Safety and feasibility of sphincter preservation surgery in low lying rectal cancers

2021 ◽  
Author(s):  
Swapnil Patel ◽  
Vivek Sukumar ◽  
Mufaddal Kazi ◽  
Avanish Saklani
Keyword(s):  
Sphincter Preservation ◽  
Rectal Cancers

scholarly journals Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

2020 ◽  
Vol 24 (10) ◽  
pp. 1025-1034 ◽  
Author(s):  
G. Sun ◽  
Z. Lou ◽  
H. Zhang ◽  
G. Y. Yu ◽  
K. Zheng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Rectal Wall ◽  
Anal Verge ◽  
Disease Free Survival ◽  
Sphincter Preservation ◽  
Low Rectal Cancer ◽  
Anal Function ◽  
Oncological Outcomes ◽  
Rectal Cancers ◽  
Very Low Rectal Cancer

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

Preoperative Radiotherapy With or Without Concurrent Fluorouracil and Leucovorin in T3-4 Rectal Cancers: Results of FFCD 9203

2006 ◽  
Vol 24 (28) ◽  
pp. 4620-4625 ◽  
Author(s):  
Jean-Pierre Gérard ◽  
Thierry Conroy ◽  
Franck Bonnetain ◽  
Olivier Bouché ◽  
Olivier Chapet ◽  
...  
Keyword(s):  
Overall Survival ◽  
Acute Toxicity ◽  
Preoperative Radiotherapy ◽  
Rectal Adenocarcinoma ◽  
Digital Rectal Examination ◽  
Concurrent Chemotherapy ◽  
Sphincter Preservation ◽  
Moderate Increase ◽  
Operative Specimen ◽  
Rectal Cancers

Purpose In 1992, preoperative radiotherapy was considered in France as the standard treatment for T3-4 rectal cancers. The present randomized trial compares preoperative radiotherapy with chemoradiotherapy. Patients and Methods Patients were eligible if they presented a resectable T3-4, Nx, M0 rectal adenocarcinoma accessible to digital rectal examination. Preoperative radiotherapy with 45 Gy in 25 fractions during 5 weeks was delivered. Concurrent chemotherapy with fluorouracil 350 mg/m2/d during 5 days, together with leucovorin, was administered during the first and fifth week in the experimental arm. Surgery was planned 3 to 10 weeks after the end of radiotherapy. All patients should receive adjuvant chemotherapy with the same fluorouracil/leucovorin regimen. The primary end point of the trial was overall survival. Results A total of 733 patients were eligible. Grade 3 or 4 acute toxicity was more frequent with chemoradiotherapy (14.6% v 2.7%; P < .05). There was no difference in sphincter preservation. Complete sterilization of the operative specimen was more frequent with chemoradiotherapy (11.4% v 3.6%; P < .05). The 5-year incidence of local recurrence was lower with chemoradiotherapy (8.1% v 16.5%; P < .05). Overall 5-year survival in the two groups did not differ. Conclusion Preoperative chemoradiotherapy despite a moderate increase in acute toxicity and no impact on overall survival significantly improves local control and is recommended for T3-4, N0-2, M0 adenocarcinoma of the middle and distal rectum.

scholarly journals Excision of the Levator Muscles With External Sphincter Preservation in the Treatment of Selected Low T4 Rectal Cancers

2002 ◽  
Vol 45 (12) ◽  
pp. 1697-1705 ◽  
Author(s):  
Claudio Fucini ◽  
Claudio Elbetti ◽  
Alessandra Petrolo ◽  
Donato Casella
Keyword(s):  
External Sphincter ◽  
Sphincter Preservation ◽  
Rectal Cancers

Controversies in Radiation for Upper Rectal Cancers

2012 ◽  
Vol 10 (12) ◽  
pp. 1567-1572 ◽  
Author(s):  
Emily Chan ◽  
Paul E. Wise ◽  
A. Bapsi Chakravarthy
Keyword(s):  
Tumor Location ◽  
Substantial Improvement ◽  
Sphincter Preservation ◽  
Radiation Delivery ◽  
Final Treatment ◽  
Pathologic Staging ◽  
Node Positive Disease ◽  
Treatment Paradigm ◽  
Rectal Cancers ◽  
Close Cooperation

