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Intensive local treatment comprising total mesorectal excision (TME) with selective lateral pelvic lymph node dissection (LPND) after neoadjuvant chemoradiotherapy (CRT) for locally advanced rectal cancer (LARC) has received attention among clinicians treating rectal cancer. It remains unclear whether adjuvant chemotherapy (ACT) after intensive local treatment is beneficial for these patients. We evaluated the oncologic benefit of ACT for patients with LARC who received intensive local treatment. This international multicentre retrospective cohort study included 737 patients treated in Japan and Korea between 2010 and 2017. The effectiveness of ACT on recurrence-free survival (RFS) was evaluated using univariable and multivariable Cox proportional hazards models, with subgroup analyses to identify subpopulations potentially benefiting from ACT. The median follow-up was 49 months; the 5-year RFS and local recurrence rates for the entire cohort were 72.1% and 4.9%, respectively; 514 patients (69.7%) received adjuvant chemotherapy, without an oncologic benefit (hazard ratio, 1.14; 95% confidence interval [CI]: 0.79–1.68) demonstrated in the multivariable Cox regression analysis. In subgroup analyses, the distributions of the 95% CI in patients aged ≥70 years and those with ypStage 0 tended to place a disproportionate emphasis that favoured the non-ACT treatment strategy. Despite achieving good local control with intensive local treatment strategy, the effectiveness of ACT for the LARC patients with CRT followed by TME with selective LPND was not proved. Elderly patients and those with ypStage0 may not receive benefit from ACT after CRT and TME ± LPND. [ABSTRACT FROM AUTHOR]

Introduction FOLFOX and panitumumab combined chemotherapy plays an important role for metastatic colorectal cancer. However the usefulness of this regimen for neoadjuvant therapy is unclear. Case report A 67-year-old man with abdominal pain and pneumaturia was diagnosed with RAS wild-type sigmoid colon cancer with urinary bladder invasion and colovesical fistulas. Because the cancer was considered to be unresectable, a transverse-loop colostomy was performed. Colonoscopy and computed tomography revealed a marked reduction in the size of the primary tumor after six courses of FOLFOX4 (oxaliplatin, leucovorin, and 5-fluorouracil) plus panitumumab. Laparoscopic sigmoidectomy and partial cystectomy were then performed. The pathological findings based on the resected specimen showed almost complete replacement of the tumor by fibrous tissue, with only a few degenerated tumor glands persisting in the submucosa. The patient’s postoperative course was uneventful and he was doing well, without disease recurrence, after 36 months of follow up. Conclusion To our knowledge, this is the first report of a successful curative resection in a patient with initially unresectable, locally advanced colorectal cancer who was treated with FOLFOX4 combined with panitumumab. [ABSTRACT FROM AUTHOR]

Background: The role of laparoscopic surgery for transverse colon cancer (TCC) remains controversial. This study aimed to evaluate the safety of laparoscopic resection of TCC.Methods: Fifty-three patients undergoing laparoscopic resection of TCC (group A) were compared with 39 patients undergoing open resection of TCC (group B) and 200 patients undergoing laparoscopic resection of ascending or descending colon cancer (group C).Results: Mean operating time was longer (224 vs. 157 min), and mean estimated blood loss was lower (40 vs. 79 ml) in group A than in group B, but these were similar in groups A and C. The rates of conversion to open surgery were similar in groups A and C (1.9% vs. 1.0%). Tumor stage was more advanced in group B than in group A. All patients in groups A and B underwent pathologic R0 resection. The rates of postoperative complications did not differ significantly between groups (9.4% vs. 7.7% vs. 5.0%). Time to flatus (1.7 vs. 2.5 days), time to liquid diet (2.4 vs. 5.3 days), and hospital stay (12 vs. 15 days) were significantly shorter in group A than in group B, but similar in groups A and C.Conclusions: Laparoscopic resection for TCC can be performed safely with similar short-term postoperative outcomes seen for colon cancer at other sites. Laparoscopic resection may be associated with faster gastrointestinal recovery and shorter length of hospital stay, compared with open surgery. [ABSTRACT FROM AUTHOR]

