The Swedish rectal cancer registry

Påhlman, Lars; Bohe, Måns; Cedermark, Björn; Dahlberg, Mikael; Lindmark, Gunilla; Sjödahl, Rune; Öjerskog, B; Damber, Lena; Johansson, Robert

doi:10.1002/bjs.5679

Cited by 337 publications

(252 citation statements)

References 22 publications

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“…Dedicated centers report local recurrence rates below 4% in selected series (3)(4)(5) and population-based recurrence rates of 7-9% are not uncommon (6). The local recurrence rate in the present population-based cohort is comparable to the national average for the relevant period, i.e., less than 10%.…”

Section: Discussionsupporting

confidence: 45%

“…However, local recurrence after resection of rectal cancer is still a substantial clinical problem. Dedicated centers report local recurrence rates in selected series of less than 4% but population-based results are rather close to 10% (3)(4)(5)(6). Such treatment failures lead to severe, often intractable symptoms and premature death in the majority of patients (7,8).…”

Section: Introductionmentioning

confidence: 99%

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Genomic CGH-assessed structural DNA alterations in rectal carcinoma as related to local recurrence following primary operation for cure

Kodeda

Asting

Lönnroth

et al. 2012

International Journal of Oncology

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Abstract. Several factors determine overall outcome and possible local recurrence after curative surgery for rectal carcinoma. Surgical performance is usually believed to be the most pertinent factor, followed by adjuvant oncological treatment and tumor histopathology. However, chromosomal instability is common in colorectal cancer and tumor clones are assumed to differ in aggressiveness and potential of causing local recurrence. The aim of this study was, therefore, to evaluate if genetic alterations in primary rectal carcinoma are predictive of local recurrences. A large clinical database with linked bio-bank allowed for careful matching of two patient groups (R0) resected for rectal carcinoma. One group had developed early, isolated local recurrences and the other group seemed cured after 93 months follow-up. DNA from the primary tumors was analysed with array-CGH (comparative genomic hybridization) including 55,000 genomic probes. DNA from all primary tumors in both groups displayed previously reported and well-recognised DNA aberrations in colorectal carcinoma. Significant copy number gains were confirmed in the 4q31.1-31.22 region in DNA from tumors with subsequent local recurrence. Twenty-two affected genes in this region code for products with high relevance in tumor biology (p53 regulation, cell cycle activity, transcription). DNA from rectal carcinoma displayed well-known aberrations as described for colon carcinoma with no obvious prediction of local rectal recurrence. Gains in the 4q31.1-31.22 DNA region are highly potential for local recurrence despite R0 resection to be confirmed in larger patient materials. IntroductionColorectal cancer is the third most common malignancy in Europe and the USA (1,2). The treatment of patients with rectal cancer has improved significantly the past decades, where meticulous surgery with clear resection margins is important for cure. Besides improved surgery, preoperative radiotherapy and chemoradiotherapy add to improved treatment results. However, local recurrence after resection of rectal cancer is still a substantial clinical problem. Dedicated centers report local recurrence rates in selected series of less than 4% but population-based results are rather close to 10% (3-6). Such treatment failures lead to severe, often intractable symptoms and premature death in the majority of patients (7,8). Thus, it is important to gain further knowledge of factors that determine increased risks for local recurrence following primary operation of rectal carcinoma aimed at cure. The present study evaluates whole genomic array-CGH (comparative genomic hybridization) analysis comparing more than 55,000 DNA sites in primary rectal tumors from patients with tissue in a large bio-bank with linked clinical information. DNA from tumors that recurred locally and non-recurrent tumors were analyzed with the aim to link structural DNA-alterations to isolated local recurrence following R0-resections. Materials and methods Selection of patients.The Sahlgrenska University Hospital is a non-...

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Section: Discussionsupporting

confidence: 45%

Section: Introductionmentioning

confidence: 99%

Genomic CGH-assessed structural DNA alterations in rectal carcinoma as related to local recurrence following primary operation for cure

Kodeda

Asting

Lönnroth

et al. 2012

International Journal of Oncology

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“…When new treatment options and therapies develop in centers outside the national welfare system, conclusions regarding the effects of a new paradigm at the national level are difficult to draw. Large national registers can be used to validate data from small centers by identifying low frequency side-effects, as well as cultural differences in outcome and indications (69).…”

