Rectal Cancer: Can We Throw Away the Scalpel?

Excerpt

It has long been held that chemotherapy and radiation are adjuncts to radical en-bloc surgical resection in the treatment of rectal cancer, that surgery is the most important modality of treatment, and, in early-stage disease, that surgery is the only treatment needed. In an effort to lessen the morbidity and potential lifestyle-altering effects of radical surgical resection, other therapeutic approaches have been advocated. Increasing evidence has suggested that chemoradiation followed by less radical (sphincter-sparing) surgery, or no surgery at all, may be adequate treatment, even for T2 and T3 tumors. However, concerns about regional disease in the mesorectum persist, even in T1 tumors, and radical surgery remains part of the therapy in most rectal cancers because we have yet to identify reliably a group of patients in whom we can predict good results without radical resection. …