Vol 8, No 2 (2018)
- Year: 2018
- Published: 12.07.2018
- Articles: 8
- URL: https://onco-surgery.info/jour/issue/view/29
Full Issue
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ORIGINAL REPORTS
Short-term and long-term outcomes of laparoscopic right hemicolectomy with d3 lymph node dissection: experience of one clinic
Abstract
Objective: to assess short-term and long-term outcomes of right hemicolectomy with extensive lymph node dissection using the experience of one clinic.
Materials and methods. This retrospective study analyzed data from a prospectively collected database containing information on all patients with right-sided colon cancer that underwent laparoscopic right hemicolectomy with D3 lymph node dissection between 2013 and 2018. We estimated intraoperative blood loss, surgery duration (taken from anesthetic records), frequency of postoperative complications, length of in-hospital stay, duration of lymphorrhea, time to gastrointestinal recovery, integrity of the mesocolon, number and location of removed lymph nodes.
Results. A total of 50 underwent laparoscopic right hemicolectomy with D3 lymph node dissection. No cases of surgical conversion were registered. Median surgery duration was 185 min; median blood loss was 30 mL. No postoperative mortality was observed in the study cohort. Twelve (24 %) patients had postoperative complications; 2 (4 %) patients underwent repeated surgery. Median number of lymph nodes examined was 26; high-quality specimens (G ) were obtained in 48 (96 %) patients. At a median follow-up of 19.5 months, 2 (4 %) patients had disease progression (developed liver metastases).
Conclusion. Our results confirm safety of laparoscopic approach for right colon resection with D3 lymph node dissection
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Impact of anastomotic leakage on outcomes in patients with rectal cancer
Abstract
Background. The effect of anastomotic leakage (AL) on oncological outcomes after total mesorectumectomy is controversial.
Objective: to investigate the influence of AL and other factors on oncological outcome.
Materials and methods. Data of 67 patients underwent total mesorectumectomy with normal healing were compared with those for 16 patients who experienced AL. Long-term oncological outcomes were analysed.
Results. Median follow-up was 43 months. AL rate was 19.4 % (16 cases out of 83). Following factors had negative influence on lower 4-year disease-free survival rate and reached statistical significance in univariant analysis: tumor invasion (hazard ratio (HR) 8.8; 95 % сonfidence interval (CI) 1.4–13.7; р = 0.01), metastases in regional lymph nodes (HR 3.5; 95 % CI 1.2–12.3; р = 0.03), tumor stage (р = 0.048), level of tumor differentiation (HR 0.1; 95 % CI 0–0.6; р <0.0001), tumor stenosis (HR 8.8; 95 % CI 1.4–13.7; р = 0.002), AL (HR 3.9; 95 % CI 1.6–37.1; р = 0.01). In the logistic regression analysis independent risk factors for the development of recurrence were not revealed.
Conclusion. AL was not proved to be a risk factor of worse oncological outcome. Hence, additional adjuvant treatment or extended follow-up on the basis of the occurrence of AL after low anterior resection of rectal cancer might not be justified.
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Tumor downstaging and therapeutic pathomorphosis in rectal cancer patients receiving combination therapy with various polyradiomodification regimens
Abstract
Objective: to evaluate therapeutic pathomorphosis and Tand N-downstaging in response to various polyradiomodification regimens used in the combination therapy for rectal cancer.
Materials and methods. A total of 241 patients received combination therapy for rectal cancer using 4 different polyradiomodification regimens. We assessed therapeutic pathomorphosis and tumor downstaging in these patients. Eighty-two participants (34 %) underwent polyradiomodification with a 14-day course of capecitabine (Cap) given in a therapeutic dose (2 g/m2body surface) (Cap14 + metronidazole (MZ) and Cap14 + MZ + microwave hyperthermia (MW-HT)), whereas the remaining 159 participants (66 %) underwent polyradiomodification with a 5-day course of Cap in a radiosensitizing dose (1.5 g/m2 body surface) (Cap5 + MZ and Cap5 + MZ + MW-HT).
Results. Grade IV therapeutic pathomorphosis was observed in 19.5 % of patients treated with a 14-day course of Cap (Cap14 + MZ and Cap14 + MZ + MW-HT) and 1.3 % of patients treated with a 5-day course of Cap (Cap5 + MZ and Cap5 + MZ + MW-HT) (p = 0.00001). Patients receiving a 14-day course of Cap demonstrated T-downstaging significantly more often than those receiving a 5-day course (41.5 % compared to 9.4 % respectively, p = 0,00001). Regression of regional lymph node metastases was diagnosed in 51.1 % of patients from the Cap14 group only.
Conclusion. Our findings suggest that grade III–IV therapeutic pathomorphosis and tumor downstaging are more frequently achieved in polyradiomodification regimens with a 14-day course of Cap at a dose of 2 g/m2 (Cap14 + MZ and Cap14 + MZ + MW-HT).
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