International Preoperative Rectal Cancer Management: Staging, Neoadjuvant Treatment, and Impact of Multidisciplinary Teams

Abstract

BackgroundLittle is known regarding variations in preoperative treatment and practice for rectal cancer (RC) on an international level, yet practice variation may result in differences in recurrence and survival rates.MethodsOne hundred seventy-three international colorectal centers were invited to participate in a survey of preoperative management of rectal cancer.ResultsOne hundred twenty-three (71%) responded, with a majority of respondents from North America, Europe, and Asia. Ninety-three percent have more than 5 years’ experience with rectal cancer surgery. Fifty-five percent use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination and 1% PET scan in all RC cases. Seventy-four percent consider threatened circumferential margin (CRM) an indication for neoadjuvant treatment. Ninety-two percent prefer 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT). A significant difference in practice exists between the US and non-US surgeons: poor histological differentiation as an indication for CRT (25% vs. 7.0%, p = 0.008), CRT for stage II and III rectal cancer (92% vs. 43%, p = 0.0001), MRI for all RC patients (20% vs. 42%, p = 0.03), and ERUS for all RC patients (43% vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influence decisions for MRI (RR = 3.62), neoadjuvant treatment (threatened CRM, RR = 5.67, stage II + III RR = 2.98), quality of pathology report (RR = 4.85), and sphincter-saving surgery (RR = 3.81).ConclusionsThere was little consensus on staging, neoadjuvant treatment, and preoperative management of rectal cancer. Regular multidisciplinary team meetings influence decisions about neoadjuvant treatment and staging methods.

Laparoscopic versus open surgery for rectal cancer after neoadjuvant chemoradiation: a matched case-control study of short-term outcomes

“…Clinical examination has been reported to have an accuracy of 82% for the staging of rectal wall invasion if done by experienced practitioners [32]. Also, a recent survey on the preoperative management of rectal cancers among 123 colorectal centers across North America, Europe, and Asia found that 55% of the responders used CT scan for staging of the local disease, whereas only 35% used MRI and 29% used ERUS [33]. The authors concluded that little consensus exists on the preoperative staging of rectal cancer among colorectal surgeons.…”

Preclinical study of the DNA repair inhibitor Dbait in combination with chemotherapy in colorectal cancer

“…Chemotherapy may be given, in addition to surgery, to prevent local recurrence and metastases, or to treat metastatic disease. In locally advanced rectal cancer, preoperative chemotherapy is used in combination with radiotherapy to improve local control, to favor tumor downstaging and to increase the possibility of being able to carry out sphincter-sparing surgical procedures [2][3][4]. Most chemotherapy protocols are based on the use of 5-fluorouracil (5-FU), which may be combined with other chemotherapy agents, such as irinotecan, oxaliplatin, and/or other targeted therapies [5][6][7][8].…”

Modern trends in the combined treatment of colorectal cancer.

“…Учитывая большие различия в качестве хирургического лечения, существующие в на-стоящее время в разных странах и разных ле-чебных учреждениях [5,9], отказ от лучевой терапии у этих больных может привести к уве-личению числа рецидивов. Вместе с тем в от-дельных учреждениях с высоким уровнем диагностики и хорошим качеством хирургиче-ского лечения возможно применение подхода, предложенного Taylor F. и соавторами [43].…”

“…Именно поэтому, опухоль даже небольших размеров, расположенная в пределах мышеч-ного слоя стенки кишки, может находиться в непосредственной близости к предпола-гаемой ЦГР [11]. Некоторые исследователи применяют предоперационную лучевую те-рапию, основываясь только на расположении опухоли, проводя облучение всем больным с локализацией опухоли в нижнеампуляр-ном отделе [9]. Предпосылкой этому явля-ются данные о том, что применение лучевой терапии может способствовать увеличению расстояния от анального края до нижнего полюса опухоли [6,45].…”

“…В 2010 году Augestad K. M. и его соавтора-ми из Норвегии [9] было проведено большое исследование, в котором участвовало 123 ко-лопроктологических центра, главным образом из стран Северной Америки, Европы и Азии. В результате опроса было показано, что суще-ствуют очень большие различия между цен-трами в отношении диагностики и определе-ния показаний к лучевой терапии при РПК.…”