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Colorectal cancer
The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes
Gyu-Seog Choi, Hye Jin Kim
Ann Coloproctol. 2024;40(4):363-374.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00521.0074
  • 1,934 View
  • 280 Download
AbstractAbstract PDF
Metastatic lateral pelvic lymph nodes (LPNs) in rectal cancer significantly impact the prognosis and treatment strategies. Western practices emphasize neoadjuvant chemoradiotherapy (CRT), whereas Eastern approaches often rely on LPN dissection (LPND). This review examines the evolving role of LPND in the context of modern treatments, including total neoadjuvant therapy (TNT), and the impact of CRT on the management of clinically suspicious LPNs. We comprehensively reviewed the key literature comparing the outcomes of LPND versus preoperative CRT for rectal cancer, focusing on recent advancements and ongoing debates. Key studies, including the JCOG0212 trial and recent multicenter trials, were analyzed to assess the efficacy of LPND, particularly in conjunction with preoperative CRT or TNT. Current evidence indicates that LPND can reduce local recurrence rates compared to total mesorectal excision alone in patients not receiving radiation therapy. However, the benefit of LPND in the context of neoadjuvant CRT is influenced by the size and pretreatment characteristics of LPNs. While CRT can effectively control smaller metastatic LPNs, larger or clinically suspicious LPNs may require LPND for optimal outcomes. Advances in surgical techniques, such as robotic-assisted LPND, offer potential benefits but also present challenges and complications. The role of TNT in controlling metastatic LPNs and improving patient outcomes is emerging but remains underexplored. The decision to perform LPND should be individualized based on patient-specific factors, including LPN size, response to neoadjuvant treatment, and surgeon expertise. Future research should focus on optimizing treatment protocols and further evaluating the role of TNT in managing metastatic LPNs.
Minimally invasive surgery
Robotic colorectal surgery training: Portsmouth perspective
Guglielmo Niccolò Piozzi, Sentilnathan Subramaniam, Diana Ronconi Di Giuseppe, Rauand Duhoky, Jim S. Khan
Ann Coloproctol. 2024;40(4):350-362.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00444.0063
  • 1,445 View
  • 58 Download
AbstractAbstract PDF
This study aims to discuss the principles and pillars of robotic colorectal surgery training and share the training pathway at Portsmouth Hospitals University NHS Trust. A narrative review is presented to discuss all the relevant and critical steps in robotic surgical training. Robotic training requires a stepwise approach, including theoretical knowledge, case observation, simulation, dry lab, wet lab, tutored programs, proctoring (in person or telementoring), procedure-specific training, and follow-up. Portsmouth Colorectal has an established robotic training model with a safe stepwise approach that has been demonstrated through perioperative and oncological results. Robotic surgery training should enable a trainee to use the robotic platform safely and effectively, minimize errors, and enhance performance with improved outcomes. Portsmouth Colorectal has provided such a stepwise training program since 2015 and continues to promote and augment safe robotic training in its field. Safe and efficient training programs are essential to upholding the optimal standard of care.
Translational/basic research
Tissue engineering and regenerative medicine approaches in colorectal surgery
Bigyan B. Mainali, James J. Yoo, Mitchell R. Ladd
Ann Coloproctol. 2024;40(4):336-349.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00437.0062
  • 990 View
  • 42 Download
AbstractAbstract PDF
Tissue engineering and regenerative medicine (TERM) is an emerging field that has provided new therapeutic opportunities by delivering innovative solutions. The development of nontraditional therapies for previously unsolvable diseases and conditions has brought hope and excitement to countless individuals globally. Many regenerative medicine therapies have been developed and delivered to patients clinically. The technology platforms developed in regenerative medicine have been expanded to various medical areas; however, their applications in colorectal surgery remain limited. Applying TERM technologies to engineer biological tissue and organ substitutes may address the current therapeutic challenges and overcome some complications in colorectal surgery, such as inflammatory bowel diseases, short bowel syndrome, and diseases of motility and neuromuscular function. This review provides a comprehensive overview of TERM applications in colorectal surgery, highlighting the current state of the art, including preclinical and clinical studies, current challenges, and future perspectives. This article synthesizes the latest findings, providing a valuable resource for clinicians and researchers aiming to integrate TERM into colorectal surgical practice.
