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  1. Article ; Online: Long-term oncological outcomes after local excision of T1 rectal cancer.

    Leijtens, J W A / Smits, L J H / Koedam, T W A / Orsini, R G / van Aalten, S M / Verseveld, M / Doornebosch, P G / de Graaf, E J R / Tuynman, J B

    Techniques in coloproctology

    2022  

    Abstract: Background: A growing proportion of patients with early rectal cancer is treated by local excision only. The aim of this study was to evaluate long-term oncological outcomes and the impact of local recurrence on overall survival for surgical local ... ...

    Abstract Background: A growing proportion of patients with early rectal cancer is treated by local excision only. The aim of this study was to evaluate long-term oncological outcomes and the impact of local recurrence on overall survival for surgical local excision in pT1 rectal cancer.
    Methods: Patients who only underwent local excision for pT1 rectal cancer between 1997 and 2014 in two Dutch tertiary referral hospitals were included in this retrospective cohort study. The primary outcome was the local recurrence rate. Secondary outcomes were distant recurrence, overall survival and the impact of local recurrence on overall survival.
    Results: A total of 150 patients (mean age 68.5 ± 10.7 years, 57.3% males) were included in the study. Median length of follow-up was 58.9 months (range 6-176 months). Local recurrence occurred in 22.7% (n = 34) of the patients, with a median time to local recurrence of 11.1 months (range 2.3-82.6 months). The vast majority of local recurrences were located in the lumen. Five-year overall survival was 82.0%, and landmark analyses showed that local recurrence significantly impacted overall survival at 6 and 36 months of follow-up (6 months, p = 0.034, 36 months, p = 0.036).
    Conclusions: Local recurrence rates after local excision of early rectal cancer can be substantial and may impact overall survival. Therefore, clinical decision-making should be based on patient- and tumour characteristics and should incorporate patient preferences.
    Language English
    Publishing date 2022-08-27
    Publishing country Italy
    Document type Journal Article
    ZDB-ID 2083309-X
    ISSN 1128-045X ; 1123-6337
    ISSN (online) 1128-045X
    ISSN 1123-6337
    DOI 10.1007/s10151-022-02661-6
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    Zs.A 5842: Show issues Location:
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  2. Article ; Online: Bowel dysfunction after sigmoid resection underestimated: Multicentre study on quality of life after surgery for carcinoma of the rectum and sigmoid.

    van Heinsbergen, M / Janssen-Heijnen, M L / Leijtens, J W / Slooter, G D / Konsten, J L

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2018  Volume 44, Issue 8, Page(s) 1261–1267

    Abstract: Aim: The Low Anterior Resection Syndrome (LARS) severely affects quality of life (QoL) after rectal cancer surgery. There are no data about functional complaints after sigmoid cancer surgery. We investigated LARS and QoL in patients with a resection for ...

    Abstract Aim: The Low Anterior Resection Syndrome (LARS) severely affects quality of life (QoL) after rectal cancer surgery. There are no data about functional complaints after sigmoid cancer surgery. We investigated LARS and QoL in patients with a resection for sigmoid cancer versus patients who had surgery for rectal cancer.
    Methods: 506 patients after resection for rectal or sigmoid cancer who were at least one year colostomy-free were included between January 2008 and December 2013. Bowel function was assessed by the LARS-Score. QoL was assessed by the EORTC QLQ-C30 and -CR29 questionnaires. QoL was compared between the LARS score categories and tumour height categories.
    Results: 412 respondents (81.5%) could be included for the analyses. The median interval since treatment was 5 years, and the median age at the follow-up point was 72 years. Major LARS increased significantly with decreasing tumour height from one fifth in sigmoid carcinoma to 90% in low rectum carcinoma. Female gender (OR = 2.162; 95% CI: 1.349-3.467), postoperative temporary diverting stoma (OR = 3.457; 95% CI: 2.019-5.919) and tumours located in the middle (OR = 3.193; 95% CI: 1.696-6.010) or lower rectum (OR = 8.247; 95% CI: 1.672-40.678) were independently associated with the development of major LARS. Patients with major LARS fared significantly worse in most QOL domains.
    Conclusions: For the first time, we found that functional abdominal complaints after sigmoid surgery are a major problem, with a negative effect on QoL, even 5 years after treatment. Patients need to be adequately informed about these long-term complaints.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Colon, Sigmoid/surgery ; Defecation/physiology ; Digestive System Surgical Procedures/adverse effects ; Fecal Incontinence/etiology ; Fecal Incontinence/physiopathology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/physiopathology ; Quality of Life ; Rectal Neoplasms/physiopathology ; Rectal Neoplasms/surgery ; Rectum/surgery ; Surveys and Questionnaires ; Syndrome
    Language English
    Publishing date 2018
    Publishing country England
    Document type Journal Article ; Multicenter Study
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2018.05.003
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  3. Article ; Online: Comparison of laparoscopic versus robot-assisted versus transanal total mesorectal excision surgery for rectal cancer: a retrospective propensity score-matched cohort study of short-term outcomes.

