Dados do Resumo

Título

Rectal adenocarcinoma: main therapeutic approaches and the role of transanal resection (TAR)

Introdução

Colorectal cancer (CRC) is the third most diagnosed neoplasm in the world, the second most common in Brazil and the third leading cause of cancer death in 2022, with adenocarcinoma being the most prevalent.

Objetivo

To review the most up-to-date articles that addressed the main therapies for adenocarcinoma, in order to analyze their curative impacts, neoplasia recurrence, patient survival and the role of transanal resection (TAR).

Métodos

The search was carried out in the PubMed and Science Direct databases. We selected articles that addressed the main therapies for adenocarcinoma, as well as the current indication for TAR, in order to analyze their curative impacts, neoplasia recurrence and patient survival.

Resultados

Surgical resection remains the main treatment for intraperitoneal rectal adenocarcinoma, while neoadjuvant therapy is considered the first-line treatment for extraperitoneal rectal neoplasms. In the “Watch and Wait” approach, patients without clinical and pathological evidence of residual extraperitoneal rectal lesions after neoadjuvant chemoradiotherapy can be monitored without the need for immediate surgical intervention. If there is residual lesion, they undergo surgery. ART has emerged as an alternative for patients with well-differentiated, small (<4 cm), T1 stage adenocarcinomas, without lymphovascular and perineural invasion, and located up to 15 cm from the anal verge. This approach has the advantages of lower recurrence rates, fewer postoperative complications, and reduced risk of anorectal, urinary, and sexual dysfunctions, when compared with conventional surgeries. In addition to this technique, there is also a trend toward choosing less invasive procedures, with robotic surgery being an alternative that has become increasingly popular.

Conclusões

In fact, the importance of TAR as an alternative with lower morbidity and mortality and neoplastic recurrence for patients who meet its specific indications has been demonstrated. Furthermore, neoadjuvant chemoradiotherapy remains the gold standard for initial treatment of extraperitoneal rectal tumors.

Palavras Chave

Trasanal resection; Neoadjuvant therapy; Colorectal cancer