Updates of 2017 ESMO guideline for rectal cancer / 中华胃肠外科杂志

ABSTRACT

Compared with the 2013 version, the basic strategies of diagnosis and treatment for rectal cancer in the 2017 version guideline remain the same. These strategies include accurate local staging approaches which combines digital rectal examination, endorectal ultrasound (ERUS), and high resolution pelvic MRI, and local recurrence risk grading system which combines tumor location/distance, T staging, N staging, EMVI (extramural vascular invasion) and MRF(mesorectal fascia). And personalized therapeutic principle based on the above local risk grading. Main updates for the 2017 version are as following (1) x-ray chest film is placed by CT scan for baseline staging, and PET-CT is recommended for patients with extensive EMVI on MRI imaging to exclude further distant metastasis. (2) For local recurrence risk grading, there is one new grade clarified as "intermediate group" added to the 2017 version, which includes patients with very low cT3a/b, levators clear, MRF clear or cT3a/b in mid or high rectum, cN1-2, no EMVI. These patients were classified as "bad group" in the old 2013 version. Accordingly, treatment recommendations for this group changed from preoperative CRT or SCPRT followed by TME surgery to TME surgery alone if good quality of TME assured. Another important notice made in the new guideline is to emphasize the critical role of surgical quality of TME, which should be assessed by a pathologist with help of photography of fresh specimen. In summary, 2017 version of ESMO guideline for rectal cancer is a more personalized and clinically relevant guideline.