    Hol, J C / Burghgraef, T A / Rutgers, M L W / Crolla, R M P H / van Geloven, N A W / Hompes, R / Leijtens, J W A / Polat, F / Pronk, A / Smits, A B / Tuynman, J B / Verdaasdonk, E G G / Consten, E C J / Sietses, C

    The British journal of surgery

    2021  Volume 108, Issue 11, Page(s) 1380–1387

    Abstract: Background: Laparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced ... ...

    Abstract Background: Laparoscopic total mesorectal excision (TME) surgery for rectal cancer has important technical limitations. Robot-assisted and transanal TME (TaTME) may overcome these limitations, potentially leading to lower conversion rates and reduced morbidity. However, comparative data between the three approaches are lacking. The aim of this study was to compare short-term outcomes for laparoscopic TME, robot-assisted TME and TaTME in expert centres.
    Methods: Patients undergoing rectal cancer surgery between 2015 and 2017 in expert centres for laparoscopic, robot-assisted or TaTME were included. Outcomes for TME surgery performed by the specialized technique in the expert centres were compared after propensity score matching. The primary outcome was conversion rate. Secondary outcomes were morbidity and pathological outcomes.
    Results: A total of 1078 patients were included. In rectal cancer surgery in general, the overall rate of primary anastomosis was 39.4, 61.9 and 61.9 per cent in laparoscopic, robot-assisted and TaTME centres respectively (P < 0.001). For specialized techniques in expert centres excluding abdominoperineal resection (APR), the rate of primary anastomosis was 66.7 per cent in laparoscopic, 89.8 per cent in robot-assisted and 84.3 per cent in TaTME (P < 0.001). Conversion rates were 3.7 , 4.6 and 1.9 per cent in laparoscopic, robot-assisted and TaTME respectively (P = 0.134). The number of incomplete specimens, circumferential resection margin involvement rate and morbidity rates did not differ.
    Conclusion: In the minimally invasive treatment of rectal cancer more primary anastomoses are created in robotic and TaTME expert centres.
    MeSH term(s) Aged ; Female ; Follow-Up Studies ; Humans ; Laparoscopy/methods ; Male ; Propensity Score ; Rectal Neoplasms/surgery ; Rectum/surgery ; Retrospective Studies ; Robotic Surgical Procedures/methods ; Time Factors ; Transanal Endoscopic Surgery/methods ; Treatment Outcome
    Language English
    Publishing date 2021-08-09
    Publishing country England
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 2985-3
    ISSN 1365-2168 ; 0263-1202 ; 0007-1323 ; 1355-7688
    ISSN (online) 1365-2168
    ISSN 0263-1202 ; 0007-1323 ; 1355-7688
    DOI 10.1093/bjs/znab233
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  4. Article ; Online: Laparoscopic Versus Robot-Assisted Versus Transanal Low Anterior Resection: 3-Year Oncologic Results for a Population-Based Cohort in Experienced Centers.

    Burghgraef, T A / Hol, J C / Rutgers, M L / Crolla, R M P H / van Geloven, A A W / Hompes, R / Leijtens, J W A / Polat, F / Pronk, A / Smits, A B / Tuynman, J B / Verdaasdonk, E G G / Verheijen, P M / Sietses, C / Consten, E C J

    Annals of surgical oncology

    2021  Volume 29, Issue 3, Page(s) 1910–1920

    Abstract: Background: Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three ... ...

