Techniques in Coloproctology

, Volume 21, Issue 7, pp 573–575 | Cite as

The good, the bad and the ugly: rectal cancers in the twenty-first century

  • G. P. São Julião
  • A. Habr-Gama
  • B. B. Vailati
  • R. O. PerezEmail author
Controversies in Colorectal Surgery

In the management of rectal cancer with neoadjuvant treatment followed by surgery, pre-operative chemoradiation used to be directed by the risk of development of local recurrence. In this setting, risk-stratification restricted the indications for neoadjuvant treatment for patients with high-risk (“ugly”) or intermediate risk (“bad”) tumors based on distance from circumferential resection margin (CRM), depth of mesorectal invasion, presence of lymph node metastases or extramural venous invasion. However, with the opportunity for organ-preserving strategies following complete response to neoadjuvant therapy, restriction of neoadjuvant treatment exclusively to high/moderate risk rectal cancers would significantly limit the amount of patients that could potentially benefit from this approach. Current trends have suggested that neoadjuvant treatment benefits patients with earlier stages of rectal cancer (previously considered “good” tumors) most likely develop complete response. It may...


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Conflict of interest

The authors declare that they have no conflict of interest.

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This article does not contain any studies with human participants or animals performed by the authors.

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Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • G. P. São Julião
    • 1
  • A. Habr-Gama
    • 1
  • B. B. Vailati
    • 1
  • R. O. Perez
    • 1
    • 2
    • 3
    Email author
  1. 1.Angelita & Joaquim Gama InstituteSão PauloBrazil
  2. 2.Colorectal Surgery DivisionUniversity of São Paulo School of MedicineSão PauloBrazil
  3. 3.Ludwig Institute for Cancer ResearchSão PauloBrazil

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