Over the past few decades substantial improvement has occurred in the diagnosis and treatment of rectal cancers. This disease requires the close cooperation of a multidisciplinary team, including radiologists, gastroenterologists, surgeons, medical oncologists, and radiation oncologists, to provide optimum treatment with minimal morbidity. The widespread use of total mesorectal excision (TME) and improvements in chemotherapy and radiation delivery have resulted in decreases in locoregional recurrence. Large randomized studies have shown a benefit with the use of preoperative chemoradiation for most patients with transmural and/or node-positive disease. Controversy remains, however, regarding whether this treatment paradigm should be applied uniformly to all patients regardless of tumor location. As the risk of local recurrence decreases with high rectal tumors and the benefit in terms of sphincter preservation is not applicable to this subgroup of patients, up-front surgery to allow for more accurate pathologic staging prior to making final treatment decisions is recommended. In patients with pathologically staged T3,N0,M0 tumors of the upper rectum who have undergone TME with 12 or more nodes removed, the addition of chemoradiation has very little benefit.

Impact of Pelvic Radiotherapy on Morbidity and Durability of Sphincter Preservation After Coloanal Anastomosis for Rectal Cancers

2008 ◽  
Vol 51 (1) ◽  
pp. 32-37 ◽  
Author(s):  
Imran Hassan ◽  
David W. Larson ◽  
Bruce G. Wolff ◽  
Robert R. Cima ◽  
Heidi K. Chua ◽  
...  
Keyword(s):  
Coloanal Anastomosis ◽  
Sphincter Preservation ◽  
Pelvic Radiotherapy ◽  
Rectal Cancers

Disparities between young and elderly patients in the first course of treatment for stage II and III rectal cancers.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e14546-e14546
Author(s):  
Yaphet Tilahun ◽  
Juan Pablo Arnoletti ◽  
Sebastian G. De La Fuente
Keyword(s):  
Rectal Cancer ◽  
Elderly Patients ◽  
Treatment Approach ◽  
Tumor Staging ◽  
Neoadjuvant Chemoradiation ◽  
Sphincter Preservation ◽  
Stage Ii ◽  
Cancer Data ◽  
Rectal Cancers ◽  
Surgery First

e14546 Background: The use of neoadjuvant chemoradiation for stage II and III rectal cancers is associated with higher rates of resectability, sphincter preservation and improved local control. In elderly patients, however, the feasibility and benefits of this approach are less understood. In this study, we determined disparities in the first course of therapy between young and elderly patients with rectal cancer using the National Cancer Data Base (NCDB). Methods: The NCDB was queried for cases of rectal cancer diagnosed from 2000-2009. Analyzed variables included tumor staging, age group and first course of treatment. For analytical purposes, study groups were divided in young (≤ 69 years of age) or elderly patients (≥ 70 years of age). Results: A total of 8,237 patients that received chemoradiation as the first treatment approach were identified from the NCDB during the study period. During the same time, 15,468 patients were treated with surgery first. Fifty-eight percent of patients in the neoadjuvant-first treatment group were equal or younger than 69 years of age. Subgroup analysis showed that elderly patients were treated with surgery first more frequently than with neoadjuvant chemoradiation therapy (surgery-first 72% vs. chemoradiation first 28%, p<0.04). In the contrary, no differences were noted in the first course of treatment received among younger patients (surgery-first 53% vs. chemoradiation first 47%, p=NS). Conclusions: This data shows that there is an age-bias after the age of 70 for surgery only as the first treatment approach for patients with stage II and III rectal cancers. This is probably confirmatory that patients are brought to surgery without neoadjuvant therapy because they are perceived as not being able to tolerate chemoradiation.

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