Treatment Of Rectal Cancer Research Articles

Role of fluorescence navigation with indocyanine green during lateral pelvic lymphodissection in the treatment of rectal cancer (meta-analysis)

INTRODUCTION: intraoperative fluorescence navigation with indocyanine green (ICG) allows visualizing possible affected lymph nodes, which hypothetically provides more precise lateral pelvic node dissection (LPND).AIM: to compare immediate results of lateral pelvic node dissection (LPND) combined with fluorescence navigation with ICG and conventional LPND for the treatment of metastatic lesions of lateral pelvic lymph nodes in patients with rectal cancer.PATIENTS AND METHODS: search was performed in the PubMed library (National Library of Medicine, Bethesda, MD, USA) with keywords “indocyanine green,” “ICG“, ”lymph nodes,” “lateral lymph node dissection,” and “rectal cancer” in various combinations. Four non-randomized studies were included in meta-analysis, three retrospective and one prospective, on the outcomes of ICG use during LPND in patients with rectal cancer in the meta-analysis.RESULTS: significantly more lymph nodes were harvested in LPND + ICG group (MD = 4.5; 95% CI: 3.0–5.9; p < 0.00001). The operation time was longer in the ICG group (MD = 32.5; 95% CI: 2.8–62.3; p = 0.03). Intraoperative blood loss was higher in conventional LPND group (MD = −52.6; 95% CI: −89.8 — −15.3; p = 0.006). Hospital stay was significantly shorter in ICG group (MD = −1.2; 95% CI: −2.0 — −0.4; p = 0.003). Patients who underwent standard LPND were significantly more likely to have postoperative urinary retention (OR = 0.4; 95% CI: 0.1–0.9; p = 0.03).CONCLUSION: fluorescence navigation with ICG improves early results of LPND. Further accumulation of experience with dynamic follow-up of patients is crucial.

Prediction of anorectal dysfunction in the combined treatment of rectal cancer

AIM: to assess the risk of severe low anterior resection syndrome (LARS) in patients with rectal cancer after combined treatment.PATIENTS AND METHODS: from July 2022 to November 2023, 50 patients with rectal cancer underwent radiation with a total focal dose of 50–54 Gy with radiomodification with capecitabine and low anterior rectal resection with preventive ileostomy. The ileostomy was closed after 4 months. Prior to and after radiation, the anorectal function was assessed using high-resolution anorectal manometry (HRAM) and the LARS scale.RESULTS: the most significant predicting factors for severe LARS were maximal contraction pressure and first sensation volume. Three months after ileostomy closure, the patients were divided into groups depending on the HRAM parameters. Group 1: nine patients with severe LARS (34 points on the LARS scale), with a decrease in maximal contraction pressure by ≥ 30% and an increased first sensation volume by ≥ 60%, according to HRAM. Group 2: four patients out of 36 had severe LARS (31 points on the LARS scale), with a decrease in maximal contraction pressure by 5–29% and an increased first sensation volume by 10–59%, according to HRAM. Group 3: in 5 patients with a decreased maximal contraction pressure by ≤ 4% and an increased volume of the first sensation by ≤ 9%, LARS did not develop.CONCLUSION: a decrease in the maximal contraction pressure by 30% or more and an increase in the volume of the first sensation by 60% or more after radiation therapy can increase the risk of severe LARS. This group of patients requires prevention and correction of anorectal dysfunction.

Reconstruction of the pelvic floor and perineal wound after extralevator abdominoperineal resection of the rectum.

This article presents an innovative technique for perineal wound reconstruction following extralevator abdominoperineal excision (ELAPE) in rectal cancer surgery. The authors trace the evolution of surgical methods for rectal cancer treatment, from W.E. Miles' abdominoperineal resection (APR) to T. Holm's ELAPE technique introduced in 2007. The proposed metod's primary advantage lies in its ability to completely fill the extensive deep and superficial perineal wound defect by moving two flaps from both sides of the wound and overlapping them. This approach potentially reduces postoperative complications and improves patients' quality of life following ELAPE. The authors describe the procedure in detail, including specific measurements and angles for flap creation. They also present a case study of a 52-year-old female patient with lower rectal ampulla cancer, demonstrating the practical application of this technique. This innovative reconstruction method addresses the current lack of consensus on perineal wound plastic surgery techniques following ELAPE and offers a promising solution to reduce postoperative morbidity in rectal cancer patients undergoing this procedure.

