Rectal Cancer

Symposium - Andrew Renehan (UK) at ESCP Nice 2018

ESCP/EAES Symposium - Francesco Bianco (Italy) at ESCP Nice 2018

ESCP/EAES Symposium - Sebastiano Biondo (Spain) at ESCP Nice 2018

ESCP/EAES Symposium - Pieter Tanis (The Netherlands) at ESCP Nice 2018

The Six Best Free Papers - Eric Rullier (France) at ESCP Nice 2018

The Six Best Free Papers - Jennifer Park (Sweden) at ESCP Nice 2018

ASCRS Visiting Fellow Free Paper - Michael Marco (USA) at ESCP Nice 2018

International Trials Results Forum - Simon Bach (UK) with Expert commentary by Quentin Denost (France) at ESCP Nice 2018

Young ESCP Members Best Three Papers - Hossam Elfeki (Egypt) at ESCP Nice 2018

Core Subject Update - Roel Hompes (The Netherlands) at ESCP Nice 2018

Surgical Video Session - Jose Maria Enriquez-Navascues (Spain) at ESCP Nice 2018

Symposium - Michael Solomon (Australia) at ESCP Nice 2018

Symposium - Bill Heald (UK) at ESCP Nice 2018

New Trials Forum - Hartwig Kroner (Norway) at ESCP Nice 2018

Educational session - Geerard Beets (The Netherlands) at ESCP Berlin 2017

International Trials Results Forum - Jérémie Lefevre (France) with expert commentary by Pieter Tanis (The Netherlands) at ESCP Berlin 2017

Surgical Video Session - Masaaki Ito (Japan) at ESCP Berlin 2017

Surgical Video Session - Luis Sanchez-Guillen (Spain) at ESCP Berlin 2017

ESCP Guidelines Update - Søren Laurberg (Denmark) at ESCP Berlin 2017

Educational session - Brendan Moran (UK) at ESCP Berlin 2017

JSCP Visiting Fellow Free Paper - Mamoru Uemura at ESCP Berlin 2017

One of the Six Best Free Papers - Anne Thyø (Denmark) at ESCP Berlin 2017

Keynote Lecture - Søren Laurberg (Denmark) at ESCP Berlin 2017

Symposium - Simon Bach (UK) at ESCP Berlin 2017

Symposium - Ivan Dimitrijević (Serbia) at ESCP Berlin 2017

Symposium - Julio Garcia Aguilar (USA) at ESCP Berlin 2017

Symposium - Geerard Beets (Netherlands) at ESCP Berlin 2017

Symposium chaired by Simon Bach (UK) and Eric Rullier (France)

As part of taTME month, Quentin Denost, Centre Hospitalier Universitaire Bordeaux, explores using the procedure following total ISR in female.

This downloadable resource is accompanied by a video. Click on the title above to view.

Rectal cancer should be managed by a multidisciplinary team (MDT) that includes input from gastroenterology, radiology, pathology, radiation oncology, and oncology in addition to colorectal surgery. The workup of suspected rectal cancer includes digital rectal examination, rectoscopy (proctoscopy), and biopsy. Staging of the tumor requires thoracic/abdominal computed tomography, pelvic magnetic resonance imaging, and complete colonoscopy to assess local tumor growth, systemic spread, and synchronous colonic lesions. The findings should be discussed during an MDT conference to determine the optimal sequence of treatment and the timing and extent of surgical resection. Radiotherapy, which is best delivered preoperatively, reduces the risk of local recurrence and may enhance survival in high-risk patients. Concomitant chemotherapy is used to increase the effect of radiotherapy (chemosensitizing radiation). Complete resection of the rectum en bloc with the surrounding mesorectal envelope enclosing draining lymphatic tissue, called total mesorectal excision, is the gold standard to decrease the risk of local recurrence and avoid injury to adjacent pelvic structures. Rectal cancers in the middle and upper third of the rectum can be treated with sphincter-saving anterior resection and colorectal anastomosis. Cancer in the lower third of the rectum may be amenable to low anterior resection with coloanal anastomosis or require abdominoperineal excision. Tumors involving the pelvic floor or external anal sphincter are treated with extralevator abdominoperineal excision and permanent colostomy. Preoperative chemoradiotherapy may result in complete clinical and radiological response. Such patients may enter a watch-and-wait program of intensive surveillance to detect tumor regrowth. Review of the surgical specimen pathology during a postoperative MDT meeting is important to ensure treatment quality and to determine the potential need for adjuvant chemotherapy. Follow-up after treatment, to detect metachronous colorectal cancer, local recurrence, or systemic disease, should continue for 5 years. Surgery and radiotherapy have adverse effects on function of the bowel, urinary bladder, sexual organs, and gonads, which warrant attention both at the onset of treatment and during follow-up.