2 research outputs found
Evaluating the incidence of pathological complete response in current international rectal cancer practice: the barriers to widespread safe deferral of surgery
- Author
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- Publication date
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- Field of study
Get PDFThis is the peer reviewed version of the following article: , which has been published in final form at https://doi.org/10.1111/codi.14361. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions."Colorectal Disease © 2018 The Association of Coloproctology of Great Britain and Ireland Introduction: The mainstay of management for locally advanced rectal cancer is chemoradiotherapy followed by surgical resection. Following chemoradiotherapy, a complete response may be detected clinically and radiologically (cCR) prior to surgery or pathologically after surgery (pCR). We aim to report the overall complete pathological response (pCR) rate and the reliability of detecting a cCR by conventional pre-operative imaging. Methods: A pre-planned analysis of the European Society of Coloproctology (ESCP) 2017 audit was performed. Patients treated by elective rectal resection were included. A pCR was defined as a ypT0 N0 EMVI negative primary tumour; a partial response represented any regression from baseline staging following chemoradiotherapy. The primary endpoint was the pCR rate. The secondary endpoint was agreement between post-treatment MRI restaging (yMRI) and final pathological staging. Results: Of 2572 patients undergoing rectal cancer surgery in 277 participating centres across 44 countries, 673 (26.2%) underwent chemoradiotherapy and surgery. The pCR rate was 10.3% (67/649), with a partial response in 35.9% (233/649) patients. Comparison of AJCC stage determined by post-treatment yMRI with final pathology showed understaging in 13% (55/429) and overstaging in 34% (148/429). Agreement between yMRI and final pathology for T-stage, N-stage, or AJCC status were each graded as âfairâ only (n = 429, Kappa 0.25, 0.26 and 0.35 respectively). Conclusion: The reported pCR rate of 10% highlights the potential for non-operative management in selected cases. The limited strength of agreement between basic conventional post-chemoradiotherapy imaging assessment techniques and pathology suggest alternative markers of response should be considered, in the context of controlled clinical trials
Outcomes from elective colorectal cancer surgery during the SARSâCoVâ2 pandemic
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- Sayyed Raza
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- Sund Malin
- Sundar Sudha
- Sundaram Venkatesan G
- Suszt\ue1k N
- Sutherland A
- Swinson B
- Syed WAS
- Syllaios A
- Szatmary P
- Szubota I
- Tabiri Stephen
- Taddei A
- Tadic B
- Taibi A
- Talal El\u2010Abur I
- Talukder S
- Talwar R
- Tamini N
- Tammaro P
- Tan JA
- Tan XS
- Tanal M
- Tang AM
- Tanzanu M
- Tartaglia D
- Tasis N
- Tatar OC
- Tavares F
- Tavares F
- Tayeh S
- Taylor Elliott H
- Tebala GD
- Teixeira J
- Teixeira M
- Teixeira M
- Tejero\u2010Pintor FJ
- Testa V
- Tewari N
- Tezas S
- Thaha M
- Thanapal MR
- Theodosopoulos T
- Theophilidou E
- Thian A
- Thomas A
- Thompson D
- Thornhill M
- Thrumurthy S
- Thulasiraman SV
- Timbrell S
- Tirloni L
- Titu S
- Tiwari Abhinav
- Tojal A
- Tonini V
- Torres Arcos C
- Torres A
- Townend D
- Townend Philip
- Townson A
- Trabulsi N
- Travaglio E
- Tribillon E
- Troncoso Pereira P
- Tropeano FP
- Trout Isobel M
- Trujillo D\uedaz J
- Tsai L
- Tsarkov P
- Tsiamalou I
- Tsiaoussis I
- Tsirlis T
- Tsoulfas Georgios
- Tucci R
- Tufo A
- Tugmen C
- Tulina I
- Tuncer K
- Turnbull A
- Turrado\u2010Rodriguez V
- Turri G
- Tweedle E
- Tzedakis S
- Tzovaras G
- Ugarte\u2010Sierra B
- Uluda\u11f SS
- Umair M
- Uras C
- Urbani A
- Urbieta A
- Usai A
- Uslu G
- Utkan NZ
- Uyanik MS
- Uzunoglu FG
- V\ue1zquez Fern\ue1ndez A
- Vaccarella G
- Valbuena Jabares V
- Valdes\u2010Hernandez J
- Valero Soriano M
- Vallance Abigail
- Vallance Abigail
- Valle Rubio A
- Valverde S
- Van den Eynde J
- Van den Eynde R
- van der Plas Willemijn
- Van Heinsbergen M
- van Ramshorst Gabrielle H
- Varma M
- Vasljevi\u107 J
- Vassiliu P
- Vaz Pereira R
- Vaz S
- Velchuru V
- Velickovic D
- Velidedeoglu M
- Venn M
- Venn Mary L
- Venn Mary L
- Venskutonis D
- Vera Mansilla C
- Verberne C
- Vergari R
- Vernon L
- Vervoort D
- Vescio G
- Vezakis A
- Videira JF
- Vidya Raghavan
- Vieira Caro\ue7o T
- Vieira Paiva Lopes AC
- Vieira A
- Vieira B
- Vignali A
- Vigorita V
- Vijayan D
- Villalabeitia Ateca I
- Vimalachandran D
- Vimalachandran Dale
- Vimalachandran Dale
- Vimalchandran Dale
- Violante T
- Viswanath YKS
- Vitali A
- Vitone L
- Vives RV
- Vo UG
- Von Papen M
- Vovola F
- Vucic N
- Wadham B
- Walkes K
- Wani R
- Waqar SH
- Warren O
- Warren Oliver J
- Watson LJ
- Watson N
- Wedderburn Duane
- Weitz J
- Welsch T
- Werner J
- Westwood E
- Whelan M
- Whitmore H
- Wilkin RJW
- Wilkins A
- Williams G
- Williams K
- Wilson M
- Wimmer A
- Wong M
- Worku D
- Wright Naomi
- Wullschleger M
- Xavier RG
- Xenaki S
- Xynos E
- Y\u131ld\u131r\u131m A
- Y\ue1nez C
- Y\ufcksel E
- Yang W
- Yassin N
- Ye G
- Ye\u15filyurt D
- Yesantharao P
- Yetkin SG
- Yiallourou A
- Yildiz A
- Young R
- Yousof EA
- Youssef M
- Yurttas C
- Zafar SN
- Zakaria AD
- Zakaria Z
- Zambon M
- Zanus G
- Zegarac M
- Zeli\u107 M
- Zengin AK
- Zerbib P
- Zervas K
- Zese M
- Zhang H
- Zizzo M
- Zografos C
- Zorrilla Ort\ufazar J
- Zourntou S
- Zubaidi AM
- Publication venue
- 'Wiley'
- Publication date
- 01/01/2020
- Field of study
Get PDFAim
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic.
Method
This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data.
Results
From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58â14.06), postoperative SARS-CoV-2 (16.90, 7.86â36.38), male sex (2.46, 1.01â5.93), age >70 years (2.87, 1.32â6.20) and advanced cancer stage (3.43, 1.16â10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%).
Conclusion
Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks
