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Journal of Gastrointestinal Surgery :... Jun 2022Outcomes of rectal adenocarcinoma vary considerably. Composite "textbook oncologic outcome" (TOO) is a single metric that estimates optimal clinical performance for...
BACKGROUND
Outcomes of rectal adenocarcinoma vary considerably. Composite "textbook oncologic outcome" (TOO) is a single metric that estimates optimal clinical performance for cancer surgery.
METHODS
Patients with stage II/III rectal adenocarcinoma who underwent single-agent neoadjuvant chemoradiation and proctectomy within 5-12 weeks were identified in the National Cancer Database (NCDB). TOO was defined as achievement of negative distal and circumferential resection margin (CRM), retrieval of ≥ 12 nodes, no 90-day mortality, and length of stay (LOS) < 75th percentile of corresponding year's range. Multivariable logistic regression was used to identify predictors of TOO.
RESULTS
Among 318,225 patients, 8869 met selection criteria. Median age was 62 years (IQR 54-71), and 5550 (62.6%) were males. Low anterior resection was the most common procedure (LAR, 6,037 (68.1%) and 3084 (34.8%) were treated at a high-volume center (≥ 20 rectal resections/year). TOO was achieved in 3967 patients (44.7%). Several components of TOO were achieved commonly, including negative CRM (87.4%), no 90-day mortality (98.0%), no readmission (93.0%), and no prolonged hospitalization (78.8%). Logistic regression identified increasing age, non-private insurance, low-volume centers, open approach, Black race, Charlson score ≥ 3, and abdominoperineal resection (APR) as predictors of failure to achieve TOO. Over time, TOOs were attained more commonly which correlated with increased minimally invasive surgery (MIS) adoption. TOO achievement was associated with improved survival.
CONCLUSIONS
Rectal adenocarcinoma patients achieve TOO uncommonly. Treatment at high-volume centers and MIS approach were among modifiable factors associated with TOO in this study.
Topics: Adenocarcinoma; Female; Humans; Laparoscopy; Male; Margins of Excision; Middle Aged; Proctectomy; Rectal Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 35441331
DOI: 10.1007/s11605-021-05213-9 -
Diseases of the Colon and Rectum Feb 2021
Topics: Humans; Intraoperative Complications; Laparoscopy; Postoperative Complications; Proctectomy; Rectal Neoplasms; Robotic Surgical Procedures
PubMed: 33394772
DOI: 10.1097/DCR.0000000000001893 -
The American Surgeon Apr 2023In recent years, intersphincteric resection (ISR) has been increasingly used to replace abdominoperineal resection (APR) in the surgical treatment of ultra-low rectal...
BACKGROUND
In recent years, intersphincteric resection (ISR) has been increasingly used to replace abdominoperineal resection (APR) in the surgical treatment of ultra-low rectal cancer.
AIM
This study was to compare the clinical efficacy of ISR and APR.
METHODS
Between 2012 and 2018, 74 consecutive patients with ultra-low rectal cancer underwent ISR or APR in our medical center. A retrospective comparison of these 2 procedures was performed.
RESULTS
A total of 43 patients underwent ISR and 31 underwent APR were included in the study. No significant differences were found between 2 groups in gender, age, BMI, and ASA score. Intersphincteric resection group showed shorter operative time ( = .02) and less blood loss ( = .001). Hospital stays, time to soft diet, and postoperative 30-day complications were not significantly different between the 2 groups. R0 resection achieved 100% in both the groups. As for the long-term outcomes, the survival and recurrence rate were similar between 2 groups. Moreover, the LARS and Wexner score showed that the postoperative anal function after ISR were satisfactory.
CONCLUSION
This study suggested that ISR was feasible and safe for selected patients with ultra-low rectal cancer, with clinically superior outcomes in select patients (small tumors/further from the anal verge) and similar oncological outcomes to APR, and the anal functional outcomes after ISR were acceptable.
Topics: Humans; Retrospective Studies; Treatment Outcome; Rectal Neoplasms; Rectum; Proctectomy; Anal Canal; Postoperative Complications
PubMed: 34783266
DOI: 10.1177/00031348211056271 -
International Journal of Surgery... Jul 2023
Meta-Analysis
How to reasonably deal with zero-events in meta-analysis of surgery-related outcomes? Oncologic outcomes of intersphincteric resection vs. abdominoperineal resection for lower rectal cancer: a systematic review and meta-analysis.