Colorectal cancer
Essential knowledge and technical tips for total mesorectal excision and related procedures for rectal cancer
Min Soo Cho, Hyeon Woo Bae, Nam Kyu Kim
Ann Coloproctol. 2024;40(4):384-411.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00388.0055
  • 1,415 View
  • 78 Download
AbstractAbstract PDF
Total mesorectal excision (TME) has greatly improved rectal cancer surgery outcomes by reducing local recurrence and enhancing patient survival. This review outlines essential knowledge and techniques for performing TME. TME emphasizes the complete resection of the mesorectum along embryologic planes to minimize recurrence. Key anatomical insights include understanding the rectal proper fascia, Denonvilliers fascia, rectosacral fascia, and the pelvic autonomic nerves. Technical tips cover a step-by-step approach to pelvic dissection, the Gate approach, and tailored excision of Denonvilliers fascia, focusing on preserving pelvic autonomic nerves and ensuring negative circumferential resection margins. In Korea, TME has led to significant improvements in local recurrence rates and survival with well-adopted multidisciplinary approaches. Surgical techniques of TME have been optimized and standardized over several decades in Korea, and minimally invasive surgery for TME has been rapidly and successfully adopted. The review emphasizes the need for continuous research on tumor biology and precise surgical techniques to further improve rectal cancer management. The ultimate goal of TME is to achieve curative resection and function preservation, thereby enhancing the patient’s quality of life. Accurate TME, multidisciplinary-based neoadjuvant therapy, refined sphincter-preserving techniques, and ongoing tumor research are essential for optimal treatment outcomes.
Anorectal benign disease
Recent advances in the diagnosis and treatment of complex anal fistula
Pankaj Garg, Kaushik Bhattacharya, Vipul D. Yagnik, G. Mahak
Ann Coloproctol. 2024;40(4):321-335.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00325.0046
  • 2,404 View
  • 373 Download
AbstractAbstract PDF
Anal fistula can be a challenging condition to manage, with complex fistulas presenting even greater difficulties. The primary concerns in treating this condition are a risk of damage to the anal sphincters, which can compromise fecal continence, and refractoriness to treatment, as evidenced by a high recurrence rate. Furthermore, the treatment of complex anal fistula involves several additional challenges. Satisfactory solutions to many of these obstacles remain elusive, and no consensus has been established regarding the available treatment options. In summary, complex anal fistula has no established gold-standard treatment, and the quest for effective therapies continues. This review discusses and highlights groundbreaking advances in the management of complex anal fistula over the past decade.
Colorectal cancer
Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
Daichi Kitaguchi, Masaaki Ito
Ann Coloproctol. 2024;40(4):375-383.   Published online August 30, 2024
DOI: https://doi.org/10.3393/ac.2024.00178.0025
  • 859 View
  • 56 Download
AbstractAbstract PDF
This study aimed to review the historical transition of rectal cancer surgery and recent evidence regarding transanal total mesorectal excision (TaTME). Additionally, it outlined the anatomical landmarks and technical considerations essential for successful TaTME. Anatomical studies and surgical techniques were analyzed to identify key landmarks and procedural steps crucial for TaTME. TaTME offers improved visibility and maneuverability even in the deep and narrow pelvis and is expected to contribute to tumor radical cure rates. By securing the circumferential resection margin and distal margin while preserving pelvic autonomic nerve function, TaTME holds promise for maintaining postoperative urinary and sexual functions. Key anatomical landmarks include the endopelvic fascia posteriorly, the S4-pelvic splanchnic nerve laterally, and the prostate or posterior vaginal wall anteriorly. Selecting the appropriate dissection layer based on tumor depth and ensuring precise incision of the tendinous arch of the pelvic fascia contributes to successful TaTME outcomes. TaTME represents a significant advancement in rectal cancer surgery, offering improved outcomes through meticulous attention to anatomical detail and precise dissection techniques. Understanding the historical context of rectal cancer surgery alongside recent evidence on TaTME is essential for optimizing patient outcomes and expanding the safe implementation of this innovative approach.
