TY - JOUR
T1 - Current treatment of rectal cancer
T2 - The watch-and-wait method. Are we there yet?
AU - Boostrom, Sarah Y.
AU - Nelson, Heidi
PY - 2013/9
Y1 - 2013/9
N2 - Surgery remains the standard treatment of rectal carcinoma, with the use of neoadjuvant chemotherapy and radiation for locally advanced rectal carcinoma significantly decreasing local recurrence rates, as well as providing tumor downstaging. In those patients who exhibit complete pathological response, the question of the benefit of surgical resection and the utility of a 'wait-and-see' approach has been raised. However, the variability in determining a true pathological complete response, as well as the inability to accurately stage the nodes, argues against a non-operative approach. Many small series have attempted to evaluate a non-operative approach in patients considered pathological complete responders; however, these series are not well designed. In addition, adequate follow-up is limited. Thus, the inability to adequately select true pathological responders and the risk of leaving nodal disease behind outweighs the benefit of a non-operative approach. The use of an observational approach is not justified until further well-designed prospective trials are performed.
AB - Surgery remains the standard treatment of rectal carcinoma, with the use of neoadjuvant chemotherapy and radiation for locally advanced rectal carcinoma significantly decreasing local recurrence rates, as well as providing tumor downstaging. In those patients who exhibit complete pathological response, the question of the benefit of surgical resection and the utility of a 'wait-and-see' approach has been raised. However, the variability in determining a true pathological complete response, as well as the inability to accurately stage the nodes, argues against a non-operative approach. Many small series have attempted to evaluate a non-operative approach in patients considered pathological complete responders; however, these series are not well designed. In addition, adequate follow-up is limited. Thus, the inability to adequately select true pathological responders and the risk of leaving nodal disease behind outweighs the benefit of a non-operative approach. The use of an observational approach is not justified until further well-designed prospective trials are performed.
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U2 - 10.1053/j.scrs.2013.03.007
DO - 10.1053/j.scrs.2013.03.007
M3 - Article
AN - SCOPUS:84883010017
SN - 1043-1489
VL - 24
SP - 147
EP - 150
JO - Seminars in Colon and Rectal Surgery
JF - Seminars in Colon and Rectal Surgery
IS - 3
ER -