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2-CONSERVATIVE TREATMENT OF RECTAL ADENOCARCINOMA AFTER NEOADJUVANT CHEMORADIOTHERAPY, IS IT ACCEPTABLE?

Author: Majeed H Alwan
Journal: Basrah Journal of Surgery مجلة البصرة الجراحية ISSN: 16833589 / ONLINE 2409501X Year: 2009 Volume: 15 Issue: 1 Pages: 3-9
Publisher: Basrah University جامعة البصرة

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Abstract

Majeed H AlwanFRCS, FRACS, FACS, Gastrointestinal and General Surgeon, New Zealand5 Tamworth Place, Gate Pa, TAURANGA, NEW ZEALAND. malwan@paradise.net.nzAbstractThe traditional treatment of patients with adenocarcinoma of the rectum involved some form ofradical surgery in fit patients followed by radiotherapy, or chemotherapy, or both depending onthe stage of the disease and the general condition of the patient. More recently the emergenceof neoadjuvant chemoradiotherapy (CRT) has fundamentally changed the management ofthese patients. Although initially it was recommended for locally advanced disease in an attemptof downstaging the tumour to make it resectable, the indication in using this modality had beenwidened.In clinical trials, up to 30% complete pathological response (pCR) of tumours have raised thequestion as to whether surgery, especially radical could be avoided in certain group of patients.A trial of omission of surgery in this group of patients has shown favourable long-term results.This article is an outline of the emerging factors for achieving complete pathological response;the non-operative or the minimal surgery strategies, methods of predicting response to chemoradiotherapy,and means of judging the complete pathological response.

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