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Yu M, Wang DC, Li S, Huang LY, Wei J. Efficacy and Safety of Preoperative Radiotherapy Versus Chemoradiotherapy in Advanced Rectal Cancer: A Meta-analysis of Randomized Controlled Trials. Am Surg 2023; 89:2262-2271. [PMID: 35435026 DOI: 10.1177/00031348221086790] [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: 11/16/2022]
Abstract
OBJECTIVE This meta-analysis was conducted to evaluate the safety and efficacy of preoperative radiotherapy (RT) combined with surgery and preoperative chemoradiotherapy (CRT) combined with surgery for locally advanced rectal cancer. METHODS PubMed, EMBASE and Cochrane Library were searched to collect published randomized controlled trials of preoperative radiotherapy or preoperative CRT combined with surgery for the treatment of locally advanced rectal cancer. Studies were screened according to inclusion and exclusion criteria, and quality was evaluated; RevMan 5.3 software was used for meta-analysis. RESULTS In total, 7 related studies involving 3100 patients with locally advanced rectal cancer were evaluated. The pathological complete response rate, negative lymph node rate, R0 resection rate, and incidence of grade III/IV adverse reactions were lower in the RT group than in the CRT group. In the absence of postoperative chemotherapy, the 5-year local recurrence rate of RT was higher than that of CRT, but there was no significant difference between the groups among those who underwent postoperative chemotherapy. Moreover, there was no significant difference between the groups with regard to the 5-year survival rate, anal-preserving rate, or incidence of anastomotic leakage. CONCLUSION Preoperative CRT is better than preoperative RT for the treatment of advanced rectal cancer, though the adverse reaction rate is higher.
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Affiliation(s)
- Miao Yu
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Deng-Chao Wang
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
| | - Sheng Li
- Department of Basic Medicine, Sichuan Vocational College of Health and Rehabilitation, Zigong, Sichuan, China
| | - Li-Yan Huang
- Department of Pathology, West China Second Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Jian Wei
- Department of General Surgery, Zigong Fourth People's Hospital, Zigong, Sichuan, China
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Eldamshety O, Kotb S, Khater A, Roshdy S, Elashry M, Zahi MS, Elkalla HMHR, Elnahas W, Farouk O, Fathi A, Senbel A, Hamed EE, Abdelwahab K, Elzahby IA, Abdallah A, Abdelaziz M, Lezoche E. Early and Late Functional Outcomes of Anal SphincterSparing Procedures With Total Mesorectal Excision for Anorectal Adenocarcinoma. Ann Coloproctol 2020; 36:148-154. [PMID: 32311866 PMCID: PMC7392569 DOI: 10.3393/ac.2018.07.19] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/19/2018] [Indexed: 01/07/2023] Open
Abstract
Purpose The study aims to assess the functional outcome of anal sphincter-sparing procedures (SSP) with total mesorectal excision (TME) for anorectal adenocarcinoma. Methods In a multicentric, prospective, single-group study in the period between December 2012 and November 2017, 93 patients presented with anorectal adenocarcinoma were included in the study. Sixty-nine patients underwent SSP with TME. SSP included the combined approach of transabdominal TME with intersphincteric resection (ISR) or transanal transabdominal TME. Using the per anal examination scoring system (PASS), postoperative anal function was assessed after 1 year. Results Bowel motility time was 50±19 hours. The time needed for narcotic analgesia was 54±18.8 hours. Mean hospital stay was 15.4±10.25 days. Incidence of evident fecal incontinence after ISR is 10.6% (7 of 67 cases). The PASS findings of 69 cases are as follows: extremely hypotonic 8.6% (6 cases), slightly hypotonic 26.1% (18 cases), normal tone 58% (40 cases), slightly stenotic 3 cases (4.3%), or occluded 2.9% (2 cases). Urinary dysfunction occurred in 1 case (1.4%). Temporary diversion was performed in 61 patients (87.1%). Conclusion Sphincter preservation with TME for anorectal adenocarcinoma helps avoid permanent stoma and provides reasonable functional outcomes. PASS is a new application for postoperative assessment of anal function.
