講演情報
[ESY1-3]Strategy for Advanced Rectal Cancer Management in Thailand
Woramin Riansuwan (Colorectal Surgery Unit, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University)
Approximately 4,000 new rectal cancers are diagnosed annually. Despite the high prevalence of locally advanced rectal cancer (LARC), Thailand currently lacks national management guidelines, leading most surgeons to follow NCCN or ESMO recommendations. This abstract summarizes current trends in LARC management in Thailand.
LARC, defined as clinical stage T3 and T4 tumors or node-positive disease, is routinely evaluated using CT scans of the chest and abdomen, while mid-to-lower rectal lesions require additional high-resolution pelvic MRI for locoregional staging. The standard treatment for decades has been total mesorectal excision (TME) performed 8-12 weeks after neoadjuvant chemoradiotherapy (CRT). More recently, total neoadjuvant therapy (TNT) combining CRT with either induction or consolidation chemotherapy has emerged as an alternative, particularly for high-risk cases featuring EMVI-positive tumors, threatened circumferential margins, N2 disease, or lateral lymph node involvement. Although the RAPIDO trial regimen (5 x 5 short-course radiotherapy with consolidation chemotherapy) was adopted during the COVID-19 pandemic, its implementation remains limited.
Surgical approaches have evolved, with laparoscopic TME gradually replacing open procedures. However, widespread adoption faces challenges, including a shortage of skilled surgeons and reimbursement limitations. Robotic TME remains uncommon due to the excessive costs and limited availability of robotic platforms.
To enhance advanced rectal cancer care, the Thai surgical society should prioritize two key initiatives, including the development of national consensus guidelines for LARC management and the establishment of structured training or mentoring programs for laparoscopic and robotic surgical techniques.
LARC, defined as clinical stage T3 and T4 tumors or node-positive disease, is routinely evaluated using CT scans of the chest and abdomen, while mid-to-lower rectal lesions require additional high-resolution pelvic MRI for locoregional staging. The standard treatment for decades has been total mesorectal excision (TME) performed 8-12 weeks after neoadjuvant chemoradiotherapy (CRT). More recently, total neoadjuvant therapy (TNT) combining CRT with either induction or consolidation chemotherapy has emerged as an alternative, particularly for high-risk cases featuring EMVI-positive tumors, threatened circumferential margins, N2 disease, or lateral lymph node involvement. Although the RAPIDO trial regimen (5 x 5 short-course radiotherapy with consolidation chemotherapy) was adopted during the COVID-19 pandemic, its implementation remains limited.
Surgical approaches have evolved, with laparoscopic TME gradually replacing open procedures. However, widespread adoption faces challenges, including a shortage of skilled surgeons and reimbursement limitations. Robotic TME remains uncommon due to the excessive costs and limited availability of robotic platforms.
To enhance advanced rectal cancer care, the Thai surgical society should prioritize two key initiatives, including the development of national consensus guidelines for LARC management and the establishment of structured training or mentoring programs for laparoscopic and robotic surgical techniques.