How does preoperative radiotherapy affect the rate of sphincter-sparing surgery in rectal cancer?

Baker, Bilal; Salameh, Habeeb; Al-Salman, M.; Daoud, Faiez

doi:10.1016/j.suronc.2012.03.004

Cited by 21 publications

(20 citation statements)

References 73 publications

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“…The influence of tumour response after radiotherapy on the surgical management (Table 3) To date, it has not been proved that neoadjuvant treatment increases the rate of sphincter preservation [29]. This may seem strange at a time when Habr-Gama et al [30,31] propose simple surveillance alone in the case of a complete clinical response.…”

Section: Resultsmentioning

confidence: 99%

Controversies in the management of rectal cancer. A survey of French surgeons, oncologists and radiotherapists

Lefèvre

Benoist

2016

Colorectal Disease

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Section: Resultsmentioning

confidence: 99%

Controversies in the management of rectal cancer. A survey of French surgeons, oncologists and radiotherapists

Lefèvre

Benoist

2016

Colorectal Disease

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“…Unfortunately, most large studies have been unable to show any significant increase in the rate of sphincter preservation with the use of neoadjuvant therapy despite clearly showing its oncological advantages. 15,16 These results are still not clear when one looks at whether short or long course therapies were given or how long of an interval to wait. 16 The use of local excision offers the potential for sphincter preservation, but it is still being explored.…”

Section: Neoadjuvant Therapymentioning

confidence: 99%

“…15,16 These results are still not clear when one looks at whether short or long course therapies were given or how long of an interval to wait. 16 The use of local excision offers the potential for sphincter preservation, but it is still being explored.…”

Section: Neoadjuvant Therapymentioning

confidence: 99%

Current Concepts in Rectal Cancer

Fleshman

Smallwood

2015

Clinics in Colon and Rectal Surgery

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Since the first recorded surgical resection for rectal cancer in 1826 by Jacques Lisfranc, 1 the management of rectal cancer has evolved remarkably with dramatic improvements in local recurrence and mortality. Surgical resection is the only proven curative treatment of rectal cancer and the important advances in care have involved improvements in surgical techniques. Most of these improvements during this time period resulted from a better understanding of the anatomy and pathology of rectal cancer. It is important to be familiar with these important advances in rectal cancer treatment to fully understand the current methods of treatment.Historical Overview: From Miles' Abdominoperineal Resection to Today's Sphincter-Preserving Techniques Rectal Resections before MilesGiovanni Morgagni in the early 18th century was the first to propose rectal resection as a treatment for cancer. 1 However, it took over a century before the first successful rectal resection was performed. Over the years, there have been constant changes in the approach used by surgeons to perform a rectal resection.Rectal resections were first performed using a perineal approach as described in 1826 by Jacques LisFranc. 1,2 He operated in the era before anesthesia and proper antiseptic techniques. Since inadvertent entry into the peritoneal cavity could prove lethal, he chose the perineal approach to evert the rectum and perform a limited resection below the peritoneal reflection. A limited amount of rectum was resected with this approach and no attempt was made to purposely include the mesorectum and draining lymph nodes. 2 Success at that time was based upon whether the patient survived to leave the hospital, and so the risk of local recurrence had very little influence. With the advent of anesthesia and aseptic techniques, operations could now be performed that would provide for a more radical resection. Paul Kraske developed a technique similar to Kocher's technique, where he would incise and detach the left side of the coccyx and sacrum to provide more exposure. This exposure allowed him to resect the rectal cancer with ½ inch margins on either side of the rectum. The proximal bowel would then be pulled down and sutured to the anal sphincter complex. However, this "sacral anus" was difficult for the patient to manage. 1,3 Carl Guessenbauer performed the first transabdominal rectal resection and with closure and colostomy in 1879. This procedure would be later popularized by Henri Hartmann for the purpose of treating diverticulitis. 4 Vincent Czerny is credited with performing the first combined abdominal and perineal approach. This combined approach was never intended but was performed only after an unsuccessful attempt at resection through the perineal approach. 1 In Vogel's review of 1,500 cases performed by 12 of the most prominent 19th century surgeons including Billroth, Kocher, Kraske, and Czerny there was a 21% operative mortality rate with a high (80%) recurrence rate. 3 Surgery certainly had progressed beyond LisFranc's perineal res...

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“…The ideal regimen for neoadjuvant therapy is a matter of study. 53 In general, the radiotherapy totals 45-50.4 Gy in 25-28 doses given concomitantly with chemotherapy, which is typically 5-fluorouracil and leucovorin. Other chemotherapy regimens continue to be studied, but no alternative strategy has demonstrated superior results.…”

Section: Multimodality Therapy and Sphincter Preservationmentioning

confidence: 99%

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

Bordeianou

Maguire

Alavi

et al. 2014

Journal of Gastrointestinal Surgery

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Background Rectal cancer management has evolved into a complex multimodality approach with survival, local recurrence, and quality of life parameters being the relevant endpoints. Surgical treatment for low rectal cancer has changed dramatically over the past 100 years. Discussion Abdominoperineal resection, once the standard of care for all rectal cancers, has become much less frequently utilized as surgeons devise and test new techniques for preserving the sphincters, maintaining continuity, and performing oncologically sound ultra-low anterior or local resections. Progress in rectal cancer surgery has been driven by improved understanding of the anatomy and pathophysiology of the disease, innovative surgical technique, improved technology, multimodality approaches, and increased appreciation of the patient's quality of life. The patient with a low rectal cancer, once almost universally destined for impotence and a colostomy, now has the real potential for improved survival, avoidance of a permanent stoma, and preservation of the normal route of defecation.Keywords Rectal cancer . Sphincter preservation . Total mesorectal excision . Anterior resection . Intersphincteric resection . Local excision rectal cancer Historical BackgroundThe modern era of rectal cancer surgery began with the description of the abdominoperineal resection (APR) by Miles in 1908. Prior perineal and sacral approaches (e.g., Kraske approach) to rectal cancer resection produced high rates of complications, cancer recurrence, poor quality of life (QOL), and poor overall survival. Miles' operation reflected greater understanding of the natural history of rectal cancer that was based on postmortem examination of his patients after perineal resection. He observed cancerous implants in the pelvic peritoneum, mesorectum, and affected nodes of the left common iliac bifurcation. These findings led him to develop a "cylindrical concept" of the spread of rectal cancer to upward, downward, and lateral zones. 1 The original operation included resection of the rectum, sigmoid, mesorectum, nodes of the iliac bifurcation, and a perineal component to include the anus and levator ani muscles. Postoperative mortality was high initially, but local recurrence decreased

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How does preoperative radiotherapy affect the rate of sphincter-sparing surgery in rectal cancer?

Cited by 21 publications

References 73 publications

Controversies in the management of rectal cancer. A survey of French surgeons, oncologists and radiotherapists

Controversies in the management of rectal cancer. A survey of French surgeons, oncologists and radiotherapists

Current Concepts in Rectal Cancer

Sphincter-Sparing Surgery in Patients with Low-Lying Rectal Cancer: Techniques, Oncologic Outcomes, and Functional Results

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