講演情報
[ESY1-5]Treatment of rectal cancer in Japanese guidelines
Yusuke Kinugasa (Institute of Science Tokyo)
The treatment of rectal cancer in Japan differs significantly from practices in Europe and the United States, particularly regarding the use of preoperative therapies. The following summarizes the key points from the Japanese guidelines on rectal cancer treatment.
In Japan, total mesorectal excision (TME) or total mesorectal excision with autonomic nerve-preserving lateral lymph node dissection (TME + LLND) is the standard surgical approach for advanced lower rectal cancer. This approach has shown favorable outcomes in terms of both survival and local recurrence rates. Preoperative radiotherapy, which is standard in Europe and the United States, is not actively performed in Japan due to the lack of evidence supporting its added benefit in reducing local recurrence or its effectiveness as an alternative to LLND.
Preoperative CRT is weakly recommended for patients with a high risk of local recurrence. For patients with a high risk of local recurrence, preoperative chemotherapy (without irradiation) is weakly recommended against.
Total Neoadjuvant Therapy (TNT), which incorporates systemic therapy into preoperative treatment, is weakly recommended against for rectal cancer. TNT aims to address the limitations of preoperative CRT by improving distant metastasis control and survival rates. However, its routine use is not recommended in Japan.
In Japan, total mesorectal excision (TME) or total mesorectal excision with autonomic nerve-preserving lateral lymph node dissection (TME + LLND) is the standard surgical approach for advanced lower rectal cancer. This approach has shown favorable outcomes in terms of both survival and local recurrence rates. Preoperative radiotherapy, which is standard in Europe and the United States, is not actively performed in Japan due to the lack of evidence supporting its added benefit in reducing local recurrence or its effectiveness as an alternative to LLND.
Preoperative CRT is weakly recommended for patients with a high risk of local recurrence. For patients with a high risk of local recurrence, preoperative chemotherapy (without irradiation) is weakly recommended against.
Total Neoadjuvant Therapy (TNT), which incorporates systemic therapy into preoperative treatment, is weakly recommended against for rectal cancer. TNT aims to address the limitations of preoperative CRT by improving distant metastasis control and survival rates. However, its routine use is not recommended in Japan.