Volume-outcome Relationship in Rectal Cancer Surgery

Siragusa, Leandro; Sensi, Bruno; Vinci, Danilo; Franceschilli, Marzia; Don, Cristine Pathirannehalage; Bagaglini, Giulia; Bellato, Vittoria; Campanelli, Michela; Sica, Giuseppe

doi:10.21203/rs.3.rs-276079/v1

Cited by 2 publications

(2 citation statements)

References 65 publications

(67 reference statements)

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“…This retrospective analysis has several limitations. Firstly, high surgical volume is associated with clinical outcomes for rectal cancer [32]. The inclusion period of locally advanced rectal cancer patients in our study was 6 years (2012-2018), which was comparable to other studies [12,13].…”

Section: Discussionsupporting

confidence: 79%

Programmed death-ligand 1 and mammalian target of rapamycin signaling pathway in locally advanced rectal cancer

et al. 2022

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Purpose To evaluate the role of programmed death-ligand 1 (PD-L1) and mammalian target of rapamycin (mTOR) signaling pathway in locally advanced rectal cancer (LARC). Methods Between February 2012 and February 2018, 103 patients with LARC treated by neoadjuvant chemoradiotherapy (neoCRT) and total mesorectal excision (TME) were included. PD-L1, mTOR and p-mTOR of pair-matched pre-neoCRT biopsies and post-neoCRT surgical tissue were evaluated by immunohistochemistry. Results The mean combined positive score (CPS), tumor proportion score (TPS) and immune cell score (IC) of pre-neoCRT were 2.24 (0–70), 1.87 (0–70) and 0.67 (0–10), respectively. The mean CPS, TPS and IC of post-neoCRT were 2.19 (0–80), 1.38 (0–80) and 1.60 (0–20), respectively. Significant difference was observed in terms of IC between pre-neoCRT and post-neoCRT (p = 0.010). The 5-year disease-free survival (DFS) rate of the whole group was 62.4%. Multivariate analysis by Cox model indicated that pre-neoCRT TPS [hazard ratio (HR) 1.052, 95% confidence interval (CI) 1.020–1.086, p = 0.001] and post-neoCRT CPS (HR 0.733, 95% CI 0.555–0.967, p = 0.028) were associated with DFS. In the 89 patients without pathological complete response, p-mTOR and IC were upregulated after neoCRT. Conclusions For patients with LARC treated by neoCRT and TME, p-mTOR and IC were upregulated after neoCRT. Pre-neoCRT TPS and post-neoCRT CPS were independent prognostic predictors of DFS.

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Section: Discussionsupporting

confidence: 79%

Programmed death-ligand 1 and mammalian target of rapamycin signaling pathway in locally advanced rectal cancer

et al. 2022

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“…Rectal cancer surgery should be applied by highly experienced teams and in concordance with the latest knowledge. Previous studies that evaluated associations between complication rates and treatment volumes have shown conflicting results [46,47].…”

Section: Patients With Stages I-iii Disease Treated With a Major Rese...mentioning

confidence: 99%

The impact of age on rectal cancer treatment, complications and survival

et al. 2022

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Background The number of older patients with rectal cancer is increasing. Treatment outcome discrepancies persist, despite similar treatment guidelines. To offer the oldest patients optimal individually adjusted care, further knowledge is needed regarding treatment strategy and outcome. The present study aimed to evaluate treatment, postoperative complications, and survival in older patients treated for rectal cancer. Methods This retrospective study included all 666 patients (n=255 females, n=411 males) treated for rectal cancer at Levanger Hospital during 1980-2016 (n=193 <65 years, n=329 65-79 years, n=144 ≥80 years). We performed logistic regression to analyse associations between complications, 90-day mortality, and explanatory variables. We performed a relative survival analysis to identify factors associated with short- and long-term survival. Results Despite a similar distribution of cancer stages across age-groups, patients aged ≥80 years were treated with a non-curative approach more frequently than younger age groups. Among patients aged ≥80 years, 42% underwent a non-curative treatment approach, compared to 25% of patients aged <65 years, and 25% of patients aged 65-79 years. The 90-day mortality was 15.3% among patients aged ≥80 years, compared to 5.7% among patients aged <65 years, and 9.4% among patients aged 65-79 years. Among 431 (65%) patients treated with a major resection with curative intent, the 90-day mortality was 5.9% among patients aged ≥80 years (n=68), compared to 0.8% among patients aged <65 years (n=126), and 3.8% among patients aged 65-79 years (n=237). The rate of postoperative complications was 47.6%. Pneumonia was the only complication that occurred more frequently in the older patient group. The severity of complications increased with three factors: age, American Society of Anaesthesiologists score, and >400 ml perioperative blood loss. Among patients that survived the first 90 days, the relative long-term survival rates, five-year local recurrence rates, and metastases rates were independent of age. Conclusion Patients aged ≥80 years were less likely to undergo a major resection with curative intent and experienced more severe complications after surgery than patients aged <80 years. When patients aged ≥80 years were treated with a major resection with curative intent, the long-term survival rate was comparable to that of younger patients.

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Volume-outcome Relationship in Rectal Cancer Surgery

Cited by 2 publications

References 65 publications

Programmed death-ligand 1 and mammalian target of rapamycin signaling pathway in locally advanced rectal cancer

Programmed death-ligand 1 and mammalian target of rapamycin signaling pathway in locally advanced rectal cancer

The impact of age on rectal cancer treatment, complications and survival

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