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Littlejohn JB, Brister KA. Management of Recurrent Anal Cancer. Surg Oncol Clin N Am 2025; 34:91-101. [PMID: 39547772 DOI: 10.1016/j.soc.2024.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2024]
Abstract
Locoregional failure or recurrence after completion of chemoradiation for anal squamous cell carcinoma occurs in up to 27% of patients. Complete restaging with multimodality imaging should be performed to evaluate the extent of local disease and distant metastases. Extensive discussion in multidisciplinary tumor board and with necessary specialties is vital to assess possibility of R0 resection. Salvage surgery with R0 resection through abdominoperineal resection and possible exenteration is recommended with pedicled flap for perineal reconstruction. Five year overall survival rates are ∼50%. Successful management of recurrent anal squamous cell carcinoma relies on careful patient selection, multidisciplinary collaboration, and R0 resection.
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Affiliation(s)
- James Blake Littlejohn
- Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA
| | - Kelly Ann Brister
- Department of Surgery, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS 39216, USA.
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Ma L, Yu H, Zhu Y, Li W, Xu K, Zhao A, Ding L, Gao H. Laparoscopy is non-inferior to open surgery for rectal cancer: A systematic review and meta-analysis. Cancer Med 2024; 13:e7363. [PMID: 38970275 PMCID: PMC11226727 DOI: 10.1002/cam4.7363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 05/19/2024] [Accepted: 05/27/2024] [Indexed: 07/08/2024] Open
Abstract
BACKGROUND Laparoscopic surgery has been endorsed by clinical guidelines for colon cancer, but not for rectal cancer on account of unapproved oncologic equivalence with open surgery. AIMS We started this largest-to-date meta-analysis to comprehensively evaluate the safety and efficacy of laparoscopy in the treatment of rectal cancer compared with open surgery. MATERIALS & METHODS Both randomized and nonrandomized controlled trials comparing laparoscopic proctectomy and open surgery between January 1990 and March 2020 were searched in PubMed, Cochrane Library and Embase Databases (PROSPERO registration number CRD42020211718). The data of intraoperative, pathological, postoperative and survival outcomes were compared between two groups. RESULTS Twenty RCTs and 93 NRCTs including 216,615 patients fulfilled the inclusion criteria, with 48,888 patients received laparoscopic surgery and 167,727 patients underwent open surgery. Compared with open surgery, laparoscopic surgery group showed faster recovery, less complications and decreased mortality within 30 days. The positive rate of circumferential margin (RR = 0.79, 95% CI: 0.72 to 0.85, p < 0.0001) and distal margin (RR = 0.75, 95% CI: 0.66 to 0.85 p < 0.0001) was significantly reduced in the laparoscopic surgery group, but the completeness of total mesorectal excision showed no significant difference. The 3-year and 5-year local recurrence, disease-free survival and overall survival were all improved in the laparoscopic surgery group, while the distal recurrence did not differ significantly between the two approaches. CONCLUSION Laparoscopy is non-inferior to open surgery for rectal cancer with respect to oncological outcomes and long-term survival. Moreover, laparoscopic surgery provides short-term advantages, including faster recovery and less complications.
