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Geitenbeek RTJ, Duhoky R, Burghgraef TA, Piozzi GN, Masum S, Hopgood AA, Denost Q, van Eetvelde E, Bianchi P, Rouanet P, Hompes R, Gómez Ruiz M, Briggs J, Khan JS, Consten ECJ, on behalf of the ALRITE Study Group. Analysis of Local Recurrence After Robotic-Assisted Total Mesorectal Excision (ALRITE): An International, Multicentre, Retrospective Cohort. Cancers (Basel) 2025; 17:992. [PMID: 40149327 PMCID: PMC11940555 DOI: 10.3390/cancers17060992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2025] [Revised: 03/09/2025] [Accepted: 03/12/2025] [Indexed: 03/29/2025] Open
Abstract
BACKGROUND/OBJECTIVES Rectal cancer is a major global health issue with high morbidity and mortality rates. Local recurrence (LR) significantly impacts patient outcomes, decreasing survival rates and often necessitating extensive secondary treatments. While robot-assisted total mesorectal excision (R-TME) is becoming a preferred method for rectal cancer surgery due to its improved precision and visualisation, long-term data on LR and predictors of recurrence remain limited. This study aims to determine the 3-year LR rate following R-TME and to identify predictors of recurrence to enhance patient selection and the personalisation of treatment. METHODS This retrospective international multicentre cohort study included 1039 consecutive rectal cancer patients who underwent R-TME between 2013 and 2020, with a minimum of 3 years of follow-up. Data from tertiary colorectal centres in the United Kingdom, the Netherlands, Spain, France, Italy, and Belgium were analysed. Potential predictors of LR were identified using backward elimination, and four machine learning models were evaluated for predicting LR. RESULTS The 3-year LR rate was 3.8%. Significant predictors of LR included advanced clinical M-staging, length of the hospital stay, postoperative ileus, postoperative complications, pathological N-staging, the completeness of resection, and the resection margin distance. The eXtreme Gradient Boosting model performed best for LR prediction, with a final accuracy of 77.1% and an AUC of 0.76. CONCLUSIONS R-TME in high-volume centres achieves low 3-year LR rates, suggesting that robot-assisted surgery offers oncological safety and advantages in rectal cancer management. This study underscores the importance of surgical precision, patient selection, and standardised perioperative care, supporting further investment in robotic training to improve long-term patient outcomes.
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Affiliation(s)
- Ritch T. J. Geitenbeek
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.T.J.G.)
- Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - Rauand Duhoky
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (G.N.P.)
- Faculty of Technology, University of Portsmouth, Portsmouth PO1 3HE, UK;
| | - Thijs A. Burghgraef
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.T.J.G.)
- Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
| | - Guglielmo Niccolò Piozzi
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (G.N.P.)
| | - Shamsul Masum
- School of Electrical and Mechanical Engineering, University of Portsmouth, Portsmouth PO1 3HE, UK
| | - Adrian A. Hopgood
- Faculty of Technology, University of Portsmouth, Portsmouth PO1 3HE, UK;
| | - Quentin Denost
- Bordeaux Colorectal Institute, Clinique Tivoli, 33300 Bordeaux, France
| | - Ellen van Eetvelde
- Department of Surgery, Universitair Ziekenhuis Brussel, 1090 Jette, Belgium
| | - Paolo Bianchi
- General Surgery Unit, Department of Health Sciences (DISS), University of Milan San Paolo Hospital, 20142 Milan, Italy
| | - Philippe Rouanet
- Surgery Department, Montpellier Cancer Institute (ICM), Université Montpellier, 34090 Montpellier, France
| | - Roel Hompes
- Department of Surgery, University Medical Center Amsterdam, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands
- Department of Surgery, Amsterdam Cancer Center, 1081 HV Amsterdam, The Netherlands
| | - Marcos Gómez Ruiz
- Department of Surgery, Marqués de Valdecilla University Hospital, 39008 Santander, Spain
- Valdecilla Biomedical Research Institute (IDIVAL), 39011 Santander, Spain
| | - Jim Briggs
- Centre for Healthcare Modelling and Informatics, University of Portsmouth, Portsmouth PO1 3HE, UK
| | - Jim S. Khan
- Department of Colorectal Surgery, Portsmouth Hospitals University NHS Trust, Portsmouth PO6 3LY, UK (G.N.P.)
- Faculty of Health Sciences, University of Portsmouth, Portsmouth PO1 3HE, UK
| | - Esther C. J. Consten
- Department of Surgery, University Medical Center Groningen, University of Groningen, 9713 GZ Groningen, The Netherlands; (R.T.J.G.)
- Department of Surgery, Meander Medical Center, 3813 TZ Amersfoort, The Netherlands
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Sakamoto J, Tsutsui A, Hagiwara C, Wakabayashi G. Oncologic Impact of Conservative Treatment Compared with Surgical Treatment of Anastomotic Leakage Following Colorectal Cancer Surgery: A Retrospective Study. J Anus Rectum Colon 2025; 9:61-68. [PMID: 39882223 PMCID: PMC11772793 DOI: 10.23922/jarc.2024-005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 10/03/2024] [Indexed: 01/31/2025] Open
Abstract
Objectives Differences in oncological outcomes between conservative and surgical treatments for anastomotic leakage (AL) in patients undergoing colorectal cancer surgery remain unclear. Methods From July 2011 to June 2020, 385 patients underwent curative resection with double-stapling anastomosis for left-sided colon and rectal cancers. Among them, 33 patients who experienced AL were retrospectively evaluated and categorized into two groups: conservative (n = 20) and surgical (n = 13). In the surgical group, abdominal lavage using a sufficient amount of normal saline was performed during reoperation. The primary endpoint was the 3-year cumulative incidence of local recurrence (LR). Results Seven (21.2%) patients in the conservative group experienced LR, while none in the surgical group. Survival analysis indicated no differences in overall and recurrent-free survival. However, the 3-year cumulative incidence of LR was significantly lower in the surgical group than in the conservative group (0% versus 31.3%, p=0.045). Conclusions Differences in AL management were associated with oncological outcomes, specifically a decreased LR. Therefore, surgeons should consider our findings when determining the most appropriate AL treatment to improve oncological outcomes.
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Affiliation(s)
- Junichi Sakamoto
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Atsuko Tsutsui
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Chie Hagiwara
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Ageo, Japan
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Furuya S, Shiraishi K, Shimizu H, Takiguchi K, Sudo M, Hidenori A, Kawaguchi Y, Amemiya H, Kondo T, Ichikawa D. Intraluminal washout in rectal and sigmoid colon cancer surgeries with double-stapling technique anastomosis: A single-institution prospective study. Ann Gastroenterol Surg 2025; 9:137-144. [PMID: 39759981 PMCID: PMC11693581 DOI: 10.1002/ags3.12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 04/21/2024] [Accepted: 07/29/2024] [Indexed: 01/07/2025] Open
Abstract
Aim This study aimed to determine the necessity of intraluminal washout through cytological assessment to prevent implantation of exfoliated cancer cells (ECCs) in patients with rectal and sigmoid cancers. Methods We studied 140 patients with either sigmoid or rectal cancer who underwent anastomosis surgery using a double-stapling technique. An intraluminal washout sample was collected before and after irrigation with 1000, 1500, or 2000 mL of physiological saline or distilled water. Cytological assessments were conducted using the Papanicolaou classification system, where classes IV and V indicated positive cytological findings. Results Initially, 46.4% of the patients (65 out of 140) had positive ECCs. Patients with cancer cells had a significantly shorter distal free margin (DM) from the tumor (p < 0.001). The length of the DM was significantly associated with the tumor distance from the anal verge (p < 0.001). After irrigation with 2000 mL, ECCs were found in only 7.3% of patients. Logistic regression analysis showed that DM (≤50 mm) and tumor size (≥50 mm) were independent risk factors for positive ECCs after intraluminal washout, regardless of the type of irrigation solution used. Conclusion In patients with sigmoid colon cancer, adequate preoperative bowel preparation, a long DM, and a small tumor size, a 1000 mL intraluminal washout may be sufficient. By contrast, in patients with rectal cancer with a short DM and a large tumor size, a ≥2000 mL intraluminal washout is required. The different types of irrigation solution did not affect the ECCs. Large randomized controlled trials are required to confirm these results.
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Affiliation(s)
- Shinji Furuya
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Kensuke Shiraishi
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Hiroki Shimizu
- Division of Digestive Surgery, Department of SurgeryKyoto Prefectural University of MedicineKyotoJapan
| | - Koichi Takiguchi
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Makoto Sudo
- Department of SurgeryYamanashi Kosei HospitalYamanashiJapan
| | - Akaike Hidenori
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Hidetake Amemiya
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of MedicineUniversity of YamanashiChuoJapan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of MedicineUniversity of YamanashiChuoJapan
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Urabe Y, Tanaka H, Nakahara H, Tanino F, Yamashita K, Akabane S, Ishikawa A, Shimomura M, Ohdan H, Oka S. A case of colon cancer implanted on endoscopic resection ulcer certified by cancer genomic testing. Clin J Gastroenterol 2024; 17:1047-1052. [PMID: 39325309 PMCID: PMC11549191 DOI: 10.1007/s12328-024-02037-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 09/05/2024] [Indexed: 09/27/2024]
Abstract
A 90 year-old man underwent endoscopic mucosal resection for lesions in the descending and sigmoid colons as well as endoscopic submucosal dissection (ESD) for a lesion in the rectal peritoneal reflection (Ra) 1 month before undergoing laparoscopic resection and D3 dissection for advanced cancer in the descending colon. One year later, he underwent a surveillance colonoscopy, and advanced colorectal cancer was detected on the ESD scar. The history suggested that this newly detected recurrent colorectal neoplasm on the ESD scar may have originated from cancer cells derived from the descending colon cancer that were implanted in the ESD ulcer, thereby initiating a new colorectal neoplasm. Cancer genomic testing further indicated that three of the four pathogenic variants detected in the recurrent colorectal neoplasm were consistent with pathogenic variants of descending colon cancer. This finding strongly supports our contention that cancer cells derived from the descending colon cancer were implanted in the post-ESD ulcer of the rectal Ra and proliferated, forming the recurrent colorectal neoplasm. This case report highlights the potential for tumor cell implantation on endoscopic resection ulcers and the utility of cancer genomic testing in validating this phenomenon.
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Affiliation(s)
- Yuji Urabe
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan.
- Department of Gastrointestinal Endoscopy and Medicine, Hiroshima University Hospital, Hiroshima, Japan.
| | - Hidenori Tanaka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Hikaru Nakahara
- Department of Clinical and Molecular Genetics, Hiroshima University Hospital, 1-2-3, Kasumi, Hiroshima, Minamiku, 734-8551, Japan
| | - Fumiaki Tanino
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Ken Yamashita
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
| | - Shintaro Akabane
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Akira Ishikawa
- Department of Molecular Pathology, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Manabu Shimomura
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Hideki Ohdan
- Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Shiro Oka
- Department of Gastroenterology, Hiroshima University Hospital, Hiroshima, Japan
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Lim JH, Lee WY, Yun SH, Kim HC, Cho YB, Huh JW, Park YA, Shin JK. Can neoadjuvant chemoradiotherapy affect exfoliated cancer cells in colorectal cancer? BMC Surg 2024; 24:321. [PMID: 39425147 PMCID: PMC11487969 DOI: 10.1186/s12893-024-02600-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Accepted: 09/30/2024] [Indexed: 10/21/2024] Open
Abstract
BACKGROUND To prevent local recurrence caused by exfoliated cancer cells caught in the suture line, intraoperative rectal washout during surgery can be performed to eliminate exfoliated cancer cells. However, the impact of neoadjuvant chemoradiotherapy on exfoliated cancer cells is not well known. This study aimed to identify positive rate of malignant cells in rectal washout fluids of neoadjuvant chemoradiotherapy patients and to determine if neoadjuvant chemoradiotherapy could affect exfoliated cancer cells. METHODS A total of 105 patients who underwent rectal washout intraoperatively for distal sigmoid colon and rectal cancer from April 2020 to September 2021 were analyzed. The primary outcome was positive rate of malignant cells in rectal washout fluids of patients who had received neoadjuvant chemoradiotherapy. RESULTS The positive rate of malignant cells in washout fluids of patients who had received neoadjuvant chemoradiotherapy was 0.0% and those who had not was 32.1%. The overall positive rate was 23.8%. In the positive group, tumor sizes were bigger (4.64 ± 1.68 cm vs. 3.64 ± 2.00 cm, p = 0.026) and more patients had a fungating tumor shown in preoperative colonoscopy (96.0% vs. 71.3%, p = 0.012). Although these factors did not show statistical significance in multivariable logistic regression analysis, fungating tumor showed a trend towards significance (OR: 7.28, 95% CI: 0.90-58.77, p = 0.063). CONCLUSIONS Our study suggests that neoadjuvant chemoradiotherapy could reduce exfoliated cancer cells, and rectal washout for the purpose of eliminating exfoliated cancer cells might be unnecessary in patients who have received neoadjuvant chemoradiotherapy.
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Affiliation(s)
- Ji Ha Lim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Woo Yong Lee
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea.
| | - Seong Hyeon Yun
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Hee Cheol Kim
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Yong Beom Cho
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Jung Wook Huh
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Yoon Ah Park
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
| | - Jung Kyong Shin
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul, 06351, Korea
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Fiori JG, Kim S, Wallace MH, Rankin S, Ayonrinde OT. Risk of metachronous colorectal cancer associated with polypectomy during endoscopic diagnosis of colorectal cancer. Int J Colorectal Dis 2024; 39:155. [PMID: 39356297 PMCID: PMC11447038 DOI: 10.1007/s00384-024-04722-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/12/2024] [Indexed: 10/03/2024]
Abstract
BACKGROUND AND AIM There are conflicting reports regarding the risk of metachronous colorectal cancer (CRC) subsequent to colonoscopy with polypectomy or biopsy performed concurrently with diagnostic biopsies for CRC. We aimed to establish the 5-year risk of CRC in patients who had synchronous polypectomy or biopsies during the colonoscopy at which CRC was diagnosed. METHODS This is a single-centre retrospective case-control study of adults who underwent surgical resection for CRC over a 2-year period (January 2016 to December 2017). Colonoscopy details of interest were the location of the CRC, polypectomy and non-CRC biopsy sites. In patients with CRC at index colonoscopy, we sought associations between the occurrence of metachronous CRC and the sites from which endoscopic specimens had been obtained. RESULTS Our study population comprised 225 patients with a median (IQR) age of 71 (60-77) years. Polypectomy or biopsy at a non-CRC site had been performed during the index colonoscopy in 108 patients (48%), including 83 (37%) polypectomies outside the surgical resection field. There were 8 (3.6%) metachronous CRCs: 1 (0.4%) at the site of endoscopic mucosal resection for a 15-mm sessile serrated lesion, 3 (1.3%) anastomotic site CRCs and 4 (1.8%) at other sites within the colon. There was no significant difference in the prevalence of metachronous CRC in patients who underwent polypectomy/biopsy at the index colonoscopy compared with those who did not (1.9% vs. 5.1%, p = 0.283). CONCLUSION There was no significant increased risk of metachronous CRC subsequent to synchronous polypectomy or biopsy during the colonoscopy at which CRC was diagnosed.
