Locally Advanced and Recurrent Rectal Cancer

A special issue of Cancers (ISSN 2072-6694).

Deadline for manuscript submissions: closed (20 October 2022) | Viewed by 10002

Special Issue Editor


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Guest Editor
Department of Digestive Surgery, Rouen University Hospital, F-76031 Rouen, France
Interests: colorectal surgery; rectal cancer; locally recurrent rectal cancer; multivisceral resection; peritoneal metastasis; HIPEC; medical ethics; quality of life
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Special Issue Information

Dear Colleagues,

Treatment for patients with locally advanced and recurrent rectal cancer differs significantly from patients with rectal cancer restricted to the mesorectum. Adequate preoperative imaging of the pelvis is therefore important to identify those patients who are candidates for multimodality treatment, including preoperative chemoradiation protocols, intraoperative radiotherapy, and extended surgical resections. Much effort should be made to select patients with these advanced tumors for treatment in specialized referral centers. This has been shown to reduce morbidity and mortality and improve long-term survival rates. Not only volume, but also a multidisciplinary team, including a radiation oncologist, urologist, surgical oncologist, plastic surgeon, and gynecologist is of importance in these surgical procedures. Traditionally, peritoneal carcinomatosis, high sacral involvement, encasement of external iliac vessels, invasion of the sciatic notch, bilateral ureteral obstruction with bilateral hydronephrosis, and the presence of gross lower limb edema (in addition to unresectable distant metastases) were considered absolute contraindications to pelvic exenterative surgery. Many of these dogmas have been challenged as exenterative centers around the world extend the traditional boundaries of resection.

The past two to three decades, however, have seen increasing acceptance of pelvic exenteration for patients with isolated locally recurrent rectal cancer because of the number of studies demonstrating reduced operative mortality and improved overall survival in large case series as well as quality-of-life outcomes. Long-term survivors after pelvic exenteration for local recurrence have comparable quality of life to patients who had primary rectal cancer. Several studies demonstrated that quality of life in pelvic exenteration patients was preserved compared to patients who underwent palliative treatment. These radical surgical approaches have previously been controversial in the surgical literature, but are no longer controversial in view of the strong and overwhelming evidence that suggests that R0 resection margin is the main predictor of long-term survival.

The aim of this Special Issue is to provide an update of articles focused on the evolution and future of multimodal therapy for locally recurrent rectal cancer.

Prof. Dr. Jean-Jacques Tuech
Guest Editor

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Keywords

  • rectal cancer
  • rectal imaging
  • chemoradiation
  • advanced rectal cancer
  • locally recurrent rectal cancer
  • multimodal treatment
  • neoadjuvant chemoradiation
  • prehabilitation
  • pelvic exenteration
  • multivisceral resection
  • pelvic reconstruction
  • urinary reconstruction
  • rehabilitation
  • quality of life
  • palliative surgery

Published Papers (3 papers)

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Research

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17 pages, 16559 KiB  
Article
Molecular Composition of Serum Exosomes Could Discriminate Rectal Cancer Patients with Different Responses to Neoadjuvant Radiotherapy
by Urszula Strybel, Lukasz Marczak, Marcin Zeman, Krzysztof Polanski, Łukasz Mielańczyk, Olesya Klymenko, Anna Samelak-Czajka, Paulina Jackowiak, Mateusz Smolarz, Mykola Chekan, Ewa Zembala-Nożyńska, Piotr Widlak, Monika Pietrowska and Anna Wojakowska
Cancers 2022, 14(4), 993; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14040993 - 16 Feb 2022
Cited by 15 | Viewed by 3126
Abstract
Identification of biomarkers that could be used for the prediction of the response to neoadjuvant radiotherapy (neo-RT) in locally advanced rectal cancer remains a challenge addressed by different experimental approaches. Exosomes and other classes of extracellular vesicles circulating in patients’ blood represent a [...] Read more.
Identification of biomarkers that could be used for the prediction of the response to neoadjuvant radiotherapy (neo-RT) in locally advanced rectal cancer remains a challenge addressed by different experimental approaches. Exosomes and other classes of extracellular vesicles circulating in patients’ blood represent a novel type of liquid biopsy and a source of cancer biomarkers. Here, we used a combined proteomic and metabolomic approach based on mass spectrometry techniques for studying the molecular components of exosomes isolated from the serum of rectal cancer patients with different responses to neo-RT. This allowed revealing several proteins and metabolites associated with common pathways relevant for the response of rectal cancer patients to neo-RT, including immune system response, complement activation cascade, platelet functions, metabolism of lipids, metabolism of glucose, and cancer-related signaling pathways. Moreover, the composition of serum-derived exosomes and a whole serum was analyzed in parallel to compare the biomarker potential of both specimens. Among proteins that the most properly discriminated good and poor responders were GPLD1 (AUC = 0.85, accuracy of 74%) identified in plasma as well as C8G (AUC = 0.91, accuracy 81%), SERPINF2 (AUC = 0.91, accuracy 79%) and CFHR3 (AUC = 0.90, accuracy 81%) identified in exosomes. We found that the proteome component of serum-derived exosomes has the highest capacity to discriminate samples of patients with different responses to neo-RT when compared to the whole plasma proteome and metabolome. We concluded that the molecular components of exosomes are associated with the response of rectal cancer patients to neo-RT and could be used for the prediction of such response. Full article
(This article belongs to the Special Issue Locally Advanced and Recurrent Rectal Cancer)
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Review