Contact X-ray Brachytherapy (CXB) as a boost therapy after neoadjuvant (chemo)radiation in high-risk locally advanced rectal cancer.

Radical surgery following neoadjuvant therapy is the standard of care for locally advanced rectal cancer. A Contact X-ray Brachytherapy (CXB) boost can alternatively be used to treat residual disease post neoadjuvant (chemo)radiation, especially in patients who are not suitable for or do not wish to have surgery. Its role has mostly been studied to date in low to intermediate-risk patients. We have now evaluated the utility of CXB-boost in high-risk rectal cancers after their tumours have been significantly downstaged by neoadjuvant (chemo)radiation. Oncological outcomes and treatment tolerability were evaluated in 328 patients based on rectal cancer treatment risk stratification: low/intermediate risk (cT1-3ab, N0-1, M0, no extramural invasion (EMVI), mesorectal fascia (MRF) involvement >1mm) and high-risk (cT3cd-4/N2, M0, MRF≤1mm and/or EMVI positive). With median follow-up of 33(IQR:15-54) months and median age of 73(IQR:62-80) years, no significant differences were found between low/intermediate and high-risk groups in clinical complete response (78% vs 73%, p=0.32), local regrowth (16.6% vs 22.4%, p=0.41), nodal (1.8% vs 5.8%, p=0.051) or regional (1.3% vs 2.9%, p=0.33) relapse, or post-radiation toxicities (p=0.16). However, the high-risk group had a higher distant relapse rate (21.2% vs 10.7%, p=0.01), with no significant differences in 3-year organ preservation (80% vs 87%, p=0.25), 5-year disease-free (DFS) (62% vs 64%, p=0.46), or overall (OS) survivals (67% vs 64%, p=0.88). Longer treatment time, treatment gap >24 weeks between therapies, and administration of a higher than standard CXB dose were newly identified factors that negatively impacted outcomes. High-risk rectal cancer patients treated with CXB-boost had more distant relapses, but comparable locoregional tumour control, organ preservation, DFS and OS to lower-risk patients, with acceptable toxicities. CXB-boost is therefore a viable option for selected high-risk rectal cancer patients. Timely reassessment, prompt referral, and CXB dose optimisation are crucial for improving outcomes.

Nonoperative management of rectal cancer

The management of locally advanced rectal cancer has changed drastically in the last few decades due to improved surgical techniques, development of multimodal treatment approaches and the introduction of a watch and wait (WW) strategy. For patients with a complete response to neoadjuvant treatment, WW offers an opportunity to avoid the morbidity associated with total mesorectal excision in favor of organ preservation. Despite growing interest in WW, prospective data on the safety and efficacy of nonoperative management are limited. Challenges remain in optimizing multimodal treatment regimens to maximize tumor regression and in improving the accuracy of patient selection for WW. This review summarizes the history of treatment for rectal cancer and the development of a WW strategy. It also provides an overview of clinical considerations for patients interested in nonoperative management, including restaging strategies, WW selection criteria, surveillance protocols and long-term oncologic outcomes.

