Colorectal cancer, when it is possible to avoid surgery (and avoid LARS syndrome)

Avoid surgery and preserve the compromised organ. This is the future prospect for two out of three patients with rectal cancer, as confirmed by the results of one study presented to European Congress of Radiation Oncology, recently closed in Glasgow and which brought together the top experts in the sector. «The results of this study are very important for the scientific world and even more so for patients – he underlines Marco KrengliPresident Airofull professor of radiotherapy at the University of Padua and director of the radiotherapy unit of the Veneto Oncology Institute – as they highlight that two out of three patients can receive radiotherapy treatment combined with chemotherapy, preserving the organ and its function. This means that in many cases, after the combined use of radiation and chemotherapy drugs to destroy tumor cells, there is no need to undergo destructive surgery with its important side effects known in the scientific world as LARS syndrome” .

What is LARS syndrome

There LARS syndrome (an acronym for «Low Anterior Resection Syndrome») is a set of gastrointestinal symptoms that can occur after rectal resection surgery. The results of the study offer a new perspective on radio-chemotherapy treatment options, underlining the importance of preserving organ function and therefore quality of life of patientshighlighting a significant change in the therapeutic paradigm and allowing personalized and targeted clinical management of rectal cancer, declared the third neoplasm in men and the second in women, with a growth of over 50 thousand cases per year.

The “non-operative management” (NOM) of rectal cancer, also known as the “watch and wait” approach or active surveillance, is a strategy that can be applied in selected cases of rectal cancer, he explains to Vanity Fair Maria Antonietta Gambacorta, professor of radiotherapy at the Catholic University of the Sacred Heart, Policlinico Gemelli in Rome. «This approach is mainly considered for patients who have achieved a complete clinical response after neoadjuvant chemoradiotherapy. THE main criteria to identify patients who can benefit from this therapy in the context of rectal cancer they include: patients with locally advanced cancer who have achieved a complete clinical response after radiochemotherapy; patients with early cancers whose surgical treatment would involve the removal of the rectum and anus with the placement of a permanent stoma, also known as a “pouch”; patients in whom the surgical removal of the rectum would lead to incontinence, fractional defecation, urgency and disorders of the sexual sphere, both male (impotence) and female (vaginal dryness)”.

This approach, says the expert, requires a active surveillance with frequent checks, especially in the first two years, to be able to promptly identify any tumor regrowth. If diagnosed in time and treated with “life-saving” surgery, it can allow the patient to recover. It is essential that this approach is performed in specialized, high-volume centers, where multidisciplinary collaboration is crucial. Furthermore, strong motivation and collaboration from the patient is necessary, given the possibility of “overtreatment” in cases of early tumors. «Disorders linked to LARS syndrome range from fecal incontinence and urgency, to constipation and voiding difficulties and often lead to a worsening of patients’ quality of life. In this way, GRECCAR12, an acronym that stands for “organ preservation after neoadjuvant chemoradiotherapy for rectal cancer”, highlights to patients and the oncology world – concludes Gambacorta – the possibility, in some cases, of a de-intensification of treatments and their effects collateral, implemented through the omission of surgical intervention, the so-called “organ-sparing” method”.

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