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Tailored Surgical Treatment Based on Response to Neoadjuvant Therapy

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Book cover Surgical Treatment of Colorectal Cancer

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Abstract

Introduction of neoadjuvant chemoradiotherapy for rectal cancer results in diversity of surgical treatment. It is based on the variable response to neoadjuvant therapy. Favorable oncologic outcomes of patients with good response to neoadjuvant therapy have been reported, and organ-preserving strategies have extended its application for these patients. However, definition of good response to neoadjuvant therapy has not clearly defined, and different categorization has been used in many researches. Usually pathologic regression grade is used for identification of good responder, but the pathologic grading system is diverse. Recently MRI is increasing in use to define response to neoadjuvant therapy because pathologic assessment is not available before surgical treatment. MRI is more useful to set plan to surgical strategies. But, the accuracy of MRI is not satisfactory as well as other imaging modalities. Therefore, we have to determine the definition of response level and standard method of assessment.

There are ongoing active studies regarding surgical or observational strategies for good responders to neoadjuvant therapy.

Functional preservation was the most attractive aspect of these strategies, but the long-term functional and oncological outcomes are not well established. In addition, the surveillance strategies are not yet established and have no consensus. Before extension of organ-preserving strategies, indication, and surveillance have to be preconditioned.

Although researches focused on good responder to neoadjuvant therapy is increasing, poor responders is not interested in surgical field. Considerate approach to poor responder to neoadjuvant therapy is needed in surgical as well as medical treatment.

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Authors and Affiliations

  1. Department of Colon and Rectal Surgery, University of Ulsan College of Medicine and Asan Medical Center, Seoul, South Korea

    In Ja Park & Chang Sik Yu

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  1. In Ja Park
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  2. Chang Sik Yu
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Correspondence to In Ja Park .

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Editors and Affiliations

  1. Department of Surgery, Yonsei University College of Medicine, Seoul, Korea (Republic of)

    Nam Kyu Kim

  2. Department of Surgery, Tokyo Medical and Dental University, Tokyo, Japan

    Kenichi Sugihara

  3. Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei City, Taiwan

    Jin-Tung Liang

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Park, I.J., Yu, C.S. (2018). Tailored Surgical Treatment Based on Response to Neoadjuvant Therapy. In: Kim, N., Sugihara, K., Liang, JT. (eds) Surgical Treatment of Colorectal Cancer. Springer, Singapore. https://doi.org/10.1007/978-981-10-5143-2_9

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  • DOI: https://doi.org/10.1007/978-981-10-5143-2_9

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-10-5142-5

  • Online ISBN: 978-981-10-5143-2

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