Prognosis Comparisons of Laparoscopy versus Open Surgery for Rectal Cancer Patients after Preoperative Chemoradiotherapy: A Meta-Analysis

2021 ◽  
Vol 44 (5) ◽  
pp. 261-268
Author(s):  
Jin-Wei Niu ◽  
Wu Ning ◽  
Zhi-Ze Liu ◽  
Dong-Po Pei ◽  
Fan-Qiang Meng ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Open Surgery ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Current Evidence ◽  
Open Thoracotomy ◽  
Oncological Outcomes ◽  
Duration Of Surgery

<b><i>Aim:</i></b> We aimed to compare the oncological outcomes of laparoscopy and open resection for patients with rectal cancer following neoadjuvant chemoradiotherapy (NCRT). <b><i>Methods:</i></b> We searched the publications that compared the efficacy of laparoscopic surgery and open thoracotomy in treatment outcomes of rectal cancer after NCRT. All trials analyzed the summary hazard ratios of the endpoints of interest, including survival and individual postoperative complications. <b><i>Results:</i></b> Totally, 10 trials met our inclusion criteria. The pooled analysis of 3-year disease-free survival (OR 1.39, 95% CI 0.93–2.06; <i>p</i> = 0.11) and 3-year overall survival (OR 1.01, 95% CI 0.70–1.45; <i>p</i> = 0.97) showed that laparoscopic surgery did not achieve beneficial effects compared with open thoracotomy. The pooled result of duration of surgery indicated that laparoscopic surgery was associated with a trend for longer surgery time (SMD 27.53, 95% CI 1.34–53.72; <i>p</i> = 0.04), shorter hospital stay (SMD –1.64, 95% CI –2.70 to –0.58; <i>p</i> = 0.002), more postoperative complications (OR 0.77, 95% CI 0.60–0.99; <i>p</i> = 0.04), and decreased blood loss (SMD –49.87, 95% CI –80.61 to –19.14; <i>p</i> = 0.001). However, the number of removed lymph nodes, positive circumferential resection margin, as well as complications after surgery showed significant differences between the 2 groups. <b><i>Conclusions:</i></b> We focused on current evidence and reviewed the studies indicating that similar oncological outcomes were associated with laparoscopic surgery following NCRT for patients with locally advanced lower rectal cancer in comparison with open surgery.

The Effectiveness and Safety of Open Versus laparoscopic Surgery for Rectal Cancer after Preoperative Chemo-radiotherapy: A Meta-Analysis

2019 ◽  
Vol 22 (3) ◽  
pp. 153-159
Author(s):  
Jun-Jie Zhang ◽  
Bao-Ling Guo ◽  
Qiu-Xiang Zheng ◽  
Zhi-Yong Chen
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Meta Analysis ◽  
Locally Advanced ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Open Thoracotomy ◽  
Free Survival

