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Article ; Online: Evaluation of mesorectal fascia in mid and low anterior rectal cancer using endorectal ultrasound is feasible and reliable: a comparison with MRI findings.

Granero-Castro, Pablo / Muñoz, Elena / Frasson, Matteo / García-Granero, Alvaro / Esclapez, Pedro / Campos, Salvador / Flor-Lorente, Blas / Garcia-Granero, Eduardo

Diseases of the colon and rectum

2014 Volume 57, Issue 6, Page(s) 709–714

Abstract: Background: Accuracy of MRI in assessing mesorectal fascia and predicting circumferential resection margin decreases in low anterior rectal tumors.: Objective: The purpose of this work was to evaluate the accuracy of endorectal ultrasound in ... ...

Abstract	Background: Accuracy of MRI in assessing mesorectal fascia and predicting circumferential resection margin decreases in low anterior rectal tumors. Objective: The purpose of this work was to evaluate the accuracy of endorectal ultrasound in predicting the pathologic circumferential resection margin in low rectal anterior tumors and to compare it with MRI findings. Design: This was a prospective series comparing the preoperative circumferential resection margin assessed by endorectal ultrasound and MRI with pathologic examination. Settings: The study was conducted by a specialized colorectal multidisciplinary team at a tertiary teaching hospital. Patients: Between 2002 and 2008, 76 patients with mid to low rectal cancer were preoperatively evaluated by endorectal ultrasound and MRI and underwent total mesorectal excision without neoadjuvant radiochemotherapy. Twenty-seven patients with posterior or postero-lateral tumors were excluded, leaving 49 patients with anterior or antero-lateral tumors for the present subanalysis. We compared preoperative circumferential resection margin status using endorectal ultrasound and MRI with pathologic examination. Interventions: We conducted a comparison between preoperative circumferential resection margin status and pathologic examination after total mesorectal excision surgery. Main outcome measures: Accuracy in predicting pathologic circumferential resection margin status was measured. Results: Overall accuracy of endorectal ultrasound and MRI in assessing circumferential resection margin status was 83.7% and 91.8%, with negative predictive values of 97.2% and 97.5%. When focusing on low rectal tumors, the overall accuracy of endorectal ultrasound increased to 87.5%, whereas the accuracy of MRI decreased to 87.5%, with a negative predictive value of 95.6% for both diagnostic tests. Limitations: The sample size is small, and interobserver variability in radiologic assessment was not evaluated. Conclusions: Endorectal ultrasound can help MRI in predicting circumferential resection margin involvement in mid to low anterior rectal cancer, especially at the low third of the rectum, with a high negative predictive value.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Endosonography ; Fascia/diagnostic imaging ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Predictive Value of Tests ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Young Adult
Keywords	covid19
Language	English
Publishing date	2014-06
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000000096
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Article ; Online: Solitary rectal ulcer: ultrasonographic and magnetic resonance imaging patterns mimicking rectal cancer.

Blanco, Francisco / Frasson, Matteo / Flor-Lorente, Blas / Minguez, Miguel / Esclapez, Pedro / García-Granero, Eduardo

European journal of gastroenterology & hepatology

2011 Volume 23, Issue 12, Page(s) 1262–1266

Abstract: The objective of this study was to analyze a series of solitary rectal ulcer syndrome (SRUS) cases initially diagnosed as rectal cancer. We analyzed all the patients (1996-2008) initially referred to our colorectal unit with a diagnosis of rectal cancer ... ...

