Once again the Scottish Cancer Prevention Network has invited members, colleagues and regular SCPN newsletter contributors to recommend what they have been reading on cancer prevention during 2016. We’ve asked each one to recommend the paper they thought would be most valuable to share. This paper has been nominated by Susan Moug a consultant colorectal surgeon and Honorary Clinical Associate Professor based at Royal Alexandra Hospital in Paisley
Title: Watch-and-wait approach versus surgical resection after chemoradiotherapy for patients with rectal cancer (the OnCoRe project): a propensity-score matched cohort analysis.
Authors: Prof Andrew G Renehan, Lee Malcomson, Richard Emsley, Simon Gollins, Andrew Maw, Prof Arthur Sun Myint, Paul S Rooney, Shabbir Susnerwala, Anthony Blower, Mark P Saunders, Malcolm S Wilson, Nigel Scott, Prof Sarah T O’Dwyer
Why is this paper important?
Many patients with rectal cancer undergo chemoradiotherapy (CRX) followed by major surgery as their treatment pathway. This pathway is prolonged over many months and the surgery, although curative, can reduce the quality of life for some patients and even leave some with a permanent stoma. In the last few years, it has become apparent to colorectal surgeons that a proportion of these patients will have no evidence of any cancer left after completing their CRX – a so-called ‘complete response’ – raising the possibility that surgery could be avoided in this group of patients.
This work from Manchester assessed cancer recurrence in patients with rectal cancer that had received CRX followed by either surgery (the traditional failsafe approach) or ‘watch and wait’ (no surgery as these patients were thought to have had a complete response). This is the largest study to date to assess ‘watch and wait’ approach finding at 3 year follow-up mark where: 60% of the ‘wait and see’ group avoided major surgery; recurrence and survival were no different to the patients that had undergone surgery and that the ‘wait and see’ group had significantly less chance of having a permanent colostomy.
Main take home messages
There is a group of rectal cancer patients that after CRX will not require surgery, significantly improving their long-term quality of life. However, further work needs to be done to clarify the specific patient group that this minimally invasive treatment approach applies to ensure the best cancer-related outcomes.
We’ll be sharing Papers of the Year throughout December – keep an eye out on our Twitter feed for more updates. Each of the papers will be available here as they are posted.