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Multidisciplinary treatment of rectal cancer in 2014: Where are we going?

World Journal of Gastroenterology 2014年第32期20卷 11249-11261页

作者： Andrea Vignali Paola De Nardi Department of Surgery San Raffaele Scientific Institute Vita Salute University

In the present review we discuss the recent developments and future directions in the multimodal treatment of locally advanced rectal cancer, with respect to staging and re-staging modalities, to the current role of neoadjuvant chemo-radiation and to the conservative and more limited surgical approaches based on tumour response after neoadjuvant combined therapy. When initial tumor staging is considered a high accuracy has been reported for T pre-treatment staging, while preoperative lymph node mapping is still suboptimal. With respect to tumour re-staging, all the current available modalities still present a limited accuracy, in particular in defining a complete response. The role of short vs long-course radiotherapy regimens as well as the optimal time of surgery are still unclear and under investigation by means of ongoing randomized trials. Observational management or local excision following tumour complete response are promising alternatives to total mesorectal excision, but need further evaluation, and their use outside of a clinical trial is not *** preoperative selection of patients who will benefit from neoadjuvant radiotherapy or not, as well as the proper identification of a clinical complete tumour response after combined treatment modalities,will influence the future directions in the treatment of locally advanced rectal cancer.

关键词： Rectal cancer Cancer staging Cancer restaging Neoadjuvant chemoradiation response Treatment Local control Local excision complete pathologic response Rectal cancer surgery

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