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Affiliation(s)
- Ling Ma
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Hai‐jiao Yu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Yu‐bing Zhu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Wen‐xia Li
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Kai‐yu Xu
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Ai‐min Zhao
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Lei Ding
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
| | - Hong Gao
- Department of Gastrointestinal Tumor SurgeryBeijing Shijitan Hospital Affiliated to Capital Medical UniversityBeijingPeople's Republic of China
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Spinelli A. Colorectal Cancer: Minimally Invasive Surgery. THE ASCRS TEXTBOOK OF COLON AND RECTAL SURGERY 2022:619-642. [DOI: 10.1007/978-3-030-66049-9_36] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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Cleary RK, Morris AM, Chang GJ, Halverson AL. Controversies in Surgical Oncology: Does the Minimally Invasive Approach for Rectal Cancer Provide Equivalent Oncologic Outcomes Compared with the Open Approach? Ann Surg Oncol 2018; 25:3587-3595. [PMID: 30187281 DOI: 10.1245/s10434-018-6740-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Indexed: 01/05/2025]
Abstract
BACKGROUND Compared with open surgery, minimally invasive surgery for colon cancer has been shown to improve short-term outcomes and yield equivalent long-term oncologic results. It remains to be seen if oncologic outcomes for the minimally invasive approach for rectal cancer are equivalent to traditional open rectal resection. METHODS We conducted a systematic review of Medline, SCOPUS, and Cochrane databases. Relevant studies were selected using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Five key questions comparing minimally invasive and open oncologic outcomes for rectal cancer were specifically analyzed. A meta-analysis was not done due to heterogeneity of studies. RESULTS Forty-five studies met inclusion criteria, including six randomized controlled trials. The laparoscopic approach to rectal resection was not more likely than the traditional open approach to have clear circumferential and distal margins, a complete total mesorectal excision grade, ≥ 12 lymph nodes in the resected specimen, reduced local recurrence rates, or reduced overall survival rates. Two randomized trials revealed that successful laparoscopic resection was not noninferior to open. CONCLUSIONS Caution should be exercised when choosing surgical options for rectal cancer. Results of randomized trials could not prove that short-term oncologic outcomes of laparoscopic surgery were equivalent to those after open surgery even when performed by surgeons with laparoscopic expertise. However, reported long-term data have not shown a difference in outcomes between laparoscopic and open surgery. Future advances in minimally invasive technology may improve oncologic margins but these will require careful study and scrutiny.
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Affiliation(s)
- Robert K Cleary
- Division of Colon and Rectal Surgery, St Joseph Mercy Hospital Ann Arbor, Ann Arbor, MI, USA.
| | - Arden M Morris
- Section of Colon and Rectal Surgery, Stanford University Medical Center, Stanford, CA, USA
| | - George J Chang
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Amy L Halverson
- Division of Colon and Rectal Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Zhang X, Wu Q, Gu C, Hu T, Bi L, Wang Z. Comparison of short and long-time outcomes between laparoscopic and conventional open multivisceral resection for primary T4b colorectal cancer. Asian J Surg 2018; 42:401-408. [PMID: 30093256 DOI: 10.1016/j.asjsur.2018.06.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 05/23/2018] [Accepted: 06/22/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND This study aimed to compare laparoscopic multivisceral resection (LMVR) with conventional open multivisceral resection (OMVR) for primary T4b colorectal cancer (CRC) in short and long-time outcomes. METHODS Patients receiving LMVR or OMVR for primary T4b CRC from January 2009 to June 2016 were enrolled. Patients' clinicopathological characteristics and survival data were collected and analyzed. Multivariable analysis was performed to find the factors related with survival. All statistical analysis was performed by SPSS 22.0. RESULTS A total of 91 patients (LMVR 38, OMVR 53) were included in this study. Patients undergoing LMVR were associated with smaller incision length (P < 0.001), less blood loss (P = 0.01) and comparable operative time (P = 0.071). Patients in LMVR group also had less time to first flatus (P = 0.025). The results also suggested LMVR could reduce the incidence of postoperative complication. The conversion rate was 28.9%. The 3-year OS was 64.2%, 68.4% in OMVR, LMVR group respectively and the 3-year DFS was 56.6%, 52.6% in OMVR, LMVR group respectively. The Kaplan curves demonstrated that LMVR group had similar OS (P = 0.896) and DFS (P = 0.806) when compared with OMVR group. In addition, the multivariate analysis demonstrated that laparoscopic surgery was not associated with poorer survival. CONCLUSION Not all MVR for T4b CRC should be performed by open procedure, LMVR can be safe and feasible for primary T4b CRC in selected patients. It can faster the postoperative recovery and reduce the incidence of postoperative complication. The OS and DFS are also not inferior to open group.
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Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China; West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China.
