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Li Y, Li S, Liu L, Zhang LY, Wu D, Xie TY, Wang XX. Incorporation of perigastric tumor deposits into the TNM staging system for primary gastric cancer. World J Gastrointest Oncol 2023; 15:1605-1615. [PMID: 37746641 PMCID: PMC10514718 DOI: 10.4251/wjgo.v15.i9.1605] [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: 06/14/2023] [Revised: 07/15/2023] [Accepted: 08/02/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The current prognostic significance of perigastric tumor deposits (TDs) in gastric cancer (GC) remains unclear. AIM To assess the prognostic value of perigastric TDs and put forward a new TNM staging framework involving TDs for primary GC. METHODS This study retrospectively analyzed the pathological data of 6672 patients with GC who underwent gastrectomy or surgery for GC with other diseases from January 1, 2012 to December 31, 2017 at the Chinese PLA General Hospital. According to the presence of perigastric TDs or not, the patients were divided into TD-positive and TD-negative groups by using the method of propensity score matching. The differences between TD-positive and TD-negative patients were analyzed using binary logistic regression modeling. The Kaplan-Meier method was used to plot survival curves. Multivariate Cox regression modeling and the log-rank test were used to analyze the data. RESULTS Perigastric TDs were found to be positive in 339 (5.09%) of the 6672 patients with GC, among whom 237 were men (69.91%) and 102 were women (30.09%) (2.32:1). The median age was 59 years (range, 27 to 78 years). Univariate and multivariate survival analyses indicated that TD-positive GC patients had a poorer prognosis than TD-negative patients (P < 0.05). The 1-, 3-, and 5-year overall survival rates of GC patients with TDs were 68.3%, 19.6%, and 11.2%, respectively, and these were significantly poorer than those without TDs of the same stages. There was significant variation in survival according to TD locations among the GC patients (P < 0.05). A new TNM staging framework for GC was formulated according to TD location. When TDs appear in the gastric body, the original stages T1, T2, and T3 are classified as T4a with the new framework, and the original stages T4a and T4b both are classified as T4b. When TDs appear in the lesser curvature, the previous stages N0, N1, N2, and N3 now both are classified as N3. When TDs appear in the greater curvature or the distant tissue, the patient should be categorized as having M1. With the new GC staging scheme including TDs, the survival curves of patients in the lower grade TNM stage with TDs were closer to those of patients in the higher grade TNM stage without TDs. CONCLUSION TDs are a poor prognostic factor for patients with primary GC. The location of TDs is associated with the prognosis of patients with primary GC. Accordingly, we developed a new TNM staging framework involving TDs that is more appropriate for patients with primary GC.
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Affiliation(s)
- Yang Li
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Shuo Li
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Lu Liu
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Li-Yu Zhang
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Di Wu
- Medical School of Chinese People's Liberation Army, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Tian-Yu Xie
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xin-Xin Wang
- Department of General Surgery, The First Medical Center, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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Adachi T, Kitaguchi D, Teramura K, Hasegawa H, Ikeda K, Tsukada Y, Nishizawa Y, Sasaki T, Ito M. Single-center comparative study of short-term outcomes of transanal and laparoscopic total mesorectal excisions for low and middle rectal cancers. Surg Endosc 2023:10.1007/s00464-023-09948-1. [PMID: 36890411 DOI: 10.1007/s00464-023-09948-1] [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: 09/20/2022] [Accepted: 02/12/2023] [Indexed: 03/10/2023]
Abstract
BACKGROUND Transanal total mesorectal excision is a promising surgical treatment for rectal cancer. However, evidence regarding the differences in outcomes between the transanal and laparoscopic total mesorectal excisions is scarce. We compared the short-term outcomes of transanal and laparoscopic total mesorectal excisions for low and middle rectal cancers. METHODS This retrospective study included patients who underwent low anterior or intersphincteric resection for middle (5-10 cm) or low (< 5 cm) rectal cancer at the National Cancer Center Hospital East, Japan, from May 2013 to March 2020. Primary rectal adenocarcinoma was confirmed histologically. Circumferential resection margins (CRMs) of resected specimens were measured; margins ≤ 1 mm were considered positive. The operative time, blood loss, hospitalization length, postoperative readmission rate, and short-term treatment results were compared. RESULTS Four hundred twenty-nine patients were divided into two mesorectal excision groups: transanal (n = 295) and laparoscopic (n = 134). Operative times were significantly shorter in the transanal group than in the laparoscopic group (p < 0.001). The pathological T stage and N status were not significantly different. The transanal group had significantly lower positive CRM rates (p = 0.04), and significantly lower incidence of the Clavien-Dindo grade III (p = 0.02) and IV (p = 0.03) complications. Both groups had distal margin positivity rates of 0%. CONCLUSIONS Compared to laparoscopic, transanal total mesorectal excision for low and middle rectal cancers has lower incident postoperative complication and CRM-positivity rates, demonstrating the safety and usefulness of local curability for middle and low rectal cancers.
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Affiliation(s)
- Toshiyuki Adachi
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Daichi Kitaguchi
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koichi Teramura
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Hiro Hasegawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Koji Ikeda
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
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Required distal mesorectal resection margin in partial mesorectal excision: a systematic review on distal mesorectal spread. Tech Coloproctol 2023; 27:11-21. [PMID: 36036328 PMCID: PMC9807492 DOI: 10.1007/s10151-022-02690-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/15/2022] [Indexed: 01/12/2023]
Abstract
BACKGROUND The required distal margin in partial mesorectal excision (PME) is controversial. The aim of this systematic review was to determine incidence and distance of distal mesorectal spread (DMS). METHODS A systematic search was performed using PubMed, Embase and Google Scholar databases. Articles eligible for inclusion were studies reporting on the presence of distal mesorectal spread in patients with rectal cancer who underwent radical resection. RESULTS Out of 2493 articles, 22 studies with a total of 1921 patients were included, of whom 340 underwent long-course neoadjuvant chemoradiotherapy (CRT). DMS was reported in 207 of 1921 (10.8%) specimens (1.2% in CRT group and 12.8% in non-CRT group), with specified distance of DMS relative to the tumor in 84 (40.6%) of the cases. Mean and median DMS were 20.2 and 20.0 mm, respectively. Distal margins of 40 mm and 30 mm would result in 10% and 32% residual tumor, respectively, which translates into 1% and 4% overall residual cancer risk given 11% incidence of DMS. The maximum reported DMS was 50 mm in 1 of 84 cases. In subgroup analysis, for T3, the mean DMS was 18.8 mm (range 8-40 mm) and 27.2 mm (range 10-40 mm) for T4 rectal cancer. CONCLUSIONS DMS occurred in 11% of cases, with a maximum of 50 mm in less than 1% of the DMS cases. For PME, substantial overtreatment is present if a distal margin of 5 cm is routinely utilized. Prospective studies evaluating more limited margins based on high-quality preoperative magnetic resonance imaging and pathological assessment are required.
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Zhou M, Yang W, Zou W, Yang J, Zhou C, Zhang Z, Wang Y, Zhang J, Wang Y, Li G, Zhang Z, Xia F. Prognostic significance of tumor deposits in radically resected gastric cancer: a retrospective study of a cohort of 1915 Chinese individuals. World J Surg Oncol 2022; 20:304. [PMID: 36138439 PMCID: PMC9502614 DOI: 10.1186/s12957-022-02773-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 08/09/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Tumor deposits (TDs) have been identified as an independent prognostic factor in gastric cancer (GC). However, the associated clinicopathological factors and how to simply and reasonably incorporate TD into the TNM staging system remain undetermined. The aim of the current study was therefore to assess the significance of TD among radically resected GC patients. METHODS We retrospectively reviewed 1915 patients undergoing radical resection between 2007 and 2012. The patients were classified into two groups according to TD status (absent vs. present), and the clinicopathologic characteristics, DFS, and OS were compared. Associations of TD presence with other clinicopathologic factors were evaluated by logistic regression analysis. Univariate and multivariate Cox regression analyses were performed to determine the prognostic factors for DFS and OS in the primary cohort. Propensity score matching (PSM) was performed to reduce the possibility of selection bias according to the presence of TD. External validation of previously proposed modified staging systems incorporating TD was conducted. RESULTS The detection rate of TD was 10.5% (201/1915). The presence of TD was significantly related to unfavorable clinicopathologic variables, including advanced T and N categories. According to the multivariate Cox regression analysis, the presence of TD was identified as an independent prognostic factor for DFS and OS in the primary cohort (both P < 0.001). In the after-PSM cohort, TD presence also significantly shortened DFS and OS. In the external validation, one system that incorporated TD into the pTNM stage had the best performance. CONCLUSIONS The presence of TD was significantly associated with poor survival in radically resected GC patients. The incorporation of TD into the TNM staging system can further improve the predictive capability. A multicenter cohort with a large sample size is needed to determine the appropriate method of incorporation.
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Affiliation(s)
- Menglong Zhou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Wang Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Wei Zou
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Jianing Yang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Changming Zhou
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Department of Cancer Prevention, Fudan University Shanghai Cancer Center, Shanghai, 200032 People’s Republic of China
| | - Zhiyuan Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Yaqi Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Jing Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Yan Wang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Guichao Li
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Zhen Zhang
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
| | - Fan Xia
- Department of Radiation Oncology, Fudan University Shanghai Cancer Center, 270 Dong’an Road, Shanghai, 200032 People’s Republic of China
- Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, 200032 People’s Republic of China
- Shanghai Key Laboratory of Radiation Oncology, Shanghai, 200032 People’s Republic of China
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Lin Q, Bai Q, Huang Q, Huang Y, Gao J, Zhang Y. Partial omentectomy maybe practicable for T3 or shallower gastric cancer patients. Cancer Med 2022; 12:1204-1216. [PMID: 35856487 PMCID: PMC9883580 DOI: 10.1002/cam4.4980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 04/18/2022] [Accepted: 06/15/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Total omentectomy is often performed with gastrectomy as radical surgery for gastric cancer (GC) patients. However, it remains controversial whether GC patients can benefit from omentectomy. The aim of this study was to analyze the incidence and clinical significance of tumor deposits (TDs) in different anatomical subregions of perigastric omentum in GC patients undergoing gastrectomy with total omentectomy. METHODS From October 2011 to December 2013, 1253 patients who underwent gastrectomy with total omentectomy for GC were retrospective reviewed. The TDs in different anatomical subregions of perigastric omentum were examined. RESULTS Of 1253 patients, TDs positivity was 11.2%. Tumor deposits in the omentum of greater curvature and in the omentum of lesser curvature were associated with lymphovascular invasion, perineural invasion, advanced tumor node metastasis stages, and unfavorable survival. Besides, TDs in the proximal omentum of greater curvature and in the omentum of lesser curvature correlated with older patients and larger tumors. Kaplan-Meier curves showed that patients with TDs had worser overall survival (OS) than those without, regardless of TD positions. Patients with TDs in the omentum of greater curvature had the worst prognosis, followed by patients with TDs in the omentum of lesser curvature and patients with no TDs. Tumor deposits in the proximal omentum of greater curvature was an independent prognostic factor for OS. Moreover, only patients classified as pT4 had TDs in the distal omentum of greater curvature. CONCLUSIONS Patients with TDs in the omentum of greater curvature had the worst prognosis, followed by patients with TDs in the omentum of lesser curvature and patients with no TDs. In addition, partial omentectomy might be practicable for gastric cancer patients classified as T3 or shallower tumors.
