Complete Clinical Response after Chemoradiotherapy in Rectal Cancer: A Crossroad

Operation is the standard of care after neoadjuvant chemoradioterapy. Therefore a nonoperative management (W&W) has been proposed as an option for patients who achieve a complete clinical response by exclusive chemoradiotherapy. This approach is still investigational and we compared outcomes between patients in this group with those who had a complete pathologic response after surgical resection to address whether W&W approach has an oncologic efficacy in terms of overall survival, disease-free survival, local relapse, and distant relapse, and also whether it should be implemented in clinical practice.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Colon and rectal surgery Source Type: research

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CONCLUSIONS: Robotic surgery for mid/low rectal cancer shows similar long-term oncologic outcomes with laparoscopic surgery but is beneficial to a certain group of patients with advanced rectal cancer with poor response to neoadjuvant chemoradiation. Additional studies are required to confirm our results. See Video Abstract at http://links.lww.com/DCR/B546. LA CIRUGÍA ROBÓTICA MUESTRA RESULTADOS ONCOLÓGICOS A LARGO PLAZO SIMILARES A LA CIRUGÍA LAPAROSCÓPICA EN CASOS DE CÁNCER DE RECTO MEDIO / BAJO, PERO ES VENTAJOSA EN CASOS YPT3-4 POST-QUIMIO-RADIOTERAPIA PREOPERATORIA ...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
CONCLUSION: Multivisceral resection for advanced colorectal cancer invading into the adjacent organ may be performed with acceptable morbidity and mortality.PMID:34111348 | DOI:10.3393/ac.2020.00178.0025
Source: Annals of Coloproctology - Category: Gastroenterology Authors: Source Type: research
CONCLUSIONS: Most mucinous rectal tumors develop and progress along the chromosomal instability pathway. Further research in the form of transcriptomics, proteomics, and analysis of the effects of the mucin barrier may yield valuable insights into the mechanisms of resistance to chemoradiotherapy in this cohort. See Video Abstract at http://links.lww.com/DCR/B464. UNA PERCEPCIÓN SOBRE MUTACIONES IMPULSORAS Y MECANISMOS MOLECULARES SUBYACENTES AL ADENOCARCINOMA MUCINOSO DEL RECTO ANTECEDENTES: El adenocarcinoma mucinoso del recto, representa el 10% de todos los cánceres rectales y tiene una respu...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
circ;me Galon Franck Pagès Four decades were needed to progress from the first demonstration of the independent prognostic value of lymphocytes infiltration in rectal cancers to the first recommendation from the international guidelines for the use of a standardized immune assay, namely the “Immunoscore” (IS), to accurately prognosticate colon cancers beyond the TNM-system. The standardization process included not only the IS conceptualization, development, fine-tuning, and validation by a large international consortium, but also a demonstration of the robustness and reproducibility across the worl...
Source: Cancers - Category: Cancer & Oncology Authors: Tags: Commentary Source Type: research
CONCLUSIONS: The optimal indication for lateral lymph node dissection was lateral lymph node size ≥8 mm before chemoradiotherapy. Cancer could be eradicated in>30% of patients with lateral lymph node metastasis by dissecting metastatic lateral lymph nodes. See Video Abstract at http://links.lww.com/DCR/B428. CRITERIOS DE TAMAÑO ÓPTIMO PARA LA DISECCIÓN DE GANGLIOS LINFÁTICOS LATERALES DESPUÉS DE LA QUIMIORRADIOTERAPIA NEOADYUVANTE PARA EL CÁNCER DE RECTO ANTECEDENTES: Aunque la quimiorradioterapia seguida por cirugía radical sin disección de...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
CONCLUSIONS: Despite the limited improvement in diagnostic accuracy, adding narrow-band imaging to chromoendoscopy improved inter-rater agreement between the expert and nonexpert endoscopists. Narrow-band imaging is a reliable and promising modality for universal standardization of the diagnosis of clinical complete response. See Video Abstract at http://links.lww.com/DCR/B275. ADICIÓN DE IMÁGENES DE BANDA ESTRECHA A LA CROMOENDOSCOPÍA PARA LA EVALUACIÓN DE LA RESPUESTA TUMORAL A LA TERAPIA NEOADYUVANTE EN EL CÁNCER DE RECTO ANTECEDENTES: La evaluación endoscóp...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
This study evaluated the role of neoadjuvant rectal score as a prognostic factor to stratify individual-level risks of survival and tumor recurrence. DESIGN: This is a retrospective study. SETTINGS: This study was conducted at the Seoul National University Hospital. PATIENTS: A total of 397 patients who underwent chemoradiotherapy plus total mesorectal excision were analyzed. INTERVENTIONS: There was no intervention. MAIN OUTCOME MEASURES: Harrell C statistic and receiver operating characteristic analysis, as well as Cox regression analysis, were used to assess the prognostic strength. ...
Source: Diseases of the Colon and Rectum - Category: Gastroenterology Tags: Original Contributions: Colorectal Cancer Source Type: research
CONCLUSION: We confirmed improved compliance to neoadjuvant CT in this study. Although there is no statistical difference in ypT0N0 rate, local recurrence, and DFS between the two arms, a trend towards favourable oncological outcomes is observed. BACKGROUND: In patients with locally advanced rectal cancer, the standard of care consists of preoperative pelvic external beam radiotherapy (EBRT) followed by total mesorectal excision (TME); EBRT either consists of long course chemoradiotherapy (LCRT) with 5-FU/ Capecitabine or short course hypofractionated radiotherapy (SCRT)(1-6). Oxaliplatin in combination with fluoropyr...
Source: Radiotherapy and Oncology : journal of the European Society for Therapeutic Radiology and Oncology - Category: Radiology Authors: Tags: Radiother Oncol Source Type: research
Clin Colon Rectal Surg 2020; 33: 366-371 DOI: 10.1055/s-0040-1714241The possibility of organ preservation in early rectal cancer has gained popularity during recent years. Patients with early tumor stage and low risk for local recurrence do not usually require neoadjuvant chemoradiation for oncological reasons. However, these patients may be considered for chemoradiation exclusively for the purpose of achieving a complete clinical response and avoid total mesorectal excision. In addition, cT2 tumors may be more likely to develop complete response to neoadjuvant therapy and may constitute ideal candidates for organ-preservi...
Source: Clinics in Colon and Rectal Surgery - Category: Surgery Authors: Tags: Review Article Source Type: research
We present a cost-effectiveness analysis of WW protocols vs abdominal-perineal-resection (APR)/low-anterior-resection (LAR) for rectal cancer patients with complete clinical response after chemoradiation.
Source: Journal of the American College of Surgeons - Category: Surgery Authors: Tags: Colon and rectal surgery Source Type: research
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