Presentation Information
[ESY1-4]Korean Strategy for advanced Rectal cancer
Jin Kim (Korea University College of Medicine)
Treatment for advanced rectal cancer in Korea has shown high survival rates despite the increasing incidence of the disease. National statistical data shows that the 5-year relative survival rate for all cancer patients diagnosed from 2018 to 2022 was 72.9%, a significant increase from 54.2% for patients diagnosed between 2001 and 2005. For colorectal cancer specifically, the 5-year survival rate was 71.8% from 2010 to 2014, with some hospital-specific data showing even higher rates up to 83.8%. This outcome is attributed to a systematic, multidisciplinary treatment strategy rather than a single approach.
The cornerstone of the Korean strategy is the use of neoadjuvant therapy, which involves combining chemotherapy and radiotherapy before surgery. The rationale behind this approach is to address the high local recurrence rate, which can be between 20% and 60% for locally advanced rectal cancer when treated with surgery alone. Neoadjuvant therapy aims to reduce this recurrence rate, improve the chances of complete tumor removal, and enhance survival. This approach is particularly crucial for low-lying tumors near the anus, as it can shrink the tumor and enable sphincter-preserving surgery, thereby preserving the patient's quality of life. A meta-analysis of neoadjuvant versus adjuvant chemotherapy showed a statistically significant improvement in overall survival and disease-free survival for the neoadjuvant group. Additionally, the rate of positive resection margins was found to be marginally lower in the neoadjuvant therapy group compared to the upfront surgery group.
In the surgical field, advanced technologies are applied. Laparoscopic surgery has offered various benefits, and robotic surgery is mainly used for rectal cancer, particularly for mid-to-low rectal cancer and in patients with a narrow pelvis. The robotic system offers enhanced dexterity and precision within the narrow pelvic cavity, which facilitates the safe and effective performance of complex procedures, such as lateral pelvic lymph node dissection. A recent study concluded that robot-assisted dissection was able to harvest more lymph nodes than laparoscopic surgery, with no difference in complication rates or survival. This technology helps pursue the dual goals of complete tumor removal and functional preservation.
The survival outcomes demonstrate the effectiveness of this comprehensive strategy. Studies have shown that when adjuvant chemotherapy is combined with surgery, the 5-year survival rate for high-risk stage 2 rectal cancer patients improves by 7.7% in terms of disease-free survival, while for stage 3 patients, certain combination therapies have been shown to reduce the mortality rate by 33%. Furthermore, research is ongoing into future treatment options. The increasing use of precision medicine, guided by next-generation sequencing(NGS), and the introduction of new drugs like immunotherapies are also contributing to more personalized treatment plans.
The cornerstone of the Korean strategy is the use of neoadjuvant therapy, which involves combining chemotherapy and radiotherapy before surgery. The rationale behind this approach is to address the high local recurrence rate, which can be between 20% and 60% for locally advanced rectal cancer when treated with surgery alone. Neoadjuvant therapy aims to reduce this recurrence rate, improve the chances of complete tumor removal, and enhance survival. This approach is particularly crucial for low-lying tumors near the anus, as it can shrink the tumor and enable sphincter-preserving surgery, thereby preserving the patient's quality of life. A meta-analysis of neoadjuvant versus adjuvant chemotherapy showed a statistically significant improvement in overall survival and disease-free survival for the neoadjuvant group. Additionally, the rate of positive resection margins was found to be marginally lower in the neoadjuvant therapy group compared to the upfront surgery group.
In the surgical field, advanced technologies are applied. Laparoscopic surgery has offered various benefits, and robotic surgery is mainly used for rectal cancer, particularly for mid-to-low rectal cancer and in patients with a narrow pelvis. The robotic system offers enhanced dexterity and precision within the narrow pelvic cavity, which facilitates the safe and effective performance of complex procedures, such as lateral pelvic lymph node dissection. A recent study concluded that robot-assisted dissection was able to harvest more lymph nodes than laparoscopic surgery, with no difference in complication rates or survival. This technology helps pursue the dual goals of complete tumor removal and functional preservation.
The survival outcomes demonstrate the effectiveness of this comprehensive strategy. Studies have shown that when adjuvant chemotherapy is combined with surgery, the 5-year survival rate for high-risk stage 2 rectal cancer patients improves by 7.7% in terms of disease-free survival, while for stage 3 patients, certain combination therapies have been shown to reduce the mortality rate by 33%. Furthermore, research is ongoing into future treatment options. The increasing use of precision medicine, guided by next-generation sequencing(NGS), and the introduction of new drugs like immunotherapies are also contributing to more personalized treatment plans.