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Affiliation(s)
- Qiaowei Lin
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Qianming Bai
- Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina,Department of Pathology, Shanghai Cancer CenterFudan UniversityShanghaiChina
| | - Qiuyi Huang
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yakai Huang
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Jianpeng Gao
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
| | - Yu Zhang
- Department of Gastric Surgery, Shanghai Cancer CenterFudan UniversityShanghaiChina,Department of Oncology, Shanghai Medical CollegeFudan UniversityShanghaiChina
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Ishii M, Takemasa I, Okita K, Okuya K, Hamabe A, Nishidate T, Akizuki E, Sato Y, Miura R, Korai T, Sugita S, Hasegawa T. A modified method for resected specimen processing in rectal cancer: Semi-opened with transverse slicing for measuring of the circumferential resection margin. Asian J Endosc Surg 2022; 15:437-442. [PMID: 34743420 DOI: 10.1111/ases.13003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/20/2021] [Accepted: 10/06/2021] [Indexed: 12/22/2022]
Abstract
Circumferential resection margin (CRM) is essential for oncological quality assessment in rectal cancer surgery. CRM represents a surrogate parameter for oncological outcomes and is important for stratifying treatment strategies in Western nations. In Japan, the mesentery is removed for specimen processing in order to extract as many lymph nodes (LNs) as possible; consequently, CRM cannot be measured. Given the diversification of treatment strategies for rectal cancer, the lack of measurement of CRM to assess surgical outcomes is a crucial issue that must be resolved. Therefore, it is necessary to establish a method enabling measurement of CRM while enjoying the advantages of the Japanese method. In the method we developed, the mesentery is removed from the rectum more than 2 cm away from the tumor, and the vicinity of the tumor is circularized. It is necessary to investigate the usefulness of this method prospectively in a multi-center study.
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Affiliation(s)
- Masayuki Ishii
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Ichiro Takemasa
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Kenji Okita
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Koichi Okuya
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Hamabe
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Toshihiko Nishidate
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Emi Akizuki
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Yu Sato
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Ryo Miura
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Takahiro Korai
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University, Sapporo, Japan
| | - Shintaro Sugita
- Department of Surgical Pathology, Sapporo Medical University Hospital, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University Hospital, Sapporo, Japan
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Yu S, Zhu Y, Shi X, Diao W, Zhu X, Gao Z, Chen X. The prognostic significance of tumor deposits in patients with head and neck squamous cell carcinomas. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:377. [PMID: 33842598 PMCID: PMC8033359 DOI: 10.21037/atm-20-4369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Background A tumor deposit (TD) is a phenomenon that has not been well studied in head and neck squamous cell carcinoma (HNSCC) but might have prognostic significance. The present study was conducted to explore the presence and the prognostic significance of TDs in patients with HNSCCs. Methods Six hundred forty-two pathologically confirmed HNSCC patients with neck dissection samples were enrolled in this retrospective study. Patients were followed up and evaluated every 3 months in the first 3 years after surgery, and every 6 months thereafter by physical examination and computed tomography (CT)/magnetic resonance imaging (MRI) scans. The five-year overall survival (OS), disease-specific survival (DSS), and recurrence-free survival (RFS) were compared in the TD and non-TD groups using multivariable analyses and propensity score matching (PSM) methodology (1:1). Results The 5-year OS, DSS, and RFS rate of all patients was 77.3%, 80.6%, and 71.9%, respectively. In the multivariable analyses, poorer rates of OS (HR =2.345, P<0.001), DSS (HR =2.818, P<0.001), and RFS (HR =2.536, P<0.001) were observed in the TD versus the non-TD group. In the PSM cohort, eighty-one patients who had TDs were paired with 70 patients without TDs. Significantly diminished rates of DSS (P=0.040) and RFS (P=0.004) were found in the TD versus the non-TD group. Conclusions In response to sparse reports regarding TDs in HNSCCs, the present study proposes the TD as an independent poor prognostic factor meriting further research because of its association with diminished OS, DSS, and RFS rates.
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Affiliation(s)
- Shuting Yu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Yingying Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaohua Shi
- Department of Pathology, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Wenwen Diao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaoli Zhu
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Zhiqiang Gao
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
| | - Xingming Chen
- Department of Otolaryngology-Head and Neck Surgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
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Yabuuchi Y, Imai K, Hotta K, Ito S, Kishida Y, Manabe S, Yamaoka Y, Hino H, Kagawa H, Shiomi A, Ono H. Efficacy of preemptive endoscopic submucosal dissection and surgery for synchronous colorectal neoplasms. Scand J Gastroenterol 2020; 55:988-994. [PMID: 32650680 DOI: 10.1080/00365521.2020.1792542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND AIM If patients with surgically resectable colorectal cancershave synchronous colorectal neoplasms that are difficult to remove by endoscopic mucosal resection, preemptive endoscopic submucosal dissection (ESD) can avoid excessive colorectal resection. The aim of this study was to evaluate the efficacy of the strategy of preemptive ESD and surgery for synchronous colorectal neoplasms. METHODS Patients who underwent preemptive ESD and surgery for synchronous colorectal neoplasms between September 2002 and December 2017 were enrolled in this retrospective cohort study. The proportion of cases in which extended surgery could be avoided following curative ESD was calculated. Clinicopathological characteristics were evaluated for all patients and long-term outcomes were analyzed for patients who underwent curative ESD and surgery. RESULTS A total of 45 consecutive patients with 47 endoscopically-resected lesions and 46 surgically-resected lesions were retrospectively evaluated. Curative ESD was achieved in 44 lesions (93.6%) and an extended surgical procedure could be avoided in 42 patients (93.3%). Intraoperative perforation occurred in two lesions (4.3%), delayed perforation in one lesion (2.1%), and delayed bleeding in two lesions (4.3%). Final stages were as follows: stage 0, 3 patients (7.1%); stage I, 23 patients (54.8%); stage II, 3 patients (7.1%); stage III, 12 patients (28.6%); and stage IV, 1 patient (2.4%). The 5-year overall survival rates of patients with all pathological stages, stage 0-II, and stage III-IV were 93.7%, 100%, and 79.1%, respectively. CONCLUSION The strategy of preemptive ESD and surgery for synchronous colorectal neoplasms is minimally invasive and has a favorable prognosis.
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Affiliation(s)
- Yohei Yabuuchi
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | - Shoichi Manabe
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yusuke Yamaoka
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hitoshi Hino
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyasu Kagawa
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Ozawa H, Kotake K, Ike H, Sugihara K. Prognostic Impact of the Length of the Distal Resection Margin in Rectosigmoid Cancer: An Analysis of the JSCCR Database between 1995 and 2004. JOURNAL OF THE ANUS RECTUM AND COLON 2020; 4:59-66. [PMID: 32346644 PMCID: PMC7186012 DOI: 10.23922/jarc.2019-013] [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: 06/11/2019] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Objectives The necessary and sufficient length of the distal resection margin (l-DRM) for rectosigmoid cancer remains controversial. This study evaluated the validity of the 3-cm l-DRM rule for rectosigmoid cancer in the Japanese classification of colorectal cancer. Methods We retrospectively reviewed 1,443 patients with cT3 and cT4 rectosigmoid cancer who underwent R0 resection in Japanese institutions between 1995 and 2004. We identified the optimal cutoff point of the l-DRM affecting overall survival (OS) rate using a multivariate Cox regression analysis model. Using this cutoff point, the patients were divided into two groups after balancing the potential confounding factors of the l-DRM using propensity score matching, and the OS rates of the two groups were compared. Results A multivariate Cox regression analysis model revealed that the l-DRM of 4 cm was the best cutoff point with the greatest impact on OS rate (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.00-1.84; P = 0.0452) and with the lowest Akaike information criterion value. In the matched cohort study, the OS rate of patients who had l-DRM of 4 cm or more was significantly higher than that of patients who had l-DRM < 4 cm (n = 402; 5-year OS rates, 87.6% vs. 80.3%, respectively; HR, 1.60; 95% CI, 1.09-2.31; P = 0.0136). Conclusions For cT3 and cT4 rectosigmoid cancer, l-DRM of 4 cm may be an appropriate landmark for a curative intent surgery, and we were unable to definitively confirm the validity of the Japanese 3-cm l-DRM rule.
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Affiliation(s)
- Heita Ozawa
- Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Kenjiro Kotake
- Department of Gastroenterological Surgery, Sano City Hospital, Sano, Japan
| | - Hideyuki Ike
- Department of Surgery, Yokohama Hodogaya Central Hospital, Yokohama, Japan
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Kosuge M, Eto K, Sasaki S, Sugano H, Yatabe S, Takeda Y, Ito D, Ohkuma M, Yanaga K. Clinical factors affecting the distal margin in rectal cancer surgery. Surg Today 2020; 50:743-748. [PMID: 31974754 DOI: 10.1007/s00595-020-01959-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 12/12/2019] [Indexed: 01/11/2023]
Abstract
PURPOSE In rectal cancer surgery, an insufficient distal margin (DM) is associated with a high risk of local recurrence, whereas an excessive DM will cause low anterior resection syndrome, impairing quality of life. This study aimed to identify the factors that affect the distance between the colorectal resection site and the tumor to optimize achieving the correct DM. METHODS The subjects of this study were 219 patients who underwent resection for primary rectal cancer in our department between January 2006 and July 2014. According to Japanese guidelines, DM (rDM) was based on the tumor location, but the pathological DM (pDM) was measured from surgical specimens. The patients were divided into two groups: the pDM-less-than-rDM group (pDM < rDM) and the pDM-greater-or-equal-to-rDM group (pDM ≥ DM). The factors associated with the DM in the two groups were compared. RESULTS In the pDM < rDM group, the tumor distance from the anal verge was shorter (p = 0.001) and significantly more patients underwent laparotomy (p = 0.047). CONCLUSION The DM tended to be shorter than that planned by the surgeon in patients with lower rectal cancers and those treated by laparotomy,; therefore, when performing rectal resection, care must be taken to ensure that the pDM is not shorter than the rDM.
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Affiliation(s)
- Makoto Kosuge
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan.
| | - Ken Eto
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Shigemasa Sasaki
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Hiroshi Sugano
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Saori Yatabe
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Yasuhiro Takeda
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Daisuke Ito
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Masahisa Ohkuma
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Katsuhiko Yanaga
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shimbashi, Minato-ku, Tokyo, 105-8461, Japan
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11
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Hashiguchi Y, Muro K, Saito Y, Ito Y, Ajioka Y, Hamaguchi T, Hasegawa K, Hotta K, Ishida H, Ishiguro M, Ishihara S, Kanemitsu Y, Kinugasa Y, Murofushi K, Nakajima TE, Oka S, Tanaka T, Taniguchi H, Tsuji A, Uehara K, Ueno H, Yamanaka T, Yamazaki K, Yoshida M, Yoshino T, Itabashi M, Sakamaki K, Sano K, Shimada Y, Tanaka S, Uetake H, Yamaguchi S, Yamaguchi N, Kobayashi H, Matsuda K, Kotake K, Sugihara K. Japanese Society for Cancer of the Colon and Rectum (JSCCR) guidelines 2019 for the treatment of colorectal cancer. Int J Clin Oncol 2020; 25:1-42. [PMID: 31203527 PMCID: PMC6946738 DOI: 10.1007/s10147-019-01485-z] [Citation(s) in RCA: 1282] [Impact Index Per Article: 256.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/29/2019] [Indexed: 02/06/2023]
Abstract
The number of deaths from colorectal cancer in Japan continues to increase. Colorectal cancer deaths exceeded 50,000 in 2016. In the 2019 edition, revision of all aspects of treatments was performed, with corrections and additions made based on knowledge acquired since the 2016 version (drug therapy) and the 2014 version (other treatments). The Japanese Society for Cancer of the Colon and Rectum guidelines 2019 for the treatment of colorectal cancer (JSCCR guidelines 2019) have been prepared to show standard treatment strategies for colorectal cancer, to eliminate disparities among institutions in terms of treatment, to eliminate unnecessary treatment and insufficient treatment and to deepen mutual understanding between healthcare professionals and patients by making these guidelines available to the general public. These guidelines have been prepared by consensuses reached by the JSCCR Guideline Committee, based on a careful review of the evidence retrieved by literature searches and in view of the medical health insurance system and actual clinical practice settings in Japan. Therefore, these guidelines can be used as a tool for treating colorectal cancer in actual clinical practice settings. More specifically, they can be used as a guide to obtaining informed consent from patients and choosing the method of treatment for each patient. Controversial issues were selected as clinical questions, and recommendations were made. Each recommendation is accompanied by a classification of the evidence and a classification of recommendation categories based on the consensus reached by the Guideline Committee members. Here, we present the English version of the JSCCR guidelines 2019.
