22 research outputs found
Risk Factors of Tumour Recurrence and Reduced Survival in Rectal Cancer
In Sweden, 2000 patients are diagnosed with rectal cancer annually. In 1995, the Swedish Rectal Cancer Registry (SRCR) was launched to supervise and assure the quality of the management of rectal cancer. Advances in the management of rectal cancer have reduced the local recurrence (LR) rate and improved survival. To improve the outcome further, identification of prognostic and predictive factors is important for optimal, personalised neoadjuvant/adjuvant treatment and follow-up strategies. This thesis identifies potential risk factors of tumour recurrence and reduced survival – i.e., surgery-related and tumour biology-related prognostic factors – in a cohort of patients registered in the SRCR between 1995 and 1997 with 5-year follow-up. SRCR data were used and for subgroups additional data from the original medical records were retrieved. In addition, SRCR data were validated. In Paper I, preoperative radiotherapy (RT) significantly reduced the LR rate irrespective of the tumour height. Moreover, preoperative RT and rectal washout reduced the LR rate after incidental perforation. Preoperative RT prolonged time to LR. LR was an isolated tumour manifestation in 39% of the patients with LR. Paper II showed that anastomotic leakage had no impact on the oncological outcome. In Paper III, incidental perforation was a significant risk factor of increased LR and overall recurrence rates as well as reduced overall and cancer-specific 5-year survival. In Paper I-III, the validity of SRCR data was acceptable. In Paper IV, high immunohistochemical expression of the tumour marker ezrin in primary tumours from patients with LR correlated to earlier occurrence of LR. A linkage of high ezrin expression and aggressive biological behaviour is suggested
Impact of rectal washout on recurrence and survival after anterior resection for rectal cancer
Background: Rectal washout (RW) is routinely performed during anterior resection (AR) for rectal cancer to reduce local recurrence (LR), although is sometimes not performed during minimally invasive surgery (MIS) procedures due to technical challenges and time consumption. The aim was to investigate the impact of RW on the oncological outcome after AR for rectal cancer in a registry cohort. Methods: Data on patients registered in the Swedish Colorectal Cancer Registry who had undergone elective radical (R0) AR for TNM stage I-III rectal cancer between 2007 and 2017 with a 3-year follow-up were analysed. Multivariable analyses were performed and the primary endpoint was LR at 3 and 5 years after AR. The occurrence of distant metastasis (DM) and overall recurrence (OAR), overall survival, and relative survival were also analysed as a secondary aim. A subgroup analysis was performed for the same outcomes in patients treated with MIS. Results: Out of 6186 patients (1923 with TNM stage I, 1907 with TNM stage II, and 2356 with TNM stage III), RW was performed in 5706 (92.2 per cent). The median age of the cohort was 67 years. RW did not impact the 3-year risk of LR. LR within 5 years occurred in 104 of 4583 patients (2.3 per cent) in the RW group compared with 16 of 408 patients (3.9 per cent) in the no RW group (P = 0.037). In multivariable analysis of the LR risk, the HR was 0.53 (95 per cent c.i. 0.31 to 0.90), favouring RW. There were no differences in rates of DM and OAR, overall survival, and relative survival. A subgroup analysis of the 1410 patients undergoing MIS did not demonstrate any differences between the groups, given, however, the low rate of LR. Conclusions: RW in AR for rectal cancer does not impact the 3-year oncological outcome; however, after the 5-year follow-up a reduction in LR risk was observed after RW
Author response to : Comment on: Impact of rectal perforation on recurrence during rectal cancer surgery in a national population registry
Rectal washout during abdominoperineal resection for rectal cancer has no impact on the oncological outcome
AimIntraoperative rectal washout is performed to eliminate exfoliated intraluminal cancer cells and thereby decrease the risk of local recurrence. Rectal washout in abdominoperineal resection has not been studied. The aim of this study was to assess the oncological outcome after rectal washout in abdominoperineal resection for rectal cancer and to find evidence as to whether rectal washout should be performed or not.MethodData for all patients registered in the Swedish Colorectal Cancer Registry who underwent elective surgery with abdominoperineal resection for rectal cancer (TNM Stages I–III) between 2007 and 2013 were analysed using multivariable analysis.ResultsNo significant differences were shown between the rectal washout group and the no rectal washout group for local recurrence [10/265 (3.8%) vs. 87/2160 (4.0%), p = 0.84], distant metastasis [51/265 (19.2%) vs. 476/2160 (22.0%), p = 0.29] or overall recurrence [53/265 (20.0%) vs. 505/2160 (23.4%), p = 0.21]. In multivariable analysis, rectal washout did not significantly affect the oncological outcome in terms of local recurrence, distant metastasis, overall recurrence or 5-year overall or relative survival.ConclusionOur results do not support routine rectal washout during abdominoperineal resection in order to improve the oncological outcome.What does this paper add to the literature?This is the first study to investigate the oncological outcome after rectal washout during abdominoperineal resection for rectal cancer in order to find evidence as to whether rectal washout should be performed or not
Oncological outcome after incidental perforation in radical rectal cancer surgery.
