Low Local Recurrence Research Articles

Tu1526 Endoscopic Submucosal Dissection (ESD) up to 11 cm for 54 Large Laterally Spreading Tumors or Local Recurrencies in the Recto-Sigmoid

immediately after polypectomy. The latter is particularly frequent there is not enough room for endoloop application due to a short polyp stalk. We report about the use of a simple and safe method combining the use of clips and endoloop. Methods: Patients with large pedunculated polyps ( 3 cm) were included. We used a prototype therapeutic sigmoidoscope (Olympus, Tokyo, Japan), 80 cm long, equipped with two working channels (2.8 mm and 3.7 mm, respectively). One working channel has an up/down elevator. Using a “twohanded” approach, 2 clips were initially placed at the base of the stalk, on two opposite sides. In order to fix it securely, the endoloop was then placed at the base of the stalk below the two clips. To facilitate the procedure the endoloop was opened through one channel, the polyp was grabbed through the other channel by a tripod and then pulled inside the endoloop. Thus, the endoloop was subsequently firmly secured at the base of the stalk. If necessary, the same procedure was repeated to capture the polyp within the diathermic snare for resection. The procedures were performed under conscious sedation using meperidine and midazolam. Results: Twenty-five pedunculated polyps in 24 patients (13 F, 11 M; median age 59) were resected with the “clip and loop” technique. It was possible to place an endoloop successfully below the clips at the basis of the stalk and perform a resection in all cases. No major complication occurred. Particularly, in no case the endoloop fell off after resection. In comparison to the previous cases performed with the endoloop only, the success rate in terms of correct and durable endoloop placement was higher (100% vs. 84%). Conclusions: Application of endoloop below the clips is feasible and safe and prevents slipping off of the endoloop after polypectomy. Use of a combination of clips and endoloop is an effective prophylactic measure to prevent bleeding after polypectomy of large pedunculated polyps, also when the stalk is short.

Fibrous hamartoma of infancy

Fibrous hamartoma of infancy is a rare benign soft tissue tumor that usually occurs within the first 2 years of life. We report 3 cases of fibrous hamartoma of infancy seen over a 10-year period. Treatment is curative by local excision with a low local recurrence rate. Fibrous hamartoma of infancy should be considered in the differential diagnosis of soft tissue masses in children because it is always benign and subject to nonaggressive treatment.

Local recurrence after partial mastectomy: Relation to initial surgical margins

Background Local recurrence (LR) after partial mastectomy (PM) has been associated with inadequate surgical margins. We assessed LR association with initial margins after PM in patients receiving postoperative radiation therapy (RT). Methods Initial margins, re-excision status, and ipsilateral LR were identified for all patients having initial PM from 2003 to 2008. Results Seven hundred twelve patients underwent PM as their final procedure, and 598 (84.0%) had adjuvant RT. Initial margins were positive or <1-mm margins in 166 patients (27.8%). Re-excision was performed for all positive and 20.2% of patients with margins <1 mm. We observed 10 LRs (1.7%) at the 3.4-year mean follow-up. For patients with initial margins <1 mm, the LR rate was 4.2% (7/167) and just .7% for margins ≥1 mm ( P = .006). Conclusions We report lower LR rates than traditionally reported. The surgical practice of re-excision to achieve margins of 1 to 5 mm needs closer scrutiny because it may have no impact on LR.

Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long-term oncological, functional, and quality of life results

The present contribution analyses long-term data regarding oncological, functional, and quality of life aspects of patients subjected to cystectomy due to malignancy with subsequent orthotopic bladder substitution. A literature search was conducted to review literature published from 1887 until today. Oncological aspects, special considerations on female patients, quality of life, geriatric patients, and impact of minimally invasive surgery were also addressed and discussed. After more than three decades, orthotopic bladder substitution subsequent to radical cystectomy has stood the test of time by providing adequate long-term survival and low local recurrence rates. Compared to radical cystectomy, neither radiation nor chemotherapy, nor a combination of both, offer similar long-term results. Orthotopic bladder substitution does not compromise oncological outcome and can be performed with excellent results regarding functional and quality of life issues. Chronological age is generally not a contraindication for cystectomy. Orthotopic bladder substitution should be the diversion of choice both in men and in women, whenever possible. For orthotopic urinary diversion, a careful patient selection considering tumor extent, patient motivation, preoperative sphincter function, other local and systemic adverse confounding factors, and overall life expectancy must be taken into account. Minimally invasive techniques are promising concepts for the future, awaiting confirmation in larger patient cohorts.

