Rectal Cancer Clinical Trial
Official title:
IPC Status as a Surgical Quality Marker in Rectal Cancer Surgery
Risk of local recurrence after rectal surgery is nationally 8% after curative surgery to 5%.
Local recurrence rate after curative surgery varies between 3-7% in the variety of regions
in the country. It is well known that the surgical technique total mesorectal excision (TME)
has led to improved prognosis after rectal cancer surgery. TME surgery is difficult to
perform and different factors affect the quality of TME preparations. Injuries in mesorectal
fascia has been reported in up to 20% of patients who underwent TME surgery and most
surgeons agree that this may be important for recurrences. However, it is unclear to what
extent a damaged mesorectal fascia can be related to a worsening of prognosis in patients
with rectal cancer.
Adjuvant oncological treatment in form of chemotherapy after surgery, is offers patients
with unfavorable tumors based on the pathological examination. Patients with favorable
tumors (less advanced) are not offered chemotherapy, even if the surgical technique was not
optimal, ie. that there is damage in the mesorectal fascia, as evidence for this is lacking.
The presence of intraperitoneal cancer cells (IPC) is related to histopathological tumor
stage of colorectal cancer. Incidence of IPC of intraperitoneal tumors (rectal cancer
patients with tumors below the peritoneal reflection) is unclear.
Assessment of IPC status with cytology and immunohistochemistry is technically easy and
could after TME surgery identify those patients who have an increased risk of tumor
recurrence. In a positive IPC status, the patient would possibly benefit from either
postoperative radiotherapy if the patient did not receive preoperative therapy, or
postoperative oncological chemotherapy.
Tumour cells may be lysed in sterile water, and some surgeons rinse the abdominal cavity and
the bowel distally to the tumour. Neither rinsing the abdomen or rectum in colorectal cancer
is routinely occurring and the clinical benefit has not been established. The value of
rinsing the abdomen after TME-surgery could also be studied by IPC status.
The study hypothesis is that the IPC status is dependent on the surgical quality of the
specimen after TME-surgery in rectal cancer patients, and its presence leads to increased
risk of local recurrence.
n/a
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