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The Proper Treatment for the Complete Responder After Neoadjuvant Therapy

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Surgical Techniques in Rectal Cancer

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Abstract

The incorporation of new treatment modalities has significantly increased the complexity of decision-making for patients with locally advanced rectal cancer. Neoadjuvant chemoradiation (CRT) is considered one of the preferred treatment strategies for these patients. In addition, this treatment strategy may lead to significant tumor regression, ultimately leading to complete pathological response in up to 42% of patients. The assessment of tumor response following CRT and prior to radical surgery may identify patients with complete clinical response that could be managed nonoperatively with strict follow-up (watch and wait strategy) and thus avoiding unnecessary postoperative morbidity, including long-term urinary, sexual, and fecal continence dysfunctions and the frequent need for temporary or definitive stomas.

Avoiding immediate surgery for patients with complete clinical response may provide good long-term oncological outcomes and excellent functional results. In addition, close surveillance may allow early detection of local recurrences with salvage options avoiding any oncological compromise. This chapter deals with critical issues in appropriate selection of patients, details in follow-up, and management of local recurrences following a nonoperative approach to a patient with complete clinical response following neoadjuvant CRT.

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Authors and Affiliations

  1. Angelita & Joaquim Gama Institute, Rua Manoel da Nóbrega, 1564, São Paulo, Brazil

    Angelita Habr-Gama M.D., Maria Susana Bruzzi M.D., Maria Laura Morici M.D., Guilherme Pagin São Julião M.D. & Rodrigo Oliva Perez M.D. Ph.D.

  2. University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, Cerqueira César, São Paulo, Brazil

    Angelita Habr-Gama M.D.

  3. Colorectal Surgery Division, Department of Gastroenterology, University of São Paulo School of Medicine, São Paulo, Brazil

    Rodrigo Oliva Perez M.D. Ph.D.

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  1. Angelita Habr-Gama M.D.
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  2. Maria Susana Bruzzi M.D.
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  3. Maria Laura Morici M.D.
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  4. Guilherme Pagin São Julião M.D.
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  5. Rodrigo Oliva Perez M.D. Ph.D.
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Correspondence to Angelita Habr-Gama M.D. .

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Editors and Affiliations

  1. Saint-Pierre University Hospital, Department of Gastrointestinal Surgery, European School of Laparoscopic Surgery, Brussels, Belgium

    Giovanni Dapri

  2. Minimally Invasive Colorectal Surgery, Lankenau Medical Center, Main Line Healthcare, Wynnewood, Pennsylvania, USA

    John H Marks

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Habr-Gama, A., Bruzzi, M.S., Morici, M.L., São Julião, G.P., Perez, R.O. (2018). The Proper Treatment for the Complete Responder After Neoadjuvant Therapy. In: Dapri, G., Marks, J. (eds) Surgical Techniques in Rectal Cancer. Springer, Tokyo. https://doi.org/10.1007/978-4-431-55579-7_5

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