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Aim Rectal cancer is a malignant disease requiring multidisciplinary management. In view of the increasing number of studies published over the past decade, a comprehensive update is required to draw recommendations for clinical practice mandated by the French Research Group of Rectal Cancer Surgery and the French National Coloproctology Society. Method Seven questions summarizing the treatment of rectal cancer were selected. A search for evidence in the literature from January 2004 to December 2015 was performed. A drafting committee and a large group of expert reviewers contributed to validate the statements. Results Recommendations include the indications for neoadjuvant therapy, the quality criteria for surgical resection, the management of postoperative disordered function, the role of local excision in early rectal cancer, the place of conservative strategies after neoadjuvant treatment, the management of synchronous liver metastases and the indications for adjuvant therapy. A level of evidence was assigned to each statement. Conclusion The current clinical practice guidelines are useful for the treatment of rectal cancer. Some statements require a higher level of evidence due to a lack of studies. [ABSTRACT FROM AUTHOR]

Background: By traditional open surgery, the tumor recurrence rate of total mesorectal excision with sphincter-preserving procedure was lower than that of abdominoperineal resection (APR) for the treatment of low rectal cancer. The present study aimed to rescrutinize whether the same conclusion can be drawn when both surgical procedures are performed laparoscopically. Methods: We retrospectively reviewed the prospectively recorded clinicopathologic data of 344 consecutive patients with low rectal cancer, in which 170 patients underwent preoperative chemoradiotherapy followed by laparoscopic total mesorectal excision (TME), whereas 174 patients underwent laparoscopic TME directly without chemoradiotherapy. Such patients were further stratified according to the pathologic tumor, node, metastasis stage (stage II or III disease) and surgical strategy (APR or sphincter-preserving operation [SPO]). The surgical procedures are presented in supplemental videos. The disease-free survival, recurrence patterns, and functional recovery of patient groups stratified as appropriate were compared. Results: In patients who received preoperative chemoradiotherapy, the estimated recurrence rate were similar between laparoscopic TME with SPO and laparoscopic APR with 10.6 %, 7 of 66, versus 18.5 %, 5 of 27, in stage II disease ( p = 0.811, log-rank test); and 19.3 %, 11 of 57, versus 20 %, 4 of 20, in stage III disease ( p = 0.980). In patients without preoperative chemoradiotherapy, the recurrence rate was significantly higher in laparoscopic APR than in the laparoscopic TME with SPO group of patients with stage III disease (45 %, 9 of 20, vs. 19.3 %, 16 of 83, p = 0.025), whereas the recurrence rate of the two procedures was similar (21.4 %, 3 of 14, vs. 17.5 %, 10 of 57, p = 0.702) in stage II disease. Conclusions: When low rectal cancer was operated on by laparoscopic approach, the poorer prognosis of APR compared to SPO was only observed in stage III patients without preoperative chemoradiotherapy. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim was to study the effects of the introduction of TME surgery and pre-operative radiotherapy on overall survival (OS) by comparing patients treated in the period before (1990–1995), during (1996–1999) and after (2000–2002) the TME trial. Patients and methods: Patients diagnosed with rectal carcinoma in the region of Comprehensive Cancer Centres South and West were used (n =3179). Results: Five-year OS was, respectively, 56%, 62% and 65% in the pre-trial, trial and post-trial periods (p <0.001). Pre-operative RT was increasingly used over time and significantly related to OS in the post-trial period (p =0.002), but not in the pre-trial and trial periods. Conclusions: Population-based OS improved markedly since the introduction of TME surgery. With standardised TME surgery, pre-operative RT improved OS, whereas withholding pre-operative RT was associated with a poorer prognosis. The present study supports that pre-operative RT was correctly introduced as a standard treatment before TME surgery in our national guideline. [Copyright &y& Elsevier]

Summary: Background: Although several authors have demonstrated that laparoscopic total mesorectal excision (TME) is feasible, safe, and has short-term benefits over open surgery, evidence about oncological outcome is lacking. Preoperative chemoradiation has been shown to improve local control in locally advanced rectal cancer. Therefore, neoadjuvant treatment followed by laparoscopic TME has become widely used. We reviewed our series of laparoscopic TME focusing on comparison between preoperative chemoradiation therapy and primary surgery. Methods: Out of 59 patients who underwent laparoscopic TME, 20 were submitted to neoadjuvant chemoradiation and represent study population. Twenty-six patients with non-metastatic rectal cancer >T1 on pathologic TNM staging who underwent primary laparoscopic surgery were considered for comparison. Results: No significant differences were found in operative time, in conversions to open surgery, in intra- and postoperative complications, and in anastomotic leakage rate between the two groups. No isolated local recurrence nor port-site metastases were detected in either group. Cumulative 3-year and 5-year survivals are also similar. Conclusion: Neoadjuvant treatment does not seem to jeopardize perioperative results of laparoscopic TME. The low incidence of local recurrence reported in both groups may be attributed to a more precise dissection allowed by the endoscopic view. Laparoscopic TME and preoperative chemoradiotherapy may significantly improve oncologic results and quality of life in patients with mid and low rectal cancer. Results should be validated by randomized trials with adequate follow-up. [Copyright &y& Elsevier]