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Affiliation(s)
- James Giulian Fiori
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Perth, WA, WA 6150, Australia
| | - Steven Kim
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Perth, WA, WA 6150, Australia
| | | | - Samantha Rankin
- Clinical Services, Fiona Stanley Hospital, Perth, WA, Australia
| | - Oyekoya Taiwo Ayonrinde
- Department of Gastroenterology and Hepatology, Fiona Stanley Hospital, 11 Robin Warren Drive, Murdoch, Perth, WA, WA 6150, Australia.
- Medical School, The University of Western Australia, Perth, WA, Australia.
- Medical School, Curtin University, Bentley, WA, Australia.
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Huang F, Jiang S, Wei R, Xiao T, Wei F, Zheng Z, Liu Q. Association of resection margin distance with anastomotic recurrence in stage I-III colon cancer: data from the National Colorectal Cancer Cohort (NCRCC) study in China. Int J Colorectal Dis 2024; 39:105. [PMID: 38995409 PMCID: PMC11245431 DOI: 10.1007/s00384-024-04684-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/06/2024] [Indexed: 07/13/2024]
Abstract
PURPOSE Few studies have focused on anastomotic recurrence (AR) in colon cancer. This study aimed to clarify the association of resection margin distance with AR and compare the prognosis with nonanastomotic local recurrence (NAR). METHODS This retrospective cohort study included the clinical data of patients who underwent radical colon cancer surgery between January 1, 2009, and December 31, 2019. RESULTS A total of 1958 colon cancer patients were included in the study. 34 of whom (1.7%) had AR and 105 of whom (5.4%) had NAR. Multivariate analysis revealed that the lower distal resection margin distance, advanced N stage, and number of lymph nodes dissected were risk factors for AR. In the proximal resection margin, the risk of AR was lowest at a distance of 6 cm or greater, with a 3-year rate of 1.3%. In the distal resection margin, the 3-year AR risk increased rapidly if the distance was less than 3 cm. The prognosis of patients in the AR group was similar to that of patients in the NAR group, regardless of synchronous distant metastases. Furthermore, the radical surgery rate for AR was significantly higher than that for NAR, but the prognosis of AR was comparable to that of NAR. CONCLUSIONS The distal resection margin distance, advanced N stage, and less number of lymph nodes dissected are associated with AR of colon cancer. The prognosis of patients with AR was similar to that of patients with NAR. TRIAL REGISTRATION Clinical Trial Numbers NCT04074538 ( clinicaltrials.gov ), August 26, 2019, registered, retrospectively registered.
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Affiliation(s)
- Fei Huang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Shan Jiang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Ran Wei
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Tixian Xiao
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Fangze Wei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China
| | - Zhaoxu Zheng
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
| | - Qian Liu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 17 Panjiayuan Nanli, Chaoyang District, Beijing, 100021, China.
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Okumura T, Hayashi T, Kudo S, Mochizuki K, Abe M, Sakurai T, Kouyama Y, Ogawa Y, Maeda Y, Toyoshima N, Misawa M, Kudo T, Wakamura K, Baba T, Ishida F, Miyachi H. Endoscopic submucosal dissection for colorectal neoplasms: Risk factors for local recurrence and long-term surveillance. DEN OPEN 2024; 4:e269. [PMID: 37404727 PMCID: PMC10315643 DOI: 10.1002/deo2.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/08/2023] [Accepted: 06/18/2023] [Indexed: 07/06/2023]
Abstract
Objectives Endoscopic submucosal dissection (ESD) is an effective procedure for the en bloc resection of colorectal neoplasms. However, risk factors for local recurrence after ESD have not been identified. This study aimed to evaluate such risk factors after ESD for colorectal neoplasms. Methods This retrospective study included 1344 patients with 1539 consecutive colorectal lesions who underwent ESD between September 2003 and December 2019. We investigated various factors associated with local recurrence in these patients. The main outcomes were the incidence of local recurrence and its relationship with clinicopathological factors during long-term surveillance. Results The en bloc resection rate was 98.6%, the R0 resection rate was 97.2%, and the histologically complete resection rate was 92.7%. Local recurrence was observed in 7/1344 (0.5%) patients and the median follow-up period was 72 months (range 4-195 months). The incidence of local recurrence was significantly higher in lesions ≥40 mm in diameter (hazard ratio [HR] 15.68 [1.88-130.5]; p = 0.011), piecemeal resection (HR 48.42 [10.7-218.7]; p < 0.001), non-R0 resection (HR 41.05 [9.025-186.7]; p < 0.001), histologically incomplete resection (HR 16.23 [3.627-72.63]; p<0.001), and severe fibrosis (F2; HR 9.523 [1.14-79.3]; p = 0.037). Conclusions Five risk factors for local recurrence after ESD were identified. Patients with such factors should undergo careful surveillance colonoscopy.
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Affiliation(s)
- Taishi Okumura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Takemasa Hayashi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Shin‐ei Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kenichi Mochizuki
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masahiro Abe
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Tatsuya Sakurai
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yuta Kouyama
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yushi Ogawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Yasuharu Maeda
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Naoya Toyoshima
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Masashi Misawa
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toyoki Kudo
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Kunihiko Wakamura
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Toshiyuki Baba
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Fumio Ishida
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
| | - Hideyuki Miyachi
- Digestive Disease CenterShowa University Northern Yokohama HospitalKanagawaJapan
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Maurer CA, Walensi M, Mattiello D, Käser SA, Zarfl K, Egger C. Intraoperative esophageal washout reduces free intraluminal tumor cells during resection of carcinomas of the esophagus and cardia. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108017. [PMID: 38377885 DOI: 10.1016/j.ejso.2024.108017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/26/2024] [Accepted: 02/10/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Intraluminally shed viable tumor cells might contribute to anastomotic recurrence in cancer of the esophagus and the cardia. The study aimed to establish a method of esophageal washout and, hence, to reduce intraluminal cancer cells before esophageal anastomosis. METHODS Forty-eight consecutive patients with esophago-gastric resection for histologically proven cancer of the esophagus or the cardia were included in a prospective, interventional study. Before transection, the esophagus was clamped proximally to the tumor and rinsed with 1:10 diluted povidone-iodine-solution (10 × 30 ml) applied by a transorally inserted 24F-Foley catheter. The first, fifth and tenth portion of the lavage fluid were sent to cytological examination. RESULTS Intraoperative frozen sections confirmed clear proximal resection margins of the esophagus. The cytological examination of the fluid recovered from the esophageal washout revealed malignant cells in 13/48 patients (27%). The presence of malignant cells was significantly less likely in patients with neoadjuvant treatment than in patients without neoadjuvant treatment: 2/23 (9%) vs. 11/25 (44%) (p = 0.009). Repetitive washout reduced the probability of detectable malignant cells from 13 to 8 (62%) patients after 5, and further to 4 patients (30%) after 10 washout maneuvers. CONCLUSIONS Free malignant cells may be present in the esophageal lumen following intraoperative manipulation of cancers of the esophagus or cardia. Transoral washout of the esophagus is novel, feasible and enables reduction or even elimination of these tumor cells. The reliability of this procedure raises with increasing washout volume. Esophageal washout might be especially worthwhile in patients who do not receive neoadjuvant therapy.
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Affiliation(s)
- Christoph Andreas Maurer
- Visceral Surgery, HIRSLANDEN Private Hospital Group, Clinic Beau-Site, Bern, Switzerland; Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland.
| | - Mikolaj Walensi
- Clinical Trial Unit, HIRSLANDEN Private Hospital Group, Klinik Hirslanden, Zurich, Switzerland; Elisabeth-Hospital Essen, Department of Vascular Surgery and Phlebology Essen, Germany
| | - Diana Mattiello
- Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; Department of Surgery, Spital Limmattal, Schlieren, Switzerland
| | - Samuel Andreas Käser
- Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; soH Solothurner Spitäler AG, Department of General, Visceral, Thoracic and Vascular Surgery, Solothurn, Switzerland
| | - Kathrin Zarfl
- Department of Surgery, Hospital of Liestal, Affiliated to the University of Basel, Liestal, Switzerland; Department of Surgery, Hospital of Dornbirn, Dornbirn, Austria
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10
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Vigneswaran J, Keskey RC, Morgan RB, Alverdy JC, Alpert L, Chang E, Weichselbaum R, Zaborina O, Shogan BD. Western Diet-induced Transcriptional Changes in Anastomotic Tissue Is Associated With Early Local Recurrence in a Mouse Model of Colorectal Surgery. Ann Surg 2023; 278:954-960. [PMID: 37522222 PMCID: PMC10775465 DOI: 10.1097/sla.0000000000006052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
OBJECTIVE To determine the timeframe and associated changes in the microenvironment that promote the development of a diet-induced local-regional recurrence in a mouse model of colorectal surgery. BACKGROUND Postoperative recurrence and metastasis occur in up to 30% of patients undergoing attempted resection for colorectal cancer (CRC). The underlying mechanisms that drive the development of postoperative recurrences are poorly understood. Preclinical studies have demonstrated a diet and microbial-driven pathogenesis of local-regional recurrence, yet the precise mechanisms remain undefined. METHODS BALB/C mice were fed a western diet (WD) or standard diet (SD), underwent a colon resection and anastomosis, given an Enterococcus faecalis enema on postoperative day (POD) 1, and subjected to a CT26 cancer cell enema (mimicking shed cancer cells) on POD2. Mice were sacrificed between POD3 and POD7 and cancer cell migration was tracked. Dynamic changes in gene expression of anastomotic tissue that were associated with cancer cell migration was assessed. RESULTS Tumor cells were identified in mice fed either a SD or WD in both anastomotic and lymphatic tissue as early as on POD3. Histology demonstrated that these tumor cells were viable and replicating. In WD-fed mice, the number of tumor cells increased over the early perioperative period and was significantly higher than in mice fed a SD. Microarray analysis of anastomotic tissue found that WD-fed mice had 11 dysregulated genes associated with tumorigenesis. CONCLUSIONS A WD promotes cancer cells to permeate a healing anastomosis and migrate into anastomotic and lymphatic tissue forming viable tumor nodules. These data offer a novel recurrence pathogenesis by which the intestinal microenvironment promotes a CRC local-regional recurrence.
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Affiliation(s)
- Janani Vigneswaran
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Robert C. Keskey
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Ryan B. Morgan
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - John C. Alverdy
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Lindsay Alpert
- The University of Chicago Medicine, Department of Pathology, Chicago, Illinois, United States
| | - Eugene Chang
- The University of Chicago Medicine, Department of Medicine, Chicago, Illinois, United States
| | - Ralph Weichselbaum
- The University of Chicago Medicine, Department of Radiation and Cellular Oncology, Chicago, Illinois, United States
| | - Olga Zaborina
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
| | - Benjamin D. Shogan
- The University of Chicago Medicine, Department of Surgery, Chicago, Illinois, United States
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11
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Sato K, Yamauchi Y, Takahashi K. A case of lymphatic flow evaluation using indocyanine green fluorescence imaging for recurrence of anastomotic site after laparoscopic right hemicolectomy. Surg Case Rep 2023; 9:180. [PMID: 37843697 PMCID: PMC10579200 DOI: 10.1186/s40792-023-01741-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 08/28/2023] [Indexed: 10/17/2023] Open
Abstract
BACKGROUND Anastomotic recurrence of colorectal cancer is rare, but reoperation improves prognosis. However, there is no clear evidence regarding the extent of dissection, and there are few reports on the details of surgery. We used intraoperative lymphatic flow imaging with indocyanine green (ICG) fluorescence as a reference to determine the range of additional resection. CASE PRESENTATION The patient was a 75-year-old man who underwent laparoscopic right hemicolectomy and extracorporeal functional terminal anastomosis for ascending colon cancer 4 years ago. Histopathological examination revealed a well-differentiated tubular adenocarcinoma, T4aN0M0, pathological stageIIB. During follow-up, anemia was observed, and colonoscopy indicated anastomotic recurrence, so additional laparoscopic resection was performed. Intraoperatively, ICG was injected into the anastomotic site, and the operation proceeded under near-infrared light observation. Lymphatic vessels along the middle colonic artery were visualized down to the root of the vessel. Using this as an indicator, the vessel was ligated from the root. Using the fact that the lymphatic vessels were also depicted in the small intestinal mesentery on the oral side of the anastomosis as an indicator, the small intestine and mesentery were resected about 7 cm from the anastomosis. CONCLUSIONS The optimal surgical approach for anastomotic recurrence of colorectal cancer has not been defined. Intraoperative ICG fluorescence imaging can provide images of lymphatic flow from the site of recurrence and may be an indicator of lymph node dissection in the case of anastomotic recurrence.
