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Morén B, Thibodeau-Antonacci A, Kalinowski J, Enger SA. Dosimetric impact of positional uncertainties and a robust optimization approach for rectal intensity-modulated brachytherapy. Med Phys 2025; 52:3528-3540. [PMID: 40162685 DOI: 10.1002/mp.17800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 01/31/2025] [Accepted: 03/03/2025] [Indexed: 04/02/2025] Open
Abstract
BACKGROUND Intensity-modulated brachytherapy (IMBT) employs rotating high-Z shields during treatment to decrease radiation in certain directions and conform the dose distribution to the target volume. Prototypes for dynamic IMBT have been proposed for prostate, cervical, and rectal cancer. PURPOSE We considered two shielded applicators for IMBT rectal cancer treatment and investigated how rotational uncertainties in the shield angle and translational uncertainties in the source position affect plan evaluation criteria. METHODS The effect of rotational errors of3 ∘ $3^\circ$ ,5 ∘ $5^\circ$ and10 ∘ $10^\circ$ , and translational errors of 1, 2 and 3 mm on evaluation criteria were investigated for shields with180 ∘ ${\rm 180}^\circ$ and90 ∘ ${\rm 90}^\circ$ emission windows. Further, a robust optimization approach based on quadratic penalties that includes scenarios with errors was proposed. The extent to which dosimetric effects of positional errors can be mitigated with this model was evaluated compared to a quadratic penalty model without scenarios with errors. A retrospective rectal cancer data set of ten patients was included in this study. Treatment planning was performed using the Monte Carlo-based treatment planning system, RapidBrachyMCTPS. RESULTS For the largest investigated rotational error of± 10 ∘ $\pm 10^\circ$ , the clinical target volume D 90 ${\rm D}_{90}$ remained, on average, within5 % $5\%$ of the result without error, while the contralateral healthy rectal wall experienced an increase in the meanD 0.1 c c ${\rm D}_{0.1cc}$ ,D 2 c c ${\rm D}_{2cc}$ , andD 50 ${\rm D}_{50}$ of26 % $26\%$ ,9 % $9\%$ , and1 % $1\%$ for the180 ∘ ${\rm 180}^\circ$ shield and of 32%, 9%, and 2% for the90 ∘ ${\rm 90}^\circ$ shield. For translational errors of± 2 $\pm 2$ mm, there were increases in dosimetric indices for both the superior (sup) and inferior (inf) dose spill regions. Specifically, for the180 ∘ ${\rm 180}^\circ$ shield, theD 0.1 c c ${\rm D}_{0.1cc}$ ,D 2 c c ${\rm D}_{2cc}$ , andD 50 ${\rm D}_{50}$ increased by13 % $13\%$ ,11 % $11\%$ , and10 % $10\%$ , respectively, for the sup region, and by26 % $26\%$ ,15 % $15\%$ , and11 % $11\%$ , respectively, for the inf region. Similar results were obtained with the90 ∘ ${\rm 90}^\circ$ shield. Overall, the robust and traditional models had similar results. However, the number of active dwell positions obtained with the robust model was larger, and the longest dwell time was shorter. CONCLUSIONS We have quantified the effect of rotational shield and translational source errors of various magnitudes on evaluation criteria for rectal IMBT. The robust optimization approach was generally not able to mitigate positional errors. However, it resulted in more homogeneous dwell times, which can be beneficial in conventional high-dose-rate brachytherapy to avoid hot spots around specific dwell positions.
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Affiliation(s)
- Björn Morén
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Department of Mathematics, Linköping University, Linköping, Sweden
| | | | - Jonathan Kalinowski
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
| | - Shirin A Enger
- Medical Physics Unit, Department of Oncology, McGill University, Montreal, Québec, Canada
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Québec, Canada
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Li Y, Piao Z, Ge X, Feng J, Sun D, Zhang J. Environmental pollutants and rectal cancer: The impact of water contamination. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2025; 294:118072. [PMID: 40127547 DOI: 10.1016/j.ecoenv.2025.118072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2024] [Revised: 03/14/2025] [Accepted: 03/14/2025] [Indexed: 03/26/2025]
Abstract
BACKGROUND Water is a fundamental resource for life, and exposure to water contamination has far-reaching implications for an increased risk of tumor diseases. METHODS Studies of rectal and colorectal cancer related to water contamination were identified from the published literature in the PUBMED databases from 2010 to 2024. RESULTS This review provides a critical analysis of the current evidence, summarizing the association of water contamination, including industrial waste, pesticides, heavy metals, with rectal and colorectal cancer. It highlights their impact on rectal and colorectal cancer progression by underlying processes of DNA damage, chronic inflammation, and microbial contamination. CONCLUSION Rectal cancer is a significant global health concern with a strong association between environmental pollutants in water sources and increased incidence of rectal cancer. It is vital to identify how waster pollutants influence the development and progression of rectal cancer and formulate targeted preventive approaches and social interventions to decrease the disease's impact.
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Affiliation(s)
- Yezhou Li
- Department of Vascular Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Zhe Piao
- Department of Neurology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xinbin Ge
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Jinbao Feng
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China
| | - Denghua Sun
- Department of Breast Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China.
| | - Jiayu Zhang
- Gastrointestinal Colorectal and Anal Surgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, China.
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Abuduaini N, Wang X, Fingerhut A, Zheng M, Li J, Yang X, Song H, Zhang S, Cheng X, Xu X, Zhong H, Aikemu B, Ding C, Yu M, Liu J, Zhang Y, Wang W, Kong LS, Cai Z, Feng B. Short-term outcomes of transanal endoscopic intersphincteric resection for locally advanced rectal cancer after neoadjuvant chemoradiotherapy: A single-center retrospective cohort study. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2025; 51:109984. [PMID: 40203672 DOI: 10.1016/j.ejso.2025.109984] [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: 11/08/2024] [Revised: 01/20/2025] [Accepted: 03/19/2025] [Indexed: 04/11/2025]
Abstract
OBJECTIVE To compare the perioperative safety and specimen characteristics after transanal endoscopic intersphincteric resection (taE-ISR) versus classical intersphincteric resection (cISR) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT). METHODS Clinicopathological data of 145 patients (75 undergoing taE-ISR and 70 undergoing cISR after nCRT) were retrospectively analyzed. Baseline characteristics, perioperative details, and pathological specimen quality of the two groups were compared. RESULTS Intraoperative blood loss was lower in the taE-ISR group compared to cISR (50.0 (40.0-100.0) ml vs. 70.0 (50.0-100.0) ml, P = 0.034). Two patients (2.6 %) in the taE-ISR group and eight patients (11.4 %) in the cISR group sustained adjacent organ injury (P = 0.037). There was no statistically significant difference in the prevalence of postoperative complications between the two groups (17.3 % vs. 30.0 %, P = 0.072). However, pelvic abscess (1.3 % vs. 8.6 %, P = 0.042) and rectovaginal fistula (0.0 % vs. 5.7 %, P = 0.036) occurred less often in taE-ISR compared to cISR. The complete resection rate was higher in taE-ISR compared to cISR (98.7 % vs. 91.4 %, P = 0.042). No patients in taE-ISR had positive distal resection margins (DRM), while four patients in cISR had positive DRM (0.0 % vs. 5.7 %, P = 0.036). CONCLUSION taE-ISR after nCRT was associated with higher-quality specimens, reduced intraoperative blood loss, and fewer perioperative complications, attesting to the feasibility and safety of taE-ISR In low-LARC patients.
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Affiliation(s)
- Naijipu Abuduaini
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Xiaohan Wang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Abe Fingerhut
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Minhua Zheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Jianwen Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Xiao Yang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Haiqin Song
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Sen Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Xi Cheng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Ximo Xu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Hao Zhong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Batuer Aikemu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Chengsheng Ding
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Mengqin Yu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Jingyi Liu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Yi Zhang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Wanyu Wang
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Lih Shyuan Kong
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China
| | - Zhenghao Cai
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China.
| | - Bo Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, PR China; Shanghai Minimally Invasive Surgery Center, Shanghai, PR China.
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Eaglehouse YL, Darmon S, Gage MM, Shriver CD, Zhu K. Racial comparisons in treatment of rectal adenocarcinoma and survival in the military health system. JNCI Cancer Spectr 2024; 8:pkae074. [PMID: 39208282 PMCID: PMC11413531 DOI: 10.1093/jncics/pkae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/29/2024] [Accepted: 08/22/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Racial disparities in treatment and outcomes of rectal cancer have been attributed to patients' differential access to care. We aimed to study treatment and outcomes of rectal cancer in the equal access Military Health System (MHS) to better understand potential racial disparities. METHODS We accessed the MilCanEpi database to study a cohort of patients aged 18 and older who were diagnosed with rectal adenocarcinoma between 1998 and 2014. Receipt of guideline recommended treatment per tumor stage, cancer recurrence, and all-cause death were compared between non-Hispanic White and Black patients using multivariable regression models with associations expressed as odds (AORs) or hazard ratios (AHRs) and their 95% confidence intervals (CIs). RESULTS The study included 171 Black and 845 White patients with rectal adenocarcinoma. Overall, there were no differences in receipt of guideline concordant treatment (AOR = 0.76, 95% CI = 0.45 to 1.29), recurrence (AHR = 1.34, 95% CI = 0.85 to 2.12), or survival (AHR = 1.08, 95% CI = 0.77 to 1.54) for Black patients compared with White patients. However, Black patients younger than 50 years of age at diagnosis (AOR = 0.34, 95% CI = 0.13 to 0.90) or with stage III or IV tumors (AOR = 0.28, 95% CI = 0.12 to 0.64) were less likely to receive guideline recommended treatment than White patients in stratified analysis. CONCLUSIONS In the equal access MHS, although there were no overall racial disparities in rectal cancer treatment or clinical outcomes between Black and White patients, disparities among those with early-onset or late-stage rectal cancers were noted. This suggests that factors other than access to care may play a role in the observed disparities and warrants further research.
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Affiliation(s)
- Yvonne L Eaglehouse
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Sarah Darmon
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
| | - Michele M Gage
- Department of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Craig D Shriver
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- Department of Surgery, Division of Surgical Oncology, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Kangmin Zhu
- Murtha Cancer Center Research Program, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD, USA
- Department of Preventive Medicine & Biostatistics, F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
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Carvalho A, Gonçalves N, Teixeira P, Goulart A, Leão P. The impact of methylene blue in colorectal cancer: Systematic review and meta-analysis study. Surg Oncol 2024; 53:102046. [PMID: 38377643 DOI: 10.1016/j.suronc.2024.102046] [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: 01/11/2024] [Revised: 02/01/2024] [Accepted: 02/04/2024] [Indexed: 02/22/2024]
Abstract
PURPOSE In patients with colorectal cancer (CRC), the most important factor to decide the need of adjuvant chemotherapy is the histological lymph node (LN) evaluation. Our work aimed to give a broad view over the use of methylene blue and its consequences in the number of lymph node harvest. METHODS PUBMED, WEB OF SCIENCE and EMBASE databases were consulted, retrieving clinical trials, which mentioned the used of intra-arterial methylene blue in patients with colorectal cancer. RESULTS Eighteen clinical trials analyzing the use of intra-arterial methylene blue in specimens of colorectal cancer were selected. The articles show a statistical difference between the use of methylene blue and the classical dissection in both variable at study. The results of the statistical analysis of the lymph node harvest variable demonstrate a significant statistical difference between the group that received methylene blue injection and the group that underwent conventional dissection. There is a significant statistical difference between the experimental and control groups for the ideal lymph node harvest (lymph node harvest count greater than 12). CONCLUSION The use of intra-arterial methylene blue revealed a high potential for the quantification of lymph nodes, considering the increase of lymph node harvest and the higher percentage of cases with more than 12 lymph nodes count, albeit the high heterogeneity between the studies in terms of reported results. Future investigations with controlled double blinded studies obtaining better categorized results should be conducted in order to better evaluate this technique and compare it to the current paradigm.
