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Personalized Treatment Modalities for Rectal Cancer
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Personalized Treatment Modalities for Rectal Cancer

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: closed (25 February 2025) | Viewed by 1828

Special Issue Editors

Dr. Christy E. Cauley

E-Mail Website
Guest Editor
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
Interests: colon and rectal cancer; inflammatory bowel disease; minimally invasive surgery
Dr. Srinivas Joga Ivatury

E-Mail Website
Guest Editor
Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Austin, TX, USA
Interests: colon and rectal cancer; shared decision making; patient-oriented health services research

Special Issue Information

Dear Colleagues,

The progress of rectal cancer treatment is remarkable. Patients with rectal cancer now have several treatment options to consider, including advanced sphincter-sparing procedures and non-operative management. Watch-and-wait programs create demanding endoscopic surveillance regimens and require diligence to ensure compliance to catch persistent and recurrent disease early for successful salvage. Surgical advances in sphincter-sparing techniques are now available, but are they always the correct decision for all patients? As we face ongoing challenges in caring for a growing number of older, frail adults, we are also seeing a surge in young-onset rectal cancer cases. The need for multidisciplinary support to discuss issues of fertility, longer-term consequences of bowel function, and quality of life during survivorship are apparent. In this Special Issue, we welcome authors to submit papers on the personalized treatment of rectal cancer.

Dr. Christy E. Cauley
Dr. Srinivas Joga Ivatury
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • rectal cancer
  • decision support
  • sphincter-sparing surgery
  • early onset colorectal cancer
  • pelvic radiation

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Further information on MDPI's Special Issue policies can be found here.

Published Papers (3 papers)

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Research

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11 pages, 1857 KiB  
Article
Regional Colon and Rectal Surgeon Density Is Associated with Variation in Rectal Cancer Surgical Treatment: A Dartmouth Atlas Study
by Srinivas J. Ivatury, Daniel L. Underbakke and Ravinder Kang
J. Clin. Med. 2025, 14(6), 2004; https://doi.org/10.3390/jcm14062004 - 15 Mar 2025
Viewed by 408
Abstract
Background/Objectives: Recent reports reflect the increased enthusiasm for restorative reconstruction after a proctectomy (LAR) for rectal cancer in appropriate candidates. Despite this, abdominoperineal resection (APR) remains common. We aimed to examine the effect of the colorectal surgeon density in a hospital referral [...] Read more.
Background/Objectives: Recent reports reflect the increased enthusiasm for restorative reconstruction after a proctectomy (LAR) for rectal cancer in appropriate candidates. Despite this, abdominoperineal resection (APR) remains common. We aimed to examine the effect of the colorectal surgeon density in a hospital referral region (HRR) on the rates of LARs and APRs performed. Methods: We conducted a retrospective cohort study of Medicare-participating hospitals in the United States for the fiscal year 2014. Our cohort was all Medicare beneficiaries (MBs) with rectal cancer (ICD-9: 154.1) who underwent an intervention of an LAR (CPT: 44145, 44146, 44207, 44298, 45112, 45397) or an APR (CPT: 45110 or 45395). We compared the APR and LAR rates per HRR with the density of board-certified colorectal surgeons per HRR (divided into low-, medium-, and high-density HRRs) using membership and zip code data from the American Board of Colon and Rectal Surgery. Results: A total of 3366 beneficiaries underwent LARs and 1821 beneficiaries underwent APRs for rectal cancer in 2014. The national rates of LARs and APRs were 12.12 and 6.66 per 100,000 MBs, respectively. The individual rates were available for 104 HRRs for the LARs and 46 HRRs for the APRs (those with >10 procedures/year). The median rates of LARs per 100,000 MBs in the low-, medium-, and high-density groups were 12.13, 13.05, and 14.25, respectively. The median rates of APRs per 100,000 MBs in the low-, medium-, and high-density groups were 7.69, 7.29, and 6.23, respectively. Both trends were significant by a test of trend. Conclusions: A higher colorectal surgeon density was associated with increased rates of LARs and decreased rates of APRs for Medicare beneficiaries. Full article
(This article belongs to the Special Issue Personalized Treatment Modalities for Rectal Cancer)
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Review

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19 pages, 947 KiB  
Review
Shared Decision Making in the Treatment of Rectal Cancer
by Jonathan S. Abelson, Racquel S. Gaetani and Alexander T. Hawkins
J. Clin. Med. 2025, 14(7), 2255; https://doi.org/10.3390/jcm14072255 - 26 Mar 2025
Viewed by 497
Abstract
Background/Objectives: The management of locally advanced rectal cancer has evolved significantly, shaped by advances in multimodal neoadjuvant therapy and a growing emphasis on organ preservation through the watch-and-wait approach. These advancements, however, introduce complex treatment decisions that require careful consideration by both [...] Read more.
Background/Objectives: The management of locally advanced rectal cancer has evolved significantly, shaped by advances in multimodal neoadjuvant therapy and a growing emphasis on organ preservation through the watch-and-wait approach. These advancements, however, introduce complex treatment decisions that require careful consideration by both patients and clinicians. Methods: This narrative review explores the evolution of the management of locally advanced rectal cancer and the role of shared decision-making in guiding treatment decisions, particularly for patients facing decisions between surgical resection and watch-and-wait. Additionally, it discusses the development of tools to aid in shared-decision making, current challenges in implementing shared decision-making and future directions for improvement patient centered care in locally advanced rectal cancer management. Results: Considerations for decision making include anatomical considerations that influence surgical options, the potential benefits and risks of watch-and-wait versus surgical resection of the rectum, and the impact of treatment on bowel, urinary, and sexual function. Additionally, patients must weigh the long-term implications of their choices on quality of life. Conclusions: Shared decision-making has emerged as a critical component of patient-centered care and ensures that treatment decisions align with patients’ values and priorities. Given the preference-sensitive nature of the management of locally advanced rectal cancer, shared decision-making plays an important role in helping patients navigate these decisions. Full article
(This article belongs to the Special Issue Personalized Treatment Modalities for Rectal Cancer)
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14 pages, 604 KiB  
Review
From Diversion to Permanence: Trends in Ostomy Creation in Rectal Cancer Surgery
by Alice Jo and Matthew Z. Wilson
J. Clin. Med. 2025, 14(6), 1913; https://doi.org/10.3390/jcm14061913 - 12 Mar 2025
Viewed by 580
Abstract
Rectal cancer surgery has undergone transformative advancements over the past few decades, evolving from radical, high-morbidity procedures to more refined techniques focused on both oncological outcomes and the preservation of anorectal function. This review provides a brief overview of the history of rectal [...] Read more.
Rectal cancer surgery has undergone transformative advancements over the past few decades, evolving from radical, high-morbidity procedures to more refined techniques focused on both oncological outcomes and the preservation of anorectal function. This review provides a brief overview of the history of rectal cancer surgery, highlighting key innovations in imaging, neoadjuvant therapy, and minimally invasive techniques that have significantly reduced the need for permanent and temporary ostomies. Additionally, the current indications for both permanent and temporary ostomies are reviewed, including a discussion of associated complications, such as non-reversal, parastomal hernias, stomal prolapse, stenosis, and skin-related issues, along with strategies and techniques to mitigate these complications. This review underscores the importance of ongoing innovation and individualized surgical planning to enhance patient outcomes in rectal cancer care by understanding the historical context, contemporary practices, and associated challenges. Full article
(This article belongs to the Special Issue Personalized Treatment Modalities for Rectal Cancer)
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