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local excision for middle-low rectal cancer after neoadjuvant chemoradiation:A retrospective study from a single tertiary center

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World Journal of Gastrointestinal Oncology 2024年第12期16卷 4614-4624页

作者： Nan Chen Chang-Long Li Lin Wang Yun-Feng Yao Yi-Fan Peng Tian-Cheng Zhan Jun Zhao Ai-Wen Wu Key Laboratory of Carcinogenesis and Translational Research(Ministry of Education/Beijing) Gastrointestinal CenterUnit IIIPeking University Cancer Hospital and InstituteBeijing 100142China

BACKGROUND Rectal cancer has become one of the leading malignancies threatening people’s *** locally advanced rectal cancer(LARC),the comprehensive strategy combining neoadjuvant chemoradiotherapy(NCRT),total mesorectal excision(TME),and adjuvant chemotherapy has emerged as a standard treatment regimen,leading to favorable local control and long-term ***,in recent years,an increasing attention has been paid on the exploration of organ preservation strategies,aiming to enhance quality of life while maintaining optimal oncological treatment *** excision(LE),compared with low anterior resection(LAR)or abdominal-perineal resection(APR)was introduced dating back to 1970’*** has historically been linked to a heightened risk of recurrence compared to TME,potentially due to occult lymph node metastasis and intraluminal *** evidence has demonstrated that LE might be an alternative approach,instead of LAR or APR,in cases with favorable tumor regression after NCRT with potentially better quality of ***,a retrospective analysis of clinicopathological data from mid-low LARC patients who underwent LE after NCRT was conducted,aiming to evaluate the treatment's efficacy,safety,and oncologic *** To explore the safety,efficacy,and long-term prognosis of LE in patients with mid-low rectal cancer who had a good response to *** Patients with LE between 2012 to 2021 were retrospectively collected from the rectal cancer database from Gastro-intestinal Ward III in Peking University Cancer *** clinicopathological features,postoperative complications,and long-term prognosis of these patients were *** Kaplan-Meier method was used to create cancer-specific survival curve,and the log-rank test was used to compare the differences regarding *** A total of 33 patients were included in this *** median interval between NCRT and surgery was 25.4(range:8.7-164.4)*** median operation t

关键词： Rectal cancer Neoadjuvant chemoradiotherapy local excision Prognosis

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Prognostic factors for 5-year survival after local excision of rectal cancer

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World Journal of Gastroenterology 2009年第10期15卷 1242-1245页

作者： Dong-Bing Zhao Yong-Kai Wu Yong-Fu Shao Cheng-Feng Wang Jian-Qiang Cai Cancer Institute (Hospital) Chinese Academy of Medical Sciences and Peking UnionMedical College Beijing 100021 China

AIM:To evaluate the prognostic factors for 5-year survival after local excision of rectal cancer,and to examine the therapeutic efficacy and surgical indications for this procedure. METHODS:Clinical data,obtained from 106 local rectal cancer excisions performed between January 1980 and December 2005,were retrospectively *** analysis was performed using the Kaplan-Meier method,statistical comparisons were performed using the log-rank test,and multivariate analysis was performed using the Cox proportional hazards model. RESULTS:Transanal,transsacral,and transvaginal excisions were performed in 92,12,and 2 cases, *** rate of complication,local recurrence, and 5-year survival was 6.6%,17.0%,and 86.7%, *** analysis showed that T stage, vascular invasion,and local recurrence were related to the prognosis of the cases(Plocal recurrence(P=0.022,95%CI=1.194-10.160)were the major prognostic factors for 5-year survival of cases after local excision of rectal cancer. CONCLUSION:local rectal cancer excision is associated with few complications,and suitable for stages Tis and T1 rectal *** of local recurrence,active postoperative follow-up,and administration of salvage therapy are the effective methods to increase the efficacy of local excision of rectal cancer.

