C S D Roxburgh1,2, P Strombom1, P Lynn1, A Cercek3, M Gonen4, J J Smith1, L K F Temple1, G M Nash1, J G Guillem1, P B Paty1, J Shia5, E Vakiani5, R Yaeger3, Z K Stadler3, N H Segal3, D Reidy3, A Varghese3, A J Wu6, C H Crane6, M J Gollub7, L B Saltz3, J Garcia-Aguilar1, M R Weiser1. 1. Department of Surgery, Memorial Sloan Kettering Cancer Center, New York City, New York, USA. 2. Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK. 3. Department of Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA. 4. Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York City, New York, USA. 5. Department of Pathology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA. 6. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA. 7. Department of Radiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA.
Abstract
AIM: Significant recent changes in management of locally advanced rectal cancer (LARC) include preoperative staging, use of extended neoadjuvant therapies and minimally invasive surgery (MIS). This study was aimed at characterizing these changes and associated short-term outcomes. METHOD: We retrospectively analysed treatment and outcome data from patients with T3/4 or N+ LARC ≤ 15 cm from the anal verge who were evaluated at a comprehensive cancer centre in 2009-2015. RESULTS: In total, 798 patients were identified and grouped into five cohorts based on treatment year: 2009-2010, 2011, 2012, 2013 and 2014-2015. Temporal changes included increased reliance on MRI staging, from 57% in 2009-2010 to 98% in 2014-2015 (P < 0.001); increased use of total neoadjuvant therapy, from 17% to 76% (P < 0.001); and increased use of MIS, from 33% to 70% (P < 0.001). Concurrently, median hospital stay decreased (from 7 to 5 days; P < 0.001), as did the rates of Grade III-V complications (from 13% to 7%; P < 0.05), surgical site infections (from 24% to 8%; P < 0.001), anastomotic leak (from 11% to 3%; P < 0.05) and positive circumferential resection margin (from 9% to 4%; P < 0.05). TNM downstaging increased from 62% to 74% (P = 0.002). CONCLUSION: Shifts toward MRI-based staging, total neoadjuvant therapy and MIS occurred between 2009 and 2015. Over the same period, treatment responses improved, and lengths of stay and the incidence of complications decreased. Colorectal Disease
AIM: Significant recent changes in management of locally advanced rectal cancer (LARC) include preoperative staging, use of extended neoadjuvant therapies and minimally invasive surgery (MIS). This study was aimed at characterizing these changes and associated short-term outcomes. METHOD: We retrospectively analysed treatment and outcome data from patients with T3/4 or N+ LARC ≤ 15 cm from the anal verge who were evaluated at a comprehensive cancer centre in 2009-2015. RESULTS: In total, 798 patients were identified and grouped into five cohorts based on treatment year: 2009-2010, 2011, 2012, 2013 and 2014-2015. Temporal changes included increased reliance on MRI staging, from 57% in 2009-2010 to 98% in 2014-2015 (P < 0.001); increased use of total neoadjuvant therapy, from 17% to 76% (P < 0.001); and increased use of MIS, from 33% to 70% (P < 0.001). Concurrently, median hospital stay decreased (from 7 to 5 days; P < 0.001), as did the rates of Grade III-V complications (from 13% to 7%; P < 0.05), surgical site infections (from 24% to 8%; P < 0.001), anastomotic leak (from 11% to 3%; P < 0.05) and positive circumferential resection margin (from 9% to 4%; P < 0.05). TNM downstaging increased from 62% to 74% (P = 0.002). CONCLUSION: Shifts toward MRI-based staging, total neoadjuvant therapy and MIS occurred between 2009 and 2015. Over the same period, treatment responses improved, and lengths of stay and the incidence of complications decreased. Colorectal Disease
Authors: Monique Maas; Regina G H Beets-Tan; Doenja M J Lambregts; Guido Lammering; Patty J Nelemans; Sanne M E Engelen; Ronald M van Dam; Rob L H Jansen; Meindert Sosef; Jeroen W A Leijtens; Karel W E Hulsewé; Jeroen Buijsen; Geerard L Beets Journal: J Clin Oncol Date: 2011-11-07 Impact factor: 44.544
Authors: Hamza Guend; Maria Widmar; Sunil Patel; Garrett M Nash; Philip B Paty; José G Guillem; Larissa K Temple; Julio Garcia-Aguilar; Martin R Weiser Journal: Surg Endosc Date: 2016-11-04 Impact factor: 4.584
Authors: Andrea Cercek; Karyn A Goodman; Carla Hajj; Emily Weisberger; Neil H Segal; Diane L Reidy-Lagunes; Zsofia K Stadler; Abraham J Wu; Martin R Weiser; Philip B Paty; Jose G Guillem; Garrett M Nash; Larissa K Temple; Julio Garcia-Aguilar; Leonard B Saltz Journal: J Natl Compr Canc Netw Date: 2014-04 Impact factor: 11.908
Authors: Joo Hee Kim; Geerard L Beets; Myeong-Jin Kim; Alfons G H Kessels; Regina G H Beets-Tan Journal: Eur J Radiol Date: 2004-10 Impact factor: 3.528
Authors: Dow-Mu Koh; Ian Chau; Diana Tait; Andrew Wotherspoon; David Cunningham; Gina Brown Journal: Int J Radiat Oncol Biol Phys Date: 2007-12-31 Impact factor: 7.038
Authors: Andrew R L Stevenson; Michael J Solomon; John W Lumley; Peter Hewett; Andrew D Clouston; Val J Gebski; Lucy Davies; Kate Wilson; Wendy Hague; John Simes Journal: JAMA Date: 2015-10-06 Impact factor: 56.272
Authors: Walid K Chatila; Jin K Kim; Henry Walch; Michael R Marco; Chin-Tung Chen; Fan Wu; Dana M Omer; Danny N Khalil; Karuna Ganesh; Xuan Qu; Anisha Luthra; Seo-Hyun Choi; Yu-Jui Ho; Ritika Kundra; Katharine I Groves; Oliver S Chow; Andrea Cercek; Martin R Weiser; Maria Widmar; Iris H Wei; Emmanouil P Pappou; Garrett M Nash; Philip B Paty; Qian Shi; Efsevia Vakiani; S Duygu Selcuklu; Mark T A Donoghue; David B Solit; Michael F Berger; Jinru Shia; Raphael Pelossof; Paul B Romesser; Rona Yaeger; J Joshua Smith; Nikolaus Schultz; Francisco Sanchez-Vega; Julio Garcia-Aguilar Journal: Nat Med Date: 2022-08-15 Impact factor: 87.241
Authors: Rosa M Jimenez-Rodriguez; Jessica Flynn; Sujata Patil; Maria Widmar; Felipe Quezada-Diaz; Patricio Lynn; Paul Strombom; Larissa Temple; Joshua J Smith; Iris H Wei; Emmanouil P Pappou; Jose G Guillem; Philip P Paty; Garrett M Nash; Martin R Weiser; Julio Garcia-Aguilar Journal: BJS Open Date: 2021-11-09