Quality of Life During and After Completion of Neoadjuvant Chemoradiotherapy for Esophageal and Junctional Cancer.

BACKGROUND: The course of health-related quality of life (HRQOL) during and after completion of neoadjuvant chemoradiotherapy (nCRT) for esophageal or junctional carcinoma is unknown. METHODS: This study was a multicenter prospective cohort investigation. Patients with esophageal or cancer to be treated with nCRT plus esophagectomy were eligible for inclusion in the study. The HRQOL of the patients was measured with European Organization for Research and Treatment of Cancer QLQ-C30, QLQ-OG25, and QLQ-CIPN20 questionnaires before and during nCRT, then 2, 4, 6, 8, 10, 12, 14, and 16 weeks after nCRT and before surgery. Predefined end points were based on the hypothesized impact of nCRT. The primary end points were physical functioning, odynophagia, and sensory symptoms. The secondary end points were global quality of life, fatigue, weight loss, and motor symptoms. Mixed modeling analysis was used to evaluate changes over time. RESULTS: Of 106 eligible patients, 96 (91%) were included in the study. The rate of questionnaires returned ranged from 94% to 99% until week 12, then dropped to 78% in week 16 after nCRT. A negative impact of nCRT on all HRQOL end points was observed during the last cycle of nCRT (all p < 0.001) and 2 weeks after nCRT (all p < 0.001). Physical functioning, odynophagia, and sensory symptoms were restored to pretreatment levels respectively 8, 4, and 6 weeks after nCRT. The secondary end points were restored to baseline levels 4-6 weeks after nCRT. Odynophagia, fatigue, and weight loss improved after nCRT compared with baseline levels at respectively 6 (p < 0.001), 16 (p = 0.001), and 12 weeks (p < 0.001). CONCLUSION: After completion of nCRT for esophageal cancer, HRQOL decreases significantly, but all HRQOL end points are restored to baseline levels within 8 weeks. Odynophagia, fatigue, and weight loss improved 6-16 weeks after nCRT compared with baseline levels.

Perineal hernia repair after abdominoperineal rectal excision.

BACKGROUND: A perineal hernia can severely disable everyday activities. Its repair is a surgical challenge, and guidance by the literature is limited. The series described so far are small or encompass a long period in which even nonmesh techniques were used. OBJECTIVE: The aim of this study was to review recent results of a perineal mesh-based repair. PATIENTS: Medical charts of patients with a symptomatic perineal hernia after abdominoperineal resection due to rectal cancer were reviewed. MAIN OUTCOME MEASURES: Data included patients' characteristics, operative details, recurrence, and complications. RESULTS: In total, 29 patients underwent repair of a symptomatic perineal hernia after an abdominoperineal resection due to rectal cancer. The majority was male (66%), and the median age was 59 years (range, 41-83). All patients received neoadjuvant treatment.From 2003 until 2006, polytetrafluoroethylene or Vypro mesh and Prolene 2.0 sutures were used for perineal hernia repair. All 8 repairs failed; repeated repair using various methods was successful in 63%. After 2006, the surgical technique was changed into a high-tension repair with the use of a nonabsorbable mesh. This technique was successful for 20 of 21 patients (95%). Complications encountered in the entire group of 29 patients were urinary retention (n = 2), wound infection, seroma, and fistula (n = 1 each). LIMITATIONS: Even though this is the largest group described in the literature, the results are limited because of the small number of patients. CONCLUSION: Repair of perineal hernia remains challenging and only a few reports offer advice on how to manage this unusual problem. However, superior results have been shown with the new mesh-based technique through perineal approach with only 5% recurrence.

Patent blue staining as a method to improve lymph node detection in rectal cancer following neoadjuvant treatment.

INTRODUCTION: Lymph node involvement is one of the most important prognostic factors in rectal cancer. After neoadjuvant treatment the number of retrieved lymph nodes is often reported to be low which impairs reliable tumour staging. This study examines the effect of patent blue staining on the number of harvested lymph nodes and evaluates whether a higher number of retrieved lymph nodes is of prognostic significance. PATIENTS AND METHODS: Between March 2007 and December 2010, 295 consecutive patients with locally advanced rectal cancer following neoadjuvant treatment were included. Specimens were either not stained (NB), injected with patent blue into the mesorectum (MB) or directly into the inferior mesenteric artery (AB). Data were retrieved from a prospective database. RESULTS: The number of evaluated lymph nodes was significantly higher in the stained specimens: mean 6.8 in the NB group (n=89), 11.5 in the MB group (n=86) and 17.4 in the AB group (n=106) (p<0.001). The percentage of patients with a minimum of 12 lymph nodes increased from 15.5% (NB) to 44.2% (MB) to 74.5% (AB) (p<0.001). The three-year cancer specific survival for the lymph node ratio (LNR) was 95% (0), 94.4% (0.01-0.1), 80.1% (0.11-0.4) and 63.7% (0.41-1). CONCLUSION: The use of patent blue in patients who underwent rectal cancer surgery after neoadjuvant treatment significantly enhanced lymph node harvest. Injection into the inferior mesenteric artery was most effective. This relatively simple and generally applicable method can help to improve lymph node detection which lowers the LNR and allows adequate tumour staging.