Journal Review in Colorectal Surgery: Local Excision for Rectal Cancer

Behind The Knife: The Surgery Podcast

Science, Health & Fitness, Medicine, Education

4.8 • 1.4K Ratings

🗓️ 13 March 2023

⏱️ 35 minutes

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Summary

You have a patient who underwent local excision of a rectal cancer. Final pathology demonstrates a T2 lesion. What is the rate of local recurrence? Is excision alone sufficient? Should the patient undergo radical resection or should chemoradiation be offered? Tune in to find out!

Join Drs. Peter Marcello, Jonathan Abelson, Tess Aulet and special guest Dr. Jose Guillem MD, MPH, MBA as they discuss high yield papers discussing local excision for Rectal Cancer.

You may follow along with the slides mentioned in this episode here: https://behindtheknife.org/video/journal-review-in-colorectal-surgery-local-excision-for-rectal-cancer/

Learning Objectives
1. Describe the features that increase risk of lymph node involvement in early stage rectal cancer
2. Discuss the different options for management of early-stage rectal cancer
3. Describe patient related factors that favor local excision of rectal cancer

References:
Kidane B, Chadi SA, Kanters S, Colquhoun PH, Ott MC. Local resection compared with radical resection in the treatment of T1N0M0 rectal adenocarcinoma: a systematic review and meta-analysis. Dis Colon Rectum. 2015 Jan;58(1):122-40. doi: 10.1097/DCR.0000000000000293. PMID: 25489704.

Garcia-Aguilar J, Renfro LA, Chow OS, Shi Q, Carrero XW, Lynn PB, Thomas CR Jr, Chan E, Cataldo PA, Marcet JE, Medich DS, Johnson CS, Oommen SC, Wolff BG, Pigazzi A, McNevin SM, Pons RK, Bleday R. Organ preservation for clinical T2N0 distal rectal cancer using neoadjuvant chemoradiotherapy and local excision (ACOSOG Z6041): results of an open-label, single-arm, multi-institutional, phase 2 trial. Lancet Oncol. 2015 Nov;16(15):1537-1546. doi: 10.1016/S1470-2045(15)00215-6. Epub 2015 Oct 22. PMID: 26474521; PMCID: PMC4984260.

Friel CM, Cromwell JW, Marra C, Madoff RD, Rothenberger DA, Garcia-Aguílar J. Salvage radical surgery after failed local excision for early rectal cancer. Dis Colon Rectum. 2002 Jul;45(7):875-9. doi: 10.1007/s10350-004-6320-z. PMID: 12130873.

Nascimbeni R, Burgart LJ, Nivatvongs S, Larson DR. Risk of lymph node metastasis in T1 carcinoma of the colon and rectum. Dis Colon Rectum. 2002 Feb;45(2):200-6. doi: 10.1007/s10350-004-6147-7. PMID: 11852333.

O'Neill CH, Platz J, Moore JS, Callas PW, Cataldo PA. Transanal Endoscopic Microsurgery for Early Rectal Cancer: A Single-Center Experience. Dis Colon Rectum. 2017 Feb;60(2):152-160. doi: 10.1097/DCR.0000000000000764. PMID: 28059911.

Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

If you liked this episode, check out other colorectal episodes here: https://behindtheknife.org/podcast-category/colorectal/

Transcript

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0:00.0	Behind the Night, the surgery podcast, relevant and engaging content designed to help you dominate the day.
0:13.0	Hello behind the knife listeners. We are so excited to be back with you for another journal club in Colton and rectal surgery on local
0:30.5	excision for rectal cancer with the Leahy colorectal surgery team. We have another very special guest who's joining us today and I'm going to introduce him shortly.
0:38.5	And today we're going to tackle some article central to the discussion on local excision for rectal cancer. So welcome to the team. We have Dr. Peter West Marcello and Dr. Tess Hannah. I'll let Hey team.
0:49.5	Hey guys. Great to be back to another episode. You know, we're just finishing up ski season, although we're getting a little late snow was not a good season, but I want to put a plug in. If you want a good ski meeting and learn some colorectal go to the Midwest colorectal meeting this year in Sun Valley Idaho next year is going to be in Squaw Valley. So in March. So look forward to that.
1:13.5	So it's phenomenal. Nice. Nice. Yeah. I'll be at the New England meeting. Yeah. Well, good to see everybody.
1:21.5	Awesome. All right. Well, today we have a very special guest who's going to be joining us. I'm honored to introduce Dr. Jose Guillem. Dr. Guillem did a surgical training at Columbia Presbyterian Medical Center, followed by his colon and rectal surgery fellowship at Leahy.
1:37.5	Dr. Guillem is the chief of the GI division at UNC and Roscoe Bennett Gray Calper Distinguished Professor. Prior to joining UNC, Dr. Guillem was an attending colorectal surgeon at Memorial Sloan Academy Cancer Center, serving as leader in the advancement of oncologic care for patients with colon and rectal cancer.
1:54.5	And that's where I was fortunate enough actually to spend a few months training under Dr. Guillem. And so it brings me great joy to welcome him to the Leahy behind the knife crew.
2:04.5	We're thrilled to have a Leahy alumni join us and shares expertise for the session. Thank you.
2:10.5	Thank you. Thanks for inviting me glad to be here.
2:13.5	So, you know, we know Jose or Pepe from his early years at Leahy and John, I'm going to show the next slide.
2:21.5	Yeah. Now, look at that difference we got going on there. No, John, let me fix my hair.
2:27.5	Do I want to remind the listener?
2:29.5	Remind the listener. So we like to do this with our videos on. So you can see our beautiful faces.
2:36.5	And with the PowerPoint slides, you can follow along with our talk. So we have a beautiful picture of Dr. Guillem.
2:43.5	It's probably not too many years ago, I would say, right?
2:46.5	He's fellowship with a couple of heckles that was at Georgetown and Phil Flesher on it.
2:52.5	Cedar Sinai in California. But the honor is is that Pepe is our first alumni, special guest. And I know that Flesher will be a little upset about that.
3:03.5	I'm sure he will. He deserves it.
3:08.5	All right, let's dive into the heart of the discussion. So local excision for rectal cancer. And so these are, these can be really difficult cases.
3:15.5	You know, in great, great discussions at tumor board, we have two great articles that we want to review.
	...

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