Young Women with Locally Advanced Breast Cancer Who Achieve Breast Conservation after Neoadjuvant Chemotherapy Have a Low Local Recurrence Rate

Young Women with Locally Advanced Breast Cancer Who Achieve Breast Conservation after Neoadjuvant Chemotherapy Have a Low Local Recurrence Rate

Surgery of colon cancer (conventional open and laparoscopic surgery)

BACKGROUND: Colon cancer is a leading cause of death in western countries and accounts for 639,000 cancer-related deaths worldwide. Surgical tumour clearance is the key treatment option and represents a classic field of action for the general and visceral surgeon. METHODS: PubMed, EMBASE and DIMDI were searched for articles referring to state of the art surgical management of colon cancer complemented by our own clinical experience to create an overview of up-to-date treatment options and theoretical background knowledge. RESULTS: The extent of bowel and mesenteric resection is dictated by the vascular supply and corresponding lymphatic drainage, careful attention to anatomical-embryological tissue planes and provision of adequate blood supply at the resection margins. Accordingly, optimal surgical clearance results in low local recurrence rates and translates into improved survival. In this context, the open and laparoscopic approaches yield similar results in terms of long-term outcome and oncological radicality. Radical resection of metastases results in long-term survival in selected patients. Fast Track rehabilitation facilitates attenuation of perioperative stress response and enhances recovery. CONCLUSION: Resectability and surgical technique are pivotal for long-term survival in all stages of colon cancer.

Long-Term Results of Targeted Intraoperative Radiotherapy (Targit) Boost During Breast-Conserving Surgery

We have previously shown that delivering targeted radiotherapy to the tumour bed intraoperatively is feasible and desirable. In this study, we report on the feasibility, safety, and long-term efficacy of TARGeted Intraoperative radioTherapy (Targit), using the Intrabeam system. A total of 300 cancers in 299 unselected patients underwent breast-conserving surgery and Targit as a boost to the tumor bed. After lumpectomy, a single dose of 20 Gy was delivered intraoperatively. Postoperative external beam whole-breast radiotherapy excluded the usual boost. We also performed a novel individualized case control (ICC) analysis that computed the expected recurrences for the cohort by estimating the risk of recurrence for each patient using their characteristics and follow-up period. The treatment was well tolerated. The median follow up was 60.5 months (range, 10-122 months). Eight patients have had ipsilateral recurrence: 5-year Kaplan Meier estimate for ipsilateral recurrence is 1.73% (SE 0.77), which compares well with that seen in the boosted patients in the European Organization for Research and Treatment of Cancer study (4.3%) and the UK STAndardisation of breast RadioTherapy study (2.8%). In a novel ICC analysis of 242 of the patients, we estimated that there should be 11.4 recurrences; in this group, only 6 recurrences were observed. Lumpectomy and Targit boost combined with external beam radiotherapy results in a low local recurrence rate in a standard risk patient population. Accurate localization and the immediacy of the treatment that has a favorable effect on tumour microenvironment may contribute to this effect. These long-term data establish the long-term safety and efficacy of the Targit technique and generate the hypothesis that Targit boost might be superior to an external beam boost in its efficacy and justifies a randomized trial.