Benign bowel disease
Colorectal screening following appendectomy in adult patients: a systematic review
Francesco Esposito, Marco Del Prete, Matilde Magri, Fanny Dufour, Alexandre Cortes
Ann Coloproctol. 2024;40(5):417-423.   Published online August 1, 2024
DOI: https://doi.org/10.3393/ac.2023.00528.0075
  • 866 View
  • 48 Download
AbstractAbstract PDF
Purpose
Although the association between appendicitis and colorectal cancer in older patients has received attention, postoperative colorectal screening through endoscopy is not currently recommended. This study conducted a systematic review of the literature on colorectal screening following appendectomy in adult patients.
Methods
A literature search was performed using online databases. Studies reporting colorectal surveillance after appendectomy in adult patients were retrieved for assessment.
Results
Eight articles including a total of 3,995 patients were published between 2013 and 2023. An age of 40 years was the lower threshold in 6 of the 8 articles. Postoperative colorectal screening occurred in 771 patients (19.3%). Endoscopy was performed in 95.2% of cases and computed tomography–colonography in 4.8%. During endoscopic examinations, a lesion was discovered in 184 of 771 patients (24.0%), and an adenomatous polyp was found in 154 of 686 patients (22.5%). The overall cancer rate was 3.9% (30 of 771 patients). The tumor was located in the right-sided colon in 46.7% of the patients, in the cecum in 20.0%, in the rectum in 16.7%, in the left-sided colon in 10.0%, and in the sigmoid colon in 6.7%.
Conclusion
Performing post-appendectomy colorectal screening in patients >40 years of age could allow early detection of an underlying lesion.
Tolerance to and postoperative outcomes with early oral feeding following elective bowel surgery: a systematic review with meta-analysis
Lord Mvoula, Evelyn Irizarry
Received July 17, 2023  Accepted November 21, 2023  Published online July 31, 2024  
DOI: https://doi.org/10.3393/ac.2023.00472.0067    [Epub ahead of print]
  • 569 View
  • 14 Download
AbstractAbstract PDF
Purpose
Advancements in gastrointestinal surgery have directed attention toward optimizing recovery, including through the use of feeding methods that reduce prolonged postoperative hospital stays, complications, and mortality, among other undesirable outcomes. This study’s primary goals were to identify current peer-reviewed literature reporting the postoperative outcomes of elective bowel surgery and to evaluate the clinical evidence of patients’ tolerance to oral feeding following elective bowel surgery.
Methods
An exhaustive literature search was conducted via PubMed and Scopus. The search results were screened for potential articles, and articles were assessed for eligibility based on prespecified eligibility criteria. The data were synthesized, and the results were reported and discussed thematically.
Results
The database search yielded 1,667 articles, from which 18 randomized controlled trials were chosen for inclusion in this study. This study included 874 early oral feeding (EOF) patients, 865 traditional oral feeding patients, and 91 patients whose postoperative care was unspecified. Data synthesis was done, and meta-analyses were conducted. The results showed that EOF patients required a significantly shorter time to tolerate a solid diet and had shorter hospital stays. In addition, bowel function was restored earlier in EOF groups.
Conclusion
The results show good tolerance to EOF, shorter hospitalizations, and faster restoration of bowel function, suggesting that EOF after elective bowel surgery is relatively safe. However, further studies with similar baseline conditions should be conducted to verify these results.