    Abstract Background: Laparoscopic, robot-assisted, and transanal total mesorectal excision are the minimally invasive techniques used most for rectal cancer surgery. Because data regarding oncologic results are lacking, this study aimed to compare these three techniques while taking the learning curve into account.
    Methods: This retrospective population-based study cohort included all patients between 2015 and 2017 who underwent a low anterior resection at 11 dedicated centers that had completed the learning curve of the specific technique. The primary outcome was overall survival (OS) during a 3-year follow-up period. The secondary outcomes were 3-year disease-free survival (DFS) and 3-year local recurrence rate. Statistical analysis was performed using Cox-regression.
    Results: The 617 patients enrolled in the study included 252 who underwent a laparoscopic resection, 205 who underwent a robot-assisted resection, and 160 who underwent a transanal low anterior resection. The oncologic outcomes were equal between the three techniques. The 3-year OS rate was 90% for laparoscopic resection, 90.4% for robot-assisted resection, and 87.6% for transanal low anterior resection. The 3-year DFS rate was 77.8% for laparoscopic resection, 75.8% for robot-assisted resection, and 78.8% for transanal low anterior resection. The 3-year local recurrence rate was in 6.1% for laparoscopic resection, 6.4% for robot-assisted resection, and 5.7% for transanal procedures. Cox-regression did not show a significant difference between the techniques while taking confounders into account.
    Conclusion: The oncologic results during the 3-year follow-up were good and comparable between laparoscopic, robot-assisted, and transanal total mesorectal technique at experienced centers. These techniques can be performed safely in experienced hands.
    MeSH term(s) Humans ; Laparoscopy ; Postoperative Complications ; Proctectomy ; Rectal Neoplasms/surgery ; Retrospective Studies ; Robotics ; Treatment Outcome
    Language English
    Publishing date 2021-10-04
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1200469-8
    ISSN 1534-4681 ; 1068-9265
    ISSN (online) 1534-4681
    ISSN 1068-9265
    DOI 10.1245/s10434-021-10805-5
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  5. Article ; Online: Reversal of Hartmann's procedure after perforated diverticulitis through the stomal side without additional incisions: the SIR procedure.

    Vermeulen, J / Leijtens, J W A / Mannaerts, G H H

    Digestive surgery

    2010  Volume 27, Issue 5, Page(s) 391–396

    Abstract: Aims: Reversal of Hartmann's procedure (HP) is a complex operation and only performed in 50-60% of the patients. Stomal incision reversal (SIR), a new minimally invasive procedure for HP reversal, was assessed and compared to the standard surgical ... ...

    Abstract Aims: Reversal of Hartmann's procedure (HP) is a complex operation and only performed in 50-60% of the patients. Stomal incision reversal (SIR), a new minimally invasive procedure for HP reversal, was assessed and compared to the standard surgical approach.
    Methods: 16 patients who had undergone HP for perforated diverticulitis underwent HP reversal by SIR. The only incision in SIR is the one to release the end colostomy. Intra-abdominal adhesiolysis is done manually. A stapled end-to-end colorectal anastomosis is created. The 16 patients who underwent SIR were compared with 32 control patients who were matched according to gender, age, American Society of Anesthesiologists (ASA) classification and Hinchey stage.
    Results: The operation time was shorter after SIR than after reversal by laparotomy [75 min (58-208) vs. 141 min (85-276); p < 0.001]. Patients after SIR had a shorter hospital stay than patients after laparotomy [4 days (2-22) vs. 9 days (4-64); p < 0.001]. The numbers of total postoperative surgical complications (early and late) were not different (p = 0.13). The anastomotic leakage rate was similar in both groups (6%). The conversion rate in the SIR group was 19% (n = 3).
    Conclusion: SIR compared favorably with HP reversal by laparotomy in terms of operation time and hospital stay, without increasing the number of postoperative complications.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Case-Control Studies ; Colon/surgery ; Colostomy/rehabilitation ; Digestive System Surgical Procedures/adverse effects ; Digestive System Surgical Procedures/methods ; Diverticulitis, Colonic/surgery ; Humans ; Intestinal Perforation/surgery ; Laparoscopy/adverse effects ; Laparoscopy/methods ; Male ; Middle Aged ; Postoperative Complications ; Prospective Studies ; Treatment Outcome
    Language English
    Publishing date 2010
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 605888-7
    ISSN 1421-9883 ; 0253-4886
    ISSN (online) 1421-9883
    ISSN 0253-4886
    DOI 10.1159/000319323
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  6. Article ; Online: Functional bowel complaints and quality of life after surgery for colon cancer: prevalence and predictive factors.

