Cuicchi D, Castagna G, Cardelli S, Larotonda C, Petrello B, Poggioli G. Restaging rectal cancer following neoadjuvant chemoradiotherapy. World J Gastrointest Oncol 2023; 15(5): 700-712 [PMID: 37275455 DOI: 10.4251/wjgo.v15.i5.700]
Corresponding Author of This Article
Dajana Cuicchi, MD, PhD, Surgeon, Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna 40138, Italy. dajana.cuicchi@aosp.bo.it
Research Domain of This Article
Oncology
Article-Type of This Article
Opinion Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Dajana Cuicchi, Giovanni Castagna, Stefano Cardelli, Cristina Larotonda, Benedetta Petrello, Gilberto Poggioli, Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna 40138, Italy
Author contributions: Cuicchi D, Castagna G, Larotonda C, Cardelli S and Petrello B collected data, drafted the initial manuscript, and approved the final version to be submitted; Poggioli G reviewed and revised the manuscript, and approved the final version to be submitted.
Conflict-of-interest statement: The authors declare having no conflicts of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Dajana Cuicchi, MD, PhD, Surgeon, Department of Medical and Surgical Sciences, Surgery of the Alimentary Tract, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Albertoni 15, Bologna 40138, Italy. dajana.cuicchi@aosp.bo.it
Received: December 22, 2022 Peer-review started: December 22, 2022 First decision: February 24, 2023 Revised: March 1, 2023 Accepted: March 29, 2023 Article in press: March 29, 2023 Published online: May 15, 2023
Abstract
Correct tumour restaging is pivotal for identifying the most personalised surgical treatment for patients with locally advanced rectal cancer undergoing neoadjuvant therapy, and works to avoid both poor oncological outcome and overtreatment. Digital rectal examination, endoscopy, and pelvic magnetic resonance imaging are the recommended modalities for local tumour restaging, while chest and abdominal computed tomography are utilised for the assessment of distant disease. The optimal length of time between neoadjuvant treatment and restaging, in terms of both oncological safety and clinical effectiveness of treatment, remains unclear, especially for patients receiving prolonged total neoadjuvant therapy. The timely identification of patients who are radioresistant and at risk of disease progression remains challenging.
Core Tip: Correct tumour restaging is pivotal for identifying the most personalised surgical treatment for patients with locally advanced rectal cancer undergoing neoadjuvant therapy; it allows avoidance of both poor oncological outcomes and overtreatment. However, there are no guidelines regarding the definition, timing, and diagnostic techniques to be carried out. This study provides the most up-to-date evidence on this topic and the outstanding issues worthy of future research.