Mitochondrial-Targeting Strategies with Homoharringtonine: A Novel Approach for Chemoresistant Rectal Cancer

5-Fluorouracil (5-FU) resistance poses a significant challenge in the treatment of rectal cancer, driving the need for novel therapeutic strategies. In this study, we established 5-FU-resistant rectal cancer cell lines (SW837-r, SNU-C1-r) and identified homoharringtonine (HHT) as a potent and selective anticancer agent through high-throughput drug screening of 291 compounds. HHT displayed the highest selective drug sensitivity score (sDSS), showing strong activity against resistant cells while sparing normal rectal epithelial cells. Further investigations revealed that 5-FU-resistant cells exhibited enhanced mitochondrial biogenesis and function compared to normal cells, and HHT exerted its cytotoxic effects by targeting mitochondrial respiration. HHT significantly reduced oxygen consumption rate (OCR), mitochondrial complex I activity, and ATP production in resistant cells, with mitochondrial respiration-deficient ρ0 cells showing reduced sensitivity to HHT. In vivo, HHT alone reduced tumor growth by 60% in the resistant xenograft model. In the sensitive xenograft model, combination therapy with 5-FU achieved an 85% reduction in tumor volume compared to controls, with tumors in the combination group displaying minimal regrowth. These results demonstrate that HHT effectively targets mitochondrial function in resistant rectal cancer cells and, in combination with 5-FU, offers synergistic antitumor effects and prolonged tumor suppression. The favorable safety profile of HHT further highlights its potential as a promising therapeutic agent for overcoming 5-FU resistance in rectal cancer.

Quality of life in Rectal Cancer treatment: A Systematic Review of randomized clinical trials published in the last 10 years.

Quality of life in Rectal Cancer treatment: A Systematic Review of randomized clinical trials published in the last 10 years.

Minimally invasive multivisceral resection in rectal cancer: Preparation or Precipitation?

Rectal cancer is a malignant neoplasm that constitutes a significant public health challenge due to its high incidence and associated mortality. In this editorial, we comment on the article by Chan et al. In recent years, there has been progress in the development of new treatments for initial and metastatic rectal cancer due to introduction of techniques of innovative and minimally-invasive surgery (MIS) such as laparoscopy and robotic surgery. However, only a few studies have analyzed the feasibility, safety, and results of MIS in relation to open surgery, thereby highlighting the promising and superior results of MIS in functional and oncological terms. The findings were corroborated by the comparative study of Chan et al which evaluated the feasibility and safety of minimally invasive multivisceral resection (miMVR). A comparison of postoperative outcomes between open MVR and miMVR showed that miMVR presented less blood loss, fewer postoperative complications, and less morbidity. This editorial article is focused specifically on analysis of the characteristics of new minimally-invasive surgical techniques in rectal cancer, particularly in advanced stages. The importance of future research is emphasized by progress in knowledge, training, and clinical practice in the application of these surgical procedures for the treatment of advanced colorectal cancer.

Neoadjuvant treatment of rectal cancer: from adjunct to surgery to primary organ sparing treatment.

Neoadjuvant treatment of rectal cancer: from adjunct to surgery to primary organ sparing treatment.

Therapeutic strategies for ypT1 rectal cancer after neoadjuvant chemoradiotherapy: a retrospective cohort study

PurposeThe optimal treatment of ypT1 rectal cancer after neoadjuvant chemoradiotherapy (nCRT) remains controversial. This study aimed to determine whether local excision is non-inferior to radical surgery and whether adjuvant chemotherapy (ACT) would improve survival in patients with ypT1 rectal cancer after nCRT.MethodsWe enrolled 1212 and 91 patients with ypT1 rectal cancer underwent nCRT followed by radical surgery from the SEER database (2004–2018) and the Zhejiang Cancer Hospital (ZJCH) (2010–2022), respectively. Another 62 patients underwent LE were also identified from SEER registries. Propensity score matching was performed to balance baseline characteristics between patients in different treatment groups.ResultsRegional nodal metastasis was histopathologically detected in 257 patients (20.7%) within the SEER cohort, showing a significant association with poor cancer-specific survival (CSS) and overall survival (OS). Consistent findings were also observed in the ZJCH cohort. After 1:1 propensity score matching (60 pairs), no significant differences were observed between the extended resection and local excision groups in CSS (hazard ratio [HR] 0.88, P = 0.785) and OS (HR 0.81, P = 0.450). Patients with regional nodal metastases were more likely to receive ACT, while no apparent survival benefit was observed with additional ACT after PSM adjusting (187 pairs). Notwithstanding, for individuals younger than 50 years, ACT might provide a survival benefit in CSS (HR 0.25, P = 0.033) and OS (HR 0.30, P = 0.022).ConclusionAlthough patients with ypT1 rectal cancer have a non-negligible risk for nodal metastasis, oncologic outcomes of local excision following nCRT seem to be comparable to radical surgery. ACT could not effectively improve prognosis in patients with ypT1 tumors, except for those younger than 50 years of age.

