Histotype influences emergency presentation and prognosis in colon cancer surgery

Sibio, Simone; Giorgio, Alessandra Di; D’Ugo, Stefano; Palmieri, Giampiero; Cinelli, Lorenzo; Formica, Vincenzo; Sensi, Bruno; Bagaglini, Giulia; Carlo, Sara Di; Bellato, Vittoria; Sica, Giuseppe

doi:10.1007/s00423-019-01826-6

Cited by 25 publications

(20 citation statements)

References 56 publications

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“…Our study seems to indirectly suggest a continuum of poorer prognosis that may not only depend on tumour type but on tumour location as well. Analysis of survival based on tumour type as well as location was not possible from the included studies although other authors have suggested location to be an independent predictor or survival [63][64][65][66][67][68][69]. Chew et al [25] on the other hand using a multivariate Cox proportional hazards model showed independent association of histological subtype but not tumour location to survival.…”

Section: Discussionmentioning

confidence: 94%

Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis

et al. 2021

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Background Histological subtypes of colorectal cancer may be associated with varied prognostic features. This systematic review and meta-analysis aimed to compare clinicopathological characteristics, recurrence and overall survival between colorectal signet-ring cell (SC) and mucinous carcinoma (MC) to conventional adenocarcinoma (AC). Methods A literature search of MEDLINE, EMBASE, Ovid and Cochrane Library was performed for studies that reported data on clinicopathological and survival outcomes on SC and/or MC versus AC from January 1985 to May 2020. Meta-analysis was performed using random-effect models and between-study heterogeneity was assessed. Results Thirty studies of 1,087,055 patients were included: 11,510 (1.06%) with SC, 110,179 (10.13%) with MC and 965,366 (88.81%) with AC. Patients with SC were younger than patients with AC (WMD − 0.47; 95% CI − 0.84 to –0.10; I2 88.6%; p = 0.014) and more likely to have right-sided disease (OR 2.12; 95% CI 1.72–2.60; I2 82.9%; p < 0.001). Locoregional recurrence at 5 years was more frequent in patients with SC (OR 2.81; 95% CI 1.40–5.65; I2 0.0%; p = 0.004) and MC (OR 1.92; 95% CI 1.18–3.15; I2 74.0%; p = 0.009). 5-year overall survival was significantly reduced when comparing SC and MC to AC (HR 2.54; 95% CI 1.98–3.27; I2 99.1%; p < 0.001 and HR 1.38; 95% CI 1.19–1.61; I2 98.6%; p < 0.001, respectively). Conclusion SC and MC are associated with right-sided lesions, advanced stage at presentation, higher rates of recurrence and poorer overall survival. This has strong implications towards surgical and oncological management and surveillance of colorectal cancer.

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Section: Discussionmentioning

confidence: 94%

Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis

et al. 2021

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“…Whenever safe margins cannot be achieved, a non-restorative procedure is still the treatment of choice. Such is the case when the CRM is involved, with involved Extra Mural Vascular Invasion (EMVI), locally advanced lesions with poor response to neoadjuvant therapy and with tumours with external sphincter or levator ani muscle invasion [10,20].…”

Section: Introductionmentioning

confidence: 99%

Sphincter preservation in patients with low rectal cancer: striking the right oncological balance

et al. 2021

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Background The surgical treatment options for low rectal cancer patients include the Abdominoperineal Resection and the sphincter saving Low Anterior Resection. There is growing evidence towards better outcomes for patients being treated with a Low Anterior Resection compared to an Abdominoperineal Resection. Objective The aim of this study was to evaluate the short term and oncological outcomes in low rectal cancer treatment. Design This is a retrospective cohort study of prospectively collected data. Setting Rectal cancer patients from a single center in the United Kingdom. Patients Patients included all low rectal cancer patients (≤ 6 cm from the anal verge) undergoing Low Anterior Resection or Abdominoperineal Resection between 2006 and 2016. Outcome measures To identify differences in postoperative complications and disease free and overall survival. Results A total of 262 patients were included for analysis (Low Anterior Resection n = 170, Abdominoperineal Resection n = 92). Abdominoperineal Resection patients were significantly older (69 versus 66 years), had lower tumours (3 versus 5 cm), received more neo-adjuvant radiation, had longer hospital stay and more complications (wound infections and wound dehiscence). Low Anterior Resections had a significantly higher number of harvested lymph nodes (17 versus 12) however there was no difference in nodal involvement and R0 resection rate. No significant difference was found for recurrence, overall survival and disease free survival. Limitation Retrospective review of cancer database and single center data. Conclusion In the treatment of low rectal cancer Abdominoperineal Resection is associated with higher rates of postoperative complications and longer hospital stay compared to the Low Anterior Resection, with similar oncological outcomes.

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“…The narrow pelvis anatomy makes rectal resection a complex surgery and noble structures proximity makes a challenge for surgeons to minimize morbidity while still achieving a good oncological outcome. Thus, morbidity and mortality in rectal cancer are still relatively high with anastomotic leakage remaining the most fearful complication characterized by long lasting clinical consequences, including mortality, signi cant impact on long-term functional and oncological outcomes and QOL [21][22][23][24][25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Volume-outcome Relationship in Rectal Cancer Surgery

Siragusa

Sensi

Vinci

et al. 2021

Preprint

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Introduction Hospital centralization effect is reported to lower complications and mortality for high risk and complex surgery operations, including colorectal surgery. However, no linear relation between volume and outcome has been demonstrated. Aim of the study was to evaluate the increased surgical volume effect on early outcomes of patient undergoing laparoscopic restorative anterior rectal resection (ARR).Methods A retrospective analysis of all consecutive patients undergoing ARR with primary anastomosis between November 2016 and December 2020 after centralization of rectal cancer cases in an academic Centre. Short outcomes are compared to those of patients operated in the same unit during the previous 10 years before service centralization. The primary outcome was anastomotic leak rate. Mean operative time, need of conversion, postoperative use of blood transfusion, radicality, in-hospital stay, number and type of complications, readmission and reoperation rate, mortality and 1-year and stoma persistence rates were evaluated as secondary outcomes.Results 86 patients were operated in the study period and outcomes compared to those of 101 patients operated during the previous ten years. Difference in volume of surgery was significant between the two periods (p 0.019) and the estimated leak rate was significantly lower in the higher volume unit (p 0.05). Mean operative time, need of conversion, postoperative use of blood transfusion and in-hospital stay (p <0.05) were also significantly reduced in Group A.Conclusion: This study suggests that the shift toward higher volume in rectal cancer surgery is associated to decreased anastomotic leak rate. Potentiation of lower volume surgical units may yield optimal perioperative outcomes.

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Histotype influences emergency presentation and prognosis in colon cancer surgery

Cited by 25 publications

References 56 publications

Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis

Clinicopathological factors and survival outcomes of signet-ring cell and mucinous carcinoma versus adenocarcinoma of the colon and rectum: a systematic review and meta-analysis

Sphincter preservation in patients with low rectal cancer: striking the right oncological balance

Volume-outcome Relationship in Rectal Cancer Surgery

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