Academic Study XR-TEMinDREC – Combination of the Concomitant Neoadjuvant Chemoradiotherapy Followed by Local Excision Using Rectoscope and Accelerated Dispensarisation and Further Treatment of the Patients with Slightly Advanced Stages of Distant Localized Rectal Adenocarcinoma in MOÚ

Česká verzia

Authors: M. Ondrák ^1,2; L. Fiala ¹; P. Pospíšil ³; I. Kocáková ⁴; M. Pacal ⁵
Authors place of work: Klinika operační onkologie MOÚ Brno ¹; Klinika operační onkologie LF MU Brno ²; Klinika radiační onkologie LF MU a MOÚ Brno ³; Klinika komplexní onkologické péče LF MU a MOÚ Brno ⁴; Oddělení radiologie, MOÚ Brno ⁵
Published in the journal: Klin Onkol 2020; 33(4): 309-317
Category: Case Report
doi: https://doi.org/10.14735/amko2020309

Summary

Background: Miniinvasive approaches are a long-term trend in surgery. Maximum possible quality of life after treatment of rectal cancer is a long-term goal. Adequate radicality of surgery is a long-term necessity. It is sometimes very difficult to fulfill all the above-mentioned requirements in low-level rectal cancer. By applying a multidisciplinary approach in the treatment of mildly advanced stages of low-seated malignant rectal tumor, a treatment procedure resulting in continence preserving can be offered to a selected group of patients meeting the strict indication criteria. We document our results with respect to a small number of patients in several interesting case reports.

Cases: We are following up one patient after ideal treatment course achieving downstaging after neoadjuvant treatment, with uncomplicated operation and after operation period and with a long-term complete remission. One patient achieved dehiscence of the rectum suture. After secondary healing we observed a long-term remission. In one patient a rectovaginal fits developed outside the operation site. We were forced to abdominoperineal amputation. The pathological investigation of the specimen proved radically of the local excision and lack of lymphangioinvasion; nevertheless, a positive perirectal lymph node was found. The last case report shows the limits of imaging diagnostics. The liver lesions described as benign were in fact liver metastases of the early rectal cancer.

Conclusion: According to the worldwide data available, the combination of neoadjuvant chemoradiotherapy and local excision by means of an operative rectoscope is a safe alternative to a resection surgery with total mesorectal excision in T2N0 rectal cancer. However, there is a need of other studies with more patients included, optimally randomized and prospective ones, which will support these claims.

Supported by MH CR – DRO (MOÚ, 00209805).

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers.

Keywords:

rectal cancer – TEM – neoadjuvant treatment – stoma

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