BACKGROUND: Neoadjuvant treatment with radiotherapy and chemotherapy is the preferred regimen for locally advanced rectal cancer, aiming to increase resectability and decrease local recurrence. AIM: To evaluate the benefits of delayed surgery after neoadjuvant chemoradiation in advanced rectal cancer regarding aspects of tumor response, survival and its deleterious effects. METHODS: Were treated 106 patients consecutively with locally advanced rectal adenocarcinoma. Neoadjuvant chemoradiation with a dose of 50.4 Gy (28 fractions), 5-fluoracil and leucovorin was given. Surgery was scheduled within five to six weeks. Patients who returned later than six weeks for the scheduled surgery were grouped into the delayed group and variables such as the downstaging rate, complete response, surgical time, blood transfusion, local recurrence, distant metastasis and survival were correlated with the remaining patients in order to determine the benefits of the delayed surgery. RESULTS: Complete tumor response was found in 15 patients (T0=15/106 - 14.2%). Partial response was achieved in 38 patients (34.9%), while one patient had pT0N2 staging. The mean follow-up was 35.6 weeks for the six weeks group, and 32.2 weeks for the delayed group. There were no significant differences between the two groups in terms of downstaging, complete tumor response, surgical time, blood transfusion and early post-operative complications. Although delayed surgery didn't have a significant difference regarding the local recurrence (p=0.1468), it showed a strong tendency in the delayed group of having a lower risk of distant metastasis (p=0.0520). CONCLUSION: Delayed surgery after chemoradiation offered no clear benefits in terms of complete tumor response or downstaging. Predictive molecular factors should be investigated in the future for the proper selection of patients who will benefit from chemoradiation.
A total of 16,660 new cases of colon and rectum cancer in men and 17,620 in women are estimated for 2016 in Brazil2. In locally advanced rectum cancer, survival after R0 resection is very good, and exenteration should be offered to patients with advanced primary or recurrent tumor, where resection is necessary in addition to total excision of the conventional mesorectum6. In the case of invasion of the sacrum, excision with free margins greatly increases the morbidity and radicality of the procedure, posing a challenge to the surgeon.
To date, the highest level of evidence for the benefits of the laparoscopic approach in rectal cancer comes from the Corean Trial5 and NCCN6 studies. However, the literature lacks data to justify the use of laparoscopy in locally advanced tumors. In Brazil, there is no report of abdominoperineal resection associated with videolaparoscopic sacrectomy.
The purpose of this report is to present an alternative for the treatment of malignant rectal cancer with posterior invasion involving a combined anterior laparoscopic approach and subsequent tumor resection.
The colorectal neoplasm is the fourth most common malignancy among males and the third among females. In the Western world is estimated that 5% of the population will develop it, making this disease a major public health problem.
To analyze the prevalence of the polymorphism -765G / C region of the COX-2 gene in colorectal cancer patients compared to a control group, analyzing the possible association between this polymorphism and susceptibility to colorectal cancer.
This is a case-control study with 85 participants. Were selected 25 with colorectal cancer (case group) and 60 participants without colorectal neoplasia (control group). The molecular genetic analysis was perform to identify the polymorphism -765G / C COX2 gene with standard literature technique. In addition, patient’s clinical and pathological data were analyzed.
There was a light increase in prevalence between men in the case group, although this difference was not statistically significant. The results showed a high prevalence of GC and CC genotype in individuals with colorectal cancer, demonstrating an association between the presence of the polymorphism in the COX2 gene and susceptibility to colorectal cancer in this pattern (p=0.02). Similarly, there was also difference in allele frequencies in the groups. When patients with cancer were separated by tumor location, there was a higher prevalence of polymorphism in the left colon (p=0.02).
The polymorphism in the COX2 gene is associated with increased susceptibility to colorectal cancer, specially rectosigmoid tumors.
Desenvolvido por Surya MKT