关键词： Rectal cancer Surgery local excision Recurrence Prognosis

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local excision of ciliary body tumors： a long-term prospective cohort study in China

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Chinese Medical Journal 2008年第21期121卷 2152-2156页

作者： WEI Wen-bin YANG Wen-li HU Shi-min LI Bin Ophthalmology and Visual Science Key Laboratory Beijing Tongren Eye Center Beijing Tongren HospitaL Capital Medical University Beijing 100730 China

Background Ciliary body tumors are usually difficult to diagnose and treat in early stages. However, treatment of such tumors has trended toward ocular conservation instead of enucleation. local excision of ciliary body tumors has become effective with the development of the modern vitrectomy, but long-term outcomes are still not clear. Therefore, we reported the outcome of locally excised ciliary body tumors after long-term follow-up. Methods Twenty-two patients （22 eyes）, who had been diagnosed with ciliary body tumors in Beijing Tongren Hospital from January 1996 to June 2001, were enrolled in this prospective cohort study. localized lamellar sclera-ciliary excisions were performed. In some cases, vitrectomies, scleral graft transplantations, and further excisions of the anterior choroid were performed. Diagnoses were confirmed by histopathologic examination. Patients were followed from five to eleven years after surgery. Their visual acuity, intraocular pressure and local recurrence were recorded with descriptive percentages. Results After surgery, all patients maintained normal eyeball appearances. Six patients maintained circular pupils. The final best corrected visual acuities （BCVA） varied from 0.02-1.00, including 18 patients （81.82%） who had BCVA equal to or better than that before surgery. Fifteen patients （68.18%） had BCVA better than 0.3. Only two patients had intraocular pressure （lOP） of less than 10 mmHg and the other patients maintained normal lOP. Nine cases （40.91%） were given confirmed diagnosis of malignant melanoma, four （18.18%） of melanocytoma, six （27.27%） of nonpigmented ciliary epithelial adenoma, two （9.09%） of neurofibroma, and one （4.55%） of neurinoma. Twenty patients （90.91%） had no recurrence during the follow-up period. In one case melanocytoma recurred seven years after surgery and enucleation was performed. One patient, whose operation removed a malignant melanoma with a diameter of 16 mm, died of hepatic metastasis five years

关键词： ciliary body tumor local excision prospective cohort study

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Neoadjuvant therapy followed by local excision and two-stage total mesorectal excision:a new strategy for sphincter preservation in locally advanced ultra-low rectal cancer

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Gastroenterology Report 2014年第1期2卷 37-43页

作者： Ting Wang Jianping Wang Yanhong Deng Xiaojian Wu Lei Wang Department of Colorectal Surgery The Sixth Affiliated Hospital(The Gastrointestinal&Anal Hospital)of Sun Yat-sen UniversityGuangzhouChina Department of Oncology The Sixth Affiliated Hospital of Sun Yat-sen UniversityGuangzhouChina

Background:With the increased usage of neoadjuvant chemoradiotherapy,improved surgical technique and stapling devices,sphincter-preserving resection has become more frequent for patients with rectal ***,as for locally advanced ultra-low rectal cancer,sphincter-preservation is still facing an enormous ***:To introduce an NLT strategy of sphincter-preservation-neoadjuvant therapy(NT)followed by local excision(LE)and two-stage total mesorectal excision(TME)-into the treatment of locally advanced ultra-low rectal cancer(lesions with anal sphincter invasion).Methods:From October 2010 to October 2011,nine patients with locally advanced rectal cancer located less than 3 cm from the anal verge were treated by the NLT *** patients had shown good clinical response to *** LE procedure was carried transanally 6-8 weeks after completion of the *** was performed to dissect mesorectal lymph nodes 4-6 weeks after ***:Of the nine patients,the lesion was assessed as T2 in two,T3 in five,and T4 in two before NT,and lymph node metastasis was detected in five *** median distance from the tumor to the anal verge was 2.5 cm(range:1-3 cm).The median follow-up was 27 months(range:24-34 months).No distant metastasis was *** one patient(11.1%)developed local recurrence at 12 months post-operatively and then underwent abdomino-perineal *** remaining eight patients had preserved long-term continence and the median Wexner score at two years post-operation was 4(range:2-6).Conclusion:The new NLT strategy can achieve sphincter-preservation in some patients with ultra-low rectal cancer,with favorable oncological outcome and preservation of normal anal sphincter function.