    van Heinsbergen, M / den Haan, N / Maaskant-Braat, A J / Melenhorst, J / Belgers, E H / Leijtens, J W / Bloemen, J G / Rutten, H J / Bouvy, N D / Janssen-Heijnen, M L / Konsten, J L

    Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

    2019  Volume 22, Issue 2, Page(s) 136–145

    Abstract: Aim: Low anterior resection syndrome (LARS) severely affects the quality of life (QoL) of patients after surgery for rectal cancer. There are very few studies that have investigated LARS-like symptoms and their effect on QoL after colon cancer surgery. ... ...

    Abstract Aim: Low anterior resection syndrome (LARS) severely affects the quality of life (QoL) of patients after surgery for rectal cancer. There are very few studies that have investigated LARS-like symptoms and their effect on QoL after colon cancer surgery. The aim of this study was to investigate the prevalence of functional abdominal complaints and related QoL after colon cancer surgery compared with patients with similar complaints after rectal cancer surgery.
    Method: All patients who underwent colorectal cancer resections between January 2008 and December 2015, and who were free of colostomy for at least 1 year, were eligible (n = 2136). Bowel function was assessed by the LARS score, QoL by the EORTC QLQ-C30 and QLQ-CR29 questionnaires. QoL was compared between the LARS score categories and tumour height categories.
    Results: A total of 1495 patients (70.0%) were included in the analyses, of whom 1145 had a colonic and 350 a rectal tumour. Symptoms of LARS were observed in 55% after rectal cancer resection compared with 21% after colon cancer resection. Female gender (OR 1.88, CI 1.392-2.528) and a previous diverting stoma (OR 1.84, CI 1.14-2.97) were independently associated with a higher prevalence of LARS after colon cancer surgery. Patients with LARS after colon cancer surgery performed significantly worse in most QoL domains.
    Conclusion: The results of this study highlight the presence of LARS-like symptoms after surgery for colonic cancer. Patients suffering from major LARS-like symptoms after colon resection reported the same debilitating effect on their QoL as patients with major LARS after rectal resection. This should be addressed by colorectal cancer specialists in order to adequately inform patients.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Colectomy/adverse effects ; Colectomy/psychology ; Colonic Neoplasms/psychology ; Colonic Neoplasms/surgery ; Cross-Sectional Studies ; Defecation ; Female ; Gastrointestinal Diseases/epidemiology ; Gastrointestinal Diseases/etiology ; Gastrointestinal Diseases/psychology ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/psychology ; Prevalence ; Proctectomy/adverse effects ; Proctectomy/psychology ; Quality of Life ; Rectal Neoplasms/surgery ; Retrospective Studies ; Risk Factors ; Sex Factors ; Syndrome ; Treatment Outcome
    Language English
    Publishing date 2019-09-03
    Publishing country England
    Document type Comparative Study ; Journal Article ; Multicenter Study
    ZDB-ID 1440017-0
    ISSN 1463-1318 ; 1462-8910
    ISSN (online) 1463-1318
    ISSN 1462-8910
    DOI 10.1111/codi.14818
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    Zs.A 5799: Show issues Location:
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  7. Article: Reversal of Hartmann’s Procedure after Perforated Diverticulitis through the Stomal Side without Additional Incisions: The SIR Procedure

    Vermeulen, J. / Leijtens, J.W.A. / Mannaerts, G.H.H.

    Digestive Surgery

    2010  Volume 27, Issue 5, Page(s) 391–396

    Abstract: Aims: Reversal of Hartmann’s procedure (HP) is a complex operation and only performed in 50–60% of the patients. Stomal incision reversal (SIR), a new minimally invasive procedure for HP reversal, was assessed and compared to the standard surgical ... ...

