Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

Chan, Charles; Bokey, E. L.; Chapuis, Pierre; Renwick, Andrew; Dent, Owen F.

doi:10.1002/bjs.5212

Cited by 43 publications

(37 citation statements)

References 36 publications

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“…This is comparable to the results of Chan et al [29], who found a 5-year relapse-free survival rate of 42% (N1-N2) compared with 85% (N0) in patients after NRC prior to surgery.…”

Section: Discussionsupporting

confidence: 81%

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

et al. 2016

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Background: Tumor response after neoadjuvant radiochemotherapy (NRC) prior to surgery and other parameters are likely to have an influence on the survival rate of patients suffering from T3 rectal cancer. Methods: 51 patients (17 female, 34 male; 59.0 years; Apache < 9 points: 95.1%; ASA I-II 88.3% and ASA III 11.8%) were treated with NRC (50.4 Gy; 5-fluorouracil/folinic acid) 4-6 weeks prior to surgery because of uT3 rectal cancer (G2: 96%; adenocarcinoma 86.3%; cUICC II 62.7%). NRC led to a tumor response (TR) (ypT0-ypT2) in 45.1% (ypT0N0M0 7.8%). Results: Neither the age of patients nor Apache/ASA score, histology, UICC staging, ypTNM, Dukes staging, infiltration of vessels, surgical procedure, local recurrence nor TR had a significant influence on the patients' survival time. Patients with metachronous distant metastasis (MDM) during the follow-up period (mean: 8.2 years; 1 month to 14.5 years) and patients with ypN1-ypN2 had a significantly shorter survival time. Conclusions: NRC prior to surgery leads to a remarkable TR rate but has no significant impact of TR on the patients' survival time. Occurrence of MDM during the follow-up period and ypN1/N2 status do have a greater influence. It is necessary to investigate larger cohorts of patients in the future to obtain more conclusive results and to define factors with influence on survival.

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“…This is comparable to the results of Chan et al [29], who found a 5-year relapse-free survival rate of 42% (N1-N2) compared with 85% (N0) in patients after NRC prior to surgery.…”

Section: Discussionsupporting

confidence: 81%

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

et al. 2016

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“…The prognostic importance of the circumferential position of the tumour has been reported by different authors, yet with conflicting results (18,19). Chan et al (19) reported that an anterior position is an independent negative prognostic factor for both local recurrence and survival, while Garcia-Granero et al (18) reported that an anterior position did not have prognostic significance. This discrepancy may be due to the definition of tumour location, the inclusion of circumferential tumours and the surgical technique.…”

Section: Discussionmentioning

confidence: 88%

Circumferential resection margin positivity after preoperative chemoradiotherapy based on magnetic resonance imaging for locally advanced rectal cancer: implication of boost radiotherapy to the involved mesorectal fascia

Kim¹,

Park²,

Lim³

et al. 2016

Jpn. J. Clin. Oncol.

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Objective: To identify patients who are at a higher risk of pathologic circumferential resection margin involvement using preoperative magnetic resonance imaging. Methods: Between October 2008 and November 2012, 165 patients with locally advanced rectal cancer (cT4 or cT3 with <2 mm distance from tumour to mesorectal fascia) who received preoperative chemoradiotherapy were analysed. The morphologic patterns on post-chemoradiotherapy magnetic resonance imaging were categorized into five patterns from Pattern A (most-likely negative pathologic circumferential resection margin) to Pattern E (most-likely positive pathologic circumferential resection margin). In addition, the location of mesorectal fascia involvement was classified as lateral, posterior and anterior. The diagnostic accuracy of the morphologic criteria was calculated using receiver operating characteristic curve analysis. Results: Pathologic circumferential resection margin involvement was identified in 17 patients (10.3%). The diagnostic accuracy of predicting pathologic circumferential resection margin involvement was 0.73 using the five-scale magnetic resonance imaging pattern. The sensitivity, specificity, positive predictive value and negative predictive value for predicting pathologic circumferential resection margin involvement were 76.5, 65.5, 20.3 and 96.0%, respectively, when cut-off was set between Patterns C and D. On multivariate logistic regression, the magnetic resonance imaging patterns D and E (P = 0.005) and posterior or lateral mesorectal fascia involvement (P = 0.017) were independently associated with increased probability of pathologic circumferential resection margin involvement. The rate of pathologic circumferential resection margin involvement was 30.0% when the patient had Pattern D or E with posterior or lateral mesorectal fascia involvement. Conclusions: Patients who are at a higher risk of pathologic circumferential resection margin involvement can be identified using preoperative magnetic resonance imaging although the predictability is moderate.

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“…The incidence of local recurrence following curative surgery for colorectal cancer, CD, UC, or diverticulitis is high, and has been reported to range from 3.7% to 50% within the first two years (1)(2)(3)(4)(5)21,23). Therefore, it is important to obtain a rapid and exact diagnosis of local recurrence to plan subsequent therapy and possibly surgical reresection of the recurrence.…”

Section: Discussionmentioning

confidence: 99%

“…COLONIC RESECTION with end-to-end-anastomosis is a common procedure in colorectal surgery for patients with colorectal malignancy or chronic inflammatory bowel diseases (1)(2)(3)(4). However, postoperative recurrences at the site of anastomosis with consecutive stricture are frequent.…”

mentioning

confidence: 99%

MR colonography for the assessment of colonic anastomoses

Ajaj

Goyen

Langhorst

et al. 2006

Magnetic Resonance Imaging

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Purpose: To assess colonic anastomoses in patients after surgical treatment by means of MR colonography (MRC) in comparison with conventional colonoscopy (CC). Materials and Methods:A total of 39 patients who had previously undergone colonic resection and end-to-endanastomosis were included in the study. MRI was based on a dark-lumen approach. Contrast-enhanced T1-weighted (T1w) three-dimensional (3D) images were collected following the rectal administration of water for colonic distension. The MRC data were evaluated by two radiologists. The criteria employed to evaluate the anastomoses included bowel wall thickening and increased contrast uptake in this region. Furthermore, all other colonic segments were assessed for the presence of pathologies. Results:In 23 and 20 patients the anastomosis was rated to be normal by MRC and CC, respectively. In three patients CC revealed a slight inflammation of the anastomosis that was missed by MRI. A moderate stenosis of the anastomosis without inflammation was detected by MRC in five patients, which was confirmed by CC. In the remaining 11 patients a relevant pathology of the anastomosis was diagnosed by both MRC and CC. Recurrent tumor was diagnosed in two patients with a history of colorectal carcinoma. In the other nine patients inflammation of the anastomosis was seen in seven with Crohn's disease (CD) and two with ulcerative colitis. MRC did not yield any falsepositive findings, resulting in an overall sensitivity/specificity for the assessment of the anastomosis of 84%/100%. Conclusion:MRC represents a promising alternative to CC for the assessment of colonic anastomoses in patients with previous colonic resection.

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Local recurrence after curative resection for rectal cancer is associated with anterior position of the tumour

Cited by 43 publications

References 36 publications

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

Incidence of Metachronous Distant Metastasis and ypN Classification Influence Patient Survival in Endosonographically Confirmed uT3 Rectal Cancer after Neoadjuvant Therapy and R0 Resection: A Historical Cohort Analysis

Circumferential resection margin positivity after preoperative chemoradiotherapy based on magnetic resonance imaging for locally advanced rectal cancer: implication of boost radiotherapy to the involved mesorectal fascia

MR colonography for the assessment of colonic anastomoses

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