Abstract	The objective of this study was to analyze a series of solitary rectal ulcer syndrome (SRUS) cases initially diagnosed as rectal cancer. We analyzed all the patients (1996-2008) initially referred to our colorectal unit with a diagnosis of rectal cancer but with a final diagnosis of SRUS. Demographic data, the diagnostic work-up, and treatment details were collected in a prospective database and analyzed retrospectively. Out of the 5035 patients registered in the colorectal unit database, 14 (0.28%) had a final diagnosis of SRUS. Nine of them had an initial diagnosis of rectal cancer. Out of these, six were preoperatively staged with endorectal ultrasound and/or magnetic resonance and were therefore analyzed for this study. Endorectal ultrasound was performed in all six patients and rectal cancer was diagnosed in five of them; MRI was performed in four patients and a diagnosis of rectal cancer was assessed in three of them; rectal cancer was finally ruled out in all cases by deep-forceps macrobiopsies. The incidence of misdiagnosis between SRUS and rectal cancer does not decrease with the regular use of imaging methods. Clinical judgment and deep-forceps macrobiopsies are essential in avoiding an erroneous diagnosis.
MeSH term(s)	Adult ; Aged ; Biopsy ; Colonoscopy ; Diagnosis, Differential ; Female ; Humans ; Magnetic Resonance Imaging/methods ; Male ; Middle Aged ; Rectal Diseases/diagnosis ; Rectal Diseases/diagnostic imaging ; Rectal Neoplasms/diagnosis ; Rectum/pathology ; Retrospective Studies ; Ulcer/diagnosis ; Ulcer/diagnostic imaging ; Ultrasonography
Language	English
Publishing date	2011-11
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1034239-4
ISSN	1473-5687 ; 0954-691X
ISSN (online)	1473-5687
ISSN	0954-691X
DOI	10.1097/MEG.0b013e32834b0dee
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Article ; Online: Self-expanding metallic stent as a bridge to surgery in the treatment of left colon cancer obstruction: Cost-benefit analysis and oncologic results.

Flor-Lorente, Blas / Báguena, Gloria / Frasson, Matteo / García-Granero, Alvaro / Cervantes, Andrés / Sanchiz, Vicente / Peña, Andres / Espí, Alejandro / Esclapez, Pedro / García-Granero, Eduardo

Cirugia espanola

2017 Volume 95, Issue 3, Page(s) 143–151

Abstract: Introduction: The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi- ... ...

Title translation	Stents metálicos autoexpandibles como puente a la cirugía en el tratamiento del cáncer de colon izquierdo en oclusión. Análisis coste-beneficio y resultados oncológicos.
Abstract	Introduction: The use of a self-expanding metallic stent as a bridge to surgery in acute malignant left colonic obstruction has been suggested as an alternative treatment to emergency surgery. The aim of the present study was to compare the morbi-mortality, cost-benefit and long-term oncological outcomes of both therapeutic options. Methods: This is a prospective, comparative, controlled, non-randomized study (2005-2010) performed in a specialized unit. The study included 82 patients with left colon cancer obstruction treated by stent as a bridge to surgery (n=27) or emergency surgery (n=55) operated with local curative intention. The main outcome measures (postoperative morbi-mortaliy, cost-benefit, stoma rate and long-term oncological outcomes) were compared based on an "intention-to-treat" analysis. Results: There were no significant statistical differences between the two groups in terms of preoperative data and tumor characteristics. The technically successful stenting rate was 88.9% (11.1% perforation during stent placement) and clinical success was 81.4%. No difference was observed in postoperative morbi-mortality rates. The primary anastomosis rate was higher in the bridge to surgery group compared to the emergency surgery group (77.8% vs. 56.4%; P=.05). The mean costs in the emergency surgery group resulted to be €1,391.9 more expensive per patient than in the bridge to surgery group. There was no significant statistical difference in oncological long-term outcomes. Conclusions: The use of self-expanding metalllic stents as a bridge to surgery is a safe option in the urgent treatment of obstructive left colon cancer, with similar short and long-term results compared to direct surgery, inferior mean costs and a higher rate of primary anastomosis.
Language	Spanish
Publishing date	2017-03
Publishing country	Spain
Document type	Journal Article
ZDB-ID	730701-9
ISSN	1578-147X ; 0009-739X
ISSN (online)	1578-147X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2016.12.014
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Article ; Online: Integrating Downstaging in the Risk Assessment of Patients With Locally Advanced Rectal Cancer Treated With Neoadjuvant Chemoradiotherapy: Validation of Valentini's Nomograms and the Neoadjuvant Rectal Score.

