Downstaging in Advanced Rectal Cancers

Colon and rectal cancers are usually combined under the same term "colorectal cancer". It should be noted that the lesion of the colon is much more common. Colorectal cancer ranks fourth in the overall structure of oncological pathology in terms of prevalence, and in some countries even comes third after lung and stomach cancer. Risk factors that contribute to the development of colorectal cancer include bowel polyps, ulcerative colitis and Crohn's disease, and a genetic predisposition. Most often, neoplastic transformation occurs at the site of an adenoma or dysplastic lesion of the intestinal mucosa. Due to the high risk of neoplastic process in a sufficiently large number of elderly people, it is recommended that every person over the age of 50 should undergo compulsory screening to detect latent cancer. The simplest, but at the same time insufficiently informative method is a blood culture test - analysis for the presence of blood in the feces. Method of total colonoscopy and double-contrast radiography is distinguished by a higher information content, but at the same time a higher cost. It is recommended to have these examinations every three to five years after the age of 50 years without clinical manifestations, and after the age of 40 for those at risk for colorectal cancer.

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IORT in Integrated Treatment of High-Risk Rectal Cancers

Frontiers of Radiation Therapy and Oncology - Intraoperative Radiation Therapy in the Treatment of Cancer ◽

10.1159/000061162 ◽

1997 ◽

pp. 209-212 ◽

Cited By ~ 1

Author(s):

L. Sofo ◽

C. Ratto ◽

V. Valentini ◽

A. Piermattei ◽

L. Trodella ◽

...

Keyword(s):

High Risk ◽

Integrated Treatment ◽

Rectal Cancers

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Safety and feasibility of sphincter preservation surgery in low lying rectal cancers

Journal of Surgical Oncology ◽

10.1002/jso.26360 ◽

2021 ◽

Author(s):

Swapnil Patel ◽

Vivek Sukumar ◽

Mufaddal Kazi ◽

Avanish Saklani

Keyword(s):

Sphincter Preservation ◽

Rectal Cancers

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Comparison of an oncology clinical decision-support system’s recommendations with actual treatment decisions

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocaa334 ◽

2021 ◽

Author(s):

Suthida Suwanvecho ◽

Harit Suwanrusme ◽

Tanawat Jirakulaporn ◽

Surasit Issarachai ◽

Nimit Taechakraichana ◽

...

Keyword(s):

Decision Support ◽

Clinical Decision Support ◽

Treatment Options ◽

Stage Iv ◽

Clinical Decision ◽

Treatment Decisions ◽

Therapeutic Options ◽

Cancer Type ◽

The Us ◽

Rectal Cancers

Abstract Objective IBM(R) Watson for Oncology (WfO) is a clinical decision-support system (CDSS) that provides evidence-informed therapeutic options to cancer-treating clinicians. A panel of experienced oncologists compared CDSS treatment options to treatment decisions made by clinicians to characterize the quality of CDSS therapeutic options and decisions made in practice. Methods This study included patients treated between 1/2017 and 7/2018 for breast, colon, lung, and rectal cancers at Bumrungrad International Hospital (BIH), Thailand. Treatments selected by clinicians were paired with therapeutic options presented by the CDSS and coded to mask the origin of options presented. The panel rated the acceptability of each treatment in the pair by consensus, with acceptability defined as compliant with BIH’s institutional practices. Descriptive statistics characterized the study population and treatment-decision evaluations by cancer type and stage. Results Nearly 60% (187) of 313 treatment pairs for breast, lung, colon, and rectal cancers were identical or equally acceptable, with 70% (219) of WfO therapeutic options identical to, or acceptable alternatives to, BIH therapy. In 30% of cases (94), 1 or both treatment options were rated as unacceptable. Of 32 cases where both WfO and BIH options were acceptable, WfO was preferred in 18 cases and BIH in 14 cases. Colorectal cancers exhibited the highest proportion of identical or equally acceptable treatments; stage IV cancers demonstrated the lowest. Conclusion This study demonstrates that a system designed in the US to support, rather than replace, cancer-treating clinicians provides therapeutic options which are generally consistent with recommendations from oncologists outside the US.

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Patient position verification in magnetic-resonance imaging only radiotherapy of anal and rectal cancers

Physics and Imaging in Radiation Oncology ◽

10.1016/j.phro.2021.07.005 ◽

2021 ◽

Vol 19 ◽

pp. 72-77

Author(s):

David Bird ◽

Matthew Beasley ◽

Michael G. Nix ◽

Marcus Tyyger ◽

Hazel McCallum ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Resonance Imaging ◽

Patient Position ◽

Rectal Cancers

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The Emerging Role of Robotics in Pelvic Exenteration Surgery for Locally Advanced Rectal Cancer: A Narrative Review

Journal of Clinical Medicine ◽

10.3390/jcm10071518 ◽

2021 ◽

Vol 10 (7) ◽

pp. 1518

Author(s):

Tou Pin Chang ◽

Aik Yong Chok ◽

Dominic Tan ◽

Ailin Rogers ◽

Shahnawaz Rasheed ◽

...

