Limitation of Surgical Radicality in Rectal Cancer Responding to Neoadjuvant Therapy

Abstract

The basic principle in the treatment of rectal cancer is the complete surgical removal of the tumor together with the lymphatic drainage region, i.e. the mesorectum encased by the mesorectal ‘fascia pelvis visceralis’ according to Westhues. It was shown in the 1990s that the results of surgery alone could be improved by additional adjuvant and neoadjuvant therapy. Because of less toxicity and a lower rate of local recurrence, neoadjuvant therapies in International Union Against Cancer (UICC) stage II and III disease are now preferred over adjuvant strategies. The German Rectal Cancer study CAO/ARO/AIO-94 showed a full remission rate of 8% after a 5-fluorouracil (5-FU)based chemotherapy added to a conventional fractional radiation therapy (50.4 Gy). This figure, together with similar results of others, leads to the question whether surgical radicality in rectal cancer treatment could be limited in case of a good remission after neoadjuvant therapy. There are several promising possibilities under investigation, e.g. local excision instead of radical resection, or even no resection at all. Nevertheless, up to now these strategies did not prove to give comparable results to standard surgical procedures. Therefore, reduction of radicality in curable rectal cancer should be limited to accurately designed randomized clinical trials.

Preoperative Treatment Does Not Improve the Therapeutic Results of Abdominosacral Amputation of the Rectum

“…Until that time; however, it should be remembered that preoperative treatment can mitigate, but not eliminate, the adverse effects of imperfect surgery, nor can it ever replace it [21,[39][40][41].…”

“…Although clinically attractive, the hypothesis proven by our study obviously requires further verification by multicenter clinical trials. Until that time; however, it should be remembered that preoperative treatment can mitigate, but not eliminate, the adverse effects of imperfect surgery, nor can it ever replace it [21,[39][40][41].…”

Abdominothorakale Ösophagusresektion wegen Ösophagusstentperforation bei metastasiertem Magenkarzinomrezidiv im Stadium der kompletten Remission – eine Kasuistik

“…Durch die bereits bestehende Situation eines "Stent-inStent" war ein nochmaliges endoskopisches Vorgehen jedoch aussichtslos. Mehrere Autoren sehen in ausgewählten Fäl-len, insbesondere bei ausgedehnter Perforation und dem Vorhandensein von Perforations-bedingten Komplikationen die Ösophagusresektion als sinnvoll an, die perioperative Morbidität betrug 14-19 % [7,8]. Dass sich die komplette Remission histologisch anhand des Operationspräparates bestätigen ließ, war ein unerwartet positives Ereignis, sodass im Konsens für eine engmaschige Tumornachsorge und vorerst eine Beendigung der Chemotherapie entschieden wurde.…”