Surgery For Advanced Colorectal Cancer Research Articles

Psychosocial intervention for late adverse effects following surgery for advanced colorectal cancer – an intervention protocol

Background: Peritoneal metastases (PM) from colorectal cancer (CRC) can be curatively treated with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS and HIPEC) and locally advanced/recurrent CRC can be curatively treated with pelvic exenteration (PE). However, both are extensive surgeries with the risk of patients developing a range of psychological and general late adverse effects following these treatments. We will test the feasibility, acceptability and efficacy of a screening procedure followed by a multidisciplinary team (MDT) conference to identify and treat selected clinically significant psychological and general late adverse effects.

Systematic assessment of complications after laparoscopic colorectal surgery for advanced colorectal cancer: A retrospective study using Clavien-Dindo classification, 5-year experience.

The presence and frequency of surgical complications indicate the quality of the surgery performed. However, a standard classification system should specify, describe, and compare complications. Clavien Dindo classification is an easily applicable classification in the evaluation of complications. Our study aimed to reveal the severity of complications and the factors affecting them by using the Clavien Dindo classification in patients undergoing laparoscopic colorectal surgery. Between January 2015 and December 2020, we retrospectively collected the laparoscopic colorectal surgery complications using Clavien Dindo grading in patients in our colorectal surgery unit in the database. The outcome variables studied were age, gender, BMI, ASA score, postoperative length of hospital stay, operation procedure, cancer size, postoperative mortality. There were 53 males and 17 female patients, with a mean age of 56,9±13,4.(19-81). Seventy patients, 32 (45%), had at least one postoperative complication. About complications; 58.6% were rated as Clavien I, 22.9% as Clavien II, 8.6% as Clavien IIIa, 4.3% as Clavien IIIb, 2.9% as Clavien IVa, and 2.9% as Clavien V. There was no Clavien grade IVb complication in any of the patients. Length of hospital stays was significantly higher in patients with had major complex surgery and had higher scores. Clavien Dindo classification was positively statistically significantly related to the day of hospitalization in male and female sex (p<0.001 for all). In addition, positively significantly related to Clavien Dindo classation and tumor diameter in the female sex (p=0.014) detected. In laparoscopic colorectal surgery, the Clavien-Dindo classification can be easily applied and used safely to determine complication rates. The reason for this statistical difference that we detected in our study and that occurs in women may be due to anatomical differences or the surgeon's experience.

High ligation of the inferior mesenteric artery with nerve-sparing in laparoscopic surgery for advanced colorectal cancer.

High ligation of the inferior mesenteric artery with nerve-sparing in laparoscopic surgery for advanced colorectal cancer.

EVALUATION OF SHORT AND LONGER-TERM SURVIVAL FOLLOWING NON-RESECTIONAL PALLIATIVE SURGERY FOR ADVANCED COLORECTAL CANCER

IntroductionPalliative surgery for advanced colorectal cancer is associated with high morbidity and mortality. Non-resectional palliative surgery can be useful in the management of malignant bowel obstruction or perforation where a...

Diagnostic accuracy and value of magnetic resonance imaging (MRI) in planning exenterative pelvic surgery for advanced colorectal cancer

PurposeTo assess the diagnostic accuracy of magnetic resonance imaging (MRI) in detecting colorectal tumour invasion according to seven intrapelvic compartments for planning exenterative pelvic surgery. MethodSixty-three consecutive patients underwent preoperative MRI planning for exenterative surgery, defined as operative excision beyond conventional mesenteric planes for locally advanced (n=23) and recurrent (n=41) pelvic colorectal cancer. The institutional research committee approved of the study and waived the need for a consent form as the images were retrospectively assessed. Two radiologists reported tumour invasion for each of seven anatomic surgical resection compartments, blinded to histopathology and the intraoperative findings. Sensitivity, specificity and predictive values were calculated for the seven intrapelvic compartments. Cox regression analysis was used to calculate the risk of death and recurrence. Overall interobserver agreement was assessed using Cohen’s Kappa coefficient (k). ResultsThe sensitivity of MRI was ⩾93.3% in all but the lateral compartment where it was 89.3%. Specificity for the posterior (82.2%) and anterior compartments below the peritoneal reflection (86.4%) was lower compared to the other compartments. Agreement between the two radiologists was found to be good or very good for all compartments (k>0.72). An MRI diagnosis of tumour invasion in the anterior compartment above the peritoneal reflection was associated with a poorer survival (p=0.012). ConclusionMRI is accurate in predicting the extent of colorectal tumour within the pelvis and therefore can be used to determine the type of surgery required for curative resection. It should always be used to stage patients with advanced colorectal pelvic cancer.

