Exploring the limits in low rectal cancer

Abstract

Investigations into the best possible surgery for cancer have generally lacked vigorous and scientific analysis and surgeons have been challenged to question the notion that surgical technique cannot be subjected to the rigours of scientific enquiry. 1 Horton R Surgical research or comic opera: questions, but few answers. Lancet. 1996; 347: 984-985 Abstract PubMed Scopus (303) Google Scholar In The Lancet Oncology, Shin Fujita and colleagues 2 Fujita S Akasu T Mizusawa J et al. a on behalf of the Colorectal Cancer Study Group of Japan Clinical Oncology GroupPostoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trial. Lancet Oncol. 2012; (published online May 15.)https://doi.org/10.1016/S140-2045(12)70158-4 Crossref PubMed Google Scholar report the early results of a randomised controlled trial that aims to show whether or not mesorectal excision alone (standard treatment in Europe and North America) is non-inferior to mesorectal excision with lateral lymph node dissection (standard treatment in Japan) for patients with clinical stage II or stage III lower rectal cancer. The primary non-inferiority analysis is planned for 2015, but the researchers present results for operation time, blood loss, postoperative morbidity (grade 3 or 4), and hospital mortality. This investigation might seem unimportant to some readers, even to those who provide modern multidisciplinary care in the form of staging, neoadjuvant and adjuvant therapy, surgery, and pathological assessment of the excised specimen. However, the detailed nature of this study means that it offers something for everyone involved in cancer care. Postoperative morbidity and mortality after mesorectal excision with and without lateral lymph node dissection for clinical stage II or stage III lower rectal cancer (JCOG0212): results from a multicentre, randomised controlled, non-inferiority trialMesorectal excision with lateral lymph node dissection required a significantly longer operation time and resulted in significantly greater blood loss than mesorectal excision alone. The primary analysis will help to show whether or not mesorectal excision alone is non-inferior to mesorectal excision with lateral lymph node dissection. Full-Text PDF