A team of doctors and scientists from the Champalimaud Clinical Centre in Lisbon, Portugal, and the Netherlands Cancer Institute in Amsterdam, has shown that patients with "low" rectal cancer (that is, very close to the anus) who show no sign of their tumors after a course of radio- and chemotherapy can safely choose to postpone invasive and complication-prone surgical procedures. These results have been published in the journal Annals of Surgery.
Agreeing instead to submit to a very close and strict surveillance of their condition during a period of at least two years, in a "Watch-and-Wait" strategy, they might even totally evade surgery without any negative impact on their health outcome, since the majority (around two-thirds) of these patients does not show any regrowth of the tumour after the first two years of "Watch-and-Wait".
What's most important, according to the scientists, is that of the remaining patients (around one-third), whose tumor does regrow within those first years and who undergo exactly the same surgical procedure as was initially planned for them, 97% show the same outcome as if the surgery had been performed immediately after radio-chemotherapy. In other words, no precious time will have been wasted by waiting and watching the patient.
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Surgery still is, today, the frontline classical treatment protocol for rectal cancer cases - which represent about 30% of all colorectal cancers, or about six million new cases per year worldwide, according to 2018 estimates. But the fact is that, for certain particularly complicated locations of the tumor in the rectum, a previous course of radio-chemotherapy before surgery is required. Why? Because in these cases, it is necessary to reduce the size of the tumor that might already be invading the pelvic wall structures or even other organs.
This pre-operative treatment comes with its own side effects, increasing the probability of urinary and sexual dysfunction, worse bowel function or even deficient healing process. These could, in turn, have devastating post-operatory consequences, such as suture defects leading to peritonitis.
"For rectal tumors located less than seven centimeters from the anus, the patient is often submitted to radiochemotherapy during five weeks, having a subsequent recovery period of another eight to ten weeks before the surgical intervention", explains Nuno Figueiredo, head of the Champalimaud Surgical Centre and a colorectal surgeon at the Digestive Cancer Unit of the Champalimaud Clinical Centre, who is one of the co-authors of the new study together with his colleagues Marit Van der Sande and Geerard Beets, from the Netherlands Cancer Institute.