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Affiliation(s)
- Alexandre Carvalho
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal.
| | | | - Pedro Teixeira
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal
| | - André Goulart
- General Surgery Department, Grupo Trofa Saúde, Braga, Portugal
| | - Pedro Leão
- Life and Health Sciences Research Institute (ICVS), Medical School, University of Minho, Braga, Portugal; General Surgery Department, Grupo Trofa Saúde, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga, Guimarães, Portugal
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Schnoz C, Schmid K, Ortega Sanchez G, Schacher-Kaufmann S, Adamina M, Peros G, Erdin D, Bode PK. Acetone compression improves lymph node yield and metastasis detection in colorectal cancer. Clin Exp Metastasis 2024; 41:45-53. [PMID: 38177714 PMCID: PMC10830779 DOI: 10.1007/s10585-023-10259-x] [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: 09/13/2023] [Accepted: 12/23/2023] [Indexed: 01/06/2024]
Abstract
Lymph node status is one of the most important prognostic factors in colorectal cancer, and accurate pathological nodal staging and detection of lymph node metastases is crucial for determination of post-operative management. Current guidelines, including the TNM staging system and European Society for Medical Oncology (ESMO) guidelines, recommend examination of at least 12 lymph nodes. However, identification of an adequate number of lymph nodes can be challenging, especially in the setting of neoadjuvant treatment, which may reduce nodal size. In this study, we investigated 384 colorectal cancer resections that were processed at our department of pathology between January 2012 and December 2022, in which the number of detected lymph nodes was less than 12 subsequent to conventional preparation of mesocolic fat tissue. By means of acetone compression, lymph node harvest increased significantly (p < 0.0001), and the intended number of ≥ 12 lymph nodes was achieved in 98% of resection specimens. The number of nodal positive cases increased significantly from n = 95 (24.7%) before versus n = 131 (34.1%) after acetone compression due to additionally identified lymph node metastases (p < 0.001). In 36 patients (9.4%) initially considered as nodal negative, acetone compression led to a staging adjustment to a nodal positive category and thereby drove a recommendation to offer post-operative therapy. In conclusion, acetone compression is a reliable and useful method implementable in routine surgical pathology for the retrieval of lymph nodes in colorectal cancer specimen, allowing for an adequate lymph node sampling and an increase in nodal staging reliability.
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Affiliation(s)
- Christina Schnoz
- Department of Pathology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland.
| | - Katrin Schmid
- Department of Pathology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
| | - Guacimara Ortega Sanchez
- Department of Medical Oncology and Hematology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
| | - Sabina Schacher-Kaufmann
- Department of Medical Oncology and Hematology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
| | - Michel Adamina
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
| | - Georgios Peros
- Department of Visceral and Thoracic Surgery, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
| | - Dieter Erdin
- Department of Pathology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
| | - Peter Karl Bode
- Department of Pathology, Kantonsspital Winterthur, Brauerstrasse 15, Winterthur, 8401, Switzerland
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Hakki L, Khan A, Gonen M, Stadler Z, Segal NH, Shia J, Widmar M, Wei IH, Smith JJ, Pappou EP, Nash GM, Paty PB, Garcia-Aguilar J, Weiser MR. Lymph Node Metastases and Associated Recurrence-Free Survival in Microsatellite Stable and Unstable Colon Cancer. Ann Surg Oncol 2023; 30:8487-8494. [PMID: 37700171 PMCID: PMC10842299 DOI: 10.1245/s10434-023-14270-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/24/2023] [Indexed: 09/14/2023]
Abstract
BACKGROUND In contrast to microsatellite stable (MSS) colon cancer, predictors of lymph node metastases and their association with recurrence are not well-defined in microsatellite instability (MSI) colon cancer. METHODS A cohort of nonmetastatic colon cancer patients undergoing surgery between 2015 and 2021 were evaluated for predictors of lymph node metastases (LNMs) and their association with recurrence-free survival (RFS). RESULTS Of 1466 patients included in the analyses, 361 (25 %) had MSI. Compared with MSS, MSI was associated with earlier stage, fewer LNMs in the patients with N1 or N2 disease, and fewer high-risk features. Compared with the T3-T4 MSS patients, the odds ratios for LNM were 0.52 (95% confidence interval [CI], 0.38-0.71) for the T3-T4 MSI patients, 0.27 (95% CI, 0.38-0.71) for the T1-T2 MSS patients, and 0.15 (95 % CI, 0.08-0.26) for the T1-T2 MSI patients. In both groups, LNMs were associated with T category, patient age, and venous, lymphatic, or perineural invasion. In the MSS patients, LNMs were additionally associated with patient sex and histologic grade. Compared with the MSS patients, the MSI patients with N0 and N1 disease had a better 3-year RFS. However, the MSI patients with N2 disease had a lower rate of 3-year RFS than the MSS patients (hazard ratio, 19.75 vs 4.49). CONCLUSIONS In MSI colon cancer, LNMs are 50 % less prevalent, but the factors associated with LNM are like those in MSS colon cancer. The improved prognosis traditionally associated with early-stage MSI colon cancers dissipates with four or more LNMs. These findings should be taken into consideration by clinicians selecting the most appropriate course of treatment for MSI colon cancer.
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Affiliation(s)
- Lynn Hakki
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Asama Khan
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mithat Gonen
- Department of Biostatistics and Epidemiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Zsofia Stadler
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Neil H Segal
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jinru Shia
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maria Widmar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Iris H Wei
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - J Joshua Smith
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Emmanouil P Pappou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Garrett M Nash
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Philip B Paty
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julio Garcia-Aguilar
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Martin R Weiser
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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Basendowah MH, Ezzat MA, Khayyat AH, Alamri ESA, Madani TA, Alzahrani AH, Bokhary RY, Badeeb AO, Hijazi HA. Comparison of flexible endoscopy and magnetic resonance imaging in determining the tumor height in rectal cancer. Cancer Rep (Hoboken) 2023; 6:e1705. [PMID: 36806725 PMCID: PMC9939992 DOI: 10.1002/cnr2.1705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 07/06/2022] [Accepted: 07/27/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Several modalities are available for the diagnosis of rectal cancer, including conventional gold standard rigid endoscopy and recent flexible endoscopy and magnetic resonance imaging (MRI). Each modality affects the management of these patients. AIM To compare the accuracy of flexible endoscopy and MRI in the measurement of tumor height in patients with rectal cancer. METHODS AND RESULTS This study included 174 patients with rectal cancer who underwent flexible endoscopy and MRI for the measurement of tumor height. Data on patient demographics, comorbidities, treatment, and histopathology were identified and collected. We evaluate intraclass correlation coefficient (ICC) and Bland-Altman plot to test the agreement between the measurements. ICC were excellent with an ICC of 89% (95%CI 48%-99%). The mean ± standard deviation of the distance from the anal verge to the distal part of the tumor was 7.73 ± .47 for flexible endoscopy and 6.21 ± 0.39 for MRI, with mean difference of 1.52 (p ˂ .001). The accordance between the two modalities was not affected by sex, age, body mass index, histopathology, or metastasis. CONCLUSION Excellent agreement between flexible endoscopy and MRI was noted, and no factor was found to affect such concordance.
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Affiliation(s)
| | | | | | | | - Turki A. Madani
- Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Anas H. Alzahrani
- Department of Surgery, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Rana Y. Bokhary
- Department of Anatomical Pathology, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Arwa O. Badeeb
- Radiology Department, Faculty of MedicineKing Abdulaziz UniversityJeddahSaudi Arabia
| | - Hussam A. Hijazi
- Radiation Oncology Unit, Radiology DepartmentKing Abdulaziz UniversityJeddahSaudi Arabia
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He L, Xiao J, Zheng P, Zhong L, Peng Q. Lymph node regression grading of locally advanced rectal cancer treated with neoadjuvant chemoradiotherapy. World J Gastrointest Oncol 2022; 14:1429-1445. [PMID: 36160739 PMCID: PMC9412927 DOI: 10.4251/wjgo.v14.i8.1429] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/30/2022] [Accepted: 07/06/2022] [Indexed: 02/05/2023] Open
Abstract
Neoadjuvant chemoradiotherapy (nCRT) and total rectal mesenteric excision are the main standards of treatment for locally advanced rectal cancer (LARC). Lymph node regression grade (LRG) is an indicator of prognosis and response to preoperative nCRT based on postsurgical metastatic lymph node pathology. Common histopathological findings in metastatic lymph nodes after nCRT include necrosis, hemorrhage, nodular fibrosis, foamy histiocytes, cystic cell reactions, areas of hyalinosis, residual cancer cells, and pools of mucin. A number of LRG systems designed to classify the amount of lymph node regression after nCRT is mainly concerned with the relationship between residual cancer cells and regressive fibrosis and with estimating the number of lymph nodes existing with residual cancer cells. LRG offers significant prognostic information, and in most cases, LRG after nCRT correlates with patient outcomes. In this review, we describe the systematic classification of LRG after nCRT, patient prognosis, the correlation with tumor regression grade, and the typical histopathological findings of lymph nodes. This work may serve as a reference to help predict the clinical complete response and determine lymph node regression in patients based on preservation strategies, allowing for the formulation of more accurate treatment strategies for LARC patients, which has important clinical significance and scientific value.
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Affiliation(s)
- Lei He
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Juan Xiao
- School of Medicine, University of Electronic Science and Technology of China, Chengdu 611731, Sichuan Province, China
| | - Ping Zheng
- Department of Pathology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China
| | - Lei Zhong
- Personalized Drug Therapy Key Laboratory of Sichuan Province, Sichuan Academy of Medical Sciences and Sichuan Provincial People’s Hospital, Chengdu 610072, Sichuan Province, China
| | - Qian Peng
- Radiation Therapy Center, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu 610041, Sichuan Province, China
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10
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Melucci AD, Loria A, Ramsdale E, Temple LK, Fleming FJ, Aquina CT. An assessment of left-digit bias in the treatment of older patients with potentially curable rectal cancer. Surgery 2022; 172:851-858. [PMID: 35843744 DOI: 10.1016/j.surg.2022.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/27/2022] [Accepted: 04/29/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Patient age is associated with poorer rectal cancer treatment compliance. However, it is unknown whether left-digit bias (disproportionate influence of leftmost age digit) influences this association. METHODS The patients diagnosed with stage I-III rectal cancer between 2006 to 2017 in the National Cancer Database were identified. The association between age and receipt of guideline-adherent care was assessed using mixed-effects multivariable analyses. RESULTS Among 97,960 patients, 46.2% received guideline-adherent overall treatment and 73.3% underwent guideline-adherent surgical resection. Of those who underwent guideline-adherent surgery, 86.4% received guideline-adherent radiotherapy and 56.6% received guideline-adherent chemotherapy. After risk-adjustment, each decade increase in age was associated with 36% decreased odds of guideline-adherent therapy (odds ratio = 0.64, 95% confidence interval = 0.63-0.65). Patients aged 58 to 59 (odds ratio = 1.15, 95% confidence interval = 1.02-1.27) and 78 to 79 (odds ratio = 1.28, 95% confidence interval = 1.08-1.51) had higher odds of guideline-adherent overall treatment compared with patients aged 60 and 80, respectively. However, there were no significant differences in the receipt of guideline-adherent treatment between patients aged 60 vs 61-62 and 80 vs 81-82. CONCLUSION Older patients with rectal cancer are less likely to receive guideline-adherent care, and a left-digit bias is present. Geriatric assessment-guided treatment decisions could help mitigate this bias.