Rectal cancer with situs inversus totalis and previous malignant middle cerebral artery infarction: a case report and review of the literature

BackgroundSitus inversus totalis is a rare congenital condition where there is complete inversion of thoracic and abdominal organs. There is limited information on the laparoscopic treatment of rectal cancer in patients with situs inversus totalis accompanied by other underlying conditions.Case presentationWe report the case of a 61-year-old Chinese male with rectal cancer accompanied by situs inversus totalis, malignant middle cerebral artery infarction, stenosis of the right internal carotid artery and anterior cerebral artery, and diabetes who underwent a successful laparoscopic radical resection of rectal cancer. We discuss the diagnosis, treatment, and considerations for patients with situs inversus totalis accompanied by other underlying conditions. We performed relevant inspections, organized multidisciplinary team discussions, and made sufficient perioperative preparations. The patient had no intraoperative complications and was successfully discharged from the hospital. Pathological stage was T3N0M0, and the patient did not develop tumor recurrence or metastasis in the 24-month follow-up period.ConclusionsWe conclude that patients with rectal cancer with situs inversus totalis, even when accompanied by underlying diseases, can undergo surgical treatment with adequate preparation, and surgical treatment is the most effective treatment method.

Laparoscopic ELAPE: a case report and review of the literature

Extralevator abdominoperineal excision (ELAPE) is relatively new method of surgical treatment for low and ultra-low rectal cancers. Combined with the laparoscopic technique, laparoscopic ELAPE (LELAPE) has the potential to reduce invasion and hasten postoperative recovery. A laparoscopic approach to the resection can result in fewer postoperative complications, and the modified ELAPE reduces the perineal complications, simplifies the operation and accelerates patient recovery. Here, we report thecase of a patient who underwent a laparoscopic ELAPE procedure for cancer, which was the first laparoscopic ELAPE procedure in Bosnia and Herzegovina.

Coding the issue: low anterior resection syndrome following rectal cancer treatment.

Coding the issue: low anterior resection syndrome following rectal cancer treatment.

Endoscopic intermuscular dissection: insights from China on minimally invasive treatment for early rectal cancer.

Endoscopic intermuscular dissection: insights from China on minimally invasive treatment for early rectal cancer.

HPB O02 - On-site hepatobiliary surgery capability independently predicts treatment pathway completion in metastatic rectal cancer: A nationwide observational study of 15,727 patients

Abstract Background Stage IV rectal cancer carries a 10% 5-year survival rate (Jemal et al., 2005). Curative-intent management requires treatment of both the primary and metastatic disease. This study aimed to identify patterns in stage IV rectal cancer treatment pathway at population level across the UK, and to identify predictors of treatment pathway completion. Method Patient demographics and treatment data were extracted from the UK Colorectal Cancer Intelligence Hub’s CORECT-R repository, national chemotherapy (SACT), radiotherapy datasets (RTDS), and Hospital Episode Statistics (HES) data. Treatment pathway completion was defined as receipt of intervention to the primary tumour, in addition to metastasis-directed therapy, or the combination alongside chemotherapy. Multivariable logistic regression analysis was performed to identify independent predictors of treatment completion. Results A total of 15,727 patients with stage IV rectal cancer diagnosed between 2010-19 were identified. There was significant variation in proportion of patients with complete treatment between MDTs. Multivariable analyses showed that lack of on-site HPB surgery capability was the only predictor of failure to complete treatment (OR 1.22, 95%CI:1.07-1.38, p<0.01). Conclusion Across the UK, there is variation in Stage IV rectal cancer patients completing treatment for both their primary and metastatic disease. Further work is needed to determine whether differences in treatment pathways stem from variation in access to specialist services between cancer alliances or whether they are due to differences in MDT decision making.

