| Theme |
Current Topics Relating to the Anus |
| Title |
Sphincter-preserving Surgery Following Neoadjuvant Chemoradiotherapy for Rectal Cancer |
| Author |
Soichiro Ishihara |
Department of Surgery, Teikyo University School of Medicine |
| Author |
Toshiaki Watanabe |
Department of Surgery, Teikyo University School of Medicine |
| [ Summary ] |
Preoperative chemoradiotherapy for rectal cancer has been shown to reduce postoperative local recurrence. Although improved results from sphincter-preserving surgery following chemoradiotherapy have been seen to be inconclusive in clinical trials, decreases in tumor volume may enable surgeons to perform low anterior resections rather than abdominoperineal resections. Preoperative chemoradiotherapy can make it easier to achieve clearer resection margins. There are greater opportunities for safe sphincter preservation with lower rectal cancers, especially when combined with the intersphincteric resection or rectal prolapsing techniques. Responses to chemoradiotherapy vary among patients. 10-20％ of the patients show pathologically complete responses. In the future, omission of surgery following chemoradiotherapy, representing the "ultimate" sphincter-preserving therapy for rectal cancer, may be justified in select patients with complete response. On the other hand, future predictions of response will allow for the selection of non-responders to this potentially harmful therapy, who will not enjoy the oncological benefits of sphincter preservation. |