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Affiliation(s)
- Alexa D Melucci
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY.
| | - Anthony Loria
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY. https://twitter.com/apl2018
| | - Erika Ramsdale
- Division of Hematology/Oncology, University of Rochester Medical Center, Rochester, NY
| | - Larissa K Temple
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY
| | - Fergal J Fleming
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY. https://twitter.com/FergaljFleming
| | - Christopher T Aquina
- Department of Surgery, Surgical Health Outcomes and Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY; Surgical Health Outcomes Consortium (SHOC), Digestive Health and Surgery Institute, Advent Health Orlando, Orlando, FL. https://twitter.com/AdventHealth
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11
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Xiong Z, Geng Z, Lian S, Yin S, Xu G, Zhang Y, Dai Y, Zhao J, Ma L, Liu X, Zheng H, Zou C, Xie C. Discriminating rectal cancer grades using restriction spectrum imaging. Abdom Radiol (NY) 2022; 47:2014-2022. [PMID: 35368206 DOI: 10.1007/s00261-022-03500-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 12/25/2022]
Abstract
PURPOSE Restriction spectrum imaging (RSI) is a novel diffusion MRI model that separates water diffusion into several microscopic compartments. The restricted compartment correlating to the tumor cellularity is expected to be a potential indicator of rectal cancer aggressiveness. Our aim was to assess the ability of RSI model for rectal tumor grading. METHODS Fifty-eight patients with different rectal cancer grading confirmed by biopsy were involved in this study. DWI acquisitions were performed using single-shot echo-planar imaging (SS-EPI) with multi-b-values at 3 T. We applied a three-compartment RSI model, along with ADC model and diffusion kurtosis imaging (DKI) model, to DWI images of 58 patients. ROC and AUC were used to compare the performance of the three models in differentiating the low grade (G1 + G2) and high grade (G3). Mean ± standard deviation, ANOVA, ROC analysis, and correlation analysis were used in this study. RESULTS The volume fraction of restricted compartment C1 from RSI was significantly correlated with grades (r = 0.403, P = 0.002). It showed significant difference between G1 and G3 (P = 0.008) and between G2 and G3 (P = 0.01). As for the low-grade and high-grade discrimination, significant difference was found in C1 (P < 0.001). The AUC of C1 for differentiation between low-grade and high-grade groups was 0.753 with a sensitivity of 72.0% and a specificity of 70.0%. CONCLUSION The three-compartment RSI model was able to discriminate the rectal cancer of low and high grades. The results outperform the traditional ADC model and DKI model in rectal cancer grading.
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Affiliation(s)
- Zhongyan Xiong
- Paul C. Lauterbur Centre for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Zhijun Geng
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Shanshan Lian
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Shaohan Yin
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Guixiao Xu
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Yunfei Zhang
- Central Research Institute, United Imaging Healthcare, Shanghai, 201807, China
| | - Yongming Dai
- Central Research Institute, United Imaging Healthcare, Shanghai, 201807, China
| | - Jing Zhao
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Lidi Ma
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China
| | - Xin Liu
- Paul C. Lauterbur Centre for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen, 518000, China
| | - Hairong Zheng
- Paul C. Lauterbur Centre for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Chao Zou
- Paul C. Lauterbur Centre for Biomedical Imaging, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China.
- Key Laboratory for Magnetic Resonance and Multimodality Imaging of Guangdong Province, Shenzhen, 518000, China.
| | - Chuanmiao Xie
- State Key Laboratory of Oncology in Southern China, Department of Radiology, Sun Yat-Sen University Cancer Center, No. 651 Dongfeng East Road, Guangzhou, 510060, China.
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12
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Wei S, Li C, Li M, Xiong Y, Jiang Y, Sun H, Qiu B, Lin CJ, Wang J. Radioactive Iodine-125 in Tumor Therapy: Advances and Future Directions. Front Oncol 2021; 11:717180. [PMID: 34660280 PMCID: PMC8514864 DOI: 10.3389/fonc.2021.717180] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 09/07/2021] [Indexed: 12/11/2022] Open
Abstract
Radioactive iodine-125 (I-125) is the most widely used radioactive sealed source for interstitial permanent brachytherapy (BT). BT has the exceptional ability to deliver extremely high doses that external beam radiotherapy (EBRT) could never achieve within treated lesions, with the added benefit that doses drop off rapidly outside the target lesion by minimizing the exposure of uninvolved surrounding normal tissue. Spurred by multiple biological and technological advances, BT application has experienced substantial alteration over the past few decades. The procedure of I-125 radioactive seed implantation evolved from ultrasound guidance to computed tomography guidance. Compellingly, the creative introduction of 3D-printed individual templates, BT treatment planning systems, and artificial intelligence navigator systems remarkably increased the accuracy of I-125 BT and individualized I-125 ablative radiotherapy. Of note, utilizing I-125 to treat carcinoma in hollow cavity organs was enabled by the utility of self-expandable metal stents (SEMSs). Initially, I-125 BT was only used in the treatment of rare tumors. However, an increasing number of clinical trials upheld the efficacy and safety of I-125 BT in almost all tumors. Therefore, this study aims to summarize the recent advances of I-125 BT in cancer therapy, which cover experimental research to clinical investigations, including the development of novel techniques. This review also raises unanswered questions that may prompt future clinical trials and experimental work.
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Affiliation(s)
- Shuhua Wei
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Mengyuan Li
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yan Xiong
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | - Bin Qiu
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
| | | | - Junjie Wang
- Department of Radiation Oncology, Peking University 3rd Hospital, Beijing, China
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13
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Abstract
Robotic transanal surgery is the culmination of major developments in rectal cancer management and minimally invasive surgery. It is the result of continuous efforts to tackle the challenges inherent to rectal cancer surgery. This latest technology holds great promise and excitement for the care of the rectal cancer patient. In this article, we will describe the evolution of transanal rectal cancer surgery and describe how the convergence of transanal transabdominal, transanal endoscopic microsurgery, transanal minimally invasive surgery (TAMIS), transanal total mesorectal excision (taTME), and the different robotic platforms have culminated in the development of single port robotic transanal minimally invasive surgery (SP rTAMIS) and single port robotic transanal total mesorectal excision (SP rtaTME). We will describe the indications, technical aspects, outcomes, benefits, and limitations of the SP rTAMIS and SP rtaTME.
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Affiliation(s)
- John H Marks
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Rafael E Perez
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
| | - Jean F Salem
- Department of Colorectal Surgery, Lankenau Medical Center, Wynnewood, Pennsylvania
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Mansha MA, Waheed A, Sadaf T, Rashid A, Irfan N, Chaudry SJ. Neoadjuvant Capecitabine and Oxaliplatin Before Concurrent Capecitabine and Radiation in Locally Advanced Rectal Cancers: Experience of a Cancer Hospital in Pakistan. JCO Glob Oncol 2021; 7:790-796. [PMID: 34043412 PMCID: PMC8457841 DOI: 10.1200/go.20.00596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
To report the toxicity and pathologic response rates after adding neoadjuvant capecitabine and oxaliplatin (CAPOX) followed by concurrent radiation and capecitabine (CAPRT) and surgery in patients with locally advanced rectal cancer.
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Affiliation(s)
- Muhammad Atif Mansha
- Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asmara Waheed
- Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Tabinda Sadaf
- Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Asma Rashid
- Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Nabia Irfan
- Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Samreen Javed Chaudry
- Clinical and Radiation Oncology Department, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
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15
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del Carmen S, Corchete LA, González Velasco C, Sanz J, Alcazar JA, García J, Rodríguez AI, Vidal Tocino R, Rodriguez A, Pérez-Romasanta LA, Sayagués JM, Abad M. High-Risk Clinicopathological and Genetic Features and Outcomes in Patients Receiving Neoadjuvant Radiochemotherapy for Locally Advanced Rectal Cancer. Cancers (Basel) 2021; 13:3166. [PMID: 34202891 PMCID: PMC8269103 DOI: 10.3390/cancers13133166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 01/16/2023] Open
Abstract
Administering preoperative radiochemotherapy (RCT) in stage II-III tumors to locally advanced rectal carcinoma patients has proved to be effective in a high percentage of cases. Despite this, 20-30% of patients show no response or even disease progression. At present, preoperative response is assessed by a combination of imaging and tumor regression on histopathology, but recent studies suggest that various genetic abnormalities may be associated with the sensitivity or resistance of rectal cancer tumor cells to neoadjuvant therapy. In the present study we investigated the relationship between genetic lesions detected by high-density single-nucleotide polymorphisms (SNP) arrays 6.0 and response to neoadjuvant RCT, evaluated according to Dworak criteria in 39 rectal cancer tumors before treatment. The highest frequency of copy-number (CN) losses detected corresponded to chromosomes 18q (n = 27; 69%), 1p (n = 22; 56%), 15q (n = 19; 49%), 8p (n = 18; 48%), 4q (n = 17; 46%), and 22q (n = 17; 46%); in turn, CN gains more frequently involved chromosomes 20p (n = 22; 56%), 8p (n = 20; 51%), and 15q (n = 16; 41%). There was a significant association between alterations in the 1p, 3q, 7q, 12p, 17q, 20p, and 22q chromosomal regions and the degree of response to therapy prior to surgery. However, 4q, 15q11.1, and 15q14 chromosomal region alterations were identified as important by five prediction algorithms, i.e., those with the greatest influence on predicting the tumor response to treatment with preoperative RCT. Multivariate analysis of prognostic factors showed that gains on 15q11.1 and carcinoembryonic antigen (CEA) levels serum at diagnosis were the only independent variables predicting disease-free survival (DFS). Lymph node involvement also showed a prognostic impact on overall survival (OS) in the multivariate analysis. A deep-learning-based algorithm showed a 100% success rate in predicting both DFS and OS at 60 months after diagnosis of the disease. In summary, our results indicate the existence of an association between tumor genetic abnormalities at diagnosis, response to neoadjuvant therapy, and survival of patients with locally advanced rectal cancer. In addition to the clinical and biological characteristics of locally advanced rectal cancer patients, these could be used in the future as therapeutic and prognostic biomarkers, to identify patients sensitive or resistant to preoperative treatment, helping guide therapeutic decision-making. Additional prospective studies in larger series of patients are required to confirm the clinical utility of the newly identified biomarkers.
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Affiliation(s)
- Sofía del Carmen
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (S.d.C.); (C.G.V.); (J.S.); (A.R.)
| | - Luís Antonio Corchete
- Cancer Research Center and Hematology Service and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain;
| | - Cristina González Velasco
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (S.d.C.); (C.G.V.); (J.S.); (A.R.)
| | - Julia Sanz
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (S.d.C.); (C.G.V.); (J.S.); (A.R.)
| | - José Antonio Alcazar
- General and Gastrointestinal Surgery Service and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (J.A.A.); (J.G.)
| | - Jacinto García
- General and Gastrointestinal Surgery Service and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (J.A.A.); (J.G.)
| | - Ana Isabel Rodríguez
- Radiation Oncology Service and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (A.I.R.); (L.A.P.-R.)
| | - Rosario Vidal Tocino
- Medical Oncology Service and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain;
| | - Alba Rodriguez
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (S.d.C.); (C.G.V.); (J.S.); (A.R.)
| | - Luis Alberto Pérez-Romasanta
- Radiation Oncology Service and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (A.I.R.); (L.A.P.-R.)
| | - José María Sayagués
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (S.d.C.); (C.G.V.); (J.S.); (A.R.)
| | - Mar Abad
- Department of Pathology and IBSAL, University Hospital of Salamanca, University of Salamanca, 37007 Salamanca, Spain; (S.d.C.); (C.G.V.); (J.S.); (A.R.)
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Liu M, Yin S, Li Q, Liu Y, Pei X, Han F, Li AH, Zhou J. Evaluation of the Extent of Mesorectal Invasion and Mesorectal Fascia Involvement in Patients with T3 Rectal Cancer With 2-D and 3-D Transrectal Ultrasound: A Pilot Comparison Study With Magnetic Resonance Imaging Findings. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:3008-3016. [PMID: 32868155 DOI: 10.1016/j.ultrasmedbio.2020.07.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 07/02/2020] [Accepted: 07/30/2020] [Indexed: 06/11/2023]
Abstract
The aim of this study was to determine the value of 2-D and 3-D transrectal ultrasound (TRUS) in assessing the extent of mesorectal invasion (EMI) and mesorectal fascia involvement (MRF+) in patients with T3 rectal tumours. We retrospectively evaluated 80 patients with T3 stage rectal cancer who were pre-operatively evaluated by 2-D and 3-D TRUS before neoadjuvant chemoradiotherapy by using magnetic resonance imaging (MRI) as a reference standard. The T3 stage was subdivided into T3 ab (EMI ≤5 mm) and T3 cd (EMI >5 mm). The consistency assessment of the T3 sub-staging and MRF+ was compared between 2-D and 3-D TRUS using Cohen's kappa statistic. The concordance of the T3 sub-staging based on EMI was excellent between the 3-D TRUS and MRI (κ = 0.84) and good between the 2-D TRUS and MRI (κ = 0.67). For the assessment of MRF+ (κ = 0.82), 3-D TRUS and MRI showed excellent concordance. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 3-D TRUS for MRF+ assessment was 95.3%, 86.5%, 89.1% and 94.1%, respectively. The agreement between 3-D TRUS and MRI for the assessment of T3 sub-staging and MRF status was better in low rectal cancer (both κ = 0.85) than in middle (κ = 0.79 and 0.77) rectal cancer. Compared with MRI, 3-D TRUS has more advantages in the sub-staging of T3 rectal cancer and the assessment of MRF+ than those of 2-D TRUS, especially in low rectal cancer. For patients with T3 rectal cancer, 3-D TRUS may well complement MRI for selecting the appropriate treatment.