Utilizing C-Reactive Protein (CRP) and CRP Ratios for Early Detection of Postoperative Complications Following Rectal Cancer Surgery.

Surgical treatment for rectal cancer may cause complications that exacerbate the condition, lengthen hospital stays, and raise healthcare costs. Rectal cancer surgery complications can be detected immediately with postoperative C-reactive protein (CRP) monitoring. Elevated levels of CRP indicate the presence of inflammation and can serve as a predictive factor for future outcomes. A retrospective cohort analysis was performed on 67 rectal cancer surgery patients. Prior to and after surgery, CRP levels were measured on days 1-3 and 4-7. Postoperative complications were linked to CRP, surgical approach (open, laparoscopic, conversion), and patient characteristics. This study included t-tests, chi-square tests, Mann-Whitney U tests, ANOVA, Pearson and Spearman correlation analyses, and logistic regression. There was a significant correlation between high levels of CRP on postoperative days 4-7 and the development of problems (p < 0.001). The ratios of CRP/albumin and CRP/platelet were highly predictive of problems over this period (p = 0.000033). Patients who encountered problems had a notably greater estimated blood loss (p = 0.0086). Logistic regression analysis demonstrated a statistically significant relationship between higher Charlson Comorbidity Index (CCI) scores and an elevated probability of experiencing problems (p = 0.0078). Moreover, patients who underwent laparoscopic surgery but had to be converted to an open method saw a notably greater incidence of complications (p = 0.0022). From a financial standpoint, the average cost per patient with complications was EUR 1128.75, resulting in a total cost of EUR 44,021.25 for all 39 patients. Conversely, patients who did not experience any difficulties had a cost of EUR 731.25 per patient, resulting in a total of EUR 20,475.00 for all 28 patients. Regularly monitoring CRP, particularly between days 4 and 7 following surgery for rectal cancer, can promptly identify any complications. Monitoring CRP levels and promptly managing any abnormalities can enhance surgical outcomes and reduce healthcare costs.

Evaluation of Volumetric Magnetic Resonance Imaging in Determining the Indication for Total Neoadjuvant Therapy in Rectal Cancer.

This study aims to evaluate the relationship between volumetric measurements of residual tumor via magnetic resonance imaging (MRI) and pathologic complete response (pCR) in rectal cancer patients undergoing neoadjuvant chemoradiotherapy (nCRT). Patients with locally advanced rectal cancer who had pelvic MRI for clinical staging and completed nCRT followed by radical resection were included. Two experienced radiologists measured tumor volume on MRI obtained before and after nCRT. We compared the pre- and post-CRT tumor volume and measured tumor volume reduction rates. The median value of tumor volume reduction rate in all patients was 64.7% (min-max - 81.1-98.1%). When the relationship between tumor volume and tumor regression grade (TRG) after nCRT was assessed, it was found that 18 of 21 (86%) patients with a good response (TRG 1) had a post-CRT tumor volume of ≤ 8 cm3 (p = 0.001). While 9 of 10 patients with pCR after nCRT had a tumor volume of ≤ 8 cm3, one patient had pCR despite having a tumor volume greater than 8 cm3 (p = 0.015). The correlation between post-nCRT residual tumor volume and pCR underscores the potential of volumetric MRI as a predictive tool in tailoring rectal cancer treatment. For patients with residual tumor volumes greater than 8 cm3, extending neoadjuvant chemotherapy as part of TNT may enhance the likelihood of achieving pCR. This approach advocates for a more personalized treatment strategy, potentially optimizing outcomes for rectal cancer patients.

