The Modern Abdominoperineal Excision

Marr, R.; Birbeck, K; Garvican, James; Macklin, Christopher P.; Tiffin, Nicholas J.; Parsons, Wendy J; Dixon, M. F.; Mapstone, Nicholas P.; Sebag‐Montefiore, David; Scott, Nigel; Johnston, D.; Sagar, P. M.; Finan, P. J.; Quirke, Philip

doi:10.1097/01.sla.0000167926.60908.15

Cited by 388 publications

(66 citation statements)

References 24 publications

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“…Previous studies of risk factors for circumferential resection margin positivity have focused on tumor factors such as T and N categories, tumor size and location, vascular invasion, and the need for abdominoperineal resection. 14,20–22 Other studies have reported associations between higher provider and hospital volumes and improved outcomes for oncologic procedures. 23–25 In the present analysis, we have identified additional patient and tumor factors associated with underlying risk for margin-positive resection.…”

Section: Discussionmentioning

confidence: 99%

A Novel Risk-Adjusted Nomogram for Rectal Cancer Surgery Outcomes

Russell

You

et al. 2013

JAMA Surg

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Context Circumferential resection margin is the primary determinant of local recurrence and a major factor in survival in rectal cancer. Neither chemotherapy nor chemoradiation compensates for a positive margin. Objective To identify treatment-related factors associated with hospital margin-positive resection and to develop a tool that could be used by individual hospitals to assess their outcomes based on their unique mix of patient and tumor characteristics. Design Retrospective review of the National Cancer Data Base, 1998–2007. Settings Community and academic/research hospitals. Patients Histologically confirmed localized rectal/rectosigmoid adenocarcinoma. Outcome measures Rate of margin positivity determined and adjusted for patient- and tumor-related factors to calculate expected margin positivity per hospital. An observed/expected ratio was calculated based on patient and tumor factors to identify treatment associated variation. Results Overall margin-positive resection rate was 5.2%. Patients with positive margins were more likely to be older, male, and African American; not have private insurance; and have their cancer diagnosed later in the study period. Associated tumor factors include rectal location, higher American Joint Committee on Cancer stage, signet/mucinous histology, and poor/undifferentiated grade. Among hospitals that were significantly low outliers, 47% were comprehensive community hospitals and 43.9% were academic/research hospitals; of those that were significantly high outliers, 52.3% were comprehensive community hospitals and 17.8% were academic/research hospitals. High-volume centers made up 80% of significantly low-outlier hospitals and 17% of significantly high outliers. Rates of chemotherapy and radiation were similar, but low-outlier hospitals gave more neoadjuvant radiation (26.3% vs 17%). Conclusions After adjustment for patient and tumor factors we identified both low and high outliers for margin positivity at resection as well as potentially modifiable risk factors. The nomogram created in this model allows evaluation of observed and expected event rates for individual hospitals, providing a hospital self-assessment tool for identifying targets for improvement.

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Section: Discussionmentioning

confidence: 99%

A Novel Risk-Adjusted Nomogram for Rectal Cancer Surgery Outcomes

Russell

You

et al. 2013

JAMA Surg

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“…The most common site of metastasis was the liver (40%), followed by the lungs (30%), peritoneal seedling (20%), and the brain (10%). The volume of tumors can be reduced by preoperative radiochemotherapy, which also induces downstaging, facilitates surgical resection (10,27), and prevents the distal intramural spread of the tumor, thereby decreasing the surgical distal margin and perirectal lymph node. The technique that allows us to obtain sufficient distal margin in all patients is called transanal intersphincteric resection.…”

Section: Discussionmentioning

confidence: 99%

301. Total mesorectal excision for the treatment of rectal cancer

Zedan¹

2016

European Journal of Surgical Oncology (EJSO)

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“…Recently Marr et al38 reported that in the linear dimension of transverse slices of tissue containing the tumor, the median, posterior, and lateral measurements were smaller in the APR than the AR. He observed that APR specimens with a histologically-positive CRM (Circumferential Resection Margin) had a smaller area of tissue outside the muscularis propria compared to CRM-negative APR specimens.…”

Section: Perineum Dissection During Abdominoperineal Resectionmentioning

confidence: 99%

Anatomic Basis of Sharp Pelvic Dissection for Curative Resection of Rectal Cancer

Kim

2005

Yonsei Med J

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The optimal goals in the surgical treatment of rectal cancer are curative resection, anal sphincter preservation, and preservation of sexual and voiding functions. The quality of complete resection of rectal cancer and the surrounding mesorectum can determine the prognosis of patients and their quality of life. With the emergence of total mesorectal excision in the field of rectal cancer surgery, anatomical sharp pelvic dissection has been emphasized to achieve these therapeutic goals. In the past, the rates of local recurrence and sexual/voiding dysfunction have been high. However, with sharp pelvic dissection based on the pelvic anatomy, local recurrence has decreased to less than 10%, and the preservation rate of sexual and voiding function is high. Improved surgical techniques have created much interest in the surgical anatomy related to curative rectal cancer surgery, with particular focus on the fascial planes and nerve plexuses and their relationship to the surgical planes of dissection. A complete understanding of rectum anatomy and the adjacent pelvic organs are essential for colorectal surgeons who want optimal oncologic outcomes and safety in the surgical treatment of rectal cancer.

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The Modern Abdominoperineal Excision

Cited by 388 publications

References 24 publications

A Novel Risk-Adjusted Nomogram for Rectal Cancer Surgery Outcomes

A Novel Risk-Adjusted Nomogram for Rectal Cancer Surgery Outcomes

301. Total mesorectal excision for the treatment of rectal cancer

Anatomic Basis of Sharp Pelvic Dissection for Curative Resection of Rectal Cancer

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