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Precis Future Med > Epub ahead of print
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DOI: https://doi.org/10.23838/pfm.2021.00163    [Epub ahead of print]
Published online December 27, 2021.
Multidisciplinary treatment strategy for early rectal cancer: A review
Gyung Mo Son1  , In Young Lee1  , Sung Hwan Cho1  , Byung-Soo Park1  , Hyun Sung Kim1  , Su Bum Park2  , Hyung Wook Kim2  , Sang Bo Oh3  , Tae Un Kim4  , Dong Hoon Shin5 
1Department of Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
2Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
3Department of Hemato-oncology, Pusan National University Yangsan Hospital, Yangsan, Korea
4Department of Radiology, Pusan National University Yangsan Hospital, Yangsan, Korea
5Department of Pathology, Pusan National University Yangsan Hospital, Yangsan, Korea
Correspondence  Gyung Mo Son ,Tel: +82-55-360-2124, Email: skm1711@pusan.ac.kr
Submitted: October 21, 2021  Accepted after revision: December 6, 2021
Abstract
The early rectal cancer (ERC) has increased with the national cancer screening project for early detection of colorectal cancer. The gold standard treatment for low rectal cancer is low anterior resection (LAR) based on total mesorectal excision. However, radical resection results in a high mortality and complication rate, and the deterioration of quality of life due to LAR syndrome, genitourinary dysfunction, and possible permanent stoma. Local excision with chemoradiation therapy could be one of the alternative therapeutic strategies for the organ preservation and a cure of cancer. To decide the treatment strategies, it is important to establish sophisticated indications that can maximize the therapeutic effect. ERC has heterogeneous pathological features, including aggressive behavior and occult lymph node metastasis, with different responses to chemoradiotherapy. Therefore, radiologic, endoscopic and pathologic evaluation to predict the risk of lymph node metastasis and local recurrence has been evolving to determine the optimal treatment strategy in the patient-tailored medicine. Recently, the long-term outcomes of prospective randomized clinical trials provide new hope for organ preservation in patients with ERC. In this paper, we aim to review various risk factors related to local recurrence and discuss the optimal treatment strategy for ERC.
Keywords: Colonoscopy; Neoadjuvant therapy; Organ preservation; Rectal Neoplasms; Transanal endoscopic surgery


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