Current technologies of response assessment in rectal cancer after neoadjuvant treatment: A review

Improvement of the multidisciplinary approach to the treatment of rectal cancer over recent years has led to the fact that in specialized high-volume oncology clinics it is possible to achieve a complete pathomorphological response to neoadjuvant therapy in a third of patients. The emergence of new knowledge about the development of tumor complete response and the accumulation of clinical experience opens up possibility for the wider use of an organ-sparing approach. Undoubtedly, making such a critical strategic decision requires reliable and effective tools for complete response predicting. This review is devoted to methods for assessing tumor response in patients diagnosed with rectal cancer. A look at the problem is presented from the perspective of modern methods of medical imaging, molecular and genetic studies, the study of the characteristics of the immune response, and a new look at clinical data. New data can form the basis for new patient selection algorithms for personalized treatment protocols for rectal cancer, thereby improving long-term results and quality of life for patients.

Assessment of Optimal Treatment Strategies and Their Outcomes in T3N1 Rectal Cancers.

Background:This study compares the outcomes of a surgery first vs a neoadjuvant treatment strategy in T3N1M0 rectal cancers. Methods:This was a single-centre retrospective cohort study of patients admitted for curative treatment of T3N1 rectal cancer. Patients with pre-treatment T3N1 and pathological T3N1 disease were included in the study. Patients were divided into two groups depending on whether they had surgery or neoadjuvant therapy as their initial phase of treatment. Primary outcome measures were local recurrence and distant recurrence. Secondary outcomes were disease-free survival (DFS) and overall survival (OS). Tabulated results were analyzed with appropriate statistical tests. Results:One hundred and ten patients were initially selected. Fourty-eight were finally included after excluding patients who did not meet the staging criteria or were not eligible for curative treatment. Twenty-nine patients underwent surgery, and 19 patients with neoadjuvant therapy as their first treatment. No local recurrence was noted in either group, with a distant recurrence noted in group 2 (6.9%) and group 1 (5.26%) cases among the surgery-first and neoadjuvant-first groups, respectively. Disease-free survival and overall survival were 29.5 and 30 months for the surgery-first group and 22 and 22 months for the neo-adjuvant group, respectively. Conclusions:Outcomes in the surgery-first group were non-inferior to that of the neoadjuvant group. A threatened circumferential resection margin (CRM) on pretreatment staging warrants neoadjuvant therapy to ensure an R0 resection. Extramural vascular invasion (EMVI), being a negative prognostic factor, doesn't preclude a surgery-first approach.

Health Related Quality of Life (HRQoL) Following APER: Early Effects on Ano Rectal Cancer Patients

Background: Colorectal cancer is the third most common cancer worldwide, accounting for approximately 10% of all cancer cases and is the second leading cause of cancer-related deaths worldwide. Treatment of rectal cancer had been primarily focused on oncologic outcome, with detailed assessment of survival and local recurrence. Less attention has been given to functional outcome and quality of life (QoL). Methodology: This prospective study was conducted in the Department of Surgical Oncology, National Cancer Research Institute &amp; Hospital, Dhaka from July, 2019 – March, 2021. Total 33 patients who fulfilled the inclusion and exclusion criteria were included in this study by purposive sampling. The scoring formulas supplied by EORTC was used for both the questionnaires (QLQ-C30 and QLQ-CR29) and in accordance to the scoring manual, the questionnaire items were grouped into scales in the categories – global health status QOL, functional scales and symptoms scales and then compiled. The p value was set as significant if p&lt;0.05. Results: Mean age of the patient was 45.1±13.9 years. Physical function, role function, emotional function, cognitive function, social function and global health status were significantly (p=0.001) decreased after treatment group than before treatment group. Fatigue, nausea and vomiting, pain, dyspnoea, insomnia, appetite loss, constipation, diarrhoea and financial difficulties were significantly increased after treatment group than before treatment group. Conclusion: Surgical oncologist can improve the quality of life of patients by saving the neurovascular structures while performing anterior/posterior/lateral dissection of rectum. Multidisciplinary approach including “Tumour Board” as well as performing sphincter saving procedures (AR) rather than APER could drastically improve the quality of life of cancer patients. Preoperative counselling, taking time to explain and understand patients’ concern results in decreased stress and improve ......