Association of Coloproctology of Great Britain &amp; Ireland (<scp>ACPGBI</scp>): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Multidisciplinary Management

Gollins, Simon; Moran, Brendan; Adams, Rachel; Cunningham, Chris; Bach, Simon; Myint, Arthur Sun; Renehan, Andrew G; Karandikar, Sharad; Goh, Vicky; Prezzi, Davide; Langman, Gerald; Ahmedzai, Sam H.; Geh, Ian

doi:10.1111/codi.13705

Cited by 82 publications

(57 citation statements)

References 196 publications

(222 reference statements)

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“…3,4 However, this procedure is associated with high permanent stoma rates along with significant morbidity mainly due to anastomotic leakage (up to 17%) that can lead to chronic pelvic sepsis and low colovaginal and colovesical fistulas. 3,4 However, this procedure is associated with high permanent stoma rates along with significant morbidity mainly due to anastomotic leakage (up to 17%) that can lead to chronic pelvic sepsis and low colovaginal and colovesical fistulas.…”

Section: Introductionmentioning

confidence: 99%

What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?

Boullenois

Lefèvre

Creavin

et al. 2019

ANZ Journal of Surgery

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Background: Delayed coloanal anastomosis (DCAA) may be used in patients with complex rectal conditions, such as chronic pelvic sepsis, low recto-vaginal and recto-vesical fistula; however, limited data are available. The aim is to report the morbidity and functional results of DCAA in redo rectal surgery. Methods: All patients undergoing DCAA between January 2014 and August 2017 were retrospectively included. Success was defined as a functional anastomosis without stoma, evaluated using the Low Anterior Resection Syndrome (LARS) score and the Gastrointestinal Quality of Life Index (GIQLI) functional assessment tools. Results: Of the 72 redo pelvic surgeries, 29 (40.3%) DCAA were performed over a 4-year period. Indications for redo resection were chronic pelvic sepsis (n = 13, 44.8%), rectovaginal fistula (n = 11, 37.9%) and recto-vesical fistula (n = 5, 17.2%). Mean interval period between the two procedures was 14 AE 3 days (8-21). Global major morbidity (Clavien-Dindo III or IV) was seen in six patients (20.7%). Stoma closure was feasible for 22 (75.9%) patients after a median period of 78 days (interquartile range 61-98). The 6-month success rate was 79.3%. Mean LARS was 28.8 AE 10.2 (3-41) (minor LARS) for 18 patients with no stoma at the end of follow-up. LARS score was significantly better with a follow-up >2 years (23.3 AE 12.2 versus 32.3 AE 7.9), P = 0.074. Mean GIQLI score was 79.2 AE 14.3 (48-98). Conclusions: Transanal colonic pull through with delayed anastomosis for redo-surgery in complex pelvic situations had low morbidity and avoided a permanent stoma in three out of four patients with an acceptable quality of life.

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Section: Introductionmentioning

confidence: 99%

What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?

Boullenois

Lefèvre

Creavin

et al. 2019

ANZ Journal of Surgery

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“…Radical surgery in the form of total mesorectal excision (TME) is the conventional treatment for rectal cancer, but in early rectal cancer local excision can provide definitive treatment in selected early-stage cases as defined in the recent ACPGBI guidelines published in 2017 [1], and indeed radical surgery may be considered as overtreatment.…”

