A Systematic Review to Assess Resection Margin Status After Abdominoperineal Excision and Pelvic Exenteration for Rectal Cancer

Simillis, Constantinos; Baird, Daniel L H; Kontovounisios, Christos; Pawa, Nikhil; Brown, Gina; Rasheed, Shahnawaz; Tekkis, Paris

doi:10.1097/sla.0000000000001963

Cited by 60 publications

(44 citation statements)

References 59 publications

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“…Clear surgical margins (R0) are associated with improved survival in patients with primary and recurrent pelvic malignancy . In order to achieve an R0 resection, surrounding structures may have to be removed en bloc , most commonly in locally advanced primary or recurrent anorectal and associated pelvic malignancy.…”

Section: Introductionmentioning

confidence: 99%

Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery

et al. 2019

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Aim Patients who undergo radical pelvic surgery often have problems with perineal wound healing and pelvic collections. While there is recognition of the perineal morbidity, there also remains uncertainty around the benefit of vertical rectus abdominus myocutaneous (VRAM) flaps due to the balance between primary healing and the complications associated with this form of reconstruction. This study aimed to evaluate factors associated with significant flap and donor site related complications following VRAM flap reconstruction for radical pelvic surgery.

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Section: Introductionmentioning

confidence: 99%

Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery

et al. 2019

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“…Following surgical resection pathological analysis of the rectal cancer specimen is a critical tool in determining prognosis and further treatment. 2 A crucial part of synoptic reporting is the circumferential resection margin (CRM), which consensus opinion has deemed to be positive if less than 1 mm, and is associated with local disease recurrence, distant metastasis and oncological related mortality. 3 Despite pre-operative local staging with magnetic resonance imaging (MRI), the widespread uptake of the total mesorectal excision technique and use of neoadjuvant radiation patients continue to remain at risk of positive CRM.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological factors associated with positive circumferential margins in rectal cancers

Pasch

MacDermid

Pasch

et al. 2019

ANZ Journal of Surgery

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Background Positive circumferential resections are associated with local disease recurrence and reduced survival in rectal cancer. We studied a cohort of consecutive rectal cancer resections to assess for clinicopathological differences and survival in patients with positive and negative circumferential margins. Methods Rectal cancers were identified from a retrospective histopathology database of colorectal resections performed at five western Sydney hospitals from 2010 to 2016. Univariate and multivariate analysis with binary logistic regression were performed on histopathology data matched with survival times from the New South Wales Registry of Births Deaths and Marriages. Results A total of 502 rectal cancer patients were identified including 66 (13.1%) with involved circumferential margins. Patients with positive and negative circumferential margins had a similar distribution of age, gender and use of neoadjuvant radiotherapy. Tumours with involved circumferential margin comprised 98.5% T3 and T4 disease of which 51.5% received neoadjuvant radiotherapy. These were significantly associated with metastatic disease, increasing tumour size, circumferential and perforated tumours on univariate analysis. Multivariate analysis identified abdomino‐perineal resection (odds ratio (OR) 3.35; P = 0.003), en‐bloc multivisceral resection (OR 2.56; P = 0.032), T4 stage (OR 6.99; P < 0.001), perineural (OR 5.61; P < 0.001) and vascular invasion (OR 2.46; P = 0.022) as independent risk factors. Five‐year survival was significantly worse for patients with involved circumferential margins (26% versus 69%; P < 0.001). Conclusion Circumferential margin status reflects not only technical success but also aggressive disease phenotypes which require adjuvant therapy. Further work is needed to determine whether omission of radiotherapy has had an effect on long‐term outcomes in some of our at‐risk patients.

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“…This approach gives the option, depending on the extent of the tumor, of several perianal dissection lines, including intersphincteric, extralevator, and ischioanal 11) . Although this approach offers good surgical exposure of the anterior aspect through minimal skin incision around the anus, which is the most dangerous area for positive circumferential resection margin (CRM) 12) , the risk of urethral injury is not negligible because of the complex anatomy of this area 13) . Some aggressive surgeons have reported an absolute transanal approach without laparoscopic assistance or abdominal scar 14) .…”

Section: Operative Proceduresmentioning

confidence: 99%

Transanal TME: new standard or fad?

Hasegawa

Yoshida

Morimoto

et al. 2019

J Anus Rectum Colon

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Transanal total mesorectal excision (taTME) has been developed to overcome the difficulty of laparoscopic dissection and transection in the deep pelvis. TaTME has several clinical benefits over laparoscopic surgery, such as better exposure of the distal rectum and direct determination of distal resection margin. Although evidence demonstrating the true benefits of taTME over laparoscopic TME (LapTME) is still insufficient, accumulating data have revealed that, as compared with LapTME, taTME is associated with shorter operative time and a lower conversion rate without jeopardizing other short-term outcomes. However, taTME is a technically demanding procedure with specific complications such as urethral injury, and so sufficient experience of LapTME and step-by-step acquisition of the skills needed for this procedure are requisite. The role of transanal endoscopic surgery is expected to change, along with the recent progress in the treatment of rectal cancer, such as robotic surgery and the watch-and-wait strategy. Optimization of treatment will be needed in the future in terms not only of oncological but also of functional outcomes.

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A Systematic Review to Assess Resection Margin Status After Abdominoperineal Excision and Pelvic Exenteration for Rectal Cancer

Abstract: Resection margin status influences survival and a multidisciplinary approach in experienced centers may result in reduced positive resection margins. For advanced anterior rectal cancer, posterior pelvic exenteration instead of abdominoperineal excision may improve resection margins.

Cited by 60 publications

References 59 publications

Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery

Morbidity associated with the immediate vertical rectus abdominus myocutaneous flap reconstruction after radical pelvic surgery

Clinicopathological factors associated with positive circumferential margins in rectal cancers

Transanal TME: new standard or fad?

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