Pathology Studies of Combined Radical Resection of Seminal Vesicle in the Treatment of Rectal Cancer

2011 ◽  
Vol 96 (1) ◽  
pp. 51-55 ◽  
Author(s):  
Koji Komori ◽  
Takashi Hirai ◽  
Yukihide Kanemitsu ◽  
Yasuhiro Shimizu ◽  
Tsuyoshi Sano ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Seminal Vesicle ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Radical Resection ◽  
Seminal Vesicles ◽  
Recurrence Of Rectal Cancer

Abstract To inhibit local recurrence of rectal cancer, it is very important to ensure that there is a sufficient circumferential resection margin. We evaluated pathology studies of combined radical resection of seminal vesicles in the treatment of rectal cancer. We analyzed data from 7 cases of combined radical resection of the seminal vesicle in the treatment of rectal cancer; we also analyzed data from 35 control cases without seminal vesicle resection. The circumferential resection margin averaged 5.97 mm for cases that had combined radical resection of the seminal vesicle, and this was significantly longer than for cases without resection (P < 0.001). Local recurrence was not seen in cases that had combined radical resection of the seminal vesicle, whereas 3 cases (5.9%) occurred in the group that did not undergo resection. Combined radical resection of the seminal vesicle in patients with rectal cancer ensures that the distance of the circumferential resection margin is sufficient to inhibit local recurrence.

scholarly journals The risk factors of local recurrence and distant metastasis on pT1/T2N0 mid-low rectal cancer after total mesorectal excision

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
I-Li Lai ◽  
Jeng-Fu You ◽  
Yih-Jong Chern ◽  
Wen-Sy Tsai ◽  
Jy-Ming Chiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Rectal Cancer ◽  
Local Recurrence ◽  
Distant Metastasis ◽  
Resection Margin ◽  
Radical Resection ◽  
Hazard Ratio ◽  
Low Rectal Cancer ◽  
Distal Resection Margin ◽  
Lymph Node Yield

Abstract Background Radical resection is associated with good prognosis among patients with cT1/T2Nx rectal cancer. However, still some of the patients experienced cancer recurrence following radical resection. This study tried to identify the postoperative risk factors of local recurrence and distant metastasis separately. Methods This retrospective, single-center study comprised of 279 consecutive patients from Linkou branch of Chang Gung Memorial Hospital in 2005–2016 with rectal adenocarcinoma, pT1/T2N0M0 at distance from anal verge ≤ 8cm, who received curative radical resection. Results The study included 279 patients with pT1/pT2N0 mid-low rectal cancer with median follow-up of 73.5 months. Nineteen (6.8%) patients had disease recurrence in total. Nine (3.2%) of them had local recurrence, and fourteen (5.0%) of them had distant metastasis. Distal resection margin < 0.9 (cm) (hazard ratio = 4.9, p = 0.050) was the risk factor of local recurrence. Preoperative carcinoembryonic antigen (CEA) ≥ 5 ng/mL (hazard ratio = 9.3, p = 0.0003), lymph node yield (LNY) < 14 (hazard ratio = 5.0, p = 0.006), and distal resection margin < 1.4cm (hazard ratio = 4.0, p = 0.035) were the risk factors of distant metastasis. Conclusion For patients with pT1/pT2N0 mid-low rectal cancer, current multidisciplinary treatment brings acceptable survival outcome. Insufficient distal resection margin attracted the awareness of risk factors for local recurrence and distant metastasis as a foundation for future research.

scholarly journals Multimodal Treatment of cT3 Rectal Cancer in a Prospective Multi-Center Observational Study: Can Neoadjuvant Chemoradiation Be Omitted in Patients with an MRI-Assessed, Negative Circumferential Resection Margin?