Roselló, Susana / Frasson, Matteo / García-Granero, Eduardo / Roda, Desamparados / Jordá, Esther / Navarro, Samuel / Campos, Salvador / Esclápez, Pedro / García-Botello, Stephanie / Flor, Blas / Espí, Alejandro / Masciocchi, Carlotta / Valentini, Vincenzo / Cervantes, Andrés

Clinical colorectal cancer

2017 Volume 17, Issue 2, Page(s) 104–112.e2

Abstract: Background: Adjuvant chemotherapy is controversial in patients with locally advanced rectal cancer after preoperative chemoradiation. Valentini et al developed 3 nomograms (VN) to predict outcomes in these patients. The neoadjuvant rectal score (NAR) ... ...

Abstract	Background: Adjuvant chemotherapy is controversial in patients with locally advanced rectal cancer after preoperative chemoradiation. Valentini et al developed 3 nomograms (VN) to predict outcomes in these patients. The neoadjuvant rectal score (NAR) was developed after VN to predict survival. We aimed to validate these tools in a retrospective cohort at an academic institution. Patients and methods: VN and the NAR were applied to 158 consecutive patients with locally advanced rectal cancer treated with chemoradiation followed by surgery. According to the score, they were divided into low, intermediate, or high risk of relapse or death. For statistical analysis, we performed Kaplan-Meier curves, log-rank tests, and Cox regression analysis. Results: Five-year overall survival was 83%, 77%, and 67% for low-, intermediate-, and high-risk groups, respectively (P = .023), according to VN, and 84%, 71%, and 59% for low-, intermediate-, and high-risk groups, respectively (P = .004), according to NAR. When the score was considered as a continuous variable, a significant association with the risk of death was observed (NAR: hazard ratio, 1.04; P < .001; VN: hazard ratio, 1.10; P < .001). Conclusion: We confirmed the value of these scores to stratify patients according to their individual risk when designing new trials.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Chemoradiotherapy, Adjuvant/methods ; Chemoradiotherapy, Adjuvant/mortality ; Disease-Free Survival ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoadjuvant Therapy/methods ; Neoadjuvant Therapy/mortality ; Neoplasm Staging ; Nomograms ; Proportional Hazards Models ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/therapy ; Retrospective Studies ; Risk Assessment ; Treatment Outcome
Language	English
Publishing date	2017-10-28
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't ; Validation Studies
ZDB-ID	2112638-0
ISSN	1938-0674 ; 1533-0028
ISSN (online)	1938-0674
ISSN	1533-0028
DOI	10.1016/j.clcc.2017.10.014
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Zs.A 5798: Show issues			Location: Je nach Verfügbarkeit (siehe Angabe bei Bestand) bis Jg. 1994: Bestellungen von Artikeln über das Online-Bestellformular Jg. 1995 - 2021: Lesesall (2.OG) ab Jg. 2022: Lesesaal (EG)
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Article ; Online: Modified Wong's classification improves the accuracy of rectal cancer staging by endorectal ultrasound and MRI.

Muñoz, Elena / Granero-Castro, Pablo / Frasson, Matteo / Escartin, Jorge / Esclapez, Pedro / Campos, Salvador / Flor-Lorente, Blas / Garcia-Granero, Eduardo

Diseases of the colon and rectum

2013 Volume 56, Issue 12, Page(s) 1332–1338

Abstract: Background: Douglas Wong proposed a new classification of tumor penetration in the rectal wall (T stage) in an attempt to incorporate the prognostic heterogeneity of T3 rectal cancers into the preoperative staging.: Objective: This study aimed to ... ...