Section: Introductionmentioning

confidence: 99%

Adjuvant radiotherapy after local excision of rectal cancer

Jones

Cunningham

2019

Acta Oncologica

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Background: Local excision is now accepted as a standard treatment option for certain patients with early rectal cancer. However, there is a higher risk of local recurrence than after radical surgery with total mesorectal excision. Adjuvant radiotherapy after local excision may reduce this excess risk, and yet retain the benefits of local excision, with rectal preservation. Methods: A review of the literature pertaining to the use of adjuvant radiotherapy after local excision of rectal cancer and a discussion of current practice. Results: We first considered local excision as a treatment option for early rectal cancer, looking at technical developments and the risks and benefits of organ preservation, in particular, the advantages for quality of life and the risk of leaving residual disease which may result in local recurrence. We then looked at reported outcomes for studies using adjuvant radiotherapy after local excision. Few of the studies routinely used modern endoscopic methods of local excision and only the recent used chemoradiation. Local recurrence rates after adjuvant radiotherapy have improved over time, with rates of around 3.5% in the recent studies. Adverse effects of adjuvant radiotherapy are not commonly described, but generally, they are relatively mild when described. We then discussed current practice regarding adjuvant radiotherapy, including pathological criteria, discussion of local recurrence risk with the patient and the importance of a surveillance regime to detect any recurrence at an early stage. Conclusion: We conclude that the current state of knowledge regarding adjuvant radiotherapy after local excision suggests a potential role in decreasing the risk of local recurrence but further studies are required to better define this effect, clarify which patients will gain the most benefit from this pathway, and identify those who should avoid exposure to the risks of radiotherapy. ARTICLE HISTORY

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“…Currently, treatment guidelines in the United Kingdom, recommend this strategy to patients, as long as they are informed that it is still in the experimental stages (28). In the European Union, the European Oncology Association (ESMO) recommends the w&w strategy for high-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Watch and Wait Strategy for Rectal Cancer: 15 Years After the First Published Study. Are We any Closer to the Non-operative Management of Rectal Cancer?

Tulin¹,

Nițipir²,

Slavu³

et al. 2019

chr

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Introducere: De-a lungul timpului, tratamentul cancerului rectal a evoluat semnificativ prin utilizarea sporită a radiochimoterapiei neoadjuvante. Material şi metoda: Ghidul P.I.C.O.S a fost utilizat pentru a structura întrebările şi topica cercetării în vederea obţinerii validităţii clinice. Rezultatele obţinute au fost filtrate conform ghidului PRISMA. Rezultate: Am identificat un număr de 42 de lucrări, după screeningul acestora, au rămas 27 pentru a completa cercetarea. Discuţii: Există un interes crescut faţă de managementul neoperator al cancerului rectal întrucât până la 25% dintre pacienţii supuşi unui regim de radiochimioterapie preoperatorie au demonstrat răspuns patologic complet (absenţa celulelor tumorale pe specimenele rezecate). Aceste informaţii conduc la ideea atrăgătoare că, în unele cazuri, intervenţia chirurgicală poate fi evitată. Din nefericire, există o lipsă de date de calitate pentru a susţine această nouă tendinţă. Datorită interesului recent crescut a fost creată o bază de date internaţională în care pacienţii aflaţi în perioada de w&w pot fi înscrişi şi monitorizaţi. Până în prezent, baza de date conţine peste 900 de pacienţi. De asemenea, sunt în curs de finalizare studii prospective de calitate. Concluzii: Cu toate aceste eforturi recente, utilizarea pe scară largă Abstract Introduction: Over time, the management of rectal cancer has undoubtedly evolved with the use of neoadjuvant radiochemotherapy. Material and method: The P.I.C.O.S guidelines were used to structure the questions and the research topic as to attain clinical validity. The results of the research were filtered in accordance with the PRISMA checklist. Results: We identified 42 papers. After screening 27 papers were used to complete the analysis. Discussion: There is an increased interest towards the non-operative management of rectal cancer, as up to 25% of patients with preoperative radiochemotherapy have demonstrated complete pathological response (absence of tumor cells on the operative specimens). This information leads to the tantalizing idea that in some cases, surgery can be avoided. Unfortunately, there is a lack of quality data to support this view. Due to increased interest in this subject, an international database in which patients with w&w therapy can be enrolled and monitored. Up to now, the database contains over 900 patients. Also, quality prospective trials are emerging. Conclusion: Even with all these recent efforts, the wide-use of this therapy is precluded due to the absence of a standardized evaluation of these patients in the follow-up period.

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Association of Coloproctology of Great Britain & Ireland (ACPGBI): Guidelines for the Management of Cancer of the Colon, Rectum and Anus (2017) – Multidisciplinary Management

Cited by 82 publications

References 196 publications

What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?

What is the functional result of a delayed coloanal anastomosis in redo rectal surgery?

Adjuvant radiotherapy after local excision of rectal cancer

Watch and Wait Strategy for Rectal Cancer: 15 Years After the First Published Study. Are We any Closer to the Non-operative Management of Rectal Cancer?

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