New trends in neoadjuvant therapy of locally advanced rectal cancer from a surgeon’s perspective – a commentary

Czech version

Authors: prof. MUDr. Kala Zdeněk, CSc. ¹; MUDr. Zatloukal Martin ¹; MUDr. Čan Vladimír ¹; MUDr. Hemmelová Beáta ¹; MUDr. Ostřížková Lenka ²; Bohatá Šárka ³; prof. RNDr. Slabý Ondřej, Ph.D. ^4,5; prof. MUDr. Svoboda Marek, Ph.D. ⁶; prof. MUDr. Šlampa Pavel, CSc. ⁷
Authors‘ workplace: Chirurgická klinika LF MU a FN Brno ¹; Interní a hematoonkologická klinika LF MU a FN Brno ²; Klinika radiologie a nukleární medicíny LF MU a FN Brno ³; Ústav patologie LF MU a FN Brno ⁴; Klinika komplexní onkologické péče MOÚ Brno ⁵; Klinika radiační onkologie MOÚ Brno ⁶
Published in: Klin Onkol 2020; 33(5): 362-371
Category: Review
doi: https://doi.org/10.14735/amko2020362

Overview

Background: Rectal cancer treatment advanced rapidly during last decades. The most important factors of this progress are new neoadjuvant therapy options, improvement in imaging (allowing for quality staging and restaging) and routine implementation of the total mesorectal excision technique. For the best outcomes, it is crucial to combine the treatment methods in the best way possible with ideal timing. It is necessary to keep in mind both advantages and complications of the individual kinds of approach. Therefore, interdisciplinary agreement is essential in the treatment of rectal cancer. Considering these new therapeutic possibilities, the debate about timing, indication and radicality of the surgical procedures is reopened. Surgical approaches are currently focused on mini-invasive methods and robotic surgery. New trend with promising potential seems to be clinical complete response achievement with watch and wait follow-up strategy. This approach, in the spirit of the organ sparing philosophy, however asks new questions about indication, timing and conception of this method. Proper answers are essential for sparing, yet radical oncotherapy of this disease.

Keywords:

rectal cancer – Surgical oncology – neoadjuvant therapy – organ sparing treatment – time management

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