Can we increase the chance of sphincter saving surgery in rectal cancer with neoadjuvant treatments: Lessons from a systematic review of recent randomized trials

Impact of Obesity on Operation Performed, Complications, and Long-term Outcomes in Terms of Restoration of Intestinal Continuity for Patients With Mid and Low Rectal Cancer

“…13 application of nCRt has been shown to reduce local recurrence 14 and also downstage cancer, but, to date, neoadjuvant treatment has not been proven to impact sphincter-saving strategies. 15 in our study, nearly 30% of the patients with mid or low rectal cancer had a permanent stoma after curative surgery. Previous studies have reported the aPR rate to be approximately 25% in all rectal cancers, with this rate rising to 40% in patients with low rectal cancer.…”

Surgeon perspectives on the use and effects of neoadjuvant chemoradiation in the treatment of rectal cancer: a comprehensive review of the literature

“…Similarly, the Polish trial that compared shortand long-course neoadjuvant radiotherapy on the primary outcome of SP failed to demonstrate any difference between each group. More recently, a systematic review of the role of neoadjuvant therapy on sphincter preservation was published, reporting data from 17 trials including the two aforementioned studies [47]. Unfortunately, as demonstrated by the authors, the trials are significantly heterogeneous which compromises the ability to perform a meta-analysis of the results.…”

New Neoadjuvant Treatment Strategies for Non-Metastatic Rectal Cancer (M0)

“…Even with TME surgery, the rate of local relapse is further reduced using neoadjuvant short course (25Gy/5fractions/ 1 week) radiotherapy [2,3] and it was the merit of the pivotal German trial [4, 5••] to demonstrate that neoadjuvant chemoradiotherapy (nCRT) was more efficient and less toxic than the postoperative strategy [6,7]. None of these nCRT was able to demonstrate an improvement in terms of overall survival, and more surprisingly, despite some increase in tumor response, they did not achieve any significant increase in sphincter-saving surgery [8,9]. Surgical technical developments using low anterior resection (LAR) and in some cases intersphincteric resection (ISR) were able to reduce the rate of abdomino-perineal resection (APR) with permanent stoma, but the bowel function and general tolerance of LAR are not always fully satisfactory [10] especially in elderly patients [11].…”