Annals of Coloproctology

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Colorectal cancer

Efficacy of preoperative chemoradiotherapy in patients with cT2N0 distal rectal cancer: Min Young Park, Chang Sik Yu, Tae Won Kim, Jong Hoon Kim, Jin-hong Park, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2023;39(3):250-259. Published online April 4, 2022; DOI: https://doi.org/10.3393/ac.2022.00066.0009

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Purpose
This study was designed to determine the feasibility of preoperative chemoradiotherapy (PCRT) in patients with clinical T2N0 distal rectal cancer.
Methods
Patients who underwent surgery for clinical T2N0 distal rectal cancer between January 2008 and December 2016 were included. Patients were divided into PCRT and non-PCRT groups. Non-PCRT patients underwent radical resection or local excision (LE) according to the surgeon’s decision, and PCRT patients underwent surgery according to the response to PCRT. Patients received 50.0 to 50.4 gray of preoperative radiotherapy with concurrent chemotherapy.
Results
Of 127 patients enrolled, 46 underwent PCRT and 81 did not. The mean distance of lesions from the anal verge was lower in the PCRT group (P=0.004). The most frequent operation was transanal excision and ultralow anterior resection in the PCRT and non-PCRT groups, respectively. Of the 46 patients who underwent PCRT, 21 (45.7%) achieved pathologic complete response, including 15 of the 24 (62.5%) who underwent LE. Rectal sparing rate was significantly higher in the PCRT group (11.1% vs. 52.2%, P<0.001). There were no significant differences in 3- and 5-year overall survival and recurrence-free survival regardless of PCRT or surgical procedures.
Conclusion
PCRT in clinical T2N0 distal rectal cancer patients increased the rectal sparing rate via LE and showed acceptable oncologic outcomes. PCRT may be a feasible therapeutic option to avoid abdominoperineal resection in clinical T2N0 distal rectal cancer.

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Lymph node metastasis following chemoradiotherapy in advanced rectal cancer: ypT2-focused analyses of total mesorectal excision specimens
A. N. Singhi, T.-G. Lee, H.-M. Ahn, H.-R. Shin, M. J. Choi, M. H. Jo, H.-K. Oh, D.-W. Kim, S.-B. Kang
Techniques in Coloproctology.2025;[Epub] CrossRef
Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Annals of Coloproctology.2024; 40(1): 13. CrossRef
Comparative analysis of organ preservation attempt and radical surgery in clinical T2N0 mid to low rectal cancer
Hyeung-min Park, Jaram Lee, Soo Young Lee, Chang Hyun Kim, Hyeong Rok Kim
International Journal of Colorectal Disease.2024;[Epub] CrossRef
Organ preservation for early rectal cancer using preoperative chemoradiotherapy
Gyung Mo Son
Annals of Coloproctology.2023; 39(3): 191. CrossRef
Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
Annals of Surgical Treatment and Research.2023; 105(6): 341. CrossRef

Malignant disease, Rectal cancer,Prognosis and adjuvant therapy

Beware of Early Relapse in Rectal Cancer Patients Treated With Preoperative Chemoradiotherapy: Seul Gi Oh, In Ja Park, Ji-hyun Seo, Young Il Kim, Seok-Byung Lim, Chan Wook Kim, Yong Sik Yoon, Jong Lyul Lee, Chang Sik Yu, Jin Cheon Kim; Ann Coloproctol. 2020;36(6):382-389. Published online June 17, 2020; DOI: https://doi.org/10.3393/ac.2020.06.11

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Abstract PDF

Purpose
Recurrence patterns in rectal cancer patients treated with preoperative chemoradiotherapy (PCRT) are needed to evaluate for establishing tailored surveillance protocol.
Methods
This study included 2,215 patients with locally-advanced mid and low rectal cancer treated with radical resection between January 2005 and December 2012. Recurrence was evaluated according to receipt of PCRT; PCRT group (n = 1,258) and no-PCRT group (n = 957). Early recurrence occurred within 1 year of surgery and late recurrence after 3 years. The median follow-up duration was 65.7 ± 29 months.
Results
The overall recurrence rate was similar between the PCRT and no-PCRT group (25.8% vs. 24.9%, P = 0.622). The most common initial recurrence site was the lungs in both groups (50.6% vs. 49.6%, P = 0.864), followed by the liver, which was more common in the no-PCRT group (22.5% vs. 33.6%, P = 0.004). Most of the recurrence occurred within 3 years after surgery in both groups (85.3% vs. 85.8%, P = 0.862). Early recurrence was more common in the PCRT group than in the no-PCRT group (43.1% vs. 32.4%, P = 0.020). Recurrence within the first 6 months after surgery was significantly higher in the PCRT group than in the no-PCRT group (18.8% vs. 7.6%, P = 0.003). Lung (n = 27, 44.3%) and liver (n = 22, 36.1%) were the frequent the first relapsed site within 6 months after surgery in PCRT group.
Conclusion
Early recurrence within the first 1 year after surgery was more common in patients treated with PCRT. This difference would be considered for surveillance protocols and need to be evaluated in further studies.

