Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Glynne‐Jones, Robert; Wyrwicz, Lucjan; Tiret, Emmanuel; Brown, Gina; Rödel, Claus; Cervantes, Andrés; Arnold, Dirk

doi:10.1093/annonc/mdx224

Cited by 1,177 publications

(757 citation statements)

References 93 publications

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“…Studies have proposed up‐front surgery for upper rectal tumors because of the low LR risk and the sphincter preservation advantage . In 2017, a multidisciplinary team of European cancer experts achieved consensus on risk‐adapted treatment in those patients with recurring cT4 tumors in the pelvis might benefit from NCRT . Nevertheless, they did not recommend applying this treatment model uniformly to all rectal cancer patients regardless of tumor location .…”

Section: Introductionmentioning

confidence: 99%

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Huang

Wang

2019

The Kaohsiung J of Med Scie

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Colorectal cancer is a major public health problem worldwide, and locally advanced rectal cancer (LARC) is known for its poor prognosis. A multimodal treatment approach is the only method to achieve satisfactory local recurrence and survival rates in LARC. Determining which therapeutic modality for LARC has the most satisfactory influence on quality of life and disease outcome is still controversial. LARC treatment is subject to continuous advancement due to the development of new and better diagnostic tools, radiotherapy techniques, and chemotherapeutic agents. Herein, we review various therapeutic modalities for LARC from several aspects. In addition to radiotherapy techniques such as neoadjuvant chemoradiotherapy (NCRT), we discuss the progress of chemotherapy, appropriate time interval between NCRT and surgery, relationship between tumor location and NCRT efficacy/safety, wait‐and‐watch policy, and predictors of treatment response following NCRT. Because of the controversies and unanswered questions regarding NCRT treatments for LARC, additional investigations are required to determine which therapeutic approach is the most feasible for LARC patients.

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Section: Introductionmentioning

confidence: 99%

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Huang

Wang

2019

The Kaohsiung J of Med Scie

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“…The rate of patients who develop a local recurrence despite NRT is at least 6% [12]. Further criteria such as the circumferential resection margin (CRM), depth of extramural invasion, and extramural vascular invasion have been identified which proved to provide even better prognostic value and resulted in a subdivision outside of the UICC classification [13]. Although these variables are continuously implemented into the actual guidelines, they have not yet fully reached daily clinical practice.…”

Section: Introductionmentioning

confidence: 99%

Overstaging: A Challenge in Rectal Cancer Treatment

et al. 2018

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Background: Preoperative staging, including computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), is decisive to envisage the therapeutic concept for rectal cancer (RC). Overstaging may subject the patient to neoadjuvant therapy that does not improve survival but may lead to therapy-associated morbidity. Methods: This study retrospectively compares and values EUS, CT, and MRI in Union Internationale Contre le Cancer (UICC) stage I-III RC with a focus on overstaging. RC patients receiving primary operation only at the University Clinic Ulm were analyzed. The therapeutic relevance of preoperative staging was determined by comparison with postoperative pathological workup. Results: 244 examinations in 184 RC patients (EUS: n = 63, CT: n = 143, MRI: n = 38) revealed therapy-relevant overstaging into the T3/4 category in 10 (16%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Patients were upgraded to the N+ category in 13 (21%) EUS, 29 (20%) CT, and 11 (29%) MRI cases. As a result, UICC stages II and III turned out to be overstaged in 13 (21%) EUS, 18 (13%) CT, and 10 (26%) MRI cases. Conclusion: More than 10% therapy-relevant overstaging by any method represents a major challenge for modern RC therapy. Physicians should scrupulously consider this fact in their treatment considerations to avoid overtreatment.

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“…However, local recurrence after TEM is a major problem in up to 24% of patients treated for rectal cancer by this method [2,11,12,13,14,15]. If a more advanced cancer stage (more than pT1 sm1) is found in TEM specimen or if the tumour is poorly differentiated, a salvage TME (sTME) procedure is indicated in these patients [16]. …”

Section: Introductionmentioning

confidence: 99%

Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis

et al. 2018

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Introduction: Transanal endoscopic microsurgery (TEM) is a minimally invasive procedure which allows local excision of early-stage rectal cancer and can be used as an alternative treatment to radical surgery. Patients can undergo salvage total mesorectal excision (sTME) following TEM after finding of unfavourable histological features. This study aimed to compare results and possible complications of sTME following TEM and primary TME (pTME) procedures. Methods: Between 2010 and 2017, early sTME was performed in 9 patients at the National Cancer Institute in Vilnius, Lithuania. These patients were compared with 18 patients who underwent pTME, matched according to gender, age, cancer stage, and operative procedure. Data were obtained from the patients' charts and reviewed prospectively. We recorded the demographics, tumour specifications, treatment, operation time, postoperative results complications, and oncological outcome. Fisher's exact test and student's T test was used to compare both groups. Results: A total of 130 patients underwent TEM at our institution during the study period, of which 9 (6.92%) had to undergo sTME. The average age of the patients was 62.7 ± 7.07 years; 44.4% of the patients were male and 55.6% female. The average tumour size in the sTME group was 2.8 ± 1.05 cm (range 1.5-5) and 2.61 ± 1.36 cm (range 1-5) in the pTME group (p = 0.696). When comparing postoperative complications, statistically significant results were not found in either of the groups (p = 0.55). Operation time of pTME was significantly shorter on average, i.e. 43 min, compared to sTME (p < 0.0267). The average number of harvested lymph nodes was 12.44 ± 7.126 in the sTME and 12.5 ± 8.06 in the pTME group (p = 0.986). The circumferential resection margin (CRM) was negative in 92.6% (25/27) of specimens, while the CRM was positive in 2 cases (7.4%), both of which were from the sTME group. The average follow-up time was 22.8 months (8-80 months) for patients undergoing sTME and 19.33 months (2-88 months) for patients after pTME (p = 0.71). Conclusions: TEM is a relatively safe method for treating patients with early rectal cancer without high-risk features. It can be used in exceptional cases with high-risk features when the patient is not fit for radical surgery.

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Rectal cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

Cited by 1,177 publications

References 93 publications

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Surgical treatment following neoadjuvant chemoradiotherapy in locally advanced rectal cancer

Overstaging: A Challenge in Rectal Cancer Treatment

Is Previous Transanal Endoscopic Microsurgery for Early Rectal Cancer a Risk Factor of Worse Outcome following Salvage Surgery A Case-Matched Analysis

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