Timing of laparoscopic surgery in the neoadjuvant treatment of rectal cancer

Excerpt

Despite advances with signal transduction inhibitors, such as cetuximab and bevacizumab, as well as small molecules that target tyrosine kinases, surgery and chemoradiotherapy still remain the backbone of therapy of rectal cancer. Laparoscopic rectal cancer surgery has two major goals: to minimize locoregional recurrence and to prevent the sphincter. Total mesorectal excision (TME) is an integral part of surgery, achieving a complete tumor resection (R0) in patients with advanced disease (T2-3N1-2M0). Preoperative chemoradiotherapy results in tumor shrinkage and downstaging and in many cases a sphincter-preserving procedure that could not be possible without neoadjuvant chemoradiotherapy (NCRT). But some patients do not respond because of inherent (primary) resistance or acquired resistance during NCRT. For nonresponder patients, immediate surgery for tumor resection is required. Biomarkers for response prediction or imaging monitoring can help surgeons for the timing of surgery. …