Principle of surgical management for rectal cancer patients with complete clinical response after neoadjuvant therapy
10.3760/cma.j.issn.1671-0274.2019.04.006
- VernacularTitle: 直肠癌新辅助治疗临床完全缓解后外科处理原则
- Author:
Xinxiang LI
1
,
2
;
Dakui LUO
Author Information
1. Department of Colorectal Surgery, Fudan University Shanghai Cancer Center
2. Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
- Publication Type:Journal Article
- Keywords:
Rectal neoplasms;
Neoadjuvant chemoradiotherapy;
Clinical complete response;
"Watch and wait" strategy
- From:
Chinese Journal of Gastrointestinal Surgery
2019;22(4):342-348
- CountryChina
- Language:Chinese
-
Abstract:
A proportion of patients with locally advanced rectal cancer will achieve clinical complete response (cCR) or pathologic complete response (pCR) after neoadjuvant chemoradiotherapy. With the proposal of the concept of total neoadjuvant therapy (TNT), higher complete response rates will be observed. The management of patients with cCR has long been an issue of controversy and is attractive for clinical trials. A "watch and wait" strategy for patients with cCR has been put forward by some scholars. A non-operative approach can preserve the organfunction and avoid complications after radical surgery. The safety and feasibility of a "watch and wait" strategy have been established in several non-randomized controlled studies. There is no consensus on how to make an optimal decision for patients with cCR. For example, it is only observed in partial patients that cCR is consistent with pCR and the molecular biomarkers for predicting pCR are suboptimal. Besides, cCR is inconsistently defined and surveillance recommendations varies. Furthermore, there are insufficient high-level evidence for the "watch and wait" strategy. For patients with good response after chemoradiotherapy, local excision is an attractive alternative to total mesorectal excision, however with uncertain indications and challenged oncological safety. For patients with cCR, we implement the therapeutic principles of goal-orientation, layered treatment and the whole process management.
