Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2023; 15(6): 1104-1115
Published online Jun 27, 2023. doi: 10.4240/wjgs.v15.i6.1104
Long-term outcomes and failure patterns after laparoscopic intersphincteric resection in ultralow rectal cancers
Wen-Long Qiu, Xiao-Lin Wang, Jun-Guang Liu, Gang Hu, Shi-Wen Mei, Jian-Qiang Tang
Wen-Long Qiu, Gang Hu, Shi-Wen Mei, Jian-Qiang Tang, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
Xiao-Lin Wang, Department of General Surgery, The Second Hospital of Yulin, Yulin 100021, Shaanxi Province, China
Jun-Guang Liu, Department of General Surgery, Peking University First Hospital, Beijing 100021, China
Author contributions: Qiu WL, Liu JG and Wang XL contributed equally to this work; Protocol/project development: Qiu WL, Tang JQ; Data collection or management: Qiu QL, Hu G, Mei SW, Liu JG, Wang XL. Data analysis: Qiu WL, Wang XL, Liu JG; Manuscript writing/editing: Qiu WL, Wang XL; All authors reviewed the manuscript.
Supported by The National Natural Science Foundation of China, No. 81272710; Beijing Nature Fund, No. 4232058; and Beijing Natural Fund Haidian Special, No. L222054
Institutional review board statement: The study was reviewed and approved by the National Cancer Center Institutional Review Board (Approval No. 17-116/1439).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Qiang Tang, MD, PhD, Chief Doctor, Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China. doc_tjq@hotmail.com
Received: September 30, 2022
Peer-review started: September 30, 2022
First decision: January 3, 2023
Revised: January 29, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: June 27, 2023
Processing time: 258 Days and 11.3 Hours
ARTICLE HIGHLIGHTS
Research background

The failure patterns and risk factors for local recurrence and distant metastasis after laparoscopic intersphincteric resection (LsISR) surgery remain controversial and require further investigation.

Research motivation

To investigate the long-term outcomes and failure patterns after LsISR.

Research objectives

Patients with ultralow rectal cancer who underwent LsISR from multicenter between January 2012 and October 2022. We included patients who underwent LsISR surgery.

Research methods

The Chi-square, Fisher's exact test, or Pearson's correlation test was used to analyze differences between the primary and validation cohorts. Variables with a P-value < 0.100 in the univariate analyses were included in the multivariate analyses. Hazard ratios and 95% confidence intervals of the risk factors were analyzed using multivariate logistic regression.

Research results

Local recurrence and distant metastasis occurred in 3.5% and 11.4% of patients, respectively. The overall survival/local recurrence-free survival/distance metastasis-free survival rates at 1, 3, and 5 years were 96.5%/91.3%/87.0%, 98.4%/97.1%/95.4%, and 96.1%/90.1%/82.6%, respectively. LRFS was associated with (y)N + and poor differentiation, whereas the independent prognostic factors for DMFS were lymph node metastasis and (y)pT3 stage.

Research conclusions

We confirmed that poor differentiation, (y)pT3 stage, and (y)Pn + were independent risk factors for treatment failure, and thus patients with these factors should be carefully managed with optimal neoadjuvant therapy and surgical strategies.

Research perspectives

This research will help clarify the high recurrence risk patients and take up most appropriate perioperative treatment strategies.