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- Påhlman, Lars, et al.
(author)
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Altering the therapeutic paradigm towards a distal bowel margin of < 1 cm in patients with low-lying rectal cancer : a systematic review and commentary
- 2013
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In: Colorectal Disease. - : Wiley. - 1462-8910 .- 1463-1318. ; 15:4, s. E166-E174
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Research review (peer-reviewed)abstract
- Aim The 1-cm rule of distal bowel clearance in patients with low-lying rectal cancer undergoing anterior resection is based mainly on pathological data showing distal intramural spread. Because clinical data are contradictory, a review that includes only cancers located 5 or 6cm from the anal verge was carried out. Method A systematic review of the literature identified seven studies that presented results in relation to a margin of 1cm (n=293) vs >1cm (n=315). In six studies, pre- or postoperative radiotherapy was implemented, and in one study patients were treated with surgery alone. Three studies, all implementing radiotherapy, reported results related to a margin of 5mm (n=51) vs >5mm (n=125). Results In none of the studies were the differences in local recurrence rate between the small and large margin groups statistically significant. The pooled analysis of six studies, in which patients received perioperative radiotherapy, showed a 1.2% [95% confidence interval (Cl) 4.57.0%] higher local recurrence rate in the 1cm margin group compared with the >1cm margin group (P=0.6). The corresponding figures for the 5mm cut-off point were 0.5% (95% CI 7.68.7%, P=0.9). The 5-year local recurrence rate in the only study in which radiotherapy had not been used was 8.6% higher in the 1cm margin group compared with the >1cm margin group (P=0.09). Conclusion Clinical evidence does not support the 1-cm rule in patients with low-lying rectal cancer undergoing pre- or postoperative radiotherapy.
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| 2. |
- Siegel, R., et al.
(author)
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Laparoscopic extraperitoneal rectal cancer surgery : the clinical practice guidelines of the European Association for Endoscopic Surgery (EAES)
- 2011
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In: Surgical Endoscopy. - : Springer Science and Business Media LLC. - 0930-2794 .- 1432-2218. ; 25:8, s. 2423-2440
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Journal article (peer-reviewed)abstract
- BACKGROUND: The laparoscopic approach is increasingly applied in colorectal surgery. Although laparoscopic surgery in colon cancer has been proved to be safe and feasible with equivalent long-term oncological outcome compared to open surgery, safety and long-term oncological outcome of laparoscopic surgery for rectal cancer remain controversial. Laparoscopic rectal cancer surgery might be efficacious, but indications and limitations are not clearly defined. Therefore, the European Association for Endoscopic Surgery (EAES) has developed this clinical practice guideline. METHODS: An international expert panel was invited to appraise the current literature and to develop evidence-based recommendations. The expert panel constituted for a consensus development conference in May 2010. Thereafter, the recommendations were presented at the annual congress of the EAES in Geneva in June 2010 in a plenary session. A second consensus process (Delphi process) of the recommendations with the explanatory text was necessary due to the changes after the consensus conference. RESULTS: Laparoscopic surgery for extraperitoneal (mid- and low-) rectal cancer is feasible and widely accepted. The laparoscopic approach must offer the same quality of surgical specimen as in open surgery. Short-term outcomes such as bowel function, surgical-site infections, pain and hospital stay are slightly improved with the laparoscopic approach. Laparoscopic resection of rectal cancer is not inferior to the open in terms of disease-free survival, overall survival or local recurrence. Laparoscopic pelvic dissection may impair genitourinary and sexual function after rectal resection, like in open surgery. CONCLUSIONS: Laparoscopic surgery for mid- and low-rectal cancer can be recommended under optimal conditions. Still, most level 1 evidence is for colon cancer surgery rather than rectal cancer. Upcoming results from large randomised trials are awaited to strengthen the evidence for improved short-term results and equal long-term results in comparison with the open approach.
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