Background: Laparoscopic surgery has been reported to be one of the approaches for total mesorectal excision (TME) in rectal cancer surgery. Intersphincteric resection (ISR) has been reported as a promising method for sphincter-preserving operation in selected patients with very low rectal cancer.Methods: From July 2005 to December 2008, 35 patients with very low rectal cancer underwent laparoscopic TME with ISR. The results were compared retrospectively with those of previous open TME with ISR.Results: Conversion to open surgery was necessary in one (3%) patient. The median operation time was 293 min and median estimated blood loss was 40 ml. The pelvic plexus was completely preserved in 32 patients. There was no mortality. Postoperative complications occurred in three (9%) patients. The median length of postoperative hospital stay was 17 days. Macroscopic complete mesorectal excision was achieved in all cases. Complete resection (R0) was achieved in 34 patients. Clinical lymph node stage, operation time, and blood loss were significantly different between the laparoscopic group and open group, but the differences of other factors were not statistically significant.Conclusions: Laparoscopic TME with ISR is technically feasible and a safe alternative to laparotomy with favorable short-term postoperative outcomes. [ABSTRACT FROM AUTHOR]

Purpose: The role of laparoscopic resection in management of rectal cancer is still controversial. The purpose of this study was to evaluate whether laparoscopic rectal resection for rectal cancer could be safely performed in elderly patients.Methods: Forty-four elderly patients (> or =75 years) undergoing laparoscopic rectal resection (group A) were compared with 228 younger patients (<75 years) undergoing laparoscopic rectal resection (group B) and 43 elderly patients (> or =75 years) undergoing open rectal resection (group C).Results: The American Society of Anesthesiologists' status was significantly higher in group A than in group B. Operative procedure, operating time, and estimated blood loss were comparable, and overall postoperative complications did not differ significantly between groups A and B (13.6% vs. 11.8%). Operating time was longer (256 vs. 196 min), but estimated blood loss was significantly less (25 vs. 241 ml) in group A than in group C. The rate of postoperative complications was lower (13.6% vs. 25.6%) in group A than in group C, but the difference was not statistically significant. Time to flatus (1.3 vs. 3.7 days), time to liquid diet (2.2 vs. 7.0 days), and hospital stay (19 vs. 22 days) were significantly shorter in group A than in group C.Conclusions: Laparoscopic rectal resection for elderly patients can be safely performed with similar postoperative outcomes as in younger patients and may have advantages in terms of faster gastrointestinal recovery and shorter length of hospital stay compared with open surgery. [ABSTRACT FROM AUTHOR]

Background: Although the laparoscopic approach is accepted for the treatment of colon cancer, its value for low rectal cancer is unknown. The purpose of this study was to evaluate the influence of patient and tumor factors, particularly pelvic dimensions, on the difficulties in laparoscopic total mesorectal excision (TME) for low rectal cancer. Methods: Seventy-nine consecutive patients underwent laparoscopic TME with intracorporeal rectal transection and double stapling technique (DST) anastomosis for low rectal cancer. Gender, body mass index (BMI), tumor diameter, tumor depth, tumor distance from the anal verge, preoperative chemoradiotherapy, and 5 pelvic dimensions (pelvic inlet, pelvic outlet, length of sacrum, interspinous distance, and intertuberous distance) were analyzed as variables affecting the difficulties of laparoscopic TME. The dependent variables were pelvic operative time, which was defined as the time required for dissection of the rectum from the pelvis, intracorporeal transaction, and anastomosis. Other dependent variables were intraoperative blood loss, overall postoperative morbidity, and anastomotic leakage. Univariate and multivariate analyses were performed to determine the predictive significance of variables. Results: Multivariate analysis showed that BMI (P < .0001), tumor distance from the anal verge (P = .0003), tumor depth (P = .0021), and pelvic outlet (P = .0362) were independently predictive of pelvic operative time. Pelvic operative time was related to intraoperative blood loss (P < .0001). The tumor distance from the anal verge (P = .0333, odds ratio [OR]: 1.06) was related to postoperative morbidity, and pelvic outlet was related to anastomotic leakage (P = .0305, OR: 1.13). Conclusion: BMI, tumor distance from the anal verge, tumor depth, and pelvic outlet were independent predictors for operative time and morbidity. These factors should be taken into account when planning laparoscopic TME. [Copyright &y& Elsevier]