Short-term clinical outcomes from a randomized controlled trial to evaluate laparoscopic and open surgery for stage II-III colorectal cancer: Japan Clinical Oncology Group study JCOG 0404 (NCT00147134).

538 Background: The benefits of laparoscopic surgery (LAP) in comparison with open surgery (OP) have been suggested; however, the long-term survival after LAP for advanced colorectal cancer (CRC) requiring complete mesocolic excision is still unclear. We conducted a study to confirm the non-inferiority of LAP to OP in terms of overall survival with less frequent post-operative morbidity. The primary analysis is planned in 2014, and short-term outcomes including post-operative complications are presented here. Methods: Only accredited surgeons from 30 Japanese institutions participated. Eligibility criteria included histologically proven CRC; tumor located in the cecum, ascending, sigmoid or rectosigmoid colon; T3 or deeper lesion without involvement of other organs; N0–2 and M0; tumor size =&lt;8 cm; patient age 20-75 years. Patients were randomized preoperatively by the minimization method. Patients with pathological stage III received adjuvant chemotherapy with fluorouracil plus leucovorin. The primary endpoint is overall survival, and the planned sample size was 1050. Results: A total of 1057 patients were randomized (OP: 528, LAP: 529) between October 2004 and March 2009. Patients assigned to LAP had less blood loss than those assigned to OP (median 30 ml vs 85 ml, p&lt;0.001), although LAP lasted 52 minutes longer than OP (p&lt;0.001). Radicality of resection, as assessed by the number of resected lymph nodes, did not differ between the two groups. LAP was associated with earlier recovery of bowel function (p&lt;0.001), and with a shorter hospital stay (p&lt;0.0001) than OP. Morbidity and mortality until discharge did not differ between the two groups, except for fewer wound-related complications in LAP (p=0.007). Conclusions: Short-term clinical benefits of LAP were demonstrated, and laparoscopic surgery for advanced CRC can be performed safely by experienced surgeons. If the non-inferiority of LAP in overall survival is demonstrated in the primary analysis planned in 2014, LAP will be the new standard surgical procedure for CRC.

Short- and Long-Term Outcomes of Laparoscopic Surgery in Patients with Pathological Stage II and III Colon Cancer

In Japan, the safety and long-term outcomes of laparoscopic surgery for advanced colorectal cancer remains a matter of debate. We studied the safety and outcomes of laparoscopic surgery in patients with pathological stage II and III colon cancer. The study group comprised 253 patients with colon cancer who underwent laparoscopic surgery from January 1998 through December 2006. We studied surgical outcomes, invasiveness, safety, recurrence rates, recurrence patterns, and long-term outcomes. Median follow-up was 67 months (range, 7-149). Laparoscopic surgery was converted to open surgery in 5 patients (2%). Postoperative complications occurred in 23 patients (9%); wound infections were most common (11 patients, 4.3%), followed by ileus (5 patients, 1.9%). Recurrence developed in 66 patients (26%). Liver and lung metastases were the most common types of recurrence; there was no port-site recurrence. The 10-year recurrence-free survival rate and the overall survival rate were respectively 92.9% and 93.3% in stage II disease, 82.7% and 82.9% in stage IIIA and IIIB disease, and 70.3% and 68.6% in stage IIIC disease. In patients with pathological stage II and III colon cancer, laparoscopic surgery is safe, minimally invasive, and has good surgical outcomes, overall survival rates and recurrence-free survival rates. Our results suggest that laparoscopic surgery is a viable treatment option for pathological stage II and III colon cancer.

