ASCO GI 2023 | Non-operative management of rectal cancer
Tsuyoshi Konishi, MD, PhD, The University of Texas MD Anderson Cancer Center, Houston, TX, discusses the latest in non-surgical treatment strategies for patients with rectal cancer, including accurate monitoring of clinical complete response after neoadjuvant therapy. Dr Konishi additionally highlights the need for monitoring patients post-surgery, where the risk of regrowth is high, as well as salvage surgery in patients where regrowth happens. This interview took place at the American Society of Clinical Oncology (ASCO) 2023 Gastrointestinal Cancers (GI) Symposium in San Francisco, CA.
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Transcript (edited for clarity)
My talk is on non-operative management for rectal cancer, especially focusing on the role of a surgeon. There are a couple of important points from the surgical viewpoint. First is how to diagnose accurately the clinical complete response after total neoadjuvant therapy in rectal cancer. Approximately 30-40% of the patients who received the total neoadjuvant therapy actually achieved a complete response...
My talk is on non-operative management for rectal cancer, especially focusing on the role of a surgeon. There are a couple of important points from the surgical viewpoint. First is how to diagnose accurately the clinical complete response after total neoadjuvant therapy in rectal cancer. Approximately 30-40% of the patients who received the total neoadjuvant therapy actually achieved a complete response.
This is quite a comprehensive multidisciplinary diagnosis by MRI, the clinical digital rectal examination, and endoscopy. So, actually, the surgeons are responsible mainly for digital examination and the endoscope, especially in the US, and these roles are quite important. None of them can be missing and we should understand what is the exact criteria of a clinical complete response.The second, once the clinical computer response is achieved, we should take quite close surveillance for the patient, because approximately 20-25% of the patients actually develops the regrowth of the tumor, and salvage surgery in time by a surgeon is critical in order to get uncompromised oncologic outcome. So, how to survey after complete response is another important take-home message, especially the first two years is quite important because the patient has a very high risk of the regrowth and usually every three to four months the patient needs to visit the surgeon’s office and undergo endoscope, clinical examination, and MRI.
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