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Abstract

Today neoadjuvant chemoradiation for T2 and T3 rectal cancers is widely adopted. Surgery is usually performed after 5-6 weeks from the beginning of the therapy and it is our policy to perform a restaging of the tumor at that moment, in order to obtain its down-staging, to discover possible complications related to the treatment, to confirm or adjust a surgical strategy, to evaluate risks for possible recurrence, and to schedule an adequate follow-up. For this, we have implemented a classification of the tumor down-staging, mainly based on radiological imaging results, contrast-enhanced computed tomography and magnetic resonance, and inspired to the current TNM scheme. Neoplastic regression inside rectal walls and mesorectum have been considered of prominent significance, and, therefore, discriminating in surgery. Besides, these aspects correlate well with the biological attitude of rectal cancer to regress following a centripetal way, starting from the most peripheral and recent zones of infiltration toward the central core of the tumor, where the tissue involvement is more marked. Interestingly, in our experience of 38 cases observed in the years 2012-2015, the down-staging score appears inversely correlated with the histological grading of the tumor, but directly with the Dowrak�s tumour regression. Certainly our classification needs to be confirmed by further clinical studies, which will have to consider also the different molecular characteristics of rectal cancer.

Biography

Email: antonio.manenti@unimore.it