Preoperative decision making for rectal cancer

• Published in: The American journal of surgery Vol. 200; no. 3; pp. 426 - 432
• Main Authors: Taflampas, Panagiotis, M.D, Christodoulakis, Manousos, M.D, de Bree, Eelco, M.D, Melissas, John, Ph.D, Tsiftsis, Dimitris D.A., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2010; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Cancer; Cancer surgery; Cancer therapies; Cancer treatment; Chemoradiotherapy; Chemotherapy; Chemotherapy, Adjuvant; Circumferences; Colorectal cancer; Combined Modality Therapy; Decision Making; Diagnostic Imaging; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Health risk assessment; High resolution; Humans; Image resolution; Lymphatic system; Magnetic resonance imaging; Meat; Medical imaging; Medical sciences; Multidisciplinary team; Multidisciplinary treatment; Neoplasm Recurrence, Local; NMR; Nuclear magnetic resonance; Patient Care Team - organization & administration; Polycyclic aromatic hydrocarbons; Preoperative Care; Radiation therapy; Radiotherapy; Radiotherapy, Adjuvant; Rectal cancer; Rectal Neoplasms - diagnosis; Rectal Neoplasms - pathology; Rectal Neoplasms - surgery; Rectum; Stomach, duodenum, intestine, rectum, anus; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Studies; Surgeons; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Surgical techniques; Total mesorectal excision; Toxicity; Tumors; Total mesorectal excision; Multidisciplinary team; Multidisciplinary treatment; Rectal cancer; Radiotherapy; Cancer treatment; Proctectomy; Rectal disease; Decision making; Rectum cancer; Malignant tumor; Medicine; Treatment; Surgery; Digestive diseases; Intestinal disease; Preoperative; Anorectal disease; Multidisciplinary; Cancer
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2009.09.023

Abstract Background Rectal cancer treatment has become multimodal as a result of significant advances in imaging, staging, surgery, radiotherapy, and chemotherapy. Multidisciplinary teams can incorporate these developments into tailor-made treatment plans and offer state-of-the-art services for rectal cancer patients. Methods We searched the MEDLINE and PubMed databases using the following keywords: “rectal cancer,” “total mesorectal excision,” “multidisciplinary treatment/team,” “radiotherapy,” “chemotherapy,” and their combinations. There were no language or publication year restrictions. References in published articles also were reviewed. Results Total mesorectal excision surgery, high-resolution pelvic magnetic resonance imaging, preoperative chemoradiotherapy, and pathologic reports according to Quirke protocol are preconditions for the initiation of an effective multidisciplinary team. Common topics for discussion are the status of the circumferential margin, the type of radiotherapy and surgery required, and the chemotherapeutic agent to be used. Conclusions This review focuses on this issue based on two main principles. First, the status of the circumferential margin dictates the use of preoperative chemoradiotherapy. Second, preoperative chemoradiotherapy is superior in terms of free circumferential resection margin rate, local recurrence rate, and toxicity.