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Comprehensive Treatment of Rectal Cancer

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

Deadline for manuscript submissions: closed (30 April 2025) | Viewed by 4570

Special Issue Editor


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Guest Editor
Department of Oncology, Azienda ULSS 9 Scaligera, Legnago, Italy
Interests: gastrointestinal cancers; randomized controlled trials; pharmacoeconomics; colorectal cancer; rectal cancer

Special Issue Information

Dear Colleagues,

Colorectal cancer (CRC) is a significant healthcare burden worldwide.

Globocam estimates the burden of CRC will increase to 3.2 million new cases and 1.6 million deaths by 2040. Treating locally advanced diseases, especially those in the rectum, is subject to debate. Traditionally, surgical resection has been the cornerstone of treatment for rectal cancer. However, the treatment paradigm has evolved in these years. In 2000, a meta-analysis showed that preoperative radiotherapy significantly improved overall survival (OS) compared with surgery alone, leading to the widespread adoption of this approach as a standard treatment. Also, it is proved that therapeutic effects can be ameliorated by associating chemotherapy with radiotherapy. The goals of chemoradiotherapy in rectal cancer should increase the results obtained with radiotherapy (downstage the tumour, the likelihood of sphincter preservation, and local tumour control) and reduce the risk of distant metastasis and more impacting (OS) outcomes. Surgical techniques had also evolved to improve the outcomes of these patients, although only recently these improvement are been standardized. Introducing the total mesorectal excision (TME) technique dramatically improved local recurrence-free survival.

The gold-standard treatment is a neoadjuvant approach with long term radiotherapy, fluoropyrimidine, and TME surgery. With the golden standard treatment, less than 5% of patients will have a local recurrence disease, but a stable rate of patients will have distant metastasis, with data at five years of 32%. Even today, the optimal management of rectal cancer remains a subject of ongoing research. Especially several attempts were made to evaluate the impact of chemotherapy-only treatment to reduce side effects on disease free survival (DFS) and OS. To this it is added the microsatellite instability-high locally advanced rectal cancer and the combination of immune checkpoint inhibitors with preoperative chemoradiotherapy. Considering all and thinking about the landscape of systemic treatments in the following years, an accurate estimate of DFS and OS rates in this group of patients is essential. Changing the natural history of rectal cancer is the only way to increase survival. 

This Special Issue of the Journal aims to comprehensively evaluate the developments in locally advanced rectal cancer treatment (surgery, radiotherapy, chemotherapy, immunotherapy) in order to optimize treatment strategies and improve long-term survival outcomes in these patients through to the collaboration of the specialists involved in rectal cancer treatment.

Dr. Jacopo Giuliani
Guest Editor

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Keywords

  • rectal cancer
  • surgery
  • chemoradiotherapy
  • neoadjuvant therapy
  • radiotherapy
  • chemotherapy
  • microsatellite instability-high
  • immunotherapy

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Published Papers (3 papers)

