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Clin Colon Rectal Surg 2017; 30(05): 324-332
DOI: 10.1055/s-0037-1606109
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

The Perfect Total Mesorectal Excision Obviates the Need for Anything Else in the Management of Most Rectal Cancers

Richard John Heald
1   Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
,
Ines Santiago
1   Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
,
Oriol Pares
1   Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
,
Carlos Carvalho
1   Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
,
Nuno Figueiredo
1   Digestive Unit, Champalimaud Cancer Center, Champalimaud Centre for the Unknown, Lisbon, Portugal
› Author Affiliations
Further Information

Publication History

Publication Date:
27 November 2017 (online)

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Abstract

This article discusses the local control of primary rectal cancer and its locoregional spread in the light of modern advances. In recent years, the use of neoadjuvant chemoradiation has spread widely. However, its true benefit is not always balanced with its morbidities. Often total mesorectal excision (TME) is the best option. We will discuss the indications for immediate surgery for chemoradiation in advance and the importance of a delay in the management plan. To understand this selection, it is mandatory to know the true extent of tissue at risk for tumor dissemination and spread. Considering that TME may be enough for many patients and that most local recurrences are failures of surgical technique we introduce a new concept of total mesorectal irradiation. This exploits the new reality that precise, focused neoadjuvant therapy can offer a better response with fewer complications. Together these important changes in cancer board (multidisciplinary team) planning can also offer selected patients complete control of their cancer with no need for surgery.

Keywords

rectal cancer - total mesorectal excision - precision surgery - total mesorectal irradiation
 

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