Modern Management of Rectal Cancer: a 2006 Update

Overview

Journal World J Gastroenterol

Publisher Baishideng Publishing Group

Specialty Gastroenterology

Date 2006 May 24

PMID 16718838

Citations 40

Authors

Glen-C Balch

Alex De Meo

Jose-G Guillem

Affiliations

Soon will be listed here.

Abstract

The goal of this review is to outline some of the important surgical issues surrounding the management of patients with early (T1/T2 and N0), as well as locally advanced (T3/T4 and/or N1) rectal cancer. Surgery for rectal cancer continues to develop towards the ultimate goals of improved local control and overall survival, maintaining quality of life, and preserving sphincter, genitourinary, and sexual function. Information concerning the depth of tumor penetration through the rectal wall, lymph node involvement, and presence of distant metastatic disease is of crucial importance when planning a curative rectal cancer resection. Preoperative staging is used to determine the indication for neoadjuvant therapy as well as the indication for local excision versus radical cancer resection. Local excision is likely to be curative in most patients with a primary tumor which is limited to the submucosa (T1N0M0), without high-risk features and in the absence of metastatic disease. In appropriate patients, minimally invasive procedures, such as local excision, TEM, and laparoscopic resection allow for improved patient comfort, shorter hospital stays, and earlier return to preoperative activity level. Once the tumor invades the muscularis propria (T2), radical rectal resection in acceptable operative candidates is recommended. In patients with transmural and/or node positive disease (T3/T4 and/or N1) with no distant metastases, preoperative chemoradiation followed by radical resection according to the principles of TME has become widely accepted. During the planning and conduct of a radical operation for a locally advanced rectal cancer, a number of surgical management issues are considered, including: (1) total mesorectal excision (TME); (2) autonomic nerve preservation (ANP); (3) circumferential resection margin (CRM); (4) distal resection margin; (5) sphincter preservation and options for restoration of bowel continuity; (6) laparoscopic approaches; and (7) postoperative quality of life.

Citing Articles

Impact of pelvic floor muscle training on sphincter function and quality-of-life in patients who underwent low anterior resection: A comparative evaluation.

Ofluoglu C, Aydin I, Altuntas Y, Cetin K, Inan R, Ilhan N North Clin Istanb. 2024; 11(4):336-342.

PMID: 39165708 PMC: 11331206. DOI: 10.14744/nci.2024.37786.

A Prospective Study on the Roles of the Lymphocyte-to-Monocyte Ratio (LMR), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR) in Patients with Locally Advanced Rectal Cancer.

Gawinski C, Mroz A, Roszkowska-Purska K, Sosnowska I, Derezinska-Wolek E, Michalski W Biomedicines. 2023; 11(11).

PMID: 38002048 PMC: 10669751. DOI: 10.3390/biomedicines11113048.

Predictive value of infiltrating tumor border configuration of rectal cancer on MRI.

Lv B, Yuan L, Li J, Kong X, Cheng Y, Shang K BMC Med Imaging. 2023; 23(1):155.

PMID: 37828450 PMC: 10571450. DOI: 10.1186/s12880-023-01118-y.

Prognostic Significance of EMVI in Rectal Cancer in a Tertiary Cancer Hospital in India.

Pangarkar S, Baheti A, Mistry K, Choudhari A, Patil V, Ahuja A Indian J Radiol Imaging. 2021; 31(3):560-565.

PMID: 34790298 PMC: 8590579. DOI: 10.1055/s-0041-1736404.

The protective effects of melatonin on blood cell counts of rectal cancer patients following radio-chemotherapy: a randomized controlled trial.

Kouhi Habibi N, Shabestani Monfared A, Ebrahimnejad Gorji K, Karimi M, Moghadamnia A, Tourani M Clin Transl Oncol. 2018; 21(6):745-752.

PMID: 30421178 DOI: 10.1007/s12094-018-1977-2.

References

Jess P, Christiansen J, Bech P . Quality of life after anterior resection versus abdominoperineal extirpation for rectal cancer. Scand J Gastroenterol. 2002; 37(10):1201-4. DOI: 10.1080/003655202760373425. View

Kim C, Yeatman T, Coppola D, Trotti A, Williams B, Barthel J . Local excision of T2 and T3 rectal cancers after downstaging chemoradiation. Ann Surg. 2001; 234(3):352-8; discussion 358-9. PMC: 1422026. DOI: 10.1097/00000658-200109000-00009. View

Nesbakken A, Nygaard K, Westerheim O, Mala T, Lunde O . Local recurrence after mesorectal excision for rectal cancer. Eur J Surg Oncol. 2002; 28(2):126-34. DOI: 10.1053/ejso.2001.1231. View

