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Article 2 - Journal Club Edition 2

Preservation of the rectum is possible in early rectal cancer with neoadjuvant radiotherapy, delay and local excision—a 12‐year single‐centre experience of the evolution of early rectal cancer treatment

The treatment of colorectal cancer is constantly evolving and improving, with improved survival and quality of life.  This paper looks at the data, over a 12 year period, of patients with early rectal cancer and how a combination of short course radio therapy, adjuvant and neoadjuvant therapy alongside local excision can aid in organ preservation.

Bilkhu, A., Robinson, J.M. and Steward, M.A. (2021). Preservation of the rectum is possible in early rectal cancer with neoadjuvant radiotherapy, delay and local excision—a 12‐year single‐centre experience of the evolution of early rectal cancer treatment. Colorectal Disease.

 

 

This article takes data over a 12-year period in the treatment of early rectal cancer. 

 

 

Treatment of early rectal cancer (ERC) is undergoing a revolution towards rectum preservation. Adjuvant and neoadjuvant therapy alongside local excision (LE) means that organ preservation is a real possibility for most patients and a viable alternative for frailer patients. This study presents our 12‐year experience as a specialist regional ERC unit, evolving towards organ preservation.

 

Data were collected prospectively between 2006 and 2018 for all patients referred to the regional ERC multidisciplinary team with suspected or confirmed ERC. Patients considered suitable for LE, or those declining radical surgery, were offered LE or neoadjuvant short‐course radiotherapy (SCRT), delay and LE with subsequent rescue surgery or contact brachytherapy for unfavourable histopathology.

 

In all, 102 patients underwent LE. Ten patients were excluded (N = 92). 45 patients underwent LE directly and 47 patients received SCRT and LE. After SCRT and LE, a pathological complete response was achieved in 44.7%. This approach also resulted in a lower rate of lymphovascular invasion (22.2% vs. 6.4%), fewer distant recurrences (4.4% vs. 0%) and a better disease‐specific mortality (11.1% vs. 0%) (P < 0.05). Although statistically insignificant, fewer patients required rescue surgery after SCRT (15.6% vs. 4.3%).

 

Organ preservation with a good oncological outcome is better achieved by neoadjuvant radiotherapy, delay and LE. To achieve this, careful patient selection, thorough preoperative investigation, experienced surgical technique, and a deep appreciation of tumour biology managed via a dedicated ERC network is paramount.

We all know that whenever possible permanent stoma formation is and should be avoided. This paper shows some positive results especially within the frailer population. How do the rates within your hospital compare with the rates within this paper? Personally, it highlighted for me the importance of the MDT and the vital role of the clinical nurse specialist within it. This paper made me reflect upon the many MDT’s I have sat in on and the impact I have had on them. I suggest taking some time after reading this paper reflecting on your role within the MDT.