Surgery of rectal cancer after neoadjuant radiochemotherapy.

Neoadjuvant radiochemotherapy has become to be a standard for the treatment of Stage II and III rectal adenocarcinoma during last 15 years in majority of European countries including Czech Republic. The effect of radiation on rectal cancer has been known for 70 years, however the use of radiotherapy was expanded since 1980. The dose, timming, purpose and goal of radiation were under debate for a long time. Pahlman and Glimelius in 1990 (1), Swedish Rectal Cancer Trial (2) and Kapitejn, Kranenbarg et al (3) and others (4, 5) showed the significance of radiotherapy on rectal cancer and the superiority of preoperative radiation. Increased dose of radiation (6), longer time interval between neoadjuvant radiotherapy and surgery (7) and particularly the chemosenzitization by combination with chemotherapy (8) enhance the effect of preoperative radiotherapy. It was proved that neoadjuvant radiochemotherapy allows to decrease local recurrency, to achieve a longer survival and longer disease free period, to downstage tumor and to perform more curative and sphincter saving surgeries. Preoperative radiochemotherapy leads to typical changes on tumor and lymphatic tissue and nodes. Tumor necrosis and sterilisation – disappearing of viable tumor cells – qualified and quantified by tumor regression grade – TRG – represents one of possible outcomes of RT (9). According to the literature the complete pathologic response (CPR) as the maximal effect of preoperative radiochemotherapy was found in the large range from 5 to 67% patients (6, 9). These patients qualified as ypT0N0M0 are free of cancer at the time of surgery. ...

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