Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

Wu, Zeyu; Wan, Jin; Zhao, Gang; Lin, Pei; Du, Jing; Yao, Yuan; Liu, Quan-Fang; Lin, Hang

doi:10.3748/wjg.14.4805

Cited by 16 publications

(9 citation statements)

References 25 publications

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“…Wu et al (24) studied 56 patients who were surgically treated for middle and lower rectal carcinoma and found 7 (12.5%) cases with local recurrence. They reported that high preoperative CEA levels and neoplasic venous emboli were significantly correlated with recurrence.…”

Section: Discussionmentioning

confidence: 99%

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Rezende

Palma

Toloi

et al. 2013

Arq. Gastroenterol.

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ContextThe serum carcinoembryonic antigen (CEA) is an important prognostic factor in colorectal cancer, however the rectum presents different routes of venous drainage, stating that the level of CEA in peripheral and mesenteric rectal tumors may be different, depending on the location of the tumor in the rectal segment.ObjectiveThe goal of this study was to evaluate the relationship between the peripheral and mesenteric venous levels of CEA and the association between these levels and the tumour location in the rectums of patients successfully operated on for rectal carcinoma.MethodsThirty-two patients who were surgically treated for rectal carcinoma were divided into patients with tumours located in the upper rectum (n = 11) or lower rectum (n = 21). The CEA values were assessed by electrochemiluminescence immunoassay. Serum and mesenteric CEA levels were associated with the tumour anatomopathological characteristics: location, histological type, cellular differentiation grade, depth of invasion into the rectal wall, angiolymphatic invasion, tumour, node, and metastasis staging; and the CEA index (≤1.0 or ≥1.0 ng /mL).ResultsAnalysis of the serum CEA values using clinical and anatomopathological parameters revealed no significant association with tumour location, histological type, cellular differentiation grade, depth of invasion into the intestinal wall, and tumour, node, and metastasis staging. The mesenteric CEA levels were significantly associated with the tumour location (P = 0.01). The CEA values in the mesenteric venous blood and the presence of angiolymphatic invasion (P = 0.047) were significantly different. A significant relationship was found between the CEA index value and the rectal tumour location (P = 0.0001).ConclusionsThe CEA levels were higher in the mesenteric vein in tumours located in the upper rectum and in the presence of angiolymphatic invasion. CEA drainage from lower rectum adenocarcinomas preferentially occurs through the systemic pathway.

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Section: Discussionmentioning

confidence: 99%

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Rezende

Palma

Toloi

et al. 2013

Arq. Gastroenterol.

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“…Following resection, circumferential margin positivity and tumor perforation are the primary factors that influence the development of locoregional recurrence (19).…”

Section: Discussionmentioning

confidence: 99%

The techniques of sphincter-saving extrasphincteric dissection and proximal segmental sphincteric excision in low rectal cancer surgery

Yücesoy¹

2014

UCD

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Objective: To define the techniques used in lower rectal cancer surgery, by transvaginal and transperineal approach; extrasphincteric dissection, proximal segmental sphincteric excision and transsphincteric rectal resection. Material and Methods:Between 2007 and 2013, 7 patients (4 female, 3 male with lower rectal cancer were operated by sphincter-saving extrasphincteric disection and proksimal sphincteric excision techniques. After completion of the rectosigmoid dissection and total mesorectal excision up to the puborectal muscle level; extrasphincteric rectal dissection, transsphincteric rectal resection and ultra-low coloanal anastomosis were performed by using the transvaginal and transperineal approach in the sublevator phase of the operation.Results: Seven patients were operated with sublevator access for lower rectal cancer. Bowel contiunity has been provided in all patients. One patient died due to surgical complications in the early postoperative period. One patient deceveloped anastomotic leakage and there were two patients with anastomotic stricture. Circumferential resection margin and tumoral perforation were found negative in all of the patients. Tumoral deposits at the distal resection line was observed in one patient. Conclusion:The techniques of sublevator rectal resection may be considered as an alternative sphincter-saving surgical method, especially in lower rectal cancer surgery.Key Words: Lower rectal cancer, sphincter-saving extrasphincteric dissection, proximal segmental sphincteric excision, transsphincteric rectal resection INTRODUCTIONColorectal cancer is the third most common tumor in men and women in the Western world, while it ranks as the second leading cause of cancer -related deaths (1). In approximately 25-30% of all cases of colorectal cancer, the tumor is located in the rectum (2), and in 70-80% of patients with rectal cancer it is located in the 2/3 of the rectum (3). In 90% of rectal cancer cases, the tumor is limited to the rectum and peri-rectal lymphatic tissue, thus surgical treatment is the primary option. Low rectal cancers have high rates of abdominoperineal resection and local recurrence as compared to those located in other parts (4, 5).The rectum is approximately 20 cm in length from the anal verge, and is evaluated in three sections of equal length (upper, middle and lower) (6). The lower rectum can be divided into two sections depending on the level of the puborectal muscle as supralevator and sublevator. The sublevator section constitutes distal 2/3 of the lower rectum, and is approximately 4-6 cm long. Sublevator access enables direct vision of the rectal segment that is below the levator muscle and performing surgical procedures. The distal rectum at the sublevator level is completely surrounded by the external sphincter complex that is located perpendicularly and shaped as pulleys, forming two intertwined cylindrical muscular structure. According to the anatomy described by Ahmed Shafik (7), the upper and wide portion of the perpendicular seated pulley -like ...

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“…Similarly, another study with 1,146 patients with CRC found that, following use of a multivariate analysis, preoperative CEA levels proved a highly significant prognostic factor even when stage and grade were introduced in the model ( 150 ). In addition, elevated preoperative CEA in stage III and IV CRC are considered to be a potent independent risk factor as far as local relapse, short disease-free survival and OS are concerned ( 151 ).…”

Section: Prognostic Markersmentioning

confidence: 99%

Improving diagnosis, prognosis and prediction by using biomarkers in CRC patients (Review)

et al. 2018

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Colorectal cancer (CRC) is among the most common cancers. In fact, it is placed in the third place among the most diagnosed cancer in men, after lung and prostate cancer, and in the second one for the most diagnosed cancer in women, following breast cancer. Moreover, its high mortality rates classifies it among the leading causes of cancer-related death worldwide. Thus, in order to help clinicians to optimize their practice, it is crucial to introduce more effective tools that will improve not only early diagnosis, but also prediction of the most likely progression of the disease and response to chemotherapy. In that way, they will be able to decrease both morbidity and mortality of their patients. In accordance with that, colon cancer research has described numerous biomarkers for diagnostic, prognostic and predictive purposes that either alone or as part of a panel would help improve patient's clinical management. This review aims to describe the most accepted biomarkers among those proposed for use in CRC divided based on the clinical specimen that is examined (tissue, faeces or blood) along with their restrictions. Lastly, new insight in CRC monitoring will be discussed presenting promising emerging biomarkers (telomerase activity, telomere length and micronuclei frequency).

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Risk factors for local recurrence of middle and lower rectal carcinoma after curative resection

Cited by 16 publications

References 25 publications

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

Carcinoembryonic Antigen Levels in the Peripheral and Mesenteric Venous Blood of Patients With Rectal Carcinoma

The techniques of sphincter-saving extrasphincteric dissection and proximal segmental sphincteric excision in low rectal cancer surgery

Improving diagnosis, prognosis and prediction by using biomarkers in CRC patients (Review)

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