Suboptimal surgery and omission of neoadjuvant therapy for upper rectal cancer is associated with a high risk of local recurrence

Bondeven, P.; Laurberg, Søren; Hagemann‐Madsen, Rikke; Pedersen, Birthe D.

doi:10.1111/codi.12869

Cited by 26 publications

(19 citation statements)

References 35 publications

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“…This study has shown a significant reduction in the risk of local recurrence after a local MDT‐directed quality assurance programme in patients with cancer of the upper rectum. A previous report on local recurrence in patients who had PME for upper rectal cancer was disappointing, and suboptimal surgery and/or selection was evident.…”

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 87%

“…A concerningly high rate of local recurrence (13⋅5 per cent) in patients with upper rectal cancer after PME has been reported previously 11 . Evidence of suboptimal surgery and/or selection was clear 9,11 . Similarly, in studies from Germany and Sweden local recurrence rates in patients with upper rectal cancer as high as 10-16 per cent have been reported 12 -15 .…”

Section: Introductionmentioning

confidence: 87%

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Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI

et al. 2019

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Background Optimal management of patients with upper rectal cancer remains unclear. Partial mesorectal excision (PME) without neoadjuvant therapy is currently advocated for the majority of patients. Recent studies, however, reported a high risk of local recurrence and suboptimal surgery. The aim of this study was to evaluate the effects of a quality assurance initiative with postoperative MRI to improve outcomes in these patients. Methods Patients who underwent mesorectal excision with curative intent for rectal cancer in 2007–2013 were included. Postoperative MRI of the pelvis was performed 1 year after surgery. In 2011, a multidisciplinary workshop with focus on extent and completeness of surgery was held for training surgeons, pathologists and radiologists involved in treatment planning. Images of residual mesorectum and histopathological reports were reviewed with regard to the distal resection margin. Local recurrence after a minimum of 3 years' follow‐up was compared between two cohorts from 2007–2010 and 2011–2013. Results A total of 627 patients were included; postoperative MRI of the pelvis was done in 381 patients. The 3‐year actuarial local recurrence rate in patients with upper rectal cancer improved from 12·9 to 5·0 per cent (P = 0·012). After the workshop, fewer patients with cancer of the upper rectum were selected to have PME (90·8 per cent in 2007–2010 versus 80·2 per cent in 2011–2013; P = 0·023), and fewer patients who underwent PME had an insufficient distal resection margin (61·7 versus 31 per cent respectively; P < 0·001). Conclusion Quality assessment of surgical practice may have a major impact on oncological outcome after surgery for upper rectal cancer.

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Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 87%

Section: Introductionmentioning

confidence: 87%

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Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI

et al. 2019

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“…Historically, RC has been associated with high risk of local recurrences, and poor long-term survival prognosis. The last decades' improvements in treatment have led to a marked decrease in the risk of local recurrence and mortality from RC [3,4]. The risk of local recurrence is 7-9%, and the overall five-year survival rate is now 62% [2,3].…”

mentioning

confidence: 99%

“…The last decades' improvements in treatment have led to a marked decrease in the risk of local recurrence and mortality from RC [3,4]. The risk of local recurrence is 7-9%, and the overall five-year survival rate is now 62% [2,3]. About 65-70% of RC patients receive treatment with a curative intent.…”

mentioning

confidence: 99%

Follow-up after rectal cancer: developing and testing a novel patient-led follow-up program. Study protocol

et al. 2017

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Patients are randomized into an intervention group, receiving standardized education and access to self-referral to an assigned project nurse, or a control group following the current follow-up program with routine medicals. The primary outcomes are symptom burden and quality of life, measured by the Functional Assessment of Cancer Therapy - Colorectal (FACT-C) questionnaire. Other outcome and demographic data are collected as patient-reported measures and register-based data. Results from developing the intervention: The education program is based on data from two focus group interviews and the feedback from experts. An algorithm is developed in order to qualify the research nurses' responses to patients' self-referral. Discussion and perspectives: The results of the FURCA study will strengthen the evidence base for RC follow-up, and qualify the ongoing transformation in cancer follow-up programs.

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Neoadjuvant chemoradiation improves oncologic outcomes in low and mid clinical T3N0 rectal cancers

Lavryk

Manilich

Valente

et al. 2019

Int J Colorectal Dis

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Suboptimal surgery and omission of neoadjuvant therapy for upper rectal cancer is associated with a high risk of local recurrence

Abstract: Tumour stage and an involved circumferential resection margin were the most important predictors of local recurrence. For cancer of the upper rectum, partial mesorectal excision was associated with a high risk of local recurrence.

Cited by 26 publications

References 35 publications

Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI

Impact of a multidisciplinary training programme on outcome of upper rectal cancer by critical appraisal of the extent of mesorectal excision with postoperative MRI

Follow-up after rectal cancer: developing and testing a novel patient-led follow-up program. Study protocol

Neoadjuvant chemoradiation improves oncologic outcomes in low and mid clinical T3N0 rectal cancers

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