Abstract
Because of recent advances in medical technology and new findings of clinical trials, treatment options for colorectal cancer are evolutionally changing, even in the last few years. Therefore, we need to update the treatment options and strategies so that patients can receive optimal and tailored treatment. The present review aimed to elucidate the recent global trends and update the surgical treatment strategies in colorectal cancer by citing the literature published in the last 2 years, namely 2016 and 2017. Although laparoscopic surgery is still considered the most common approach for the treatment of colorectal cancer, new surgical technologies such as transanal total mesorectal excision, robotic surgery, and laparoscopic lateral pelvic lymph node dissection are emerging. However, with the recent evidence, superiority of the laparoscopic approach to the open approach for rectal cancer seems to be controversial. Surgeons should notice the risk of adverse outcomes associated with unfounded and uncontrolled use of these novel techniques. Many promising results are accumulating in preoperative and postoperative treatment including chemotherapy, chemoradiotherapy, and targeted therapy. Development of new biomarkers seems to be essential for further improvement in the treatment outcomes of colorectal cancer patients.
Highlights
Surgical approaches such as transanal endoscopic surgery and robotic surgery are being innovated
Colorectal cancer is the fourth most deadly cancer in the world, clinical trials to elucidate the efficacy of laparoscopic versus open because 700 000 patients die of colorectal cancer every year.[1] surgery, lateral pelvic lymph node dissection (LLND), preoperative
A multicenter RCT comgery (5.7% vs 13.4%; P < .01).[21]. It had significantly higher paring Transanal total mesorectal excision (TME) (TaTME) versus laparoscopic TME for mid and low rectal cantotal hospital costs compared with laparoscopic surgery (mean differcer (COLOR III) is ongoing.[34] ence, US$24 890; P < .01)
Summary
Surgical approaches such as transanal endoscopic surgery and robotic surgery are being innovated. The tion.[46] The optimal cut-off value of LLN size for prediction of systematic review published in 2017 reported that the regrowth rate in the watch-and-wait group was 21.3% and salvage surgery was improved OS was associated with adjuvant chemotherapy regardless possible in 93.2% of these patients.[55] Another meta-analysis comof treatment regimen, patient age, or high-risk pathological risk facpared the oncological outcomes of the patients who had watch-andtors in stage II colon cancer.[64] For rectal cancer, a review published wait after cCR versus those who had radical surgery after cCR or in 2017 concluded that data from the adjuvant rectal cancer trials did versus patients with pCR after surgery.[56] There was no significant not support the use of postoperative adjuvant chemotherapy for difference among those three groups in terms of non-regrowth patients with rectal cancer treated with preoperative CRT.[65] recurrence, cancer-specific mortality, or OS. Recent large-scale retrospective studies showed that primary tumor resection with systemic chemotherapy con-
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