Diseases of the Colon & Rectum最新文献

Background: The main surgical resection options in rectal cancer are anterior resection for tumors in the mid- or upper rectum and abdominoperineal excision for tumors in the lower rectum. A previous study showed long-term persistent perineal symptoms and sitting difficulties after abdominoperineal excision.

Objective: To examine the prevalence and extent of sitting and walking difficulties after abdominoperineal excision compared with anterior resection.

Design: An observational, prospective, longitudinal, multicenter, international study.

Settings: Data were collected from participants in the quality of life in rectal cancer study. Participants answered questionnaires about bodily functions, symptoms and quality of life at baseline and 1 and 2 years after diagnosis.

Patients: Patients with newly diagnosed rectal cancer regardless of stage were included. The study included 1024 patients, of whom 64% underwent anterior resection and 36% underwent abdominoperineal excision.

Main outcome measures: The primary objective was to estimate the prevalence and odds ratios of sitting or walking difficulties between the two surgical procedure groups: abdominoperineal excision and anterior resection.

Results: In the group of patients who underwent abdominoperineal excision, 29% had sitting difficulties after 2 years compared with 12% in the group who underwent anterior resection (OR 2.65, 95% CI 1.71-4.09, p < 0.0001). Walking difficulties after 2 years were reported by 35% after abdominoperineal excision compared with 24% after anterior resection (OR 1.50, 95% CI 1.02-2.22, p = 0.04).

Limitations: The observational nature of the study could be regarded as a limitation.

Conclusions: Abdominoperineal excision was associated with both sitting and walking difficulties among patients with rectal cancer at significantly higher rates compared with anterior resection. It is probable that attention from healthcare could improve the situation of the patients by enhanced rehabilitation. See Video Abstract.Registered with ClinicalTrials.gov (NCT01477229).

Background: The extent of neoadjuvant therapy response, prior to surgery, is an important prognosticator in locally advanced rectal cancer. A spectrum of response exists, with a dearth of reliable measurements. The host response to treatment remains unexplored. Within operable colorectal cancer, circulating markers of elevated systemic inflammation associate with poor survival. Studies have suggested that elevated pre-neoadjuvant inflammatory markers, including the modified Glasgow prognostic score and the neutrophil:lymphocyte ratio, associate with poorer response.

Objective: This study aimed to comprehensively evaluate hematological markers of inflammation pre- and post-neoadjuvant therapy.

Design: Longitudinal cohort study.

Settings: Single health board from a prospectively maintained regional cancer database.

Patients: Consecutive locally advanced rectal cancer patients who underwent curative-intent neoadjuvant therapy between; June 2016-July 2021.

Main outcome measures: Elevated markers of the systemic inflammatory response pre- and post-neoadjuvant therapy.

Results: A total of 278 patients (67.3% male, median age 65) were identified. A complete response (clinical or pathological complete response) was achieved in 27.34%, and good tumor regression was achieved in 37.05% (tumor regression grading 0-1). No pre-neoadjuvant marker associated with response or regression. Multivariate analysis of post-neoadjuvant variables revealed an elevated modified Glasgow prognostic score (OR 2.8, 95% CI: 1.22-6.41, p = 0.015), and an elevated carcinoembryonic-antigen (OR 4.09, 95% CI: 1.6-10.44, p = 0.003) independently associated with incomplete response. An elevated post-neoadjuvant modified Glasgow prognostic score (OR 2.14, 95% CI: 1.08-4.23, p = 0.029) also independently associated with poor tumor regression on multivariate analysis.

Limitations: Retrospective design. Slight variation in the timing of post-neoadjuvant blood tests.

Conclusions: We report that post-neoadjuvant modified Glasgow prognostic score associated with poorer response and regression, potentially indicating that radiation resistance is associated with the development of a protumor inflammatory environment. Further work is required to define the local intratumoral processes associated with response and their inter-relationship with systemic parameters. Ultimately, there may be a rationale for testing anti-inflammatory strategies in combination with radiotherapy as an option for optimizing treatment response. See Video Abstract.

Background: Total neoadjuvant therapy has been introduced to enhance oncological outcomes and minimize toxicity in locally advanced rectal cancer, with the superiority between the induction and consolidation of therapy remains unclear.

Objective: Evaluate oncological and postoperative outcomes by comparing induction chemotherapy and consolidation chemotherapy with conventional chemoradiotherapy in patients with locally advanced rectal cancer.

Data sources: Systematic searches of PubMed, Embase, and Cochrane databases were performed for studies published from their inception until June 2023.

Study selection: The inclusion criteria: patients diagnosed with rectal cancer, interventions including induction chemotherapy and consolidation chemotherapy, comparisons were specified as conventional neoadjuvant chemoradiotherapy.

Main outcome measures: Primary outcomes were the rates of pathological or clinical complete response, postoperative results, chemoradiotherapy-related toxicity, and survival outcomes.

Results: Thirty-three studies, encompassing patients from 1991 to 2021, were eligible for analysis. In network meta-analysis, a significantly increased odds ratio for a pathologic complete response was observed in both induction therapy group at 1.65 (95% CrI 1.18-2.30) and the consolidation therapy group at 1.87 (95% CrI 1.40-2.47) compared to conventional chemoradiotherapy. However, no difference was observed in complete response rates, postoperative results, or chemoradiotherapy-related toxicity ≥ 3 between the groups. There were no differences among the groups in local recurrence, distant metastasis, or disease-free survival, while the induction group showing a non-significant improvement in overall survival.

Limitations: There was significant heterogeneity among the studies and the short follow-up period in most studies limits the assessment of long-term survival outcomes.

Conclusions: Both induction and consolidation total neoadjuvant therapy increase the pathologic complete response rate in locally advanced rectal cancer without compromising safety or postoperative outcomes. However, total neoadjuvant therapy was not associated with a significant improvement in survival outcomes. While total neoadjuvant therapy strategies for locally advanced rectal cancer are considered safe, additional long-term studies are needed.REGISTRATION NO: CRD42023445348.