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Efficacies of radiotherapy in rectal cancer patients treated with total mesorectal excision or other types of surgery: an updated meta-analysis
Wenshu Wang, Runyuan Zhao, Xi Liang, Manjun Liu, Haiyan Bai, Jianli Ge, Binxi Yao, Zheng Zhi, Jianming He
Oncology Reviews.2025;[Epub] CrossRef
Watch and wait strategies for rectal cancer: A systematic review
In Ja Park
Precision and Future Medicine.2022; 6(2): 91. CrossRef
Update on Diagnosis and Treatment of Colorectal Cancer
Chan Wook Kim
The Ewha Medical Journal.2022;[Epub] CrossRef
The watch-and-wait strategy versus radical resection for rectal cancer patients with a good response (≤ycT2) after neoadjuvant chemoradiotherapy
Chungyeop Lee, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Annals of Surgical Treatment and Research.2022; 103(6): 350. CrossRef
Optimal Postoperative Surveillance Strategies for Colorectal Cancer: A Retrospective Observational Study
Min-Young Park, In-Ja Park, Hyo-Seon Ryu, Jay Jung, Min-Sung Kim, Seok-Byung Lim, Chang-Sik Yu, Jin-Cheon Kim
Cancers.2021; 13(14): 3502. CrossRef
Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
Shifting Treatment Strategies to Prevent Early Relapse of Locally Advanced Rectal Cancer After Preoperative Chemoradiotherapy
Eun Jung Park
Annals of Coloproctology.2020; 36(6): 357. CrossRef

Sensitivity of Various Evaluating Modalities for Predicting a Pathologic Complete Response After Preoperative Chemoradiation Therapy for Locally Advanced Rectal Cancer: Sungwoo Jung, Anuj Parajuli, Chang Sik Yu, Seong Ho Park, Jong Seok Lee, Ah Young Kim, Jong Lyul Lee, Chan Wook Kim, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Jin Cheon Kim; Ann Coloproctol. 2019;35(5):275-281. Published online October 31, 2019; DOI: https://doi.org/10.3393/ac.2019.01.07

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Abstract PDF

Purpose
We investigated the sensitivity of various evaluating modalities in predicting a pathologic complete response (pCR) after preoperative chemoradiation therapy (PCRT) for locally advanced rectal cancer (LARC).
Methods
From a population of 2,247 LARC patients who underwent PCRT followed by surgery at Asan Medical Center, Seoul, Korea from January 2007 to June 2016, we retrospectively analyzed 313 patients (14.1%) who showed a pCR after surgery. Transrectal ultrasound (TRUS), high-resolution magnetic resonance imaging (MRI), abdominopelvic computed tomography (AP-CT), and endoscopy were performed within 2 weeks prior to surgery.
Results
Of the 313 patients analyzed, 256 (81.8%) had a pCR after radical surgery and 57 (18.2%) showed total regression after local excision. Preoperative TRUS, MRI, and AP-CT were performed in 283, 305, and 139 patients, respectively. Among these 3 groups, a prediction of a pCR of the primary tumor was made in 41 (14.5%), 51 (16.7%), and 27 patients (19.4%), respectively, before surgery. A prediction of a clinical N0 stage was made in 204 patients (88.3%) using TRUS, 130 (52.2%) using MRI, and 78 (65.5%) using AP-CT. Of the 211 patients who underwent endoscopy, 87 (41.2%) had a mention of clinical CR in their records. A prediction of a pathologic CR was made for 124 patients (39.6%) through at least one diagnostic modality.
Conclusion
The various evaluation methods for predicting a pCR after PCRT show a predictive sensitivity of 0.15–0.41 for primary tumors and 0.52–0.88 for lymph nodes. Endoscopy is a relatively superior modality for predicting the pCR of the primary tumor of LARC patients.

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Comparison between Local Excision and Radical Resection for the Treatment of Rectal Cancer in ypT0-1 Patients: An Analysis of the Clinicopathological Factors and Survival Rates
Soo Young Oh, In Ja Park, Young IL Kim, Jong-Lyul Lee, Chan Wook Kim, Yong Sik Yoon, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Cancers.2021; 13(19): 4823. CrossRef
Predicting Neoadjuvant Chemoradiotherapy Response in Locally Advanced Rectal Cancer Using Tumor-Infiltrating Lymphocytes Density
Yao Xu, Xiaoying Lou, Yanting Liang, Shenyan Zhang, Shangqing Yang, Qicong Chen, Zeyan Xu, Minning Zhao, Zhenhui Li, Ke Zhao, Zaiyi Liu
Journal of Inflammation Research.2021; Volume 14: 5891. CrossRef
A Nine-Gene Signature for Predicting the Response to Preoperative Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer
In Ja Park, Yun Suk Yu, Bilal Mustafa, Jin Young Park, Yong Bae Seo, Gun-Do Kim, Jinpyo Kim, Chang Min Kim, Hyun Deok Noh, Seung-Mo Hong, Yeon Wook Kim, Mi-Ju Kim, Adnan Ahmad Ansari, Luigi Buonaguro, Sung-Min Ahn, Chang-Sik Yu
Cancers.2020; 12(4): 800. CrossRef