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Affiliation(s)
- Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan.
| | - Kei Muro
- Department of Clinical Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Saito
- Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan
| | - Yoshinori Ito
- Department of Radiation Oncology, Showa University School of Medicine, Tokyo, Japan
| | - Yoichi Ajioka
- Division of Molecular and Diagnostic Pathology, Graduate School of Medical and Dental Sciences, Niigata University, Niigata, Japan
| | - Tetsuya Hamaguchi
- Department of Gastroenterological Oncology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Megumi Ishiguro
- Department of Chemotherapy and Oncosurgery, Tokyo Medical and Dental University Medical Hospital, Tokyo, Japan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Keiko Murofushi
- Department of Radiation Oncology, faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Takako Eguchi Nakajima
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Shiro Oka
- Department of Gastroenterology and Metabolism, Hiroshima University Hospital, Hiroshima, Japan
| | - Toshiaki Tanaka
- Department of Surgical Oncology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroya Taniguchi
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Akihito Tsuji
- Department of Clinical Oncology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Keisuke Uehara
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Takeharu Yamanaka
- Department of Biostatistics, Yokohama City University School of Medicine, Yokohama, Japan
| | - Kentaro Yamazaki
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Takayuki Yoshino
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Keiji Sano
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Yasuhiro Shimada
- Division of Clinical Oncology, Kochi Health Sciences Center, Kochi, Japan
| | - Shinji Tanaka
- Department of Endoscopy, Hiroshima University Hospital, Hiroshima, Japan
| | - Hiroyuki Uetake
- Department of Specialized Surgeries, Tokyo Medical and Dental University, Tokyo, Japan
| | - Shigeki Yamaguchi
- Department of Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | | | - Hirotoshi Kobayashi
- Department of Surgery, Mizonokuchi Hospital, Teikyo University School of Medicine, Kanagawa, Japan
| | - Keiji Matsuda
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8606, Japan
| | - Kenjiro Kotake
- Department of Surgery, Sano City Hospital, Tochigi, Japan
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Tan J, Yang B, Xu Z, Zhou S, Chen Z, Huang J, Gao H, Zheng S, Wen L, Han F. Tumor deposit indicates worse prognosis than metastatic lymph node in gastric cancer: a propensity score matching study. ANNALS OF TRANSLATIONAL MEDICINE 2019; 7:671. [PMID: 31930072 DOI: 10.21037/atm.2019.10.33] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background The prognostic value of tumor deposit (TD) in gastric cancer is controversial. This study aims to investigate the prognostic value of TD. Methods The consecutive patients diagnosed with gastric cancer from October 2007 to October 2012 were selected. The patients were divided by whether they suffered TD into two groups. The basic data were comparable between the two groups after propensity score matching (PSM), then survival analysis [overall survival (OS) and cancer-specific survival (CSS)] was applied in two groups. After that, all the patients were divided by pN staging and survival analysis were applied in each subgroup. At last, all patients were divided into TD group, pN1 stage group, pN2 stage group, pN3a, and pN3b stage group, OS and CSS were compared between them. Multivariable competing risk analyses tested association of TD with OS and CSS, before and after PSM. Results Eight hundred and three patients were concluded. After PSM, 137 patients with TD and 274 patients without TD were selected, the 5-year OS and CSS rates of patients with TD were significantly worse than patients without TD (OS: 19.7% vs. 42.0%, P<0.001; CSS: 22.6% vs. 45.6%, P<0.001). In all patients' survival analysis, the 5-year OS and CSS rates of TD group were comparable with pN3a group (OS: 19.7% vs. 25.3%, P=0.221, CSS: 22.6% vs. 30.1%, P=0.092) and pN3b group (OS: 19.7% vs. 19.6% P=0.349, CSS: 22.6% vs. 23.5%, P=0.452). Meanwhile, on multivariable cox regression analyses, the presence of TD significantly reduces the OS and CSS of patients in gastric cancer. Conclusions TD has a marked impact on the prognosis of gastric cancer. Even patients with TD had the same prognosis with pN3 stage.
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Affiliation(s)
- Jianan Tan
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Bin Yang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhimeng Xu
- Department of Biostatistics and Epidemiology, School of Public Health, Sun Yat-sen University, Guangzhou 510000, China
| | - Shengning Zhou
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Zhitao Chen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Jing Huang
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Han Gao
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Senyou Zheng
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Liqiang Wen
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
| | - Fanghai Han
- Department of Gastrointestinal Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou 510000, China
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13
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The clinical significance of distal spread differs according to the primary tumor location in rectal cancer. Surg Today 2019; 50:360-368. [DOI: 10.1007/s00595-019-01882-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/13/2019] [Indexed: 12/13/2022]
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Graham Martínez C, Knijn N, Verheij M, Nagtegaal ID, van der Post RS. Tumour deposits are a significant prognostic factor in gastric cancer - a systematic review and meta-analysis. Histopathology 2019; 74:809-816. [PMID: 30376189 PMCID: PMC6850601 DOI: 10.1111/his.13781] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 10/29/2018] [Indexed: 12/11/2022]
Abstract
AIMS Tumour deposits (TDs) are clusters of cancer cells in the soft tissue that are discontinuous from the primary tumour. In this review we are exploring their relevance for prognosis in patients with gastric cancer. METHODS AND RESULTS A literature search was performed to identify studies providing data on TDs and prognosis in gastric cancer patients. Eight papers were included in the meta-analysis, which was carried out in terms of risk ratios (RR) and hazard ratios (HR) with 95% confidence interval (95% CI). Of 7445 patients, 1551 had TDs (20.9%). TDs were associated with a decreased overall survival (OS) in univariate (HR = 2.82, 95% CI = 1.9-4.3) and multivariate analyses (HR = 1.65, 95% CI = 1.3-2.1). TDs were also associated with known prognostic factors such as synchronous metastatic disease (RR = 9.5), invasion depth (RR = 1.8), lymph node metastasis (RR = 1.7), lymphatic invasion (RR = 1.7), vascular invasion (RR = 2.6) and poor differentiation (RR = 1.2). CONCLUSIONS We found a strong indication that TDs are independent predictors of prognosis in patients with gastric cancer; hence, TDs should be included in the staging of gastric cancers.
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Affiliation(s)
| | - Nikki Knijn
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
| | - Marcel Verheij
- Department of RadiotherapyRadboud University Medical CentreNijmegenthe Netherlands
| | - Iris D Nagtegaal
- Department of PathologyRadboud university medical centreNijmegenthe Netherlands
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15
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Socha J, Pietrzak L, Zawadzka A, Paciorkiewicz A, Krupa A, Bujko K. A systematic review and meta-analysis of pT2 rectal cancer spread and recurrence pattern: Implications for target design in radiation therapy for organ preservation. Radiother Oncol 2019; 133:20-27. [PMID: 30935577 DOI: 10.1016/j.radonc.2018.12.024] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND There are no guidelines on clinical target volume (CTV) delineation for cT2 rectal cancer treated with organ preservation. MATERIALS AND METHODS A systematic review and meta-analysis were performed to determine the extent of distal mesorectal (DMS) and distal intramural spread (DIS), the risk of lateral lymph node (LLN) metastases in pT2 tumours, and regional recurrence pattern after organ preservation. RESULTS The rate of DMS > 1 cm was 1.9% (95% CI: 0.4-5.4%), maximum extent: 1.3 cm. The rate of DIS > 0.5 cm was 4.7% (95% CI: 1.3-11.5%), maximum extent: 0.8 cm. The rate of LLN metastases was 8.2% (95% CI: 6.7-9.9%) for tumours below or at peritoneal reflexion and 0% for higher tumours. Regional nodal recurrences alone were recorded in 1.0% (95% CI: 0.5-1.7%) of patients after watch-and-wait and in 2.1% (95% CI: 1.2-3.4%) after preoperative radiotherapy and local excision. Thus, the following rules for CTV delineation are proposed: caudal border 1.5 cm from the tumour to account for DMS or 1 cm to account for DIS, whichever is more caudal; cranial border at S2/S3 interspace; inclusion of LLN for tumours at or below peritoneal reflexion. A planning study was performed in eight patients to compare dose-volume parameters obtained using these rules to that obtained using current guidelines for advanced cancers. The proposed rules led to a mean 18% relative reduction of planning target volume, which resulted in better sparing of organs-at-risk. CONCLUSION This meta-analysis suggests a smaller CTV for cT2 tumours than the current guidelines designed for advanced cancers.
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Affiliation(s)
- Joanna Socha
- Department of Radiotherapy, Military Institute of Medicine, Warsaw, Poland; Department of Radiotherapy, Regional Oncology Center, Czestochowa, Poland.
| | - Lucyna Pietrzak
- Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Anna Zawadzka
- Medical Physics Department, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Anna Paciorkiewicz
- Medical Physics Department, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Anna Krupa
- Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
| | - Krzysztof Bujko
- Department of Radiotherapy I, Maria Skłodowska-Curie Memorial Cancer Centre, Warsaw, Poland
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16
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Kondo A, Tsukada Y, Kojima M, Nishizawa Y, Sasaki T, Suzuki Y, Ito M. Effect of preoperative chemotherapy on distal spread of low rectal cancer located close to the anus. Int J Colorectal Dis 2018; 33:1685-1693. [PMID: 30215109 DOI: 10.1007/s00384-018-3159-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/29/2018] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to clarify the frequency of distal spread and the optimal distal margin after preoperative chemotherapy for advanced low rectal cancer. METHODS The study included patients with advanced lower rectal cancer who received preoperative chemotherapy and underwent surgery during 2012-2015. We investigated the distal spread of tumor cells, defined as the distal distance from the intramucosal distal tumor edge to the farthest tumor cells located under the submucosal layer. Clinical characteristics were compared for distal spreads ≥ 10 and < 10 mm, and risk factors for distal spread ≥ 10 mm were investigated. RESULTS Of the 71 patients, 42 (59%) showed distal spread. Distal spreads of 1-9, 10-19, and ≥ 20 mm were observed in 27 (38%), 11 (15%), and 4 (6%) patients, respectively. Multivariate analysis revealed two independent risk factors for distal spread ≥ 10 mm after preoperative chemotherapy. The first risk factor is the presence of different therapeutic effects between the mucosal and deeper layers (meaning that superficial tumor shrinkage was evident on colonoscopy, but little tumor shrinkage was evident on magnetic resonance imaging) (odds ratio, 11.6; 95% CI, 2.22-61.3). The second risk factor is poorly differentiated or mucinous adenocarcinoma (odds ratio, 8.86; 95% CI, 1.58-49.9). CONCLUSION A distal margin of 20 mm is required (10 mm is insufficient) for advanced lower rectal cancer patients who receive preoperative chemotherapy followed by surgery. Independent risk factors for distal spread ≥ 10 mm include (1) the presence of different therapeutic effects between mucosal and deeper layers and (2) poorly differentiated or mucinous adenocarcinomas.