Colorectal cancer
Postoperative outcomes after prehabilitation for colorectal cancer patients undergoing surgery: a systematic review and meta-analysis of randomized and nonrandomized studies
Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Eileen Sim, Chee Hoe Koo, Wenjie Lin, Chang Meihuan, Emile Kwong-Wei Tan
Ann Coloproctol. 2024;40(3):191-199.   Published online May 16, 2024
DOI: https://doi.org/10.3393/ac.2022.01095.0156
  • 1,922 View
  • 189 Download
AbstractAbstract PDF
Purpose
Prehabilitation (PH) is purported to improve patients’ preoperative functional status. This systematic review and meta-analysis sought to compare short-term postoperative outcomes between patients who underwent a protocolized PH program and the existing standard of care among colorectal cancer patients awaiting surgery.
Methods
A search in MEDLINE/PubMed, the Cochrane Library, Embase, Scopus, and CINAHL was conducted to identify relevant articles. Repetitive and exhaustive combinations of MeSH search terms (“prehabilitation,” “colorectal cancer,” “colon cancer,” and “rectal cancer”) were used to identify randomized and nonrandomized studies comparing PH versus standard of care for colorectal cancer patients awaiting surgery. The primary outcomes included postoperative morbidity, length of hospital stay, and readmission rates.
Results
Seven studies including 1,042 colorectal cancer patients (PH, 382) were included. No significant differences were found in intraoperative outcomes. The postoperative complication rates were comparable between groups (Clavien-Dindo grades I and II: risk ratio, 0.82; 95% confidence interval, 0.62–1.07; P=0.15; Clavien-Dindo grades ≥III: risk ratio, 1.02; 95% confidence interval, 0.72–1.44; P=0.92). There were also no significant differences in length of hospital stay (P=0.21) or the risk of 30-day readmission (P=0.68).
Conclusion
Although PH does not appear to improve short-term postoperative outcomes following colorectal cancer surgery, the quality of evidence is impaired by the limited trials and heterogeneity. Thus, further large-scale trials are warranted to draw definitive conclusions and establish the long-term effects of PH.
ERAS
Venous thromboembolism among Asian populations with localized colorectal cancer undergoing curative resection: is pharmacological thromboprophylaxis required? A systematic review and meta-analysis
Shih Jia Janice Tan, Emile Kwong-Wei Tan, Yvonne Ying Ru Ng, Rehena Sultana, John Carson Allen, Isaac Seow-En, Ronnie Mathew, Aik Yong Chok
Ann Coloproctol. 2024;40(3):200-209.   Published online May 16, 2024
DOI: https://doi.org/10.3393/ac.2022.01046.0149
  • 1,647 View
  • 165 Download
AbstractAbstract PDF
Purpose
We compared the incidence of venous thromboembolism (VTE) among Asian populations with localized colorectal cancer undergoing curative resection with and without the use of pharmacological thromboprophylaxis (PTP).
Methods
A comprehensive literature search was undertaken to identify relevant studies published from January 1, 1980 to February 28, 2022. The inclusion criteria were patients who underwent primary tumor resection for localized nonmetastatic colorectal cancer; an Asian population or studies conducted in an Asian country; randomized controlled trials, case-control studies, or cohort studies; and the incidence of symptomatic VTE, deep vein thrombosis, and/or pulmonary embolism as the primary study outcomes. Data were pooled using a random-effects model. This study was registered in PROSPERO on October 11, 2020 (No. CRD42020206793).
Results
Seven studies (2 randomized controlled trials and 5 observational cohort studies) were included, encompassing 5,302 patients. The overall incidence of VTE was 1.4%. The use of PTP did not significantly reduce overall VTE incidence: 1.1% (95% confidence interval [CI], 0%–3.1%) versus 1.9% (95% CI, 0.3%–4.4%; P = 0.55). Similarly, PTP was not associated with significantly lower rates of symptomatic VTE, proximal deep vein thrombosis, or pulmonary embolism.
Conclusion
The benefit of PTP in reducing VTE incidence among Asian patients undergoing curative resection for localized colorectal cancer has not been clearly established. The decision to administer PTP should be evaluated on a case-bycase basis and with consideration of associated bleeding risks.
