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Surgical Results and Oncologic Outcomes for Rectal Cancer with Tailored Mesorectal Excision over Two Decades

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Abstract

Objective

This study aimed to compare the characteristics of the tumors, the management strategy, and oncologic outcomes of patients with rectal cancer surgery in these two periods: period 1 (1993–2001) and period 2 (2002–2011).

Methods

All patients who underwent radical resection of rectal cancer from 1993 to 2011 were included. Comparisons of the patients’ demographics, characteristics, operating results, and oncologic outcome between the two periods were undertaken.

Results

Radical resection for rectal cancer was performed in 1611 patients (993 men). Patients were significantly older and more had comorbid medical diseases in period 2. More laparoscopic resections were performed and more patients had preoperative chemoradiation in period 2. The postoperative mortality was significantly lower and the hospital stay was significantly shorter in period 2. In those with non-metastatic cancer, the 5-year local recurrences of patients in period 1 and period 2 were 11.9 and 5.9 %, respectively. (p = 0.002) The patients in period 2 had significantly better 5-year overall (68.1 vs. 60.2 %, p = 0.003) and 5-year cancer-specific survival (76.1 vs. 69.4 %, p < 0.001) when compared with those treated in period 1. The improvement occurred mainly in patients with abdominoperineal resection and those with stage III diseases. In the multivariate analysis, among the other histological factors, operations performed in period 2 and laparoscopic surgery were independent factors associated with better overall survival.

Conclusions

Significant improvement in the surgical outcomes in terms of a lower recurrence rate and better survival was achieved in the recent years with the increase in neoadjuvant therapy and the application of laparoscopic surgery.

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References

  1. Heald RJ, Husband EM, Ryall RD (1982) The mesorectum in rectal cancer surgery—the clue to pelvic recurrence? Brit J Surg 69:613–616

    Article  CAS  PubMed  Google Scholar 

  2. Heald RJ, Karanjia ND (1992) Results of radical surgery for rectal cancer. World J Surg 16:848–857

    Article  CAS  PubMed  Google Scholar 

  3. Heald RJ (1995) Total mesorectal excision is optimal surgery for rectal cancer: a Scandinavian consensus. Brit J Surg 82:1297–1299

  4. Maurer CA, Z’Graggen K, Renzulli P et al (2001) Total mesorectal excision preserves male genital function compared with conventional rectal cancer surgery. Brit J Surg 88(1501–150):5

    Google Scholar 

  5. van der Pas MH, Haglind E, Cuesta MA et al (2013) Laparoscopic versus open surgery for rectal cancer (COLOR II): short-term outcomes of a randomised, phase 3 trial. Lancet Oncol 14:210–218

    Article  PubMed  Google Scholar 

  6. Delaney CP, Kiran RP, Senagore AJ et al (2003) Case-matched comparison of clinical and financial outcome after laparoscopic or open colorectal surgery. Ann Surg 238(67–7):2

    Google Scholar 

  7. Poon JT, Law WL (2009) Laparoscopic resection for rectal cancer: a review. Ann Surg Oncol 16(3038–304):7

    Google Scholar 

  8. Taylor FG, Quirke P, Heald RJ et al (2011) Preoperative high-resolution magnetic resonance imaging can identify good prognosis stage I, II, and III rectal cancer best managed by surgery alone: a prospective, multicenter, European study. Ann Surg 253:711–719

    Article  PubMed  Google Scholar 

  9. Law WL, Chu KW (2001) Impact of total mesorectal excision on the results of surgery of distal rectal cancer. Brit J Surg 88:1607–1612

    Article  CAS  PubMed  Google Scholar 

  10. Law WL, Chu KW (2002) Local recurrence following total mesorectal excision with double-stapling anastomosis for rectal cancers: analysis of risk factors. World J Surg 26:1272–1276. doi:10.1007/s00268-002-6560-9

    Article  PubMed  Google Scholar 

  11. Law WL, Chu KW (2002) Strategies in the management of mid and distal rectal cancer with total mesorectal excision. Asian J Surg/Asian Surgical Association 25:255–264

    Article  CAS  Google Scholar 

  12. Law WL, Chu KW (2004) Anterior resection for rectal cancer with mesorectal excision: a prospective evaluation of 622 patients. Ann Surg 240:260–268