    Institution Department of Surgery, Maasstad Hospital, Rotterdam Department of Surgery, Laurentius Hospital, Roermond, and Department of Surgery, Sint Franciscus Hospital, Rotterdam, The Netherlands
    Abstract Aims: Reversal of Hartmann’s procedure (HP) is a complex operation and only performed in 50–60% of the patients. Stomal incision reversal (SIR), a new minimally invasive procedure for HP reversal, was assessed and compared to the standard surgical approach. Methods: 16 patients who had undergone HP for perforated diverticulitis underwent HP reversal by SIR. The only incision in SIR is the one to release the end colostomy. Intra-abdominal adhesiolysis is done manually. A stapled end-to-end colorectal anastomosis is created. The 16 patients who underwent SIR were compared with 32 control patients who were matched according to gender, age, American Society of Anesthesiologists (ASA) classification and Hinchey stage. Results: The operation time was shorter after SIR than after reversal by laparotomy [75 min (58–208) vs. 141 min (85–276); p < 0.001]. Patients after SIR had a shorter hospital stay than patients after laparotomy [4 days (2–22) vs. 9 days (4–64); p < 0.001]. The numbers of total postoperative surgical complications (early and late) were not different (p = 0.13). The anastomotic leakage rate was similar in both groups (6%). The conversion rate in the SIR group was 19% (n = 3). Conclusion: SIR compared favorably with HP reversal by laparotomy in terms of operation time and hospital stay, without increasing the number of postoperative complications.
    Keywords Hartmann’s procedure ; Perforated diverticulitis ; Stomal incision reversal procedure, minimal invasive
    Language English
    Publishing date 2010-10-13
    Publisher S. Karger AG
    Publishing place Basel, Switzerland
    Document type Article
    Note Original Paper
    ZDB-ID 605888-7
    ISSN 1421-9883 ; 0253-4886
    ISSN (online) 1421-9883
    ISSN 0253-4886
    DOI 10.1159/000319323
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  8. Article ; Online: Unexpected rectal cancer after TEM: outcome of completion surgery compared with primary TME.

    van Gijn, W / Brehm, V / de Graaf, E / Neijenhuis, P A / Stassen, L P S / Leijtens, J W A / Van De Velde, C J H / Doornebosch, P G

    European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

    2013  Volume 39, Issue 11, Page(s) 1225–1229

    Abstract: Background: Transanal endoscopic microsurgery (TEM) has gained wide-spread acceptance as a safe and useful technique for the resection of rectal adenomas and selected T1 malignant lesions. If the lesion appears >T1 rectal cancer after resection with TEM, ...

