PURPOSE: This study was designed to examine the effect of neoadjuvant chemoradiation on pelvic sepsis after mesorectal excision for rectal cancer. METHODS: A retrospective chart review was conducted for all patients w...PURPOSE: This study was designed to examine the effect of neoadjuvant chemoradiation on pelvic sepsis after mesorectal excision for rectal cancer. METHODS: A retrospective chart review was conducted for all patients who underwent curative mesorectal excision for rectal cancer during an eight-year period. Demographic, preoperative, perioperative data were collected. Pelvic sepsis was defined as clinical or radiographically demonstrable leak or a pelvic abscess. Neoadjuvant chemoradiation included 5,040 Gy in conjunction with three cycles of 5-fluorouracil-based chemotherapy, followed by a one-month waiting period. RESULTS: From January 1994 to December 2002, 246 patients (151 males; mean age 68 (range, 36-97) years) underwent curative resection for rectal cancer. Procedures included 186 anterior resections, 52 abdominoperineal resections, and 8 Hartmann’s. Of 60 patients (24.4 percent) who had neoadjuvant chemoradiation, 9 (15 percent) developed pelvic sepsis (3 leaks, 6 abscesses) compared with 9 of 186 (4.8 percent) after primary surgery (6 leaks, 3 abscesses; P < 0.01). Ninety-three patients had an anastomosis ≤6 cm from the anal verge. Of these, 9 patients (9.7 percent) developed pelvic sepsis (5 leaks, 4 abscesses): 5 of 28 (17.9 percent) after neoadjuvant chemoradiation vs. 4 of 65 (6.2 percent) after primary surgery (P = 0.22). Only 6 of 93 patients (6.5 percent) with an anastomosis ≥7 cm developed pelvic sepsis (5 leaks and 1 abscess), of whom 1 had preoperative radiation. Pelvic abscess developed in 3 of 24 patients after neoadjuvant chemotherapy and abdominoperineal resection. After primary abdominoperineal resection, none of the remaining 28 patients developed pelvic sepsis. A multivariable logistic regression model was constructed to determine predictors of sepsis. Neoadjuvant chemotherapy was the only variable that was predictive (odds ratio, 3.4; 95 percent confidence interval, 1.3-9). CONCLUSIONS: The addition of neoadjuvant chemoradiation to mesorectal excision significantly increased the rate of pelvic sepsis. This was particularly true for anastomoses in the lower third of the rectum. Fecal diversion should be considered in these patients.展开更多
Following curative resection for rectal cancer, approximately 5 percent of locoregional recurrences occur intraluminally, presumably because of tumor exfoliation during the initial operation. The rate of resectability...Following curative resection for rectal cancer, approximately 5 percent of locoregional recurrences occur intraluminally, presumably because of tumor exfoliation during the initial operation. The rate of resectability, subsequent locoregional control, and survival in patients with isolated intraluminal recurrence have not been well studied. From 1994 to 2003, nine patients (seven males; median age, 68 years) with isolated intraluminal rectal cancer recurrence were treated for cure at our center. Initial procedures performed were four high anterior resections and five low anterior resections for tumors having a median distance from the anal verge of 12.5 (range, 7.5- 16) cm. Median resected distal margin was 2.5 (range, 1.2- 4.0) cm. Original tumor staging was T2 N0 M0 in three, T3 N0 M0 in three, T3 N1 M0 in one, and T3 N2 M0 in two. Median time between primary resection and intraluminal recurrence was 21 (range, 8- 53) months. Intraluminal recurrence distal to the anastomosis occurred in three of nine patients and anastomotic recurrence occurred in six of nine patients. Pathologically clear margins were obtained in all patients at the time of curative re- resection. Following re- resection, patients were followed for a mean of 30 (range, 6- 59) months. No patient has developed locoregional recurrence to date or to the time of patient death. Six of nine patients are alive and disease- free with a median follow- up of 34.5 (range, 6- 59) months. One patient died disease- free at 35 months. One patient died from pulmonary metastases 30 months postoperatively and another patient developed liver metastasis 11 months postoperatively. Endoscopic surveillance following sphincter- sparing rectal cancer resection is warranted as re- resection for intraluminal recurrence can result in locoregional control and significant disease- free survival.展开更多
