Journal ArticleDOI
Is watch and wait a safe and effective way to treat rectal cancer in older patients
Hester E. Haak,Hester E. Haak,Monique Maas,Doenja M. J. Lambregts,Regina G. H. Beets-Tan,Regina G. H. Beets-Tan,Geerard L. Beets,Geerard L. Beets,Jarno Melenhorst,Marit E. van der Sande,Marit E. van der Sande,Henderik L van Westreenen,A.K. (Koen) Talsma,Stephanie O. Breukink,David D. E. Zimmerman,Denise E. Hilling,Johannes H. W. de Wilt,K.C.M.J. Peeters,Eelco J. R. de Graaf,Jurriaan B. Tuynman,D. J. A. Sonneveld,Niels Komen,A.A. Pronk,Martijn Intven,Wilhelmina H. Schreurs,Christiaan Hoff +25 more
TLDR
W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths.Abstract:
Introduction: The aim was assess the oncological and functional outcome of the watch-and-wait (W&W) approach in older patients with a clinical (near)complete response after neoadjuvant treatment for rectal cancer. Material and methods: Patients were included in a W&W-approach (2004–2019) when digital rectal examination, endoscopy and MRI showed a (near)clinical complete response. Patients underwent endoscopy and MRI every 3 months during the first year, and 6-monthly thereafter. Patients aged ≥75 and ≥ 2 years of follow-up (FU) were selected. Oncological outcomes were assessed with Kaplan-Meier curves. Functional outcome was assessed with colostomy-free rate, Vaizey incontinence score, low anterior resection syndrome-score and International Prostate Syndrome Score. Results: 43/304 (14%) of patients in a W&W-approach met the inclusion criteria. Median FU was 37 (24–109) months. 5/43(12%) developed a local regrowth. All were treated surgically, with one patient experiencing a pelvic failure. Distant metastases occurred in 3/43 patients and 4 patients died, 3 of whom not related to rectal cancer. The 3-year local regrowth-free rate was 88%, 3-year non-regrowth disease-free survival 91%, overall survival 97% and 3-year colostomy-free rate 93%. Overall, the bowel- and urinary dysfunction scores at 3, 12 and 24 months indicated good continence, no or minor LARS and moderate urinary problems. Conclusion: W&W for older patients with a clinical (near) complete response appears to be a safe alternative to a total mesorectal excision (TME), with a very high pelvic control rate, and few rectal cancer related deaths. Most patients can avoid major surgery and a definitive colostomy, and have a reasonable anorectal and urinary function.read more
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Multidisciplinary management of elderly patients with rectal cancer : recommendations from the SICG (Italian Society of Geriatric Surgery), SIFIPAC (Italian Society of Surgical Pathophysiology), SICE (Italian Society of Endoscopic Surgery and new technologies), and the WSES (World Society of Emergency Surgery) International Consensus Project
Mauro Podda,Patricia Sylla,Gian Luca Baiocchi,Michel Adamina,Vanni Agnoletti,Ferdinando Agresta,Luca Ansaloni,Alberto Arezzo,Nicola Avenia,Walter L. Biffl,Antonio Biondi,Simona Bui,Fabio Cesare Campanile,Paolo Carcoforo,Claudia Commisso,Antonio Crucitti,Nicola de’Angelis,Gian Luigi de’Angelis,Massimo De Filippo,Belinda De Simone,Salomone Di Saverio,Giorgio Ercolani,Gustavo Pereira Fraga,Francesco Gabrielli,Federica Gaiani,Mario Guerrieri,Angelo Guttadauro,Yoram Kluger,Ari Leppäniemi,Andrea Loffredo,Tiziana Meschi,Ernest E. Moore,Monica Ortenzi,Francesco Pata,Dario Parini,Adolfo Pisanu,Gilberto Poggioli,Andrea Polistena,Alessandro Puzziello,Fabio Rondelli,Massimo Sartelli,Neil J. Smart,Michael Sugrue,Patricia Tejedor,Marco Vacante,Federico Coccolini,Justin Davies,Fausto Catena +47 more
TL;DR: The steering committee of the SICG-SIFIPAC-SICE-WSES consensus for the multidisciplinary management of elderly patients with rectal cancer aims to provide updated evidence-based statements and recommendations on each of the following topics: epidemiology, pre-intervention strategies, diagnosis and staging, neoadjuvant chemoradiation, surgery, watch and wait strategy, adjuvant chemotherapy, synchronous liver metastases, and emergency presentation.
Journal ArticleDOI
Optimising functional outcomes in rectal cancer surgery
TL;DR: The causes of dysfunction after anterior resection (AR) and the accordingly preventive strategies are explored and the indication for low AR in the light of functional outcome is discussed and the last therapeutic strategies to deal with bowel, anorectal, and urogenital disorders are depicted.
Journal ArticleDOI
Low anterior resection syndrome: can it be prevented?
Alfredo Annicchiarico,Jacopo Martellucci,Stefano Solari,Maximilian Scheiterle,Carlo Bergamini,Paolo Prosperi +5 more
TL;DR: In this paper, the authors explored an extensive bibliographic research on preventive strategies for low anterior resection syndrome (LARS) and concluded that the role of defunctioning stoma, local excision, neoadjuvant radiotherapy, and non operative management seems to significantly affect risk of LARS, while type of anastomosis and surgical TME approach do not impact on LARS incidence or gravity in the long term period.
Journal ArticleDOI
Survival of surgical and non-surgical older patients with non-metastatic colorectal cancer: A population-based study in the Netherlands
Ellen van der Vlies,Lisette M. Vernooij,Felice N. van Erning,Geraldine R. Vink,Willem Jan W. Bos,Johanneke E.A. Portielje,Peter G. Noordzij,Maartje Los +7 more
TL;DR: In this paper, the authors examined the characteristics and survival of surgical and non-surgical older patients with non-metastatic colorectal cancer (CRC) in the Netherlands.
Journal ArticleDOI
The survival gap between young and older patients after surgical resection for colorectal cancer remains largely based on early mortality: A EURECCA comparison of four European countries.
Renu R. Bahadoer,Esther Bastiaannet,Koen C.M.J. Peeters,E. Van Eycken,Julie Verbeeck,Marianne Grønlie Guren,Hartwig Kørner,Anna Martling,Robert Johansson,Cornelis J.H. van de Velde,Jan Dekker +10 more
TL;DR: In this paper , the authors investigated whether a survival gap between younger and older patients with colorectal cancer still exists on a national level in four European countries, namely Belgium, the Netherlands, Norway, and Sweden.
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