Low anterior resection for rectal cancer is associated with high morbidity, permanent stomas and functional impairment. Different strategies to avoid this surgery in low rectal cancer are being pursued. Several prospective trials have explored a strategy of neoadjuvant treatment to downstage rectal cancer and allow for local resection of the tumor. In this paper we review these trials and the published results of this strategy in regards of patient selection, successful downstaging, oncologic outcomes, morbidity and functional outcomes. In selected patients, this new strategy achieved good downstaging of tumors and similar oncologic outcomes when compared to radical resection. Some questions regarding patient selection remain, mainly which patients should undergo completion surgery after local resection.
Background: Preoperative staging of rectal cancer (RC) with magnetic resonance imaging (MRI) made it possible to individualize treatment and select high-risk patients who will benefit from neoadjuvant treatment, by identifying prognostic risk factors, which were previously established only through histopathological studies. Among these prognostic risk factors, emphasis should be given to extramural venous invasion (EMVI) and extramural depth of tumor (EMDT). Methods: This study aimed to evaluate the following issues: first the accuracy of MRI for detection of EMVI compared to histopathologic analysis second to evaluate the prognostic value of EMVI determined by MRI and third to establish the relationship between EMVI and EMDT. Results: MRI staging of 151 patients that underwent surgical resection for RC, were analyzed for MRI grading of EMVI, using a score of three levels. Comparison between MRI grading of EMVI and histopathology made it possible to conclude that there was no significant difference between the two methods. As far as the prognostic value of EMVI, the estimated average survival rate and estimated relapse-free survival were higher in patients with degree 0. Furthermore, there was a strong positive correlation between EMVI and EMDT from MRI. Conclusions: MRI grading of EMVI correlates with histopathological findings and should be included in the multidisciplinary preoperative discussion of RC patients.
Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.