Clinical Significance of Tumor Regression Grade in Rectal Cancer with Preoperative Chemoradiotherapy: Young Joo Park, Byung Ryul Oh, Sang Woo Lim, Jung Wook Huh, Jae Kyun Joo, Young Jin Kim, Hyeong Rok Kim; J Korean Soc Coloproctol. 2010;26(4):279-286. Published online August 31, 2010; DOI: https://doi.org/10.3393/jksc.2010.26.4.279

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Abstract PDF

Purpose

Neoadjuvant chemoradiotherapy applied to the locally advanced rectal cancer reduces local recurrence and improves survival. We assessed tumor regression grade (TRG) and its influence on survival in rectal cancer patients treated with chemoradiotherapy followed by surgical resection.

Methods

We studied 108 patients that were seen at our hospital between August 2004 and December 2008. Patients received preoperative chemoradiotherapy consisting of 5-fluorouracil and leucovorin by continous infusion during the first and fifth week, delivered with concurrent pelvic radiation of 50.4 Gy, followed by radical surgery at 6-8 weeks. The TRG was determined by the amount of fibrosis in the tumor embedding area and was divided into 5 grades based on the relative amount of fibrosis. We analyzed all preoperative clinicopathologic factors, postoperative pathologic stages, TRG and prognosis, retrospectively.

Results

Downstaging of rectal cancer through neoadjuvant chemoradiotherapy occurred in 64 (59%) patients. The numbers of total regressions (TRG4), good regressions (TRG3), moderate regressions (TRG2), minor regressions (TRG1), and no regression (TRG0) were 19 (18%), 65 (60%), 17 (16%), 6 (5%), and 1 (1%) respectively. The TRG was inversely correlated with perineural invasion and lymphovascular invasion (P = 0.008, P = 0.032). The local recurrence rate declined as the tumor regression grade increased (P = 0.032). The 19 patients with TRG4 had a better three-year disease free survival than the 89 patients with TRG0-3 (P = 0.034). The 16 patients with pathologic complete remission (pCR) had a better three-year disease free survival than the 92 patients with non-pCR (P = 0.025).

Conclusion

Higher TRG after preoperative chemoradiotherapy for rectal cancer closely correlates with better survival and low local recurrence. The TRG is considered to be a significant prognostic factor.

