological examination revealed similar numbers of lymph nodes in both groups (p>0.05). The duration of hospital stay was statistically significantly lower in the open surgery group than in the laparoscopic group (p<0.05). The rates of disease-free survival were 74% in the open surgery group and 82.5% in the laparoscopic group, and no statistically significant difference was found (p>0.05). Conclusion: There was no significant difference in complication and recurrence between laparoscopic and open surgery for rectal cancer in our study. The duration of hospital stay of patients was statistically significantly lower in the laparoscopic group than in the open surgery group. Laparoscopic or open surgical options could be preferred according to the clinical suitability of the patient, experience of the surgeon, and resources of the center in rectal cancer treatment.
Critical appraisal of laparoscopicvsopen rectal cancer surgery
World Journal of Gastrointestinal Surgery, 2016
AIM: To evaluate the long-term clinical and oncological outcomes of laparoscopic rectal resection (LRR) and the impact of conversion in patients with rectal cancer. METHODS: An analysis was performed on a prospective database of 633 consecutive patients with rectal cancer who underwent surgical resection. Patients were compared in three groups: Open surgery (OP), laparoscopic surgery, and converted laparoscopic surgery. Short-term outcomes, long-term outcomes, and survival analysis were compared. RESULTS: Among 633 patients studied, 200 patients had successful laparoscopic resections with a conversion rate of 11.1% (25 out of 225). Factors predictive of survival on univariate analysis include the laparoscopic approach (P = 0.016), together with factors such as age, ASA status, stage of disease, tumor grade, presence of perineural invasion and vascular emboli, circumferential resection margin < 2 mm, and postoperative adjuvant chemotherapy. The survival benefit of laparoscopic surgery was no longer significant on multivariate
A randomized trial of laparoscopic versus open surgery for rectal cancer
The New England journal of medicine, 2015
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. In this international trial conducted in 30 hospitals, we randomly assigned patients with a solitary adenocarcinoma of the rectum within 15 cm of the anal verge, not invading adjacent tissues, and without distant metastases to undergo either laparoscopic or open surgery in a 2:1 ratio. The primary end point was locoregional recurrence 3 years after the index surgery. Secondary end points included disease-free and overall survival. A total of 1044 patients were included (699 in the laparoscopic-surgery group and 345 in the open-surgery group). At 3 years, the locoregional recurrence rate was 5.0% in the two ...
2014
Background This review of cancer outcomes is based on key literature searches of the medical databases and metaanalysis of short-term benefits of laparoscopy in rectal cancer treatment. Methods We carried out a systematic review of randomized clinical trials (RCTs) and prospective non-randomized controlled trials (non-RCTs) published between January 2000 and September 2013 listed in the MEDLINE and EMBASE databases (PROSPERO Registration number: CRD42013005076). The primary endpoint was clearance of the circumferential resection margin. Meta-analysis was performed using a fixed-effect model, and sensitivity analysis by a random-effect model; subgroup analysis was performed on subsets of patients with extraperitoneal cancer of the rectum. Relative risk (RR) and mean difference (MD) were used as outcome measures. Results Twenty-seven studies (10,861 patients) met the inclusion criteria; eight were RCTs (2,659 patients). The RCTs reported involvement of the circumferential margin in 7.9 % of patients who underwent laparoscopic and in 6.9 % of those undergoing open surgery; the overall RR was 1.00 (95 % confidence interval 0.73-1.35) with no heterogeneity.
The Lancet Oncology, 2013
Methods A non-inferiority phase 3 trial was undertaken at 30 centres and hospitals in eight countries. Patients (aged ≥18 years) with rectal cancer within 15 cm from the anal verge without evidence of distant metastases were randomly assigned to either laparoscopic or open surgery in a 2:1 ratio, stratifi ed by centre, location of tumour, and preoperative radiotherapy. The study was not masked. Secondary (short-term) outcomes-including operative fi ndings, complications, mortality, and results at pathological examination-are reported here. Analysis was by modifi ed intention to treat, excluding those patients with post-randomisation exclusion criteria and for whom data were not available. This study is registered with ClinicalTrials.gov, number NCT00297791.
Reconsideration of the oncologic safety of laparoscopic rectal cancer surgery
Annals of Coloproctology
The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in the recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or disease-free survival rate between laparoscopic and open surgery. However, the non-inferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaCaRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TME had unfavorable oncologic outcomes compared to the complete TME. Although the TME quality can be clearly identified on pathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery. It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgery with near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-term outcomes and the meta-analysis of the ongoing large-scale RCTs. The laparoscopic rectal cancer surgery has been steadily increasing with its oncologic safety having been reported consistently in various multicenter RCTs. To improve the surgical quality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.
Medicine, 2016
The goal of rectal cancer treatment is to minimize the local recurrence rate and extend the disease-free survival period and survival. For this aim, obtainment of negative circumferential radial margin (CRM) plays an important role. This study evaluated predictive factors for positive CRM status and its effect on patient survival in mid- and distal rectal tumors.Patients who underwent curative resection for rectal cancer were included. The main factors were demographic data, tumor location, surgical technique, neoadjuvant therapy, tumor diameter, tumor depth, lymph node metastasis, mesorectal integrity, CRM, the rate of local recurrence, distant metastasis, and overall and disease-free survival. Statistical analyses were performed by using the Chi-squared test, Fisher exact test, Student t test, Mann-Whitney U test and the Mantel-Cox log-rank sum test.A total of 420 patients were included, 232 (55%) of whom were male. We observed no significant differences in patient characteristics...
Laparoscopic Resection for Rectal Cancer: What Is the Evidence?
BioMed Research International, 2014
Laparoscopic colectomy for colon cancer is a well-established procedure supported by several well-conducted large-scale randomised controlled trials. Patients could now be conferred the benefits of the minimally invasive approach while retaining comparable oncologic outcomes to the open approach. However, the benefits of laparoscopic proctectomy for rectal cancer remained controversial. While the laparoscopic approach is more technically demanding, results from randomised controlled trials regarding long term oncologic outcomes are only beginning to be reported. The impacts of bladder and sexual functions following proctectomy are considerable and are important contributing factors to the patients' quality of life in the long-term. These issues present a delicate dilemma to the surgeon in his choice of operative approach in tackling rectal cancer. This is compounded further by the rapid proliferation of various laparoscopic techniques including the hand assisted, robotic assisted, and single port laparoscopy. This review article aims to draw on the significant studies which have been conducted to highlight the short-and long-term outcomes and evidence for laparoscopic resection for rectal cancer. Pendlimari et al. 's [31] analysed results for both rectal and colon cancers. No subdivision was made between the two types and hence cannot be accurately reflected here.
Reconsideration of the Safety of Laparoscopic Rectal Surgery for Cancer
Annals of Coloproctology, 2019
The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or diseasefree survival rate between laparoscopic and open surgery. However, the noninferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaC-aRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incomplete TME had unfavorable oncologic outcomes compared to complete TME. Although TME quality can be clearly identified on pathologic evaluation, there is controversy regarding the acceptable range of oncologically safe TME for laparoscopic surgery. It is not certain whether near-complete TME has an unfavorable oncologic impact and whether laparoscopic surgery with near-complete TME is an oncological threat. Therefore, the surgical community will be interested in the long-term outcomes and meta-analyses of ongoing large-scale RCTs. Laparoscopic rectal cancer surgery has been steadily improving its safety for oncology surgery, which has been reported consistently in various multicenter RCTs. To improve surgical quality, colorectal surgeons should choose the most appropriate surgical technique, including laparoscopic surgery.