Surgical tactics for «near-complete» rectal cancer response to neoadjuvant therapy: total mesorectumectomy or local excision?
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Keywords

review
rectal cancer
combination therapy
chemoradiotherapy
post-radiation tumor regression
therapeutic pathomorphosis
surgical treatment
local excision

How to Cite

Karachun, A., & Samsonov, D. (2022). Surgical tactics for «near-complete» rectal cancer response to neoadjuvant therapy: total mesorectumectomy or local excision?. Voprosy Onkologii, 67(1), 40–43. https://doi.org/10.37469/0507-3758-2021-67-1-40-43

Abstract

The successes of neoadjuvant therapy for locally advanced rectal cancer, which can sometimes achieve significant tumor regression, suggests that the performance of total mesorectumectomy in certain categories of such patients may be excessive. The rapid development of minimally invasive surgical technologies designed to limit the trauma due to the intervention, reduce the risk of postoperative complications, improve the quality of life and increase the proportion of sphincter-preserving operations, initiated several studies investigating the results of local excision of irradiated tumors of rectal cancer. This review article considers the published results of such studies, the problems, and prospects of this surgical strategy. The search of scientific literature was carried out using the PubMed database.

https://doi.org/10.37469/0507-3758-2021-67-1-40-43
pdf (Русский)

References

Злокачественные новообразования в России в 2018 году (заболеваемость и смертность) / Под ред. Каприна А.Д., Старинского В.В., Петровой Г.В. – М.: МНИОИ им. П.А. Герцена  филиал ФГБУ «НМИЦ радиологии» Минздрава России. 2019. [Zlokachestvennye novoobrazovaniya v Rossii v 2018 godu (zabolevaemost i smertnost). Ed by Kaprin A.D., Starinskii V.V., Petrova G.V. Moscow: P.A. Hertsen Moscow Oncology Research Center – branch of FSBI NMRRC of the Ministry of Health of Russia; 2019 (In Russ)].

Беляев А.М., Карачун А.М., Петров А.С., Самсонов Д.В. Современные тенденции развития хирургии опухолей желудочно-кишечного тракта. Вопросы онкологии. 2016; 62(2):187-195 [Belyaev A.M., Karachun A.M., Petrov A.S., Samsonov D.V. Modern trends in surgery of gastrointestinal tract tumors. Problems in oncology. 2016;62(2):187-195 (In Russ)]

Карачун А.М., Самсонов Д.В., Доманский А.А. и др. Малоинвазивная хирургия рака прямой кишки: проблемы и перспективы. Поволжский онкологический вестник. 2016;5 (27):76-82 [Karachun A.M., Samsonov D.V., Domanskiy А.А. et al. Minimally invasive surgery of rectal cancer: problems and prospects. Oncology bulletin of the Volga region. 2016;5(27):76-82 (In Russ)].

Lezoche E., Baldarelli M., Lezoche G. et al. Randomized clinical trial of endoluminal locoregional resection versus laparoscopic total mesorectal excision for T2 rectal cancer after neoadjuvant therapy. B J Surg. 2012;99(9):1211-1218. doi: 10.1002/bjs.8821.

Bujko K., Richter P., Smith F.M. et al. Preoperative radiotherapy and local excision of rectal cancer with immediateradical re-operation for poor responders: a prospective multicentre study. Radiother Oncol. 2009;92(2):195-201. doi: 10.1016/j.radonc.2012.12.005.

Verseveld M., de Graaf E.J.R., Verhoef C. et al. Chemoradiation therapy for rectal cancer in the distal rectum followed by organ-sparing transanal endoscopic microsurgery (CARTS study). B J Surg. 2015;102(7):853-860. doi: 10.1002/bjs.9809.

Stijns R.C.H., de Graaf E.J.R., Punt C. et al. Long-term oncological and functional outcomes of chemoradiotherapy followed by organ-sparing transanal endoscopic microsurgery for distal rectal cancer: the CARTS study. JAMA Surg. 2019;154(1):47-54. doi: 10.1001/jamasurg.2018.3752.

Pucciarelli S., De Paoli A., Guerrieri M. et al. Local Excision After Preoperative chemoradiotherapy for rectal cancer. Dis Colon Rectum. 2013;56(12):1349-1356. doi:10.1097/dcr.0b013e3182a2303e.

Smart C.J., Korsgen S., Hill J. et al. Multicentre study of short-course radiotherapy and transanal endoscopic microsurgery for early rectal cancer. B J Surg. 2016;103(8): 1069-1075. doi:10.1002/bjs.10171.

Garcia-Aguilar J, Renfro LA, Chow OS et al. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015;16(15):1537-1546. doi:10.1016/s1470-2045(15)00215-6.

Rullier E., Rouanet P., Tuech J-J. et al. Organ preservation for rectal cancer (GRECCAR 2): a prospective, randomised, open-label, multicentre, phase 3 trial. Lancet. 2017;390(10093):469–479. doi:10.1016/s0140-6736(17)31056-5.

Rullier E., Vendrely V., Asselineau J. et al. Organ preservation with chemoradiotherapy plus local excision for rectal cancer: 5-year results of the GRECCAR 2 randomised trial. Lancet Gastroenterol Hepatol. 2020;5(5): 465-474. doi: 10.1016/S2468-1253(19)30410-8.

Smith J.J., Chow O.S., Gollub M.J. et al. Organ preservation in rectal adenocarcinoma: a phase II randomized controlled trial evaluating 3-year disease-free survival in patients with locally advanced rectal cancer treated with chemoradiation plus induction or consolidation chemotherapy, and total mesorectal excision or nonoperative management. BMC Cancer. 2015;15(1):767 doi:10.1186/s12885-015-1632-z.

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