Evidence Based Clinical Practice Guideline on Curable Rectal Cancer – An Update A Joint Project of the Philippine College of Surgeons and the Philippine Society of Colon and Rectal Surgeons
Author(s): Catherine S. Co, M.D., F.P.C.S.; Manuel Francisco T. Roxas, M.D., F.P.C.S.; Robert L. Chang, M.D., F.P.C.S.; Marie Dione A. Parreno-Sacdalan, M.D., F.P.C.S.; Armando C. Crisostomo, M.D., F.P.C.S., Carlo C. Cajucom, M.D., F.P.C.S.; Marc Paul J. Lopez, M.D., F.P.C.S.; Hermogenes J. Monroy III, M.D., F.P.C.S. and Maria Lourdes O. Daez, M.D.
Cancers of the colon and rectum are the third most commonly diagnosed cancer in the world. In the Philippines, it is the fourth leading cause of death and new cancer cases in both sexes. The Philippine College of Surgeons (PCS) and the Philippine Society of Colon and Rectal Surgeons (PSCRS) recognized that the management of rectal cancer is vastly distinct from the management of colon cancer. The management varies from the diagnostic examinations requested, to the use of neoadjuvant therapy and to the type of surgery – total mesorectal excision (TME), with or without sphincter preservation. As early as 2005, an evidence-based clinical practice guideline (EBCPG) was formulated and published in the Philippine Journal of Surgical Specialties (PJSS). Majority of the recommendations in the guideline are still relevant up to the present. However, there are a number of developments and advances in the management of rectal cancer since the literature was last reviewed in 2004.
The objective of this paper was to update the previous guideline with regards the current management of curable rectal cancer. Specific objectives were: For patients with curable rectal cancer, 1) to determine the diagnostic examinations for pre-operative staging; 2) to define and determine the role of the multidisciplinary team approach; 3) to determine the role of neoadjuvant treatment; 4) to determine the recommended management; 5) to determine the recommended adjuvant treatment and 6) to determine the surveillance regimen to detect recurrence after surgical resection. It was intended to guide practitioners in General Surgery and Colon and Rectal Surgery working in the Philippines regarding decisions on the management of curable rectal cancer. It was not intended to substitute for individualized and tailored decision-making with regards patient care.
Key words: Curable Rectal Cancer