Laparoscopic Surgery for Advanced Colorectal Cancer: Selection Criteria and Exclusion Factors in our department

Introduction: Laparoscopic assisted colectomy (LAC) for early colorectal cancer has been established and been proven to be equivalent to open colectomy in terms of survival and safety. Although the indications for LAC in advanced colorectal cancer remain controversial, LAC has been performed increasingly often. Purpose: To clarify the selection criteria of laparoscopic surgery for advanced colorectal cancer. Methods: The indications for laparoscopic surgery in advanced colorectal cancer were established from 2001∼2004, as: 1) the cecum, ascending colon, descending colon, sigmoid colon, and rectosigmoid colon, 2) tumor depth within the subserosa, 3) no regional lymph node involvement, and 4) no distant metastasis. Indications established from 2005 to 2007 were: 1) all colorectal cancer with none in the lower rectum, 2) no distant metastasis, and 3) no direct invasion to neighboring organs. The reasons to exclude indications and the exclusion factors for laparoscopic colectomy for advanced colorectal cancer were analyzed. Results: The percentage of cases consistent with the indications were 55% (2001∼2004) and 78% (2005∼2007). The reasons for exclusion were liver metastasis (19% and 40%), tumor location (33% and 37%), direct invasion to the neighboring organs (21% and 17%), and peritoneal dissemination (3% and 6%). The exclusion factors for laparoscopic colectomy were tumor size (31% and 27%), synchronous malignancies (11% and 26%), ileus and emergencies (17% and 14%), history of previous abdominal surgery (15% and 14%), age and general condition (17% and 9%), and obesity (8% and 5%). There was no significant difference between the short-term performance of LAC from 2001∼2004 and from 2005 to 2007. Operation time, blood loss, conversion rate to open surgery and postoperative complications were similar between the patients with a body mass index (BMI) less than 25 and those with a body mass index greater than 25. Conclusion: Practical indications for LAC in advanced colorectal cancer are 1) all colorectal cancer with none in the lower rectum, 2) no distant metastasis, and 3) no direct invasion to neighbouring organs. Obesity is not necessarily an exclusion factor for LAC. However long-term analysis is still necessary.

Lumican expression in advanced colorectal cancer with nodal metastasis correlates with poor prognosis

Lumican is a member of a small leucine-rich proteoglycan family, and it is reportedly overexpressed in human breast cancer. The expression of lumican in the extracellular matrix in breast cancer is associated with a high tumor grade, low estrogen receptor levels and young age. Lumican expression has been previously reported in colorectal cancer, but the role of lumican in the tumor is not well understood. In this study, we examined the expression and role of lumican in advanced colorectal cancer. Immunohistochemical staining was performed on 158 patients who underwent curative surgery for advanced colorectal cancer with lymph node metastasis. In the normal colorectal tissues, lumican immunoreactivity was observed in the fibroblasts and neural cells, but not in the colorectal epithelial cells. Lumican was localized in the cytoplasm of the cancer cells and its overexpression was detected in 99 of the 158 (62.7%) colorectal cancer patients. Clinicopathologically, there was no association of lumican expression with age, sex, histological typing, or venous and lymphatic invasion. However, lumican expression tended to correlate with the spread of lymph node metastasis and the depth of tumor invasion (p=0.136 and 0.135, respectively). Furthermore, the survival rate was significantly lower in patients with a high lumican expression level than in those with a low lumican expression level (p=0.048). These results indicate that lumican expression is a potential prognostic factor in patients with advanced colorectal cancer with nodal metastasis.

Randomized controlled trial of laparoscopic versus open colectomy for advanced colorectal cancer

After confirming a favorable outcome of laparoscopic surgery for early colorectal cancer, we conducted a randomized controlled trial to compare short-term outcomes of laparoscopic and open colectomy for advanced colorectal cancer. Fifty-nine patients with T2 or T3 colorectal cancer were randomized to undergo laparoscopic (n = 29) or open (n = 30) colectomy. Median follow-up was 20 months (range, 6-34 months). Operative time was longer (p <0.0001) and blood loss (p = 0.0034) and postoperative analgesic requirement were less in the laparoscopic group than in the open group. An earlier return of bowel motility and earlier discharge from the hospital (p = 0.0164) were observed after laparoscopic surgery. Serum C-reactive protein levels on postoperative days 1 (p <0.0001) and 4 (p = 0.0039) were lower in the laparoscopic group than in the open group. Postoperative complications did not differ between the two groups. Laparoscopic surgery for advanced colorectal cancer is feasible, with favorable short-term outcome.