Section: Study IVmentioning

confidence: 99%

Response to neoadjuvant treatment in rectal cancer surgery

Loftås

2016

Linköping University Medical Dissertations

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Rectal cancer is one of the three most common malignancies in Sweden with an annual incidence of about 2000 cases. Current treatment consists of surgical resection of the rectum including the loco-regional lymph nodes in the mesorectum. In advanced cases, neoadjuvant chemo-radiotherapy (CRT) prior to the operative treatment reduces local recurrences and enables surgery. The neoadjuvant treatment can also eradicate the tumour completely, i.e. complete response. This research project was designed to investigate the effects of preoperative radiotherapy/ CRT and analyze methods to predict response to CRT. Study I investigated the expression of the FXYD-3 protein with immunohistochemistry in rectal cancer, with or without preoperative radiotherapy. The results from the total cohort showed that, strong FXYD-3 expression was correlated to infiltrative tumour growth (p = 0.02). In the radiotherapy group, strong FXYD-3 expression was related to an unfavourable prognosis (p = 0.02). Tumours with strong FXYD-3 expression had less tumour necrosis (p = 0.02) after radiotherapy. FXYD-3 expression in the primary tumour was increased compared to normal mucosa (p=0.008). We concluded that FXYD-3 expression was a prognostic factor in patients receiving preoperative radiotherapy for rectal cancer. Study II investigated FXYD-3 expression in tumours that developed local recurrences following surgery and compared this with expression in tumours that did not develop local recurrences. There was no difference in the expression of FXYD-3 between the group that developed local recurrences and the group that did not develop local recurrences. There was no difference in survival between those with strong or weak FXYD-3 expression. We concluded that this study could not confirm the findings from study 1 i.e. that FXYD-3 expression has prognostic significance in rectal cancer. Study III was a register-based study on the incidence and effects of complete response to neoadjuvant treatment. Eight per cent of the patients with adequate CRT to achieve complete response also had a complete histological response of the luminal tumor in the resected bowel. Sixteen per cent of that group had remaining lymph node metastases in the operative specimen. Chemotherapy together with radiotherapy doubled the chance of complete response in the luminal tumour. Patients with remaining lymph node metastases had a lower survival rate compared to those without. We concluded that residual nodal involvement after neoadjuvant treatment was an important factor for reduced survival after complete response in the luminal tumour. Study IV followed up the results from the previous study by re-evaluating magnetic resonance imaging (MRI)- images in patients with complete tumour response. Two experienced MRI radiologists performed blinded re-staging of post CRT MR- images from patients with complete response in the luminal tumour. One group with lymph node metastases and another one without were studied and the results compared with the pathology reports. The sensitivity, spe...

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“…Generally accepted international treatment guidelines are yet to be developed. Some countries recommend preoperative radiation or chemoradiation to almost all rectal cancer patients [11,18] , whereas others recommend neoadjuvant chemotherapy to all patients with stage Ⅱ and Ⅲ rectal cancer [19] . Finally, others argue for a more selective neoadjuvant treatment policy offering it only to patients with preoperative MRI showing threatened CRM (nearest tumor tissue < 3 mm from predicted CRM) or for tumors in the lower half of the rectum [3,[20][21][22] .…”

Section: Neoadjuvant Treatmentmentioning

confidence: 99%

“…has yielded local recurrence rates of 30% or higher [30] . The benefits of the mesorectal dissection technique have been confirmed in several European countries after introduction of training programs and national consensuses of TME as the standard operation method for rectal cancer [11,18,31] . It has been documented that cancers located in the upper rectum do not need to be removed along with all the fatty tissue surrounding the rectum (mesorectum) down to the pelvic floor [32] .…”

Section: Anterior Resectionmentioning

confidence: 99%

Surgical treatment for rectal cancer: An international perspective on what the medical gastroenterologist needs to know

Lindsetmo¹,

Joh²,

Delaney³

2008

WJG

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Rectal cancer accounts for one third of all colorectal cancers. The age adjusted death rates from colorectal cancer have declined over recent decades due to a combination of colorectal cancer screening, improved diagnostic tests, improved standardized surgical technique, improved medical support, neoadjuvant chemotherapies and radiation treatment or combinations of these. Because of complex treatment algorithms, use of multidisciplinary teams in the management of rectal cancer patients has also been popularized. Medical gastroenterologists performing colonoscopies are frequently the first health care provider to raise the suspicion of a rectal cancer. Although the diagnosis depends on histological confirmation, the endoscopic presentation is almost diagnostic in many cases. In order to meet the patient's immediate needs for information, it is important that the endoscopist has knowledge about the investigations and treatment options that will be required for their patient. The aim of this paper is to describe the modern preoperative investigations and operative procedures commonly offered to rectal cancer patients taking into account perspectives of three colorectal surgeons, practicing in the USA, Europe and Asia.

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The Swedish rectal cancer registry

Abstract: These good population-based results are due, in part, to the nationwide prospective quality assurance registration.

Cited by 337 publications

References 22 publications

Genomic CGH-assessed structural DNA alterations in rectal carcinoma as related to local recurrence following primary operation for cure

Genomic CGH-assessed structural DNA alterations in rectal carcinoma as related to local recurrence following primary operation for cure

Response to neoadjuvant treatment in rectal cancer surgery

Surgical treatment for rectal cancer: An international perspective on what the medical gastroenterologist needs to know

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