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Journal of Gastrointestinal Surgery

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01-02-2014 | Evidence-Based Current Surgical Practice

Paradigm-Shifting New Evidence for Treatment of Rectal Cancer

Authors: Alessandro Fichera, Marco E. Allaix

Published in: Journal of Gastrointestinal Surgery | Issue 2/2014

Abstract

Background

Treatment of rectal cancer has dramatically evolved during the last three decades shifting toward a tailored approach based on preoperative staging and response to neoadjuvant combined modality therapy (CMT).

Methods

A literature search was performed using PubMed/Medline electronic databases.

Results

Selected patients with T1 N0 rectal cancer are best treated with local excision by transanal endoscopic microsurgery (TEM). Satisfactory results have been reported after CMT and TEM for the treatment of highly selected T2 N0 rectal cancers. CMT followed by rectal resection and total mesorectal excision is considered the standard of care for the treatment of locally advanced rectal cancer. However, a subset of stage II and III patients may not require neoadjuvant radiation treatment. Finally, there are mounting data supporting a “watch and wait” approach or local excision in patients with complete clinical response after neoadjuvant CMT.

Conclusions

Current evidence shows that selected T1 N0 rectal cancers can be managed by TEM alone, while locally advanced cancers should be treated by CMT followed by radical surgery. Studies are underway to identify patients that do not benefit from neoadjuvant radiation therapy. A non-operative approach in case of complete clinical response must be validated by large prospective studies.

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Title: Paradigm-Shifting New Evidence for Treatment of Rectal Cancer
Authors: Alessandro Fichera
Marco E. Allaix
Publication date: 01-02-2014
Publisher: Springer US
Published in: Journal of Gastrointestinal Surgery / Issue 2/2014
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-013-2297-z

At a glance: The STEP trials

Springer Medicine

Paradigm-Shifting New Evidence for Treatment of Rectal Cancer

Abstract

Background

Methods

Results

Conclusions

At a glance: The STEP trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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