Abstract	Background: Douglas Wong proposed a new classification of tumor penetration in the rectal wall (T stage) in an attempt to incorporate the prognostic heterogeneity of T3 rectal cancers into the preoperative staging. Objective: This study aimed to evaluate if the accuracy of endorectal ultrasound and MRI in predicting rectal cancer T staging improves when using a modified Wong's classification. Design: This prospective series compares local standard TN staging and a modified Wong's classification. Settings: This study was conducted by a specialized Colorectal Multidisciplinary Team at a tertiary teaching hospital. Patients: Seventy patients underwent surgery for middle or low rectal cancer between 2002 and 2008 without neoadjuvant radiochemotherapy. We compared the preoperative staging with the pathological staging to determine the preoperative accuracy of endorectal ultrasound and MRI when using a modified Wong's classification vs the standard TN classification. Interventions: A modified version of Wong's classification was used for preoperative and pathological staging. Main outcome measures: The primary outcome measured was the accuracy in the preoperative T staging. Results: The overall accuracy of endorectal ultrasound and MRI in assessing T staging was 68.6% and 72.9% (uT1/2, 90%; uT3, 58.3%; and uT4, 100% and rT1/2, 88%; rT3, 63.4%; and rT4, 75%). By using the proposed modified Wong's classification, the overall accuracy of endorectal ultrasound and MRI improved to 82.9% and 90%. Limitations: The interobserver variability in radiological assessment was not evaluated. Conclusion: With use of the modified Wong's classification proposed in this study, the overall accuracy of preoperative imaging in assessing T staging of rectal cancer is substantially improved, especially when endorectal ultrasound and MRI stage match, enhancing the selection of patients for neoadjuvant radiochemotherapy.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Carcinoma/diagnostic imaging ; Carcinoma/pathology ; Carcinoma/therapy ; Endosonography ; Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prospective Studies ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/pathology ; Rectal Neoplasms/therapy
Keywords	covid19
Language	English
Publishing date	2013-12
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0b013e3182a69a3b
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Article ; Online: Changes in anorectal morphologic and functional parameters after fistula-in-ano surgery.

Roig, José V / Jordán, Julio / García-Armengol, Juan / Esclapez, Pedro / Solana, Amparo

Diseases of the colon and rectum

2009 Volume 52, Issue 8, Page(s) 1462–1469

Abstract: Purpose: This study aimed to analyze changes in anal continence and morphologic and functional anorectal variables after fistula-in-ano surgery in a patient series with a high rate of complex fistulas.: Methods: One hundred twenty patients with a ... ...

Abstract	Purpose: This study aimed to analyze changes in anal continence and morphologic and functional anorectal variables after fistula-in-ano surgery in a patient series with a high rate of complex fistulas. Methods: One hundred twenty patients with a mean age of 46.9 (standard deviation, 12.8) years were prospectively analyzed by evaluating anal continence, results of endoanal ultrasound examination and anorectal manometry, and pudendal nerve terminal motor latency before and after fistula-in-ano surgery. Results: Forty-three patients (35.8%) were referred for recurrent fistulas; fistulas in and 70 (58.3%) were considered complex. Preoperatively, 17 patients (14.2%) presented with impaired continence. At follow-up, 59 patients (49.2%) had some degree of incontinence (P < 0.001). The techniques that most affected continence were rectal advancement flap and fistulotomy. Endoanal ultrasound examination showed that the number of patients with internal anal sphincter defects increased from 37 (30.8%) to 78 (74.3%) after surgery (P < 0.001); those with external anal sphincter defects increased from 17 (15.9%) to 34 (32.4%) (P < 0.001). Techniques most associated with increases in internal anal sphincter defects were fistulotomy (P < 0.003) and rectal advancement flap (P < 0.004). Anal manometry showed significant decreases in maximal resting pressure and maximum squeeze pressure in patients with previous incontinence (P < 0.001), and in those with internal anal sphincter defects (P < 0.001). Fistulotomy decreased both resting pressure (P < 0.004) and squeeze pressure (P < 0.007), whereas rectal advancement flap significantly reduced only resting pressure. Pudendal nerve latency did not differentiate continent and incontinent patients, and showed no postoperative change. Conclusions: Anal continence is significantly affected after fistula-in-ano surgery, mainly because of sphincteric lesions that affect anal canal pressures and that can be imaged with endoanal ultrasound. It is important to preoperatively recognize sphincter defects to allow adequate surgical treatment.
MeSH term(s)	Anal Canal/diagnostic imaging ; Anal Canal/physiopathology ; Defecation/physiology ; Digestive System Surgical Procedures/methods ; Endosonography ; Female ; Follow-Up Studies ; Humans ; Male ; Manometry ; Middle Aged ; Postoperative Period ; Pressure ; Prospective Studies ; Rectal Fistula/diagnostic imaging ; Rectal Fistula/physiopathology ; Rectal Fistula/surgery ; Rectum/diagnostic imaging ; Rectum/physiopathology ; Treatment Outcome
Language	English
Publishing date	2009-08
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1007/DCR.0b013e3181a80e24
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Article ; Online: Low rectal cancer: abdominoperineal resection or low Hartmann resection? A postoperative outcome analysis.

