Outcomes of patients with abdominoperineal resection (APR) and low anterior resection (LAR) who had very low rectal cancer

Yeom, Seung-Seop; Park, In Ja; Jung, Sung Woo; Oh, Se Heon; Lee, Jong Lyul; Yoon, Yong Sik; Kim, Chan Wook; Lim, Seok‐Byung; Kim, Nayoung; Yu, Chang Sik; Kim, Jin Cheon

doi:10.1097/md.0000000000008249

Cited by 19 publications

(9 citation statements)

References 29 publications

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“…were compared. 49 The overall recurrence rates were 37% and 27%, respectively, and RFS did not differ according to the mode of surgery for different cancer stages.…”

Section: Prognosis Links To the Surgery: Apr Versus Isrmentioning

confidence: 78%

Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

Rouanet

Rivoire

Gourgou

et al. 2020

Journal of Surgical Oncology

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Background: Rate of abdominoperineal resection (APR) varies from countries and surgeons. Surgical impact of preoperative treatment for ultra-low rectal carcinoma (ULRC) initially indicated for APR is debated. We report the 10-year oncological results from a prospective controlled trial (GRECCAR 1) which evaluate the sphincter saving surgery (SSR). Methods: ULRC indicated for APR were included (n = 207). Randomization was between high-dose radiation (HDR, 45 + 18 Gy) and radiochemotherapy (RCT, 45 Gy + 5FU infusion). Surgical decision was based on tumour volume regression at

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“…were compared. 49 The overall recurrence rates were 37% and 27%, respectively, and RFS did not differ according to the mode of surgery for different cancer stages.…”

Section: Prognosis Links To the Surgery: Apr Versus Isrmentioning

confidence: 78%

Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

Rouanet

Rivoire

Gourgou

et al. 2020

Journal of Surgical Oncology

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“…Most studies (including the largest of its kind to date (21)), report that a LAR overall produces a higher survival rate than an APR (paradoxically the disease-free survival rates were suggested to be very similar). Though ndings were commonly confounded by the fact, that the tumours of the patients were relatively high from the anal verge, and that the subgroups had different PCRT rates (22,23). Most studies on the subject of local failure indicate greater rates with APR.…”

Section: Discussionmentioning

confidence: 99%

Discussion of QOL (with Concise Summary of Newer Clinical Research) in Colorectal Cancer Patients Treated in a Retrospective Trial on the Effect of Surgical Resection Margins on Survival, with Relation to Operation Type

Arslani

Rachimis

2020

Preprint

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Background: the survival of patients treated for CRC is showing a trend of increase and with it increasing concern for the QOL of the operated patient. The aim of this study was to examine the relative influence of distal and circumferential resection margin lenght on survival among a select group patients (undergoing routine treatment) in our institution, with no metastases, and not operated on as an emergency. We also hoped to provide a concise reflection of newer clinical research on the topic.Methods: records of 303 patients, that were operated on between January 2009 and January 2014, were retrospectively reviewed for this study. Patients who underwent emergency surgery and those with metastases were excluded, which left 128 patients suitable for statistical analysis. Results: the number of survivors was noticeably higher than the number of deaths in all groups. Analysis with the Mann-Whitney-Wilcoxon test showed statistically significant differences (p < 0.05) in survival between the group with different CRM-s (p=0.01396), and could not be found between different DRM groups (p=0.1132). The logistic regression model of survival analysis showed that the size CRM is an independent predictor (p = 0.0202, AIC = 92.181) and the size of the DRM is not (p = 0.119, AIC = 109.89). Conclusions: a distal resection margin smaller than 1 cm may be oncologically acceptable in a complete R0 excision, which could theoretically help surgeons perform SSR operations with better oncological and functional results.

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“…After exclusion of reports or reviews or meeting abstracts, 12 studies finally remained. [11][12][13][14][15][16][17][18][19][20][21][22] The study characteristics, number of patients, matching, and the scores of the quality assessment of each study are summarized in Table 1. There were 11 retrospective studies and 1 prospective observational study, but no RCTs.…”

Section: Studies Selection and Quality Assessmentmentioning

confidence: 99%

“…Regarding the survival of patients, we used the 5-year OS rate, 5-year DFS rate, and 3-year LAR to reflect. Eight studies 11,13,14,16,17,19,21,22 reporting on DFS showed no significant differences between ISR and APR (hazard ratio [HR] = 0.98; 95% CI = 0.79 to 1.20; P = .82; Figure 5), without significant heterogeneity (χ 2 = 5.18, df = 7, P = .64; I 2 = 0%) and publication bias (Egger's test: P = .05). Similarly, no significant differences were noted in 5-year OS rate (HR = 1.12; 95% CI = 0.70 to 2.14; P = .48) and 3-year LAR (HR = 1.20; 95% CI = 0.78 to 1.87; P = .41) between the 2 groups.…”

Section: Survival Of Patientsmentioning

confidence: 99%

Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer: A Meta-Analysis

Peng

et al. 2020

Surg Innov

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Background. Abdominoperineal resection (APR) has been the standard surgery for ultra-low rectal cancer for a century. In recent years, intersphincteric resection (ISR) has been increasingly used to avoid the permanent colostomy. Up to now, there is no relevant meta-analysis comparing the clinical efficacy of ISR and APR. This meta-analysis aimed to compare the outcomes of these 2 procedures. Methods. A comprehensive search of online databases was performed on PubMed, EMBASE, and the Cochrane Library to obtain comparative studies of ISR and APR. Then the data from studies that met the inclusion criteria were extracted and analyzed. Results. A total of 12 studies covering 2438 patients were included. No significant differences were found between ISR and APR in gender, body mass index, distance from tumor to anal edge, operative time, and blood loss. In addition, hospital stay (weighted mean differences = −2.98 days; 95% confidence interval [CI] = −3.54 to −2.43; P < .00001) and postoperative morbidity (odds ratio [OR] = 0.76; 95% CI = 0.59 to 0.99; P = .04) were significantly lower in ISR group compared with APR group. However, patients who underwent ISR showed lower pathological T-stage (T3T4%, OR = 0.49; 95% CI = 0.28 to 0.86; P = .01) and lymph node metastasis rate (OR = 0.77; 95% CI = 0.59 to 1.01; P = .06) compared with those who underwent APR. Moreover, oncological outcomes were similar between the 2 groups. Conclusion. ISR may provide a safe alternative to APR, with shorter hospital stays, lower postoperative morbidity, and similar oncological outcomes. Well-designed randomized controlled trials are needed to confirm and update the findings of this analysis.

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Outcomes of patients with abdominoperineal resection (APR) and low anterior resection (LAR) who had very low rectal cancer

Abstract: Supplemental Digital Content is available in the text

Cited by 19 publications

References 29 publications

Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

Sphincter‐saving surgery for ultra‐low rectal carcinoma initially indicated for abdominoperineal resection: Is it safe on a long‐term follow‐up?

Discussion of QOL (with Concise Summary of Newer Clinical Research) in Colorectal Cancer Patients Treated in a Retrospective Trial on the Effect of Surgical Resection Margins on Survival, with Relation to Operation Type

Intersphincteric Resection Versus Abdominoperineal Resection for Low Rectal Cancer: A Meta-Analysis

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