Citations

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An investigation into tumor regression grade as a parameter for locally advanced rectal cancer and 5-year overall survival rate
Supparerk Laohawiriyakamol, Wongsakorn Chaochankit, Worawit Wanichsuwan, Kanet Kanjanapradit, Teeranan Laohawiriyakamol
Annals of Coloproctology.2023; 39(1): 59. CrossRef
Rezultate preliminare ale markerilor ca predictori ai răspunsului tisular la radiochimioterapie în cancerul rectal
Sânziana Ionescu, Petre Radu, Octavia Luciana Madge, Victor Strâmbu
Oncolog-Hematolog.ro.2022; 1(58): 8. CrossRef
Clinical Implication of Perineural and Lymphovascular Invasion in Rectal Cancer Patients Who Underwent Surgery After Preoperative Chemoradiotherapy
Young Il Kim, Chan Wook Kim, Jong Hoon Kim, Jihun Kim, Jun-Soo Ro, Jong Lyul Lee, Yong Sik Yoon, In Ja Park, Seok-Byung Lim, Chang Sik Yu, Jin Cheon Kim
Diseases of the Colon & Rectum.2022; 65(11): 1325. CrossRef
Downstaging in Advanced Rectal Cancers: A Propensity-Matched Comparison Between Short-Course Radiotherapy Followed by Chemotherapy and Long-Course Chemoradiotherapy
Praveen S. Kammar, Niharika R. Garach, Sivasanker Masillamany, Ashwin de’Souza, Vikas Ostwal, Avanish P. Saklani
Diseases of the Colon & Rectum.2022; 65(10): 1215. CrossRef
Overexpression of MLPH in Rectal Cancer Patients Correlates with a Poorer Response to Preoperative Chemoradiotherapy and Reduced Patient Survival
Wan-Shan Li, Chih-I Chen, Hsin-Pao Chen, Kuang-Wen Liu, Chia-Jen Tsai, Ching-Chieh Yang
Diagnostics.2021; 11(11): 2132. CrossRef
How to measure tumour response in rectal cancer? An explanation of discrepancies and suggestions for improvement
Iris D. Nagtegaal, Rob Glynne-Jones
Cancer Treatment Reviews.2020; 84: 101964. CrossRef
Neoadjuvant chemoradiotherapy might provide survival benefit in patients with stage IIIb/IIIc locally advanced rectal cancer: A retrospective single‐institution study with propensity score‐matched comparative analysis
Xi‐yu Sun, Song‐hua Cai, Lai Xu, Dan Luo, Hui‐zhong Qiu, Bin Wu, Guo‐le Lin, Jun‐yang Lu, Guan‐nan Zhang, Yi Xiao
Asia-Pacific Journal of Clinical Oncology.2020; 16(3): 142. CrossRef
Prognostic value of tumour regression grade in locally advanced rectal cancer: a systematic review and meta‐analysis
J. C. Kong, G. R. Guerra, S. K. Warrier, A. Craig Lynch, M. Michael, S. Y. Ngan, W. Phillips, G. Ramsay, A. G. Heriot
Colorectal Disease.2018; 20(7): 574. CrossRef
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United European Gastroenterology Journal.2018;[Epub] CrossRef
Prognostic significance of tumour regression grade after neoadjuvant chemoradiotherapy for a cohort of patients with locally advanced rectal cancer: an 8‐year retrospective single‐institutional study
L. Xu, S. Cai, T. Xiao, Y. Chen, H. Qiu, B. Wu, G. Lin, X. Sun, J. Lu, W. Zhou, Y. Xiao
Colorectal Disease.2017;[Epub] CrossRef
Magnetic resonance tumor regression grade (MR-TRG) to assess pathological complete response following neoadjuvant radiochemotherapy in locally advanced rectal cancer
Marco Rengo, Simona Picchia, Simona Marzi, Davide Bellini, Damiano Caruso, Mauro Caterino, Maria Ciolina, Domenico De Santis, Daniela Musio, Vincenzo Tombolini, Andrea Laghi
Oncotarget.2017; 8(70): 114746. CrossRef
Oncologic impact of pathologic response on clinical outcome after preoperative chemoradiotherapy in locally advanced rectal cancer
Wook Hyeon Yoon, Hun Jin Kim, Chang Hyun Kim, Jae Kyoon Joo, Young Jin Kim, Hyeong Rok Kim
Annals of Surgical Treatment and Research.2015; 88(1): 15. CrossRef
Low Lymph Node Retrieval After Preoperative Chemoradiation for Rectal Cancer is Associated with Improved Prognosis in Patients with a Good Tumor Response
Hun Jin Kim, Jeong Seon Jo, Soo Young Lee, Chang Hyun Kim, Young Jin Kim, Hyeong Rok Kim
Annals of Surgical Oncology.2015; 22(6): 2075. CrossRef
Clinical Prediction of Pathological Complete Response After Preoperative Chemoradiotherapy for Rectal Cancer
Jung Wook Huh, Hyeong Rok Kim, Young Jin Kim
Diseases of the Colon & Rectum.2013; 56(6): 698. CrossRef
Prognostic Significance of Partial Tumor Regression After Preoperative Chemoradiotherapy for Rectal Cancer
Yen-Chien Lee, Chung-Cheng Hsieh, Jen-Pin Chuang
Diseases of the Colon & Rectum.2013; 56(9): 1093. CrossRef
Prognostic Role of p53 Messenger Ribonucleic Acid Expression in Patients after Curative Resection for Stage I to III Colorectal Cancer: Association with Colon Cancer Stem Cell Markers
Jung Wook Huh, Hyeong Rok Kim, Young Jin Kim
Journal of the American College of Surgeons.2013; 216(6): 1063. CrossRef
A phase II study of neoadjuvant chemoradiotherapy with oxaliplatin and capecitabine for rectal cancer
Lin Zhao, Chunmei Bai, Yajuan Shao, Mei Guan, Ning Jia, Yi Xiao, Huizhong Qiu, Fuquan Zhang, Ti Yang, Guangxi Zhong, Shuchang Chen
Cancer Letters.2011; 310(2): 134. CrossRef
Oncologic outcomes of pathologic stage I lower rectal cancer with or without preoperative chemoradiotherapy: Are they comparable?
Jung Wook Huh, Chang Hyun Kim, Hyeong Rok Kim, Young Jin Kim
Surgery.2011; 150(5): 980. CrossRef

Pathologic Complete Remission after Preoperative Chemoradiation for Rectal Cancer: Analysis of Clinicopathologic Characteristics and Oncologic Outcome.: Kim, Dae Dong , Yu, Chang Sik , Shin, Ui Sup , Yoon, Sang Nam , Kim, Jin Cheon; J Korean Soc Coloproctol. 2008;24(6):473-478.; DOI: https://doi.org/10.3393/jksc.2008.24.6.473