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Affiliation(s)
- Keita Sato
- Department of Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise City, Mie, 516-8512, Japan.
| | - Yosuke Yamauchi
- Department of Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise City, Mie, 516-8512, Japan
| | - Koji Takahashi
- Department of Surgery, Ise Red Cross Hospital, 1-471-2 Funae, Ise City, Mie, 516-8512, Japan
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12
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Siwiński P, Dziki Ł, Mik M, Dziki A. Risk factors and clinical characteristics of rectal cancer recurrence after radical surgical treatment. POLISH JOURNAL OF SURGERY 2023; 96:27-33. [PMID: 38353092 DOI: 10.5604/01.3001.0053.9182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
<b><br>Introduction:</b> Recurrence of rectal cancer affects from 4% to even 50% of patients after surgical treatment. The incidence may be influenced by numerous factors depending on the patient, the characteristics of the tumor and the type and quality of the surgical technique used.</br> <b><br>Aim:</b> The aim of this study was to assess the clinical characteristics of rectal cancer recurrence, identify potential risk factors and role of patient surveillance after primary resection of rectal cancer.</br> <b><br>Materials and methods:</b> The study comprised patients operated on due to recurrence of rectal cancer at the Department of General and Colorectal Surgery of Medical University of Lodz between 2014 and 2020, who were in the follow-up program at the hospital's outpatient clinic after the primary surgery. Risk factors for disease recurrence were sought by analyzing the characteristics of the primary tumor, treatment history and postoperative care.</br> <b><br>Results:</b> Twenty-nine patients were included in the study, the majority (51.7%) of the patients were men. The largest group was represented by patients with stage II and III disease. The most frequently performed primary surgery was low anterior resection (LAR) (62.8%). 35% of patients received neoadjuvant treatment prior to primary surgery. We demonstrated that the lack of neoadjuvant treatment before primary surgery increases the risk of cancer recurrence nine times. Higher stage of disease at the point of primary surgery is associated with nearly seven times the risk of recurrence compared to stage I disease.</br> <b><br>Conclusions:</b> Optimal preoperative staging, reasonable neoadjuvant treatment, proper surgical technique and precise follow-up regimen are essential for further improvement of rectal cancer outcomes.</br>.
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Affiliation(s)
- Paweł Siwiński
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland
| | - Łukasz Dziki
- Department of General and Oncological Surgery, Medical University of Lodz, Poland
| | - Michał Mik
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland
| | - Adam Dziki
- Department of General and Colorectal Surgery, Medical University of Lodz, Poland
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13
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Matsunaga K, Sasaki K, Nozawa H, Kawai K, Murono K, Emoto S, Kishikawa J, Ozawa T, Yokoyama Y, Abe S, Nagai Y, Anzai H, Sonoda H, Hata K, Ishihara S. Clinicopathological Characteristics of Anastomotic Recurrence After Curative Resection for Colorectal Cancer: Comparison With Nonanastomotic Local Recurrences. Dis Colon Rectum 2023; 66:e1014-e1022. [PMID: 36649156 DOI: 10.1097/dcr.0000000000002566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Anastomotic recurrence is thought to be caused by implantation of tumor cells to the anastomotic line; however, its risk factors and prognostic significance remain unclear. OBJECTIVE This study aimed to clarify the risk factors for anastomotic recurrence in colorectal cancer and assess the prognosis in comparison to nonanastomotic local recurrence. DESIGN A single-center retrospective observational study. SETTINGS The medical records of the study participants were retrospectively collected from the Department of Surgical Oncology at the University of Tokyo Hospital database. PATIENTS This study included 1584 patients with colorectal cancer who underwent surgical resection between January 2005 and December 2017. We focused on 15 patients who had an anastomotic recurrence. MAIN OUTCOME MEASURES The main outcome measures were the risk factors of anastomotic recurrence at the primary resection and prognosis data in comparison to that of nonanastomotic local recurrence. RESULTS There were 15 patients (0.95%) with anastomotic recurrence and 35 (2.21%) with nonanastomotic local recurrence. Univariate analysis revealed that lymph node metastasis and advanced T stage are the risk factors for anastomotic recurrence. The prognosis of patients with anastomotic recurrence was similar to that of those with nonanastomotic local recurrence who underwent resection. LIMITATIONS The small number of patients with anastomotic recurrence is a major limitation of this study. Additionally, the retrospective study design may have increased the risk of selection bias. CONCLUSIONS Lymph node metastasis and advanced T stage were associated with anastomotic recurrence. The prognosis of patients with anastomotic recurrence was similar to that with resected nonanastomotic local recurrence. Thus, surveillance should be carefully continued while considering the poor prognosis of patients with anastomotic recurrence. See Video Abstract at http://links.lww.com/DCR/C92 . CARACTERSTICAS CLINICOPATOLGICAS DE LA RECURRENCIA ANASTOMTICA DESPUS DE LA RESECCIN CURATIVA DEL CNCER COLORRECTAL COMPARACIN CON LAS RECURRENCIAS LOCALES NO ANASTOMTICAS ANTECEDENTES:Se cree que la recurrencia anastomótica es causada por la implantación de células tumorales en la línea anastomótica; sin embargo, los factores de riesgo asociados y el significado en cuanto a pronóstico siguen sin estar claros.OBJETIVO:Este estudio tuvo como objetivo aclarar los factores de riesgo para la recurrencia anastomótica en el cáncer colorrectal y evaluar el pronóstico en comparación con la recurrencia local no anastomótica.DISEÑO:Un estudio observacional retrospectivo de un solo centro.ESCENARIO:Los registros médicos de los participantes del estudio se recopilaron retrospectivamente de la base de datos del Departamento de Cirugía Oncológica del Hospital de la Universidad de Tokio.PACIENTES:Este estudio incluyó a 1584 pacientes con cáncer colorrectal que se sometieron a resección quirúrgica entre enero de 2005 y diciembre de 2017. Nos enfocamos en 15 pacientes que tuvieron recurrencia anastomótica.PRINCIPALES MEDIDAS DE RESULTADO:Las principales medidas de resultado fueron los factores de riesgo de recurrencia anastomótica en la resección primaria y los datos de pronóstico en comparación con la recurrencia local no anastomótica.RESULTADOS:Hubo 15 pacientes (0.95%) con recurrencia anastomótica y 35 (2.21%) con recurrencia local no anastomótica. El análisis univariable reveló que la metástasis en los ganglios linfáticos y el estadio T avanzado son los factores de riesgo para la recurrencia anastomótica. El pronóstico de los pacientes con recidiva anastomótica fue similar al de aquellos con recidiva local no anastomótica sometidos a resección.LIMITACIONES:El pequeño número de pacientes con recurrencia anastomótica es una limitación importante de este estudio. Además, el diseño retrospectivo del estudio puede haber aumentado el riesgo de sesgo de selección.CONCLUSIONES:La metástasis en los ganglios linfáticos y el estadio T avanzado se asociaron con recurrencia anastomótica. El pronóstico de los pacientes con recidiva anastomótica fue similar al de la recidiva local no anastomótica resecada. Por lo tanto, la vigilancia debe continuarse cuidadosamente considerando el mal pronóstico de los pacientes con recurrencia anastomótica. Consulte Video Resumen en http://links.lww.com/DCR/C92 . (Traducción-Dr. Jorge Silva Velazco ).
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Affiliation(s)
- Keigo Matsunaga
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazuhito Sasaki
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kazushige Kawai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Koji Murono
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shigenobu Emoto
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Junko Kishikawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tsuyoshi Ozawa
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yuichiro Yokoyama
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinya Abe
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yuzo Nagai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroyuki Anzai
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Hirofumi Sonoda
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Keisuke Hata
- Nihonbashi Muromachi Mitsui Tower Midtown Clinic, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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14
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Pace M, Minervini A, Goglia M, Cinquepalmi M, Moschetta G, Antolino L, D'Angelo F, Valabrega S, Petrucciani N, Berardi G, Aurello P. Overall Survival Following Anastomotic Leakage After Surgery for Carcinoma of the Esophagus and Gastroesophageal Junction: A Systematic Review. In Vivo 2023; 37:1423-1431. [PMID: 37369467 PMCID: PMC10347909 DOI: 10.21873/invivo.13226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 05/22/2023] [Accepted: 05/26/2023] [Indexed: 06/29/2023]
Abstract
The effect of anastomotic leakage, in patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction, on overall survival (OS) is a debated and controversial topic. The aim of this systematic review was to clarify the impact of anastomotic leakage on long-term survival of patients with esophageal cancer undergoing esophagectomy. A systematic literature review was carried out from 2000 to 2022. We chose articles reporting data from patients who underwent surgery for carcinoma of the esophagus and gastroesophageal junction. Data regarding 1-, 3- and 5-year OS were analyzed. Twenty studies met the inclusion criteria, yielding a total of 9,279 patients. Analyzing data from selected studies, anastomotic leakage was found to be associated with decreased OS in 5,456 cases while in the remaining 3,823 it had no impact on long term survival (p<0.05). However, this result did not emerge from the other studies considered in the systematic review. Anastomotic leakage is a severe postoperative complication, which seems to have an impact on overall survival. However, the topic remains debated and not supported by all case series included in this systematic review.
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Affiliation(s)
- Marco Pace
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Minervini
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy;
| | - Marta Goglia
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Matteo Cinquepalmi
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Giovanni Moschetta
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Laura Antolino
- Department of Surgery, Hospital of Belcolle, Viterbo, Italy
| | - Francesco D'Angelo
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Stefano Valabrega
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Niccolo Petrucciani
- General Surgery Unit, Department of Medical and Surgical Sciences and Translational Medicine, St. Andrea University Hospital, Sapienza University of Rome, Rome, Italy
| | - Giammauro Berardi
- Department of General, Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Paolo Aurello
- General Surgery Unit, Department of Surgery, Sapienza University of Rome, Rome, Italy
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15
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Okazawa Y, Sugimoto K, Ii Y, Irie T, Kawaguchi M, Kobari A, Momose H, Tsuchiya Y, Amemiya K, Motegi S, Tsukamoto R, Kure K, Honjo K, Ro H, Takahashi R, Kawano S, Kawai M, Ishiyama S, Takahashi M, Kojima Y, Tomiki Y, Arakawa A, Yao T, Satomi K, Matsushita Y, Ichimura K, Sakamoto K. Local recurrence of submucosal invasive colorectal cancer after endoscopic submucosal dissection revealed by copy number variation. DEN OPEN 2023; 3:e208. [PMID: 36742280 PMCID: PMC9889967 DOI: 10.1002/deo2.208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/19/2022] [Accepted: 12/25/2022] [Indexed: 02/04/2023]
Abstract
We report a case in which analysis of copy number variation revealed local recurrence of submucosal invasive colorectal cancer after curative endoscopic submucosal dissection (ESD). An 86-year-old man with a history of abdominoperineal resection of the rectum for rectal cancer underwent resection with ESD for early-stage sigmoid cancer 5 cm away from the stoma opening. At the same time, ileocecal resection was performed for advanced cecal cancer. Twelve months after ESD, advanced cancer occurred in the area of the ESD lesion. It was unclear if the cancer was a local recurrence after ESD, implantation of cecal cancer, or a new lesion. Copy number variation analysis performed for the three lesions revealed that the new lesion originated from residual tumor cells from ESD and was unlikely to be cecal cancer.
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Affiliation(s)
- Yu Okazawa
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Kiichi Sugimoto
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Yuki Ii
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Takahiro Irie
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Megumi Kawaguchi
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Aya Kobari
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Hirotaka Momose
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Yuki Tsuchiya
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Kota Amemiya
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Shunsuke Motegi
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Ryoichi Tsukamoto
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Kazumasa Kure
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Kumpei Honjo
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Hisashi Ro
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Rina Takahashi
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Shingo Kawano
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Masaya Kawai
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Shun Ishiyama
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Makoto Takahashi
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Yutaka Kojima
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Yuichi Tomiki
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
| | - Atsushi Arakawa
- Department of Human PathologyJuntendo University Faculty of MedicineTokyoJapan
| | - Takashi Yao
- Department of Human PathologyJuntendo University Faculty of MedicineTokyoJapan
| | - Kaishi Satomi
- Department of Pathology, Kyorin UniversitySchool of MedicineTokyoJapan
| | - Yuko Matsushita
- Department of Brain Disease Translational ResearchFaculty of MedicineJuntendo UniversityTokyoJapan
| | - Koichi Ichimura
- Department of Brain Disease Translational ResearchFaculty of MedicineJuntendo UniversityTokyoJapan
| | - Kazuhiro Sakamoto
- Department of Coloproctological SurgeryJuntendo University Faculty of MedicineTokyoJapan
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16
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Nishino K, Hongo M, Mori N, Shimamoto K, Kobayashi Y, Nakamura F, Hino M, Togawa T, Andoh A, Ban H. Implantation of sigmoid colon cancer into the endoscopic resection site of intramucosal rectal cancer: A case report. DEN OPEN 2022; 3:e193. [PMID: 36514801 PMCID: PMC9731169 DOI: 10.1002/deo2.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 12/13/2022]
Abstract
A 70-year-old woman was diagnosed with intramucosal rectal cancer and advanced sigmoid colon cancer at the same time. First, the intramucosal rectal cancer was curatively resected by endoscopic submucosal dissection, and surgery was subsequently performed for sigmoid colon cancer. After 20 months, a follow-up colonoscopy revealed a tumor growth at the ulcer scar of the endoscopic submucosal dissection. Histological findings and KRAS mutation analysis suggested implantation of sigmoid colon cancer to the post-endoscopic submucosal dissection site of intramucosal rectal cancer.
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Affiliation(s)
- Kyohei Nishino
- Department of GastroenterologyOmi Medical CenterShigaJapan
| | - Masanori Hongo
- Department of GastroenterologyOmi Medical CenterShigaJapan
| | - Naoko Mori
- Department of GastroenterologyOmi Medical CenterShigaJapan
| | | | - Yu Kobayashi
- Department of GastroenterologyOmi Medical CenterShigaJapan
| | | | - Michiko Hino
- Department of PathologyOmi Medical CenterShigaJapan
| | - Takeshi Togawa
- Department of Digestive SurgeryOmi Medical CenterShigaJapan
| | - Akira Andoh
- Department of MedicineShiga University of Medical ScienceShigaJapan
| | - Hiromitsu Ban
- Department of GastroenterologyOmi Medical CenterShigaJapan
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17
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Yu GY, Gao XH, Xia LJ, Sun DB, Liu T, Zhang W. Implantation metastasis from sigmoid colon cancer to rectal anastomosis proved by whole exome sequencing and lineage inference for cancer heterogeneity and evolution analysis: Case report and literature review. Front Oncol 2022; 12:930715. [PMID: 36203423 PMCID: PMC9530747 DOI: 10.3389/fonc.2022.930715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
It was estimated that 70% of patients with colorectal cancer were found to have viable exfoliated malignant cells in adjacent intestinal lumen. Exfoliated malignant cells had been reported to implant on raw surfaces, such as polypectomy site, anal fissure, anal fistula, hemorrhoidectomy wound, and anastomotic suture line. Tumors at anastomosis could be classified into four groups: local recurrence, local manifestation of widespread metastasis, metachronous carcinogenesis, and implantation metastasis. However, all of the previous studies only reported the phenomena of implantation metastasis at anastomosis. No study had proved the origin of anastomotic metastasis by genomic analysis. In this study, a 43-year-old woman presented with persistent hematochezia was diagnosed as having severe mixed hemorrhoids. She was treated by procedure for prolapse and hemorrhoids (PPH), without receiving preoperative colonoscopy. Two months later, she was found to have sigmoid colon cancer by colonoscopy due to continuous hematochezia and received radical sigmoidectomy. Postoperative histological examination confirmed the lesion to be a moderately differentiated adenocarcinoma (pT3N1M0). Six months later, she presented with hematochezia again and colonoscopy revealed two tumors at the rectal anastomosis of PPH. Both tumors were confirmed to be moderately differentiated adenocarcinoma without lymph node and distant metastasis and were finally removed by transanal endoscopic microsurgery (TEM). Pathological examination, whole exome sequencing (WES), and Lineage Inference for Cancer Heterogeneity and Evolution (LICHeE) analysis demonstrated that the two tumors at the rectal anastomosis were probably implantation metastases arising from the previous sigmoid colon cancer. This is the first study to prove implantation metastasis from colon cancer to a distal anastomosis by WES and LICHeE analysis. Therefore, it is recommended to rule out colorectal cancer in proximal large bowel before performing surgery with a rectal anastomosis, such as PPH and anterior resection. For patients with a suspected implanted tumor, WES and LICHeE could be used to differentiate implantation metastasis from metachronous carcinogenesis.
