-
Chikara Kunisaki,
Masazumi Takahashi,
Hidetaka A Ono,
Shinichi Hasegawa,
Kazuhito Tsuchida,
Takashi Oshima, Mitsuyoshi Ota,
Tadao Fukushima,
Motohiko Tokuhisa,
Yusuke Izumisawa,
Ryo Takagawa,
Jun Kimura,
Takashi Kosaka,
Hirochika Makino,
Hirotoshi Akiyama,
Itaru Endo
[show abstract]
[hide abstract]
ABSTRACT: Background/Aim: This study assessed the toxicity and activity of biweekly docetaxel and S-1 combination therapy in elderly patients with advanced gastric cancer.
One-hundred and thirteen patients were enrolled: 35 were 75 years old or more. The objective response rate, toxicity, progression-free survival (PFS), and overall survival (OS) were compared.
Dose reduction was significantly frequent in the elderly group (24/35 versus 25/78, p<0.001). The overall response rate was 54.9%. Out of these, 18 (15.9%) underwent gastrectomy (13 R0 gastrectomy). The median OS was 17.3 months and the median PFS was 8.0 months. Neutropenia was the most frequently observed hematological toxicity at grade 3 and 4 (34.5%), followed by leukopenia (24.8%). Most non-hematological toxicities were of grade 1 or 2. There were no significant differences in overall response rate, median OS, median PFS, or toxicities between the two groups.
This combination offers favourable survival benefits with controllable tolerance for therapy of AGC in the elderly.
Anticancer research 02/2013; 33(2):697-704. · 1.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: BACKGROUND: Although short- and long-term results have been described in previous reports of 2-stage hepatectomy, growth activity in metastases resected at the first versus second hepatectomy has not been compared. METHODS: We analyzed growth activity of liver metastases from colorectal cancers resected at first and second hepatectomy by real-time reverse-transcription polymerase chain reaction and immunohistochemistry in 21 patients undergoing 2-stage hepatectomy to justify the 2-stage approach. RESULTS: Of 24 patients planned to undergo 2-stage hepatectomy for colorectal liver metastases, 21 had completion of both stages. Although maximum tumor size and serum carcinoembryonic antigen before and after the first procedure did not differ, volume of the future liver remnant increased after the first procedure. Ki67 and proliferating cell nuclear antigen positivity rates were comparable between initially and subsequently resected tumors (P = .09 and P = .83, respectively). Expression of mRNA (relative to glyceraldehyde-3-phosphate dehydrogenase mRNA) in initially versus subsequently resected tumors for cyclin D1 (4.27 ± 1.29 vs 6.52 ± 2.23; P = .90), cyclin E1 (24.18 ± 16.81 vs 10.53 ± 2.28; P = .60), hepatocyte growth factor (3.16 ± 1.42 vs 0.58 ± 0.15; P = .11), basic fibroblast growth factor (5.42 ± 1.54 vs 5.92 ± 3.33; P = .13), epidermal growth factor (19.56 ± 14.76 vs 9.07 ± 4.54; P = .74), and transforming growth factor-α (2.63 ± 1.02 vs 2.07 ± 1.15; P = .29) showed no differences between the 2 time points. CONCLUSION: Two-stage hepatectomy did not seem to induce tumor growth activity or growth factor expression. The 2-stage strategy in combination with effective preoperative chemotherapy is a valuable strategy for colorectal metastases.
Surgery 08/2012; · 3.10 Impact Factor
-
Shoichi Fujii,
Kazuteru Watanabe, Mitsuyoshi Ota,
Jun Watanabe,
Yasushi Ichikawa,
Shigeru Yamagishi,
Kenji Tatsumi,
Hirokazu Suwa,
Chikara Kunisaki,
Masataka Taguri,
Satoshi Morita,
Itaru Endo
[show abstract]
[hide abstract]
ABSTRACT: Laparoscopic colectomy for colorectal cancer has become established as a minimally invasive surgical approach. However, many disposable instruments are required, and there is an associated disadvantage of cost. We have developed a new technique, which uses a suture string to lift up the colon. This method is expected to reduce the number of access ports required without compromising the radical cure. OPERATIVE PROCEDURE: A suture string piercing the abdominal wall is passed through the mesocolon. The colon is retracted anteriorly and is fixed at the abdominal wall. The main mesenteric vessels are under tension, and lymph node dissection is performed easily by a medial approach. The working space is more stable because the colon is fixed to the abdominal wall.
