B. Griffiths

Surgery for recurrent rectal cancer: higher and wider?

Aim  There has been a steady increase in the number of centres that carry out resection of locally recurrent rectal cancer (LRRC). The aim of this review was to highlight the present management and suggest technical strategies that may improve survival and quality of life.

Surgical resection of recurrent colonic cancer

Locoregional recurrence of colonic cancer includes anastomotic recurrence, associated nodal masses, masses that involve the abdominal wall and pelvic masses. The aim of this study was to report the outcome of resection of such recurrences and to provide guidance on the management of this disease.

Systematic review of health-related quality of life issues in locally recurrent rectal cancer

The standardization of surgical techniques supplemented with appropriate neoadjuvant chemoradiation has led to the decline in local recurrence rates of rectal cancer (LRRC) from 25–50% to 5–10%. The outcomes reported for surgical intervention in LRRC is encouraging, however, a number of controversies exist especially in the ultra‐advanced and palliative setting. Incorporating health‐related quality of life (HRQoL) outcomes in this field could supplement traditional clinical endpoints in assessing the effectiveness of surgical intervention in this cohort. This review aimed to identify the HRQOL themes that might be relevant to patients with LRRC. A systematic review was undertaken to identify all studies reporting HRQoL in LRRC. Each study was evaluated with regards to its design and statistical methodology. A meta‐synthesis of qualitative and quantitative studies was undertaken to identify relevant HRQoL themes. A total of 14 studies were identified, with 501 patients, with 80% of patients undergoing surgery. HRQoL was the primary endpoint in eight studies. Eight themes were identified: physical, psychological and social impact, symptoms, financial and occupational impact, relationships with others, communication with healthcare professionals and sexual function. The impact on HRQoL is multifactorial and wide ranging, with a number of issues identified that are not included in current measures. These issues must be incorporated into the assessment of HRQoL in LRRC through the development of a validated, disease‐specific tool. J. Surg. Oncol. 2015 111:431–438.

Current UK management of locally recurrent rectal cancer.

Aim  The study aimed to determine current UK practice in the management of locally recurrent rectal cancer (LRRC).

Systematic review of health-related quality of life in patients undergoing pelvic exenteration

BACKGROUND Pelvic exenteration is a radical operative treatment reserved for the management of a number of advanced primary and recurrent pelvic malignancies, including, rectal, gynaecological and urological. The advances in radiological staging, surgical techniques and greater use of chemotherapeutic agents haves translated clinically into improvements in the overall survival of this cohort of patients, irrespective of underlying disease pathology. Consequently, a greater proportion of the surviving population will present to healthcare professionals with a range of physical and psychological issues, therefore the profiling and understanding of the health-related quality of life (HrQoL) is integral to the long term management of this cohort of patients. The aim of this systematic review is to identify HrQoL themes from the current literature relevant to patients undergoing a pelvic exenteration. METHODS Literature searches were performed in three databases: MEDLINE (1975-November 2015), EMBASE and CINAHL. Each study was evaluated with regards to its design and statistical methodology. Data quality was reviewed in accordance with the Newcastle-Ottowa score and Critical Appraisal Skills Programme Checklist (CAPS) for quantitative and qualitative data accordingly. A narrative synthesis of all identified HrQoL issues was undertaken using the principles of content analysis. RESULTS A total of 24 studies were identified; 20 quantitative and 4 qualitative with 976 patients assessed in total. HrQoL was assessed as the main primary endpoint in 15 studies. The majority of studies were retrospective. Baseline data prior to the initiation of treatments were available in 6 studies alone. Nine themes were identified across the literature, which included body image, social impact, sexual function, treatment expectations, symptoms, communication, psychological impact, relationships and work and finance. CONCLUSIONS Pelvic exenteration has a wide ranging impact on patients HrQoL affecting a range of physical and psychological domains.

Systematic review of emergency laparoscopic colorectal resection

Laparoscopic surgery (LS) has become standard practice for a range of elective general surgical operations. Its role in emergency general surgery is gaining momentum. This study aimed to assess the outcomes of LS compared with open surgery (OS) for colorectal resections in the emergency setting.

Outcome of surgical resection of second-time locally recurrent rectal cancer†

Locally recurrent rectal cancer relapses in the pelvis in up to 60 per cent of patients following resection. This study assessed the surgical and oncological outcomes of patients who underwent surgery for re‐recurrent rectal cancer.

Feasibility of a multicentre, randomised controlled trial of laparoscopic versus open colorectal surgery in the acute setting: the LaCeS feasibility trial protocol.

Introduction Acute colorectal surgery forms a significant proportion of emergency admissions within the National Health Service. There is limited evidence to suggest minimally invasive surgery may be associated with improved clinical outcomes in this cohort of patients. Consequently, there is a need to assess the clinical effectiveness and cost-effectiveness of laparoscopic surgery in the acute colorectal setting. However,emergency colorectal surgical trials have previously been difficult to conduct due to issues surrounding recruitment and equipoise. The LaCeS (randomised controlled trial of Laparoscopic versus open Colorectal Surgery in the acute setting) feasibility trial will determine the feasibility of conducting a definitive, phase III trial of laparoscopic versus open acute colorectal resection. Methods and analysis The LaCeS feasibility trial is a prospective, multicentre, single-blinded, parallel group, pragmatic randomised controlled feasibility trial. Patients will be randomised on a 1:1 basis to receive either laparoscopic or open surgery. The trial aims to recruit at least 66 patients from five acute general surgical units across the UK. Patients over the age of 18 with a diagnosis of acute colorectal pathology requiring resection on clinical and radiological/endoscopic investigations, with a National Confidential Enquiry into Patient Outcome and Death classification of urgent will be considered eligible for participation. The primary outcome is recruitment. Secondary outcomes include assessing the safety profile of laparoscopic surgery using intraoperative and postoperative complication rates, conversion rates and patient-safety indicators as surrogate markers. Clinical and patient-reported outcomes will also be reported. The trial will contain an embedded qualitative study to assess clinician and patient acceptability of trial processes. Ethics and dissemination The LaCeS feasibility trial is approved by the Yorkshire and The Humber, Bradford Leeds Research Ethics Committee (REC reference: 15/ YH/0542). The results from the trial will be presented at national and international colorectal conferences and will be submitted for publication to peer-reviewed journals. Trial registration number ISRCTN15681041; Pre-results.

Re: A proposal for the annotation of recurrent colorectal cancer

Dear Sir, We read with interest the paper in Colorectal Disease by Majeed et al. [1] on the Sheffield classification of recurrence in patients treated for large bowel cancer. We believe the principle of ‘super-staging’ metastatic disease has considerable merit, since it separates metastatic disease according to site. More importantly it would be extremely useful to the multidisciplinary team (MDT) when making decisions on the management of patients with multi-site recurrence. However, we consider the omission of a scoring system for pelvic recurrence to be an oversight. An estimated 10% of patients treated for rectal cancer develop locoregional recurrent disease [2,3]. For some of these patients re-resection of pelvic recurrence is technically possible and can achieve good results [4]. With this in mind we propose a modification to the staging system presented by Majeed et al. [1] to include the status of disease in the pelvis as follows: 1 Pel 0: No pelvic recurrence. 2 Pel 1 Stage 1: Pelvic recurrent disease that is considered resectable with anticipated clear surgical margins. 3 Pel 1 Stage 2: Pelvic recurrent disease with threatened surgical margins. 4 Pel 1 Stage 3: Pelvic recurrent disease considered surgically unresectable. We suggest furthermore that this could be known as the ‘Leeds modification’ of the ‘Sheffield classification’!