Progress in the multidisciplinary treatment of gastrointestinal cancer and the impact on clinical practice: perioperative management of rectal cancer

Rectal cancer staging: focus on the prognostic significance of the findings described by high-resolution magnetic resonance imaging

“…Thus, HR MRI provides the information needed to stratify patients into 2 groups: good prognosis or poor prognosis. The standardized HR MRI report should include the following information for further discussion by the MDT: (1) the potential involvement of the CMR, (2) depth of tumor spread beyond the muscularis propria, (3) nodal status, (4) the presence of extramural vascular invasion, and (5) the commitment of the puborectalis sling muscle [ 13 , 15 ] . Patients with a good prognosis are selected for primary surgery, i.e.…”

“…total mesorectal excision (TME), with a 5-year survival rate of 85–90% [ 13 ] . Tumors presenting the following features are considered to have a good prognosis: (1) potentially negative CRM (>1 mm), (2) T1–T2 or T3 tumors with extramural extension <5 mm, (3) absence of extramural vascular invasion, (4) N0/N1, (5) tumors located in the middle or upper third [ 13 , 15 ] . Patients with a poor prognosis include the following: patients with tumors with a low risk of local recurrence because of a free CRM, but increased risk of systemic failure.…”

Chinese guidelines for the diagnosis and comprehensive treatment of hepatic metastasis of colorectal cancer

“…Neoadjuvant chemoradiotherapy may make TME easier to perform, reducing the risk of local recurrence and result in a better prognosis. Neoadjuvant therapy will also reduce T staging for rectal cancer patients with phase II with local infiltration in addition to reducing T stage of phase III patients and regional lymph nodes to reduce N staging (Cervantes et al 2008;Huang et al 2001;Ceelen et al 2009;Soumarova et al 2009). …”

“…Radiotherapy before operation: Short duration radiotherapy (5 days) with total dosage of 25 Gy (Cervantes et al 2008;Roohipour et al 2008;Sebag-Montefiore et al 2009;Siegel et al 2009) for rectal cancer and regional lymph nodes with radical surgery performed at days 1-7 after radiotherapy improves the risk of local recurrence. However, short-course radiotherapy will make the surgery technically more difficult, increasing the probability of anastomotic leakage, which should be monitored carefully (Vermaas et al 2007) (2b evidence, level B recommendation).…”

Radiotherapy in rectal cancer: development, adequacy and radiotherapy utilisation rate. A comparative analysis with the most frequent tumour sites

“…Historically, the fi rst therapeutic intervention for dealing with oncological processes has been greatly infl uenced by the referring services that are specifi c to the particular healthcare centre involved. Today, no one questions that the therapeutic decisions for dealing with rectal cancer should be taken by a multidisciplinary group, irrespective of the patient's point of entry to the health-care system, and on the basis of agreed protocols [6].…”