This study examined the short-term and long-term surgical outcomes of laparoscopic resection for colorectal cancer using our colon lifting-up technique (CLT), compared with the standard multiport technique. The study design was a case-matched control by propensity scoring. Analyzed variables were sex, age, American Society of Anesthesiologists score, cancer in a different organ, multiple colorectal cancer, operator, operative year, tumor location, operative procedure, adjuvant chemotherapy, and International Union Against Cancer TNM stage.
From 2000 to 2010, 301 patients underwent CLT and 436 standard multiport technique, 148 patients were matched by propensity score and analyzed. Regarding short-term outcomes, there was no difference between the 2 groups. The mean number of ports needed was 3.37±0.48 for CLT (93 with 3 ports, 55 with 4). There were no differences in recurrence-free survival and overall survival in long-term follow-up results for each stage. There were neither recurrences nor complications due to CLT.
The CLT facilitated laparoscopic colectomy without compromising cure rates. It is a useful method to keep a stable view and to conserve medical resources.
Surgical laparoscopy, endoscopy & percutaneous techniques 02/2012; 22(1):38-45. · 1.23 Impact Factor
-
Shoichi Fujii,
Kazuteru Watanabe, Mitsuyoshi Ota,
Jun Watanabe,
Yasushi Ichikawa,
Shigeru Yamagishi,
Kenji Tatsumi,
Hirokazu Suwa,
Chikara Kunisaki,
Masataka Taguri,
Satoshi Morita,
Itaru Endo
[show abstract]
[hide abstract]
ABSTRACT: Single-incision laparoscopic surgery (SILS) has been used for colorectal cancer as a minimally invasive procedure. However, there are still difficulties concerning effective triangulation and countertraction. The study's purpose was to clarify the usefulness of the colon-lifting technique (CLT) in SILS for colorectal cancer.
SILS was performed for cancer (cT2N0 or less) of the right-sided colon (near the ileocecum), sigmoid, or rectosigmoid. The SILS™ Port was used for transumbilical access. A suture string was inserted through the abdominal wall and passed through the mesocolon. The colon was retracted anteriorly and fixed to the abdominal wall. The main mesenteric vessels were placed under tension. Lymph node dissection was performed by medial approach. Short-term surgical outcomes and access port costs were compared between SILS (using CLT) and the standard multiport technique (MPT). The two groups were case-matched by propensity scoring. Analyzed variables included preoperative Dukes stage and tumor location.
From June 2009 to April 2011, 27 patients underwent SILS, and from April 2005 to April 2011, 85 patients underwent MPT. Propensity scoring generated 23 matched patients per group for SILS versus MPT comparisons. There were no significant differences in operating time, blood loss, early complications, postoperative analgesic frequency, or length of hospital stay. One MPT patient was converted to open surgery (4.5%); no SILS patients were converted. There were no significant differences in the length of distal cut margin and the number of harvested lymph nodes, except incision length (SILS vs. MPT: 33 vs. 55 mm, P < 0.001). Significant differences favored SILS in access instrument cost (SILS vs. MPT: 62,761 vs. 77,130 Japanese yen, P < 0.001).
SILS performed using CLT was safe and effective in providing radical treatment of cT2N0 cancer in the right-sided colon, sigmoid, or rectosigmoid. SILS was advantageous with respect to cosmesis and lower cost of access instruments.
Surgical Endoscopy 11/2011; 26(5):1403-11. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate the validity of surgical therapy for isolated hepatic and pulmonary colorectal metastases.
Among 256 patients with liver resection for colorectal cancer metastases, 31 patients underwent resection for lung metastases synchronously or following liver resection.
Twenty-nine patients (93.5%) underwent pulmonary resection for lung metastases after hepatectomy. Two patients (6.5%) with synchronously identified liver and lung metastases underwent staged liver and lung resection. The 5-, and 10-year overall survival rates were 77.5% and 39.5% after the initial liver resection and were 44.7% and 38.2% after the pulmonary resection, respectively. By multivariate analysis, the presence of three or more pulmonary metastases (risk ratio=3.692, 95% confidence interval C I=1.039-13.118, p=0.043) was an independent adverse prognostic factor.
Surgical resection for both hepatic and pulmonary metastases from colorectal cancer appears feasible and efficacious in patients with <3 pulmonary metastases.
