Management of early rectal cancer; current surgical options and future direction

Abstract

Rectal cancer is the second commonest cause of cancer death within the United Kingdom. Utilization of national screening programmes have resulted in a greater proportion of patients presenting with early-stage disease. The technique of transanal endoscopic microsurgery was first described in 1984 following which further options for local excision have emerged with transanal endoscopic operation and, more recently, transanal minimally invasive surgery. Owing to the risks of local recurrence, the current role of minimally invasive techniques for local excision in the management of rectal cancer is limited to the treatment of pre-invasive disease and low risk early-stage rectal cancer (T1N0M0 disease). The roles of chemotherapy and radiotherapy for the management of early rectal cancer are yet to be fully established. However, results of high-quality research such as the GRECCAR II, TESAR and STAR-TREC randomised control trials may highlight a wider role for local excision surgery in the future, when used in combination with oncological therapies. The aim of our review is to provide an overview in the current management of early rectal cancer, the surgical options available for local excision and the future multimodal direction of early rectal cancer treatment.

Preservation of left colic artery in laparoscopic colorectal operation: The benefit challenge

“…High ligation of IMA in colorectal cancer operation is a simple method that can clean the lymph nodes completely. However, the incidence of intestinal fistula increased significantly, and the postoperative recovery was slow[ 16 ]. In this study, with the investigation of the prognostic impact of the ligation site of IMA in colorectal cancer surgery in 194 patients, it is found that complete mesenteric resection and IMA root LND while preserving the LCA is a more reliable and safe surgical approach in patients undergoing colorectal cancer surgery.…”

Multidisciplinary treatment strategy for early rectal cancer

“…In order to apply these treatment strategies in a patient-specific manner, it is important to establish sophisticated indications that can maximize the therapeutic effect. ERC has heterogeneous pathological features, including aggressive behavior and occult lymph node metastasis, with different responses to CRT [11]. Therefore, predicting the risk of lymph node metastasis and local recurrence based on the pathological characteristics of ERC is important to determine the optimal treatment strategy for each patient.…”