Molina Rodríguez, José Luis / Flor-Lorente, Blas / Frasson, Matteo / García-Botello, Stephanie / Esclapez, Pedro / Espí, Alejandro / García-Granero, Eduardo

Diseases of the colon and rectum

2011 Volume 54, Issue 8, Page(s) 958–962

Abstract: Background: In distal rectum cancers, when the sphincters are not affected and it is not possible to perform a coloanal anastomosis because of the presence of comorbidities or the advanced age of the patient, a low Hartmann resection with total ... ...

Abstract	Background: In distal rectum cancers, when the sphincters are not affected and it is not possible to perform a coloanal anastomosis because of the presence of comorbidities or the advanced age of the patient, a low Hartmann resection with total mesorectal excision can be performed. Low Hartmann resection is usually considered to be a shorter procedure and to have an inferior morbidity compared with abdominoperineal resection of the rectum. Objective: This study aimed to compare the postoperative outcome of a series of patients with low rectal cancer who have undergone either low Hartmann resection or abdominoperineal resection. Design: This study is a retrospective analysis of data collected in a prospective database. Settings: This study was conducted in a specialized Colorectal Unit, Department of Surgery, of a tertiary teaching hospital. Patients: Patients who underwent low Hartmann or abdominoperineal resection for rectal cancer between 1996 and 2009 at our specialized Colorectal Unit were considered. Interventions: The main interventions were low Hartmann resection vs abdominoperineal resection. Main outcome measures: The main outcome measures were 60-day morbidity and mortality. Results: The pelvic abscess rate was 12.2% in patients who underwent low Hartmann resection and 3.0% in those who underwent abdominoperineal resection (P = .02). The reoperation rate was 14.6% in the Hartmann group and 3.8% in the abdominoperineal group (P = .013). The rehospitalization rates in the Hartmann and abdominoperineal groups were 7.3% and 0.7% (P = .015). No differences were found in the other variables analyzed. At multivariate analysis, the surgical technique performed was the only independent risk factor for pelvic abscess development, readmission, and reoperation. Limitations: : This study was limited by its retrospective nature. Conclusion: In our series, low Hartmann resection was associated with higher pelvic abscess, reoperation, and readmission rates. These findings suggest that in patients with rectal cancer without sphincter infiltration and who are unsuitable for coloanal anastomosis, abdominoperineal resection should be a valid alternative to low Hartmann resection.
MeSH term(s)	Abdominal Abscess/etiology ; Adult ; Aged ; Aged, 80 and over ; Digestive System Surgical Procedures/adverse effects ; Digestive System Surgical Procedures/methods ; Female ; Humans ; Male ; Middle Aged ; Patient Readmission ; Postoperative Complications/etiology ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Reoperation ; Retrospective Studies ; Survival Rate ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2011-08
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0b013e31821c4b95
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Article: Importancia de la exploración física y técnicas de imagen en la valoración diagnóstica de las fístulas de ano.

Jordán, Julio / Roig, José V / García Armengol, Juan / Esclapez, Pedro / Jordán, Yolanda / García Granero, Eduardo / Alós, Rafael / Lledó, Salvador

Cirugia espanola

2009 Volume 85, Issue 4, Page(s) 238–245

Abstract: Aim: The study was designed to determine the role of clinical examination and imaging techniques in the diagnosis of anorectal fistula.: Material and methods: We performed an observational study with prospective recruiting using the data of 120 ... ...

