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. 2019 Jun;30(2):79-84.
doi: 10.1053/j.scrs.2019.04.007. Epub 2019 Apr 20.

Non-operative management of rectal cancer

Jonathan B Greer  1 , Alexander T Hawkins  2
Affiliations

Non-operative management of rectal cancer

Jonathan B Greer et al. Semin Colon Rectal Surg. 2019 Jun.

Abstract

Despite advances in technique, surgical resection of rectal cancer remains a morbid procedure that can lead a profound decrease in a patient's quality of life. A novel method of management, termed "Non-operative management" (NOM), mirrors the management of anal carcinoma. Patients undergo definitive treatment with only chemotherapy and radiation, with resection reserved only for salvage. Current data is encouraging- both in reduction in morbidity and similar, if not superior oncologic results. However, there are a number of barriers to the wide adoption of this practice. This manuscript seeks to describe the rationale and execution of NOM as well as present the current data and pitfalls of the approach.

Keywords: chemotherapy; radiotherapy; rectal cancer; “Non-operative management”; “Watch and wait”.

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Conflict of interest statement

Conflicts of Interest: None

Figures

Figure 1-
Figure 1-
Post CRT photos of rectal cancer demonstrating a complete clinical response on endoscopy. Photos courtesy of David S. Medich, MD.
Figure 2-
Figure 2-
Flow Chart for Potential NOM Management of Patients with Low Rectal Cancer Legend: CRT- Chemoradiation Therapy; TNT- Total Neoadjuvant Therapy; cCR- clinical Complete Response; nCR- near Complete Response; NOM- Non-Operative Management; TEM- Transanal Endoscopic Microsurgery.
See this image and copyright information in PMC

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