[Therapeutic choices for cancer of the rectum: discussion and update of the consensus conference].
Three years after the consensus conference on the therapeutic options for rectal cancer, a recent literature review gave us some decision elements. Quality of the surgical resection appears to be the most important therapeutic factor in the prognosis of rectal cancer. Total mesorectal excision was followed by a significant decrease of locoregional recurrence rate for the tumor of the two lower thirds of rectum. In this way, it has been shown that pelvic nerves can be easily preserved. Which nerves are important for a good postoperative sexual activity remains however debated. Furthermore, whether the nerve sparing techniques influence the prognosis is also a matter of controversy. On the other hand, abdominoperineal resection is still indicated in most lower tumors to prevent local recurrences. Preoperative radiation therapy appears more effective than the postoperative one to decrease postoperative local recurrence rate after B2 (Astler-Coller) or T3 (TNM) tumors. At present, only one study showed that preoperative radiation therapy improved five-year survival. Combination of radiotherapy and chemotherapy improves also five-year survival, but this option leads to high toxicity. Thus the best adjuvent treatment remains to be defined. Awaiting for this, the good quality of surgical resection is mandatory.
Service de Chirurgie Digestive et Thoracique, Hôpital Trousseau, Tours. decalan@med.univ-tours.fr
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D003131:Combined Modality Therapy; D003245:Consensus Statements as Topic; D006801:Humans; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012004:Rectal Neoplasms / Q000601:surgery*; D016019:Survival Analysis; D016896:Treatment Outcome
Le choix des thérapeutiques du cancer du rectum: discussion et mise à jour de la conférence de consensus.