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Affiliation(s)
- Guan Yu Yu
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Xian Hua Gao
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
| | - Li Jian Xia
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Shandong First Medical University, Ji'nan, Shandong, China
| | - De Bin Sun
- Department of Medicine, Genecast Biotechnology Co. Ltd, Wuxi, China
| | - Tao Liu
- Department of Anorectal Surgery, Zaozhuang Central Hospital, Shandong, China
| | - Wei Zhang
- Department of Colorectal Surgery, Changhai Hospital, Naval Medical University, Shanghai, China
- Hereditary Colorectal Cancer Center and Genetic Block Center of Familial Cancer, Changhai Hospital, Shanghai, China
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18
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Okasha HH, Wahba M, Fontagnier E, Abdellatef A, Haggag H, AbouElenin S. Hidden local recurrence of colorectal adenocarcinoma diagnosed by endoscopic ultrasound: A case series. World J Gastrointest Endosc 2022; 14:502-507. [PMID: 36158634 PMCID: PMC9453309 DOI: 10.4253/wjge.v14.i8.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 04/29/2022] [Accepted: 07/18/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Almost half of the patients with colorectal cancer (CRC) will experience local-regional recurrence after standard surgical excision. Many local recurrences of colorectal cancer (LRCC) do not grow intraluminally, and some may be covered by a normal mucosa so that they could be missed by colonoscopy. Early detection is crucial as it offers a chance to achieve curative reoperation. Endoscopic ultrasound (EUS) is mainly used in CRC staging combined with cross-section imaging study. EUS can provide an accurate assessment of sub-mucosal lesions by demarcating the originating wall layer and evaluating its echostructure. EUS fine-needle aspiration (FNA) provides the required tissue examination and confirms the diagnosis.
CASE SUMMARY We report a series of five cases referred to surveillance for LRCC with negative colonoscopy and/or negative endoscopic biopsies. EUS-FNA confirmed LRCC implanted deep into the third and fourth wall layer with normal first and second layer.
CONCLUSION Assessment for LCRR is still problematic and may be very tricky. EUS and EUS-FNA may be useful tools to exclude local recurrence.
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Affiliation(s)
- Hussein Hassan Okasha
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Mahmoud Wahba
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Eva Fontagnier
- Department of Internal Medicine and Gastroenterology, Tawam Hospital, Al-Ain 00000, United Arab Emirates
| | - Abeer Abdellatef
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Hani Haggag
- Department of Internal Medicine and Hepatogastroenterology, Kasr Al-Aini Hospitals, Cairo University, Cairo 11451, Egypt
| | - Sameh AbouElenin
- Department of Internal Medicine and Gastroenterology, Military Medical Academy, Cairo 11451, Egypt
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19
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Zhang Y, Qin X, Li Y, Zhang X, Luo R, Wu Z, Li V, Han S, Wang H, Wang H. A Prediction Model Intended for Exploratory Laparoscopy Risk Stratification in Colorectal Cancer Patients With Potential Occult Peritoneal Metastasis. Front Oncol 2022; 12:943951. [PMID: 35912189 PMCID: PMC9326510 DOI: 10.3389/fonc.2022.943951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 06/22/2022] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND The early diagnosis of occult peritoneal metastasis (PM) remains a challenge due to the low sensitivity on computed tomography (CT) images. Exploratory laparoscopy is the gold standard to confirm PM but should only be proposed in selected patients due to its invasiveness, high cost, and port-site metastasis risk. In this study, we aimed to develop an individualized prediction model to identify occult PM status and determine optimal candidates for exploratory laparoscopy. METHOD A total of 622 colorectal cancer (CRC) patients from 2 centers were divided into training and external validation cohorts. All patients' PM status was first detected as negative on CT imaging but later confirmed by exploratory laparoscopy. Multivariate analysis was used to identify independent predictors, which were used to build a prediction model for identifying occult PM in CRC. The concordance index (C-index), calibration plot and decision curve analysis were used to evaluate its predictive accuracy and clinical utility. RESULTS The C-indices of the model in the development and validation groups were 0.850 (95% CI 0.815-0.885) and 0.794 (95% CI, 0.690-0.899), respectively. The calibration curve showed consistency between the observed and predicted probabilities. The decision curve analysis indicated that the prediction model has a great clinical value between thresholds of 0.10 and 0.72. At a risk threshold of 30%, a total of 40% of exploratory laparoscopies could have been prevented, while still identifying 76.7% of clinically occult PM cases. A dynamic online platform was also developed to facilitate the usage of the proposed model. CONCLUSIONS Our individualized risk model could reduce the number of unnecessary exploratory laparoscopies while maintaining a high rate of diagnosis of clinically occult PM. These results warrant further validation in prospective studies. CLINICAL TRIAL REGISTRATION https://www.isrctn.com, identifier ISRCTN76852032.
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Affiliation(s)
- Yuanxin Zhang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xiusen Qin
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yang Li
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xi Zhang
- General Surgery Center, Department of Gastrointestinal Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Rui Luo
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhijie Wu
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Victoria Li
- Department of Secondary Education, Yew Chung International School, Kowloon Tong, Hong Kong, China
| | - Shuai Han
- General Surgery Center, Department of Gastrointestinal Surgery, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Hui Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huaiming Wang
- Department of Colorectal Surgery, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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20
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Bao QR, Pellino G, Spolverato G, Restivo A, Deidda S, Capelli G, Ruffolo C, Bianco F, Cuicchi D, Jovine E, Lombardi R, Belluco C, Amato A, La Torre F, Asteria C, Infantino A, Contardo T, Del Bianco P, Delrio P, Pucciarelli S. The impact of anastomotic leak on long-term oncological outcomes after low anterior resection for mid-low rectal cancer: extended follow-up of a randomised controlled trial. Int J Colorectal Dis 2022; 37:1689-1698. [PMID: 35773492 PMCID: PMC9262787 DOI: 10.1007/s00384-022-04204-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2022] [Indexed: 02/04/2023]
Abstract
PURPOSE The impact of anastomotic leaks (AL) on oncological outcomes after low anterior resection for mid-low rectal cancer is still debated. The aim of this study was to evaluate overall survival (OS), disease-free survival (DFS), and local and distant recurrence in patients with AL following low anterior resection. METHODS This is an extension of a multicentre RCT (NCT01110798). Kaplan-Meier method and the log-rank test were used to estimate and compare the 3-, 5-, and 10-year OS and DFS, and local and distant recurrence in patients with and without AL. Predictors of OS and DFS were evaluated using the Cox regression analysis as secondary aim. RESULTS Follow-up was available for 311 patients. Of them, 252 (81.0%) underwent neoadjuvant chemoradiotherapy and 138 (44.3%) adjuvant therapy. AL occurred in 63 (20.3%) patients. At a mean follow-up of 69.5 ± 31.9 months, 23 (7.4%) patients experienced local recurrence and 49 (15.8%) distant recurrence. The 3-, 5-, and 10-year OS and DFS were 89.2%, 85.3%, and 70.2%; and 80.7%, 75.1%, and 63.5% in patients with AL, and 88.9%, 79.8% and 72.3%; and 83.7, 74.2 and 62.8%, respectively in patients without (p = 0.89 and p = 0.84, respectively). At multivariable analysis, AL was not an independent predictor of OS (HR 0.65, 95%CI 0.34-1.28) and DFS (HR 0.70, 95%CI 0.39-1.25), whereas positive circumferential resection margins and pathological stage impaired both. CONCLUSIONS In the context of modern multimodal rectal cancer treatment, AL does not affect long-term OS, DFS, and local and distant recurrence in patients with mid-low rectal cancer.
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Affiliation(s)
- Quoc Riccardo Bao
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Gianluca Pellino
- Department of Advanced Medical and Surgical Sciences, Università Degli Studi Della Campania "Luigi Vanvitelli", Naples, Italy
| | - Gaya Spolverato
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy.
| | - Angelo Restivo
- Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Simona Deidda
- Colorectal Surgery Unit, A.O.U. Cagliari, Department of Surgical Science, University of Cagliari, Cagliari, Italy
| | - Giulia Capelli
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Cesare Ruffolo
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
| | - Francesco Bianco
- Department of Abdominal Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Dajana Cuicchi
- General Surgery Unit, Department of Alimentary Tract, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
| | - Elio Jovine
- General Surgery and Emergency, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
| | - Raffaele Lombardi
- General Surgery and Emergency, IRCCS Azienda Ospedaliera Universitaria Di Bologna, Bologna, Italy
| | - Claudio Belluco
- Department of Surgical Oncology, National Cancer Institute, Aviano, PN, Italy
| | - Antonio Amato
- Department of Coloproctology, Sanremo Hospital, Sanremo, IM, Italy
| | - Filippo La Torre
- Division of Emergency and Trauma Surgery, Emergency Department, Policlinico Umberto I, College of Medicine and Dentistry, Sapienza University, Rome, Italy
| | - Corrado Asteria
- Department of General Surgery, Ospedale Carlo Poma, Mantua, Italy
| | - Aldo Infantino
- Surgical Unit, Department of General Surgery, Santa Maria Dei Battuti Hospital, San Vito al Tagliamento (PN), Italy
| | - Tania Contardo
- Department of Surgery, Regional Centre for Laparoscopic and Robotic Surgery, Camposampiero Hospital, Padua, Italy
| | - Paola Del Bianco
- Clinical Research Unit, Istituto Oncologico Veneto IOV - IRCCS, Padua, Italy
| | - Paolo Delrio
- Department of Colorectal Surgical Oncology, Istituto Nazionale Tumori - IRCCS Fondazione G. Pascale, Naples, Italy
| | - Salvatore Pucciarelli
- General Surgery 3, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, Via Giustiniani 2, 35128, Padova, Italy
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21
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Fukai S, Tsujinaka S, Miyakura Y, Matsuzawa N, Hatsuzawa Y, Maemoto R, Kakizawa N, Rikiyama T. Anal fistula metastasis of rectal cancer after neoadjuvant therapy: a case report. Surg Case Rep 2022; 8:57. [PMID: 35357598 PMCID: PMC8971341 DOI: 10.1186/s40792-022-01410-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Anal metastasis of colorectal cancer is very rare and may present synchronously or metachronously, regardless of pre-existing anal diseases. We report a case of anal fistula metastasis after completion of neoadjuvant therapy for rectal cancer, followed by surgical resection of the primary tumor and metastatic lesion. CASE PRESENTATION A 50-year-old man was diagnosed with rectal cancer located 5 cm from the anal verge, with a clinical stage of cT3N0M0. He denied any medical or surgical history, and physical examination revealed no perianal disease. He underwent preoperative chemoradiation therapy (CRT) consisting of a tegafur/gimeracil/oteracil potassium (S-1)-based regimen with 45 Gy of radiation. After completion of CRT, computed tomography (CT) revealed the primary tumor's partial response, but a liver mass highly suggestive of metastasis was detected. This mass was later diagnosed as cavernous hemangioma 3 months after CRT initiation. He then underwent and completed six cycles of consolidation chemotherapy with a capecitabine-based regimen. Subsequent colonoscopy revealed the complete response of the primary tumor, but CT showed thickening of the edematous rectal wall. Therefore, we planned to perform low anterior resection as a radical surgery. However, he presented with persistent anal pain after the last chemotherapy, and magnetic resonance imaging revealed a high-intensity mass behind the anus, suggestive of an anal fistula. We considered the differential diagnosis of a benign anal fistula or implantation metastasis into the anal fistula. Fistulectomy was performed, and a pathological diagnosis of tubular adenocarcinoma, suggestive of implantation metastasis, was made. Thereafter, we performed laparoscopic abdominoperineal resection. Histopathological examination revealed well-differentiated adenocarcinoma, ypT2N0, with a grade 2 therapeutic effect. Subsequent immunohistochemistry of the resected anal fistula showed a CDX-2-positive, CK20-positive, CK7-negative, and GCDFP-15 negative tumor, with implantation metastasis. There was no cancer recurrence 21 months after the radical surgery. CONCLUSIONS This is the first report of anal fistula metastasis after neoadjuvant therapy for rectal cancer in a patient without a previous history of anal disease. If an anal fistula is suspected during or after neoadjuvant therapy, physical and radiological assessment, differential diagnosis, and surgical intervention timing for fistula must be carefully discussed.
