Recent advances in multidisciplinary approach for rectal cancer

Area of Science:

• Oncology
• Surgical Oncology
• Gastrointestinal Oncology

Background:

• Total mesorectal excision (TME) is the standard surgical approach for rectal cancer, improving oncological outcomes.
• Neoadjuvant chemoradiotherapy (nCRT) is the standard treatment for advanced rectal cancer in many countries to control local recurrence.
• Research is exploring novel agents like oxaliplatin and targeted therapies within nCRT, but 5-fluorouracil (5-FU) based nCRT remains the standard.

Purpose of the Study:

• To evaluate the oncological effect of the Japanese standard surgical approach (mesorectal excision with lateral lymph node dissection) compared to mesorectal excision alone.
• To assess the efficacy of TME with lateral lymph node dissection in reducing recurrence rates for clinical stage II and III lower rectal cancer.

Main Methods:

• Phase III clinical trial.
• Comparison of two surgical techniques: mesorectal excision (ME) with lateral lymph node dissection versus ME alone.
• Focus on clinical stage II and III lower rectal cancer patients.

Main Results:

• The study is ongoing, and results are not yet available.
• The Japanese standard operation, involving ME with lateral lymph node dissection, is hypothesized to reduce recurrence rates.
• The trial aims to provide evidence for the oncological superiority of the Japanese standard approach.

Conclusions:

• Neoadjuvant therapy is not standard in Japan due to the effectiveness of surgery with lateral lymph node dissection.
• The ongoing phase III study will determine the oncological benefit of the Japanese standard surgical approach compared to TME alone.
• Findings could influence future treatment guidelines for rectal cancer, particularly in Japan.