Contemporary snapshot of tumor regression grade (TRG) distribution in locally advanced rectal cancer: a cross sectional multicentric experience.

Pre-operative chemoradiotherapy (CRT) followed by surgical resection is still the standard treatment for locally advanced low rectal cancer. Nowadays new strategies are emerging to treat patients with a complete response to pre-operative treatment, rendering the optimal management still controversial and under debate. The primary aim of this study was to obtain a snapshot of tumor regression grade (TRG) distribution after standard CRT. Second, we aimed to identify a correlation between clinical tumor stage (cT) and TRG, and to define the accuracy of magnetic resonance imaging (MRI) in the restaging setting. Between January 2017 and June 2019, a cross sectional multicentric study was performed in 22 referral centers of colon-rectal surgery including all patients with cT3-4Nx/cTxN1-2 rectal cancer who underwent pre-operative CRT. Shapiro-Wilk test was used for continuous data. Categorical variables were compared with Chi-squared test or Fisher's exact test, where appropriate. Accuracy of restaging MRI in the identification of pathologic complete response (pCR) was determined evaluating the correspondence with the histopathological examination of surgical specimens.In the present study, 689 patients were enrolled. Complete tumor regression rate was 16.9%. The "watch and wait" strategy was applied in 4.3% of TRG4 patients. A clinical correlation between more advanced tumors and moderate to absent tumor regression was found (p = 0.03). Post-neoadjuvant MRI had low sensibility (55%) and high specificity (83%) with accuracy of 82.8% in identifying TRG4 and pCR.Our data provided a contemporary description of the effects of pre-operative CRT on a large pool of locally advanced low rectal cancer patients treated in different colon-rectal surgical centers

The ladies trial: laparoscopic peritoneal lavage or resection for purulent peritonitisA and Hartmann's procedure or resection with primary anastomosis for purulent or faecal peritonitisB in perforated diverticulitis (NTR2037)

Background: Recently, excellent results are reported on laparoscopic lavage in patients with purulent perforated diverticulitis as an alternative for sigmoidectomy and ostomy. The objective of this study is to determine whether LaparOscopic LAvage and drainage is a safe and effective treatment for patients with purulent peritonitis (LOLA-arm) and to determine the optimal resectional strategy in patients with a purulent or faecal peritonitis (DIVA-arm: perforated DIVerticulitis: sigmoidresection with or without Anastomosis). Methods/Design: In this multicentre randomised trial all patients with perforated diverticulitis are included. Upon laparoscopy, patients with purulent peritonitis are treated with laparoscopic lavage and drainage, Hartmann's procedure or sigmoidectomy with primary anastomosis in a ratio of 2:1:1 (LOLA-arm). Patients with faecal peritonitis will be randomised 1:1 between Hartmann's procedure and resection with primary anastomosis (DIVA-arm). The primary combined endpoint of the LOLA-arm is major morbidity and mortality. A sample size of 132:66:66 patients will be able to detect a difference in the primary endpoint from 25% in resectional groups compared to 10% in the laparoscopic lavage group (two sided alpha = 5%, power = 90%). Endpoint of the DIVA-arm is stoma free survival one year after initial surgery. In this arm 212 patients are needed to significantly demonstrate a difference of 30% (log rank test two sided alpha = 5% and powe

Long term oncological results and quality of life after HIPEC for carcinomatosis of colorectal origin

Introduction : Peritoneal carcinomatosis (PC) of colorectal origin remains the most advanced form of colorectal cancer and is still associated with poor outcome. Cytoreducive surgery (CRS) and hyperthermic intra-peritoneal chemotherapy (HIPEC) has deeply modified patients’ prognosis. Aim : This study aims to review our results of CRS and HIPEC based on Oxaliplatin and using a closed abdomen technique as treatment of peritonela carcinomatosis of colorectal origin. Beside oncologic outcome, this study examines the long term quality of life (QoL) of patients treated by CRS and HIPEC. Methods : This is a retrospective monocentric study based on consecutive patients presenting colorectal cancer with perioneal carcinomatosis and treated by CRS and HIPEC. Demographic, operative, post-operative and pathological data have been collected. Long term oncological results have been computed and quality of life has been evaluated using the EORTC QLQ C-30 and GIQLI questionnaires. Results : Between October 2007 and December 2015, 82 patients have undergone 92 HIPEC, of which 70 patients underwent 75 CS with Oxaliplatin HIPEC using a closed abdomen technique. Among the 38 patients alive at the time of the study, 34 had not benefited from a redo-HIPEC after December 31, 2015.Of the 82 patients operated between October 2007 and December 2015, 10 (10.9%) received prophylactic HIPEC. There were 44 women and 38 men with a median age of 60 (18-77). Twenty-one patients (32.6%) had synchronous resecable liver metastases. The median level of carcinoembryonic antigen was 2,7 ng / mL. The CC-0 and CC-1 resection scores were obtained for 75 (87.2%) and 10 (11.6%) procedures, respectively. The median index of peritoneal carcinomatosis (PCI) was 6 (0 to 30). Twenty-two patients (23.9%) had a Dindo-Clavien complication> 2 and the postoperative mortality was 1,6%. The median follow-up time is 35 months. Twenty-seven patients (29.3%) received neoadjuvant chemotherapy and 48 (53.3%) received adjuvant chemotherapy. Twelve patients (13.0%) had isolated recurrence of CP and 35 patients (38.0%) presented distant metastases. Overall survival (OS) and 5-year survival without recurrence (DFS) were 45.7% and 8.7%, respectively. The deterioration of the quality of life in the long term is related to the presence of an invasion and to the occurrence of distal recurrences. The EORTC and GIQLI questionnaires showed a high incidence and intensity of diarrhea. Conclusions : HIPEC with Oxaliplatin using a closed abdomen technique to treat CP of colorectal origin offers acceptable oncological results. This treatment strategy should therefore be considered for all patients with peritoneal carcinomatosis, while ensuring that patients live not only longer but also enjoy a good quality of life