Table of Contents  

Matzel: Editorial

The treatment of rectal cancer has evolved significantly over the last two decades. With the implemenation of standardized surgery and histopathological assessment, the stage-related use of radiotherapy or radiochemotherapy in a neoadjuvant or adjuvant setting, and stringent quality assessment, the oncological outcome has improved. The marked change in surgical procedure for rectal cancer [i.e. the introduction and worldwide acceptance of total mesorectal excision (TME)] has resulted in a fall in the local recurrence rate to about 5%.1,2 In conjunction with this surgical change, the concept of multidisciplinary involvement and multimodal treatment is today considered a standard of care in oncological centres and forms the basis of dedicated stage-related therapy.

The same evolution can now be seen in colon cancer treatment, although the modification of the surgical procedure evolved later than that for rectal cancer. Somewhat analogous to TME, surgery for colon cancer is directed by dissection along embryological planes with central vascular ligation and complete mesocolic excision.3 This produces a very different histological specimen from that obtained with more conventional colon resection; as a logical consequence, this has prompted a completely different, and more accurate, mode of histological assessment.4,5

Quality management – of both process and outcome indicators – is essential to monitor the effect of these evolutionary steps and serves as the basis for continuous development.6 Outcome data in dedicated centres show better oncological results;3 population-based data are still maturing, but already indicate a possible survival benefit.710

With the changes in outcome, driven by the changes in surgery and its evaluation, the role of adjuvant chemotherapy – itself evolving and offering a broader armamentarium – also deserves to be reassessed and redefined to provide optimal individual therapy.11

This special issue on colon cancer aims to give the reader up-to-date knowledge of the surgical therapy, histopathological assessment, chemotherapeutic treatment and quality monitoring in colon cancer treatment. Each section presents an in-depth insight, but is best appreciated as an aspect of an integrated, interdisciplinary effort reflecting the high level and complexity of treatment currently available to our patients.

References

1. 

Påhlman L, Bohe M, Cedermark B, et al. The Swedish rectal cancer registry. Br J Surg 2007; 94:1285–92. http://dx.doi.org/10.1002/bjs.5679

2. 

Guren MG, Korner H, Pfeffer F, et al. Nationwide improvement of rectal cancer treatment outcomes in Norway, 1993–2010. Acta Oncol 2015; 54:1–9. http://dx.doi.org/10.3109/0284186X.2015.1034876

3. 

Hohenberger W, Weber K, Matzel K, Papadopoulos T, Merkel S. Standardized surgery for colonic cancer: complete mesocolic excision and central ligation--technical notes and outcome. Colorectal Dis 2009; 11:354–64; discussion 64–5.

4. 

West NP, Morris EJ, Rotimi O, Cairns A, Finan PJ, Quirke P. Pathology grading of colon cancer surgical resection and its association with survival: a retrospective observational study. Lancet Oncol 2008; 9:857–65. http://dx.doi.org/10.1016/S1470-2045(08)70181-5

5. 

West NP, Hohenberger W, Weber K, Perrakis A, Finan PJ, Quirke P. Complete mesocolic excision with central vascular ligation produces an oncologically superior specimen compared with standard surgery for carcinoma of the colon. J Clin Oncol 2010; 28:272–8. http://dx.doi.org/10.1200/JCO.2009.24.1448

6. 

Merkel S, Weber K, Matzel K, Agaimy A, Göhl J, Hohenberger W. Prognosis of patients with colonic carcinoma before, during and after implementation of complete mesocolic excision [published online ahead of print 25 May 2016]. Br J Surg 2016. http://dx.doi.org/10.1002/bjs.10183

7. 

West NP, Kobayashi H, Takahashi K, et al. Understanding optimal colonic cancer surgery: comparison of Japanese D3 resection and European complete mesocolic excision with central vascular ligation. J Clin Oncol 2012; 30:1763–9. http://dx.doi.org/10.1200/JCO.2011.38.3992

8. 

Bertelsen CA, Neuenschwander AU, Jansen JE, et al. Disease-free survival after complete mesocolic excision compared with conventional colon cancer surgery: a retrospective, population-based study. Lancet Oncol 2015; 16:161–8. http://dx.doi.org/10.1016/S1470-2045(14)71168-4

9. 

Kotake K, Mizuguchi T, Moritani K, et al. Impact of D3 lymph node dissection on survival for patients with T3 and T4 colon cancer. Int J Colorectal Dis 2014; 29:847–52. http://dx.doi.org/10.1007/s00384-014-1885-z

10. 

Shimada Y, Hamaguchi T, Mizusawa J, et al. Randomised phase III trial of adjuvant chemotherapy with oral uracil and tegafur plus leucovorin versus intravenous fluorouracil and levofolinate in patients with stage III colorectal cancer who have undergone Japanese D2/D3 lymph node dissection: final results of JCOG0205. Eur J Cancer 2014; 50:2231–40. http://dx.doi.org/10.1016/j.ejca.2014.05.025

11. 

Påhlman LA, Hohenberger WM, Matzel K, Sugihara K, Quirke P, Glimelius B. Should the benefit of adjuvant chemotherapy in colon cancer be re-evaluated? J Clin Oncol 2016; 34:1297–9. http://dx.doi.org/10.1200/JCO.2015.65.3048




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