1 / 18

Radical surgery is the preferable treatment option for T1-2/N0 low rectal cancer

Radical surgery is the preferable treatment option for T1-2/N0 low rectal cancer. Jose G. Guillem, MD, MPH Department of Surgery Memorial Sloan Kettering Cancer Center. Great Debates & Updates in GI Malignancies March 28-29, 2014. Rectal Cancer Surgical Options. Local Recurrence

korbin
Download Presentation

Radical surgery is the preferable treatment option for T1-2/N0 low rectal cancer

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Radical surgery is the preferable treatment option for T1-2/N0 low rectal cancer Jose G. Guillem, MD, MPH Department of Surgery Memorial Sloan Kettering Cancer Center Great Debates & Updates in GI Malignancies March 28-29, 2014

  2. Rectal Cancer Surgical Options Local Recurrence T1N0 18% 0% T2N0 47% 6% Mellgren et al. Dis Colon Rectum, 2000

  3. Inadequacy of baseline ERUS staging of primary and LN disease *Meta-analysis N = 2732 cases Puli SR et al. Ann Surg Oncol.. 2009

  4. Inadequacy of baseline MRI staging of primary, MRF, and LN involvement *Meta-analysis N = 1249 cases Al-Sukhni E et al. Ann Surg Oncol. 2012

  5. ERUS Identification of N1 Disease Photomicrograph (x20, H&E) of a lymph node that is 70% replaced by tumor. 6.4mm 5.7mm

  6. Micrometastatic Disease Photomicrograph (x20, H&E) of a lymph node with a 1mm tumor deposit

  7. ERUS Lymph Node Staging is T Dependent Landman, et al Dis Col Rectum (2007)

  8. TAE for T1 Rectal Cancer 1. High risk of ca recurrence vs. RAD. 2. TAE has a lower cancer cure rate. 3. Neither adjuvant therapy nor surgical salvage are reliable. Paty P et al Ann Surg 2002 Bentran D et al Ann Surg , 2005 Nash, G DCR, 2008

  9. Survival outcome of local excision versus radical resection of colon or rectal carcinoma: a surveillance, epidemiology, and end results (SEER) population-based study • N = 13,262 pts with rectal cancer • Surgery • 3715 (28%) local excision • 9547 (72%) major resection • Preoperative clinical T staging • 953 (7%) Tis • 6223 (47%) T1 • 6086 (46%) T2 Bhangu A et al. Annals of Surg. 2013.

  10. Survival outcome of local excision versus radical resection of colon or rectal carcinoma: a surveillance, epidemiology, and end results (SEER) population-based study *Estimated 5y OS and CSS Bhangu A et al. Annals of Surg. 2013.

  11. Local excision in early rectal cancer – outcome worse than expected: a population based study • N = 3694 consecutive stage I rectal ca pts from Swedish Rectal Cancer Register • 448 LE vs 3246 radical resection (Hartmann, LAR, APR) • LE pts • LR 11.2% (vs ~3% for all radical procedures combined) • Relative survival 0.81 (95% CI 0.75-0.88) Saraste D et al. Eur J Surg Oncol. 2013.

  12. Multimodality salvage of recurrent disease after local excision for rectal cancer 5y OS s/p salvage 63% 3y RFS s/p salvage 43% In salvage surgery R0 resection in 80%, Multivisceral 30%, neoadjuvant 70% Sphincter preservation in 33% You YN et al. Dis Colon Rectum. 2012.

  13. Salvage resection after local excision for rectal cancer

  14. Predicting lymph node metastases in early rectal cancer • N = 677 pts with pT1-2 rectal Ca in the Swedish Rectal Cancer Register Saraste D et al. Eur J Cancer. 2013.

  15. Predicting lymph node metastases in early rectal cancer Saraste D et al. Eur J Cancer. 2013.

  16. Preoperative Considerations if Pursuing a Sphincter Preserving Resection Determination is both preop and intraop Body habitus, sphincter mass? Sphincter tone, squeeze? Co-morbidities? Patient expectations, enthusiasm? Understands the “good news/bad news” post operative scenario.

  17. As in fly fishing…“Match the Hatch” “Match the Disease” Should be the governing paradigm in the management of rectal cancer J Guillem, Ann Surg 2007

More Related