How to successfully perform non-operative management for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review

doi:10.3877/cma.j.issn.1674-0793.2016.04.019

Abstract

Abstract:

The current treatment for locally advanced rectal cancer (LARC) is neoadjuvant chemoradiotherapy (NCRT) followed by radical surgery 4-8 weeks later. NCRT can lead to tumor downstaging or even to all tumor cell disappearance by imaging [MRI, PET/CT, and transrectal ultrasound (TU)], clinical examination such as digital rectal examination, and endoscopy ± biopsy, which means clinical complete response (cCR). For those with cCR, the traditional treatment is radical surgery, but some authors have proposed a non-operative management: a wait-and-see policy with strict selection criteria, follow-up and salvage treatments achieves outcomes at least as good as radical surgery, which has dramatic priorities such as avoiding complications and colostomy. However, some study report this new method increased the risk of local recurrence (LR). The reason for that is mainly because of poor assessment accuracy of initial cCR and the schedule of follow-up for detection of sustained cCR. We therefore review all literature related to cCR, with highlights on how to more successfully perform a non-operative management for LARC patients with a cCR after NCRT.

Key words: Rectal neoplasms, Neoadjuvant chemoradiotherapy, Clinical complete response, Non-operative management

Xin Zhang, Jiatian Yuan, Bo Lyu, Jun Fan, Shasha Xing, Jun Li. How to successfully perform non-operative management for rectal cancer patients with clinical complete response after neoadjuvant chemoradiotherapy: a systematic review[J]. Chinese Archives of General Surgery(Electronic Edition), 2016, 10(04): 307-310.

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