Organ Preservation and Palliative Options for Rectal Cancer
Local excision is a well-accepted organ preserving method for early rectal cancer with substantial lower morbidity and impact on quality of life compared to radical surgery. However, only rectal cancers staged as a T1 tumor limited to the superficial third of the submucosa (sm1) and less than 3 cm in diameter without signs of poor differentiation, lymphatic or vascular invasion, budding, or clustering in the final pathology are oncologically safely treated with radical local excision. These tumors have local recurrence rates of less than 5%. Small locally excised lesions with more risk factors as budding, poor differentiation, and lymphovascular invasion or even T2 lesions have been associated with relatively high recurrence rates. Due to the increased recurrence rate, most guidelines recommend completion radical surgery after local excision of high-risk lesions.
KeywordsOrgan preservation Palliative options Rectal cancer Local excision Adjuvant therapy Palliative radiotherapy
- 5.Borstlap WAA, van Oostendorp SE, Klaver CEL, Hahnloser D, Cunningham C, Rullier E, et al. Organ preservation in rectal cancer: a synopsis of current guidelines. Colorectal Dis. 2017. https://doi.org/10.1111/codi.13960.
- 7.Van Oostendorp SE, Vroom Y, Tuynman JB. Local recurrence rates after local excision of early rectal cancer followed by watchful waiting, completion TME and adjuvant (chemo) radiation; a meta-analysis. In preparation.Google Scholar
- 17.Giannoulopoulos D, Nastos C, Gavriatopoulou M, Vezakis A, Dellaportas D, Sotirova I, et al. The role of TAMIS (Transanal minimally invasive surgery) in the Management of Advanced Rectal Cancer – one shared story of three exceptional cases. J Invest Surg. 2018. https://doi.org/10.1080/08941939.2017.1418462.
- 25.Perez RO, Habr-Gama A, Sao Juliao GP, Proscurshim I, Scanavini Neto A, Gama-Rodrigues J. Transanal endoscopic microsurgery for residual rectal cancer after neoadjuvant chemoradiation therapy is associated with significant immediate pain and hospital readmission rates. Dis Colon Rectum. 2011;54(5):545–51.CrossRefGoogle Scholar
- 27.Rombouts AJM, Al-Najami I, Abbott NL, Appelt A, Baatrup G, Bach S, et al. Can we save the rectum by watchful waiting or TransAnal microsurgery following (chemo) radiotherapy versus Total mesorectal excision for early REctal Cancer (STAR-TREC study)?: protocol for a multicentre, randomised feasibility study. BMJ Open. 2017;7(12):e019474.PubMedPubMedCentralGoogle Scholar
- 29.Dattani M, Heald RJ, Goussous G, Broadhurst J, Sao Juliao GP, Habr-Gama A, et al. Oncological and survival outcomes in watch and wait patients with a clinical complete response after neoadjuvant Chemoradiotherapy for rectal Cancer: a systematic review and pooled analysis. Ann Surg. 2018;268:955.CrossRefGoogle Scholar
- 30.Smith FM, Rao C, Oliva Perez R, Bujko K, Athanasiou T, Habr-Gama A, et al. Avoiding radical surgery improves early survival in elderly patients with rectal cancer, demonstrating complete clinical response after neoadjuvant therapy: results of a decision-analytic model. Dis Colon Rectum. 2015;58(2):159–71.CrossRefGoogle Scholar
- 34.Rijkmans EC, Cats A, Nout RA, van den Bongard D, Ketelaars M, Buijsen J, et al. Endorectal brachytherapy boost after external beam radiation therapy in elderly or medically inoperable patients with rectal Cancer: primary outcomes of the phase 1 HERBERT study. Int J Radiat Oncol Biol Phys. 2017;98(4):908–17.CrossRefGoogle Scholar
- 36.Surgery for colorectal cancer in elderly patients: a systematic review. Colorectal Cancer Collaborative Group. Lancet. 2000;356(9234):968–74.Google Scholar