    Abstract Background: Transanal endoscopic microsurgery (TEM) has gained wide-spread acceptance as a safe and useful technique for the resection of rectal adenomas and selected T1 malignant lesions. If the lesion appears >T1 rectal cancer after resection with TEM, a completion TME resection is recommended. The aim of this study was to investigate the results of TME surgery after TEM for rectal cancer.
    Methods: In four tertiary referral hospitals for TEM, all patients with completion TME surgery after initial TEM were selected. All eligible patients who were treated with 5 × 5 Gy radiotherapy followed by TME surgery from the Dutch TME trial were selected as reference group. A multivariate logistic regression model was used to calculate odds ratio's (OR) for colostomies and for colo- and ileostomies combined. Local recurrence and survival rates were compared in hazard ratio's (HR) using the multivariate Cox proportional hazard model.
    Results: Fifty-nine patients were included in the TEM-COMPLETION group and 881 patients from the TME trial. In the TEM-COMPLETION group, 50.8% of the patients had a colostomy compared to 45.9% in the TME trial, OR 2.51 (p < 0.006). There is no significant difference when ileo- and colostomies are analyzed together. In the TEM-COMPLETION group, 10.2% developed a local recurrence compared to 5.2% in the TME trial, HR 6.8 (p < 0.0001).
    Conclusions: Completion TME surgery after TEM for unexpected rectal adenocarcinoma results in more colostomies and higher local recurrence rates compared to one stage TME surgery preceded with preoperative 5 × 5 Gy radiotherapy. Pre-operative investigations must be optimized to distinguish malignant and benign lesions and prevent avoidable local recurrence and colostomies.
    MeSH term(s) Adult ; Aged ; Anal Canal ; Colostomy/statistics & numerical data ; Dose Fractionation ; Endoscopy, Gastrointestinal/adverse effects ; Erectile Dysfunction/etiology ; Erectile Dysfunction/prevention & control ; Fecal Incontinence/etiology ; Fecal Incontinence/prevention & control ; Female ; Follow-Up Studies ; Humans ; Ileostomy/statistics & numerical data ; Logistic Models ; Male ; Microsurgery ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local/diagnosis ; Neoplasm Recurrence, Local/epidemiology ; Neoplasm Recurrence, Local/mortality ; Neoplasm Recurrence, Local/prevention & control ; Neoplasm Staging ; Netherlands/epidemiology ; Odds Ratio ; Proportional Hazards Models ; Radiotherapy, Adjuvant ; Rectal Neoplasms/diagnosis ; Rectal Neoplasms/epidemiology ; Rectal Neoplasms/mortality ; Rectal Neoplasms/surgery ; Survival Analysis ; Treatment Outcome
    Language English
    Publishing date 2013-11
    Publishing country England
    Document type Comparative Study ; Journal Article
    ZDB-ID 632519-1
    ISSN 1532-2157 ; 0748-7983
    ISSN (online) 1532-2157
    ISSN 0748-7983
    DOI 10.1016/j.ejso.2013.08.003
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  9. Article ; Online: Modern multidisciplinary treatment of rectal cancer based on staging with magnetic resonance imaging leads to excellent local control, but distant control remains a challenge.

    Engelen, S M E / Maas, M / Lahaye, M J / Leijtens, J W A / van Berlo, C L H / Jansen, R L H / Breukink, S O / Dejong, C H C / van de Velde, C J H / Beets-Tan, R G H / Beets, G L

    European journal of cancer (Oxford, England : 1990)

    2013  Volume 49, Issue 10, Page(s) 2311–2320

    Abstract: Aim: The purpose of this multicenter cohort study was to evaluate whether a differentiated treatment of primary rectal cancer based on magnetic resonance imaging (MRI) can reduce the number of incomplete resections and local recurrences and improve ... ...

    Abstract Aim: The purpose of this multicenter cohort study was to evaluate whether a differentiated treatment of primary rectal cancer based on magnetic resonance imaging (MRI) can reduce the number of incomplete resections and local recurrences and improve recurrence-free and overall survival.
    Methods: From February 2003 until January 2008, 296 patients with rectal cancer underwent preoperative MRI using a lymph node specific contrast agent to predict circumferential resection margin (CRM), T- and N-stage. Based on expert reading of the MRI, patients were stratified in: (a) low risk for local recurrence (CRM>2mm and N0 status), (b) intermediate risk and (c) high risk (close/involved CRM, N2 status or distal tumours). Mainly based on this MRI risk assessment patients were treated with (a) surgery only (TME or local excision), (b) preoperative 5 × 5 Gy+TME and (c) a long course of chemoradiation therapy followed by surgery after a 6-8 week interval.
    Results: Overall 228 patients underwent treatment with curative intent: 49 with surgery only, 86 with 5 × 5 Gy and surgery and 93 with chemoradiation and surgery. The number of complete resections (margin>1mm) was 218 (95.6%). At a median follow-up of 41 months the three-year local recurrence rate, disease-free survival rate and overall survival rate is 2.2%, 80% and 84.5%, respectively.
    Conclusion: With a differentiated multimodality treatment based on dedicated preoperative MR imaging, local recurrence is no longer the main problem in rectal cancer treatment. The new challenges are early diagnosis and treatment, reducing morbidity of treatment and preferably prevention of metastatic disease.
    MeSH term(s) Aged ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Capecitabine ; Chemoradiotherapy/methods ; Deoxycytidine/administration & dosage ; Deoxycytidine/analogs & derivatives ; Disease-Free Survival ; Female ; Fluorouracil/administration & dosage ; Fluorouracil/analogs & derivatives ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Metastasis ; Neoplasm Recurrence, Local/pathology ; Neoplasm Recurrence, Local/prevention & control ; Neoplasm Staging ; Organoplatinum Compounds/administration & dosage ; Prospective Studies ; Rectal Neoplasms/pathology ; Rectal Neoplasms/surgery ; Rectal Neoplasms/therapy ; Remission Induction ; Treatment Outcome
    Chemical Substances Organoplatinum Compounds ; oxaliplatin (04ZR38536J) ; Deoxycytidine (0W860991D6) ; Capecitabine (6804DJ8Z9U) ; Fluorouracil (U3P01618RT)
    Language English
    Publishing date 2013-07
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
    ZDB-ID 82061-1
    ISSN 1879-0852 ; 0277-5379 ; 0959-8049 ; 0964-1947
    ISSN (online) 1879-0852
    ISSN 0277-5379 ; 0959-8049 ; 0964-1947
    DOI 10.1016/j.ejca.2013.03.006
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  10. Article ; Online: A multi-centred randomised trial of radical surgery versus adjuvant chemoradiotherapy after local excision for early rectal cancer.

