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
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Transanal total mesorectal excision for rectal carcinoma: short-term outcomes and experience after 80 cases.
M. Veltcamp Helbach,Charlotte L. Deijen,Simone Velthuis,Hendrik J. Bonjer,Jurriaan B. Tuynman,Colin Sietses +5 more
TL;DR: Transanal total mesorectal excision is a safe alternative to standard laparoscopic TME in selected low-risk patients with rectal carcinoma when treated by an experienced colorectals team and in the future, randomized trials are necessary to prove its oncological safety.
Journal ArticleDOI
Clinical outcomes and case volume effect of transanal total mesorectal excision for rectal cancer: a systematic review.
Charlotte L. Deijen,Alice Tsai,T. W. A. Koedam,M. Veltcamp Helbach,Colin Sietses,Antonio M. Lacy,H. J. Bonjer,Jurriaan B. Tuynman +7 more
TL;DR: TaTME for mid and low rectal cancer is a promising technique; however, it is associated with considerable morbidity and safety and should include proctoring and quality assurance preferably within a trial setting.
Journal ArticleDOI
Transanal total mesorectal excision for rectal cancer: evaluation of the learning curve
T. W. A. Koedam,M. Veltcamp Helbach,P. M. van de Ven,Ph M Kruyt,N T van Heek,Hendrik J. Bonjer,Jurriaan B. Tuynman,C. Sietses +7 more
TL;DR: The learning curve of TaTME affected major (surgical) postoperative complications for the first 40 patients, and a two-team approach decreased operative time and conversion rate.
Journal ArticleDOI
Personalized management of elderly patients with rectal cancer: Expert recommendations of the European Society of Surgical Oncology, European Society of Coloproctology, International Society of Geriatric Oncology, and American College of Surgeons Commission on Cancer
Isacco Montroni,Giampaolo Ugolini,Nicole M. Saur,Antonino Spinelli,Siri Rostoft,Monica Millan,Albert Wolthuis,Ian R. Daniels,Roel Hompes,Marta Penna,Alois Fürst,Demetris Papamichael,Avni M. Desai,Stefano Cascinu,Jean Pierre Gerard,Arthur Sun Myint,Valery E.P.P. Lemmens,Mariana Berho,Mark Lawler,Nicola de Liguori Carino,Fabio Potenti,Oriana Nanni,Mattia Altini,Geerard L. Beets,Harm J. T. Rutten,David E. Winchester,Steven D. Wexner,Riccardo A. Audisio +27 more
TL;DR: Careful patient selection and improved surgical and perioperative techniques are responsible for a substantial improvement in rectal cancer outcomes, and properly selected patients should be considered for surgical resection.
Journal ArticleDOI
Open Versus Laparoscopic Versus Robotic Versus Transanal Mesorectal Excision for Rectal Cancer: A Systematic Review and Network Meta-analysis.
Constantinos Simillis,Nikhil Lal,Sarah N. Thoukididou,Christos Kontovounisios,Christos Kontovounisios,J. J. Smith,J. J. Smith,Roel Hompes,Michel Adamina,Paris P. Tekkis,Paris P. Tekkis +10 more
TL;DR: The different techniques for rectal cancer resection result in comparable perioperative morbidity and long-term survival, and the laparoscopic and robotic approaches may improve postoperative recovery.
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.
Journal ArticleDOI
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.