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Affiliation(s)
- Shota Fukai
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Natsumi Matsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Yuuri Hatsuzawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847, Amanumacho, Omiya, Saitama-shi, Saitama, 330-8503 Japan
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22
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Svensson Neufert R, Jörgren F, Buchwald P. Rectal washout during abdominoperineal resection for rectal cancer has no impact on the oncological outcome. Colorectal Dis 2022; 24:284-291. [PMID: 34726339 DOI: 10.1111/codi.15977] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 09/14/2021] [Accepted: 10/22/2021] [Indexed: 02/08/2023]
Abstract
AIM Intraoperative rectal washout is performed to eliminate exfoliated intraluminal cancer cells and thereby decrease the risk of local recurrence. Rectal washout in abdominoperineal resection has not been studied. The aim of this study was to assess the oncological outcome after rectal washout in abdominoperineal resection for rectal cancer and to find evidence as to whether rectal washout should be performed or not. METHOD Data for all patients registered in the Swedish Colorectal Cancer Registry who underwent elective surgery with abdominoperineal resection for rectal cancer (TNM Stages I-III) between 2007 and 2013 were analysed using multivariable analysis. RESULTS No significant differences were shown between the rectal washout group and the no rectal washout group for local recurrence [10/265 (3.8%) vs. 87/2160 (4.0%), p = 0.84], distant metastasis [51/265 (19.2%) vs. 476/2160 (22.0%), p = 0.29] or overall recurrence [53/265 (20.0%) vs. 505/2160 (23.4%), p = 0.21]. In multivariable analysis, rectal washout did not significantly affect the oncological outcome in terms of local recurrence, distant metastasis, overall recurrence or 5-year overall or relative survival. CONCLUSION Our results do not support routine rectal washout during abdominoperineal resection in order to improve the oncological outcome.
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Affiliation(s)
- Rebecca Svensson Neufert
- Department of Internal Medicine, Helsingborg Hospital, Helsingborg, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Fredrik Jörgren
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Helsingborg Hospital, Helsingborg, Sweden
| | - Pamela Buchwald
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Department of Surgery, Skåne University Hospital, Malmö, Sweden
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23
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Solomon J, Majeed T, Magee C, Wilson J. The influence of intraoperative rectal washout on local recurrence of colorectal cancer following curative resection: a systematic review and meta-analysis. Int J Colorectal Dis 2022; 37:403-409. [PMID: 35013821 DOI: 10.1007/s00384-021-04071-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine the effectiveness of rectal washout in preventing local recurrence of distal colorectal cancer following curative resection. METHODS A systematic review and meta-analysis was performed after a literature search was conducted on MEDLINE, EMBASE, the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP), ClinicalTrials.gov, and the ISRCTN registry. The study was reported using PRISMA guidelines. The primary endpoint was incidence of local recurrence of cancer after distal colonic and rectal cancer surgery. RESULTS After screening, 8 studies with a total sample size of 6739 patients were identified. At 5-year follow-up, local recurrence in the washout group (WO) was 6.08% compared to 9.48% in the no-washout group (NWO) group (OR 0.63, 95% CI = 0.51-0.78, Chi2 = 6.76, df = 7, p = 0.45). The relative risk reduction was 36.9%. To exclude a 36.9% relative risk reduction from 9.48 to 6.08% with a 5% significance level and 80% power a randomized control trial would require a total sample size of 1946 participants distributed equally between the two treatment arms. CONCLUSION It is safe to recommend the use of rectal washout for left sided and rectal tumour resections. It is a simple and safe step during colorectal surgery that appears to improve long-term oncological outcomes and was not reported to be associated with any complications.
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Affiliation(s)
- Josh Solomon
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK.
| | - Talal Majeed
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK
| | - Conor Magee
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK
| | - Jeremy Wilson
- Wirral University Teaching Hospitals NHS Foundation Trust, Birkenhead, UK
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24
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Koedam TWA, Bootsma BT, Deijen CL, van de Brug T, Kazemier G, Cuesta MA, Fürst A, Lacy AM, Haglind E, Tuynman JB, Daams F, Bonjer HJ. Oncological Outcomes After Anastomotic Leakage After Surgery for Colon or Rectal Cancer: Increased Risk of Local Recurrence. Ann Surg 2022; 275:e420-e427. [PMID: 32224742 DOI: 10.1097/sla.0000000000003889] [Citation(s) in RCA: 88] [Impact Index Per Article: 29.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate oncological outcome for patients with and without anastomotic leakage after colon or rectal cancer surgery. SUMMARY OF BACKGROUND DATA The role of anastomotic leakage in oncological outcome after colorectal cancer surgery is still topic of debate and impact on follow-up and consideration for further treatment remains unclear. METHODS Patients included in the international, multicenter, non-inferior, open label, randomized, controlled trials COLOR and COLOR II, comparing laparoscopic surgery for curable colon (COLOR) and rectal (COLOR II) cancer with open surgery, were analyzed. Patients operated by abdominoperineal excision were excluded. Both univariate and multivariate analyses were performed to investigate the impact of leakage on overall survival, disease-free survival, local and distant recurrences, adjusted for possible confounders. Primary endpoints in the COLOR and COLOR II trial were disease-free survival and local recurrence at 3-year follow-up, respectively, and secondary endpoints included anastomotic leakage rate. RESULTS For colon cancer, anastomotic leakage was not associated with increased percentage of local recurrence or decreased disease-free-survival. For rectal cancer, an increase of local recurrences (13.3% vs 4.6%; hazard ratio 2.96; 95% confidence interval 1.38-6.34; P = 0.005) and a decrease of disease-free survival (53.6% vs 70.9%; hazard ratio 1.67; 95% confidence interval 1.16-2.41; P = 0.006) at 5-year follow-up were found in patients with anastomotic leakage. CONCLUSION Short-term morbidity, mortality, and long-term oncological outcomes are negatively influenced by the occurrence of anastomotic leakage after rectal cancer surgery. For colon cancer, no significant effect was observed; however, due to low power, no conclusions on the influence of anastomotic leakage on outcomes after colon surgery could be reached. Clinical awareness of increased risk of local recurrence after anastomotic leakage throughout the follow-up is mandatory.Trial Registration: Registered with ClinicalTrials.gov, number NCT00387842 and NCT00297791.
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Affiliation(s)
- Thomas W A Koedam
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Boukje T Bootsma
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Charlotte L Deijen
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Tim van de Brug
- Department of Epidemiology and Biostatistics, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Geert Kazemier
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Miguel A Cuesta
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Alois Fürst
- Department of Surgery, Caritas Krankenhaus St Josef Regensburg, Regensburg, Germany
| | - Antonio M Lacy
- Department of Surgery, Hospital Clínic Universitari, Barcelona, Spain
| | - Eva Haglind
- Department of Surgery, Sahlgrenska University Hospital-Östra, Gothenburg, Sweden
| | - Jurriaan B Tuynman
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Freek Daams
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
| | - Hendrik J Bonjer
- Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Centers, VUmc, Amsterdam, The Netherlands
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25
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Sato H, Kotake K, Maeda K, Kobayashi H, Takahashi H, Sugihara K. Factors Affecting Positive Peritoneal Lavage Cytology in Patients with Stage II and III Colorectal Cancer with R0 Resection: A Multi-institutional, Prospective Study. JOURNAL OF THE ANUS RECTUM AND COLON 2021; 5:355-365. [PMID: 34746500 PMCID: PMC8553352 DOI: 10.23922/jarc.2021-006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/17/2021] [Indexed: 11/30/2022]
Abstract
Objectives: This study aimed to explore the risk factors associated with cancer cell exfoliation in Stage II and III colorectal cancer (CRC). Methods: This multicenter, prospective, observational study targeted 1,698 patients with cStage II and III CRC who underwent R0 resection between 2013 and 2017. Clinicopathological variables were analyzed for correlations with positive peritoneal lavage cytology (PLC). Results: The positive PLC rate was 2.7% (46/1,694 cases) at laparotomy and 1.6% (25/1,590 cases) after tumor resection. Logistic regression analyses identified that undifferentiated histologies diagnosed by preoperative biopsy specimen, cT4, and pN+ were independent factors that affected the positive PLC at laparotomy. The positive PLC rate at laparotomy was 4.5% (33/736 cases) among the patients with undifferentiated histology and/or cT4. Logistic regression analyses revealed that the presence of ascites and undifferentiated histology by biopsy independently affected positive PLC after tumor resection. Conclusions: The undifferentiated histology and/or T4 indicated by preoperative diagnosis were identified as factors affecting PLC at laparotomy. Furthermore, ascites and preoperative histological type were identified as factors affecting positive PLC after tumor resection. As factors affecting positive PLC, these preoperative findings were found to be equivalent to pathological findings.
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Affiliation(s)
- Harunobu Sato
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Kenjiro Kotake
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Sano City Hospital, Sano, Japan
| | - Kotaro Maeda
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Fujita Health University, School of Medicine, Toyoake, Japan
| | - Hirotoshi Kobayashi
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Hiroshi Takahashi
- Department of Medical Statistics, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kenichi Sugihara
- Study Group for Peritoneal Metastasis from Colorectal Cancer by the Japanese Society for Cancer of the Colon and Rectum.,Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan
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26
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Nakaoka M, Nemoto T, Chiba H, Okada N, Tachikawa J, Arimoto J, Kuwabara H, Sakamoto A, Goto T. Recurrence of gastric cancer caused by implantation of tumor cells after curative endoscopic submucosal dissection. Gastric Cancer 2021; 24:1160-1166. [PMID: 33860382 DOI: 10.1007/s10120-021-01189-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/06/2021] [Indexed: 02/07/2023]
Abstract
A 93-year-old female underwent curative endoscopic submucosal dissection (ESD) for intramucosal gastric cancer (70 mm in diameter) in the antrum. The lesion showed an irregularly villous structure covered with mucus. En bloc resection was performed. The large resected specimen induced a longitudinal laceration on the right wall of the esophagogastric junction (EGJ) during retrieval. Unavoidably, we segmented the specimen in the stomach to facilitate retrieval. Histopathological evaluation of the specimen revealed well-to-moderately differentiated tubular and papillary adenocarcinoma. A new elevated lesion (15 mm in diameter) was found at the gastric side of the EGJ laceration scar 6 months after the first ESD, necessitating a second resection with ESD. Endoscopic, histopathological, and immunohistochemical features of the new lesion resembled those of the antral lesion. We assessed the new lesion as a recurrence of cancer caused by implantation of tumor cells in the mucosal laceration after ESD.We experienced recurrence caused by implantation of tumor cells in a mucosal laceration after curative gastric ESD. Endoscopist should be aware of the risk of implantation after gastric ESD.
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Affiliation(s)
- Michiko Nakaoka
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan.
| | - Tetsuo Nemoto
- Department of Clinical Pathology, Showa University Northern Yokohama Hospital, Chigasaki-chuo 35-1, Tsuzuki-ku, Yokohama-shi, Kanagawa-ken, 224-8503, Japan
| | - Hideyuki Chiba
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
| | - Naoya Okada
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
| | - Jun Tachikawa
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
| | - Jun Arimoto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
| | - Hiroki Kuwabara
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
| | - Atsuhiko Sakamoto
- Department of Pathology and Laboratory Medicine, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
| | - Tohru Goto
- Department of Gastroenterology, Omori Red Cross Hospital, 4-30-1, Chuo, Ota-Ku, Tokyo, 143-0024, Japan
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Short- and long-term outcomes of laparoscopic surgery with extracorporeal anastomosis for transverse colon cancer: comparison of triangulating anastomosis with functional end-to-end anastomosis. Surg Endosc 2021; 36:3261-3269. [PMID: 34341908 DOI: 10.1007/s00464-021-08638-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 07/13/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND We compared triangulating anastomosis (TRI) with functional end-to-end anastomosis (FEEA) in terms of patient demographics, clinicopathological features, and short- and long-term outcomes in this study. METHODS From November 2005 to May 2016, 315 patients with transverse colon cancer underwent laparoscopic resection. TRI was performed in 62 patients and FEEA in 253 patients. Patients with another concomitant cancer, who received neoadjuvant chemotherapy, and/or who underwent another operation at the same time were excluded. RESULTS The patients' backgrounds were comparable in each group. Transverse colectomy was selected more frequently in TRI and right hemicolectomy in FEEA. The operation time was shorter in TRI. The rate of anastomotic leakage was comparable (1.6% in TRI vs. 0.8% in FEEA). Stricture was more common in TRI (8.1% vs. 0%) and bleeding was more common in FEEA (1.6% vs. 10.6%). The rate of long-term complications was comparable in each group. Overall survival of stage 0-III patients was comparable in each group (94.7% in TRI vs. 93.7% in FEEA). 5-year disease-free survival of stage 0-III, stage II, and stage III patients was also comparable in each group (94.8% vs. 93.0%, 100% vs. 92.1%, and 80.3% vs. 79.2% in TRI and FEEA, respectively). CONCLUSION The short- and long-term outcome rates were acceptable in both groups. Specific attempts to prevent complications are required for each anastomotic procedure.
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Zhang LM, Schuitevoerder D, White MG, Feldt S, Krishnan P, Hyman N, Shogan BD. Combined mechanical and oral antibiotic bowel preparation is associated with prolonged recurrence-free survival following surgery for colorectal cancer. J Surg Oncol 2021; 124:1106-1114. [PMID: 34310702 DOI: 10.1002/jso.26619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 06/26/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent studies suggest that bacteria influence the pathogenesis of primary colorectal cancer (CRC), yet their role in recurrence after resection is largely unknown. We have discovered that collagenase-producing bacteria promote cancer recurrence in mice, and that antibiotic bowel decontamination decreases colonization of these same organisms in humans. We hypothesized that preoperative combined mechanical and oral antibiotic bowel preparation would improve disease-free survival (DFS) in patients undergoing surgery for CRC. METHODS We reviewed a cancer registry of patients treated for CRC at a tertiary center. Patients who received bowel preparation were compared to those that did not via a 1:1-propensity score matched for follow-up, age, sex, BMI, stage, location, chemoradiation, infection, anastomotic leak, and blood transfusion. RESULTS One thousand two hundred and seventy-nine patients met inclusion criteria. Following propensity score matching, 264 patients receiving bowel prep were matched to 264 patients who did not. Kaplan-Meier estimates showed that patients who received bowel prep had a significantly improved 5-year DFS compared to those that did not (76.3% vs. 64.2%; p < .01). Cox regression demonstrated that bowel prep was associated with improved DFS (HR, 0.57; 95% CI, 0.37-0.89; p < .01). CONCLUSION Combined mechanical and oral antibiotic bowel preparation is independently associated with improved recurrence-free survival in patients undergoing surgery for CRC.
