A current perspective on local excision of rectal cancer Journal Article
| Authors: | Gimbel, M. I.; Paty, P. B. |
| Article Title: | A current perspective on local excision of rectal cancer |
| Abstract: | Local excision of rectal cancer is appealing because of its technical ease and excellent functional results, but concern over inadequate pathologic staging and inferior treatment outcomes when compared with radical surgery remain a major hurdle for its widespread use. Local failure rates in modern series for local excision are 4%-18% for T1 rectal cancers and 22%-67% for T2 cancers, and cancer cure rates are only 70%-80%. In addition, data from the past decade suggest that preoperative staging with endorectal ultrasound, use of postoperative adjuvant chemotherapy/radiation therapy, and aggressive salvage surgery have not been reliable methods of limiting local tumor recurrence or improving long-term cure rates. At present, highly stringent criteria for patient selection are recommended, yet such stringency decreases the utility of the procedure. What are needed are new approaches to an old problem. Novel strategies under evaluation include enhanced imaging modalities for lymph node metastases, neoadjuvant chemotherapy/radiation therapy, and more liberal use of immediate salvage resection for high-risk pathologic features. Molecular profiling of tumors with genetic markers and better integration of traditional and gene-targeted systemic therapy are promising approaches for the future. This review of the literature evaluates the recent successes and failures of local excision of rectal cancer and provides a current perspective on the expanded use of local excision without compromising care. |
| Keywords: | cancer survival; treatment outcome; treatment failure; review; cancer localization; salvage therapy; fluorouracil; patient selection; chemotherapy, adjuvant; neoadjuvant therapy; radiotherapy, adjuvant; cancer staging; follow up; lymph node metastasis; lymphatic metastasis; gene targeting; neoplasm recurrence, local; histology; ultrasound; high risk patient; tumor recurrence; adjuvant chemotherapy; cancer size; long term care; surgical procedures, operative; radiation therapy; rectal neoplasms; rectum cancer; genetic marker; rectum resection; abdominoperineal resection; transanal endoscopic microsurgery; salvage surgery; endorectal ultrasound; humans; human; transsphincteric excision |
| Journal Title: | Clinical Colorectal Cancer |
| Volume: | 4 |
| Issue: | 1 |
| ISSN: | 1533-0028 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2004-05-01 |
| Start Page: | 26 |
| End Page: | 35 |
| Language: | English |
| PROVIDER: | scopus |
| PUBMED: | 15207017 |
| DOI: | 10.3816/CCC.2004.n.007 |
| DOI/URL: | |
| Notes: | Clin. Colorectal Cancer -- Cited By (since 1996):15 -- Export Date: 16 June 2014 -- CODEN: CCCLC C2 - 15207017 -- Source: Scopus |
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