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Abstract PDF

PURPOSE
To assess the clinico-pathologic characteristics associated with pathologic complete remission (pCR) after preoperative chemoradiotherapy (PCRT) for rectal cancer and evaluate predictive factors for pCR and prognostic impact of pCR.
METHODS
We analyzed 325 patients who underwent PCRT and surgical resection between September 1999 and September 2006. We have treated 319 patients with PCRT for locally advanced rectal cancer and 6 patients for sphincter-saving procedure. Chemotherapy consisted of either of bolus 5-FU (325 mg/m2/d) or capecitabine (1,650 mg/m2/d) for the duration of radiation and after surgery. Radiation therapy was delivered and surgery was performed 4~6 weeks following the completion of PCRT. We compared pCR patients with non-pCR patients according to the clinico-pathologic characteristics and followed up with a median of 32 (range, 12~91) months.
RESULTS
The pCR (n=41, 12.6%) and non-pCR (n=284) groups were comparable in age, sex, location of the tumor, chemotherapy regimen, pre-CRT CEA level except pre-CRT clinical stage (12.2% vs. 0.4% in stage I, P= 0.047). There was no significant difference in genetic characteristics between groups. There was no specific predictive factors for pCR except pre-CRT T category (pCR in T2 (5/8, 62.5%) vs. T3 (33/283, 11.7%) or T4 (3/33, 9.1%), P=0.001). The 3-year disease free survival (DFS) was 100% and 83.6% in the pCR and non-pCR group respectively (P=0.012). There were 5 local and 34 systemic recurrences only in non-pCR group.
CONCLUSIONS
Rectal cancer patients with pCR after PCRT have an excellent prognosis and are unlikely to fail locally or systemically because of the effect of stage. However there was no specific predictive factor for pCR except preoperative T category.

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Monitoring of Residual Pesticides in Grape Seed Oil being Sold in Gyeonggi Province
Mi-Hui Son, Jae-Kwan Kim, You-Jin Lee, Ji-Eun Kim, Eun-Jin Baek, Byeong-Tae Kim, Myoung-Ki Park, Bo-yeon Kwon
Journal of Food Hygiene and Safety.2024; 39(2): 128. CrossRef

Pathological Analysis of Tumor Response after Preoperative Chemoradiation Therapy for Advanced Rectal Cancer.: Lee, Seok Young , Choi, Yoon Jung , Kang, Jung Gu , Chung, Eun Ji , Kim, Yong Tai; J Korean Soc Coloproctol. 2007;23(6):511-517.; DOI: https://doi.org/10.3393/jksc.2007.23.6.511

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PURPOSE
We investigated the association of survivin expression with the prognosis in advanced rectal cancer with preoperative chemoradiotherapy for pathological analysis.
METHODS
We examined 16 patients with rectal cancer who were preoperatively staged as T3 or T4. The enrolled patients were given 5-FU, 425 mg/m2/day, and leucovorin, 20 mg/m2/day, intravenously for 3 days during weeks 1 and 5 of pelvic radiotherapy. Surgical resection was performed 4~6 weeks after completion of the schedule. Tumor response was divided into CR (complete remission), PR (partial remission), and NR (non remission). Immunohistochemical staining of paraffin sections using monoclonal antibodies for survivin, bcl-2, and p53 was performed on pretreatment biopsy and surgically resected tissue by using the standard avidin-biotin-peroxidase technique.
RESULTS
No CR was achieved. PR was achieved in 10 patients (62.5%), and NR in 6 patients (37.5%). After preoperative treatment, survivin expression tended to be decreased in tumor cells (62.5% to 31.3%) and slightly increased in adjacent normal mucosa a (12.5% to 25%). After preoperative treatment, survivin expression was correlated with lymph-node metastasis in the statistical analysis. We failed to find any other significant relationship between survivin expression and any parameters, except lymph node metastasis and apoptotic index.
CONCLUSIONS
Survivin expression before preoperative treatment was not related to the prognosis in rectal cancer patients, but survivin expression after preoperative treatment was related to lymph node metastasis of advanced rectal cancer. Further studies, including large numbers of rectal cancer cases with a sufficient follow-up period, are needed in order to establish survivin as a prognostic target in rectal cancer.

