Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer
Abstract The current standard treatment for locally advanced rectal cancer (LARC) in Korea and Western countries is a multimodal approach incorporating preoperative long‐course chemoradiotherapy (LCRT) followed by total mesorectal excision (TME) and adjuvant chemotherapy. This approach has significa...
| Main Authors: | , |
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| Format: | Article |
| Language: | English |
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Wiley
2020-07-01
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| Series: | Annals of Gastroenterological Surgery |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ags3.12349 |
| _version_ | 1818608952052547584 |
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| author | Ho Seung Kim Nam Kyu Kim |
| author_facet | Ho Seung Kim Nam Kyu Kim |
| author_sort | Ho Seung Kim |
| collection | DOAJ |
| description | Abstract The current standard treatment for locally advanced rectal cancer (LARC) in Korea and Western countries is a multimodal approach incorporating preoperative long‐course chemoradiotherapy (LCRT) followed by total mesorectal excision (TME) and adjuvant chemotherapy. This approach has significantly improved local control and reduced recurrence rates; however, the overall survival benefit has not been established. Although LCRT is a good option, there remain challenging unresolved problems for colorectal surgeons. We focused on four challenging issues in this review article. The first is LARC with resectable liver metastases, for which there has been no consensus regarding optimal management and practice thus far. The second is cancer progression at the time of restaging after completion of preoperative LCRT. To date, there have been few reports on this issue. The third is early recurrence after TME following preoperative LCRT, the reason for which is thought to be the delayed systemic chemotherapy in the preoperative LCRT protocol. The fourth is cost‐effectiveness. The preoperative LCRT protocol takes 5 weeks. After a 6‐8‐week waiting period, surgery is performed. Therefore, it is more time‐consuming than short‐course chemoradiotherapy. To overcome these issues, total neoadjuvant treatment (TNT) modalities, performed using various protocols, have been conducted globally based on cumulative experience. We also attempted to discuss previous TNT protocols in this article. One treatment strategy is not sufficient for patients with varying clinical characteristics. Therefore, we should revisit current treatment strategies based on recent clinical experience. |
| first_indexed | 2024-12-16T14:50:49Z |
| format | Article |
| id | doaj.art-9341a3975e6f4ba6a8350d8cc7086776 |
| institution | Directory Open Access Journal |
| issn | 2475-0328 |
| language | English |
| last_indexed | 2024-12-16T14:50:49Z |
| publishDate | 2020-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Annals of Gastroenterological Surgery |
| spelling | doaj.art-9341a3975e6f4ba6a8350d8cc70867762022-12-21T22:27:35ZengWileyAnnals of Gastroenterological Surgery2475-03282020-07-014437938510.1002/ags3.12349Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancerHo Seung Kim0Nam Kyu Kim1Division of Colorectal Surgery Department of Surgery Yonsei University College of Medicine Seoul KoreaDivision of Colorectal Surgery Department of Surgery Yonsei University College of Medicine Seoul KoreaAbstract The current standard treatment for locally advanced rectal cancer (LARC) in Korea and Western countries is a multimodal approach incorporating preoperative long‐course chemoradiotherapy (LCRT) followed by total mesorectal excision (TME) and adjuvant chemotherapy. This approach has significantly improved local control and reduced recurrence rates; however, the overall survival benefit has not been established. Although LCRT is a good option, there remain challenging unresolved problems for colorectal surgeons. We focused on four challenging issues in this review article. The first is LARC with resectable liver metastases, for which there has been no consensus regarding optimal management and practice thus far. The second is cancer progression at the time of restaging after completion of preoperative LCRT. To date, there have been few reports on this issue. The third is early recurrence after TME following preoperative LCRT, the reason for which is thought to be the delayed systemic chemotherapy in the preoperative LCRT protocol. The fourth is cost‐effectiveness. The preoperative LCRT protocol takes 5 weeks. After a 6‐8‐week waiting period, surgery is performed. Therefore, it is more time‐consuming than short‐course chemoradiotherapy. To overcome these issues, total neoadjuvant treatment (TNT) modalities, performed using various protocols, have been conducted globally based on cumulative experience. We also attempted to discuss previous TNT protocols in this article. One treatment strategy is not sufficient for patients with varying clinical characteristics. Therefore, we should revisit current treatment strategies based on recent clinical experience.https://doi.org/10.1002/ags3.12349early recurrencelocally advanced rectal cancerneoadjuvantradiationtotal neoadjuvant treatment |
| spellingShingle | Ho Seung Kim Nam Kyu Kim Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer Annals of Gastroenterological Surgery early recurrence locally advanced rectal cancer neoadjuvant radiation total neoadjuvant treatment |
| title | Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer |
| title_full | Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer |
| title_fullStr | Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer |
| title_full_unstemmed | Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer |
| title_short | Challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer |
| title_sort | challenges and shifting treatment strategies in the surgical treatment of locally advanced rectal cancer |
| topic | early recurrence locally advanced rectal cancer neoadjuvant radiation total neoadjuvant treatment |
| url | https://doi.org/10.1002/ags3.12349 |
| work_keys_str_mv | AT hoseungkim challengesandshiftingtreatmentstrategiesinthesurgicaltreatmentoflocallyadvancedrectalcancer AT namkyukim challengesandshiftingtreatmentstrategiesinthesurgicaltreatmentoflocallyadvancedrectalcancer |