BACKGROUND: Incidence of rectal cancer has wide geographical variation. Disease pattern in developing countries is different from developed countries as majority of the patients present in advanced stage because of delayed referral and lack of uniform treatment practices. AIMS: Present study describes the patient profile and treatment results from a tertiary care cancer center in India. SETTING AND DESIGN: Tertiary care Regional cancer center. Retrospective analysis 89 patients with rectal adenocarcinoma treated between 1995 and 2002 were analyzed. METHODS: Patients with adenocarcinoma rectum were evaluated in a G.I. Oncology clinic and were treated using multimodality protocols involving surgery, radiotherapy and adjuvant chemotherapy. STATISTICAL ANALYSIS: A descriptive analysis of patient and disease profile, treatment patterns and out come was performed. Survival analysis was performed using Kaplan-Meier method. RESULTS: Mean age of the patients was 45.4 years and majority of them had tumor in lower third of rectum with evidence of extrarectal spread. Seventy five percent of the patients underwent curative resection with abdominoperineal resection being the commonest procedure. Forty seven percent of patients were given short course preoperative radiotherapy and the remaining received postoperative radiotherapy. Sixty four percent of patients could complete planned adjuvant chemotherapy. Operative mortality was 2% and 23% had morbidity. Local recurrence rate was 8.9%. 5-year disease free and overall survival was 54% and 58% respectively. CONCLUSION: Majority of rectal cancer patients present with locally advanced and low rectal growths leading to low sphincter salvage rates. Despite the advanced stage of presentation optimal oncologic results can be obtained by using a good surgical techniques in combination with adjuvant radiotherapy and chemotherapy. Short course preoperative radiotherapy seems to be more feasible in Indian context. Timely referral and uniform treatment guidelines throughout the country are needed for optimal management of rectal cancer in India. [ABSTRACT FROM AUTHOR]

Background: Total mesorectal excision (TME) offers the lowest reported rates of local recurrence and the best survival results in patients with rectal cancer. However, the laparoscopic approach to resection for colorectal cancer remains controversial due to fears that oncologic principles will be compromised. We assessed the feasibility, safety and long-term outcome of laparoscopic rectal cancer resections following the principles of TME. The aim of this study was to evaluate the perioperative outcome and long-term results of laparoscopic TME.Methods: We reviewed the prospective database of 102 consecutive unselected patients undergoing laparoscopic TME for rectal cancer between November 1991 and December 2000. Follow-up was done through office charts or direct patient contact. Recurrence and survival curves were generated by the Kaplan-Meier method.Results: Laparoscopic TME was completed successfully in 99 patients, whereas conversion to an open approach was required in three cases (3%). The overall morbidity and mortality rates were 27% and 2%, respectively, with an overall anastomotic leak rate of 17%. Of the 102 patients, four were excluded from the oncologic evaluation because final pathology was not confirmatory (two had anal canal squamous cell carcinoma and two had villous adenoma with dysplasia). In 90 of the 98 remaining patients (91.8%), the resection was considered curative. The remainder had a palliative resection due to synchronous metastatic disease or locally advanced disease. Mean follow-up was 36 months (range, 6-96). There were no trocar site recurrences. The local recurrence rate was 6%, and the cancer-specific survival of all curatively resected patients was 75% at 5 years. The overall survival rate of all curatively resected patients was 65% at 5 years; mean survival time was 6.23 years (95% confidence interval [CI], 5.39-7.07).Conclusion: Laparoscopic TME is feasible and safe. The laparoscopic approach to the surgical treatment of operable rectal cancer does not seem to entail any oncologic disadvantages. [ABSTRACT FROM AUTHOR]

Rectovaginal fistula (RVF) is one of the intractable complications following chemoradiation and total mesorectal excision (TME) for rectal cancer. It is supposed that there is a strong possibility of this complication occurring in patients after radiation therapy and having underlying sepsis. We describe herein two female patients (73 and 40 years old) who developed RVF after chemoradiation and TME for rectal cancer, who were successfully managed by gracilis muscle transposition. Fecal diversion was done as a preliminary step to the fistula repair. Success was defined as healed fistula after stoma closure. The strategy in the present report is a useful option for RVF management in such patients as other successful modalities are very limited. [ABSTRACT FROM AUTHOR]