关键词： rectal cancer sphincter-preservation neoadjuvant therapy local excision total mesorectal excision

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local excision of early rectal cancer: A multi-centre experience of transanal endoscopic microsurgery from the United Kingdom

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World Journal of Gastrointestinal Surgery 2024年第10期16卷 3114-3122页

作者： Ahmed Farid Matthew Tutton Prem Thambi TS Gill Jim Khan Department of General Surgery Oncology Center Mansoura UniversityCairo 11432Egypt Department of Colorectal Surgery East Suffolk and North Essex NHS TrustColchester CO11AAEssexUnited Kingdom Department of Colorectal Surgery Portsmouth Hospitals University NHS TrustPortsmouth PO63LYHampshireUnited Kingdom Department of Surgery University Hospital of North TeesStockton on Tees TS18-TS21DarlingtonUnited Kingdom Department of General Surgery Portsmouth Hospitals NHS TrustQueen Alexandra HospitalPortsmouth PO63LYHampshireUnited Kingdom

BACKGROUND Total mesorectal excision remains the gold standard for the management of rectal cancer however local excision of early rectal cancer is gaining popularity due to lower morbidity and higher acceptance by the elderly and frail *** To investigate the results of local excision of rectal cancer by transanal endoscopic microsurgery(TEMS)approach carried out at three large cancer centers in the United *** TEMS database was retrospectively reviewed to assess demographics,operative findings and post operative clinical and oncological *** is a retro-spective review of the prospective databases,which included all patients operated with TEMS approach,for early rectal cancer(Node-negative T1-T2),selected T3 in unfit/frail *** Two hundred and twenty-two patients underwent TEMS *** included 144 males(64.9%)and 78 females(35.1%),Median age was 71 *** median distance of the tumours from the anal verge 4.5 *** tumour size was 2.6 *** most frequent operative position of the patient was lithotomy(32.3%),Full-thickness rectal wall excision was done in 204 *** operating time was 90 *** blood loss was *** were two 90-day *** excision of the tumour with free microscopic margins by>1mm were accomplished in 171 patients(76.7%).Salvage total mesorectal excision was performed in 42 patients(19.8%).Median disease-free survival was 65 months(range:3-146 months)(82.8%),and median overall survival was 59 months(0-146 months).CONCLUSION TEMS provides a promising option for early rectal cancers(Large adenomas-cT1/cT2N0),and selected therapy-responding ***-thickness complete excision of the tumour is mandatory to avoid jeopardising the oncological outcomes.

关键词： local excision Transanal endoscopic microsurgery Early rectal cancer Rectum preservation Rectum saving

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Treatment of rectal cancer by transanal endoscopic microsurgery: Experience with 425 patients

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World Journal of Gastroenterology 2014年第28期20卷 9556-9563页

作者： Mario Guerrieri Rosaria Gesuita Roberto Ghiselli Giovanni Lezoche Andrea Budassi Maddalena Baldarelli Department of General Surgery Università Politecnica delle Marche Interdepartmental "Epidemilogia Biostatistica e Informatica Medica (EBI)" CentreUniversità Politecnica delle Marche

AIM: To describe our experience in treating rectal cancer by transanal endoscopic microsurgery (TEM), report morbidity and mortality and oncological outcome.

关键词： Rectal cancer Transanal endoscopic microsurgery Chemoradiotherapy local excision Downstaging

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Multidisciplinary treatment of rectal cancer in 2014: Where are we going?

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World Journal of Gastroenterology 2014年第32期20卷 11249-11261页

作者： Andrea Vignali Paola De Nardi Department of Surgery San Raffaele Scientific Institute Vita Salute University

In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not *** preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.

关键词： Rectal cancer Cancer staging Cancer restaging Neoadjuvant chemoradiation Response Treatment local control local excision Complete pathologic response Rectal cancer surgery

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Anal canal gastrointestinal stromal tumors:Case report and literature review

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World Journal of Gastroenterology 2014年第1期20卷 319-322页

作者： Nuno Carvalho Diogo Albergaria Rui Lebre Joo Giria Vitor Fernandes Helena Vidal Maria José Brito Department of General Surgery Garcia de Orta Hospital2801-951 AlmadaPortugal Department of Gastroenterology Garcia de Orta Hospital2801-951 AlmadaPortugal Department of Radiology Garcia de Orta Hospital2801-951 AlmadaPortugal Department of Pathology Garcia de Orta Hospital2801-951 AlmadaPortugal

Gastrointestinal stromal tumors (GIST) are an uncommon group of tumors of mesenchymal origin. GIST of the anal canal is extremely rare. At present, only 10 cases of c-kit positive anal GIST have been reported in the literature. There is no widely accepted treatment approach for this neoplasia. Literature is sparse on imaging evaluation of anal canal GIST, usually described as a lesion in the intersphincteric space. We describe the case of a 73-year-old man with a mass in the anal canal, and no other symptoms. Endoanal ultrasound and magnetic resonance imaging showed a well circumscribed solid nodule in the intersphincteric space. The patient was treated by local excision. Gross pathological examination showed a 7 cm × 3.5 cm × 3 cm mass, and histological examination showed a proliferation of spindle cells, with prominent nuclear palisading. The mitotic count was of 12 mitoses/50 HPF. The tumor was positive for KIT protein, CD34 and vimentin in the majority of cells, and negative for desmin and S100. A diagnosis of GIST, with high risk aggressive behavior was made. An abdomino-perineal resection was discussed, but refused. The follow-up included clinical evaluation and anal ultrasound. After 5 years the patient is well, with maintained continence and no evidence of local recurrence.

