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Operative treatment versus non operative treatment in rectal cancer

Ajit Pai, Fahad Alsabhan, John J Park, George Melich, Suela Sulo, Slawomir J Marecik
PURPOSE: To analyze the feasibility and outcomes of robotic rectal cancer surgery in obese patients. METHODS: From 2005 to 2012, 101 consecutive rectal cancers operated robotically were enrolled in a prospective database. Patients were stratified into obese (BMI ≥ 30 kg/m2) and non-obese (BMI < 30 kg/m2) groups. Operative, perioperative parameters, and pathologic outcomes were compared. Data were analyzed using SPSS 22.0, while statistical significance was defined as a p value ≤ ...
August 31, 2017: Polski Przeglad Chirurgiczny
Bernard Lelong, Cécile de Chaisemartin, Helene Meillat, Sandra Cournier, Jean Marie Boher, Dominique Genre, Mehdi Karoui, Jean Jacques Tuech, Jean Robert Delpero
BACKGROUND: Total mesorectal excision is the standard surgical treatment for mid- and low-rectal cancer. Laparoscopy represents a clear leap forward in the management of rectal cancer patients, offering significant improvements in post-operative measures such as pain, first bowel movement, and hospital length of stay. However, there are still some limits to its applications, especially in difficult cases. Such cases may entail either conversion to an open procedure or positive resection margins...
April 11, 2017: BMC Cancer
R Geva, H Davidovics, S Soyfer, S Pelles-Avraham, J M Klausner, M Inbar, H Tulchinsky
AIM: This study aimed to assess the progression-free and overall survival of patients with residual microscopic disease following neoadjuvant chemoradiotherapy and rectal resection for locally advanced rectal cancer. METHOD: Two-hundred and thirty-four consecutive rectal cancer patients who had neoadjuvant chemoradiotherapy followed by radical resection (from May 2000 to April 2012) were divided according to pathological tumour response: residual microscopic disease (MIC), complete response (pCR) and partial/no response (non-CR)...
March 2017: Colorectal Disease: the Official Journal of the Association of Coloproctology of Great Britain and Ireland
Sichen Zhang, Shaowei Wang, Aiming Lv, Shuai Huang
OBJECTIVE: The aim of this study was to compare intraoperative and short-term postoperative outcomes and recurrence of laparoscopically assisted radical vaginal hysterectomy (LARVH) to abdominal radical hysterectomy (ARH) in the treatment of early-stage cervical cancer. METHODS: A search of PubMed, EMBASE, and Cochrane library search trial (central) databases was conducted from database inception through December 2015. We included studies comparing surgical approaches with radical hysterectomy (LARVH vs ARH) in women with stages IA1 to IIB cervical cancer...
October 2016: International Journal of Gynecological Cancer
Michael P Achiam, Vibeke B Løgager, Bjørn Skjoldbye, Jakob M Møller, Torben Lorenzen, Vera L Rasmussen, Henrik S Thomsen, Talie H Mollerup, Cecilie Okholm, Jacob Rosenberg
Introduction. Colorectal cancer is one of the most frequent cancers in the world and liver metastases are seen in up to 19% of patients with colorectal cancers. Detection of liver metastases is not only vital for sufficient treatment and survival, but also for a better estimation of prognosis. The aim of this study was to evaluate the feasibility of diffusion weighted MRI of the liver as part of a combined MR evaluation of patients with rectal cancers and compare it with the standard preoperative evaluation of the liver with CT...
2016: PeerJ
Giancarlo D'Ambrosio, Alessandro M Paganini, Andrea Balla, Silvia Quaresima, Pietro Ursi, Paolo Bruzzone, Andrea Picchetto, Fabrizio I Mattei, Emanuele Lezoche
BACKGROUND: In selected patients with N0 rectal cancer, endoluminal loco-regional resection (ELRR) by transanal endoscopic microsurgery (TEM) may be an alternative treatment option to laparoscopic total mesorectal excision (LTME). Aim of this study is to evaluate the short- and medium-term quality of life (QoL) from a retrospective analysis of prospectively collected data in patients with iT2-iT3 N0-N+ rectal cancer, who underwent ELRR by TEM or LTME after neoadjuvant radio-chemotherapy (n-RCT)...
