Rectum-conserving surgery in the era of chemoradiotherapy.

Hdl Handle:
http://hdl.handle.net/10147/206299
Title:
Rectum-conserving surgery in the era of chemoradiotherapy.
Authors:
Smith, F M; Waldron, D; Winter, D C
Affiliation:
Department of Surgery, Mid-Western Regional Hospital, Limerick, Ireland.
Citation:
Br J Surg. 2010 Dec;97(12):1752-64.
Journal:
The British journal of surgery
Issue Date:
31-Jan-2012
URI:
http://hdl.handle.net/10147/206299
DOI:
10.1002/bjs.7251
PubMed ID:
20845400
Abstract:
BACKGROUND: A complete pathological response occurs in 10-30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. METHODS: A systematic review was performed using PubMed and Embase databases. Keywords included: 'rectal', 'cancer', 'transanal', 'conservative', 'complete pathological response', 'radiotherapy' and 'neoadjuvant'. Original articles from all relevant listings were sourced. These were hand searched for further articles of relevance. Main outcome measures assessed were rates of local recurrence and overall survival, and equivalence to radical surgery. RESULTS: Purely conservative 'watch and wait' strategies after CRT are still controversial. Originally used for elderly patients or those who refused surgery, the data support transanal excision of rectal tumours showing a good response to CRT. A complete pathological response in the T stage (ypT0) indicates < 5 per cent risk of nodal metastases. CONCLUSION: Rectal tumours showing an excellent response to CRT may be suitable for local excision, with equivalent outcomes to radical surgery. This approach should be the subject of prospective clinical trials in specialist centres.
Language:
eng
MeSH:
Digestive System Surgical Procedures/adverse effects/*methods; Humans; Neoadjuvant Therapy; Prognosis; Rectal Neoplasms/drug therapy/pathology/radiotherapy/*surgery; Rectum/*surgery; Sentinel Lymph Node Biopsy; Surgical Stomas; Treatment Outcome
ISSN:
1365-2168 (Electronic); 0007-1323 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorSmith, F Men_GB
dc.contributor.authorWaldron, Den_GB
dc.contributor.authorWinter, D Cen_GB
dc.date.accessioned2012-01-31T16:47:40Z-
dc.date.available2012-01-31T16:47:40Z-
dc.date.issued2012-01-31T16:47:40Z-
dc.identifier.citationBr J Surg. 2010 Dec;97(12):1752-64.en_GB
dc.identifier.issn1365-2168 (Electronic)en_GB
dc.identifier.issn0007-1323 (Linking)en_GB
dc.identifier.pmid20845400en_GB
dc.identifier.doi10.1002/bjs.7251en_GB
dc.identifier.urihttp://hdl.handle.net/10147/206299-
dc.description.abstractBACKGROUND: A complete pathological response occurs in 10-30 per cent of patients with locally advanced rectal cancer undergoing neoadjuvant chemoradiotherapy (CRT). The standard of care has been radical surgery with high morbidity risks and the challenges of stomata despite the favourable prognosis. This review assessed minimalist approaches (transanal excision or observation alone) to tumours with a response to CRT. METHODS: A systematic review was performed using PubMed and Embase databases. Keywords included: 'rectal', 'cancer', 'transanal', 'conservative', 'complete pathological response', 'radiotherapy' and 'neoadjuvant'. Original articles from all relevant listings were sourced. These were hand searched for further articles of relevance. Main outcome measures assessed were rates of local recurrence and overall survival, and equivalence to radical surgery. RESULTS: Purely conservative 'watch and wait' strategies after CRT are still controversial. Originally used for elderly patients or those who refused surgery, the data support transanal excision of rectal tumours showing a good response to CRT. A complete pathological response in the T stage (ypT0) indicates < 5 per cent risk of nodal metastases. CONCLUSION: Rectal tumours showing an excellent response to CRT may be suitable for local excision, with equivalent outcomes to radical surgery. This approach should be the subject of prospective clinical trials in specialist centres.en_GB
dc.language.isoengen_GB
dc.subject.meshDigestive System Surgical Procedures/adverse effects/*methodsen_GB
dc.subject.meshHumansen_GB
dc.subject.meshNeoadjuvant Therapyen_GB
dc.subject.meshPrognosisen_GB
dc.subject.meshRectal Neoplasms/drug therapy/pathology/radiotherapy/*surgeryen_GB
dc.subject.meshRectum/*surgeryen_GB
dc.subject.meshSentinel Lymph Node Biopsyen_GB
dc.subject.meshSurgical Stomasen_GB
dc.subject.meshTreatment Outcomeen_GB
dc.titleRectum-conserving surgery in the era of chemoradiotherapy.en_GB
dc.contributor.departmentDepartment of Surgery, Mid-Western Regional Hospital, Limerick, Ireland.en_GB
dc.identifier.journalThe British journal of surgeryen_GB
dc.description.provinceMunster-

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