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resection, and quality of life. The trial proposes that, following the
advances in rectal cancer management, increased focus on survival
rather than only on local control is now justified.
FUTURE MANAGEMENT AND TREATMENT
Professor Heald noted that, by conducting the following procedures,
there should be reasonable evidence to influence whether surgeons
need to operate or not:
bioprobe, i.e. digital rectal examination by an experienced
surgeon;
endoscopy;
MRI; and,
PET CT.
He continued: "Regression is a prognostic marker. If you look at the
studies conducted by Professor André d'Hoore, Professor of Surgery,
at K.U. Leuven (University of Leuven), Belgium, you will see that
waiting longer than six weeks after CRT treatment improves outcome.
I am in total agreement with this, surgeons should reassess at six
weeks before conducting rectal cancer surgery and be prepared to
delay further if there is good regression."
Professor Heald concluded: "My hope for the future of rectal cancer
management is that there will be the following progression: more
precise TME surgery; immediate and earlier screening; immediate
and earlier endoscopy; detailed MRI planning; eventual triumph
over leakage; and more advanced laparoscopic and robotic surgical
equipment. In addition when CRT treatment is given, re-assessment
is now essential because further delay before fixing the operation may
be beneficial. In some carefully selected cases surgery may even be
avoided altogether."
REFERENCE
1. Nilsson PJ, van Etten B, Hospers GA et al. Short-course
radiotherapy followed by neo-adjuvant chemotherapy in locally
advanced rectal cancer ­ the RAPIDO Trial. BMC Cancer 2013; 13:
279. doi: 10.1186/1471-2407-13-279
Professor Richard John Heald is Director of Surgery at the Pelican Cancer Foundation and Director of the National MDT/
TME Development Programme and is highly involved in the Champalimaud Centre for the Unknown in Lisbon, Portugal.
For the past 20 years his main interest has been the research and development of the total mesorectal excision (TME)
technique for rectal cancer.
He is a former Vice-President of the Council at the Royal College of Surgeons of England and is past-President of the
Section of Coloproctology. He has received honorary degrees and/ or professorships from a number of countries including
Sweden, Austria, Switzerland, US and China.
19
JOHNSON & JOHNSON LECTURE
Professor Patrick Broe and Professor Richard Heald.
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