PURPOSE: Identification of risk factors of poor oncological outcome in rectal cancer surgery is of utmost importance. This study examines the impact of incidental perforation on the oncological outcome. METHODS: Using the Swedish Rectal Cancer Registry, patients were selected who received major abdominal surgery for rectal cancer between 1995 and 1997 with registered incidental perforation. A control group was also selected for analysis of the oncological outcome after 5-year follow-up. Multivariate analysis was performed. Registry data were validated, and additional data were supplemented from medical records. RESULTS: After validation and exclusion of non-radically operated patients, 118 patients with incidental perforation and 155 controls in TNM stages I-III were included in the analysis. The rate of local recurrence (LR) [20% (23/118) vs. 8% (12/155) (p = 0.007)] was significantly higher among patients with perforation, whereas the rates of distant metastasis [27% (32/118) vs. 21% (33/155) (p = 0.33)] and overall recurrence (OAR) [35% (41/118) vs. 25% (38/155) (p = 0.087)] were not significantly different between the groups. Overall as well as cancer-specific 5-year survival rates were significantly reduced for the patients with perforation [44 vs. 64% (p = 0.002) and 66 vs. 80% (p = 0.026), respectively]. In the multivariate analysis, perforation was a significant risk factor of increased rates of LR and OAR as well as reduced 5-year overall and cancer-specific survival. CONCLUSIONS: Incidental perforation in rectal cancer surgery is an important risk factor of poor oncological outcome and should be considered in the discussion concerning postoperative adjuvant treatment as well as the follow-up regime
Risk Factors of Rectal Cancer Local Recurrence: Population-based Survey and Validation of the Swedish Rectal Cancer Registry.
Aim Despite advances in rectal cancer treatment local recurrence (LR) remains a significant problem. To select high-risk patients for different treatment options aimed at reducing LR, it is essential to identify LR risk factors. Method LR and survival rates of 4157 patients registered 1995-1997 in the Swedish Rectal Cancer Registry were analysed. LR risk factors were analysed by multivariate methods. For LR patients the registry was validated and additional data retrieved. Results The five-year overall and cancer specific survival rates were 45% and 62%. LR was registered in 326 (8%) patients. After R0-resections for tumours in TNM-stages I-III, LR developed in 10% of tumours at 0-5 cm, 8% at 6-10 cm, and 6% at 11-15 cm above the anal verge. Preoperative radiotherapy (RT) reduced the LR rate irrespective of height [0-5 cm: OR 0.50 (0.30-0.83), 6-10 cm: OR 0.42 (0.25-0.71), and 11-15 cm: OR 0.29 (0.13-0.64)]. Patients without preoperative RT had significantly higher LR risk after rectal perforation [OR 2.50 (1.48-4.24)], and almost significantly decreased LR risk when rectal washout was performed [OR 0.65 (0.43-1.00)]. Preoperative RT prolonged time to LR but did not significantly influence survival among LR patients. LR was an isolated tumour manifestation in 103 (39%) patients with validated LR. Conclusions Preoperative RT should be considered for rectal cancer also in the upper third of the rectum. Intraoperative perforation should be avoided, and rectal washout is indicated as valuable. Follow-up for detection of isolated LR is important. Extended follow-up should be considered for patients treated with RT
Validity of the Swedish Rectal Cancer Registry for patients treated with major abdominal surgery between 1995 and 1997.