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Affiliation(s)
- Akihiro Kondo
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Yuichiro Tsukada
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Motohiro Kojima
- Division of Pathology, Exploratory Oncology Research and Clinical Trial Center, National Cancer Center, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Yuji Nishizawa
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Takeshi Sasaki
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Faculty of Medicine, Kagawa University, 1750-1, Ikenobe, Miki-cho, Kita-gun, Kagawa, 761-0793, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, 6-5-1, Kashiwanoha, Kashiwa-shi, Chiba, 277-8577, Japan.
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Basnet S, Lou QF, Liu N, Rana R, Shah A, Khadka M, Warrier H, Sigdel S, Dhakal S, Devkota A, Mishra R, Sapkota G, Zheng L, Ge HY. Tumor deposit is an independent prognostic indicator in patients who underwent radical resection for colorectal cancer. J Cancer 2018; 9:3979-3985. [PMID: 30410602 PMCID: PMC6218780 DOI: 10.7150/jca.27475] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
Background: Tumor deposits are one of the promising factors among the different edition of Tumor, Node, Metastasis classification. Despite improvement in the treatment of various types of metastatic disease the source and prognostic significance of tumor deposits in staging has not been deliberating the agreeable opinion. We investigated the possibility of tumor deposit as independent prognostic factor and evaluating its prognostic value in colorectal carcinoma patients. Methods: Author studied 313 colorectal cancer patients clinocopathological data and outcome who underwent radical resection. Data between 2011-2015 were retrospectively collected from Shanghai East Hospital, affiliated with Tongji University data information centre. The analysis was used to calculate 2 years disease free survival(DFS) and relation of tumor deposit with number of lymph node positive. Cox-regression analysis was performed to assess the prognostic factor. Results: Out of 313 colorectal patients included in the study, tumor deposits were detected in 17%. Tumor deposits (TDs) are relevantly associated with significant poor outcomes. The tumor deposit were significantly correlated with T-stage(P=<0.001), N-stage(P=<0.001), PLNC(P=<0.001), venous invasion(P=<0.001), TNM staging(P=<0.001), CEA(P=0.021) and CA19-9(P=0.042) of primary tumor. The Kaplan-Meier analysis revealed that disease-free survival of CRC patients with positive tumor deposit were significantly poorer that those with negative tumor deposit cohort(P=<0.001) And with multivariate analysis in different model, we found that positive tumor deposit were significantly associated with shorter DSF which is totally independent with lymph node status (P=0.001 and P=0.023 respectively). Subgroup analysis found that of 179 CRC patients with negative lymph node status, the DFS of patients with positive tumor deposit were significantly shorter that those with negative tumor deposit(P=,0.001). Of 134patients with positive lymph node status, the DFS of patients shows similar result. (P=<0.001). Conclusion: We have shown that TDs are not equal to lymph node metastasis with respect to biology and outcome. Tumor deposits are an independent adverse prognostic factor in CRC patient who have undergone radical resection.
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Affiliation(s)
- Shiva Basnet
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China.,Dulegaunda Polyclinic and Research Centre, Gandaki Province, Nepal.,Metro city Hospital and Research Centre Gandaki Province Nepal
| | - Qi-Feng Lou
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Nan Liu
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ramesh Rana
- Department of Internal Medicine, Gautam Buddha Community Heart Hospital Butwal Nepal
| | - Abilasha Shah
- National Center for Rheumatic Diseases, Ratopul Kathmandu Nepal
| | - Mamata Khadka
- University of Maryland College Park, School of Public Health, USA
| | | | | | - Sunil Dhakal
- B.P Koirala Memorial Cancer Hospital Bharatpur Nepal
| | - Anita Devkota
- B.P Koirala Memorial Cancer Hospital Bharatpur Nepal
| | - Roshan Mishra
- B.P Koirala Memorial Cancer Hospital Bharatpur Nepal
| | - Ganga Sapkota
- B.P Koirala Memorial Cancer Hospital Bharatpur Nepal
| | - Liang Zheng
- Research Centre for Translational Medicine, Key Laboratory of Arrhythmias, Ministry of Education, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hai-Yan Ge
- Department of Gastrointestinal Surgery, Shanghai East Hospital, Tongji University School of Medicine, Shanghai, China
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Munakata S, Murai Y, Koizumi A, Kato H, Yamamoto R, Ueda S, Tokuda S, Sakuraba S, Kushida T, Orita H, Sakurada M, Maekawa H, Sato K, Wada R. Abdominoperineal Resection for Unexpected Distal Intramural Spreading of Rectal Cancer. Case Rep Gastroenterol 2018; 12:297-302. [PMID: 30022919 PMCID: PMC6047569 DOI: 10.1159/000490043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 05/03/2018] [Indexed: 01/30/2023] Open
Abstract
Introduction In rectal cancer, distal intramural spread may sometimes occur, but a maximum extent of distal spread of > 6 cm is very rare. Case Presentation A 65-year-old Japanese male with an advanced rectal cancer tumor with para-aortic lymph node metastasis was admitted. We performed a low anterior resection with lymphadenectomy, but the intraoperative frozen-section analysis of margins revealed malignant cell positivity; we, therefore, performed an abdominoperineal resection. Pathological findings showed that the maximum extent of distal spread was 6 cm. After 12 courses of FOLFOX4 as adjuvant chemotherapy, abdominal computed tomography revealed whole lymph node metastases, including Virchow's node. Though FOLFIRI + panitumumab was started, he was not eligible for additional chemotherapy after 10 cycles. Conclusion An intraoperative frozen pathology examination was helpful for the additional resection, when unexpected distal spreading had occurred in rectal cancer. The evidence of a distal negative margin should not be underestimated.
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Affiliation(s)
- Shinya Munakata
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Yuta Murai
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Akihiro Koizumi
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Hisaki Kato
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Riku Yamamoto
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Syuhei Ueda
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Satoshi Tokuda
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Syunsuke Sakuraba
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Tomoyuki Kushida
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Hajime Orita
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Mutsumi Sakurada
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Hiroshi Maekawa
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Koichi Sato
- Department of Surgery, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
| | - Ryo Wada
- Department of Pathology, Juntendo Shizuoka Hospital, Juntendo University School of Medicine, Shizuoka, Japan
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Distribution of metastases in mesorectum is unpredictable: Metastases do not respect tumor localization even in small non-circumferential rectal cancers. Eur J Surg Oncol 2018; 44:87-92. [DOI: 10.1016/j.ejso.2017.11.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 10/09/2017] [Accepted: 11/16/2017] [Indexed: 01/01/2023] Open
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Suwa K, Ushigome T, Ohtsu M, Narihiro S, Ryu S, Shimoyama Y, Okamoto T, Yanaga K. Risk Factors for Early Postoperative Small Bowel Obstruction After Anterior Resection for Rectal Cancer. World J Surg 2017; 42:233-238. [PMID: 28748420 DOI: 10.1007/s00268-017-4152-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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21
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Anup S, Lu J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Yu Q, Yang YH, Huang CM. Prognostic significance of perigastric tumor deposits in patients with primary gastric cancer. Ann Oncol 2017; 17:84. [PMID: 28724367 DOI: 10.1093/annonc/mdx261.118] [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: 03/23/2017] [Accepted: 07/07/2017] [Indexed: 02/05/2025] Open
Abstract
BACKGROUND The presence and the prognostic significance of perigastric tumor deposits (TDs) in primary gastric cancer have not been extensively studied. The aim of this study was to evaluate the prognostic significance perigastric TDs in primary gastric cancer. METHODS From 2005 to 2010, 1250 patients underwent R0 gastrectomy at the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. Out of 1250 patients, 132 patients with perigastric TDs were identified. Additionally, 132 patients with staged matched gastric cancer without tumor deposits were selected as a control group. RESULTS Perigastric TDs were observed in 132 (10.5%) of the 1250 patients with gastric cancer who underwent R0 gastrectomy. There were 94 males (71.21%) and 38 females (28.79%) (2.47:1). The mean age was 57.21 years. Clinicopathologic characteristics between the two groups matched well. There was a significant difference in the overall survival of those with and without TDs by univariate (p<0.05) and multivariate (p < 0.05) survival analysis. The 1-, 3-and 5-year overall survival rates of patients with TDswere69.6%, 39.3%, and 24.2%, respectively, and were significantly poorer than those of the staged matched control group. There was no correlation between the number of TDs and patient survival in patients with gastric cancer (p>0.05); however, when comparing each pT tumor group with the perigastric TD group, the stage T4 survival rate was very similar to that observed in patients with TDs. CONCLUSIONS Perigastric TDs are an independent predictive prognostic factor for gastric cancer and may be appropriately considered a form of serosal invasion. We suggest that TDs should be included in TNM staging system for better outcomes.
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Affiliation(s)
- Shrestha Anup
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qian Yu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying-Hong Yang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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Anup S, Lu J, Zheng CH, Li P, Xie JW, Wang JB, Lin JX, Chen QY, Cao LL, Lin M, Yu Q, Yang YH, Huang CM. Prognostic significance of perigastric tumor deposits in patients with primary gastric cancer. BMC Surg 2017; 17:84. [PMID: 28724367 PMCID: PMC5518113 DOI: 10.1186/s12893-017-0280-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 07/07/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The presence and the prognostic significance of perigastric tumor deposits (TDs) in primary gastric cancer have not been extensively studied. The aim of this study was to evaluate the prognostic significance perigastric TDs in primary gastric cancer. METHODS From 2005 to 2010, 1250 patients underwent R0 gastrectomy at the Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China. Out of 1250 patients, 132 patients with perigastric TDs were identified. Additionally, 132 patients with staged matched gastric cancer without tumor deposits were selected as a control group. RESULTS Perigastric TDs were observed in 132 (10.5%) of the 1250 patients with gastric cancer who underwent R0 gastrectomy. There were 94 males (71.21%) and 38 females (28.79%) (2.47:1). The mean age was 57.21 years. Clinicopathologic characteristics between the two groups matched well. There was a significant difference in the overall survival of those with and without TDs by univariate (p<0.05) and multivariate (p < 0.05) survival analysis. The 1-, 3-and 5-year overall survival rates of patients with TDswere69.6%, 39.3%, and 24.2%, respectively, and were significantly poorer than those of the staged matched control group. There was no correlation between the number of TDs and patient survival in patients with gastric cancer (p>0.05); however, when comparing each pT tumor group with the perigastric TD group, the stage T4 survival rate was very similar to that observed in patients with TDs. CONCLUSIONS Perigastric TDs are an independent predictive prognostic factor for gastric cancer and may be appropriately considered a form of serosal invasion. We suggest that TDs should be included in TNM staging system for better outcomes.
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Affiliation(s)
- Shrestha Anup
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jun Lu
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chao-Hui Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ping Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Wei Xie
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jia-Bin Wang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Jian-Xian Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qi-Yue Chen
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Long-Long Cao
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Mi Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China
| | - Qian Yu
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Ying-Hong Yang
- Department of Pathology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Chang-Ming Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
- Department of General Surgery, Fujian Medical University Union Hospital, Fuzhou, China.