February 2016: Surgical Endoscopy
J P Maarten Burbach, Helena M Verkooijen, Martijn Intven, Jean-Paul J E Kleijnen, Mirjam E Bosman, Bas W Raaymakers, Wilhelmina M U van Grevenstein, Miriam Koopman, Enrica Seravalli, Bram van Asselen, Onne Reerink
BACKGROUND: Treatment for locally advanced rectal cancer (LARC) consists of chemoradiation therapy (CRT) and surgery. Approximately 15% of patients show a pathological complete response (pCR). Increased pCR-rates can be achieved through dose escalation, thereby increasing the number patients eligible for organ-preservation to improve quality of life (QoL). A randomized comparison of 65 versus 50Gy with external-beam radiation alone has not yet been performed. This trial investigates pCR rate, clinical response, toxicity, QoL and (disease-free) survival in LARC patients treated with 65Gy (boost + chemoradiation) compared with 50Gy standard chemoradiation (sCRT)...
February 22, 2015: Trials
Minia Hellan, James Ouellette, Jorge A Lagares-Garcia, Stephen M Rauh, Harold L Kennedy, John D Nicholson, David Nesbitt, Craig S Johnson, Alessio Pigazzi
BACKGROUND: Conventional laparoscopy has been applied to colorectal resections for more than 2 decades. However, laparoscopic rectal resection is technically demanding, especially when performing a tumor-specific mesorectal excision in a difficult pelvis. Robotic surgery is uniquely designed to overcome most of these technical limitations. The aim of this study was to confirm the feasibility of robotic rectal cancer surgery in a large multicenter study. METHODS: Retrospective data of 425 patients who underwent robotic tumor-specific mesorectal excision for rectal lesions at seven institutions were collected...
July 2015: Annals of Surgical Oncology
Binghong Xiong, Li Ma, Wei Huang, Qikang Zhao, Yong Cheng, Jingshan Liu
BACKGROUND: Robotic surgery has been used successfully in many branches of surgery, but there is little evidence in the literature on its use in rectal cancer (RC). We conducted this meta-analysis of randomized controlled trials (RCTs) and non-randomized controlled trials (NRCTs) to evaluate whether the safety and efficacy of robotic total mesorectal excision (RTME) in patients with RC are equivalent to those of laparoscopic TME (LTME). METHODS: Pubmed, Embase, Cochrane Library, Ovid, and Web of Science databases were searched...
March 2015: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Michael S Tam, Mohammad Abbass, Maher A Abbas
BACKGROUND AND OBJECTIVES: Robotic surgery has been advocated for the radical excision of rectal cancer. Most data supporting its use have been reported from European and Asian centers, with a paucity of data from the United States documenting clear advantages of the robotic technique. This study compares the short-term outcome of robotic versus laparoscopic surgery. METHODS: Consecutive patients who underwent laparoscopic (group 1) or robotic (group 2) rectal cancer excision at a single institution over a 2-year period were retrospectively reviewed...
July 2014: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Stéphanie Truant, Cédric Séquier, Emmanuelle Leteurtre, Emmanuel Boleslawski, Mehdi Elamrani, Guillemette Huet, Alain Duhamel, Mohamed Hebbar, François-René Pruvot
BACKGROUND: The aim of the authors was to reassess the impact of a positive surgical margin (R1) after a liver resection for colorectal liver metastases (CLMs) on survival in the era of modern chemotherapy, through their own experience and a literature review. METHODS: Inclusion criteria were: R1 or R0 resection with no local treatment modalities, extra-hepatic metastases or other cancer. RESULTS: Among 337 patients operated between 2000 and 2010, 273 patients were eligible (214 R0/59 R1)...
February 2015: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
R Oliphant, G A Nicholson, P G Horgan, R G Molloy, D C McMillan, D S Morrison
BACKGROUND: Reorganization of colorectal cancer services has led to surgery being increasingly, but not exclusively, delivered by specialist surgeons. Outcomes from colorectal cancer surgery have improved, but the exact determinants remain unclear. This study explored the determinants of outcome after colorectal cancer surgery over time. METHODS: Postoperative mortality (within 30 days of surgery) and 5-year relative survival rates for patients in the West of Scotland undergoing surgery for colorectal cancer between 1991 and 1994 were compared with rates for those having surgery between 2001 and 2004...
September 2013: British Journal of Surgery
Steven R Brown, Himanshu Wadhawan, Richard L Nelson
BACKGROUND: Faecal incontinence is a debilitating problem with significant medical, social and economic implications. Treatment options include conservative, non-operative interventions (for example pelvic floor muscle training, biofeedback, drugs) and surgical procedures. A surgical procedure may be aimed at correcting an obvious mechanical defect, or augmenting a functionally deficient but structurally intact sphincter complex. OBJECTIVES: To assess the effects of surgical techniques for the treatment of faecal incontinence in adults who do not have rectal prolapse...
