The English National Low Rectal Cancer Development Programme: key messages and future perspectives

Moran, Brendan; Holm, Torbjörn; Brannagan, G.; Chave, Helen; Quirke, Philip; West, Nicholas P.; Brown, Gina; Glynne‐Jones, Rob; Sebag‐Montefiore, David; Cunningham, Chris; Janjua, A. Z.; Battersby, Nicholas J.; Crane, S; McMeeking, Alexander A.

doi:10.1111/codi.12501

Cited by 65 publications

(66 citation statements)

References 31 publications

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“…This has been attributed to optimal surgery by total mesorectal excision (TME),3 in conjunction with multidisciplinary team management4 5 and selective multimodal therapy 6. Furthermore, the widespread introduction of circular stapling devices has reduced the need for permanent colostomies and a restorative anterior resection is currently regarded as the optimal procedure for the majority of patients with rectal cancer 7…”

Section: Introductionmentioning

confidence: 99%

Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

Battersby

Bouliotis

Emmertsen

et al. 2017

Gut

144

172

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Section: Introductionmentioning

confidence: 99%

Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

Battersby

Bouliotis

Emmertsen

et al. 2017

Gut

144

172

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“…However, improvements in pre-operative assessment and surgical quality, including the widespread adoption total mesorectal excision (TME) [1].and optimal surgery for low rectal cancers [2], together with the selective use of pelvic radiotherapy, has markedly reduced pelvic LR from historically approx 25% [3], to approximately 5-10% [4,5,6,7]. However, this has not reduced the rate of distant metastatic relapse, which is now the major cause of rectal cancer death.…”

Section: Introductionmentioning

confidence: 99%

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Gollins

Sebag‐Montefiore

2016

Clinical Oncology

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Improved surgical technique plus selective pre-operative radiotherapy, has decreased rectal cancer pelvic local recurrence (LR) from historically 25%, down to approximately 5-10%. However, this improvement has not reduced distant metastatic relapse, the main cause of death and a key issue in rectal cancer management.The current standard is local pelvic treatment (surgery +/-pre-operative radiotherapy) followed by adjuvant chemotherapy (AC), depending on resection histology. For circumferential resection margin (CRM)-threatened cancer on baseline MRI, downstaging long-course pre-operative chemoradiation (LCPCRT) is generally used. However, for non-CRM threatened disease, varying approaches are currently adopted in the UK, including straight to surgery (STS), short-course pre-operative radiotherapy (SCPRT) and LCPCRT.Clinical trials are investigating intensification of concurrent chemoradiation. There is also increasing interest in investigating pre-operative neoadjuvant chemotherapy (NAC) as a way of exposing micro-metastatic disease to full dose systemic chemotherapy as early as possible and potentially reducing metastatic relapse.Phase II trials suggest that this strategy is feasible, with promising histological response and low rates of tumour progression during NAC. Phase III trials are needed to determine the benefit of NAC when added to standard therapy and also to determine if it can be used instead of neoadjuvant radiotherapy based schedules.

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“…LOREC project looked at training radiologist, surgeons, and pathologists using the cadaver models (24). Extent of levator involvement is the single most important factor in deciding the approach.…”

Section: Discussionmentioning

confidence: 99%

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

Pai

Patil

Arya

et al. 2016

J. Gastrointest. Oncol.

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Background: To compare extra levator abdomino perineal resection (ELAPER) with conventional abdominoperineal resection (APER) in terms of short-term oncological and clinical outcomes.Methods: This is a retrospective review of a prospectively maintained database including all the patients of rectal cancer who underwent APER at Tata Memorial Center between July 1, 2013, and January 31, 2015.Short-term oncological parameters evaluated included circumferential resection margin involvement (CRM), tumor site perforation, and number of nodes harvested. Peri operative outcomes included blood loss, length of hospital stay, postoperative perineal wound complications, and 30-day mortality. The χ 2 -test was used to compare the results between the two groups.Results: Forty-two cases of ELAPER and 78 cases of conventional APER were included in the study.Levator involvement was significantly higher in the ELAPER compared with the conventional group; otherwise, the two groups were comparable in all the aspects. CRM involvement was seen in seven patients (8.9%) in the conventional group compared with three patients (7.14%) in the ELAPER group. Median hospital stay was significantly longer with ELAPER. The univariate analysis of the factors influencing CRM positivity did not show any significance.Conclusions: ELAPER should be the preferred approach for low rectal tumors with involvement of levators. For those cases in which levators are not involved, as shown in preoperative magnetic resonance imaging (MRI), the current evidence is insufficient to recommend ELAPER over conventional APER. This stresses the importance of preoperative MRI in determining the best approach for an individual patient.

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The English National Low Rectal Cancer Development Programme: key messages and future perspectives

Abstract: Optimal staging, selective preoperative chemoradiotherapy and precise surgery were considered as crucial to improve the outcome for patients with low rectal cancer.

Cited by 65 publications

References 31 publications

Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

Development and external validation of a nomogram and online tool to predict bowel dysfunction following restorative rectal cancer resection: the POLARS score

Neoadjuvant Treatment Strategies for Locally Advanced Rectal Cancer

Selective extra levator versus conventional abdomino perineal resection: experience from a tertiary-care center

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