The Current Status of Nodal Staging in Rectal Cancer

AbstractPurpose of ReviewTo review current practice in MRI-based nodal staging in rectal cancer and assess the associated evidence.Recent FindingsNodal staging is less accurate than other MRI-detected prognostic markers such as circumferential resection margin status, extramural venous invasion and T stage. Previous research has focused on matching MRI and pathology findings but crucially N stage has never been shown to have prognostic importance on MRI. Recent pathological evidence suggests that tumour deposits may be more important than nodal status and these can be clearly distinguished from nodal metastases on MRI.SummaryNodal staging on MRI is prognostically inaccurate. MRI staging should move away from TNM to focus on those radiological markers which can be proved to have prognostic accuracy. Tumour deposits should be reported separately to lymph node metastases on both histopathology and imaging. Research is underway confirming their prognostic importance on MRI.
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research

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ConclusionTreatment decisions must be individualized, and depend on the presence of systemic disease. Selected patients may benefit from resection of metastases, and PET scan may be useful to identify patients who will benefit from resection.
Source: International Journal of Surgery Case Reports - Category: Surgery Source Type: research
AbstractPurposePreoperative short-course radiotherapy (PSRT) and preoperative long-course radiotherapy (PLRT) are standard treatment regimens for locally advanced rectal cancer. However, whether the efficacy and safety of PSRT with delayed surgery (more than 4  weeks) are superior to those of PLRT remains unresolved and was explored in this meta-analysis.MethodsStudies published in PubMed, Embase, the Cochrane Library, andClinicalTrials.gov databases were systematically searched. RevMan 5.3 was used to calculate pooled hazard ratios (HR) and relative risk (RR).ResultsSeven studies including 4973 patients were identifi...
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
ConclusionCRT should be considered for cT3N0 patients, but its timing (neoadjuvant vs. adjuvant) seems not to affect the disease-free survival in the present cohort of patients.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
Authors: Son GM, Kye BH, Kim MK, Kim JG Abstract The oncological outcomes of laparoscopic rectal cancer surgery were evaluated in recent multicenter randomized clinical trials (RCTs). The MRC-CLASSIC, COLOR II, and COREAN trials found no differences in local recurrence or diseasefree survival rate between laparoscopic and open surgery. However, the noninferiority of laparoscopic surgery with respect to open surgery for rectal cancer was not established on statistical analysis in the ACOSOG Z6051 and the ALaCaRT trials. Quality of total mesorectal excision (TME) is one of the most important prognostic factors. Incom...
Source: Annals of Coloproctology - Category: Gastroenterology Tags: Ann Coloproctol Source Type: research
No abstract available
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Viewpoints Source Type: research
This study was conducted in a tertiary referral center. PATIENTS: All consecutive patients undergoing redo pelvic surgery after low anterior resection for rectal cancer between January 2005 and March 2018 were included. INTERVENTIONS: Redo surgery was divided into redo anastomosis and intersphincteric completion proctectomy. Transanal minimally invasive surgery procedures since November 2014 were compared with the conventional approach. MAIN OUTCOME MEASURES: Primary end points were procedural characteristics and 90-day major complications. RESULTS: In total, 104 patients underwent redo surgery; 47 received a r...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
BACKGROUND: Reconstruction of the pelvic floor defect caused by extralevator abdominoperineal excision poses a challenge for the surgeon. OBJECTIVE: The aim of this study was to analyze the long-term perineal wound complications in patients undergoing conventional primary closure versus biological mesh–assisted repair after extralevator abdominoperineal excision. DESIGN: This was a single-institution retrospective observational study. SETTINGS: The study was conducted at a tertiary academic medical center. PATIENTS: Patients with low advanced rectal cancer undergoing extralevator abdominoperineal excisi...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
No abstract available
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Video Vignette Source Type: research
This study aimed to compare the performance of two lymph node revealing solutions.MethodsThis randomized clinical trial (NTC02704988) investigated patients with colon or rectal cancer who underwent surgical resection with D2 lymphadenectomy. Specimens submitted for conventional pathological examination were randomly assigned for additional fixation with Carnoy or GEWF solution, and dissection was performed to examine the missed lymph nodes. The number of lymph nodes retrieved, additional identified metastatic lymph nodes, lymph node upstaging, and complementary indication of adjuvant therapy were investigated.ResultsThe nu...
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
ConclusionsOne-fifth of patients with locally advanced rectal cancer are manageable with a rectum-sparing approach after neoadjuvant therapy. With this strategy, about 80% patients will have their rectum preserved and 90% will be without stoma at long term.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
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