Robotic Surgery for Colon and Rectal Cancer: Current Status, Recent Advances, and Future Directions
AbstractPurpose of ReviewThe minimally invasive approach to colorectal cancers has been validated as providing oncologic outcomes comparable to open surgery. Current laparoscopic instrumentation, however, has its limitations especially in the performance of rectal cancer resections. Robotic surgery for colorectal cancers is an important addition to the technologies available to the surgeon. We review the literature and draw on our own experience to examine the advantages and disadvantages of robot-assisted surgery for the treatment of colorectal cancers and the evidence for the superior outcomes frequently cited and to ide...
Source: Current Colorectal Cancer Reports - February 3, 2017 Category: Cancer & Oncology Source Type: research
Local Excision Versus Total Mesorectal Excision for Clinical Stage I (cT1 –cT2) Rectal Cancer
This article aimed to review the current evidence of TME and LE in early rectal cancer, to critically review the role and consequence of chemoradiation in LE, and to update ongoing trials on this subject. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - February 1, 2017 Category: Cancer & Oncology Source Type: research
Microsatellite Instability Pathway and EMAST in Colorectal Cancer
AbstractMicrosatellite instability (MSI) refers to the biochemical detection of frameshifted microsatellite sequences from genomic DNA. Genesis of MSI is due to defective DNA mismatch repair (MMR) that fails to correct post-DNA replicative slippage mistakes at microsatellites. Most of the estimated 100,000 genomic microsatellites are non-coding; however, ∼150–300 microsatellites are coding such that, when frameshifted during the pathogenesis of an MSI tumor, they can generate immunogenic neopeptide antigens that limit the growth of tumor and prolong patient survival. In addition to the immune reaction and longer surviv...
Source: Current Colorectal Cancer Reports - February 1, 2017 Category: Cancer & Oncology Source Type: research
Molecular Stratification of Colorectal Cancer: Moving from the Laboratory to Clinical Practice
AbstractPurpose of ReviewColorectal cancer is increasingly recognised as a heterogeneous disease entity, and subtyping is carried out based upon clinical and pathological characteristics, individual somatic gene mutations and, more recently, gene expression profiling. This paper will discuss advances in the molecular stratification of colorectal cancer and the potential challenges and applications for real-world clinical management.Recent FindingsBeyond the established biomarkers ofRAS andBRAF mutational status, a number of rarer genetic mutations have been identified, and trials are ongoing to identify and target these ef...
Source: Current Colorectal Cancer Reports - January 25, 2017 Category: Cancer & Oncology Source Type: research
Current Concepts on the Distal Margin of Resection of Rectal Cancer Tumors after Neoadjuvant Chemoradiation
ConclusionA 1.0-cm margin is the most accepted distal margin of resection for adenocarcinoma of the rectum. Subcentimeter margins as small as 2.0 –5.0 mm may be safe, as recent reports show similar rates of recurrence and survival when compared to larger margins. At this time, we require more evidence to conclude that a distal margin of resection smaller than 1.0 cm is appropriate in the surgical management of rectal cancer. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - January 22, 2017 Category: Cancer & Oncology Source Type: research
Current Status of the Watch-and-Wait Policy for Patients with Complete Clinical Response Following Neoadjuvant Chemoradiation in Rectal Cancer
AbstractPreoperative chemoradiation is the standard of care for patients with locally advanced rectal cancer to reduce the risk of local recurrence. Chemoradiation can achieve a pathological complete response (pCR) in 10 –20% of patients when surgery is performed at 4–12 weeks following completion, and a clinical complete response (cCR) in 15–30% if surgery is withheld. The probability of pCR and cCR is partly dependent on initial clinical T- and N-stage. Observational/retrospective studies suggest a selectiv e watch-and-wait policy with rigorous surveillance, avoiding radical surgery, is a safe option to offer pati...
Source: Current Colorectal Cancer Reports - January 20, 2017 Category: Cancer & Oncology Source Type: research
Current Status of Laparoscopic Surgery in Colorectal Cancer
We present a review of current status of laparoscopic surgery in the treatment of colorectal cancer. We discuss recent controversies and describe the results of latest minimally invasive techniques and technological innovations.Recent FindingsDespite recent studies questioning the quality of laparoscopic total mesorectal excision, the long-term data currently available continue to support the use of laparoscopy for the treatment of rectal cancer. Laparoscopy can also achieve a complete oncologic resection of T4 colon cancer similar to open surgery in selected patients. However, the evidence for laparoscopic complete mesoco...
Source: Current Colorectal Cancer Reports - January 17, 2017 Category: Cancer & Oncology Source Type: research
Molecular Classification of Colon Cancer: Perspectives for Personalized Adjuvant Therapy
AbstractAlthough surgery for early-stage colorectal cancer (CRC) is often curative, many patients require adjuvant chemotherapy to treat micrometastatic disease and to reduce the risk of recurrence. Targeted therapies have improved outcomes for patients with metastatic disease but, in the adjuvant setting, options are limited to a fluoropyrimidine alone or in combination with oxaliplatin. There is an unmet need for new predictive biomarkers to personalise treatment in the adjuvant setting. With goals to address this gap and to better characterise disease heterogeneity, several groups including our own have identified three...