    Article  PubMed  PubMed Central  Google Scholar 

  13. Elferink MA, van Steenbergen LN, Krijnen P et al (2010) Marked improvements in survival of patients with rectal cancer in the Netherlands following changes in therapy, 1989–2006. Eur J Cancer 46:1421–1429

    Article  CAS  PubMed  Google Scholar 

  14. Lee JL, Yu CS, Kim CW et al (2013) Chronological improvement in survival following rectal cancer surgery: a large-scale, single-center study. World J Surg 37:2693–2699. doi:10.1007/s00268-013-2295-z

    Article  PubMed  Google Scholar 

  15. Enker WE, Thaler HT, Cranor ML et al (1995) Total mesorectal excision in the operative treatment of carcinoma of the rectum. J Am Coll Surg 181(335–34):6

    Google Scholar 

  16. Kapiteijn E, Marijnen CA, Nagtegaal ID et al (2001) Preoperative radiotherapy combined with total mesorectal excision for resectable rectal cancer. N Engl J Med 345(638–64):6

    Google Scholar 

  17. Peeters KC, Marijnen CA, Nagtegaal ID et al (2007) The TME trial after a median follow-up of 6 years: increased local control but no survival benefit in irradiated patients with resectable rectal carcinoma. Ann Surg 246:693–701

    Article  PubMed  Google Scholar 

  18. Sauer R, Becker H, Hohenberger W et al (2004) Preoperative versus postoperative chemoradiotherapy for rectal cancer. N Engl J Med 351:1731–1740

    Article  CAS  PubMed  Google Scholar 

  19. Law WL, Chu KW (2004) Abdominoperineal resection is associated with poor oncological outcome. Brit J Surg 91:1493–1499

    Article  CAS  PubMed  Google Scholar 

  20. Heald RJ, Smedh RK, Kald A et al (1997) Abdominoperineal excision of the rectum—an endangered operation. Norman Nigro Lectureship Dis Colon Rectum 40:747–751

    Article  CAS  PubMed  Google Scholar 

  21. Clinical Outcomes of Surgical Therapy Study Group (2004) A comparison of laparoscopically assisted and open colectomy for colon cancer. N Engl J Med 350:2050–2059

  22. Fleshman J, Sargent DJ, Green E et al (2007) Laparoscopic colectomy for cancer is not inferior to open surgery based on 5-year data from the COST Study Group trial Ann Surg 246:655–662; discussion 662–654

  23. Veldkamp R, Kuhry E, Hop WC et al (2005) Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol 6(477–48):4

    Google Scholar 

  24. Colon Cancer Laparoscopic or Open Resection Study G, Buunen M, Veldkamp R et al (2009) Survival after laparoscopic surgery versus open surgery for colon cancer: long-term outcome of a randomised clinical trial. Lancet Oncol 10(44–5):2

    Google Scholar 

  25. Guillou PJ, Quirke P, Thorpe H et al (2005) Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet 365:1718–1726

    Article  PubMed  Google Scholar 

  26. Jayne DG, Guillou PJ, Thorpe H et al (2007) Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group. J Clin Oncol 25:3061–3068

    Article  PubMed  Google Scholar 

  27. Jeong SY, Park JW, Nam BH et al (2014) Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial. Lancet Oncol 15:767–774

    Article  PubMed  Google Scholar 

  28. Green BL, Marshall HC, Collinson F et al (2013) Long-term follow-up of the Medical Research Council CLASICC trial of conventional versus laparoscopically assisted resection in colorectal cancer. Brit J Surg 100(75–8):2

    Google Scholar 

  29. Law WL, Lee YM, Choi HK et al (2006) Laparoscopic and open anterior resection for upper and mid rectal cancer: an evaluation of outcomes. Dis Colon Rectum 49(1108–111):5

    Google Scholar 

  30. Mohamed ZK, Law WL (2014) Outcome of tumor-specific mesorectal excision for rectal cancer: the impact of laparoscopic resection. World J Surg 38(2168–217):4. doi:10.1007/s00268-014-2533-z

    Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China

    Wai Lun Law & Dominic C. C. Foo

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  1. Wai Lun Law
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  2. Dominic C. C. Foo
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Correspondence to Wai Lun Law.

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Law, W.L., Foo, D.C.C. Surgical Results and Oncologic Outcomes for Rectal Cancer with Tailored Mesorectal Excision over Two Decades. World J Surg 40, 1500–1508 (2016). https://doi.org/10.1007/s00268-016-3408-2

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  • DOI: https://doi.org/10.1007/s00268-016-3408-2

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