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23
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Imai K, Hotta K, Ito S, Yamaguchi Y, Kawakami T, Wada T, Igarashi K, Kishida Y, Kinugasa Y, Kawata N, Tanaka M, Kakushima N, Takizawa K, Ishiwatari H, Matsubayashi H, Ono H. Use of a novel shorter minimum caliber needle for creating endoscopic tattoos for preoperative localization: a comparative ex vivo study. Endosc Int Open 2017; 5:E513-E517. [PMID: 28596984 PMCID: PMC5462608 DOI: 10.1055/s-0043-106182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 03/02/2017] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND AND STUDY AIMS In colorectal cancer surgery, inadvertent deep injections during endoscopic tattooing can cause India ink leakage into the peritoneum, leading to complications or to poor visualization of the surgical plane. This ex vivo animal study compared the use of novel shorter, minimum caliber needles versus conventional injection needles for endoscopic tattooing. ANIMALS AND METHODS Four endoscopists used the novel needles and conventional needles to make ten endoscopic tattoos (five tattoos/needle type/endoscopist) in harvested porcine rectum using a saline test-injection method. India ink leakage and the success of the tattoo (i. e. visible, < 40 mm, plus no India ink leakage) were compared. RESULTS India ink leakage was observed for 30 % (6/20) of the conventional needle tattoos but for none of the novel needle tattoos ( P = 0.02). Tattoos created using the novel needles were more successful than those made with the conventional needles: 18/20 (90 %) vs. 11/20 (55 %); P = 0.01. CONCLUSIONS The use of novel shorter minimum caliber needles may be safe and effective for endoscopic tattooing for preoperative localization prior to colorectal cancer surgery.
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Affiliation(s)
- Kenichiro Imai
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan,Corresponding author Kenichiro Imai Division of EndoscopyShizuoka Cancer Center1007 ShimonagakuboNagaizumi, Suntogun, Shizuoka, 411-8777Japan+81-55-989-5692
| | - Kinichi Hotta
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Sayo Ito
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Takuya Wada
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan,Department of Gastroenterology, Kitasato University School of Medicine, Kanagawa, Japan
| | | | | | - Yusuke Kinugasa
- Division of Colorectal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Noboru Kawata
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Masaki Tanaka
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Naomi Kakushima
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kohei Takizawa
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
| | | | | | - Hiroyuki Ono
- Division of Endoscopy, Shizuoka Cancer Center, Shizuoka, Japan
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Li J, Yang S, Hu J, Liu H, Du F, Yin J, Liu S, Li C, Xing S, Yuan J, Lv B, Fan J, Leng S, Zhang X, Wang B. Tumor deposits counted as positive lymph nodes in TNM staging for advanced colorectal cancer: a retrospective multicenter study. Oncotarget 2017; 7:18269-79. [PMID: 26934317 PMCID: PMC4951287 DOI: 10.18632/oncotarget.7756] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/13/2016] [Indexed: 02/06/2023] Open
Abstract
We investigated the possibility of counting tumor deposits (TDs) as positive lymph nodes (pLNs) in the pN category and evaluated its prognostic value for colorectal cancer (CRC) patients. A new pN category (npN category) was calculated using the numbers of pLNs plus TDs. The npN category included 4 tiers: npN1a (1 tumor node), npN1b (2-3 tumor nodes), npN2a (4-6 tumor nodes), and npN2b (≥7 tumor nodes). We identified 4,121 locally advanced CRC patients, including 717 (11.02%) cases with TDs. Univariate and multivariate analyses were performed to evaluate the disease-free and overall survival (DFS and OS) for npN and pN categories. Multivariate analysis showed that the npN and pN categories were both independent prognostic factors for DFS (HR 1.614, 95% CI 1.541 to 1.673; HR 1.604, 95% CI 1.533 to 1.679) and OS (HR 1.633, 95% CI 1.550 to 1.720; HR 1.470, 95% CI 1.410 to 1.532). However, the npN category was superior to the pN category by Harrell's C statistic. We conclude that it is thus feasible to consider TDs as positive lymph nodes in the pN category when evaluating the prognoses of CRC patients, and the npN category is potentially superior to the TNM (7th edition) pN category for predicting DFS and OS among advanced CRC patients.
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Affiliation(s)
- Jun Li
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Shengke Yang
- General Surgery Department, Sichuan Cancer Hospital/Institution, Chengdu, People's Republic of China
| | - Junjie Hu
- Gastrointestinal Tumor Surgery Department, Hubei Cancer Hospital, Wuhan, People's Republic of China
| | - Hao Liu
- General Surgery Department, 2nd Affiliated Hospital of Jilin University, Changchun, People's Republic of China
| | - Feng Du
- Internal Medicine-Oncology, Cancer Institute/Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, People's Republic of China
| | - Jie Yin
- General Surgery Department, Xuzhou Central Hospital, Xuzhou, People's Republic of China
| | - Sai Liu
- Surgical Department of Gastrointestinal Diseases, Youan Hospital of Capital Medical University, Beijing, People's Republic of China
| | - Ci Li
- Department of Pathology, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Shasha Xing
- Central Laboratory, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Jiatian Yuan
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Bo Lv
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Jun Fan
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Shusheng Leng
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Xin Zhang
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
| | - Bing Wang
- General Surgery Department, Affiliated Hospital/Clinical Medical College of Chengdu University, Chengdu, People's Republic of China
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Bondeven P, Hagemann-Madsen RH, Bro L, Moran BJ, Laurberg S, Pedersen BG. Objective measurement of the distal resection margin by MRI of the fresh and fixed specimen after partial mesorectal excision for rectal cancer: 5 cm is not just 5 cm and depends on when measured. Acta Radiol 2016; 57:789-95. [PMID: 26377262 DOI: 10.1177/0284185115604007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 08/12/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Most studies have directly established the optimal perioperative in situ clearance margin in surgery for rectal cancer from the histologically observed extent of distal spread, neglecting the tissue variability that occurs after resection and fixation of the rectal specimen. PURPOSE To measure the length of the distal resection margin in the fresh and fixed specimen following partial mesorectal excision for rectal cancer using magnetic resonance imaging (MRI) to document tissue shrinkage after surgical removal and fixation. MATERIAL AND METHODS The length of the distal resection margin was measured by MRI of the fresh and fixed specimen and at histopathological examination of the fixed specimen in 10 patients who underwent surgery for upper rectal cancer. In addition, tissue shrinkage was estimated by measuring the total length of the fresh and fixed specimen and distance from the peritoneal reflection anteriorly to the distal cut edge of the specimen. RESULTS Measured by MRI, the distal resection margin was in the range of 0.6-10.2 cm (mean, 4.6 cm) in the fresh specimen, and 0.5-6.2 cm (mean, 3.2 cm) in the fixed specimen. The tissue shrinkage ratio was a mean of 69% (interquartile range, 61-77%). Taking all ratios from MRI and histopathological examination of tissue shrinkage into account, the collective tissue shrinkage ratio was 70% (95% confidence interval, 67-73%) CONCLUSION The length of the distal resection margin was reduced by 30% after surgical removal and fixation of the specimen.
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Affiliation(s)
- Peter Bondeven
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Lise Bro
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brendan J Moran
- Colorectal Surgery, Hampshire Hospitals Foundation Trust, Basingstoke, UK
| | - Søren Laurberg
- Department of Surgery P, Aarhus University Hospital, Aarhus, Denmark
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Saitoh Y, Inaba Y, Sasaki T, Sugiyama R, Sukegawa R, Fujiya M. Management of colorectal T1 carcinoma treated by endoscopic resection. Dig Endosc 2016; 28:324-9. [PMID: 26076802 DOI: 10.1111/den.12503] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 12/28/2022]
Abstract
As a result of recent advances in endoscopic therapeutic technology, the number of endoscopic resections carried out in the treatment of early colorectal carcinomas with little risk of lymph node metastasis has increased. There are no reports of lymph node metastasis in intramucosal (Tis) carcinomas, whereas lymph node metastasis occurs in 6.8-17.8% of submucosal (T1) carcinomas. Three clinical guidelines have been published in Japan and the management strategy for early colorectal tumors has been demonstrated. According to the 2014 Japanese Society for Cancer of the Colon and Rectum (JSCCR) Guidelines for the Treatment of Colorectal Cancer, additional surgery should be done in cases of endoscopically resected T1 carcinoma with a histologically diagnosed positive vertical margin. Additional surgery may also be considered when one of the following histological findings is detected: (i) SM invasion depth ≥1000 µm; (ii) histological type por., sig., or muc.; (iii) grade 2-3 tumor budding; and (iv) positive vascular permeation. A resected lesion that is histologically diagnosed as a T1 carcinoma without any of the above-mentioned findings can be followed up without additional surgery. As for the prognosis of endoscopically resected T1 carcinomas, the relapse ratio of approximately 3.4% (44/1312) is relatively low. However, relapse is associated with a poor prognosis, with 72 cancer-related deaths reported out of 134 relapsed cases (54%). A more detailed stratification of the lymph node metastasis risk after endoscopic resection for T1 carcinomas and the prognosis of relapsed cases will be elucidated through prospective studies. Thereafter, the appropriate indications and safe and secure endoscopic resection for T1 carcinomas will be established.
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Affiliation(s)
- Yusuke Saitoh
- Digestive Disease Center, Asahikawa City Hospital, Japan
| | - Yuhei Inaba
- Digestive Disease Center, Asahikawa City Hospital, Japan
| | | | - Ryuji Sugiyama
- Digestive Disease Center, Asahikawa City Hospital, Japan
| | - Ryuji Sukegawa
- Digestive Disease Center, Asahikawa City Hospital, Japan
| | - Mikihiro Fujiya
- Division of Gastroenterology and Hematology/Oncology, Department of Internal Medicine, Asahikawa Medical University, Asahikawa, Japan
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Guedj N, Maggiori L, Poté N, Norkowski E, Cros J, Bedossa P, Panis Y. Distal intramural and tumor spread in the mesorectum after neoadjuvant radiochemotherapy in rectal cancer: about 124 consecutive patients. Hum Pathol 2016; 52:164-72. [PMID: 27210028 DOI: 10.1016/j.humpath.2016.01.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 01/15/2016] [Accepted: 01/24/2016] [Indexed: 02/07/2023]
Abstract
This observational prospective study aimed to assess the distribution of intramural and mesorectal tumor spread in mid/low rectal cancer after neoadjuvant radiochemotherapy. Distribution of mesorectal metastatic lymph nodes (MLNs) and mesorectal extranodal cancer tissue (EX), according to the tumor location, were analyzed. Distal intramural tumor spread was also performed. A total of 1676 LNs, 135 MLNs, and 69 EX were detected on 124 consecutive surgical specimens. Forty-two patients (34%) had MLNs. Six patients (4.8%) were classified as ypN1c. Distal viable cancer spread was observed in 3 patients (2.4%), all with mid rectal carcinoma. Two patients (1.6%) presented distal direct intramural extension less than 1 cm; and 1 (0.8%), with EX localized no more than 2 cm from the lower edge of the tumor. MLNs (76%) and EX (94%) were preferentially localized in the peritumoral area and in the first 3 cm just above the tumor. No viable distal intramural or mesorectal spread was observed in low rectal carcinoma. Distal intramural and mesorectal cancer spread is a rare event after neoadjuvant RCT. These results suggest that the 1-cm distal margin recommended in patients with low rectal carcinoma could be reduced with insurance to obtain a negative distal margin. The knowledge of preferential localization of MLNs and EX would help the pathologist to improve patient's lymph node staging.
