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Optimizing Preoperative Management of Rectal Cancer

Optimizing Preoperative Management of Rectal Cancer,10.1007/s00268-010-0930-5,World Journal of Surgery,Christof Hottenrott

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Optimizing Preoperative Management of Rectal Cancer   (Citations: 1)
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Advances in the preoperative staging for rectal cancer, including imaging technology such as computerized tomography (CT), magnetic resonance imaging (MRI), endorectal ultrasound (ERUS), 18 F fluorodeoxyglucose positron emission tomography (FDG-PET), and microarray-based gene-expression profiling signatures, permit improvement in tumor stage-guided neoadjuvant treatment. These improvements as well as standardization of total mesorectal excision (TME), laparoscopic or robot-assisted surgery, and multimodal treatment promise to improve substantially oncological and quality-of-life outcomes of patients with rectal cancer. However, state-of-the-art preoperative, surgical, and postoperative management of rectal cancer for optimizing treatment effect and minimizing adverse events and toxicity has not yet been defined. To assess whether there is a consensus in the management of rectal cancer, Augestad et al. [1] invited 173 international colorectal centers to participate in a survey of preoperative management of rectal cancer. The results of their study, published in November issue of the World Journal of Surgery, are interesting in that potential consensus or debate can influence and improve decisions on preoperative treatment of rectal cancer outside of specialized hospitals. The survey showed variations in the use of preoperative imaging: 55% use CT scan, 35% MRI, 29% ERUS, 12% digital rectal examination, and 1% PET scan in all rectal cancer cases. The most common reason for deciding on neoadjuvant treatment (75%) was the consideration of threatened circumferential margin. In a very high proportion (92%), 5-FU-based long-course neoadjuvant chemoradiation therapy (CRT) was preferred. There a significant difference in practice between the U.S. and nonU.S. surgeons regarding poor histological differentiation for deciding on CRT, CRT for stage II and stage III rectal cancer (92 vs. 43%, p = 0.0001), MRI, and ERUS for all rectal cancer patients (43 vs. 21%, p = 0.01). Multidisciplinary team meetings significantly influenced preoperative decisions. The authors conclude that regular multidisciplinary team meetings influence decisions about staging and neoadjuvant treatment.
Journal: World Journal of Surgery - WORLD J SURGERY , vol. 35, no. 6, pp. 1416-1417, 2011
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