Dutch national guidelines for locally recurrent rectal cancer.

Due to improvements in treatment for primary rectal cancer, the incidence of LRRC has decreased. However, 6-12% of patients will still develop a local recurrence. Treatment of patients with LRRC can be challenging, because of complex and heterogeneous disease presentation and scarce - often low-grade - data steering clinical decisions. Previous consensus guidelines have provided some direction regarding diagnosis and treatment, but no comprehensive guidelines encompassing all aspects of the clinical management of patients with LRRC are available to date. The treatment of LRRC requires a multidisciplinary approach and overarching expertise in all domains. This broad expertise is often limited to specific expert centres, with dedicated multidisciplinary teams treating LRRC. A comprehensive, narrative literature review was performed and used to develop the Dutch National Guideline for management of LRRC, in an attempt to guide decision making for clinicians, regarding the complete clinical pathway from diagnosis to surgery.

Locally recurrent rectal cancer: Oncological outcomes for patients with a pathological complete response after neoadjuvant therapy.

BACKGROUND: For patients with locally recurrent rectal cancer, it is an ongoing pursuit to establish factors predicting or improving oncological outcomes. In locally advanced rectal cancer, a pCR appears to be associated with improved outcomes. The aim of this retrospective cohort study was to compare the oncological outcomes of patients with locally recurrent rectal cancer with and without a pCR. METHODS: Patients who underwent neoadjuvant treatment and surgery for locally recurrent rectal cancer with curative intent between January 2004 and June 2020 at a tertiary referral hospital were analysed. Primary outcomes included overall survival, disease-free survival, metastasis-free survival, and local re-recurrence-free survival, stratified according to whether the patient had a pCR. RESULTS: Of a total of 345 patients, 51 (14.8 per cent) had a pCR. Median follow-up was 36 (i.q.r. 16-60) months. The 3-year overall survival rate was 77 per cent for patients with a pCR and 51.1 per cent for those without (P < 0.001). The 3-year disease-free survival rate was 56 per cent for patients with a pCR and 26.1 per cent for those without (P < 0.001). The 3-year local re-recurrence-free survival rate was 82 and 44 per cent respectively (P < 0.001). Surgical procedures (for example soft tissue, sacrum, and urogenital organ resections) and postoperative complications were comparable between patients with and without a pCR. CONCLUSION: This study showed that patients with a pCR have superior oncological outcomes to those without a pCR. It may therefore be safe to consider a watch-and-wait approach in highly selected patients, potentially improving quality of life by omitting extensive surgical procedures without compromising oncological outcomes.

High prevalence of self-reported shoulder complaints after thyroid carcinoma surgery.

BACKGROUND: Shoulder complaints are frequently reported after surgical treatment for thyroid carcinoma. However, no specific literature on this topic is available for these patients and, hence, its impact on quality of life (QOL) is unknown and there are no known predictors of shoulder complaints in this specific patient population. Therefore, the purpose of this study was to assess the prevalence of shoulder-related complaints and its relation to QOL and clinical characteristics after thyroid carcinoma surgery by means of a cross-sectional case control study in a tertiary referral center. METHODS: The prevalence of shoulder complaints and its relation to clinical characteristics and QOL after thyroid carcinoma surgery (n = 109) was compared to a healthy control group (n = 81). Main outcome measures are prevalence of self-reported shoulder complaints, results of the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH), and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30-questions (EORTC-QLQ-C30). RESULTS: Patients with thyroid carcinoma, on average 10.2 years after thyroid surgery, reported a 58.7% prevalence of shoulder-related complaints, which was significantly more than the 13.6% reported by healthy controls (p < .01). Patients with thyroid carcinoma scored worse than healthy controls on most of the different subscales of the DASH and EORTC-QLQ-C30. Bivariate association analysis identified level V neck dissection as being associated with the prevalence of shoulder complaints and the DASH score, and spinal accessory nerve damage and employment status as being associated with the DASH score. Prevalence of shoulder complaints and the DASH scores were significantly correlated to several EORTC-QLQ-C30 scores. Only 11.9% of patients with thyroid carcinoma retrospectively reported having received preoperative information on possible shoulder complaints and only 34.9% of patients with thyroid carcinoma retrospectively reported having received additional care for their shoulder complaints. CONCLUSION: Shoulder complaints represent and underestimated problem and are reported by many patients who had surgery for thyroid carcinoma. Information provision to the patient should be improved, shoulder complaints should be registered, and additional care should be provided after thyroid carcinoma surgery to improve QOL. © 2016 Wiley Periodicals, Inc. Head Neck 39: 260-268, 2017.