Our Summary

This research paper is about the treatment of early-stage rectal cancer, which is still a subject of debate among medical professionals. The study highlights the importance of endoscopy and ultrasonography in precisely identifying small cancers.

During the endoscopy procedure, doctors can estimate how deep the cancerous lesion is, which helps them decide if they should perform a local excision (removing the cancerous tissue and some surrounding healthy tissue).

According to current international recommendations, if a patient’s cancer is found to be aggressive or not completely removed during the initial operation, a proctectomy (removal of the rectum) should be done. However, there is still ongoing debate about whether the depth of the cancer’s invasion into the tissue can accurately predict if it has spread to the lymph nodes.

Recent studies suggest that the depth of the cancer’s invasion alone should not be the only factor determining if additional cancer surgery is needed. Instead, radio-chemotherapy (a combination of radiation and chemotherapy) could be an alternative to a proctectomy for patients with early-stage rectal cancer who have unfavorable results from the examination of the cancer tissue.

A clinical trial in the Netherlands is currently being conducted to validate this approach.

FAQs

  1. What is the controversy surrounding the treatment of superficial rectal cancers?
  2. What role does endoscopy and endorectal ultrasonography play in the treatment of small rectal cancers?
  3. What are some alternatives to completion proctectomy in patients with pT1 rectal cancer and unfavorable histopathological criteria?

Doctor’s Tip

A doctor might advise a patient undergoing proctectomy to follow a high-fiber diet and stay well-hydrated to prevent constipation and promote smooth bowel movements during the recovery period. They may also recommend gentle exercises to help with circulation and prevent blood clots. Additionally, the patient should closely follow the post-operative care instructions provided by the medical team to ensure optimal healing and recovery.

Suitable For

Patients who are typically recommended proctectomy include those with superficial rectal cancers that cannot be adequately treated with local excision alone. This includes patients with poorly-differentiated lesions, lymphovascular invasion, grade 2 or 3 tumor budding, and incomplete resection. Additionally, patients with pT1 rectal cancer and unfavorable histopathological criteria may also be recommended for proctectomy. Adjuvant radio-chemotherapy may be considered as an alternative to proctectomy in some cases.

Timeline

  • Patient undergoes endoscopy and endorectal ultrasonography for precise initial definition of small rectal cancers
  • Depth of lesion estimated during endoscopy using virtual chromoendoscopy with magnification
  • Wide local excision performed
  • Pathologic examination reveals poorly-differentiated lesions, lymphovascular invasion, grade 2 or 3 tumor budding, and incomplete resection
  • Completion proctectomy recommended based on pathologic findings
  • Debate continues on whether depth of submucosal invasion accurately predicts risk of lymph node spread
  • Recent data suggests depth of submucosal invasion alone should not be indication for additional surgery
  • Adjuvant radio-chemotherapy considered as alternative to completion proctectomy in patients with pT1 rectal cancer and unfavorable histopathological criteria
  • Dutch randomized controlled trial underway to validate radio-chemotherapy strategy for rectal cancer treatment.

What to Ask Your Doctor

  1. What are the different treatment options available for superficial rectal cancers?
  2. How is the depth of the lesion determined and how does it impact the decision for completion proctectomy?
  3. What are the potential risks and complications associated with proctectomy?
  4. How will my quality of life be affected after undergoing proctectomy?
  5. Are there any alternative treatments to proctectomy, such as adjuvant radio-chemotherapy?
  6. What are the long-term outcomes and survival rates associated with proctectomy for superficial rectal cancers?
  7. How experienced is the medical team in performing proctectomies for rectal cancer?
  8. Will I need a colostomy bag after proctectomy, and if so, is it temporary or permanent?
  9. How long is the recovery period after proctectomy and what kind of post-operative care will be needed?
  10. Are there any clinical trials or research studies that I may be eligible for regarding treatment options for rectal cancer?

Reference

Authors: Labiad C, Alric H, Barret M, Cazelles A, Rahmi G, Karoui M, Manceau G. Journal: J Visc Surg. 2024 Jun;161(3):173-181. doi: 10.1016/j.jviscsurg.2024.02.003. Epub 2024 Mar 5. PMID: 38448362