Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer

Nelson, Rachel; Boland, Elena; Ewing, B. Mark; Blatchford, Garnet J.; Ternent, Charles A.; Shashidharan, Maniamparampil; Tran, Nancy; Beaty, Jennifer; Thorson, Alan G.

doi:10.1016/j.amjsurg.2009.05.024

Cited by 15 publications

(19 citation statements)

References 17 publications

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“…This result is consistent with the finding of Nelson et al 8 Anastomosis-related complications tended to develop either early or much later after the LAR in 25% of patients; this was consistent with data reported by others. 2-4,12-15. Our analyses showed that the risk factors for anastomosisrelated complications were male gender and lower situated tumors.…”

Section: Discussionsupporting

confidence: 93%

“…In a study by den Dulk et al 5 neoadjuvant radiotherapy increased the risk that a stoma established in a secondary procedure would not be reversible. In contrast, Nelson et al, 8 who provided radiotherapy to 77% of patients, found that radiotherapy was not a risk factor for a permanent stoma.…”

Section: Discussionmentioning

confidence: 91%

“…Comparisons with other studies are limited, because available data were mainly based on the frequency of a defunctioning stoma that was not reversed. 5,8 Comparable studies with shorter follow-up periods and more frequent applications of radiotherapy (55%-77%) reported that 14% 4,8 and 24% of patients, respectively, received a permanent stoma after LAR. 6 Nearly a half of permanent stomas were due to nonreversal of a defunctioning stoma.…”

Section: Discussionmentioning

confidence: 99%

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Permanent Stoma After Low Anterior Resection for Rectal Cancer

Junginger

Gönner

Trinh

et al. 2010

Diseases of the Colon &Amp; Rectum

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 99%

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Permanent Stoma After Low Anterior Resection for Rectal Cancer

Junginger

Gönner

Trinh

et al. 2010

Diseases of the Colon &Amp; Rectum

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“…Further studies that focus on this cohort may provide answers in the future. Although our study did not show that preoperative anal function is a significant predictor of permanent stoma, anal function may be associated with the patient's quality of life after surgery, as well as conversion to permanent stoma after SPS [13,32].…”

Section: Discussioncontrasting

confidence: 85%

Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function

Kim

et al. 2019

Colorectal Disease

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Aim Preoperative factors predictive of permanent stoma creation were investigated in a long‐term follow‐up of patients with mid or low rectal cancer. Method We included patients who underwent radical resection for mid or low rectal cancer with available data for preoperative anal function measured by manometry and Faecal Incontinence Severity Index questionnaire between January 2005 and December 2015 in three tertiary referral hospitals. A permanent stoma was defined as a stoma present until the patient’s last follow‐up visit or death. Preoperative factors that predicted permanent stoma creation were analysed. Results Over a median follow‐up of 57.4 months (range 12–143 months), a permanent stoma was created in 144/577 (25.0%) patients, including 89 (15.4%) who underwent abdominoperineal resection, one (0.2%) who underwent Hartmann’s operation without reversal, 15 (2.6%) with a diverting ileostomy at the time of initial sphincter‐preserving surgery without undergoing stoma reversal, and 39 (6.8%) who underwent permanent ileostomy formation after sphincter‐preserving surgery. Patients with permanent stoma creation had a shorter tumour distance from the anal verge (P < 0.001), larger tumour size (P = 0.020) and higher preoperative Faecal Incontinence Severity Index score (P = 0.020). On multivariable analysis, tumour distance from the anal verge predicted permanent stoma formation (relative risk 0.53 per centimetre increase; 95% confidence interval 0.46–0.60; P < 0.001) but preoperative anal function did not. Conclusion Tumour distance from the anal verge was the only preoperative determinant of permanent stoma creation in rectal cancer patients. These data may help mid and low rectal cancer patients understand the need for permanent stoma.

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“…This observation has led to an enormous interest in accelerated partial breast irradiation (APBI) for early breast cancer over the last decade. Multi-catheter (King et al, 2000; Polgar et al, 2002; Benitez et al, 2004) and balloon catheter brachytherapy (Cuttino et al, 2008; Nelson et al, 2009; Vicini et al, 2011) initially paved the way. However, because of the invasiveness of these procedures, their steep learning curve and risks of infection, lumpectomy cavity coverage with three-dimensional conformal radiotherapy (3D-CRT), and intensity-modulated radiotherapy (IMRT) have grown in popularity.…”

Section: Introductionmentioning

confidence: 99%

Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer

Vermeulen¹,

Cotrutz²,

Morris³

et al. 2011

Front. Oncol.

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We evaluate the CyberKnife (Accuray Incorporated, Sunnyvale, CA, USA) for non-invasive delivery of accelerated partial breast irradiation (APBI) in early breast cancer patients. Between 6/2009 and 5/2011, nine patients were treated with CyberKnife APBI. Normal tissue constraints were imposed as outlined in the National Surgical Adjuvant Breast and Bowel Project B-39/Radiation Therapy Oncology Group 0413 (NSABP/RTOG) Protocol (Vicini and White, 2007). Patients received a total dose of 30 Gy in five fractions (group 1, n = 2) or 34 Gy in 10 fractions (group 2, n = 7) delivered to the planning treatment volume (PTV) defined as the clinical target volume (CTV) +2 mm. The CTV was defined as either the lumpectomy cavity plus 10 mm (n = 2) or 15 mm (n = 7). The cavity was defined by a T2-weighted non-contrast breast MRI fused to a planning non-contrast thoracic CT. The CyberKnife Synchrony system tracked gold fiducials sutured into the cavity wall during lumpectomy. Treatments started 4–5 weeks after lumpectomy. The mean PTV was 100 cm3 (range, 92–108 cm3) and 105 cm3 (range, 49–241 cm3) and the mean PTV isodose prescription line was 70% for groups 1 and 2, respectively. The mean percent of whole breast reference volume receiving 100 and 50% of the dose (V100 and V50) for group 1 was 11% (range, 8–13%) and 23% (range, 16–30%) and for group 2 was 11% (range, 7–14%) and 26% (range, 21–35.0%), respectively. At a median 7 months follow-up (range, 4–26 months), no acute toxicities were seen. Acute cosmetic outcomes were excellent or good in all patients; for those patients with more than 12 months follow-up the late cosmesis outcomes were excellent or good. In conclusion, the lack of observable acute side effects and current excellent/good cosmetic outcomes is promising. We believe this suggests the CyberKnife is a suitable non-invasive radiation platform for delivering APBI with achievable normal tissue constraints.

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Permanent diversion rates after neoadjuvant therapy and coloanal anastomosis for rectal cancer

Cited by 15 publications

References 17 publications

Permanent Stoma After Low Anterior Resection for Rectal Cancer

Permanent Stoma After Low Anterior Resection for Rectal Cancer

Predictors of permanent stoma creation in patients with mid or low rectal cancer: results of a multicentre cohort study with preoperative evaluation of anal function

Accelerated Partial Breast Irradiation: Using the CyberKnife as the Radiation Delivery Platform in the Treatment of Early Breast Cancer

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