Background: Only a limited number of studies considered the combined chemo-radiation therapy after surgery for treating locally advanced rectal cancer. Comparative studies on laparoscopic and open procedures indicated that laparoscopy surgery may be associated with fewer postoperative complications. Despite encouraging results from rectal cancer patients who received neoadjuvant chemo-radiotherapy prior to laparoscopic surgery, the acceptance of this procedure remains controversial, and conflicting evidence exists only in the form of retrospective trials. Objectives: Since laparoscopic surgery was introduced into clinical practice to treat rectal cancer after neoadjuvant chemo-radiotherapy, it has been discussed controversially whether laparoscopic surgery can be performed as effectively as an open procedure. To overcome the biases inherent in any nonrandomized comparison, we analyzed the propensity-matched analysis and randomized clinical trial. In this study, we set out to determine whether laparoscopic resection was non-inferior to open resection in treatment outcomes of rectal cancer after neoadjuvant chemo-radiotherapy. Method: Publications on laparoscopic surgery in comparison with open thoracotomy in treatment outcomes of rectal cancer after neo-adjuvant chemo-radiotherapy to November 2017 were collected. Summary hazard ratios (HRs) of endpoints of interest such as 3-OS (overall survival), 3-DFS (disease-free survival), and individual postoperative complications were analyzed in all trials. By using fixed- or random-effects models according to the heterogeneity, meta-analysis Revman 5.3 software was applied to analyze combined pooled HRs. Results: A total of 6 trials met our inclusion criteria. The pooled analysis of 3-DFS showed that laparoscopic surgery did not improve disease -free survival, compared with open thoracotomy (OR =1.48, 95% CI 0.95 – 2.29; P = 0.08), as well with the 3-OS (OR=0.96, 95%CI=0.66-1.41, P=0.084). The pooled result of duration of surgery indicated that laparoscopic surgery had a tendency towards a longer surgery time (SMD= 43.96, 95% CI 34.04– 53.88; P 0.00001) and a shorter hospital stay (SMD= -0.97, 95% CI -1.75– -0.18; P=0.02). However, no significant differences between laparoscopic surgery and open thoracotomy were observed in terms of the meta-analysis on the number of removed lymph nodes (SMD =-0.37, 95% CI -0.1.77 – 1.03; P = 0.60), blood loss (SMD =-21.30, 95% CI -0.48.36 – 5.77; P = 0.12), positive circumferential resection margin (OR =0.73, 95% CI 0.22– 2.48; P = 0.61) or postoperative complications (OR =0.89, 95% CI 0.67 – 1.17; P = 0.40) l. Conclusions: The current data supported the concept that laparoscopic surgery had correlated with a longer operative time but a shorter hospital stay, without superior advantages in short-term survival rates or oncologic efficiency for locally treating advanced rectal cancer after neoadjuvant chemoradiotherapy. However, prospective investigation on long-term oncological results from laparoscopic surgery is required in the future to verify the benefits of laparoscopic surgery over open surgery after chemo-radiation therapy for treating locally advanced rectal cancer.

scholarly journals Lateral Pelvic Lymph Node Dissection After Neoadjuvant Chemoradiotherapy in Patients With Rectal Cancer: A Single-Center Experience and Literature Review

2021 ◽  
Vol 37 (6) ◽  
pp. 382-394
Author(s):  
Min Chul Kim ◽  
Jae Hwan Oh
Keyword(s):  
Rectal Cancer ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Locally Advanced ◽  
Neoadjuvant Chemoradiotherapy ◽  
Pelvic Lymph Node Dissection ◽  
Pelvic Lymph Node ◽  
Node Dissection ◽  
Lateral Pelvic Lymph Node ◽  
Oncological Outcomes

Purpose: We aimed to evaluate the surgicopathological outcomes of lateral pelvic lymph node dissection (LPLD) and long-term oncological outcomes of selective LPLD after neoadjuvant chemoradiotherapy (nCRT) in patients with locally advanced rectal cancer and compare them to those of total mesorectal excision (TME) alone based on pretreatment magnetic resonance imaging (MRI).Methods: We compared the TME-alone group (2001–2009, n=102) with the TME with LPLD group (2011–2016, n=69), both groups having lateral lymph nodes (LLNs) of ≥5 mm in short axis diameter. The surgicopathological outcomes were analyzed retrospectively. Oncological outcomes were analyzed using the Kaplan-Meier method.Results: The rates of overall postoperative 30-day morbidity (42.0% vs. 26.5%, P=0.095) and urinary retention (13.7% vs. 10.1%, P=0.484) were not significantly different between the LPLD and TME-alone groups, respectively. Pathologically proven LLN metastasis was identified in 24 (34.8%) LPLD cases after nCRT. The LPLD group showed a lower 5-year local recurrence (LR) rate (27.9% vs. 4.6%, P<0.001) and better recurrence-free survival (RFS) (59.6% vs. 78.2%, P=0.008) than those of the TME-alone group, while the 5-year overall survival was not significantly different between the 2 groups (76.2% vs. 86.5%, P=0.094).Conclusion: This study suggests that LPLD is a safe and feasible procedure. The oncological outcomes suggest that selective LPLD improves LR and RFS in patients with clinically suspicious LLNs on pretreatment MRI. Considering that lateral nodal disease is not common, a multicenter large-scale study is necessary.

