Current Surgical Strategies in the Management of Rectal Cancer

AbstractPurpose of ReviewThe surgical approach to rectal cancer has become significantly more complex with the introduction of neoadjuvant therapies and organ preservation strategies. Optimal radiological imaging in association with relevant clinical findings provides critical information for final surgical management decision. The present review focuses on the surgical alternatives available in different clinical scenarios for the management of rectal cancer.Recent FindingsMost of evidence for surgical management of rectal cancer is provided by non-randomized studies. However, a few randomized clinical trials have attempted to address the optimal surgical approach for total mesorectal excision. In addition, recent randomized trials have also contributed to the understanding of the role of organ-preserving strategies among patients with excellent response to neoadjuvant treatment. Finally, one randomized Japanese study has provided oncological evidence in favor of prophylactic lateral node dissection among these patients.SummaryRadical proctectomy with total or partial mesorectal excision is the standard procedure for most patients with primary rectal cancer. Optimal approach for this procedure remains controversial. The decision between sphincter-preservation strategies and abdominal perineal resections should take into account the radiological and clinical findings. More recently, organ-preserving strategies including transanal local excisions may be used in select patients...
Source: Current Colorectal Cancer Reports - Category: Cancer & Oncology Source Type: research

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ConclusionsOne-fifth of patients with locally advanced rectal cancer are manageable with a rectum-sparing approach after neoadjuvant therapy. With this strategy, about 80% patients will have their rectum preserved and 90% will be without stoma at long term.
Source: International Journal of Colorectal Disease - Category: Gastroenterology Source Type: research
ConclusionAside from one reader demonstrating increased sensitivity, no significant difference in accuracy parameters or inter-observer agreement was found between MR using b800 and b1500 for the detection of residual tumor after neoadjuvant CRT for LARC. However, there was a suggestion of a trend towards increased sensitivity with b1500, and further studies using larger cohorts may be needed to further investigate this topic.
Source: Abdominal Imaging - Category: Radiology Source Type: research
This study aimed to compare the oncologic outcomes of patients undergoing rectal preservation as intended by the surgeon, and the outcomes of patients refusing rectal resection against medical advice.MethodsThe study population consisted of patients in whom the rectum was preserved after neoadjuvant chemoradiotherapy for clinical stage I –III mid or low rectal cancer between May 2003 and August 2017 (n  =  2883); these patients were divided into those in whom rectal preservation was intended by their surgeon (intended rectal preservation, group A,n  =  41) and those in whom the rectum was ...
Source: World Journal of Surgery - Category: Surgery Source Type: research
Conclusion: The strategy proposed seemed safe and effective, resulting in radical treatment and persistence of regular menstrual period. Further studies are needed. PMID: 31650042 [PubMed]
Source: Clinical Colorectal Cancer - Category: Cancer & Oncology Authors: Tags: Clin Transl Radiat Oncol Source Type: research
ConclusionIn patients with rectal cancer, nCRT may decrease the number of exfoliated cancer cells in the rectum, and rectal washout including the tumor may be oncologically acceptable.
Source: Surgery Today - Category: Surgery Source Type: research
Conclusion: Extending the waiting period by 4 weeks following RCT has no influence on the oncological outcomes of T3/T4 rectal cancers.
Source: Annals of Surgery - Category: Surgery Tags: ESA-RANDOMIZED CONTROLLED TRIALS Source Type: research
Authors: Kye BH, Lee SH, Jeong WK, Yu CS, Park IJ, Kim HR, Kim J, Lee IK, Park KJ, Choi HJ, Kim HY, Baek JH, Lee YS Abstract Purpose: The optimal treatment for synchronous liver metastasis (LM) from colorectal cancer (CRC) depends on various factors. The present study was intended to investigate the oncologic outcome according to the time of resection of metastatic lesions. Methods: Data from patients who underwent treatment with curative intent for primary CRC and synchronous LM between 2004 and 2009 from 9 university hospitals in Korea were collected retrospectively. One hundred forty-three patients underwent...
Source: Annals of Surgical Treatment and Research - Category: Surgery Tags: Ann Surg Treat Res Source Type: research
Tumour deposits (TDs) are a poor prognostic marker in colorectal cancer, but their significance after neoadjuvant chemoradiotherapy is less certain because this group of patients is excluded in most studies. Post-treatment TD might even be a sign of tumour response. No previous reviews have assessed outcomes in this group.
Source: European Journal of Cancer - Category: Cancer & Oncology Authors: Tags: Review Source Type: research
In vitro and in vivo studies on the association of long non‑coding RNAs H19 and urothelial cancer associated 1 with the susceptibility to 5‑fluorouracil in rectal cancer. Int J Oncol. 2019 Oct 04;: Authors: Yokoyama Y, Sakatani T, Wada R, Ishino K, Kudo M, Koizumi M, Yamada T, Yoshida H, Naito Z Abstract There is no predictive biomarker for response to 5‑fluorouracil (5FU)‑based neoadjuvant chemotherapy (NAC) in rectal cancer. In the present study, we examined potential long non‑coding RNAs (lncRNAs) linked to the susceptibility to 5FU in cultured colorectal cancer cells, and in bi...
Source: International Journal of Oncology - Category: Cancer & Oncology Authors: Tags: Int J Oncol Source Type: research
In conclusion, irradiation or chemicals induce the formation of PGCCs and PGCCs produce daughter cells with strong migration and invasion abilities after a long incubation period. Appropriate rest interval (incubation period) is very important for patients with LARC who will receive nCRT. PMID: 31558902 [PubMed]
Source: Journal of Oncology - Category: Cancer & Oncology Tags: J Oncol Source Type: research
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