Anticancer research 03/2011; 31(3):1049-54. · 1.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to determine the efficacy of hepatic artery infusion (HAI) plus systemic chemotherapy (SYS) as the prehepatectomy chemotherapy for liver metastases from colorectal cancer. Clinicopathologic data were available for 117 patients who were treated with chemotherapy before liver surgery. Response rate of chemotherapy and frequency of liver resection after chemotherapy of patients treated with HAI/SYS (n=26; 65% and 96%, respectively) were higher than those treated with HAI alone (n=63; 41% and 70%) or SYS alone (n=28; 25% and 42%). Histological examination of adjacent nonneoplastic liver confirmed that severe sinusoidal dilatation was less frequent in HAI/SYS group than in SYS group, and moderate to severe steatosis was also less frequent in HAI/SYS group as compared to HAI group. The combination of regional HAI and systemic chemotherapy is an effective prehepatectomy regimen for the treatment of patients with aggressive liver metastases from colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2267-70.
-
Shoichi Fujii, Mitsuyoshi Ota,
Yasushi Ichikawa,
Shigeru Yamagishi,
Kazuteru Watanabe,
Kenji Tatsumi,
Jun Watanabe,
Hirokazu Suwa,
Takashi Oshima,
Chikara Kunisaki,
Shigeo Ohki,
Itaru Endo,
Hiroshi Shimada
[show abstract]
[hide abstract]
ABSTRACT: A multicenter randomized study is high quality, but it is also true that there are differences between institutions. The quality of treatment is consistent in a single center so comparisons in a retrospective study can be matched for many variables.
This single-center study examined short-term and long-term outcomes for colorectal cancer in 258 patients who underwent laparoscopic resection (LC) and 258 matched open resection (OC) cases. The health-related qualities of life (HRQOL) at 1-2 years after the operations in 62 patients (35 LC and 27 OC) were compared by SF-36.
The conversion rate was 5.0%. Mean follow-up periods in LC and OC were 62.3 and 62.1 months, respectively. Operation time was longer in LC than in OC, although the difference was not significant in the later period. Bleeding and postoperative stay were reduced in LC. The morbidity rate was 18.6% in LC and 26.4% in OC. The 5-year overall survival in LC and OC were 94.6% vs. 92.0% for stage I, 95.2% vs. 91.8% for stage II, and 80.9% vs. 79.1% for stage III, respectively. The corresponding 5-year disease-free survival were 94.0% vs. 88.4%, 92.1% vs. 84.0%, and 64.3% vs. 65.4%, respectively. Recurrence rates did not differ between groups. In the analysis of HRQOL scores, role physical, bodily pain, social functioning, role emotional, and physical component summary scores in LC were better than in OC.
In LC for colorectal cancer, short-term outcomes except operation time and mid-term HRQOL were better than in OC, and there were no adverse effects relating to long-term outcomes.
International Journal of Colorectal Disease 11/2010; 25(11):1311-23. · 2.38 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: This study evaluates the clinical characteristics of rectal cancer involving the anal canal.
A total of 346 consecutive patients with primary low rectal cancer located below the peritoneal reflection were reviewed in this study. Patients were divided into two groups according to whether the lower edge of the tumor came in contact with the anal canal (P group, n = 78) or not (Rb group, n = 268). Clinical and pathological parameters, recurrence rates, and survival rates were compared between the two groups.
The occurrence of uncommon histological types of tumor was significantly higher in the P group than in the Rb group. P group patients also had a significantly higher lateral pelvic node metastasis rate (p < 0.001), lower 5-year overall survival rate (p = 0.0491), and higher 5-year local recurrence rate (p = 0.0171) than Rb group patients. Multivariate analysis revealed that tumor location was a significant risk factor for local recurrence. In the P group, multivariate analysis showed that uncommon histological tumor types were a significant prognostic factor.
Rectal cancer involving the anal canal should be treated with special care, considering the particularly high lateral pelvic lymph node metastasis rate and high local recurrence rate.