Topics: Humans; Rectal Neoplasms; Proctectomy; Treatment Outcome; Anal Canal
PubMed: 37300885
DOI: 10.1097/JS9.0000000000000379 -
ANZ Journal of Surgery Jul 2020Post-operative complications following rectal resection pose significant health and cost implications for patients and health providers. The objective of this study is... (Review)
Review
BACKGROUND
Post-operative complications following rectal resection pose significant health and cost implications for patients and health providers. The objective of this study is to review the associated cost of complications following rectal resection. This included reporting on the proportion and severity of these complications, associated length of stay and surgical technique used. Studies were sourced from Embase OVID, MEDLINE OVID (ALL) and Cochrane Library databases by utilizing a search strategy.
METHODS
This search contained studies from 1 January 2010 until 13 February 2019. Studies were included from the year 2010 to account for the implementation of enhanced recovery after surgery protocols. Studies that reported the financial cost associated with complications were included. Any indication for rectal resection was considered. Data was extracted into a formatted table and a narrative synthesis was performed.
RESULTS
We identified 13 eligible studies for inclusion. There was strong evidence to suggest that complications are associated with increased costs. There was considerable variation as to the costs attributable to complications ($1443 (P < 0.001) to $17 831 (P < 0.0012), n = 12). The presence of complications was associated with an increased length of stay (5.54 (P-value not given) to 21.04 (P < 0.0001) days, n = 7). There was significant variation in the proportion of complications (6.41 to 64.71%, n = 8). Weak evidence existed around surgical technique used and the associated cost of complications. There was considerable heterogeneity among included studies.
CONCLUSIONS
Complications following rectal resection increased health costs. Costs should be standardized and provide a clear methodology for their calculation. Complications should be standardized and include a grading of severity.
Topics: Health Care Costs; Humans; Postoperative Complications; Proctectomy
PubMed: 32053858
DOI: 10.1111/ans.15708 -
ANZ Journal of Surgery 2023Video demonstrating the technical details of minimally invasive, simultaneous liver resection, retroperitoneal lymph node dissection, and abdominoperineal resection for...
Video demonstrating the technical details of minimally invasive, simultaneous liver resection, retroperitoneal lymph node dissection, and abdominoperineal resection for synchronous metastasis.
Topics: Humans; Metastasectomy; Lymph Node Excision; Laparoscopy; Rectal Neoplasms; Proctectomy; Liver
PubMed: 37376776
DOI: 10.1111/ans.18540 -
Surgical Endoscopy Aug 2020While the ACOSOG and ALaCaRT trials found that laparoscopic resections for rectal cancer failed to demonstrate non-inferiority of pathologic outcomes when compared with... (Comparative Study)
Comparative Study
BACKGROUND
While the ACOSOG and ALaCaRT trials found that laparoscopic resections for rectal cancer failed to demonstrate non-inferiority of pathologic outcomes when compared with open resections, the COLOR II and COREAN studies demonstrated non-inferiority of clinical outcomes, leading to uncertainty regarding the value of minimally invasive (MIS) techniques in rectal cancer surgery. We analyzed differences in pathologic and clinical outcomes between open versus MIS resections for rectal cancer.
METHODS
We identified patients who underwent resection for stage II or III rectal adenocarcinoma from the National Cancer Database (2010-2015). Surgical approach was categorized as open or MIS (laparoscopic or robotic). Logistic regression and Cox proportional hazard analysis were used to assess differences in outcomes and survival. Analysis was performed in an intention-to-treat fashion.
RESULTS
A total of 31,190 patients who underwent rectal adenocarcinoma resection were identified, of whom 52.8% underwent open resection and 47.2% underwent MIS resection (31.0% laparoscopic, 16.2% robotic). After adjustment for patient, tumor, and institutional characteristics, MIS approaches were associated with significantly decreased risk of positive circumferential resection margins (OR 0.82, 95% CI 0.72-0.94), increased likelihood of harvesting ≥ 12 lymph nodes (OR 1.12, 95% CI 1.04-1.21), shorter length of stay (OR 0.57, 95% CI 0.53-0.62), and improved overall survival (HR 0.90, 95% CI 0.83-0.98).