Background. Founded in 1995, the Swedish Rectal Cancer Registry (SRCR) is frequently used for rectal cancer research. However, the validity of the registry has not been extensively studied. This study aims to validate a large amount of registry data to assess SRCR quality. Material and methods. The study comprises 906 patients treated with major abdominal surgery registered in the SRCR between 1995 and 1997. SRCR data for 14 variables were scrutinized for validity against the medical records. Kappa's and Kendall's correlation coefficients for agreement between SRCR data and medical records data were calculated for 13 variables. Results. For 11 variables, concerning the tumor, neoadjuvant therapy, the surgical procedure, local radicality and TNM stage, data were missing in 5% or less of the registrations; for the remaining three variables, anastomotic leakage, local and distant recurrence, data were missing in 13-38%. For the variables surgery performed or not and type of surgical procedure, no data were missing. Erroneous registrations were found in less than 10% of all variables; for the variables preoperative chemotherapy and surgery performed or not, all registrations were correct. For the variables concerning neoadjuvant therapy, local radicality according to the surgeon as well as the pathologist and distant metastasis, the false-positive or -negative registrations were equally distributed, and for the variables rectal washout, rectal perforation, anastomotic leakage and local recurrence there was a discrepancy in distribution. The correlation coefficient for 12 variables ranged from 0.82 to 1.00, and was 0.78 for the remaining variable. Conclusion. The validity of the SRCR was good for the initial three registry years. Thus, research based on SRCR data is reliable from the beginning of the registry's use
Anastomotic leakage after surgery for rectal cancer: a risk factor of local recurrence, distant metastasis and reduced cancer-specific survival?
ABSTRACT Background We explored the impact of anastomotic leakage (AL) on the oncological outcome after anterior resection (AR) for rectal cancer which is still controversial.. Local recurrence (LR) and overall recurrenc(OAR) and cancer-specific survival were analysed. Method Patients undergoing AR for rectal cancer with a registered AL between 1995 and 1997 and a control group were identified in the Swedish Rectal Cancer Registry. The medical records were retrieved for additional data and validation. Differences in the oncological outcome at 5 year follow-up were analysed with multivariate methods. Results After validation, 114 patients with AL and 136 controls with locally radical surgery for tumours of TNM stages I-III were analysed. There was no difference detected between patients with AL and controls regarding rates of LR [8% (9/114) vs 9% (12/136); P=0.97], distant metastasis [18% (20/114) vs 23% (31/136); P=0.37] and OAR [19% (22/114) vs 28% (38/136); P=0.15]. The 5 year cancer specific survival was almost 80% in both groups. In multivariate analysis, AL was not a risk factor for LR, distant metastasis or OAR and had no impact on 5 year overall or 5 year cancer specific survival. Irrespective of the occurrence of AL, preoperative radiotherapy (P=0.055) and rectal washout (P=0.046) reduced the LR rate, but did not influence survival. Conclusion AL was not proven to be a risk factor for worse oncological outcome. Hence additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after AR might not be justified
Circumferential resection margin and local recurrence after rectal cancer surgery: a population-based study cohort
Aim: Studies have suggested that there is a difference in risk of local recurrence(LR) with circumferential resection margins (CRM) less than 1.0 mm. We aimed toexamine how exact resection margins affect LR risk.Method: Data from the Swedish Colorectal Cancer Registry (SCRCR) were usedfor retrospective analysis of resected rectal cancers between 2005 and 2013. Primaryendpoint was LR.Results: 12146 cases were identified of which 8666 cases were analysed after exclusion. 388 cases had CRM < 1.0 mm and 8278 cases CRM ≥ 1.0 mm. There were 42LR (11.4%) when CRM < 1.0 mm and 280 LR (3.5%) when CRM ≥ 1.0 mm. LRrate was 17% (n = 27/159), 7.1% (n = 15/210), 5.5% (n = 26/473) and 3.4%(n = 254/7550) when CRM was 0.0 mm, 0.1–0.9 mm, 1.0–1.9 mm andCRM ≥ 2 mm respectively. LR risk at CRM 0.0 mm was significantly increased compared to all other groups. No significant difference in LR between CRM 1.0–1.9 mm and ≥ 2 mm was observed. LR was diagnosed earlier when CRM < 1.0 mm.Conclusion: LR risk is related with accuracy to the surgical circumferential resec-tion margin distance. There was no difference in LR risk above CRM 1.0 mm.Most LRs occurred within two years after surgery when CRM was below 1.0 m
Rektalcancer: : Risk för lokalt recidiv är beroende av RESEKTIONSMARGINAL
Rektalcancer är en sjukdom där behandlingsresultaten förbättrats kraftigt de senaste decennierna. Behandling för ändtarmscancer sker med antingen endast kirurgi eller kirurgi i kombination med onkologisk neoadjuvant behandling. Kirurgisk radikalitet, mikroskopisk marginal mellan tumörvävnad och frisk vävnad, är av stor betydelse för att minska risken för lokalrecidiv och öka överlevnade