Colorectal cancer
Performance reporting design in artificial intelligence studies using image-based TNM staging and prognostic parameters in rectal cancer: a systematic review
Minsung Kim, Taeyong Park, Bo Young Oh, Min Jeong Kim, Bum-Joo Cho, Il Tae Son
Ann Coloproctol. 2024;40(1):13-26.   Published online February 28, 2024
DOI: https://doi.org/10.3393/ac.2023.00892.0127
  • 2,187 View
  • 162 Download
  • 3 Web of Science
  • 4 Citations
AbstractAbstract PDF
Purpose
The integration of artificial intelligence (AI) and magnetic resonance imaging in rectal cancer has the potential to enhance diagnostic accuracy by identifying subtle patterns and aiding tumor delineation and lymph node assessment. According to our systematic review focusing on convolutional neural networks, AI-driven tumor staging and the prediction of treatment response facilitate tailored treat­ment strategies for patients with rectal cancer.
Methods
This paper summarizes the current landscape of AI in the imaging field of rectal cancer, emphasizing the performance reporting design based on the quality of the dataset, model performance, and external validation.
Results
AI-driven tumor segmentation has demonstrated promising results using various convolutional neural network models. AI-based predictions of staging and treatment response have exhibited potential as auxiliary tools for personalized treatment strategies. Some studies have indicated superior performance than conventional models in predicting microsatellite instability and KRAS status, offer­ing noninvasive and cost-effective alternatives for identifying genetic mutations.
Conclusion
Image-based AI studies for rectal can­cer have shown acceptable diagnostic performance but face several challenges, including limited dataset sizes with standardized data, the need for multicenter studies, and the absence of oncologic relevance and external validation for clinical implantation. Overcoming these pitfalls and hurdles is essential for the feasible integration of AI models in clinical settings for rectal cancer, warranting further research.

Citations

Citations to this article as recorded by  
  • L’intelligence artificielle pourrait-elle aider le chirurgien digestif dans la prise en charge du cancer du rectum ?
    Arnaud Alves, Karem Slim
    Journal de Chirurgie Viscérale.2024; 161(4): 253.     CrossRef
  • Can artificial intelligence help a digestive surgeon in management of rectal cancer?
    Arnaud Alves, Karem Slim
    Journal of Visceral Surgery.2024; 161(4): 231.     CrossRef
  • Artificial intelligence for the colorectal surgeon in 2024 – A narrative review of Prevalence, Policies, and (needed) Protections
    Kurt S. Schultz, Michelle L. Hughes, Warqaa M. Akram, Anne K. Mongiu
    Seminars in Colon and Rectal Surgery.2024; 35(3): 101037.     CrossRef
  • Artificial Intelligence in Coloproctology: A Review of Emerging Technologies and Clinical Applications
    Joana Mota, Maria João Almeida, Miguel Martins, Francisco Mendes, Pedro Cardoso, João Afonso, Tiago Ribeiro, João Ferreira, Filipa Fonseca, Manuel Limbert, Susana Lopes, Guilherme Macedo, Fernando Castro Poças, Miguel Mascarenhas
    Journal of Clinical Medicine.2024; 13(19): 5842.     CrossRef
Colorectal cancer
Survival outcomes of salvage surgery in the watch-and-wait approach for rectal cancer with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review and meta-analysis
Wenjie Lin, Ian Jun Yan Wee, Isaac Seow-En, Aik Yong Chok, Emile Kwong-Wei Tan
Ann Coloproctol. 2023;39(6):447-456.   Published online December 28, 2023
DOI: https://doi.org/10.3393/ac.2022.01221.0174
  • 2,709 View
  • 154 Download
  • 2 Web of Science
  • 3 Citations
AbstractAbstract PDFSupplementary Material
Purpose
This systematic review and meta-analysis compared the outcomes of the watch-and-wait (WW) approach versus radical surgery (RS) in rectal cancers with clinical complete response (cCR) after neoadjuvant chemoradiotherapy.
