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Cited 4 time in webofscience Cited 5 time in scopus
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Risk factors for local recurrence and long term survival after minimally invasive intersphincteric resection for very low rectal cancer: Multivariate analysis in 161 patients

Authors
Piozzi, G.N.Park, H.Lee, T.H.Kim, Ji SeanChoi, H.B.Baek, S.J.Kwak, J.M.Kim, J.Kim, S.H.
Issue Date
Aug-2021
Publisher
W.B. Saunders Ltd
Keywords
Anal sparing surgery; Intersphincteric resection; Minimally invasive surgery; Pelvic local recurrence; Rectal cancer; Robotic surgery
Citation
European Journal of Surgical Oncology, v.47, no.8, pp.2069 - 2077
Indexed
SCIE
SCOPUS
Journal Title
European Journal of Surgical Oncology
Volume
47
Number
8
Start Page
2069
End Page
2077
URI
https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52927
DOI
10.1016/j.ejso.2021.03.246
ISSN
0748-7983
Abstract
Introduction: Intersphincteric resection (ISR) is the ultimate anal-sparing technique as an alternative to abdominoperineal resection in selected patients. Oncological safety is still debated. This study analyses long-term oncological results and evaluates risk factors for local recurrence (LR) and overall survival (OS) after minimally-invasive ISR. Materials and methods: Retrospective single-center data were collected from a prospectively maintained colorectal database. A total of 161 patients underwent ISR between 2008 and 2018. OS and local recurrence-free survival (LRFS) were assessed using Kaplan-Meier analysis (log-rank test). Risk factors for OS and LRFS were assessed with Cox-regression analysis. Results: Median follow-up was 55 months. LR occurred in 18 patients. OS and LRFS rates at 1, 3, and 5 years were 96%, 91%, and 80% and 96%, 89%, and 87%, respectively. Tumor size (p = 0.035) and clinical T-stage (p = 0.029) were risk factors for LRFS on univariate analysis. On multivariate analysis, tumor size (HR 2.546 (95% CI: 0.976–6.637); p = 0.056) and clinical T-stage (HR 3.296 (95% CI: 0.941–11.549); p = 0.062) were not significant. Preoperative CEA (p < 0.001), pathological T-stage (p = 0.033), pathological N-stage (p = 0.016) and adjuvant treatment (p = 0.008) were prognostic factors for OS on univariate analysis. Preoperative CEA (HR 4.453 (95% CI: 2.015–9.838); p < 0.001) was a prognostic factor on multivariate analysis. Conclusions: This study confirms the oncological safety of minimally-invasive ISR for locally advanced low-lying rectal tumors when performed in experienced centers. Despite not a risk factor for LR, tumor size and, locally advanced T-stage with anterior involvement should be carefully evaluated for optimal surgical strategy. Preoperative CEA is a prognostic factor for OS. © 2021 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology
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Baek, Se Jin
안암병원 (Department of Colon and Rectal Surgery, Anam Hospital)
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