Source: Current Colorectal Cancer Reports - October 16, 2016 Category: Cancer & Oncology Source Type: research
Ongoing Adjuvant/Neoadjuvant Trials in Resectable Metastatic Colorectal Cancer
AbstractThe treatment of patients with colorectal cancer with colorectal liver metastases remains an exciting challenge for the multidisciplinary team. The role and choice of induction chemotherapy, the timing of surgery in resectable disease and the prioritisation of resection of the primary or the metastases are all still controversial. A true multidisciplinary approach and individualisation of treatment strategies are recommended. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - September 28, 2016 Category: Cancer & Oncology Source Type: research
The Role of Adjuvant Treatment in Resected T3N0 Rectal Cancer
AbstractSince the adoption of total meso-rectal excision as the standard surgical approach for management of locally advanced rectal cancer, there has been a significant reduction in local recurrence. Neoadjuvant combined modality treatment with 5-fluorouracil-based chemotherapy and radiation has further improved local disease control and overall survival. Given the excellent survival obtained with this combined approach in T3N0 rectal cancer, there are concerns about the need for further exposure to chemotherapy with unproven benefit. We review the evidence for adjuvant chemotherapy in this setting and set out clinico-pat...
Source: Current Colorectal Cancer Reports - September 28, 2016 Category: Cancer & Oncology Source Type: research
Novel Radiation Approaches for the Treatment of Rectal Cancer: Where Are We Now?
This article will explore recent innovations and novel approaches involving radiation therapy to address these issues, including the use of intensity- modulated radiation therapy, avoidance of radical resection with the use of chemoradiation alone, total neoadjuvant chemotherapy with the selective use of chemoradiation, and the use of local excision approaches following neoadjuvant treatment. Although many of these novel strategies appear promisin g, data from prospective randomized trials will be necessary before implementation into standard practice. (Source: Current Colorectal Cancer Reports)
Source: Current Colorectal Cancer Reports - September 23, 2016 Category: Cancer & Oncology Source Type: research
What Is the Best Approach to Avoid Colorectal Cancer Risk in Inflammatory Bowel Disease?
AbstractInflammatory bowel diseases (IBD) comprise ulcerative colitis and Crohn ’s disease that primarily affect the colon and small intestine. IBD patients have a higher incidence of colorectal cancer (CRC) than the general population due to chronic colonic mucosal inflammation that predisposes to the development of dysplasia, the earliest form of neoplastic change in IBD an d other chronic inflammatory disorders (e.g., Barrett’s esophagus). Therefore, the two demonstrated means of reducing the risk of cancer in IBD are to control inflammation and to survey for dysplasia and remove the dysplastic area, if possible. (S...
Source: Current Colorectal Cancer Reports - September 23, 2016 Category: Cancer & Oncology Source Type: research
Molecular Biomarkers of Colorectal Cancer and Cancer Disparities: Current Status and Perspective
AbstractThis review provides updates on the efforts for the development of prognostic and predictive markers in colorectal cancer based on the race/ethnicity of patients. Since the clinical consequences of genetic and molecular alterations differ with patient race and ethnicity, the usefulness of these molecular alterations as biomarkers needs to be evaluated in different racial/ethnic groups. To accomplish personalized patient care, a combined analysis of multiple molecular alterations in DNA, RNA, microRNAs (miRNAs), metabolites, and proteins in a single test is required to assess disease status in a precise way. Therefo...
Source: Current Colorectal Cancer Reports - September 19, 2016 Category: Cancer & Oncology Source Type: research
Adjuvant Chemotherapy for Colon Cancer: Guidelines and Clinical Trials in Japan
AbstractIn Japan, adjuvant chemotherapy for colon cancer was mainly developed using oral fluoropyrimidines. However, all Japanese studies to date have failed to demonstrate a statistically significant survival benefit of adjuvant chemotherapy with a combination of uracil and tegafur (UFT) monotherapy over surgery alone in patients with stage II or III colon cancer. The non-inferiority trials comparing different oral fluoropyrimidine monotherapies showed any fluoropyrimidine except S-1 was comparable in patients with stage III colon cancer. Japanese guideline plays an important role in the distribution of the optimal adjuva...
Source: Current Colorectal Cancer Reports - September 13, 2016 Category: Cancer & Oncology Source Type: research
Modern Technical Approaches in Hepatic Surgery for Colorectal Metastases
AbstractThe liver is the most common site of metastases from colorectal cancer and can present as synchronous or metachronous lesions. Successful, margin-negative resection of all liver metastases is associated with significant long-term survival, but was traditionally possible in only a minority of patients. Due to advances in multimodality systemic therapy, improved understanding of tumor biology, and new advances in technical and procedural strategies, a greater number of patients are eligible for resection and potential cure. The purpose of this report is to review the technical advances in liver resection for patients...
Source: Current Colorectal Cancer Reports - August 29, 2016 Category: Cancer & Oncology Source Type: research