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Affiliation(s)
- Min Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - ShaoHan Yin
- Department of Medical Imaging and Interventional Radiology, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Qing Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Ying Liu
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - XiaoQing Pei
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - Feng Han
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - An-Hua Li
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
| | - JianHua Zhou
- Department of Ultrasound, Sun Yat-Sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China.
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17
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Yang SY, Han YD, Cho MS, Hur H, Min BS, Lee KY, Kim NK. Late anastomotic leakage after anal sphincter saving surgery for rectal cancer: is it different from early anastomotic leakage? Int J Colorectal Dis 2020; 35:1321-1330. [PMID: 32372379 DOI: 10.1007/s00384-020-03608-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE Although multiple studies have examined anastomotic leakage (AL) after low anterior resection (LAR), their definitions of AL varied, and few have studied late diagnosed AL after surgery. This study aimed to characterize late AL after anal sphincter saving surgery (SSS) for rectal cancer by examining clinical characteristics, risk factors, and management of patients with late AL compared with early AL. METHODS Data from January 2005 to December 2014 were collected from a total of 1903 consecutive patients who underwent anal sphincter saving surgery for rectal cancer and were retrospectively reviewed. Late AL was defined as AL diagnosed more than 30 days after surgery. Variables and risk factors associated with early and late diagnosed AL were analyzed by multivariate logistic regression. RESULTS Overall, early, and late rates of AL were 13.7%, 6.7%, and 7%, respectively. Receiving neoadjuvant chemoradiotherapy (nCRT) was a risk factor for developing late AL, but not early AL (OR, 3.032; 95% CI, 1.947-4.722; p < 0.001). Protective ileostomy did not protect against late AL. Among the 134 patients with late AL, 26 (19.4%) were classified as asymptomatic and 108 patients (80.6%) as symptomatic. The most frequent symptomatic complications related to late AL were fistula (42 cases, 39.7%), chronic sinus (33 cases, 31.1%), and stenosis (31 cases, 29.2%). CONCLUSION Clinical characteristics, risk factors, and management of patients with late AL after SSS were different from early AL. Close attention should be given to consider late AL as the continuation of early AL.
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Affiliation(s)
- Seung Yoon Yang
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Yoon Dae Han
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Min Soo Cho
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Hyuk Hur
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Byung Soh Min
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Kang Young Lee
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea
| | - Nam Kyu Kim
- Division of Colon and Rectal Surgery, Department of Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-Gu, Seoul, 03722, South Korea.
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An evaluation of trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS): a new platform for transanal surgery. Int J Colorectal Dis 2020; 35:1681-1687. [PMID: 32447482 PMCID: PMC7415033 DOI: 10.1007/s00384-020-03641-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE The study aimed to evaluate the feasibility and safety of a new trans-anal rectoscopic-assisted minimally invasive surgery (ARAMIS) platform to treat rectal lesions. METHODS ARAMIS was first compared with two transanal minimally invasive surgery platforms (SILS Port and GelPOINT Path) on human cadavers. Surgeons with different experience performed running sutures at different distances, at four quadrants, using the three platforms and gave a score to visibility, safety, and maneuverability. ARAMIS was then utilized on patients affected with rectal neoplasia who met the inclusion criteria. Patients and tumor characteristic and results were prospectively collected. The follow-up examinations included proctoscopy at 3, 6, and 12 months. RESULTS According to surgeons' scores, ARAMIS improves visibility and safety with respect to other platforms for distances beyond 10 cm. The procedure, which lasted an average of 59 min, was successfully carried out in 14 patients. No intraoperative or postoperative complications were reported. The mean tumor size was 3 cm; they were located a mean of 11 cm from the anal verge. Complete removal of the lesion was possible in 13/14 patients. There was one case of adenoma recurrence at follow-up. CONCLUSION Study results showed that ARAMIS, which is equipped with an adjustable rectoscope, can be considered a safe, effective platform for transanal surgery. The rectoscope protects the rectum during the procedure, a particularly important consideration when proximal rectal lesions are being treated. Further clinical studies are warranted to confirm these encouraging results.
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19
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Transperineal minimally invasive abdomino-perineal resection: preliminary outcomes and future perspectives. Updates Surg 2019; 72:97-102. [DOI: 10.1007/s13304-019-00692-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 10/31/2019] [Indexed: 12/31/2022]
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Huang W, Wu J, Liu G, Lv Y, Huang J, Li W. Chemoradiotherapy with Concurrent Regional Arterial Chemotherapy for Locally Bulky Unresectable Rectal Cancer: A Case Series. Oncol Res Treat 2019; 42:678-683. [PMID: 31514189 DOI: 10.1159/000502802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 08/18/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We evaluated the feasibility and efficacy of chemoradiotherapy with concurrent regional arterial chemotherapy (CRT/RAC) for locally bulky unresectable rectal cancer (LBURC). CASE PRESENTATION We retrospectively reviewed 9 patients with LBURC who received CRT/RAC between January 2012 and December 2018. The regimen consisted of chemoradiotherapy and 3 cycles of regional arterial chemotherapy. Surgery was performed 6 weeks after completion of radiotherapy. The median longest tumor diameter was 10 cm (range 8.2-13.6). Grade 3 toxicity and postoperative complications occurred in 3 and 4 patients, respectively. All patients showed partial response according to the Response Evaluation Criteria in Solid Tumors (RECIST). One patient refused the operation after completion of the scheduled regimen but then had a bowel obstruction and had to undergo urgent surgery. Of the 8 patients who underwent scheduled surgery, all had R0 resection without multivisceral resection; 3 achieved pathological complete response and 5 exhibited good tumor regression. The median follow-up period was 35 months (range 9-63). Recurrences occurred in 3 of 9 patients (pelvic relapses in 2 and lung in 1). CONCLUSION CRT/RAC appeared to be beneficial to LBURC, as it achieves remarkable rates of R0 resection, good tumor regression, and pathologic complete response. These preliminary results have to be confirmed in larger cohorts of patients.
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Affiliation(s)
- Wenpeng Huang
- Department of General Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China,
| | - Jiaming Wu
- Department of General Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Gui Liu
- Department of General Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Yongchang Lv
- Department of General Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Jinqiu Huang
- Department of General Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
| | - Wanlang Li
- Department of General Surgery, The Second Affiliated Hospital of Guangxi University of Science and Technology, Liuzhou, China
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Kobayashi ST, Campolina AG, Diz MDPE, de Soárez PC. Integrated care pathway for rectal cancer treatment: cross-sectional post-implementation study using a logic model framework. SAO PAULO MED J 2019; 137:438-445. [PMID: 31939569 PMCID: PMC9745824 DOI: 10.1590/1516-3180.2018.0364160919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Management of rectal cancer has become more complex with multimodality therapy (neoadjuvant chemoradiotherapy and surgery) and this has led to the need to organize multidisciplinary teams. The aim of this study was to report on the planning, implementation and evaluation of an integrated care pathway for neoadjuvant treatment of middle and lower rectal cancer. DESIGN AND SETTING This was a cross-sectional post-implementation study that was carried out at a public university cancer center. METHODS The Framework for Program Evaluation in Public Health of the Centers for Disease Control and Prevention (CDC) was used to identify resources and activities; link results from activities and outcomes with expected goals; and originate indicators and outcome measurements. RESULTS The logic model identified four activities: stakeholders' engagement, clinical pathway development, information technology improvements and training programs; and three categories of outcomes: access to care, effectiveness and organizational outcomes. The measurements involved 218 patients, among whom 66.3% had their first consultation within 15 days after admission; 75.2% underwent surgery < 14 weeks after the end of neoadjuvant treatment and 72.7% completed the treatment in < 189 days. There was 100% adherence to the protocol for the regimen of 5-fluorouracil and leucovorin. CONCLUSIONS The logic model was useful for evaluating the implementation of the integrated care pathways and for identifying measurements to be made in future outcome studies.
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Affiliation(s)
- Silvia Takanohashi Kobayashi
- MD, MSc. Ophthalmologist, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Alessandro Gonçalves Campolina
- MD, MSc, PhD. Scientific Researcher, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de Sao Paulo (FMUSP), Sao Paulo, SP, BR.
| | - Maria del Pilar Estevez Diz
- MD, PhD. Attending Physician, Centro de Investigação Translacional em Oncologia, Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Patrícia Coelho de Soárez
- MPH, PhD. Associate Professor, Department of Preventive Medicine, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, SP, BR.
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Brown PJ, Hyland R, Quyn AJ, West NP, Sebag-Montefiore D, Jayne D, Sagar P, Tolan DJ. Current concepts in imaging for local staging of advanced rectal cancer. Clin Radiol 2019; 74:623-636. [PMID: 31036310 DOI: 10.1016/j.crad.2019.03.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/22/2019] [Indexed: 12/20/2022]
Abstract
Imaging of rectal cancer has an increasingly pivotal role in the diagnosis, staging, and treatment stratification of patients with the disease. This is particularly true for advanced rectal cancers where magnetic resonance imaging (MRI) findings provide essential information that can change treatment. In this review we describe the rationale for the current imaging standards in advanced rectal cancer for both morphological and functional imaging on the baseline staging and reassessment studies. In addition the clinical implications and future methods by which radiologists may improve these are outlined relative to TNM8.
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Affiliation(s)
- P J Brown
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK.
| | - R Hyland
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - A J Quyn
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - N P West
- Pathology and Data Analytics, Leeds Institute of Medical Research at St James's, University of Leeds, Welcome Trust Brenner Building, St James's University Hospital, Leeds, LS9 7TF, UK
| | - D Sebag-Montefiore
- Department of Clinical Oncology, Bexley Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D Jayne
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - P Sagar
- Department of General Surgery, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
| | - D J Tolan
- Department of Clinical Radiology, Lincoln Wing, St James' University Hospital, Leeds Teaching Hospitals NHS Trust, Beckett Street, Leeds, LS9 7TF, UK
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Choi T, Baek SJ, Kwak JM, Kim J, Kim SH. Early Systemic Failure After Preoperative Chemoradiotherapy for the Treatment of Patients With Rectal Cancer. Ann Coloproctol 2019; 35:94-99. [PMID: 31113174 PMCID: PMC6529755 DOI: 10.3393/ac.2018.08.28] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 08/28/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Distant metastasis can occur early after neoadjuvant chemoradiotherapy (CRT) in patients with rectal cancer. This study was conducted to evaluate the clinical characteristics of patients who developed early systemic failure. Methods The patients who underwent neoadjuvant CRT for a rectal adenocarcinoma between June 2007 and July 2015 were included in this study. Patients who developed distant metastasis within 6 months after CRT were identified. We compared short- and long-term clinicopathologic outcomes of patients in the early failure (EF) group with those of patients in the control group. Results Of 107 patients who underwent neoadjuvant CRT for rectal cancer, 7 developed early systemic failure. The lung was the most common metastatic site. In the EF group, preoperative carcinoembryonic antigen was higher (5 mg/mL vs. 2 mg/mL, P = 0.010), and capecitabine as a sensitizer of CRT was used more frequently (28.6% vs. 3%, P = 0.002). Of the 7 patients in the EF group, only 4 underwent a primary tumor resection (57.1%), in contrast to the 100% resection rate in the control group (P < 0.001). In terms of pathologic outcomes, ypN and TNM stages were more advanced in the EF group (P < 0.001 and P = 0.047, respectively), and numbers of positive and retrieved lymph nodes were much higher (P < 0.001 and P = 0.027, respectively). Conclusion Although early distant metastasis after CRT for rectal cancer is very rare, patients who developed early metastasis showed a poor nodal response with a low primary tumor resection rate and poor oncologic outcomes.
