Treatment and outcomes of local re-recurrence in rectal cancer:a multicentre observational cohort

Objective: This study aimed to assess patient, tumour and treatment characteristics in locally re-recurrent rectal cancer (LrRRC), and relate these to long-term oncological outcomes since limited literature on this topic is available. Methods: A retrospective study of locally recurrent rectal cancer (LRRC) patients treated with curative intent between 1994 and 2022 in two tertiary centres in the Netherlands. Data on patient, tumour and treatment characteristics were collected. Oncological outcomes of patients treated with curative and palliative intent were displayed. Results: Of 852 curatively treated LRRC patients, 277 (33 %) developed LrRRC. The median survival of this LrRRC group was 23 months (95 % CI 20–26). Treatment with curative intent was offered to 92/277 (33 %) patients, resulting in surgical resection in 81/277 (29 %) patients. Complete oncological clearance (R0) was achieved in 50/81 cases (62 %). Surgical resection resulted in a median survival of 35 months (95 % CI 27–43). Palliative treatment resulted in a median survival of 16 months (95 % CI 11–21). Median progression free survival (PFS) in patients treated with curative intent was 16 months (95 % CI 12–20). Median local re-re-recurrence free survival (LrrRFS) in patients who underwent surgery was 11 months (95 % CI 8–16). Conclusion: The median OS in 277 LrRRC patients was 23 months. Aggressive treatment in selected patients resulted in a median OS of 35 months. Furthermore, locoregional control was achieved for 11 months in patients undergoing surgery. These findings underscore the need for meticulous patient selection and tailored treatment strategies to improve survival while minimising unnecessary morbidity.</p

Contemporary results from the PelvEx collaborative: improvements in surgical outcomes for locally advanced and recurrent rectal cancer

Aim: The PelvEx Collaborative collates global data on outcomes following exenterative surgery for locally advanced and locally recurrent rectal cancer (LARC and LRRC, respectively). The aim of this study is to report contemporary data from within the collaborative and benchmark it against previous PelvEx publications. Method: Anonymized data from 45 units that performed pelvic exenteration for LARC or LRRC between 2017 and 2021 were reviewed. The primary endpoints were surgical outcomes, including resection margin status, radicality of surgery, rates of reconstruction and associated morbidity and/or mortality. Results: Of 2186 patients who underwent an exenteration for either LARC or LRRC, 1386 (63.4%) had LARC and 800 (36.6%) had LRRC. The proportion of males to females was 1232:954. Median age was 62 years (interquartile range 52-71 years) compared with a median age of 63 in both historical LARC and LRRC cohorts. Compared with the original reported PelvEx data (2004-2014), there has been an increase in negative margin (R0) rates from 79.8% to 84.8% and from 55.4% to 71.7% in the LARC and LRRC cohorts, respectively. Bone resection and flap reconstruction rates have increased accordingly in both cohorts (8.2%-19.6% and 22.6%-32% for LARC and 20.3%-41.9% and 17.4%-32.1% in LRRC, respectively). Despite this, major morbidity has not increased. Conclusion: In the modern era, patients undergoing pelvic exenteration for advanced rectal cancer are undergoing more radical surgery and are more likely to achieve a negative resection margin (R0) with no increase in major morbidity

Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative

Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multi-disciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments

Colorectal-vaginal fistula after rectal cancer resection: international comparative cohort study of characteristics and treatment

A colorectal-vaginal fistula (CRVF) can occur as a complication of rectal cancer surgery. They can cause discomfort, repeated infection, need for treatment/further surgery, and a permanent stoma (an opening in the abdomen to collect bowel contents). This study looked at how often CRVF happened after surgery complicated by a leak where bowels ends have been joined together, how they were treated, and how likely patients were to live without a stoma 1 year after surgery. Researchers collected data on women from around the world who had rectal cancer surgery between 2014 and 2018 and developed a bowel leak (called anastomotic leakage). They compared those with and without a CRVF. A total of 88 out of 694 patients (12.7%) developed a CRVF. These patients more often had major surgery involving removal of nearby organs, including part of the vagina. They were more likely to have ongoing problems and needed more surgeries to manage them. Most had a temporary stoma, but only 29.5% could live without it after 1 year, compared with 48.7% of women without CRVF. CRVF is a serious complication that makes recovery harder. These patients are less likely to live without a stoma and usually need more surgery. However, if the leak is small, the chances of recovery without a permanent stoma are better

A case report of a mesenteric cystic lymphangioma in a young adult woman presenting to the emergency room

BackgroundMesenteric cystic lymphangiomas (MCLs) are rare benign tumours seen in adults. The clinical presentation may vary from asymptomatic to acute abdominal pain with inexplicable abdominal pain, nausea and vomiting.Case presentationIn the current case report, a 22-year old, healthy women presented to the emergency room with acute abdominal pain in need of urgent surgical exploration. Histopathological examination revealed an mesenteric cystic lymphangioma.ConclusionIn patients with inexplicable abdominal pain, the suspicion of MCLs and proper diagnostic strategies are important. The primary treatment of MCLs consists of radical surgical resection to prevent invasion in surrounding tissue. Tertiary referral centres should be consulted to support in the diagnosis, treatment and follow-up of MCLs

When and how should surgery be performed in senior colorectal cancer patients?

