Outcomes following surgery without radiotherapy for rectal cancer

Mathis, Kellie L.; Larson, David W.; Dozois, Eric J.; Cima, Robert R.; Huebner, Marianne; Haddock, Michael G.; Wolff, Bruce G.; Nelson, Heidi; Pembérton, John H.

doi:10.1002/bjs.7739

Cited by 68 publications

(35 citation statements)

References 28 publications

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“…That area is prone to retention and infection. Besides, it is well documented that postoperative complications of the perineal wound and their long-term residuals comprise the major morbidity factor, especially when combined with neoadjuvant radio/chemotherapy [6–8]. …”

Section: Introductionmentioning

confidence: 99%

Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing?

Pramateftakis

Kanellos

Christoforidis

et al. 2012

International Journal of Surgical Oncology

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Aim. The aim of this paper is to investigate if the insertion of the pelvic drainage tube via the perineal wound could be considered as an independent risk factor for perineal healing disorders, after abdominoperineal resection for rectal malignancy. Patients and Methods. The last two decades, 75 patients underwent elective abdominoperineal resection for malignancy. In 42 patients (56%), the pelvic drain catheter was inserted through the perineal wound (PW group), while in the remaining 33 (44%) through a puncture skin wound of the perineum (SW group). Patients' data with respect to age (P = 0.136), stage (P > 0.05), sex (P = 0.188) and comorbidity (P = 0.128) were similar in both groups. 25 patients (PW versus SW: 8 versus 17, P = 0.0026) underwent neoadjuvant radio/chemotherapy. Results. The overall morbidity rate was 36%, but a significant increase was revealed in PW group (52.4% versus 9%, P = 0.0007). In 33.3% of the patients in the PW group, perineal healing was delayed, while in the SW group, no delay was noted. Perineal healing disorders were revealed as the main source of increased morbidity in this group. Conclusion. The insertion of the pelvic drain tube through the perineal wound should be considered as an independent risk factor predisposing to perineal healing disorders.

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Section: Introductionmentioning

confidence: 99%

Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing?

Pramateftakis

Kanellos

Christoforidis

et al. 2012

International Journal of Surgical Oncology

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“…It is recognised that high-resolution MRI staging can accurately predict those patients with good prognosis stage III rectal tumours suitable for treatment with high-quality surgery alone 22. The Mayo Clinic group reported just 5.5% local recurrence rate in which APER comprised 38% of the series in a cohort of 655 patients treated without RT, in which over 20% had stage III rectal tumours 28. Data from Swansea reports equivalent rates of margin involvement, local recurrence and survival in T3/T4 node positive rectal cancers in which neoadjuvant treatment was reserved for predicted margin involvement and significant nodal disease,29 which is confirmed by longitudinal analysis of this selective approach to RT 30.…”

Section: Discussionmentioning

confidence: 99%

Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR)

et al. 2016

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IntroductionThere are 11 500 rectal cancers diagnosed annually in the UK. Although surgery remains the primary treatment, there is evidence that preoperative radiotherapy (RT) improves local recurrence rates. High-quality surgery in rectal cancer is equally important in minimising local recurrence. Advances in MRI-guided prediction of resection margin status and improvements in abdominoperineal excision of the rectum (APER) technique supports a reassessment of the contribution of preoperative RT. A more selective approach to RT may be appropriate given the associated toxicity.Methods and analysisThis trial will explore the feasibility of a definitive trial evaluating the omission of RT in resectable low rectal cancer requiring APER. It will test the feasibility of randomising patients to (1) standard care (neoadjuvant long course RT±chemotherapy and APER, or (2) APER surgery alone for cT2/T3ab N0/1 low rectal cancer with clear predicted resection margins on MRI. RT schedule will be 45 Gy over 5 weeks as current standard, with restaging and surgery after 8–12 weeks. Recruitment will be for 24 months with a minimum 12-month follow-up.ObjectivesObjectives include testing the ability to recruit, consent and retain patients, to quantify the number of patients eligible for a definitive trial and to test feasibility of outcomes measures. These include locoregional recurrence rates, distance to circumferential resection margin, toxicity and surgical complications including perineal wound healing, quality of life and economic analysis. The quality of MRI staging, RT delivery and surgical specimen quality will be closely monitored.Ethics and disseminationThe trial is approved by the Regional Ethics Committee and Health Research Authority (HRA) or equivalent. Written informed consent will be obtained. Serious adverse events will be reported to Swansea Trials Unit (STU), the ethics committee and trial sites. Trial results will be submitted for peer review publication and to trial participants.Trial registration numberISRCTN02406823.

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“…indeed, a recent report from a singleinstitution series shows local recurrence rates of 4.3% for surgery alone in this same population. 17 unfortunately, this study is limited by its nonrandomized design and small sample size. in particular, 47% (57/122) of the patients in this study had stage i tumors and 53% (65/122) had stage ii and stage iii tumors.…”

Section: Selected Articlementioning

confidence: 93%

Canadian Association of General Surgeons, the American College of Surgeons, the Canadian Society of Colon and Rectal Surgeons, and the American Society of Colon and Rectal Surgeons

Morris¹,

Kennedy²,

Macdonald³

et al. 2013

Diseases of the Colon &Amp; Rectum

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Outcomes following surgery without radiotherapy for rectal cancer

Abstract: Well-performed, standardized APRs have similar local recurrence to AR. Radiation therapy may not confer much additional benefit.

Cited by 68 publications

References 28 publications

Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing?

Abdominoperineal Resection for Rectal Cancer: Is the Pelvic Drain Externalization Site an Independent Risk Factor for Perineal Wound Healing?

Protocol for a multicentre randomised feasibility trial evaluating early Surgery Alone In LOw Rectal cancer (SAILOR)

Canadian Association of General Surgeons, the American College of Surgeons, the Canadian Society of Colon and Rectal Surgeons, and the American Society of Colon and Rectal Surgeons

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