الفهرس 
Predisposing factors of rectal cancerOnly 14 pages are availabe for public view
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Abstract
The treatment of rectal cancer has advanced tremendously in the last decade, leading to a decrease in local recurrence and an increase in sphincter-sparing rates. Accurate preoperative staging guides important management decisions, such as identification of patients who will benefit from neoadjuvant therapy as well as those amenable to sphincter-sparing surgery rather than abdominoperineal resection.
There are a number of potential advantages for using neoadjuvant chemoradiation. They include the ability to deliver higher doses of chemotherapy with radiation. Another advantage is not only to downstage the tumor, which has been noted in 60–80٪ of patients, but also to achieve a pathologic complete response, which occurs in 15–30٪ of patients. The ability to ”shrink” the tumor facilitates surgical resection, thereby allowing one to achieve negative margins and perform a sphincter-preserving operation in patients who otherwise would require an APR. Additional advantages include radiating tissues with a greater oxygen supply, not radiating the anastomosis, and decreased likelihood of developing radiation enteritis because small bowel is less likely to enter the pelvis. Patients are more likely to complete the course of radiation therapy because it precedes their surgical resection.
Pathologic complete response rates by using a neoadjuvant approach range from 3% to 30%.Complete clinical response after treatment range from 7% to 14% and has been judged by combinations of examination, proctoscopy, CT-scan, endorectal ultrasound, and biopsy.
National Comprehensive Cancer Network (NCCN) guidelines recommend preoperative concurrent chemoradiotherapy as a priority standard treatment for II/III rectal cancer.
This study is a prospective randomized phase III clinical study that was carried out between 2013 and 2018, Including Forty patients with with operable cancer rectum confirmed by history, clinical examination histopathology and Investigations. Randomized 20 patients (group A) will be treated with the neoadjuvant chemoradiotherapy followed by surgery and the other 20 patients (group B) will undergo surgery without neoadjuvant chemoradiotherapy.
Overall infectious complications, morbidity and anastomotic leak were more frequent in the neoadjuvant therapy group (A) compared to the surgery alone group(B)
PCR was achieved in 10% in group A and also group had low recurrence rate than group B with better DFS