THERAPEUTIC OPTIONS FOR RECTAL-CANCER - D ISCUSSION AND UPDATING OF THE CONSENSUS CONFERENCE

Three years after the consensus conference on the therapeutic options for rectal cancer, a recent litterature review gave us some decision e lements. Quality of the surgical resection appears to be the most impo rtant therapeutic factor in the prognosis of rectal cancer. Total meso rectal excision was followed by a significant decrease of locoregional recurrence rate for the tumor of the two lower thirds of rectum. Tn t his way, it has been shown that pelvic nerves can be easily preserved. Which nerves are important for a good postoperative sexual activity r emains however debated. Furthermore, whether the nerve sparing techniq ues influence the prognosis is also a matter of controversy. On the ot her hand, abdominoperineal resection is still indicated in most lower tumors to prevent local recurrences. Preoperative radiation therapy ap pears more effective than the postoperative one to decrease postoperat ive local recurrence rate after B2 (Astler-Coller) or T3 (TNM) tumors. At present, only one study showed that preoperative radiation therapy improved five-year survival. Combination of radiotherapy and chemothe rapy improves also five-year survival, but this option leads to high t oxicity. Thus the best adjuvent treatment remains to be defined. Await ing for this, the good quality of surgical resection is mandatory.