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Affiliation(s)
- Osama Eldamshety
- surgical oncology, oncology centre, Mansoura university, Elmansoura, Egypt
| | - Sherif Kotb
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Ashraf Khater
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Sameh Roshdy
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Mohamed Elashry
- Department of clinical oncology and nuclear medicine, Mansoura University, Mansoura, Mansoura, Egypt
| | - Mohamed S Zahi
- Department of clinical oncology and nuclear medicine, Mansoura University, Mansoura, Mansoura, Egypt
| | | | - Waleed Elnahas
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Omar Farouk
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Adel Fathi
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Ahmed Senbel
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Emad-Eldeen Hamed
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Khaled Abdelwahab
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | | | - Ahmed Abdallah
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Mahmoud Abdelaziz
- Surgery department, Oncology Centre of Mansoura University, Mansoura, Egypt
| | - Emanuele Lezoche
- Surgery department, Policlinico Umberto primo, Sapienza University of Rome, Rome, Italy
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Tong G, Zhang G, Liu J, Zheng Z, Chen Y, Li M, Zhong Y, Niu P, Xu X. When do defecation function and quality of life recover for patients with non-ostomy and ostomy surgery of rectal cancer? BMC Surg 2020; 20:57. [PMID: 32228547 PMCID: PMC7106805 DOI: 10.1186/s12893-020-00719-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/17/2020] [Indexed: 12/15/2022] Open
Abstract
Background Rectal cancer (RC) surgery often results in permanent colostomy, seriously limiting the quality of life (QOL) in patients in terms of bowel function. This study aimed to examine defecation function and QOL in RC patients who underwent non-ostomy or ostomy surgery, at different time-points after surgery. Methods In total, 82 patients who underwent an ostomy and 141 who did not undergo an ostomy for the treatment of RC at our colorectal surgery department between January 2013 and January 2015 were enrolled. Surgical methods, tumor distance from the anal margin (TD), anastomosis distance from the anal margin (AD) and complications were compered between the non-ostomy and ostomy surgery groups. QOL was compared between the two groups at years 2, 3, and 4 after surgery. The Wexner score and the validated cancer-specific European Organization for Research and Treatment of Cancer (EORTC QLQ-CR30) questionnaire scores were assessed for all patients in January 2017. SPSS 21.0 was utilized for all data analyses. Results Surgical methods, TD, and AD significantly differed between the non-ostomy and ostomy surgery groups (all P < .001). However, no differences were found in the number of complications between the groups (P = .483). For the 192 patients undergoing Dixon surgery, role function (RF), global QOL (GQOL), sleep disturbance, and the incidence of constipation showed significant differences between the two groups (P = .012, P = .025, P = .036, and P = .015, respectively). In the 31 cases of permanent ostomy, we observed significant differences in GQOL scores, dyspnea incidence, and financial difficulties across the different years (P = .002, P = .036, and P < .01, respectively). Across all 223 cases, there were significant differences in social function and GQOL scores in the second year after surgery (P = .014 and P < .001, respectively). However, no differences were observed in the other indices across the three time-points. Conclusions RC patients undergoing ostomy surgery, especially those with low and super-low RC, revealed poorer defecation function and QOL in the present study. However, 2 years after surgery, most of the defecation and QOL indicators showed recovery.
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Affiliation(s)
- Guojun Tong
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China. .,Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China.
| | - Guiyang Zhang
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Jian Liu
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China.,Vice President of Huzhou Central Hospital, Zhejiang, 313000, China
| | - Zhaozheng Zheng
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Yan Chen
- Department of Colorectal Surgery, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Min Li
- Huzhou Central Hospital, Zhejiang, 313000, China
| | - Yan Zhong
- Huzhou Central Hospital, Zhejiang, 313000, China
| | - Pingping Niu
- Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China
| | - Xuting Xu
- Central Laboratory, Huzhou Central Hospital, Zhejiang, 313000, China
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Akça O, Zargar H, Autorino R, Brandao LF, Gürler AS, Avşar A, Horuz R, Albayrak S. The transrectal single port laparoscopic radical prostatectomy in a cadaver model. Turk J Urol 2015; 41:78-82. [PMID: 26328206 DOI: 10.5152/tud.2015.40336] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Accepted: 03/03/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To explore the feasibility of laparoscopic trans-rectal Natural Orifice Transluminal Endoscopic Surgery (NOTES) radical prostatectomy in a cadaveric model and to define anatomical landmarks of this surgical route. MATERIALS AND METHODS After the ethical clearance, the study was conducted in Turkish Council of Forensic Medicine. With the cadaver in an exaggerated lithotomy position, a full thickness incision was made on the anterior wall of the rectum. The anteriorly visible Denonvilliers' fascia was incised sharply, exposing the posterior surface of the prostate. A single-port device (GelPOINT(®)Path) was inserted transanally passing the incision on the anterior wall of the rectum, into the bluntly created space between rectum and prostate. Three, 10 mm ports were placed through the GelPOINT(®)Path, at 3, 6, and 9 o'clock positions. A 5 mm, 0° degree lens was introduced at 6 o'clock position; followed by laparoscopic scissors and laparoscopic grasper. Prostatic and periprostatic anatomy was defined as encountered during each step of the procedure. RESULTS Exposure of the posterior surface of the prostate and seminal vesicles was easily achieved. No additional openings of the rectal wall were made. Surgical specimen was extracted keeping its integrity. CONCLUSION Transrectal radical prostatectomy is technically feasible in the cadaver model, being facilitated by previous experience with perineal surgery. Anatomical observations during the present experimental study suggest that the transrectal NOTES route provides good exposure of the operative field and easy access to the posterior surface of prostate, Future experimental endeavors should focus on reproducibility of this approach and feasibility of lymph node dissection using trans-rectal route.