2013: Cochrane Database of Systematic Reviews
Ryan P Merkow, David J Bentrem, Jeanette W Chung, Jennifer L Paruch, Clifford Y Ko, Karl Y Bilimoria
BACKGROUND: Interest in comparing hospital surgical quality continues to increase, particularly with respect to examining certain hospital designations such as National Cancer Institute-designated Cancer Centers (NCI-CC). Our objectives were to compare patients, surgical complexity, and risk-adjusted 30-day outcomes following major cancer surgery at NCI-CC versus non-NCI centers. METHODS: From the American College of Surgeons National Surgical Quality Improvement Program, patients were identified who underwent colorectal, pancreatic, or esophagogastric resection for cancer (2007-2011)...
July 2013: Medical Care
Martijn Hgm van der Pas, Eva Haglind, Miguel A Cuesta, Alois Fürst, Antonio M Lacy, Wim Cj Hop, Hendrik Jaap Bonjer
BACKGROUND: Laparoscopic surgery as an alternative to open surgery in patients with rectal cancer has not yet been shown to be oncologically safe. The aim in the COlorectal cancer Laparoscopic or Open Resection (COLOR II) trial was to compare laparoscopic and open surgery in patients with rectal cancer. METHODS: A non-inferiority phase 3 trial was undertaken at 30 centres and hospitals in eight countries. Patients (aged ≥18 years) with rectal cancer within 15 cm from the anal verge without evidence of distant metastases were randomly assigned to either laparoscopic or open surgery in a 2:1 ratio, stratified by centre, location of tumour, and preoperative radiotherapy...
March 2013: Lancet Oncology
Kathryn McCarthy, Katherine Pearson, Rachel Fulton, Jonathan Hewitt
BACKGROUND: This review sets out to assess the efficacy of pre-operative chemoradiation when compared to radiotherapy alone before surgery in the treatment of advanced non metastatic rectal surgery. OBJECTIVES: To determine the efficacy of pre-operative chemoradiation (CRT) compared with radiation (RT) alone, in locally advanced rectal cancer with respect to overall survival, local recurrence and 30 day mortality, sphincter preservation and toxicity of treatment (both acute and late)...
December 12, 2012: Cochrane Database of Systematic Reviews
(no author information available yet)
The standard treatment for rectal cancer is surgical removal of the rectum and mesorectum. Is the prognosis for non-metastatic rectal cancer that extends beyond the bowel wall improved by adding radiotherapy and/or chemotherapy to surgery? To answer this question, we conducted a review of the literature using the standard Prescrire methodology. Randomised trials conducted before optimal surgery was developed showed that, compared with surgery alone, postoperative radiotherapy reduced the risk of local recurrence and possibly increased overall survival...
June 2012: Prescrire International
I Gunka, J Dostalik, L Martinek, P Gunkova, M Mazur, P Vavra
PURPOSE: Laparoscopic surgery for colon cancer has been proven safe, but controversy continues over implementation of laparoscopic technique for rectal cancer. The aim of this study was to compare the long-term outcomes of laparoscopically assisted and open surgery for nonmetastatic colorectal cancer. MATERIAL AND METHODS: From January 2001 to December 2006 all patients with nonmetastatic adenocarcinoma of the colon and rectum were considered for inclusion in this prospective non-randomised trial...
March 2012: Acta Chirurgica Belgica
R Glynne-Jones, R Hughes
BACKGROUND: Some 10-20 per cent of patients with locally advanced rectal cancer achieve a pathological complete response (pCR) at surgery following preoperative chemoradiation (CRT). Some demonstrate a sustained clinical complete response (cCR), defined as absence of clinically detectable residual tumour after CRT, and do not undergo resection. The aim of this review was to evaluate non-operative treatment of rectal cancer after CRT, and the outcome of patients observed without radical surgery...
July 2012: British Journal of Surgery
Anthony Kong, Nick Johnson, Henry C Kitchener, Theresa A Lawrie
BACKGROUND: This is an updated version of the original Cochrane review published in Issue 2, 2007. The role of radiotherapy (both pelvic external beam radiotherapy (EBRT) and vaginal intracavity brachytherapy (VBT)) in stage I endometrial cancer following hysterectomy remains controversial. OBJECTIVES: To assess the efficacy of adjuvant radiotherapy following surgery for stage I endometrial cancer. SEARCH METHODS: We searched The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and the Specialised Register to end-2005 for the original review, and extended the search to January 2012 for the update...
April 18, 2012: Cochrane Database of Systematic Reviews
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