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Zhang X, Wu Q, Hu T, Gu C, Bi L, Wang Z. Laparoscopic Versus Conventional Open Abdominoperineal Resection for Rectal Cancer: An Updated Systematic Review and Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:526-539. [PMID: 29406806 DOI: 10.1089/lap.2017.0593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Xubing Zhang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Qingbin Wu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Tao Hu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Chaoyang Gu
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Liang Bi
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
- West China School of Medicine, Sichuan University, Chengdu, China
| | - Ziqiang Wang
- Department of Gastrointestinal Surgery, West China Hospital, Sichuan University, Chengdu, China
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Wu QB, Deng XB, Zhang XB, Kong LH, Zhou ZG, Wang ZQ. Short-Term and Long-Term Outcomes of Laparoscopic Versus Open Surgery for Low Rectal Cancer. J Laparoendosc Adv Surg Tech A 2018; 28:637-644. [PMID: 29323615 DOI: 10.1089/lap.2017.0630] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
AIM To compare the short-term and long-term outcomes of laparoscopic versus open surgery for low rectal cancer. METHODS Patients with low rectal cancer who underwent laparoscopic or open surgery at our department from January 2009 to December 2013 were enrolled in this retrospective study. The primary end points were 3-year local recurrence and overall and disease-free survival (DFS) rates. Secondary end points were intraoperative and postoperative outcomes. RESULTS Laparoscopic group had longer operative time (165.0 versus 140.0, P < .001), less blood loss (20.0 versus 40.0, P < .001), shorter length of incision (5.0 versus 18.0, P < .001), and more lymph node harvested (11.0 versus 9.0, P = .002). However, time to first flatus (P = .941), postoperative hospital stay (P = .095), postoperative complications (P = .155), and 30-day mortality (P = .683) was similar between two groups. With the median follow-up period of 65 months, the 3-year local recurrence rate was 4.3% in laparoscopic group and 7.5% in open group (P = .077); the 3-year overall and DFS rates were similar in two groups (85.9% versus 88.8%, P = .229 and 76.9% versus 79.2%, P = .448, respectively); and the overall and DFS curves were comparable between two groups (hazard ratio [HR] = 0.858, 95% confidence intervals [CI] 0.709-1.037, P = .112 and HR = 1.076, 95% CI 0.834-1.389, P = .275, respectively). CONCLUSIONS Laparoscopic surgery is safe and has equivalent long-term oncologic outcomes for low rectal cancer when compared to open surgery. Furthermore, large-scale, prospective randomized clinical trials are needed to confirm the present findings.
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Affiliation(s)
- Qing-Bin Wu
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Xiang-Bing Deng
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Xu-Bing Zhang
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China .,2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Ling-Hong Kong
- 2 West China School of Medicine, Sichuan University , Chengdu, China
| | - Zong-Guang Zhou
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China
| | - Zi-Qiang Wang
- 1 Department of Gastrointestinal Surgery, West China Hospital, Sichuan University , Chengdu, China
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Huang C, Shen JC, Zhang J, Jiang T, Wu WD, Cao J, Huang KJ, Qiu ZJ. Clinical comparison of laparoscopy vs open surgery in a radical operation for rectal cancer: A retrospective case-control study. World J Gastroenterol 2015; 21:13532-13541. [PMID: 26730165 PMCID: PMC4690183 DOI: 10.3748/wjg.v21.i48.13532] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Revised: 09/06/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the diverse immediate and long-term clinical outcomes, a retrospective comparison between laparoscopic and conventional operation was performed.
METHODS: A total number of 916 clinical cases, from January 2006 to December 2013 in our hospital, were analyzed which covered 492 patients underwent the laparoscopy in radical resection (LRR) and 424 cases in open radical resection (ORR). A retrospective analysis was proceeded by comparing the general information, surgery performance, pathologic data, postoperative recovery and complications as well as long-term survival to investigate the diversity of immediate and long-term clinical outcomes of laparoscopic radical operation.
