Factors Influencing Local Recurrence after Curative Surgery for Rectal Cancer

Secco, G B; Fardelli, R; Campora, E; Rovida, S; Bertoglio, Sergio

doi:10.1159/000226673

Cited by 31 publications

(17 citation statements)

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“…17, 18]. Tumor differentiation or grading has also been used to determine prognosis [1,5,12,17,19]. However the majority of authors agree that this method is inadequate since assessment of grade is in part subjective and can vary even when carried out by expert pathologists [2, 6.…”

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confidence: 99%

Prognostic Value of the Jass Histopathologic Classification in Left Colon and Rectal Cancer: A Multivariate Analysis

Secco

Fardelli

Campora³

et al. 1990

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Variables correlated to survival were studied in 121 patients who had undergone potentially curative surgery for left colon and rectal cancer. To investigate the prognostic value of the parameters both univariate and multivariate analysis were carried out. Minimum follow-up was 5 years. Multivariate analysis showed that while disease stage (p < 0.0001) and site of primary tumor (p < 0.0006) independently influenced survival, type of surgical procedure and histopathologic grade had no impact on survival. Jass histopathologic classification predicted survival for patient group I and IV whereas no significant relationship was observed for group II and III, which, in our series, were the most frequently encountered groups. Of the three parameters considered for Jass classification, tubule configuration, pattern of tumor growth and lymphocytic infiltration, only the latter was significantly correlated to survival (p < 0.005). Different results were obtained when the prognostic values of Jass group was investigated separately for the 49 patients with adenocarcinoma of the left colon and the 72 patients with rectal cancer. Further investigation is required before routine clinical application of the Jass classification can be recommended.

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confidence: 99%

Prognostic Value of the Jass Histopathologic Classification in Left Colon and Rectal Cancer: A Multivariate Analysis

Secco

Fardelli

Campora³

et al. 1990

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“…In previous reports [11, 12], a significant increase in local relapse was demonstrated when distal clearance was <2 cm. In group I cases, distal free margins ≥2 cm were significantly more frequent compared to stapled patients, but improved local control of disease was observed in the latter group.…”

Section: Discussionmentioning

confidence: 88%

“…Neverthless, the critical difference between APR and LAR consists in the amount of distal bowel and perirectal tissue which are removed [6, 9, 22]. It must be observed that although the surgical practice is uncommon, total mesorectal excision combined with a distal clearance of at least 2 cm also appears to increase the volume excised [10, 11, 12, 13, 14, 23]. …”

Section: Discussionmentioning

confidence: 99%

“…At the beginning of the 1980s, Heald et al [10]suggested that the total removal of the mesorectum during the preparation of the distal rectum could improve results. In the last two decades a 2-cm margin in distal clearance has become the accepted standard and conservative surgery has consequently increased [11, 12, 13]. This retrospective study was carried out in 264 cases, surgically treated with curative intent over a 20-year period for extraperitoneal rectal carcinoma.…”

Section: Introductionmentioning

confidence: 99%

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Local Control after Curative Surgery for Cancer of the Extraperitoneal Rectum

Secco

Fardelli²,

Campora³

et al. 1999

Oncology

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A retrospective study was carried out in 264 patients with low rectal cancer surgically treated with curative intent from January 1975 to December 1995 to analyze the influence of stapling devices on surgical and disease outcome. Patients were classified as follows: group 1 underwent surgery from 1975 to 1980, when staplers were not employed, and group 2 from 1981 to 1995, when stapling devices were routinely used. The use of stapling devices determined a corresponding increase in low anterior resection (LAR) and a decrease in postoperative mortality. A statistically significant difference in local recurrence rate between abdominoperineal resection (APR) patients and LAR sutured cases of group 1 was observed. In T3, N+ cases local recurrence rate was comparable in APR patients and LAR cases with stapled anastomosis. Improved local control occurred in stapled group 2 patients which was independent of the distal clearance. Although APR still plays an important role in treatment of lower rectal cancer, results indicated that a similar outcome after stapled LAR can also be expected in locally advanced carcinoma of the distal rectum, if accurate excision of perirectal tissue is carried out.

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“…Local recurrence is a major problem in patients undergoing the surgical treatment of rectal carcinoma because it is frequent and always associated with a poor prognosis (11,12). Therefore, prediction of local recurrence could be extremely important for the management of rectal carcinoma and better local control could improve the quality of life after surgery.…”

Section: Discussionmentioning

confidence: 99%