文摘PURPOSE: This study was designed to examine the effect of neoadjuvant chemoradiation on pelvic sepsis after mesorectal excision for rectal cancer. METHODS: A retrospective chart review was conducted for all patients who underwent curative mesorectal excision for rectal cancer during an eight-year period. Demographic, preoperative, perioperative data were collected. Pelvic sepsis was defined as clinical or radiographically demonstrable leak or a pelvic abscess. Neoadjuvant chemoradiation included 5,040 Gy in conjunction with three cycles of 5-fluorouracil-based chemotherapy, followed by a one-month waiting period. RESULTS: From January 1994 to December 2002, 246 patients (151 males; mean age 68 (range, 36-97) years) underwent curative resection for rectal cancer. Procedures included 186 anterior resections, 52 abdominoperineal resections, and 8 Hartmann’s. Of 60 patients (24.4 percent) who had neoadjuvant chemoradiation, 9 (15 percent) developed pelvic sepsis (3 leaks, 6 abscesses) compared with 9 of 186 (4.8 percent) after primary surgery (6 leaks, 3 abscesses; P < 0.01). Ninety-three patients had an anastomosis ≤6 cm from the anal verge. Of these, 9 patients (9.7 percent) developed pelvic sepsis (5 leaks, 4 abscesses): 5 of 28 (17.9 percent) after neoadjuvant chemoradiation vs. 4 of 65 (6.2 percent) after primary surgery (P = 0.22). Only 6 of 93 patients (6.5 percent) with an anastomosis ≥7 cm developed pelvic sepsis (5 leaks and 1 abscess), of whom 1 had preoperative radiation. Pelvic abscess developed in 3 of 24 patients after neoadjuvant chemotherapy and abdominoperineal resection. After primary abdominoperineal resection, none of the remaining 28 patients developed pelvic sepsis. A multivariable logistic regression model was constructed to determine predictors of sepsis. Neoadjuvant chemotherapy was the only variable that was predictive (odds ratio, 3.4; 95 percent confidence interval, 1.3-9). CONCLUSIONS: The addition of neoadjuvant chemoradiation to mesorectal excision significantly increased the rate of pelvic sepsis. This was particularly true for anastomoses in the lower third of the rectum. Fecal diversion should be considered in these patients.
文摘Following curative resection for rectal cancer, approximately 5 percent of locoregional recurrences occur intraluminally, presumably because of tumor exfoliation during the initial operation. The rate of resectability, subsequent locoregional control, and survival in patients with isolated intraluminal recurrence have not been well studied. From 1994 to 2003, nine patients (seven males; median age, 68 years) with isolated intraluminal rectal cancer recurrence were treated for cure at our center. Initial procedures performed were four high anterior resections and five low anterior resections for tumors having a median distance from the anal verge of 12.5 (range, 7.5- 16) cm. Median resected distal margin was 2.5 (range, 1.2- 4.0) cm. Original tumor staging was T2 N0 M0 in three, T3 N0 M0 in three, T3 N1 M0 in one, and T3 N2 M0 in two. Median time between primary resection and intraluminal recurrence was 21 (range, 8- 53) months. Intraluminal recurrence distal to the anastomosis occurred in three of nine patients and anastomotic recurrence occurred in six of nine patients. Pathologically clear margins were obtained in all patients at the time of curative re- resection. Following re- resection, patients were followed for a mean of 30 (range, 6- 59) months. No patient has developed locoregional recurrence to date or to the time of patient death. Six of nine patients are alive and disease- free with a median follow- up of 34.5 (range, 6- 59) months. One patient died disease- free at 35 months. One patient died from pulmonary metastases 30 months postoperatively and another patient developed liver metastasis 11 months postoperatively. Endoscopic surveillance following sphincter- sparing rectal cancer resection is warranted as re- resection for intraluminal recurrence can result in locoregional control and significant disease- free survival.
