The American Society of Colon and Rectal Surgeons Clinical Practice Guidelines for the Management of Rectal Cancer 2023 Supplement

Abstract

he American Society of Colon and Rectal Surgeons (ASCRS) is dedicated to ensuring high-quality patient care by advancing the science, prevention, and management of disorders and diseases of the colon, rectum, and anus. The Clinical Practice Guidelines (CPG) Committee is composed of society members who are chosen because they have demonstrated expertise in the specialty of colon and rectal surgery. This committee was created to lead international efforts in defining quality care for conditions related to the colon, rectum, and anus and develop CPG based on the best available evidence.Although not proscriptive, these guidelines provide information on which decisions can be made and do not dictate a specific form of treatment. These guidelines are intended for the use of all practitioners, health care workers, and patients who desire information about the management of the conditions addressed by the topics covered in these guidelines. These guidelines should not be deemed inclusive of all proper methods of care nor exclusive of methods of care reasonably directed toward obtaining the same results. The ultimate judgment regarding the propriety of any specific procedure must be made by the physician considering all the circumstances presented by the individual patient. STATEMENT OF THE PROBLEMColorectal cancer is the third most common cancer and the third most common cause of cancer-related deaths in the United States. 1 Approximately 30% of these cancers will originate in the rectum, and the American Cancer Society estimated a total of 44,850 new rectal cancer diagnoses in the United States for 2022. 2 Adenocarcinoma of the rectum is inherently complex. Surgery for rectal cancer is technically challenging and is associated with major alterations in GI, urinary, and sexual functions and with decreased quality of life. [3][4][5] The treatment of rectal cancer is also rapidly evolving, with new data emerging on a regular basis.In 2020, the ASCRS published its most recent CPG for rectal cancer. 6 This was a comprehensive assessment covering a wide spectrum of topics. Since then, there have been Earn continuing medical education (CME) credit online at cme.lww. com. This activity has been approved for AMA PRA category 1 credit.Funding/Support: None reported.

Treatment of Locally Advanced Rectal Cancer in the Era of Total Neoadjuvant Therapy

“…This number needed to treat should be regarded as clinically relevant, considering an association with significant improvement in long-term survival of patients reaching pCR 19 , 20 , 21 and that the active comparator is currently considered the gold standard in many countries. 1 , 4 , 69 Although the Clinical Practice Guidelines from the National Comprehensive Cancer Network and the American Society of Colon and Rectal Surgeons suggest TNT as the preferred treatment for patients with LARC as an alternative to L-CRT1, 2 , 14 European and Eastern guidelines still suggest standard chemoradiotherapy. 1 , 4 , 69 Despite some increase in toxic effects with TNT, there were no significant differences in terms of the number of patients undergoing surgery, postoperative complications, and pathological outcomes, including the rate of R0 and circumferential resection margin–negative specimens.…”

“…According to the rationale of these studies, the advantages of preoperative chemotherapy include better adherence, early treatment of micrometastases, and higher pathological complete response (pCR) rates. 11,13 The initial results of these studies were extremely encouraging, showing high pCR rates, and TNT protocols were rapidly incorporated in some US guidelines, 2,14 even though results on locoregional and distant recurrence rates, disease-free survival (DFS), and overall survival (OS) were not yet available. Some systematic reviews and meta-analyses assessed the efficacy and tolerability of TNT protocols compared with standard treatment, [15][16][17][18] but they used standard pairwise meta-analyses.…”

Effect of a Mobile Health–Based Remote Interaction Management Intervention on the Quality of Life and Self-Management Behavior of Patients With Low Anterior Resection Syndrome: Randomized Controlled Trial

“…Colorectal cancer incidence is also on the rise in China, with rectal cancer accounting for 60% of cases and middle and lower rectal cancers being the most common [2] .With the advancement of medical technology, optimal management of middle and lower rectal cancers increasingly favors sphincter-preserving surgery (SPS) [3] . This operation preserves anal function and avoids the inconvenience and pressure caused by permanent colostomy [4] . However, 70%-90% of patients after SPS struggle with long-term anorectal functional disturbances called low anterior resection syndrome (LARS) [5,6] .…”

An Unusual and Protracted Course of a Haggitt 3 Malignant Polyp Recurrence

“…Decisions regarding formal oncological resection and surveillance are ultimately based on the risk of locoregional lymphatic spread. This risk is based on the level of carcinoma differentiation, lymphovascular invasion, completeness of endoscopic resection margin, and level of submucosal invasion [ 2 , 3 ]. Patients with low-risk features and low Kikuchi (Sm1) or Haggitt levels (1-3) (i.e.…”

“…Patients with low-risk features and low Kikuchi (Sm1) or Haggitt levels (1-3) (i.e. invasion confined to the polyp stalk, and not colonic submucosa) can commonly be managed with endoscopic mucosal resection alone, with minimal risk of nodal involvement [ 3 ]. Post-resection surveillance regimes assess for locoregional recurrence and metasynchronous disease through interval endoscopy at three to six months one year, three years, and five years [ 4 , 5 ], which will determine the need for surgical resection.…”