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Affiliation(s)
- Nathalie Guedj
- Department of Pathology, Beaujon Hospital, 92110 Clichy, France.
| | - Léon Maggiori
- Department of Colo-rectal Surgery, Beaujon Hospital, 92110 Clichy, France
| | - Nicolas Poté
- Department of Pathology, Beaujon Hospital, 92110 Clichy, France
| | - Emma Norkowski
- Department of Pathology, Beaujon Hospital, 92110 Clichy, France
| | - Jérôme Cros
- Department of Pathology, Beaujon Hospital, 92110 Clichy, France
| | - Pierre Bedossa
- Department of Pathology, Beaujon Hospital, 92110 Clichy, France
| | - Yves Panis
- Department of Colo-rectal Surgery, Beaujon Hospital, 92110 Clichy, France
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28
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Hav M, Libbrecht L, Ferdinande L, Geboes K, Pattyn P, Cuvelier CA. Pathologic Assessment of Rectal Carcinoma after Neoadjuvant Radio(chemo)therapy: Prognostic Implications. BIOMED RESEARCH INTERNATIONAL 2015; 2015:574540. [PMID: 26509160 PMCID: PMC4609786 DOI: 10.1155/2015/574540] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 06/14/2015] [Indexed: 12/21/2022]
Abstract
Neoadjuvant radio(chemo)therapy is increasingly used in rectal cancer and induces a number of morphologic changes that affect prognostication after curative surgery, thereby creating new challenges for surgical pathologists, particularly in evaluating morphologic changes and tumour response to preoperative treatment. Surgical pathologists play an important role in determining the many facets of rectal carcinoma patient care after neoadjuvant treatment. These range from proper handling of macroscopic specimens to accurate microscopic evaluation of pathological features associated with patients' prognosis. This review presents the well-established pathological prognostic indicators and discusses challenging features in order to provide both surgical pathologists and treating physicians with a checklist that is useful in a neoadjuvant setting.
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Affiliation(s)
- Monirath Hav
- Department of Pathology, Calmette Hospital, No. 3, Monivong Boulevard (93), Phnom Penh 12201, Cambodia ; Department of Pathology, Ghent University Hospital, 9000 Gent, Belgium
| | - Louis Libbrecht
- Department of Pathology, Calmette Hospital, No. 3, Monivong Boulevard (93), Phnom Penh 12201, Cambodia
| | - Liesbeth Ferdinande
- Department of Pathology, Calmette Hospital, No. 3, Monivong Boulevard (93), Phnom Penh 12201, Cambodia
| | - Karen Geboes
- Department of Gastrointestinal Oncology, Ghent University Hospital, 9000 Gent, Belgium
| | - Piet Pattyn
- Department of Gastrointestinal Surgery, Ghent University Hospital, 9000 Gent, Belgium
| | - Claude A Cuvelier
- Department of Pathology, Calmette Hospital, No. 3, Monivong Boulevard (93), Phnom Penh 12201, Cambodia
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Abstract
BACKGROUND The detection of lymph node involvement is fundamental to the staging of rectal cancer, and aids in prognostication and identification of patients who will benefit from adjuvant therapy. The anatomical variation in distribution and size of mesorectal lymph nodes has received scant attention. OBJECTIVE This study aimed to determine the size and distribution of lymph nodes in rectal cancer resection specimens. DESIGN This was a prospective, observational study of rectal cancer resection specimens analyzed by a single histopathologist. SETTING This study was conducted from January 2007 to July 2013 at the authors' institution. PATIENTS Two hundred forty-four consecutive patients underwent resection for rectal cancer. MAIN OUTCOME MEASURES The size and distribution of lymph nodes in the resection specimens and the anatomical position of mesorectal lymph nodes in relation to the peritoneal reflection, tumor, and anal verge were recorded. RESULTS A total of 10,473 lymph nodes were retrieved in 244 patients (75 women; median age, 68 years (interquartile range, 59-75 years)). One hundred seventy-three anterior resection and 71 abdominoperineal resection specimens were analyzed. Median lymph node yield was 41 lymph nodes (interquartile range, 31-52); 344 of 10,473 (3.2%) lymph nodes were positive. Lymph nodes were distributed in the mesorectum, sigmoid mesentery, and vascular pedicle in 40%, 32%, and 28% of the patients. Sixty-eight percent of mesorectal lymph nodes were above the peritoneal reflection. Mesorectal lymph node distribution in relation to the tumor was 53% above, 36% adjacent to, and only 11% below the tumor. Ninety-five of 334 (28%) positive nodes were ≤3 mm in diameter. LIMITATIONS Resection specimens analyzed by other pathologists (<5%) have not been included, and fat clearance techniques were not used to retrieve lymph nodes. CONCLUSIONS To ensure accurate nodal staging of rectal cancer, both resection and subsequent pathological evaluation should focus on the mesorectum in close proximity to the tumor and along the superior rectal artery. Small lymph nodes (<3 mm in size) should not be overlooked, and lymph node metastasis to the sigmoid mesentery is rare (see Video, Supplemental Digital Content 1, http://links.lww.com/DCR/A177).
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Kulaylat MN. Mesorectal excision: Surgical anatomy of the rectum, mesorectum, and pelvic fascia and nerves and clinical relevance. World J Surg Proced 2015; 5:27-40. [DOI: 10.5412/wjsp.v5.i1.27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 12/10/2014] [Accepted: 12/31/2014] [Indexed: 02/06/2023] Open
Abstract
Biologic behavior and management of rectal cancer differ significantly from that of colon cancer. The surgical treatment is challenging since the rectum has dual arterial blood supply and venous drainage, extensive lymphatic drainage and is located in a bony pelvic in close proximity to urogenital and neurovascular structures that are invested with intricate fascial covering. The rectum is encased by fatty lymphovascular tissue (mesorectum) that is surrounded by perirectal fascia that act as barrier to the spread of the cancer and constitute the surgical circumferential margin. Locoregional recurrence after rectal cancer surgery is influenced by tumor-related factors and adequacy of the resection. Local recurrence is associated with incomplete excision of circumferential margin, violation of perirectal fascia, transmesorectal dissection, presence of isolated deposits in the mesorectum and tumor in regional lymph nodes and incomplete lymph node clearance. Hence to eradicate the primary rectal tumor and control regional disease, the rectum, first area of lymph node drainage and surrounding tissue must be completely excised while maintaining an intact fascial envelope around the rectum and preserving surrounding structures. This is achieved with extrafascial dissection and removal of the entire mesorectum including the portion distal to the tumor (total mesorectal excision) within its enveloping fascia as an intact unit. Total mesorectal excision is the standard of care surgical treatment of mid and low rectal cancer and can be performed in conjunction with low anterior resection, abdominoperineal resection, extralevator abdominoperineal resection, and extraregional dissection. To accomplish such a resection, thorough knowledge of the surgical anatomy of the rectum and pelvic structures and fascial planes is paramount.
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Søndenaa K, Quirke P, Hohenberger W, Sugihara K, Kobayashi H, Kessler H, Brown G, Tudyka V, D'Hoore A, Kennedy RH, West NP, Kim SH, Heald R, Storli KE, Nesbakken A, Moran B. The rationale behind complete mesocolic excision (CME) and a central vascular ligation for colon cancer in open and laparoscopic surgery : proceedings of a consensus conference. Int J Colorectal Dis 2014; 29:419-28. [PMID: 24477788 DOI: 10.1007/s00384-013-1818-2] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/12/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND It has been evident for a while that the result after resection for colon cancer may not have been optimal. Several years ago, this was showed by some leading surgeons in the USA but a concept of improving results was not consistently pursued. Later, surgeons in Europe and Japan have increasingly adopted the more radical principle of complete mesocolic excision (CME) as the optimal approach for colon cancer. The concept of CME is a similar philosophy to that of total mesorectal excision for rectal cancer and precise terminology and optimal surgery are key factors. METHOD There are three essential components to CME. The main component involves a dissection between the mesenteric plane and the parietal fascia and removal of the mesentery within a complete envelope of mesenteric fascia and visceral peritoneum that contains all lymph nodes draining the tumour area (Hohenberger et al., Colorectal Disease 11:354-365, 2009; West et al., J Clin Oncol 28:272-278, 2009). The second component is a central vascular tie to completely remove all lymph nodes in the central (vertical) direction. The third component is resection of an adequate length of bowel to remove involved pericolic lymph nodes in the longitudinal direction. RESULT The oncological rationale for CME and various technical aspects of the surgical management will be explored. CONCLUSION The consensus conference agreed that there are sound oncological hypotheses for a more radical approach than has been common up to now. However, this may not necessarily apply in early stages of the tumour stage. Laparoscopic resection appears to be equally well suited for resection as open surgery.
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Affiliation(s)
- K Søndenaa
- Department of Surgery, Haraldsplass Deaconess Hospital, POB 6165, 5892, Bergen, Norway,
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Ueno H, Hashiguchi Y, Shimazaki H, Shinto E, Kajiwara Y, Nakanishi K, Kato K, Maekawa K, Nakamura T, Yamamoto J, Hase K. Peritumoral deposits as an adverse prognostic indicator of colorectal cancer. Am J Surg 2014; 207:70-7. [DOI: 10.1016/j.amjsurg.2013.04.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2012] [Revised: 04/18/2013] [Accepted: 04/29/2013] [Indexed: 01/17/2023]
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Hida JI, Okuno K, Tokoro T. Distal dissection in total mesorectal excision, and preoperative chemoradiotherapy and lateral lymph node dissection for rectal cancer. Surg Today 2013; 44:2227-42. [PMID: 24363114 DOI: 10.1007/s00595-013-0811-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/05/2013] [Indexed: 01/26/2023]
Abstract
The local recurrence rate after total mesorectal excision (TME) appears to be markedly lower than that after conventional operations. We reviewed all relevant articles identified from the MEDLINE databases and clarified the rationale for TME. It is clear that distal intramural spread is rare. Even when present, such spread is not likely to extend beyond 2 cm. Data with attention to mesorectal cancer deposits suggest that mesorectal clearance of at least 4-5 cm distal to the tumor should be sufficient. TME should be performed for most tumors of the mid- and lower rectum. This does not mean that the gut tube needs to be divided at the same level in every case. Dissection of the distal mesorectum off the gut tube can be performed, so the distal line of division of the bowel wall can be made at a minimum of 2 cm below the tumor if such a maneuver would ensure that the sphincters are preserved. In cases with cancer in the upper third of the rectum, the mesorectum and gut tube can safely be divided 5 cm below the tumor without jeopardizing the recurrence rates. Our findings indicate that TME is an essential treatment approach for rectal cancer, and lateral lymph node dissection and preoperative chemoradiotherapy are additional therapies that should be considered for advanced rectal cancer.
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Affiliation(s)
- Jin-ichi Hida
- Department of Surgery, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan,
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Farinella E, Viganò L, Fava MC, Mineccia M, Bertolino F, Capussotti L. In vivo lymph node mapping and pattern of metastasis spread in locally advanced mid/low rectal cancer after neoadjuvant chemoradiotherapy. Int J Colorectal Dis 2013; 28:1523-1529. [PMID: 23877264 DOI: 10.1007/s00384-013-1727-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE The lymph node status is one of the strongest prognostic determinants in rectal cancers. After chemoradiotherapy (CRT), lymph nodes are difficult to detect. This study aims to evaluate the feasibility of lymph node mapping in the mesorectum after CRT to analyze the pattern of metastasis spread and to assess the reliability of blue dye injection in sentinel lymph node detection. METHOD Ten patients with cN+ mid/low RCs after CRT were prospectively enrolled. The protocol scheduled intraoperative blue dye injection, surgery, and specimen examination with fat clearance technique. The mesorectum was divided into three equal "levels" (upper, middle, and lower); each level was divided into three equal "sectors" (right anterolateral, posterior, and left anterolateral). Lymph nodes were defined "small" if ≤5 mm. RESULTS Two hundred seventy-six lymph nodes were retrieved in ten patients; 76.5 % were small lymph nodes. Six patients were pN+ (33 metastatic lymph nodes, 76 % small); small lymph node analysis upstaged one patient from N0 to N1 and four patients from N1 to N2. Metastasis distribution across sectors was continuous, without "skip sectors." The blue dye detected the sentinel lymph node in all patients; in half of the cases, it was out of the tumor sector. Blue dye identified 69.7 % of metastatic lymph nodes; its sensitivity decreased together with the metastatic deposit size (84 % macrometastases, 28.6 % micrometastases, 0 % occult tumor cells; p = 0.004). CONCLUSION The fat clearance technique should be the standard pathological examination in patients with RCs after CRT; N staging was improved by small lymph node identification. Lymph node metastases have a continuous spread through mesorectal sectors. Blue dye injection is effective in sentinel lymph node detection.