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Clinicopathologic significance of survivin expression in colorectal adenocarcinoma
Woong Na, Se Min Jang, Young Jin Jun, Young Soo Song, Ki‐Seok Jang, Kang Hong Lee, Kyeong Geun Lee, Hong Xiu Han, Seung Sam Paik
Basic and Applied Pathology.2009; 2(3): 94. CrossRef

Long-term Result for Rectal Cancer in Cases of a Curative Resection after Preoperative Chemoradiotherapy.: Lee, Dong Hyun , Jung, Sang Hun , Kim, Jae Hwang , Shim, Min Chul; J Korean Soc Coloproctol. 2007;23(6):503-510.; DOI: https://doi.org/10.3393/jksc.2007.23.6.503

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PURPOSE
Preoperative chemoradiation is the recommended standard therapy for locally advanced rectal cancer and is associated with sphincter preservation and improved survival. Our study was performed to determine the surgical outcomes and the prognostic factors for rectal cancer with preoperative chemoradiotherapy (PCRT) followed by a relative curative resection.
METHODS
We retrospectively reviewed the cases of 251 advanced rectal cancer patients who underwent a PCRT, between Jan 1995 and Dec 2002. All patients a received 25 days RTX (total dose: 4,500~5,040 cGy) and intravenous 5-FU (425 mg/m2/ day) plus leucovorin (20 mg/day) for 24 hrs. Surgery was performed about 4~6 weeks after completion of RTX. The median follow up was 79 months (range 1-142).
RESULTS
All patients were comfortable with PCRT. Postoperative mortality was 1.1%. After PCRT, 92.2% of the patients and, especially, 82.2% of the low rectal cancer patients had sphincter preserving surgery. Complete remission of the tumor was stenin 15.1% of the cases, but was not significantly associated with recurrence. The overall recurrence and the local recurrence rates were 15.1% and 4.4%, respectively. Cell differentiation, circumferential margin, and lymphovascular invasion were independent risk factors for local recurrence in the multivariate analysis. Prognostic factors for overall and disease-free survival were cell differentiation, circumferential margin, lymphovascular invasion, and lymph node metastasis in the multivariate analysis. The 5-year disease-free survival rates for stages I, II, and III, and for no-residual tumor were 96.1%, 83.4%, 69.0%, and 89.1%, respectively (P<0.05).
CONCLUSIONS
Advanced rectal cancer treated using preoperative chemoradiation resulted in excellent sphincter preservation. Our long-term follow-up results showed good local control and improved survival for rectal cancer.

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Long-term Outcomes of Laparoscopic Surgery for Colorectal Cancer
Jeong-Eun Lee, Yong-Geul Joh, Sang-hwa Yoo, Geu-Young Jeong, Sung-Han Kim, Choon-Sik Chung, Dong-Gun Lee, Seon Hahn Kim
Journal of the Korean Society of Coloproctology.2011; 27(2): 64. CrossRef

Distant Metastasis Identified Immediately after Preoperative Chemoradiotherapy for Locally Advanced Rectal Cancer.: Park, In Ja , Kim, Hee Cheol , Yu, Chang Sik , Choi, Pyung Hwa , Jung, Sang Hoon , Hong, Dong Hyun , Kim, Dae Dong , Ryu, Min Hee , Chang, Heung Moon , Kim, Jong Hoon , Kim, Jin Cheon; J Korean Soc Coloproctol. 2007;23(5):327-332.; DOI: https://doi.org/10.3393/jksc.2007.23.5.327

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Abstract PDF: PURPOSE
This study was designed to analyze the clinical characteristics of patients with immediate distant metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer and to help select patients for preoperative chemoradiotherapy.
METHODS
Two hundred eight patients, who underwent preoperative chemoradiotherapy for locally advanced rectal cancer, were included. Patients were excluded from the study if they had tumor types other than an adenocarcinoma, prior chemotherapy, radiotherapy, or hereditary nonpolyposis colorectal cancer. The clinicopathological characteristics of patients with distant metastasis immediately after preoperative chemoradioterapy were compared with those of patients without distant metastasis.
RESULTS
Distant metastases immediately after preoperative chemoradiotherapy were identified in 15 patients (7.2%). The liver was the most common site of metastasis (8/15), followed by peritoneal seeding (4), the lung (2), bone (1), and the aortocaval lymph node (1). Age, sex, chemotherapy regimen used, and primary tumor response for patients with distant metastases were similar to those for patients without distant metastasis. In patients with immediate distant metastasis, pre-chemoradiotherapy CEA was significantly higher (11.1 vs. 7.4 ng/ml; P= 0.003).
CONCLUSIONS
Immediate distant metastasis after preoperative chemoradiotherapy is associated with pre-chemoradiotherapy CEA level. A careful work-up is necessary when pre-chemoradiotherapy CEA is higher than the normal range.

Preoperative Chemoradiation Therapy in the Management of Locally Advanced Rectal Cancer.: Kim, Ik Yong , Shin, Dae Geun , Park, Kyung Ran , Sung, Seong Hoon , Chu, Young Keun , Kim, Dae Sung; J Korean Soc Coloproctol. 2005;21(1):19-26.

