Helen J S Jones1, Chris Cunningham2, Gary A Nicholson2, Roel Hompes2. 1. Department of Colorectal Surgery, Oxford University Hospitals, United Kingdom. Electronic address: helen.jones3@ouh.nhs.uk. 2. Department of Colorectal Surgery, Oxford University Hospitals, United Kingdom.
Abstract
OBJECTIVES: To establish outcomes after completion and salvage surgery following local excision in literature published since 2005, to inform decision-making when offering local excision. BACKGROUND: Local excision of early rectal cancer aims to offer cure while maintaining quality of life through organ preservation. However, some patients will require radical surgery, prompted by unexpected poor pathology or local recurrence. Consistent definition and reporting of these scenarios is poor. We propose the term "salvage surgery" for recurrence after local excision and "completion surgery" for poor pathology. METHODS: Electronic databases were searched in February 2016. Studies since 2005 describing outcomes for radical surgery following local excision of rectal cancer were included. Pooled and average values were obtained. RESULTS: A total of 23 studies included 262 completion and 165 salvage operations. Most completion operations were done within 4 weeks; local recurrence rate was 5% and overall disease recurrence rate was 14%. The majority of salvage operations for local recurrence were within 15 months of local excision, often following adjuvant treatment. Re-do local excision was used in 15%; APR was the most common radical procedure. Further local recurrence was uncommon (3%) but overall disease recurrence rate was 13%. Estimated 5-year survival was in the order of 50%. Heterogeneity was high among the studies. CONCLUSIONS: Patients undergoing local excision must be informed of risks and expected outcomes, but better data on completion and salvage surgery are required to achieve this. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42014014758.
OBJECTIVES: To establish outcomes after completion and salvage surgery following local excision in literature published since 2005, to inform decision-making when offering local excision. BACKGROUND: Local excision of early rectal cancer aims to offer cure while maintaining quality of life through organ preservation. However, some patients will require radical surgery, prompted by unexpected poor pathology or local recurrence. Consistent definition and reporting of these scenarios is poor. We propose the term "salvage surgery" for recurrence after local excision and "completion surgery" for poor pathology. METHODS: Electronic databases were searched in February 2016. Studies since 2005 describing outcomes for radical surgery following local excision of rectal cancer were included. Pooled and average values were obtained. RESULTS: A total of 23 studies included 262 completion and 165 salvage operations. Most completion operations were done within 4 weeks; local recurrence rate was 5% and overall disease recurrence rate was 14%. The majority of salvage operations for local recurrence were within 15 months of local excision, often following adjuvant treatment. Re-do local excision was used in 15%; APR was the most common radical procedure. Further local recurrence was uncommon (3%) but overall disease recurrence rate was 13%. Estimated 5-year survival was in the order of 50%. Heterogeneity was high among the studies. CONCLUSIONS:Patients undergoing local excision must be informed of risks and expected outcomes, but better data on completion and salvage surgery are required to achieve this. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42014014758.
Authors: R Zinicola; R Nascimbeni; R Cirocchi; G Gagliardi; N Cracco; M Giuffrida; G Pedrazzi; G A Binda Journal: Tech Coloproctol Date: 2021-06-25 Impact factor: 3.781
Authors: J W A Leijtens; L J H Smits; T W A Koedam; R G Orsini; S M van Aalten; M Verseveld; P G Doornebosch; E J R de Graaf; J B Tuynman Journal: Tech Coloproctol Date: 2022-08-27 Impact factor: 3.699
Authors: William J Lossius; Tore Stornes; Tor A Myklebust; Birger H Endreseth; Arne Wibe Journal: Int J Colorectal Dis Date: 2021-12-16 Impact factor: 2.571
Authors: S E van Oostendorp; L J H Smits; Y Vroom; R Detering; M W Heymans; L M G Moons; P J Tanis; E J R de Graaf; C Cunningham; Q Denost; M Kusters; J B Tuynman Journal: Br J Surg Date: 2020-09-16 Impact factor: 6.939
Authors: Caroline D M Witjes; Abhilashaben S Patel; Aniruddh Shenoy; Stephen Boyce; James E East; Christopher Cunningham Journal: Surg Endosc Date: 2021-02-05 Impact factor: 4.584
Authors: Helen J S Jones; Chris Cunningham; Hanne A Askautrud; Håvard E Danielsen; David J Kerr; Enric Domingo; Tim Maughan; Simon J Leedham; Viktor H Koelzer Journal: Histopathology Date: 2021-09-03 Impact factor: 7.778