Vena Cava Thrombectomy and Primary Repair After Radical Nephrectomy for Renal Cell Carcinoma: Single-Center Experience

Inferior vena cava (IVC) reconstruction for locally advanced renal cell carcinoma (RCC) includes resection with and without interposition grafting, patch graft, or primary repair. The proposed benefits of lateral venorrhaphy and primary repair are avoidance of foreign material, a more expeditious repair, and preservation of lower extremity venous outflow. A single-center retrospective review of 22 patients with RCC and IVC tumor thrombus treated with radical nephrectomy, lateral venorrhaphy, thrombectomy, and primary vena cava repair between July 2002 and June 2009 was carried out. Demographic data, diagnostic information, radiographic cross-sectional imaging, and procedural outcomes were examined. Among the 13 men and nine women, the mean age was 62.1 years (42-83); mean tumor size was 9.8 cm (3-17 cm), and 90% (n = 18) of the cases with RCC were identified pathologically as clear cell adenocarcinoma; on the basis of the classification system adopted by Neves, level I was for 50% (n = 11), level II for 32% (n = 7), level III for 9% (n = 2), and level IV for 9% (n = 2) of the patients. All patients underwent en bloc radical nephrectomy with tumor thrombus removal and primary IVC repair. Mean total operative time was 547.9 ± 138.5 minutes, whereas mean IVC cross-clamp time was 10.8 minutes (6-29 minutes). There were no intraoperative deaths or pulmonary embolism and all IVC margins were found to be pathologically negative. Postoperative complications included one pulmonary embolism, one exacerbation of chronic lymphedema, and two cases of new onset erectile dysfunction. Mean follow-up was 36.4 ± 23.2 months (6-92 months). There were no radiographic or clinically significant changes in mean IVC diameter during follow-up. Five late deaths (23%) occurred as a result of metastatic RCC over a mean period of 24 months (range, 12-48), but without any local recurrences. For advanced RCC with tumor thrombus extension into the IVC, lateral venorrhaphy and primary IVC repair avoids complicated caval reconstructions and results in high patency rates with a low local tumor recurrence rate.

Radical cystectomy with orthotopic neobladder for invasive bladder cancer: a critical analysis of long term oncological, functional and quality of life results

Analyze current knowledge and practice regarding tumor-related cystectomy with subsequent orthotopic neobladder both in male and female patients. Evaluate literature predominantly from the last decade dealing with long-term experience in large numbers of patients with an orthotopic neobladder following cystectomy. Oncological outcome specific to an orthotopic neobladder, functional aspects such as urinary continence, renal function, sexual activity and other quality of life issues are elucidated. Local pelvic recurrences after urothelial bladder cancer occur in 7-12%. Urethral second primary tumors in male and female patients in contemporary series with bladder substitution are 4-6% and 1.4 o 4%, respectively. Upper tract recurrences vary between 2.4-17%. Complications regarding the upper urinary tract have dramatically diminished due to simplified forms of upper tract protection as well as a more refined technique of ureterointestinal anastomosis. Depending on the technique ureteroileal stenosis was lately reported to lie between 2.7 to 3.8%. Renal function remained stable in 96% after a mean follow-up of up to 5 years. Radical cystectomy in carefully selected patients has stood the test of time by providing adequate long-term survival and low local recurrence rates. Orthotopic bladder substitution does not compromise oncological outcome, yields excellent functional results, is cost effective compared to other types of urinary diversion, may improve quality of life and should therefore be the diversion of choice both in men and women. Chronological age is generally not a contraindication for cystectomy, but for orthotopic urinary diversion, tumor extent, functional pelvic floor deficits and general life expectancy are limiting factors.

