Local excision following chemoradiotherapy in T2 –T3 rectal cancer: current status and critical appraisal

AbstractLocal excision following chemoradiotherapy in rectal cancer is an organ-preserving procedure which aims at reducing morbidity and functional disorders associated with total mesorectal excision (TME) in selected patients. Although TME after chemoradiotherapy remains the gold standard for locally advanced mid and low rectal cancer, in the last years multicenter research trials have offered encouraging oncologic results which have allowed to preserve the rectum in patients with a pathologic complete response after chemoradiotherapy. A review of the available literature on this topic was conducted to define the state of the art of this conservative approach and to focus on the most controversial aspects concerning local excision performed after chemoradiotherapy, in particular tumor scatter and lymph node status, completion and salvage surgery, morbidity and quality of life. The analysis of these topics should be considered, in trial setting or in current practice, for their clinical implications. Oncologic outcomes of recent trials are encouraging for part of the patients presenting T2 rectal cancer; however, TME still remains the standard treatment in clinical practice. In such cases, local excision should include a surgical safety margin of at least 1 cm from the resection margin to achieve a true negative margin from residual tumor cells. The selection of the patients should be carefully performed and their consensus extremely detailed because TME is necessary in abou...
Source: Updates in Surgery - Category: Surgery Source Type: research

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Conclusion: Even in the setting of stage IV rectal cancer with synchronous liver metastases, there may be potential for extended survival and cure by aggressive management of primary tumor and metastases in selected patients. Despite lack of consensus on sequencing of treatment modalities, pelvic RT may serve as a critical component of multidisciplinary management. Resectability of primary rectal tumor and liver metastases, patient preferences, comorbidities, symptomatology, and logistical issues should be thoroughly considered in decision making for optimal management of patients. PMID: 31139467 [PubMed - in process]
Source: International Journal of Surgical Oncology - Category: Surgery Tags: Int J Surg Oncol Source Type: research
Saeed Nourmohammadi1†, Thazin Nwe Aung2†, Jian Cui2, Jinxin V. Pei1, Michael Lucio De Ieso1, Yuka Harata-Lee2, Zhipeng Qu2, David L. Adelson2* and Andrea J. Yool1* 1Adelaide Medical School, The University of Adelaide, Adelaide, SA, Australia 2Department of Molecular and Biomedical Science, School of Biological Sciences, The University of Adelaide, Adelaide, SA, Australia Traditional Chinese Medicines are promising sources of new agents for controlling cancer metastasis. Compound Kushen Injection (CKI), prepared from medicinal plants Sophora flavescens and Heterosmilax chinensis, disrupts cell cycle...
Source: Frontiers in Oncology - Category: Cancer & Oncology Source Type: research
ConclusionTen patients had a (near) complete response of their primary tumour and, in retrospect, rectum sparing therapies could have been considered. Together with 36 patient in whom palliative rectum resection was not necessary this entails that nearly 40% patients with LARC and sRLM might be spared major pelvic surgery if the liver-first approach is applied. A predictor (CEA) was found for non-completion of the liver-first protocol. The majority of patients underwent resection of both primary tumour and hepatic metastasis with curative intent. These findings together entail that the liver-first approach may be considere...
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
ConclusionThe pooled local recurrence rate of sigmoid cancer of 10.5% is higher than contemporary rates of local recurrence of rectal cancer. A large number of papers fail to describe or include R1 resections of sigmoid cancer, which are frequently described as palliative.
Source: European Journal of Surgical Oncology (EJSO) - Category: Surgery Source Type: research
o Paulo Novais Prediction in health care is closely related with the decision-making process. On the one hand, accurate survivability prediction can help physicians decide between palliative care or other practice for a patient. On the other hand, the notion of remaining lifetime can be an incentive for patients to live a fuller and more fulfilling life. This work presents a pipeline for the development of survivability prediction models and a system that provides survivability predictions for years one to five after the treatment of patients with colon or rectal cancer. The functionalities of the system are made ava...
Source: Sensors - Category: Biotechnology Authors: Tags: Article Source Type: research
Authors: McGee SF, AlGhareeb W, Ahmad CH, Armstrong D, Babak S, Berry S, Biagi J, Booth C, Bossé D, Champion P, Colwell B, Finn N, Goel R, Gray S, Green J, Harb M, Hyde A, Jeyakumar A, Jonker D, Kanagaratnam S, Kavan P, MacMillan A, Muinuddin A, Patil N, Porter G, Powell E, Ramjeesingh R, Raza M, Rorke S, Seal M, Servidio-Italiano F, Siddiqui J, Simms J, Smithson L, Snow S, St-Hilaire E, Stuckless T, Tate A, Tehfe M, Thirlwell M, Tsvetkova E, Valdes M, Vickers M, Virik K, Welch S, Marginean C, Asmis T Abstract The annual Eastern Canadian Gastrointestinal Cancer Consensus Conference 2017 was held in St. John'...
Source: Current Oncology - Category: Cancer & Oncology Tags: Curr Oncol Source Type: research
This study aims to evaluate the clinical value of SL in treatment decision-making for advanced rectal cancer (RC) with near or complete obstructing tumors. Observational review of colorectal database at Tata Memorial Hospital from January 2013 to December 2016 identified 562 patients diagnosed and treated for advanced RC. Of the 562 cases, 48.7% (274) were clinically and radiologically diagnosed of near or complete obstructing advanced RC. Medical records of 34% (94/274) who underwent SL with diversion stoma (DS) were analyzed. In the absence of ascites, extensive peritoneal deposits, and unresectable liver metastases on S...
Source: Indian Journal of Surgical Oncology - Category: Cancer & Oncology Source Type: research
Conclusion: Mucinous CRC was predominantly located in the right hemicolon; it was diagnosed at more advanced stages and occurred with preponderance in women. A higher rate of G3/4 grading was observed at diagnosis (allp #x3c; 0.001). An association of mucinous CRC with younger age at initial diagnosis, previously reported by other groups, could not be confirmed. Patients with mucinous stage IV colon cancer demonstrated poorer survival (p = 0.006). In contrast, no differences in survival were observed for specific stages I –III colon cancer. Stage-dependent analysis of rectal cancer stages I–IV also showed no di...
Source: Digestion - Category: Gastroenterology Source Type: research
DiscussionThe findings of this systematic review and meta-analysis will provide novel insights into the efficacy and safety of combined neoadjuvant chemoradiotherapy including a platinum derivative and may form a basis for future clinical decision-making, guideline evaluation, and research prioritization.Systematic review registrationPROSPEROCRD42017073064
Source: Systematic Reviews - Category: International Medicine & Public Health Source Type: research
Regorafenib, an oral multikinase inhibitor, was approved in September 2012 by the US Food and Drug Administration for the treatment of patients with metastatic colorectal cancer progressing on standard therapies. Here, we describe the clinical history of a 63-year-old male patient who was treated with regorafenib in the pivotal CORRECT trial. The patient was initially diagnosed in November 2008 with nonmetastaticKRAS-mutated (exon 2, codon 12) rectal cancer. He underwent successful surgery and was treated with 5 cycles of adjuvant chemotherapy. In 2010, lung metastases (KRAS-mutated) were detected and the patient received ...
Source: Case Reports in Oncology - Category: Cancer & Oncology Source Type: research
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