Methods
This study followed the PRISMA guidelines. Major databases were searched to identify relevant articles. WW and RS were compared through meta-analyses of pooled proportions. Primary outcomes included overall survival (OS), disease-free survival (DFS), local recurrence, and distant metastasis rates. Pooled salvage surgery rates and outcomes were also collected. The Newcastle-Ottawa scale was employed to assess the risk of bias.
Results
Eleven studies including 1,112 rectal cancer patients showing cCR after neoadjuvant chemoradiation were included. Of these patients, 378 were treated nonoperatively with WW, 663 underwent RS, and 71 underwent local excision. The 2-year OS (risk ratio [RR], 0.95; P = 0.94), 5-year OS (RR, 2.59; P = 0.25), and distant metastasis rates (RR, 1.05; P = 0.80) showed no significant differences between WW and RS. Local recurrence was more frequent in the WW group (RR, 6.93; P < 0.001), and 78.4% of patients later underwent salvage surgery (R0 resection rate, 97.5%). The 2-year DFS (RR, 1.58; P = 0.05) and 5-year DFS (RR, 2.07; P = 0.02) were higher among RS cases. However, after adjustment for R0 salvage surgery, DFS showed no significant between-group difference (RR, 0.82; P = 0.41).
Conclusion
Local recurrence rates are higher for WW than RS, but complete salvage surgery is often possible with similar long-term outcomes. WW is a viable strategy for rectal cancer with cCR after neoadjuvant chemoradiation, but further research is required to improve patient selection.

Citations

Citations to this article as recorded by  
  • Advancing Personalized Medicine in the Treatment of Locally Advanced Rectal Cancer
    Francesco Giulio Sullo, Alessandro Passardi, Chiara Gallio, Chiara Molinari, Giorgia Marisi, Eleonora Pozzi, Leonardo Solaini, Alessandro Bittoni
    Journal of Clinical Medicine.2024; 13(9): 2562.     CrossRef
  • Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
    Youn Young Park, Nam Kyu Kim
    Annals of Gastroenterological Surgery.2024; 8(5): 761.     CrossRef
  • Combined Transanal and Laparoscopic Approach for Full-Thickness Local Excision of Locally Advanced Rectal Cancer Following Near-Complete Response after Chemotherapy
    Joshua S. H. Lim, Si-Lin Koo, Iain Beehuat Tan, Isaac Seow-En
    World Journal of Colorectal Surgery.2024; 13(3): 95.     CrossRef
Colorectal cancer
Essential anatomy for lateral lymph node dissection
Yuichiro Yokoyama, Hiroaki Nozawa, Kazuhito Sasaki, Koji Murono, Shigenobu Emoto, Hiroyuki Matsuzaki, Shinya Abe, Yuzo Nagai, Yuichiro Yoshioka, Takahide Shinagawa, Hirofumi Sonoda, Daisuke Hojo, Soichiro Ishihara
Ann Coloproctol. 2023;39(6):457-466.   Published online December 8, 2023
DOI: https://doi.org/10.3393/ac.2023.00164.0023
  • 2,424 View
  • 188 Download
  • 2 Citations
AbstractAbstract PDF
In Western countries, the gold-standard therapeutic strategy for rectal cancer is preoperative chemoradiotherapy (CRT) following total mesorectal excision (TME), without lateral lymph node dissection (LLND). However, preoperative CRT has recently been reported to be insufficient to control lateral lymph node recurrence in cases of enlarged lateral lymph nodes before CRT, and LLND is considered necessary in such cases. We performed a literature review on aspects of pelvic anatomy associated with rectal surgery and LLND, and then combined this information with our experience and knowledge of pelvic anatomy. In this review, drawing upon research using a 3-dimensional anatomical model and actual operative views, we aimed to clarify the essential anatomy for LLND. The LLND procedure was developed in Asian countries and can now be safely performed in terms of functional preservation. Nonetheless, the longer operative time, hemorrhage, and higher complication rates with TME accompanied by LLND than with TME alone indicate that LLND is still a challenging procedure. Laparoscopic or robotic LLND has been shown to be useful and is widely performed; however, without a sufficient understanding of anatomical landmarks, misrecognition of vessels and nerves often occurs. To perform safe and accurate LLND, understanding the landmarks of LLND is essential.