Adjuvant chemoradiotherapy of advanced resectable rectal cancer: results of a randomised trial comparing modulation of 5-fluorouracil with folinic acid or with interferon-α

Background:Standard adjuvant chemoradiotherapy of rectal cancer still consists of 5-fluorouracil (5-FU) only. Its cytotoxicity is enhanced by folinic acid (FA) and interferon-α (INFα). In this trial, the effects of FA and IFNα on adjuvant 5-FU chemoradiotherapy in locally advanced rectal cancer were investigated.Methods:Patients with R0-resected rectal cancer (UICC stage II and III) were stratified and randomised to a 12-month adjuvant chemoradiotherapy with 5-FU, 5-FU+FA, or 5-FU+IFNα. All patients received levamisol and local irradiation with 50.4 Gy.Results:Median follow-up was 4.9 years (n=796). Toxicities (WHO III+IV) were observed in 32, 28, and 58% of patients receiving 5-FU, 5-FU+FA, and 5-FU+IFNα, respectively. No differences between the groups were observed for local or distant recurrence. Five-year overall survival (OS) rates were 60.3% (95% confidence interval (CI): 54.3–65.8), 60.4% (54.4–65.8), and 59.9% (53.0–66.1) for 5-FU, 5-FU+FA, and 5-FU+IFNα, respectively. A subgroup analysis in stage II (pT3/4pN0) disease (n=271) revealed that the addition of FA tended to reduce the 5-year local recurrence (LR) rate by 55% and increase recurrence-free survival and OS rates by 12 and 13%, respectively, relative to 5-FU alone.Conclusions:Interferon-α cannot be recommended for adjuvant chemoradiotherapy of rectal cancer. In UICC stage II disease, the addition of FA tended to lower LR and increased survival. The addition of FA to 5-FU may be an effective option for adjuvant chemoradiotherapy of UICC stage II rectal cancer.

Single-Center Long-Term Follow-Up After Intraoperative Radiotherapy as a Boost During Breast-Conserving Surgery Using Low-Kilovoltage X-Rays

Intraoperative radiotherapy (IORT) during breast-conserving surgery as a boost followed by whole-breast radiotherapy is increasingly used. Between February 2002 and December 2008, a total of 197 patients were treated with IORT as a boost (20 Gy, 50 kV x-rays; Intrabeam System, Carl Zeiss Surgical, Oberkochen, Germany) during breast-conserving surgery, followed by whole-breast radiotherapy (46-50 Gy). Systemic therapy was provided according to the St. Gallen consensus. Patients were recalled every 6-12 months for follow-up. Findings were scored according to the LENT-SOMA scale. Median age was 61.8 (range 30-84) years, and median follow-up was 37 (range 5-91) months. There were T1, T2, and Tx tumors in 129, 67, and 1 patients, respectively, and N0, N1, N2, and N3 disease in 144, 36, 15, and 2 patients, respectively. Until December 2009, 5 local invasive relapses, 1 local ductal carcinoma-in-situ, 1 axillary relapse, 6 secondary cancers, and 11 distant metastases were seen, resulting in a 5-year disease-free survival of 81.0% and an overall survival of 91.3%. Local relapse-free survival (invasive cancers) at 3 and 5 years was 97.0%. After a follow-up of 5 years (n =58), only 8 patients (13.8%) had chronic skin toxicities, and 2 patients (3.4%) had a marked increase in density (fibrosis III), while 62.0% had no/barely palpable fibrosis 0-I. Other toxicities observed included severe pain (n = 4, 6.9%), retraction (n =17, 29.3%), edema of the breast (n =1, 1.7%), and lymphedema in general (n =2, 3.4%). After IORT as a tumor bed boost with low-kilovoltage x-rays followed by whole-breast radiotherapy, low local recurrence and chronic toxicity rates were seen after 5-year follow-up.

Analysis of the related factors of local recurrence in patients with rectal cancer after Dixon operation

Objective To analyze the related factors of local recurrence in patients with rectal cancer after Dixon operation. Methods A retrospective analysis of clinical data of 100 patients from September 2005 to September 2007 in our hospital by TME standard surgicai treatment of low rectal cancer was carried out. Results Of 100 patients, the pre-sacral recurrence rate was 10. 0%, with gender, age, tumor size, tunor invasion lumen circumference,depth of invasion,lymph node metastasis and Duke's stage has nothing to do with the gross type,histological type and lumen,peritoneal tumor cell shedding,and as an independent prognostic factor. Of 90 patients without local recurrence,the 5-year survival rate was 76. 0% ,haff of the survival of 62 months;10 cases of local recurrence,5-year survival rate was 5. 0%, half of the survival of 24 months, suggested that local recurrence in patients influenced the prognosis. Conclusion The low local recurrence of rectal cancer related factors were gross type,histological type and the intestine, peritoneal tumor cells shed, seriously affect the prognosis of patients with local recurrence. Key words: Rectal neoplasms; Recurrence; Factor analysis,statistical