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Affiliation(s)
- E Farinella
- Department of HPB and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10129, Turin, Italy
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Vyslouzil K, Brychtova S, Zboril P, Skalicky P, Vomackova K, Bezdekova M, Brychta T. Unusual recurrent rectal carcinoma: a cancer field theory viewpoint. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 158:433-7. [PMID: 23128827 DOI: 10.5507/bp.2012.091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 12/15/2022] Open
Abstract
AIM The rate of rectal cancer locoregional recurrence following radical surgery varies from 4% to 33%. Though the causes are unclear, likely factors include microscopic tumor residues in the lymphatics, positive resection margins and exfoliation of tumor cells and their subsequent intraluminar spread during operation. Other significant factors include type and technique of surgical procedure. Recently, it has been demonstrated that local recurrence may also be associated with the biological behaviour of the tumor and/or with the composition of the cellular microenvironment which creates optimal conditions for the growth and spread of tumor cells. CASE REPORT The presented case here is interesting because the tumour recurred early following a curative surgical procedure with negative resection margins, without positive lymph nodes, without infiltration of the pelvic wall and without distant metastases. CONCLUSION In patients with a determined risk of genetically altered tumor field encompassing epithelial or stromal changes, a different treatment strategy, including gene therapy, anti-inflammatory or anti-angiogenic therapy should be chosen to minimize increased tumor risk.
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Affiliation(s)
- Kamil Vyslouzil
- Department of Surgery I, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic
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Tsumura A, Yokoyama S, Takifuji K, Hotta T, Matsuda K, Watanabe T, Mitani Y, Yamaue H. Endoscopically observable white nodule caused by distal intramural lymphatic spread of rectal cancer: a case report. World J Surg Oncol 2012; 10:216. [PMID: 23050553 PMCID: PMC3506560 DOI: 10.1186/1477-7819-10-216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 09/26/2012] [Indexed: 02/06/2023] Open
Abstract
This report describes a case of rectal cancer with endoscopically observable white nodules caused by distal intramural lymphatic spread. A 57-year-old female presented to our hospital with frequent diarrhea and hemorrhoids. Computed tomography showed bilateral ovarian masses and three hepatic tumors diagnosed as rectal cancer metastases, and also showed multiple lymph node involvement. The patient was preoperatively diagnosed with stage IV rectal cancer. Colonoscopy demonstrated that primary rectal cancer existed 15 cm from the anal verge and that there were multiple white small nodules on the anal side of the primary tumor extending to the dentate line. Biopsies of the white spots were performed, and they were identified as adenocarcinoma. The patient underwent Hartmann's procedure because of the locally advanced primary tumor. The white nodules were ultimately diagnosed as being caused by intramural lymphatic spreading because lymphatic permeation was strongly positive at the surrounding area. Small white nodules near a primary rectal cancer should be suspected of being intramural spreading. Endoscopic detection of white nodules may be useful for the diagnosis of distal intramural spread.
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Affiliation(s)
- Ayako Tsumura
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Shozo Yokoyama
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Katsunari Takifuji
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Tsukasa Hotta
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Kenji Matsuda
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Takashi Watanabe
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Yasuyuki Mitani
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8510, Japan
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Komori K, Kanemitsu Y, Ishiguro S, Shimizu Y, Sano T, Ito S, Abe T, Senda Y, Misawa K, Ito Y, Uemura N, Kato T. Adequate length of the surgical Distal resection margin in rectal cancer: from the viewpoint of pathological findings. Am J Surg 2012; 204:474-80. [DOI: 10.1016/j.amjsurg.2011.11.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Revised: 11/22/2011] [Accepted: 11/22/2011] [Indexed: 11/30/2022]
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Multicenter Study for Optimal Categorization of Extramural Tumor Deposits for Colorectal Cancer Staging. Ann Surg 2012; 255:739-46. [DOI: 10.1097/sla.0b013e31824b4839] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Tong LL, Gao P, Wang ZN, Song YX, Xu YY, Sun Z, Xing CZ, Xu HM. Is the seventh edition of the UICC/AJCC TNM staging system reasonable for patients with tumor deposits in colorectal cancer? Ann Surg 2012; 255:208-13. [PMID: 21527844 DOI: 10.1097/sla.0b013e31821ad8a2] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To assess the rationality of the seventh edition of TNM staging system on tumor deposits (TDs) and propose a novel subclassification. SUMMARY BACKGROUND DATA The TDs had been debated for many years. The seventh edition of TNM staging system proposed a "pN1c" concept. However, the value of the modification is still debated. METHODS A total of 1541 patients with colorectal cancer were reviewed. Overall survival rates were compared between patients without LNM but TD (+), and those who were TD (-). The TDs were stratified into the "any T + any N" category. Two-step multivariate analysis was performed to identify significant prognostic factors. Univariate analysis was used to determine whether a correlation existed between the number of TDs and prognosis. RESULTS There was a significant prognostic difference between patients without LNM or TDs compared with those with positive TDs. Only in T3N2bM0 there was a significant prognostic difference between LNM (+), TD (+) patients and TD (-) patients. The seventh edition of TNM staging system was substituted by the novel TNM staging system in 2-step multivariate analysis. Only in T3N1cM0 there was a significant prognostic difference between patients with only 1 TD and those with more than 1 TD. CONCLUSION The seventh edition of TNM staging system on TDs satisfactorily predicts patients' outcome for those without LNM. Patients who categorized as T3N2bM0TD (+) and T4N2bM0TD (-/+) should be reclassified as stage IV. Number of TDs was not an independent prognostic parameter in the TNM staging system.
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Affiliation(s)
- Lin-lin Tong
- Department of Surgical Oncology and General Surgery, First Hospital of China Medical University, Shenyang, People's Republic of China
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Ueno H, Mochizuki H, Akagi Y, Kusumi T, Yamada K, Ikegami M, Kawachi H, Kameoka S, Ohkura Y, Masaki T, Kushima R, Takahashi K, Ajioka Y, Hase K, Ochiai A, Wada R, Iwaya K, Shimazaki H, Nakamura T, Sugihara K. Optimal colorectal cancer staging criteria in TNM classification. J Clin Oncol 2012; 30:1519-26. [PMID: 22430272 DOI: 10.1200/jco.2011.39.4692] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Histologic components of the TNM classification system have been repeatedly revised since the fifth edition (TNM5). TNM classification revisions provide different criteria for categorizing tumor nodules without residual lymph node structure (ND). However, there are few systematic evaluations regarding the effectiveness of these revisions. PATIENTS AND METHODS A multicenter pathologic review for ND in colorectal cancer (CRC) was performed. Tumor staging defined by TNM5, sixth edition (TNM6), and seventh edition (TNM7) were compared on the basis of Akaike information criterion (AIC) and Harrell's concordance index (c-index). Moreover, TNM7's prognostic value was compared between the original ND and modified criteria, which considered all regional NDs as lymph node metastasis (LNM) irrespective of the original structure. RESULTS In 1,716 treated patients with CRC (1994 to 1998), tumor stages (I/II/III) exhibited better prognoses in TNM7 (AIC, 3055.1; c-index, 0.7215) than in TNM6 (AIC, 3063.7; c-index, 0.7149), but not better than in TNM5 (AIC, 3051.6; c-index, 0.7240). Comparing the original TNM7 and modified criteria, 4.2% of patients were classified in different N stages (N0/N1/N2a/N2b); both AIC and the c-index were superior in the modified criteria (AIC, 3029.40; c-index, 0.7271) compared with the original criteria (AIC, 3040.58; c-index, 0.7230). Modified criteria were also associated with improved prognostic power of tumor stages (I/IIA/IIB/IIC/IIIA/IIIB/IIIC). These results were similar in another cohort of 2,242 treated patients with CRC (1999 to 2003). CONCLUSION The prognostic value of TNM7 is better than that of TNM6; however, improvement over TNM5 is insignificant. By considering all regional NDs as LNM irrespective of their morphology, TNM classification can be simplified and its prognostic value improved.
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Affiliation(s)
- Hideki Ueno
- National Defense Medical College, Tokorozawa, Japan.
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Sun Z, Wang ZN, Xu YY, Zhu GL, Huang BJ, Xu Y, Liu FN, Zhu Z, Xu HM. Prognostic significance of tumor deposits in gastric cancer patients who underwent radical surgery. Surgery 2012; 151:871-81. [PMID: 22386276 DOI: 10.1016/j.surg.2011.12.027] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Accepted: 12/22/2011] [Indexed: 02/09/2023]
Abstract
BACKGROUND To investigate the prognostic significance of tumor deposits (TDs) in gastric cancers patients who underwent radical surgery. METHODS Clinicopathologic and prognostic data from 2998 gastric cancer patients who underwent R0 surgery with D2/D3 lymphadenectomy were retrospectively reviewed. A TD was defined as discrete foci of tumor found in the perigastric fat or in adjacent ligament away from the leading edge of the tumor and showing no evidence of residual lymph node tissue, but within the lymph drainage area of the primary carcinoma. RESULTS TDs were detected in 17.8% of patients. TDs were more frequently observed in cancers of larger size, of Borrmann type 4, with lymphovascular invasion, deeper in depth of invasion, and with extended lymph node metastasis. Multivariate analysis confirmed the presence of TDs as 1 of independent factors predicting a poorer outcome. When stratified by pN category, significant differences in survival were observed between patients with and without TDs for those in pN0/pT1-3, pN1/pT3, pN2/pT1-3 and pN3/pT2-3 category, but not for those in pT4a and pT4b category. Moreover, for cancers in each pN category, the prognosis for patients with TDs in pT1-4a category was similar with that of those without TDs in pT4a category, but significantly better than that of those with or without TDs in pT4b category. A revised pT category and a revised pTNM system were proposed, in which all the cancers with TDs in pT1-4a category were incorporated into those without TDs in pT4a category according to the pN category. Further analysis revealed the revised pT category and the revised pTNM system had better homogeneity, discriminatory ability, and monotonicity of gradients than the American Joint Committee on Cancer (AJCC) pT category and the AJCC pTNM system, respectively, representing optimum prognostic stratification. CONCLUSION TDs significantly correlated with gastric cancer patients' survival. It might be more suitable for TDs to be treated as a form of serosal invasion. Consequently, en bloc resection of the primary carcinoma is crucially important, and adjuvant chemotherapy should always be considered if TDs have been detected.