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Affiliation(s)
- Oktay Akça
- Department of Urology, Kartal Training and Research Hospital, İstanbul, Turkey
| | - Homayoun Zargar
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Riccardo Autorino
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Luis Felipe Brandao
- Department of Urology, Glickman Urological and Kidney Institute, Cleveland, USA
| | - Ahmet Selçuk Gürler
- T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey
| | - Abdullah Avşar
- T.C. Ministry of Justice, Turkish Council of Forensic Medicine, İstanbul, Turkey
| | - Rahim Horuz
- Department of Urology, Medipol University Hospital, İstanbul, Turkey
| | - Selami Albayrak
- Department of Urology, Medipol University Hospital, İstanbul, Turkey
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Germline and somatic genetic predictors of pathological response in neoadjuvant settings of rectal and esophageal cancers: systematic review and meta-analysis. THE PHARMACOGENOMICS JOURNAL 2015; 16:249-65. [PMID: 26122021 DOI: 10.1038/tpj.2015.46] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 05/10/2015] [Accepted: 05/21/2015] [Indexed: 12/21/2022]
Abstract
Oncologists have pointed out an urgent need for biomarkers that can be useful for clinical application to predict the susceptibility of patients to preoperative therapy. This review collects, evaluates and combines data on the influence of reported somatic and germline genetic variations on histological tumor regression in neoadjuvant settings of rectal and esophageal cancers. Five hundred and twenty-seven articles were identified, 204 retrieved and 61 studies included. Among 24 and 14 genetic markers reported for rectal and esophageal cancers, respectively, significant associations in meta-analyses were demonstrated for the following markers. In rectal cancer, major response was more frequent in carriers of the TYMS genotype 2 R/2 R-2 R/3 R (rs34743033), MTHFR genotype 677C/C (rs1801133), wild-type TP53 and KRAS genes. In esophageal cancer, successful therapy appeared to correlate with wild-type TP53. These results may be useful for future research directions to translate reported data into practical clinical use.
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Zbar AP. Commentary on neoadjuvant therapy followed by local excision and two-stage total mesorectal excision: a new strategy for sphincter preservation in locally advanced ultra-low rectal cancer. Gastroenterol Rep (Oxf) 2014; 2:134-5. [PMID: 24812283 PMCID: PMC4020121 DOI: 10.1093/gastro/gou024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Andrew P Zbar
- Department of Surgery and Transplantation, Chaim Sheba Medical Center, Sackler Medical School, Tel Aviv University, Ramat Gan 52621 and Assia Medical Group, Barzel Street 10, Ramat Gan 52621, Israel. Tel: +972-54-980-5414;
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Li SY, Chen G, Bai X, Zuo FY, Chen G, Du JF, Wei XJ, Cui W. Anus-preserving rectectomy via telescopic colorectal mucosal anastomosis for low rectal cancer: Experience from a Chinese cohort. World J Gastroenterol 2013; 19:3841-3846. [PMID: 23840123 PMCID: PMC3699045 DOI: 10.3748/wjg.v19.i24.3841] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 06/04/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the safety and efficacy of anus-preserving rectectomy via telescopic colorectal mucosal anastomosis (TCMA) for low rectal cancer.
METHODS: From August 1993 to October 2012, 420 patients including 253 males and 167 females with low rectal cancer underwent transabdominal and transanal anterior resection, followed by TCMA. The distance between the anus and inferior margin of the tumor ranged from 5 to 7 cm, and was 5 cm in 6 patients, 6 cm in 127, and 7 cm in 287 patients. Tumor-node-metastasis staging showed that 136 patients had stage I, 252 had stage II and 32 had stage III. Fifty-six patients with T3 or over received preoperative neoadjuvant chemoradiotherapy.
RESULTS: The postoperative follow-up rate was 91.9% (386/420) with a median time of 6.4 years. All 420 patients underwent radical resection. No postoperative death occurred. Postoperative complications included anastomotic leakage in 13 (3.1%) patients and anastomotic stenosis in 7 (1.6%). The local recurrence rate after surgery was 6.2%, the hepatic metastasis rate was 13.2% and the pulmonary metastasis rate was 2.3%. The 5-year survival rate was 74.0% and the disease-free survival rate was 71.0%. Kirwan classification showed that continence was good in 94.4% of patients with stage I when scored 12 mo after resection.
CONCLUSION: TCMA for patients with low rectal cancer leads to better quality of life and satisfactory defecation function, and lowers anastomotic leakage occurrence, and might be one of the safe operative procedures in anus-preserving rectectomy.
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Rectal cancer: multimodal treatment approach. Int J Surg Oncol 2012; 2012:279341. [PMID: 23008766 PMCID: PMC3447353 DOI: 10.1155/2012/279341] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 08/02/2012] [Indexed: 12/18/2022] Open
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