Systematic review of classification systems for locally recurrent rectal cancer
File(s)
Published version
Author(s)
Kontovounisios, Christos
Type
Journal Article
Abstract
BACKGROUND
Classification of pelvic local recurrence (LR) after surgery for primary rectal cancer is not currently standardised and optimal imaging is required to categorise anatomical site and plan treatment in patients with LR. The aim of this review was to evaluate the systems used to classify locally recurrent rectal cancer (LRRC) and the relevant published outcomes.
METHODS
A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE and CENTRAL databases. The primary outcome was to review the classifications currently in use; the secondary outcome was the extraction of relevant information provided by these classification systems including prognosis, anatomy and prediction of R0 after surgery.
RESULTS
A total 21 out of 58 eligible studies, classifying LR in 2,086 patients were reviewed. Studies used at least one of the following eight classification systems proposed by Institutions or Institutional Groups (Mayo Clinic, Memorial Sloan-Kettering -original and modified-, Royal Marsden and Leeds) or authors (Yamada, Hruby and Kusters).
Negative survival outcomes were associated with increased pelvic fixity, associated symptoms of LR, lateral compared with central LR and three or more pelvic compartment involvement. A total of seven studies used MRI with specifically defined anatomical compartments to classify LR.
CONCLUSION
This review highlights the various imaging systems in use to classify LRRC and some of the prognostic indicators for survival and oncological clearance based on these systems. Implementation of an agreed classification system to consistently document pelvic LR should provide more detailed information on anatomical site of recurrence, burden of disease and standards for comparative outcome assessment. This would optimise treatment planning, operative procedures and research into LR. An MRI classification system with its inherent anatomic precision is ideally placed as a standardised preoperative planning tool for LR.
Classification of pelvic local recurrence (LR) after surgery for primary rectal cancer is not currently standardised and optimal imaging is required to categorise anatomical site and plan treatment in patients with LR. The aim of this review was to evaluate the systems used to classify locally recurrent rectal cancer (LRRC) and the relevant published outcomes.
METHODS
A systematic review of the literature prior to April 2020 was performed through electronic searches of the Science Citation Index Expanded, EMBASE, MEDLINE and CENTRAL databases. The primary outcome was to review the classifications currently in use; the secondary outcome was the extraction of relevant information provided by these classification systems including prognosis, anatomy and prediction of R0 after surgery.
RESULTS
A total 21 out of 58 eligible studies, classifying LR in 2,086 patients were reviewed. Studies used at least one of the following eight classification systems proposed by Institutions or Institutional Groups (Mayo Clinic, Memorial Sloan-Kettering -original and modified-, Royal Marsden and Leeds) or authors (Yamada, Hruby and Kusters).
Negative survival outcomes were associated with increased pelvic fixity, associated symptoms of LR, lateral compared with central LR and three or more pelvic compartment involvement. A total of seven studies used MRI with specifically defined anatomical compartments to classify LR.
CONCLUSION
This review highlights the various imaging systems in use to classify LRRC and some of the prognostic indicators for survival and oncological clearance based on these systems. Implementation of an agreed classification system to consistently document pelvic LR should provide more detailed information on anatomical site of recurrence, burden of disease and standards for comparative outcome assessment. This would optimise treatment planning, operative procedures and research into LR. An MRI classification system with its inherent anatomic precision is ideally placed as a standardised preoperative planning tool for LR.
Date Issued
2021-05
Date Acceptance
2021-02-13
Citation
BJS Open, 2021, 5 (3), pp.1-14
ISSN
2474-9842
Publisher
Oxford University Press (OUP)
Start Page
1
End Page
14
Journal / Book Title
BJS Open
Volume
5
Issue
3
Copyright Statement
© The Author(s) 2021. Published by Oxford University Press on behalf of BJS Society Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://academic.oup.com/bjsopen/article/5/3/zrab024/6272170
Publication Status
Published
Date Publish Online
2021-05-08