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Thomas et al. Mini-invasive Surg 2018;2:17 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2018.25

Review Open Access

The treatment of early rectal cancer in the era of
adjuvant and neo-adjuvant therapy

Michael G. Thomas, David E. Messenger, Katherine Gash

Department of Colorectal Surgery, University Hospitals Bristol NHS Foundation Trust, Bristol BS2 8HW, UK.
Correspondence to: Dr. Michael G. Thomas, Department of Colorectal Surgery, Bristol Royal Infirmary, Marlborough Street,
Bristol BS2 8HW, UK. E-mail: Michael.Thomas@UHBristol.nhs.uk
How to cite this article: Thomas MG, Messenger DE, Gash K. The treatment of early rectal cancer in the era of adjuvant and
neo-adjuvant therapy. Mini-invasive Surg 2018;2:17. http://dx.doi.org/10.20517/2574-1225.2018.25
Received: 9 May 2018 First Decision: 15 Jun 2018 Revised: 22 Jun 2018 Accepted: 2 Jul 2018 Published: 18 Jul 2018

Science Editor: Gordon Buchanan Copy Editor: Jun-Yao Li Production Editor: Huan-Liang Wu

Abstract
The accurate staging of rectal cancer improves the stratification of patients for adjuvant therapy. Staging of tumor with
endoluminal ultrasonography (EUS) shows a good correlation with histology (κ = 0.85; 95% confidence interval 0.76-
0.95). Overall pT and pN stage accuracy of EUS was 92% and 65% respectively. The staging of local disease can be
further augmented by EUS guided fine needle aspiration of extra rectal lesions lying within or outside of the mesorectum.
In a systematic review of local excision after neoadjuvant therapy a total of 22 unique studies reporting on 1068 patients
were analysed. At a median follow-up of 54 months, ypT0 tumours had a pooled local recurrence rate of 4% and a
median disease-free survival rate of 95%. Outcomes for ≥ ypT1 tumours were much worse with pooled local recurrence
and disease-free survival of 22% and 68%, respectively. In a review of 22 studies, 804 patients who underwent local
excision followed by adjuvant therapy either for unfavourable histology, prohibitive comorbidity or patient choice. the
pooled local recurrence was 5.8% for pT1 tumours, 13.8% for pT2 tumours and 33.7% for pT3 tumours. In addition, the
response to radiotherapy may be enhanced by aspirin, metformin and statins.

Keywords: Early rectal cancer, local excision, neoadjuvant chemoradiotherapy

BACKGROUND
The treatment of rectal cancer has advanced considerably during the last 30 years. It is widely accepted
that surgery should be based on sound oncological principles where the aim is to completely excise the
surrounding mesorectum in order to achieve a resection margin free from microscopic disease, together
with an adequate lymph node harvest. Commonly referred to as total mesorectal excision (TME), this
technique in combination with accurate post-operative staging has improved the oncological results of

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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