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Affiliation(s)
- Taesun Choi
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Se-Jin Baek
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jung Myun Kwak
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Jin Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
| | - Seon-Hahn Kim
- Department of Surgery, Korea University College of Medicine, Seoul, Korea
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Yoo RN, Kim HJ. Organ Preservation Strategies After Neoadjuvant Chemoradiotherapy for Locally Advanced Rectal Cancer. Ann Coloproctol 2019; 35:53-64. [PMID: 31113170 PMCID: PMC6529751 DOI: 10.3393/ac.2019.04.15.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/15/2019] [Indexed: 02/06/2023] Open
Abstract
Standard use of neoadjuvant chemoradiotherapy, total mesorectal excision, and postoperative adjuvant chemotherapy in locally advanced rectal cancer has tremendously improved oncologic outcomes over the past several decades. However, these improvements come with costs of significant morbidity and poor quality of life. Along with developments in imaging techniques, clinical experience and evidence have identified a certain subgroup of patients that have exceptionally good clinical outcomes while preserving quality of life. Driven by patient demand and interest in preserving quality of life, numerous organ preservation treatment strategies for managing rectal cancer are rapidly evolving. Herein, the flow of research in organ preservation strategies and counter arguments are discussed.
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Affiliation(s)
- Ri Na Yoo
- Division of Colorectal Surgery, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Hyung Jin Kim
- Division of Colorectal Surgery, Department of Surgery, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
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26
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Schollbach J, Kircher S, Wiegering A, Seyfried F, Klein I, Rosenwald A, Germer CT, Löb S. Prognostic value of tumour-infiltrating CD8+ lymphocytes in rectal cancer after neoadjuvant chemoradiation: is indoleamine-2,3-dioxygenase (IDO1) a friend or foe? Cancer Immunol Immunother 2019; 68:563-575. [PMID: 30671614 PMCID: PMC11028246 DOI: 10.1007/s00262-019-02306-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 01/17/2019] [Indexed: 01/05/2023]
Abstract
The prognostic value of the local immune phenotype in patients with colorectal cancer has been extensively studied. Neoadjuvant radiotherapy and/or chemotherapy may potentially influence these immune responses. In this study, we examined the prognostic role of indoleamine-2,3-Dioxygenase (IDO1) and infiltrating cytotoxic T lymphocytes (CD8+) in locally advanced rectal carcinomas after neoadjuvant treatment. Expression of IDO1 and CD8 was evaluated by immunohistochemistry in 106 archival tumour tissue samples from patients following neoadjuvant chemoradiation and radical resection. The average infiltration of IDO1+ and CD8+ cells was calculated along the tumour invasive front, in the tumour centre and within the neoplastic cells and expressed as total scores. Of the tumour specimens evaluable for immunohistochemistry, 100% showed CD8+ lymphocyte infiltration and 93.4% stained positive for IDO1. Total IDO1 score positively correlated with total CD8 score for all three subsites (p = 0.002, Kendall-tau-b 0.357). A high total CD8 score was positively correlated with lower ypUICC-stages (p = 0.047) and lower ypT-categories (p = 0.032). Total IDO1 expression showed a clear trend towards a lower risk of recurrence (p = 0.078). A high total IDO1 score was an independent prognostic marker for prolonged disease-free survival (HR 0.38, p = 0.046) and a high total CD8 score for favourable overall survival (HR 0.16, p = 0.029). Analysis of the local CD8 and IDO1 expression profile may be a helpful tool in predicting prognosis for patients with locally advanced rectal cancer following neoadjuvant chemoradiation.
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Affiliation(s)
- Julia Schollbach
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Stefan Kircher
- Department of Pathology, University of Würzburg, Würzburg, Germany
| | - Armin Wiegering
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Theodor Boveri Institute, Biocenter, University of Würzburg, Am Hubland, 97074, Würzburg, Germany
| | - Florian Seyfried
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
| | - Ingo Klein
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Josef-Schneider-Str. 6, 97080, Würzburg, Germany
| | - Andreas Rosenwald
- Department of Pathology, University of Würzburg, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Josef-Schneider-Str. 6, 97080, Würzburg, Germany
| | - Christoph-Thomas Germer
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Josef-Schneider-Str. 6, 97080, Würzburg, Germany
| | - Stefan Löb
- Department of General-, Visceral-, Transplant-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Oberdürrbacherstr. 6, 97080, Würzburg, Germany.
- Comprehensive Cancer Center Mainfranken, University of Würzburg, Josef-Schneider-Str. 6, 97080, Würzburg, Germany.
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Fleshman J, Branda ME, Sargent DJ, Boller AM, George VV, Abbas MA, Peters WR, Maun DC, Chang GJ, Herline A, Fichera A, Mutch MG, Wexner SD, Whiteford MH, Marks J, Birnbaum E, Margolin DA, Larson DW, Marcello PW, Posner MC, Read TE, Monson JR, Wren SM, Pisters PWT, Nelson H. Disease-free Survival and Local Recurrence for Laparoscopic Resection Compared With Open Resection of Stage II to III Rectal Cancer: Follow-up Results of the ACOSOG Z6051 Randomized Controlled Trial. Ann Surg 2019; 269:589-595. [PMID: 30080730 PMCID: PMC6360134 DOI: 10.1097/sla.0000000000003002] [Citation(s) in RCA: 267] [Impact Index Per Article: 44.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To determine the disease-free survival (DFS) and recurrence after the treatment of patients with rectal cancer with open (OPEN) or laparoscopic (LAP) resection. BACKGROUND This randomized clinical trial (ACOSOG [Alliance] Z6051), performed between 2008 and 2013, compared LAP and OPEN resection of stage II/III rectal cancer, within 12 cm of the anal verge (T1-3, N0-2, M0) in patients who received neoadjuvant chemoradiotherapy. The rectum and mesorectum were resected using open instruments for rectal dissection (included hybrid hand-assisted laparoscopic) or with laparoscopic instruments under pneumoperitoneum. The 2-year DFS and recurrence were secondary endpoints of Z6051. METHODS The DFS and recurrence were not powered, and are being assessed for superiority. Recurrence was determined at 3, 6, 9, 12, and every 6 months thereafter, using carcinoembryonic antigen, physical examination, computed tomography, and colonoscopy. In all, 486 patients were randomized to LAP (243) or OPEN (243), with 462 eligible for analysis (LAP = 240 and OPEN = 222). Median follow-up is 47.9 months. RESULTS The 2-year DFS was LAP 79.5% (95% confidence interval [CI] 74.4-84.9) and OPEN 83.2% (95% CI 78.3-88.3). Local and regional recurrence was 4.6% LAP and 4.5% OPEN. Distant recurrence was 14.6% LAP and 16.7% OPEN.Disease-free survival was impacted by unsuccessful resection (hazard ratio [HR] 1.87, 95% CI 1.21-2.91): composite of incomplete specimen (HR 1.65, 95% CI 0.85-3.18); positive circumferential resection margins (HR 2.31, 95% CI 1.40-3.79); positive distal margin (HR 2.53, 95% CI 1.30-3.77). CONCLUSION Laparoscopic assisted resection of rectal cancer was not found to be significantly different to OPEN resection of rectal cancer based on the outcomes of DFS and recurrence.
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Affiliation(s)
- James Fleshman
- Baylor University Medical Center, Department of Surgery, 3500 Gaston Avenue, 1 Floor Roberts Hospital, Dallas, TX 75246,
| | - Megan E. Branda
- , Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Daniel J. Sargent
- Formerly with Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | - Maher A. Abbas
- , Dubai Colorectal and Digestive Clinic, Dubai, United Arab Emirates
| | | | | | - George J. Chang
- , The University of Texas M.D. Anderson Cancer Center, Houston, TX
| | | | | | | | | | - Mark H. Whiteford
- , The Oregon Clinic, Oregon Health and Sciences University, Portland, OR
| | - John Marks
- , Lankenau Hospital, Main Line Health, Wynnewood, PA
| | | | | | | | | | | | | | | | - Sherry M. Wren
- , Stanford University School of Medicine, Palo Alto Veterans Health Care System, Palo Alto, CA
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The value of four imaging modalities in diagnosing lymph node involvement in rectal cancer: an overview and adjusted indirect comparison. Clin Exp Med 2019; 19:225-234. [PMID: 30900099 DOI: 10.1007/s10238-019-00552-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 03/12/2019] [Indexed: 12/28/2022]
Abstract
Several systematic reviews have investigated the accuracy of imaging modalities for lymph node involvement of rectal cancer, but there are considerable differences in conclusions. This overview aimed to assess the methodological and reporting quality of systematic reviews that evaluated the diagnostic value of imaging modalities for lymph node involvement in patients with rectal cancer and to compare the diagnostic value of different modalities for lymph node involvement. The PubMed, EMBASE, Cochrane Library and Chinese Biomedicine Literature were searched to identify relevant systematic reviews. The methodological quality was assessed using the AMSTAR checklist, and the reporting quality was assessed using PRISMA-DTA checklist. The indirect comparison was conducted to compare the accuracy of different imaging modalities. Seven systematic reviews involving 353 primary studies were included. The median (Range) AMSTAR scores were 6.0 (4.0-9.0); the median (Range) PRISMA-DTA scores were 18.0 (11.0-23.0). Sensitivity of MRI [0.69 (95% CI 0.63, 0.77)] was significantly higher than that of ERUS [0.57 (95% CI 0.53, 0.62)]. Specificity of ERUS [0.80 (95% CI 0.77, 0.83)] was significantly higher than that of CT [0.72 (95% CI 0.67, 0.78)]. Positive likelihood ratio of EUS [3.04 (95% CI 2.75, 3.36)] was significantly higher than that of CT [2.21 (95% CI 1.69, 2.90)]. EUS had better diagnostic value than CT and ERUS in the diagnosis of lymph node involvement. Compared with CT and ERUS, MRI was more sensitive. EUS and MRI had comparable diagnostic accuracy, but no modality was proved to be particularly accurate.
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Bottarelli L, De' Angelis GL, Azzoni C, Di Mario F, De' Angelis N, Leandro G, Fornaroli F, Gaiani F, Negri F. Potential predictive biomarkers in locally advanced rectal cancer treated with preoperative chemo-radiotherapy. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:102-106. [PMID: 30561402 PMCID: PMC6502185 DOI: 10.23750/abm.v89i9-s.7881] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Indexed: 02/08/2023]
Abstract
Fluorouracil-based preoperative chemoradiotherapy represents a standard option for the treatment of locally advanced rectal cancer. Randomized clinical trials have shown that fluorouracil concomitant to preoperative radiation enhances tumor shrinkage (with 10% to 15% of the patients showing a complete pathological tumor response) compared with preoperative radiation alone. A high response rate is of clinical importance in rectal cancer, since patients who achieve a complete pathological response may experience improved long-term survival. Adding oxaliplatin to fluorouracil-based preoperative chemoradiotherapy has no effect on response of the primary rectal tumor and single-agent fluoropyrimidine remains the standard chemotherapy in this setting. Despite novel biological insights and therapeutic advances, little is known about potential biological markers able to predict pathological tumor response before treatment and to subsequently impact patients' prognosis. This review focuses on the current available data on main molecular markers and molecular subtypes and the possible upcoming introduction of such analyses in the clinical setting.
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Affiliation(s)
- Lorena Bottarelli
- Department of Medicine and Surgery, Unit of Pathological Anatomy, University Hospital of Parma, Parma, Italy.
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30
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Poulsen LØ, Yilmaz MK, Ljungmann K, Jespersen N, Wille-Jørgensen P, Petersen LN, Falkmer U. Local recurrence rate in a national Danish patient cohort after curative treatment for rectal cancer. Acta Oncol 2018; 57:1639-1645. [PMID: 30169998 DOI: 10.1080/0284186x.2018.1497299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
AIM Several trials have shown that preoperative (chemo)radiotherapy (CRT) reduces local recurrence rates (LRRs) in rectal cancer (RC). The use of CRT varies greatly between countries. It is unknown whether the restrictive use of CRT in Denmark results in a higher LRR relative to other countries. The aim was to evaluate the LRR in a national Danish consecutive cohort of patients with RC. METHODS All data from patients with RC in Denmark in 2009-2010 who were operated on with curative intent were retrieved from the Danish Colorectal Cancer Group database. Patients with metastases at the time of diagnosis, patients with synchronous colon cancer, and patients, in whom only local surgical procedures were performed, were excluded. In total, 1633 patients met the inclusion criteria. Clinical follow-up was at least five years with a cut-off date of 31 December 2015. RESULTS Clinical follow-up was 5.4 years (median) with an interquartile range of 4.5-6.1 years. Of all included patients, 479 (29%) were treated with preoperative long-course CRT. Local recurrence was found in 68 patients, resulting in an LRR of 4.2%, and 182 (11%) patients developed distant metastases. Five-year overall survival was 74% (95% CI: 71.64-75.91). CONCLUSIONS Five-year follow-up of curatively treated patients with RC in Denmark revealed a low LRR. This figure is identical to those reported in other Nordic countries, despite Denmark's considerably stricter guidelines for CRT. The obtained results justify the currently adopted restrictive use of preoperative CRT in Denmark.