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Affiliation(s)
- Lindsey M Zhang
- Division of Colon and Rectal Surgery, University of Chicago, Chicago, Illinois, USA
| | | | - Michael G White
- Department of Surgical Oncology, MD Anderson Cancer Center, Houston, Texas, USA
| | - Susan Feldt
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Pranav Krishnan
- University of Chicago Pritzker School of Medicine, Chicago, Illinois, USA
| | - Neil Hyman
- Division of Colon and Rectal Surgery, University of Chicago, Chicago, Illinois, USA
| | - Benjamin D Shogan
- Division of Colon and Rectal Surgery, University of Chicago, Chicago, Illinois, USA
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Gray M, Marland JRK, Murray AF, Argyle DJ, Potter MA. Predictive and Diagnostic Biomarkers of Anastomotic Leakage: A Precision Medicine Approach for Colorectal Cancer Patients. J Pers Med 2021; 11:471. [PMID: 34070593 PMCID: PMC8229046 DOI: 10.3390/jpm11060471] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/19/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
Development of an anastomotic leak (AL) following intestinal surgery for the treatment of colorectal cancers is a life-threatening complication. Failure of the anastomosis to heal correctly can lead to contamination of the abdomen with intestinal contents and the development of peritonitis. The additional care that these patients require is associated with longer hospitalisation stays and increased economic costs. Patients also have higher morbidity and mortality rates and poorer oncological prognosis. Unfortunately, current practices for AL diagnosis are non-specific, which may delay diagnosis and have a negative impact on patient outcome. To overcome these issues, research is continuing to identify AL diagnostic or predictive biomarkers. In this review, we highlight promising candidate biomarkers including ischaemic metabolites, inflammatory markers and bacteria. Although research has focused on the use of blood or peritoneal fluid samples, we describe the use of implantable medical devices that have been designed to measure biomarkers in peri-anastomotic tissue. Biomarkers that can be used in conjunction with clinical status, routine haematological and biochemical analysis and imaging have the potential to help to deliver a precision medicine package that could significantly enhance a patient's post-operative care and improve outcomes. Although no AL biomarker has yet been validated in large-scale clinical trials, there is confidence that personalised medicine, through biomarker analysis, could be realised for colorectal cancer intestinal resection and anastomosis patients in the years to come.
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Affiliation(s)
- Mark Gray
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian, Edinburgh EH25 9RG, UK;
| | - Jamie R. K. Marland
- School of Engineering, Institute for Integrated Micro and Nano Systems, University of Edinburgh, Scottish Microelectronics Centre, King’s Buildings, Edinburgh EH9 3FF, UK;
| | - Alan F. Murray
- School of Engineering, Institute for Bioengineering, University of Edinburgh, Faraday Building, The King’s Buildings, Edinburgh EH9 3DW, UK;
| | - David J. Argyle
- The Royal (Dick) School of Veterinary Studies and Roslin Institute, University of Edinburgh, Easter Bush, Roslin, Midlothian, Edinburgh EH25 9RG, UK;
| | - Mark A. Potter
- Department of Surgery, Western General Hospital, Crewe Road, Edinburgh EH4 2XU, UK;
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Nuytens F, Dabakuyo-Yonli TS, Meunier B, Gagnière J, Collet D, D'Journo XB, Brigand C, Perniceni T, Carrère N, Mabrut JY, Msika S, Peschaud F, Prudhomme M, Markar SR, Piessen G. Five-Year Survival Outcomes of Hybrid Minimally Invasive Esophagectomy in Esophageal Cancer: Results of the MIRO Randomized Clinical Trial. JAMA Surg 2021; 156:323-332. [PMID: 33595631 DOI: 10.1001/jamasurg.2020.7081] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Available data comparing the long-term results of hybrid minimally invasive esophagectomy (HMIE) with that of open esophagectomy are conflicting, with similar or even better results reported for the minimally invasive esophagectomy group. Objective To evaluate the long-term, 5-year outcomes of HMIE vs open esophagectomy, including overall survival (OS), disease-free survival (DFS), and pattern of disease recurrence, and the potential risk factors associated with these outcomes. Design, Setting, and Participants This randomized clinical trial is a post hoc follow-up study that analyzes the results of the open-label Multicentre Randomized Controlled Phase III Trial, which enrolled patients from 13 different centers in France and was conducted from October 26, 2009, to April 4, 2012. Eligible patients were 18 to 75 years of age and were diagnosed with resectable cancer of the middle or lower third of the esophagus. After exclusions, patients were randomized to either the HMIE group or the open esophagectomy group. Data analysis was performed on an intention-to-treat basis from November 19, 2019, to December 4, 2020. Interventions Hybrid minimally invasive esophagectomy (laparoscopic gastric mobilization with open right thoracotomy) was compared with open esophagectomy. Main Outcomes and Measures The primary end points of this follow-up study were 5-year OS and DFS. The secondary end points were the site of disease recurrence and potential risk factors associated with DFS and OS. Results A total of 207 patients were randomized, of whom 175 were men (85%), and the median (range) age was 61 (23-78) years. The median follow-up duration was 58.2 (95% CI, 56.5-63.8) months. The 5-year OS was 59% (95% CI, 48%-68%) in the HMIE group and 47% (95% CI, 37%-57%) in the open esophagectomy group (hazard ratio [HR], 0.71; 95% CI, 0.48-1.06). The 5-year DFS was 52% (95% CI, 42%-61%) in the HMIE group vs 44% (95% CI, 34%-53%) in the open esophagectomy group (HR, 0.81; 95% CI, 0.55-1.17). No statistically significant difference in recurrence rate or location was found between groups. In a multivariable analysis, major intraoperative and postoperative complications (HR, 2.21; 95% CI, 1.41-3.45; P < .001) and major pulmonary complications (HR, 1.94; 95% CI, 1.21-3.10; P = .005) were identified as risk factors associated with decreased OS. Similarly, multivariable analysis of DFS identified overall intraoperative and postoperative complications (HR, 1.93; 95% CI, 1.28-2.90; P = .002) and major pulmonary complications (HR, 1.85; 95% CI, 1.19-2.86; P = .006) as risk factors. Conclusions and Relevance This study found no difference in long-term survival between the HMIE and open esophagectomy groups. Major postoperative overall complications and pulmonary complications appeared to be independent risk factors in decreased OS and DFS, providing additional evidence that HMIE may be associated with improved oncological results compared with open esophagectomy primarily because of a reduction in postoperative complications. Trial Registration ClinicalTrials.gov Identifier: NCT00937456.
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Affiliation(s)
- Frederiek Nuytens
- Department of Digestive and Oncological Surgery, Hôpital Claude Huriez, Centre Hospitalier Universitaire (CHU) de Lille, Lille, France
| | - Tienhan Sandrine Dabakuyo-Yonli
- Epidemiology and Quality of Life Unit, Institut National de la Santé et de la Recherche Médicale (INSERM) Unité 1231, Centre Georges François Leclerc, Dijon, France
| | - Bernard Meunier
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes, University of Rennes 1, Rennes, France
| | - Johan Gagnière
- Université Clermont Auvergne, INSERM, CHU Clermont-Ferrand, Service de Chirurgie Digestive, Clermont-Ferrand, France
| | - Denis Collet
- Department of Digestive Surgery, Haut Lévèque University Hospital, Bordeaux, France
| | - Xavier B D'Journo
- Department of Thoracic Surgery, Hôpital Nord, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Cécile Brigand
- Department of Digestive Surgery, Strasbourg University, Strasbourg, France
| | - Thierry Perniceni
- Department of Digestive Surgery, Institut Mutualiste Montsouris, Paris, France
| | - Nicolas Carrère
- Department of Digestive Surgery, Purpan Hospital, CHU Toulouse, Université Toulouse III, Toulouse, France
| | - Jean-Yves Mabrut
- Department of General Surgery and Liver Transplantation, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Equipe Mixte de Recherche 3738, Université Lyon 1, Lyon, France
| | - Simon Msika
- Department of Digestive and General Surgery, CHU Louis Mourier, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris 7, Denis Diderot, Pôle de Recherche et d'Enseignement Supérieur (PRES) Sorbonne Paris Cité, Colombes, France
| | - Frédérique Peschaud
- Department of Surgery and Oncology, CHU Ambroise Paré, AP-HP, Université de Versailles, Boulogne-Billancourt, France
| | | | - Sheraz R Markar
- Department of Surgery and Cancer, Imperial College, London, United Kingdom.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Guillaume Piessen
- Department of Digestive and Oncological Surgery, Hôpital Claude Huriez, Centre Hospitalier Universitaire (CHU) de Lille, Lille, France.,Université de Lille, Centre National de la Recherche Scientifique, INSERM, CHU Lille, UMR9020-U1277-CANTHER-Cancer Heterogeneity, Plasticity and Resistance to Therapies, Lille, France
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Teurneau-Hermansson K, Svensson Neufert R, Buchwald P, Jörgren F. Rectal washout does not increase the complication risk after anterior resection for rectal cancer. World J Surg Oncol 2021; 19:82. [PMID: 33740992 PMCID: PMC7980676 DOI: 10.1186/s12957-021-02193-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 03/09/2021] [Indexed: 12/31/2022] Open
Abstract
Background To reduce local recurrence risk, rectal washout (RW) is integrated in the total mesorectal excision (TME) technique when performing anterior resection (AR) for rectal cancer. Although RW is considered a safe practice, data on the complication risk are scarce. Our aim was to examine the association between RW and 30-day postoperative complications after AR for rectal cancer. Methods Patients from the Swedish Colorectal Cancer Registry who underwent AR between 2007 and 2013 were analysed using multivariable methods. Results A total of 4821 patients were included (4317 RW, 504 no RW). The RW group had lower rates of overall complications (1578/4317 (37%) vs. 208/504 (41%), p = 0.039), surgical complications (879/4317 (20%) vs. 140/504 (28%), p < 0.001) and 30-day mortality (50/4317 (1.2%) vs. 12/504 (2.4%), p = 0.020). In multivariable analysis, RW was a risk factor neither for overall complications (OR 0.73, 95% CI 0.60–0.90, p = 0.002) nor for surgical complications (OR 0.62, 95% CI 0.50–0.78, p < 0.001). Conclusions RW is a safe technique that does not increase the 30-day postoperative complication risk after AR with TME technique for rectal cancer.
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Affiliation(s)
| | | | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital, Malmö, Lund University, Lund, Sweden
| | - Fredrik Jörgren
- Department of Surgery, Helsingborg Hospital, Helsingborg, Lund University, Lund, Sweden
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Baig M, Sayyed R, Nasim S, Khan S. Effect of rectal washout on local recurrence of rectal cancer in the era of total mesorectal excision: Meta-analysis. Surgeon 2021; 19:351-355. [PMID: 33583687 DOI: 10.1016/j.surge.2020.11.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/11/2020] [Accepted: 11/27/2020] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Presence of intraluminal viable cancer cells implanting into the anastomosis has been proposed as a potential cause for developing local recurrence in patients undergoing anterior resection for rectal cancer. Rectal washout has been proposed as a method to prevent this from happening. There have been conflicting reports in literature regarding the effect of rectal washout on local recurrence. We aim to look at the role of rectal washout in preventing local recurrence of rectal cancer in patients undergoing total or tumor-specific mesorectal excision (TME). MATERIALS AND METHODS A literature review of studies evaluating the role of rectal washout on rectal cancer local recurrence was performed using PubMed, Scopus, EMBASE and non-English language literature search using CiNii (Japanese) and CNKI (Chinese). Inclusion criteria were use of TME, comparison of rectal washout with no washout, and evaluation of local recurrence as outcome. RESULTS Four studies were identified according to inclusion criteria. The meta-analysis showed a protective effect of rectal washout on local recurrence (OR 0.45 95% CI 0.45-0.75). However, one of the studies included had more than 90% weightage. Excluding this study from analysis showed no difference on local recurrence with rectal washout (OR 0.94, 95% CI 0.37-2.36). CONCLUSION The effect of rectal washout on rectal cancer local recurrence in patients who undergo TME is questionable and needs to be evaluated further by prospective studies.
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Affiliation(s)
- Mariam Baig
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, 7-A, Block R3, Johar Town, Lahore, Pakistan.
| | - Raza Sayyed
- Department of Surgical Oncology, Shaukat Khanum Memorial Cancer Hospital & Research Center, 7-A, Block R3, Johar Town, Lahore, Pakistan
| | - Sana Nasim
- Department of Surgery, The Aga Khan University Hospital, National Stadium Road, Karachi, Sindh, Pakistan
| | - Sadaf Khan
- Department of Surgery, The Aga Khan University Hospital, National Stadium Road, Karachi, Sindh, Pakistan
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Implantation of rectosigmoid cancer in a preexisting anal fissure. Int Cancer Conf J 2021; 10:139-143. [PMID: 33786288 DOI: 10.1007/s13691-020-00465-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 12/17/2020] [Indexed: 12/14/2022] Open
Abstract
Colorectal cancer (CRC) rarely spreads by implantation. We report a case of implantation of rectosigmoid cancer in an anal fissure. A 70-year-old woman with a 15-year medical history of anal fissure was referred to our hospital with anal pain of 3-month duration. Colonoscopy revealed a rectosigmoid tumor and a 10-mm submucosal tumor at the anal verge. Biopsy of the rectosigmoid and anal tumors revealed that both were moderately differentiated adenocarcinomas, and abdominoperineal resection (APR) was performed. The anal adenocarcinoma was surrounded by squamous cell epithelium and mainly proliferated in the submucosal and muscular layers. The patient was diagnosed as having rectosigmoid cancer with implantation of cancer in a preexisting anal fissure. The patient remains well 43 months post-surgery with no sign of recurrence. Implantation of CRC in anal fissure is a rare occurrence. Nevertheless, performing adequate anal examination of patients with CRC before surgery and during follow-up is necessary. Further, it is important to perform preoperative large bowel examination of patients with benign anal diseases to prevent implantation of CRC.
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The Role of the Intestinal Microbiome on Colorectal Cancer Pathogenesis and its Recurrence Following Surgery. J Gastrointest Surg 2020; 24:2349-2356. [PMID: 32588187 DOI: 10.1007/s11605-020-04694-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 02/06/2023]
Abstract
Colorectal cancer is the result of multiple genetic mutations that drive normal cells to adenoma and then carcinoma. Recent technology has evolved to allow for an in-depth examination of the microbiota and it has become clear that many components of the intestinal microbiome play a role in promoting carcinogenesis. This review aims to describe the potential mechanisms that lead to the dysbiosis that initiates tumor formation and that influence the development of cancer recurrence following surgical resection. We further discuss how manipulation of the microbiome may be a future novel strategy to prevent both primary and secondary colorectal cancer. While we discuss how bacterial communities and individual strains can promote cancer, the microbiome is individualized, dynamic, and complex, and our understanding of its role in carcinogenesis is still in its infancy.