Das Optimult-Studienkonzept – Grundlage für selektiven Einsatz neoadjuvanter Radiochemotherapie auf MRT-Basis?

Optimal surgery for rectal cancer, i. e., total mesorectal excision in the middle and lower rectum reduces local recurrence substantially. Multi-modal therapy further improves the rate of local recurrence in advanced rectal cancer. In Germany neoadjuvant chemoradiation therapy is most frequently given for these tumours. However, clinical staging by endosonography, CT scan and / or MRI is unreliable, particulary as regards lymph node category, which entails overtreatment of a relevant number of patients secondary to overstaging. Thus, a subgroup of patients has to tolerate side effects and long-term sequelae of neoadjuvant therapy without having oncological benefit from this pretreatment. It is of note that the prognosis of patients with advanced rectal cancer depends not only on the T and N category but also on the free circumferential margin of the tumour as determined by pathological examination. In contrast to the T and N category, the latter may be predicted before treatment by pelvic MRI. While several case series demonstrated that low local recurrence rates are achieved in patients when preoperative MRI showed free circumferential margins, this concept was never tested in a randomised controlled trial. We, therefore, designed a two-armed randomised study with patients who suffer from rectal cancer and who have 2 mm or more free circumferential margins on their preoperative MRI. These patients are either operated without pretreatment (intervention arm) or receive neoadjuvant chemoradiation therapy with subsequent surgery (control arm). If local recurrence in the intervention arm is not inferior to the control arm, this study may form the basis for an individualised therapeutic concept for rectal cancer based on preoperative MRI. Potentially, chemoradiation therapy may be avoided in the future for patients who will have no oncological benefit from this treatment modality.

Feline injection-site sarcoma: Past, present and future perspectives

Feline injection-site sarcomas (FISS) have been known since the early 1990s. After an initial correlation with rabies and feline leukaemia virus vaccination, subsequent studies have demonstrated that an abnormal reaction of feline tissues to chronic inflammation was mainly responsible for the disease. The low incidence of FISS in the population is explained by its multifactorial aetiology, since individual genetic characteristics are also implicated. FISS is an infiltrative tumour with low metastatic potential but local recurrence is common. Multimodal treatment (extensive surgery, radiotherapy, chemotherapy) is recommended. The use of sophisticated imaging techniques can improve diagnosis and help in surgical planning. After the initial enthusiasm in understanding the disease, only few advances have been made in the last few years. New promising therapies may arise from a better knowledge of the molecular pathogenesis of FISS and the successful development of drugs modulating the immune system.

Stereotactic radiosurgery for stage I NSCLC in medically inoperable patients: A prospective multicenter study.

