Annals of Surgical Oncology

, Volume 12, Issue 2, pp 95–97 | Cite as

Rectal Cancer: Can We Throw Away the Scalpel?

  • Michael O. Meyers
  • Joel E. Tepper

It has long been held that chemotherapy and radiation are adjuncts to radical en-bloc surgical resection in the treatment of rectal cancer, that surgery is the most important modality of treatment, and, in early-stage disease, that surgery is the only treatment needed. In an effort to lessen the morbidity and potential lifestyle-altering effects of radical surgical resection, other therapeutic approaches have been advocated. Increasing evidence has suggested that chemoradiation followed by less radical (sphincter-sparing) surgery, or no surgery at all, may be adequate treatment, even for T2 and T3 tumors. However, concerns about regional disease in the mesorectum persist, even in T1 tumors, and radical surgery remains part of the therapy in most rectal cancers because we have yet to identify reliably a group of patients in whom we can predict good results without radical resection.

In this issue of Annals of Surgical Oncology, Pucciarelli et al.1address this issue. They report on a...


  1. 1.
    Pucciarelli S, Capirci C, Emanuele U, et al. Relationship between pathologic T-stage and nodal metastasis after preoperative chemoradiotherapy for locally advanced rectal cancer. Ann Surg Oncol (in press).Google Scholar
  2. 2.
    Hager, T, Gall, FP, Hermanek, P 1983Local excision of cancer of the rectumDis Colon Rectum2614951PubMedGoogle Scholar
  3. 3.
    Taylor, RH, Hay, JH, Larsson, SN 1998Transanal local excision of selected low rectal cancersAm J Surg.1753603Google Scholar
  4. 4.
    Garcia-Aguilar, J, Mellgren, A, Sirivongs, P, Buie, D, Madoff, RD, Rothenberger, DA 2000Local excision of rectal cancer without adjuvant therapy: a word of cautionAnn Surg.23134551Google Scholar
  5. 5.
    Steele, GD,Jr, Herndon, JE, Bleday, R,  et al. 1999Sphincter-sparing treatment for distal rectal adenocarcinomaAnn Surg Oncol.643341Google Scholar
  6. 6.
    Steele, G,Jr, Busse, P, Huberman, MS,  et al. 1991A pilot study of sphincter-sparing management of adenocarcinoma of the rectumArch Surg.126696701discussion 701–2Google Scholar
  7. 7.
    Sitzler, PJ, Seow-Choen, F, Ho, YH, Leong, AP 1997Lymph node involvement and tumor depth in rectal cancers: an analysis of 805 patientsDis Colon Rectum4014726Google Scholar
  8. 8.
    Nascimbeni, R, Burgart, LJ, Nivatvongs, S, Larson,  2002Risk of lymph node metastasis in T1 carcinoma of the colon and rectumDis Colon Rectum452006CrossRefPubMedGoogle Scholar
  9. 9.
    Mohiuddin, M, Marks, G, Bannon, J 1994High-dose preoperative radiation and full thickness local excision: a new option for selected T3 distal rectal cancersInt J Radiat Oncol Biol Phys.308459Google Scholar
  10. 10.
    Kim, CJ, Yeatman, TJ, Coppola, D,  et al. 2001Local excision of T2 and T3 rectal cancers after downstaging chemoradiationAnn Surg.2343528discussion 358–9Google Scholar
  11. 11.
    Habr-Gama, A, Perez, RO, Nadalin, W,  et al. 2004Operative versus nonoperative treatment for stage 0 distal rectal cancer following chemoradiation therapy: long-term resultsAnn Surg.2407117discussion 717–8Google Scholar
  12. 12.
    Hiotis, SP, Weber, SM, Cohen, AM,  et al. 2002Assessing the predictive value of clinical complete response to neoadjuvant therapy for rectal cancer: an analysis of 488 patientsJ Am Coll Surg.1941315discussion 135–6Google Scholar

Copyright information

© The Society of Surgical Oncology, Inc. 2005

Authors and Affiliations

  1. 1.Department of Surgery, Division of Surgical OncologyUNC/Lineberger Comprehensive Cancer Center and the University of North Carolina School of Medicine at Chapel HillChapel Hill
  2. 2.Department of Radiation OncologyUNC/Lineberger Comprehensive Cancer Center and the University of North Carolina School of Medicine at Chapel HillChapel Hill

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