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Tzivanakis A, Moran BJ. Perforated Colorectal Cancer. Clin Colon Rectal Surg 2020; 33:247-252. [PMID: 32968359 DOI: 10.1055/s-0040-1713741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The majority of patients with colorectal tumors will present via the elective route. However, one-fifth of patients will present as an emergency. The most common cause of emergency presentation of colorectal cancer is obstruction followed by perforation, and in many cases, patients will present with both. We discuss the management of the patient presenting with a perforated colorectal tumor covering the acute presentation and also how to deal with consequences of a perforated tumor, namely, the management of colorectal peritoneal metastasis (CPM). CPM used to be considered a terminal condition; however, a strategy of early detection of CPM, careful patient selection for cytoreductive surgery and hyperthermic intraperitoneal chemotherapy, leads to much improved outcomes and even cure, in some patient compared with systemic chemotherapy alone.
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Affiliation(s)
| | - Brendan J Moran
- Peritoneal Malignancy Institute, Basingstoke, Hampshire, United Kingdom
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36
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The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer. Dis Colon Rectum 2020; 63:1191-1222. [PMID: 33216491 DOI: 10.1097/dcr.0000000000001762] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Stakelum A, Zaborowski A, Collins D, Winter DC. The influence of the gastrointestinal microbiome on colorectal metastasis: a narrative review. Colorectal Dis 2020; 22:1101-1107. [PMID: 31869511 DOI: 10.1111/codi.14930] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 11/12/2019] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The gastrointestinal microbiome has been suggested to contribute to the development of both primary and secondary colorectal cancer. Despite advances in understanding the prognostic and predictive value of clinico-pathological parameters, the underlying mechanisms that result in progression to metastatic disease have yet to be defined. The metastatic cascade involves a number of sequential steps, including detachment of tumour cells from the primary site, intravasation and dissemination within the circulatory and lymphatic systems, with extravasation and proliferation at a secondary site. OBJECTIVE An analysis of the literature relating to the gastrointestinal microbiome and its role in colorectal metastasis was conducted. This review aims to examine the current evidence supporting a role for the microbiome in colorectal metastasis and to describe the mechanisms by which it may contribute to metastatic progression. CONCLUSION The invasive pathways utilized by bacteria and how they may be manipulated by tumour cells for migration and metastasis are presented and the potential of the intestinal microbiome as a therapeutic target in colorectal carcinogenesis and metastasis is detailed here.
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Affiliation(s)
- A Stakelum
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland
| | - A Zaborowski
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland
| | - D Collins
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland
| | - D C Winter
- Centre for Colorectal Disease, St Vincent's University Hospital, Dublin 4, Ireland
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Badiani S, Cooper E, Berney CR. A Fall Worth It: Cutaneous Metastatic Deposit of a Distant Colorectal Cancer With Fistula-in-Ano. Cureus 2020; 12:e9979. [PMID: 32983681 PMCID: PMC7511083 DOI: 10.7759/cureus.9979] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A seeded fistula-in-ano from a synchronous colon cancer is rare. We report an unconventional case of a 70-year old male who presented with an incidental post-traumatic perianal cutaneous lump following a fall. Lesion biopsy confirmed the presence of a cutaneous malignant deposit. Further workup confirmed the diagnosis of upper rectal adenocarcinoma associated with a fistula-in-ano. The patient underwent long-course neoadjuvant chemoradiotherapy, followed by an "en bloc" laparoscopic abdominoperineal and extended fistula tract resection without complication. This case highlights a rare case of post-traumatic synchronous upper rectal cancer seeding into a low fistula-in-ano tract associated with a cutaneous perianal metastatic deposit.
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Affiliation(s)
- Sarit Badiani
- Department of Surgery, Bankstown Hospital, Sydney, AUS
| | - Edward Cooper
- Department of Surgery, Bankstown Hospital, Sydney, AUS
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Kryzauskas M, Bausys A, Degutyte AE, Abeciunas V, Poskus E, Bausys R, Dulskas A, Strupas K, Poskus T. Risk factors for anastomotic leakage and its impact on long-term survival in left-sided colorectal cancer surgery. World J Surg Oncol 2020; 18:205. [PMID: 32795348 PMCID: PMC7427291 DOI: 10.1186/s12957-020-01968-8] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/23/2020] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Anastomotic leakage (AL) significantly impairs short-term outcomes. The impact on the long-term outcomes remains unclear. This study aimed to identify the risk factors for AL and the impact on long-term survival in patients with left-sided colorectal cancer. METHODS Nine-hundred patients with left-sided colorectal carcinoma who underwent sigmoid or rectal resection were enrolled in the study. Risk factors for AL after sigmoid or rectal resection were identified, and long-term outcomes of patients with and without AL were compared. RESULTS AL rates following sigmoid and rectal resection were 5.1% and 10.7%, respectively. Higher ASA score (III-IV; OR = 10.54, p = 0.007) was associated with AL in patients undergoing sigmoid surgery on multivariable analysis. Male sex (OR = 2.40, p = 0.004), CCI score > 5 (OR = 1.72, p = 0.025), and T3/T4 stage tumors (OR = 2.25, p = 0.017) were risk factors for AL after rectal resection on multivariable analysis. AL impaired disease-free and overall survival in patients undergoing sigmoid (p = 0.009 and p = 0.001) and rectal (p = 0.003 and p = 0.014) surgery. CONCLUSION ASA score of III-IV is an independent risk factor for AL after sigmoid surgery, and male sex, higher CCI score, and advanced T stage are risk factors for AL after rectal surgery. AL impairs the long-term survival in patients undergoing left-sided colorectal surgery.
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Affiliation(s)
- Marius Kryzauskas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Augustinas Bausys
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | | | - Vilius Abeciunas
- Faculty of Medicine, Vilnius University, Ciurlionio str. 21, 03101, Vilnius, Lithuania.
| | - Eligijus Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Rimantas Bausys
- Faculty of Medicine, Vilnius University, Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Audrius Dulskas
- Faculty of Medicine, Vilnius University, Ciurlionio str. 21, 03101, Vilnius, Lithuania
| | - Kestutis Strupas
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Tomas Poskus
- Clinic of Gastroenterology, Nephrourology and Surgery, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
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Shimizu H, Sudo M, Furuya S, Takiguchi K, Saito R, Maruyama S, Kawaguchi Y, Kawaida H, Kondo T, Ichikawa D. Is Intraluminal Washout Necessary for Patients with Sigmoid Colon Cancer to Eliminate Exfoliated Cancer Cells as in Patients with Rectal Cancer? A Pilot Study at a Single Institute. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:145-150. [PMID: 32743117 PMCID: PMC7390616 DOI: 10.23922/jarc.2020-030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/25/2020] [Indexed: 11/30/2022]
Abstract
Objectives: Rectal stump washout has been widely performed to prevent the implantation of exfoliated cancer cells (ECCs) in patients with rectal cancer. However, it remains unclear whether intraluminal washout before transection is required in patients with sigmoid colon cancer. Therefore, this pilot study was conducted to elucidate the necessity of intraluminal washout for sigmoid colon cancer patients in comparison with rectal cancer patients by cytological assessments. Methods: A total of 16 patients with sigmoid colon cancer and 24 patients with rectal cancer who underwent sigmoidectomy or anterior resection with anastomosis using double-stapling technique were enrolled. A transanal washout sample was collected before washout and after irrigation with 500 and 1,000 mL of saline. Cytological assessments were conducted according to the Papanicolaou classification, and class IV and V cells were defined as malignant. Results: Before washout, exfoliated cancer cells were found in 15 of 24 (62.5%) patients with rectal cancer and in 1 of 16 (6.2%) patients with sigmoid colon cancer (p < 0.001). Distal-free margin from the tumor was significantly shorter in patients with cancer cells (p = 0.002), and the length of the distal-free margin was significantly associated with the tumor location. After irrigation with 500 and 1,000 mL of saline, no cancer cell was found in all patients with sigmoid colon cancer, whereas ECCs were still found in five patients with rectal cancer (20.8%). Conclusions: Intraluminal washout with 1,000 mL may be sufficient for sigmoid colon cancer patients with longer distal-free margin. A large-scale, randomized controlled study is necessary to confirm these results.
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Affiliation(s)
- Hiroki Shimizu
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan.,Division of Digestive Surgery, Department of Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Makoto Sudo
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Shinji Furuya
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Koichi Takiguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Ryo Saito
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Suguru Maruyama
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Yoshihiko Kawaguchi
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Hiromichi Kawaida
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Tetsuo Kondo
- Department of Pathology, Faculty of Medicine, University of Yamanashi, Chuo, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
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Koide Y, Maeda K, Katsuno H, Hanai T, Masumori K, Matsuoka H, Endo T, Cheong YC, Uyama I. Exfoliated cancer cells during intersphincteric resection for very low rectal cancer. Surg Today 2020; 50:1652-1656. [PMID: 32617675 DOI: 10.1007/s00595-020-02064-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the frequency of exfoliated cancer cells and the efficacy of rectal washout during intersphincteric resection (ISR) in patients not receiving chemoradiotherapy (CRT) for very low rectal cancer. METHOD The subjects of this prospective study were 16 consecutive patients who underwent ISR without CRT for very low rectal cancer. Brushing cytology of the posterior anorectal wall was performed twice in each step of the ISR procedure and the samples were sent for blind cytological examination to identify exfoliated cancer cells. RESULTS Exfoliated cancer cells were identified in 9 of 13 patients (69%) preoperatively. The number of cancer cells identified after abdominal total mesorectal dissection decreased significantly from 94% (15/16) to 25% (4/16) after transanal irrigation with 2000 mL saline (p < 0.001). No cancer cells were identified after swabbing the anal wall following transanal dissection with purse-string closure of the distal stump. No suture-line recurrence was found during a median follow-up duration of 6 years. CONCLUSION Exfoliated cancer cells, confirmed in 94% of patients after total mesorectal excision, could be eliminated by performing rectal irrigation after clamping the rectum proximal to the tumor and swabbing the anorectal wall during ISR.
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Affiliation(s)
- Yoshikazu Koide
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Kotaro Maeda
- International Medical Center, Fujita Health University Hospital, 1-98, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Hidetoshi Katsuno
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Tsunekazu Hanai
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Koji Masumori
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Hiroshi Matsuoka
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Tomoyoshi Endo
- Department of Surgery, Fujita Health University Okazaki Medical Center, Okazaki, Japan
| | - Yeong Cheol Cheong
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University School of Medicine, Toyoake, Japan
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Karim A, Cubas V, Zaman S, Khan S, Patel H, Waterland P. Anastomotic leak and cancer-specific outcomes after curative rectal cancer surgery: a systematic review and meta-analysis. Tech Coloproctol 2020; 24:513-525. [PMID: 32206962 DOI: 10.1007/s10151-020-02153-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 01/24/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The aim of the present study was to perform a systematic review and meta-analysis of cancer-specific outcomes after curative rectal cancer surgery comparing anastomotic leak (AL) with no leak. METHODS PubMed, Medline and Embase databases were searched to identify studies comparing cancer-specific outcomes after rectal cancer surgery in patients with AL and without. A meta-analysis with a random-effects model was used to calculate pooled odds ratios (OR) and confidence intervals (CI) for each outcome measure. RESULTS A total of 18 studies were included for meta-analysis, comprising a total of 18,039 patients after curative rectal resection (1764 AL, 16,275 without AL). The overall rate of AL was 9.8%. After AL and excluding 30-day mortality there was an increased risk of local recurrence (OR 1.50; CI 1.23, 1.82), worse overall survival (OR 0.69; CI 0.60-0.81), decreased disease free survival (OR 0.51; CI 0.36-0.73) and cancer specific survival (OR 0.71; CI 0.54-0.94). Distant recurrence (OR 1.10; CI 0.89-1.37) and overall recurrence (OR 1.33; CI 0.64-2.76) were not significantly different between the two groups. CONCLUSIONS AL may negatively impact cancer-specific outcomes after curative rectal cancer surgery and could be considered an independent negative prognostic factor.
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Affiliation(s)
- A Karim
- Department of Colorectal Surgery, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK.
| | - V Cubas
- Department of Colorectal Surgery, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK
| | - S Zaman
- Department of Colorectal Surgery, Russels Hall Hospital, Dudley, UK
| | - S Khan
- Department of Colorectal Surgery, Russels Hall Hospital, Dudley, UK
| | - H Patel
- Department of Colorectal Surgery, Worcester Royal Hospital, Charles Hastings Way, Worcester, WR5 1DD, UK
| | - P Waterland
- Department of Colorectal Surgery, Russels Hall Hospital, Dudley, UK
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Atallah S. Anatomical Considerations and Procedure-Specific Aspects Important in Preventing Operative Morbidity during Transanal Total Mesorectal Excision. Clin Colon Rectal Surg 2020; 33:157-167. [PMID: 32351339 DOI: 10.1055/s-0040-1701604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
As transanal total mesorectal excision (taTME) becomes increasingly utilized, its technical challenges and potential pitfalls have become more clearly appreciated. This chapter explores the differences in how anatomy presents itself from the taTME vantage point as compared with traditional approaches to taTME, and how special problems unique to taTME pose a new set of operative challenges. Morbidity related, specifically, to the technique of taTME is also delineated with particular focus on male urethral injury.
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Affiliation(s)
- Sam Atallah
- Department of Colorectal Surgery, Florida Hospital, Orlando, Florida
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44
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Yang J, Chen Q, Jindou L, Cheng Y. The influence of anastomotic leakage for rectal cancer oncologic outcome: A systematic review and meta-analysis. J Surg Oncol 2020; 121:1283-1297. [PMID: 32243581 DOI: 10.1002/jso.25921] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE Anastomotic leakage is a serious complication after arterial resection of rectal cancer. It has been found that anastomotic leakage is related to the oncological outcome. The purpose of the study is to evaluate the long-term outcome of the rectal tumor after anastomotic leakage. METHODS The effect of anastomotic leakage on the oncological outcome of rectal cancer was studied by electronic literature retrieval. Using the DerSimonian Laird random effect model to calculate the odds ratio and 95% confidence interval. Research heterogeneity was evaluated by Q statistics and I2 , and bias was evaluated by funnel plot and Begg's test. RESULTS A total of 35 studies and 44 698 patients were included in the study. The studies have shown that anastomotic leakage is associated with local recurrence (OR = 1.93; 95% CI, 1.57-2.38; P < .0001), overall survival (OR = 1.64; 95% CI, 1.37-1.95; P < .00001), disease-free survival (OR = 2.07; 95% CI, 1.50-2.87; P < .00001) and cancer-specific survival (OR = 1.32; 95% CI, 1.02-1.70; P = .012), while it was not related to distant recurrence (OR = 1.25; 95% CI, 0.95-1.65; P = .12). CONCLUSIONS The results showed that anastomotic leakage after anterior resection increased the risk of local recurrence, decreased the overall survival, cancer-specific survival and disease-free survival.
