Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial

Kang, Seung Joo; Park, Ji Won; Jeong, Seung‐Yong; Nam, Byung Ho; Choi, Hyo Seong; Kim, Duck-Woo; Lim, Seok‐Byung; Lee, Taek-Gu; Kim, Dae Yong; Kim, Jae-Sung; Chang, Hee Jin; Lee, Hye-Seung; Kim, Sun Young; Jung, Kyung Hae; Hong, Yong Sang; Kim, Jee Hyun; Sohn, Dae Kyung; Kim, Dae-Hyun; Oh, Jae Hwan

doi:10.1016/s1470-2045(10)70131-5

Cited by 923 publications

(847 citation statements)

References 28 publications

Supporting

Mentioning

721

Contrasting

Unclassified

Order By: Relevance

“…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: 71%

“…Generally, SPPs are not preferable for poorly differentiated tumors as a result of distal intramural spread 34. Although the proportion would be only a few percent of the cohort,26, 34 it is possible that lack of data might have led to the slight difference in recurrence rate. Furthermore, if a tumor directly invades the intersphincteric plane, sphincter excision and a permanent stoma are needed to achieve a clear pathological resection margin.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussioncontrasting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

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

View full text Add to dashboard Cite

show abstract

“…After the recommendations above were presented, data from two randomised controlled trials have been published [148,149]. These results strengthen our recommendations by confirming the safety of the laparoscopic approach and providing evidence for no difference in long-term outcome.…”

Section: Discussionsupporting

confidence: 72%

“…Furthermore, the authors report a very low conversion rate of 1.2% and confirmed the known recovery benefits of the laparoscopic approach such as fewer wound complications, less pain and better recovery of intestinal function. These results show that excellent outcomes can be achieved by the laparoscopic approach in expert hands [148].…”

Section: Discussionmentioning

confidence: 63%

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

et al. 2011

View full text Add to dashboard Cite

Background The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline. Methods An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference. Results Laparoscopic surgery for extraperitoneal (midand low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not

show abstract

“…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

View full text Add to dashboard Cite

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).

show abstract

Open versus laparoscopic surgery for mid or low rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): short-term outcomes of an open-label randomised controlled trial

Cited by 923 publications

References 28 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

Laparoscopic extraperitoneal rectal cancer surgery: the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)

Paradigm Shift in the Management of Rectal Cancer

Contact Info

Product

Resources

About