Title translation	Importance of physical examination and imaging techniques in the diagnosis of anorectal fistulae.
Abstract	Aim: The study was designed to determine the role of clinical examination and imaging techniques in the diagnosis of anorectal fistula. Material and methods: We performed an observational study with prospective recruiting using the data of 120 patients, by means of clinical evaluation by an experienced coloproctologist surgeon (EE), a surgeon without special training in coloproctology (CE), and examination under anaesthesia (SE), endoanal ultrasound (EAU) and magnetic resonance (MR), using the surgical findings as a reference. Results: SE was significantly better than EE or CE for detecting an internal opening (IO), primary track and abscess cavities (AC). EAU was significantly more sensitive and accurate than the EE in identifying an IO, and AC, but not compared to the SE. MR was more sensitive than the EE in the identification of the IO, transphincter and suprasphincter tracks and AC with no significant differences compared to EAU, and more sensitive than the SE to detect AC. Conclusions: Examination under anaesthesia still has a place in the evaluation of anorectal fistula. Imaging methods are an occasional complement to a clinical evaluation that can help the less experienced to decide the appropriate treatment, particularly when a complex fistula is suspected.
MeSH term(s)	Female ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Physical Examination ; Prospective Studies ; Rectal Fistula/diagnosis ; Rectal Fistula/diagnostic imaging ; Ultrasonography
Language	Spanish
Publishing date	2009-04
Publishing country	Spain
Document type	Comparative Study ; Journal Article
ZDB-ID	730701-9
ISSN	0009-739X
ISSN	0009-739X
DOI	10.1016/j.ciresp.2008.10.003
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Article ; Online: Prognostic heterogeneity of endosonographic T3 rectal cancer.

Esclapez, Pedro / Garcia-Granero, Eduardo / Flor, Blas / García-Botello, Stephanie / Cervantes, Andres / Navarro, Samuel / Lledó, Salvador

Diseases of the colon and rectum

2009 Volume 52, Issue 4, Page(s) 685–691

Abstract: Purpose: This study aimed to assess the prognostic implications of uT3 rectal carcinomas according to the tumor thickness and to analyze the correlation between this ultrasound-based parameter and other prognostic factors.: Methods: Seventy-four ... ...

Abstract	Purpose: This study aimed to assess the prognostic implications of uT3 rectal carcinomas according to the tumor thickness and to analyze the correlation between this ultrasound-based parameter and other prognostic factors. Methods: Seventy-four patients with uT3(pM0) rectal tumors underwent primary surgery from 1996 to 2003. Preoperative endorectal ultrasound was used to assess uN stage, maximum tumor perimeter, and maximum tumor thickness. An ultrasound maximum tumor thickness cutoff point for local recurrence subdividing T3 tumors into uT3a and uT3b was established. Results: Median follow-up was 41 months (range, 24-59). The 5-year actuarial local and overall recurrence rates were 9.82 percent (n = 7) and 42.46 percent (n = 23), respectively. uN stage(P = 0.05), circumferential resection margin involvement (P = 0.002), an ultrasound maximum tumor thickness (P = 0.01), and locally advanced tumors (P = 0.001) were related to a significantly increased risk of local recurrence. An ultrasound maximum tumor thickness (hazard ratio, 1.15; 95 percent confidence interval, 1.0-1.2) and locally advanced tumor (hazard ratio, 17.21; 95 percent confidence interval, 2.99-98.84) were preoperative independent variables for predicting local recurrence. Locally advanced tumor was the only preoperative independent prognostic factor for overall recurrence (P = 0.004; hazard ratio, 1.09; 95 percent confidence interval, 1.0-1.1). An ultrasound maximum tumor thickness with a 19-mm cutoff point, subdividing the T3 tumors into uT3a and uT3b, can be used to predict local recurrence. Locally advanced tumors (P = 0.02) and circumferential resection margin involvement (P = 0.005) showed a significant association with an ultrasound maximum tumor thickness >19 mm. Conclusions: A maximum tumor thickness measured by endorectal ultrasound in pT3 rectal cancer is an independent prognostic factor for local and overall recurrence. An ultrasound maximum tumor thickness cutoff point of 19 mm may be useful to classify patients preoperatively and to select them for primary surgery or neoadjuvant therapy.
MeSH term(s)	Aged ; Endosonography ; Female ; Humans ; Kaplan-Meier Estimate ; Male ; Middle Aged ; Neoplasm Invasiveness ; Neoplasm Recurrence, Local/epidemiology ; Prognosis ; Rectal Neoplasms/diagnostic imaging ; Rectal Neoplasms/mortality ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery
Language	English
Publishing date	2009-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1007/DCR.0b013e31819ed03d
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Article ; Online: Preoperative chemoradiation may not always be needed for patients with T3 and T2N+ rectal cancer.