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Affiliation(s)
- L. Ø. Poulsen
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - M. K. Yilmaz
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg
| | - K. Ljungmann
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - N. Jespersen
- Gastrounit, Surgical Division, Hvidovre University Hospital, Copenhagen, Denmark
| | - P. Wille-Jørgensen
- Abdominal Disease Center K, Bispebjerg University Hospital, Copenhagen, Denmark
| | - L. N. Petersen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - U.G. Falkmer
- Department of Oncology, Clinical Cancer Research Center, Aalborg University Hospital, Aalborg
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Saklani A, Sugoor P, Chaturvedi A, Bhamre R, Jatal S, Ostwal V, Engineer R. Clinical Utility of Staging Laparoscopy for Advanced Obstructing Rectal Adenocarcinoma: Emerging Tool. Indian J Surg Oncol 2018; 9:488-494. [PMID: 30538377 PMCID: PMC6265173 DOI: 10.1007/s13193-018-0803-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Accepted: 07/17/2018] [Indexed: 02/07/2023] Open
Abstract
The multimodal treatment for advanced rectal adenocarcinoma mandates accurate preoperative staging with contrast-enhanced computed tomography (CECT) of the thorax, abdomen, and pelvis, and magnetic resonance imaging (MRI) of the pelvis. Unlike gastric cancer, the role of staging laparoscopy (SL) in advanced colorectal cancer has not been evaluated. This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of near or complete obstructing advanced RC. Medical records of 34% (94/274) who underwent SL with diversion stoma (DS) were analyzed. In the absence of ascites, extensive peritoneal deposits, and unresectable liver metastases on SL, a curative treatment was offered, which entailed neoadjuvant chemoradiation (NACTRT), whereas the cohort of patients with extensive peritoneal disease received palliative therapy. Of the 94 patients with advanced RC, conventional imaging studies staged 73.5% (69/94) cohort as non-metastatic locally advanced and 26.5% (25/94) had potentially resectable metastatic RC. Pre-therapeutic SL upstaged the disease by 26% (18/69) and 8% (2/25) in locally advanced and potentially resectable metastatic RC cohorts, respectively. Treatment decision changed in 21.2% (20/94) of the patients, and midline laparotomy was thus avoided. In our observational study, SL was found to be a safe and effective staging modality in RC; it detected occult peritoneal disease and prevented midline laparotomy in 21.2% of the cohort, which was of value to determine treatment strategy in patients with advanced RC before initiating NACTRT. SL and laparoscopic-assisted de-functioning stoma were associated with minimal morbidity and led to early initiation of NACTRT.
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Affiliation(s)
- Avanish Saklani
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - P. Sugoor
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - A. Chaturvedi
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - R. Bhamre
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - S. Jatal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
| | - V. Ostwal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - R. Engineer
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Dr Ernest Borges Marg, Parel, Mumbai, Maharashtra 400012 India
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Ma B, Gao P, Song Y, Huang X, Wang H, Xu Q, Zhao S, Wang Z. Short-Course Radiotherapy in Neoadjuvant Treatment for Rectal Cancer: A Systematic Review and Meta-analysis. Clin Colorectal Cancer 2018; 17:320-330.e5. [DOI: 10.1016/j.clcc.2018.07.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 07/23/2018] [Accepted: 07/28/2018] [Indexed: 02/07/2023]
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Saklani A, Sugoor P, Bhandare M, Jatal S, Desouza A, Ostwal V. Chemo-Radiation After Upfront Rectal Resections-a Clinical Dilemma. Indian J Surg Oncol 2018; 9:495-500. [PMID: 30538378 PMCID: PMC6265169 DOI: 10.1007/s13193-018-0805-z] [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: 12/20/2017] [Accepted: 07/17/2018] [Indexed: 10/28/2022] Open
Abstract
To compare the impact of adjuvant chemo-radiotherapy (ACRT) versus adjuvant chemotherapy (ACT) alone on recurrence and survival in patients with stage II and III rectal adenocarcinoma undergoing upfront curative resection. Prospective observational review of colorectal database at Tata Memorial Hospital from July 2010 to March 2015 identified 84 patients who underwent upfront curative resection for stage II or III rectal cancer. None of the patient received preoperative chemo-radiation. Of these, adjuvant chemo-radiotherapy was administered to 29 patients (ACRT group) and 55 patients received CAPEOX/FOLFOX-based adjuvant chemotherapy (ACT group) alone. At a median follow-up of 20 months, there were 10 recurrences (3 local recurrence) in the ACRT group and 15 (2 local recurrence) in ACT group. The estimated disease-free survival at 3 years in the ACRT group was 62.7% and in ACT group was 49.7% (p = 0.417) with an estimated 3-year overall survival of 74 and 78% in the ACRT and ACT group, respectively (p = 0.241). Subgroup analysis was performed after risk stratifying prognostic features (pT4, pN2, poor differentiation, involved resection margin). Our study does not show any benefit of ACRT over ACT on local control, disease-free and overall survival after upfront rectal cancer resection for low-risk stage II-III. In the subgroup analysis, local recurrence did not occur in patients who did not have poor prognostic features irrespective whether they received ACRT or ACT. Adjuvant chemo-radiation can be avoided in low-risk stage II-III rectal cancer after upfront resection.
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Affiliation(s)
- A. Saklani
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - P. Sugoor
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - M. Bhandare
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - S. Jatal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - A. Desouza
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
| | - V. Ostwal
- Department of Gastrointestinal Surgery and Colorectal Surgical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra 400012 India
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Abstract
Treatment of locally advanced rectal cancer is evolving through surgical innovation and paradigm shifts in neoadjuvant treatment. Whereas local recurrence was a significant concern before the systematic implementation of neoadjuvant chemoradiation therapy and surgery according to total mesorectal excision principles, distant relapse remains a major drawback. Hence, efforts in recent years have focused on delivering preoperative chemotherapy regimens to overcome compliance issues with adjuvant administration. In parallel, new surgical techniques, including transanal video-assisted total mesorectal excision and robot-assisted surgery, emerged to face the challenge to navigate in the deep and narrow spaces of the pelvis. Furthermore, patients experiencing a complete response after neoadjuvant treatment might even escape surgery within a close surveillance strategy. This novel "watch and wait" concept has gained interest to improve quality of life in highly selected patients. This review summarizes recent evidence and controversies and provides an overview on timely and innovative aspects in the treatment of locally advanced rectal cancer.
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Affiliation(s)
- Fabian Grass
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
| | - Kellie Mathis
- Department of Surgery, Division of Colon and Rectal Surgery, Mayo Clinic, Rochester, MN, USA
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Arsoniadis EG, Kwaan MR. ASO Author Reflections: African Americans and Rectal Cancer Surgery. Ann Surg Oncol 2018; 25:856-857. [PMID: 30426263 DOI: 10.1245/s10434-018-7054-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Indexed: 11/18/2022]
Affiliation(s)
- Elliot G Arsoniadis
- Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, FL, USA. .,Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA.
| | - Mary R Kwaan
- Section of Colorectal Surgery, Division of General Surgery, University of California, Los Angeles, CA, USA
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Wang X, Gao Y, Li J, Wu J, Wang B, Ma X, Tian J, Shen M, Wang J. Diagnostic accuracy of endoscopic ultrasound, computed tomography, magnetic resonance imaging, and endorectal ultrasonography for detecting lymph node involvement in patients with rectal cancer: A protocol for an overview of systematic reviews. Medicine (Baltimore) 2018; 97:e12899. [PMID: 30412090 PMCID: PMC6221605 DOI: 10.1097/md.0000000000012899] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 09/27/2018] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Rectal cancer is one of the most common tumors and is the leading cause of cancer-related deaths in developed countries. Lymph node involvement remains the strongest prognostic factor associated with a worse prognosis in patients with rectal cancer. Several systematic reviews have investigated the accuracy of endoscopic ultrasound, computed tomography, magnetic resonance imaging, and endorectal ultrasonography for lymph node involvement of rectal cancer and compared the diagnostic accuracy of different imaging techniques, but there are considerable differences in conclusions. This study aims to assess the methodological quality and reporting quality of systematic reviews and to determine which diagnostic imaging techniques is the optimal modality for the diagnosis of lymph node involvement in patients with rectal cancer. METHODS We will search PubMed, EMBASE, Cochrane Library, and Chinese Biomedicine Literature to identify relevant studies from inception to June 2018. We will include systematic reviews that evaluated the accuracy of diagnostic imaging techniques for lymph node involvement. The methodological quality will be assessed using AMASAR checklist, and the reporting quality will be assessed using PRISMA-DTA checklist. The pairwise meta-analysis and indirect comparisons will be performed using STATA V.12.0. RESULTS The results of this overview will be submitted to a peer-reviewed journal for publication. CONCLUSION This overview will provide comprehensive evidence of different diagnostic imaging techniques for detecting lymph node involvement in patients with rectal cancer. ETHICS AND DISSEMINATION Ethics approval and patient consent are not required as this study is an overview based on published systematic reviews. PROSPERO REGISTRATION NUMBER CRD42018104906.
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Affiliation(s)
- Xin Wang
- Department of Ultrasound Medicine, Second Hospital of Lanzhou University
| | - Ya Gao
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | - Jipin Li
- The Second Clinical Medical College of Lanzhou University, Lanzhou
| | - Jiarui Wu
- Department of Clinical Pharmacology of Traditional Chinese Medicine, School of Chinese Materia Medica, Beijing University of Chinese Medicine, Beijing
| | - Bo Wang
- Department of Nursing, Rehabilitation Center Hospital of Gansu Province
| | - Xueni Ma
- The Second Clinical Medical College of Lanzhou University, Lanzhou
| | - Jinhui Tian
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University
| | - Minghui Shen
- Department of Clinical Laboratory, Second Hospital of Lanzhou University
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Canbey Göret C, Göret NE. Histopathological Analysis of 173 Consecutive Patients with Colorectal Carcinoma: A Pathologist's View. Med Sci Monit 2018; 24:6809-6815. [PMID: 30255856 PMCID: PMC6178881 DOI: 10.12659/msm.911012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Worldwide, colorectal carcinomas are the third most common carcinomas in men and the second most common carcinomas in women. Pathological examination of rectum specimens requires special attention for correctly evaluating many prognostically important factors. In this study, we present pathological results of 173 lower anterior resection (LAR) and abdominoperineal resection (APR) specimens retrospectively evaluated. Material/Methods We included 173 LAR and APR specimens in this study. Patients were evaluated in the Istanbul Ekin Private Pathology Laboratory and underwent surgery at Çanakkale State Hospital, General Surgery Clinic. Results Of the 173 specimens, 15 (8.7%) were APR and 158 (91.3%) were LAR specimens. Ninety-four patients (54.3%) were males and 79 patients (45.7%) were females. The mean age of the patients was 63.5 years (range 26–90 years). In the histopathological examination, malignant neoplasm was detected in 172 of the cases (99.4%) and benign endometriosis was detected in 1 of the cases (0.6%). There were 151 (87.2%), 8 (4.6%), 5 (2.9%), 1 (0.6%), 1 (0.6%), 1 (0.6%), 1 (0.6%), 1 (0.6%), and 4 (2.3%) patients with adenocarcinoma, mucinous adenocarcinoma, intramucosal adenocarcinoma in the setting of a high-grade tubulovillous adenoma, synchronous colon/prostate adenocarcinoma, malignant melanoma, signet ring cell carcinoma, gastrointestinal stromal tumor, endometriosis, and adenocarcinoma diagnosed by the examination of colonoscopic biopsy specimens that showed complete regression with neoadjuvant therapy, respectively. Conclusions When evaluating specimens from patients with colorectal carcinoma, pathological evaluation, which is one of the most fundamental pillars in managing patients with cancer, must be performed carefully and meticulously. Each pathological parameter should be evaluated carefully and clinicians and pathologists should evaluate these cases together.