Keyword(s):

Pelvic Exenteration ◽

Locally Advanced ◽

Advanced Rectal Cancer ◽

Locally Advanced Rectal Cancer ◽

Invasive Approach ◽

Perioperative Morbidity ◽

Rectal Cancers ◽

Beyond Tme ◽

Assisted Technologies

Pelvic exenteration surgery for locally advanced rectal cancers is a complex and extensive multivisceral operation, which is associated with high perioperative morbidity and mortality rates. Significant technical challenges may arise due to inadequate access, visualisation, and characterisation of tissue planes and critical structures in the spatially constrained pelvis. Over the last two decades, robotic-assisted technologies have facilitated substantial advancements in the minimally invasive approach to total mesorectal excision (TME) for rectal cancers. Here, we review the emerging experience and evidence of robotic assistance in beyond TME multivisceral pelvic exenteration for locally advanced rectal cancers where heightened operative challenges and cumbersome ergonomics are likely to be encountered.

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State-of-the-art surgery for recurrent and locally advanced rectal cancers

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02285-8 ◽

2021 ◽

Author(s):

Mufaddal Kazi ◽

Vivek Sukumar ◽

Ashwin Desouza ◽

Avanish Saklani

Keyword(s):

State Of The Art ◽

Locally Advanced ◽

Rectal Cancers

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The Digital Divide: A Retrospective Survey of Digital Rectal Examinations during the Workup of Rectal Cancers

Healthcare ◽

10.3390/healthcare9070855 ◽

2021 ◽

Vol 9 (7) ◽

pp. 855

Author(s):

Omar Farooq ◽

Ameer Farooq ◽

Sunita Ghosh ◽

Raza Qadri ◽

Tanner Steed ◽

...

Keyword(s):

Primary Care ◽

Rectal Cancer ◽

Care Provider ◽

Primary Care Provider ◽

Demographic Data ◽

Significant Proportion ◽

Digital Rectal Examination ◽

Patient Questionnaire ◽

Rectal Examination ◽

Rectal Cancers

Background: Digital rectal examination (DRE) is considered an important part of the physical examination. However, it is unclear how many patients have a DRE performed at the primary care level in the work-up of rectal cancer, and if the absence of a DRE causes a delay to consultation with a specialist. Methods: A retrospective patient questionnaire was sent to 1000 consecutive patients with stage II or stage III rectal cancer. The questionnaire asked patients to recall if they had a DRE performed by their general practitioner (GP) when they first presented with symptoms or a positive FIT test. Demographic data, staging data, and time to consultation with a specialist were also collected. Results: A thousand surveys were mailed out, and a total of 262 patients responded. Of the respondents, 46.2% did not recall undergoing a digital rectal examination by their primary care provider. Women were less likely to undergo a DRE than men (28.6% vs. 44.3%, p = 0.019). While there was a trend towards longer times to specialist consultation in patients who did not undergo a DRE (27.0 vs. 12.2 weeks), this was not statistically significant (p = 0.121). Conclusion: A significant proportion of patients who are FIT positive or have symptomatic rectal bleeding do not recall having a DRE by their primary care provider. Barriers may include lack of comfort with performing DRE or lack of time. Clearer guidelines and more support for GP’s may increase uptake of DRE.

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Retrospective study of the functional and oncological outcomes of conformal sphincter preservation operation in the treatment of very low rectal cancer

Techniques in Coloproctology ◽

10.1007/s10151-020-02229-2 ◽

2020 ◽

Vol 24 (10) ◽

pp. 1025-1034 ◽

Cited By ~ 1

Author(s):

G. Sun ◽

Z. Lou ◽

H. Zhang ◽

G. Y. Yu ◽

K. Zheng ◽

...

Keyword(s):

Rectal Cancer ◽

Rectal Wall ◽

Anal Verge ◽

Disease Free Survival ◽

Sphincter Preservation ◽

Low Rectal Cancer ◽

Anal Function ◽

Oncological Outcomes ◽

Rectal Cancers ◽

Very Low Rectal Cancer

Abstract Background Conformal sphincter preservation operation (CSPO) is a new surgical procedure for very low rectal cancers (within 4–5 cm from the anal verge). CSPO preserves more of the dentate line and distal rectal wall and also avoids injuring nerves in the intersphincteric space, resulting in satisfactory anal function after resection. The aim of this study was to analyze the short-term surgical results and long-term oncological and functional outcomes of CSPO. Methods Consecutive patients with very low rectal cancer, who had CSPO between January 2011 and October 2018 at Changhai Hospital, Shanghai were included. Patient demographics, clinicopathological features, oncological outcomes and anal function were analyzed. Results A total of 102 patients (67 men) with a mean age of 56.9 ± 10.8 years were included. The median distance of the tumor from the anal verge was 3 (IQR, 3–4) cm. Thirty-five patients received neoadjuvant chemoradiation (nCRT). The median distal resection margin (DRM) was 0.5 (IQR, 0.3–0.8) cm. One patient had a positive DRM. All circumferential margins were negative. There was no perioperative mortality. The postoperative complication rate was 19.6%. The median duration of follow-up was 28 (IQR, 12–45.5) months. The local recurrence rate was 2% and distant metastasis rate was 10.8%. The 3-year overall survival and disease-free survival rates were 100% and 83.9%, respectively. The mean Wexner incontinence and low anterior resection syndrome scores 12 months after ileostomy reversal were 5.9 ± 4.3, and 29.2 ± 6.9, respectively. Conclusions For patients with very low rectal cancers, fecal continence can be preserved with CSPO without compromising oncological results.

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