AffiliationDepartment of Surgery, Mid-Western Regional Hospital, Limerick, Ireland.
MeSHDigestive System Surgical Procedures/adverse effects/*methods
Rectal Neoplasms/drug therapy/pathology/radiotherapy/*surgery
Sentinel Lymph Node Biopsy
MetadataShow full item record
CitationBr J Surg. 2010 Dec;97(12):1752-64.
JournalThe British journal of surgery
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.
- Preoperative chemoradiotherapy and radical surgery for locally advanced distal rectal adenocarcinoma: pathologic findings and clinical implications.
- Authors: Medich D, McGinty J, Parda D, Karlovits S, Davis C, Caushaj P, Lembersky B
- Issue date: 2001 Aug
- The effects of preoperative chemoradiotherapy on lymph node sampling in rectal cancer.
- Authors: Miller ED, Robb BW, Cummings OW, Johnstone PA
- Issue date: 2012 Sep
- [Downstaging after neoadjuvant therapy for rectal cancer modifies the planned original surgery].
- Authors: Scutari F, Tramutola G, Morlino A, Rossi MT, Manzione L, Rosati G, Sopranzi A
- Issue date: 2008 Jun-Jul
- Complete clinical response after neoadjuvant chemoradiation for distal rectal cancer.
- Authors: Habr-Gama A, Perez R, Proscurshim I, Gama-Rodrigues J
- Issue date: 2010 Oct
- The surgical significance of residual mucosal abnormalities in rectal cancer following neoadjuvant chemoradiotherapy.
- Authors: Smith FM, Chang KH, Sheahan K, Hyland J, O'Connell PR, Winter DC
- Issue date: 2012 Jul