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Journal of Gastrointestinal Surgery

Erschienen in:

01.02.2014 | Evidence-Based Current Surgical Practice

Paradigm-Shifting New Evidence for Treatment of Rectal Cancer

verfasst von: Alessandro Fichera, Marco E. Allaix

Erschienen in: Journal of Gastrointestinal Surgery | Ausgabe 2/2014

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Abstract

Background

Treatment of rectal cancer has dramatically evolved during the last three decades shifting toward a tailored approach based on preoperative staging and response to neoadjuvant combined modality therapy (CMT).

Methods

A literature search was performed using PubMed/Medline electronic databases.

Results

Selected patients with T1 N0 rectal cancer are best treated with local excision by transanal endoscopic microsurgery (TEM). Satisfactory results have been reported after CMT and TEM for the treatment of highly selected T2 N0 rectal cancers. CMT followed by rectal resection and total mesorectal excision is considered the standard of care for the treatment of locally advanced rectal cancer. However, a subset of stage II and III patients may not require neoadjuvant radiation treatment. Finally, there are mounting data supporting a “watch and wait” approach or local excision in patients with complete clinical response after neoadjuvant CMT.

Conclusions

Current evidence shows that selected T1 N0 rectal cancers can be managed by TEM alone, while locally advanced cancers should be treated by CMT followed by radical surgery. Studies are underway to identify patients that do not benefit from neoadjuvant radiation therapy. A non-operative approach in case of complete clinical response must be validated by large prospective studies.

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Titel: Paradigm-Shifting New Evidence for Treatment of Rectal Cancer
verfasst von: Alessandro Fichera
Marco E. Allaix
Publikationsdatum: 01.02.2014
Verlag: Springer US
Erschienen in: Journal of Gastrointestinal Surgery / Ausgabe 2/2014
Print ISSN: 1091-255X
Elektronische ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2297-z

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