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Affiliation(s)
- Zhe Sun
- Department of Surgical Oncology, First Affiliated Hospital of China Medical University, Shenyang, China
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SAITO K, MUNEMOTO Y, TAKASHIMA Y, IIDA Y, AMAYA S, MITSUI T. Anastomotic recurrence cases after functional end-to-end anastomosis for colon cancer. ACTA ACUST UNITED AC 2012. [DOI: 10.3919/jjsa.73.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Intramural and mesorectal distal spread detected by whole-mount sections in the determination of optimal distal resection margin in patients undergoing surgery for rectosigmoid or rectal cancer without preoperative therapy. Dis Colon Rectum 2011; 54:1510-20. [PMID: 22067179 DOI: 10.1097/dcr.0b013e318233fc4a] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The current Japanese general rules for clinical and pathologic studies on cancer of the colon, rectum, and anus state that a 3-cm distal resection margin is needed in resecting rectosigmoid cancer and rectal cancer with a distal edge above the peritoneal reflection, and 2 cm is needed for rectal cancer with a distal edge below the peritoneal reflection. The appropriateness of these rules has not been proved. OBJECTIVE Our aim was to evaluate the appropriateness of the Japanese rules. DESIGN AND SETTING We retrospectively analyzed surgical and pathology records of patients who underwent surgery at a tertiary care cancer center in Japan. PATIENTS The study included 381 consecutive patients with stage I to IV rectosigmoid or rectal cancer without preoperative chemotherapy or radiotherapy. MAIN OUTCOME MEASURES We investigated both intramural and mesorectal distal spread, using whole-mount sections to measure the maximum length of distal spread. Long distal spread was defined as distal spread longer than the distal resection margin stated in the Japanese general rules. Risk factors for both distal spread and long distal spread were evaluated. RESULTS Of 381 patients, 325 (85.3%) had no distal spread and a total of 56 (14.7%) had distal spread. Distal spread was within the limits specified by the Japanese general rules in 48 of the 381 patients (12.6%) and beyond the Japanese limits (long distal spread) in 8 patients (2.1%). The prevalence of distal spread increased with TNM stage (stage I, 2.7%; stage II, 5.3%; stage III, 17.4%; stage IV, 46.2%). Long distal spread was not observed in stage I or II, was found in only 1.4% of patients with stage III disease and in 11.5% of patients with stage IV. The maximum extent of distal spread in patients with rectosigmoid cancer or rectal cancer with the distal edge above the peritoneal reflection was 38 mm; in patients with rectal cancer with the distal edge below the peritoneal reflection, 35 mm. Multivariable analyses showed that nodal involvement and distant metastasis were independent risk factors for distal spread; distant metastasis was the only independent risk factor for long distal spread. CONCLUSIONS The Japanese general rules specifying the distal resection margin are appropriate for most patients who undergo surgery for rectosigmoid and rectal cancer without preoperative chemotherapy or radiotherapy. A further increase of 1 to 2 cm beyond the recommended distal resection margin may contribute to improved local control for patients with distant metastasis.
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Yao YF, Wang L, Liu YQ, Li JY, Gu J. Lymph node distribution and pattern of metastases in the mesorectum following total mesorectal excision using the modified fat clearing technique. J Clin Pathol 2011; 64:1073-7. [PMID: 21821862 DOI: 10.1136/jclinpath-2011-200190] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM To define the distribution, size, location and metastasis of lymph nodes (LNs) within the mesorectum from rectal cancer specimens following total mesorectal excision (TME) surgery without neoadjuvant therapy. METHODS Specimens from 60 patients who underwent TME were treated with modified fat clearing solution to retrieve LNs. The mesorectum was divided into right lateral, anterior, posterior and left lateral sides, which were further subdivided into three levels (upper, middle and lower). RESULTS 1436 LNs were harvested, including 985 small LNs (<5 mm in size). The number of LNs from the anterior, posterior and bilateral mesorectum was 125 (8.7%), 696 (48.5%) and 615 (42.8%), respectively. In the longitudinal axis, the difference in distribution at the three levels was not significant. 200 LN metastases (mLNs) were detected in 33 patients. 48% (96/200) of these were small LNs. More mLNs, especially small LNs, were shown in the more advanced T stage patients. The mLN metastasis rate was not influenced by tumour level. CONCLUSION Small LN detection increased the accuracy of N staging by 20% in this study. The incidence of metastasis was the same among the anterior, bilateral and posterior areas of the mesorectum. An increased incidence of mLN metastasis in small LNs was associated with more advanced T staging. mLN metastasis rates in both middle and low rectal cancer were higher in the distal mesorectum than that in the proximal mesorectum. LN number and density were not consistent with spread of the primary tumour. Distal mLNs were found in 35% of cases of both middle and distal rectal cancer, implying a need for TME in both.
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Affiliation(s)
- Yun-Feng Yao
- Key Laboratory of Carcinogenesis and Translational Research, Ministry of Education, Department of Colorectal Surgery, Peking University School of Oncology, Beijing Cancer Hospital & Institute, Beijing, PR China
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Ueno H, Mochizuki H, Shirouzu K, Kusumi T, Yamada K, Ikegami M, Kawachi H, Kameoka S, Ohkura Y, Masaki T, Kushima R, Takahashi K, Ajioka Y, Hase K, Ochiai A, Wada R, Iwaya K, Nakamura T, Sugihara K. Actual Status of Distribution and Prognostic Impact of Extramural Discontinuous Cancer Spread in Colorectal Cancer. J Clin Oncol 2011; 29:2550-6. [DOI: 10.1200/jco.2010.33.7725] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To clarify the prognostic impact of tumor nodules without residual lymph node (LN) structure (ND) in colorectal cancer and to determine optimal categorization of ND in tumor staging. Patients and Methods A multicenter, retrospective pathologic review was performed for 1,716 patients with stages I to III curatively resected colorectal cancer treated at 11 institutions between 1994 and 1998. An additional 2,242 patients from nine institutions were enrolled between 1999 and 2003 as a second cohort to validate the results. Results LN metastasis (LNM) and ND were observed in 33.7% and 16.0% (smooth-contour nodule [S-ND], 8.2%; irregular-contour nodule [I-ND], 10.7%) of patients in the first cohort. S-ND and I-ND were similarly distributed in the regional area. There was no considerable difference in the impact on survival between S-ND (hazard ratio [HR], 2.7; 95% CI, 1.9 to 3.8) and I-ND (HR, 4.3; 95% CI, 3.3 to 5.8) or between LNM (HR, 4.5; 95% CI, 3.4 to 6.0) and ND (HR, 4.0; 95% CI, 3.1 to 5.3). LNM and ND were similarly associated with the mode of recurrence. Tumor nodules ≥ 5 mm growing with venous/perineural invasion (ND [v/pni+]), judged with 0.61 κ value among 11 observers, had an independent prognostic value for 5-year survival of 42%; similar results were observed in the second cohort. Conclusion These results do not support the TNM system in which S-ND is treated differently from I-ND in tumor staging; LNM and ND should be considered together in the same category. The presence of ND (v/pni+) has a considerable adverse prognostic effect.
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Affiliation(s)
- Hideki Ueno
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Hidetaka Mochizuki
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Kazuo Shirouzu
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Takaya Kusumi
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Kazutaka Yamada
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Masahiro Ikegami
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Hiroshi Kawachi
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Shingo Kameoka
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Yasuo Ohkura
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Tadahiko Masaki
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Ryoji Kushima
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Keiichi Takahashi
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Yoichi Ajioka
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Kazuo Hase
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Atsushi Ochiai
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Ryo Wada
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Keiichi Iwaya
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Takahiro Nakamura
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
| | - Kenichi Sugihara
- Hideki Ueno and Hidetaka Mochizuki, National Defense Medical College, Tokorozawa; Kazuo Shirouzu, Kurume University Faculty of Medicine, Kurume; Takaya Kusumi, Keiyukai Sapporo Hospital, Sapporo; Kazutaka Yamada, Coloproctology Center, Takano Hospital, Kumamoto; Masahiro Ikegami, Jikei University School of Medicine; Hiroshi Kawachi and Kenichi Sugihara, Tokyo Medical and Dental University; Shingo Kameoka, Tokyo Women's Medical University; Yasuo Ohkura and Tadahiko Masaki, Kyorin University, School of
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TNM staging system of colorectal carcinoma: surgical pathology of the seventh edition. ACTA ACUST UNITED AC 2011. [DOI: 10.1016/j.mpdhp.2011.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Anatomic Study of Distribution, Numbers, and Size of Lymph Nodes in Mesorectum in Indians: A Autopsy Study. Int J Surg Pathol 2011; 19:315-20. [DOI: 10.1177/1066896910393242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study was conducted to find the number, size, and distribution of the lymph nodes in the mesorectum in fresh cadavers without rectal cancer in Indians and to compare fat clearance method versus manual dissection of lymph nodes in terms of efficacy of lymph node yield. Thirty fresh cadavers underwent total mesorectal excision (TME) by midline incision. TME specimen was divided transversely (upper, middle, and lower thirds), and then further divided radially into 4 equal areas and the right lateral, left lateral, and posterior areas were taken for lymph node harvesting. In the first 15 cases (group A), lymph nodes were dissected manually from each of 9 areas. Number and diameters of harvested nodes were noted, and specimens were histopathologically examined. In the next 15 cases (group B), fat clearing technique was used, and the procedure was repeated. Mean number of lymph nodes recovered per cadaver was 6.2 (SD = 1.3; range, 5 to 9, group A = 5.86 ± 1.24, group B = 6.60 ± 1.29, P = .126) and mean size of the lymph node was 2.1 mm (SD = 0.38; range, 2 to 8 mm). Size and numbers of nodes in all the areas were similar between the 2 groups except in lower third, where smaller nodes were identified in greater numbers in group B. Manual dissection is an effective technique for node harvesting after TME, except for very small nodes found in the lower third of mesorectum. Accurate pathological examination of TME specimen is mandatory to avoid understaging of disease.
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Puppa G, Sonzogni A, Colombari R, Pelosi G. TNM staging system of colorectal carcinoma: a critical appraisal of challenging issues. Arch Pathol Lab Med 2010; 134:837-52. [PMID: 20524862 DOI: 10.5858/134.6.837] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Colorectal cancer is the leading cause of morbidity and death among gastrointestinal tumors and ranks fourth after lung, breast, and ovarian cancers. Despite a continuous refinement of the T (tumor), N (node), and M (metastasis) staging system to express disease extent and define prognosis, and eventually to guide treatment, the outcome of patients with colorectal cancer may vary considerably even within the same tumor stage. Therefore, the need for new factors, either morphologic or molecular, that could more precisely stratify patients into different risk categories is clearly warranted. OBJECTIVES To present the state of the art with regard to the colorectal cancer staging system and to discuss confusing and/or challenging issues, including the assessment of peritoneal membrane involvement, vascular invasion, tumor deposits, and pathologic tumor response to neoadjuvant chemoradiotherapy. DATA SOURCES Literature review of relevant articles indexed in PubMed (US National Library of Medicine) and primary material from the authors' institutions. CONCLUSIONS Two emerging needs exist for the TNM system, namely, further stratification of patients with the same tumor stage and incorporation of nonanatomic factors, the latter including molecular and treatment factors. The identification and classification of morphologic features encountered in the pathologic examination of colorectal cancer specimens may be difficult and a source of subjective variability. Enhanced pathologic analysis, agreed-upon standard protocols, and standardization should improve the completeness and accuracy of pathology reports.
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Affiliation(s)
- Giacomo Puppa
- Division of Pathology, G. Fracastoro City Hospital, Verona, Italy.
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Kim SJ, Choi YJ, Kang JG. Clinicopathologic Analysis of Mesorectal Spread of Rectal Cancer with Whole Mount Section. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2010. [DOI: 10.4174/jkss.2010.78.5.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Seo-Jeon Kim
- Department of Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Yoon-Jung Choi
- Department of Pathology, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Jung-Gu Kang
- Department of Surgery, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
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Liang JW, Wang ZN, Song YX, Xu HM. Advances in research on pericolonic tumor deposits in colorectal cancer. Shijie Huaren Xiaohua Zazhi 2009; 17:3620-3622. [DOI: 10.11569/wcjd.v17.i35.3620] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Clinical studies have shown that pericolonic tumor deposits (PTDs) may develop in some patients with colorectal cancer. PTDs are different from lymph node metastases and are usually located along the perivascular, perineural or intravascular spaces. The characteristics of PTDs and their relationship with colorectal cancer prognosis have attracted wide attention. In this article, we will review the recent advances in research on PTDs in colorectal cancer with regard to their location and structural characteristics and their value in TNM staging. Moreover, we will highlight their important value in prediction of the biological behavior and pathology of colorectal cancer, and their potential use as a parameter for evaluation of prognosis and development of individualized treatment.
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