Our Summary

Total neoadjuvant therapy (TNT) is a treatment method that has become very popular in managing rectal cancer. This approach is now used worldwide, not only for advanced cancers but even for those that might not necessarily need chemotherapy. However, this method increases the risk of side effects from treatment for patients and also puts a strain on the healthcare services of a country. Therefore, it’s crucial to customize the treatment for each patient, taking into account not only the nature of the tumor but also the patient’s personal expectations and goals. When using TNT, it’s important to understand that it may not be the best approach for everyone, especially for those aiming to preserve the organ (via a “watch and wait” approach), and that the benefits of TNT in terms of survival rates may not be as significant as many believe.

FAQs

  1. What is Total Neoadjuvant Therapy (TNT) in the context of rectal cancer treatment?
  2. What are some potential drawbacks of widespread use of TNT for rectal cancer, including less severe cases?
  3. How does a patient’s expectations and goals affect the decision to use TNT in rectal cancer treatment?

Doctor’s Tip

One helpful tip a doctor might tell a patient about proctectomy is to carefully follow post-operative care instructions to promote healing and prevent complications. This may include proper wound care, taking prescribed medications as directed, maintaining a healthy diet, and avoiding heavy lifting or strenuous activities. It is important to communicate any concerns or changes in symptoms to your healthcare provider promptly.

Suitable For

Patients with rectal cancer who are typically recommended for proctectomy include those with locally advanced tumors that are not amenable to organ preservation approaches, such as the “watch and wait” strategy. These patients may have large tumors, involvement of adjacent organs, or other factors that make organ preservation challenging. Additionally, patients who have not responded well to neoadjuvant therapy or who have experienced disease progression may also be recommended for proctectomy. Ultimately, the decision to recommend proctectomy should be based on a thorough evaluation of the individual patient’s tumor characteristics, treatment response, and overall goals of care.

Timeline

Before proctectomy:

  1. Diagnosis of rectal cancer through imaging tests and a biopsy.
  2. Consultation with a colorectal surgeon and oncologist to discuss treatment options.
  3. Decision to undergo total neoadjuvant therapy (TNT) which includes chemotherapy and radiation therapy before surgery.
  4. Completion of TNT regimen and evaluation of response to treatment.
  5. Pre-operative preparation including bowel preparation and discussion of surgery risks and recovery process.

After proctectomy:

  1. Proctectomy surgery to remove the rectum and possibly part of the colon.
  2. Recovery in the hospital followed by a period of rehabilitation and physical therapy.
  3. Monitoring for complications such as infection or bowel obstruction.
  4. Adjustment to changes in bowel function and possible need for a temporary or permanent colostomy.
  5. Follow-up appointments with the surgical team and oncologist to monitor for recurrence and discuss further treatment options if necessary.

What to Ask Your Doctor

  1. What is a proctectomy and why is it recommended for my condition?
  2. What are the different types of proctectomy procedures and which one is most suitable for me?
  3. What are the potential risks and complications associated with a proctectomy?
  4. What is the expected recovery time and rehabilitation process after a proctectomy?
  5. Will I need to make any lifestyle changes or modifications after the surgery?
  6. Are there any alternative treatment options to a proctectomy that I should consider?
  7. How will a proctectomy affect my bowel function and quality of life in the long term?
  8. What is the overall success rate of proctectomy for my condition?
  9. What follow-up care and monitoring will be necessary after the surgery?
  10. Are there any specific questions or concerns I should discuss with a colorectal surgeon before undergoing a proctectomy?

Reference

Authors: Ballal DS, Vispute TP, Saklani AP. Journal: Colorectal Dis. 2024 May;26(5):1068-1071. doi: 10.1111/codi.16991. Epub 2024 Apr 12. PMID: 38609336