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Affiliation(s)
- Ceren Canbey Göret
- Department of Surgical Pathology, Health Sciences University, Sancaktepe Research and Education Hospital, Istanbul, Turkey
| | - Nuri Emrah Göret
- Department of General Surgery, Health Sciences University, Kartal Research and Education Hospital, Istanbul, Turkey
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Gollub MJ, Hotker AM, Woo KM, Mazaheri Y, Gonen M. Quantitating whole lesion tumor biology in rectal cancer MRI: taking a lesson from FDG-PET tumor metrics. Abdom Radiol (NY) 2018; 43:1575-1582. [PMID: 29159523 PMCID: PMC5960599 DOI: 10.1007/s00261-017-1389-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To determine the value of novel whole tumor metrics in DWI-MRI and DCE-MRI of rectal cancer treatment assessment. MATERIALS AND METHODS This retrospective study included 24 uniformly treated patients with rectal adenocarcinoma who underwent MRI including diffusion-weighted (DW) and dynamic contrast-enhanced (DCE) sequences, before and after chemoradiotherapy. Two experienced readers independently measured tumor volume and apparent diffusion coefficient (ADC) on DWI-MRI and tumor volume and transfer constant K trans on DCE-MRI. In addition, we explored and defined Total Lesion Diffusion (TLD) as Total DWI tumor volume multiplied by mean volumetric ADC and Total Lesion Perfusion (TLP) as the total DCE tumor volume multiplied by the mean volumetric K trans. These metrics were correlated with histopathologic percent tumor regression in the resected specimen (%TR). Inter-reader agreement was assessed using the concordance correlation coefficient (CCC). RESULTS For both readers, post-treatment TLP revealed comparable correlations with %TR compared with K trans (reader 1; Spearman's rho = - 0.36 vs. - 0.32, reader 2; Spearman's rho = - 0.32 vs. - 0.28). In addition, TLP afforded the highest inter-reader agreement at post-treatment among TLP, DCE vol, and K trans (CCC: 0.64 vs. 0.36 vs. 0.35). Post-treatment TLD showed similar correlation with %TR as DWI volume in reader 1 and superior correlation with %TR for reader 2 (reader 1; Spearman's rho - 0.56 vs. - 0.57, reader 2; Spearman's rho - 0.59 vs. - 0.45). CONCLUSION The novel tumor metrics TLD and TLP revealed similar results to established metrics for correlation with tumor response with equivalent or superior inter-reader agreements and we recommend that these be studied in larger trials.
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Affiliation(s)
- Marc J Gollub
- Department of Radiology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
| | - Andreas M Hotker
- Department of Diagnostic and Interventional Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
- Department of Radiology, Universitätsmedizin Mainz, Langenbeckstr. 1, 55131, Mainz, Germany
| | - Kaitlin M Woo
- Department of Biostatistics and Medical Informatics, University of Wisconsin, K6/446 Clinical Sciences Center 600 Highland Avenue, Madison, WI, 53792-4675, USA
| | - Yousef Mazaheri
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
| | - Mithat Gonen
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA
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Sun S, Yang C, Huang Z, Jiang W, Liu Y, Wu H, Zhao J. Diagnostic value of magnetic resonance versus computed tomography colonography for colorectal cancer: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2018; 97:e10883. [PMID: 29851808 PMCID: PMC6393025 DOI: 10.1097/md.0000000000010883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Advanced colorectal cancers were associated with poor prognosis, and early diagnosis was important for high-risk patients. Colonography is commonly used for diagnosing colorectal cancer. However, a few studies reported the diagnostic value of magnetic resonance colonography (MRC) versus computed tomography colonography (CTC). This study aimed to compare the diagnostic value of MRC versus CTC for colorectal cancer. METHODS Twenty-three studies on the diagnosis of colorectal cancer using MRC or CTC were obtained from PubMed, Embase, and the Cochrane Library databases until July 2017. The ratios of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), and receiver operating characteristic (ROC) curve were calculated to compare the diagnostic value of MRC versus CTC. RESULTS The summary sensitivity, specificity, PLR, NLR, and area under the ROC for MRC were 0.97 (0.81-1.00), 0.92 (0.80-0.97), 11.71 (4.46-30.73), 0.03 (0.00-0.24), and 0.98 (0.97-0.99), respectively, for diagnosing colorectal cancer. The pooled estimates for CTC in diagnosing colorectal cancer were as follows: sensitivity, 0.96 (0.90-0.98); specificity, 1.00 (0.99-1.00); PLR, 197.32 (73.21-531.85); NLR, 0.04 (0.02-0.11); and area under the ROC, 1.00 (0.99-1.00). No significant differences were found between MRC and CTC for sensitivity, specificity, and NLR. MRC was associated with lower PLR and area under the ROC for diagnosing colorectal cancer compared with CTC. CONCLUSION This study demonstrated MRC and CTC as potential diagnostic approaches for colorectal cancer. CTC had a higher diagnostic value of PLR and area under the ROC for colorectal cancer.
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Affiliation(s)
| | | | | | | | - Yan Liu
- Medical Oncology Translational Research Lab
| | - Hongfen Wu
- Department of Radiation Oncology, Jilin Cancer Hospital, Changchun, Jilin, China
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Poulsen LØ, Yilmaz MK, Oddershede L, Bøgsted M, Holt G, Eld M, Ljungmann K, Falkmer UG. Is the accuracy of preoperative MRI stage in rectal adenocarcinoma influenced by tumour height? Acta Oncol 2018; 57:728-734. [PMID: 29383974 DOI: 10.1080/0284186x.2018.1433319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM To our knowledge, no prior studies have addressed the possible effects of tumour height on the accuracy of preoperative magnetic resonance imaging (MRI)-based staging relative to postoperative histopathological assessments in patients with adenocarcinoma of the rectum (RC). This study aimed to investigate whether the accuracy of preoperative MRI stage in RC is influenced by tumour height. METHODS A total of 489 consecutive RC patients scheduled for curative treatment between 2009 and 2013 were included. Of the 489 patients, 133 patients had preoperative chemoradiotherapy (CRT), and 356 patients underwent primary surgery. Low, mid and high RC were defined as a tumour <5 cm, 5-10 cm and >10 cm from the anal verge, respectively. Diagnostic MRI and, for patients with CRT, re-staging MRI features including tumour T-stage (mrT), distance between the tumour border and the distance to the mesorectal fascia (mrMRF), extramural tumour depth (mrEMD), extramural vascular invasion (mrEMVI) and nodal involvement (mrN) were correlated with the corresponding postoperative histopathological findings. RESULTS There were 115, 186 and 188 patients with low RC, mid RC and high RC, respectively. For all patients, the correlations between mrT and pT and between mrMRF and pCRM were not influenced by tumour height. None of the correlations between mrEMD, mrEMVI and mrN and the corresponding postoperative histopathological findings significantly differed for tumours of different heights. For patients with CRT, a remarkable proportion with low RC were overstaged as ymrT3 compared to ypT0-2. CONCLUSIONS The ability to preoperatively use MRI to accurately stage is not influenced by tumour height. For patients with preoperative CRT, low RC may be MRI overstaged due to post-radiation fibrosis. We found that mrEMD predicts pEMD reliably and should therefore be considered in treatment decisions. Although new MRI techniques are emerging, preoperative RC staging remains incompletely definitive in daily clinical practice.
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Affiliation(s)
| | | | | | - Martin Bøgsted
- Department of Clinical Science, Aalborg University, Aalborg, Denmark
| | - Gitte Holt
- Department of Radiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mikkel Eld
- Department of Pathology, Aalborg University Hospital, Aalborg, Denmark
| | - Ken Ljungmann
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
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Becerra AZ, Wexner SD, Dietz DW, Xu Z, Aquina CT, Justiniano CF, Swanger AA, Temple LK, Noyes K, Monson JR, Fleming FJ. Nationwide Heterogeneity in Hospital-Specific Probabilities of Rectal Cancer Understaging and Its Effects on Outcomes. Ann Surg Oncol 2018; 25:2332-2339. [DOI: 10.1245/s10434-018-6530-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Indexed: 01/09/2023]
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Cho MS, Park YY, Yoon J, Yang SY, Baik SH, Lee KY, Kim IY, Kim NK. MRI-based EMVI positivity predicts systemic recurrence in rectal cancer patients with a good tumor response to chemoradiotherapy followed by surgery. J Surg Oncol 2018; 117:1823-1832. [PMID: 29790177 DOI: 10.1002/jso.25064] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 03/04/2018] [Indexed: 01/13/2023]
Abstract
BACKGROUND This study aimed to determine the prognostic value of baseline magnetic resonance imaging-based extramural vascular invasion status (EMVI) among rectal cancer patients with a good tumor response to standard chemoradiotherapy followed by surgery. METHODS A total of 359 patients with ypT0-2/N0 disease from The Yonsei Multicenter Colorectal Cancer Electronic Database were retrospectively included between January 2000 and December 2014. Magnetic resonance images and medical records were reviewed to investigate risk factors for tumor recurrence. RESULTS When we compared patients without and with EMVI, significant differences were observed in the 5-year disease-free survival rate (DFS) (80.8% vs 57.8%, P = 0.005) and in the 5-year systemic recurrence-free survival rate (SRFS) (86.9% vs 64.3%, P = 0.007). In the multivariate analysis, both mrEMVI and APR independently predicted overall DFS (APR; HR 2.088, 95% CI: 1.082-4.031, P = 0.028, mrEMVI; HR: 2.729, 95% CI: 1.230-6.058, P = 0.014). mrEMVI was only independent prognostic factor for systemic recurrence with statistical significance (HR: 3.321, 95% CI: 1.185-9.309, P = 0.022). CONCLUSION Even in rectal cancer patients with a good response to chemoradiotherapy followed by curative surgery, extramural vascular invasion and APR may predict poor disease-free survival outcomes. Intensified treatment strategy should be considered.
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Affiliation(s)
- Min Soo Cho
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Youn Young Park
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Jiho Yoon
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Yoon Yang
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyuk Baik
- The Division of Colon and Rectal Surgery, Department of Surgery, Gangnam Severance Hospital, Seoul, Korea
| | - Kang Young Lee
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Ik Yong Kim
- The Division of Gastrointestinal Surgery, Department of Surgery of Surgery, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Nam Kyu Kim
- The Division of Colon and Rectal Surgery, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Clinical Feasibility Assessment of T3 Sub-Stage in Rectal Cancer Using MRI. IRANIAN JOURNAL OF RADIOLOGY 2018. [DOI: 10.5812/iranjradiol.16801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Babaei M, Jansen L, Balavarca Y, Sjövall A, Bos A, van de Velde T, Moreau M, Liberale G, Gonçalves AF, Bento MJ, Ulrich CM, Schrotz-King P, Lemmens V, Glimelius B, Brenner H. Neoadjuvant Therapy in Rectal Cancer Patients With Clinical Stage II to III Across European Countries: Variations and Outcomes. Clin Colorectal Cancer 2018; 17:e129-e142. [PMID: 29074354 PMCID: PMC6002839 DOI: 10.1016/j.clcc.2017.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 09/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers. MATERIALS AND METHODS Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders. RESULTS A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53-0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69-0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50-0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80-1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers. CONCLUSIONS Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.
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Affiliation(s)
- Masoud Babaei
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Yesilda Balavarca
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Annika Sjövall
- Center for Digestive Diseases, Karolinska Institutet, Sweden
| | - Amanda Bos
- Comprehensive Cancer Organization The Netherlands, Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Tony van de Velde
- Biometrics Department, the Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Michel Moreau
- Datacenter, Institute Jules Bordet, Bruxelles, Belgium
| | | | | | | | - Cornelia M Ulrich
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany
| | - Petra Schrotz-King
- Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany
| | - Valery Lemmens
- Comprehensive Cancer Organization The Netherlands, Utrecht, The Netherlands; Department of Public Health, Erasmus MC University Medical Centre, Rotterdam, The Netherlands
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Section of Experimental and Clinical Oncology, Uppsala University, Uppsala, Sweden
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany; Division of Preventive Oncology, German Cancer Research Center and National Center for Tumor Diseases, Heidelberg, Germany; German Cancer Consortium, German Cancer Research Center, Heidelberg, Germany.