Laparoscopic versus open surgery for locally advanced rectal cancer following neoadjuvant chemoradiotherapy with S-1: Short- and long-term outcomes of multicenter prospective phase II trials.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 793-793
Author(s):  
Takao Hara ◽  
Tomonori Akagi ◽  
Shinichiro Empuku ◽  
Kentaro Nakajima ◽  
Iwaki Kentaro ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Open Surgery ◽  
Locally Advanced ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer ◽  
Phase Ii Trials ◽  
Long Term Outcomes ◽  
Short And Long Term

793 Background: We have reported the effectiveness of neoadjuvant radiotherapy (RT) combined with S-1 in terms of compliance and pathologic response for locally advanced rectal cancer. In the present study, we aimed to evaluate the safety and efficacy of laparoscopic surgery for locally advanced rectal cancer following neoadjuvant RT combined with S-1 in comparison with open surgery. Methods: Two multicenter prospective phase II trials were conducted (UMIN003396, UMIN003398). A total of 63 patients with locally advanced rectal cancer classified as T3-4, N0-3, and M0 were enrolled, and neoadjuvant RT combined with S-1 and total mesorectal excision with D3 lymphadenectomy was performed. Of these, 57 patients were analyzed and divided into a laparoscopic group (LAP, n = 43) and open group (OP, n = 14). We evaluated the short- and long-term outcomes of laparoscopic surgery compared with open surgery by univariate and multivariate analyses. Results: In the patient background, there were no significant differences between the two groups except that cases with T3 and N0 were significantly higher in the LAP compared with the OP. In the operative findings, operation time was longer (mean 447 min vs. 352 min, p = 0.007) and blood loss was lesser (median 220 ml vs. 485 ml, p = 0.033) in the LAP than those in the OP. Although there were no significant differences observed in the incidence of perioperative and late complications between the two groups, reoperation within 30 days was significantly less in the LAP compared with the OP (1 case vs. 5 cases, p = 0.0004). In the multivariate analysis, a distance of the tumor from anal verge within 3 cm was the independent risk factor for reoperation within 30 days. Furthermore, estimated 5-year disease-free survival (LAP 72 % vs. OP 73 %, p = 0.945) and 5-year overall survival (LAP 76 % vs. 75 %, p = 0.836) didn’t significantly differ between the two groups in the Kaplan–Meier curve. Conclusions: The findings of this study demonstrated that laparoscopic surgery for locally advanced rectal cancer following neoadjuvant RT combined with S-1 could be an optional procedure in terms of short- and long-term outcomes. Clinical trial information: UMIN000003396, UMIN000003398.

scholarly journals Laparoscopic Surgery vs. Open Surgery for Older Patients with Rectal Cancer: A Comparative Study of Propensity Score

2021 ◽  
Author(s):  
Qiang Li ◽  
Hong Gao ◽  
Jin-Zhong Wang ◽  
Yu-Bing Zhu
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Postoperative Complications ◽  
Propensity Score ◽  
Blood Loss ◽  
Older Patients ◽  
Open Surgery ◽  
Postoperative Hospital Stay ◽  
Cancer Surgery ◽  
Rectal Cancer Surgery

Abstract Background The purpose of this study was to compare the efficacy of laparoscopic surgery to open rectal cancer surgery in patients aged 70 years and older. Methods Consecutive patients (≥70 years old) who underwent rectal cancer surgery were retrospectively selected. Based on the covariates (age, gender, body mass index (BMI), ASA, TNM staging), the propensity score was calculated for paired comparison. The Tumor Distance from the Anal Verge (TDAV), history of abdominal surgery, combined diseases, time of operation, amount of blood loss, anastomosis method, postoperative hospital stay, time to first exhaust, time to first oral diet, postoperative complications, postoperative 30-day mortality and postoperative pathological staging of two groups were collected. Results Shorter operating time, higher intraoperative blood loss, slower intestinal function, longer time to first exhaust, longer postoperative hospital stay, higher incidence of postoperative complications (no statistical difference), and shorter duration of analgesics were observed in the OS group (all P<0.05). The sphincter preserving rate was basically the same in the two groups. For low rectal cancer with TDAV < 5 cm, more patients tended to choose LS (P=0.051); for middle rectal cancer with TDAV of 5-10 cm, more patients tended to choose OS (P=0.032). There was no significant difference in postoperative survival rate between the two groups. Conclusions In older patients, laparoscopic rectal cancer surgery led to less trauma, and a faster recovery compared to open surgery, with significant short-term advantages and no significant long-term advantages. For low rectal cancer, the advantage of LS was more prominent.

scholarly journals Conversion-to-open of laparoscopic surgery for rectal cancer: Impact on outcomes

2014 ◽  
Vol 61 (2) ◽  
pp. 31-33
Author(s):  
Evaghelos Xynos
Keyword(s):  
Rectal Cancer ◽  
Laparoscopic Surgery ◽  
Low Anterior Resection ◽  
Survival Rates ◽  
Mortality Rates ◽  
Wound Infection Rate ◽  
Mesorectal Excision ◽  
Technical Limitation ◽  
Oncological Outcomes ◽  
Duration Of Surgery

Low anterior resection of the rectum (LARR) with total mesorectal excision (TME) for rectal cancer by laparoscopy is considered very technically demanding, particularly at the stages of dissection around the mesorectal fascia deep into the pelvis and transection of the rectum distally to the tumour. These technical difficulties translate to an increased conversion-to-open rate, higher than that seen after laparoscopic surgery for colon cancer. Conversion-to-open is considered as a technical limitation of the approach rather than a complication. There are reports claiming that converted cases are associated with higher morbidity rates than the laparoscopically completed. However, a review of the published articles indicates that conversion-to-open shows similar overall morbidity and mortality rates to those seen in the laparoscopically completed LARR-TME cases, and only duration of surgery is longer and wound infection rate is higher in the former group. Similarly, the overall oncological outcomes, namely local recurrence, distant metastasis and overall survival rates, are similar between the two groups.

scholarly journals Molecular and Dynamic Evaluation of Proteins Related to Resistance to Neoadjuvant Treatment with Chemoradiotherapy in Circulating Tumor Cells of Patients with Locally Advanced Rectal Cancer

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1539
Author(s):  
Virgílio Souza e Silva ◽  
Emne Ali Abdallah ◽  
Bianca de Cássia Troncarelli Flores ◽  
Alexcia Camila Braun ◽  
Daniela de Jesus Ferreira Costa ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Tumor Cells ◽  
Circulating Tumor Cells ◽  
Transforming Growth Factor ◽  
Locally Advanced ◽  
Neoadjuvant Treatment ◽  
Neoadjuvant Chemoradiotherapy ◽  
Disease Free Survival ◽  
Advanced Rectal Cancer ◽  
Locally Advanced Rectal Cancer

The heterogeneity of response to neoadjuvant chemoradiotherapy (NCRT) is still a challenge in locally advanced rectal cancer (LARC). The evaluation of thymidylate synthase (TYMS) and RAD23 homolog B (RAD23B) expression in circulating tumor cells (CTCs) provides complementary clinical information. CTCs were prospectively evaluated in 166 blood samples (63 patients) with LARC undergoing NCRT. The primary objective was to verify if the absence of RAD23B/TYMS in CTCs would correlate with pathological complete response (pCR). Secondary objectives were to correlate CTC kinetics before (C1)/after NCRT (C2), in addition to the expression of transforming growth factor-β receptor I (TGF-βRI) with survival rates. CTCs were isolated by ISET and evaluated by immunocytochemistry (protein expression). At C1, RAD23B was detected in 54.1% of patients with no pCR and its absence in 91.7% of patients with pCR (p = 0.014); TYMS− was observed in 90% of patients with pCR and TYMS+ in 51.7% without pCR (p = 0.057). Patients with CTC2 > CTC1 had worse disease-free survival (DFS) (p = 0.00025) and overall survival (OS) (p = 0.0036) compared with those with CTC2 ≤ CTC1. TGF-βRI expression in any time correlated with worse DFS (p = 0.059). To conclude, RAD23B/TYMS and CTC kinetics may facilitate the personalized treatment of LARC.

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