CONCLUSIONS
MIS approaches to rectal cancer resection were associated with improved pathologic and clinical outcomes when compared to the open approach. In this nationwide, facility-based sample of cancer cases in the United States, our data suggest superiority of MIS techniques for rectal cancer treatment.
Topics: Adenocarcinoma; Aged; Databases, Factual; Female; Humans; Kaplan-Meier Estimate; Laparoscopy; Length of Stay; Lymph Nodes; Male; Margins of Excision; Middle Aged; Minimally Invasive Surgical Procedures; Proctectomy; Rectal Neoplasms; Rectum; Retrospective Studies; Robotic Surgical Procedures; Treatment Outcome; United States
PubMed: 31844971
DOI: 10.1007/s00464-019-07120-2 -
The British Journal of Surgery Aug 2021Bowel dysfunction after rectal cancer surgery is common, with some experiencing low anterior resection syndrome (LARS) is common after rectal cancer surgery. This study...
BACKGROUND
Bowel dysfunction after rectal cancer surgery is common, with some experiencing low anterior resection syndrome (LARS) is common after rectal cancer surgery. This study examined if transanal total mesorectal excision (TaTME) has a similar risk of LARS and altered quality of life (QoL) as patients who undergo low anterior resection (LAR).
METHODS
Patients who underwent TaTME or traditionally approached total mesorectal excision in a prospective colorectal cancer cohort study (2014-2019) were propensity score matched in a 1 : 1 ratio. LARS and QoL scores were assessed before and after surgery with a primary endpoint of major LARS at 12 months analysed for possible association between factors by logistic regression.
RESULTS
Of 61 TaTME and 317 LAR patients eligible, 55 from each group were propensity score matched. Higher LARS scores (30.6 versus 25.4, P = 0.010) and more major LARS (65 versus 42 per cent, P = 0.013; OR 2.64, 95 per cent c.i. 1.22 to 5.71) were reported after TaTME. Additionally, QoL score differences (body image, bowel frequency, and embarrassment) were worse in the TaTME group.
CONCLUSIONS
TaTME may be associated with more severe bowel dysfunction than traditional approaches to rectal cancer.
Topics: Female; Humans; Incidence; Laparoscopy; Male; Middle Aged; Netherlands; Postoperative Complications; Proctectomy; Propensity Score; Prospective Studies; Rectal Neoplasms; Rectum; Syndrome; Transanal Endoscopic Surgery
PubMed: 33837383
DOI: 10.1093/bjs/znab056 -
Colorectal Disease : the Official... Nov 2020
Topics: Humans; Lymph Node Excision; Lymph Nodes; Pelvis; Proctectomy; Rectal Neoplasms; Robotic Surgical Procedures
PubMed: 32645242
DOI: 10.1111/codi.15234 -
BMC Surgery Jan 2022There is still no consensus on the management of colorectal anastomotic leakage after low anterior resection. The goal was to evaluate the outcomes of patients who...
BACKGROUND
There is still no consensus on the management of colorectal anastomotic leakage after low anterior resection. The goal was to evaluate the outcomes of patients who underwent transanal endoluminal repair + laparoscopic drainage ± stoma vs. drainage only ± stoma.
METHODS
Retrospective chart review of patients sustaining anastomotic leakage after laparoscopic low anterior resection between January 2013 and September 2020 who required laparoscopic reoperation.
RESULTS
Forty-nine patients were included, 22 patients underwent combined laparoscopy and transanal endoluminal repair and 27 patients had drainage with a stoma (n = 16) or drainage alone (n = 11), without direct anastomotic repair. The overall morbidity rate was 30.6% and the mortality rate was 2%. Combined laparoscopic lavage/drainage and transanal endoluminal repair of anastomotic leakage was associated with a lower complication rate (13.6% vs. 44.4%, p = 0.03) and fewer intraabdominal infections (4.5% vs. 29.6%, p = 0.03) compared with no repair.
CONCLUSIONS
Combined laparoscopic lavage/drainage and transanal endoluminal repair is effective in the management of colorectal anastomosis leakage and was associated with lower morbidity-in particular intraabdominal infection-compared with no repair. However, our results need to be confirmed in larger, and ideally randomized, studies.
Topics: Anastomosis, Surgical; Anastomotic Leak; Angioplasty; Humans; Laparoscopy; Proctectomy; Retrospective Studies
PubMed: 35081948
DOI: 10.1186/s12893-022-01484-4