The treatment of early rectal cancer in the era of adjuvant and neo-adjuvant therapy

Abstract

The accurate staging of rectal cancer improves the stratification of patients for adjuvant therapy. Staging of tumor with endoluminal ultrasonography (EUS) shows a good correlation with histology (κ = 0.85; 95% confidence interval 0.76-0.95). Overall pT and pN stage accuracy of EUS was 92% and 65% respectively. The staging of local disease can be further augmented by EUS guided fine needle aspiration of extra rectal lesions lying within or outside of the mesorectum. In a systematic review of local excision after neoadjuvant therapy a total of 22 unique studies reporting on 1068 patients were analysed. At a median follow-up of 54 months, ypT0 tumours had a pooled local recurrence rate of 4% and a median disease-free survival rate of 95%. Outcomes for ≥ ypT1 tumours were much worse with pooled local recurrence and disease-free survival of 22% and 68%, respectively. In a review of 22 studies, 804 patients who underwent local excision followed by adjuvant therapy either for unfavourable histology, prohibitive comorbidity or patient choice. the pooled local recurrence was 5.8% for pT1 tumours, 13.8% for pT2 tumours and 33.7% for pT3 tumours. In addition, the response to radiotherapy may be enhanced by aspirin, metformin and statins.

The Risk Factors of Anastomotic Leakage After Rectal Cancer Surgery

“…Splenic flexure mobilization was performed in 71.3% (50 women and 72 men) of patients, two of which had anas- tomotic leakage in our study. Most of authors recommend splenic flexure mobilization to decrease the tension in colorectal anastomosis since it will decrease the leakage risk (26). Despite the fact that splenic flexure was mobilized, the incidence of anastomotic leak in most of our cases showed that other factors may be responsible rather than tension.…”