The impact of transanal local excision of early rectal cancer on completion rectal resection without neoadjuvant chemoradiotherapy: a systematic review

Zinicola, R.; Nascimbeni, Riccardo; Cirocchi, Roberto; Gagliardi, Giuseppe; Cracco, N.; Giuffrida, Mario; Pedrazzi, Giuseppe; Binda, Gian Andrea

doi:10.1007/s10151-020-02401-8

Cited by 5 publications

(11 citation statements)

References 63 publications

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“…has also been reported in a recent systematic review by Zinicola and colleagues, which analysed 16 studies involving 353 patients with cTME after LE without previous neoadjuvant treatment [27].…”

Section: Discussionsupporting

confidence: 52%

“…In a major series of nonirradiated patients, the prevalence of event ranged between 20% and 88.3%, and the mean prevalence of cTME specimens with no residual cancer was 50% [11,24,25,[27][28][29][30][31][32][33]. In a previously irradiated series, the rate of no residual cancer in the cTME specimen was 45.5% in the series of Pucciarelli et al [7] and 47.5% in the series of Bujko et al [13]; in contrast, in the GRECCAR II trial, residual cancer was found in only three of 28 patients (10.7%) with a rate of no residual cancer of 89.3% [19].…”

Section: Discussionmentioning

confidence: 99%

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Completion total mesorectal excision after neoadjuvant radiochemotherapy and local excision for rectal cancer

Coco,

Delrio,

Rega

et al. 2023

Colorectal Disease

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AimLocal excision (LE) in selected cases after neoadjuvant radiochemotherapy (RCT) for locally advanced rectal cancer in clinically complete or major responders has been recently reported as an alternative to standard radical resection. Completion total mesorectal excision (cTME) is generally performed when high‐risk pathological features are found in LE surgical specimens. The aim of this study was to evaluate the incidence of residual tumour and lymph node metastases after cTME in patients previously treated by RCT + LE. The secondary aims were to quantify the rate of postoperative morbidity and mortality and to evaluate the long‐term oncological outcome of this group of patients.MethodsAll patients treated from 2007 to 2020 by LE for locally advanced rectal cancer with a clinically complete or major response to RCT who had a subsequent cTME for high‐risk pathological factors (ypT >1 and/or TRG >2 and/or positive margins) were included in this multicentre retrospective study. Pathological data, postoperative short‐term morbidity (classified according to Clavien–Dindo) and mortality and oncological long‐term outcome after cTME were recorded in a database. Statistical analysis was performed using Wizard for iOS version 1.9.31.ResultsA total of 47 patients were included in the study. The rate of R0 resection was 95.7%, and a sphincter‐saving procedure was performed in 37 patients (78.7%), with a protective stoma rate of 78.4%. In 28 cases (59.6%), it was possible to perform a minimally invasive approach. A residual tumour (pT and/or pN) on cTME specimens was found in 21 cases (44.7%). The rate of lymph node metastases was 12.8%. The overall short‐term (within 30 days) postoperative morbidity was 34%, but grade >2 postoperative complications occurred in only nine patients (19.1%), with a reoperation rate of 6.4%. No short‐term postoperative deaths occurred. At a median follow‐up of 57 months (range: 21–174), the long‐term stoma‐free rate was 70.2%, and the actuarial 5‐year overall survival (OS), disease‐free survival (DFS) and local control (LC) were 86.7%, 88.9% and 95.7%, respectively.ConclusionWhen patients exhibit high‐risk pathological factors after RCT + LE, cTME should be suggested due to the high risk of residual tumour or lymph node involvement (44.7%). The results after cTME in terms of the rate of R0 resection, sphincter‐saving procedure, postoperative morbidity and mortality and long‐term oncological outcome seem to be acceptable and do not represent a contraindication to use LE as a first‐step treatment in patients with major or complete clinical response after RCT.

