[show abstract][hide abstract] ABSTRACT: BackgroundOver the past several years, preoperative chemoradiotherapy (CRT) has contributed remarkably to make more sphincter-preserving
procedure (SPP) possible for lower rectal cancer. The aim of this study was to compare the outcomes between abdominoperineal
resection (APR) and SPP after preoperative CRT in patients with locally advanced lower rectal cancer.
MethodsA retrospective investigation was conducted with a total of 122 patients who underwent radical surgery combined with preoperative
CRT for locally advanced lower rectal cancer. Of these, 50 patients underwent APR and 72 received SPP. Surgery was performed
6–8weeks after completion of preoperative CRT. Oncologic outcomes were compared between the two groups, and the clinicopathologic
factors affecting the treatment outcomes were evaluated.
ResultsCircumferential resection margin (CRM) involvement (P=0.037) and postoperative complication rate (P=0.032) were significantly different between APR and SPP. Patients who underwent APR had a higher 5-year local recurrence
(22.0% vs. 11.5%, P=0.028) and lower 5-year cancer-specific survival (52.9% vs. 71.1%, P=0.03) rate than those who underwent SPP. Pathologic N stage was the most critical predictor for local recurrence and survival.
ConclusionsOur study shows that APR following preoperative CRT exhibited more adverse oncologic outcomes compared with SPP. This result
may be due to higher rates of CRM involvement in APR even with preoperative CRT. We suggest that sharp perineal dissection
and wider cylindrical excision at the level of the anorectal junction are required to avoid CRM involvement and improve oncologic
outcomes in patients who undergo APR following preoperative CRT.
Annals of Surgical Oncology 04/2012; 16(5):1266-1273. · 4.12 Impact Factor
[show abstract][hide abstract] ABSTRACT: Laparoscopic rectal transection carries the risk of anastomotic leakage because of its technical difficulty and long staple line with an inadequate cutting angle. Our objective was to investigate the risk factors affecting anastomotic leakage after laparoscopic intracorporeal colorectal anastomosis with a double stapling technique.
Between November 2006 and September 2008, 270 consecutive patients underwent laparoscopic sigmoidectomy and anterior resection with double stapling technique for distal sigmoid and rectal cancer. Data were collected prospectively. Univariate and multivariate analyses were performed to determine risk factors for anastomotic leakage. Additionally, we evaluated the relationship between the number of stapler firings and clinical parameters.
Anastomotic leakage was noted in 17 (6.3%) of 270 patients. In univariate analyses, tumor location (p = 0.021), operation time (p = 0.025), number of stapler firings (p = 0.040), and diameter of the circular stapler (p = 0.022) were significant risk factors for anastomotic leakage. Multivariate analyses showed that middle or lower rectal cancer was an independent factor affecting anastomotic leakage (p = 0.013). The number of stapler firings increased significantly in men (p = 0.023), in patients with a tumor at a lower level (p = 0.034), and in those with longer operation times (p < 0.001).
A reduction in the number of linear stapler firings is necessary to avoid anastomotic leakage after laparoscopic colorectal anastomosis with a double stapling technique. We recommend that a diverting ileostomy is mandatory in patients with middle and lower rectal cancer where multiple linear staplers were used.
Journal of the American College of Surgeons 12/2009; 209(6):694-701. · 4.50 Impact Factor