2021 ◽  
pp. 1-8
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Observational Study ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Anal Verge ◽  
Final Analysis ◽  
Radical Resection ◽  
Distant Recurrence ◽  
Neoadjuvant Chemoradiation ◽  
Recurrence Rates

<b><i>Background/Aim:</i></b> Neoadjuvant chemoradiation (nCRT) in rectal cancer is associated with significant long-term morbidity. It is unclear whether nCRT in resectable mesorectal fascia circumferential resection margin (mrCRM)-negative rectal cancer treated by adequate total mesorectal excision (TME) is beneficial. The aim was to determine if nCRT can be omitted in patients with MRI-assessed cT3 rectal cancer and a negative mrCRM undergoing good-quality TME. <b><i>Methods:</i></b> By means of a prospective nationwide registry (<i>n</i> = 43.147; prospective multi-center observational study), patients with cT3 rectal cancer &#x3c;12 cm from the anal verge with a negative (&#x3e;1 mm) MRI-assessed CRM undergoing radical resection from 2006 to 2008 were selected. Overall, 87 patients were available for the final analysis (TME-alone, <i>n</i> = 25; nCRT+TME, <i>n</i> = 62). Groups were balanced for age, sex, and ASA score, with a nonsignificant predominance of males in the nCRT+TME group. As main outcome measures, local and distant recurrence rates were compared between patients undergoing primary surgery (TME-alone) vs. neoadjuvant chemoradiation + surgery (nCRT+TME). <b><i>Results:</i></b> In the TME-alone group, tumors were located closer to the anal verge (<i>p</i> = 0.018) and demonstrated a smaller minimal circumferential distance from the resection margin (<i>p</i> = 0.036). TME quality was comparable, as was median follow-up (48.9 vs. 44.9 months; <i>p</i> = 0.268). Local recurrences occurred at a similar rate in the TME-alone (<i>n</i> = 1; 5.3%) and nCRT+TME groups (<i>n</i> = 3; 5.5%) (<i>p</i> = 0.994) and were diagnosed at 10 months (TME-alone) and at 8, 13, and 18 months (nCRT+TME). Distant recurrences occurred in 28.9 and 17.4% of the cases, respectively (<i>p</i> = 0.626). The analysis was limited to cT3 cancers with a negative mrCRM. In addition, caution is required when appraising these results because of the limited number of evaluable subjects (especially in the TME-alone group), which adds some uncertainty to the statistical analysis. <b><i>Conclusions:</i></b> In this cohort of patients with rectal cancer located &#x3c;12 cm from the anal verge and a negative mrCRM undergoing adequate TME, omission of nCRT had no impact onto the local recurrence rate.

scholarly journals Clinical Reality and Treatment for Local Recurrence of Rectal Cancer: A Single-Center Retrospective Study

Medicina ◽  
2021 ◽  
Vol 57 (3) ◽  
pp. 286
Author(s):  
Michał Jankowski ◽  
Manuela Las-Jankowska ◽  
Andrzej Rutkowski ◽  
Dariusz Bała ◽  
Dorian Wiśniewski ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Rectal Cancer Patient ◽  
Radical Resection ◽  
Single Center ◽  
Curative Intent ◽  
Immediate Surgery ◽  
Histopathological Results ◽  
Isolated Local Recurrence ◽  
Recurrence Of Rectal Cancer

Background and Objectives: Despite advances in treatment, local recurrence remains a great concern in patients with rectal cancer. The aim of this study was to investigate the incidence and risk factors of local recurrence of rectal cancer in our single center over a 7-year-period. Materials and Methods: Patients with stage I-III rectal cancer were treated with curative intent. The necessity for radiotherapy and chemotherapy was determined before surgery and/or postoperative histopathological results. Results: Of 365 rectal cancer patients, 76 (20.8%) developed recurrent disease. In total, 27 (7.4%) patients presented with a local tumor recurrence (isolated in 40.7% of cases). Radiotherapy was performed in 296 (81.1%) patients. The most often used schema was 5 × 5 Gy followed by immediate surgery (n = 214, 58.6%). Local recurrence occurred less frequently in patients treated with 5 × 5 Gy radiotherapy followed by surgery (n = 9, 4%). Surgical procedures of relapses were performed in 12 patients, six of whom were operated with radical intent. Only two (7.4%) patients lived more than 5 years after local recurrence treatment. The incidence of local recurrence was associated with primary tumor distal location and worse prognosis. The median overall survival of patients after local recurrence treatment was 19 months. Conclusions: Individualized rectal cancer patient selection and systematic treatment algorithms should be used clinical practice to minimize likelihood of relapse. 5 × 5 Gy radiotherapy followed by immediate surgery allows good local control in resectable cT2N+/cT3N0 patients. Radical resection of isolated local recurrence offers the best chances of cure.