Frasson, Matteo / Garcia-Granero, Eduardo / Roda, Desamparados / Flor-Lorente, Blas / Roselló, Susana / Esclapez, Pedro / Faus, Carmen / Navarro, Samuel / Campos, Salvador / Cervantes, Andrés

Cancer

2011 Volume 117, Issue 14, Page(s) 3118–3125

Abstract: Background: Preoperative chemoradiation is becoming the standard treatment for patients with locally advanced rectal cancer. However, since the introduction of total mesorectal excision (TME), local recurrence rates have been reduced significantly, and ... ...

Abstract	Background: Preoperative chemoradiation is becoming the standard treatment for patients with locally advanced rectal cancer. However, since the introduction of total mesorectal excision (TME), local recurrence rates have been reduced significantly, and some patients can be spared from potentially toxic over treatment. The current study was designed to assess the factors that predict recurrence in an institutional series of patients with rectal cancer who had clinical T2 lymph node-positive (cT2N+) tumors or cT3N0/N+ tumors and underwent radical surgery without receiving preoperative chemoradiation. Methods: Between November 1997 and November 2008, the authors' multidisciplinary group preoperatively staged 398 patients with rectal cancer by using endorectal ultrasonography and/or magnetic resonance imaging. The analysis included 152 consecutive patients with cT2N+, cT3N0, or cT3N+ rectal cancer who underwent TME without receiving preoperative chemoradiation. Macroscopic assessment of the mesorectal excision and circumferential resection margins were determined. Factors potentially related to local recurrence (LR), disease-free survival (DFS) and cancer-specific survival (CSS) were analyzed. Results: After a median follow-up of 39 months, the 5-year actuarial LR, DFS, and CSS rates were 9.5%, 65.4%, and 77.8%, respectively, for the whole group. Threatened mesorectal fascia at preoperative staging was the only independent preoperative factor that predicted a higher risk for LR (P = .007), shorter DFS (P = .007), and shorter CSS (P = .05). In particular, the 5-year LR rates for patients with and without preoperative threatened circumferential resection margins were 19.4% and 5.4%, respectively. Conclusions: The current results suggested that patients with rectal cancer clinically staged as T3N0/N+ or T2N+ with a free margin >2 mm from mesorectal fascia may undergo TME alone, avoiding over treatment with preoperative chemoradiation.
MeSH term(s)	Adenocarcinoma/drug therapy ; Adenocarcinoma/mortality ; Adenocarcinoma/pathology ; Adenocarcinoma/radiotherapy ; Adenocarcinoma/surgery ; Adult ; Aged ; Aged, 80 and over ; Combined Modality Therapy ; Disease-Free Survival ; Female ; Humans ; Lymphatic Metastasis ; Male ; Middle Aged ; Neoadjuvant Therapy ; Neoplasm Recurrence, Local ; Neoplasm Staging ; Rectal Neoplasms/drug therapy ; Rectal Neoplasms/pathology ; Rectal Neoplasms/radiotherapy ; Rectal Neoplasms/surgery ; Survival Rate ; Treatment Outcome
Keywords	covid19
Language	English
Publishing date	2011-07-15
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1429-1
ISSN	1097-0142 ; 0008-543X ; 1934-662X
ISSN (online)	1097-0142
ISSN	0008-543X ; 1934-662X
DOI	10.1002/cncr.25866
Database	MEDical Literature Analysis and Retrieval System OnLINE

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