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Abstract PDF: PURPOSE
Surgery is the standard care in the treatment of rectal cancer. However, after surgery alone, local recurrence and distant metastasis remain high for locally advanced rectal cancer. Preoperative chemoradiation therapy (pre-CRT) has been thought to be effective for increasing resectability and decreasing the rate of local recurrence for locally advanced rectal cancer. This study was designed to assess the efficacy of preoperative concurrent chemoradiation therapy in the management of locally advanced rectal cancer.
METHODS
Between July 1999 and December 2003, 29 patients had locally advanced rectal cancer (uT3/ T4, uN1 by endorectal ultrasonography) or were ineligible to undergo sphincter-preserving surgery. All patients were treated with pre-CRT, followed by surgery in 25 patients. Patients were treated with radiation therapy with a total dose of 45~50.4 Gy to the surgical bed and pelvic lymph- node area for 5.5 weeks. We analyzed the degree of toxicity and the therapeutic resopnse from CRT, the type of surgery, including sphincter-saving procedures, and the mid- term outcome.
RESULTS
Of the 29 patients who received pre-CRT, a radical resection was possible in 25 patients. A low anterior resection and an ultra-low anterior resection- coloanal anastomosis were performed in 13 (52%) and 7 (28%) cases, respectively. Sphincter-preserving surgery was performed in 80% of the patients. The postoperative pathological response rates of CRT were 25% complete remission, 45% partial remission, 30% no response. Postoperative complications and toxicity from CRT were acceptable. The duration of median follow-up was 24 months (9~62 months). Recurrence was seen in 6 cases. Distant recurrence alone was seen in 5 patients (19.2%) and distant and local recurrences were seen in only one patient (4%). The 3-year overall survival rate was 72.4%, and 3-year disease-free survival rate was 59.5%.
CONCLUSION
Our data suggested that preoperative concurrent CRT therapy for locally advanced rectal cancer is safe and tolerable. These data showed a high local control rate and a high 3-year survival rate. Preoperative CRT was an effective modality for sphincter preservation in selected patients who would have required an abdominoperineal resection. Additional studies with larger numbers of patients and long-term follow up are warranted to confirm our results. In addition, more effective chemotherapeutic regimens are needed to decrease distant metastasis.

The Effects and Surgical Morbidity of Preoperative Combined Chemoradiotherapy for Locally Advanced Rectal Cancer.: Chung, Ji Eun , Kim, Kap Tae , Chung, Eul Sam; J Korean Soc Coloproctol. 2001;17(6):324-331.

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Abstract PDF: PURPOSE
The aim of this study is to evaluate the effectiveness and surgical morbidity of preoperative chemoradiotherapy for locally advanced rectal cancer.
METHODS
Between December 1997 and March 2000, 36 patients with locally advanced rectal cancer (clinical stage II or III) were treated with preoperative chemoradiation: bolus i.v. leucovorin, 20 mg/m2, plus 24-h continuous infusion i.v. 5-Fluorouracil, 425 mg/m2, Days 1-5, 29-33 and concurrent radiotherapy 4,500 cGy over 5 weeks. Surgery was performed 4-8 weeks after completion of the chemoradiotherapy.
RESULTS
Grade 3-4 toxicity during chemoradiotherapy was low: hematological toxicities 2.8%, gastro-intestinal toxicities 5.5% and skin toxicities 8.3%. Complete response rate was 16.7% and partial response rate was 47.2%, the rate of downstaging for tumor was 65.5%. The overall rate of resectability was 94.1%. In 13 of 22 (59.1%) patients planned APR, the sphincter was preserved. The overall rate of surgical morbidity was 23.5%, but there was no postoperative mortality. One patient needed a reoperation because a complication may be associated with preoperative chemoradiotherapy.
CONCLUSIONS
Preoperative chemoradiotherapy for locally advanced rectal cancer seems to afford some potential advantages: patients are able to tolerate higher chemotherapy doses with low toxicities; tumor downstaging and resectability rates are high; sphincter preservation is feasible; But perioperative morbidity has generally tolerable complications. And so we recommend the preoperative chemoradiotherapy may be one of the best treatments for locally advanced rectal cancer.

Preoperative Concurrent Chemoradiotherapy in Locally Advanced Rectal Cancer.: Kim, Nam Kyu , Sohn, Seung Kok , Min, Jin Sik , Sung, Jin Sil , Noh, Jae Kyung; J Korean Soc Coloproctol. 2000;16(2):93-98.