RESULTS: There were no statistically significance differences between gender, age, height, weight, body mass index (BMI), tumor loci, tumor node metastasis stages, cell differentiation degree or American Society of Anesthesiologists scores of the patients (P > 0.05). In contrast to the ORR group, the LRR group experienced less operating time (P < 0.001), a lower blood loss (P < 0.001), and had a 2.44% probability of conversion to open surgery. Postoperative bowel function recovered more quickly, analgesic usage and the average hospital stay (P < 0.001) were reduced after LRR. Lymph node dissection during LRR appeared to be slightly more than in ORR (P = 0.338). There were no obvious differences in the lengths and margins (P = 0.182). And the occurrence rate in the two groups was similar (P = 0.081). Overall survival rate of ORR and LRR for 1, 3 and 5 years were 94.0% and 93.6% (P = 0.534), 78.1% and 80.9% (P = 0.284) and 75.2% and 77.0% (P = 0.416), respectively.
CONCLUSION: Laparoscopy as a radical operation for rectal cancer was safe, produced better immediate outcomes. Long-term survival of laparoscopy revealed that it was similar to the open operation.
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Palter VN, MacLellan S, Ashamalla S. Laparoscopic translevator approach to abdominoperineal resection for rectal adenocarcinoma: feasibility and short-term oncologic outcomes. Surg Endosc 2015; 30:3001-6. [PMID: 26487217 DOI: 10.1007/s00464-015-4589-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 09/19/2015] [Indexed: 12/31/2022]
Abstract
BACKGROUND The extra-levator approach to abdominal perineal resection (APR) was developed in order to reduce the rates of positive circumferential resection margin. This approach, however, is associated with significant morbidity. We postulate that a less radical resection of the levators done laparoscopically could significantly decrease the rate of perineal complications while ensuring an oncologically adequate specimen. To date, to our knowledge, there are no reports in the literature describing a laparoscopic translevator approach for APR. The purpose of this study is to describe our initial experience with this approach and assess our short-term oncologic and clinical outcomes. METHODS This is a retrospective study of patients who underwent laparoscopic APR with intra-abdominal levator transection for rectal cancer from 2012 to 2014 at a single tertiary care institution. Main outcome measures include: perineal flap rates, post-operative complications, length of stay, distance from tumour to circumferential resection margin, R0 status, and disease recurrence. Data are presented as median (interquartile range) unless otherwise noted. RESULTS Seventeen cases were identified. Patient age was 61 (range 34-75), and 59 % were male. Pre-operative distance of the tumour from the anal verge was 2.6 cm (0.4-3.9). Post-operative length of stay was 4 (4-6) days. One patient required a perineal flap for reconstruction. Four patients (22 %) had perineal complications (three wound infections and one hernia). No patients reported sexual dysfunction, and one (5 %) developed urinary retention. Five (29 %) patients had a complete pathological response. The circumferential resection margin was 1.5 (0.8-2.5) cm, with no positive margins reported. The number of retrieved lymph nodes was 12 (range 2-30). Follow-up was 9.7 months (range 20 days-23 months), during which one patient developed recurrent disease. CONCLUSIONS This study describes a novel surgical approach to APR that has the potential to both decrease perineal complications and provide excellent oncologic results.
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Affiliation(s)
- Vanessa N Palter
- Department of Surgery, University of Toronto, 600 University Ave., Rm 440, Toronto, ON, M5G 1X5, Canada.
| | - Steven MacLellan
- Department of Surgery, University of Toronto, 600 University Ave., Rm 440, Toronto, ON, M5G 1X5, Canada
- Humber River Hospital, 2111 Finch Ave West, Toronto, ON, M3N 1N1, Canada
| | - Shady Ashamalla
- Department of Surgery, University of Toronto, 600 University Ave., Rm 440, Toronto, ON, M5G 1X5, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, T2015, Toronto, M4N 3M5, Canada
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A population-based comparison of open versus minimally invasive abdominoperineal resection. Am J Surg 2015; 209:815-23; discussion 823. [DOI: 10.1016/j.amjsurg.2014.12.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 12/22/2014] [Accepted: 12/30/2014] [Indexed: 12/27/2022]
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