The Prognostic Value of Circumferential Resection Margin Involvement in Patients with Extraperitoneal Rectal Cancer

2016 ◽  
Vol 82 (4) ◽  
pp. 348-355 ◽  
Author(s):  
Dong Woo Shin ◽  
Jin Yong Shin ◽  
Sung Jin Oh ◽  
Jong Kwon Park ◽  
Hyeon Yu ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Cox Model ◽  
Prognostic Significance ◽  
Multivariate Logistic Regression Analysis ◽  
T3 Rectal Cancer ◽  
Circumferential Resection Margin Involvement ◽  
Cox Analysis

The prognostic influence of circumferential resection margin (CRM) status in extraperitoneal rectal cancer probably differs from that of intraperitoneal rectal cancer because of its different anatomical and biological behaviors. However, previous reports have not provided the data focused on extraperitoneal rectal cancer. Therefore, the aim of this study was to examine the prognostic significance of the CRM status in patients with extraperitoneal rectal cancer. From January 2005 to December 2008, 248 patients were treated for extraperitoneal rectal cancer and enrolled in a pro-spectively collected database. Extraperitoneal rectal cancer was defined based on tumors located below the anterior peritoneal reflection, as determined intraoperatively by a surgeon. Cox model was used for multivariate analysis to examine risk factors of recurrence and mortality in the 248 patients, and multivariate logistic regression analysis was performed to identify predictors of recurrence and mortality in 135 patients with T3 rectal cancer. CRM involvement for extraperitoneal rectal cancer was present in 29 (11.7%) of the 248 patients, and was the identified predictor of local recurrence, overall recurrence, and death by multivariate Cox analysis. In the 135 patients with T3 cancer, CRM involvement was found to be associated with higher probability of local recurrence and mortality. In extraperitoneal rectal cancer, CRM involvement is an independent risk factor of recurrence and survival. Based on the results of the present study, it seems that CRM involvement in extraperitoneal rectal cancer is considered an indicator for (neo)adjuvant therapy rather than conventional TN status.

scholarly journals Oncologic superiority of extralevator abdominoperineal excision for low rectal cancer

2013 ◽  
Vol 21 (1) ◽  
pp. 11-13
Author(s):  
Dejan Lukic ◽  
Zoran Radovanovic ◽  
Tomislav Petrovic ◽  
Milan Breberina ◽  
Andrija Golubovic ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Local Recurrence ◽  
Circumferential Resection Margin ◽  
Resection Margin ◽  
Abdominoperineal Excision ◽  
Low Rectal Cancer ◽  
Margin Involvement ◽  
Radio Therapy ◽  
Circumferential Resection Margin Involvement ◽  
Prone Jackknife Position

Background: Rectal cancer treatment has been dramatically improved during the last two decades in terms of a lower local recurrence rate and prolonged survival. This improvement was achieved mainly due to a better surgical technique (implementation of a total mesorectal excision-TME) and neoadjuvant chemo and radio therapy. A more radical approach to abdominoperineal excision, extralevator abdominoperineal excision technique in the prone Jackknife position, may improve the oncological outcome. The aim of this study is to show our early experience by using extralevator abdominoperineal excision. Methods: Extralevator abdominoperineal excision has been used routinely at Oncology Institute of Vojvodina since 2011. In the last 23 months, we had 11 operations. Clinical and pathological data were obtained from operative protocols, histopathological data and patients? medical history. Results: An audit of results showed reduced rate of intra-operative perforations and circumferential resection margin involvement. Late postoperative complications have occurred in two patients, sexual dysfunction in one and pelvic pain in the other. The follow up period is too short (min 2 months, max 23 months, median 8 months) for analysis of local recurrence. Conclusion: Extralevator abdominoperineal excision, with the emphasis on the perienal dissection and prone Jackknife position, may help achieve the goals of radical resections for low rectal cancer. This technique could be associated with less intra-operative perforations and circumferential resection margin involvement.

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