Organ preservation in rectal cancer: a synopsis of current guidelines

W A A Borstlap, S E van Oostendorp, C E L Klaver, D Hahnloser, C Cunningham, E Rullier, W.A. Bemelman, J B Tuynman, P J Tanis, research committee of the European Society of Coloproctology.

Research output: Contribution to journalArticleAcademicpeer-review

Abstract

BACKGROUND: The high morbidity associated with radical resection for rectal cancer is an incentive for surgeons to adopt strategies aimed at organ preservation, particularly for early disease. There are a number of different approaches to achieve this. In this study we have collated current national and international guidelines to produce a synopsis to support this changing practice.

METHODS: The databases PubMed, Embase, Trip database, national guideline clearinghouse, BMJ Best practice were interrogated. Guidelines published before 2010 were excluded. The AGREE-II tool was used for quality assessment.

RESULTS: 24 guidelines were drawn from 2278 potential publications. A consensus exists for local excision for "low risk" T1 rectal cancer but there is no agreement how to stratify the risk of treatment failure. There is a low level of agreement for rectal preservation for more advanced disease but when mentioned is recommended for unfit patients or in th context of a clinical trial. Guidelines are inconsistent with respect to surveillance in node negative disease and after, complete response to chemoradiotherapy CONCLUSION: According to current guidelines and consensus statements organ preservation for rectal cancer beyond low risk T1, is still considered experimental and only indicated in patients unsuitable for radical surgery.. Follow up strategies and cN0 staging deserve attention and highlight the need for high quality clinical trials. This article is protected by copyright. All rights reserved.

Original languageEnglish
Pages (from-to)201-210
Number of pages10
JournalColorectal Disease
Volume20
Issue number3
Early online date14 Nov 2017
DOIs
Publication statusPublished - 1 Mar 2018

Cite this

Borstlap, W. A. A., van Oostendorp, S. E., Klaver, C. E. L., Hahnloser, D., Cunningham, C., Rullier, E., ... research committee of the European Society of Coloproctology. (2018). Organ preservation in rectal cancer: a synopsis of current guidelines. Colorectal Disease, 20(3), 201-210. https://doi.org/10.1111/codi.13960