7080 Background: Surgical resection is the standard of care for patients with stage I non-small cell lung cancer (NSCLC). However, for high-risk patients stereotactic radiosurgery (SRS), offers an alternative option. Our objective was to prospectively evaluate SRS as definitive treatment for high risk patients with stage I NSCLC in a multi-institutional setting Methods: This is a prospective multicenter study (14 centers) to evaluate Cyberknife SRS for the treatment of stage I NSCLC in medically inoperable patients. Patients were accrued after evaluation by thoracic surgeons and oncologists. The tumor was stratified by location. A high biological effective dose (BED) was delivered (60 Gy) in three fractions to the 80% isodose line for peripheral lesions. We evaluated the initial response rate by the modified RECIST (Response Evaluation Criteria in Solid Tumors) criteria at 3-6 months. This modification incorporated imaging with Positron emission tomography (PET) scanning. We also evaluated time to progression and overall survival. Results: A total of 78 patients, 63 with stage IA, 15 with stage IB peripheral NSCLC underwent SRS. Seventy patients were evaluable for response. A complete response was observed in 11 patients (16%), partial response in 37 (53%), stable disease in 20 (28%), and progression in 2 patients (3%). The median follow-up was 11 months (range 0.1–49 months); the median overall survival was not reached. The probability of 2 year overall-survival for the entire group was 62% (95% CI 42%-77%). Overall survival did not differ by stage IA vs. IB (p=0.187). During follow-up with PET and/or CT, 18 patients had recurrence: only 1 local (5%), and 17 with regional or distant recurrence. Median recurrence-free survival (RFS) was 43 months. The probability of 2 year RFS was 54% (95% CI=33%-71%). Conclusions: Our preliminary results of the prospective multicenter study of SRS for high-risk patients with stage I peripheral NSCLC is promising compared to standard radiation. In particular, local control was good with a low local recurrence rate (5%), with this dose of 60 Gy in 3 fractions. Additional follow-up is needed, and is ongoing to fully evaluate the results of stereotactic radiosurgery for stage I NSCLC. Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration Accuray

Endoscopic submucosal dissection for the treatment of early esophageal and gastric cancer - initial experience of a western center

BACKGROUNDEndoscopic submucosal dissection is a new Japanese technique characterized by en-bloc resection of the entire lesion irrespective of size, with lower local recurrence when compared to endoscopic mucosal resection.OBJECTIVETo evaluate the feasibility, early results and complications of the endoscopic submucosal dissection technique for treating early gastric and esophageal cancer at the Endoscopic Unit of Clinics Hospital and Cancer Institute of the São Paulo University.MATERIALS AND METHODSTwenty patients underwent endoscopic resection using the endoscopic submucosal dissection technique for early gastric or esophageal cancer. The patients were evaluated prospectively as to the executability of the technique, the short-term results of the procedure and complications.RESULTSSixteen gastric adenocarcinoma lesions and six esophageal squamous carcinoma lesions were resected. In the stomach, the mean diameter of the lesions was 16.2 mm (0.6–3.5 mm). Eight lesions were type IIa + IIc, four were type IIa and four IIc, with thirteen being well differentiated and three undifferentiated. Regarding the degree of invasion, five were M2, seven were M3, two were Sm1 and one was Sm2. The mean duration of the procedures was 85 min (20–160 min). In the esophagus, all of the lesions were type IIb, with a mean diameter of 17.8 mm (6–30 mm). Regarding the degree of invasion, three were M1, one was M2, one was M3 and one was Sm1. All had free lateral and deep margins. The mean time of the procedure was 78 min (20–150 min)CONCLUSIONThe endoscopic submucosal dissection technique was feasible in our service with a high success rate.

683h: Prospective Evaluation of Clinical, Endoscopic and EUS FNA Peri-Iliac Lymph Node Status in Primary Rectal Cancer

Total mesorectal excision (TME) results in low local recurrence rates in lymph node (LN) positive rectal cancer. However, lymphatic flow from low-lying rectal cancers (distal 1/3 of rectum) passes beyond the boundaries of TME to LN's in close proximity to the iliac vessels in the lateral pelvic region. The low prognostic value of EUS nodal appearance mandates EUS guided fine needle aspiration (FNA). It is currently unknown, if iliac LN status confirmed by EUS FNA in primary rectal cancer is of potential clinical significance.