Older studies reported high rates of postoperative morbidity and mortality in the senior population, which lead to a tendency to withhold curative surgery in the older population. However, more recent studies showed impressing developments in postoperative outcomes in seniors. Probably, these improvements are due to enhancements in both surgical and non-surgical aspects in the pre-, peri- and postoperative period, such as minimally invasive techniques and anesthesiological insights. The postoperative survival gap seen earlier between younger and older patients is fading. For optimal treatment in the older population, special awareness and care on several aspects is needed. As only a minority of the seniors are frail, a quick frailty assessment is crucial to distinguish the fit from the frail in the decision-making process. In addition, it could be valuable to improve the lacks in physical condition in the preoperative period with the use of prehabilitation programs. Furthermore, it is important to evolve an emergency to an elective setting by postponing emergency surgery to prevent any high-risk situation. In conclusion, based on modern insights, surgery is a valid option in the curative treatment of colorectal cancer in seniors, however individual attention and care is required. (C) 2020 Elsevier Ltd, BASO similar to The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.</p

Outcomes on diverting ostomy formation and reversal after low anterior resection in the older more advanced rectal cancer patient

BACKGROUND: To decrease morbidity caused by anastomotic leakages after a low anterior resection (LAR) with primary anastomosis, a diverting ostomy is often created. Reversal of a diverting ostomy is associated with morbidity, which may result in non-reversal, particularly in the elderly. This study aimed to describe the diverting ostomy-related outcomes in elderly patients with more advanced rectal cancer after LAR. MATERIALS AND METHODS: All rectosigmoid and rectal cancer patients ≥70 years who underwent LAR with primary anastomosis between 2006 and 2019 in the Catharina Hospital (Eindhoven, The Netherlands) were included for analyses. Reversal rates, ostomy-related complications, morbidity and mortality after ostomy reversal, and definitive ostomy rates were evaluated. RESULTS: In total 164 patients were included, of which 150 (91.5%) underwent primary or secondary ostomy creation. Ostomy-related complications were reported in 34.7% (95%-CI 27.1-42.9%). In total, 72.5% (95%-CI 64.2-79.7%) reversed their diverting ostomy. Non-reversal was mostly due to relapsing disease (52.6%). Median time to ostomy reversal was 3.2 months (IQR 2.3-5.0). No or minor complications after ostomy reversal were observed in 84.0% (95%-CI 75.3-90.6%). Over time, ostomy recreation was performed in 15.0% (95%-CI 8.6-23.5%), and ultimately 65.8% (95%-CI 57.8-73.2%) were ostomy-free after the median follow-up of 3.8 years. CONCLUSION: Although most elderly successfully reversed their diverting ostomy after LAR with limited morbidity, attention should be paid for the risk of non-reversal and ostomy recreation over time. Preoperative patient counselling is important in every individual to be able to decide if LAR with primary anastomosis or a permanent end colostomy is preferred

Palliative management of patients with locally recurrent rectal cancer:Clinical presentation, treatment strategies, and overall survival

Introduction: Locally recurrent rectal cancer (LRRC) occurs in 6-12 % of the patients after curative treatment for primary rectal cancer. Palliative treatment plays a critical role, as over half of the patients are ineligible for curative treatment. However, data on patients treated with palliative intent is limited. This study aims to evaluate palliative treatment strategies and overall survival (OS) in LRRC patients. Methods: We retrospectively included all LRRC discussed at the multidisciplinary team in a tertiary referral center, between May 2018 and June 2023. Patients treated with palliative intent were categorized as palliative due to locally unresectable disease, metastatic disease, frailty, or patient preference. Outcomes were OS, treatment response, duration of treatment effect, and hospital admissions. Local control was defined as response or stable disease on imaging. Results: Out of 188 patients, 58 (30.9 %) were treated with palliative intent. Palliative treatments included systemic therapy, chemoradiotherapy and radiotherapy. The median OS for patients treated with palliative intent was 22 months. 3-year OS was 27.1 %, compared to 73.1 % for curative intent patients. Patients with locally unresectable disease had a significantly better OS compared to patients with distant metastases (31 versus 12 months). Local control was achieved in 53.3 % of patients after any palliative treatment, with a median effect duration of 9 months. Chemoradiotherapy was associated with best results for local control. Conclusion: LRRC patients treated with palliative intent can experience substantial survival, particularly those with unresectable disease. Local control due to palliative treatment is feasible, possibly improving survival. Individualized palliative treatment is crucial