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Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Completion total mesorectal excision after neoadjuvant radiochemotherapy and local excision for rectal cancer

Coco,

Delrio,

Rega

et al. 2023

Colorectal Disease

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“…Worse outcomes have been reported following subsequent rectal excision with TME after LE, in addition to poor specimen quality, increased APR rate, and lower DFS [13,14,45,46]. In the present study, only mild adhesion during subsequent surgery, an intact mesorectal fascia plane, a low APR rate, and no recurrent disease were confirmed following subsequent surgery, possibly because MITAS LE was performed without opening or perforating the rectal wall, and two inverted layers of the rectal wall were excised and anastomosed simultaneously by the stapler.…”

Section: Discussionmentioning

confidence: 99%

“…If pathological examination after LE reveals significant risk factors, subsequent radical resection is typically recommended [3,6,[9][10][11], but its significance is unclear [12]. Furthermore, on subsequent total mesorectal excision (TME) after LE, an increased risk of abdominoperineal resection (APR) and worsening quality of TME have been reported [13,14].…”

Section: Introductionmentioning

confidence: 99%

Long-term results of minimally invasive transanal surgery for rectal tumors in 249 consecutive patients

Maeda¹,

Koide

Katsuno

et al. 2022

Surg Today

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Purpose To delineate the long-term results of minimally invasive transanal surgery (MITAS) for selected rectal tumors. Methods We analyzed data, retrospectively, on consecutive patients who underwent MITAS between 1995 and 2015, to establish the feasibility, excision quality, and perioperative and oncological outcomes of this procedure. Results MITAS was performed on 243 patients. The final histology included 142 cancers, 47 adenomas, and 52 neuroendocrine tumors (NET G1). A positive margin of 1.6% and 100% en bloc resection were achieved. The mean operative time was 27.4 min. Postoperative morbidity occurred in 7% of patients, with 0% mortality. The median follow-up was 100 months (up to ≥ 5 years or until death in 91.8% of patients). Recurrence developed in 2.9% of the patients. The 10-year overall survival rate was 100% for patients with NET G1 and 80.3% for those with cancer. The 5-year DFS was 100% for patients with Tis cancer, 90.6% for those with T1 cancer, and 87.5% for those with T2 or deeper cancers. MITAS for rectal tumors ≥ 3 cm resulted in perioperative and oncologic outcomes equivalent to those for tumors < 3 cm. Conclusion MITAS is feasible for the local excision (LE) of selected rectal tumors, including tumors ≥ 3 cm. It reduces operative time and secures excision quality and long-term oncological outcomes.

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“…The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used. [16][17][18] We included studies that reported OBI in HIV participants in Africa. Diagnosis of OBI was laboratory-based in all studies.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of occult hepatitis B among HIV-positive individuals in Africa: A systematic review and meta-analysis

2022

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The prevalence of hepatitis B virus among HIV-seropositive individuals is believed to be high, and yet the disease remains neglected in many areas of the continent. Little is known about occult hepatitis in HIV individuals. This review assessed occult hepatitis B infection and its prevalence in the different regions of the African continent. It also determines its prevalence in the HIV population which is endemic in the region. Studies were searched from the Cochrane, google scholar, PubMed/Medline, and African Journals online. Authors included cross-sectional studies, case controls, and cohorts, from 2010 to January 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Participants, Interventions, Comparisons, Outcomes, and Study design frameworks to develop the search strategy. All studies had participants who were HIV-positive, covering different regions of the continent. Risk ratio was used to measure effect size, and Stata 14 software was used for analysis. Eleven studies met the eligibility criteria, with 2567 participants. Overall prevalence of occult hepatitis B was 11.2%. Regional prevalence was 26.5% for the south, 11% for the north, 9.1% for the east, and 8.5% for the western region. Approximately 10% of HIV-seropositive individuals were co-infected with occult hepatitis B virus. Regionally, the prevalence was highest in the southern region and lowest in the west. The prevalence of occult HBV infection was compared between the southern region and the other regions. It was higher in the south compared to the east (risk ratio = 0.87, 95% confidence interval (0.83–0.91)). It was also higher in the south compared to the north (risk ratio = 0.82, 95% confidence interval (0.79–0.85)), and it was also higher in the south compared to the west (risk ratio = 0.85, 95% confidence interval (0.82–0.87)). Public health measures and interventions are required to raise awareness, increase prevention, and reduce spread of the disease. More evidence-based studies need to be carried out.

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The impact of transanal local excision of early rectal cancer on completion rectal resection without neoadjuvant chemoradiotherapy: a systematic review

Cited by 5 publications

References 63 publications

Completion total mesorectal excision after neoadjuvant radiochemotherapy and local excision for rectal cancer

Completion total mesorectal excision after neoadjuvant radiochemotherapy and local excision for rectal cancer

Long-term results of minimally invasive transanal surgery for rectal tumors in 249 consecutive patients

Prevalence of occult hepatitis B among HIV-positive individuals in Africa: A systematic review and meta-analysis

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