Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Huang, Ching‐Wen; Wang, Jaw‐Yuan

doi:10.1002/kjm2.12161

Cited by 15 publications

(13 citation statements)

References 81 publications

(227 reference statements)

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“…Moreover, the number of harvested lymph nodes essentially decreased after preoperative CCRT (median, 4-14) (39). In the present study, the median number of harvested lymph nodes after neoadjuvant CCRT was 10 (range, [8][9][10][11][12][13][14], which is consistent with previous results (39).…”

Section: Discussionsupporting

confidence: 92%

“…However, a comparable DRM distance and favorable negative rates of CRM were reached. The introduction of extended oxaliplatin-based chemotherapy and a longer interval between radiotherapy completion and robotic surgery might have contributed to the success (8,33). The sphincter preservation rate in patients with rectal cancer in our study was 96.3%, comparable to that reported by Kim et al (18) and Saklani et al (16).…”

Section: Discussionsupporting

confidence: 83%

“…A German study reported that the 5-year cumulative incidence of local relapse was 6% in patients who received preoperative CCRT (3,4). Similar results were reported in other studies (5)(6)(7), and preoperative CCRT with subsequent surgical intervention has been highly recommended as the treatment for patients with of LARC (8).…”

Section: Introductionsupporting

confidence: 64%

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Oncological Outcomes of Robotic-Assisted Surgery With High Dissection and Selective Ligation Technique for Sigmoid Colon and Rectal Cancer

Yin

Chen

et al. 2020

Front. Oncol.

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Background: Curative resection of sigmoid colon and rectal cancer includes "high tie" of the inferior mesenteric artery (IMA). However, IMA ligation compromises blood flow to the anastomosis, which may increase the complication rate. We present preliminary experiences of operative and oncologic outcomes of patients with rectal or sigmoid colon cancer who underwent robotic surgery employing the high dissection and selective ligation technique. Methods: Over May 2013 to April 2017, 113 stage I-III rectal or sigmoid colon cancer patients underwent robotic surgery with the single-docking technique at one institution. We performed D3 lymph node dissection and low-tie ligation of the IMA (i.e., high dissection and selective ligation technique). Clinicopathological features, perioperative parameters, and postoperative outcomes were retrospectively analyzed. Overall survival (OS) and disease-free survival (DFS) were calculated using the Kaplan-Meier method. Results: Sphincter preservation rate was 96.3% in rectal cancer patients. Median number of harvested lymph nodes was 12. Apical nodes were pathologically harvested in 84 (82.4%) patients. R0 resection was performed in 108 (95.6%) patients. Overall complication rate was 17.7%; but most complications were mild and the patients recovered uneventfully. Estimated 5-year OS was 86.1% and 3-year DFS was 79.6% after median follow-up periods of 49.1 months (range, 5.3-85.3). Yin et al. High Dissection and Selective Ligation Conclusions: High dissection of the IMA and selective ligation of the major feeding vessel to the sigmoid colon or rectum can be safely performed using da Vinci Surgical System,yielding favorable clinical, and oncologic outcomes in rectal or sigmoid colon cancer treatment.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 83%

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Oncological Outcomes of Robotic-Assisted Surgery With High Dissection and Selective Ligation Technique for Sigmoid Colon and Rectal Cancer

Yin

Chen

et al. 2020

Front. Oncol.

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“…Microscopically, no differences were noted regarding the histologic grade, PNI, and CRM distance between the three groups. In addition, LVI and advanced stage were observed in the LS group, probably because of fewer patients receiving preoperative CCRT in the LS group because neoadjuvant therapy can decrease the size of tumor cells, besides downstaging or even causing complete remission after the treatment [24,25]. However, no differences were noted regarding TRS and CR among the three groups.…”

Section: Discussionmentioning

confidence: 89%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

Chen

Huang

et al. 2020

BMC Surg

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Background: Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation. Methods: This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months. Results: Upon multivariate analysis, histologic grade (P = 0.016), and stage (P < 0.001) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P < 0.05). Multivariable analyses observed the surgical method (P = 0.037), histologic grade (P = 0.006), and CRM involvement (P = 0.043) were the independent factors of DFS, whereas histologic grade (P = 0.011) and pathologic stage (P = 0.022) were the independent prognostic variables of OS. Conclusions: This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

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“…Microscopically, no differences were noted regarding the histologic grade, PNI, and CRM distance between the three groups. In addition, LVI and advanced stage were observed in the LS group, probably because of fewer patients receiving preoperative CCRT in the LS group because neoadjuvant therapy can 9 decrease the size of tumor cells, besides downstaging or even causing complete remission after the treatment [24,25]. However, no differences were noted regarding TRS and CR among the three groups.…”

Section: Discussionmentioning

confidence: 99%

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

CHEN

Huang

et al. 2020

Preprint

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Background Total mesorectal excision (TME) with or without neoadjuvant concurrent chemoradiotherapy (CCRT) is the treatment for rectal cancer (RC). Recently, the use of conventional laparoscopic surgery (LS) or robotic-assisted surgery (RS) has been on a steady increase cases. However, various oncological outcomes from different surgical approaches are still under investigation.Materials and methods This is a retrospective observational study comprising 300 consecutive RC patients who underwent various techniques of TME (RS, n = 88; LS, n = 37; Open surgery, n = 175) at a single center of real world data to compare the pathological and oncological outcomes, with a median follow-up of 48 months.Results Upon multivariate analysis, histologic grade ( P =0.048), tumor depth ( P =0.003), and pre-operative CCRT ( P =0.038) were the independent factors of circumferential resection margin (CRM) involvement. The Kaplan-Meier survival analysis determined RS, early pathologic stage, negative CRM involvement, and pathologic complete response to be significantly associated with better overall survival (OS) and disease-free survival (DFS) (all P <0.05). Multivariable analyses observed the surgical method ( P =0.037), histologic grade ( P =0.006), and CRM involvement ( P =0.043) were the independent factors of DFS, whereas histologic grade ( P =0.011) and pathologic stage ( P =0.022) were the independent prognostic variables of OS.Conclusions This study determined that RS TME is feasible because it has less CRM involvement and better oncological outcomes than the alternatives have. The significant factors influencing CRM and prognosis depended on the histologic grade, tumor depth, and pre-operative CCRT. RS might be an acceptable option owing to the favorable oncological outcomes for patients with RC undergoing TME.

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Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Cited by 15 publications

References 81 publications

Oncological Outcomes of Robotic-Assisted Surgery With High Dissection and Selective Ligation Technique for Sigmoid Colon and Rectal Cancer

Oncological Outcomes of Robotic-Assisted Surgery With High Dissection and Selective Ligation Technique for Sigmoid Colon and Rectal Cancer

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

An observational study of patho-oncological outcomes of various surgical methods in total mesorectal excision for rectal cancer: a single center analysis

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