Nonoperative Management of Distal Rectal Cancer After Chemoradiation: Experience with the “Watch & Wait” Protocol

摘要: Surgical treatment alone for locally advanced rectal cancer (T3/T4 or N1 tumors) has been associated with considerably high local recurrence rates. Even appropriate total mesorectal excision (TME), radical surgery leads to excellent disease control only in highly selected cases.(Simunovic et al. 2003) In this setting, the need additional complementary strategies was warranted. late 80’s and early 90’s it observed that addition of adjuvant radiotherapy without chemotherapy significantly improved as well survival rates group patients.(Krook 1991) Later on, results from randomized controlled trials suggested neoadjuvant approach superior control, even when surgical technique (total excision) performed compared treatment. (Sauer 2004) Apart theoretical advantage exposing unscarred tissue optimal oxygen delivery chemoradiation (CRT), further benefits including reduced toxicity rates, significant tumor downstaging downsizing, greater sphincter preservation, better functional have reported after CRT. (Habr-Gama 2004; Sauer Tumor some patients may be so significant, no residual detected during final pathological assessment. Still, immediate postoperative mortality morbidity usual complications, lead sexual urinary dysfunctions. Also, abdominal perineal (and a permanent stoma) could avoided, temporary loop ileostomies are mandatory order avoid potential septic consequences anastomotic leaks these patients. (Peter Matthiessen 2007)