Early rectal cancer: the European Association for Endoscopic Surgery (EAES) clinical consensus conference

Research output: Contribution to journalArticle

Authors

  • Mario Morino
  • Mauro Risio
  • Regina Beets-Tan
  • Krzysztof Bujko
  • Yves Panis
  • Philip Quirke
  • Bjorn Rembacken
  • Eric Rullier
  • Yutaka Saito
  • Tonia Young-Fadok
  • Marco Ettore Allaix

Colleges, School and Institutes

External organisations

  • University of Torino
  • IRCCS
  • Academic Department of Surgery
  • Maastricht University
  • Institute of Oncology, Warsaw
  • University Paris VII
  • University of Leeds
  • Leeds Teaching Hospitals Trust
  • Saint André Hospital
  • National Cancer Center Hospital
  • Mayo Clinic Scottsdale-Phoenix, Arizona

Abstract

Background: The last 30 years have witnessed a significant increase in the diagnosis of early-stage rectal cancer and the development of new strategies to reduce the treatment-related morbidity. Currently, there is no consensus on the definition of early rectal cancer (ERC), and the best management of ERC has not been yet defined. The European Association for Endoscopic Surgery in collaboration with the European Society of Coloproctology developed this consensus conference to provide recommendations on ERC diagnosis, staging and treatment based on the available evidence.

Methods: A multidisciplinary group of experts selected on their clinical and scientific expertise was invited to critically review the literature and to formulate evidence-based recommendations by the Delphi method. Recommendations were discussed at the plenary session of the 14th World Congress of Endoscopic Surgery, Paris, 26 June 2014, and then posted on the EAES website for open discussion.

Results: Tumour biopsy has a low accuracy. Digital rectal examination plays a key role in the pre-operative work-up. Magnification chromoendoscopy, endoscopic ultrasound and magnetic resonance imaging are complementary staging modalities. Endoscopic submucosal dissection and transanal endoscopic microsurgery are the two established approaches for local excision (LE) of selected ERC. The role of all organ-sparing approaches including neoadjuvant therapies followed by LE should be formally assessed by randomized controlled trials. Rectal resection and total mesorectal excision is indicated in the presence of unfavourable features at the pathological evaluation of the LE specimen. The laparoscopic approach has better short-term outcomes and similar oncologic results when compared with open surgery.

Conclusions: The management of ERC should always be based on a multidisciplinary approach, aiming to increase the rate of organ-preserving procedures without jeopardizing survival.

Details

Original languageEnglish
Pages (from-to)755-773
Number of pages19
JournalSurgical endoscopy
Volume29
Issue number4
Publication statusPublished - 5 Mar 2015

Keywords

  • Early rectal cancer, Laparoscopy, Local excision, Neoadjuvant chemoradiation, Total mesorectal excision

ASJC Scopus subject areas