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YAMAGUCHI SHIGEKI
Department School of Medicine(Tokyo Women's Medical University Hospital), School of Medicine Position Professor and Division head |
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| Article types | Original article |
| Language | English |
| Peer review | Non peer reviewed |
| Title | Japanese multicenter prospective study investigating laparoscopic surgery for locally advanced rectal cancer with evaluation of CRM and TME quality (PRODUCT trial). |
| Journal | Formal name：Annals of gastroenterological surgery Abbreviation：Ann Gastroenterol Surg ISSN code：24750328/24750328 |
| Domestic / Foregin | Foregin |
| Volume, Issue, Page | 6(6),pp.767-777 |
| Author and coauthor | Takemasa Ichiro, Hamabe Atsushi, Ito Masaaki, Matoba Shuichiro, Watanabe Jun, Hasegawa Suguru, Kotake Masanori, Inomata Masafumi, Ueda Kazuki, Uehara Kay, Sakamoto Kazuhiro, Ikeda Masataka, Hanai Tsunekazu, Konishi Tsuyoshi, Yamaguchi Shigeki, Nakano Daisuke, Yamagishi Shigeru, Okita Kenji, Ochiai Atsushi, Sakai Yoshiharu, Watanabe Masahiko, |
| Publication date | 2022/11 |
| Summary | AIM:In Japan, we have not been able to validate the results of laparoscopic surgery for locally advanced rectal cancer using the universal index "circumferential resection margin (CRM)." Previously, we established a semi-opened circular specimen processing method and validated its feasibility. In the PRODUCT trial, we aimed to assess CRM in patients with locally advanced rectal cancer who underwent laparoscopic rectal resection.METHODS:This was a multicenter, prospective, observational study. Eligible patients had histologically confirmed rectal adenocarcinoma located at or below 12 cm above the anal verge with clinical stage II or III and were scheduled for laparoscopic or robotic surgery. The primary endpoint was pathological CRM. CRM ≤1 mm was defined as positive.RESULTS:A total of 303 patients operated on between August 2018 and January 2020 were included in the primary analysis. The number of patients with clinical stage II and III was 139 and 164, respectively. Upfront surgery was performed for 213 patients and neoadjuvant therapy for 90 patients. The median CRM was 4.0 mm (IQR, 2.1-8.0 mm), and CRM was positive in 26 cases (8.6%). Univariate and multivariate analyses demonstrated that a predicted CRM from the mesorectal fascia of ≤1 mm on MRI was the significant factor for positive CRM (P = .0012 and P = .0045, respectively).CONCLUSION:This study showed the quality of laparoscopic rectal resection based on the CRM in Japan. Preoperative MRI is recommended for locally advanced rectal cancer to prevent CRM positivity. |
| DOI | 10.1002/ags3.12592 |
| PMID | 36338586 |