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Affiliation(s)
- Jianguo Yang
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Qingwei Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Li Jindou
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yong Cheng
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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45
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Gaines S, van Praagh JB, Williamson AJ, Jacobson RA, Hyoju S, Zaborin A, Mao J, Koo HY, Alpert L, Bissonnette M, Weichselbaum R, Gilbert J, Chang E, Hyman N, Zaborina O, Shogan BD, Alverdy JC. Western Diet Promotes Intestinal Colonization by Collagenolytic Microbes and Promotes Tumor Formation After Colorectal Surgery. Gastroenterology 2020; 158:958-970.e2. [PMID: 31655031 PMCID: PMC7062578 DOI: 10.1053/j.gastro.2019.10.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 09/24/2019] [Accepted: 10/20/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND & AIMS The Western diet, which is high in fat, is a modifiable risk factor for colorectal recurrence after curative resection. We investigated the mechanisms by which the Western diet promotes tumor recurrence, including changes in the microbiome, in mice that underwent colorectal resection. METHODS BALB/c male mice were fed either standard chow diet or Western-type diet (characterized by high fat, no fiber, and decreased minerals and vitamins) for 4 weeks; some mice were given antibiotics or ABA-PEG20k-Pi20 (Pi-PEG), which inhibits collagenase production by bacteria, but not bacterial growth, in drinking water. Colorectal resections and anastomoses were then performed. The first day after surgery, mice were given enemas containing a collagenolytic rodent-derived strain of Enterococcus faecalis (strain E2), and on the second day they were given mouse colon carcinoma cells (CT26). Twenty-one days later, distal colons were removed, and colon contents (feces, distal colon, and tumor) were collected. Colon tissues were analyzed by histology for the presence of collagenolytic colonies and by 16S ribosomal RNA sequencing, which determined the anatomic distribution of E faecalis at the site of the anastomosis and within tumors using in situ hybridization. Mouse imaging analyses were used to identify metastases. RESULTS Colorectal tumors were found in 88% of mice fed the Western diet and given antibiotics, surgery, and E faecalis compared with only 30% of mice fed the standard diet followed by the same procedures. Colon tumor formation correlated with the presence of collagenolytic E faecalis and Proteus mirabilis. Antibiotics eliminated collagenolytic E faecalis and P mirabilis but did not reduce tumor formation. However, antibiotics promoted emergence of Candida parapsilosis, a collagenase-producing microorganism. Administration of a Pi-PEG reduced tumor formation and maintained diversity of the colon microbiome. CONCLUSIONS We identified a mechanisms by which diet and antibiotic use can promote tumorigenesis by colon cancer cells at the anastomosis after colorectal surgery. Strategies to prevent emergence of these microbe communities or their enzymatic activities might be used to reduce the risk of tumor recurrence in patients undergoing colorectal cancer surgery.
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Affiliation(s)
- Sara Gaines
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Jasper B. van Praagh
- University of Chicago, Pritzker School of Medicine, Chicago, IL.,University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Richard A. Jacobson
- University of Chicago, Pritzker School of Medicine, Chicago, IL.,Rush University Medical Center, Chicago, IL
| | - Sanjiv Hyoju
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | | | - Jun Mao
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Hyun Y. Koo
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Lindsay Alpert
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | | | | | - Jack Gilbert
- University of Chicago, Pritzker School of Medicine, Chicago, IL.,University of California San Diego, Department of Pediatrics, La Jolla, CA
| | - Eugene Chang
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Neil Hyman
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | - Olga Zaborina
- University of Chicago, Pritzker School of Medicine, Chicago, IL
| | | | - John C. Alverdy
- University of Chicago, Pritzker School of Medicine, Chicago, IL.,To whom correspondence should be addressed: John C. Alverdy, 5841 S. Maryland Ave, MC 6090, Chicago, IL, 60637, Phone: 773-702-4876 Fax: 773-834-0201,
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46
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Kamarajah SK, Navidi M, Wahed S, Immanuel A, Hayes N, Griffin SM, Phillips AW. Anastomotic Leak Does Not Impact on Long-Term Outcomes in Esophageal Cancer Patients. Ann Surg Oncol 2020; 27:2414-2424. [PMID: 31974709 PMCID: PMC7311371 DOI: 10.1245/s10434-020-08199-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Indexed: 12/18/2022]
Abstract
Background Esophagectomy is a technically demanding procedure associated with high levels of morbidity. Anastomotic leak (AL) is a common complication with potentially major ramifications for patients. It has also been associated with poorer long-term overall survival (OS) and disease recurrence. Objective The aim of this study was to determine whether AL contributes to poor OS and recurrence-free survival (RFS) for patients with esophageal cancer. Methods Consecutive patients undergoing a two-stage, two-field transthoracic esophagectomy from a single high-volume unit between 1997 and 2016 were evaluated. Clinicopathologic characteristics, along with oncological and postoperative outcomes, were stratified by no AL versus non-severe leak (NSL) versus severe esophageal AL (SEAL). SEAL was defined as ALs associated with Clavien–Dindo grade III/IV complications. Results This study included 1063 patients, of whom 8% (87/1063) developed AL; 45% of those who developed AL were SEALs (39/87). SEAL was associated with a prolonged critical care stay (median 8 vs. 3 vs. 2 days; p < 0.001) and prolonged hospital stay (median 43 vs. 27 vs. 15 days; p < 0.001) compared with NSL or no AL. There were no significant differences in number of lymph nodes harvested and rates of R1 resection between groups. OS and RFS were not affected by either NSL or SEAL, and Cox multivariate regression showed NSL and SEAL were not independently associated with OS and RFS. Sensitivity analysis in patients receiving neoadjuvant therapy followed by esophagectomy demonstrated similar findings. Conclusion These results demonstrate that AL leads to prolonged critical care and in-hospital length of stay; however, contrary to previous reports, our results do not compromise long-term outcomes and are unlikely to have a detrimental oncological impact.
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Affiliation(s)
- S K Kamarajah
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK.,Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - M Navidi
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK
| | - S Wahed
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK
| | - A Immanuel
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK
| | - N Hayes
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK
| | - S M Griffin
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK
| | - A W Phillips
- Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle University Trust Hospitals, Newcastle upon Tyne, UK. .,School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.
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47
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Anastomotic Leak Does Not Impact Oncologic Outcomes After Preoperative Chemoradiotherapy and Resection for Rectal Cancer. Ann Surg 2020; 269:678-685. [PMID: 29112004 DOI: 10.1097/sla.0000000000002582] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the relationship of anastomotic leakage, local recurrence, and overall survival in rectal cancer patients treated with preoperative chemoradiotherapy (CRT) and curative resection. BACKGROUND Little is known about the association between anastomotic leakage and oncologic outcomes after preoperative CRT. METHODS A total of 698 consecutive primary rectal cancer patients after preoperative CRT between April 19, 2000, and December 27, 2013, were retrospectively reviewed. Forty-seven patients who had anastomotic leakage were compared with 651 patients who had no anastomotic leakage. RESULTS Of 698 patients, 47 (6.7%) patients had anastomotic leakage. Among these 47 patients, 39 (83.0%) had grade C leak that required urgent operation, while 8 (17.0%) had grade B leak that was managed expectantly or by percutaneous drainage. The median follow-up period was 47.6 months (range, 27.1 to 68.9 months). One hundred twenty (17.2%) recurrences were identified among all patients. The median overall disease-free survival was 43 months (range, 22.4 to 66.7 months). Five-year disease-free survival did not differ significantly between the 2 groups (80.5% vs 80.4%, P = 0.839). Five-year local recurrence-free survival did not differ significantly either between the 2 groups (93.7% vs 94.9%, P = 0.653). Five-year overall survival rates of patients with or without leakage were 90.9% and 86.3%, respectively (P = 0.242). Five-year cancer-specific survival rates of patients with or without leakage were 92.2% and 86.3%, respectively (P = 0.248). CONCLUSION After preoperative CRT, an anastomotic leak is not associated with a significant increase in local recurrence or long-term survival in rectal cancer.
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48
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Okada K, Sadahiro S, Kamei Y, Chan LF, Ogimi T, Miyakita H, Saito G, Tanaka A, Suzuki T. A prospective clinical study assessing the presence of exfoliated cancer cells and rectal washout including tumors in patients who receive neoadjuvant chemoradiotherapy for rectal cancer. Surg Today 2019; 50:352-359. [DOI: 10.1007/s00595-019-01883-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 09/07/2019] [Indexed: 02/07/2023]
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49
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Peacock O, Waters PS, Bressel M, Lynch AC, Wakeman C, Eglinton T, Koh CE, Lee PJ, Austin KK, Warrier SK, Solomon MJ, Frizelle FA, Heriot AG. Prognostic factors and patterns of failure after surgery for T4 rectal cancer in the beyond total mesorectal excision era. Br J Surg 2019; 106:1685-1696. [PMID: 31339561 DOI: 10.1002/bjs.11242] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/31/2019] [Accepted: 04/26/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite advances in the rates of total mesorectal excision (TME) for rectal cancer surgery, decreased local recurrence rates and increased 5-year survival, there still exists large variation in the quality of treatment received. Up to 30 per cent of rectal cancers are locally advanced at presentation and approximately 5-10 per cent still breach the mesorectal plane and invade adjacent structures despite neoadjuvant therapy. With the evolution of extended resections for rectal cancers beyond the TME plane, proponents advocate that these resections should be performed only in specialist centres. The aim was to assess the prognostic factors and patterns of failure after beyond TME surgery for T4 rectal cancers. METHODS Data were collected from prospective databases at three high-volume institutions specializing in beyond TME surgery for T4 rectal cancers between 1990 and 2013. The primary outcome measures were overall survival, local recurrence and patterns of first failure. RESULTS Three hundred and sixty patients were identified. The negative resection margin (R0) rate was 82·8 per cent (298 patients) and the local recurrence rate was 12·5 per cent (45 patients). The type of surgical procedure (Hartmann's: hazard ratio (HR) 4·49, 95 per cent c.i. 1·99 to 10·14; P = 0·002) and lymphovascular invasion (HR 2·02, 1·08 to 3·77; P = 0·032) were independent predictors of local recurrence. The 5-year overall survival rate for all patients was 61 (95 per cent c.i. 55 to 67) per cent. The 5-year cumulative incidence of first failure was 8 per cent for local recurrence, 6 per cent for local and distant disease, and 18 per cent for distant disease. CONCLUSION This study has demonstrated that a coordinated approach in specialist centres for beyond TME surgery can offer good oncological and long-term survival in patients with T4 rectal cancers.
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Affiliation(s)
- O Peacock
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - P S Waters
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - A C Lynch
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - C Wakeman
- Colorectal Surgery Unit, Christchurch Hospital, Christchurch, New Zealand
| | - T Eglinton
- Colorectal Surgery Unit, Christchurch Hospital, Christchurch, New Zealand
| | - C E Koh
- Department of Colorectal Surgery and Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - P J Lee
- Department of Colorectal Surgery and Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - K K Austin
- Department of Colorectal Surgery and Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - S K Warrier
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - M J Solomon
- Department of Colorectal Surgery and Royal Prince Alfred Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Surgical Outcomes Research Unit, University of Sydney, Sydney, New South Wales, Australia
| | - F A Frizelle
- Colorectal Surgery Unit, Christchurch Hospital, Christchurch, New Zealand
| | - A G Heriot
- Colorectal Surgery Unit, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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More SK, Vomhof-Dekrey EE, Basson MD. ZINC4085554 inhibits cancer cell adhesion by interfering with the interaction of Akt1 and FAK. Oncol Lett 2019; 17:5251-5260. [PMID: 31186741 PMCID: PMC6507311 DOI: 10.3892/ol.2019.10192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/27/2019] [Indexed: 11/06/2022] Open
Abstract
Perioperative or circulatory forces enhance disseminated cancer cell adhesiveness by modulating focal adhesion kinase (FAK)-Akt1 interaction. Selectively blocking FAK-Akt1 interaction by a peptide derived from the FAK-Four-point-one, ezrin, radixin, moesin (FERM) domain reduces colon cancer cell adhesion in vitro and in mice. A preliminary in silico screening identified two small molecules resembling a peptide that may inhibit pressure-stimulated SW620 cancer cell adhesion to collagen I. The present study selected ZINC4085554 for further study to validate its proposed mechanism of action, using human SW620 colon cancer cells as a model system. At 25 and 50 µM, ZINC4085554 inhibited the pressure-stimulated adhesion of SW620 colon cancer cells to collagen I. This molecule prevented pressure-stimulated FAK-Tyr-397 phosphorylation; however, it did not affect Akt1-Ser-473 phosphorylation, indicating that ZINC4085554 acts downstream of Akt1, while Akt-Thr-308 remains unchanged in the presence of pressure and or ZINC4085554. Indeed, ZINC4085554 inhibited FAK-Akt1 interaction in response to increased extracellular pressure, consistent with the proposed mechanism. ZINC4085554 did not inhibit FAK-Tyr-397 phosphorylation in response to cell adhesion to collagen I, indicating the specificity of the inhibitory effects towards force-stimulated pathways. Finally, the present study confirmed that ZINC4085554 at 50 µM prevented pressure-activation of adhesion to surgical wounds in vivo in parallel to its ablation of intracellular signaling. In summary, ZINC4085554 is a small molecule mimicking part of the structure of FAK that reduces cancer cell adhesion by impairing pressure-stimulated FAK-Akt1 interaction and its downstream consequences. ZINC4085554 does not inhibit conventional outside-in FAK signaling and may be less toxic than global FAK inhibitors, and ZINC4085554 may be an important step towards the inhibition of metastasis.
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Affiliation(s)
- Shyam K. More
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, USA
| | - Emilie E. Vomhof-Dekrey
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, USA
| | - Marc D. Basson
- Department of Surgery, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND 58202, USA
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