Citations

Citations to this article as recorded by  
  • The role of lateral pelvic lymph node dissection in advanced rectal cancer: a review of current evidence and outcomes
    Gyu-Seog Choi, Hye Jin Kim
    Annals of Coloproctology.2024; 40(4): 363.     CrossRef
  • Dissection layer selection based on an understanding of pelvic fascial anatomy in transanal total mesorectal excision
    Daichi Kitaguchi, Masaaki Ito
    Annals of Coloproctology.2024; 40(4): 375.     CrossRef
Colorectal cancer
Total neoadjuvant therapy for rectal cancer: evidence and challenge
Suk-Hwan Lee
Ann Coloproctol. 2023;39(4):301-306.   Published online August 29, 2023
DOI: https://doi.org/10.3393/ac.2023.00269.0038
  • 2,334 View
  • 126 Download
  • 4 Web of Science
  • 5 Citations
AbstractAbstract PDF
Recent advances in the management of rectal cancer have dramatically changed the clinical practice of colorectal surgeons because the main focus of rectal cancer treatment has changed from sphincter-saving to an organ-preserving strategies. Modifying the delivery of systemic chemotherapy to improve patients’ survival is another progress in colorectal cancer management, known as total neoadjuvant therapy (TNT). TNT is a new strategy used by colorectal surgeons to improve the quality of life and survival of patients after treatment. TNT poses limitations or obstacles, such as overtreatment issues in patients with stage I rectal cancer. However, considering the quality-of-life issues in patients with low-lying rectal cancer necessitating a permanent colostomy, the indication for TNT will be expanded. This review summarizes the recently conducted clinical trials and foresees future perspectives on TNT.

Citations

Citations to this article as recorded by  
  • Current Surgical Methods in Local Rectal Excision
    Kristina Šemanjski, Karla Lužaić, Jure Brkić
    Gastrointestinal Tumors.2024; : 1.     CrossRef
  • Tailoring rectal cancer surgery: Surgical approaches and anatomical insights during deep pelvic dissection for optimal outcomes in low‐lying rectal cancer
    Youn Young Park, Nam Kyu Kim
    Annals of Gastroenterological Surgery.2024; 8(5): 761.     CrossRef
  • A nomogram for predicting the overall survival in rectal cancer patients after total neoadjuvant therapy
    Z. Liu, M. He, X. Wang
    Techniques in Coloproctology.2024;[Epub]     CrossRef
  • Impact of the laparoscopic approach, early closure and preoperative stimulation on outcomes of ileostomy closure after rectal resection
    Andrea Norte, Carmen Martínez, Ana Pasalodos, Ivette Tort, Anna Sánchez, Pilar Hernández, Jesús Bollo, Eduard Maria Targarona
    Cirugía Española (English Edition).2024;[Epub]     CrossRef
  • Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
    Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
    Annals of Surgical Treatment and Research.2023; 105(6): 341.     CrossRef
Colorectal cancer
Total neoadjuvant therapy in rectal cancer: a network meta-analysis of randomized trials
Sergey Sychev, Aleksey Ponomarenko, Stanislav Chernyshov, Mikhail Alekseev, Zaman Mamedli, Dmitriy Kuzmichev, Andrey Polynovskiy, Evgeny Rybakov
Ann Coloproctol. 2023;39(4):289-300.   Published online April 11, 2023
DOI: https://doi.org/10.3393/ac.2022.00920.0131
  • 3,931 View
  • 204 Download
  • 2 Web of Science
  • 5 Citations
AbstractAbstract PDFSupplementary Material
Purpose
To assess the efficacy of total neoadjuvant therapy (TNT) for rectal carcinoma in comparison with conventional chemoradiotherapy (CRT).
