Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial

Pas, M. H. G. M. van der; Haglind, Eva; Cuesta, Miguel A.; Fürst, Alois; Lacy, Antonio M.; Hop, Wim C. J.; Bonjer, H. Jaap

doi:10.1016/s1470-2045(13)70016-0

Cited by 1,461 publications

(974 citation statements)

References 20 publications

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“…Our data have some features such as simultaneous LLN dissection or lower rate of radiotherapy, but we surmise that our results would be generalizable to other countries because similar tendencies could be observed even after stratification by these factors (Figure 3). Regarding radial margin involvement rate, an established risk factor of LR,22, 23, 24, 25 the respective results (4% and 6%) were not inferior to the CRM involvement rates from recent RCTs (3%‐22%) although the radial margins as to criterion of 1 mm or 2 mm were not evaluated in the present study 26, 27, 28, 29. However, it should be noted that most hospitals participating in the present study were leading institutes in cancer care in Japan, such as university hospitals and medical centers.…”

Section: Discussioncontrasting

confidence: 61%

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Okamura

Hida

Yamaguchi

et al. 2017

Annals of Gastroent Surgery

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Sphincter‐preserving procedures (SPPs) for surgical treatment of low‐lying rectal tumors have advanced considerably. However, their oncological safety for locally advanced low rectal cancer compared with abdominoperineal resection (APR) is contentious. We retrospectively analyzed cohort data of 1500 consecutive patients who underwent elective resection for stage II‐III rectal cancer between 2010 and 2011. Patients with tumors 2‐5 cm from the anal verge and clinical stage T3‐4 were eligible. Primary outcome was 3‐year local recurrence rate, and confounding effects were minimized by propensity score matching. The study involved 794 patients (456 SPPs and 338 APR). Before matching, candidates for APR were more likely to have lower and advanced lesions, whereas SPPs were carried out more often following preoperative treatment, by laparoscopic approach, and at institutions with higher case volume. After matching, 398 patients (199 each for SPPs and APR) were included in the analysis sample. Postoperative morbidity was similar between the SPPs and APR groups (38% vs 39%; RR 0.98, 95% CI 0.77‐1.27). Margin involvement was present in eight patients in the SPPs group (one and seven at the distal and radial margins, respectively) and in 12 patients in the APR group. No difference in 3‐year local recurrence rate was noted between the two groups (11% vs 14%; HR 0.77, 95% CI 0.42‐1.41). In this observational study, comparability was ensured by adjusting for possible confounding factors. Our results suggest that SPPs and APR for locally advanced low rectal cancer have demonstrably equivalent oncological local control.

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Section: Discussioncontrasting

confidence: 61%

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Okamura

Hida

Yamaguchi

et al. 2017

Annals of Gastroent Surgery

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“…One of the principal difficulties of the laparoscopic approach is the limited space in the pelvis in which to operate, particularly in the male and with low-lying rectal tumours. Several case series and trials have demonstrated the safety and feasibility of the laparoscopic approach for rectal cancer [55][56][57][58][59][60][61][62][63]. These trials suggest that laparoscopic surgery affords similar oncological results to open surgery with less blood loss, have shorter recovery periods but take longer to perform.…”

Section: Management Of Early Rectal Cancer and The Malignant Polypmentioning

confidence: 99%

Paradigm Shift in the Management of Rectal Cancer

Rawat

Evans

2014

Indian J Surg

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Surgery for rectal cancer in the pre-Total Mesorectal Excision (TME) era was associated with high local recurrence rates. The widespread adoption of the TME technique together with the addition of neoadjuvant oncological therapies have reduced local failure rates and improved survival for patients with rectal cancer. Advances in our knowledge, better understanding of tumour biology and refinement in minimal access techniques and equipment have significantly changed the management of rectal cancer. This paper reviews these changes and proposes a paradigm shift in how rectal cancer management is conceptualised and treated, such that the treatment of rectal cancer is separated into early tumours (potentially suitable for local excison), TME tumours (optimally managed by TME) and beyond TME tumours (optimally managed by multivisceral resection outside the TME plane).

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“…Adverse events after colorectal radical resection range from 20% to 40%, including anastomotic leakage, urinary dysfunction, and/or poor functional outcomes 7, 8. Local excision for early CRC has been accepted as an alternative surgical option, with a reduced risk of mortality and a better quality of life compared with radical resection 9.…”

Section: Introductionmentioning

confidence: 99%

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

et al. 2018

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The incidence and mortality of colorectal carcinoma are rising in young adults. This population‐based propensity matching study aimed to compare long‐term oncological outcomes of local excision with radical resection for early localized colorectal cancer (CRC) in young patients without preoperative chemoradiotherapy. Patients under 45 years old with T1 colon or rectal adenocarcinoma who underwent local excision or radical resection were included from the Surveillance, Epidemiology, and End Results (SEER) database between 1998 and 2014. Survival curves were plotted using the Kaplan–Meier method. Cancer‐specific survival (CSS) was compared using adjusted hazard ratios (HRs) between local excision and radical resection. After propensity score matching procedure, total of 1719 patients were included in the analysis, among which 573 treated with local excision and 1146 treated with radical resection. The median follow‐up was 80 months (interquartile range(IQR): 37–132), with 1074 patients followed for ≥5 years and 508 patients followed for ≥10 years. Five‐year CSS of local excision versus radical resection was 93.4% versus 96.7% for colon cancer and 96.6% versus 98.4% for rectal cancer. Ten‐year CSS of local excision versus radical resection was 91.4% versus 94.0% for colon cancer and 92.8% versus 96.7% for rectal cancer. On multivariable analysis, compared with radical resection, local excision was not associated with inferior CSS for colon (HR 1.74, 95% CI: 0.92–3.29, P = 0.090) and rectal cancer (HR 2.16, 95% CI: 0.99–4.71, P = 0.052). There is no evidence of differential long‐term oncological outcomes between local excision and radical resection. These findings supported clinical application of local excision for early colon and rectal cancer in young adults.

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Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial

Cited by 1,461 publications

References 20 publications

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Local control of sphincter‐preserving procedures and abdominoperineal resection for locally advanced low rectal cancer: Propensity score matched analysis

Paradigm Shift in the Management of Rectal Cancer

Long‐term oncological outcomes of local excision versus radical resection for early colorectal cancer in young patients without preoperative chemoradiotherapy: a population‐based propensity matching study

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