Long-term follow-up of nephron sparing surgery for renal cell carcinoma

Objective To evaluate the long-term therapeutic results and the safety of nephronsparing surgery(NSS) for the treatment of renal cell carcinoma. Methods Clinical data of 243 NSSfor renal cell carcinoma were retrospectively analysed. Of them, 159 were males and 84 were femaleswith average age of 58 years (range from 24 ?77 years). The average tumor size was 3. 4 cm (rangefrom 1.1 to 6. 7 cm). Three cases were solitary renal cell carcinoma, 11 were bilateral renal cell carcinoma; 237 cases were in stage T_(1a). and 6 cases were in stage T_(1b). No lymph node and distant metastasis, no renal vein cancer tumor embolus and inferior vena cava tumor embolus was found. Postoperative follow-up was carried out by ultrasound, CT and renal function. Cancer specific survival was estimated using Kaplan-Meier method and log-rank test. Results After a mean 31 months (1-147months) follow-up, long-term follow-up data were obtained in 232 cases because the other 11 did notlive in Dalian, 52 were treated with interferon. Four of the 232 patients treated with NSS had died:1died from lung cancer 16 months after lung cancer treatment, the other 3 died from cardiovascular diseases. The total survival rate and cancer specific survival rate were 98. 3% and 100. 0%, respectively.Local tumor recurrences were detected in 5 patients and tumor metastasis was detected in 1 patient.The recurrence rate was 2. 2%, and the metastasis rate was 0. 4%. The complications included temporary renal failure and urine leakage. The complication rate was 5. 6%. Conclusions NSS for renalcell carcinoma is a safe and feasible treatment option. It has the advantages of low local recurrence,good long-term survival rate and low complication rate. NSS can maximally reserve functional nephron, reduce the risk of chronic renal failure, preserve patient's quality of life and increase patient'ssatisfaction. Key words: Carcinoma, renal cell; Nephron sparing surgery; Prognosis

Efficacy of preoperative radiotherapy combined with total mesorectal excision in the treatment of locally resectable rectal cancer: a systematic review

To assess the clinical efficacy of preoperative radiotherapy combined with total mesorectal excision (TME) in the treatment of locally resectable rectal cancer. Literature search was carried out to identify prospective clinical randomized controlled trails on preoperative radiotherapy for rectal cancer published from January 1982 to April 2009. The basic characteristics and clinical efficacy of the trials meeting the screening criteria were enrolled. Date analysis was performed by RevMan 4.2. According to the selection criteria, 9 clinical trials were included. Compared with surgery alone, the short-term preoperative radiotherapy was associated with reduced 2-year local recurrence rate (2.4% vs 8.2%, P<0.01). There were no significant differences in 4-year overall survival (67.2% vs 66.2%), 4-year disease-free survival (58.4% vs 55.6%) and local recurrence (RR=1.16, 95% CI:0.37~3.61, P=0.80) between the preoperative radiotherapy and radiochemotherapy. High-dose preoperative radiotherapy could increase the complete response rate and sphincter sparing surgery rate than that low-dose (16.0% vs 2.0%, P<0.05). The interval between preoperative radiotherapy and operation did not affect the overall survival, disease-free survival and local recurrence. Preoperative radiotherapy combined with total mesorectal excision is associated with lower local recurrence.

Laparoscopic sphincter-preserving total mesorectal excision: 10-year report

Total mesorectal excision (TME) is currently the gold standard for resection of mid or low rectal cancer and is associated with a low local recurrence rate. However, few studies have reported the long-term oncological outcome following use of a laparoscopic approach. The aim of this study was to evaluate the long-term oncological outcome after laparoscopic sphincter-preserving TME with a median follow up of about 4 years. Patients with mid or low rectal cancer who underwent laparoscopic sphincter-preserving TME with curative intent between March 1999 and March 2009 were prospectively recruited for analysis. During the 10-year study period, 177 patients underwent laparoscopic sphincter-preserving TME with curative intent for rectal cancer. Conversion was required in two (1%) patients. There was no operative mortality. At a median follow-up period of 49 months, local recurrence had occurred in nine (5.1%) patients. The overall metastatic recurrence rate after curative resection was 22%. The overall 5-year survival and 5-year disease-free survival in the present study were 74% and 71%, respectively. The results of this study show that laparoscopic sphincter-preserving TME is safe with long-term oncological outcomes comparable to those of open surgery.