Introduction: Total mesorectal excision (TME) with preoperative chemoradiation therapy is an accepted standard treatment for low rectal cancer. Although the laparoscopic approach is accepted for the treatment of colon cancer, its value for low rectal cancer is unknown. The purpose of this study was to evaluate whether preoperative chemoradiation therapy exerted an adverse influence on laparoscopic TME for low rectal cancer.Methods: We studied 125 consecutive patients who underwent laparoscopic TME for low rectal cancer. Twenty patients with preoperative chemoradiation therapy (CRT-Lap group) were compared with 105 patients without chemoradiation therapy (non-CRT-Lap group).Results: Operating time in the CRT-Lap group (276 min, range 160-390 min) was no different from that in the non-CRT-Lap group (263 min, range 143-456 min). The CRT-Lap group had more blood loss during the operation (70 vs. 37 ml), but mean blood loss was <100 ml. The distal tumor margin was longer in the CRT-Lap group (25.8 vs. 18.6 mm). The number of lymph node harvested did not differ between the groups (14.5 vs. 15.4). Conversion to open surgery was necessary only in one case in the non-CRT-Lap group. There was no anastomotic leakage in the CRT-Lap group, whereas three patients (3.1%) had anastomotic leakage in the non-CRT-Lap group.Conclusion: Laparoscopic TME with preoperative chemoradiation therapy is a safe procedure with reasonable operating time and does not appear to pose any threat to the surgical and oncologic outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Laparoscopic rectal cancer surgery involving rectal division with intracorporeal stapling devices is technically difficult. This study aimed to identify risk factors for anastomotic leakage associated with laparoscopic anterior resection for rectal cancer. Methods: We studied 363 patients who underwent laparoscopic anterior resection with intracorporeal rectal transection and double-stapling technique (DST) anastomosis for rectal cancer between July 2005 and February 2010. Twenty-two independent clinical variables were examined by univariate and multivariate analyses. The outcome of interest was clinical anastomotic leakage. Results: Anastomotic leakage was identified in 13 (3.6%) patients. Multivariate analysis identified middle/lower rectal cancer (odds ratio, 9.446) and lack of pelvic drain (odds ratio, 3.814) as independent predictive factors for anastomotic leakage. The number of cartridges used for rectal division had no significant impact on anastomotic leakage. Conclusions: Laparoscopic anterior resection involving intracorporeal rectal transection and DST anastomosis is safe if performed using an appropriate technique. [Copyright &y& Elsevier]

Abstract: Background: Although locoregional recurrence after rectal cancer resection has been extensively investigated, studies of salvage surgery for locoregionally recurrent colon cancer are scarce. This study aimed to determine the predictors of postsalvage survival for locoregionally recurrent colon cancer. Methods: We studied 45 consecutive patients who underwent macroscopically complete resection of locoregionally recurrent colon cancer between April 1988 and December 2007. The primary end point was cancer-specific survival, and 20 clinical variables were analyzed for their prognostic significance. Results: Cancer-specific 5-year survival for the entire cohort of 45 patients was 46%. Multivariate survival analysis showed that margin status (P = .0311), number of locoregional recurrent tumors (P = .0002), pathological grade (P = .0416), largest tumor diameter (P = .0247), and distant metastasis (P = .0006) were independently associated with cancer-specific survival. Conclusions: Salvage surgery for locoregional recurrence of colon cancer can provide a chance for long-term survival in selected patients. [Copyright &y& Elsevier]