Methods
A systematic review was performed according to the PRISMA guidelines. A Bayesian network meta-analysis was done using NetMetaXL and WinBUGS. This study was registered in PROSPERO on March 3, 2022 (No. CRD-42022307867).
Results
Outcomes of 2,719 patients from 10 randomized trials between 2010 and 2022 were selected. Of these 1,191 (44%) had conventional long-course CRT (50–54 Gy) and capecitabine, 506 (18%) had induction chemotherapy followed by CRT (50–54 Gy) and capecitabine (iTNT), 230 (9%) had long-course CRT (50–54 Gy) followed by consolidation chemotherapy (cTNT), and 792 (29%) undergone modified short-course radiotherapy (25 Gy) with subsequent chemotherapy (mTNT). Total pathologic complete response (pCR) was 20% in the iTNT group, 21% in the mTNT group, 22% in the cTNT group, and 12% in the CRT group. Statistically significant difference in pCR rates was detected when comparing iTNT with CRT (odds ratio [OR], 1.76; 95% credible interval [CrI], 1.06–2.8), mTNT with CRT (OR, 1.90; 95% CrI, 1.25–2.74), and cTNT with CRT groups (OR, 2.54; 95% CrI, 1.26–5.08). No differences were found in R0 resection rates. No significant difference was found in long-term outcomes.
Conclusion
The early administration of systemic chemotherapy in the TNT regimen has improved short-term outcomes, though long-term results are underreported. Randomized trials with survival as the endpoint are necessary to evaluate the possible advantages of TNT modes.

Citations

Citations to this article as recorded by  
  • Predictive Value of Tumor-Infiltrating Lymphocytes and Ki-67 for Pathological Response to Total Neoadjuvant Therapy in Rectal Cancer
    Amrallah Mohammed, Adel Bakry, Shimaa Gharieb, Amira Hanna, Ahmed Obaya, Waleed Abdelhady, Abdelrahman Metwalli
    Journal of Gastrointestinal Cancer.2024; 55(2): 869.     CrossRef
  • Changes in clinical guidelines for the treatment of colorectal cancer in 2024
    S. S. Gordeev, M. Yu. Fedyanin, M. V. Chernykh, Ye. G. Rubakov, A. M. Karachun, A. A. Nevolskikh, A. A. Tryakin, Z. Z. Mamedli
    Surgery and Oncology.2024; 14(1): 21.     CrossRef
  • Oncological Outcomes and Response Rate After Total Neoadjuvant Therapy for Locally Advanced Rectal Cancer: A Network Meta-Analysis Comparing Induction vs. Consolidation Chemotherapy vs. Standard Chemoradiation
    Sergei Bedrikovetski, Luke Traeger, Warren Seow, Nagendra N. Dudi-Venkata, Sudarsha Selva-Nayagam, Michael Penniment, Tarik Sammour
    Clinical Colorectal Cancer.2024;[Epub]     CrossRef
  • Executive Summary of the American Radium Society on Appropriate Use Criteria for Nonoperative Management of Rectal Adenocarcinoma: Systematic Review and Guidelines
    Christopher J. Anker, Leila T. Tchelebi, J. Eva Selfridge, Salma K. Jabbour, Dmitriy Akselrod, Peter Cataldo, Gerard Abood, Jordan Berlin, Christopher L. Hallemeier, Krishan R. Jethwa, Ed Kim, Timothy Kennedy, Percy Lee, Navesh Sharma, William Small, Vone
    International Journal of Radiation Oncology*Biology*Physics.2024;[Epub]     CrossRef
  • Unveiling the profound advantages of total neoadjuvant therapy in rectal cancer: a trailblazing exploration
    Kyung Uk Jung, Hyung Ook Kim, Hungdai Kim, Donghyoun Lee, Chinock Cheong
    Annals of Surgical Treatment and Research.2023; 105(6): 341.     CrossRef

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