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Radical Resection of Locally Recurrent Colorectal Cancer Significantly Improves Overall Survival: A Single-Center Cohort Study
Abstract
Background:
Despite multimodal treatment strategies, locoregional recurrence rates are still significant in colorectal carcinoma (CRC).
Methods:
Clinical, pathological, perioperative, and survival data of 203 patients with recurrent CRC enlisted in a prospective database from 1990 to 2011 were analyzed.
Results:
Median disease-free survival in our cohort of 203 patients was 23 months after resection of the primary tumor. In total, 113 of these patients had surgical therapy with resection of the recurrent tumor. The primary tumor was localized in the rectum in 63 (56%) patients and in the colon in 50 (44%) patients. A complete resection of the recurrent tumor (R0) was achieved in 69 (61%) patients. Postoperative complications occurred in 42 (37%) patients. Postoperative mortality was 2.7%. The median overall survival for R0-resected patients without distant metastasis was 91 months. Those patients had better overall survival compared to patients in whom no complete resection of the recurrent tumor was possible (p < 0.001). There was no statistically significant difference (overall survival) between patients that had R0-resection with systemic metastasis and R1 (p = 0.794) or R2 (p = 0.422) resection.
Conclusion:
Surgical resection of a locally recurrent CRC leads to a substantial long-term survival rate for R0-resected patients.
... Colon cancer with aortoiliac invasion is generally unresectable because patients have a high risk of morbidity and mortality, and curative resection is difficult [1]. However, it has been reported that patients who have undergone curative resection have a good prognosis, even if the tumor is locally advanced [2][3][4][5]. Although vascular reconstruction has been performed previously in the process of radical resection, cases of primary tumor resection with vascular reconstruction have not been reported. ...
Introduction
Curative resection generally has a good prognosis if the tumor is a locally advanced colorectal tumor. However, resection of a primary tumor that has invaded the aortoiliac artery is controversial. Herein, we report a case of successful resection of advanced cecal cancer invading the external iliac artery.
Case report
A 29-year-old male patient had advanced cecal cancer invading the right external iliac artery and vein, right ureter, iliopsoas muscle, and sigmoid colon. We collected the patient's pre-/intra-/postoperative, clinical, and histological data. We reviewed the factors that may have contributed to curative resection without complications. We performed a palliative terminal ileum-sigmoid anastomosis for the prevention of intestinal obstruction. The patient received neoadjuvant chemotherapy, and the tumor patently regressed. After arterial reconstruction was performed with a femoral-femoral bypass, we performed radical resection: right hemicolectomy; partial sigmoidectomy; and partial resection of the right ureter, iliopsoas muscle, right testicular, and external iliac vessels. Pathologically, 99% of the tumor cells disappeared after chemotherapy. The patient was discharged on postoperative day 9. No recurrence has been noted 24 months after surgical resection, and the patient is receiving adjuvant chemotherapy.
Conclusions
Thus, we successfully resected advanced cecal cancer without complications. Reconstruction with femoral-femoral arterial bypass and neoadjuvant chemotherapy are useful methods for curative resection without complications.
Background:
Endoscopic submucosal dissection (ESD) for anastomotic lesions is technically challenging. We aimed to characterize the clinicopathologic characteristics, feasibility, and effectiveness of ESD for anastomotic lesions of the lower gastrointestinal tract.
Method:
We retrospectively investigated 55 patients with anastomotic lesions of the lower GI tract who underwent ESD from February 2008 to January 2021. The lesions involving one or both sides of anastomoses were classified into the unilaterally involving anastomosis (UIA) or straddling anastomosis (SA) group, respectively. We collected clinicopathological characteristics, procedure-related parameters and outcomes, and follow-up data and analyzed the impact of anastomotic involvement.
Results:
The mean age was 62.5 years and the median procedure duration was 30 min. The rates of en bloc resection and R0 resection were 90.9% and 85.5%, respectively. Four patients (7.3%) experienced major adverse events (AEs). During a median follow-up of 66 months (range 14-169), seven patients had local recurrence and 6 patients had metastases. The 5-year disease-free survival (DFS) and overall survival (OS) rates were 82.4%, and 90.7%, respectively. The 5-year disease -specific survival (DSS) rate was 93.3%. Compared with the UIA group, the SA group had significantly longer procedure duration, larger specimen, lower rates of en bloc resection and R0 resection, and shorter DFS (all P<0.05). However, rates of AEs did not differ significantly between the two groups.
Conclusions:
The short- and long-term outcomes of ESD for colorectal anastomotic lesions were favorable. Although with technically challenging, ESD could be performed safely and effectively for lesions at the anastomoses.
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