Journal of Gastrointestinal Surgery 11/2010; 15(3):460-5. · 2.83 Impact Factor
-
Surgical Endoscopy 07/2010; · 4.01 Impact Factor
-
Yasushi Ichikawa,
Yohei Miyagi,
Shoichi Fujii, Mitsuyoshi Ota,
Shigeru Yamagishi,
Shingo Hasegawa,
Shuuji Saito,
Hideyuki Ike,
Shigeo Ohki,
Akira Nakano,
Naomi Matsumura,
Takashi Ishikawa,
Chikara Kunizaki,
Hiroshi Shimada
[show abstract]
[hide abstract]
ABSTRACT: We report a case of a gastrointestinal stromal tumor (GIST) with strong and faint KIT protein staining, respectively, at two different sites. A single point mutation (c1727 T>C) was detected in DNA extracted from both sites, and a further deletion mutation (c1678_1680 del GTT) was detected in DNA from the site with strong KIT protein staining. Cloning analysis indicated that the point mutation and the deletion were present on different alleles.
Surgery Today 03/2010; 40(3):262-6. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to assess the usefulness of intraperitoneal lavage cytology (lavage Cy) status before the resection of colorectal cancer as a predictive factor of peritoneal recurrence.
The lavage Cy-positive [lavage Cy (+)] rate, peritoneal recurrence rate, and 5-year survival rate were examined in 298 cases of colorectal cancer in relation to various clinicopathological factors.
The overall lavage Cy (+) rate was 6.0%. The lavage Cy (+) rate within the group with peritoneal and hepatic metastases was significantly higher than that in the group without metastases (46.7% vs. 3.9% and 26.9% vs. 4.0%, respectively). The lavage Cy (+) rate was not significantly associated with any of the clinicopathological factors examined. The peritoneal recurrence rate was higher in the lavage Cy (+) group than in the lavage Cy-negative [lavage Cy (-)] group, although the difference was not statistically significant. There was no significant difference in survival, regardless of the lavage Cy status, among the 263 patients who underwent curative resection.
The lavage Cy status before resection was not a useful predictive factor of peritoneal recurrence in cases of colorectal cancer.
International Journal of Colorectal Disease 09/2009; 24(8):907-14. · 2.38 Impact Factor
-
Yasushi Ichikawa,
Ayumu Goto,
Satoru Hirokawa,
Miyuki Kijima,
Takashi Ishikawa,
Takashi Chishima,
Hirokazu Suwa,
Harumi Yamamoto,
Shigeru Yamagishi,
Shunichi Osada, Mitsuyoshi Ota,
Shoichi Fujii
[show abstract]
[hide abstract]
ABSTRACT: Allergic reactions to oxaliplatin can be severe and are an important cause of discontinuation of treatment. A retrospective review was performed for 105 patients who received FOLFOX regimens between May 2005 and June 2007. Twenty-five cases (23.8%) of allergic reactions were identified, including 9 late onset reactions (8.6%) and 16 immediate reactions (15.2%). Severe allergy (Grades 3 and 4) occurred in seven patients (6.7%). Re-introduction of FOLFOX was attempted for seven immediate onset patients with a severity grade of 1 or 2, and three of these patients (42.9%) showed relapse of allergy. In approximately 10% of the patients, FOLFOX had to be discontinued due to allergy before the disease became refractory to the regimen. Our experience indicates that allergy to oxaliplatin may be a significant concern and that methods are required for suppression of this allergy.
Japanese Journal of Clinical Oncology 07/2009; 39(9):616-20. · 1.78 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Many studies have focused on laparoscopic techniques for the treatment of colon cancer, but such work is more limited for the treatment of rectal cancer, largely because of concerns for safety issues. This report presents an effective method of anal lavage and excision in laparoscopic low anterior resection.
The authors developed clamp forceps for intestinal lavage and a Y-shaped vinyl hood that can be operated under pneumoperitoneum for airproof surgery. These devices enabled secure clamping and cleansing of the area and use of automatic suture instruments for open laparotomy through a minilaparotomy wound. The authors called this technique the Y-Hood method and compared its short-term results from May 2005 to October 2008 (n = 28) with those for double-stapling technique surgical cases between September 2000 and October 2008 in which automatic suture instruments were used more than once (n = 107). A multivariate analysis of risk factors for anastomotic leakage also was performed.
No difference in background factors such as patient sex, age, and tumor node metastasis (TNM) staging were detected. Anastomotic leakage was found in 12 cases that used multiple stapling for rectal transection (11.2%) and 2 cases that used the Y-Hood (7.1%). The cost for rectectomy was 92,505 yen for multiple stapling and 53,107 yen for the Y-Hood (p < 0.0001). As risk factors for anastomotic leakage, multivariate analysis identified the number of times stapling for rectal transection was performed and the height of the anastomotic region.
