Journal ArticleDOI
Open versus laparoscopic surgery for mid-rectal or low-rectal cancer after neoadjuvant chemoradiotherapy (COREAN trial): survival outcomes of an open-label, non-inferiority, randomised controlled trial.
Seung-Yong Jeong,Seung-Yong Jeong,Ji Won Park,Ji Won Park,Byung-Ho Nam,Sohee Kim,Sung Bum Kang,Seok Byung Lim,Hyo Seong Choi,Duck Woo Kim,Hee Jin Chang,Dae Yong Kim,Kyung Hae Jung,Tae You Kim,Gyeong Hoon Kang,Eui Kyu Chie,Sun-Young Kim,Dae Kyung Sohn,Dae-Hyun Kim,Jae Sung Kim,Hye Seung Lee,Jee Hyun Kim,Jae Hwan Oh +22 more
TLDR
The results show that laparoscopic resection for locally advanced rectal cancer after preoperative chemoradiotherapy provides similar outcomes for disease-free survival as open resection, thus justifying its use.Abstract:
Summary Background Compared with open resection, laparoscopic resection of rectal cancers is associated with improved short-term outcomes, but high-level evidence showing similar long-term outcomes is scarce. We aimed to compare survival outcomes of laparoscopic surgery with open surgery for patients with mid-rectal or low-rectal cancer. Methods The Comparison of Open versus laparoscopic surgery for mid or low REctal cancer After Neoadjuvant chemoradiotherapy (COREAN) trial was an open-label, non-inferiority, randomised controlled trial done between April 4, 2006, and Aug 26, 2009, at three centres in Korea. Patients (aged 18–80 years) with cT3N0–2M0 mid-rectal or low-rectal cancer who had received preoperative chemoradiotherapy were randomly assigned (1:1) to receive either open or laparoscopic surgery. Randomisation was stratified by sex and preoperative chemotherapy regimen. Investigators were masked to the randomisation sequence; patients and clinicians were not masked to the treatment assignments. The primary endpoint was 3 year disease-free survival, with a non-inferiority margin of 15%. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00470951. Findings We randomly assigned 340 patients to receive either open surgery (n=170) or laparoscopic surgery (n=170). 3 year disease-free survival was 72·5% (95% CI 65·0–78·6) for the open surgery group and 79·2% (72·3–84·6) for the laparoscopic surgery group, with a difference that was lower than the prespecified non-inferiority margin (–6·7%, 95% CI −15·8 to 2·4; p Interpretation Our results show that laparoscopic resection for locally advanced rectal cancer after preoperative chemoradiotherapy provides similar outcomes for disease-free survival as open resection, thus justifying its use. Funding National Cancer Center, South Korea.read more
Citations
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Impact of Prolonged Neoadjuvant Treatment-surgery Interval on Histopathologic and Operative Outcomes in Patients Undergoing Total Mesorectal Excision for Locally Advanced Rectal Cancer.
Ata C Akbaba,Serkan Zenger,Erman Aytac,Tahir Koray Yozgatli,Fuat Baris Bengur,Eren Esen,Ismail Ahmet Bilgin,Bilgehan Sahin,Banu Atalar,Duygu Sezen,Sibel Erdamar,Yersu Kapran,Volkan Ozben,Bilgi Baca,Emre Balik,Ismail Hamzaoglu,Dursun Bugra,Tayfun Karahasanoglu +17 more
TL;DR: PNSI can be considered in patients undergoing short-course NT due to its potential oncological benefits and the mode of surgery performed at tertiary centers has no impact on postoperative morbidity after both NT modalities.
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Comparative Analysis of Surgical and Pathological Outcomes between Laparoscopic and Open Rectal Cancer Surgeries: Single Institution Experience
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Robot-Assisted Colorectal Surgery
TL;DR: In this paper , the authors proposed a robot-assisted colorectal surgery for minimally invasive minimally-invasive surgery, which is not different from laparoscopic surgery, and abundant research demonstrates comparable results from both modalities for postoperative complications, oncological outcomes, and functional outcomes.
Journal ArticleDOI
Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries
Kay Uehara,Atsushi Ogura,Yuji Murata,Masanori Sando,Toshiki Mukai,Toshisada Aiba,T. Yamamura,Masanori Nakamura +7 more
TL;DR: The benefits of transanal lateral lymph node dissection and pelvic exenteration are discussed in this paper , where the benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy.
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Advances in surgery for locally advanced rectal cancer
TL;DR: It is necessary to define appropriate indications and standardize surgical techniques to establish the emerging roles of minimally invasive surgery in LARC and to demonstrate the non-inferiority of laparoscopic surgery for pathologic outcomes such as completeness of total mesorectal excision and negative resection margins.
References
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Preoperative versus Postoperative Chemoradiotherapy for Rectal Cancer
Rolf Sauer,Heinz Becker,Werner Hohenberger,Claus Rödel,Christian Wittekind,Rainer Fietkau,Peter Martus,Jörg Tschmelitsch,Eva Hager,Clemens F. Hess,Torsten Liersch,Heinz Schmidberger,Rudolf Raab +12 more
TL;DR: Preoperative chemoradiotherapy, as compared with postoperative cheMoradi therapy, improved local control and was associated with reduced toxicity but did not improve overall survival.
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A comparison of laparoscopically assisted and open colectomy for colon cancer.
Heidi Nelson,Daniel J. Sargent,H Sam Wieand,James W. Fleshman,Mehran Anvari,Steven J. Stryker,Robert W. Beart,Michael D. Hellinger,Richard Flanagan,Walter R. Peters,David M. Ota +10 more
TL;DR: In this multi-institutional study, the rates of recurrent cancer were similar after laparoscopically assisted colectomy and open-colectomy, suggesting that the laparoscopic approach is an acceptable alternative to open surgery for colon cancer.
Journal ArticleDOI
Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial
Pierre J. Guillou,Philip Quirke,H. Thorpe,J. Walker,David G. Jayne,Adrian Smith,Richard M. Heath,Julia Brown +7 more
TL;DR: Laroscopic-assisted surgery for cancer of the colon is as effective as open surgery in the short term and is likely to produce similar long-term outcomes, however, impaired short- term outcomes after laparosc-assisted anterior resection forcancer of the rectum do not yet justify its routine use.
Journal ArticleDOI
Laparoscopy-assisted colectomy versus open colectomy for treatment of non-metastatic colon cancer: a randomised trial
Antonio M. Lacy,Juan Carlos García-Valdecasas,Salvadora Delgado,Antoni Castells,Pilar Taura,Josep M. Piqué,Josep Visa +6 more
TL;DR: LAC is more effective than OC for treatment of colon cancer in terms of morbidity, hospital stay, tumour recurrence, and cancer-related survival.
Journal ArticleDOI
Randomized trial of laparoscopic-assisted resection of colorectal carcinoma: 3-year results of the UK MRC CLASICC Trial Group.
David G. Jayne,Pierre J. Guillou,H. Thorpe,Philip Quirke,Joanne Copeland,Adrian Smith,Richard M. Heath,Julia Brown +7 more
TL;DR: Long-term outcomes for patients with rectal cancer were similar in those undergoing abdominoperineal resection and AR, and support the continued use of laparoscopic surgery in these patients.