关键词： Gastrointestinal stromal tumors Anal canal Endoanal ultrasound Magnetic resonance imaging C-Kit receptor local excision

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Evaluating the benefit of adjuvant chemotherapy in patients with ypT0-1 rectal cancer treated with preoperative chemoradiotherapy

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World Journal of Gastrointestinal Surgery 2021年第9期13卷 1000-1011页

作者： Ye Won Jeon In Ja Park Jeong Eun Kim Jin-Hong Park Seok-Byung Lim Chan Wook Kim Yong Sik Yoon Jong Lyul Lee Chang Sik Yu Jin Cheon Kim Department of Surgery Asan Medical Center and University of Ulsan College of MedicineSeoul 05505South Korea Department of Colon and Rectal Surgery Asan Medical Center and University of Ulsan College of MedicineSeoul 05505South Korea Department of Oncology Asan Medical Center and University of Ulsan College of MedicineSeoul 05505South Korea Department of Radiation Oncology Asan Medical Center and University of Ulsan College of MedicineSeoul 05505South Korea

BACKGROUND Adjuvant chemotherapy(ACTx)is recommended in rectal cancer patients after preoperative chemoradiotherapy(PCRT),but its efficacy in patients in the early post-surgical stage who have a favorable prognosis is *** To evaluate the long-term survival benefit of ACTx in patients with ypT0–1 rectal cancer after PCRT and surgical *** We identified rectal cancer patients who underwent PCRT followed by surgical resection at the Asan Medical Center from 2005 to *** with ypT0–1 disease and those who received ACTx were *** 5-year overall survival(OS)and 5-year recurrence-free survival(RFS)were analyzed according to the status of the *** Of 520 included patients,413 received ACTx(ACTx group)and 107 did not(no ACTx group).No significant difference was observed in 5-year RFS(ACTx group,87.9%vs no ACTx group,91.4%,P=0.457)and 5-year OS(ACTx group,90.5%vs no ACTx group,86.2%,P=0.304)between the *** stage was associated with RFS and OS in multivariate analysis[hazard ratio(HR):2.57,95%confidence interval(CI):1.07–6.16,P=0.04 and HR:2.27,95%CI:1.09–4.74,P=0.03,respectively].Furthermore,ypN stage was associated with RFS and OS(HR:4.74,95%CI:2.39–9.42,P<0.00 and HR:4.33,95%CI:2.20–8.53,P<0.00,respectively),but only in the radical resection *** Oncological outcomes of patients with ypT0–1 rectal cancer who received ACTx after PCRT showed no improvement,regardless of the radicality of *** trials are needed to evaluate the efficacy of ACTx in these group of patients.

关键词： Rectal neoplasm Adjuvant chemotherapy ypT0-1 Radical resection local excision

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Advances for achieving a pathological complete response for rectal cancer after neoadjuvant therapy

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Chronic Diseases and Translational Medicine 2016年第1期2卷 -页

作者： Jian Cui Hui Fang Lin Zhang Yun-Long Wu Hai-Zeng Zhang Department of Colorectal Surgery National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing 100021 China Department of Radiation 0ncology National Cancer Center/Cancer Hospital Chinese Academy of Medical Sciences Peking Union Medical College Beijing 100021 China

Neoadjuvant therapy has become the standard of care for locally advanced mid-low rectal cancer. Pathological complete response (pCR) can be achieved in 12%e38% of patients. Patients with pCR have the most favorable long-term outcomes. Intensifying neoadjuvant therapy and extending the interval between termination of neoadjuvant treatment and surgery may in-crease the pCR rate. Growing evidence has raised the issue of whether local excision or observation rather than radical surgery is an alternative for patients who achieve a clinical complete response after neoadjuvant therapy. Herein, we highlight many of the advances and resultant controversies that are likely to dominate the research agenda for pCR of rectal cancer in the modern era.

关键词： Rectal cancer Neoadjuvant therapy Pathological complete response local excision Wait and see

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