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Abstract PDF: PURPOSE
Preoperative concurrent chemoradiation for locally advanced rectal cancer can reduce tumor volume and can eliminate viable tumor cells at surgical margin (lateral or posterior margin). It also achieve a rate of high resectability, and negative margin and also have been known to be a safe treatment modality even though its fatal complication was reported as 4%. The aim of this study is to analyze its efficacy and complications after concurrent chemoradiation treatment for advanced rectal cancer.
METHODS
We recruited a total thirty three patients with locally advanced rectal cancer, which were staged preoperatively as T3 or T4 and multiple enlarged lymph nodes by Transrectal Ultrasonography or pelvic Magnetic Resonance Image between march 1996 and June, 1998. 5 Fluorouracil 450 mg/m2 and leucovorin 30 mg infused intravenously during the first and fifth weeks of radiation therapy (4500~5040 cGy). Surgical resection was performed after four or six weeks after completing radiation therapy. To follow up tumor response, digital rectal examination and transrectal ultrasonography were done every two weeks.
RESULTS
Tumor level was distal (N=16, 48.4%), middle (N=9, 27.2%) and upper (N=8, 24.4%). mean age was fifty two years old. Overall resectability was 91%. Types of operations were abdominoperineal resection (N=10, 30.3%), Low anterior resection (N=8, 24.2), Hartmann (N=8, 24.2%), Posterior exenteration (N=2. 6.1%), Total pelvic exenteration (N=2, 6.1%), colostomy only (N=3, 9.1%). Tumor response was Complete remission (N=3,10%), Partial response (N=17, 57%), Non-response (N=10, 33%), progressive disease (N=3). Pathological status was No residual tumor (N=3, 10%), T2N1 (N=5, 16.6%), T3N0 (N=6, 20%), T4N0 (N=4, 13.3%), T2N1 (N=1, 3.3%), T3N1 (N=11, 36.6%). Downstaging status was as follows: from T3 to T0 (N=2), to T2 (N=3) and From T4 to T0 (N=1), to T2 (N=3), to T3 (N=3). Postoperative morbidity was noted in 2 patients (1 case of anastomotic leakage, 1 case of wound infection).
CONCLUSIONS
Preoperative concurrent chemoradiation therapy for locally advanced rectal cancer can be performed safely and show high tumor response and resectability.

Effects of Preoperative Chemoradiotherapy on the Healing of Colonic Anastomosis with the Lapse of Operation Time in the Rat.: Yun, Sung Su , Kim, Dong Sik , Kim, Chun Jik , Kim, Sang Woon , Kim, Jae Whang , Suh, Bo Yang , shim, Min Chul , Kwun, Kaing Bo , Sung, Un Ki; J Korean Soc Coloproctol. 1999;15(1):21-30.

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Abstract PDF: PURPOSE
Preoperative chemoradiotherapy has become an important adjunct in the management of rectal cancer. But both systemic toxicity of chemotherapy and local effect of radiation interfere wound healing of intestinal anastomosis and ultimately may lead to anastomotic leak and septic complications. The purpose of this study is to determine the optimal time interval between preoperative chemoradiotherapy and anastmotic construction, and it was evaluated by security of anastomotic construction.
METHODS
One hundred and twenty male Sprague Dawley rats weighing approximately 250 g were randomly divided into 4 groups (Control group; n=40, Group 1; n=20, Group 2; n=20, Group 3; n=40). The control group (n=20) underwent anastomotic construction at 1 week after general anesthesia without preoperative chemoradiotherapy. The experimental animals (group 1, 2, 3) received preoperative chemoradiotherapy with 5 daily dose (20 mg/kg) of 5-fluorouracil and single dose of 1500 cGy radiation at the rectosigmoid junction under general anesthesia on the day after last dose of chemotherapy. And group 1~3 subsequently underwent a laparotomy to make anastomotic construction at 1 week (Group 1), 2 weeks (Group 2), and 3 weeks (Group 3; n=20) after completion of chemoradiotherapy. The security of anastomotic construction was determined by bursting pressure, tissue hydroxyproline content, gross and microscopic findings of anastomotic area at the 5th and 10th postoperative day after anastomotic construction. To evaluate systemic toxicity after che-moradiotherapy, serial body weight and alteration of CBC were measured in the control group (n=20) and Group 3 (n=20) without anastomotic construction.
RESULTS
At the 5th postoperative day, Mean bursting pressures of the all treated groups were lower than that of the control group (Control group; 88 23 mmHg, Group 1; 49 22 mmHg, Group 2; 56 17 mmHg, Group 3; 78 23 mmHg). The difference was not significant in the group 3 compared with the control group. Body weight decreased in the all treated animals. The mean body weight was lowest on the day 8 after completion of chemoradiotherapy and then it gradually increased. WBC and platelet counts also decreased in the all treated animals. WBC count was lowest on the day 1 and platelet count was lowest on the day 3 after completion of chemoradiotherapy. Mean hydroxyproline contents at the anastomotic sites in the all treated groups were higher than that of the control group, especially in the group 2 and 3. Similar histologic changes were observed in both group 3 and control group.
CONCLUSION
The results suggest that the optimal time interval for safe intestinal anastomosis after preoperative chemoradiotherapy is 3 weeks or later.

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