    Borstlap, W A A / Tanis, P J / Koedam, T W A / Marijnen, C A M / Cunningham, C / Dekker, E / van Leerdam, M E / Meijer, G / van Grieken, N / Nagtegaal, I D / Punt, C J A / Dijkgraaf, M G W / De Wilt, J H / Beets, G / de Graaf, E J / van Geloven, A A W / Gerhards, M F / van Westreenen, H L / van de Ven, A W H /
    van Duijvendijk, P / de Hingh, I H J T / Leijtens, J W A / Sietses, C / Spillenaar-Bilgen, E J / Vuylsteke, R J C L M / Hoff, C / Burger, J W A / van Grevenstein, W M U / Pronk, A / Bosker, R J I / Prins, H / Smits, A B / Bruin, S / Zimmerman, D D / Stassen, L P S / Dunker, M S / Westerterp, M / Coene, P P / Stoot, J / Bemelman, W A / Tuynman, J B

    BMC cancer

    2016  Volume 16, Page(s) 513

    Abstract: Background: Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly ... ...

    Abstract Background: Rectal cancer surgery is accompanied with high morbidity and poor long term functional outcome. Screening programs have shown a shift towards more early staged cancers. Patients with early rectal cancer can potentially benefit significantly from rectal preserving therapy. For the earliest stage cancers, local excision is sufficient when the risk of lymph node disease and subsequent recurrence is below 5 %. However, the majority of early cancers are associated with an intermediate risk of lymph node involvement (5-20 %) suggesting that local excision alone is not sufficient, while completion radical surgery, which is currently standard of care, could be a substantial overtreatment for this group of patients.
    Methods/study design: In this multicentre randomised trial, patients with an intermediate risk T1-2 rectal cancer, that has been locally excised using an endoluminal technique, will be randomized between adjuvant chemo-radiotherapylimited to the mesorectum and standard completion total mesorectal excision (TME). To strictly monitor the risk of locoregional recurrence in the experimental arm and enable early salvage surgery, there will be additional follow up with frequent MRI and endoscopy. The primary outcome of the study is three-year local recurrence rate. Secondary outcomes are morbidity, disease free and overall survival, stoma rate, functional outcomes, health related quality of life and costs. The design is a non inferiority study with a total sample size of 302 patients.
    Discussion: The results of the TESAR trial will potentially demonstrate that adjuvant chemoradiotherapy is an oncological safe treatment option in patients who are confronted with the difficult clinical dilemma of a radically removed intermediate risk early rectal cancer by polypectomy or transanal surgery that is conventionally treated with subsequent radical surgery. Preserving the rectum using adjuvant radiotherapy is expected to significantly improve morbidity, function and quality of life if compared to completion TME surgery.
    Trial registration: NCT02371304 , registration date: February 2015.
    MeSH term(s) Chemoradiotherapy, Adjuvant ; Colectomy ; Humans ; Rectal Neoplasms/therapy ; Research Design
    Language English
    Publishing date 2016--21
    Publishing country England
    Document type Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
    ISSN 1471-2407
    ISSN (online) 1471-2407
    DOI 10.1186/s12885-016-2557-x
    Database MEDical Literature Analysis and Retrieval System OnLINE

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