Chen C, Lee R, Lin J, Wang L, Yang S . How accurate is magnetic resonance imaging in restaging rectal cancer in patients receiving preoperative combined chemoradiotherapy?. Dis Colon Rectum. 2005; 48(4):722-8. DOI: 10.1007/s10350-004-0851-1. View

Bosset J, Magnin V, Maingon P, Mantion G, Pelissier E, Mercier M . Preoperative radiochemotherapy in rectal cancer: long-term results of a phase II trial. Int J Radiat Oncol Biol Phys. 2000; 46(2):323-7. DOI: 10.1016/s0360-3016(99)00411-3. View

Guillem J . Ultra-low anterior resection and coloanal pouch reconstruction for carcinoma of the distal rectum. World J Surg. 1997; 21(7):721-7. DOI: 10.1007/s002689900297. View

Anthuber M, Fuerst A, Elser F, Berger R, Jauch K . Outcome of laparoscopic surgery for rectal cancer in 101 patients. Dis Colon Rectum. 2003; 46(8):1047-53. DOI: 10.1007/s10350-004-7279-5. View

Guillem J, Chessin D, Cohen A, Shia J, Mazumdar M, Enker W . Long-term oncologic outcome following preoperative combined modality therapy and total mesorectal excision of locally advanced rectal cancer. Ann Surg. 2005; 241(5):829-36. PMC: 1357138. DOI: 10.1097/01.sla.0000161980.46459.96. View

Bedrosian I, Rodriguez-Bigas M, Feig B, Hunt K, Ellis L, Curley S . Predicting the node-negative mesorectum after preoperative chemoradiation for locally advanced rectal carcinoma. J Gastrointest Surg. 2004; 8(1):56-62. DOI: 10.1016/j.gassur.2003.09.019. View

10.

Pucciarelli S, Capirci C, Emanuele U, Toppan P, Friso M, Pennelli G . Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. Ann Surg Oncol. 2005; 12(2):111-6. DOI: 10.1245/ASO.2005.03.044. View

11.

Ho Y, Brown S, Tsang C, Seow-Choen F, Eu K, Tang C . Comparison of J-pouch and coloplasty pouch for low rectal cancers: a randomized, controlled trial investigating functional results and comparative anastomotic leak rates. Ann Surg. 2002; 236(1):49-55. PMC: 1422548. DOI: 10.1097/00000658-200207000-00009. View

12.

Rich T, Skibber J, Ajani J, Buchholz D, Cleary K, Dubrow R . Preoperative infusional chemoradiation therapy for stage T3 rectal cancer. Int J Radiat Oncol Biol Phys. 1995; 32(4):1025-9. DOI: 10.1016/0360-3016(95)00020-y. View

13.

Janjan N, Khoo V, Abbruzzese J, Pazdur R, Dubrow R, Cleary K . Tumor downstaging and sphincter preservation with preoperative chemoradiation in locally advanced rectal cancer: the M. D. Anderson Cancer Center experience. Int J Radiat Oncol Biol Phys. 1999; 44(5):1027-38. DOI: 10.1016/s0360-3016(99)00099-1. View

14.

Heald R, Moran B, Ryall R, Sexton R, Macfarlane J . Rectal cancer: the Basingstoke experience of total mesorectal excision, 1978-1997. Arch Surg. 1998; 133(8):894-9. DOI: 10.1001/archsurg.133.8.894. View

15.

Arbman G, Nilsson E, Hallbook O, Sjodahl R . Local recurrence following total mesorectal excision for rectal cancer. Br J Surg. 1996; 83(3):375-9. DOI: 10.1002/bjs.1800830326. View

16.

Jemal A, Murray T, Ward E, Samuels A, Tiwari R, Ghafoor A . Cancer statistics, 2005. CA Cancer J Clin. 2005; 55(1):10-30. DOI: 10.3322/canjclin.55.1.10. View

17.

Engel J, Kerr J, Schlesinger-Raab A, Eckel R, Sauer H, Holzel D . Quality of life in rectal cancer patients: a four-year prospective study. Ann Surg. 2003; 238(2):203-13. PMC: 1422675. DOI: 10.1097/01.sla.0000080823.38569.b0. View

18.

Williamson P, Hellinger M, Larach S, Ferrara A . Endorectal ultrasound of T3 and T4 rectal cancers after preoperative chemoradiation. Dis Colon Rectum. 1996; 39(1):45-9. DOI: 10.1007/BF02048268. View

19.

Fazio V . Indications and surgical alternatives for palliation of rectal cancer. J Gastrointest Surg. 2004; 8(3):262-5. DOI: 10.1016/j.gassur.2003.11.019. View

20.

Minsky B, Cohen A, Enker W, Paty P . Sphincter preservation with preoperative radiation therapy and coloanal anastomosis. Int J Radiat Oncol Biol Phys. 1995; 31(3):553-9. DOI: 10.1016/0360-3016(94)00375-U. View