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Review

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26 pages, 1237 KiB  
Review
Therapeutic Management of Locally Advanced Rectal Cancer: Existing and Prospective Approaches
by Horia-Dan Lișcu, Nicolae Verga, Dimitrie-Ionuț Atasiei, Andreea-Teodora Ilie, Maria Vrabie, Laura Roșu, Alexandra Poștaru, Stefania Glăvan, Adriana Lucaș, Maria Dinulescu, Andreea Delea and Andreea-Iuliana Ionescu
J. Clin. Med. 2025, 14(3), 912; https://doi.org/10.3390/jcm14030912 - 30 Jan 2025
Cited by 1 | Viewed by 1529
Abstract
Rectal cancer (RC) presents significant challenges in diagnosis and treatment, with increasing incidence among younger populations. Treatment approaches, particularly for locally advanced rectal cancer (LARC), have evolved, notably with the introduction of total neoadjuvant therapy (TNT). TNT combines neoadjuvant chemotherapy and chemoradiotherapy before [...] Read more.
Rectal cancer (RC) presents significant challenges in diagnosis and treatment, with increasing incidence among younger populations. Treatment approaches, particularly for locally advanced rectal cancer (LARC), have evolved, notably with the introduction of total neoadjuvant therapy (TNT). TNT combines neoadjuvant chemotherapy and chemoradiotherapy before surgery, improving overall survival and reducing both metastasis and local recurrence rates compared to traditional methods, while enabling more patients to complete the full oncological treatment. Clinical trials, such as RAPIDO, OPRA, and PRODIGE 23, have demonstrated the effectiveness of TNT in tumor downstaging and complete pathological responses, offering better outcomes for patients; however, debates persist regarding the role of neoadjuvant radiotherapy, with novel strategies exploring its omission in specific cases to reduce toxicity and enhance quality of life. In addition, organ preservation strategies, such as the watch-and-wait (WW) approach, have emerged as viable options for patients with a complete response to neoadjuvant therapy. Future directions point towards personalized treatment plans incorporating radiogenomics and the integration of artificial intelligence into diagnostics to optimize patient outcomes. This review aims to synthesize current treatment strategies and ongoing advancements in rectal cancer management, providing insights into potential future innovations. Full article
(This article belongs to the Special Issue Comprehensive Treatment of Rectal Cancer)
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18 pages, 713 KiB  
Review
Total Mesorectal Excision with New Robotic Platforms: A Scoping Review
by Francesco Marchegiani, Carlo Alberto Schena, Gaia Santambrogio, Emilio Paolo Emma, Ivan Tsimailo and Nicola de’Angelis
J. Clin. Med. 2024, 13(21), 6403; https://doi.org/10.3390/jcm13216403 - 25 Oct 2024
Viewed by 1243
Abstract
Colorectal surgery is one of the specialties that have significantly benefited from the adoption of robotic technology. Over 20 years since the first robotic rectal resection, the Intuitive Surgical Da Vinci system remains the predominant platform. The introduction of new robotic systems into [...] Read more.
Colorectal surgery is one of the specialties that have significantly benefited from the adoption of robotic technology. Over 20 years since the first robotic rectal resection, the Intuitive Surgical Da Vinci system remains the predominant platform. The introduction of new robotic systems into the market has enabled the first documented total mesorectal excision (TME) using alternative platforms. This scoping review aimed to assess the role and adoption of these emerging robotic systems in performing TME for rectal cancer surgery. Methods: A comprehensive search of the Medline, Embase, and Cochrane databases was conducted up to August 2024, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. Results: Thirty-six studies were included in the review. The majority of rectal surgical procedures were performed using eight different robotic platforms. Intraoperative, short-term, and functional outcomes were generally favorable. However, pathological results were frequently incomplete. Several studies identified the lack of advanced robotic instruments as a significant limitation. Conclusions: The quality of the resected specimen is critical in rectal cancer surgery. Although TME performed with new robotic platforms appears to be feasible and safe, the current body of literature is limited, particularly in the assessment of pathological and long-term survival outcomes. Full article
(This article belongs to the Special Issue Comprehensive Treatment of Rectal Cancer)
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9 pages, 596 KiB  
Systematic Review
“Defendit Numerus”: A Pooled Analysis of 6145 Locally Advanced Rectal Cancer Treated with Preoperative Chemoradiotherapy
by Jacopo Giuliani, Marta Mandarà, Marco Muraro, Elvira Rampello, Antonella Franceschetto and Francesco Fiorica
J. Clin. Med. 2024, 13(18), 5456; https://doi.org/10.3390/jcm13185456 - 14 Sep 2024
Cited by 1 | Viewed by 1292
Abstract
Objective: The optimal management of rectal cancer remains a subject of ongoing research. This meta-analysis of individual patient data assessed the benefit of chemoradiotherapy (fluorouracil-based) in local advanced rectal cancer: disease-free survival and overall survival. Methods: We pooled the data of 6145 patients [...] Read more.
Objective: The optimal management of rectal cancer remains a subject of ongoing research. This meta-analysis of individual patient data assessed the benefit of chemoradiotherapy (fluorouracil-based) in local advanced rectal cancer: disease-free survival and overall survival. Methods: We pooled the data of 6145 patients from 24 studies of rectal cancer who received neoadjuvant radiotherapy with concomitant fluorouracil or capecitabine and surgery. The PRISMA 2020 abstract checklist was followed. Individual participant survival was reconstructed with an algorithm from published Kaplan–Meier curves. Results: The median OS was not reached; the mean survival time was 135.4 months (127.9–141.5). The median DFS was 176.9 months, and the mean disease-free survival time was 122.6 months (111.7–131.9). Conclusions: We provided a benchmark for future studies on rectal cancer treatment. The present results can be used in decision-making for locally advanced rectal cancer patients. Full article
(This article belongs to the Special Issue Comprehensive Treatment of Rectal Cancer)
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