The Y-Hood method enables operations to be performed within the interior of the pelvis without reducing the number of ports because the instruments can be accessed using minilaparotomy. Because the use of stapling for rectal transection is minimized, this method is effective in avoiding anastomotic leakage and also cost efficient. The Y-Hood method allows for thorough intestinal lavage and safe laparoscopic low anterior resection.
Surgical Endoscopy 06/2009; 24(2):476-84. · 4.01 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Aberrant activation of epidermal growth factor receptors (EGFR/HER1) by ligand stimulation or heterodimerization with human epidermal growth factor 2 (HER2) is considered to play an important role in the development of colorectal carcinoma. Amphiregulin (AR) is a ligand of EGFR that might be related to the development and progression of gastrointestinal tumors. The aim of this study was to determine the AR, EGFR, and HER2 protein expression levels and to evaluate their prognostic relevance to the clinical course of colorectal cancer.
The AR, EGFR, and HER2 protein levels in primary tumors of colorectal cancer (n = 106) were examined using immunohistochemistry. Metastatic sites in liver specimens (n = 16) were also analyzed in the same manner.
Thirteen (81.6%) metastatic lesions of the liver stained positive for AR. Among the primary lesions of colorectal cancer, 58 (54.7%) stained positive for AR, 13 (12.3%) stained positive for EGFR, and 5 (4.7%) stained positive for HER2. When the relationships between each protein expression level and the clinicopathologic factors were examined, only the AR expression level was significantly related to liver metastasis (P = 0.0296). A multivariate analysis of liver metastasis proved that AR expression was an independent prognostic factor of liver metastasis from colorectal cancer (P = 0.0217).
AR expression in primary lesions of colorectal cancer is an important predictive marker of liver metastasis.
Clinical Cancer Research 05/2008; 14(8):2351-6. · 7.74 Impact Factor
-
Kazutaka Narui,
Hideyuki Ike,
Shoichi Fujii,
Kazunori Nojiri,
Kenji Tatsumi,
Shigeru Yamagishi,
Shuji Saito,
Chikara Kunisaki,
Toshio Imada,
Akinori Nozawa,
Shigeo Ohki, Mitsuyoshi Ota,
Yasushi Ichikawa,
Hiroshi Shimada
[show abstract]
[hide abstract]
ABSTRACT: We report a case of radiation-induced rectal cancer, which is thought to originate from dysplasia due to radiation colitis. The patient is a 73 year-old woman, who underwent radical hysterectomy and radiotherapy for uterine cervical cancer 31 years ago. She visited to our hospital complaining of hematochezia. Colonoscopy in January 2004 disclosed redness of the rectal mucosa accompanied with contact bleeding and pathological study of the biopsy specimen revealed severe dysplasia. However, colonoscopy showed an ulcerative lesion of the rectum in December 2004, and pathological findings of the biopsy specimen disclosed moderately differentiated adenocarcinoma. She underwent a rectal resection in January 2005. Pathological study of resected specimen revealed fibrous change induced by radiation. Predominant histological type of the tumor was moderately differentiated carcinoma followed by well differentiated type. However, multiple dysplasias were found around the main tumor or in the mucosa which was treated with radiotherapy.
Nippon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology 06/2006; 103(5):551-7.
-
[show abstract]
[hide abstract]
ABSTRACT: The aim of this study was to evaluate the effect and the toxicity of prophylactic adjuvant hepatic arterial infusion chemotherapy (HAIC) on liver metastases and on overall survival of Dukes C colorectal cancer patients.
Ninety patients in whom Dukes C colorectal cancer was diagnosed and were treated with curative resection between 1993 and 1997 underwent HAIC. The HAIC regimen consisted of a 24-hour continuous infusion of 1500 mg of 5-fluorouracil, administered once a week for 8 weeks, utilizing a portable infusion drug delivery system to ambulatory patients. Patients to whom 7 g or more of 5-fluorouracil could be given were included in the HAIC group, which resulted in 70 of the 90 patients being in this group. The HAIC group overall survival and liver recurrence rates were compared with those of 62 non-treated cases of Dukes C, which formed the non-HAIC control group.
