New trends in criteria indicative of neoadjuvant oncological therapy of lower and middle rectal cancers.

The indication for primary surgical resection or neoadjuvant therapy in lower and middle rectal cancers is often disputable. The aim of the study was to evaluate the occurrence of local recurrence of rectal cancer as for a period of at least 4 years after radical resection. The second aim was to evaluate and compare the results of preoperative magnetic resonance (MR) staging with definitive histology.From September 2013 to December 2017, we, at the 3rd Surgical Department Comenius University, Bratislava, prospectively evaluated patients with lower and middle rectal cancers with the distal tumor border being in a 12-cm distance from the anal verge. All patients underwent MR examination at the same MRI department and were operated on at the 3rd Surgical Department, Comenius University, Bratislava. Inclusion criteria included parameters based on MRI examination, i.e., T-staging of T1-T3b, negative extramural vascular infiltration (EMVI), negative circumferential margin (CRM), no mesorectal fascia infiltration with a distance of more than 2 mm. We did not take lymph node staging into account in the indication for primary surgical resection. We performed a radical primary resection procedure (R0 resection) in all patients. The group consisted of 87 patients, of whom 49 were men and 38 were women. The mean age of the patients was 66 years (min. 36 - max. 86 years). Our study also shows significant differences in preoperative T and N staging as compared to definitive histology. The incidence of local recurrence during a period of at least 4 years after surgery was 6.76 %. Study also shows that the indication for preoperative radiotherapy for lower and middle rectal cancers based on N status is inaccurate and leads to unnecessary indications for preoperative radiotherapy which may decrease the patients´ quality of life and increase the post­operative complications. We have also shown that leaving out the N-based radiotherapy from indications does not lead to an increase in the number of local recurrences in lower and middle rectal cancers (Tab. 1, Fig. 5, Ref. 22). Text in PDF www.elis.sk Keywords: rectal cancer, neoadjuvant therapy, local recurrence.

Squamous cell rectal cancer in a young woman.

BACKGROUND: Rectal squamous cell carcinoma (RSCC) belongs to rare gastrointestinal malignancies. There are no consensus recommendations for the treatment of non-metastatic RSCC, which can cause problems when considering optimal therapy. PURPOSE: The objective of this report is to point out that RSCC is a rare disease which needs to be distinguished from anal squamous cell cancer (ASCC) and the treatment of which differs from that of rectal adenocarcinoma. CASE REPORT: We discuss the dia-gnosis and therapy of a patient with non-metastatic RSCC. A forty-two-year-old woman with a history of diarrhea and rectal bleeding was dia-gnosed for RSCC with locoregional lymphadenopathy, stage T3N1MO. Protective sigmostomy was performed for stenotizing tumor; then the patient underwent chemoradiotherapy with the effect of complete response in MR scans. Subsequently, the patient underwent rectal resection according to Dixon with histological confirmation of complete tumor regression and without detection of residual tumor in the rectum. CONCLUSION: It can be sometimes difficult to distinguish primary RSCC from ASCC. Nowadays, there is no standardized staging system for RSCC, and it causes problems in comparative studies as well as in the determination of treatment protocols. The backbone of RSCC treatment is chemoradiotherapy.