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15 pages, 1430 KiB  
Review
Understanding the Philosophy, Anatomy, and Surgery of the Extra-TME Plane of Locally Advanced and Locally Recurrent Rectal Cancer; Single Institution Experience with International Benchmarking
by Charlotte S. van Kessel and Michael J. Solomon
Cancers 2022, 14(20), 5058; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14205058 - 15 Oct 2022
Cited by 8 | Viewed by 1773
Abstract
Pelvic exenteration surgery has become a widely accepted procedure for treatment of locally advanced (LARC) and locally recurrent rectal cancer (LRRC). However, there is still unwarranted variation in peri-operative management and subsequently oncological outcome after this procedure. In this article we will elaborate [...] Read more.
Pelvic exenteration surgery has become a widely accepted procedure for treatment of locally advanced (LARC) and locally recurrent rectal cancer (LRRC). However, there is still unwarranted variation in peri-operative management and subsequently oncological outcome after this procedure. In this article we will elaborate on the various reasons for the observed differences based on benchmarking results of our own data to the data from the PelvEx collaborative as well as findings from 2 other benchmarking studies. Our main observation was a significant difference in extent of resection between exenteration units, with our unit performing more complete soft tissue exenterations, sacrectomies and extended lateral compartment resections than most other units, resulting in a higher R0 rate and longer overall survival. Secondly, current literature shows there is a tendency to use more neoadjuvant treatment such as re-irradiation and total neoadjuvant treatment and perform less radical surgery. However, peri-operative chemotherapy or radiotherapy should not be a substitute for adequate radical surgery and an R0 resection remains the gold standard. Finally, we describe our experiences with standardizing our surgical approaches to the various compartments and the achieved oncological and functional outcomes. Full article
(This article belongs to the Special Issue Locally Advanced and Recurrent Rectal Cancer)
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19 pages, 746 KiB  
Review
Contemporary Management of Locally Advanced and Recurrent Rectal Cancer: Views from the PelvEx Collaborative
by PelvEx Collaborative
Cancers 2022, 14(5), 1161; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14051161 - 24 Feb 2022
Cited by 18 | Viewed by 4356
Abstract
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections [...] Read more.
Pelvic exenteration is a complex operation performed for locally advanced and recurrent pelvic cancers. The goal of surgery is to achieve clear margins, therefore identifying adjacent or involved organs, bone, muscle, nerves and/or vascular structures that may need resection. While these extensive resections are potentially curative, they can be associated with substantial morbidity. Recently, there has been a move to centralize care to specialized units, as this facilitates better multidisciplinary care input. Advancements in pelvic oncology and surgical innovation have redefined the boundaries of pelvic exenterative surgery. Combined with improved neoadjuvant therapies, advances in diagnostics, and better reconstructive techniques have provided quicker recovery and better quality of life outcomes, with improved survival This article provides highlights of the current management of advanced pelvic cancers in terms of surgical strategy and potential future developments. Full article
(This article belongs to the Special Issue Locally Advanced and Recurrent Rectal Cancer)
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