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Lopez-Lopez V, Robles R, Brusadin R, López Conesa A, Torres J, Perez Flores D, Navarro JL, Gil PJ, Parrilla P. Role of 18F-FDG PET/CT vs CT-scan in patients with pulmonary metastases previously operated on for colorectal liver metastases. Br J Radiol 2018; 91:20170216. [PMID: 29034693 PMCID: PMC5966201 DOI: 10.1259/bjr.20170216] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 08/31/2017] [Accepted: 10/05/2017] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE There is currently no conclusive scientific evidence available regarding the role of the 18F-FDG PET/CT for detecting pulmonary metastases from colorectal cancer (PMCRC) in patients operated on for colorectal liver metastases (CRLM). In the follow up of patients who underwent surgery for CRLM, we compare CT-scan and 18F-FDG PET/CT in patients with PMCRC. METHODS We designed the study prospectively performing an 18F-FDG PET/CT on all patients operated on for CRLM where the CT-scan detected PMCRC during the follow up. We included patients who were operated on for PMCRC because the histological findings were taken as a control rather than biopsies. RESULTS Of the 101 pulmonary nodules removed from 57 patients, the CT-scan identified a greater number (89 nodules) than the 18F-FDG PET/CT (75 nodules) (p < 0.001). Sensitivity was greater with the CT-scan (90 vs 76%, respectively) with a lower specificity (50 vs 75%, respectively) than with the 18F-FDG PET/CT. There were no differences between positive-predictive value and negative-predictive value. The 18F-FDG PET/CT detected more pulmonary nodules in four patients (one PMCRC in each of these patients) and more extrapulmonary disease in six patients (four mediastinal lymph nodes, one retroperitoneal lymph node and one liver metastases) that the CT-scan had not detected. CONCLUSION Although CT-scans have a greater capacity to detect PMCRC, the 18F-FDG PET/CT could be useful in the detection of more pulmonary and extrapulmonary disease not identified by the CT-scan. Advances in knowledge: We tried to clarify the utility of 18F-FDG PET/CT in the management of this subpopulation of patients.
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Affiliation(s)
- Victor Lopez-Lopez
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Ricardo Robles
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Roberto Brusadin
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Asuncion López Conesa
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Juan Torres
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Domingo Perez Flores
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Jose Luis Navarro
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Pedro Jose Gil
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
| | - Pascual Parrilla
- Virgen de la arrixaca clinic and university hospital, University of Murcia, IMIB, Murcia, Spain
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Arsoniadis EG, Fan Y, Jarosek S, Gaertner WB, Melton GB, Madoff RD, Kwaan MR. Decreased Use of Sphincter-Preserving Procedures Among African Americans with Rectal Cancer. Ann Surg Oncol 2017; 25:720-728. [PMID: 29282601 DOI: 10.1245/s10434-017-6306-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Improved multimodality rectal cancer treatment has increased the use of sphincter-preserving surgery. This study sought to determine whether African American (AA) patients with rectal cancer receive sphincter-preserving surgery at the same rate as non-AA patients. METHODS The study used the Nationwide Inpatient Sample for years 1998-2012 to compare AA and non-AA patients with rectal cancer undergoing low anterior resection or abdominoperineal resection. The logistic regression model was used to adjust for age, gender, admission type, Elixhauser comorbidity index, and hospital factors such as size, location (urban vs.rural), teaching status, and procedure volume. RESULTS The search identified 22,697 patients, 1600 of whom were identified as AA. After adjustment for age and gender, the analysis showed that AA patients were less likely to undergo sphincter-preserving surgery than non-AA patients [odds ratio (OR) 0.70; 95% confidence interval (CI) 0.63-0.78; p < 0.0001). After further adjustment for the Elixhauser comorbidity index, admission type, hospital-specific factors, and insurance status, the analysis showed that AA patients still were less likely to undergo sphincter-preserving surgery (OR 0.78; 95% CI 0.70-0.87; p < 0.0001). Although the proportion of non-AA patients undergoing sphincter-preserving surgery increased during the study period (p = 0.0003), this trend was not significant for the AA patients (p = 0.13). CONCLUSION In this data analysis, the AA patients with rectal cancer had lower rates of sphincter-preserving surgery than the non-AA patients, even after adjustment for patient- and hospital-specific factors. Further work is required to elucidate why. Eliminating racial disparities in rectal cancer treatment should continue to be a priority for the surgical community.
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Affiliation(s)
- Elliot G Arsoniadis
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA. .,Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA.
| | - Yunhua Fan
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Stephanie Jarosek
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Wolfgang B Gaertner
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Genevieve B Melton
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA.,Institute for Health Informatics, University of Minnesota, Minneapolis, MN, USA
| | - Robert D Madoff
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Mary R Kwaan
- Division of Colon and Rectal Surgery, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Integrated care pathway for rectal cancer treatment: health care resource utilization, costs, and outcomes. INT J EVID-BASED HEA 2017; 15:53-62. [PMID: 28157723 DOI: 10.1097/xeb.0000000000000099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIM Managed Flow C20 (MFC20) is an integrated care pathway (ICP) for rectal cancer implemented at a public teaching hospital. This study aims to quantify resource utilization and estimate direct costs and outcomes associated with the use of this ICP. METHODS We evaluated consecutive rectal cancer patients treated with neoadjuvant chemoradiotherapy (nCRT) followed by surgery, comparing the period before the ICP implementation (Pre-MFC20 group) and after (MFC20 group). We assessed times between treatment steps and quantified the resources utilized, as well as their costs. RESULTS There were 112 patients in the Pre-MFC20 group and 218 in the MFC20 group. The mean treatment intervals were significantly shorter in the MFC20 group - from the first medical consultation to nCRT (48.3 vs. 87.5 days; P < 0.001); and from nCRT to surgery (14.8 vs. 23.0 weeks; P < 0.001) - as was the mean total treatment time (192.0 vs. 290.2 days; P < 0.001). Oncology consultations, computed tomography, MRI, and radiotherapy sessions were utilized more frequently in the Pre-MFC20 group (P < 0.001). The median per-patient cost was US$11 180.92 in the Pre-MFC20 group, compared with US$10 412.88 in the MFC20 group (P = 0.125). Daily hospital charges and consultations were the major determinants of the total cost of the treatment. There was no statistical difference in overall survival in the time periods examined. CONCLUSION: Implementation of a rectal cancer ICP reduced all treatment intervals and promoted rational utilization of oncology consultations and imaging, without increment in per-patient costs or detrimental effects in overall survival.
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Gómez Ruiz M, Cagigas Fernández C, Alonso Martín J, Cristobal Poch L, Manuel Palazuelos C, Barredo Cañibano FJ, Gómez Fleitas M, Castillo Diego J. Robotic Assisted Transanal Polypectomies: Is There Any Indication? Cir Esp 2017; 95:601-609. [PMID: 29146073 DOI: 10.1016/j.ciresp.2017.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 09/04/2017] [Accepted: 09/11/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Robotic assisted transanal polipectomy may have advantages compared with the conventional transanal minimally invasive surgery technique. We evaluate the safety, feasibility and advantages of this technique. METHODS Between February 2014 and October 2015, 9patients underwent robotic transanal polypectomy. We performed a retrospective study in which we analyse prospectively collected data regarding patient and tumor characteristics, perioperative outcomes, pathological report, morbidity and mortality. RESULTS A total of 5 male and 4 female patients underwent robotic TAMIS. Lesions were 6,22cm from the anal verge. Mean size was 15,8cm2. All procedures were performed in the lithotomy position. Closure of the defect was performed in all cases. Mean blood loss was 39,8ml. Mean operative time was 71,9min. No severe postoperative complications or readmissions occured. Median hospital stay was 2,5 days. CONCLUSIONS Robotic TAMIS is useful to treat complex rectal lesions. Our transanal platform allowed a wider range of movements of the robotic arms and to perform all procedures in the lithotomy position.
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Affiliation(s)
- Marcos Gómez Ruiz
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España.
| | - Carmen Cagigas Fernández
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Joaquín Alonso Martín
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Lidia Cristobal Poch
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Carlos Manuel Palazuelos
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Francisco Javier Barredo Cañibano
- Anestesiología en Cirugía General, Servicio de Anestesiología, Reanimación y Unidad del Dolor, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Manuel Gómez Fleitas
- Departamento de Innovación y Cirugía Robótica, Hospital Universitario Marqués de Valdecilla, Santander, España
| | - Julio Castillo Diego
- Cirugía Colorrectal, Servicio de Cirugía General y Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, España
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Joshi HM, Keller DS, Chand M. Utilization of Indocyanine green to demonstrate lymphatic mapping in colon cancer. J Surg Oncol 2017; 116:1005-1007. [PMID: 29082528 DOI: 10.1002/jso.24795] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/13/2017] [Indexed: 01/06/2023]
Affiliation(s)
- Heman M Joshi
- Department of Surgery, University College London Hospital, London, United Kingdom
| | - Deborah S Keller
- Department of Surgery, University College London Hospital, London, United Kingdom.,Division of Colorectal Surgery, Department of Surgery, Baylor University Medical Center, Dallas, Texas
| | - Manish Chand
- Department of Surgery, University College London Hospital, London, United Kingdom
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Jacobs L, Meek DB, van Heukelom J, Bollen TL, Siersema PD, Smits AB, Tromp E, Los M, Weusten BL, van Lelyveld N. Comparison of MRI and colonoscopy in determining tumor height in rectal cancer. United European Gastroenterol J 2017; 6:131-137. [PMID: 29435323 PMCID: PMC5802669 DOI: 10.1177/2050640617707090] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 03/29/2017] [Indexed: 01/11/2023] Open
Abstract
Background and aim Endoscopy and magnetic resonance imaging (MRI) are used routinely in the diagnostic and preoperative work-up of rectal cancer. We aimed to compare colonoscopy and MRI in determining rectal tumor height. Methods Between 2002 and 2012, all patients with rectal cancer with available MRIs and endoscopy reports were included. All MRIs were reassessed for tumor height by two abdominal radiologists. To obtain insight in techniques used for endoscopic determination of tumor height, a survey among regional endoscopists was conducted. Results A total of 211 patients with rectal cancer were included. Tumor height was significantly lower when assessed by MRI than by endoscopy with a mean difference of 2.5 cm (95% CI: 2.1-2.8). Although the agreement between tumor height as measured by MRI and endoscopy was good (intraclass correlation coefficient (ICC) 0.7 (95% CI: 0.7-0.8)), the 95% limits of agreement varied from -3.0 cm to 8.0 cm. In 45 patients (21.3%), tumors were regarded as low by MRI and middle-high by endoscopy. MRI inter- and intraobserver agreements were excellent with an ICC of 0.8 (95% CI: 0.7-0.9) and 0.9 (95% CI: 0.9-1.0), respectively. The survey showed no consensus among endoscopists as to how to technically measure tumor height. Conclusion This study showed large variability in rectal tumor height as measured by colonoscopy and MRI. Since MRI measurements showed excellent inter- and intraobserver agreement, we suggest using tumor height measurement by MRI for diagnostic purposes and treatment allocation.
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Affiliation(s)
- Lotte Jacobs
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
| | - David B Meek
- Department of Radiology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Joost van Heukelom
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Peter D Siersema
- Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands.,Department of Gastroenterology and Hepatology, Radboud University Medical Center Nijmegen, The Netherlands
| | - Anke B Smits
- Department of Surgery, St Antonius Hospital Nieuwegein, The Netherlands
| | - Ellen Tromp
- Department of Epidemiology and Statistics, St Antonius Hospital Nieuwegein, The Netherlands
| | - Maartje Los
- Department of Internal Medicine/Oncology, St Antonius Hospital Nieuwegein, The Netherlands
| | - Bas Lam Weusten
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands.,Department of Gastroenterology and Hepatology, University Medical Center Utrecht, The Netherlands
| | - Niels van Lelyveld
- Department of Gastroenterology and Hepatology, St Antonius Hospital Nieuwegein, The Netherlands
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