There were no serious toxic effects in this study. Significant differences were seen in the cumulative overall 5-year survival (HAIC group, 84.1%; non-HAIC group, 65.2%; p=0.0369). The cumulative 5-year liver metastasis-free rate was 92.7% in the HAIC group and 78.6% in the non-HAIC group (p=0.0649). In cases of distal lymph node metastasis, a risk factor for liver metastasis, the cumulative 5-year liver metastasis-free rate in the HAIC group (91.7%) was significantly higher than that in the non-HAIC group (58.6%; p=0.0268).
HAIC effectively prevents metachronous liver metastasis, especially in patients with pre-existing distal lymph node metastases, and improves the prognosis of advanced colorectal cancer.
Hepato-gastroenterology 51(55):124-7. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Intravenous chemotherapy with a combination of several drugs is commonly used to treat metastatic colorectal cancer. However, the associated adverse events can be severe. Here we report a rare case of metastatic rectal cancer in an elderly patient who got complete response for metastatic rectal cancer with oral uracil-tegafur plus leucovorin therapy.
77-year-old male. An abdominoperineal resection of the rectum was performed, but para-aortic lymph-node metastasis occurred. Uracil-tegafur plus leucovorin therapy was started on postoperative day 48. Each chemotherapy course comprised 400 mg/day uracil-tegafur and 75 mg/day leucovorin administered for 28 days every 35 days.
After 10 courses, abdominal computed tomography indicated that a good partial response had been achieved. The para-aortic lymph-node swelling disappeared after 17 courses, indicating a complete response. During this period, no adverse events were noted. No recurrence had occurred 4 months after the complete response.
This case demonstrates that uracil-tegafur plus leucovorin therapy can be used safely even in elderly patients, and suggests that it is likely to be effective in treating metastatic colorectal cancer.
Hepato-gastroenterology 57(99-100):472-6. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Recent technical developments have enabled solo surgery in laparoscopic surgery. Our experience of solo surgery using the voice-guided robotic arm in laparoscopic colectomy for colorectal cancer was analyzed.
The colon-lifting method was used in this study. The laparoscope was handled by AESOP3000. The colon was retracted anteriorly by the thread that passed through the mesocolon. This method enables lymphadenectomy by stretching of feeding vessels and obviates the need for an assistant. The short-term outcomes and survival between robotic arm and human scopist in a series of laparoscopic colectomies were compared with a case-matched control study.
The numbers of both group patients were 11 respectively. There was no conversion to open surgery in both groups. The operation time (Robotic vs. Human=269 min. vs. 265) and laparoscopic time (209 vs. 212) were not significant differences. There were also no significant differences in the bleeding, the morbidity rate and the numbers of dissected lymph nodes between the two groups. The five-year overall (81.8% vs. 72.7%) and disease-free (72.7% vs. 62.3%) survivals showed no significant differences.
Laparoscopic solo-surgery in colectomy is safe and feasible, without any deterioration of the curative potential of the procedure.
Hepato-gastroenterology 58(106):406-10. · 0.66 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: To evaluate surgery for local recurrence after rectal cancer resection.
In total, 76 patients with local recurrence after rectal cancer resection were enrolled between 1978 and 1998. Of these, 61 underwent curative resection. Outcomes were assessed according to treatment. Recurrence was classified as visceral or parietal based on preoperative computed tomography or magnetic resonance imaging.
The 5-year survival rates were 17.8%, 25.9%, and 36.9% for patients who underwent total pelvic exenteration, abdomino-perineal resection, and local resection, respectively. Of the 61 patients who underwent curative resection, 18 (29.5%) showed visceral recurrence and 43 (70.5%) showed parietal recurrence. Among patients with visceral recurrence, 9 (50%) underwent total pelvic exenteration, 6 (33.3%) underwent abdomino-perineal resection, and 3 (16.7%) underwent local resection. Among patients with parietal recurrence, 27 (62.8%) underwent total pelvic exenteration, 4 (9.3%) underwent abdomino-perineal resection, and 12 (27.9%) underwent local resection. Mucinous adenocarcinomas were most common among patients with parietal recurrence. Overall 5-year survival rates were 64.9% and 14.0% for patients with visceral and parietal recurrence, respectively.
Curative resection was effective in rectal cancer patients with visceral recurrence. Novel systemic chemical radiotherapy should be considered for patients with parietal recurrence.
Hepato-gastroenterology 56(91-92):667-71. · 0.66 Impact Factor
