Technical feasibility of laparoscopic total mesorectal excision for patients with low rectal cancer after concurrent radiation and chemotherapy with bevacizumab plus FOLFOX
Journal
Surgical Endoscopy
Journal Volume
25
Journal Issue
1
Pages
305-308
Date Issued
2011
Author(s)
Abstract
Background: This study aimed to evaluate the technical feasibility of laparoscopic total mesorectal excision (TME) for the treatment of low rectal cancer after concurrent chemoradiation therapy (CCRT) with bevacizumab and FOLFOX. Methods: Patients with clinical T3, T4, or N1-2 rectal cancer were subjected to a preoperative CCRT protocol with FOLFOX and bevacizumab (5 mg/kg) biweekly for 6 cycles followed by a standardized laparoscopic TME procedure, as detailed in the attached video. Results: The treatment protocol was completed by 28 patients. Scrutiny of the video indicated that the dissection plane was a little blurred due to preoperative CCRT, but this did not significantly increase the technical difficulties. Laparoscopic TME was efficiently performed with acceptable operation time (214.4 ± 44.4 min). However, the median blood loss (420 ml; range, 120-1,200 ml) in this series was significantly greater than in the historic series without bevacizumab therapy. Bevacizumab seems not to increase the severity of FOLFOX-related liver steatosis and sinusoidal dilation. One operative mortality (3.6%) occurred. Six patients (21.4%) presented with postoperative complications including upper gastrointestinal bleeding, deep vein thrombosis, pelvic abscess, wound infection, enterocutaneous fistula, and perineal fistula. The patients presented with mild postoperative pain and had a quick convalescence. The addition of bevacizumab to FOLFOX achieved a superior pathologic response for 78.3% of the patients, whose residual tumor cells were very few (< 10% microscopic field). Conclusions: Based on the controllable surgical complications and minimal invasiveness in the current patient series, laparoscopic TME is shown to be technically feasible and can be recommended for patients with advanced lower rectal cancer requiring preoperative CCRT using bevacizumab as the additional therapeutic agent. ? 2010 Springer Science+Business Media, LLC.
SDGs
Other Subjects
bevacizumab; fluorouracil; folinic acid; oxaliplatin; adult; aged; article; cancer cell; cancer combination chemotherapy; cancer localization; cancer patient; cancer radiotherapy; cancer staging; clinical article; convalescence; deep vein thrombosis; disease severity; enterocutaneous fistula; fatty liver; feasibility study; female; human; human cell; human tissue; laparoscopic surgery; laparoscopic total mesorectal excision; liver sinusoid; male; minimal residual disease; multiple cycle treatment; operation duration; patient safety; pelvis abscess; perineum injury; postoperative hemorrhage; postoperative pain; preoperative treatment; priority journal; rectum cancer; rectum surgery; side effect; surgical infection; surgical mortality; treatment response; upper gastrointestinal bleeding
Publisher
Springer New York LLC
Type
journal article